Management of endometrial, ovarian and cervical cancer in the elderly: current approach to a challenging condition

Vitale, Salvatore Giovanni; Capriglione, Stella; Zito, Gabriella; Lopez, Salvatore; Gulino, Ferdinando Antonio; Guardo, Federica Di; Vitagliano, Amerigo; Noventa, Marco; Rosa, Valentina Lucia La; Sapia, Fabrizio; Valenti, Gaetano; Rapisarda, Agnese Maria Chiara; Peterlunger, Isabel; Rossetti, Diego; Laganà, Antonio Simone

doi:10.1007/s00404-018-5006-z

Cited by 122 publications

(83 citation statements)

References 74 publications

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“…Accumulating evidence suggests that the management of ovarian cancer should be personalized taking into account the performance status of the patient, in particular in case of elderly women [33,34]. We included several important preoperative non-invasive parameters (age, FIGO stage, histological type, grade, preoperative serum CA125 level, preoperative serum HE4 level, ECOG performance status, and ASA).…”

Section: Discussionmentioning

confidence: 99%

Preoperative serum levels of HE4 and CA125 predict primary optimal cytoreduction in advanced epithelial ovarian cancer: a preliminary model study

Feng

Liao

2020

J Ovarian Res

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Objective: The aim of this study is to establish a noninvasive preoperative model for predicting primary optimal cytoreduction in advanced epithelial ovarian cancer by HE4 and CA125 combined with clinicopathological parameters. Methods: Clinical data including preoperative serum HE4 and CA125 level of 83 patients with advanced epithelial ovarian cancer were collected. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of each clinical parameter were calculated. The Predictive Index score model and the logistic model were constructed to predict the primary optimal cytoreduction. Results: Optimal surgical cytoreduction was achieved in 62.65% (52/83) patients. Cutoff values of preoperative serum HE4 and CA125 were 777.10 pmol/L and 313.60 U/ml. (1) Patients with PIV ≥ 6 may not be able to achieve optimal surgical cytoreduction. The diagnostic accuracy, NPV, PPV and specificity for diagnosing suboptimal cytoreduction were 71, 100, 68, and 100%, respectively. (2) The logistic model was: logit p = 0.12 age − 2.38 preoperative serum CA125 level − 1.86 preoperative serum HE4 level-2.74 histological type-3.37. AUC of the logistic model in the validation group was 0.71(95%CI 0.54-0.88, P = 0.025). Sensitivity and specificity were 1.00 and 0.44, respectively. Conclusion: Age, preoperative serum CA125 level and preoperative serum HE4 level are important non-invasive predictors of primary optimal surgical cytoreduction in advanced epithelial ovarian cancer. Our PIV and logistic model can be used for assessment before expensive and complex predictive methods including laparoscopy and diagnostic imaging. Further future clinical validation is needed.

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Section: Discussionmentioning

confidence: 99%

Preoperative serum levels of HE4 and CA125 predict primary optimal cytoreduction in advanced epithelial ovarian cancer: a preliminary model study

Feng

Liao

2020

J Ovarian Res

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“…23,24 Many studies have demonstrated that older patients can benefit from treatment to manage their gynaecological cancers. 25,26 Therefore, proper management is needed to address the upcoming outbreak of older cancer patients. Specific difficulties of cervical screening in older women have long been documented with the loss of efficiency of TCT examination in this population.…”

Section: Discussionmentioning

confidence: 99%

<p>Evaluation of PCR-Reverse Dot Blot Human Papillomavirus Genotyping Test in Predicting Residual/Recurrent CIN 2+ in Posttreatment Patients in China</p>

Zhang¹,

Dong²,

Chen³

et al. 2020

CMAR

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To assess the clinical value of the PCR-reverse dot blot human papillomavirus genotyping test during follow-up of patients with CIN grade 2 or worse (CIN 2+). Methods: Four hundred patients with CIN 2+ receiving treatment from January 2008 to January 2017 were included in our study. Postoperative follow-up procedures comprised HPV examination and cervical cytology every 3-6 months for the first 2 years and then followed up every 6-12 months. A pathology examination was performed when there was a positive funding for HPV 16/18 or an abnormal ThinPrep cytology test (TCT) with or without positive for HR-HPV according to the American Society for Coloscopy and Cervical Pathology (ASCCP) guidelines. Results: The median follow-up period was 27.10±12.47 months (ranging from 3 to 50 months). During follow-up, 12.00% (48/400) of the women developed residual/recurrent disease. The highest risk in CIN 2+ and CIN 3+ residual/recurrence was HPV-16/-18 (hazard ratio (HR)=12.898, 95% CI= 6.849-24.289; HR= 20.726, 95% CI= 9.64-44.562, respectively). Among the different follow-up methods, type-specific (TP) HR-HPV persistent infection showed the highest cumulative incidence risk (CIR) (84.62%, 95% CI=73.29-95.94) and HR (5.38, 95% CI= 2.596-11.149) during the 4-year follow-up period. At the CIN 2+ and CIN 3+ endpoints, TP-HPV testing had relatively high sensitivity (84.62%, 95% CI=73.29-95.94 and 89.28%, 95% CI= 77.83-100.00, respectively) and specificity (78.07%, 95% CI= 72.70-83.44 and 75.73%, 95% CI= 70.30-81.17, respectively). However, at the CIN 2+/CIN 3+ endpoint, TCT follow-up had a sensitivity of 60.42%/62.16% (95% CI=46.58-72.25/46.54-77.79) and specificity of 90.18%/88.72% (95% CI=86.95-93.41/85.35-92.10). Conclusion: TP HR-HPV follow-up can provide a reliable and sensitive clinical reference for CIN 2+ postoperative patients.

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“…In particular, we failed to show why differences among histological subtypes of OC occur. Furthermore, particularly in cases in elderly women, the management of OC should be personalized because of their differences from younger patients [43,44]. Further research in a larger cohort is required to pursue the potential of serum miR-34a as an OC biomarker.…”

Section: Discussionmentioning

confidence: 99%

Serum exosomal microRNA-34a as a potential biomarker in epithelial ovarian cancer

et al. 2020

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Background: Ovarian cancer (OC) is a leading cause of cancer-related death in women, and thus an accurate diagnosis of the predisposition and its early detection is necessary. The aims of this study were to determine whether serum exosomal microRNA-34a (miR-34a) in ovarian cancer could be used as a potential biomarker. Methods: Exosomes from OC patients' serum were collected, and exosomal miRNAs were extracted. The relative expression of miR-34a was calculated from 58 OC samples by quantitative real-time polymerase chain reaction. Results: Serum exosomal miR-34a levels were significantly increased in early-stage OC patients compared with advanced-stage patients. Its levels were significantly lower in patients with lymph node metastasis than in those with no lymph node metastasis. Furthermore, its levels in the recurrence group were significantly lower than those in the recurrence-free group. Conclusions: Serum exosomal miR-34a could be a potential biomarker for improving the diagnostic efficiency of OC.

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Management of endometrial, ovarian and cervical cancer in the elderly: current approach to a challenging condition

Cited by 122 publications

References 74 publications

Preoperative serum levels of HE4 and CA125 predict primary optimal cytoreduction in advanced epithelial ovarian cancer: a preliminary model study

Preoperative serum levels of HE4 and CA125 predict primary optimal cytoreduction in advanced epithelial ovarian cancer: a preliminary model study

<p>Evaluation of PCR-Reverse Dot Blot Human Papillomavirus Genotyping Test in Predicting Residual/Recurrent CIN 2+ in Posttreatment Patients in China</p>

Serum exosomal microRNA-34a as a potential biomarker in epithelial ovarian cancer

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