Human chorionic gonadotropin and its relation to grade, stage and patient survival in ovarian cancer

Background: An influence of gonadotropins (hCG) on the development of ovarian cancer has been discussed. Therefore, we quantified serum hCG levels in patients with benign and malignant ovarian tumors and the hCG expression in ovarian cancer tissue in order to analyze its relation to grade, stage, gonadotropin receptor (LH-R, FSH-R) expression and survival in ovarian cancer patients. Methods: Patients diagnosed and treated for ovarian tumors from 1990 to 2002 were included. Patient characteristics, histology including histological subtype, tumor stage, grading and follow-up data were available. Serum hCG concentration measurement was performed with ELISA technology, hCG tissue expression determined by immunohistochemistry. Results: HCG-positive sera were found in 26.7% of patients with benign and 67% of patients with malignant ovarian tumors. In addition, significantly higher hCG serum concentrations were observed in patients with malignant compared to benign ovarian tumors (p = 0.000). Ovarian cancer tissue was positive for hCG expression in 68%. We identified significant differences in hCG tissue expression related to tumor grade (p = 0.022) but no differences with regard to the histological subtype. In addition, mucinous ovarian carcinomas showed a significantly increased hCG expression at FIGO stage III compared to stage I (p = 0.018). We also found a positive correlation of hCG expression to LH-R expression, but not to FSH-R expression. There was no significant correlation between tissue hCG expression and overall ovarian cancer patient survival, but subgroup analysis revealed an increased 5-year survival in LH-R positive/FSH-R negative and hCG positive tumors (hCG positive 75.0% vs. hCG negative 50.5%). Conclusions: Serum human gonadotropin levels differ in patients with benign and malignant ovarian tumors. HCG is often expressed in ovarian cancer tissue with a certain variable relation to grade and stage. HCG expression correlates with LH-R expression in ovarian cancer tissue, which has previously been shown to be of prognostic value. Both, the hormone and its receptor, may therefore serve as targets for new cancer therapies

Understanding sustainability policy: Governance, knowledge and the search for integration

The EU, through the Cardiff and the Gothenburg strategies, sought to counter what was seen as fragmented and uncoordinated environmental policy development by promoting a broad and integrated approach to sustainability. This article seeks to assess two recently implemented EU directives on environmental issues in light of this aim, namely the directives on Air Quality Management and Strategic Environmental Assessment. Drawing on theoretical foundations and empirical evidence from the EU FP6 project 'Governance for Sustainability', this article seeks to understand how policy integration is a matter of knowledge use, which is again related to the governance arrangements in which implementation takes place. Drawing on a total of 15 case studies in nine countries, the article finds that actual decision-making practice varies a lot albeit based on the same directives. In many cases, the directives were viewed as a sectoral 'environmental tools', and these cases were often dominated by expert knowledge being funnelled through relatively closed, hierarchical governance arrangements. In other cases, however, the directives were viewed as opportunities for politicians to cultivate a network mode of governance that 'aspired' to arguing and sometimes opened up for competing knowledge claims. © 2011 Copyright Taylor and Francis Group, LLC