Patients' subjective assessment as a decisive predictor of malignancy in pelvic masses: results of a multicentric, prospective pelvic mass study.

OBJECTIVE: The prognosis for ovarian cancer patients remains poor. A key to maximizing survival rates is early detection and treatment. This requires an accurate prediction of malignancy. Our study seeks to improve the accuracy of prediction by focusing on early subjective assessment of malignancy. We therefore investigated the assessment of patients themselves in comparison to the assessment of physicians. METHODS: One thousand three hundred and thirty patients participated in a prospective and multicenter study in six hospitals in Berlin. Using univariate analysis and multivariate logistic regression models, we measured the accuracy of the early subjective assessment in comparison to the final histological outcome. Moreover, we investigated factors related to the assessment of patients and physicians. RESULTS: The patients' assessment of malignancy is remarkably accurate. With a positive predictive value of 58%, the majority of patients correctly assessed a pelvic mass as malignant. With more information available, physicians achieved only a slightly more accurate prediction of 63%. CONCLUSIONS: For the first time, our study considered subjective factors in the diagnostic process of pelvic masses. This paper demonstrates that the patients' personal assessment should be taken seriously as it can provide a significant contribution to earlier diagnosis and thus improved therapy and overall prognosis.

Polymorphism of IL-1alpha, IL-1beta and IL-10 in patients with advanced ovarian cancer: results of a prospective study with 147 patients.

OBJECTIVE: Interleukin 1 (IL-1) and IL-10 are critically involved in tumorigenesis. We investigated polymorphisms of IL-1 and IL-10 genes in patients with ovarian cancer (OC). METHODS: In a prospective, case-control study 147 patients with OC and 129 patients without history of any malignancy (CG) were genotyped for IL-1 gene (IL-1alpha -889 T/C and IL-1beta -511 C/T) and IL-10 gene (IL-10 -1082 G/A, -819 C/T and -592 C/A) using pyrosequencing. RESULTS: IL-10 polymorphisms in -819 and -592 positions correlated with the postoperative residual tumor mass (p=0.036 and p=0.035, respectively). The chance of achieving optimal tumor debulking was 1.49 times greater for patients with the C/C genotype at -819 and -512 positions than for patients with other genotypes. There were no significant associations between allelic frequencies for IL-1alpha and IL-1beta in OC. IL-10 -819 CC and -592 CC genotypes were associated in univariate analysis with a better disease-free and overall survival. CONCLUSIONS: IL-10 promoter polymorphism may be related with the ability to achieve optimal tumor debulking. Polymorphism in IL-10 gene seems to influence the overall and disease-free survival rate. Subsequent multi-institutional studies with high number of patients are warranted to confirm these results.