@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 {8050, title = {Positron emission tomography-laparoscopy based method in the prediction of complete cytoreduction in platinum-sensitive recurrent ovarian cancer.}, journal = {Ann Surg Oncol}, volume = {22}, year = {2015}, month = {2015 Feb}, pages = {649-54}, abstract = {

BACKGROUND: This study was designed to evaluate the positron emission tomography-laparoscopy-based method in the prediction of complete/optimal cytoreduction in platinum sensitive recurrent epithelial ovarian cancer patients.

METHODS: We analysed 223 consecutive recurrent epithelial ovarian cancer patients. Inclusion criteria were absence of extra-abdominal disease and Eastern Cooperative Oncology Group Performance Status <=2. Complete and optimal secondary cytoreduction are defined as macroscopic absence or less than 1~cm of residual tumor at the end of surgery.

RESULTS: Laparoscopy was feasible in 210 of 223 patients (94.2~\%). Laparoscopy stated 127 (60.5~\%) possible cytoreductions and 83 (39.5~\%) systemic chemotherapies. In the same population, AGO score evaluation avowed 150 possible cytoreduction (71.5~\%) and 60 unresectable women (28.5~\%). Overall, 115 of 210 patients (54.7~\%) underwent successful secondary cytoreduction: complete and optimal cytoreduction was obtained in 103 (89.5~\%) and 12 (10.5~\%) patients, respectively. Laparoscopy obtained a positive predictive value of 91.3~\%. Laparoscopy recovered to secondary cytoreduction 13 of 60 patients (21.7~\%) deemed as not resectable according to AGO score. Forty-eight of 150 AGO score positive patients (32~\%) were judged nonresectable by laparoscopy.

CONCLUSIONS: This study confirmed that laparoscopy could be effective for the selection of platinum-sensitive recurrent epithelial ovarian cancer patients suitable for complete cytoreduction.

}, keywords = {Adult, Aged, Algorithms, Cytoreduction Surgical Procedures, Female, Humans, Laparoscopy, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Neoplasms, Glandular and Epithelial, Ovarian Neoplasms, Positron-Emission Tomography, Tomography, X-Ray Computed}, issn = {1534-4681}, doi = {10.1245/s10434-014-4011-0}, author = {Fanfani, Francesco and Monterossi, Giorgia and Fagotti, Anna and Gallotta, Valerio and Costantini, Barbara and Vizzielli, Giuseppe and Petrillo, Marco and Carbone, Maria Vittoria and Scambia, Giovanni} }