Inflammatory and Nutritional Serum Markers as Predictors of Peri-operative Morbidity and Survival in Ovarian Cancer.

AIM: To identify preoperative nutritional and inflammatory markers that predict perioperative outcomes in patients with ovarian cancer (OC). PATIENTS AND METHODS: Fifty patients who underwent primary debulking for advanced (stage III/IV) OC were selected from a cohort of patients who underwent surgery between 2002 and 2009. We analyzed C-reactive protein (CRP), interleukin-6 (IL6) and albumin and their impact on mortality and surgical outcomes. RESULTS: Two patients were excluded since they did not have adequate measurements of CRP and IL6. Among the remaining patients, 25 (52%) were ≥70 years old. Nine (19%), 12 (25%) and 12 (25%) patients had low serum albumin (<3.0 g/dl), elevated CRP (≥70 mg/l) and elevated IL6 (≥24 pg/ml), respectively. Age was a significant predictor of non-home discharge (p=0.01). Low serum albumin (<3.0 g/dl) was a predictor of death within 6 month (p=0.03). Elevated CRP (≥70 mg/l) was a predictor of non-home discharge (p=0.02), death within 6 months (p=0.02), death within 12 months (p=0.04), and longer hospital stay (p=0.01). Elevated IL6 (≥24 pg/ml) was a predictor of non-home discharge (p=0.002) and surgical complications (p=0.02), and also associated with longer hospital stay (p=0.03). CONCLUSION: Poor nutrition and high inflammatory status negatively influence surgical and oncological outcomes of patients with OC. These preoperative markers can be used for selection of patients for neoadjuvant chemotherapy at high risk of short survival, non-home discharge and long hospital stay.

Nutritional status, CT body composition measures and survival in ovarian cancer.

OBJECTIVE: Body composition measures (BCMs) are an important predictor of nutritional status in patients with cancer. Poor nutritional status is common in ovarian cancer (OC) and is a well-known variable that influences cancer treatment and outcome. We aim to establish the role of BCMs measured by computed tomography (CT) in predicting outcomes in patients with OC. METHODS: We retrospectively searched our institutional database for patients with stage IIIC/IV OC who underwent surgery as primary treatment at Mayo Clinic between 1996 and 2005 and had adequate presurgical CT images available. For each patient, 1 axial CT image at the level of the 3rd lumbar vertebra was evaluated. Adipose and lean tissues were discriminated using commercially available software. Cox models were fit to evaluate the relationship between patient factors and overall survival (OS). Associations were summarized using hazard ratios (HRs) and corresponding 95% CIs. RESULTS: A total of 82 patients were identified, with a median age of 68.4 years. OS at 1 and 5 years was 84.1% and 24.1%, respectively. Older age (P=.01), stage IV disease (P<.001), and subcutaneous and muscular fat<77.21cm(2) (P<.001) were independently associated with poor OS. Longer hospital stay was independently predicted by albumin≤3g/dL (P=.03), suboptimal surgery (P=.02), and subcutaneous and muscular fat<77.21cm(2) (P<.001). Surgical complications were independently predicted only by albumin≤3g/dL (P<.01). CONCLUSIONS: CT BCMs, as indicators of nutritional status, are independent predictors of longer hospital stay and poor OS in patients with OC.

Risk factors for developing endometrial cancer after benign endometrial sampling.

OBJECTIVE: To identify risk factors for endometrial cancer after benign results of endometrial biopsy or dilation and curettage (D&C). METHODS: Nested case-control study from Rochester Epidemiology Project data. Among 370 Olmsted County, Minnesota, residents who received an endometrial cancer diagnosis between 1970 and 2008, we identified 90 patients (24.5%) who had previous benign endometrial biopsy or D&C results (no atypical hyperplasia). We compared them with 172 matched control group participants who had benign endometrial biopsy or D&C results without subsequent endometrial cancer. RESULTS: Using a multivariable conditional logistic regression model, we found that oral contraceptive pill (OCP) use was protective (odds ratio [OR] 0.18, 95% CI [CI] 0.08-0.45; P<.001), and personal history of colorectal cancer (OR 4.44, 95% CI 1.02-19.31; P<.05), endometrial polyp (OR 4.12, 95% CI 1.40-12.17; P=.01), and morbid obesity (OR 3.40, 95% CI 1.18-9.78; P<.03) were independently associated with subsequent endometrial cancer. Compared with the presence of no risk factor, presence of one and two or more risk factors increased the risk of endometrial cancer by 8.12 (95% CI 3.08-21.44) and 17.87 (95% CI 5.57-57.39) times, respectively. Assuming a 2.6% lifetime risk of endometrial cancer, ORs of 8.12 and 17.87 for one and two or more of the four aforementioned risk factors confer a lifetime risk of approximately 18% and 32%, respectively. CONCLUSION: One fourth of patients with endometrial cancer had previous benign endometrial biopsy or D&C results. Personal history of colorectal cancer, presence of endometrial polyps, and morbid obesity are the strongest risk factors for having endometrial cancer after a benign endometrial biopsy or D&C result, and OCP use is the strongest protective factor. LEVEL OF EVIDENCE: II.