52例原发性阴道癌临床分析

Objective?To investigate the clinical features and prognostic factors of primary vaginal cancer. Methods?A total of 52 patients with complete pathological diagnosis and clinical follow-up data were selected from the first Affiliated Hospital of Zhengzhou University from January 2013 to January 2020. The general characteristics, different treatment methods and overall prognosis of the patients were analyzed. Results?the 1-year, 3-year and 5-year survival rates of 52 patients with primary vaginal cancer were 80.7%, 61.1%, and 48.1%, respectively. Among them, 28 patients (53.8%) had squamous cell carcinoma, and the median survival time was 92 months. There were 12 cases of malignant melanoma (23.0%), and the median survival time was 12 months The 5-year survival rates of early stage (stageⅠ+stageⅡ) and late stage (stageⅢ+stageⅣ) were 61.0% and 0.0%, respectively. Univariate analysis showed that FIGO stage, pathological type, tumor size, treatment mode, tumor growth stage and vaginal invasion length were related to the prognosis of patients (P<0.05). COX multivariate regression analysis showed that 2009 FIGO stage (P=0.002) and pathological type (P=0.000) were independent factors affecting the prognosis of patients with primary vaginal cancer.  The prognosis of different pathological types, such as squamous cell carcinoma and malignant melanoma, was significantly different (χ2=17.704, P=0.000). There was statistically significant difference between combined radiotherapy and chemotherapy with radiotherapy or chemotherapy alone (χ2= 4.017, P=0.045). Conclusion?The prognosis of primary vaginal cancer is related to pathological type and clinical stage. The earlier the clinical stage, the better the prognosis. The survival cycle of squamous cell carcinoma is much higher than that of malignant melanoma. The treatment is mainly radiotherapy, and the combined treatment of radiotherapy and chemotherapy is better than radiotherapy or chemotherapy alon.     

42例原发性阴道恶性肿瘤临床分析

目的 总结原发性阴道恶性肿瘤的l临床特点,探讨原发性阴道恶性肿瘤的治疗方法 及预后因素.方法 同顾性分析1984年1月-2006年8月北京协和医院收治的42例原发性阴道恶性肿瘤患者的临床特点、治疗方法 及预后情况.结果 原发性阴道恶性肿瘤患者占本院同期收治妇科恶性肿瘤患者的0.98%(42/4286).42例患者中,鳞癌13例,黑色素瘤13例,腺癌8例,内胚窦瘤及肉瘤各3例,癌肉瘤及阴道上皮瘤样癌各1例;1期19例,Ⅱ期12例,Ⅲ期5例,Ⅳ期6例.治疗七采用了以手术为主的综合治疗.随诊至2007年8月,有19例患者牛存,死亡18例,失访5例.随诊时间最长为10年,中位随诊时间为2年,总体两年生存率达60.6%.其中,1期患者的两年生存率为71.3%,Ⅱ期为58.3%,Ⅲ～Ⅵ期为29.6%.根据病理类型不同,鳞癌患者的两年生存率为46.8%,黑色素瘤为72.9%,腺癌为20.0%,3例内胚窦瘤患者随诊6～10年全部尤瘤存活.结论 原发性阴道恶性肿瘤的预后与分期、病理类型相关.阴道黑色素瘤患者以手术+化疗+免疫治疗取得了较好的效果,阴道内胚窦瘤患者以单纯化疗效果好.对于其他少见的病理类型,缺乏治疗经验,但基本上仍以手术+化疗为主.     

原发性阴道癌的放射治疗

原发性阴道癌的治疗方法有单纯放射治疗、手术或手术加放疗、放疗加化疗综合治疗等。治疗方法的选择主要取决于病变部位，病灶大小、期别、各单位医疗条件、医生的经验。原位癌可局部切除或单纯腔内放疗，Ⅰ期和少数Ⅱ期早期可行手术治疗或单纯放疗，Ⅱ期至Ⅳ期行单纯放射治疗或同时性进行放射治疗和化疗。     

卵巢单纯性原发性绒癌1例

患者 ,女 ,18岁 ,未婚 ,无性生活史 ;因“停经伴下腹部包块伴间歇性疼痛 3+ 月”于 2 0 0 1年月 4月 2 4日入院。入院查体 :Ｔ37.9℃ ,Ｒ 2 2次 /分 ,ＢＰ 13.5 / 9.0ｋＰａ ,Ｐ 140次 /分 ,ＷＴ 36ｋｇ。一般情况差 ,全身恶病质 ,浅表淋巴结不肿大。下腹部膨隆 ,腹壁无静脉曲张 ,腹部包块底达脐上一指 ,表面高低不平 ,质硬 ,如孕 5个月大 ,活动度差 ,边界尚清 ,轻压痛。妇检 :处女膜完整。肛诊 :子宫扪诊不满意 ,可触及肿块的下极 ,质硬 ;二侧宫旁可触及增厚。辅助检查 :血常规 :Ｈｂ6 4ｇ/Ｌ ,ＷＢＣ14.4× 10 9/Ｌ ,ＲＢＣ3.2 7× 10 12 …     

FIGO IGCS妇癌分期和临床实践指南(之二)阴道癌

阴道癌指原发部位在阴道的癌症，大多数发生于绝经后或老年妇女。原发性阴道癌是最罕见的妇科肿瘤，占妇科恶性肿瘤的1％以下。然而，不管是宫颈或外阴肿瘤的直接扩散，还是子宫内膜癌和妊娠滋养细胞疾病的经淋巴或静脉转移，阴道均是常见的转移部位。阴道的转移肿瘤也可来源自非妇科部位如膀胱、尿道或尿道旁腺，少数源于     

原发性卵巢小细胞癌六例临床分析

卵巢小细胞癌，尤其是原发于卵巢的小细胞癌，是少见的卵巢恶性肿瘤，恶性程度高且进展快，患者的发病年龄为9-40岁，平均24岁。此病预后很差，75％的患者在发病1-2年内死亡。本研究总结了1989年至2004年在北京协和医院治疗的6例原发性卵巢小细胞癌患者的临床资料，对其手术方式、化疗及预后等情况进行分析，现报道如下。     

原发性阴道恶性黑色素瘤25例临床分析

探讨病灶大小和不同治疗后手段对原发性阴道恶性黑色素瘤预后的影响。方法对我院１９６４年１２月至１９９７年１０月,收治的２５例原发性阴道恶性黑色素瘤患者的临床资料进行回顾性分析。结论原发性阴道恶性黑色素瘤预后差,但如早期诊断并采用以手术为主的综合治疗,有可能改善预后。     

原发性输卵管癌45例临床分析

目的:探讨原发性输卵管癌的临床表现及病理特征、诊治方法,以期提高对该病的认识.方法:回顾性分析我院2000～2010年收治的45例原发性输卵管癌患者的临床情况及诊治结果.结果:45例患者平均年龄56.9岁,30例(66.7％)为绝经后妇女.最常见的临床表现依次为盆腔肿块40例(88.9％),阴道排液13例(28.9％),腹胀10例(22.2％),腹痛9例(20.0％),异常阴道流血伴流液7例(15.6％),便秘2例(4.4％).超声检查发现40例(88.9％)有盆腔肿块;32例行血清癌抗原125( CA125)水平测定,26例(81.3％)高于35 U/ml.Ⅰ～Ⅳ期患者的5年生存比例分别为:Ⅰ期66.7％、Ⅱ期50.0％、Ⅲ期36.0％,Ⅳ期0.满意的肿瘤细胞减灭术患者较缩瘤术患者存活时间长.结论:原发性输卵管癌恶性程度高,临床表现多样且缺乏特异性,很少能在术前明确诊断.超声检查及CA125检测有助于诊断.手术是主要治疗手段.     

原发性输卵管癌8例临床误诊分析

为提高原发性输卵管癌术前诊断水平,减少误诊,我们对近6年来3所医院8例原发性输卵管癌的临床资料进行复习,结合文献对误诊原因、诊断及鉴别诊断讨论如下。1 临床资料原发性输卵管癌8例,22～65岁,平均49.5岁。其中原发不孕1例,继发不孕6例,阴道流液7例,阴道流血4例,腹痛6例,盆腔肿物7例。术前诊断为卵巢肿瘤(癌)5例,诊断为子宫肿瘤2例,诊断为阑尾炎1例。2 结 果8例均行手术治疗,其中一侧附件切除1例,一侧附件切除加阑尾切除1例,次全子宫切除加单侧附件切除1例,全子宫切除加双侧附件切除2例,全子宫切除加双侧附件切除及大网…     

Concomitant radiotherapy and hyperthermia for primary carcinoma of the vagina: a cohort study

OBJECTIVE: To evaluate the supplementary value of adding hyperthermia to radiotherapy in patients with primary vaginal cancer. STUDY DESIGN: Cohort of 44 patients diagnosed with primary vaginal cancer between 1990 and 2002 was assessed. Survival rates and median survival of patients with primary vaginal cancer undergoing radiotherapy with and without hyperthermia were compared. Hyperthermia was solely added to radiotherapy in case of a tumor size >4 cm in diameter for FIGO stage III disease. RESULTS: The calculated overall 5-year survival of primary vaginal cancer was 63%. In comparison to histologic high grade tumors, higher survival rates for histologic low grade tumors were calculated. For FIGO stage III of disease, the addition of hyperthermia to radiotherapy for tumors >4 cm in diameter resulted similar survival rates and median survival when compared to those achieved by radiotherapy as monotherapy in tumors of <4 cm in diameter. CONCLUSIONS: The addition of hyperthermia to radiotherapy might result in better survival rates in primary vaginal cancer for tumors >4 cm in diameter. The supplementary effect of hyperthermia to radiotherapy may be a feasible and beneficial approach in the treatment of vaginal cancer.     

Outcomes after radiation therapy with concurrent weekly platinum-based chemotherapy or every-3-4-week 5-fluorouracil-containing regimens for squamous cell carcinoma of the vulva

Objective

To compare outcomes in patients with squamous cell carcinoma (SCC) of the vulva treated with radiation (RT) and concurrent weekly platinum-based or every-3-4-week regimens containing 5-fluorouracil (5-FU).

Methods

Records of 44 patients with vulvar SCC treated with concurrent chemotherapy and radiation (chemoRT) from 1988 to 2008 were reviewed. Rates of disease-free survival (DFS), overall survival (OS), locoregional recurrence (LRR), and distant metastases (DM) were estimated using the Kaplan-Meier method.

Results

The median age was 63 years (range, 44-90), 84.1% of patients had ECOG performance status 0-1, and patients had FIGO Stage II (n = 6), III (n = 31), or IVA (n = 7) disease. Patients were treated preoperatively (n = 10), postoperatively (n = 10), or without surgery (n = 24). The median RT dose to the vulva was 50.2 Gray (range, 22-75). Concurrent chemotherapy regimens included weekly platinum (n = 16) or every 3-4 week regimens with 5-FU as the backbone (n = 28).With a median follow-up of 31.5 months, there was no significant difference in 2-year OS (74.5% vs. 70.0%; p = 0.65), DFS (61.9% vs. 56.0%; p = 0.85), LRR (31.3% vs. 32.9%; p = 0.93), or DM (6.3% vs. 10.6%; p = 0.81) between the weekly platinum and every-3-4-week 5-FU regimens. Twenty patients (45.4%) recurred: 16 LRR, 2 DM, and 2 with both. The clinical and pathologic complete response rates were 58.8% (20/34), and 53.8% (14/26), respectively. There was a higher proportion of grade 3 or higher acute non-skin toxicities in patients receiving every-3-4-week 5-FU (46.1% vs. 13.3%; p = 0.07), but more grade 3 or higher skin toxicity in patients receiving weekly platinum (62.5% vs. 32.0%; p = 0.01).

Conclusion

OS, response rates, and recurrence rates were not significantly different after RT with concurrent weekly platinum-based versus every-3-4-week regimens containing 5-FU for vulvar SCC.     

Primary small cell carcinoma of the vagina

BACKGROUND: Primary vaginal small cell carcinoma is extremely rare, with a total number reported in English-language journals to date of 23. Most patients die of the disease within 2 years of diagnosis from metastatic disease. CASE: A 69-year-old woman presented with vaginal spotting while on Premarin. She was subsequently diagnosed with Stage I (T1N0M0) small cell carcinoma of the vagina. She underwent concurrent chemoradiation and then brachytherapy for persistent disease. Due to residual disease after the brachytherapy, surgical resection was planned but aborted because of metastatic disease. CONCLUSIONS: Of the three reported cases treated with concurrent chemoradiation, ours is the first case reported with persistent local disease after therapy. Extrapolating from the available clinical trials from lung carcinoma, concurrent chemoradiation as a primary treatment approach should still be considered.     

Comparison of treatment outcomes between squamous cell carcinoma and adenocarcinoma in locally advanced cervical cancer

Objective

To compare the treatment outcomes between squamous cell carcinoma (SCC) and adenocarcinoma (ACA) in locally advanced cervical cancer patients.

Methods

All medical records of stages IIB-IVA of cervical cancer patients who had completed treatment between 1995 and 2008 were reviewed. ACA 1 case was matched for SCC 2 cases with clinical stage, tumor size, treatment modalities (radiation therapy (RT) vs concurrent chemoradiation (CCRT)). Treatment outcomes including response to RT/CCRT, time to complete response (CR), patterns of treatment failure and survival outcomes were analyzed.

Results

A total of 423 patients with stages IIB-IVA (141 ACA: 282 SCC) were included. Most of the patients (about 60%) had stage IIB. The overall complete responses (CR) between ACA and SCC were 86.5% and 94.7%, respectively (p = 0.004). Median time to clinical CR from RT/CCRT of ACA were 2 months (0-5 months) compared with 1 month (0-4 months) for SCC (p = 0.001). Pelvic recurrence and distant failure were found in 2.1% and 14.9% in ACA, and corresponding with 3.9% and 15.6% in SCC. The 5-year overall survival rates of ACA compared to SCC were 59.9% and 61.7% (p = 0.191), respectively. When all prognostic factors are adjusted, clinical staging was the only factor that influenced overall survival.

Conclusion

ACA in locally advanced cervical cancer had poorer response rate from treatment and also used longer time to achieve CR than SCC. However, these effects were not determinants of survival outcomes.     

Comparison of gene expression in squamous cell carcinoma and adenocarcinoma of the uterine cervix

OBJECTIVES: Microarray expression analysis of cervical tumors has revealed differential expression of genes that may be useful as markers or targets for treatment. We question the application of array findings across the major categories of cervical cancer. We sought to identify differences between normal squamous epithelium (NSQ) and glandular epithelium (NGL) of the uterine cervix and their malignant variants: squamous cell cancer (SCC) and adenocarcinoma (ACA). METHODS: Eight genes were selected: 12-lipoxygenase (12-LOX), keratin 4, trypsinogen 2 (TRY2), Rh glycoprotein C (RhGC), collagen type V alpha 2, integrin alpha 5, integrin alpha 6, and c-myc. Ten cases each of SCC and ACA of the cervix were selected from our tumor bank. NSQ and NGL epithelia were obtained from consecutive patients undergoing surgery for benign disease. RNA extraction, cDNA synthesis, and DNA amplification of all samples were performed according to an established protocol. Electrophoresis of the multiplexed polymerase chain reaction (PCR) products was performed under standard conditions, followed by digital image capture. A ratio of target to control gene (beta-actin) was obtained for each sample. Analysis of variance was applied to the mean ratios for each tissue to establish significant differences. Individual pairwise comparisons were made by Student t tests and verified with the Tukey-Kramer test. RESULTS: Clinically valid comparisons are NSQ to NGL, NSQ to SCC, NGL to ACA, and SCC to ACA. Various expression patterns were observed between the epithelia and their malignant phenotypes. Significant differences in gene expression were observed between benign squamous and glandular epithelium in four of the eight genes and between malignant squamous and glandular epithelium in three of the eight genes. Significant differences in gene expression between benign and malignant tissues were demonstrated in four of the eight genes. CONCLUSIONS: We have defined significant differential expression changes between the two principal cervical tumor types. Differences in genes are demonstrated and must be considered if array technology is applied to the study of the biologic behavior of these tumors as well as their screening and management. The observed differential expression should be a compelling argument to perform type-specific expression analysis for other tumors with histological variants.     

Squamous cell carcinoma of the vagina: a report of 32 cases

Between 1982 and 1992, 32 patients with squamous cell vaginal cancer were treated. Fourteen patients had stage I, 11 stage II, two stage III and five stage IV disease. The mean age of stage I and II patients was 64, of stage III and IV patients 73. Six patients were pessary-bearing, two had a total procidentia, eight had been treated for cervical intraepithelial neoplasia (CIN), one for cervical cancer and one for vulvar cancer 5–21 years before diagnosis. One patient had had external irradiation for endometrial cancer 15 years before. Nine patients had no follow-up examinations after treatment for CIN, for vulvar cancer or after insertion of a pessary. In 14 patients doctors' or patients' delays were considerable. Most patients presented with vaginal discharge or bleeding, and urinary symptoms. Various treatment modalities were used. The selected patients who could be treated by surgery did best. Only patients with a stage I tumor or a stage II tumor with a diameter of at most 30 mm survived. Tumor stage and tumor diameter were the important prognostic factors. No patient died of disease after 33 months. Failure in obtaining local control was the usual cause of death. Recommendations for prevention or early diagnosis are formulated.     

Stage I squamous cell carcinoma of vagina complicating pregnancy: successful conservative treatment

BACKGROUND: Vaginal squamous cell carcinoma in pregnancy is very rare situation. CASE: The patient was a 33-year-old woman, presenting with a complaint of vaginal brownish discharge at a 23 weeks of gestation. On pelvic examination at that time, a 2 by 2 cm mass on posterior vaginal fornix was seen. Biopsy of the lesion demonstrated a nonkeratinizing type invasive squamous cell carcinoma. She desired to continue the pregnancy and postpone the treatment until after delivery. On 23 weeks of gestation, we performed wide local excision, confirming T1 stage. On 33 weeks of gestation, a pelvic lymphadenectomy was carried out at the time of cesarean section to secure lymph node status pathologically. Further, she began intracavitary brachytherapy via vaginal cylinder in an adjuvant setting. She is 36 months from her initial surgery and remains disease free. CONCLUSION: Treatment could be individualized for primary stage I vaginal squamous cell carcinoma complicating pregnancy.     

Use of squamous cell carcinoma antigen as a biomarker of chemotherapy response in patients with metastatic cervical carcinoma

Objective

To examine the use of squamous cell carcinoma antigen (SCCA) as a biomarker of chemotherapy response in patients who underwent chemotherapy for metastatic cervical carcinoma.

Study design

The study population consisted of patients who underwent first-line chemotherapy for metastatic cervical carcinoma between 1999 and 2009. SCCA levels were serially measured before, during and after chemotherapy. Radiographic responses were evaluated according to the criteria of the World Health Organization. A logistic model was used to determine the best prediction model, and internal and external validation of the prediction model were performed to compare the areas under the receiver operating characteristic curves (AUCs).

Results

In total, 55 patients were included in the analysis. Data for 32 patients enrolled in various clinical trials were used to develop the prediction model. Patients who achieved a radiographic response showed a significant decline in SCCA levels between the second and third cycles of chemotherapy, whereas patients who did not achieve a radiographic response showed constant SCCA levels over the same period. The prediction model was developed on the basis of changes in the SCCA level between the second and third cycles of chemotherapy (AUC = 0.832) and the baseline SCCA level. The AUC after external validation, calculated using the data of the clinical practice population (n = 22), was 0.871.

Conclusions

A response to chemotherapy was possible for patients in whom SCCA levels declined between the second and third cycles of chemotherapy.