Expression III: patients' expectations and preferences regarding physician-patient relationship and clinical management-results of the international NOGGO/ENGOT-ov4-GCIG study in 1830 ovarian cancer patients from European countries.

Backround: The primary aim of this study was to investigate information needs and treatment preferences of patients with ovarian cancer, focusing especially on physician-patient relationship and treatment. Patients and methods: A questionnaire was developed based on the experiences of the national German survey 'Expression II', and was provided to patients with ovarian cancer either at initial diagnosis or with recurrent disease via Internet (online-version) or as print-out-version. Results: From December 2009 to October 2012, a total of 1830 patients with ovarian cancer from eight European countries (Austria, Belgium, France, Germany, Italy, Poland, Romania, Spain) participated, 902 (49.3%) after initial diagnosis and 731 (39.9%) with recurrent ovarian cancer. The median age was 58 years (range 17-89). Nearly all patients (96.2%) had experienced upfront surgery followed by first-line chemotherapy (91.8%). The majority of patients were satisfied with the completeness and comprehensibility of the explanation about the diagnosis and treatment options. The three most important aspects, identified by patients to improve the treatment for ovarian cancer included: 'the therapy should not induce alopecia' (42%), 'there must be more done to counter fatigue' (34.5%) and 'the therapy should be more effective' (29.7%). Out of 659 (36%) patients, who were offered participation in a clinical trial, 476 (26%) were included. Conclusion: This study underlines the high need of patients with ovarian cancer for all details concerning treatment options irrespective of their cultural background, the stage of disease and the patient's age. Increased information requirements regarding potential side effects and treatment alternatives were recorded. Besides the need for more effective therapy, alopecia and fatigue are the most important side effects of concern to patients.

TP53 status determines clinical significance of ERBB2 expression in ovarian cancer.

ERBB2 expression has been found in 19 to 44% of ovarian carcinomas; however, its predictive value has not been demonstrated, and trastuzumab has not found clinical application in ovarian cancer patients. We evaluated clinical significance of ERBB2 expression in relation to TP53 accumulation in ovarian carcinoma patients treated with platinum-based regimens. Immunohistochemical analysis with CB11 and a novel NCL-CBE356 antibody (against the internal and external domains of ERBB2, respectively) was performed on 233 tumours (FIGO stage IIB-IV); the US Food and Drug Administration-approved grading system with 0 to 3+ scale was used for evaluation, and the results were analysed by the Cox and logistic regression models. In all, 42% of the tumours expressed (category 1+, 2+ or 3+) either CB11 or CBE356 or both (CB11/CBE356 parameter). Associations between ERBB2 expression and clinical factors were observed only if tumours with staining category 1+ were grouped together with tumours showing staining categories 2+ and 3+. CB11/CBE356 parameter had a better predictive value than CB11 alone. CB11/CBE356 expression was negatively associated with platinum sensitivity (PS) in the TP53(-) group (P=0.022) and with disease-free survival (DFS) in the TP53(+) group (P=0.009). Our results may suggest that trastuzumab should be given postoperatively to patients with TP53(-)/ERBB2(+) ovarian carcinomas to enhance PS, and after completion of chemotherapy to patients with complete remission and TP53(+)/ERBB2(+) carcinomas to extend DFS time (in total to 30.4% of all patients analysed). Thus, novel criteria for ovarian cancer patient inclusion for clinical trials with trastuzumab should be considered and tested.

P21WAF1, P27KIP1, TP53 and C-MYC analysis in 204 ovarian carcinomas treated with platinum-based regimens.

BACKGROUND: The prognostic and predictive value of cell cycle regulatory proteins in ovarian cancer has not been established. We evaluated the clinical and biological significance of P21(WAF1), P27(KIP1), C-MYC, TP53 and Ki67 expressions in ovarian cancer patients. MATERIALS AND METHODS: Immunohistochemical analysis was performed on 204 ovarian carcinomas of International Federation of Gynecology and Obstetrics (FIGO) stage IIB to IV treated with platinum-based chemotherapy. Multivariate analysis with Cox and logistic regression models was performed in the whole group, and in the TP53-negative and TP53-positive subgroups. RESULTS: High P21(WAF1) labeling index (LI) was an independent positive predictor of platinum-sensitive response (P = 0.02). Overall survival was positively influenced by P21(WAF1) LI (P = 0.02) or by P21(WAF1) plus P27(KIP1) LI (P = 0.004) in the TP53-negative group only. Ki67 LI showed borderline association with disease-free survival (P = 0.05). Growth fraction was negatively associated with P21(WAF1) and P27(KIP1) indices in the TP53-negative group (P = 0.023 and 0.008, respectively), and these associations were borderline or lost in the TP53-positive group. Endometrioid and clear cell carcinomas differed from other carcinomas by having a low incidence of TP53 accumulation, a high incidence of C-MYC overexpression (70%) and a low median Ki67 LI (all with P <0.001). CONCLUSIONS: We have shown an independent predictive value of P21(WAF1) LI in ovarian carcinoma patients. The prognostic value of P21(WAF1) and P21(WAF1) plus P27(KIP1) LI was determined by TP53 status. A high frequency of C-MYC overexpression in endometrioid and clear cell carcinomas may suggest its role in the development of these tumor types.

Evaluation of clinical significance of TP53, BCL-2, BAX and MEK1 expression in 229 ovarian carcinomas treated with platinum-based regimen.

In cell line studies, BCL-2, BAX, as well as novel MEK1 protein levels have strong influence on ovarian cancer response to cisplatin-based chemotherapy. However, such associations have not been demonstrated clinically. We evaluated prognostic/predictive significance of these proteins with regard to TP53 status. Immunohistochemical analysis was performed on 229 ovarian carcinomas FIGO stage IIB-IV treated with platinum-based chemotherapy; the results were analysed by the Cox and logistic regression models. Clinical parameters (residual tumour size, patient age, FIGO stage) were the only indicators of overall survival (OS) and the strongest predictors of complete remission (CR). On the other hand, BAX expression was the strongest (P=0.005) or the only (in FIGO IIIC, P=0.02) prognostic indicator of disease-free survival (DFS) in the TP53(+) group. TP53(+) and TP53(-) ovarian carcinomas differed in clinical and molecular prognostic and predictive factors. Another novel finding is that CR was negatively influenced by high BAX expression in all patients group (P=0.047) and by BCL2 expression in the TP53(-) group (P=0.05). High MEK1 expression was associated with endometrioid and clear cell carcinomas (P=0.049); its loss was found with advancing FIGO stage (P=0.002). Our results suggest that binomial TP53 status divides ovarian carcinomas into two biologically distinct groups. BAX expression is an important factor of DFS in the TP53(+) group. BCL-2 and BAX, but not MEK1 expressions have predictive value in ovarian cancer patients treated with platinum-based chemotherapy.

[E-cadherin in the serum and the peritoneal fluid of women with endometriosis]. / E-kadheryna w surowicy i plynie otrzewnowym kobiet z endometrioza.

Endometriosis, a disease of unclear etiopathogenesis, is a quite common problem in gynecology. It is thought that the retrograde flow of the menstrual debris to the peritoneal cavity plays an important role in the origin of endometriosis but the mechanism of endometrial cells implantation remains unknown. Recently many centers have reported the importance of adhesion molecules in this process. We studied the concentrations of E-cadherin in the serum and the peritoneal fluid of women with endometriosis. Our results show a significant decrease of E-cadherin concentrations in sera and peritoneal fluids in women with endometriosis. We suggest that screening the level of E-caherin may be useful in the monitoring the therapy of endometriosis.

[VEGF, TNF-alpha and IL-6 in the peritoneal fluid of women with unexplained infertility]. / VEGF, TNF-alpha i IL-6 w plynie otrzewnowym kobiet z nieplodnoscia niejasnego pochodzenia.

Unexplained infertility is an important problem in diagnosis and therapy in everyday gynecologist's practice. Looking for possible reasons of the unexplained infertility we studied the concentrations of selected cytokines (VEGF, TNF-alpha and IL-6) in the peritoneal fluid of women suffering from the unexplained infertility. We compared the results in the studied group with the control group and with the patients with endometriosis. Immunological disorders of the peritoneal fluid in endometriosis are thought to take part in its pathomechanism. Our results suggest that the levels of one of the main factors of endothelium proliferation (VEGF) in the peritoneal fluid from women with unexplained infertility and women with endometriosis are comparable. Concentration IL-6 and TNF-alpha in the peritoneal fluid in case of unexplained infertility and control group was lower than in the endometriosis patients.

[The analysis of sodium, potassium and calcium concentration in myomas, myometrium and peripheral blood]. / Analiza zawartosci sodu, potasu i wapnia w miesniakach i miesniu trzonu macicy oraz w pelnej krwi zylnej.

We have examined the concentration of sodium and potassium in myomas, myometrium and peripheral blood of 55 women and in 69 women calcium was examined. The levels of these elements were correlated to the phase of the menstrual cycle. The sodium concentration is similar in the examined tissues in both phases. The potassium concentration is significantly higher in myomas and myometrium in comparison with the peripheral blood in both phases of the menstrual cycle. The calcium concentration is significantly lower in myomas and myometrium during the proliferation and significantly lower in the myomas comparing to the myometrium and peripheral blood in the secretion. Concerning the differences between two phases of the cycle we observed that the level of the potassium is significantly lower in the myomas in the proliferative phase but the the level of the sodium is higher in the secretory phase.

[Hematometra in 76-year-old woman followed by DIC and the result of the carcinoma of cervix--a case report]. / Haematometra u 76 letniej kobiety na podlozu raka szyjki macicy jako przyczyna DIC--prezentacja przypadku.

This is a case report of a 76-year-old women with hematometra due to cervical cancer followed by DIC. To the authors' knowledge this is the first report of such case.

[Current views on the etiopathogenesis of endometriosis]. / Wspólczesne poglady na etiopatogeneze endometriozy.

In the article contemporary knowledge concerning the ethiopathogenesis of endometriosis has been reviewed. The authors especially concentrate on immunological disorders in this disease, emphasizing the complexity of the development of endometriosis and multiple factors influencing its ethiopathogenesis.

[Mycoplasma hominis and Ureaplasma urealyticum of cervical canal and in the pouch of Douglas in infertile women: a preliminary report]. / Mycoplasma hominis i Ureaplasma urealyticum w kanale szyjki macicy i w zatoce Douglasa u nieplodnych kobiet-doniesienie wstepne.

Detection of Mycoplasma hominis and Ureaplasma urealyticum in the samples obtained from the cervical canal of the uterus and from the pouch of Douglas in 71 women in whom underwent diagnostic and operative laparoscopy is presented. Ureaplasma urealyticum in 33 cases diagnosed for infertility was present in 6 (18.2%) patients. In cervical canal and the pouch of Douglas in 5 and 2 women respectively. In 1 (3.0%) woman Ureaplasma urealyticum was present in both places. In the women from the control group U. urealyticum was detected in 6 (15.5%) cases only in cervical canal. Mycoplasma hominis was present only in cervical canal more frequently in the control group 4 (cases) than among infertile women 1 (3.0%).

[The concentration of exfoliative adhesion molecules (ICAM-1 and E-Selectin) in serum and peritoneal fluid of women with endometriosis]. / Stezenie zluszczonych molekul adhezyjnych (ICAM-1 i E-Selektyny) w surowicy i plynie otrzewnowym u kobiet z endometrioza. Doniesienie wstepne.

It is commonly known that retrograde transport of exfoliative fragments of endometrium to peritoneal cavity during the menstruation is an important factor of the ethiopathogenesis of endometriosis. The mechanism of inplantation of endometrial cells to peritoneal sites still remains unclear. Adhesions molecules are suggested to take part in this process. In our study we tried to establish the concentration of the adhesion molecules (ICAM-1 and E-Selectin) in the sera and peritoneal fluids of women with endometriosis in comparison to the control group. These concentrations were significantly higher in the sera of all patients. We did not find any significant differences between two examined groups although further studies should be carried out.

[Cytotoxic activity of NK cells in the presence of the peritoneal fluid fro women with unexplained infertility and with endometriosis related infertility]. / Aktywnosc cytotoksyczna komórek NK w obecnosci plynu otrzewnowego pobranego od kobiet z nieplodnoscia niejasnego pochodzenia oraz z nieplodnoscia zwiazana z endometrioza.

We examined peritoneal fluid obtained during laparoscopy in the aspect of its influence on cytotoxic activity of NK cells. We showed significant suppression of this activity in women with unexplained infertility. The suppression of NK activity was also present in women fertile and infertile both, with severe endometriosis. These results may indicate the immunological disorders in unexplained infertility and in endometriosis-related infertility.