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Background: Vascular endothelial growth factor action in tumour angiogenesis is well characterised; nevertheless, it functions as a key element in the promotion of the immune system’s evasion by tumours. We sought to investigate the possible direct effect of VEGF on T-cell activation and through which type of VEGF receptor it exerts this effect on cells isolated from ovarian cancer patients’ ascites. Methods: T cells isolated from the ascites of ovarian cancer patients were cultured with anti-CD3 and IL-2, with or without VEGF for 14 days and the number of viable T cells was counted. Cytotoxic activity of cultured T cells and expression of VEGF receptor-2 (VEGFR-2), was assayed. Results: The addition of VEGF in cultures significantly reduced the number and proliferation rate of T cells in a dose-dependent manner and CD3 + T cells expressed VEGFR-2 on their surface upon activation. Experiments with specific anti-VEGFR-2 antibodies revealed that the direct suppressive effect of VEGF on T-cell proliferation is mediated by VEGFR-2. We also showed that VEGF significantly reduced the cytotoxic activity of T cells. Conclusion: Our study showed that ascites-derived T cells secrete VEGF and express VEGFR-2 upon activation. Vascular endothelial growth factor directly suppresses T-cell activation via VEGFR-2.

Introduction/Background*The application of fertility sparing surgery (FSS) in patients with clear cell ovarian carcinoma (CCOC) has been extensively criticized, even in patients with stage IA or IC disease, due to the high reported recurrence rates and the resistance to chemotherapy. The objective of the present study was to evaluate the obstetric and fertility outcomes of patients with early stage CCOC following fertility sparing surgery (FSS).MethodologyThree electronic databases were systematically searched for articles published in the field up to December 2020 using the terms “ovarian cancer”, “clear cell”, “fertility sparing”, “conservative treatment”. Studies that reported pregnancy and obstetric outcomes after FSS for the management of early stage CCOC were considered eligible for inclusion.Result(s)*A total of 5 retrospective studies with 60 patients with CCOC who underwent FSS were included. Mean patients‘ age was 34.8 years. The total clinical pregnancy rate was 32% with a proportion of 24% of live birth rates in 12 of the included patients. The median interval from disease management to pregnancy was 41.5 months. Recurrence rate was 16.6% among the included patients. Survival and recurrence rates were not different in patients who had FSS compared to those who had radical surgery.Conclusion*Fertility-sparing treatment for stage IA/IC CCOC seems to be an acceptable treatment option for selected women of reproductive age with a strong desire of fertility preservation. Further larger multicenter studies and studies derived from registries are warranted to validate the special aspects of the procedure and to designate the potential candidates who will receive survival and fertility benefit from fertility-sparing surgery.

The shedding of Coxiella burnetii in bovine, caprine, and ovine milk was measured using PCR, in 3 herds for each species, the bulk tank milk samples of which were positive at the time of their selection. Milk samples of 95 cows, 120 goats, and 90 ewes were sampled over 16 wk, as was the bulk tank milk. The shedding of C. burnetii in vaginal mucus and feces was checked at the beginning of the experiment and 2 mo later. The clinical signs in the selected herds as well as the duration and the shedding routes differed among the 3 species. The cows were asymptomatic and shed C. burnetii almost exclusively in milk. In one of the caprine herds, abortions due to C. burnetii were reported. The goats excreted the bacteria mainly in milk. In contrast, the ewes, which came from flocks with abortions due to Q fever (C. burnetii infection), shed the bacteria mostly in feces and in vaginal mucus. This could explain why human outbreaks of Q fever are more often related to ovine flocks than to bovine herds. These excretions did not seem more frequent when the samples were taken close to parturition. The samples were taken from 0 to 421 d after parturition in bovine herds and from 5 to 119 d and 11 to 238 d after parturition in the caprine and ovine herds, respectively. The shedding in milk was sometimes intermittent, and several animals shed the bacteria but were negative by ELISA: 80% of the ewes were seronegative, underscoring the lack of sensitivity of the ELISA tests available for veterinary diagnosis. The detection of antibodies in milk seems more sensitive than it is in serum.

Introduction/BackgroundPrognostic nutritional index (PNI) has been investigated extensively in the field of cancer and seems to be associated both with the extent of disease, perioperative wellbeing of patients as well as with postoperative disease survival. Its value in ovarian cancer patients remains to date unclear. The purpose of the present study is to evaluate the diagnostic accuracy of PNI in detecting metastases in the upper abdominal cavity and correlate its levels to postoperative hospitalization duration.MethodologyA retrospectively identified consecutive series of patients that were treated in our institution for ovarian cancer was used for analysis. Preoperative PNI was calculated as serum albumin (g/L) + 0.005 × lymphocyte count (per mm3). Inferential statistics were performed with non-parametric tests and correlation analysis was based in Spearman’s rho.ResultsOverall, 50 patients were included in our analysis with a mean PNI of 41.2±0.7 and a mean age of 62±1.8 years. No differences were observed in PNI levels among patients with ascites (p= 0.807), metastases in the upper abdominal cavity (p= 0.658) as well as among patients at various stages of the disease. Correlation statistics did not reveal significant associations between PNI and postoperative high dependency unit hospitalization (rho=0.181, p= 0.271) and total duration of hospitalization (rho=0.081, p= 0.630), age (rho=−0.239, p= 0.143). The area under the curve (AUC) for detecting metastases in the upper abdominal cavity was poor (AUC=0.456) as well as for cases requiring bowel excision (AUC=0.525).ConclusionThe findings of our study do not support the use of prognostic nutritional index as a tool for the preoperative assessment of ovarian cancer patients as it does not seem to correlate with the extent of disease and postoperative hospitalization. Larger studies are needed to support our findings and help reach definitive conclusions.DisclosureNothing to disclose.

Introduction/Background*Management of a pelvic mass is a common cause of surgery among women. In nearly 20% of cases, such masses represent primary ovarian malignancies, treated with complete surgical staging. However, in 6-7% of cases, the ovarian malignancy will present as a metastatic lesion form other sites, known as Krukenberg tumors. This term usually characterizes primary gastric cancer, but Krukenberg tumors can also arise from other primary sites. In the present study we assessed the characteristics of metastatic tumors to the ovaries from non-genital tract primary sites and attempted to determine the route of tumor spread.MethodologyWe retrospectively reviewed medical records of patients whose indication for surgery was a pelvic mass from January 2000 to December 2018. The study was conducted after approval of the Institutional Review Board. Reports and medical files were reviewed for age at diagnosis, tumor size, laterality of metastasis and primary tumor site. Only patients with metastatic disease to the ovary were included in the study.Result(s)*A total of 64 cases of metastasis to the ovary were identified. The median age the patients was 58 years old (range: 28 – 81). Primary gastric cancer was identified in 28 (43.9%) cases; breast cancer 14 (21.9%) and colon cancer 13 (20.3%). Pancreatic cancer and urinary bladder each contributed 3 (4.7%) cases, while b-cells lymphoma, primary peritoneal cancer and lung cancer each recorded 1 (1.5%) case. In most cases bilateral disease was present (43 cases, 67.2%), while surface involvement was recorded in 55 patients (86%). Survival data existed only for a subset of 15 patients with median overall survival of 23.7 months (95%CI12.7-34.8).Conclusion*Metastatic ovarian cancer is more usually seen from primary gastric, breast and colon cancer. Hematogenous spread appears a more common route in these cases, rather than transserosal pathway. Despite survival data were limited in a subset of patients, data indicate the presence of long-term survivors. Analysis of larger datasets is warranted to optimize surgical and medical treatment in patients with metastatic disease to the ovary.

Introduction/Background*The impact of COVID-19 pandemic caused a disruption of the healthcare systems and led to significant delays in diagnosis and treatment of gynecological cancer patients. New algorithms that aim to sustain balance between management of oncological patients and the need to maintain a sufficient amount of resources were adapted.MethodologyThis retrospective study reviewed the patients with gynecological cancer operated in our hospital during the first lockdown period in Greece (between 13 March 2020 and 30 May 2020) and compared the results with the corresponding time period in 2019 before COVID-19 pandemic. We also examine the number of patients that were referred for neoadjuvant chemotherapy or radiotherapy between those periods.Result(s)*The gynecological oncological operations performed during the lockdown period of the first pandemic wave were not altered by the outbreak (153 in 2019 vs 130 in 2020) (figure 1). There was no difference in ovarian cancer surgeries (34 vs 31) and the number of primary debulking was not affected (20 vs 19). The patients referred to neoadjuvant chemotherapy was the same between the two periods. No significant difference was obtained in the endometrial, vaginal and cervical cancer surgeries and the number of surgically treated recurrences. Contrastingly there was a significant decrease in endoscopic procedures and diagnostic biopsies (72 vs 53) and the fertility sparring surgeries were postponed from patients at a later date (table 1).Abstract 798 Figure 1Gynecological cancer surgeries on both periodsAbstract 798 Table 1Type of procedures on both periodsConclusion*The findings of our study suggest that at the first wave of the pandemic lockdown, the operations conducted in our department did not alter. In accordance with international consensus guidelines the stage, the grade and the type of cancer, and the potential comorbidities were the main factors that accounted for the decision of the optimal mode of treatment.

Introduction/Background*The nutritional adequacy of patients undergoing major surgery is an important prognostic indicator of survival. Studies in other surgical subspecialties highlight the importance of the nutritional status during the perioperative period of patients undergoing surgery for oncological purposes. In the present interim analysis, we aim to evaluate differences in the values of the prognostic nutritional index among gynecologic oncology patients that develop postoperative infectious morbidity and those that have an uneventful postoperative hospitalization.MethodologyThe study is based on a prospective series of patients who underwent surgery for gynecological malignancies. The PNI index was calculated on the basis of admission data as follows: 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count (per mm(3)). Data on postoperative infections were retrieved and analyzed with SPSS (IBM Corp. Released 2019.).Result(s)*Overall 100 patients were followed-up for a period of 30 days postoperatively. Of those 26 patients developed postoperative infectious morbidity. Preoperative PNI was significantly lower among patients that developed infections compared to those that had uneventful recovery (43.0 (12.7-59.1) vs 50,1 (8.1-140.0). Using multiple logistic regression that took into account co-factors of age, BMI, ECOG status, preoperative Hgb, smoking, transfusion rates, implementation of ERAS protocol and PNI we observed that the latter was a significant moderator of post-operative infectious morbidity (HR 0.924, 95% CI 0.876, 0.974). Receiver operative characteristics (ROC) analysis revealed that PNI had a moderate value in determining postoperative infectious morbidity (AUC 0.782, Sensitivity 77%, Specificity 68% using an optimal cut-off of 45.4).Conclusion*Taking into consideration the results of this interim analysis we believe that PNI could be a valuable tool in clinical practice that may help determine patients at risk of developing postoperative morbidity. Future studies may also use this index as a prognostic factor that could indicate the nutritional status of patients undergoing prehabilitation in anticipation of major surgical operations.

Introduction/Background*Primary ovarian sarcoma is a very rare malignancy representing <2% of ovarian cancer. Aim of this study is to investigate the clinicopathologic features and outcomes in patients with primary sarcoma of the ovary.MethodologyWe retrospectively reviewed between 2012 and 2019, all patients with primary ovarian sarcoma who were treated at Alexandra Hospital of Athens.Result(s)*A total of 17 patients with ovarian sarcoma had been surgically treated. The median age of patients was 61 [33-84] years. The most common symptom was abdominal pain and bloating. The majority of patients were postmenopausal (14) and only three were premenopausal. The histopathological diagnosis revealed 14 patients with carcinosarcoma, two with ovarian endometrial stromal sarcoma and one with leiomyosarcoma. After the surgery 23% of patients were at stage I, 12% at stage II, 53% at stage III and 12% at stage IV. Only 5 (29%) patients had suboptimal debulking surgery and 12 (71%) had optimal debulking surgery. The mean number of chemotherapy courses were 6.8 ± 4 with unsatisfactory response. Five patients had a recurrence at two years and 4 of them had a secondary debulking surgery.Conclusion*Primary ovarian sarcoma has a poor prognosis. Optimal debulking surgery appears to be a significant factor for recurrence. There is a need for more studies to explore the role of optimal debulking surgery and adjuvant chemotherapy in primary ovarian sarcoma.

Introduction/Background*Pelvic exenteration is an ultraradical surgical procedure that is performed in patients with pelvic malignancies that refractory to primary treatment. The purpose of the present study is to evaluate differences in patient and tumor characteristics of patients that experience recurrence of the disease following the procedure to those that remain disease free.MethodologyWe conducted a retrospective study that was based on patient records of patients treated with pelvic exenteration in our department between 2006 and 2020. We sought to determine differences in terms of tumor and patients` characteristics that might influence the postoperative course of these patients.Result(s)*Ninety-four women were recruited of whom 33 developed recurrence. The median follow-up was 18 months (4 – 72 months). We observed that patients treated for recurrent disease had comparable relapse rates to those that were primarily treated with pelvic exenteration. Neither the presence of positive surgical margins (p=.546), nor the type of malignancy (p=.434) significantly differed among patients that developed recurrence and those that did not. Parametrial involvement and positive pelvic lymph nodes were also equally distributed among the two groups. Patients with refractory disease to chemotherapy had, however, substantial higher risk of relapse (p=.002). On the other hand, the percentage of patients that had been priorly treated with radiotherapy did not differ among the two groups (p=.859). Patients with parametrial involvement had significantly higher rates of local relapse (p=.035).Conclusion*The findings of our study reveal that it is still difficult to determine which proportion of patients that undergo pelvic exenteration will benefit from the procedure in terms of recurrence free rates. Patients with parametrial involvement are more likely to develop local relapse; however, this does not seem to be influenced by the presence of positive surgical margins. Larger studies are needed to fully elucidate this field.

Introduction/BackgroundThe purpose of the present study is to evaluate the efficacy of the combination of low dose megestrol acetate (MA) (80 mg/day) and the levonorgestrel-releasing intrauterine device (LNG-IUD) for the treatment of complex atypical hyperplasia (CAH) and low-grade endometrial adenocarcinoma (EC) in premenopausal women, 45 years old or younger, who desire to preserve their fertility.MethodologyA retrospective study that included a consecutive series of patients of reproductive age who were treated conservatively with the combination of per os MA (80 mg/day) and the LNG-IUD for CAH and grade I endometrioid EC. The response rate for each of the two conditions was monitored following a 6-month period of treatment.ResultsTwenty-two patients were diagnosed with CAH or grade I endometrioid EC. Eighteen of them were evaluable at the 6-month study point. Among them, 5 patients (27.8%) had an initial diagnosis of CAH and the other 13 (72.2%) were diagnosed with grade I endometrioid EC. Overall, the response rate was 77.7% at the 6-month evaluation exam (80% for the CAH group and 76.9% for the grade I endometrioid EC).ConclusionThe concomitant use of low-dose MA orally and the LNG-IUD seems to be an efficient option for the conservative treatment of CAH or early- grade EC in young women who wish to preserve their fertility. Future studies should provide head to head comparison with systemic progestin therapy to corroborate our findings.DisclosureNothing to disclose.