Prognostic Impact of Carcinoembryonic Angtigen (CEA) in Locally Advanced Cervical Cancer Treated with Concurrent Chemoradiotherapy

Objective: To identify prognostic factors in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy (CCRT). Methods and Materials: We analyzed 76 patients with FIGO stage IB2 - IVb cervical cancer treated with CCRT between 2001 and 2006 at the Nagoya University Hospital. Patients with an advanced cervical cancer treated with CCRT. Overall survival (OS) and Progression-free survival (PFS) rates were estimated using the Kaplan-Meier method. The log-rank test was used to test differences in survival. Fisher's exact test was employed for univariate analysis. The Cox proportional hazard model was used for multivariate analysis. Results: The median age was 52, and the median follow-up period was 36 months. The 5 - year OS and PFS rates of all patients were 88.2% and 72.4%, respectively. Twenty-one of the 76 patients were diagnosed with recurrence. A higher serum CEA before CCRT was an independent predictive factor for a poor prognosis on multivariate analysis. Conclusions: A high level of serum CEA was a predictive factor for a poor prognosis. New strategies should be considered to control disease in this group of patients.

Patterns of Recurrence and Their Significance in Patients with Endometrial Carcinoma<br>—For Improved Follow-Up after Initial Treatment<br>

Objectives: The aim of this study was to identify the patterns of recurrence and their significance in patients with endometrial carcinoma (EMCA). Patients and Methods: After a search of the medical records from single institutions, a total of 49 patients with relapsed endometrial carcinoma were retrospectively evaluated. Various clinical information was examined, including the site of recurrence, detection procedure, and presence or absence of any symptom at the time of recurrence. Furthermore, the postrecurrence survival analysis was based on the Kaplan-Meier method. Results: The median follow-up period of all patients was 39.4 months (5.8 - 293.1). In all, twenty-five (51.0%) patients experienced recurrence within 12 months after the final treatment. At the time of recurrence, 15 (30.6%) and 34 (69.4%) patients were symptomatic and asymptomatic, respectively. Among the 34 asymptomatic patients, recurrence was detected by CT scan in 14 (28.6%), tumor markers alone in 14 (28.6%), and pelvic examination/ultrasound scan in 5 (10.2%). There was no relapsed case detected by vaginal vault cytology alone. The 5-year postrecurrence survival rates in symptomatic and asymptomatic patients were 57.5 and 36.6 months, respectively (P = 0.2973). After recurrence, 12 patients underwent debulking surgery, and 37 received salvage chemotherapy or radiotherapy. The postrecurrence survival of patients receiving surgery did not differ from that of those with chemotherapy/radiotherapy (P = 0.9198). Conclusion: Although imaging studies and tumor marker measurement contributed to the early detection of recurrence, they did not necessarily improve the prognosis postrecurrence.

Postrecurrence Clinical Outcome of Patients with Stage I Epithelial Ovarian Cancer Who Underwent Fertility-Sparing Surgery Compared to Those with Radical Surgery

Background: To examine the difference in the survival of patients with recurrent ovarian cancer who received fertility-sparing surgery (FSS) and those receiving radical surgery. Methods: Clinicopathologic data on a total of 90 patients with stage I recurrent ovarian cancer collected under the central pathological review system were subjected to survival analyses. Patients were divided into 2 groups: 1) FSS (N = 11), 2) Radical (N = 79). Results: Five-year overall survival rates of patients in the two groups were as follows: 40.8% (FSS)/44.2% (Radical), respectively. There was no significant difference in overall survival among the groups (P = 0.887). Additionally, three-year postrecurrence survival rates of patients in the two groups were 24.8% (FSS) and 25.3% (Radical) (P = 0.730). Furthermore, we accumulated 137 patients {FSS (N = 58), Radical group (N = 79)} with stage I recurrent ovarian cancer from the current study and six representative reports in the literature. Patients who experienced recurrence in the remaining ovary alone (FSS) showed a more favorable prognosis than those who had extra-ovarian site recurrence (overall survival: P = 0.021, postrecurrence survival: P = 0.069). Conclusions: Although our retrospective analysis was very preliminary, we could propose the hypothesis that patients with stage I recurrent ovarian cancer who undergo FSS may not show poorer survival rates than patients who receive radical surgery.