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Cervical cancer is one of the most common gynecologic malignant tumor, the survival rate of cervical cancer over the past decades hadn't improved significantly since radical hysterectomy and lymphadenectomy has been the gold standard of operation method. Local recurrence has an important impact on the survival rate of cervical cancer for the moment, especially the patients with pelvic lymph node metastasis. There is evidence supporting that if the local recurrence has been cut down, the survivals will be improved. Laterally extended parametrectomy (LEP) can remove more lymphatic tissue closed to pelvic wall, which providing an effective surgical treatment among the extended hysterectomy. To provide another efficient operation method, now review the theory, efficacy, controversy and outlook of LEP in the treatment of cervical cancer in this article. [ABSTRACT FROM AUTHOR]

Objective: To compare intraoperative, pathologic, postoperative outcomes and quality of life of laparoscopic radical hysterectomy and pelvic lymphadenectomy (LRH + LPL) with abdominal radical hysterectomy and pelvic lymphadenectomy (ARH + APL) for patients with early-stage cervical cancer., Methods: The consecutive cases with International Federation of Gynecology and Obstetrics (FIGO) stages Ia2-IIa cervical cancer who underwent surgery from Jan. 1, 2002 to Jan. 1, 2011 were documented, including 85 patients underwent LRH + LPL, and 85 patients underwent ARH + APL as control group. The clinical data of intraoperative, pathologic, postoperative outcomes and quality of life were compared between two groups. Survival data were estimated using Kaplan-Meier survival curves and compared with the log-rank test. Cox proportional hazards model was used for multivariate analysis., Results: All but 2 surgical procedures were completed laparoscopically because of right common iliac vein vessel injuries. Mean operative time, it was longer for LRH + LPL than that for ARH + APL [(242 ± 74) minutes vs. (190 ± 61) minutes, P = 0.000]. Mean recovery time of intestines function was less for LRH + LPL than that for ARH + APL [(45 ± 7) hours vs. (63 ± 11) hours, P = 0.000]. Mean estimated blood loss was less for LRH + LPL than that for ARH + APL [(367 ± 252) ml vs. (460 ± 220) ml, P = 0.006]. Mean recovery time of urinary function was less that for LRH + LPL than that for ARH + APL [(19 ± 4) days vs. (21 ± 4) days, P = 0.000]. There were no significant difference in numbers of the pelvic lymph nodes resected, the extent of parametrial tissue, vaginal cuff, negative margins obtained and complications. The median follow-up was 32 months (range 4 to 105 months), there was no significant difference in the recurrence rate (7% vs. 5%, P = 0.540) and mortality rate (7% vs. 5%, P = 0.540), 5 years disease-free survival (90% vs. 94%, P = 0.812), 5 years over survival (90% vs. 95%, P = 0.532). There were not significant difference in quality of life between ARH + APL group and LRH + LPL group (P > 0.05). Only lympho-vascular space invasion was an independent prognostic factor by multivariate analysis (P = 0.016)., Conclusions: For early-stage cervical cancer, LRH + LPL has similar outcomes compared with ARH + APL. Laparoscopic treatment by experienced surgeons should be an ideal alternative.

Objective: To analyse the clinico-pathologic characteristics, diagnosis, therapy and prognostic of small cell neuroendocrine carcinoma of the cervix (SCNCC)., Methods: The clinic-pathological features of 12 patients with SCNCC treated in Tumor Hospital of Guangxi Medical University, admitted during March 2006 to July 2010, were analyzed retrospectively., Results: Of 12 patients, the mean age was 38.7 years (rang 28 - 57 years), 6 had stages Ib1-IIa, 6 had stages IIb-IV. Among 8 patients (Ib1-IIIb) underwent surgery, 4 of them received neoadjuvant chemotherapy, 8 of them received adjuvant chemotherapy and(or) radiotherapy. All had greater than one-half stromal invasion, 4 patients had positive pelvic lymph nodes metastases. The positive ratio of the chromogranin (CgA), synaptophysin, neuronspecific enolase (NSE), cytokeratins (CK), CD(56) tested by immunohistochemical staining were 8/12, 9/10, 4/4, 4/4, 4/4, respectively. Median follow-up period was 3 months (1 - 22 months). Among 8 patients underwent surgery, 2 patients developed lung metastases, 1 patient developed liver and lung metastases, 1 patient developed liver metastases concurrently with bone metastases, disease-free survival (DFS) were 3 months (Ib2 with positive lymph nodes), 4.6 months (IIa), 7 months (Ib1), 17 months (Ib2); 2 patient died (8.5 and 11.3 months, respectively) after surgery; 4 patients are alive and show no evidence of disease. Among 4 patients untreated, 1 patients received concurrent chemoradiation and are alive for 10.1 months. Two patient untreated (IIIb, IV) died after 0.6 and 1.3 months final diagnosis, respectively. One patient was lost follow-up., Conclusions: SCNCC is a highly malignant tumor with rare morbility, propensity for distant spread and dismal prognosis. Final diagnosis of SCNCC depends on pathomorphology and immunohistochemical analysis. Combined therapeutic modalities may in favor of survival in some patients.

Objective: To explore the relationship between hormone therapy (HT) in women with ovarian malignancy and prognosis., Methods: HT was used in 31 patients with ovarian cancer after surgery, and 44 cases with ovarian cancer served as control. The expression of estrogen receptor (ER)alpha, ERbeta and progesterone receptor (PR) was detected by immunohistochemical staining respectively. The level of serum calcitonin and transforming growth factor alpha (TGFalpha) was detected by radio-immune and enzyme-linked immunosorbent assay pre- or post-surgery, as well as half a year to one year later post-surgery respectively in these cases. The survival curve of Kaplan-Meier and log-rank test as well as scale risk of Cox model were used to analyze the relationship between HT and prognosis of ovarian cancer., Results: (1) The results of log-rank test showed that there was no difference in survival curve of patients with or without HT [(1108 +/- 52), (1086 +/- 43) d; P = 0.940]; the results of scale risk of Cox model also showed that HT was not an independent prognosis factor for patients with HT. (2) There was no relationship with HT and the accumulated survival in patients with either positive or negative expression of ERalpha, ERbeta and PR in tissue; as well as between HT and the level of serum TGFalpha pre-, post-surgery, or half a year to one year after surgery. (3) The level of serum calcitonin in patients without HT post-surgery half a year to one year later was higher than that pre-surgery [(141 +/- 13), (95 +/- 11) microg/L; P < 0.05], but there was no significant difference between patients with HT half a year to one year later post-surgery and pre-surgery [(90 +/- 18) microg/L, (93 +/- 14) microg/L; P > 0.05]. (4) There was a significant difference in body and emotion function between HT and without HT groups [(1.84 +/- 1.50), (1.45 +/- 0.82); (12.69 +/- 10.20), (12.90 +/- 11.61); P < 0.05], as well as in sex quality and autonomic nerve maladjustment and in the special list made [(1.05 +/- 0.74), (1.77 +/- 1.08); (10.10 +/- 3.21), (13.09 +/- 4.30); P < 0.05]., Conclusions: There is no adverse influence on prognosis in using of HT for patients with ovarian cancer after surgery. HT for patients with ovarian cancer post-surgery can help keep a stable level of serum calcitonin as well as improve the quality of life.

Objective: To evaluate the relationship between combined multigene detection and response to chemotherapy and prognosis in epithelial ovarian carcinomas (EOCS)., Methods: A total of 80 ovarian tissue samples taken from the surgical specimens of patients with EOCS of our hospital in the last two decades who had received chemotherapy after surgery were paraffin-embedded. The samples were divided into 2 groups, good prognosis group (patients who survived more than 2 years, n = 46) and poor prognosis group (patients who survived less than 2 years, n = 34). The expression levels of ToPo-II, Ki-67, MGMT, PCNA, p27, p53, p16, P-gp, LRP, GST-pi, bcl-2, C-myc, Fas, bax, MSH2, MRP and BCRP were investigated by the combination of tissue arrays and immunohistochemical streptavidin-biotin peroxidase (SP) method in all samples. Data were analysed with SPSS 12.0 for windows., Results: There were statistically significant differences in the positive expression levels of P-gp, BCRP, MGMT, MSH2, p27 and p16 (62%, 50% and 50% in poor prognosis group vs 33%, 28% and 28% respectively, P < 0.05) in the good prognosis group, suggesting that the positive expression levels of P-gp, BCRP, MGMT, MSH2, p27 and p16 were related to the response to chemotherapy and prognosis in EOCS. And the positive expression of P-gp, BCRP and MSH2 (43%, 54% and 43%) indicated poor prognosis, while the positive expression of MGMT, p27 and p16 (18%, 29% and 24%, P < 0.05) indicated good prognosis. Cox multigene expression analysis confirmed that the positive expression levels of MRP, C-myc, LRP, p16, p27, MGMT, ToPo-II, P-gp and GST-pi were related to the response to chemotherapy and prognosis in EOCS. And the positive expression of MRP, C-myc, LRP, ToPo-II, P-gp and GST-pi indicated poor prognosis, while the positive expression of MGMT, p27 and p16 indicated good prognosis. Combined multigene detections were conducted among P-gp, BCRP, MGMT, MSH2, p27 and p16, and there were statistically significant differences in the positive coexpression of P-gp plus MGMT in the two groups (P < 0.05); indicating that the combined multigene expression were related to the response to chemotherapy and prognosis in EOCS. The predictive value to response to chemotherapy and prognosis of the positive coexpression of P-gp plus MGMT was 70%., Conclusions: By univariate and multivariate analyses, the positive expression of P-gp, MGMT, p27 and p16 are related to the response to chemotherapy and prognosis in EOCS. The combined multigene expression of P-gp plus MGMT are related to the response to chemotherapy and prognosis and could predict prognosis more effectively.

Objective: To study the function of c-myc and K-ras in tumorigenesis of ovarian cancer., Methods: K-ras and/or c-myc cDNAs were introduced into mouse ovarian surface epithelium cells (MOSE) using recombinant Moloney retroviral vectors. The resulting MOSE cells were studied by cell proliferation assays, the ability to form colonies in soft agarose, matrigel invasion assays and tumorigenicity assays in nude mice., Results: K-ras and c-myc can be easily delivered to the normal MOSE cells by recombinant retroviruses. mRNA and protein of the target genes can be detected by RT-PCR and Western blot. Cell proliferation assays showed that MOSE-Ras cells and MOSE-RM cells (MOSE-Ras/Myc) grew more rapidly than parental cells (MOSE) and MOSE-Myc cells (P <0.01). In addtition, MOSE-RM cells grew more rapidly than MOSE-Ras cells (P <0. 05). Cell colony formation assays showed that while MOSE-Ras and MOSE-RM cells can form colonies in soft-agarose, the MOSE-Myc and MOSE cells did not. Matrigel invasion assays showed that MOSE-Ras and MOSE-RM cells have invasion ability, but not MOSE-Myc ascites and the control MOSE cells. Xenograft experiments showed that MOSE-Ras and MOSE-RM cells were able to form tumors in nude mice following intraperitoneal injection. Tumors were not observed in animals injected with either MOSE-Myc or MOSE cells., Conclusion: The recombinant Moloney retroviral system is a highly efficient and convenient method for introducing and expressing foreign genes in murine surface epithelial cell cultures. In this model, expression of K-ras alone is sufficient to generate tumorigenic MOSE, however expression of c-myc in conjunction with K-ras results in cells with a higher index of malignancy. Based on the assays described in this report, expression of c-myc alone can not transform MOSE cultures although it does play a role in cooperation with K-ras.

Objective: To study the inhibition of OPCML on ovarian cancer cell lines using a lentiviral vector system for efficient gene transduction., Methods: The murine OPCML cDNA was amplified by PCR from CD1 murine brain cDNA using gene specific primers, and subcloned into the lentiviral vector, pWPI-GFP, to generate the lentiviral expression vector, pWPI-OPCML. Recombinant lentiviruses were produced by 293T cells following the co-transfection of pWPI-OPCML, with the packaging plasmids pCMV-dR8.74 and pMDG. The resulting recombinant lentiviruses which carried OPCML or control viruses (only carrying GFP), were then used to infect the human ovarian cancer cell lines A2780 and OCC1 in addition to normal CD1 mouse ovarian surface epithelial cells. The infected cells were then characterized by cell proliferation assays, cell aggregation assays, cell cycle analysis by flow cytometry and tumorigenicity assays following injection into nude mice., Results: (1) The efficiency of infection of the cell lines using the lentiviral vectors was almost 100% allowing the stable expression of OPCML in nearly all cells. Stable expression of OPCML (60 000) and GFP (27 000) proteins was confirmed by western blot analysis. (2) A2780 cells expressing OPCML [(7.6 +/- 1.0) x 10(5)] grew slowly compared to A2780 parental [(20.0 +/- 2.6) x 10(5)] or control virus infected cells [(18.1 +/- 1.7) x 10(5), P < 0.01], but the expression of OPCML had no effect on the proliferation rates of OCC1 and the normal CD1 cells when compared to their respective parental or controls (P > 0.05). (3) Flow cytometry based cell cycle assays showed that the expression of OPCML could arrest A2780 cells (G(0) approximately G(1) 67% vs 75%, P < 0.05); but not OCC1, CD1 cells. (4) The rate of aggregation of single cell suspensions was measured and found to be increased in all cell lines expressing OPCML indicating the increased cell surface adhesion mediated by OPCML. (5) A2780 cells expressing OPCML only formed a single tumor in 1/4 mice (10 mg) which was significantly smaller than controls [4/4; A2780 (280 +/- 53) mg and A2780/pWPI (677 +/- 323) mg; P < 0.01]. Expression of OPCML in tumor was confirmed by immunohistochemistry., Conclusions: The use of lentiviral vectors allowed the efficient expression of OPCML in nearly 100% of target cells. Expression of the OPCML cDNA resulted in an increase of cell adhesion in all cell lines tested, and decreased the proliferation and tumorigenicity of the A2780 ovarian cancer cell line. This indicates that the OPCML may be a new tumor suppressor gene.

Objective: To explore the diagnostic value of serum vascular endothelial growth factor (VEGF) level in patients with ovarian carcinomas, and to evaluate the correlation between serum VEGF level and prognosis of ovarian cancer., Method: Serum VEGF level in patients with ovarian neoplasms (120 cases of ovarian carcinomas, 25 cases of benign tumors) and 90 healthy women as controls was determined by enzyme linked immunosorbent assay (ELISA), also the change of preoperative and postoperative serum VEGF level of 25 cases of epithelial ovarian cancer was observed., Results: (1)The preoperative serum VEGF levels were (766 +/- 1237) mg/L in malignant groups, and there was a significant difference compared with normal controls (55 +/- 19) mg/L or patients with benign tumor (56 +/- 23) mg/L (P < 0.05). As a cut-off at 100 mg/L, sensitivity and specificity of preoperative serum VEGF levels for diagnosing ovarian cancer was 77% and 87% respectively. (2) Serum VEGF level were significantly elevated in advanced stage (955 +/- 1716) mg/L and poorly differentiated (991 +/- 1349) mg/L compared with early stage (198 +/- 287) mg/L and well differentiated (280 +/- 552) mg/L (P < 0.05), but there is no significant difference between the VEGF level and pathological types (P > 0.05). (3) The postoperative serum VEGF levels (118 +/- 110) mg/L were significantly lower than that in preoperative (1074 +/- 1211) mg/L. (4) The average total survival-time in patients with VEGF(+) was 28 months, but it in patients with VEGF(-) was 35 months (P < 0.05)., Conclusion: Serum VEGF values were higher in malignant tumors and preoperative serum VEGF level has a potential as a marker for diagnosing and monitoring in ovarian neoplasms.