Iron deficiency is the most frequent deficiency disease and parameters of iron metabolism appear to be linked to major metabolic and cardiovascular diseases. We screened a large set of small ...molecules in plasma for associations with iron status among apparently healthy subjects to elucidate subclinical profiles which may provide a link between iron status and onset of diseases. Based on mass spectrometry and nuclear magnetic resonance spectroscopy we determined 613 plasma metabolites and lipoprotein subfractions among 820 apparently healthy individuals. Associations between ferritin, transferrin, haemoglobin and myoglobin and metabolite levels were tested by sex-specific linear regression analyses controlling for common confounders. Far more significant associations in women (82 out of 102) compared to men became obvious. The majority of the metabolites associated with serum ferritin and haemoglobin in women comprising fatty acid species, branched-chain amino acid catabolites and catabolites of heme. The latter was also obvious among men. Positive associations between serum transferrin and VLDL and IDL particle measures seen in women were observed in men with respect to serum ferritin. We observed a sexual-dimorphic fingerprint of surrogates of iron metabolism which may provide a link for the associations between those parameters and major metabolic and cardiovascular disease.
Gynecological sarcomas account for 3% of all gynecological malignancies and are associated with a poor prognosis. Due to the rarity and heterogeneity of gynecological sarcomas there is still no ...consensus on optimal therapeutic strategies. This study's objective was to describe the treatment strategies used in patients with gynecological sarcomas in the primary course of disease.
The German prospective registry for gynecological sarcoma (REGSA) is the largest registry for gynecological sarcomas in Germany, Austria and Switzerland. Primary inclusion criteria for REGSA are histological diagnosis of sarcoma of the female genital tract, sarcoma of the breast or uterine smooth muscle tumors of uncertain malignant potential (STUMP). We evaluated data of the REGSA registry on therapeutic strategies used for primary treatment from August 2015 to February 2021.
A total of 723 patients from 120 centers were included. Data on therapeutic strategies for primary treatment were available in 605 cases. Overall, 580 (95.9%) patients underwent primary surgery, 472 (81.4%) of whom underwent only hysterectomy. Morcellation was reported in 11.4% (n=54) of all hysterectomies. A total of 42.8% (n=202) had no further surgical interventions, whereas an additional salpingo-ophorectomy was performed in 54% (n=255) of patients. An additional lymphadenectomy was performed in 12.7% (n=60), an omentectomy in 9.5% (n=45) and intestinal resection in 6.1% (n=29) of all patients. Among 448 patients with available information, 21.4% (n=96) received chemo- or targeted therapies, more commonly as single-agent treatment than as drug combinations. Information about anti-hormonal treatment was available for 423 patients, among which 42 (9.9%) received anti-hormonal treatment, 23 (54.8%) of whom with low-grade endometrial stroma sarcomas. For radiotherapy, data of 437 patients were available, among which 29 (6.6%) patients underwent radiotherapy.
Our study showed that treatment of patients with gynecologic sarcomas is heterogeneous. Further trials are needed along with more information on treatment modalities, therapy response and patient-reported outcomes to implement new treatment strategies.
Primary cytoreductive surgery (CS) for epithelial ovarian cancer (EOC) is well-established. CS at relapse remains controversial, with an unclear morbidity profile.
We analyzed 121 patients with EOC ...who underwent CS. Two groups were identified by timing of surgery due to primary disease and due to recurrent disease.
CS for primary versus recurrent EOC led to no differences in haemodynamic management, such as transfusion rates, application of vasopressors, ICU and hospital length of stay, or mortality. The risk for postoperative ileus was higher in patients with relapsed versus primary EOC. This might be attributed to patients being operated due to preoperative ileus and a higher small bowel resection rate at CS for relapse.
CS for EOC relapse does not seem to be more challenging in terms of perioperative management compared to that at initial diagnosis. The major surgical morbidity profile was comparable apart from a higher risk for postoperative ileus at relapse.
Cytoreductive surgery for epithelial ovarian cancer (EOC) is the cornerstone of multimodal therapy and considered as a high-risk surgery because of extensive multivisceral procedures. In most ...patients, ascites is present, but its impact on the surgical and clinical outcomes is unclear.
One hundred nineteen patients undergoing surgical cytoreduction because of EOC between 2005 and 2008 were included. All surgical data and the individual tumor pattern were collected systematically based on a validated documentation tool (intraoperative mapping of ovarian cancer) during primary surgery. The amount of ascites was determined at the time of surgery, and 3 groups were classified (no ascites NOA, n = 56, low amount of ascites < 500 mL, n = 42, and high amount of ascites HAS > 500 mL, n = 21).
Group NOA compared with HAS showed less transfusions of packed red blood cells (median quartiles, 0 0-2 vs 0 0-2 vs 3 1-4 U; P < 0.001) and fresh frozen plasma (median quartiles, 0 0-2 vs 0 0-4 vs 2 2-6 U; P < 0.001). In addition, in patients with ascites, noradrenaline was administered more frequently and in higher doses. The postoperative length of stay in the intensive care unit was significantly shorter in the NOA versus the group with low amount of ascites and HAS (median quartiles, 1 0-1 vs 1 0-2 vs 2 1-5 days; P < 0.001). The hospital length of stay is extended in HAS compared with that in NOA (median quartiles, 16 13-20 vs 17 14-22 vs 21 17-41 days; P = 0.004). Postoperative complications were increased in patients with ascites at the time of surgery (P = 0.007).
The presence of a high amount of ascites at cytoreductive surgery because of EOC is associated with higher amounts of blood transfusions, whereas the length of hospital stay and the postoperative intensive care unit treatment are significantly prolonged compared with those of patients without ascites.
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