Synthesis and release of cell surface-derived and sulfated lactosaminoglycans by human ovarian carcinoma cells

Ovarian carcinoma cell clusters were isolated from patient effusions. Cell-surface glycoconjugates were radiolabelled by a galactose oxidase-borotritide method. The surface-labelled glycoconjugates and metabolically labelled glycoconjugates released to culture medium were characterized. The surface-derived glycoconjugates were highly heterodisperse and had the same molecular weight distribution as the metabolically labelled components. Lectin precipitation assays showed that both classes of glycoconjugates contained N-linked oligosaccharides bearing N-acetyllactosamine moieties. A121 ovarian carcinoma cells also synthesized and released a heterodisperse array of glycoconjugates to culture medium. Ricinus communis agglutinin I (RCAI) precipitated glycoconjugates of MW greater than 100 kDa for both A121 cells and cells from effusions. Cells of different ovarian carcinoma histology yielded similar results. Metabolic labelling experiments with 35SO4 showed that the RACI-bound glycoconjugates released by A121 cells were sulfated. The RCAI-bound sulfated lactosaminoglycans may be associated with malignant transformation and/or metastasis since similar components were not produced by mesothelial cells isolated from effusions [Allen, H.J., M. Gamarra M.S. Piver and E.A.Z. Johnson (1989). Cancer Biochem. Biophys. 10, 219-226].

Prospective trial of cisplatin, adriamycin, and dacarbazine in metastatic mixed mesodermal sarcomas of the uterus and ovary

Twenty-four patients with advanced or recurrent uterine (13) and ovarian (11) mixed mesodermal sarcomas received a combination of cisplatin. Adriamycin and dacarbazine (PAD) as initial therapy after surgical debulking. Of the 13 patients with metastatic uterine sarcoma, six (46.1%) remained without evidence of disease (NED) from 8 to 36 months from the start of PAD. The estimated 1-, 2-, and 3-year survivals for these patients were 68%, 68%, and 51%, respectively. Of the 11 ovarian sarcoma patients, five (45.4%) were NED at 5, 7, 32, 56, and 59 months from the start of PAD. The estimated 1-, 2-, and 3-year survivals for these patients were 70%, 35%, and 35%, respectively. The PAD regimen is an active regimen in patients with metastatic uterine and ovarian mixed mesodermal sarcomas and progression-free survival may be improved by maximum debulking surgery prior to the initiation of PAD chemotherapy.

Characterization of glycoconjugates released in vitro by human ovarian carcinoma cells isolated from effusions

Ovarian carcinoma cell clusters were isolated from patient effusions. The glycoconjugates released to culture medium in vitro were characterized by electrophoretic, immunoassay and gel filtration procedures. Metabolically radiolabelled glycoconjugates were heterodisperse with respect to molecular weight and this heterodispersity was independent of incubation time in vitro. This heterodispersity was also characteristic of mixed Mullerian tumor cells of endometrial origin whereas mesothelial cells released a discrete glycoconjugate of MW 65-70 kDa. Multiple Coomassie blue-stained polypeptides were released by the carcinoma cells. These polypeptides were not adsorbed serum components as assessed by immunodiffusion analyses. Periodic acid-Schiff-reactive macromolecules appeared only at the top of electrophoresis gels. The high molecular weight glycoconjugates synthesized by ovarian carcinoma cells precipitated with an effusion globulin fraction at low ionic strength, but the low molecular weight components (40-70 kDa) were soluble. Immunoprecipitation with anti-Ig failed to precipitate carcinoma glycoconjugates. Antisera raised against the released carcinoma macromolecules precipitated carcinoma glycoconjugates and normal ovarian polypeptides. Antisera raised against normal ovarian macromolecules precipitated ovarian polypeptides but reacted only slightly with carcinoma glycoconjugates. Immunodiffusion analyses showed the presence of alpha 1-acid glycoprotein and carcinoembryonic antigen (CEA)-like components in the carcinoma glycoconjugates. The presence of CEA-like glycoconjugates was confirmed by immunoprecipitation. The antigens and antisera for different histologic types of ovarian carcinoma were cross-reactive. The presence of beta 2-microglobulin suggested that some of the glycoconjugates were shed from the cell surface.

Phase II trial of cisplatin, adriamycin, and etoposide for metastatic endometrial adenocarcinoma

Twenty patients with metastatic or recurrent endometrial adenocarcinoma not amenable to surgery or radiation were treated with monthly cisplatin (20 mg/m2 x 3), etoposide (75 mg/m2 x 3), Adriamycin (40 mg/m2) (PAV) and Megace. Patient characteristics were as follows: grade 3 differentiation, 55%; papillary subtype, 15%; prior radiotherapy, 70%; prior chemotherapy, 10%; and prior hormonal therapy, 20%. Hematologic toxicity was significant but acceptable: WBC nadirs, 50%; platelet nadirs, 40%. There was no hematologic mortality. There was a 75% objective response rate and a 55% complete response rate with PAV. The median survival was 15+ months, the 2-year survival was 42%, and the 2-year progression-free survival was 20%. PAV appears to be an active combination with acceptable toxicity in the treatment of metastatic or recurrent endometrial cancer, and we believe that phase III evaluation is indicated.

Antigenic studies on an enzymatically sialylated carbohydrate: NeuAc(alpha 2-3)Gal(beta 1-3)GalNAc

Sialic acid residues are often the end moiety of the carbohydrate chain of biologically important glycoconjugates. It is difficult to study sialylated glycoconjugates because the purification of these compounds is often laborious yielding only very small amounts of oligosaccharides for study. Chemical synthesis of sialylated compounds is complicated by the labile nature of the sialic acid bond. In both of these cases the sialylated compounds would need to be conjugated to a polypeptide to be an effective immunogen, and again, such conjugation is fraught with problems due to the instability of the sialic acid linkage. We have developed a combined enzymatic and synthetic route for obtaining quantities of sialylated carbohydrates conjugated to a protein carrier in amounts sufficient for antigenic studies. The notable novelty of this protocol is the addition of sialic acid after the carbohydrate-protein conjugation step. Antiserum to the compounds was developed and after absorption, antibodies that demonstrate a requirement for sialic acid for their binding were produced and studied. CA 125 has been shown to be a prognostically significant marker for ovarian adenocarcinoma. The nature of the epitope involved has been analyzed with conflicting results. To attempt to resolve this conflict, we initiated studies on sialylated antigens with NeuAc alpha 2-3Gal beta 1-3GalNAc. This trisaccharide occupies the terminal region in a series of complex carbohydrates which have been suggested to be involved as the epitope. Hanisch et al. reported that the neuraminic acid was important for the reaction.

Antigenic studies on an enzymatically sialylated carbohydrate: NeuAc(alpha 2-3)Gal(beta 1-3)[GlcNAc(beta 1-6)]GalNAc

The CA 125 antigenic determinant has been shown to be elevated in the serum of ovarian cancer patients and is a useful prognostic marker. The chemical epitope which characterizes the CA 125 antigen is found on a high molecular weight glycoprotein and has been suggested to be carbohydrate in nature. This study was undertaken to establish the relationship of a carbohydrate to the epitope recognized by the monoclonal antibody, OC 125. Along this line a carbohydrate structure conjugated to bovine serum albumin (BSA), was enzymatically sialylated using a purified sialyltransferase to yield NeuAcGal[GlcNAc]GalNAc-OC6H4N = N-BSA. This sialylated product was used to immunize a goat and two rabbits for the development of polyclonal antisera. The resultant antisera were tested against related carbohydrates in EIA biased competitive inhibition assays. It was determined that the GlcNAc(beta 1-6)GalNAc residue was immunologically dominant for all antisera tested. As the immune response matured (greater than 40 days), there was an increase in the proportion of the antibodies that were directed to the NeuAc(alpha 2-3)Gal(beta 1-3)GalNAc residue compared to the nonsialylated form. Known CA 125 molecules did not inhibit the binding of raised antisera to the sialylated product, nor did the sialylated product react with OC 125 monoclonal antibodies. It was therefore concluded that the carbohydrate structure in question is not the epitope, or is not a large enough part of the epitope to be recognized in these assays by the OC 125 monoclonal antibodies.

The interferon system in carcinoma of the cervix. Effect of radiation and chemotherapy

Thirteen patients with advanced carcinoma of the cervix were studied for parameters of the interferon system compared with 40 age-matched and sex-matched controls. All patients had measurable serum interferon levels; controls did not. All patients had non-antibody-type interferon-inhibitory activity, and controls had none. Interferon-synthesizing potential was higher in controls than in patients. After successful radiation and chemotherapy, these parameters normalized in the patients. No change was seen in one patient who did not respond to therapy.

Prognostic significance of the extent of cervical involvement by endometrial cancer

The prognostic significance of the extent of cervical involvement by endometrial cancer is impossible to determine from the literature because previous reports have included fractional dilatation and curettage for staging, preoperative radiotherapy, and surgical stage III and IV disease. Therefore, we reviewed and restaged according to the new FIGO system all patients with endometrial cancer from January 1981 to December 1989. Of 180 patients undergoing hysterectomy for endometrial cancer, 20 had surgical stage II disease. No patient received preoperative radiotherapy. None of 12 patients (0%) with stage IIA disease developed recurrence, while 5 of 8 (63%) with stage IIB disease recurred (P less than 0.01). All 5 recurrences were in extrapelvic sites. Endocervical stroma invasion appears to import a statistically significant worse prognosis than endometrial glandular involvement.

Fallopian tube cancer. The Roswell Park experience

Sixty-four patients with primary fallopian tube cancer treated at Roswell Park Memorial Institute from 1964 to 1987 underwent retrospective clinicopathologic review. In 40 patients fallopian tube cancer was the only primary, but in 24 patients primary fallopian tube cancer was part of a multifocal upper genital tract malignancy. Of the 40 patients with unifocal fallopian disease, the median survival was 28 months. Only 15% of patients were alive and disease free with follow-up ranging from 22 to 141 months (median, 90.5 months). Survival was not associated with stage of disease, tumor histology, grade, or depth of invasion in this series. Fourteen patients who received cisplatin-based chemotherapy were evaluable for response. Three patients (21%) responded; two complete and one partial. Twelve patients without clinical evidence of disease underwent second-look procedures, ten laparotomy and two laparoscopy. Four of ten second-look laparotomies were negative. Secondary debulking was done in three of four patients with gross disease, one of which had a negative third-look laparotomy. Negative laparotomy, second-look or third-look, was associated with improved survival (P = 0.016). One of the two laparoscopies was negative, but the patient recurred. In the remaining 24 patients cancer of the fallopian tube was part of a multifocal upper genital tract malignancy. In 12 patients tubal disease was invasive, and in 12, it was in situ. Separate primaries occurred in the ovaries (n = 20); uterus (n = 7); and cervix (n = 2). This represents 1.3% of ovarian malignancies treated at Roswell Park Memorial Institute during the study period. Fallopian tube cancer seems as virulent as ovarian cancer with few long-term survivors. It is frequently associated with other sites of upper genital tract malignancy. Second-look laparotomy is an important predictor of survival. Second-look laparoscopy may be useful if positive.

Cisplatin-based chemotherapy for stage II ovarian adenocarcinoma: a preliminary report

We have performed three sequential trials in patients with FIGO stage II ovarian cancer in an attempt to improve long-term survival. The first trial utilized whole-abdomen radiation and a pelvic boost and the second study utilized pelvic radiation plus melphalan chemotherapy. These trials resulted in estimated 5-year survivals of 40 and 50%, respectively (Gynecol. Oncol. 23, 168-175, 1986). In the current study, 20 patients were treated with 6 months of adjuvant cisplatin-based chemotherapy. The estimated progression-free survival was only 45%. However, by tailoring salvage therapy to the findings at second-look laparotomy, the estimated 5-year survival was 77%. Notwithstanding the latter result of 77%, improved therapy is still required for the relatively rare patient who has stage II ovarian cancer.

Primary resection of vaginal metastases with the Cavitron ultrasonic surgical aspirator in stage III endometrial carcinoma

Use of the Cavitron ultrasound surgical aspirator (CUSA) to resect vaginal metastases in clinical stage III endometrial carcinoma is reported in two cases. The CUSA allowed cytoreduction before pelvic radiation therapy without additional morbidity.

Comparison of cisplatin and carboplatin cytotoxicity in human ovarian cancer cell lines using the MTT assay

In this study, we compared the cytotoxicity of cisplatin and carboplatin against a panel of human ovarian cancer cell lines using the MTT assay, a rapid colorimetric test that can be used to evaluate the number of residual viable tumor cells following chemotherapy. The established human ovarian cancer cell line OVCAR-3 and the recently isolated and characterized A721, A90, A286, A1, and A121A cell lines were evaluated for chemosensitivity. Each cell line was treated separately with cisplatin and carboplatin at concentrations ranging from 500 to 0.16 micrograms/ml. Various chemotherapeutic exposure periods (1, 4, 24, and 48 hr) were tested to determine maximal efficacy. All cell lines were more susceptible to cisplatin than carboplatin at all drug concentrations and all exposure periods tested (P = 0.005). The overall median 50% inhibitory concentration (ID50) for cisplatin was 107 micrograms/ml compared with 490 micrograms/ml for carboplatin P = 0.005). For both cisplatin and carboplatin a 24-hr exposure was significantly more cytotoxic than a 1-hr exposure (P = 0.003 and P = 0.006, respectively). These in vitro results suggest that cisplatin is significantly more cytotoxic than carboplatin against human ovarian cancer cell lines and that cisplatin should not be replaced by carboplatin in the treatment of advanced epithelial ovarian cancer until randomized trials using maximum dosing of the cisplatin-containing regimen are performed.

A case-control study of milk-drinking and ovarian cancer risk

It has been hypothesized that milk consumption increases the risk of ovarian cancer because of a possible association of lactose with human ovarian failure. Milk is also a source of animal fats in the diet, and animal fat intake is associated with ovarian cancer risk. To explore further the possible confounding of the milk-ovarian cancer association by the animal fat content of milk, the authors performed a case-control study of 303 ovarian cancer cases and 606 age-matched nonmalignant-disease controls seen between 1982 and 1988 at Roswell Park Memorial Institute in Buffalo, New York. Total frequency of usual milk intake was not associated with increased risk. Usually drinking more than one glass of whole milk daily relative to never drinking whole milk was associated with a relative risk of 3.1 (95% confidence interval (CI) 1.8-5.5). Consumption of reduced-fat milk was associated with reduced relative risk. Among persons who reported drinking milk regularly, persons reporting drinking only whole milk were at increased risk (relative risk = 2.6, 95% CI 1.7-4.0) relative to persons who drank only skim milk or 2% milk. These findings suggest that milk-drinking is not a source of ovarian cancer risk independently of its fat content. Additional study of lactose and ovarian cancer risk involving careful control for confounding is needed.

A prospective trial of postoperative vaginal radium/cesium for grade 1-2 less than 50% myometrial invasion and pelvic radiation therapy for grade 3 or deep myometrial invasion in surgical stage I endometrial adenocarcinoma

A prospective trial was performed to evaluate the recurrence rate and 5-year disease-free survival rate in patients with surgical Stage I endometrial adenocarcinoma. Patients with Stage I, Grade 1 or 2 disease, less than 50% myometrial invasion, and no evidence of disease outside the corpus of the uterus were treated by hysterectomy and bilateral salpingo-oophorectomy and postoperative vaginal radium/cesium (Group 1). Patients with surgical Stage I, Grade 3 disease or deep myometrial invasion, and histologically negative paraaortic lymph nodes were treated with postoperative pelvic radiation therapy (5000-5040 cGY) (Group 2). Patients with malignant peritoneal cytologic findings also received progesterone therapy. Of the 92 Group 1 patients, there have been no recurrences and the 5-year estimated disease-free survival rate was 99%. Of the 41 Group 2 patients, there have been four (9.7%) recurrences but only one (2.4%) within the treated field (pelvis), and the 5-year estimated disease-free survival rate was 88%. Of the 133 patients, the 5-year estimated disease-free survival rate was 96%, and only one patient (0.7%) had a local pelvic recurrence. Of the 16 patients with malignant peritoneal cytologic findings who were treated with progesterone therapy, none has had a recurrence.

Intraoperative frozen section diagnosis of depth of myometrial invasion in endometrial adenocarcinoma

From January 1981 to December 1988, a prospective trial was conducted on 216 consecutive patients undergoing hysterectomy for FIGO stage I endometrial adenocarcinoma to determine the accuracy of intraoperative frozen section (IFS) diagnosis of depth of myometrial invasion. IFS and D&C diagnoses were compared to the permanent section diagnosis to determine their accuracy. Patients with an IFS or D&C diagnosis of grade 3 carcinoma, deep myometrial invasion, cervical invasion, or adnexal involvement were considered high risk for paraaortic nodal metastasis, and paraaortic lymphadenectomy was performed. IFS correctly diagnosed the depth of myometrial invasion in 194 of 204 cases (95%). The sensitivity of IFS diagnosis of deep invasion was 87%, the specificity was 99%, the positive predictive value was 98%, and the negative predictive value was 94%. Grade, subtype, cervical invasion, and adnexal involvement were also accurately diagnosed. Based on IFS and D&C diagnosis, paraaortic lymphadenectomy was performed in 32% of patients, while 68% were considered low risk and were spared paraaortic lymphadenectomy. Eight patients (5%) were incorrectly diagnosed as low risk and did not have paraaortic lymphadenectomy performed. Sixty-five of seventy-three (90%) patients considered high risk on permanent section had paraaortic lymphadenectomies performed on the basis of IFS and D&C diagnosis. Inaccurate IFS diagnosis of depth of myometrial invasion can occur when tumor involves the uterine isthmus or cornua and when tumor invades areas of adenomyosis.

Invasive cervical cancer in the 1990s

The death rate from invasive cervical cancer has decreased by 70% since the classic work by Papanicolaou and Traut in 1941 on the use of cytologic evaluation to detect cancer of the uterine cervix in the preinvasive in situ stage--a nearly 100% curable disease. Unfortunately, the survival stage for stage of invasive cervical cancer has remained static over the nearly 5 decades since their report. However, discoveries in the decade of the 1970s of the natural spread of cervical cancer, not only to the known pelvic lymph nodes, but the increasing incidence of paraaortic lymph node metastasis with advanced stages, the higher dose of radiation required to sterilize pelvic lymph node metastasis discovered at the time of radical hysterectomy or for locally advanced cervical cancer treated solely by radiation therapy, and the use of radiation potentiators, such as hydroxyurea, should lead to the significant reduction in the annual 7,000 deaths from this disease in the decade of the 1990s.

Metastatic patterns in histologic variants of ovarian cancer. An autopsy study

The autopsy findings of 428 patients with various histologic types of ovarian cancer were studied to determine if metastatic patterns were different. Epithelial tumors were the most frequent (89%), followed by sarcomas (7.2%). Germ cell and stromal tumors each occurred in 1.9% of cases. Sites of metastasis were nearly identical, with no statistical difference among histologic types. The peritoneum was most frequently involved (83% to 100% of cases), but lymph node metastasis was common (50% to 60% of cases). Metastasis was more common to the paraaortic lymph nodes than to the pelvic lymph nodes. In seven of eight stromal tumors, hepatic metastasis was present but did not cause the patient's death. For epithelial tumors, metastasis to distant sites was dependent on nodal and intraperitoneal disease. However, this was not true in the 31 ovarian sarcomas or the series of germ cell or stromal tumors. This finding supports a hematogenous route of metastasis for ovarian sarcomas. Understanding the metastatic potential of ovarian cancer is important in designing effective treatment regimens.

Adjuvant cisplatin-based chemotherapy for stage I ovarian adenocarcinoma: a preliminary report

Thirty stage I patients with invasive ovarian adenocarcinoma were treated with 6 months of adjuvant induction cisplatin and monthly cisplatin, adriamycin, and cyclophosphamide. To date, 97% (29) are alive with no evidence of disease and normal CA-125 levels and 93% (28) are alive progression free with a median follow-up of 34 months (13-56).

Metastatic patterns in histologic variants of ovarian cancer. An autopsy study

The autopsy findings of 428 patients with various histologic types of ovarian cancer were studied to determine if metastatic patterns were different. Epithelial tumors were the most frequent (89%), followed by sarcomas (7.2%). Germ cell and stromal tumors each occurred in 1.9% of cases. Sites of metastasis were nearly identical, with no statistical difference among histologic types. The peritoneum was most frequently involved (83% to 100% of cases), but lymph node metastasis was common (50% to 60% of cases). Metastasis was more common to the paraaortic lymph nodes than to the pelvic lymph nodes. In seven of eight stromal tumors, hepatic metastasis was present but did not cause the patient's death. For epithelial tumors, metastasis to distant sites was dependent on nodal and intraperitoneal disease. However, this was not true in the 31 ovarian sarcomas or the series of germ cell or stromal tumors. This finding supports a hematogenous route of metastasis for ovarian sarcomas. Understanding the metastatic potential of ovarian cancer is important in designing effective treatment regimens.