Nobuhiro Tsuruchi

Multivariate analysis of the histopathologic prognostic factors of cervical cancer in patients undergoing radical hysterectomy

Three hundred forty‐five patients with invasive carcinoma of the uterine cervix, Stages Ib (211 patients) and II I (134 patients), underwent radical hysterectomy and pelvic lymphadenectomy. The influence of histologic factors including histologic subtype, maximum depth of cervical stromal invasion, degree of stromal invasion, longitudinal tumor diameter, lymph‐vascular space invasion, corpus invasion, parametrial invasion, vaginal invasion, and pelvic lymph node (PLN) metastases on survival were examined by multivariate analysis. Univariate analysis revealed that all the variables except corpus invasion and vaginal invasion were significant in survival (P < 0,05). Among these variables, however, PLN metastases, histologic subtype, and longitudinal tumor diameter were identified as independent and significant prognostic factors by multivariate analysis using Cox regression models. The prognostic index (PI), defined by the model (an indicator of the patients place in the prognostic spectrum), was able to divide the patients into three prognostic groups. The key factors in the definition of these groups were (1) squamous cell carcinoma, small tumor diameter, and no PLN metastases for the good prognostic group and (2) PLN metastasis in two or more node groups, adenocarcinoma with one positive PLN group, or squamous cell carcinoma with one PLN group and large diameter for the poor prognostic group. These prognostic findings could predict the prognosis more precisely than that of clinical staging.

Association of endometrial epithelial metaplasias with endometrial carcinoma and hyperplasia in Japanese and American women.

We reviewed endometrial tissue from 166 cases of endometrial adenocarcinoma and hyperplasia--91 seen at Kyushu University, Fukuoka, Japan, and 75 at George Washington University, Washington, D.C., U.S.A.--to compare the prevalence of epithelial metaplastic changes in the two populations. Metaplasias were more common in the benign endometrium associated with carcinoma at George Washington University (78%) than at Kyushu University (54%). They were associated with carcinomas of lower grade and accompanied by hyperplasia at both institutions. These results indicate that endometrial metaplasias, like endometrial hyperplasias, tend to be associated with less virulent endometrial carcinomas and to be more common in American women (who represent a high-risk population for endometrial carcinoma) than in Japanese women (in whom the risk is low but rising.

Histopathologic prognostic factors in stage IIb cervical carcinoma treated with radical hysterectomy and pelvic‐node dissection — an analysis with mathematical statistics

Of 107 patients with stage IIb cervical cancer who underwent laparotomy, 82 (77%) could be treated with radical hysterectomy (RAH) and pelvic-node dissection (PND). The remaining 25 patients were unsuitable for radical surgery because of para-aortic lymph node metastases, direct cancer invasion into the bladder muscle, and/or fixed enlarged pelvic lymph nodes (PLN): Such patients were treated with radiation therapy after laparotomy. Fifty-nine of RAH patients were given postoperative pelvic radiation because they had PLN metastases, parametrial invasion, and/or full thickness cervical stromal invasion. The overall 5-year survival of the patients undergoing RAH was significantly better than that of those who could not be treated with RAH (P < 0.001). In the RAH patients, parametrial invasion, which clinically defines stage IIb, was found only in 45%. Univariate analysis of histopathologic prognostic factors revealed that PLN metastasis, parametrial invasion, adenocarcinoma, and lymph-vascular space invasion significantly affected survival of the RAH patients (P < 0.05). Multivariate analysis using Coxs proportional hazards regression model, however, selected only PLN metastasis as a strong prognostic factor (P < 0.001). Concerning PLN metastasis patients with two or more positive nodal groups vs. 49%, P < 0.0001). The logistic regression analysis revealed that tumor diameter, parametrial invasion and lymph-vascular space invasion were independently correlated with PLN metastases in two or more nodal groups. The present data suggest that (i) the patients with massive pelvic extension of cancer cannot be cured by radiation therapy alone, (ii) the strong determinant of the prognosis of the patients undergoing RAH and PND is PLN metastasis. Therefore, for these patients with poor prognosic factors, other treatment modalities should be considered. From the present study it seems that planning RAH and PND for patients with stage IIb disease might make it possible to select poor prognostic subgroups, who have extra cervical extension or PLN metastases in two or more groups, and be useful in individualizing treatment.

Endometrial carcinoma in women aged 40 years or younger: a Japanese experience

We report on the clinical and pathologic findings in 17 cases of endometrial carcinoma in Japanese women aged 40 years or younger. Age of the patients ranged from 16 to 40 years, with a median of 35 years. Nine of 17 tumors (52.9%) were stage I or II (FIGO 1988) but 8 (47.1%) were stage III. Four of the 8 patients with stage III disease had pelvic lymph node metastases and one also had para-aortic lymph node metastasis. One patient had metastasis to the ovary and peritoneal cytology was positive in 4 patients. Histologically, 13 of these 17 patients had endometrioid adenocarcinoma, 3 had adenoacanthoma and 1 had an undifferentiated carcinoma. Ten were well differentiated tumors (G1), 3 were moderately differentiated tumors (G2), and 4 were poorly differentiated tumors (G3). Nine of 17 (52.9%) showed deep myometrial invasion (more than a half of the myometrium) and 5 of 17 (29.4%) demonstrated lymphatic/vascular space invasion. Pelvic and para-aortic lymph node metastases were seen in 4 of 15 (26.7%) and 1 of 15 (6.7%), respectively. Two of these 17 patients died of disease in a relatively short follow-up period. In our experience there is no difference in the survival rates between patients aged 40 years or younger and those over 40 years.

Squamous cell carcinoma arising in a cystic teratoma presenting as a vulvar mass

A case of squamous cell carcinoma arising in a cystic teratoma presenting as a vulvar mass is reported. This appears to be the first report of such a case.