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Narva S, Polo-Kantola P, Oksa S, Kallio J, Huvila J, Rissanen T, Hynninen J, Hietanen S, Joutsiniemi T. Is it safe to operate selected low-risk endometrial cancer patients in secondary hospitals? Eur J Surg Oncol 2024; 50:108317. [PMID: 38581756 DOI: 10.1016/j.ejso.2024.108317] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/23/2024] [Accepted: 03/30/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION The aim of this study was to assess the accuracy of a preoperative screening algorithm in identifying low-risk endometrial cancer (EC) patients to ensure optimal care. METHODS A total of 277 patients with primary EC confirmed through biopsy underwent magnetic resonance imaging (MRI). Patients with risk factors for advanced high-risk EC, such as non-endometrioid histology, high-grade differentiation status, deep myometrial invasion, or spread beyond the uterine corpus, were systematically excluded. The remaining preoperatively screened patients with stage IA low-grade endometrioid EC (EEC) (n = 93) underwent surgery in a tertiary hospital. The accuracy of the preoperative diagnosis was evaluated by comparing the findings with the postoperative histopathological results. Disease-free survival (DFS) and overall survival (OS) were analyzed using 8-year follow-up data. RESULTS Postoperative histopathological analysis revealed that all patients had grade 1-2 EEC localized to the corpus uteri. Only three patients had deep myometrial invasion (stage IB), but they remained disease-free after 6-9 years of follow-up. The median follow-up time for all patients was 8.7 years. The DFS was 7.6 years, and the OS was 8.6 years. Two patients with stage IA grade 1 EEC experienced relapse and, despite treatment, died of EC. No other EC-related deaths occurred. CONCLUSIONS The screening algorithm accurately identified low-risk EC patients without compromising survival. Therefore, the algorithm appears to be feasible for selecting patients for surgery in secondary hospitals.
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Affiliation(s)
- Sara Narva
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland; TYKS Cancer Centre, FICAN West, Organization of EU Cancer Institutes, Finland.
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Sinikka Oksa
- Department of Obstetrics and Gynecology, Satasairaala Hospital, Pori, Finland
| | - Johanna Kallio
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland; TYKS Cancer Centre, FICAN West, Organization of EU Cancer Institutes, Finland
| | - Jutta Huvila
- Department of Pathology, Turku University Hospital and University of Turku, Turku, Finland; TYKS Cancer Centre, FICAN West, Organization of EU Cancer Institutes, Finland
| | - Tiia Rissanen
- Department of Biostatistics, Turku University Hospital and University of Turku, Turku, Finland
| | - Johanna Hynninen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland; TYKS Cancer Centre, FICAN West, Organization of EU Cancer Institutes, Finland
| | - Sakari Hietanen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland; TYKS Cancer Centre, FICAN West, Organization of EU Cancer Institutes, Finland
| | - Titta Joutsiniemi
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland; TYKS Cancer Centre, FICAN West, Organization of EU Cancer Institutes, Finland
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Marchi G, Rajavuori A, Nguyen MTN, Huhtinen K, Oksa S, Hietanen S, Hautaniemi S, Hynninen J, Oikkonen J. Extensive mutational ctDNA profiles reflect High-grade serous cancer tumors and reveal emerging mutations at recurrence. Transl Oncol 2024; 39:101814. [PMID: 37924564 PMCID: PMC10641709 DOI: 10.1016/j.tranon.2023.101814] [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: 07/17/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVE Circulating tumor DNA (ctDNA) offers a minimally-invasive alternative to study genomic changes in recurrent malignancies. With a high recurrence rate, the overall survival in high-grade serous ovarian carcinoma (HGSC) has remained low. Our objectives were to determine whether ctDNA from plasma adequately represents HGSC, and to find mutational changes at relapse suggesting therapy options that could alter patient outcome. METHODS We collected 152 longitudinal plasma and 92 fresh tissue samples from 29 HGSC patients, sequencing and detecting mutations with a gene panel of more than 700 cancer-related genes. Tumor content was measured using TP53 VAF. We analyzed the concordance between the mutations in tissue and plasma samples and calculated correlations to patient outcomes. We also searched for novel mutations appearing at relapse. RESULTS The concordance rate between mutations in plasma compared to tumor tissue was 83 % at diagnosis and 90 % at relapse. CtDNA was released similarly from the tubo-ovarian tumors, intra-abdominal metastases and ascites. CtDNA release was high when CA-125 level was elevated. The TP53 VAF in ctDNA from plasma samples before the third cycle of primary chemotherapy showed a negative correlation to patient outcome. At relapse, 19 novel, pathogenic DNA mutations appeared, suggesting possible actionable alterations and biological mechanisms related to chemoresistance. CONCLUSION Relapse ctDNA samples reflect tissue samples well and longitudinal sampling provides a timely source for mutational profiling. The emerging genetic mutations at recurrence propose that ctDNA accurately represents the widespread disease and provides possibilities for personalized therapy options.
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Affiliation(s)
- Giovanni Marchi
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki 00291, Finland
| | - Anna Rajavuori
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, 20521 Turku, Finland
| | - Mai T N Nguyen
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki 00291, Finland
| | - Kaisa Huhtinen
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki 00291, Finland
| | - Sinikka Oksa
- Satasairaala Central Hospital, Department of Obstetrics and Gynecology, 28500 Pori, Finland
| | - Sakari Hietanen
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, 20521 Turku, Finland
| | - Sampsa Hautaniemi
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki 00291, Finland
| | - Johanna Hynninen
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, 20521 Turku, Finland
| | - Jaana Oikkonen
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki 00291, Finland.
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Salminen L, Nadeem N, Jain S, Grènman S, Carpén O, Hietanen S, Oksa S, Lamminmäki U, Pettersson K, Gidwani K, Huhtinen K, Hynninen J. A longitudinal analysis of CA125 glycoforms in the monitoring and follow up of high grade serous ovarian cancer. Gynecol Oncol 2019; 156:689-694. [PMID: 31889528 DOI: 10.1016/j.ygyno.2019.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/16/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cancer antigen 125 (CA125) is generally considered the gold standard of biomarkers in the diagnosis and monitoring of high grade serous ovarian carcinoma (HGSC). We recently reported, that two CA125 glycoforms (CA125-STn and CA125-MGL) have a high specificity to HGSC and further hypothesized, that these cancer specific glycoforms are feasible candidates as biomarkers in HGSC treatment and follow up. METHODS Our cohort consisted of 122 patients diagnosed with HGSC. Serum samples were collected longitudinally at the time of diagnosis, during treatment and follow up. Serum levels of CA125, CA125-STn and CA125-MGL were determined and compared or correlated with different end points (tumor load assessed intraoperatively, residual disease, treatment response, progression free survival). RESULTS Serum CA125-STn levels at diagnosis differentiated patients with low tumor load and high tumor load (p = 0,030), indicating a favorable detection of tumor volume. Similarly, the CA125-STn levels at diagnosis were significantly lower in patients with subsequent complete cytoreduction than in patients with suboptimal cytoreduction (p = 0,025). Conventional CA125 did not differentiate these patients (p = 0,363 and p = 0,154). The CA125-STn nadir value predicted the progression free survival of patients. The detection of disease relapse was improved with CA125-STn, which presented higher fold increase in 80,0% of patients and earlier increase in 37,0% of patients. CONCLUSIONS CA125-STn showed promise as a useful biomarker in the monitoring and follow up of patients with HGSC utilizing a robust and affordable technique. Our findings are topical as a suitable indicator of tumor load facilitates patient selection in an era of new targeted therapies.
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Affiliation(s)
- Liina Salminen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Nimrah Nadeem
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Shruti Jain
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Seija Grènman
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Olli Carpén
- Institute of Biomedicine, Research Center for Cancer, Infections and Immunity, Department of Pathology, University of Turku, Finland; Department of Pathology and Genome Scale Biology Research Program, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sakari Hietanen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Sinikka Oksa
- Department of Obstetrics and Gynecology, Satakunta Central Hospital, Finland
| | - Urpo Lamminmäki
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Kim Pettersson
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Kamlesh Gidwani
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Kaisa Huhtinen
- Institute of Biomedicine, Research Center for Cancer, Infections and Immunity, Department of Pathology, University of Turku, Finland
| | - Johanna Hynninen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.
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Vallius T, Hynninen J, Auranen A, Matomäki J, Oksa S, Roering P, Grènman S. Postoperative human epididymis protein 4 predicts primary therapy outcome in advanced epithelial ovarian cancer. Tumour Biol 2017; 39:1010428317691189. [PMID: 28218038 DOI: 10.1177/1010428317691189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Primary chemotherapy treatment response monitoring in advanced epithelial ovarian cancer (EOC) is currently based on CT-imaging and serum CA125 values. Serum HE4 profile during first line chemotherapy has not been previously studied. We evaluated the HE4 profile during first line chemotherapy after primary (PDS) and interval debulking surgery (IDS). In total, 49 FIGO stage III/IV EOC patients were included in the study. 22 patients underwent PDS and 27 patients neoadjuvant chemotherapy (NACT) followed by IDS. Serial HE4 and CA125 serum samples were taken during first line chemotherapy. The association of postoperative tumor markers to surgery outcome, primary therapy outcome and progression free survival (PFS) were determined. The lowest HE4 and CA125 values during chemotherapy were compared to primary therapy outcome and PFS. The postoperative HE4 was associated to residual tumor after surgery (p = 0.0001), primary therapy outcome (p = 0.004) and PFS (p = 0.03) in all patients (n = 40). The postoperative CA125 was associated to PFS after IDS (n = 26, p = 0.006), but not after PDS. In multivariate analysis with FIGO stage (III/IV), residual tumor (0/>0) and postoperative CA125, the postoperative HE4 was the only statistically significant prognostic variable predicting PFS. Both HE4 and CA125 nadir corresponded to primary therapy outcome (HE4 p < 0.0001, CA125 p < 0.0001) and PFS (HE4 p = 0.009, CA125 p < 0.0001). HE4 is a promising candidate for EOC response monitoring. In our study, the performance of HE4 in response monitoring of first line chemotherapy was comparable to that of CA125. Of the postoperative values, only HE4 was statistically significantly associated to primary therapy outcome.
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Affiliation(s)
- Tuulia Vallius
- 1 Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Johanna Hynninen
- 1 Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Annika Auranen
- 2 Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Jaakko Matomäki
- 3 Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Sinikka Oksa
- 4 Department of Obstetrics and Gynecology, Satakunta Central Hospital, Pori, Finland
| | - Pia Roering
- 5 Department of Pathology, Turku University Hospital, University of Turku, Turku, Finland
| | - Seija Grènman
- 1 Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
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Vallius T, Hynninen J, Auranen A, Matomäki J, Oksa S, Roering P, Grènman S. Postoperative human epididymis protein 4 predicts primary therapy outcome in advanced epithelial ovarian cancer. Tumour Biol 2017. [PMID: 28218038 DOI: 10.1177/1010428317691189] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Primary chemotherapy treatment response monitoring in advanced epithelial ovarian cancer (EOC) is currently based on CT-imaging and serum CA125 values. Serum HE4 profile during first line chemotherapy has not been previously studied. We evaluated the HE4 profile during first line chemotherapy after primary (PDS) and interval debulking surgery (IDS). In total, 49 FIGO stage III/IV EOC patients were included in the study. 22 patients underwent PDS and 27 patients neoadjuvant chemotherapy (NACT) followed by IDS. Serial HE4 and CA125 serum samples were taken during first line chemotherapy. The association of postoperative tumor markers to surgery outcome, primary therapy outcome and progression free survival (PFS) were determined. The lowest HE4 and CA125 values during chemotherapy were compared to primary therapy outcome and PFS. The postoperative HE4 was associated to residual tumor after surgery (p = 0.0001), primary therapy outcome (p = 0.004) and PFS (p = 0.03) in all patients (n = 40). The postoperative CA125 was associated to PFS after IDS (n = 26, p = 0.006), but not after PDS. In multivariate analysis with FIGO stage (III/IV), residual tumor (0/>0) and postoperative CA125, the postoperative HE4 was the only statistically significant prognostic variable predicting PFS. Both HE4 and CA125 nadir corresponded to primary therapy outcome (HE4 p < 0.0001, CA125 p < 0.0001) and PFS (HE4 p = 0.009, CA125 p < 0.0001). HE4 is a promising candidate for EOC response monitoring. In our study, the performance of HE4 in response monitoring of first line chemotherapy was comparable to that of CA125. Of the postoperative values, only HE4 was statistically significantly associated to primary therapy outcome.
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Affiliation(s)
- Tuulia Vallius
- 1 Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Johanna Hynninen
- 1 Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Annika Auranen
- 2 Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Jaakko Matomäki
- 3 Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Sinikka Oksa
- 4 Department of Obstetrics and Gynecology, Satakunta Central Hospital, Pori, Finland
| | - Pia Roering
- 5 Department of Pathology, Turku University Hospital, University of Turku, Turku, Finland
| | - Seija Grènman
- 1 Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
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Vallius T, Peter A, Auranen A, Carpén O, Kemppainen J, Matomäki J, Oksa S, Roering P, Seppänen M, Grénman S, Hynninen J. 18F-FDG-PET/CT can identify histopathological non-responders to platinum-based neoadjuvant chemotherapy in advanced epithelial ovarian cancer. Gynecol Oncol 2015; 140:29-35. [PMID: 26515076 DOI: 10.1016/j.ygyno.2015.10.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/22/2015] [Accepted: 10/24/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between the reduction of maximum standardized uptake values (SUVmax) in 18F-FDG-PET/CT to histopathological changes obtained with neoadjuvant chemotherapy (NACT) in advanced epithelial ovarian cancer (EOC). We wanted to evaluate whether 18F-FDG-PET/CT is useful for identifying patients who will not respond to NACT and would therefore benefit from second-line chemotherapy instead of interval debulking surgery (IDS). METHODS Twenty-six primarily inoperable EOC patients treated with NACT were enrolled in this study. 18F-FDG-PET/CT imaging was performed before diagnostic laparoscopy and after three to four NACT cycles. The relationship between the decrease in omental SUVmax from before to after NACT with omental histopathological response was examined in samples taken from the corresponding anatomical sites during IDS. Patients were divided into three groups according to chemotherapy-induced histopathological changes. Serum CA125 and HE4 halftimes during NACT as well as Ki-67 antigen expression in IDS samples were determined. RESULTS The median omental SUVmax change during NACT was -64% (range-16% to -84%), and it was associated with histopathological response (p=0.004, OR 0.9, CI 0.84-0.97). A SUVmax decrease of less than 57% identified histopathological non-responders. Progression-free survival (PFS) differed between the poor, moderate and good histopathological response groups (0.9 year vs. 1.2 years vs. 1.4 years, respectively, p=0.05). The SUVmax change was not associated with PFS. CONCLUSION 18F-FDG-PET/CT was able to identify patients who would not respond to NACT. To obtain a histopathological response in EOC, a substantial metabolic response in 18F-FDG-PET/CT is necessary.
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Affiliation(s)
- Tuulia Vallius
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Finland.
| | - Anniina Peter
- Department of Pathology, Turku University Hospital, University of Turku, Finland
| | - Annika Auranen
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Finland; Department of Obstetrics and Gynecology, Tampere University Hospital, Finland
| | - Olli Carpén
- Department of Pathology, Turku University Hospital, University of Turku, Finland; Auria biobank, Turku University Hospital, Finland
| | - Jukka Kemppainen
- Department of Clinical Physiology and Nuclear Medicine, Turku PET Centre, Turku University Hospital, University of Turku, Finland
| | - Jaakko Matomäki
- Department of Pediatrics, Turku University Hospital, University of Turku, Finland
| | - Sinikka Oksa
- Department of Obstetrics and Gynecology, Satakunta Central Hospital, Finland
| | - Pia Roering
- Department of Pathology, Turku University Hospital, University of Turku, Finland
| | - Marko Seppänen
- Department of Clinical Physiology and Nuclear Medicine, Turku PET Centre, Turku University Hospital, University of Turku, Finland
| | - Seija Grénman
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Finland
| | - Johanna Hynninen
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Finland
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Vallius T, Hynninen J, Auranen A, Carpén O, Matomäki J, Oksa S, Virtanen J, Grénman S. Serum HE4 and CA125 as predictors of response and outcome during neoadjuvant chemotherapy of advanced high-grade serous ovarian cancer. Tumour Biol 2014; 35:12389-95. [PMID: 25190018 DOI: 10.1007/s13277-014-2553-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022] Open
Abstract
Human epididymis protein 4 (HE4) is a novel tumour marker in epithelial ovarian cancer (EOC). Data on its profile and predictive potential for subsequent outcome after neoadjuvant chemotherapy (NACT) are still under investigation. The aim of this study was to compare CA125 and HE4 profiles with radiologic response after NACT and to evaluate their potential as predictors of clinical outcome in a primarily inoperable EOC patient cohort. Twenty-five EOC patients of high-grade subtype (HGSC) treated with NACT were enrolled in the study. Serum HE4 and CA125 samples were taken at the time of diagnosis and before interval debulking surgery (IDS). Pre-NACT and pre-IDS HE4 and CA125 and their percentage changes were compared with NACT response seen on CT and surgical outcome in IDS. We also evaluated the biomarkers' abilities to predict platinum-free interval (PFI), progression-free survival (PFS) and overall survival (OS). All 25 patients were considered inoperable in laparoscopy at the time of diagnosis. HE4 and CA125 changes during NACT did not correlate with the changes seen on CT. Surgical outcome in IDS was associated with pre-IDS biomarker values but not with those taken before diagnosis. In IDS, 87 % had <1-cm residual tumour. In patients with HE4 change >80 and <80 % during NACT, the median OS was 3.38 and 1.60 years (p = 0.01), respectively. Serum HE4 is a promising additional tool when evaluating advanced HGSC patient's response to NACT. It may be helpful when deciding whether to proceed to IDS or to second-line chemotherapy.
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MESH Headings
- Biomarkers, Tumor
- CA-125 Antigen/blood
- Carcinoma, Ovarian Epithelial
- Chemotherapy, Adjuvant
- Cystadenocarcinoma, Serous/blood
- Cystadenocarcinoma, Serous/drug therapy
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/pathology
- Female
- Follow-Up Studies
- Humans
- Neoplasm Grading
- Neoplasm Staging
- Neoplasms, Glandular and Epithelial/blood
- Neoplasms, Glandular and Epithelial/drug therapy
- Neoplasms, Glandular and Epithelial/mortality
- Neoplasms, Glandular and Epithelial/pathology
- Ovarian Neoplasms/blood
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Prognosis
- Proteins/metabolism
- Treatment Outcome
- WAP Four-Disulfide Core Domain Protein 2
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Affiliation(s)
- Tuulia Vallius
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, 20520, Turku, Finland,
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Hynninen J, Kemppainen J, Lavonius M, Virtanen J, Matomäki J, Oksa S, Carpén O, Grénman S, Seppänen M, Auranen A. A prospective comparison of integrated FDG-PET/contrast-enhanced CT and contrast-enhanced CT for pretreatment imaging of advanced epithelial ovarian cancer. Gynecol Oncol 2013; 131:389-94. [PMID: 23994535 DOI: 10.1016/j.ygyno.2013.08.023] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/15/2013] [Accepted: 08/22/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The use of tumor debulking surgery in the management of epithelial ovarian cancer (EOC), which is often disseminated in the peritoneal cavity at the time of diagnosis, has a significant impact on prognosis. We compared (18)F-fluorodeoxyglucose (FDG) positron emission tomography/contrast-enhanced computed tomography (PET/CT) to contrast-enhanced CT for the detection of dissemination into the abdominal cavity preventing successful primary debulking surgery. METHODS Forty-one women with EOC underwent preoperative whole-body low-dose FDG-PET/CT followed by diagnostic high dose contrast-enhanced CT scan, and the results were compared with systematically recorded surgical findings as a reference standard. Both site-based and patient-based analyses were conducted. RESULTS FDG-PET/CT was superior to conventional CT for the detection of carcinomatosis in subdiaphragmatic peritoneal surfaces (p=0.020) and in the bowel mesentery (p=0.001). Patient-based analysis of upper abdominal areas requiring extensive surgical procedures showed no significant differences between the two imaging methods. The sensitivity of PET/CT and CT was poor in certain areas of the peritoneal cavity (64% vs. 27% in the small bowel mesentery and 65% vs. 55% in the right upper abdomen). Extra-abdominal disease spread was detected by PET/CT in 32 patients and by CT in 25 patients. CONCLUSIONS PET/CT was not superior to CT for the detection of intra-abdominal disease spread. Patients with suspected EOC should be referred for upfront radical surgery regardless of the results of preoperative imaging studies. PET/CT is more effective for the detection of extra-abdominal disease than CT, but the clinical significance of this finding is unclear.
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Affiliation(s)
- Johanna Hynninen
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, FI-20520 Turku, Finland.
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Hynninen J, Lavonius M, Oksa S, Grénman S, Carpén O, Auranen A. Is perioperative visual estimation of intra-abdominal tumor spread reliable in ovarian cancer surgery after neoadjuvant chemotherapy? Gynecol Oncol 2013; 128:229-32. [DOI: 10.1016/j.ygyno.2012.11.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/31/2012] [Accepted: 11/03/2012] [Indexed: 11/30/2022]
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Abstract
AIMS To find out if there is any link between the therapeutic effect of toremifene on premenstrual mastalgia and luteal phase serum inhibin A and/or B levels. METHODS Forty-eight patients participating in a randomized cross-over trial on toremifene vs. placebo for premenstrual mastalgia gave three blood samples during the luteal phase of the menstrual cycle: the first at baseline, the second during the third toremifene/placebo cycle, and the third during the third placebo/toremifene cycle, respectively. The blood samples were analyzed for inhibin A and B with respective specific two-site enzyme-linked immunosorbent assays. Toremifene (20 mg/d) and placebo were administered during the luteal phase only. RESULTS When all the toremifene-treated cycles were compared with all the placebo cycles and with the baseline, the median inhibin A levels were 42, 38, and 40 pg/ml, respectively (baseline versus toremifene, p = 0.638; baseline versus placebo, p = 0.468; and toremifene versus placebo, p = 0.365). The median inhibin B levels were at baseline 19 ng/l, during placebo 20 ng/l, and during toremifene 17 ng/l (baseline versus toremifene, p = 0.983; baseline versus placebo, p = 0.519; and toremifene versus placebo, p = 0.880). CONCLUSION A luteal administration of toremifene does not seem to result in any changes in mid-luteal concentrations of inhibin A or B in serum.
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Affiliation(s)
- Sinikka Oksa
- Department of Obstetrics and Gynecology, Satakunta Central Hospital, Pori, Finland
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Oksa S, Parkkola R, Luukkaala T, Mäenpää J. Breast magnetic resonance imaging findings in women treated with toremifene for premenstrual mastalgia. Acta Radiol 2009; 50:984-9. [PMID: 19863407 DOI: 10.3109/02841850903168083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Toremifene, a selective estrogen receptor modulator, has been shown to be effective in alleviating premenstrual breast pain. However, the exact mechanism by which toremifene and related compounds work in premenstrual mastalgia is poorly understood. PURPOSE To find out if the effect of toremifene on breast would be detectable with dynamic magnetic resonance imaging (MRI). MATERIAL AND METHODS This randomized, double-blind crossover study was performed on women suffering from marked premenstrual mastalgia. Ten women were randomized to receive either toremifene (20 mg) or placebo from cycle day 15 until next menstruation for three menstrual cycles. After a washout period, the treatment was crossed over for three additional cycles. The MRI evaluations were performed premenstrually at the end of each treatment phase. Breast pain and quality-of-life scores were collected from one baseline cycle and from all the treatment cycles. RESULTS Nine patients were evaluable for this analysis. Both the enhancement ratio and the maximum slope of enhancement tended to be smaller during the toremifene cycles as compared to placebo. On the left side, the difference in the maximum slope of enhancement between toremifene and placebo was statistically significant (median 5.150 [range 3.7-6.7] and 6.500 [range 4.9-9.5], respectively; P=0.047). T2 relaxation times as well as breast pain and quality-of-life scores were inconsistent. CONCLUSION Use of toremifene is associated with measurable changes in dynamic breast MRI findings in women with cyclic breast pain.
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Affiliation(s)
- S. Oksa
- Department of Obstetrics and Gynecology, Satakunta Central Hospital, Pori, Finland
| | - R. Parkkola
- Department of Radiology, University Hospital of Turku, Turku, Finland
| | - T. Luukkaala
- Science Center, Pirkanmaa Hospital District, and Tampere School of Public Health, University of Tampere, Tampere, Finland
| | - J. Mäenpää
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Hospital of Tampere, and Medical School, University of Tampere, Tampere, Finland
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Oksa S, Parkkola R, Luukkaala T, Maenpaa J. Breast Magnetic Resonance Imaging Findings in Women Treated with Toremifene for Premenstrual Mastalgia. Acta Radiol 2009. [DOI: 10.1080/02841850903168083] [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: 10/20/2022]
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Rovio PH, Luukkaala T, Vuento M, Oksa S, Sundström H, Heinonen PK. Ultrasonographic assessment of weight of the myomatous uterus: A pilot study using a new combined geometrical formula. Eur J Obstet Gynecol Reprod Biol 2008; 137:193-7. [DOI: 10.1016/j.ejogrb.2007.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Revised: 12/09/2006] [Accepted: 02/19/2007] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE To investigate the efficacy of toremifene in the treatment of premenstrual mastalgia. DESIGN Double-blind, placebo-controlled crossover study. SETTING Three Finnish general practices from the districts of Satakunta Central Hospital and Tampere University Hospital. POPULATION A total of 62 women aged 25-45 years with premenstrual mastalgia during at least three previous menstrual cycles. METHODS Women were randomised to receive toremifene 20 mg daily or placebo from day 15 of the menstrual cycle until menstruation for three consecutive cycles. After a wash-out cycle, the women were crossed over to receive placebo or toremifene for three additional cycles. MAIN OUTCOME MEASURES Cyclic breast pain relief assessed by visual analogue scale (VAS) score. Quality-of-life scores assessed by a modified 36-item Finnish Depression Scale, with a score ranging from 0 to 108. Acceptability of treatment. RESULTS About 32 women were randomised to receive toremifene first and 30 to receive placebo first. Twenty-nine and 27 participants in the groups treated with toremifene first or placebo first completed the treatment, respectively. There were significant reductions in VAS scores in both groups after three treatment cycles. This was significantly greater in the toremifene-treated group (VAS: 1.8 in the toremifene group and 3.7 in the placebo group, P= 0.004). Treatment effect between treatment cycles was significant (P= 0.001). Quality of life was similar during the toremifene and placebo cycles. CONCLUSION This study demonstrates that the antiestrogenic compound, toremifene, is able to relieve premenstrual breast pain without major adverse effects. There was a 64% reduction in median pain scores in the toremifene-treated cycles compared with a 26% reduction in placebo-treated cycles.
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Affiliation(s)
- S Oksa
- Department of Obstetrics and Gynaecology, Satakunta Central Hospital, Pori, Finland.
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