Elevated serum alpha-fetoprotein (AFP) in patients with chronic hepatitis C is not uncommonly seen, but the pathogenesis of this phenomenon remains unclear. The aims of this study were to assess the prevalence of elevated serum AFP in patients with chronic hepatitis C and to evaluate the clinical, virologic, and histopathologic significance of this phenomenon. One hundred and fifteen Chinese patients with a histologic diagnosis of chronic hepatitis C were enrolled. None had evidence of hepatocellular carcinoma by image study at enrollment and for at least 2 years' follow-up. Of the 115 patients, 33 (29%) had elevated serum AFP (more than 12 ng/mL). There was a significantly lower mean serum albumin (4.0 ± 0.1 vs. 4.3 ± 0.1 gm/dL, p <0.001) and higher mean scores for periportal necroinflammation (3.3 ± 0.3 vs. 2.3 ± 0.2, p = 0.007) and fibrosis (2.3 ± 0.2 vs. 1.1 ± 0.1, p < 0.001) in patients with elevated serum AFP when compared with patients without elevated serum AFP. Patients with elevated serum AFP had significantly more incidences of genotype 1b infection when compared with patients without elevated serum AFP (77% vs. 51%, p = 0.021). Mean serum hepatitis C virus (HCV) RNA titer showed no significant difference between the two groups. Multivariate logistic regression analysis showed that as serum albumin of less than 4.2 gm/dL, a histology fibrotic score of more than 3, and HCV genotype 1b infection were significantly independent predictors associated with elevated serum AFP. In conclusion, elevated serum AFP levels were significantly correlated with lower serum albumin levels, advanced fibrosis/cirrhosis, and genotype 1b infection in patients with chronic hepatitis C.
A solitary peritoneal metastasis from a poorly differentiated adenocarcinoma of unknown origin in a 38-year-old female is described. The patient presented with a left ovarian tumor and elevated cancer antigen 125. She underwent complete excision of tumor and received six courses of postoperatively adjuvant cisplatin-based combination plus radiation therapy simultaneously. Second-look operation was done later and complete surgicopathologic remission was demonstrated. Two further courses of consolidation chemotherapy were given. She has been followed up for 25 months, and is living and well. We suggest that the combination of aggressive surgery, cisplatin-based chemotherapy and an open-field technique of abdominopelvic irradiation (concurrent chemoradiation) may be an appropriate approach to manage solitary peritoneal metastases from poorly differentiated adenocarcinoma of unknown origin.
Ovarian clear cell carcinoma (OCCC), a chemoresistant ovarian cancer, shows a modest response to anti–programmed death-1/programmed death ligand-1 (PD-1/PD-L1) therapies. The effects of anti-PD-1/PD-L1 therapies rely on cytotoxic T-cell response, which is triggered by antigen presentation mediated by major histocompatibility complex (MHC) class I. The loss of MHC class I with simultaneous PD-L1 expression has been noted in several cancer types; however, these findings and their prognostic value have rarely been evaluated in OCCC. We collected data from 76 patients with OCCC for clinicopathologic analysis. Loss of MHC class I expression was seen in 44.7% of the cases including 39.3% to 47.4% of the PD-L1 + cases and was associated with fewer CD8 + tumor-infiltrating lymphocytes (TILs). PD-L1 positivity was associated with a higher number of CD8 + TILs. Cox proportional hazard models showed that high (≥50/mm 2 ) CD8 + TILs was associated with shorter disease-specific survival (hazard ratio [HR]=3.447, 95% confidence interval [CI]: 1.222-9.720, P =0.019) and overall survival (HR=3.053, 95% CI: 1.105-8.43, P =0.031). PD-L1 positivity using Combined Positive Score was associated with shorter progression-free survival (HR=3.246, 95% CI: 1.435-7.339, P =0.005), disease-specific survival (HR=4.124, 95% CI: 1.403-12.116, P =0.010), and overall survival (HR=4.489, 95% CI: 1.553-12.972, P =0.006). Loss of MHC class I may contribute to immune evasion and resistance to anti-PD-1/PD-L1 therapies in OCCC, and CD8 + TILs and PD-L1 positivity using Combined Positive Score may have a negative prognostic value.
OBJECTIVE. The purposes of this study were to determine the feasibility of diffusion-weighted imaging (DWI) with a single-shot echo-planar sequence and parallel technique for depicting endometrial cancer and to examine the role of this technique in preoperative assessment.
Many clinicopathological factors of cervical cancer are still controversial in their prognostic significance. The case records of 1,115 patients who received radical hysterectomy at the Veterans General Hospital, Taipei, from 1980 to 1989 were collected to evaluate prognosis-related factors by univariate and multivariate analyses. The pathology was reviewed retrospectively by one pathologist. Ten parameters known to be prognostic in the literature were included for analysis. Univariate analysis showed that patients with all these factors had higher recurrence rates. However, when the effects of parametrial invasion, progressive stage and stromal invasion were weighed against the presence of lymph node metastasis, their influence on recurrence became unimportant. Nevertheless, these factors still influenced prognosis when there was no lymph node metastasis. Multivariate analysis of both recurrence and survival time in the patients with squamous cell carcinoma shared a consensus that pelvic lymph node metastasis and deep stromal invasion were significant risk factors. We conclude that these simplified and consistent results obtained by multivariate analysis provide a basis for subclassification of patients to predict prognosis and change therapy.
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