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Objective: To evaluate the clinical significance of positive peritoneal cytology in patients with endometrial cancer., Methods: The records of 315 patients with endometrial cancer who were operated at Cancer Hospital, Fudan University between January 1996 and December 2008 were reviewed. Peritoneal cytology were performed and diagnosed in all patients. Factors related with peritoneal cytology were analyzed by correlation analysis. Log-rank test and Cox regression test was used for the analysis of prognosis, respectively., Results: (1) Peritoneal cytology were positive in 30 (9.5%) patients. Positive peritoneal cytology was associated with pathological subtype (P = 0.013), stage (P = 0.000), myometrial invasion (P = 0.012), lymph-vascular space invasion (P = 0.012), serosal involvement (P = 0.004), cervical involvement (P = 0.016), adnexal involvement (P = 0.000), and omental involvement (P = 0.000), with no association with grade (P = 0.152) and lymph node metastasis (P = 0.066). (2) Three-year overall survival (OS) and progression-free survival (PFS) were 93.0% and 85.5%, respectively. Positive peritoneal cytology, surgical stage, pathological subtype, myometrial invasion, grade, and lymph-vascular space invasion were significantly associated with worse prognosis by univariate analysis (P < 0.05), while only surgical-pathology stage and myometrial invasion were independent prognostic factors by multivariate analysis (P < 0.05). For 30 cases with positive peritoneal cytology, the patients with no high risk factors shown significantly prognoses better than those with any risk factors. The results shown that for patients with late stage (stage III-IV) endometrial cancer with positive peritoneal cytology was significantly associated with the worse OS and PFS by multivariate analysis (P = 0.006)., Conclusions: Positive peritoneal cytology was associated with serosal involvement, cervical involvement, adnexal involvement, omental involvement, and late stage. Therefore, peritoneal cytology should be performed and reported separately as a part of full surgical staging procedure.

Objective: The purpose of this study was to evaluate gene amplification by chromogenic in situ hybridization (CISH) and the protein expression of Her-2/neu gene in patients with uterine papillary serous carcinoma (UPSC) and to determine its prognostic value., Methods: Thirty-six patients with confirmed pathologic diagnosis of UPSC in Cancer Hospital of Fudan University from Jan. 1996 to Jan. 2006, were analysed retrospectively. CISH was performed to assess Her-2/neu gene amplification, and protein expression was evaluated by immunohistochemistry (IHC). The prognostic factors were analyzed by log-rank test or Cox proportional hazard model., Results: Among 36 cases with UPSC, 13 patients (36.1%) showed moderate staining (++) to strong staining (+++) for Her-2/neu protein, while amplification of the Her-2/neu gene by CISH was observed in 4 of the 36 (11.1%) cases. Her-2/neu protein over-expression was significantly associated with advanced surgical stage and worse prognosis by univariate analysis (P=0.030 and P=0.002, respectively), while the multivariate analysis shown that only Her-2/neu protein over-expression and deep myometrial invasion were associated with a poor prognosis (P<0.05). In 13 patients with Her-2/neu protein over-expression, the mean survival period with chemotherapy was shorter than those without chemotherapy (20 vs. 42 months, P=0.370)., Conclusion: Her-2/neu protein over-expression is significantly associated with advanced surgical stage UPSC and poor survival outcome, and might reduce the chemotherapy sensitivity.

Objective: To evaluate prognostic factors and treatment of patients with advanced stage endometrial cancer., Methods: One hundred and eighteen patients with advanced stage endometrial cancer were treated in our hospital between January 1996 and December 2006. The treatment and prognosis were retrospectively analyzed. The mean follow-up time was 26 months., Results: During the follow-up, 33 cases (28.0%) died and 25 patients (21.2%) had disease progression. The 3-year overall survival for patients with stage III and stage IV was 78.3% and 39.4%, and for endometrioid and nonendometrioid endometrial carcinoma was 69.3% and 42.0%, respectively. Four patients with positive cytology only were followed closely after surgery and were free of disease up to the report time. Patients with late stages, deep myometrial invasion, nonendometrioid endometrial cancer, poor differentiation, without lymphadenectomy and without radiochemotherapy after surgery were associated with a worse prognosis by univariate analysis (P < 0.05), while in a multivariate analysis only late stages and deep myometrial invasion were associated with a poor prognosis (P < 0.05). The patients who received lymphadenectomy and whose residual disease after the surgery was less than 1 cm had better prognoses than those otherwise (P < 0.05). The patients who received postoperative radiochemotherapy had better prognoses than those who did not (P < 0.05)., Conclusions: Pathological stage and myometrial invasion are independent prognostic factors for late stage endometrial cancer. Satisfactory cytoreduction surgery and lymphadenectomy, followed by postoperative radiochemotherapy, except for stage IIIa patients with positive cytology only, are recommended in order to improve prognosis.

Objective: To analyze the clinico-pathological characteristics, prognostic factors and the rational therapy for the uterine papillary serous carcinoma (UPSC)., Methods: Thirty-three cases of UPSC were treated in our hospital between January 1996 and December 2005. The clinico-pathologic characteristics, treatment and prognosis were retrospectively analyzed., Results: The three-year overall survival for patients with stage I, III and IV was 77.4%, 53.3% and 12.1%, respectively. Patients with late stages and deep myometrial invasion were associated with a worse prognosis by univariate analysis (P < 0.05), while in a multivariate analysis only late stages and poor differentiation were associated with a poor prognosis (P < 0.05). The prognosis of patients in late stages treated with postoperative chemotherapy was significantly better than those without chemotherapy (P = 0.014)., Conclusions: Most UPSC patients are in late stages at diagnosis. They often have extra-uterine metastasis and have a poor prognosis. Complete surgical staging is recommended, and postoperative chemotherapy seems to improve the prognosis.

Objective: To evaluate the effectiveness and safety of fertility-sparing treatment with progestins in patients with well-differentiated endometrial adenocarcinoma in women 40 years old or younger., Methods: Six patients before the age of 40 diagnosed with grade I endometrial adenocarcinoma, who had undergone primary progestin treatment, were retrospectively studied. The clinical records and pathologic slides and the follow-up information were reviewed. Relevant articles describing patients with endometrial adenocarcinoma who were treated with hormonal therapy were searched. A total of 56 cases were found and used in integrated analysis., Results: Four of six cases responded to treatment with normal pathology on follow-up endometrial samplings. Two patients had a recurrence within a period between 10 and 12 months. No response was noted in the other two cases, who were offered surgery. Therefore, a total of 4 patients ultimately underwent hysterectomy. None of these four patients had extrauterine metastasis on postoperation pathologic examination. All these six patients were alive without evidence of disease at last follow-up. According to literatures, 46 of 56 cases responded to hormonal treatment and 11 cases had a recurrence. Seven of the 11 patients who recurred were re-treated with progesterone. Five patients had a second complete response. Sixteen of the 56 patients underwent hysterectomy. One of the patients had a pelvic recurrence after operation. The others remained without evidence of disease. Six patients in author's group had neither pregnancy nor delivery. Among 56 patients described in literatures, there were 41 person-times pregnancies and 40 infants were delivered, including 4 twins and 2 triples., Conclusions: Progestin treatment is proved a safe and feasible therapy in well-differentiated endometrial adenocarcinoma in women 40 years old or younger. This approach may provide the possibility of conceiving and carrying a pregnancy with the aid of assisted reproduction technology.

Objective: To investigate the feasibility of sentinel lymph node (SLN) detection in patients with cervical cancer undergoing radical hysterectomy., Methods: Twenty patients with cervical cancer at stage Ib (n = 3), stage IIa (n = 12) and stage IIb (n = 5) underwent SLNs detection by using blue dye. Four ml of methylene blue or lymphazurin was injected into the cervix at 4 points around the tumor at the time of radical hysterectomy and bilateral pelvic lymphadenectomy. Tumor characteristics, surgical findings, and specific locations of lymphatic dye uptake were recorded and correlated with final pathology results., Results: Among 20 patients underwent this detection, dye uptake was seen in 18 patients. Total number of SLNs were 33. Eighteen SLNs identified located in right pelvic and 15 SLNs located in left. The SLNs were successfully detected in 78% patients (14/18). Six patients (33%) were diagnosed with lymph node metastases and there were 5 patients with positive nodes in the group of SLN. Two patients had both positive SLNs and pelvic lymph nodes. Three patients had positive SLNs only. The predictive rate was 100% and the false-negative rate was zero., Conclusion: SLN detection undergoing radical hysterectomy is feasible and safe, however, the detection rate of SLN needs improvement.