Luciano Savino

Expression of the retinoblastoma-related gene Rb2/p130 correlates with clinical outcome in endometrial cancer.

PURPOSE The retinoblastoma gene is the prototype of tumor-suppressor genes and has been shown to be involved in the pathogenesis and progression of several human malignancies. In this study, we determined the relation between the expression of a newly discovered retinoblastoma-related gene Rb2/p130 and outcome in patients with endometrial carcinoma. PATIENTS AND METHODS pRb2/p130 expression was determined immunohistochemically in specimens of endometrial carcinoma (stages I to IV) from 100 patients who underwent surgery as the first treatment. The pRb2/p130 status was analyzed in relation to the length of disease-free survival and disease-specific survival. RESULTS Decreased levels of pRb2/p130 in endometrial cancer cells was significantly associated with a decreased probability of remaining disease-free after treatment (P = .003) and with decreased probability of survival (P < .0001). In a multivariate analysis, pRb2/p130 status (P = .004), tumor stage (P = .009), and ploidy status (P = .02) were independent predictors of clinical outcome. The risk of dying of disease was increased substantially (risk ratio, 4.91; 95% confidence interval, 1.66 to 14.54) among patients with decreased levels of pRb2/p130 in tumor cells. CONCLUSION In patients with endometrial carcinoma who did not receive radiotherapy or chemotherapy before surgery, the presence of decreased levels of pRb2/p130 in tumor cells is associated with a significantly increased risk of recurrence and death of disease, independent of tumor stage and ploidy status.

Vaginal hysterectomy versus abdominal hysterectomy for the treatment of stage I endometrial adenocarcinoma

OBJECTIVE The aims of the current study were to (1) determine the effectiveness of vaginal hysterectomy for the treatment of stage I endometrial cancer and (2) analyze which clinical pathologic parameters were independent predictors of clinical outcome. STUDY DESIGN In a retrospective analysis, 5- and 10-year results of vaginal hysterectomy were compared with those of abdominal hysterectomy in 327 cases of stage I adenocarcinoma. No preoperative irradiation was given. Overall, 180 patients underwent vaginal hysterectomy, whereas 147 patients had abdominal hysterectomy (106 cases with lymphadenectomy). The log-rank test was used for evaluation of survival differences. RESULTS The 5- and 10-year survival rates (Kaplan-Meier method) were, respectively, 90% and 87% in the vaginal hysterectomy group and 91% and 90% in the abdominal hysterectomy group (difference not significant). The grade of differentiation, depth of myometrial invasion, and age were significantly correlated with survival, whereas histologic type, mode of surgery, lymphadenectomy, and adjuvant radiotherapy were not. In a multivariate analysis (Cox proportional hazards), grade of differentiation and age were independent predictors of clinical outcome, whereas depth of myometrial invasion lost significance. CONCLUSIONS Vaginal hysterectomy showed a high rate of cure in stage I endometrial cancer. Therefore it can be used as an alternative to the abdominal operation in obese and poor surgical risk patients and, possibly, in selected low-risk cases.

Epithelial ovarian tumors in the reproductive age group : Age is not an independent prognostic factor

While ovarian carcinoma is rare in the reproductive age group, these younger patients are known to fare better than the older patients. To determine whether age is an independent prognostic factor, as well as to investigate the clinicopathologic profile and survival rate of young women with ovarian carcinoma, a retrospective analysis in a series of patients aged 40 years or younger was performed.

Prognostic value of flow cytometric deoxyribonucleic acid index in endometrial carcinoma: Comparison with other clinical-pathologic parameters

OBJECTIVE: The aims of the current study were to verify the impact of flow cytometric deoxyribonucleic acid index on clinical outcome in endometrial carcinoma and to assess whether its value is independent from the other clinical-pathologic features. STUDY DESIGN: In a prospective series 74 cases of endometrial carcinoma with surgery performed at our institution were studied. Flow cytometry was performed on fresh tumor samples. The median follow-up period was 31 months (range 8 to 52). Disease-free survival and actuarial survival were the end points of the study. RESULTS: Among the 74 patients (53 with diploid and 21 with aneuploid tumors) there were 14 recurrences and 10 deaths caused by the disease. The recurrence rate was 7.5% for the diploid and 47.6% for the aneuploid tumors (p < 0.001). Mortality was 3.8% for diploid and 38% for aneuploid cases (p < 0.001). Disease-free survival was 89.1% in the former group and 36.3% in the latter. Actuarial survival (Kaplan-Meier method) was 94.7% and 49.5%, respectively. Deoxyribonucleic acid index, stage (International Federation of Gynecology and Obstetrics), and grade of differentiation were significantly correlated with survival, whereas age, depth of myometrial invasion, and histologic type were not. In a multivariate analysis (Cox proportional hazards) deoxyribonucleic acid index was the strongest independent predictor of clinical outcome, followed by International Federation of Gynecology and Obstetrics stage, whereas grade of differentiation yielded no independent prognostic information. CONCLUSIONS: The flow cytometric deoxyribonucleic acid index is an important independent prognosticator, and its determination should be included in the standard management of endometrial cancer.

GnRH Analogs in Gynecological Oncology: a Review

Chronic GnRH analogs (GnRH-A) administration has proven to be effective for the control of some hormone-dependent tumors. GnRH-A are now in the standard treatment of prostatic cancer. In the present paper experimental and clinical data on the use of GnRH-A in gynecologic oncology are reviewed in order to identify a possible role in the therapy of breast, endometrial and ovarian cancer. Besides the indirect hormonal effect of GnRH-A, mediated by the suppression of gonadal steroidogenesis, in vitro evidence suggests a direct anti-proliferative action involving autocrine-paracrine regulation of cellular function. In advanced or recurrent breast cancer objective responses were observed in 157 out of 378 premenopausal patients (41%) and in 18 out of 166 postmenopausal women (10%). In ovarian cancer complete and partial responses were observed in 14 out of 121 (11%). At present, data on advanced endometrial carcinoma are limited: only 18 treated patients are reported, of whom 7 responded (38.8%). However, in general, most of the responses observed were transient. Thus, so far, the use of GnRH-A in gynecologic oncology has to be considered for palliation, after the failure of other better understood treatment modalities. The possible use of GnRH-A as an adjuvant is still under investigation.

Management of benign adnexal masses by vaginal route.

Until recently, surgical treatment of a benign adnexal mass implied a laparotomy. In recent years, the development of laparoscopic surgery, as well as ultrasound-guided aspiration techniques, have significantly modified the treatment options for these patients. These procedures have shown considerable advantages. They have reduced surgical trauma and have shortened the hospital stay. We present the results of our experience on the feasibility of a trans-vaginal surgical approach for the removal of benign adnexal masses. This technique, using traditional and cheap surgical instruments, allows the surgeon to excise benign adnexal masses, by entering the peritoneum through the posterior vaginal fornix and thus avoids the trauma of laparotomy. Fifty-four patients were operated on by this technique at our Department. The mean age was 39 years (range 21-66). In all cases, the operation was completed by the trans-vaginal approach. The median operative time was 30 minutes (range 20-45), and no blood transfusion was needed. The pathological diagnoses were as follows: functional ovarian cyst; 19, endometriotic cyst; 18, dermoid cyst; 11, parovarian cyst; 4 and peduncolated fibroid of the uterine fundus; 2 cases. The diameter of the adnexal masses ranged from 3 to 10 cm (median of 6 cm). In 30 cases, a conservative surgery was done (including 2 myomectomies), whereas in 24 cases, the adnexectomy was needed. Median post-operative stay in hospital was 4 days (range 1-14). This study shows the feasibility of trans-vaginal surgical approach for benign adnexal masses. The advantages and limitations of this technique, as well as of the traditional and laparoscopic surgery are considered and discussed. We believe that the transvaginal approach could be useful and cost-effective for the treatment of selected cases of adnexal masses.

Hemangioma of the umbilical cord: report of a case.

A 31-year-old woman with a large placental tumor underwent a caesarean section. After delivery, the lesion, detected by ultrasound examination, was found to originate from the umbilical cord. A live female infant with cyanosis, hypotonia and diffuse edema was delivered. A review of the literature, which revealed 31 cases of umbilical cord hemangioma, showed that this tumor has a polymorphous presentation. Some fetuses and infants died from various causes, indicating that a close follow-up is necessary in these pregnancies

Estradiol and progestin receptors, 17-beta-hydroxysteroid-dehydrogenase and histopathologic grade in endometrial carcinoma.

The possible correlations between steroid receptor systems, 17-β-HSD and histopathologic examinations were investigated. The well-differentiated tumors showed higher steroid receptor and 17-β-HSD values than undifferentiated carcinomas. The steroid receptors did not present a statistically significant correlation with 17-β-HSD. Nevertheless, some neoplastic endometria (29%) show higher values of progestin receptors and 17-β-HSD, with a progestin: estrogen receptor ratio greater than one.