Objective: Ovarian cancer is the fifth most frequent tumor in women and the second most common gynecological cancer. Recurrence of ovarian cancer develops in up to 50–90% of patients within the first five years after diagnosis. Approximately 70% of patients with advanced disease will experience a relapse. The aim of this study was to assess prognostic factors that may predict a higher probability of additional recurrences, as well as their treatment and impact on disease-free and overall survival. Method: A retrospective observational study was conducted on patients diagnosed with recurrent ovarian cancer at the Gynecologic Oncology Unit of Hospital Universitario La Paz (Madrid, Spain) from January 2000 to December 2020. All variables related to the initial treatment, diagnosis, and management of the recurrence were collected and analyzed. Results: Data from 144 patients with recurrent ovarian cancer were analyzed. Statistically significant differences were found in disease-free survival between patients depending on initial tumor staging and primary treatment. Better outcomes were observed in patients with FIGO (International Federation of Gynecology and Obstetrics) stages I–II compared to those with FIGO stages III–IV at diagnosis (p = 0.021), as well as in patients who underwent primary cytoreduction compared to those who received neoadjuvant chemotherapy followed by interval surgery (p < 0.001). The disease-free interval was categorized into three periods, <6 months, 6–12 months, and ≥12 months, with greater survival observed in those with a longer disease-free interval (p < 0.001). After the first recurrence, two factors significantly influenced patient survival: the type of treatment received after the first recurrence (p < 0.001) and the type of chemotherapy regimen (p = 0.001). Complete cytoreduction during primary treatment was an independent prognostic factor and was related to better overall survival in patients where it was achieved (p = 0.004), regardless of the number of recurrences. Conclusions: The prognostic factors with impact on the survival of patients with a first recurrence of ovarian cancer are the following: treatment modality of the primary tumor, treatment modality of the recurrence, type of chemotherapy regimen, and disease-free interval from initial diagnosis to the first recurrence.

Adequate surgical management of malignant endometriosis remains a clinical challenge in gynecology. Age, sonography variables, and tumor biomarkers have been reported as candidates in the clinical decision. This study aims were to analyze the factors of women’s age, body mass index, ultrasound features, and tumor biomarkers to predict endometriosis-associated ovarian cancer in a large series of endometriomas and to study the surgical treatment performed in this cohort. In this retrospective study, we reviewed the medical records of patients with ultrasound diagnosis of ovarian cyst classified as endometrioma (benign as well as with risk of malignancy), surgically treated in the endometriosis unit of Hospital Universitario La Paz (Madrid, Spain) between January 2019 and July 2021. According to the final histology examination, the women were clustered as non-endometriosis-associated ovarian cancer (OE, benign endometriomas, n = 59) and endometriosis-associated ovarian cancer (EAOC) (n = 17). Demographic, clinical, and surgical data were collected from these women. International Ovarian Tumor Analysis (IOTA) criteria were assessed for the ultrasound examination. The age of the women in the EAOC group was 50.0 [43.0; 63.0] years, which was significantly higher than OE (39.0 [34.0; 46.0] years; p-value < 0.001). In addition, the body mass index for the OE group (24.9 ± 5.3 kg/m²) was significantly higher than for the EAOC group (23.3 ± 4.6 kg/m²; p-value < 0.001). However, the tumor biomarker levels (CA 125, CA 19.9 and He4) were not significantly different among the groups. We performed 51.4% cystectomies and 48.6% adnexectomies, with an association between the adnexectomy and EAOC group (p-value < 0.001). In addition, a significant association was found between ultrasound features suspicious for malignancy and the EAOC group. Conclusively, women’s age and ultrasound features, such as papillary projections, septa, and positive echo-Doppler, were the main factors to consider when evaluating the malignancy risk associated with endometriosis.

The outbreak of COVID-19 has overwhelmed healthcare systems all over the world. The aim of this article is to describe the process of transforming the Vall d’Hebron University Hospital, the second largest hospital in Spain, into a COVID-19 centre coordinating response to the pandemic in its reference area. The study draws on the experience of the authors in transforming the hospital into a comprehensive resource in response to the COVID-19 pandemic. The strategy is based on four central strategies: early planning, coordination of all healthcare agents in its reference area, definition of clear leadership roles, and the organisation of care based on multidisciplinary teams with minimal recruitment of new staff. The transformation strategy enabled the hospital to cope with the surge in patients without exceeding its capacity. During the response phases, which amounted to a period of 57 days, 3106 patients consulted the ER and 2054 were admitted, 346 of whom were treated at the ICU. To accommodate the number of adult COVID-19 patients, adult ICU availability was progressive increased by 371%, and ordinary beds increased by 240. A total of 671 staff members went on sick leave after testing positive for COVID-19. The transformation experience of the hospital provides insight into how effectively adapt the structures and functioning of large hospitals. The relevance of territorial coordination during the pandemic is stressed as an effective strategy that contributed coping the pandemic.

Background: the association between ovarian endometriosis (OE) and endometriosis-associated ovarian cancer (EAOC) is extensively documented, and misfunction of the immune system might be involved. The primary objective of this study was to identify and compare the spatial distribution of tumour-infiltrating lymphocytes (TILs) and tumour-associated macrophages (TAMs) in OE and EAOC. Secondary objectives included the analysis of the relationship between immunosuppressive populations and T-cell exhaustion markers in both groups. Methods: TILs (CD3, CD4, and CD8) and macrophages (CD163) were assessed by immunochemistry. Exhaustion markers (PD-1, TIM3, CD39, and FOXP3) and their relationship with tumour-associated macrophages (CD163) were assessed by immunofluorescence on paraffin-embedded samples from n = 43 OE and n = 54 EAOC patients. Results: we observed a predominantly intraepithelial CD3+ distribution in OE but both an intraepithelial and stromal pattern in EAOC (p < 0.001). TILs were more abundant in OE (p < 0.001), but higher TILs significantly correlated with a longer overall survival and disease-free survival in EAOC (p < 0.05). CD39 and FOXP3 significantly correlated with each other and CD163 (p < 0.05) at the epithelial level in moderate/intense CD4 EAOC, whereas in moderate/intense CD8+, PD-1+ and TIM3+ significantly correlated (p = 0.009). Finally, T-cell exhaustion markers FOXP3-CD39 were decreased and PD-1-TIM3 were significantly increased in EAOC (p < 0.05). Conclusions: the dysregulation of TILs, TAMs, and T-cell exhaustion might play a role in the malignization of OE to EAOC.