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Papers by Anna Letizia Di Pinto
In Vivo, 2021
Background/Aim: Treatment of locally advanced cervical cancer (LACC) consists of concomitant chem... more Background/Aim: Treatment of locally advanced cervical cancer (LACC) consists of concomitant chemoradiation or neoadjuvant chemotherapy (NACT) plus radical surgery (RS). This study analyzed the prognostic role of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), tumor infiltrating lymphocytes (TILs), and PD-L1 expression in LACC patients, treated with NACT+RS. Patients and Methods: We prospectively analyzed 37 LACC patients treated from December 2016 to September 2019. Patients were submitted to pelvic examination, biopsy and imaging. Results: In 65% of cases, a nodal involvement was present at pretreatment MRI. All cancers showed the presence of stromal TILs and PD-L1 staining of inflammatory cells. No significant correlations were found between clinicopathological parameters and the number of TILs and PDL-1 at baseline. After NACT, 29 patients (78%) were submitted to RS; 28% of patients showed pathological complete response, 62% partial response and 10% stable disease. Seven (24%) patients reported a positive node. Patients with high levels of stromal TILs and low NLR and PLR showed a significantly better response to NACT. No significant correlation was observed between PD-L1 expression and response to NACT. Conclusion: The number of TILs, the expression of PDL1, and NLR and PLR ratios correlate significantly with the response of LACC patients to NACT. Locally advanced cervical cancer (LACC) patients who do not respond to primary treatment, either with concomitant chemoradiation (CTRT) or neoadjuvant chemotherapy (NACT) plus radical surgery (RS), represent a challenge for physicians. Alongside the known negative prognostic factors, such as FIGO stage, tumor volume, nodal metastasis, smoking, and anaemia, there is an urgent need to understand why, among patients affected by the same cervical cancer, some respond to treatment while others do not (1-5). Thus, new therapeutic strategies are under evaluation for the treatment of this tumor, with particular attention to immunotherapy strategies that might represent a valid alternative, as they have been shown to significantly improve the management of many malignancies in the last decade. In this scenario, some "immunologic markers" have been recently studied in some cancer patients. and correlated to the prognosis and to the efficacy of immunotherapy, particularly immune checkpoint inhibitors. Several studies have shown that high neutrophil-tolymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of host inflammation and are associated with worse overall survival (OS) (6-8); high eosinophils both in tumor tissue as well as in peripheral blood, have been reported to be prognostic markers for a better outcome in some solid tumors (9-11); tumor infiltrating lymphocytes (TILs) and programmed death ligand 1 (PD-L1) can predict response to chemotherapy and immunotherapy, and reflect the immune response in the tumor microenvironment (12-16). The aim of the present study was to analyze the prognostic effect, in terms of response to therapy, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, TILs and PD-L1 expression in cervical cancer patients at diagnosis, treated by NACT+RS.
ecancermedicalscience, 2018
A considerable number of patients with a cancer diagnosis are of childbearing age and have not sa... more A considerable number of patients with a cancer diagnosis are of childbearing age and have not satisfied their desire for a family. Despite ovarian cancer (OC) usually occurring in older patients, 3%-14% are diagnosed at a fertile age with the overall 5-year survival rate being 91.2% in women ≤44 years of age when it is found at 1A-B stage. In this scenario, testing the safety and the efficacy of fertility sparing strategies in OC patients is very important overall in terms of quality of life. Unfortunately, the lack of randomised trials to validate conservative approaches does not guarantee the safety of fertility preservation strategies. However, evidence-based data from descriptive series suggest that in selected cases, the preservation of the uterus and at least one part of the ovary does not lead to a high risk of relapse. This conservative surgery helps to maintain organ function, giving patients of childbearing age the possibility to preserve their fertility. We hereby analysed the main evidence from the international literature on this topic in order to highlight the selected criteria for conservative management of OC patients, including healthy BRCA mutations carriers.
Ecancermedicalscience, 2018
Due to substantial improvement in the diagnosis and treatment of gynaecologic cancers, a better u... more Due to substantial improvement in the diagnosis and treatment of gynaecologic cancers, a better understanding of patient care needs to be revised. We reviewed the literature related to fertility preservation strategies in gynaecological cancer and discussed current general management approaches. New technical modalities and patients' own desire for motherhood should be integral and paramount in the clinical evaluation to significantly contribute to preserving fertility in those women diagnosed with gynaecologic cancers during the reproductive years.
Archives of gynecology and obstetrics, Jan 21, 2017
The aim of this study was to assess the effectiveness and safety of vaginal native tissue repair ... more The aim of this study was to assess the effectiveness and safety of vaginal native tissue repair (VNTR) as a surgical treatment for severe pelvic organ prolapse (POP) and, second, to evaluate the impact on the quality-of-life (QoL) and sexual function. Women with symptomatic POP (≥III stage according to POP Quantification System) with or without stress urinary incontinence (SUI) underwent VNTR. The clinical stage, 3-day voiding diary, and urodynamic testing were evaluated in the preoperative and postoperative times, respectively. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Questionnaire Short Form (ICIQ-UI SF), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12), and the prolapse quality-of-life questionnaire (P-QoL) were administered. One hundred forty-six patients were recruited. The median follow-up was 48 months (36-63). Fifty-two women (36%) had a previous hysterectomy, and 16 (11%) had a previous prolap...
Annals of Surgical Oncology, 2015
Background. The standard treatments of patients with platinum-sensitive recurrent ovarian cancer ... more Background. The standard treatments of patients with platinum-sensitive recurrent ovarian cancer (ROC) remains poorly defined. Chemotherapy (CT) and secondary cytoreductive surgery (SCS) represent both valid options, even if several studies demonstrated a greater survival benefit, with survival rates up to 62 months, for platinumsensitive patients undergoing complete SCS. The purpose of the present study was to develop a predictive model, named SeC-Score (SeC-s), to assess the risk of optimal SCS, including, for the first time in literature, HE4. Methods. All patients affected by suspicious ROC at radiologic imaging, referred to the Department of Gynecology of Campus Bio-medico of Rome, were prospectively included in the study. The preoperative variables considered in our predictive model were: age, residual tumour (RT) at primary cytoreduction (0 vs. [0 cm), preoperative CA125 and HE4, and ascites at recurrence. After exploratory laparotomy, patients were submitted to secondary SCS (Group A) or addressed to CT (Group B). Results. A total of 135 patients with ROC were considered for the analysis. Preoperative CA125, HE4, ascites, and RT at first surgery were found statistically significant and included into a multivariate logistic regression model to determine the risk to not optimal SCS. In the overall cohort of patients, SeC-s reported sensitivity and specificity of 82 and 83 %, respectively (PPV = 0.79, NPV = 0.81). Conclusions. Our data support the use of SeC-s to preoperative triage patients suitable of optimal SCS, even if external validation is needed.
Arzneimittelforschung, 2011
In Vivo, 2021
Background/Aim: Treatment of locally advanced cervical cancer (LACC) consists of concomitant chem... more Background/Aim: Treatment of locally advanced cervical cancer (LACC) consists of concomitant chemoradiation or neoadjuvant chemotherapy (NACT) plus radical surgery (RS). This study analyzed the prognostic role of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), tumor infiltrating lymphocytes (TILs), and PD-L1 expression in LACC patients, treated with NACT+RS. Patients and Methods: We prospectively analyzed 37 LACC patients treated from December 2016 to September 2019. Patients were submitted to pelvic examination, biopsy and imaging. Results: In 65% of cases, a nodal involvement was present at pretreatment MRI. All cancers showed the presence of stromal TILs and PD-L1 staining of inflammatory cells. No significant correlations were found between clinicopathological parameters and the number of TILs and PDL-1 at baseline. After NACT, 29 patients (78%) were submitted to RS; 28% of patients showed pathological complete response, 62% partial response and 10% stable disease. Seven (24%) patients reported a positive node. Patients with high levels of stromal TILs and low NLR and PLR showed a significantly better response to NACT. No significant correlation was observed between PD-L1 expression and response to NACT. Conclusion: The number of TILs, the expression of PDL1, and NLR and PLR ratios correlate significantly with the response of LACC patients to NACT. Locally advanced cervical cancer (LACC) patients who do not respond to primary treatment, either with concomitant chemoradiation (CTRT) or neoadjuvant chemotherapy (NACT) plus radical surgery (RS), represent a challenge for physicians. Alongside the known negative prognostic factors, such as FIGO stage, tumor volume, nodal metastasis, smoking, and anaemia, there is an urgent need to understand why, among patients affected by the same cervical cancer, some respond to treatment while others do not (1-5). Thus, new therapeutic strategies are under evaluation for the treatment of this tumor, with particular attention to immunotherapy strategies that might represent a valid alternative, as they have been shown to significantly improve the management of many malignancies in the last decade. In this scenario, some "immunologic markers" have been recently studied in some cancer patients. and correlated to the prognosis and to the efficacy of immunotherapy, particularly immune checkpoint inhibitors. Several studies have shown that high neutrophil-tolymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of host inflammation and are associated with worse overall survival (OS) (6-8); high eosinophils both in tumor tissue as well as in peripheral blood, have been reported to be prognostic markers for a better outcome in some solid tumors (9-11); tumor infiltrating lymphocytes (TILs) and programmed death ligand 1 (PD-L1) can predict response to chemotherapy and immunotherapy, and reflect the immune response in the tumor microenvironment (12-16). The aim of the present study was to analyze the prognostic effect, in terms of response to therapy, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, TILs and PD-L1 expression in cervical cancer patients at diagnosis, treated by NACT+RS.
ecancermedicalscience, 2018
A considerable number of patients with a cancer diagnosis are of childbearing age and have not sa... more A considerable number of patients with a cancer diagnosis are of childbearing age and have not satisfied their desire for a family. Despite ovarian cancer (OC) usually occurring in older patients, 3%-14% are diagnosed at a fertile age with the overall 5-year survival rate being 91.2% in women ≤44 years of age when it is found at 1A-B stage. In this scenario, testing the safety and the efficacy of fertility sparing strategies in OC patients is very important overall in terms of quality of life. Unfortunately, the lack of randomised trials to validate conservative approaches does not guarantee the safety of fertility preservation strategies. However, evidence-based data from descriptive series suggest that in selected cases, the preservation of the uterus and at least one part of the ovary does not lead to a high risk of relapse. This conservative surgery helps to maintain organ function, giving patients of childbearing age the possibility to preserve their fertility. We hereby analysed the main evidence from the international literature on this topic in order to highlight the selected criteria for conservative management of OC patients, including healthy BRCA mutations carriers.
Ecancermedicalscience, 2018
Due to substantial improvement in the diagnosis and treatment of gynaecologic cancers, a better u... more Due to substantial improvement in the diagnosis and treatment of gynaecologic cancers, a better understanding of patient care needs to be revised. We reviewed the literature related to fertility preservation strategies in gynaecological cancer and discussed current general management approaches. New technical modalities and patients' own desire for motherhood should be integral and paramount in the clinical evaluation to significantly contribute to preserving fertility in those women diagnosed with gynaecologic cancers during the reproductive years.
Archives of gynecology and obstetrics, Jan 21, 2017
The aim of this study was to assess the effectiveness and safety of vaginal native tissue repair ... more The aim of this study was to assess the effectiveness and safety of vaginal native tissue repair (VNTR) as a surgical treatment for severe pelvic organ prolapse (POP) and, second, to evaluate the impact on the quality-of-life (QoL) and sexual function. Women with symptomatic POP (≥III stage according to POP Quantification System) with or without stress urinary incontinence (SUI) underwent VNTR. The clinical stage, 3-day voiding diary, and urodynamic testing were evaluated in the preoperative and postoperative times, respectively. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Questionnaire Short Form (ICIQ-UI SF), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12), and the prolapse quality-of-life questionnaire (P-QoL) were administered. One hundred forty-six patients were recruited. The median follow-up was 48 months (36-63). Fifty-two women (36%) had a previous hysterectomy, and 16 (11%) had a previous prolap...
Annals of Surgical Oncology, 2015
Background. The standard treatments of patients with platinum-sensitive recurrent ovarian cancer ... more Background. The standard treatments of patients with platinum-sensitive recurrent ovarian cancer (ROC) remains poorly defined. Chemotherapy (CT) and secondary cytoreductive surgery (SCS) represent both valid options, even if several studies demonstrated a greater survival benefit, with survival rates up to 62 months, for platinumsensitive patients undergoing complete SCS. The purpose of the present study was to develop a predictive model, named SeC-Score (SeC-s), to assess the risk of optimal SCS, including, for the first time in literature, HE4. Methods. All patients affected by suspicious ROC at radiologic imaging, referred to the Department of Gynecology of Campus Bio-medico of Rome, were prospectively included in the study. The preoperative variables considered in our predictive model were: age, residual tumour (RT) at primary cytoreduction (0 vs. [0 cm), preoperative CA125 and HE4, and ascites at recurrence. After exploratory laparotomy, patients were submitted to secondary SCS (Group A) or addressed to CT (Group B). Results. A total of 135 patients with ROC were considered for the analysis. Preoperative CA125, HE4, ascites, and RT at first surgery were found statistically significant and included into a multivariate logistic regression model to determine the risk to not optimal SCS. In the overall cohort of patients, SeC-s reported sensitivity and specificity of 82 and 83 %, respectively (PPV = 0.79, NPV = 0.81). Conclusions. Our data support the use of SeC-s to preoperative triage patients suitable of optimal SCS, even if external validation is needed.
Arzneimittelforschung, 2011