Desmoplastic stromal response as defined by positive α-smooth muscle actin staining is predictive of invasion in adenocarcinoma of the uterine cervix.

The objective of this research was to examine the immunohistochemical profiles of adenocarcinoma in situ (AIS) and early invasive adenocarcinoma (AC) to identify biomarkers that enhance the accurate diagnosis of early invasive glandular lesions of the cervix. The University of California, Irvine, and Long Beach Memorial tumor registries were used to identify 20 women with AIS or early AC treated between 1990 and 2008. An immunohistochemical study was performed, and the primary endpoint measured was the correlation between biomarker expression and invasive disease as diagnosed on hematoxylin and eosin examination. The biomarkers studied included α-smooth muscle actin (α-SMA), estrogen receptor, carcinoembryonic antigen, Ki67, p16, cyclooxygenase-2, and cluster of differentiation 1a. Stains were described on the basis of (1) positive or negative staining; (2) intensity; (3) percentage of positive cells; and (4) pattern of staining. Statistical analysis was performed using SYSTAT v. 11.0. Fisher exact test, Mann-Whitney nonparametric test, κ statistic, and intraclass correlation coefficient were used to evaluate results and interpreter agreement. A statistically significant increase in the staining of the periglandular stroma for α-SMA was seen in AC as compared with AIS. The intensity was 2.2 versus 1.2 (P=0.04) and the percent of positive-staining cells was 44% versus 18% (P=0.05) in AC and AIS, respectively. The presence of a desmoplastic stromal response as identified by the increased periglandular staining for α-SMA is useful in identifying invasive glandular lesions of the endocervix. Further studies are necessary to establish biologically relevant cut-off values for α-SMA staining.

Assessment and significance of quality of life in women with gynecologic cancer.

In the design of randomized clinical trials, quality of life (QOL) has become an important component across multiple cancer types. QOL includes the measurement of patient-reported outcomes, mostly described as the physical, social, emotional and functional wellbeing of the patient. These realms of wellbeing are reported by the patient themself and are thought to be a subjective measurement of response to treatment and/or treatment outcomes. Therapeutic interventions such as chemotherapy and/or radiation can thus be monitored from a patient perspective. In addition, while researchers and oncologists may recognize the futility of advanced and/or recurrent cancer therapy in the setting of reduced QOL, patients may have difficulty with discontinuing therapy. QOL research adds to the literature by introducing a patient perspective into the decision to treat aggressively. Specifically, in gynecologic cancers, there is a wide range of outcomes and patient characteristics to be considered. All three cancer settings - endometrial, cervical and ovarian - are remarkable in the QOL literature as this is a relatively new field with room to create interventions targeted towards improving QOL in often challenging clinical and life situations.