Expression of ER, PR, and Her-2/neu in endometrial cancer: a clinicopathological study.

OBJECTIVE: To determine any association between expression of estrogen receptor (ER), progesterone receptor (PR), and Her-2/neu and clinicopathological features, including survival, of endometrial carcinoma (EMC) patients. METHODS: Samples of formalin-fixed, paraffin-embedded tissue of 108 patients with EMC treated at our institution between January 1994 and December 2007 were immunohistochemically studied. RESULTS: ER, PR, and Her-2/neu expression were positive in 59.3%, 65.7% and 2.8% of cases, respectively. Positive ER expression was significantly associated with grade I-II tumor while PR expression was linked with endometrioid histology, grade I-II tumor, less myometrial invasion (MI) and negative lymph node involvement. Her-2/neu expression was significantly associated with deep MI, while positive ER and negative Her-2/neu expression in combination was significantly associated with longer disease-free and overall survival. CONCLUSION: ER expression is a good prognostic factor while Her-2/neu expression appears to be a poor indicator for both disease-free and overall survival, while PR tended to show favorable influence for only disease-free survival of Thai EMCs.

Clinicopathological features including hormonal receptor expression and survival in young endometrial cancer patients: a case control study.

OBJECTIVE: To compare clinicopathological features, including hormonal receptor expression and survival, in young Thai endometrial carcinoma (EMC) patients with older patients. METHODS: Young EMC patients aged ≤45 years, treated in the institution from 1992 to 2008, were identified as cases. Controls included EMC patients aged >45 years who had an operation on the nearest dates to the cases. Clinicopathological data and survival of the cases and controls were compared. RESULTS: Mean ages of 41 cases and 123 controls were 40.4 ± 3.7 years and 58.4 ± 8.3 years, respectively. Cases were significantly different from controls in terms of having more nulliparity (58% vs 25%), less medical illness (57% vs 79%), more low-grade tumors (49% vs 14%), more positive estrogen (78% vs 56%) and progesterone (97% vs 61%) receptors expression, and fewer nodal metastases (3% vs 21%). Adjuvant therapy was administered in 29% of the cases and 46% of the controls. From a median follow up of 51 months, cases had significantly fewer progression events and recurrence (5% vs 19%), cancer-related deaths (2% vs 16%), and all deaths (5% vs 23%), with significantly longer 5-year disease-free (97.2% vs 79.6%, p=0.023), cancer-specific (97.1% vs 83.2%, p=0.020), and overall survival (93.1% vs 78.8% p=0.005) than controls as determined by univariate analysis. Survival of cases and controls were not significantly different after adjusting for other prognostic factors. CONCLUSION: Young Thai EMC patients had more favorable clinicopathological features with significantly longer survival than older patients as determined by univariate analysis.

Expression of Cyclooxygenase-1 and 2 in Epithelial Ovarian Cancer: A Clinicopathologic Study.

BACKGROUND: To examine the rate and degree of expression of Cyclooxygenase-1 (COX-1) and Cyclooxygenase-2 (COX-2) in epithelial ovarian cancer (EOC) and associated with clinicopathological factors and survival. METHODS: EOC patients being treated in our institute with available pathological tissue sections during 1996-2003 were identified. Immunohistochemical staining with antibody to COX-1 and COX-2 were studied. Degree of expression was categorized into low and high levels. The degrees of immunohistochemistry staining were associated with clinicopathological factors and overall survival. RESULTS: A total of 107 patients were included in the study. Most of patients had stage 1 and 3, and the most common histology type was serous carcinoma. The expression rate of COX-1 and COX-2 was 83.2 % and 95.3 %, respectively. Non-mucinous tumor had significant higher level of expression of both COX-1 and COX-2. Except for a high level of expression of COX-2 in association with better response to chemotherapy, no significant association with other clinicopathologic factors were observed. Level of COX-1 or COX-2 expression did not associate with progression-free and overall survival. The combination of COX-1 and COX-2 level was analyzed and the combination of high COX-1 and low COX-2 level significant associated with short progression-free and overall survival. CONCLUSION: EOC in our study showed high rate of COX-1 and COX-2 expression, especially in non-mucinous tumors. High level of COX-2 associated with better response to chemotherapy. Neither COX-1 nor COX-2 expression showed association with survivals while combination of high COX-1 and low COX-2 level of expression was associated with poor progression-free and overall survivals.

Oral etoposide for refractory or recurrent epithelial ovarian cancer.

OBJECTIVE: To study the response rate (RR), toxicity, progression-free survival (PFS), and overall survival (OS) of the patients with recurrent or refractory epithelial ovarian cancer (EOC), who had oral etoposide at dosage of 75 mg/day. MATERIAL AND METHOD: Patients with recurrent or refractory EOC who were treated with oral etoposide between January 1998 and December 2007 were identified from the Archive of the Gynecologic Oncology Unit of the institution. Clinical and pathological data were reviewed. RESULTS: During the present study period, 38 patients receiving oral etoposide were identified. Median age was 51 years (range, 33-72 years). Seven patients could not tolerate chemotherapy side effects during the first cycle, leaving 31 patients evaluable for response. The overall RR was 25.8% (8/31 patients), 19.4% complete (6/31) and 6.4% partial responses (2/31). Stable diseases were demonstrated in 19.4% (6/31) while progressive diseases were found in 54.8% (17/31). The median PFS was 4.8 months (range, 3.3-6.4 months) with 2-year PFS of 16.7% (95% confidence interval [CI], 2.1-31.4%) while median OS was 12.0 months (range, 0.75-25.5 months) and 2-year OS was 36.4% (95% CI, 17.4-55.3%). The main toxicity was gastrointestinal side effect. CONCLUSION: Oral etoposide at a daily dosage of 75 mg is an active agent for refractory or recurrent EOC. Gastrointestinal symptom is the most common side effect. This oral chemotherapeutic agent has some advantages over other drugs in terms of convenience for administration and fewer visits.

Comparison between clinical and surgical staging for endometrial cancer in Thailand.

OBJECTIVES: To compare preoperative clinico-pathological findings and clinical staging of endometrial cancers (EMC) with postoperative surgico-pathological findings and final surgical staging. MATERIALS AND METHODS: All EMC patients who underwent surgical staging between January 1993 and December 2008 were identified from the tumor registry of the Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, of our institution. Clinico-pathological data were extracted from the patients' charts and pathological reports, including clinical stage assignments before the operation, and compared to the surgico-pathological findings. RESULTS: Two hundred and thirty five EMC patients were included in this study. Mean age was 55.8-/+9.9 years. All except one had clinical stage I and II disease. The most common preoperative histopathology of endometrial tissue was endometrioid adenocarcinoma, with or without squamous differentiation (164 cases or 69.8%), while grade II tumors accounted for 107 cases (46.7%). Cervical involvement was evidenced from endocervical curettage in 58/235 cases (24.7%). From the final surgico-pathologic findings, the surgical stages were the same as clinical stage in 145 patients (61.7%), sixty patients (25.5%) being upstaged and 30 patients (12.8%) downstaged. Histopathology of endometrial cancer from hysterectomy was the same as for the preoperative tissues in 175 cases (74.5%), without change in preoperative grading in 155 (67.6%), upgrading in 57 (25%) and downgrading in 17 (7.4%). CONCLUSION: Clinical staging was comparable to surgical staging in approximately 61.7% and final surgical staging change was evident in 38.3%, with postoperative histopathological change in 25.5%. Preoperative endocervical curettage had false positive and false negative rates of 60.3% and 14.1% respectively. Thus clinicians should be aware of these possibilities in preoperative counseling for patients and planning surgical procedures.

Prevalence of high grade squamous intraepithelial lesions (HSIL) and invasive cervical cancer in patients with atypical squamous cells of undetermined significance (ASCUS) from cervical pap smears.

To determine the prevalence and factors associated with histologic diagnoses of High Grade Squamous Intraepithelial Lesions (HSIL) or invasive cervical cancer in women with a cytologic diagnosis of atypical squamous cells of undertermined significance (ASCUS), medical records of women with an ASCUS Pap smear from January 2003 to December 2006 were reviewed. Of 287 women with ASCUS Pap smears in whom data were available, 189 were annotated with "favoring a premalignant or malignant process", 74 with "favoring reactive", and 24 with "not otherwise specified". The prevalences of HSIL and invasive cervical cancer were 9.1% and 1.2%, respectively. Only subtypes of ASCUS were significantly associated with the detection of HSIL or invasive cancer, 12.7% with favoring premalignant or malignant process, 2.7% with favoring reactive, and 16.7% in with ASCUS-NOS (p=0.034).

Expression of cyclooxygenase-1 in epithelial ovarian cancer: a clinicopathological study.

OBJECTIVE: To determine immunohistochemical expression of cyclooxygenase-1 (COX-1) in epithelial ovarian cancer (EOC), and its association with clinical features and prognosis. METHODS: EOC patients treated in Bangkok Metropolitan Administration Medical College and Vajira Hospital during 1996-2003, and with available pathological tissue sections, were identified. Immunohistochemical staining was accomplished with antibodies to COX-1 and degree of expression was categorized into low and high for assessment of any. association with clinicopathological factors and survival. RESULTS: One-hundred and seven patients were included in the study, with a median age of 50 years. Most had stage I and III disease. The most common histologic subtype was serous carcinoma. Overall, we found COX-1 expression in 83.2 %. Non-mucinous lesions had significant higher levels of expression than mucinous tumors, but there was no link expression with other clinicopathological factors or survival. CONCLUSIONS: EOCs showed highexpression of COX-1, especially with a non-mucinous histology, but this appears to lack prognostic significance.

Paclitaxel and carboplatin for large cell neuroendocrine carcinoma of the uterine cervix.

The prognosis of large cell neuroendocrine carcinoma (LCNEC) of the uterine cervix is generally poor despite multimodality of treatments. We report a case of advanced stage cervical LCNEC that showed definite response to paclitaxel/carboplatin, resulting in years of survival. The patient was referred to our institution after undergoing a simple hysterectomy with bilateral salpingo-oophorectomy in her local hospital because of a ruptured metastatic ovarian mass. She declined pelvic radiation treatment, so adjuvant chemotherapy (six cycles of paclitaxel/carboplatin) was given for the residual pelvic nodal diseases. Clinical complete remission was obtained, with a disease-free period of 19 months. Systemic recurrent diseases also showed partial response to the same drug regimen for months with only minimal toxicity. However, she subsequently had progressive diseases in the liver and brain and finally died at 44 months after primary diagnosis and 19 months after recurrent diseases.

Granulocyte-colony stimulating factors for secondary prevention of leucopenia in patients receiving chemotherapy.

OBJECTIVE: To evaluate the effectiveness of GCSF as a secondary preventive adjunct to chemotherapy in the gynaecologic cancer patients who previously had grade 3-4 neutropenia or leucopenia from chemotherapy. MATERIAL AND METHOD: We retrospectively reviewed the medical records of 94 chemotherapeutic cycles with GCSF as secondary prophylaxis in 29 patients with gynaecologic malignancy between January 1996 and April 2005. RESULTS: The median age of the patients was 51 years (21-75). Most of the patients had ovarian cancers (19 cases, 65.6%). From secondary GCSF, grade 4 neutropenia was developed in 12 of 94 cycles (12.8%), and grade 4 leucopenia was developed in 5 of 94 cycles (5.3%). There were no patients developing febrile neutropenia after GCSF support. CONCLUSION: Secondary GCSF prophylaxis was effective in preventing grade 4 leucopenia, grade 4 neutropenia, and febrile neutropenia.

Efficacy of platinum plus cyclophosphamide in patients with epithelial ovarian cancer.

OBJECTIVES: To determine the response rate (RR), 5-year progression-free survival (PFS), and the 5-year survival rate (SVR) of epithelial ovarian cancer patients who received platinum plus cyclophosphamide as adjuvant postoperative chemotherapy. MATERIAL AND METHOD: Epithelial ovarian cancer patients who underwent tumor debulking surgery and received platinum plus cyclophosphamide as adjuvant chemotherapy at Vajira Hospital from January 1995 to December 2003 were identified. All clinical and pathological data were reviewed RESULTS: Among 114 patients included in the present study, 101 patients were evaluable for response. Overall response rate was 79.2%. The 5-year PFS and 5-year SVR were 60.3% (95% confidence interval [95% CI]; 50.5, 70.1%) and 60.7% (95% CI; 50.9, 70.5%) respectively. Subgroup analysis showed better RR, PFS, and SVR in early stage than advanced stage disease. CONCLUSION: The overall RR, 5-year PFS, and 5-year SVR of patients of the whole group were modest. These outcomes were significantly better in the early stage than the advanced stage.

Comparison of ultrasound score, CA125, menopausal status, and risk of malignancy index in differentiating between benign and borderline or malignant ovarian tumors.

OBJECTIVES: To evaluate the diagnostic performances of ultrasound score (US), CA 125, menopausal status, risk of malignancy index (RMI)-- in differentiating between benign and borderline or malignant ovarian tumors. MATERIAL AND METHOD: Women with ovarian masses who were scheduled to have elective surgery at the Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital between May 1999 and December 2001 were included in the study. Ultrasonographic study and CA 125 were examined preoperatively. The RMI was obtained from the ultrasound score, CA 125, and menopausal status. The diagnostic values of each parameter and the RMI were determined. RESULTS: From 175 women, 35 women (20%) had malignant ovarian tumors. RMI yielded better diagnostic performance to differentiate between benign and borderline or malignant ovarian tumors than US score, CA 125, and menopausal status in respective order The optimal RMI to predict malignancy was 0.135 with the sensitivity of 88.6% (95% CI; 81.1%-96.1%), specificity of 90.7% (95% CI; 83.9%-97.6%), positive and negative predictive value of 70.5% (95% CI; 59.7%-81.2%) and 97.0% (95% CI; 92.9%-100.0%) respectively. CONCLUSION: RMI yielded better diagnostic performance than the individual parameter of ultrasound score, CA 125, or menopausal status in differentiation of benign from borderline or malignant ovarian tumors.