Promising treatment results of adjuvant chemotherapy following radical hysterectomy for intermediate risk stage 1B cervical cancer

OBJECTIVE: The aim of this retrospective study is to evaluate the efficacy of adjuvant chemotherapy following radical hysterectomy for intermediate risk stage IB cervical cancer. METHODS: From January 1993 to December 2007, a total of 100 patients of stage IB were enrolled in this study who had at least two of the following three intermediate risk factors (deep stromal invasion, lymphovascular space involvement, and large tumor size) after radical hysterectomy and all patients had no high risk factors and no radiotherapy. Of these patients, 22 patients had surgery only and 78 patients had cisplatin-based combination chemotherapy as adjuvant therapy postoperatively to improve survival. Kaplan-Meier survival curves and Cox's proportional-hazards regression model and log-rank test were used for survival analysis and to estimate the impact of prognostic factors on survival. RESULTS: The mean age was 52 years (range, 28 to 76 years). The overall survival rate of all intermediate tumors are 92% (92/100). Surgery only group is 81.8% (18/22) and adjuvant chemotherapy group is 94.9% (74/78). Comparison of survival between two groups revealed significant statistical difference in both univariant and multivariant survival analysis (P<0.05). The main toxicities of adjuvant chemotherapy were bone marrow suppression (18%), nausea and vomiting (5.2%) and alopecia in etoposide-cisplatin chemotherapy group (100%) but most side effects of postoperative adjuvant chemotherapy were transient, reversible and within acceptable limits to all patients. CONCLUSION: Cisplatin based combined adjuvant chemotherapy for intermediate risk tumors after radical hysterectomy is promising with significant improvement of overall survival and with acceptable toxicity profile.

Expressions of MMP-2, MMP-9, TIMP-1, and TIMP-2 as prognostic factors in endometrial cancer / 부인종양

OBJECTIVE: Homeostasis of the extracellular matrix (ECM) is maintained by the action of a specific system of proteolytic enzymes known as matrix metalloproteinases (MMP) and tissue inhibitors of metalloproteinases (TIMP). The MMP/TIMP system regulates the composition and turnover of ECM to control the site and extent of connective tissue remodeling. In pathologic conditions, MMP play a key role in degradation of basement membrane and extracellular matrix, and is responsible for cancer invasion, progression and metastasis. The aim of this study is to evaluate the correlation between expressions of MMP/TIMP and clinicopathologic factors in endometrial cancer. METHODS: Expressions of MMP-2, MMP-9, TIMP-1, and TIMP-2 were assessed by immunohistochemistry in a total of 55 endometrial cancers and were analyzed by the correlation between expressions of MMP/TIMP and clinicopathologic factors in endometrial cancer. RESULTS: Expression rates of MMP-2,-9, TIMP-1, and TIMP-2 were 71.7%, 54.9%, 41.2%, and 76.5% respectively. Expression of MMP-2 was correlated with the group of positive lymph node metastasis in endometrial cancer (p=0.04). Specially, coexpression of MMP-2 and TIMP-2 was significantly more frequent in the group of positive lymph node metastasis (p<0.01) and the group of positive peritoneal CONCLUSION: The expressions of MMP and TIMP were not a significant difference in survival analysis, but this study was recognized that the coexpression MMP-2 and TIMP-2 is correlated with lymph node metastasis and positive peritoneal cytology.

Clinocopathologic analysis of survival of 98 patients with uterine endometrial cancer / 대한산부인과학회지

OBJECTIVE: This study was performed to evaluate the clinicopathologic prognostic factors and overall survival in patients with uterine endometrial cancer. METHODS: From Jan, 1995 to Dec. 2000, medical records of 98 patients with endometrial cancer treated in Kosin University Gospel Hospital were reviewed and the overall survival of patients was determined by support of the death statistics of Korea National Statistical Office. Survival rate was analyzed by Kaplan-Meier method and log-rank test was used for curve comparison, Cox proportional hazards model was used for multivariate analysis. RESULTS: The median age of all patients was 53 years. The most common presenting symptom was abnormal vaginal bleeding (65.3%). The most common histological type was endometrioid adenocarcinoma. (85.1%) The overall 5 years survival rate (5YSR) for all 98 patients was 66.8%. The overall 5YSR for premenopause and postmenopause were 80% and 50%, respectively (p=0.08). The overall 5YSR for preop CA-125 level above 35 U/mL, below 35 U/mL were 40%, 80% (p=0.001). The overall 5YSR of stage I, stage II, stage III, stage IV were 86.8%, 76.9%, 39.4%, 14.4% (p=0.001). The overall 5YSR of grade 1, grade 2, grade 3 were 75%, 70%, 45% (p=0.002). The overall 5YSR of myometrium invasion of none, or=1/2, were 84.3%, 80.3%, 57.2% (p=0.004). The overall 5YSR of peritoneal cytology of negative, posivite were 73.4%, 23.8% (p=0.001). The overall 5YSR of lymphnode metastasis negative, positive were 80.1%, 15% (p=0.001). CONCLUSION: The age (>50), preop CA-125 level, FIGO surgical stage, grade, myometrial invasion, lymph node metastasis and peritoneal cytology were significant prognostic factors of uterine endometrial cancer affecting 5YSR by univariate analysis. The myometrium invasion and grade were significant prognostic factors affecting 5YSR by multivariate analysis.