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Doroftei B.,Grigore T. Popa University of Medicine and Pharmacy | Doroftei B.,Origyn Fertility Center | Mambet C.,Ynevo Central Laboratory Medicover Group | Zlei M.,Origyn Fertility Center | Zlei M.,Regional Institute of Oncology
PLoS ONE | Year: 2015

Wide regional differences in the age-related Anti Mullerian hormone (AMH) regression patterns or age at onset of natural menopause have been reported, possibly reflecting genetic, socioeconomic, environmental, racial or ethnic peculiarities. Moreover, adaptation of AMH levels from different assays using regression functions may lack accuracy and externally defined references for AMH levels may not fully comply with a specific geographical area. The current study aimed to establish an accurate mathematical relationship between AMH serum values and age in a large group of women from Romania, as any consistent difference from previously reported regression models may aid in building specific profiles for the AMH decline with age in this geographical region. Our study pointed out to the quadratic regression as the most fitted pattern of correlation for all the age groups between 24 and 45. To our knowledge the current manuscript is based on the singular study carried out in this geographical region, generating a particular age-related pattern of association between age and serum AMH levels in women, regardless of their subjacent pathologies. © 2015 Doroftei et al.


Makkai-Popa S.-T.,Grigore T. Popa University of Medicine and Pharmacy | Makkai-Popa S.-T.,Regional Institute of Oncology | Lunca S.,Regional Institute of Oncology | Tarcoveanu E.,St Spiridon University Hospital | And 2 more authors.
Romanian Journal of Morphology and Embryology | Year: 2014

The current literature related to colorectal cancer shows there is a great inhomogeneity in patient outcome, even between patients in the same stage, which means that the TNM staging does not seem enough anymore to make a therapeutic decision. This is why many of the recent studies focus on the study of prognostic and predictive factors that would make the therapeutic decision-making process more accurate. In the current study, we focused on the study of two lymph node based scores - the lymph node ratio and the log odds ratio and the morphological characteristics of the tumor to try to see if any of them can predict a more aggressive tumor behavior in order to approach the patient in an appropriate way. The study included 25 patients presenting over a period of two years (2009-2011) for a local relapse or a metastasis after curative surgery for colorectal cancer. From the morphological characteristics of the tumor, only the protruding character of the tumor positively correlated at a statistically significant level with the recurrence-free time. We also proved that between the two lymph node scores and the pN stage, the log odds ratio was the one that best correlated with both the number of invaded lymph nodes and the number of resected nodes. The log odds ratio also proved to correlate well with the risk of developing a distant metastasis. Our study also shows for the first time that the log odds ratio is able to stratify patients according to their risk of a fast relapse.


Lunca S.,Regional Institute of Oncology | Porumb V.,Regional Institute of Oncology | Velenciuc N.,Regional Institute of Oncology | Ferariu D.,Regional Institute of Oncology | Dimofte G.,Regional Institute of Oncology
Journal of gastrointestinal and liver diseases : JGLD | Year: 2014

A solitary Peutz-Jeghers polyp is defined as a unique polyp occurring without associated mucocutaneous pigmentation or a family history of Peutz-Jeghers syndrome. Gastric solitary localization is a rare event, with only eight reported cases to date. We report herein the case of a 43-year old woman who presented with upper gastrointestinal bleeding, severe anemia, weight loss and asthenia. Endoscopy revealed a giant polypoid tumor with signs of neoplastic invasion of the cardia, with pathological aspect suggesting a Peutz-Jeghers hamartomatous polyp. Computed tomography suggested a malignant gastric tumor and a total gastrectomy was performed. The pathological specimen showed a giant 150/70/50 mm polypoid tumor and immunochemistry established the final diagnostic of a Peutz-Jegers type polyp. This is the largest solitary Peutz-Jeghers gastric polyp reported until now, and the second one mimicking a gastric malignancy with lymph node metastasis.


Anitei M.-G.,Grigore T. Popa University of Medicine and Pharmacy | Anitei M.-G.,Regional Institute of Oncology | Zeitoun G.,Georges Pompidou European Hospital | Mlecnik B.,French Institute of Health and Medical Research | And 26 more authors.
Clinical Cancer Research | Year: 2014

Purpose: To determine whether the tumor immune infiltrate, as recently evaluated with the Immunoscore methodology, could be a useful prognostic marker in patients with rectal cancers. Experimental design: The influence of the immune infiltrate on patient's outcome was investigated in patients with or without preoperative chemoradiation therapy (pCRT). The density of total (CD3+) and cytotoxic (CD8+) T lymphocytes was evaluated by immunohistochemistry and quantified by a dedicated image analysis software in surgical specimens of patients with rectal cancer (n = 111) who did not receive pCRT and in tumor biopsies performed before pCRT from additional 55 patients. The results were correlated with tumor recurrence, patient's survival, and response to pCRT. Results: The densities of CD3+ and CD8+ lymphocytes and the associated Immunoscore (from I0 to I4) were significantly correlated with differences in disease-free and overall survival (HR, 1.81 and 1.72, respectively; all P < 0.005). Cox multivariate analysis supports the advantage of the Immunoscore compared with the tumor-node-metastasis (TNM) staging in predicting recurrence and survival (all P < 0.001). Lymph node ratio added information in a prognostic model (all P < 0.05). In addition, high infiltration of CD3+ and CD8+ lymphocytes in tumor biopsies was associated with downstaging of the tumor after pCRT (CD3 + cells; Fisher exact test P = 0.01). Conclusions: The Immunoscore could be a useful prognostic marker in patients with rectal cancer treated by primary surgery. The determination of the immune infiltrate in biopsies before treatment could be a valuable information for the prediction of response to pCRT. ©2014 AACR.


Antoniu S.A.,Grigore T. Popa University of Medicine and Pharmacy | Puiu A.,Regional Institute of Oncology | Zaharia B.,Center Hospitalier Auxerre | Azoicai D.,Grigore T. Popa University of Medicine and Pharmacy
Expert Review of Pharmacoeconomics and Outcomes Research | Year: 2014

Hospitalisations for chronic obstructive pulmonary disease (COPD) exacerbations are characterised by a significant worsening of the respiratory symptoms which can impair the health status (HS). However little is known on the HS behaviour during such events. Prospective study evaluating the validity of the Clinical COPD Questionnaire (CCQ) as a HS measure in hospitalisations for COPD exacerbations. The CCQ total score (CCQ-T) correlated with EQ-VAS (-0.51, p < 0.0001), was able to discriminate between longer and shorter duration hospitalisation (CCQ-T 3.83 vs 3.03, respectively p = 0.001), had a Cronbach-α of 0.86, and improved significantly over the hospitalisation period (CCQ-T on day 7 of hospitalisation 2.55 vs 3.77 at baseline, p < 0.0001). CCQ is an excellent tool for the assessment of the HS dynamics in hospitalisations for COPD exacerbations. © 2014 Informa UK Ltd.


Alexa T.,Regional Institute of Oncology | Lavinia A.,Pneumology Hospital | Luca A.,Grigore T. Popa University of Medicine and Pharmacy | Miron L.,Grigore T. Popa University of Medicine and Pharmacy | Alexa I.D.,Grigore T. Popa University of Medicine and Pharmacy
Wspolczesna Onkologia | Year: 2014

Aim of the study: To compare patient's characteristics, clinical data, and rates of chemotherapy discontinuation in advanced NSCLC (non-small cell lung cancer) patients treated with platinum-based association chemotherapy (elderly vs. younger counterparts). To evaluate if there are certain factors that can predict discontinuation of chemotherapy.Material and methods: A retrospective analysis of all cases of advanced NSCLC treated with either cisplatin- -gemcitabine or cisplatin-vinorelbine at the Regional Institute of Oncology Iasi between January 2012 and December 2013 was performed. Patients were divided into two groups: over 70 years old and under 70 years old. Patient's characteristics and clinical data (including whether or not the patient discontinued treatment) were recorded for each case.Results: The elderly patients had more comorbidities (p = 0.003), were prescribed a larger number of pills (p = 0.02), and had longer periods of hospitalisation (p = 0.005). No difference in toxicity was noted between the two groups. Five patients chose to discontinue chemotherapy in the elderly group. Only two patients made the same choice (p = = 0.02) in the younger group. Correlation analysis revealed that refusal of further chemotherapy was associated with the length of hospital stay, number of pills per day, and smoking status.Conclusions: Geriatricians should minimise iatrogeny and polypharmacy by optimising long-term treatment. This will increase the chance that elderly patients will not discontinue chemotherapy. Hospital stay should be reduced to a minimum. As life span increases so does the number of elderly patients with cancer; it is vital to understand and prevent the causes of chemotherapy discontinuation in order to achieve optimal therapeutic results.


Capilna M.E.,University of Medicine and Pharmacy of Targu Mures | Ioanid N.,Regional Institute of Oncology | Scripcariu V.,Regional Institute of Oncology | Gavrilescu M.M.,Regional Institute of Oncology | Szabo B.,University of Medicine and Pharmacy of Targu Mures
International Journal of Gynecological Cancer | Year: 2014

Objective: Abdominal radical trachelectomy (ART) is one of the fertility-sparing procedures in women with early-stage cervical cancer. The published results of ART, in comparison with vaginal radical trachelectomy, so far are limited. Materials and Methods: This retrospective study comprises all cases of female patients referred to ART with early-stage cervical cancer from 2 gynecologic oncology centers in Romania. Results: A total of 29 women were referred for ART, but subsequently, fertility could not be preserved in 3 of them. Eleven women had stage IA2 disease (42.3%), 14 (53.8%) women had stage IB1 disease, and 1 (3.8%) woman had stage IB2 disease. Histologic subtypes were 15 (57.6%) squamous, 8 (30.7%) adenocarcinoma, and 3 (11.5%) adenosquamous. There were no major intraoperative complications in both hospitals. Early postoperative complications were mainly related to the type C parametrectomyVbladder dysfunction for more than 7 days (8 [30.7%] women) and prolonged constipation (6 [23.0%] women). Other complications consisted in symptomatic lymphocele in 2 (7.6%) patients, which were drained. Median follow-up time was 20 months (range, 4-43 months). Up to the present time, there has been 1 (3.8%) recurrence in our series. Most patients did not experience late postoperative complications. Three (11.5%) women are amenorrheic, and 1 (3.8%) woman developed a cervical stenosis. Of the 23 women who have normal menstruation and maintained their fertility, a total of 7 (30.4%) women have attempted pregnancy, and 3 (42.8%) of them achieved pregnancy spontaneously. These pregnancies ended in 2 first trimester miscarriages and 1 live birth at term by cesarean delivery. Conclusions: Our results demonstrate that ART preserves fertility and maintains excellent oncological outcomes with low complication rates. Copyright © 2014 by IGCS and ESGO.


PubMed | Grigore T. Popa University of Medicine and Pharmacy and Regional Institute of Oncology
Type: Case Reports | Journal: Journal of gastrointestinal and liver diseases : JGLD | Year: 2014

A solitary Peutz-Jeghers polyp is defined as a unique polyp occurring without associated mucocutaneous pigmentation or a family history of Peutz-Jeghers syndrome. Gastric solitary localization is a rare event, with only eight reported cases to date. We report herein the case of a 43-year old woman who presented with upper gastrointestinal bleeding, severe anemia, weight loss and asthenia. Endoscopy revealed a giant polypoid tumor with signs of neoplastic invasion of the cardia, with pathological aspect suggesting a Peutz-Jeghers hamartomatous polyp. Computed tomography suggested a malignant gastric tumor and a total gastrectomy was performed. The pathological specimen showed a giant 150/70/50 mm polypoid tumor and immunochemistry established the final diagnostic of a Peutz-Jegers type polyp. This is the largest solitary Peutz-Jeghers gastric polyp reported until now, and the second one mimicking a gastric malignancy with lymph node metastasis.


CApilna M.E.,University of Medicine and Pharmacy of Targu Mures | Szabo B.,University of Medicine and Pharmacy of Targu Mures | Becsi J.,University of Medicine and Pharmacy of Targu Mures | Ioanid N.,Regional Institute of Oncology | Moldovan B.,St Constantin Hospital
International Journal of Gynecological Cancer | Year: 2016

Objective Cervical cancer is one of the most frequent malignant diseases diagnosed during pregnancy. Abdominal or vaginal radical trachelectomies are fertility-preserving alternatives to radical hysterectomy for young women with early-stage cervical cancer that can be performed during ongoing pregnancy. Methods A literature review of articles on this subject was conducted through a Medline search for articles published in English or French. Results At this moment, 21 cervical cancer patients, including ours (4 stage IA2, 16 IB1, and 1 IB2) who underwent radical trachelectomy during pregnancy have been reported. Of these, 10 were performed by vaginal route and 11 were abdominal radical trachelectomies. Conclusions Radical trachelectomy could be offered as an option for pregnant patients with early invasive cervical cancer. It may help women avoid the triple losses of a desired pregnancy, fertility, and motherhood. © 2016 by IGCS and ESGO.


PubMed | Synevo Central Laboratory Medicover Group, Grigore T. Popa University of Medicine and Pharmacy and Regional Institute of Oncology
Type: Journal Article | Journal: PloS one | Year: 2015

Wide regional differences in the age-related Anti Mullerian hormone (AMH) regression patterns or age at onset of natural menopause have been reported, possibly reflecting genetic, socioeconomic, environmental, racial or ethnic peculiarities. Moreover, adaptation of AMH levels from different assays using regression functions may lack accuracy and externally defined references for AMH levels may not fully comply with a specific geographical area. The current study aimed to establish an accurate mathematical relationship between AMH serum values and age in a large group of women from Romania, as any consistent difference from previously reported regression models may aid in building specific profiles for the AMH decline with age in this geographical region. Our study pointed out to the quadratic regression as the most fitted pattern of correlation for all the age groups between 24 and 45. To our knowledge the current manuscript is based on the singular study carried out in this geographical region, generating a particular age-related pattern of association between age and serum AMH levels in women, regardless of their subjacent pathologies.

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