Effectiveness of Sequential Chemoradiation vs Concurrent Chemoradiation or Radiation Alone in Adjuvant Treatment After Hysterectomy for Cervical Cancer: The STARS Phase 3 Randomized Clinical Trial.

IMPORTANCE: There is no current consensus on the role of chemotherapy in addition to radiation for postoperative adjuvant treatment of patients with early-stage cervical cancer with adverse pathological factors. OBJECTIVE: To evaluate the clinical benefits of sequential chemoradiation (SCRT) and concurrent chemoradiation (CCRT) compared with radiation alone (RT) as a postoperative adjuvant treatment in early-stage cervical cancer. DESIGN, SETTING, AND PARTICIPANTS: After radical hysterectomy at 1 of 8 participating hospitals in China, patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB to IIA cervical cancer with adverse pathological factors were randomized 1:1:1 to receive adjuvant RT, CCRT, or SCRT. Data were collected from February 2008 to December 2018. INTERVENTIONS: Patients received adjuvant RT (total dose, 45-50 Gy), CCRT (weekly cisplatin, 30-40 mg/m2), or SCRT (cisplatin, 60-75 mg/m2, plus paclitaxel, 135-175 mg/m2) in a 21-day cycle, given 2 cycles before and 2 cycles after radiotherapy, respectively. MAIN OUTCOMES AND MEASURES: The primary end point was the rate of disease-free survival (DFS) at 3 years. RESULTS: A total of 1048 women (median [range] age, 48 [23-65] years) were included in the analysis (350 in the RT group, 345 in the CCRT group, and 353 in the SCRT group). Baseline demographic and disease characteristics were balanced among the treatment groups except that the rate of lymph node involvement was lowest in the RT group (18.3%). In the intention-to-treat population, SCRT was associated with a higher rate of DFS than RT (3-year rate, 90.0% vs 82.0%; hazard ratio [HR], 0.52; 95% CI, 0.35-0.76) and CCRT (90.0% vs 85.0%; HR, 0.65; 95% CI, 0.44-0.96). Treatment with SCRT also decreased cancer death risk compared with RT (5-year rate, 92.0% vs 88.0%; HR, 0.58; 95% CI, 0.35-0.95) after adjustment for lymph node involvement. However, neither DFS nor cancer death risk was different among patients treated with CCRT or RT. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, conducted in a postoperative adjuvant treatment setting, SCRT, rather than CCRT, resulted in a higher DFS and lower risk of cancer death than RT among women with early-stage cervical cancer. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00806117.

Blocking PPARγ interaction facilitates Nur77 interdiction of fatty acid uptake and suppresses breast cancer progression.

Nuclear receptor Nur77 participates in multiple metabolic regulations and plays paradoxical roles in tumorigeneses. Herein, we demonstrated that the knockout of Nur77 stimulated mammary tumor development in two mouse models, which would be reversed by a specific reexpression of Nur77 in mammary tissues. Mechanistically, Nur77 interacted and recruited corepressors, the SWI/SNF complex, to the promoters of CD36 and FABP4 to suppress their transcriptions, which hampered the fatty acid uptake, leading to the inhibition of cell proliferation. Peroxisome proliferator-activated receptor-γ (PPARγ) played an antagonistic role in this process through binding to Nur77 to facilitate ubiquitin ligase Trim13-mediated ubiquitination and degradation of Nur77. Cocrystallographic and functional analysis revealed that Csn-B, a Nur77-targeting compound, promoted the formation of Nur77 homodimer to prevent PPARγ binding by steric hindrance, thereby strengthening the Nur77's inhibitory role in breast cancer. Therefore, our study reveals a regulatory function of Nur77 in breast cancer via impeding fatty acid uptake.

Evaluation of related factors, prediction and treatment drugs of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction after direct PCI.

This study determined the related factors of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) after direct percutaneous coronary intervention (PCI), and evaluated related factor scores in predicting the occurrence of no-reflow phenomenon and drug treatments. A total of 203 patients with acute STEMI receiving PCI who were admitted to the Department of Cardiovascularology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine (Xiangyang, China) from January 2015 to December 2016 were selected. The clinical and image data were analyzed to determine the related factors of no-reflow phenomenon after operation, and related factor scores were quantified to predict the occurrence of no-reflow phenomenon. Three drugs (diltiazem, nitroglycerin and tirofiban needles) were continuously injected in coronary arteries of patients with no-reflow phenomenon, and the effects of these drugs were analyzed. There were 38 patients (18.7%) with no-reflow phenomenon. The correlation analysis showed that 10 factors were associated with no-reflow phenomenon, in which five factors were identified as risk factors, including IRA open-up time ≥8 h, SBP <100 mmHg, Hs-CRP >18 mg/l, thrombus loads, length of the culprit vessel ≥20 mm. The score analysis of related factors of 38 patients with no-reflow phenomenon was conducted. Three points were set for five risk factors each, and 1 point was set for the other five factors each. It was found that the score was approximately normally distributed. The average was 11.5±1.57 points and the lower limit of 95% confidence interval was >8.93 points. The effective rates of three drugs were different (P<0.05), and the pairwise comparison showed their effective rates were not fully identical (P<0.05). The results showed that: i) Τhere are 10 related factors, including five risk factors; ii) related factors with the score ≥9 points can be used for clinical prediction of STEMI after direct PCI; and iii) it is obviously effective to use diltiazem needle and tirofiban needle to treat no-reflow phenomenon, but this conclusion lacks statistical support.

Clinical effects of carvedilol and trimetazidine for the treatmentof alcoholic myocardiopathy.

The aim of the study was to compare the clinical effects of carvedilol and trimetazidine for the treatment of alcoholic cardiomyopathy. A total of 60 patients diagnosed with alcoholic cardiomyopathy were enrolled in the study. The patients were randomly divided into the carvedilol (n=20), trimetazidine (n=20) and control (n=20) groups. The patients in the control, carvedilol and trimetazidine groups were treated with conventional drugs, conventional drugs + carvedil and conventional drugs + trimetazidine respectively, for 12 weeks. The patients were compared for their heart functions [left ventricular ejection fraction (LVEF), C-reactive protein (CRP) and 6 min walking], heart rate, blood pressure and heart enlargement (cardiothoracic proportion and left ventricular diameter) before and after treatment. The parameters studied for heart functions, heart rate, blood pressure, heart enlargement, clinical effects before and after treatment were statistically insignificant (p>0.05). After treatment, the carvedilol and trimetazidine groups showed higher LVEF and CRP, longer walking distance in 6 min, as well as lower heart rate and blood pressure (both systolic and diastolic) compared to the control group. Similarly, the cardiothoracic proportion and left ventricular internal diameter for the carvedilol and trimetazidine groups was lower than those of the control group, with better clinical effects (p<0.05). In conclusion, the curative effects of the carvedilol and trimetazidine groups of alcoholic myocardiopathy similar. Both are safe agents that may improve the cardiac function and heart expansion of patients.

[Research on predicting the qualities of stem of alfalfa hay by near infrared reflectance spectroscopy].

The present research was attempted to predict the qualities of stem of alfalfa (Medicago sativa L. ) without separation from the whole plant by near infrared reflectance spectroscopy and discussed the feasibility of using the near infrared reflectance spectra information of the whole object to predict the qualities of a certain part. Sixty six whole alfalfa hay samples of separated stems from leaves were collected and they were distinguishing by years, cultivars, cuts and growing periods. There were 138 calibration samples and 60 validation samplers. Fourier transform-near infrared reflectance spectroscopy (FT-NIRS) and partial least square (PLS) were used to set up the calibration models of stem's crude protein (CP), neutral detergent fiber (NDF), acid detergent fiber (ADF), crude ash (CA) and in vitro digestible dry matter (IVDDM) contents. All models showed great calibration and prediction performances except the one of stem's NDF content. The correlation coefficients of cross-validation (rCV) were between 0.8523 and 0.9007, the root mean square errors of cross-validation (RMSECV) were between 0.72% and 3.96% and the correlation coefficients of NIRS values and chemical values (r) were between 0.9255 and 0.9512. However, rCV, RMSECV and r of the model of stem's NDF content were 0.8214, 3.70% and 0.9020, respectively. It wasn't exact enough and would be used for rough predicting only. All of the results showed that near infrared reflectance spectra information of whole alfalfa hay could be used to predict some components of its stem exactly. It was the maiden attempt of using near infrared reflectance spectra information of the whole objects to evaluated the qualities of a certain part.

[Clinical characteristics and prognosis of epithelial ovarian cancer in young women].

BACKGROUND & OBJECTIVE: Epithelial ovarian cancer mostly appears in aged women, but rarely in young women. Little is known about the clinical characteristics and prognosis of epithelial ovarian cancer in women aged below 35 years. This study was to evaluate the clinical characteristics, treatment, survival and prognosis of young patients with epithelial ovarian cancer. METHODS: A total of 71 patients with confirmed epithelial ovarian cancer under the age of 35 years between Jun.1980 and Dec. 2003 were retrospectively analyzed. The survival rate was calculated using the life table method. Cox model was used to determine prognostic factors. RESULTS: The medium age of the 71 patients was 28 years. The common symptoms included self-detected pelvic masses or pelvic masses found at the check-up (18 cases), abdominal pain and abdomen distension (11 cases). The average maximum diameter of the tumor was 13.7 cm. The tumor was located at one side of the ovary in 52 cases (73.2%). Sixty-eight cases underwent optimal cytoreduction. Forty-four patients were classified as stage I (62.0%), five patients were stage II, 18 patients were stage III, and four patients were stage IV. Serous adenocarcinoma (40 cases, 56.3%) and mucinous adenocarcinoma (22 cases, 30.9%) were the most common pathologic types. There were 42 cases (59.2%) of well-differentiated tumor, 18 cases (25.4%) of moderately-differentiated tumor and 11 cases (15.5%) of poorly differentiated tumor. Sixty-eight patients received platinum and paclitaxel-based chemotherapy before or after operation. Twelve patients achieved tumor free survival (80.0%) out of 15 patients (Ia, G1) underwent conservative surgery. The 2- and 5-year survival rates were 86.0% and 82.0%, respectively. Pathological grade and residual tumor size were independent prognostic factors affecting ovarian cancer. CONCLUSIONS: Young women with epithelial ovarian cancer under the age of 35 years mostly have serous adenocarcinoma; tumors are normally unilateral; and the prognosis is good. The ovarian function can be preserved in part of stage Ia and Grade I patients. Pathological grade and residual tumor size are independent prognostic factors of epithelial ovarian cancer.

[Determination of main fiber compositions of alfalfa hay by near infrared reflectance spectroscopy].

Sixty alfalfa samples, with different growth stage, cultivars, and preparing method (drying by oven, shade and sun), were selected to study the potential of determination of cellulose, hemicellulose and lignin content in the present research. The result showed that the correlation coefficient of cross-validation (R(cv)), determination coefficient of external validation(r2) and the ratio of standard deviation to root mean square error of prediction (RPD) of cellulose and lignin were 0.97, 0.97 and 4.44, and 0.94, 0.94 and 4.08, respectively. This indicated the feasibility of determining cellulose and lignin content of alfalfa using near infrared reflectance spectroscopy. Hemicellulose was not predicted accurately by NIRS in this study, due to the lowest accuracy (R(cv) = 0.39, r2 = 0.29, RPD = 1.09). The exact determination of cellulose and lignin using near infrared reflectance spectroscopy will be useful to quality control in alfalfa production and quickly analyzing the fiber composition of alfalfa samples breeding research.

[Quality prediction of alfalfa hay using Fourier transform near infrared reflectance spectroscopy].

Alfalfa hay has high nutritive value, and it is one of the most important protein feed for domestic animals. The quality parameters of alfalfa hay, including CP, Ash, NDF, ADF, ADL and IVDMD, were predicted using Fourier transform near infrared reflectance spectroscopy with PLS regression in this test. Then the 6 models were validated by cross-validation and external-validation. The results indicated that FT-NIR models of alfalfa hay quality have considerable accuracy and precision: the correlation coefficient of cross-validation is 0.953 88 to 0. 990 19, and the RMSECV is 1.980-0.345; The correlation coefficient of external-validation is 0.963-0. 990. By using FT-NIR, analysis can rapidly and accurately determine the quality of alfalfa without any chemical reagent. This method is of great significance for analysing the trait of alfalfa production, the quality determination, the estimation of germ plasm resource, and the identifying and selecting of hybridized generations in alfalfa research of China.

[Comparison of therapeutic efficacy between TP regimen and CBP regimen on epithelial ovarian cancer after optimal cytoreductive operation].

BACKGROUND & OBJECTIVE: The most effective treatment for epithelial ovarian cancer is the combination of surgical operation and chemotherapy. Complete removal of the tumor is the key of surgical treatment; TP regimen (paclitaxel plus carboplatin) is the preference for postoperative chemotherapy, but its superiority is controversial. This study was to compare the efficacy of TP regimen and CBP regimen (cyclophosphamide, bleomycin plus carboplatin/cisplatin) on epithelial ovarian cancer. METHODS: Clinical data of 125 patients with stage IIb-IV epithelial ovarian cancer, underwent optimal cytoreductive operation and received regular postoperative chemotherapy in Cancer Center of Sun Yat-sen University, were analyzed. Of the 125 patients, 65 were treated with CBP regimen, 60 were treated with TP regimen. The 3-year survival statuses and main adverse events were compared between the 2 groups. RESULTS: The 3-year survival rates were 69.2% in CBP group and 75.3% in TP group (P=0.473); the 3-year tumor-free survival rates were 38.5% and 43.3%, respectively (P=0.580); the medians of progression-free survival time of the patients with recurrent disease were 12 months and 13 months, respectively (P=0.672). The comparisons of overall survival curves and tumor-free survival curves between the 2 groups showed no significant differences, too (P=0.285 and P=0.517). The comparisons of adverse effects between the 2 groups showed no significant differences except for neurologic toxicity. CONCLUSION: TP regimen and CBP regimen have identical therapeutic effects when used as first-line chemotherapy regimen for epithelial ovarian cancer after optimal cytoreductive operation.

[Expression and clinical significance of uPA and PAI-1 in epithelial ovarian cancer].

BACKGROUND & OBJECTIVE: Recent researches showed that urokinase-type plasminogen activator (uPA) and its inhibitor, plasminogen activator inhibitor (PAI)-1, play an important role in the invasion and metastasis of solid tumors. However, their correlations to epithelial ovarian cancer have seldom been reported. This study was to investigate the roles of uPA and PAI-1 in the invasion and metastasis of epithelial ovarian cancer, to clarify their localization and relationship with prognosis. METHODS: Immunohistochemistry was applied to examine the protein expression of uPA and PAI-1 in 80 specimens of epithelial ovarian cancer and 20 specimens of benign ovarian tumor. The correlations of their expression to the clinicopathologic characteristics and prognosis of the patients were analyzed. RESULTS: The positive rates of uPA and PAI-1 were significantly higher in epithelial ovarian cancer than in benign ovarian tumor (77.5% vs. 30.0%, P<0.001; 55.0% vs. 20.0%, P=0.005). uPA expression was correlated positively to PAI-1 expression in epithelial ovarian cancer (P=0.001). Higher positive rate of uPA was associated with greater metastatic tumor in the peritoneal cavity (P=0.038), but not associated with age, FIGO stage, histological type, pathologic grade, serum CA125 level, ovarian tumor size, and the size of residual tumor (P>0.05). Higher positive rate of PAI-1 was associated with early FIGO stage (P=0.022), but not associated with other parameters (P>0.05). Multivariate analysis showed that uPA was an independent factor for progression-free survival and overall survival, and PAI-1 was an independent factor for overall survival. CONCLUSION: Both uPA and PAI-1 are up-regulated in epithelial ovarian cancer, and might be used as markers to predict the prognosis of epithelial ovarian cancer patients.

[Evaluation of transvaginal ultrasonography-color Doppler energy imaging in surveillance of gynecologic malignant tumors after operation].

BACKGROUND & OBJECTIVE: Transvaginal ultrasonography (TVS) and color Doppler energy imaging (CDE) have been already applied in ultrasonography diagnosis extensively, but articles about the methods in surveillance of gynecologic malignant tumors after operation are few. The objective of this study was to evaluate TVS-CDE in surveillance of gynecologic malignant tumors after operation. METHODS: Fifty-four cases of gynecologic malignant tumors after operation, which were doubted as recurrent malignant tumors in clinic, were scanned with transabdominal ultrasonography (TAS), TVS, and TVS-CDE. The results were compared with that of pathology. Then their sensitivity, specificity,and accuracy were calculated, and the accuracy was compared by Chi-square test. RESULTS: Forty-three cases were diagnosed as malignant tumors by TAS; Forty-six cases were diagnosed as malignant tumors by TVS,and the positions, sizes, characteristics of the recurrent malignant tumors could be depicted visually. Forty-seven cases were diagnosed as malignant tumors by TVS-CDE; Not only the blood flow characteristics of masses,but also more diagnostic information than TVS were provided. The sensitivity was 81.3%, 91.7%, and 95.9%, respectively; the specificity was 33.3%,66.7%, and 83.3%, respectively; the accuracy was 75.9%, 88.9%, and 94.4%, respectively. Obviously, the accuracy of both TVS and TVS-CDE was higher than that of TAS(P< 0.05), but the accuracy of TVS and TVS-CDE was similar (P >0.05). CONCLUSION: TVS-CDE is helpful in the diagnosis of gynecologic malignant masses. It will be more effective in surveillance of recurrent gynecologic malignant tumors if it combined with CDE.

[How to increase the optimal rate of secondary cytoreductive surgery in recurrent epithelial ovarian cancer].

BACKGROUND & OBJECTIVE: Optimal secondary cytoreduction is of prognostic importance for recurrent epithelial ovarian cancer. To increase the optimal rate of secondary cytoreductive surgery in these patients is helpful for improving the prognosis of recurrent epithelial ovarian cancer patients. In this retrospective study, we investigated how to increase the optimal rate of secondary cytoreductive surgery in recurrent epithelial ovarian cancer patients. METHODS: The clinical data of 54 patients with recurrent epithelial ovarian cancer were analyzed retrospectively, who received secondary cytoreductive surgery during March 1 1997 to March 31 2003 in Cancer Center, Sun Yat-sen University. Nineteen patients had tumors only in pelvis, and 35 patients both in pelvis and abdomen. Single tumor was found in 16 patients and multiple tumors in 38 patients. Thirty-eight patients had ascites and 16 patients no ascites. Preoperative chemotherapy was given to 20 cases, and responses were observed in 12 patients and no response in 8. Multivariate logistic regression was carried out to investigate the relationship of residual diseases of secondary cytoreduction with age, time to recurrence, recurrent sites, ascites, and preoperative salvage chemotherapy. RESULTS: Optimal surgical cytoreduction was obtained in 81.5% (44/54) of the patients, with no macroscopic residual diseases in 53.7% (29/54) and residual diseases

[Clinical analysis of 57 patients with ovarian dysgerminoma].

BACKGROUND & OBJECTIVE: Ovarian dysgerminoma is an uncommen ovarian malignancy. Its clinical features are special and there are many factors influencing the prognosis. If treated properly, the patient can be cured. Otherwise it may endanger the patient's life. The aim of this study is to investigate the clinical features and factors related to prognosis of ovarian dysgerminoma. METHOD: The data of 57 patients with pure Ovarian Dysgerminoma were analyzed retrospectively, who were admitted to Cancer Center, Sun Yat-sen University of Medical Sciences from January 1, 1964 to December 31, 2000. RESULTS: The main clinical features were abdominal mass (56.1%), abdominal pain (21.1%), abdominal swelling(17.5%), vaginal bleeding(5.3%), genital tract abnormality (5.3%). Twenty-six patients had stage Idiseases, 8 stage II, 9 stage III, 1 stage IV and 13 recurrent and persistent diseases. The uterus was involved in 41.2% patients with stage II-III diseases. Combined modality was given to 52 cases and single-method treatment 5 cases. The overall 5-year and 10-year survival rate for stage I-IV was 80.1% and 70.0% respectively. The 5-year survival rate for stage I was 100%, stage II 55.2%, stage III 55.6%, stage IV 0% and recurrent and persistent diseases 72.7%. In the group of stage I, 12 patients received adnexectomy and 14 patients underwent hysterectomy and adnex removal, there was no significant difference between the 5-year and 10-year survival rate (all 100%) (P < 0.05). Of 23 patients in stage I group to whom only chemotherapy were given after operation, 19 cases received 3 or more courses and were well being without recurrence; four patients received only one course and one of them recurred 21 months after operation. In the group of stage II and III cases the 5-year survival rate was 86.7% for those whose chemotherapy courses were > or = 4 and 25.0% for patients who received less than 4 courses of chemotherapy (P < 0.05). CONCLUSIONS: The prognosis of ovarian dysgerminoma is closely related to disease stage and modality of treatment. Fertility-preserving operation can be considered in early-staged patients, and be careful of doing so in middle-late staged cases. Good results can be achieved with operation-based combined modality in recurrent patients.

[Relationship between expressions of p53, c-erbB2 genes, proliferating cell nuclear antigen and prognosis of patients with ovarian epithelial carcinoma].

BACKGROUND & OBJECTIVE: There were a few reports about the relationship between the expressions of p53, c-erbB2 Genes, and proliferating cell nuclear antigen (PCNA) with the prognosis from the patients with ovarian epithelial carcinoma(EOC). But conclusions were difference because of various methods and samples. This study was designed to investigate the relationship between the expressions of p53, c-erbB2 Genes, and PCNA with the prognosis from the patients with EOC. MATERIALS & METHODS: A total of 84 female patients with EOC were enrolled in this study, who were hospitalized in Department of Gynecology, Cancer Center, Sun yat-sen University from March 1 1990 to March 31 1994. The expressions of p53, c-erbB-2, and PCNA from the tumor samples were detected by Labelling-streptavidin-biotin (LSAB) immunohistochemistry assay. The relationship between the expression of the above marks and the prognosis of the patients were then analyzed. Statistical analyses were performed using SPSS 8.0 softwave. RESULTS: Forty-nine tumor samples (58.3%) exhibited p53 overexpression, 65 (77.4%) exhibited c-erbB2 overexpression, and all (100%) exhibited PCNA overexpression. In univariate analysis, there was marginally significant difference in the mean survival, the 5 years survival between the patients exhibited no c-erbB2 overexpression and the patients exhibited any c-erbB2 overexpression (P = 0.05). There was significant difference in the mean survival, the 5 years survival between the patients showed lower expression of PCNA and those showed higher expression of PCNA (P < 0.01), and there was no significant difference in the mean survival, the 5 years survival between the patients with overexpression of p53 and without overexpression of p53 (P > 0.05). In multivariate analysis, only stage and histological grade were the important significant prognostic factors of the patients with EOC, and there was no statistical significance between the overexpression of c-erbB-2 and PCNA with the prognosis. CONCLUSIONS: There was no significant correlation between the overexpression of p53 gene and the prognosis of the patients with EOC. The expression of c-erbB2 or PCNA was not an independent prognostic factor for prognosis of the patients with EOC. Stage and histological grade were still the independent significant prognostic factors of EOC.

[Expression and clinical significance of p53 and c-erbB2 in geriatric women with cervical carcinoma].

BACKGROUND & OBJECTIVE: Few reports have reported on molecular biological study of cervivcal carcinoma in eldely woman, So the authors designed this study to evaluate the expression and clinical significance of tumor suppressor gene p53 and oncogene c-erbB2 in the progression of this kind of cancer. METHODS: Seventy-nine patients with cervical cancer and 23 with cases of normal cervical epithelium in geriatric people were investigated immunohistochemically for expression of p53 and c-erbB2 in paraffin sections. RESULTS: The expression of p53 in ICC (invasive cervical carcinoma) and normal epithelium were 18.98% and 0%, respectively (P < 0.01), and the rate of c-erbB2 oncoprotein were 43.04% and 34.78%, respectively (P = 0.63). p53 staining in ICC with grade 1, 2, and 3 were 50.00%, 11.76%, and 17.14%, respectively (P = 0.01), and frequency of c-erbB2 oncoprotein were 80.00%, 38.24%, and 37.14%, respectively (P < 0.01). c-erbB2 staining in patients with stage I, II, and III or more were 33.33%, 38.46%, and 51.61%, respectively (P < 0.01), while p53 overexpression was not associated with clinical stage. Percentage of p53 staining in the groups with negative lymph nodes and positive ones were 6.67% and 41.67%, respectively (P = 0.01). While c-erbB2 expression was not associated with lymph node status. CONCLUSION: The p53 overexpression was an important factor in the process of carcinogenesis of elder women with cervical cancer and a predictive indicator for lymph node status. c-erbB2 gene may be activated in the early stage of pathogenesis of cervical carcinoma in geriatric patients.

[Phase II clinical study of topotecan hydrochloride in patients with recurrent advanced ovarian cancer].

BACKGROUND AND OBJECTIVE: Clinical studies showed there was no satisfying treatment of the patients with recurrent advanced ovarian cancer by using chemotherapy of combining platinum, and it is very important for oncologist to seek the second-line drugs to treat the patients with recurrent ovarian cancer. The current study was designed to evaluate the efficacy and toxicity of single agent Topotecan hydrochloride in the patients with recurrent advanced ovarian cancer. MATERIAL AND METHOD: A total of 31 patients with recurrent ovarian cancer in a multiple centers clinical trial were treated with Topotecan 1.25 mg/m2 qd, i.v. inf. for 5 consecutive days every three weeks. RESULT: Among 21 evaluable cases, overall response rate was 33.33%. Among 29 ITT population the response rate was 24.14%, including 3 CR and 4 PR. Main side effects were hematologic toxicities, 31.0% patients and 37.5% courses developed Grade III-IV leukocytopenia, 20.7% patients and 14.3% courses developed Grade III-IV thrombocytopemia. Non-hematologic toxicities were mild. CONCLUSION: Topotecan is effective for treating the patients with recurrent ovarian cancer who failed with platinum-based regimes.

[Analysis of clinical efficiency of treatment for 179 geriatric women with stage I or II cervical carcinoma].

BACKGROUND & OBJECTIVE: Elderly women with cervical carcinoma have the features of poor prognosis and high incidence rate of complications. This study was designed to evaluate the prognostic impact of surgery versus radiotherapy in old women with stage I and stage II cervical carcinoma and seek suitable treatment for such patients. METHODS: Clinical data of 179 elderly women with stage Ia to stage IIb cervical cancer were analyzed retrospectively. One hundred and thirty-four cases underwent radical hysterectomy also received appropriate adjuvant radiotherapy and/or chemotherapy. Forty-five cases underwent radiation therapy received appropriate adjuvant chemotherapy. RESULTS: The 5-year survival rates of patients underwent surgery and radiotherapy were 78.32% and 49.08% (P = 0.04), respectively. The incidence rate of complications of patients receiving surgery was 47.01% (63/134). Three patients died of complications after radical hysterectomy. The incidence rate of complications of patients underwent radiotherapy was 75.63% (34/45). CONCLUSION: Geriatric patients with stage I and stage II cervical carcinoma should receive operation if possible and should receive adjuvant treatments according to personal conditions.