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Grand multiparity and reproductive cancer in the Jerusalem Perinatal Study Cohort. Cancer Causes Control 2015; 27:237-47. [PMID: 26669321 DOI: 10.1007/s10552-015-0701-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/24/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Grand multiparity is associated with reduced mortality from reproductive cancers. We aimed to separate the components of mortality, by measuring incidence of and survival after reproductive cancer onset in grand multiparous compared to other parous women. STUDY DESIGN We linked data from the population-based Jerusalem Perinatal Study Cohort, which included women aged 13-55 who delivered 1964-1976, with Israel's National Cancer Registry. We compared breast and gynecologic cancer risk and all-cause survival following a cancer diagnosis, among grand multiparae (GMPs = parity 5+, n = 8,246) versus women with parity 1-4 (n = 19,703), adjusting for reproductive and demographic variables. RESULTS Grand multiparae were at significantly lower risk of breast cancer than others (adjusted hazard ratio (HRadj) = 0.62, 95 % confidence interval (CI) 0.54-0.71), after controlling for age at first birth, education, and other covariates. This reduction was greater among GMPs whose first birth occurred after age 30 (p-interaction = 0.0001) and for cancer occurring before age 50 years (p = 0.002). In contrast, GMPs were at greater risk of death than women with parity <5, following a breast cancer diagnosis (HRadj = 1.69, CI 1.39-2.1). Ovarian, uterine, and cervical cancer incidence did not differ between the groups, but survival was reduced for GMPs with uterine cancer (HRadj = 2.48, CI 1.22-5.03). CONCLUSION Reduced reproductive cancer mortality reported among GMPs masks two opposing phenomena: decreased breast cancer risk and poorer survival after breast and uterine cancers. The latter unfavorable outcome suggests that tumors in GMPs may be particularly aggressive, having perhaps escaped protective mechanisms conferred by parity. This finding calls for heightened clinical attention in this group.
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Felix AS, Scott McMeekin D, Mutch D, Walker JL, Creasman WT, Cohn DE, Ali S, Moore RG, Downs LS, Ioffe OB, Park KJ, Sherman ME, Brinton LA. Associations between etiologic factors and mortality after endometrial cancer diagnosis: the NRG Oncology/Gynecologic Oncology Group 210 trial. Gynecol Oncol 2015; 139:70-6. [PMID: 26341710 DOI: 10.1016/j.ygyno.2015.08.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 08/25/2015] [Accepted: 08/26/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few studies have analyzed relationships between risk factors for endometrial cancer, especially with regard to aggressive (non-endometrioid) histologic subtypes, and prognosis. We examined these relationships in the prospective NRG Oncology/Gynecologic Oncology Group 210 trial. METHODS Prior to surgery, participants completed a questionnaire assessing risk factors for gynecologic cancers. Pathology data were derived from clinical reports and central review. We used the Fine and Gray subdistribution hazards model to estimate subhazard ratios (HRs) and 95% confidence intervals (CIs) for associations between etiologic factors and cause-specific subhazards in the presence of competing risks. These models were stratified by tumor subtype and adjusted for stage and socioeconomic status indicators. RESULTS Median follow-up was 60months after enrollment (range: 1day-118months). Among 4609 participants, a total of 854 deaths occurred, of which, 582 deaths were attributed to endometrial carcinoma. Among low-grade endometrioid cases, endometrial carcinoma-specific subhazards were significantly associated with age at diagnosis (HR=1.04, 95% CI=1.01-1.06 per year, P-trend) and BMI (class II obesity vs. normal BMI: HR=2.29, 95% CI=1.06-4.98, P-trend=0.01). Among high-grade endometrioid cases, endometrial carcinoma-specific subhazards were associated with age at diagnosis (HR=1.05, 95% CI=1.02-1.07 per year, P-trend<0.001). Among non-endometrioid cases, endometrial carcinoma-specific subhazards were associated with parity relative to nulliparity among serous (HR=0.55, 95% CI=0.36-0.82) and carcinosarcoma cases (HR=2.01, 95% CI=1.00-4.05). DISCUSSION Several endometrial carcinoma risk factors are associated with prognosis, which occurs in a tumor-subtype specific context. If confirmed, these results would suggest that factors beyond histopathologic features and stage are related to prognosis. ClinicalTrials.gov Identifier: NCT00340808.
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Affiliation(s)
- Ashley S Felix
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - D Scott McMeekin
- Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA
| | - David Mutch
- Washington University School of Medicine, St. Louis, MO, USA
| | - Joan L Walker
- Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA
| | - William T Creasman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Shamshad Ali
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Richard G Moore
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital/Brown University, Providence, RI, USA
| | - Levi S Downs
- Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Olga B Ioffe
- Anatomical Pathology, University of Maryland, College Park, MD, USA
| | - Kay J Park
- Surgical Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark E Sherman
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Baek MH, Lee SW, Park JY, Kim D, Kim JH, Kim YM, Kim YT, Nam JH. Feasibility and safety of laparoscopic surgery for obese Korean women with endometrial cancer: long-term results at a single institution. J Korean Med Sci 2014; 29:1536-43. [PMID: 25408586 PMCID: PMC4234922 DOI: 10.3346/jkms.2014.29.11.1536] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/25/2014] [Indexed: 01/25/2023] Open
Abstract
The purpose of this study was to evaluate the surgical feasibility of and survival outcome after laparoscopy in obese Korean women with endometrial cancer which has recently been increasing. We reviewed the medical records of the patients treated at our medical institution between 1999 and 2012. The patients were divided into three groups, non-obese (Body Mass Index [BMI]<25.0), overweight (BMI 25-27.99), and obese (BMI≥28.0). These patient groups were compared in terms of their clinical characteristics, treatment methods, as well as surgical and survival outcomes. In total, 55 of the 278 eligible patients were obese women. There were no differences in the three groups in terms of the proportion of patients who underwent lymphadenectomy, their cancer stage, histologic type, type of adjuvant treatment administered, intra-, post-operative, and long-term complications, operative time, number of removed lymph nodes, blood loss, and duration of hospitalization (P=0.067, 0.435, 0.757, 0.739, 0.458, 0.173, 0.076, 0.124, 0.770, 0.739, and 0.831, respectively). The Disease-Free Survival (DFS) times were 139.1 vs. 121.6 vs. 135.5 months (P=0.313), and the Overall Survival (OS) times were 145.2 vs. 124.8 vs. 139.5 months (P=0.436) for each group, respectively. Obese women with endometrial cancer can, therefore, be as safely managed using laparoscopy as women with normal BMIs.
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Affiliation(s)
- Min-Hyun Baek
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Daeyeon Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong-Hyeok Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Tak Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joo-Hyun Nam
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Soleymani E, Ziari K, Rahmani O, Dadpay M, Taheri-Dolatabadi M, Alizadeh K, Ghanbarzadeh N. Histopathological findings of endometrial specimens in abnormal uterine bleeding. Arch Gynecol Obstet 2013; 289:845-9. [PMID: 24121689 DOI: 10.1007/s00404-013-3043-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 09/19/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to assess the frequency of different histopathological findings obtained from dilatation and curettage (D&C) specimens in patients with abnormal uterine bleeding (AUB). METHODS In a retrospective review of 591 specimens, the included subjects were all women with AUB who underwent D&C between 2002 and 2006 in Be'sat Hospital, Tehran, Iran. The pathological diagnoses were analyzed in four groups from normal to malignant endometrium. The pathological groups were evaluated for patients' characteristics including demographic data and medical history. RESULTS The majority of patients (61.6%) were in the 41-50 year age group. Totally, 81.4% of patients had normal pathology. The disordered proliferative endometrium/polyps, hyperplasia, and malignant pathology were found in 15.4, 2.5, and 0.7% of specimens, respectively. The abnormal pathologies were seen more among patients with postmenopausal status, nulli-/primigravid women, and those with hypertension, diabetes, hypothyroidism, and polycystic ovary syndrome. CONCLUSIONS The proliferative endometrium and secretory endometrium were the most common histopathological observations in AUB patients in our region, and except normal endometrium, disordered proliferative endometrium was the most common cause of AUB.
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Affiliation(s)
- Ebrahim Soleymani
- Department of Pathology, Be'sat Hospital, AJA University of Medical Sciences, Basij Highway, Tehran, Iran
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Trovik J, Mauland KK, Werner HM, Wik E, Helland H, Salvesen HB. Improved survival related to changes in endometrial cancer treatment, a 30-year population based perspective. Gynecol Oncol 2012; 125:381-7. [DOI: 10.1016/j.ygyno.2012.01.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 01/25/2012] [Accepted: 01/26/2012] [Indexed: 11/26/2022]
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ENGELSEN INGEBORGB, AKSLEN LARSA, SALVESEN HELGAB. Biologic markers in endometrial cancer treatment. APMIS 2009; 117:693-707. [DOI: 10.1111/j.1600-0463.2009.02467.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Albrektsen G, Heuch I, Wik E, Salvesen HB. Parity and Time Interval Since Childbirth Influence Survival in Endometrial Cancer Patients. Int J Gynecol Cancer 2009; 19:665-9. [DOI: 10.1111/igc.0b013e3181a3e1bf] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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O'Hanlan KA, Dibble SL, Fisher DT. Total laparoscopic hysterectomy for uterine pathology: Impact of body mass index on outcomes. Gynecol Oncol 2006; 103:938-41. [PMID: 16828849 DOI: 10.1016/j.ygyno.2006.05.036] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 05/21/2006] [Accepted: 05/24/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We sought to analyze surgical results of women with uterine cancers having TLH+/-staging, stratifying data by body mass index (BMI). METHODS This is a retrospective analysis of data from 9 years, using Pearson and Spearman correlations, ANOVA and Fisher's Exact Test with significance at P<0.05, stratifying by BMI (kg/m2): underweight (<18.5 kg/m2), ideal (18.5-24.9 kg/m2), overweight (25 to 29.9 kg/m2), obese (30 to 39.9 kg/m2) and morbidly obese (40 kg/m2 or more). RESULTS Of 702 patients having TLH over 9 years, 90 patients had uterine pathology. Two (2%) procedures were converted to laparotomy due to unsuspected widespread metastasis and excluded from analysis. BMI ranged from 18 to 60 kg/m2, with 31 patients having ideal, 19 having overweight and 38 having obese BMI. Of these, 19 patients had hyperplasia, while 63 had endometrial carcinoma, 1 had both ovarian and endometrial carcinoma and 5 had sarcoma. Of these 88 patients, 61 had TLH while 27 patients had indicated pelvic and aortic node dissection. The mean age was 60 years, and mean parity was 1.5 for all BMI groups. There were no significant differences in mean duration of surgery (150 min), blood loss (129 cm3) and days in hospital (1.7 days) for all BMI groups. There was no significant difference in uterine weight (140 gm) or number of nodes dissected (21 nodes). Complications occurred in 4 patients (4.5%): 1 diverticulitis, 1 ureteral injury, 1 laparotomy for bleeding and 1 incisional hernia. CONCLUSIONS Total laparoscopic hysterectomy is feasible and safe for women with uterine neoplasia for every BMI category and extends the benefits of minimally invasive hysterectomy to more women, regardless of BMI.
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Affiliation(s)
- Katherine A O'Hanlan
- Gynecologic Oncology Associates, 4370 Alpine Rd. Suite 104, Portola Valley, CA 94028, USA.
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Nishimura N, Hachisuga T, Yokoyama M, Iwasaka T, Kawarabayashi T. Clinicopathologic analysis of the prognostic factors in women with coexistence of endometrioid adenocarcinoma in the endometrium and ovary. J Obstet Gynaecol Res 2005; 31:120-6. [PMID: 15771637 DOI: 10.1111/j.1447-0756.2005.00256.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To compare the survival and prognostic factors of patients with dual primary ovarian and endometrial cancers (primary group), and endometrial cancers metastatic to the ovaries (metastatic group). METHODS Thirty-six patients with gross tumors confined to the pelvis and of endometrioid adenocarcinoma subtype in both the endometrium and ovary were selected from our file of 546 Japanese women with endometrial carcinoma. The patients were divided into two groups. Eleven were classified into the primary group. Twenty-five were classified into the metastatic group. Both univariate and multivariate regression analyses were carried out. RESULTS The mean age of the primary group was significantly younger than that of the metastatic group (45.2 years vs 51.2 years; P < 0.01). The cumulative 10-year survival of the primary group was significantly better than that of the metastatic group (90.9%vs 46.6%; P < 0.05). Univariate analyses showed that older age (P < 0.05) and the presence of lymphovascular space invasion (LVSI; P < 0.004) of the tumor of the uterus were significantly associated with a poor prognosis in the metastatic group. Multivariate analysis including the above variables showed no independent prognostic factor (older age, P < 0.60 and LVSI, P < 0.06). CONCLUSION When encountering women with coexisting endometrioid carcinoma in the endometrium and ovary with gross tumor limited to the pelvis, more attention should be paid to LVSI of the tumor of the uterus as a poor prognostic indicator.
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Affiliation(s)
- Noriko Nishimura
- Department of Obstetrics and Gynecology, School of Medicine, Fukuoaka University, Nanakuma, Fukuoka, Japan
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Abstract
HEALTH ISSUE: Total fertility rates (TFRs) have decreased worldwide. The Canadian fertility rate has gone from 3.90 per woman in 1960 to 1.49 in 2000. However, not many studies have examined the impact on women's health of reduced fertility rates, delayed fertility and more births to unmarried women. This paper presents information on the relation between family size and specific determinants of health. KEY FINDINGS: The rate of TFR decline varies considerably by geographic location and socio-demographic subgroup. Further, the associations between family size and selected determinants of health are different for women and men. For example a woman with one child is almost four times more likely to be "coupled" than a childless woman, and if she has two children she is significantly more likely to be "coupled" than if she had only one child. However, a man with one or more children is over six times more likely to be "coupled" than his childless counterpart, and this does not vary with family size. DATA GAPS AND RECOMMENDATIONS: There is a paucity of data on the impact of reduced fertility rates on women's health in general and on how women's roles affect their decision to have children. While it would be useful to examine longer-term health outcomes by parity and age of first birth, as well as socio-economic and role-related variables these longitudinal and detailed "role related" data are not available. Given the differing profiles of women and men with children, further health policies research is needed to support vulnerable women with children.
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Affiliation(s)
- Jennifer Payne
- Centre for Chronic Disease Prevention and Control, Health Canada, 120 Colonnade Rd, Ottawa, Canada.
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OʼHanlan KA, Lopez L, Dibble SL, Garnier AC, Huang GS, Leuchtenberger M. Total Laparoscopic Hysterectomy. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200312000-00028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Models for all-cause mortality among 45,000 men and women with cancer in 12 different sites were estimated, using register and census data for complete Norwegian birth cohorts. This observed-survival method appeared to be an adequate approach. The results support the idea that women who were pregnant shortly before a breast cancer diagnosis may have a poorer prognosis than others. In principle, such an effect may also reflect that these women have a young child during the follow-up period and are burdened by that. However, this social explanation can hardly be very important, given the absence of a corresponding significant effect in men and for other cancer sites in women. Breast cancer is different from other malignancies also with respect to the effect of parenthood more generally, regardless of the timing of the pregnancies. On the whole, male and female cancer patients with children experience lower mortality than the childless, though without a special advantage associated with adult children. This suggests a social effect, perhaps operating through a link between parenthood, lifestyle and general health. No parity effect was seen for breast cancer, however, which may signal that the social effect is set off against an adverse physiologic effect of motherhood for this particular cancer. Among men, both marriage and parenthood were associated with a good prognosis. Married male cancer patients with children had mortality one-third lower than that among the childless and never-married. Women who had never married did not have the same disadvantage.
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Abstract
Endometrial carcinoma is today among the most common gynecologic malignancies in industrialized countries. In order to improve the treatment and follow-up of these patients, various prognostic factors have been extensively studied. Patient age, stage of disease, histologic type and histologic grade have been shown to influence survival significantly, and the prognostic impact of these traditional clinicopathologic variables is well established. In addition, parity, hormone receptor concentration in the tumor, DNA ploidy and morphometric nuclear grade have all been found to influence prognosis. Information about DNA ploidy has especially been used in the clinical situation to determine individualized treatment. The prognostic significance of markers for tumor cell proliferation, cell cycle regulation (p53, p21 and p16) and angiogenesis is discussed as well as the molecular basis of endometrial carcinoma. In conclusion, several prognostic markers have been identified. It is likely that the information derived from these tumor biomarkers will reduce the need for extensive surgical staging and adjuvant treatment in endometrial carcinoma.
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Affiliation(s)
- Helga B Salvesen
- Department of Gynecology and Obstetrics, The Gade Institute, Haukeland University Hospital, Bergen, Norway.
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