Desfechos reprodutivos e de sobrevida em adolescente tratada com cirurgia preservadora de fertilidade por tumor borderline de ovário em estádio avançado: relato de caso e revisão da literatura / Reproductive and survival outcomes in an adolescent treated with fertility- sparing surgery for advanced stage borderline ovarian tumor: case report and review of the literature

Existem poucos dados na literatura sobre os resultados obstétricos e oncológicos de adolescentes com tumores borderline de ovário em estádio avançado trata- das com cirurgia preservadora da fertilidade. Uma adolescente de 15 anos com diagnóstico de tumor borderline de ovário estádio IIIc foi inicialmente tratada com tumorectomia ovariana bilateral e quimioterapia adjuvante com esquema de platina/taxano (seis ciclos). Durante o seguimento, foi submetida a outras três tumorectomias devido a tumor borderline de ovário (duas vezes) e cistadenoma ovariano (uma vez). Outra recidiva de tumor borderline de ovário ocorreu seis anos após o diagnóstico inicial, quando ela estava grávida; foi tratada com tumorecto- mia realizada durante a cesariana. Em sua última consulta ambulatorial, a mulher de 27 anos não apresentava evidência da doença e tinha um filho saudável. Mesmo em estádio avançado, a cirurgia de preservação da fertilidade foi segura e factível nessa paciente com tumor borderline de ovário.

There are few data in the literature regarding obstetric and oncological outcomes of adolescents with advanced-stage borderline ovarian tumors treated with fertility spa- ring surgery. A 15 years old adolescent who was diagnosed with a stage IIIc borderline ovarian tumor, was treated with bilateral ovarian tumorectomies and adjuvant chemotherapy with platinum/taxane regimen (six cycles). During follow up she was submitted to other three tumorectomies due to borderline ovarian tumor(twice) and ovarian cysta- denoma (once). Another borderline ovarian tumorrecurren- ce occurred six years after initial diagnosis, when she was pregnant; treated with tumorectomy performed during ce- sarean section. At her last outpatient visit, the 27-year-old woman had no evidence of disease and a had healthy child. Even at an advanced stage, fertility sparing surgery was safe and feasible in this patient with borderline ovarian tumor.

Diffusion-weighted magnetic resonance sequence and CA125/CEA ratio can be used as add-on tools to ultrasound for the differentiation of ovarian from non-ovarian pelvic masses.

OBJECTIVE: To provide a straightforward approach to the sequential use of ultrasound (US), magnetic resonance (MR) and serum biomarkers in order to differentiate the origin of pelvic masses, making the most efficient use of these diagnostic resources. STUDY DESIGN: This is a cross-sectional study with 159 patients (133 with ovarian and 26 with non-ovarian tumors) who underwent surgery/biopsy for an adnexal mass. Preoperative CA125 and CEA serum measurements were obtained and a pelvic/abdominal ultrasound was performed. Preoperative pelvic MR studies were performed for all patients. Morphological and advanced MR sequences were obtained. Using a recursive partitioning algorithm to predict tumor origin, we devised a roadmap to determine the probability of non-ovarian origin using only statistically significant US, laboratory and MR parameters. RESULTS: Upfront US classification as ovarian versus non-ovarian and CA125/CEA ratio were significantly associated with non-ovarian tumors. Signal diffusion (absent/low versus high) was the only MR parameter significantly associated with non-ovarian tumors. When upfront US designated a tumor as being of ovarian origin, further MR signal diffusion and CA125/CEA ratio were corrected nearly all US errors: patients with MR signal diffusion low/absent and those with signal high but CA125/CEA ratio ≥25 had an extremely low chance (<1%) of being of non-ovarian origin. However, for women whose ovarian tumors were incorrectly rendered as non-ovarian by upfront US, neither MR nor CA125/CEA ratio were able to determine tumor origin precisely. CONCLUSION: MR signal diffusion is an extremely useful MR parameter to help determine adnexal mass origin when US and laboratory findings are inconclusive.

Early Blood Flow Abnormalities in Axillary and Brachial Arteries Precede the Onset of Persistent Lymphedema in Women Treated Surgically for Breast Cancer.

Background: surgery to treat breast cancer (BC) is associated with upper limb (UL) lymphedema, which in some cases may become permanent. It is uncertain whether lymphedema results from injury to either lymphatic or blood vessels, or to both. Methods and Results: a cohort of 200 BC patients was examined 1, 3, 6, 12, and 24 months after surgery. Axillary and brachial blood vessels were evaluated using Doppler Ultrasound, and patients had their UL examined for lymphedema at each visit. Patients who developed lymphedema 24 months after surgery presented with higher mean flow velocity (MFV) and end diastolic velocity (EDV) in both axillary (MFV = 13.57 vs. 10.7 cm/s, p = 0.02; EDV = 5.62 vs. 3.47 cm/s; p = 0.004) and brachial (MFV = 11.44 vs. 8.74 cm/s; p = 0.03; EDV = 5.08 vs. 3.04; p = 0.04) arteries as early as 1 month after surgery. Similar associations were found 3, 6, and 12 months after surgery. Early abnormalities of the resistive and pulsatility indexes were also significantly associated with persistent lymphedema. EDV measured 1 month after surgery had the best performance to detect patients who will later develop long-term lymphedema, (sensitivity = 73.7%; specificity = 71.2%; negative predictive value = 57.6%). Conclusion: vascular abnormalities precede and are possible causal factors for UL lymphedema in BC patients.

Assessment of the performance of the O-RADS MRI score for the evaluation of adnexal masses, with technical notes.

Objective: To assess the performance of the Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging (O-RADS MRI) score in the evaluation of adnexal masses and to provide technical notes about its current MRI parameters and concepts. Materials and Methods: This was a prospective study of 226 patients with 287 adnexal masses (190 submitted to surgery or biopsy and 97 followed for at least one year). We calculated the sensitivity, specificity, positive predictive value, and negative predictive value for the O-RADS MRI score, using ≥ 4 as the cutoff for malignancy. We performed a technical analysis of the main updates to the score, announced in September 2020 by the American College of Radiology, in comparison with the original (2013) version. Results: We found that an O-RADS MRI score of 4 or 5 was associated with malignancy of an adnexal mass, with a sensitivity of 91.11% (95% CI: 83.23-96.08), specificity of 94.92% (95% CI: 90.86-97.54), positive predictive value of 89.13% (95% CI: 81.71-93.77), negative predictive value of 95.90% (95% CI: 92.34-97.84), and overall accuracy of 93.73% (95% CI: 90.27-96.24). Conclusion: Our findings support the use of the O-RADS MRI score for evaluating adnexal masses, especially those considered indeterminate on ultrasound. The updates made recently to the O-RADS MRI score facilitate its interpretation and will allow its more widespread use, with no loss of diagnostic accuracy.

Objetivo: Determinar o desempenho do escore de ressonância magnética para lesões anexiais ovarianas (escore O-RADS RM), com notas técnicas sobre seus atuais parâmetros e conceitos de RM utilizados. Materiais e Métodos: Este estudo incluiu 226 pacientes com 287 massas anexiais (190 pacientes submetidas a cirurgia/biópsia e 97 pacientes com pelo menos um ano de seguimento). Calculamos sensibilidade, especificidade, valores preditivos positivos e negativos para as categorias do escore O-RADS RM, usando ≥ 4 como ponto de corte para malignidade. Realizamos análise técnica das principais atualizações do escore, anunciadas em setembro de 2020 pelo American College of Radiology, em comparação com a versão original de 2013. Resultados: Escores O-RADS RM categorias 4 ou 5 foram associados com malignidade da massa anexial, com sensibilidade de 91,11% (IC 95%: 83,23-96,08), especificidade de 94,92% (IC 95%: 90,86-97,54), valor preditivo positivo de 89,13% (IC 95%: 81,71-93,77), valor preditivo negativo de 95,90% (IC 95%: 92,34-97,84) e acurácia de 93,73% (IC 95%: 90,27-96,24). Conclusão: Este estudo reforçou o uso do escore O-RADS RM para avaliar massas anexiais, principalmente as indeterminadas por ultrassom. As atualizações feitas recentemente no escore O-RADS RM facilitam sua interpretação e permitirão seu uso mais difundido, sem perder a precisão diagnóstica.

Assessment of the performance of the O-RADS MRI score for the evaluation of adnexal masses, with technical notes / Desempenho do escore O-RADS RM para avaliação de massas anexiais, com notas técnicas

Abstract Objective: To assess the performance of the Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging (O-RADS MRI) score in the evaluation of adnexal masses and to provide technical notes about its current MRI parameters and concepts. Materials and Methods: This was a prospective study of 226 patients with 287 adnexal masses (190 submitted to surgery or biopsy and 97 followed for at least one year). We calculated the sensitivity, specificity, positive predictive value, and negative predictive value for the O-RADS MRI score, using ≥ 4 as the cutoff for malignancy. We performed a technical analysis of the main updates to the score, announced in September 2020 by the American College of Radiology, in comparison with the original (2013) version. Results: We found that an O-RADS MRI score of 4 or 5 was associated with malignancy of an adnexal mass, with a sensitivity of 91.11% (95% CI: 83.23-96.08), specificity of 94.92% (95% CI: 90.86-97.54), positive predictive value of 89.13% (95% CI: 81.71-93.77), negative predictive value of 95.90% (95% CI: 92.34-97.84), and overall accuracy of 93.73% (95% CI: 90.27-96.24). Conclusion: Our findings support the use of the O-RADS MRI score for evaluating adnexal masses, especially those considered indeterminate on ultrasound. The updates made recently to the O-RADS MRI score facilitate its interpretation and will allow its more widespread use, with no loss of diagnostic accuracy.

Resumo Objetivo: Determinar o desempenho do escore de ressonância magnética para lesões anexiais ovarianas (escore O-RADS RM), com notas técnicas sobre seus atuais parâmetros e conceitos de RM utilizados. Materiais e Métodos: Este estudo incluiu 226 pacientes com 287 massas anexiais (190 pacientes submetidas a cirurgia/biópsia e 97 pacientes com pelo menos um ano de seguimento). Calculamos sensibilidade, especificidade, valores preditivos positivos e negativos para as categorias do escore O-RADS RM, usando ≥ 4 como ponto de corte para malignidade. Realizamos análise técnica das principais atualizações do escore, anunciadas em setembro de 2020 pelo American College of Radiology, em comparação com a versão original de 2013. Resultados: Escores O-RADS RM categorias 4 ou 5 foram associados com malignidade da massa anexial, com sensibilidade de 91,11% (IC 95%: 83,23-96,08), especificidade de 94,92% (IC 95%: 90,86-97,54), valor preditivo positivo de 89,13% (IC 95%: 81,71-93,77), valor preditivo negativo de 95,90% (IC 95%: 92,34-97,84) e acurácia de 93,73% (IC 95%: 90,27-96,24). Conclusão: Este estudo reforçou o uso do escore O-RADS RM para avaliar massas anexiais, principalmente as indeterminadas por ultrassom. As atualizações feitas recentemente no escore O-RADS RM facilitam sua interpretação e permitirão seu uso mais difundido, sem perder a precisão diagnóstica.

Evaluation of PD-L1 and tumor infiltrating lymphocytes in paired pretreatment biopsies and post neoadjuvant chemotherapy surgical specimens of breast carcinoma.

Herein it was evaluated the impact of PD-L1 immunohistochemical expression and stromal tumor-infiltrating lymphocyte (sTIL) counts in pretreatment needle core biopsy on response to neoadjuvant chemotherapy (NACT) for patients with breast carcinomas (BC). In 127 paired pre- and post-NACT BC specimens, immunohistochemical expression of PD-L1 was evaluated in stroma and in neoplastic cells. In the same samples sTILs were semi-quantified in tumor stroma. Post-NACT specimens were histologically rated as having residual cancer burden (RCB of any degree), or with complete pathological response (pCR). PD-L1 expression and higher sTIL counts were associated with histological grade 3 BC. PD-L1 expression was also associated with the non-luminal-HER2+ and triple negative immunohistochemical profiles of BC. Pathological complete response was associated with histological grade 3 tumors, and with the non-luminal-HER2+ and triple negative profiles. Additionally, our results support an association between PD-L1 expression and pCR to NACT. It was also observed that there is a trend to reduction of sTIL counts in the post-NACT specimens of patients with pCR. Of note, PD-L1 was expressed in half of the hormone receptor positive cases, a finding that might expand the potential use of immune checkpoint inhibitors for BC patients.

Maintenance of Muscle Mass and Cardiorespiratory Fitness to Cancer Patients During COVID-19 Era and After SARS-CoV-2 Vaccine.

There is emerging evidence that decreased muscle mass and cardiorespiratory fitness (CRF) are associated with increased risk of cancer-related mortality. This paper aimed to present recommendations to prescribe effective and safe exercise protocols to minimize losses, maintain or even improve muscle mass, strength, and CRF of the cancer patients who are undergoing or beyond treatment during the COVID-19 era. Overall, we recommend performing exercises with bodyweight, elastic bands, or suspension bands to voluntary interruption (i.e., interrupt the exercise set voluntarily, according to their perception of fatigue, before concentric muscular failure) to maintain or increase muscle strength and mass and CRF during COVID-19 physical distancing. Additionally, rest intervals between sets and exercises (i.e., long or short) should favor maintaining exercise intensities between 50 and 80% of maxHR and/or RPE of 12. In an exercise program with these characteristics, the progression of the stimulus must be carried out by increasing exercise complexity, number of sets, and weekly frequency. With feasible exercises attainable anywhere, modulating only the work-to-rest ratio and using voluntary interruption, it is possible to prescribe exercise for a wide range of patients with cancer as well as training goals. Exercise must be encouraged; however, exercise professionals must be aware of the patient's health condition even at a physical distance to provide a safe and efficient exercise program. Exercise professionals should adjust the exercise prescription throughout home confinement whenever necessary, keeping in mind that minimal exercise stimuli are beneficial to patients in poor physical condition.

Longitudinal, Long-Term Comparison of Single- versus Multipoint Upper Limb Circumference Periodical Measurements as a Tool to Predict Persistent Lymphedema in Women Treated Surgically for Breast Cancer: An Optimized Strategy to Early Diagnose Lymphedema and Avoid Permanent Sequelae in Breast Cancer Survivors.

PURPOSE: We aim to evaluate whether upper limb (UL) circumference (ULC) and UL swelling sensation (ULSS) performed shortly after surgery or later on during follow-up can predict long-term/persistent forms of lymphedema in women who underwent surgery for breast cancer. PATIENTS AND METHODS: Eighty-five women completed at least 24 months of follow-up. At each follow-up visit (1, 3, 6, 12, and 24 months after surgery), patients were tested for lymphedema using ULC and ULSS. Two different approaches to ULC were compared: (1) a "positive" lymphedema diagnosis if a difference ≥ 2 cm between the affected and contralateral UL was detected in at least two contiguous measurement points (MPs) and (2) a "positive" result if just one MP ≥ 2 cm. Patients were also questioned about their perception of weight, swelling, and/or tension (ULSS). The gold standard for long-term lymphedema was a water displacement difference between the UL ≥ 200 mL 24 months after surgery (ULWD). RESULTS: Twenty-four months after surgery, 19 (22.4%) women were diagnosed with long-term lymphedema. Using 24-month data, comparison of log-likelihoods denoted a clear superiority of the ULC approach 1 compared with 2 for the diagnosis of long-term lymphedema (p < 0.001). Using approach 1, the best prediction of a woman developing long-term lymphedema if she had a positive ULC in the follow-up was obtained at 6 months after surgery (posterior probability of 60%). CONCLUSIONS: Our study reveals that performing ULC 6 months after surgery, regarding as "positive" only women with a difference ≥ 2 cm at two contiguous MPs, is the best strategy to identify women at increased risk of later developing permanent forms of lymphedema.

High Expression of SOD2 Protein Is a Strong Prognostic Factor for Stage IIIB Squamous Cell Cervical Carcinoma.

High superoxide dismutase 2 (SOD2) expression is associated with a poor prognosis at many cancer sites, the presence of metastases, and more advanced cervical cancer. This study aims to determine whether SOD2 protein expression is associated with the prognosis of stage IIIB cervical carcinoma. METHODS: sixty-three patients with stage IIIB squamous cell cervical carcinoma were included. The evaluation of SOD2 expression by immunohistochemistry was based on a positive cell ratio score and the staining intensity score. Taking disease recurrence and death as endpoints, receiver operating characteristic curves were used to discriminate between high and low SOD2 expression. RESULTS: high SOD2 expression was associated with recurrence (p = 0.001), distant recurrence (p = 0.002), and death (p = 0.005). A multivariate analysis showed that patients with high SOD2 expression had a threefold increased risk for recurrence (HR = 3.16; 1.33-7.51) and death (HR = 2.98; 1.20-7.40) compared with patients who had low SOD2 expression. Patients with high SOD2 expression had shorter disease-free survival (p = 0.001) and overall survival (p = 0.003) than patients with low SOD2 expression. CONCLUSION: high SOD2 expression is a strong prognostic factor for stage IIIB squamous cell carcinoma of the cervix and could be used as a prognostic marker in women with cervical carcinoma.

Aerobic Fitness is a Predictor of Body Composition in Women With Breast Cancer at Diagnosis.

BACKGROUND: The objective of this study was to investigate the relationship of aerobic fitness (AF) at diagnosis, before treatment and its relationship with body composition, physical function, lipidic profile, comorbidities, tumor characteristics, and quality of life of women with breast cancer (BC) PATIENTS AND METHODS: This cross-sectional cohort study included 78 women with BC that were assessed before treatment. A 6-minute walk test was used to evaluate the subjects' AF, estimating the maximum oxygen consumption (VO2max) to classify the women with BC into 2 groups: good/excellent AF or fair/weak/very weak AF. Dual-energy x-ray absorptiometry was performed to assess body composition. The International Global Physical Activity Questionnaire and the Functional Assessment of Cancer Therapy - Fatigue questionnaires were applied to assess the level of physical activity and the quality of life, respectively. RESULTS: Among the women included, the majority (81%) had the luminal subtype of BC. Most of the women were diagnosed with T1/T2 tumors and with negative axillary lymph nodes. We found that women with BC with good/excellent AF (VO2max = 32.9 ± 6.0 mL/kg/min-1) presented significantly lower weight, body mass index, abdominal circumference, percentual and total body fat, and bone mineral density compared with women with fair/weak/very weak AF (VO2max = 21.8 ± 6.9 mL/kg/min-1). Also, women with BC with good/excellent AF showed better performance on physical functional tests. No relationship between estimated VO2max and comorbidities, tumor characteristics, or quality of life was found. CONCLUSION: AF is a predictor of body composition and physical function in women with BC. These data suggest that women with BC with higher AF can decrease the chance of adverse effects during BC treatment.

Physical and functional well-being and symptoms of ovarian cancer in women undergoing first-line of chemotherapy: a one-year follow-up.

PURPOSE: Clinicopathological features and chemotherapy can influence the quality of life (QOL), women with ovarian cancer. This study aimed to evaluate the physical and functional well-being, and ovarian cancer-specific effects scores reported from QOL questionnaire among women with ovarian cancer at the time of in their initial diagnosis and access the scores trajectory of women receiving neoadjuvant and adjuvant chemotherapy. METHODS: This prospective study used cross-sectional analysis at baseline and longitudinal analysis from baseline to 12-month post-chemotherapy. QOL was evaluated at the baseline, at sixth cycle and 12-month post-chemotherapy using FACT-O questionnaire. Clinicopathological features and chemotherapy regime were evaluated and tested for associations with QOL measures. RESULTS: Of the 38 women enrolled in this study, 27 (80.1%) completed the questionnaire for 12 months. The multivariate linear regression results suggest, at the baseline, women with advance stage and presence of post-surgery residual disease showed lower scores in physical and functional well-being, ovarian cancer-specific effects, and FACT-O TOI domains (p < 0.05). Longitudinal analysis spanning over 12 months showed an improvement in mean physical well-being, functional well-being, and ovarian cancer-specific effects scores, independent of chemotherapy received (p < 0.05). CONCLUSIONS: At the baseline, the clinicopathological features such as stage, presence of post-surgery residual disease, and type of chemotherapy correlated with on QOL scores. At one-year follow-up, women who underwent chemotherapy showed improvement in QOL regardless of the type of chemotherapy they received. Future prospective study with a larger group is recommended.

Current physical therapy care of patients undergoing breast reconstruction for breast cancer: a survey of practice in the United Kingdom and Brazil.

BACKGROUND: In both the United Kingdom (UK) and Brazil, women undergoing mastectomy should be offered breast reconstruction. Patients may benefit from physical therapy to prevent and treat muscular deficits. However, there are uncertainties regarding which physical therapy program to recommend. OBJECTIVE: The aim was to investigate the clinical practice of physical therapists for patients undergoing breast reconstruction for breast cancer. A secondary aim was to compare physical therapy practice between UK and Brazil. METHODS: Online survey with physical therapists in both countries. We asked about physical therapists' clinical practice. RESULTS: 181 physical therapists completed the survey, the majority were from Brazil (77%). Respondents reported that only half of women having breast reconstruction were routinely referred to physical therapy postoperatively. Contact with patients varied widely between countries, the mean number of postoperative sessions was 5.7 in the UK and 15.1 in Brazil. The exercise programs were similar for different reconstruction operations. Therapists described a progressive loading structure over time: range of motion (ROM) was restricted to 90° of arm elevation in the first two postoperative weeks; by 2-4 weeks ROM was unrestricted; at 1-3 months muscle strengthening was initiated, and after three months the focus was on sports-specific activities. CONCLUSION: Only half of patients having a breast reconstruction are routinely referred to physical therapy. Patients in Brazil have more intensive follow-up, with up to three times more face-to-face contact with a physical therapist than in the UK. Current practice broadly follows programs for mastectomy care rather than being specific to reconstruction surgery.

GSTP1 and ABCB1 Polymorphisms Predicting Toxicities and Clinical Management on Carboplatin and Paclitaxel-Based Chemotherapy in Ovarian Cancer.

Variation in drug disposition genes might contribute to susceptibility to toxicities and interindividual differences in clinical management on chemotherapy for epithelial ovarian cancer (EOC). This study was designed to explore the association of GST and ABCB1 genetic variation with hematologic and neurologic toxicity, changes in chemotherapy, and disease prognosis in Brazilian women with EOC. A total of 112 women with a confirmed histological diagnosis of EOC treated with carboplatin/paclitaxel were enrolled (2014-2019). The samples were analyzed by multiplex polymerase chain reaction (PCR) for the deletion of GSTM1 and GSTT1 genes. GSTP1 (c.313A>G/rs1695) and ABCB1 (c.1236C>T/rs1128503; c.3435C>T/rs1045642; c.2677G>T>A/rs2032582) single nucleotide polymorphisms (SNPs) were detected by real-time PCR. Subjects with the GSTP1 c.313A>G had reduced risk of anemia (odds ratio (OR): 0.17, 95% confidence interval (CI): 0.04-0.69, P = 0.01, dominant model) and for thrombocytopenia (OR: 0.27, 95% CI: 0.12-0.64, P < 0.01; OR 0.18, 95% CI 0.03-0.85, P = 0.03, either dominant or recessive model), respectively. The GSTP1 c.313A>G AG genotype was associated with a lower risk of dose delay (OR: 0.35, 95% CI: 0.13-0.90, P = 0.03). The ABCB1 c.1236C>T was associated with increased risk of thrombocytopenia (OR: 0.15, 95% CI: 0.03-0.82, P = 0.03), whereas ABCB1 c.3435C>T had increased risk of grade 2 and 3 neurotoxicity (OR: 3.61, 95% CI: 1.08-121.01, P = 0.03) in recessive model (CC + CT vs. TT). This study suggests that GSTP1 c.313A>G, ABCB1 c.1236C>T, and c.3435C>T SNP detection is a potential predictor of hematological toxicity and neurotoxicity and could help predict the clinical management of women with EOC.

Long-term outcomes of concomitant cisplatin plus radiotherapy versus radiotherapy alone in patients with stage IIIB squamous cervical cancer: A randomized controlled trial.

OBJECTIVE: The present analysis determined the disease free survival (DFS) and overall survival (OS) at up to 14 years of follow-up in women who participated in our previous phase 3 randomized controlled clinical trial, in which women with stage IIIB squamous cervical cancer received either cisplatin plus RT or RT alone for treatment. The first study showed that the addition of cisplatin to RT offered a significant benefit in DFS, but not in OS. METHODS: The present analysis examined DFS and OS in 146 women from the original cohort (72 patients in the CRT arm and 74 patients in the RT-only arm) with follow-up of up to 14 years. RESULTS: Longer term follow-up showed that treatment with CRT offers a significant benefit in DFS and OS compared with treatment with RT only. Patients who received RT alone had significantly worse OS (HR, 1.88; 95% CI, 1.09-3.24) and DFS (HR, 1.82; 95% CI, 1.07-3.08) compared with patients who received CRT. The multivariate analyses also showed that the patients with baseline Karnofsky performance status (KPS) <90% showed significantly worse OS (HR, 3.11; 95% CI, 1.78-5.43), as did those with hemoglobin <10 mg/dL (HR, 4.32; 95% CI, 2.23-8.36). Patients with baseline KPS < 90% showed significantly worse DFS (HR, 2.83; 95% CI, 1.60-5.01), as did those with hemoglobin <10 mg/dL (HR, 4.16; 95% CI, 2.17-7.95). CONCLUSIONS: For stage IIIB cervical cancer, treatment with CRT offers a significant benefit in DFS and OS compared with treatment with RT only.

Preoperative Differentiation of Benign and Malignant Non-epithelial Ovarian Tumors: Clinical Features and Tumor Markers.

OBJECTIVE: To evaluate the role of clinical features and preoperative measurement of cancer antigen 125 (CA125), human epididymis protein (HE4), and carcinoembryonic antigen (CEA) serum levels in women with benign and malignant non-epithelial ovarian tumors. METHODS: One hundred and nineteen consecutive women with germ cell, sex cord-stromal, and ovarian leiomyomas were included in this study. The preoperative levels of biomarkers were measured, and then surgery and histopathological analysis were performed. Information about the treatment and disease recurrence were obtained from the medical files of patients. RESULTS: Our sample included 71 women with germ cell tumors (64 benign and 7 malignant), 46 with sex cord-stromal tumors (32 benign and 14 malignant), and 2 with ovarian leiomyomas. Among benign germ cell tumors, 63 were mature teratomas, and, among malignant, four were immature teratomas. The most common tumors in the sex cord-stromal group were fibromas (benign) and granulosa cell tumor (malignant). The biomarker serum levels were not different among benign and malignant non-epithelial ovarian tumors. Fertility-sparing surgeries were performed in 5 (71.4%) women with malignant germ cell tumor. Eleven (78.6%) patients with malignant sex cord-stromal tumors were treated with fertility-sparing surgeries. Five women (71.4%) with germ cell tumors and only 1 (7.1%) with sex cord-stromal tumor were treated with chemotherapy. One woman with germ cell tumor recurred and died of the disease and one woman with sex cord-stromal tumor recurred. CONCLUSION: Non-epithelial ovarian tumors were benign in the majority of cases, and the malignant cases were diagnosed at initial stages with good prognosis. The measurements of CA125, HE4, and CEA serum levels were not useful in the preoperative diagnosis of these tumors.

OBJETIVO: Avaliar o papel das características clínicas e a medida pré-operatória dos níveis séricos de CA125, HE4, e CEA em mulheres com tumores de ovário não epiteliais benignos e malignos. MéTODOS: Cento e dezenove mulheres consecutivas com tumores ovarianos de células germinativas, do cordão sexual-estroma, e miomas ovarianos foram incluídas neste estudo. Os níveis pré-operatórios dos biomarcadores foram medidos, a cirurgia e a análise histopatológica foram realizadas. Informações sobre tratamento e recorrência da doença foram obtidas dos prontuários médicos das pacientes. RESULTADOS: Nossa amostra incluiu 71 mulheres com tumores de células germinativas (64 benignos e 7 malignos), 46 com tumores do cordão sexual-estroma (32 benignos e 14 malignos), e 2 com leiomiomas ovarianos. Entre os tumores benignos de células germinativas, 63 eram teratomas maduros, e, entre os malignos, quatro eram teratomas imaturos. Os tumores mais comuns do grupo do cordão sexual-estroma foram fibromas (benignos) e tumores de células da granulosa (malignos). Os níveis séricos dos biomarcadores não diferiram entre os tumores de ovário não epiteliais benignos e malignos. A cirurgia preservadora de fertilidade foi realizada em 5 (71,4%) mulheres com tumores malignos de células germinativas. Onze (78,6%) mulheres com tumores do cordão sexual-estroma malignos foram tratadas com cirurgia preservadora de fertilidade. Cinco (71,4%) mulheres com células germinativas e apenas 1 (7,1%) com tumor do cordão sexual-estroma foram tratadas com quimioterapia. Uma mulher com tumor de células germinativas recidivou e morreu da doença. Uma mulher com tumor do cordão sexual-estroma recidivou. CONCLUSãO: Os tumores de ovário não epiteliais foram benignos na maioria dos casos e os malignos foram diagnosticados em estágios iniciais, com bom prognóstico. A medida dos níveis séricos de CA125, HE4, e CEA não foram úteis no diagnóstico pré-operatório desses tumores.

Breast Cancer in Men: Clinical and Pathological Analysis of 817 Cases.

The objective of the current study was to describe breast cancer cases in men according to age, stage, and histology, calculating risks compared to women. It is a retrospective cross-sectional study of all breast cancer cases of the Hospital Cancer Registry of São Paulo state, Brazil, 2000-2015. Variables were age, sex, stage, and histology. Absolute numbers and proportions, Mann-Whitney test and prevalence ratio with 95% confidence interval were used. The study included 93,737 cases, of which 817 were males. The mean age at diagnosis was 60.3 years in men and 56.2 years in women (p < .001). Stage II was the most common in both sexes (33.9% in men and 36.5% in women). Men had a higher frequency of stage III than women (PR 1.18, 95% CI 1.01-1.37). Stage 0 was significantly more common in women (PR 0.69, 95% CI 0.51-0.94). Ductal carcinoma and its variants were the most common histological types in both sexes (88.7% in men and 89.0% in women). Men had a higher frequency of rarer histological types such as papillary (PR 2.17, 95% CI 1.36-3.44) and sarcomas (PR 4.10, 95% CI 1.86-9.01). In conclusion, in men, breast cancer diagnosis occurred in more advanced ages and stages. Invasive ductal carcinoma was the primary histological type observed, although rarer types were more frequent.

Diagnostic Value of the Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio, and Thrombocytosis in the Preoperative Investigation of Ovarian Masses.

OBJECTIVE: To evaluate the diagnostic accuracy of cancer antigen 125 (CA125) and complete blood count (CBC) parameters, such as the neutrophil to lymphocyte ratio (NLR), the platelet to lymphocyte ratio (PLR), and thrombocytosis in patients with ovarian masses. METHODS: The present is a retrospective study conducted at a single tertiary hospital from January 2010 to November 2016. We included consecutive women referred due to suspicious adnexal masses. The CBC and CA125 were measured in the serum of 528 women with ovarian masses before surgery or biopsy. We evaluated the diagnostic performance of the NLR, PLR, platelets (PLTs), CA125, and the associations between them. We tested the clinical utility of the CBC parameters and CA125 in the discrimination of ovarian masses through decision curve analysis (DCA). RESULTS: The best balance between sensitivity and specificity was obtained by the associations of CA125 or PLTs ≥ 350/nL, with 70.14% and 71.66%, CA125 or PLTs ≥ 400/nL, with 67.30% and 81.79%, CA125 or PLR, with 76.3% and 64.87%, and CA125 or NLR, with 71.09% and 73.89% respectively. In the DCA, no isolated CBC parameter presented a higher clinical utility than CA125 alone. CONCLUSION: We showed that no CBC parameter was superior to CA125 in the prediction of the malignancy of ovarian tumors in the preoperative scenario.

OBJETIVO: Avaliar a acurácia diagnóstica do antígeno de câncer 125 (cancer antigen 125, CA125, em inglês) e dos parâmetros do hemograma como as razões neutrófilo/linfócito (RNL), plaqueta/linfócito (RPL), e trombocitose em pacientes com massas ovarianas. MéTODOS: Este é um estudo retrospectivo realizado em um hospital terciário no período de janeiro de 2010 a novembro de 2016. Foram incluídas de forma consecutiva mulheres encaminhadas por massas anexiais suspeitas. Foram dosados hemogramas e CA125 no soro de 528 mulheres com massas ovarianas antes da cirurgia ou biópsia. Foram avaliados os desempenhos diagnósticos da RNL, da RPL, das plaquetas (PLQs) e do CA125, considerando-os isoladamente e associados entre si. Testamos a utilidade clínica dos parâmetros do hemograma e do CA125 na discriminação das massas ovarianas por análise de curva de decisão (ACD). RESULTADOS: Os melhores equilíbrios entre sensibilidade e especificidade foram obtidos por meio das associações do CA125 ou PLQs ≥ 350/nL, com 70,14% e 71,66%, CA125 ou PLQs ≥ 400/nL, com 67,30% e 81,79%, CA125 ou RPL, com 76,3% e 64,87%, e CA125 ou RNL, com 71,09% e 73,89%, respectivamente. CONCLUSãO: Na ACD, nenhum parâmetro do hemograma isolado se mostrou superior ao CA125 na predição de malignidade de tumores ovarianos no pré-operatório.

Influence of Gender and Undergraduate Course on the Knowledge about HPV and HPV Vaccine, and Vaccination Rate among Students of a Public University.

OBJECTIVE: To evaluate the knowledge related to human papillomavirus (HPV) infection and the rate of HPV vaccination among undergraduate freshmen and senior students of medicine, pharmacy, speech therapy, nursing and physical education in a Brazilian university. METHODS: A questionnaire concerning sociodemographic aspects, sexual background, and knowledge about HPV and its vaccine was filled out by 492 students. Three months later, a second questionnaire, concerning the new rate of vaccination, was applied to 233 students. RESULTS: Among the 290 women who answered the first questionnaire, 47% of the freshmen and 13% of the seniors stated they were not sexually active, as well as 11% of the 202 freshman and senior male students. Although the knowledge about HPV was higher among women, they reported a lower use of condoms. More than 83% of the women and 66% of the men knew that HPV can cause cervical cancer, but less than 30% of the students knew that HPV can cause vulvar, anal, penile and oropharyngeal cancer. Less than half of the students knew that HPV causes genital, anal and oropharyngeal warts. Comparing the students, the seniors had more knowledge of the fact that HPV is sexually transmitted, and that HPV infection can be asymptomatic. The rate of vaccination was of 26% for women, and of 8% for men, and it increased to 52% and 27% respectively among the 233 students evaluated in the second questionnaire. CONCLUSION: As almost half of freshman women declared being sexually inactive, the investment in public health information programs and easier access to the HPV vaccine seem to be a useful strategy for undergraduate students.

OBJETIVO: Avaliar o conhecimento sobre a infecção pelo vírus do papiloma humano (human papillomavirus, HPV, em inglês) e a taxa de vacinação entre estudantes calouros e veteranos do quarto ano dos cursos de medicina, farmácia, fonoaudiologia, enfermagem e educação física de uma universidade brasileira. MéTODOS: Um primeiro questionário sobre aspectos sociodemográficos, antecedentes sexuais e conhecimento sobre o HPV e sua vacina foi aplicado a 492 estudantes. Três meses depois, foi aplicado um novo questionário, a 233 estudantes, que avaliava a nova taxa de vacinação entre eles. RESULTADOS: Entre as 290 mulheres que responderam ao questionário, 47% das calouras e 13% das veteranas negaram início de atividade sexual. Entre os 202 calouros e veteranos do sexo masculino avaliados, essa taxa foi de 11%. Apesar de o conhecimento sobre o HPV ter sido maior entre as mulheres, elas declararam menor uso de preservativo. Mais de 83% das mulheres e 66% dos homens sabiam que o HPV causa câncer de colo de útero, mas menos de 30% de todos os alunos sabiam que o HPV pode causar câncer de vulva, ânus, pênis e orofaringe, e menos de 50% sabiam que o HPV pode causar verrugas genitais, anais e orofaríngeas. Comparando calouros e veteranos, houve um aumento no conhecimento de que o HPV é sexualmente transmitido, e de que sua infecção pode ser assintomática, entre os veteranos em comparação com os calouros. Pela taxa de vacinação analisada no segundo questionário, identificou-se que, antes do início da pesquisa, 26% das mulheres e 8% dos homens haviam sido vacinados, e, no momento da aplicação do segundo questionário, essas taxas subiram para 52% e 27%, respectivamente, entre os 233 alunos avaliados. CONCLUSãO: Quase metade das calouras relataram não ser sexualmente ativas, e a maioria delas ainda não era vacinada contra o HPV. O ingresso no Ensino Superior parece um momento oportuno para a realização de campanhas governamentais de conscientização e vacinação contra o HPV.