Relationship between P53 Protein Expression and Prognosis of Advanced Ovarian Serous Adenocarcinoma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the expression of P53 protein in the advanced ovarian serous adenocarcinoma and explore its potential correlation with the clinicopathological features and prognosis of ovarian cancer.</p><p><b>METHODS</b>The immunohistochemical staining was used to detect the expression of P53 protein in 183 patients with advanced ovarian serous adenocarcinoma. The correlation of P53 protein with the clinicopathological features and its significance in the assessment of prognosis were explored.</p><p><b>RESULTS</b>The P53 protein expression was positive in 62.8% of the patients. Chi-square test showed that the overexpression of P53 protein was positively correlated with the elevation of serum CA125 and the two-tier grading of ovarian serous adenocarcinoma (P<0.001, P=0.038). Univariate analysis suggested that the prognosis of patients was associated with two-tier grading (P=0.007), lymph node metastasis (P=0.036), preoperative serum CA125 level (P=0.002), and P53 overexpression (P<0.001). Multivariate analysis showed that the International Federation of Gynecology and Obstetrics stage (P=0.038), lymph node metastasis (P=0.002), and overexpression of P53 (P=0.001) were independent prognostic factors.</p><p><b>CONCLUSION</b>The P53 protein expression is closely related to the prognosis of advanced ovarian serous adenocarcinoma and can be used as an important indicator for predicting the prognosis.</p>

A preliminary study of genes related to concomitant chemoradiotherapy resistance in advanced uterine cervical squamous cell carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Tumor intrinsic chemoradiotherapy resistance is the primary factor in concomitant chemoradiotherapy failure in advanced uterine cervical squamous cell carcinoma. This study aims to identify a set of genes and molecular pathways related to this condition.</p><p><b>METHODS</b>Forty patients with uterine cervical squamous cell carcinoma in International Federation of Gynecology and Obstetrics stage IIb or IIIb, treated with platinum-based concomitant chemoradiotherapy between May 2007 and December 2012, were enrolled in this trial. Patients included chemoradiotherapy resistant (n = 20) and sensitive (n = 20) groups. Total RNA was extracted from fresh tumor tissues obtained by biopsy before treatment and microarray analysis was performed to identify genes differentially expressed between the two groups.</p><p><b>RESULTS</b>Microarray analysis identified 108 genes differentially expressed between concomitant chemoradiotherapy resistant and sensitive patients. Functional pathway cluster analysis of these genes revealed that DNA damage repair, apoptosis, cell cycle, Map kinase signal transduction, anaerobic glycolysis and glutathione metabolism were the most relevant pathways. Platelet-derived growth factor receptor alpha (PDGFRA) and protein kinase A type 1A (PRKAR1A) were significantly upregulated in the chemoradiosensitive group, while lactate dehydrogenase A (LDHA), bcl2 antagonist/killer 1 (BAK1), bcl2/adenovirus E1B 19 kDa interacting protein 3 (BNIP3), single-strand-selective monofunctional uracil-DNA glycosylase 1 (SMUG1), and cyclin-dependent kinase 7 (CDK7) were upregulated in the chemoradiotherapy resistant group.</p><p><b>CONCLUSION</b>We have identified seven genes that are differentially expressed in concomitant chemoradiotherapy resistant and sensitive uterine cervical squamous cell carcinomas, which may represent primary predictors for this condition.</p>

The mRNA expression of BRCA1, ERCC1, TUBB3, PRR13 genes and their relationship with clinical chemosensitivity in primary epithelial ovarian cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the expression of BRCA1, ERCC1, TUBB3 and PRR13 mRNA and their relationship with clinical chemosensitivity in primary ovarian cancer, and to assess the predictive value of joint detection of both BRCA1 and ERCC1 genes for the treatment of primary ovarian cancer.</p><p><b>METHODS</b>Primary epithelial ovarian tumor samples were collected from 46 patients who underwent cytoreductive surgery. Real-time quantitative PCR was used to analyze the relative expression of BRCA1, ERCC1, TUBB3 and PRR13 mRNA in those cases. The correlation of clinical chemosensitivity and the test results was statistically analyzed. The efficacy of the joint prediction of clinical chemosensitivity by combining the two drug resistance gene detection was evaluated.</p><p><b>RESULTS</b>The BRCA1 mRNA relative expression logarithm in the clinical-resistant group was 0.673±2.143, and clinical-sensitive group -1.436±2.594 (P=0.008). The ERCC1 mRNA relative expression logarithm in the clinical-resistant group was -0.529±1.982 and clinical-sensitive group -3.188±2.601 (P=0.001). BRCA1 and ERCC1 expression level is negatively correlated with platinum-based chemosensitivity. The PRR13 expressions in the two groups were not significantly different (P=0.074), and the TUBB3 expressions between the two groups were also not significantly different (P=0.619). When the intercept point value BRCA1 mRNA expression logarithm was -0.6, the predictive sensitivity, specificity, positive predictive value and negative predictive value were 73.3%, 75.0%, 84.6% and 60.0%, respectively, with the best comprehensive assessment. When the intercept point value of ERCC1 mRNA expression logarithm was -1, the predictive sensitivity, specificity, positive predictive value and negative predictive value were 80.0%, 68.8%, 82.8% and 64.7%, respectively, with the best comprehensive assessment. The combination detection of BRCA1 and ERCC1 can improve the chemotherapeutic sensitivity, specificity, positive predictive value and negative predictive value to 86.7%, 68.8%, 83.9% and 73.3%, respectively.</p><p><b>CONCLUSIONS</b>BRCA1 and ERCC1 mRNA expression has a negative correlation with the clinical sensitivity of platinum-based chemotherapy. Combination detection of the two drug-resistance associated genes can improve the predictive efficacy of ovarian cancer chemosensitivity and beneficial to individual treatment of ovarian cancer.</p>

Clinical analysis of the recurrence of early stage bulky cervical carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics, influencing factors and outcome of recurrent patients with early stage bulky cervical carcinoma.</p><p><b>METHODS</b>Between January 1(st) 2000 and December 31(st) 2009, 76 patients with stage Ib2 and IIa2 bulky cervical carcinoma developed recurrence and (or) metastasis. The recurrence time, recurrence location, recurrence-related factors, treatment and survival were analyzed.</p><p><b>RESULTS</b>The median follow up was 44 months (9-137 months). The overall recurrence and (or) metastasis rate was 22.6%. The 1-, 1-2, 3-5 and 5-year recurrence and (or) metastasis rates were 38.2%, 27.6%, 30.3% and 3.9%, respectively. The 5-year survival rate of local recurrence was 34.5%, that of distant metastasis was 23.6%, and that of distant metastasis with synchronous pelvic recurrence was 11.1%, (P = 0.555). The 5-year survival rate of patients who received surgery plus chemotherapy, radiation plus chemotherapy and chemotherapy alone after recurrence and (or) metastasis were 53.3%, 30.7% and 24.6%, respectively (P = 0.686). Univariate analysis demonstrated that tumor recurrence and (or) metastasis in patients of the stage Ib2 and IIa2 bulky cervical carcinoma were influenced by the disease stage, pelvic lymph node metastasis, deep cervical stromal invasion, lymphovascular tumor thrombus and pathological types. Multivariate regression analysis demonstrated that pelvic lymph node metastasis, lymphovascular tumor thrombus and pathological types were the key factors affecting the recurrence and (or) metastases of the stage Ib2 and IIa2 bulky cervical carcinoma. Subgroup analysis showed that pelvic lymph node metastasis and stage were the main factors affecting the local recurrence in those patients, and the pathological type, vascular tumor thrombus and pelvic lymph node metastasis were the main factors affecting the distant metastasis.</p><p><b>CONCLUSIONS</b>Recurrence and(or) metastasis of early stage bulky cervical cancer are mostly happened within 2 years post operation. Patients with pelvic lymph node metastasis have high probability to develop local recurrence and distant metastasis. Patients with non-squamous cell carcinoma and lymphovascular tumor thrombus are more likely to develop distant metastasis. Neoadjuvant chemotherapy does not decrease local recurrence and distant metastasis in patients with stage Ib2 and IIa2 bulky cervical carcinoma. Individualized treatment is advised for recurrent patients.</p>

Neoadjuvant chemotherapy with paclitaxel and cisplantin or carboplatin for patients with locally advanced uterine cervical cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and toxicity of neoadjuvant chemotherapy with paclitaxel and carboplatin or cisplatin for patients with locally advanced cervical cancer.</p><p><b>METHODS</b>A total of 70 patients with locally advanced cervical cancer were treated with neoadjuvant chemotherapy with paclitaxel and carboplatin or cisplatin in our department from July 2007 to May 2010. The stage distribution among the patients included 45 stage IB2, 21 stage IIa, and 4 stage IIb. Of the 70 patients, 6 were G1, 26 were G2, 32 were G3, and the rest 6 patients were not histologically classified. Sixty-five patients had squamous cell carcinoma, 3 had adenocarcinoma, and 2 patients had adenosquamous cell carcinoma. The clinicopathological parameters were analyzed, and their impact on tumor response were investigated.</p><p><b>RESULTS</b>Of the 70 patients, 14 (20.0%) showed a complete response, 37 (52.9%) had a partial response to chemotherapy, making an overall response rate of 72.9%. Sixty-eight (95.7%) patients underwent surgery, and among them 12 (17.1%) pathological CR were identified. Eleven (16.2%) patients were found to have lymph node metastasis after surgery. Response rates of stage Ib2 and IIa patients were 73.7% and 52.3%, respectively, P<0.05. Patients with SCC exhibited a better response rate than patients with adenocarcinoma and adenosquamous cell carcinoma (73.8% vs. 60.0%). Initial tumor volume, histological classification and cycles of neoadjuvant chemotherapy were not significantly correlated with the response rate.</p><p><b>CONCLUSION</b>Paclitaxel and carboplatin or cisplatin regimen is a promising therapy with definite short-term efficacy, can improve the resection rate with tolerable side effects, and is an applicable option of treatment for patients with locally advanced cervical cancer in the neoadjuvant setting.</p>

Nerve plane-sparing radical hysterectomy: a simplified technique of nerve-sparing radical hysterectomy for invasive cervical cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In order to simplify the complicated procedure of nerve-sparing radical hysterectomy, a novel technique characterized by integral preservation of the autonomic nerve plane has been employed for invasive cervical cancer. The objective of this study was to introduce the nerve plane-sparing radical hysterectomy technique and compare its efficacy and safety with that of nerve-sparing radical hysterectomy.</p><p><b>METHODS</b>From September 2006 to August 2010, 73 consecutive patients with International Federation of Gynecology and Obstetrics stage IB to IIA cervical cancer underwent radical hysterectomy with two different nerve-sparing approaches. Nerve-sparing radical hysterectomy was performed for the first 16 patients (nerve-sparing radical hysterectomy group). The detailed autonomic nerve structures were identified and separated by meticulous dissection during this procedure. After January 2008, the nerve plane-sparing radical hysterectomy procedure was developed and performed for the next 57 patients (nerve plane-sparing radical hysterectomy group). During this modified procedure, the nerve plane (meso-ureter and its extension) containing most of the autonomic nerve structures was integrally preserved. The patients' clinicopathologic characteristics, surgical parameters, and outcomes of postoperative bladder function were compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences between the nerve plane-sparing radical hysterectomy and nerve-sparing radical hysterectomy groups regarding age, International Federation of Gynecology and Obstetrics stage, pathological type, preoperative treatment, or need for intraoperative blood transfusion. The nerve plane-sparing radical hysterectomy group had a higher body mass index than that of the nerve-sparing radical hysterectomy group (P = 0.028). The mean surgical duration in the nerve plane-sparing radical hysterectomy and nerve-sparing radical hysterectomy groups were (262 ± 46) minutes and (341 ± 36) minutes (P < 0.01). On the 8th postoperative day, 41 (71.9%) patients in the nerve plane-sparing radical hysterectomy group and nine (56.3%) patients in the nerve-sparing radical hysterectomy group had a postvoid residual urine volume of < 100 ml (P = 0.233). The median duration of catheterization was eight days (range 8 - 23 days) for the nerve plane-sparing radical hysterectomy group and eight days (range 8 - 22 days) for the nerve-sparing radical hysterectomy group (P = 0.509). Neither surgery-related injury nor pathologically positive margins were reported in either group.</p><p><b>CONCLUSION</b>Nerve plane-sparing radical hysterectomy is a reproducible and simplified modification of nerve-sparing radical hysterectomy, and may be preferable to nerve-sparing radical hysterectomy for treatment of early-stage invasive cervical cancer.</p>

Clinicopathological analysis of nine cases of small cell carcinoma of the uterine cervix / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathologic characteristics, therapy and prognostic factors of small cell carcinoma of the uterine cervix (SCCC).</p><p><b>METHODS</b>Nine patients with SCCC underwent radical hysterectomy at the Cancer Hospital of CAMS between 2000 to 2009. Clinical and pathological data were analyzed, and the related literature was reviewed.</p><p><b>RESULTS</b>The average age of 9 patients was 41 years old. Irregular vaginal bleeding and postcoital spotting were the most common symptoms. According to FIGO staging criteria, six patients were stage Ib1 disease, 2 stage Ib2 and 1 stage IVb. All tumors were composed of small-sized cells with scant cytoplasm, darkly stained round to oval nuclei, finely dispersed chromatin and absence of nucleoli. High mitotic activity and lymphovascular invasion were also common findings. Immunohistochemical staining showed at least three neuroendocrine markers (NSE, CgA, Syn and CD56) were positive in each case. All patients received postoperative chemotherapy, with or without radiotherapy. Seven patients remained alive 6 to 104 months and one died 14 months postoperatively.</p><p><b>CONCLUSION</b>SCCC is a highly malignant tumor with aggressive behavior. Correct diagnosis of SCCC depends on the combination of light microscopic and immunohistochemical analysis. It is necessary to use multimodality treatment for SCCC, especially the chemotherapy. However, the prognosis is dismal.</p>

Clinicopathological characteristics of six patients with adenoid cystic carcinoma of the Bartholin gland / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the clinicopathological characteristics and treatment of adenoid cystic carcinoma of the Bartholin gland.</p><p><b>METHODS</b>The clinicopathological data of six patients with adenoid cystic carcinoma of the Bartholin gland were retrospectively analyzed. The median age was 40.8 years (range 30 to 54 years). Surgery was the primary treatment. Simple vulvar tumor resection was performed in 1 patient. Four cases underwent radical vulvectomy with bilateral inguinal lymph node dissection and 1 case underwent wide local excision of the vulva with bilateral inguinal lymph node biopsy. Two cases with high risk factors received postoperative radiotherapy.</p><p><b>RESULTS</b>All patients had definite pathological diagnosis. Cribriform arrangement of tubules and gland-like elements and infiltration of perineural spaces were two main microscopic features of this type of tumor. The pathological examination after surgery revealed that two patients had positive surgical margins, one had negative margin, 1 adjacent to the tumor and 1 unknown; 5 cases had negative inguinal lymph nodes and 1 unknown. All the 6 patients were followed-up. Recurrence developed in 4 cases including 3 with both local recurrence and lung metastasis, and one had lung metastasis only. One patient died of lung metastasis and her total survival period was 135 months. The other 3 recurrent patients survived with tumor and the total survival period was 241, 128 and 103 months, respectively. Two cases without recurrence survived 8 and 121 months, respectively.</p><p><b>CONCLUSION</b>Adenoid cystic carcinoma of the Bartholin gland is a slow growing but locally very aggressive neoplasm with a high capacity for local recurrence and lung metastasis. Surgery is the most common and useful treatment. Radiation is a choice of treatment for patients with high risk factors after surgery such as positive surgical margin, deep local invasion and infiltration of perineural spaces or for recurrent patients without opportunity of excision.</p>

Application of ATP-tumor chemosensitivity assay in primary epithelial ovarian cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the predictive value of the adenosine triphosphate-tumor chemosensitivity assay (ATP-TCA) in the chemotherapy applied in primary epithelial ovarian cancer (PEOC), and to analyze if the neoadjuvant chemotherapy have any influence on the postoperative chemosensitivity.</p><p><b>METHODS</b>ATP-TCA results from 61 PEOC specimens were analyzed retrospectively. Patients were divided into sensitive group and resistant group according to the ATP-TCA results. Sensitive index (SI) was applied to analyze the ATP-TCA results. The correlation between in vitro results and clinical outcome was assessed by univariate and multivariate analysis.</p><p><b>RESULTS</b>SI set at > 250 had the highest test sensitivity, specificity, positive and negative predictive value of 91.6%, 73.9%, 84.6% and 85.0%, respectively. The ATP-TCA results had significant correlation with clinical outcome (chi(2) = 26.9, P < 0.001). Patients with tumors shown to be resistant had a higher risk of recurrence in comparison with those who were tested as sensitive (P = 0.030, OR = 0.033, 95%CI 0.002 approximately 0.724). The median progression-free survival (PFS) and overall survival (OS) of in vitro-sensitive patients were 26 months and 39 months, respectively, significantly longer than those in the in vitro drug-resistant group of patients (PFS 10 months and OS 25 months) (both P < 0.01). Neoadjuvant chemotherapy had a significant correlation with the clinical chemoresistance (chi(2) = 15.214, P < 0.001).</p><p><b>CONCLUSION</b>ATP-TCA assay may effectively predict the chemosensitivity of primary ovarian cancer, and predict the early recurrence of the tumor.</p>

Application of ATP-tumor chemosensitivity assay in recurrent epithelial ovarian cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the value of adenosine triphosphate-tumor chemosensitivity assay (ATP-TCA) in individualized treatment of recurrent epithelial ovarian cancer (REOC), and to evaluate the correlation between the in vitro chemosensitivity assay and clinical drug sensitivity.</p><p><b>METHODS</b>Sixty-nine REOC specimens were tested by ATP-TCA assay retrospectively. The patients were divided into strong sensitive, moderate sensitively and resistant groups according to the ATP-TCA assay results. The clinical results were evaluated according to imaging and serum CA125 analysis. The correlation between in vitro ATP-TCA assay and clinical outcome was statistically analyzed by χ(2) test. The progression free survival (PFS) and overall survival (OS) of each group were analyzed using Kaplan-Meier method.</p><p><b>RESULTS</b>The results of ATP-TCA assay had significant correlation with clinical outcome. The clinical chemotherapy outcome became better with increased drug sensitivity in vitro (χ(2) = 9.066, P = 0.004). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate for ATP-TCA method to predict the clinical chemotherapy sensitivity of REOC were 87.5%, 45.9%, 58.3%, 80.9% and 65.2%, respectively. The mean PFS of strong sensitive group, moderately sensitive group and resistant group were 187.1 days, 195.0 days and 60.3 days, respectively. The mean OS were 476.7, 335.7 and 237.5 days, respectively, following the start of TCA-directed therapy. The PFS and OS of the two sensitivity groups in vitro were significantly longer than that of the in vitro-resistant group (P < 0.01).</p><p><b>CONCLUSION</b>The results of ATP-TCA assay are well correlated with clinical treatment responses. The assay may be an important and useful method for individualized chemotherapy for recurrent ovarian cancer.</p>

Clinical characterization of vulvar epithelioid sarcoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Vulvar epithelioid sarcoma is a rare, undifferentiated soft-tissue sarcoma, with a high rate of local relapse, regional nodal spread and distant metastases. The aim of this study was to investigate the clinical features, diagnosis, treatment and prognosis of this malignancy.</p><p><b>METHODS</b>We studied the clinicopathologic features of 20 cases of vulvar epithelioid sarcoma, of which 4 cases were admitted to our hospital from 1999 to 2009. All of the patients received radical local excision with inguinofemoral lymphadenectomy. Seven patients were treated without adjuvant therapy. Seven patients received postoperative radiotherapy only and three underwent chemotherapy. Chemotherapy plus radiotherapy were given postoperatively in three.</p><p><b>RESULTS</b>The patients ranged in age from 23 to 80 years (median: 36 y). The tumors ranged from 1 to 10 cm in their greatest diameter (median: 5.1 cm). All cases showed immunoreactivity for both vimentin and cytokeratin. Follow-up information on all 20 patients was available, and covered periods ranging from 3 to 104 months.11 patients were alive with no evidence of disease. 2 patients developed lymph node metastases but alive. 7 patients had died of the disease. Survival of the early stage (I-II) patients was significantly longer than those in the advanced stage (III-IV) (median, 21 vs. 6 months, P < 0.01). There was no significant difference between survival of patients with or without inguinofemoral lymphadenectomy (median, 11.5 vs. 6 months, P = 0.086).</p><p><b>CONCLUSIONS</b>Because of the relatively frequent misdiagnosis, a differential diagnosis combined with immunohistochemistry is needed to determine an early and accurate diagnosis. The tumor markers exhibiting immunoreactivity includ vimentin, epithelial membrane antigen (EMA) and cytokeratin (CK). Radical local excision with adequate margin (at least 2 cm) and bilateral inguinofemoral lymphadenectomy is effective for the treatment of vulvar epithelioid sarcoma. The role of adjuvant therapy, chemotherapy and radiation remains unclear but merits consideration.</p>

Effects of survivin siRNA on growth, apoptosis and chemosensitivity of ovarian cancer cells SKOV3/DDP / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore a new approach in gene therapy of ovarian cancer, we used RNAi to inhibit survivin gene expression, and explore the effect of survivin and neu RNAi on growth, apoptosis and chemosensitivity of ovarian cancer cell line SKOV3/DDP cells.</p><p><b>METHODS</b>Expression vector of survivin gene-targeting siRNA was constructed using pSilencer 1.0-U6 vector containing U6 promotor (pSilencer-survivin) and transfected into SKOV3/DDP cells by lipofectamine. The untransfected group and pSilencer-control group were used as control. The expressions of survivin mRNA and protein were identified by RT-PCR and Western blot assay. The proliferation of SKOV3/DDP cells was determined by MTT assay. The apoptosis rate and cell cycle distribution were analyzed by flow cytometry. Cisplatin (DDP) resistance experiment was performed in SKOV3/DDP cells with RNAi.</p><p><b>RESULTS</b>Survivin RNAi plasmid knocked-down survivin expression in SKOV3/DDP cells obviously, arrested the cells at G(1)/G(0) phase, inhibited the cell proliferation and promoted cell apoptosis. The IC(50) of DDP to SKOV3/DDP cells transfected with survivin siRNA was dropped.</p><p><b>CONCLUSION</b>Survivin RNAi can partly suppress the expression of survivin in SKOV3/DDP cells, inhibit the cell proliferation and promote cell apoptosis. Survivin RNAi can enhance the cell sensitivity to apoptosis induced by cisplatin, which implies that survivin RNAi may partly reverse the drug resistance of ovarian cancer. RNAi could be a new approach for gene therapy of cancer.</p>

Clinical analysis of 215 elderly patients with cervical cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical features, treatment outcomes and possible prognostic factors in elderly patients with cervical cancer.</p><p><b>METHODS</b>Clinical data of 215 elderly women (> or = 65-years-old) with cervical cancer were retrospectively analyzed. Most patients (89.3%) had advanced stage ( II b-IV) disease. Eight of the 215 patients (3.7%) underwent surgical treatment, and six of those received postoperative radiotherapy. 133 patients received radiotherapy alone, and 74 patients underwent concurrent chemotherapy and radiotherapy.</p><p><b>RESULTS</b>The median follow-up time was 48 months (range: 12-102 months). The overall 5-year survival rate was 63.7%. The 5-year survival rate for stage I, II, III, IV were 83.2%, 76.4%, 39.0% and 0, respectively. There was no significant difference in 5-year survival rate between patients treated with concurrent chemotherapy combined with radiotherapy and radiotherapy alone. In multivariate analysis, lymph node metastasis, advanced stage, non-squamous histologies and poor differentiation were all negative prognostic factors for the overall survival.</p><p><b>CONCLUSION</b>The treatment strategy for elderly cervical cancer patients should be individually planned according to the disease stage and performance status of the patients. Usually, one radical therapy modality can be chosen, and combined modality therapy is not suggested.</p>

Analysis of treatment and prognosis of recurrent epithelial ovarian carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To discuss the prognostic factors of recurrent ovarian epithelial carcinoma and to analyze the curative effect of post-relapse treatment.</p><p><b>METHODS</b>The clinical records of 293 patients with ovarian epithelial carcinoma were reviewed retrospectively. There were 199 recurrent cases during the following up.</p><p><b>RESULTS</b>All the 199 patients received chemotherapy. And 173 patients only received chemotherapy. 16 patients received surgery and chemotherapy and the other 10 patients received radiotherapy and chemotherapy. 158 patients received platinum-based chemotherapy again and 41 patients received chemotherapy without platinum. The response rate of all the patients was 43.7% (87/199), the response rate of only chemotherapy was 39.9% (69/173), the response rate of surgery and chemotherapy was 75.0% (12/16), and the response rate of radiotherapy and chemotherapy was 60.0% (6/10). The patients were divided into four groups according to the progression free interval (PFI). The response rates in groups that PFI < or = 6 months, 7 - 12 months, 13 - 24 months and > 24 months were 5.1%, 47.2%, 82.1% and 96.0%, respectively. The median survival time in the 16 patients received second cyto-reductive surgery was 41 months. Multivariate analysis revealed that PFI was significantly correlated with prognosis of recurrent ovarian epithelial carcinoma (OR = 0.589, P = 0.021).</p><p><b>CONCLUSION</b>PFI is an individual prognostic factor for survival of recurrent ovarian epithelial carcinoma. PFI is significantly associated with the response rate of chemotherapy. Optimal secondary cytoreductive surgery may improve the overall survival of recurrent patients. The response rate of paclitaxel plus platinum chemotherapy in platinum-sensitive patients is higher than that of other platinum-based chemotherapy.</p>

Preliminary study of nerve sparing radical hysterectomy in patients with cervical cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To assess the feasibility of nerve sparing radical hysterectomy (NSRH) technique and the impact on the improvement of postoperative bladder function in patients with cervical cancer.</p><p><b>METHODS</b>Forty-two patients with FIGO stage Ib1 approximately Ib2 cervical cancer were selected to receive NSRH (study group, 21 cases) or routine hysterectomy (RH) (control group, 21 cases). Duration of surgery, blood loss and mean length of postoperative stay were compared between the two groups. Immunohistochemical analysis of surgical margins using a general nerve marker (S-100) was performed to compare the nerve damages.</p><p><b>RESULTS</b>The operation time of NSRH group and RH group was (248 +/- 24) min and (227 +/- 27) min, respectively, with a significant difference between the two groups (P < 0.01). No significant difference in blood loss was found between the NSRH and RH group [(459 +/- 143) ml vs. (454 +/- 121) ml, P > 0.05]. However, the median urinary catheterization time was 7 days in NSRH group versus 16 days in the RH group, with a statistically significant difference between the two groups (P < 0.01). The rate of patients who had postoperative residual urine volume in bladder (PVR) < or =100 ml was 66.7% in the NSRH group versus 19.0% in the RH group, with a significant difference between the two groups (P < 0.01). No severe perioperative complications occurred in both groups. After a follow-up of 11 to 16 months (median: 14 months), no recurrence was detected in the two groups. Immunohistochemistry with S-100 staining revealed only small nerve fibers in the surgical margins of the NSRH group, but full with large nerve bundles in that of the RH group. There was a significant difference between two group (P < 0.01).</p><p><b>CONCLUSION</b>The results of our preliminary study indicate that nerve sparing radical hysterectomy (NSRH) for the patients with FIGO stage Ib1 approximately Ib2 cervical cancer is safe and feasible, and can well preserve the pelvic autonomic nerves and improve the recovery of bladder voiding function.</p>

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>

The clinical significance and management of cervico-cytologically diagnosed ASCUS/LSIL / 中华实验和临床病毒学杂志

<p><b>PURPOSE</b>To investigate the clinical significance and management of ASCUS/LSIL.</p><p><b>METHODS</b>254 patients who were examined with cervical cytology in the Cancer Institute and Hospital Chinese Academy of Medical Sciences were ASCUS/LSIL, of whom 136 cases underwent colposcopy, Data were analyzed retrospectively according to the golden criterion of pathology outcome.</p><p><b>RESULTS</b>140 cases were ASCUS, and 114 cases were LSIL. Cervical intra-epithelial neoplasia (CIN) were diagnosed in 51.5% of patients with ASCUS, compared with 59.6% of patients with LSIL (P>0.05). High-grade cervical intraepithelial neoplasia were diagnosed in 22.9% of patients with ASCUS, compared with 30.7% of patients with LSIL (P >0.05). In the 136 patients examined with colposcopy, inflammation was found in 47 cases, low-grade intraepithelial lesion in 53 cases, High-grade intraepithelial lesion in 36 cases. The pathological results show inflammation in 55 cases, low-grade intraepithelial lesion in 41 cases, High-grade intraepithelial lesion in 40 cases (Kappa=0.314, U=0.064, P less than 0.05). CIN were diagnosed in 79% (67/84) of HPV-positive patients identified by pathology, compared with 43.5% (74/170) of HPV-negative patients (chi2=29.88 P less than 0.05). 83.5% of 254 patients were between 35 to 55 years old, and that was consistent with HPV-positive women age peak.</p><p><b>CONCLUSION</b>Patients with ASCUS should be paid the same attention with LSIL patients and colposcopy examination should be done immediately to avoid missed diagnosis and missed follow-up examination, especially for HPV positive patients between 35 to 55 years old.</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>

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>

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>