上海市区妇科“三癌”诊治分析

回顾调查了１９８８年１月１日至同年１２月３１日上海市区妇科＂三癌＂（宫颈癌、子宫内膜癌、卵巢恶性肿瘤）４１１例。结果：＂三癌＂的发病率分别为４．０５、４．４５、５．３７／１０万。平均发病年龄分别为６４．２、５８．８、５０．７岁。临床分期：宫颈癌≥Ⅱ期占８７．７％、内膜癌Ⅰ期占６０．８％、卵巢癌Ⅱ～Ⅲ期占４３．８％。病理：宫颈鳞癌占８５．５％，内膜腺癌占８１．５％，卵巢上皮癌占８１．５％。治疗方法：宫颈癌以放疗为主，内膜癌及卵巢癌以手术为主。

Effects of trichostatin A(TSA)on growth and gene expression in HeLa cells

Objective： To investigate the expressions of p53, RB1, Fas, c-fos, Ras, EGFR mRNA in human cervical cancer （HeLa） cell in response to the trichostatin A （TSA）. Methods： We took count of HeLa cells in different incubation times with TSA （0.2μm/L）. The result indicated that HeLa cells changed evidently when HeLa cells were incubated for 36 h. Then, we investigated the genes expression （mRNA levels） of HeLa cells after treatment for 36 h using SYBR green real-time PCR. Results： We demonstrated that trichostatin A （TSA） could make human cervical cancer （HeLa） cell morphological change and induce HeLa cell apoptosis. Furthermore, the data suggest that TSA-induced down-regulation of p53, RB1, Fas, but upregulated c-fos gene expression after treatment for 36 h, and Ras, EGFR did not show obvious response to TSA treatments. Conclusion： TSA has different effects on gene expression.

RESPONSE OF EARLY STAGE BULKY CERVICAL SQUAMOUS CARCINOMA TO PREOPERATIVE ADJUVANT CHEMOTHERAPY

Objective To investigate the potential role of preoperative adjuvant chemotherapy on early stage cervical squamous carcinoma with bulky tumor. Methods One hundred and forty-five patients with cervical squamous cancer stagesⅠb-Ⅱa were investigated, among which17 patients with bulky tumors (≥4 cm) were managed by cisplatin-based chemotherapy for 1-2 courses followed by radical hysterectomy and pelvic lymphadenectomy (BC group). The change of tumor size, pelvic lymph nodes metastasis, cervical wall invasion, the involvement of surgical specimen margin, and the blood loss during operation were assessed after opera-tion and compared with those in 51 patients with bulky tumors (BN group) and 77 patients with small local tumors (S group) who underwent surgery directly. Results (1) The tumor size of 17 patients in BC group were decreased in various degrees after chemotherapy, with 13 pati-ents of clinical effectiveness (76.47%). And the responsiveness pertained to neither histological differentiation nor size of local tumors. (2) Post-operative histology has showed that patients in BC and BN group have higher incidence of lymph node metastasis and deep cervical infiltration (5/68 and 3/68, respectively) than in S group (1/77 and 1/77, respectively) while with no statistical significance. (3) Blood loss during operation in BC group was less than BN and S group. (4) Seventeen patients, including those underwent surgeries of vaginal prolongation and/or ovarian transposition, appeared disease-free survival within the follow-up time. Conclusions Most of patients with bulky early stage cervical squamous carcinoma are sensitive to cisplatin-based chem-otherapy, which could greatly reduce local tumor size and in turn facilitate the following operation by well controlling blood loss.

Expressions of NF-κBp50, p53 and Bcl-2 in cervical cancer and their relationship with human papillomavirus infection

Objective:To explore the relationship between expressions of NF-κBp50,p53 and Bcl-2 in tissue of cervical can-cer and human papillomavirus(HPV)infection.Methods:The expressions of NF-κBp50,p53 and Bcl-2 were detected using immuohistochemical staining in 46 specimens of cervical cancer and 26 specimens of normal cervical tissue.The infection of HPV DNA were determined by PCR.Results:The expressions of NF-κBp50,p53 and Bcl-2 in tissue of cervical cancer were significantly higher than that in normal cervical tissue(P<0.01),and the expressions of NF-κBp50 and p53 or Bcl-2 were closely related(P<0.05).The expression of NF-κBp50 in HPV DNA positive group was significantly higher than that in HPV negative group(P<0.05),but there were no significantly differences in the expressions of p53 and Bcl-2 between HPV DNA positive group and HPV negative group(P>0.05).Conclusion:The expressions of NF-κBp50,p53 and Bcl-2 were significantly correlated with cervical carcinogenesis.NF-κBp50 may be activated by HPV infection.

Malignant neoplasms of the uterus following radiation therapy for cervical carcinoma: a clinical study of 47 cases

Objective： To study the characteristics and clinical features of uterine neoplasms developed after radiation therapy for cervical carcinoma. Methods： Clinical data of 47 cases of uterine neoplasms occurred following radiation therapy for cervical carcinoma were retrospectively reviewed. Results： The median age at uterine neoplasms diagnosis was 62 years （range： 38-77 years）, and the median latency period from initial therapy to development of uterine neoplasms was 14 years （range： 5-35 years）. Thirty of 47 cases were endometrial carcinoma, of which 3 were uterine papillary serous carcinoma （UPSC）. Seventeen of 47 patients were uterine sarcoma, all of those were carcinosarcoma. The distribution by stage, grade, and histology of 30 cases of endometrial carcinoma was as follows： stage Ⅰb, 1 case; stage Ⅰc, 2 cases; stage Ⅱ, 6; stage Ⅲa, 4; stage Ⅲb, 2; stage Ⅲc, 11; stage Ⅳ, 4 cases; grade 1, two cases; grade 2, nine; grade 3 （include 3 UPSC patients）, seventeen; unknown grade, two; endometriod, 27; UPSC, 3 cases; 7 of 30 cases of endometrial carcinoma had recurrences （23.3%）, at median time to recurrence was 24 months, and their median survival time was 26 months. The overall 3- and 5-year survival rates were 60% and 38%, respectively. Of the 17 cases of uterine sarcoma, the median survival was 10 months, 6 patients occurred recurrence （35.9%）, at a median time to recurrence was 9 months, and their median survival was 6 months. The overall 3- and 5-year survival rates were 12% and 0, respectively. Conclusion： The main uterine neoplasms development after radiation therapy for cervical carcinoma is endometrial carcinomas, of which there is a preponderance of high-risk histological subtypes and a poor prognosis. Most of the uterine sarcomas occurred following radiation therapy for cervical carcinoma are carcinosarcomas and the prognosis is very poor.

Pharmacokinetic comparison between ultraselection of uterine artery and peripheral vein chemotherapy of carboplatin in cervical cancer

Objective:The present study is to compare pharmacokinetics difference of carboplatin by using ultraselection uterine artery with by using peripheral vein in cervical cancer.Methods:Thirteen patients with locally advanced cervical cancer who had been proved by pathobiology were randomly divided into two groups:the ultraselection uterine artery group(group A, n = 6) and the peripheral vein(group B, n = 7).Carboplatin was administered by infusing into artery or vein in both groups at the dosage of 300 mg/m2.Tissues from the cervical tumor were collected at different times after infusion in both groups and then analyzed.Results:The peak concentration of platinum in tumor tissue was about 2.79 times higher in group A than that of group B(P < 0.05).The platinum concentrations in tumor in group A reached its peak levels immediately after infusion.But, group B had delayed time.While, for the time point of 0 min, when the administration finished immediately, the platinum concentration in tumor was significantly higher when compared with group B(P < 0.05).The tumor tissue area under the concentration(AUC) of carboplatin was about 2 times higher in group A than that of group B(P < 0.05).Conclusion:We observed the pharmacological advantages of chemotherapy by using ultraselection uterine artery administration of chemotherapeutic agent carboplatin in tumor tissue which provided theoretical basis and laboratory parameters of the intra-arterial chemotherapy for gynecologic malignancy.