Distribution of HPV Genotype in Invasive Cervical Carcinoma and Cervical Intraepithelial Neoplasia in Zhejiang Province, Southeast China: Establishing the Baseline for Surveillance.

Human papillomavirus (HPV) are firmly established as the principal causative agent for cervical carcinoma. Current vaccines may provide some protection for women from cervical carcinoma linked to HPV genotype 16 and 18. This may be the best vaccine for Western women, but the geographical variation in HPV distributions may not make it the most appropriate vaccine for China or Asia. This study provided an observational, retrospective, hospital-based cross-sectional study on the distribution of HPV genotypes among 5410 women with invasive cervical cancer (ICC) or cervical intraepithelial neoplasia (CIN). Overall, the positive rates of the four HPV types included in current prophylactic vaccines were counted, the two high-risk types (HPV-16 and -18) covered by current vaccines represented 66.9% of women with squamous cancer, 55.0% with adenocarcinoma, 64.9% with adenosquamous carcinoma and 77.4% of other type ICC, as well as 59.5% of CIN III, 45.0% of CIN II and 38.1% of CIN I cases. As expected, two low-risk types (HPV-6 and -11) included in the quadrivalent vaccine did not show good coverage data. Particularly worth mentioning is the fact that the addition of HPV-52 and -58 to the vaccine cocktail would increase cancer protection in our population, potentially preventing up to beyond 16% of squamous/adenosquamous carcinoma and other type of cervical cancers, and 7.75% of adenocarcinomas. It might also potentially reduce the rate of CIN III by a further 28.6% and CIN II and I by a third. This study established the baseline for surveillance in Zhejiang Province, and provides data for further vaccine designs: a quadrivalent HPV vaccine covering HPV-16/-58/-18/-52, would be more welcome in our region in the forthcoming year compared to the currently available vaccine.

[Detection of micrometastases and its clinical significance in sentinel and non-sentinel lymph nodes from early cervical carcinoma].

OBJECTIVE: To investigate the clinical significance of micrometastasis detection in sentinel lymph nodes (SLN) from patients with early cervical carcinoma. METHODS: Thirty patients with early cervical carcinoma were studied to identify SLN intraoperatively using methylene blue. One lymph node was removed randomly from palpable SLN and other pelvic lymph nodes (nSLN) in each patient, so 268 lymph nodes were collected and cut into two halves, one half of the lymph node was used to analyze the expression of cytokeratin 19 (CK19) mRNA by real-time fluorescence quantitative polymerase chain reaction to determine the presence of micrometastasis, the other half was examined by routine histology with HE staining. RESULTS: 67 SLNs were detected in 28 cases (93.3%). Pelvic lymph nodes of 6 cases were confirmed pathological metastasis. The sensitivity of SLN detection was 66.7%, the accuracy rate was 96.4%, and the false negative rate was 16.7%. Among 268 lymph nodes (including 9 lymph nodes with pathological metastasis) detected by real-time fluorescence quantitative polymerase chain reaction, 68 lymph nodes were pathological negative but had micrometastasis, accounting for 26.3% (68/259) in pathologically negative lymph nodes. Among 24 patients with pathological negative lymph nodes, 16 cases had micrometastasis, accounting for 66.7% in those patients. Among 16 patients with micrometastasis, SLN of 3 cases were negative, but nSLN were micrometastasis, so the SLN false-negative rate rose to 18.2%. There were no significant relationships between pelvic lymph nodes micrometastasis and perivascular space involvement, deep stromal invasion and tumor grade (all P > 0.05). The micrometastasis rate of nSLN in patients with SLN micrometastasis was 100%, significantly higher than that in the patients with SLN non-micrometastasis (27.3%, P < 0.01). CONCLUSIONS: Real-time fluorescence quantitative polymerase chain reaction is a sensitive method to detect SLN micrometastasis. SLN micrometastasis may be an effective complement to SLN pathology to predict nSLN metastasis. Pelvic lymph nodes micrometastases have no significant relationship with pathological risk factors in cervical cancer and prognosis of patients.

[Clinical significance of serum proteomic profiling before and after cervical cancer surgery].

OBJECTIVE: To investigate the value of serum proteomic profiling in cervical cancer detected pre-surgery and post-surgery. METHODS: Magnetic bead and matrix-assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS) were used to detect the serum samples from 54 cases with cervical cancer before and after surgery and 53 serum samples from healthy women. The results of spectra were analyzed by Biomarker Wizard software. RESULTS: Significant variation of proteomic profiling between pre-surgery and post-surgery were analyzed. There were 22 proteins with different mass/charge (M/Z) values significantly different (P < 0.01) at the M/Z value range from 1500 to 50 000, among of which relative content of proteins with M/Z 3981, 4290, and 28 066 in pre-surgery cervical cancer patients were higher than those in health women [(1.51 +/- 1.78)% vs (0.83 +/- 0.38)%, (2.70 +/- 2.19)% vs (1.72 +/- 0.91)%, (1.99 +/- 1.70)% vs (0.92 +/- 0.95)%; P < 0.01], while in the post-surgery patients, relative content of these three proteins significantly decreased to (0.59 +/- 0.45)%, (1.01 +/- 0.64)%, (0.54 +/- 0.37)%, respectively. But the relative content of another three proteins with M/Z 11 487, 11 529, and 11 678 were significantly increased in post-surgery patients [(0.38 +/- 1.41)% vs (2.74 +/- 3.67)%, (0.16 +/- 0.46)% vs (2.00 +/- 1.76)%, (1.02 +/- 1.67)% vs (7.71 +/- 9.46)%; P < 0.01]. CONCLUSION: Serum proteomic profiling could screen out the proteins which had significant variation between pre-surgery and post-surgery serum, of which with M/Z 3981, 4290, and 28 066 may be related with tumor burden, while with M/Z 11 487, 11 529, and 11 678 may be response to surgical stress.

[Lymphatic metastasis in patients with invasive cervical carcinoma after initial treatment].

BACKGROUND & OBJECTIVE: Lymphatic metastasis is the major recurrent way in invasive cervical carcinoma. This study was to summarize the characteristics, treatment, and prognosis of lymphatic metastasis in invasive cervical carcinoma patients after initial treatment. METHODS: Clinical data of 123 invasive cervical carcinoma patients with lymphatic metastasis after initial treatment at Zhejiang Provincial Cancer Hospital between 1990 and 2000 were analyzed. Of the 123 patients, 5 received operation alone, 45 received operation and adjuvant radiotherapy, and 73 received radiotherapy alone. All patients received salvage treatment of local radiotherapy and/or chemotherapy. RESULTS: Of the 123 patients, 95 (77.2%) had supraclavicular lymph node metastasis, 62 (50.4%) had para-aortic lymph node metastasis, 12 (9.8%) had inguinal lymph node metastasis, and 3 (2.4%) had axillary lymph node metastasis. The median duration from initial treatment to lymphatic metastasis was 14 months. Of the 123 patients, 36 developed metastasis within 6 months after initial treatment and 87 developed metastasis more than 6 months later. The 3-and 5-year overall survival rates were 15.0% and 1.5%. The 3-year survival rates were 23.1% for the 76 patients with lymphatic metastasis alone, and 4.7% for the 47 patients with both lymphatic metastasis and pelvic recurrence or hematogenous metastasis. Multivariate analysis revealed that the duration from initial treatment to lymphatic metastasis and concomitance of hematogenous metastasis and/or pelvic recurrence were significant prognostic factors of invasive cervical carcinoma. CONCLUSION: Invasive cervical carcinoma patients with lymphatic metastasis alone after initial treatment may benefit from aggressive salvage treatment.

[Sentinel lymph node detection and intra-operational diagnosis in patients with early stage cervical cancer].

OBJECTIVE: To study the effective method for rapid detection of sentinel lymph nodes in patients with early stage cervical cancer and clinical value thereof. METHODS: Thirty female patients with early stage cervical cancer, 14 at FIGO stage IB1 and 16 at stage IIA, underwent injection of 99mTc-labelled sulfur colloid 0.4 mci/0.4 ml at the positions of 3, 6, 9, and 12 o'clock of the cervix 5 h or 18 h before operation, and injection of 1 ml of methylene blue at the same cervical positions as mentioned above after the abdomen was opened. The blue-stained lymph nodes or the lymph nodes directed by the blue-stained lymph vessels were identified as SLNs: gamma-detector was used to position the hot nodes. The SLNs were resected and then radical hysterectomy and pelvic lymphadenectomy were performed. SLN frozen section and imprint cytology were conducted during the operation, the results were compared with that of HE staining RESULTS: SLN were detected successfully in 29 of the 30 patients with a detection rate of 96.7%. Routine HE staining indicated pelvic lymph node metastasis in 9 patients. The SLN was positive in 8 of the 29 patients, negative in 20 patients, and false negative in 1 patient. The sensitivity, accuracy, and false-negative rates of SLN detection were 88.9%, 96.6%, and 11.1% respectively. The sensitivity, specificity, accuracy, and positive and negative predictive rates were 92.3%, 100%, 98.9%, 100%, and 98.8% for frozen section, and 92.3%, 97.6%, 96.8%, 85.7%, and 98.8% for imprint cytology respectively. CONCLUSION: Frozen section and imprint cytology may be effective rapid methods to diagnose SLN metastasis during operation. SLN detection can predict pelvic lymph node metastasis in cervical cancer.

[Synchronous primary cancer of the endometrium and ovary].

UNLABELLED: To investigate the clinical and pathological characteristics, treatment, and The data of 12 patients prognosis of synchronous primary cancer of the endometrium and ovary. Methods with synchronous primary cancer of the endometrium and ovary were retrospectively reviewed . Results Eight patients had the same histological type of endometrioid carcinoma in both uterus and ovary, 4 patients had different histological types in uterus and ovary. Synchronous primary cancer of the endometrium and ovary was difficult to be dignosed preoperatively. All ovarian tumors were small with an average diameter of 7 cm. Infertility was common among these patients(40.7%). Most of them had early stage I lesion (66.7%). endometrioid carcinomas was the main pathologic type (66.7%). All patients were treated surgically followed by chemotherapy with a 3-year survival rate of 66.7% (8/12). CONCLUSION: Synchronous primary endometrium and ovary cancer is a specific kind of tumor different from either the primary endometrium carcinoma or ovary carcinoma, and usually can be detected in early stage with a good prognosis.