Chairat Leelaphatanadit

Residual Disease Following Conization of Women with Stage IA-IB1 Cervical Carcinoma in a High Incidence Region

BACKGROUND To determine rates of residual disease along with influencing factors in women with stage IA to IB1 cervical carcinoma after conization. MATERIALS AND METHODS A retrospective study was conducted of medical records of 198 stage IA to IB1 cervical carcinoma patients who had undergoing cervical conization followed by primary surgical treatment during 2006-2013. Independent factors correlating with residual carcinoma in subsequent surgical specimens were analyzed by stepwise regression analysis. RESULTS Mean age was 48.9 years. Cone specimens demonstrated free margins in 36 women (18.8%). In case of having disease at margin, high-grade cervical intraepithelial neoplasia (CIN) and carcinoma were evidenced in 58 and 97 women, respectively. Pathology of subsequent specimens revealed residual carcinoma in 78 women (39.4%), high-grade CIN or adenocarcinoma in situ (AIS) in 45 (22.7%), and no residual pathology in 75 (37.9%). Age more than 35 years, postmenopausal status, having symptoms, diseases or invasive lesions at conization margins or disease on endocervical aspect, and higher stage were significantly correlated with residual cancer in surgical treatment specimens. On regression analysis, postmenopause and stage were independent factors associated with residual carcinoma. CONCLUSIONS Patient and tumor characteristics are predictive factors for residual cancer in the studied group of women.

Clinicopathologic importance of women with squamous cell carcinoma cytology on Siriraj liquid-based cervical cytology.

OBJECTIVES The purposes of this study were to determine the prevalence and predictive value to detect significant neoplasia and invasive lesions, and to evaluate the correlation between clinical and histopathology of women with squamous cell carcinoma (SCCA) on Siriraj liquid-based cervical cytology (Siriraj-LBC). METHODS The computerized database of women who underwent Siriraj-LBC at Siriraj Hospital, Mahidol University from January 2007 to December 2010 were retrieved. The hospital records of women with SCCA cytology were reviewed. RESULTS The prevalence of SCCA cytology was 0.07%. A total of 86 women, mean age was 58.1 years. Sixty-one women (70.9%) were post-menopausal. Overall significant pathology and invasive gynecologic cancer were detected in 84 women (97.7%) and 71 women (82.5%), respectively. The positive predictive values for detection of significant neoplasia and invasive lesion were 97.7% and 82.6%, respectively. The cervical cancer was diagnosed in 69 women and among these 58 women were SCCA. Thirteen women (15.1%) had cervical intraepithelial neoplasia (CIN) 3 and two women (2.3%) had cervicitis. The sensitivity and specificity of colposcopy for cervical cancer detection in SCCA cytology were 83.3% and 75%, respectively. Median follow up period was 17.6 months and 64 patients were alive without cytologic abnormality. CONCLUSIONS The final histopathology of SCCA cytology in our populations demonstrated a wide variety, from cervicitis to invasive cancer and the most common diagnosis was invasive cervical cancer. Colposcopy with biopsy and/or endocervical curettage and loop electrosurgical excision procedure should be undertaken to achieve histologic diagnosis.

Oncologic Outcomes of Stage IVB or Persistent or Recurrent Cervical Carcinoma Patients Treated With Chemotherapy at Siriraj Hospital: Thailand’s Largest Tertiary Referral Center

Objectives To determine response rate and survival outcomes of chemotherapeutic treatment in stage IVB, persistent, or recurrent cervical carcinoma patients. Methods Medical records of stage IVB or persistent or recurrent cervical carcinoma patients who received chemotherapy from January 2006 to December 2013 were retrospectively reviewed. Patients with neuroendocrine carcinoma and patients who received only 1 cycle of chemotherapy were excluded. The demographic data, tumor characteristics, chemotherapeutic agents, and response rate were reported. Factors associated with overall response rate from the first-round chemotherapeutic treatment were analyzed using χ2 test. Kaplan-Meier method and Cox proportional hazards model were used for survival analysis. Results Of 286 cervical carcinoma patients, 47 patients had stage IVB and 239 patients had persistent or recurrent disease. One hundred sixty-nine patients (59.1%) had squamous cell carcinoma (SCC). A majority of disease sites (38.8%) had both local and distant metastases. Overall response rate for first-round chemotherapeutic treatment was 37.8%, with 23.1% of patients having a complete response and 14.7% of patients having a partial response. Regarding disease response, 32.2% of patients had stable disease and 30% had disease progression. Median overall survival (OS) and progression-free survival (PFS) for first-round chemotherapeutic treatment were 11.6 (range, 0.7–108.3) months and 5.6 (range, 0.7–102.2) months, respectively. Patients with distant metastasis had a shorter OS duration with an adjusted hazard ratio (HR) of 1.78, 95% confidence interval (CI) of 1.09 to 2.90; P = 0.02. Patients with a body mass index of 25 kg/m2 or more had a longer PFS duration than those with a normal body mass index (adjusted HR, 0.72; 95% CI, 0.55–0.94; P = 0.018). Patients with non-SCC had a longer PFS duration than that of patients with SCC (adjusted HR, 0.77; 95% CI, 0.60–0.99; P = 0.041). Conclusions Response rates, median PFS, and median OS of cervical cancer patients treated by chemotherapy in our center were rather high when compared with those of previous gynecologic oncology group studies.

8-year analysis of the prevalence of lymph nodes metastasis, oncologic and pregnancy outcomes in apparent early-stage malignant ovarian germ cell tumors.

PURPOSE To determine the rate of lymph node metastasis, oncologic and pregnancy outcomes in apparent early-stage malignant ovarian germ cell tumor (MOGCT). MATERIALS AND METHODS Medical records of apparent early-stage MOGCT patients undergoing primary surgical treatment at Siriraj Hospital, Bangkok, Thailand, between January 2006 and December 2013, were retrospectively reviewed. RESULTS Thirty-eight patients had apparent stage I-II MOGCT. The mean age was 22.1±7.7 years (median, 20.8 years; range, 7.7-35.6 years). The mean tumor size was 17.8±6.5 cm with a median of 20 (range 4-30) cm. Three most common histopathologies were dysgerminoma (12 patients, 31.6%), immature teratoma (12 patients, 31.6%), and endodermal sinus tumor (6 patients, 15.8%). Twenty-seven of 38 patients underwent lymphadenectomy; 13 patients (48.2%) were stage IA and 8 patients (29.6%) were stage IC. The rate of retroperitoneal nodes metastasis was 7.4% (2/27 patients). At 26.1 months of median follow-up time (range 1.9-88.5 months), 9 patients retained fertility functions, with uneventful pregnancies in 3 of these. Only one patient (2.6%) had progression of disease at 4.9 months after surgery. The 5-year survival rate was 97.4%. CONCLUSION As the rate of pelvic or para-aortic node metastasis in MOGCT is considerable, lymphadenectomy should be incorporated in surgical staging procedures.

Pathologic Risk Factors and Oncologic Outcomes in Early-stage Cervical Cancer Patients Treated by Radical Hysterectomy and Pelvic Lymphadenectomy at a Thai University Hospital: A 7 year Retrospective Review.

BACKGROUND To evaluate the rate of pathologic high-risk factors, intermediate-risk factors, and treatment outcomes in early-stage cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy (RHPL). MATERIALS AND METHODS Medical records of stage IA-IIA1 cervical cancer patients who underwent RHPL during the 2006 to 2012 time period and patient follow-up data until December 2013 were reviewed. RESULTS Of 331 patients, 52 women (15.7%) had pathologic high-risk factors and 59 women (17.8%) had intermediate-risk factors without high-risk factors. All studied patients had an initial complete response. At median follow-up time of 40.9 months (range 1-103.3 months) and mean follow-up time of 43.3±25.3 months, 37 women had disease recurrence and 4 women had died of disease. The most common site of recurrence was the pelvis (64.8%). Five- year and 10-year disease free survival rates were 96.1% and 91.5%, respectively. Five-year and 10-year overall survival rates were 100% and 99.4%, respectively. Independent factors related to recurrence were pelvic node metastasis (odds ratio [OR], 2.670; 95%CI, 1.001-7.119), and >1/3 cervical stromal invasion (OR, 3.763; 95%CI, 1.483-9.549). CONCLUSIONS The rates of pathologic high-risk and intermediate-risk factors should be considered and disclosed when counseling patients regarding primary treatment by RHPL. Oncologic outcomes of primary surgical treatment for early-stage cervical carcinoma were found to be excellent.