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.

[Relationship between crown form of upper central incisors and papilla filling in Chinese Han-nationality youth]

OBJECTIVE

To explore a crown form classification method for upper central incisor which is more objective and scientific than traditional classification method based on the standardized photography technique. To analyze the relationship between crown form of upper central incisors and papilla filling in periodontally healthy Chinese Han-nationality youth.

METHODS

In the study, 180 periodontally healthy Chinese youth ( 75 males, and 105 females ) aged 20-30 (24.3±4.5) years were included. With the standardized upper central incisor photography technique, pictures of 360 upper central incisors were obtained. Each tooth was classified as triangular, ovoid or square by 13 experienced specialist majors in prothodontics independently and the final classification result was decided by most evaluators in order to ensure objectivity. The standardized digital photo was also used to evaluate the gingival papilla filling situation. The papilla filling result was recorded as present or absent according to naked eye observation. The papilla filling rates of different crown forms were analyzed. Statistical analyses were performed with SPSS 19.0.

RESULTS

The proportions of triangle, ovoid and square forms of upper central incisor in Chinese Han-nationality youth were 31.4% (113/360), 37.2% (134/360) and 31.4% (113/360 ), respectively, and no statistical difference was found between the males and females. Average κ value between each two evaluators was 0.381. Average κ value was raised up to 0.563 when compared with the final classification result. In the study, 24 upper central incisors without contact were excluded, and the papilla filling rates of triangle, ovoid and square crown were 56.4% (62/110), 69.6% (87/125), 76.2% (77/101) separately. The papilla filling rate of square form was higher (P=0.007).

CONCLUSION

The proportion of clinical crown form of upper central incisor in Chinese Han-nationality youth is obtained. Compared with triangle form, square form is found to favor a gingival papilla that fills the interproximal embrasure space. The consistency of the present classification method for upper central incisor is not satisfying, which indicates that a new classification method, more scientific and objective than the present one, is to be found.

Progress of beam diagnosis system for EAST neutral beam injector

Neutral beam injection has been recognized as one of the most effective means for plasma heating. According to the research plan of the EAST physics experiment, two sets of neutral beam injector (NBI) were built and operational in 2014. The paper presents the development of beam diagnosis system for EAST NBI and the latest experiment results obtained on the test-stand and EAST-NBI-1 and 2. The results show that the optimal divergence angle is (0.62°, 1.57°) and the full energy particle is up to 77%. They indicate that EAST NBI work properly and all targets reach or almost reach the design targets. All these lay a solid foundation for the achievement of high quality plasma heating for EAST.

Note: A new regulation method of stable operation of high power cathode ion source

The hot cathode ion source will tend to be unstable when operated with high power and long pulse. In order to achieve stable operation, a new regulation method based on the arc power (discharge power) feedback control was designed and tested on the hot cathode ion source test bed with arc discharge and beam extraction. The results show that the new regulation method can achieve stable arc discharge and beam extraction. It verifies the success of feedback control of arc source with arc power.

Clinical significance of peritumoral lymphatic vessel density and lymphatic vessel invasion detected by D2-40 immunostaining in FIGO Ib1-IIa squamous cell cervical cancer

The clinical significance of lymphangiogenesis in cervical cancer remains controversial. Our aim was to investigate the correlation between lymphangiogenesis, lymphatic vessel invasion (LVI) and tumor metastasis, invasion and prognosis in squamous cell cervical cancer. Paraffin sections of 90 patients with FIGO (Fédération Internationale de Gynécologie et d'Obstétrique) Ib1-IIa squamous cell cervical cancer were stained for immunohistochemistry with a D2-40 monoclonal antibody against the carcinoembryonic antigen M2A. The lymphatic vessel density (LVD) and LVI were measured, and their relationship with the clinicopathological data was analyzed. D2-40-positive lymphatic vessels were found in 75 of the 90 patients (83.3 %). All D2-40-positive vessels were located in peritumoral areas. The mean±SD of the peritumoral LVD was 10.08±4.16. The positive rate of LVI was 32.0 % (24/75). The recurrence rate of patients with LVD >10 (62.1 %, 18/29) was significantly higher than that of patients with LVD ≤10 (34.8 %, 16/46, P = 0.021). The 5-year recurrence-free survival rate of patients with LVD >10 (41.0 %) was significantly lower than that of patients with LVD ≤10 (67.0 %, P = 0.045). Univariate analysis showed that the peritumoral LVD (≤10 vs >10) was correlated with LVI (absent vs present, P = 0.016). The peritumoral LVD and LVI showed no correlation with age, FIGO stage, tumor size, tumor grade, depth of invasion, or pelvic lymph node metastasis (all: P > 0.05). Peritumoral lymphangiogenesis was correlated with the recurrence and recurrence-free survival in patients with squamous cell cervical cancer. Examination of peritumoral LVD in these patients might therefore help to estimate the risk of recurrence.

Clinical significance of combined examination of pretreatment serum CYFRA21-1 and SCCAg in cervical cancer patients

BACKGROUND AND OBJECTIVE

Cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) can be used for the quantitative examination of fragment of cytokeratin 19, and is a valuable tumor marker in various malignancies. This study was to investigate the significance of pretreatment serum CYFRA21-1 and squamous cell carcinoma antigen (SCCAg) in diagnosis and their correlations to the clinicopathologic features of cervical carcinoma.

METHODS

One hundred cervical carcinoma patients underwent pretreatment serum CYFRA21-1 and SCCAg evaluation; 20 healthy women were subjected as control. The specificity and sensitivity of CYFRA21-1 and SCCAg as diagnostic indexes were analyzed; their correlations to clinicopathologic features were investigated through univariate and multivariate analyses.

RESULTS

The specificity of CYFRA21-1 and SCCAg in diagnosing cervical cancer were both 100%. The sensitivity of CYFRA21-1 and SCCAg in diagnosing cervical cancer were 36.0% and 47.0% respectively, without significant difference. The combined examination of CYFRA21-1 and SCCAg elevated the sensitivity to 60.0%, which was significantly higher than that of examining CYFRA21-1 alone. Univariate analysis showed elevation of CYFRA21-1 was related with FIGO stage and tumor size; elevation of SCCAg was related with pathologic type, tumor size, deep stromal invasion and pelvic node metastasis. Multivariate analysis showed that elevation of CYFRA21-1 had no relationship with any factors, while elevation of SCCAg was related with deep stromal invasion and pelvic node metastasis. The sensitivity of SCCAg in predicting pelvic node metastasis and deep stromal invasion were significantly higher than those of CYFRA21-1 (75.0% vs. 29.2%, p = 0.001; 55.8% vs. 26.9%, p = 0.024), and the addition of CYFRA21-1 to SCCAg could not significantly improve the sensitivity compared with SCCAg alone (79.2% vs. 75.0%, p > 0.05; 63.5% vs. 55.8%, p > 0.05).

CONCLUSION

The value of pretreatment serum CYFRA21-1 as predictor of pelvic node metastasis and deep stromal invasion is less significant compared with that of SCCAg. For cervical squamous cell cancer, SCCAg is the preferred tumor marker.

Molecular diagnosis of sentinel lymph node metastases in cervical cancer using squamous cell carcinoma antigen

PURPOSE

To clarify the prognostic value of molecular diagnosis of SLN metastases in cervical cancer using SCCA.

EXPERIMENTAL DESIGN

All SLNs and primary tumors, part of non-SLNs, were harvested from 36 patients with cervical cancer. Expression levels of SCCA, cytokeratin 19 (CK19), and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) mRNA in 178 samples (29 primary tumors, 5 histologic positive nodes, 60 histologic negative SLNs, 69 non-SLNs, and 15 normal nodes) were assessed by quantitative reverse transcription-PCR assay. The quantitative value of SCCA or CK19 mRNA was described as each value relative to GAPDH mRNA. The cutoff value was set at the upper limit of the quantitative value of nodes from noncancer patients, and those above this value constituted the molecular metastasis group.

RESULTS

The SCCA mRNA expression values were more than 1 x 10(3) in 28 primary tumors and all histologic positive nodes, and its expression levels in SLNs were higher than in non-SLNs. SLNs from patients with adverse prognostic features had higher SCCA mRNA expression levels. Four histologic negative SLNs were diagnosed molecular metastases based on SCCA mRNA. Two cases with histologically uninvolved pelvic nodes recurred. Survival analysis indicates that molecular lymphatic metastasis based on elevated SCCA mRNA level is the best predictor of recurrence. However, CK19 is not a suitable marker due to its low specificity and relative higher baseline expression in normal nodes.

CONCLUSIONS

SCCA mRNA levels for molecular diagnosis of SLN metastases in cervical cancer more accurately identifies patients at risk for recurrence than the routine histology does.

[Expression and clinical significance of microtubule-associated protein 1 light chain 3 (LC3) and Beclin1 in epithelial ovarian cancer]

BACKGROUND & OBJECTIVE

Some studies have showed that changes of autophagic capacity may be correlated to tumorigenesis and tumor development. This study was to investigate the expression of microtubule-associated protein 1 light chain 3 (LC3) and autophagy-related gene Beclin1 in ovarian tumor tissues, and explore their correlations to the tumorigenesis and development of epithelial ovarian carcinoma.

METHODS

Expressions of LC3 and Beclin1 in 25 specimens of benign ovarian tumor, 25 specimens of borderline ovarian tumor, and 75 specimens of epithelial ovarian carcinoma were detected by immunohistochemistry. The correlations of LC3 and Beclin1 expression to the clinicopathologic characteristics of the 75 epithelial ovarian cancer patients were analyzed.

RESULTS

The positive rates of LC3 and Beclin1 were significantly higher in benign and borderline ovarian tumors than in epithelial ovarian carcinoma (100% and 96% vs. 57%, P<0.001; 100% and 84% vs. 57%, P<0.001). The expression of LC3 was associated with FIGO stage and histological grade (P=0.017;0.001). The expression of Beclin1 was related to FIGO stage (P=0.04). The expression of LC3 was not correlated to Beclin1 (P=0.875).

CONCLUSIONS

Expressions of LC3 and Beclin1 are down-regulated in epithelial ovarian cancer tissues. The decrease of autophagic capacity may relate to tumorigenesis and the development of epithelial ovarian cancer.

Sentinel lymph node detection using methylene blue in patients with early stage cervical cancer

OBJECTIVE

To evaluate the feasibility of sentinel lymph node (SLN) detection in patients with cervical cancer using the low-cost methylene blue dye and to optimize the application procedure.

PATIENTS AND METHODS

Patients with stage Ib(1)-IIa cervical cancer and subjected to abdominal radical abdominal hysterectomy and pelvic lymphadenectomy were enrolled. Methylene blue, 2-4 ml, was injected into the cervical peritumoral area in 77 cases (4 ml patent blue in the other four cases) 10-360 min before the incision, and surgically removed lymph nodes were examined for the blue lymph nodes that were considered as SLNs.

RESULTS

High SLN detection rate was successfully achieved when 4 ml of methylene blue was applied (93.9%, 46/49). Bilaterally SLN detection rate was significantly higher (78.1% vs. 47.1% P=0.027) in cases when the timing of application was more than 60 min before surgery than those with timing no more than 30 min. The blue color of methylene blue-stained SLNs sustained both in vivo and ex vivo, compared with the gradually faded blue color of patent blue that detected in 3 of 4 cases unilaterally. In the total of 112 dissected sides, the most common location of SLNs was the obturator basin (65.2%, 73/112), followed by external iliac area (30.4%, 34/112) and internal iliac area (26.8%, 30/112). Three patients who gave false negative results all had enlarged nodes.

CONCLUSION

Methylene blue is an effective tracer to detect SLNs in patients with early stage cervical cancer. The ideal dose and timing of methylene blue application are 4 ml and 60-90 min prior surgery, respectively.

[Correlation of CXCR4/CXCL12 overexpression to lymph node metastasis and chronic inflammation in cervical adenocarcinoma]

BACKGROUND & OBJECTIVE

CXCL12 is a kind of chemokine. CXCR4, the specific receptor of CXCL12, is involved in metastasis of tumors. CXCR4/CXCL12 expression in cervical adenocarcinoma has seldom been reported. This study was to investigate the correlation of CXCR4/CXCL12 overexpression to lymph node metastasis and chronic inflammation in cervical adenocarcinoma.

METHODS

CXCR4 and CXCL12 immunohistochemical staining and HE staining were performed in 35 specimens of cervical adenocarcinoma, including 8 with lymph node metastasis and 27 without. Marked expression of CXCR4 or CXCL12 observed in more than 90% tumor cells was defined as overexpression. Fisher's exact test, Chi-square test, and Pearson correlation test were used to analyze the results.

RESULTS

All 35 specimens of cervical adenocarcinoma expressed CXCR4. The overexpression rate of CXCR4 was significantly higher in the cases with lymph node metastasis than in those without (62.50% vs. 22.00%, P<0.05), slightly higher in the IB cases with lymph node metastasis than in those without (33.33% vs. 26.01%, P>0.05), and significantly higher in the IIB cases with lymph node metastasis than in those without (80.00% vs. 0.00%, P<0.05). The positive predictive value of CXCR4 overexpression to assess lymph node metastasis was 45.45%, and the negative predictive value was 87.50%. A variable number of tumor cells in 33 specimens expressed CXCL12. The overexpression rate of CXCL12 was significantly higher in IB cases than in IIB cases either in tumors with lymph node metastasis (0.00% vs. 80.00%, P<0.05) or without (21.73% vs. 75.00%, P<0.05). CXCR4 overexpression was positively correlated to CXCL12 overexpression in the 23 IB cases without lymph node metastasis; but the correlation did not exist in the 3 IB cases with lymph node metastasis and the 9 IIB cases. All the 35 specimens were accompanied with chronic inflammation; the infiltrates were mainly lymphocytes. CXCL12 overexpression was not correlated to the infiltration degree of chronic inflammation.

CONCLUSIONS

CXCR4 overexpression indicates a higher lymph node metastasis potential of cervical adenocarcinoma. The overexpression rate of CXCL12 is increasing by the progression of tumors. The chronic inflammatory cells in cervical adenocarcinoma are not attracted by CXCL12.

[Effect of survivin shRNA on chemosensitivity of human ovarian cancer cell line OVCAR3 to paclitaxel]

BACKGROUND & OBJECTIVE

Drug resistance is a major obstacle to the successful chemotherapy of ovarian cancer. Recent studies have shown overexpression of Survivin in ovarian cancer tissues and cell lines, which may play an important role in the drug resistance of ovarian cancer. This study was to explore the effects of Survivin short hairpin RNA (shRNA) on Survivin expression, apoptosis, and chemosensitivity of human ovarian cancer cell line OVCAR3.

METHODS

OVCAR3 cells were transfected with Survivin shRNA. Untransfected, lip-transfected, and mU6-transfected cells were set as controls. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expression of Survivin mRNA. Flow cytometry was applied to examine the expression of Survivin protein and cell apoptosis. MTT assay was used to examine the effect of Survivin shRNA on chemosensitivity of OVCAR3 cells.

RESULTS

The mRNA and protein levels of Survivin were obviously lower in Survivin shRNA-transfected OVCAR3 cells than in untransfected cells, lip-transfected cells, and mU6-transfected cells 24 h after transfection. The apoptotic rates of OVCAR3 cells 12 h, 24 h, 36 h, 48 h after Survivin shRNA transfection were 20.7%, 31.9%, 39.0%, and 46.7%, respectively, that showed a time-dependent manner. The 50% inhibitory concentrations (IC50) of paclitaxel were (0.305+/-0.032) micromol/L for untransfected cells, (0.157+/-0.031) micromol/L for lip-transfected cells, (0.175+/-0.010) micromol/L for mU6-transfected cells, and (0.019+/-0.001) micromol/L for Survivin shRNA-transfected cells; and the IC50 of cisplatin were (9.410+/-0.796) micromol/L, (6.675+/-1.739) micromol/L, (6.930+/-1.273) micromol/L, and (7.862+/-0.081) micromol/L, respectively. Survivin shRNA increased the sensitivity of OVCAR3 cells to paclitaxel by 16 folds (P<0.01), but had no significant effect on the sensitivity to cisplatin (P>0.05).

CONCLUSION

Sequence-specific shRNA targeting Survivin can suppress the expression of Survivin gene effectively in OVCAR3 cells, and sensitize OVCAR3 cells to paclitaxel, but has no significant effect on the sensitivity to cisplatin.

[Recurrence risk factors of platinum-sensitive epithelial ovarian cancer]

BACKGROUND & OBJECTIVE

The prognosis of platinum-sensitive ovarian cancer patients was better than that of chemoresistant ones. However, platinum-sensitive ovarian cancer patients still have a high recurrence rate, which affects their prognosis. This study was designed to analyze clinical features and recurrence risk factors of platinum-sensitive epithelial ovarian cancer.

METHODS

Factors that might relate to recurrence of 90 platinum-sensitive epithelial ovarian cancer patients, admitted in Cancer Center of Sun Yat-sen University from 1993 to 1999, with complete remission of more than 6 months, were assessed. Univariate analysis was performed using Chi(2) test; while multivariate analysis was carried out using Cox proportional hazard model.

RESULTS

Among the 90 patients, 36(40.0%) relapsed with the median recurrence-free interval of 20 months. Pelvic cavity (18/36, 50.0%) was the most frequently involved. The 3-and 5-year survival rates of all patients were 79.6% and 69.5%; while those of the recurrent ones were 62.3% and 39.6%. Univariate analysis showed that the early FIGO stage group, mucinous type group, and no neoadjuvant chemotherapy group had lower recurrence rates than advanced FIGO stage group, non-mucinous type group, and neoadjuvant chemotherapy group, respectively (P=0.001, P=0.002, and P=0.025). Cox multivariate analysis showed that only FIGO stage was the independent risk factor of recurrence of ovarian cancer (risk ratio=1.771, P=0.003). There was no significant difference in recurrence rate between CBP and other postoperative chemotherapy regimen groups. More cycles of chemotherapy could not reduce the recurrence rate.

CONCLUSION

Since FIGO stage is an independent recurrence risk factor of platinum-sensitive epithelial ovarian cancer patients, early diagnosis is the key point to decrease the recurrence rate.

[Expression of metastasis suppressor gene KAI1/CD82 in cervical squamous cell carcinoma and its clinical significance]

BACKGROUND & OBJECTIVE

Metastasis suppressor gene KAI1/CD82 plays an important role in infiltration and metastasis of several types of human cancers, while the researches on its relation with cervical carcinoma are far from adequate now. Therefore, immunohistochemical techniques were employed in this study to determine the expression of KAI1 gene, and explore its clinical significance in cervical squamous cell carcinoma.

METHODS

SP immunohistochemistry was used to detect the expression of KAI1 gene in 99 specimens of cervical squamous cell carcinoma, 25 specimens of cervical intraepithelial neoplasm (CIN) II-III, and 18 specimens of normal cervix. Correlations of expression of KAI1 gene to clinicopathologic factors, and prognosis of cervical squamous cell carcinoma were statistically analyzed.

RESULTS

The rates of negative, weak, moderate, and strong expression of KAI1 in cervical squamous cell carcinoma were 52.5% (52/99), 16.2% (16/99), 15.2% (15/99), and 16.2% (16/99), respectively, significantly lower than those in normal cervix, and CIN II-III (P=0.000). Expression of KAI1 has no correlation with FIGO stage, age, pelvic lymph node metastasis, tumor histological grade, depth of cervical infiltration, serum squamous cell carcinoma antigen (SCC) level, tumor size, and gross type of cervical lesion (P>0.05). Both univariate and multivariate analyses showed expression of KAI1 has no correlation with prognosis of cervical squamous cell carcinoma (P>0.05).

CONCLUSION

KAI1 gene may be an early event in development of cervical cancer, and has no correlation with prognosis of cervical squamous cell carcinoma.

Up-regulated expression of cytoplasmic clusterin in human ovarian carcinoma

BACKGROUND

Recently, tumorigenic roles of the clusterin gene in several human malignancies have been suggested, but its potential role in the development and progression of ovarian carcinoma is unclear.

METHODS

In the current study, immunohistochemistry was used to examine the expression status of clusterin in 10 normal ovaries, 20 ovarian cystadenomas, 15 borderline ovarian tumors, and 240 ovarian carcinomas (nonmetastatic and metastatic) by tissue microarray. In addition, the apoptotic index of each tumor was assessed with a terminal deoxyuridine triphosphate nick-end labeling assay.

RESULTS

Positive staining for clusterin in different ovarian tissues was observed primarily a cytoplasmic pattern. Cytoplasmic overexpression of clusterin was detected in none of the normal ovaries, in 17% of cystadenomas, in 38% of borderline tumors, and in 58% of invasive ovarian carcinomas. A significant association was observed (P < 0.001) between the overexpression of clusterin and late clinical stage according to the International Federation of Gynecology and Obstetrics staging system. In addition, the overexpression of clusterin was detected more frequently in metastatic lesions than that in their matched primary tumors. The current results also provided evidence that the overexpression of cytoplasmic clusterin in carcinomas was correlated inversely with the tumors' apoptotic index, demonstrating an antiapoptotic function of cytoplasmic clusterin in ovarian carcinomas.

CONCLUSIONS

The current results suggested that the overexpression of cytoplasmic clusterin may represent an acquired malignant phenotypic feature of ovarian carcinoma and may be one of the important factors in determining the aggressive nature of ovarian carcinoma.

[Comparison of pelvic transarterial chemoembolization with lipiodol ultra-fluid carboplatin and transarterial carboplatin through experiment in dogs]

BACKGROUND & OBJECTIVE

Transarterial chemoembolization, based on transarterial chemotherapy, is a new treatment for malignant neoplasms. This study was to investigate distribution of platinum (Pt) in blood and uterine tissue after infusing different carboplatin arterially.

METHODS

Fourteen female dogs were randomly divided into 2 groups: embolizational group (group A, 7 dogs),and chemotherapy group (group B, 7 dogs). In group A, carboplatin (12 mg/kg), mingled with lipidol ultra-fluid (0.2 ml/kg), was injected into dogs' iliac arteries. In group B, carboplatin (12 mg/kg), dissolved in 5% glucose, was injected into the same arteries. The uterine tissues and blood samples were collected at different time points, concentrations of Pt in samples were measured by atomic absorption method.

RESULTS

Peak concentration of Pt in uterine tissues of group A was (215.0+/-17.6) microg/g, that of group B was (211.3+/-40.1) microg/g (P >0.05), the peak appeared at 0 min in both groups. Area under concentration-time curve (AUC) of Pt in tissues of group A was (13.9+/-3.9) mg x min x g(-1), significantly larger than that of group B (5.9+/-0.6) mg x min x g(-1). Peak concentration of Pt in plasma of group A was (8.7+/-12.5) microg/g, that of group B was (16.7+/-3.6) microg/g. AUC(0-240 min) was (0.5+/-0.1) mg x min x g(-1) in group A,and (1.2+/-0.4) mg x min x g(-1) in group B (P< 0.05).

CONCLUSION

Compared with arterial chemotherapy, arterial chemo- embolization may result in higher Pt concentration in local area, and lower Pt concentration in plasma, it may reduce the systemic toxicities, and enhance local effect on tumor.

[Sentinel lymph node identification with methylene blue in cervical cancer]

BACKGROUND & OBJECTIVE

Study of sentinel lymph node(SLN) in cervical cancer has been initiated since recent years, and there are still a lot of unknown factors about SLN identification in cervical cancer. This study was to investigate influential factors of identifying SLN with methylene blue in cervical cancer.

METHODS

For 41 patients with cervical cancer enrolled from Jun. 2002 to May 2003, 2-4 ml of methylene blue was injected into cervix at 4-6 sites around the tumor about 90-400 min before operation. The blue-dyed lymph node (BDLN) was considered as SLN. HE staining in step sections, and immunohistochemistry were applied to detect SLN. The influential factors of using methylene blue to detect SLN in cervical cancer were assessed based on the identification rate of SLN, and its false negative rate.

RESULTS

SLNs were detected in 31 of 41(75.6%) patients with cervical cancer of stage Ib1-IIb. A total of 85 SLNs were identified,and most frequently located in obturator fossa. SLNs were successfully detected in 20 of 23 (87.0%) patients who had no preoperative radiotherapy or chemotherapy, while in only 11 of 18 (61.1%) patients who had preoperative radiotherapy and/or chemotherapy. SLNs were detected in only 17 of 27(63.0%) patients who were injected with 2-3 ml of methylene blue, while in all of 14 patients whose dose was 3.4-4 ml. Eight patients were confirmed of lymph node metastases by pathology.

CONCLUSIONS

The dose of methylene blue recommended to detect SLN in cervical cancer is 3-4 ml. SLN varies in different sites, but most frequently located in obturator fossa.

[Clinical analysis of 8 cases of vulvar Paget's disease]

BACKGROUND & OBJECTIVE

Vulvar Paget's disease is a rare disease. It has a relatively high misdiagnosis rate and there are still controversies regarding its treatment. The objective of this study was to investigate its clinical features and summarize the experience of the management of this disease in order to gain a better acknowledge of this rare disease and improve its cure rate.

METHODS

The clinical records of 8 cases of vulvar Paget's disease admitted in Cancer Center, Sun Yet-sen University from January 1964 to December 2001 were analyzed.

RESULTS

The average age of 8 cases was 66.5 years, and the mean time from the onset of the disease to diagnosis was 5 years. Pathologically, intraepithelial Paget's disease was the commonest (5/8), followed by invasive Paget's disease (2/8) and Paget's disease with underlying adenocarcinoma (1/8). Eight cases underwent altogether 10 times of surgery, and radical vulvectomy was the most frequently used procedure (6/10). One case of Paget's disease with underlying adenocarcinoma died 21 months after surgery and 1 case of intraepithelial Paget's disease died of other etiology, 5 cases achieved long-term disease free survival, 1 case developed recurrence.

CONCLUSION

Surgery is the first choice for the patients of vulvar Paget's disease. For those patients whose lesions are extensive,or old aged,or not suitable for long-term follow-up, a radical vulvectomy is more preferable and a lower recurrence rate is expected.

[Expression of p21(WAF1) and its relationship with p53 and PCNA protein in epithelial ovarian cancer]

BACKGROUND & OBJECTIVE

Recent researches manifested that down-regulation of p21(WAF1) had relationship with carcinogenesis and development in various tumors, but its association with epithelial ovarian cancer (EOC) was not clear. This study was designed to investigate the role of p21(WAF1) in the tumorigenesis and development of EOC and its relationship with p53 and proliferating cell nuclear antigen (PCNA) protein.

METHODS

Fifty-five EOC tissues, 32 benign ovarian tumor tissues, and 30 normal ovarian tissues were collected. Reverse transcription polymerase chain reaction (RT-PCR) was applied to determine the p21(WAF1)mRNA expression. Immunohistochemistry was applied to examine the protein expression of p21(WAF1), p53, and PCNA. The relationship between the expression of these markers and the clinicopathological characteristics, prognosis of the patients was analyzed.

RESULTS

The positive rates of p21(WAF1)mRNA in EOC, benign ovarian tumor, and normal ovary were 40%, 56.25%, and 73.33%, respectively (P=0.012). The positive rates of p21(WAF1) protein were 36.36%, 56.25%, and 80%, respectively (P=0.001). The positive expression rates of p21(WAF1)mRNA and its protein in EOC were lower than those of the other two groups, while the positive expression rates of p53 and PCNA protein in EOC were higher than those of the other two groups (P< 0.05). Expression of p21(WAF1)mRNA had positive relation to its protein, negative relation to PCNA protein, no relation to p53 protein, while expression of p21(WAF1) protein had negative relation to p53 and PCNA protein in EOC. Low-expression of p21(WAF1) protein was associated with advanced FIGO stage (P=0.032), but not with age, histological type, pathological grade, and remnant tumor (P >0.05). There was no relationship between p21(WAF1)mRNA and former parameters (P >0.05). Univariate analysis showed that the patients with low-expression of p21(WAF1)mRNA and p21(WAF1) protein had poor prognosis (P< 0.05).

CONCLUSION

p21(WAF1) is down-regulated in EOC. p21(WAF1) might be able to be used as a marker to predict the prognosis of patients with EOC.

Recent Outbreak of Fusarium Wilt of Basil in Florida

Symptoms of wilt, leaf chlorosis, leaf drop, and shoot and plant death were observed in commercial fields of basil (Ocimmum basilicum L.). Disease incidence ranged from 10 to 80% among individual fields. Initial isolations from infected stem tissue were made on water agar amended with streptomycin sulfate. Single-spore isolates transferred onto corn leaf agar were identified as Fusarium oxysporum Schlechtend.:Fr. f. sp. basilicum Dzidzariya. Pathogenicity tests were performed on 10-cm-tall basil plants, cv. Siam Queen, for three Florida isolates and one Massachusetts isolate. An inoculum concentration of 1 × 10⁶ conidia per ml was applied to soil around the roots. Symptoms of wilt, external stem discoloration, and death of basil occurred after 14 days, and F. oxysporum f. sp. basilicum was reisolated from plants inoculated with all four isolates. Controls were disease-free. Identification of the isolates as F. oxysporum f. sp. basilicum was done with a set of DNA primers developed by Pan and Wick (2) for a 0.7-kb DNA fragment unique to this pathogen. This report confirms the existence of F. oxysporum f. sp. basilicum in Florida (1), and identifies this disease as a potential threat to commercial basil production. References: (1) S. A. Alfieri et al. Diseases and Disorders of Plants in Florida. Bull. No. 14. Fla. Dept. Agric. Consumer Serv., 1993. (2) Z. Pan and R. L. Wick. Phytopathology 85:1559, 1995.

[Peripheral blood T-cell subsets in patients with ovarian malignancies]

Blood samples from 79 subjects (27 cases of ovarian malignancy, 2 ovarian borderline epithelial tumor, 38 benign gynecologic disease and 12 healthy women) were measured for peripheral blood T-cell subsets using monoclonal antibodies and SPA-Ig rosette technique. It was found that in patients with ovarian malignancy, the percentage of OKT4+ cells was significantly reduced whereas the percentage of OKT8+ cells was markedly increased as compared with those in the healthy women and patients with benign gynecologic disease; OKT4/OKT8 ratio declined obviously; which were more pronounced in patients with advanced or recurrent tumor.