Faculty of Medicine
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Item type:Publication, NGAL and HPV Subtypes in Cervical Carcinoma: Implications for Cancer Progression and Treatment Response(MDPI AG, 2026-02-23) ;Raci, Behar; ;Hodolli, Gezim; Background/Objectives: Cervical cancer is a prominent source of morbidity and mortality among women, particularly in low- and middle-income nations. Neutrophil Gelatinase-Associated Lipocalin (NGAL), a glycoprotein involved in cancer-related activities, has been proposed as a biomarker; however, its involvement in cervical cancer remains unknown. The study aim is to evaluate the prognostic significance of serum NGAL levels in cervical cancer patients in relation to International Federation of Gynecology and Obstetrics (FIGO) stage, operability, and HPV subtype distribution before and after treatment. Methods: The study involved 130 women, 100 with histologically proven cervical cancer and 30 healthy controls. The serum NGAL levels were determined before and after treatment using an ELISA test. HPV genotyping was carried out using real-time PCR on 21 high- and low-risk subtypes. Results: NGAL levels increased marginally during therapy (from 134 to 144 ng/mL; p = 0.28), but the rise was significant in inoperable patients (p = 0.02) and increased with advanced FIGO stage, although this did not reach statistical significance (p = 0.07). HPV 16 was the most common subtype (26.0%), while women aged 51–60 had the highest overall HPV positive rate (72.7%). There was no significant association between NGAL levels and HPV subtypes (p = 0.17). Conclusion: NGAL does not appear to be an accurate short-term indicator of therapy response. However, increased levels in advanced-stage and inoperable instances indicate prognostic significance. NGAL most likely represents tumor-associated inflammation rather than HPV subtype. These findings support its possible inclusion in future biomarker panels, subject to validation in bigger investigations. Persistent HPV infection in midlife women highlights the significance of ongoing screening.</jats:p> - Some of the metrics are blocked by yourconsent settings
Item type:Publication, EVALUATION OF THE HISTOPATHOLOGICAL PROFILE OF CERVICAL BIOPSIES(Македонска асоцијација на гинеколози и опстетричари = MACEDONIAN ASSSOCIATION OF GYNECOLOGISTS AND OBSTETRICIANS, 2025); ;Dika, Bekim; ;Koprivnjak, IvanShurlani, Arben - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Association of IL-10 (rs1800872) and IL-4R (rs1805010) polymorphisms with cervical intraepithelial lesions and cervical carcinomas(BAKIS Productions LTD, 2020) ;Duvlis, Sotirija; ;Noveski, Predrag ;Ivkovski LjubePlaseska-Karanfilska, DijanaPurpose: Genetic characteristic of cytokines may influence cervical intraepithelial neoplasia (CIN) and cervical cancer (CCa) susceptibility. We analysed an association of IL-10592 A/C, IL-4R I75VA/G polymorphisms with susceptibility to human papillomavirus (HPV) positive CIN and CCa. Methods: Using multiplex PCR- SNaPShot analysis, 134 cases (HPV positive CINs and CCa) and 113 controls (HPV negative NILM) were genotyped for these two cytokine variants. Results: Data analyzed using odds ratio (OR) and chisquare (x2) test showed that the frequency of CC of IL-10-592 genotype was significantly higher in cases (67.2%) than in controls (49.6%) [CC vs CA+AA; p=0.005, OR=2.08 (95%CI: 1.24-3.49)] as well as the allelic frequency of major C allele (82.1%) in cases than in controls (72.6%) [p=0.01, OR=1.73 (95%CI: 1.13-2.66)]. Furthermore, AA genotype of IL-4RI75V had significantly lower frequency in CIN1 (25.0%) compared with CIN2+ group (30.8%) (p=0.03, OR=0.39, 95%CI: 0.141.11) after the stratifications of the cases in low grade and high grade with CCa as separate groups. Conclusion: We concluded that IL-10-592 A/AA variant indicates a protective role in cervical cancer development and the GG genotype of IL-4RI75V conferred protection against progression of CIN1 to CIN2+ or CCa among women from Republic of North Macedonia. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Association of TNF-a (rs361525 and rs1800629) with susceptibility to cervical intraepithelial lesion and cervical carcinoma in women from Republic of North Macedonia(Wiley-Blackwell Publishing Ltd., 2020) ;Duvlis, Sotirija; ;Cvetkovski, Aleksandar; Cervical cancer (CCa) is one of the most common malign diseases in women associated with human papillomavirus (HPV). The virus is an initiating factor, but not sufficient for the development of cervical intraepithelial lesions (CIN) and CCa. The disease might be a result of the influence of host's genetic factors and polymorphisms in inflammatory-related genes that modify the immune response to HPV and attribute to cancer susceptibility. We carried out a study to determine the association between TNF-a-238G/A and TNF-a-308 G/T polymorphisms with HPV-positive CIN and CCa in women living in the Republic of North Macedonia. Using multiplex SNaPshot analysis for single nucleotide polymorphisms (SNPs), we analysed the genotype and allele distributions of TNF-a-238G/A and TNF-a-308 G/T in 134 cases (HPV-positive and histologically confirmed CIN and CCa) and in 113 controls (cytological and HPV-negative women). For further analysis, the case group was stratified in three subgroups (all cases: CINs+ CCa− group; CIN2+ -group and CIN1− group). Data analysed using the odds ratio (OR) and chi-square test showed the frequency of AA genotypes and A alleles are not significantly higher in cases compared to the controls for both SNPs: AA of TNF-a-238 (0.7% versus 0%) and TNF-a-308 (1.5% versus 0.9%) as well as A allelic frequency (3.0% versus 1.7%) and (13.1% versus 10.6), respectively. The comparison of the case's subgroups with the control group did not show a statistically significant difference. Compared to controls, TNF-a-238G/A and TNF-a-308 G/T are not associated with the risk of HPV associated CIN or CCa in the studied women. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, SUCCOR quality: validation of ESGO quality indicators for surgical treatment of cervical cancer(2022-10-03) ;Boria, Felix ;Chiva, Luis ;Chacon, Enrique ;Zanagnolo, VannaFagotti, AnnaAbstract Objective: To evaluate whether compliance with European Society of Gynaecological Oncology (ESGO) surgery quality indicators impacts disease-free survival in patients undergoing radical hysterectomy for cervical cancer. Methods: In this retrospective cohort study, 15 ESGO quality indicators were assessed in the SUCCOR database (patients who underwent radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage 2009 IB1, FIGO 2018 IB1, and IB2 cervical cancer between January 2013 and December 2014), and the final score ranged between 0 and 16 points. Centers with more than 13 points were classified as high-quality indicator compliance centers. We constructed a weighted cohort using inverse probability weighting to adjust for the variables. We compared disease-free survival and overall survival using Cox proportional hazards regression analysis in the weighted cohort. Results: A total of 838 patients were included in the study. The mean number of quality indicators compliance in this cohort was 13.6 (SD 1.45). A total of 479 (57.2%) patients were operated on at high compliance centers and 359 (42.8%) patients at low compliance centers. High compliance centers performed more open surgeries (58.4% vs 36.7%, p<0.01). Women who were operated on at centers with high compliance with quality indicators had a significantly lower risk of relapse (HR=0.39; 95% CI 0.25 to 0.61; p<0.001). The association was reduced, but remained significant, after further adjustment for conization, surgical approach, and use of manipulator surgery (HR=0.48; 95% CI 0.30 to 0.75; p=0.001) and adjustment for adjuvant therapy (HR=0.47; 95% CI 0.30 to 0.74; p=0.001). Risk of death from disease was significantly lower in women operated on at centers with high adherence to quality indicators (HR=0.43; 95% CI 0.19 to 0.97; p=0.041). However, the association was not significant after adjustment for conization, surgical approach, use of manipulator surgery, and adjuvant therapy. Conclusions: Patients with early cervical cancer who underwent radical hysterectomy in centers with high compliance with ESGO quality indicators had a lower risk of recurrence and death. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, COMPARISON OF TWO RADIOTHERAPY TECHNIQUES IN TREATMENT OF PATIENTS WITH INOPERABLE (ADVANCED) CERVICAL CANCER(Macedonian Association of Anatomists, 2022-08-31); ; ;Kostadinova, Lenche ;Dameska, AngelaAdjiska Mitkov, AleksandraAdvanced cervical cancer is treated with radiotherapy, target therapy, chemotherapy or a combination of those. Standardized accepted treatment of inoperable cervical cancer is concurrent chemoradiotherapy (CCRT) followed by brachytherapy. Radiotherapy techniques used are three-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiation therapy (IMRT). In this study participated 30 female patients, average age of 52 at the time of irradiation.3D-CRT plans were made, patients were treated on linear accelerator (LINAC) with 3D-CRT. IMRT plans were made additionally. Planning target volume (PTV) dose coverage was 105.36% for 3D-CRT and 105.64% for IMRT. Homogeneity index (HI) was 0.062 for 3D-CRT and 0.048 for IMRT. Conformity index (CI) for 3D-CRT was 1.93 for PTV of 2990.77 ccm. CI for IMRT was 1.305 for PTV of 2019.83 ccm. Bladder V40 (%) for 3D-CRT averaged 96.61%, while IMRT averaged 73.11%. Rectal V50 (%) for 3D-CRT was 72.55% and for IMRT was 17.80%. Rectal V40 (%) for 3D-CRT and IMRT averaged 92.12% and 73.49% respectively. Quantitative Analysis of normal Tissue Effects in the Clinic (QUANTEC) – V45 for 3D-CRT was 228.80ccm and for IMRT was 104.55ccm. Femoral heads dose for 3D-CRT was 51.50Gy for left and 51.29Gy for right. Absorbed doses for IMRT were 47.28Gy for left and 47.32Gy for right femoral head, respectively. 13 patients had grade 1 cystitis and urethritis, 2 with grade 2. 7 patients developed grade 1 diarrhea, 1 with grade 2. It can be concluded that dosimetrically IMRT is superior to 3D-CRT in patients treating cervical cancer. Keywords: cervical cancer, 3D-CRT, IMRT. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Dosimetric evaluation of two intracavitary brachytherapy modalities in treatment of inoperable cervical cancer(Eight international conference on radiation in varoius fields of research, 2020-07-24); ; ;Lenche KostadinovaMarija SimonovskaIntroduction. Brachytherapy comprises an integral part of inoperable cervical cancer definitive treatment. Mostly used is intracavitary brachytherapy (ICB) with its primary role of boosting the total dose needed for obtaining disease local control. ICB uses intra-uterine probe and ovoids/ring placed inside the natural cavities combined with after-loading source placement in several applications following external beam radiotherapy treatment (EBRT). Although three-dimensional (3D) ICB planning is used, sometimes plans are calculated with two-dimensional planning (2D), especially when shorter treatment time is needed due to various reasons. Methods and materials. 20 patients were treated with ICB, with prior EBRT dose of 50.4Gy. 10 patients received high dose rate (HDR) ICB in three applications (once a week) with dose of 7Gy/weekly and total dose reaching 21Gy. 10 patients received their HDR ICB in two applications with dose of 9Gy and total dose of 18Gy. All patients had 2D planning. Organ at risk (OAR) constrains were adequate for 2D planning (70% of the prescribed dose for rectal points and 80% of the prescribed dose for bladder point). Radiobiological equivalent for 2Gy daily dose (EQD2, alpha/beta=10) for 3x7Gy ICB treatment is 29.8Gy and 28.5Gy for 2x9Gy ICB respectively. Results. Organs at risk absorbed doses were evaluated in bladder and rectum. 2x9Gy ICB whole treatment doses for rectum averaged at 4.04Gy, while doses for bladder averaged at 3.93Gy. 3x7Gy ICB doses for rectum averaged at 3.47Gy and averaged at 2.57Gy for bladder. Conclusion. OAR absorbed doses were comparable and both maintained the prescribed dose constraints. Keeping in mind that three-dimensional (3D) ICB is the mainstay, yet in some situations where patient conditions differ or when 3D planning resources are limited, both modalities (2x9Gy and 3x7Gy) of 2D HDR ICB can be equally used successfully.
