Adjuvant chemotherapy versus adjuvant concurrent chemoradiotherapy after radical surgery for early-stage cervical cancer: a randomized, non-inferiority, multicenter trial / 医学前沿

We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB-IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415-1.757; P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.

Chemotherapy initiation with single-course methotrexate alone or combined with dactinomycin versus multi-course methotrexate for low-risk gestational trophoblastic neoplasia: a multi-centric randomized clinical trial / 医学前沿

We aimed to evaluate the effectiveness and safety of single-course initial regimens in patients with low-risk gestational trophoblastic neoplasia (GTN). In this trial (NCT01823315), 276 patients were analyzed. Patients were allocated to three initiated regimens: single-course methotrexate (MTX), single-course MTX + dactinomycin (ACTD), and multi-course MTX (control arm). The primary endpoint was the complete remission (CR) rate by initial drug(s). The primary CR rate was 64.4% with multi-course MTX in the control arm. For the single-course MTX arm, the CR rate was 35.8% by one course; it increased to 59.3% after subsequent multi-course MTX, with non-inferiority to the control (difference -5.1%,95% confidence interval (CI) -19.4% to 9.2%, P = 0.014). After further treatment with multi-course ACTD, the CR rate (93.3%) was similar to that of the control (95.2%, P = 0.577). For the single-course MTX + ACTD arm, the CR rate was 46.7% by one course, which increased to 89.1% after subsequent multi-course, with non-inferiority (difference 24.7%, 95% CI 12.8%-36.6%, P < 0.001) to the control. It was similar to the CR rate by MTX and further ACTD in the control arm (89.1% vs. 95.2%, P =0.135). Four patients experienced recurrence, with no death, during the 2-year follow-up. We demonstrated that chemotherapy initiation with single-course MTX may be an alternative regimen for patients with low-risk GTN.

Gestational trophoblastic diseases in cesarean scar: an analysis of 20 cases / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To analyze the clinical features, diagnosis and treatment of gestational trophoblastic diseases in cesarean scar.</p><p><b>METHODS</b>Clinical data of three cases of gestational trophoblastic diseases in cesarean scar diagnosed in Women's Hospital, Zhejiang University School of Medicine during December 2011 and December 2016 were collected. And literature search was performed in Wanfang data, VIP, CNKI, PubMed, ISI Web of Knowledge and EMbase database.</p><p><b>RESULTS</b>A total of 20 cases of gestational trophoblastic diseases were included in the analysis. Clinical features were mainly abnormal vaginal bleeding after menopause, artificial abortion or medical abortion, which might be accompanied by abdominal pain. Serum β-human chorionic gonadotropin (β-hCG) levels were increased in 19 patients. The sonographic features were increase of uterine volume, honeycomb-like abnormal intrauterine echo (or described as multiple cystic dark area, multiple anechoic area and multiple liquid dark area) or heterogeneity echo conglomeration, and no clear bound with muscular layer in some cases. There were abundant blood flow signals inside or around the lesions. The ultrasonography indicated that the lesions were located in the anterior side of the uterine isthmus with the involvement of cesarean section scar. In 12 cases with lesions in cesarean scar shown by preliminary diagnosis, 9 underwent uterine artery embolization (UAE) for pretreatment; the blood loss greater than 1500 mL was observed in only one case without UAE; no patient received hysterectomy. In 8 patients whose lesions were not shown in cesarean scar, only one case received UAE pretreatment, and hysterectomy was performed in 3 cases due to blood loss greater than 1500 mL. Two cases were lost in follow-up and no death was reported in remaining 18 cases. The serum β-hCG levels returned to normal or satisfactory level during the follow-up in 17 cases with increased β-hCG levels before treatment and no recurrence was observed.</p><p><b>CONCLUSIONS</b>The misdiagnosis rate and missed diagnosis rate of gestational trophoblastic diseases in cesarean section scar are high. The identification of cesarean section scar involvement and UAE may reduce the bleeding and avoid hysterectomy.</p>

The relationship between different types of lymph node metastasis and contralateral neck metastasis and their impact on prognosis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the relationship between different types of lymph node metastasis and contralateral neck metastasis and their impacts on prognosis.@*METHOD@#Two hundred and forty-eight patients with supraglottic carcinomas and complete follow-up were analyzed retrospectively. Transparent lymph node detection and continuous sectioning methods were applied on postoperative neck specimens.@*RESULT@#Cervical lymph node metastases were found in 115 patients and the lymph node metastatic rate was 46.4%. There were three types of lymph node metastases, 39 cases with single type, 34 with multiple type, 42 with fusion type. Contralateral metastatic rates were 5.1%, 44.1% and 61.9% in single, multiple and fusion type respectively. Contralateral metastasis was also related with tumor extension across midline and clinical N stages. The 3- and 5-year survival rates were 79.5% and 74.4% in single type, 61.8% and 41.2% in multiple type, 61.9% and 35.7% in fusion type.@*CONCLUSION@#Bilateral neck dissections should be undertaken in multiple and fusion types of lymph node metastasis. The lymph node metastatic type should be an important criteria to judge prognosis.

Clinic and pathological analysis the larynx leukoplakia in 74 cases / 临床耳鼻咽喉头颈外科杂志

Objective: To study the clinic and pathological features of leukoplakia of the larynx, and reduce canceration rate. Method: Seventy-four postoperative patients of leukoplakia of the larynx were followed up for four years by telephone or clinic service. Result: None of eighteen cases of pure leukoplakia was recurrence. Fifty-six ca-ses were leukoplakia with epithelial dysplasia histologically. Seven out of fifty-six postoperative cases occurred hoarseness; three out of fifty-six postoperative cases recured, and accepted twice or more operations successively; three out of fifty-six postoperative cases occurred canceration. Conclusion:Operation is the main means for the treatment of leukoplakia of the larynx, and the effect is comparatively well. The patients with histological epitheli-al dysplasia should be pay great attention because of their higher canceration rate, and enlarged operation ranges appropriately with the patient consent could effectually prevent recurrence or canceration during the early lesions. Close observation is important for these patients.

Accuracy of preoperative tumor grading and intraoperative gross examination of myometrial invasion in clinical stage Ⅰ endometriod adenocarcinoma / 中华妇产科杂志

Objective To evaluate accuracy of preoperative tumor grade and intracperative gross examination of myometrial invasion in patients with clinical stage Ⅰ endometriod adenocarcinoma for lymphadenectomy. Methods Clinic-pathological data were retrospectively collected from 687 patients with clinical stage Ⅰ endometriod adenocarcinoma who underwent operation in Women's Hospital, Zhejiang University School of Medicine from January 1999 to December 2008. According to postoperative histology diagnosis, accuracy of preoperative tumor grade by curettage and depth of myometrial invasion by intraoperative gross examination was evaluated, and clinic-pathological factors associated with accuracy were analyzed. Results Sensitivity, specificity, accuracy, false negative rate, false positive rate, and positive and negative predictive value for the prediction of needing for intraoperative lymphadenectomy in patients with clinical stage Ⅰ endometriod adenocarcinoma were 70. 4% ,80. 2% ,77.6% ,12.0%, 43.0%, 57.0% and 88.0%, respectively. Analysis of mutil-factors shown that patient age, tumor size, lymph node metastasis and extrauterine spread lesions were independent factors affected the accuracy of prediction(P ＜ 0. 05 ). Conclusion Prediction of needing for lymphadenectomy by preoperative tumor grade and intraoperative gross examination of myometrial invasion is reliable in clinical stage Ⅰ endometriod adenocarcinoma patients, while there is a highly false negative rate in prediction of not needing for lymphadenectomy, while other prognostic factors such as patient age, tumor size, lymph node metastasis and extrauterine spread lesion should be together considered.

Clinic and pathological analysis the larynx leukoplakia in 74 cases / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the clinic and pathological features of leukoplakia of the larynx, and reduce canceration rate.@*METHOD@#Seventy-four postoperative patients of leukoplakia of the larynx were followed up for four years by telephone or clinic service.@*RESULT@#None of eighteen cases of pure leukoplakia was recurrence. Fifty-six cases were leukoplakia with epithelial dysplasia histologically. Seven out of fifty-six postoperative cases occurred hoarseness; three out of fifty-six postoperative cases recurred, and accepted twice or more operations successively; three out of fifty-six postoperative cases occurred canceration.@*CONCLUSION@#Operation is the main means for the treatment of leukoplakia of the larynx, and the effect is comparatively well. The patients with histological epithelial dysplasia should be pay great attention because of their higher canceration rate, and enlarged operation ranges appropriately with the patient consent could effectually prevent recurrence or canceration during the early lesions. Close observation is important for these patients.

Expression of gene BRMS1 and CD44v6 protein in supraglottic laryngeal carcinoma and its clinical significance / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of breast cancer metastasis suppressor 1 (BRMS1) and CD44v6 protein in supraglottic cancer and to evaluate its clinical significance.@*METHOD@#The expression of BRMS1 protein and CD44v6 protein were examined by using immunohistochemical method in 70 cases of paraffin-embedded supraglottic cancer tissues and their surrounding laryngeal normal mucosa tissues (LNT).@*RESULT@#The expression of BRMS1 protein in LNT of supraglottic cancer was positive, and the positive rate was 85.7% (60/70); in tumor tissue was negative or lower expression, and the positive rate was 35.7% (25/70). The expression of CD44v6 protein in tumor tissue of supraglottic cancer was positive, the positive rate was 82.9% (58/70), in LNT was negative. There was a significant difference in BRMS1 and CD44v6 protein expression between the supraglottic cancer tissue and LNT (P0.05). The expression of BRMS1 protein was related to the expression of CD44v6 protein (r = -0.9042, P0.05), there is a significant survival difference at 3-year between the group with positive CD44v6 protein expression and the group with negative CD44v6 protein expression in tumor tissues (P<0.05).@*CONCLUSION@#The expression of BRMS1 protein in supraglottic cancer is significantly decreased and the expression of CD44v6 protein in supraglottic cancer is significantly increased. The expression of BRMS1 protein and CD44v6 protein has a close relationship with pathologic differentiation and clinical stage and cervical lymph node metastasis of supraglottic cancer. Combined detection of the expression of them in supraglottic cancer may provide a significant parameter to judge the cervical lymph node metastasis of supraglottic cancer.

Expression and clinical significance of breast cancer metastasis suppressor 1 mRNA in supraglottic laryngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of breast cancer metastasis suppressor 1 (BRMS1) mRNA in supraglottic cancer and to evaluate its clinical significance.@*METHOD@#The expression of BRMS1 mRNA was examined by using RT-PCR method which take beta-actin mRNA as reference template in 66 cases of supraglottic cancer tissues and their adjacent normal mucosa tissues (ANT).@*RESULT@#The expression of BRMS1 mRNA in the tissues of supraglottic cancer is lower significantly than that in the tissues of ANT ( P<0.05). There is correlation between BRMS1 mRNA expression and the clinical stage, differentiation and cervical lymph node metastasis in the laryngeal supraglottic cancers (P<0.05). There is no correlation between BRMS1 mRNA expression and sex and age.@*CONCLUSION@#Expression of BRMS1 mRNA in supraglottic cancer is lower than that in adjacent normal mucosa. The decrease of BRMS1 mRNA expression may be related to clinical stage and low differentiation and lymph node metastasis of supraglottic laryngeal cancer.

Expression and prognostic significance of cyclooxygenase-2 in supraglottic laryngeal squamous cell carcinomas / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the expression and prognostic significance of cyclooxygenase-2 (Cox-2) in supraglottic laryngeal squamous cell carcinomas (SGLSCC) and identify the relationship between Cox-2 and angiogenesis and the roles of Cox-2 in SGLSCC as a biological marker.@*METHOD@#Eighty-eight primary SGLSCC patients received surgical treatment were studied by immunohistochemical staining, and reverse transcription-polymerase chain reaction (RT-PCR) technique.@*RESULT@#The percentage of Cox-2-positive cells was 94.3% (83/88) in SGLSCC whereas there was no immunostaining in the all cells of normal mucosa of paracarcinoma. Cox-2 expression was higher in well-differentiated tumors compared with poorly-differentiated SGLSCC. The relative concentration of Cox-2 mRNA was 141.871 +/- 20.5435 in SGLSCC and 17.031 +/- 2.2597 in normal paracarcinoma mucosa (P 0.05). Cox's regression analysis indicated that Cox-2 intensity were significantly independent prognostic factors (P < 0.01).@*CONCLUSION@#Cox-2 expression maybe relate to the carcinogenesis and progress in tumors especially in well-differentiated ones; The changes of Cox-2 expression are synchronous with MVD. Cox-2 intensity is a significantly independent prognostic factor. So Cox-2 may be an effective target of prevention, therapy and prognostic evaluation for laryngeal carcinoma and other head and neck squamous cell carcinomas (HNSCC).

Problems and solutions in the clinical education of obstetrics and gynecology / 中华医学教育探索杂志

Clinical practice was an important part in the medical education.To improve the clinical education quality of obstetrics and gynecology,several methods were chosen to settle the problems such as setting up and perfecting the management mechanism,strengthening the construction of teachers and the cultivation of students’overall quality.

Frequency and prognosis of extracapsular spread in neck metastasis in supraglottic carcinomas / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the frequencyof extracapsular spread (ECS) in neck metastasis and its impact on prognosis in supraglottic carcinoma. METHODS A total of 177 patients with radical or modified neck dissection between Jan. 1994 and Dec. 1997 for supraglottic carcinoma were summarized. Transparent lymph node detection and a series of sectioning method were applied on all neck dissection specimens. The SPSS software package (version 11.5) was used to make statistical analysis. Survival curves were calculated with the Kaplan-Meier model. Impact of extracapsular spread on prognosis was assessed for significance with the Log-Rank test. RESULTS Eighty one patients were pathologically positive in neck specimens and the neck metastatic rate was 45.8 %. ECS was found in 32 cases and the ECS frequency was 39.5 % (32/81). The ECS was related with pathological N stage and the number of positive nodes. Patients with ECS had a higher possibility of regional recurrence and contralateral metastasis. The 5-year survival rates of patients with neck metastasis ECS- and patients with ECS+ were 61.9 % and 22.2 % respectively. The differences had statistically significance. CONCLUSION ECS in neck metastasis affects the prognosis in patients with supraglottic carcinoma. If bilateral neck dissection was not selected simultaneously, close follow-up on contralateral neck should be selected in patients with ECS because of a higher incidence of contralateral neck metastasis.

Feasibility of University of Washington-Quality of Life questionnaire for follow up of laryngeal cancer in China / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To assess the feasibility of University of Washington Quality of Life (UW-QOL) questionnaire in laryngeal cancer patients treated by total or partial laryngectomy and their prognostic factors in China.</p><p><b>METHODS</b>With UW-QOL questionnaire, a survey was conducted in patients treated by partial (81, Group A) or total (37, Group B) laryngectomy for laryngeal cancer.</p><p><b>RESULTS</b>The composite QOL scores of group A (692.34 +/- 127.94) were higher than those of group B (636.35 +/- 139.97), with a difference statistically significant (P < 0.05). Group A (74.32 +/- 23.82; 80.86 +/- 20.26) was better than group B (40.27 +/- 25.76; 69.59 +/- 27.09) in speech and appearance (P < 0.001; P < 0.05); but group B (92.57 +/- 13.00) was superior to group A (83.02 +/- 20.47) in pain (P < 0.01). Six factors including stage, operative, modality, complication, postoperative radiotherapy or chemotherapy, with whom to live, chronic disease before or after operation were related to postlaryngectomy QOL.</p><p><b>CONCLUSION</b>Partial laryngectomy is superior to total laryngectomy in speech, appearance and overall QOL. UW-QOL questionnaire is suitable for QOL research in laryngeal cancer in China.</p>