Menopausal Status Combined with Serum CA125 Level Significantly Predicted Concurrent Endometrial Cancer in Women Diagnosed with Atypical Endometrial Hyperplasia before Surgery

About 10–66% of patients with atypical endometrial hyperplasia diagnosed before surgery (preoperative-AEH) are found to have concurrent endometrial cancer (EC) at definitive hysterectomy, leading to incomplete primary surgery and delayed adjuvant treatment. This study aims to investigate the potential risk factors of concurrent EC in preoperative-AEH patients in a clinical setting with a gynecological pathology review. All patients diagnosed with AEH by endometrial biopsy or curettage that then underwent definitive hysterectomy from January 2016 to December 2019 in a tertiary hospital were retrospectively analyzed. All diagnoses were reviewed by gynecological pathologists. A total of 624 preoperative-AEH patients were included, 30.4% of whom had concurrent EC. In multivariate analysis, postmenopausal status and CA125 ≥ 35 U/mL significantly correlated with concurrent EC (OR = 3.57; 95% CI = 1.80–7.06; OR = 2.15; 95% CI = 1.15–4.03). This risk was remarkably increased in patients with both postmenopausal status and CA125 ≥ 35 U/mL (OR = 16.20; 95% CI = 1.73–151.44). Notably, concurrent EC seemed to occur more frequently in women with postmenopausal time ≥ 5 years (OR = 4.04, 95% CI = 1.80–5.85). In addition, CA125 ≥ 35 U/mL seemed to be an independent risk factor (OR = 5.74; 95% CI = 1.80–18.27) for concurrent intermediate-high-risk EC. Intermediate-high-risk EC was also more commonly seen in preoperative-AEH women with postmenopausal time ≥ 5 years (OR = 5.52, 95% CI = 1.21–25.19, p = 0.027). In conclusion, preoperative-AEH patients with postmenopausal status or elevated level of CA125 might have a high risk of concurrent EC. Adequate pre-surgical evaluation might be suggested for such patients.

The Association between Fat Taste Sensitivity, Eating Habits, and Metabolic Health in Menopausal Women

The aim of our study was to evaluate the associations between sensitivity to fat taste, eating habits and BMI value in a sample of menopausal Polish women. In a population of 95 women, fat taste thresholds with oleic acid were determined, allowing us to classify each woman as a hypersensitive or hyposensitive taster. Eating habits were assessed using a validated KomPAN questionnaire for food frequency. Dietary intake was evaluated based on a food diary. Selected biochemical parameters were measured using a Konelab20i biochemical analyzer. Anthropometric parameters and blood pressure were also measured. Twenty-two menopausal women were classified as hyposensitive to fat taste and 73 as hypersensitive. The hyposensitive tasters were significantly older (p = 0.006), with the majority of them (92%) being postmenopausal (p < 0.001); this group had significantly higher BMI values (p < 0.001) and other adiposity indicators compared to their hypersensitive counterparts. The hyposensitive tasters had higher blood pressure (systolic blood pressure; SBP p = 0.030; diastolic blood pressure; DBP p = 0.003), glucose (p = 0.011) and triacylglycerols levels than the hypersensitive tasters (p = 0.031). Almost half of them had diagnosed metabolic syndrome. Daily eating occasions were associated with low oral fatty acid sensitivity, irrespective of age (p = 0.041) and BMI value (p = 0.028). There were also significant associations between frequency of consumption of meats and eggs, as well as snacks and fast foods and low oral fatty acid sensitivity before adjustment for potential confounders (both associations p < 0.05), which remained after adjustment for age (both associations p < 0.05), but not after adjustment for BMI. A multivariate logistic regression analysis showed that higher BMI value (p = 0.003), along with postmenopausal status (p = 0.003), were associated with low fat taste sensitivity irrespective of age and consumed percentage energy from fat. Postmenopausal status and BMI are associated with low fat taste sensitivity. Fat hyposensitivity may also play a role in eating habits, leading to increased eating occasions and favoring certain types of food. These eating habits may determine increased body weight and the occurrence of metabolic syndrome in mid-life women, especially those who have undergone menopause and have been exposed to the physiological changes which are conducive to these relationships.

Alcohol consumption and breast cancer risk

Background: Breast cancer (BC) is the most common disease in women around the world. The risk factors associated to BC have been widely discussed in the literature, however, the possible effect of alcohol consumption remains unclear and requires further clarification and in-depth understanding. In this mini-review, we discusse numerous prospective studies conducted from 1989 to 2018 to monitor the emergence of BC, and to clarify the association between alcohol consumption and BC risk. Results: Alcohol consumption is positively associated with the risk of BC compared to non-drinkers. The findings showed that this positive association could be influenced by several factors, including age, premenopausal and postmenopausal status, social factors ,duration and intensity of alcohol use and family history. Conclusion: There is a positive effect of alcohol consumption BC risk at all levels of consumption.

Risk Factors Associated to Residual Tumor in Re-excision for Positive Margins in Breast Conservative Surgery

Background Breast conservative surgery (BCS) is an adequate treatment for patients with early breast cancer. Local recurrence is associated with diverse factors. Our objective was to evaluate risk factors associated with finding residual tumor in patients with positive margins in BCS. Methods Observational retrospective study, including patients diagnosed with breast cancer undergoing BCS between 2000 and 2016. Clinicopathological and treatment variables were collected. Main outcome was the finding of residual tumor on re-excision. Positive margins were defined as tumor present on ink. Results Three hundred and six patients underwent BCS. Mean age was 57 ± 12.2 years. Positive margins were found in 84 (27.4%) patients, 15 (4.9%) had unknown margin status, and 207 (67.6%) had negative margins. Seventy-eight patients from the positive margin group and 23 patients from the unknown/negative margin group were reintervened. Residual tumor was present in 41% of patients with positive margins and in 45% of patients with negative margins ( P = .192). In univariate analysis, overweight (P = .04) and positive axillary lymph nodes ( P = .02) were associated with residual tumor on re-excision. In multivariate analysis, postmenopausal status was a protective factor (HR .047, P = .30). Mean follow-up was 58.4 months and mean local recurrence-free survival (LRFS) was 56.4 months (.1-203.2), with no difference regarding margin status or residual tumor. Discussion Postmenopausal status was associated with a decreased rate of residual tumor in patients with positive margins. The presence of residual tumor on re-excision was not associated with a lower LRFS. These factors must be considered when positive margins are present in BCS.

Palliative Care in Gynaecological Oncology

Palliative care in gynaecologic oncology focuses on specific and severe symptoms resulting from affected abdominal and pelvic organs and feminine genitals. These symptoms are mainly connected to advanced gynaecologic malignancies. Patients with locally advanced or recurrent gynaecologic cancers may present with various symptoms. Among those we discuss vaginal bleeding, vaginal discharge and fistulas. Vice versa non-malignant diseases and non-pelvic site diseases such as inflammations, overdose of anticoagulants, wounds or pressure ulcers may have similar clinical manifestation. Some symptoms may result from aggressive cancer treatment (oncological surgery, radiotherapy) with curative intent. Some symptoms get worse on account of the postmenopausal status (natural or artificial following any type of ovarian failure). For advanced gynae-oncological diseases it has been in practise, that the best palliative care is offered and practised simultaneously with curative treatment. The problematics of gynaecologic symptoms in palliative care represents delicate and intimate sphere and it may disturb patient’s autonomy and dignity. The mission of physicians, nurses and caregivers is to consider treatment options thoroughly in context of patient’s quality of life, prognosis and life conditions to fulfil the ideals of the best symptomatic and supportive care.

Clinicopathological Prognostic Factors Influencing Survival Outcomes of Vulvar Cancer

Backgroud: Squamous cell carcinoma (SCCA) is the most common vulva cancer. This study purpose to evaluate the clinicopathological prognostic factors for survival outcomes of this disease after treated with surgery. Methods: All SCCA vulva cancer patients who underwent surgery between January 2006 and December 2017 were reviewed. The clinicopathological factors were analyzed to identify the prognostic factors for the progression-free survival (PFS) and overall survival (OS) using the Kaplan- Meier method and Cox-Proportional Hazard model.Results: One hundred twenty-five patients were recruited with a median age of 57 years. The recurrence rate was 35.2%. Patients with recurrence revealed a significant poorer five-year OS rate than those who did not recur (23.7% vs. 79.4%, P < 0.001). About 58.1% of palpable groin nodes revealed metastasis. The independent poor prognostic factors for PFS were groin node-positive and a tumor diameter more than 25 mm. whereas postmenopausal status, preoperative tumor area more than 11 cm2, and groin node enlargement were independent poor prognostic factors for OS. Conclusion: Groin node-positive and tumor diameter longer than 25 mm. were independent poor prognostic factors for PFS whereas postmenopausal status, large tumor area than 11 cm2, and enlargement of groin nodes were independent poor prognostic factors for OS. Patients with these factors should be closely followed.

HER2-Positive Breast Cancer Patients with Pre-Treatment Axillary Involvement or Postmenopausal Status Benefit from Neoadjuvant Rather than Adjuvant Chemotherapy Plus Trastuzumab Regimens

Background: No survival benefit has yet been demonstrated for neoadjuvant chemotherapy (NAC) against HER2-positive tumors in patients with early breast cancer (BC). The objective of this study was to compare the prognosis of HER2-positive BC patients treated with NAC to that of patients treated with adjuvant chemotherapy (AC). Materials and methods: We retrospectively analyzed disease-free (DFS) and overall survival (OS) in 202 HER2-positive patients treated with NAC and 701 patients treated with AC. All patients received trastuzumab in addition to chemotherapy. Patient data were weighted by a propensity score to overcome selection bias. Results: After inverse probability of treatment weights (IPTW) adjustment, no difference in DFS (p = 0.3) was found between treatments for the total population. However, after multivariate analysis, an interaction was found between cN status and chemotherapy strategy (IPTW-corrected corrected Hazard ratio cHR = 0.52, 95% CI (0.3–0.9), pinteraction = 0.08) and between menopausal status and chemotherapy (CT) strategy (cHR = 0.35, 95%CI (0.18–0.7)) pinteraction < 0.01). NAC was more beneficial than AC strategy in cN-positive patients and in postmenopausal patients. Moreover, after IPTW adjustment, the multivariate analysis showed that the neoadjuvant strategy conferred a significant OS benefit (cHR = 0.09, 95%CI [0.02–0.35], p < 0.001). Conclusion: In patients with HER2-positive BC, the NAC strategy is more beneficial than the AC strategy, particularly in cN-positive and postmenopausal patients. NAC should be used as a first-line treatment for HER2-positive tumors.