妇科恶性肿瘤筛查中基因检测技术的应用

近年来的研究认为癌症是一种基因疾病,遗传性或获得性基因缺陷可导致癌症的发生和发展。因而,基因检测技术在妇科肿瘤的筛查中显得尤为重要。目前,人乳头瘤病毒（HPV）检测已在宫颈癌筛查中广泛应用,对于遗传性卵巢癌和子宫内膜癌高危群体,也可通过检测BRCA1/2和MLH1/MSH2突变进行高危人群风险分层。     

妇科恶性肿瘤保留生育功能肿瘤结局

子宫颈癌、卵巢癌和子宫内膜癌是妇科常见的恶性肿瘤，近年发病有年轻化趋势。对于有生育要求的年轻患者，如何在不增加肿瘤风险的情况下，保留患者术后的生育功能，成为近年来备受关注的问题。文章对保留生育功能的妇科恶性肿瘤患者的肿瘤结局进行阐述。     

妇科恶性肿瘤术后化疗后淋巴囊肿并发感染及治疗分析

目的:探讨妇科恶性肿瘤术后化疗后淋巴囊肿感染的易感因素、防治方法及预防措施。方法:对67例妇科恶性肿瘤患者术后化疗后淋巴囊肿发生感染及治疗情况进行回顾性分析。结果:中性粒细胞计数(ANC)降低、贫血、年龄>60岁患者淋巴囊肿感染率增高,抗生素联合粒细胞集落刺激因子(G-CSF)治疗使化疗后淋巴囊肿感染患者发热及ANC恢复天数分别缩短为(7.0±1.6)天和(6.0±1.3)天。结论:妇科恶性肿瘤术后患者化疗后ANC降低、贫血、患者年龄>60岁是淋巴囊肿感染感染主要易感因素,抗生素加用G-CSF合理应用,能减少淋巴囊肿感染发生率及严重程度。     

Complications of pelvic radiation therapy for gynecologic malignancies in elderly women

The purpose of this study was to determine the frequency and severity of complications following pelvic irradiation in elderly women with gynecologic malignancies. A retrospective analysis was conducted of the 60 women over 65 years of age treated with pelvic radiation therapy for cervical (26), endometrial (31) or proximal vaginal (3) cancer at the UCLA Medical Center between 1978 and 1991. Acute grade 3 to 4 gastrointestinal (GI) complications, using Gynecologic Oncology Group (GOG) criteria occured in three of 60 patients (5%). Chronic complications occured in 28 of 49 patients (57%) followed for longer than 3 months after radiation therapy. The 3-year actuarial rate of chronic GI and/or genitourinary (GU) complications was 63% for any grade and 24% for grades 2,3 or 4. Twelve of the 14 grade 2–4 chronic complications were GI. The 3-year actuarial chronic complication rate was 45% for GI compared to 17% for GU ( P = 0.01). The median time to occurrence for GI and GU chronic complications was 8 and 19 months, respectively. In multivariate analysis, two or more pre-existing medical problems ( P = 0.03) and dose of external beam radiation therapy 45 Gy ( P = 0.07) were associated with the development of a chronic complication. We conclude that moderate to severe intestinal complications are common after pelvic irradiation of elderly women, particularly those with two or more pre-existing medical problems. Pelvic radiation therapy should be used judiciously in elderly women.     

Multiple primary malignancies in patients with gynecologic cancer

A retrospective analysis was made of 1044 patients with gynecologic malignancies treated in our department over a 12-year period, in order to review the frequency and types of multiple primary neoplasms. Multiple primary neoplasms were detected in 45 (4.3%) cases, including 16 (2.1%) out of 733 cervical cancers, 14 (8.2%) out of 166 endometrial cancers, three (15%) out of 20 vaginal cancers and 12 (9.8%) out of 123 ovarian cancers. Fifteen cases were synchronous and the remaining 24 cases were heterochronous, with an average 4.9-year interval. The most frequent other site of neoplasm was the breast, particularly in patients with endometrial or ovarian cancer. We conclude that gynecologic malignancies are often associated with primary cancers elsewhere, especially in the breast, stomach, colon and thyroid. A patient presenting with a gynecologic malignancy should be thoroughly examined for a second cancer, as should patients being followed-up after treatment for genital tract cancer.     

Technique and feasibility of radical para-aortic and pelvic lymphadenectomy for gynecologic malignancies: a prospective study

Abstract. Of 284 patients evaluated for entry into the study between January 1986 and June 1990, systematic para-aortic and pelvic lymphadenectomy was performed in 208 cases (108 cervical cancer, 43 and 57 ovarian and endometrial cancer, respectively). The median number of nodes removed was 58, 49 and 54 for cervical, ovarian and endometrial cancer, respectively. The operating data are divided into 2 groups according to the consecutive number of the cases. The median operating time and the median estimated blood loss of lymphadenectomy was 230 minutes (range 120–270) and 390 ml (range 200–3300) in the first 95 cases. These operating data decreased to 150 minutes (range 100–240) and 250 ml (range 100–2800) in the second 113 cases. No surgery-related deaths occurred. Severe hemor-rages (blood loss exceeding 1000 ml) occurred in 6 patients. The obturator nerve was dissected in 1 patient and in 1 case the left ureter was cut. Formation of lymphoceles occurred in 20.4% of patients. Eighteen patients (8.8%) developed deep venous thrombosis. Nine of these patients experienced pulmonary microembolism. In 3 patients a retroperitoneal abscess was diagnosed. One patient developed a fistula of the most proximal part of the right ureter during the third postoperative week. The resection or coagulation of branches of the genito-femoral and obturator nerves determined mild paresthesis localized at the supero-anterior and internal side of thigh in 11 cases (5.4%). No statistically significant differences were found between the clinical (age, weight and previous chemotherapy) and pathological (type of cancer and lymph node status) parameters considered on one hand and postoperative complications on the other.     

Intraoperative radiation therapy in the treatment of pelvic gynecologic malignancies: a review of fifteen cases

OBJECTIVE: The aim of this study was to review the experience with intraoperative radiation therapy (IORT) in the treatment of gynecologic pelvic malignancies at the Massachusetts General Hospital. METHODS: From July 3, 1996, through July 28, 1999, 15 patients were treated with IORT for gynecologic malignancies in a dedicated IORT operating room suite at the Massachusetts General Hospital. Hospital medical records, radiation oncology records, and office charts were reviewed on all patients treated with IORT. IORT was given in the presence of positive surgical margins and where the doses needed for adjuvant postoperative external beam radiotherapy (EBRT) would exceed those tolerated by normal structures. One patient presented with primary disease and 14 with local or regional recurrence. Follow-up time ranged from 3 to 36 months. RESULTS: Treatment in conjunction with IORT included surgery only (7 patients); preoperative EBRT, preoperative brachytherapy, and surgery (1 patient); preoperative chemotherapy and surgery (2 patients); and surgery and postoperative chemotherapy (5 patients). IORT doses ranged from 10 to 22.5 Gy. At the completion of this review, 4 patients (26.6%) have died, 6 (40%) are alive and free of disease, and 5 (33%) are alive with disease persistence or relapse. Of the 10 patients with gross total resection, 5 are alive and free of disease. Of the 5 women with gross residual disease at the time of IORT, only 1 is alive and free of disease. CONCLUSIONS: The volume of residual disease prior to IORT may be an important prognostic indicator for disease relapse. Both local recurrence and distant metastasis were more common among patients with gross residual disease at the time of IORT. Our institutional experience with IORT further supports the importance of optimal surgical resection.     

The value of CT scanning in the management of patients with gynecologic malignancies

Summary The management of gynecologic malignancies is exceedingly complex, requiring thoughtful coordination of surgery, radiation therapy and chemotherapy. Despite the fact that the natural history and clinical course of these cancers are generally well understood, the scarring caused by surgery and/or radiation, and the marked limitations of pelvic examination make clinical staging and evaluation of limited value and known inaccuracy in following women with ovarian, cervical, uterine, vulvar and vaginal cancers. Understandably, the development of computerized axial tomography (CT), and its ability to visualize the abdomen and pelvis, lead to rapid acceptance of CT scans in defining extent of cancer and following patient response to various therapeutic interventions (Chen et al. 1980; Feigen et al. 1987; Photopoulos et al. 1977).Authors have compared the accuracy of CT findings with physical examination, surgical findings, lymphography, conventional radiography or ultrasound (Clarke-Pearson et al. 1986; Vercamb et al. 1987; Amendola 1981; Kerr-Wilson et al. 1984). However, little has been written on the effect of CT scanning on patient management. If we define and accept the accuracy of CT scanning in detecting pelvic and abdominal disease, can we show a benefit in patient management? Or, does CT scanning provide us with expensive information, or misinformation, which fails to translate into better patient care. Do complex imaging modalities compliment thorough examination and experienced clinical judgement, or only duplicate findings and provide extraneous information? To answer these questions, eighty-one months experience in using CT scanning in managing patients with gynecologic malignancies was reviewed.     

妇科恶性肿瘤的动脉化疗

该文就动脉灌注化疗(动脉化疗)在妇科恶性肿瘤中的应用历史、基础研究和临床研究方面进行了阐述。提出了妇科恶性肿瘤动脉化疗的两个阶段,系统地总结了动脉化疗的用药原则及后续治疗原则,并指出动脉化疗目前存在的问题及研究方向。     

Paraneoplastic cerebellar degeneration and gynecologic malignancies

Paraneoplastic subacute cerebellar degeneration is a rare syndrome associated with a variety of malignancies, most commonly lung and ovarian. The syndrome is typically identified by signs and symptoms of cerebellar ataxia and the presence of anti-Purkinje cell antibodies in the serum and cerebrospinal fluid, specifically anti-Yo antibodies when a gynecologic cancer is responsible. A common observation is the presence of advanced stage disease but a remarkably small volume of metastatic cancer. Neurologic symptoms precede the diagnosis of cancer in most cases. Clinical findings consistent with cerebellar degeneration and the presence of anti-Yo antibodies require an aggressive search for an occult breast or gynecologic malignancy; surgical exploration may be necessary. Paraneoplastic syndromes involving the nervous system are not commonly seen in association with a gynecologic malignancy. Two cases are presented in which the patient's neurologic complaints preceded and led to the diagnosis of an advanced but yet occult gynecologic malignancy. The literature was also reviewed in an effort to explain the relevance of anti-Purkinje cell antibodies in relationship to gynecologic cancer and paraneoplastic cerebellar degeneration.     

Prediction of malignancy using transvaginal color flow Doppler in patients with gynecologic tumors

Eighty-five patients referred to the Women's Cancer Center, University of Minnesota had transvaginal color flow Doppler performed to determine if pelvic malignancy could be predicted by blood flow assessment. Their mean age was 49 years (range 21–86 years). Thirty-five patients were subsequently found to have malignant tumors of the cervix, uterus or ovary. The presence of increased intratumoral blood flow as depicted by color flow Doppler had a sensitivity of 83%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 89% for malignancy. The mean intratumoral Pulsatility Index (PI) of the patients with malignant tumors was 0.81 (SD 0.24; range 0.3–1.2), which was significantly lower than for the benign group ( P = 0.001). A PI of 1.0 had a sensitivity of 96.3%, specificity of 94.3%, PPV of 89.7% and NPV of 98% for predicting malignancy. Transvaginal color flow Doppler shows promise as a method of predicting malignancy in patients with gynecologic pathology.     

Oncolytic virotherapy of gynecologic malignancies

Objective

Gynecologic cancer is still the third leading cause of cancer death among women in the US. Therapeutics employing novel mechanisms of action are therefore urgently needed. Oncolytic viruses (OVs) selectively infecting and replicating in cancer cells have recently attracted considerable interest as promising anti-cancer agents. Here, we provide an overview of different OVs currently being used for virotherapy of gynecologic cancers and discuss challenges and implications for their future development.

Methods

Relevant literature obtained from the PubMed database by searching for articles including the terms “oncolytic” or “virus”, or “virotherapy” as well as “ovarian” or “cervical” was thoroughly reviewed.

Results

Preclinical in vivo models as well as early clinical trials demonstrated safety and efficacy when targeting gynecologic malignancies with OVs.

Conclusions

While gaining more and more insight into the underlying molecular mechanisms of OVs, virotherapy represents an appealing approach to fight gynecologic malignancies.     

Feasibility of laparoscopic extraperitoneal pelvic lymphadenectomy in gynecologic malignancies

Objective

The aim of this study is to evaluate the feasibility of laparoscopic extraperitoneal pelvic lymphadenectomy (LEPL) in gynecologic malignancies.

Methods

Twenty-nine women with cervical, ovarian or endometrial cancer underwent laparoscopic extraperitoneal pelvic lymphadenectomy between July 2008 and December 2010. The operating time, nodal yield, blood loss and complications were recorded.

Results

The number of patients with cervical, ovarian and endometrial carcinoma was 14, 3 and 12, respectively. The median age of patients was 48.9 ± 12.6 years. The median body mass index was 25.6 ± 4.8. Conversion to the transperitoneal laparoscopic approach was necessary in 6 patients for peritoneal tears causing CO₂ gas leakage. Among the remaining 23 patients, the median operating time for laparoscopic extraperitoneal pelvic lymphadenectomy was 69 min (range 50-126 min), and the median estimated blood loss was 20 ml (range 5-105 ml). The median total number of resected nodes was 26 (range 14-42), and complications related to the procedure were rare.

Conclusions

Laparoscopic extraperitoneal pelvic lymphadenectomy is a feasible and safe procedure. It can be used in gynecologic malignancies.     

Fertility preserving options in patients with gynecologic malignancies

A proportion of reproductive age women are affected by gynecologic malignancies. This patient population is faced with difficult decisions, related to their cancer care and treatment, as well as future childbearing potential. Therefore, it is important for gynecologists to be familiar with fertility sparing management options in patients with cervical, ovarian, and endometrial cancer. In addition to understanding the surgical approaches available, providers should be able to counsel patients regarding their eligibility for and the indications and limitations of fertility sparing therapy for gynecologic cancer, allowing for appropriate referrals. A comprehensive PUBMED literature search was conducted using the key words "fertility preservation," "cervical cancer," "endometrial cancer," "ovarian cancer," "borderline tumor of the ovary," "germ cell tumor," "obstetrical outcomes," "chemotherapy," and "radiation." The following review summarizes fertility sparing options for patients with cervical, ovarian and endometrial cancer, with an emphasis on appropriate patient selection, oncologic, and obstetric outcomes.     

腹腔镜在妇科恶性肿瘤诊治中的应用与规范化问题

腹腔镜在妇科恶性肿瘤诊治中的应用日益广泛,除肿瘤细胞减灭术外,几乎所有妇科恶性肿瘤开腹手术都有相对应的腹腔镜手术。腹腔镜技术与经阴道手术等其他的手术技术相结合,产生了一些新的手术方式。严格遵循妇科恶性肿瘤手术治疗原则的腹腔镜手术效果与相应的开腹手术相当或者更佳。机器人腹腔镜手术可能是妇科恶性肿瘤手术未来的发展方向。     

Serum lipid-associated sialic acid levels in gynecologic malignancies

Significantly elevated serum concentrations of lipid-associated sialic acid (LSA) were observed in 183 patients with invasive cervical carcinoma, 31 with uterine corpus adenocarcinoma and 71 with epithelial ovarian carcinoma prior to any treatment when compared with 50 normal control women ( P < 0.05). Elevated LSA levels were also observed in five women with microinvasive cervical carcinoma and in four patients with uterine corpus leiomyosarcoma ( P < 0.05). By contrast there were no significant elevations of serum LSA levels in 12 cases of cervical intraepithelial neoplasia, 32 of uterine corpus leiomyoma, 52 of benign ovarian cyst and 14 of mature ovarian teratoma when compared with normal control women. If the upper limit of the normal serum LSA concentration is set at 20 mg 100 ml⁻¹, uterine corpus malignancy was distinguished from benign uterine corpus tumor with a sensitivity of 71% and a specificity of 94%; and ovarian malignancies were distinguished from benign ovarian masses with a sensitivity of 82% and a specificity of 85%. The positive predictive values of LSA assays in uterine and ovarian masses were 93% and 85%, respectively, whilst the negative predictive values were 75% and 81%, respectively. The sensitivity of LSA assays in cervical carcinoma was 57%. The present study suggests that serum LSA assays may be useful for the detection of gyncological malignancies.     

Molecular imaging in the management of gynecologic malignancies

Objectives

The purpose of this review is to summarize literature pertaining to clinical roles of positron emission tomography (PET) or integrated PET and computed tomography (PET/CT) scans, magnetic resonance imaging (MRI) and emerging techniques of these two molecular imaging tools for gynecologic malignancies.

Methods

PubMed and MEDLINE databases search for articles published before June 2014 was performed. Only English-language articles were considered. Search terms included “cervical cancer”, “endometrial cancer”, “uterine cancer”, “uterine sarcoma”, “ovarian cancer” and “vulvar cancer”, in association with “FDG”, “PET”, “PET/CT”, “MRI”, “PET/MR”, “diffusion”, “spectroscopy” and “clinical trial”.

Results

Topics explored included PET, PET/CT and MRI for diagnosis of malignancy, prognostic implications, clinical staging of disease extent, monitoring treatment response, post-therapy surveillance, diagnosis of treatment failure and restaging, and follow-up after salvage therapy in gynecologic malignancies.

Conclusions

Molecular imaging (mainly PET and MRI) plays important roles in the management of gynecologic malignancies. Molecular imaging has various impacts in different clinical scenarios. Emerging technologies will continuously improve our practice. Prospective studies with defined endpoints are necessary to evaluate roles of these novel tools in management of gynecologic malignancies.     

腹腔镜下淋巴结清扫术后并发淋巴漏的临床分析

目的:探讨妇科恶性肿瘤患者行腹腔镜下淋巴结清扫术后淋巴漏的发生、危险因素、临床表现及诊断治疗方法。方法:回顾分析2009年9月至2012年8月在复旦大学附属妇产科医院行腹腔镜下腹膜后淋巴结清扫术的849例妇科恶性肿瘤患者的临床资料,分析患者术后淋巴漏发生的相关因素。结果:46例(5.42%)患者术后发生淋巴漏,其中42例为淡黄色引流液,4例为乳糜样引流液,引流量为300～1150ml/d。Logistic多元回归分析显示,淋巴结清扫数、淋巴结转移、术中出血量与淋巴漏发生有关。46例患者经限制饮食或禁食、静脉营养及引流等保守治疗后,均治愈。结论:淋巴漏的临床症状依据发生位置不同而表现各异。淋巴结转移、淋巴结清扫数及术中出血量是淋巴漏发生的危险因素。保守治疗及充分引流可获得满意效果;术中轻柔操作、提高手术技巧及术后预防性禁食可预防淋巴漏发生。     

Prevalence of telomerase activity in human cancer

Telomerase activity has been measured in a wide variety of cancerous and non-cancerous tissue types, and the vast majority of clinical studies have shown a direct correlation between it and the presence of cancerous cells. Telomerase plays a key role in cellular immortality and tumorigenesis. Telomerase is activated in 80-90% of human carcinomas, but not in normal somatic cells, therefore, its detection holds promise as a diagnostic marker for cancer. Measurable levels of telomerase have been detected in malignant cells from various samples: tissue from gestational trophoblastic neoplasms; squamous carcinoma cells from oral rinses; lung carcinoma cells from bronchial washings; colorectal carcinoma cells from colonic luminal washings; bladder carcinoma cells from urine or bladder washings; and breast carcinoma or thyroid cancer cells from fine needle aspirations. Such clinical tests for telomerase can be useful as non-invasive and cost-effective methods for early detection and monitoring of cancer. In addition, telomerase activity has been shown to correlate with poor clinical outcome in late-stage diseases such as non-small cell lung cancer, colorectal cancer, and soft tissue sarcomas. In such cases, testing for telomerase activity can be used to identify patients with a poor prognosis and to select those who might benefit from adjuvant treatment. Our review of the latest medical advances in this field reveals that telomerase holds great promise as a biomarker for early cancer detection and monitoring, and has considerable potential as the basis for developing new anticancer therapies.