RESUMEN
OBJECTIVE: We evaluated the usefulness of daily low-dose cisplatin-based concurrent chemoradiotherapy (daily CCRT) in patients with cervical cancer with an emphasis on elderly patients. METHODS: Between January 2003 and December 2008, a total of 65 patients with untreated stage IIA to IIIB cervical cancer were enrolled and 54 were selected for this nonrandomized prospective study. The daily CCRT comprised pelvic external beam radiotherapy (2 Gy/d × 25) with daily low-dose cisplatin (8.0 mg/m(2) per day) and either low- or high-dose rate intracavitary brachytherapy. RESULTS: The median age of the patients was 62 years (range, 29-85 years), and 21 patients (39%) were 70 years or older. The median follow-up period was 47 months (range, 4-107 months). Daily CCRT was successfully completed in 91% (49/54) of the patients. The mean total cisplatin dose was 191 mg/m (range, 128-224 mg/m(2)), and a neutropenia grade higher than 3 was observed in 24% of the patients. Of the 21 patients 70 years or older, 17 (81%) completed daily CCRT with acceptable toxicity. The 3-year overall survival (OS) rate for all the patients was 82.9%. No statistically significant differences in the OS rate and toxicity were observed between patients 70 years or older and those younger than 70 years. CONCLUSIONS: Daily CCRT showed acceptable toxicity and compliance, leading to the use of a high total dosage of cisplatin. The OS rate for daily CCRT was comparable to that for previously reported weekly CCRT. Daily CCRT could be an alternate choice for the CCRT treatment in elderly patients with cervical cancer.
Asunto(s)
Antineoplásicos/administración & dosificación , Carcinoma/terapia , Quimioradioterapia , Cisplatino/administración & dosificación , Neoplasias del Cuello Uterino/terapia , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antineoplásicos/efectos adversos , Quimioradioterapia/efectos adversos , Cisplatino/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
We report a case of hepatoid adenocarcinoma of the uterus in an 86-year-old woman. Serum AFP was elevated (7824ng/ml) on admission. The surgical specimen obtained by simple hysterectomy and bilateral salpingo-oophorectomy showed an exophytic tumor, 10.5cm×6.0cm×3.7cm in size, in the uterine corpus. Microscopically, tumor cells proliferated in trabecular or cord-like arrangement, which was considered as "hepatoid appearance". An adenocarcinomatous component was intermingled. The expressions of liver-enriched transcription factors, hepatocyte nuclear factor (HNF)-1ß, HNF-3, HNF-4α, and CCAAT/enhancer binding protein (C/EBP)-ß, were investigated in the present case and in 19 cases of endometrioid adenocarcinoma (11 cases of Grade 2 and 8 cases of Grade 3), because these nuclear factors are involved in embryonal hepatogenesis. HNF-4α was diffusely positive in the present case, but negative in all cases of endometrioid adenocarcinoma. HNF-3 and C/EBP-ß were positive for the present case and control adenocarcinoma cases (HNF-3, 36.8% and C/EBP-ß, 84.2%). HNF-1ß was negative for both the present case and endometrioid adenocarcinomas. This is the first report to demonstrate HNF-4α expression in this rare uterine tumor.
Asunto(s)
Adenocarcinoma/patología , Factor Nuclear 4 del Hepatocito/metabolismo , Neoplasias Uterinas/patología , Útero/patología , Adenocarcinoma/metabolismo , Adenocarcinoma/cirugía , Anciano de 80 o más Años , Biomarcadores de Tumor/metabolismo , Femenino , Humanos , Resultado del Tratamiento , Neoplasias Uterinas/metabolismo , Neoplasias Uterinas/cirugía , Útero/metabolismo , Útero/cirugíaRESUMEN
OBJECTIVE: The purpose of this study was to investigate the diagnostic impact of preoperative serum p53 antibody (S-p53 Ab) in patients with endometrial cancer. STUDY DESIGN: A hospital-based series of 67 patients, comprising 58 endometrioid adenocarcinomas (EA) and 9 serous adenocarcinomas (SA) between 1998-2002 were included. First, preoperative pathology was compared with final pathology in terms of histologic classification and tumor grade. Second, S-p53 Ab and CA125 were measured using preoperative serum samples, and immunohistochemical staining for p53 protein was assessed using hysterectomy specimens. RESULTS: There were discrepancies between preoperative and final pathology in terms of histologic classification (7%) and tumor grade in EAs (30%); other objective tests, therefore, were needed to minimize the diagnostic problems. S-p53 Ab titers varied from 0.27-786 (mean, 124) in SAs and from 0.1-7.47 (mean, 0.46) U/mL in EAs, respectively, and were positive in 6 (67%) SAs and in 3 (6%) EAs using 1.3 U/mL as cut-off. S-p53 Ab-positive rate was significantly correlated with SA histology and grade 3 EA tumor (odds ratio, 40; P = .005; 95% confidence interval, 3.04-525.43) with higher sensitivity and higher specificity than p53 staining and CA125, respectively. CONCLUSION: S-p53 Ab could conveniently and specifically identify high-risk endometrial cancer.
Asunto(s)
Adenocarcinoma/diagnóstico , Neoplasias Endometriales/diagnóstico , Proteína p53 Supresora de Tumor/sangre , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Antígeno Ca-125/sangre , Cistadenocarcinoma Seroso/diagnóstico , Neoplasias Endometriales/cirugía , Femenino , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
Yolk sac tumor (endodermal sinus tumor) is a malignant germ cell tumor characterized by AFP production, in which histologic foci similar to hepatocellular carcinoma occasionally coexist. We assumed a possible contribution of CCAAT/enhancer binding protein (C/EBP)-beta, a transcription factor implicated in the regulation of plasma proteins in the liver, to the regulation of AFP production and to the expression of other plasma proteins in yolk sac tumor cells because our immunohistochemical analysis revealed nuclear expression of C/EBP-beta in human yolk sac tumors. Overexpression of C/EBP-beta in a rat yolk sac tumor cell line, AT-2-TC, increased production of AFP and other plasma proteins, including albumin, alpha-1-antitrypsin, hepatoglobin, and transferrin. Liver-enriched transcription factors, including hepatocyte nuclear factors (HNF)-1alpha, -1 beta, and -4, were also induced. The induction of this protein expression was only evident in xenografts, where C/EBP-beta was phosphorylated and the activating isoform of C/EBP-beta was relatively predominant. These results indicate that C/EBP-beta plays a role in the production of plasma proteins of yolk sac tumors.
Asunto(s)
Proteínas Sanguíneas/biosíntesis , Proteína beta Potenciadora de Unión a CCAAT/metabolismo , Tumor del Seno Endodérmico/metabolismo , Adulto , Animales , Western Blotting , Línea Celular Tumoral , Tumor del Seno Endodérmico/patología , Humanos , Inmunohistoquímica , Masculino , Fosforilación , Isoformas de Proteínas/metabolismo , Ratas , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de Transcripción/metabolismo , TransfecciónRESUMEN
This study was designed to correlate tissue expression of CA125 with the corresponding serum value in endometrial cancer. The records of 52 endometrioid adenocarcinomas diagnosed were reviewed. Serum CA125 levels were examined before definitive surgery, and 20 U/ml was used as the cutoff value. Immunohistochemical staining for CA125 was assessed according to the ImmunoReactive Score. Statistical analyzes were performed to identify independent factor for high serum CA125 levels, including CA125 staining and the conventional pathologic features. Elevated serum CA125 levels were found in 15 of 52 patients (29%) (range, 0.1-172.1; mean 22.6 U/ml). The frequency of positive CA125 tissue staining (35/52, 67%) tended to be higher than that of elevated serum levels (p = 0.046). Fifteen patients with elevated serum CA125 levels statistically differed from the remaining 37 patients with normal serum CA125 level with respect to International Federation of Gynecology and Obstetrics (FIGO) stage (p = 0.027) and lymph node metastasis (p = 0.024), and tended to have positive washing cytology (p = 0.052). In multivariate analysis, elevated serum CA125 significantly correlated only with FIGO stage III, but not with tumor size or CA125 tissue staining. Intrauterine tumor may not be the main source of serum CA125 in endometrial cancer, and elevated serum level is closely related to the presence of disseminated cancer cells in the peritoneal cavity.