A novel multiparameter flow-cytometric method was used to quantify the expression of epidermal gr... more A novel multiparameter flow-cytometric method was used to quantify the expression of epidermal growth factor receptor (EGFR) and c-erbB-2 oncoprotein on 85 cryopreserved normal tissues (30 ovary, 29 endometrium, 16 cervix) and 67 carcinomas (31 ovarian, 18 cervical, 15 endometrial, 3 vulvar). Overexpression of the EGFR and c-erbB-2 oncoproteins was found in respectively 3/31 (9%) and 10/31 (32%) ovarian carcinomas, 13/18 (72%) and 7/18 (38%) cervical carcinomas, and 2/15 (13%) and 2/15 (13%) endometrial carcinomas. Oncoprotein expression was significantly higher in the malignant tumors (for all tumor sites) than in the corresponding normal tissues (P less than 0.034 for all combinations). Aneuploid tumors expressed levels of EGFR and c-erbB-2 oncoprotein significantly higher than those of DNA diploid tumors (P = 0.042 and P = 0.048, respectively). Oncoprotein could be detected in nearly all normal tissues: expression was higher in premenopausal than in postmenopausal patients (EGFR, P = 0.07; c-erbB-2, P less than 0.001). The present study supports the idea that EGFR and c-erbB-2 may play an important role in the autocrine, paracrine, and/or endocrine growth control and differentiation of normal tissues. Alteration in the expression of these oncoproteins is probably involved in malignant transformation and tumorigenesis.
Bjog: An International Journal Of Obstetrics And Gynaecology, Dec 1, 2008
Sir, We welcome the comments from Naik et al.1 at Gateshead who share a similar surgical philosop... more Sir, We welcome the comments from Naik et al.1 at Gateshead who share a similar surgical philosophy to ours. The data from surgical studies on the benefit of optimal primary cytoreductive surgery in ovarian cancer are more consistent and convincing, whereas those data on neoadjuvant chemotherapy are less so. Despite massive expenditure on chemotherapeutic agents, optimal primary surgical cytoreduction, not chemotherapy, is the single most important means to give women the best chance of a prolonged disease-free interval. Naik et al.1 suggest reasons to explain the low optimal/ complete primary surgical cytoreductive rate on average in the UK. At a recent British Gynaecological Cancer Society meeting, we presented some results of a questionnaire on advanced epithelial ovarian cancer sent to all UK gynaecological oncologists. One finding was that the mean operating time was about 3 hours, yet many claimed to achieve optimal cytoreduction in that time. This contrasts with our units and other in the USA or Europe, which achieve a high rate of optimal cytoreduction where the mean operating time is 5 hours or more! There are evidently two mindsets or philosophies. Fundamentally, how are the patients’ interests best served? For advanced peritoneal ovarian carcinosis, the surgical challenge is in the upper abdomen and not the pelvis. The argument has been confused by whether a gynaecological oncologist should or should not undertake upper abdominal surgery. Just as one would involve an oncoplastic surgeon for a complicated vulvovaginal reconstruction, there must be careful consideration given to the team approach to advanced ovarian cancer with upper abdominal disease. In experienced hands, this may be the gynaecological oncology team alone or it might involve the upper gastrointestinal or hepatobiliary team. What is key is that the gynaecological oncology team’s philosophy is a priori to aim for compete cytoreduction, involve other surgical colleagues if necessary or not, and plan the operating day appropriately. As pointed out by Naik et al.,1 surgical centres in the UK have been slow to maintain comprehensive data sets and publish data on outcomes, including morbidity, mortality, and survival. Today, it still remains a truism that appropriate radical surgery is the key to the control of the majority of solid malignancies. j
Urinary metabolites of the (3 subunit of human chorionic gonadotropin (hCG(3), particularly the f... more Urinary metabolites of the (3 subunit of human chorionic gonadotropin (hCG(3), particularly the fragment known as (3-core, are potential tumor markers for gynecological cancers (1-6). We have found that an increased concentration (�tg’L) of (3-core in early-morning urine samples is relatively common in gynecological cancers, but the sensitivity (36%) and specificity (90%) of such measurements are low (7). Most clinical studies have reported /3-core concentrations in early-morning or random urine specimens without correction for urine volume or concentration (1-7). For many urinary solutes, however, including proteins, expressing the concentration as a ratio to the urinary creatinine concentration is less variable and may better reflect the true urine output than does concentration per unit volume (8-11). In the present study, we examined the variation of urinary (3-core excretion over a 24-h period, to determine whether expressing (3-core results as a ratio to creatinine or to total...
BJOG: An International Journal of Obstetrics & Gynaecology, 2008
Sir, We welcome the comments from Naik et al.1 at Gateshead who share a similar surgical philosop... more Sir, We welcome the comments from Naik et al.1 at Gateshead who share a similar surgical philosophy to ours. The data from surgical studies on the benefit of optimal primary cytoreductive surgery in ovarian cancer are more consistent and convincing, whereas those data on neoadjuvant chemotherapy are less so. Despite massive expenditure on chemotherapeutic agents, optimal primary surgical cytoreduction, not chemotherapy, is the single most important means to give women the best chance of a prolonged disease-free interval. Naik et al.1 suggest reasons to explain the low optimal/ complete primary surgical cytoreductive rate on average in the UK. At a recent British Gynaecological Cancer Society meeting, we presented some results of a questionnaire on advanced epithelial ovarian cancer sent to all UK gynaecological oncologists. One finding was that the mean operating time was about 3 hours, yet many claimed to achieve optimal cytoreduction in that time. This contrasts with our units and other in the USA or Europe, which achieve a high rate of optimal cytoreduction where the mean operating time is 5 hours or more! There are evidently two mindsets or philosophies. Fundamentally, how are the patients’ interests best served? For advanced peritoneal ovarian carcinosis, the surgical challenge is in the upper abdomen and not the pelvis. The argument has been confused by whether a gynaecological oncologist should or should not undertake upper abdominal surgery. Just as one would involve an oncoplastic surgeon for a complicated vulvovaginal reconstruction, there must be careful consideration given to the team approach to advanced ovarian cancer with upper abdominal disease. In experienced hands, this may be the gynaecological oncology team alone or it might involve the upper gastrointestinal or hepatobiliary team. What is key is that the gynaecological oncology team’s philosophy is a priori to aim for compete cytoreduction, involve other surgical colleagues if necessary or not, and plan the operating day appropriately. As pointed out by Naik et al.,1 surgical centres in the UK have been slow to maintain comprehensive data sets and publish data on outcomes, including morbidity, mortality, and survival. Today, it still remains a truism that appropriate radical surgery is the key to the control of the majority of solid malignancies. j
Annals of the Royal College of Surgeons of England, 1986
The management of 191 patients with ovarian cancer is presented. A significant proportion of thes... more The management of 191 patients with ovarian cancer is presented. A significant proportion of these patients were initially seen (16%) or operated on (7%) by a general surgeon. The current surgical approach to this disease should be aggressive, and in 23% of these patients a non-gynaecological surgical procedure was required. Although chemotherapy is the main form of treatment following surgery, its chances of success are influenced by the amount of tumour left after surgery. The picture is not uniformly hopeless, and of 34 patients who subsequently underwent laparotomy to check the effectiveness of chemotherapy, 10 (29%) had no evidence of disease. Palliative surgery also has an important place in the management of this disease to provide comfort from disabling symptoms, and in some cases it may prolong life.
Purpose Invasive mucinous carcinoma of the ovary (mucinous epithelial ovarian cancer [mEOC]) is a... more Purpose Invasive mucinous carcinoma of the ovary (mucinous epithelial ovarian cancer [mEOC]) is a histologic subgroup of epithelial ovarian cancer (EOC). Chemotherapy for mEOC is chosen according to guidelines established for EOC. The purpose of this study is to determine whether this is appropriate. Patients and Methods Women with advanced mEOC (International Federation of Gynecology and Obstetrics stage III or IV) who underwent first-line platinum-based chemotherapy were compared with women with other histologic subtypes of EOC in a case-controlled study. Results Eighty-one patients (27 cases, 54 controls) treated with platinum-based regimens were analyzed. The response rates for cases and controls were 26.3% (95% CI, 9.2% to 51.2%) and 64.9% (95% CI, 47.5% to 79.8%), respectively (P = .01). The odds ratio for complete or partial response to chemotherapy for mEOC was 0.19 (95% CI, 0.06 to 0.66; P = .009) compared with other histologic subtypes of EOC. Median progression-free survi...
A novel multiparameter flow-cytometric method was used to quantify the expression of epidermal gr... more A novel multiparameter flow-cytometric method was used to quantify the expression of epidermal growth factor receptor (EGFR) and c-erbB-2 oncoprotein on 85 cryopreserved normal tissues (30 ovary, 29 endometrium, 16 cervix) and 67 carcinomas (31 ovarian, 18 cervical, 15 endometrial, 3 vulvar). Overexpression of the EGFR and c-erbB-2 oncoproteins was found in respectively 3/31 (9%) and 10/31 (32%) ovarian carcinomas, 13/18 (72%) and 7/18 (38%) cervical carcinomas, and 2/15 (13%) and 2/15 (13%) endometrial carcinomas. Oncoprotein expression was significantly higher in the malignant tumors (for all tumor sites) than in the corresponding normal tissues (P less than 0.034 for all combinations). Aneuploid tumors expressed levels of EGFR and c-erbB-2 oncoprotein significantly higher than those of DNA diploid tumors (P = 0.042 and P = 0.048, respectively). Oncoprotein could be detected in nearly all normal tissues: expression was higher in premenopausal than in postmenopausal patients (EGFR, P = 0.07; c-erbB-2, P less than 0.001). The present study supports the idea that EGFR and c-erbB-2 may play an important role in the autocrine, paracrine, and/or endocrine growth control and differentiation of normal tissues. Alteration in the expression of these oncoproteins is probably involved in malignant transformation and tumorigenesis.
Bjog: An International Journal Of Obstetrics And Gynaecology, Dec 1, 2008
Sir, We welcome the comments from Naik et al.1 at Gateshead who share a similar surgical philosop... more Sir, We welcome the comments from Naik et al.1 at Gateshead who share a similar surgical philosophy to ours. The data from surgical studies on the benefit of optimal primary cytoreductive surgery in ovarian cancer are more consistent and convincing, whereas those data on neoadjuvant chemotherapy are less so. Despite massive expenditure on chemotherapeutic agents, optimal primary surgical cytoreduction, not chemotherapy, is the single most important means to give women the best chance of a prolonged disease-free interval. Naik et al.1 suggest reasons to explain the low optimal/ complete primary surgical cytoreductive rate on average in the UK. At a recent British Gynaecological Cancer Society meeting, we presented some results of a questionnaire on advanced epithelial ovarian cancer sent to all UK gynaecological oncologists. One finding was that the mean operating time was about 3 hours, yet many claimed to achieve optimal cytoreduction in that time. This contrasts with our units and other in the USA or Europe, which achieve a high rate of optimal cytoreduction where the mean operating time is 5 hours or more! There are evidently two mindsets or philosophies. Fundamentally, how are the patients’ interests best served? For advanced peritoneal ovarian carcinosis, the surgical challenge is in the upper abdomen and not the pelvis. The argument has been confused by whether a gynaecological oncologist should or should not undertake upper abdominal surgery. Just as one would involve an oncoplastic surgeon for a complicated vulvovaginal reconstruction, there must be careful consideration given to the team approach to advanced ovarian cancer with upper abdominal disease. In experienced hands, this may be the gynaecological oncology team alone or it might involve the upper gastrointestinal or hepatobiliary team. What is key is that the gynaecological oncology team’s philosophy is a priori to aim for compete cytoreduction, involve other surgical colleagues if necessary or not, and plan the operating day appropriately. As pointed out by Naik et al.,1 surgical centres in the UK have been slow to maintain comprehensive data sets and publish data on outcomes, including morbidity, mortality, and survival. Today, it still remains a truism that appropriate radical surgery is the key to the control of the majority of solid malignancies. j
Urinary metabolites of the (3 subunit of human chorionic gonadotropin (hCG(3), particularly the f... more Urinary metabolites of the (3 subunit of human chorionic gonadotropin (hCG(3), particularly the fragment known as (3-core, are potential tumor markers for gynecological cancers (1-6). We have found that an increased concentration (�tg’L) of (3-core in early-morning urine samples is relatively common in gynecological cancers, but the sensitivity (36%) and specificity (90%) of such measurements are low (7). Most clinical studies have reported /3-core concentrations in early-morning or random urine specimens without correction for urine volume or concentration (1-7). For many urinary solutes, however, including proteins, expressing the concentration as a ratio to the urinary creatinine concentration is less variable and may better reflect the true urine output than does concentration per unit volume (8-11). In the present study, we examined the variation of urinary (3-core excretion over a 24-h period, to determine whether expressing (3-core results as a ratio to creatinine or to total...
BJOG: An International Journal of Obstetrics & Gynaecology, 2008
Sir, We welcome the comments from Naik et al.1 at Gateshead who share a similar surgical philosop... more Sir, We welcome the comments from Naik et al.1 at Gateshead who share a similar surgical philosophy to ours. The data from surgical studies on the benefit of optimal primary cytoreductive surgery in ovarian cancer are more consistent and convincing, whereas those data on neoadjuvant chemotherapy are less so. Despite massive expenditure on chemotherapeutic agents, optimal primary surgical cytoreduction, not chemotherapy, is the single most important means to give women the best chance of a prolonged disease-free interval. Naik et al.1 suggest reasons to explain the low optimal/ complete primary surgical cytoreductive rate on average in the UK. At a recent British Gynaecological Cancer Society meeting, we presented some results of a questionnaire on advanced epithelial ovarian cancer sent to all UK gynaecological oncologists. One finding was that the mean operating time was about 3 hours, yet many claimed to achieve optimal cytoreduction in that time. This contrasts with our units and other in the USA or Europe, which achieve a high rate of optimal cytoreduction where the mean operating time is 5 hours or more! There are evidently two mindsets or philosophies. Fundamentally, how are the patients’ interests best served? For advanced peritoneal ovarian carcinosis, the surgical challenge is in the upper abdomen and not the pelvis. The argument has been confused by whether a gynaecological oncologist should or should not undertake upper abdominal surgery. Just as one would involve an oncoplastic surgeon for a complicated vulvovaginal reconstruction, there must be careful consideration given to the team approach to advanced ovarian cancer with upper abdominal disease. In experienced hands, this may be the gynaecological oncology team alone or it might involve the upper gastrointestinal or hepatobiliary team. What is key is that the gynaecological oncology team’s philosophy is a priori to aim for compete cytoreduction, involve other surgical colleagues if necessary or not, and plan the operating day appropriately. As pointed out by Naik et al.,1 surgical centres in the UK have been slow to maintain comprehensive data sets and publish data on outcomes, including morbidity, mortality, and survival. Today, it still remains a truism that appropriate radical surgery is the key to the control of the majority of solid malignancies. j
Annals of the Royal College of Surgeons of England, 1986
The management of 191 patients with ovarian cancer is presented. A significant proportion of thes... more The management of 191 patients with ovarian cancer is presented. A significant proportion of these patients were initially seen (16%) or operated on (7%) by a general surgeon. The current surgical approach to this disease should be aggressive, and in 23% of these patients a non-gynaecological surgical procedure was required. Although chemotherapy is the main form of treatment following surgery, its chances of success are influenced by the amount of tumour left after surgery. The picture is not uniformly hopeless, and of 34 patients who subsequently underwent laparotomy to check the effectiveness of chemotherapy, 10 (29%) had no evidence of disease. Palliative surgery also has an important place in the management of this disease to provide comfort from disabling symptoms, and in some cases it may prolong life.
Purpose Invasive mucinous carcinoma of the ovary (mucinous epithelial ovarian cancer [mEOC]) is a... more Purpose Invasive mucinous carcinoma of the ovary (mucinous epithelial ovarian cancer [mEOC]) is a histologic subgroup of epithelial ovarian cancer (EOC). Chemotherapy for mEOC is chosen according to guidelines established for EOC. The purpose of this study is to determine whether this is appropriate. Patients and Methods Women with advanced mEOC (International Federation of Gynecology and Obstetrics stage III or IV) who underwent first-line platinum-based chemotherapy were compared with women with other histologic subtypes of EOC in a case-controlled study. Results Eighty-one patients (27 cases, 54 controls) treated with platinum-based regimens were analyzed. The response rates for cases and controls were 26.3% (95% CI, 9.2% to 51.2%) and 64.9% (95% CI, 47.5% to 79.8%), respectively (P = .01). The odds ratio for complete or partial response to chemotherapy for mEOC was 0.19 (95% CI, 0.06 to 0.66; P = .009) compared with other histologic subtypes of EOC. Median progression-free survi...
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