血清鳞状细胞癌抗原在宫颈鳞状细胞癌中的变化及意义

[目的]探讨血清鳞状细胞癌抗原水平在宫颈鳞状细胞癌中的变化及其临床意义。[方法]应用微粒子酶免分析（MEIA）对2000年3月～2000年7月在浙江省肿瘤医院收治的宫颈鳞癌（包括5例鳞腺癌）165例患者进行血清鳞状细胞癌抗原水平检测并分析其与临床分期、肿瘤大小、病理分级、淋巴结转移之间关系,其中放射治疗的93例患者进行治疗前后的血清鳞状细胞癌抗原水平的自身比较,以及与近期疗效的关系。[结果]165例宫颈鳞癌患者血清鳞状细胞癌抗原阳性率为64.2％（106/165）。鳞状细胞癌抗原水平与临床分期、肿瘤大小有关（P<0.05）;与病理分级、淋巴结转移之间无统计学差异（P>0.05）;放射治疗前后患者血清鳞状细胞癌抗原水平变化有统计学意义（P<0.05）,且与疗效相关（P<0.05）。[结论]血清鳞状细胞癌抗原是宫颈鳞癌的相关的肿瘤标记物,在监测宫颈鳞癌的发生和评价疗效等方面具有重要价值,对判断宫颈鳞癌的预后具有一定的临床意义。     

宫颈鳞癌患者血清鳞状上皮细胞癌抗原检测及其临床意义

目的：探讨宫颈鳞癌患者血清鳞状上皮细胞癌抗原（ＳＣＣＡｇ）的检测及其临床意义。方法采用微粒子酶免疫分析法检测１２４例宫颈癌患者治疗前血清ＳＣＣＡｇ值,早期患者（Ⅰ－Ⅱａ期）术后１周重复检测,部分手术患者随诊中监测。结果宫颈癌血清ＳＣＣＡｇ检测的敏感性为７３．４％,特异性为９６．１％。ＳＣＣＡｇ阳性率随临床分期进展而增高,有非常性差异（Ｐ〈０．０１）,早期患者术前ＳＣＣＡｇ异常者术后均下降至正常水平     

Spontaneous Apoptosis as a Predictor of Radiotherapy in Patients with Stage IIB Squamous Cell Carcinoma of the Uterine Cervix

The purpose of this study was to investigate the correlation between the spontaneous apoptotic index (SAI) determined from pretreatment biopsy specimens with the various clinical outcomes of patients with FIGO stage IIB squamous cell carcinoma of the uterine cervix in a retrospective analysis. Forty-eight patients treated with curative radiotherapy between 1989 and 1993 were evaluated. Pretreatment biopsy specimens of those patients were scored for apoptosis, mitosis, and proliferating cell nuclear antigen (PCNA) immunohistochemical staining. The range of the SAI was 0.2-4.7% (median 1.1%). Patients whose tumours had a SAI above the median had better local control (p=0.0062) and overall survival (p=0.0053) than those with a lower SAI. Furthermore, the SAI was marginally significant on local control by a multivariate Cox regression analysis (p=0.0571). There was no correlation between the SAI and proliferation (mitosis and PCNA).     

Oxygen Tension and Vascular Density in Adenocarcinoma and Squamous Cell Carcinoma of the Uterine Cervix

The prognosis of patients with carcinoma of the uterine cervix has been shown to depend on the oxygenation and vascularization status of the tumors. The purpose of the study reported here was to search for possible differences in oxygen tension and vascular density between adenocarcinomas and squamous cell carcinomas. Ten patients with adenocarcinoma and forty patients with squamous cell carcinoma were included in the study. Oxygen tension was measured polarographically using the Eppendorf pO₂ Histograph 6650. Vascular density was determined by histological examination of tumor biopsies. The adenocarcinomas were significantly better oxygenated than the squamous cell carcinomas. The squamous cell carcinomas and the adenocarcinomas did not differ significantly in vascular density. The difference in prognosis between patients with adenocarcinoma and patients with squamous cell carcinoma is probably not attributable to differences in tumor oxygenation or vascularization.     

Combination Cisplatin and Carboplatin in Advanced Squamous Cell Carcinoma of the Head and Neck

Twenty-three patients with advanced squamous cell carcinoma of the head and neck who had received no prior chemotherapy were treated with carboplatin 350 mg/m² followed by cisplatin 50 mg/m² every 28 days. Twenty-one of 23 patients were evaluablefor response and toxicity. Eight patients (38%) achieved complete response (CR) or partial response (PR) with 2 CR and 6 PR. The overall median survival was 8.4 months (range 19 days-56% months). The major toxicity was hematological with grade III/IV granulocytopenia in 32% and grade III/IV thrombocytopenia in 32%. There was very little nonhematological toxicity and no nephrotoxicity. There were no therapy-related deaths. The combination carboplatin/cisplatin is tolerable in patients with squamous cell carcinoma of the head and neck, with objective responses in 38%; however, the response rate was not superior to single-agent carboplatin or cisplatin. Further studies with a higher dose of cisplatin should be considered.     

Lack of any Impact of Histopathology Type on Prognosis in Patients with Early-Stage Adenocarcinoma and Squamous Cell Carcinoma of the Uterine Cervix

Background: The aim of this study was to evaluate the prognosis of patients with stage IA-IIB cervicalcarcinoma and to investigate a possible correlation of histology with prognosis. Materials and Methods: Twohundred fifty one patients with adenocarcinoma and squamous cell carcinoma (SCC) histology for FIGO(International Federation of Gynecology and Obstetrics) stage IA-IIB uterine cervical carcinomas at the RadiationOncology Clinic of GH Okmeydanı Training and Research Hospital between January 1996 and December 2006were selected, analyzed retrospectively and evaluated in terms of general characteristics and survival. Diseasefreesurvival (DFS) and overall survival (OS) was calculated using the Kaplan-Meier method and differenceswere compared with the log-rank test. Multivariate analysis using a Cox-proportional hazards model was usedto adjust for prognostic factors and to estimate hazard ratio (HR) with 95% confidence interval (CI). Results:There was no differences between the two tumour types in age, stage, pelvic nodal metastasis, parametrialinvasion, surgical margin status, DSI, LVSI, maximal tumor diameter, grade, and treatment modalities. 5-yearOS and DFS were 73% and 77%, versus 64% and 69%, for SCC and adenocarcinoma, respectively (p> 0.05).Multivariate analysis revealed independent prognostic factors including pelvic nodal metastasis and resectionmargin status for OS (p=0.008, p=0.002, respectively). Conclusions: Prognosis of FIGO stage IA-IIB cervicalcancer patients was found to be the same for those with adenocarcinoma and SCC.     

Prognostic Model in Patients with Early-stage Squamous Cell Carcinoma of the Uterine Cervix: A Combination of Invasive Margin Pathological Characteristics and Lymphovascular Space Invasion

Background: This study aimed to develop a prognostic model in patients with early-stage cervical squamouscell carcinoma based on clinicopathological features, including invasive margin characteristics. Materials andMethods: Clinicopathological features and outcomes of 190 patients with FIGO stage IB-IIA cervical squamouscell carcinoma treated by surgery were collected and analyzed for factors associated with tumor recurrence. Inaddition to well-recognized pathological risk factors, the pathological characteristics of invasive margin (type ofinvasive pattern and degree of stromal desmoplasia and peritumoral inflammatory reaction) were also includedin the analysis. Multiple scoring models were made by matching different clinicopathological variables and/or different weighting of the score for each variable. The model with the best performance in the prediction ofrecurrence and decreased survival was selected. Results: The model with the best performance was composed of acombined score of invasive pattern, lymphovascular space invasion (LVSI), and degree of inflammatory reactionand stromal desmoplasia (total score =10). Compared to those with score ≤8, the patients with score 9-10 had asignificantly higher recurrence rate in the overall group (p<0.001) and the subgroup without adjuvant therapy(p<0.001), while the significance was marginal in the subgroup with adjuvant therapy (p=0.069). In addition,the patients with score 9-10 had a higher rate of tumor recurrence at distant sites (p=0.007). The disease-freesurvival was significantly lower in the patients with score 9-10 than those with score ≤8 among the overallpatients (p<0.001), in the subgroup without adjuvant therapy (p<0.001), and the subgroup with adjuvant therapy(p=0.047). Conclusions: In this study, a prognostic model based on a combination of pathological characteristicsof invasive margin and LVSI proved to be predictive of tumor recurrence and decreased disease-free survivalin patients with early-stage cervical squamous cell carcinoma.     

Evidence Based Analysis of Cisplatin for Treating Patients with Cutaneous Squamous Cell Carcinoma

Background: This analysis was conducted to evaluate the efficacy and safety of cisplatin based chemotherapyfor treating patients with cutaneous squamous cell carcinoma. Methods: Clinical studies evaluating the efficacy andsafety of cisplatin based regimens on response and safety for patients with cutaneous squamous cell carcinoma wereidentified using a predefined search strategy. Pooled response rates (RR) of treatment were calculated. Results:In cisplatin based regimens, 4 clinical studies which including 50 patients with advanced cutaneous squamouscell carcinoma were considered eligible for inclusion. Regimens included cisplatin, doxorubicin, or vindesine.Pooled analysis suggested that, in all patients, the pooled RR was 60% (30/50) in cisplatin based regimens. Nauseaand vomiting were the main side effects. No grade III or IV renal or liver toxicity were observed. No treatmentrelated death occurred with the cisplatin based treatments. Conclusion: Evidence based analysis suggests thatcisplatin based regimens are associated with a good response rate and acceptable toxicity for treating patientswith cutaneous squamous cell carcinoma.     

Vinorelbine, Ifosfamide and Cisplatin in Advanced Non-Small Cell Lung Cancer

Between September 1994 and July 1997, 78 patients with advanced/metastatic, non-small cell lung cancer (NSCLC) were selected for the NIP (vinorelbine, ifosfamide, and cisplatin) protocol. The study group included 43 males; age range 34-74 years; median age 56 years; median follow-up for all patients was 14 months and for surviving patients, 30 months. Histological distribution included 55 adenocarcinomas (70.5%), 8 squamous cell carcinomas, and 9 large cell carcinomas. Stage distribution was 14 stage IIIB (malignant effusions) and 64 stage IV or recurrent metastatic; sites of metastasis were lungs, -26; liver-19; bones-27; brain-7; adrenals-3; distant nodes-2; skin-2. The NIP regimen was well tolerated by most of the patients but nausea/vomiting was noted in 55% of the cycles administered, most of them of grade 1-2 severity. Fifteen neutropenic episodes (5%) were encountered. Response to NIP was: 44 partial responses (56%); 1 complete response (1%); overall response, 58%. For stage IIIB, overall response was 36%, while for stage IV/metastatic, overall response was 63%. The median time to progression was 7 months for stage IIIB and 8 months for stage IV/metastatic disease and the overall median survival achieved was 14 months, with 60% of patients alive after one year. No significant difference in survival outcome was noted between patients with metastatic disease and those with stage IIIB (malignant effusion) disease. The NIP regimen has produced encouraging results in advanced NSCLC, as well as a favourable toxicity profile. The efficacy of NIP as a palliative tool should be assessed. A randomized trial to compare NIP with a two-drug combination of vinorelbine and cisplatin has been initiated.