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Panczel I, Acs M, Herold M, Madar-Dank V, Piso P, Schlitt HJ, Dank M, Szasz AM, Herold Z. Survival Difference of Endometrial Cancer Patients with Peritoneal Metastasis Receiving Cytoreductive Surgery (CRS) with and without Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Systematic Review and Meta-Analysis. Int J Mol Sci 2024; 25:7495. [PMID: 39000603 PMCID: PMC11242309 DOI: 10.3390/ijms25137495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/04/2024] [Accepted: 07/06/2024] [Indexed: 07/16/2024] Open
Abstract
Although several studies have been completed to investigate the effect of cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) in endometrial cancer with peritoneal metastasis (ECPM), a direct comparison was not performed previously. A meta-analysis was performed to investigate the suspected additional survival benefits of CRS plus HIPEC over CRS only. Twenty-one and ten studies with a total number of 1116 and 152 cases investigating CRS only and CRS plus HIPEC were identified, respectively. When all articles were analyzed, the 1-year survival rate was 17.60% higher for CRS plus HIPEC (82.28% vs. 64.68%; p = 0.0102). The same tendency was observed for the 2-year (56.07% vs. 36.95%; difference: 19.12%; p = 0.0014), but not for the 5-year (21.88% vs. 16.45%; difference: 5.43%; p = 0.3918) survival rates. The same clinical significance, but statistically less strong observations, could be made if only the studies published after 2010 were investigated (1-year survival rate: 12.08% and p = 0.0648; 2-year survival rate: 10.90% and p = 0.0988). CRS remains one of the core elements of ECPM treatment, but the addition of HIPEC to CRS can increase the positive clinical outcome, especially in the first 2 years.
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Affiliation(s)
- Ivan Panczel
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, H-1083 Budapest, Hungary; (I.P.)
| | - Miklos Acs
- Department of Surgery, University Medical Center Regensburg, D-93053 Regensburg, Germany
| | - Magdolna Herold
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, H-1083 Budapest, Hungary; (I.P.)
- Department of Internal Medicine and Hematology, Semmelweis University, H-1088 Budapest, Hungary
| | | | - Pompiliu Piso
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder, D-93049 Regensburg, Germany
| | - Hans Jürgen Schlitt
- Department of Surgery, University Medical Center Regensburg, D-93053 Regensburg, Germany
| | - Magdolna Dank
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, H-1083 Budapest, Hungary; (I.P.)
| | - Attila Marcell Szasz
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, H-1083 Budapest, Hungary; (I.P.)
| | - Zoltan Herold
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, H-1083 Budapest, Hungary; (I.P.)
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Uijterwaal MH, van Dijk D, Lok CAR, De Kroon CD, Kasius JC, Zweemer R, Gerestein CG, Horeweg N, Bosse T, van der Marel J, Nooij LS. Prognostic value of molecular classification in stage IV endometrial cancer. Int J Gynecol Cancer 2024; 34:847-854. [PMID: 38658021 DOI: 10.1136/ijgc-2023-005058] [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: 04/26/2024] Open
Abstract
OBJECTIVES Multiple studies have proven the prognostic value of molecular classification for stage I-III endometrial cancer patients. However, studies on the relevance of molecular classification for stage IV endometrial cancer patients are lacking. Hypothetically, poor prognostic molecular subtypes are more common in higher stages of endometrial cancer. Considering the poor prognosis of stage IV endometrial cancer patients, it is questionable whether molecular classification has additional prognostic value. Therefore, we determined which molecular subclasses are found in stage IV endometrial cancer and if there is a correlation with progression-free and overall survival. METHODS A retrospective multicenter cohort study was conducted using data from five Dutch hospitals. Patients with stage IV endometrial cancer at diagnosis who were treated with primary cytoreductive surgery or cytoreductive surgery after induction chemotherapy between January 2000 and December 2018 were included. Exclusion criteria were age <18 years or recurrent disease. The molecular classification was performed centrally on all tumor samples according to the World Health Organization 2020 classification (including POLE and estrogen receptor status). The Kaplan-Meier method was used to calculate progression free and overall survival in the molecular subclasses, for the different histological subtypes and for estrogen receptor positive versus estrogen receptor negative tumors. Groups were compared using the log-rank test. RESULTS 164 stage IV endometrial cancer patients were molecularly classified. Median age of the patients was 67 years (range 33-86). Most patients presented with a non-endometrioid histological subtype (58%). Intra-abdominal complete cytoreductive surgery was achieved in 60.4% of the patients. 101 tumors (61.6%) were classified as p53 abnormal, 35 (21.3%) as no specific molecular profile, 21 (12.8%) as mismatch repair deficient, and 6 (3%) as POLE mutated. Molecular classification had no significant impact on progression free (p=0.056) or overall survival (p=0.12) after cytoreductive surgery. Overall survival was affected by histologic subtype (p<0.0001) and estrogen receptor status (p=0.013). CONCLUSION The distribution of the molecular subclasses in stage IV endometrial cancer patients differed substantially from the distribution in stage I-III endometrial cancer patients, with the unfavorable subclasses being more frequently present. Although the molecular classification was not prognostic in stage IV endometrial cancer, it could guide adjuvant treatment decisions.
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Affiliation(s)
| | - Dione van Dijk
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Christianne A R Lok
- Department of Gynecologic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Cor D De Kroon
- Department of Gynecologic Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jenneke C Kasius
- Department of Gynecologic Oncology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Ronald Zweemer
- Department of Gynecologic Oncology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Linda S Nooij
- Department of Gynecologic Oncology, Leiden University Medical Center, Leiden, The Netherlands
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Horala A, Szubert S, Nowak-Markwitz E. Range of Resection in Endometrial Cancer-Clinical Issues of Made-to-Measure Surgery. Cancers (Basel) 2024; 16:1848. [PMID: 38791927 PMCID: PMC11120042 DOI: 10.3390/cancers16101848] [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: 03/29/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
Endometrial cancer (EC) poses a significant health issue among women, and its incidence has been rising for a couple of decades. Surgery remains its principal treatment method and may have a curative, staging, or palliative aim. The type and extent of surgery depends on many factors, and the risks and benefits should be carefully weighed. While simple hysterectomy might be sufficient in early stage EC, modified-radical hysterectomy is sometimes indicated. In advanced disease, the evidence suggests that, similarly to ovarian cancer, optimal cytoreduction improves survival rate. The role of lymphadenectomy in EC patients has long been a controversial issue. The rationale for systematic lymphadenectomy and the procedure of the sentinel lymph node biopsy are thoroughly discussed. Finally, the impact of the molecular classification and new International Federation of Gynecology and Obstetrics (FIGO) staging system on EC treatment is outlined. Due to the increasing knowledge on the pathology and molecular features of EC, as well as the new advances in the adjuvant therapies, the surgical management of EC has become more complex. In the modern approach, it is essential to adjust the extent of the surgery to a specific patient, ensuring an optimal, made-to-measure personalized surgery. This narrative review focuses on the intricacies of surgical management of EC and aims at summarizing the available literature on the subject, providing an up-to-date clinical guide.
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Affiliation(s)
- Agnieszka Horala
- Division of Gynaecological Oncology, Department of Gynaecology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (S.S.); (E.N.-M.)
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Datta A, Thomas V, Sebastian A, George R, Thomas A, Ram TS, Daniel S, Reka K, Peedicayil A. The clinico pathological features and survival in serous endometrial cancers. Gynecol Oncol Rep 2023; 47:101194. [PMID: 37234700 PMCID: PMC10206430 DOI: 10.1016/j.gore.2023.101194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 04/06/2023] [Indexed: 05/28/2023] Open
Abstract
Background & Introduction Serous cancers are a biologically aggressive variety of endometrial cancer (EC) with a high rate of recurrence and mortality among all the subtypes. Herein we describe our experience with serous endometrial cancer. Objective This study was conducted to identify the clinicopathological characteristics, treatment modalities and survival outcomes in women diagnosed with serous endometrial malignancies. Methods This was a retrospective descriptive analysis of data on patients diagnosed with serous endometrial tumours between January 2010 to September 2019 in our institute collected from electronic medical records. Descriptive statistics such as proportions, means and standard deviations and Cox regression hazards model on risk factors were performed. Survival was plotted by Kaplan-Meier curves. Results During the study period, 32 (5.7%) patients out of 564 diagnosed cases of endometrial cancer had serous histology. The mean age at diagnosis was 62.5 years (SD 7.6) while mean BMI was 26.4 kg/m2 (SD 4.6). Staging laparotomy was done in 27(84%) of the patients. Advanced stages (III and IV) were detected in 16 patients (50%) at primary surgery.Adjuvant chemo therapy and radiation was received by 21(65.6%) patients therapy. Out of 32 patients, 13 (40%) developed recurrence while another 13 expired. Stage at diagnosis and type of adjuvant therapy were important factors in determining the outcome. Median recurrence free and overall survival was 22(95% CI 1.4-42) and 36 months (95% CI 10.1-61.8) respectively. Conclusion Serous endometrial cancers are an intrusive subtype of EC. Comprehensive surgical staging with optimal cytoreduction should be aimed at. Adequate upfront molecular categorization of these tumors is mandated. Adjuvant therapy with chemotherapy and radiation is given in postoperative setting. Targeted therapies and immunotherapy could be considered in recurrences.
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Affiliation(s)
- Amrita Datta
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vinotha Thomas
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajit Sebastian
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rachel George
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anitha Thomas
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas Samuel Ram
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sherin Daniel
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - K Reka
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Abraham Peedicayil
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, Tamil Nadu, India
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McEachron J, Zhou N, Hastings V, Bennett M, Gorelick C, Kanis MJ, Lee YC. Optimal cytoreduction followed by chemoradiation in stage IVB uterine serous carcinoma. Cancer Treat Res Commun 2022; 33:100631. [PMID: 36096033 DOI: 10.1016/j.ctarc.2022.100631] [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: 08/16/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The prognosis of patients presenting with stage IVB uterine serous carcinoma (USC) remains extremely poor, with a reported 5-year survival of <20%. Here were evaluate the survival impact of cytoreductive surgery and identify other prognostic factors in stage IVB USC. METHODS A multicenter retrospective analysis of patients with stage IVB USC was conducted from 2000 to 2018. Inclusion criteria were patients who had undergone comprehensive surgical staging/tumor debulking; followed by adjuvant chemotherapy+/-external beam radiation therapy (EBRT). Optimal cytoreduction (R1) was defined as residual disease ≤1 cm at completion of surgery, and suboptimal cytoreduction (R2) was defined as >1 cm. Progression free survival (PFS) and overall survival (OS) analysis was performed using Kaplan-Meier estimates. Multivariate analysis (MVA) was performed using Cox proportional hazards model. RESULTS Final analysis included 68 patients. There was no difference in the frequency of treatment delays between regimens (p = 0.832). 96% of patients received platinum-based chemotherapy. There was no difference in the age (p = 0.227), race (p = 0.936), type of radiotherapy (p = 0.852) or chemotherapy regimen received (p = 0.996) between R1 and R2 cohorts. The median PFS for all patients was 8 months and the median OS was 13 months. Cytoreduction to R1 was associated with a median PFS of 9 months, compared to R2 with a median PFS of 4 months (p < 0.001, HR 0.32, 95% CI 7.4-14.1). Median OS was also improved with R1 vs. R2 cytoreduction (17 months vs. 7 months, respectively) (p < 0.001, HR 0.21, 95% CI 13.7-26.4). Compared to R1, cytoreduction to R0 was not associated with a survival benefit. The R0 median OS was 17 months versus 18 months in R1 (p = 0.67). The combination of adjuvant chemoradiation was associated with improved PFS (11 months vs. 7 months) (p = 0.024, HR 0.41, 95% CI 6.5-9.4) and OS (22 months vs 13 months) (p = 0.65, HR 0.25, 95% CI 10.5-15.4) compared to chemotherapy-alone, respectively. On MVA, only the amount of residual disease (p = 0.003, HR 0.39, 95% CI 0.2-0.7) and receipt of adjuvant chemoradiation (p = 0.010, HR 0.09, 95% CI 0.01-0.58) were independent predictors of survival. CONCLUSIONS In stage IVB USC, optimal cytoreduction should be the goal at the time of primary surgery. The combination of chemoradiation was associated with superior survival compared to chemotherapy alone and should be further investigated in this patient population.
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Affiliation(s)
- Jennifer McEachron
- Division of Gynecologic Oncology, Good Samaritan Hospital Medical Center - Catholic Health, Long Island, NY, United States.
| | - Nancy Zhou
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Victoria Hastings
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Michelle Bennett
- Division of Gynecologic Oncology, Good Samaritan Hospital Medical Center - Catholic Health, Long Island, NY, United States
| | - Constantine Gorelick
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Margaux J Kanis
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Yi-Chun Lee
- Division of Gynecologic Oncology, Good Samaritan Hospital Medical Center - Catholic Health, Long Island, NY, United States
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Xu H, Cui SS, Ran L, Liu Y, Hu C, Xu Y, Tian Y. Incidence of omental metastasis in uterine serous carcinoma: a systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2022; 51:102395. [PMID: 35489712 DOI: 10.1016/j.jogoh.2022.102395] [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: 01/23/2022] [Revised: 04/09/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Previous studies examining the incidence of omental metastasis in uterine serous carcinoma generally suffered from the small sample size, retrospective observational design, and single-center setting. So far, there was no systematic review and meta-analysis available on this topic, we conducted this study to quantitatively synthesize the data relating to this topic. DESIGN systematic review and meta-analysis. MATERIAL AND METHODS PubMed, Embase, and Web of Science were searched up until August 15, 2020. Two reviewers independently performed study selection, data extraction, and quality assessment. I2 was employed to assess the heterogeneity among included studies. Effect sizes along with 95% confidence intervals were calculated to analyze outcomes of interest. Funnel plots and the Egger test were used to detect the possibility of publication bias. OUTCOME MEASURES incidence of omental metastasis in uterine serous carcinoma. RESULTS A total of 16 studies involving 1012 women with uterine serous carcinoma were included in this systematic review and meta-analysis. All the included studies were at low risk of bias, and the heterogeneity among them was low. The pooled incidence of overall omental metastasis, occult omental metastasis, and gross omental metastasis in uterine serous carcinoma were 18% (95% CI, 0.15-0.20), 6% (95% CI, 0.04-0.08), and 10% (95% CI, 0.08-0.13), respectively. CONCLUSIONS Uterine serous carcinoma has a high tendency of omental metastasis. The main form of omentum involvement is gross metastasis. However, occult metastasis in the normal-looking omentum is also worthy of note.
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Affiliation(s)
- Hui Xu
- Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Shuang-Shuang Cui
- Department of Obstetrics and Gynecology, Jianshi Hospital of Traditional Chinese Medicine, Jianshi, Hubei, China
| | - Lin Ran
- Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Yi Liu
- Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Cui Hu
- Department of Obstetrics and Gynaecology, Mianzhu People's Hospital, Mianzhu, Sichuan, China
| | - Yu Xu
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong Tian
- Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China.
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Adoption of minimally invasive surgery after neoadjuvant chemotherapy in women with metastatic uterine cancer. Gynecol Oncol 2021; 164:341-347. [PMID: 34920885 DOI: 10.1016/j.ygyno.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/01/2021] [Accepted: 12/04/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Utilization of neoadjuvant chemotherapy (NACT) for advanced stage uterine cancer is increasing. We analyzed the use and outcomes of open versus minimally invasive surgery (MIS) for women with stage IV uterine cancer who received NACT and underwent IDS. METHODS The National Cancer Database was used to identify women with stage IV uterine cancer diagnosed from 2010 to 2017 and treated with NACT. Among women who underwent IDS, overall survival (OS) was compared between those who underwent laparotomy vs a minimally invasive approach. To account for imbalances in confounders, a propensity score analysis using inverse probability of treatment weighting (IPTW) was performed. RESULTS A total of 1618 women were identified. Minimally invasive IDS was performed in 31.1% and increased from 16.2% in 2010 to 40.4% in 2017 (P < 0.001). More recent year of diagnosis and performance of surgery at a comprehensive cancer center were associated with increased use of MIS (P < 0.05). Women with serous and clear cell tumors, and carcinosarcomas (compared to endometrioid tumors), as well as Medicaid coverage (compared to commercial insurance) were less likely to undergo an MIS approach (P < 0.05). The median OS was 28 months (95% CI 23.7-30.7) and 24.3 months (95% CI 22.3-26.1) for MIS and laparotomy, respectively. After propensity score balancing, there was no association between the use of MIS and survival (HR = 0.90, 95% CI 0.71-1.14). CONCLUSIONS Among women with stage IV uterine cancer treated with NACT performance of minimally invasive debulking surgery is increasing. Compared to laparotomy, MIS does not appear to negatively impact survival.
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Zhang T, Liu Q, Zhu Y, Zhang S, Peng Q, Strickland AL, Zheng W, Zhou F. PD-L1 Expression in Endometrial Serous Carcinoma and Its Prognostic Significance. Cancer Manag Res 2021; 13:9157-9165. [PMID: 34934360 PMCID: PMC8684396 DOI: 10.2147/cmar.s337271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/07/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Programmed death-ligand 1 (PD-L1) has been widely used as a prognostic biomarker and an immunotherapeutic target in numerous cancers, but information on the clinical significance of its expression in endometrial serous carcinoma (ESC) is largely lacking. Here, we evaluate the predictive value of PD-L1 expression in ESC. Materials and Methods A total of 79 cases of ESC accessioned between January 2003 and September 2015 were selected for further analysis. PD-L1 expression was evaluated in whole tissue sections of these cases by using the tumor proportion score (TPS, cut-off 1%) and combined positive score (CPS, cut-off 1) scoring methods. Results Overall, there was a heterogeneous expression of PD-L1, focal or patchy, in ESCs. PD-L1 positivity was observed in 43.0% of ESCs by TPS and 73.4% of ESCs by CPS. Kaplan–Meier survival analysis showed that patients with PD-L1-positive tumors suffered significantly worse OS and PFS, when compared with PD-L1 negative tumors (log-rank p = 0.037 and p = 0.003, respectively). In contrast, PD-L1 positivity by CPS within the ESC cases showed no statistical significance for OS and PFS (log-rank p = 0.720 and p = 0.928, respectively). Multivariate Cox analysis showed that PD-L1 positivity by TPS was significantly associated with PFS (HR = 1.921, p = 0.039) but not OS (HR = 1.229, p = 0.631). Conclusion PD-L1 expression is frequently found in ESC, suggesting a potential role of the PD-1/PD-L1 pathway as a potential therapeutic target for these tumors. PD-L1 expression by TPS also serves as a negative prognostic marker in ESC and implies an unfavorable outcome.
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Affiliation(s)
- Tao Zhang
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Qin Liu
- Department of Pathology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yingfan Zhu
- Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Songfa Zhang
- Department of Oncology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Qiaohua Peng
- Department of Oncology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | | | - Wenxin Zheng
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Feng Zhou
- Department of Pathology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
- Correspondence: Feng Zhou Department of Pathology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, 310006, People’s Republic of ChinaTel +86-571-89991702Fax +86-571-87061878 Email
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Chambers LM, Chau D, Yao M, Costales AB, Rose PG, Michener CM, Debernardo R, Vargas R. Efficacy of hyperthermic intraperitoneal chemotherapy and interval debulking surgery in women with advanced uterine serous carcinoma. Gynecol Oncol Rep 2021; 38:100876. [PMID: 34761096 PMCID: PMC8567198 DOI: 10.1016/j.gore.2021.100876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022] Open
Abstract
In this small series, HIPEC is well tolerated in patients with advanced USC. HIPEC at IDS is associated with favorable PFS and OS in advanced USC. Further investigation of HIPEC in women with advanced USC is warranted.
Objective(s) To investigate the efficacy and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) at the time of iterval debulking surgery (IDS) in women with advanced uterine serous carcinoma (USC) following neoadjuvant chemotherapy (NACT). Methods An IRB-approved single-institution prospective registry was queried to identify women with incidentally identified USC at the time of IDS + HIPEC for high-grade serous carcinoma. Patient demographic, oncologic, and surgical outcomes data were recorded. Univariate analysis determined progression-free survival (PFS) and overall survival (OS). Results In total, seven patients were found to have advanced USC after undergoing IDS + HIPEC, with a median age of 64.5 years. The majority had stage IV, (n = 6, 85.7%), MMR proficient (n = 5, 71.4%), p53 mutant (n = 6, 85.1%) USC. The median pre-operative CA125 was 24.0U/mL. HIPEC regimen was cisplatin (n = 3, 42.9%) or cisplatin with paclitaxel (n = 4, 57.1%). All patients underwent optimal cytoreduction, with 71.4% (n = 5) having no gross residual disease. Accordion post-operative complications were mild in 14.3% (n = 1), moderate in 57.1% (n = 4) and severe in 14.3% (n = 1); 14.3% (n = 1) had no complications. The median length of stay was 6.5 days (IQR 4–8 days) with a median time to chemotherapy of 33.0 days. The median PFS was 14.0 months (95% CI 3.5–20.8 months), and the median OS was 27.0 months (95% CI 5.1- not reached). Conclusions In this small, prospective series, we demonstrate that IDS + HIPEC is well tolerated in patients with USC and is associated with favorable PFS and OS following NACT. Further prospective investigation is needed to validate these promising findings in larger, heterogeneous cohorts of women with advanced USC who are not candidates for primary surgical management.
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Affiliation(s)
- Laura M Chambers
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States.,Division of Gynecologic Oncology, James Cancer Hospital and Solove Research Institute, The Ohio State University Medical Center, Columbus, OH 43210, United States
| | - Danielle Chau
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Meng Yao
- Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Anthony B Costales
- Department of Gynecologic Oncology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Peter G Rose
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Chad M Michener
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Robert Debernardo
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Roberto Vargas
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
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Huang AB, Wu J, Chen L, Albright BB, Previs RA, Moss HA, Davidson BA, Havrilesky LJ, Melamed A, Wright JD. Neoadjuvant chemotherapy for advanced stage endometrial cancer: A systematic review. Gynecol Oncol Rep 2021; 38:100887. [PMID: 34820496 PMCID: PMC8601999 DOI: 10.1016/j.gore.2021.100887] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/18/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE While primary cytoreductive surgery (PCS) is considered the standard of care for women who present with stage IV endometrial cancer, neoadjuvant chemotherapy (NACT) followed by interval cytoreductive surgery (ICS) has emerged as an alternative treatment strategy. We summarized the literature and compared outcomes of PCS compared to NACT and ICS. METHODS We conducted a systematic search on PubMed, Embase, Web of Science, and Scopus for articles published from January 1, 1990 to December 31, 2020. Key search terms included multiple descriptors of advanced disease status in combination with "endometrial cancer" and "neoadjuvant chemotherapy". Our review included studies that examined survival and surgical outcomes of patients with stage III or IV endometrial cancer treated with neoadjuvant chemotherapy followed by interval cytoreductive surgery versus those who received primary cytoreductive surgery. We excluded studies examining only patients with leiomyosarcomas, carcinosarcomas, and stromal sarcomas due to the biologic heterogeneity of these malignancies. RESULTS The nine included studies encompassed 5,844 patients, of which 1,317 (22.5%) received NACT and 4,527 received PCS (77.5%). With the exception of a single study, all were retrospective observational studies or case series. Use of NACT in patients with stage IV EC increased from 16.0% in 2010 to 23.9% in 2015. Five studies analyzed median overall survival and all but one reported no significant difference between NACT + ICS vs. PCS. Optimal cytoreduction (<1 cm of residual disease) rates were similar across both treatment groups in three separate analyses, however pooled data suggest improved rates of optimal cytoreduction for NACT + ICS vs. PCS patients (81.9% vs. 51.5% respectively). Patients receiving NACT experienced significantly shorter hospital admissions and lower operative times compared to PCS counterparts. CONCLUSIONS NACT followed by ICS reduces perioperative morbidity while offering similar overall survival.
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Affiliation(s)
- Allan B. Huang
- Columbia University Vagelos College of Physicians and Surgeons, United States
| | - Jenny Wu
- Duke University School of Medicine, United States
| | - Ling Chen
- Columbia University Vagelos College of Physicians and Surgeons, United States
| | | | | | | | | | | | - Alexander Melamed
- Columbia University Vagelos College of Physicians and Surgeons, United States
- Herbert Irving Comprehensive Cancer Center, United States
- NewYork-Presbyterian Hospital, United States
| | - Jason D. Wright
- Columbia University Vagelos College of Physicians and Surgeons, United States
- Herbert Irving Comprehensive Cancer Center, United States
- NewYork-Presbyterian Hospital, United States
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Albright BB, Monuszko KA, Kaplan SJ, Davidson BA, Moss HA, Huang AB, Melamed A, Wright JD, Havrilesky LJ, Previs RA. Primary cytoreductive surgery for advanced stage endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 225:237.e1-237.e24. [PMID: 33957111 DOI: 10.1016/j.ajog.2021.04.254] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Endometrial cancer uncommonly presents at an advanced stage and little prospective evidence exists to guide the management thereof. We aimed to summarize the evidence about primary cytoreductive surgery in the treatment of advanced stage endometrial cancer. DATA SOURCES MEDLINE, Embase, and Scopus databases were searched from inception to September 11, 2020, using search terms representing the themes "endometrial cancer," "advanced stage," and "primary cytoreductive surgery." STUDY ELIGIBILITY CRITERIA We included full-text, English reports that included ≥10 patients undergoing primary cytoreductive surgery for advanced stage endometrial cancer and that reported on the outcomes of primary cytoreductive surgery and survival rates based on the residual disease burden. METHODS Two reviewers independently screened the studies and with disagreements between the reviewers resolved by a third reviewer. Data were extracted using a standardized form. The percentage of cases reaching maximal (no gross residual disease) and optimal (<1 cm or <2 cm residual disease) cytoreduction were assessed by summing binomials proportions, and the association with survival was assessed using an inverse variance-weighted meta-analysis of logarithmic hazard ratios. RESULTS From 1219 unique records identified, 34 studies were selected for inclusion. Studies consisted of single or multi-institutional cohorts of patients collected over a period of 6 to 24 years and included various mixes of histologies (endometrioid, serous, clear cell, and carcinosarcoma) and disease stages (III or IV). In a meta-analysis of the extent of residual disease after primary cytoreductive surgery, we found that 52.1% of cases reached no gross residual disease status (n=18 studies; 1329 patients) and 75% reached <1 cm residual disease status (n=27 studies; 2343 patients). The proportion of cytoreduction for both thresholds was lower for studies of stage IV vs stage III to IV disease (41.4% vs 69.8% for no gross residual disease; 63.2% vs 82.2% for <1 cm residual disease) but did not vary notably by histology. In a meta-analysis of the reported hazard ratios, submaximal (any gross residual disease vs no gross residual disease) and suboptimal (≥1 cm vs <1 cm) cytoreduction thresholds were associated with worse progression-free survival (submaximal hazard ratio, 2.16; 95% confidence interval, 1.45-3.21; I2=68%; suboptimal hazard ratio, 2.55; 95% confidence interval, 1.93-3.37; I2=63%) and overall survival rates (submaximal hazard ratio, 2.57; 95% confidence interval, 2.13-3.10; I2=1%; suboptimal hazard ratio, 2.62; 95% confidence interval, 2.20-3.11; I2=15%). Sensitivity analyses limited to high-quality studies demonstrated consistent results. CONCLUSION Among cases of advanced stage endometrial cancer undergoing primary cytoreductive surgery, a significant proportion of patients are left with residual disease, which is associated with worse survival outcomes. Further investigations about the roles of neoadjuvant chemotherapy and primary cytoreductive surgery in prospective trials is warranted in this population.
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Wright JD, Huang Y, Melamed A, Albright BB, Hillyer GC, Previs R, Hershman MSDL. Use and outcomes of neoadjuvant chemotherapy for metastatic uterine cancer. Gynecol Oncol 2021; 162:599-605. [PMID: 34158181 DOI: 10.1016/j.ygyno.2021.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Neoadjuvant chemotherapy (NACT) has emerged as an alternative to primary cytoreductive surgery (PCS) for stage IV uterine cancer. We examined utilization, perioperative outcomes and survival for NACT and PCS for stage IV uterine cancer. METHODS The Surveillance, Epidemiology, End Results-Medicare database was used to identify women with stage IV uterine cancer treated from 2000 to 2015. Women were classified as NACT or PCS. Interval cytoreductive surgery (after NACT) or chemotherapy (after PCS) were recorded. The extent of surgery and perioperative outcomes were estimated for the groups. Multivariable proportional hazards models and Kaplan-Meier analyses were used to examine survival. RESULTS Among 3037 women, 1629 (53.6%) were treated with primary cytoreductive surgery, 554 (18.2%) with NACT, and 854 (28.1%) received no treatment. Use of NACT increased from 9.5% to 29.2%. After NACT, interval hysterectomy was performed in 159 (28.6%), while within the PCS group, 1052 (64.6%) received chemotherapy. Extended cytoreductive procedures were performed in 71.7% of women who received NACT vs. 79.1% after PCS (P = 0.03). The complication rate was 52.8% for NACT versus 56.2% for PCS (P = 0.42); medical complications were more frequently seen in the PCS group (39.4% versus 28.9%; P = 0.01). There was no difference in cancer specific (P = 0.48) or overall survival (P = 0.25) in women who received both chemotherapy and surgery regardless of whether the initial treatment was NACT or PCS. CONCLUSION Use of NACT is increasing for advanced stage uterine cancer. There was no difference in survival between NACT and primary cytoreductive surgery and NACT was associated with fewer perioperative medical complications.
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Affiliation(s)
- Jason D Wright
- Columbia University Vagelos College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; NewYork-Presbyterian Hospital, USA.
| | - Yongmei Huang
- Columbia University Vagelos College of Physicians and Surgeons, USA
| | - Alexander Melamed
- Columbia University Vagelos College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; NewYork-Presbyterian Hospital, USA
| | | | - Grace C Hillyer
- Joseph L. Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, USA
| | | | - M S Dawn L Hershman
- Columbia University Vagelos College of Physicians and Surgeons, USA; Joseph L. Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, USA; NewYork-Presbyterian Hospital, USA
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Jani I, Lastra RR, Brito KS, Liao C, Lazo I, Lee NK, Yamada SD, Kurnit KC. Chemotherapy response score as a prognostic tool in patients with advanced stage endometrial carcinoma treated with neoadjuvant chemotherapy. Int J Gynecol Cancer 2021; 31:852-858. [PMID: 33833085 DOI: 10.1136/ijgc-2020-002202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Chemotherapy response score (CRS) applied to interval debulking specimens quantifies histopathologic response to neoadjuvant chemotherapy in patients with advanced ovarian carcinoma and correlates with progression-free and overall survival. OBJECTIVE To investigate whether the chemotherapy response score could be applied to interval debulking specimens in patients with advanced endometrial carcinoma and be a prognostic indicator. METHODS The study included patients with clinical stage III-IV endometrial carcinoma who received neoadjuvant chemotherapy followed by interval debulking surgery. Chemotherapy response scores were assigned to omental and adnexal metastases, and categorized as no/minimal (CRS1), partial (CRS2), and complete/near-complete (CRS3) response to neoadjuvant chemotherapy. Descriptive statistics were used to evaluate baseline characteristics and feasibility of chemotherapy response score assessment. Univariate analyses were used to evaluate associations between the chemotherapy response score, complete cytoreduction, and survival. RESULTS This study included 40 patients. The median age was 63.5 years, and 31 patients (78%) had stage IV disease. Thirty patients had an omentectomy, 22 patients (73%) had an omental chemotherapy response score assigned. Thirty-nine patients had a bilateral salpingo-oophorectomy, 28 patients (72%) had an adnexal chemotherapy response score assigned. Omental CRS2 and CRS3 were associated with improved progression-free survival (CRS2: HR=0.18, p<0.01; CRS3: HR=0.11, p<0.01) and overall survival (CRS2: HR=0.10, p<0.01; CRS3: HR=0.16, p=0.04). Adnexal CRS2 and CRS3 were associated with improved progression-free survival (CRS2: HR=0.23, p<0.01; CRS3: HR=0.20, p=0.03). Chemotherapy response scores were also associated with an increased likelihood of having a complete cytoreduction. CONCLUSION Chemotherapy response score can be applied to omental and adnexal metastases in patients with advanced endometrial carcinoma and was associated with survival and complete cytoreduction. The score may be a prognostic indicator and help to guide first-line treatment of patients with endometrial carcinoma.
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Affiliation(s)
- Ina Jani
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Katherine S Brito
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Chuanhong Liao
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Isabel Lazo
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Nita Karnik Lee
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - S Diane Yamada
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Katherine C Kurnit
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
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The role of lymphadenectomy in patients with stage III&IV uterine serous carcinoma: Results of multicentric Turkish study. J Gynecol Obstet Hum Reprod 2021; 50:102063. [PMID: 33453448 DOI: 10.1016/j.jogoh.2021.102063] [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: 10/19/2020] [Revised: 12/29/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate clinicopathological features, oncological outcome and prognostic factors for recurrence in advanced stage uterine serous carcinoma (USC) patients. METHODS Patients with 2009 International Federation of Gynecology and Obstetrics stage III&IV uterine serous carcinoma were enrolled from 4 gynecologic oncology centers and a study group was created. Response to therapy was evaluated according to the WHO criteria. Progression-free survival (PFS) and overall survival (OS) estimates were determinated by using the Kaplan-Meier method. Survival curves were compared with the log-rank test. Multivariate analysis was performed using the Cox proportional hazards model. RESULTS Entire cohort included 63 patients. Median age of cohort was 64 years. Thirty-five (55.6 %) patients were stage IV. Lymphadenectomy was performed in 57 (90.5 %) patients and lymph node metastasis was positive in 45 (71.4 %) patients. Maximal cytoreduction (no residue tumor) was achieved in 53 (84.1 %) patients. However, optimal cytoreduction (residue tumor ≤1 cm) was achieved in 6 (9.5 %) patients and suboptimal cytoreduction (residue tumor >1 cm) was achieved in 3 (4.8 %) patients. Median follow-up time was 19 (range;1-152) months. Complete clinical response was obtained in 58 (92.1 %) patients after standard adjuvant therapy. Disease failure was detected in 25 patients. Study group had a 2-year PFS of 51 % and 2-year OS of 80 %. On multivariate analysis, performing lymphadenectomy was an independent prognostic factor for PFS (Odds ratio: 24.794, 95 % Confidence Interval: 4.214-145.869; p < 0.001). CONCLUSION Lymphadenectomy should be a part of the standard surgical therapy in advanced stage USC.
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Abstract
This article addresses the role of surgery in the management of gynecologic cancers with liver metastases. The authors review the short-term and long-term outcomes of aggressive resection through retrospective and randomized studies. Although the data supporting aggressive resection of liver metastasis are largely retrospective and case based, the randomized control data to address neoadjuvant versus chemotherapy have been widely criticized. Residual disease remains an important predictor for survival in ovarian cancer. If a patient cannot achieve near optimal cytoreduction, radical cytoreductive procedures, such as hepatic resection, should be considered for palliation only.
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Affiliation(s)
- Kiran H Clair
- Division of Gynecologic Oncology, University of California, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA.
| | - Juliet Wolford
- Division of Gynecologic Oncology, University of California, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA
| | - Jason A Zell
- Division of Hematology/Oncology, Department of Medicine, University of California, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA
| | - Robert E Bristow
- Department of Obstetrics and Gynecology, University of California, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA
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McEachron J, Mendoza R, Lee YC, Kanis MJ. Breast metastases: A rare manifestation of advanced uterine serous carcinoma. Gynecol Oncol Rep 2019; 30:100500. [PMID: 31656850 PMCID: PMC6806454 DOI: 10.1016/j.gore.2019.100500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 11/28/2022] Open
Abstract
Metastasis to the breast is a rare, accounting for <1.0% of all breast tumors. Over 50% of patient with USC will recur despite multimodality treatment. The majority of USC recur locally within the pelvis or abdominal cavity. Hematogenous metastasis to the breast has not been reported in USC. A new breast mass in a patient with USC is more likely to primary breast cancer.
Metastasis of non-mammary tumors to the breast are uncommon, representing <1% of all breast tumors. Breast metastasis are associated with advanced disease and poor prognosis regardless of the origin of the primary tumor. Uterine cancer metastasis to the breast is an extremely rare finding and has not been reported in the case of serous histology. Here, we review two cases of uterine serous carcinoma metastatic to the breast. Both patients presented with breast-specific complaints including pain and palpable mass and were found to have widely metastatic disease. Tissue biopsy and immunohistochemistry consistent with primary uterine serous carcinoma confirmed the diagnosis of metastasis in both cases. Our findings suggest hematogenous metastasis to the breast is a late phenomenon in the course of endometrial carcinoma and associated with the development of disease at multiple sites. This emphasizes the importance of complete evaluation in patients presenting with breast complaints and known history of malignancy, as this may be the only presenting symptoms in patients with widely metastatic disease.
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Affiliation(s)
- Jennifer McEachron
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, United States
| | - Rachel Mendoza
- Division of Pathology, SUNY Downstate Medical Center, United States
| | - Yi-Chun Lee
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, United States
| | - Margaux J Kanis
- Division of Gynecologic Oncology, New York-Presbyterian Brooklyn Methodist Hospital, United States
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de Lange NM, Ezendam NPM, Kwon JS, Vandenput I, Mirchandani D, Amant F, van der Putten LJM, Pijnenborg JMA. Neoadjuvant chemotherapy followed by surgery for advanced-stage endometrial cancer. ACTA ACUST UNITED AC 2019; 26:e226-e232. [PMID: 31043831 DOI: 10.3747/co.26.4655] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Data showing the value of neoadjuvant chemotherapy (nact) followed by interval debulking surgery (ids) in the management of advanced-stage serous endometrial carcinoma (eca) are limited; the aim of the present study was to expand the knowledge about that treatment strategy in patients with advanced eca, including endometrioid eca. Methods Data were collected retrospectively from all patients with advanced-stage eca treated with nact between 2005 and 2014 at 3 oncology referral centres. Primary outcomes were the radiologic response to nact and achievement of optimal or complete ids. Secondary outcomes were recurrence rate and progression-free and overall survival. Results Of 102 eca cases included, a complete radiologic response was achieved in only 4 cases, with a partial response being achieved in 72% (64% of endometrioid cases, 80% of serous cases). Complete ids was achieved in 62% of the endometrioid cases and in 56% of the serous eca cases, with optimal ids achieved in 31% and 28% of those cases respectively. Survival rates were calculated for all patients with complete and optimal ids; recurrence was observed in 56% and 67% of the cases respectively, and progression-free survival was 18 months and 13 months respectively. Median survival duration was 24 months for endometrioid eca and 28 months for serous eca. Conclusions For patients with advanced eca who are not suitable for primary debulking, nact followed by ids can be considered regardless of histologic subtype. The treatment options for this group of patients are limited and have to be explored.
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Affiliation(s)
- N M de Lange
- Formerly: Department of Obstetrics and Gynaecology, Catharina Hospital Eindhoven, Eindhoven, Netherlands; Currently: Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, Netherlands
| | - N P M Ezendam
- Tilburg University and Comprehensive Cancer Centre, Tilburg, Netherlands
| | - J S Kwon
- Department of Obstetrics and Gynaecology, BC Cancer, University of British Columbia, Vancouver, BC
| | - I Vandenput
- Department of Obstetrics and Gynaecology, AZ Turnhout, Turnhout, Belgium
| | - D Mirchandani
- Department of Oncology, BC Cancer-Sindi Ahluwalia Hawkins Centre for the Southern Interior, Kelowna, BC
| | - F Amant
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven, Belgium.,Centre for Gynaecologic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - L J M van der Putten
- Formerly: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands; Currently: Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Hertogenbosch, Netherlands
| | - J M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands.,Radboud Institute for Health Sciences, Nijmegen, Netherlands
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Rajkumar S, Nath R, Lane G, Mehra G, Begum S, Sayasneh A. Advanced stage (IIIC/IV) endometrial cancer: Role of cytoreduction and determinants of survival. Eur J Obstet Gynecol Reprod Biol 2019; 234:26-31. [DOI: 10.1016/j.ejogrb.2018.11.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/05/2018] [Accepted: 11/30/2018] [Indexed: 11/17/2022]
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Abstract
OBJECTIVES The aims of this study were to determine the role of omental sampling in staging of uterine serous carcinoma (USC) and to evaluate its impact on patient outcomes. MATERIALS AND METHODS A retrospective study of 106 women with USC who underwent primary surgery between 2005 and 2014 was done. Overall survival, disease-free survival, and progression and recurrence patterns were studied in 84 patients with follow-up over 1 year. Diagnostic characteristics were evaluated for preoperative imaging and operative findings. Univariate and multivariate analyses were performed to evaluate risk factors for omental metastasis. Survival curves were used to compare omental sampling status and the presence of omental metastasis. RESULTS Of the 106 patients, 66 underwent surgical staging with omental biopsy (54; 82%) or omentectomy (12, 18%). Eight (12%) patients had metastatic disease in the omental samplings. All 6 patients with macrometastasis had visible lesions or palpable nodules and preoperative computed tomography (CT) was suspicious in 3. In 2 (3%) patients, omentum was not suspicious on CT or intraoperatively but had micrometastases. The negative predictive value regarding the staging CT scan was 92% and of the operative findings was 97%. On multivariate analysis, no variable was associated with omental involvement. Disease progressed or recurred in 40 (48%) patients. The most frequent sites of recurrence or progression were the omentum (23; 27%), peritoneum (26; 31%), pelvis (15, 18%), lung (15, 18%), and liver (12, 14%). Comparing the groups with or without omental assessment, no significant difference was found regarding progression and recurrence patterns, overall survival, and disease-free survival. CONCLUSIONS Omental involvement in USC upstages patients to stage IV disease and traditional risk factors fail to predict extrauterine disease. Although omental sampling does not influence disease progression or survival, a comprehensive intraoperative evaluation of the omentum is advised as most cases have grossly visible lesions.
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Trends in Survival of Patients With Uterine Serous Carcinoma From 1988 to 2011: A Population-Based Study. Int J Gynecol Cancer 2017; 27:1155-1164. [DOI: 10.1097/igc.0000000000001007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveOur study used the Surveillance, Epidemiology, and End Result database to determine if the changes in treatment paradigm observed over the last 2 decades have improved outcomes in patients with uterine serous carcinoma (USC).MethodsWomen with USC were identified using the Surveillance, Epidemiology, and End Result database from 1988 to 2011 (n = 8230) and grouped into 3 cohorts (1988–1997, 1998–2004, and 2005–2011). Disease-specific survival and overall survival were estimated. Kaplan-Meier survival curves and Cox regression models were used.ResultsDisease-specific survival (59 vs 94 months vs not reached;P< 0.001) and overall survival (31 vs 37 vs 45 months;P< 0.001) improved over time. In univariable analyses, only those with stage I–III and those who reside in the Western or Central regions were noted to have improvement over time. In multivariable analyses when adjusting for age, race, marital status, stage, geographic location, cancer-related surgery, extent of lymphadenectomy, and adjuvant radiation, patients who received the diagnosis during 2005 to 2011 were 22% less likely to die of uterine cancer (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.70–0.87;P< 0.001) and 17% less likely to die of any cause (HR, 0.83; 95% CI, 0.76–0.90;P< 0.0001) compared with patients who received a diagnosis during 1988–1997. Similarly, patients who received a diagnosis during 1998–2004 were 15% less likely to die of uterine cancer (HR, 0.85; 95% CI, 0.77–0.94;P= 0.0015) and 10% less likely to die of any cause (HR, 0.90; 95% CI, 0.83–0.97;P= 0.0048) compared with patients who received a diagnosis during 1988–1997.ConclusionsChanges in treatment trends for USC over the last 2 decades have resulted in an improvement in outcome especially those with stage I–III disease.
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Holman LL, Pal N, Iglesias DA, Soliman PT, Balakrishnan N, Klopp A, Broaddus RR, Fleming ND, Munsell MF, Lu KH, Westin SN. Factors prognostic of survival in advanced-stage uterine serous carcinoma. Gynecol Oncol 2017; 146:27-33. [PMID: 28465008 DOI: 10.1016/j.ygyno.2017.04.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/19/2017] [Accepted: 04/24/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The study objective was to analyze the impact of prognostic factors, including treatment modality, on outcome in patients with advanced-stage uterine serous carcinoma (USC). METHODS A retrospective review of patients diagnosed with stage III or IV USC between 1993 and 2012 was performed. Summary statistics were used to describe demographic and clinical characteristics. Overall survival (OS) and recurrence free survival (RFS) were estimated by Kaplan-Meier analysis. Cox proportional hazards regression was used to model the association of potential prognostic factors with OS and RFS. RESULTS The study included 260 patients with median follow-up of 26.6months (range 1-172.8). Median age was 63years (range 30-88) and 52.3% had stage III disease. In all, 60% were treated with surgery followed by chemotherapy, 18.1% received surgery, chemotherapy, and radiotherapy, 11.5% had surgery and radiotherapy, and 10.4% had neoadjuvant chemotherapy. The overall complete response rate was 68.9%, and the cumulative incidence of recurrence was 82.7%. Treatment that included surgery, chemotherapy, and radiation and stage III disease were associated with improved RFS on multivariate analysis. For OS, therapy with surgery, chemotherapy, and radiation, mixed histology, and stage III disease were associated with better OS on multivariate analysis. CONCLUSIONS Patients with advanced-stage USC have a poor prognosis, regardless of clinical factors or treatment received. However, combination therapy that includes chemotherapy and radiation appears to be associated with improved survival in these women.
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Affiliation(s)
- Laura L Holman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Navdeep Pal
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - David A Iglesias
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pamela T Soliman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nyla Balakrishnan
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ann Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Russell R Broaddus
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nicole D Fleming
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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Sundar S, Balega J, Crosbie E, Drake A, Edmondson R, Fotopoulou C, Gallos I, Ganesan R, Gupta J, Johnson N, Kitson S, Mackintosh M, Martin-Hirsch P, Miles T, Rafii S, Reed N, Rolland P, Singh K, Sivalingam V, Walther A. BGCS uterine cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2017; 213:71-97. [PMID: 28437632 DOI: 10.1016/j.ejogrb.2017.04.015] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
The British Gynaecological Cancer Society has issued the first Endometrial (Uterine) Cancer guidelines as recommendation for practice for the UK.
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Affiliation(s)
- Sudha Sundar
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Janos Balega
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Emma Crosbie
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Alasdair Drake
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Richard Edmondson
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Christina Fotopoulou
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom.
| | - Ioannis Gallos
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Raji Ganesan
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Janesh Gupta
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Nick Johnson
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Sarah Kitson
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Michelle Mackintosh
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Pierre Martin-Hirsch
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Tracie Miles
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Saeed Rafii
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Nick Reed
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Phil Rolland
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Kavita Singh
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Vanitha Sivalingam
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Axel Walther
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
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Lee SW, Lee TS, Hong DG, No JH, Park DC, Bae JM, Seong SJ, Shin SJ, Ju W, Lee KH, Lee YK, Cho H, Lee C, Paek J, Kim HJ, Lee JW, Kim JW, Bae DS. Practice guidelines for management of uterine corpus cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement. J Gynecol Oncol 2016; 28:e12. [PMID: 27894165 PMCID: PMC5165063 DOI: 10.3802/jgo.2017.28.e12] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/16/2016] [Indexed: 11/30/2022] Open
Abstract
Clinical practice guidelines for gynecologic cancers have been developed by many organizations. Although these guidelines have much in common in terms of the practice of standard of care for uterine corpus cancer, practice guidelines that reflect the characteristics of patients and healthcare and insurance systems are needed for each country. The Korean Society of Gynecologic Oncology (KSGO) published the first edition of practice guidelines for gynecologic cancer treatment in late 2006; the second edition was released in July 2010 as an evidence-based recommendation. The Guidelines Revision Committee was established in 2015 and decided to produce the third edition of the guidelines as an advanced form based on evidence-based medicine, considering up-to-date clinical trials and abundant qualified Korean data. These guidelines cover screening, surgery, adjuvant treatment, and advanced and recurrent disease with respect to endometrial carcinoma and uterine sarcoma. The committee members and many gynecologic oncologists derived key questions from the discussion, and a number of relevant scientific literatures were reviewed in advance. Recommendations for each specific question were developed by the consensus conference, and they are summarized here, together with other details. The objective of these practice guidelines is to establish standard policies on issues in clinical areas related to the management of uterine corpus cancer based on the findings in published papers to date and the consensus of experts as a KSGO Consensus Statement.
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Affiliation(s)
- Shin Wha Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Taek Sang Lee
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dong Choon Park
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae Man Bae
- Department of Obstetrics and Gynecology, Hanyang University Medical Center, Seoul, Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - So Jin Shin
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, Korea
| | - Woong Ju
- Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Keun Ho Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo Kyung Lee
- Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Hanbyoul Cho
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chulmin Lee
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, Inje University, Seoul, Korea
| | - Jiheum Paek
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Duk Soo Bae
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Mahdi H, Han X, Abdul-Karim F, Vargas R. Racial disparity in survival of patients with uterine serous carcinoma: Changes in clinical characteristics, patterns of care and outcomes over time from 1988 to 2011. Gynecol Oncol 2016; 143:334-345. [PMID: 26948694 DOI: 10.1016/j.ygyno.2016.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/29/2016] [Accepted: 03/01/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To determine if the disparities in the outcome between white (W) and African American (AA) patients with uterine serous carcinoma (USC) have changed over time. METHODS Women with USC were identified using the SEER database from 1988 to 2011 (N=7667). Years of the study were divided into three periods (1988-1997, 1998-2004 and 2005-2011). Overall (OS) and disease-specific survivals (DSS) was estimated. RESULTS Over the three time periods, African American patients continued to be younger and less likely to have cancer directed surgery and extensive lymphadenectomy when compared to white patients. In multivariable analysis adjusting for age, race, marital status, stage, cancer-directed surgery, extent of lymphadenectomy, adjuvant radiation, and geographic location, AA was significantly associated with worse DSS and OS in the three time periods compared to white race. African American patients were 29% (95% CI 1.03-1.62, p=0.027) in 1988-1997, 40% in 1998-2004 (95% CI 1.21-1.63, p<0.0001) and 34% in 2005-2011 (95% CI 1.13-1.59, p=0.0008) more likely to die from uterine cancer compared to their white counterparts. A slight improvement in the difference in OS over time was noted comparing African American and white patients. African American patients were 46% (95% CI 1.23-1.73, p<0.0001) in 1988-1997, 39% in 1998-2004 (95% CI 1.23-1.56, p<0.0001) and 26% in 2005-2011 (95% CI 1.10-1.45, p<0.0001) more likely to die from any cause compared to their white counterparts. CONCLUSIONS Significant improvement in outcome was noted in both racial groups over time. However, African American patients continued to have worse outcome than white patients over time.
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Affiliation(s)
- Haider Mahdi
- Gynecologic Oncology Division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Xiaozhen Han
- Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH, USA
| | - Fadi Abdul-Karim
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Roberto Vargas
- Gynecologic Oncology Division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
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Analysis of clinical and pathological characteristics, treatment methods, survival, and prognosis of uterine papillary serous carcinoma. TUMORI JOURNAL 2016; 102:593-599. [PMID: 27514313 DOI: 10.5301/tj.5000531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Uterine papillary serous carcinoma (UPSC) is an atypical variant of endometrial carcinoma with a poor prognosis. It is commonly associated with an increased risk of extrauterine disease. The aim of this study was to investigate clinical and pathological characteristics, therapeutic methods, and prognostic factors in women with UPSC. METHODS All patients who underwent surgery for UPSC at a single high-volume cancer center between January 1995 and December 2010 were retrospectively reviewed. Patients who did not undergo surgical staging and those with mixed tumor histology were excluded. Univariate and multivariate regression models were used to identify the risk factors for overall survival (OS) and progression-free survival (PFS). RESULTS A total of 46 patients were included, the majority of whom having stage I disease (IA, 13 [28.2%] and IB, 12 [26.7%]). Stages II, III, and IV were identified in 5 (10.9%), 8 (17.4%), and 8 (17.4%) women, respectively. Optimal cytoreduction was obtained in 67.3% of patients. Recurrences developed in 8 (17.4%) patients. Multivariate analysis confirmed that lymphovascular space invasion (LVSI) (odds ratio [OR] 26.83, p = 0.003) was the only independent prognostic factor for OS, whereas LVSI and optimal cytoreduction were found to be independent prognostic factors for PFS (OR 6.91, p = 0.013 and OR 2.69, p = 0.037, respectively). The 5-year overall survival rate was 63%. CONCLUSIONS Our study demonstrated that LVSI is the only independent prognostic factor for OS, whereas LVSI and optimal cytoreduction are independent prognostic factors for PFS in patients with UPSC.
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Solmaz U, Mat E, Ekin A, Gezer C, Biler A, Peker N, Ayaz D, Sanci M. Optimal cytoreduction, depth of myometrial invasion, and age are independent prognostic factors for survival in women with uterine papillary serous and clear cell carcinomas. Int J Surg 2016; 32:71-7. [PMID: 27365052 DOI: 10.1016/j.ijsu.2016.06.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 05/26/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the clinicopathological characteristics, treatment methods, and prognostic factors in women with uterine papillary serous carcinoma (UPSC) and uterine clear-cell carcinoma (UCCC). STUDY DESIGN All patients who had undergone surgery for UPCS and UCCC between January 1995 and December 2012 were retrospectively reviewed. Patients with missing data, who did not undergo surgical staging and patients with mixed tumor histology were excluded. Multivariate regression models were used to identify the risk factors for overall survival (OS) and progression-free survival (PFS). RESULTS A total of 49 UPSC and 22 UCCC women were included. The majority of the patients were at stage I [IA, 22 (31%) and IB, 18 (25.4%)]. Stages II, III, and IV were identified in 9 (12.7%), 13 (18.3%), and 9 (12.7%) of cases, respectively. Optimal cytoreduction was achieved in 71.8% of cases. Recurrences occurred in 16 patients (22.5%). The 5-year OS rates were 67% for UPSC; 76% for UCCC; 68% for both histology, respectively. Multivariate analysis pointed out that age>67 years (odds ratio (OR): 3.85, p = 0.009 and OR: 3.35, p = 0.014), >50% myometrial invasion (MI) (OR: 2.87, p = 0.037 and OR: 2.46, p = 0.046) and optimal cytoreduction (OR: 3.26, p = 0.006 and OR: 2.77, p = 0.015) were the independent prognostic factors for both PFS and OS. CONCLUSIONS Our study demonstrated that optimal cytoreduction, >50% MI, and age >67 years are the most significant factors affecting survival in women with UPSC and UCCC.
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Affiliation(s)
- Ulas Solmaz
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Emre Mat
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Atalay Ekin
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Cenk Gezer
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Alper Biler
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Nuri Peker
- Department of Obstetrics and Gynecology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Duygu Ayaz
- Department of Pathology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Muzaffer Sanci
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
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Neoadjuvant chemotherapy versus primary cytoreductive surgery for stage IV uterine serous carcinoma. Int J Gynecol Cancer 2015; 25:63-8. [PMID: 25365590 DOI: 10.1097/igc.0000000000000321] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study compares surgical and survival outcomes of women with stage IV uterine serous carcinoma (USC) treated with neoadjuvant chemotherapy (NAC) and interval cytoreduction to women treated with primary cytoreductive surgery (PCS) followed by adjuvant chemotherapy. METHODS This retrospective dual cohort study included women diagnosed with stage IV USC at a single academic institution. Kruskal-Wallis and Fisher exact tests were used to compare demographics and surgical outcomes. Progression-free survival (PFS) and overall survival (OS) were estimated by using Kaplan-Meier methods. Comparison between study groups was tested by log-rank statistics. RESULTS Ten women with stage IV USC who received NAC and 34 who underwent PCS met inclusion criteria. Neoadjuvant chemotherapy patients had a lower mean body mass index and were more often African American. Compared with PCS, the NAC cohort had shorter mean operative times (137 ± 66 vs 203 ± 80 minutes, P = 0.025) and were discharged from the hospital earlier (median length of stay, 3 vs 5 days; P = 0.002). Rates of debulking to no gross residual disease (70% NAC vs 32.3% PCS) or less than 1 cm of disease (30% NAC vs 50% PCS) did not differ (P = 0.10). Median follow-up time was 17.5 months. There was no difference in median PFS (10.4 vs 12 months, P = 0.29) or OS (17.3 vs 20.7 months, P = 0.23) for NAC and PCS cohorts. CONCLUSIONS Women receiving NAC for stage IV USC had shorter surgeries and hospital stays than did those receiving PCS. There was no difference in PFS or OS, although our sample size was small. Neoadjuvant chemotherapy may be an appropriate therapy for select patients with advanced-stage USC.
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Distribution and volume of extrauterine disease in uterine serous carcinoma: is minimally invasive surgery a suitable approach? Int J Gynecol Cancer 2015; 25:87-91. [PMID: 25474625 DOI: 10.1097/igc.0000000000000326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Minimally invasive surgery (MIS) is the preferred technique for managing endometrial cancer. Given that uterine serous carcinoma (USC) has a predilection for multiquadrant peritoneal dissemination, our objective was to estimate the potential risk for overlooking occult peritoneal spread with the use of MIS. METHODS A single-institution, retrospective review was conducted of patients who underwent primary surgical staging for endometrial cancer via laparotomy between 1999 and 2008. Patterns of metastases were analyzed to estimate the potential risk for understaging via MIS. RESULTS A total of 202 USC cases met inclusion criteria. Pelvic and para-aortic nodes were positive in 59 (36%) of 166 and 43 (31%) of 138, respectively. Stage IVb disease was diagnosed in 77 (38%) of 202 patients. The majority (86%, 66/77) harbored bulky and/or multisite macroscopic abdominal implants. Isolated microscopic peritoneal disease was present in 5 of 77 cases (6% of stage IV, 2% of the entire cohort) but, in all cases, was limited to the omentum; 6 of 77 cases (8% of stage IV, 3% of the cohort) harbored a single implant in the context of a negative omentum but, in all cases, were macroscopic (locations included the ileum, the diaphragm, and the base of the mesentery). CONCLUSIONS For providers who aim to remove all visible disease in patients with USC, the rate of extrauterine disease escaping detection using MIS is low (<3%) provided an omentectomy is performed together with staging.
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Identification of a preoperative predictive factor for lymph node metastasis in uterine papillary serous carcinoma: long-term results from a single institution. Int J Gynecol Cancer 2015; 25:69-74. [PMID: 25470688 DOI: 10.1097/igc.0000000000000318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to identify preoperative clinicopathological predictive factors for lymph node (LN) metastasis in women diagnosed with uterine papillary serous carcinoma (UPSC). METHODS Women diagnosed with UPSC in our institution from 1997 to 2012 were identified. All patients underwent hysterectomy and bilateral salpingo-oophorectomy plus pelvic and/or para-aortic lymphadenectomy. The predictive values of the risk factors for LN metastasis were analyzed using χ and multivariate logistic regression analyses. RESULTS A total of 94 patients met our study criteria. A CA-125 cutoff of 47.5 IU/mL on the receiver operating characteristic curve provided the best sensitivity and specificity (56.5% vs 90.1%, respectively) for LN metastasis prediction. The sensitivities and specificities of old age (≥60 years), body mass index of 25 kg/m or greater, deep myometrial invasion, tumor size greater than 2 cm, tumor size greater than 4 cm, preoperative CA-125 greater than 47.5 IU/mL, LN metastasis on imaging, and extrauterine spread on imaging for the presence of a positive LN were 39.1%, 34.8%, 30.4%, 34.8%, 21.7%, 56.5%, 43.5%, and 52.2%, and 52.1%, 45.1%, 78.9%, 57.7%, 83.1%, 90.1%, 93.0%, and 90.1%, respectively. Preoperative CA-125 (P < 0.001), LN metastasis on preoperative imaging (P < 0.001), and extrauterine spread on preoperative imaging (P = 0.009) were risk factors for LN metastasis on univariate analysis. Multivariate analysis revealed that preoperative CA-125 (P = 0.001) was the only independent risk factor for LN metastasis. CONCLUSIONS Preoperative CA-125 is a preoperative predictive factor for LN metastasis in UPSC.
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Huang CY, Tang YH, Chiang YC, Wang KL, Fu HC, Ke YM, Lau HY, Hsu KF, Wu CH, Cheng WF. Impact of management on the prognosis of pure uterine papillary serous cancer - a Taiwanese Gynecologic Oncology Group (TGOG) study. Gynecol Oncol 2014; 133:221-8. [PMID: 24556064 DOI: 10.1016/j.ygyno.2014.02.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/03/2014] [Accepted: 02/08/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the clinical and pathological characteristics and the management of uterine papillary serous carcinoma (UPSC) in relation to patients' outcomes. METHODS Clinicopathological data and the management of patients treated between 1991 and 2010 at 11 member hospitals of the Taiwanese Gynecologic Oncology Group (TGOG) were retrospectively reviewed. The Kaplan-Meier method was used to generate survival curves, and factors predictive of outcome were compared using the log-rank test and Cox regression analysis. RESULTS A total of 119 pure UPSC patients were recruited. Stages I, II, III, and IV were identified in 34.5%, 2.5%, 36.1%, and 26.9% of the patients, respectively. The recurrence rate was 20.5% in FIGO stage I/II disease and 55.2% in FIGO stage III/IV disease. The 5-year overall survival rates for the patients with stage I, II, III, and IV disease were 92.0%, 66.7%, 34.2%, and 17.3%, respectively. Multivariate analysis showed that tumor stage (stage III/IV hazard ratio [HR] 8.65, 95% confidence interval [CI] 3.00-24.9) and optimal cytoreduction (HR 0.40, 95% CI 0.22-0.73) independently influenced the overall survival rate of UPSC patients. In addition, optimal cytoreduction (HR 0.36, 95% CI 0.17-0.78) and the combination of chemotherapy and radiation (HR 0.11, 95% CI 0.04-0.37) improved the overall survival of the advanced stage (FIGO stage III/IV) UPSC patients. CONCLUSIONS UPSC represents an aggressive subtype of endometrial cancer commonly accompanied by extra-uterine disease. Comprehensive surgical staging with cytoreductive surgery is mandatory and beneficial for UPSC patients. Systemic chemotherapy combined with radiation should be considered as an adjuvant therapy for advanced stage UPSC patients.
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Affiliation(s)
- Chia-Yen Huang
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yun-Hsin Tang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ying-Cheng Chiang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kung-Liahng Wang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and Mackay Medical College, Taipei, Taiwan; Department of Nursing, Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - Hung-Chun Fu
- Obstetrics and Gynecology Department, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Min Ke
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hei-Yu Lau
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan
| | - Keng-Fu Hsu
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Hu Wu
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Chung-Ho Memorial Hospital, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Wen-Fang Cheng
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Roelofsen T, van Ham MA, de Hullu JA, Massuger LF. Clinical management of uterine papillary serous carcinoma. Expert Rev Anticancer Ther 2014; 11:71-81. [DOI: 10.1586/era.10.199] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fader AN, Boruta D, Olawaiye AB, Gehrig PA. Updates on uterine papillary serous carcinoma. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.09.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Clinical predictors of long-term survival for stage IVB uterine papillary serous carcinoma confined to the abdomen. Gynecol Oncol 2014; 132:65-9. [DOI: 10.1016/j.ygyno.2013.10.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/29/2013] [Accepted: 10/29/2013] [Indexed: 11/17/2022]
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Eto T, Saito T, Shimokawa M, Hatae M, Takeshima N, Kobayashi H, Kasamatsu T, Yoshikawa H, Kamura T, Konishi I. Status of treatment for the overall population of patients with stage IVb endometrial cancer, and evaluation of the role of preoperative chemotherapy: A retrospective multi-institutional study of 426 patients in Japan. Gynecol Oncol 2013; 131:574-80. [DOI: 10.1016/j.ygyno.2013.08.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/26/2013] [Accepted: 08/30/2013] [Indexed: 11/27/2022]
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Ricci S, Fader AN. Treatment of uterine papillary serous carcinoma. Expert Opin Orphan Drugs 2013. [DOI: 10.1517/21678707.2013.847365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Eto T, Saito T, Kasamatsu T, Nakanishi T, Yokota H, Satoh T, Nogawa T, Yoshikawa H, Kamura T, Konishi I. Clinicopathological prognostic factors and the role of cytoreduction in surgical stage IVb endometrial cancer: A retrospective multi-institutional analysis of 248 patients in Japan. Gynecol Oncol 2012; 127:338-44. [DOI: 10.1016/j.ygyno.2012.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 08/07/2012] [Accepted: 08/12/2012] [Indexed: 12/22/2022]
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Analysis of Treatment Failures and Survival of Patients With Uterine Papillary Serous Carcinoma: A Cooperation Task Force (CTF) Study. Int J Gynecol Cancer 2012; 22:1355-60. [DOI: 10.1097/igc.0b013e318267f7a0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
ObjectiveTo assess the pattern of failures and the survival of patients with uterine papillary serous carcinoma (UPSC).MethodsThe hospital records of 119 women with UPSC were reviewed. Surgery was the initial therapy for all the cases. The median follow-up of survivors was 133 months (range, 3–216 months).ResultsPostoperative treatment was used in 98 patients (82.4%). Adjuvant treatment was radiotherapy in 25 women, chemotherapy in 61 women, and chemotherapy plus radiotherapy in 12 women. Tumor recurred in 44 (37.0%) of the 119 patients, after a median time of 15.1 months. Relapse was symptomatic in 15 patients (34.1%), and recurrent disease involved peritoneum or distant sites in 26 (66.7%) of the 39 patients for whom the site of failure was known. Five- and 10-year survival rates were 61.8% and 54.6%, respectively. Survival was related to disease stage (P< 0.0001). Among patients with advanced tumor, 5-year survival was lower in women who had macroscopic residual disease after surgery than in those who had not (15.4% vs 37.5%;P= 0.08). Distant failures were higher in women with histologically proven positive nodes than in those with negative nodes (28.6% vs 9.1%;P= 0.048). There was a trend to better survival for patients with stage I to stage II disease who underwent chemotherapy when compared with those who did not.ConclusionsUterine papillary serous carcinoma has an aggressive clinical behavior with a great tendency to recur especially in peritoneal and distant sites. Tumor stage is a strong prognostic factor, whereas the role of adjuvant treatment is still uncertain.
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del Carmen MG, Birrer M, Schorge JO. Uterine papillary serous cancer: a review of the literature. Gynecol Oncol 2012; 127:651-61. [PMID: 23000148 DOI: 10.1016/j.ygyno.2012.09.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/09/2012] [Accepted: 09/13/2012] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Uterine papillary serous carcinoma (UPSC) represents a distinct subtype of endometrial cancer. UPSC is less common than endometrioid carcinoma (ECC) but accounts for a disproportionate number of uterine cancer related deaths. This article critically reviews the literature pertinent to the pathology, pathogenesis, diagnosis, management, and outcome of patients with UPSC. METHODS MEDLINE was searched for all research articles published in English between January 1, 1967-January 1, 2012 which reported on patients diagnosed with UPSC. Given the rarity of this tumor, studies were not limited by design or number of reported patients. RESULTS UPSC represents a histologically aggressive subtype of endometrial cancer. It commonly presents with extra uterine disease involvement which can be identified by comprehensive surgical staging. Optimal cytoreduction and systemic platinum/taxane-based adjuvant therapy appear to confer a survival advantage. CONCLUSIONS UPSC is a biologically distinct entity, different from ECC. Future studies should explore the role of targeted therapies in the management of UPSC.
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Affiliation(s)
- Marcela G del Carmen
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Togami S, Sasajima Y, Oi T, Ishikawa M, Onda T, Ikeda SI, Kato T, Tsuda H, Kasamatsu T. Clinicopathological and prognostic impact of human epidermal growth factor receptor type 2 (HER2) and hormone receptor expression in uterine papillary serous carcinoma. Cancer Sci 2012; 103:926-32. [PMID: 22329832 DOI: 10.1111/j.1349-7006.2012.02240.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/02/2012] [Accepted: 02/02/2012] [Indexed: 01/22/2023] Open
Abstract
Uterine papillary serous carcinoma (UPSC) is a rare and aggressive variant of endometrial carcinoma. Little is known about the pathological and biological features of this tumor. Human epidermal growth factor receptor 2 (HER2) and hormone receptor (HR) expression have an important role in tumor behavior and clinical outcome, but their relevance in UPSC is not clear. In the present study, the immunohistochemical expression of HER2 and HR was assessed in 27 patients with Stage I disease, 13 with Stage II disease, 25 with Stage III disease, and 6 with Stage IV disease. Correlations between HER2 and HR expression and the clinicopathological parameters of UPSC were evaluated using Cox's univariate and multivariate analyses. For all patients, the 5-year recurrence-free survival (RFS) and overall survival (OS) rates were 51% and 66%, respectively; in patients with Stage I, II, III and IV disease, the RFS and OS were 67%/81%, 59%/77%, 43%/54% and 0%/0%, respectively. Of all 71 patients, 14% (10/71) were positive for HER2 and 52% (37/71) were positive for HR. Overexpression of HER2 was correlated with lower OS (P = 0.01), whereas HR overexpression was correlated with higher OS (P = 0.008). In multivariate models, HER2, HR, and histologic subtype were identified as independent prognostic indicators for RFS (P = 0.022, P = 0.018, and P = 0.01, respectively), but HR was the only independent factor associated with OS (P = 0.044). Thus, HER2 and HR are prognostic variables in UPSC, with HR an independent prognostic factor for OS.
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Affiliation(s)
- Shinichi Togami
- Division of Gynecology, National Cancer Center Hospital, Tokyo, Japan.
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[Advanced endometrial carcinoma: primary debulking surgery or neoadjuvant chemotherapy?]. Bull Cancer 2011; 99:43-9. [PMID: 22198346 DOI: 10.1684/bdc.2011.1515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endometrial cancers with peritoneal spread are stage IVB of FIGO classification. Their pattern is similar to that of ovarian cancer. Optimal debulking surgery and chemotherapy are predictor of better overall and disease free survival. Despite the poor outcome, there is a need for new treatment options. Recommended management for this group of patients should consist of surgical cytoreduction followed by chemotherapy. There may be a role for neoadjuvant chemotherapy followed by interval surgery in selected subgroups of patients.
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Langmár Z, Németh M, Kornya L. [Uterine papillary serous carcinoma]. Orv Hetil 2011; 152:1206-8. [PMID: 21733794 DOI: 10.1556/oh.2011.29157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Zoltán Langmár
- Semmelweis Egyetem, Általános Orvostudományi Kar, II. Szülészeti és Nőgyógyászati Klinika, Budapest, Üllői út 78/A 1082.
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Naumann RW. Endometrial Cancer. Gynecol Oncol 2011. [DOI: 10.1002/9781118003435.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Patsavas K, Woessner J, Gielda B, Rotmensch J, Yordan E, Bitterman P, Guirguis A. Optimal surgical debulking in uterine papillary serous carcinoma affects survival. Gynecol Oncol 2011; 121:581-5. [PMID: 21440290 DOI: 10.1016/j.ygyno.2010.11.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 11/11/2010] [Accepted: 11/14/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE UPSC is similar to papillary serous ovarian carcinoma in its histology and pattern of spread. The survival advantage with optimal debulking for ovarian cancer has been demonstrated. We examined our experience with UPSC. METHODS Seventy-eight UPSC patients were seen between 1995 and 2008 at Rush University Medical Center for surgery and/or adjuvant treatment. Information was obtained retrospectively from the Rush computer system, National Death Registry, and charts from chemotherapy, radiation, and gynecologic oncology. RESULTS Mean survival was 67.1 months for all stages (95% CI 52.8-81.2), 47.6 months for stage III (95% CI 26.7-68.3), and 21.7 months for stage IV (95% CI 14.5-29.1). No deaths occurred in stages I and II. No significant survival difference was found between African-Americans and Whites (log-rank test, p=0.62), nor between full serous and mixed pathology (log-rank test, p=0.52). Optimally debulked stage IV patients had a mean survival of 30.9 months, compared to 10.3 months in suboptimally debulked patients (p<0.001). Optimal debulking had no significant effect on stage III survival (p=0.47). Although weight was not statistically significant (p=0.059), there was a trend associated with suboptimal debulking. The mean time to recurrence for stage I was 79.9 months (95% CI 12.8-54.9), stage III was 27.4 months (95% CI 7.8-47.1), and stage IV was 20.2 months (95% CI 11.1-29.4) (p<0.001). There were no recurrences in stage II. CONCLUSION Our results suggest that UPSC should be optimally debulked. Weight is a risk factor for suboptimal debulking, which decreases mean survival and time to recurrence.
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Affiliation(s)
- Kristia Patsavas
- Department of Obstetrics and Gynecology, Rush University Medical Center, 600 South Paulina, Chicago, IL 60612, USA
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Rauh-Hain JA, Growdon WB, Schorge JO, Goodman A, Boruta DM, McCann C, Horowitz NS, del Carmen MG. Prognostic determinants in patients with stage IIIC and IV uterine papillary serous carcinoma. Gynecol Oncol 2010; 119:299-304. [DOI: 10.1016/j.ygyno.2010.07.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 07/07/2010] [Accepted: 07/11/2010] [Indexed: 01/22/2023]
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Barlin JN, Puri I, Bristow RE. Cytoreductive surgery for advanced or recurrent endometrial cancer: a meta-analysis. Gynecol Oncol 2010; 118:14-8. [PMID: 20434198 DOI: 10.1016/j.ygyno.2010.04.005] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 03/29/2010] [Accepted: 04/05/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the relative effect and quantify the impact of multiple prognostic variables on median overall survival time among cohorts of patients with advanced or recurrent endometrial cancer undergoing cytoreductive surgery. METHODS Fourteen retrospective cohorts with advanced or recurrent endometrial cancer (672 patients) meeting study inclusion criteria were identified. Univariate analysis was used to assess the effect on median overall survival time of multiple variables. The limited number of studies available made multivariate analysis impractical. RESULTS Statistically significant clinical variables associated with median overall survival time were the proportion of patients undergoing complete surgical cytoreduction, adjuvant radiation, or receiving adjuvant chemotherapy. Cohort median overall survival time was positively associated with increasing proportion of patients undergoing complete surgical cytoreduction (each 10% increase improving survival by 9.3 months, p=0.04) and receiving post-operative radiation therapy (each 10% increase improving survival by 11.0 months, p=0.004), while an increasing proportion of patients receiving chemotherapy was negatively associated with survival (each 10% increase decreasing survival by 10.4 months, p=0.007). CONCLUSIONS The current analysis suggests that among patients with advanced or recurrent endometrial cancer, complete cytoreduction to no gross residual disease is associated with superior overall survival outcome. The unexpected correlation between treatment modality and survival may be a surrogate marker for more precise factors such as location of disease, performance status, or cytoreductive status post-operatively, which may have influenced the decision to administer adjuvant radiation versus chemotherapy and were not able to be controlled for given the limitations of the extracted data.
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Affiliation(s)
- Joyce N Barlin
- Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, 600 North Wolfe St, Phipps 281, Baltimore, MD 21287, USA.
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Ueda Y, Enomoto T, Miyatake T, Egawa-Takata T, Ugaki H, Yoshino K, Fujita M, Kimura T. Endometrial carcinoma with extra-abdominal metastasis: improved prognosis following cytoreductive surgery. Ann Surg Oncol 2010; 17:1111-7. [PMID: 20058191 DOI: 10.1245/s10434-009-0892-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Incidence of endometrial carcinoma, the most common malignancy of the female pelvis, has been steadily increasing during the last three decades. The prognosis for stage IVb cases with extra-abdominal metastases is extremely poor, with no current consensus regarding treatment. The aim of the present study was to examine the benefits of cytoreductive surgery for such cases. METHODS Clinicopathological features of 33 stage IVb cases of endometrial carcinoma diagnosed during the 1991-2008 study period were retrospectively reviewed utilizing clinical records. Cytoreduction was conducted in 30 cases. RESULTS The median progression-free survival (PFS) and overall survival (OS) of those patients with optimal cytoreduction of their disease (with residual masses < or =2 cm), were significantly better than those with suboptimal reduction (with residual masses > 2 cm), not only among the 15 stage IVb patients with only intra-abdominal metastasis (group I) (P = 0.0003 and 0.0007) but also among the 15 cases with extra-abdominal metastasis (group E) (P = 0.013 and 0.016). Multivariate Cox proportional-hazards analysis demonstrated that the adjusted hazard ratio (HR) for the maximum size of residual disease (>2 vs. < or =2 cm) was 10.4 [95% confidence interval (CI), 1.27-84.70, P = 0.030] in group I and 16.92 (95% CI, 1.41-203.09, P = 0.026) in group E. CONCLUSIONS This is the first demonstration that aggressive cytoreductive surgery for stage IVb endometrial carcinoma with extra-abdominal metastasis has a beneficial role. However, further investigation is still required to establish better standard therapy for stage IVb endometrial cancer.
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Affiliation(s)
- Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
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Abstract
PURPOSE OF REVIEW Uterine papillary serous carcinoma (UPSC) is a rare but aggressive subtype of endometrial cancer. Although it represents only 10% of all endometrial cancer cases, UPSC accounts for up to 40% of all endometrial cancer-related recurrences and subsequent deaths. The present article reviews the literature concerning the epidemiology, molecular pathogenesis and recent updates on management of UPSC. RECENT FINDINGS Women most often present with postmenopausal vaginal bleeding but may also be diagnosed by vaginal cytology. In women diagnosed with metastatic disease, ascites, omental implants or a pelvic mass may be present. Pelvic and extrapelvic recurrences occur frequently, with extrapelvic relapses being observed most commonly. Although few prospective trials exist, several retrospective series have demonstrated that optimal cytoreduction and adjuvant platinum/taxane-based chemotherapy with or without radiotherapy appears to improve survival. In addition, another approach to UPSC management may lie in targeted therapy. SUMMARY Women diagnosed with UPSC should undergo comprehensive surgical staging and an attempt at optimal cytoreduction. Platinum/taxane-based adjuvant chemotherapy should be considered in the treatment of both early and advanced-stage patients. Careful long-term surveillance is indicated as many of these women will recur. Prospective studies are needed to define the optimal treatment regimens and to study the role of targeted therapies in UPSC.
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Management of women with uterine papillary serous cancer: A Society of Gynecologic Oncology (SGO) review. Gynecol Oncol 2009; 115:142-153. [DOI: 10.1016/j.ygyno.2009.06.011] [Citation(s) in RCA: 212] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 06/05/2009] [Accepted: 06/08/2009] [Indexed: 11/22/2022]
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Landrum LM, McMeekin DS. Response to “Residual tumor after neoadjuvant chemotherapy and interval debulking for advanced endometrial cancer”. Gynecol Oncol 2009. [DOI: 10.1016/j.ygyno.2009.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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WANG W, DO V, HOGG R, WAIN G, BRAND A, BULL C, STENLAKE A, GEBSKI V. Uterine papillary serous carcinoma: Patterns of failure and survival. Aust N Z J Obstet Gynaecol 2009; 49:419-25. [DOI: 10.1111/j.1479-828x.2009.01016.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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