Hematologic parameters as a predictor of myometrial and cervical invasion in endometrial cancer.

BACKGROUND: Despite significant improvements in molecular biology for uterine cancer, we did not have specific peripheral blood biomarkers for clinical usage such as prognostic or predictive outcomes of disease in the last decade. METHODS: A retrospective endometrial cancer database was collected from a tertiary gynecologic cancer center. The cohort included only endometrioid type uterine cancer. Subsequently, we investigated the relationship between preoperative hematologic parameters and pathologic findings. RESULTS: In this study, 191 non-metastatic endometrial cancer (median age was 61 years, ranging from 41 to 86 years) were analyzed. Lymphocyte-to-monocyte ratio (LMR) was significantly different between the FIGO stage I and II (4.48 vs. 3.88, P=0.004). Platelet-to-lymphocyte (PLR) was significantly higher in FIGO stage III than stage I, and LMR was significantly decreased by each FIGO stage. LMR values significantly decreased with a depth of myometrial invasion. PLR and eosinophil-to-lymphocyte ratio (ELR) values were significantly higher in patients with cervical invasion compared to those without invasion, 287 vs. 144, P=0.005, 10.3 vs. 6, P=0.022, respectively. CONCLUSIONS: This study revealed that low-LMR levels and high-PLR with ELR levels correlated with myometrial and cervical invasion, respectively. These findings can explain why hematologic parameters have an impact on oncologic outcomes.

Performing gynecologic cancer surgery during the COVID-19 pandemic in Turkey: A multicenter retrospective observational study.

OBJECTIVE: To report the perioperative outcomes of 200 patients with gynecologic cancer who underwent surgery during the Novel Coronavirus Disease (COVID-19) pandemic and the safety of surgical approach. METHODS: Data of patients operated between March 10 and May 20, 2020, were collected retrospectively. Data were statistically analyzed using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows v. SP21.0. RESULTS: Data of 200 patients were included. Their mean age was 56 years. Of the patients, 54% (n=108), 27.5% (n=55), 12.5% (n=25), and 2% (n=4) were diagnosed as having endometrial, ovarian, cervical, and vulvar cancer, respectively. Of them, 98% underwent non-emergent surgery. A minimally invasive surgical approach was used in 18%. Stage 1 cancer was found in 68% of patients. Surgeons reported COVID-related changes in 10% of the cases. The rate of postoperative complications was 12%. Only two patients had cough and suspected pneumonic lesions on thoracic computed tomography postoperatively, but neither was positive for COVID-19 on polymerase chain reaction testing. CONCLUSION: Based on the present findings, it is thought that gynecologic cancer surgery should continue during the COVID-19 pandemic while adhering to the measures. Postponement or non-surgical management should only be considered in patients with documented infection. Gynecologic cancer surgery should continue during the COVID-19 pandemic while adhering to measures. Only 1% of patients developed COVID-19-related symptoms during the postoperative follow-up period.

Could mean platelet volume in late first trimester of pregnancy predict intrauterine growth restriction and pre-eclampsia?

AIM: The present study aims to determine whether mean platelet volume (MPV) specified in late first trimester of pregnancy can be used to predict pre-eclampsia and intrauterine growth restriction (IUGR). METHODS: This study prospectively reviews 200 healthy women with 11-14-week-old pregnancies. RESULTS: Average pregnancy-associated plasma protein-A (PAPP-A) multiples of the median (MoM) value was significantly lower and MPV was significantly higher in pre-eclamptic pregnancies (P = 0.001 for both). MPV values of 10.5 fl or more can predict pre-eclampsia with 66.7% sensitivity and 63.8% specificity. The combination of MPV of 10.5 fl or more and PAPP-A MoM of 0.33 or less can predict pre-eclampsia with 75% sensitivity and 70.0% specificity. MPV values of 10.5 fl or more can predict IUGR with 82.4% sensitivity and 60.0% specificity. The combination of MPV of 10.5 fl or more and PAPP-A MoM of 0.33 or less can predict IUGR with 85.3% sensitivity and 62.0% specificity. CONCLUSION: Increased MPV reflects enhanced platelet activation which may be caused by impairment in uteroplacental circulation. When MPV of 10.1 or more and PAPP-A MoM of 0.33 or less are combined as a threshold, the pregnancies that are destined to develop IUGR and pre-eclampsia can be predicted with considerably high sensitivity and specificity. The MPV and PAPP-A combination can be addressed as a useful biochemical tool for the prediction of IUGR and pre-eclampsia in late first trimester.

Short period of preconditioning protects by decreasing the TNF-alpha and IL-6 values before laparoscopic surgery (a rat experiment).

BACKGROUND: Laparoscopy produces ischemia reperfusion injury mediated by inflammatory cytokines. Preconditioning is a protective maneuver in laparoscopic surgery; however, there is an argument in the literature about the length and number of the preconditioning sequence(s), thus the present study evaluates the effects of short (5 min) and long (10 min) periods of preconditioning on laparoscopy-induced inflammatory response. MATERIAL/METHODS: Thirty-two rats were enrolled into 4 groups: control, laparoscopy, 5 min preconditioning and 10 min preconditioning groups, each containing 8 rats. Laparoscopy was performed by application of 60 min of pneumoperitoneum with 15 mmHg. The preconditioning maneuvers were performed before laparoscopy in respective groups. Following the cessation of experiment blood samples were obtained to determine the TNF-alpha and IL-6 levels. RESULTS: Laparoscopy produced significantly increased levels of plasma TNF-alpha and IL-6 values as compared to the sham group. Five min preconditioning caused significant decrease in plasma TNF-alpha and IL-6 values compared to laparoscopy group. Although 10 min preconditioning caused partially decreased levels of TNF-alpha and IL-6 values, they were still higher than that of the 5 min preconditioning group. CONCLUSIONS: Preconditioning maneuvers longer than 5 min lose protective activity and begin to produce ischemia reperfusion injury. We found that 5 min of inflation followed by 5 min of deflation seems to protect against subsequent post-laparoscopic inflammatory response. Thus it is advisable not to use any preconditioning maneuvers longer than 5 min in order to avoid increasing the operation and anesthesia times.