Search

Objective:The Austrian Association for Gynecologic Oncology initiated in 1998 a prospective quality assurance program for patients with ovarian cancer. The aim of this study was to evaluate factors predicting overall survival especially under consideration of department volume.Methods:All Austrian gynecological departments were invited to participate in the quality assurance program. A questionnaire was sent out that included birth date, histology, date of diagnosis, stage, and basic information on primary treatment. Description of comorbidity was not requested. Patient life status was assessed in a passive way. We did record linkage between each patient's name and birth date and the official mortality data set collected by Statistics Austria. No data were available on progression-free survival. Patients treated between January 1, 1999 and December 31, 2004 were included in the analysis. Mortality dates were available to December 31, 2006. Data were analyzed by means of classical statistical methods. Cut-off point for departments was 24 patients per year.Results:A total of 1948 patients were evaluable. Approximately 75% of them were treated at institutions with fewer than 24 new patients per year. Patient characteristics were grossly similar for both department types. Multivariate analysis confirmed established prognostic factors such as International Federation of Gynecologists and Obstetricians (FIGO) stage, lymphadenectomy, age, grading, and residual disease. In addition, we found small departments (P < 0.001).Conclusions:The results indicate that in Austria, rules prescribing minimum department case load can further improve survival for patients with ovarian cancer.

Objective: To determine whether delayed laparotomy after attempted laparoscopic excision of an ovarian mass later found to be malignant has an impact on the stage of disease. Methods: A questionnaire regarding laparoscopic management of ovarian masses later found to be malignant was mailed to all gynecologic departments in Austria. Of the 70 cases reported, laparotomy was performed after laparoscopy in 48 cases. In 24 of these cases, laparotomy was performed within 17 days of laparoscopy, whereas 24 cases involved a delay of more than 17 days. Twenty-two patients in whom laparotomy was performed immediately after laparoscopy were used as controls. Results: In patients with borderline tumors who underwent laparotomy more than 17 days after laparoscopy, the odds ratio (OR) for International Federation of Gynecology and Obstetrics (FIGO) stage IIB-IV disease was 5.3 (95% confidence interval [CI] 0.40, ∞), compared with patients undergoing immediate laparotomy (multivariate analysis). Patients with invasive ovarian cancer who underwent laparotomy more than 17 days after laparoscopy had an OR of 9.2 (CI 0.92, 481) for stage IIB-IV disease compared with patients undergoing immediate laparotomy (multivariate analysis). In patients with borderline tumors, multivariate analysis showed that the timing of laparotomy is an independent prognostic factor for the stage of disease. In invasive ovarian cancer, none of the factors evaluated by multivariate analysis was found to be an independent prognostic factor for the distribution of disease stage. A delay between laparoscopy and laparotomy may affect adversely the distribution of disease stage. Conclusion: The timing of subsequent laparotomy was found to be a factor predictive of the distribution of disease stage.

A meta-analysis of 55 prospective randomized clinical trials including more than 37,000 patients has analyzed the effectiveness of tamoxifen in the treatment of breast cancer. Standard treatment consists of 20 mg tamoxifen daily for 5 years in patients with either a positive estrogen receptor or a positive progesterone receptor status. This treatment achieves a 50% improvement of the 5-year relapse-free survival and a 28% improvement of the overall survival. Tamoxifen is effective in lymph node-negative and lymph node-positive patients as well as in premenopausal and postmenopausal women. The combination of chemotherapy with hormonal treatment is even more effective and brings a further improvement of survival of 50%. In addition, tamoxifen reduces the number of contralateral breast cancer cases to 50%, but increase the occurrence of endometrial cancers from 1.2/1,000 breast cancer patients within 10 years to 4.4/1,000 women. In conclusion, tamoxifen 20 mg daily for 5 years is the standard treatment of hormone receptor-positive breast cancer patients.

Salvage chemotherapy in platin-resistant patients typically results in low response rates and short survival, therefore new active cytotoxic agents must be found. One of these agents is paclitaxel (Taxol), isolated from the bark of the western yew which acts as an antimicrotubule agent. In our study 28 patients were treated with Taxol, 20 of whom had platinum-resistant tumors. Taxol was administered at a starting dose of 175 mg/m2, infused over 3 hr every 21 days. A total of 145 courses of Taxol was infused. Dexamethasone, diphenhydramine, and ranitidine were given as premedication. The response rate was 25% (3 complete and 4 partial remissions), the median survival duration was 15 months. In contrast to other studies we found a lower response rate in patients resistant to platinum-based therapy: 15% (no complete, 3 partial remissions). The most common severe toxicity was leukopenia, with grade 3 toxicity occurring in 10% of the courses; no grade 4 leukopenia or neutropenia was noted. Neurologic toxicity was a clinically significant adverse effect, with 1% of patients experiencing grade 3, 9% experiencing grade 2, and 3% experiencing grade 1 toxicity. Other adverse effects were less frequent and less severe. We conclude that paclitaxel, which in a prospective randomized trial has been shown to be the most active treatment of advanced ovarian cancer, yields low response rates in platinum-resistant patients. Only a few of them profited from second-line treatment with Taxol. This could be a new aspect in the treatment of platinum-resistant ovarian cancer with Taxol.

The extent of conization seems to influence the risk of preterm birth. The aim of this study was to compare the cone volume after surgical resection with large loop excision of the transformation zone (LLETZ) and cold knife conization (CKC). The present retrospective multi-center study comprises 804 consecutive women, who underwent LLETZ (n = 412) or CKC (n = 392) between 2004 and 2009. Univariate and multivariable analyses were performed to compare cone volumes removed by LLETZ and CKC and identify independent risk factors for large cone volume. The median resected cone volume after LLETZ was significantly smaller [1.6 cm3 (0.8–2.9)] than after CKC [2.1 cm3 (1.4–3.5)] (

The proteolytic enzyme urokinase-type plasminogen activator (uPA) plays an important role in degrading extracellular matrix. This seems to be an important step in cancer invasion and metastasis. uPA antigen levels correlate significantly with disease recurrence and death in breast cancer. To build up tumour stroma in primary tumours as well as in metastases, inhibition of proteolytic activity is necessary. In this study we investigated the correlation of the Plasminogen Activator Inhibitor 1 (PAI-1), which is the specific inhibitor of uPA and which seems to be important for tumour formation, with prognosis in breast cancer. PAI-1 antigen levels were measured in cytosols of 268 primary breast cancers. In 205 cases we correlated the PAI-1 status (cut-off value : 1 ng/mg) with the clinical outcome. Furthermore we investigated PAI-1 antigen levels in 10 benign breast tumours and 33 metastases. PAI-1 levels were significantly higher in primary carcinomas (median value : 0,62 ng/ mg, range : 0 to 30,7) than in benign tumours (median value : 0 ng/mg, range : 0 to 0.1) and metastases showed elevated levels (median value : 1.05 ng/mg, range : 0 to 7.8) in comparison to the primary tumours (Kruskal-Wallis test : p < 0.05). We found that the PAI-1 status correlated significantly with early disease recurrence (Mantel-Test p =0.0069) and overall survival (Mantel-Test p = 0.0121). After a median follow-up of 32 months (range 2-58), 36% of patients with PAI-1 antigen levels ≥ 1 ng/mg (n= 72) showed an early relapse and 24% died, whereas only 19% of patients with PAI-1 antigen levels < 1 ng/mg (n = 133) relapsed and 9% died within the study period. A multivariate analysis revealed that in our study population PAI-1 is not an independent prognostic factor. According to our findings PAI-1 seems to be involved in the formation of extracellular matrix in primary carcinomas and metastases and is related to poor prognosis in breast cancer.

To evaluate the prognostic importance of preoperative CA 125 levels in patients with International Federation of Gynecology and Obstetrics (FIGO) stage I epithelial ovarian cancer in comparison with the established prognostic factors: degree of differentiation, FIGO substage, and age.In a retrospective analysis, the traditional prognostic factors and CA125 levels (cutoff value 65 U/mL) were studied in 201 patients who were treated in five centers during 1984-1993. Patients with borderline tumors or non-epithelial ovarian carcinomas were excluded, as were women in whom CA 125 had not been determined preoperatively.In univariate analysis (Mantel test), overall survival decreased significantly in patients positive for CA 125 (P.001). Substage (P = .004) and histologic grade (P = .01) also significantly influenced survival prognosis. When the effects of preoperative CA 125 levels were correlated with histologic grade, all three subgroups with CA 125 levels equal to or greater than 65 U/mL were associated with a decreased survival probability (grade 1, P = .04; grade 2, P = .003; grade 3, P = .01). Multivariate analysis (Cox model) identified preoperative CA 125 as the most powerful prognostic factor for survival (P.001), the risk of dying of disease being 6.37 times higher (95% confidence interval 2.39-16.97) in CA 125-positive patients. Although FIGO substage retained its significant influence on survival (P = .03), histologic grade and age were not prognostically important.Randomized trials investigating the efficacy of adjuvant treatment in patients with FIGO stage I epithelial ovarian cancer should also include stratification by preoperative CA 125 levels.

Nous avons mesure les concentrations de carnitine totale, de carnitine libre et d'acylcarnitine sur le sang, le plasma et les erythrocytes de 88 femmes pendant la grossesse. D'une facon generale, a la 12 e semaine de la grossesse, le taux moyen de carnitine sanguine a ete nettement plus bas (p < 0,01) que sur les sujets temoins. A partir de la 12 e semaine de grossesse et jusqu'a l'accouchement, nous avons releve une baisse significative (p < 0,01). Cette diminution de la carnitine totale dans le sang total est provoquee generalement par une baisse nette (p < 0,01) du taux de carnitine libre alors que nous n'avons pas note de modifications prononcees des valeurs des chaines courtes de l'acylcarnitine pendant toute la grossesse. L'apport de la L-carnitine des erythrocytes a la carnitine du sang total a progresse nettement (p < 0,05) pour atteindre 61% a l'accouchement contre 39% chez les temoins. Sur le sang du cordon ombilical, les taux de camitine libre et de carnitine total etaient nettement plus eleves (p < 0,05) que les taux maternels correspondants. L'apport de la L-carnitine des erythrocytes a l'ensemble de la camitine du sang total etait plus eleve dans le sang du cordon que dans le sang maternel. Chez les omnivores, la synthese de L-carnitine intervient pour le huitieme a la moitie de la carnitine disponible dans l'organisme. Nous savons maintenant que la biosynthese endogene a elle seule ne suffit pas pour porter le taux de L-carnitine a un niveau suffisant. La biosynthese de la carnitine est desormais bien connue. La premiere etape est constituee par la methylation des residus de lysine des proteines specifiques donnant la trimethyllysine. La biosynthese de la trimethyllysine est controlee par reconstitution de la proteine, l'hypothese etantque la lysine libre n'est pas methylee chez l'homme. En consequence, il n'y a pas d'interaction entre l'accroissement des pertes renales de carnitine et le taux de la synthese de carnitine. En conditions normales, la concentration de carnitine dans le plasma est reglee partiellement par la cinetique de la reabsorption de L-carnitine par les reins. Plus de 90% de la L-carnitine filtree est reabsorbee. Bien que le taux de L-carnitine soit bas pendant la grossesse, la clairance renale de l'acylcarnitine est nettement plus elevee que chez les sujets non enceintes. En consequence, la diminution de la carnitine du plasma ne provoque pas de demande durant les premieres semaines de la grossesse. La carnitine facilite donc le rejet des cellules des groupes acyles excedentaires et potentiellement toxiques, qui sont rejetees avec l'urine sous forme d'acylcarnitine. Il est possible que les besoins de carnitine augmentent pendant la grossesse pour pouvoir realiser cette fonction metabolique. Les resultats de la presente etude etablissent que pendant la grossesse, les taux de carnitine su sang total et du plasma diminuent pour atteindre ceux des sujets souffrant de deficience de carnitine. Les taux d'acylcarnitine dans la camitine totale etablis par la presente etude sont eux aussi typiques d'un deficit de carnitine secondaire. En consequence, la substitution de L-carnitine peut etre avantageuse, tout specialement dans les grossesses a risque.

The histological sections of 106 patients, who underwent a primary breast cancer operation in the years 1986 and 1987, were inspected for the presence of tumour vascular invasion. With immunohistochemical methods, tumour vessels were tomographed and the paraffin sections were stained with an antibody, which is sensitive to factor VHI-antigen. A tumour embolus was considered present, if a malignant cell was established within a positively stained lumen. The question of possible influence on the pathogenesis of breast cancer was examined in case of vascular invasion in the histological preparation. In 46 of the 106 patients (43.4 %), tumour emboli were found. After an average observation period of 59 months, no tumour progression was seen in 60 patients, 46 patients developed a recurrence of the tumour at the check-up date. The presence of vascular invasion correlates with undifferentiated tumour grading. The probability of relapse- free survival after 5 years was 83.9 % within the group without vascular invasion, compared with 47.9 % (p = 0.0001) within the group with established vascular invasion. In the multivariate analysis of the factors lymphonodular status, grading and vascular invasion, it was found, that the presence of tumour vascular invasion with a relative risk of 3.68 (95 % CI 1.93 - 7.03) was the strongest statistically significant prognostic factor for relapse - free survival (p = 0.0001).

Pregnant rats received betamethasone 0.02, 0.05, 0.10, or 0.20 mg/kg body weight/day or saline (controls) for three days before delivery of fetuses at day 19 of gestation. Dose related effects on morphology, dipalmitoyl phosphatidylcholine content, and phosphatidylcholine species composition of the fetal lungs were evaluated. Injection of 0.02 and 0.05 mg/kg body weight betamethasone resulted in cellular differentiation of some cells, but the increase in dipalmitoyl phosphatidylcholine content was not significant. Dosages of either 0.10 or 0.20 mg/kg body weight resulted in markedly accelerated organ differentiation, complete cytodifferentiation of type II cells, and markedly increased numbers of lamellar bodies per alveolar type II cell. Compared to the controls, maternal administration of 0.10 or 0.20 mg/kg betamethasone caused significant increases of both fetal lung dipalmitoyl phosphatidylcholine content, and the fraction of dipalmitoyl phosphatidylcholine of total phosphatidylcholine. None of the parameters differed between the groups that were treated with 0.10 or 0.20 mg/kg body weight betamethasone respectively. Diminution of lung DNA content was significant after treatment with betamethasone in doses of 0.05, 0.10, and 0.20 mg/kg body weight. The results of the present study suggest that maternal treatment with lower doses than those in common usage may be successful in prevention of respiratory distress syndrome, and that higher dosages do not confer any additional advantage.

In the present study, plasma oxytocin and prostaglandin F2 alpha metabolite (PGFM) concentrations were measured in 46 patients admitted for preterm labour. Gestational age ranged from 20-34 weeks. Samples were collected 12 hours before and after initiation of tocolysis. Patients with a premature rupture of the membranes and/or intra-amniotic infection were excluded in this study. There was a significant difference in the oxytocin (p = 0.05) and PGFM levels (p = 0.007, after 12 hours: p = 0.004) between a control group without preterm labour and women with preterm labour. No differences were seen between the successfully treated (delivery more than 5 days after start of tocolysis) and the failure group. There was no significantly different increase or decrease in PGFM and Oxytocin plasma levels between treatment failures and successfully treated patients.

In this study, correlations between the epidermal growth factor receptor (EGF-R), steroid receptors, and other prognostic parameters (grading, pTNM-status, menopausal status) were analysed in 326 primary breast carcinomas. 19% of the tumour samples were EGF-R positive, 63% were estrogen receptor (ER) and 54% progesteron receptor (PR) positive. Both steroid receptors were positive in 46% of all samples. We found a highly significant inverse correlation between EGF-R and steroid receptors. 88% of the ER positive tumours were EGF-R negative (p less than 5 x 10(-5)), 90% of the PR positive tumours were EGF-R negative (p less than 5 x 10(-5)) and 91% of the ER plus PR positive tumours were ERF-R negative (p less than 1 x 10(-6)). Grading was available in 170 cases. Six (4%) of the carcinomas were highly differentiated (G1), 82 (48%) were classified as G2, and another 82 (48%) were poorly differentiated (G3). A combination of negative ER and positive EGF-R was found more often in the population of G3 tumours. EGF-R was also positively correlated to tumour size. With regard to receptor status, we did not find a correlation with lymph node involvement. The ER correlated negatively (p less than 1.3 x 10(-5) and the EGF-R positively (p less than 0.042) with menopausal status. Thus, EGF-R overexpression seems to be a marker of morphological and functional dedifferentiation which is associated with a loss of steroid dependency and an increase of an autostimulatory-paracrine growth control. These changes seem to be related to poor prognosis.

The present retrospective study attempts to evaluate the significance of factors such as age, histological type, histological grading, tumour size, lymph node metastases and tumour infiltration of the corpus uteri. Between 1975 and 1988, 312 patients were operated at our department or referred to postoperative radiotherapy. They fulfilled the inclusion criteria: histopathological stage Ib and radical hysterectomy with pelvic lymphadenectomy. The multivariate analysis confirmed, that the factors histological grading (G3 vs G1 + G2: relative risk (RR) = 2.66; 95% confidence interval (CI) = 1.36-5.18), tumour size (tumour infiltration of the cervix greater than 2/3 vs less than 2/3: RR = 2.36; 95% CI = 1.07-5.17), and pelvic lymph node metastases (positive vs negative: RR = 5.36; 95% CI = 2.70-10.65) are of significant importance for the survival. The results show, that patients with a cervical carcinoma in FIGO stage IB, with an infiltration of more than two thirds of the cervix with a more or less differentiation and with or without positive lymph node status, should be classified as high risk patients. In these unfavourable situations, a prospective randomised study should clarify the success rate of adjuvant therapy.

Between December 1983 and December 1988 we examined the postoperative tumor marker development and correlated this to the clinical course of the disease in 56 patients suffering from primary epithelial ovarian carcinoma of International Federation of Gynecology and Obstetrics stages I-III and with a preoperative CA-125 serum level less than or equal to 65 U/ml. In 54% of all cases there was a reduction of more than 50% of the CA-125 serum level within the first 3 months after surgery. Nine out of thirteen patients with progressive disease (69%) showed an increasing CA-125 serum level with a median lead time of 6 months (0-11 months) prior to clinical diagnosis. These preliminary results indicate that the monitoring of cancer patients with CA-125 tumor marker seems to be a useful method of early diagnosis of progressive disease even in patients with preoperative serum levels lower than 65 U/ml.

145 women (22.2%) out of 652 patients with primary breast cancer, who were operated on between January 1980 and September 1988, developed tumour relapse until May 1990. The aim of our retrospective analysis in these 145 patients with local and/or distant tumour relapse was to evaluate the prognostic importance for further survival of the following factors: menopausal status, stage of disease, number of involved axillary lymph nodes, tumour grading, ER and PgR content, postoperative irradiation, adjuvant treatment, localisation of tumor relapse and relapse-free interval. Multivariate stepwise regression analysis of all these factors identified the number of positive axillary lymph nodes (0-3 versus 4+) with a relative risk (RR) of 2.49 and localisation of tumour relapse (local versus visceral metastasis RR = 2.08 and local versus bone metastases RR = 2.08) as the only two significant prognostic factors for further survival. Therefore, these two factors should be stratification criterias for prospectively randomized phase III studies in patients with tumour relapse after primary breast cancer.

The influence which female sexual steroids, especially estrogen, have on the development of cancer has not only been shown epidemiologically, but also by experimental findings. Hormones, in spite of a known marginal increase in the risk of thrombosis and endometrial cancer, play an important role in the preventive cancer medication (oral contraceptives: ovarian and endometrial cancer; chemoprevention: high-risk breast cancer patients). Basically, hormone replacement therapy should be administered to all patients suffering from gynecological malignomas. In the case of patients suffering from breast cancer, the advantages of hormone replacement therapy (e.g., less risk of cardiovascular complications) need to be weighed against the disadvantages.

Background: The aim of this retrospective study was to evaluate whether a delay between a preliminary exploratory laparotomy and a definitive staging laparotomy and interval chemotherapy between the two operations affected the prognosis of ovarian cancer. Methods: Of 504 patients with malignant tumors of the ovary who were treated at the Department of Obstetrics and Gynecology between 1980 and 1993, there were 24 who had a delayed definitive staging laparotomy. Results: Sixteen patients did not have chemotherapy between their two operations. After definitive laparotomy, 13 patients (54.2%) were free of disease and 11 patients had residual disease (45.8%). Conclusions: The value of chemotherapy between preliminary and definitive laparotomy in halting tumor growth was not demonstrated by the results of our analysis.

Between October 1988 and March 1991, 23 ovarian cancer patients with progressive disease whilst receiving second- or third-line polychemotherapy received subcutaneously 3.6 mg Goserelin, a GnRH analogue, at monthly intervals until further tumor progression. Four patients (17.4%) achieved partial response, 7 patients (30.4%) had stable disease and 12 patients (52.2%) showed further tumor progression. Median time to tumor progression was 8.5, 5.3 and 2.1 months, respectively (Mantel test,P= 0.0003). Ten out of 11 patients who showed partial response or no change had grade 2 or grade 3 tumors. We conclude that Goserelin shows evidence of antitumor activity also in grade 2 and grade 3 ovarian carcinoma. It offers a therapeutic alternative to a group of patients, in whom we usually terminate cytotoxic treatment.

Aim of the study was to find out the influence of iron medication of pregnant women on the iron levels of their newborn. In a prospective randomised study the iron-substituted group (n = 57) was treated with 2 x 1 Aktiferrin comp. Kps. (Merckle) during pregnancy, starting from the 22nd week. The control group (n = 46) had no medication during pregnancy. The substituted group had statistically significantly higher serum ferritin levels in the 30th week of pregnancy (p less than 0.048), higher levels measured in the cord blood at birth (p less than 0.001), and also the newborn of this group had statistically significant higher serum ferritin levels than the newborn of the control group (p less than 0.001). Our conclusion is that prepartal iron medication leads to increased iron stores in the newborn.

The purpose of the study was to determine the frequency of discovering a malignant ovarian mass when laparoscopy is used to manage an adnexal mass. A countrywide survey was undertaken in Austria, comprising questions about ovarian malignancy detected or accidentally treated by laparoscopy. The response rate of 66.7% represented a total of 54,198 laparoscopies, 16,601 laparoscopic surgeries on adnexal masses, and 108 cases of ovarian tumors subsequently found to be malignant (96 well-documented). Twenty patients were treated with laparoscopy alone. In 22 cases, laparoscopy was followed by immediate laparotomy. A delayed laparotomy (3-1415 days) was performed in 54 cases. Staging revealed FIGO classifications from stages Ia to IV. The follow-up time ranges from 2 to 220 months. Four recurrences have been reported. Thirteen patients died of tumor progression. Laparoscopic surgery on ovarian malignancies is a rare situation (0.65% of all endoscopic surgeries on adnexal masses). In cases of malignancy, a laparotomy has to be performed to ensure optimal staging and treatment.

Objective: Oncogene alterations are thought to be prognostic indices in patients with breast cancer. The present study was carried out to investigate the amplification of the HER-2/neu and INT-2 oncogenes in ovarian cancer. Methods: In a retrospective study of 196 patients with epithelial ovarian cancer, the amplification of the oncogenes HER-2/neu and INT-2 in the DNA of paraffin-embedded tumor cells was determined by quantitative PCR. The purpose of this study was to analyze whether the two oncogenes correlated with such predictive factors as FIGO stage, histological grade, ascites, postoperative residual tumor mass, hormone receptor content, and preoperative CA 125 serum levels. The effect of HER-2/neu and INT-2 amplification on patient survival was also studied. Results: The only correlation found in this study was between INT-2 and preoperative CA 125 levels ( P = 0.03). No correlations were demonstrable between HER-2/neu (log-rank test; P = 0.67) and INT-2 (log-rank test; P = 0.75) amplifications and overall survival. Conclusion: Unlike the established prognostic factors, neither HER-2/neu nor INT-2 appears to be predictive for survival in patients with ovarian cancer.

Tumorigenic roles were variably suggested for HER-2 and INT-2 oncogene amplifications and the "atypical" aspartate to glycine mutability in the butyrylcholinesterase (BCHE) gene in ovarian adenocarcinomas. To examine this notion we searched for correlations between these three phenomena and ovarian tumor classification and aggressiveness, using quantitative polymerase chain reaction (PCR), single-strand conformation polymorphism (SSCP), and direct PCR sequencing. Our findings revealed no alleles carrying the atypical BCHE mutability in 30 European-originated patients with ovarian tumors compared with 11% (2/18) such alleles in Israeli patients with malignant ovarian tumors. This apparently reflected population diversity rather than disease relationship. INT-2 amplification was observed in 14/94 (15%) of the European patients; however, there was no correlation between this phenomenon and clinicopathological indices in the corresponding patients. In contrast, in 94 tumor samples we found that 40% (38/94) of the cases had HER-2 amplification. Moreover, there was a highly significant correlation (P < 0.008) between the over fivefold HER-2 amplification and ovarian tumor severity. These findings demonstrate an informative value for HER-2 amplification tests in tumor DNA, but not for INT-2 amplification or BCHE mutability, for the assessment of treatment.

Site of recurrence and histological type are significant prognostic factors for survival in recurrent endometrial carcinoma. The aim of this retrospective analysis of 56 patients suffering from recurrences of endometrial carcinoma following initial surgery was to establish the prognostic relevance that the following factors had on the survival rate: age, primary tumor stage, histological assessment (papillary vs non-papillary), postoperative adjuvant radiation therapy, recurrence free interval (24 months,24 months) and localisation of recurrence. The univariate analysis showed a significantly longer median survival time after recurrence for the following parameters: local recurrence vs extra vaginal recurrence (77.5 months vs 15.7 months, p = 0.02), non-papillary vs papillary carcinoma (36.1 months vs 7.7 months, p = 0.02), no adjuvant irradiation vs adjuvant irradiation (82.0 months vs 8.8 months, p = 0.007). Patients after adjuvant radiation treatment and patients suffering from papillary carcinomas have a significantly higher proportion of patients with distant metastasis (patients with adjuvant radiation treatment: Chi-square test: p = 0.001; patients suffering from papillary carcinomas: p = 0.033). In the case of local recurrences, a three year survival rate of 54% can be achieved with radiation treatment. Recurrences of papillary endometrial carcinomas and patients suffering from distant metastasis on the other hand, show very low survival rates if they are treated with radiation therapy (papillary carcinomas: three-year survival rate of 18%, patients suffering from distant metastasis: 19%). These patients should be included in randomised studies with a view to examining the therapeutic effects of either additional or exclusive treatment with chemotherapy.

Levels of oestrogen receptor (ER) and progesterone receptor (PgR) in ovarian cancer tissue were examined with regard to their prognostic importance for survival in 179 patients with primary epithelial ovarian cancer stage III or IV in relation to: FIGO-stage, histological type, histological grade, age, ascites, and postoperative residual tumour. Hormone receptor content was determined with the DCC-method, receptor values higher than 9 fmol/mg protein were considered positive. Response to postoperative chemotherapy was significantly correlated with PgR content (80% responders in the group with PgR positive tumours and only 61% responders in the group with PgR negative tumours). A Cox proportional hazards regression model identified histological grade, residual tumour, age and PgR content as independent prognostic factors for survival in advanced epithelial ovarian carcinoma. PgR content had particularly significant prognostic relevance for patients with postoperative residual tumour mass less than or equal to 2 cm in diameter. Within this group of patients, those who are PgR positive have a 2-years survival probability of 83% compared with only 51% in the PgR-negative group.

Due to its high specificity (90%) and sensitivity (86%) measurement of CA125 has become well-established in patients with epithelial ovarian cancer. We have formulated a CA125 prognostic score and examined its validity as an additional prognosis index. This score is composed of two CA125 values (one determined preoperatively and one 1 month after operation). CA125 serum levels of 0-64 IU/ml received 1 point, levels of 65-299 IU/ml were given 2 points, and those greater than 300 IU/ml were given 3 points. These points are added to produce the CA125 prognostic score. Statistical comparison demonstrated that patients with scores of 2 or 3 had a significantly (P = 0.0005) better prognosis than patients with scores of 4, 5 or 6. The classical prognostics features such as the FIGO stage, residual tumor mass and ascites were found to correlate with the CA125 prognostic score.

In a retrospective analysis of 181 gynaecological operations performed in women older than 75 years the authors examined whether surgery had been meaningful and useful. Malignancy was established histologically in 50.3% of the cases, whereas in 49.7% benign diseases had led to an operation. Postoperative morbidity was 7.73% and depended on the magnitude of the procedure as well as on the diagnosed status of the histological findings. The mortality was 0.55%. Because of this low complication rate under appropriate internal and intensive care, surgery is recommended even in elderly women, if medical indication necessitates an invasive diagnostic or therapeutic procedure.