Background: Ovarian, fallopian tube, and primary peritoneal cancers often share clinical characteristics and are typically diagnosed at advanced stages due to nonspecific symptoms. The utility of tumor markers, particularly CA125 and HE4, in the diagnosis and follow-up of these cancers remains an area of active investigation. Objectives: The CEEGOG (Central and Eastern European Gynecologic Oncology Group) OX-01 study aimed to evaluate HE4's role alongside CA125 in follow-up for advanced-stage ovarian, fallopian tube, and primary peritoneal cancers. It assessed the potential for detecting recurrence using marker elevation and imaging methods, examining the necessity of dynamic monitoring and current cut-off values' accuracy for early relapse detection. Methods: In this multicenter prospective cohort study, 117 eligible patients with Stage III-IV cancers were included. Patients had elevated CA125 or HE4 at diagnosis and achieved complete remission after first-line treatment. HE4 and CA125 levels were monitored every 3-4 months in the first two years and every six months thereafter. CT scans were performed if markers exceeded set thresholds or increased by over 20%. Results: During a median follow-up of 13.7 months, 73% of patients relapsed. Median HE4 levels were significantly higher in relapsed patients. A 10 IU/mL increase from baseline in CA125 had a sensitivity of 83% and specificity of 93%, while a 15 pmol/L increase in HE4 had a sensitivity of 74% and specificity of 92% for predicting relapse up to three months before CT scan detection. Conclusions: The study found that dynamic changes in HE4 and CA125 levels, rather than predefined cut-off values, are crucial for early relapse detection. These markers may offer a significant lead time over imaging, potentially enabling earlier intervention. Further research is needed to validate these findings.
- Publikační typ
- časopisecké články MeSH
Východiská: Z pohľadu liečby predstavuje zhubný nádor (ZN) pankreasu jednu z najnáročnejších malignít. Pokrok vo výskume sa zatiaľ nepremieta do zníženia mortality ochorenia. Identifikácia a validácia účinných prognostických biomarkerov sú kľúčové pre zlepšenie presnosti diagnostiky a výsledkov liečby. Cieľ: Cieľom práce je analyzovať najnovšie údaje o incidencii a mortalite na ZN pankreasu porovnávajúc ich s globálnymi epidemiologickými údajmi. Naratívny prehľad si kladie zároveň za cieľ zhrnúť súčasné poznatky o rôznych prognostických biomarkeroch pri liečbe ZN pankreasu, vrátane ukazovateľov stavu výkonnosti, nutričných a zápalových markerov. Metódy: Analyzujú sa najnovšie dostupné národné epidemiologické údaje o ZN pankreasu. Literárny prehľad je zameraný na markery, ktoré hodnotia celkový stav pacientov: výkonnostný stav, index telesnej hmotnosti, prognostický nutričný index a markery zápalovej odpovede, ako Glasgowské prognostické skóre, C-reaktívny proteín, pomer neutrofilov k lymfocytom, index systémovej zápalovej odpovede a index systémového imunitného zápalu. Údaje o biomarkeroch sa analyzujú z hľadiska ich úlohy pri predpovedaní prognózy a odpovede na systémovú liečbu ZN pankreasu. Výsledky: Slovenská republika i Česká republika sa v odhadoch i v reálnych dátach vyskytujú na popredných miestach v incidencii i mortalite na ZN pankreasu. Ukazovatele nutričného a výkonnostného stavu zohrávajú rozhodujúcu úlohu pri hodnotení stavu pacienta a ovplyvňujú rozhodnutia o liečbe, s potenciálnym dopadom na liečebné výsledky. Zápalové markery preukázali významnú prognostickú hodnotu, korelujúcu s imunitnou odpoveďou pacienta na nádor a zápalovými procesmi, ktoré môžu podporovať progresiu ochorenia. Napriek ich sľubným prediktívnym schopnostiam sa však tieto biomarkery v klinickej praxi bežne nepoužívajú z dôvodu potreby ďalšej validácie. Záver: Integrácia nových biomarkerov do klinickej praxe by mohla viesť k personalizovanejším liečebným rozhodnutiam a zlepšeniu výsledkov liečby. Pre komplexnejšie posúdenie validity týchto biomarkerov a ich využitia v bežnej klinickej praxi je potrebný ďalší výskum.
Background: Pancreatic cancer remains one of the most challenging malignancies to treat, with consistently low survival rates despite advances in medical research. The identification and validation of effective prognostic biomarkers are crucial for improving diagnostic accuracy and treatment outcomes. Objective: The aim of the work is to analyze the latest data of the pancreatic cancer incidence and mortality, comparing them with global epidemiological data. The narrative review also aims to summarize current knowledge about various prognostic biomarkers in the pancreatic cancer treatment, including indicators of performance status, nutritional and inflammatory markers. Methods: The most recently available national epidemiological data on pancreatic cancer are analyzed. The literature review is focused on markers that evaluate the general condition of patients, such as performance status, body mass index, prognostic nutritional index and markers of the inflammatory response, such as Glasgow prognostic score, C-reactive protein, neutrophil to lymphocyte ratio, systemic inflammatory response index and systemic immune inflammation index. These biomarkers are analyzed for their role in predicting prognosis and response to systemic therapy for pancreatic cancer. Results: Both the Slovak Republic and the Czech Republic are globally ranked in the leading places in terms of pancreatic cancer incidence and mortality, both in estimates and real data. Indicators of nutritional and performance status play a critical role in patient assessment and influence treatment decisions, with potential impact on treatment outcomes. Inflammatory markers have shown significant prognostic value, correlating with the patient‘s immune response to the tumor and inflammatory processes that may promote disease progression. However, despite their promising predictive capabilities, these biomarkers are not routinely used in clinical practice due to the need for further validation. Conclusion: Integration of new biomarkers into clinical practice could lead to more personalized therapeutic decisions and improved treatment outcomes. Further research is needed for a more comprehensive assessment of the validity of these biomarkers and their use in common clinical conditions.
- MeSH
- hodnocení stavu výživy MeSH
- individualizovaná medicína MeSH
- lidé MeSH
- nádorové biomarkery analýza MeSH
- nádory slinivky břišní * diagnóza epidemiologie MeSH
- prognóza MeSH
- rizikové faktory MeSH
- zánět imunologie MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
AIMS: Hypotension can be a symptom of paraneoplastic autonomic neuropathy (PAN). Onconeural antibodies (OA) provide strong evidence for the paraneoplastic origin of neurological syndromes. Our goal was to assess the frequency of PAN among patients with advanced malignancies and hypotension using OA. METHODS: Patients with advanced malignancies and hypotension were screened and enrolled as per protocol. Plasma levels of six classical OAs were assessed in these patients. We prospectively evaluated other symptoms of PAN in these patients. RESULTS: 31 patients out of 740 screened met the criteria of this cross-sectional study. OAs were present in 4 patients (12.9%). Anti-amphiphysin was found in 1 patient (3.23%), anti- CV2 (anti-CRPM5, anti- collapsin- response mediator protein) was present in 1 patient (3.23%), 1 patient (3.23%) was positive for anti-Hu and anti-Ma2 was present in 1 patient (3.23%). No patient was positive for 2 or more OAs. Normalization of blood pressure in concordance with partial remission occurred in 5 patients. The most used criteria for PAN were fulfilled in 9 patients. CONCLUSION: The frequency of PAN may be underestimated in a busy oncology clinic. Assessing OAs may aid in the differential diagnosis of hypotension of unknown origin.
- MeSH
- autonomní nervový systém patofyziologie MeSH
- autoprotilátky krev MeSH
- dospělí MeSH
- hypotenze etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metastázy nádorů patofyziologie MeSH
- nádorové biomarkery krev MeSH
- nádory komplikace patofyziologie MeSH
- nemoci nervového systému etiologie MeSH
- průřezové studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
AIMS: Hypotension can be a symptom of paraneoplastic autonomic neuropathy (PAN). Onconeural antibodies (OA) provide strong evidence for the paraneoplastic origin of neurological syndromes. Our goal was to assess the frequency of PAN among patients with advanced malignancies and hypotension using OA. METHODS: Patients with advanced malignancies and hypotension were screened and enrolled as per protocol. Plasma levels of six classical OAs were assessed in these patients. We prospectively evaluated other symptoms of PAN in these patients. RESULTS: 31 patients out of 740 screened met the criteria of this cross-sectional study. OAs were present in 4 patients (12.9%). Anti-amphiphysin was found in 1 patient (3.23%), anti- CV2 (anti-CRPM5, anti- collapsin- response mediator protein) was present in 1 patient (3.23%), 1 patient (3.23%) was positive for anti-Hu and anti-Ma2 was present in 1 patient (3.23%). No patient was positive for 2 or more OAs. Normalization of blood pressure in concordance with partial remission occurred in 5 patients. The most used criteria for PAN were fulfilled in 9 patients. CONCLUSION: The frequency of PAN may be underestimated in a busy oncology clinic. Assessing OAs may aid in the differential diagnosis of hypotension of unknown origin.
- Publikační typ
- časopisecké články MeSH
We present a rare case of malignant rhabdoid tumor (ovarian small cell carcinoma of hypercalcemic type) in a 24-year-old female with fulminant course. Clinically, hypercalcemia was not found at the time of primary diagnosis. However, it appeared later during the course of tumor progression. Histologically, the tumor showed classical features of small cell carcinoma of hypercalcemic type. Therapy included radical surgery with adjuvant chemotherapy. Despite this intensive therapy, the disease recurred and the patient died 10 months after the diagnosis. We discuss the diagnosis and therapy of this tumor, as well as its recent classification as malignant rhabdoid tumor.
- Publikační typ
- časopisecké články MeSH
Východiská: Paraneoplastické syndrómy často predchádzajú diagnózu malignity. Ich včasná diagnostika môže viesť ku skorému rozpoznaniu okultného karcinómu ešte v kuratívnon štádiu. Diferenciálna diagnostika zriedkavej paraneoplastickej vaskulitídy vyžaduje multidisciplinárnu spoluprácu medzi internistami‑reumatológmi, rádiodiagnostikmi a onkológmi. Prípad: 41-ročná pacientka s karcinómom cervixu uteru IVB štádium (paraaortálna lymfadenopatia) s klinickými i rádiologickými známkami akútnej vaskulitídy bola prijatá na naše oddelenie k onkologickej liečbe. Začalo sa s chemorádioterapiou, súčasne bola podávaná kortikoterapia. Počas liečby sme pozorovali zmiernenie príznakov vaskulitídy. Pri ďalších dispenzárnych kontrolách sa stav pacientky viac nezlepšoval, čo nás viedlo k podozreniu relapsu malígneho ochorenia, ktoré sa potvrdilo CT vyšetrením. Zahájená paliatívna chemoterapia však nepriniesla očakávaný efekt a kvôli zhoršujúcemu sa výkonnostnému stavu bola ukončená. Záver: Aktivita vaskulitídy bola u našej pacientky pomerne úzko spojená s aktivitou malígneho ochorenia. Rozpoznanie paraneoplastického syndrómu má význam nielen v diagnostike malignity, ale aj počas dispenzárnych kontrol. Kľúčová slová: karcinóm krčka maternice – paraneoplastický syndróm – vaskulitída – angiografia
Background: Paraneoplastic syndromes precede the diagnosis of malignancy. Early detection of paraneoplastic syndrome may lead to detection of malignancy in its early and potencially curable stage. Differential diagnostic process of rare paraneoplastic vasculitis requires multidisciplinar cooperation between rheumatologists, radiologists and oncologists. Case: 41‑year‑old female patient with cervical cancer in stage IVB (paraaortic lymphadenopathy) and clinical symptoms of acute vasculitis was admitted to our ward for oncological treatment. Chemoradiotheraphy was initiated concurently with corticotherapy. During the treatment we observed alleviation of vasculitis‑related symptoms. Ongoing follow‑up, however, brought no further improvement in vasculitis‑related symptoms. This lead us to suspiction of recurrence, confirmed on CT scan. Paliative chemotherapy was without any effect and due to worsening performance status was terminated. Conclusion: The activity of vasculitis was closely associated with the activity of primary malignant disease. Early recognition of paraneoplastic syndrome may contribute not only to diagnosis of malignancy, but is helpfull during follow‑up of these patients. Key words: cervical cancer – paraneoplastic syndrome – vasculitis – angiography The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers. Submitted: 14. 6. 2014 Accepted: 6. 7. 2014
- Klíčová slova
- sekundární vaskulitida,
- MeSH
- dospělí MeSH
- glukokortikoidy terapeutické užití MeSH
- kvadruplegie etiologie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- methylprednisolon terapeutické užití MeSH
- mozek radiografie MeSH
- nádory děložního čípku * diagnóza terapie MeSH
- paraneoplastické syndromy * MeSH
- počítačová rentgenová tomografie MeSH
- poruchy zraku etiologie MeSH
- progrese nemoci MeSH
- radioterapie MeSH
- recidiva MeSH
- spinocelulární karcinom diagnóza terapie MeSH
- vaskulitida centrálního nervového systému * diagnóza etiologie farmakoterapie komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Východiska: Syndróm hornej dutej žily (superior vena cava obstruction – SVCO) je spôsobený obštrukciou prietoku v hornej dutej žile. V súčasnosti najčastejšou príčinou je karcinóm pľúc alebo iná malignita rastúca expanzívne v hornom mediastine. SVCO je jeden z urgentných stavov u onkologických pacientov a vyžaduje neodkladnú diagnostiku a liečbu. Prípad 1: Sedemdesiat deváť ročného pacienta s nemalobunkovým karcinómom pľúc vpravo, IIIB štádium, po dvoch cykloch chemoterapie sme prijali k hospitalizácii pre klinické známky SVCO. U pacienta sme indikovali urgentnú rádioterapiu na oblasť tumoru. Pre progredujúci klinický stav počas rádioterapie sme pristúpili k implantácii samoexpanzibilného stentu do hornej dutej žily s rýchlym ústupom klinických ťažkostí. Prípad 2: V druhom prípade ide o 56-ročnú pacientku s novodiagnostikovaným difúznym veľkobunkovým B lymfómom vo IV. štádiu s postihnutím mediastina. Pacientka bola s klinickými známkami SVCO privezená na našu chemoterapeutickú ambulanciu ešte pred zahájením onkologickej liečby. Pacientka udávala rozvoj opuchu viečok, tváre a úporného kašľa v priebehu dvoch dní. CT vyšetrenie ukázalo tumor mediastina s kompresiou vena cava superior. U pacientky bola indikovaná urgentná chemoterapia v schéme R‑CHOP, ktorá viedla k rýchlemu vymiznutiu príznakov SVCO. Záver: Syndróm hornej dutej žily je urgentný stav u onkologických pacientov spôsobený externým útlakom hornej dutej žily najčastejšie pľúcnym karcinómom, lymfómom alebo, zriedkavejšie, trombózou centrálneho venózneho katétra. Stav vyžaduje promptnú liečbu a multidisciplinárnu spoluprácu medzi radiačnými a klinickými onkológmi a intervenčnými rádiológmi.
Background: Superior vena cava syndrome (SVCO) is caused by compression of superior vena cava and restriction of blood flow to the heart. The most common underlying condition in cancer patients is lung cancer or other malignancy expanding in the upper mediastinum. SVCO belongs to oncological emergencies and requires a prompt diagnostic work‑up and treatment. Case 1: A 79‑year‑old man with a history of right‑sided stage IIIB non‑small cell lung cancer, after two cycles of chemotherapy, was admitted to hospital with clinical signs of SVCO. The initial radiotherapy brought no relief of symptoms and due to deterioration of patient‘s status during the treatment we proceeded to self‑expanding caval stent insertion. This was followed by immediate resolution of SVCO symptoms. Case 2: In the second case we describe a 56‑year‑old female with a newly diagnosed diffuse large B cell lymphoma who presented with SVCO symptoms when referred to our outpatient chemotherapy department. She had no history of previous treatment and she complained of a rapid face and eye‑lid edema and intractable cough in the last two days. CT scan revealed mediastinal mass compressing the superior vena cava. Urgent anti‑lymphoma chemotherapy (RCHOP schedule) was commenced and yielded quick resolution of her symptoms. Conclusion: Superior vena cava syndrome is a medical emergency in oncological patients usually caused by external compression of cava by lung cancer, lymphoma, other tumors, less frequently, from a thrombosis of indwelling central venous catheter. Multidisciplinary cooperation among radiation and medical oncologists and interventional radiologists is needed in order to provide an early treatment without an undue delay. Key words: superior vena cava syndrome – non‑small‑cell lung carcinoma – diffuse large-B-cell lymphoma – radiotherapy – chemotherapy – stents The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers. Submitted: 9. 7. 2013 Accepted: 10. 8. 2013
- MeSH
- difúzní velkobuněčný B-lymfom * komplikace MeSH
- heparin nízkomolekulární * terapeutické užití MeSH
- intervenční radiologie * MeSH
- kombinovaná terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemalobuněčný karcinom plic * komplikace MeSH
- protokoly protinádorové kombinované chemoterapie * MeSH
- senioři MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- staging nádorů MeSH
- stenty MeSH
- syndrom horní duté žíly * diagnóza terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
