1.Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma
Jvan CASARIN ; Giorgio BOGANI ; Elisa PIOVANO ; Francesca FALCONE ; Federico FERRARI ; Franco ODICINO ; Andrea PUPPO ; Ferdinando BONFIGLIO ; Nicoletta DONADELLO ; Ciro PINELLI ; Antonio Simone LAGANÀ ; Antonino DITTO ; Mario MALZONI ; Stefano GREGGI ; Francesco RASPAGLIESI ; Fabio GHEZZI
Journal of Gynecologic Oncology 2020;31(5):e64-
Objective:
Uterine serous carcinoma (USC) is a rare highly aggressive disease. In the present study, we aimed to investigate the survival implication of the systematic lymphadenectomy in patients who underwent surgery for apparent early-stage USC.
Methods:
Consecutive patients with apparent early-stage USC surgically treated at six Italian referral cancer centers were analyzed. A comparison was made between patients who underwent retroperitoneal staging including at least pelvic lymphadenectomy “LND” vs.those who underwent hysterectomy alone “NO-LND”. Baseline, surgical and oncological outcomes were analyzed. Kaplan- Meier curves were calculated for disease-free survival (DFS) and disease-specific survival (DSS). Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratio (HR).
Results:
One hundred forty patients were analyzed, 106 LND and 34 NO-LND. NO-LND group (compared to LND group) included older patients (median age, 73 vs.67 years) and with higher comorbidities (median Charlson Comorbidity Index, 6 vs. 5) (p<0.001). No differences in terms of recurrence rate (LND vs. NO-LND, 33.1% vs. 41.4%; p=0.240) were observed. At Cox regression analysis lymphadenectomy did not significantly influence DFS (HR=0.59; 95% confidence interval [CI]=0.32–1.08; p=0.09), and DSS (HR=0.14; 95% CI=0.02–1.21; multivariable analysis p=0.07). Positive node was independently associated with worse DFS (HR=6.22; 95% CI=3.08–12.60; p<0.001) and DSS (HR=5.51; 95% CI=2.31– 13.10; p<0.001), while adjuvant chemotherapy was associated with improved DFS (HR=0.38;95% CI=0.17–0.86; p=0.02) and age was independently associated with worse DSS (HR=1.07;95% CI=1.02–1.13; p<0.001).
Conclusions
Although lymphadenectomy did not show survival benefits in patients who underwent surgery for apparent early-stage USC, the presence of lymph node metastasis was the main adverse prognostic factors, supporting the prognostic role of the retroperitoneal staging also in this histological subtype.
2.Twenty-four-hour serum creatinine variation is associated with poor outcome in the novel coronavirus disease 2019 (COVID-19) patients
Gaetano ALFANO ; Annachiara FERRARI ; Francesco FONTANA ; Giacomo MORI ; Giulia LIGABUE ; Silvia GIOVANELLA ; Riccardo MAGISTRONI ; Marianna MESCHIARI ; Erica FRANCESCHINI ; Marianna MENOZZI ; Gianluca CUOMO ; Gabriella ORLANDO ; Antonella SANTORO ; Margherita DI GAETANO ; Cinzia PUZZOLANTE ; Federica CARLI ; Andrea BEDINI ; Jovana MILIC ; Cristina MUSSINI ; Gianni CAPPELLI ; Giovanni GUARALDI ;
Kidney Research and Clinical Practice 2021;40(2):231-240
Background:
The development of acute kidney injury (AKI) in patients with coronavirus disease 2019 (COVID-19) is associated with a high risk of death. Published data demonstrate the possibility of severe kidney injury in patients suffering from COVID-19. However, these data are still controversial.
Methods:
A total of 1,280 patients with a proven diagnosis of COVID-19 were included in our study. COVID-19 was confirmed in all patients using reverse transcriptase polymerase chain reaction test of a nasopharyngeal swab, and based on the typical computed tomography findings. Demographic data, underlying comorbidities, and laboratory blood tests were assessed. We assessed the incidence of AKI and its associated mortality defined by survival status at discharge.
Results:
Proteinuria was identified with 648 patients (50.6%) with COVID-19. AKI was identified in 371 patients (29.0%). Ten of these patients (2.7%) required dialysis. The risk factors for AKI included age of > 65 years, augmentation of C-reactive protein, ferritin and an increase in values of activated partial thromboplastin time. Overall, 162 of the 1,280 hospitalized patients (12.7%) and 111 of the 371 patients (29.9%) with AKI did not survive. The hazard ratio (HR) for mortality was 3.96 (95% confidence interval, 2.83–5.54) for patients with AKI vs. no AKI.
Conclusion
AKI was a relatively common finding among patients with COVID-19. The risk factors for AKI in COVID-19 included old age, the inflammatory response, the severity of lung involvement, and disseminated intravascular coagulation. These same factors, in addition to arterial hypertension, were found to increase the risk of mortality.
3.Twenty-four-hour serum creatinine variation is associated with poor outcome in the novel coronavirus disease 2019 (COVID-19) patients
Gaetano ALFANO ; Annachiara FERRARI ; Francesco FONTANA ; Giacomo MORI ; Giulia LIGABUE ; Silvia GIOVANELLA ; Riccardo MAGISTRONI ; Marianna MESCHIARI ; Erica FRANCESCHINI ; Marianna MENOZZI ; Gianluca CUOMO ; Gabriella ORLANDO ; Antonella SANTORO ; Margherita DI GAETANO ; Cinzia PUZZOLANTE ; Federica CARLI ; Andrea BEDINI ; Jovana MILIC ; Cristina MUSSINI ; Gianni CAPPELLI ; Giovanni GUARALDI ;
Kidney Research and Clinical Practice 2021;40(2):231-240
Background:
The development of acute kidney injury (AKI) in patients with coronavirus disease 2019 (COVID-19) is associated with a high risk of death. Published data demonstrate the possibility of severe kidney injury in patients suffering from COVID-19. However, these data are still controversial.
Methods:
A total of 1,280 patients with a proven diagnosis of COVID-19 were included in our study. COVID-19 was confirmed in all patients using reverse transcriptase polymerase chain reaction test of a nasopharyngeal swab, and based on the typical computed tomography findings. Demographic data, underlying comorbidities, and laboratory blood tests were assessed. We assessed the incidence of AKI and its associated mortality defined by survival status at discharge.
Results:
Proteinuria was identified with 648 patients (50.6%) with COVID-19. AKI was identified in 371 patients (29.0%). Ten of these patients (2.7%) required dialysis. The risk factors for AKI included age of > 65 years, augmentation of C-reactive protein, ferritin and an increase in values of activated partial thromboplastin time. Overall, 162 of the 1,280 hospitalized patients (12.7%) and 111 of the 371 patients (29.9%) with AKI did not survive. The hazard ratio (HR) for mortality was 3.96 (95% confidence interval, 2.83–5.54) for patients with AKI vs. no AKI.
Conclusion
AKI was a relatively common finding among patients with COVID-19. The risk factors for AKI in COVID-19 included old age, the inflammatory response, the severity of lung involvement, and disseminated intravascular coagulation. These same factors, in addition to arterial hypertension, were found to increase the risk of mortality.
4.Characteristics and patterns of care of endometrial cancer before and during COVID-19 pandemic
Giorgio BOGANI ; Giovanni SCAMBIA ; Chiara CIMMINO ; Francesco FANFANI ; Barbara COSTANTINI ; Matteo LOVERRO ; Gabriella FERRANDINA ; Fabio LANDONI ; Luca BAZZURINI ; Tommaso GRASSI ; Domenico VITOBELLO ; Gabriele SIESTO ; Anna Myriam PERRONE ; Vanna ZANAGNOLO ; Pierandrea DE IACO ; Francesco MULTINU ; Fabio GHEZZI ; Jvan CASARIN ; Roberto BERRETTA ; Vito A CAPOZZI ; Errico ZUPI ; Gabriele CENTINI ; Antonio PELLEGRINO ; Silvia CORSO ; Guido STEVENAZZI ; Serena MONTOLI ; Anna Chiara BOSCHI ; Giuseppe COMERCI ; Pantaleo GRECO ; Ruby MARTINELLO ; Francesco SOPRACORDEVOLE ; Giorgio GIORDA ; Tommaso SIMONCINI ; Marta CARETTO ; Enrico SARTORI ; Federico FERRARI ; Antonio CIANCI ; Giuseppe SARPIETRO ; Maria Grazia MATARAZZO ; Fulvio ZULLO ; Giuseppe BIFULCO ; Michele MORELLI ; Annamaria FERRERO ; Nicoletta BIGLIA ; Fabio BARRA ; Simone FERRERO ; Umberto Leone Roberti MAGGIORE ; Stefano CIANCI ; Vito CHIANTERA ; Alfredo ERCOLI ; Giulio SOZZI ; Angela MARTOCCIA ; Sergio SCHETTINI ; Teresa ORLANDO ; Francesco G CANNONE ; Giuseppe ETTORE ; Andrea PUPPO ; Martina BORGHESE ; Canio MARTINELLI ; Ludovico MUZII ; Violante Di DONATO ; Lorenza DRIUL ; Stefano RESTAINO ; Alice BERGAMINI ; Giorgio CANDOTTI ; Luca BOCCIOLONE ; Francesco PLOTTI ; Roberto ANGIOLI ; Giulia MANTOVANI ; Marcello CECCARONI ; Chiara CASSANI ; Mattia DOMINONI ; Laura GIAMBANCO ; Silvia AMODEO ; Livio LEO ; Raphael THOMASSET ; Diego RAIMONDO ; Renato SERACCHIOLI ; Mario MALZONI ; Franco GORLERO ; Martina Di LUCA ; Enrico BUSATO ; Sami KILZIE ; Andrea DELL'ACQUA ; Giovanna SCARFONE ; Paolo VERCELLINI ; Marco PETRILLO ; Salvatore DESSOLE ; Giampiero CAPOBIANCO ; Andrea CIAVATTINI ; Giovanni Delli CARPINI
Journal of Gynecologic Oncology 2022;33(1):e10-
Objective:
Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients.
Methods:
This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak.
Results:
Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.7% in period 1 vs. 52.8% in period 2; p<0.001). Overall, 1,280 (50.4%) and 1,021 (44.7%) patients had no adjuvant therapy in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during COVID-19 pandemic (p<0.001).
Conclusion
Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of EC patients. These findings highlight the need to implement healthcare services during the pandemic.
5.Long-term results of suppressing thyroid-stimulating hormone during radiotherapy to prevent primary hypothyroidism in medulloblastoma/PNET and Hodgkin lymphoma: a prospective cohort study.
Maura MASSIMINO ; Marta PODDA ; Lorenza GANDOLA ; Emanuele PIGNOLI ; Ettore SEREGNI ; Carlo MOROSI ; Filippo SPREAFICO ; Andrea FERRARI ; Emilia PECORI ; Monica TERENZIANI
Frontiers of Medicine 2021;15(1):101-107
Primary hypothyroidism commonly occurs after radiotherapy (RT), and coincides with increased circulating thyroid-stimulating hormone (TSH) levels.We tested therefore the protective effect of suppressing TSH with L-thyroxine during RT for medulloblastoma/PNET and Hodgkin lymphoma (HL) in a prospective cohort study. From1998 to 2001, a total of 37 euthyroid children with medulloblastoma/PNET plus 14 with HL, scheduled for craniospinal irradiation and mediastinum/neck radiotherapy, respectively, underwent thyroid ultrasound and free triiodothyronine (FT3), free thyroxine (FT4), and TSH evaluation at the beginning and end of craniospinal iiradiation. From 14 days before and up to the end of radiotherapy, patients were administered L-thyroxine checking every 3 days TSH to ensure a value < 0.3 μIU/mL. During follow-up, blood tests and ultrasound were repeated; primary hypothyroidism was considered an increased TSH level greater than normal range. Twenty-two/37 patients with medulloblastoma/PNET and all the 14 patients with HL were alive after a median 231 months from radiotherapy with 7/22 and 8/14 having correctly reached TSH levels < 0.3 μIU/mL and well matched for other variables. Twenty years on, hypothyroidism-free survival rates differed significantly, being 60% ± 15% and 15.6% ± 8.2% in TSH-suppressed vs. not-TSH suppressed patients, respectively (P = 0.001). These findings suggest that hypothyroidism could be durably prevented in two populations at risk of late RT sequelae, but it should be confirmed in a larger cohort.
Cerebellar Neoplasms
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Child
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Hodgkin Disease/radiotherapy*
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Humans
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Hypothyroidism/prevention & control*
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Medulloblastoma/radiotherapy*
;
Prospective Studies
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Thyrotropin