Title: Gynecologic Surgeries and Risk of Ovarian Cancer in Women With BRCA1 and BRCA2 Ashkenazi Founder Mutations: An Israeli Population-Based Case–Control Study

Authors: Joni L. Rutter, Sholom Wacholder, Angela Chetrit, Flora Lubin, Joseph Menczer, Sarah Ebbers, Margaret A. Tucker, Jeffery P. Struewing, and Patricia Hartge

Source:  J Natl Cancer Inst 2003; 95: 1072-1078.

Summary: This retrospective review from Israel assessed ovarian and peritoneal cancer risk after gynecologic surgeries for women who carry BRCA1/2 mutations but were not selected from high risk clinics. 847 patients with ovarian carcinoma (187 BRCA1 positive (22%), 64 BRCA2 positive (8%), and and 596 BRCA1/2 negative (70%)) were compared with 2396 control patients drawn from population registry. Bilateral salpingo-oophorectomy provided the greatest risk reduction (OR=0.12, 95% CI=0.06 to 0.24). Other gynecologic surgeries were associated with 30%-50% risk reduction. Comparable risk reduction was seen among BRCA1/2 carriers and non-carriers.

Title: Stages III and IV invasive epithelial ovarian carcinoma in younger versus older women: what prognostic factors are important?

Authors: John K. Chan, Vera Loizzi, Yvonne G. Lin, Kathryn Osann, Wendy R. Brewster and Philip J. DiSaia

Source:  Obstetrics & Gynecology, Volume 102, Issue 1, July 2003, Pages 156-161.

Summary: Survival rates in younger (45 years or younger) and older women (over 45) diagnosed with advanced-stage invasive epithelial ovarian cancer were compared. 52 younger women with advanced-stage epithelial ovarian carcinoma diagnosed between 1984 and 2001 were identified from tumor registry databases at two hospitals and matched to comparable older patients.  The 5-year survival rate and median survival in younger patients were 48% and 54 months, compared with 22% and 34 months in the older women (P = .003).  Age, performance status, stage of disease, and extent of cytoreductive surgery are important independent prognostic factors for survival.

Authors: Andrew J. Li, Rae Lynn Baldwin and Beth Y. Karlan.

Source:  American Journal of Obstetrics and Gynecology, 2003, Volume 189, Issue 1,Pages 22-27.

Summary: Primary cell cultures of human ovarian surface epithelium (n=23)and ovarian cancer (n=23) were evaluated for ER-alpha, ER-beta, PR A, and PR B messenger RNA and protein expression using RT-PCR and Western analysis. The authors found that the ER alpha/beta mRNA ratio was 10 times higher in ovarian cancer compared with normal ovarian surface epithelium (p=.04) PR B protein levels in primary ovarian cancer were twice that of normal surface ovarian epithelium cultures (2.08 vs 1.0; p=.04). No difference was found between PR B RNA and PR A protein expression. The data suggest that alterations in the expression of sex steroid hormone receptors play a role in malignant transformation of ovarian epithelium.

Title: Serum CA 125 is an independent prognostic factor in cervical adenocarcinoma.

Authors: David P.  Bender, Joel I. Sorosky, Richard E. Buller and Anil K. Sood.

Source:  American Journal of Obstetrics and Gynecology, Volume 189, Issue 1, July 2003, Pages 113-117.

Summary: To determine the prognostic significance of a pretreatment serum CA 125 value in patients who were diagnosed with adenocarcinoma of the cervix 73 pts diagnosed with adenocarcinoma or adenosquamous carcinoma of the cervix between 1986 and 1998 were reviewed. A CA 125 value of 30 U/mL was defined as elevated by the ROC curve analysis. Elevated serum CA 125 values were identified in 33% of the 73 patients. The median survival time was 2.8 years for patients with a pretreatment CA 125 value of 30 U/mL and not yet reached for patients with values of <30 U/mL (P < .001). In a Cox proportional hazards model, an elevated CA 125 value was the most significant predictor of survival (P < .001).

Title: Low-Molecular-Weight Heparin versus a Coumarin for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer

Authors: Lee, Agnes Y.Y., Levine, Mark N., Baker, Ross I., Bowden, Chris, Kakkar, Ajay K., Prins, Martin, Rickles, Frederick R., Julian, Jim A., Haley, Susan, Kovacs, Michael J., Gent, Michael, the Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators

Source:  N Engl J Med 2003 349: 146-153

Summary: To compared the efficacy of a low-molecular-weight heparin and an oral anticoagulant agent in preventing recurrent thrombosis in patients with cancer pts who had acute, symptomatic proximal deep-vein thrombosis, pulmonary embolism, or both were randomly assigned to receive low-molecular-weight heparin and a coumarin derivative or dalteparin alone for six months.  27 of 336 patients in the dalteparin group had recurrent venous thromboembolism, as compared with 53 of 336 patients in the oral-anticoagulant group (hazard ratio, 0.48; P=0.002). The probability of recurrent thromboembolism at six months was 17 percent in the oral-anticoagulant group and 9 percent in the dalteparin group.  Dalteparin was more effective than an oral anticoagulant in reducing the risk of recurrent thromboembolism without increasing the risk of bleeding.

Nothing of interest this month

Title: Analysis of Racial Differences in Incidence, Survival, and Mortality for Malignant Tumors of the Uterine Corpus

Authors: Mark E. Sherman and Susan S. Devesa

Source:  Cancer, July 1, 2003, Volume 98, Issue 1, Pages: 176-186.

Summary: This analysis of data from the SEER program addressed the higher level of mortality among black women with endometrial cancer.  The authors compared incidence and survival rates from 1992-1998 among white Hispanic, black and white non-Hispanic patients.  The incidence of uterine cancer was lower among white Hispanics and blacks compared with white non-Hispanics.  Compared with white non-Hispanics, blacks had significantly higher incidence of aggressive tumors and had worse outcomes for aggressive and common types of endometrial carcinoma.

Click here for abstract from Cancer

Title: A Pilot Phase II Trial of Concurrent Radiotherapy, Chemotherapy, and Hyperthermia for Locally Advanced Cervical Carcinoma

Authors: Ellen L. Jones, Thaddeus V. Samulski, Mark Dewhirst, Angeles Alverez-Secord, Andrew Berchuck, Daniel Clarke-Pearson, Laura J. Havrilesky, John Soper, Leonard R. Prosnitz

Source:  Cancer, Volume 98, Issue 2, 2003. Pages: 277-282.

Summary: 12 patients with locally advanced cervical cancer or locally recurrent cervical carcinoma following hysterectomy were treated with weekly cisplatin-based chemotherapy, hyperthermia, and radiotherapy in this pilot study.  All achieved clinical complete response and durable local control.  Two of the 10 pts with locally advanced disease experienced recurrence outside the pelvis.  Two patients treated for locally recurrent cervical carcinoma experienced disease progression and died of disease within six months.  The authors concluded that, in this small series, trimodality therapy resulted in a favorable clinical response and was well tolerated.

Click here for abstract from Cancer

Title: Mortality in relation to oral contraceptive use and cigarette smoking.

Authors: Vessey M, Painter R, Yeates D.

Source:  Lancet. 2003 Jul 19;362(9379):185-91.

Summary:  Mortality in relation to oral contraceptive use and smoking was studied in 17032 women, aged 25-39 years at entry, recruited between May 1, 1968, and July 31, 1974.  With 889 deaths, women who had ever used oral contraceptives had increased mortality from cervical cancer (rate ratio 7.2, 95% CI 1.1-303), and decreased mortality from other uterine (0.2, 0.0-0.8) and ovarian cancers (0.4, 0.2-0.7).  For all causes of mortality, the rate ratio for death in women who ever used oral contraceptives was 0.89 (95% CI 0.77-1.02). By contrast, this rate ratio was 1.24 (1.03-1.49) in those who smoked one to 14 cigarettes per day, and 2.14 (1.81-2.53) in those who smoked 15 or more cigarettes per day. Though not the purpose of the study, it confirms that OCPs reduce the risk of ovarian cancer, confirming findings from multiple prior publications. 

Click here for abstract from The Lancet

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Cancer Research – Destin Black

Nothing of interest this month

Title: Primary and Metastatic Mucinous Adenocarcinomas in the Ovaries: Incidence in Routine Practice With a New Approach to Improve Intraoperative Diagnosis.

Authors:  Seidman JD, Kurman RJ, and BM Ronnett.

Source:  Am J of Surg Path 27(7): 985-993, 2003.

Summary: In this retrospective study, the authors evaluated the histologic-type distribution of pure mucinous adenocarcinomas and the proportions of primary and metastatic mucinous carcinomas. In 124 consecutive ovarian carcinoma patients, the authors only found three case of pure mucinous carcinomas (2.4%), lower than previously reported (6-25%). In 52 consecutive patients with mucinous carcinoma in the ovaries, 40 (77%) were metastatic and 12 were primary (23%). A simple rule developed from this study, classifying all bilateral mucinous carcinomas as metastatic, unilateral mucinous carcinomas <10cm as metastatic, and unilateral mucinous carcinomas >10cm as primary, which correctly classified 90% of these neoplasms.

Click here for Am J of Surg Path