Objective To study the characteristics, therapies and prognosis of the patients with epithelial ovarian cancer (EOC) that are initially categorized as extra abdominal adenocarcinoma of unknown primary Methods Twenty five patients with EOC, who were treated in the Cancer Hospital of Fudan University from Jan 1986 to Dec 1997, and manifesting as extra peritoneal or liver parenchyma metastases at the time of presentation, without detectable ovarian tumors, were retrospectively studied Results Supraclavicular and inguinal lymph node metastases were common in this group of patients, with 6 and 5 cases respectively, and 6 patients with more than two sites metastases simultaneously 16 patients (64%) were optimally surgical debulked 20 patients with stage Ⅳ EOC initially presenting as extra abdominal metastases experienced a better prognosis, with an estimated median survival of 24 months. Of whom the median survival was 30 months in patients presenting with pleural effusion or supraclavicular lymph node metastases Vs 19 months in those with other sites spread ( P =0 026 4) Conclusions The prognosis of such cases, particularly for those with supraclavicular lymphadenopathy or malignant pleural effusion, is a lot better than other stage Ⅳ EOC patients, probably because of most of the patients initially presenting with distant metastases being generally in a good condition competent for aggressive surgery or multi cycle chemotherapy

6) of platinum based intravenous chemotherapy prolonged the survival of patients with suboptimal cytoreduction Intraperitoneal chemotherapy was one of the dominant long term survival determinants, and mainly on those with size of residual disease less than 1 cm

1 cm after secondary cytoreduction.

Purpose:To investigate the survival and prognostic factors in patients with stage Ib～IIb node-negative cervical carcinoma.Methods:From Nov.1993 to Dec. 1997,236 patients who had radical hysterectomy and pelvic lymphadenectomy and pelvic lymph node found negative were reviewed retrospectively. Survival rates were calculated by Kaplan-Meier method with differences in survival estimated by Log-rank test. Independent prognostic factors were identified by the Cox's proportional-hazards regression model. Results:The overall 5-year survival of the patients was 82.0% and the median survival time was 100.0 months. The recurrence and/or metastatic rate was 19.5%. Of these patients the 5-year survival rate was 16.9% and median survival time was 15.0 months. Among the variables,clinical stage(Ⅱb),tumor size(≥4 cm),histological type (non-squamous carcinoma),poor differentiation,deep stromal invasion,parametrial extension,vaginal margin involved,and lymphvascular permeation were the poor prognostic factors in univariate survival analysis ( P

Purpose:To evaluate the significance of abdominal residue after primary cytoreductive su rgery for stage Ⅲ ovarian cancer.Methods:From Nov 1990 to Nov 1996, 57 patients with stage Ⅲ ovarian cancer who underwen t primary cytoreduction in our hospital and their residual disease were analyzed , with mean age of 51.9 (23～74). 20 patients achieved optimal cytoreduction (th e largest residual tumor ≤ 1cm). 9 patients had no gross residual tumor after s urgery, 37 cases had residual disease both in the abdomen and pelvis. Abdominal residual disease was found in 7 cases and pelvic residual disease in 4 cases. 30 cases were given chemotherapy before surgery. After primary surgery, 36 patient s received a mean of 3 courses of intraperitoneal chemotherapy and 46 patients were treated with a mean of 4 cycles of platinum-based intravenous chemotherapy . Complete remission were achieved in 32 cases (56.1%).Results:With a mean follow-up of 29.1 months (0.3～109.1months), 1-5 year survival rat es were 79.82%, 57.59%, 49.06%, 39.93%, 23.41%, respectively. Univariate analysi s indicated stage (P=0.0283), size of residual disease (P=0.0041), resid ue in the abdomen (P=0.0362), type of surgery (P=0.0337) and intraperito neal chemotherapy after surgery (P=0.0469) influenced survival. Multivariate analysis suggested that size of residual disease (P=0.0025), intraperiton eal chemotherapy (P=0.0323) and intravenous chemotherapy (P=0.0297)aft er surgery were independent prognostic factors of survival. Those patients who h ad no macroscopic residual lesion in the abdomen after cytoreducion had a better survival, with estimated median survival of 58.0 months vs 22.7 months for pati ents with abdominal residue (P=0.0362), with 3-year, 5-year survival rate of 83.64% vs 37.60% and 29.57% vs 21.05%, respectively. Residual disease in the pelvis did not affect the survival (P=0.2782). For patients with abdominal r esidue after surgery, optimal abdominal cytoreduction predicted increased surviv al (P=0.0319), while optimal pelvic cytoreduction predicted increased progre ss-free survival (P=0.0104). Stage(P=0.041), chemotherapy before surg ery(P=0.009)and pathologic classification(P=0.042)were determinants for abdominal residue after cytoreduction.Conclusions:The size of residual disease and abdominal residue after cytoreduction affected the progn osis for stage Ⅲ ovarian cancer. Patients with abdominal residue suffered a pes simistic outcome. Residual lesions in the abdomen influenced the patients' surv ival, while pelvic residue affected progress-free survival.

Objective　To study the response rate and toxic side effect of Vindesine, aclarubicin and mitomycin (VAM) as a new regime of second line chemotherapy for ovarian carcinoma refractory to platinum group of drugs.Methods　From June 1997 through August 1998, 25 cases of refractory ovarian carcinoma were treated with VAM regime. The response rate and the side reactions were analyzed. Results　The overall response rate was 32.0%, with 3 complete response (CR) and 5 partial response (PR). In the platinum refractory, platinum-resistant platinum-senstitive strata, the response rates were 18.2% 28.6% and 57.1% respectively. Myelosuppression was the main toxic effect. Grade 3 and grade 4 neutropenia occurred in 40.0% and thrombocytopenia in 28.0% of the patients. Alopecia occurred in 32% of cases. Gastrointastinal, cardiac and neurologic toxicities were mild. Conclusion　VAM regime is a practical and effective second-line chemotherapy for patients with ovarian carcinoma refractory to platinum based chemothrapy.

Purpose:To detect the expression of cytokeratin 19 (CK19) mRNA and human papillomavirus type 16 (HPV16) mRNA in peripheral blood of cervical cancer patients. Methods:We used reverse transcription polymerase chain reaction (RT-PCR) to determine the expression of CK19 and HPV16 mRNA of 30 cervical cancer patients,8 patients with known distant metastases,16 patients with benign gynecological tumors and 9 healthy persons as control. Results:The presence of CK19 mRNA was observed in 3 peripheral blood samples among 30 cervical cancer patients (10%). The positive ratios for cervical patients with metastases,benign tumors and healthy control were 8/8,0/16 and 0/9. Only 10 cervical samples were proved to be HPV 16 positive by immunohistochemistry and/or hybridization in situ,whose expression of HPV16 mRNA in the peripheral blood were all negative (0/10). The positive ratios for cervical patients with metastasis,benign tumors and healthy control were 1/8,0/16 and 0/9,respectively. Conclusions:CK19 mRNA may be considered a powerful biomarker in the detection of peripheral blood of cervical cancer patients due to its high sensitivity and specificity. The detection of HPV16 mRNA was low and its clinical significance needs further evaluation.

6 months was 42.3 months, longer than 17.5 months for patients with PFI ≤ 6 months, no statistical significance was found ( P =0.1418). Multivariate analysis strongly suggested that PFI and the courses of second line chemotherapy were independent prognostic factors of survival after secondary treatment for epithelial ovarian cancer. For those patients with PFI ≤ 6 months, the smaller the size of residual lesion ( P =0.0003) and the more the cycle of effective second line chemotherapy ( P =0.0004), the longer the survival after the secondary cytoreduction. Conclusions:The results suggested that successful secondary cytoreductive surgery combined with multicycles second line chemotherapy may be an effective way to lengthen the survival on retreatment for patients with platinum resistant and recurrent epithelial ovarian cancer.

Objective To evaluate the effects of combined treatment for advanced epithelial ovarian carcinoma and to analyze its prognostic factors Methods Fifty three patients treated with a three step combined therapeutic regimen were defined as research arm The procedures of the three step combined treatment were as follows: induction of tumor remission, sequential chemotherapy and adjuvant immunotherapy Three hundred and eighteen patients with advanced epithelial ovarian carcinoma treated with cytoreductive surgery and systemic chemotherapy were retrospectively classified into control arm Results The rates of complete response and partial response in the research arm were significantly differed from those in the control arm (90 6%, 5 7% Vs 70 1%, 5 3%, P

1cm, there was a significant statistical difference in median survival of 61 and 12 months, respectively (? 2 =16.60, P =0.0001). The median survival for patients with and without peritoneal chemotherapy were 27 and 12 months, respectively (? 2 =3.45, P =0.0633). Residual disease, FIGO stage, recurrent ascites, uterus muscle involvement were independent prognostic determinants of survival identified by Cox's stepwise regression analysis. Conclusions Aggressive surgical cytoreduction should be performed in elderly AEOC patients as well as in younger patients, but multi-course platinum-based chemotherapy should be used in accordance with the performance status of elder women.