Prognostic factors in patients with carcinoma of the vulva--our own experience and literature review.

AIM OF THE STUDY: The objective was the analysis of prognostic factors and treatment outcomes of 104 patients with vulvar cancer, treated between 1990 and 2003 in the Center of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow, Poland. MATERIAL AND METHODS: The median age of patients was 67. Advanced disease (TNM III and IVA) was found in 54 (51.9%) patients and grade 2 and 2 in 50 (48.1%). Inguinal lymph nodes were clinically uni- or bilaterally involved in 40.4% of patients. Fifty-seven (54.8%) patients underwent radical vulvectomy with bilateral inguinal lymphadenectomy and 47 (45.2%) radical vulvectomy only. Cancer differentiation was well in 38 (36.2%) of patients, moderate in 38 (36.2%) and poor in 28 (36.6%). Adjuvant radiotherapy was applied in 30 (28.8%) cases. RESULTS: Five-year overall survival rate was observed in 44.4% of patients. Depending on TNM grade, 5-year OS rates were 61.4% for grade 1, 54.9% for grade 2, 40.1% for grade 3 and 13.3% for IVA. In patients aged < 70, 5-year OS rate was 54.7% compared to 30.5% for those > or = 70. Among patients with G1 cancer differentiation 64.4% survived five years, with G2 39.1% and with G3 24.9%, respectively. CONCLUSION: Univariate analysis revealed a statistically significant, unfavorable impact of age > or = 70, with G3 cancer differentiation, clinically confirmed inguinal lymph node involvement and TNM classification stage on 5-year overall survival. Cox multivariate analysis demonstrated that independent prognostic factors for 5-year survival were the age of the patient, clinical status of inguinal lymph nodes and TNM classification grade.

Dynamics of cervical langerhans cell counts in the course of HPV-positive CIN treatment with the use of human recombinant interferon gamma.

OBJECTIVES: Langerhans cells play a pivotal role as professional antigens presenting cells in cervical epithelium, thus changes in their density or/and function may profoundly influence the proper activation of the afferent arm of immune response in cases of HPV-related intraepithelial lesions. AIM OF THE STUDY: Assessment of intraepithelial Langerhans cell count changes in CIN I/CIN II after human recombinant interferon gamma (IFNgamma) application and correlation with clinical outcome. MATERIAL & METHODS: The present study is a part of prospective trial on IFNgamma application in the treatment of CIN I/CINII associated with high-risk HPV infection. Seventeen subjects underwent uniform IFNgamma treatment (four intracervical injections in a two-day interval for a total dose of 6,000,000 IU). Langerhans cells were stained within cervical punch biopsy specimens with the use of polyclonal anti-S-100 antibody according to the three-step indirect peroxidase protocol, and their mean count calculated for the following groups: before IFNgamma treatment launching, immediately after completion of the treatment, and after two months of follow-up. RESULTS: The analysis revealed a rapid and significant increase in Lagerhans' cell count immediately after treatment completion (21.17/mm2 and 25.94/mm2, respectively, at p = 0.019) which further increased in the group of complete response (in 9 subjects; 32.22/mm2). After transient elevation of the Langerhans' cell count it returned to a level even lower than initially in the non-responder group (4 subjects; 20.25/mm2). CONCLUSION: Our data strongly support the observation from static studies suggesting that regression of HPV-related cervical lesions is associated with increased density of epithelial Langerhans cells.

Natural human interferon alpha given orally has different effects on patients with distinct forms of chronic viral hepatitis B.

During therapy of chronic viral hepatitis B (CVHB), some patients treated with natural human interferon alpha (nHuIFN-alpha) lozenges failed to respond. These observations triggered studies aimed to determine whether there are markers predicting patients' response to therapy with nHuIFN-alpha lozenges. In these studies, 32 patients with CVHB were involved: 20 males and 12 females, 16-61 years of age with proven persistent hepatitis B viremia (HBV). Patients were evaluated for clinical, biochemical liver function, and virological markers of disease. During 300 days of treatment of the patients received 75-150 IU nHuIFN-alpha daily in form of lozenges. The responders to oral interferon therapy were those who had initially alanine amino transferase (ALAT) level higher than 100 IU (85.7% cure rate) and weak responses were observed among patients who had an initial ALAT level below 100 IU (9.0% response rate). Therefore, ALAT test in patients with CVHB may serve as a predicting indicator of the outcome of IFN lozenges therapy.

Treatment of chronic viral hepatitis type B with oral mucosal administration of natural human interferon alpha lozenges.

Results of the administration of natural human interferon alpha (nIFN-alpha) into the oral cavity of 28 patients with chronic aggressive viral hepatitis type B are shown. Diagnosis of chronic aggressive viral hepatitis type B was based on clinical symptoms of disease, histopathological changes as evidenced by liver biopsy and persistence of HBV markers in patient sera. The daily dose of nIFN-alpha ranged from 75-200 IU/day. The twenty eight patients have been treated for a variable amount of time: thirteen over 300 days, two over 180 days, two over 120 days and eleven for less than 120 days. Only those patients who have been treated for over 300 days are considered to have completed the therapeutical program and remain under observation only. Oral IFN-alpha therapy is safe and efficacious in patients with chronic aggressive viral type B hepatitis. Among these 28 patients, 23 were initially positive for both hepatitis Bs antigen (HBsAg) and hepatitis Be antigen (HBeAg). Eight of these 23 patients have lost HBeAg and developed anti-HBe antibody. In addition one patient from this group seroconverted 356 days after initiation of treatment with IFN-alpha. Three patients lost HBs and HBe antigens and developed antibodies to both HBs and HBe antigens. Two patients who had eliminated HBe antigen before IFN-alpha therapy eliminated HBeAg following treatment and developed antibodies against HBs antigen. Three additional patients initially HBsAg+.HBcAg-, and HBeAg- developed antibody to HBe antigen during IFN-alpha therapy. At the time of this report 12 of the 23 initially viremic patients have seroconverted (52%).(ABSTRACT TRUNCATED AT 250 WORDS)