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Kovács AR, Lukács L, Pál L, Szűcs S, Kovács KS, Lampé R. Recovery of the Decreased Phagocytic Function of Peripheral Monocytes and Neutrophil Granulocytes following Cytoreductive Surgery in Advanced Stage Epithelial Ovarian Cancer. Medicina (Kaunas) 2023; 59:1602. [PMID: 37763721 PMCID: PMC10533144 DOI: 10.3390/medicina59091602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/13/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
(1) Monocytes and neutrophil granulocytes are the phagocytic cells of the innate immune system, playing a crucial role in recognizing and eliminating tumor-transformed cells. Our objective was to assess the impact of advanced-stage epithelial ovarian cancer (EOC) and cytoreductive surgery on the phagocytic function of peripheral monocytes and neutrophil granulocytes. We aimed to compare the pre- and postoperative phagocytic function of these immune cells in EOC patients with healthy control women. Additionally, we aimed to examine the influence of surgery on phagocytic function by comparing pre- and postoperative samples from patients with benign gynecological tumors. (2) We examined peripheral blood samples from 20 patients with FIGO IIIC stage high-grade serous EOC and 16 patients with benign gynecological tumors as surgical controls, collected before and seven days after tumor removal surgery, and from 14 healthy women. After separation, the cells were incubated with Zymosan-A particles, and the phagocytic index (PI) was assessed using immunofluorescence microscopy. One-way ANOVA, the Kruskal-Wallis H-test, and the paired samples t-test were used for the statistical analysis of the data. A significance level of p < 0.05 was applied. (3) Peripheral monocytes and neutrophils from EOC patients exhibited significantly lower preoperative PI values compared to healthy controls (p < 0.001; p < 0.001, respectively). Following cytoreductive surgery, the PI values of immune cells in EOC patients significantly increased by the 7th postoperative day (p < 0.001; p < 0.001), reaching levels comparable to those of healthy controls (p = 0.700 and p = 0.991). In contrast, there was no significant disparity in the PI values of cells obtained from pre- and postoperative blood samples of surgical controls when compared to healthy women (monocytes: p = 0.361 and p = 0.303; neutrophils: p = 0.150 and p = 0.235). (4) EOC and/or its microenvironment may produce factors that reduce the phagocytic function of monocytes and neutrophils, and the production of these factors may be reduced or eliminated after tumor removal.
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Affiliation(s)
- Anna Rebeka Kovács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Luca Lukács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - László Pál
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26. Kassai út, 4028 Debrecen, Hungary
| | - Sándor Szűcs
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26. Kassai út, 4028 Debrecen, Hungary
| | - Kincső Sára Kovács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
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Kovács AR, Sulina A, Kovács KS, Lukács L, Török P, Lampé R. Prognostic Significance of Preoperative NLR, MLR, and PLR Values in Predicting the Outcome of Primary Cytoreductive Surgery in Serous Epithelial Ovarian Cancer. Diagnostics (Basel) 2023; 13:2268. [PMID: 37443662 DOI: 10.3390/diagnostics13132268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
(1) The degree of cytoreduction achieved during primary debulking surgery (PDS) is an important prognostic factor for the survival of patients with epithelial ovarian cancer (EOC). Our aim was to investigate the prognostic value of preoperative laboratory parameters for the outcome of PDS. (2) We analyzed the preoperative laboratory parameters of 150 serous EOC patients who underwent PDS between 2006 and 2013. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values of the variables for predicting the PDS outcome. We used binary logistic regression to examine the independent predictive value of the factors for incomplete cytoreduction. (3) Among the parameters, we established optimal cut-off values for cancer antigen (Ca)-125, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) to predict the outcome of PDS. The results of binary logistic regression showed that stage (FIGO III-IV), MLR (>0.305), and Ca-125 (>169.15 kU/L) were independent significant predictors of the degree of tumor reduction achieved during PDS. (4) In the future, MLR, especially in combination with other parameters, may be useful in determining prognosis and selecting the best treatment option (PDS or neoadjuvant chemotherapy + interval debulking surgery) for ovarian cancer patients.
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Affiliation(s)
- Anna Rebeka Kovács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Anita Sulina
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Kincső Sára Kovács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Luca Lukács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Péter Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
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Lukács L, Kovács AR, Pál L, Szűcs S, Lampé R. Evaluating the Phagocytic Index of Peripheral Leukocytes in Endometriosis by Plasma Experiments. Medicina (B Aires) 2022; 58:medicina58070925. [PMID: 35888644 PMCID: PMC9316155 DOI: 10.3390/medicina58070925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Endometriosis is a benign, chronic disease, that negatively influences the quality of life of affected women and is responsible for a remarkable amount of infertility. The pathophysiology of the disease is still not clarified, but the insufficient immune surveillance plays a significant role in it. The phagocyte function of innate immune cells may play a role in the elimination of ectopic endometrium. The purpose of this study is to examine the phagocyte function of neutrophil granulocytes and monocytes, incubated in heat-inactivated and not-inactivated plasma samples from healthy women and from women with endometriosis before and after the surgical treatment. Materials and Methods: Blood samples were collected from eight preoperative and eight postoperative patients with endometriosis before and after the surgical treatment, and from 16 healthy patients as controls. Neutrophil granulocytes, monocytes and blood plasma samples were isolated. Cells were incubated in different plasma samples, and the phagocytic index was determined with a fluorescence microscope. Results: The phagocytic index of granulocytes and monocytes isolated from patients with endometriosis was significantly decreased compared to healthy women after the cells were incubated in their own plasma. Preoperatively isolated cells from patients with endometriosis demonstrated an improved phagocyte function after incubating them in plasma samples from healthy controls. In contrast, the phagocytic activity of cells from healthy women significantly reduced after being incubated in the plasma of preoperative endometriosis patients. The heat-inactivation of plasma samples did not affect the results. Conclusions: Active endometriosis lesions may produce heat-stable systemic immunomodulatory factors, which reduced the phagocyte function of peripheral monocytes and neutrophil granulocytes. The phagocyte function of these cells can be normalized after the complete surgical removal of endometriosis, which then demonstrates similar values as in healthy women.
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Affiliation(s)
- Luca Lukács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary; (L.L.); (A.R.K.)
| | - Anna Rebeka Kovács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary; (L.L.); (A.R.K.)
| | - László Pál
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (L.P.); (S.S.)
| | - Sándor Szűcs
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (L.P.); (S.S.)
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary; (L.L.); (A.R.K.)
- Correspondence:
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Kovács KS, Kovács AR, Harangi B, Lampé R, Török P. Standardized measurement in uterine ultrasonography. Orv Hetil 2020; 161:2029-2036. [PMID: 33249410 DOI: 10.1556/650.2020.31929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/18/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: Jelenleg a méh méretének pontos megítélése meglehetősen szubjektív, az azt leíró ultrahangleletek igen nagy eltérést mutatnak. Számos klinikai szituációban azonban nagyon fontos az eltérések méretének, elhelyezkedésének, meghatározott anatómiai pontokhoz való viszonyának pontos leírása. Célkitűzés: Célunk egy egységes mérési módszer kifejlesztése, mellyel sorvezetőt adunk a vizsgálók kezébe, így csökkentve az egyéni variabilitásból adódó eltéréseket. A standardizált adatok lehetőséget adnak a szisztematikus gyűjtésre, azok egységes feldolgozására, rendszerbe foglalására, tudományos értékelésére, segítséget nyújtva a mindennapi klinikai gyakorlatban és kutatásokban. Módszer: A méh általunk végzett ultrahangvizsgálatait, valamint a nemzetközi tanulmányokat alapul véve kívánunk javaslatot tenni egy egységes mérési módszer kialakítására, mellyel egyértelmű, pontos, reprodukálható adatokat kaphatunk a méhről. Eredmények: Létrehoztunk egy standardizált paraméterekkel rendelkező mérési eljárást Uteromap néven, melyet alkalmazva objektív méretadatokat kaphatunk a méh ultrahangvizsgálata során. Külön figyelmet fordítottunk arra, hogy az általunk létrehozni kívánt standardizált mérési eljárás alkalmas legyen minden általános, valamint speciális esetben is. A kipróbálás során a legelső 253 páciens adatait elemeztük retrospektív módon. Eredményeink szerint az idősebb életkor megnövekedett méhmagassággal és nagyobb hátsó falvastagsággal korrelált. Következtetés: Arra a következtetésre jutottunk, hogy standardizált mérési módszerünk alkalmazásával a méhről és elváltozásairól sokkal pontosabb, objektívebb és egységesebb adatokat nyerhetünk anélkül, hogy a vizsgálathoz szükséges idő szignifikánsan hosszabb lenne. Munkánk folytatásaként minél több vizsgáló bevonásával szeretnénk a standardizált módszert a mindennapi gyakorlatra kiterjeszteni, a felmerülő igények, javaslatok alapján fejleszteni és létrehozni egy nemzetközileg elfogadott, standardizált mérési eljárást, mellyel az ultrahangvizsgálatok minőségét növelhetnénk, azzal a végső céllal, hogy javítsuk a betegek biztonságát és az ellátás eredményességét. Orv Hetil. 2020; 161(48): 2029-2036. SUMMARY INTRODUCTION Currently, the accurate assessment of the size of the uterus is rather subjective as the related ultrasound findings show an immense difference. However, in several clinical situations it is crucial to accurately describe the size and location of abnormalities and their relationship to specific anatomical positions. OBJECTIVE We aim to develop a unified measurement method that can serve as a guide for the examiners, thus reducing variances due to individual variability. Standardized data provide an opportunity for systematic collection, unified processing, systematization, and scientific evaluation, assisting in everyday clinical practice and research. METHOD Based on our ultrasound examinations and the international studies, we propose a unified measurement method that can provide precise, accurate and reproducible data on the uterus. RESULTS We have established a measurement procedure with standardized parameters called Uteromap, which obtained objective size data during the ultrasound examination of the uterus. Special attention was given to creating a standardized measurement procedure suitable for general and special cases, too. According to our results, older age was correlated with increased uterine height and greater posterior wall thickness. During the trial, the data of the first 253 patients were analyzed retrospectively. CONCLUSION We concluded that our standardized measurement method could obtain more accurate, objective, and consistent data about the uterus and its lesions without significantly increasing the time of the examination. Continuing our work, we would like to extend the standardized method to everyday practice, develop and create an internationally accepted standardized measurement procedure based on the emerging needs and recommendations, with the ultimate aim of improving patient safety and effectiveness of care. Orv Hetil. 2020; 161(48): 2029-2036.
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Affiliation(s)
- Kincső Sára Kovács
- 1 Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Debrecen, Nagyerdei krt. 98., 4032
| | - Anna Rebeka Kovács
- 1 Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Debrecen, Nagyerdei krt. 98., 4032
| | - Balázs Harangi
- 2 Informatikai Kar, Komputergrafika és Képfeldolgozás Tanszék, Debreceni Egyetem, Debrecen
| | - Rudolf Lampé
- 1 Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Debrecen, Nagyerdei krt. 98., 4032
| | - Péter Török
- 1 Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Debrecen, Nagyerdei krt. 98., 4032
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Lukács L, Kovács AR, Pál L, Szűcs S, Kövér Á, Lampé R. Phagocyte function of peripheral neutrophil granulocytes and monocytes in endometriosis before and after surgery. J Gynecol Obstet Hum Reprod 2020; 50:101796. [PMID: 32413524 DOI: 10.1016/j.jogoh.2020.101796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Endometriosis is a chronic systemic disease, which influence negatively the quality of life of affected women and responsible for infertility and chronic pelvic pain. Pathophysiology of the disease is still enigmatic, but insufficient immune surveillance may play a role in it. Peripheral natural immune cell function is rarely examined. The aim of the study was to examine phagocyte function of peripheral neutrophil granulocytes and monocytes, whether this phagocytic activity is affected by the presence or removal of endometriotic lesions in women with endometriosis. MATERIAL AND METHODS Twenty-six preoperative, 13 postoperative samples from women with endometriosis, 23 samples from healthy women, 14 pre- and postoperative samples from the surgical control group were enrolled. Cells were isolated from peripheral blood samples, marked and evaluated for the phagocytosis index with immunofluorescent microscope after phagocyting the zymosane molecules. RESULTS Phagocyte function of monocytes and neutrophil granulocytes decreased significantly women with endometriosis before surgery compared to healthy controls. However, 7 days after surgery the postoperative values showed significant improvement compared to the preoperative results of women with endometriosis. This increment reached the values of the healthy women. In the surgical control group no difference was detected between the pre- and postoperative outcomes. DISCUSSION Decreased phagocyte function of the examined cells, which can be the result of the circulating immunosuppressive factors, may play a role in the deficient clearance of ectopic endometrial tissue. Based on the postoperative results, these immunosuppressive factors may be reduced or eliminated 7 days after surgery in women with endometriosis.
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Affiliation(s)
- Luca Lukács
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, 98. Nagyerdei krt., Debrecen 4012, Hungary
| | - Anna Rebeka Kovács
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, 98. Nagyerdei krt., Debrecen 4012, Hungary
| | - László Pál
- University of Debrecen, Faculty of Public Health, Department of Preventive Medicine, Hungary
| | - Sándor Szűcs
- University of Debrecen, Faculty of Public Health, Department of Preventive Medicine, Hungary
| | - Ágnes Kövér
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, 98. Nagyerdei krt., Debrecen 4012, Hungary
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, 98. Nagyerdei krt., Debrecen 4012, Hungary.
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Kovács AR, Póka R, Szücs S, Pál L, Lampé R. Phagocytic function of peripheral monocytes and neutrophils in ovarian cancer. Eur J Obstet Gynecol Reprod Biol 2019. [DOI: 10.1016/j.ejogrb.2018.08.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
INTRODUCTION Recently, tumor-infiltrating immune cells have been studied in various cancers. However, fewer studies address the role of peripheral immune cells in the pathogenesis of cancer. AIM Our aim was to investigate whether the phagocytic activity of peripheral monocytes and neutrophil granulocytes is affected by the removal of tumor in advanced ovarian cancer. METHOD We investigated peripheral blood samples from 12 patients with advanced stage of serous epithelial ovarian cancer - which were collected before the optimal tumor reduction surgery and on the 7th postoperative day - and from 8 healthy women. After separation of monocytes and neutrophils, the cells were incubated with opsonized fluorescein isothiocyanate-labeled zymosan A particles as the target of phagocytosis. By using fluorescence microscope we counted the number of particles phagocytized by the cells and calculated the phagocytic index. Statistical analysis of the data was performed using analysis of variances method. RESULTS Preoperative phagocytic indexes of monocytes and neutrophils from patients were significantly lower than phagocytic indexes of the corresponding cells from healthy women. The phagocytic function of monocytes and granulocytes isolated from postoperative samples of patients significantly increased compared to preoperative values and reached the phagocytic indexes of monocytes and neutrophils from healthy controls. CONCLUSION Based on our results we assume that the tumor and/or its microenvironment in ovarian cancer may produce factors that can depress the phagocytic function of monocytes and granulocytes. Since the phagocytic indexes increased following the cytoreductive surgery, it can be assumed that after the removal of the tumor, the production of these factors is reduced or eliminated. Orv Hetil. 2018; 159(33): 1353-1359.
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Affiliation(s)
- Anna Rebeka Kovács
- Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem Debrecen, Nagyerdei krt. 98., 4032
| | - László Pál
- Népegészségügyi Kar, Megelőző Orvostani Intézet, Debreceni Egyetem Debrecen
| | - Sándor Szűcs
- Népegészségügyi Kar, Megelőző Orvostani Intézet, Debreceni Egyetem Debrecen
| | - Luca Lukács
- Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem Debrecen, Nagyerdei krt. 98., 4032
| | - Róbert Póka
- Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem Debrecen, Nagyerdei krt. 98., 4032
| | - Rudolf Lampé
- Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem Debrecen, Nagyerdei krt. 98., 4032
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