Synchronous primary cancers of the endometrium and ovary: review of 43 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical and pathological characteristics, treatment methods, and prognosis of synchronous primary cancers of the endometrium and ovary.</p><p><b>METHODS</b>The clinical data of 43 patients with synchronous primary cancers of the endometrium and ovary were retrospectively reviewed. The survival was calculated by Kaplan-Meier method and compared using the log-rank test.</p><p><b>RESULTS</b>The median age at diagnosis was 49 years (range, 28-73 years). The most common symptoms were abnormal vaginal bleeding (69.8%) and abdominal or pelvic pain (44.2%).Pelvic masses were found in 39.5% of the patients and enlarged corpus in 27.9% at physical examination, while pelvic masses were found in 67.4% of the 43 patients (29 cases) and thickening or abnormal endometrium in 23.3% (10 cases) during ultrasound examination. Of 25 patients examined by CT/MRI, pelvic masses were found in 13 cases and enlarged uterus in 11 cases. All 15 patients who underwent endometrial biopsies were proven to have endometrial carcinomas. Serum CA125 level was found to be elevated in 22 of the 34 examined cases (64.7%) with a median value of 500 U/ml (range, 39-3439 U/ml). FIGO stages of endometrial carcinomas: IA 18 cases, IB 20 cases, IC 2 cases, IIA 3 cases; Stages of ovarian carcinomas: IA 19 cases, IB 4 cases, IC 7 cases, II 4 cases, III C 9 cases. Twenty-four patients (55.8%) were in stage I both endometrial and ovarian carcinomas. Thirty-one patients underwent total hysterectomy plus bilateral salpingo-oophorectomy with omentectomy and appendectomy, meanwhile, 12 patients had pelvic lymph node dissection. Thirty-eight of the 43 patients (88.4%) had a pathologically proven endometrial adenocarcinoma. The predominant ovarian histology was endometrioid or mixed tumor with endometrioid components (30/43, 69.8%). Postoperatively, 26 patients (60.5%) received adjuvant chemotherapy alone, 12 had chemotherapy plus radiotherapy, only one patient had radiation alone and the remaining 4 cases received no adjuvant treatment. The 3- and 5-year survival rates of the group were 87.4% and 71.1%, respectively. The 3- and 5-year survival rates of patients with both endometrioid and ovarian carcinomas were higher than that of those with non-endometrioid or mixed subtypes (93.8%, 82.0% vs. 79.7%, 69.0%). The 3-year and 5-year survival rates of patients with early stage disease were better than those of the other patients (93.3%, 93.3% vs. 69.7%, 36.7%). Recurrence developed in 15 patients (34.9%). It was showed by univariate analysis that lower CA125 level, early FIGO stage, and adjuvant chemotherapy plus radiotherapy significantly and positively affect the 5-year survival rates, while only early FIGO stage and chemotherapy plus radiotherapy were revealed by multivariate analysis as independent prognostic factors.</p><p><b>CONCLUSION</b>Synchronous primary cancers of the endometrium and ovary are different from either primary endometrial carcinoma or ovarian cancer, while it can usually be detected in early stage and with a good prognosis. The impact of the CA125 level on prognosis needs to be further studied. Surgical treatment alone may be enough for early stage patients. Chemotherapy plus radiotherapy may be necessary for advanced stage patients.</p>

Prognostic analysis of 88 patients with ovarian clear cell carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics of clear cell carcinoma of the ovary and to compare the survival of the patients treated by three different chemotherapy regimens.</p><p><b>METHODS</b>Between 1984 and 2005, the clinical data of 88 surgically treated patients with clear cell carcinoma of the ovary were retrospectively analyzed. Of the 88 patients, 55 (62.5%) had tumor in stage I, 2 in stage II, 22 in stage II, 3 in stage IV and 6 in indefinite stage. These patients underwent either bilateral salpingo-oophorectomy with hysterectomy and omemtectomy or cytoreduction surgery. Of 55 stage I patients, 20 received pelvic lymohadenectomy. All patients were given postoperative chemotherapy, 43 patients received CAP/CP, 33 paclitaxel combination with carboplatinum/cisplatin (TC/TP) and 12 CPT-11 plus MMC.</p><p><b>RESULTS</b>The response rate, recurrence rate, 3- and 5-year survival was 35.0%, 30.2% (13/43), 67.4% (29/43), 43.9% and 29.3%, respectively in patients treated with CAP/CP; 73.9%, 18.2% (6/33), 45.5% (15/33), 57.3% and 40.5%, respectively in the patients with TC/TP; 71.4%, 16.7% (2/12), 25.0% (3/12), 70.7% ( 3-yr survival, no available 5-yr survival), respectively in the patients with CPT-11 + MMC (P < 0.05). During follow-up, 47 (53.4%) patients were found to have recurrence, it was 45.4% (25/55) in stage I patients including 29.6% (8/27) in stage I a + I b and 60.7% (17/28) in stage I c, 75.0% (18/24) in stage II + III and 4/6 in the indefinite FIGO stage. The recurrences rate was 27.8% (5/18) in stage I patients with pelvic lymphadenectomy vs. 51.3% (19/37) in those without. It was 67.3% in 46 patients with elevated CA125, and 38.1% in the other 42 patients with normal or unavailable CA125 (P < 0.05). The overall 3- and 5-year survival rate of 88 patients was 48.7% and 40.9% , respectively, with 72.5% and 66.8% in stage I, 100.0% and 70.5% in stage Ia + Ib, 68.5% and 60.3% in stage Ic, 41.8% and 20.8% in stage II + III, 0 in stage IV (P < 0.05). The 3- and 5-year survival in stage I with pelvic lymphadenectomy was 88.5% and 75.8% vs. 70.3% and 65.1% in those without (P < 0.05). The 3- and 5-year survival of the patients with optimal (residual disease less than 2 cm) was 36.7% and 23.1% vs. 22.2% and 0 in those with suboptimal cytoreduction (P < 0.05), it was 46.8% and 38.8% in the patients with elevated CA125 vs. 46.7% and 43.5% in those with normal one (P > 0.05).</p><p><b>CONCLUSION</b>Our data show that ovarian clear cell cancer patient have a poor response to CAP/CP and may have a better response to TC/TP, especially to CPT-11 plus MMC. However, the overall prognosis is still poor and further clinical investigations are needed to improve it.</p>

Treatment and prognosis of low-grade malignant endometrial stromal sarcoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To review the experience in the treatment of low-grade malignant endometrial stromal sarcoma.</p><p><b>METHODS</b>The data of 41 patients with low-grade malignant endometrial stromal sarcoma surgically treated between 1982 and 2004 were reviewed. Statistical analysis was carried out using chi(2) and Kaplan-Meier life table.</p><p><b>RESULTS</b>Of these 41 patients, 24 suffered from irregular vaginal bleeding, and 30 had been diagnosed to have leiomyoma before treatment. Thirty patients but 11 underwent surgical management with uterus removed. Thirty-three patients received postoperative adjuvant therapy including radiation and/or chemotherapy. The 5-year and 10-year actuarial survival was 87. 5% and 77. 8%, respectively. Eighteen patients (43. 9%) developed recurrent disease, most of which in the pelvis. The mean time to recurrence was 31 months (range 6 to 78 months) with the median time of 26 months. The recurrent rate was 66.7% for patients whose ovarian function was reserved versus 37. 5% for those without reservation. Patients who received adjuvant therapy had a lower recurrent rate (30. 3%) than those who did not (87. 5%). The recurrent rate of the patients treated with postoperative adjuvant radiation was 32. 3% (10/31) versus 80% (8/10) for those patients without. The 5-year actuarial survival rate of patients with recurrent disease was 71. 8%.</p><p><b>CONCLUSION</b>Low-grade malignant endometrial stromal sarcoma has a good prognoses though dwarfed by higher late recurrence after initial treatment. Postoperative adjuvant radiation is helpful to reduce local recurrence. Endometrial stromal sarcoma;</p>

Efficiency and side effects of concurrent radiotherapy and chemotherapy for advanced cervical cancers / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the efficiency of concurrent radiotherapy and chemotherapy for advanced cervical cancer.</p><p><b>METHODS</b>Between Dec. 1999 and Dec. 2003, 158 women with cervical cancer were treated with concurrent radiotherapy and chemotherapy. The regimen was 45 Gy/25 fraction radiation to the pelvis, intracavitary after-loading 7-9 fractions, (42 +/- 7) Gy to point A and 10-30 Gy to cervical submucosa 0.5 cm for debulking; meanwhile, chemotherapy was given with cisplatin 60 mg/m2, d1-d4, and 5-Fu 2400 mg/m2, over a 96-hour period.</p><p><b>RESULTS</b>The rate of local resistence and pelvic recurrence was 4.4% and 3.2%, respectively. The rate of distant metastasis was 17.1%. The overall 5-year survival rate was 66.3%, without statistically significant difference between concurrent chemoradiation group and radiation alone group during the same period. The adverse effect included grade 3 or grade 4 leukopenia in 12.7% of these patients, grade 3 thrombocytopenia in 1.3%, anemia in 3.2%, diarrhoea in 17.8%, cardiac toxicity in 10.1% and radiation- related rectitis in 13.3% and cystitis in 0.6%, but alopecia was rare.</p><p><b>CONCLUSION</b>Concurrent chemotherapy and radiotherapy may not be able to improve survival for advanced cervical cancer, however, adverse effect is tolerable.</p>

Border-line smooth-muscle tumor of the uterus: analysis of 131 patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate whether the border-line uterine smooth-muscle tumor is different from leiomyoma or leiomyosarcoma in history and clinical manifestations.</p><p><b>METHODS</b>The medical records of 131 surgically treated patients suffering from the so-called cellular leiomyoma or mitotically active leiomyoma of the uterus treated from 1984 to 2002 were retrospectively reviewed. All pathological sections of these patients were reviewed by a senior pathologist. Chi-square test and Kaplan-Meier life table were used for statistical analysis.</p><p><b>RESULTS</b>The overall 5-year survival rate of patients with the border-line uterine smooth-muscle tumors was 100%, however, 19.1% (24/131) of whom developed a late recurrence and 8 patients had repeated recurrences with a more shortened course and aggressive potential changes of mitosis and cellular atypia. The overall 5-year survival rate the patients with recurrence was 91.7%, but only 75.0% for those with repeated recurrences.</p><p><b>CONCLUSION</b>Patients with border-line uterine smooth-muscle tumor do possess some difference in nature from the leiomyoma or leimyosarcoma. Long-term follow-up is very important for these patients after surgery.</p>