RESUMEN
The aim of this study was to examine a possible association between the levels of total serum cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and lipoprotein(a), and the development of severe preeclampsia. We measured the levels of these lipoproteins in a prospective observational longitudinal cohort study that recruited 50 third-trimester pregnant women with mild preeclampsia at the time of recruitment. Two assessments were performed; the first measurement was at 29-31 weeks of pregnancy (at recruitment), and the second took place 4 weeks later. Patients with BMI 30, those < 20 years of age and those > 35 years of age were not included in the study. Eight mildly preeclamptic women developed severe preeclampsia within 4 weeks. In these patients, lipoprotein(a) level showed a twofold increase. A serum lipoprotein(a) level > 40.5 mg/dL in a mildly preeclamptic patient predicted the development of severe preeclampsia later on in the pregnancy, whereas a serum lipoprotein(a) level > 52.5 mg/dL was a marker of severity with high sensitivity and specificity. We suggest through our results that that lipoprotein(a) level correlates with the severity of the disease.IMPACT STATEMENTWhat is already known on this subject? Changes in blood lipids have been reported in preeclampsia. Abnormal lipoprotein levels are thought to play a role in the pathophysiology of the disease.What the results of this study add? In this study, we showed that a serum lipoprotein(a) level >40.5 mg/dL in a mildly preeclamptic patient predicted the development of severe preeclampsia later on in the pregnancy, whereas a serum lipoprotein(a) level >52.5 mg/dL was a marker of severity with high sensitivity and specificity.What the implications are of these findings for clinical practice and/or further research? Our results suggest that blood lipids, and especially lipoprotein(a), are involved in the pathogenesis of preeclampsia. The lipoprotein(a) level correlates with the severity of the disease. Hence, lipoprotein(a) could be used as a predictor of severe preeclampsia and a marker of the severity of preeclampsia. This should be validated through prospective studies recruiting an adequate sample size.
Asunto(s)
Lipoproteína(a)/sangre , Lipoproteínas HDL/sangre , Lipoproteínas LDL/sangre , Preeclampsia/sangre , Índice de Severidad de la Enfermedad , Adulto , Femenino , Humanos , Estudios Longitudinales , Embarazo , Tercer Trimestre del Embarazo/sangre , Estudios Prospectivos , Adulto JovenRESUMEN
OBJECTIVE: A numerical score, the peritoneal cancer index (PCI), was developed to reflect the extent of tumor growth in gastric and colorectal cancers and to tailor treatment. This study aimed to examine the value of the PCI score in advanced epithelial ovarian cancer (EOC) regarding completeness of surgical cytoreduction and survival. METHODS: This was a prospective observational cohort study. Patients with primary serous EOC at International Federation of Gynecology and Obstetrics (FIGO) stages IIIB or higher were included. Patients with FIGO stage IVB as well as those assigned to receive neoadjuvant treatment were excluded from the study. The PCI was obtained and registered intraoperatively. RESULTS: In the study period we recruited 96 patients with serous EOC stage IIIB-IVA. A PCI score cut-off value of 13 was calculated using a receiver operator characteristic (ROC) curve, above which worse survival is expected (area under the curve [AUC]=0.641; 95% confidence interval [CI]=0.517-0.765; sensitivity and specificity 80.6%, 45.0%, respectively; p=0.050). A multivariate analysis determined that suboptimal surgical cytoreduction was the only independent predictive factor for recurrence (odds ratio [OR]=7.548; 95% CI=1.473-38.675; p=0.015). A multivariate analysis determined that only suboptimal surgical cytoreduction (hazard ratio [HR]=2.33; 95% CI=0.616-8.795; p=0.005), but not PCI score >13 (HR=1.289; 95% CI=0.329-5.046; p=0.716), was an independent predictive factor for death. CONCLUSION: We conclude from this study that the PCI score is a reliable tool helping to assess the extent of disease in advanced serous EOC patients and may help predicting complete surgical cytoreduction but cannot qualify as a predictor of survival.
Asunto(s)
Carcinoma Epitelial de Ovario/mortalidad , Neoplasias Ováricas/mortalidad , Neoplasias Peritoneales/patología , Neoplasias Peritoneales/secundario , Adulto , Anciano , Carcinoma Epitelial de Ovario/patología , Carcinoma Epitelial de Ovario/cirugía , Femenino , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Curva ROCRESUMEN
PURPOSE: Cluster of differentiation (CD) 44 is a cell surface receptor that correlates with the development of drug resistance in epithelial ovarian cancer (EOC). Here, we prospectively investigated the clinical impact of CD44 expression on the development of chemoresistance, and on disease-free and overall survival in EOC. METHODS: This study included patients with primary serous EOC that was at International Federation of Gynecology and Obstetrics stages IIIB-IVA and tumors that were CD44 positive and negative in a 1:1 ratio. All patients underwent primary surgical cytoreduction, followed by six cycles of combined paclitaxel and carboplatin chemotherapy every 3 weeks. The treatment was considered complete after the chemotherapy had finished. All patients were followed up for 24 months after completing their chemotherapy. RESULTS: Of the 96 patients with serous EOC at stages IIIB-IVA, 51 % of the tumors were negative for the expression of CD44 and 49 % showed variable CD44 expression. Patients who had CD44-positive tumors had statistically significant shorter disease-free (p ≤ 0.001) and overall survival (p ≤ 0.001) intervals compared with patients with CD44-negative tumors. The hazard ratio for death was 6.8 (95 % confidence interval 2.4-19.2, p ≤ 0.001) among the patients with CD44-positive tumors. A multivariate analysis showed that carboplatin-resistant or carboplatin-refractory EOC was the only independent predictive factor for death. CONCLUSIONS: CD44 expression contributes to the development of carboplatin resistance in advanced serous EOC, and it may contribute to worse prognoses for patients, but it is neither an independent predictor of survival nor of recurrence.
Asunto(s)
Biomarcadores de Tumor/metabolismo , Cistadenocarcinoma Seroso/patología , Resistencia a Antineoplásicos , Receptores de Hialuranos/metabolismo , Recurrencia Local de Neoplasia/patología , Neoplasias Glandulares y Epiteliales/patología , Neoplasias Ováricas/patología , Adulto , Anciano , Antineoplásicos/uso terapéutico , Carboplatino/uso terapéutico , Carcinoma Epitelial de Ovario , Cistadenocarcinoma Seroso/tratamiento farmacológico , Cistadenocarcinoma Seroso/metabolismo , Cistadenocarcinoma Seroso/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Técnicas para Inmunoenzimas , Persona de Mediana Edad , Clasificación del Tumor , Invasividad Neoplásica , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/metabolismo , Recurrencia Local de Neoplasia/mortalidad , Estadificación de Neoplasias , Neoplasias Glandulares y Epiteliales/tratamiento farmacológico , Neoplasias Glandulares y Epiteliales/metabolismo , Neoplasias Glandulares y Epiteliales/mortalidad , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/metabolismo , Neoplasias Ováricas/mortalidad , Pronóstico , Estudios Prospectivos , Tasa de SupervivenciaRESUMEN
OBJECTIVES: To study the accuracy of four-dimensional (4D) ultrasound and power Doppler flow mapping in detecting tubal patency in women with sub-/infertility, and compare it with laparoscopy and chromopertubation. STUDY DESIGN: A prospective study. The study was performed in the outpatient clinic and infertility unit of a university hospital. The sonographic team and laparoscopic team were blinded to the results of each other. Women aged younger than 43 years seeking medical advice due to primary or secondary infertility and who planned to have a diagnostic laparoscopy performed, were recruited to the study after signing an informed consent. All of the recruited patients had power Doppler flow mapping and 4D hysterosalpingo-sonography by injecting sterile saline into the fallopian tubes 1 day before surgery. Registering Doppler signals, while using power Doppler, both at the tubal ostia and fimbrial end and the ability to demonstrate the course of the tube especially the isthmus and fimbrial end, while using 4D mode, was considered a patent tube. RESULTS: Out of 50 recruited patients, 33 women had bilateral patent tubes and five had unilateral patent tubes as shown by chromopertubation during diagnostic laparoscopy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for two-dimensional power Doppler hysterosalpingography were 94.4%, 100%, 100%, 89.2%, and 96.2%, respectively and for 4D ultrasound were 70.4%, 100%, 100%, 70.4%, and 82.6%, respectively. CONCLUSIONS: Four-dimensional saline hysterosalpingography has acceptable accuracy in detecting tubal patency, but is surpassed by power Doppler saline hysterosalpingography. Power Doppler saline hysterosalpingography could be incorporated into the routine sub-/infertility workup.