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1.
Ocena finančnega bremena pri bolnikih z rakom v Sloveniji
Marjeta Skubic, Katja Vöröš, Andraž Perhavec, Mojca Bavdaž, Petra Došenović Bonča, Tjaša Redek, Ivica Ratoša, Helena Barbara Zobec Logar, 2024, izvirni znanstveni članek

Povzetek: Izhodišče: Finančna toksičnost (FT) predstavlja vse objektivne finančne posledice in subjektivne finančne skrbi, ki se pojavljajo pri bolnikih z rakom in njihovih svojcih zaradi bolezni in zdravljenja. Finančno breme, ki ga imajo slovenski bolniki z rakom, pred našo raziskavo še ni bilo opredeljeno, prav tako ni bil poznan vpliv FT na kakovost življenja (QoL).Namen: Cilj raziskave je bila ocena FT pri bolnikih z rakom v Sloveniji, njen vpliv na QoL bolnikov in preizkus dosedanjih inštrumentov za oceno FT in QoL.Metode: Za merjenje FT smo uporabili anketno metodologijo. Razvili smo lasten vprašalnik za oceno FT in uporabili mednaro-dno validirana vprašalnika FACIT-COST in EORTC QLQ-C30. Raziskava je bila prospektivna in presečna, potekala je na Onkolo-škem inštitutu Ljubljana od junija do oktobra 2023. Rezultati: Analizirali smo 590 veljavnih anket. Na podlagi vprašalnika FACIT-COST smo ugotovili, da večina anketiranih bolnikov (53,7 %) nima FT, pri 42,9 % anketiranih bolnikov pa je bila ta večinoma blaga do zmerna. Nizko FT med slovenski-mi bolniki z rakom smo potrdili tudi z vprašalnikom EORTC QLQ-C30 in lastnim vprašalnikom. Večina bolnikov (85,1 %) je ocenila, da zaradi bolezni in zdravljenja niso imeli večjih stroškov. Na podlagi kazalnika finančnega bremena FACIT-COST in EORTC QLQ-C30 smo ugotovili, da so rizične skupine za večjo FT predvsem bolniki z nižjim neto dohodkom na gospodinjstvo (p ≤0,001), mlajši bolniki (p < 0,001), bolniki z rakom dojk (p = 0,016), zaposleni (p < 0,001), pa tudi bolniki na aktivnem onkološkem zdravljenju (p = 0,039). Pri lastnem vprašalniku so se za statistično pomembne pokazali še nižja stopnja izobrazbe (p ≤ 0,001), pode-želsko okolje (p = 0,033) in vrsta zdravstvenega zavarovanja (p = 0,006). Vpliv veroizpovedi na FT na podlagi lastnega vprašalnika ni povezan z večjo FT, kot je to razvidno iz vprašalnikov FACI-T-COST in EORTC QLQ-C30. Potrdili smo tudi vpliv nižjega dohodka na slabšo QoL, ostali parametri, ki vplivajo na QoL, pa so še: zelo nizka ali zelo visoka stopnja izobrazbe, rak glave in vratu in aktivnost onkološkega zdravljenja.Zaključki: V Sloveniji večina bolnikov z rakom ne občuti FT, v 42,9 % pa je ta blaga do zmerna. FT je statistično značilno povezana z višino dohodka, starostjo, vrsto raka, zaposlitvenim statusom, aktivnostjo onkološkega zdravljenja, pa tudi s stopnjo izobrazbe, podeželskim okoljem in vrsto zdravstvenega zavarova-nja. Večja FT je povezana s slabšo QoL. Ta je povezana prav tako z višino dohodka, stopnjo izobrazbe, vrsto raka in aktivnostjo onkološkega zdravljenja.
Ključne besede: finančno breme, kakovost življenja, breme raka
Objavljeno v DiRROS: 26.07.2024; Ogledov: 304; Prenosov: 156
.pdf Celotno besedilo (5,00 MB)

2.
Does concurrent gynaecological surgery affect infectious complications rate after mastectomy with implant-based reconstruction?
Nina Pišlar, Barbara Perić, Uroš Ahčan, Romi Cencelj-Arnež, Janez Žgajnar, Andraž Perhavec, 2023, izvirni znanstveni članek

Povzetek: Background. Women who undergo breast cancer surgery often have an indication for gynaecological procedure. The aim of our study was to compare infectious complications rate after mastectomy with implant-based reconstruc-tion in patients with and without concurrent gynaecological procedure.Patients and methods. We retrospectively reviewed clinical records of 159 consecutively operated patients after mastectomy with implant-based reconstruction. The patients were divided in 2 groups: 102 patients without (Group 1) and 57 with (Group 2) concurrent gynaecological procedure. Infectious complications rates between the groups were compared using χ2-test. Logistic regression was performed to test for association of different variables with infec-tious complications.Results. There were240 breast reconstructions performed. Median follow-up time was 297 days (10–1061 days). Mean patient age was 47.2 years (95% CI 32.8–65.9); 48.2 years (95% CI 46.1–50.3) in Group 1 and 45.8 years (95% CI 43.2–48.3) in Group 2; p = 0.002). Infectious complications rate was 17.6% (17.6% vs. 17.5%, p = 0.987), implant loss occurred in 5.7% (4.9% vs. 7.0%, p = 0.58). Obesity (body mass index[BMI] > 30 kg/m2), age, previous breast conserv-ing treatment (BCT) with radiotherapy (RT) were identified as risk factors for infectious complications in univariate analysis. Obesity (adjusted odds ratio [aOR] 3.319, 95% CI 1.085–10.157, p = 0.036) and BCT with RT (aOR 7.481, 95% CI 2.230–25.101, p = 0.001) were independently associated with infectious complications in multivariate model.Conclusions. Concurrent gynaecological procedure for patients undergoing mastectomy with implant-based re-construction did not carry an increased risk for infectious complications.
Ključne besede: rak na dojki, infekcijski zapleti, rekonstrukcija z vsadki
Objavljeno v DiRROS: 25.07.2024; Ogledov: 262; Prenosov: 141
.pdf Celotno besedilo (927,32 KB)
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3.
Completely resected stage III melanoma controversy : 15 years of national tertiary centre experience
Barbara Perić, Sara Milićević, Andraž Perhavec, Marko Hočevar, Janez Žgajnar, 2021, izvirni znanstveni članek

Povzetek: Background Two prospective randomized studies analysing cutaneous melanoma (CM) patients with sentinel lymph node (SLN) metastases and rapid development of systemic adjuvant therapy have changed our approach to stage III CM treatment. The aim of this study was to compare results of retrospective survival analysis of stage III CM patients% treatment from Slovenian national CM register to leading international clinical guidelines. Patients and methods Since 2000, all Slovenian CM patients with primary tumour % TIb are treated at the Institute of Oncology Ljubljana and data are prospectively collected into a national CM registry. A retrospective analysis of 2426 sentinel lymph node (SLN) biopsies and 789 lymphadenectomies performed until 2015 was conducted using Kaplan-Meier survival curves and log-rank tests. Results Positive SLN was found in 519/2426 (21.4%) of patients and completion dissection (CLND) was performed in 455 patients. The 5-year overall survival (OS) of CLND group was 58% vs. 47% of metachronous metastases group (MLNM) (p = 0.003). The 5-year OS of patients with lymph node (LN) metastases and unknown primary site (UPM) was 45% vs. 21% of patients with synchronous LN metastasis. Patients with SLN tumour burden < 0.3 mm had 5-year OS similar to SLN negative patients (86% vs. 85%; p = 0.926). The 5-year OS of patients with burden > 1.0 mm was similar to the MLNM group (49% vs. 47%; p = 0.280). Conclusions Stage III melanoma patients is a heterogeneous group with significant OS differences. CLND after positive SLNB might still remain a method of treatment for selected patients with stage III.
Ključne besede: cutaneous melanoma, surgery treatment, sentinel node biopsy
Objavljeno v DiRROS: 17.07.2024; Ogledov: 281; Prenosov: 146
.pdf Celotno besedilo (406,28 KB)
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4.
The prevalence of occult ovarian cancer in the series of 155 consequently operated high risk asymptomatic patients : Slovenian population based study
Andreja Gornjec, Sebastjan Merlo, Srdjan Novaković, Vida Stegel, Barbara Gazić, Andraž Perhavec, Ana Blatnik, Mateja Krajc, 2020, izvirni znanstveni članek

Povzetek: We assessed the prevalence, localization, type and outcome of occult cancer at risk-reducing salpingo-oophorectomy or salpingectomy (RRSO) in asymptomatic carriers of pathogenic or likely pathogenic BRCA1/2 variants and high-risk BRCA1/2 negative women. Patients and methods. A retrospective analysis of all consecutive gynaecologic preventive surgeries from January 2009 to December 2015 was performed. Participants underwent genetic counselling and BRCA1/2 testing before the procedure. Data on clinical parameters, adjuvant treatment and follow-up were collected and analysed. Results. One hundred and fifty-five RRSO were performed in 110 BRCA1, 35 BRCA2 carriers of pathogenic or likely pathogenic variants and 10 high-risk BRCA1/2 negative women, at the mean age of 48.3 years. Nine occult cancers (9/155, 5.8%) were identified; eight in BRCA1 positive women and one in high-risk BRCA1/2 negative woman. We identified four non-invasive serous intraepithelial tubal carcinomas (3 in BRCA1 carriers and 1 in a high-risk BRCA1/2 negative woman) and five invasive tubo-ovarian high grade serous cancers (all detected in BRCA1 carriers). Only one out of nine patients (11.1%) with occult cancer had a slightly elevated CA-125 value preoperatively. Conclusions. A 5.8% prevalence of occult invasive and noninvasive tubo-ovarian serous cancer after RRSO was found in high risk asymptomatic and screen negative women. We conclude that RRSO should be performed in BRCA1/2 carriers and in high-risk BRCA1/2 negative women. Age of preventive gynaecologic surgery should be carefully planned, taking into account the completion of childbearing age and type of mutation. The results favour the tubal hypothesis of tubal origin of high grade serous ovarian and peritoneal cancer. Cytology result of peritoneal cavity washing was important for the decision making process in determining treatment. Cytology examination should be performed in all cases of RRSO. CA-125 assay did not prove to be an effective screening tool for early cancer detection in our patients.
Ključne besede: risk-reducing salpingo-oophorectomy, occult serous cancer, serous tubal intraepithelial cancer, BRCA1/2 pathogenic or likely pathogenic variant
Objavljeno v DiRROS: 12.07.2024; Ogledov: 240; Prenosov: 97
.pdf Celotno besedilo (525,37 KB)

5.
Does regular quality control improve the quality of surgery in Slovenian breast cancer screening program?
Andraž Perhavec, Sara Milićević, Barbara Perić, Janez Žgajnar, 2020, izvirni znanstveni članek

Povzetek: The aim of our study was to evaluate the quality of surgery of Slovenian breast cancer screening program (DORA) using the requested EU standards. Furthermore, we investigated whether regular quality control over the 3-year period improved the quality of surgical management. Patients and methods. Patients who required surgical management within DORA between January 1st, 2016 and December 31st, 2018 were included in the retrospective study. Quality indicators (QIs) were adjusted mainly according to European Society of Breast Cancer Specialists (EUSOMA) and European Breast Cancer Network (EBCN) recommendations. Five QIs for therapeutic and two for diagnostic surgeries were selected. Additionally, variability in achieving the requested QIs among surgeons was analysed. Results. Between 2016 and 2018, 14 surgeons performed 1421 breast procedures in 1398 women. There were 1197 therapeutical (for proven breast cancer) and 224 diagnostic surgical interventions respectively. Overall, the minimal standard was met in two QIs for therapeutic and none for diagnostic procedures. A statistically significant improvement in three QIs for therapeutic and in one QI for diagnostic procedures was observed however, indicating that regular quality control improves the quality of surgery. A high variability in achieving the requested QIs was observed among surgeons, which remained high throughout the study period. Conclusions. Adherence to all selected surgical QIs in patients from screening program is difficult to achieve, especially to those specifically defined for screen-detected lesions. Regular quality control may improve results over time. Reducing the number of surgeons dedicated to breast pathology may reduce variability of management inside the institution.
Ključne besede: breast surgery, mammography, screening program, quality control
Objavljeno v DiRROS: 12.07.2024; Ogledov: 236; Prenosov: 92
.pdf Celotno besedilo (276,28 KB)

6.
Significance of nuclear factor - kappa beta activation on prostate needle biopsy samples in the evaluation of Gleason score 6 prostatic carcinoma indolence
Marko Zupančič, Boris Pospihalj, Snežana Cerović, Barbara Gazić, Primož Drev, Marko Hočevar, Andraž Perhavec, 2020, izvirni znanstveni članek

Povzetek: The goal of our study was to find out whether the immunohistochemical expression of nuclear factor-kappa beta (NF-%B) p65 in biopsy samples with Gleason score 3 + 3 = 6 (GS 6) can be a negative predictive factor for Prostate cancer (PCa) indolence. Patients and methods Study was conducted on a retrospective cohort of 123 PCa patients with initial total PSA % 10 ng/ml, number of needle biopsy specimens % 8, GS 6 on biopsy and T1/T2 estimated clinical stage who underwent laparoscopic radical prostatectomy and whose archived formalin-fixed and paraffin-embedded (FFPE) prostate needle biopsy specimens were used for additional immunohistochemistry staining for detection of NF-%B p65. Both cytoplasmic and nuclear NF-%B p65 expression in biopsy cores with PCa were correlated with postoperative pathological stage, positive surgical margins, GS and biochemical progression of disease. Results After follow-up of 66 months, biochemical progression (PSA % 0.2 ng/ml) occurred in 6 (5.1%) patients, 3 (50%) with GS 6 and 3 (50%) with GS 7 after radical prostatectomy. Both cytoplasmic and nuclear NF-%B p65 expressions were not significantly associated with pathological stage, positive surgical margin and postoperative GS. Patients with positive cytoplasmic NF-kB reaction had significantly more frequent biochemical progression than those with negative cytoplasmic NF-kB reaction with PSA 0.2 ng/ml as cutoff point (p = 0.015) and a trend towards more biochemical progression with PSA % 0.05 ng/ml as cutoff point (p = 0.068). Conclusions Cytoplasmic expression of NF-%B is associated with more biochemical progression and might be an independent prognostic factor for recurrence-free survival (RFS), but further studies including larger patient cohorts are needed to confirm these initial results.
Ključne besede: prostate cancer, needle biopsy, nuclear factor-kappa beta, Gleason
Objavljeno v DiRROS: 12.07.2024; Ogledov: 258; Prenosov: 142
.pdf Celotno besedilo (399,54 KB)
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7.
Spremljanje bolnikov z rakom dojk po zaključenem zdravljenju
Andraž Perhavec, Simona Borštnar, 2024, objavljeni strokovni prispevek na konferenci

Povzetek: Prevalenca raka dojk hitro narašča, s tem pa tudi breme spremljanja bolnic z rakom dojk. Namen spremljanja bolnic z rakom dojk je odkrivanje zgodnje ponovitve bolezni in novega primarnega raka dojk, obvladovanje kratko- in dolgoročnih posledic zdravljenja in čim hitrejša vrnitev v normalen življenjski ritem, spodbujanje k nadaljevanju morebitnega zdravljenja in promocija zdravega življenjskega sloga. Pogostost kontrol je odvisna od ogroženosti za ponovitev bolezni. Bolnice prva tri leta spremljamo na 3-6 mesecev, od 3. do 5. leta na 6-12 mesecev in nato enkrat letno. Anamneza in klinični pregled sta osnova vsake kontrole, enkrat letno pa opravimo tudi mamografijo. Spremljanje z laboratorijskimi preiskavami, slikanjem prsnih organov, scintigrafijo skeleta, UZ trebuha in drugimi preiskavami ne izboljša preživetja pri asimptomatskih bolnicah, zato te preiskave opravimo le, če so navzoči klinični simptomi in znaki, sumljivi za ponovitev bolezni. V prispevku navajamo predloge za dolgoročno rešitev spremljanja bolnic z rakom dojk.
Ključne besede: bolniki, rak dojk, spremljanje bolnikov
Objavljeno v DiRROS: 06.06.2024; Ogledov: 599; Prenosov: 201
.pdf Celotno besedilo (201,56 KB)

8.
Genetic counselling, BRCA1/2 status and clinico-pathologic characteristics of patients with ovarian cancer before 50 years of age
Mirjam Cvelbar, Marko Hočevar, Srdjan Novaković, Vida Stegel, Andraž Perhavec, Mateja Krajc, 2017, izvirni znanstveni članek

Povzetek: In Slovenia like in other countries, till recently, personal history of epithelial ovarian cancer (EOC) has not been included among indications for genetic counselling. Recent studies reported up to 17% rate of germinal BRCA1/2 mutation (gBRCA1/2m) within the age group under 50 years at diagnosis. The original aim of this study was to invite to the genetic counselling still living patients with EOC under 45 years, to offer gBRCA1/2m testing and to perform analysis of gBRCA1/2m rate and of clinico-pathologic characteristics. Later, we added also the data of previously genetically tested patients with EOC aged 45 to 49 years. Patients and methods. All clinical data have to be interpreted in the light of many changes happened in the field of EOC just in the last few years: new hystology stage classification (FIGO), new hystology types and differentiation grades classification, new therapeutic possibilities (PARP inhibitors available, also in Slovenia) and new guidelines for genetic counselling of EOC patients (National Comprehensive Cancer Network, NCCN), together with next-generation sequencing possibilities. Results. Compliance rate at the invitation was 43.1%. In the group of 27 invited or previously tested patients with EOC diagnosed before the age of 45 years, five gBRCA1/2 mutations were found. The gBRCA1/2m detection rate within the group was 18.5%. There were 4 gBRCA1 and 1 gBRCA2 mutations detected. In the extended group of 42 tested patients with EOC diagnosed before the age of 50 years, 14 gBRCA1/2 mutations were found. The gBRCA1/2m detection rate within this extended, partially selected group was 33.3%. There were 11 gBRCA1 and 3 gBRCA2 mutations detected. Conclusions. The rate of gBRCA1/2 mutation in tested unselected EOC patients under the age of 50 years was higher than 10%, namely 18.5%. Considering also a direct therapeuthic benefit of PARP inhibitors for BRCA positive patients, there is a double reason to offer genetic testing to all EOC patients younger than 50 years. Regarding clinical data, it is important to perform their re-interpretation in everyday clinical practice, because this may influence therapeutic possibilities to be offered.
Ključne besede: ovarian cancer, BRCA 1/2, genetic counseling
Objavljeno v DiRROS: 24.05.2024; Ogledov: 437; Prenosov: 232
.pdf Celotno besedilo (513,68 KB)

9.
Leiomyosarcoma of the renal vein : analysis of outcome and prognostic factors in the world case series of 67 patients
Marko Novak, Andraž Perhavec, Katherine E. Maturen, Snežana Pavlović Djokić, Simona Jereb, Darja Eržen, 2017, izvirni znanstveni članek

Povzetek: Background Leiomyosarcoma is a rare malignant mesenchymal tumour. Some cases of leiomyosarcoma of the renal vein (LRV) have been reported in the literature, but no analysis of data and search for prognostic factors have been done so far. The aim of this review was to describe the LRV, to analyse overall survival (OS), local recurrence free survival (LRFS) and distant metastases free survival (DMFS) in LRV world case series and to identify significant predictors of OS, LRFS and DMFS. Methods Cases from the literature based on PubMed search and a case from our institution were included. Results Sixty-seven patients with a mean age of 56.6 years were identified; 76.1% were women. Mean tumour size was 8.9 cm; in 68.7% located on the left side. Tumour thrombus extended into the inferior vena cava lumen in 13.4%. All patients but one underwent surgery (98.5%). After a median follow up of 24 months, the OS was 79.5%. LRFS was 83.5% after a median follow up of 21.5 months and DMFS was 76.1% after a median follow up of 22 months. Factors predictive of OS in univariate analysis were surgical margins, while factors predictive of LRFS were inferior vena cava luminal extension and grade. No factors predictive of DMFS were identified. In multivariate analysis none of the factors were predictive of OS, LRFS and DMFS. Conclusions Based on the literature review and presented case some conclusions can be made. LRV is usually located in the hilum of the kidney. It should be considered in differential diagnosis of renal and retroperitoneal masses, particularly in women over the age 40, on the left side and in the absence of haematuria. Core needle biopsy should be performed. Patients should be managed by sarcoma multidisciplinary team. LRV should be surgically removed, with negative margins.
Ključne besede: leiomysarcoma, renal vein, surgery, outcomes, prognostic factors
Objavljeno v DiRROS: 24.05.2024; Ogledov: 445; Prenosov: 286
.pdf Celotno besedilo (458,38 KB)
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