Chen-Hsuan Wu

Traffic Air Pollution and Risk of Death from Ovarian Cancer in Taiwan: Fine Particulate Matter (PM2.5) as a Proxy Marker

The relationship between mortality attributed to ovarian cancer and exposure to ambient air pollutants was examined using an ecological design. The study areas consisted of 61 municipalities in Taiwan. Air quality data for recorded concentrations of fine particulate matter (PM2.5) from study municipalities for 2006–2009 were obtained as a marker of traffic emissions. These were used as a proxy for polycyclic aromatic hydrocarbons (PAH) exposure. Age-standardized mortality rates for ovarian cancer were calculated for the study municipalities for the years 1999–2008. A weighted multiple regression model was employed to calculate the adjusted risk ratio (RR) in relation to PM2.5 levels. After adjusting for urbanization level and fertility rate, the adjusted RR values (95% confidence interval [CI]) for ovarian cancer were 1.2 (1.02–1.41) for the municipalities with PM2.5 levels between 30.48 μg/m3 and 39.41 μg/m3 and 1.2 (1.03–1.39) for the municipalities with PM2.5 levels between 39.48 μg/m3 and 51.1 μg/m3, compared to the municipalities with PM2.5 levels less than 30.39 μg/m3. Results showed that individuals who resided in municipalities with higher levels of PM2.5, a proxy measure of PAH, were at an increased risk of death from ovarian cancer compared to those subjects living in municipalities with the lowest PM2.5. The findings of this study warrant further investigation into the role of exposure to air pollutants in the etiology of ovarian cancer development.

Parity, age at first birth, and risk of death from liver cancer: Evidence from a cohort in Taiwan

Background and Aim:  The present study was undertaken to examine whether there is an association between parity and age at first birth and risk of liver cancer.

High immunohistochemical expression of TGF-β1 predicts a poor prognosis in cervical cancer patients who harbor enriched endoglin microvessel density.

Endoglin, a coreceptor for transforming growth factor &bgr;1 (TGF-&bgr;1) in vascular endothelial cells, is highly upregulated in tumor vessels and therefore is a specific biomarker for angiogenesis. Some studies have suggested that assessment of tumor angiogenesis may predict cancer response to chemotherapy and radiotherapy. In this study, we attempted to analyze the immunohistochemical expression of endoglin and TGF-&bgr;1 from 80 patients with different International Federation of Gynecology and Obstetrics (FIGO) stages of cervical cancer before they received concurrent chemoradiation and to investigate their prognostic significance. The median follow-up period was 86 months (range, 2–144 months). Endoglin staining was assessed by microvessel density (MVD), whereas TGF-&bgr;1 expression was semiquantified as negative, weakly, or strongly staining. A receiver operating characteristic curve was established for endoglin MVD in predicting survival; the optimal cutoff value was 11.125. With a Cox regression analysis, we found that an advanced FIGO stage (hazard ratio 4.66; 95% confidence interval 2.10–10.32, P<0.001) and endoglin MVD more than 11.125 (hazard ratio 12.21; 95% confidence interval 3.62–41.16, P=<0.001) were independent factors to predict survival. Interestingly, a strong TGF-&bgr;1 expression was significantly associated with poor survival only when the endoglin MVD value was higher than 10. Our study shows that evaluation of endoglin MVD by immunochemistry can be used as an independent prognostic marker for cervical cancer patients receiving concurrent chemoradiation. TGF-&bgr;1 also had an impact on survival only when endoglin MVD was enriched, suggesting its involvement in tumor progression in the later stage of angiogenesis.

Statin use and the risk of breast cancer: a population-based case–control study

Objective: The aim of this study was to investigate whether the use of statins was associated with breast cancer risk. Background: Experimental studies have shown that statins have potential protective effects against cancer. Methods: We conducted a population-based case–control study in Taiwan. Cases consisted of all patients who were aged 50 years and older and had a first-time diagnosis of breast cancer for the period between 2004 and 2011. The controls were matched to cases by age, sex and index date. Adjusted odds ratios (ORs) and 95% CIs were estimated by using multiple logistic regression. Results: We examined 565 breast cancer cases and 2260 controls. The unadjusted OR for any statin prescription was 1.19 (95% CI = 0.95 – 1.49) and the adjusted OR was 1.13 (95% CI = 0.84 – 1.51). Compared with no use of statins, the adjusted ORs were 1.02 (95% CI = 0.61 – 1.69) for the group with cumulative defined daily doses (DDDs) below 44.67 DDDs, 1.21 (95% CI = 0.83 – 1.76) for the group with cumulative dose between 44.68 DDDs and 308 DDDs, and 1.10 (95% CI = 0.66 – 1.83) for the group with the highest cumulative dose (> 308 DDDs). Conclusions: The present data do not provide evidence to support either beneficial or harmful associations between statin use and breast cancer risk.

Statin use and the risk of esophageal cancer: a population-based case-control study.

Objective: The aim of this study was to investigate whether the use of statins was associated with esophageal cancer risk. Methods: A population-based case-control study was conducted in Taiwan. Cases consisted of all patients who were aged 50 years and older and had a first-time diagnosis of esophageal cancer for the period between 2004 and 2010. The controls were matched to cases by age, sex and index date. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by using multiple logistic regression. Results: A total of 197 esophageal cancer cases and 788 controls were examined. The unadjusted ORs for any statin prescription was 0.86 (95% CI = 0.56 – 1.34) and the adjusted OR was 0.96 (95% CI = 0.59 – 1.58). Compared with no use of statins, the adjusted ORs were 0.77 (95% CI = 0.39 – 1.55) for the group having been prescribed statins with cumulative defined daily dose (DDDs) below 115 and 1.16 (95% CI = 0.63 – 2.14) for the group with cumulative statin use of 115 DDDs or more. Conclusions: The present data do not provide evidence to support either beneficial or harmful associations between statin use and esophageal cancer risk.

Difficulty in diagnosis and different prognoses between colorectal cancer with ovarian metastasis and advanced ovarian cancer: An empirical study of different surgical adoptions

OBJECTIVE To determine the clinical manifestations and optimal management of female patients with advanced colorectal cancer (CRC) metastasis in ovaries mimicking advanced ovarian malignancy. MATERIALS AND METHODS A retrospective medical records review of female patients with primary CRC metastasis to ovaries, which were initially diagnosed as ovarian malignancy, and treated between 2001 and 2013. Clinical presentations, pathologic findings, and treatment outcomes were analyzed. RESULTS In total, 19 cases were collected in the study through a hospital tumor registry. The mean age of the patients at the time of diagnosis was 45 years (range, 28-63 years). The most common symptoms were abdominal pain or increased abdominal girth (63%). None of them had rectal bleeding. The ratio of cancer antigen-125 to carcinoembryonic antigen was available in 13 out 19 patients (less than 25 in 76.9%). Barium enema or colonoscopic exam was only performed in 10 outpatients. None of them had a positive finding. All 19 patients went for surgery, all of them had ovarian metastasis but only eight of them had bilateral involvement, and 14 of them had carcinomatosis. All patients went for either optimal cytoreduction surgery or suboptimal cytoreduction surgery. The patients who received optimal cytoreduction surgery had a significant better progression-free and overall survival than those who did not. CONCLUSION Clinical manifestations of primary CRC with ovarian metastasis may be confused with advanced ovarian cancer. Negative barium enema or colonoscopic exam cannot rule out the possibility of CRC. For patients with a cancer antigen-125 to carcinoembryonic antigen ratio less than 25, 76% are good reference of CRC metastasis to ovaries. Optimal cytoreduction surgery like that used for treating advanced ovarian cancer had a better prognosis than suboptimal cytoreduction colorectal cancer treatment.

The use of weekly topotecan in the treatment of heavily pretreated recurrent epithelial ovarian and primary peritoneal cancer: The Kaohsiung Chang Gung experience

OBJECTIVE We attempted to investigate the safety and efficacy of alternative weekly topotecan dosing in a heavily pretreated Taiwanese population with recurrent epithelial ovarian cancer (EOC) and primary peritoneal carcinoma (PPC). MATERIALS AND METHODS We retrospectively reviewed the medical records of patients with recurrent EOC and PPC who had been treated with weekly topotecan between November 2008 and May 2012. Topotecan was given at a dose of 2.75-4 mg/m(2) via a 30-minute intravenous (IV) infusion on Days 1, 8, and 15 of a 28-day cycle until disease progression or unacceptable toxicity occurred. RESULTS Thirty-two patients were identified and 24 (75%) of them had received at least two previous regimens of chemotherapy; the median number of treatment courses was seven. The main toxicities (Grades 3 and 4) were anemia in seven (21.9%), neutropenia in six (18.8%), and thrombocytopenia in two patients (6.2%). No deaths were attributable to the therapy. Overall, seven patients (21.9%) showed a partial response (PR), while seven patients (21.9%) with stable disease (SD) were observed. Furthermore, we found a favorable response and toxicity profile in patients who received the lowest dose intensity (2.75 mg/m(2)). The median progression-free survival (PFS) and overall survival (OS) were 3 months [95% confidence interval (CI) 2.7-3.2] and 20 months (95% CI 11.1-28.9), respectively. CONCLUSION Topotecan administered as a weekly dosage (2.75-4 mg/m(2)) seems to be a tolerable regimen with modest activity in a Taiwanese population. Although the lower dose schedule showed a higher response with a better toxicity profile, further studies with more cases are needed to confirm this finding.

Parity and Risk of Death from Gallbladder Cancer among a Cohort of Premenopausal Parous Women in Taiwan

Little epidemiologic research has been done on the etiology of gallbladder cancer (GC). This cohort study was undertaken to examine whether there is an association between parity and risk of death from GC. The study cohort consisted of 1,292,462 women who had a first and singleton childbirth between 1 January 1978 and 31 December 1987. We tracked each woman from the time of their first childbirth to 31 December 2009, and their vital status was ascertained by linking records with the computerized mortality database. Cox proportional hazard regression models were used to estimate the hazard ratios (HR) of death from GC associated with parity. There were 257 GC deaths during 34,980,246 person-years of follow-up. The mortality rate of GC was 0.73 cases per 100,000 person-years. As compared with women who had given birth to only one child, the adjusted HR was 1.20 (95% CI = 0.79–1.83) for women who had two children, 1.47 (95% CI = 0.95–2.29) for women who had three children, and 1.68 (95% CI = 0.99–2.85) for women with four or more births. There was a significant increasing trend in the adjusted HRs for GC with increasing parity. The findings suggested that premenopausal women of higher parity may increase the risk of death from GC.

Pretreatment Factors Associated with Recurrence for Patients with Cervical Cancer International Federation of Gynecology and Obstetrics Stage IB1 Disease

Background: Pretreatment prognostic information is lacking for patients with cervical cancer International Federation of Gynecology and Obstetrics (FIGO) stage IB1 disease. Thus, we attempted to identify a high-risk subgroup among them prior to treatment. Methods: Cervical cancer FIGO stage IB1 patients who had received curative treatment with various modalities in our institute between January 2004 and December 2010 were enrolled. Pretreatment clinical parameters including age, squamous cell carcinoma antigen (SCC-Ag), carcinoembryonic antigen, hemoglobin (Hb) level, platelet count, histological type, and treatment modality were analyzed for treatment outcomes. Results: One hundred ninety-seven patients were included with a median follow-up of 66 months (range 6-119 months). In Cox regression analysis, only SCC histology (HR 0.457, 95% CI 0.241-0.967, p = 0.017) was an independent factor predicting better disease-free survival (DFS). Among SCC histology, patients with an Hb level less than 12 g/dl and a SCC-Ag level more than 3 ng/ml had worse treatment outcomes. The 5-year DFS rates were 89.2, 69.3, and 44.4% for the patients at low-risk (SCC, Hb >12 g/dl, SCC-Ag ≤3 ng/ml), intermediate-risk (non-SCC), and high-risk (SCC, Hb ≤12 g/dl, SCC-Ag >3 ng/ml), respectively (p < 0.001). Conclusion: Non-SCC and SCC histology with both anemia and high pretreatment SCC-Ag level were associated with recurrence. Further validation studies are warranted for clarification.

RECURRENT UTERINE LEIOMYOSARCOMA IMPLANTED IN A LAPAROTOMY SCAR

Uterine leiomyosarcoma, one of the most malignant groups of uterine tumors, constitutes 0.1–2% of all uterine malignancies. The pattern of tumor spread is commonly to the liver or lung via the blood stream. The treatment of most patients with stage I and II uterine leiomyosarcomas should include at least total hysterectomy and bilateral salpingo-oophorectomy. There is no firm evidence that adjuvant chemotherapy or radiation therapy is beneficial for these patients. However, recurrences develop in more than half of the cases of uterine leiomyosarcoma, even when the disease is apparently localized at the time of treatment. The most common sites of recurrence are the abdomen and lungs, and less than 10% of cases showed recurrence in the pelvic cavity. However, recurrences in the laparotomy wound are extremely rare and, to our knowledge, only one case has been previously reported [1]. It is still not known how neoplastic cells can implant and grow in an abdominal scar without other concomitant metastases. We present a patient with uterine leiomyosarcoma who developed a recurrence in her abdominal wall incision and review the reports in the literature about potential etiologies as well as the mechanism. A 43-year-old woman, gravida 3, para 2, presented to our gynecologic oncology clinic in February 2004, complaining of self-palpable abdominal mass associated with intermittent lower abdominal pain for more than 1 year. On pelvic examination, an enlarged uterus, the size of which was similar to that at 12 weeks’ gestation, was noted, and transvaginal sonography revealed a huge uterine tumor of about 12 cm in diameter with increased vascularity. A laparotomy was performed through a Pfannenstiel incision. Findings included a huge uterine tumor measuring 12 × 9.5 × 8 cm with central necrosis, and there was no obvious disease involving the bilateral ovaries, lymph nodes or omentum. The patient underwent total abdominal hysterectomy, because an atypical leiomyoma was disclosed from intraoperative frozen section. The final pathologic evaluation was reported to be uterine leiomyosarcoma with mitotic count higher than 10 per 10 high-power fields. There was no evidence of uterine serosal involvement. No adjuvant treatment, such as chemotherapy or radiotherapy, was arranged after the surgery. The patient was free of disease until 2 years after the operation, when a solitary mass was noted at the laparotomy scar. On examination, she had a 4 × 4 cm hard mass with restricted mobility in the right side of the Pfannenstiel scar. Pelvic examination and serum tumor markers were within reference ranges. Ultrasonography of the abdomen showed one subcutaneous cystic mass that was 4 cm in diameter near the laparotomy scar. The abdominal computed tomography scan revealed a 4-cm, well-enhanced mass at the right lower anterior abdominal wall, and there was no evidence of intra-abdominal or distant disease (Figure 1). Under the impression of recurrent leiomyosarcoma, local excision of the mass RECURRENT UTERINE LEIOMYOSARCOMA IMPLANTED IN A LAPAROTOMY SCAR