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Background and purpose: Ovarian lymphoma (OL) is usually misdiagnosed as ovarian cancer with bulk lymph node invasion (OC-BLN), and vice versa. Therefore, to distinguish these two types of disease, we compared their clinical characteristics in this study. Methods: This study retrospectively reviewed 14 OL and 14 OC-BLN patients from Fudan University Shanghai Cancer Center and Shanghai Eighth People's Hospital. The clinical char-acteristics, image and laboratory examination data were compared. Results: There was no significant difference in age, symptom, fever, weight loss and volume of ascitic fluid between the two groups. Comparing with OC-BLN, OL patients have larger tumor in ovaries [(13.04±5.94) cm vs (7.78±6.38) cm, P=0.033], and higher percentage of solid ovarian tumor (85.71% vs 28.5%, P=0.006). Lactate dehydrogenase(LDH)/CA125 was higher in OL (7.66±8.03) than OC-BLN (0.31±0.27, P=0.009). Using LDH/CA125 to diagnose OL, area under the curve (AUC) was 0.952. When the threshold value was set at 1, the sensitivity and specificity was 91.7% and 100%, respectively. Conclusion: OL and OC-BLN are easily to be misdiagnosed. OL has larger and more solid tumor than OC-BLN. LDH/CA125 can help to distinguish these two diseases and guide clinical decision making.
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OBJECTIVE: Distal pancreatectomy with splenectomy may be required for optimal cytoreductive surgery in patients with epithelial ovarian cancer (EOC) metastasized to splenic hilum. This study evaluates the morbidity and treatment outcomes of the uncommon procedure in the management of advanced or recurrent EOC. METHODS: This study recruited 18 patients who underwent distal pancreatectomy with splenectomy during cytoreductive surgery of EOC. Their clinicopathological characteristics and follow-up data were retrospectively analyzed. RESULTS: All tumors were confirmed as high-grade serous carcinomas. The median diameter of metastatic tumors located in splenic hilum was 3.5 cm (range, 1 to 10 cm). Optimal cytoreduction was achieved in all patients. Eight patients (44.4%) suffered from postoperative complications. The morbidity associated with distal pancreatectomy and splenectomy included pancreatic leakage (22.2%), encapsulated effusion in the left upper quadrant (11.1%), intra-abdominal infection (11.1%), pleural effusion with or without pulmonary atelectasis (11.1%), intestinal obstruction (5.6%), pneumonia (5.6%), postoperative hemorrhage (5.6%), and pancreatic pseudocyst (5.6%). There was no perioperative mortality. The majority of complications were treated successfully with conservative management. During the median follow-up duration of 25 months, nine patients experienced recurrence, and three patients died of the disease. The 2-year progression-free survival and overall survival were 40.2% and 84.8%, respectively. CONCLUSION: The inclusion of distal pancreatectomy with splenectomy as part of cytoreduction for the management of ovarian cancer was associated with high morbidity; however, the majority of complications could be managed with conservative therapy.
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Adult , Aged , Female , Humans , Middle Aged , Cytoreduction Surgical Procedures , Disease-Free Survival , Neoplasms, Glandular and Epithelial/mortality , Ovarian Neoplasms/mortality , Pancreatectomy/adverse effects , Postoperative Complications/epidemiology , Splenectomy/adverse effects , Splenic Neoplasms/pathologyABSTRACT
Background and purpose:Primary malignant melanomas of the uterine cervix and vagina are rare neoplasms with very poor prognosis. This article aimed at investigating the clinicopathologic characteristics, treatment and prognosis of primary malignant melanomas of the cervix and vagina. Methods:The clinical data of 51 patients with primary malignant melanomas of the cervix and vagina treated at Fudan University Shanghai Cancer Center from Dec.1998 to Jul. 2011 were reviewed. Results:The 2-and 4-year progression-free survival (PFS) rates were 32.8%and 13.1%, respectively. The 2-and 4-year overall survival (OS) rates were 67.2%and 39.8%, respectively. Three patients survived more than 5 years. Twenty-nine (56.9%) patients had a recurrence. The common sites were vaginal stump/pelvis (10 patients, 34.5%), liver (4 patients, 13.9%), lung (3 patients, 10.3%), bone (3 patients, 10.3%) and vulva (3 patients, 10.3%). Larger tumor size and lymphovascular space invasion were the independent predictors of poor OS (P<0.05). Pelvic lymph nodes metastases were associated with shorter PFS (P=0.05). Among them, those who received combined immunotherapy and chemoradiotherapy achieved longer median time to progression (TTP) (17 months) compared with patients who had chemotherapy alone (9 months) or immunotherapy alone (11 months). Conclusion:Primary melanomas of cervix and vagina have a very poor prognosis. The multidisciplinary treatment of combining surgery, chemoradiotherapy, and immunotherapy can improve the patients’ prognosis.
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10.3969/j.issn.1007-3969.2013.05.009
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an those received RH (29% vs. 9%, P=0.042). Conclusion NSRH is safe and feasible surgical management for cervical cancer patients, which would improved the physiology of pelvic autonomic nerve postoperatively.
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Objective To establish the methods of three-dimensional eonformal(3DCRT) and intensity-modulated radiotherapy(IMRT) for whole pelvic irradiation in post-hysterectomy cervical carcinoma, And to optimize the methods for clinical practice. Methods Between 2004 and 2005,10 patients with cervical carcinoma who underwent hysterectomy with high risk of recurrence were selected for this study. The following observations and measurements were used for the study: Set-up errors with supine or prone position were measured to determine appropriate immobilization position. Influence of full and empty bladder on irradiated normal tissue volume was measured. Treatment errors were detected and CTV/PTV were then delineated. 3DCRT and IMRT planning and comparison were applied. Results The set-up error was within 5 mm of three dimensions in prone position and more than 5 mm in supine position, the difference of which was statistically significant. The percentage of irradiated volume of the bladder and bowel was smaller when the bladder was full comparing with empty bladder. In prone position and with full bladder,portal films showed the movement of isocenter in three directions. The total uncertainty was [7.4±1.6]mm. For 95% confidence interval,the margin from CTV to PTV was 1 cm. CIPTV for 3,4,5,and 6 fields 3DCRT was 0.46,O. 67, O. 68, and O. 68, respectively. When beyond 4 fields, the advantage of adding fields was not significant.Four fields planning was feasible for clinical practice. CI for 5,7,9,11 ,and 13 fidds IMRT was 0.75,0.83, 0.84,0.85 ,and 0.85 ,respectively. When beyond 9 fields,the advantage of adding fields was not significant. Nine fields planning was feasible for clinical practice. Conclusions For whole pelvic radiotherapy for post-hysterectomy cervical carcinoma,prone position was better than supine position for immobilization due to smaller set-up errors. The full bladder is recommended during radiotherapy, planning,For clinical practice,4 fields planning is feasible in 3DCRT while 9 fields planning is feasible in IMRT.
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Background and purpose:It has been confirmed that homozygous deletion of p16/p15 gene and its co-deletion of p16/p15 genes were related to the occurrence, progress and prognosis of epithelial ovarian cancer. However, the mono-deletion and co-deletion of the genes has been detected with tissue but not in serum DNA of the epithelial ovarian cancer. In this article, we studied the relationship between homozygous deletion of p16/p15 gene and its co-deletion of p16/p15 genes in serum DNA of the epithelial ovarian cancer.Methods:Primers were used to amplify exon 2 of p16 and exon 2 of p15 gene by polymerase chain reaction. Homozygous deletions of the p16, p15 and co-deletion of p16/p15 genes were studied in either serum DNA of 165 patients with epithelial ovarian cancer, their counterpart lymphocytes DNA, serum DNA of 25 benign ovarian cyst or of 15 health donors.Results:The homozygous deletion rates of either p15 or p16 gene were 27.9%(46/165)and 27.3%(45/165)serum DNA in the patients with epithelial ovarian cancer respectively, while the co-deletion rate of p16/p15 genes was 24.2% (40/165). However, the deletions of p15/p16 genes and its co-deletion were not found in serum DNA of the counterpart lymphocytes,25 benign ovarian cyst and 15 health donors (The P values were 0.000、0.000 and 0.000 respectively). The deletions of either p15 or p16 gene for the patients with stage Ⅰ~Ⅱ were 14.3%(5/35) and 11.4%(4/35), 33.3%(25/75) and 32.0%(24/75) for the patients with stage Ⅲ, 29.1%(16/55) and 30.9% (17/55) for stage Ⅳ, respectively. Although there was no significant differences among the groups, the deletion of p15 and p16 genes in the patients with advanced stage were higher than that with early stage. The deletion was not found to be associated with histopathology of epithelial ovarian cancer.Conclusions:Homozygous deletions of the p16, p15 genes and its co-deletion of p15/p16 genes were commonly found in the serum DNA of epithelial ovarian cancer and might be associated with clinical stage of the disease. It was suggested that detection with serum DNA may be used as a micro-invasive approach and the deletion of genes might served as biological markers for the development and prognosis of the patients with epithelial ovarian cancer.
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1cm)(P=0.0000)and the type of adjuvant chemotherapy implemented (non-standard chemotherapy versus standard chemotherapy)( P=0.0028). Among them tumor size was exclusively an independent factor.Conclusions:Histology、FIGO stage、residual tumor after surgery and the type of adjuvant chemotherapy were independent factors associated with recurrence in MOGCT .For those patients with high risks of recurrence, full dose and cycles of standard BEP/PVB regimen should be used.
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1cm, there was a significant statistical difference in median survival of 61 and 12 months, respectively (? 2 =16.60, P =0.0001). The median survival for patients with and without peritoneal chemotherapy were 27 and 12 months, respectively (? 2 =3.45, P =0.0633). Residual disease, FIGO stage, recurrent ascites, uterus muscle involvement were independent prognostic determinants of survival identified by Cox's stepwise regression analysis. Conclusions Aggressive surgical cytoreduction should be performed in elderly AEOC patients as well as in younger patients, but multi-course platinum-based chemotherapy should be used in accordance with the performance status of elder women.
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Objective Intestinal obstruction is a frequent sequela of recurrent ovarian cancer and difficult to deal with We analyzed a series of such patients to determine if their outcomes have changed after undergoing palliative surgery Method We retrospectively reviewed 67 patients undergoing surgery for intestinal obstruction due to recurrent ovarian carcinoma and 75 patients receiving non surgical treatmen from 1997 to 2002 Results During the study period,67 operations were performed on 67 patients Among them,surgical procedure was completed in 58 cases Successful palliation was achieved in 64 2% of cases in which surgical correction was possible The median survival of the entire cohort was 7 8 months,and 12 6 months for the surgically successfully relieved patients and 3 7 months for those non surgical patients The rate of major surgical morbidities was 22 4 % The perioperative mortality rate was 6 0% Successful palliation was associated with the absence of two prognostic factors:multiple obstructive sites and palpable abdominal and pelvic masses Conclusion Palliative surgery for bowel obstruction in recurrent ovarian cancer can be worthwhile,and properly selected patients are the key to its success
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Objective To investigate the incidence,the diagnosis,the multimodal treatment and the relevant factors of the brain metastases in patients with epithelial ovarian carcinoma(EOC) Method The clinical data were analysed in 10 cases of brain metastases from 478 cases of EOC after treatment between 1996-2001 Results The incidence of brain metastases in EOC was 2 1% The most common manifestation of the brain metastases was headache,nausea and limb paralysis The most common metastatic sites were the cupular and occipital part of the cerebra.Seven of ten patients were treated with brain radiation and systemic chemotherapy, three abandoned The brain irradiation dosage was 30-38 Gy for only one focus in the brain lasting for 4 weeks and 40-45 Gy for two or three foci in the brain lasting for 5 weeks The overall survival after identification of brain metastases was
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chronic cervicitis(0%),(P=0.000).The positive rates of EPMMPRIN overexpression in metastatic lymph nodes was 54.5%(12/22),no difference was found from corresponding primary tumor(72.7%,P=0.210).But EMMPRIN overexpression in primary tumor was related to lymph node metastasis(P=0.026),no relationship was found between EMMPRIN expression and other clinical-pathological parameters.Univariate analyses revealed that EMMPRIN expression did not correlate to tumor-specific survival.In contrast,lymph vascular space invasion,deep stromal invasion and lymph node metastasis were significantlyassociated with poor prognosis.In multivariate analysis,lymph-node metastasis was the independent prognostic factor for tumor-specific survival(P=0.006;HR=0.038;95% confidence interval,0.0190.763).Conclusion:EMMPRIN overexpression may play an important role in progression of human cervical cancer,and in the development of cervical cancer from CIN.
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Objective To evaluate the effects of combined treatment for advanced epithelial ovarian carcinoma and to analyze its prognostic factors Methods Fifty three patients treated with a three step combined therapeutic regimen were defined as research arm The procedures of the three step combined treatment were as follows: induction of tumor remission, sequential chemotherapy and adjuvant immunotherapy Three hundred and eighteen patients with advanced epithelial ovarian carcinoma treated with cytoreductive surgery and systemic chemotherapy were retrospectively classified into control arm Results The rates of complete response and partial response in the research arm were significantly differed from those in the control arm (90 6%, 5 7% Vs 70 1%, 5 3%, P
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Objective Investigate the frequency of loss of heterozygosity (LOH) at chromosome arm the short arm chromosome 3p14,25 in the serum DNA from ovarian cancer and its clinical application Methods Thirty eight ovarian cancer serum samples with 18 corresponding tumor tissues and 8 benign ovarian tumors were obtained,and DNA samples extracted from serum and tissue were examined for 3p14,25 LOH by using of polymerase chain reaction with four polymorphic microsatellite markers (D3S1029, D3S1228, D3S1300, D3S1481) Results Matched serum and tissue DNAs from 18 ovarian cancer patients showed significant concordance of 3p14,25 LOH ( P
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Purpose:To investigate the survival and prognostic factors in patients with stage Ib～IIb node-negative cervical carcinoma.Methods:From Nov.1993 to Dec. 1997,236 patients who had radical hysterectomy and pelvic lymphadenectomy and pelvic lymph node found negative were reviewed retrospectively. Survival rates were calculated by Kaplan-Meier method with differences in survival estimated by Log-rank test. Independent prognostic factors were identified by the Cox's proportional-hazards regression model. Results:The overall 5-year survival of the patients was 82.0% and the median survival time was 100.0 months. The recurrence and/or metastatic rate was 19.5%. Of these patients the 5-year survival rate was 16.9% and median survival time was 15.0 months. Among the variables,clinical stage(Ⅱb),tumor size(≥4 cm),histological type (non-squamous carcinoma),poor differentiation,deep stromal invasion,parametrial extension,vaginal margin involved,and lymphvascular permeation were the poor prognostic factors in univariate survival analysis ( P
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Objective To investigate individualized and multi-phase management of recurrent epithelial ovarian carcinoma in order to improve survival of the patients. Methods From 1998 to 2002, 70 patients with recurrent epithelial ovarian carcinoma were enrolled in the present study. The treatments were divided into: (1) Induction of tumor remission:platinum sensitive patients were treated with paclitaxol + cisplatin (TP) or carboplatin + cyclophosphamide(CP)regimen; platinum resistant patients used Taxol + mitomycin(TM)or etoposide+ mitomycin(VM)regimen. Resection of tumors was done in an attempt to reduce the residual tumor with a diameter less than 1cm. Local radiotherapy was performed for those with residual tumor and who achieved clinical response after chemotherapy or surgery. (2) Consolidation therapy: chemotherapy with lower doses was administrated after disease remission. Interferon was used as immunotherapy during chemotherapy and radiotherapy. Survial analysis was done. Results (1) The 1, 2, 3, 4, 5-year survival rates were 67%, 51%, 45%, 38%, 32% . Median survival was 38.57 months. (3)The 1,2,3-year progression-free survival rates of the research arm were 41%, 37%, 24%. Median progression-free survival was 12.00 months. (4) Multivariate analysis revealed that platinum-free interval (P
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Purpose:To study prognostic factors of younger women's eptihelial ovarian neoplasms.Methods: From Jan. 1980 to Dec. 1992, there were 86 cases of younger women's epithelial ovarian carcinoma in our hospital. We studied serveral prognostic factors retrospectively.Results:In this setting, 2 year survival rate were 79.07%, 5 year survival rate were 54.65%. There were 49 cases with stage Ⅰ and 41 cases with grade Ⅰ. No recurrence was found in 4 patients who preserved ovarian function. Cox model multifactor results showed that grade, residual tumor size and the method of surgery were prognostic factors( P 0 05). The pathological type, FIGO staging, grade, residual tumor size, the method of surgery were important factors according to unifactor analyze ( P
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Purpose:To detect the expression of cytokeratin 19 (CK19) mRNA and human papillomavirus type 16 (HPV16) mRNA in peripheral blood of cervical cancer patients. Methods:We used reverse transcription polymerase chain reaction (RT-PCR) to determine the expression of CK19 and HPV16 mRNA of 30 cervical cancer patients,8 patients with known distant metastases,16 patients with benign gynecological tumors and 9 healthy persons as control. Results:The presence of CK19 mRNA was observed in 3 peripheral blood samples among 30 cervical cancer patients (10%). The positive ratios for cervical patients with metastases,benign tumors and healthy control were 8/8,0/16 and 0/9. Only 10 cervical samples were proved to be HPV 16 positive by immunohistochemistry and/or hybridization in situ,whose expression of HPV16 mRNA in the peripheral blood were all negative (0/10). The positive ratios for cervical patients with metastasis,benign tumors and healthy control were 1/8,0/16 and 0/9,respectively. Conclusions:CK19 mRNA may be considered a powerful biomarker in the detection of peripheral blood of cervical cancer patients due to its high sensitivity and specificity. The detection of HPV16 mRNA was low and its clinical significance needs further evaluation.