@article {10561, title = {Preoperative Serum Human Epididymis Protein 4 Levels in Early Stage Endometrial Cancer: A Prospective Study.}, journal = {Int J Gynecol Cancer}, volume = {27}, year = {2017}, month = {2017 07}, pages = {1200-1205}, abstract = {

OBJECTIVE: The aim of the study was to evaluate the prognostic value of human epididymis protein 4 (HE4) and cancer antigen 125 markers with pathological prognostic factor to complete the preoperative clinical panel and help the treatment planning.

METHODS: This prospective multicenter study was conducted in 2 gynecologic oncology centers between 2012 and 2014 (Institute for Maternal and Child Health IRCCS Burlo Garofolo in Trieste and Catholic University of the Sacred Heart in Rome, Italy). We enrolled 153 patients diagnosed with clinical early (International Federation of Gynecology and Obstetrics stages I-II) type I endometrial cancer.

RESULTS: Human epididymis protein 4 levels seemed to be strictly related to age (P < 0.001) and menopausal status (P < 0.002). Compared with myometrial invasion (MI), the HE4 values were significantly higher in case of invasion of greater than 50\% of the thickness: MI of greater than 50\%, median of 94.85 pmol/L (38.3-820.8 pmol/L), versus MI of less than 50\%, median of 65.65 pmol/L (25.1-360.2 pmol/L), (P < 0.001). The HE4 levels increase significantly with increasing tumor size: diameter of larger than 2 cm, median of 86.9 pmol/L (35.8-820.8 pmol/L), versus diameter of smaller than 2 cm, median of 52.2 pmol/L (33.3-146.8 pmol/L), (P < 0.001). In our population, HE4 did not correlate with the histological grade, endometrial cancer type I versus type II (P = 0.86), the lymphovascular infiltration (P = 0.12), and the cervical invasion (P = 0.6). We established a new variable, considering 3 high-risk tumor features: MI of greater than 50\% and/or histological G3 and/or type II. Human epididymis protein 4 levels significantly increase in high-risk tumors (high risk HE4, 93.6 pmol/L vs low-medium risk, 65.5 pmol/L; P < 0.001).

CONCLUSIONS: A preoperative HE4 evaluation could help stratify patients with deep invasion and/or metastatic disease and is correlated with other relevant prognostic factors to be considered to tailor an adequate surgical strategy.

}, keywords = {Adult, Aged, Aged, 80 and over, Biomarkers, Tumor, Endometrial Neoplasms, Female, Humans, Middle Aged, Neoplasm Staging, Preoperative Care, Prognosis, Prospective Studies, Proteins}, issn = {1525-1438}, doi = {10.1097/IGC.0000000000001015}, author = {Fanfani, Francesco and Restaino, Stefano and Cicogna, Stefania and Petrillo, Marco and Montico, Marcella and Perrone, Emanuele and Radillo, Oriano and De Leo, Rossella and Ceccarello, Matteo and Scambia, Giovanni and Ricci, Giuseppe} } @article {3566, title = {Effects of estroprogestins containing natural estrogen on vaginal flora.}, journal = {Gynecol Endocrinol}, volume = {30}, year = {2014}, month = {2014 Nov}, pages = {830-5}, abstract = {

Estroprogestins with "natural oestrogen" has represented a new option in terms of combined hormonal contraception. So, the aim of this study is to investigate how estroprogestins with natural estrogen may modify the vaginal niche. In literature, very few studies focused on the interaction between hormonal contraception and vaginal milieu. This is a prospective comparative study. We enrolled 60 women from January 2013 to September 2013, 30 of them were administered estradiol valerate dienogest (E2V+DNG - Klaira{\textregistered}) in a quadriphasic regimen, while the other 30 women were administered 17-β estradiol with nomestrol acetate (EV+NOMAC - Zoely{\textregistered}) in a monophasic regimen. After a baseline study of vaginal milieu at recruitment of patients (Gram stain with Nugent score, vaginal pH, vaginal wet mount for the quantification of leukocytes, Lactobacilli and/or presence of Candida), we performed the same follow-up after six months of estroprogestin therapy. Our results showed that the women treated with E2V+DNG had a trend of an improvement of vaginal health in terms of increase of lactobacillar flora and reduction of vaginal pH in place of women treated with EV+NOMAC that showed a reduction of cervical mucus. Finally, our data about the effects on vaginal flora exerted by two estroprogestin pills (EPs) containing a natural estrogen suggest slight, but interesting differences in terms of vaginal ecology. These differences could be related to the type of estrogen, type of progestin, regimen of administration and, after all, to the net balance between estrogenic and progestin component of the EPs.

}, keywords = {Adolescent, Adult, Drug Combinations, Estradiol, Female, Humans, Megestrol, Middle Aged, Nandrolone, Norpregnadienes, Prospective Studies, Vagina, Young Adult}, issn = {1473-0766}, doi = {10.3109/09513590.2014.936847}, author = {De Seta, Francesco and Restaino, Stefano and Banco, Rubina and Conversano, Ester and De Leo, Rossella and Tonon, Maddalena and Maso, Gianpaolo and Barbati, Giulia and Lello, Stefano} }