Abnormal fragile histidine triad (Fhit) expression in invasive cervical adenocarcinoma: association with tumor aggressiveness

The fragile histidine triad (FHIT) gene is a candidate tumor suppressor gene. Aberrant expression of the encoded protein and inactivation of FHIT correlate with several clinicopathological parameters in various tumor types, including cervical cancer, but Fhit expression has rarely been studied in cervical adenocarcinoma. We assessed Fhit protein expression in 35 surgical specimens of invasive adenocarcinomas of the uterine cervix and investigated whether expression alteration on immunohistochemistry staining is associated with important clinicopathological features. Considerably reduced or absent Fhit staining was observed in 11 cancers (31.4%). By univariate analysis, Fhit protein expression was significantly associated with nodal status (P = .002), histologic grade (P = .000), and International Federation of Gynecology and Obstetrics stage (P = .032). Depth of invasion, tumor size, or parametrial invasion did not show important association with Fhit. Lymph node status, International Federation of Gynecology and Obstetrics stage, and histologic grade are known prognostic factors of cervical adenocarcinoma, and Fhit status on immunohistochemistry staining demonstrated significant association with tumor aggressiveness. Staining of biopsy specimens for Fhit is worthy of study as a prognostic tool.     

Sarcopenia as a Predictor of Prognosis in Early Stage Ovarian Cancer

BackgroundTo identify sarcopenia as a predictive prognostic factor of ovarian cancer in terms of survival outcome in patients with early-stage ovarian cancer.MethodsData of Konkuk University Medical Center from March 2002 to December 2017 were reviewed retrospectively. Eighty-two patients who underwent surgery due to early-stage (International Federation of Gynecology and Obstetrics stage I/II) ovarian cancer and had computed tomography (CT) images taken at the initial diagnosis were included. The initial CT scan images were analyzed with SliceOmatic software (TomoVision). A sarcopenia cutoff value was defined as a skeletal muscle index of ≤ 38.7 cm²/m². Overall survival (OS) times were compared according to the existence of sarcopenia, and subgroup analyses were performed.ResultsA Kaplan-Meier analysis showed a significant survival disadvantage for patients with early-stage ovarian cancer when they had sarcopenia (P < 0.001; log-rank test). Sarcopenia remained a significant prognostic factor for OS in early-stage ovarian cancer, in a Cox proportional hazards model regression analysis (HR, 21.9; 95% CI, 2.0–199.9; P = 0.006).ConclusionThis study demonstrated that sarcopenia was predictive of OS in patients with early-stage ovarian cancer. Further prospective studies with a larger number of patients are warranted to determine the extent to which sarcopenia can be used as a prognostic factor in ovarian cancer.     

Insulin-like growth factor-I receptor and PTEN protein expression in endometrial carcinoma. Correlation with bax and bcl-2 expression,microsatellite instability status,and outcome

We immunohistochemically analyzed 89 endometrial carcinomas for insulin-like growth factor-I receptor (IGF-IR) and PTEN (phosphatase and tensin homolog deleted on chromosome 10) expression. Results were compared with clinicopathologic factors, bcl-2 and bax expression, microsatellite instability (MSI) status, and prognosis. Increased expression of IGF-IR and bcl-2 (> 50% cells) was seen in 60 cases (67%) and 15 cases (17%), respectively; loss of PTEN was seen in 13 cases (15%) and of bax in 11 cases (12%). No significant correlation was observed between the proteins or with clinicopathologic factors. Loss of PTEN was more frequent in MSI-positive tumors (4/10 [40%]) than in negative tumors (9/79 [11%]; P = .016). Longer survival was observed for patients with endometrioid tumors, International Federation of Gynecology and Obstetrics stage I or II tumors, grade 1 tumors, superficial myometrial infiltration (< or = 50%), less than 5% necrosis, no vascular invasion, or low level IGF-IR (< 10% of cells) (P < or = .05). Cox analysis showed independent value only for stage, grade, type, and lymph-vascular invasion (P < .05). Our data demonstrate that IGF-IR overexpression occurs in a subset of endometrioid carcinomas, which has potential prognostic value, while loss of PTEN often is associated with the MSI phenotype.     

蛋白激酶CK2α在人子宫内膜腺癌中的表达及意义

目的探讨蛋白激酶CK2α在子宫内膜腺癌中的表达及其临床意义。方法 36例人子宫内膜腺癌和癌旁正常组织标本,其患者年龄44~67岁,中位年龄57.5岁。子宫内膜腺癌按2000年国际妇产科联盟(FIGO)分期标准进行临床分期:Ⅰ期19例(其中肌层浸润≤1/2为11例,>1/2为8例),Ⅱ期9例,Ⅲ、Ⅳ期8例。组织学分级按2000年FIGO子宫内膜腺癌3级分类法:Ⅰ级11例,Ⅱ级15例,Ⅲ级10例。采用逆转录聚合酶链反应及免疫组织化学方法检测癌组织标本和其癌旁正常组织中CK2αmRNA及蛋白表达水平,分析CK2α蛋白表达与子宫内膜腺癌临床病理特征之间关系。结果 CK2αmRNA在子宫内膜腺癌组织中表达量明显高于癌旁正常组织,而CK2α蛋白在子宫内膜腺癌组织中表达阳性率亦明显高于癌旁正常组织,但CK2α蛋白表达与临床分期、组织学分级及肌层浸润程度无关。结论 CK2α表达或活性增加与子宫内膜腺癌发生密切相关,CK2α可能是治疗子宫内膜腺癌的潜在分子靶点。     

Clinicopathological correlation and prognostic significance of sonic hedgehog protein overexpression in human gastric cancer

Objectives: This study investigated the expression of Sonic Hedgehog (Shh) protein in gastric cancer, and correlated it with clinicopathological parameters. The prognostic significance of Shh protein was analyzed. Methods: Shh protein expression was evaluated in 113 cases of gastric cancer and 60 cases of normal gastric mucosa. The immunoreactivity was scored semi quantitatively as: 0 = absent; 1 = weak; 2 = moderate; and 3 = strong. All cases were further classified into two groups, namely non-overexpression group with score 0 or 1, and overexpression group with score 2 or 3. The overexpression of Shh protein was correlated with clinicopathological parameters. Survival analysis was then performed to determine the Shh protein prognostic significance in gastric cancer. Results: In immunohistochemistry study, nineteen (31.7%) normal gastric mucosa revealed Shh protein overexpression, while eighty-one (71.7%) gastric cancer revealed overexpression. The expression of Shh protein were significantly higher in gastric cancer tissues than in normal gastric mucosa (P < 0.001), which was statistically correlated with age (P = 0.006), tumor differentiation (P < 0.001), depth of invasion (P = 0.042), pathologic staging (P = 0.017), and nodal metastasis (P = 0.019). We found no significant difference in both overall and disease free survival rates between Shh overexpression and non-expression groups P = 0.168 and 0.071). However, Shh overexpression emerged as a significant independent prognostic factor in multivariate Cox regression analysis (hazard ratio 1.187, P = 0.041). Conclusions: Shh protein expression is upregulated and is statistically correlated with age, tumor differentiation, depth of invasion, pathologic staging, and nodal metastasis. The Shh protein overexpression is a significant independent prognostic factor in multivariate Cox regression analysis in gastric cancer.     

High TRIM44 expression in endometrial carcinoma is associated with a poorer patient outcome

Background

Tripartite motif‐containing protein 44 (TRIM44) has been recently identified as a novel oncogene that is overexpressed in several types of human cancers; however, its role in endometrial cancer (EC) remains unknown. The purpose of the current study was to investigate the TRIM44 protein expression and clinicopathological significance of TRIM44 in EC.

Lymph Node Ratio Is a Strong Prognostic Factor in Patients with Early-Stage Cervical Cancer Undergoing Minimally Invasive Radical Hysterectomy

PurposeTo determine whether the prognostic impact of lymph node ratio (LNR), defined as the ratio between the number of positive lymph nodes and removed lymph nodes, differs between open and minimally invasive surgical approaches for radical hysterectomy (RH) in node-positive, early-stage cervical cancer.Materials and MethodsWe retrospectively identified 2009 International Federation of Gynecology and Obstetrics stage IB1-IIA2 patients who underwent primary type C RH between 2010 and 2018. Among them, only those with pathologically proven lymph node metastases who received adjuvant radiation therapy were included. The prognostic significance of LNR was investigated according to open surgery and minimally invasive surgery (MIS).ResultsIn total, 55 patients were included. The median LNR (%) was 9.524 (range, 2.083–62.500). Based on receiver operating characteristic curve analysis, the cut-off value for LNR (%) was determined as 8.831. Overall, patients with high LNR (≥8.831%; n=29) showed worse disease-free survival (DFS) than those with low LNR (<8.831%, n=26) (p=0.027), whereas no difference in overall survival was observed. Multivariate analyses adjusting for clinicopathologic factors revealed that DFS was adversely affected by both MIS [adjusted hazard ratio (HR), 8.132; p=0.038] and high LNR (adjusted HR, 10.837; p=0.045). In a subgroup of open surgery cases, LNR was not associated with disease recurrence. However, in a subgroup of MIS cases, high LNR was identified as an independent poor prognostic factor for DFS (adjusted HR, 14.578; p=0.034).ConclusionIn patients with node-positive, early-stage cervical cancer, high LNR was associated with a significantly higher disease recurrence rate. This relationship was further consolidated among patients who received MIS RH.     

Immunohistochemical expression and prognostic relevance of Bmi-1, a stem cell factor,in epithelial ovarian cancer

Ovarian cancer is the fourth most common cause of cancer-related death in women. Bmi-1 is a stem cell factor implicated in many human malignancies with poor outcome. Few published reports on the expression of Bmi-1 in epithelial ovarian cancer were either experimental or performed on cell lines. This study evaluates the immunohistochemical expression of Bmi-1 protein in epithelial ovarian cancer tissue specimens and its relevance to the clinicopathologic prognostic variables and patient survival. Forty cases of epithelial ovarian cancer were selected according to the availability of paraffin-embedded tissue and the clinicopathologic and survival data. Immunohistochemistry was performed for anti–Bmi-1 antibody. Low and high Bmi-1 expression groups were compared with age, tumor stage, laterality, grade, histology, and patient survival. Bmi-1 expression was detected in 72.5% of cases, of which 42.5% had high expression. High Bmi-1 expression strongly associated with advanced International Federation of Gynecology and Obstetrics stages (P = .007), bilaterality (P = .01), and higher Gynecologic Oncology Group grades (P = .031) and carcinomas of serous histology (P = .027). It had no association with patient age. Bmi-1 expression displayed a significant inverse association with patient overall and mean survival (P = .006, P < .001). These observations suggested correlation between increased Bmi-1 expression and clinical progression in ovarian epithelial cancer.     

Cytoplasmic Maspin Expression Correlates with Poor Prognosis of Patients with Adenocarcinoma of the Uterine Cervix

Background

Maspin is known to be a tumor suppressor protein and its prognostic significance in patients with several types of cancer has been reported. To date, however, no study has focused on the association between maspin expression and the prognosis of patients with adenocarcinoma of the uterine cervix. We explored the prognostic value of maspin expression with particular reference to its subcellular localization in patients with adenocarcinoma of the uterine cervix.

Methods

Paraffin-embedded tissue samples from 46 patients diagnosed as adenocarcinoma of the uterine cervix were immunohistochemically analyzed using an antibody for maspin. The patients were followed up for 3 to 165 months (median: 64.2 months) and the prognostic value was evaluated by the log-rank test and the Cox regression hazard model.

Results

A sample was considered maspin-positive if maspin was expressed in only the cytoplasm; 69.6% (32 cases) of the specimens were maspin-positive, and there was significant correlation between positivity and recurrence (P = 0.022). Maspin-positive patients had both shorter disease free survival and shorter overall survival by the log-rank test (P = 0.023, P = 0.043, respectively). By Cox’s multivariate analysis, the International Federation of Obstetrics and Gynecology (FIGO) status was the only independent prognostic factor for disease free survival and overall survival in patients with adenocarcinoma of the uterine cervix.

Conclusion

This is the first report to reveal an association between cytoplasmic maspin expression and the prognosis of patients with adenocarcinoma of the uterine cervix. Although further studies with a larger series of patients and a longer follow up period are necessary, the present results suggest that cytoplasmic maspin expression could be an indicator of unfavorable prognosis in patients with adenocarcinoma of the uterine cervix.     

Lymphovascular space invasion does not predict vaginal relapses in stage I endometrioid adenocarcinoma of the endometrium

This study was conducted to determine whether, in a pure population of patients with International Federation of Gynecology and Obstetrics stage I endometrioid endometrial (S1EE) carcinoma that is confined to the uterus and without lymph node metastases, the presence of lymphovascular space invasion (LVSI) is positively associated with vaginal relapses. Pathologic reports for all S1EE diagnosed in a hysterectomy specimen during a 9-year period (1997-2005) were reviewed. Cases with LVSI were selected and immunohistochemical staining for CD34, factor VIII-related antigen and pancytokeratin were performed on the relevant slides for confirmation. Various established prognostic/predictive clinicopathologic parameters were documented for the whole cohort and were correlated with the presence or absence of LVSI. One-way analysis of variance with Bonferroni correction and Fisher exact/chi(2) tests were used in the respective comparisons of continuous and categoric variables among the different groups. A total of 345 patients were diagnosed with S1EE during this period. The mean patient age for the cohort was 61.9 (+/-12.2) years (range, 28-89 years) and median follow-up was 80 months. Among these 345 patients, LVSI was present in 52 (15%), representing 1 (0.8%) of 121 stage 1A, 23 (14.5%) of 159 stage 1B, and 28 (43%) of 65 stage 1C cases (P < .001). Pelvic and/or para-aortic lymph node dissection was performed in 216 cases, and none had positive lymph nodes. We noted that LVSI correlated significantly with nuclear grade, with LVSI being present in 48% (10/21), 18% (32/175), and 5% (7/140) of cases with nuclear grades 3, 2, and 1 cases, respectively (P < .001). It was also more likely to be present in cases with architectural grades 2 and 3 (35/105) than grade 1 (16/234) (P < .01). Vaginal recurrences occurred in 2 (3.8%) of 52 patients with LVSI and 8 (2.7%) of 293 patients without LVSI (P = .65). In addition, on univariate analysis, LVSI did not correlate significantly with patient age, body mass index (using 50-year and 30 body mass index thresholds, respectively), or diabetic status. We conclude that LVSI is seen in approximately 15% of S1EE, and correlates with established prognostic parameters such as the level of myometrial invasion (substage), nuclear grade, and architectural grade. However, LVSI does not denote an increased likelihood of vaginal recurrences in S1EE. The presence of LVSI should not, in of itself, alter clinical staging, or trigger unnecessary therapeutic intervention.     

Ki-67 reactivity in primary fallopian tube cancers

Forty-four cases of primary cancer of the fallopian tube (PFTC) were analyzed as to Ki-67 expression, grade, stage and the cancer histological type. Among patients with an average age of 57.5 years (range 38-70 years), 27 patients were FIGO I, 7 were FIGO II and 10 were FIGO III. Histological classification of PFTC revealed 18 cases of endometrioid type, 9 serous, 7 undifferentiated, 6 urothelial, 2 clear-cell and 2 of other type. Histological grading revealed 11 cases of G1, 16 of G2 and 17 of G3 tumors. The quantity of Ki-67 positive cells was counted on 300 cancer cells in random high-power fields (10 x 40) and recorded as the labeling index (LI, %). Positive staining for Ki-67 was shown in the nuclei in all cases. Ki-67 LI values ranged from 14.2 to 97.2% (median 36.1). Ki-67 LI values were graded as > or = 36.1% as high and <36.1% as low. We did not find any significant differences in Ki-67 LI values among tumors of various clinical stages, histological grades and histological types. The p value was statistically significant only for stage as a prognostic factor.     

血小板计数及纤维蛋白原水平与卵巢上皮性癌临床病理因素的相关性及其对预后的影响

目的:研究血小板计数及纤维蛋白原(fibrinogen,FIB)水平与卵巢上皮性癌临床病理因素之间的相关性及其对预后的影响.方法:选取2012年6月至2016年6月在连云港妇幼保健院住院手术的卵巢上皮性肿瘤患者297例,其中卵巢上皮性癌患者137例,卵巢上皮性良性肿瘤患者160例作为对照.回顾性分析卵巢上皮性癌患者的临床病理资料以及良性肿瘤患者的年龄、术前血常规、凝血功能,术后病理资料等.计算血小板及FIB增多在卵巢良恶性肿瘤中的发生率,以及其与卵巢上皮性癌患者临床病理因素之间的相关性;所有卵巢上皮性癌患者随访至2017年6月,计算其总生存期(overall survival,OS)及无进展生存期(progress-free survival,PFS),分析血小板及FIB增多与其预后的关系.结果:卵巢上皮性癌患者血小板及FIB含量显著高于卵巢良性肿瘤患者,差异有统计学意义(P<0.05).FIGO手术-病理分期越晚、分化程度越低、腹水量越多、术后残留肿瘤越大、术前CA125水平越高、术前肿瘤体积越小的患者合并血小板增多的发生率越高(P<0.05);FIB增多与FIGO手术-病理分期、腹水量、术后残留肿瘤大小及术前CA125水平有一定的相关性(P<0.05).血小板增多是卵巢上皮性癌患者PFS的独立不良预后因子(P<0.05).FIB增多与卵巢上皮性癌患者的预后无相关性.结论:血小板及FIB增多是卵巢上皮性癌常见现象之一,这可能与肿瘤的侵袭、转移相关;血小板增多是卵巢上皮性癌不良预后的危险因子.     

Stromelysin-3 expression in invasive ovarian carcinomas and tumours of low malignant potential

Stromelysin (ST)-3 is considered to be a marker of invasion and preinvasive lesions to indicate the likelihood of subsequent invasion. The expression of ST-3 has not been systematically studied in ovarian neoplasms. We studied 47 ovarian carcinomas and 49 ovarian tumours of low malignant potential (LMP) to see whether the expression of ST-3 correlated with any histopathologic features and, in the LMP tumours, whether its expression might be a prognostic indicator. All of the primary tumours and available metastases or implants were studied using immunohistochemistry (IHC) for ST-3 and, in 52 selected lesions, in situ hybridisation (ISH) using a cDNA probe. Expression of ST-3 was seen in 42 of 47 (89%) of the carcinomas and in 16 of 49 (33%) of the LMP cases. A significantly higher percentage of carcinomas than LMP tumours (P<0.00001) expressed ST-3 in the stroma adjacent to the tumour, with a correlation to increasing FIGO (International Federation of Gynecology and Obstetrics) tumour stage. ST-3 was expressed in the surrounding stroma of 1 of 8 LMP implants and 46 of 55 (84%) of the carcinoma metastases. The single LMP patient who died of tumour recurrence had ST-3 expression, but a significant prognostic impact was not found. The infrequent expression of ST-3 in LMP compared with carcinoma metastases appears to be more consistent with a peritoneal "field effect" than spread from the ovarian LMP tumour.     

The value of cystoscopy and intravenous urography after magnetic resonance imaging or computed tomography in the staging of cervical carcinoma.

The clinical staging system for cervical carcinoma presently recommended by the International Federation of Gynecology and Obstetrics (FIGO) does not include MRI or CT findings and thus suffers limited accuracy. Recently however, the positive contributions of MRI and CT to preoperative staging have been reported. This study involves a determination of the value of routine cystoscopy and intravenous urography, in the detection of bladder invasion or hydronephrosis resulting from cervical carcinoma, among patients who had undergone MRI or CT. Among a total 296 patients with cervical carcinoma, 271 patients (92%) had undergone MRI and 25 (8%) CT. Bladder invasion was identified pathologically by cystoscopic biopsy in 8 (57%) of the 14 patients with suspected bladder invasion on MRI or CT. There was no bladder invasion in any of the other cases lacking in bladder invasion evidence on MRI or CT. Hydronephrosis was identified by intravenous urography in 18 patients, as it also was in all of these cases on MRI or CT, confirming a negative predictive value for MRI or CT, in detecting bladder invasion or hydronephrosis from cervical carcinoma, of 100%. Therefore, although MRI or CT cannot totally replace cystoscopy, the latter is unnecessary in the absence of bladder invasion evidence on MRI or CT. Intravenous urography, however, can be safely omitted whenever MRI or CT is performed.     

Upstaging based solely on positive peritoneal washing does not affect outcome in endometrial cancer.

Surgical staging of endometrial carcinoma includes the collection of peritoneal washings in the abdomen and pelvis. A positive finding upstages patients to International Federation of Gynecology and Obstetrics stage IIIA. However, the prognostic significance of such an upstaging, and thus the justification for the routine performance of this procedure, is unclear. This 5-year retrospective study was conducted to determine the frequency and prognostic significance of upstaging of endometrial carcinoma based solely on positive washings. The cohort for the study was collected by review of pathology reports of all washings that were performed prior to hysterectomies for suspected endometrial carcinomas over a 5-year period (01/1995-12/1999). Cases with positive cytology were selected if there was no grossly apparent intraperitoneal disease, no histologic evidence of extra-uterine tumor and the cases would otherwise have been considered stage I or II (case group). An age-matched control group was selected of stage I and II patients with the same histologic subtypes and negative washings (n=19). Of 220 endometrial carcinomas, peritoneal washing cytology was abnormal in 19 (8.6%) and was solely responsible for upstaging only 10 patients (4.5% of all cases, eight-endometrioid, one-serous, one-mixed; nine stage IA or IB and one stage IIB). Adjuvant therapy was administered in 90% of the case group and 74% of the control group. After a median follow-up of 51 months (case group) and 63 months (control group), we found only a single patient with progression of disease (recurrence, metastases or death) in the control group. It is concluded that abnormal cytology without other evidence of extrauterine disease leads to upstaging of a minority of endometrial carcinoma patients (4.5%), but does not appear to affect their overall outcome. Although this is a small single site study, it raises questions about the value of this procedure in patients with endometrial cancer.     

Prognostic and predictive values of Nrf2, Keap1, p16 and E-cadherin expression in ovarian epithelial carcinoma

Objectives: Despite considerable interest in the Nuclear factor-erythroid 2-related factor 2 (Nrf2)/Kelch-like ECH-associated protein-1 (Keap1), p16 and epithelial cadherin (E-cadherin) activation in carcinoma progression, contradictory results regarding association of Nrf2/Keap1/E-cadherin and p16 expression with clinico-pathological features and prognosis have been reported. The predictive value of these markers in ovarian carcinoma is unknown. Methods/Materials: In this retrospective study, 108 cases were evaluated immunohistochemically with antibodies to Nrf2, Keap1, estrogen receptor (ER), p16 and E-cadherin. The results were compared with histological and clinical data, disease-free survival (DFS) and overall survival (OS). Results: A cohort of 108 ovarian carcinomas (47 serous, 23 mucinous, 13 endometrioid and 25 clear cell), including 68 FIGO stage I-II cases and 40 FIGO stage III-IV cases was studied. The age of patients (P=0.005), FIGO stage (P<0.001), immunohistochemical expression of Keap1 (P<0.000), E-cadherin (P=0.045), p53 (P=0.003), p16 (P<0.001) and ER (P=0.004) were significant factors between different histological subtypes. Patients with serous carcinoma were older in age, presented with more advanced stage disease, worst prognosis, highest Keap1 expression and least percentage of E-cadherin immunoreactivity. In univariate analysis, FIGO staging (P=0.000 for DFS; P=0.000 for OS), Nrf2 (P=0.010 for DFS; P=0.001 for OS), and p16 (P=0.004 for DFS; P=0.019 for OS) were associated with worse prognosis. After multivariate analysis, FIGO staging and Nrf2 remained significance prognostic factors. Conclusions: There were differences in the expression of Nrf2, Keap1, p16 and E-cadherin between different ovarian carcinoma subtypes. In multivariate analysis, FIGO stage and Nrf2 expression were associated with poorer DFS and OS.     

Hysterosalpingography: a potential alternative to laparoscopy in the evaluation of tubal obstruction in infertile patients?

BackgroundEvaluation of the fallopian tubes are important for infertile patients. The two most important diagnostic procedures used to evaluate tubal patency are hysterosalpingography and laparoscopy.ObjectivesTo asses the hysterosalpingography and laparoscopy results of patients diagnosed with infertility and investigate the diagnostic value of hysterosalpingography in patients with tubal factor infertility.MethodsThe hysterosalpingography and laparoscopy results of 208 patients who presented to the Obstetrics and Gynecology Clinic at Dicle University, Faculty of Medicine between January 2014- January 2018 were retrospectively evaluated. Hysterosalpingography and laparoscopy results were compared with regard to the investigation of the presence of tubal obstruction and of the pelvic structures that could cause tubal obstruction. The specificity, sensitivity, positive, and negative predictive values of hysterosalpingography were computed.ResultsThe number of patients evaluated was 208. The ratio of primary infertile patients was 57.2% and 42.8% was secondary infertile. Hysterosalpingography was found to have a specificity of 64.6%, the sensitivity of 81.3%, the positive predictive value of 56.4%, and a negative predictive value of 86% in the determination of tubal obstruction.ConclusionPatients with suspected tubal infertility can primarily be examined using hysterosalpingography in consideration of the invasive nature and the higher complication rate of laparoscopy.     

AROS Is a Significant Biomarker for Tumor Aggressiveness in Non-cirrhotic Hepatocellular Carcinoma

Despite a low risk of liver failure and preserved liver function, non-cirrhotic hepatocellular carcinoma (HCC) has a poor prognosis. In the current study, we evaluated an active regulator of SIRT1 (AROS) as a prognostic biomarker in non-cirrhotic HCC. mRNA levels of AROS were measured in tumor and non-tumor tissues obtained from 283 non-cirrhotic HCC patients. AROS expression was exclusively up-regulated in recurrent tissues from the non-cirrhotic HCC patients (P = 0.015) and also in tumor tissues irrespective of tumor stage (P < 0.001) or BCLC stage (P < 0.001). High mRNA levels of AROS were statistically significantly associated with tumor stage (P < 0.001), BCLC stage (P = 0.007), alpha fetoprotein (AFP) level (P = 0.013), microvascular invasion (P = 0.001), tumor size (P = 0.036), and portal vein invasion (P = 0.005). Kaplan-Meir curve analysis demonstrated that HCC patients with higher AROS levels had shorter disease-free survival (DFS) in both the short-term (P < 0.001) and long-term (P = 0.005) compared to those with low AROS. Cox regression analysis demonstrated that AROS is a significant predictor for DFS along with large tumor size, tumor multiplicity, vascular invasion, and poor tumor differentiation, which are the known prognostic factors. In conclusion, AROS is a significant biomarker for tumor aggressiveness in non-cirrhotic hepatocellular carcinoma.     

Problematic issues in the staging of endometrial,cervical and vulval carcinomas

The International Federation of Gynecology and Obstetrics (FIGO) staging of tumours of the uterine corpus, cervix and vulva was revised in 2009. The greatest impact of the revised staging was on carcinomas of the uterine corpus. Uterine sarcomas are now staged separately. Changes to the staging system for vulvar carcinomas largely reflect the significance of lymph node status. Only minor amendments have been introduced for cervical carcinomas, which remain the only gynaecological tumours to be staged clinically. These revisions, based on recent evidence, require careful, more detailed assessment of several histological parameters at each anatomical site. The present review deals with the evidence and rationale underpinning the revisions, and includes practical guidance on tumour staging. This covers the assessment and measurement of myoinvasion and evaluation of cervical, parametrial, serosal and vaginal involvement in carcinomas of the uterine corpus; the identification and accurate measurement of stromal invasion in cervical and vulvar carcinomas; the assessment of unusual variants of carcinoma at each of these sites; and the assessment of lymph node involvement.     

Expression of Tim-3 in gastric cancer tissue and its relationship with prognosis

As a negative regulatory molecule, T-cell immunoglobulin–and mucin domain-3 (Tim-3) plays a crucial role in the tumor immunological tolerance. In the present study, we aimed to determine the Tim-3 expression in gastric cancer tissue and its relationship with clinicopathological parameters and prognosis. The Tim-3 expression was assessed in 52 gastric cancer specimens and 15 gastritis tissues by flow cytometry, and gastritis tissues served as the control. As a result, we found that the Tim-3 expressions on CD4⁺T cells and CD8⁺T cells in gastric cancer tissue was significantly higher than those in gastritis tissue (P=0.022, P=0.047, respectively). The median expression level of Tim-3 on CD4⁺T cells were significantly correlated with clinicopathological parameters, such as tumor size, lymph node metastasis, the depth of tumor invasion and TNM staging (P=0.042, P=0.026, P=0.001, P=0.003, respectively), while it was not correlated with sex, age and histological subtype (all P>0.05). In CD8⁺T cells, the Tim-3 expression was relevant to tumor invasion and TNM staging (P=0.035, P=0.017, respectively), while it was irrelevant to other clinicopathological parameters (all P>0.05). Additionally, Kaplan-Meier survival curves showed that the median overall survival time of patients with lower Tim-3 expression was greater than that of patients with higher Tim-3 expression in CD4⁺T cells and CD8⁺T cells (χ²=18.036, P<0.001 and χ²=18.036, P<0.001, respectively). Moreover, the multivariate analysis revealed that the Tim-3 expression and TNM stage were independent prognostic factors for gastric cancer patients (P=0.029, P=0.043 and P=0.003, respectively). These results suggest that Tim-3 played an important role in the development and progression of gastric cancer, and it could be used as an independent prognostic factor for gastric cancer patients.