Recovery of the Decreased Phagocytic Function of Peripheral Monocytes and Neutrophil Granulocytes following Cytoreductive Surgery in Advanced Stage Epithelial Ovarian Cancer

(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.

Prognostic Significance of Preoperative NLR, MLR, and PLR Values in Predicting the Outcome of Primary Cytoreductive Surgery in Serous Epithelial Ovarian Cancer

(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.

Standardized measurement in uterine ultrasonography

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.