Clinicopathologic variables predictive of residual dysplasia after cervical conization.

OBJECTIVE: To evaluate the clinicopathologic variables that are important for predicting residual dysplasia after cervical conization or the loop electroexcisional procedure. STUDY DESIGN: A retrospective review of 80 cases was performed on patients with squamous dysplasia in the conization specimen, endocervical curettage (ECC) performed immediately after resection, margin status reported by the pathologist and adequate postprocedure follow-up. RESULTS: Twelve patients had residual dysplasia. No case progressed to invasive carcinoma. A multivariate analysis was performed with presence or absence of residual dysplasia as the dependent variable and patient age, type of procedure (cold knife conization or loop excision), grade of dysplasia, margin status and ECC status as independent variables. Margin status was the strongest predictor of residual disease, followed by ECC status. Patient age had a minimal association with persistence. Of the 12 patients with residual dysplasia, 11 had a positive margin, and 8 had a positive ECC. Only 38% of patients with a positive margin had residual disease, but 67% with a positive margin and ECC had residual dysplasia. CONCLUSION: Margin status and ECC are useful in predicting residual dysplasia after conization.

Leukemia following cisplatin-based chemotherapy for ovarian carcinoma at Roswell Park.

Three cases of leukemia following cisplatin-based chemotherapy are reported. All three patients received cyclophosphamide, a known leukemogen. In two cases, the leukemia was diagnosed after second line chemotherapy with intraperitoneal cisplatin and cytarabine, one of which is the first report of a chronic granulocytic leukemia as a result of cytotoxic chemotherapy.

Five-year survival for cisplatin-based chemotherapy versus single-agent melphalan in patients with advanced ovarian cancer and optimal debulking surgery.

The purpose of this study was to evaluate 5-year survival and 5-year progression-free survival in previously untreated patients with advanced ovarian cancer treated with single-agent melphalan in which very few patients underwent optimal debulking surgery (less than 2 cm residual) as compared with the patients treated with Cisplatin-based chemotherapy in which most patients underwent optimal debulking surgery. Significant increases in 5-year survival and 5-year progression-free survival were noted as we changed from the melphalan trial, in which only 14% underwent optimal debulking surgery, to PAC-H, in which 57% and the PAC trial in which 90%, respectively, underwent optimal debulking surgery. However, for those patients whose tumors were optimally debulked in the three trials, there were no statistically significant differences in median survival, median progression-free survival, 5-year survival, or 5-year progression-free survival in those patients treated with melphalan, PAC-H, or PAC. Without optimal debulking surgery, Cisplatin-based multiagent chemotherapy offered a small survival advantage. These results are similar to that reported by Gruppo Interregionale Cooperativo Oncologico Ginecologia, in which survival curves were identical for all the subgroups of chemotherapy regimens for those patients with residual disease less than 2 cm at the onset of chemotherapy whether they received (1) cyclophosphamide; (2) cyclophosphamide and Adriamycin; (3) cyclophosphamide, Adriamycin, and Cisplatin; (4) cyclophosphamide, Adriamycin, and hexamethylmelamine; (5) Cisplatin and cyclophosphamide; (6) low-dose Cisplatin; (7) high-dose Cisplatin; or (8) carboplatin.

CA 125, NB/70K, and lipid-associated sialic acid in monitoring uterine papillary serous carcinoma.

Ninety-four plasma samples from 18 women with uterine papillary serous carcinoma were analyzed for three circulating tumor markers: CA 125, NB/70K, and lipid-associated sialic acid. Tumor marker values were correlated with the patients' clinical status. Preoperatively, CA 125, NB/70K, and lipid-associated sialic acid were elevated in 62, 64, and 67%, respectively. The distribution of clinical stages was I -- 56%, II -- 28%, III -- 6%, and IV -- 11%. The distribution of surgical stages was I -- 28%, II -- 17%, III -- 0%, and IV -- 56%. Nine of ten patients with an elevated tumor marker had extrauterine disease confirmed surgically. Eight of nine patients with elevated levels of two markers had extrauterine disease. Four of four patients with three elevated markers had extrauterine disease. There were two false-positive elevations, both in patients who had occult surgical stage II disease. Rising and falling tumor marker levels correlated with progression and regression of disease, respectively. A doubling of CA 125 predicted clinical recurrence in four of six women an average of 17 weeks before clinical confirmation. Lipid-associated sialic acid levels that increased by 25% or by five units predicted recurrence or rapid progression in three of six patients in an average of 5 weeks, and a 50% elevation in NB/70K predicted recurrence in two of three patients by 5 and 3 weeks before clinical confirmation. Although the number of patients in this series is small, preoperative elevated tumor markers in patients known to have uterine papillary serous carcinoma correlate closely with the presence of extrauterine disease. This information should influence surgical management and may be useful in postsurgical treatment assessment.

Single inoculation immune hamster sera for typing California group arboviruses by the complement-fixation test.

Eight reference California group viruses of North America were typed using sera of immune hamsters bled 21 days after a single inoculation. The complement-fixation test reactions were relatively specific, although only 2-fold differences were observed reciprocally with the closely-related La Crosse and snowshoe hare viruses. Hamster serum taken 10 days post inoculation was more specific than a 21-day serum. Sepcificity after second inoculation was lost with some antigens. Jamestown Canyon and South River viruses were identical by complement-fixation test and showed minor differences in the plaque reduction neutralization test.