Intraperitoneal mitomycin C improves survival compared to cytoreductive surgery alone in an experimental model of high-grade pseudomyxoma peritonei

Pseudomyxoma peritonei (PMP) is a rare cancer commonly originating from appendiceal neoplasms that presents with mucinous tumor spread in the peritoneal cavity. Patients with PMP are treated with curative intent by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The value of adding HIPEC to CRS has not been proven in randomized trials, and the objective of this study was to investigate the efficacy of intraperitoneal mitomycin C (MMC) and regional hyperthermia as components of this complex treatment. Xenograft tissue established from a patient with histologically high-grade PMP with signet ring cell differentiation was implanted intraperitoneally in 65 athymic nude male rats and the animals were stratified into three treatment groups; the cytoreductive surgery group (CRSG, CRS only), the normothermic group (NG, CRS and intraperitoneal chemotherapy perfusion (IPEC) with MMC at 35 ºC), and the hyperthermic group (HG, CRS and IPEC at 41 ºC). The main endpoints were survival and tumor weight at autopsy. Adequate imitation of the clinical setting and treatment approach was achieved. The median survival was 31 days in the CRSG, 60 days in NG and 67 days in HG. The median tumor weights at autopsy were 34 g in CRSG, 23 g NG and 20 g in HG. In conclusion, the addition of IPEC with MMC after CRS doubled the survival time and reduced tumor growth compared to CRS alone. Adding regional hyperthermia resulted in a modest improvement of treatment outcome.

Resection of biliary mucinous cystic neoplasms of the liver: a prospective cohort series of 13 consecutive patients

BACKGROUND

Biliary mucinous cystic neoplasms (BMCNs) are uncommon neoplastic septated intrahepatic cysts which are often incorrectly diagnosed and have the potential for malignant transformation.

OBJECTIVE

To assess the outcome of surgical resection of BMCNs.

METHOD

A prospective liver surgery database was used to identify patients who underwent surgery at Groote Schuur Hospital Complex for BMCN from 1999 to 2015. Demographic variables including age and gender were documented as well as detailed preoperative imaging, location and size, operative treatment, extent of resection, histology, postoperative complications and outcome.

RESULTS

Thirteen female patients (median age 45 years) had surgery. Eleven were diagnosed by imaging for symptoms. Two were jaundiced. One cyst was found during an elective cholecystectomy. Five cysts were located centrally in the liver. Before referral three cysts were treated with percutaneous drainage and two were treated with operative deroofing. Six patients had anatomical liver resections and seven patients had non anatomical liver resections of which two needed ablation of residual cyst wall. One patient needed a biliary-enteric reconstruction to treat a fistula. Median operative time was 183 minutes (range: 130-375). No invasive carcinoma was found. There was no operative mortality. One surgical site infection and one intra-abdominal collection were treated. Two patients developed recurrent BMCN after 24 months.

CONCLUSION

BMCNs should be considered in middle aged women who have well encapsulated multilocular liver cysts. Treatment of large central BMCNs adjacent to vascular and biliary structures may require technically complex liver resections and are best managed in a specialised hepato-pancreatico-biliary unit.

Association of pancreatic adenocarcinoma up-regulated factor expression in ovarian mucinous adenocarcinoma with poor prognosis

Pancreatic adenocarcinoma up-regulated factor (PAUF) expression is elevated in both ovarian tumors and pancreatic adenocarcinoma. However, PAUF expression in ovarian tumors according to histologic subtype and grade has not been investigated. In this study, we examined various clinicopathologic features of 24 patients with mucinous cystadenoma (MCA), 36 with mucinous borderline tumors (MBTs), and 46 with mucinous adenocarcinomas (MACs) according to PAUF expression status assessed using immunohistochemistry. We found that MACs more frequently stained positive for PAUF than did MCAs and MBTs (P < 0.0001). Although there was no significant differences with respect to other clinicopathologic characteristics of MACs according to PAUF expression status, patients with PAUF-weakly positive and PAUF-strongly positive MACs tended to have a shorter overall survival (OS) than those with PAUF-negative MAC, determined using a Kaplan-Meier analysis (P = 0.1885). After adjusting for various clinicopathologic parameters, PAUF positivity of MACs was a significant predictive factor for disease-free survival (DFS) (negative vs. weakly positive: P = 0.045, hazard ratio [HR] = 57.406, 95% confidence interval [CI]: 1.090-3022.596; and negative vs. strongly positive: P = 0.034, HR = 97.890, 95% CI: 1.412-6785.925). In conclusion, PAUF was more frequently expressed in MAC than in its benign and borderline counterparts, and was associated with a poor OS and DFS in MAC patients. Therefore, we suggest that PAUF may be a practical biomarker for histopathological categorization and a prognostic marker for patients with an ovarian mucinous tumor.

Prognostic significance of APE1 cytoplasmic localization in human epithelial ovarian cancer

Cytoplasmic localization of apurinic/apyrimidinic endonuclease 1 (APE1) correlates with different tumorigenic processes and poor prognosis in several cancer types. However, rare investigation into the prognosis value of cytoplasmic localization of APE1 was provided in ovarian cancer. The present study examined for the first time the cytoplasmic localization of APE1 in epithelial ovarian cancer (EOC) by immunohistochemistry. The relationship between cytoplasmic localization of APE1 and clinicopathological parameters, as well as the correlation between cytoplasmic localization of APE1 and prognosis, was investigated. We found that cytoplasmic positivity was significantly higher in EOCs with low tumor differentiation (P = 0.002) and was significantly higher in advanced Federation International of Gynecology and Obstetrics (FIGO) stage (III + IV) patients compared to that in early FIGO stage (I + II) patients (40.7% vs. 11.8%; P = 0.002). No significant difference was observed in APE1 pattern referring to age, tumor size, family history, histological type, ascites, and lymphatic metastasis (P > 0.05). In addition, a lower survival rate was found in patients with cytoplasmic positive localization of APE1 compared to that in patients with cytoplasmic negative localization (P < 0.05). All these findings suggest that cytoplasmic localization of APE1 is associated with tumor progression and might be a valuable prognostic marker for EOC.

[Clinicopathologic features of 234 cases with borderline ovarian tumors]

OBJECTIVE

To determine the clinicopathologic characteristics and prognostic factors that may be used to predict the poor outcome of patients with borderline ovarian tumors.

METHODS

All cases with borderline ovarian tumors treated in the West China Second University Hospital from January 2001 to June 2007 were analyzed retrospectively for clinicopathologic features, treatment parameters and outcome of treatment. Univariate and multivariate analyses were used to assess independent prognostic factors using the logistic regression model.

RESULTS

The median age of 234 patients was 40.1 years with a range of 14 to 80 years. There were 101 (43.2%), 94 (40.2%), 19 (8.1%), 12 (5.1%), 8 (3.4%) cases of serous, mucinous, mixed, endometrioid and clear cell tumors, respectively. Out of 234 cases, 182 (77.8%) underwent laparotomy and 45 (19.2%) underwent laparoscopy. Seven women underwent laparoconversion. Fertility sparing surgery was performed on 119 cases (50.9%) and radical surgery was performed on 115 cases (49.1%). Totally 161 (68.8%) patients had stage I, 19 (8.1%) had stage II, 54 (23.1%) had stage III, and none had stage IV disease. Sixty-four women received postoperative chemotherapy. The median follow-up was 40 months with a range of 8 to 78 months. Recurrence was found in 26 cases (11.1%) during follow-up, and no tumor-related death was reported. The logistic regression model showed that surgery procedure (OR = 2.304, P = 0.024), cyst rupture (OR = 2.213, P = 0.038), stage (OR = 4.114, P < 0.01), microinvasion (OR = 2.291, P = 0.046) and peritoneal implants (OR = 2.101, P = 0.016) were the five independent prognostic factors affecting recurrence.

CONCLUSIONS

Although patients with borderline ovarian tumors have an excellent prognosis, the risk of recurrence remains in some patients. Emphasis should be put on these patients with high risk factors and preventive strategies should be taken to prevent their progression.

Expression of the chromatin remodeling factor Rsf-1 is upregulated in ovarian carcinoma effusions and predicts poor survival

OBJECTIVE

We recently identified Rsf-1, a chromatin remodeling gene, as a potential oncogene that is frequently amplified and overexpressed in ovarian serous carcinoma. However, its clinical role in ovarian cancer effusions is not clear. In the present study, we assessed the clinical significance of Rsf-1 overexpression in ovarian carcinoma effusions.

METHODS

Formalin-fixed paraffin-embedded sections from 168 effusions (134 peritoneal, 34 pleural) were analyzed for Rsf-1 expression using immunocytochemistry. Matched primary tumors (n=48) and solid metastases (n=73) from 48 patients were additionally studied. Rsf-1 expression in tumor cells in effusions was analyzed for possible association with clinicopathologic parameters and survival.

RESULTS

Rsf-1 protein expression was found in carcinoma cells in 157/168 (93%) effusions. Of these, 70 (45%) stained weakly and 87 (55%) strongly. Specimens from patients diagnosed with FIGO stage IV disease had higher staining score (extent x intensity) compared with stage III tumors (P=0.008). Rsf-1 expression level was significantly lower in primary tumors and solid metastases (P<0.001 for extent, intensity and score). Univariate survival analysis for 59 patients with post-chemotherapy recurrence effusions demonstrated a significant association between higher Rsf-1 staining and shorter overall survival (OS; P=0.009 for staining extent and intensity, P=0.02 for staining score). FIGO stage was the only clinical parameter associated with OS in this group (P=0.032). In Cox analysis, Rsf-1 expression (P=0.022 for staining extent and intensity, P=0.045 for staining score) and FIGO stage (P=0.035) were independent predictors of shorter survival.

CONCLUSIONS

Rsf-1 is frequently expressed and upregulated in ovarian carcinoma cells in effusions and is a novel prognostic marker for patients with post-chemotherapy recurrent disease. The above findings support a role of Rsf-1 in mediating disease progression and aggressive clinical behavior in this subset of ovarian carcinoma patients.

Expression of transmembrane carbonic anhydrases IX and XII in ovarian tumours

AIMS

Carbonic anhydrase (CA) isozymes IX and XII have been suggested to play a role in oncogenic processes. The aim of the present study was to investigate CA IX and XII expression in patients with ovarian tumours.

METHODS AND RESULTS

A series of ovarian tumours was immunostained for CA IX and XII and the results were correlated with histopathological and clinical parameters. Most cases of borderline mucinous cystadenomas, mucinous cystadenocarcinomas and serous cystadenocarcinomas were moderately or strongly positive for CA IX. In malignant tumours, the staining was most prominent in hypoxic regions. Expression of CA XII was detected in all tumour categories, although the mean staining intensity was weaker than for CA IX in all groups except for clear cell carcinomas.

CONCLUSIONS

The wide expression of CA IX and XII in ovarian tumours suggests that these isozymes could represent potential targets in ovarian cancer therapy. The expression pattern of CA IX suggests that it could also serve as a useful histopathological marker protein for hypoxia in malignant ovarian tumours.

Is complete surgical staging necessary in patients with stage I mucinous epithelial ovarian tumors?

OBJECTIVE

To evaluate the impact on prognosis of complete surgical staging in patients with stage I mucinous epithelial ovarian tumors.

METHODS

We retrospectively reviewed the medical records of all patients with stage I mucinous epithelial tumors apparently confined to ovaries treated in the Department of Obstetrics and Gynecology, Asan Medical Center, from 1990 through 2005.

RESULTS

Of 264 patients treated during this time period, 62 (23.5%) had complete and 202 (76.5%) had incomplete initial surgical staging. No patient with clinically apparent stage I borderline tumor was upstaged, 5 of 85 patients with invasive mucinous cancer was upstaged due to positive peritoneal cytology and there was no upstaged patient owing to occult lymph node metastasis. No recurrence was observed in the completely staged and 2 (1.4%) in the incompletely staged group among the patients with borderline tumor developed relapse. Three (11.5%) recurrences in the completely staged and four (6.8%) in the incompletely staged group among the patients with invasive cancer were observed, and the difference was not statistically significant. We also observed no significant differences between two groups in progression-free survival and overall survival.

CONCLUSION

Complete surgical staging could probably be omitted in patients with stage I mucinous epithelial tumors.

[Clinicopathological aspects of pancreatic cancer]

Using the nationwide database of the Japan Pancreas Society (JPS), the clinicopathological features of 23,284 cases (1981-2000) and 2,298 cases (2001-2002) with pancreatic neoplasms were compared. Intraductal papillary mucinous neoplasms and mucinous cystic neoplasms were increased in the registry. More detailed histological repertoires of endocrine tumors, intraductal tubular tumors and solid-pseudopapillary tumors were registered in the last two years. The numbers of serous cystadenocarcinomas and carcinomas in situ were decreased. The proportion of less differentiated adenocarcinoma was increased in the more advanced stages of the disease. In Stage IVa, the survival of the patients with papillary adenocarcinoma was not statistically different from that of patients with well or moderate tubular adenocarcinoma, though the difference was significant in earlier stages. The survival of the patients with poorly differentiated adenocarcinoma, adenosquamous carcinoma and undifferentiated carcinoma was miserable. Histological confirmation is critically important to prospect the outcome and to determine the treatment modality. Integration of the nationwide registry and pathological information will give new insights for the treatment of pancreatic cancer.

[Morphometrical and immunohistochemical criteria of prognosis in patients with serous and mucinous ovarian carcinoma]

The aim of the study was to investigate the prognostic value of morphometrical features and expression of receptors to progesterone in malignant epithelial ovarian tumours. Surgical biopsy materials of 92 patients with serous and mucinous ovarian cancer were investigated. Tissues stained by hematoxilin and eosin were studied. Morphometry was performed with computer program Axio Vision 3.0. Immunohistochemical characteristics were evaluated with monoclonal progesterone antibodies. It was found that cytomorphometrical features vary in ovarian cancer with different histological structures and the level of differentiation of tumour, and can be used as prognostic factors. We revealed correlation between cytomorphometric factors (carcinoma cell area, total nuclear area, roundness of cell) and risk of recurrences and metastatic spread. In serous cancers presence of progesterone receptors is a favorable factor of prognosis and, as a rule, associates with a high degree of tumour differentiation. In this group of patients 3-year survival reached almost 100% indicating the efficiency of hormonotherapy and chemotherapy.

[Carcinoma of the pancreas head, papilla Vateri, and cystadenocarcinoma--different biologic entities and different results]

Between 1986-1995 we operated 337 patients with ductal adenocarcinoma of the pancreas, 45 cases of carcinoma of the papilla of Vater and 11 patients with cystadenocarcinoma of the pancreas. The evaluation of prognostic factors showed the influence of lymph node invasion. Furthermore we saw a significant influence of lymph- and haemangiosis carcinomatosa, of tumor-grading and tumor-size. The carcinoma of the papilla showed a better 5-year survival even in nodal-positive patients--this as a result of a different biological behaviour. We think that--instead of missing improvement of cure in ductal adenocarcinoma over the past decade--there is no place for therapeutic nihilism especially in non-ductal cancer, which represents almost 15 % of all pancreatic neoplasms.

[Clinical and pathological features of borderline ovarian tumors]

OBJECTIVE

To study the relationship between clinical pathological factors and prognosis.

METHODS

Thirty-four cases with borderline ovarian tumors (BOT) and 30 cases with stage I ovarian epithelial cancer admitted in our hospital from Jan.1973 to Dec.2000 were studied retrospectively. All the cases were diagnosed according to the International Histological Classification and Staging of Ovarian Tumors (WHO, 1999).

RESULTS

Thirty-seven cases were finally diagnosed of BOT, 6 cases with "microinvasive" had been misinterpreted as stage I ovarian cancer and one had "non-invasive peritoneal implants". Serous (38%) and mucinous (51%) tumors were dominant type of BOT and 95% of tumors were at stage I (International Federation of Gynecology and Obstetrics, FIGO). All patients were operated, 11 cases given conservative surgery with a recurrence rate of 9%, 26 cases had adjuvant chemotherapy, cyclophosphamide + adriamycin + cis-platinum used mostly. 5-year and 10 year survival rates were both 100%. The prognosis of BOT is related to pathology and adjuvant therapy.

CONCLUSION

Surgery is the main treatment choice of BOT, and the criteria of chemotherapy must be adequately used.

Expression of survivin is associated with malignant potential in epithelial ovarian carcinoma

Survivin is a new member of the inhibitor of apoptosis family of anti-apoptotic proteins. It has been reported that survivin is expressed during fetal development and in cancer tissues. Because suppression of apoptosis is important for carcinogenesis and tumor growth, we investigated the expression of survivin in human endometrial carcinomas. We analyzed serial frozen sections for survivin protein expression in 26 patients with ovarian epithelial carcinoma and 10 patients with benign cystadenoma of the ovary by fluorescent immunohistochemistry. We analyzed the relationship between the percentages of survivin-stained cells and the characteristics of the patient including histological classification, clinical stage, histological grade, and clinical outcome. Survivin was weakly detected in some benign ovarian cystadenomas (0-12.1%). There was, however, abundant survivin immunoreactivity in the nucleus and/or cytoplasm of the epithelial ovarian carcinoma cells. Scoring on the basis of the percentage of positive cells indicated that survivin expression was significantly associated with PCNA-labeling index, clinical stage, histological grade, clinical outcome, and survival rate (p<0.01, respectively). We conclude that the survivin protein is a defining diagnostic marker for epithelial ovarian carcinomas that may also yield prognostic information.

Resectional therapy for cystic neoplasms of the pancreas

Currently there is uncertainty in diagnosis between the serous (benign) and mucinous (premalignant) forms of cystic neoplasms of the pancreas without operation. Our objective is to evaluate resectional therapy as a treatment for these lesions. A retrospective review of cases from 1985 to 1999 were performed. There were 14 cases of serous cystadenoma (SCA), 11 cases of mucinous cystadenoma (MCA), and five cases of mucinous cystadenocarcinoma (MCAC). A female predominance was seen in all lesions (100% in SCA, 64% in MCA, and 80% in MCAC) with a mean age at presentation of 59 years. Most patients presented with pain (SCA = 64%, MCA = 55%, and MCAC = 80%). Weight loss was seen in 35 per cent of all patients and was present in all cases of MCAC. Importantly 36 per cent of MCA patients were asymptomatic. Lesions were identified as multicystic on CT reports of 62 per cent of SCA patients, 50 per cent of MCA patients and 75 per cent of MCAC patients. Size was similar between groups. All patients were treated with surgical resection; operative morbidity was 27 per cent and mortality was zero. Actuarial 5-year survival for SCA, MCA, and MCAC was 100, 100, and 33 per cent, respectively. Differentiating serous from mucinous is not possible based on presenting symptoms and radiologic findings. Surgical resection is justified on the basis of low morbidity and negligible mortality rates.

Prognostic results of cisplatin IP and carboplatin IV with G-CSF in patients with ovarian cancer

We performed a dose-escalation study of carboplatin combined with a fixed dose of intraperitoneal cisplatin and G-CSF in patients with epithelial ovarian cancer, and analyzed the progression-free and overall survival. Six of the patients who entered the study with stage IC and II disease are still alive with no evidence of disease. The five-year survival rate was 61% for the 18 patients with stage III and IV disease; progression-free survival over 5 years was 32%. Our results show this to be an effective treatment regimen for epithelial ovarian cancer. Prognosis is good with this combined carboplatin/cisplatin/G-CSF therapy, especially for those patients with microscopic or no residual disease.

Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: can one reliably differentiate benign from malignant (or premalignant) neoplasms?

OBJECTIVE

To determine whether the long-term behavior of cystic mucinous neoplasms of the pancreas could be predicted using a novel, precisely defined classification of benign mucinous cystadenomas, noninvasive proliferative cystic mucinous neoplasms, and invasive mucinous cystadenocarcinomas. The primary interest was to obtain long-term follow-up after complete resection to determine the recurrence rates based on this objective classification.

BACKGROUND

Current understanding is that all cystic mucinous neoplasms of the pancreas are potentially malignant and that mucinous cystadenomas, when completely removed, are biologically benign. Cystadenocarcinomas are thought to be less aggressively malignant than ordinary ductal adenocarcinoma, but reported recurrence rates vary widely and are unpredictable.

METHODS

All patients who underwent "curative" resection for cystic mucinous neoplasms at Mayo Clinic Rochester from 1940 to 1997 were identified. All available pathology slides, gross specimens, and clinical records were reviewed, eliminating patients with inadequate documentation. Neoplasms were reclassified as mucinous cystadenomas, noninvasive proliferative mucinous cystic neoplasms, or invasive cystadenocarcinomas based on specific histologic criteria.

RESULTS

Of 84 patients (70 women, 14 men) with cystic mucinous neoplasms of the pancreas, 54 were classified as cystadenomas, 23 as noninvasive proliferative cystic mucinous neoplasms, and only 7 as cystadenocarcinomas. Recurrent disease developed in none of the 77 patients without invasion, but 5 of the 6 patients surviving resection for cystadenocarcinomas died of recurrent cystadenocarcinoma within 5 years.

CONCLUSIONS

When the neoplasm is completely resected and subjected to adequate histopathologic examination based on these objective criteria, absence of tissue invasion predicts a curative operation and detailed follow-up may be unnecessary. In contrast, a histologic diagnosis of invasive cystadenocarcinoma portends a dismal prognosis, similar to that of typical ductal adenocarcinoma of the pancreas.

Mucinous cystic neoplasms of the pancreas

Since their initial description, mucinous cystic neoplasms have been difficult to classify. This article attempts to clarify histological, clinical, and genetic criteria so that the pathologist can categorize each mucinous cystic neoplasm into 1 of 4 possible categories. Mucinous cystadenomas contain a single layer of mucin-producing, columnar epithelium lacking significant atypia. Borderline mucinous cystic neoplasms contain cells with moderate atypia. Mucinous cystic neoplasms with in situ carcinoma show significant architectural and cytological atypia. When invasive carcinoma is present in association with a mucinous cystic neoplasm, then the diagnosis of invasive mucinous cystadenocarcinoma should be made. The categorization of mucinous cystic neoplasms into these groups is essential because it accurately predicts outcome, provided that the tumor has been sampled and examined thoroughly. Completely removed mucinous cystadenomas, borderline mucinous cystic neoplasms, and mucinous cystic neoplasms with in situ carcinoma follow benign courses. Partial resection should be avoided as evidence suggests that mucinous cystic neoplasms can progress from adenomas to borderline lesions to carcinomas in situ to invasive carcinomas over time; partial resection should be avoided if possible. Modern molecular genetic techniques are helping to unravel the origins of rare variants of mucinous cystic tumors, such as the mucinous cystic tumor with an associated osteoclast-like giant cell tumor and the mucinous cystic tumor with sarcomatous stroma.

Expression of metallothionein and nuclear size in discrimination of malignancy in mucinous ovarian tumors

Metallothioneins (MTs) are low molecular weight proteins that control cell proliferation via their metalloregulatory function. Several studies in various tumors have shown their influence in determining response to chemotherapy and prognosis. Because there has been no such study pertaining to ovarian tumors, we investigated MT expression and nuclear size in mucinous ovarian neoplasms (12 benign, 6 borderline, and 8 malignant). The percentage of MT-positive stained cells was significantly higher in the borderline than in the benign tumors, but lower than in the malignant tumors. Single layers of cells in the borderline tumors showed mild immunostaining in 50% of the cells and moderate staining in the remaining 50%, while 83.3% of cells within multilayered epithelium showed moderate to strong immunostaining. In the carcinomas, 87.5% of tumors showed moderate to strong staining in single-layered epithelium and moderate to strong staining of all the cells in multilayered epithelium. Morphometry measurements showed that the mean nuclear area of cells in the carcinomas was significantly larger than in the borderline or benign tumors. The nuclear area of cells in the carcinomas with early recurrence or metastasis was also significantly larger than in carcinomas without recurrence or metastasis. It is concluded that MT protein expression and nuclear size are possible markers for the evaluation of the progression of malignancy in mucinous ovarian tumors.

Borderline ovarian tumours in Vaud, Switzerland: incidence, survival and second neoplasms

Between 1976 and 1996, 176 borderline ovarian tumours were registered in the Cancer Registry of the Swiss canton of Vaud, corresponding to an age-adjusted incidence (world standard) of 2.7 in 100,000. Incidence rose from 1.7 per 100,000 during 1976-81 to 2.7 per 100,000 during 1987-91, and then levelled off; 58% of cases were serous and 41% mucinous. Relative survival was 94% at 10 years; 18 second neoplasms were observed, compared with 10.3 expected, and there was a significant excess of invasive ovarian cancers (four observed, including three synchronous, compared with 0.4 expected).

[Cystic neoplasms of the pancreas: surgical therapy and chances for cure]

Between 1986 and 1997 we treated 67 patients with 68 cystic tumors of the pancreas including 17 mucinous cystadenocarcinomas, four serous cystadenocarcinomas, 15 mucinous cystadenomas, 18 serous cystadenomas, ten intraductal papillary-mucinous tumors, three solid-pseudopapillary tumors, and one cystic neuroendocrine tumor. Regarding surgical therapy our results reveal a differentiated management with respect to the histological findings. While in benign tumors a local resection is adequate the cystadenocarcinomas require an extended resection. In general there is an indication for surgical therapy in all cystic tumors of the pancreas--not only in malignant neoplasias. A nonoperative management is not justified. With a mean follow-up of 35 months the prognosis of the patients with a benign cystic tumor was excellent revealing a mortality of 0% whereas survival of the patients with a cystadenocarcinoma was 67% at five years.

[The clinical and pathological characteristics of epithelial ovarian carcinoma in patients with age under 40]

OBJECTIVE

To investigate the clinical and pathological characteristics of epithelial ovarian carcinoma in patients with age under 40.

METHODS

From Jan 1978 to Dec 1992, 54 cases with epithelial ovarian carcinoma under 40 years old were admitted to our hospital and enrolled in the study group, another 54 patients suffered from the same disease with age over 40 in the same period were served as control. Comparison analysis for clinical and pathologic data of 2 groups was performed using SPSS and SURVALC statistics software.

RESULTS

Main complaint because of either pelvic mass or abdominal mass found by chance was more common in study group (46.3%) than that in control group (27.8%). whereas because of symptoms was less common in study group (53.7%) than in control group (72.2%). Other parameters such as early stage (I and II) rate (61.1%), unilateral tumor rate (68.5%), average maximum diameter of tumor (13.6 cm), highly differentiated rate (50%) and the possibility for tumor reductive surgery were higher in study group than in control group. The difference of histological pattern and chemotherapy between 2 groups was not significant. Single variate analysis showed that the prognosis was better in study group. The 2-year and 5-year survival rates were 69.8% and 50.2% respectively. No recurrence was found in the 8 patients in whom the contralateral healthy ovary remained. However multiple variate analysis indicated that age was not a prognostic factor.

CONCLUSION

Epithelial ovarian carcinoma was prone to be lower degree malignancy in patients under 40 years therefore the prognosis of them was better. It might be resonable to have healthy ovary left in some select cases.

[Expression of glutathione S-transferase-pi in operative specimens as marker of chemoresistance in patients with ovarian cancer]

OBJECTIVE

To study the relationship between the expression of glutathione S-transferase-pi (GST-pi) in operative specimens and chemoresistance in patients with ovarian cancer.

METHODS

The expression of GST-pi in 87 epithelial ovarian cancer tissues and 30 normal ovarian epithelial tissues was determined with labelled streptavidin biotin method (LSAB). All the patients had not received chemotherapy before operation. We used Chi-Square and Cox-Mantel test to analyze the relativity between the expression of GST-pi and clinical pathological data, chemotherapeutic response, prognosis in patients with ovarian cancer.

RESULTS

(1) 59 (67.8%) of 87 ovarian cancer tissue were demonstrated to be positive expression with GST-pi, but all 30 normal ovarian epithelial tissue were negative. (2) There was no direct correlation between the expression of GST-pi and clinical pathological data. (3) 43 (43/59) of GST-pi positive cases were chemoresistant, while only 3 (3/28) of GST-pi negative ones were chemoresistant. (4) The difference in the chemotherapeutic response between the two groups was obviously significant (P < 0.005). The survival period of the patients with GST-pi positive expression was also obviously shorter than that of those with GST-pi negative expression (P = 0.004).

CONCLUSION

These results strongly suggest that GST-pi expression in epithelial ovarian cancer tissues is closely related to chemoresistance clinically and it may be served as a useful marker to predict the prognosis of patients.

[Treatment and prognostic factors of epithelial ovarian cancer]

OBJECTIVE

To study the treatment results and prognostic factors of epithelial ovarian carcinoma.

METHODS

Retrospective study of 155 cases of ovarian epithelial carcinoma admitted in our hospital since Jan. 1970 to Dec. 1992. All of these cases had postoperative pathological diagnosis and staging according to FIGO. 42 cases had second operations and 4 cases had the third. 149 cases had postoperative chemotherapies except for 6. Chemotherapies were also given to 32 cases after the second operation, while 9 for recurrence.

RESULTS

The 2-year, 5-year, 10-year survival rates of stage I were 92.4%, 87.0%, 70.6%; and II 91.9%, 63.6% 47.8%; III 59.9%, 38.2%, 19.2% and IV 25.0%, 25.0%, 0.0% respectively. All 6 cases without chemotherapy after surgery died within 2 years. The results indicated that the prognosis of ovarian epithelial carcinoma was related to clinical stage, cellular grade and tumor residues. The 5-year survival rates for stage I was 87.0% and III 38.2% (P < 0.001); and cell G1 95.0% and G3 11.8% (P < 0.001), while no residual tumor 97.6% and with residual tumor > 2cm 21.2% (P < 0.001) respectively.

CONCLUSION

Residual tumor of ovarian epithelial carcinoma < 2cm after primary surgery and chemotherapy right after surgery can improve survival rates.

[Characterization of intraoperative rupture of epithelial ovarian cancer at early stage]

OBJECTIVE

To investigate whether intraoperative rupture of epithelial ovarian cancer. influences the prognosis.

METHODS

Between 1984 and 1994, 46 patients with stage Ia and Ic epithelial ovarian cancer were treated at Oita Medical University Hospital. Of 46 patients, 20 had stage Ia tumors, 16 stage Ic secondary to capsular invasion-serosal disease or positive ascites or washings (stage Ic-ascites), and 10 stage Ic secondary to intraoperative rupture (Ic-rupture). Survival analysis was performed to compare the three groups of patients.

RESULTS

The ages (mean +/- SD) of patients with stage Ia, Ic-ascites and Ic-rupture at the first diagnosis were 40.1 +/- 17.0, 47.6 +/- 13.4 and 52.8 +/- 15.7, respectively. The age of the stage Ia group tended to be lower than those of the Ic-ascites and Ic-rupture groups. At operation, ovarian tumors of all patients in the Ic-rupture group were firmly adhered to surrounding organs, had markedly thin weak cyst walls and were easily ruptured during operation. Fourteen of 20 patients in the Ia group (70%), 5 of 16 patients in the Ic-ascites group (31.3%) and 3 of 10 patients in the Ic-rupture group (30%) showed signs of mucinous cystadenocarcinoma. The incidence of mucinous cystadenocarcinoma in Ia group was significantly lower than in the Ic-ascites (p < 0.025, chi 2-test) and Ic-rupture (p < 0.05, chi 2-test) groups. The Kaplan-Meier survival plot for stage Ia, Ic-ascites and Ic-rupture patients revealed a probability of 5-year survival of 100%, 87.5% and 63.5%, respectively. The probability of 5-year survival in the Ic-rupture group tended to be lower than that in other groups.

CONCLUSIONS

The results of our study suggest that intraoperative rupture of a malignant ovarian cystic tumor may worsen the prognosis of patients with the FIGO stage I epithelial ovarian cancer.

[The clinical significance of retroperitoneal lymph node metastasis and lymphadenectomy on 3-year survival in ovarian carcinoma]

Fifty-two patients with primary epithelial ovarian cancer received surgical treatment and chemotherapy at the Hospital of Shiga University of Medical Science and retroperitoneal lymph node metastases were evaluated clinico-pathologically. Forty patients underwent paraaortic and pelvic lymphadenectomy, although 12 patients with stage IIIc underwent no lymphadenectomy. In the patients with lymphadenectomy, stage I and II groups had 100% of 3-year survival, stage III group, 40.0% and stage IV group, 0.0%. A series of 27 patients with stage IIIc diagnosed from findings in the abdominal cavity had cytoreductive surgery and chemotherapy including cisplatinum, and were evaluated for 3-year survival. No significant difference in the survival rate was found between the stage IIIc groups with and without para-aortic and pelvic lymphadenectomy. The most important prognostic factors for 3-year survival were retroperitoneal lymph node metastases, complete remission, and residual tumor at second surgery. A three year survival analysis confirmed that para-aortic and pelvic lymphadenectomy is not an important procedure for the treatment for stage III ovarian cancer. However, retroperitoneal lymph node metastases was one of the most important prognostic factors.

Histopathological determinants of survival in resected cases of pancreas cancer

We have examined the histopathological factors affecting the degree of local spread, regional lymph node (RLN) metastases, and overall survival (O.S.) in a group of 39 cases of resected carcinoma of the exocrine pancreas. Although the mean O.S. for the group was 14.3 months, resected patients without RLN involvement had a mean survival of 24 months. In contrast the mean O.S. rate was 8 months for patients with RLNs involved. Size, tumor location, and histological grade were compared to RLN involvement and O.S. The mean size of primary tumor did not differ significantly between patients with or without RLN's (r.1 versus 4.6 cms). However, 7 or 8 T1 tumors were < 4 cm and 35% of tumors < 4 cm were T1 lesions. In contrast, only 1 of 17 tumors (6%) > 4 cm was T1. Histological grade was correlated with nodal status and O.S. There was a significant difference between histological grade and the presence of metastatic lymph nodes (G1, 37% positive, G2-4.50% positive). Patients with well differentiated tumors had a mean survival of 21 months compared to a mean survival of 10 months for less differentiated tumors (p < 0.05). This difference was even more significant when stratified for nodal status. The patients with well differentiated tumors and no RLN involvement had a mean survival of 32.5 months compared to 8.6 months for well differentiated tumors with RLN involvement. In summary, we have shown that size, histological grade, and local spread predict for nodal status. However, specific patient subsets (G1, node negative) may exhibit an excellent survival when curative pancreas resection is successful.