Exploration of Extracellular Vesicle Long Non-Coding RNAs in Serum of Patients with Cervical Cancer.

INTRODUCTION: Cervical cancer (CC) is the fourth most common cancer type and a leading cause of cancer-related deaths in women worldwide. Its underlying molecular mechanisms are unclear. Cancer cell-derived extracellular vesicles (EVs) are involved in cancer development and progression by delivering regulatory factors, including microRNAs and long non-coding RNAs (lncRNAs). METHODS: Here, we identified the EV lncRNA expression profiles associated with different developmental stages of CC using next-generation sequencing. EVs from the serum of patients with stages I-III CC and healthy donors were characterized using EV marker immunoblotting and transmission electron microscopy. RESULTS: The EV concentration increases with progression of the disease. Most particles had a 100-250-nm diameter, and their sizes were similar in all groups. We identified many lncRNAs that were uniquely and differentially expressed (DE) in patients with different stages of CC. The pathway analysis results indicated that the upregulated DE EV lncRNAs abundant in stages I and II were associated with cell proliferation and inflammation and cancer progression pathways, respectively. LINC00941, LINC01910, LINC02454, and DSG2-AS1 were highly expressed, suggesting poor overall survival of CC patients. Interestingly, DSG2-AS1 was associated with the human papillomavirus infection pathway through AKT3, DLG1, and COL6A2 genes. CONCLUSION: This is the first study that reports the levels of EVs and their lncRNA contents change during cancer development, demonstrating the existence of a unique vesicle-mediated cell-to-cell communication network underlying cancer progression.

Microsatellite instability and oncological outcomes in Thai patients with endometrial cancer.

Here, we determined the frequency of microsatellite instability (MSI) and the impact of MSI-high (MSI-H) on clinical outcomes of Thai patients with endometrial cancer (EC). Tissue samples of 110 Thai patients with EC, who had undergone surgical staging, were tested for mismatch repair (MMR) gene deficiency, and the patients were grouped into MSI-H and MSI-stable (MSI-S) groups; 24.5% had MSI-H. Unlike MSI-S group patients, MSI-H group patients had synchronous and metachronous cancer. They showed better 3-year disease-free survival (DFS) than those in the MSI-S group (p=.182; 92.3% vs. 82.6%). The 3-year overall survival was 96.2% in MSI-H and 86.4% in MSI-S groups (p=.163). Multivariate analyses showed lower uterine involvement (p=.004), myometrial invasion ≥50% (p=.032), lymphovascular space invasion (p<.001) and MSI-S (p=.006) as prognostic factors for DFS. Our study showed that the prevalence of MMR gene deficiency in Thai patients with EC is common and associated with better outcomes.Impact StatementWhat is already known on this subject? Microsatellite instability (MSI) occurs in approximately 20-40% of endometrial cancer (EC) cases. MSI analysis in EC can identify patients at higher risk of hereditary nonpolyposis colorectal cancer and those having prognostic factors. Additionally, it is predictive of immune checkpoint inhibitor treatment. However, current evidence shows a correlation between clinicopathological characteristics and EC prognosis. Studies on EC and MSI status effect on survival outcome have yielded inconsistent results regarding the pathological significance of MSI in such malignancies.What do the results of this study add? The prevalence of mismatch repair (MMR) gene deficiency in Thai patients with EC is common (24.5%) and associated with better outcomes.What are the implications of these findings for clinical practice and/or further research? This study highlights the prevalence and impact of MSI on oncological outcomes in patients with EC in a low-incidence country. Future studies should focus on the detection of germline mutation to understand the accurate prevalence of Lynch syndrome in Thai patients with EC.

The Effect of Metformin on Oncological Outcomes in Patients With Cervical Cancer With Type 2 Diabetes Mellitus.

OBJECTIVE: The aim of this study was to evaluate any association between metformin use and oncological outcomes of cervical cancer in patients with type 2 diabetes mellitus (DM). METHODS: We retrospectively identified 248 patients with cervical cancer with type 2 DM who received primary treatment between 2004 and 2015. The clinicopathological characteristics and oncological outcomes were collected and analyzed. The patients were then separated into metformin use (n = 118) or non-metformin use (n = 130) groups. RESULTS: With a median follow-up of 2.85 years, patients who were given metformin had lower recurrence rate than patients who did not receive metformin (P = 0.011). The 5-year disease-free survival (DFS) and overall survival (OS) were 81.55% and 93.27% in the metformin use group, and 65.06% and 86.82% for the non-metformin use group, respectively. In multivariate analysis, non-metformin use (hazard ratio [HR], 1.89; P = 0.037), baseline hypertension (HR, 2.52; P = 0.005), and stage (HR for stage II vs I, 3.48; HR for stage III vs I, 6.45; P = 0.01) were independent adverse prognostic factors for DFS, whereas the statistically significant independent prognostic factors for OS were age (HR for age >65 vs ≤50, 3.86; P = 0.044) and stage (HR for stage III-IVA vs I-II, 3.45; P = 0.007). CONCLUSIONS: Our findings demonstrate that metformin use is associated with improved DFS, but not in OS in patients with cervical cancer with type 2 DM. Further large-scale and long-term follow-up studies are warranted to confirm the antitumor effects of metformin.

The prognostic impact of histological type on clinical outcomes of early-stage cervical cancer patients whom have been treated with radical surgery.

The aim of this study was to determine the prognostic impact of histological type among squamous cell carcinoma (SCC), adenocarcinoma (AC) and adenosquamous carcinoma (ASC) on the treatment outcome of early-stage cervical cancer patients after radical hysterectomy. The cohort comprised of 626 patients, diagnosed with stages IA2-IB1 cervical cancer between 1987 and 2013. Four hundred and one patients had SCC, 190 had AC and 35 had ASC. The 5-year disease-free survival (DFS) rates for AC, SCC and ASC were 89.3% (95%CI 83.2-93.2), 88.7% (95%CI 84.8-91.7) and 82.1% (95%CI 61.9-92.2), respectively (p = .594). In multivariate analyses, only older age and deep stromal invasion were statistically significantly associated with DFS, whereas histologic cell type was not (p = .524). Subgroup analysis showed that in the intermediate-high-risk groups, the SCC group had a significantly longer DFS, compared with the AC group or the ASC group (p = .001) while there was no DFS difference in the low-risk group. We believe that histologic cell type had no impact in low-risk early-stage cervical cancer patients. However, in the intermediate-high-risk groups, SCC is a more favourable factor for survival than AC/ASC.

Prognostic value of ABO blood group in patients with early stage cervical cancer treated with radical hysterectomy with pelvic node dissection.

This study aimed to evaluate the prognostic value of ABO blood groups in early-stage cervical cancer patients. The cohort included 413 patients diagnosed with stages IA2-IB1 cervical cancer who received a radical hysterectomy between 2002 and 2014. The 5-year recurrence-free survival (RFS) and overall survival (OS) were 93.13 and 96.81 % for blood group O, 87.68 and 88.22 % for blood group A, 81.66 and 89.40 % for blood group B, and 83.12 and 94.12 % for blood group AB groups, respectively. Patients were stratified for analysis as either blood group O or non-O. The 5-year RFS and OS were 93.13 and 96.81 % for blood group O and 83.66 and 89.76 % for blood group non-O, respectively. In multivariate analysis, age (P = 0.025), histology (P = 0.020), and deep stromal invasion (P = 0.006) were independent adverse prognostic factors for RFS, while the statistically significant independent prognostic factors for OS were age (P = 0.007) and parametrial involvement (P < 0.001). The Cox model did not show any significant effects of non-O blood group on survival outcome. However, a time-varying-effect Cox model revealed that the non-O blood group was associated with a worse RFS (hazard ratio (HR) 2.69, 95 % confidence interval (95%CI) 1.12-6.46, P = 0.017) and OS (HR 3.13, 95%CI 0.88-11.16, P = 0.053) during the first 5 years. These findings suggest that early-stage cervical cancer patients with a non-O blood group have poorer RFS than the O blood group, which is evidence during the first 5 years.

Subsequent gestational diabetes mellitus prediction in advanced maternal age using amniotic fluid glucose concentration during second trimester genetic amniocentesis.

This prospective study aimed to present the reference range of amniotic fluid glucose (AFglu) among second trimester pregnant women in southern Thailand, to evaluate the possibility of predicting subsequent gestational diabetes mellitus (GDM) using AFglu, and to estimate AFglu cut-off levels for identifying pregnancies at high or low risk for subsequent GDM in singleton pregnancies undergoing genetic amniocentesis due to advanced maternal age. A total of 438 eligible pregnant women were analysed, among whom 58 were subsequently diagnosed as having GDM. The reference range that included the central 95% of AFglu values at 16, 17 and 18 weeks of gestation in women not subsequently developing GDM was determined from a linear regression model. Logistic regression was used to identify predictors of subsequent GDM. Odds ratio of subsequent diagnosed GDM participant increased by 7% for each 1 mg/dl increase in AFglu. Risk of subsequent GDM was also increased in women aged over 36 years and in 17-18 weeks compared to 16 weeks of gestation. Depending on gestational and maternal age, AFglu levels above 51 to 75 mg/dl were at elevated risk of subsequent GDM (likelihood ratio 2.38). We conclude that AFglu tended to decrease with increasing of gestational age. Gestational age and maternal age accompanied with elevated AFglu are predictive factors for subsequent GDM.

Diagnostic Performance and Agreement of Preoperative, Intraoperative Evaluations, and Final Pathology for Lymphadenectomy and Lymph Node Involvement in Endometrial Cancer

Objective: To determine the accuracy of clinical parameters examined by preoperative and intraoperative evaluations compared with final histological results in patients with endometrial cancer, and to evaluate the application of preoperative investigations, intraoperative evaluations, and final histological results in predicting lymph node involvement Material and Method: The medical records of the patients diagnosed with endometrial cancer who had surgical staging between January 1, 2006 and December 31, 2012 at Songklanagarind Hospital were retrospectively reviewed. The agreement of clinical parameters identified through preoperative investigations and intraoperative evaluations with the final histology findings were calculated using kappa statistics. The diagnostic performance of preoperative investigations, intraoperative evaluations, and final histological results to predict lymph node involvement were calculated in terms of sensitivity, specificity, positive predictive value, and negative predictive value. Results: Preoperative investigations showed a slight to fair agreement whereas intraoperative evaluations had a fair to moderate agreement in detecting clinical parameters compared with the final histological results. Endocervical curettage and endometrial biopsy exhibited the highest sensitivity, pelvic ultrasonography the highest specificity, and intraoperative evaluations had a high-level sensitivity and specificity Conclusion: Preoperative investigations have role as an adjunctive evaluation, whereas intraoperative gross assessment remains the most accurate and useful method of detecting patients for lymphadenectomy.

Comparison of the effectiveness of different counseling methods before second trimester genetic amniocentesis in Thailand.

OBJECTIVE: The objective of this study is to compare the effectiveness of counseling methods before second trimester genetic amniocentesis. STUDY DESIGN: The design of this study is a randomized controlled study comparing the improvement in patients' knowledge satisfaction anxiety and perceived pain between computer-assisted instruction (CAI) and leaflet self-reading (LSR) and subsequent individual counseling among pregnant women scheduled for second trimester genetic amniocentesis in a developing country. RESULTS: There were 164 and 157 participants in the LSR and CAI groups, respectively. In both groups, knowledge improved significantly after LSR/CAI (p < 0.001) and increased further after individual counseling (p < 0.001). After combined counseling, knowledge was significantly higher in the LSR than in the CAI group (p = 0.032). Knowledge was associated with higher level of education and previous exposure to genetic counseling. Pain decreased more in the CAI than in the LSR group after completion of counseling (p = 0.021). Reduction in anxiety and increase in satisfaction did not differ between the groups. Counseling method did not affect the final decision of patients to accept amniocentesis. CONCLUSION: Both counseling methods improved patients' knowledge and satisfaction and reduced pain and anxiety. In combination with individual counseling, LSR was more effective than CAI in improving patients' knowledge before second trimester genetic amniocentesis.

Association between Resting Heart Rate and Oncological Outcomes in Patients with Early-Stage Cervical Cancer Who Have Undergone Radical Hysterectomy with Pelvic Lymphadenectomy.

INTRODUCTION: A few studies have explored the association of resting heart rate (RHR) with mortality and/or other oncological outcomes in patients with specific cancers such as breast, colorectal, and lung cancer. This study aimed to evaluate the association between the RHR and oncological outcomes in patients with early-stage cervical cancer (CC) who underwent radical surgical resection. METHODS: We included 622 patients with early-stage CC (stages IA2-IB1). The patients were divided into four groups based on the RHR as follows: quartile 1, ≤64; quartile 2, 65-70; quartile 3, 71-76; and quartile 4, >76 beats per min (bpm), with the lowest quartile being the reference group. We evaluated the associations of the RHR and clinicopathological features with oncological outcomes using Cox proportional-hazards regression. RESULTS: There were clear among-group differences. Further, there was a significant positive correlation of RHR with tumor size and deep stromal invasion. Multivariate analysis revealed that RHR was an independent prognostic factor for disease-free survival (DFS) and overall survival (OS). Compared with patients with an RHR ≤70 bpm, those with an RHR of 71-76 bpm had a 1.84- and 3.05-times higher likelihood of DFS (p = 0.016) and OS (p = 0.030), respectively, while those with RHR >76 bpm had a 2.20-times higher likelihood of DFS (p = 0.016). CONCLUSION: This is the first study to demonstrate that RHR may be an independent prognostic factor for oncological outcomes in patients with CC.

Proteomic analysis of small extracellular vesicles unique to cervical cancer.

Background: Cervical cancer (CC) is the fourth most common cancer in females worldwide. Existing biomarkers for CC, such as squamous cell carcinoma antigens, show low specificity. Hence, a novel biomarker for the diagnosis of CC is required. Through proteomic analysis, this study aimed to distinguish between the small extracellular vesicle (sEV) protein profiles of healthy controls (HC) and CC sera and to identify potential sEV proteins that can serve as biomarkers for CC diagnosis. Methods: The number and size distribution of sEVs in HC and CC sera were measured using nanoparticle tracking analysis. Differential ultracentrifugation combined with size-exclusion chromatography was used to isolate and purify sEVs. Liquid chromatography-tandem mass spectrometry was used to identify and compare the protein profiles between patients with CC and HC. Differentially expressed extracellular vesicle (EV) proteins were validated using The Cancer Genome Atlas database. Results: The EV particle concentration in patients with CC was marginally higher than that in HC. Proteomic and functional protein analyses revealed a difference in the EV protein profiles between HC and CC and identified proteins that can serve as biomarkers for CC. Conclusions: This study provides insights into the potential of sEVs as less invasive biomarkers for CC diagnosis. Validation with a well-designed cohort should be performed to determine the clinical diagnostic value of specific protein markers for CC.

Clinical Outcomes and Their Prognostic Factors among Cervical Cancer Patients with Bone Recurrence.

Background: Bone recurrence occurs in 0.75%-8% of cervical cancer patients after primary treatment. Only a few previous studies have reported on survival times associated with prognostic factors for bone recurrent cervical cancer. This study aimed to evaluate the oncological outcomes and their predictors among cervical cancer patients with bone recurrence. Methods: The medical records of cervical cancer patients with bone recurrence who received primary treatment at Songklanagarind Hospital from January 2002 to December 2017 were retrospectively reviewed. Prognostic factors were identified using a Cox regression model. Results: The study included 6,354 cervical cancer patients, of whom 98 (1.54%) had bone recurrence at a median time of 25 months after the primary treatment (range 4.9-136 months). The most frequent site of bone recurrence was the spine (81.00%); the two most common visceral coexisting recurrence sites were the lungs and the liver. The median recurrence-free interval (RFI) was 21 months. Of the patients with recurrence, 75 (76.50%) were treated with combined radiation therapy and chemotherapy. The one-year overall survival (OS) after recurrence was 22.70%. On multivariate analysis, age under 60 years at the time of recurrence diagnosis (hazard ratio [HR] = 2.48, 95% CI = 1.47-4.18, p=0.001) and an RFI less than 21 months (HR = 1.63, 95% CI = 1.04-2.55, p=0.03) were independent prognostic factors for OS after recurrence. Conclusion: Bone recurrence in cervical cancer patients is rare and is associated with poor survival. Our study found that age and RFI were significant prognostic factors for OS in cervical cancer patients with bone recurrence.

Predictive Value of the Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) Index on the Oncological Outcomes of Locally Advanced Cervical Cancer Patients.

Purpose: The oncological outcomes of locally advanced cervical cancer (LACC) patients after treatment are poor and heterogeneous. This study aimed to determine the role of the hemoglobin-albumin-lymphocyte-platelet (HALP) inflammatory index in predicting oncological outcomes in LACC patients. Patients and Methods: A total of 1588 LACC patients who received radiation therapy or concurrent chemoradiation were divided into training and test sets. Characteristics, survival, and a HALP cutoff determined by X-tile software were used to build predictive survival models on the training data. Validation of the model was performed on both sets. Results: Patients with a HALP score ≤22.2 tended to have lower age (p < 0.001), lower comorbidity rate (p = 0.016), lower body mass index (p < 0.001), higher stage (p < 0.001), larger tumor size (p < 0.001), and higher likelihood to receive radiation alone than concurrent chemoradiation (p < 0.001). Survival analysis demonstrated that HALP >22.2 was independently associated with better progression-free survival (PFS; hazard ratio; HR 0.55) and overall survival (OS; HR 0.43). Validation of survival prediction by receiver-operating characteristics demonstrated a significantly improved area under the curve of survival prediction in both sets (p < 0.001) after the addition of the HALP index to the model. Conclusion: A lower HALP score was an independent predictive factor for poorer oncological outcomes. The addition of the HALP index can improve the accuracy of predicting the oncological outcomes of LACC patients.

Impact of chemotherapy cycles on oncological outcomes in elders with locally advanced cervical cancer treated with concurrent chemoradiotherapy.

INTRODUCTION: To investigate the association between chemotherapy (CMT) cycles and oncological outcomes in elders with locally advanced cervical cancer (LACC) who treated with concurrent chemoradiotherapy (CCRT). METHODS: We retrospective studied 498 elders with LACC who treated with radiotherapy (RT) or CCRT between 2002 and 2018. Patients were divided into three groups: RT, CCRT with 1-4 and CCRT with 5-6 cycles of CMT. We compared progression-free survival (PFS) and overall survival (OS) among the three groups and explored survival prognostic factors via multivariate analysis and time-varying analysis effect. RESULTS: There were 453 eligible patients; 222, 119 and 112 patients who received RT, CCRT with 1-4 and CCRT with 5-6 cycles of CMT, respectively. Patients in the RT group had older age, poorer performance status, more treatment with conventional RT technique and earlier treatment year comparing with both CCRT groups. Patients who received 5-6 cycles of CMT were less to have underweight, comorbidities and anaemia compared with the RT group. There were patients with lower FIGO stage in 5-6 cycles than in 1-4 cycles of CMT and RT groups. The 5-year PFS and OS between RT, CCRT with 1-4 and CCRT with 5-6 cycles of the CMT group were significantly different. Performance status, comorbidity, histology, FIGO stage and total received 5-6 CMT cycles were significant prognostic factors of PFS and OS. However, the benefits of receiving 5-6 CMT cycles were evidenced only within the first 2.5 years. CONCLUSION: Elders with LACC who received 5-6 cycles of CMT concurrently with RT can improve PFS and OS, but the benefit persisted only within the first 2.5 years.

Molecular insights and clinical impacts of extracellular vesicles in cancer.

Cell-to-cell communication is a pivotal aspect of cancer biology. Recently, extracellular vesicles (EVs)have been shown to play essential roles in intercellular communications between cancer cells and the surrounding microenvironment owing to cancer development. EVs are small membrane-bound vesicles secreted by various cells containing proteins, lipids, mRNAs, and non-coding RNAs (microRNAs and long non-coding RNAs), which contribute to cancer cell development and progression. Here, we provide an overview of current research direction on EVs, especially biomolecules in EVs, and also point out the novel diagnostics, monitoring, predicting, and therapeutic aspects using EVs against cancer.

Malignant ovarian germ cell tumors: clinico-pathological presentation and survival outcomes.

OBJECTIVE: To evaluate clinico-pathological features, treatment, survival, and prognostic factors of patients with malignant ovarian germ cell tumors. DESIGN: Descriptive study. SETTING: Bangkok Metropolitan Administration Medical College and Vajira Hospital and Prince of Songkla University. POPULATION: Malignant ovarian germ cell tumor patients treated between January 1996 and December 2007. METHODS: Clinico-pathological data were collected. Patients with malignant tumors arising from benign cystic teratoma were excluded. Survival and potential prognostic factors were analyzed. MAIN OUTCOME MEASURES: Clinico-pathological features, survival. RESULTS: One hundred and thirty patients were identified. The median age was 21 years (range, 4-44 years). The most common complaint was pelvic or abdominal mass (63%). Primary surgery was performed by a gynecologic oncologist in only 39.2% of cases. More than half (64.2%) had early stage disease (stages I-II) and the majority had conservative surgery (73.1%). The most common histopathology was dysgerminoma. Of 124 patients with available follow-up data, 22 did not receive adjuvant treatment; 1 had whole abdominal radiation; and 101 had chemotherapy. Of 89 patients who were evaluable for responses, 4 patients had progressive disease while 85 had complete response. The five-year progression-free survival (PFS) and overall survival (OS) were 82.4% [95% confidence interval (CI), 75.4-89.5%)] and 92.4% (95% CI, 87.6-97.2%), respectively. Only preoperative tumor marker elevation was a significant poor prognostic factor for PFS. CONCLUSIONS: Malignant ovarian germ cell tumors have a good prognosis with conservative surgical treatment. Chemotherapy is important. Elevated preoperative serum tumor markers are a poor prognostic factor for PFS.

Correlation of p53 and Ki-67 (MIB-1) expressions with clinicopathological features and prognosis of early stage cervical squamous cell carcinomas.

AIM: To evaluate the prognostic significance of the expression of p53 and Ki-67, and their correlation with various clinicopathological factors in patients with squamous cell carcinoma of the uterine cervix treated by radical hysterectomy. METHODS: Two hundred and thirty five patients diagnosed between 1987 and 2004 were investigated for p53 and Ki-67 expression by immunohistochemistry. The relationship of these proteins and other potential prognostic factors with recurrence-free survival (RFS) was evaluated. RESULTS: The mean age of the patients was 43.9 years (range, 27-68). There were 28 cases with stage IA2 (11.9%) and 207 cases with stage IB1 (88.1%). The overall 5-year RFS was 91.1% (95% confidence interval [CI] 86.0, 94.4). p53 and Ki-67 expressions were seen in 33.6% and 81.3% of cases, respectively. p53 expression was significantly associated only with parametrial or marginal involvement (P = 0.005), while Ki-67 expression significantly correlated only with larger tumor (P = 0.011) and parametrial or marginal involvement (P = 0.024). There was significant correlation between the expression of p53 and Ki-67 (P = 0.021). In multivariate analysis, Ki-67 expression (hazard ratio for >or=3rd vs 1st tertile [>or=30% vs <20% expression] = 16.0, 95%CI 2.1-124.5; P = 0.0015) appeared to be an independent prognostic factor for RFS, while no prognostic significance of p53 expression was found. CONCLUSION: Ki-67 expression is an independent prognostic parameter for RFS in patients with early stage squamous cell carcinoma of the uterine cervix. Ki-67 expression at or above the cut-off point of 30.0% had significantly poorer RFS.

Safety and Prognostic Impacts of Ovarian Preservation during Radical Hysterectomy for Early-Stage Adenocarcinoma and Adenosquamous Cervical Cancer.

OBJECTIVE: To identify the incidence of ovarian metastasis and the impact of ovarian preservation on oncological outcomes for early-stage adenocarcinoma and adenosquamous cervical cancer. METHODS: 281 patients with stages IA2-IB1 adenocarcinoma and adenosquamous cervical cancer who underwent radical hysterectomy with pelvic lymphadenectomy (RHND) were included in the study. The incidence of ovarian metastasis was evaluated from 173 patients who underwent oophorectomy during RHND. Subgroup analysis was performed for patients less than 50 years (196 of 281 patients) who were classified into two groups, ovarian preservation and nonovarian preservation groups. 5-year recurrence-free survival (5-yr RFS) and 5-year overall survival (5-yr OS) were evaluated and compared between these groups. RESULTS: There was no evidence of ovarian metastasis, synchronous ovarian cancer, or ovarian recurrence during follow-up. In patients less than 50 years of age, there were no statistically significant differences in the 5-yr RFS (P = 0.363), or 5-yr OS (P = 0.974) between the ovarian preservation and nonovarian preservation groups. In Kaplan-Meier analysis, the ovarian preservation group seemed to have a slightly better OS in long-term follow-up (after 15 years); however, the difference was not statistically significant. CONCLUSIONS: Ovarian preservation was safe in adenocarcinoma and adenosquamous cervical cancer stages IA2-B1. However, the impact of ovarian preservation on oncological outcomes needs to be further investigated.

Cost-utility analysis of adjuvant chemotherapy after concurrent chemoradiation in patients with locally advanced cervical cancer.

INTRODUCTION: This study aimed to compare the cost utility of concurrent chemoradiation (CCRT) to CCRT followed by adjuvant chemotherapy (CCRT/ACT) in locally advanced cervical cancer (LACC) using provider and societal viewpoints. METHODS: Data from our trial which was a multi-centre study evaluating the efficacy of ACT compared to CCRT/ACT were entered into a decision tree model. The data included clinical probability, direct medical and non-medical costs, and utility obtained from the patients. The total cost, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) were estimated for a time horizon of 3 years. All costs and outcomes were discounted at 3% annually. RESULTS: The cost of CCRT and CCRT/ACT was approximately 3,058 and 6,896 USD and 4,309 and 7,480 USD from provider and from societal viewpoints, respectively. The QALYs for CCRT and CCRT/ACT were 2.31480 and 2.32045, respectively. The ICER was 569,575 USD per QALY. For stage III-IVA LACC, the ICER was 28,050 USD per QALY. In the sensitivity analysis, the cost of ACT was the most significant influential parameter on the ICER. The ICER would be 0.26-fold lower if the cost of ACT was reduced by 25%. At the current ceiling threshold of 5,000 USD/QALY, CCRT had a 100% probability of being the best option. CONCLUSIONS: In the Thai context, CCRT is more cost effective than CCRT/ACT for stage IIB-IVA LACC. CCRT/ACT may be considered only for stage III-IVA LACC because it has a lower ICER than other types of LACC.

Fertility-sparing in endometrial cancer.

Because endometrial cancer (EMC) patients frequently present at an early stage of disease, most have favorable outcomes, thus their quality of life after treatment is as important a consideration as a cure of cancer. This issue is especially important when EMC is encountered in younger or reproductive ages when the afflicted woman has not achieved her fertility function. It is a complicated situation when a physician encounters a request or question from a woman with EMC or her family concerning whether she could conceive a child prior to a definite cancer treatment. Despite being an interesting issue, there are only a few studies with definite treatment guidelines or any evidence-based recommendations concerning conservative treatment for EMC. Thus, we undertook this study to explore various considerations regarding the criteria and caveats for the management of EMC women who desire to preserve their fertility function. An algorithm guideline for conservative fertility treatment for EMC is also presented.

Cerebral venous sinus thrombosis in early pregnancy: an unusual presentation of primary antiphospholipid syndrome.

Cerebral venous sinus thrombosis, an unusual presentation of antiphospholipid syndrome, is a rare condition in pregnancy, particularly in the first trimester. The authors of this case report present the case of a 20-year-old woman with sudden onset of headaches and hemiparesis in the first trimester of pregnancy. She underwent a computed tomography scan and magnetic resonance imaging. The image findings and the autoimmune serum test were consistent with a cerebral venous sinus thrombosis complicated by primary antiphospholipid syndrome. The patient's hemiparesis improved with subcutaneous low molecular weight heparin and oral aspirin. In the third trimester of pregnancy, she developed seizures that were controlled by antiepileptic drugs. She delivered a healthy baby at 37 weeks' gestation without immediate or late postpartum complications.