Effectiveness of Sequential Chemoradiation vs Concurrent Chemoradiation or Radiation Alone in Adjuvant Treatment After Hysterectomy for Cervical Cancer: The STARS Phase 3 Randomized Clinical Trial.

IMPORTANCE: There is no current consensus on the role of chemotherapy in addition to radiation for postoperative adjuvant treatment of patients with early-stage cervical cancer with adverse pathological factors. OBJECTIVE: To evaluate the clinical benefits of sequential chemoradiation (SCRT) and concurrent chemoradiation (CCRT) compared with radiation alone (RT) as a postoperative adjuvant treatment in early-stage cervical cancer. DESIGN, SETTING, AND PARTICIPANTS: After radical hysterectomy at 1 of 8 participating hospitals in China, patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB to IIA cervical cancer with adverse pathological factors were randomized 1:1:1 to receive adjuvant RT, CCRT, or SCRT. Data were collected from February 2008 to December 2018. INTERVENTIONS: Patients received adjuvant RT (total dose, 45-50 Gy), CCRT (weekly cisplatin, 30-40 mg/m2), or SCRT (cisplatin, 60-75 mg/m2, plus paclitaxel, 135-175 mg/m2) in a 21-day cycle, given 2 cycles before and 2 cycles after radiotherapy, respectively. MAIN OUTCOMES AND MEASURES: The primary end point was the rate of disease-free survival (DFS) at 3 years. RESULTS: A total of 1048 women (median [range] age, 48 [23-65] years) were included in the analysis (350 in the RT group, 345 in the CCRT group, and 353 in the SCRT group). Baseline demographic and disease characteristics were balanced among the treatment groups except that the rate of lymph node involvement was lowest in the RT group (18.3%). In the intention-to-treat population, SCRT was associated with a higher rate of DFS than RT (3-year rate, 90.0% vs 82.0%; hazard ratio [HR], 0.52; 95% CI, 0.35-0.76) and CCRT (90.0% vs 85.0%; HR, 0.65; 95% CI, 0.44-0.96). Treatment with SCRT also decreased cancer death risk compared with RT (5-year rate, 92.0% vs 88.0%; HR, 0.58; 95% CI, 0.35-0.95) after adjustment for lymph node involvement. However, neither DFS nor cancer death risk was different among patients treated with CCRT or RT. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, conducted in a postoperative adjuvant treatment setting, SCRT, rather than CCRT, resulted in a higher DFS and lower risk of cancer death than RT among women with early-stage cervical cancer. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00806117.

Spatiotemporal photosynthetic physiology responses of remnant Myricaria laxiflora populations to regulated water level fluctuations.

The construction of the Three Gorges-Gezhouba Dam cascade hydropower station has changed the water level fluctuation pattern of the habitats for remnant rare and endangered Myricaria laxiflora populations downstream of the dam. The present study utilized biochemical markers of photosynthetic physiology to evaluate the spatiotemporal responses of remnant populations to human-regulated water level fluctuations. The results showed that the photosynthetic physiological activities of remnant M. laxiflora populations underwent a period of rapid growth, followed by a gradual decline in the growth recovery phase after flooding. During the entire experimental period, photosynthetic physiological activities of remnant M. laxiflora populations changed with prolongation of emergence time: specifically, net photosynthetic rate and stomatal conductance initially decreased and then subsequently increased, intercellular carbon dioxide concentrations peaked at mid-phase and transpiration rate continuously increased. The maximum net photosynthetic rate, apparent photosynthetic quantum efficiency and dark respiration rate in the light-response curves of the plants continuously increased during growth. The water level gradient also significantly affected the photosynthetic physiological activities in the remnant populations, i.e. the photosynthetic physiological activities of high-altitude plants were significantly higher than the middle- and low-altitude plants. The changes in photosynthetic pigment content of plants in remnant populations during the growth recovery phase and the entire growth period were similar to those occurring in photosynthetic activities in plants. Further, canonical correspondence analysis showed that photosynthetic physiological activities in the plants were significantly correlated with changes in water levels, emergence time, elevation gradient, soil water and soil nitrogen contents. Therefore, the artificial regulation of water level fluctuations by large hydropower stations will inevitably affect the photosynthetic activities and growth of remnant M. laxiflora populations.

Association of BRCA1/2 mutations with ovarian cancer prognosis: An updated meta-analysis.

OBJECTIVE: A meta-analysis was performed to determine if BRCA1/2 mutations are associated with improved overall survival (OS) and progression-free survival (PFS) in patients with ovarian cancer. RESEARCH DESIGN AND METHODS: Studies of patients with primary or recurrent ovarian cancer that examined the relationship between BRCA1/2 mutation status and outcomes were included. MAIN OUTCOME MEASURES: The primary outcomes were OS and PFS of patients with and without BRCA1 and BRCA2 mutations. The secondary outcome was treatment response: complete response, partial response, and overall response. RESULTS: Overall analysis revealed BRCA1/2 mutations were associated with improved OS [hazard ratio (HR) = 0.75; 95% confidence interval (CI): 0.64, 0.88; P < .001] and PFS (HR = 0.80; 95% CI: 0.64, 0.99; P = .039). BRCA1 mutations were significantly associated with improved OS (HR = 0.75) but not PFS, and BRCA2 mutations alone were not associated with either improved OS or PFS. The presence of BCRA1/2 mutations was associated with a better overall response rate, higher complete response rate, and lower partial response rate; however, BRCA1 or BRCA2 alone was not associated with overall response rate. CONCLUSIONS: BRCA1 mutations appear to be associated with improved OS in patients with ovarian cancer. However, the effect of BRCA1 mutations on PFS and BRCA2 mutations alone on OS and PFS is less clear.

Tumor-induced VEGF-C overexpression in retroperitoneal lymph nodes in VX2 carcinoma-bearing rabbits.

OBJECTIVE: To establish the retroperitoneal lymph node (RLN) metastasis model of cervical carcinoma in rabbits and evaluate the relationship of vascular endothelial growth factor-C (VEGF-C) expression and the lymph node status. METHODS: Forty-eight rabbits were injected with VX2 cells or RPMI solution at muscular mucosae of the myometrium 0.5 cm away from the cervix. Animals were treated with or without cis-diamminedichloroplatinum(II) (cisplatin: DDP) and sacrificed on days 15, 21, and 27 post-VX2 or RPMI injections. Tumor mass and RLNs were examined histopathologically. Quantitative real-time PCR was used to examine the changes in VEGF-C mRNA expression. Levels of VEGF-C protein expression in tissues were determined using immunohistochemistry staining. RESULTS: Development of VX2 cervical carcinoma and the RLNs metastasis was confirmed with pathological examination. Significantly increased tumor volume was observed on days 15, 21, and 27 postinjection (P<0.05). The enlargement of RLNs was found on day 21. Expression of VEGF-C was significantly upregulated in peripheral white blood cells, tumor mass, and RLNs in an association with cancer progression. DDP resulted in a suppression of VEGF-C expression, whereas the influences on tumor mass and lymphatic metastasis were insignificant. CONCLUSION: Elevated VEGF-C expressions in peripheral white blood cells and RLNs are associated with tumor progression and lymphatic metastasis. DDP treatment inhibits VEGF-C expression and fails to protect against metastatic cervical cancer.

[Anti-A/B Antibody Titers in Group O Healthy Donors in Hainan Province Area].

OBJECTIVE: To detect the IgM anti-A (B) and IgG anti-A (B) antibody titers of group O healthy donors in Hainan province area, to understand the distribution of O-type blood donor IgM and IgG antibody titers and to analyze the relationship between antibody titers, so as to provide experimental evidences for the safety and feasibility of urgent transfusion of uncrossmatched group O RBCs. METHODS: Group O whole blood sample was collected from 80 volunteers blood donors. IgM antibody titrations was performed using the immediate spin (IS) tube, and IgG antibody titration were performed using the column agglutination technique with anti-human globulin (AHG). Using two-way ANOVA, paired t-test and correlation analysis, the different types of antibodies were compared. RESULTS: The IgM antibody titers distributed in 4-1 024, IgG antibody titer distributed in 2-2 048. Anti-A antibody titers of IgG were significantly higher than that of IgM anti-B, IgG anti-B and IgM anti-A titers (P < 0.05). There was a positive correlation bewteen IgM anti-A and anti-B, IgM anti-B and IgG anti-B, IgG anti-A and anti-B (P < 0.05). CONCLUSION: Group O blood donors have high antibody titers in Hainan province area, type O RBC suspensions should be first screened through screening the anti-A titer of IgG, so that can significantly improve the pass rate of O-type universal blood and reduce testing costs.

Primary vaginal sarcoma: Experience of a regional cancer center in China.

AIM: To evaluate the clinical characteristics of primary vaginal sarcoma, which is a rare malignancy METHODS: We retrospectively reviewed the clinical records of eight patients with primary vaginal sarcoma treated at Sun Yat-Sen University Cancer Centre from 1997 to 2012. RESULTS: Eight patients aged ≥ 17 years were identified (four had leiomyosarcoma, two had endometrial stromal sarcoma, one had undifferentiated sarcoma, and one had adenosarcoma). Four patients had stage I disease, one had stage II, and three had stage IV. Five patients with stage I or II tumor received surgery of mainly local wide excision. One of the five patients received postoperative radiation plus chemotherapy and two had postoperative chemotherapy only. Three of the four stage I patients who had low-grade tumors and received wide local excision were alive without disease at 21, 53, and 81 months, respectively. One stage I patient with a high-grade tumor received simple tumor excision only and died of the disease at 20 months. The patient with stage II disease was lost to follow up. The three stage IV patients received radiotherapy and/or chemotherapy and all died within 2 years. CONCLUSIONS: Surgery is the main treatment for primary vaginal sarcoma. Prognosis may be associated with tumor grade and stage.

Establishment of the retroperitoneal lymph node metastasis model of endometrial VX2 carcinoma in rabbits and observation of its metastatic features.

BACKGROUND: The objective of this study is to establish the retroperitoneal lymph node metastasis model of endometrial VX2 carcinoma in rabbits and observe of its metastatic features. METHODS: The VX2 cells were transplanted into the uterine muscularis mucosae of 48 rabbits by injecting carcinoma mass suspension. According to time, the rabbits were killed after the transplantation of VX2 cells, and they were divided into six groups, 15-, 18-, 21-, 24-, 27-, and 30-day group, and six rabbits in each group. Control groups consisted of those receiving no treatment or an injection of saline. The specimens of transplanted endometrial carcinoma and retroperitoneal lymph node in the rabbits were examined histopathologically after they were killed. RESULTS: All rabbits developed VX2 endometrial carcinoma which was confirmed with pathological examination. Significantly increased tumor volume was observed at day 24, 27, and 30 post-injection of VX2 cells (P < 0.05). The retroperitoneal lymph nodes were not enlarged completely in each rabbit in the 15-day group, partly enlarged in the 18- and 21-day group, and all enlarged in the 24-, 27-, and 30-day group. The histopathological examination revealed no complete retroperitoneal lymph node metastasis in the 15- and 18-day group, partial metastasis in the 21-day group, and complete metastasis in the 24-, 27-, and 30-day group. CONCLUSIONS: The model was established successfully by injecting carcinoma mass suspension, and various retroperitoneal lymph node metastasis model of endometrial VX2 carcinoma can be established rapidly in a month after the transplantation.

Tumor feeding artery reconstruction with multislice spiral CT in the diagnosis of pelvic tumors of unknown origin.

PURPOSE: We aimed to compare multislice spiral computed tomography (MSCT) angiography diagnosis with both surgical findings and postoperative pathological results in patients with pelvic tumors of unknown origin. In addition, the diagnostic accuracy of MSCT angiography was compared with that of routine computed tomography for tumor feeding artery volume reconstruction to determine the origin and nature of pelvic tumors. MATERIALS AND METHODS: The records of 43 patients with pelvic tumors of unknown origin who underwent MSCT angiography were retrospectively reviewed. Volume reconstructions using add vessel and merge views methods were performed for abdominal and pelvic blood vessels. The tumor origin was identified based on observations of the origin, number, morphology, starting/ending locations, route, and distribution of the tumor feeding arteries. RESULTS: Overall, the mean tumor diameter was 9.8±3.5 cm (range, 4.2-23.5 cm); 11 tumors (25.6%) were cystic in nature; and 32 tumors (74.4%) were either solid/cystic or solid in nature. When considering all MSCT angiography examinations used to predict the nature of the tumor (e.g., malignant or benign), the sensitivity and specificity were 77.3% and 95.2%, respectively. The positive and negative predictive values were 94.4% and 80%, respectively. The overall diagnostic accuracy was 86.05% with an area under the curve of 0.961 (95% confidence interval, 0.913-1.000). CONCLUSIONS: MSCT angiography volume reconstruction for pelvic tumor feeding arteries of unknown origin is highly valuable for localization, qualitative diagnosis, and quantitative diagnosis of pelvic tumors.

Large animal model for retroperitoneal lymphatic and lung metastasis.

Retroperitoneal lymph node and lung metastasis are important prognostic factors for gynecologic cancer. The present study aimed to develop a new animal model for retroperitoneal lymph node and lung metastasis. VX2 squamous cell carcinoma tumor tissues were injected into the left gastrocnemius muscle of 38 healthy female New Zealand white rabbits. Animals were randomized into three groups according to day of sacrifice: 1, day 19; 2, day 22; and 3, day 25. Implanted primary tumor (IPTu), left and right retroperitoneal lymph node volumes and lung wet weights were measured on the day of sacrifice. The IPTu and left and right retroperitoneal lymph node volumes increased in a time­dependent manner. In addition, the proportion of animals with metastasis to the left peritoneal lymph nodes and the number of nodes involved increased over time. For days 19, 22 and 25, the proportion of animals with nodal metastasis was 58.3, 84.6 and 100%, respectively, and the number of affected nodes (range) was 3 (2­3), 3 (3­5) and 4 (4­5), respectively. No metastasis was detected in the right peritoneal lymph nodes. Metastasis to the lungs also increased with time, but was not statistically significant at days 19, 22 and 25 with metastasis present in 33.3, 38.5 and 76.9% of animals, respectively. Rates of metastases to the left retroperitoneal lymph nodes and lungs were found to positively correlate with the volumes (r=0.416 and 0.449, respectively). The current study assessed the characterization of a rabbit VX2 carcinoma model. This animal model is likely to be useful for evaluating retroperitoneal lymph node and lung metastasis.

VEGF-c expression in an in vivo model of orthotopic endometrial cancer and retroperitoneal lymph node metastasis.

BACKGROUND: Retroperitoneal lymph node (RLN) metastasis is an important indicator of endometrial cancer (EC) prognosis. Because vascular endothelial growth factor c (VEGF-c) is known to influence lymphangiogenesis and thereby lymph node metastasis, this study assessed the relationship of VEGF-c mRNA expression with RLN metastasis in EC. METHODS: The uterine muscularis mucosae of New Zealand white rabbits were inoculated with a VX2 tumor cell suspension after which they were sacrificed at 15, 18, 21, 24, 27 and 30 days. Control groups consisted of those receiving no treatment or an injection of saline. EC and metastatic RLN tissues along with peripheral blood samples were collected, and VEGF-c mRNA expression was evaluated using fluorescence real-time quantitative PCR. RESULTS: The establishment of an in vivo model of EC with complete RLN metastasis was pathologically confirmed at day 21 post-injection with VX2 cells. As compared to the control groups, VEGF-c mRNA expression increased significantly over time in the tumor site, RLN, and peripheral white blood cells of EC rabbits. Significantly higher VEGF-c mRNA expression was observed in metastatic RLNs as compared to those without metastasis (P < 0.001). In addition, increased VEGF-c mRNA expression was observed in peripheral white blood cells of rabbits with RLN metastasis (P < 0.002). CONCLUSION: Injection of a VX2 cell suspension is a simple method of establishing an in vivo EC model. VEGF-c may play an important role in the development of EC and its metastasis to RLN and may be useful marker to predict RLN metastasis.

Expression of c-Src and phospho-Src in epithelial ovarian carcinoma.

Abnormal c-Src expression and activation has been observed in a number of tumors. To determine the therapeutic potential of Src inhibitors for ovarian cancer patients, this study aimed to explore the expression patterns of c-Src and phospho-Src in epithelial ovarian cancer. A total of 82 patients with epithelial ovarian cancer treated at Sun Yat-sen University Cancer Center from January 1999 to December 2005 were enrolled along with 25 patients with benign ovarian lesions; 20 normal ovarian tissues served as controls. Expression of c-Src and phospho-Src (Tyr416) was examined using immunohistochemistry. Survival analyses were performed using Kaplan-Meier curves. As compared to the control group, a significantly greater proportion of ovarian cancer tissues were positive for c-Src and phospho-Src expression (P < 0.001). c-Src expression was associated with age, while phospho-Src expression was significantly associated with age, FIGO stage, histology grade, and residual tumor size after surgery (all P < 0.05). The mean survival time was associated with phospho-Src expression, but not with c-Src expression. The mean survival times of patients with phospho-Src-positive tumors were significantly greater than those with phospho-Src-negative tumors (87.4 months, 95 % CI = 74.3-100.5 months and 91.5 months, 95 % CI = 84.7-98.2 months, respectively; P = 0.013). The increased c-Src expression and activation in epithelial ovarian cancer suggests that ovarian cancer patients may benefit from tyrosine kinase inhibitors such as Dasatinib. Activation of c-Src through phosphorylation at Tyr416 may play a role in the early stages of ovarian cancer development, and evaluation of its expression may be a useful prognostic marker of epithelial ovarian cancer.

Differential routes of carboplatin administration influence lymphocyte apoptosis in retroperitoneal lymph nodes.

We aimed to investigate carboplatin distribution in retroperitoneal lymph nodes and its effect on lymphocyte apoptosis following intravenous (IV), intra-arterial (IA), and retroperitoneal (RP) administration. Sixty-three healthy female canines were randomly assigned as IV, IA, or RP administration of carboplatin. At 0.5, 1, 2, 4, 8, 24, and 72 h after carboplatin treatment, retroperitoneal lymph nodes (n = 6 at each time point) were collected and high-performance liquid chromatography was employed to measure the carboplatin content. The differences in carboplatin pharmacokinetics of the three administration routes were compared. Terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) was carried out to measure the lymphocyte apoptosis of the retroperitoneal lymphocytes. The peak concentration of carboplatin in plasma following IV administration was the highest among all approaches; as to the peak time, RP administration was longer than the other two administrations. Concentration for carboplatin in the retroperitoneal lymph node was highest following IA administration at early time points, but at higher time points, concentration was significantly higher following RP administration. Penetration of carboplatin into the retroperitoneal space was higher following RP administration. Following RP administration, the level of apoptotic lymphocytes in the retroperitoneal lymph nodes was significantly greater than either IV or IA. Following RP administration of carboplatin, the concentration, area under the curve of carboplatin and the number of apoptotic lymphocytes were significantly higher than those following IV and IA administration. This suggests that RP administration of carboplatin is beneficial for the treatment of retroperitoneal lymph node metastasis.

[Selecting postoperative chemotherapy regimen and optimizing therapy cycle for stage II-IV ovarian epithelial carcinoma].

BACKGROUND & OBJECTIVE: The postoperative chemotherapy for ovarian epithelial carcinoma need to be improved. This study was conducted to seek suitable chemotherapy for patients with stage II-IV ovarian epithelial carcinoma. METHODS: The records of 325 patients with stage II-IV ovarian epithelial carcinoma, received different postoperative chemotherapy (HCBP, CP, CBP, or CAP) regimens for different cycles from Jan. 1986 to Dec. 2000 in our cancer center, were analyzed retrospectively. The treatment outcome and prognosis of these patients were analyzed. RESULTS: The 5-year survival rate of the patients received HCBP regimen was significantly higher than those of the patients received CP, CBP, or CAP regimens (84.3% vs. 43.0%, P=0.008; 46.1%, P=0.016; and 40.0%, P=0.002). The incidence of chemotherapy-related complications was significantly lower in the patients received CP regimen than in the patients received HCBP, CBP, or CAP regimens (76.0% vs. 91.3%, P=0.015; 88.2%, P=0.043; and 87.7%, P=0.038). The 5-year survival rates of the patients received more than 6 or 5-6 cycles were significantly higher than that of the patients received less than 5 cycles (56.2% or 59.5% vs. 35.1%, P< 0.001). The incidences of chemotherapy-related complications in such patients were 89.6%, 81.1%, and 82.8% (P=0.214), respectively. CONCLUSIONS: We recommend 5-6 cycles of CP-based chemotherapy regimens for stage II-IV ovarian epithelial carcinoma. Prolonging the duration of each chemotherapy cycle might achieve good prognosis.

[Analysis of long-term prognostic factors of epithelial ovarian cancer].

BACKGROUND & OBJECTIVE: Because most of patients with ovarian cancer are in advanced stage when initially noted, and are prone to relapse, ovarian cancer is a tough disease to treat. This study was to determine long-term prognostic factors correlated with prolonged survival of epithelial ovarian cancer patients, give reference for clinical practice. METHODS: Records of 691 patients with epithelial ovarian cancer, admitted in our hospital from Jan. 1986 to Dec. 2000, were retrospectively analyzed. Survival rate was calculated by life table method, and relevant factors were evaluated by univariate analysis. The potential prognostic variables were studied by Cox regression model. RESULTS: The 5-year, and 10-year survival rates of all patients were 56.0%, and 44.6%. Cox regression model revealed that clinical stage, size of tumor residues, pathologic type, histological grade, and number of chemotherapy cycles after surgery emerged as independent prognostic factors. CONCLUSION: Accurate clinical staging and histopathologic assessment, satisfactory cytoreduction, and effective adequate chemotherapy may affect prognosis of ovarian cancer patients.

[Study of different surgeries for clinical stage I endometrial carcinoma].

OBJECTIVE: To compare the outcomes and the risk of post-operative complications in patients with stage I endometrial carcinoma who were treated with different surgeries. METHODS: A total of 211 cases with stage I endometrial cancer treated with surgery in our Cancer Center from Jan 1986 to Dec 1997 were analyzed retrospectively. Sixty-one patients (group 1) underwent simple hysterectomy and salpingo-oophorectomy and 150 patients (group 2) underwent radical hysterectomy. The 5-year survival rates and the risk of post-operative complications were compared between two groups. RESULTS: Five-year survival rates of the group 1 and 2 were 96.0% and 93.5% (P > 0.05), respectively. The recurrence rates of the two groups were 6.6% and 10.7% (P > 0.05), respectively. The overall rates of post-operative complications in the two groups were 11.5% and 24.7% (P < 0.05), respectively. CONCLUSION: The patients with stage I endometrial carcinoma who were treated with simple hysterectomy and salpingo-oophorectomy did almost as well as those who underwent radical hysterectomy.

[Clinical analysis of 57 patients with ovarian dysgerminoma].

BACKGROUND & OBJECTIVE: Ovarian dysgerminoma is an uncommen ovarian malignancy. Its clinical features are special and there are many factors influencing the prognosis. If treated properly, the patient can be cured. Otherwise it may endanger the patient's life. The aim of this study is to investigate the clinical features and factors related to prognosis of ovarian dysgerminoma. METHOD: The data of 57 patients with pure Ovarian Dysgerminoma were analyzed retrospectively, who were admitted to Cancer Center, Sun Yat-sen University of Medical Sciences from January 1, 1964 to December 31, 2000. RESULTS: The main clinical features were abdominal mass (56.1%), abdominal pain (21.1%), abdominal swelling(17.5%), vaginal bleeding(5.3%), genital tract abnormality (5.3%). Twenty-six patients had stage Idiseases, 8 stage II, 9 stage III, 1 stage IV and 13 recurrent and persistent diseases. The uterus was involved in 41.2% patients with stage II-III diseases. Combined modality was given to 52 cases and single-method treatment 5 cases. The overall 5-year and 10-year survival rate for stage I-IV was 80.1% and 70.0% respectively. The 5-year survival rate for stage I was 100%, stage II 55.2%, stage III 55.6%, stage IV 0% and recurrent and persistent diseases 72.7%. In the group of stage I, 12 patients received adnexectomy and 14 patients underwent hysterectomy and adnex removal, there was no significant difference between the 5-year and 10-year survival rate (all 100%) (P < 0.05). Of 23 patients in stage I group to whom only chemotherapy were given after operation, 19 cases received 3 or more courses and were well being without recurrence; four patients received only one course and one of them recurred 21 months after operation. In the group of stage II and III cases the 5-year survival rate was 86.7% for those whose chemotherapy courses were > or = 4 and 25.0% for patients who received less than 4 courses of chemotherapy (P < 0.05). CONCLUSIONS: The prognosis of ovarian dysgerminoma is closely related to disease stage and modality of treatment. Fertility-preserving operation can be considered in early-staged patients, and be careful of doing so in middle-late staged cases. Good results can be achieved with operation-based combined modality in recurrent patients.

[Expression and clinical significance of p53 and c-erbB2 in geriatric women with cervical carcinoma].

BACKGROUND & OBJECTIVE: Few reports have reported on molecular biological study of cervivcal carcinoma in eldely woman, So the authors designed this study to evaluate the expression and clinical significance of tumor suppressor gene p53 and oncogene c-erbB2 in the progression of this kind of cancer. METHODS: Seventy-nine patients with cervical cancer and 23 with cases of normal cervical epithelium in geriatric people were investigated immunohistochemically for expression of p53 and c-erbB2 in paraffin sections. RESULTS: The expression of p53 in ICC (invasive cervical carcinoma) and normal epithelium were 18.98% and 0%, respectively (P < 0.01), and the rate of c-erbB2 oncoprotein were 43.04% and 34.78%, respectively (P = 0.63). p53 staining in ICC with grade 1, 2, and 3 were 50.00%, 11.76%, and 17.14%, respectively (P = 0.01), and frequency of c-erbB2 oncoprotein were 80.00%, 38.24%, and 37.14%, respectively (P < 0.01). c-erbB2 staining in patients with stage I, II, and III or more were 33.33%, 38.46%, and 51.61%, respectively (P < 0.01), while p53 overexpression was not associated with clinical stage. Percentage of p53 staining in the groups with negative lymph nodes and positive ones were 6.67% and 41.67%, respectively (P = 0.01). While c-erbB2 expression was not associated with lymph node status. CONCLUSION: The p53 overexpression was an important factor in the process of carcinogenesis of elder women with cervical cancer and a predictive indicator for lymph node status. c-erbB2 gene may be activated in the early stage of pathogenesis of cervical carcinoma in geriatric patients.

[Analysis of clinical efficiency of treatment for 179 geriatric women with stage I or II cervical carcinoma].

BACKGROUND & OBJECTIVE: Elderly women with cervical carcinoma have the features of poor prognosis and high incidence rate of complications. This study was designed to evaluate the prognostic impact of surgery versus radiotherapy in old women with stage I and stage II cervical carcinoma and seek suitable treatment for such patients. METHODS: Clinical data of 179 elderly women with stage Ia to stage IIb cervical cancer were analyzed retrospectively. One hundred and thirty-four cases underwent radical hysterectomy also received appropriate adjuvant radiotherapy and/or chemotherapy. Forty-five cases underwent radiation therapy received appropriate adjuvant chemotherapy. RESULTS: The 5-year survival rates of patients underwent surgery and radiotherapy were 78.32% and 49.08% (P = 0.04), respectively. The incidence rate of complications of patients receiving surgery was 47.01% (63/134). Three patients died of complications after radical hysterectomy. The incidence rate of complications of patients underwent radiotherapy was 75.63% (34/45). CONCLUSION: Geriatric patients with stage I and stage II cervical carcinoma should receive operation if possible and should receive adjuvant treatments according to personal conditions.