子宫颈鳞状细胞癌复发患者血清鳞状细胞癌抗原监测的意义

目的探讨血清鳞状细胞癌抗原（SCCAg）在监测宫颈鳞癌患者复发中的意义。方法对1999-2005年收治的72例宫颈鳞癌复发患者血清SCCAg水平与诊断、预后的关系进行单因素和多因素分析。结果72例复发患者中,术后复发30例、放化疗后复发42例,其中血清SCCAg水平升高者61例（占85％）。此61例患者中,20例在随诊中首先出现血清SCCAg水平升高而临床及影像学检查未发现肿瘤,血清SCCAg水平提前升高的中位时间为3个月,平均4．6个月（1～13个月）。72例复发患者中,45例患者无任何临床症状,仅因血清SCCAg水平升高或常规随诊发现复发;27例患者有症状,其中单侧下肢水肿或疼痛15例,阴道不规则流血7例,出现远处转移相关症状5例。细胞或组织病理学检查诊断复发者33例;临床及影像学检查结合血清SCCAg水平诊断复发者39例,其中29例仅依靠血清SCCAg水平升高及影像学检查即诊断复发。72例复发患者的中位生存时间为11个月,平均生存时间为23个月（2～62个月）,总的3年生存率为25％,5年生存率为19％。单因素分析发现,初治前患者血清SCCAg水平、病理分级、复发部位、复发后治疗方式以及复发时、复发后治疗中、治疗后血清SCCAg水平对患者的3年生存率有明显影响（P〈0．01）;但20例血清SCCAg水平提前出现升高的患者与52例血清SCCAg水平未提前升高的患者相比,3年生存率分别为22％、27％,差异无统计学意义（P=0．5761）。多因素分析发现,复发患者仅病理分级、复发后的治疗方式是独立的预后影响因素（P〈0．05）;而复发部位及各种血清SCCAg状态不是独立的预后影响因素（P〉0．05）。结论血清SCCAg水平监测在宫颈鳞癌复发患者中的诊断及其对预后的判断中有一定的价值。     

淋巴结转移的Ⅰb 1～Ⅱb期子宫颈癌患者手术后的综合治疗及预后分析

目的研究淋巴结转移的Ⅰb1～Ⅱb期宫颈癌患者广泛性子宫切除加盆腔淋巴结切除术后综合治疗的方式和预后。方法选取1990年1月至2003年6月复旦大学附属肿瘤医院接受手术治疗的Ⅰb1～Ⅱb期淋巴结转移的宫颈癌患者215例。所有患者均接受了广泛性子宫切除加盆腔淋巴结切除术。根据术后治疗情况将患者分为4组：放疗加化疗组（107例）、放疗组（45例）、化疗组（22例）和无辅助治疗组（41例）。通过比较4组患者的临床病理资料,对患者预后及可能影响预后的有关因素进行分析。结果放疗加化疗组、化疗组、放疗组和无辅助治疗组患者的3年无瘤生存率分别为60．7％、53．5％、47．4％和36．0％,放疗加化疗组患者的3年无瘤生存率显著高于无辅助治疗组,两组比较,差异有统计学意义（P=0．001）,而化疗组、放疗组的3年无瘤生存率分别与无辅助治疗组比较,差异无统计学意义（P值分别为0．060和0．159）。放疗加化疗组、化疗组、放疗组和无辅助治疗组患者的盆腔复发率分别为7．5％、22．7％、26．7％和34．1％,远处转移率分别为16．8％、18．2％、15．6％和22．0％,复发合并转移率分别为4．7％、0、4．4％和7．3％。放疗加化疗组盆腔复发率显著低于其余3组,与其余3组比较,差异有统计学意义（P〈0．01）,而远处转移率、复发合并转移率与其余3组比较,差异无统计学意义（P〉0．05）。多因素分析显示,肿瘤直径、病理类型、淋巴结转移数目和术后辅助治疗是影响淋巴结转移的宫颈癌患者预后的重要因素（P〈0．05）。结论淋巴结转移的宫颈癌患者根治性手术后辅助放、化疗能提高3年无瘤生存率,降低盆腔复发率。     

血清鳞状细胞癌抗原检测对宫颈鳞癌的诊断价值

目的:探讨检测血清鳞状细胞癌抗原(SCCAg)在宫颈鳞癌诊断中的价值。方法:用化学发光法测定32例宫颈鳞癌(宫颈鳞癌组)、21例宫颈上皮内瘤变(CIN组)和30例慢性宫颈炎(慢性宫颈炎组)患者治疗前血清SCCAg值(以≥2.5ng/ml为阳性参考值),并根据最大约登指数计算最佳诊断界值及计算曲线下面积(AUC)。结果:宫颈鳞癌组术前血清SCCAg水平(5.516±1.523ng/ml)明显高于CIN组(0.806±0.152ng/ml)和慢性宫颈炎组(0.412±0.053ng/ml),差异均有统计学意义(t=2.492,P=0.001;t=4.715,P=0.000)。宫颈鳞癌组术前血清SC-CAg阳性率(43.75%)明显高于CIN组(4.76%)和慢性宫颈炎组(0),差异均有统计学意义(χ2=9.498,P=0.000;χ2=35.497,P=0.000);宫颈鳞癌组ⅠB期、ⅡA期、ⅡB期、Ⅳ期术前血清SCCAg阳性率分别是31.25%、40.00%、75.00%、100.00%,但4组比较,差异无统计学意义(χ2=3.2,P=0.362)。血清SCCAg对宫颈鳞癌最佳诊断界值、灵敏度、特异度和ROC曲线下面积分别为1.48ng/ml、44.00%、99.00%、0.727。结论:血清SCCAg是宫颈鳞癌特异度较高的肿瘤标志物,可作为辅助诊断指标,而降低SCCAg诊断界值可能有助于提高诊断率。     

子宫颈癌伴盆腔淋巴结转移患者的复发及预后分析

目的 探讨宫颈癌伴盆腔淋巴结转移患者的复发规律及预后影响因素.方法 选取1994年1月至2001年12月问中山大学肿瘤防治中心收治的按国际妇产科联盟(FIGO)的标准其临床分期为I b1～II a期的宫颈癌伴盆腔淋巴结转移的患者共124例,结合临床病理资料对其复发及预后情况进行回顾性分析.结果 患者的5年总生存率和5年无瘤生存率分别为63.3%、61.4%;总复发率为39.5%(49/124),其中复发部位明确的41例患者(盆腔内、盆腔外和盆腔内外同时复发患者分别为25、13和3例)中盆腔内复发率(61.O%,25/41)显著高于盆腔外复发率(31.7%,13/41;P=0.008).多因素分析显示,髂总淋巴结转移是影响患者预后的独立的危险因素(P=0.035).根据这一因素,将盆腔淋巴结转移的患者分为低危组(髂总淋巴结无转移,104例)和高危组(髂总淋巴结转移,20例),其5年无瘤生存率分别为69.4%和24.5%,两组比较,差异有统计学意义(P=0.003);低危组盆腔内复发率为22.1%(23/104),高危组为25.0%(5/20),两组比较,差异无统计学意义(P>0.05);低危组盆腔外复发率为7.7%(8/104),高危组为40.O%(8/20),两组比较,差异有统计学意义(P<0.01).结论 伴盆腔淋巴结转移的宫颈癌患者以盆腔内复发为主,而其中髂总淋巴结转移者以盆腔外复发为主.髂总淋巴结转移是影响宫颈癌患者预后的独立的危险因素.     

局部晚期子宫颈癌新辅助化疗价值的评估

目的 探讨局部晚期宫颈癌新辅助化疗的疗效及影响近期疗效的相关因素,以及对患者长期生存的影响。方法 收集行新辅助化疗的Ⅰb2—Ⅱb期局部晚期宫颈癌患者64例,分析其化疗后的近期疗效及长期生存率,采用多元线性回归法分析影响化疗近期疗效的相关因素。结果 新辅助化疗的近期总有效率为80％（51／64）。化疗患者的近期疗效与病理类型有关,鳞癌患者的有效率（82％）明显高于腺癌（6／9,P〈0．05）;而与其他因素无关（P〉0．05）。化疗有效者手术后盆腔淋巴结阳性率为8％（4／51）,宫旁血管癌栓阳性率为2％（1／51）,均明显低于化疗无效者（分别为3／6、2／6;P〈0．05）。新辅助化疗后患者的总5年生存率为89％,其中化疗有效者5年生存率为100％,明显高于化疗无效者的46％（P〈0.05）。新辅助化疗有效者3、5年无瘤生存率分别为95％、83％,化疗无效者分别为33％、0,两者分别比较,差异均有统计学意义（P〈0．05）。结论 局部晚期宫颈癌新辅助化疗的近期疗效与病理类型有关,对化疗有效者应选择手术,可提高长期生存率。     

生殖系统原发性恶性黑色素瘤42例临床分析

目的探讨生殖系统原发性恶性黑色素瘤的诊断、治疗及预后影响因素。方法对42例生殖系统原发性恶性黑色素瘤患者的临床和病理资料进行回顾性分析。结果42例患者中,原发于外阴、阴道及宫颈的恶性黑色素瘤患者分别为14例（33％）、23例（55％）及5例（12％）。其中,38例手术治疗前行肿瘤组织活检,6例误诊,术前误诊率为16％;18例术后行免疫组化S-100蛋白检测,18例（100％）均阳性;16例术后行抗黑色素瘤特异性抗体（HMB-45）检测,14例（88％）阳性。本组患者的2年、5年累积无瘤生存率分别为35％及23％,2年、5年累积总生存率分别为53％及27％。按国际妇产科联盟（FIGO,2000年）的分期标准,Ⅰ、Ⅱ期（早期）和Ⅲ、Ⅳ期（晚期）患者的2年累积总生存率分别为77％及34％,两者比较,差异有统计学意义（P〈0．05）;Ⅰ、Ⅱ期患者的2年累积总生存率分别为78％及74％,两者比较,差异无统计学意义（P=0．303）。对40例接受手术治疗患者的临床资料进行单因素分析显示,术后辅助化疗对患者的累积无瘤生存率和累积总生存率有明显影响（P〈0．05）;广泛性手术、区域淋巴结切除、生物治疗对预后则无明显影响（P〉0．05）。化疗联合生物治疗和单纯化疗患者的2年累积无瘤生存率分别为49％及34％,两者比较,差异无统计学意义（P〉0．05）。结论生殖系统原发性恶性黑色素瘤术前活检的误诊率高,应用免疫组化染色检测可提高诊断的准确性。FIGO分期难以准确评价早期患者的预后。手术是主要治疗手段,术后辅助化疗可显著改善患者的预后。     

子宫颈鳞状细胞癌中细胞凋亡相关基因产物的免疫组织化学研究

目的：研究子宫颈鳞状细胞癌组织中细胞凋亡的相关基因表达及其与临床病理特征和患者预后的关系。方法：用免疫组织化学ＬＳＡＢ方法，分析５１份子宫颈鳞癌石蜡包埋组织中细胞凋亡相关基因ｐ５３、Ｃ－ｍｙｃ、ｂｃｌ－２及ｂａｘ的表达情况。另取石蜡包埋的正常子宫颈组织５份、上皮内瘤样病变（ＣＩＮ）组织８份作为对照。结果：１．ｐ５３、Ｃ－ｍｙｃ、ｂｃｌ－２和ｂａｘ在子宫颈鳞癌中的表达率分别为５２．９４％（２７／５１）、４９．０２％（２５／５１）、４３．１３（２２／５１）及５２．９４（２７／５１），其中ｐ５３、Ｃ－ｍｙｃ表达与正常子宫颈组织及ＣＩＮ比较差异有显著性（Ｐ＜０．０５）。２．子宫颈鳞癌中ｍｔｐ５３表达多见于组织分化程度低、有淋巴结转移及不良预后的患者。Ｃ－ｍｙｃ在有淋巴结转移及预后不良患者中表达显著增高。在分化程度高、无淋巴结转移患者中ｂｃｌ－２高表达。在临床分期晚、分化程度低、有淋巴结转移患者中ｂａｘ高表达。３．ｐ５３与ｂｃｌ－２以及ｂｃｌ－２与ｂａｘ表达间呈负相关；ｐ５３与ｂａｘ以及Ｃ－ｍｙｃ与ｂａｘ表达间呈正相关。结论：细胞凋亡相关基因ｐ５３、Ｃ－ｍｙｃ、ｂｃｌ－２及ｂａｘ在子宫颈鳞癌的发生、发展中起一定作用，?     

子宫内膜癌患者血清CP2、CA125、唾液酸和癌胚抗原检测的临床意义

目的探讨肿瘤标志物CP2、CA125、唾液酸（SA）和癌胚抗原（CEA）检测对子宫内膜癌患者的临床意义。方法选取154例具有肿瘤标志物检测结果的子宫内膜癌患者的临床病理资料进行回顾性分析。结果子宫内膜癌患者血清CP2、SA、CA125和CEA水平升高的百分率分别为23．4％、36．8％、19．0％和30．3％。血清CP2水平升高与手术病理分期、病理分化程度、附件受累、腹腔细胞学检查阳性及盆腔淋巴结转移相关（P值分别为0．002、0．040、0．019、0．019、0．005）;血清SA水平升高与附件受累、腹腔细胞学检查阳性相关（P值分别为0．021、0．000）;血清CA125水平升高与病理分化程度、宫颈受累和盆腔淋巴结转移相关（P值分别为0．014、0．006、0．018）;CEA与各临床病理特征间均无相关性（P均〉0．05）。血清CP2、CA125和CEA水平升高与患者预后相关（P值分别为0．016、0．000、0．016）,其中CA125水平与预后关系最为密切。结论子宫内膜癌缺乏特异性肿瘤标志物,CP2与子宫内膜癌临床病理特征相关性较强,CP2、CA125和CEA对患者预后有提示作用。     

盆腔淋巴结清扫术用于子宫内膜癌

目的 探讨盆腔淋巴结清扫术（清扫术）对子宫内膜癌治疗的作用。方法 分析行清扫术者１０４例,分别比较各种临床病理因素的盆腔淋巴结转移发生率,淋巴结行清扫术与非清扫术的５个生存率。结果 临床Ⅰ期子宫膜癌患者的盆腔淋巴结转移率为４．４％。深肌层浸润及低分化癌（Ｇ３）的盆腔淋巴结转移率升高,分别为３７．３％及３７．８％。临床Ⅰ、Ⅱ期患者盆深淋巴结转移与非转移的５年生存率分别为３８．９％及７４．２％,差异有     

癌基因c－erbB2与子宫颈鳞状上皮细胞癌生物学行为的关系

目的：探讨癌基因ｃ－ｅｒｂＢ２在人宫颈鳞状上皮细胞癌（鳞癌）中的表达及其与生物学行为及预后的关系。方法：采用免疫组织化学方法，检测宫颈鳞癌６２例、宫颈上皮内瘤变（ＣＩＮ）９例及正常宫颈（１０例）的宫颈上皮组织中ｃ－ｅｒｂＢ２的表达。结果：６２例鳞癌中，１９例细胞呈阳性染色，９例ＣＩＮ中１例呈阳性染色，正常宫颈上皮无一例呈阳性染色。细胞学１、２和３级阳性率分别为１２．５％、２７．６％和５２．９％，１级及２级与３级比较，差异有显著意义（Ｐ＝０．０１９）。手术治疗的２０例患者中，６例阳性染色者，３例有盆腔淋巴结转移，１４例例阴性染色者，仅１例淋巴结转移，两者比较，差异有显著意义（Ｐ＝０．０３２）。ｃ－ｅｒｂＢ２阳性表达者，５年生存率（３１．５％）明显低于阴性者（７４．４％，Ｐ＜０．００１）。结论：癌基因ｃ－ｅｒｂＢ２表达与宫颈鳞癌生物学行为及预后相关，检测其表达可能作为宫颈鳞癌预后判断的参考指标     

早期子宫颈鳞癌盆腔淋巴结转移的影响因素

目的 探讨早期(Ⅰ b～Ⅱa期)宫颈鳞癌盆腔淋巴结转移的影响因素.方法 回顾性分析2004年2月-2007年1月在浙江大学医学院附属妇产科医院接受治疗、资料完整的135例早期宫颈鳞癌患者的临床病理资料.选择10个非重复的特征性因素,包括患者年龄、临床期别、肿瘤直径、病理分化程度、深肌层浸润、脉管浸润、治疗前血清鳞状细胞癌抗原水平,以及治疗前血小板数量、血浆纤维蛋白原和血红蛋白水平,通过单因素和多因素分析研究这些特征性因素与盆腔淋巴结转移之间的关系.结果 135例宫颈鳞癌患者中,术后病理检查证实共切除盆腔淋巴结3996枚,平均每例29.6枚(20～47枚).其中,病理检查证实盆腔淋巴结转移的患者有17例,盆腔淋巴结转移率为12.6%(17/135).单因素分析结果 显示,肿瘤直径(P=0.003)、深肌层浸润(P=0.004)、脉管浸润(P<0.01)、血小板数量(P=0.006)、血浆纤维蛋白原水平(P<0.01)是与盆腔淋巴结转移明显相关的因素.多因素分析结果 显示,脉管浸润(OR=3.674,95%CI:1.825～7.393,P<0.01)和血浆纤维蛋白原水平(OR=4.568,95%CI:1.779～11.725,P=0.002)是与盆腔淋巴结转移明显相关的因素.结论 脉管浸润和高血浆纤维蛋白原水平是影响早期宫颈鳞癌患者盆腔淋巴结转移的高危因素.     

子宫颈鳞癌Ⅰb～Ⅱa期患者预后预测系统的建立及其临床意义

目的分析子宫颈鳞癌Ⅰb~Ⅱa期患者的预后影响因素并建立预后预测系统,以探讨其在指导术后辅助治疗中的作用。方法回顾性分析接受手术治疗的306例Ⅰb~Ⅱa期宫颈鳞癌患者的临床病理资料,对影响其预后的因素进行单因素和多因素分析。结果306例患者的5年生存率为78 1%。单因素分析结果显示,与其预后有关的因素为淋巴结转移、病理分化程度、肿瘤直径、宫旁组织浸润、深肌层浸润和脉管内瘤栓(P<0 05);多因素分析结果显示,淋巴结转移、深肌层浸润、宫旁组织浸润是影响其预后的独立危险因素(P<0 05)。根据危险因素的不同建立预后预测系统,即将患者分为低危组、中危组和高危组3组,其5年生存率分别为90 3%、83 9%和43 1%。低危组(无危险因素或仅宫旁组织浸润)局部复发的发生率仅为2 2%;中危组(深肌层浸润或合并有宫旁组织浸润)局部复发的发生率为13 5%,远处转移的发生率为1 3%, 局部复发合并远处转移的发生率为0 6%;高危组(淋巴结转移或合并其他危险因素)局部复发和远处转移的发生率分别为25 9%和48 3%,局部复发合并远处转移的发生率为10 3%。结论淋巴结转移、深肌层浸润、宫旁组织浸润是影响Ⅰb~Ⅱa期宫颈鳞癌患者预后的独立因素;根据预后影响因素建立的预后预测系统有助于指导术后辅助治疗。     

A comparison of prognoses of pathologic stage Ib adenocarcinoma and squamous cell carcinoma of the uterine cervix

OBJECTIVES: The influence of the histology of adenocarcinoma on recurrence and survival for patients treated with radical hysterectomy and diagnosed as having pathologic stage Ib cervical cancer was investigated. METHODS: Five hundred and nine patients (405 squamous cell carcinomas, 104 adenocarcinomas) with pathologic stage Ib cervical cancer treated initially at the Aichi Cancer Center between 1976 and 1995 were studied. RESULTS: Multivariate analysis identified the prognostic variables as histology of adenocarcinoma, number of lymph nodes involved, and tumor size beyond 4 cm. Five-year overall survival and disease-free survival of patients with adenocarcinoma in the presence of lymph node metastasis were 63.2 and 47.4%, respectively, significantly poorer than for squamous cell carcinoma (83.6 and 80.6%; P < 0.001 and P = 0.002, respectively). These were not different in the absence of lymph node metastasis (adenocarcinoma, 93.9 and 92.7%; squamous cell carcinoma, 97.9% and 96.1%; P = 0.067 and P = 0.250, respectively). CONCLUSIONS: The independent significant risk factors for the recurrence and survival of pathologic stage Ib cervical cancer were the presence of lymph node metastasis, large tumor size beyond 4 cm, and histology of adenocarcinoma. The prognosis of patients with adenocarcinoma was poorer than of patients with squamous cell carcinoma in the presence of lymph node metastasis, while the prognosis of pathologic stage Ib cervical cancer was equivalent when there was no metastasis.     

A comparison of prognoses of FIGO stage IB adenocarcinoma and squamous cell carcinoma

OBJECTIVES: The objective of this study was to compare clinical and pathologic variables and prognosis of FIGO stage IB adenocarcinoma and squamous cell carcinoma of uterine cervix. METHODS: A retrospective review was performed of 521 patients with stage IB squamous cell carcinoma and adenocarcinoma of cervix who treated primarily by type 3 hysterectomy and pelvic and/or para-aortic lymphadenectomy at Hacettepe University Hospitals between 1980 and 1997. RESULTS: Age, tumor size, grade, depth of invasion, lymph node metastasis, parametrial, vaginal, and lymphvascular space involvement (LVSI) were not different between two cell types except number of the lymph nodes involved. Metastasis to three or more lymph nodes was significantly higher in adenocarcinoma. Overall and disease-free survival were 87.7%, 84.0% versus 86.4%, 83.1% for squamous cell carcinoma and adenocarcinoma, respectively (P > 0.05). The rate and site of recurrence were not different between two cell types. Multivariate analysis of disease-free and overall survival revealed independent prognostic factors as tumor size, LVSI, number of involved lymph node, and vaginal involvement. CONCLUSION: Prognosis of FIGO stage IB cervical cancer patients who were treated by primarily radical surgery was found to be same for those with adenocarcinoma and squamous cell carcinoma.     

The role of pretreatment squamous cell carcinoma antigen level in locally advanced squamous cell carcinoma of the uterine cervix treated by radiotherapy

The purpose of this study was to determine the pretreatment serum squamous cell carcinoma antigen (SCC-ag) level as a generally applicable measurement in predicting and estimating the treatment outcome of patients with locally advanced SCC of the cervix. Three hundred fifty-two patients with stage IIB-IVA SCC of the cervix were managed with both external irradiation and high-dose rate intracavitary brachytherapy. A significantly higher median SCC-ag was seen in association with increasing stage, tumor size, and lymph node involvement. The difference in disease-free survival (DFS) between stages IIB and III patients was not statistically significant with SCC-ag level <2 ng/mL. In multivariate analysis, median SCC-ag level (> or =6.0 ng/mL) and lymph node metastases had significant independent effects on absolute survival and DFS. A direct linear relationship (y=-2.932x+ 84.896) existed between the median SCC-ag of groups distributed by pretreatment prognostic factors and the 5-year DFS rate. The 5-year DFS rate as a function of SCC-ag level defined by cervix size, lymph node status, and hydronephrosis was obtained from a formula combining risk scores and the baseline survival function. From the obtained formulas, we can objectively estimate the treatment outcome in patients with locally advanced squamous cell cervical cancer.     

Oncogene expression and microvessel count in recurrent and nonrecurrent stage Ib squamous cell carcinoma of the cervix.

OBJECTIVE: To evaluate p53, epidermal growth factor receptor (EGFR) and c-erbB-2 oncogene expression and compare it with microvessel count (MVC) in determining the clinical outcome of stage Ib squamous cell carcinoma (SCC) of the cervix. STUDY DESIGN: Immunostaining with p53, EGFR, C-erbB-2 and factor VIII antibodies was performed on tumor sections from 22 patients (11 with cancer recurrence, 11 free of cancer after four years). The levels of oncogene expression were semiquantitatively graded (0-4). Microvessels were counted (per 200 x field) in areas of highest neovascularization. RESULTS: Eight of 11 patients (72.7%) with recurrence expressed EGFR as compared with 5 of 11 patients (45.5%) free of disease. This difference is not significant (P = .39). An equal number of patients with and without recurrence expressed c-erbB-2. Five of 11 patients (45.5%) with recurrence expressed p53, as compared with 6 of 11 (54.5%) free of disease (P = 1.00). Eight of 11 patients (72.7%) with recurrence had an MVC above 24 as compared with 2 of 11 patients (18.2%) free of disease; this difference was statistically significant (P = .03). CONCLUSION: The expression of EGFR, p53 and c-erbB-2 appears to have little prognostic value in stage Ib SCC of the uterine cervix. The prognostic value of MVC is in keeping with previous findings.     

Association between CD31 expression and histopathologic features in stage IB squamous cell carcinoma of the cervix

This study was undertaken to evaluate the association between the expression of CD31 in the tumor and the histopathologic findings in patients with carcinoma of the cervix. This study included prospectively 30 women, aged 46.6 +/- 10.7 years, with stage IB squamous cell carcinoma of the cervix submitted to radical hysterectomy from November 2001 to September 2002. Samples from the tumor were taken and immunohistochemically evaluated by a monoclonal antibody for CD31. Clinicopathologic characteristics such as stage, tumor size, grade of differentiation, lymphatic vascular space invasion (LVSI), parametrial involvement, and status of pelvic lymph nodes were also recorded. The clinical stage (FIGO) was IB1 in 22 patients (73.3%) and IB2 in 8 patients (26.7%). The expression of CD31 was significantly associated with tumor size and the presence of LVSI, but not with grade of differentiation and vaginal or parametrial involvement (P= 0.03, P= 0.032, P= 0.352, P= 0.208, and P= 0.242, respectively). On univariate analysis, the presence of pelvic lymph node metastasis was influenced by LVSI (P= 0.003) and CD31 expression (P= 0.032). However, on multivariate analysis, the presence of LVSI (P= 0.007) was the only independent predictor of pelvic lymph node metastasis. The CD31 expression in tumor is significantly associated with LVSI and tumor size in patients with early-stage squamous cell carcinoma of the cervix.     

The curative role of radiotherapy in patients with isolated para-aortic node recurrence from cervical cancer and value of squamous cell carcinoma antigen for early detection

The objective of this study was to examine the clinical benefits of routine squamous cell carcinoma antigen (SCC-ag) monitoring of patients with locally advanced cervical cancer. Recurrent disease occurred in 99 uterine cervical cancer patients with elevated pretreatment SCC-ag before primary radiotherapy. Elevated SCC-ag levels persisted in 23 patients after primary radiotherapy (group 1), and SCC-ag was normalized in 76 patients after primary radiotherapy (group 2). The overall survival (OS) rate was higher for patients with SCC-ag elevation as the first sign than for patients with recurrence predicted by other modalities for group 2 patients (P = 0.033). The prediction of isolated para-aortic node recurrence significantly correlated with SCC-ag elevation as an initial sign (P = 0.001). The SCC-ag level before primary radiotherapy (> or = 10.8 ng/mL) significantly affected recurrence predicted by SCC-ag elevation as an initial sign (P = 0.002). For multivariate analysis, the presence of para-aortic node recurrence was statistically significant in OS (P < 0.0001). Routine SCC-ag monitoring of patients with carcinoma of the uterine cervix can lead to the early diagnosis of isolated para-aortic lymph node recurrence, and prolonged survival can be achieved by applying radiation therapy to the para-aortic region. To reduce the number of patients monitored for SCC-ag, we recommend monitoring group 2 patients with pretreatment SCC-ag level before primary radiotherapy > or = 10.8 ng/mL.     

Hepatic resection for metastatic squamous cell carcinoma from the uterine cervix.

A solitary hepatic tumor was diagnosed 3.5 years after a 67-year-old woman had undergone radical hysterectomy and postoperative irradiation for stage Ib squamous cell carcinoma of the cervix. Hepatic resection confirmed squamous cell carcinoma that had metastasized from the uterine cervix. One year and 10 months following hepatic resection, this patient is doing well with no evidence of any recurrence. This is a report of successful hepatic resection for metastatic carcinoma from the uterine cervix.