Jerzy Stelmachów

TP53 status and taxane-platinum versus platinum-based therapy in ovarian cancer patients: A non-randomized retrospective study

BackgroundTaxane-platinum therapy (TP) has replaced platinum-based therapy (PC or PAC, DNA damaging chemotherapy) in the postoperative treatment of ovarian cancer patients; however, it is not always effective. TP53 protein plays a differential role in response to DNA-damaging agents and taxanes. We sought to define profiles of patients who benefit the most from TP and also of those who can be treated with PC.MethodsWe compared the effectiveness of PC/PAC (n = 253) and TP (n = 199) with respect to tumor TP53 accumulation in ovarian cancer patients with FIGO stage IIB-IV disease; this was a non-randomized retrospective study. Immunohistochemical analysis was performed on 452 archival tumors; univariate and multivariate analysis by the Coxs and logistic regression models was performed in all patients and in subgroups with [TP53(+)] and without TP53 accumulation [TP53(-)].ResultsThe advantage of taxane-platinum therapy over platinum-based therapy was seen in the TP53(+), and not in the TP53(-) group. In the TP53(+) group taxane-platinum therapy enhanced the probability of complete remission (p = .018), platinum sensitivity (p = .014), platinum highly sensitive response (p = .038) and longer survival (OS, p = .008). Poor tumor differentiation diminished the advantage from taxane-platinum therapy in the TP53(+) group. In the TP53(-) group PC/PAC was at least equally efficient as taxane-platinum therapy and it enhanced the chance of platinum highly sensitive response (p = .010). However, in the TP53(-) group taxane-platinum therapy possibly diminished the risk of death in patients over 53 yrs (p = .077). Among factors that positively interacted with taxane-platinum therapy in some analyses were endometrioid and clear cell type, FIGO III stage, bulky residual tumor, more advanced age of patient and moderate tumor differentiation.ConclusionOur results suggest that taxane-platinum therapy is particularly justified in patients with TP53(+) tumors or older than 53 years. In the group of patients ≤53 yrs and with TP53(-) tumors platinum-based therapy is possibly equally efficient. We provide hints for planning randomized trials to verify these observations.

Expression of vascular endothelial growth factor mRNA in human leiomyomas.

Aim. Growth factors play a major role in the pathogenesis of uterine myomas. The aim of this study was to evaluate vascular endothelial growth factor (VEGF) mRNA expression during leiomyoma growth at different phases of the menstrual cycle with RT-PCR. Method. We studied 56 patients: 43 with myomas, 13 with healthy myometriums. In patients with myomas (secretory phase), VEGF expression was 2.82 times higher than in control patients (p < 0.05). In patients with myomas (phase I), VEGF expression was 2.53 times higher (p < 0.05) than in control patients. For all patients with myomas, those who were in menopause had 1.52 times higher VEGF expression than those who menstruated. For patients with healthy myometriums, those who were in menopause had 1.97 times higher VEGF expression than those who menstruated. A comparison of all the patients in menopause revealed that VEGF expression was 2.03-fold higher in those with myomas than in those with healthy myometriums. Conclusion. We observed the highest VEGF mRNA expression in women with myomas who were in menopause. Among menstruating patients, VEGF expression was significantly higher in those with myomas compared to those with a healthy myometrium. This suggested that VEGF may play a significant role in the pathogenesis of uterine myomas.

P373: Visualization of blood flow in bladder vessels in incontinent women by transvaginal color doppler sonography with contrast agent—Levovist

follows: (a) absent, (b) poor, (c) moderate, (d) good; the nearest artery to the urethral mucosa evaluated for Doppler velocimetric rates. In the vertical plane 1 cm from the urethrovesical junction was assessed the thickness of the urethral mucosa. The Doppler velocimetric tests were performed before HRT and 1, 3, 6 months following the use of Climen (AG Schering, Germany). For the statistical analysis, the paired t-test was used. Results: Statistically significant differences were found between incontinent postmenopausal and premenopausal women regarding of periurethral vessels score, velocimetric values. The thickness of the urethral mucosa were recorded. From the analysis of results, we found that periurethral vessels score, varied significantly when compared the patients prior the HRT and after 1,3, 6 months use. Other statistically significant differences were seen in velocimetric values prior and after HRT. Conclusions: Our results allow to conclude that HRT in postmenopausal women increase the number of periurethral vessels, well velocimetric values, show increases vascularization throughout the urinary tract to originate from neovascularization, angiogenessis and vascular congestion. There were decrease in urinary symptoms associated with HRT.

P48.09: Transvaginal sonography assessment of levator ani muscles in incontinent women

Objectives: To assess the feasibility and diagnostic criteria for vaginal and uterine fistulas using transvaginal pelvic sonography and color Doppler. Methods: We report on nine consecutive cases of vaginal and uterine fistulas (four rectovaginal, three vesicovaginal and two vesicouterine) diagnosed by transvaginal pelvic ultrasound and color Doppler between January 1996 and February 2006. Results: Diagnosis and localization of the fistulas were performed sonographically and confirmed using standard physical, rentgenographic and/or cystoscopic techniques. Seven cases were treated surgically and two were treated conservatively. All treated cases were successful (Table). Sonographic criteria for vesicovaginal fistulas included: (1) delineating a defect in the bladder and vaginal walls, (2) demonstrating passage of urine through the fistula tract (jet phenomenon) using colored Doppler with back flow (from the vagina back to the bladder) upon mechanical compression of the transducer. Criteria for rectovaginal fistulas included a defect in the rectal wall, and visualization of air bubbles passing through the fistula tract.

P48.08: Three‐dimensional ultrasound assessment of urethrae in incontinent women

Objectives: To assess the feasibility and diagnostic criteria for vaginal and uterine fistulas using transvaginal pelvic sonography and color Doppler. Methods: We report on nine consecutive cases of vaginal and uterine fistulas (four rectovaginal, three vesicovaginal and two vesicouterine) diagnosed by transvaginal pelvic ultrasound and color Doppler between January 1996 and February 2006. Results: Diagnosis and localization of the fistulas were performed sonographically and confirmed using standard physical, rentgenographic and/or cystoscopic techniques. Seven cases were treated surgically and two were treated conservatively. All treated cases were successful (Table). Sonographic criteria for vesicovaginal fistulas included: (1) delineating a defect in the bladder and vaginal walls, (2) demonstrating passage of urine through the fistula tract (jet phenomenon) using colored Doppler with back flow (from the vagina back to the bladder) upon mechanical compression of the transducer. Criteria for rectovaginal fistulas included a defect in the rectal wall, and visualization of air bubbles passing through the fistula tract.

P21.01: Do selected Doppler parameters of flow correlate with myometrial invasion and histological grading in endometrial cancer?

Objective: To determine if there is a relation of selected Doppler flow parameters with myometrial invasion and histological grading in endometrial cancer. Methods: TVCD were performed on 90 women with endometrial cancer. The location and intensity (vascular density – v. ds.) of vascularity, the peak systolic velocity (PSV) and the resistance index (RI) from blood flow waveforms of neoplastic infiltration were assessed. Ultrasonographic findings were compared to histopathology of the surgical specimen in which the degree of neoplastic invasion and histological grading was established. Results: In 80 of 90 patients (88.9%) abnormal flow with low impedance and high velocity levels (mean RI 0.38 ± 0.09 and PSV 20.45 ± 9.6 cm/sec) was found. In endometrial, superficial and deep neoplastic invasion (E,S,D) in 8/13 (61.5%), 38/41 (92.7%) and 34/36 (94.4%) respectively. Among 22 cases with neoplastic cervical canal involvement vascularity was seen in 21/22 i.e. 95.5% of cases, in 15/21 (71.4%) of high and in 6/21 (28.6%) of low vascular density. There was positive correlation between vascular density increase and surgicopathological stage (p < 0.005). Differences of RI and PSV between each type of infiltration was statistically significant (p < 0.01 and 0.02 respectively). In G1,G2,G3 vascularity was seen in 9/15 (60%), 56/60 (93.3%) and 15/15 (100%) of cases respectively, and these are significant differences (p < 0.05). Resistance index values manifested distinct decrease, and PSV a distinct increase with increasing histological malignancy of tumor. Well-differentiated tumors showed low vascular density, with relatively high impedance flow and low velocity: RI 0.44 ± 0.05 and PSV 14.1 ± 8.31 cm/sec, respectively. Conclusions: The correlation was seen between flow parameters, vascular density and staging (depth of tumor invasion) and grading of neoplasm. Lower resistance indices were reflected by higher grade and stage tumors, deeper invasion into the uterus.

OP16.07: Assessment of selected transvaginal sonography parameters in incontinent women

5.9 mm. The urethral angulation of 29.7◦ at Valsalva following the tape placement was significant (p < 0.01). All tapes were at midurethra, with no signs of migration toward the BN. All tapes moved dorsocranial to ventrocaudal during Valsalva. There were no signs of mesh cording after placement. Conclusions: There is no significant change in BN position with the TOT, similar to findings with the TVT. There was no tape migration and there was significant urethral angulation seen with the tape, suggesting the TOT acts in linking the urethra without significant urethral compression against the symphysis as seen with the TVT. TOT cure rates in short-term follow-up are comparable to the TVT.

OC28.03: Colour Doppler assessment of blood flow in cases of lymphatic metastases in endometrial cancer

There were 12 intrauterine fetal death (IUFD) and 1 neonatal death (15.7%) in AFP against 3 (4.4%) in hCG Group, despite tertiary perinatal care. Mean gestational age at delivery was 34.5 weeks (range 21–41) for AFP and 37.7 weeks (range 22–42) for hCG Group. 6 (7.2%) in AFP and 3 (4.4%) in hCG Group developed severe preeclampsia. Multimodal screening predicted preterm delivery < 32 weeks with a likelihood ratio (LR+) of 6.932 in AFP against 0 in hCG group and IUFD with LR+ of 4.438 in AFP against 0 in hCG group. Conclusion: Predictive value of placental morphology and uterine artery Doppler was higher in the AFP group. Pregnancies with an elevated maternal serum AFP are more commonly associated with adverse perinatal outcomes than those with elevated hCG warranting increased maternal and fetal surveillance.

P14.05: Usefulness of transvaginal sonography in assessment of patients with stress incontinence

Results: Defects of the anorectal muscularis, implying a true rectocele, were identified in 2 out of 68 women before and in 8 out of 52 women after childbirth (P = 0.02). In those two women in whom defects were diagnosed before childbirth, they had deepened from 14 to 23 mm and from 15 to 18 mm. After childbirth, the ampulla or rectal contents descended over 22 mm further than before (P < 0.0001 on paired ttest). Symptoms regarded as typical for a rectocele, ie., digitation (n = 2), straining at stool (n = 10) and incomplete emptying (n = 11), were not uncommon 2–6 months postpartum; but out of 8 rectoceles, 4 were asymptomatic. Conclusions: As shown previously, defects of the rectovaginal septum, i.e., ‘true rectoceles’ occur in young nulliparous women. However, childbirth is associated with an increase in prevalence and size of such defects, and it seems to cause increased downwards displacement of the rectal ampulla, ie., perineal hypermobility.

P13.06: Importance of fine needle aspiration biopsy of parametria in cervical cancer

Objective: To estimate the change in ovarian volume after uterine artery embolization for fibroid uterus. Methods: Women presenting for uterine artery embolization were followed for up to three years. These women had baseline ultrasound examinations which included uterine size, fibroid number and volume, endometrial echo and ovarian volume. These women were followed yearly with pelvic ultrasound to determine shrinkage of uterine myomas and to assess ovarian volume. Mean ovarian volumes (cm3) were compared at 1 and 3 years to the baseline exam by means of a paired t-test. Only those subject with complete measurements were compared. Results: The mean age of the cohort was 43 (SD = 5.2) years of age with an average gravidity of 1 (SD = 1). Data was complete for 51 women at 1 year and 21 women at 3 years. The mean left ovarian volume (cm3) at baseline, 1 year and 3 years was 11.2, 8.7, 14 (p = 0.92). The mean right ovarian volume (cm3) at baseline, 1 year and 3 years was 11.1, 10.1 and 6.2. (p = 0.08). There were significant correlations in ovarian volume from baseline to each subsequent measurement with the exception of the left ovary between baseline and 3 year follow-up. Conclusion: There is no significant change in ovarian volume in 3 year follow-up of women who underwent uterine artery embolization for fibroid uterus. This suggests that there is ample collateral circulation to the ovaries form the ovarian artery which sustains ovarian mass.