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Cheung TH, Cheng SSY, Hsu D, Wing-Lei Wong Q, Pavelyev A, Sukarom I, Saxena K. Health impact and cost-effectiveness of implementing gender-neutral vaccination with the 9-valent HPV vaccine in Hong Kong. Hum Vaccin Immunother 2023; 19:2184605. [PMID: 37183965 DOI: 10.1080/21645515.2023.2184605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Human papillomavirus (HPV) can cause several diseases, including cancers, in both sexes. In January 2020, the Hong Kong government launched a school-based vaccination program for girls 10-12 years of age with the 9-valent HPV (9vHPV) vaccine for the prevention of HPV-related diseases; however, boys were not included. The current study estimated the potential health and economic impact of a routine gender-neutral vaccination (GNV) approach compared with the current female-only vaccination (FOV) strategy. We used a dynamic transmission model, adapted to Hong Kong. The model estimates changes in HPV-related disease incidence and mortality, treatment costs (in 2019 Hong Kong dollars), quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs) over a 100-year time horizon. The base case analysis compared FOV with the 9vHPV vaccine with routine GNV (coverage rate 70%) for the prevention of HPV-related diseases. Compared with a FOV approach, routine GNV with the 9vHPV vaccine is predicted to provide greater reductions in cumulative HPV-related disease incidence and mortality, as well as lower HPV-related treatment costs. In the base case analysis, the ICER was $248,354 per QALY for routine GNV. As compared with FOV, routine GNV fell below the cost-effectiveness ceiling of $382,046/year for Hong Kong. These results highlight the potential value of a routine GNV program with the 9vHPV vaccine among 12-year-olds in Hong Kong to reduce the public health and economic burden of HPV-related diseases.
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Affiliation(s)
- Tak Hong Cheung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Danny Hsu
- Global Medical and Scientific Affairs, MSD Hong Kong, Hong Kong, China
| | | | - Andrew Pavelyev
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Rahway, NJ, USA
| | - Isaya Sukarom
- Center for Observational and Real-world Evidence, MSD Thailand, Bangkok, Thailand
| | - Kunal Saxena
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Rahway, NJ, USA
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Wu J, Wang T, Guo H, Wang Y, Guo D, Lu B, Wang Z, Zhong F, Wang H, Yuan J, Li Y, Cheung TH, Wang Y, Liu YH. Design, Control, and Experiments of A Novel Robotic Uterine Manipulator with the Motorized 3-DoF Manipulation Rod. IEEE Trans Biomed Eng 2023; PP. [PMID: 37022424 DOI: 10.1109/tbme.2023.3238762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
To address the issue of declining performance over time with manual uterine manipulation during minimally invasive gynecologic surgery, we propose a novel uterine manipulation robot that offers tireless, stable, and safer manipulation. This proposed robot consists of a 3-DoF remote center of motion (RCM) mechanism and a 3-DoF manipulation rod. The RCM mechanism uses a single-motor bilinear-guided design that allows for a wide range of pitch motion (-50 to 34 degrees) while maintaining a compact structure. The manipulation rod has a tip diameter of only 6 mm, allowing it to accommodate almost any patient's cervix. The 30-degree distal pitch motion and ± 45-degree distal roll motion of the instrument further improve uterine visualization. The tip of the rod can be opened into a T-shape to minimize damage to the uterus. Laboratory tests have revealed that our device has a highly precise mechanical RCM accuracy of 0.373mm and is capable of handling a maximum load of 500g. Furthermore, through clinical testing, the robot has been proven to offer improved manipulation and visualization of the uterus, making it a valuable addition to the surgical tools available to gynecologists.
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Affiliation(s)
- Jiahao Wu
- T Stone Robotics Institute and Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Taowang Wang
- T Stone Robotics Institute and Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Huanhuan Guo
- T Stone Robotics Institute and Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Yaqing Wang
- T Stone Robotics Institute and Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Dezhao Guo
- T Stone Robotics Institute and Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Bo Lu
- T Stone Robotics Institute and Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Ziyi Wang
- T Stone Robotics Institute and Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Fangxun Zhong
- T Stone Robotics Institute and Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Hesheng Wang
- Department of Automation, Shanghai Jiao Tong University, Shanghai, China
| | - Jiangjing Yuan
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yuhong Li
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Tak Hong Cheung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yudong Wang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yun-hui Liu
- T Stone Robotics Institute and Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
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Cheung TH, Cheng SSY, Hsu DC, Wong QWL, Pavelyev A, Walia A, Saxena K, Prabhu VS. The impact and cost-effectiveness of 9-valent human papillomavirus vaccine in adolescent females in Hong Kong. Cost Eff Resour Alloc 2021; 19:75. [PMID: 34801050 PMCID: PMC8606050 DOI: 10.1186/s12962-021-00328-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction In Hong Kong (HK), a single-cohort vaccination program for 10–12-year-old girls with the 9-valent human papillomavirus (HPV) vaccine (9vHPV; types 6/11/16/18/31/33/45/52/58) has been launched. This study assessed the public health impact and cost-effectiveness of implementing routine 9vHPV vaccination (12-year-olds) with or without catch-up 9vHPV vaccination (13–18-year-olds) in HK. Methods The health impact and costs of implementing routine 9vHPV vaccination with or without catch-up vaccination over a 100-year time horizon were evaluated using a validated HPV-type transmission dynamic model adapted to the HK population; analyses were performed from a healthcare payer perspective. Routine vaccination (12-year-old girls) and catch-up vaccination (13–18 years) assumed vaccine coverage rates of 70% (base case) and 30%, respectively. The model also assumed herd immunity, lifelong vaccine protection, a discount rate of 3%, and a cost per dose of HK dollars (HKD) 858 [United States dollars (USD) 110] and HKD 1390 (USD 179) for the 2-valent HPV (2vHPV) and 9vHPV vaccines, respectively. HPV disease-related incidence and the incremental cost-effectiveness ratio (ICER) per quality-adjusted-life-year (QALY) were estimated. Cost-effectiveness was determined at a ceiling threshold of HK dollars (HKD) 382,046 (USD 49,142) or 1.0 times the gross domestic product per capita of HK. Results Compared with routine 9vHPV alone, routine plus catch-up 9vHPV is projected to reduce cervical cancer incidence by 3.4%. Routine plus catch-up 9vHPV will also reduce genital warts incident cases for males/females by 2.6%/5.4%. The incremental cost-effectiveness ratios were HKD 29,911 (USD 3847)/quality-adjusted life-year (QALY) for routine plus catch-up 9vHPV versus routine 9vHPV alone and HKD 25,524 (USD 3283)/QALY for routine 9vHPV alone versus screening only. Sensitivity analyses indicated that routine plus catch-up 9vHPV compared with routine 9vHPV alone remained cost-effective at coverage rates of 30% and 90%. Conclusions This analysis predicts that the current HK vaccination strategy can be considered cost-effective and will provide maximum health benefit. These results support addition of the routine 9vHPV vaccine with or without catch-up 9vHPV vaccination to the regional vaccination program in HK. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-021-00328-x.
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Affiliation(s)
- Tak Hong Cheung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Sally Shuk Yee Cheng
- Global Medical and Scientific Affairs, MSD Asia Ltd, 27/F Lee Gardens Two, 28 Yun Ping Road, Causeway Bay, Hong Kong, People's Republic of China
| | - Danny C Hsu
- Global Medical and Scientific Affairs, MSD Asia Ltd, 27/F Lee Gardens Two, 28 Yun Ping Road, Causeway Bay, Hong Kong, People's Republic of China
| | - Queenie Wing-Lei Wong
- Global Medical and Scientific Affairs, MSD Asia Ltd, 27/F Lee Gardens Two, 28 Yun Ping Road, Causeway Bay, Hong Kong, People's Republic of China
| | - Andrew Pavelyev
- MRL, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA.,HCL America, Inc., Sunnyvale, CA, USA
| | - Anuj Walia
- MRL, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Kunal Saxena
- MRL, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Vimalanand S Prabhu
- MRL, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA.
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Chan LKY, Lau TS, Chung KY, Tam C, Cheung TH, Yim SF, Lee JHS, Leung RWT, Qin J, Or YYY, Lo KW, Kwong J. Short-Form Thymic Stromal Lymphopoietin (sfTSLP) Is the Predominant Isoform Expressed by Gynaecologic Cancers and Promotes Tumour Growth. Cancers (Basel) 2021; 13:cancers13050980. [PMID: 33652749 PMCID: PMC7956741 DOI: 10.3390/cancers13050980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary Cytokines are a group of small proteins in the body that play an important part in boosting the immune system. Thymic stromal lymphopoietin (TSLP) is a cytokine that plays an important role in the maturation of T cells. Two variants of TSLP, long-form (lfTSLP) and short-form (sfTSLP), have been found, however their roles in cancers are not known. In this study, we discovered that sfTSLP, but not lfTSLP, is predominantly expressed in ovarian and endometrial cancers. The switch that turns the sfTSLP gene on or off is controlled by external modifications of DNA. Our results also found that sfTSLP promotes tumour growth through activating several signal pathways in cancer cells. Abstract Thymic stromal lymphopoietin (TSLP) is an epithelial cell derived cytokine belonging to the IL-7 family and a key initiator of allergic inflammation. Two main isoforms of TSLP, classified as long- (lfTSLP) and short-form (sfTSLP), have been reported in human, but their expression patterns and role(s) in cancers are not yet clear. mRNA expression was examined by isoform-specific RT-PCR and RNA in situ hybridisation. Epigenetic regulation was investigated by chromatin immunoprecipitation-PCR and bisulfite sequencing. Tumour progression was investigated by gene overexpression, cell viability assay, cancer organoid culture and transwell invasion. Signals were investigated by proteome profiler protein array and RNA-sequencing. With the use of isoform-specific primers and probes, we uncovered that only sfTSLP was expressed in the cell lines and tumour tissues of human ovarian and endometrial cancers. We also showed the epigenetic regulation of sfTSLP: sfTSLP transcription was regulated by histone acetylation at promoters in ovarian cancer cells, whereas silencing of the sfTSLP transcripts was regulated by promoter DNA methylation in endometrial cancer cells. In vitro study showed that ectopically overexpressing sfTSLP promoted tumour growth but not invasion. Human phosphokinase array application demonstrated that the sfTSLP overexpression activated phosphorylation of multiple intracellular kinases (including GSK3α/β, AMPKα1, p53, AKT1/2, ERK1/2 and Src) in ovarian cancer cells in a context-dependent manner. We further investigated the impact of sfTSLP overexpression on transcriptome by RNA-sequencing and found that EFNB2 and PBX1 were downregulated in ovarian and endometrial cancer cells, suggesting their role in sfTSLP-mediated tumour growth. In conclusion, sfTSLP is predominantly expressed in ovarian and endometrial cancers and promotes tumour growth.
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Affiliation(s)
- Loucia Kit Ying Chan
- Department of Obstetrics of Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (L.K.Y.C.); (T.S.L.); (K.Y.C.); (C.T.); (T.H.C.); (S.F.Y.); (J.H.S.L.)
| | - Tat San Lau
- Department of Obstetrics of Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (L.K.Y.C.); (T.S.L.); (K.Y.C.); (C.T.); (T.H.C.); (S.F.Y.); (J.H.S.L.)
| | - Kit Ying Chung
- Department of Obstetrics of Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (L.K.Y.C.); (T.S.L.); (K.Y.C.); (C.T.); (T.H.C.); (S.F.Y.); (J.H.S.L.)
| | - Chit Tam
- Department of Obstetrics of Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (L.K.Y.C.); (T.S.L.); (K.Y.C.); (C.T.); (T.H.C.); (S.F.Y.); (J.H.S.L.)
| | - Tak Hong Cheung
- Department of Obstetrics of Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (L.K.Y.C.); (T.S.L.); (K.Y.C.); (C.T.); (T.H.C.); (S.F.Y.); (J.H.S.L.)
| | - So Fan Yim
- Department of Obstetrics of Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (L.K.Y.C.); (T.S.L.); (K.Y.C.); (C.T.); (T.H.C.); (S.F.Y.); (J.H.S.L.)
| | - Jacqueline Ho Sze Lee
- Department of Obstetrics of Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (L.K.Y.C.); (T.S.L.); (K.Y.C.); (C.T.); (T.H.C.); (S.F.Y.); (J.H.S.L.)
| | - Ricky Wai Tak Leung
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-Sen University, Shenzhen 510006, China; (R.W.T.L.); (J.Q.)
| | - Jing Qin
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-Sen University, Shenzhen 510006, China; (R.W.T.L.); (J.Q.)
| | - Yvonne Yan Yan Or
- Department of Anatomical and Cellular Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (Y.Y.Y.O.); (K.W.L.)
| | - Kwok Wai Lo
- Department of Anatomical and Cellular Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (Y.Y.Y.O.); (K.W.L.)
| | - Joseph Kwong
- Department of Obstetrics of Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (L.K.Y.C.); (T.S.L.); (K.Y.C.); (C.T.); (T.H.C.); (S.F.Y.); (J.H.S.L.)
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Newcastle-under-Lyme ST5 5BG, UK
- Correspondence: ; Tel.: +852-3505-2801
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Wong L, Cheung TH, Yim SF, Lao TT. Prevalence and impact of hepatitis B virus infection in ovarian cancer patients in an endemic area-A retrospective cohort study. J Viral Hepat 2020; 27:520-525. [PMID: 31854060 DOI: 10.1111/jvh.13250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/19/2019] [Accepted: 12/07/2019] [Indexed: 12/13/2022]
Abstract
Hepatitis B virus (HBV) infection is associated with many extrahepatic malignancies, but its association with and impact on ovarian cancer has not been examined. We therefore examined the prevalence of HBV infection among women with primary ovarian carcinoma in an endemic area, and whether this impacts the presentation and survival of these patients. In a retrospective study, we reviewed 523 patients presenting with primary ovarian cancer and known HBV status between 1 January 2006 and 31 December 2017. Patients were divided into HBV-positive and negative groups for the comparison of the patient characteristics and presentation, including staging and histological types, and short term (2 years) mortality from ovarian cancer. Among the 10.1% (53/523) patients screened positive for HBV, more of them presented with advanced staging at FIGO stage 3 or above (OR 1.378, 95% CI 1.063-1.787), although there were no significant differences in patient characteristics. Within 24 months from presentation, there were more deaths due to malignancy in the HBV-positive group (73.3% vs 44.2%, OR 1.659, 95% CI 1.135-2.425). On multivariate analysis after adjusting for nulliparity status, previous use of oestrogens, presence of metastases, histological type (epithelial or others) and grading (high grade or not), whether optimal debulking was performed, and chemotherapy, HBV infection was independently associated with increased death within 24 months of presentation (aOR 2.683, 95% CI 1.015-7.091). In conclusion, the findings of this study suggested an adverse effect of chronic HBV infection on survival within two years of presentation in patients with primary ovarian cancer.
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Affiliation(s)
- Lo Wong
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tak Hong Cheung
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - So Fan Yim
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Terence T Lao
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Lau TS, Chan LKY, Man GCW, Wong CH, Lee JHS, Yim SF, Cheung TH, McNeish IA, Kwong J. Paclitaxel Induces Immunogenic Cell Death in Ovarian Cancer via TLR4/IKK2/SNARE-Dependent Exocytosis. Cancer Immunol Res 2020; 8:1099-1111. [PMID: 32354736 DOI: 10.1158/2326-6066.cir-19-0616] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [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: 08/13/2019] [Revised: 02/25/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022]
Abstract
Emerging evidence shows that the efficacy of chemotherapeutic drugs is reliant on their capability to induce immunogenic cell death (ICD), thus transforming dying tumor cells into antitumor vaccines. We wanted to uncover potential therapeutic strategies that target ovarian cancer by having a better understanding of the standard-of-care chemotherapy treatment. Here, we showed in ovarian cancer that paclitaxel induced ICD-associated damage-associated molecular patterns (DAMP, such as CALR exposure, ATP secretion, and HMGB1 release) in vitro and elicited significant antitumor responses in tumor vaccination assays in vivo Paclitaxel-induced TLR4 signaling was essential to the release of DAMPs, which led to the activation of NF-κB-mediated CCL2 transcription and IkappaB kinase 2-mediated SNARE-dependent vesicle exocytosis, thus exposing CALR on the cell surface. Paclitaxel induced endoplasmic reticulum stress, which triggered protein kinase R-like ER kinase activation and eukaryotic translation initiation factor 2α phosphorylation independent of TLR4. Paclitaxel chemotherapy induced T-cell infiltration in ovarian tumors of the responsive patients; CALR expression in primary ovarian tumors also correlated with patients' survival and patient response to chemotherapy. These findings suggest that the effectiveness of paclitaxel relied upon the activation of antitumor immunity through ICD via TLR4 and highlighted the importance of CALR expression in cancer cells as an indicator of response to paclitaxel chemotherapy in ovarian cancer.
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Affiliation(s)
- Tat San Lau
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Loucia Kit Ying Chan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Gene Chi Wai Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Chi Hang Wong
- Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Jacqueline Ho Sze Lee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - So Fan Yim
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Tak Hong Cheung
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Iain A McNeish
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Joseph Kwong
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
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Yip HM, Wang Z, Navarro-Alarcon D, Li P, Cheung TH, Greiffenhagen C, Liu YH. A collaborative robotic uterine positioning system for laparoscopic hysterectomy: Design and experiments. Int J Med Robot 2020; 16:e2103. [PMID: 32163664 DOI: 10.1002/rcs.2103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/07/2018] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Uterus manipulation is a lengthy and tedious task that is usually performed by a human assistant during laparoscopic hysterectomy. Note that the performance of the assistant may decrease with time. Moreover, under this approach, the primary surgeon does not have direct control over the uterus position. He/she can only verbally request the assistant to place it on a particular configuration. METHODS A robotic system composed of a 3 degrees-of-freedom uterine positioner is developed to assist in changing configuration of the uterus during laparoscopic hysterectomy. The developed system has a remote centre of motion structure; independently controlling the uterus motion with one joint at the time is allowed. RESULTS From the lab experiments, it is found that the robot shows better performance in retaining the uterus position and shows quicker response to the surgeon's instruction. Cadaver studies have been conducted to evaluate the feasibility of the robot. The robot was also applied to real patients in a clinical study. CONCLUSIONS The robot is capable of assisting in uterus manipulation during laparoscopic hysterectomy. However, its user friendliness can be improved by simplifying the docking procedure. Furthermore, a more ergonomic user interface is desired.
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Affiliation(s)
- Hiu Man Yip
- The Chinese University of Hong Kong, Shatin, Hong Kong.,The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Zerui Wang
- The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Peng Li
- Harbin Institute of Technology, Shenzhen, China
| | | | | | - Yun-Hui Liu
- The Chinese University of Hong Kong, Shatin, Hong Kong
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Garland SM, Pitisuttithum P, Ngan HYS, Cho CH, Lee CY, Chen CA, Yang YC, Chu TY, Twu NF, Samakoses R, Takeuchi Y, Cheung TH, Kim SC, Huang LM, Kim BG, Kim YT, Kim KH, Song YS, Lalwani S, Kang JH, Sakamoto M, Ryu HS, Bhatla N, Yoshikawa H, Ellison MC, Han SR, Moeller E, Murata S, Ritter M, Sawata M, Shields C, Walia A, Perez G, Luxembourg A. Efficacy, Immunogenicity, and Safety of a 9-Valent Human Papillomavirus Vaccine: Subgroup Analysis of Participants From Asian Countries. J Infect Dis 2019; 218:95-108. [PMID: 29767739 PMCID: PMC5989602 DOI: 10.1093/infdis/jiy133] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/16/2018] [Indexed: 01/17/2023] Open
Abstract
Background A 9-valent human papillomavirus-6/11/16/18/31/33/45/52/58 (9vHPV) vaccine extends coverage to 5 next most common oncogenic types (31/33/45/52/58) in cervical cancer versus quadrivalent HPV (qHPV) vaccine. We describe efficacy, immunogenicity, and safety in Asian participants (India, Hong Kong, South Korea, Japan, Taiwan, and Thailand) from 2 international studies: a randomized, double-blinded, qHPV vaccine-controlled efficacy study (young women aged 16–26 years; NCT00543543; Study 001); and an immunogenicity study (girls and boys aged 9–15 years; NCT00943722; Study 002). Methods Participants (N = 2519) were vaccinated at day 1 and months 2 and 6. Gynecological samples (Study 001 only) and serum were collected for HPV DNA and antibody assessments, respectively. Injection-site and systemic adverse events (AEs) were monitored. Data were analyzed by country and vaccination group. Results 9vHPV vaccine prevented HPV-31/33/45/52/58–related persistent infection with 90.4%–100% efficacy across included countries. At month 7, ≥97.9% of participants seroconverted for each HPV type. Injection-site AEs occurred in 77.7%–83.1% and 81.9%–87.5% of qHPV and 9vHPV vaccine recipients in Study 001, respectively, and 62.4%–85.7% of girls/boys in Study 002; most were mild to moderate. Conclusions The 9vHPV vaccine is efficacious, immunogenic, and well tolerated in Asian participants. Data support 9vHPV vaccination programs in Asia. Clinical Trials Registration NCT00543543; NCT00943722.
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Affiliation(s)
- S M Garland
- Western Pacific Regional HPV Labnet Reference Laboratory, Department of Infectious Disease and Microbiology, Royal Women's Hospital, Murdoch Children's Research Institute, Royal Children's Hospital and Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | | | - H Y S Ngan
- Department of Obstetrics and Gynaecology, the University of Hong Kong, China
| | - C-H Cho
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
| | - C-Y Lee
- Department of Gynecology, Chang Gung Memorial Hospital, Chiayi Branch, Taipei
| | - C-A Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei
| | - Y C Yang
- MacKay Memorial Hospital, Taipei
| | - T-Y Chu
- Tzu Chi Medical Center, Hualien
| | - N-F Twu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - R Samakoses
- Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand
| | | | - T H Cheung
- Department of Obstetric and Gynaecology, Chinese University of Hong Kong, China
| | - S C Kim
- Division of Gynecologic Oncology, Ewha Womans University Mokdong Hospital, School of Medicine Ewha Womans University, Seoul, South Korea
| | - L-M Huang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - B-G Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Y-T Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asian Medical Center, Seoul, South Korea
| | - K-H Kim
- Department of Pediatrics and Center for Vaccine Evaluation and Study, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Y-S Song
- Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, South Korea
| | - S Lalwani
- Bharati Vidyapeeth Deemed University Medical College and Hospital, Pune, India
| | - J-H Kang
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, South Korea
| | - M Sakamoto
- Department of Gynaecology, Sasaki Foundation Kyoundo Hospital and Department of Obstetrics and Gynaecology, School of Medicine, the Jikei University, Tokyo, Japan
| | - H-S Ryu
- Department of Obstetrics and Gynecology, School of Medicine, Ajou University, Suwon, South Korea
| | - N Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - H Yoshikawa
- Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | | | | | - E Moeller
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | - M Ritter
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | - C Shields
- Merck & Co., Inc., Kenilworth, New Jersey
| | - A Walia
- Merck & Co., Inc., Kenilworth, New Jersey
| | - G Perez
- Merck & Co., Inc., Kenilworth, New Jersey
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9
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Cheung TH, Yim SF, Yu MY, Worley MJ, Fiascone SJ, Chiu RWK, Lo KWK, Siu NSS, Wong MCS, Yeung ACM, Wong RRY, Chen ZG, Elias KM, Chung TKH, Berkowitz RS, Wong YF, Chan PKS. Liquid Biopsy of HPV DNA in Cervical Cancer. Obstet Gynecol Surv 2019. [DOI: 10.1097/01.ogx.0000562136.89767.55] [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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10
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Cheung TH, Yim SF, Yu MY, Worley MJ, Fiascone SJ, Chiu RW, Lo KW, Siu NS, Wong MC, Yeung AC, Wong RR, Chen ZG, Elias KM, Chung TK, Berkowitz RS, Wong YF, Chan PK. Liquid biopsy of HPV DNA in cervical cancer. J Clin Virol 2019; 114:32-36. [DOI: 10.1016/j.jcv.2019.03.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/21/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
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11
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Chung TK, Cheung TH, Yim SF, Yu MY, Chiu RW, Lo KW, Lee IP, Wong RR, Lau KK, Wang VW, Worley MJ, Elias KM, Fiascone SJ, Smith DI, Berkowitz RS, Wong YF. Liquid biopsy of PIK3CA mutations in cervical cancer in Hong Kong Chinese women. Gynecol Oncol 2017; 146:334-339. [DOI: 10.1016/j.ygyno.2017.05.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/23/2017] [Accepted: 05/29/2017] [Indexed: 12/13/2022]
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12
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Wong MCS, Nelson EAS, Leung C, Lee N, Chan MCW, Choi KW, Rainer TH, Cheng FWT, Wong SYS, Lai CKC, Lam B, Cheung TH, Leung TF, Chan PKS. Ad Hoc Influenza Vaccination During Years of Significant Antigenic Drift in a Tropical City With 2 Seasonal Peaks: A Cross-Sectional Survey Among Health Care Practitioners. Medicine (Baltimore) 2016; 95:e3359. [PMID: 27175633 PMCID: PMC4902475 DOI: 10.1097/md.0000000000003359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We evaluated the acceptability of an additional ad hoc influenza vaccination among the health care professionals following seasons with significant antigenic drift.Self-administered, anonymous surveys were performed by hard copy questionnaires in public hospitals, and by an on-line platform available to all healthcare professionals, from April 1st to May 31st, 2015. A total of 1290 healthcare professionals completed the questionnaires, including doctors, nurses, and allied health professionals working in both the public and private systems.Only 31.8% of participating respondents expressed an intention to receive the additional vaccine, despite that the majority of them agreed or strongly agreed that it would bring benefit to the community (88.9%), save lives (86.7%), reduce medical expenses (76.3%), satisfy public expectation (82.8%), and increase awareness of vaccination (86.1%). However, a significant proportion expressed concern that the vaccine could disturb the normal immunization schedule (45.5%); felt uncertain what to do in the next vaccination round (66.0%); perceived that the summer peak might not occur (48.2%); and believed that the summer peak might not be of the same virus (83.5%). Furthermore, 27.8% of all respondents expected that the additional vaccination could weaken the efficacy of previous vaccinations; 51.3% was concerned about side effects; and 61.3% estimated that there would be a low uptake rate. If the supply of vaccine was limited, higher priority groups were considered to include the elderly aged ≥65 years with chronic medical conditions (89.2%), the elderly living in residential care homes (87.4%), and long-stay residents of institutions for the disabled (80.7%). The strongest factors associated with accepting the additional vaccine included immunization with influenza vaccines in the past 3 years, higher perceived risk of contracting influenza, and higher perceived severity of the disease impact.The acceptability to an additional ad hoc influenza vaccination was low among healthcare professionals. This could have a negative impact on such additional vaccination campaigns since healthcare professionals are a key driver for vaccine acceptance. The discordance in perceived risk and acceptance of vaccination regarding self versus public deserves further evaluation.
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Affiliation(s)
- Martin C S Wong
- From the School of Public Health and Primary Care (MCSW, SYSW); Department of Paediatrics (EASN, FWTC, TFL); Department of Anesthesia and Intensive Care (CL); Department of Medicine and Therapeutics (NL, KWC); Department of Microbiology (MCWC, PKSC); Accident and Emergency Medicine Academic Unit (THR); Department of Obstetrics and Gynaecology, Faculty of Medicine, Chinese University of Hong Kong (THC); Department of Pathology (Microbiology), Queen Elizabeth Hospital (CKCL); and Department of Pathology (Microbiology), Princess Margaret Hospital (BL), Hong Kong SAR
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13
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Wong ASM, Li WH, Cheung TH. Predictive factors for residual disease in hysterectomy specimens after conization in early-stage cervical cancer. Eur J Obstet Gynecol Reprod Biol 2016; 199:21-6. [PMID: 26894378 DOI: 10.1016/j.ejogrb.2016.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 02/25/2015] [Revised: 10/22/2015] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify predictive factors for residual disease in hysterectomy specimens after a loop electrical excision procedure (LEEP) or cold knife conization in early-stage cervical cancer. STUDY DESIGN A retrospective review was undertaken of the clinical records and pathology reports of 108 consecutive patients who were diagnosed with early invasive cervical cancer stage IA1 to IB1 by cold knife conization or LEEP, and underwent subsequent hysterectomy or radical hysterectomy at the Gynae-oncology Unit, Queen Elizabeth Hospital between 2000 and 2012. Residual disease was defined as the presence of cervical intra-epithelial neoplasia (CIN) 2-3 or invasive carcinoma in hysterectomy specimens. Clinicopathological factors associated with residual disease were analyzed. Risk factors for the prediction of residual disease were identified by univariate and multivariate analysis. RESULTS Residual disease was found in 32 (29.7%) patients. Stage, tumour size, depth of invasion, lymphovascular space invasion, ectocervical margin, endocervical margin, and combined ectocervical and endocervical margin were significantly associated with residual disease in hysterectomy specimens on univariate analysis. On multivariate analysis, depth of invasion (odds ratio 2.1, p=0.033) and combined margin status (odds ratio 10.8, p≤0.001) were independent risk factors for residual disease. In a subgroup analysis using depth of invasion ≤5mm and a negative combined margin, none (0%) of the 52 patients who met the criteria had residual disease. CONCLUSIONS Conization (combined ectocervical and endocervical) margin and tumour depth of invasion are independent predictors of residual disease in hysterectomy specimens. A negative conization margin and depth of invasion ≤5mm are associated with low risk of residual disease in patients with early-stage cervical cancer.
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Affiliation(s)
- A S M Wong
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region.
| | - W H Li
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - T H Cheung
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region
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14
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Lau YM, Cheung TH, Yeo W, Mo F, Yu MY, Lee KM, Ho WCS, Yeung ACM, Law PTY, Chan PKS. Prognostic implication of human papillomavirus types and species in cervical cancer patients undergoing primary treatment. PLoS One 2015; 10:e0122557. [PMID: 25855986 PMCID: PMC4391755 DOI: 10.1371/journal.pone.0122557] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/22/2015] [Indexed: 01/09/2023] Open
Abstract
High-risk human papillomavirus (HPV) types are associated with cervical cancer. It is well established that individual HPV types vary in oncogenicity, but current data on their prognostic implication remain controversial. We examined the association between HPV types/species and the survival of 236 Chinese women aged 26–87 (mean 54.4) years after receiving primary treatment for cervical cancer. Overall, 45.8% were of FIGO stage I, 41.9% stage II, and 12.3% stage III. The four most prevalent types found were HPV-16 (60.2%), HPV-18 (21.6%), HPV-52 (11.9%), and HPV-58 (9.3%). Overall, 19.5% of patients had multiple-type infections, 78.4% harboured one or more alpha-9 species, and 28.8% harboured one or more alpha-7 species. After a median follow-up of 8.0 years, 156 (66.1%) patients survived. The 3-year overall survival rate was 75.5%. Factors independently associated with a poorer 3-year overall survival were age >60 years, tumour size >4 cm, lymph node involvement and treatment with radiotherapy+/-chemotherapy. Univariate analysis showed HPV-16 single-type infection was associated with a marginally poorer disease-specific survival (71.6% vs. 87.0%, HR: 1.71, 95% CI = 1.01–2.90), whereas non-HPV-16 alpha-9 species was associated with a better disease-specific survival (90.0% vs. 76.2%, HR: 0.36, 95% CI = 0.16–0.79). However, on multivariate analysis, HPV infection status irrespective of different grouping methods, including individual types, species, single-type or co-infection, did not carry any significant prognostic significance. In conclusion, we did not observe any association between infection with a particular HPV type/species and survival. An HPV type-based stratification in treatment and follow-up plan could not be recommended.
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Affiliation(s)
- Yat Ming Lau
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong Special Administrative Region, People's Republic of China
| | - Tak Hong Cheung
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Winnie Yeo
- State Key Laboratory in Oncology in South China, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Sir YK Pao Center for Cancer, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Frankie Mo
- State Key Laboratory in Oncology in South China, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Sir YK Pao Center for Cancer, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Mei Yung Yu
- Department of Anatomical and Cellular Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Kun Min Lee
- Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Wendy C. S. Ho
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Apple C. M. Yeung
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Priscilla T. Y. Law
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Paul K. S. Chan
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- * E-mail:
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15
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Chung TKH, Van Hummelen P, Chan PKS, Cheung TH, Yim SF, Yu MY, Ducar MD, Thorner AR, MacConaill LE, Doran G, Pedamallu CS, Ojesina AI, Wong RRY, Wang VW, Freeman SS, Lau TS, Kwong J, Chan LKY, Fromer M, May T, Worley MJ, Esselen KM, Elias KM, Lawrence M, Getz G, Smith DI, Crum CP, Meyerson M, Berkowitz RS, Wong YF. Genomic aberrations in cervical adenocarcinomas in Hong Kong Chinese women. Int J Cancer 2015; 137:776-83. [PMID: 25626421 DOI: 10.1002/ijc.29456] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 08/12/2014] [Accepted: 01/12/2015] [Indexed: 01/14/2023]
Abstract
Although the rates of cervical squamous cell carcinoma have been declining, the rates of cervical adenocarcinoma are increasing in some countries. Outcomes for advanced cervical adenocarcinoma remain poor. Precision mapping of genetic alterations in cervical adenocarcinoma may enable better selection of therapies and deliver improved outcomes when combined with new sequencing diagnostics. We present whole-exome sequencing results from 15 cervical adenocarcinomas and paired normal samples from Hong Kong Chinese women. These data revealed a heterogeneous mutation spectrum and identified several frequently altered genes including FAT1, ARID1A, ERBB2 and PIK3CA. Exome sequencing identified human papillomavirus (HPV) sequences in 13 tumors in which the HPV genome might have integrated into and hence disrupted the functions of certain exons, raising the possibility that HPV integration can alter pathways other than p53 and pRb. Together, these provisionary data suggest the potential for individualized therapies for cervical adenocarcinoma based on genomic information.
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Affiliation(s)
- Tony K H Chung
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Paul Van Hummelen
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Paul K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Tak Hong Cheung
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - So Fan Yim
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Mei Y Yu
- Department of Anatomical & Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Matthew D Ducar
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Aaron R Thorner
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Laura E MacConaill
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Graeme Doran
- Department of Pathology, Harvard Medical School, Boston, MA
| | - Chandra Sekhar Pedamallu
- Cancer Program, The Broad Institute of MIT and Harvard University, Cambridge, MA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Akinyemi I Ojesina
- Cancer Program, The Broad Institute of MIT and Harvard University, Cambridge, MA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Raymond R Y Wong
- Harvard Medical School, Pediatric Surgical Laboratories, Massachusetts General Hospital, Boston, MA
| | - Vivian W Wang
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Samuel S Freeman
- Cancer Program, The Broad Institute of MIT and Harvard University, Cambridge, MA
| | - Tat San Lau
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Joseph Kwong
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Loucia K Y Chan
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Menachem Fromer
- Division of Psychiatric Genomics, Mount Sinai School of Medicine, New York, NY
| | - Taymaa May
- Division of Gynecologic Oncology, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Michael J Worley
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Katharine M Esselen
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kevin M Elias
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael Lawrence
- Cancer Genomics Informatics and Computational Biology, The Broad Institute of Harvard and MIT, Cambridge, MA
| | - Gad Getz
- Cancer Genomics Informatics and Computational Biology, The Broad Institute of Harvard and MIT, Cambridge, MA
| | - David I Smith
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Christopher P Crum
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Matthew Meyerson
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.,Cancer Program, The Broad Institute of MIT and Harvard University, Cambridge, MA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ross S Berkowitz
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Yick Fu Wong
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.,Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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16
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Tang T, Wong HK, Gu W, Yu MY, To KF, Wang CC, Wong YF, Cheung TH, Chung TKH, Choy KW. MicroRNA-182 plays an onco-miRNA role in cervical cancer. Gynecol Oncol 2013; 129:199-208. [PMID: 23313739 DOI: 10.1016/j.ygyno.2012.12.043] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 12/20/2012] [Accepted: 12/27/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purposes of this study were to identify aberrantly expressed miRNAs and investigate their pathogenic roles in cervical cancer. METHODS miRNA expression was assessed in cervical cancer cell lines, micro-dissected normal cervical epithelium cells and primary cervical carcinoma by TaqMan RT-PCR. Spatial expression of miR-182 in cervical carcinoma and normal cervix was explored by in situ hybridization. HeLa xenograft mice model was used for evaluation of the effect on tumor growth of miR-182 inhibitor. Western blot, flow cytometry and gene expression analysis were used for identification of the functional role of miR-182 in HeLa cells. RESULTS Two up-regulated (miR-182 and -183) and nine down-regulated (miR-211, 145, 223, 150, 142-5p, 328, 195, 199b, 142-3p) microRNAs were consistently identified in cervical cancer cell lines. Further investigation confirmed the most up-regulated miRNA (miR-182) was significantly elevated in primary cervical carcinoma and discovered a significant correlation between the increased expression of miR-182 and advanced stages of cervical cancer. In HeLa xenograft mouse model, we demonstrated that inhibition of the miR-182 could exert the effect of tumor growth regression. Western blot, flow cytometry and pathway analysis for the HeLa cells with miR-182 over/down-expression in vitro showed that miR-182 was involved in apoptosis and cell cycle pathways, it also associated with the regulation of FOXO1. CONCLUSIONS Our findings indicated that miR-182 plays an onco-miRNA role in cervical cancer and its alteration is associated with cervical cancer pathogenesis by disrupting cell proliferation.
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Affiliation(s)
- Tao Tang
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
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17
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Chan PKS, Liu SJ, Cheung JLK, Cheung TH, Yeo W, Chong P, Man S. T-cell response to human papillomavirus type 52 L1, E6, and E7 peptides in women with transient infection, cervical intraepithelial neoplasia, and invasive cancer. J Med Virol 2012; 83:1023-30. [PMID: 21503915 DOI: 10.1002/jmv.21889] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The E6 and E7 proteins encoded by human papillomaviruses (HPV) are prime targets for therapeutic vaccine development. Ninety-five women with HPV 52 infection (33 transient infections, 17 cervical intraepithelial neoplasia grade II, 15 cervical intraepithelial neoplasia grade III, and 30 invasive cervical cancers) were examined for T-cell responses using interferon-γ enzyme-linked immunospot (IFN-γ ELISPOT) assay. Of the 29 peptides (13 L1, 10 E6, and 6 E7) screened positive by an in vitro peptide-binding assay, 14 were positive by the IFN-γ ELISPOT assay. Positive epitopes for HLA A11 were located at amino acid positions 103-111, 332-340, 342-350, and 373-381 of the L1 protein; and at 27-35 and 86-94 of the E6 protein; and at 1-9 and 27-35 of the E7 protein. A24-specific epitopes included 60-68 and 98-106 of the L1 protein, 42-50 and 59-67 of the E6 protein, and 24-32 of the E7 protein. Only one epitope (99-107) of the E6 protein showed positive responses for HLA A2 subjects. Overall, T-cell responses against L1 were observed mainly in subjects who had cleared infection; whereas responses against E6 and E7 were confined mainly to subjects who had developed cervical neoplasia. The proportion of subjects showing detectable T-cell responses was low across all grades of cervical neoplasia suggesting that immune evasion mechanisms had set on early in the course of disease progression. This study provides the first set of T-cell epitopes mapped for HPV 52, which can be considered for further evaluation as targets for immunotherapy.
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Affiliation(s)
- Paul K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region, China.
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18
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Chan PKS, Picconi MA, Cheung TH, Giovannelli L, Park JS. Laboratory and clinical aspects of human papillomavirus testing. Crit Rev Clin Lab Sci 2012; 49:117-36. [PMID: 22913405 PMCID: PMC3469219 DOI: 10.3109/10408363.2012.707174] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 05/13/2012] [Accepted: 06/25/2012] [Indexed: 12/14/2022]
Abstract
Human papillomavirus (HPV) infection is associated with a wide spectrum of disease that ranges from self-limited skin warts to life-threatening cancers. Since HPV plays a necessary etiological role in cervical cancer, it is logical to use HPV as a marker for early detection of cervical cancer and precancer. Recent advances in technology enable the development of high-throughput HPV assays of different formats, including DNA-based, mRNA-based, high-risk group-specific and type-specific methods. The ultimate goal of these assays is to improve the accuracy and cost-effectiveness of cervical screening programs. HPV testing has several potential advantages compared to cytology-based screening. However, since the cancer to transient infection ratio is always low in the general population, HPV test results are bound to have a low positive predictive value that may subject women to unnecessary follow-up investigations. The wide-spread administration of prophylactic HPV vaccine will substantially decrease the incidence of cancer and precancer. This poses a number of challenges to cytology-based screening, and the role of HPV testing is expected to increase. Finally, apart from technical and cost-effectiveness considerations, one should also keep in mind the psycho-social impact of using sexually-transmitted agents as a marker for cancer screening.
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Affiliation(s)
- Paul K S Chan
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China.
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19
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Wong YF, Cheung TH, Man MKN, Yu MY, Yim SF, Siu NS, Lo KW, Doran G, Wong RR, Wang VW, Smith DI, Worley MJ, Chung TK. Abstract 5047: Dysregulated microRNAs in cervical neoplasm. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-5047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
MicroRNAs (miRNAs) play an important role in a variety of physiological processes as well as pathophysiological processes, including cancinogenesis. This study was to identify a distinct miRNA expression signature for cervical intraepithelial neoplasia (CIN) and to reveal individual miRNAs that may be involved in the development of cervical carcinoma. Expression profiling using quantitative real-time RT-PCR of 202 miRNAs was performed on micro-dissected high-grade CIN (CIN 2/3) tissues as compared to normal cervical epithelium. The expression of 12 miRNAs including miR-518a, miR-34b, miR-34c, miR-20b, miR-338, miR-9, miR-512-5p, miR-424, miR-345, miR-10a, miR-193b and miR-203 were significantly different between high-grade CIN and normal epithelium. This miRNA signature was further validated by an independent set of high-grade CIN tissue. The same characteristic signature can also be used to distinguish cervical squamous cell carcinoma (SCC) from normal controls. Target prediction analysis revealed that these dysregulated miRNAs control the apoptosis signaling pathway and cell cycle regulation. These findings contribute to understanding of the pathogenesis of cervical carcinoma at the molecular level.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5047. doi:1538-7445.AM2012-5047
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Affiliation(s)
- Yick Fu Wong
- 1The Chinese Univ. of Hong Kong, Shatin, Hong Kong
| | | | | | - Mei Yun Yu
- 1The Chinese Univ. of Hong Kong, Shatin, Hong Kong
| | - So Fan Yim
- 1The Chinese Univ. of Hong Kong, Shatin, Hong Kong
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Wong RRY, Chan LKY, Tsang TPT, Lee CWS, Cheung TH, Yim SF, Siu NSS, Lee SNC, Yu MY, Chim SSC, Wong YF, Chung TKH. CHD5 Downregulation Associated with Poor Prognosis in Epithelial Ovarian Cancer. Gynecol Obstet Invest 2011; 72:203-7. [PMID: 21860208 DOI: 10.1159/000323883] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 12/14/2010] [Indexed: 01/01/2023]
Abstract
BACKGROUND The CHD5 gene located on 1p36 encodes a protein-chromodomain helicase DNA-binding protein 5. CHD5 has been shown to be a tumor suppressor gene candidate. This study investigated the involvement of CHD5 in ovarian cancer and its clinicopathological significance. METHODS CHD5 expression in ovarian cancer and its counterpart were determined by quantitative RT-PCR. The correlation of CHD5 expression to clinicopathological features of the tumor was analyzed. RESULTS CHD5 expression was downregulated by at least twofold in 32 of 72 (41%) invasive epithelial ovarian carcinomas when compared to 12 controls in Hong Kong Chinese women. CHD5 downregulation was correlated to clinical status (p < 0.05), but not to patient age, tumor type and grade, recurrence and clinical stage (p > 0.05). Survival analysis showed that patients with CHD5 downregulation in their tumors were associated with shorter disease-free and total survival times compared to those without CHD5 downregulation (p < 0.05). Cox proportional-hazards regression analysis indicated that downregulation of CHD5 is an independent adverse prognostic factor in ovarian cancer. CONCLUSION This study shows that CHD5 is downregulated in a certain number of ovarian cancers and appears to be an adverse predictor candidate of ovarian cancer disease-free and total survival.
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Affiliation(s)
- Raymond R Y Wong
- Departments of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
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Chung TKH, Lau TS, Cheung TH, Yim SF, Lo KWK, Siu NSS, Chan LKY, Yu MY, Kwong J, Doran G, Barroilhet LM, Ng ASW, Wong RRY, Wang VW, Mok SC, Smith DI, Berkowitz RS, Wong YF. Dysregulation of microRNA-204 mediates migration and invasion of endometrial cancer by regulating FOXC1. Int J Cancer 2011; 130:1036-45. [PMID: 21400511 DOI: 10.1002/ijc.26060] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 02/15/2011] [Indexed: 01/26/2023]
Abstract
MicroRNAs (miRNAs) regulate mRNA stability and protein expression, and certain miRNAs have been demonstrated to act either as oncogenes or tumor suppressors. Differential miRNA expression signatures have been documented in many human cancers but the role of miRNAs in endometrioid endometrial cancer (EEC) remains poorly understood. This study identifies significantly dysregulated miRNAs of EEC cells, and characterizes their impact on the malignant phenotype. We studied the expression of 365 human miRNAs using Taqman low density arrays in EECs and normal endometriums. Candidate differentially expressed miRNAs were validated by quantitative real-time PCR. Expression of highly dysregulated miRNAs was examined in vitro through the effect of anti-/pre-miRNA transfection on the malignant phenotype. We identified 16 significantly dysregulated miRNAs in EEC and 7 of these are novel findings with respect to EEC. Antagonizing the function of miR-7, miR-194 and miR-449b, or overexpressing miR-204, repressed migration, invasion and extracellular matrix-adhesion in HEC1A endometrial cancer cells. FOXC1 was determined as a target gene of miR-204, and two binding sites in the 3'-untranslated region were validated by dual luciferase reporter assay. FOXC1 expression was inversely related to miR-204 expression in EEC. Functional analysis revealed the involvement of FOXC1 in migration and invasion of HEC1A cells. Our results present dysfunctional miRNAs in endometrial cancer and identify a crucial role for miR-204-FOXC1 interaction in endometrial cancer progression. This miRNA signature offers a potential biomarker for predicting EEC outcomes, and targeting of these cancer progression- and metastasis-related miRNAs offers a novel potential therapeutic strategy for the disease.
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Affiliation(s)
- T K H Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
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Samuelsson J, Alonso S, Ruiz-Larroya T, Cheung TH, Wong YF, Perucho M. Frequent somatic demethylation of RAPGEF1/C3G intronic sequences in gastrointestinal and gynecological cancer. Int J Oncol 2011; 38:1575-7. [PMID: 21399874 DOI: 10.3892/ijo.2011.972] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 02/04/2011] [Indexed: 11/05/2022] Open
Abstract
RAPGEF1 (also known as C3G and GRF2) is a guanine nucleotide exchange factor that releases GDP from the inactive Rap1 protein, facilitating its subsequent activation by the binding of GTP. Rap1 plays regulatory roles in proliferation, differentiation and apoptosis. Amplification and overexpression of RAPGEF1 have been found in small cell lung cancers, suggesting an oncogenic role. In contrast, hypermethylation of a promoter CpG island (CGI-A) of RAPGEF1 has been reported in squamous cervical tumors, suggesting an anti-oncogenic role in these gynecological cancers. In our studies of DNA methylation alterations in gastrointestinal cancer we found somatic demethylation of a relaxed-criterion CpG island (CGI-B) located in the first intron of RAPGEF1 in 40% of colon cancers and 8% of gastric cancers relative to their matching normal tissues that were always methylated. We also found somatic demethylation in 47% of squamous cervical carcinomas as well as 33% of ovarian cancers. This somatic change in methylation, however, did not extend to the strict-criterion CpG island located in the promoter region (CGI-A) that was unmethylated in all normal and tumor tissues analyzed. Thus, promoter hypermethylation of RAPGEF1 seems insignificant in colorectal, cervical and ovarian cancers. In contrast, tumor-specific hypomethylation of the gene appears to be frequent in gastrointestinal and gynecological cancers.
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Affiliation(s)
- Johanna Samuelsson
- Graduate School of Biomedical Sciences, Sanford-Burnham Medical Research Institute, 10901 North Torrey Pines Road, La Jolla, CA 92037, USA
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Chan SSC, Pang SMW, Cheung TH, Cheung RYK, Chung TKH. Laparoscopic sacrocolpopexy for the treatment of vaginal vault prolapse: with or without robotic assistance. Hong Kong Med J 2011; 17:54-60. [PMID: 21282827] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE To assess perioperative and medium-term outcome after laparoscopic sacrocolpopexy with or without robotic assistance for vaginal vault prolapse in a Hong Kong tertiary centre. DESIGN Retrospective study. SETTING An urogynaecology unit in Hong Kong. PATIENTS All women who underwent laparoscopic sacrocolpopexy with or without robotic assistance for vaginal vault prolapse from March 2005 to May 2010. MAIN OUTCOME MEASURES The perioperative and medium-term outcomes. RESULTS A total of 36 women underwent the operation during the study period. The mean operating time was 205 minutes, mean blood loss was 144 mL. The median hospital stay was 4 days. Two women required early re-operation but recovered fully. In all, 35 women were followed up for 29 (standard deviation, 19) months. Three of them (9%) had a recurrence of stage II prolapse, but there was statistically significant improvement in the pelvic organ prolapse quantification assessment for all three compartments of the vagina, and the length of vagina was well preserved. There were no mesh exposure or erosions. The overall objective cure rate of 91% (32/35) was high, and 91% (32/35) were satisfied with the operative outcome. Stress incontinence and voiding difficulty were significantly reduced. CONCLUSION Laparoscopic sacrocolpopexy for vaginal vault prolapse is safe, although complications arising from concomitant surgery should not be neglected. High rates of objective cures and patient satisfaction were achieved. There were no mesh exposure or erosions. Laparoscopic sacrocolpopexy should be considered an option for women with vaginal vault prolapse.
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Affiliation(s)
- S S C Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Kong GWS, Yim SF, Cheung TH, Chung TKH. Cryotherapy as the treatment modality of postcoital bleeding: a randomised clinical trial of efficacy and safety. Aust N Z J Obstet Gynaecol 2010; 49:517-24. [PMID: 19780737 DOI: 10.1111/j.1479-828x.2009.01049.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postcoital bleeding is a common gynaecological problem that impacts on a woman's quality of life and sexual function. There is little systematic research into its management. AIMS To assess the efficacy and side-effects of cryotherapy as treatment for postcoital bleeding. METHODS A prospective randomised controlled trial was conducted in a tertiary referral hospital in Hong Kong. A total of 85 women who presented with postcoital bleeding were recruited, and randomised to cryotherapy or no treatment. The treatment group received cryotherapy with compressed carbon dioxide through a cryoprobe placed on the cervix, and controls had cryoprobe on the cervix without compressed carbon dioxide flow. All recruited women were followed up two weeks, three months and six months to review their symptoms and response to the treatment. RESULTS The treatment group had a significantly better long-term cure rate and improvement rate. At six months, the cryotherapy group reported a cure rate of 72.1% while that in the control group the cure rate was 50.0% (P = 0.04). The number needed to treat was 5. The mean improvement rate of the cryotherapy group was 82.88% +/- 35.87 but was only 61.62% +/- 55.30 in the control group (P = 0.04). The results were more significant in women with the defined pathological cervix. Apart from the vaginal discharge at second week follow up in the treatment group, there was no statistical significant difference in side-effects and complications among two groups. CONCLUSION Our study demonstrated that cryotherapy is a safe and an effective treatment for postcoital bleeding.
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Affiliation(s)
- Grace Wing Shan Kong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Chan SSC, Yan Ng BH, Lo WK, Cheung TH, Hung Chung TK. Adolescent girls' attitudes on human papillomavirus vaccination. J Pediatr Adolesc Gynecol 2009; 22:85-90. [PMID: 19345913 DOI: 10.1016/j.jpag.2007.12.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 12/14/2007] [Accepted: 12/14/2007] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE The objective of the study was to assess the attitudes of adolescent girls on Human papillomavirus (HPV) vaccination and the impact of an information pamphlet on their attitude. Other factors that may affect their attitude were also studied. DESIGN Questionnaire survey. SETTING Pediatric and adolescent gynecology clinic. PARTICIPANTS 250 adolescents aged 12 to 19 years. INTERVENTIONS Participants completed a questionnaire regarding their knowledge and attitudes towards HPV vaccination. Immediately following this, they read an information pamphlet on HPV vaccination. They then completed the same questionnaire again. MAIN OUTCOME MEASURES The attitude of the adolescents towards HPV vaccination. RESULTS Initially, 35% intended to receive the vaccination but after reading the information pamphlet, it rose to 69%. Their intention was positively correlated with their knowledge (P = 0.003), health belief (P < 0.001) and belief in who should receive the vaccine (P < 0.001) but negatively correlated with their belief that other people would approve of their vaccination (normative belief) (P < 0.001). There was a significant increase in their knowledge score (P < 0.001) after reading the pamphlet. Their health belief and belief in who should receive vaccine became more positive (P < 0.001), but the normative belief was more negative (P = 0.002) after reading. CONCLUSION 69% of adolescent girls intended to receive HPV vaccination and their intention was improved by reading an information pamphlet. It was positively correlated with their knowledge, health belief, and belief in who should receive the vaccine, but negatively correlated with their normative belief.
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Affiliation(s)
- Symphorosa Shing Chee Chan
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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Chan SSC, Cheung TH, Lo WK, Chung TKH. Women's attitudes on human papillomavirus vaccination to their daughters. J Adolesc Health 2007; 41:204-7. [PMID: 17659226 DOI: 10.1016/j.jadohealth.2007.04.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2006] [Revised: 04/10/2007] [Accepted: 04/25/2007] [Indexed: 10/23/2022]
Abstract
This study assessed the impact of an information pamphlet on acceptance of human papillomavirus (HPV) vaccine in Chinese women. The pamphlet increased the self-perceived knowledge on cervical cancer and HPV of the study subjects and had a positive influence on women accepting HPV vaccination for their daughters (p < .001).
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Affiliation(s)
- Symphorosa Shing Chee Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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Siu SSN, Cheung TH, Chan PKS, Lin CK, Lo KWK. Patients with malignant or pre-malignant cervical lesion have increased risk of becoming hepatitis B carrier. J Exp Clin Cancer Res 2007; 26:77-81. [PMID: 17550135] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Human Papillomavirus (HPV) and Hepatitis B virus (HBV) are known aetiology of cervical and hepatocellular carcinoma, respectively. Both diseases share a similar clinical course, that is, the vast majority of those infected by these two viruses can eradicate the viruses spontaneously. A small sub-group who fails to clear the virus becomes chronic carrier and can progress to carcinoma many years later. We postulated that patients with pre-malignant or malignant cervical lesion are at increased risk of becoming chronic HBV carrier if infected, which may be attributed to inherent immunological deficiency against viral infection. We tested HBV carrier status from 288 patients with cervical carcinoma, 242 patients with high grade cervical intra-epithelial neoplasia (CIN) and 311 women with neither of the above conditions as control subjects. The HBV carrier rate in the Cancer Group, CIN Group and Control Group was 21.4%, 24.1% and 10.6%. The carrier rate was significantly higher in both the Cancer Group (p<0.01) and the CIN Group (p<0.01), compared to the Control Group. Our study suggests that a common immunological mechanism is involved in eradication of HBV and HPV infections and inherent immuno-deficiency might lead to an association of HBV carrier status with cervical carcinoma. Further studies are needed to confirm our findings and delineate the mechanism involved.
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Affiliation(s)
- S S N Siu
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong.
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Abstract
Objective Syntometrine is an effective uterotonic agent used in preventing primary postpartum haemorrhage but has adverse effects including nausea, vomiting, hypertension and coronary artery spasm. Carbetocin is a newly developed long-acting oxytocin analogue that might be used as an uterotonic agent. We compare the efficacy and safety of intramuscular (IM) carbetocin with IM syntometrine in preventing primary postpartum haemorrhage. Design Prospective, double-blinded, randomised controlled trial. Setting Delivery suite of a university-based obstetrics unit. Population Women with singleton pregnancy achieving vaginal delivery after and throughout 34 weeks. Methods Three hundred and twenty-nine eligible women were randomised to receive either a single dose of 100 microgram IM carbetocin or 1 ml IM syntometrine (a mixture of 5 iu oxytocin and 0.5 mg ergometrine) at the end of second stage of labour. Main outcome measures Difference in haemoglobin drop measured 2 days after delivery between the two groups. Results There was no difference in the drop of haemoglobin concentration within the first 48 hours between the two groups. The incidence of additional oxytocic injections, postpartum haemorrhage (blood loss ≥ 500 ml) and retained placenta were also similar. The use of carbetocin was associated with significant lower incidence of nausea (relative risk [RR] 0.18, 95% confidence interval [CI] 0.04–0.78), vomiting (RR 0.1, 95% CI 0.01–0.74), hypertension 30 minutes (0 versus 8 cases, P < 0.01) and 60 minutes (0 versus 6 cases, P < 0.05) after delivery but a higher incidence of maternal tachycardia (RR 1.68, 95% CI 1.03–3.57). Conclusions IM carbetocin is as effective as IM syntometrine in preventing primary postpartum haemorrhage after vaginal delivery. It is less likely to induce hypertension and has a low incidence of adverse effect. It should be considered as a good alternative to conventional uterotonic agents used in managing the third stage of labour.
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Affiliation(s)
- S W Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR.
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Siu SSN, Lo KWK, Cheung TH, Yim SF, Chung TKH. Is aortic lymphadenectomy necessary in the management of endometrial carcinoma? EUR J GYNAECOL ONCOL 2007; 28:98-102. [PMID: 17479669] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To evaluate the role of aortic lymphadenectomy in the management of endometrial carcinoma. METHODS Clinical notes of 163 patients with endometrial carcinoma were reviewed. All patients had peritoneal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy with or without aortic lymphadenectomy. RESULTS Seventy-five (46.0%) patients had pelvic lymphadenectomy alone whereas 88 (54.0%) had both pelvic and aortic lymphadenectomy. Thirty-five (21.5%) patients had nodal metastases with positive pelvic and aortic nodes in 26 (16.0%) and 24 (27.3%) patients, respectively. Isolated aortic metastases were found in 17 cases (19.3%). Among 35 patients with nodal metastases, recurrence developed in 15 (42.9%) patients and all except one died within five to 50 months. The remaining patients had a median disease-free period of 55 months (13-93 months). The recurrence rate was higher (63.6%) among patients with upper aortic lymph node metastases, and all those who recurred died of disease within seven to 28 months. CONCLUSIONS Our data suggest that aortic lymphadenectomy provides both diagnostic and therapeutic value in the management of endometrial carcinoma with high metastatic risk. After surgical removal and adjuvant radiotherapy, patients with nodal metastases achieved a better survival chance.
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Affiliation(s)
- S S N Siu
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Wong YF, Sahota DS, Cheung TH, Lo KWK, Yim SF, Chung TKH, Chang AMZ, Smith DI. Gene expression pattern associated with radiotherapy sensitivity in cervical cancer. Cancer J 2006; 12:189-93. [PMID: 16803676 DOI: 10.1097/00130404-200605000-00006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [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: 11/26/2022]
Abstract
UNLABELLED The objective of the present preliminary study was to determine if a difference in the pattern of gene expression exists between tumors that were subsequently found to be sensitive to radiotherapy and tumors found to be resistant to radiotherapy. PATIENTS AND METHODS A total of 16 patients with invasive squamous cell carcinoma of the uterine cervix were included in this study. All patients were treated with standardized radiotherapy alone. Ten of the tumors were clinically radiosensitive and six were radioresistant. Total RNA, extracted from tumor specimens obtained prior to treatment, was hybridized onto an oligonucleotide microarray with probe sets complementary to over 20,000 transcripts. The genes were first subjected to a statistical filter to identify genes with statistically significant differential expression levels between those that were radiosensitive and those that were radioresistant. A back-propagation neural network was then constructed to model the differences so that patterns could be easily identified. RESULTS Although a number of genes were found to express differentially between radiosensitive and radioresistant tumors; the 10 most discriminating genes were used to construct the model. Using the expressions from these 10 genes, we found that neural networks constructed from random subsets of the whole data were capable of predicting radiotherapy responses in the remaining subset, which appears stable within the dataset. DISCUSSION This study shows that such an approach has the potential to differentiate tumor radiosensitivity, although confirmation of such a pattern using other larger independent datasets is necessary before firm conclusions can be drawn.
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Affiliation(s)
- Y F Wong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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Wong YF, Cheung TH, Lo KWK, Yim SF, Siu NSS, Chan SCS, Ho TWF, Wong KWY, Yu MY, Wang VW, Li C, Gardner GJ, Bonome T, Johnson WB, Smith DI, Chung TKH, Birrer MJ. Identification of molecular markers and signaling pathway in endometrial cancer in Hong Kong Chinese women by genome-wide gene expression profiling. Oncogene 2006; 26:1971-82. [PMID: 17043662 DOI: 10.1038/sj.onc.1209986] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Endometrial cancer is the third most common gynecologic malignancy and the ninth most common malignancy for females overall in Hong Kong. Approximately 80% or more of these cancers are endometrioid endometrial adenocarcinomas. The aim of this study was to reveal genes contributing to the development of endometrioid endometrial cancer, which may impact diagnosis, prognosis and treatment of the disease. Whole-genome gene expression analysis was completed for a set of 55 microdissected sporadic endometrioid endometrial adenocarcinomas and 29 microdissected normal endometrium specimens using the Affymetrix Human U133 Plus 2.0 oligonucleotide microarray. Selected genes of interest were validated by quantitative real-time-polymerase chain reaction (qRT-PCR). Pathway analysis was performed to reveal gene interactions involved in endometrial tumorigenesis. Unsupervised hierarchical clustering displayed a distinct separation between the endometrioid adenocarcinomas and normal endometrium samples. Supervised analysis identified 117 highly differentially regulated genes (>or=4.0-fold change), which distinguished the endometrial cancer specimens from normal endometrium. Twelve novel genes including DKK4, ZIC1, KIF1A, SAA2, LOC16378, ALPP2, CCL20, CXCL5, BST2, OLFM1, KLRC1 and MBC45780 were deregulated in the endometrial cancer, and further validated in an independent set of 56 cancer and 29 normal samples using qRT-PCR. In addition, 10 genes were differentially regulated in late-stage cancer, as compared to early-stage disease, and may be involved in tumor progression. Pathway analysis of the expression data from this tumor revealed an interconnected network consisting of 21 aberrantly regulated genes involved in angiogenesis, cell proliferation and chromosomal instability. The results of this study highlight the molecular features of endometrioid endometrial cancer and provide insight into the events underlying the development and progression of endometrioid endometrial cancer.
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Affiliation(s)
- Y F Wong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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Wong YF, Cheung TH, Lo KWK, Yim SF, Chan LKY, Buhard O, Duval A, Chung TKH, Hamelin R. Detection of microsatellite instability in endometrial cancer: advantages of a panel of five mononucleotide repeats over the National Cancer Institute panel of markers. Carcinogenesis 2006; 27:951-5. [PMID: 16490738 DOI: 10.1093/carcin/bgi333] [Citation(s) in RCA: 45] [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: 12/28/2022] Open
Abstract
The aim of this study was to find the optimal set of microsatellite markers for diagnosis of the microsatellite instability (MSI) phenotype in endometrial cancers. We compared the sensitivity, specificity and ease of use of a reference panel of five markers originally recommended by the National Cancer Institute (NCI) for colorectal cancer and a panel of five quasi-monomorphic mononucleotide repeat markers (pentaplex PCR system). We used these panels for establishing the MSI status of a series of 80 sporadic endometrial adenocarcinomas by comparing the allelic profiles of the markers between tumor and matching germline DNA. Both panels detected the same subset of 21 out of 80 (26%) endometrial MSI carcinomas. However, in the MSI cases, the mean instability of the five mononucleotide repeats was 96.1% as compared with a mean instability of 69.8% for the three dinucleotide repeats of the NCI panel, indicating a superiority of mononucleotide repeats over dinucleotide repeats in detecting MSI. The fact that the two panels of markers detect the same set of MSI tumors is due to the presence of two mononucleotide repeats within the NCI panel. As demonstrated previously in gastric and colon MSI cases, the pentaplex PCR reaction using mononucleotide repeats is thus an easier and more sensitive method than the NCI panel, for the screening of MSI status in endometrial tumors.
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Affiliation(s)
- Yick Fu Wong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China and Inserm, U762, Paris, F-75010 France;, Univ Paris 6, Paris, F-75005 France
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Wang F, Zhu Y, Huang Y, McAvoy S, Johnson WB, Cheung TH, Chung TKH, Lo KWK, Yim SF, Yu MMY, Ngan HYS, Wong YF, Smith DI. Transcriptional repression of WEE1 by Kruppel-like factor 2 is involved in DNA damage-induced apoptosis. Oncogene 2005; 24:3875-85. [PMID: 15735666 DOI: 10.1038/sj.onc.1208546] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Human Kruppel-like factor 2 (KLF2) is a Cys(2)/His(2) zinc-finger-containing transcriptional factor, which is involved in multiple cellular pathways. Utilizing gene expression profiling to identify aberrantly expressed genes in ovarian cancer, we found that KLF2 was significantly and specifically downregulated in ovarian tumors. After reintroducing KLF2 into ovarian cancer cell lines, we observed decreased cell growth and increased sensitivity to DNA damage-induced apoptosis. Analysis of genes that could be potential targets of KLF2 revealed that KLF2 negatively regulated WEE1 expression. WEE1 encodes a tyrosine kinase that regulates the G2/M cell cycle transition. Expression of KLF2 markedly repressed the transcription of WEE1 by directly binding to an SP1/CPBP motif located between -252 bp and the start codon of the WEE1 promoter. Both activation and zinc-finger domains of KLF2 were required for this suppression of Wee1 expression. In addition, we demonstrated that Wee1 expression prevents cancer cells from undergoing apoptosis in response to DNA damage; however, this resistance was abolished by coexpression of KLF2, which inhibits WEE1 transcription. Thus, the level of WEE1 is regulated by KLF2 and enhanced KLF2 expression sensitizes cells to DNA damage-induced apoptosis.
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Affiliation(s)
- Fang Wang
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Wu TT, Qu J, Cheung TH, Yim SF, Wong YF. Study of dynamic process of acetic acid induced-whitening in epithelial tissues at cellular level. Opt Express 2005; 13:4963-73. [PMID: 19498484 DOI: 10.1364/opex.13.004963] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Acetic acid, inducing transient whitening (acetowhitening) when applied to epithelial tissues, is a commonly used contrast agent for detecting early cervical cancer. The goals of this research are to investigate the temporal characteristics of acetowhitening process in cervical epithelial tissue at cellular level and develop a clear understanding of the diagnostic information carried in the acetowhitening signal. A system measuring time-resolved reflectance was built to study the rising and decay processes of acetowhitening signal from the monolayered cell cultures of normal and cancerous cervical squamous cells. It is found that the dynamic processes of acetowhitening in normal and cancerous cells are significantly different. The results of this study provide insight valuable to further understand the acetowhitening process in epithelial cells and to encourage the development of an objective procedure to detect the early cervical cancers based on quantitative monitoring of the dynamic process of acetowhitening.
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Yu T, Ferber MJ, Cheung TH, Chung TKH, Wong YF, Smith DI. The role of viral integration in the development of cervical cancer. ACTA ACUST UNITED AC 2005; 158:27-34. [PMID: 15771901 DOI: 10.1016/j.cancergencyto.2004.08.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Revised: 08/09/2004] [Accepted: 08/10/2004] [Indexed: 11/26/2022]
Abstract
The development of invasive cervical cancer is associated with human papillomavirus (HPV) infection and subsequent integration into the host epithelium. More than 99% of cervical cancers contain HPV sequences, and many of these contain a truncated HPV genome integrated into a single position within the host genome. Studies examining the role of viral integration in cervical cancer development have found that the sites of integration appear randomly distributed throughout the genome. This, and the observation that it frequently takes years after HPV infection for cervical cancer to develop, has led to the current paradigm that the site of HPV integrations is unimportant to the invasive cervical cancer that eventually develops. In our previous studies of HPV16 and HPV18 integration in cervical cancers, we also found integrations throughout the genome, but observed as well that more than half of the integrations occurred within common fragile site regions. To determine if HPV integration might play an important role in cervical cancer, we conducted two complementary studies. We first localized 40 new HPV16 integration sites from cervical tumors from women in Hong Kong; this, together with previous integration studies, provided a better picture of the distribution of integration sites throughout the genome. We then analyzed the sites of viral integration in an in vitro model of HPV integration. By comparing the sites of HPV integration in vivo (in multiple primary cervical tumors) to those obtained in vitro, the data can help to determine if HPV integrations observed in vivo are the result of random and nonselected integrations.
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Affiliation(s)
- Tingxi Yu
- Division of Experimental Pathology and Mayo Clinic Cancer Center, Mayo Clinic College of Medicine, 800C Hilton, 200 First Street, S.W., Rochester, MN 55905, USA
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Selvanayagam ZE, Cheung TH, Wei N, Vittal R, Lo KWK, Yeo W, Kita T, Ravatn R, Chung TKH, Wong YF, Chin KV. Prediction of chemotherapeutic response in ovarian cancer with DNA microarray expression profiling. ACTA ACUST UNITED AC 2004; 154:63-6. [PMID: 15381375 DOI: 10.1016/j.cancergencyto.2004.01.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [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: 10/24/2003] [Revised: 01/21/2004] [Accepted: 01/23/2004] [Indexed: 01/03/2023]
Abstract
Ovarian carcinoma is a leading cause of gynecologic cancer death in women. Despite treatment, a large number of women with ovarian cancer eventually relapse and die of the disease. Hence, recurrent ovarian cancer continues to be a therapeutic dilemma, possibly a result of the emergence of drug resistance during relapse. Recent advances in expression genomics enable global transcript analysis that leads to molecular classification of cancers and prediction of outcome and treatment response. We did a cDNA microarray examination of the expression profiles of eight primary ovarian cancers stratified into two groups based on their chemotherapeutic response. We applied a voice-speech-pattern recognition algorithm for microarray data analysis and were able to model and predict the response of these patients to chemotherapy from their expression profiles. Hence, gene expression profiling by means of DNA microarray may be applied diagnostically for predicting treatment response in ovarian cancer.
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Affiliation(s)
- Zachariah E Selvanayagam
- Department of Pediatrics, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA
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Lo KWK, Cheung TH, Yim SF, Yu MY, Chan LYS, Chung TKH. Prospective self-controlled study on prevention of hysteroscopic dissemination in endometrial carcinoma. Int J Gynecol Cancer 2004; 14:921-6. [PMID: 15361204 DOI: 10.1111/j.1048-891x.2004.014530.x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Patients diagnosed to have endometrial carcinoma without prior hysteroscopic examination were recruited from March 2000 to August 2003. Normal saline was used to distend the uterine cavity during the hysteroscopic examination to look for endocervical spread before the definitive surgical treatment. We performed laparotomy, clamped both fallopian tubes, and collected peritoneal washing before the hysteroscopic examination was performed. Peritoneal washing was collected once more after the hysteroscopic examination. Hysteroscopic assessment was performed in 103 patients. Of them, 10 patients were excluded from the study due to previous history of tubal sterilization or blockage. The final analysis was confined to 93 patients. Positive peritoneal cytology was found in 10 (10.8%) patients and this finding was significantly related to the tumor grading (P = 0.023), adnexal involvement (P = 0.003), cervical invasion (P = 0.01), and the presence of peritoneal seedlings (P = 0.001). In five of the 10 patients with positive peritoneal cytology before the hysteroscopic examination, malignant cells could also be recovered in the peritoneal washing collected after the hysteroscopic examination. For patients with negative peritoneal cytology before hysteroscopy, none exhibited positive peritoneal cytology after the procedure. Our data suggested that complete occlusion of both fallopian tubes can effectively prevent the dissemination of endometrial malignant cells into the peritoneal cavity during hysteroscopy.
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Affiliation(s)
- K W K Lo
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
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Wong YF, Cheung TH, Lo KWK, Wang VW, Chan CS, Ng TB, Chung TKH, Mok SC. Protein profiling of cervical cancer by protein-biochips: proteomic scoring to discriminate cervical cancer from normal cervix. Cancer Lett 2004; 211:227-34. [PMID: 15219946 DOI: 10.1016/j.canlet.2004.02.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [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: 10/26/2003] [Revised: 02/18/2004] [Accepted: 02/19/2004] [Indexed: 10/26/2022]
Abstract
Analysis of multiple proteins is thought to be essential for establishment of signature proteomic patterns that may distinguish cancer from non-cancer. Surface-enhanced laser desorption/ionization (SELDI) is an affinity-based mass spectrometric method in which proteins of interest are selectively absorbed to a chemically modified surface on a biochip. This technology may provide protein profiling of a variety of biological specimens. In this study, we explored whether the protein biochip SELDI approach could differentiate cervical cancer from non-cancer cohorts. We screened protein profiles generated by SELDI in 62 cervical epithelial cell samples microdissected from 35 invasive cervical cancer and 27 age-matched normal cervix tissue specimens, respectively. The cell lysates of pure populations of cervical cells were applied onto Ciphergen ProteinChip WCX2 Arrays. Proteins bound to the chips were analyzed on a ProteinChip Reader Model PBS II. Derived proteomic patterns were converted to a simple proteomic scoring for distinguishing cancer from non-cancer cohorts. SELDI protein profiles of cell lysates from 20 cervical cancer and 15 normal cervix tissue specimens were used to train and develop a classification scoring system that used a seven-protein mass pattern. The training samples could be correctly discriminated. When a test set of 27 samples was used for evaluation of this scoring system to distinguish cervical cancer from non-cancer, a sensitivity of 87%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 86% for the test population were obtained. All seven proteins appeared to be down regulated in cervical cancer. The results from this study indicate that the proteomics approach of SELDI mass spectrometry, in combination with a simple scoring system, may distinguish cervical cancer from its normal counterpart. If this approach is also workable in the analysis of cervical exfoliated cell lysate, it might potentially be used in the early diagnosis of invasive cervical cancer. In addition, the identification of these specific proteins in cervical cancer may also facilitate the discovery of new cervical tumor marker(s).
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Affiliation(s)
- Y F Wong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China.
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Abstract
BACKGROUND In previous studies comparing patient-controlled-analgesia and intramuscular pain management have been unable to provide conclusive evidence of the benefits of either method of postoperative pain control. AIM The purpose of the study was to compare the efficacy and cost-effectiveness of intravenous patient-controlled-analgesia with intermittent intramuscular morphine for Chinese women in the first 24 hours following elective gynaecological surgery. METHODS A randomized control design was used. The main outcomes were level of pain and cost for the two types of pain management. Participants indicated their level of pain at rest and when deep breathing or coughing on a 100 mm Visual Analogue Scale, on seven occasions within 24 postoperative hours. Costs for the two types of pain management were based on the costs of equipment, drugs and nursing time. RESULTS A total of 125 women participated in the study. Mean pain level over the 24 hours in the patient-controlled-analgesia group was significantly lower than in the intramuscular group (P < 0.001). Mean pain level over the seven occasions for the patient-controlled-analgesia group was 11.83 points (95% CI 7.14-16.52) lower when at rest and 11.73 points (95% CI 5.96-17.50) lower during motion than the intramuscular group. Cost per patient was $81.10 (Hong Kong) higher for patient-controlled-analgesia than for intramuscular pain management. Women in the patient-controlled-analgesia group had significantly greater satisfaction with pain management than those in the intramuscular group (P < 0.001), but reported significantly more episodes of nausea (P < 0.05). CONCLUSIONS While patient-controlled-analgesia was more costly, it was also more effective than conventional on-demand intramuscular opioid injections after laparotomy for gynaecological surgery.
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Affiliation(s)
- A M Chang
- School of Nursing, Queensland University of Technology/Mater Misericordiae Health Services, Brisbane, Australia.
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Cheung TH, Lo WK, Yu MY, Yang WT, Ho S. Extended experience in the use of laparoscopic ultrasound to detect pelvic nodal metastasis in patients with cervical carcinoma. Gynecol Oncol 2004; 92:784-8. [PMID: 14984941 DOI: 10.1016/j.ygyno.2003.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 03/05/2003] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the use of laparoscopic ultrasound (USG) to detect pelvic nodal metastasis in patients with early stage cervical carcinoma. METHODS Laparoscopic USG was used to search for pelvic lymph node metastasis in stage Ia2 to IIa cervical carcinoma patients before radical hysterectomy. Suspicious lymph nodes identified by laparoscopic USG were removed laparoscopically for pathological confirmation by frozen section. If nodal metastasis was diagnosed, radical hysterectomy would be cancelled but enlarged lymph nodes were removed preferably by laparoscopic approach before closing the abdomen. These patients were treated with radiotherapy after recovering from the surgery. By comparing the laparoscopic USG and pathological findings of lymph nodes removed with or without radical hysterectomy, diagnostic accuracy of laparoscopic USG was determined. RESULTS Ninety-three patients were recruited and the final analysis included 90 patients. Laparoscopic USG found suspicious lymph nodes in 17 patients and nodal metastases were confirmed pathologically in 14 of them. Three patients with macroscopic and five patients with microscopic pelvic nodal metastases were missed by laparoscopic USG. The accuracy, sensitivity, specificity, positive and negative predictive value of laparoscopic USG in detecting pelvic lymph node metastasis were 87.8%, 63.6%, 95.6%, 82.4%, and 89%, respectively. Macroscopic metastatic nodes were successfully removed laparoscopically in 11 out of 14 patients and laparotomy was required for the other three patients. CONCLUSIONS Laparoscopic USG can be performed with no major morbidity. This technique is sensitive in detecting macroscopic but not microscopic metastatic pelvic lymph nodes. Removal of macroscopic metastatic nodes identified via laparoscopic USG via laparoscopic approach could be accomplished in majority of patients.
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Affiliation(s)
- T H Cheung
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hongkong, China.
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Chin KV, Selvanayagam ZE, Vittal R, Kita T, Kudoh K, Yang CS, Wong YF, Cheung TH, Yeo W, Chung TKH, Lin Y, Liao J, Shih JW, Yap SF, Lin AW. Application of expression genomics in drug development and genomic medicine. Drug Dev Res 2004. [DOI: 10.1002/ddr.10375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Ferber MJ, Thorland EC, Brink AATP, Rapp AK, Phillips LA, McGovern R, Gostout BS, Cheung TH, Chung TKH, Fu WY, Smith DI. Preferential integration of human papillomavirus type 18 near the c-myc locus in cervical carcinoma. Oncogene 2003; 22:7233-42. [PMID: 14562053 DOI: 10.1038/sj.onc.1207006] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The development of cervical cancer is highly associated with human papillomavirus (HPV) infection. Greater than 99% of all cervical tumors contain HPV DNA. Integration of high-risk HPV has been temporally associated with the acquisition of a malignant phenotype. Recent work from our lab has shown that HPV16, the most common high-risk HPV associated with cervical carcinoma, preferentially integrates at loci containing human common fragile sites (CFSs). CFSs are regions of genomic instability that have also been associated with deletions, translocations, and gene amplification during cancer development. The current work shows that HPV18, the second most prevalent high-risk HPV type found in cervical tumors, preferentially targets the CFSs. We identified 27 unique HPV18 integrations in cervical tumors, of which 63% (P<0.001) occur in CFSs. However, the distribution of HPV18 integrations found were profoundly different from those found for HPV16. Specifically, 30% of all HPV18 integrations occurred within the chromosomal band 8q24 near the c-myc proto-oncogene. None of the HPV16 integrations occurred in this region. Previous low-resolution mapping suggested that c-myc may be a target of HPV integration. Our data at nucleotide resolution confirm that in HPV18-positive cervical tumors, the region surrounding c-myc is indeed a hot spot of viral integration. These results demonstrate that CFSs are preferred sites of integration for HPV18 in cervical tumors. In addition, we have identified multiple cellular genes that have been disrupted by HPV18 integration in cervical tumors. Our results suggest that the sites of HPV18 integration are nonrandom and may play an important role in the development of cervical tumors.
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Affiliation(s)
- Matthew J Ferber
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
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Wong YF, Selvanayagam ZE, Wei N, Porter J, Vittal R, Hu R, Lin Y, Liao J, Shih JW, Cheung TH, Lo KWK, Yim SF, Yip SK, Ngong DT, Siu N, Chan LKY, Chan CS, Kong T, Kutlina E, McKinnon RD, Denhardt DT, Chin KV, Chung TKH. Expression genomics of cervical cancer: molecular classification and prediction of radiotherapy response by DNA microarray. Clin Cancer Res 2003; 9:5486-92. [PMID: 14654527] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
PURPOSE The incidence and mortality rates of cervical cancer are declining in the United States; however, worldwide, cervical cancer is still one of the leading causes of death in women, second only to breast cancer. This disparity is at least partially explained by the absence of or comparatively ineffective screening programs in the developing world. Recent advances in expression genomics have enabled the use of DNA microarray to profile gene expression of various cancers. These expression profiles may be suitable for molecular classification and prediction of disease outcome and treatment response. We envision that expression genomics applied in cervical cancer may provide a more rational approach to the classification and treatment of the disease. EXPERIMENTAL DESIGN In this report, we examined the expression profiles of cervical cancer compared with normal cervical tissues in DNA microarrays that contained approximately 11,000 features that correspond to either human transcripts with known function or anonymous expressed sequence tags. RESULTS Our results showed that normal cervical tissues were completely segregated from the cancer samples using about 40 genes whose expressions were significantly different between these specimens. In addition, clinical stage IB and stage IIB tumors could also be classified based on their signature expression patterns. Most importantly, some of the tumor samples were further stratified into two major groups based on their response to radiotherapy, and we were able to predict the response of these patients to radiotherapy from their expression profiles. CONCLUSIONS Gene expression profiling by DNA microarray may be used for further molecular classification of disease stages and prediction of treatment response in cervical cancer.
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Affiliation(s)
- Yick Fu Wong
- Department of Obstetrics and Gynecology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People's Republic of China
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Lo KWK, Cheung TH, Yu MY, Yim SF, Chung TKH. The value of pelvic and para-aortic lymphadenectomy in endometrial cancer to avoid unnecessary radiotherapy. Int J Gynecol Cancer 2003; 13:863-9. [PMID: 14675325 DOI: 10.1111/j.1525-1438.2003.13320.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [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: 11/29/2022] Open
Abstract
The case histories of 95 patients with endometrial carcinoma treated between July 1998 and December 2002 were reviewed. These patients were staged according to FIGO classification and included peritoneal cytology, total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAHBSO), and pelvic with or without para-aortic lymphadenectomy. The FIGO surgical stages were as follow: IA, 9 (9.5%); IB, 35 (36.8%); IC, 16 (16.8%); IIB, 10 (10.5%); IIIA, 5 (5.3%); IIIB, 1 (1.1%); IIIC, 19 (20.0%). In addition to TAHBSO, 47 (49.5%) patients had pelvic lymphadenectomy whereas 48 (50.5%) had both pelvic and para-aortic lymphadenectomy. Nineteen (20.0%) of 95 patients had nodal metastases. Positive pelvic and para-aortic lymph nodes were found in 15 (15.8%) of 95 and 12 (25.0%) of 48 patients, respectively. According to the result of the lymphadenectomy, 19 (20.0%) patients had their surgical stage upgraded to stage IIIC and 61 (64.2%) patients had a change in their management plan. Twelve (12.6%) patients required extended field irradiation due to para-aortic nodal metastases and 49 (51.6%) patients with negative nodes avoided postoperative external radiotherapy. By defining the lymphatic spread via surgical staging, postoperative radiotherapy can be recommended to patients with nodal metastases, while it can be withheld from those patients with negative nodes, irrespective of the presence of risk factors.
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Affiliation(s)
- K W K Lo
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, the Prince of Wales Hospital, Hong Kong SAR, China.
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Ferber MJ, Montoya DP, Yu C, Aderca I, McGee A, Thorland EC, Nagorney DM, Gostout BS, Burgart LJ, Boix L, Bruix J, McMahon BJ, Cheung TH, Chung TKH, Wong YF, Smith DI, Roberts LR. Integrations of the hepatitis B virus (HBV) and human papillomavirus (HPV) into the human telomerase reverse transcriptase (hTERT) gene in liver and cervical cancers. Oncogene 2003; 22:3813-20. [PMID: 12802289 DOI: 10.1038/sj.onc.1206528] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Chronic infections with the hepatitis B virus (HBV) and high-risk human papillomaviruses (HPVs) are important risk factors for hepatocellular carcinoma (HCC) and cervical cancer (CC), respectively. HBV and HPV are DNA viruses that almost invariably integrate into the host genome in invasive tumors. The viral integration sites occur throughout the genome, leading to the presumption that there are no preferred sites of integration. A number of viral integrations have been shown to occur within the vicinity of important cancer-related genes. In studies of HBV-induced HCC and HPV-induced CC, we have identified two HBV and three HPV integrations into the human telomerase reverse transcriptase (hTERT) gene. Detailed characterization of the integrations revealed that four integrations occurred within the hTERT promoter and upstream region and the fifth integration occurred in intron 3 of the hTERT gene. None of the integrations altered the hTERT coding sequence and all resulted in juxtaposition of viral enhancers near hTERT, with potential activation of hTERT expression. Our work supports the hypothesis that the sites of oncogenic viral integration are nonrandom and that genes at the sites of viral integration may play important roles in carcinogenesis.
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Affiliation(s)
- M J Ferber
- Division of Experimental Pathology, Mayo Clinic, Rochester, MN 55905, USA
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Wong YF, Cheung TH, Poon KY, Wang VW, Li JCB, Lo KWK, Yim SF, Yu MY, Lahr G, Chung TKH. The role of microsatellite instability in cervical intraepithelial neoplasia and squamous cell carcinoma of the cervix. Gynecol Oncol 2003; 89:434-9. [PMID: 12798708 DOI: 10.1016/s0090-8258(03)00134-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study was conducted to define the role of microsatellite instability (MSI) in cervical intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC) of the cervix. We also tested the validity of using markers recommended for MSI study in colonic carcinoma by the National Cancer Institute (NCI) for cervical neoplasm. METHODS Twenty normal cervical, 24 low-grade CIN (CIN-L), 59 high-grade CIN (CIN-H), and 93 SCC tissues were examined for MSI after microdissection. A polymerase chain reaction based MSI detection was performed using five markers recommended by the NCI for colonic cancer (panel one) as well as five other markers (panel two) found to be informative in earlier studies. High-frequency MSI (MSI-H) was defined as instability in > or = 2 of 5 loci if one panel was used and > or = 30% of loci when more than five loci were used. Low-frequency MSI (MSI-L) was diagnosed if instability was noted but did not meet the criteria of MSI-H. Findings were correlated with clinicopathologic information. RESULTS The combined use of panel one and two markers showed no MSI in normal cervical or CIN-L tissue, MSI-L in 1 CIN-H (1.7%), MSI-L in 16 (17.2%), and MSI-H in 11 (11.8%) SCC, respectively. The NCI-recommended panel alone detected 19 of 27 MSI-positive SCC. MSI-positive was not related to patient age, disease stage, and tumor grade. The overall survival of MSI-positive patients was significantly worse than that of microsatellite stable patients (P = 0.02). An increasing trend of MSI-H rate with higher disease stages was noted (P = 0.035) but MSI-H was not associated with poor prognosis. CONCLUSIONS The NCI recommended panel of markers might not be useful in MSI study for SCC and using more than five markers improves the MSI detection. MSI is rare in cervical dysplasia but is present in a subset of SCC. The association between MSI-positivity and prognosis awaits future confirmation.
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Affiliation(s)
- Yick Fu Wong
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong.
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Abstract
Intravenous leiomyomatosis (IVL) is a rare smooth muscle tumor. We report a case of IVL with atypical histologic features, which did not respond to gonadotropin-releasing hormone agonists and could be only partially resected due to adherence to the vessel wall. Atypical histology may signify more aggressive behavior. IVL should always be considered when a patient presents with both uterine leiomyoma and venous thrombosis, and a high index of suspicion is crucial for early diagnosis. An adequate surgical preparation including venous graft or prosthetic reconstruction is essential as difficulty in removal may arise if the intravascular tumor adheres to the vessel wall.
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Affiliation(s)
- P M Lam
- Departments of Obstetrics and Gynecology, the Chinese University of Hong Kong, the Prince of Wales Hospital, Hong Kong SAR, China.
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Chan PKS, Lam CW, Cheung TH, Li WWH, Lo KWK, Chan MYM, Cheung JLK, Xu LY, Cheng AF. Human papillomavirus type 16 intratypic variant infection and risk for cervical neoplasia in southern China. J Infect Dis 2002; 186:696-700. [PMID: 12195358 DOI: 10.1086/342048] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2002] [Revised: 04/19/2002] [Indexed: 11/03/2022] Open
Abstract
A case-control study was conducted on 1986 Hong Kong women to assess the risk of human papillomavirus (HPV) type 16 variants for cervical neoplasia. In total, 255 women were HPV-16 positive and were analyzed for E6 and E7 sequence variation. Two novel substitutions at E6 (T86I and Q116E) and 1 at E7 (R66W) were found. Most HPV-16 variants were of Asian (50.6%) or European (44.3%) lineage, and both lineages showed similar risk associations for high-grade and invasive cervical neoplasia. No increased risk was observed for the subclasses European variant and European 350G, which carry a higher risk for invasive cancer in some Western populations. The E7 N29S substitution, reported to have a higher risk in Korean women, was found equally distributed among normal and various degrees of neoplasia. The epidemiology and risk implication of HPV-16 variant infection in Hong Kong differ markedly from other parts of the world.
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Affiliation(s)
- Paul K S Chan
- Department of Microbiology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China.
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Lo KWK, Wong YF, Chan MKM, Li JCB, Poon JS, Wang VW, Zhu SN, Zhang TM, He ZG, Wu QL, Li GD, Tam JSL, Kahn T, Lam P, Cheung TH, Chung TKH. Prevalence of human papillomavirus in cervical cancer: a multicenter study in China. Int J Cancer 2002; 100:327-31. [PMID: 12115548 DOI: 10.1002/ijc.10506] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [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: 11/06/2022]
Abstract
A large-scale epidemiologic survey on the prevalence of different types of human papillomavirus (HPV) in cervical cancer in China is indicated because of the implications for the development of diagnostic probes and vaccines against cervical cancer. A total of 809 cervical cancer specimens were collected from 5 regions in China including Shanghai, Guangzhou, Sichuan, Beijing and Hong Kong. HPV DNA was detected in 83.7% of the specimens. HPV-16 was present in 79.6%, HPV-18 in 7.5%, HPV-52 in 2.6% and HPV-58 in 3.8% of all HPV-positive specimens. The prevalences of HPV-16 and HPV-18 in Hong Kong were 61.7 and 14.8%, respectively, representing a lower HPV-16 and a higher HPV-18 proportion compared with the other regions. HPV-16 remained the most common HPV infection in both squamous cell carcinoma (SCC) and adenocarcinoma (AC). The proportion of HPV-18 infection was significantly higher in AC than in SCC.
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Affiliation(s)
- Keith W K Lo
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, S.A.R. China.
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Abstract
Insufficient apoptosis is implicated in many human cancers, including cervical carcinoma. The objectives of this study were to explore changes of apoptosis-regulating gene expression and their clinical significance in cervical cancer. The expression of apoptosis-regulating genes, including five Bcl-2 family and two caspase family members, was evaluated in 43 cervical invasive squamous cell carcinomas, using immunohistochemistry. Specimens in which >or=10% of the neoplastic cells showed cytosolic immunoreactivity were considered to be immunopositive. Results were correlated with clinico-pathologic characteristics of the subjects. All seven apoptotic regulators examined were positive in a proportion of the tumors. The percentage of cases expressing Bax was higher in the patients without evidence of disease after treatment than in the patients alive with disease or who died of disease (P<0.05). A significant difference in disease-free survival was detected between Bax-positive and -negative groups (P<0.05), and in overall survival between Mcl-1-positive and -negative groups (P<0.05). Significant association between the seven markers tested was only found for caspase 3 and Bak immunoreactivity in cervical carcinoma (P<0.05). The results demonstrate expression of multiple apoptosis-modulating proteins in cervical cancer. There appears to be complex regulation of apoptosis protein levels in association with clinical behavior of cervical squamous cell carcinoma.
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Affiliation(s)
- T K H Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong
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