RESUMEN
The paper presents a clinical case of a patient of 29 years old with a diagnosis of cervical cancer sIIA1 stage with the modern therapeutic approach: as a diagnostic and treatment phase there was performed videoendoscopic pelvic lymph node dissection at a 16-week pregnancy, excluded lymphogenous spread of tumor and on the basis of which it was decided to prolong pregnancy, given the strong desire of the patient to keep the baby. At a 19-week and a 23-week pregnancy there were two courses of neoadjuvant chemotherapy and at a 34-week--Cesarean delivery with simultaneous radical hysterectomy and ovarian transposition followed by a course of adjuvant distant radiotherapy. The final diagnosis was as pT2aN0M0. The observation was during 7 months: the patient is alive without recurrence, the child develops without physical and psychomotor abnormalities.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cesárea , Histerectomía , Escisión del Ganglio Linfático/métodos , Terapia Neoadyuvante/métodos , Medicina de Precisión , Complicaciones Neoplásicas del Embarazo/terapia , Neoplasias del Cuello Uterino/terapia , Adulto , Femenino , Humanos , Histerectomía/métodos , Estadificación de Neoplasias , Pelvis , Embarazo , Complicaciones Neoplásicas del Embarazo/patología , Resultado del Embarazo , Segundo Trimestre del Embarazo , Radioterapia Adyuvante , Resultado del Tratamiento , Neoplasias del Cuello Uterino/patología , Cirugía Asistida por VideoRESUMEN
In solid tumors, human leucocyte antigen (HLA)-A2 has been suggested to be a risk factor and a negative prognostic factor. The HLA-A2 allele in Scandinavia has a high prevalence; it decreases with latitude and also with ovarian cancer mortality in Europe. Furthermore, an association of the HLA-A2 allele with severe prognosis in serous adenocarcinoma of the ovary in stages III-IV was found. Thirty-two unrelated Swedish women with relapsing or progressive ovarian cancer were analysed for the genotypes at the HLA-A, HLA-B, HLA-Cw, and HLA-DRB1 loci by the polymerase chain reaction/sequence-specific primer method. The frequencies of HLA alleles of healthy Swedish bone marrow donors provided by the coordinating centre of the Bone Marrow Donors Worldwide Registries, Leiden, the Netherlands were used as controls. When this cohort of epithelial ovarian cancer patients was compared with healthy Swedish donors, the frequency of HLA-A1 and HLA-A2 gene/phenotype appears, although not statistically significant, to be increased in patients with ovarian carcinoma, while HLA-A3 was decreased. HLA-A2 homozygotes were twofold higher in patients. The A2-B8 haplotype was significantly increased (corrected P value). A2-B5, A2-B15, A2-DRB1*03, A2-DRB1*04, A2-B15-Cw3, and A2-B8-DRB1*03 had odds ratio as well as the level of the lower confidence interval above 1 and significant P value only when considered as single, non-corrected analysis. HLA-B15 and HLA-Cw3 were only present in HLA-A2-positive patients showing that the HLA-A2-HLA-Cw3 and HLA-B15 haplotypes were segregated. In this selected cohort with advanced disease, there are indications of an unusual overrepresentation of HLA class I and II genes/haplotypes as well as segregation for the HLA-A2-HLA-Cw3 and HLA-B15 haplotypes. These findings are presented as a descriptive analysis and need further investigations on a larger series of ovarian cancer patients to establish prognostic associations.
Asunto(s)
Predisposición Genética a la Enfermedad , Antígenos HLA/genética , Haplotipos , Antígenos de Histocompatibilidad Clase II/genética , Antígenos de Histocompatibilidad Clase I/genética , Neoplasias Ováricas/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/genética , Neoplasias Ováricas/mortalidadRESUMEN
It has been recently shown that the HLA-A2 gene may be a negative predictor of ovarian cancer in Swedish patients with advanced tumor grades and stages (III and IV). We performed HLA-A2 typing in 69 ovarian cancer patients admitted to some St. Petersburg hospitals. HLA-A2 expression was determined by the PCR/sequence-specific oligonucleotide hybridization test (PCR/SSOP), by extracting DNA from the paraffin-embedded tissue specimens. The purified tissue was disrupted at 55(C in 10% SDS, proteinase K buffer twice. The amount and purity of DNA were measured by the Nano-Drop technology. HLA-A2 frequency from 2 832 healthy St. Petersburg bone marrow donors was used as a control. HLA-A2 was detected in 32.2% of the patients by PCR versus 51% in the healthy St. Petersburg population. Five year survival in our patient group was higher than that in ovarian cancer patients in St. Petersburg, which was 35.7% in general. The difference was statistically insignificant in 5-year survival between our ovarian cancer patients with stages III and IV according to the presence or absence of the HLA-A2 gene. In the cohort of the examinees, HLA-A2 expression does not correlate with prognosis. The selection of these patients for referral to our clinic is a possible explanation of the discrepancy of the rate of clinical stage and HLA-A2 phenotypes.