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Matsuo K, Chen L, Klar M, Lee MW, Machida H, Mikami M, Muderspach LI, Carlson JW, Roman LD, Wright JD. Prognostic performance of the 2023 FIGO staging schema for endometrial cancer. Gynecol Oncol 2024; 187:37-45. [PMID: 38713997 DOI: 10.1016/j.ygyno.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/24/2024] [Accepted: 04/21/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVE To assess the prognostic performance of the 2023 International Federation of Gynecology and Obstetrics (FIGO) endometrial cancer staging schema. METHODS This retrospective cohort study queried the Commission-on-Cancer's National Cancer Database. Study population was 129,146 patients with stage I-IV endometrial cancer per the 2009 FIGO staging schema. Stage-shifting and overall survival (OS) were assessed according to the 2023 FIGO staging schema. RESULTS Upstage (IA → II, 21.4 %; IB → II, 53.0 %) and downstage (IIIA→IA3, 22.2 %) occurred in both early and advanced diseases. Inter-stage prognostic performance improved in the 2023 schema with widened 5-year OS rate difference between the earliest and highest stages (68.2 % to 76.9 %). Stage IA1-IIB and IIC had distinct 5-year OS rate differences (85.8-96.1 % vs 75.4 %). The 5-year OS rate of the 2009 stage IIIA disease was 63.9 %; this was greater segregated in the 2023 schema: 88.0 %, 62.4 %, and 55.7 % for IIIA→IA3, IIIA1, and IIIA2, respectively (inter-substage rate-difference, 32.3 %). This 5-year OS rate of stage IA3 disease was comparable to the 2023 stage IB-IIB diseases (88.0 % vs 85.8-89.5 %). In the 2023 stage IIIC schema (micrometastasis rates: 29.6 % in IIIC1 and 15.6 % in IIIC2), micrometastasis and macrometastasis had the distinct 3-year OS rates in both pelvic (IIIC1-i vs IIIC1-ii, 84.9 % vs 71.1 %; rate-difference 13.8 %) and para-aortic (IIIC2-i vs IIIC2-ii, 82.9 % vs 65.2 %; rate-difference 17.7 %) nodal metastasis cases. The 5-year OS rate of the 2009 stage IVB disease was 23.4 %; this was segregated to 25.4 % for stage IVB and 19.2 % for stage IVC in the 2023 staging schema (rate-difference, 6.2 %). CONCLUSION The 2023 FIGO endometrial cancer staging schema is a major revision from the 2009 FIGO schema. Almost doubled enriched sub-stages based on detailed anatomical metastatic site and incorporation of histological information enable more robust prognostication.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Ling Chen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Matthew W Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Hiroko Machida
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
| | - Laila I Muderspach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Joseph W Carlson
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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Han L, Chen Y, Zheng A, Tan X, Chen H. Prognostic value of three-tiered scoring system for lymph-vascular space invasion in endometrial cancer: A systematic review and meta-analysis. Gynecol Oncol 2024; 184:198-205. [PMID: 38335803 DOI: 10.1016/j.ygyno.2024.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/05/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To investigate the impact of lymph-vascular space invasion (LVSI) status on the prognosis of endometrial cancer (EC) according to a three-tiered scoring system for LVSI. METHODS PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), International Clinical Trials Registry Platform (ICTRP), and Clinical Trials.gov were searched from inception to September 1st, 2023. The analysis was conducted using STATA 16.0. RESULTS A total of 9 studies with 4456 EC patients were included in the analysis. No LVSI was found in 72% of EC patients (95% CI 0.65-0.79), while focal and substantial LVSI were present in 16% (95% CI 0.11-0.21) and 13% (95% CI 0.08-018) of patients, respectively. Compared to the no LVSI group, the focal and substantial LVSI groups had poorer overall survival (for focal LVSI: HR 1.33, 95% CI 1.02-1.74; for substantial LVSI: HR 2.51, 95% CI 1.61-3.90), poorer disease-free survival (for substantial LVSI: HR 2.86, 95% CI 1.21-6.77), and an increased risk of recurrence, including pelvic recurrence (for focal LVSI: HR 2.05, 95% CI 1.03-4.07; for substantial LVSI: HR 6.06, 95% CI 3.31-11.08), distant recurrence (for focal LVSI: HR 2.04, 95% CI 1.42-2.92; for substantial LVSI: HR 3.36, 95% CI 2.35-4.793), and lymph node involvement (for focal LVSI: OR 3.52, 95% CI 1.339.34; for substantial LVSI: OR 5.42, 95% CI 2.78-10.58). Substantial LVSI was more prone to pelvic recurrence (HR 1.82, 95% CI 1.05-3.15) and distant recurrence (HR 2.21, 95% CI 1.48-3.28) than focal LVSI. CONCLUSIONS EC patients with focal and substantial LVSI had poorer survival, recurrence, and a higher incidence of lymph node metastasis than patients without LVSI. The substantial LVSI group was associated with even worse prognosis than the focal LVSI group. The three-tiered LVSI scoring system might effectively predict the prognosis of EC and guide clinical decision-making. PROTOCOL REGISTRATION CRD 42023451793.
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Affiliation(s)
- Ling Han
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu 610041, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan 610041, China
| | - Yali Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu 610041, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan 610041, China
| | - Ai Zheng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu 610041, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan 610041, China
| | - Xin Tan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu 610041, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan 610041, China; Day Surgery Department, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu 610041, Sichuan, China
| | - Hengxi Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu 610041, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan 610041, China; Day Surgery Department, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu 610041, Sichuan, China.
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Yoshida H, Matsuo K, Machida H, Matsuzaki S, Maeda M, Terai Y, Fujii T, Mandai M, Kawana K, Kobayashi H, Mikami M, Nagase S. Intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer: association for pathological factors and oncologic outcomes. Int J Gynecol Cancer 2024; 34:510-518. [PMID: 38316444 DOI: 10.1136/ijgc-2023-005102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To examine the association between intrauterine manipulator use and pathological factors and oncologic outcomes in patients with endometrial cancer who had laparoscopic hysterectomy in Japan. METHODS This was a nationwide retrospective cohort study of the tumor registry of the Japan Society of Obstetrics and Gynecology. Study population was 3846 patients who had laparoscopic hysterectomy for endometrial cancer from January 2015 to December 2017. An automated 1-to-1 propensity score matching with preoperative and intraoperative demographics was performed to assess postoperative pathological factors associated with the intrauterine manipulator. Survival outcomes were assessed by accounting for possible pathological mediators related to intrauterine manipulator use. RESULTS Most patients had preoperative stage I disease (96.5%) and grade 1-2 endometrioid tumors (81.9%). During the study period, 1607 (41.8%) patients had intrauterine manipulator use and 2239 (58.2%) patients did not. In the matched cohort, the incidences of lymphovascular space invasion in the hysterectomy specimen were 17.8% in the intrauterine manipulator group and 13.3% in the non-manipulator group. Intrauterine manipulator use was associated with a 35% increased odds of lymphovascular space invasion (adjusted odds ratio 1.35, 95% confidence interval (CI) 1.08 to 1.69). The incidences of malignant cells identified in the pelvic peritoneal cytologic sample at hysterectomy were 10.8% for the intrauterine manipulator group and 6.4% for the non-manipulator group. Intrauterine manipulator use was associated with a 77% increased odds of malignant peritoneal cytology (adjusted odds ratio 1.77, 95% Cl 1.29 to 2.31). The 5 year overall survival rates were 94.2% for the intrauterine manipulator group and 96.6% for the non-manipulator group (hazard ratio (HR) 1.64, 95% Cl 1.12 to 2.39). Possible pathological mediators accounted HR was 1.36 (95%Cl 0.93 to 2.00). CONCLUSION This nationwide analysis of predominantly early stage, low-grade endometrial cancer in Japan suggested that intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer may be associated with an increased risk of lymphovascular space invasion and malignant peritoneal cytology. Possible mediator effects of intrauterine manipulator use on survival warrant further investigation, especially with a prospective setting.
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Affiliation(s)
- Hiroshi Yoshida
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Hiroko Machida
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
| | - Shinya Matsuzaki
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Michihide Maeda
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Kobe University School of Medicine, Hyogo, Japan
| | - Takuma Fujii
- Department of Obstetrics and Gynecology, Fujita Health University Okazaki Medical Center, Aichi, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kei Kawana
- Department of Obstetrics and Gynecology, Nihon University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Yamagata University Graduate School of Medicine School of Nursing, Yamagata, Japan
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Matsuo K, Chen L, Neuman MK, Klar M, Roman LD, Wright JD. Low-grade endometrioid endometrial cancer with adnexal only metastasis: Evaluation of de-escalation of adjuvant therapy. Eur J Cancer 2024; 200:113533. [PMID: 38309016 DOI: 10.1016/j.ejca.2024.113533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/19/2023] [Accepted: 12/26/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To assess survival outcomes of stage IA3 endometrial cancer and the association of adjuvant therapy and survival. METHODS The National Cancer Database was retrospectively queried to examine 594 and 1455 patients with stage IA3 and IIIA1 endometrial cancer, respectively, from 2010-2015. Overall survival (OS) was examined based on adjuvant therapy: multimodal combination chemotherapy and external beam radiotherapy, chemotherapy alone, external beam radiotherapy alone, and none. RESULTS For stage IA3 disease, 109 (18.4%) patients did not receive adjuvant therapy. The 5-year OS rates for the no adjuvant therapy group and the combination group were 86.3% and 91.4%, respectively (adjusted-hazard ratio [aHR] 1.23, 95% confidence interval [CI] 0.70-2.18). This survival association was consistent when compared to chemotherapy alone (5-year OS rates 86.3% vs 86.3%, aHR 1.11, 95%CI 0.67-1.83). The results were similar among those who underwent nodal evaluation (5-year OS rates, 92.6%, 86.6%, and 89.4% for combination therapy, chemotherapy alone, and no adjuvant therapy), including grade 1 lesions (96.2%, 89.4%, and 100%, respectively). In grade 2 lesions, 5-year OR rates was modestly lower for no adjuvant therapy than combination therapy (89.4%, 84.0%, and 82.7% for combination, chemotherapy alone, and no adjuvant therapy, P = 0.03). For stage IIIA1 disease, omission of adjuvant therapy was associated with decreased OS compared to combination therapy (43.2% vs 73.1%, aHR 1.65, 95%CI 1.30-2.11) or chemotherapy alone (43.2% vs 67.1%, aHR 1.62, 95%CI 1.32-1.99). CONCLUSION The results of this investigation suggest that survival effects of adjuvant therapy differ for stage IA3 and IIIA1 diseases. Patients with stage IA3 disease have overall good prognosis regardless of adjuvant therapy particularly grade 1 lesions, partly supporting the FIGO committee suggestion for adjuvant therapy de-escalation in stage IA3 endometrial cancer.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Ling Chen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Monica K Neuman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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Hui C, Mendoza MG, von Eyben R, Dorigo O, Litkouhi B, Renz M, Karam A, Hammer PM, Howitt BE, Kidd E. Does lymph node assessment change the prognostic significance of substantial LVSI and p53 status in endometrial endometrioid carcinoma? Gynecol Oncol 2023; 177:150-156. [PMID: 37696217 DOI: 10.1016/j.ygyno.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE The PORTEC-2 update suggested that substantial lymphovascular space invasion (LVSI) and abnormal p53 expression (p53abnl) predict for poorer outcomes and that these patients should be treated with external beam radiation therapy (EBRT). We aim to determine if patients with these risk factors who undergo a lymph node (LN) assessment show similar outcomes. METHODS We retrospectively reviewed 126 patients with FIGO 2009 stage IA grade 3, stage IB grade 1-2, and stage IIIC (positive LN but no other stage II/III risk factors) endometrioid endometrial cancer who underwent LN assessment. Local (LR), regional recurrences (RR), and distant metastases were analyzed using competing risk methods, and overall survival (OS) was analyzed using Kaplan-Meier. RESULTS Median follow-up time was 37.2 months. OS was significantly different between patients with and without p53abnl expression (16.7% versus 3.1% deceased), and between patients with and without LVSI (11.1% versus 1.5% deceased; p < 0.01 for both). The 2-year cumulative incidence of LR for patients with p53abnl versus wild type p53 and LVSI versus no LVSI was 11.1% (95% CI 0-25.6) versus 2.2% (95% CI 0-5.25; p = 0.04), and 11.4% (95% CI 2.0-20.9) versus 0%, respectively (p < 0.01). The 2-year cumulative RR in patients with LVSI versus no LVSI was 6.9% (95% CI 0-14.4) versus 0% (p = 0.05). No patients who completed pelvic RT experienced an in-field recurrence. CONCLUSIONS Despite LN assessment, patients with high-intermediate risk early-stage or stage IIIC (with positive lymph nodes only but no other stage II or III risk factors) endometrial cancer with p53abnl expression and/or LVSI have worse outcomes. These patients may derive benefit from intensification with EBRT to improve local and pelvic control.
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Affiliation(s)
- Caressa Hui
- Department of Radiation Oncology, Stanford University, USA
| | | | - Rie von Eyben
- Department of Radiation Oncology, Stanford University, USA
| | - Oliver Dorigo
- Division Gynecologic Oncology, Stanford Department of Obstetrics and Gynecology, Stanford Women's Cancer Center and Stanford Cancer Institute, USA
| | - Babak Litkouhi
- Division Gynecologic Oncology, Stanford Department of Obstetrics and Gynecology, Stanford Women's Cancer Center and Stanford Cancer Institute, USA
| | - Malte Renz
- Division Gynecologic Oncology, Stanford Department of Obstetrics and Gynecology, Stanford Women's Cancer Center and Stanford Cancer Institute, USA
| | - Amer Karam
- Division Gynecologic Oncology, Stanford Department of Obstetrics and Gynecology, Stanford Women's Cancer Center and Stanford Cancer Institute, USA
| | | | | | - Elizabeth Kidd
- Department of Radiation Oncology, Stanford University, USA.
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Oliver-Perez MR, Padilla-Iserte P, Arencibia-Sanchez O, Martin-Arriscado C, Muruzabal JC, Diaz-Feijóo B, Cabrera S, Coronado P, Martín-Salamanca MB, Pantoja-Garrido M, Marcos-Sanmartin J, Cabezas-López E, Lorenzo C, Beric D, Rodriguez-Hernandez JR, Roldan-Rivas F, Gilabert-Estelles J, Sanchez L, Laseca-Modrego M, Tauste-Rubio C, Gil-Ibañez B, Tejerizo-Garcia A. Lymphovascular Space Invasion in Early-Stage Endometrial Cancer (LySEC): Patterns of Recurrence and Predictors. A Multicentre Retrospective Cohort Study of the Spain Gynecologic Oncology Group. Cancers (Basel) 2023; 15:cancers15092612. [PMID: 37174081 PMCID: PMC10177148 DOI: 10.3390/cancers15092612] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
The main aim is to compare oncological outcomes and patterns of recurrence of patients with early-stage endometrioid endometrial cancer according to lymphovascular space invasion (LVSI) status. The secondary objective is to determine preoperative predictors of LVSI. We performed a multicenter retrospective cohort study. A total of 3546 women diagnosed with postoperative early-stage (FIGO I-II, 2009) endometrioid endometrial cancer were included. Co-primary endpoints were disease-free survival (DFS), overall survival (OS), and pattern of recurrence. Cox proportional hazard models were used for time-to-event analysis. Univariate and multivariate logistical regression models were employed. Positive LVSI was identified in 528 patients (14.6%) and was an independent prognostic factor for DFS (HR 1.8), OS (HR 2.1) and distant recurrences (HR 2.37). Distant recurrences were more frequent in patients with positive LVSI (78.2% vs. 61.3%, p < 0.01). Deep myometrial invasion (OR 3.04), high-grade tumors (OR 2.54), cervical stroma invasion (OR 2.01), and tumor diameter ≥ 2 cm (OR 2.03) were independent predictors of LVSI. In conclusion, in these patients, LVSI is an independent risk factor for shorter DFS and OS, and distant recurrence, but not for local recurrence. Deep myometrial invasion, cervical stroma invasion, high-grade tumors, and a tumor diameter ≥ 2 cm are independent predictors of LVSI.
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Affiliation(s)
- M Reyes Oliver-Perez
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 12 de Octubre Research Institute (i+12), 28041 Madrid, Spain
| | - Pablo Padilla-Iserte
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain
| | - Octavio Arencibia-Sanchez
- Department of Gynecologic Oncology, University Hospital Materno-Infantil de Canarias, 35016 Las Palmas de Gran Canaria, Spain
| | - Cristina Martin-Arriscado
- Scientific Support Unit, Hospital Universitario 12 de Octubre, 12 de Octubre Research Institute (i+12), 28041 Madrid, Spain
| | - Juan Carlos Muruzabal
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Berta Diaz-Feijóo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain
| | - Silvia Cabrera
- Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Pluvio Coronado
- Women's Health Institute of the Hospital Clínico San Carlos, IdISSC, School of Medicine, Complutense University Madrid, 28040 Madrid, Spain
| | | | - Manuel Pantoja-Garrido
- Department of Gynecology and Obstetrics, University Hospital Virgen Macarena, 41009 Sevilla, Spain
| | - Josefa Marcos-Sanmartin
- Departments of Obstetrics and Gynecology, Dr. Balmis General University Hospital, 03010 Alicante, Spain
- Department of Public Health, Miguel Hernandez University, Sant Joan D'Alacant, 03550 Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Elena Cabezas-López
- Department of Gynecologic Oncology, University Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Cristina Lorenzo
- Department of Obstetrics and Gynecology, Hospital Nuestra Señora de la Calendaria, 38010 Santa Cruz de Tenerife, Spain
| | - Duska Beric
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrevieja, 03186 Alicante, Spain
| | | | - Fernando Roldan-Rivas
- Department of Obstetrics and Gynaecology, Clinico Lozano Blesa Hospital, 50009 Zaragoza, Spain
| | - Juan Gilabert-Estelles
- Department of Pediatrics, Obstetrics and Gynecology, University General Hospital of Valencia, 46014 Valencia, Spain
| | - Lourdes Sanchez
- Department of Gynecology and Obstetrics, University General Hospital of Ciudad Real, 13005 Ciudad Real, Spain
| | - Maria Laseca-Modrego
- Department of Gynecologic Oncology, University Hospital Materno-Infantil de Canarias, 35016 Las Palmas de Gran Canaria, Spain
| | - Carmen Tauste-Rubio
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Blanca Gil-Ibañez
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 12 de Octubre Research Institute (i+12), 28041 Madrid, Spain
| | - Alvaro Tejerizo-Garcia
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 12 de Octubre Research Institute (i+12), 28041 Madrid, Spain
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Tutkun Kilinc EC, Korkmaz V, Yalcin HR. Factor affecting lymph node metastasis in uterine papillary serous carcinomas: a retrospective analysis. J OBSTET GYNAECOL 2023; 42:3725-3730. [PMID: 36927276 DOI: 10.1080/01443615.2022.2158311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
The aim of this study was to investigate the risk factors for lymph node metastasis (LNM) in patients with uterine serous cancer (USC) who underwent systematic staging surgery. Eighty patients who were operated on for pure uterine serous papillary carcinoma between 2008 and 2020 in our clinic were retrospectively analysed. The effects of demographic information and clinicohistopathological characteristics of the included patients on LNM were examined. The median age of the patients included in the study was 64.3 and the tumour diameter was 3.8 cm. At the time of diagnosis, 65.8% of the cases were in the advanced stage, while 34.2% were in the early stage. There was no LNM in 42 (52.5%) of the cases, only pelvic in six (7.5%), only paraaortic LNM in four (5%) patients, and both pelvic and paraaortic LNM in 24 (30%) patients. When factors that may affect LNM were evaluated with multivariate analysis, lymphovascular space invasion (LVSI) and cytology positivity were found to be independent risk factors (p < 0.05). In addition, the rate of isolated paraaortic lymph node involvement in LNM positive patients is 5%, which is 100% associated with LVSI.Impact StatementWhat is already known on this subject? Uterine papillary serous carcinomas (UPSC) are an uncommon and aggressive histological subtype of endometrial cancer. The high risk of recurrence and tendency to migrate into the abdomen of these tumours is not always connected with lymph node and distant organ metastasis, tumour size, LVSI positive and depth of myometrial invasion.What do the results of this study add? Most patients with UPSC are diagnosed at an advanced stage. In this study, in which 80 patients with pure serous histology were evaluated retrospectively, and LVSI and peritoneal cytology positivity were found to be two important prognostic factors for lymph node metastasis.What are the implications of these findings for clinical practice and/or further research? In this study, cytology and LVSI positivity were identified as two predictive markers for LNM, and it is seen that cytology positivity still maintains its importance in these tumours with peritoneal spread. Furthermore, patients with isolated paraaortic lymph node involvement were shown to be LVSI positive, and isolated paraaortic LNM should be investigated in patients with LVSI positivity.
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Affiliation(s)
| | - Vakkas Korkmaz
- Department of Gynecologic Oncology, Faculty of Medicine, Etlik City Hospital, University of Health Sciences, Ankara, Turkey
| | - Hakan Rasit Yalcin
- Department of Gynecologic Oncology, Faculty of Medicine, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Nasioudis D, Oh J, Ko EM, Haggerty AF, Cory L, Giuntoli Ii RL, Kim SH, Morgan MA, Latif NA. Adjuvant chemotherapy for stage I high-intermediate risk endometrial carcinoma with lymph-vascular invasion. Int J Gynecol Cancer 2022; 32:ijgc-2022-003496. [PMID: 35649658 DOI: 10.1136/ijgc-2022-003496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The goal of this study was to evaluate if addition of adjuvant chemotherapy to radiation therapy improves overall survival in patients with high-intermediate risk stage I endometrial carcinoma with lymphovascular invasion. METHODS Patients diagnosed between January 2010 and December 2015 with FIGO (International Federation of Gynecology and Obstetrics) stage I endometrioid endometrial carcinoma with lymphovascular invasion who underwent hysterectomy with lymphadenectomy and met the GOG-99 criteria for high-intermediate risk were identified in the National Cancer Database. Patients who received adjuvant radiotherapy with or without adjuvant chemotherapy (administered within 6 months of surgery) and had at least 1 month of follow-up were selected for further analysis. Overall survival was compared with the log-rank test following stratification by type of radiation treatment. A Cox model was constructed to control for a priori selected confounders. RESULTS A total of 2881 patients who met the inclusion criteria were identified; 2417 (83.9%) patients received radiation therapy alone while 464 (16.1%) received chemoradiation. Rate of adjuvant chemotherapy administration was comparable between patients who received vaginal brachytherapy alone (16.2%), and external beam radiation therapy (with or without vaginal brachytherapy) (15.8%), p=0.78. Rate of chemoradiation was higher for patients with grade 3 (28.8%) tumors compared with those with grade 2 (9.9%) and grade 1 (8.3%) tumors, p<0.001. After controlling for confounders for patients receiving external beam radiation, addition of chemotherapy was not associated with improved overall survival (HR 0.90, 95% CI 0.56 to 1.46). For patients receiving vaginal brachytherapy addition of chemotherapy was associated with better overall survival (HR 0.644, 95% CI 0.45 to 0.92). Benefit was limited to patients with grade 3 tumors, p=0.026; 4-year overall survival rate was 81.1% versus 74.9%. CONCLUSIONS In patients with high-intermediate risk FIGO stage I endometrioid endometrial carcinoma and lymphovascular invasion, addition of chemotherapy to radiation therapy was associated with a survival benefit for patients with grade 3 tumors receiving vaginal brachytherapy.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jinhee Oh
- Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashley F Haggerty
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lori Cory
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert L Giuntoli Ii
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah H Kim
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark A Morgan
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nawar A Latif
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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9
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Sahin EA, Toprak S, Sayal HB, Ekinci T, Yılmaz E, Bakay K, Melekoğlu R, Sezgin B, Tohma YA, Şahin H. Analysis of prognostic factors in Grade 3 endometrioid type endometrial carcinoma. Int J Gynaecol Obstet 2022; 159:719-726. [PMID: 35598153 DOI: 10.1002/ijgo.14277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/25/2022] [Accepted: 05/17/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the prognostic factors of patients with Grade 3 endometrioid endometrial cancer (G3EEC). METHODS This four-center, retrospective study included a total of 129 women with G3EEC. Demographic, clinicopathologic, and survival data were collected. Kaplan-Meier method was used for survival analysis. Predictors of outcome were analyzed using Cox proportional hazards models. RESULTS Median age at the time of diagnosis was 63 (range 39-87) years and median follow up was 37 (range 6-126) months. For the entire cohort, the 5-year disease-free survival (DFS) and overall survival (OS) were 54.3% and 63.6%, respectively. The 5-year DFS rates for lymphovascular space invasion (LVSI) -positive and -negative patients were 41.6% and 88.3%, respectively (P < 0.001). The 5-year OS rates for LVSI-positive and -negative patients were 54.7% and 88.3%, respectively (P = 0.001). Positive LVSI status was identified as the independent prognostic factor for decreased DFS and OS (hazard ratio [HR] 5.5, 95% confidence interval [CI] 1.65-18.86; P = 0.006 versus HR 4.4, 95% CI 1.33-14.58; P = 0.013, respectively). CONCLUSION LVSI seems to be an independent prognostic factor for decreased DFS and OS in G3EEC patients.
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Affiliation(s)
- Eda Adeviye Sahin
- Department of Obstetrics and Gynecology, Kolan international Hospital, Istanbul, Turkey
| | - Serhat Toprak
- Department of Pathology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Hasan Berkan Sayal
- Department of Obstetrics and Gynecology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Tekin Ekinci
- Department of Obstetrics and Gynecology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Ercan Yılmaz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Kadir Bakay
- Department of Obstetrics and Gynecology, Faculty of Medicine, 19 Mayıs University, Samsun, Turkey
| | - Rauf Melekoğlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Burak Sezgin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Yusuf Aytaç Tohma
- Department of Obstetrics and Gynecology, Bahçeci Health Group, Ankara, Turkey
| | - Hanifi Şahin
- Department of Gynecologic Oncology, Privata Clinic, Istanbul, Turkey
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10
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Benbrook DM, Hocker JRS, Moxley KM, Hanas JS. Sera Protein Signatures of Endometrial Cancer Lymph Node Metastases. Int J Mol Sci 2022; 23:3277. [PMID: 35328698 PMCID: PMC8954239 DOI: 10.3390/ijms23063277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 12/10/2022] Open
Abstract
The presence of lymph node metastases in endometrial cancer patients is a critical factor guiding treatment decisions; however, surgical and imaging methods for their detection are limited by morbidity and inaccuracy. To determine if sera can predict the presence of positive lymph nodes, sera collected from endometrial cancer patients with or without lymph node metastases, and benign gynecology surgical patients (N = 20 per group) were subjected to electron spray ionization mass spectrometry (ES-MS). Peaks that were significantly different among the groups were evaluated by leave one out cross validation (LOOCV) for their ability to differentiation between the groups. Proteins in the peaks were identified by MS/MS of five specimens in each group. Ingenuity Pathway Analysis was used to predict pathways regulated by the protein profiles. LOOCV of sera protein discriminated between each of the group comparisons and predicted positive lymph nodes. Pathways implicated in metastases included loss of PTEN activation and PI3K, AKT and PKA activation, leading to calcium signaling, oxidative phosphorylation and estrogen receptor-induced transcription, leading to platelet activation, epithelial-to-mesenchymal transition and senescence. Upstream activators implicated in these events included neurostimulation and inflammation, activation of G-Protein-Coupled Receptor Gβγ, loss of HER-2 activation and upregulation of the insulin receptor.
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Affiliation(s)
- Doris Mangiaracina Benbrook
- Gynecologic Oncology Section, Department of Obstetrics and Gynecology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - James Randolph Sanders Hocker
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Katherine Marie Moxley
- Department of Obstetrics and Gynecology, Rogel Cancer Center, University of Michigan Health System, Ann Arbor, MI 48109, USA;
| | - Jay S. Hanas
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
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11
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Zhang H, Yu R, Zhang L, Wang R, Xiao L. Chemotherapy versus chemoradiotherapy for FIGO stages IB1 and IIA1 cervical squamous cancer patients with lymphovascular space invasion: a retrospective study. BMC Cancer 2022; 22:202. [PMID: 35193525 PMCID: PMC8864837 DOI: 10.1186/s12885-022-09309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 02/17/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the impact of different adjuvant therapy on IB1 and IIA1 stage cervical squamous cell cancer patients with lymphovascular space invasion. It also aimed to analyze the relationship between lymphovascular space invasion and other clinical pathological characteristics on IB1 and IIA1 stage cervical squamous cell cancer patients. Methods This retrospective observational study collected data of FIGO stages IB1 and IIA1 squamous cervical cancer patients at the First Affiliated Hospital of Chongqing Medical University between 2014 and 2018. A correlation analysis between lymphovascular space invasion and other clinical or pathological factors was conducted. Prognosis analysis of patients with lymphovascular space invasion were performed to assess associations between clinical-pathological characteristics and survival. Results A total of 357 women were identified including 110 (30.8%) with lymphovascular space invasion, 247 (69.2%) without lymphovascular space invasion. Both middle 1/3 cervical stromal invasion (p = 0.000) and deep 1/3 cervical stromal invasion (p = 0.000) were independently associated with lymphovascular space invasion. Among lymphovascular space involved women, tumor differentiation (P = 0.001) and postoperative therapy (P = 0.036) had a significant influence on disease recurrence. Multivariate analysis showed that lymph node metastasis (P = 0.017), poorer tumor differentiation (P = 0.036) and postoperative chemotherapy alone (P = 0.021) can increase the risk of tumor relapse. Conclusion Our study suggested that the presence of deep stromal invasion independently increases the risk of lymphovascular space invasion. Compared with chemotherapy, chemoradiotherapy seems to improve progression-free survival in squamous cervical cancer patients with lymphovascular space invasion.
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Affiliation(s)
- Hao Zhang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Rao Yu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lan Zhang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Rong Wang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lin Xiao
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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12
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Bai H, Yuan F, Liang B, Sun H, Gao Y, Jin M, Xing X. Clinicopathological characteristics and treatment of patients with high-grade endometrial stromal sarcoma: A retrospective study of 40 cases. Medicine (Baltimore) 2022; 101:e28490. [PMID: 35029198 PMCID: PMC8758035 DOI: 10.1097/md.0000000000028490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 12/16/2021] [Indexed: 01/05/2023] Open
Abstract
To investigate the clinicopathological characteristics of patients with high-grade endometrial stromal sarcoma (HG-ESS).The clinicopathological characteristics, treatments, and prognostic information of consecutive HG-ESS patients were collected from medical records and then evaluated.A total of 40 women were included in the analysis. The immunohistochemical profiles indicated that HG-ESS tumors tend to be locally or weakly positive for vimentin (100%) and CD10 (72.0%) but mostly negative for desmin (7.7%) and AE1/AE3 (9.1%). The progression-free survival intervals and the clinical benefit rates of patients receiving radiotherapy and/or chemotherapy were slightly longer and higher than those receiving simple observation (progression-free survival: 6 and 5 months vs 2 months; clinical benefit rate: 83.3% and 75.0% vs 28.6%). The 1-year disease-specific survival (DSS) rate was 62.7%. Tumor size, myometrial invasion, lymphovascular space invasion, cervical involvement, Federation International of Gynecology and Obstetrics (FIGO) stage, and residual disease all significantly affected the DSS rate (P < .001, =.002, <.001, =.004, <.001, and <.001, respectively). For patients with stage I disease, the 1-year DSS rate was as high as 91.7%, in contrast to 66.7%, 26.7%, and 0% for those with stage II, III, and IV disease, respectively.HG-ESS is associated with an adverse prognosis. FIGO stage could effectively predict the prognosis of patients with this lethal disease. Immunohistochemical markers, vimentin+/CD10+ (local or very weak), in combination with desmin-/AE1/AE3-, may be helpful for improving the diagnostic accuracy of this lethal condition. The therapeutic roles of adjuvant chemotherapy and radiotherapy warrant further investigation.
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Affiliation(s)
- Huimin Bai
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fang Yuan
- Department of Obstetrics and Gynecology, the Affiliated Hospital Qingdao University, Qingdao, China
| | - Bing Liang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hengzi Sun
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yutao Gao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Mulan Jin
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoming Xing
- Department of Pathology, the Affiliated Hospital Qingdao University, Qingdao, China
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13
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Wang J, Xu P, Yang X, Yu Q, Xu X, Zou G, Zhang X. Association of Myometrial Invasion With Lymphovascular Space Invasion, Lymph Node Metastasis, Recurrence, and Overall Survival in Endometrial Cancer: A Meta-Analysis of 79 Studies With 68,870 Patients. Front Oncol 2021; 11:762329. [PMID: 34746002 PMCID: PMC8567142 DOI: 10.3389/fonc.2021.762329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/30/2021] [Indexed: 12/22/2022] Open
Abstract
Background Myometrial invasion has been demonstrated to correlate to clinicopathological characteristics and prognosis in endometrial cancer. However, not all the studies have the consistent results and no meta-analysis has investigated the association of myometrial invasion with lymphovascular space invasion (LVSI), lymph node metastasis (LNM), recurrence, and overall survival (OS). Therefore, a meta-analysis was performed to evaluate the relationship between myometrial invasion and clinicopathological characteristics or overall survival in endometrial cancer. Materials and Methods A search of Pubmed, Embase, and Web of Science was carried out to collect relevant studies from their inception until June 30, 2021. The quality of each included study was evaluated using Newcastle–Ottawa scale (NOS) scale. Review Manager version 5.4 was employed to conduct the meta-analysis. Results A total of 79 articles with 68,870 endometrial cancer patients were eligible including 9 articles for LVSI, 29 articles for LNM, 8 for recurrence, and 37 for OS in this meta-analysis. Myometrial invasion was associated with LVSI (RR 3.07; 95% CI 2.17–4.35; p < 0.00001), lymph node metastasis (LNM) (RR 4.45; 95% CI 3.29–6.01; p < 0.00001), and recurrence (RR 2.06; 95% CI 1.58–2.69; p < 0.00001). Deep myometrial invasion was also significantly related with poor OS via meta-synthesis of HRs in both univariate survival (HR 3.36, 95% CI 2.35–4.79, p < 0.00001) and multivariate survival (HR 2.00, 95% CI 1.59–2.53, p < 0.00001). Funnel plot suggested that there was no significant publication bias in this study. Conclusion Deep myometrial invasion correlated to positive LVSI, positive LNM, cancer recurrence, and poor OS for endometrial cancer patients, indicating that myometrial invasion was a useful evaluation criterion to associate with clinical outcomes and prognosis of endometrial cancer since depth of myometrial invasion can be assessed before surgery. The large scale and comprehensive meta-analysis suggested that we should pay more attention to myometrial invasion in clinical practice, and its underlying mechanism also deserves further investigation.
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Affiliation(s)
- Jianzhang Wang
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ping Xu
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xueying Yang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qin Yu
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinxin Xu
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gen Zou
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinmei Zhang
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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14
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Lorenzini J, Deberti M, Body G, Carcopino X, Touboul C, Dabi Y, Collinet P, Coutant C, Akladios C, Lavoué V, Bolze PA, Huchon C, Bricou A, Canlorbe G, Mimoun C, Bendifallah S, Ouldamer L. Lymphovascular space invasion and Estrogen Receptor status in high-grade serous ovarian cancer-a multicenter study by the FRANCOGYN group. J Gynecol Obstet Hum Reprod 2021; 51:102242. [PMID: 34715402 DOI: 10.1016/j.jogoh.2021.102242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of Lymphovascular Space Invasion (LVSI) on Overall Survival (OS) and Recurrence-Free Survival (RFS) in patients managed for high-grade serous epithelial ovarian cancer (HGSOC). MATERIALS AND METHODS Retrospective multicenter study by the FRANCOGYN research group between January 2001 and December 2018. All patients managed for HGSOC and for whom histological slides for the review of LVSI were available, were included. The characteristics of patients with LVSI (LVSI group) were compared to those without LVSI (No LVSI group). A Cox analysis for OS and RFS analysis was performed in all populations. RESULTS Over the study period, 410 patients were included in the thirteen institutions. Among them, 289 patients had LVSI (33.9%). LVSI was an independent predictive factor for poorer Overall and Recurrence-Free Survival. LVSI affected OS (p<0.001) and RFS (p<0.001), Association of LVSI status and estrogen receptor status (ER) also affected OS and RFS (p=0.04; p=0.04 respectively). CONCLUSION The presence of LVSI in HGSOC has an impact on OS and RFS and should be routinely included in the pathology examination along with ER status.
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Affiliation(s)
- Jerome Lorenzini
- Department of Gynecology, Service de Gynécologie, Tours University Hospital, 2 Boulevard Tonnellé, Tours 37044, France
| | - Marion Deberti
- Department of Gynecology, Service de Gynécologie, Tours University Hospital, 2 Boulevard Tonnellé, Tours 37044, France
| | - Gilles Body
- Department of Gynecology, Service de Gynécologie, Tours University Hospital, 2 Boulevard Tonnellé, Tours 37044, France; INSERM U1069 Université François-Rabelais, Tours, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Cyril Touboul
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Creteil, France
| | - Yohann Dabi
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Creteil, France
| | - Pierre Collinet
- Department of Gynecologic surgery, Jeanne de Flandre Hospital, CHRU LILLE, Rue Eugene Avinée 59037 Lille Cedex, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Centre, Dijon, France
| | - Cherif Akladios
- Department of Surgical Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Vincent Lavoué
- Department of Gynecology, Rennes University Hospital, France. INSERM 1242, COSS, Rennes. Université de Rennes 1. France
| | - Pierre-Adrien Bolze
- Department of Gynecologic and Oncologic Surgery and Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, Université Lyon 1, France
| | - Cyrille Huchon
- Department of gynecology, CHI Poissy-St-Germain, Université Versailles-Saint-Quentin en Yvelines, EA 7285 Risques cliniques et sécurité en santé des femmes, Université Versailles-Saint-Quentin en Yvelines, Versailles, France
| | - Alexandre Bricou
- Department of Gynecology, Bobigny University, AP-HP, Jean-Verdier Hospital, Bondy, France
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière, University Hospital, Paris, France
| | - Camille Mimoun
- Department of Gynecology and Obstetrics, Lariboisiere Hospital, 750019 Paris, France
| | - Sofiane Bendifallah
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Lobna Ouldamer
- Department of Gynecology, Service de Gynécologie, Tours University Hospital, 2 Boulevard Tonnellé, Tours 37044, France; INSERM U1069 Université François-Rabelais, Tours, France.
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15
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Substantial Lymphovascular Space Invasion Is an Adverse Prognostic Factor in High-risk Endometrial Cancer. Int J Gynecol Pathol 2021; 41:227-234. [PMID: 34392268 DOI: 10.1097/pgp.0000000000000805] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Approximately 15% of patients with endometrial cancer present with high-risk disease (HREC). Moreover, assessing the extent of lymphovascular space invasion (LVSI) may provide prognostic insight among patients with HREC. The aim of this study was to determine whether the extent of LVSI can serve as a prognostic factor in HREC. All cases of ESMO-ESGO-ESTRO 2016 classified HREC in the Danish Gynecological Cancer Database (DGCD) diagnosed from 2005 to 2012 were reviewed for the presence and extent of LVSI (categorized using a 3-tiered definition). We used the Kaplan-Meier analysis to calculate actuarial survival rates, both adjusted and unadjusted Cox regression analyses were used to calculate the proportional hazard ratio (HR). A total of 376 patients were included in our analysis. Among 305 patients with stage I/II HREC, 8.2% and 6.2% had focal or substantial LVSI, respectively, compared with 12.7% and 38.0% of 71 patients with stage III/IV HREC, respectively. Moreover, the estimated 5-yr recurrence-free survival rate was significantly lower among patients with substantial LVSI compared with patients with no LVSI for both stage I/II (HR: 2.8; P=0.011) and stage III/IV (HR: 2.9; P=0.003) patients. Similarly, overall survival was significantly lower among patients with substantial LVSI for both stage I/II (HR: 3.1; P<0.001) and stage III/IV (HR: 3.2; P=0.020) patients. In patients with HREC, substantial LVSI is an independent adverse prognostic factor for lymph node and distant metastases, leading to reduced survival. Thus, the extent of LVSI should be incorporated into routine pathology reports in order to guide the appropriate choice of adjuvant treatment.
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Lymphovascular invasion as a criterion for adjuvant chemotherapy for FIGO stage I-IIa clear cell carcinoma, mucinous, low grade serous and low grade endometrioid ovarian cancer. J Gynecol Obstet Hum Reprod 2021; 50:102193. [PMID: 34224900 DOI: 10.1016/j.jogoh.2021.102193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of lymphovascular space invasion (LVSI) on overall survival (OS) and recurrence-free survival (RFS) in patients managed for stage I-IIa clear cell carcinoma, mucinous, low-grade serous and low-grade endometrioid ovarian cancer MATERIAL AND METHODS: Retrospective multicentre study of the research group FRANCOGYN between January 2001 and December 2018. All patients managed for stage I-IIa clear cell carcinoma, mucinous /low grade serous and endometrioid ovarian cancer and for whom the presence of histological slides for the review of LVSI was available, were included. Patient's characteristics with LVSI (LVSI group) were compared to those without LVSI (No LVSI group). A cox analysis for OS and RFS analysis were performed in all population. RESULTS Over the study period, 133 patients were included in the thirteen institutions. Among them, 12 patients had LVSI (9%). LVSI was an independent predictive factor for poorer Overall and recurrence free survivals. LVSI affected OS (p < 0.001) and RFS (p = 0.0007), CONCLUSION: The presence of LVSI in stage I-IIa clear cell carcinoma, mucinous /low grade serous and endometrioid ovarian cancer has an impact on OS and RFS and should put them at high risk and consider the option of adjuvant chemotherapy.
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Substantial lymphovascular space invasion predicts worse outcomes in early-stage endometrioid endometrial cancer. Brachytherapy 2021; 20:527-535. [PMID: 33485810 DOI: 10.1016/j.brachy.2020.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/04/2020] [Accepted: 12/16/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Substantial as opposed to focal or no lymphovascular space invasion (LVSI) is proposed as an independent adverse prognostic factor in patients with early-stage endometrioid endometrial cancer (EEC). We reviewed outcomes of patients treated with adjuvant vaginal brachytherapy (VB) alone in a single institution, stratified by LVSI extent. METHODS AND MATERIALS Retrospective review identified Stage I-II EEC patients receiving VB alone from 2010 to 2017. Extent of LVSI was reported as none, focal, or substantial. Kaplan-Meier estimates and Log-Rank test were used to determine significance between variables. Cox proportional hazards model was used for multivariate analyses. RESULTS In total, 325 patients were identified with a median follow-up of 35 (23-48) months. LVSI was found in 112 patients with extent reported in 78, 45 (58%) had focal, and 33 (42%) substantial LVSI. Estimated disease-free survival for those with substantial LVSI was 73 (57-94)%, focal LVSI 89 (79-100)%, and no LVSI 94 (90-98)% at 48 months (p = 0.012). On multivariate analyses substantial LVSI was the only risk factor predictive of pelvic [HR substantial vs no: 7.2 (1.0-51.6); p = 0.048] and distant failure [HR substantial vs no: 4.4 (1.2-16.3); p = 0.027]. Both high-grade disease [HR 3 vs 1: 5.5 (1.2-25.6); p = 0.031] and extent of LVSI [HR substantial vs no: 4.4 (1.7-11.4); p = 0.002] predicted for worse disease-free survival. DISCUSSION Substantial LVSI was the strongest adverse prognostic factor for pelvic and distant failure in this cohort of EEC patients receiving adjuvant VB alone, suggesting this subset may benefit from additional adjuvant therapy. This study underscores the importance of quantifying LVSI extent in EEC.
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Cuylan ZF, Akilli H, Gungorduk K, Demirkiran F, Oz M, Salman MC, Sozen H, Celik H, Gokcu M, Bese T, Meydanli MM, Ozgul N, Topuz S, Kuscu E, Kuru O, Gokmen S, Gultekin M, Ayhan A. Is the extent of lymphadenectomy a prognostic factor in International Federation of Gynecology and Obstetrics stage II endometrioid endometrial cancer? J Obstet Gynaecol Res 2021; 47:1134-1144. [PMID: 33426779 DOI: 10.1111/jog.14648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/23/2020] [Accepted: 12/25/2020] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to evaluate the prognostic significance of adequate lymph node dissection (LND) (≥10 pelvic lymph nodes (LNs) and ≥ 5 paraaortic LNs removed) in patients with International Federation of Gynecology and Obstetrics (FIGO) stage II endometrioid endometrial cancer (EEC). METHODS A multicenter department database review was performed to identify patients who had been operated and diagnosed with stage II EEC at seven centers in Turkey retrospectively. Demographic, clinicopathological, and survival data were collected and analyzed. RESULTS We identified 284 women with stage II EEC. There were 170 (59.9%) patients in the adequate lymph node dissection (LND) group and 114 (40.1%) in the inadequate LND group. The 5-year overall survival (OS) rate of the inadequate LND group was significantly lower than that of the adequate LND group (84.1% vs. 89.1%, respectively; p = 0.028). In multivariate analysis, presence of lymphovascular space invasion (LVSI) (hazard ratio [HR]: 2.39, 95% confidence interval [CI]: 1.23-4.63; p = 0.009), age ≥ 60 (HR: 3.30, 95% CI: 1.65-6.57; p = 0.001], and absence of adjuvant therapy (HR: 2.74, 95% CI: 1.40-5.35; p = 0.003) remained as independent risk factors for decreased 5-year disease-free survival (DFS). Inadequate LND (HR: 2.34, 95% CI: 1.18-4.63; p < 0.001), age ≥ 60 (HR: 2.67, 95% CI: 1.25-5.72; p = 0.011), and absence of adjuvant therapy (HR: 4.95, 95% CI: 2.28-10.73; p < 0.001) were independent prognostic factors for decreased 5-year OS in multivariate analysis. CONCLUSION Adequate LND and adjuvant therapy were significant for the improvement of outcomes in FIGO stage II EEC patients. Furthermore, LVSI was associated with worse 5-year DFS rate in stage II EEC.
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Affiliation(s)
| | - Huseyin Akilli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Kemal Gungorduk
- Department of Gynecologic Oncology, Izmir Tepecik Education and Research Hospital, Izmır, Turkey
| | - Fuat Demirkiran
- Department of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Oz
- Department of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Coskun Salman
- Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hamdullah Sozen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Husnu Celik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Mehmet Gokcu
- Department of Gynecologic Oncology, Izmir Tepecik Education and Research Hospital, Izmır, Turkey
| | - Tugan Bese
- Department of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Nejat Ozgul
- Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Samet Topuz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esra Kuscu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Oguzhan Kuru
- Department of Gynecologic Oncology, Izmir Tepecik Education and Research Hospital, Izmır, Turkey
| | - Sibel Gokmen
- Department of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Gultekin
- Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
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Is It Possible to Develop a Prediction Model for Lymphovascular Space Invasion in Endometrioid Endometrial Cancer? Int J Gynecol Pathol 2021; 39:213-220. [PMID: 31033799 DOI: 10.1097/pgp.0000000000000596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this retrospective study was to define a risk index that would serve as a surrogate marker of lymphovascular space invasion (LVSI) in women with endometrioid endometrial cancer (EC). MATERIALS AND METHODS Final pathology reports of 498 women who underwent surgery with curative intent for endometrioid EC between January 2008 and June 2018 were retrospectively reviewed. Logistic regression was used to investigate clinicopathologic factors associated with positive LVSI status. Independent risk factors for LVSI were used to build a risk model and "risk of LVSI index" was defined as "tumor grade×primary tumor diameter×percentage of myometrium involved." The scores used in the "risk of LVSI index" were weighted according to the odds ratios assigned for each variable. The risk of LVSI index was noted for each patient. The diagnostic performance of the model was expressed as sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio. RESULTS According to the "risk of LVSI index," presence of LVSI was correctly estimated in 89 of 104 LVSI-positive women at a cutoff of 161.0 (sensitivity 85.5%, specificity 79.4%, negative predictive value 95.4%, positive predictive value 52.3%, positive likelihood ratio 4.15, negative likelihood ratio 0.18). The area under curve of the receiver-operating characteristics was 0.90 (95% confidence interval, 0.87-0.93) at this cutoff. CONCLUSIONS It seems possible to predict the presence of LVSI in women with endometrioid EC when the "risk of LVSI index" is calculated. However, external validation of this model is warranted.
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20
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Restaino S, Tortorella L, Dinoi G, Zannoni GF, Baroni A, Capasso I, Distefano E, Sozzi G, Chiantera V, Scambia G, Fanfani F. Semiquantitative evaluation of lymph-vascular space invasion in patients affected by endometrial cancer: Prognostic and clinical implications. Eur J Cancer 2020; 142:29-37. [PMID: 33217679 DOI: 10.1016/j.ejca.2020.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/11/2020] [Accepted: 10/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The interpretation of lymph-vascular space invasion (LVSI) is usually qualitative, as presence or absence. The aim of this study is to investigate the prognostic role of LVSI in patients affected by endometrial cancer, when evaluated with a semiquantitative analysis. METHODS This retrospective multicentre study enrolled patients who received a histologically confirmed diagnosis of endometrial cancer. The assessment of LVSI was semiquantitative in accordance with the three-tiered scoring system (absent, focal and diffuse). RESULTS Among 1258 patients with surgical-stage endometrial cancer, LVSI has been found in 32.8% of cases (n = 412), whose 12.7% (n = 160) were focal, and 20% (n = 252) diffuse. The rate of lymph node metastasis increased from the 5% in patients with no LVSI to 15% in patients with focal LVSI and 33% in those with diffuse LVSI (p < 0.001). Distant recurrences were more frequent in patients with diffuse LVSI than in focal or no LVSI (24.9% versus 14.7% and 6.6%, respectively, p < 0.001). Diffuse LVSI was found to significantly increase the risk of distant metastasis (adjusted odds ratio (A OR) 2.57, p < 0.001). Adjuvant radiation were associated with improved overall survival (OS) and disease-free survival (DFS) in patients with diffuse LVSI. CONCLUSION The presence of diffuse LVSI is an independent risk factor for both lymph node metastasis and distant recurrence in endometrial cancer patients, and it is associated with a significantly decreased OS and DFS. Adjuvant radiation improved survival regardless of grading, histotype and lymph nodal metastasis in women with diffuse LVSI.
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Affiliation(s)
- Stefano Restaino
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento per La Tutela Della Salute Della Donna e Della Vita Nascente, L.go A. Gemelli, 00167, Roma, Italy
| | - Lucia Tortorella
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento per La Tutela Della Salute Della Donna e Della Vita Nascente, L.go A. Gemelli, 00167, Roma, Italy
| | | | - Gian-Franco Zannoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Area Anatomia Patologica, Dipartimento per La Tutela Della Salute Della Donna e Della Vita Nascente, L.go A. Gemelli, 00167, Roma, Italy
| | | | | | | | - Giulio Sozzi
- Dipartimento di Ginecologia Oncologica, Università di Palermo, Italy
| | - Vito Chiantera
- Dipartimento di Ginecologia Oncologica, Università di Palermo, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento per La Tutela Della Salute Della Donna e Della Vita Nascente, L.go A. Gemelli, 00167, Roma, Italy; Università Cattolica Del Sacro Cuore, Roma, Italy.
| | - Francesco Fanfani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento per La Tutela Della Salute Della Donna e Della Vita Nascente, L.go A. Gemelli, 00167, Roma, Italy; Università Cattolica Del Sacro Cuore, Roma, Italy
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21
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Malignant peritoneal cytology and decreased survival of women with stage I endometrioid endometrial cancer. Eur J Cancer 2020; 133:33-46. [PMID: 32434109 DOI: 10.1016/j.ejca.2020.03.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/18/2020] [Accepted: 03/29/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND To examine the association between malignant peritoneal cytology and survival in women with early-stage endometrioid endometrial cancer. METHODS This is a retrospective cohort study using the Surveillance, Epidemiology, and End Results Program from 2010 to 2016. Women with stage I endometrioid endometrial cancer who had peritoneal cytology testing at hysterectomy were examined (N = 24,800). Characteristics and survival related to malignant peritoneal cytology were assessed. The propensity score inverse probability of treatment weighting was used to balance the measured covariates. FINDINGS Malignant peritoneal cytology was reported in 1081 (4.4%) women. In multivariable analysis, stage IB disease and moderately/poorly differentiated tumours were associated with an increased likelihood of malignant peritoneal cytology (both P < 0.05). In a weighted model, malignant peritoneal cytology was associated with decreased cause-specific survival (5-year rates, 92.1% versus 96.8%, hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.56-2.52) and overall survival (89.4% versus 93.1%, HR 1.41, 95% CI 1.16-1.72). In sensitivity analyses, malignant peritoneal cytology was associated with decreased overall survival in the high-intermediate-risk group (5-year rates, 77.8% versus 83.6%, HR 1.57, 95% CI 1.20-2.06) and decreased cause-specific survival in the low-risk group (95.4% versus 98.0%, HR 1.64, 95% CI 1.01-2.68). In the high-intermediate-risk group with malignant peritoneal cytology, postoperative chemotherapy was associated with improved overall survival compared to whole pelvic radiotherapy (5-year rates, 82.7% versus 64.6%, HR 0.36, 95% CI 0.14-0.96). This association was not observed in negative cytology cases (81.5% versus 79.7%, HR 0.78, 95% CI 0.53-1.14). INTERPRETATION Malignant peritoneal cytology may be associated with decreased survival in stage I endometrioid endometrial cancer.
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22
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Ørtoft G, Lausten-Thomsen L, Høgdall C, Hansen ES, Dueholm M. Lymph-vascular space invasion (LVSI) as a strong and independent predictor for non-locoregional recurrences in endometrial cancer: a Danish Gynecological Cancer Group Study. J Gynecol Oncol 2020; 30:e84. [PMID: 31328462 PMCID: PMC6658591 DOI: 10.3802/jgo.2019.30.e84] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/26/2019] [Accepted: 04/06/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the effect of lymph-vascular space invasion (LVSI) on location of recurrences in Danish patients with endometrial cancer. METHODS This national cohort study (2005-2012) included 4,380 radically operated patients (no visual tumor, all distant metastasis removed). LVSI status was recorded in 3,377 (77.1%). In stage I patients, 2.6% received adjuvant radiotherapy and 1.4% adjuvant chemotherapy. Adjusted Cox regression was used to compare actuarial recurrence rates. RESULTS LVSI was present in 18.7% of 3,377 patients with known LVSI status. Of these, 7.6% stage I patients with LVSI experienced an isolated locoregional and 19.4% a non-locoregional recurrence. Compared to no LVSI, 5-year recurrence rate was higher (25.5% vs. 8.5%) in patients with LVSI and the frequency of distant recurrences was strikingly higher (stage I: 15.2% vs. 2.7%), the effect being similar across International Federation of Gynecology and Obstetrics stages and histological types. In intermediate-risk stage I patients with LVSI, 8.0% experienced an isolated locoregional recurrence compared to 20.1% with non-locoregional recurrence, giving these patients a seriously adverse risk of survival. A separate analysis in patients with recurrences demonstrated that those with LVSI had significantly more distant recurrences (55.4% vs. 29.9%) and fewer isolated vaginal recurrences (24.3% vs. 42.8%) than patients with no LVSI. CONCLUSION LVSI is a strong independent risk factor for the development of non-locoregional recurrences even in intermediate-risk stage I endometrial cancer. The non-locoregional recurrence pattern suggests a future focus for optimization of postoperative treatment in these patients.
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Affiliation(s)
- Gitte Ørtoft
- Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | | | - Claus Høgdall
- Department of Gynecology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Estrid S Hansen
- Department of Histopathology, Aarhus University Hospital, Aarhus, Denmark
| | - Margit Dueholm
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
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23
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Beavis AL, Yen TT, Stone RL, Wethington SL, Carr C, Son J, Chambers L, Michener CM, Ricci S, Burkett WC, Richardson DL, Staley AS, Ahn S, Gehrig PA, Torres D, Dowdy SC, Sullivan MW, Modesitt SC, Watson C, Veade A, Ehrisman J, Havrilesky L, Secord AA, Loreen A, Griffin K, Jackson A, Viswanathan AN, Jager LR, Fader AN. Adjuvant therapy for early stage, endometrial cancer with lymphovascular space invasion: Is there a role for chemotherapy? Gynecol Oncol 2020; 156:568-574. [PMID: 31948730 DOI: 10.1016/j.ygyno.2019.12.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Lymphovascular space invasion (LVSI) is an independent risk factor for recurrence and poor survival in early-stage endometrioid endometrial cancer (EEC), but optimal adjuvant treatment is unknown. We aimed to compare the survival of women with early-stage EEC with LVSI treated postoperatively with observation (OBS), radiation (RAD, external beam and/or vaginal brachytherapy), or chemotherapy (CHEMO)+/-RAD. METHODS This was a multi-institutional, retrospective cohort study of women with stage I or II EEC with LVSI who underwent hysterectomy+/-lymphadenectomy from 2005 to 2015 and received OBS, RAD, or CHEMO+/-RAD postoperatively. Progression-free survival and overall survival were evaluated using Kaplan-Meier estimates and Cox proportional hazards models. RESULTS In total, 478 women were included; median age was 64 years, median follow-up was 50.3 months. After surgery, 143 (30%) underwent OBS, 232 (48.5%) received RAD, and 103(21.5%) received CHEMO+/-RAD (95% of whom received RAD). Demographics were similar among groups, but those undergoing OBS had lower stage and grade. A total of 101 (21%) women recurred. Progression-free survival (PFS) was improved in both CHEMO+/-RAD (HR = 0.18, 95% CI: 0.09-0.39) and RAD (HR = 0.31, 95% CI: 0.18-0.54) groups compared to OBS, though neither adjuvant therapy was superior to the other. However, in grade 3 tumors, the CHEMO+/-RAD group had superior PFS compared to both RAD (HR 0.25; 95% CI: 0.12-0.52) and OBS cohorts (HR = 0.10, 95% CI: 0.03-0.32). Overall survival did not differ by treatment. CONCLUSIONS In early-stage EEC with LVSI, adjuvant therapy improved PFS compared to observation alone. In those with grade 3 EEC, adjuvant chemotherapy with or without radiation improved PFS compared to observation or radiation alone.
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Affiliation(s)
- Anna L Beavis
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Ting-Tai Yen
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebecca L Stone
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephanie L Wethington
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Caitlin Carr
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Ji Son
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Laura Chambers
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Chad M Michener
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Stephanie Ricci
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Wesley C Burkett
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Debra L Richardson
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Allison-Stuart Staley
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Susie Ahn
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Paola A Gehrig
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Diogo Torres
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Sean C Dowdy
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Mackenzie W Sullivan
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA
| | - Susan C Modesitt
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA
| | - Catherine Watson
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Ashely Veade
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Jessie Ehrisman
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Laura Havrilesky
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Angeles Alvarez Secord
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Amy Loreen
- Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Kaitlyn Griffin
- Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Amanda Jackson
- Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Akila N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Leah R Jager
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda N Fader
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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24
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Stålberg K, Bjurberg M, Borgfeldt C, Carlson J, Dahm-Kähler P, Flöter-Rådestad A, Hellman K, Hjerpe E, Holmberg E, Kjølhede P, Marcickiewicz J, Rosenberg P, Tholander B, Åvall-Lundqvist E, Högberg T. Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer - a Swedish Gynecologic Cancer Group (SweGCG) study. Acta Oncol 2019; 58:1628-1633. [PMID: 31373248 DOI: 10.1080/0284186x.2019.1643036] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: The aim of this study is to evaluate the impact of lymphovascular space invasion (LVSI) on the risk of lymph node metastases and survival in endometrioid endometrial adenocarcinoma.Material and methods: As regard the study design, this is a cohort study based on prospectively recorded data. Patients with endometrioid endometrial adenocarcinoma registered in the Swedish Quality Registry for Gynecologic Cancer 2010-2017 with FIGO stages I-III and verified nodal status were identified (n = 1587). LVSI together with established risk factors, namely DNA ploidy, FIGO grade, myometrial invasion and age, were included in multivariable regression analyses with lymph node metastases as the dependent variable. Associations between the risk factors and overall and relative survival were included in multivariable models. Estimates of risk ratios (RR), hazard ratios (HR), excess mortality rate ratios (EMR), and 95% confidence intervals (95% CI) were calculated.Results: The presence of LVSI presented the strongest association with lymph node metastases (RR = 5.46, CI 3.69-8.07, p < .001) followed by deep myometrial invasion (RR = 1.64, CI 1.13-2.37). In the multivariable survival analyses, LVSI (EMR = 7.69, CI 2.03-29.10,) and non-diploidy (EMR = 3.23, CI 1.25-8.41) were associated with decreased relative survival. In sub-analyses including only patients with complete para-aortic and pelvic lymphadenectomy and negative lymph nodes (n = 404), only LVSI (HR = 2.50, CI 1.05-5.98) was associated with a worsened overall survival.Conclusion: This large nationwide study identified LVSI as the strongest independent risk factor for lymph node metastases and decreased survival in patients with endometrioid adenocarcinomas. Moreover, decreased overall survival was also seen in patients with LVSI-positive tumors and negative lymph nodes, indicating that hematogenous dissemination might also be important.
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Affiliation(s)
- Karin Stålberg
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Maria Bjurberg
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital Lund, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Christer Borgfeldt
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden
| | - Joseph Carlson
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Göteborg University, Sahgrenska University Hospital, Göteborg, Sweden
| | | | - Kristina Hellman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabet Hjerpe
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Holmberg
- Department of Oncology, Sahlgrenska Academy, Institute of Clinical Sciences, Goteborg, Sweden
- Sahlgrenska University Hospital, Regionalt Cancercentrum Väst, Goteborg, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linkoping, Sweden
| | - Janusz Marcickiewicz
- Regionalt cancercentrum vast, Goteborg, Sweden
- Department of Obstetrics and Gynecology, Hallands Hospital Varberg, Varberg, Sweden
| | - Per Rosenberg
- Department of Clinical and Experimental Medicine, Linköping University, Linkoping, Sweden
- Department of Clinical Oncology, Linköping University, Linkoping, Sweden
| | - Bengt Tholander
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Elisabeth Åvall-Lundqvist
- Department of Clinical and Experimental Medicine, Linköping University, Linkoping, Sweden
- Department of Clinical Oncology, Linköping University, Linkoping, Sweden
| | - Thomas Högberg
- Department of Cancer Epidemiology, Lund University, Lund, Sweden
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25
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Matsuo K, Ross MS, Yunokawa M, Johnson MS, Machida H, Omatsu K, Klobocista MM, Im DD, Satoh S, Baba T, Ikeda Y, Bush SH, Hasegawa K, Blake EA, Takekuma M, Shida M, Nishimura M, Adachi S, Pejovic T, Takeuchi S, Yokoyama T, Ueda Y, Iwasaki K, Miyake TM, Yanai S, Nagano T, Takano T, Shahzad MM, Ueland FR, Kelley JL, Roman LD. Tumor characteristics and outcome of uterine carcinosarcoma in women aged ≥80 years. Surg Oncol 2019; 29:25-32. [PMID: 31196490 PMCID: PMC7523232 DOI: 10.1016/j.suronc.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/19/2019] [Accepted: 02/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine clinico-pathological characteristics and outcomes of uterine carcinosarcoma (UCS) in women aged ≥80 years. METHODS This is a secondary analysis of a previous multicenter retrospective study examining 906 women with stage I-IV UCS who underwent primary hysterectomy. Patient demographics, treatment types, tumor characteristics, and survival were examined across aged ≥80 (n = 82 [9.1%]), aged 60-79, (n = 526 [58.1%]), and aged <60 (n = 298 [32.9%]). RESULTS Women in the aged ≥80 group were more likely to be Caucasian, undergo simple hysterectomy without lymphadenectomy, and receive no postoperative therapy (all, P < 0.05). Tumors in the aged ≥80 group were more likely to have high-grade carcinoma, heterologous sarcoma, and sarcoma dominance but less likely to have lympho-vascular space invasion (all, P < 0.05). Lymphadenectomy did not improve survival in the aged ≥80 group (P > 0.05), whereas lymphadenectomy was protective for survival in the younger groups (both, P < 0.05). Postoperative chemotherapy was associated with improved progression-free survival (PFS) in the aged ≥80 group (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.22-0.89, P = 0.021). With chemotherapy treatment, women in the aged ≥80 group had PFS similar to those in the aged 60-79 group (HR 0.97, 95%CI 0.51-1.83, P = 0.92). In contrast, without chemotherapy treatment, women in the aged ≥80 group had significantly decreased PFS compared to the aged 60-79 group (HR 1.62, 95%CI 1.09-2.40, P = 0.016). Similar associations were observed for postoperative radiotherapy. CONCLUSION Nearly 10% of women with UCS are aged ≥80 that are characterized by aggressive tumor factors. Postoperative therapy but not extensive surgery may improve survival in this age group.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, CA, USA.
| | - Malcolm S Ross
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Magee-Womens Hospital, University of Pittsburgh, PA, USA
| | - Mayu Yunokawa
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Marian S Johnson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, KY, USA
| | - Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, CA, USA
| | - Kohei Omatsu
- Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan
| | - Merieme M Klobocista
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, NY, USA
| | - Dwight D Im
- The Gynecologic Oncology Center, Mercy Medical Center, Baltimore, MD, USA
| | - Shinya Satoh
- Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan
| | - Tsukasa Baba
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
| | - Yuji Ikeda
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - Stephen H Bush
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, FL, USA
| | - Kosei Hasegawa
- Department of Obstetrics and Gynecology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Erin A Blake
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, CO, USA
| | | | - Masako Shida
- Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan
| | - Masato Nishimura
- Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan
| | - Sosuke Adachi
- Department of Obstetrics and Gynecology, Niigata University, Niigata, Japan
| | - Tanja Pejovic
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, OR, USA
| | - Satoshi Takeuchi
- Department of Obstetrics and Gynecology, Iwate Medical University, Morioka, Japan
| | - Takuhei Yokoyama
- Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan
| | - Keita Iwasaki
- Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan
| | - Takahito M Miyake
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan
| | - Shiori Yanai
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Tadayoshi Nagano
- Department of Obstetrics and Gynecology, Kitano Hospital, Osaka, Japan
| | - Tadao Takano
- Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan
| | - Mian Mk Shahzad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, FL, USA
| | - Frederick R Ueland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, KY, USA
| | - Joseph L Kelley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Magee-Womens Hospital, University of Pittsburgh, PA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, CA, USA
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Ayhan A, Şahin H, Sari ME, Yalçin I, Haberal A, Meydanli MM. Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer. Int J Gynecol Cancer 2019; 29:505-512. [DOI: 10.1136/ijgc-2018-000069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 12/18/2022] Open
Abstract
ObjectiveThe purpose of this study was to assess the prognostic significance of lymphovascular space invasion in women with low-risk endometrial cancer.MethodsA dual-institutional, retrospective department database review was performed to identify patients with ‘low-risk endometrial cancer’ (patients having <50% myometrial invasion with grade 1 or 2 endometrioid endometrial cancer according to their final pathology reports) at two gynecologic oncology centers in Ankara, Turkey. Demographic, clinicopathological and survival data were collected.ResultsWe identified 912 women with low-risk endometrial cancer; 53 patients (5.8%) had lymphovascular space invasion. When compared with lymphovascular space invasion-negative patients, lymphovascular space invasion-positive patients were more likely to have post-operative grade 2 disease (p<0.001), deeper myometrial invasion (p=0.003), and larger tumor size (p=0.005). Patients with lymphovascular space invasion were more likely to receive adjuvant therapy when compared with lymphovascular space invasion-negative women (11/53 vs 12/859, respectively; p<0.001). The 5-year recurrence-free survival rate for lymphovascular space invasion-positive women was 85.5% compared with 97.0% for lymphovascular space invasion-negative women (p<0.001). The 5-year overall survival rate for lymphovascular space invasion-positive women was significantly lower than that of lymphovascular space invasion-negative women (88.2% vs 98.5%, respectively; p<0.001). Age ≥60 years (HR 3.13, 95% CI 1.13 to 8.63; p=0.02) and positive lymphovascular space invasion status (HR 6.68, 95% CI 1.60 to 27.88; p=0.009) were identified as independent prognostic factors for decreased overall survival.ConclusionsAge ≥60 years and positive lymphovascular space invasion status appear to be important prognostic parameters in patients with low-risk endometrial cancer who have undergone complete surgical staging procedures including pelvic and para-aortic lymphadenectomy. Lymphovascular space invasion seems to be associated with an adverse prognosis in women with low-risk endometrial cancer; this merits further assessment on a larger scale with standardization of the lymphovascular space invasion in terms of presence/absence and quantity.
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Intrauterine Manipulator Use During Minimally Invasive Hysterectomy and Risk of Lymphovascular Space Invasion in Endometrial Cancer. Int J Gynecol Cancer 2019; 28:208-219. [PMID: 29324541 DOI: 10.1097/igc.0000000000001181] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to examine an association between intrauterine manipulator (IUM) use and frequency of lymphovascular space invasion (LVSI) in women with endometrial cancer undergoing minimally invasive hysterectomy. METHODS A retrospective case-control study was conducted among stage I-IV endometrial cancer patients who underwent hysterectomy between 2008 and 2015. Medical records were reviewed for patient demographics, surgical details, and tumor characteristics. Women who underwent total laparoscopic hysterectomy (TLH) with IUM use were compared with women who underwent total abdominal hysterectomy (TAH). Review of archived medical record for data collection and propensity score matching were performed to adjust for background differences between TLH-IUM and TAH groups. A systematic literature review with pooled analysis was performed to examine frequency of LVSI. RESULTS There were 687 women who underwent hysterectomy for endometrial cancer. Of those, 419 women underwent TLH with IUM use and 194 women underwent TAH. The most common type of IUM was VCare (89.5%). There was no statistically significant difference in the frequency of LVSI between the 2 groups: 15.1% for TLH-IUM vs 19.9% for TAH (P = 0.14). After propensity score matching, frequencies of LVSI were similar between the 2 groups: 21.2% for TLH-IUM vs 19.6% for TAH (P = 0.78). Systematic literature review identified 1371 cases of TLH-IUM and 1246 cases of TAH performed for endometrial cancer, and frequencies of LVSI were similar between the 2 groups (15.0% vs 13.6%, P = 0.31). CONCLUSION Our study suggests that IUM use during TLH for endometrial cancer is not associated with increased frequency of LVSI.
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L1 Cell Adhesion Molecule (L1CAM) expression in endometrioid endometrial carcinomas: A possible pre-operative surrogate of lymph vascular space invasion. PLoS One 2018; 13:e0209294. [PMID: 30557309 PMCID: PMC6296540 DOI: 10.1371/journal.pone.0209294] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 12/03/2018] [Indexed: 01/18/2023] Open
Abstract
Background Risk stratification of endometrial carcinomas is primarily based on surgical staging that requires extensive retroperitoneal lymph node dissection. One of the most powerful predictor of lymph node involvement is the lymph vascular space invasion (LVSI). The objective of this study was to determine the potential of L1 Cell Adhesion Molecule (L1CAM) to predict LVSI and its association with other risk factors in endometrioid endometrial carcinomas. Materials and methods We studied 47 consecutive patients aged 37–88 (61.34±10.52). Twenty-three patients (48.9%) were submitted to complete surgical staging. Nine patients (19.1%) underwent surgical staging without para-aortic dissection. Seven (14.9%) were submitted to hysterectomy with no lymph node dissection. Eight patients (17.0%) only had the biopsy material for analysis. The 32 patients submitted to lymphadenectomy were staged according to the FIGO system and classified among the risk categories of the ESMO-ESGO-ESTRO guidelines. The following histological characteristics were analyzed: tumor size (mm), depth of myometrial infiltration, presence of microcystic, elongated, and fragmented (MELF) pattern of myoinvasion, and lymph vascular space invasion (LVSI). Immunohistochemical analyses of mismatch repair (MMR) proteins MLH1, MSH2, MSH6, and PMS2, p53, and L1CAM were performed in formalin-fixed paraffin embedded whole tumor tissue sections. Results LVSI was identified in 26/41 (63,4%) of the cases. L1CAM was positive in 8/47 (17%) cases, all of them positive for LVSI and within the high-risk category of ESMO-ESGO-ESTRO. L1CAM-positive cases were associated with high histological grade and p53 aberrant immunohistochemical profile. Besides, it showed a trend to larger tumors, greater depth of myometrial infiltration, and with a higher frequency of the MELF pattern of myoinvasion. LVSI was also associated with FIGO stage, tumor size, depth of myometrial infiltration, and tumor grade. Conclusions L1CAM is highly associated with LVSI and could be used as a pre-operative predictor of lymph node involvement in endometrioid endometrial carcinomas.
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Sarı ME, Meydanlı MM, Yalçın I, Şahin H, Çoban G, Çelik H, Kuşçu E, Gungor T, Ayhan A. Risk Factors for Lymph Node Metastasis among Lymphovascular Space Invasion-Positive Women with Endometrioid Endometrial Cancer Clinically Confined to the Uterus. Oncol Res Treat 2018; 41:750-754. [DOI: 10.1159/000492585] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/31/2018] [Indexed: 01/15/2023]
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Matsuo K, Takazawa Y, Ross MS, Elishaev E, Yunokawa M, Sheridan TB, Bush SH, Klobocista MM, Blake EA, Takano T, Baba T, Satoh S, Shida M, Ikeda Y, Adachi S, Yokoyama T, Takekuma M, Yanai S, Takeuchi S, Nishimura M, Iwasaki K, Johnson MS, Yoshida M, Hakam A, Machida H, Mhawech-Fauceglia P, Ueda Y, Yoshino K, Kajiwara H, Hasegawa K, Yasuda M, Miyake TM, Moriya T, Yuba Y, Morgan T, Fukagawa T, Pejovic T, Nagano T, Sasaki T, Richmond AM, Post MD, Shahzad MMK, Im DD, Yoshida H, Enomoto T, Omatsu K, Ueland FR, Kelley JL, Karabakhtsian RG, Roman LD. Significance of Lymphovascular Space Invasion by the Sarcomatous Component in Uterine Carcinosarcoma. Ann Surg Oncol 2018; 25:2756-2766. [PMID: 29971677 DOI: 10.1245/s10434-018-6547-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of this study was to examine the significance of lymphovascular space invasion (LVSI) with a sarcomatous component on the tumor characteristics and clinical outcomes of women with uterine carcinosarcoma (UCS). METHODS This was a secondary analysis of a prior multicenter retrospective study that examined women with stage I-IV UCS who underwent primary hysterectomy. Archived histopathology slides were reviewed and LVSI was scored as follows: LVSI with a carcinomatous component alone (LVSI-carcinoma; n = 375, 76.8%) or LVSI containing a sarcomatous component with or without a carcinomatous component (LVSI-sarcoma; n = 113, 23.2%). Qualitative metrics of LVSI were correlated to clinicopathological factors and survival outcome. RESULTS Tumors in the LVSI-sarcoma group were more likely to have sarcoma dominance (82.1 vs. 26.4%) heterologous sarcomatous component (51.3 vs. 37.9%), low-grade carcinoma (42.5 vs. 22.4%), and large tumor size (81.0 vs. 70.2%) in the primary tumor site compared with tumors in the LVSI-carcinoma group (all p < 0.05). On multivariate analysis, LVSI-sarcoma was independently associated with decreased progression-free survival (5-year rates: 34.9 vs. 40.8%, adjusted hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.36-2.50, p < 0.001), and cause-specific survival (5-year rates: 41.8 vs. 55.9%, adjusted HR 1.95, 95% CI 1.39-2.75, p < 0.001) compared with LVSI-carcinoma. Postoperative radiotherapy for women with LVSI-sarcoma had a higher reduction rate of recurrence/progression of disease (54% reduction, p = 0.04) compared with postoperative radiotherapy for women with LVSI-carcinoma (26% reduction, p = 0.08). CONCLUSION In UCS, the presence of a sarcomatous component in LVSI is particularly prevalent when a tumor has sarcoma dominance. Our study suggests that LVSI containing a sarcomatous component may be a predictor of decreased survival for women with UCS.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
| | - Yutaka Takazawa
- Department of Pathology, Cancer Institute Hospital, Tokyo, Japan
| | - Malcolm S Ross
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, MaGee-Womens Hospital, University of Pittsburgh, Pittsburgh, PA, USA
| | - Esther Elishaev
- Department of Pathology, MaGee-Womens Hospital, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mayu Yunokawa
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Todd B Sheridan
- Department of Pathology, Mercy Medical Center, Baltimore, MD, USA
| | - Stephen H Bush
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Merieme M Klobocista
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY, USA
| | - Erin A Blake
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, Boulder, CO, USA
| | - Tadao Takano
- Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan
| | - Tsukasa Baba
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
| | - Shinya Satoh
- Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan
| | - Masako Shida
- Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan
| | - Yuji Ikeda
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - Sosuke Adachi
- Department of Obstetrics and Gynecology, Niigata University, Niigata, Japan
| | - Takuhei Yokoyama
- Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Shiori Yanai
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Satoshi Takeuchi
- Department of Obstetrics and Gynecology, Iwate Medical University, Morioka, Japan
| | - Masato Nishimura
- Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan
| | - Keita Iwasaki
- Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan
| | - Marian S Johnson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Masayuki Yoshida
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Ardeshir Hakam
- Department of Pathology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | | | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan
| | | | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takahito M Miyake
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan
| | - Takuya Moriya
- Department of Pathology, Kawasaki Medical School, Okayama, Japan
| | - Yoshiaki Yuba
- Department of Pathology, Kitano Hospital, Osaka, Japan
| | - Terry Morgan
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | | | - Tanja Pejovic
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Tadayoshi Nagano
- Department of Obstetrics and Gynecology, Kitano Hospital, Osaka, Japan
| | - Takeshi Sasaki
- Department of Pathology, The University of Tokyo, Tokyo, Japan
| | - Abby M Richmond
- Department of Pathology, University of Colorado, Boulder, CO, USA
| | - Miriam D Post
- Department of Pathology, University of Colorado, Boulder, CO, USA
| | - Mian M K Shahzad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Dwight D Im
- Department of Gynecology, Mercy Medical Center, Baltimore, MD, USA
| | - Hiroshi Yoshida
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University, Niigata, Japan
| | - Kohei Omatsu
- Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan
| | - Frederick R Ueland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Joseph L Kelley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, MaGee-Womens Hospital, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rouzan G Karabakhtsian
- Department of Pathology, University of Kentucky Medical Center, Lexington, KY, USA.,Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
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Cuylan ZF, Oz M, Ozkan NT, Comert GK, Sahin H, Turan T, Akbayir O, Kuscu E, Celik H, Dede M, Gungor T, Meydanli MM, Ayhan A. Prognostic factors and patterns of recurrence in lymphovascular space invasion positive women with stage IIIC endometriod endometrial cancer. J Obstet Gynaecol Res 2018. [DOI: 10.1111/jog.13615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Zeliha F. Cuylan
- Department of Gynecologic Oncology, Faculty of Medicine; Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Murat Oz
- Department of Gynecologic Oncology, Faculty of Medicine; Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Nazli T. Ozkan
- Department of Gynecologic Oncology, Faculty of Medicine; Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Gunsu K. Comert
- Department of Gynecologic Oncology, Faculty of Medicine; Etlik Zubeyde Hanim Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Hanifi Sahin
- Department of Gynecologic Oncology, Faculty of Medicine; Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Taner Turan
- Department of Gynecologic Oncology, Faculty of Medicine; Etlik Zubeyde Hanim Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Ozgur Akbayir
- Department of Gynecologic Oncology, Faculty of Medicine; Kanuni Sultan Suleyman Teaching and Research Hospital, University of Health Sciences; Istanbul Turkey
| | - Esra Kuscu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine; Baskent University; Ankara Turkey
| | - Husnu Celik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine; Baskent University; Ankara Turkey
| | - Murat Dede
- Department of Obstetrics and Gynecology, Faculty of Medicine; Gulhane Training and Researh Hospital, University of Health Sciences; Ankara Turkey
| | - Tayfun Gungor
- Department of Gynecologic Oncology, Faculty of Medicine; Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Mehmet M. Meydanli
- Department of Gynecologic Oncology, Faculty of Medicine; Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine; Baskent University; Ankara Turkey
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Abbink K, Zusterzeel PL, Geurts-Moespot AJ, Herwaarden AEV, Pijnenborg JM, Sweep FC, Massuger LF. HE4 is superior to CA125 in the detection of recurrent disease in high-risk endometrial cancer patients. Tumour Biol 2018; 40:1010428318757103. [PMID: 29463191 DOI: 10.1177/1010428318757103] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To date, biomarkers are not routinely used in endometrial cancer diagnosis, prognosis, and follow-up. The purpose of this study was to evaluate whether serum HE4 was related to clinicopathological risk factors and outcome. Second, the role of serum HE4 and CA125 was assessed as indicator for recurrent disease during follow-up. METHODS A total of 174 patients with endometrial cancer between 1999 and 2009 were selected for this retrospective study. Serum HE4 and CA125 were analyzed at primary diagnosis, during follow-up, and at the time of recurrence. Correlations with clinicopathological factors were studied by univariate and multivariate survival analyses. Lead time was calculated in order to determine which serum marker was elevated prior to clinical detection of recurrent disease. RESULTS Serum levels of HE4 and CA125 were significantly associated with high tumor grade, myometrial invasion, lymph node involvement, and advanced stage (p < 0.01). HE4 was an independent prognostic factor for reduced disease-free survival and overall survival with hazard ratios of 2.96 (95% confidence interval: 1.18-7.99) and 3.27 (95% confidence interval: 1.18-9.02), respectively. At recurrence, 75% of the patients had an elevated HE4 compared to 54% with an elevated CA125. HE4 levels were more frequently elevated in patients with distant metastasis compared to local recurrences, 67% and 37%, respectively. Serum HE4 detected a recurrence with a median of 126 days earlier than clinical confirmation. CONCLUSION Elevated serum HE4 is an independent risk factor for reduced disease-free survival and overall survival. HE4 seems to be superior to CA125 in the detection of recurrent disease during follow-up, mainly in high-risk endometrial cancer patients who are more prone to distant metastasis.
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Affiliation(s)
- Karin Abbink
- 1 Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petra Lm Zusterzeel
- 1 Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anneke J Geurts-Moespot
- 2 Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Johanna Ma Pijnenborg
- 1 Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fred Cgj Sweep
- 2 Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leon Fag Massuger
- 1 Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
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Abstract
OBJECTIVE The aim of the study was to examine contributing factors associated with developing menopausal symptoms after surgical staging in women with endometrial cancer. METHODS This is a retrospective study examining patients with endometrial cancer who were premenopausal at the time of hysterectomy-based surgical staging including bilateral oophorectomy between January 2000 and October 2013. Cox proportional hazard regression model was used to evaluate demographics, medical comorbidity, liver function tests, tumor factors, and medication history for menopausal symptoms. RESULTS There were 269 premenopausal women who were eligible. Mean age was 44.5 years, and the majority had endometrioid histology (91.1%), grade 1 tumor (60.2%), and stage I disease (65.8%). Postoperatively, 73 (27.1%) women developed menopausal symptoms, with hot flushes (20.1%) being the most common symptom followed by night sweats (4.1%). On multivariate analysis, younger age was independently associated with increased risk of developing menopausal symptoms (hazard ratio per unit 0.91, 95% CI 0.88-0.94, P < 0.01). In addition, lower albumin level remained an independent predictor for decreased risk of developing menopausal symptoms (hazard ratio per unit 2.16, 95% CI 1.19-3.93, P = 0.012). Lower albumin level was associated with medical comorbidity (hypertension and diabetes mellitus), use of antihypertensive/glycemic agents (angiotensin-converting enzyme inhibitors or receptor blocker, hydrochlorothiazide, sulfonylurea, and insulin), aggressive tumor (high cancer antigen 125 level, nonendometrioid histology, and advanced stage), and abnormal liver function (high alkaline phosphatase level and low total protein level; all, P < 0.05). CONCLUSIONS Assessing albumin level, medical comorbidity, and medication type for the development of postoperative menopausal symptoms is a valuable step in the preoperative management of women with endometrial cancer.
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Lymphovascular Space Invasion for Endometrial Cancer: Undertreatment and Overtreatment Risks: A Survey of the Spanish Gynecologic Oncology Group. Int J Gynecol Cancer 2018; 27:1191-1199. [PMID: 28557833 DOI: 10.1097/igc.0000000000001022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this study is to asses the impact of lymphovascular space invasion (LVSI) present in early-stage endometrial cancer, regarding its therapeutic management and prognosis knowledge, based on a survey among Spanish oncologic gynecologist. METHODS/MATERIALS Between October and November 2014, the Young Spanish Onco-gynecologist Group carried out a survey to perform a cross-sectional study about the management of LVSI. All active members in the oncology field of the Spanish Society of Gynecology and Obstetrics were invited to participate in the survey. RESULTS Most respondents consider LVSI a bad prognosis factor for endometrial cancer (66%) and also consider that it should be included in the International Federation of Gynecology and Obstetrics classification (56%). Seventy-five percent of all gynecologists did not modify their surgical treatment. Regarding follow-up, 38% of the respondents do not change their surveillance, 28% modify it, and 31% reported any change only with additional factors. Forty-seven percent of respondents advise systemic treatment with chemotherapy.Data were dichotomized between less than or equal to 20 versus greater than 20 years of OB-GYN specialist and less than or equal to 5 versus greater than 5 years of main dedication to gynecology oncology, but it was not possible to show any significant differences among the groups. The response rate (34 individuals) was too low to expect any significant differences. CONCLUSIONS Results suggest that LVSI remains a controversial issue in the management of patients with endometrial cancer. Acquiring a deeper knowledge and uniform criteria could avoid the risk of undertreatment and overtreatment in this group of patients with early-stage endometrial cancer. The identification of vascular pseudoinvasion is recommended, although the clinical and prognostic implications still need to be determined.
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Significance of Monocyte Counts at Recurrence on Survival Outcome of Women With Endometrial Cancer. Int J Gynecol Cancer 2018; 27:302-310. [PMID: 27922978 DOI: 10.1097/igc.0000000000000865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Tumor-associated macrophages (TAMs) are known to have adverse effects on the survival of women with endometrial cancer. Because monocytes function as progenitors of macrophages, this study examined the association between monocyte count at the first recurrence/progression of endometrial cancer and survival time after recurrence/progression (SAR). METHODS This is a retrospective study evaluating 141 consecutive cases of recurrent endometrial cancer after surgical staging (n = 114) and progression after nonsurgical management (n = 27). Complete blood cell counts with cell differentiation at the time of the first recurrence/progression were correlated to SAR. RESULTS Median time of SAR was 7.8 months, and there were 97 (68.8%) patients who died from endometrial cancer with 1-, 2-, and 5-year SAR rates being 51.0%, 32.9%, and 14.2%, respectively. Median monocyte counts at recurrence/progression were 0.5 × 10/L. The strongest correlation to monocyte counts was seen in neutrophil counts (r = 0.57, P < 0.01) followed by platelet counts (r = 0.43, P < 0.01). An elevated monocyte count at recurrence/progression was significantly associated with decreased SAR (hazard ratio per unit, 3.97; 95% confidence interval, 2.00-7.90; P < 0.01). On multivariate analysis controlling for patient demographics, complete blood cell counts, tumor factors, and treatment types for recurrent/progressed disease, higher monocyte counts at recurrence/progression remained an independent predictor for decreased SAR (hazard ratio per unit, 3.12; 95% confidence interval, 1.52-6.67; P < 0.01). CONCLUSIONS Our study demonstrated that the increased monocyte counts at recurrence/progression may be a useful biomarker for predicting decreased survival outcome of women with endometrial cancer.
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Kamran SC, Manuel MM, Catalano P, Cho L, Damato AL, Lee LJ, Schmidt EJ, Viswanathan AN. MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer. Brachytherapy 2017; 16:1159-1168. [PMID: 28823395 DOI: 10.1016/j.brachy.2017.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/21/2017] [Accepted: 07/06/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE To compare clinical outcomes of MR-based versus CT-based high-dose-rate interstitial brachytherapy (ISBT) for vaginal recurrence of endometrioid endometrial cancer (EC). METHODS AND MATERIALS We reviewed 66 patients with vaginal recurrent EC; 18 had MR-based ISBT on a prospective clinical trial and 48 had CT-based treatment. Kaplan-Meier survival modeling was used to generate estimates for local control (LC), disease-free interval (DFI), and overall survival (OS), and multivariate Cox modeling was used to assess prognostic factors. Toxicities were evaluated and compared. RESULTS Median followup was 33 months (CT 30 months, MR 35 months). Median cumulative equivalent dose in 2-Gy fractions was 75.5 Gy for MR-ISBT and 73.8 Gy for CT-ISBT (p = 0.58). MR patients were older (p = 0.03) and had larger tumor size (>4 cm vs. ≤ 4 cm) compared to CT patients (p = 0.04). For MR-based versus CT-based ISBT, 3-year KM rate for local control was 100% versus 78% (p = 0.04), DFI was 69% versus 55% (p = 0.1), and OS was 63% versus 75% (p = 0.81), respectively. On multivariate analysis, tumor Grade 3 was associated with worse OS (HR 3.57, 95% CI 1.25, 11.36) in a model with MR-ISBT (HR 0.56, 95% CI 0.16, 1.89). Toxicities were not significantly different between the two modalities. CONCLUSION Despite worse patient prognostic features, MR-ISBT was associated with a significantly better (100%) 3-year local control, comparable survival, and improved DFI rates compared to CT. Toxicities did not differ compared to CT-ISBT patients. Tumor grade contributed as the most significant predictor for survival. Larger prospective studies are needed to assess the impact of MR-ISBT on survival outcomes.
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Affiliation(s)
- Sophia C Kamran
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA.
| | - Matthias M Manuel
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Bronx-Lebanon Hospital Center, Bronx, NY
| | - Paul Catalano
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | - Linda Cho
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Antonio L Damato
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Larissa J Lee
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ehud J Schmidt
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (Cardiology), Johns Hopkins Medicine, Baltimore, MD
| | - Akila N Viswanathan
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, MD.
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Matsuo K, Wong KK, Fotopoulou C, Blake EA, Robertson SE, Pejovic T, Frimer M, Pardeshi V, Hu W, Choi JS, Sun CC, Richmond AM, Marcus JZ, Hilliard MAM, Mostofizadeh S, Mhawech-Fauceglia P, Abdulfatah E, Post MD, Saglam O, Shahzad MMK, Karabakhtsian RG, Ali-Fehmi R, Gabra H, Roman LD, Sood AK, Gershenson DM. Impact of lympho-vascular space invasion on tumor characteristics and survival outcome of women with low-grade serous ovarian carcinoma. J Surg Oncol 2017; 117:236-244. [PMID: 28787528 DOI: 10.1002/jso.24801] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/19/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES To examine association of lympho-vascular space invasion (LVSI) with clinico-pathological factors and to evaluate survival of women with low-grade serous ovarian carcinoma containing areas of LVSI. METHODS This is a multicenter retrospective study examining consecutive cases of surgically treated stage I-IV low-grade serous ovarian carcinoma (n = 178). Archived histopathology slides for the ovarian tumors were reviewed, and LVSI was scored as present or absent. LVSI status was correlated to clinico-pathological findings and survival outcome. RESULTS LVSI was seen in 79 cases (44.4%, 95% confidence interval [CI] 37.1-51.7). LVSI was associated with increased risk of omental metastasis (87.0% vs 64.9%, odds ratio [OR] 3.62, P = 0.001), high pelvic lymph node ratio (median 12.9% vs 0%, P = 0.012), and malignant ascites (49.3% vs 32.6%, OR 2.01, P = 0.035). On multivariable analysis, controlling for age, stage, and cytoreductive status, presence of LVSI in the ovarian tumor remained an independent predictor for decreased progression-free survival (5-year rates 21.0% vs 35.7%, adjusted-hazard ratio 1.57, 95%CI 1.06-2.34, P = 0.026). LVSI was significantly associated with increased risk of recurrence in lymph nodes (OR 2.62, 95%CI 1.08-6.35, P = 0.047). CONCLUSION LVSI in the ovarian tumor is associated with adverse clinico-pathological characteristics and decreased progression-free survival in women with low-grade serous ovarian carcinoma.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.,Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kwong-Kwok Wong
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Christina Fotopoulou
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colarodo
| | - Erin A Blake
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | - Sharon E Robertson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Tanja Pejovic
- Department of Pathology, Wayne State University, Detroit, Michigan
| | - Marina Frimer
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Vishakha Pardeshi
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Wei Hu
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jong-Sun Choi
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Charlotte C Sun
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Abby M Richmond
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Jenna Z Marcus
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Maren A M Hilliard
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Sayedamin Mostofizadeh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Paulette Mhawech-Fauceglia
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Eman Abdulfatah
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Miriam D Post
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Ozlen Saglam
- Department of Pathology, University of Southern California, Los Angeles, California
| | - Mian M K Shahzad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Rouzan G Karabakhtsian
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Rouba Ali-Fehmi
- Clinical Discovery Unit, Early Clinical Development, AstraZeneca, Cambridge, UK
| | - Hani Gabra
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colarodo
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.,Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anil K Sood
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - David M Gershenson
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Extent of lymphovascular space invasion may predict lymph node metastasis in uterine serous carcinoma. Gynecol Oncol 2017; 147:24-29. [PMID: 28709703 DOI: 10.1016/j.ygyno.2017.07.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/06/2017] [Accepted: 07/08/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Emerging evidence suggests that extent of lymphovascular space invasion (LVSI) predicts for risk of lymph node metastasis in endometrioid uterine cancers. However, this correlation remains unknown in the setting of uterine serous carcinoma (USC). We sought to examine the association between extent of LVSI and other histopathologic characteristics with risk of nodal metastasis for women with USC. MATERIALS/METHODS Pathological data from all cases of uterine serous carcinoma between July 1998 to July 2015 at our institution were reviewed. Descriptive, univariate, and multivariate logistic regression analysis of selected pathologic features were performed. RESULTS 88 patients with USC underwent total abdominal or laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and selective lymphadenectomy. Surgical staging revealed the following FIGO stage distributions: I (41%), II (8%), III (32%), IV (19%). LVSI was present in 44 (50%) patients. 36 patients (41%) had LN metastases with median number of total nodes removed of 17 (range, 1-49). On univariate analysis, depth of myometrial invasion, LVSI, tumor size, and cervical stromal involvement were significantly associated with nodal involvement. In a multivariate model, LVSI (OR 6.25, 95% CI 2.2-18.0, p<0.01) and cervical stromal involvement (OR 3.33, 95% CI 1.10-10.0, p=0.03) were the only factors that remained significant. Among patients with LVSI-positive disease, extensive LVSI was associated with increased risk of nodal involvement compared to focal LVSI (90% vs 29%, p=0.04). CONCLUSIONS Presence and extent of LVSI, and cervical stromal invasion are important predictors for lymph node metastasis in uterine serous carcinoma.
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Abstract
OBJECTIVE To examine the survival outcomes in women with endometrial cancer who were taking low-dose aspirin (81-100 mg/d). METHODS A multicenter retrospective study was conducted examining patients with stage I-IV endometrial cancer who underwent hysterectomy-based surgical staging between January 2000 and December 2013 (N=1,687). Patient demographics, medical comorbidities, medication types, tumor characteristics, and treatment patterns were correlated to survival outcomes. A Cox proportional hazard regression model was used to estimate adjusted hazard ratio for disease-free and disease-specific overall survival. RESULTS One hundred fifty-eight patients (9.4%, 95% confidence interval [CI] 8.8-11.9) were taking low-dose aspirin. Median follow-up time for the study cohort was 31.5 months. One hundred twenty-seven patients (7.5%) died of endometrial cancer. Low-dose aspirin use was significantly correlated with concurrent obesity, hypertension, diabetes mellitus, and hypercholesterolemia (all P<.001). Low-dose aspirin users were more likely to take other antihypertensive, antiglycemic, and anticholesterol agents (all P<.05). Low-dose aspirin use was not associated with histologic subtype, tumor grade, nodal metastasis, or cancer stage (all P>.05). On multivariable analysis, low-dose aspirin use remained an independent prognostic factor associated with an improved 5-year disease-free survival rate (90.6% compared with 80.9%, adjusted hazard ratio 0.46, 95% CI 0.25-0.86, P=.014) and disease-specific overall survival rate (96.4% compared with 87.3%, adjusted hazard ratio 0.23, 95% CI 0.08-0.64, P=.005). The increased survival effect noted with low-dose aspirin use was greatest in patients whose age was younger than 60 years (5-year disease-free survival rates, 93.9% compared with 84.0%, P=.013), body mass index was 30 or greater (92.2% compared with 81.4%, P=.027), who had type I cancer (96.5% compared with 88.6%, P=.029), and who received postoperative whole pelvic radiotherapy (88.2% compared with 61.5%, P=.014). These four factors remained significant for disease-specific overall survival (all P<.05). CONCLUSION Our results suggest that low-dose aspirin use is associated with improved survival outcomes in women with endometrial cancer, especially in those who are young, obese, with low-grade disease, and who receive postoperative radiotherapy.
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Machida H, Maeda M, Cahoon SS, Scannell CA, Garcia-Sayre J, Roman LD, Matsuo K. Endometrial cancer arising in adenomyosis versus endometrial cancer coexisting with adenomyosis: are these two different entities? Arch Gynecol Obstet 2017; 295:1459-1468. [PMID: 28444512 DOI: 10.1007/s00404-017-4375-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/18/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE While adenomyosis is one of the most common benign histologic findings in hysterectomy specimens of endometrial cancer, demographics of endometrial cancer arising in adenomyosis (EC-AIA) has not been well elucidated. The aim of this study is to evaluate histopathological findings and disease-free survival (DFS) of EC-AIA in comparison to endometrial cancer coexisting with adenomyosis (EC-A). METHODS EC-AIA cases were identified via a systematic literature search (n = 46). EC-A cases were identified from a historical cohort that underwent hysterectomy-based surgical staging in two institutions (n = 350). Statistical comparisons of the two groups were based on univariate and multivariate analyses. RESULTS The EC-AIA group was significantly older than the EC-A group (58.9 versus 53.8, p = 0.002). As to tumor characteristics, 63.6% of EC-AIA cases reported tumor within the myometrium without endometrial extension. The EC-AIA group was significantly associated with more non-endometrioid histology (23.9 versus 14.8%; p = 0.002) and deep myometrial tumor invasion (51.6 versus 19.4%; p < 0.001) than EC-A. Tumor grade, stage, and nodal metastasis risk were similar (all, p > 0.05). In a univariate analysis, the EC-AIA group had a significantly decreased DFS compared to EC-A (5-year rates, 72.2 versus 85.5%, p = 0.001). After controlling for age, histology, tumor grade, and stage, EC-AIA remained an independent prognostic factor associated with decreased DFS compared to EC-A (adjusted-hazard ratio 2.87, 95% confidence interval 1.44-5.70, p = 0.031). CONCLUSION Our study demonstrated that EC-AIA has distinct tumor characteristics and a poorer survival outcome compared to EC-A. This suggests a benefit of recognition of this unique entity as an aggressive variant of endometrial cancer.
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Affiliation(s)
- Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA
| | - Midori Maeda
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Sigita S Cahoon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA
| | | | - Jocelyn Garcia-Sayre
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA.,Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA. .,Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
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Afrogheh AH, Meserve E, Sadow PM, Stephen AE, Nosé V, Berlin S, Faquin WC. Molecular Characterization of an Endometrial Endometrioid Adenocarcinoma Metastatic to a Thyroid Hürthle Cell Adenoma Showing Cancerization of Follicles. Endocr Pathol 2016; 27:213-9. [PMID: 26687112 DOI: 10.1007/s12022-015-9412-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Tumor-to-tumor metastasis is rare. Herein, we present a unique case of endometrial endometrioid adenocarcinoma metastatic to a thyroid Hürthle cell adenoma 9 years after initial diagnosis. On histologic examination of the thyroid, the malignant endometrioid glands and single cells (donor tumor) were dispersed within the Hürthle cell adenoma (recipient tumor). In several sections of the adenoma with still preserved microfollicular architecture, malignant endometrial adenocarcinoma cells were admixed within oncocytic adenomatous epithelium (so-called "cancerization of the follicles"). This unusual phenomenon, to our knowledge, is a novel finding in the thyroid gland. Immunohistochemistry, subsequently elicited clinical history, and morphologic comparison of the tumor in the thyroid to the primary endometrial tumor confirmed the origin of the donor tumor cells. Molecular analysis of both the metastatic and primary endometrial tumors demonstrated PIK3CA and PTEN mutations in both tumors, as is characteristic of well-differentiated endometrioid tumors of the endometrium. Amplification of chromosome 1q was detected in both sites; however, only the metastatic tumor showed loss of chromosomes 2, 9, and 22. The morphologic differential diagnosis of metastatic endometrioid adenocarcinoma in the thyroid includes columnar cell variant of papillary thyroid carcinoma (CCVPTC) arising in a preexisting adenoma, endocrine glandular atypia within an adenoma, and metastasis from other anatomic sites. Histomorphologic differences among these entities may be subtle; therefore, knowledge of and morphologic comparison with prior malignancies and immunohistochemistry can be helpful in rendering the correct diagnosis.
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Affiliation(s)
- Amir H Afrogheh
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Emily Meserve
- Department of Pathology, Brigham & Women's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Antonia E Stephen
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Vânia Nosé
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Suzanne Berlin
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, 02114, USA.
- Pathology Service, WRN219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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Body N, de Kerdaniel O, Lavoué V, Leblanc M, Henno S, Levêque J. [Early-stage endometrial cancer: Sentinel node or lymphadenectomy?]. ACTA ACUST UNITED AC 2016; 44:239-43. [PMID: 27053036 DOI: 10.1016/j.gyobfe.2016.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/25/2016] [Indexed: 11/30/2022]
Abstract
The endometrial cancers are mainly discovered at an early stage justifying a less aggressive treatment. The therapeutic choices are today based on preoperative classifications themselves based on histo-prognostic factors of the tumor and its extension measured in MRI: consequently, lymph node dissection in case of low and intermediate risk cancer is not systematically achieved. But a number of patients have lymph node involvement finally, probably justifying an adapted surgical and adjuvant treatment. The technique of sentinel node would compensate the weaknesses of preoperative prognostic evaluation. This new operative technique needs to be precised and evaluated: the topics subject to discussion are the technical implementation, the definition of its quality standards and the management of its histological results especially in cases of low volume lymph node metastasis.
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Affiliation(s)
- N Body
- Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90 203, 35203 Rennes cedex 2, Breizh, France
| | - O de Kerdaniel
- Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90 203, 35203 Rennes cedex 2, Breizh, France; Service de gynécologie obstétrique, centre hospitalier de Vannes, 56000 Vannes, France
| | - V Lavoué
- Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90 203, 35203 Rennes cedex 2, Breizh, France
| | - M Leblanc
- Service de gynécologie obstétrique, centre hospitalier de Vannes, 56000 Vannes, France
| | - S Henno
- Service d'anatomie et cytologie pathologiques, CHU Pontchaillou, 35000 Rennes, France
| | - J Levêque
- Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90 203, 35203 Rennes cedex 2, Breizh, France.
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