PubMed Health⌕ Search

Biomedical subjects

Robert E Bristow

Publications and source records attributed to Robert E Bristow.

At least 19 recordsLinked to original sources
PubMed2007

Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer: analysis of prognostic factors and survival outcome.

BACKGROUND: The objective of this study was to evaluate the role of secondary cytoreductive surgery in the outcome of patients who had recurrent epithelial ovarian carcinoma that was limited to or=12 months between initial diagnosis and recurrence, and or=18 months (median survival, 49 months vs 3 months; P < .01), the number of radiographic recurrence sites (median survival, 50 months for patients with 1 or 2 sites vs 12 months for patients with 3 to 5 sites; P < .03), and residual disease (median survival, 50 months for patients with no macroscopic residual disease vs 7.2 months for patients with macroscopic residual disease; P < .01). Age, tumor grade, histology, CA-125 level, ascites, and tumor size were not associated significantly with survival. CONCLUSIONS: : The current data supported the definition of localized recurrent ovarian cancer as patients with 1 or 2 radiographic recurrence sites. In this select population, a diagnosis-to-recurrence interval >or=18 months and complete secondary surgical cytoreduction, which was achievable in the majority of patients, were associated with a median postrecurrence survival of approximately 50 months.

Adult↗
PubMed2006

Delaying the primary surgical effort for advanced ovarian cancer: a systematic review of neoadjuvant chemotherapy and interval cytoreduction.

OBJECTIVE: To summarize the existing data on interval cytoreductive surgery and neoadjuvant chemotherapy as alternative treatment strategies for patients with advanced-stage ovarian cancer. METHODS: All investigational studies with evaluable survival data on interval cytoreductive surgery and neoadjuvant chemotherapy for ovarian cancer reported in the English language literature between 1989 and 2006 were systematically reviewed. RESULTS: Three randomized trials and six non-randomized studies of interval cytoreduction following suboptimal initial surgery were identified. Twenty-six studies, including a total of 1336 patients, reporting on neoadjuvant chemotherapy administered in lieu of primary cytoreductive surgery were analyzed according to the survival outcome achieved, the degree of surgical effort or success, and the particular selection criteria employed to justify deferring an attempt at primary cytoreductive surgery. CONCLUSIONS: Interval surgery following a concerted but suboptimal attempt at up-front cytoreduction does not appear to have an appreciable impact on survival outcome. Maximal primary cytoreductive surgery remains the standard of care for the majority of women with suspected advanced ovarian cancer. Neoadjuvant chemotherapy represents a viable alternative management strategy for the limited number of patients felt to be optimally unresectable by an experienced ovarian cancer surgical team; however, currently available data suggest that the survival outcome achievable with initial chemotherapy is inferior to successful up-front cytoreductive surgery. Additional research is needed to devise universal selection criteria for neoadjuvant chemotherapy, determine the most efficacious treatment program, and characterize the appropriate proportion of patients in which an attempt at primary surgery should be abandoned in favor of initial chemotherapy.

Chemotherapy, Adjuvant↗
PubMed2006

Secondary cytoreductive surgery for isolated nodal recurrence in patients with epithelial ovarian cancer.

OBJECTIVES: To evaluate the feasibility and associated survival outcome of secondary cytoreductive surgery in patients with isolated lymph node recurrence of epithelial ovarian cancer. METHODS: Twenty-five patients with epithelial ovarian cancer who underwent secondary cytoreductive surgery for isolated lymph node recurrence were identified from tumor registry databases. Demographic, diagnostic, operative, pathologic, and follow-up data were abstracted retrospectively. Overall survival was calculated using the Kaplan-Meier method. RESULTS: The median age at time of primary surgery for ovarian cancer was 55 years; 72% of patients had FIGO III/IV disease, and all had high-grade tumors. All patients received platinum-based chemotherapy following primary surgery. The median time from completion of primary chemotherapy to nodal recurrence surgery was 16 months (range=6 to 40 months). The distribution of nodal involvement was pelvic=12% (n=3), para-aortic=60% (n=15), inguinal=20% (n=5), peri-cardiac=4% (n=1), and pelvic plus para-aortic=4% (n=1). The maximal nodal tumor diameter ranged from 1.5 cm to 14 cm, with a median of 3.0 cm. Optimal secondary cytoreductive surgery (residual disease </=1 cm) was achieved in 100% of patients. The median estimated intra-operative blood loss was 100 cc (range=10 cc to 600 cc). The length of hospitalization ranged from 2 days to 10 days, with a median of 4 days. There was no instance significant postoperative morbidity. At a median post-recurrence follow-up time of 19 months, 8 patients (32%) have died of the disease, 7 (28%) are alive with disease, and 10 (40%) patients are without evidence of disease. For the entire study population, the median post-recurrence OS after secondary cytoreduction of recurrent nodal disease was 37 months. CONCLUSION: Complete optimal secondary cytoreductive surgery for recurrent epithelial ovarian cancer presenting as isolated node metastases is achievable in the majority of cases and is associated with a favorable long-term survival outcome.

Adult↗
PubMed2006

A BTB/POZ protein, NAC-1, is related to tumor recurrence and is essential for tumor growth and survival.

Recent studies have suggested an oncogenic role of the BTB/POZ-domain genes in hematopoietic malignancy. The aim of this study is to identify and characterize BTB/POZ-domain genes in the development of human epithelial cancers, i.e., carcinomas. In this study, we focused on ovarian carcinoma and analyzed gene expression levels using the serial analysis of gene expression (SAGE) data in all 130 deduced BTB/POZ genes. Our analysis reveals that NAC-1 is significantly overexpressed in ovarian serous carcinomas and several other types of carcinomas. Immunohistochemistry studies in ovarian serous carcinomas demonstrate that NAC-1 is localized in discrete nuclear bodies (tentatively named NAC-1 bodies), and the levels of NAC-1 expression correlate with tumor recurrence. Furthermore, intense NAC-1 immunoreactivity in primary tumors predicts early recurrence in ovarian cancer. Both coimmunoprecipitation and double immunofluorescence staining demonstrate that NAC-1 molecules homooligomerize through the BTB/POZ domain. Induced expression of the NAC-1 mutant containing only the BTB/POZ domain disrupts NAC-1 bodies, prevents tumor formation, and promotes tumor cell apoptosis in established tumors in a mouse xenograft model. Overexpression of full-length NAC-1 enhanced tumorigenicity of ovarian surface epithelial cells and NIH 3T3 cells in athymic nu/nu mice. In summary, NAC-1 is a tumor recurrence-associated gene with oncogenic potential, and the interaction between BTB/POZ domains of NAC-1 proteins is critical to form the discrete NAC-1 nuclear bodies and essential for tumor cell proliferation and survival.

Animals↗
PubMed2006

Prevention of adhesion formation after radical hysterectomy using a sodium hyaluronate-carboxymethylcellulose (HA-CMC) barrier: a cost-effectiveness analysis.

OBJECTIVE: To evaluate the cost-effectiveness of an adhesion prevention strategy compared to routine care, in which no adhesion prevention measures are taken, through a decision analysis model in the clinical setting of patients undergoing radical hysterectomy and pelvic lymphadenectomy for Stage IB cervical cancer. METHODS: A decision analysis model compared two strategies to manage the risk of adhesion-related morbidity following radical hysterectomy for Stage IB cervical cancer: (1) routine care with no adhesion prevention measures, and (2) the intervention strategy with a HA-CMC anti-adhesion barrier. The cost-effectiveness of each strategy was evaluated from the perspective of society and that of a third party payer. RESULTS: From the perspective of society, the HA-CMC strategy had an overall cost per patient of $1932 and effectiveness of 7.901 QALYs and dominated the routine care strategy, which had a cost per patient of $3043 and effectiveness of 7.805 QALYs. From the perspective of a third party payer, the HA-CMC strategy had an overall cost per patient of $1247 and effectiveness of 7.987 QALYs and dominated the routine care strategy, which had a cost per patient of $1629 and effectiveness of 7.970 QALYs. A series of one-way sensitivity analyses confirmed the robustness of the model. CONCLUSIONS: Under a conservative set of clinical and economic assumptions, an adhesion prevention strategy utilizing a HA-CMC barrier in patients undergoing radical hysterectomy for Stage IB cervical cancer is cost-effective from both the perspective of society as a whole and that of a third party payer.

Carboxymethylcellulose Sodium↗
PubMed2006

Clinical utility of atypical glandular cells (AGC) classification: cytohistologic comparison and relationship to HPV results.

OBJECTIVES: To determine the utility of the category of atypical glandular cells (AGC) in the management of patients with putative cervical neoplasia and to correlate HPV-DNA test results when available. METHODS: The Johns Hopkins Hospital cytopathology records of 50,668 women patients were searched for all liquid-based gynecologic cytology (LBP) results of Atypical Glandular cells of Undetermined Significance (AGUS) and AGC from January 1, 2001 through December 31, 2003, yielding 98 patients (0.19%). Oncogenic HPV-DNA tests were performed on the residual fluids of 43 of these patients, 37 of whom had follow-up biopsy. During the period of January 1, 2000 and December 31, 2002, we identified 237 patients (0.58%) with conventional Pap smears in the AGUS or AGC category, among 41,024 conventional smears collected contemporaneously. To avoid confusion in this paper, AGC will be used to replace those results that originally were AGUS. RESULTS: Following the 98 LBP AGC interpretations, 24 lesions (33.8%) were discovered out of 71 biopsies. HPV-DNA tests were performed on the residual of 43 LBPs, 18 (41.9%) were positive for oncogenic HPV. Only 37 patients had follow-up biopsy and 15 (40.5%) were positive for oncogenic HPV, of which 40% (6/15) had a significant lesion. Of the 237 conventional AGC Paps, 18 lesions (15.3%) were discovered out of 118 biopsies. CONCLUSIONS: Comparison of liquid-based and conventional Pap tests revealed a significant difference (33.8% vs. 15.3% respectively) (OR: 2.84, 95% CI: 1.4-5.73, p=0.004) in the detection of glandular and squamous lesions. HPV testing may prove beneficial to triage AGC patients with negative colposcopic findings and positive HPV results.

Adenocarcinoma↗
PubMed2006

Tertiary cytoreductive surgery in recurrent ovarian cancer: selection criteria and survival outcome.

OBJECTIVES: Studies of tertiary cytoreductive surgery (TCS) in recurrent epithelial ovarian cancer are limited, and appropriate patient selection remains a clinical challenge. We sought to evaluate the impact of TCS on survival and to determine predictors of optimal tertiary resection. METHODS: Between January 1997 and July 2004, 47 women with recurrent epithelial ovarian cancer underwent TCS at two institutions. All patients received initial platinum and taxane-based chemotherapy following primary cytoreductive surgery. Clinico-pathologic factors and survival were retrospectively abstracted from medical records. Optimal TCS was defined as microscopic residual disease. RESULTS: Thirty of 47 (64%) patients underwent optimal TCS. Size of tumor implants<5 cm on preoperative imaging was the only significant predictor of achieving optimal TCS. Overall survival after TCS was statistically longer in patients with microscopic versus macroscopic residual disease (24 versus 16 months, p=0.03). After controlling for age, time to progression and optimal TCS, only the presence of diffuse disease at tertiary exploration remained a significant poor predictor of survival. However, in a cohort of patients with limited disease implants, multivariate analysis indicated that optimal TCS retained prognostic significance as a positive predictor of survival. Twelve patients (26%) experienced severe postoperative complications, including six with pulmonary embolism, four with fistulae and two with postoperative myocardial infarctions. CONCLUSIONS: Size of disease implants on preoperative imaging may guide the selection of candidates for TCS. In those patients with limited disease implants at laparotomy, optimal TCS is associated with improved survival.

Adult↗
PubMed2006

Uterine cancer in Maryland: impact of surgeon case volume and other prognostic factors on short-term mortality.

OBJECTIVES: To characterize the patterns of primary surgical care and short term outcomes for uterine cancer according to surgeon and hospital case volume. METHODS: A statewide hospital discharge database was used to identify women undergoing primary surgery for uterine cancer during 1994-2005. Surgeon case volume was categorized as low ( or=100 cases/12 years). Hospital case volume was categorized as low ( or=200 cases/12 years). Logistic regression models were used to evaluate for significant factors associated with in-hospital death and access to high volume care. RESULTS: Overall, 6,181 cases for uterine cancer were performed by 894 surgeons at 49 hospitals. Low volume surgeons performed 62.4% of the cases. Management by high volume surgeons was associated with a 53% reduction in the risk of the case being managed by different attending physician/surgeon (95% CI 0.38-0.57, p<0.00). In contrast, 90.5% of cases were performed at high volume hospitals. Management by different attending physician/surgeon was associated with a 2.6 increase in the risk of in hospital death (95%CI 1.41-4.79, p=0.00). Surgery performed by high-volume surgeons was associated with a 48% reduction in the risk of in-hospital death (95%CI 0.26-1.00, p=0.05). CONCLUSIONS: Surgical management of uterine cancer by high volume surgeons is associated with a decrease risk in in-hospital death. Increased efforts to concentrate the surgical management of uterine cancer by high volume surgeons at high volume centers should be undertaken.

Adult↗
PubMed2006

Predictors of surgical outcome and survival among elderly women diagnosed with ovarian and primary peritoneal cancer.

OBJECTIVE: To identify perioperative variables that will predict surgical outcome and survival among elderly women diagnosed with ovarian and primary peritoneal cancer. METHODS: A retrospective review of 78 women>or=75 years treated for ovarian and primary peritoneal cancer from 1/1/90 to 06/30/04 was performed. Patients were categorized in two groups based on optimal versus suboptimal cytoreductive surgery. Perioperative variables were compared across the two groups by univariate and multivariate logistic regression analysis to evaluate the impact on survival. RESULTS: The median age at the time of diagnosis was 79.3 years. Overall, 50% of the patients underwent optimal cytoreductive surgery. Patients with low perioperative serum albumin levels were associated with a 2.4-fold increased risk of suboptimal cytoreductive surgery (95% CI 1.02-5.88, p=0.04). Median survival of patients that underwent cytoreductive surgery was 19 months. As expected, survival analysis showed that patients with suboptimal cytoreductive surgery had a lower survival (median=17 months) than patients with optimal surgery (median=62 months, p=0.00). Patients>or=80 years were associated with a nearly 2-fold increase in the risk of mortality (95% CI 1.05-3.54, p=0.03), while albumin levels of >or=3.7 g/dl were associated with a 40% reduction in risk of mortality (95% CI 0.41-0.89, p=0.01). CONCLUSIONS: Optimal cytoreductive surgery is feasible in many elderly patients. Women>or=80 years and with poor nutritional status are associated with a poor survival outcome. Perioperative variables such as these can be used to identify the elderly patients that are most likely to be suboptimally cytoreduced and thus have a dismal survival outcome.

Aged↗
PubMed2006

Platinum-based neoadjuvant chemotherapy and interval surgical cytoreduction for advanced ovarian cancer: a meta-analysis.

OBJECTIVE: To determine the overall survival and relative effect of multiple prognostic variables in cohorts of patients with advanced-stage ovarian cancer treated with platinum-based neoadjuvant chemotherapy in lieu of primary cytoreductive surgery. METHODS: Twenty-two cohorts of patients with Stage III and IV ovarian cancer (835 patients) were identified from articles in MEDLINE (1989-2005). Linear regression models, with weighted correlation calculations, were used to assess the effect on median survival time of the proportion of each cohort undergoing maximum interval cytoreduction, proportion of patients with Stage IV disease, median number of pre-operative chemotherapy cycles, median age, and year of publication. RESULTS: The mean weighted median overall survival time for all cohorts was 24.5 months. The weighted mean proportion of patients in each cohort undergoing maximal interval cytoreduction was 65.0%. Each 10% increase in maximal cytoreduction was associated with a 1.9 month increase in median survival time (p=0.027). Median overall survival was positively correlated with platinum-taxane chemotherapy (p<0.001) and increasing year of publication (p=0.004) and negatively correlated with the proportion of Stage IV disease (p=0.002). Each incremental increase in pre-operative chemotherapy cycles was associated with a decrease in median survival time of 4.1 months (p=0.046). CONCLUSIONS: Neoadjuvant chemotherapy in lieu of primary cytoreduction is associated with inferior overall survival compared to initial surgery. Increasing percent maximal cytoreduction is positively associated with median cohort survival; however, the negative survival effect of increasing number of chemotherapy cycles prior to interval surgery suggests that definitive operative intervention should be undertaken as early in the treatment program as possible.

Aged↗
PubMed2006

Impact of surgeon specialty on ovarian-conserving surgery in young females with an adnexal mass.

PURPOSE: To evaluate the patterns of surgical care among pediatric and adolescent females undergoing operative intervention for an adnexal mass with particular attention toward factors associated with ovarian-conserving surgery and access to gynecologic care. METHODS: All female patients aged < or = 18 years undergoing surgery for an adnexal mass between January 1, 1991 and December 31, 2002 were retrospectively identified and demographic, operative, and pathologic data abstracted. Logistic regression analyses were used to identify factors independently associated with ovarian-conserving surgery and access to gynecologic care. RESULTS: Eighty-two consecutive cases were identified. The median age at surgery was 15 years, and 91.7% of patients were > or = 12 years of age. A malignant ovarian neoplasm was present in 14.6% of cases. Oophorectomy was performed in 52.4% of cases, while 47.6% of patients underwent ovarian-conserving surgery. Multivariate regression analysis revealed that ovarian-conserving surgery was significantly less likely in the setting of malignancy, torsion, and an ovarian size of > or = 6 cm. The presence of a gynecologic surgeon, compared to other surgical specialties, was statistically significantly and independently associated with ovarian-conserving surgery (odds ratio [OR] 8.71, 95% confidence interval [CI] 2.12-41.41, p = .001). Post-menarchal status and age > or = 16 years were the characteristic most predictive of access to gynecologic surgical care. CONCLUSIONS: In pediatric and adolescent patients, operative intervention for an adnexal mass is significantly more likely to result in ovarian conservation when performed by a gynecologic surgeon. For such patients, improved access to gynecologic consultation prior to surgical intervention may reduce the number of patients subjected to oophorectomy for benign conditions.

Adnexal Diseases↗
PubMed2006

Cost-effectiveness of routine vaginal cytology for endometrial cancer surveillance.

OBJECTIVE: To examine the cost-effectiveness of routine vaginal cytology in detecting asymptomatic isolated vaginal recurrence during post-treatment endometrial cancer surveillance. METHODS: All patients treated for endometrial cancer between 7/1/97 and 6/30/2005 were retrospectively identified from the tumor registry database. Clinico-pathologic characteristics and surveillance testing data were abstracted from medical records. The total number of Pap tests performed during surveillance or until the time of recurrence was calculated and charges associated with detecting asymptomatic isolated vaginal recurrence assigned based on 2005 Pap test costs adjusted retroactively using the consumer price index. RESULTS: Three hundred seventy-seven patients met inclusion criteria: FIGO Stage I=63.7%, Stage II=10.1%, Stage III=18.8%, Stage IV=7.4%. The median follow-up time was 30.4 months. A total of 2,134 Pap tests were collected during the study interval (median 5, mean 5.76 samples/patient). Endometrial cancer recurred in 61 patients (16.2%); 11 patients (2.9%) had an isolated vaginal recurrence. Seven isolated vaginal recurrences were detected by physical examination alone, and 2 were detected by interval computed tomography. An asymptomatic isolated vaginal recurrence was detected by routine vaginal cytology in 2 of 377 patients (0.5%). Detection of each asymptomatic vaginal recurrence required 1067 Pap tests, generating 44,049 US dollar in cumulative charges. CONCLUSIONS: As a surveillance test for endometrial cancer recurrence, routine vaginal cytology is costly, inefficient, and benefits less than 1% of patients. Elimination or reduction in the use of vaginal cytology for this purpose offers an opportunity for significant cost savings in gynecologic oncology health care expenditure.

Cost-Benefit Analysis↗
PubMed2006

Salvage cytoreductive surgery for recurrent endometrial cancer.

OBJECTIVE: To determine the survival impact of salvage cytoreductive surgery, and other prognostic variables, among patients with recurrent endometrial cancer. METHODS: All patients diagnosed with endometrial cancer recurrence between 7/1/97 and 6/30/05 were retrospectively identified from the tumor registry database. Demographic, pathological, and clinical data were abstracted from the medical record. Survival estimates were calculated using the Kaplan and Meier method. Univariate and multivariate regression analyses were used to identify characteristics associated with overall survival from time of recurrence. RESULTS: Sixty-one patients were identified with endometrial cancer recurrence a median of 18.5 months after initial diagnosis. Median age at recurrence was 63 years, and the median post-recurrence follow-up time was 22.0 months. Thirty-five patients underwent salvage cytoreductive surgery and had a median survival time of 28.0 months, compared to 13.0 months for patients treated non-surgically (P < 0.0001). Complete cytoreduction (no gross residual) was achieved in 23/35 surgical patients (65.7%). The median EBL was 350 cc and 28.6% of patients received blood products. There were no peri-operative deaths; however, 31.4% of patients experienced minor morbidity. Patients undergoing complete salvage cytoreduction had a median post-recurrence survival time of 39.0 months, compared to 13.5 months for those patients with gross residual disease (P = 0.0005). On multivariate analysis, salvage surgery and residual disease status were significant and independent predictors of post-recurrence survival. CONCLUSIONS: Complete salvage cytoreductive surgery for recurrent endometrial cancer is associated with prolonged post-recurrence survival compared to patients left with any gross residual disease. Additional studies are warranted to define appropriate surgical indications and selection criteria.

Adult↗
PubMed2006

Associations between hospital and surgeon procedure volumes and patient outcomes after ovarian cancer resection.

BACKGROUND: Strong associations between provider (i.e., hospital or surgeon) procedure volumes and patient outcomes have been demonstrated for many types of cancer operation. We performed a population-based cohort study to examine these associations for ovarian cancer resections. METHODS: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to identify 2952 patients aged 65 years or older who had surgery for a primary ovarian cancer diagnosed from 1992 through 1999. Hospital- and surgeon-specific procedure volumes were ascertained based on the number of claims submitted during the 8-year study period. Primary outcome measures were mortality at 60 days and 2 years after surgery, and overall survival. Length of hospital stay was also examined. Patient age at diagnosis, race, marital status, comorbid illness, cancer stage, and median income and population density in the area of residence were used to adjust for differences in case mix. All P values are two-sided. RESULTS: Neither hospital- nor surgeon-specific procedure volume was statistically significantly associated with 60-day mortality following primary ovarian cancer resection. However, differences by hospital volume were seen with 2-year mortality; patients treated at the low-, intermediate-, and high-volume hospitals had 2-year mortality rates of 45.2% (95% confidence interval [CI] = 42.1% to 48.4%), 41.1% (95% CI = 38.1% to 44.3%), and 40.4% (95% CI = 37.4% to 43.4%), respectively. The inverse association between hospital procedure volume and 2-year mortality was statistically significant both before (P = .011) and after (P = .006) case-mix adjustment but not after adjustment for surgeon volume. Two-year mortality for patients treated by low-, intermediate-, and high-volume surgeons was 43.2% (95% CI = 40.7% to 45.8%), 42.9% (95% CI = 39.5% to 46.4%), and 39.5% (95% CI = 36.0% to 43.2%), respectively; there was no association between 2-year mortality and surgeon procedure volume, with or without case-mix adjustment. After case-mix adjustment, neither hospital volume (P = .031) nor surgeon volume (P = .062) was strongly associated with overall survival. CONCLUSION: Hospital- and surgeon-specific procedure volumes are not strong predictors of survival outcomes following surgery for ovarian cancer among women aged 65 years or older.

Aged↗
PubMed2006

Effect of surgeon specialty on processes of care and outcomes for ovarian cancer patients.

BACKGROUND: For many diseases, specialized care (i.e., care rendered by a specialist) has been associated with superior-quality care (i.e., better outcomes). We examined associations between physician specialty and outcomes in a population-based cohort of elderly ovarian cancer surgery patients. METHODS: We analyzed the Medicare claims, by physician specialty, of all women aged 65 years or older who underwent surgery for pathologically confirmed invasive epithelial ovarian cancer between January 1, 1992, and December 31, 1999, while living in an area monitored by the Surveillance, Epidemiology, and End Results (SEER) program to assess important care processes (i.e., the appropriate extent of surgery and use of adjuvant chemotherapy) and outcomes (i.e., surgical complications, ostomy rates, and survival). All statistical tests were two-sided. RESULTS: Among 3067 ovarian cancer patients who underwent surgery, 1017 patients (33%) were treated by a gynecologic oncologist, 1377 patients (45%) by a general gynecologist, and 673 patients (22%) by a general surgeon. Among patients with stage I or II disease, those treated by a gynecologic oncologist (60%) were more likely to undergo lymph node dissection than those treated by a general gynecologist (36%) or a general surgeon (16%). Patients with stage III or IV disease were more likely to undergo a debulking procedure if the initial surgery was performed by a gynecologic oncologist (58%) than by a general gynecologist (51%) or a general surgeon (40%; P < .001) and were more likely to receive postoperative chemotherapy when operated on by a gynecologic oncologist (79%) or a general gynecologist (76%) than by a general surgeon (62%, P < .001). Survival among patients operated on by gynecologic oncologists (hazard ratio [HR] of death from any cause = 0.85, 95% confidence interval [CI] = 0.76 to 0.95) or general gynecologists (HR = 0.86, 95% CI = 0.78 to 0.96) was better than that among patients operated on by general surgeons. CONCLUSIONS: Ovarian cancer patients treated by gynecologic oncologists had marginally better outcomes than those treated by general gynecologists and clearly superior outcomes compared with patients treated by general surgeons.

Aged↗
PubMed2006

Paraneoplastic cerebellar degeneration in a woman with ovarian cancer.

BACKGROUND: A 52-year-old white female presented with sudden onset of light-headedness followed by diplopia, horizontal vertigo and severe nystagmus with oscillopsia. She had previously been in good health. MRI of the brain was normal. Lumbar puncture revealed monocytic pleocytosis. During her initial admission, the patient improved to some degree and was discharged with a possible diagnosis of viral meningitis. After a few weeks, the patient's condition worsened and further evaluation was initiated. Examination revealed an unsteady widespread gait, severe nystagmus and mild dysarthria. A general and gynecological examination was otherwise unremarkable. INVESTIGATIONS: General physical and gynecological examinations, MRI of the brain, lumbar punctures, electroencephalogram, transvaginal ultrasound, mammogram, tumor markers, anti-neuronal antibodies, colonoscopy, whole-body positron emission tomography scan, laparoscopy and biopsies. DIAGNOSIS: Stage IIIC endometrioid adenocarcinoma of the ovary with paraneoplastic cerebellar degeneration. MANAGEMENT: Tumor cytoreduction, plasmapheresis, total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and para-aortic lymph-node dissection, total omentectomy, carboplatin and paclitaxel chemotherapy, rehabilitation, and speech therapy.

Carcinoma, Endometrioid↗