Efficacy evaluation of vaginal-assisted laparoscopic radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer: a single-center retrospective case series study.

Background: To investigate the survival outcomes of abdominal radical hysterectomy (ARH), laparoscopic radical hysterectomy (LRH), and vaginal-assisted laparoscopic radical hysterectomy (VALRH) in the treatment of cervical cancer patients. Methods: This was a retrospective study. We collected the clinical data of 654 patients with cervical cancer (406 ARH, 172 LRH, and 76 VALRH), then compared the effects of different surgical methods on recurrence and survival. Results: Total overall survival (OS) were no significant differences in three groups (P>0.05). Total disease-free survival (DFS) was significantly higher in ARH group than in LRH group [hazard ratio (HR) =2.8, 95% confidence interval (CI): 1.199-3.607, P=0.004]; however, there were no significant differences between the VALRH (94.7%) and ARH (93.3%) groups. Subgroup stratification analysis showed that the overall recurrence rate in LRH group was significantly higher than that of the ARH groups for patients with a tumor size from ≥2 to <4 cm, negative postoperative lymph nodes, and no postoperative adjuvant therapy (all P<0.05). However, in the subgroup with tumor sizes of ≥2, <4, and ≥4 cm, no matter whether the lymph nodes were positive or not, and those with no postoperative supplementary adjuvant therapy, LRH was associated with a significantly higher local pelvic recurrence rate than ARH (all P<0.05). No significant differences between VALRH and ARH in any of the subgroup analyses (all P>0.05). A Cox analysis indicated that LRH increased the risk of overall and local pelvic recurrence after surgery compared with ARH (HR =2.338, 95% CI: 1.186-4.661, P=0.014; HR =10.313, 95% CI: 2.839-37.460, P<0.001); however, no significant difference between VALRH and ARH (all P>0.05). Sensitivity analysis of surgeons did not change the conclusions. Conclusions: Our analyses showed that the local pelvic recurrence rates and overall recurrence rates of LRH were significantly higher than ARH. VALRH could avoid tumor intraperitoneal exposure and achieve the same tumor prognosis as open surgery. By improving the standardization of minimally invasive surgery for early cervical cancer and paying close attention to the tumor-free concept, minimally invasive radical hysterectomy may achieve the same tumor outcome as open surgery.

Neutrophil-to-Lymphocyte Ratio and Platelet Count Predict Long-Term Outcome of Stage IIIC Epithelial Ovarian Cancer.

BACKGROUND/AIMS: Prognostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet count (PC) in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC epithelial ovarian cancer (EOC) is controversial. METHODS: A total of 370 stage IIIC EOC patients who underwent primary debulking surgery (PDS) at the Department of Gynecology of Liaoning Cancer Hospital and Institute between January 2003 and August 2016 and had full information were involved. Patients were stratified into a high NLR (H-NLR) group versus a low NLR (L-NLR) group and a high PC (H-PC) group versus a low PC (L-PC) group according to cutoff values calculated through receiver operating characteristic (ROC) curves. Prognostic values of NLR and PC for progression-free survival (PFS) and overall survival (OS) were assessed. RESULTS: We identified the optimal cut-off value of 3.08 for NLR and 289.5*109/L for PC. The median PFS and OS of the patients with H-NLR were shorter than L-NLR (PFS: 16.9 months vs. 19.5 months, hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.03-1.63, P = 0.022; OS: 33.5 months vs. 46.8 months, HR 1.3, 95% CI 1.01-1.66, P = 0.001). The median PFS and OS of the patients with H-PC were shorter than L-PC (PFS: 15.3 months vs. 21.6 months, HR 1.3, 95% CI 1.04-1.63, P < 0.001; OS: 37.3 months vs. 46.1 months, HR 1.14, 95% CI 0.89-1.46, P = 0.306). CONCLUSIONS: H-NLR and H-PC could predict poor long-term outcome of patients with FIGO stage III EOC.

Human papillomavirus infection and cervical dysplasia in female sex workers in Northeast China: an observational study.

BACKGROUND: Women having multiple sex partners are reportedly at an increased risk of HPV infection. However, the prevalence and risk factors of HPV infection in female sex workers (FSWs) vary considerably across racial/ethnic, socioeconomic, and geographic groups. This study aimed to determine the prevalence and risk factors of HPV infection in FSWs in Northeast China. METHODS: A total of 309 FSWs identified and approached through a local police office and 1000 healthy subjects from a single factor undergoing annual gynecological examinations in Shenyang were recruited. A liquid-based ThinPrep Pap test and the Hybrid Capture II-based high-risk HPV DNA test, with or without a colposcopic examination, were performed on both FSWs and control subjects. Data on HPV infection and histological and cytological lesions of the cervix were obtained and analyzed. A questionnaire survey was administered to all 309 FSWs with their socio-demographic and behavioral information collected. The association of various socio-demographic and behavioral variables with HPV infection was assessed. RESULTS: HPV was significantly more prevalent in FSWs (61.90%) than in healthy control subjects (21.00%) (P < 0.01), so were cervical lesions (P < 0.01). HPV prevalence in our sample of FSWs fell in the upper range of reported values in FSWs across different countries, and was similar to that for FSWs in the southeast Chinese city of Huzhou but higher than that for FSWs in southwest China, Guangxi, as compared with data from other studies within China. HPV infection in FSWs was significantly associated with the age at first sexual intercourse (OR 0.699, 95% CI 0.492-0.992) and post-menopause (OR 2.928, 95% CI 1.099-7.800) (P < 0.05). CONCLUSIONS: FSWs are at a substantially high risk of HPV infection and cervical dysplasia development as compared with healthy control subjects in Shenyang, China. Age of first sexual intercourse and post-menopause are two independent risk factors for HPV infection in this special group of population. Intensified and coordinated efforts from government, public health sector, communities and families are needed to reduce the risk of HPV infection in this specific group of population.

Impact of genital warts on health related quality of life in men and women in mainland China: a multicenter hospital-based cross-sectional study.

BACKGROUND: Information on the health-related quality of life (HRQoL) of patients with genital warts (GW) in populations in mainland China is still limited. The aim of the study was to use a generic instrument to measure the impact of genital warts on HRQoL in men and women in this setting. METHODS: A multi-centre hospital-based cross-sectional study across 18 centers in China was conducted to interview patients using the European quality of life-5 dimension (EQ-5D) instrument; respondents' demographic and clinical data were also collected. RESULTS: A total of 1,358 GW patients (612 men, 746 women) were included in the analysis, with a mean age of 32.0 ± 10.6 years. 56.4% of the patients reported some problems in the dimension of Anxiety/Depression (highest), followed by Pain/Discomfort (24.7%) and Mobility (3.5%). The overall visual analogue scale (VAS) score of the study population was found to be 65.2 ± 22.0, and the EQ-5D index score was found to be 0.843 ± 0.129 using Japanese preference weights (the Chinese preference was unavailable yet). Patients with lower VAS means and EQ-5D index scores were more often female, living in urban area, and suffering multiple GW (all p values < 0.05), but the values did not differ notably by age (p values > 0.05). CONCLUSIONS: The HRQoL of patients with GW was substantially lower, compared to a national representative general population in China (VAS = ~80); the findings of different subgroups are informative for future GW prevention and control efforts.

Anti-tumor effects of Astragalus on hepatocellular carcinoma in vivo.

OBJECTIVE: The objective of the present study is to investigate the anti-proliferation activity of Astragalus on human hepatocellular carcinoma (HCC) cells and its mechanism. MATERIALS AND METHODS: Hepatic cancer H22 bearing mice were used to study the anti-hepatocarcinoma activity of Astragalus in vivo. The growth curve and inhibitory rate of tumor growth were measured. Cell apoptosis of each group was measured by flow cytometry (FCM). Protein expression of Bax and Bcl-2 were analyzed by immunohistochemistry (IHC). The Statistical Package for Social Sciences version 13.0 (SPSS Inc, Chicago, IL) was used for standard statistical analysis including one-way ANOVA and Student's t-test. A value of P<0.05 was considered to be statistically significant. RESULTS: Astragalus significantly inhibited the growth of H22 carcinoma, with an inhibitory rate of 17.28-52.36%. FCM and immunohistochemical assay show that the cell apoptosis rate and protein expression of Bax and Bax/Bcl-2 ratio of H22 transplanted tumor in Astragalus treated group were significantly higher than the control group (P<0.05). The protein expression of Bcl-2 was significantly lower than control (P<0.05). CONCLUSION: The results of the present study suggest that Astragalus has significant anti-tumor effect in vivo in inducing apoptosis of H22 tumor cells by promoting protein expression of Bax, decreasing protein expression of Bcl-2 gene, and markedly increasing the Bax/Bcl-2 ratio.

Human papillomavirus type-distribution in cervical cancer in China: the importance of HPV 16 and 18.

Prophylactic vaccination against HPV 16 and 18 has the potential for effective prevention of high-grade precancer (cervical intraepithelial neoplasia [CIN)] 2/3) and ICC caused by these viruses (globally 50 and 70%, respectively) when employed in women prior to starting sexual activity. To provide data for decisions on HPV vaccination in China, we determined HPV type-distribution in ICC and CIN 2/3 from women of different regions within China. A multicenter study was conducted by randomized sampling of paraffin blocks of 664 ICC (630 squamous cell carcinoma [SCC]; 34 adenocarcinoma [ADC]), 569 CIN 2/3 cases from seven regions of China. Histological diagnosis was confirmed in 1,233 cases by consensus review. HPV DNA was detected using the SPF10 LiPA25 version 1 assay. HPV prevalence was 97.6% in SCC, 85.3% in adenocarcinoma, and 98.9% in CIN 2/3. HPV 16 (76.7%) and HPV 18 (7.8%) were the most common, together accounting for 84.5% of SCC, followed by HPV 31 (3.2%), HPV 52 (2.2%), and HPV 58 (2.2%). HPV positivity in SCC did not differ notably by region. However, SCC cases from women

Knowledge and attitudes about human papillomavirus (HPV) and HPV vaccines among women living in metropolitan and rural regions of China.

Infection with the human papillomavirus (HPV) is one of the most common sexually transmitted infections and causes virtually all cervical cancer globally. The recent development of two safe and clinically effective vaccines against HPV is a promising step towards lowering cervical cancer rates in the future. What Chinese women think about HPV and the vaccines remains unknown. We undertook a population-based survey, which was embedded in a cervical cancer screening project and was designed to assess women's knowledge about HPV and their acceptability to the vaccines. We found that only 15.0% of women in our study reported to have ever heard of HPV, and this knowledge differs by rural (9.3%) and metropolitan areas (21.6%) and also by education. Most (84.6%) participants were willing to be vaccinated if HPV vaccine became available to them. The present study documents ways in which women learn about HPV and indicates the potential barriers and success of introducing HPV vaccine to China.

Prognostic factors of patients with ovarian yolk sac tumors: a study in Chinese patients.

BACKGROUND: The aim of this study was to investigate the prognostic factors of ovarian yolk sac tumors (YST) and the survival rates in Chinese patients. PATIENTS AND METHODS: We retrospectively reviewed 76 patients with ovarian YST from the Department of Obstetrics and Gynecology, Liaoning Cancer Hospital & Institute, China, between 1984 and 2007. RESULTS: Five-year overall survival rates in stages I, II, III, and IV were 91.8, 88.9, 39.5, and 25.0%, respectively. Age, histologic type, preoperative serum alpha-fetoprotein level, fertility-sparing surgery, tumor size and lymphadenectomy did not affect the prognosis of YST in our study. Multivariate analysis confirmed cisplatin-based chemotherapy (hazard ratio (HR) = 4.945), chemotherapy courses > 3 (HR = 2.954), residual tumor < or = 2 cm (HR = 0.224) and ascites volume < or = 100 ml (HR = 0.389) as independent predictors for overall survival. CONCLUSIONS: Our study demonstrated that the 5-year overall survival rate of YST was 53.9% for the Liaoning Cancer Hospital & Institute, China. Cisplatin-based chemotherapy, chemotherapy courses, residual tumor size and ascites volume were independent prognosis factors.

[Clinical evaluation of the xMAP technology in detection of high-risk human papillomavirus].

OBJECTIVE: To evaluate the clinical application value of flexible multi-analyte profiling (xMAP) technology in detecting high-risk human papillomavirus (HR-HPV). METHODS: Totally 1 061 women, aged 21-65 years, were randomly enrolled into the study. Cervical exfoliated cells were used in xMAP technology and hybrid capture II (hc2). Pathological diagnosis was used as golden standard. Consistency of these two methods was assessed. RESULTS: The sensitivity and specificity of xMAP technology were 80.31% and 85.83%, respectively. The positive and negative predictive values were 44.5% and 96.9%, respectively. The Kappa value for consistency between xMAP technology and hc2 was 0.58. CONCLUSIONS: The specificity of xMAP technology is similar to hc2 test, but the sensitivity is inferior to hc2. However, these two methods show good consistency in the detection of HR-HPV.

[Study on the prevalence of human papillomavirus infection and distribution of types in Shenyang city].

OBJECTIVE: To study the status of infection and type-specific distribution on human papillomavirus (HPV) in the urban areas of Shenyang city, China and to provide data for vaccine introduction. METHODS: A list of 1000 women aged 15-59 years were obtained randomly from the local population, and a questionnairey was filled in. Samples of cervical cell were obtained from 702 women who had had sexual experience and were not pregnant during the study was carried on. HPV type was detected using a GP5+/6+ -based PCR, liquid-based cytology, VIA, VILI and electronic coloscopy were used for screening on cervical cancer. RESULTS: The prevalence of any HPV type was 17.0% among the 702 women who had been enrolled in this study, 64.1% in women with abnormal cytology, 11.1% in women with normal cytology and the difference was significant. The prevalence of high-risk HPV type was 11.9% and the low-risk type was 6.5%. The prevalence of either high-risk or low-risk HPV type was significantly higher in women with abnormal cytology than those with normal cytology. There were a total number of 32 HPV types identified and the most common HPV types were 16 (3.4%), 52 (2.4%) and 58 (1.9%). The prevalence rates of either high-risk or low-risk HPV type were not statistically different among different age-groups with P>0.05. HPV types with high risk were predominantly distributed in the groups below 45 years old and the difference was significant with P < 0.05. There was no significant difference between high-risk and low-risk types above 45 years old. CONCLUSION: The prevalence of HPV in women with abnormal cytology was statistically higher than those with normal cytology. The most common HPV types in this population were 16, 52 and 58, and the validity of present vaccines was not good enough for cervical cancer prevention in this local area.

[Inhibitory effect of NS398 on the proliferation of human ovarian cancer cell lines CAOV3 and OVCAR3 in vitro].

OBJECTIVE: To observe the inhibitive effect of cyclooxygenase-2 (COX-2) selective inhibitor, [N-[2-(cyclohexyloxy)-4-nitrophenyl]-methane sulfonamide] (NS398, one of nonsteroidal anti-inflammatory drugs), on human ovarian cancer cell lines CAOV3 and OVCAR3 during the proliferative process in vitro. METHODS: Streptovidin peroxidase conjugated (SP) immunohistochemical assay was performed to examine the expression of COX-2 protein in human ovarian epithelial serous cancer cell lines CAOV3 and OVCAR3 respectively. The proliferative inhibition process of the two cell lines by NS398 was observed with methyl thiazolyl tetrazolium (MTT) rapid photocolorimetric assay. Cell morphologic changes were observed under the inverted phase contrast microscope and electron microscope. DNA ladder assay and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay were employed for the cell apoptosis. RESULTS: COX-2 protein was expressed in both of the cell lines. The inhibitory rate of proliferation exerted by NS398 increased with the density and the time of NS398 respectively. In contrast to the control, the absorbance of the experiment (NS398 200 micro mol/L for 72 h) decreased obviously (P < 0.05). With regard to the cell morphology, the "vacuole" presented in the cytoplasm and apoptosis body was able to be observed, and the microvilli on the surface of the cell disappeared. There were characteristic ladder bands after CAOV3 and OVCAR3 were treated by NS398 (100 micro mol/L) for 72 h. The brown-yellow granules located in the nucleus of most CAOV3 cells, which indicated apoptosis. CONCLUSIONS: Above findings suggest that COX-2 may provide an effective chemotherapeutic target for ovarian cancer, and selective COX-2 inhibitors can be used as chemotherapeutic agents for ovarian cancer.