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Background/aim: In selected patients, pelvic exenteration (PE) is curative, but morbidity and mortality are feared. Unfortunately, prerequisites for indicating PE are not generally defined. The aim of the study was to identify prognostic factors for survival after PE in advanced pelvic gynecological malignancies for finding possible prerequisites for the indication of PE., Patients and Methods: Between 2002 and 2016, 49 patients underwent pelvic exenteration for advanced pelvic malignancies apart from ovarian cancer. Progression-free survival (PFS) and overall survival (OS) were calculated based on the Kaplan-Meier method. Factors significantly affecting 5-year overall survival were identified using multivariate regression analysis. Survival distributions between the best and the worst group were compared by the log rank test., Results: Forty-nine patients with recurrent or primary pelvic gynecological malignancy (20 recurrent disease, 29 primary disease) were included. Seventeen patients had oligometastatic disease at surgical intervention. Resection margin, age, primary versus secondary exenteration and metastatic disease were independent prognostic factors in multivariate regression analysis. A significant difference was observed in 5-year overall survival regarding the best group (57.14%) and the worst group (10%) (p=0.009). Cervical cancer was the only identified risk factor for increased morbidity., Conclusion: Pelvic exenteration is a valuable therapeutic option with most long-term survivors in the group of patients below 63 years, as primary treatment, with clear microscopic margins and no distant metastases. These four factors may serve as valuable prerequisites for the indication of pelvic exenteration as survival and morbidity in this group of patients compares favorably to alternative therapeutic options., (Copyright © 2021 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Backround: Due to extensive surgical intervention for macroscopic complete cytoreduction in epithelial ovarian cancer (EOC) patients, severe complications in the postoperative course are possible., Patients and Methods: A total of 345 EOC patients who underwent cytoreductive surgery were retrospectively evaluated regarding risk factors for an unfavorable postoperative course. Possible pre-, intra- and postoperative risk factors were statistically analyzed performing multivariate ordinal logistic regression., Results: A total of 345 EOC patients underwent cytoreductive surgery. There were no complications in 114 patients, mild complications in 114 patients and severe complications in 117 patients. The risk factor evaluation identified age (p=0.049), smoking (p=0.032) and duration of surgery (p<0.0001) as significant factors for severe postoperative morbidity., Conclusion: In EOC patients age, smoking and the duration of surgery have significant impact on the postoperative course. Only the duration of surgery can be positively influenced by a well-trained EOC team., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Cytokines are involved in the pathogenesis of different gynecological malignancies. Additionally, they stimulate the spread of cancer cells. Interleukin 10 (IL-10) was described as a pro-inflammatory factor and seems to be implicated in the immune deficiency of patients with cancer. The aim of this study was to determine whether the level of IL-10 in the serum and ascites was associated with the prognosis of advanced ovarian cancer (OC)., Materials and Methods: In a prospective study from 2001 to 2003, the concentration of IL-10 in the serum and ascites of 117 consecutive patients with advanced OC and 30 women with benign disease who underwent surgery as a control group (CG), was analyzed by the enzyme-linked immunosorbent assay. For statistical analyses, the Chi-square test by Pearson, Fisher's exact test and the Mann-Whitney test were employed., Results: The concentrations of IL-10 were a median of 9.87 pg/ml (range 7.8 to 500 pg/ml) in the serum and a median of 43.70 pg/ml (range 7.8 to 389.4 pg/ml) in the ascites of the OC patients. The IL-10 level in the sera of the CG was a median of 7.80 pg/ml (range 7.8 to 62.8 pg/ml) and 18.34 pg/ml (range 7.8 to 88.72 pg/ml) in the peritoneal fluid. A significant association was observed between the IL-10 serum levels (p = 0.003) and levels in the peritoneal fluid (p = 0.03) in both OC and the CG. IL-10 was significantly more expressed in the ascites of patients with OC than in their sera (p = 0.003). The concentration of IL-10 correlated significantly with proven conventional prognostic factors such as recurrence status (p = 0.005), volume of (ascites, p < 0.001, serum, p = 0.03), histological grading (p = 0.053) and histological type (ascites p = 0.005/ serum p = 0.09). There was no significant correlation between the levels of lL-10 in the ascites and/or serum and FIGO stage, residual tumor mass or age. The cut-off value of 8.0 pg/ml for IL-10 serum levels had a positive predictive value of 84% (95% CI: 76-91) and a negative predictive value of 29% (95% CI: 16-41), with a specificity and sensibility of 47% (95% CI: 29-65) and 70% (95% CI: 62-78), respectively., Conclusion: Due to the fact that the levels of IL-10 were significantly higher in the ascites and serum of OC patients than in those of the CG, IL-10 may play an important immunosuppressive role in the pathogenesis of OC. The association between high IL-10 levels in ascites and serum and the histological type of the tumor, as well as between the levels in the peritoneal cavity and grading, suggest that IL-10 could be a prognostic factor in OC.

Background: Some studies have shown that the detection of epithelial cells in peripheral blood indicates minimal residual disease status. There is a lack of data concerning the prognostic relevance of the detection of epithelial cells in the blood of patients with solid tumors. Therefore, we conducted the present study to analyse the relationship between the detection of epithelial cells in the blood, "conventional" prognosis factors and overall survival in patients with gynaecological malignancies., Materials and Methods: In a prospective study we investigated blood samples of patients with benign and malignant gynaecologic diseases from 11/97 to 03/99. We used an immunocytochemical approach using cytokeratin-directed antibodies CK 8-18 in 135 and A45-B/B3 in another 123 patients for detection of epithelial cells. Follow-up was obtained by checking the local tumor register and contact with all patients included in the study., Results: There was no significant correlation between detection rate and tumour stage, grading or lymph node status. The median time of follow-up was 45.9 (range 0.7-63) months. There was no significant correlation between the detection rate of positive epithelial cells (method A + B) and overall survival., Conclusion: The results of this study underline the need to further investigate the role of disseminated tumor cells in the blood and bone marrow of patients with gynaecological malignancies.

Background: Some investigations have shown that evidence of epithelial tumor cells in bone marrow is a relevant prognostic factor in various solid tumors. However there is a lack of data concerning the value of detection methods for epithelial cells in the serum of cancer patients., Materials and Methods: In a prospective study we investigated the blood samples of patients with benign and malignant gynaecological diseases from November 1997 to March 1999. We used an immunocytochemical approach with cytokeratin-directed antibodies CK 8-18 in 135 and A45-13/133 in another 123 patients for detection of epithelial cells., Results: There was no significant correlation between the detection rate and tumour stage, grading or lymph node status. The CK8-18 antibody had a higher detection rate for epithelial cells than A45-B/B3 (52% vs. 10%)., Conclusion: Both methods showed a low sensitivity and a high specificity. Further studies are needed to determine the prognostic value of epithelial cells in the blood of patients with gynaecological malignancies.

Background: CA-125 is the most important tumor marker in epithelial ovarian cancer. Due to its low specificity, a combination with CASA may improve the clinical discrimination between benign and malignant adnexal masses., Materials and Methods: In a prospective study CA-125 and CASA were analyzed in blood specimens of 153 patients, including 29 ovarian cancer., Results: The median levels of both markers were significantly higher in ovarian cancer than in benign diseases. The sensitivity of CA-125 was 90%, while the specificity was 79%. PPV and NPV were 50% and 97%. In comparison, the sensitivity of CASA was lower (38%), while the specificity was slightly higher (86%). PPV and NPV were 39% and 86%. When both markers were used together, the specificity could be increased to 96% but the sensitivity remained at only 38%. The PPV and NPV was 69% and 87%., Conclusion: The combination of CA-125 and CASA can improve the detection of patients with suspected ovarian cancer.

Background: Several studies suggest that immunological components play a key role in the development of cervical cancer. Polymorphism in the IL-1 RA gene was associated with various malignant diseases. Data is lacking for cervical cancer., Materials and Methods: In a prospective study we analysed the polymorphism of IL-1RA in 113 women with cervical cancer and 107 with benign diseases. Genomic DNA fragments were amplified by PCR., Results: The distribution of genotype frequencies was different between the study and control group with respect to allele 2 heterozygotes (24.8% vs. 13.1%; p = 0.04) but not in the frequencies of allele 1/3 and homozygous allele 2. There were no differences between IL-1 RA 1/2 polymorphism and all other alleles in tumour stage, grading, recurrence status and age., Conclusion: This data supports the role for allele 2 of the gene encoding for IL1-RA as a genetic determinant of cervical cancer.

Background: IL-1-cytokines are strongly involved in carcinogenesis and tumor genesis. In this systematic review we will describe the role of IL-1 RA within the cytokine network and its predictive and prognostic value in cancer., Materials and Methods: We analysed preclinical and clinical studies., Results: A polymorphism is present in intron 2 of the human IL-1RA gene. The IL-1RA allele 2 has an influence on the IL-1RA plasma level. The IL-1 beta level is elevated at the homozygous for IL-1RA, allele 2 (IL-1RN*2). The IL-1 gene cluster polymorphism is associated with gastric cancer. Carriers of IL-1 1B- 511T and IL-1RN*2 homozygotes have an increased risk of developing gastric cancer. Patients with a heterozygosity of allele 2 for IL-1 RA (IL-RA1/2) have an increased risk of cervical cancer. There are negative associations between IL-1 RA polymorphism and the occurrence of ovarian cancer., Conclusion: The polymorphism of IL-1RA seems to be involved in the induction of different solid tumors.