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Eastern Europe continues to have the highest rates of cancer of the uterine cervix (CUC) and human papillomavirus (HPV) infection in Europe. Aim: The aim of this study was to investigate CUC trends in Bulgaria in the context of a lack of a population-based screening program and a demographic crisis. Methodology: This was a retrospective study of 7861 CUC patients who were registered in the Bulgarian National Cancer Registry (BNCR) between 2013 and 2020 and followed up with until March 2022. We used descriptive statistics and modeling to assess temporal trends in new CUC incidence rates and identify factors associated with survival. Results: Bulgaria’s population has decreased by 11.5% between 2011 and 2021. The CUC incidence rate decreased from 29.5/100,000 in 2013 to 23.2/100,000 in 2020 but remains very high. The proportion of patients diagnosed in earlier stages of CUC has decreased over time. Up to 19% of patients with CUC in Bulgaria are diagnosed between the age of 35 and 44 years. The median survival was 101.5 months, with some improvement in later years (adjusted HR = 0.83 for 2017–2020). Conclusions: In countries with well-established population-based screening, CUC is nowadays considered a rare disease. However, it is not considered rare in Bulgaria. Population-based screening starting at an earlier age is the fastest way to improve outcomes.

Salvage therapy represents a rescue therapy, given after the first line of treatment had failed.The purpose of this study was to review the outcomes of patients who underwent salvage laparoscopic radical prostatectomy (sLRP) in our department and to review current published studies.Our mini-series consisted of 6 patients with recurrent prostate cancer(PCa) after non-surgical primary treatment. All interventions were performed by a single surgeon from the Oncological Institute "Prof. Dr. Ion Chiricuta" Cluj Napoca, Romania.A literature review was carried out in June 2020 using the PubMed and MEDLINE databases to identify relevant studies published in the literature between 2000 and 2020. Six papers were selected for our review.We reviewed the oncological and functional outcomes of patients that underwent sLRP.Extraperitoneal sLRP was performed in 6 patients. Biochemical failure after primary treatment developed between one and five years. Mean operative time was 135.5 min, mean blood loss was 328 ml. No intraoperative complications occurred and no conversions to open surgery. R0 was achieved in 5 out of the 6 patients (83.5%). Out of the 6 patients 2 are incontinent.SLRP remains an underused procedure and a missed therapeutic opportunity for selected patients. From published data and personal experience, we conclude that in experienced hands sLRP for localized prostate cancer is a feasible, safe and efficient method to treat recurrent PCa. Short-term oncological outcomes are optimistic but further studies need to be made to observe the long-term outcomes.

Purpose Surface-enhanced Raman scattering (SERS) spectroscopy on serum and other biofluids for cancer diagnosis represents an emerging field, which has shown promising preliminary results in several types of malignancies. The purpose of this study was to demonstrate that SERS spectroscopy on serum can be employed for the differential diagnosis between five of the leading malignancies, ie, breast, colorectal, lung, ovarian and oral cancer. Patients and methods Serum samples were acquired from healthy volunteers (n=39) and from patients diagnosed with breast (n=42), colorectal (n=109), lung (n=33), oral (n=17), and ovarian cancer (n=13), comprising n=253 samples in total. SERS spectra were acquired using a 532 nm laser line as excitation source, while the SERS substrates were represented by Ag nanoparticles synthesized by reduction with hydroxylamine. The classification accuracy yielded by SERS was assessed by principal component analysis-linear discriminant analysis (PCA-LDA). Results The sensitivity and specificity in discriminating between cancer patients and controls was 98% and 91%, respectively. Cancer samples were correctly assigned to their corresponding cancer types with an accuracy of 88% for oral cancer, 86% for colorectal cancer, 80% for ovarian cancer, 76% for breast cancer and 59% for lung cancer. Conclusion SERS on serum represents a promising strategy of diagnosing cancer which can discriminate between cancer patients and controls, as well as between cancer types such as breast, colorectal, lung ovarian and oral cancer.

Background and Objectives: Local and distant relapse (LR, DR) in breast cancer vary according to its molecular subtypes, with triple-negative breast cancer (TNBC) being the most aggressive. The surgical resection margin width (SRMW) for breast-conserving surgery (BCS) has been intensely debated, especially for the aforementioned subtype. The aim of this study was to examine the impact of SRMW on LR following BCS in TNBC patients. Materials and Methods: We conducted a retrospective study including all patients with TNBC for whom BCS was performed between 2005 and 2014. Results: Final analysis included a total of 92 patients, with a median tumor size of 2.5 cm (range 0–5 cm) and no distant metastasis at the time of diagnosis. A total of 87 patients had received neoadjuvant and/or adjuvant chemotherapy, and all patients had received adjuvant whole-breast radiotherapy. After a median follow-up of 110.7 months (95% CI, 95.23–126.166), there were 5 local recurrences and 8 regional/distant recurrences with an overall LR rate of 5.4%. The risk of LR and DR was similar between groups of patients with several SRMW cut-off values. Conclusions: Our study supports a safe “no ink on tumor” approach for TNBC patients treated with BCS.

The Hippo signaling pathway, one of the most conserved in humans, controlling dimensions of organs and tumor growth, is frequently deregulated in several human malignancies, including ovarian cancer (OC). The alteration of Hippo signaling has been reported to contribute to ovarian carcinogenesis and progression. However, the prognostic roles of individual Hippo genes in OC patients remain elusive. Herein we investigated the expression level and prognostic value of key Hippo genes in OC using online databases, followed by a qRT-PCR validation step in an additional patient cohort. Using the GEPIA database, we observed an increased level for TP53 and reduced expression level for LATS1, LATS2, MST1, TAZ, and TEF in tumor tissue versus normal adjacent tissue. Moreover, LATS1, LATS2, TP53, TAZ, and TEF expression levels have prognostic significance correlated with progression-free survival. The qRT-PCR validation step was conducted in an OC patient cohort comprising 29 tumor tissues and 20 normal adjacent tissues, endorsing the expression level for LATS1, LATS2, and TP53, as well as for two of the miRNAs targeting the TP53 gene, revealing miR-25-3p upregulation and miR-181c-5p downregulation. These results display that there are critical prognostic value dysregulations of the Hippo genes in OC. Our data demonstrate the major role the conserved Hippo pathway presents in tumor control, underlying potential therapeutic strategies and controlling several steps modulated by miRNAs and their target genes that could limit ovarian cancer progression.

More than 50% of all gynecologic tumors can be classified as rare (defined as an incidence of less than 6 per 100,000 women) and usually have a poor prognosis owing to delayed diagnosis and treatment. In contrast to almost all other common solid tumors, the treatment of rare gynecologic tumors (RGT) is often based on retrospective studies, expert opinion, or extrapolation from other tumor sites with similar histology, leading to difficulty in developing guidelines for clinical practice. Currently, gynecologic cancer research, due to distinct scientific and technological challenges, is lagging behind. Moreover, the overall efforts for addressing these challenges are fragmented across different European countries and indeed, worldwide. The GYNOCARE, COST Action CA18117 (European Network for Gynecological Rare Cancer Research) programme aims to address these challenges by creating a unique network between key stakeholders covering distinct domains from concept to cure: basic research on RGT, biobanking, bridging with industry, and setting up the legal and regulatory requirements for international innovative clinical trials. On this basis, members of this COST Action, (Working Group 1, “Basic and Translational Research on Rare Gynecological Cancer”) have decided to focus their future efforts on the development of new approaches to improve the diagnosis and treatment of RGT. Here, we provide a brief overview of the current state-of-the-art and describe the goals of this COST Action and its future challenges with the aim to stimulate discussion and promote synergy across scientists engaged in the fight against this rare cancer worldwide., peer-reviewed

Introduction: Historically, the incidence rate of cervical cancer (CC) in Eastern Europe and particularly in Bulgaria has constantly been higher than that in the other European countries. Adenosquamous carcinoma (ASC) is a rare histological subtype of CC with incidence rate of less than 6 per 100,000. We aimed to analyze the epidemiology and prognosis of all Bulgarian patients with ASC, registered at the Bulgarian National Cancer Registry (BNCR), and to compare patients’ characteristics and outcomes with those of patients, treated at a large specialized institution – the Department of Gynecologic Oncology, University Hospital in Pleven, Bulgaria. Materials and Methods: This is a retrospective study of all cases of ASC, registered at the BNCR for a 10-year period of time. The Kaplan–Meier analysis with Log rank test was used to estimate the significant differences. Results: The incidence rate of ASC was calculated as 3.2% of all CC registered in BNCR and 4.97% of all stage I patients, treated in our department. The 5-year overall survival (OS) rate of all patients with ASC tumors from the registry was 50.5%. A total of 171 (48.4%) of the patients had T1 tumors and a 5-year OS of 67.1%. Lymph node status was a significant prognostic factor for OS (p=0.001). Thirty-one patients with T1 tumors and ASC histology were treated in our department for the same period of time. Lymph node metastases were found in 10 of them (32.2%). The 5-year observed OS in ASC group was 74.19%. Conclusion: The histological subtype of cancer of the uterine cervix has an impact on prognosis and should not be simply considered as a descriptive characteristic but a poor prognostic feature and should be an integral part of the decision-making in clinical management of patients., peer-reviewed

Introduction/Background Clinical trials in Epithelial Ovarian Cancer (EOC) frequently examine treatment at a particular phase of the patient’s disease trajectory. Few major studies have examined the management of patients from diagnosis to death. This international network was developed to compare treatment sequencing and outcomes from six centres across Europe and South Korea. Methodology This retrospective cohort study used longitudinal data collected from electronic medical records from 6 European and South Korean treatment centres. A standard protocol & common data model was developed to capture consistent data for patients diagnosed between January 2012 and December 2018, with a minimum of 12 months follow-up. Full treatment data was collected and categorized in programmes of care based on exemplar patient narratives. An extensive data harmonization process was implemented to ensure different country and site medical records were interpreted in a common manner. Overall survival (OS) and time to next treatment (TTNT) were estimated using Kaplan Meier methodology and outcomes stratified by categories of interest. Each site analysed their own EMR data and shared aggregated results for comparison. Results Table 1 demonstrates patient characteristics from six sites. In total the overall study cohort includes 2889 patients. Median age for each centre ranged from 53 to 67 years. The majority of patients were FIGO stage III (range 31% to 66%) and high-grade serous morphology (52% to 69.9%) Additional data on treatment pathways and outcomes for each centre will be presented. Conclusion Preliminary analysis from this network suggests a consistent profile of adults treated for EOC across most contributing treatment centres in Europe, but with some substantial differences compared to patients treated at centres in South Korea and Romania. The establishment of a common data model between sites across five different countries allows for detailed exploration of the factors influencing differences in patient management and treatment outcomes in ovarian cancer patients. Disclosures Sue Cheeseman: I receive consultancy fees from IQVIA Bethany Levick: I am an employee of IQVIA Eunji Nam: I have no conflict of interest to disclose Dongkyu Kim: I have no conflict of interest to disclose Roman Rouzier: I have no conflict of interest to disclose Claire Bonneau: I have no conflict of interest to disclose Paul Kubelac: served on a speaker’s bureau for Roche, Bristol-Myers Squibb, AstraZeneca, Novartis. Patriciu Achimas-Cadariu: I have no conflict of interest to disclose Jean-Marc Classe: I have no conflict of interest to disclose Francois Bocquet: I have no conflict of interest to disclose Sven Becker: I have no conflict of interest to disclose Mariana Guergova-Kuras: I am an employee of IQVIA Geoff Hall: I receive grant support and consultancy fees from IQVIA

The purpose of this study was to evaluate the predictive performance of OncoOVARIAN Dx algorithm, which takes into account tumor markers (beta HCG, CA 19.9, CEA, AFP, CA 125, HE4), general biochemistry and clinical data (age, menopause, comorbidities) in patients scheduled for surgical removal of a suspicious adnexal tumor in comparison with the Risk of Malignancy Algorithm (ROMA) model.Consecutive women diagnosed with an adnexal tumor mass and scheduled for surgical intervention at a single tertiary cancer between October 2018 - June 2019 were enrolled. Preoperative values of tumor markers and general biochemistry (ASAT, ALAT, GGT, total bilirubin, creatinine) were determined. Following surgery with adequate surgical staging, a definite pathological diagnosis was made and used as reference.A total of 50 patients were selected, including 20 benign, 5 borderline and 25 malignant epithelial ovarian cancer (EOC) cases on final pathology. Borderline tumors comprised 3 serous and 2 mucinous FIGO stage I cases. Malignant tumors included 17 high grade serous, 4 endometrioid and 4 mucinous types, FIGO stage IA-IIIC. The two models demonstrated very good correlation (Phi 0.78, p0.001). The sensibility (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) of OncoOVARIAN Dx versus ROMA model were 76.66% vs. 60%, 95% vs. 100%, 95.83% vs. 100%, 73.07% vs. 62.5%, respectively. In postmenopausal patients higher Se (85.71%), Sp (100%) and PPV (100%) were observed for OncoOVARIAN Dx.OncoOVARIAN Dx model demonstrated higher Se and NPV compared to ROMA and could be a useful marker in the preoperative management of adnexal masses; however larger studies are warranted to validate and further refine this algorithm.

We report our experience with 23 cases in utilizing ileum to perform totally intracorporeal 3D laparoscopic neobladder reconstruction using two different surgical techniques.Patients candidates for reconstructive surgery were in a good biological status with a body mass index (BMI) in the range of 18.5-25 and presented a muscle-infiltrative bladder tumor with negative nodal frozen sections performed during the operation. Twenty-one modified Studer neobladder and 2 modified Y-shaped neobladder techniques for totally intracorporeal 3D laparoscopic ileal neobladder cases were performed using drawings and intra-operative images. An emphasis was made on different tips and tricks that can be applied when using ileum for the neobladder reconstruction, to avoid surgical complications and obtain optimal functional results.The operations were performed in a mean time of 5 h, with a mean blood loss of 350 ml and grade II postoperative Clavien Dindo complications. The 23 patients were discharged after a mean hospital stay of 21 days and had a functional ileal neobladder after a mean of 30 days. The results were monitored also on the long-term, taking into account functional results and possible complications from utilizing ileum as a urinary reservoir.Resecting a digestive segment and using it as a urinary reservoir may lead to multiple complications. Therefore, laparoscopic technical adaptations and highly skilled surgical teams are required for performing a totally intracorporeal 3D laparoscopic orthotopic ileal neobladder reconstruction.

Introduction/Background The aim of this study is to evaluate the predictive performance of OncoOVARIAN Dx algorithm, which takes into account tumor markers (beta HCG, CA 19.9, CEA, AFP, CA 125, HE4), general biochemistry and clinical data (age, menopause, comorbidities) in patients scheduled for surgical removal of a suspicious adnexal tumor in comparison with the ROMA model. Methodology Consecutive women diagnosed with an adnexal tumor mass and scheduled for surgical intervention at a single tertiary cancer center between October 2018–April 2019 were enrolled. Preoperative values of tumor markers and general biochemistry (ASAT, ALAT, GGT, total bilirubin, creatinine) were determined. Following surgery, histological type and stage were determined based on FIGO classification. Results A total of 44 patients were selected, including 19 benign (BEN), 5 borderline (BOR) and 20 malignant (MAL) epithelial ovarian cancer (EOC) cases on final pathology. BOR tumors comprised 3 serous (S) and 2 mucinous (M) FIGO stage I cases. MAL tumors included 13 high grade S, 4 endometrioid and 3 M histotypes, FIGO stage IA–IIIC. The two models demonstrated very good correlation (Phi 0.78, p Conclusion OncoOVARIAN Dx model demonstrated higher Se and NPV compared to ROMA and could be a useful marker in the preoperative management of adnexal masses however larger studies are warranted to validate and further refine this algorithm. Disclosure This work was supported by a National Grant PN-III-P2-2.1-CI-2018-1509.

The treatment of ovarian cancer continues to pose a challenge especially through the development of platinum-resistant disease and still has the highest mortality rate among gynecologic cancers. Patients are usually diagnosed with advanced stages where complete cytoreduction and standard platinum-based chemotherapy are the mainstay of treatment. Advances into the molecular underpinnings of DNA damage repair highlighted BRCA 1/2 and other related genes as key regulators of platinum sensitivity. Our study characterizes clinical features and outcomes associated with BRCA mutations in a cohort of ovarian cancer patients.Patient data from our Institute was retrospectively extracted for all patients that were tested for the presence of BRCA germline or somatic mutations through next generation sequencing between May 2016 and August 2018.Eighty-eight patients were included in the present analysis. Advanced FIGO stage IIIC-IV was common at presentation (71.6%), with 58% of patients undergoing primary debulking surgery. BRCA mutant cases represented 44% and were associated with a significantly higher frequency for complete pathologic response, first and second platinum sensitive relapse and a significantly longer overall survival for advanced stage cases treated with neoadjuvant chemotherapy. Mean age at presentation was significantly lower in the BRCA mutated (52 years) compared to BRCA wildtype patients (54.2 years, p=0.045).Upfront knowledge of BRCA status is encouraged, given the recent advent of targeted therapies and for the decision regarding optimal sequence of available therapeutic strategies.

e13554 Background: The value of real-world evidence derived from the care of patients managed outside the context of clinical trials is well recognised. However, the ability to link data from multiple centres, especially those from different countries, is complicated by complex legal and information governance differences. The Oncology Evidence Network is a collaboration of large hospital centres, with strong clinical informatics capabilities in six countries in Europe and Asia working with the support of an industrial partner to provide high quality, real world data reflecting routine clinical care. We have developed an efficient workflow based on a study-specific common data model (CDM) clinically validated at each site and analysed with a single analysis script, which embeds a set of data quality rules. Local implementation allows each centre to generate analytical outputs aligned across the different sites without the need for any patient level data to leave the participating site. This approach has been designed and tested in Epithelial Ovarian Cancer (EOC) patients. Methods: A CDM was agreed using expert advisors from each centre. Clinical alignment was achieved through iterative assessment of clinical vignettes, to ensure common definitions of clinical assessment, prognosis, and treatment algorithms in EOC patients. A data guide detailing variable level derivations and validation rules, general data coding principles, and conversions/codes from international coding systems was developed. The analysis scripts were implemented as a bespoke package (OpenOvary) in R. The package includes functions to validate the data against the CDM, and generate a standard output including tables, numerical summaries and Kaplan-Meier analysis of progression and overall survival. Results: 2,925 patient records from 6 centres across 6 countries were included in the study with 27 key data items curated by each centre. Treatment data is available detailing relevant surgical procedures and their outcomes, and regimens of SACT throughout patients’ care from diagnosis to death. Data completeness was generally high for key data items, with missing data ranging from 0-16% for FIGO stage at diagnosis and 0-14% for tumour morphology. The CDM and R script will be made publicly available for other centres to adopt and facilitate analysis of their local data. Conclusions: This collaboration has brought together a substantial body of data describing the care and outcomes for EOC patients. A CDM and flexible shared analysis approach enabled unified analysis and reporting whilst avoiding the transfer of patient level data and its pooling into a common database. The process of clinical and data alignment has generated a replicable model for rapid extension to other study centres to join the EOC study, or application to other disease areas.

5531 Background: Few major studies have examined and compared the management and outcomes of patients from diagnosis to death between countries. We have established an international collaboration across Europe and South Korea to compare treatment and outcomes in Epithelial Ovarian Cancer (EOC). Methods: Patients diagnosed with EOC between January 2012 and December 2018 (age ≥18), were included for analysis. Data from medical records from five European and a single South Korean treatment centre were extracted, standardised to a common data model and analysed at each centre using a common script developed in R. Time to each progression/recurrence event (defined as time to next treatment) and overall survival have been estimated using Kaplan Meier methodology and outcomes stratified by categories of interest. Changes in the use of anti-cancer therapies over time and the incidence of BRCA mutations and incidence/timing of second breast cancers have also been examined. Results: A total cohort of 2925 patients was identified with a median age at each centre of 53 to 67 years. Advanced disease (FIGO stage III - IV) (range 57% to 84%) and high-grade serous morphology (38% to 70%) were most common at each centre. The timing of surgery (primary, interval debulking or delayed) and the proportion of patients undergoing surgery varied with stage. Patients with stage I disease where most likely to undergo surgery (range 73% to 100%) and stage IV the least (range 39% to 84%). Median overall survival for high grade serous cancers ranged from 1.9 to 4.9 years, and for the whole cohort from 2.1 to 5.5 years. Median time to next treatment at first relapse for the whole cohort ranged from 14 to 22 months. Second breast cancers were noted in 6 to 17% of patients and the majority of these occurred before the diagnosis of EOC at a median time of 96 to 118 months prior to diagnosis of EOC. Additional data on treatment pathways, BRCA status and outcomes by line of therapy for each centre will be presented. Conclusions: Preliminary analysis of results across this network suggests a variation in patient populations between sites and substantial differences in both treatments and outcomes. The establishment of a common data model and the use of a common analytic script between sites across six different countries allows for detailed exploration of the factors influencing differences in patient management and treatment outcomes in ovarian cancer patients.

12023 Background: So-called long-term survivors (LTS) may be cured from cancer but still experience a wide range of long-term side effects. Aim was to analyze the main concerns in long-term survival to improve follow-up care. Methods: Within the study “Carolin meets HANNA” (www.carolinmeetshanna.com) long-term survivors with ovarian cancer (LTS) were recruited since 11/2016. Long-term survival was defined as an ovarian cancer diagnosis more than five years ago. Results: Until 02/2021 1,044 long-term survivors with ovarian cancer could be recruited. Median survival time at recruitment was 11 years (range 5-43 years). More than half had been diagnosed with advanced stage ovarian cancer (58.6% FIGO III/IV). Almost half have developed recurrent disease (43.4%). 26.0% were under cancer treatment at recruitment. Health status was rated very good or good by 52.0% while 20.3% report a bad or very bad health status. Almost half of the LTS have current concerns/long-term side effects (46.1%). Main concerns are fatigue (23.9%), pain (21.6%), polyneuropathy (16.9%), gastrointestinal symptoms (16.6%) and memory problems (15.5%). 42.8% still regard themselves as cancer patients. Health status and distress did not differ between LTS 5-10 years after diagnosis and > 10 years after diagnosis (p = 0.59 and p = 0.0843 respectively). Patients with a history of recurrence and those under current treatment had a worse health status and more health concerns. LTS without recurrence reported fatigue in 18.4%, pain in 19.2%, polyneuropathy in 13.1%, gastrointestinal problems in 13.4% and memory problems in 14.4%. Fatigue, polyneuropathy, nausea and concentration problems improve with the time of survival. However, fatigue is still present in 21.1% after ten years survival time. There was no significant difference in pain between 5-10 (20.1%) and > 10 years (22.0%) survival time. In this cohort 94.2% receive regular follow-up care including CA125 testing in 77.0%, clinical examination in 54.3%, transvaginal ultrasound in 55.1%, abdominal ultrasound in 43.9%, mammogram in 50.5% and further radiological examinations such as CT scans in 53.4%. Conclusions: Follow-up care in ovarian cancer is usually delivered within the first five years after diagnosis. However, our analyses show the high frequency of health concerns in LTS despite the high frequency of follow-up care in this cohort. Therefore, specialized survivorship care should be offered beyond the typical five years of follow-up care with a focus on long-term side effects.

Pupose: Nestin and CD133 are regarded as putative markers of cancer stem cells (CSCs) and related to poor prognosis in various cancer sites. Since few studies have focused on their role in ovarian cancer, we aimed to investigate their predictive value and association with neoangiogenesis.Immunohistochemical analysis for nestin and CD133 was performed on 85 serous ovarian carcinoma tumor samples using tissue microarray technique. Nestin immunoreactivity was detected in both tumor and endothelial cells, whilst CD133 was only identified in tumor cells. CD34 endothelial expression was used to assess intratumor microvessel density (MVD).Of the tissue samples 49.4% were nestin-positive and 24.7% were positive for CD133. In both univariate and multivariate analysis nestin or CD133 expressions in tumor cells were not significantly associated with clinicopathological parameters (age, serum CA125, peritoneal carcinomatosis, malignant ascites, tumor grade). However, in multivariate analysis nestin expression in tumor cells proved to be an independent prognostic factor, associated with poorer survival and time to progression (p=0.025 and p=0.05, respectively). This has not been achieved for CD133. Furthermore, a significant concordance between nestin endothelial expression (nestin-determined MVD) and CD34-determined MVD was achieved.In addition to the well-known clinicopathological characteristics, tumor expression of nestin might be a valuable prognostic factor for survival in patients with advanced ovarian cancer. With regard to its endothelial expression, nestin might be as reliable as CD34 for quantifying tumor angiogenesis. Further investigation is justified in order to better clarify the role of these biomarkers.

The tumor microenvironment in ovarian cancer (OC) seems to play an important role, and besides tumor cells, biomarkers can derive from endothelial cells. We investigated CDCP1 and ADAM12 expression in relation with other clinical and pathological characteristics in OC patients.We retrospectively evaluated patient files between 2006-2011. A histochemical score was developed to evaluate tumor staining, the microvessel density (MVD), and stromal expression patterns for both ADAM12 and CDCP1. A CD34 antibody was used to assess tumor MVD.102 patients were selected and 83% had FIGO stage III/IV. A high CDCP1 tumor score correlated significantly with a shorter overall survival (OS) (p0.01). Cases with positive CDCP1 had an elevated CD34 MVD (p0.01). An absent/low ADAM12 tumor score correlated with significantly improved OS (p0.01). Mean CD34 MVD was higher in cases with positive ADAM12 MVD (p=0.012).Our results indicate that both tumor markers are negative prognostic factors for overall survival and additional studies are required to validate their future potential.

Ovarian cancer (OC) is the second most common gynecological cancer and the deadliest in industrialized countries, with poor outcomes that indicate an urgent need to provide a greater insight into the molecular mechanisms underlying OC. Insights into the complex tumor microenviroment show that besides tumor islets, OC biomarkers can derive from newly formed blood vessels that have endothelial cells with a different molecular signature in comparison with their normal counterparts. In this view, recent research has been able to highlight promising candidates such as CDCP1 and ADAM12. Our present review summarises their implications in cancer progression with a focus on OC.

Tumor angiogenesis is regarded as a hallmark of cancer and provides an important target for therapy. Nestin is an intermediate filament protein (IF) originally recognized as a neural stem cell marker. Development and progression of cancer requires sustained angiogenesis, dependent on the proliferation and migration of endothelial cells which seem to be better portrayed by nestin expression in various malignancies such as central nervous system, gastro-intestinal cancers, malignant melanoma, lung, prostate or breast cancer. The purpose of the present review was to emphasize the insights into nestin expression in relation to tumor angiogenesis in different types of cancer. Current evidence suggests that nestin positivity in tumor cells reflects stem-like properties of those cells. Whether or not expressed in both tumor and endothelial cells, nestin overexpression might reflect the extent of angiogenesis and function as a molecular anti-angiogenic target for cancer.

Morphopathological factors continue to be the most important prognostic factors in colorectal cancer, but there is evidence regarding the prognostic value of some factors that are not yet used in current clinical practice. The purpose of the present study was to evaluate the most important clinical, morphopathological and therapeutic prognostic factors in rectal cancer.This study retrospectively analyzed 317 patients diagnosed and treated at the Ion Chiricuta Institute of Oncology between 2000-2008. The prognostic value of 13 variables was analyzed and correlations between them were established. Nine variables were included in a multivariate analysis model.The 5-year overall survival (OS) was 55.6%, significantly higher for patients with TNM stage I disease 7l.7%), compared to stage II (71.4%), stage III (45.4%) and stage IV (12.5%; p0.001). In multivariate analysis, the independent prognostic factors were tumor stage, age, lymph node invasion, venous, lymphatic and perineural invasion.In addition to the TNM stage and lymph node invasion, age, venous, lymphatic and perineural invasion were also proved to have prognostic significance in rectal cancer. Further studies are required for the validation of prognostic assessment models in patients diagnosed with rectal cancer.

The evaluation of CD3(+) T-cell density is believed to have a higher prognostic value than the conventionally used TMN stage in colorectal cancer (CRC), but the role of regulatory T lymphocytes (Treg) is still debated. Our study determined the prognostic value of forkhead box P3 nuclear transcription factor (FOXP3) positive Treg and CD3(+) T-cells in the invasive margin of CRC compared with other known prognostic factors.The prognostic factors analysed in 42 patients with CRC stage II (N=13) and III (N=29), were age, tumor location, TNM stage, histological grade, vascular, lymphatic and perineural invasion. CD3(+) T-cells and FOXP3(+) Treg density was evaluated by immunohistochemistry.The median CD3(+) T-cells and FOXP3(+) Treg density was 438.93/mm(2) and 162.25/mm(2), respectively. Patients with high FOXP3(+) Treg density showed improved 5-year survival rate of 89.41%, compared with 64.6% of those with low density (p=0.024).Increased CD3(+) T-cells and FOXP3(+) Treg density is associated with improved survival, but only the latter proved to be an independent prognostic factor. FOXP3(+) Treg infiltrate may play an important prognostic role, which, in combination with other predictive factors, could lead to the development of specific treatment regimens.

Overexpression of Inhibitor of DNA-binding 1 protein (ID-1) is correlated with poor prognosis in some malignancies and few studies have assessed its role in ovarian cancer. This led us to investigate its association with the microvessel density (MVD) in patients with ovarian cancer.Fifty-six patients with epithelial serous ovarian cancer were selected. The early-stage group consisted of 14 patients and the advanced-stage group comprised 42 patients. ID-1 expression and MVD were evaluated by immunohistochemistry.The histoscore for ID-1 and MVD were significantly higher in advanced-stage cancer (p0.05). The MVD was significantly higher in the high ID-1 expression group compared to the low ID-1 expression group (p0.001). The mean follow-up time was 52 months. The survival period in patients with high ID-1 expression was not significantly shorter than for those with low ID-1 expression (p=0.62). The role of ID-1 protein requires further investigation.

We have investigated a relational model of expectations and preferences among ovarian cancer patients centred on physician–patient communication, treatment approach, and the need for information. Consecutive patients anonymously filled in the EXPRESSION III questionnaire between 2009 and 2012. Following descriptive statistics, structural equation modelling was used to analyse the relationships between physician's evaluation by the patient (PEP), result of therapy (RT), need for changes in treatment (NCT) and patient's desire to be informed (PD). From a total of 108 patients, 53 (49.1%) knew their disease stage, 103 (95.4%) underwent surgery, 91 (84.3%) had chemotherapy and 51 (46.3%) relapsed. The final model demonstrated a good fit of data with fit indices >0.90. There was a significant positive effect of PEP on RT and a significant negative effect of PEP on NCT, with the final model explaining 84% of the NCT variance. Physicians represent the main point of contact, not only as a source of information about the disease and various treatment options, but also in the coping processes. As patients benefit from completeness of medical consultations, their awareness of the treatment outcome increases, while a negative perception of the physician leads to a desire to make changes in therapy.