OBJECTIVE: The aim of this study was to estimate the survival impact of lymphadenectomy in patients diagnosed with uterine clear cell cancer (UCCC). METHODS: Patients with a diagnosis of UCCC were identified from Surveillance, Epidemiology, and End Results (SEER) program from 1988 to 2007. Only surgically treated patients were included. Statistical analysis using Student t-test, Kaplan-Meier survival methods, and Cox proportional hazard regression were performed. RESULTS: One thousand three hundred eighty-five patients met the inclusion criteria; 955 patients (68.9%) underwent lymphadenectomy. Older patients (> or =65) were less likely to undergo lymphadenectomy compared with their younger cohorts (64.3% vs. 75.9%, p<0.001). The prevalence of nodal metastasis was 24.8%. Out of 724 women who had disease clinically confined to the uterus and underwent lymphadenectomy, 123 (17%) were found to have nodal metastasis. Lymphadenectomy was associated with improved survival. Patients who underwent lymphadenectomy were 39% (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.52 to 0.72; p<0.001) less likely to die than patient who did not have the procedure. Moreover, more extensive lymphadenectomy correlated positively with survival. Compared to patients with 0 nodes removed, patients with more extensive lymphadenectomy (1 to 10 and >10 nodes removed) were 32% (HR, 0.68; 95% CI, 0.56 to 0.83; p<0.001) and 47% (HR, 0.53; 95% CI, 0.43 to 0.65; p<0.001) less likely to die, respectively. CONCLUSION: The extent of lymphadenectomy is associated with an improved survival of patients diagnosed with UCCC.
Adenocarcinoma, Clear Cell/*diagnosis/mortality/pathology/*surgery ; Adult ; Aged ; Aged, 80 and over ; Endometrial Neoplasms/*diagnosis/mortality/pathology/*surgery ; Female ; Humans ; *Lymph Node Excision ; Lymphatic Metastasis ; Middle Aged ; Pelvis ; Prognosis ; Retrospective Studies ; Survival Rate ; Uterine Neoplasms/diagnosis/mortality/pathology/surgery

OBJECTIVETo investigate whether the border-line uterine smooth-muscle tumor is different from leiomyoma or leiomyosarcoma in history and clinical manifestations.

METHODSThe medical records of 131 surgically treated patients suffering from the so-called cellular leiomyoma or mitotically active leiomyoma of the uterus treated from 1984 to 2002 were retrospectively reviewed. All pathological sections of these patients were reviewed by a senior pathologist. Chi-square test and Kaplan-Meier life table were used for statistical analysis.

RESULTSThe overall 5-year survival rate of patients with the border-line uterine smooth-muscle tumors was 100%, however, 19.1% (24/131) of whom developed a late recurrence and 8 patients had repeated recurrences with a more shortened course and aggressive potential changes of mitosis and cellular atypia. The overall 5-year survival rate the patients with recurrence was 91.7%, but only 75.0% for those with repeated recurrences.

CONCLUSIONPatients with border-line uterine smooth-muscle tumor do possess some difference in nature from the leiomyoma or leimyosarcoma. Long-term follow-up is very important for these patients after surgery.

Adult ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Leiomyoma ; pathology ; surgery ; Leiomyosarcoma ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Retrospective Studies ; Smooth Muscle Tumor ; mortality ; pathology ; surgery ; Survival Rate ; Uterine Neoplasms ; mortality ; pathology ; surgery

OBJECTIVE: A prospective, randomized controlled trial was conducted to evaluate the efficacy of nerve-sparing radical hysterectomy (NSRH) in preserving bladder function and its oncologic safety in the treatment of cervical cancer. METHODS: From March 2003 to November 2005, 92 patients with cervical cancer stage IA2 to IIA were randomly assigned for surgical treatment with conventional radical hysterectomy (CRH) or NSRH, and 86 patients finally included in the analysis. Adequacy of nerve sparing, radicality, bladder function, and oncologic safety were assessed by quantifying the nerve fibers in the paracervix, measuring the extent of paracervix and harvested lymph nodes (LNs), urodynamic study (UDS) with International Prostate Symptom Score (IPSS), and 10-year disease-free survival (DFS), respectively. RESULTS: There were no differences in clinicopathologic characteristics between two groups. The median number of nerve fiber was 12 (range, 6 to 21) and 30 (range, 17 to 45) in the NSRH and CRH, respectively (p<0.001). The extent of resected paracervix and number of LNs were not different between the two groups. Volume of residual urine and bladder compliance were significantly deteriorated at 12 months after CRH. On the contrary, all parameters of UDS were recovered no later than 3 months after NSRH. Evaluation of the IPSS showed that the frequency of long-term urinary symptom was higher in CRH than in the NSRH group. The median duration before the postvoid residual urine volume became less than 50 mL was 11 days (range, 7 to 26 days) in NSRH group and was 18 days (range, 10 to 85 days) in CRH group (p<0.001). No significant difference was observed in the 10-year DFS between two groups. CONCLUSION: NSRH appears to be effective in preserving bladder function without sacrificing oncologic safety.
Adenocarcinoma/mortality/pathology/surgery ; Adult ; Carcinoma, Adenosquamous/mortality/pathology/surgery ; Carcinoma, Squamous Cell/mortality/pathology/surgery ; Female ; Humans ; Hysterectomy/adverse effects/*methods ; Middle Aged ; *Organ Sparing Treatments/adverse effects/methods ; Pelvis/*innervation/surgery ; Recovery of Function ; Survival Analysis ; Treatment Outcome ; Urinary Bladder/*innervation/physiology/surgery ; Uterine Cervical Neoplasms/mortality/pathology/*surgery ; Uterus/*innervation/surgery

PURPOSE: The aim of the study was to determine steroid sulfatase (STS) expression in endometrial cancer patients and its correlation with disease prognosis. MATERIALS AND METHODS: We conducted a retrospective study in 59 patients who underwent surgery with histologically confirmed endometrial cancer from January 2000 to December 2011 at Hanyang University Hospital. Immuno-histochemical staining of STS was performed using rabbit polyclonal anti-STS antibody. RESULTS: Sixteen of the 59 patients (27.1%) were positive for STS expression. Disease free survival (DFS) was 129.83±8.67 [95% confidence interval (CI): 112.84-146.82] months in the STS positive group (group A) and 111.06±7.17 (95% CI: 97.01-125.10) months in the STS negative group (group B) (p=0.92). Overall survival (OS) was 129.01±9.38 (95% CI: 110.63-147.38) months and 111.16±7.10 (95% CI: 97.24-125.07) months for the groups A and B, respectively (p=0.45). Univariate analysis revealed that FIGO stage and adjuvant therapy are significantly associated with DFS and OS. However, in multivariate analysis, FIGO stage and adjuvant therapy did not show any statistical significance with DFS and OS. STS was also not significantly associated with DFS and OS in univariate and multivariate analysis. CONCLUSION: STS expression was not significantly associated with DFS and OS, despite positive STS expression in 27% of endometrial cancer patients. Therefore, the role of STS as a prognostic factor in patients with endometrial cancer remains unclear and requires further research.
Adult ; Aged ; Biomarkers, Tumor ; Combined Modality Therapy ; Disease-Free Survival ; Endometrial Neoplasms/mortality/*surgery ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Steryl-Sulfatase/*metabolism ; Uterine Neoplasms/mortality/pathology/*surgery

OBJECTIVE: The aim of this study was to evaluate the impact of surgical waiting time on clinical outcome in early stage cervical cancer. METHODS: The cohort consisted of 441 patients diagnosed with stages IA2-IB1cervical cancer who underwent radical hysterectomy and pelvic node dissection. The patients were divided into two groups based on surgical waiting time. The associations between waiting time and other potential prognostic factors with clinical outcome were evaluated. RESULTS: The median surgical waiting time was 43 days. Deep stromal invasion (hazard ratio [HR], 2.5; 95% confidence interval [CI], 1.4 to 4.6; p=0.003) and lymph node metastasis (HR, 2.9; 95% CI, 1.3 to 6.7; p=0.026) were identified as independent prognostic factors for recurrence-free survival while no prognostic significance of surgical waiting time was found (p=0.677). On multivariate analysis of overall survival (OS), only deep stromal invasion (HR, 2.6; 95% CI, 1.3 to 5.0; p=0.009) and lymph node metastasis (HR, 3.6; 95% CI, 1.5 to 8.6; p=0.009) were identified as independent prognostic factors for OS. Although OS showed no significant difference between short (< or =8 weeks) and long (>8 weeks) waiting times, multivariate analysis of OS with time-varying effects revealed that a waiting time longer than 8 weeks was associated with poorer long-term survival (after 5 years; HR, 3.4; 95% CI, 1.3 to 9.2; p=0.021). CONCLUSION: A longer surgical waiting time was associated with diminished long-term OS of early stage cervical cancer patients.
Adult ; Aged ; Disease-Free Survival ; Female ; Humans ; Hysterectomy/*methods/mortality/statistics & numerical data ; Middle Aged ; Neoplasm Recurrence, Local/etiology/mortality ; Prognosis ; Retrospective Studies ; *Time-to-Treatment ; Uterine Cervical Neoplasms/mortality/pathology/*surgery