Prognosis and treatment of primary adenocarcinoma and adenosquamous cell carcinoma of the uterine cervix.

PURPOSE: To evaluate a cohort of women with primary invasive carcinomas of the uterine cervix, and to compare the biological characteristics and behavior of a cohort of adenosquamous carcinomas with a cohort of adenocarcinomas and squamous cell carcinomas. METHODS: One hundred and fourteen cases of primary invasive cervical carcinoma presenting between 1 January 1987 and 31 December 1997 were studied. Sixteen (14%) women with adenosquamous cell carcinomas and eight (7%) adenocarcinomas were compared with 90 (79%) women with squamous cell carcinomas. Patients with Stage Ib and IIa were treated by radical hysterectomy and pelvic lymph node dissection. All patients with stage IIb and over were treated by radiation. Patients with bulky, large, barrel-shaped lesions were selected for treatment by a combination of radiation and extrapelvic hysterectomy. RESULTS: The corrected survival rate for stage Ib patients with adenosquamous cell carcinoma was only 27.2%, compared with a 92.2% corrected survival rate for squamous cell, and a 100% corrected survival rate for adenocarcinoma. CONCLUSION: There is a higher proportion of adenosquamous cell and adenocarcinoma of the cervix than generally appreciated. The epidemiological risk factors associated with adenosquamous carcinomas of the cervix are more similar to those of squamous cell carcinomas than of adenocarcinomas. The survival difference between two groups is explained by effects of clinical stage, nodal spread, and vascular space involvement.     

The prognosis of adenosquamous carcinomas of the uterine cervix.

OBJECTIVES: Firstly, to identify a cohort of women with invasive adenosquamous carcinomas of the uterine cervix, including mucin-producing squamous cell carcinomas. Secondly, to compare the biological characteristics and behaviour of a cohort of adenosquamous carcinomas with a cohort of non-mucin-producing squamous cell carcinomas. DESIGN: Histological review, retrospective survival analysis. SETTING: Regional multidisciplinary gynaecological oncology service. SUBJECTS: 161 cases of stage 1B and above invasive cervical carcinoma presenting between 1 January 1980 and 31 July 1987. Thirty nine women with adenosquamous carcinomas were compared with 103 women with non-mucin-producing squamous cell tumours. RESULTS: Inclusion of routine stains for mucin in the assessment of histological material resulted in the reclassification of 38 (24%) of the cases, including the identification of 31 mucin-producing squamous cell carcinomas. The survival with adenosquamous tumours was significantly worse than with squamous cell cancers (P = 0.006), 5-year survival rates being 52% and 75% respectively. Multivariate analysis showed that this effect was explained by differences in clinical stage, pelvic lymph node metastasis and vascular invasion by tumour. CONCLUSIONS: The application of routine mucin stains to cervical tumours identifies a group of previously unrecognized adenosquamous cancers. Tumours so identified are likely to pursue a more aggressive clinical course associated with a poorer survival when compared to non-mucin-producing squamous carcinomas.     

The pathology of cervical tumours

Carcinomas of the cervix may be categorized on morphological grounds into four main groups: squamous carcinomas; adenocarcinomas; neuro-endocrine tumours; and others including adenosquamous carcinomas. Each group contains several morphological subvariants. Invasive squamous carcinomas and adenocarcinomas are preceded by cervical intra-epithelial neoplasia and cervical glandular intra-epithelial neoplasia, respectively. Each is graded into low and high grade. Micro-invasive carcinomas with stromal invasion less than 3mm in depth have a minimal chance of lymph node metastasis. When there is lymph node involvement, the obturator node may be the most common. Presence or absence of lymph node involvement, tumour size and depth of invasion are the important independent histopathological indicators of prognosis. The presence or absence of vascular space invasion is a valuable prognostic indicator. Small cell carcinomas, large cell neuro-endocrine carcinomas and possibly adenoid cystic carcinomas are aggressive. With these exceptions, it is doubtful whether tumour type is of much clinical significance. Tumour grade, as currently assessed, is of no significant value.     

Abnormal distribution of E-cadherin and beta-catenin in different histologic types of cancer of the uterine cervix

OBJECTIVE: The goal of this study was to analyze the cellular distribution and possible alterations of beta-catenin and E-cadherin proteins in different histologic types of uterine cervical cancer and precursor lesions, compared to normal controls. METHODS: We performed an immunochemical staining analysis of the cellular distribution of beta-catenin and E-cadherin proteins in biopsy samples from 20 normal exocervical squamous epithelium, 43 premalignant lesions, and a large series of 126 invasive tumors of different histologic types that included 68 squamous carcinomas, 31 adenosquamous carcinomas, and 27 adenocarcinomas. Statistical significance was evaluated by the chi-square or Fisher's Exact test. RESULTS: We observed beta-catenin abnormally distributed in the cytoplasm of 62% of premalignant lesions and more than 70% of invasive cancers, statistically significant when compared with normal tissue (P < 0.05). Similarly, we found that E-cadherin exhibit a significant abnormal distribution in the cytoplasm of 58% of premalignant lesions (P < 0.05) and in more than 71% of squamous carcinoma and adenosquamous carcinoma when compared with normal tissue (P < 0.05). We found no differences in the distribution of E-cadherin between adenocarcinomas compared with control samples. Interestingly, we found that both, beta-catenin and E-cadherin, were absent in the membrane of nearly 40% premalignant lesions. Nuclear staining of beta-catenin was rarely seen in any cases, contrary to what has been reported for this and other neoplasias. CONCLUSION: Our findings indicate that cellular alterations of both beta-catenin and E-cadherin are frequent in tumors of the uterine cervix of different histologic types, and support a role for these proteins in cervical cancer development.     

Locally advanced adenocarcinoma and adenosquamous carcinomas of the cervix compared to squamous cell carcinomas of the cervix in Gynecologic Oncology Group trials of cisplatin-based chemoradiation

Objective

Conflicting results have been reported for adeno- and adenosquamous carcinomas of the cervix with respect to their response to therapy and prognosis. The current study sought to evaluate impact of adeno- and adenosquamous histology in the randomized trials of primary cisplatin-based chemoradiation for locally advanced cervical cancer.

Methods

Patients with adeno- and adenosquamous cervical carcinomas were retrospectively studied and compared to squamous cell carcinomas in GOG trials of chemoradiation.

Results

Among 1671 enrolled in clinical trials of chemoradiation, 182 adeno- and adenosquamous carcinomas were identified (10.9%). A higher percentage of adeno- and adenosquamous carcinomas were stage IB₂ (27.5% versus 20.0%) and fewer had stage IIIB (21.4% versus 28.6%). The mean tumor size was larger for squamous than adeno- and adenosquamous. Adeno- and adenosquamous carcinomas were more often poorly differentiated (46.2% versus 26.8%). When treated with radiation therapy alone, the 70 patients with adeno- and adenosquamous carcinoma of the cervix showed a statistically poorer overall survival (p = 0.0499) compared to the 647 patients with squamous cell carcinoma of the cervix. However, when treated with radiation therapy with concurrent cisplatin-based chemotherapy, the 112 patients with adeno- and adenosquamous carcinomas had a similar overall survival (p = 0.459) compared the 842 patients with squamous cell carcinoma. Adverse effects to treatment were similar across histologies.

Conclusion

Adeno- and adenosquamous carcinomas of the cervix are associated with worse overall survival when treated with radiation alone but with similar progression-free and overall survival compared to squamous cell carcinomas of the cervix when treated with cisplatin based chemoradiation.     

Prognostic significance of adenocarcinoma histology in women with cervical cancer

Objectives

We performed a population-based analysis to determine the effect of histology on survival for women with invasive cervical cancer.

Methods

The Surveillance, Epidemiology and End Results database was used to identify women with stage IB-IVB cervical cancer treated from 1988 to 2005. Patients were stratified by histology (squamous, adenocarcinoma, and adenosquamous). Clinical characteristics, patterns of care, and outcomes were analyzed using multivariable logistic regression and Cox proportional hazards models.

Results

A total of 24,562 patients were identified including 18,979 (77%) women with squamous cell carcinomas, 4103 (17%) with adencarcinomas, and 1480 (6%) with adenosquamous tumors. Women with adenocarcinomas were younger, more often white, and more frequently married than patients with squamous cell tumors (p < 0.0001 for all). Patients with adenocarcinomas were more likely to present with early-stage disease (p < 0.0001). At diagnosis, 26.7% of women with adenocarcinomas had stage IB1 tumors compared to 16.9% of those with squamous cell carcinomas. Among women with early-stage (IB1-IIA) tumors, patients with adenocarcinomas were 39% (HR = 1.39; 95% CI, 1.23-1.56) more likely to die from their tumors than those with squamous cell carcinomas. For patients with advanced-stage disease (stage IIB-IVA) women with adenocarcinomas were 21% (HR = 1.21; 95% CI, 1.10-1.32) more likely to die from their tumors than those with squamous neoplasms. Five-year survival for stage IIIB neoplasms five-year survival was 31.3% (95% CI, 29.2-33.3%) for squamous tumors vs. 20.3% (95% CI, 14.2-27.1%) for adenocarcinomas.

Conclusion

Cervical adenocarcinomas are more common in younger women and white patients. Adenocarcinoma histology negatively impacts survival for both early and advanced-stage carcinomas.     

Recent trends in histological pattern of cervical carcinoma among three ethnic groups in Malaysia

OBJECTIVE: To study the trend of different histological types of cervical carcinoma among the 3 major ethnic groups in Malaysia. METHODS: All invasive cervical carcinoma histologically diagnosed for the first time in 1991-1992 and 1996-1997 at the University Hospital, Kuala Lumpur (UHKL) were reviewed for the following parameters; age, ethnic group, histological category. RESULTS: One hundred and twenty-one and 145 cases were diagnosed in 1991-1992 and 1996-1997, respectively. During both periods, squamous was followed by adeno and adenosquamous carcinoma in frequency. Patients' mean ages ranged within the 4th decade for all 3 major histological types. Ethnically, an overall predilection for the Chinese was observed. While squamous carcinomas had declined among the Chinese and Malays, adenocarcinomas were noted to increase. The converse was observed among the Indians. CONCLUSIONS: Ethnically, cervical carcinoma showed a predilection for Malaysians of Chinese descent. A decreasing incidence of squamous with a worrying increasing trend of adenocarcinoma was observed, like in other populations studied.     

Endocervical adenocarcinoma. Clinico-pathologic and histochemical study of 29 cases

Twenty-nine women were treated for endocervical adenocarcinoma in the University of Bari in the years 1975-1981. The histological type was "endocervical" or "mucinous" in 12 patients (41.4%), "endometrioid" in 12 (41.4%), "clear cell" in 2 (6.9%), "adenosquamous" in 2 (6.9%), and "serous" or "papillary" in 1. Foci of papillary and endometrioid metaplasia were present in 2 adenocarcinomas of endocervical type. The following histochemical methods were used: PAS reaction, PAS reaction with diastase predigestion, Bleu Alcian at pH 2.5 and pH 1, mucicarmine, Toluidine Bleu at 0.3%. The "endocervical" type adenocarcinoma showed mucicarmine positive and PAS positive, diastase resistant material in the whole cytoplasm. This material was not metachromatic and Bleu Alcian positive only in the well differentiated forms. In the "endometrial" adenocarcinoma only in the apex of the glandular cells was PAS positive diastase resistant, Alcian and mucicarmine positive. "Clear cell" and "adenosquamous" carcinomas showed only few cytoplasmatic PAS positive, diastase sensitive granules (= glycogen). No positivity was present in the "papillary" or "serous" carcinomas. Our results permit us to unify the histological and the histochemical patterns of the cervical adenocarcinomas and those of the similar forms of the endometrium and of the ovary, and stress the common müllerian origin of these neoplasms.     

Clear cell carcinoma of the uterine cervix: pathology and prognosis in surgically treated stage IB-IIB disease in women not exposed in utero to diethylstilbestrol

OBJECTIVE: The purpose of this research was to compare the clinical behavior, pathology findings, and prognosis of surgically treated FIGO stage IB-IIB clear cell carcinomas of the cervix with those of squamous cell carcinomas and non-clear cell adenocarcinomas. METHODS: Fifteen patients with clear cell adenocarcinomas of the cervix (8 FIGO stage IB, 7 FIGO stage IIB) were reviewed. The control group consisted of 444 squamous cell carcinomas and 59 non-clear cell adenocarcinomas. None of the patients had a history of in utero exposure to diethylstilbestrol. All patients underwent radical abdominal hysterectomy with systematic pelvic lymphadenectomy. All specimens were processed as serial giant frontal sections. The mean follow-up in the clear cell group was 83 (13-182) months. Statistical analysis was done with contingency tables, chi(2) tests, and Fisher's exact test. RESULTS: Twelve of the fifteen clear cell carcinomas (80%) were endophytic and tended toward deep cervical infiltration. Clear cell carcinomas extended to the uterine corpus significantly more often than squamous cell and non-clear cell adenocarcarcinomas (P < 0.001). The rates of parametrial involvement and pelvic lymph node involvement were 40 and 47%, respectively. Four patients (27%), all with positive pelvic nodes, developed recurrences an average of 14 (4-48) months after initial therapy. The extrapelvic sites of relapse were the lung, liver, and bone. Clear cell carcinomas had a worse 5-year survival rate (67%) than squamous cell carcinomas (80%) and non-clear cell adenocarcinomas (77%) but this was not statistically significant (P = 0.6). No significant differences were seen for age, growth pattern, parametrial and vaginal involvement, parametrial and pelvic lymph node metastases, frequency of recurrent disease, and time to first recurrence. CONCLUSION: The clinicopathologic findings and prognosis of surgically treated patients with stage IB-IIB clear cell carcinomas without exposure to diethylstilbestrol in utero are similar to those of patients with squamous cell carcinomas and non-clear cell adenocarcinomas.     

Association of syndecan-1 with tumor grade and histology in primary invasive cervical carcinoma

OBJECTIVES: The expression of syndecan-1, a cell surface heparan sulfate proteoglycan, is reduced during malignant transformation of squamous cells. Studies on squamous cell carcinoma of the head and neck have shown that syndecan-1-positive tumors are associated with longer overall and recurrence-free survival. The purpose of this study was to analyze syndecan-1 expression in invasive cervical carcinoma and to examine the association of syndecan-1 expression with prognostic factors and overall survival. METHODS: The study population consisted of 124 patients treated for primary invasive carcinoma of the uterine cervix at the Turku University Central Hospital during the years 1970-1988. The material consisted of 102 (82.3%) squamous cell carcinomas, 16 (12.9%) adenocarcinomas and 1 (0.8%) adenosquamous carcinoma, 1 (0.8%) small cell carcinoma, 1 (0. 8%) adenoid basal carcinoma, 1 (0.8%) carcinosarcoma, and 2 (1.6%) unclassified cervical carcinomas. Syndecan-1 expression was determined on paraffin-embedded tissue blocks using a human syndecan-1-specific monoclonal antibody B-B4 and immunohistochemistry. The expression of syndecan-1 was classified according to staining intensity as well as the percentage of positively stained tumor cells. RESULTS: Staining intensity was strong in 44 (36%) samples, while 24 (19%) specimens remained syndecan-1-negative. In 49 (40%) samples, the percentage of syndecan-1-positive cells was >/=90%. Syndecan-1 expression, as determined by >/=50% positively stained tumor cells, was associated with the grade of differentiation (P = 0.03) and squamous histology (P < 0.001), but was not associated with clinical stage (P = 0.16) or disease-free survival (P = 0.86). Age (P = 0.003) and clinical stage (P < 0.001) were significant prognostic factors, but syndecan-1 expression determined neither by percentage of positively stained tumor cells nor by staining intensity was associated with the outcome. CONCLUSIONS: In cervical carcinoma syndecan-1 is associated with histological differentiation grade and squamous histology, but does not predict clinical outcome.     

High cyclooxygenase-2 expression in cervical adenocarcinomas

OBJECTIVE: The purpose of this study was to examine the relationships between cyclooxygenase-2 (COX-2) expression and prognostic factors in cervical carcinomas. METHODS: We studied COX-2 expression in 53 women with cervical cancers, including 35 squamous cell carcinomas (SCCs), 1 adenosquamous cell carcinoma (ASCC), and 17 adenocarcinomas (ACs), using commercially available polyclonal antibodies on Formalin-fixed, paraffin-embedded tissues. Normal cervical tissues were obtained as from other patients with uterine myomas treated with a total hysterectomy (n = 16). The immunoreactivity was quantified using an immunohistochemical scoring system that approximates the use of an image analysis-based system. RESULTS: Twenty-two cervical cancer tissues (41.5%), including 10 SCCs and 12 ACs, expressed COX-2 at a moderate to strong level, which significantly, differed from the negligible expression found in the control group of 16 normal cervical tissues (P = 0.001). Different cell types showed significantly different expression levels of COX-2 (SCC at 28.6% vs AC at 70.6%, P = 0.004). The presence of deep stromal invasion (n = 40) showed a significant inverse relationship to COX-2 expression (32.5% vs 69.2%, P = 0.02). The expression of COX-2 in well-differentiated carcinomas was significantly increased compared to that in moderately and poorly differentiated carcinomas (72.7% vs 33.3%, respectively, P = 0.018). CONCLUSIONS: Overexpression of COX-2 was found in both SCC and AC, but SCCs showed infrequent and low expression. These findings suggest that increased COX-2 expression may play an important role in cervical adenocarcinomas.     

The clinicopathologic significance of laminin-5 γ2 chain expression in cervical squamous carcinoma and adenocarcinoma

Carcinoma of the uterine cervix is one of the most prevalent malignancies among women in developing countries and the third most common type worldwide. Squamous cell carcinoma predominates in the cervix uteri, while adenocarcinoma and adenosquamous carcinomas represent about 10-15% of all cervical cancers. Many studies have confirmed that the human papillomavirus (HPV) is the most important etiologic factor in the development of cervical cancer. The aim of our study was to investigate the expression of the laminin-5 gamma2 chain in primary malignancies of the cervix uteri and to focus on the clinicopathologic significance of the expression of the laminin-5 gamma2 chain in cervical squamous carcinoma and adenocarcinoma with respect to age and survival of the patients. The study consisted of a total of 89 cases of invasive cervical cancer (54 squamous carcinomas and 35 adenocarcinomas). The laminin-5 gamma2 chain was found in 80% of all the squamous carcinoma and in 66% of cervical adenocarcinoma. There was no correlation of the high expression of laminin-5 with survival. The univariate analysis in squamous cell carcinoma showed that factors such as the stage of the disease and positive lymph nodes had an impact on the survival of the patients, whereas in the multivariate analysis, only age at diagnosis was an independent prognostic factor. However, in cases with cervical adenocarcinoma, only the stage of the disease was an independent prognostic factor. There was no difference between HPV-positive and HPV-negative tumors concerning the high expression of laminin-5 gamma2 chain. Our results indicate that the majority of the primary cervical tumors, especially squamous cell carcinoma, showed expression of laminin-5 gamma2 chain immunoreactivity. Independent prognostic values for the survival of the patients were age and stage of the disease.     

Does adenocarcinoma of uterine cervix have a worse prognosis than squamous carcinoma?

OBJECTIVE: The objective of this study was to examine the influence of histology on the outcome of patients with cervix carcinoma, treated with radiotherapy and radical surgery. PATIENTS AND METHODS: Clinical, histological, therapeutical and outcome data of 360 patients with stage IB-II cervix carcinoma patients (45 adenocarcinomas and 315 squamous cell carcinoma) managed between 1985 and 1998 were collected from the database of the Institut Gustave-Roussy. RESULTS: The incidence of adenocarcinomas slightly increased during the study period (P =0.07). Histological grade was higher for squamous cell carcinoma than for adenocarcinoma (P =0.08). Adenocarcinomas were smaller than squamous cell carcinoma (P =0.06). With only 38% of sterilized hysterectomy specimen vs 52% for squamous cell carcinomas (P =0.07), adenocarcinoma seemed to be less radiosensitive. With a median follow-up of 67 months, histological type did not influence survival. DISCUSSION AND CONCLUSIONS: Our study demonstrates that radiosensitivity is different between adenocarcinoma and squamous cell carcinoma of the cervix and that surgery may compensate the low radiosensitivity of adenocarcinoma.     

Endocervical carcinoma: A study of 23 patients with clinical-pathological correlation

Twenty-three patients with endocervical carcinomas diagnosed at the Mount Sinai Medical Center during the last 5 years were reviewed (clinical history and histologic material). The tumors were endocervical-type adenocarcinomas, adenosquamous carcinoma, mucinous (colloid), papillary, and clear cell carcinomas. Eight associated carcinomas in situ were found. Younger patients tended to have more adenosquamous carcinomas, perhaps related to the frequency of squamous metaplasia in sexually active women. Twenty-two out of twenty-three patients were multiparous, many of them grand multiparas. In two patients the tumor followed parturition, and in two patients it was found in the cervical stump. No association with oral contraceptives was found. Multiparous women seem to be at increased risk for this malignancy. The early detection of endocervical carcinoma is based on the recognition of dysplasia and adenocarcinoma in situ in the biopsy material. This is of particular significance in the endocervical cancer because its location often prevents early detection.     

Multidirectional differentiation of endometrial carcinoma with special reference to tumor aggressiveness evaluated by Ki-67 expression

To clarify the correlation between multidirectional differentiation and aggressiveness of endometrial adenocarcinomas, we assessed both proliferative activities (PA) using Ki-67 expression and squamous and/or endocrine differentiation. We divided 51 adenocarcinomas into 22 adenocarcinomas with typical squamous differentiation (>/=10% of tumor cells, typical SQ) classified into 10 adenoacanthomas (AA) and 12 adenosquamous carcinomas (AS), 17 adenocarcinomas with focal squamous differentiation (<10% of tumor cells), and 12 typical adenocarcinomas without morphological squamous differentiation (pure AC), according to the new WHO classification. Paraffin-embedded sections were stained using monoclonal antibodies against high-molecular-weight keratins (HMWK) to recognize squamous cells, chromogranin A to recognize endocrine cells, and Ki-67 antigen to recognize proliferating cells. Both AA and AS exhibited lower PA than pure AC. Typical SQ exhibited lower PA than pure AC. This difference was also significant after selecting only grade 1 or stage I/II cases. AA exhibited lower PA than AS and also after selecting only grade 1 or stage I/II cases. PA of adenocarcinoma with the expression of HMWK in >/=30% of tumor cells was lower than those without HMWK. PA of adenocarcinoma with the expression of chromogranin A in >/=10% of tumor cells was lower than those without chromogranin A. These differences were also significant after selecting only grade 1 or stage I/II cases. Squamous and/or endocrine differentiation is a good marker for a reduction of PA. Endometrial adenocarcinomas with multidirectional differentiation exhibited lower PA and were likely to be more mature than those with monodirectional differentiation.     

Combination chemotherapy of docetaxel and carboplatin in advanced or recurrent cervix cancer. A pilot study

OBJECTIVES: This is a pilot study for a future trial to assess the efficacy and safety of combination chemotherapy with docetaxel and carboplatin in advanced or recurrent uterine cervix cancer. METHODS: The patients eligible for this study had histologically confirmed, advanced (stage IB2-IV) or recurrent uterine cervix cancer. Eligible patients had measurable lesions and must have sufficient bone marrow, renal, and liver functions. Docetaxel was administered intravenously (IV) at 60 mg/m2 followed by IV carboplatin administration based on AUC = 6. Chemotherapy was repeated in 1-6 courses depending on the purpose of the therapy. The response was evaluated based on RECIST criteria. The toxicity grade was determined by NCI-CTC version 2. RESULTS: During January 2001 and April 2004, 17 patients were entered in this study. The distribution of stage was IB2, 3; IIB, 8; IIIB, 3; IVB, 1; recurrent, 2. There were 9 squamous cell carcinomas, 6 adenocarcinomas, 1 adenosquamous cell carcinoma, and 1 small cell carcinoma. The overall response rate was 76% (2 CR, 11 PR, and 4 SD). No progression of disease was observed. All 5 adenocarcinoma patients in the neoadjuvant chemotherapy group responded including 1 pathological CR. The incidences of grade 3/4 toxicities were 76% for neutrocytopenia, 12% for thrombocytopenia, and 6% for anemia. No grade 3/4 neurotoxicity was observed. CONCLUSIONS: The combination of docetaxel and carboplatin is an effective and safe treatment for uterine cervix cancer. Further evaluation particularly targeted on cervical adenocarcinoma is warranted.     

环氧合酶-2、bcl-2蛋白在宫颈鳞癌组织中的表达及意义

目的:探讨宫颈鳞癌组织中环氧合酶(COX-2)、bcl-2蛋白的表达及其与宫颈癌临床分期、病理分级、淋巴转移的关系。方法:采用免疫组化法对40例宫颈癌组织中COX-2和bcl-2蛋白的表达进行检测分析,以10例正常宫颈组织作为对照。结果:COX-2和bcl-2蛋白在正常宫颈组织中阳性表达率均为0(0/10)。COX-2在宫颈原位癌、Ⅰ~Ⅱ期及Ⅲ期的阳性表达率分别为50.0%、54.5%和66.7%,宫颈鳞癌及正常宫颈组织组之间比较差异有显著性(P<0.05),宫颈原位癌、宫颈鳞癌Ⅰ、Ⅱ、Ⅲ期间差异无显著性(P>0.05)。COX-2在Ⅰ~Ⅱ期宫颈鳞癌表达与淋巴结转移有关(P<0.05)。bcl-2在宫颈原位癌、宫颈鳞癌Ⅰ~Ⅱ期、Ⅲ期癌细胞胞浆中未着色,但在癌间质有不同程度染色。bcl-2在宫颈癌及正常宫颈组织组之间差异有显著性(P<0.05)。宫颈原位癌、宫颈癌Ⅰ、Ⅱ、Ⅲ期间差异无显著性(P>0.05)。bcl-2与癌细胞分化程度及淋巴结转移无关(P>0.05)。COX-2与bcl-2在宫颈鳞癌组织中表达无相关性(P>0.05)。结论:COX-2和bcl-2蛋白在正常宫颈组织中均不表达。COX-2在宫颈鳞癌中的表达与临床分期和病理分级无关,与淋巴结转移有关。二者在宫颈癌中的表达无相关性。检测宫颈鳞癌组织中COX-2的表达有利于早期诊断及估计宫颈癌患者的预后。     

Expression of cathepsin D and epidermal growth factor receptor in stage III cervical carcinomas

Cathepsin D and epidermal growth factor receptor (EGFR) antigens are related to tumor invasion, metastasis, progression, and recurrence. To assess the prognostic significance of the expression of these two antigens, biopsy specimens consecutively obtained from 216 patients with stage III cervical carcinomas (191 with squamous cell carcinomas and 25 with adenocarcinomas), who were treated with radiotherapy, were investigated immunohistochemically. The positive rate of cathepsin D expression in squamous cell carcinomas was 74%, significantly higher than the 47% observed in adenocarcinomas ( P  = 0.015). The EGFR positive rate in squamous cell carcinomas was 33%, somewhat higher than the 16% in adenocarcinomas ( P  = 0.088). The chi-square test and Kaplan–Meier method showed no significant relationship between the expression of either cathepsin D or EGFR and the prognosis in these patients. These results indicate that in stage III cervical carcinomas cathepsin D and EGFR expression do not correlate with prognosis.     

Adenocarcinoma of the uterine cervix: the presence of human papillomavirus and the method of detection

BACKGROUND: Effective screening programs have contributed to a decrease in the incidence of cervical squamous cell carcinomas but have had a limited sensitivity in the detection of adenocarcinoma precursor lesions. The aim of our study was to analyze cervical adenocarcinoma in greater detail: symptoms preceding the detection, the method of detection and the prevalence of human papillomavirus (HPV) with respect to age at diagnosis. MATERIAL AND METHODS: Clinical data were abstracted from the medical records of 82 women with pure invasive cervical adenocarcinomas. As diagnostic tools we used polymerase chain reaction (PCR)-based single-strand conformation polymorphism (SSCP) and/or direct DNA sequencing for HPV detection. RESULTS: Age at diagnosis predicting factors were HPV status, positive lymph nodes, histology and stage. HPV-negativity, lymph node metastases, advanced stage and poor differentiation were all associated with a high diagnostic age. In the multivariate analysis only HPV status was shown to have an independent impact on age at diagnosis, while stage showed only borderline significance. Twenty-three percent of the cancers were detected by screening and the remaining were due to different symptoms. Among the women considered, 93% had a normal Papanicolaou (Pap) smear 3 years before diagnosis and 60% within 1 year. There was no significant correlation between smoking, oral contraceptives and HPV-positivity. CONCLUSIONS: The absence of HPV was significantly associated with a high age at diagnosis. Pap screening had a limited effect in detecting adenocarcinoma at an early stage.