Browsing by Author "Baidekalna, Ieva"
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Item Midline involvement as a risk factor for vulvar cancer recurrence(2012) Stankeviča, Jekaterīna; Macuks, Ronalds; Baidekalna, Ieva; Donina, Simona; Department of Obstetrics and GynaecologyObjective: This observational study was to identify risk factors for vulvar cancer recurrence. Materials and Methods: In the study 107 patients with primary vulvar cancer were analyzed. Surgical treatment consisted of radical excision of the primary tumor in combination with unilateral or bilateral superficial and deep inguinofemoral lymphadenectomy through separate incisions. Patients with deeper tumor invasion >1 mm or wider than 2 cm and/or groin lymphnode metastases were referred for adjuvant radiotherapy. Those with large privary vulvar tumors received neoadjuvant radiotherapy of 30Gy followed by surgical treatment and adjuvant radiotherapy. Results: Most of patients had only primary radiotherapy to the vulva and inguinal lymph nodes and only 34.5% of patients were eligible for surgical treatment. In 5 year follow-up period 25.2% (27) patients were alive without the disease, 15.0% (16) were alive with the disease and 59.8% (64) were dead. 60.7% (65) patients experienced local recurrence and 2.8% (3) patients had distant metastases. Median survival for patients without recurrent disease was 38.9±3.2 months and 36.0±2.6 months with no statistically significant difference. Patients with early stage vulvar cancer had longer mean survival rates-for stage I 53.1±3.4 months, 38.4±4.4 months for stage II and 33.4±2.6 and 15.6±5.2 months for patients with stage III and stage IV vulvar cancer, respectively. The only signifficant prognostic factor predicting vulvar cancer recurrence was involvement of the midline. Conclusions: Patients having midline involvement of vulvar cancer has lower recurrence risk, probably because of receiving more aggressive treatment. There is a tendency for lower vulvar cancer recurrence risk for patients over 70 years of age and patients who are receiving radiotherapy as an only treatment without surgery, but tendency for higher risk of recurrence in patients with multifocal vulvar cancer.Item Seruma šķīstošā interleikīna 2 receptora alfa (sIL-R2α) un CA-125 kombinētais tests olnīcu vēža diagnostikai(2011-01-01) Mačuks, Ronalds; Baidekalna, Ieva; Nuķe, Inta; Doniņa, Simona; Rīga Stradiņš University; Institute of Microbiology and VirologyDetection of ovarian cancer can be improved using a combined diagnostic test consisting of Ca-125 and serum interleukine-2 receptor alpha (sIL-R2α) at a particular threshold. The objective of the study was to evaluate the accuracy of a diagnostic marker assay that combined Ca-125 and serum interleukine-2 receptor alpha. A case-control study of 38 patients with ovarian cancer, 40 patients with benign ovarian diseases and 31 age-matched healthy controls was designed. Ca-125 and sIL-2Rα were detected in patients' serum by standardized chemiluminescent immunometric assays. For Ca-125, a standard cutoff level of 21 U/ml was applied and for sIL-R2α - two cutoff levels were calculated from women included in the control group - one as a mean concentration and the other as an upper limit of a 95% confidence interval. Mean serum concentrations among ovarian cancer patients for CA125 and sIL-2Rα were 265.9 ± 40.2 U/ml and 651.0 ± 50.5 U/ml, respectively. The upper limit of the 95% confidence interval for a healthy control group of women was 304.5 U/ml for sIL-2Rα. Sensitivity and specificity of 89.4% and 85.9% was achieved when CA125 was combined together with sIL-2Rα at a threshold of 304.5U/ml with the condition that both markers are elevated. Sensitivity and specificity of 92.5% and 88.4% was observed when both biomarkers were applied to menopausal women. Serum sIL-2Rα in combination with CA125 can be used as a differential diagnostic test for ovarian cancer at a specific threshold, especially among menopausal women.Item Urinary concentrations of human epidydimis secretory protein 4 (He4) in the diagnosis of ovarian cancer : A case-control study(2012) Macuks, Ronalds; Baidekalna, Ieva; Doniņa, Simona; Institute of Microbiology and VirologyObjective: To analyze differential diagnostic accuracy of urinary human epidydimis secretory protein 4 (HE4)in patients with ovarian tumors. Materials and methods: In the case-control study 23 patients with ovarian cancer, 37 patients with benign ovarian tumors and 18 women in the control group were included. Serum CA125 values and urinary concentrations of HE4were assessed quantitatively. Urinary creatinine concentrations and glomerular filtration rate were also determined and used to calculate ratios to HE4. Results: Higher urinary HE4 concentrations were observed in patients with late stage ovarian cancer (p=0.001) and also in patients with early stage ovarian cancer when compared to patients with benign ovarian tumors (p=0.044). On analysis where all ovarian cancer patients were included, higher diagnostic accuracy was observed with calculated ratio of HE4 to glomerular filtration rate (GFR) to unchanged urinary HE4 concentrations -AUC 0.861 vs. 0.858. When discriminatory accuracy was calculated for urinary HE4/GFR ratio and unchanged urinary HE4 concentrations, the last demonstrated a higher area under the curve - 0.701 vs. 0.602. The urinary HE4/creatinine ratio had lower discriminatory characteristics than unchanged concentrations of urinary HE4. However, HE4 serum concentration was more accurate for discrimination of patients with benign and malignant ovarian tumors when compared to urinary HE4 and CA125 in sera (AUCs were 0.868 for serum HE4 and 0.856 and 0.653 for urinary HE4 and CA125, respectively). Conclusions: Ovarian cancer patients have higher urinary concentrations of human epidydimis secretory protein 4 than patients with benign ovarian tumors. Urinary HE4 has comparable discriminatory accuracy with serum HE4 for benign and malignant ovarian tumors and can be recommended as a non-invasive ovarian cancer riskassessment method.