[Oncologic and fertility outcomes of young patients with early stage of cervical cancer treated by vaginal radical trachelectomy]

OBJECTIVE

To evaluate the prognosis and fertility outcomes of patients with early stage of cervical cancer treated by vaginal radical trachelectomy (VRT) in combination with laparoscopic pelvic lymphadenectomy.

METHODS

The surgical data, disease recurrences and fertility outcomes were analyzed retrospectively for 51 patients who received VRT in Peking Union Medical College Hospital from Dec. 2003 to Nov. 2013.

RESULTS

Forty-eight patients succeeded in preserving fertility. The median age was 29 years. International Federation of Gynecology and Obstetrics (FIGO) stage: 5 cases Ia1 with lymph vascular space invasion (LVSI), 4 cases Ia2 and 39 cases in stage Ib1. Tumor size: 20 cases with no visible lesion, 20 cases with tumor size ≤ 2 cm, 8 cases with tumor size > 2 cm. Histological type: 42 cases with squamous carcinoma, 6 cases with adenocarcinoma or adeno-squamous carcinoma. The mean excised cervical length and parametrial width was (2.6 ± 0.6) cm and (1.9 ± 0.5) cm, respectively. Six recurrences (12%) were observed after following up for a mean duration of (35 ± 21) months. The recurrent rate in patients with tumor size > 2 cm was 3/8, which was significantly higher than that of the patients with tumor size ≤ 2 cm (8%, 3/40;P < 0.01). Of the 35 patients who desired to conceive after the surgery, 13 women had 17 pregnancies and the pregnant rate was 37% (13/35). Nine women obtained 10 healthy live birth babies. The fertility rate was 26% (9/35).

CONCLUSIONS

VRT in combination with laparoscopic pelvic lymphadenectomy could preserve the fertility of patients with early stage of cervical cancer with acceptable oncologic and fertility outcomes. Tumor size ≤ 2 cm should be emphasized as the indication of VRT in considering of the higher recurrent rate in patients with tumor size > 2 cm.

Cell-cycle synchronization reverses Taxol resistance of human ovarian cancer cell lines

Background

Taxol is a powerful chemotherapy agent leading to mitotic arrest and cell death; however, its clinical efficacy has been hampered due to the development of drug resistance. Taxol specifically targets the cell cycle. Progress through mitosis (M stage) is an absolute requirement for drug-induced death because cell death is markedly reduced in cells blocked at the G₁-S transition. The measured doubling time for ovarian cancer cells is about 27 h. As such, during treatment with Taxol most of the cells are not in the M stage of the cell cycle. Thus, the effect of cell-cycle synchronization was investigated in regard to reversing Taxol resistance in ovarian cancer cells.

Methods

Giemsa-Wright staining was used for assessing the morphology of the cells. The doubling time of the cells was calculated using formula as follows: Td = In2/slope. The resistant index and cell cycle were measured via MTT assays and flow cytometry. Thymidine was used to induce cell-cycle synchronization, and cell apoptosis rates following exposure to Taxol were measured using a flow cytometer.

Results

The growth doubling time of two Taxol-resistant cell lines were longer than that of Taxol-sensitive cells. Apoptotic rates in Taxol-sensitive and -resistant cell lines after synchronization and exposure to Taxol were all higher compared to unsynchronized controls (p <0.05).

Conclusions

Synchronization of the cell-cycle resulted in an increased effectiveness of Taxol toward ovarian cancer cell lines. We speculated that formation of drug resistance toward Taxol in ovarian cancer could be partly attributed to the longer doubling time of these cells.

[Identification of low-risk indicators of early stage cervical cancer]

OBJECTIVE

To explore the low-risk indicators of early cervical cancer.

METHODS

The medical records of 201 patients undergoing radical surgery between March 2000 and April 2011 for staging Ia2,Ib1 (tumor diameter≤2cm) cervix cancer were retrospectively reviewed, with particular focus on the pathological findings [parametrial involvement, positive margin, positive pelvic lymph node, and lymph vascular space invasion (LVSI)], treatment, and outcomes.

RESULTS

The operation duration ranged 75-330min (mean:188.87 min) and the intra-operative blood loss was approximately 100-2500 ml (mean: 583.33 ml). Pathology showed the rate of parametrial spread, positive margins, lymph node metastasis, LVSI was 0, 6.97%, 12.44%, and 17.41%. Based on the pathologic findings, the patients were classified as two groups: group A had 147 patients(73.13%) with no neoplasm or tumor diameter ≤2 cm,while group B had 54 patients (26.87%) with tumor diameter > 2 cm. The incidence of ≥ 1/2 cervical stromal invasion, LVSI, positive lymph node, underlying section of uterus involvement, and low tumor differentiation in group A and B were 20.14% vs. 85.19% (p = 0.000), 13.61% vs. 27.78%(p = 0.019), 9.52% vs. 20.37% (p=0.039), 4.82% vs. 14.81% (p=0.008), and 35.37% vs. 44.44% (p=0.025), respectively, with significant differences. Among the 163 patients who were followed up for more than 3 months, 10(6.13%) developed recurrence whereas no patient died.

CONCLUSIONS

Pathologic parametrial involvement in clinical stage 1a2 and 1b1 cervical cancer is uncommon. Tumor size and cervical stromal invasion can be used to identify low-risk population that are worthy of consideration for studies of less radical surgery performed in conjunction with pelvic lymphadenectomy.

[Management of invasive cervical cancer in pregnancy: clinical analysis of 13 cases]

OBJECTIVE

To analyze the clinical characteristics and assess the outcome of treatment for cervical cancer during pregnancy.

METHODS

A cohort of 13 patients with cervical cancer diagnosed during pregnancy from January 2001 to September 2011 in Peking Union Medical College Hospital (PUMCH) was retrospectively studied. Clinical information, gestational age at diagnosis, treatment options and maternal and child outcomes were collected and analyzed.

RESULTS

Thirteen patients out of 2030 cases of invasive cervical cancer were diagnosed during pregnancy with an incidence of 0.64% (13/2030). The Mean gestational age at diagnosis of 13 patients is 21(+6) weeks. Two cases were diagnosed during the first trimester, 8 cases at second trimester and 3 cases at third trimester respectively. Vaginal bleeding during the pregnancy was main clinical manifestation presented in 8 patients and all thirteen cases were diagnosed by biopsy with pathological types of squamous cell carcinoma in 10 cases. The International Federation of Gynecology and Obstetrics (FIGO) stage was I in eleven cases and stage II in two cases. Six patients of them received treatment promptly after diagnosis. The other 7 patients had delayed treatment with mean diagnosis-treatment interval time of 65 days due to fertility reasons, who ended pregnancy by cesarean section at mean gestational age of 34(+6) weeks, two of them received chemotherapy with cisplatin + fluorouracil (PF) or cisplatin respectively before the end of the pregnancy, while the one with PF chemotherapy experienced neonatal death. The rest 6 neonatal outcomes were good. As follow-up of 13 cases: 11 cases in stage I received surgical treatment, and two of which had recurrence respectively, 15 months and 7 months post surgery, and one case had died. One case of Stage II patients died and one had recurrence after 53 months after radiotherapy. The recurrence rate in 13 cases was 3/13 and the mortality rate was 2/13.

CONCLUSIONS

Most cases of cervical cancer diagnosed during pregnancy were in early FIGO stage. For those patients diagnosed in late pregnancy with strong fertility demand, considering delayed treatment according to FIGO stage of the disease and fetus maturity is appropriate. Chemotherapy during pregnancy may cause neonatal complications.

Secretion of annexin A3 from ovarian cancer cells and its association with platinum resistance in ovarian cancer patients

Early detection of resistance to platinum-based therapy is critical for improving the treatment of ovarian cancers. We have previously found that increased expression of annexin A3 is a mechanism for platinum resistance in ovarian cancer cells. Here we demonstrate that annexin A3 can be detected in the culture medium of ovarian cancer cells, particularly these cells that express high levels of annexin A3. Levels of annexin A3 were then determined in sera from ovarian cancer patients using an enzyme-linked immunosorbent assay. Compared with those from normal donors, sera from ovarian cancer patients contain significantly higher levels of annexin A3. Furthermore, serum levels of annexin A3 were significantly higher in platinum-resistant patients than in platinum-sensitive patients. To gain insight into the mechanism of secretion, the ovarian cancer cell lines were examined using both transmission electron microscopy and immunoelectron microscopy. Compared with parent cells, there are significantly more vesicles in the cytoplasm of ovarian cancer cells that express high levels of annexin A3, and at least some vesicles are annexin A3-positive. Moreover, some vesicles appear to be fused with the cell membrane, suggesting that annexin A3 secretion may be associated with exocytosis and the release of exosomes. This is supported by our observation that ovarian cancer cells expressing higher levels of annexin A3 released increased numbers of exosomes. Furthermore, annexin A3 can be detected in exosomes released from cisplatin-resistant cells (SKOV3/Cis) by immunoblotting and immunoelectron microscopy.

Primary sarcoma of the ovary: clinicopathological characteristics, prognostic factors and evaluation of therapy

BACKGROUND

The primary ovarian sarcoma is a very rare malignancy. The objective of this study was to further investigate the clinicopathologic features and outcome in patients with primary sarcoma of the ovary.

METHODS

Between 1988 and 2007, 24 patients with primary ovarian sarcoma who underwent treatment at Peking Union Medical Hospital were reviewed retrospectively. Response to treatment, progression and overall survival were analyzed.

RESULTS

Patients with ovarian sarcoma had a mean age of (54.3 ± 10.3) years, and 16 of them were postmenopausal. The most common symptom was abdominal pain, present in 14 patients. Of the 24 patients, 16 patients were pathologically diagnosed as carcinosarcoma (known as malignant mixed mesodermal tumor (MMMT)), 2 as ovarian leiomyosarcoma (LS) and 6 patients as ovarian endometrial stromal sarcoma (ESS). The patients in optimal debulking group had a median survival period of 28 months and 1-year survival rate of 71%. The patients in suboptimal debulking group had a significantly lower median survival of 6 months (P = 0.02) and 1-year survival rate of 29%. Among the patients, 23 patients received chemotherapy and most of regimens were based on platinum, 3 patients received chemoradiation. The mean number of courses of combined chemotherapy was 6.6 ± 5.0, and the response was unsatisfactory. The median survival for the entire group was 18.7 months. The one-year survival rate was 58%, and two-year survival rate only 29%.

CONCLUSIONS

Ovarian primary sarcoma has a poor overall prognosis. Optimal debulking surgery appears to be of prognostic significance. There is a clear need for further study to explore the role and the regimen of platinum-based chemotherapy in primary ovarian sarcoma.

[Clinicopathologic analysis of 130 cases of mucinous borderline ovarian tumors]

OBJECTIVE

To determine the clinicopathologic characteristics of mucinous borderline ovarian tumors (MBOT) and evaluate the risk factors for recurrence.

METHODS

A retrospective study included age, the level of preoperative serum CA₁₂₅, surgical procedures, surgical-staging and the risk factors for recurrence in 130 patients with MBOT who were treated from Jan. 1994 to Dec. 2008 in Peking Union Medical College Hospital was done.

RESULTS

Preoperative serum CA₁₂₅ and CA₁₉₉ were elevated in 34% (33/96) and 50% (13/26) of patients respectively. Fifty-two radical surgeries included total hysterectomy and bilateral salpingo-ovarectomy (THBSO) and 78 fertility-sparing surgeries included 54 salpingo-oovarectomies (SO) and 24 cystectomy were done. Fifty-five cases underwent comprehensive surgical staging. Mean size of the tumors was (16 ± 10) cm and 90.0% (117/130) were limited to unilateral ovary. There were 59 (45.4%) cases, 62 (47.7%) cases, 2 (1.5%) cases and 7 (5.4%) cases in stage Ia, Ic, II, III, respectively. Forty-five (34.6%) concurrent with benign mucinous tumors, 14 (10.8%) ovarian intraepithelial carcinoma, 8 (6.2%) micro-invasive carcinoma and 4 (3.1%) pseudomyxoma peritonei were found. Median duration for follow-up was 56.3 months. Sixteen (12.3%) recurrences and 2 tumor related deaths were found. Median duration from surgery to recurrence was 25.6 months. Recurrent rate after THBSO (4%, 2/49) was significantly lower than that of SO (13%, 7/54) and cystectomy (17%, 4/24; P < 0.05). The recurrent rate of Ic or III was 18% (11/62) or 3/7, which were significantly higher than that of stage Ia (3%, 2/59; P < 0.05). Three of the 4 pseudomyxoma peritonei appeared of recurrence. While, the results showed that these were no effect on recurrent rate whether concurrent intraepithelial, microinvasive carcinoma or not comprehensive staging surgery.

CONCLUSIONS

Majority of MBOT were diagnosed in early stage and have favorable prognosis. Patients who take conservative surgery had higher recurrence rate than those radical surgery, but it doesn't affect survival. Late stage and concurrent pseudomyxoma peritonei are risk factors for recurrence.

Clinical characteristics of endometrial stromal sarcoma from an academic medical hospital in China

OBJECTIVES

The purpose of this study was to evaluate the clinical features, treatments, and outcomes of endometrial stromal sarcoma (ESS) in China.

METHODS

Seventy consecutive ESS patients were treated at Peking Union Medical College Hospital from 1983 to 2005, and 51 of them completed the treatment and follow-up. The demographic, clinicopathologic, treatment, and survival information was retrospectively reviewed. Data were analyzed using Kaplan-Meier methods and Cox proportional hazards regression.

RESULTS

In all, the mean age of the patients was 43.5 years. Irregular vaginal bleeding and uterine enlargement were presented in 71.0% and 65.7% of the cases, respectively. Uterine cavity lesions were found in 17 patients (24.3%). Twenty-six cases (37.2%) were diagnosed preoperatively through diagnostic curettage. Among 51 patients who completed the treatment and follow-up in Peking Union Medical College Hospital, 37 were diagnosed as having low-grade ESS (LGESS) and 14 high-grade ESS, which is now classified as undifferentiated endometrial sarcoma (UES). The median overall survival time was 334 months, and the 5-year survival rate was 87.8%. Twenty-six of 51 patients, including 14 with LGESS and 12 with UES, developed disease recurrence. The tumor's classification, initial surgery, and adjuvant therapy were the factors related to the disease-free survival, whereas only the tumor's classification was associated with the overall survival.

CONCLUSIONS

Endometrial stromal sarcoma is a rare kind of uterine malignancy; the possibilities of preoperative diagnosis may be improved by diagnostic curettage. Low-grade ESS and UES represent 2 distinct clinical entities and should be treated as such. The tumor's classification may be the most important prognostic factor.

[Prognostic factors and reproductive outcomes of borderline ovarian tumors: a review of 186 patients]

OBJECTIVE

To determine the clinicopathological characteristics of borderline ovarian tumors and to evaluate their prognostic factors and pregnancy rates/fertility outcomes after conservative surgery.

METHODS

A total of 186 patients with borderline ovarian tumors receiving treatment at our hospital from 1990 to 2007 were retrospectively studied and followed-up post-operatively for at least six months. The effects of clinicopathological characteristics upon recurrence and mortality were analyzed by independent sample t test, Chi-square test, Kaplan-Meier and Cox proportional hazard model.

RESULTS

The median follow-up time was 44 months. One hundred and nine patients underwent conservative surgery and 77 patients underwent radical surgery. Thirty-one relapses were reported. Only 3 died of disease. As demonstrated by multivariate analysis, surgical procedure, stage and pseudomyxoma peritonei were the independent prognostic factors for recurrence.

CONCLUSION

The recurrence rate of conservative surgery is higher than that of radical surgery. However, conservative surgery is safe as it does not result in a higher mortality rate.

[Microarray analysis of gene expression profiles in pelvic organ prolapse]

OBJECTIVE

To identify the differentially expressed genes in cardinal ligament between patients with pelvic organ prolapse (POP) and postmenopausal women without POP by Human Genome Expression Chip and explore the potential molecular mechanism involved in POP.

METHODS

From January to May, 2007, cardinal ligament samples were obtained from 3 postmenopausal patients with POP-Q stage III and 3 postmenopausal patients underwent hysterectomy due to other benign gynecologic diseases without POP in Peking Union Medical College Hospital. HE and Masson's trichrome staining was used to verify tissue origin and inspect histological changes. Those differentially expressed genes in cardinal ligaments were identified by Human Genome Chip and further interrogated with Gene Ontology (GO) and Pathway Analysis. Those remarkable expressed genes were confirmed by qRT-PCR.

RESULTS

Alterations of ligament architecture in POP patients included disarrangement and collapse of smooth muscle bundles and collagen fibers. A total of 179 differentially expressed genes were screened between POP and non-POP cardinal ligament tissue, including 20 functional unknown genes. A total of 107 genes were upregulated in POP group, while 72 genes downregulated. Those differentially genes were revealed associated with multiple functional proteins and metabolic pathways by biological analysis. Among these, Wnt signaling pathway exhibited the most remarkable changes. Real-time quantitative PCR showed the genes of COL1A1, DKK1, SFRP1, FZD5, WNT16b in POP group (2.98+/-1.40, 3.03+/-0.48, 8.13+/-4.42, 5.19+/-3.50, 12.40+/-3.88) were upregulated significantly compared with non-POP group (1.09+/-0.08, 1.20+/-0.18, 0.41+/-0.51, 0.87+/-0.24, 1.40+/-0.47; P<0.05).

CONCLUSIONS

The pathophysiology of POP is complex and associated with multiple functional proteins and metabolic pathways. Among these, the antagonist DKK1, SFRP1 in Wnt signaling pathway may contribute to a neurodegenerative role in POP development.

Increased expression of annexin A3 is a mechanism of platinum resistance in ovarian cancer

Resistance to platinum drugs has emerged as a major obstacle in the treatment of ovarian cancers. Through proteomic analysis, we have found that the expression of annexin A3, a member of the Ca(2+) and phospholipid-binding annexin family, is significantly increased in platinum-resistant ovarian cell lines. Anti-annexin A3 immunostaining indicated that cancers from platinum-resistant patients also possess higher levels of annexin A3 than those from platinum-sensitive patients. Although expression of annexin A3 made susceptible ovarian cancer cells more resistant to platinum, expression of antisense annexin A3 downregulated its expression and rendered the resistant cells more sensitive to platinum. In athymic mice, the growth of tumors from inoculated SKOV3 cells was inhibited by the administration of platinum, whereas tumors from annexin A3-expressing SKOV3/Ann were resistant to platinum treatment. Interestingly, the intracellular platinum concentration and platinum-DNA binding are significantly lower in annexin A3-overexpressing cells than those in parental cells. The lower cisplatin concentration was also accompanied by reduced induction of p53, which could be restored by downregulation of annexin A3. These results indicate that increased expression of annexin A3 is a mechanism of platinum resistance in ovarian cancer. It seems to act by preventing uptake or accumulation of platinum in cells. Therefore, it is conceivable that annexin A3 could be a target for therapeutic intervention and may also serve as a biomarker for drug resistance in ovarian cancer patients.

[Mullerian adenosarcoma of the uterus: A clinicopathologic analysis of 9 cases]

OBJECTIVE

To investigate the clinicopathologic features, diagnosis, treatment and prognosis of uterine mullerian adenosarcoma.

METHODS

The clinicopathological data of 9 cases of uterine mullerian adenosarcoma in PUMC hospital from January 2003 to February 2009 were retrospectively analyzed.

RESULTS

There were 6 uterine endometrial adenosarcomas and 3 cervical adenosarcomas. The main clinical manifestations were abnormal vaginal bleeding and pelvic pain. Physical examination showed cervical/vaginal mass, enlarged uterus or pelvic mass. The adenosarcoma was characterized by benign or atypical-appearing neoplastic glands within a sarcomatous stroma. This stroma could appear as periglandular cuffs or intraglandular polypoid projections of increased cellular structure. The primary diagnostic rate was 66.7% and the most common clinical stage was stage I (7/9). All patients received surgical treatment and seven had postoperative chemotherapy, radiotherapy or hormone therapy. Conservation of unilateral ovary or bilateral ovaries was performed in 5 cases. Three patients underwent local excision, which resulted in the preservation of reproductive function. During the follow-up, 2 cases of uterine endometrial adenosarcoma recurred. One patient of clinical stage III containing sarcomatous overgrowth died from recurrence 13 months after surgery. The other one recurred 2 years after local excision of the tumor in the uterine cavity and she remained healthy since hysterectomy.

CONCLUSION

Uterine mullerian adenosarcoma is a rare tumor without specific clinical symptoms and signs. The diagnosis depends on pathomorphologic examination. The tumors show low malignant potential and the vast majority are at early stage. Surgical excision is the main treatment strategy with a good prognosis in the early stage disease with complete removal of tumors. The prognosis is poor in advanced adenosarcoma with sarcomatous overgrowth. Due to the relatively high rate of recurrence, long-term follow-up is recommended.

[Treatment of malignant ovarian germ cell tumors with relapse or failed in primary therapy]

OBJECTIVE

To study the clinical characteristic, the optimal treatments and the prognosis for the recurrence and failure of primary treatment in malignant ovarian germ cell tumors (MOGCT).

METHODS

The clinical data of 17 recurrent and failure of primary treatment in MOGCT cases treated in Pecking Union Medical College Hospital from January 1983 to May 2008 were analyzed retrospectively to evaluate failure of primary treatment and second treatment.

RESULTS

Only the 4 cases of recurrent and failure of primary treatment of MOGCT were underwent comprehensive surgical staging. After primary surgery in 1 - 8 months, 16 cases received the non-standard chemotherapy were found the lesion again. The secondary debulking surgery was done for the 15 cases and also received the standard chemotherapy. Among of them, 8 cases were survival during follow up, 5 cases gave up the treatment and 4 patients were lost following up during the treatment.

CONCLUSIONS

The standard primary treatment is the most important for the MOGCT. Even for the recurrence and failure of primary treatment of MOGCT, the satisfied cytoreductive surgery plus the standard chemotherapy also show the significant impact on the prognosis.

Impact of Platinum on the Whole Mitochondrial Genome of Ovarian Carcinomas Both In Vivo and In Vitro

Objectives:

To investigate somatic mitochondrial DNA mutation in primary and recurrent ovarian carcinoma tissues as well as that in drug-resistant cell lines to illuminate the impact of chemotherapeutic drugs on mitochondrial DNA (mtDNA).

Methods:

Complete mtDNA genomes of 20 pairs of ovarian carcinomas and their matched normal tissues together with 2 ovarian carcinoma cell lines and their 4 platinum-resistant cell lines were sequenced. Mitochondrial DNA alterations, consequent amino acid alterations were compared between the 2 groups of patients and the 2 types of cell lines.

Results:

A large number of mtDNA new polymorphisms (55) and mutations (18) were identified in 20 ovarian carcinoma samples. Platinum-based chemotherapy did not increase the number of new polymorphisms (P = 0.094), mutations (P = 0.688), and consequent amino acid alterations (P = 0.202 and 0.795). Data gained from the cell lines also indicated that platinum had some effect on the mitochondrial genome but not specific to particular positions.

Conclusions:

What we found suggested that mtDNA damage could be made by chemotherapeutic drugs but not as much as imagined in ovarian carcinomas. Some of the mtDNA defects might be part of the disease processes and cell properties as well as a consequence of treatment.

[Clinical analysis of 42 cases of primary malignant tumor in vagina]

OBJECTIVE

To analyze the clinical characters, treatment and prognosis of primary malignant tumor in vagina.

METHODS

A retrospective analysis of 42 patients diagnosed with primary malignant tumor in vagina in Peking Union Medical College Hospital (PUMCH) between Jan 1984 and Aug 2006 was performed.

RESULTS

Primary malignant tumor accounted for 0.98% (42/4286) in the total gynecological malignant tumors during that period in PUMCH. According to the International Federation of Gynecology and Obstetrics (FIGO) staging system, 19 cases were at stage I, 12 cases at stage II, 5 cases at stage III, and 6 cases at stage IV. Thirteen cases were squamous carcinoma, 13 cases were malignant melanoma, 8 cases were adenocarcinoma, 3 cases were yolk sac tumor and 5 cases were other types. The majority of patients were treated with surgery combined with radiotherapy and chemotherapy. Up to August 2007, 19 cases survived, 18 cases were dead and 5 cases were lost. The longest follow up was 10 years, with the median time of 2 years. The overall 2-year survival rate was 60.6%. For stage I, stage II and stage III - IV, the 2-year survival rates were 71.3%, 58.3% and 29.6% respectively. The 2-year survival rate of patients with squamous carcinoma was 46.8%, malignant melanoma 72.9%, adenocarcinoma 20.0% and patients with yolk sac tumor were all alive tumor-free after 6 - 10 years' follow up.

CONCLUSIONS

The prognosis of primary malignant tumor in vagina is affected by clinical stage and histological type. As to malignant melanoma, radical surgery combined with chemotherapy and immunotherapy produce good effects. Patients with yolk sac tumor can be cured only with chemotherapy. As to other types, more treatment experiences are needed.

[Comparison of effectiveness between intra-arterial and intra-venous neoadjuvant chemotherapy in stage Ib2-IIb cervical carcinoma]

OBJECTIVE

To compare the effect between intra-arterial and intra-venous neoadjuvant chemotherapy (NACT) in stage Ib2-IIb cervical carcinoma.

METHODS

A retrospective analysis was done on 52 cases of intra-venous NACT and 95 cases of intra-arterial NACT for stage Ib2-IIb cervical carcinoma treated in Peking Union Medical College Hospital from 1999.

RESULTS

The response rate of intra-venous NACT and intra-arterial NACT was 88% (46/52) and 79% (75/95), and the operative rate after NACT was 81% (42/52) and 72% (68/95) respectively (P > 0.05). There were no significant differences in surgery time, blood loss and post-operative morbidity between these two groups. Pathological parametrial positive rate after NACT in arterial group (6%) was significantly lower than that of venous group (50%, P > 0.05). The venous group had very similar recurrence rates (13% vs 17%) and death rates (9% vs 12%) when compared with the arterial group (P > 0.05).

CONCLUSIONS

The intra-arterial and intra-venous NACT for stage Ib2-IIb cervical carcinoma show similar response rate, operative rate and surgical difficulties. Arterial NACT shows a better effect on parametrial infiltration.

[Clinical features of recurrence of vulvar squamous cell carcinoma: analysis of 18 cases]

OBJECTIVE

To analyze the clinical characteristics of recurrence of vulvar squamous cell cancer and to explore the treatment thereof.

METHODS

The clinical data of 18 patients vulvar squamous cell cancer, confirmed at the age 28-76, who developed recurrence were retrospectively analyzed.

RESULTS

The overall recurrence rate was 21.3%. The time range between the primary operation and the discovery of primary recurrence was 2 months - 16 years. Local recurrence occurred in 11 of the 18 patients (61.1%). Recurrence in groin alone occurred in 4 of the 10 patients (22.2%) and recurrence in both the vulva and groin occurred in 3 of the 18 patients (16.7%). Local recurrence occurred more than 1 year after the primary treatment and inguinal recurrence occurred mostly within 1 year after the primary treatment. The survival time of the patients with vulvar recurrence was (63.2 +/- 8.1) months, significantly longer than that of the patients with groin recurrence [(10.7 +/- 1.6) months, P < 0.01].

CONCLUSION

The clinical characteristics and the prognosis of recurrent vulvar squamous cell cancer depend on the site of recurrence. The best treatment option for recurrence is surgery.

[Role of high-risk human papillomavirus testing in the screening and management of cervical cancer precursors]

Human papillomavirus (HPV) infection is an essential cause of cervical cancer. HPV testing therefore may maximize the clinical benefits of cervical screening and abnormal cervical cytology management. A negative HPV test in combination with a normal Pap test result in women age 30 years or older allows the safe extension of the cervical screening interval to 3 years. However, because HPV infection is common in young women and is usually transient, HPV testing is not recommended as part of primary cervical screening for women younger than 30 years. HPV testing is recommended for women of any age as a triage test with atypical squamous cells of undetermined significance (ASC-US) results and as an option for follow-up of women with HPV-positive ASC-US, atypical squamous cells "cannot rule out high-grade", low-grade squamous intraepithelial lesions, or atypical granular cells not found to have CIN 2/3. HPV testing is also recommended as an alternative to colposcopy and/or cytology for follow-up of treated cases. Proper use of HPV testing improves the management of women with cytologic abnormalities.

Phase II study of gemcitabine combined with platinum chemotherapy for recurrent epithelial ovarian cancer

OBJECTIVE

To evaluate the anti-tumor effect and toxicity of gemcitabine combined with platinum chemotherapy on recurrent epithelial ovarian cancer.

METHODS

Phase II study of gemcitabine combined with platinum chemotherapy was carried out in 22 patients with recurrent epithelial ovarian cancer. Median age of patients was 50.5 years old. Seven patients were platinum-sensitive and 15 patients were platinum-resistant or -refractory. All patients received gemcitabine combined with carboplatin or oxaliplatin chemotherapy. Patients' response rate (RR) and toxicity of gemcitabine combined with platinum chemotherapy were evaluated.

RESULTS

A total of 98 gemcitabine-based chemotherapy cycles were performed. Total RR was 36.4%, RR of platinum-sensitive patients was 4/7 and platinum-resistant and -refractory patients was 4/15. The estimated median survival time was 10.0 months (95% CI: 7.0-13.0) after initiation of gemcitabine combined with platinum chemotherapy. There was no significant difference in survival time between platinum-resistant/refractory group and platinum-sensitive group (P = 0.061). Side effects of gemcitabine combined with platinum chemotherapy were observed in 81.8% of patients. Grade II/III anemia (54.5%) and grade III/IV neutropenia (54.5%) were most common toxicities. Ten (45.5%) patients had to delay their chemotherapy cycles or reduce the dose of chemotherapeutic drugs because of the severe side effects. Fourteen (63.6%) patients received granulocyte colony-stimulating factor to relieve neutropenia, and 8 (36.4%) patients received component blood transfusion to treat anemia or thrombocytopenia. There was no treat-ment-associated death.

CONCLUSION

Gemcitabine combined with platinum chemotherapy appears to be an effective and well-tolerant treatment for recurrent epithelial ovarian cancer, including platinum-resistant or -refractory diseases.