Problems in the use of urinary hCG-beta-core as a tumor marker in gynecologic cancer.

Urinary human chorionic gonadotrophin beta-core (hCG-betaC) was detected in 55-77% of gynecologic malignancies. The use of spot and early morning urine hCG-betaC as a tumor marker was explored with regard to the stability of the hCG-betaC level in serial spot urine samples collected within 24 hours and in early morning urine collected over 3 days. Thirteen patients with gynecologic malignancies were asked, before treatment, to collect serial urine samples voided within 24 hours. Nine of these 13 patients were also asked to save early morning urine for 2-3 consecutive days. Their urine was assayed for creatinine and hCG-betaC using an immunoradiometric assay. Variation of urine concentration was corrected by using the hCG-betaC/creatinine (betaC/Cr) ratio expressed in pmolg-1. Wide fluctuations of betaC/Cr ratios were found both in the serial spot urine within 24 hours and in early morning urine within 3 days. Eight per cent of the patients had one or more spot hCG-betaC level double or half the median of their own serial urine samples. Neither spot urine nor early morning urine hCG-betaC were suitable for use as a tumor marker for continuous monitoring because of the large fluctuation in hCG-betaC levels. The reason for such a wide fluctuation is not clear.

Multivariate analysis of factors affecting survival in pelvic exenteration.

Of 153 patients with primary or recurrent pelvic malignancy referred for consideration of exenteration, only 40.6% (62 patients) were found to be suitable for exenteration after full assessment. Thirty percent (46 patients) were found to be inoperable on examination under anesthesia. Of the remaining 107 patients, 33% (35 patients) were found to be inoperable at laparotomy, 9% (10 patients) underwent radical hysterectomy and 58% (62 patients) had an exenterative procedure. One patient had no active disease found on final histologic review of the exenteration surgical specimen and was excluded, as the aim of this study was to look at the prognostic factors affecting survival. There remained 61 patients in the exenteration group who were analyzed. The 2-year survival rate was less than 2% for patients with inoperable disease, 48% for patients who underwent radical hysterectomy and 54.1% for patients who underwent exenteration. The 5-year survival rate for all patients undergoing exenteration for pelvic malignancies was 44% and that for cervical cancer only was 52%. Multivariate analysis of patients who had undergone exenteration showed four significantly poor prognostic factors influencing survival. They were: (a) aged older than 69 years, (b) recurrence of the tumor within 3 years, (c) persistent recurrence, and (d) positive resection margins.

Vaginal sarcoma: the Royal Marsden experience.

Six patients with vaginal sarcoma are reported here. This clinicopathologic review confirms the poor prognosis of this disease. However, there were three 5-year survivors, all of whom had early stage disease and low to intermediate grade tumors. Apart from tumor grade, stage was of prognostic importance. Late recurrences at 5 and 21 years were noted in two of the three 5-year survivors. Neither chemotherapy nor radiotherapy were of use in the treatment of late stage or recurrent disease.

Clinicopathologic study of 16 cases of primary tubal malignancy.

Sixteen cases of primary carcinoma of the fallopian tube were diagnosed and treated at Queen Mary Hospital, Hong Kong from July 1972 to June 1992 constituting 0.26% of the total gynecologic malignancies seen during that period. The average age was 61 years and the most common presenting symptom was abnormal vaginal bleeding. Preoperative diagnosis is difficult; in only one case was a diagnosis of malignancy made by cervical smear. An adnexal mass was detected in 13 of the cases (81.3%) either by clinical examination and/or ultrasonography. Therapy consisted of surgical resection, usually followed by various combinations of adjuvant radiation therapy and chemotherapy. The cumulative survival was 62%. In addition to the typical form of adenocarcinoma, one case of squamous cell carcinoma and a case of multifocal endometrioid adenocarcinoma were observed. One case of an apparently usual form of adenocarcinoma recurred as a heterologous malignant mixed Müllerian tumor 2 years after diagnosis. This series further emphasises the wide range of differentiation possible in the Müllerian system and the variety of neoplasms which may arise from it.

An evaluation of the prognostic factors in metastatic gestational trophoblastic disease.

A retrospective evaluation of prognostic factors in 55 patients suffering from metastatic gestational trophoblastic disease (MGTD) treated by modified Bagshawe's CHAMOCA regimen was done. The prognostic significance of the eight prognostic factors in the WHO scoring system, number of sites of metastasis and FIGO staging were evaluated by univariate analysis using Chi-square test with Yates' correction and odds ratio and by multivariate analysis using Cox proportional hazard analysis and logistic regression analysis. In the univariate analysis, the intervals between antecedent pregnancy and the diagnosis of GTD, (P = 0.004) the level of hCG (P = 0.02) and the number of metastatic sites (P = 0.046) were significantly associated with death. In the multivariate analysis, only the interval between the antecedent pregnancy and the diagnosis and the level of hCG were significantly associated with death. Thus, it seems that the interval between antecedant pregnancy and the diagnosis and the level of hCG were the two most significant factors in predicting mortality in high risk MGTD. The WHO staging was more predictive of poor outcome than that of the FIGO staging in this group of patients.