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  • 1.
    Bjurberg, Maria
    et al.
    Lund Univ, Sweden.
    Holmberg, Erik
    Reg Canc Ctr West, Sweden; Sahlgrens Acad, Sweden.
    Borgfeldt, Christer
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Floter-Radestad, Angelique
    Karolinska Inst, Sweden.
    Dahm-Kahler, Pernilla
    Sahlgrens Univ Hosp, Sweden.
    Hjerpe, Elisabet
    Visby Hosp, Sweden.
    Hogberg, Thomas
    Lund Univ, Sweden.
    Kjölhede, Preben
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Marcickiewicz, Janusz
    Reg Canc Ctr West, Sweden; Halland Hosp, Sweden.
    Rosenberg, Per
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi.
    Stalberg, Karin
    Uppsala Univ, Sweden.
    Tholander, Bengt
    Uppsala Univ Hosp, Sweden.
    Hellman, Kristina
    Karolinska Univ Hosp, Sweden.
    Åvall Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Primary treatment patterns and survival of cervical cancer in Sweden: A population-based Swedish Gynecologic Cancer Group Study2019Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 155, nr 2, s. 229-236Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Survival in cervical cancer has improved little over the last decades. We aimed to elucidate primary treatment patterns and survival. Methods: Population-based study of patients included in the Swedish Quality Registry for Gynecologic Cancer diagnosed 2011-2015. Main outcome was 5-year relative survival (RS). Age-standardised RS (AS-RS) was estimated for the total cohort and for the pooled study population of squamous, adenosquamous-, adenocarcinoma. Results: Median follow-up time was 4.6 years. The study population consisted of 2141 patients; 97% of the 2212 patients in the total cohort and the 5-year AS-RS was 71% and 70%, respectively. RS stage IB1: surgery alone 95% vs. 72% for definitive chemoradiotherapy (CT-RT) (p amp;lt; 0.001). In stage IIA1 74% had CTRL, and 47% of operated patients received adjuvant (CT)-RT. RS stage IB2: surgically treated 81% (69% received adjuvant (CT)-RT) vs. 76% for (CT)-RT (p = 0.73). RS stage IIB: 77% for CT-RT + brachytherapy BT), 37% for RT + BT (p = 0.045) and 27% for RT-BT (p amp;lt; 0.001). Stages III-IVA; amp;lt;40% received CT-RT + BT, RS 45% vs. 18% for RT-BT (RR 4.1, p amp;lt; 0.001). RS stage IVB 7%. Conclusion: Primary treatment of cervical cancer in Sweden adhered to evidence-based standard of care. Areas of improvement include optimising treatment for stages III-IVA, and avoiding combining surgery and radiotherapy. (C) 2019 Elsevier Inc. All rights reserved.

  • 2.
    Campbell, Rachel
    et al.
    Univ Sydney, Australia.
    Costa, Daniel S. J.
    Univ Sydney, Australia.
    Stockler, Martin R.
    Univ Sydney, Australia.
    Lee, Yeh Chen
    Univ Sydney, Australia; Australia New Zealand Gynaecol Oncol Grp ANZGOG, Australia; Prince Wales Hosp, Australia.
    Ledermann, Jonathan A.
    NCRI UK, England.
    Berton, Dominique
    GINECO Grp Invest Nationaux Etud Canc Ovariens, France; Ctr Rene Gauducheau, France.
    Sehouli, Jalid
    Arbeitsgesmeinschaft Gynakol Onkol Studiengrp AGO, Germany; North Eastern German Soc Gynecol Oncol NOGGO, Germany; Charite, Germany.
    Roncolato, Felicia T.
    Univ Sydney, Australia; Australia New Zealand Gynaecol Oncol Grp ANZGOG, Australia; Prince Wales Hosp, Australia; Campbelltown Hosp, Australia.
    Connell, Rachel O.
    Univ Sydney, Australia.
    Okamoto, Aikou
    Japanese Gynecol Oncol Grp JGOG, Japan; Jikei Univ, Japan.
    Bryce, Jane
    Ist Nazl Tumori IRCCS, Italy; Ascens St John Clin Res Inst, OK USA.
    Oza, Amit M.
    Princess Margaret Consortium PMHC, Canada; Univ Toronto, Canada.
    Åvall Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US. Nordic Soc Gynaecol Oncol NSGO, Denmark; Karolinska Inst, Sweden.
    Berek, Jonathan S.
    Cooperat Gynecol Oncol Investigators COGI, CA USA; Stanford Univ, CA USA.
    Lanceley, Anne
    UCL, England.
    Joly, Florence
    GINECO Grp Invest Nationaux Etud Canc Ovariens, France; Ctr Francois Baclesse, France.
    Hilpert, Felix
    Arbeitsgesmeinschaft Gynakol Onkol Studiengrp AGO, Germany; North Eastern German Soc Gynecol Oncol NOGGO, Germany; Krankenhaus Jerusalem, Germany.
    Feeney, Amanda
    NCRI UK, England.
    Kaminsky, Marie C.
    GINECO Grp Invest Nationaux Etud Canc Ovariens, France; Alexis Vautrin, France.
    Diamante, Katrina
    Univ Sydney, Australia.
    Friedlander, Michael L.
    Australia New Zealand Gynaecol Oncol Grp ANZGOG, Australia; Prince Wales Hosp, Australia.
    King, Madeleine T.
    Univ Sydney, Australia.
    Measure of Ovarian Symptoms and Treatment concerns (MOST) indexes and their associations with health-related quality of life in recurrent ovarian cancer2022Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 166, nr 2, s. 254-262Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose. The Measure of Ovarian Symptoms and Treatment (MOST) concerns is a validated patient-reported symptom assessment tool for assessing symptom benefit and adverse effects of palliative chemotherapy in women with recurrent ovarian cancer (ROC). We aimed to examine (i) how symptoms within MOST symptom indexes track together (i.e. co-occur) and (ii) the association between MOST symptom indexes and key aspects of health-related quality of life (HRQL). Method. A prospective cohort of women with ROC completed the MOST-T35, EORTC QLQ-C30 and EORTC QLQ-OV28 at baseline and before each cycle of chemotherapy. Analyses were conducted on baseline and end -of-treatment data. Exploratory factor analysis and hierarchical cluster analysis identified groups of co-occurring symptoms. Path models examined associations between MOST symptom indexes and HRQL. Results. Data from 762 women at baseline and 681 at treatment-end who completed all 22 symptom-specific MOST items and at least one HRQL measure were analysed. Four symptom clusters emerged at baseline and treatment-end: abdominal symptoms, symptoms associated with peripheral neuropathy, nausea and vomiting, and psychological symptoms. Psychological symptoms (MOST-Psych) and symptoms due to disease (ovarian cancer) or treatment (MOST-DorT) were associated with poorer scores on QLQ-C30 and OV28 functioning do-mains and worse overall health at both time points. Conclusion. Four MOST symptom clusters were consistent across statistical methods and time points. These findings suggest that routine standardized assessment of psychological and physical symptoms in clinical prac-tice with MOST plus appropriate symptom management referral pathways is an intervention for improving HRQL that warrants further research. (c) 2022 Elsevier Inc. All rights reserved.

  • 3.
    Corvigno, Sara
    et al.
    Karolinska Inst, Sweden; Uppsala Univ, Sweden.
    Mezheyeuski, Artur
    Karolinska Inst, Sweden; Uppsala Univ, Sweden.
    De La Fuente, Laura Martin
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Westbom-Freme, Sofia
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Carlson, Joseph W.
    Karolinska Inst, Sweden.
    Fernebro, Josefin
    Karolinska Univ Hosp, Sweden; Uppsala Univ, Sweden.
    Åvall Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US. Karolinska Inst, Sweden.
    Kannisto, Paivi
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Hedenfalk, Ingrid
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Malander, Susanne
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Rolny, Charlotte
    Karolinska Inst, Sweden.
    Dahlstrand, Hanna
    Karolinska Inst, Sweden; Uppsala Univ, Sweden.
    Östman, Arne
    Karolinska Inst, Sweden.
    High density of stroma-localized CD11c-positive macrophages is associated with longer overall survival in high-grade serous ovarian cancer2020Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 159, nr 3, s. 860-868Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Pre-clinical studies have identified markerand tumor compartment-defined functionally distinct macrophage subsets. Our study analyzes marker-defined macrophage subsets in different tumor compartments of high-grade serous ovarian cancer (HGSC). Methods. A discovery cohort (N = 113) was subjected to immunohistochemistry (IHC) analyses. CD68-positivity was confirmed for CD11c-, CD80and CD163-positive cells. Subset-marker-positive cells were scored in the total tumor and in four tumor compartments. Correlation analyses investigated co-expression of subsets, relationship to CD8(+) cells and survival associations. A validation cohort (N = 121) was used to confirm selected findings from the discovery cohort. Results. CD163-positve cells was the most abundant subtype in all compartments. CD11c and CD163 subsets were strongly correlated with each other in stroma and epithelial areas, whereas CD80 and CD163 were correlated in epithelial areas. CD80 and CD11c in perivascular areas showed low correlations. Strong associations were detected between CD8 and CD80 in the tumor epithelium-dominated areas, and between CD8 and CD11c in stroma areas. High stromal CD11c density was associated with a longer median overall survival in the discovery cohort (HR 0.39; CI 95%, 0.23-0.68; p = 0.001) and in the validation cohort (HR 0.46; CI 95%, 0.22-0.93; p = 0.03). Conclusions. Our study supports the existence of clinically relevant markerand localization defined macrophage subsets in HGSC, which are independently regulated. Moreover, it suggests stromal CD11c as a novel prognostic marker in HGSC. (C) 2020 Elsevier Inc. All rights reserved.

  • 4.
    Dahm-Kahler, Pernilla
    et al.
    Univ Gothenburg, Sweden.
    Holmberg, Erik
    Reg Canc Ctr Western Sweden, Sweden.
    Holtenman, Mikael
    Reg Canc Ctr Western Sweden, Sweden.
    Radestad, Angelique Floter
    Karolinska Inst, Sweden.
    Borgfeldt, Christer
    Lund Univ, Sweden.
    Hjerpe, Elisabet
    Visby Hosp, Sweden.
    Marcickiewicz, Janusz
    Varbergs Hosp, Sweden.
    Bjurberg, Maria
    Lund Univ, Sweden.
    Tholander, Bengt
    Uppsala Univ Hosp, Sweden.
    Hellman, Kristina
    Karolinska Univ Hosp, Sweden.
    Kjölhede, Preben
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Hogberg, Thomas
    Lund Univ, Sweden.
    Rosenberg, Per
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Åvall Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Stalberg, Karin
    Uppsala Univ, Sweden.
    Implementation of National Guidelines increased survival in advanced ovarian cancer: A population-based nationwide SweGCG study2021Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 161, nr 1, s. 244-250Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim. The first Swedish National Guidelines for Ovarian Cancer (NGOC) were published in 2012. We aimed to evaluate surgical outcomes and survival in patients with stage IIIC-IV disease, before and after the NGOC implementation. Method. Women with primary epithelial ovarian cancer, FIGO stage IIIC?IV, registered in the Swedish Quality Registry for Gynecologic Cancer 2008?2011 and 2013?2016 were included. Surgical outcomes were analyzed, including frequency of complete cytoreduction (R0). Relative survival (RS) and excess mortality rate ratios (EMRRs) were computed as measures of survival. Univariable and multivariable regression (Poisson) were calculated. Results. In total, 3728 women were identified, 1746 before and 1982 after NGOC. After adjusting for age and stage, survival was improved 2013?2016 vs. 2008?2011 (EMRR 0.89; 95%CI:0.82?0.96, p < 0.05). For women undergoing primary debulking surgery (PDS), R0 frequency (28.9% vs. 53.3%; p < 0.001) and 5-year RS (29.6% (95% CI:26.8?32.8) vs. 37.4% (95%CI:33.6?41.7)) were increased, but fewer patients (58% vs. 44%, p < 0.001) underwent PDS after NGOC implementation. Median survival for the PDS cohort increased from 35 months (95%CI,32.8?39.2) to 43 months (95%CI,40.9?46.4). In the neoadjuvant chemotherapy (NACT) + interval debulking surgery (IDS) cohort, R0 increased (36.8% to 50.1%, p < 0.001), but not 5-year RS (17.5% vs. 20.7%,ns). Compared to PDS, the EMRR was 1.32 (95%CI,1.19 & ndash;1.47, p < 0.001) for NACT+IDS and 3.00 (95% CI,2.66 & ndash;3.38, p < 0.001) for chemotherapy alone. In multivariable analyses, PDS, R0, age <= 70 years, and stage IIIC were found to be independent factors for improved RS. Conclusion. Implementation of the first National Guidelines for Ovarian Cancer improved relative survival in advanced ovarian cancer. (c) 2021 Published by Elsevier Inc.

  • 5.
    Dahm-Kahler, Pernilla
    et al.
    Univ Gothenburg, Sweden; Reg Canc Ctr Western Sweden, Sweden; Gothenburg Univ, Sweden.
    Radestad, Angelique Floter
    Karolinska Univ Hosp, Sweden; Karolinska Univ Hosp, Sweden.
    Holmberg, Erik
    Reg Canc Ctr Western Sweden, Sweden.
    Borgfeldt, Christer
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Bjurberg, Maria
    Lund Univ, Sweden.
    Skold, Camilla
    Uppsala Univ, Sweden.
    Hellman, Kristina
    Karolinska Univ Hosp, Sweden.
    Kjölhede, Preben
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Stalberg, Karin
    Uppsala Univ, Sweden.
    Åvall Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Has time to chemotherapy from primary debulking surgery in advanced ovarian cancer an impact on survival? - A population-based nationwide SweGCG study2024Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 186, s. 69-76Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. The aim of the study was to investigate if time to start chemotherapy (TTC) after primary debulking surgery (PDS) impacted relative survival (RS) in advanced epithelial ovarian/fallopian tube/primary peritoneal cancer (EOC). Methods. Nationwide population-based study of women with EOC FIGO stages IIIC-IV, registered 2008-2018 in the Swedish Quality Register for Gynecologic Cancer, treated with PDS and chemotherapy. TTC was categorized into; <= 21 days, 22-28 days, 29-35 days, 36-42 days and > 42 days. Relative survival (RS) was estimated using the Pohar-Perme estimate of net survival. Multivariable analyses of excess mortality rate ratios (EMRRs) were estimated by Poisson regression models. Results. In total, 1694 women were included. The median age was 65.0 years. Older age and no residual disease were more common in TTC >42 days than 0-21 days. The RS at 5-years was 37.9% and did not differ between TTC groups. In the R0 (no residual disease) cohort (n = 806), 2-year RS was higher in TTC <= 21 days (91.6%) and 22-28 days (91.4%) than TTC >42 days (79.1%). TTC >42 days (EMRR 2.33, p = 0.026), FIGO stage IV (EMRR 1.83, p = 0.007) and non-serous histology (EMRR 4.20, p < 0.001) were associated with 2-year worse excess mortality compared to TTC 0-21 days, in the R0 cohort. TTC was associated with 2-year survival in the R0 cohort in FIGO stage IV but not in stage IIIC. TTC was not associated with RS in patients with residual disease. Conclusions. For the entire cohort, stage IV, non-serous morphology and residual disease, but not TTC, influenced 5-year relative survival. However, longer TTC was associated with a poorer 2-year survival for those without residual disease after PDS. (c) 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

  • 6.
    Dahm-Kähler, Pernilla
    et al.
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden. Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Borgfeldt, Christer
    Department of Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden.
    Holmberg, Erik
    Regional Cancer Center Western Sweden, Sahlgrenska University Hospital, Gothenburg, Sweden. Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Staf, Christian
    Regional Cancer Center Western Sweden, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Falconer, Henrik
    Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
    Bjurberg, Maria
    Department of Clinical Sciences, Skåne University Hospital, Lund, Sweden.
    Kjölhede, Preben
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Rosenberg, Per
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Stålberg, Karin
    Department of Women's and Children's health Uppsala University, Uppsala, Sweden.
    Högberg, Thomas
    Department of Cancer Epidemiology, Lund University, Lund, Sweden.
    Åvall-Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US. Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
    Population-based study of survival for women with serous cancer of the ovary, fallopian tube, peritoneum or undesignated origin - on behalf of the Swedish gynecological cancer group (SweGCG).2017Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 144, nr 1, s. 167-173Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The aim of the study was to determine survival outcome in patients with serous cancer in the ovary, fallopian tube, peritoneum and of undesignated origin.

    METHODS: Nation-wide population-based study of women≥18years with histologically verified non-uterine serous cancer, included in the Swedish Quality Registry for primary cancer of the ovary, fallopian tube and peritoneum diagnosed 2009-2013. Relative survival (RS) was estimated using the Ederer II method. Simple and multivariable analyses were estimated by Poisson regression models.

    RESULTS: Of 5627 women identified, 1246 (22%) had borderline tumors and 4381 had malignant tumors. In total, 2359 women had serous cancer; 71% originated in the ovary (OC), 9% in the fallopian tube (FTC), 9% in the peritoneum (PPC) and 11% at an undesignated primary site (UPS). Estimated RS at 5-years was 37%; for FTC 54%, 40% for OC, 34% for PPC and 13% for UPS. In multivariable regression analyses restricted to women who had undergone primary or interval debulking surgery for OC, FTC and PPC, site of origin was not independently associated with survival. Significant associations with worse survival were found for advanced stages (RR 2.63, P<0.001), moderate (RR 1.90, P<0.047) and poor differentiation (RR 2.20, P<0.009), neoadjuvant chemotherapy (RR1.33, P<0.022), residual tumor (RR 2.65, P<0.001) and platinum single (2.34, P<0.001) compared to platinum combination chemotherapy.

    CONCLUSION: Survival was poorer for serous cancer at UPS than for ovarian, fallopian tube and peritoneal cancer. Serous cancer at UPS needs to be addressed when reporting and comparing survival rates of ovarian cancer.

  • 7.
    Heitz, F.
    et al.
    Evangelische Huyssens Stiftung, Germany; Charite Univ Med Berlin, Germany; Free Univ Berlin, Germany; Humboldt Unive Berlin, Germany; Berlin Inst Hlth, Germany; AGO Study Grp, Germany.
    Harter, P.
    Evangelische Huyssens Stiftung, Germany; AGO Study Grp, Germany.
    Åvall-Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US. Karolinska Inst, Linkoping, Sweden; NSGO Study Grp, Germany.
    Reuss, A.
    Coordinating Ctr Clin Trials, Germany; AGO Study Grp, Germany.
    Pautier, P.
    Inst Gustave Roussy, France; GINECO Study Grp, Germany.
    Cormio, G.
    Univ Bari, Italy; Natl Canc Inst Giovanni Paolo II, Italy; MITO Study Grp, Germany.
    Colombo, N.
    Univ Milano Bicocca, Italy; Inst Europeo Oncol, Italy; MaNGO Study Grp, Germany.
    Reinthaller, A.
    Med Univ Vienna, Austria; AGO Austria Study Grp, Austria.
    Vergote, I.
    Univ Leuven, Belgium; BGOG Study Grp, Austria.
    Poveda, A.
    Inst Valenciano Oncol, Spain; GEICO Study Grp, Spain.
    Ottevanger, P. B.
    Radboud Univ Nijmegen, Netherlands; DGOG Study Grp, Spain.
    Hanker, L. C.
    Univ Schleswig Holstein, Germany; AGO Study Grp, Germany.
    Leminen, A.
    Womens Hosp Med Ctr, Finland; NSGO Study Grp, Germany.
    Alexandre, J.
    Hop Univ Paris Ctr, France; GINECO Study Grp, Germany.
    Canzler, U.
    Tech Univ Dresden, Germany; AGO Study Grp, Germany.
    Sehouli, J.
    Charite Campus Virchow Klinikum, Germany; AGO Study Grp, Germany.
    Herrstedt, J.
    Odense Univ Hosp, Denmark; Zealand Univ, Denmark; NSGO Study Grp, Germany.
    Fiane, B.
    Stavanger Univ Hosp, Norway; NSGO Study Grp, Germany.
    Merger, M.
    Boehringer Ingelheim Pharma GmbH and Co KG, Germany.
    du Bois, A.
    AGO Study Grp, Germany.
    Early tumor regrowth is a contributor to impaired survival in patients with completely resected advanced ovarian cancer. An exploratory analysis of the Intergroup trial AGO-OVAR 122019Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 152, nr 2, s. 235-242Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Surgical assessment of residual tumor provides the strongest prognostic information in advanced ovarian cancer (AOC), with the best outcome observed after complete resection. Postoperative radiological assessment before initiation of chemotherapy can supplement the information obtained by surgical assessment; however, it may also reveal conflicting findings. Methods. Patients with AOC enrolled in the AGO-OVAR 12 trial underwent baseline imaging before the first chemotherapy cycle. The findings from surgical and radiologic assessment for disease extend were compared. Additionally, an integrated approach was assessed. Results. Complete data from all 3 assessment methods were available for 1345 patients. Of 689 patients with complete resection, tumor was observed in 28% and 22% of patients undergoing radiologic and integrated assessment, respectively. Patients with surgical- radiological and surgical-integrated concordant findings showed a 5-year overall survival (5Y-OS) of 72% and 71%, whereas patients with surgical-radiological and surgical-integrated discordant results showed inferior 5Y-OS of 47% and 49%, respectively. Patients with surgically assessed residual disease had a 5-YOS of 37%. The interval between surgery and baseline assessment was independently associated with discordance between assessment methods, which might reflect early tumor regrowth. Conclusions. Baseline tumor assessment before chemotherapy provides information that stratifies patients with complete resection into different prognostic groups. Integrating the data from different assessment methods might lead to improved definitions of prognostic groups. Further investigation to determine if earlier initiation of chemotherapy after debulking surgery could increase survival of patients with early tumor regrowth is warranted. (C) 2018 Published by Elsevier Inc.

  • 8.
    Hellman, Kristina
    et al.
    Karolinska Univ Hosp, Sweden.
    Holmberg, Erik
    Reg Canc Ctr West, Sweden; Sahlgrens Acad, Sweden.
    Bjurberg, Maria
    Lund Univ, Sweden.
    Borgfeldt, Christer
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Dahm-Kahler, Pernilla
    Sahlgrens Univ Hosp, Sweden.
    Radestad, Angelique Floter
    Karolinska Univ Hosp, Sweden.
    Hjerpe, Elisabet
    Visby Hosp, Sweden.
    Hogberg, Thomas
    Lund Univ, Sweden.
    Marcickiewicz, Janusz
    Halland Hosp, Sweden.
    Rosenberg, Per
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Stalberg, Karin
    Uppsala Univ, Sweden.
    Tholander, Bengt
    Uppsala Univ Hosp, Sweden.
    Kjölhede, Preben
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Åvall Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Primary treatment and relative survival by stage and age in vulvar squamous cell carcinoma: A population-based SweGCG study2020Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 159, nr 3, s. 663-671Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Vulvar cancer affects mainly elderly women and with an ageing population the incidence has increased. We explored the primary treatment patterns and relative survival of patients with vulvar squamous cell carcinoma (VSCC) by stage and age-group. Methods. A population-based nationwide study on women diagnosed with VSCC between 2012 and 2016 and registered in the Swedish Quality Registry for Gynecologic Cancer (SQRGC). Main outcome was 5-year relative survival (RS) estimated by the Pohar Perme method. The relative risk of excess mortality (EMRR) between different groups was analyzed by Poisson regression. The age-standardized relative survival (AS-RS) was estimated for the total cohort. Results. Median follow-up time was 41 months. The study population included 657 women; 33% were &gt;= 80 years old. FIGO stage I was most common (55%). Primary surgery was performed in 96% stage I, 65% stage II, 80% stage III and 28% stage IV. In women &gt;= 80 years, exploration of the groins and chemoradiotherapy was less often performed. They also received lower mean doses of radiation than younger women. The 5-year AS-RS was 74%. 5-year RS was 84% for stage I, 60% for stage II, 54% for stage III and 35% for stage IV. The EMRR for women &gt;= 80 years compared with women &lt;60 years was 4.3 (p &lt; 0.001); 4.9 (p &lt; 0.001) for stages I-II and 3.5(p = 0.007) for stage III. Conclusions. In general, primary treatment of patients with vulvar squamous cell carcinoma in Sweden ad-hered to guidelines. Areas of improvement include treatment for stage II and for the very old. (C) 2020 Elsevier Inc. All rights reserved.

  • 9.
    Roncolato, Felicia
    et al.
    Univ Sydney, Australia; Western Sydney Univ, Australia; Campbelltown Hosp, Australia.
    King, Madeleine T.
    Univ Sydney, Australia.
    O'Connell, Rachel L.
    Univ Sydney, Australia.
    Lee, Yeh Chen
    Univ Sydney, Australia; UNSW, Australia; Prince Wales & Royal Hosp Women, Australia.
    Joly, Florence
    Grp Investigateurs Nationaux Etud Canc Ovariens GI, France; Ctr Francois Baclesse, France.
    Hilpert, Felix
    Arbeitsgesmeinschaft Gynakol Onkol Studiengrp AGO, Germany; North Eastern German Soc Gynecol Oncol NOGGO, Germany; Krankenhaus Jerusalem, Germany.
    Lanceley, Anne
    UCL, England.
    Yoshida, Yoshio
    Univ Fukui, Japan.
    Bryce, Jane
    Multictr Italian Trials Ovarian Canc & Gynecol Mal, Italy; Ascens St John Clin Res Inst, OK USA; Ist Nazl Tumori IRCCS Fdn Pascale, Italy.
    Donnellan, Paul
    Galway Univ Hosp, Ireland.
    Oza, Amit
    Univ Toronto, Canada.
    Åvall Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US. Nord Soc Gynaecol Oncol NSGO, Denmark; Karolinska Inst, Sweden.
    Berek, Jonathan S.
    Cooperat Gynecol Oncol Investigators COGI, CA USA; Stanford Univ, CA USA.
    Ledermann, Jonathan A.
    Canc Res UK, England; UCL Canc Trials Ctr, England.
    Berton, Dominique
    Grp Investigateurs Nationaux Etud Canc Ovariens GI, France; Inst Cancerol Ouest, France.
    Sehouli, Jalid
    Arbeitsgesmeinschaft Gynakol Onkol Studiengrp AGO, Germany; North Eastern German Soc Gynecol Oncol NOGGO, Germany; Charite Univ Med Berlin, Germany.
    Kaminsky, Marie-Christine
    Grp Investigateurs Nationaux Etud Canc Ovariens GI, France; Inst Cancerol Lorraine, France.
    Stockler, Martin R.
    Univ Sydney, Australia.
    Friedlander, Michael
    UNSW, Australia; Prince Wales & Royal Hosp Women, Australia.
    Hidden in plain sight - Survival consequences of baseline symptom burden in women with recurrent ovarian cancer2024Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 185, s. 128-137Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. To describe the baseline symptom burden(SB) experienced by patients(pts) with recurrent ovarian cancer(ROC) prior and associations with progression free survival (PFS) and overall survival (OS). Methods. We analysed baseline SB reported by pts. with platinum resistant/refractory ROC (PRR-ROC) or potentially-platinum sensitive ROC receiving their third or greater line of chemotherapy (PPS-ROC &gt;= 3) enrolled in the Gynecologic Cancer InterGroup - Symptom Benefit Study (GCIG-SBS) using the Measure of Ovarian Symptoms and Treatment concerns (MOST). The severity of baseline symptoms was correlated with PFS and OS. Results. The 948 pts. reported substantial baseline SB. Almost 80% reported mild to severe pain, and 75% abdominal symptoms. Shortness of breath was reported by 60% and 90% reported fatigue. About 50% reported moderate to severe anxiety, and 35% moderate to severe depression. Most (89%) reported 1 or more symptoms as moderate or severe, 59% scored 6 or more symptoms moderate or severe, and 46% scored 9 or more symptoms as moderate or severe. Higher SB was associated with significantly shortened PFS and OS; five symptoms had OS hazard ratios larger than 2 for both moderate and severe symptom cut-offs (trouble eating, vomiting, indigestion, loss of appetite, and nausea; p &lt; 0.001). Conclusion. Pts with ROC reported high SB prior to starting palliative chemotherapy, similar among PRR-ROC and PPS-ROC &gt;= 3. High SB was strongly associated with early progression and death. SB should be actively managed and used to stratify patients in clinical trials. Clinical trials should measure and report symptom burden and the impact of treatment on symptom control. (c) 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://

  • 10.
    Roncolato, Felicia T
    et al.
    NHMRC Clinical Trials Centre, University of Sydney, Australia; Macarthur Cancer Therapy Centre, NSW, Australia; Australia New Zealand Gynaecological Oncology Group (ANZGOG), Australia.
    Berton-Rigaud, Dominique
    ICO Centre René Gauducheau, Saint Herblain, France.
    O'Connell, Rachel
    NHMRC Clinical Trials Centre, University of Sydney, Australia.
    Lanceley, Anne
    University College London, United Kingdom.
    Sehouli, Jalid
    Charite Berlin, Germany.
    Buizen, Luke
    NHMRC Clinical Trials Centre, University of Sydney, Australia.
    Okamoto, Aikou
    Jikei University School of Medicine, Japan.
    Aotani, Eriko
    Kitasato Academic Research Organization, Japan.
    Lorusso, Domenica
    MITO, Rome, Italy.
    Donnellan, Paul
    Galway University Hospital, Ireland; All-Ireland Oncology Research Group (ICORG), Ireland.
    Oza, Amit
    Princess Margaret Hospital, Canada.
    Åvall-Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US. Karolinska Institutet, Stockholm, Sweden.
    Berek, Jonathan
    Stanford Women's Cancer Center, USA.
    Hilpert, Felix
    Klinik fur Gynakologie und Geburtshilfe, UKSH, Germany.
    Ledermann, Jonathan A
    CRUK and UCL Cancer Trials Centre, NCRI UK, United Kingdom.
    Kaminsky, Marie Christine
    ICL Institut de Cancérologie de Lorraine, Vandoeuvre-Les-Nancy, France.
    Stockler, Martin R
    NHMRC Clinical Trials Centre, University of Sydney, Australia.
    King, Madeleine T
    Psycho-oncology Research Group (PoCoG), School of Psychology, Central Clinical School, Sydney Medical School, University of Sydney, Australia.
    Friedlander, Michael
    Australia New Zealand Gynaecological Oncology Group (ANZGOG), Australia; Prince of Wales Hospital, Sydney, Australia.
    Validation of the modified Glasgow Prognostic Score (mGPS) in recurrent ovarian cancer (ROC): Analysis of patients enrolled in the GCIG Symptom Benefit Study (SBS)2018Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 148, nr 1, s. 36-41, artikel-id S0090-8258(17)31422-1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Modified Glasgow Prognostic Score (mGPS) is predictive of survival in many advanced cancers, but has not been evaluated in recurrent ovarian cancer (ROC). The aim was to determine validity of mGPS in ROC, investigate its associations with health related quality of life (HRQL) and ECOG performance status (PS).

    METHODS: mGPS is based on serum C reactive protein (CRP) and albumin, with scores ranging from 0 (least) to 2 (most). HRQL was measured with EORTC QLQ C-30 and OV-28. χ2 tests for trend were used to examine the relationship between HRQL, PS and mGPS. Cox proportional hazards regression was used to assess associations between mGPS, HRQL, clinicopathological factors, and overall survival (OS).

    RESULTS: Inflammatory markers were available in 516 of 948 patients in GCIG SBS. 200(39%) had potentially platinum sensitive ROC with ≥3 lines of chemotherapy, 316(61%) had platinum resistant ROC. 282(55%), 123(24%), 111(22%) had mGPS of 0, 1, 2, respectively. Median OS (months) was 18.1, 9.6, and 6.6 for mGPS 0, 1, and 2 respectively. mGPS was an independent predictor of OS after adjusting for PS and platinum sensitivity (p<0.001). mGPS remained a predictor of OS after adjusting for physical function, role function, global health status, abdominal/GI symptoms, and multiple clinicopathologic factors (p=0.02). Worse PS and higher mGPS were associated with poorer HRQL (p<0.001). Higher mGPS was associated with worse HRQL, independent of PS.

    CONCLUSION: The mGPS is an independent predictor of OS in ROC after adjusting for HRQL and clinicopathological factors. Higher mGPS is associated with worse HRQL independent of PS. mGPS is simple, inexpensive and may be suitable for clinical practice, clinical trial patient selection and stratification.

  • 11.
    Silins, Ilvars
    et al.
    Oncology Center of Latvia, Riga, Latvia / Department of Gynecologic Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden / Department of Medical Microbiology, MAS University Hospital, Malmö, Sweden.
    Wang, Xiaodong
    Linköpings universitet, Institutionen för teknik och naturvetenskap, Fysik och elektroteknik. Linköpings universitet, Tekniska högskolan. Department of Medical Microbiology, MAS University Hospital, Malmö, Sweden.
    Tadesse, Amha
    Merck Research Laboratories, West Point, PA 19486, USA.
    Jansen, Kathrin U
    Merck Research Laboratories, West Point, PA 19486, USA.
    Schiller, John T
    Laboratory of Cellular Oncology, The National Cancer Institute, Bethesda, MD 20892, USA.
    Åvall-Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Department of Gynecologic Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
    Frankendal, Bo
    Department of Gynecologic Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
    Dillner, Joakim
    Department of Medical Microbiology, MAS University Hospital, Malmö, Sweden.
    A population-based study of cervical carcinoma and HPV infection in Latvia.2004Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 93, nr 2, s. 484-492Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: We wished to quantify the population-based importance of cervical carcinoma risk factors in Latvia.

    METHODS: Totally, 223 of 224 eligible cases of incident invasive cervical carcinoma were enrolled during July 1998-February 2001 in Latvia. An age-matched sample of 300 healthy control women was selected from the Latvian population registry and 239 of these women (79%) were enrolled. A demographic and life-style questionnaire was completed, cervical brush samples were analyzed for human papillomavirus (HPV) DNA by PCR and serum samples for HPV antibodies.

    RESULTS: Risk factors for cervical cancer in multivariate analysis were HPV type 16 or 18 DNA positivity (OR = 32.4; CI 95% 16.5-63.6) and living in the capital (OR = 2.4; CI 95% 1.2-4.7). Oral contraceptive use was not a risk factor (OR = 0.4; CI 95% 0.2-1.1). A strong protective effect was found for having had more than three Pap smears in the last 5 years (OR = 0.07 CI 95% 0.03-0.19).

    CONCLUSIONS: Inadequate population coverage of Pap smears, in spite of excessive smear usage, caused 28.4% of cervical cancers in age groups eligible for screening. HPV type 16 infection was the most important risk factor for cervical cancer in Latvia, with a population-attributable risk percent for all ages of 58.5%.

  • 12.
    Silins, Ilvars
    et al.
    Department of Medical Microbiology, MAS University Hospital, S-20502, Malmö, Sweden / Department of Gynaecologic Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
    Åvall-Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Department of Gynaecologic Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
    Tadesse, Amha
    Merck Research Laboratories, West Point, Pennsylvania, USA.
    Jansen, Kathrin U
    Merck Research Laboratories, West Point, Pennsylvania, USA.
    Stendahl, Ulf
    Department of Oncology, Umeå University, Umeå, Sweden.
    Lenner, Per
    Department of Oncology, Umeå University, Umeå, Sweden.
    Zumbach, Klaus
    Applied Tumour Virology, Deutsches Krebsforschungszentrum, Heidelberg, Germany.
    Pawlita, Michael
    Department of Medical Microbiology, MAS University Hospital, S-20502, Malmö, Sweden.
    Dillner, Joakim
    Department of Medical Microbiology, MAS University Hospital, S-20502, Malmö, Sweden.
    Frankendal, Bo
    Department of Gynaecologic Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
    Evaluation of antibodies to human papillomavirus as prognostic markers in cervical cancer patients.2002Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 85, nr 2, s. 333-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: We wished to evaluate whether the presence of antibodies to HPV or to the HPV oncoproteins E6 and E7 or type of HPV DNA is related to prognosis among cervical cancer patients.

    METHODS: Blood samples were drawn from 313 patients with incident, untreated cervical cancer on admission to two hospitals in Sweden. Patients were followed from enrollment in 1984-1991 until death or up to June 1999. Clinical information was obtained from a review of medical records. Survival and cause of death were ascertained from both medical records and population-based cancer registries. The correlation of survival with antibodies to HPV16, to oncoproteins E6 and E7, and to type of HPV DNA was evaluated using multivariate Cox regression analysis, including stage, age, histology, and hospital in the model.

    RESULTS: Stage was the only significant prognostic factor influencing cervical cancer patient survival (OR = 3.62, 95% CI = 2.71-4.83). Age over 50 was associated with increased death rate among stage I-IIa patients (OR = 2.29, 95% CI = 1.12-4.68). Presence of antibodies to the oncoproteins E6 and E7 or to the HPV16 capsid or type of HPV DNA did not associate significantly with disease prognosis.

    CONCLUSIONS: Antibodies to HPV16 capsids and to oncoproteins E6 and E7 or type of HPV DNA do not appear to be useful as indicators of cervical cancer prognosis.

  • 13. Sörensen, Peter
    et al.
    Höjer, Morten
    Jakobsen, Anders
    Malmström, Henric
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Onkologi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Onkologiska kliniken US.
    Havsteen, Hanne
    Bertelsen, Kamma
    Phase II study of vinorelbine in the treatment of platinum-resistant ovarian carcinoma2001Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 81, nr 1, s. 58-62Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. The purpose of this phase II study was to evaluate on an intent-to-treat basis the activity and toxicity of single-agent vinorelbine (VRL) as second-line chemotherapy of patients with platinum-resistant ovarian cancer. Platinum-resistant disease was defined as disease refractory to or relapsing within 12 months after finishing platinum-containing chemotherapy. Methods. VRL (30 mg/m2) was administered intravenously as a bolus injection days 1 and 8 every 21 days. Initially, four courses of VRL were given. Patients with responding or stable disease received four more courses of VRL to a maximum of eight courses. Results. Twenty-eight of 33 eligible patients were considered evaluable for response. The overall response rate was 21% (7/33) (95% CI: 7-35). Median time to progression was 3.1 months and median survival was 10.1 months. Toxicity was generally mild. Leukopenia was the dose-limiting toxicity. CALGB grade III/IV infection was observed in 15/0% of patients. The most important nonhematologic toxicities were nausea and constipation. Grade III/IV nausea was observed in 6/0% and grade III/IV constipation in 3/3% of patients. Peripheral neurotoxicity was only a minor problem with no grade III/IV toxicity. No patients stopped treatment because of toxicity and no toxic death was reported. Conclusion. VRL was generally well tolerated, but the activity in platinum-resistant ovarian cancer was only modest, although fully comparable to other second-line treatments. Further studies are required to define the role of VRL in combination chemotherapy for ovarian cancer.

  • 14.
    Tzortzatos, Gerasimos
    et al.
    Karolinska Institute, Sweden.
    Andersson, Emil
    Karolinska Institute, Sweden.
    Soller, Maria
    Skåne University Hospital, Sweden.
    Stenmark Askmalm, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Region Östergötland, Diagnostikcentrum, Klinisk patologi och klinisk genetik. Linköpings universitet, Medicinska fakulteten.
    Zagoras, Theofanis
    University of Gothenburg, Sweden.
    Georgii-Hemming, Patrik
    Uppsala University, Sweden.
    Lindblom, Annika
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Tham, Emma
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Mints, Miriam
    Karolinska Institute, Sweden.
    The gynecological surveillance of women with Lynch Syndrome in Sweden2015Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 138, nr 3, s. 717-722Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Women with Lynch syndrome (LS) have up to a 60% lifetime risk of endometrial cancer (EC) and up to a 24% risk of ovarian cancer (OC). Gynecological surveillance is recommended, but the benefit and how it should be performed remain unclear. The purpose of this study was to assess diagnostic modalities for gynecological screening of LS patients in Sweden and clinical outcome. Methods. A retrospective nationwide study of 170 women with molecularly confirmed LS. Data including gynecological LS screening history, biopsy results (if any), genetic records, number of screening visits, results from screening including transvaginal ultrasound (TVUS), endometrial biopsy (EB), blood test for tumor marker cancer antigen (CA) 125, prophylactic surgery including age at procedure, and setting from which screening data were obtained from medical records. Results. A total of 117 women were eligible for gynecological screening and of these, 86 patients attended screening visits. Of these, 41 underwent prophylactic hysterectomy and/or bilateral salpingo-oophorectomy. Two patients (4.9%) were diagnosed with EC and two (4.9%) with precancerous lesions in conjunction with prophylactic surgery. Total incidence of gynecological cancer in the surveillance group (45 women) was 20% EC, 4% OC. Five patients had endometrial cancer or complex hyperplasia with atypia (n = 2) detected by endometrial biopsy. Four additional cases were detected due to interval bleeding. Both cases of ovarian cancer were detected by transvaginal ultrasound in patients with ovarian cysts under surveillance. The youngest woman with endometrial cancer was diagnosed at 35 years of age, before she was aware of her diagnosis of Lynch syndrome. Conclusions. Gynecological surveillance of women with Lynch syndrome may lead to earlier detection of precancerous lesions, which might have some impact on the morbidity from endometrial cancer although further studies are needed to prove this. Prophylactic hysterectomy with or without bilateral salpingo-oophorectomy reduces the cancer incidence. A practical approach to surveillance in Lynch syndrome women would be to offer annual surveillance beginning at age 30 years including probably both TVUS and EB in order to increase diagnostic yield with prospective data registry for follow-up studies. Prophylactic surgery could be performed at a suitable age after childbearing to obtain a balance between reducing the risk of cancer and minimizing long-term complications from premature menopause. (C) 2015 Elsevier Inc. All rights reserved.

  • 15.
    Van der Kolk, W. L.
    et al.
    Univ Groningen, Netherlands.
    Van der Zee, A. G. J.
    Univ Groningen, Netherlands.
    Slomovitz, B. M.
    Mt Sinai Med Ctr, FL 33140 USA.
    Baldwin, P. J. W.
    Cambridge Univ Hosp NHS Fdn Trust, England.
    Van Doorn, H. C.
    Univ Med Ctr Rotterdam, Netherlands.
    De Hullu, J. A.
    Radboud Univ Nijmegen, Netherlands.
    Van der Velden, J.
    Amsterdam Univ Med Ctr, Netherlands.
    Gaarenstroom, K. N.
    Leiden Univ, Netherlands.
    Slangen, B. F. M.
    Maastricht Univ, Netherlands.
    Kjölhede, Preben
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Brännstrom, M.
    Univ Gothenburg, Sweden.
    Vergote, I
    Leuven Canc Inst, Belgium.
    Holland, C. M.
    Manchester Univ NHS Fdn Trust, England.
    Coleman, R.
    Univ Texas MD Anderson Canc Ctr, TX 77030 USA.
    Van Dorst, E. B. L.
    Univ Med Ctr Utrecht, Netherlands.
    Van Driel, W. J.
    Netherlands Canc Inst, Netherlands.
    Nunns, D.
    Nottingham Univ Hosp NHS Trust, England.
    Widschwendter, M.
    Univ Innsbruck, Austria.
    Nugent, D.
    Leeds Teaching Hosp NHS Trust, England.
    DiSilvestro, P. A.
    Women & Infants Hosp Rhode Isl, RI 02908 USA.
    Mannel, R. S.
    Univ Oklahoma, OK USA.
    Tjiong, M. Y.
    Amsterdam Univ Med Ctr, Netherlands.
    Boll, D.
    Catharina Ziekenhuis Eindhoven, Netherlands.
    Cibula, D.
    Charles Univ Prague, Czech Republic; Gen Univ Hosp Prague, Czech Republic.
    Covens, A.
    Univ Toronto, Canada.
    Provencher, D.
    Univ Montreal, Canada.
    Runnebaum, I. B.
    Friedrich Schiller Univ, Germany.
    Monk, B. J.
    St Josephs Hosp, AZ USA.
    Zanagnolo, V
    European Canc Inst, Italy.
    Tamussino, K.
    Med Univ Graz, Austria.
    Oonk, M. H. M.
    Univ Groningen, Netherlands.
    Unilateral inguinofemoral lymphadenectomy in patients with early-stage vulvar squamous cell carcinoma and a unilateral metastatic sentinel lymph node is safe2022Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 167, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Optimal management of the contralateral groin in patients with early-stage vulvar squamous cell carcinoma (VSCC) and a metastatic unilateral inguinal sentinel lymph node (SN) is unclear. We analyzed patients who participated in GROINSS-V I or II to determine whether treatment of the contralateral groin can safely be omitted in patients with a unilateral metastatic SN.Methods. We selected the patients with a unilateral metastatic SN from the GROINSS-V I and II databases. We determined the incidence of contralateral additional non-SN metastases in patients with unilateral SN-metastasis who underwent bilateral inguinofemoral lymphadenectomy (IFL). In those who underwent only ipsilateral groin treatment or no further treatment, we determined the incidence of contralateral groin recurrences during follow-up.Results. Of 1912 patients with early-stage VSCC, 366 had a unilateral metastatic SN. Subsequently, 244 had an IFL or no treatment of the contralateral groin. In seven patients (7/244; 2.9% [95% CI: 1.4%-5.8%]) disease was di-agnosed in the contralateral groin: five had contralateral non-SN metastasis at IFL and two developed an isolated contralateral groin recurrence after no further treatment. Five of them had a primary tumor &gt;= 30 mm. Bilateral ra-diotherapy was administered in 122 patients, of whom one (1/122; 0.8% [95% CI: 0.1%-4.5%]) had a contralateral groin recurrence.Conclusion. The risk of contralateral lymph node metastases in patients with early-stage VSCC and a unilateral metastatic SN is low. It appears safe to limit groin treatment to unilateral IFL or inguinofemoral radiotherapy in these cases.(c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

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  • 16.
    Wedin, Madelene
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Stalberg, Karin
    Uppsala Univ, Sweden.
    Marcickiewicz, Janusz
    Varberg Hosp, Sweden.
    Ahlner, Eva
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Akesson, Asa
    Univ Gothenburg, Sweden; Univ Gothenburg, Sweden.
    Lindahl, Gabriel
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Kjölhede, Preben
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Incidence of lymphedema in the lower limbs and lymphocyst formation within one year of surgery for endometrial cancer: A prospective longitudinal multicenter study2020Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 159, nr 1, s. 201-208Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. The study aimed to determine the incidence of lower limb lymphedema (LLL) after surgery for endometrial cancer (EC) by means of three methods, and to determine the incidence of lymphocysts after one year. Methods. A prospective longitudinal multicenter study was conducted in 14 hospitals in Sweden. Two-hundred-and-thirty-five women with EC were included; 116 underwent surgery that included lymphadenectomy (+LA) and 119 were without lymphadenectomy ( -LA). Lymphedema was assessed objectively on four occasions; preoperatively, at 4-6 weeks, six months and one year postoperatively using systematic measurement of leg circumferences, enabling calculation of leg volumes, and a clinical grading of LLL, and subjectively by the patients perception of lymphedema measured by a lymphedema-specific quality-of-life instrument. Lymphocyst was evaluated by vaginal ultrasonography. Results. After one year the incidence of LLL after increase in leg volume adjusted for body mass index was 15.8% in +LA women and 3.4% in -IA women. The corresponding figures for clinical grading were 24.1% and 11.8%, and for patient-reported perceived LLL 10.7% and 5.1%. The agreement between the modalities revealed fair to moderate correlation between patient-reported LLL and clinical grading, but poor agreement between volume increase and patient-reported LLL or clinical grading. Lymphocysts were found in 43% after one year. Conclusions. Although the incidence of ILL and lymphocysts after surgery for EC including LA seemed to be relatively high the study demonstrated significant variations in incidence depending on the measurement modality. This emphasizes the need for a gold standard of measurement of LLL in clinical practice and research. (C) 2020 Elsevier Inc. All rights reserved.

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  • 17.
    Zach, Diana
    et al.
    Karolinska Univ Hosp, Sweden.
    Åvall Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Falconer, Henrik
    Karolinska Univ Hosp, Sweden.
    Hellman, Kristina
    Karolinska Univ Hosp, Sweden.
    Johansson, Hemming
    Karolinska Univ Hosp, Sweden.
    Radestad, Angelique Floter
    Karolinska Univ Hosp, Sweden.
    Patterns of recurrence and survival in vulvar cancer: A nationwide population-based study2021Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 161, nr 3, s. 748-754Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. To examine the patterns of recurrence and how these patterns are associated with survival in vulvar squamous cell carcinoma. We also explored the survival impact of surgical groin staging (SGS). Methods. Nationwide population-based study including women diagnosed with vulvar squamous cell carcinoma between 2012 and 2015 and registered in the Swedish Quality Registry for Gynecologic Cancer. Cumulative incidence rates (CIR), recurrence-free (RFS) and overall survival (OS) were calculated by Kaplan Meier estimates. The impact of SGS on RFS and OS was analyzed by proportional hazards models. Results. 489 eligible women were included. Median follow-up time was 64 months. The overall recurrence rate was 22.3%. Site of recurrence: local in 61.0%, groin in 30.0%, distant in 9.0%. The CIR for local recurrences increased with time (5.9% at 2-years, 14.7% at 5-years) while the rate of groin and distant recurrences was nearly steady (5.5% to 6.3% and 1.5% to 1.7%, respectively). Median 2-year and 4-year OS post-recurrence was 57.8% and 37.4% for local, 17.2%, 10.3% for groin and 0% for distant recurrences, respectively. SGS was omitted in 23.7% of surgically treated women with FIGO stages IB-II and significantly associated with worse RFS (Hazard ratio, HR, 1.9; 95%CI, 1.0-3.5; p = 0.04) and OS (HR 2.0; 95%CI, 1.1-3.8; p = 0.04) after adjustment for age, FIGO stage, tumor size, resection margins and performance status. Conclusion. The cumulative incidence of isolated vulvar recurrence was low but for those affected the prognosis was poor. Surgical groin staging is a crucial part of primary treatment and should not be omitted. (c) 2021 Published by Elsevier Inc.

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