MIB-1 in endometrial carcinoma: prognostic significance with 5-year follow-up

OBJECTIVE: MIB-1, a monoclonal antibody to the Ki-67 antigen, has presumptively been shown to be predictive of recurrent disease in patients with endometrial cancer. In order to more conclusively establish whether MIB-1 staining can be used as a prognostic indicator of recurrent disease or survival, a larger group of patients with a minimum follow-up of 5 years was analyzed. METHODS: The tumors from 147 consecutive patients receiving primary surgical therapy for endometrial carcinoma were evaluated with the MIB-1 monoclonal antibody. Proliferation index was quantified by image analysis. Patients were followed for a minimum of 60 months. In addition to MIB-1 staining, histologic type, stage, grade, depth of invasion, lymphovascular space invasion, and peritoneal cytology were evaluated as prognostic indicators. RESULTS: Twenty-five of 147 patients died during the study period. MIB-1 staining was not significantly elevated in advanced (stage II, III, and IV) as opposed to early (stage I) carcinomas (P = 0.38). In patients whose tumor MIB-1 staining was less than 33.0%, no deaths occurred. By multivariate analysis, only MIB-1 staining (P < 0.001), FIGO stage (P = 0.005), and LVI (P = 0.005) were shown to be independent prognostic indicators predictive of survival. CONCLUSION: In this series of 147 consecutive patients with endometrial carcinoma, the monoclonal antibody MIB-1 was shown to be an independent prognostic indicator of 5-year survival. This follow-up further validates the previous work regarding the significance and potential usefulness of MIB-1 as a prognostic indicator.     

Bowel obstruction in patients with ovarian carcinoma: analysis of prognostic factors

A retrospective study was performed in which patients with both bowel obstruction and ovarian carcinoma admitted to the gynecologic oncology service at the Milton S. Hershey Medical Center between July 1, 1980, and June 30, 1987, were examined. Thirty-three patients were identified who fulfilled the inclusion criteria for bowel obstruction that did not occur in the postoperative period. Historical, physical, nutritional, and laboratory variables thought to contribute to patient survival were evaluated by a retrospective chart review. Survival time was not significantly related to presence or absence of tumor at obstruction, type of intervention whether medical or surgical, patient age, or interval from initial diagnosis of ovarian cancer to obstruction. Survival time was found to be significantly related to the prognostic index initially proposed by H. B. Krebs and D. R. Goplerud [Obstet. Gynecol. 61, 327-330 (1983)], P = 0.002. This prognostic index incorporates a multifactorial assessment of patient status including age, nutritional status, tumor spread, ascites, and prior chemotherapy and radiotherapy and can be used to evaluate patients at the time of presentation with intestinal obstruction and to help select optimal treatment for palliation.     

Cancer-associated serum antigen level: a novel prognostic indicator for survival in patients with recurrent ovarian carcinoma

The aim was to examine the value of the pretherapeutic serum cancer-associated serum antigen (CASA) level as a prognostic factor for survival in patients with recurrent epithelial ovarian carcinoma. Serum levels of CASA and cancer antigen (CA)125 were prospectively determined in 70 consecutive patients with recurrent ovarian cancer before the start of second-line chemotherapy. Univariate and multivariate analyses of survival were performed. The median level of serum CASA was 6.5 U/mL (range: 0.2-1437 U/mL). Univariate analysis showed that patients with a CASA level >10.0 U/mL had significantly shorter survival than patients with CASA level < or =10.0 U/mL (P= 0.002). Using different CASA cutoff levels (6.0, 6.5, and 10.0 U/mL), multivariate Cox analyses identified CASA as an independent prognostic factor for survival at every cutoff level. The strongest prognostic function for CASA was found at a cutoff level of 10.0 U/mL (>10 vs < or =10 U/mL; hazard ratio, 2.7; 95% confidence interval, 1.6-4.7; P < 0.001). The pretreatment CA125 level was not found to be significantly associated with survival by any of the cutoffs (35, 65, 132, and 339 U/mL). A pretreatment elevated level of the tumor marker CASA is an adverse prognostic factor for survival in patients with ovarian cancer relapse.     

Testing the validity of a prognostic classification in patients with surgically optimal ovarian carcinoma: a 15-year review

A retrospectively designed classification using stage, residuum and a variable which combines prognostic information from both grade and histology (histology-grade variable) has been used at our institution to predict prognosis, and choose therapy in patients with ovarian carcinoma, stages I–III having no or small residuum. In this study, multivariate analysis of prognostic factors were performed over two time periods: Group 1 (1971–1978), contains the patients from which the original classification was derived, and Group 2 (1979–1985), contains a different cohort of patients who are used to test the validity and reproducibility of the original classification. Multivariate analysis showed that the prognostic significance of two variables changed over the two study periods: tumor grade, and residuum. It was found that in the ideal combination of grade and histologic type, when used in conjunction with stage and residuum in a prognostic classification, was unique to each patient cohort. Because of these changes, new and more accurate prognostic classifications were derived for Group 2. However, when all classifications were examined, (including the original), the differences in their ability to stratify patients into risk categories was negligible, and there was no major advantage to using one classification over another for clinical applications. Thus, the retrospectively derived prognostic classification using grade, instead of a combined histology-grade variable, in conjunction with the other significant prognostic factors (stage and residuum), is preferred for prospective application, and for its simplicity.     

Endometriosis is the independent prognostic factor for survival in Chinese patients with epithelial ovarian carcinoma

Background

Clinico-pathological characteristics and possible prognostic factors among women with epithelial ovarian carcinoma (EOC) with or without concurrent endometriosis were explored.

Method

We retrospectively identified 304 patients with EOC treated primarily at Peking Union Medical College Hospital with median follow-up time of 60 months.

Results

Of 304 patients with EOC, concurrent endometriosis was identified in 69 (22.7%). The patients with concurrent endometriosis were younger and more probably post-menopausal at onset, were less likely to have abdominal distension, with significantly lower level of pre-surgery serum Ca125 and less possibility of having the history of tubal ligation. The women with concurrent endometriosis group were more likely to have early stage tumors (88.41% versus 52.77%), receive optimal cytoreductive surgery (92.75% versus 71.06%), and less likely to have lymph node metastasis or to develop platinum resistance disease (7.25% versus 14.89%, and 7.35% versus 20%), when compared with women without coexisting endometriosis. The univariate analysis showed that concurrent endometriosis was a prognostic factor for overall survival (OS) and disease-free survival (DFS), but this association just remained in the DFS by multivariate analysis. Besides, multivariate analysis also showed that FIGO stage, residual disease, chemotherapy cycles, chemotherapy resistance and concomitant hypertension were the independent impact factors of OS for EOC patients; whereas FIGO stage, lymphadenectomy, residual disease, coexisting endometriosis and chemoresistance were independent impact factors of DFS for those patients.

Conclusions

EOC patients with concurrent endometriosis showed distinct characteristics and had longer overall survival and disease-free survival when compared with those without endometriosis. Endometriosis was the independent prognostic factor for DFS for patients in this series.

     

Five-year survival rate of postoperative ovarian cancer patients:a 15-year retrospective study

Objective:Ovarian cancer has the highest mortality rate of all gynecologic tumors. We compared the survival rate of ovarian cancer patients with different histological types and different time periods,aiming to elucidate the therapeutic effect and provide more evidence for the prevention and treatment of ovarian cancer.Methods:605 patients with ovarian cancer who underwent surgery at Qilu Hospital,Shandong University from September 1998 to August2012 were retrospectively reviewed. The 5-year survival rate was calculated in epithelial ovarian cancer(EOC)and non-epithelial ovarian cancer(Non-EOC). In addition,the patients were divided into two groups according to time at diagnosis(September 1998 to August 2007 and September 2007 to August 2012). The difference of 5-year survival rate between these two periods was compared.Results:The 5-year overall survival rate of all patients with ovarian cancer was59. 2% from September 1998 to August 2012. The survival rate of patients with EOC was lower(63. 0%)than that of Non-EOC(90. 8%). For both histological types,the 5-year survival rate of patients with localized disease(90. 8%)was significantly higher than that of patients with distant-stage(57. 6%). For different time periods,there was no significant difference in 5-year survival rate between ovarian cancer with different stages.Conclusion:Histological types and stages are closely related to survival of patients with ovarian cancer. More comprehensive clinical and follow-up information could provide convincing evidence for the prevention and treatment of ovarian cancer.     

Bowel obstruction in patients with ovarian cancer: a search for prognostic factors

Patients with concomitant ovarian cancer and bowel obstruction were studied in an effort to find objective prognostic factors predictive of patient outcome. A total of 62 patients were followed from 31 to 354 weeks, and a total of 20 variables were considered in the analyses. At the end of the study 49 patients were dead of their disease, and 13 were alive (six disease free and seven with persistent disease). Survival probabilities of the sample were 79% at 6 weeks, 48% at 20 weeks, and 24% at 104 weeks. Univariate analyses revealed no significant difference in the survival times of medically versus surgically treated patients; age greater than 60 years at diagnosis of cancer, presence of ascites, low serum albumin levels, elevated blood urea nitrogen levels, elevated alkaline phosphatase levels, lack of previous radiotherapy (p less than 0.002 for all), advanced tumor stage, normal/ileus x-ray results, and a short diagnosis to obstruction interval (p less than 0.04 for all) resulted in lower survival probabilities.     

Laparoscopic follow-up of patients with ovarian carcinoma

Laparoscopy with cytology of ascitic fluid or peritoneal washings was performed on 110 occasions in 62 patients with ovarian cancer to assess response to chemotherapy. Damage to bowel occurred on three occasions and complete visualisation of the peritoneal cavity was not possible in 14 patients. When tumour was seen and/or cytology was positive, the prognosis was poor; absence of macroscopic tumour with negative cytology did not preclude continuing disease. A group of patients was identified in whom a change of therapy based on laparoscopic findings after six months of treatment, might have proven beneficial. Laparoscopy has a limited place as a second-look procedure in patients undergoing treatment for carcinoma of the ovary.     

Long-term outcome and prognostic factors in patients with cervical carcinoma: a retrospective study

This study evaluates treatment outcomes and possible prognostic factors of inoperable cervical cancer patients treated with external beam radiotherapy (EBRT) and high-dose rate brachytherapy (HDR BRT). Between 1993 and 2000, 183 patients with cervical cancer were treated at our institute. Radiotherapy was the sole treatment modality until January 1997; after the announcement of National Cancer Institute in 1999, 40 mg/m(2) of cisplatin (49%) was routinely applied every week. Median age was 54 years (32-92 years). Most patients (88%) had advanced-stage disease (IIB-IIIB). With a median follow-up time of 45 months (6-121 months), the 5-year overall survival (OS), local recurrence-free survival, disease-free survival (DFS), and distant metastasis-free survival (DMFS) rates were 55%, 71%, 51%, and 77%, respectively. Univariate analysis revealed that age, tumor size, lymph node status, and concomitant cisplatin were prognostic factors for OS. The DFS rates were lower in young age group. Patients with tumor greater than 4 cm and age greater than 40 were at greater risk for local recurrence. Distant metastases were more frequent in patients with adenocarcinoma. Concurrent cisplatin use increases DMFS rates (91% vs 78%; P= 0.05). In multivariate analysis, extensive stage, parametrial infiltration, young age, adenocarcinoma histopathology, and lymph node metastasis were negative prognostic factors for OS while concomitant cisplatin increases OS. Likewise, patients with extensive stage, adenocarcinoma, and without concurrent cisplatin administration had more risk for distant metastasis. There was no treatment-related mortality. Grade 3-4 morbidity rates were seen only in eight patients (4%). The combination of EBRT and HDR BRT together with concomitant chemotherapy in the treatment of locally advanced carcinoma of cervix is safe and well tolerated with acceptable morbidity.     

卵巢浆液性癌三年生存预后因素的分类树分析

目的 应用分类树模型探讨影响卵巢浆液性癌3年生存的预后因素.方法 收集1991年1月-2003年12月北京大学人民医院初次收治、随诊3年并已有临床结局的81例卵巢浆液性癌患者的临床资料,采用分类与回归树(CART)软件建立分类树模型,评价预后因素.结果 采用CART软件建立的分类树模型中,年龄是影响卵巢浆液性癌3年生存的最重要的预后因素,其他预后因素包括:手术病理分期、淋巴结转移、术后残余病灶、术后化疗方法及病理分级.替代变量分析显示,手术病理分期和淋巴结转移是年龄的主要替代变量.结论 年龄、手术病理分期、淋巴结转移、术后残余病灶、术后化疗方法及病理分级是影响卵巢浆液性癌3年生存预后的主要因素.     

HSP27 in patients with ovarian carcinoma: still an independent prognostic indicator at 60 months follow-up

OBJECTIVE: Heat shock protein 27 (HSP27) is produced in response to pathophysiologic stress in animal cells. The authors have previously shown that HSP27 is an independent prognostic indicator in patients with ovarian carcinoma. The present study was performed to see whether HSP27 remained an independent prognostic indicator with longer follow-up. METHODS: One hundred and three consecutive patients with epithelial ovarian carcinoma were studied. Slides were prepared from fresh tissue. HPS27 staining was performed as previously described. Patient records were examined for FIGO stage, grade, histology, level of cytoreduction and survival. RESULTS: One hundred and three patients were followed for a mean of 60 months. Twenty patients had FIGO Stage I disease, four Stage II, 59 Stage III, and 20 Stage IV. Immunohistochemical (IHC) staining for HSP27 was not related to histologic grade, level of cytoreduction or histologic subtype. A statistically significant decrease in HSP27 staining was found to correlate with increased FIGO stage (p = 0.008). Using cox-regression analysis, HSP27 staining (p = 0.025), stage (p = 0.0012), and level of cytoreduction (p < 0.0001) were independent predictors of survival in these patients. CONCLUSION: Cox-regression analysis found HSP27 to be an independent indicator of prognosis and survival in patients with ovarian carcinoma who had longer follow-up. Decreased HSP27 staining was related to decreased survival. This study confirms the authors' earlier report on the importance of HSP27 as a prognostic indicator in ovarian carcinoma.     

MIB-1: a predictor of survival in patients with ovarian carcinoma

Geisler JP, Geisler HE, Wiemann MC, Zhou Z, Miller GA, Crabtree W. MIB-1: A predictor of survival in patients with ovarian carcinoma. Int J Gynecol Cancer 1998; 8 : 392–396.
Objective: MIB-1, a monoclonal antibody, reacts with the Ki-67 antigen, functioning as a marker of proliferation index. This study was carried out to determine whether MIB-1 staining, using image analysis, was a prognostic indicator in patients with ovarian carcinoma.
Methods: The tumors from 93 consecutive patients receiving primary surgical therapy for ovarian cancer were evaluated with MIB-1. Staining was quantified by image analysis. The patients were followed for a mean of 41 months (median, 37 months; minimum, 27 months; maximum, 68 months). Their charts were reviewed to determine survival, histologic type, grade, stage, and level of cytoreduction.
Results: Seventy-three patients had serous carcinomas, eight clear cell carcinomas, four endometrioid carcinomas, four mucinous carcinomas, two transitional carcinomas, and two undifferentiated carcinomas. Sixteen patients had stage I disease, four patients had stage II disease, 53 patients had stage III disease, and 20 patients had stage IV disease. Thirty-nine patients died within the observation period of the study. The MIB-1 staining of those patients alive at the conclusion of the study (28.3%) was significantly less than the MIB-1 staining of those who died (42.6%) ( P < 0.001). No patient whose tumor had MIB-1 staining of less than 22.0% died during the observation period of the study. MIB-1 staining less than 22.0% ( P = 0.020), FIGO stage ( P = 0.025), and the level of cytoreduction ( P = 0.0006) were independent predictors of survival.
Conclusion: In this series of 93 patients with ovarian carcinoma, MIB-1 monoclonal antibody staining was shown to be an independent prognostic indicator of survival. No patient whose tumor stained less than 22% positive nuclear area for MIB-1 died of her ovarian carcinoma.     

Polycystic ovarian morphology and bulimia nervosa: a 9-year follow-up study

OBJECTIVE: To examine long-term changes in polycystic ovarian morphology in women with polycystic ovaries and bulimia nervosa after treatment of the latter condition. DESIGN: Longitudinal follow-up study. SETTING: Eating disorder unit of a university hospital. PATIENT(S): Eight women originally treated for bulimia nervosa (T(0)) who underwent ultrasonography up to 2 years after treatment (T(1)) and had a second ultrasonographic scan 9 years later (T(2)). INTERVENTION(S): Treatment of bulimia nervosa that combined cognitive behavioral therapy with insight-orientated psychotherapy. MAIN OUTCOME MEASURE(S): Ovarian morphology evaluated by ultrasonography, using the criteria of Adams to define polycystic ovaries; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of eating disorders. RESULT(S): At T(1), 7 women had recent bulimia and 1 was quiescent. The woman with quiescent disease had normal ovaries. Of the 7 bulimic women, 6 had polycystic ovaries and 1 had multifollicular morphology. At T(2), 5 women were bulimic, all of whom had polycystic ovaries. Three women had normal eating patterns and normal ovarian morphology. CONCLUSION(S): This study clearly shows a strong association between resolution of bulimia and changes in ovarian morphology, suggesting that changes in the former mirror changes in the latter. It also demonstrates normalization of ovarian morphology in previously polycystic ovaries.     

Elevated platelet count in patients with endometrial carcinoma: correlation with selected prognostic factors and with survival

Platelets may play a role in the metastatic process and, among gynecologic malignancies, thrombocytosis has been reported in cervical and ovarian malignancy. The present study was conducted in order to assess the prevalence of thrombocytosis in endometrial carcinoma and to correlate platelet count with prognostic factors and with survival. The prevalence of preoperative thrombocytosis was assessed in 66 endometrial carcinoma patients and their platelet count was correlated with selected prognostic factors and with projected survival. The prevalence of thrombocytosis ( 400 000 µL⁻¹) was low (one of 66 patients) compared with that in cervical and ovarian carcinoma. Nevertheless, a significant ( P = 0.032) correlation was found between an elevated ( 300 000 µL⁻¹) platelet count and unfavorable grade of differentiation. Patients with an elevated count also had a poorer survival rate and a higher prevalence of older age, high stage and deep myometrial invasion, but this trend did not reach statistical significance. The combination of unfavorable grade and an elevated platelet count had a higher specificity and positive predictive value for deep myometrial invasion than unfavorable grade alone. The prevalence of thrombocytosis in endometrial carcinoma is low. An elevated platelet count may have some prognostic significance, but its ultimate role in endometrial carcinoma remains to be elucidated.     

卵巢上皮性癌的预后影响因素分析

目的 探讨卵巢上皮性癌(卵巢癌)的预后影响因素.方法 回顾性分析2002年1月至2005年12月在山西省肿瘤医院初诊的卵巢癌患者的临床病理资料.结果年龄、分期、病理类型、病理分化程度、术后残余瘤的大小以及术后化疗疗程数是卵巢癌的预后因素(P<0.01).以Ⅳ期患者的死亡风险为1,则Ⅰ期、Ⅱ期、Ⅲ期患者的死亡风险分别为0.005、0.106、0.361,95% CI分别为0.001～0.024、0.038～0.297、0.181～0.718(P<0.01);以术后残余瘤直径>2 cm患者的死亡风险为1,则残余瘤直径≤2 cm患者的死亡风险仅为0.307,95% CI为0.176～0.536(P<0.01);术后化疗疗程数<6个疗程患者的死亡风险为≥6个疗程者的8.191倍,95% CI为4.666～14.379(P<0.01).是否有恶性肿瘤家族史对卵巢癌预后无影响(P>0.05).结论 分期、术后残余瘤的大小、术后化疗的疗程数是卵巢痛的独立预后影响因素.尽力做到早诊断、早治疗,术后辅以正规、足疗程的化疗是提高卵巢癌生存率的关键.     

Prognostic factors for outcome of and survival after second-look laparotomy in patients with advanced ovarian carcinoma

In ovarian cancer stages IIB-IV, pre-treatment variables and variables obtained intraoperatively at second-look laparotomy were investigated for their prognostic influence on the outcome of 109 patients and survival after second-look laparotomy in 131 patients. The subjects came from a randomized trial of sequential versus alternating combination chemotherapy. The overall median survival after second-look laparotomy was 62 months. Logistic regression analysis identified stage and hysterectomy plus bilateral salpingo-oophorectomy and omentectomy as significant prognostic covariates for second-look laparotomy outcome. Based on a Cox multivariate stepwise analysis, independent prognostic factors for survival after second-look laparotomy were secondary residual tumor size, pre-treatment histologic differentiation grade, and performance status. A high differentiation grade and a good performance status at the start of therapy thus still had a prolonging effect on survival after second-look laparotomy. The prognostic power of these pre-treatment variables was increased substantially by the addition of the secondary residual tumor size variable. The 3-year survival rate after second-look laparotomy for high- and low-risk patients was 15 and 87%, respectively. Second-look laparotomy thus provides prognostic information in patients with advanced ovarian carcinoma, but the benefit in terms of survival is still unclear.     

Quantitative pathological variables as prognostic factors for overall survival in Danish patients with FIGO stage III ovarian cancer

Earlier studies have shown the strong prognostic value of the mitotic activity index (MAI), volume percent of epithelium (VPE), mean nuclear area (MNA) and the standard deviation of the nuclear area (SDNA) in early and advanced ovarian cancer. In one study of Danish patients however, these features were not significant and methodological causes were excluded as a cause of this. Therefore, we have re-evaluated these features in another group of 112 Danish patients with FIGO stage III ovarian cancer who were treated with debulking surgery followed by cisplatin combination chemotherapy. Thirty-seven patients (33%) survived. In survival analysis residual disease status, performance status, peritoneal carcinomatosis, histologic grade, age and the presence or absence of ascites had significant influence on the eventual clinical outcome. Of the quantitative pathologic features the MAI, MNA, SDNA were correlated with grade, but had stronger prognostic value than grade. Residual disease status, performance status at diagnosis, peritoneal carcinomatosis, the MNA and the SDNA were the best single prognostic variables ( P < 0.00001). With multivariate analysis residual disease status, MNA and age had independent additional value (grade was not selected once these more significant features were included). With this combination (called F3MS) four prognostically important groups could be distinguished (MC = 61.7, P < 0.00001). Survival in the most favourable F3MS group ( n = 28) was 71% (median survival time 84 months), while in the worst group ( n = 29) none of the patients survived and the median survival time in this group was only 13 months (Relative Risks (RR) = 3.50). It is concluded that morphometric variables have important value in predicting prognosis in patients with FIGO stage III ovarian cancer and add to the classical prognostic factors of residual disease status and age.