Xiaohua Wu

Fudan University, Shanghai, Shanghai Shi, China

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Publications (36)133.46 Total impact

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    Zheng Feng · Hao Wen · Rui Bi · Yachen Duan · Wentao Yang · Xiaohua Wu
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    ABSTRACT: Background Over 20 % of ovarian cancer patients have preoperative thrombocytosis or hyperfibrinogenemia. We aimed to demonstrate the clinical and prognostic significance of thrombocytosis and hyperfibrinogenemia in high-grade serous ovarian cancer (HGSC). Methods We retrospectively investigated HGSC patients who underwent primary staging or debulking surgery between April 2005 and June 2013 in our institution. None of these patients had received neoadjuvant chemotherapy. Data, including age, performance status, FIGO stage, serum CA125, platelet count, fibrinogen level, and surgical residual disease, were collected. Thrombocytosis was defined as a platelet count greater than 450 × 109/L, and hyperfibrinogenemia was defined as a fibrinogen level higher than 4.00 g/L. Progression-free survival (PFS) and overall survival (OS) were analyzed with the Kaplan-Meier method and log-rank tests for univariate analyses. For the multivariate analyses, Cox regression analysis was used to evaluate the effects of the prognostic factors, which are expressed as hazard ratios (HRs). Results A total of 875 consecutive HGSC patients were identified. The median follow-up time was 29 (1–115) months. The median (interquartile range, IQR) preoperative platelet count was 301 (235–383) × 109/L, and 121 (13.8 %) women had thrombocytosis. The median (IQR) preoperative fibrinogen level was 3.85 (3.19–4.45) g/L, and 332 (45.9 %) of the patients had hyperfibrinogenemia. Both preoperative thrombocytosis and hyperfibrinogenemia were associated with an advanced FIGO stage (p = 0.008 and <0.001, respectively), an increased CA125 level (p = 0.004 and 0.001, respectively), more extensive ascites (p < 0.001 and <0.001, respectively), more extensive residual disease (p < 0.001 and <0.001, respectively) and chemosensitivity (p = 0.043 and <0.001, respectively). In the univariate analyses, hyperfibrinogenemia was associated with reduced PFS (p < 0.001) and OS (p < 0.001). However, thrombocytosis was not found to be a potential predictor of PFS (P = 0.098) or OS (p = 0.894). In the multivariate analyses, hyperfibrinogenemia was an independent predictor of OS (p = 0.014) but not PFS (p = 0.062). Conclusion Preoperative thrombocytosis and hyperfibrinogenemia reflected tumor burden to some extent and thus influenced treatment outcomes, and the fibrinogen level was found to be useful as a prognostic predictor in the HGSC patients.
    Preview · Article · Dec 2016 · BMC Cancer
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    ABSTRACT: Objective: The adjuvant treatment of high-risk endometrial cancer (HREC) remains controversial. This prospective phase-II clinical trial was conducted to evaluate the adjuvant concurrent chemoradiotherapy followed by chemotherapy in patients with HREC. Methods: Altogether 122 patients were enrolled between January 2007 and January 2013, in which 112 were analyzable. The inclusion criteria included endometrioid endometrial cancer of histological grade 3 and with greater than 50% myometrial invasion, cervical stromal invasion, pelvic and/or para-aortic lymph node metastases; non-endometrioid endometrial cancer; no residual disease and distant metastases. Pelvic radiation was administered with cisplatin on days 1 and 28. Para-aortic radiation was administered with confirmed para-aortic lymph node metastases, and vaginal afterloading brachytherapy with cervical stromal invasion after total hysterectomy. Four courses of paclitaxel and carboplatin (PC) or cisplatin, cyclophosphamide and epirubicin (CEP) were administered at three-week interval after radiation. Results: Ninety-six patients (85.7%) completed the planned treatment. Treatment discontinuation was the result of toxicity (5/112, 4.5%), disease progression (8/112, 7.1%), and patients refusal (3/112, 2.7%). There was no life-threatening toxicity. Twenty-five (22.3%) patients recurred, in which 4 cases recurred in the field of radiation, and 13 (11.6%) patients died of endometrial cancer during follow-up. The estimated five-year progression-free survival and overall survival were 73% and 84%, respectively. Adverse effects were less common in patients who received PC than CEP (p=0.001). Conclusions: This regimen demonstrated acceptable toxicity and good survival outcomes despite a preponderance (62.5%) of late stage disease. PC showed less adverse effects than CEP. A well designed randomized trial is under development. CLINICAL TRIAL ID: https://clinicaltrials.gov/: 070148-7.
    No preview · Article · Nov 2015 · Gynecologic Oncology
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    ABSTRACT: The aim of this study was to evaluate the clinicopathological and prognostic relevance of PIK3CA mutations in Chinese patients with surgically resected cervical cancer. PIK3CA mutations were screened in 771 cervical cancer specimens using reverse transcription polymerase chain reaction and Sanger sequencing. In total, 13.6% (105 of 771) of patients harbored non-synonymous PIK3CA mutations. Patients harboring PIK3CA mutations were older than patients with wild-type PIK3CA (mean age: 50.7 years vs. 47.0 years, P < 0.01). PIK3CA mutations were more commonly observed in postmenopausal patients than in premenopausal patients (19.6% vs. 10.2%, P < 0.01). PIK3CA mutations were more common in squamous cell carcinomas than in non-squamous cell tumors (15.3% vs 7.3%, of P < 0.01). The 3-year relapse-free survival was 90.2% for PIK3CA mutant patients and 80.9% for PIK3CA wild-type patients (P = 0.03). PIK3CA mutation was confirmed as an independent predictor for better treatment outcome in the multivariate analyses (HR = 0.54, 95% CI: 0.29-0.99, P = 0.048). PIK3CA mutations were significantly associated with less distant metastases (mutant-type: 8/105, wild-type: 98/666, p = 0.048). Thus, patients with mutant PIK3CA had distinct characteristics in age, menopausal status, and histological subtype and have better treatment outcome and less distant metastasis after surgery-based multimodal therapy.
    Preview · Article · Sep 2015 · Scientific Reports
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    ABSTRACT: This study assessed the performance of a novel flow cytometry (FCM) cervical cancer screening system compared with human papillomavirus (HPV) Hybrid Capture 2 (HC2). Chinese women aged 20years or older were enrolled in this study at Fudan University Shanghai Cancer Center. All participants underwent cytology/pathology testing (gold standard), HPV HC2 testing and FCM testing involving analysis of cell proliferation index (CPIx). Among 437 women enrolled in this study, 185 women (42.3%) were diagnosed as "gold standard positive" by pathology with diseases including cervical intraepithelial neoplasia (CIN) grade 2 (n=11), CIN3 (n=41), squamous cell carcinoma (SCC; n=115), adenocarcinoma in situ (n=2) and adenocarcinoma (n=16). The remaining 252 cases were deemed "gold standard negative". The sensitivity was 87.6% (95% CI, 82.8-92.3) for FCM testing and 89.7% (95% CI, 85.4-94.1; p=0.5121) for HPV HC2 testing. The specificity of FCM testing was 90.5% (95% CI, 86.2-94.7), which was superior to the specificity of HPV HC2 testing (84.5%, 95% CI, 79.3-89.7; p=0.04). In the 20-29 years old group, the sensitivity and the specificity of FCM testing were 90.0% (95% CI, 71.4-100.0) and 92.9% (95% CI, 76.9-100.0), respectively. The FCM testing CPIx statistically increased with the transition from normal cervical specimens to SCC specimens. Our results showed that the FCM screening system had high sensitivity and specificity for women of various ages. The FCM CPIx was able to evaluate the severity of disease quantitatively. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Jul 2015 · Gynecologic Oncology
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    ABSTRACT: The aim of the present study was to evaluate the incidences of margin involvement, disease relapse, and complications in patients who had undergone conization using an electrosurgical knife (EKC) for cervical intraepithelial neoplasia (CIN) or microinvasive carcinomas (micro-CAs). A retrospective case series analysis was performed with a total of 1359 patients who underwent EKC in Fudan University Shanghai Cancer Center between June 2004 and July 2010. The median age of the patients was 39 years old (range: 19-72). Conization revealed the presence of CIN in 1113 (81.9%) patients, micro-CA in 72 (5.3%) patients and invasive carcinomas in 44 (3.2%) patients. The remaining 130 (9.6%) patients were free of diseases in the cone specimens. Positive surgical margins, or endocervical curettages (ECCs) were found in 90 (7.6%) patients with CINs or micro-CAs. Three factors were associated with positive margins and ECCs and included age (>50 years; odds ratio (OR), 3.0, P<0.01), postmenopausal status (OR, 3.1, P<0.01) and microinvasive disease (OR, 2.7, P<0.01). One thousand and eighty-nine (92.0%) patients were followed-up regularly for a median follow-up duration of 46 months (range: 24-106 months). Disease relapse was documented in 50 (4.6%) patients. Eighty-two (6.0%) cases experienced surgical complications that needed to be addressed, including early or late hemorrhages, infections, cervical stenosis, etc. Our patients demonstrated that EKC was an alternative technique for diagnosis and treatment of CIN or micro-CAs with relatively low rate of recurrence and acceptable rate of complications. A randomized clinical trial is warranted to compare EKC, CKC and LEEP in the management of CIN or micro-CA.
    Preview · Article · Jul 2015 · PLoS ONE
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    Xiaoqi Li · Jin Li · Xiaohua Wu
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    ABSTRACT: Cervical stenosis is a major and specific postoperative complication following radical trachelectomy. The current article presents a review of studies describing the incidence, risk factors and treatment methods of cervical stenosis after this fertility sparing procedure. We searched PubMed, MEDLINE, Embase (January 1994 through November 2014) using the following terms: uterine cervix neoplasms, cervical cancer, radical trachelectomy, fertility sparing and fertility preservation. We included original articles and case series. Case reports, review articles, articles not in English and articles not mentioning cervical stenosis were all excluded. We identified 1547 patients. The incidence rates of cervical stenosis ranged from 0% to 73.3% with an average rate of 10.5%. Among patients with abdominal, vaginal, laparoscopic and robotic radical trachelectomy, the incidences of cervical stenosis were 11.0%, 8.1%, 9.3% and 0%, respectively. In patients in whom whether cerclage was placed or not, the incidence rates of cervical stenosis were 8.6% and 3.0%, respectively (P=NS). Among those in whom whether anti-stenosis tools were placed or not, the incidences of cervical stenosis were 4.6% and 12.7%, respectively (P<0.001). Cervical stenosis was a potential cause of infertility and increased the use of artificial reproductive technology. Surgical dilatation resolved stenosis in the majority of cases but had to be repeated. Cervical stenosis is related to the surgical approach, cerclage and anti-stenosis tools utilised. It affects not only the quality of life but also obstetrical outcomes of patients following radical trachelectomy. Greater attention should be given to the prevention and treatment of this complication. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Preview · Article · Jun 2015 · European journal of cancer (Oxford, England: 1990)
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    Zhong Zheng · Bingya Liu · Xiaohua Wu
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    ABSTRACT: Multidrug resistance (MDR) is a major clinical obstacle in treatment of gastric cancer. Previously, using 2D electrophoresis-mass spectrometry, we identified RhoGDI2 as a contributor to 5-FU resistance in colon cancer cells, and also confer gastric cancer cells resistance to 5-FU. Here, we reported RhoGDI2 also induced MDR in gastric cancer cell line (MKN-45). To explore the underlining mechanism, we detected the mRNA, protein expression, activity of P-glycoprotein (P-gp) in MKN-45 stably transfected with RhoGDI2 expressing or control vector. All the mRNA, protein level, activity were increased by 130%, 230%, 35% respectively after ectopic expression of RhoGDI2. RhoGDI2 was correlated with P-gp expression in gastric cancer tissues as detected by immunohistochemistry. To further study how RhoGDI2 up-regulates P-gp expression, we tested the activity of Rac1 in MKN-45/RhoGDI2 and MKN-45/GFP. Ectopic expression of RhoGDI2 increased Rac1 activity (P < 0.05). For more important, silencing of Rac1 expression by siRNA decreased P-gp expression to undetectable level. Overall, these findings suggest that RhoGDI2 up-regulates P-gp expression via Rac1 to induce MDR. Electronic supplementary material The online version of this article (doi:10.1186/s12935-015-0190-4) contains supplementary material, which is available to authorized users.
    Preview · Article · Apr 2015 · Cancer Cell International
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    ABSTRACT: A new FIGO staging system for vulvar cancer was issued in 2009. The aim of this study was to identify its value in estimating the outcome of patients with vulvar squamous cell carcinoma (VSCC) in the Chinese population. A total of 184 patients who underwent radical surgery for VSCC were recruited. Their medical records and pathology slides were reviewed. Disease reclassification was conducted according to the FIGO staging system (2009). The primary outcomes were cause-specific survival (CSS), relapse-free survival (RFS) and overall survival (OS). A total of 76 patients (41.3%) were downstaged and no patients were upstaged in the new FIGO staging system (2009). The stage distribution was as follows: stage I (99), stage II (13), stage III (65) and stage IV (7). According to CSS, the patients were classified into 4 groups: stage IA (group 1), stage IB/II/IIIA (group 2), stage IIIB (group 3), and stage IIIC/IV (group 4) (5-year CSS: 100%, 85%, 34.6% and 0%, respectively). The 5-year CSS was similar among the patients with stage IB, II and IIIA carcinomas (84.4%, 84.6% and 84.8%, respectively, p=0.986), whereas, significant decline of the CSS was found with increased substages of stages IIIA, IIIB and IIIC (84.8%, 34.6%, and 0 respectively, p<0.001). The 2009 FIGO staging system for VSCC displayed good performance for the subdivisions of stage III VSCC, but it failed to stratify survival well between stages IB, II and IIIA. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Mar 2015 · Gynecologic Oncology
  • Dandan Zhang · Huijuan Ge · Jin Li · Xiaohua Wu
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    ABSTRACT: The aim of this study was to introduce a new method of assuring surgical margins for abdominal radical trachelectomy (ART) and report our experience using the method. We combined transverse and perpendicular sections to assess surgical margins of specimens from RT. All surgeries from 1st August 2012 to 1st October 2013 were performed by one surgeon. The frozen section (FS) was consistently performed by a group of gynaecologic pathologists according to the detailed protocol described in this article. All cases were prepared by the same pathologist, and the slides were reviewed by two pathologists. There were 53 patients treated using the new method in our institution. The patient ages ranged from 20 to 41years old (median 32). The surgeries were performed for clinical stage IA (n=11) with LVSI and IB (n=42) tumours (40 squamous cell carcinoma, 11 adenocarcinoma, two adenosquamous and two others). In 20 (37.74%) cases, no residual tumour of the ART specimen on frozen section was observed in the specimens as it was cleared by the preceding loop electrical excision procedure (LEEP) or conization. The margins were initially reported as negative in 45 cases and positive in nine cases. In those nine cases, a second slice of cervix was removed and negative in six cases and positive again in two cases, the other one with positive nodes. The results of frozen sections were concordant with the final paraffin-embedded sections. There were no false negative intraoperative assessments. There were no recurrences after a median follow-up of 15.4months (range, 6-21months). Combining transverse and perpendicular sections to assess surgical margins of specimens from RT makes the protocol simple, reliable and produces accurate results. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Feb 2015 · European Journal of Cancer
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    ABSTRACT: Polymorphisms in Caspase-7 (CASP7) may modulate the programmed cell death and thus contribute to cervical cancer risk. In this case-control study of 1,486 cervical cancer cases and 1,301 controls, we investigated associations between four potentially functional polymorphisms in CASP7 and cervical cancer risk and evaluated their locus-locus interaction effects on the risk. The genotype-phenotype correlation was performed by a generalized linear regression model. We found that the rs4353229 polymorphism was associated with cervical cancer risk (under a recessive model: crude OR=1.20, 95% CI=1.02-1.40). Compared with the TT genotype, the rs10787498GT genotype was associated with an increased cervical cancer risk (adjusted OR=1.19, 95% CI=1.00-1.41). Combination analysis showed that subjects with four putative risk genotypes had a 1.54-fold increased cancer risk, compared with those who carried three or less putative risk genotypes. We also observed significant locus-locus joint effects on the risk, which may be mediated by the polymorphisms regulating CASP7 mRNA expression. Subsequent multifactor dimensionality reduction and classification and regression tree analyses indicated that the CASP7 genotypes might have a locus-locus interaction effect that modulated cervical cancer risk. Out data suggest that CASP7 polymorphisms may interact to modify cervical cancer risk by a possible mechanism of regulating CASP7 mRNA expression.
    Full-text · Article · Feb 2015 · Scientific Reports
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    ABSTRACT: Mutations in 16 targetable oncogenic genes were examined using reverse transcription polymerase chain reaction (RT-PCR) and direct sequencing in 285 Chinese cervical cancers. Their clinicopathological relevance and prognostic significance was assessed. Ninety-two nonsynonymous somatic mutations were identified in 29.8% of the cancers. The mutation rates were as follows: PIK3CA (12.3%), KRAS (5.3%), HER2 (4.2%), FGFR3-TACC3 fusions (3.9%), PTEN (2.8%), FGFR2 (1.8%), FGFR3 (0.7%), NRAS (0.7%), HRAS (0.4%) and EGFR (0.4%). No mutations were detected in AKT1 or BRAF, and the fusions FGFR1-TACC1, EML4-ALK, CCDC6-RET and KIF5B-RET were not found in any of the cancers. RTK and RAS mutations were more common in non-squamous carcinomas than in squamous carcinomas (P=0.043 and P=0.042, respectively). RAS mutations were more common in young patients (<45 years) (13.7% vs. 7.7%, P=0.027). RTK mutations tended to be more common in young patients, whereas PIK3CA/PTEN/AKT mutations tended to be more common in old patients. RAS mutations were significantly associated with disease relapse. To our knowledge, this is the first comprehensive analysis of major targetable oncogenic mutations in a large cohort of cervical cancer cases. Our data reveal that a considerable proportion of patients with cervical cancers harbor known druggable mutations and might benefit from targeted therapy.
    Preview · Article · Dec 2014 · Oncotarget
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    ABSTRACT: Ovarian cancer is the leading cause of death from gynaecological malignancies worldwide. Here we perform a three-stage genome-wide association study (GWAS) in Han Chinese women to identify risk genetic variants for epithelial ovarian cancer (EOC). We scan 900,015 single-nucleotide polymorphisms (SNPs) in 1,057 EOC cases and 1,191 controls in stage I, and replicate 41 SNPs (Pmeta<10(-4)) in 960 EOC cases and 1,799 controls (stage II), and an additional 492 EOC cases and 1,004 controls (stage III). Finally, we identify two EOC susceptibility loci at 9q22.33 (rs1413299 in COL15A1, Pmeta=1.88 × 10(-8)) and 10p11.21 (rs1192691 near ANKRD30A, Pmeta=2.62 × 10(-8)), and two consistently replicated loci at 12q14.2 (rs11175194 in SRGAP1, Pmeta=1.14 × 10(-7)) and 9q34.2 (rs633862 near ABO and SURF6, Pmeta=8.57 × 10(-7)) (P<0.05 in all three stages). These results may advance our understanding of genetic susceptibility to EOC.
    Preview · Article · Aug 2014 · Nature Communications
  • Jia Tang · Jin Li · Shengping Wang · Dandan Zhang · Xiaohua Wu
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    ABSTRACT: Objective: To guarantee a better perfusion, the preservation of the uterine arteries during ART has sometimes been performed but has seldom been tested. We share the results of our tests to provoke a potentially different point of view on such uses of ART. Methods: Using computed tomography angiography (CTA), we identified the uterine blood supply in patients who underwent ART with uterine artery preserved and sacrificed. Results: We included 26 consecutive post-ART patients from the outpatient service. The uterine arteries were preserved in 16 patients (61.5%) and ligated in 10 patients (38.5%). Out of the 26 patients studied, 17 (65.4%) were supplied by only the ovarian arteries; seven (26.9%) by one uterine artery and the contralateral ovarian artery; and only 2 (7.6%) by the uterine artery supply alone. No recanalization of the ligated uterine artery or other newly formed compensatory circulation was observed. Among the 16 patients who had preserved uterine arteries, only two (12.5%) showed identifiable bilateral uterine arteries, whereas seven (43.6%) had unilateral uterine artery occlusion and another seven (43.6%), bilateral occlusion. We had three obstetric outcomes, two of which came from the ovarian artery supplying group and one from the hybrid supplying group. Conclusions: The ovarian artery became the dominant supplying vessel after ART. The anatomically preserved uterine artery had an 87.5% chance of occlusion after the procedure. Moreover, the contributing uterine artery did not show any functional superiority. Thus, the benefit of preserving the uterine arteries during ART is probably very limited.
    No preview · Article · Jul 2014 · Gynecologic Oncology
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    ABSTRACT: Objectives: The aim of this study was to compare the surgical and pathological outcomes for patients with early-stage cervical cancer after abdominal radical trachelectomy (ART) and abdominal radical hysterectomy (ARH). Methods: A prospective database of ART and ARH procedures performed in a standardized manner by the same surgical group was analyzed. The 3-segment technique was used for the accurate analysis of parametrial lymph nodes (PMLNs), and parametrial measurements were recorded by the same pathologist. Standard statistical tests were used. Result: Between August 2012 and August 2013, ART was attempted in 39 patients (28.6%), and ARH was attempted in 90 patients (71.4%). The parametrium resection length was similar with ART and ARH (44.60 vs 45.48 mm, P = 0.432), as were additional surgical and pathological outcomes, including histology, lymph node positive rate, and operation time. The PMLNs were found in 28 patients (77.78%) in the ART group and in 86 (95.56%) in the ARH group (P > 0.05). Solitary PMLN metastases were observed in 3 patients (10.71%) in the ART group and in 6 (6.98%) in the ARH group. Five (55.6%) of these 9 patients had tumors of 2 cm or greater. The ARH patients (36, 40.00%) were more likely to receive postoperative chemotherapy or radiation compared with ART patients (13, 33.33%; P = 0.017). At a median follow-up of 12 and 12.5 months (P = 0.063), respectively, there were no recurrences or deaths in the ART or ARH groups. Conclusions: Using standardized techniques, ART provides similar surgical and pathological outcomes as ARH. For the patients with tumors of 2 cm or greater, PMLNs should be examined carefully. Further prospective data are urgently needed.
    No preview · Article · Jul 2014 · International Journal of Gynecological Cancer
  • Shanhui Liang · Yuqi Zhou · Yiran Chen · Guihao Ke · Hao Wen · Xiaohua Wu
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    ABSTRACT: Objective: The aim of this study is to investigate whether EIF4A1, EIF4E, and EIF4G1 can serve as prognostic markers for patients with cervical cancer receiving preoperative brachytherapy. Materials and methods: Tissue microarrays composed of 35 normal cervix samples, 87 cervical cancers treated without preoperative therapy, and 50 pairs of cervical cancer tissues collected before and after preoperative brachytherapy were constructed and evaluated for the expression of EIF4A1, EIF4E, and EIF4G using immunohistochemistry. Immunohistochemical staining was scored by the staining intensity and the percentages of tumor cells. The χ test was used to analyze the association between the immunohistochemistry results and clinicopathologic variables. The Kaplan-Meier method was applied to analyze the disease-specific survival. Results: Overexpression of EIF4A1, EIF4E, and EIF4G1 were detected in 83.9%, 84.7%, and 80.3% of cervical cancers, respectively, all of which were significantly related to advanced International Federation of Gynecology and Obstetrics stage, squamous cell histology, lymph node metastasis, and deep stromal invasion (P < 0.05). The altered expression pattern of EIF4A1 and EIF4E after preoperative brachytherapy was significantly correlated with the cervical cancer response to brachytherapy (P = 0.029 and 0.012, respectively). The decreased expression of EIF4A1 predicted better tumor-specific survival (P = 0.02). The alteration of EIF4A1 was an independent predictor for tumor-specific survival (P = 0.047; hazards ratio, 0.272; 95% confidence interval, 0.076-0.982). Conclusions: Overexpression of EIF4A1, EIF4E, and EIF4G1 were acquired malignant phenotypic features of cervical cancer. EIF4A1 might function as a novel prognostic indicator and a potential therapeutic target for cervical cancer.
    No preview · Article · Jun 2014 · International Journal of Gynecological Cancer
  • Xiaohua Wu
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    ABSTRACT: To guarantee a better perfusion, the preservation of the uterine arteries during ART has sometimes been performed but has seldom been tested. We share the results of our tests to provoke a potentially different point of view on such uses of ART. Using computed tomography angiography (CTA), we identified the uterine blood supply in patients who underwent ART with uterine artery preserved and sacrificed. We included 26 consecutive post-ART patients from the outpatient service. The uterine arteries were preserved in 16 patients (61.5%) and ligated in 10 patients (38.5%). Out of the 26 patients studied, 17 (65.4%) were supplied by only the ovarian arteries; seven (26.9%) by one uterine artery and the contralateral ovarian artery; and only 2 (7.6%) by the uterine artery supply alone. No recanalization of the ligated uterine artery or other newly formed compensatory circulation was observed. Among the 16 patients who had preserved uterine arteries, only two (12.5%) showed identifiable bilateral uterine arteries, whereas seven (43.6%) had unilateral uterine artery occlusion and another seven (43.6%), bilateral occlusion. We had three obstetric outcomes, two of which came from the ovarian artery supplying group and one from the hybrid supplying group. The ovarian artery became the dominant supplying vessel after ART. The anatomically preserved uterine artery had a 87.5% chance of occlusion after the procedure. Moreover, the contributing uterine artery did not show any functional superiority. Thus, the benefit of preserving the uterine arteries during ART is probably very limited.
    No preview · Article · Apr 2014 · Gynecologic Oncology
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    ABSTRACT: To investigate the clinical application of diffusion weighted imaging (DWI) in uterine cervical cancer and the apparent diffusion coefficient (ADC) value in diagnosis and predicting treatment response. Twenty-eight patients with advanced primary cervical cancer confirmed by pathology and 10 cases of normal uterine cervix as control were recruited in this prospective clinical trial. To analyze the correlation between tumor volume measured in DWI and tumor maximum diameter measured according to the RECIST criteria. To compare the ADC value differences among the uterine cervical cancer, uterine myometrium, and normal uterine cervix. To compare the ADC values in 17 cancer patients before and after treatment. The illustration of tumor boundary in DWI was superior to conventional T2WI and post-enhancement T1WI. The DWI with higher b value (2000 s/mm(2)) had a better signal-to-noise ratio. The tumor volume measured in DWI has good correlation with tumor maximum diameter according to RECIST criteria (r = 0.759, P < 0.01). When b = 800 s/mm(2), the ADC values of the uterine cervical cancer, uterine myometrium, and normal uterine cervix were (9.85 ± 1.55)×10(-3) mm(2)/s, (14.20 ± 2.80)×10(-3) mm(2)/s, and (14.14 ± 0.45) ×10(-3) mm(2)/s. When b = 2000 s/mm(2), the ADC values of the uterine cervical cancer, uterine myometrium and normal uterine cervix were (7.38 ± 0.98)×10(-3) mm(2)/s, (8.52 ± 2.38)×10(-3) mm(2)/s, and (8.60 ± 0.63)×10(-3) mm(2)/s, respectively. There were significant differences between the cervical cancer and normal cervix or uterine myometrium (P < 0.001 for both). When b = 800 s/mm(2), the ADC value was (9.85 ± 1.55)×110(-3) mm(2)/s before and (13.41 ± 2.93)×10(-3) mm(2)/s after treatment (P < 0.001). When b = 2000 s/mm(2), the ADC value was (7.38 ± 0.98)×10(-3) mm(2)/s before and (8.93 ± 1.92)×10(-3) mm(2)/s after treatment (P = 0.008). Univariate logistic regression analysis showed that 25% ADC, 50%ADC, and 75%ADC in the tumor ADC value histogram before treatment were significantly correlated to the treatment outcome of cervical cancer (P < 0.05 for all). Multivariate regression analysis showed that 25%ADC, 50%ADC, and 75%ADC in the tumor ADC value histogram before treatment were not significantly correlated to the treatment outcome of cervical cancer (P > 0.05 for all). The values of ROC curves were 25%ADC = 0.818, 50%ADC = 0.775, and 75%ADC = 0.716 (P > 0.05), however, the 25% ADC showed a relatively stronger statistical power. DWI helps to confirm the morphology and exact target zone of the tumor for radiotherapy. DWI volume measurement is well correlated with RECIST criteria, particularly in volume measurement of irregular tumors. ADC value has a potential in quantitatively monitoring treatment response and predicting outcome of cervical cancers.
    No preview · Article · Feb 2014 · Zhonghua zhong liu za zhi [Chinese journal of oncology]
  • Lingfang Xia · Duo Han · Wentao Yang · Jin Li · Linus Chuang · Xiaohua Wu
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    ABSTRACT: This study aimed to identify prognostic factors of survival and improve treatment strategies in women diagnosed with primary malignant melanoma of the vagina. Between December 2002 and August 2011, 44 patients with lesions confined to the vagina and diagnosed with melanoma at Fudan University Shanghai Cancer Center were evaluated retrospectively. Prognostic factors were analyzed by Kaplan-Meier method. With a median follow-up time of 18.9 months (range, 6.0-94.3 months), 30 (68.2%) patients developed recurrences, whereas 21 (47.7%) died of disease. Median progression-free survival (PFS) was 14.4 months and median overall survival (OS) was 39.5 months. Depth of invasion (DOI) was significantly associated with OS (P = 0.023), and there was an obvious tendency toward improved OS with a negative lymph node status (P = 0.063). The DOI was significantly associated with lymph node status (P = 0.047). The extent of surgery (wide local excision vs radical excision) was not associated with differences in PFS or OS (P = 0.573 and P = 0.842, respectively). Longer PFS was observed in patients who received adjuvant chemotherapy and radiotherapy (P = 0.038). The prognosis of primary vaginal melanoma is dependent on the DOI and lymph node status in our study. Surgical resection of disease, especially wide local excision, should be considered as the optimal treatment when complete removal of tumor with a negative margin is possible. Adjuvant therapy may be associated with a longer PFS.
    No preview · Article · Jan 2014 · International Journal of Gynecological Cancer
  • Yiran Chen · Guihao Ke · Duo Han · Shanhui Liang · Gong Yang · Xiaohua Wu
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    ABSTRACT: MicroRNAs(miRNAs) are involved in regulating the response of cancer cells to various therapeutic interventions, but their involvement in the chemoresistance of human cervical squamous cell carcinoma is not fully understood. We found miR-181a was significantly up-regulated in specimens from patients with chemoresistant cervical squamous cell carcinoma. In this study, we aimed to clarify the role of miR-181a in regulating the chemoresistance of cervical cancer. Two human cervical squamous cancer cell lines, SiHa and Me180, were used. Enforced expression of miR-181a enhanced chemoresistance to cisplatin in cervical cancer cells through apoptosis reversion. In a nude mouse xenograft model, the overexpression of miR-181a markedly inhibited the therapeutic response to cisplatin. PRKCD, a target gene of miR-181a and a promoter of apoptosis, was negatively regulated by miR-181a. We found that the effect of miR-181a on chemoresistance was mediated by PRKCD. Additionally, silencing of PRKCD yielded an effect similar to that of miR-181a up-regulation and inhibited apoptosis in cervical cancer cells. Our findings suggest that miR-181a may function as an oncogene and induce chemoresistance in cervical squamous cell carcinoma cells at least in part by down-regulating PRKCD, thus may provide a biomarker for predicting chemosensitivity to cisplatin in patients with cervical squamous cancer.
    No preview · Article · Oct 2013 · Experimental Cell Research
  • Jin Li · Xiaohua Wu · Xiaoqiu Li · Xingzhu Ju
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    ABSTRACT: As abdominal radical trachelectomy (ART) has become a favored fertility-sparing procedure, the relative contraindication of a tumor ≥ 2cm in size has been questioned. The aim of the study was to report the surgical and oncological safety of ART for selected patients with cervical cancer ≥ 2cm in size. We conducted a retrospective review of a prospectively maintained database of patients undergoing ART at our institution from 04/2004 to 01/2013. The largest tumor dimension was determined by physical exam, MRI or final pathology. Clinical and pathological data were tabulated. All patients were followed postoperatively. Of the133 patients who underwent planned ART, sixty-two (46.6%) had tumors ≥ 2cm in size (2- 4 cm). Forty-six patients were documented by exam or MRI, while 16 were documented by pathology reports. The mean age was 30.4 years, and 42 patients (67.7%) were nulliparous. Fifty (80.7%) had squamous carcinoma, 7 (11.3%) adenocarcinoma, and 5 (8%) adenosquamous carcinoma. Due to frozen-section results, 6 (9.7%) patients underwent an immediate hysterectomy. Due to high-risk features on final pathology, 27(43.5%) were treated with adjuvant chemotherapy (n=20) or chemoradiation (n=7). In total, 55 of 62 (88.7%) patients with a tumor ≥ 2cm in size preserved their fertility potential. Among these patients, 35 underwent ART without further adjuvant treatment. At a median follow-up of 30.2 months, there were no recurrences. Expanding the ART inclusion criteria to cervical cancers ≥ 2cm in size allows a fertility-sparing procedure in young women who would have otherwise been denied the option with no apparent compromise in oncological outcome. However, this may result in higher rates of conversion to hysterectomy or the need for adjuvant chemotherapy/ or chemoradiation.
    No preview · Article · Jul 2013 · Gynecologic Oncology

Publication Stats

236 Citations
133.46 Total Impact Points

Institutions

  • 2005-2015
    • Fudan University
      • Department of Oncology
      Shanghai, Shanghai Shi, China
  • 1998
    • Shanghai Medical University
      • Department of Gynecological Oncology
      Shanghai, Shanghai Shi, China