PubMed Health⌕ Search

Biomedical subjects

K C Podratz

Publications and source records attributed to K C Podratz.

At least 91 records · Page 5Linked to original sources
PubMed1990

DNA ploidy in endometrial carcinoma: major objective prognostic factor.

Paraffin-embedded tissue samples from 256 patients who received primary treatment (surgical staging, reduction of tumor size, and adjuvant therapy based on surgical and pathologic risk factors) for endometrial carcinoma at the Mayo Clinic between 1979 and 1983 were analyzed by flow cytometry to determine DNA ploidy characteristics. Diploid patterns constituted 78% of the cases, whereas aneuploid and tetraploid patterns accounted for 17% and 5%, respectively. Only 10% of patients with diploid tumors had a relapse in comparison with 39% of those with nondiploid lesions (34% with aneuploid; 58% with tetraploid). Significant differences (P less than 0.001) were noted in estimated 4-year progression-free survivals--88% for patients with diploid and 57% for those with nondiploid tumors. Stage, grade, depth of myometrial invasion, histologic subtype, peritoneal cytology, and DNA ploidy all demonstrated independent prognostic significance (P less than 0.001) in this study population. When subjected to multivariate analysis, however, grade and depth of myometrial penetration failed to retain prognostic significance (P greater than 0.15) and surgical stage was marginally significant (P = 0.05), whereas histologic subtype and DNA ploidy maintained significant predictive powers (P less than 0.001 and P less than 0.01, respectively). We conclude that DNA ploidy is a major objective prognostic factor and therapeutic determinant for endometrial carcinoma.

Adult↗
PubMed1989

Identification of prognostic factors and risk groups in patients found to have nodal metastasis at the time of radical hysterectomy for early-stage squamous carcinoma of the cervix.

In a retrospective study conducted at the University of Alabama at Birmingham, the University of Michigan, and the Mayo Clinic, 185 patients with previously untreated FIGO stage IB and IIA squamous cell carcinoma of the cervix were found to have nodal metastasis at the time of radical hysterectomy and pelvic lymphadenectomy. Of these patients, 103 received adjuvant pelvic irradiation. Cancer recurred in 76 patients; the median time to recurrence was 3.1 years. The prognostic significance of patient age, clinical stage, lesion diameter, number and location of nodal metastases, and use of adjuvant radiation therapy was determined by multivariate analysis. Only patient age (P = 0.0006), lesion diameter (P less than 0.0001), and number of nodal metastases (P = 0.0004) were noted to be significant factors in determining overall survival. Rates of recurrence were also related to these factors. Employment of these significant variables led to identification of four risk groups. In general, patients with small cervical lesions (diameter less than 1 cm) and no more than two nodes with metastases fell into the low-risk category; those patients with large cervical lesions (diameter greater than 4 cm) and more than two involved nodes fell into the high-risk category. All other patients were categorized into intermediate-risk groups. Ten-year survival was 92% in the low-risk group (n = 13), 70% in the low-intermediate-risk group (n = 66), 56% in the high-intermediate-risk group (n = 66), and 13% in the high-risk group (n = 20). This risk group classification identifies subgroups of early-stage cervical carcinoma patients found to have nodal metastasis at the time of radical hysterectomy that warrant appropriately selected adjuvant therapy.

Carcinoma, Squamous Cell↗
PubMed1989

Phenotypic and functional characteristics of mononuclear cells in ovarian carcinoma tumors.

By using monoclonal antibodies and flow cytometry, the phenotype and activation state [based on presence of interleukin 2 (IL-2) receptors] were determined on the mononuclear cell (MNC) fraction of ovarian carcinoma tissue from 12 patients. Thymidine incorporation response to IL-2 and phytohemagglutinin stimulation was measured in five cases. By FACS analysis, tumor MNCs contained 79% T cells, 11% monocytes/macrophages, 5% B cells, and 5% natural killer cells. Similar findings were noted in the patients' peripheral blood MNC population. The respective T-helper:cytotoxic/suppressor ratios in tumor and blood MNC populations were less than 1 and approximately 2. The percentage of IL-2 receptor-positive cells was low in both populations. The proliferative response of tumor MNCs was lower than that of blood MNCs from patients and from normal volunteers. These results suggest an intratumor immune suppression, perhaps secondary to the absence of a specific responder population or to the presence of suppressor cells or a soluble factor secreted by the tumor that directly suppresses or affects MNC transport into and out of the tumor.

B-Lymphocytes↗
PubMed1989

Value of adjuvant whole-pelvis irradiation after Wertheim hysterectomy for early-stage squamous carcinoma of the cervix with pelvic nodal metastasis: a matched-control study.

In a retrospective study, 185 patients with previously untreated stage IB or IIA (International Federation of Gynecology and Obstetrics) squamous cell carcinoma of the cervix were found to have pelvic nodal metastasis at the time of Wertheim hysterectomy and bilateral pelvic lymphadenectomy. Of these patients, 103 received adjuvant whole-pelvis irradiation and 82 received no adjuvant therapy. Median dose of pelvic irradiation was 5000 cGy. Among the irradiated patients, in 75% the dose was 5000 cGy or greater. Matching irradiated and nonirradiated patients according to stage, tumor size, and number and location of positive nodes yielded 60 pairs. Mean length of follow-up was 3.9 years for the 60 irradiated patients and 5.8 years for the non-irradiated patients. Kaplan-Meier overall and cancer-specific survival estimates for the two groups were not significantly different (P greater than 0.30). During the follow-up period, 21 surgery-only patients and 22 patients treated with adjuvant radiotherapy had recurrence, but adjuvant radiotherapy decreased the proportion of recurrences occurring in the pelvis alone--27% compared with 67% in the surgery-only group (P = 0.01).

Adult↗
PubMed1989

Flow cytometric DNA analysis of stage I endometrial carcinoma.

Flow cytometric DNA analysis was performed on 203 paraffin-embedded archival specimens obtained from patients with surgical stage I endometrial carcinoma. Primary therapy for those patients (1979-1983) had been definitive extirpation with adjuvant therapy determined by histologic grade, histologic subtype, myometrial invasion, and peritoneal cytologic findings. Diploid DNA patterns were identified in 171 (84%) specimens and nondiploid characteristics were observed in the remaining 32 (25 DNA aneuploid, 7 DNA tetraploid). Although DNA nondiploid specimens accounted for only 16% of all stage I patients, they accounted for 50% of all relapses. Regardless of treatment or other pathologic features, progression-free 5-year Kaplan-Meier survival estimates were 92 and 63% for patients with DNA diploid and DNA non-diploid patterns, respectively (P less than 0.001). Overall 5-year progression-free survival for patients with grade 1 or 2 lesions was 90%; stratification by DNA diploid and DNA nondiploid patterns revealed progression-free survivals of 94 and 64%, respectively (P less than 0.001). Peritoneal cytologic study was positive in seven patients; none of the five with a DNA diploid pattern had a relapse and both with the DNA nondiploid pattern had relapses. These studies suggest that DNA ploidy status may be an objective prognostic determinant for patients with stage I endometrial carcinoma.

DNA, Neoplasm↗
PubMed1989

Clinicopathologic analysis of uterine malignant mixed müllerian tumors.

A clinicopathologic evaluation of 60 patients (median age, 66 years) presenting for primary treatment of uterine malignant mixed müllerian tumors between 1959 and 1982 was conducted. Surgical stage was utilized for assessment of survival by stage. With a minimum follow-up of 5 years, overall 2- and 5-year Kaplan-Meier survival estimates were 53 and 39%, respectively; they were 75 and 58% when disease was confined to the uterus and 27 and 15% when disease extended beyond the uterus. By log-rank and logit-rank analysis, surgical stage and depth of invasion stratified by stage were significant prognostic determinants; no significant association was found with carcinoma grade, sarcoma mitotic figure count, sarcoma histologic subtype, sarcoma necrosis, or capillary-like space involvement. No significant survival advantage was found for surgery plus irradiation or surgery plus chemotherapy compared with surgery alone after stratification according to stage. Progression-free survival after complete extirpation of macroscopic disease was not significantly different, stage for stage, between surgery alone and surgery plus radiotherapy.

Aged↗
PubMed1988

Recurrent disease after negative second-look laparotomy in stages III and IV ovarian carcinoma.

Between 1977 and 1984, second-look laparotomy to evaluate disease status after adjuvant chemotherapy was performed in 134 patients originally presenting with advanced epithelial ovarian carcinoma. Surgical and histologic assessment did not detect persistent disease in 50 patients (37%). Recurrent carcinoma was subsequently documented in 15 patients (30%), all failures occurring within the abdominal cavity or the retroperitoneal space. Several patient subgroups at high risk for recurrence after negative second-look laparotomy are identified that might benefit from additional adjunctive therapy. Because of different treatment-associated morbidities, the corresponding sensitivities and specificities of the high-risk groups may assist subsequent treatment selection.

Adult↗
PubMed1988

Evaluation of treatment and survival after positive second-look laparotomy.

During the 9-year interval 1977 through 1985, of 250 patients undergoing second-look laparotomy, 116 (46%) were found to have clinically occult ovarian carcinoma. Salvage therapy consisted of external irradiation in 37, intraperitoneal 32P in 12, chemotherapy in 63, and no therapy in 3 or other therapy in 1. Eligible follow-up time ranged from 1 to 9 years. The Kaplan-Meier projected median time-to-progression and survival were 15 and 22.5 months, respectively, with 4-year progression-free and overall survival rates being 21 and 27%, respectively. Survival was independent of the original stage of disease but was significantly influenced by histologic grade and microscopic (55%) versus macroscopic (19%) residual tumor after the laparotomy. Projected 4-year salvage rates in patients with microscopic or residual disease less than or equal to 5 mm was 72, 39, and 19% for intraperitoneal 32P, external irradiation (33/37, whole abdominopelvic), and chemotherapy, respectively. However, multivariable analysis demonstrated that histologic grade and isotope therapy retained independent influence on survival, but no therapeutic advantage for external irradiation over chemotherapy was demonstrable. Furthermore, use of regimens that were identical to, partially altered from, or different from the first-trial agents did not affect chemotherapy salvage rates.

Carcinoma↗
PubMed1988

Wertheim hysterectomy in the geriatric population.

A series of 38 patients 65 years of age or older who underwent Wertheim hysterectomy for primary treatment of stages IB and IIA (FIGO) carcinoma of the cervix is reported. There were no ureteral fistulas and no perioperative mortality, but 4 of the patients required reoperation. A control population of 320 patients less than age 65 was identified who had been treated in the same fashion and who resembled the older group in regard to stage, histologic features, grade, and incidence of pelvic nodal metastasis. Transfusion requirements and incidence of postoperative lower extremity edema were similar between groups. Febrile morbidity was less frequent in the geriatric group (P = 0.03) but postoperative small bowel obstruction (P = 0.01), bladder dysfunction (P = 0.06), and pulmonary emboli were more frequent (P = 0.11). Five-year cancer-specific Kaplan-Meier survival estimates were 84 and 85% for the geriatric and younger patient populations, respectively.

Adenocarcinoma↗
PubMed1988

Preoperative evaluation of serum CA 125 levels in premenopausal and postmenopausal patients with pelvic masses: discrimination of benign from malignant disease.

CA 125 levels were measured in 158 patients with palpable pelvic masses who were about to undergo diagnostic laparotomy. When the 68 patients found to have cancer were compared with the 90 patients with benign disease, those with malignancies were significantly older, were more frequently postmenopausal, and had significantly higher values of serum CA 125. Patients with benign pelvic masses had CA 125 levels greater than 65 U/ml in 8% of cases, whereas those with malignancies had CA 125 levels greater than 65 U/ml in 75% of cases. If only those patients who had frankly malignant, primary, nonmucinous epithelial ovarian carcinomas were considered, CA 125 levels greater than 65 U/ml predicted malignancy with a sensitivity of 91% for all patients. Greater sensitivity and specificity were observed in the postmenopausal subgroup than in the premenopausal subgroup. In the postmenopausal group with a 63% prevalence of ovarian cancer the predictive positive value was 98% and the predictive value negative was 72%. In a premenopausal population with a 15% prevalence of ovarian cancer the predictive value for a positive test was 49%, while the predictive value for a negative test was 93%.

Adolescent↗
PubMed1988

Advanced epithelial ovarian cancer: salvage whole abdominal irradiation for patients with recurrent or persistent disease after combination chemotherapy.

Between 1979 and 1984, 53 patients received whole abdominal irradiation in a curative salvage effort for residual (32 patients) or recurrent (21 patients) epithelial ovarian cancer after combination chemotherapy (cisplatin-based in 48 patients). Residual cancer less than or equal to 2 cm in diameter was confirmed at operation in all patients before irradiation consisting of 2,550 to 3,000 rad to the whole abdomen with partial liver/kidney shielding and boosting of the dose to the diaphragmatic/paraaortic nodal regions and pelvis to approximately 4,000 and 5,000 rad, respectively. Twelve patients (23%) did not complete therapy as a result of hematologic intolerance. Actuarial overall and disease-free survival at 3 years are 35% and 30%, respectively, with follow-up for disease-free patients ranging from 30 to 79 months (median, 43 months). Twenty-seven of 36 relapses (75%) occurred within the irradiated abdomen alone. At 3 years, 70% of patients with well- or moderately-differentiated tumors were disease-free v 10% of those with poorly differentiated tumors (P less than .001). Among prognostic factors evaluated, including grade, initial residual disease before chemotherapy, residual disease at time of irradiation, age, chemotherapy response v progression, and completion of irradiation, only grade and initial residual disease before chemotherapy were statistically significant in multivariate analysis (both P less than .01). Patients with the combination of high-grade tumor, initial residual disease greater than 2 cm before chemotherapy, and macroscopic disease after "second-look" laparotomy do not benefit from irradiation. Eleven patients (21%) developed an apparent treatment-related bowel obstruction after completion of irradiation. Selected subsets of patients do well; however, the role of irradiation in this setting can be confirmed only with randomized clinical study.

Actuarial Analysis↗
PubMed1987

In vitro chemotherapy sensitivity testing of human ovarian carcinoma: comparison of optical colony counting and [3H]thymidine incorporation assays.

Optical colony counting was used for assessing drug sensitivity of 87 samples (from 51 primary solid tumors, 19 metastatic solid tumors, and 17 ascites fluids) from 83 common epithelial type ovarian carcinomas. The evaluability rate by the optical counting method was 26.4%. Fifty of these samples were also assessed by a tritiated thymidine ( [3H]dThd) incorporation assay (evaluability rate by incorporation assay, 74%). In the 12 cases fully evaluable by both methods, the correlation coefficients for regression of drug sensitivity data between the methods ranged from 0.503 to 0.976 (mean, 0.745); for the combined data of these cases, the correlation coefficient was 0.707. The new [3H]dThd assay appears useful and efficient for performing in vitro chemotherapy sensitivity testing of human ovarian cancer.

Antineoplastic Agents↗
PubMed1987

Ovarian dysgerminoma: a retrospective analysis of results of treatment, sites of treatment failure, and radiosensitivity.

Thirty-five patients with a diagnosis of pure ovarian dysgerminoma underwent assessment at our institution between 1950 and 1984. The median age of these patients was 21 years (range, 8 to 41 years). The surgical pathologic stages of the tumors were as follows: stage IA1 in 18 patients, stage IA2 in 2, stage IB1 in 2, stage IC in 1, stage IIB in 2, stage III in 9, and stage IV in 1. The overall survival at 5, 10, and 20 years was 94.3%, 82.9%, and 82.9%, respectively, for all 35 patients and 100%, 83.9%, and 83.9%, respectively, for the 18 patients with stage IA1 lesions. The maximum interval from diagnosis to relapse was 3.7 years. All patients were under surveillance for a minimum of 2 years (median follow-up, 15.9 years). Of the 18 patients with stage IA1 disease, 16 did not receive prophylactic radiation therapy to the para-aortic lymph nodes, and in 6 of the 16 (38%) recurrent disease developed in this region. Five of these patients were salvaged with radiation therapy and one with radiation therapy and subsequent chemotherapy. No definite correlation was noted between the size or mass of the resected unilateral encapsulated tumor and the risk of development of recurrent disease. For patients with stage IA1 dysgerminoma who have undergone unilateral oophorectomy, two treatment options seem reasonable: (1) observation, with radiation therapy reserved for subsequent recurrence, or (2) prophylactic radiation therapy (2,000 cGy) to para-aortic and ipsilateral common iliac lymph nodes, which would preserve fertility.

Adolescent↗
PubMed1987

Fallopian tube cancer: the role of radiation therapy.

Thirty-four patients with fallopian tube cancer were evaluated at the Mayo Clinic between 1964 and 1985 and received radiation therapy postoperatively. Employing a system analogous to FIGO ovarian cancer staging, there were 9 patients with stage I disease, 13 with stage II, and 12 with stage III/IV. Residual disease was present in 15 patients and absent in 19. Nodal metastases were documented in 12 patients or 35% (10 at presentation, two at relapse), with para-aortic nodes most commonly involved (67%) and 7 of the 12 having disease otherwise limited to the pelvis at presentation. Fifteen of 34 (44%) patients survived disease-free until intercurrent death or to a median follow-up of 70 months. Seven patients were treated with palliative intent for massive disease, and 27 patients were treated with curative intent (21 radiation alone, six radiation plus chemotherapy). Of those treated with curative intent, 15 patients received pelvic irradiation (with or without para-aortic nodal irradiation), 10 received whole abdominal irradiation, and 2 received intraperitoneal radiophosphorus. In the potentially curative group, seven of nine (78%) patients with stage I disease, five of 12 (42%) with stage II, and 2 of 6 (33%) with stage III have remained disease-free. Among the 21 patients with stage I or II disease, only four of the 11 (36%) patients who received pelvic irradiation alone were disease-free, but four patients had an isolated upper abdominal failure. In contrast, eight of 10 (80%) patients receiving treatment to the entire abdomen (including two patients who received 32P) were disease-free.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1986

CA 125 in gynecologic practice.

Serum CA 125 levels were determined in 64 women with benign ovarian lesions, 92 women with uterine fundal lesions, and six patients who had negative second-look laparotomy for epithelial ovarian carcinoma. Of those with benign lesions, 13 of 31 patients with endometriosis had levels greater than 35 U/ml. Six of 34 patients with endometrial carcinoma had elevated levels before the primary operation, and six of 15 patients with recurrent endometrial carcinoma had elevated levels. The six ovarian cancer patients had had negative findings at second look 7 to 40 months before recurrence. Where close serial levels were available, the level became elevated 2 to 5 months before clinically apparent recurrent disease was noted.

Antigens, Neoplasm↗
PubMed1986

Primary carcinoma of the fallopian tube.

From 1964 through 1983, 47 patients with a mean age of 63 years underwent primary treatment of fallopian tube carcinoma. Vaginal bleeding, abdominopelvic pain or pressure, and a palpable pelvic mass (or masses) were frequent retrospective clinical associations. Survival analysis demonstrated a rapid initial rate of patient attrition with stabilization after 3 years, resulting in an overall 5-year survival rate of 41%. While independent of age, histologic grade, or original tumor size, patient longevity was significantly decreased (p less than 0.01) by the presence of disease beyond the pelvis, neoplastic cells in the peritoneal washings, and size of residual disease. Therapy consisted of primary surgical resection, usually followed by adjunctive radiotherapy or chemotherapy. Initial sites of relapse were predominantly (88%) within the intraperitoneal cavity. The study supports definitive surgical staging and tumor reduction, as well as more selective adjuvant therapy based on surgical stage and residual tumor size and location.

Adenocarcinoma↗