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Purpose Integrins may be involved in the metastatic spread of high-grade serous ovarian cancer (HGSOC) which determines the therapeutical approach and prognosis. We investigated the integrin expression in primary tumor and metastases of advanced HGSOC. Methods The expression of integrin α2, α4, α5, α6, and β1 was assessed by immunostaining in tumor samples of the ovary, omentum, and peritoneum of each patient. Differences in integrin expression among tumor localizations and their association with clinicopathological parameters were examined by Fisher’s exact test. The impact of integrin expression on progression-free survival (PFS) and overall survival (OS) was examined by Cox regression and Kaplan–Meier analyses. Results Hundred and thirteen tumor samples of 40 HGSOC patients were examined. The expression of the integrins did not differ between the three tumor localizations (all p values > 0.05) with the exception of high expression of integrin α4 in primary tumor and omentum (52.5% versus 47.5%, p = 0.008) and primary tumor and peritoneum (52.5% versus 47.5%, p = 0.050). High expression of integrin α4 in peritoneum was associated with poorer PFS (HR 2.02 95% CI 1.01–4.05, p = 0.047), younger age (p = 0.047), and death (p = 0.046). Median PFS in patients with high expression of integrin α4 was 13.00 months, whereas median PFS in patients without high expression of integrin α4 was 21.00 months (p = 0.040). Expression of other integrins did not correlate with PFS or OS. Conclusion Expression of integrin α4 may be altered during the metastatic spread of HGSOC and affect prognosis, whereas expression of integrin α2, α5, α6, and β1 did not reveal any prognostic value.

Introduction/Background* We evaluated the prognostic impact of various global health assessment tools in accordance to conventional prognostic factors in patients with endometrial cancer (EC) older than 60 years. Methodology G-8 geriatric screening tool (G-8 geriatric score), Lee Schonberg prognostic index (Lee-Index), Charlson Comorbidity Index (CCI) and American Society of Anesthesiologists (ASA-PS) – Physical Status System were retrospectively determined in a consecutive cohort of elderly patients with EC. Univariate and multivariate Cox regression analyses and Kaplan-Meier method were performed to determine the impact of the global health assessment tools on progression free survival (PFS) and overall survival (OS). Result(s)* 153 patients entered the study. In multivariate analysis adjusted for common clinical-pathological risk factors (e.g. histological type and stadium, histological grading, FIGO-stadium, tumor stadium and postoperative tumor burden) and different global health assessment tools (G-8 geriatric score, Lee-Index, CCI and ASA-PS) only the G-8 geriatric score retained its significance as a considerable and independent prognostic factor of 5-year OS rate (HR: 3.173; 95%-CI [1.436-7.010]; p=0.004) but not for univariate 5-year PFS rate (HR: 2.033; 95%-CI [0.925-4.468]; p=0.078). 92 patients (61.3%) were assigned to the G-8-non-frail cohort (cut-off value > 14 points) with an increased 5-year PFS and OS rate compared to the 58 patients (38.7%) classified as G-8-frail (PFS: 82.1% vs. 65.4%; p=0.071 and OS: 88.2% vs. 49.7%; p Conclusion* Preoperative G-8 geriatric score independently predicted 5-year OS in elderly EC patients irrespectively of the maximal surgical effort.

Introduction/Background* Treatment of vulvar cancer contains surgery if applicable and often primary or neo-/adjuvant chemoradiation. Cisplatin and Mitomycin/5-FU are widely used radiosensitizers in vulvar cancer, although evidence is limited. We retrospectively investigated both radiosensitizers for outcome and toxicity. Methodology We screened the archive for patients treated with chemoradiation for pathologically-confirmed squamous cell cancer of the vulva between 01/2010 – 02/2021 at our institution. The impact of both radiosensitizers on prognosis was compared using Kaplan-Meier method and Cox-Regression analysis. Result(s)* 127 patients with vulvar cancer were screened. 24 patients received chemoradiation (Cisplatin n=11; Mitomycin/5-FU n=11; others n=2) as a neoadjuvant, primary or adjuvant treatment. Median follow-up was 17 months in both groups. Median age was 65 (35-91) years. Patients in the Cisplatin group were older than in the Mitomycin/5-FU group (Median age 73 vs. 55, p=0.007). Median radiation dose in total was 59.6 (41.4 – 85.0) Gy. 68.2% of the patients had FIGO stage III and 18.2% of the patients had FIGO stage IV before chemoradiation. Both groups showed no differences in terms of FIGO stage. 72.7% (8 out of 11) patients receiving Mitomycin/5-FU achieved clinical complete response compared to 45.5% (5 out of 11) receiving Cisplatin (p=0.309). One patient in each group was progressive during chemoradiation. Three patients stopped chemoradiation due to toxicity (Cisplatin n=2; Mitomycin/5-FU n=1) and one patient in the Cisplatin group died of treatment related sequelae. Radiodermatitis with epitheliolysis were the most common adverse events in both groups. Additionally, four patients in the Mitomycin/5-FU group required treatment for myelotoxicity. The 2 -year overall survival showed a numerical but not statistically significant difference in favour of the Mitomycin/5-FU group (59.7% vs. 30.7%; p= 0.306). The 2-year-recurrence-free-survival was comparable between Mitomycin/5-FU and Cisplatin (43.6% vs. 31.8%; p=0.829). Conclusion* Cisplatin and Mitomycin/5-FU showed a numerical but not statistically significant difference in overall survival in vulvar cancer. MitomycinC/5-FU tended to result in a clinical complete response more frequently but required more often a treatment for myelotoxicity. However, overall toxicity of Mitomycin/5-FU was acceptable and may be considered in the treatment of young, healthy patients with locally advanced vulvar cancer.

Introduction/Background* In the treatment of both platinum-resistant recurrent ovarian cancer (ROC) and metastatic breast cancer (MBC), symptom control and maintenance of quality of life (QoL) play a crucial role. In the advanced stage of disease, metronomic chemotherapy (MCT) may be a favourable treatment option. The aim of this study is to assess the QoL of heavily pretreated patients with ROC and MBC treated with MCT. Methodology PROmetronomic, FoR.UM 19-02193, is a monocentric, open-label, single-arm observational study to assess health-related patient-reported outcome data in ROC and MBC patients treated with MCT (cyclophosphamide 50 mg p.o. daily ± methotrexate 2.5 mg p.o. every other day). QoL data are evaluated using European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 version 3.0, EORTC QLQ-OV28 version 1.0 (ROC)/EORTC QLQ-BR23 version 1.0 (MBC), and Hospital anxiety and depression scale (HADS-D) questionnaires via an internet-based therapy support system CANKADO. Patients previously treated with at least 1 line of platinum-based and 1 platinum-free chemotherapy (ROC)/at least 2 lines of endocrine therapy (for hormone receptor-positive cancer) and at least 2 lines of chemotherapy (MBC) are included. Secondary endpoints are disease control rate at 12 and 24 weeks, duration of response, progression-free survival and overall survival. Assessment of safety and tolerability is conducted according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5.0. As part of the translational research approach, potentially relevant anti-angiogenic and immunomodulatory biomarkers are being investigated. Result(s)* Until 2021-05-01, 4 ROC and 3 MBC patients have been enrolled. It is planned to include a total of 65 patients until 08/2023. Conclusion* Potentially toxic chemotherapy is often required to achieve disease control in patients with metastatic cancer. However, well-being and personal preferences must not be neglected. MCT could provide an efficacious treatment option with limited toxicities and positive impact on QoL.

Introduction/Background* The aim of this study was to evaluate the impact of the preoperative global health status on the prognosis of patients with ovarian cancer (OC) older than 60 years, who received cytoreductive surgery. Methodology G-8 geriatric screening tool (G-8 score), Lee Schonberg prognostic index, Eastern Cooperative Oncology Group (ECOG) performance status and Charlson Comorbidity Index (CCI) were determined retrospectively in a consecutive cohort of elderly patients with OC. Univariate and multivariate Cox regression analyses and Kaplan-Meier method were performed to analyze the impact of the preoperative global health status on survival. Result(s)* 116 patients entered the study. In multivariate analysis adjusted for clinical-pathological factors, only the G-8 score retained significance as a prognostic parameter of PFS (HR: 2.009; 95%-CI [1.091-3.699]. 56 patients were classified as G-8 non-frail with an increased PFS compared to 50 G-8 frail patients (53.4% vs. 16.7%; p=0.010). A higher CCI was associated with decreased PFS (45.1% vs. 22.2%; p=0.012) but it did not influence the risk of recurrences or death (p=0.360; p=0.111, respectively). The Lee Schonberg prognostic index, the ECOG and mean age were not associated with survival. Conclusion* The G-8 score independently predicted PFS in elderly OC patients regardless of maximal surgical effort. Thus, it could be useful to assess surgical treatment based on frailty rather than age alone.

Introduction/Background* This study evaluated the impact of the global health status on the rate of postoperative clinical complications in patients with ovarian cancer (OC) older than 60 years. Methodology Selected global health status assessment tools were retrospectively determined in a cohort of OC patients older than 60 years, treated at our institution between 2008 and 2019. The primary outcome was the incidence and type of postoperative clinical complications in accordance with the Veteran Affairs’ National Surgical Quality Improvement Program (NSQIP). Differences in binary and ordinal variables between independent groups were analyzed by the chi-square test. Furthermore, rank correlations were examined with Spearman-Correlation. Result(s)* 116 patients entered the study. 54 patients (46.6%) were classified as G-8 frail and 56 patients (48.3%) as G-8 non-frail. CCI classified 24 patients (20.7%) into CCI-1, 63 patients (54.3%) into CCI-2 and 29 patients (25.0%) into CCI-3. The ASA PS allocated 48 patients (44.0%) as ASA-2 and 61 patients (56.0%) as ASA-3. The Lee-Index allocated 60 patients (61.9%) to a cohort with a four-year-mortality Conclusion* Preoperative evaluation of global health status with G-8 score and CCI were significantly associated with elevated rates of postoperative complications and the need of transfusions, in contrast to age alone in elderly patients with OC.

Study question The aim was to assess the prevalence of self-reported symptoms of depression and anxiety and the moderating factors influencing mental symptoms during the COVID–19 pandemic. Summary answer Endometriosis patients were at risk of developing mental disorders during the pandemic. Associated risk factors were: reduction of the social network and the employment status. What is known already Endometriosis is a disease affecting up to 10% of women of fertile age. The leading symptoms are sub- or infertility and chronic pain. Additionally, the psychological impact on womeńs life is enormous. Women with endometriosis show higher rates of depression, anxiety and emotional distress, and these alterations in mental health were associated with the presence of pain rather than with the diagnosis of endometriosis. Additionally, a higher level of depression was observed in women with endometriosis. Study design, size, duration To assess the impact of the government-imposed social distancing or quarantine on mental health, an online questionnaire was placed on internet platforms of endometriosis patients support groups between 6th and 27th April 2020. Data collection and analysis were performed anonymously. Recruitment was conducted via a direct link to the survey and an invitation to participate was distributed via the internet platforms of patients support groups. Participants/materials, setting, methods 274 participants answered the Patient Health Questionnaire for Depression and Anxiety (PHQ–4), which screens for depression (PHQ–2), anxiety (GAD–2) and the level of psychological distress (PHQ–4). PHQ–2 and GAD–2 scores ≥ 3 are cut-off points between normal range and probable cases of mental disorders. A PHQ–4 score above 6 is indicative for severe symptoms. We used descriptive statistics to describe the study population. Correlates of depression and anxiety were identified using multivariate logistic regressions. Main results and the role of chance We showed that depression and anxiety were highly prevalent in endometriosis patients during the pandemic: 46.7% and 48.2% of participants showed scale scores of ≥ 3 on the PHQ–2 and GAD–2 scales, respectively. The mean PHQ–4 score was 5.72 (SD = 3.21), thus endometriosis patients were achieving significantly higher PHQ–4 sores (p Risk factors for higher probability of depressive disorders were the employment status (being employed, OR 2.890, p Risk factors for higher probability of anxiety were the employment status (being employed, OR 2.697, p Endometriosis patients were at higher risk for developing mental health problems. The effective use of brief screening measures, such as PHQ–4, can be widely implemented even in the busy outpatient care of general practitioners and gynecologists and may help to reduce morbidity. Limitations, reasons for caution We used self-reports for assessment of anxiety and depression and those are susceptible to response bias, such as giving socially desirable responses. Moreover, as PHQ–4 is only a screening tool, the diagnosis must be confirmed in accordance to the appropriate DSM–V criteria. Wider implications of the findings: A better understanding of potential mental problems in endometriosis patients during stressful events, such as the COVID–19 pandemic or other comparable difficult environmental or social circumstances, is crucial for providing an optimal patient centered care in cases of upcoming stressful events. Trial registration number Not applicable