Predictive value of HPV DNA in lymph nodes in surgically treated cervical carcinoma patients--a prospective study.

OBJECTIVE: High-risk types of HPV are etiological factors in cervical cancer. Lymph node involvement in cervical cancer patients reduces 5-year survival rates by 25-60%. However, the influence on survival of HPV DNA positivity in histopathologically negative lymph nodes remains unresolved. METHODS: The study included 116 of 148 patients who underwent Piver type III radical hysterectomy and pelvic lymphadenectomy and who showed HPV DNA positivity in the primary lesion. Lymph node tissues were tested for the presence of HPV DNA, using a PCR technique. RESULTS: We found the presence of HPV DNA sequences in lymph nodes dissected intraoperatively in 81 (69.83%) cases. In analysis, we compared patients from 3 groups: HPV- and metastatic-negative (LN HPV-M-); HPV-positive metastatic-negative (LN HPV+M-); and metastatic-positive (LN M+). We discovered that survival in groups LN M+ and LN HPV+M- did not differ statistically (p=0.37). However, the survival periods in these two groups differed when compared with LN HPV-M- patients (p<0.001). Using Cox's proportional hazards model, we found that the presence of lymph node HPV DNA, and FIGO stage, and primary lesion volume were independent parameters correlating with survival and mortality risk. CONCLUSION: We conclude that the presence of HPV DNA in lymph nodes is an early sign of metastasis and should be treated as such in prognostic outlook and planning the therapeutic strategy.

Optimization of estradiol supplementation during the luteal phase improves the pregnancy rate in women undergoing in vitro fertilization-embryo transfer cycles.

OBJECTIVE: To evaluate the influence of different E2 supplementation doses during the luteal phase on implantation and pregnancy rates in women undergoing intracytoplasmic sperm injection (ICSI) cycles. DESIGN: Prospective, randomized study. SETTING: A private IVF unit. PATIENT(S): One hundred sixty-six women younger than 40 years who were undergoing IVF with long protocol controlled ovarian hyperstimulation (COH). A total of 231 cycles were investigated. Group 1 (P only) included 80 cycles, group 2 (P and 2 mg of E2) included 73 cycles, and group 3 (P and 6 mg of E2) included 78 cycles. INTERVENTION(S): Supplementation in the luteal phase with different doses of E2 (0, 2, or 6 mg/d). MAIN OUTCOME MEASURE(S): Serum E2 and P levels in the late luteal phase, and implantation rate and pregnancy rate (PR) were documented. The data were analyzed with regard to the entire study population and further stratified according to the E2 dose used. RESULT(S): Significantly higher implantation rate and PR were recorded in those who received low dose E2 supplementation compared with no substitution (PR 23.1% vs. 32.8%). The best implantation and pregnancy results were found significantly in the group with high dose E2 supplementation (PR 51.3%). CONCLUSION(S): For women treated with a long GnRH analogue protocol for COH, addition of a high dose of E2 to daily P supplementation significantly improved the IVF-embryo transfer results.