Role of CD44 and CD24 Expression on 2-years Disease Free Survival in Patients with Advanced Epithelial Ovarian Carcinoma

OBJECTIVE

Ovarian cancer is one of the most common cancers with a high mortality rate worldwide. Despite optimal surgical therapy and chemotherapy, recurrence is still common. Cancer stem cells expressing CD44 and CD24 are thought to be contributing factors in recurrence.

METHODS

A cohort retrospective study with survival analysis was carried out on advanced ovarian cancer patients who underwent optimal debulking surgery followed by 6 cycles of chemotherapy at Cipto Mangunkusumo General Hospital and Fatmawati General Hospital from January 2019 to March 2023. Immunohistochemical examination was performed on tumor tissue with CD44 and CD24 expression were assessed using the H-Score method then determined the cut off-point expression level using the ROC curve. Furthermore, the relationship between these expression levels with the disease-free survival was assessed using the survival curve.

RESULTS

There were 48 subjects who were included in the study. There were high expression levels of CD44 in 47.9% and CD24 in 50% of cases. High CD44 expression had mean and median survival of 13.2 ± 1.8 and 11 months (HR 5.05, 95% CI 1.84- 13.85). High CD24 expression had mean and median survival of 13.5 ± 2.4 and 7 months (HR 7.73, 95% CI 2.58 - 23.15). The combination of the two high expressions had mean and median survival of 10.44 ± 1.88 and 7 months.

CONCLUSION

High expression of CD44 and CD24 will shorten the disease-free survival of patients with advanced ovarian cancer.

Analysis of Clinicopathologic Factors and KRAS Gene Mutation in Epithelial Ovarian Cancer Outcomes

BACKGROUND: Raise of ovarian cancer mortality is caused by high ovarian cancer recurrence. This is related to many prognostic factors. Kirsten-rat sarcoma virus oncogene (KRAS) is a proto-oncogene that regulates proliferation, growth and cell motility. The controversy of some experts regarding KRAS mutations in the prognosis of ovarian cancer makes it interesting to analyze. AIM: The aim of this study is to clarify whether the clinicopathologic factors and KRAS gene mutation affect the recurrence of patients with ovarian cancer in Indonesia. METHODS: The authors conducted a retrospective cohort study. Clinicopathological factors and prognoses were obtained for 205 patients who were histopathologically diagnosed with epithelial ovarian cancer or ovarian borderline malignant tumor, operated from June 2015 to January 2019 at Dr. M. Djamil General Hospital. We gathered 80 patients who were diagnosed with epithelial ovarian cancer since June 2015 until January 2019. These cases were analyzed after 2-year follow-up or recurrence occurred. Survival rate was determined using the Kaplan–Meier method and examined by Log rank test. All analyses were performed using STATA ver. 12.0, with p < 0.05 considered to be significant. RESULTS: Among KRAS mutation group, the 2-year disease free survival rate (2y-DFS) was 31.56% and 47.58% in non-mutation group with significant differences between mutation and non-mutation (p = 0.02). There was a significant difference between early stage ovarian cancer with non-mutation group and advanced stages ovarian cancer with mutation group (p = 0.00). Among combination staging with mutation group, the 2y-DFS was 85.79% in early stage ovarian cancer with non-mutation, 44.44% in early stage with mutation, 10.65% in advanced stage with non-mutation, and 20.00% in advanced stage with mutation. CONCLUSION: The results suggest that staging and KRAS mutation are the most influence prognostic factors for epithelial ovarian cancer. There was a discrepancy of prognosis by staging and mutation between early stage with non-mutation and advanced stage with KRAS mutation.

Revised FIGO staging for carcinoma of the cervix uteri

OBJECTIVE

To revise FIGO staging of carcinoma of the cervix uteri, allowing incorporation of imaging and/or pathological findings, and clinical assessment of tumor size and disease extent.

METHODS

Review of literature and consensus view of the FIGO Gynecologic Oncology Committee and related societies and organizations.

RESULTS

In stage I, revision of the definition of microinvasion and lesion size as follows. Stage IA: lateral extension measurement is removed; stage IB has three subgroups-stage IB1: invasive carcinomas ≥5 mm and <2 cm in greatest diameter; stage IB2: tumors 2-4 cm; stage IB3: tumors ≥4 cm. Imaging or pathology findings may be used to assess retroperitoneal lymph nodes; if metastatic, the case is assigned stage IIIC; if only pelvic lymph nodes, the case is assigned stage IIIC1; if para-aortic nodes are involved, the case is assigned stage IIIC2. Notations 'r' and 'p' will indicate the method used to derive the stage-i.e., imaging or pathology, respectively-and should be recorded. Routine investigations and other methods (e.g., examination under anesthesia, cystoscopy, proctoscopy, etc.) are not mandatory and are to be recommended based on clinical findings and standard of care.

CONCLUSION

The revised cervical cancer staging is applicable to all resource levels. Data collection and publication will inform future revisions.

Prevention of post-mole malignant trophoblastic disease with vitamin A

OBJECTIVE

Around 15-28% of hydatidiform mole patients suffer from malignant degeneration following evacuation. Since retinoic acid can control cell proliferation and stimulate apoptosis, vitamin A could be used as a therapy for preventing such malignant transformation. The objective of this study was to demonstrate the use of vitamin A as a chemoprevention following hydatidiform mole development.

MATERIALS AND METHODS

The study made use of a randomized clinical trial, double blind protocol. Subjects were patients with complete hydatidiform moles, not receiving cytostatics. The intervention was administration of placebo or vitamin A at 200,000 IU per day, performed until the patients were declared as having recovered or having malignant trophoblastic disease (MTD). The outcome variables were the incidence of regression and MTD, established based on WHO criteria.

RESULTS

At clinical trial as many as 67 cases met the requirements for the study. Two cases were lost from observation and three experienced pregnancy. The incidence rate of malignant trophoblastic disease in the control group was 28.6%, and in the therapy group was 6.3%. No difference was found in the changes of SGOT and SGPT levels of the therapy group compared with the control group.

CONCLUSION

The rate of malignant trophoblastic disease (MTD) was reduced in the group receiving vitamin A therapy.