Tsung-Hsien Su

The present study describes 31 clinical cases of neuroendocrine cervical carcinoma (NECC) treated at Mackay Memorial Hospital between January 1, 1991 and October 31, 2003. There are two cases of atypical carcinoid tumor (ACT), four cases of large-cell neuroendocrine carcinoma (LCNEC), and 25 cases of small-cell neuroendocrine carcinoma (SCNEC). Overall survival did not differ significantly in relation to surgery, tumor histology, age, FIGO stages, chemotherapeutic regimens or lymph node involvement. The specimens available did not permit HPV (human papillomavirus)-DNA analysis in 5 cases (5/31, 9.7%). The HPV viral infection was absent in 8 cases (8/31, 26%); 17 cases of HPV-18 (17/31); and 1 case of HPV-16 (1/31). The prognosis between mixed and pure type histologic patterns is not significant. The mean survival time for all patients was 32.3 months. The 2-year and 5-year survival rates were 54.8% and 31.5% for all patients. The results of this study reaffirm the biologically aggressive nature of this rare malignancy, its low survival rate, and its very unpredictable prognostic factors. Effective treatments of neuroendocrine cervical tumor still remain inconclusive. Further efforts are still required to identify prognostic factors for this uncommon disease.

Human papillomavirus (HPV) is considered to be a necessary but not sufficient cause for cervical cancer. The host immunogenetic background plays an important role in the persistence of HPV infection and subsequent development of cervical cancer. Cytotoxic T-lymphocyte antigen-4 (CTLA-4) is a molecule expressed mainly on activated T cells and is important in the down-regulation of T-cell activation. The aim of this study was to determine if polymorphisms of the CTLA-4 gene are associated with HPV-induced cervical cancer in Taiwanese women. Polymerase chain reaction-restriction fragment length polymorphism was used to genotype -318 C/T, +49 A/G and CT60 A/G polymorphisms in 144 women with cervical squamous cell carcinoma (CSCC) and 378 ethnicity-matched healthy control women. The presence and genotypes of HPV in CSCC were determined by E6-, E7-based nested polymerase chain reaction. The frequency of C/T genotype of -318 C/T polymorphism was significantly higher in patients with HPV-16-positive CSCC compared with controls (odds ratio = 1.99, 95% confidence interval = 1.16-3.42, P(c) = 0.03). No significant associations were found for +49 A/G and CT60 A/G polymorphisms. Analysis of haplotypes, computationally inferred from genotype data, also revealed no significant differences in distribution among all subjects with CSCC, those with HPV-16-positive CSCC and controls. Our results suggest that the -318 C/T variant in the promoter region of the CTLA-4 gene is associated with HPV-16-associated CSCC in Taiwanese women.

INTRODUCTION: Sexual dysfunction is prevalent in women with pelvic organ prolapse and/or urinary incontinence. An instrument is needed to assess sexual function in urogynecologic patients who speak Chinese. AIM: To evaluate the reliability and validity of a Chinese translation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in urogynecologic patients in Taiwan. METHODS: After a pilot study showing good test-retest reliability and internal consistency of the Chinese PISQ-12, 120 urogynecological patients and 63 normal women were recruited. All participants underwent the Pelvic Organ Prolapse Quantification (POP-Q) system and urodynamic assessment. They each completed the Chinese PISQ-12 and the short form of Incontinence Impact Questionnaire (IIQ-7). MAIN OUTCOME MEASURES: PISQ-12, POP-Q system and IIQ-7 scores were compared between the urogynecologic patients and normal controls. RESULTS: The test-retest reliability and internal consistency of the Chinese PISQ-12 total score (Pearson correlation coefficient r = 0.939, Cronbach's alpha = 0.892, respectively) and of each of its three domains were excellent. The mean total PISQ-12 score and mean scores in each domain indicated significantly worse sexual dysfunction in the urogynecologic group as compared with the control group were correlated with the severity of prolapse and distress caused by incontinence. CONCLUSION: This Chinese translation of the PISQ-12 is a reliable, consistent and valid instrument to evaluate sexual function in Taiwanese women with pelvic organ prolapse and/or urinary incontinence.