[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.

[Clinical analysis of the effect of cervical conization on fertility and pregnancy outcome]

OBJECTIVE

To evaluate the effect of conization for cervical intraepithelial neoplasia on the outcome of subsequent fertility and pregnancy.

METHODS

A retrospective study was performed of patients who underwent conization from 1999 to 2005 in Peking Union Medical College Hospital. The nullipara patients below 40-years old without primary or secondary infertility were followed up.

RESULTS

Thirty-five patients aged from 23 to 40 years, who had pregnancy desire, were included in the study. The mean age of patients was 31 years. Twenty-five women with 26 pregnancies were identified among the 35 patients, and the pregnancy rate was 74% (26/35), which was not significantly different from that of the same patients before conization (69%, P > 0.05). Among the 26 pregnancies, there occurred one ectopic pregnancy and four cases of spontaneous abortion. In the 13 delivery cases, there were one premature delivery, two cases of premature rupture of the membrane, and ten cases of cesarean section. The sample height of the cone was less than 2.0 cm in the nine delivery cases, and the mean width of the cone was over 2.5 cm.

CONCLUSION

No evidence of secondary infertility caused by cervical conization was found. There was also no significant increase in the number of either premature delivery cases or low birth weight infants. The sample height of the cone might play a more important role in the pregnancy outcome than the width, which still needs to be further verified by larger studies.

[Comparison of three subcategories of laparoscopic hysterectomy]

OBJECTIVE

To compare the clinical characteristics of three subcategories of laparoscopic hysterectomy: total laparoscopic hysterectomy (TLH) and two subcategories of laparoscopic-assisted vaginal hysterectomy (LAVH): LAVHs and LAVHb.

METHODS

We retrospectively analyzed the clinical data of 393 patients underwent laparoscopic hysterectomy, including TLH (n=178), LAVHa (n=177), and LAVHb (n=38), in our hospital from September 2002 to September 2005.

RESULTS

Myoma and adenomyosis of uterus were the most common diseases in this study, accounting for 66.9%, 38.4%, and 52.6% in TLH group, LAVHa group, and LAVHb group, respectively. The mean surgery duration and blood loss were not significantly different between TLH group and LAVHa group (P > 0.05), but were significantly less in TLH group than in LAVHb group (P < 0.05). The bulk of uterus in TLH group was significantly bigger than in other two groups (P < 0.05). The incidence of major complications in the TLH group (9. 0%) was lower than in LAVHa group (14.1%) and in LAVHb group (18.4%), but without statistical significance. Conclusion Compared with LAVH, TLH is feasible to deal with bigger uterus with less blood loss and shorter surgery duration and without more frequent complications.

Identification of platinum-resistance associated proteins through proteomic analysis of human ovarian cancer cells and their platinum-resistant sublines

Chemoresistance is a major therapeutic obstacle in cancer patients, and the mechanisms of drug resistance are not fully understood. In the present study, we established platinum-resistant human ovarian cancer cell lines and identified differentially expressed proteins related to platinum resistance. The total proteins of two sensitive (SKOV3 and A2780) and four resistant (SKOV3/CDDP, SKOV3/CBP, A2780/CDDP, and A2780/CBP) human ovarian cancer cell lines were isolated by two-dimensional gel electrophoresis (2-DE). The differentially expressed proteins were identified using matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS). In total, 57 differential protein spots were identified, and five proteins, including annexin A3, destrin, cofilin 1, Glutathione-S-transferase omega 1 (GSTO1-1), and cytosolic NADP+-dependent isocitrate dehydrogenase (IDHc), were found to be co-instantaneous significance compared with their parental cells. The expression of the five proteins was validated by quantitative PCR and western blot, and the western blot results showed complete consistency with proteomic techniques. The five proteins are hopeful to become candidates for platinum resistance. These may be useful for further study of resistance mechanisms and screening of resistant biomarkers.

[Proteomic analysis of human ovarian cancer cell lines and their platinum-resistant clones]

OBJECTIVE

To perform comparative proteomic analysis of human ovarian cancer cell lines for detecting platinum-resistance associated proteins.

METHODS

The total proteins of two sensitive (SKOV3 and A2780) and four resistant (SKOV3/CDDP, SKOV3/CBP, A2780/CDDP and A2780/CBP) human ovarian cancer cell lines were separated by two-dimensional gel electrophoresis (2-DE). The differentially expressed proteins were analyzed using image analysis software, stained with Coomassie Brilliant Blue, then identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and database searching. The mRNA and protein levels of the differentially expressed protein which was most significant in all of the four resistant cell lines were validated by RT-PCR and western blotting, respectively.

RESULTS

Five proteins were found to be significant in four cell lines. Annexin A3 and destrin were up-regulated and nicotinamide-adenine dinucleotide phosphate (NADP)-dependent isocitrate dehydrogenase 1 was down-regulated in all the four resistant samples. Glutathione transferase omega 1 had an increased expression in the other three resistant cell lines except for SKOV3/CBP in which its expression was not changed. However, cofilin 1 represented a different trend. In the two resistant sublines of SKOV3, cofilin 1 had a down-regulation, but it had an up-regulation in the cell lines induced from SKOV3. The expression of annexin A3 was up-regulated by 3 - 20 fold and the results of RT-PCR and western blotting showed complete consistency with that by 2-DE.

CONCLUSIONS

Proteomic techniques are useful to the identification of the resistance-associated proteins in ovarian cancer platinum-resistant cell lines and five candidates have been found. The five differential proteins might become hopeful candidate biomarkers for resistance.

[Vulvar form reconstruction in extended radical vulvectomy of vulvar carcinoma]

OBJECTIVE

To evaluate the method of vulvar reconstruction after extended vulvectomy.

METHODS

Retrospectively, fourteen cases of vulva carcinoma were treated by radical wide local excision, and the defects were repaired with anterolateral thigh flap and inferior pedicle rectus abdominal myocutaneous flap. After the flap was harvested, it was put on the defect through the tunnel between the donor and the recipient site and the vulvae was reconstructed.

RESULTS

All the flaps were survived except 1 anterolateral thigh flap with partial necrosis. One patient was infected at the groin incision but the flap and the grafted skin were survived. The patients were treated with change of the dressing and recovered after skin grafting. All other incisions were healed with first intention. The partial necrosis area was about 4 cm x 6 cm, it healed at 36 postoperative days after free skin grafting. The reconstructed vulvae were plump and elastic. It appeared like the normal vulvae and there was no contraction of the vagina.

CONCLUSIONS

Vulvar reconstruction with the anterolateral thigh flap and rectus abdominal flaps after the radical vulvectomy could make the patients recover easily. It produces almost normal appearance and function of the vulvae, reduces the time of wound healing. The patient could have the next therapy more quickly and the quality of life improves. It has wide application value in clinics.

[Repair of abdominal wall defect after resection of abdominal wall endometriosis]

OBJECTIVE

To study the techniques to repair the fascia layer of abdominal wall after the resection of abdominal wall endometriosis (AWE).

METHODS

Fifty-five AWE patients aged 28 approximately 38 underwent resection of the lesion. After the resection a defect fascia in abdominal wall larger than 2 cm(2) was seen in 29 patients (large fascia defect group), and in the other 26 patients the fascia defect was less than 2 cm(2) (small fascia defect group). In the large fascia defect group, 11 cases underwent routine closure of the abdominal wall, 2 underwent abdominal wall reconstruction by applying tension suture, 1 case underwent fascia layer/skin tension-relieving suture, 4 cases abdominal wall reconstruction by PDS-II suture, 4 cases underwent fascia patch grafting, and 7 cases underwent abdominal wall plastic repair plus fascia patch grafting, the different techniques being selected according to the size of the defect. Routine abdominal wall closure was performed on all the 26 patients in the small fascia detect group. The features of the lesion and operation, and the outcomes were compared.

RESULTS

Primary healing was achieved in all the patients. In comparison with the small fascia defect group, the mean size of the masses measured by pre-operational ultrasonography of the large fascia defect group was significantly bigger [(3.8 +/- 1.4) cm vs. (2.5 +/- 1.1 cm)], the mean size of the masses resected in operation was significantly larger [(5, 5 +/- 2.0) cm vs. (3.7 +/- 1.9) cm, P = 0.004], the operation time was significantly longer [(66 +/- 42) min vs. (35 +/- 24) min, P = 0.002], and the intra-operational blood loss was significantly more [(52 +/- 50) ml vs. (23 +/- 19) ml, P = 0.006]. Relapse occurred in 1 case in the large fascia defect group.

CONCLUSION

Ultrasonography helps estimate the extension of AWE before operation. Fascia layer/skin tension-relieving suture can be used in the fascia defect of abdominal wall larger than 2 cm(2). Abdominal wall plastic repair plus fascia patch grafting is capable of repairing larger fascia layer and skin defects of abdominal wall.

[Outcome analysis of conservative treatment of well-differentiated endometrial adenocarcinoma and severe atypical hyperplasia in young women]

OBJECTIVE

To evaluate the effect of hormonal therapy on well-differentiated endometrial adenocarcinoma and severe atypical hyperplasia in young women aged 35 years and younger.

METHODS

We retrospectively studied the clinical characteristics of 25 patients under 35 years of age (average: 28.6) diagnosed with well-differentiated endometrial adenocarcinoma or severe atypical hyperplasia, who were treated with progestin in Peking Union Medical College Hospital from 1991 to 2005. According to pathologic results, 25 patients were divided into two groups: 8 cases of endometrial carcinoma and 17 cases of severe atypical hyperplasia. In the endometrial carcinoma group, pelvic ultrasound, MRI, chest X-ray and serum CA(125) were used in pretreatment evaluation. Progesterone receptors were examined with immunohistochemical method. All patients received dilation and curettage of endometrium every 1-6 months as an assessment of treatment results. For chemotherapy, most of them were treated with medroxyprogesterone acetate.

RESULTS

Six cases (6/7) in endometrial carcinoma group, and 17 cases (100%) in severe atypical hyperplasia group responded to treatment respectively; among them, 5 cases (5/7) and 14 cases (82%) had complete response, which was defined as the absence of any carcinoma or hyperplasia on endometrial samplings; one case (1/5) and 3 cases (21%) recurred within 6 to 30 months after their complete response. Follow-up on 14 patients with complete response, and the desire for childbearing showed that none of the 4 cases of endometrial carcinoma had conceived a pregnancy and 4 (40%) patients had pregnancy for totally 7 times of 10 cases of severe atypical hyperplasia. Three patients delivered full-term fetuses with induced ovulation, one of whom had artificial abortion 3 times after her delivery. One patient was lost to follow up after her spontaneous pregnancy.

CONCLUSIONS

Progestin therapy is a good choice for young women having fertility desires diagnosed with well-differentiated endometrial adenocarcinoma or severe atypical hyperplasia. Endometrial carcinoma patients should be selected carefully before therapy. Pregnant rate is not satisfactory after conservative treatment. Assistant reproductive technology is potentially helpful to improve pregnant rate of patients responded to progestin therapy.

[Analysis of 16 patients with early cervical cancer treated by laparoscopic vaginal radical trachelectomy]

OBJECTIVE

To evaluate the therapeutic efficacies of preserving fertility treatment in patients with early cervical cancer.

METHODS

Sixteen patients with early cervical cancer treated by laparoscopic vaginal radical trachelectomy and pre- or postoperative chemotherapy were analyzed retrospectively, focusing on the treatment indication and management of high risk patients.

RESULTS

The median age was 29 years (range 26 to 34 years). Eleven were nulligravida and 4 multipara. All patients had a desire to maintain fertility. For clinical stage, 2 were stage Ia2, 13 stage Ib1 and 1 stage Ib2. Fifteen patients had squamous cell carcinoma and 1 had adenosquamous cell carcinoma. Mean operative time was 3 hours and 12 minutes, and mean blood loss was 320 ml. There were no intra- or postoperative complications. With mean follow-up time of 13 months, one patient had recurrence (6%), and no one became pregnant.

CONCLUSIONS

It is possible to preserve fertility in the treatment of patients with early cervical cancer, but treatment indication should be considered carefully. The management of high risk patients should be investigated extensively.

Treatment options for patients with recurrent ovarian cancer: a review of 54 cases

OBJECTIVE

To evaluate the efficacy of treatment options for patients with recurrent ovarian cancer.

METHODS

From 1990 to 2000, 54 patients with recurrent ovarian cancer primarily treated in Peking Union Medical College Hospital were selected and reviewed. All the clinical data related to the recurrent tumor were collected. Two-side P values for differences in survival were calculated by the Cox regression model.

RESULTS

The platinum-free interval > 6 months and the surgery followed by salvage chemotherapy prolonged survival time of the patients with recurrent ovarian cancer (95% CI = 0.153-0.987, P = 0.047; 95% CI = 1.611-10.914, P = 0.003, respectively). The increased number of chemotherapy cycles ( > 10 months) offered some benefit on the survival (95% CI = 0.110-1.090, P = 0.070). The initiation of treatment and chemotherapy regiments failed to demonstrate an improvement in survival.

CONCLUSION

The treatment options for patients with recurrent ovarian cancer depend on the platinum-free-interval of the patients. A strategy of secondary surgical cytoreduction followed by salvage chemotherapy is suggested for the patients with platinum-sensitive disease.

[Cervical carcinoma in situ: a clinical and pathological analysis of 118 cases]

OBJECTIVE

To analyze the clinical characteristics and treatment of cervical carcinoma in situ.

METHODS

The clinical data of 118 patients with cervical carcinoma in situ (CIS), aged 38.8 (24-77), were retrospectively analyzed.

RESULTS

Cervical cytology showed that most of the lesions were cervical intraepithelial neoplasm (CINIII), high-grade squamous intraepithelial lesion (HSIL), or CIS. Most of the patients underwent colposcopic examination. All the patients underwent conization. 54% of the patients were given cold knife conization, and 46% of the patients received electric knife conization. 71 of the patients undergoing conization (60%) were followed-up. Another 40% received total hysterectomy and/or bilateral salpingo-oophorectomy. 17 cases were found pregnant after the conization. There were no differences in pathologically thorough resection and operational complication between the two surgery methods: cold knife conization and electric knife conization. Follow up study showed that conization had no effect on the subsequent pregnancy.

CONCLUSION

Conization is necessary for the final diagnosis of cervical carcinoma in situ. Both cervical cytology and colposcopic examination are very important for screening of CINIII or CIS. For the young patients conization suffices, however, for the postmenopausal women or those unable to receive follow-up examination total hysterectomy and bilateral salpingo-oophorectomy should be considered.

[Comprehensive staging surgery in treatment of malignant ovarian germ cell tumor]

OBJECTIVE

To evaluate the impact of comprehensive staging surgery on relapse and survival of malignant ovarian germ cell tumor (MOGCT).

METHODS

The clinical data of 127 MOGCT cases treated in Peking Union Medical College Hospital from June 1980 to June 2003 were analyzed retrospectively. All the data about comprehensive staging surgery during primary surgery were collected, and other factors related to prognosis were also collected at the same time. COX model was applied in multivariate analysis related to relapse and survival.

RESULTS

Among 127 patients, 45 (35.4%) received comprehensive staging surgery. Seventy-one cases (55.9%) received satisfied cytoreduction with residual tumor < 2 cm, 11 cases (8.7%) with residual tumor > or = 2 cm, and another 45 cases (35.4%) were undetermined. Seventy-five cases (59.1%) received cisplatin, etoposide, and bleomycin (BEP) or cisplatin, vinblastine, and bleomycin (PVB) chemotherapy, 18 cases (14.2%) received vincristine, actinomycin D, cyclophosphamide (VAC) chemotherapy, and 34 cases (26.8%) received other regimens or no chemotherapy. During the follow up period, 7 of 45 patients relapsed in patients who received compressive staging surgery, while the latter was not a significant factor (P = 0.061). Chemotherapy regimen and residual tumor were the significant factors related to the relapse (P < 0.05). All the patients were followed up for 2-254 months. Chemotherapy regimen and residual tumor were also the significant factors related to survival (P < 0.05). Compressive staging surgery showed no significant effect on survival (P > 0.05).

CONCLUSIONS

The critical treatment for MOGCT is satisfactory cytoreduction surgery plus standard chemotherapy. Comprehensive staging surgery shows no significant impact on the prognosis of MOGCT patients.

[Lymphadenectomy in the treatment of malignant ovarian germ cell tumor]

OBJECTIVE

To evaluate the impact of lymphadenectomy on the relapse and survival of malignant ovarian germ cell tumor (OGCT).

METHODS

The clinical data of 102 OGCT cases treated in Peking Union Medical College Hospital from June 1980 to June 2003 were analyzed retrospectively. All the data about lymphadenectomy during primary and secondary surgery were collected, and other factors related to prognosis were also collected at the same time. Chi-squared test was applied in the univariate analysis related to relapse of disease. Cox model was applied in multivariate analysis related to relapse and survival of disease.

RESULTS

Pelvic and paraaortic lymph node metastasis was not significantly related to prognosis in primary and secondary treated patients. Lymphadenectomy showed no significant impact on disease relapse and survival. In the primary treatment, International Federation of Gynecology and Obstetrics (FIGO) staging, chemotherapy regimen, residual tumor and lymphadenectomy were the significant factors related to the relapse. After being stratified for the chemotherapy regimen, lymphadenectomy was not significantly related to the relapse in bleomycin +etoposide +cisplatin or cisplatin +vincristine +bleomycin regimen group, and lymphadenectomy could prevent relapse in no chemotherapy or other chemotherapy regimen group. In relapsed patients, only residual tumor was significantly related to survival time after relapse.

CONCLUSIONS

Pelvic lymph node metastasis is not the significant risk factor related to prognosis. Lymphadenectomy may have a beneficial effect on survival, although such effect is not significant. Although lymphadenectomy provides important information for prognosis, they provide little benefit to those patients already requiring chemotherapy based on the original operative findings. Lymphadenectomy should be performed to primary or relapsed patients by an expert surgical team.

[Analysis of prognostic factors of malignant ovarian tumor after fertility-preserving treatment]

OBJECTIVE

To explore the prognostic factors of malignant ovarian tumor after fertility-preserving treatment.

METHODS

189 patients with malignant ovarian tumor who had undergone fertility-preserving management in the past 20 years were retrospectively analyzed. The correlative factors for survival, recurrence and reproductive status were evaluated. Among the patients, 136 cases suffered from ovarian germ cell tumor (OGCT), 31 cases suffered from ovarian sex cord-stromal tumor (OSCST), and 22 cases suffered from epithelial ovarian cancer (EOC). The median follow-up time of different groups was 50 months for OGCT, 46 months for OSCST, 45 months for EOC respectively.

RESULTS

The 5-year survival rates for OGCT, OSCST and EOC groups were 94.0% (131/134), 77.1% (26/30) and 64.7% (16/21) respectively. The recurrent rates were 29.9% (40/134), 20.0% (6/30) and 47.6% (10/21) respectively. 46 babies were delivered during the follow-up period. Standard chemotherapy was the most important prognostic factor for OGCT. FIGO stage and standard chemotherapy were favourable factors for prognosis in OSCST group. The important prognostic factors included FIGO stage and standard comprehensive surgical staging for EOC.

CONCLUSION

Fertility-preserving treatment should be considered for OGCT without limitation of FIGO stage, whereas it should be performed individually for OSCST and EOC. The treatment outcome for OGCT is the best, for EOC the worst.

[Alterations of mitochondrial DNA in ovarian cancer patients with and without chemotherapy]

OBJECTIVE

To explore the alterations of mitochondrial DNA in ovarian cancer patients with and without chemotherapy.

METHODS

Tumor tissues and their adjacent normal tissues of 9 ovarian cancer patients with chemotherapy and 7 ovarian cancer patients without chemotherapy were collected respectively from November 2002 to August 2003 in Peking Union Medical College Hospital. The complete mitochondrial DNAs were sequenced and the results were compared with the data in Genbank.

RESULTS

A total of 69 novel polymorphisms and 17 mutations were detected. The mean polymorphisms in patients without chemotherapy were 2.7, whereas those with chemotherapy were 5.6. There was significant difference between them (P = 0.01). In the coding area, the proportion of amino acid changes accounted for 21% and 32% in the two groups induced by polymorphisms. The mutation rates were 5/7 and 5/9 in the two groups respectively and the amino acid changes were 3/4 and 5/5.

CONCLUSIONS

There are more polymorphisms which do not alter the amino acids accordingly in ovarian cancer patients with chemotherapy compared with patients without chemotherapy. Meanwhile, the amount of mutations does not enhance in these patients. It indicates that mitochondrial DNA mutation may be a unique characteristic of tumors.

[Analysis of 21 cases of epithelial ovarian malignancies in women aged below 30 years]

OBJECTIVE

To study the presentation, histology type, stage of disease, treatment and outcome of epithelial ovarian malignancies in young women less than 30 years old.

METHOD

A total of 21 cases of epithelial ovarian malignancies in young women less than 30 years old between Jan 1986 and Mar 2002 were analyzed retrospectively.

RESULTS

The median age at the time of diagnosis was 24 years (range 16-29 years). All carcinomas occurred after menarche. The most common presenting symptoms were abdominal pain (50%), followed by tympanites (25%) and dysmenorrhea (19%), and the initial diagnosis was usually made based on physical examination, ultrasonography and serum CA(125). The mean maximal tumor diameter was 17.6 cm. Ten (67%) patients had stage I disease (5 Ia, 5 Ic), and 5 (33%) had stage III disease at the time of diagnosis; 43% were mucinous tumors, and 29% serous ones. Most tumors were well-differentiated ones classified as grade 1, 73%, others were grade 2, 13%, and grade 3, 13%. Optimal cytoreduction was achieved in 93% (14/15) of patients in primary treatment and 83% (5/6) in recurrence treatment. Eight patients were treated with conservative surgery, and 18 patients with chemotherapy, of which 7 patients had more than six courses of chemotherapy. The median follow-up was 50 months (range, 2-192 months). Six patients died in this series, 2 were alive with tumor, 11 alive free of tumor, and two were lost in follow-up. The 3-year and 5-year survival rate was 89%, and 76%, respectively.

CONCLUSION

Young patients with epithelial ovarian carcinoma appear to have favorable stage and histologic grade and good survival.

[Clinical analysis of prognostic factors for stage III ovarian epithelial carcinoma]

OBJECTIVE

To evaluate the prognostic factors for stage III ovarian epithelial carcinoma so as to provide scientific basis for further reasonable therapy.

METHODS

The clinical records of 369 patients with stage III ovarian epithelial carcinoma, aged 53 +/- 9 (22-77), were reviewed retrospectively. SPSS 10.0 was utilized to analyze the possible prognostic factors statistically.

RESULTS

All patients received cytoreductive surgery, 289 cases (71.8%) of which achieved optimal cytoreduction. During the operation, 150 cases (41.8%) and 265 cases (71.8%) were found with intestinal and diaphragmatic involvement respectively. Pathologic results showed that serous type was the most common histological type (48.9%) and mucinous type was the least one (2.2%). The grades G1, G2, and G3 accounted for 1.7%, 42.7%, and 55.6% respectively. 290 cases with effective response to surgery underwent chemotherapy for 3-22 (10 +/- 4) courses. Recurrence was recorded in 190 cases (51.5%) and death was recorded in 152 cases (41.2%). Multivariate analysis revealed that intestinal involvement, diaphragmatic invasion, tumor residuals, and course number of chemotherapy were significantly correlated with prognosis (P < 0.01, < 0.05, < 0.01, and < 0.01 respectively).

CONCLUSION

Cytoreduction for the tumor in peritoneal cavity and positive chemotherapy should be emphasized sufficiently and may be helpful for the prognosis of stage III ovarian epithelial carcinoma.

[Epithelial ovarian tumors in adolescence: a study of clinical features and treatment]

OBJECTIVE

To study the clinical feature, diagnosis and treatment of epithelial ovarian tumors in adolescent patients.

METHODS

A retrospective analysis was performed on 29 patients of epithelial ovarian tumors between the age of 13 and 19 during the period of 1983 - 2002 in Peking Union Medical College Hospital. Twenty of the cases were with benign tumors, four with borderline, and five with malignant tumors.

RESULTS

The average age was 16.5 years old. The majority of patients presented with abdominal pain, abdominal distention and a large pelvic mass. The histological types included mucinous tumor in twenty-two cases, serous tumor in six, and endometroid tumor in one case. Among the nine cases with borderline or malignant tumors, eight were at stage I and one at stage IIIc. Of benign tumor group, an abdominal unilateral salpingo-oophorectomy was performed on nine cases. A laparoscopic cystectomy was undertaken in 11 patients. The nine cases with borderline or malignant tumors underwent cytoreductive surgery and comprehensive staging surgery; fertility was preserved for eight of them. A cisplatin combined chemotherapy was given to four patients with malignant tumors. All of the patients were without evidence of disease recurrence during the follow-up.

CONCLUSIONS

The incidence of epithelial ovarian tumors during adolescence increases with age. Mucinous tumor is the most common histological type in adolescent patients. A laparoscopic cystectomy could be considered for most benign patients. The therapeutic strategy should be individualized, and surgical approach should consider both cure and preservation of fertility in malignant cases.

[Comparative analysis of laparoscopic surgery and laparotomy for early stage endometrial cancer]

OBJECTIVE

To evaluate the feasibility of laparoscopic surgical treatment of early stage endometrial cancer.

METHODS

From January 1998 to August 2003, 24 endometrial cancer cases treated by laparoscopy were analyzed as the study group. And 41 endometrial cancer cases treated by laparotomy during the same period were randomly selected as the control group. The two groups were compared in terms of the clinic data of perioperative periods.

RESULTS

The clinicopathological characteristics before operation between both groups were similar. The mean operating time in the laparoscopy group (97 minutes) was significantly shorter (P < 0.001) than that in the laparotomy group (134 minutes). The blood loss during the operation in the laparoscopy group (163 ml) was fewer than that in the laparotomy group (259 ml). The numbers of the lymph nodes resected between the two groups were similar. The rate of complications in the laparoscopy group was lower than that in the laparotomy group. The laparoscopy group had shorter hospitalization (6.3 days) than that of the laparotomy group (9.6 days, P < 0.01). The pathological type and International Federation of Gynecology and Obstetrics (FIGO) stage between the two groups were similar. One case had recurrence and 1 case died in the control group but there was no such case in the laparoscopy group. The survival rate of the study group was 100% and that of the control group was 97% (P > 0.05).

CONCLUSION

Laparoscopic surgery is feasible and safe in treatment of early stage endometrial cancer, and the clinic value should be confirmed by multicenter randomized clinic trial.

[Clinical analysis of endometrial carcinoma patients aged 45 years and younger]

OBJECTIVE

To retrospectively analyze the clinical characteristics and outcomes of endometrial carcinoma patients aged 45 years and younger.

METHODS

Fifty-two cases of endometrial carcinoma aged 45 years and younger were treated in Peking Union Medical College Hospital. They were further divided into group A (35 years of age and younger) and group B (older than 35 years). Clinical data of these patients were reviewed and the two groups were compared.

RESULTS

Patients aged 45 years and younger accounted for 12.7% of all the endometrial carcinoma cases. About 50% of the patients were nulliparous, infertile or had irregular menstruation and endometrial hyperplasia, 29% were obese, 23% had polycystic ovaries. Eighty-three percent of the patients were stage [International Federation of Gynecology and Obstetrics (FIGO), 1988]. Group A had more polycystic ovaries and atypical endometrial hyperplasia than group B (53% vs 9%, 59% vs 26% respectively, P < 0.05). All group A patients were stage I endometrial carcinoma. In group B, 26% had high risk factors, and compared with group A, FIGO stage was higher (P < 0.05). Operation was the main treatment. Two patients were treated successfully with conservative high dose progestin. Two patients relapsed.

CONCLUSIONS

There were high incidences of infertility, irregular menstruation, endometrial hyperplasia, obese and polycystic ovaries in patients aged 45 years and younger, indicating the relationship between endometrial carcinoma and estrogen. Most patients, especially those younger than 35 years, were stage I with few risk factors and good prognosis. Conservation of fertility and ovarian function should be considered in these patients.

[Role of positron emission tomography in diagnosis of recurrent ovarian cancer]

OBJECTIVE

To investigate the efficiency of positron emission tomography (PET) with (fluorine-18)-2-deoxyglucose ((18)FDG) in diagnosis of recurrent ovarian cancer.

METHODS

(18)FDG-PET scanning and computerized tomography (CT) were performed on 31 patients 35 times, who were clinically free of disease after optimal cytoreductive surgery and first-line chemotherapy. Twenty-two patients were confirmed pathologically after second-look or re-debulking operation and the others were followed up by many methods (ultrasonography, CA(125) and pelvic examination combined), evaluating the role of PET and CT in the diagnosis of recurrent ovarian cancer.

RESULTS

(1) PET demonstrated recurrent sites through increased (18)FDG uptake. In 35 times, PET showed 1 false-negative and 1 false-positive cases. (2) The sensitivity of (18)FDG-PET is 96.3%, and CT is 70.4%. There was significant difference between two groups (P < 0.05).

CONCLUSION

PET is more sensitive in diagnosing recurrent ovarian cancer than CT, so it improve early diagnosis in recurrent ovarian cancer.

[Recytoreductive surgery for recurrent epithelial ovarian cancer]

OBJECTIVE

To evaluate the role of recytoreductive surgery (RCRS) in recurrent epithelial ovarian cancer.

METHODS

Fifty-five patients who underwent recytoreductive surgery at Peking Union Medical College Hospital between Nov. 1998 and Apr. 2002 were retrospectively reviewed. They were divided into four groups firstly by the identity of recurrent lesion: group A, single lesion; B, disseminated lesion; C, intestinal obstruction; D, palliative surgery. Then they were divided into 3 groups according to the sensitivity to chemotherapy. Group A, diseases relapsed more than 6 months after chemotherapy; group B, relapsed less than 6 months; group C, relapsed during chemotherapy. We review the cases with regard to its macroscopic residual disease, complications of operation, cases with complete remission and partial remission, postoperation survival time and disease-free interval.

RESULTS

Recytoreductive surgery for patients with isolated recurrent tumor were optimal. For those diagnosed as local lesion preoperatively, 61% of these cases were found to have disseminated diseases postioeratively. Sixty-five percents of these cases received optimal RCRS, but their prognosis were not as well as those with real isolated leasion (response rate: 36% vs 67%). Cases with different sensitivity to chemotherapy had different prognosis (response rate: A, 50%; B, 26%; C, 28%).

CONCLUSION

Recytoreductive surgery should be considered in patients with isolated recurrent ovarian cancer and patient with recurrence more than 6 months after chemotherapy.

[Clinical features and treatment of cervical malignant tumor in young women]

OBJECTIVE

To evaluate clinical characteristics, prognosis, prognostic factors, and the ideal treatment of the young patients with cervical malignant tumor.

METHODS

We analyzed retrospectively 52 cervical malignant tumor patients younger than 35 years (study group) and 45 cervical carcinoma patients older than 50 years (control group) who were admitted in Peking Union Medical College Hospital from 1985 to 2002. The data were analyzed statistically by SPSS10.0. The ovarian functions were evaluated by the questionnaire and the serum sex hormone assay.

RESULTS

In study group, the median age was (31.0 +/- 0.6) years old. The most common clinical symptoms were contact bleeding and irregular bleeding; 55.8% of patients had more than one symptom. HPV positive rate was 20.5%, which was higher than control group significantly (P < 0.05). The percentage of advanced stage (stage II b-stage IV b) of disease in study group and control group were 30.8% and 22.2%, respectively, the difference was significant (P < 0.05). The most common histological type was squamous cell carcinoma (71.2%) in study group, while the percentage of non-squamous cell carcinoma (43.8%) in patients younger than 30 years was much higher than control group (P < 0.05). All the histological type was non-squamous cell carcinoma in the patients younger than 25 years. Histological grade showed that G1, G2, and G3 were 21.2%, 54.5%, and 24.2% respectively in study group. The percentage of bulky cervix (tumor diameter > 4 cm) in study group and control group was 27.9% and 2.7% respectively (P < 0.005). The overall 5-year survival rates were 75.7% in study group, lower than control group (P < 0.05). The COX hazards regression model showed histological type (P = 0.003) and bulky cervix (P = 0.001) were of significant prognostic values.

CONCLUSIONS

There are more advanced stage carcinoma and non-squamous cell carcinoma patients with poor prognosis in study group. The treatment to younger patients should be concerned individually, as well as preservation of reproductive and female endocrine function should be considered.