Adenocarcinoma histology is a poor prognostic factor in locally advanced cervical cancer.

OBJECTIVE: This retrospective study aimed to compare prognostic factors and survival between adenocarcinoma (AC) and squamous cell carcinoma (SCC) in locally advanced cervical cancer treated at a single center. METHODS: All medical records of cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIB or IIIA,B, treated between 2004 and 2012, were reviewed. We treated patients with chemoradiotherapy (CRT) followed by brachytherapy (BT). Multivariate logistic regression and Cox proportional hazard models were used to analyze clinicopathological characteristics, patterns of care and outcomes. RESULTS: We included in the analysis 161 patients (52 AC; 109 SCC). Patients with AC were younger (age 50 vs. 55 years), more likely to die from the disease (HR: 1.60; 95% CI: 1.26-2.58; p = .001) and to have disease recurrence (HR: 1.69; 95% C.I: 1.21-2.12; p = .004) than those with SCC. The other significant prognostic factors for overall survival (OS) and recurrence-free survival (RFS) in AC were FIGO stage (p = .001; p = .002), WHO status (0 vs. 1-3; p = .003; p = .04), and hemoglobin level (<12 g/dl>; p = .04; p = .02). The 5 year overall survival for stage II of AC and SCC was 63% and 82% (p = .03), and for IIIA,B it was 33.6% and 73% (p = .0005). The 5 year RFS for AC and SCC stage FIGO IIIA,B was 24% and 57% (p = .001). CONCLUSIONS: Adenocarcinoma histology negatively impacts OS and RFS for advanced cervical cancer. Histology-specific therapy may be an opportunity for survival improvement in these women.

Pretreatment neutrophil to lymphocyte and platelet to lymphocyte ratios as predictive factors for the survival of cervical adenocarcinoma patients.

OBJECTIVE: Our study assessed the clinical utility and prognostic value of pretreatment hematological parameters and calculated coefficients including the platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), and monocyte to lymphocyte ratio (MLR) in patients with cervical adenocarcinoma (CA). MATERIALS AND METHODS: Among 738 cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) stages IA-IV treated at our institution, 96 (13%) presented with CA histology. The blood samples, collected within 10 days before treatment, were analyzed using a Sysmex XN-2000 system. The statistical tests included Mann-Whitney U-tests, log-rank tests, and Cox regression models. The cutoff points for the calculated hematological coefficients (NLR, PLR, and MLR) were determined using the MedCalc statistical program. RESULTS: The prognostic factor for overall survival (OS) and recurrence-free survival (RFS) in CA was clinical stage according to FIGO classification (FIGO IIB-IV vs I-IIA) (P=0.0001; P=0.002). Among patients with FIGO stage IIB-IV treated with radiotherapy/chemoradiotherapy, an elevated PLR was a negative prognostic factor for OS (P=0.017; HR: 2.96; 95% CI: 2.069-3.853). Among all patients, an elevated pretreatment NLR was a poor prognostic factor for OS (P=0.014; HR: 2.85; 95% CI: 2.011-3.685) and RFS (P=0.049; HR: 4.0; 95% CI: 2.612-5.392). The white blood cell count (WBC) before treatment was significantly higher in patients who died during follow-up (P=0.009). CONCLUSION: Elevated NLR values before treatment may be associated with a shorter time of RFS and OS, while PLR index may have prognostic significance for OS in patients with advanced disease (FIGO IIB-IV). Both indexes and WBC may be a cost-effective biomarker that can be used conveniently for stratification of recurrence risk and death.

Serous Carcinoma of the Uterine Cervix, an Extremely Rare Aggressive Entity: A Literature Review.

BACKGROUND/AIMS: Serous carcinoma of the uterine cervix (USCC) is an extremely rare subtype. To establish the treatment strategy in patients with USCC is an important issue. METHODS: MEDLINE (PubMed) was searched for all articles published after the first publication by Lurie et al. [Eur J Obstet Gynecol Reprod Biol 1991; 40: 79-81], reporting woman diagnosed with USCC. Because of limited numbers of studies on the topic of the study, we could not keep a restriction of eliminating smaller sample sizes. RESULTS: A search of PubMed demonstrated that 113 cases of USCC have been reported in the literature since the first publication. The current treatment modality adopted for early cervical cancer is hysterectomy with bilateral iliac-obturator lymphadenectomy and postoperative radiotherapy (RT) or radiochemotherapy (RT-CT) if risk factors for cervical carcinoma appear. The treatment strategy for locally advanced USCC is preoperative RT-CT or chemotherapy (CHTH) with the intention to treat the patient surgically. The treatment option for disseminated disease is CHTH with paclitaxel and carboplatin. CONCLUSION: Risk factors and a more advanced clinical stage of USCC have an impact on poor outcomes despite the use of standard treatment methods, adapted for cervical cancer. The outside-pelvic failures tend to seek effective systemic treatment.

Birth body length, birth body weight and birth head circumference in neonates born in a single centre between 2011 and 2016.

OBJECTIVES: Access to updated and accurate standards for local populations is important for the interpretation of body measurements in neonates and may have an impact on the doctor's recommendations for monitoring early childhood development. STUDY AIM: to present individual mean values for the most prevalent body measurements (i.e. birth body length (BBL), birth body weight (BBW) and birth head circumference (BHC)) in neonates and compare them to the duration of pregnancy. MATERIAL AND METHODS: The measurements (BBL, BBW and BHC) were collected and analyzed from over 27,000 neonates born in a single center. All women with single pregnancies with gestation ranging from 33 to 42 weeks were included in the study. RESULTS: Mean values and statistically significant standard deviation values from population standards of BBL, BBW, and BHC were evaluated for neonates that were born between the 33rd and 42nd week of gestation. Analysis was conducted for the lower limit (10th percentile), average (50th percentile) and upper limit (90th percentile). CONCLUSIONS: This was the first time in Polish literature when population standards were presented for three body meas-urements of neonates. With the size of the cohort, these standards can be successfully implemented into routine clinical practice, especially for screening children with body size deficits.

[Therapeutic value of lymphadenectomy in ovarian cancer patients]. / Terapeutyczna wartosc wyciecia wezlów chlonnych u chorych leczonych z powodu raka jajnika.

Ovarian cancer has the highest mortality rate among the female genital malignancies. Its incidence is steadily increasing worldwide, especially in highly industrialized countries. Scarce and non-specific clinical symptoms in the early stages, and lack of effective screening methods, are the reasons why in the majority of cases the disease is diagnosed in advanced stage. Early diagnosis and optimal therapeutic method have significant impact on the prognosis. Surgery remains the basic treatment method in all stages of ovarian cancer. The general principle is the removal of the entire tumor or maximal cytoreduction. Pelvic and para-aortic lymphadenectomy is an integral part of the operating protocol. Evaluation of the regional lymph nodes is an important element of the diagnosis in patients with ovarian cancer, as the disease stage and the decision about the method of adjuvant therapy both depend on it. The diagnostic value of lymphadenectomy is unquestionable and is the basis of proper classification, while its therapeutic value remains the subject of controversy. The aim of the paper is to review the results of the most important research concerning lymphadenectomy in ovarian cancer, based on the available literature.

[Merkel cell carcinoma of the vulva - case report and the literature review]. / Rak sromu z komórek Merkla - opis przypadku i przeglad pismiennictwa.

UNLABELLED: Merkel cell carcinoma (MCC) is a rare malignant neoplasm, mostly affecting the skin (97% of cases). It is usually found in elderly people, in the sun-exposed areas of the skin. About 50-60% of MCC cases are located on the head and the neck, less often on the extremities and the torso, and extremely rarely in the genital area. Ultraviolet radiation may be the main factor responsible for the development of the tumors but viral etiology is also debated. Due to extremely rare incidence of MCC in the area of the vulva, proper management remains a challenging task. AIM: To present a case of an aggressive MCC of the vulva and a review of the literature. MATERIAL AND METHODS: A previously healthy 72-year-old patient presented at the Oncology Center of the Maria Sklodowska-Curie Institute, Warsaw, in June 2010. Four months previously the patient noticed a painless lump in the vestibular region of the vagina. She received anti-inflammatory treatment at her local gynecological clinic, with no success. In February the patient underwent removal of the vulvar tumor Histopathological examination confirmed anaplastic carcinoma. Microscopic evaluation revealed the tumor diameter to be 15mm. Surgical margins were free of neoplastic infiltration. The patient did not receive adjuvant therapy due to the results from the histopathological protocol. The disease recurred after three months. Radical vulvectomy and bilateral inguinal femoral lymphadenectomy were performed in May 2010. Histopathological examination confirmed microcellular carcinoma with no metastases to the lymph nodes and complete resection of the tumor (RO). The disease recurred in the next two months: a 50-mm tumor was found in the right inguinal lymph nodes. The decision to verify all histopathological material obtained during all procedures performed so far was made. Immunohistochemical evaluation confirmed MCC. Adjuvant radiotherapy was recommended. The area of the vulva, pelvic and inguinal lymph nodes were irradiated. One month after therapy completion the patient complained of pain in the lumbar area. An ultrasound examination of the abdomen revealed a tumor (9 cm in diameter) in the para-aortic region but it was not histopathologically verified due to extremely poor overall condition of the patient. As the condition of the woman deteriorated systematically the patient was referred to a hospice facility where she died 9 months since the primary diagnosis. CONCLUSIONS: MCC of the vulva is a rare neoplasm with an aggressive course. Clinical and histopathological diagnostic difficulties and consequently lack of standardized management, result in low survival rates.

[Influence of tumor diameter on treatment results in cervical cancer patients]. / Wplyw wielkosci guza nowotworowego na wyniki leczenia chorych na raka szyjki macicy.

UNLABELLED: The impact of the tumor size on treatment outcomes in cervical cancer patients remains a subject of controversy OBJECTIVES: The assessment of prognostic value of pretreatment tumor size in cervical cancer patients. MATERIALS AND METHODS: Patients of Maria Sklodowska - Curie Memorial Cancer Centre in Warsaw, treated between January 1996 and December 2000, were included into the retrospective study. 242 patients were diagnosed with a histologically confirmed squamous cell carcinoma and 42 with adenocarcinoma, FIGO staged IB-IVA, having undergone the clinical assessment and USG examination of the tumor treated with curative intent with surgery and/ or radiotherapy. The widest tumor diameter was adopted as the tumor size. In most cases of adenocarcinoma, the tumors were described as endocervical and the tumor measurement was connected with the risk of mistake, therefore, the analysis of the squamous cell cancer patients only was performed. A multivariate analysis of 242 patients with regard to overall survival (OS) and disease-free survival (DFS), depending on the selected clinico-pathological factors, was performed. The mean potential follow-up time for surviving patients was 50 months (range 8.7-62). The 5-year overall survival (OS) rate was 62%. RESULTS: As the result of the multivariate analysis, the impact of FIGO stage (p=0.002), hemoglobin pretreatment concentration (p=0.031) and tumor size before treatment (p = 0.044) on OS, and FIGO stage (p=0.001), hemoglobin level before treatment (p=0.019) on DFS, was demonstrated. CONCLUSIONS: Tumor diameter before treatment in squamous cell cervical cancer patients provides important prognostic information, regardless of other prognostic factors.

Evaluation of intraoperative and postoperative complications related to lymphadenectomy in ovarian cancer patients.

Assessment of the regional lymph node status is an integral part of diagnostics for ovarian cancer patients. Due to the risk of complications, lymphadenectomy for ovarian cancer patients, as a routine treatment procedure, is still a subject of controversy. Therefore, the present study aimed to evaluate the frequency and nature of intraoperative and postoperative complications in ovarian cancer patients treated with surgery. In addition, a comparison of the frequency and nature of surgical complications between patients who underwent lymphadenectomy and those who did not was carried out. A retrospective analysis of 211 consecutive ovarian cancer patients treated with surgery with pelvic and aortic lymphadenectomy (group I), and 258 ovarian cancer patients treated with surgery but without lymphadenectomy (group II) was carried out. All of the patients were treated with complementary chemotherapy. The frequency and nature of the intraoperative and postoperative complications were determined. The most frequent intraoperative complications in the two groups were haemorrhage, urinary system damage and digestive tract damage. The difference in the frequency and nature between the groups was not statistically significant (p=0.683). The most frequent postoperative complications were haemorrhage, intestinal junction dehiscence, eventrations, wound dehiscence, anaemia, wound healing complications and intestinal fistulas. Haemorrhage, eventrations and wound healing complications were more frequent in group I. The difference was statistically significant (p=0.002). Due to postoperative complications, reoperative procedures were necessary in two women in group II (0.78) and in 15 women (7.11%) in group I. The difference was statistically significant (p=0.000). In conclusion, the most frequent intraoperative complications were haemorrhage, urinary system damage and digestive tract damage. The frequency of complication was found to be similar in the two groups. A statistically significant higher rate of postoperative complications, such as haemorrhage, eventrations and wound healing complications was confirmed in the lymphadenectomy group.

[Fertility-conserving therapy in cervical cancer patients]. / Leczenie oszczedzajace plodnosc u chorych na raka szyjlk macicy.

Treatment of the cervical cancer patients, especially young women, is a very important clinical problem. This is related to the standard treatment methods, used in this malignancy and the treatment complications. In most patients, the oncological treatment, be it surgery or radiotherapy results in gonadal dysfunction with unavoidable loss of the ability to procreate. As cervical cancer affects mostly young women, fertility preserving treatment remains a considerable challenge. Due to the fact that the recent decade has brought significant progress in the diagnosis of prognostically important features characterizing the tumor biology their precise determination enables specialists to detect a subpopulation of patients with malignancies, who do not require the total resection of the uterus and ovaries. Currently in such cases, fertility-sparing surgery is considered in every young woman with early cervical cancer who wishes to preserve the reproductive function. The aim of the paper is to revive the current opinions concerning fertility sparing treatment options in gynecological malignancies.

[Prognostic value of histopathology in cervical cancer patients]. / Rokownicze znaczenie utkania histopatologicznego u chorych na raka szyjki macicy.

UNLABELLED: Cervical cancer is the sixth cause of cancer morbidity and the seventh cause of cancer death among women in Poland. The rising tendency of cervical adenocarcinoma morbidity and the decrease of cervical squamous cell carcinoma have been observed. Many authors emphasize the worse outcome of cervical adenocarcinoma patients, when compared with the squamous cell cancer. OBJECTIVES: The assessment of prognostic value of histopathology in cervical cancer patients. MATERIAL AND METHODS: The retrospective analysis of 142 cervical adenocarcinoma and 242 squamous cell cancer patients, treated between January 1989 and December 1999, at Gynecological Oncology Department of Maria Sklodowska-Curie Memorial Cancer Center in Warsaw, has been performed, In each case, the clinical diagnosis was histologically confirmed. All patients were treated with surgery and/or radiotherapy The above methods were used as the routine therapeutic modalities, during the analyzed period. The analysis of the overall survival (OS) and the disease-free survival (DFS), in dependence on the selected clinico-pathological factors, was performed. RESULTS: The percentage of the 5-year OS for cervical adenocarcinoma patients amounted to 45.0%, whereas for squamous cell cancer to 62.5%. The difference was statistically significant (p = 0.05). In spite of higher percentage of cervical adenocarcinoma, diagnosed at early stage, when compared with squamous cell cancer the outcome of the whole adenocarcinoma group was worse. CONCLUSIONS: Regardless of the other clinico-pathological factors, adenocarcinoma was associated with poorer survival Identification of women who are at risk and different treatment modalities for both types of tumor should be the subject of future studies.

Early cervical cancer managed by laparoscopy and conventional surgery: comparison of treatment results.

INTRODUCTION: The goal of this retrospective analysis was to compare the results of treatment in patients with early cervical cancer managed by laparoscopy with those for patients observed after laparotomy. METHODS: The retrospective analysis was carried out with 22 patients operated on with total laparoscopic hysterectomy and 58 patients treated by abdominal hysterectomy. Patients with clinical tumor stage IA, IB1, or IIA were eligible for surgery. The main efficacy end point was disease-free survival evaluated by the Kaplan-Meier method. The survival curves were compared using log-rank tests. In addition, length of hospitalization, duration of surgery, and complication rate were compared. P < 0.05 was set as statistically significant. RESULTS: Predicted 3-year disease-free survival rates in the "open surgery" and "laparoscopy" groups were 0.86 (standard deviation [SD], 0.049) and 0.82 (SD, 0.098), respectively (P = 0.53). Recurrence rate was 13.6% after laparoscopy and 12% in open surgery. In 2 patients, intraperitoneal spread occurred after laparoscopy. The operation time was longer and hospitalization shorter after laparoscopy. CONCLUSIONS: The 3-year disease-free survival was similar in both groups. Total laparoscopic radical hysterectomy may be an option in early cervical cancer; however, the intraperitoneal spread in 2 patients compels a search for possible risk factors in patients managed by laparoscopy.

[Recurrence risk analysis in patients treated for I clinical stage of endometrial cancer]. / Ocena ryzyka nawrotu nowotworu u chorych leczonych z powodu raka blony sluzowej trzonu macicy w stopniu I wg klasyfikacji klinicznej FIGO.

INTRODUCTION: The risk of endometrial cancer recurrence is estimated to be about 20%. In most cases, such situations are recognized in the first 3 years after the primary treatment. Early detection of such episodes leads to effective treatment. The aim of this study was to evaluate some histoclinical factors in the risk of recurrence. MATERIAL AND METHODS: Between the year 2001 and 2003, 203 from 243 patients with endometrial cancer underwent surgery. All procedures were performed in accordance with surgical-pathological staging system. The following histoclinical factors were taken into account: age, number of deliveries, BMI, use of estrogens, co-morbidity, histoclinical type, grading and the spread of cancer inside the uterus, pelvis and retroperitoneal space. RESULTS: 29 recurrences (14.3%) were found in all analyzed groups. The mean time of follow-up was 43 months. The mean time of recurrences was 16 months (9-51 months). Lymph node metastases were recognized in 28 patients (13.7%). The most important factors in the multivariate analysis were: type of histology (serous or clear cell cancer) and lymph node involvement. Recognizing 2 or more metastatic lymph nodes significantly increased the risk of recurrences. CONCLUSION: In patients with endometrial cancer the risk of recurrences increases when lymph node metastases are recognized. This risk is 5 times higher when 2 or more lymph nodes are involved, comparing with patients with one node metastasis. Four times higher recurrence risk is observed in serous or clear cell cancer, comparing with other histological types.