Is Surgical Staging Necessary for Patients with Low-risk Endometrial Cancer? A Retrospective Clinical Analysis

Purpose: The aim of this study was to compare the tumor-free and overall survival rates between patientswith low-risk endometrial cancer who underwent surgical staging and those who did not undergo surgicalstaging. Materials and Methods: Data, including demographic characteristics, grade of the tumor, myometrialinvasion, cervical involvement, peritoneal washing, lymph node involvement, lymphovascular space invasion,postoperative complication, adjuvant treatment, cancer recurrence, and tumor-free and overall survival rates, forpatients with low-risk endometrioid endometrial cancer who were treated surgically with and without pelvic andparaaortic lymph node dissection (LND) were analyzed retrospectively. The patients diagnosed with endometrioidendometrial cancer including the following criteria were considered low-risk: 1) a grade 1 (G1) or grade 2 (G2)endometrioid histology; 2) myometrial invasion of <50% upon magnetic resonance imaging (MRI); 3) no stromalglandular or stromal invasion upon MRI; and 4) no evidence of intra-abdominal metastasis. Then the patientsat low-risk were divided into two groups; group 1 (n=117): patients treated surgically with pelvic and paraaorticLND and group 2 (n=170): patients treated surgically without pelvic and paraaortic LND. Results: There wasno statistical significance when the groups were compared in terms of lymphovascular space invasion, cervicalinvolvement, positive cytology, and recurrence, whereas the administration of an adjuvant therapy was higher ingroup 2 (p<0.005). The number of patients with positive pelvic nodes and the number of metastatic pelvic nodeswere significantly higher in the group with positive LVI than in the group without LVI (p<0.005). No statisticallysignificant differences were detected between the groups in terms of tumor-free survival (p=0.981) and overallsurvival (p=0.166). Conclusions: Total hysterectomy with bilateral salpingo-oophorectomy and stage-adaptedpostoperative adjuvant therapy without pelvic and/or paraaortic lymphadenectomy may be safe and efficienttreatments for low-risk endometrial cancer.     

Predicting Factors for Pelvic Lymph Node Metastasis in Patients with Apparently Early-Stage Endometrial Cancer

Background: Performing lymphadenectomy in all patients with early-stage endometrial cancer (EC) is debatable because the procedure may expose patients to unnecessary risks of postoperative complications. Aim of this study was to evaluate the prevalence and risk factors of pelvic lymph node metastasis (PLNM) in patients with apparently early-stage EC. Materials and methods: Two hundred and two patients with apparently early-stage EC who underwent surgical staging at Thammasat University Hospital between the years 2013 and 2020 were included in this retrospective study. Clinicopathological data and preoperative laboratory results were obtained from computer-based medical records. All data were statistically analyzed to determine the prevalence of PLNM and risk factors for developing PLNM. Results: PLNM was detected in 22 (10.9%) patients. Univariate analysis demonstrated that having grade 3 tumor, myometrial invasion of 50% or greater, vaginal involvement, cervical involvement, adnexal involvement, lower uterine segment involvement, lymphovascular space invasion (LVSI), and positive peritoneal cytology were associated with higher risk for developing PLNM. In addition, lower preoperative hemoglobin level and higher preoperative white blood cell count were significantly associated with PLNM. Multivariate analysis demonstrated that myometrial invasion of 50% or greater and LVSI were independent risk factors for developing PLNM (odds ratio (OR) 9.31, 95% confidence interval (CI) 2.58-33.55, p = 0.001, and OR 3.73, 95%CI 1.39-10.02, p = 0.009, respectively). Conclusions: Myometrial invasion of 50% or greater and LVSI were independent risk factors for developing PLNM in patients with apparently early-stage EC and thus lymphadenectomy in these patients should be provided.     

The grading of lymphovascular space invasion in endometrial carcinoma

BACKGROUND: This study was conducted to elucidate the prognostic significance of a three-grade system for lymphovascular space invasion (LVSI). METHODS: The prognostic significance of the grading of LVSI as compared with other pathologic variables was evaluated in a study of 303 Japanese women with endometrial carcinoma. The criteria for determining the grade of LVSI were as follows: none (no LVSI), mild (a focus of LVSI was recognized around a tumor), and severe (diffuse or multifocal LVSI were recognized around the tumor or in the myometrium regardless of the degree of myometrial invasion). Both univariate and multivariate regression analyses were performed. The effects of different surgical methods and adjuvant therapies on survival were also examined. RESULTS: A univariate survival analysis showed that survival significantly correlated with surgical stage, histologic grade, depth of myometrial invasion, LVSI, cervical invasion, ovarian metastasis, and tubal metastasis. Of the three grades of LVSI, survival showed the most difference between the mild and severe groups. In multivariate analysis, the highest correlation with survival was observed for LVSI (P = 0.0008). Lymph node metastasis was also significantly associated with LVSI (P = 0. 0001). The correlation between histologic variables and survival was only slightly influenced by the differences in surgical methods and adjuvant therapies. CONCLUSIONS: The grading of LVSI was found to be an important histologic prognostic variable. The severe degree of LVSI also was found to be a good indicator of lymph node metastasis. It is therefore important to evaluate the grade of LVSI based on a histologic examination of at least one cut surface of the hysterectomy specimen that macroscopically shows the deepest myometrial invasion.     

519例宫颈癌患者预后影响因素的分析研究

目的 分析影响宫颈癌患者预后的因素。方法 选取2007年1月—2008年12月哈尔滨医科大学附属肿瘤医院收治的、符合纳入标准的519人为研究对象。采用COX回归的方法分析不同生物学行为对宫颈癌预后的影响。结果 肿瘤大小(P=0.015)、淋巴结转移(P＜0.001)、卵巢转移(P＜0.001)、宫旁浸润(P＜0.001)、阴道切缘(P=0.040)、侵及深度(P=0.001)和脉管瘤栓(P＜0.001)对患者的结局有显著影响。单因素COX分析的结果表明肿瘤大小(RR=2.325)、组织学分级(RR=3.195)、淋巴结转移(RR=3.196,)、卵巢转移(RR=7.016)、宫旁浸润(RR=7.487)、侵及深度(RR=4.688)和脉管瘤栓(RR=4.014)与宫颈癌的预后显著相关。多因素COX分析结果显示组织学分级(RR=2.092)、卵巢转移(RR=5.680)、宫旁浸润(RR=4.114)、侵及深度(RR=2.065)和脉管瘤栓(RR=3.11)可显著影响宫颈癌的预后。结论 组织学分级、卵巢转移、宫旁浸润、侵及深度和脉管瘤栓为宫颈癌预后的独立影响因素。     

Presence of Anemia and Poor Prognostic Factors in Patients with Endometrial Carcinoma

This study evaluated the relationship between pretreatment hemoglobin (Hb) and prognostic factors in Thaipatients with endometrial cancer. Medical records of 228 patients who had undergone surgery between January2005 and December 2007 were retrospectively reviewed. Associations between clinicopathological variables andpretreatment Hb levels were described using Pearson’s chi square test or two-tailed Fisher’s exact test. Survivalanalysis was performed with Kaplan-Meier estimates. Univariate and Cox-regression models were used toevaluate the prognostic impact of various factors, including Hb levels, in term of disease-free survival. The medianduration of follow-up was 38.2 months. Eighty-nine patients (39%) had a preoperative Hb level of <12 g/dL, thesehaving significantly higher rates of non-endometrioid histology, advanced FIGO stage, lymphovascular spaceinvasion, cervical involvement, adnexal involvement, positive peritoneal cytology, and lymph node involvementthan patients with Hb ≥12 g/dL. The 5-year disease-free and overall survival were significantly lower in patientswith pretreatment Hb levels <12 g/dL compared with those with Hb ≥12 g/dL (79.3% vs. 89.2%, p=0.044 and87.6% vs. 99.3%, p<0.001, respectively). In the multivariate analysis only histology, myometrial invasion, andlymphovascular invasion proved to be independent prognostic factors, whereas tumor grading, stage, cervicalinvolvement, adnexal involvement, positive peritoneal cytology, lymph node involvement, and low Hb werenot. In conclusion, presence of anemia before treatment may reflect poor prognostic factors in patients withendometrial cancer and low pretreatment hemoglobin level may have a prognostic impact on clinical outcome.     

Risk factors for paraaortic lymph node metastasis in endometrial cancer

Objective

The purpose of this study was to determine the risk factors for paraaortic lymph node (LN) metastasis in endometrial cancer (EC) patients who underwent comprehensive surgical staging.

Methods

A total of 641 women with EC (endometrioid, non-endometrioid, or mixed histology) who underwent comprehensive surgical staging including pelvic and paraaortic LN dissection between 2008 and 2016 were included in this retrospective study. Patient data were analyzed with respect to paraaortic LN involvement, and predictive factors for paraaortic LN metastasis were investigated.

Results

Lymph node metastasis was detected in 90 (14%) patients, isolated pelvic LN metastasis in 28 (4.3%), isolated paraaortic LN metastasis in 15 (2.3%), and both pelvic and paraaortic LN metastasis in 47 (7.3%) women, respectively. Univariate analysis showed that the risk of paraaortic LN metastasis significantly increased in patients with non-endometrioid histology, age greater than 60 years, grade 3 tumor, deep myometrial invasion, lymphovascular space invasion (LVSI), primary tumor diameter (≥2 cm), cervical stromal invasion, adnexal involvement, serosal invasion, pelvic LN involvement, two or more positive pelvic LNs, and positive peritoneal cytology (p < 0.05). At the end of multivariate analysis, the presence of LVSI [odds ratio (OR), 4.8; 95% confidence interval (CI), 1.25–18.2; p = 0.022] and pelvic LN metastasis (OR, 18.8; 95% CI, 5.7–61.6; p < 0.001) remained as independent risk factors for paraaortic LN involvement in women with EC.

Conclusion

The presence of LVSI and pelvic LN involvement appear to be independent risk factors for paraaortic LN metastasis in patients with EC. LVSI may be considered as a routine pathological parameter during frozen section analysis in women with EC undergoing surgery.

     

Ⅰ、Ⅱ期宫颈癌淋巴转移特征及相关因素与预后

目的探讨宫颈癌盆腔淋巴结转移的特征,相关危险因素及其对预后的影响。方法回顾性分析32例宫颈癌根治术后盆腔淋巴结转移及同期无转移患者的临床与病理资料。结果盆腔淋巴结总转移率为23．35％（32／137）,以闭孔淋巴结转移率最高,占全部淋巴结转移的59．37％。盆腔淋巴结转移与宫颈肌层癌浸润深度有关,而与患者年龄、病理分化及组织学类型、宫旁侵犯及淋巴管浸润无关。淋巴结转移个数（≥3个）与宫颈癌的预后密切相关。淋巴管浸润、肌层浸润深度、病理类型（鳞癌与非鳞癌）、病理分化与预后无显著相关。结论肌层浸润≥1／2是宫颈癌患者盆腔淋巴结转移的危险因素,淋巴结转移33个者预后差,可为指导临床治疗提供帮助。     

Clinicopathological factors predicting retroperitoneal lymph node metastasis and survival in endometrial cancer

BACKGROUND: By clarifying the significance of clinicopathological factors for retroperitoneal lymph node metastasis and survival of patients with endometrial cancer, we suggest ideas for optimal treatment of this disease. METHODS: A retrospective study was conducted in 310 women with endometrial cancer who underwent surgery with retroperitoneal lymphadenectomy. To evaluate retroperitoneal lymph node metastasis, age-adjusted and multivariable analyses were carried out for six clinicopathological factors including pathological grade, myometrial invasion, cervical invasion, peritoneal cytology, lymphatic permeation and vascular invasion. To evaluate survival, besides the above factors, a positive rate of metastasis of dissected retroperitoneal lymph nodes was included. RESULTS: In 40 patients (13%) with nodal metastasis, the average positive rate of metastasis of dissected retroperitoneal lymph nodes was 22%. For retroperitoneal lymph node metastasis, the odds ratio of deep myometrial invasion, cervical invasion and severe lymphatic permeation were 5.97, 2.72 and 12.01, respectively. For survival, the hazard ratios of the positive rates of metastasis of dissected retroperitoneal lymph nodes (both 25% and < 25%), positive peritoneal cytology and poor pathological grade were 7.10, 3.24, 3.82 and 3.27, respectively, and 5-year survival rates for them were 0, 50, 72 and 77%, respectively. CONCLUSIONS: For retroperitoneal lymph node metastasis, lymphatic permeation, deep myometrial invasion and cervical invasion were the independent prognostic factors. For survival, retroperitoneal lymph metastasis, poor pathological grades and positive peritoneal cytology were the independent prognostic factors. The positive rate of metastasis of dissected retroperitoneal lymph metastasis plays an important role in predicting survival of endometrial cancer. Lymph node biopsy is insufficient in treatment of this disease.      

子宫内膜乳头状浆液性腺癌与透明细胞癌临床分析

  目的  分析子宫内膜乳头状浆液性腺癌(UPSC)与透明细胞癌(UCCC)的临床特点及预后。   方法  回顾性分析天津市中心妇产科医院2004年4月至2012年7月收治的41例UPSC与19例UCCC临床资料。   结果   UPSC完全手术分期24例, 早期(仅Ⅰ期)9例, 晚期(Ⅲ、Ⅳ期)15例。UCCC完全手术分期10例, 早期(仅Ⅰ期)6例, 晚期(Ⅲ、Ⅳ期)4例。单因素分析显示: 脉管浸润、腹水/腹腔冲洗液细胞学阳性及淋巴结转移者总生存期(OS)较短; 脉管浸润、肌层浸润、腹水/腹腔冲洗液细胞学阳性者无病生存期(DFS)较短。多因素Cox回归分析显示: 淋巴结转移、腹水/腹腔冲洗液细胞学阳性者的患者OS较短; 脉管浸润、腹水/腹腔冲洗液细胞学阳性者的患者DFS较短。   结论  UPSC确诊时多为晚期, 预后差。治疗强调全面手术分期, 脉管浸润、肌层浸润、腹水/腹腔冲洗液及淋巴结转移与预后相关。      

Tumor Diameter for Prediction of Recurrence,Disease Free and Overall Survival in Endometrial Cancer Cases

Aims: To analyse the predictors of recurrence, disease free survival and overall survival in cases with endometrial cancer. Materials and Methods: A total of 152 women diagnosed with endometrial cancer were screened using a prospectively collected database including age, smoking history, menopausal status, body mass index, CA125, systemic disorders, tumor histology, tumor grade, lymphovascular space invasion, tumor diameter, cervical involvement, myometrial invasion, adnexal metastases, positive cytology, serosal involvement, other pelvic metastases, type of surgery, fertility sparing approach to assess their ability to predict recurrence, disease free survival and overall survival. Results: In ROC analyses tumor diameter was a significant predictor of recurrence (AUC:0.771, P<0.001). The optimal cut off value was 3.75 with 82% sensitivity and 63% specificity. In correlation analyses tumor grade (r=0.267, p=0.001), tumor diameter (r=0.297, p<0.001) and the serosal involvement (r=0.464, p<0.001) were found to significantly correlate with the recurrence. In Cox regression analyses when some different combinations of variables included in the model which are found to be significantly associated with the presence of recurrence, tumor diameter was found to be a significant confounder for disease free survival (OR=1.2(95 CI,1.016-1.394, P=0.031). On Cox regression for overall survival only serosal involvement was found to be a significant predictor (OR=20.8 (95 % CI 2.4-179.2, P=0.006). In univariate analysis of tumor diameter > 3.75 cm and the recurrence, there was 14 (21.9 %) cases with recurrence in group with high tumor diameter where as only 3 (3.4 %) cases group with smaller tumor size (Odds ratio:7.9 (95 %CI 2.2-28.9, p<0.001). Conclusions: Although most of the significantly correlated variables are part of the FIGO staging, tumor diameter was also found to be predictor for recurrence with higher values than generally accepted.     

Multivariate prognostic analysis of adenocarcinoma of the uterine cervix treated with radical hysterectomy and systematic lymphadenectomy

Objective

The aim of this study was to investigate the prognostic factors and treatment outcome of patients with adenocarcinoma of the uterine cervix who underwent radical hysterectomy with systematic lymphadenectomy.

Methods

A total of 130 patients with stage IB to IIB cervical adenocarcinoma treated with hysterectomy and systematic lymphadenectomy from 1982 to 2005 were retrospectively analyzed. Clinicopathological data including age, stage, tumor size, the number of positive node sites, lymphovascular space invasion, parametrial invasion, deep stromal invasion (>2/3 thickness), corpus invasion, vaginal infiltration, and ovarian metastasis, adjuvant therapy, and survival were collected and Cox regression analysis was used to determine independent prognostic factors.

Results

An estimated five-year survival rate of stage IB1 was 96.6%, 75.0% in stage IB2, 100% in stage IIA, and 52.8% in stage IIB. Prognosis of patients with one positive-node site is similar to that of those with negative-node. Prognosis of patients with multiple positive-node sites was significantly poorer than that of negative and one positive-node site. Multivariate analysis revealed that lymph node metastasis, lymphovascular space invasion, and parametrial invasion were independent prognostic factors for cervical adenocarcinoma. Survival of patients with cervical adenocarcinoma was stratified into three groups by the combination of three independent prognostic factors.

Conclusion

Lymph node metastasis, lymphovascular space invasion, and parametrial invasion were shown to be independent prognostic factors for cervical adenocarcinoma treated with hysterectomy and systematic lymphadenectomy.     

早期宫颈癌淋巴结转移的高危因素分析及列线图预测模型的构建

 目的 探讨临床病理特征与早期宫颈癌淋巴结转移的关系，同时建立列线图模型预测只行根治性手术而未进行淋巴结清扫的早期宫颈癌患者淋巴结转移情况。方法 回顾性收集福建医科大学附属第一医院妇科432例行子宫切除及淋巴结清扫术并经病理组织学确诊的早期宫颈癌患者术后临床病理资料。运用Logistic回归分析确定早期宫颈癌淋巴结转移的高危因素。建立预测早期宫颈癌淋巴结转移风险的列线图模型，分别用一致性系数（C-index）和校准曲线评估模型的预测性能和符合度。结果 432例早期宫颈癌患者中，有84例患者出现转移，阳性率19.4%。多因素分析显示肿瘤最大径>3 cm、宫旁浸润、淋巴血管间质浸润是早期宫颈癌患者淋巴结转移的独立危险因素，其OR分别为1.98（95%CI:1.17~3.34）、2.64（95%CI: 1.28~5.44）、4.77（95%CI: 2.60~8.75）。用于预测淋巴结转移风险的列线图的准确度为0.687。结论 基于肿瘤最大径>3 cm、宫旁浸润和淋巴血管间质浸润构建的列线图，可用于指导只行根治性手术而未行淋巴结清扫的早期宫颈癌患者的进一步治疗。     

Sensitivity of cervico-vaginal cytology in endometrial carcinoma: A systematic review and meta-analysis

Cervico-vaginal cytology is primarily a cervical cancer screening test. The anatomical continuity of the uterine cavity with the cervix makes the Papanicolaou (Pap) test accessible to evaluate signs of disease shed from the endometrium. Our aim was to determine the sensitivity of routine Pap test in endometrial carcinoma detection and its relationship with clinico-pathologic factors. We performed a systematic review of studies reporting Pap test results prior to diagnosis of or surgery for endometrial carcinoma between 1990 and 2018 in PubMed or Web of Science. Two independent reviewers extracted data and assessed study quality using an adapted Newcastle-Ottawa Quality Assessment Scale and Quality Assessment of Diagnostic Accuracy Studies tool. We identified 45 studies including a total of 6599 women with endometrial cancer. Abnormal Pap test results prior to diagnosis of or surgery for endometrial carcinoma were observed in 45% (95% CI, 40%-50%) of study participants. This percentage was significantly higher among those of non-endometrioid histology compared with endometrioid subtypes (77% [95% CI, 66%-87%] vs 44% [95% CI, 34%-53%], respectively; P heterogeneity <.001). Several clinico-pathologic factors were related to a higher percentage of abnormal Pap test results, including high-stage, myometrial invasion >50%, high histological grade, positive peritoneal cytology, presence of lymph node metastasis, cervical involvement, and lymphovascular invasion (P heterogeneity <.05 for all variables). Routine cervical cytology can detect endometrial cancer in almost half of patients, whereas sensitivity is higher among individuals with non-endometrioid histology or more advanced cancers. This review summarizes the current clinical and prognostic value of cervical cytology in endometrial carcinoma. Recent technological developments using molecular biomarkers may improve accuracy for early cancer detection.     

乳腺癌乳头乳晕复合体受侵犯的相关临床病理因素

保留乳头乳晕复合体(nipple areola complex,NAC)的乳房切除术(nipple-areola complexsparing mastectomy,NSM)是传统的乳腺切除手术的一种改进术式,能完整切除肿瘤并最大限度保持乳房外形美观。目前有关NSM仍存在许多尚待解决的问题,其中一个重要问题就是如何在术前选择合适的患者。许多肿瘤的临床病理特征,如肿瘤到乳头的距离(tumor-to-nipple distance,TND)和肿瘤位置、肿瘤大小、多中心性肿瘤、淋巴结转移和脉管侵犯、组织学分级、HER-2表达情况等与NAC隐匿性的肿瘤累及率密切相关,但如何在NSM术前对这些指标进行精确评估仍需进一步探索。临床评估NAC有无异常,NAC后方乳腺组织的病理评估,并综合分析与NAC累及相关的临床病理因素是目前用于判断乳腺癌患者是否可行NSM的主要方法。更多的大规模临床研究仍需进行,以利于制定统一的NSM患者选择标准。     

Clinicopathological implication of cripto expression in early stage invasive cervical carcinomas

This study evaluates the expression of cripto (CR-1) protein in matched sets of non-neoplastic cervical epithelium, primary cervical carcinoma and metastatic tumours in the lymph nodes to investigate its role in uterine cervical cancer development and progression. Ninety-four primary cervical carcinomas in an early clinical stage and having the same surgical treatment modality were analysed. Immunoreactivity in the primary tumour was compared with that of non-neoplastic cervical epithelium and metastatic lymph nodes. The conventional clinicopathological prognostic variables for cervical carcinomas such as grade, tumour size, depth of invasion, parametrial and endometrial extension, lymphovascular space involvement and lymph node metastasis status were also compared with CR-1 expression of the primary tumour. Strong CR-1 immunopositivity was significantly correlated with tumour size and lymphovascular space involvement (P < 0.05). Furthermore, a significant relationship was found between CR-1 immunoreactivity and endometrial extension as well as parametrial involvement (P < 0.05). Interestingly, the CR-1 expression level was increased in metastatic lymph nodes compared with their primary tumours. These results suggest that CR-1 may contribute to disease progression in cervical carcinomas.     

Sperm-Associated Antigen 9 is a Promising marker for Early Diagnosis of Endometrial Cancer

Background: Sperm-associated antigen 9 (SPAG9) has been recently proposed as a novel biomarker for earlydiagnosis of several human tumors, including ovarian, cervical and breast cancers. Its clinical value remainsto be clarified for endometrial cancer (EC). In this study, we investigated the utility of serum SPAG9 levels indiagnosis of EC and its association with important clinicopathological parameters. Materials and Methods:This cross-sectional study was performed at a tertiary women’s referral center in Ankara, Turkey. Preoperativeserum samples were collected from patients surgically treated for endometrial cancer between June 2012-April2013. Similar aged women with a biopsy proven benign endometrium were used as controls. Serum SPAG9levels were measured with an enzyme-linked immunosorbent assay (ELISA) method and assessed for linkswith clinicopathological factors. Receiver operating characteristic (ROC) curve analysis was performed toassess power of SPAG9 levels for EC prediction. P values less than 0.05 were considered statistically significant.Results: A total of 63 women with EC and 27 with benign endometrium were included in the study. Mean agein the EC group was 58.7±1.1. Median SPAG9 levels in the EC and control groups were 18.3 (range, 12.7-53.8)and 14.1 (range, 4.3-65.3), respectively (p<0.001). A cut-off value of 17 ng/ml for SPAG9 predicted presence ofmalignant endometrium with 74% sensitivity and 83% specificity [Area under curve (AUC)=0.82, p<0.001].SPAG9 levels did not demonstrate any significant association with histological type, FIGO stage, tumor grade,size, myometrial invasion, lymphovascular space invasion, cervical involvement, adnexal involvement, peritonealcytology or lymph node status (all p>0.05). Conclusions: Testing for SPAG9 may be useful for early detectionof EC in asymptomatic high-risk women. Its role in post-treatment follow-up and early detection of recurrenceshould be assessed in future trials.     

Ki-67、TOPOⅡα在食管鳞状细胞癌组织中的表达及意义

目的:探讨Ki-67、TOPOⅡα在食管鳞状细胞癌组织中的表达及临床意义。方法:收集我院食管鳞状细胞癌组织标本60例,采用免疫组织化学法检测Ki-67、TOPOⅡα在食管鳞状细胞癌组织中的表达情况。结果:食管鳞状细胞癌组织中Ki-67表达的阳性率为86.7%（52/60）,Ki-67阳性表达与组织学分级、浸润深度、淋巴结转移、脉管侵犯及临床分期相关,差异具有统计学意义（P＜0.05）。食管鳞状细胞癌组织中TOPOⅡα表达的阳性率为83.3%（50/60）,TOPOⅡα 阳性表达与淋巴结转移、脉管侵犯、临床分期相关,差异具有统计学意义（P＜0.05）。Ki-67与TOPOⅡα共表达与组织学分级、淋巴结转移、脉管侵犯、临床分期相关（P＜0.05）。Spearman 相关分析显示Ki-67 和TOPOⅡα 两者在食管鳞状细胞癌组织中的表达呈正相关（r=0.351,P=0.006）。结论:Ki-67和TOPOⅡα 与食管鳞状细胞癌的发生发展相关,可作为食管鳞状细胞癌预后的预测指标。     

Clinicopathologic Features Predicting Involvement of Nonsentinel Axillary Lymph Nodes in Iranian Women with Breast Cancer

Background: Almost half of the breast cancer patients with positive sentinel lymph nodes have no additional disease in the remaining axillary lymph nodes. This group of patients do not benefit from complete axillary lymph node dissection. This study was designed to assess the clinicopathologic factors that predict non-sentinel lymph node metastasis in Iranian breast cancer patients with positive sentinel lymph nodes. Materials and Methods: The records of patients who underwent sentinel lymph node biopsy, between 2003 and 2012, were reviewed. Patients with at least one positive sentinel lymph node who underwent completion axillary lymph node dissection were enrolled in the present study. Demographic and clinicopathologic characteristics including age, primary tumor size, histological and nuclear grade, lymphovascular invasion, perineural invasion, extracapsular invasion, and number of harvested lymph nodes, were evaluated. Results: The data of 167 patients were analyzed. A total of 92 (55.1%) had non-sentinel lymph node metastasis. Univariate analysis of data revealed that age, primary tumor size, histological grade, lymphovascular invasion, perineural invasion, extracapsular invasion, and the number of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes ratio, wereassociated with non-sentinel lymph node metastasis. After logistic regression analysis, age (OR=0.13; 95% CI, 0.02-0.8), primary tumor size (OR=7.7; 95% CI, 1.4-42.2), lymphovascular invasion (OR=19.4; 95% CI, 1.4-268.6), extracapsular invasion (OR=13.3; 95% CI, 2.3-76), and the number of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes ratio (OR=20.2; 95% CI, 3.4-121.9), were significantly associated with non-sentinel lymph node metastasis. Conclusions: According to this study, age, primary tumor size, lymphovascular invasion, extracapsular invasion, and the ratio of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes, were found to be independent predictors of non-sentinel lymph node metastasis.     

Pr?diktive und prognostische Marker beim Endometriumkarzinom

Within the last years a reliable number of studies have analysed predictive and prognostic factors fort the definition of biologically similar subgroups, testing treatment results and for the definition of tailored therapy approaches in patients affected by endometrial cancer (EC). Several studies have demonstrated the prognostic and therapeutic impact of lymph node status, histological tumor type (type 1 vs. type 2 cancers), histological grade, stage of disease, depth of myometrial invasion, lymphovascular space involvement and cervical involvement. Understanding pathogenesis at the molecular level is essential in identifying biomarkers for successful targeted therapies. New parameters and gene expression analysis are identifying different types of endometrial cancer with different prognoses, but theses data are still provisory.     

Lack of Relation of Survivin Gene Expression with Survival and Surgical Prognostic Factors in Endometrial Carcinoma Patients

Background: The relation of survivin gene expression to survival and surgical prognostic factors in the patients with endometrial carcinoma is unclear. Materials and Methods: In this study, 62 cases who were operated due to endometrial carcinoma were investigated between 2003 and 2011 in the the gynecological oncology clinic of Female Disease Training and Investigation Hospital of Etlik Zubeyde, Hanim, Turkey. Clinical and surgical prognostic factors were investigated by screening the records of these cases. With the standard streptavidin-biotin immune peroxidase method, cytoplasmic and nuclear expression of survivin was investigated in sections with specific antibodies (1:100, diagnostic Bio Systems, USA) primer. The aim was to elucidate any relation between survivin expression and defined prognostic factors and survival. Results: There was no statistically significant relationship between cytoplasmic and nuclear indexes identified for survivin and age, body mass index, the levelsof preoperative hemoglobin, platelet and Ca 125, stage, grade, lymph node meastasis, the number of metastatical lymph nodes (total, paraaortic and pelvic), myometrial invasion, serosal invasion, adnexal involvement, the presence of acid in the first diagnosis, the involvement of omentum, the adjuvant treatment application of the cases, the presence of recurrence and rate of mortality (p>0.05). Statistical significance was noted for the presence of advanced stage lymph node metastasis (pelvic, paraaortic, pelvic and paraaortic), serosal involvement, positive cytology, lymph vascular space invasion, intra abdominal metastasis, and omentum involvement. When investigated the relation between cytoplasmic and nuclear survivin indexes and total survival, the result wasnot statistically significant (p>0.05). Conclusions: In our study, there was no statistically significant relationship between the rates of cytoplasmic and nuclear survivin expression with identified prognostic factors and total or non-disease survival.