A comparison of uterine papillary serous, clear cell carcinomas, and grade 3 endometrioid corpus cancers using 2009 FIGO staging system / 부인종양

OBJECTIVE: This study was designed to compare survival outcomes of patients with uterine papillary serous carcinoma (UPSC) or clear cell carcinoma (CC) to those of patients with grade 3 endometrioid carcinoma (G3EC) according to 1988 and 2009 International Federation of Gynecology and Obstetrics (FIGO) staging systems. METHODS: We retrospectively reviewed all patients with endometrial cancer treated at a single institution between 1995 and 2009. Among the 647 patients with endometrial cancer, 51 with G3EC and 46 with UPSC and CC histology were confirmed. RESULTS: 1988 FIGO stage, 2009 FIGO stage, and extrauterine metastasis were significantly different between the UPSC and CC group and G3EC group (p=0.002, p=0.041, and p=0.020, respectively). Restaging from the 1988 FIGO to the 2009 FIGO criteria increased the number of stage I cases by 10 (11.0%). Overall, 8 in the UPSC and CC and 2 in the G3EC group were down-staged to stage I. In the UPSC and CC group, the 3-year overall survival for 1988 FIGO stage I was 92.9%. When UPSC and CC patients were restaged using the 2009 staging system, the 3-year overall survival of 2009 FIGO stage I dropped to 81.6%. UPSC and CC was associated with poor OS outcome compared with G3EC, after adjustment for 2009 FIGO stage and other clinicopathologic factors. CONCLUSION: We observed that UPSC and CC patients had different prognosis according to the old and new FIGO staging system. Our results suggest that UPSC and CC compared with the G3EC may retain the 1988 FIGO to be a slightly better discriminator than 2009 FIGO.

Analysis of clinical characteristics and prognosis in patients with recurrent cervical cancer / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to analyze the clinical course and prognosis in patients with recurrent cervical cancer. METHODS: Between January 1999 and December 2003, sixty-three patients were diagnosed as recurrent cervical cancer. The data for clinical characteristics and survival were analyzed retrospectively. Survival after recurrence (SAR) according to prognostic factors was evaluated using Kaplan-Meier analysis with log-rank test. Independent prognostic factors were identified by use of Cox regression model. RESULTS: The most common stage and age group of the patients were FIGO stage Ib (38.1%) and age between 40 and 49 (39.7%) respectively. Distant metastases were present in 29 patients (46.0%) and the most common site was para-aortic lymph node. Median disease-free survival before the recurrence of cervical cancer was 19 months (95% CI = 9.5 - 28.5). Median SAR was 24 months (95% CI = 17.4 - 30.6) and 5-year survival rate after recurrence was 20.0%. In univariate analysis of the prognostic factors, age, FIGO stage, primary treatment with surgery and number of recurred site were statistically significant. But, multivariate analysis showed that only FIGO stage and the number of recurrent site had prognostic significance. CONCLUSION: FIGO stage and number of recurrent site may be independent prognostic factors for the survival in patients with recurrent cervical cancer.

Clinical analysis of the effect to survival by FIGO stage and surgical treatment combined with chemotherapy in patients with pseudomyxoma peritonei / 부인종양

OBJECTIVE: The purpose of this study was to compare the survival of patients with pseudomyxoma peritonei (PMP) according to the modalities of treatment and find out the prognostic factors by evaluating clinical variables. METHODS: Thirty one patients were treated at Seoul National University Hospital between May 1995 and May 2005. The clinical data were collected retrospectively and all charts were reviewed. Kaplan-Meier survival analyses with low-rank test were performed for the comparison of survival according to clinical variables, and univariate and multivariate Cox regression analyses were performed for finding out the prognostic factors of PMP. RESULTS: The mean age at diagnosis was 60.9 years and the mean survival (MS) was 25 months. The recurrence rate was 46.7 % and the disease free survival (DFS) till recurrence was 22.6 months. The prognostic factors affecting DFS were histology, FIGO stage, ascites, CA 125, residual disease in 1st and last operations by univariate analyses, but only FIGO stage was the statistically significant prognostic factor by multivariate analysis. Surgical treatment combined with chemotherapy (intraperitoneal or adjuvant) improved MS more than surgical treatment alone by univariate analysis. CONCLUSION: FIGO stage is a prognostic factor that can predict the DFS in patients with PMP. Histology, CA 125, ascites, residual disease may be probably prognostic factors associated with DFS. Surgical treatment combined with chemotherapy is more effective than surgical treatment alone for the treatment of PMP.

Clinical analysis of the effect to survival by FIGO stage and surgical treatment combined with chemotherapy in patients with pseudomyxoma peritonei / 부인종양

OBJECTIVE: The purpose of this study was to compare the survival of patients with pseudomyxoma peritonei (PMP) according to the modalities of treatment and find out the prognostic factors by evaluating clinical variables. METHODS: Thirty one patients were treated at Seoul National University Hospital between May 1995 and May 2005. The clinical data were collected retrospectively and all charts were reviewed. Kaplan-Meier survival analyses with low-rank test were performed for the comparison of survival according to clinical variables, and univariate and multivariate Cox regression analyses were performed for finding out the prognostic factors of PMP. RESULTS: The mean age at diagnosis was 60.9 years and the mean survival (MS) was 25 months. The recurrence rate was 46.7 % and the disease free survival (DFS) till recurrence was 22.6 months. The prognostic factors affecting DFS were histology, FIGO stage, ascites, CA 125, residual disease in 1st and last operations by univariate analyses, but only FIGO stage was the statistically significant prognostic factor by multivariate analysis. Surgical treatment combined with chemotherapy (intraperitoneal or adjuvant) improved MS more than surgical treatment alone by univariate analysis. CONCLUSION: FIGO stage is a prognostic factor that can predict the DFS in patients with PMP. Histology, CA 125, ascites, residual disease may be probably prognostic factors associated with DFS. Surgical treatment combined with chemotherapy is more effective than surgical treatment alone for the treatment of PMP.

Malignant Mixed Mullerian Tumor of the Uterus: Retrospective Study of 26 cases / 대한산부인과학회지

OBJECTIVE: To review the clinicopathological characteristics and prognosis of patients with malignant mixed Mullerian tumor (MMMT) of the uterus. METHODS: Retrospective clinical study was done on 26 patients diagnosed with the MMMT of the uterus at our hospital from Janurary, 1994 to December, 2004. Demographic data, pathologic findings, stages, treatment, prognosis and survival time were reviewed. RESULTS: The median age of patients was 59 years. Most of the patients (76.9%) were in the postmenopausal state. The most common symptom was vaginal bleeding (65.4%). There were 17 patients (65.4%) with stage I, 3 patients (11.6%) with stage II, 4 patients (15.4%) with stage III, 2 patients (7.6%) with stage IV disease in this study. Of the hysterectomy specimens, 4 (15.4%) of them were heterologous tumors, 22 (84.6%) of them were homologous tumors. Overall 5 year survival rate of all stages was 60% and the patients with advanced stages (III, IV) showed poorer prognosis than the patients with early stages (I, II) (P=0.001). Myometrial invasion depth was also significant prognostic factor (P<0.001). CONCLUSION: The MMMT of the uterus is a highly malignant tumor and the significant prognostic factor is the FIGO stage and myometrial invasion depth.

Clinical Study of Borderline Ovarian Malignancy / 대한산부인과학회잡지

OBJECTIVES: The purpose of this study is to investigate the clinicopathologic characteristics and the risk factors affecting the recurrence in patients with borderline ovarian malignancy. METHODS: From January 1996 to January 2001, 37 patients with borderline tumors of the ovaries were retrospectively investigated in the Department of Obstetrics and Gynecology, Catholic University, Kangnam and Uijongbu St. Mary's Hospital. Several clinicopathologic factors including DNA ploicly was analyzed for the prognosis and recurrence. Analysis for the kinds of treatment and recurrence were conducted to test the prognostic significance of several clinicopathologic factors including DNA analysis. RESULTS: Histologically, 27 borderline tumors were serous, 9 were mucinous and 1 was mixed epithelial type. The FIGO stage I was 91.8% (34/37) and stageII was 8.2% (3/37). Mean value of CA125 in mucinous borderline malignancy was significantly higher (162.4 IU/mL) than serous types (52.2 IU/mL) (p35 IU/mL) were 56.3% (9/16) in serous type and 75% (6/8) in mucinous tumors. Ten of 13 cases with DNA flow cytometry showed aneuploidy (76.9%). When considering pathologic types between diploid and aneuploid groups, there were no statistically significant differences. However, the patients with old age (>40) were more likely to be aneuploid (p<0.05). Mean duration of follow-up investigation was 26 months after primary operation. In this period, only one patient with serous borderline tumor stage Ia had recurrence on the contra-lateral ovary at 13-month. CONCLUSION: Data from this study showed that the majority of borderline tumors have good prognosis. And young patients who have not completed childbearing can be safely treated with unilateral salpingo- oophorectomy and omentectomy in stage I diploid tumor. In ovarian bordeline tumors, further studies on DNA ploidy would be needed.

Two Cases of Juvenile Granulosa Cell Tumor / 대한소아혈액종양학회지

Juvenile granulosa cell tumor (JGCT) is one of the rare sex cord stromal tumors of the ovary. The majority of JGCT are found in prepubertal girls and young women. Unlike adult granulosa cell tumor (AGCT), JGCT is characterized by high frequency of mitosis and early relapse after treatment. Patients with JGCT in FIGO stage Ia have an excellent outcome with an event-free survival of about 90% following surgical resection alone, while those in advanced stages have an unfavorable outcome. We report two cases of JGCT in stage Ic, who showed a quite different outcome. One was managed initially with surgical resection alone and died of subsequent relapse. Another was managed with multimodality treatments including surgical resection, adjuvant chemotherapy and radiotherapy, and didn't show any evidence of relapse during 16 months of follow-up period. Further studies to evaluate the beneficial effects of chemotherapy and/or radiotherapy are required in patients with JGCT in stage Ic.

Tumor Angiogenesis and Stage in Ovarian Carcinoma

Tumor angiogenesis has been found to have prognostic significance in many tumor types for predicting an increased risk of metastasis. We assessed tumor vascularity in 28 cases of borderline malignancy and 71 cases of carcinoma of the ovary which had been resected and diagnosed, using the highly specific endothelial cell marker CD34. The numbers of microvessels were counted in 200 magnification in three highly vascularised areas. The numbers of microvessels in carcinomas were higher than that in the borderline malignancy of serous and mucinous tumors. The number of microvessels of mucinous carcinomas was significantly higher than that of serous carcinomas. There were neither significant differences in the number of microvessels according to histological tumor types (p=0.075) nor significant differences in the number of microvessels according to FIGO stages (p=0.072). But in serous carcinomas, the number of microvessels was higher in the FIGO III-IV stage than in the FIGO I-II stage (p=0.017). This study showed higher neovascularization in malignant tumor than borderline malignancy, and in the advanced stage (FIGO III-IV) than less advanced stage (FIGO I-II) of serous carcinomas.

A Clinical Study of 20 Uterine Sarcomas / 영남의대학술지

Sarcoma of the uterus is very rare malignant tumor originating from uterine muscle or connective tissue. We have experienced 20 cases of uterine sarcoma from January 1991 to June 1998. The results were as follows: 1. The pathologic types were 13 cases(65.0%) of leiomyosarcoma, 5 cases(25.0%) of malignant mixed Mullerian tumor, 1 case of rhabdomyosarcoma, and 1 case of angiosarcoma. 2. The average age and parity was 50.2 and 3.7. The chief complaints were irregular vaginal bleeding(35.0%), lower abdominal pain(25.0%), and abdominal mass(25.0%). 3. Nine cases(45.0%) were FIGO stage I, 1 case(5.0%) was stage II, 6 cases(30.0%) were stage III, and 4 cases(20.0%) were stage IV. 4. The survival was from 1.5 months to over 130 months(median 16.5 months), and there was no correlation between survival and FIGO stage or pathologic type. The correlation between survival and number of mitotic figure was incalcurable. 5. CA 125 levels were serially measured as a tumor marker in monitoring patients and the positive rate was 40%. Further study was needed to make a conclusion for usefulness of CA 125 as a tumor marker.

Effect of Tumor Grade and FIGO Stage on Preoperative Serum CA 125 Level in Epithelial Ovarian Cancer / 대한부인종양콜포스코피학회잡지

The preoperative serum level of tumor marker CA 125 has served as rough orientation in making the distinction between a benign and a malignant adnexal mass or as a reference for monitoring the success of therapy. But there were some reports suggesting that the stage of the disease and tumor grade, which are known to be the independent prognostic factors in ovarian cancer patients, may exert an influence on the preoperative CA 125 level. In this retrospective study we analysed the significance of preoperative serum CA 125 level with respect to tumor grade and tumor stage. Between June, 1989 and January, 1997, 82 patients with epithelial ovarian cancer managed at Asan Medical Center were evaluated, in whom serum level CA 125 were measured preoperatively. Tumor grade bears no meaningful influence on the preoperative CA 125 level, and also the correlation is low and statistically insignificant (r=0.12, p=0.29 in all stages; r=0.01, p=0.97 in stage I; r=-0.09, p=0.83 in stage II; r=0.06, p=0.72 in stage III; r=0.25, p=0.41 in stage IV). There was no significant effect of FIGO stage on preoperative CA 125 level (r=0.21, p=0.06 in all grades; r=0.32, p=0.10 in G1; r=0.08, p=0.74 in G2; r=0.17, p=0.30 in G3). However, we found a significant correlation between FIGO stage and tumor grade (r=0.45, p<0.01). In conclusion, our data suggests that both tumor grade and FIGO stage have no significant effect on preoperative serum CA 125 level.