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Xu B, Lefringhouse J, Liu Z, West D, Baldwin LA, Ou C, Chen L, Napier D, Chaiswing L, Brewer LD, St Clair D, Thibault O, van Nagell JR, Zhou BP, Drapkin R, Huang JA, Lu ML, Ueland FR, Yang XH. Inhibition of the integrin/FAK signaling axis and c-Myc synergistically disrupts ovarian cancer malignancy. Oncogenesis 2017; 6:e295. [PMID: 28134933 PMCID: PMC5294249 DOI: 10.1038/oncsis.2016.86] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/23/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
Integrins, a family of heterodimeric receptors for extracellular matrix, are promising therapeutic targets for ovarian cancer, particularly high-grade serous-type (HGSOC), as they drive tumor cell attachment, migration, proliferation and survival by activating focal adhesion kinase (FAK)-dependent signaling. Owing to the potential off-target effects of FAK inhibitors, disruption of the integrin signaling axis remains to be a challenge. Here, we tackled this barrier by screening for inhibitors being functionally cooperative with small-molecule VS-6063, a phase II FAK inhibitor. From this screening, JQ1, a potent inhibitor of Myc oncogenic network, emerged as the most robust collaborator. Treatment with a combination of VS-6063 and JQ1 synergistically caused an arrest of tumor cells at the G2/M phase and a decrease in the XIAP-linked cell survival. Our subsequent mechanistic analyses indicate that this functional cooperation was strongly associated with the concomitant disruption of activation or expression of FAK and c-Myc as well as their downstream signaling through the PI3K/Akt pathway. In line with these observations, we detected a strong co-amplification or upregulation at genomic or protein level for FAK and c-Myc in a large portion of primary tumors in the TCGA or a local HGSOC patient cohort. Taken together, our results suggest that the integrin–FAK signaling axis and c-Myc synergistically drive cell proliferation, survival and oncogenic potential in HGSOC. As such, our study provides key genetic, functional and signaling bases for the small-molecule-based co-targeting of these two distinct oncogenic drivers as a new line of targeted therapy against human ovarian cancer.
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Affiliation(s)
- B Xu
- Department of Pharmacology and Nutritional Science, University of Kentucky, Lexington, KY, USA.,Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - J Lefringhouse
- Department of Pharmacology and Nutritional Science, University of Kentucky, Lexington, KY, USA.,Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA.,Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA.,Department of Pathology, University of Kentucky, Lexington, KY, USA
| | - Z Liu
- Department of Pharmacology and Nutritional Science, University of Kentucky, Lexington, KY, USA.,Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA.,Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Jiangsu Province, PR China
| | - D West
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA.,Department of Pathology, University of Kentucky, Lexington, KY, USA
| | - L A Baldwin
- Department of Pharmacology and Nutritional Science, University of Kentucky, Lexington, KY, USA.,Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA.,Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA.,Department of Pathology, University of Kentucky, Lexington, KY, USA
| | - C Ou
- Department of Pharmacology and Nutritional Science, University of Kentucky, Lexington, KY, USA.,Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - L Chen
- Department of Pharmacology and Nutritional Science, University of Kentucky, Lexington, KY, USA.,Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - D Napier
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA.,Department of Pathology, University of Kentucky, Lexington, KY, USA
| | - L Chaiswing
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY, USA
| | - L D Brewer
- Department of Pharmacology and Nutritional Science, University of Kentucky, Lexington, KY, USA.,Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - D St Clair
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY, USA
| | - O Thibault
- Department of Pharmacology and Nutritional Science, University of Kentucky, Lexington, KY, USA.,Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - J R van Nagell
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA.,Department of Pathology, University of Kentucky, Lexington, KY, USA
| | - B P Zhou
- Department of Pharmacology and Nutritional Science, University of Kentucky, Lexington, KY, USA.,Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - R Drapkin
- Department of Gynecologic Cancer Research, Basser Center for BRCA, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - J-A Huang
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Jiangsu Province, PR China
| | - M L Lu
- Department of Biomedical Science, Florida Atlantic University, Boca Raton, FL, USA
| | - F R Ueland
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA.,Department of Pathology, University of Kentucky, Lexington, KY, USA
| | - X H Yang
- Department of Pharmacology and Nutritional Science, University of Kentucky, Lexington, KY, USA.,Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA.,Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Jiangsu Province, PR China
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Matsuo K, Takazawa Y, Ross MS, Elishaev E, Podzielinski I, Yunokawa M, Sheridan TB, Bush SH, Klobocista MM, Blake EA, Takano T, Matsuzaki S, Baba T, Satoh S, Shida M, Nishikawa T, Ikeda Y, Adachi S, Yokoyama T, Takekuma M, Fujiwara K, Hazama Y, Kadogami D, Moffitt MN, Takeuchi S, Nishimura M, Iwasaki K, Ushioda N, Johnson MS, Yoshida M, Hakam A, Li SW, Richmond AM, Machida H, Mhawech-Fauceglia P, Ueda Y, Yoshino K, Yamaguchi K, Oishi T, Kajiwara H, Hasegawa K, Yasuda M, Kawana K, Suda K, Miyake TM, Moriya T, Yuba Y, Morgan T, Fukagawa T, Wakatsuki A, Sugiyama T, Pejovic T, Nagano T, Shimoya K, Andoh M, Shiki Y, Enomoto T, Sasaki T, Fujiwara K, Mikami M, Shimada M, Konishi I, Kimura T, Post MD, Shahzad MM, Im DD, Yoshida H, Omatsu K, Ueland FR, Kelley JL, Karabakhtsian RG, Roman LD. Significance of histologic pattern of carcinoma and sarcoma components on survival outcomes of uterine carcinosarcoma. Ann Oncol 2016; 27:1257-66. [PMID: 27052653 DOI: 10.1093/annonc/mdw161] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/29/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To examine the effect of the histology of carcinoma and sarcoma components on survival outcome of uterine carcinosarcoma. PATIENTS AND METHODS A multicenter retrospective study was conducted to examine uterine carcinosarcoma cases that underwent primary surgical staging. Archived slides were examined and histologic patterns were grouped based on carcinoma (low-grade versus high-grade) and sarcoma (homologous versus heterologous) components, correlating to clinico-pathological demographics and outcomes. RESULTS Among 1192 cases identified, 906 cases were evaluated for histologic patterns (carcinoma/sarcoma) with high-grade/homologous (40.8%) being the most common type followed by high-grade/heterologous (30.9%), low-grade/homologous (18.0%), and low-grade/heterologous (10.3%). On multivariate analysis, high-grade/heterologous (5-year rate, 34.0%, P = 0.024) and high-grade/homologous (45.8%, P = 0.017) but not low-grade/heterologous (50.6%, P = 0.089) were independently associated with decreased progression-free survival (PFS) compared with low-grade/homologous (60.3%). In addition, older age, residual disease at surgery, large tumor, sarcoma dominance, deep myometrial invasion, lymphovascular space invasion, and advanced-stage disease were independently associated with decreased PFS (all, P < 0.01). Both postoperative chemotherapy (5-year rates, 48.6% versus 39.0%, P < 0.001) and radiotherapy (50.1% versus 44.1%, P = 0.007) were significantly associated with improved PFS in univariate analysis. However, on multivariate analysis, only postoperative chemotherapy remained an independent predictor for improved PFS [hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.27-0.43, P < 0.001]. On univariate analysis, significant treatment benefits for PFS were seen with ifosfamide for low-grade carcinoma (82.0% versus 49.8%, P = 0.001), platinum for high-grade carcinoma (46.9% versus 32.4%, P = 0.034) and homologous sarcoma (53.1% versus 38.2%, P = 0.017), and anthracycline for heterologous sarcoma (66.2% versus 39.3%, P = 0.005). Conversely, platinum, taxane, and anthracycline for low-grade carcinoma, and anthracycline for homologous sarcoma had no effect on PFS compared with non-chemotherapy group (all, P > 0.05). On multivariate analysis, ifosfamide for low-grade/homologous (HR 0.21, 95% CI 0.07-0.63, P = 0.005), platinum for high-grade/homologous (HR 0.36, 95% CI 0.22-0.60, P < 0.001), and anthracycline for high-grade/heterologous (HR 0.30, 95% CI 0.14-0.62, P = 0.001) remained independent predictors for improved PFS. Analyses of 1096 metastatic sites showed that carcinoma components tended to spread lymphatically, while sarcoma components tended to spread loco-regionally (P < 0.001). CONCLUSION Characterization of histologic pattern provides valuable information in the management of uterine carcinosarcoma.
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Affiliation(s)
- K Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
| | - Y Takazawa
- Department of Pathology, Cancer Institute Hospital, Tokyo, Japan
| | - M S Ross
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology
| | - E Elishaev
- Department of Pathology, MaGee-Womens Hospital, University of Pittsburgh, Pittsburgh
| | - I Podzielinski
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, USA
| | - M Yunokawa
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - T B Sheridan
- Department of Pathology, Mercy Medical Center, Baltimore
| | - S H Bush
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of South Florida, Tampa
| | - M M Klobocista
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Bronx
| | - E A Blake
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology; University of Colorado, Boulder, USA
| | - T Takano
- Department of Obstetrics and Gynecology, Tohoku University, Miyagi
| | - S Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University, Osaka
| | - T Baba
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto
| | - S Satoh
- Department of Obstetrics and Gynecology, Tottori University, Tottori
| | - M Shida
- Department of Obstetrics and Gynecology, Tokai University, Kanagawa
| | - T Nishikawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama
| | - Y Ikeda
- Departments of Obstetrics and Gynecology, The University of Tokyo, Tokyo
| | - S Adachi
- Department of Obstetrics and Gynecology, Niigata University, Niigata
| | - T Yokoyama
- Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka
| | - M Takekuma
- Department of Obstetrics and Gynecology, Shizuoka Cancer Center, Shizuoka
| | - K Fujiwara
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama
| | - Y Hazama
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama
| | - D Kadogami
- Department of Obstetrics and Gynecology; Kitano Hospital, Osaka, Japan
| | - M N Moffitt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Portland, USA
| | - S Takeuchi
- Department of Obstetrics and Gynecology, Iwate Medical University, Morioka
| | - M Nishimura
- Department of Obstetrics and Gynecology, Tokushima University, Tokushima
| | - K Iwasaki
- Department of Obstetrics and Gynecology, Aichi Medical University, Aichi
| | - N Ushioda
- Department of Gynecology, Cancer Institute Hospital, Tokyo
| | - M S Johnson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, USA
| | - M Yoshida
- Departments of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - A Hakam
- Department of Pathology, Moffitt Cancer Center, University of South Florida, Tampa
| | - S W Li
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Bronx
| | - A M Richmond
- Department of Pathology, University of Colorado, Boulder
| | - H Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
| | - P Mhawech-Fauceglia
- Department of Pathology, University of Southern California, Los Angeles, USA
| | - Y Ueda
- Department of Obstetrics and Gynecology, Osaka University, Osaka
| | - K Yoshino
- Department of Obstetrics and Gynecology, Osaka University, Osaka
| | - K Yamaguchi
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto
| | - T Oishi
- Department of Obstetrics and Gynecology, Tottori University, Tottori
| | - H Kajiwara
- Department of Pathology, Tokai University, Kanagawa
| | - K Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama
| | - M Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Saitama
| | - K Kawana
- Departments of Obstetrics and Gynecology, The University of Tokyo, Tokyo
| | - K Suda
- Department of Obstetrics and Gynecology, Niigata University, Niigata
| | - T M Miyake
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama
| | - T Moriya
- Department of Pathology, Kawasaki Medical School, Okayama
| | - Y Yuba
- Department of Pathology, Kitano Hospital, Osaka, Japan
| | - T Morgan
- Department of Pathology, Oregon Health & Science University, Portland, USA
| | - T Fukagawa
- Department of Pathology, Iwate Medical University, Morioka
| | - A Wakatsuki
- Department of Obstetrics and Gynecology, Aichi Medical University, Aichi
| | - T Sugiyama
- Department of Obstetrics and Gynecology, Iwate Medical University, Morioka
| | - T Pejovic
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Portland, USA
| | - T Nagano
- Department of Obstetrics and Gynecology; Kitano Hospital, Osaka, Japan
| | - K Shimoya
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama
| | - M Andoh
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama
| | - Y Shiki
- Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka
| | - T Enomoto
- Department of Obstetrics and Gynecology, Niigata University, Niigata
| | - T Sasaki
- Department of Pathology, The University of Tokyo, Tokyo, Japan
| | - K Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama
| | - M Mikami
- Department of Obstetrics and Gynecology, Tokai University, Kanagawa
| | - M Shimada
- Department of Obstetrics and Gynecology, Tottori University, Tottori
| | - I Konishi
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto
| | - T Kimura
- Department of Obstetrics and Gynecology, Osaka University, Osaka
| | - M D Post
- Department of Pathology, University of Colorado, Boulder
| | - M M Shahzad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of South Florida, Tampa
| | - D D Im
- Department of Gynecology, Mercy Medical Center, Baltimore
| | - H Yoshida
- Departments of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - K Omatsu
- Department of Gynecology, Cancer Institute Hospital, Tokyo
| | - F R Ueland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, USA
| | - J L Kelley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology
| | - R G Karabakhtsian
- Department of Pathology, University of Kentucky, Lexington Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, USA
| | - L D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
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Powell MA, Filiaci VL, Rose PG, Mannel RS, Hanjani P, DeGeest K, Miller BE, Susumu N, Ueland FR. A phase II evaluation of paclitaxel and carboplatin in the treatment of carcinosarcoma of the uterus: A Gynecologic Oncology Group (GOG) study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5515 Background: Both platinum and taxane compounds have demonstrated activity in uterine carcinosarcoma (malignant mixed Mullerian tumor). Ifosfamide plus paclitaxel is the regimen supported by randomized phase III trials through the GOG. However, the toxicity, multi-day schedule, and limited activity of this regimen indicate that development of other regimens is still needed. The primary aims of this prospective study were to estimate the antitumor activity and toxicity of paclitaxel plus carboplatin in patients with uterine carcinosarcomas. Methods: Eligible patients had advanced stage (III or IV), persistent, or recurrent measurable disease with histologic confirmation of the primary tumor, no prior chemotherapy, and a GOG Performance Status of 2 or better. At entry hematologic and all other labs were within pre-defined limits. Patients received the combination of paclitaxel 175 mg/m2 IV over 3 hours plus carboplatin (AUC 6) IV over 30 minutes every 3 weeks until disease progression or adverse effects prohibit further therapy. The primary endpoint of confirmed response was assessed by RECIST criteria. CTCAE v3 was used to grade adverse events. This study used an optimal but flexible two-stage design with early stopping guidelines intended to limit patient accrual to inactive treatments. Forty to 47 eligible patients were targeted for accrual. Central pathology review (CPR) is still pending for 5 patients. Results: Fifty-five patients were entered on study with 9 being excluded from analysis; 7 with unconfirmed diagnosis at CPR and 2 were never treated. Treatment was generally tolerated with expected hematologic toxicity and minimal non-hematologic grade 4 toxicity (1 cardiovascular and 2 pain) with 59% of patients completing 6 or more cycles of chemotherapy. The proportion of patients with confirmed complete and partial responses were 11% and 41%, respectively (52%; 95% CI 37%-67%). Additionally 4% experienced an unconfirmed response and 26% had stable disease. Conclusions: Paclitaxel plus carboplatin demonstrates anti-tumor activity against uterine carcinosarcoma with acceptable toxicity and warrants further evaluation in phase III randomized trials. No significant financial relationships to disclose.
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Affiliation(s)
- M. A. Powell
- Washington University, St Louis, MO; Gynecologic Oncology Group Statistical Office, Buffalo, NY; Cleveland Clinic Foundation, Cleveland, OH; University of Oklahoma, Oklahoma City, OK; Abington Memorial Hospital, Abington, PA; University of Iowa Hospitals and Clinics, Iowa City, IA; Wake Forest University, Wake Forest, NC; Keio University from GOG Japan institutions, Keio, Japan; University of Kentucky, Lexington, KY
| | - V. L. Filiaci
- Washington University, St Louis, MO; Gynecologic Oncology Group Statistical Office, Buffalo, NY; Cleveland Clinic Foundation, Cleveland, OH; University of Oklahoma, Oklahoma City, OK; Abington Memorial Hospital, Abington, PA; University of Iowa Hospitals and Clinics, Iowa City, IA; Wake Forest University, Wake Forest, NC; Keio University from GOG Japan institutions, Keio, Japan; University of Kentucky, Lexington, KY
| | - P. G. Rose
- Washington University, St Louis, MO; Gynecologic Oncology Group Statistical Office, Buffalo, NY; Cleveland Clinic Foundation, Cleveland, OH; University of Oklahoma, Oklahoma City, OK; Abington Memorial Hospital, Abington, PA; University of Iowa Hospitals and Clinics, Iowa City, IA; Wake Forest University, Wake Forest, NC; Keio University from GOG Japan institutions, Keio, Japan; University of Kentucky, Lexington, KY
| | - R. S. Mannel
- Washington University, St Louis, MO; Gynecologic Oncology Group Statistical Office, Buffalo, NY; Cleveland Clinic Foundation, Cleveland, OH; University of Oklahoma, Oklahoma City, OK; Abington Memorial Hospital, Abington, PA; University of Iowa Hospitals and Clinics, Iowa City, IA; Wake Forest University, Wake Forest, NC; Keio University from GOG Japan institutions, Keio, Japan; University of Kentucky, Lexington, KY
| | - P. Hanjani
- Washington University, St Louis, MO; Gynecologic Oncology Group Statistical Office, Buffalo, NY; Cleveland Clinic Foundation, Cleveland, OH; University of Oklahoma, Oklahoma City, OK; Abington Memorial Hospital, Abington, PA; University of Iowa Hospitals and Clinics, Iowa City, IA; Wake Forest University, Wake Forest, NC; Keio University from GOG Japan institutions, Keio, Japan; University of Kentucky, Lexington, KY
| | - K. DeGeest
- Washington University, St Louis, MO; Gynecologic Oncology Group Statistical Office, Buffalo, NY; Cleveland Clinic Foundation, Cleveland, OH; University of Oklahoma, Oklahoma City, OK; Abington Memorial Hospital, Abington, PA; University of Iowa Hospitals and Clinics, Iowa City, IA; Wake Forest University, Wake Forest, NC; Keio University from GOG Japan institutions, Keio, Japan; University of Kentucky, Lexington, KY
| | - B. E. Miller
- Washington University, St Louis, MO; Gynecologic Oncology Group Statistical Office, Buffalo, NY; Cleveland Clinic Foundation, Cleveland, OH; University of Oklahoma, Oklahoma City, OK; Abington Memorial Hospital, Abington, PA; University of Iowa Hospitals and Clinics, Iowa City, IA; Wake Forest University, Wake Forest, NC; Keio University from GOG Japan institutions, Keio, Japan; University of Kentucky, Lexington, KY
| | - N. Susumu
- Washington University, St Louis, MO; Gynecologic Oncology Group Statistical Office, Buffalo, NY; Cleveland Clinic Foundation, Cleveland, OH; University of Oklahoma, Oklahoma City, OK; Abington Memorial Hospital, Abington, PA; University of Iowa Hospitals and Clinics, Iowa City, IA; Wake Forest University, Wake Forest, NC; Keio University from GOG Japan institutions, Keio, Japan; University of Kentucky, Lexington, KY
| | - F. R. Ueland
- Washington University, St Louis, MO; Gynecologic Oncology Group Statistical Office, Buffalo, NY; Cleveland Clinic Foundation, Cleveland, OH; University of Oklahoma, Oklahoma City, OK; Abington Memorial Hospital, Abington, PA; University of Iowa Hospitals and Clinics, Iowa City, IA; Wake Forest University, Wake Forest, NC; Keio University from GOG Japan institutions, Keio, Japan; University of Kentucky, Lexington, KY
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4
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Dietrich CS, Desimone CP, Modesitt SC, Depriest PD, Ueland FR, Pavlik EJ, Kryscio R, Cibull M, Huh W, Partridge E, Numnum TM, Schilder J, Higgins RV, van Nagell JR. Primary appendiceal cancer: Gynecologic manifestations and treatment options. Gynecol Oncol 2007; 104:602-6. [PMID: 17055559 DOI: 10.1016/j.ygyno.2006.09.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 09/15/2006] [Accepted: 09/18/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the presenting symptoms, gynecologic manifestations, and optimal intraoperative management of women with primary appendiceal cancer. METHODS A multi-institutional investigation was performed to identify female patients with primary appendiceal cancer who were treated from 1990 to present. RESULTS Forty-eight women with primary appendiceal cancer were identified from the tumor registries of participating institutions. The most common symptoms were abdominal pain (40%) and bloating (23%), but only 8% experienced rectal bleeding. Serum CEA was elevated (>2.5 U/ml) in 67% of patients, and serum Ca-125 was elevated (>35 U/ml) in 50% of patients. Thirty-one patients (65%) presented with a right adnexal or right lower quadrant mass and were operated on initially by a gynecologic oncologist. Ovarian involvement by metastatic appendiceal cancer was documented in 18 patients (38%). All of these patients underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and staging, but only 8 had a right hemicolectomy at the time of initial surgery. Forty-one patients (85%) presented with advanced stage appendiceal cancer (Stage III or IV) and 19 patients (46%) received postoperative chemotherapy, most commonly with a combination of 5-FU/Leukovorin. Following surgery, 22 patients (46%) experienced disease progression or recurrence, and 14 have died of disease. The most common sites of recurrence were abdominal or pelvic peritoneum (18), colon (2), and ovary (2). Patient survival was 70% at 2 years, and 60% at 5 years. CONCLUSION Women with primary appendiceal cancer frequently present with ovarian metastases, and initial surgical intervention is often performed by a gynecologic oncologist. All patients with mucinous epithelial ovarian cancer should undergo appendectomy at the time of surgical staging. The appendix should be examined intraoperatively, and if appendiceal carcinoma is identified, a right hemicolectomy and appropriate surgical staging should be considered.
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Affiliation(s)
- C S Dietrich
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Medical Center-Markey Cancer Center, 800 Rose Street, Lexington, KY 40536, USA
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Zhang Z, Bast RC, Vergote I, Høgdall C, Ueland FR, Van der Zee A, Wang Z, Yip C, Chan DW, Fung ET. A large-scale multi-center independent validation study of a panel of seven biomarkers for the detection of ovarian cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5057 Background: Previously we discovered seven serum biomarkers: ITIH4, transthyretin, ApoA1, CTAPIII, hepcidin, transferrin, and SAA, for the detection of ovarian cancer. They are fragments, cleavages, or PTMs of circulating proteins that are difficult to measure by conventional immunoassays. Using optimzed mass spectrometry assays, we evaluated these biomarkers in a large-scale multi-center study. Methods: A total of 607 serum samples from five sites were analyzed using SELDI TOF-MS protocols optimized for the seven biomarkers. They included 234 women with benign gynecologic diseases, and 373 patients with invasive epithelial ovarian cancer (101 early stage, 231 late stage, and 40 stage unknown). Among them, 165 benigns and 228 cancers had a CA125 available at time of analysis. The median and quartiles of CA125 for benign, early stage, and late or unknown stage were 26/11/57 IU, 80/22/434 IU, and 234/40/1114 IU, respectively. The biomarkers were assessed individually using the Mann-Whitney U Test. A linear composite index was derived in an unsupervised fashion using data from one site and then calculated for the remaining data using the fixed formula. ROC curve analyses were performed on data from individual sites and all sites combined. Results: All seven biomarkers individually demonstrated statistically significant differentiating power, and the majority had p-value<0.00001. AUCs of the composite index in ROC analyses for the six sites were 0.602, 0.566, 0.821, 0.813, and 0.592 in detecting cancer at all stages from benign. On the combined data, the differences in AUC between the index and CA125 were not statistically significant for the detection of cancer at all stages (AUC=0.706 vs. 0.725) or early stages only (AUC=0.534 vs. 0.653). However, the index did better at the high-sensitivity range. At a fixed sensitivity of 86%, the specificity of the index was 34% (77/226) compared to CA125 at 26% (42/163). For early stage cases, at a fixed sensitivity of 84%, the specificity of the index was 24% (55/226) compared to CA125 at 14%% (22/163). Conclusions: We validated seven previously discovered biomarkers, individually and in combination. Prospective studies and assay development are under way to further characterize their clinical utility. [Table: see text]
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Affiliation(s)
- Z. Zhang
- Johns Hopkins University School of Medicine, Baltimore, MD; UT M. D. Anderson Cancer Center, Houston, TX; University Hospitals, Leuven, Belgium; Rigshospitalet, University of Copenhagen Hospital, Copenhagen, Denmark; University of Kentucky, Lexington, KY; Groningen University Medical Center, Groningen, The Netherlands; Ciphergen, Fremont, CA
| | - R. C. Bast
- Johns Hopkins University School of Medicine, Baltimore, MD; UT M. D. Anderson Cancer Center, Houston, TX; University Hospitals, Leuven, Belgium; Rigshospitalet, University of Copenhagen Hospital, Copenhagen, Denmark; University of Kentucky, Lexington, KY; Groningen University Medical Center, Groningen, The Netherlands; Ciphergen, Fremont, CA
| | - I. Vergote
- Johns Hopkins University School of Medicine, Baltimore, MD; UT M. D. Anderson Cancer Center, Houston, TX; University Hospitals, Leuven, Belgium; Rigshospitalet, University of Copenhagen Hospital, Copenhagen, Denmark; University of Kentucky, Lexington, KY; Groningen University Medical Center, Groningen, The Netherlands; Ciphergen, Fremont, CA
| | - C. Høgdall
- Johns Hopkins University School of Medicine, Baltimore, MD; UT M. D. Anderson Cancer Center, Houston, TX; University Hospitals, Leuven, Belgium; Rigshospitalet, University of Copenhagen Hospital, Copenhagen, Denmark; University of Kentucky, Lexington, KY; Groningen University Medical Center, Groningen, The Netherlands; Ciphergen, Fremont, CA
| | - F. R. Ueland
- Johns Hopkins University School of Medicine, Baltimore, MD; UT M. D. Anderson Cancer Center, Houston, TX; University Hospitals, Leuven, Belgium; Rigshospitalet, University of Copenhagen Hospital, Copenhagen, Denmark; University of Kentucky, Lexington, KY; Groningen University Medical Center, Groningen, The Netherlands; Ciphergen, Fremont, CA
| | - A. Van der Zee
- Johns Hopkins University School of Medicine, Baltimore, MD; UT M. D. Anderson Cancer Center, Houston, TX; University Hospitals, Leuven, Belgium; Rigshospitalet, University of Copenhagen Hospital, Copenhagen, Denmark; University of Kentucky, Lexington, KY; Groningen University Medical Center, Groningen, The Netherlands; Ciphergen, Fremont, CA
| | - Z. Wang
- Johns Hopkins University School of Medicine, Baltimore, MD; UT M. D. Anderson Cancer Center, Houston, TX; University Hospitals, Leuven, Belgium; Rigshospitalet, University of Copenhagen Hospital, Copenhagen, Denmark; University of Kentucky, Lexington, KY; Groningen University Medical Center, Groningen, The Netherlands; Ciphergen, Fremont, CA
| | - C. Yip
- Johns Hopkins University School of Medicine, Baltimore, MD; UT M. D. Anderson Cancer Center, Houston, TX; University Hospitals, Leuven, Belgium; Rigshospitalet, University of Copenhagen Hospital, Copenhagen, Denmark; University of Kentucky, Lexington, KY; Groningen University Medical Center, Groningen, The Netherlands; Ciphergen, Fremont, CA
| | - D. W. Chan
- Johns Hopkins University School of Medicine, Baltimore, MD; UT M. D. Anderson Cancer Center, Houston, TX; University Hospitals, Leuven, Belgium; Rigshospitalet, University of Copenhagen Hospital, Copenhagen, Denmark; University of Kentucky, Lexington, KY; Groningen University Medical Center, Groningen, The Netherlands; Ciphergen, Fremont, CA
| | - E. T. Fung
- Johns Hopkins University School of Medicine, Baltimore, MD; UT M. D. Anderson Cancer Center, Houston, TX; University Hospitals, Leuven, Belgium; Rigshospitalet, University of Copenhagen Hospital, Copenhagen, Denmark; University of Kentucky, Lexington, KY; Groningen University Medical Center, Groningen, The Netherlands; Ciphergen, Fremont, CA
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Dietrich CS, Modesitt SC, DePriest PD, Ueland FR, Wilder J, Reedy MB, Pavlik EJ, Kryscio R, Cibull M, Giesler J, Manahan K, Huh W, Cohn D, Powell M, Slomovitz B, Higgins RV, Merritt W, Hunter J, Puls L, Gehrig P, van Nagell JR. The efficacy of adjuvant platinum-based chemotherapy in Stage I uterine papillary serous carcinoma (UPSC). Gynecol Oncol 2005; 99:557-63. [PMID: 16154185 DOI: 10.1016/j.ygyno.2005.07.104] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Revised: 06/30/2005] [Accepted: 07/19/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the efficacy of adjuvant platinum-based chemotherapy in Stage I uterine papillary serous carcinoma (UPSC). METHODS A retrospective multi-institutional investigation was performed to identify surgically staged patients with Stage I UPSC who were (1) treated after surgery with 3-6 courses of platinum-based chemotherapy without radiation from 1990-2003, and (2) followed for a minimum of 12 months, or until recurrence. RESULTS Six patients (IA-2, IB-3, IC-1) were treated with carboplatin (AUC 6) or cisplatin (50 mg/m2) alone. One patient recurred to the vagina, was treated with chemo-radiation, and is alive and well at 122 months. One patient recurred to the lung, liver, and brain, and died of disease at 24 months. The remaining 4 patients are alive with no evidence of disease 15-124 months (mean 62 months) after treatment. Two patients (IB-1, IC-1) were treated with cisplatin (50 mg/m2) and cyclophosphamide (1000 mg/m2), and both are alive and well with no evidence of disease 75 and 168 months after treatment. Twenty-one patients (IA-5, IB-13, IC-3) were treated with a combination of carboplatin (AUC 6) and paclitaxel (135 mg/m2-175 mg/m2). One patient recurred to the vagina after 3 cycles of carboplatin/paclitaxel, and was treated with chemo-radiation. She is now without evidence of disease 10 months after treatment. At present, all 21 patients with Stage I UPSC treated following surgical staging with carboplatin/paclitaxel chemotherapy are alive and well with no evidence of disease 10-138 months (mean 41 months) after treatment. CONCLUSION Combination carboplatin/paclitaxel chemotherapy following surgery is effective in the treatment of Stage I UPSC.
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Affiliation(s)
- C S Dietrich
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Medical Center, 800 Rose Street, Lexington, KY 40536, USA
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Ueland FR, DePriest PD, Pavlik EJ, Kryscio RJ, van Nagell JR. Preoperative differentiation of malignant from benign ovarian tumors: the efficacy of morphology indexing and Doppler flow sonography. Gynecol Oncol 2003; 91:46-50. [PMID: 14529661 DOI: 10.1016/s0090-8258(03)00414-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The goal of this study was to determine the efficacy of morphology indexing and Doppler flow sonography as methods to predict risk of malignancy in sonographically confirmed ovarian tumors. METHODS Risk of malignancy was assessed preoperatively in 442 ovarian tumors using a new morphology index (MI) based on tumor volume and wall structure. Each tumor was assigned a score of 0 to 10 based on increasing volume and morphologic complexity. Doppler flow studies were performed on 371 of these tumors. Following morphologic evaluation, all ovarian tumors were removed surgically. RESULTS Of 315 tumors with a MI < 5 there was only 1 malignancy (a stage IA granulosa cell tumor <2 cm in diameter) whereas there were 52 malignancies in 127 tumors with a MI > or = 5. Stage of disease was as follows: stage I, 33; stage II, 6; stage III, 14. Risk of malignancy was related directly to MI score, varying from 0.3% in tumors with a MI < 5 to 84% in tumors with a MI > or = 8. A MI value of > or = 5 as indicative of malignancy was associated with the following statistical parameters: sensitivity 0.981, specificity 0.808, PPV 0.409, NPV 0.997. A pulsatility index (PI) < 1.0 as indicative of malignancy was associated with: sensitivity 0.528, specificity 0.776, PPV 0.288, NPV 0.906. A resistive index (RI) < 0.4 as indicative of malignancy was associated with: sensitivity 0.222, specificity 0.867, PPV 0.222, and NPV 0.867. The addition of Doppler flow indices to MI did not improve the accuracy of predicting malignancy. Likewise, the absence or presence of ovarian tumor blood flow was not reliable as a means to differentiate benign from malignant ovarian tumors. CONCLUSIONS Morphology indexing is an accurate and inexpensive method of differentiating benign from malignant ovarian tumors, and can be a valuable adjunct in treatment planning. The addition of Doppler flow studies did not improve diagnostic accuracy of MI.
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Affiliation(s)
- F R Ueland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center,Lexington, KY 40536-0298, USA.
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Pavlik EJ, Liu C, DePriest PD, Gallion HH, Ueland FR, Kryscio RJ, van Nagell JR. Relating ovarian size to age, menopausal status, and use of hormones. Gynecol Oncol 2001; 80:333-4. [PMID: 11161877 DOI: 10.1006/gyno.2000.6114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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9
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van Nagell JR, DePriest PD, Reedy MB, Gallion HH, Ueland FR, Pavlik EJ, Kryscio RJ. The Efficacy of Transvaginal Sonographic Screening in Asymptomatic Women at Risk for Ovarian Cancer. Obstet Gynecol Surv 2000. [DOI: 10.1097/00006254-200010000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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van Nagell JR, DePriest PD, Reedy MB, Gallion HH, Ueland FR, Pavlik EJ, Kryscio RJ. The efficacy of transvaginal sonographic screening in asymptomatic women at risk for ovarian cancer. Gynecol Oncol 2000; 77:350-6. [PMID: 10831341 DOI: 10.1006/gyno.2000.5816] [Citation(s) in RCA: 287] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the efficacy of annual transvaginal sonography (TVS) as a screening method for ovarian cancer. METHODS Annual TVS screening was performed on 14, 469 asymptomatic women from 1987 to 1999. Eligibility criteria included (1) all women >/= 50 years of age and (2) women >/= 25 years of age with a family history of ovarian cancer. Ovarian volume was calculated using the prolate ellipsoid (length x height x width x 0.523). An abnormal sonogram was defined by (1) an ovarian volume >10 cm(3) in postmenopausal women or >20 cm(3) in premenopausal women or (2) a papillary or complex tissue projection into a cystic ovarian tumor. All women with abnormal TVS had a repeat sonogram in 4-6 weeks. Patients with a persistently abnormal second screen had a serum CA-125 determination, tumor morphology indexing, and Doppler flow sonography, and were advised to have surgical tumor removal. RESULTS One hundred eighty patients with persisting TVS abnormalities underwent exploratory laparoscopy or laparotomy. Seventeen ovarian cancers were detected: 11 Stage I, 3 Stage II, and 3 Stage III. Only three patients with Stage I cancers had a palpable ovarian mass on clinical examination. All patients with Stage I and II ovarian cancer are alive without recurrence 1.8-9.8 years (median, 4.5 years) after diagnosis. Two of the three Stage III patients have died of disease: one at 4.3 years and one at 7.7 years after detection. Four patients developed ovarian cancer within 12 months of a negative scan (FN): 2 Stage II, 2 Stage III. Three of these patients are alive with no evidence of disease 0.4, 1.9, and 5.5 years after diagnosis, and 1 patient has died of disease 0.7 years after diagnosis. Four patients developed ovarian cancer more than 12 months following a normal screen. All 4 presented clinically with Stage III disease. Two of these patients have died of disease and two patients are alive 1.5 and 2.1 years after diagnosis. TVS screening was associated with the following statistical variables: sensitivity, 81%; specificity, 98.9%; positive predictive value (PPV), 9.4%; and negative predictive value (NPV), 99.97%. After 46, 113 screening years, there have been 3 ovarian cancer deaths in the annually screened population and 2 ovarian cancer deaths in women receiving less than annual screening. The survival of ovarian cancer patients in the annually screened population was 95.0 +/- 4.9% at 2 years and 88.2 +/- 8.0% at 5 years. Excluding all cases of nonepithelial or borderline epithelial malignancies, the survival of patients with ovarian cancer in the annually screened population was 92.9 +/- 6.9% at 2 years and 83.6 +/- 10.8% at 5 years. CONCLUSIONS (1) TVS screening, when performed annually, is associated with a decrease in stage at detection and a decrease in case-specific ovarian cancer mortality. (2) TVS screening does not appear to be effective in detecting ovarian cancer in which ovarian volume is normal.
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Affiliation(s)
- J R van Nagell
- Division of Gynecologic Oncology, University of Kentucky Chandler Medical Center and Markey Cancer Center, Lexington, Kentucky 40536-0298, USA
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Abstract
OBJECTIVE The goal of this study was to determine the relationship of ovarian volume to age, height, and weight in women undergoing transvaginal sonography. METHODS Thirteen thousand nine hundred sixty-three women 25-91 years of age undergoing annual transvaginal sonography as part of the University of Kentucky Ovarian Cancer Screening Program were the subjects for this investigation. Each ovary was measured in three dimensions, and ovarian volume was calculated using the prolate ellipsoid formula (L x H x W x 0.523). Mean ovarian volume according to age was calculated for each decade of life. RESULTS Data were obtained from 58,673 observations of ovarian volume. Mean ovarian volume was 6.6 +/- 0.19 cm(3) in women less than 30 years of age; 6.1 +/- 0.06 cm(3) in women 30-39; 4.8 +/- 0.03 cm(3) in women 40-49; 2.6 +/- 0.01 cm(3) in women 50-59; 2. 1 +/- 0.01 cm(3) in women 60-69; and 1.8 +/- 0.08 cm(3) in women >/=70. Mean ovarian volume was 4.9 +/- 0.03 cm(3) in premenopausal women and 2.2 +/- 0.01 cm(3) in postmenopausal women (P < 0.001). The use of exogenous estrogens was associated with a significant reduction in ovarian volume in women 40-59 years of age, but not in women >/= 60. Ovarian volume was unrelated to patient weight but was greater in tall women (>68 in.) than in short women (<58 in.). CONCLUSION There is a statistically significant decrease in ovarian volume with each decade of life from age 30 to age 70. Mean ovarian volume in premenopausal women is significantly greater than that in postmenopausal women. The upper limit of normal for ovarian volume is 20 cm(3) in premenopausal women and 10 cm(3) in postmenopausal women.
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Affiliation(s)
- E J Pavlik
- Division of Gynecologic Oncology, University of Kentucky Medical Center, Lexington, Kentucky 40536, USA
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Abstract
Recent data indicate that assessment of sonographically determined tumor volume and morphology is the most accurate means to differentiate benign from malignant ovarian tumors. Doppler flow studies generally have shown a lower impedance to flow in vessels supplying ovarian malignancies than in those associated with benign tumors. However, the overlap in pulsatility index and resistive index values of benign and malignant ovarian tumors, and the cost of this procedure, make its routine use impractical. In a postmenopausal woman with a sonographically confirmed ovarian tumor, a progressively rising serum Ca-125 is highly suspicious for malignancy.
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Affiliation(s)
- J R van Nagell
- Department of Obstetrics and Gynecology, University of Kentucky Medical Center, Lexington 40536, USA
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Bailey CL, Ueland FR, Land GL, DePriest PD, Gallion HH, Kryscio RJ, van Nagell JR. The malignant potential of small cystic ovarian tumors in women over 50 years of age. Gynecol Oncol 1998; 69:3-7. [PMID: 9570990 DOI: 10.1006/gyno.1998.4965] [Citation(s) in RCA: 152] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine the risk of malignancy in cystic ovarian tumors < 10 cm in diameter in asymptomatic postmenopausal women or women >or =50 years of age. METHODS All cystic ovarian tumors detected by transvaginal sonography screening in asymptomatic postmenopausal women or women > or =50 years of age were evaluated with respect to size and morphology. Histology was recorded on all tumors removed surgically. Follow-up data were available both on patients undergoing surgery and on those who elected to be followed without operative intervention. RESULTS Unilocular cystic tumors were detected in 256 of 7705 patients (3.3%). All tumors were < 10 cm in diameter and 90% were < 5 cm in diameter. One hundred twenty-five of these cysts (49%) resolved spontaneously within 60 days and 131 (51%) persisted. Forty-five patients with persisting ovarian cysts underwent operative removal of these tumors. Thirty-two patients had ovarian serous cystadenomas, and the remainder had a variety of benign lesions. There were no cases of ovarian carcinoma in this group. Eighty-six patients with unilocular cystic ovarian tumors were followed at 3- to 6-month intervals without surgery, and none have developed ovarian cancer. Complex cystic ovarian tumors were detected in 250 patients (3.2%). All tumors were < 10 cm in diameter and 89% were < 5 cm in diameter. One hundred thirty-five (55%) resolved spontaneously within 60 days, and 115 (45%) persisted. One hundred fourteen of these patients underwent operative tumor removal. Seven patients had ovarian carcinoma, 1 had primary peritoneal cancer, and 1 had metastatic breast cancer to the ovary. CONCLUSION Unilocular ovarian cysts < 10 cm in diameter in asymptomatic postmenopausal women or women > or =50 years of age are associated with minimal risk for ovarian cancer. In contrast, complex ovarian cysts with wall abnormalities or solid areas are associated with a significant risk for malignancy. These data are important in determining optimal strategies for operative intervention in these patients.
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Affiliation(s)
- C L Bailey
- Department of Obstetrics and Gynecology, University of Kentucky Medical Center, Lexington 40536, USA
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Buckley SL, Tritz DM, Van Le L, Higgins R, Sevin BU, Ueland FR, DePriest PD, Gallion HH, Bailey CL, Kryscio RJ, Fowler W, Averette H, van Nagell JR. Lymph node metastases and prognosis in patients with stage IA2 cervical cancer. Gynecol Oncol 1996; 63:4-9. [PMID: 8898159 DOI: 10.1006/gyno.1996.0268] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ninety-four patients with squamous cell carcinoma invading the cervical stroma to a depth of >3.0-5.0 mm with 7 mm or less in horizontal spread (FIGO Stage IA2) were evaluated. Depth and lateral extent of stromal invasion were verified using an ocular micrometer. Cell type and lymph vascular space invasion (LVSI) were recorded in each case. Patients were treated primarily by radical hysterectomy with pelvic lymphadenectomy, and those with lymph node metastases were offered postoperative radiation. Following treatment, patients were seen at 3-month intervals for 2 years, and every 6 months thereafter. The mean duration of follow-up was 6.9 years (range 0.4-23.5 years). Seven of 94 patients (7.4%) had lymph node metastases. Five patients had 1 positive node, 1 patient had 2 positive nodes, and 1 patient had 3 positive nodes. Five patients developed recurrent cancer and 4 died of disease. LVSI was present in 31 cases (33%). Tumor recurrence was significantly increased in patients with positive LVSI (9.7% vs 3.2%). The 5-year survival rate of patients with LVSI was 89% vs 98% in patients without this finding (P = 0.058). The 5-year survival rate of all Stage IA2 cervical cancer patients was 95%. Patients with Stage IA2 cervical cancer have a significant risk of lymph node metastases and should be treated by radical hysterectomy with pelvic lymphadenectomy. LVSI is an important prognostic variable in these patients and should be recorded in all cases.
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Affiliation(s)
- S L Buckley
- Department of Obstetrics and Gynecology, University of Kentucky Medical Center, Lexington 40536, USA
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Ferguson JE, Ueland FR, Stevenson DK, Ueland K. Oxytocin-induced labor characteristics and uterine activity after preinduction cervical priming with prostaglandin E2 intracervical gel. Obstet Gynecol 1988; 72:739-45. [PMID: 3173925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Labor characteristics and quantitation of uterine activity resulting from oxytocin induction of labor after intracervical prostaglandin E2 (PGE2) gel priming have not been previously reported. Forty-seven women with modified Bishop scores of 5 or less received preinduction priming with 0.5 mg of intracervical PGE2 gel. Oxytocin was used to induce labor after priming, and uterine activity was quantitated. A matched group of control patients was managed identically but did not receive PGE2 gel. In the gel group, modified Bishop scores improved significantly and in two patients (4%), priming alone induced labor. No uterine hyperstimulation or fetal heart rate abnormalities occurred during priming. Cesarean sections for all indications and those for failed induction were less common in the gel group. The length of the active phase and the second stage of labor were significantly shorter in the gel group. Uterine activity was similar in both groups. The data suggest a primary cervical action of the gel.
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Affiliation(s)
- J E Ferguson
- Department of Gynecology and Obstetrics, Stanford University School of Medicine, California
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