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ABSTRACT: OBJECTIVE: To identify independent prognostic variables for surgically staged intermediate risk endometrial carcinoma as defined by the Gynecologic Oncology Group 99 (GOG99) criteria. STUDY DESIGN: Retrospective study of 239 patients with FIGO stage IB-occult IIB endometrioid type endometrial cancer, who were primarily treated with comprehensive staging surgery. Data were collected on clinicopathological variables, extent of primary surgery, postoperative adjuvant treatment, and patterns of recurrences. Kaplan-Meier survival curves were used to estimate disease free survival (DFS) and overall survival (OS), and multivariate Cox regression models were used to identify independent prognostic variables. The median follow-up time was 67 months (range, 12-183 months). RESULTS: The 5-year DFS and OS were 91.0% and 93.0%, respectively. On univariate Kaplan-Meier analysis, age>60 years, deep myometrial invasion (MI), presence of lymph vascular invasion (LVSI), and negative progesterone receptor (PR) status were significantly associated with diminished 5-year DFS and OS. The univariate analysis on patterns of failures demonstrated that patients with older age or positive LVSI were more inclined to develop locoregional recurrence, while PR status and the depth of MI had a statistically significant impact on distant failure. On multivariate analysis, PR status, age, and the depth of MI were independent prognostic variables for 5-year DFS, and age was the only independent prognostic variable for 5-year OS. LVSI and age were independent prognostic variables for locoregional recurrence, while PR status and depth of MI were independent prognostic variables for distant recurrence. CONCLUSIONS: Age, depth of MI, PR status and presence of LVSI are of independent prognostic value for intermediate risk endometrial cancer. The presence of these variables warrants consideration when deciding upon treatment strategies.
European journal of obstetrics, gynecology, and reproductive biology 03/2013; · 1.97 Impact Factor
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ABSTRACT: To analyze the clinicopathologic characteristics, treatment and prognostic factors in malignant transformation of mature cystic teratoma (MCT) of ovary.
The clinical data of 44 patients with MCT from January 1961 to June 2009 were reviewed.
The median age of the 44 patients was 48 years (range, 16 - 84 years). Mean tumor size was (16 ± 6) cm. Thirty-two cases were diagnosed squamous cell carcinoma (73%, 32/44), and 5 of them with the elevated level of serumal squamous cell antigen (SCC-Ag). Three of 37 cases (8%, 3/37) were identified with malignant transformation in image examinations. Rapid frozen section examination and multiple-location biopsy were performed in 8 cases, and 5 of them were detected with malignant diseases. Twenty-two patients with disease confined within the unilateral ovary (10 with intact capsule, and 12 with ruptured capsule). Diseases extended extra ovaries in the others 22 patients. The median cumulative overall survivals were 126 and 10 months, respectively. The difference between the two groups was significant (P < 0.01). Twenty-seven patients had no residual tumor after primary surgery. The median cumulative overall survivals between the patients with and without residual tumor were 10 and 84 months respectively, and there were significant difference between two groups (P < 0.01). Seven selected patients with malignant disease confined within unilateral ovary underwent fertility-sparing surgery, and 2 cases of them had successful pregnancies and delivery, while other 4 cases with ruptured capsule recurred.
The most common pathology type of malignant transformation in mature cystic teratoma of the ovary is squamous cell carcinoma. Comprehensive pre-operation image examination and tumor marker level detection might be of great help in diagnosis. Tumor extension extraovary and residual tumor after surgery are the most significant poor prognostic factors. Early stage patient with ruptured capsule should be very discreet to choose fertility-sparing surgery.
Zhonghua fu chan ke za zhi 02/2013; 48(2):123-8.
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ABSTRACT: To analyze the clinical characteristics, diagnoses, treatments and prognoses of vaginal leiomyosarcoma (LMS).
The clinical and pathological recordings of 9 patients suffering from vaginal leiomyosarcoma from January 1973 to May 2011 were analyzed retrospectively.
The study group constituted 2.7% (9/330) of all the malignant vaginal tumor admitted to our hospital in the same period. The major clinical manifestations were asymptomatic vaginal mass (3/9), bellyache and vaginal bleeding (2/9), vaginal pain (2/9), and difficulty in defecation (1/9) and micturition (1/9). Preoperative diagnosis was highly unreliable. Based on the sample chose, the diagnosis were made in 3 cases by preliminary biopsy before undertaking surgery, while 6 cases were confirmed shortly after simple tumor excision or unexpected recurrence. All the patients were pathologically confirmed diagnosis by tumor resection specimen or biopsy, 5 cases of them were also confirmed by virtue of immunohistochemistry staining. All 9 patients, 8 cases received initial surgery, four of them patients received postoperative adjuvant chemotherapy or radiation therapy, the remaining 1 patients received initial chemotherapy and radiotherapy. Follow-up was performed for all the 9 patients, of which 3 cases were lost, the median follow-up time was 50 months (range 7 - 134). Four patients underwent local recurrence and adjacent organ metastases within two years, with 5 years survival rate 4/9.
Primary vaginal leiomyosarcoma is a rare and difficult to diagnose preoperatively tumor. In this regard, It is strongly recommend preoperative biopsy for definitive diagnosis and perform surgery as the principal approach, in conjunction with radiotherapy or chemotherapy when needed to improve survival.
Zhonghua fu chan ke za zhi 10/2012; 47(10):747-50.
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ABSTRACT: To analyze the clinical characteristics, influencing factors and outcome of recurrent patients with early stage bulky cervical carcinoma.
Between January 1(st) 2000 and December 31(st) 2009, 76 patients with stage Ib2 and IIa2 bulky cervical carcinoma developed recurrence and (or) metastasis. The recurrence time, recurrence location, recurrence-related factors, treatment and survival were analyzed.
The median follow up was 44 months (9-137 months). The overall recurrence and (or) metastasis rate was 22.6%. The 1-, 1-2, 3-5 and 5-year recurrence and (or) metastasis rates were 38.2%, 27.6%, 30.3% and 3.9%, respectively. The 5-year survival rate of local recurrence was 34.5%, that of distant metastasis was 23.6%, and that of distant metastasis with synchronous pelvic recurrence was 11.1%, (P = 0.555). The 5-year survival rate of patients who received surgery plus chemotherapy, radiation plus chemotherapy and chemotherapy alone after recurrence and (or) metastasis were 53.3%, 30.7% and 24.6%, respectively (P = 0.686). Univariate analysis demonstrated that tumor recurrence and (or) metastasis in patients of the stage Ib2 and IIa2 bulky cervical carcinoma were influenced by the disease stage, pelvic lymph node metastasis, deep cervical stromal invasion, lymphovascular tumor thrombus and pathological types. Multivariate regression analysis demonstrated that pelvic lymph node metastasis, lymphovascular tumor thrombus and pathological types were the key factors affecting the recurrence and (or) metastases of the stage Ib2 and IIa2 bulky cervical carcinoma. Subgroup analysis showed that pelvic lymph node metastasis and stage were the main factors affecting the local recurrence in those patients, and the pathological type, vascular tumor thrombus and pelvic lymph node metastasis were the main factors affecting the distant metastasis.
Recurrence and(or) metastasis of early stage bulky cervical cancer are mostly happened within 2 years post operation. Patients with pelvic lymph node metastasis have high probability to develop local recurrence and distant metastasis. Patients with non-squamous cell carcinoma and lymphovascular tumor thrombus are more likely to develop distant metastasis. Neoadjuvant chemotherapy does not decrease local recurrence and distant metastasis in patients with stage Ib2 and IIa2 bulky cervical carcinoma. Individualized treatment is advised for recurrent patients.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 05/2012; 34(5):378-81.
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ABSTRACT: Objective: To review our experience in diagnosis, pathology, treatment, and prognosis of extramammary Paget’s disease of the
vulva. Methods: Seven patients with vulvar Paget’s disease who were treated at the Cancer Hospital cAMS were retrospectively
reviewed for the period from 1960 to 2002. The symptoms, location of disease, pathology, mode of treatment and current status
of the patients were evaluated. Results: A total of seven women with Paget’s disease of the vulva were admitted to the Department
of Gynecologic of Oncology. The mean age was 67.3 years (range 54–81 years). Vulvar lesion and pruritus were the common symptoms
and it took average 3.4 years to confirm the diagnosis. All patients underwent surgery as initial treatment, vulvectomy was
performed for 2 patients and radical vulvectomy plus groin node dissection for 5 patients. Two patients had invasive disease
and four were associated with underlying adenocarcinoma. Five patients experienced recurrence, on average, 16.2 months after
the surgery. Four of them underwent radiotherapy or chemotherapy and the other received no further treatment. The mean follow-up
time was 41.1 months. Three patients, with invasive lesion or underlying adenocarcinoma were dead of the disease. Conclusion:
There is a delay in the diagnosis of vulvar Paget’s disease. The major treatment is surgery. Recurrence is relatively common.
Patients with invasive disease or underlying carcinoma have a poor prognosis.
Chinese Journal of Cancer Research 04/2012; 16(3):212-215. · 0.18 Impact Factor
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ABSTRACT: A theoretical study on the two-dimensional, three-dimensional quantitative structure-activity relationships and docking analysis of a novel series of ethynyl-3-quinolinecarbonitriles acting as Src inhibitors has been carried out. To correlate the c-Src kinase-inhibition activity of these compounds with the two-dimensional and three-dimensional structural properties for 39 known compounds, some excellent quantitative structure-activity relationships models with satisfying internal and external predictive abilities were established. A combined method of the density functional theory, molecular mechanics and statistics as well as the comparative molecular field analysis was applied to develop two-dimensional- and three-dimensional-quantitative structure-activity relationship models. The leave-one-out cross-validation q² values of two-dimensional-quantitative structure-activity relationship and comparative molecular field analysis models are 0.834 and 0.812, respectively. The predictive abilities of these models were further validated by the test set including 10 compounds, and the predicted IC₅₀ values were in a good agreement with the experimental ones. The appropriate binding orientations and conformations of these compounds interacting with c-Src kinase were also revealed by the docking study. Based on two-dimensional- and three-dimensional-quantitative structure-activity relationship results along with docking analysis, some important factors responsible for inhibitory activity of this series of compounds were discussed in detail. These factors can be summarized as follows: selecting certain large-size substituent R₂, increasing the negative charge of the first atom of substituent R₁ and the net charge of the C₁₅ atom on ring-C will enhance the activity. Meanwhile, the interaction information between protein and ligand was also revealed in detail. These results help to understand the action mechanism and designing novel potential Src inhibitors. Based on the established models and some designing considerations, three new compounds with rather high predicted Src-inhibitory activity have been theoretically designed and presented to experimenters for reference.
Chemical Biology & Drug Design 03/2012; 80(1):134-47. · 2.28 Impact Factor
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ABSTRACT: Radix Astragalus has been identified to exert beneficial effects in preventing postmenopausal bone loss. However, the active ingredients and mechanism of action remain unknown. In this study, we examined the effect of Astragaloside II (AST II), which is a monomer of Astragalus saponin, on the viability, proliferation, differentiation and maturation of rat primary osteoblasts, as well as its relevant molecular mechanism. We found that AST II exhibits a significant induction of proliferation, differentiation and mineralization in primary osteoblasts. AST II stimulates osteoblast differentiation at various stages, from early to late stage of differentiated osteoblasts. Furthermore, induction of differentiation by AST II is associated with increased expression of bone morphogenetic protein-2 (BMP-2), activation of Smad1/5/8, ERK1/2 and p38, and increased expression of core-binding factor 1 (Cbfa1)/Runx2. BMP antagonist (Noggin) blocks the effect of AST II on cell differentiation, and Smad1/5/8, p38, Cbfa1 expression, but only partly decreases ERK1/2 activation. This indicates that BMP-2 is essential in AST II-mediated osteoblast differentiation and Smad1/5/8, p38, Cbfa1 activation, and is partly involved in ERK1/2 activation. In conclusion, although in vivo studies are required in the future, as a phyto-saponin of Radix Astragalus, AST II may become a novel candidate that is beneficial for stimulating the osteoblastic activity resulting in bone formation, which has not been recognized and reported previously.
International Journal of Molecular Medicine 03/2012; 29(6):1090-8. · 1.98 Impact Factor
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ABSTRACT: The effect of different periods of lead exposure on deficits of learning and memory is still unclear. In this study, we conduct in vivo experiment to investigate the critical stages when lead induced neurotoxicity in rats and its underlying mechanisms in some critical stages. Rats were exposed to 0.2% mg/ml lead acetate solution via drinking water during gestation, lactation and ablactation periods. Behavior deficits were found in gestation and lactation. N-Methyl- d -aspartate (NMDA) receptor subunit 2A (NR2A) increased during gestation both in hippocampus and cerebral cortex compared to the control group; in all treatment groups NR2B decreased in hippocampus and in cerebral cortex during the lactation period. Meanwhile, in hippocampus metabotropic glutamate receptor 1 (mGluR1) decreased during gestation and lactation periods but increased during the ablactation period. These observations suggest that exposure to lead in gestation and lactation periods could cause neurobehavioral deficits which extend to adulthood, and lactation was a more sensitive period for lead exposure. Furthermore, the abnormal expression of NMDA receptor 2 (NMDAR 2) subunits and mGluR1 are likely to be associated with the impairment.
Toxicology and Industrial Health 02/2012; · 1.42 Impact Factor
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ABSTRACT: B3 domain-containing proteins constitute a large transcription factor superfamily. The plant-specific B3 superfamily consists of four family members, i.e., LAV (LEC2 [LEAFY COTYLEDON 2]/ABI3 [ABSCISIC ACID INSENSITIVE 3] − VAL [VP1/ABI3-LIKE]), RAV (RELATED to ABI3/VP1), ARF (AUXIN RESPONSE FACTOR) and REM (REPRODUCTIVE MERISTEM) families. The B3 superfamily plays a central role in plant life, from embryogenesis to seed maturation and dormancy. In previous research, we have characterized ARF family, member of the B3 superfamily in silico (Wang et al., Mol Biol Rep, 2011, doi:10.1007/s11033-011-0991-z). In this study, we systematically analyzed the diversity, phylogeny and evolution of B3 domain-containing proteins based on genomic resources of 11 sequenced species. A total of 865 B3 domain-containing genes were identified from 11 sequenced species through an iterative strategy. The number of B3 domain-containing genes varies not only between species but between gene families. B3 domain-containing genes are unevenly distributed in chromosomes and tend to cluster in the genome. Numerous combinations of B3 domains and their partner domains contribute to the sequences and structural diversification of the B3 superfamiy. Phylogenetic results showed that moss VAL proteins are related to LEC2/ABI3 instead of VAL proteins from higher plants. Lineage-specific expansion of ARF and REM proteins was observed. The REM family is the most diversified member among the B3 superfamily and experiences a rapid divergence during selective sweep. Based on structural and phylogenetic analysis results, two possible evolutional modes of the B3 superfamily were presented. Results presented here provide a resource for further characterization of the B3 superfamily.
Molecular Biology Reports 02/2012; 39(5):6267-82. · 2.93 Impact Factor
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Liang Xie,
Chenglong Luo,
Chengguang Zhang, Rong Zhang,
Jun Tang,
Qinghua Nie,
Li Ma,
Xiaoxiang Hu,
Ning Li,
Yang Da,
Xiquan Zhang
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ABSTRACT: Chicken growth traits are important economic traits in broilers. A large number of studies are available on finding genetic factors affecting chicken growth. However, most of these studies identified chromosome regions containing putative quantitative trait loci and finding causal mutations is still a challenge. In this genome-wide association study (GWAS), we identified a narrow 1.5 Mb region (173.5-175 Mb) of chicken (Gallus gallus) chromosome (GGA) 1 to be strongly associated with chicken growth using 47,678 SNPs and 489 F2 chickens. The growth traits included aggregate body weight (BW) at 0-90 d of age measured weekly, biweekly average daily gains (ADG) derived from weekly body weight, and breast muscle weight (BMW), leg muscle weight (LMW) and wing weight (WW) at 90 d of age. Five SNPs in the 1.5 Mb KPNA3-FOXO1A region at GGA1 had the highest significant effects for all growth traits in this study, including a SNP at 8.9 Kb upstream of FOXO1A for BW at 22-48 d and 70 d, a SNP at 1.9 Kb downstream of FOXO1A for WW, a SNP at 20.9 Kb downstream of ENSGALG00000022732 for ADG at 29-42 d, a SNP in INTS6 for BW at 90 d, and a SNP in KPNA3 for BMW and LMW. The 1.5 Mb KPNA3-FOXO1A region contained two microRNA genes that could bind to messenger ribonucleic acid (mRNA) of IGF1, FOXO1A and KPNA3. It was further indicated that the 1.5 Mb GGA1 region had the strongest effects on chicken growth during 22-42 d.
PLoS ONE 01/2012; 7(2):e30910. · 4.09 Impact Factor
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ABSTRACT: To analyze the changes of 2009 FIGO staging system compared with the 1988 FIGO staging system of endometrial carcinoma and evaluate the diagnostic value of MRI staging by the 2009 FIGO criteria.
A retrospective study was performed on 63 consecutive patients with pathologically confirmed endometrial carcinoma who were treated by surgery initially from January to December 2009. The diagnostic value of preoperative MRI by the 2009 FIGO staging system was compared with that using the 1988 FIGO system, respectively.
According to the 2009 FIGO staging system of endometrial carcinoma, stage Ia was defined as no or less than half myometrial invasion, which included stage Ia (confined to endometrium) and stage Ib (invasion less than half of the myometrium) of the 1988 FIGO staging system. Stage Ib assessed by the 2009 FIGO system was the same as the stage Ic of 1988 FIGO system, indicating the lesions more than half myometrial invasion. Endocervical glandular involvement only (stage IIa of 1988 FIGO system) was classified as stage I. Positive cytology of ascites (stage IIIa of 1988 FIGO system) was excluded by the 2009 FIGO criteria. Using the 1988 FIGO system, the accuracy of MRI for the evaluation of endometrial carcinoma of stage Ia, Ib, Ic, whole stage I, IIa, IIb, whole stage II, IIIa, IIIb, IIIc, whole stage III and IVb were 95.2%, 79.4%, 81.0%, 84.1%, 96.8%, 90.5%, 90.5%, 92.1%, 98.4%, 92.1%, 82.5%, and 98.4%, respectively, while using the 2009 FIGO system, the accuracy of MRI of stage Ia, Ib, whole stage I, II, IIIa, IIIb, IIIc, whole stage III and IVb were 88.9%, 81.0%, 88.9%, 92.1%, 98.4%, 98.4%, 92.1%, 88.9% and 98.4%, respectively.
The 2009 FIGO staging system is simplified on the basis of the 1988 FIGO system. It gives an improved accuracy of MRI in evaluating the stage I to III endometrial carcinoma.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 09/2011; 33(9):692-6.
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ABSTRACT: To investigate the efficacy and toxicity of neoadjuvant chemotherapy with paclitaxel and carboplatin or cisplatin for patients with locally advanced cervical cancer.
A total of 70 patients with locally advanced cervical cancer were treated with neoadjuvant chemotherapy with paclitaxel and carboplatin or cisplatin in our department from July 2007 to May 2010. The stage distribution among the patients included 45 stage IB2, 21 stage IIa, and 4 stage IIb. Of the 70 patients, 6 were G1, 26 were G2, 32 were G3, and the rest 6 patients were not histologically classified. Sixty-five patients had squamous cell carcinoma, 3 had adenocarcinoma, and 2 patients had adenosquamous cell carcinoma. The clinicopathological parameters were analyzed, and their impact on tumor response were investigated.
Of the 70 patients, 14 (20.0%) showed a complete response, 37 (52.9%) had a partial response to chemotherapy, making an overall response rate of 72.9%. Sixty-eight (95.7%) patients underwent surgery, and among them 12 (17.1%) pathological CR were identified. Eleven (16.2%) patients were found to have lymph node metastasis after surgery. Response rates of stage Ib2 and IIa patients were 73.7% and 52.3%, respectively, P<0.05. Patients with SCC exhibited a better response rate than patients with adenocarcinoma and adenosquamous cell carcinoma (73.8% vs. 60.0%). Initial tumor volume, histological classification and cycles of neoadjuvant chemotherapy were not significantly correlated with the response rate.
Paclitaxel and carboplatin or cisplatin regimen is a promising therapy with definite short-term efficacy, can improve the resection rate with tolerable side effects, and is an applicable option of treatment for patients with locally advanced cervical cancer in the neoadjuvant setting.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 08/2011; 33(8):616-20.
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ABSTRACT: In order to simplify the complicated procedure of nerve-sparing radical hysterectomy, a novel technique characterized by integral preservation of the autonomic nerve plane has been employed for invasive cervical cancer. The objective of this study was to introduce the nerve plane-sparing radical hysterectomy technique and compare its efficacy and safety with that of nerve-sparing radical hysterectomy.
From September 2006 to August 2010, 73 consecutive patients with International Federation of Gynecology and Obstetrics stage IB to IIA cervical cancer underwent radical hysterectomy with two different nerve-sparing approaches. Nerve-sparing radical hysterectomy was performed for the first 16 patients (nerve-sparing radical hysterectomy group). The detailed autonomic nerve structures were identified and separated by meticulous dissection during this procedure. After January 2008, the nerve plane-sparing radical hysterectomy procedure was developed and performed for the next 57 patients (nerve plane-sparing radical hysterectomy group). During this modified procedure, the nerve plane (meso-ureter and its extension) containing most of the autonomic nerve structures was integrally preserved. The patients' clinicopathologic characteristics, surgical parameters, and outcomes of postoperative bladder function were compared between the two groups.
There were no significant differences between the nerve plane-sparing radical hysterectomy and nerve-sparing radical hysterectomy groups regarding age, International Federation of Gynecology and Obstetrics stage, pathological type, preoperative treatment, or need for intraoperative blood transfusion. The nerve plane-sparing radical hysterectomy group had a higher body mass index than that of the nerve-sparing radical hysterectomy group (P = 0.028). The mean surgical duration in the nerve plane-sparing radical hysterectomy and nerve-sparing radical hysterectomy groups were (262 ± 46) minutes and (341 ± 36) minutes (P < 0.01). On the 8th postoperative day, 41 (71.9%) patients in the nerve plane-sparing radical hysterectomy group and nine (56.3%) patients in the nerve-sparing radical hysterectomy group had a postvoid residual urine volume of < 100 ml (P = 0.233). The median duration of catheterization was eight days (range 8 - 23 days) for the nerve plane-sparing radical hysterectomy group and eight days (range 8 - 22 days) for the nerve-sparing radical hysterectomy group (P = 0.509). Neither surgery-related injury nor pathologically positive margins were reported in either group.
Nerve plane-sparing radical hysterectomy is a reproducible and simplified modification of nerve-sparing radical hysterectomy, and may be preferable to nerve-sparing radical hysterectomy for treatment of early-stage invasive cervical cancer.
Chinese medical journal 06/2011; 124(12):1807-12. · 0.86 Impact Factor
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ABSTRACT: To evaluate the results of surgical treatment for central recurrence or persistent local lesion of uterine cervical carcinoma following full-dose radiotherapy.
Forty-seven patients were diagnosed having central recurrence or persistent local lesion of uterine cervical carcinoma following full-dose radiotherapy. The patients were treated surgically: extrafascial hysterectomy was performed in 37 cases, radical hysterectomy in 7, and modified radical hysterectomy in 3. Their clinicopathological features were retrospectively reviewed.
Central recurrence or persistent local lesion was confirmed by pathology in 36 patients, while negative in 11. For patients receiving extrafascial hysterectomy, the median survival time and 5-year survival rate were 22 months and 40.4%, while for radical hysterectomy corresponding figures were 26 months and 40.0%. The mean operation time for the extrafascial hysterectomy and the radical or modified hysterectomy was 2.5 and 3.8 hours, respectively. The mean blood loss was 272.1 and 610.0 ml, respectively. The postoperative morbidity was 21.6% for extrafascial hysterectomy and 70.0% for radical or modified hysterectomy (P = 0.007).
For some patients with central recurrence or persistent local lesion of uterine cervical carcinoma following full-dose radiotherapy, surgical intervention may achieve long time survival. Extrafascial hysterectomy is a feasible and effective treatment for some selected patients.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 01/2010; 32(1):52-5.
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ABSTRACT: To evaluate the feasibility of sentinel lymph node biopsy (SLNB) in patients with vulvar cancer.
Twenty-one patients with vulvar squamous cancer undergoing radical surgery admitted in Cancer Hospital of Chinese Academy of Medical Sciences from Oct. 2004 to Apr. 2008, were enrolled in the study. SLNB procedure was performed with blue dye alone in the first eleven patients, while the later ten patients, a combination procedure with radioactive tracer and blue dye was used to detect sentinel lymph node (SLN). All resected nodes were submitted to the pathological examination, which was considered as the gold standard to determine the efficacy of SLNB. The complications related to SLNB were also observed during the study.
The sentinel node was identified in 20 patients (95%), included 8 cases with unilateral SLNs and 12 cases with bilateral SLN. A total of 83 SLN were identified with a mean number of 4.2 per patient (range, 1 - 9) or 2.6 per groin (range, 1 - 6). Difference between the mean number of SLN (4.4 per patient, 2.5 per groin) identified by blue dye or by combined procedure (3.9 per patient, 2.7 per groin) was not statistically significant (t = 0.459, P = 0.652;t = -0.421, P = 0.717). Twenty patients were detected to positively superficial inguinal SLN and one of them also positively bilateral deep femoral SLN, 8 (10 groins) of them were detected positively nodal metastases. Among of eight patients, 7 (9 groins) of them were detected more than one SLN involved, while 1 of them were detected false-negative node involved. The false negative rate of was 10% (1/10), negative predictive value was 96% (22/23). No complications were attributed to the study.
SLNB procedure in vulvar cancer is feasible and safe. SLN identification appears to be highly accurate for detecting metastases in the ipsilateral inguinal lymphatic basins.
Zhonghua fu chan ke za zhi 06/2009; 44(5):364-8.
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ABSTRACT: To investigate the clinical features, treatment outcomes and possible prognostic factors in elderly patients with cervical cancer.
Clinical data of 215 elderly women (> or = 65-years-old) with cervical cancer were retrospectively analyzed. Most patients (89.3%) had advanced stage ( II b-IV) disease. Eight of the 215 patients (3.7%) underwent surgical treatment, and six of those received postoperative radiotherapy. 133 patients received radiotherapy alone, and 74 patients underwent concurrent chemotherapy and radiotherapy.
The median follow-up time was 48 months (range: 12-102 months). The overall 5-year survival rate was 63.7%. The 5-year survival rate for stage I, II, III, IV were 83.2%, 76.4%, 39.0% and 0, respectively. There was no significant difference in 5-year survival rate between patients treated with concurrent chemotherapy combined with radiotherapy and radiotherapy alone. In multivariate analysis, lymph node metastasis, advanced stage, non-squamous histologies and poor differentiation were all negative prognostic factors for the overall survival.
The treatment strategy for elderly cervical cancer patients should be individually planned according to the disease stage and performance status of the patients. Usually, one radical therapy modality can be chosen, and combined modality therapy is not suggested.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 05/2009; 31(5):388-91.
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ABSTRACT: To explore the clinical-pathologic characteristics, treatment modalities and prognosis of patients with vaginal intraepithelial neoplasia (VAIN).
The clinical, pathologic and follow-up data of 20 cases with vaginal intraepithelial neoplasia treated primarily in Cancer Hospital of Chinese Academy of Medical Sciences from Jan. 1999 to Dec. 2007, were reviewed and analyzed retrospectively.
There were not any of symptoms on diagnosis in all patients, and most of them (17 cases, 85%) were frequently detected VAIN for the abnormal pap smears or pelvic examination from cervical carcinoma patients and under the colposcopy as well as colposcopic biopsies. There were 3 cases (15%) with cervical cancer were diagnosed as VAIN during the postoperative follow up, while 17 cases (85%) of patients were accompanied with cervical cancer (12 cases) or cervical intraepithelial neoplasia (CIN, 5 cases) concomitantly or antecedently. Ninety percent of patients were diagnosed as VAIN III, 17 cases (85%) were mainly localized in the upper third of vagina, and 13 cases (65%) affected to the multiple vaginal walls. Thirteen cases were performed surgery, and 7 cases were treated by irradiation. The local control rate was achieved to 100% in all of patients. Three cases (included 1 post-irradiated and 2 post-operative) were relapsed after treatment, but still be controlled completely by radiotherapy or surgery.
VAIN was difficult to be diagnosed independently, which was frequently accompanied by cervical cancer or CIN, significantly localized in the upper third of vagina involving the multiple walls of vagina, and treated synchronously with cervical carcinoma and CIN accompanying. Surgery and radiotherapy was equally effective to control VAIN, and then follow-up post-treatment should be closely to detect, diagnose and treat recurrent VAIN as soon as possible after treatment.
Zhonghua fu chan ke za zhi 05/2009; 44(4):277-80.
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ABSTRACT: To assess the nerve-sparing radical hysterectomy (NSRH) technique and its impact on postoperative voiding function.
Forty-four patients with International Federation of Gynecology and Obstetrics (FIGO) stage I b1-IIa cervical cancer were enrolled and randomized into NSRH group (study group, n = 22) and conventional radical hysterectomy (CRH) group (control group, n = 22). The pelvic autonomic nerve pathway (including hypogastric nerve, pelvic splanchnic nerve, inferior hypogastric plexus and bladder branch) was completely preserved in the NSRH group. Related parameters were compared between the two groups.
The estimated blood loss in NSRH group and CRH group were (550 +/- 241) ml and (475 +/- 284) ml, respectively, with no significant difference (P > 0.05). The mean operation time in NSRH group and CRH group were (329 +/- 43) min and (272 +/- 56) min, respectively, with a significant difference (P < 0.01). More patients in NSRH group had post-void residual urine volume (PVR) < 100 ml than that in CRH group on day 8 after surgery (68% vs. 18%, P < 0.01). The median duration of postoperative catheterization was significantly shorter in NRSH group (8 - 23 days, median 8 days) than that in CRH group (8 - 32 days, median 20 days; P < 0.01). Neither surgery-related injury nor pathologically positive margin was reported in either of the groups.
NSRH is a feasible and safe technique for preserving bladder function. Larger prospective studies are needed to confirm the efficacy of this technique.
Zhonghua fu chan ke za zhi 08/2008; 43(8):606-10.
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ABSTRACT: To investigate the clinicopathologic characteristics, therapy and prognostic factors of small cell carcinoma of the cervix.
Clinical and pathological data of eight patients were analyzed retrospectively.
Eight patients all presented with symptoms of abnormal vaginal bleeding or postcoital spotting. One patient had stage I b1 disease, 2 had stage I b2 disease, 2 had stage II b disease and 3 had stage III b disease. Histopathologic findings showed the small tumor cells had scant cytoplasm, round nuclei, absence of nucleoli, and finely dispersed chromatin. Immunohistochemical findings were positive in 7 cases for neuron-specific enolase. Three patients with stage I b disease and 1 patient with stage III b disease underwent radical hysterectomy and postoperative chemotherapy, with or without radiotherapy, and the survival period was 64, 22, 14 and 6 months respectively. Two patients with stage II b disease and 2 with stage III b disease underwent chemotherapy and radiotherapy, and the survival period was 25, 9, 10 and 5 months respectively.
Immunohistochemical analysis using several kinds of neuroendocrine markers is helpful in establishing the correct diagnosis in addition to focusing on characteristic histopathological features. It is necessary to use comprehensive treatment including surgery, chemotherapy and radiotherapy for patients with small cell carcinoma of the cervix. Chemotherapy may play an important role in the treatment.
Zhonghua fu chan ke za zhi 04/2008; 43(3):189-92.
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ABSTRACT: To investigate the clinical significance and management of ASCUS/LSIL.
254 patients who were examined with cervical cytology in the Cancer Institute and Hospital Chinese Academy of Medical Sciences were ASCUS/LSIL, of whom 136 cases underwent colposcopy, Data were analyzed retrospectively according to the golden criterion of pathology outcome.
140 cases were ASCUS, and 114 cases were LSIL. Cervical intra-epithelial neoplasia (CIN) were diagnosed in 51.5% of patients with ASCUS, compared with 59.6% of patients with LSIL (P>0.05). High-grade cervical intraepithelial neoplasia were diagnosed in 22.9% of patients with ASCUS, compared with 30.7% of patients with LSIL (P >0.05). In the 136 patients examined with colposcopy, inflammation was found in 47 cases, low-grade intraepithelial lesion in 53 cases, High-grade intraepithelial lesion in 36 cases. The pathological results show inflammation in 55 cases, low-grade intraepithelial lesion in 41 cases, High-grade intraepithelial lesion in 40 cases (Kappa=0.314, U=0.064, P less than 0.05). CIN were diagnosed in 79% (67/84) of HPV-positive patients identified by pathology, compared with 43.5% (74/170) of HPV-negative patients (chi2=29.88 P less than 0.05). 83.5% of 254 patients were between 35 to 55 years old, and that was consistent with HPV-positive women age peak.
Patients with ASCUS should be paid the same attention with LSIL patients and colposcopy examination should be done immediately to avoid missed diagnosis and missed follow-up examination, especially for HPV positive patients between 35 to 55 years old.
Zhonghua shi yan he lin chuang bing du xue za zhi = Zhonghua shiyan he linchuang bingduxue zazhi = Chinese journal of experimental and clinical virology 09/2007; 21(3):267-9.
