Evaluating the significance of location of lymph node metastasis and extranodal disease in women with stage IIIC endometrial cancer

Objective

To determine the prognostic significance of location of lymph node metastasis and extranodal disease for women with stage IIIC endometrial cancer.

Methods

Data were extracted from the Surveillance, Epidemiology, and End Results database between 1988 and 2005. Statistical analysis used Chi-square test, Kaplan–Meier method, and Cox proportional hazards model.

Results

A total of 2559 women were identified; 1453 stage IIIC1, and with 906 stage IIIC2 tumors. Compared to stage IIIC1; more stage IIIC2 patients demonstrated high-risk factors such as grade III disease (p < 0.001), unfavorable histologic types (p = 0.01), concurrent disease at other extrauterine sites (p < 0.001), and greater than two positive lymph nodes (p < 0.001). While the 5-year disease specific survival was comparable (p > 0.05) among node positive patients found to have positive peritoneal cytology (44.0%), adnexal/serosal metastasis (42.9%), and vaginal/parametrial involvement (41.8%); it differed individually in all three categories from those with nodal metastasis alone (67.0%, p < 0.001). Among women with extranodal disease, the location of nodal metastasis had no effect on survival (HR = 0.92; 95% CI, 0.74–1.14). For women with node only stage IIIC tumors, those patients with positive para-aortic nodes were more likely to die from their tumors (HR = 1.40; 95% CI, 1.12–1.75).

Conclusion(s)

Location of lymph node metastasis is prognostic in patients with nodal disease alone, and not in those with extranodal disease. Extranodal disease is associated with a poor prognosis and should be regarded in conjunction with location of lymph node metastasis for risk-stratification in stage IIIC endometrial cancer.     

Spontaneous regression in recurrent epithelial ovarian cancer

Background Although spontaneous regression has been reported in several cancers, it is generally believed that this rare phenomenon does not occur in epithelial ovarian cancer. Case We presented a stage IV epithelial ovarian cancer patient with long-term disease-free survival after palliative local irradiation alone against recurrence. The recurrent supraclavicular lymph node was almost completely necrotic, and the swelling of the para-aortic lymph node spontaneously regressed. Conclusion The histologic features and unexpected clinical course in this patient strongly suggest that spontaneous regression occurred in recurrent epithelial ovarian cancer.     

Apoptotic Index in Ovarian Carcinoma: Correlation with Clinicopathologic Factors and Prognosis

The apoptotic index (apoptotic cells/1000 tumor cells, AI) was evaluated in 71 ovarian carcinomas, all surgically resected. Apoptosis was examined by modified terminal deoxynucleotidyltransferase-mediated deoxyuridine triphosphate–biotin nick end-labeling (TUNEL) method in histologic sections. High AI (≥2.8) significantly correlated with high mitotic index (P= 0.05), high histologic grade of the tumor (P= 0.018), and short overall survival (P= 0.017). An inverse relationship between AI and bcl-2 protein expression was also observed (P= 0.007). In addition, AI was assessed in 5 ovarian epithelial tumors of borderline malignancy, and all were categorized as low AI (<2.8). No significant correlation was found between AI and other clinicopathologic factors, such as age, clinical stage, lymph node metastasis, tumor size, histology of the tumor, and expression of p53 protein. Multivariate survival analysis showed that only clinical stage (P= 0.0395) and mitotic index (P= 0.0387) had independent prognostic value, whereas AI did not. Our results suggest that counting apoptosis can be useful for predicting the patient survival in ovarian carcinoma, although AI is not an independent prognostic factor. It is also suggested that bcl-2 protein is an important regulator of apoptosis in ovarian carcinoma.     

Is it necessary to do retroperitoneal evaluation in borderline epithelial ovarian tumors?

Objective Borderline epithelial ovarian tumors have good prognosis without any adjuvant therapy. The advantage of aggressive surgical staging, especially retroperitoneal lymph node sampling is questionable in patients with borderline ovarian tumors. We designed this study to evaluate the necessity of retroperitoneal pelvic and para-aortic lymph node dissection in the treatment of borderline epithelial ovarian tumors. Study design From 1998 to 2007, 57 women who were diagnosed with borderline epithelial ovarian tumor in our hospital were prospectively accrued and evaluated; 27 of them (47.3%) had full surgical staging procedure including para-aortic and pelvic node dissection. Student’s t-test was used to compare follow-up times. Results Median follow-up time was 54.6 (12–96) months for all patients in the study. There was one recurrence of disease, which was in the complete staging group. Follow-up times of patients were not statistically different between lymph node evaluated and non-evaluated groups (p = 0.10). We did not find any metastasis in lymph nodes in 27 women who had complete surgical staging procedure. Conclusion Patients with borderline epithelial tumors who had full surgical staging procedure do not have survival advantage over those who had no lymph node evaluation and yet were patients with malignant ovarian tumors.     

A validation study of the new revised FIGO staging system to estimate prognosis for patients with stage IIIC endometrial cancer

Objective

The aim of this study was to validate the role of the new FIGO staging system for estimating prognosis for patients with stage IIIC endometrial cancer.

Methods

A total of 93 cases with stage IIIC were entered in this study and classified into three groups: one group of patients who underwent pelvic lymphadenectomy (PLX) and para-aortic lymphadenectomy (PALX) and who were for positive for pelvic node metastasis (PLNM) and negative for para-aortic node metastasis (PANM) (Group 1), one group of patients who underwent PLX alone and were positive for PLNM (Group 2) and one group of patients who underwent PLX and PALX and were positive for PANM (Group 3). Information on clinicopathologic findings and treatments was obtained from medical charts. Cox regression analysis was used to select prognostic factors.

Results

The 5-years survival rates were 89.3% in Group 1, 46.5% in Group 2 and 59.9% in Group 3. The overall survival rate in Group 1 was significantly better than that in Group 2 (p = 0.0001) and Group 3 (p = 0.0016). No significant difference in overall survival was found between Group 2 and Group 3. Age, number of metastatic lymph nodes, type of lymphadenectomy and type of adjuvant therapy were significantly and independently related to overall survival. Only when patients received PALX, PANM was a prognostic risk factor.

Conclusion

Sub-classification of stage IIIC would be functional for estimating prognosis in the revised FIGO staging system. Systematic lymphadenectomy including PALX has therapeutic significance for patients with stage IIIC endometrial cancer. Prognosis of patients with stage IIIC endometrial cancer would depend much more on application of lymphadenectomy including PALX than nodal status.     

Angiogenesis, p53, and bcl-2 expression as prognostic indicators in endometrial cancer: comparison with traditional clinicopathologic variables.

We investigated the relation of expression of tumor-suppressor gene product p53, apoptosis-regulator gene product bcl-2, and CD34 (as a measure of microvessel density [MVD]) with traditional clinicopathologic prognostic variables in endometrial carcinoma (histologic type, grade, depth of myometrial invasion, angiolymphatic invasion, lymph node involvement). In specimens from 63 patients with endometrial carcinoma, the mean MVD (64.38+/-28.71 microvessels per 200x field) was not related to any clinicopathologic variables. Nuclear p53 expression was detected in 15 (23.8%) patients and was higher in nonendometrioid carcinomas (p<0.05) and in tumors with increasing histologic grade (p<0.001). Cytoplasmic bcl-2 staining was seen in 79.3% of the tumors. There was a negative correlation between bcl-2 expression and histologic type and tumor grade (p<0.05). In survival analysis, patient age, FIGO stage, high expression of p53, low expression of bcl-2, and high and intermediate MVD values were found to be the most significant prognostic indicators of survival (p<0.05). In multivariate regression analysis, FIGO stage and low bcl-2 expression were found to be the only independent indicators of prognosis (p<0.05).     

Significance of Lymph Node Sampling in Epithelial Carcinoma of the Ovary

From 1979 to 1984, 127 patients operated on for ovarian cancer underwent pelvic, para-aortic, or pelvic and para-aortic lymph node sampling. Forty-seven patients proved to be stage I (14 IA and 33 IC), 14 were stage II (3 IIA, 8 IIB, and 3 IIC), 58 were stage III (7 IIIA, 13 IIIB, and 38 IIIC), and 8 were stage IV. Positive lymph nodes were found in 4.2% of patients at stage I, 35.7% at stage II, 41.3% at stage III, and 87.5% at stage IV. With regard to grading, positive lymph nodes were found in 4.4% of G1, in 21.6% of G2, and in 49.1% of G3. A significant increase in survival (P= 0.04) was found for patients classified as stage IIIC only according to lymph node involvement compared to patients in peritoneal stage IIIC with positive lymph nodes (3-year survival: 46% vs 12%). A small increase in survival was observed for N− patients compared to N+ patients, at both stage III and IV, even with same residual tumor size, but the difference is not statistically significant. All other things being equal, because the prevalence of lymph node positivity depends closely on the number of lymph nodes removed and examined (OR = 3.9 for >10 lymph nodes removed compared to 1–5 lymph nodes removed), lymph node sampling does not seem to be a reliable method for evaluating the retroperitoneal status. With regard to the therapeutic role of systematic lymphadenectomy, few data in literature are available and, most important, are not derived from experimental studies. Probably, only randomized studies with a large number of patients will provide useful answers.     

Lymph node metastasis in stage I epithelial ovarian cancer

OBJECTIVES: A relatively high incidence of para-aortic and pelvic lymph node metastasis is found in epithelial ovarian cancer. This paper investigates the clinicomorphological features of intra-abdominal stage I epithelial ovarian cancer that may predict the occurrence of lymph node metastasis and the prognosis of patients in whom lymph node metastases are identified. METHODS: From November 1988 to December 1997 we performed systematic para-aortic and pelvic lymphadenectomy as primary surgery in 47 patients with intra-abdominal stage I epithelial ovarian cancer. The incidence of lymph node metastasis in these patients and the clinicomorphological features of the patients with lymph node involvement were examined. RESULTS: Five patients (10.6%) were metastasis positive (IC: four; IA: one), of whom four had serous adenocarcinoma. Serous adenocarcinoma was associated with a significantly higher incidence of metastases than other histological types (P < 0.05). The number of positive lymph nodes was one in four patients and two in one patient, and the metastatic sites ranged from the para-aortic to the suprainguinal lymph nodes. All five metastasis-positive patients were alive and disease free at the time of this report (survival 28-85 months: median 59 months). CONCLUSION: This clinical study suggests that serous adenocarcinoma carries a high risk of lymph node metastasis, requiring systematic lymphadenectomy for accurate staging in intra-abdominal stage I epithelial ovarian cancer.     

卵巢上皮性癌P-糖蛋白表达及其与化疗耐药性的关系

目的：了解多药耐药ＭＤＲ基因在卵巢癌中的表达及表达产物Ｐ－糖蛋白（Ｐ－ｇｐ）与化疗耐药性的关系。方法：用免疫组化法测定卵巢癌５４例手术切除肿瘤组织Ｐ－ｇｐ的表达情况，分析其与临床、病理及化疗效果的关系。结果：Ｐ－ｇｐ表达阳性者２４例，占４４．４％，Ｐ－ｇｐ表达与临床分期、病理分级、术后残余瘤大小无关。Ｐ－ｇｐ阳性与阴性者所接受的化疗无差异。术前用过与ＭＤＲ有关药物化疗者，Ｐ－ｇｐ阳性率为６９．２％，高于未化疗者（３６．６％）。Ｐ－ｇｐ阳性者化疗近期疗效差，化疗有效率为４７．１％，低于Ｐ－ｇｐ阴性者的８１．８％，但两组预后无差异。结论：测定Ｐ－ｇｐ表达有助于预测肿瘤的耐药性及指导化疗药物的选择。Ｐ－ｇｐ表达是化疗耐药原因之一。     

Value of lymph node assessment in ovarian cancer: Status of the art at the end of the second millennium

Abstract. di Re F, Baiocchi G. Value of lymph node assessment in ovarian cancer: Status of the art at the end of the second millennium.
Available data on the incidence and the clinical value of lymph node assessment in ovarian cancer are reported. In early ovarian cancer, positive nodes are found in 4–25% of patients. Serous adenocarcinoma and poorly differentiated tumors are characterized by the highest incidence of node metastases. Five-year survival for stage IIIC disease with only retroperitoneal spread is clearly better than for stage IIIC with intraperitoneal dissemination. In advanced ovarian cancer, the rate of node involvement ranges from 55 to 75%. The percentage of positive nodes is significantly related to the amount of residual tumor after cytoreductive surgery, and node status seems to be an important prognostic factor for survival. Although data from retrospective studies advocate a therapeutic effect for systematic lymphadenectomy, results from prospective randomized trials are warranted. After chemotherapy a high percentage of patients (range, 25–77%) are found to have metastatic nodes. In particular, at second-look laparotomy, positive nodes are detected in 17–40% of patients who have no intraperitoneal disease.     

Epidermal growth factor receptor expression in normal ovarian epithelium and ovarian cancer. I. Correlation of receptor expression with prognostic factors in patients with ovarian cancer

Previous studies in breast and bladder cancer have suggested that epidermal growth factor receptor is expressed by only a proportion of cancers and is associated with poor clinical outcome. We used a monoclonal antibody specifically reactive with the extracellular domain of the epidermal growth factor receptor to localize this receptor immunohistochemically in frozen sections of normal ovary and epithelial ovarian cancer. Normal ovarian epithelium was found to express epidermal growth factor receptor in all cases. Among 87 ovarian cancers, however, 23% did not express immunohistochemically detectable receptor. Epidermal growth factor receptor expression was not related to histologic grade or stage, but was associated with poor survival (p less than 0.05). The median length of survival of patients with tumors that did not express epidermal growth factor receptor was 40 months compared with 26 months in patients with tumors that did express epidermal growth factor receptor. As in breast and bladder cancer, expression of epidermal growth factor receptor in ovarian cancer appears to be a poor prognostic factor.     

Ovarian cancer stage IIIC. Consequences of treatment level on overall and progression-free survival

BACKGROUND: Maximum cytoreduction at primary surgery has been found to be one of the strongest prognostic factors for survival of ovarian cancer. The aim of the study was to investigate the influence of hospital level (primary vs secondary care centre), number and timing of surgery and chemotherapy on how radical the surgery was at primary treatment of epithelial ovarian cancer Stage IIIC. MATERIAL AND METHODS: A retrospective study based on record information from all patients with epithelial ovarian cancer Stage IIIC treated at the Norwegian Radium Hospital (NRH) 1985-2000, in total 776, subdivided into four groups: 1) Local primary surgery, no direct re-operation at NRH, no interval debulking; 2) local primary surgery, no direct re-operation, but interval debulking after 3-4 courses of chemotherapy at NRH; 3) local primary surgery, direct re-operation at NRH, no interval debulking; 4) primary surgery at NRH. Lymph node biopsies at re-operation in early stages and upgrading of stage where necessary were registered. RESULTS: Whether surgery was radical or not was an independent prognostic factor for overall and progression-free survival. The treatment group was an independent prognostic factor for overall, but not for progression-free survival. Group 3 had significantly the best overall and progression-free survival (p = 0.01 and 0.05). For macroscopically radical surgery both overall and progression-free survival were found significantly better for groups 3, 4 and 1 than for group 2. Most lymph node biopsies were performed during the last period and 28% were upgraded from Stage I and II to IIIC. More patients were referred for primary surgery at NRH during the last 5-year period during which overall survival and time to progression were significantly better. INTERPRETATION: Whether primary surgery is radical or not is a significant prognostic factor for survival and primary surgery is best performed by specialists in gynaecological oncology.     

FIGO stage IIIC endometrial carcinoma with metastases confined to pelvic lymph nodes: analysis of treatment outcomes, prognostic variables, and failure patterns following adjuvant radiation therapy.

OBJECTIVES: This study was undertaken to evaluate the prognostic significance of isolated positive pelvic lymph nodes on survival and to analyze other prognostic variables, overall survival, and failure patterns in surgically staged endometrial carcinoma patients with positive pelvic lymph nodes and negative para-aortic lymph nodes following radiation therapy (RT). METHODS: Between January 1, 1987, and December 31, 1997, 782 women underwent primary treatment for uterine cancer at Indiana University Medical Center. Through a review of the medical records, we identified 58 patients with pathologic stage IIIA, 27 patients with pathologic stage IIIB, and 77 patients with pathologic stage IIIC endometrial carcinoma. Patients with pathologically positive or unsampled para-aortic lymph nodes and patients who received preoperative radiation therapy were excluded, leaving a study group of 17 patients with nodal metastases confined to pelvic lymph nodes. Thirteen patients received adjuvant pelvic RT using AP-PA or four-field technique. A median dose of 5040 cGy was delivered. Four patients received whole abdominal irradiation (WAI) delivering a median dose of 3000 cGy. Two patients received vaginal cuff boosts of 1000 and 3560 cGy to 0.5 cm from the vaginal surface mucosa via Cs-137 brachytherapy. Two patients also received adjuvant chemotherapy (cis-platinum and doxorubicin) and/or hormonal therapy (megestrol acetate). Disease-free and overall survivals were estimated using the Kaplan-Meier method of statistical analysis and prognostic variables were analyzed using the log-rank test. RESULTS: With a median follow-up of 51 months the actuarial 5-year disease-free survival was 81% and the actuarial 2-year and 5-year overall survival rates were 81 and 72%, respectively. Univariate analysis revealed that positive peritoneal cytology in conjunction with positive pelvic lymph nodes imparts a greater risk of recurrence and decreased overall survival. There were no pelvic and/or upper abdominal failures, but there were recurrences in the para-aortic lymph nodes (two patients) and distantly (two patients). CONCLUSION: Surgery followed by postoperative pelvic RT is a viable treatment option for pathologically staged stage IIIC endometrial carcinoma with disease confined to the pelvic lymph nodes. Failures in the para-aortic region suggest a possible role for extended-field RT. Patients with positive peritoneal cytology in conjunction with nodal metastasis fared poorly with pelvic RT. Studies evaluating the efficacy of WAI are ongoing. Finally, substages within FIGO stage IIIC are recommended in an effort to better understand and define treatment strategies which might be appropriate for these patients.     

The combined evaluation of p27Kip1 and Ki-67 expression provides independent information on overall survival of ovarian carcinoma patients

OBJECTIVE: Considering the limited and controversial information on the significance of the cyclin-dependent kinase inhibitor p27Kip1 in ovarian cancer, we conducted a retrospective investigation to clarify the relationships of this protein to proliferation rate, clinicopathologic variables, and prognosis of epithelial ovarian tumors. METHODS: Paraffin-embedded tissue from 43 ovarian tumors of low malignant potential (LMP) and 80 primary ovarian adenocarcinomas was stained immunohistochemically for p27Kip1, Ki-67 antigen (a marker of cell proliferation), and p53 protein. Expression of these markers was correlated with clinicopathologic features and with overall survival of patients with adenocarcinomas. RESULTS: p27Kip1 levels were significantly higher in LMP tumors as well as in low-grade, early-stage, slowly proliferating adenocarcinomas and those associated with minimal residual disease (P < 0.001). Decreased p27Kip1 expression was related to poor overall survival on its own (P = 0.0304) and, when combined, to increased proliferation rate (P = 0.0232). More importantly, in multivariate analysis, p27Kip1/Ki-67 status was independently related to survival (P = 0.040) along with histologic type and FIGO stage. CONCLUSION: Decreased p27Kip1 expression is related to several clinicopathologic indicators of aggressiveness in ovarian adenocarcinomas and is a major player in cell cycle control in these neoplasms. On the contrary, deregulation of the protein does not seem to participate in the pathogenesis of LMP tumors. Furthermore, combined p27Kip1/Ki-67 expression is a better prognostic marker than expression of p27Kip1 or Ki-67 alone and supplements the prognostic information gained from traditional prognosticators.     

Prognostic significance of morphology of tumor and retroperitoneal lymph nodes in epithelial carcinoma of the ovary: II. Correlation with survival

Correlation between prognostic indices derived from morphologic studies of retroperitoneal lymph nodes as well as primary tumor and survival in 39 patients with epithelial carcinoma of the ovary is reported. All had maximal surgery, adjuvant chemotherapy, and were followed for more than 2 years. A selective biopsy of pelvic and para-aortic lymph nodes was performed during the staging laparotomy in all instances. The chemotherapeutic regimen was a combination of Adriamycin, cis-platinum, and Cytoxan in a majority of cases.Prognostic indices, which showed positive correlation with survival, were cancer involvement, type of lymph node reaction, sinus histiocytosis, and fibroblastic proliferation in the regional lymph nodes; tumor grade, lymphocytic infiltration, stromal fibrosis, and histologic type in primary tumor; and stage of disease. Unfavorable factors for survival were nodal metastasis, lymphocytic depletion in abdominal nodes, and Grade 3 tumor. Clinical implications of our findings are discussed.     

Altered CD44 Variant 6 Expression in FIGO Stage IB Cervical Carcinoma

OBJECTIVE: CD44 is an adhesion molecule which plays an important role in metastatic cascade by mediating tumor cell interaction with the endothelium and the subendothelial matrix. In this study CD44v6 expression was immunohistochemically investigated on 88 uterine cervical cancers. Correlation between expression and prognostic variables and the survival was examined. METHODS: Eighty-eight patients with stage IB disease, treated primarily with surgery, were examined histopathologically and immunohistochemically. CD44v6 expressions of tumoral tissue and the nonneoplastic tissue nearby were examined using antiCD44v6 monoclonal antibody. CD44v6 expression was compared to the known clinicopathologic prognostic variables and survival of patients. RESULTS: Nonneoplastic epithelium of the sections showed CD44v6 expression predominantly in basal and parabasal layers at least in traces. CD44v6 overexpression in neoplastic islands was evaluated as "general," "basal" (only in the basal portion of neoplastic islands), and "nonbasal" (also in the central portion of the neoplastic islands) separately. When expression and prognostic variables were compared, CD44v6 non-basal expression was found to be significant in nonsquamous cancers, when the tumor diameter was greater than 3 cm and in the tumors that showed recurrences. Univariate survival analysis with the Kaplan-Meier method showed that only the age of the patient is significantly correlated with disease-free survival. Interestingly when the same analysis was done for 5-year overall survival, diameter of the primary tumor, depth of cervical stromal invasion, existence and number of lymph node involvement, positivity for general CD44v6 expression, and positivity for nonbasal expression were found to be statistically significant. Furthermore multivariate analysis with Cox regression showed that nonbasal CD44v6 expression and lymph node involvement are independent variables for 5-year overall survival. CONCLUSION: These results indicate that CD44v6 expression is associated with some of the important clinicopathologic prognostic variables and appears to be a predictor of advanced pathological-surgical stage of early clinical stage cervical carcinoma. CD44v6 nonbasal expression is significantly correlated with overall survival.     

Is it justified to classify patients to Stage IIIC epithelial ovarian cancer based on nodal involvement only?

BACKGROUND: Stage IIIC epithelial ovarian cancer is generally associated with upper abdominal tumor implants of greater than 2 cm and carries a grave prognosis. A subset of patients is upstaged to Stage IIIC because of lymph node metastases, in which prognosis is not well defined. We undertook this study to describe the clinical behavior of occult Stage IIIC. METHODS: All consecutive patients found to have Stage IIIC epithelial ovarian cancer during a 9-year period (1994-2002) were analyzed for surgical procedures, pathology, and disease-free (DFS) and overall survival (OS). RESULTS: Thirty-six patients were upstaged to Stage IIIC by virtue of positive nodes. Nine had small volume upper abdominal disease (IIIA/B before upstaging), 15 had disease limited to the pelvis and 12 had disease confined to the ovaries. 32/36 patients had no gross residual disease at the conclusion of surgery. The 5-year DFS and OS survivals were 52% and 76% respectively, for all patients. We observed no significant difference in outcomes between patients upstaged from IIIA/B versus I-II stage disease. The outcomes were superior to a control group of patients cytoreduced to either no gross RD or RD<1 cm, who had large volume upper abdominal disease at beginning of surgery (p<0.001). CONCLUSIONS: Patients upstaged to Stage IIIC epithelial ovarian cancer for node involvement have an excellent 5-year OS relative to all patients with Stage IIIC disease. These data demonstrate the necessity for stratifying patients classified as having Stage IIIC disease based solely on nodal disease when comparing outcomes. This information is particularly valuable when counseling patients regarding prognosis.     

Survival of ovarian carcinoma with or without lymph node metastasis

Because of the limited number of reports concerning the influence of retroperitoneal lymph node metastasis upon survival in patients with ovarian carcinoma, a prospective study was conducted between December 1975 and December 1982 to provide such information. This series consisted of 75 unselected patients with epithelial carcinoma of the ovary in all stages. Thirty-three patients had tumor-positive nodes and 42 had negative nodes. The two groups were compared with regard to stage of disease, grade of tumor, histology of tumor, residual disease after initial operation, finding at second-look laparotomy, and survival. All had initial maximal surgery and biopsy of para-aortic and pelvic nodes: most received postoperative chemotherapy. Follow-up was from 36 months to 10 years. Patients with positive nodes preferentially had more advanced disease (Stage III and IV). Grade 3 tumor, papillary serous cystadenocarcinoma, residual disease greater than 2%, low rate of second-look laparotomy, and death. Patients with negative nodes were connected with earlier disease (Stage I and II), nonserous tumor, minimal residual disease, high rate of second-look laparotomy, and survival. No patient with isolated nodal metastasis to pelvic or para-aortic survived. Only 18.2% with concomitant para-aortic and pelvic node involvements are currently alive, opposed to 64.3% with negative node. The results indicate that tumor-positive nodes in ovarian carcinoma are a poor prognostic factor and current combination chemotherapy is not effective. Alternative treatment for these patients should be considered.     

The role of thrombocytosis in prognostic evaluation of epithelial ovarian tumors

Background  Thrombocytosis has been reported in a variety of solid tumors, including certain gynecologic cancers such as endometrial, vulvar, and cervical cancers. The present study aims to determine the incidence of thrombocytosis in women with epithelial ovarian tumors and to evaluate its association with clinical and pathologic prognostic factors. Material and methods  Between January 2001 and December 2006, 292 patients were diagnosed with epithelial ovarian tumors, and they underwent primary surgical treatment and subsequent platinum-based chemotherapy at the Gynecologic Oncology Department of the study center. The medical records of these patients were evaluated retrospectively. Results  Of the 292 women with epithelial ovarian tumors undergoing primary surgical exploration, 124 (42.5%) had thrombocytosis, indicating platelet counts >400 × 10⁹/l. Patients with thrombocytosis were found to have statistically higher levels of preoperative CA-125 levels, more advanced stage disease, higher grade tumors, and shorter periods of survival. Thrombocytosis is a significant negative prognostic factor for survival in patients with epithelial ovarian tumors. Conclusions  Thrombocytosis is frequently detected in preoperative evaluation of women diagnosed with epithelial ovarian tumors. The data obtained by the previous and present studies suggest that thrombocytosis is associated with factors reflecting a more aggressive tumor biology, and predicting poor survival in women with epithelial ovarian tumors. However, these data are limited by the retrospective nature of the studies and do not confirm a casual relationship between thrombocytosis and tumor behavior. Molecular studies investigating the expression of platelet secretory factors are required to clarify the differences among data provided by the literature.     

Expression of cyclooxygenase-2 in association with clinicopathological prognostic factors and molecular markers in epithelial ovarian cancer

OBJECTIVES: This study examines whether expression of COX-2 is associated with clinicopathological features and other molecular markers of ovarian cancer. METHODS: Sixty-four paraffin-embedded tissue specimens were obtained from patients with ovarian cancer who received cytoreductive surgery and combination chemotherapy. Tissue specimens were subjected to immunohistochemical analysis using antibodies to COX-2, p53, and VEGF. RESULTS: Increased COX-2 expression significantly correlated with histologic type (mucinous 5.6% vs. non-mucinous 65.2%, P<0.001). COX-2 expression was also significantly associated with stage, tumor grade, residual disease status, and presence of ascites. COX-2 expression correlated positively with expression of p53 (P=0.006) and VEGF (P=0.025). Although survival was lower in patients with high COX-2 expression than in those without high COX-2 expression (P<0.001), only tumor grade and stage were independent prognostic indicators. In patients with non-mucinous cancer, COX-2 expression correlated with stage (P<0.001) and presence of ascites (P=0.033). CONCLUSIONS: Our results suggest that expression of COX-2 in ovarian cancers is specific to histologic type of tumor and is associated with poor clinicopathologic prognostic factors. Expression of COX-2 also correlates well with expression of p53 and VEGF.