OBJECTIVE: To determine whether preoperative platelets to lymphocyte ratio (PLR) could predict disease stage, surgical outcome, and survival in patients with epithelial ovarian cancer (EOC). METHODS: Medical records of EOC patients who had surgery between January 2004 and December 2010 were reviewed. Clinicopathological and complete blood count data were collected. The optimal predictive value of PLR to predict advanced stage, suboptimal surgery, and survival was determined and compared with those of thrombocytosis (> or =400,000 cells/mm3) and neutrophil to lymphocyte ratio (NLR) > or =2.6. RESULTS: A total of 166 EOC patients were included in the study. PLR of 200 yielded better predictive values than those of thrombocytosis and NLR > or =2.6. The area under curve (AUC), sensitivity, specificity, positive and negative predictive values, and accuracy of PLR to predict advanced stage were: 0.66, 59.0%, 72.7%, 65.7%, 66.7%, and 66.3%, respectively. The corresponding values to predict suboptimal surgery were: 0.70, 70.0%, 69.8%, 50.0%, 84.4%, and 69.9%. The patients who had PLR> or =200 had significantly shorter progression-free and overall survivals than those with PLR<200. Stage, grade, surgical outcome, thrombocytosis, and PLR were significant prognostic factors for survivals by univariable analyses while only stage remained significant by multivariable analysis. CONCLUSION: PLR had potential clinical value in predicting advanced stage disease or suboptimal surgery. PLR was a better prognostic indicator for survivals of EOC patients compared to thrombocytosis or NLR>2.6.
Area Under Curve ; Blood Cell Count ; Blood Platelets ; Humans ; Lymphocytes ; Medical Records ; Neoplasms, Glandular and Epithelial ; Neutrophils ; Ovarian Neoplasms ; Sensitivity and Specificity ; Thrombocytosis

OBJECTIVE: To determine whether preoperative platelets to lymphocyte ratio (PLR) could predict disease stage, surgical outcome, and survival in patients with epithelial ovarian cancer (EOC). METHODS: Medical records of EOC patients who had surgery between January 2004 and December 2010 were reviewed. Clinicopathological and complete blood count data were collected. The optimal predictive value of PLR to predict advanced stage, suboptimal surgery, and survival was determined and compared with those of thrombocytosis (> or =400,000 cells/mm3) and neutrophil to lymphocyte ratio (NLR) > or =2.6. RESULTS: A total of 166 EOC patients were included in the study. PLR of 200 yielded better predictive values than those of thrombocytosis and NLR > or =2.6. The area under curve (AUC), sensitivity, specificity, positive and negative predictive values, and accuracy of PLR to predict advanced stage were: 0.66, 59.0%, 72.7%, 65.7%, 66.7%, and 66.3%, respectively. The corresponding values to predict suboptimal surgery were: 0.70, 70.0%, 69.8%, 50.0%, 84.4%, and 69.9%. The patients who had PLR> or =200 had significantly shorter progression-free and overall survivals than those with PLR<200. Stage, grade, surgical outcome, thrombocytosis, and PLR were significant prognostic factors for survivals by univariable analyses while only stage remained significant by multivariable analysis. CONCLUSION: PLR had potential clinical value in predicting advanced stage disease or suboptimal surgery. PLR was a better prognostic indicator for survivals of EOC patients compared to thrombocytosis or NLR>2.6.
Area Under Curve ; Blood Cell Count ; Blood Platelets ; Humans ; Lymphocytes ; Medical Records ; Neoplasms, Glandular and Epithelial ; Neutrophils ; Ovarian Neoplasms ; Sensitivity and Specificity ; Thrombocytosis

OBJECTIVE: To analyze the cost-utility of two common clinical practices for stage IB cervical cancer patients from provider and societal viewpoints. METHODS: A decision tree model was conducted to examine value for expenditure between the following: (1) radical hysterectomy with pelvic lymph node dissection (RHPLND) with or without postoperative adjuvant therapy according to the risk of recurrence and (2) concurrent chemoradiotherapy (CCRT). The relevant studies were identified to extract the probability data, and meta-analysis was performed. Direct medical costs were estimated from hospital database and medical records review. Direct non-medical costs and utility parameters were obtained through interviews with patients to estimate quality-adjusted life years (QALYs) outcome. The time horizon was according to the life expectancy of Thai women. RESULTS: From provider viewpoint, RHPLND and CCRT resulted in approximate costs of US $5,281 and US $5,218, respectively. The corresponding costs from societal viewpoint were US $6,533 and US $6,335, respectively. QALYs were 16.40 years for RHPLND and 15.94 years for CCRT. The estimated incremental cost effectiveness ratio of RHPLND in comparison to CCRT from provider and societal viewpoints were US $100/QALY and US $430/QALY, respectively. RHPLND had more cost-effectiveness than CCRT if patients did not need adjuvant therapy. The most effective parameter in model was a direct medical cost of CCRT. At the current ceiling ratio in Thailand, RHPLND provides better value for money than CCRT, with a probability of 75%. CONCLUSION: RHPLND is an efficient treatment for stage IB cervical cancer. This advantage is only for patients who require no adjuvant treatment.
Asian Continental Ancestry Group ; Chemoradiotherapy ; Cost-Benefit Analysis ; Decision Trees ; Female ; Health Expenditures ; Humans ; Hysterectomy ; Life Expectancy ; Lymph Node Excision ; Medical Records ; Quality-Adjusted Life Years ; Recurrence ; Thailand ; Uterine Cervical Neoplasms*

OBJECTIVE: To evaluate the value of visual inspection with acetic acid (VIA) test to detect high grade lesion in women with atypical squamous cells or low grade squamous intraepithelial lesions cervical cytology. METHODS: Women with atypical squamous cells or low grade squamous intraepithelial lesions who were scheduled to undergo colposcopy at Vajira Hospital and met inclusion criteria were included. All participants underwent VIA test prior to usual steps of colposcopy. The VIA results were interpreted as positive or negative using the criteria by the International Agency for Cancer Research. The standard colposcopic examination and appropriate investigations for cervical pathology were then continued. The diagnostic values of VIA test including sensitivity, specificity, positive predictive value, and negative predictive value were determined using high grade lesion including cervical intraepithelial neoplasia 2-3 and squamous cell carcinoma as a threshold. RESULTS: Total of 106 women was included. The VIA test was positive in 33 women (31.1%) and negative in 73 women (68.9%). Among the women with VIA test positive, 14 had high grade lesion (42.4%) while 19 had no significant lesions. Only 2/73 (2.7%) cases with negative VIA test had high grade lesion (both had cervical intraepithelial neoplasia 2). The sensitivity, specificity, positive predictive value and negative predictive value with 95% confidence interval were 87.5% (81.2 to 93.8%), 78.8% (71.1 to 86.7%), 42.4% (33.0 to 51.8%), and 97.2% (94.2 to 1.0%) respectively. CONCLUSION: VIA as the intermediate test in atypical squamous cells and low grade squamous intraepithelial lesions cytology may reduce the necessity to refer some women for colposcopy.
Acetic Acid ; Carcinoma, Squamous Cell ; Cervical Intraepithelial Neoplasia ; Colposcopy ; Female ; Humans ; International Agencies ; Sensitivity and Specificity