OBJECTIVE: This study was performed to identify the prognostic factor for survival of patients with recurrent cervical cancer. METHODS: Sixty-eight patients were diagnosed as recurrent cervical cancer at the Seoul National University Hospital from January, 1988 to December, 1998. Recurrence was defined as new evidence of tumor after 6 months of disease free survival. Retrospective analysis was done in terms of clinical features and the Cox proportional hazard model was used to identify independent variables associated with an improved survival rate. Histopathologic types were distributed as follows; squamous cell carcinoma in 70.6%, adenocarcinoma in 11.8%, adenosquamous cell carcinoma in 11.8%, and small cell carcinoma in 1.5%. Distribution of FIGO stage was as follows; stage I in 25.0%, stage II in 66.2%, and stage III in 4.4%. Sites of recurrence were as follows; central pelvic recurrence in 44.1%, pelvic side wall recurrence in 11.8%, and distant metastasis in 44.1% and the most common site of distant recurrence was extrapelvic lymph nodes (29.4%). 29.4% of recurrences were observed within the first 12 months after initial therapy, 50.0% within 2 years and 64.7% within 3 years. RESULTS: Positive rate of SCC-Ag at initial diagnosis was 45.2% with cutoff value of 2.0 ng/ml. Positive rate of SCC-Ag at the diagnosis of recurrence was 60.0%. Overall response rate to the treatment was 29.1%. Complete response rate was higher in central pelvic recurrrence than pelvic side wall recurrence and distant metastasis (P = 0.002) and also higher in normal SCC-Ag level (< or = 2.0 ng/ml) at the diagnosis of recurrence than elevated level (P = 0.032). Cumulative survival rates of 1 year after recurrence was 66.8%, 2 year 36.7%, and 5 year 18.7%. Central recurrence showed higher cumulative survival rate than pelvic side wall or distant recurrence (P = 0.029). The patients with elevated SCC-Ag level at the time of diagnosis of recurrence showed lower cumulative survival rate than those with normal SCC-Ag level (P < 0.001). Cox proportional hazard model showed that SCC-Ag elevation at the time of diagnosis of recurrence retained significant values in predicting survival(OR = 2.56; 95% CI = [1.22-5.39]; P = 0.01). CONCLUSION: SCC-Ag elevation at the diagnosis of the recurrence is a strong independent prognostic indicator for survival of patients with recurrent cervical cancer.
Adenocarcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Disease-Free Survival ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate ; Uterine Cervical Neoplasms*

Cancer of the vulva accounts for approximately 0.5% of all gynecologic malignancies. At diagnosis, one-third of these cases is detected in an advanced stage (FIGO stages III, IV), and local extension of primary vulvar cancer may involve adjacent midline structures such as the clitoris, urethra, vagina, and anus. Initial surgical therapy of such locally advanced primary cancers may compromise the functional integrity of midline structures, necessitating ultraradical surgery including pelvic exenteration. In view of the relatively elderly age of the patients and the morbidity of this ultraradical dissection, concomitant chemoradiation therapy - that the efficacy had been proven in head and neck cancer, anal cancer has approached for patients with locally advanced vulvar cancer. We experienced a case of stage III vulvar cancer patient, who underwent concomitant chemoradiation therapy with 5-fluorouracil(FU) and cisplatin and who showed complete response. So, we report this case with brief review of the literatures.
Aged ; Anal Canal ; Anus Neoplasms ; Cisplatin ; Clitoris ; Diagnosis ; Female ; Head and Neck Neoplasms ; Humans ; Pelvic Exenteration ; Urethra ; Vagina ; Vulvar Neoplasms*

BACKGROUND: The HER-2/neu proto-oncogene (also known as c-ErbB-2) encodes a 185 kD transmembrane glycoprotein with intrinsic tyrosine kinase activity. Many studies revealed the correlation between the aberrant overexpression of HER-2/neu oncogene and poor prognosis of the malignant tumors such as breast, stomach, colon, lung cancers. But the significance of HER-2/neu oncogene overexpression as a prognostic factor in ovarian cancer remains controversial. OBJECTIVE: The aims of this study were to assess the prevalence of HER-2/neu oncogene amplification by polymerase chain reaction(PCR) and to evaluate the prognostic significance of HER-2/neu oncogene overexpression in terms of chemo-responsiveness and survival rate. MATERIALS AND METHODS: This study included 32 patients with advanced ovarian cancers(24 epithelial ovarian cancers, 2 Brenner tumors, 2 malignant mixed miillerian tumors, 2 granulosa cell tumors, 1 struma ovarii, 1 Krukenberg tumor). All patients had underwent staging laparotomy, and postoperative adjuvant chemotherapy with platinum-based combination chemotherapy. PCR was performed using tissues preserved in liquid nitrogen at the time of debulking operation. Overexpression of HER-2/neu oncogene was defined as being equal to or greater than 1.5 a.u. We analyzed whether the HER-2/neu overexpression correlated with chemoresponsiveness and 5-year survival rate(5-YSR). RESULT: HER-2/neu oncogene amplification was present in all of the ovarian cancers(32/32). Significant overexpression[gene copy number(GCN) > or =1.5 a.u.] was present in 13 of 32 ovarian cancers(41%) and 12 of 24 epithelial ovarian cancers (50%). The clinical response rate to chemotherapy in high copy group(GCN > or = 1.5 a.u.) was 67%(8/12) and that of low copy group(GCN<1.5 a.u.) was 92%(11/12)(p>0.05). Pathologic response rate to chemotherapy was 0%(0/5) and 50%(3/6), respectively(p>0.05). 5-YSR was 8% in high copy group and 25% in low copy group, but this difference was not statistically significant(p=0.17). CONCLUSION: HER-2/neu overexpression might be a poor prognostic factor, but this difference was not definitely elucidated by satistical analytsis in this study. Larger scaled prospective randomized study is needed to define the prognostidc significance of the HER-2/neu overezpression in ovarian cancer.
Breast ; Brenner Tumor ; Chemotherapy, Adjuvant ; Colon ; Drug Therapy ; Drug Therapy, Combination* ; Glycoproteins ; Granulosa Cell Tumor ; Humans ; Laparotomy ; Lung Neoplasms ; Nitrogen ; Oncogenes* ; Ovarian Neoplasms* ; Polymerase Chain Reaction ; Prevalence ; Prognosis ; Protein-Tyrosine Kinases ; Proto-Oncogenes ; Stomach ; Struma Ovarii ; Survival Rate

Backgrouad & Aims: Cyclophosphamide, adriamycin and cisplatin(CAP) combination chemo- therapy improved the response rate in the treatment of advanced epithelial ovarian cancer, and it has been the gold standard. However, adriamycin is a rather toxic drug, and there is still confusion concerning the choice of adriamycin to be included in optimal regimen. The present study was designed to compare the activity and toxicity of combination regimens in advanced epithelial ovarian cancer between CAP and CTP which substitutes adriamycin with pirarubicin(THP- adriamycin). PATIENTS AND METHODS: From March 1995 to December 1997, 47 patients with FIGO stage III-IV epithelial ovarian cancer who were diagnosed after initial cytoreductive surgery were divided into two groups at random: (1) The case group were treated with CTP(500/40/50 mg/m2) as a first line chemotherapy. (2) The control group were treated with CAP(500/50/50 mg/m2) as that of case group. Clinical characteristics, response rates and toxicities according to Gynecologic Oncology Group criteria were compared between those treated with CAP and CTP respectively. RESULTS: Forty one patients out of 47 were evaluable and the number of patients in case and control group was 22 and 19 respectively. There was no significant differences in patient characteristics such as age, stage, histologic type between two groups. Clinical complete response rate was 50.0%(11/22) in patients treated with CTP regimen and 47.4%(9/19) with CAP regimen and there was no significant difference between two groups. Second look operation was undergone in 10 patients of CTP group and 7 patients of CAP group who showed clinical complete response and the pathologic complete response rate was 27.3%(6/22) with CTP and 21.1%(4/19) with CAP. The incidence of leukocytopenia of grade 3 or 4 was more frequently occurred in CAP group(52.6%, 10/19) than CTP group(22.7%, 5/22). There was no significant difference in the incidence of other toxicitied such as hepatic, renal and G-I toxicities. Suspicious cardiac toxicity according to the finding of EKG was seen in 15.8%(3/19) only with CAP regimen and all of them showed decreased cardiac function in gated blood pool scan. There were no significant differences in risponse rates between two groups, but the incidence of cardiac toxicity and leukocytopenia o f grade 3 or 4 was more frequently occurred in CAP group than CTP group. CONCLUSION : CTP regimen has comparable response rates to CAP regimen, with lower incidence of hematolohic and cardiac toxicity.
Cyclophosphamide* ; Cytidine Triphosphate ; Doxorubicin* ; Drug Therapy ; Drug Therapy, Combination* ; Electrocardiography ; Humans ; Incidence ; Leukopenia ; Ovarian Neoplasms*

PURPOSE: This study was undertaken to analyze whether the p53 codon 72 single nucleotide polymorphism might be correlated with the risk and/or the prognosis of cervical cancer in Korean women. MATERIALS AND METHODS: Peripheral blood samples derived from patients with cervical squamous cell carcinoma (SCC) (n=68), cervical adenocarcinoma (n=37), cervical intraepithelial neoplasia (CIN) III (n=98) and normal controls (n=98) were examined. Germline genomic DNA was extracted from peripheral blood leukocytes and examined by PCR amplification of the specific alleles assay described by Storey et al.5 Statistical analysis was performed using the Chi-Square test or the Kaplan-Meier survival analysis, logistic regression analysis. RESULTS: The proportions of individuals who were homozygous for the proline allele, and heterozygous for the two allele, homozygous for arginine allele in each group were 15%, 47%, 38% in the SCC group; 6%, 7%, 24% in the adenocarcinoma group; 7%, 33%, 60% in the CIN III group; and 11%, 38%, 51% in the control group. No significant difference was found between the three groups (p>0.05). However there was a significant difference in the adenocarcinoma group (p<0.05). Arg/Arg homozygote reduced the risk of adenocarcinoma. No significant difference existed in 5-year survival rates in the three groups (p=0.22 in SCC, p=0.91 in adenocarcinoma). CONCLUSION: These findings suggest that Arg/Arg homozygocity of the p53 codon 72 would be a protective factor against the development of cervical adenocarcinoma.
Adenocarcinoma* ; Alleles ; Arginine ; Carcinoma, Squamous Cell ; Cervical Intraepithelial Neoplasia ; Codon* ; DNA ; Female ; Homozygote ; Humans ; Leukocytes ; Logistic Models ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Prognosis ; Proline ; Survival Rate ; Uterine Cervical Neoplasms

PURPOSE: The aim of this study was to determine whether certain genotype of p21WAF1/Cip1 might be associated with risk of cervical cancer in Korean women. MATERIALS AND METHODS: We used the specimens derived from cervical cancer (n=111) composed of two histologic groups; SCCA (n=67) and adenocarcinoma (n=44), CIN III (n=101) and controls (n=98). For the determination of p21WAF1/Cip1 polymorphism, DNA was examined by PCR-RFLP using BsmAI. We compared the distribution of p21WAF1/Cip1 genotype of Korean women with that of other ethnic groups and analyzed the distribution of invasive cancer, CIN III and controls. RESULTS: The genotype frequency of controls was different from that of Caucasian and Chinese (p<0.001) but similar to that of Japanese (p=0.21). There was no difference in the genotype frequency of p21WAF1/Cip1 among SCCA, CIN III and controls (p>0.05). A significant increase of Ser/Ser genotype was found in adenocarcinoma patients with high-risk HPV compared with the controls (p=0.009). The OR was 3.59, 95% CI=1.55~8.31, when comparing that group with controls. However, we could not find differences of prognosis. CONCLUSION: We found that codon 31 Ser/Ser homozygote of the p21WAF1/Cip1 would be a risk factor for the adenocarcinoma of cervix associated with high-risk HPV in Korean women.
Adenocarcinoma ; Asian Continental Ancestry Group ; Cervix Uteri ; Codon* ; DNA ; Ethnic Groups ; Female ; Genotype ; Homozygote ; Humans ; Prognosis* ; Risk Factors ; Uterine Cervical Neoplasms*

OBJECTIVE: The aim of this study is to investigate the incidence of genetic instability, defined as microsatellite instability (MI) or loss of heterozygosity (LOH) in cervical carcinoma and its relationship with clinical characteristics. MATERIALS AND METHODS: Twenty-four patients with cervical carcinoma were studied. Genomic DNA was extrected from tumor tissues collected from consenting patients undergoing surgery. MI and LOH were analyzed with five microsatellite regions on chromosome 2, 3 and 6 (D2S123; 2p16-2p16 and 2p21-2p16, D3S1619; 3p24.2-3p22, D6S291; 6p21.3-6p21.2, D6S308; 6q16.3-6q27, D6S270; 6q22.3-6q23.2) by polymerase chain reaction (PCR) and automatic laser fluorescent DNA sequencer. MI was defined as tumor-associated alteration in at least of one of five dinucleotide microsatellite markers examined. The relationship between genetic instability and clinical profile was analyzed. The significance of BAT-26 sequence size as a marker of replication error (RER) phenotype was assessed. RESULTS: Total genetic instability was detected in 79%(19/24) of cervical carcinoma. MI was detected in 50% of the cervical carcinomas and LOH in 45.8%. BAT-26 size variation was observed only in one case. There was no statistically significant difference between the groups of positive and negative genetic instability in human papillomavirus (HPV) 16 or 18 positive rate, stage, 2 year-survival rate. CONCLUSION: This results suggest that MI and LOH are present in a subset of cervical carcinoma and may have a role for carcinogenesis as co-factors. BAT-26 has no value as a marker of RER in cervical cancer.
Carcinogenesis ; Chromosomes, Human, Pair 2 ; DNA ; Humans ; Incidence ; Loss of Heterozygosity ; Microsatellite Instability ; Microsatellite Repeats ; Phenotype ; Polymerase Chain Reaction ; Uterine Cervical Neoplasms

OBJECTIVES: To review the clinical features, histological types and the mode of treatment of malignant gynecologic tumors in childhood and adolescence, and to analyze the survival according to the histologic types. METHODS: We analyzed clinicopathologic data for 29 patients aged less than 20 years who were referred to Dept. of Ob/Gyn in SNUH for the years Jan. 1986 through Mar. 1999. RESULTS: Of the 29 cases, 26 cases were ovarian malignancy, 2 metastatic cancers from other organs, and 1 uterine adenosarcoma. Of the 26 ovarian malignancy, histologic distrubutions were follows: 18(69%) cases were germ cell tumor, 7(27%) epithelial ovarian cancers, l(4%) stromal cell tumors. Main symptoms of the patients were abdominal pain(41.4%), abdominal distension(24.1%), and palpable mass(17.2%). The stage of the 20 cases (80%) with the ovarian malignancy was the stage 1. The most frequent treatment modality was the USO(ineluding contralateral wedge biopsy) and postoperative chemotherapy(83%). Five-year survival rate of the patients with germ cell tumor was 83% and that of the patients with epithelial ovarian malignancy was 38%, but the numbers of the cases was too small to get a statistical significance(P>0.05). CONCLUSION: Ovarian malignancy, especially germ cell tumor, was the most frequent tumors of the gynecologic malignancies developed in childhood and adolescence and mainly the stages of the cases were stage 1. Our data showed the trend that the survival rate of the patients with the germ cell tumors was better than that of the patients with the epithelial ovarian cancer. Larger scaled analysis is needed to get a final conclusion.
Adenosarcoma ; Adolescent* ; Humans ; Neoplasms, Germ Cell and Embryonal ; Ovarian Neoplasms ; Stromal Cells ; Survival Rate

PURPOSE: To examine the distribution of HPV 16 E6 polymorphisms and analyse the possible association between the polymorphisms and cervical cancer development in Korean women. MATERIALS AND METHODS: Fifty-four cases of uterine cervical tissues containing HPV 16 DNA confirmed by polymerase chain reaction (PCR) from Korean women were subjected to investigate the E6 gene mutations. PCR-amplified products were sequenced by the fluorescent dideoxy ter mination method and the results obtained from sequencing were analysed. And newly designed PASA method was tried to develop rapid test for identification of the most commonly detected variation. RESULTS: Among the 27 cervical cancer cases, only two (7.4%) was found as a prototype. Among 11 kind of variants identified in total, 4 variants (5 nucleotide sites) which were never reported before has been found, registered firstly to GenBank. The most frequently found variation was D25E, absolutely different from the previous reports from the western country. There was no statistically significant trend for the D25E variation to be more frequently detected in cancerous lesions than in noncancerous lesions. All of the DNA sequencing results observed could be confirmed by PASA method. CONCLUSION: These results suggest that Korean-specific genetic factors might operate during the cervical carcinogenesis.
Carcinogenesis ; Databases, Nucleic Acid ; DNA ; Female ; Human papillomavirus 16 ; Humans* ; Polymerase Chain Reaction ; Sequence Analysis, DNA ; Uterine Cervical Neoplasms

Since after 2006 when the first edition of practice guidelines for gynecologic oncologic cancer treatment was released, the Korean Society of Gynecologic Oncology (KSGO) has published the following editions on a regular basis to suggest the best possible standard care considering updated scientific evidence as well as medical environment including insurance coverage. The Guidelines Revision Committee was summoned to revise the second edition of KSGO practice guidelines, which was published in July 2010, and develop the third edition. The current guidelines cover strategies for diagnosis and treatment of primary and recurrent ovarian cancer. In this edition, we introduced an advanced format based on evidence-based medicine, collecting up-to-date data mainly from MEDLINE, EMBASE, and Cochrane Library CENTRAL, and conducting a meta-analysis with systematic review. Eight key questions were raised by the committee members. For every key question, recommendations were developed by the consensus meetings and provided with evidence level and strength of the recommendation.
Committee Membership ; Consensus* ; Diagnosis ; Drug Therapy ; Evidence-Based Medicine ; Insurance Coverage ; Korea* ; Ovarian Neoplasms*