2017, Vol 15, No 3
Analysis of prognostic factors in vulvar cancer, with special emphasis on FIGO 2009 staging classification – results of own study and literature review
Curr Gynecol Oncol 2017, 15 (3), p. 157–171
DOI: 10.15557/CGO.2017.0016

Aim: The study is aimed at the analysis of prognostic factors in a group of 160 patients with vulvar cancer managed with primary surgery at the Center of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, with special emphasis on the prognostic value of FIGO 2009 staging classification for vulvar cancer. Material and method: The clinical data of patients affected with invasive vulvar cancer treated with primary surgery at the Center of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch in the years 1985–2009. In 6 (3.8%) patients, partial radical vulvectomy and unilateral lymphadenectomy were performed, in 65 (40.6%) – complete radical vulvectomy and unilateral lymphadenectomy, and in 89 (55.6%) – complete radical vulvectomy and bilateral lymphadenectomy. The survival probability was estimated with the Kaplan–Meier method, and the Cox proportional hazards model was used to evaluate the effect of selected factors on patient survival. Results: The mean follow-up time was 9 years (range 0.6–23 years). The 5-year survival rate equaled 45.6%. Multivariate analysis showed patients with cancer spread to inguinal lymph nodes to be characterized by an over 15 times higher risk of death than patients without lymph node metastases. In univariate analysis, the use of FIGO 2009 staging classification for vulvar cancer deteriorated the outcomes for stage IB patients compared with FIGO 1988 classification, with 5-year survival rates amounting to 69% and 88%, respectively. No differences in outcomes were identified for the remaining FIGO stages compared between the two classifications. Conclusions: The microscopic status of regional lymph nodes was identified as the sole independent prognostic factor of 5-year overall survival rates.

Keywords: vulvar cancer, prognostic factors, surgical management
Assessment of preoperative counselling and quality of life of patients with endometrial cancer
Curr Gynecol Oncol 2017, 15 (3), p. 172–182
DOI: 10.15557/CGO.2017.0017

Purpose: The main aim of the study was to obtain feedback from patients with endometrial cancer on the quality of information provided to them prior to surgery. An additional aim was to correlate these opinions with sociodemographic factors. Material and methods: One hundred and twenty-three patients with endometrial cancer diagnosed by means of tissue sampling, treated surgically at the Department of Gynecology and Obstetrics in Rzeszów, Poland in 2012–2014 were enrolled in a prospective cohort study. The questionnaires used were: EORTC QLQ-C30 and QLQ-INFO25, completed before discharge from hospital. Statistical analysis assessed the influence of ordinal categorical variables by means of rank correlation analysis. For nominal variables, the mean and median values in the groups compared were calculated, and then the difference in the distribution of the domains of information quality in these groups was estimated using the Kruskal–Wallis test or the Mann–Whitney test. Results: According to data supplied by the patients who filled out INFO-25, they received the largest amount of information about medical tests (60.3%) and the disease itself (55%). They were informed less adequately about treatment (43.4%), and the scarcest information was provided in regard to follow-up (28.5%). The helpfulness of the information received (64.5%) was assessed the highest. Overall quality of their life amounted to 55 ± 22. A low correlation was found between the assessment of information and the quality of life. A younger age, higher level of education and having a partner correlated with a higher score awarded to the information received. Conclusion: The assessment of the quality of the information provided preoperatively depends on the individual characteristics of the recipient, which should be taken into account in the information process. In addition, more attention should be paid to the provision of information concerning the treatment protocol and follow-up.

Keywords: endometrial cancer, information, quality of life
Lymphovascular space invasion, a prognostic marker for disease recurrence in patients with early endometrioid endometrial cancer
Curr Gynecol Oncol 2017, 15 (3), p. 183–188
DOI: 10.15557/CGO.2017.0018

Aim of the study: To evaluate the clinicopathologic factors of early International Federation of Gynecology and Obstetrics (FIGO) stage I–II endometrioid endometrial cancer in a single institution and to emphasize factors contributing to recurrence. Material and methods: We selected several clinicopathologic factors including age, height, body weight, body mass index, cancer antigen-125, FIGO tumor grade, myometrial invasion, lymphovascular space invasion, estrogen receptor/ progesterone receptor status, and adjuvant radiation therapy or systemic chemotherapy. Univariate and multivariate Cox proportional hazard model and Kaplan–Meier estimates were used for analyzing all clinicopathologic factors related to the risk of disease recurrence. Results: The median age was 55.05 years, and the median follow-up time was 35 months. Eleven patients (11%) showed disease recurrence, 3 patients – distant, and 8 patients – local metastasis. In univariate analysis, tumor grade (P = 0.0045) and lymphovascular space invasion (P = 0.0374) were associated with disease recurrence. Multivariate analysis demonstrated an association between any type of recurrence and lymphovascular space invasion (hazard ratio, HR, 6.308; 95% confidence interval, CI 1.851–11.484). Conclusions: Our study showed that the presence of lymphovascular space invasion is an important factor for disease recurrence in early endometrial cancer. Therefore, adjuvant systemic chemotherapy may be considered in patients with early endometrial cancer with lymphovascular space invasion.

Keywords: endometrial cancer, recurrence, lymphovascular space invasion
Frequency and pattern of gynecologic cancers from 2010 to 2014 in Beira, Mozambique
Curr Gynecol Oncol 2017, 15 (3), p. 189–193
DOI: 10.15557/CGO.2017.0019

Objective: Gynecologic cancers represent a large health, social and economic burden worldwide. In low-income countries, particularly in Mozambique, little data is available and no effective policies are implemented to fight these diseases. Our objective was to trace the epidemiological profile of gynecologic cancers from 2010 to 2014 in Beira, Mozambique. Methods: We retrospectively reviewed the registers of the Department of Pathology of Central Hospital of Beira to identify all cases of gynecologic malignancies recorded from January 2010 to December 2014. Results: Most of the diagnosed female cancers (43.4%) were gynecologic and, among these, cervical cancer was definitely the most commonly reported cancer every year, ranging from 86.7% in 2013 to 93.3% in 2014. Conclusion: As in many low-income countries, the access to screening programs for gynecologic cancer is not effective in Mozambique; therefore urgent preventive policies are crucial to address this emergent issue.

Keywords: gynecologic cancers, low-income countries, epidemiology, cervical cancer
Ultrasound diagnosis of adnexal masses: the practical usefulness of various malignancy risk prediction models
Curr Gynecol Oncol 2017, 15 (3), p. 194–217
DOI: 10.15557/CGO.2017.0020

Adnexal masses are found in women of all ages, both pre- and postmenopausal. A large majority of them are benign and are diagnosed incidentally. Some cases, nonetheless, pose diagnostic and clinical challenges regarding the character of the lesion (whether benign or malignant). Correct preoperative classification is crucial for proper management both in terms of the scope and technique of surgery as well as the choice of the medical center where a given medical procedure is to be held (an gynecologic oncology center/a gynecologic ward). The usefulness of various imaging modalities (each characterized by a given level of sensitivity and specificity) for the diagnosis of ovarian cancer has been analyzed in multicenter studies. Studies by international groups, such as the IOTA, indicate the possibility of applying various diagnostic algorithms, relying on ultrasound assessment (Simple Rules model), complex mathematical models (LR1, LR2), biomarker measurements (ROMA, ROCA, OVERA), or a conjunction of clinical data, serum marker levels and ultrasound findings (ADNEX, RMI). All these models facilitate a differential diagnosis of ovarian tumors and help to triage patients into low-, moderate- or highrisk groups, thus warranting correct classification of patients for further management even when expert diagnosis is not feasible, and optimizing the quality of care provided. This study is a review of the available predictive formulas utilizing ultrasound findings, serum biomarker measurements and complex mathematical models as well as newly proposed diagnostic algorithms, based on the results of the most recent studies and guidelines of various gynecologic and obstetric societies. They may be helpful in day-to-day practice of gynecologists, aiding preoperative classification of adnexal masses as likely benign or malignant.

Keywords: adnexal masses, diagnosis, predicting malignancy risk
Trabectedin for the treatment of ovarian cancer
Curr Gynecol Oncol 2017, 15 (3), p. 218–223
DOI: 10.15557/CGO.2017.0021

The paper describes standard therapeutic management used in patients with ovarian cancer, which is based, among other things, on the recommendations of the Polish Gynecological Oncology Society. Therapeutic management encompasses surgical treatment and systemic therapy with cytostatic drugs (typically derivatives of platinum and paclitaxel as first-line therapy). Total or optimal cytoreduction is an important element of surgical treatment. Additionally, the response to first-line adjuvant chemotherapy is a highly significant prognostic factor. Bevacizumab is an effective treatment in the first-line chemotherapy and in patients with platinum-sensitive relapsed ovarian cancer. Trabectedin (Yondelis) used in patients with relapsed ovarian cancer (partially platinum-sensitive) (relapse within 6–12 months after first-line chemotherapy) proved to be an effective drug. Used in combination with pegylated liposomal doxorubicin, the drug significantly improved progressionfree survival (time to progression ranging between 9.2 vs. 7.2 months, p = 0.017) as compared to pegylated liposomal doxorubicin alone. Improvement of overall survival was also demonstrated (22.4 vs. 18.9 months, p = 0.835), however, it was insignificant. In addition, trabectedin used in relapsed ovarian cancer increased sensitivity to platinum and exhibited low toxicity.

Keywords: ovarian cancer, surgery in ovarian cancer, chemotherapy, trabectedin