宇田川 康博

The aim of this study was to evaluate the efficacy of cross-linked hyaluronate hydrogel (HA gel) as an adjuvant for postoperative adhesion prevention, in a mouse uterine horn model. In experiment 1 uterine horns were abrased with iodine. HA gel was applied to the injured surface before closure in the treatment group. In experiment 2, after injuring the uterine horns, three stitches were placed at equal distances around the uterine horns to appose the injured medial surfaces of the two horns during healing. HA gel was inserted between the uterine horns in the treatment group. In experiment 3 prevention of adhesion reformation was assessed. After lysis of adhesions that were induced as in experiment 2, HA gel was introduced between the serosal surfaces of apposing uterine horns. Untreated animals served as controls in each experiment. Statistical analysis was carried out using Student's t-test. The adhesion score was significantly lower in the HA gel group on the 14th day compared with controls in all the experiments: in experiment 1, 0.3 +/- 0.4 versus 1.7 +/- 1.2; in experiment 2, 0.9 +/- 1.0 versus 2.6 +/- 0.5; and in experiment 3, 1.5 +/- 0.9 versus 2.2 +/- 0.6 respectively. Cross-linked HA gel significantly reduced de-novo adhesions (P < 0.03) and adhesion reformation (P < 0.03).

The histoculture drug sensitivity assay (HDRA) has been demonstrated to have high predictability for resistance sensitivity and survival for gastrointestinal cancer (Clin Cancer Res 1: 305-311, 1995; Clin Cancer Res 1: 1537-1543, 1995). In this report, we evaluated the clinical usefulness of the HDRA in ovarian cancer HDRA was performed on tumors from patients with ovarian cancer. Eighty-five cases (97%) were evaluable. Tumor fragments were cultured on collagen-sponge gels. The cultures were incubated with cisplatin (CDDP) for seven days. Cell viability were assessed with the MTT end point. The optimal cut off concentration of CDDP was determined to be 25 mu g/ml by correlation with the historical clinical response rate to CDDP. HDRA results were correlated to clinical response of 15 patients who received CDDP-based therapy that included doxorubicin and cyclophosphamide (CAP therapy). The true positive rate was 88%, the true negative rate was 86%, the sensitivity was 88%, the specificity was 86%. and the accurate prediction rate was 87% when HDRA results were compared to the response of the treated patients. The data suggest that the HDRA is capable of predicting the response to antitumor chemotherapy in patients with ovarian cancer and that measuring response to CDDP can be useful for optimization of CAP chemotherapy for patients with this disease.

We review the cases of 31 patients with stage IVb or recurrent cervical adenocarcinoma who were treated with combination chemotherapy utilizing mitomycin C, etoposide, and cisplatin (MEP). The total response rate was 16.1% (95% confidence intervals (CIs), 5.5 to 33.7%) with 4 patients having a complete response (CR) and 1 having a partial response. In patients with no prior chemotherapy, the response rate was 26.7% (95% CIs, 7.8 to 55.1%) with 2 of these CR patients surviving over 3 years, 1 a disease-free survival, A marked response was found in distant recurrent lesions. The major toxicity was myelosuppression. Forty-five percent of patients I-rad leukocytopenia above grade 3; thrombocytopenia and anemia were not common. In patients with cervical adenocarcinoma and no prior chemotherapy, there was a moderate response to MEP therapy. (C) 1999 Academic Press.

Objective. Ovarian clear cell carcinoma is commonly associated with pelvic endometriosis. We retrospectively evaluated clinicopathological data on the association between ovarian clear cell carcinoma and pelvic endometriosis. Methods. Between 1984 and 1995, we evaluated clinicopathological data on 53 Japanese patients with primary ovarian clear cell carcinoma who had been initially treated at Keio University Hospital. The clinical backgrounds and 5-year survival rates were evaluated. Results. Twenty (37.7%) of the 53 patients had carcinoma accompanied by pelvic endometriosis. These 20 cases were classified as FIGO stage I (n = 13, 65%), stage II(n = 1, 5%), stage III(n = 6, 30%), or stage IV (n = 0). The other 33 cases of ovarian clear cell carcinoma had no evidence of association with endometriosis and were classified as stage I (n = 19, 57.6%), stage II (n = 2, 6.1%), stage III (n = 9, 27.2%), or stage TV (n = 3, 9.1%). The incidence of a positive intraperitoneal cytology in stage Ic was significantly less in the group with endometriosis than in that without the endometriosis (n = 1, 14.3% vs n = 9, 64.3%, P = 0.03). The 5-year survival rate of stage I patients was significantly greater in ovarian clear cell carcinoma with pelvic endometriosis (100%) than in that without it (60%, P < 0.05). Conclusion. Patients having ovarian clear cell carcinoma with pelvic endometriosis exhibited a better prognosis than those without endometriosis, especially those patients with stage I cancer. (C) 1999 Academic Press.