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- Graflund, Marianne
(författare)
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Prognostic Factors in Early Stage Cervical Carcinomas Treated with Wertheim-Meigs Surgery
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cervical cancer is the second most common malignancy and a leading cause of morbidity and mortality among women worldwide. In Sweden, cervical cancer constitutes 2.4% of all newly diagnosed cancers and is the fifteenth cause of death.An improved estimation of the prognosis in early stages of cervical carcinomas is desirable. The most important of the established prognostic factors are tumor size, radical excision margins, and lymph node status. The objectives of this study were to assess the value of oncogene and tumor suppressor gene products, angiogenesis, proliferation markers and histopathological malignancy grading systems as predictors of pelvic lymph node metastases (LNM), tumor recurrences and death due to the disease in early stage (FIGO I-II).In a complete geographic series of cervical carcinomas treated by Wertheim-Meigs surgery, a number of clinical, biological, and histopathological prognostic factors were evaluated and long-term survival data were presented. In all, 367 woman with FIGO stage I-II cervical tumors were included.Significant prognostic factors for disease-free survival were lymph node status, radical surgical margins, and tumor size. In a multivariate Cox analysis, it was shown that lymph node status was the single most important prognostic factor (P < 0.0000001). Presence of LNM, tumor recurrence, and death from disease were significantly associated with the FIGO stage. There was also a significant (P = 0.002) association between the vascular space invasion of tumor cells and the presence of lymph node metastases.The complete malignancy grading system (MGS), partial index (PI), and invasive front grading (IFG) scores were highly significantly (P = 0.0001, P = 0.0001, P = 0.002) associated with the presence of pelvic LNM and with the disease-free survival rate. No pelvic lymph node metastases were encountered in tumors with MGS scores below 16. The predictive value (the specificity) for no pelvic lymph node metastases was 97%. The complete IFG score and the individual scores of the two variables, pattern of invasion and host response, were all significantly (P = 0 .002, P = 0.007, P = 0.0001) associated with pelvic LNM. Host response was the single most important factor in the IFG system, and it was superior to the complete score in predicting LNM.The activity of the proliferation marker MIB-1 was lower in pelvic lymph node metastases than in the primary tumors. The expression ofMIB-1 in lymph nodes was a prognostic factor for disease-free survival in both univariate and multivariate analyses.In our series, it was concluded that microvessel density (CD31) and expressions of p53, bcl-2, p21 (WAF1), DNA ploidy, and S-phase fraction (FCM) did not add any further predictive or prognostic information.In conclusion, this study has confirmed that histopathological malignancy grading (MGS), the partial index (PI), and invasive front grading (IFG) in the original or modified versions can predict low and high-risk groups of tumors and therefore be of value in planning the treatment of early stage squamous cell carcinomas of the uterine cervix. The expression of the proliferative marker MIB-1 in primary tumors and in LNM seems to be a factor that should be studied further in an attempt to identify different prognostic groups of tumors requiring more individualized postoperative treatment planning.
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| 2. |
- Lundgren, Caroline, et al.
(författare)
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2-DE protein expression in endometrial carcinoma
- 2006
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Ingår i: Acta Oncologica. - Oslo : Taylor & Francis. - 0284-186X .- 1651-226X. ; 45:6, s. 685-694
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to explore the protein expression pattern in normal endometrial mucosa (n = 5) and endometrial carcinoma ( n = 15) of low ( diploid) and high ( aneuploid) malignancy potential by two-dimensional gel electrophoresis (2-DE). The specimens were evaluated for histopathologic subtype, stage and grade in relation to DNA ploidy. A match-set consisting of five samples from normal endometrium, eight diploid and seven aneuploid tumours was created. All the diploid and three of the aneuploid tumours were of endometrioid subtype, while the remaining four were of uterine seropapillary type. There were 192 protein spots differentiating diploid tumours from normal endometrium and 238 protein spots were separating aneuploid tumours from normal endometrium (p < 0.01). A cluster analysis based on 52 significantly deviating protein spots within the groups showed clustering and separation of the normal endometrium, diploid and aneuploid tumours. In conclusion this study showed significant differences in protein expression between normal endometrium and endometrial carcinoma as well as between endometrial carcinoma of low and high malignancy potential. In future studies these results may provide useful in finding new sensitive prognostic markers for endometrial cancer.
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| 3. |
- Silins, Ilvars, et al.
(författare)
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A population-based study of cervical carcinoma and HPV infection in Latvia.
- 2004
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Ingår i: Gynecologic Oncology. - : Academic Press. - 0090-8258 .- 1095-6859. ; 93:2, s. 484-492
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We wished to quantify the population-based importance of cervical carcinoma risk factors in Latvia.METHODS: Totally, 223 of 224 eligible cases of incident invasive cervical carcinoma were enrolled during July 1998-February 2001 in Latvia. An age-matched sample of 300 healthy control women was selected from the Latvian population registry and 239 of these women (79%) were enrolled. A demographic and life-style questionnaire was completed, cervical brush samples were analyzed for human papillomavirus (HPV) DNA by PCR and serum samples for HPV antibodies.RESULTS: Risk factors for cervical cancer in multivariate analysis were HPV type 16 or 18 DNA positivity (OR = 32.4; CI 95% 16.5-63.6) and living in the capital (OR = 2.4; CI 95% 1.2-4.7). Oral contraceptive use was not a risk factor (OR = 0.4; CI 95% 0.2-1.1). A strong protective effect was found for having had more than three Pap smears in the last 5 years (OR = 0.07 CI 95% 0.03-0.19).CONCLUSIONS: Inadequate population coverage of Pap smears, in spite of excessive smear usage, caused 28.4% of cervical cancers in age groups eligible for screening. HPV type 16 infection was the most important risk factor for cervical cancer in Latvia, with a population-attributable risk percent for all ages of 58.5%.
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| 4. |
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| 5. |
- Silins, Ilvars, et al.
(författare)
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Serological evidence for protection by human papillomavirus (HPV) type 6 infection against HPV type 16 cervical carcinogenesis.
- 1999
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Ingår i: Journal of General Virology. - : Microbiology Society. - 0022-1317 .- 1465-2099. ; 80:11, s. 2931-2936
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Tidskriftsartikel (refereegranskat)abstract
- Human papillomavirus (HPV) exists as more than 100 genotypes. It is not well-established whether the different HPV types interfere with infection or pathogenesis by each other. Possible interactions in cervical carcinogenesis between infection with the most common HPV types (6, 11, 16, 18 and 33) were studied in a seroepidemiological case- control study of 218 women with primary untreated cervical cancer and 219 healthy age-matched control women. As previously shown, HPV-16 seropositivity was associated with cervical cancer risk [odds ratio (OR), 2.39], but HPV-16 was not associated with cervical cancer risk among HPV-6 seropositive women (OR, 1.0). The relative excess risk due to interaction between HPV-6 and -16 was -2. 35 (95% confidence interval, -0.04 to -4.65), indicating significant antagonism. The results suggest that infection with HPV-6 may interfere with HPV-16-associated cervical carcinogenesis.
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