[Evidence of perineural invasion on early-stage cervical cancer and prognostic significance].

OBJECTIVE: To evaluate the incidence and significance of perineural invasion (PNI) in cervical cancer. METHODS: Retrospective chart review of patients with cervical cancer (stages Ia2-IIb) who underwent radical hysterectomy and pelvic lymphadenectomy from 2007 to 2012. To evaluate the incidence and significance of PNI in cervical and uterine tissues by microscopic examination. RESULTS: A total of 238 patients were included, 9.2% (22/238) patients with PNI in the cervical stroma. Patients with PNI were more likely to have adverse histopathologic features, including lymphoma vascular space invasion, parametrical invasion, depth of invasion, tomor size and lymph nodes metastases (all P < 0.05). PNI were independent of age, international federation of gynecology and obstetrics (FIGO) stage, histopathology type and grade, and positive vaginal margin (all P > 0.05). Patients with PNI had shorter disease-free and overall survival (P = 0.002 and P = 0.008, respectively). On multivariate analysis, risk factors for recurrence and death included parametrical invasion and depth of invasion (P < 0.05). Similarly, risk factors for recurrence included lymph nodes metastases (P = 0.024). However, PNI was not identified as an independent risk factor for either recurrence or death (P > 0.05). CONCLUSIONS: PNI exists in early cervical cancer. PNI is associated with tumor size, depth of invasion, parametrical invasion, lymphoma vascular space invasion and lymph nodes metastases. PNI represente a decreasing disease-free and overall survival in patients with early-stage cervical cancer, and is independently associated with multiple high-risk factors, which be informed management decisions regarding adjuvant therapy.

[Therapeutic evaluation of cisplatin, etoposide, and bleomycin chemotherapy regimen in high-risk gestational trophoblastic neoplasia].

OBJECTIVE: To evaluate the effectiveness and safety of combination chemotherapy with bleomycin, etoposide and cisplatin (BEP) regimen on the patients with high-risk gestational trophoblastic neoplasia (GTN). METHODS: Forty-two patients with high-risk GTN admitted in Sichuan Cancer Hospital between Jan.1997 and Oct. 2011 were analyzed retrospectively. The International Federation of Gynecology and Obstetrics (FIGO) prognostic score of all patients was more than 7. The mean age of patients was 30.2 years (range 20 - 49 years). All patients were treated with more than two cycles BEP regimen and followed up to the patients' death or at the end of Feb.2012. The clinical response, toxicity and the occurrence of secondary tumors were investigated. RESULTS: Forty-two high-risk GTN patients received the total of 251 courses of the BEP regimen, the average number of courses for each patient was 6.0 courses. Thirty-seven patients achieved complete remission and 5 patients showed drug-resistant. The total complete remission rate of BEP regimen was 88% (37/42). Among the complete remission patients, the total courses of BEP regimen of cases getting normal serum ß-hCG level was 129 courses (average 3.5 courses), and the total courses of cases achieving complete remission was 227 courses (average 6.1 courses). Among the 37 complete remission patients, 31 cases were treated with BEP regimen chemotherapy alone, 4 patients with BEP regimen chemotherapy combined with surgical treatment (1 case had no cancer after surgery) and 2 cases with BEP regimen chemotherapy combined with radiation therapy. Therefore, the complete remission rate of BEP regimen chemotherapy alone was 74% (31/42). There were 5 patients who showed drug-resistance after 24 courses of BEP regimen chemotherapy (average 4.8 courses), then received etoposide, methotrexate and dactinomycin (EMA)/cyclophosphamide and vincristine sulfate (CO) regimen chemotherapy after drug-resistance, 2 cases combined with radiation therapy, 1 case combined with surgical treatment. Ultimately, 4 cases achieved complete remission, 1 case died of cancer. The major toxicities of BEP regimen were included bone marrow suppression, digestive tract side effect and alopecic, followed by mild peripheral neuritis and abnormal liver function, rare cases of mild pulmonary toxicity. There were no severe anaphylaxis and obvious impairment of cardiac, liver, pulmonary and kidney function, except 1 patient (49 years old) had grade IV bone marrow suppression and pulmonary fibrosis worsened after chemotherapy. The bone marrow suppression was mainly I-III degree neutropenia, and Incidence rate was 66.5% (167/251). All the survival patients without secondary tumor. CONCLUSION: For young high-risk GTN patients, BEP regimen chemotherapy may be safe and effective.

Perineural invasion in early-stage cervical cancer and its relevance following surgery.

Perineural invasion (PNI) is the neoplastic invasion of nerves by cancer cells, a process that has attracted attention as a novel prognostic factor for cancer. The present study aimed to investigate the prognostic value of PNI in patients with early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA2-IIA). A total of 210 patients who underwent radical hysterectomy and pelvic lymphadenectomy between 2007 and 2012 were included in the current study, of whom 8.57% (18/210) exhibited PNI. Patients with PNI were more likely to exhibit adverse histopathological features, such as increased tumor size, depth of stromal invasion, parametrial invasion, lymphovascular space invasion and lymph nodes metastases (all P<0.05). Patients with PNI exhibited shorter disease-free and overall survival (P=0.002 and P=0.017, respectively). However, PNI was not identified as an independent risk factor for either recurrence or death by multivariate analysis. Furthermore, 88.9% (16/18) of patients with PNI received adjuvant therapy following surgery. PNI was significantly associated with well-established indicators for adjuvant therapy. In conclusion, PNI was associated with multiple high-risk factors and its presence was indicative of a poor outcome in patients with early-stage cervical cancer, which may influence management decisions regarding adjuvant therapy.