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Volume 3, Number 2 – February, 2004 |
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The following articles appeared in this month's issues of the surveyed journals. Articles that seem to be of most interest to the practicing gynecologic oncologist are included. The journals that are surveyed are New England Journal of Medicine, Journal of Clinical Oncology, Gynecologic Oncology, Cancer, American Journal of Obstetrics and Gynecology, Lancet, Cancer Research, Obstetrics and Gynecology, Journal of the National Cancer Institute, Journal of the American Medical Association and American Journal of Surgical Pathology. The participants in this program are the active clinical fellows at Memorial Hospital: Mario Leitao, Christopher Awtrey, Sarah Ferguson, Alan Schlaerth, Destin Black and Margrit Juretzka. The managing editor is Douglas Levine. Comments, questions, complaints and suggestions are always welcome, please E-mail us at: VJC@smgo.org or click here. To subscribe or unsubscribe to the VJC, click here. Gynecologic Oncology – Christopher Awtrey Title: BRCA germline mutations in Jewish women with uterine serous papillary carcinoma Authors: Ofer Lavie, Gila Hornreich, Alon Ben-Arie, Gad Rennert, Yoram Cohen, Rehuven Keidar, Shlomi Sagi, Efrat Levy Lahad, Ron Auslander and Uzi Beller Source: Gynecologic Oncology, Volume 92, Issue 2, February 2004, Pages 521-524 Summary: Though ovarian and fallopian tube cancers have been associated with BRCA mutations the relationship between these mutations and uterine papillary serous cancers (UPSC) is unclear. The authors determined the incidence of germline mutations in patients with UPSC from 3 centers in Israel between 12/99 and 7/02. Four (20%) founder mutations were identified in 20 Ashkenazi Jewish women with UPSC. There were 3 185delAG mutations and 1 5382insC mutation. Loss of heterozygosity was reported for 3 of the 4 cases. The authors suggest that UPSC may be part of the hereditary breast-ovarian cancer in syndrome. While intriguing, this report should be interpreted with caution as the sample size is small. A more definitive study is required before hysterectomy to prevent UPSC can be recommended in BRCA heterozygotes undergoing prophylactic oophorectomy. Click here for abstract from Gynecologic Oncology Journal of Clinical Oncology - Mario Leitao Nothing of interest this month Journal of the National Cancer Institute – Alan Schlaerth Nothing of interest this month Obstetrics and Gynecology – Margrit Juretzka Title: ZYC101a for Treatment of High-Grade Cervical Intraepithelial Neoplasia: A Randomized Controlled Trial Authors: Garcia, Francisco, Petry, Karl Ulrich, Muderspach, Laila, Gold, Michael A., Braly, Patricia, Crum, Christopher P., Magill, Marianne, Silverman, Michael, Urban, Robert G., Hedley, Mary Lynne, Beach, Kathleen J. Source: Obstet Gynecol 2004 103: 317-326 Summary: This multicenter, double-blind, randomized, placebo-controlled trial enrolled women with CIN 2/3 to evaluate the safety and efficacy of ZYC101a. ZYC101a contains plasmid-DNA–encoding fragments derived from the E6 and E7 proteins of human papillomavirus (HPV) 16 and 18, and is formulated within small biodegradable microparticles. Pts (n=161) received either 3 IM doses of ZYC101a (100 or 200 µg) or placebo and proceeded to cervical conization at 6 months. Resolution of dysplasia was 43% in the ZYC101a group vs 27% in the placebo group (p=.12). In patients less than 25 yrs old (n=43), resolution was significantly higher in the combined ZYC101a groups compared to placebo (70% versus 23%; P = .007). Click here for abstract from OB/GYN American Journal of Obstetrics and Gynecology – Sarah Ferguson Nothing of interest this month New England Journal of Medicine – Mario Leitao Nothing of interest this month Journal of the American Medical Association – Margrit Juretzka Nothing of interest this month Cancer – Destin Black Title: Restaging of recurrent cervical carcinoma with dual-phase [18F]fluoro-2-deoxy-D-glucose positron emission tomography Authors: Chyong-Huey Lai, M.D. , Kuan-Gen Huang, M.D. , Lai-Chu See, Ph.D., Tzu-Chen Yen, M.D., Ph.D., Chien-Sheng Tsai, M.D., Ting-Chang Chang, M.D., Hung-Hsueh Chou, M.D., Koon-Kwan Ng, M.D., Swei Hsueh, M.D., Ji-Hong Hong, M.D. Source: Cancer, Volume 100, Issue 3, pages 544-552 Summary: This prospective study evaluated the diagnostic efficacy and benefit of PET for cervical cancer patients with a first recurrence who were potentially curable. Restaging was performed using PET and either CT and/or MRI on a cohort of 40 consecutive patients who had recurrent disease. Lesion status was verified by ultrasound–guided biopsy or surgical exploration. If biopsy was not feasible, a second assessment (CT/MRI and PET imaging) was performed 3-6 months later. Patients considered to be potentially curable based on conventional restaging were selected as historical controls (n=125). After PET imaging, twenty-two patients (55%) had their treatment modified. In identifying metastatic lesions, PET was significantly superior to CT or MRI (sensitivity: 92% vs. 60%; AUC: 0.962 vs. 0.771; P < 0.0001). A significantly better 2-year overall survival was observed for patients receiving surgery when compared to historical controls who also received surgery (HR, 0.21 [95% confidence interval, 0.05-0.83]; P = 0.02). The authors concluded that restaging with PET is superior to CT or MRI and allows the physician to offer optimal management of recurrent cervical carcinoma. Click here for abstract from Cancer Title: Prognostic Significance and Interobserver Variability of Histologic Grading Systems for Endometrial Carcinoma Authors: Astrid N. Scholten, M.D. , Vincent T. H. B. M. Smit, M.D., Ph.D. , Henk Beerman, M.D. , Wim L. J. van Putten, M.Sc. , Carien L. Creutzberg, M.D., Ph.D. Source: Cancer, Volume 100, Issue 4, Pages 764-772
Summary:
This pathology
review included 800 patients with Stages I-III endometrioid endometrial
carcinomas. Each slide was evaluated by two independent pathologist and
assigned a grade based on the widely used three-tiered grading system and a
novel binary grading system. The binary grading system is based on the
amount of solid growth, the pattern of myometrial invasion, and the presence
of tumor cell necrosis. The interobserver agreement rate for the FIGO
grading system was 73% and 70% for the binary system. The agreement rate
was 85% when converting the FIGO grading system into an artificial, 2-tiered
system (Grade 3 vs. Grades 1-2). The 2-tiered FIGO grading system and the
binary grading system were significant predictors of local recurrence,
distant recurrence, and disease-specific survival (hazard ratios [HRs]: 1.7,
2.5, and 2.6, respectively, for FIGO and 2.1, 4.1, and 3.8, respectively,
for the binary grading system). The amount of solid growth ( Click here for abstract from Cancer Lancet – Sarah Ferguson Nothing of interest this month Cancer Research – Destin Black Nothing of interest this month American Journal of Surgical Pathology – Alan Schlaerth Title: Clinicopathologic Analysis of Early-stage Sporadic Ovarian Carcinoma Authors: Leitao MM, Boyd J, Hummer A, Olvera N, Arroyo CD, Venkatraman V, Baergen RN, Dizon DS, Barakat RR, and RA Soslow. Source: Am J Surg Path. Vol 28, Number 2, February 2004, 147-159 Summary: This purpose of this study was to reanalyze the clinical and pathologic features of early stage ovarian carcinomas, after applying current pathologic criteria distinguishing invasive and borderline tumors. In this analysis, H&E slides of 140 patients with early stage ovarian carcinomas were reviewed. Diagnosis was changed to borderline in 41 cases (29.3%). Twenty-nine of the 41 (70.3%) changes in diagnosis involved endometrioid or mucinous tumors. The five-year PFS and DSS were greater for the cases reclassified as borderline (4.5% vs. 26.2% [p=0.006]; 4.5% vs. 25.6% [p=0.003], respectively). The five-year PFS and DSS were worse for carcinomas with TP53 mutations (22.6% vs. 41.2% [P=0.04]; 21.7% vs 24.7% [p=0.04], respectively). There were no statistically significant differences in outcome between stage I and II, tumor grade, clear cell histology vs. other histology, and stage IC preoperative versus intraoperative rupture. Click here for abstract from AM J Surg Path Title: Distinction of Endocervical and Endometrial Adenocarcinomas: Immunohistochemical p16 Expression Correlated with Human Papillomavirus (HPV) DNA Detection Authors: Ali Ansari-Lari M, Staebler A, Zaino RJ, Shah KV, and BM Ronnett Source: Am J Surg Path. Vol 28, Number 2, February 2004: 160-167 Summary: The purpose of this study was to more accurately differentiate endocervical adenocarcinomas (ECAs) from endometrial adenocarcinomas (EMAs). Most ECAs contain high risk HPV DNA, but EMAs do not. Overexpression of p16, an inhibitor of cyclin-dependent kinases, is associated with high risk HPV subtypes. The authors evaluated p16 by IHC in 24 unequivocal EMAs and 19 unequivocal ECAs to correlate with HPV DNA by in situ hybridization and PCR. Then, four equivocal lower uterine segment/upper endocervical adenocarcinomas were analyzed based on the IHC results. p16 expression was moderate-strong and diffuse in 18 ECAs, and weak and diffuse in one. HPV DNA was detected in only 14/19 ECAs by in situ hybridization. p16 staining in all 24 EMAs was weak and patchy. When analyzing the four equivocal lower uterine segment adenocarcinomas, 2 showed weak and patchy staining consistent with EMAs, and 2 displayed strong, diffuse p16 expression consistent with ECAs. Thus, the authors conclude that p16 immunohistochemistry appears to be a more sensitive method for distinguishing ECAs from EMAs, and can be used to assist in classifying equivocal lower uterine segment adenocarcinomas. |
50% vs. > 50%) had the greatest reproducibility of the histologic features
(agreement rate, 80%; 
=
0.50) and also was a strong prognostic factor for local recurrence, distant
recurrence, and disease-specific survival (HRs: 2.4, 3.9, and 3.8,
respectively). The authors concluded that a binary grading system and that
describes tumors based on the proportion of solid growth (© 2004 SMGO, All Rights Reserved.