Preoperative serum CA125 levels do not predict suboptimal cytoreductive surgery in epithelial ovarian cancer.

The objective is to assess the ability of preoperative serum CA125 levels to identify patients at high risk of suboptimal cytoreductive surgery for epithelial ovarian cancer (EOC). One hundred and thirty-two women diagnosed with EOC between 1998 and 2004, who had serum CA125 levels measured preoperatively and received primary cytoreductive surgery, were retrospectively evaluated. The value of CA125 and patient and disease characteristics to predict suboptimal cytoreduction were determined, and a prognostic scoring system, based on statistically significant variables, was created. Optimal cytoreduction was achieved in 42.7% of the women with FIGO stage III/IV EOC. The optimal cutoff point of preoperative CA125 to predict surgical outcome in this group was 330 U/mL (sensitivity 80.0%; specificity 41.5%). The area under the receiver-operating characteristic curve (AUC) for preoperative CA125 predicting suboptimal surgery in FIGO stage III/IV was 0.576 (P = 0.617). Preoperative radiologic amount of ascites and weight loss (ie, >or=10% in the last 6 months before diagnosis) were independent prognostic factors for suboptimal cytoreduction, showing an AUC of 0.76 (P < 0.001) in women with FIGO stage III/IV. A prognostic scoring system showed that the chance of suboptimal surgery was 84.6% in FIGO stage III/IV when both these factors are present preoperatively. The role of CA125 levels predicting suboptimal cytoreduction seems questionable. Instead, women with considerable weight loss and a gross amount of ascites have a higher risk of suboptimal cytoreduction. These patients may be candidates for neoadjuvant chemotherapy.

Doxorubicin versus doxorubicin and cisplatin in endometrial carcinoma: definitive results of a randomised study (55872) by the EORTC Gynaecological Cancer Group.

BACKGROUND: Combination chemotherapy yields better response rates which do not always lead to a survival advantage. The aim of this study was to investigate whether the reported differences in the efficacy and toxicity of monotherapy with doxorubicin (DOX) versus combination therapy with cisplatin (CDDP) in endometrial adenocarcinoma lead to significant advantage in favour of the combination. PATIENTS AND METHODS: Eligible patients had histologically-proven advanced and/or recurrent endometrial adenocarcinoma and were chemo-naïve. Treatment consisted of either DOX 60 mg/m(2) alone or CDDP 50 mg/m2 added to DOX 60 mg/m2, every 4 weeks. RESULTS: A total of 177 patients were entered and median follow-up is 7.1 years. The combination DOX-CDDP was more toxic than DOX alone. Haematological toxicity consisted mainly of white blood cell toxicity grade 3 and 4 (55% versus 30%). Non-haematological toxicity consisted mainly of grade 3 and 4 alopecia (72% versus 65%) and nausea/vomiting (36 % versus 12%). The combination DOX-CDDP provided a significantly higher response rate than single agent DOX (P <0.001). Thirty-nine patients (43%) responded on DOX-CDDP [13 complete responses (CRs) and 26 partial responses (PRs)], versus 15 patients (17%) on DOX alone (8 CR and 7 PR). The median overall survival (OS) was 9 months in the DOX-CDDP arm versus 7 months in the DOX alone arm (Wilcoxon P = 0.0654). Regression analysis showed that WHO performance status was statistically significant as a prognostic factor for survival, and stratifying for this factor, treatment effect reaches significance (hazard ratio = 1.46, 95% confidence interval 1.05-2.03, P = 0.024). CONCLUSIONS: In comparison to single agent DOX, the combination of DOX-CDDP results in higher but acceptable toxicity. The response rate produced is significantly higher, and a modest survival benefit is achieved with this combination regimen, especially in patients with a good performance status.

Thrombin-antithrombin III and D-dimer plasma levels in patients with benign or malignant ovarian tumours.

In 50 patients with benign ovarian tumours, 39 malignant ovarian carcinoma patients and 39 age-matched healthy women, plasma levels of thrombin-antithrombin III complex and D-dimer were determined as well as CA 125. The coagulation activation marker thrombin-antithrombin III complex and D-dimer levels were elevated in the malignant group compared to the benign and control groups. The results suggest that coagulation and fibrinolysis must play a prominent role in ovarian cancer. Moreover, D-dimer and thrombin-antithrombin III were equally useful as CA 125 for the discrimination of patients with benign or malignant ovarian tumours as evidenced by receiver operating and likelihood ratio calculations.

Whole blood cell counts and leucocyte differentials in patients with benign or malignant ovarian tumours.

OBJECTIVE: The purpose of the study was to determine whether ovarian cancer patients had haematological anomalies compared to patients with benign ovarian tumours. STUDY DESIGN: Whole blood cell counts and leucocyte differentials were measured in 70 patients suspected of having ovarian tumours. Postoperatively, 20 patients had metastatic ovarian cancer and 50 patients had benign ovarian tumours. A control group consisted of 39 healthy women. Cell counting was performed by the Sysmex NE-8,000 system. The significance of differences was assessed by the Mann-Whitney U-test or the chi 2-test, where appropriate. RESULTS: The median haemoglobin and haematocrit levels were significantly lower (P-values 0.004 and 0.02, respectively) and the platelet count was higher (P = 0.02) in the malignant group compared with the benign group. The leucocyte differentials revealed significantly lower values for lymphocytes in the malignant group in comparison to the design and control groups (P-values 0.02 and 0.00005, respectively). A significant increase in monocytes (P = 0.002) and decreases in eosinophils and basophils (P-values 0.04 and 0.02, respectively) were found in the malignant group compared to the benign group. CONCLUSION: These results demonstrate significant changes in whole blood cell counts and leucocyte differentials in patients with ovarian cancer. The low lymphocyte counts in the malignant group possibly indicate a primary immunodeficiency as a casual factor.

Clinical and pathological aspects of benign and malignant squamous epithelium of the corpus uteri; a report of two cases.

Two patients with primary squamous cell carcinoma of the uterus are described. In both patients, the disease was at an advanced stage when the diagnosis was made. Although endometrial malignancies with squamous elements account for 10-30% of endometrial carcinomas, primary squamous cell carcinoma of the uterus is extremely rare. Up to now fewer than 30 cases have been reported. The pathogenesis, morphogenesis and aetiology of squamous epithelium in the corpus uteri is discussed. Finally, some clinical aspects of the primary squamous cell carcinoma of the corpus uteri are reviewed.

Is immunohistochemical analysis of oestrogen and progesterone receptors in endometrial carcinoma superior to the radioligand binding assay?

The aim of this study was to evaluate tissue and steroid receptor heterogeneity in endometrial carcinoma specimens as a possible source of discordance between biochemically assayed receptor status and response to endocrine treatment. For this purpose the oestrogen receptor (OR) and progesterone receptor (PR) levels in specimens from 16 endometrial carcinoma patients were analysed on adjacent tissue sections using both a radiochemical and an immunohistochemical assay. With immunohistochemical receptor analysis extensive tissue and tumour cell receptor heterogeneity was observed. Many tumour samples revealed up to 75 per cent contamination with benign tissue. In the majority of cases, evaluation of immunoreactivity in normal tissue elements of the specimen could explain the apparent discordance between semiquantitative immunohistochemical receptor scoring of tumour cells and radiochemical receptor assay. Immunohistochemical analysis of OR and PR in endometrial carcinoma specimens allows a more specific determination of tumour cell receptor content and hence may yield a more accurate prediction of response to endocrine therapy than the biochemical assay.

Single-dose oral fluconazole versus single-dose topical miconazole for the treatment of acute vulvovaginal candidosis.

OBJECTIVES: To compare efficacy, safety and patient preference of a single oral dose of 150 mg fluconazole with a single intravaginal dose of 1200 mg miconazole in vaginal candidosis. To investigate the effect of treatment on Candida colonization of throat and rectum. DESIGN: Double-blind, double-dummy, parallel, randomized trial. Ninety-nine patients with symptomatic and mycologically verified candidosis were given 150 mg fluconazole with an intravaginal dummy, or 1200 mg miconazole with an oral dummy. Patients with an inadequate short-term response were given a second dose. RESULTS: At each visit a patient self assessment and an investigators' global assessment were recorded, and cultures were set up. Adverse events were recorded and laboratory tests were performed. Clinical cure or improvement (investigators' assessment) was obtained in 100% (short-term) and 95% (long term) of the fluconazole group and in 94% and 90%, respectively, of the miconazole group. Patients considered the treatment excellent or good in 81% (short-term) and 88% (long-term) in the fluconazole group and in 84% and 76%, respectively, of the miconazole group. Mycological cure was achieved in 98% (short-term) and 73% (long-term) of the fluconazole group and in 96% and 82% respectively in the miconazole group. The differences in results were not significant. Both treatments significantly reduced the number of positive rectal cultures: neither treatment had a significant effect on throat cultures. Four percent of the patients preferred intravaginal therapy. CONCLUSION: A single dose fluconazole is as safe and effective as a single dose of miconazole.

Puerperal ultrasonic hysterography.

Ultrasonic hysterography was performed in 104 patients, between the 2nd and 5th postpartum day. An unexpectedly high number of women (16%) exhibited an abnormal uterine configuration. The ultrasonic diagnoses were compared to the results of previous investigations of the uterine configuration, if available.

Clinical experience in nonstressed antepartum cardiotocography.

The condition of the fetus during pregnancy was assessed by 1,763 antepartum cardiotocograms made in 386 patients with the use of fetal movements and physiologic uterine contractions. There appeared to be a significant correlation between the cardiotocograms and the obstetric outcome.

Restriction on the indications for metroplasty.

When a congenital uterine anomaly has been diagnosed, surgical correction of the malformed uterus is usually carried out. However, minor disturbances of glucose metabolism are easily overlooked in the presence of major congenital uterine malformation. In this paper we studied the obstetrical histories of 76 patients with congenital uterine anomalies. In the group with repeated pregnancy failure we found significantly more disturbances in carbohydrate metabolism than in the group with uneventful pregnancies (P less than 0.001). Treatment of any disturbances of carbohydrate metabolism greatly improves the fetal outcome. This suggests that such treatment is essential in the management of patients with a bad obstetrical history and may even make surgical correction unnecessary.