Prognostic value of tissue plasminogen activator (tPA) in patients with epithelial ovarian cancer undergoing chemotherapy.

OBJECTIVES: Tissue plasminogen activator (tPA) is a key enzyme for fibrin degradation and the proteolytic defense against formation of the thrombotic endothelial deposits. tPA is involved in carcinogenesis but its exact role in tumor biology is not very well understood and a prognostic value of tPA remains ambiguous in different cancers. The aim of the study was to assess the prognostic value of plasma tPA in patients with epithelial ovarian cancer (EOC) in the course of the first line chemotherapy. MATERIAL AND METHODS: the study covered 60 patients with EOC who underwent the 1st line chemotherapy. Plasma tPA was assessed at onset, after 3 and 6 cycles of chemotherapy. The groups were stratified according to tPA level at onset of chemotherapy (low tPA group < 6.5 mg/L, N = 37 and high tPA group > 6.5 mg/L, N = 23). Survival analysis was repeated for the cut-off of tPA level at 6.5 mg/L and 5.1 mg/L after 3 and 6 cycles. RESULTS: Only subjects with tPA > 6.5 mg/L at onset of chemotherapy had a significantly lower probability of a 5-year survival (34.8% vs. 72.7%, P < 0.006) and lower chance for disease free survival within 5 years (39.3% vs. 72.7%, P < 0.014). tPA < 6.5 mg/L plasma level evaluated at onset of chemotherapy was an independent marker of better overall survival (RR = 0.44, 95%CI = 0.19-0.98) but not disease-free survival. CONCLUSIONS: Plasma tPA may serve as a marker of survival if assessed at onset of the first line chemotherapy in patients with ovarian cancer.

Plasminogen Activator Inhibitor Type 1 in Blood at Onset of Chemotherapy Unfavorably Affects Survival in Primary Ovarian Cancer.

Plasminogen activator inhibitor type 1 (PAI-1) belongs to the family of the plasminogen activator system. PAI-1 stimulates fibrinolysis and also promotes tumor progression. The aim of this study was to evaluate the prognostic value of blood plasma PAI-1 content in patients with epithelial ovarian cancer who start the first-line chemotherapy. PAI-1 content was measured in the blood of 61 patients with epithelial ovarian cancer at onset of first-line chemotherapy. The patients were further stratified into the low PAI-1 group (≤20 ng/mL; 33 patients) and the high PAI-1 group (>20 ng/mL; 28 patients). We found that the greater plasma PAI-1 content was associated with a significantly lower probability of a 5-year-long survival compared to that when PAI-I content was lower (45.5% vs. 69.5%, respectively; p = 0.04). However, the risk of cancer recurrence within 5 years failed to differ appreciably. A multivariate analysis revealed that the lower PAI-1 plasma content was an independent factor of longer overall survival (death risk ratio of 0.36, 95%CI = 0.16-0.79; p < 0.01). We conclude that PAI-1 is yet another biomarker of survival in patients with ovarian cancer.

Results of Further Diagnostic Procedures Among Patients with Cytological Characteristics of Minor Changes on Pap Smears.

BACKGROUND: Atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) are the two most common results of positive Pap smears. AIM: The aim of this study was to compare the management of patients with ASCUS and LSIL. PATIENTS AND METHODS: All procedures were performed between 2003 and 2014 in an outpatient clinic affiliated to a tertiary referral center, and included Pap smears, colposcopy, histology and invasive treatment. RESULTS: There were 131 patients in the ASCUS group and 84 in the LSIL group. Further negative cytological results were obtained more frequently among the ASCUS group than the LSIL group [relative risk (RR)=1.18, 95% confidence interval (CI)=1.33-2.40; p<0.001]. Histological results revealed higher occurrence of cervical intraepithelial neoplasia grade III or invasive squamous cancer in the LSIL group than the ASCUS group [RR=6.8 (95% CI=0.95-144.63), p=0.033]. Patients from the LSIL group more frequently required invasive treatment [RR=2.53, 95% CI=1.40-4.67, p=0.001]. CONCLUSION: Diagnosis of ASCUS is associated with more frequent cases of total remission in follow-up Pap smears and requires for less-invasive management.

[Recurrent ovarian cancer--qualification and results of surgical treatment]. / Nawrotowy rak jajnika--kwalifikacja i wyniki leczenia operacyjnego.

INTRODUCTION: Complete tumor cytoreduction seems to be beneficial for platinum-sensitive women with recurrent ovarian cancer (ROC). Selection of patients who might have a chance for complete debulking constitutes a real challenge. Several predictive models defining a chance for complete cytoreduction and help in patient selection for surgery have been developed. OBJECTIVES: The aim of the study was to evaluate the effectiveness of selected models in one clinical center and the impact of complete resection on treatment outcome. MATERIAL AND METHODS: A total of 17 patients with ROC, diagnosed at least 6 months after first-line chemotherapy were recruited for the study. The inclusion criteria were based on the AGO-score (DESKTOP I trial). The group were retrospectively analyzed based on the predictive model International Collaborative Cohort Score (Tian- score). The end point was the percentage of complete cytoreduction. Also, postoperative complications and progression-free survival (PFS) were evaluated. RESULTS: Out of 17 patients who meet the criteria of the the AGO-score, complete debulking was achieved in 13 (76.47%) cases. Comparing the results of the Tian-score, 12 (100%) patients who were considered to be at 'low-risk of surgical failure' were debulked optimally In addition, complete debulking was achieved in 1 patient from the high-risk group. In all optimally operated patients, the number of changes detected during pre-operative imaging was ≤ 3. In 11 patients after complete cytoreduction there was another relapse. The median of PFS was 16 months. CONCLUSIONS: The applied predictive models have proven to be effective in selecting patients who will benefit from surgical treatment of ROC.