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The clinical value of serum concentrations of cancer antigen 125 in patients with primary fallopian tube carcinoma: a multicenter study.

BACKGROUND: Primary fallopian tube carcinoma (PFTC) is a rare disease, and data on the serum concentration of tumor marker cancer antigen 125 (CA 125) in patients with this disease are sparse. The authors assessed the clinical value of the serum concentration of CA 125 as a prognostic and monitoring marker in patients with surgically treated PFTC. METHODS: In a multicenter study, the concentration of CA 125 was measured in 406 serum samples from 53 patients with PFTC. The results were correlated with clinical data. RESULTS: The pretreatment median serum CA 125 level was 183 U/mL (range, 6.5-5440.0 U/mL) in patients with PFTC. In a univariate Cox regression model, tumor stage and serum CA 125 level were associated significantly with shortened disease free survival (P = 0.006 and P < 0.001, respectively) and with overall survival (P = 0.03 and P = 0. 001, respectively). Lymph node involvement, tumor grade, and patient age were not associated with the length of survival. A multivariate Cox regression model showed that pretreatment the serum CA 125 level was a prognostic factor of disease free and overall survival, independent of tumor stage (P = 0.005 and P = 0.01, respectively). The pretreatment serum CA 125 level was correlated with tumor stage (P < 0.001) but not with lymph node involvement (P = 0.8), histologic grade (P = 0.3), or patient age (P = 0.2). The serum CA 125 level during chemotherapy was correlated significantly with Gynecologic Oncology Group response criteria to chemotherapy (P = 0. 001). During the follow-up of patients, serum CA 125 levels reached sensitivity, specificity, positive predictive value, and negative predictive value of 92%, 90%, 67%, and 98%, respectively, for differentiating between no evidence of disease and the presence of recurrent disease. In 90% of the patients, an increase of serum CA 125 level preceded the clinical or radiologic diagnosis of recurrent disease with a median lead time of 3 months (range, 0.5-7.0 months). CONCLUSIONS: This is the largest study to date with respect to serum CA 125 levels in patients with PFTC. The current data indicate that the pretreatment serum CA 125 level is an additional independent prognostic factor of disease free and overall survival in patients with PFTC. The serum CA 125 level adequately defines the response to chemotherapy and displays good sensitivity and specificity characteristics during the follow-up of patients with PFTC.

Adult↗

Common polymorphisms in TP53 and MDM2 and the relationship to TP53 mutations and clinical outcomes in women with ovarian and peritoneal carcinomas.

The importance of somatic TP53 mutations and germline TP53 codon 72 genotype in the survival of women with epithelial ovarian cancer is controversial. Recent data suggest that a promoter polymorphism in the MDM2 gene may influence age of cancer onset in a gender-specific fashion. We sought to determine the relationship between somatic TP53 mutations, germline genotypes at TP53 codon 72 and MDM2 SNP309, and overall survival and response to chemotherapy in a large series of patients with ovarian and peritoneal carcinomas. Of the 188 cancers, 103 (54.8%) had a TP53 mutation, of which 71% were missense mutations and 29% were null mutations. TP53 mutation status and mutation type (null vs. missense) did not influence response to therapy or overall survival. Women with the codon 72 Pro/Pro had a decreased overall survival (median, 29 months) compared with women with one or two arginine alleles (median, 49 months; P=0.04). Somatic mutation or deletion was equally common for either codon 72 allele. Age of diagnosis was not influenced by codon 72 but showed a trend for younger age in women with somatic TP53 mutations and the MDM2 G/G genotype.

Alleles↗

Complex karyotypic abnormalities in a primary carcinoma of the fallopian tube.

Short-term cultures from a primary carcinoma of the Fallopian tube, a tumor type not characterized before by chromosome banding, were examined cytogenetically. Complex chromosome aberrations were found in all mitoses, yielding the karyotype 41,XX,del(1)(p34),del(2)(q31),i(8)(q10),-9, + dic(9;19)(p13;p13), der(12)t(9;12)(p13;q22),-13,-16,-17,-18,-19,-22, +r [61]/84-86,idemx2[15]. Several of the aberrations in the present case are similar to changes found in adenocarcinomas of other organs, including carcinomas of the ovaries and uterus, indicating pathogenetic similarities between Fallopian tube malignancies and the more common gynecologic cancers.

Adenocarcinoma, Papillary↗

Sociodemographic determinants of incidence of primary fallopian tube carcinoma, Finland 1953-97.

Primary fallopian tube carcinoma is very rare. In Western countries, it accounts for about 1% of all female genital malignant tumors. Its etiology remains poorly known, but high parity is considered to be protective. We studied determinants of incidence of primary fallopian tube carcinoma in Finland. Incidence rates for primary fallopian tube carcinoma, according to the population based Finnish Cancer Registry, from 1953- 97 were assessed by age, year of diagnosis, and type of residential area. Standardized incidence ratios (SIRs) for the years 1971- 95 were calculated by occupation and social class variables taken from the 1970 Population Census. There were 485 cases of primary fallopian tube carcinoma registered during 45 years. The age-adjusted incidence rate increased from 1.2/1000000 in 1953-57 to 5.4/1000000 in 1993-97. This 4.5-fold increase in incidence rate corresponds to a 7-fold increase in the number of new cases. The increase is attributable to the age group beyond 55 years, the peak incidence occurring between 60-64 years. Although the relative increase in incidence rate has been larger in rural areas than in cities, the rate in the latter remains 2-fold. Women in the 2 highest social classes had a 1.8-fold incidence (95% CI = 1.2-2.6) as compared to the lowest social class. Women in agriculture and those not working outside the home had only half the cancer incidence of those in academic or clerical occupations. The incidence of primary fallopian tube carcinoma increases in Finland. Evidently, the incidence has increased simultaneously with the affluence of urban life. Part of the variation in incidence correlates with variation in parity.

Adult↗

Parity, tubal sterilization, hysterectomy and risk of primary fallopian tube carcinoma in Finland, 1975-2004.

We studied the possible relationship among parity, female sterilization, hysterectomy and the risk of primary fallopian tube carcinoma (PFTC) in a case-control study in Finland in cases occurring between 1975 and 2004. A total of 573 PFTC cases were identified from the Finnish Cancer Registry, and 10 age-matched controls per case were randomly selected from the Finnish Central Population Registry. In multivariate analysis (including 189 PFTC cases and 1764 controls) parity was protective: the odds ratio (OR) for 1-2 deliveries was 0.63 (95% CI 0.44-0.91) and for > or =3 deliveries, 0.32 (95% CI 0.19-0.52). The OR for sterilization was 0.74 (95% CI 0.42-1.30) and for hysterectomy 1.27 (95% CI 0.73-2.21). Our findings suggest a possible hormonal background as regards the development of PFTC.

Carcinoma↗

Carcinoma in situ of the Fallopian tube associated with cervical carcinoma. Case report.

A case of carcinoma in situ of the fallopian tube in a 55-year-old woman, associated to cervical carcinoma is described. The necessary criteria for the diagnosis of pre-invasive carcinoma of the fallopian tube, among which the number of mitoses seems to be of great importance, are discussed. This previously unreported association of carcinoma in situ of the fallopian tube, with carcinoma of the uterine cervix, emphasizes the notion of the multicentric neoplastic possibilities of the müllerian tract derivatives.

Carcinoma in Situ↗

Primary malignancy of the fallopian tube: a clinical review of 13 cases.

Thirteen cases of primary fallopian tube cancer are presented from The Ohio State University Hospital. The majority of these tumors were diagnosed in the advanced stage of the disease with a considerable variety in histology for a small series. The Pap smear was quite meaningful in the diagnosis of malignancy in three of the cases; however, none of these cases was diagnosed preoperatively as a tubal primary cancer per se. A careful consideration of the history of pain, vaginal discharge, and pelvic mass is most important in making this diagnosis of tubal cancer preoperatively, along with a high index of clinical suspicion. In our experience, the stage of the disease was the single most important factor effecting patient survival. The mode of therapy appears to be a less important factor influencing survival. Patients treated with surgery and adjuvant chemotherapy had slightly better survival than did those patients in advanced stages treated by surgery and adjuvant radiation therapy.

Adenocarcinoma↗

Primary carcinoma of the fallopian tube in an adolescent.

Only three cases of adenocarcinoma of the fallopian tube in an adolescent have been reported previously in the literature, and we report the fourth such case. The main presenting symptom in those patients was lower abdominal pain. Type of therapy and outcome of these four cases is reviewed. The small number of patients precludes definitive conclusion on optimal therapy. For this reason, we urge continued reporting of cases to insure the formation of concrete therapeutic recommendations.

Adult↗

Primary fallopian tube carcinoma: treatment and spread pattern.

The clinicopathologic aspects of seven cases of Fallopian tube adenocarcinoma are analyzed. Potential early spread of this malignancy to the retroperitoneal lymph nodes and right subdiaphragmatic area is documented. Multimodality treatment of tubal cancer to include surgery, radiation, and drug therapy (alkylating agents, progestins, with or without 5-fluorouracil and adriamycin) appears feasible and promising.

Adenocarcinoma↗

Fluorescence staining of human ovarian cancer tissue following application of 5-aminolevulinic acid: fluorescence microscopy studies.

BACKGROUND AND OBJECTIVES: Application of 5-aminolevulinic acid (ALA) for fluorescence-guided second-look laparoscopy has been shown to be a promising new procedure in the early diagnosis of ovarian carcinoma metastases. However, for assessing the reliability of this method, information on the microscopic distribution of protoporphyrin IX (PP IX) in the tissue is needed. Additionally, the selectivity of PP IX uptake is essential for a potential photodynamic therapy (PDT) of ovarian cancer metastases. STUDY DESIGN/MATERIALS AND METHODS: Thirty-six patients with epithelial ovarian cancer and two patients suffering from fallopian tube carcinoma underwent a laparoscopic second-look procedure 5 hours after the application of ALA. In 17 patients 36 fluorescence-guided biopsies were taken from fluorescing and non-fluorescing tissues for further evaluation. Fluorescence microscopy and digital image processing were utilized to determine the presence of PP IX fluorescence. RESULTS: A specificity of 88% and a sensitivity of 100% with a negative predictive value of 100% and a positive predictive value of 91% were calculated for PP IX fluorescence on a microscopic level as marker for ovarian cancer metastases. CONCLUSIONS: On a microscopic scale, ALA-induced PP IX fluorescence is confined to ovarian cancer tumor tissue sparing stromal tissues.

Aminolevulinic Acid↗