1
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Sun H, Zhang L, Fu P, Liu R. OS and DFS are affected by different diagnostic methods and hysterectomy procedures in endometrial cancer patients: A single-center retrospective study. Cancer Med 2023; 12:19072-19080. [PMID: 37584224 PMCID: PMC10557905 DOI: 10.1002/cam4.6465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE We aimed to evaluate whether hysteroscopy increases the risk of intraperitoneal dissemination or worsens the prognosis of endometrial carcinoma (EC) patients and whether radical hysterectomy (RH) improves overall survival (OS) or disease-free survival (DFS) in patients with stage II to III EC and to investigate the effects of different procedures for identifying EC and the effects of different surgical methods on the OS and DFS of endometrial cancer patients. METHODS Four hundred sixty-five women with EC were included in this retrospective study. Log-rank tests and Kaplan-Meier analysis were used for the outcome comparisons of the effects of the EC diagnostic method and different hysterectomy procedures. A Cox proportional hazards model was used for univariate regression analysis. RESULTS Among the three procedures for diagnosing EC (diagnostic curettage, hysteroscopy, and hysterectomy), the incidences of fallopian tube and ovarian invasion were not significantly different (p = 0.506 and 0.066, respectively). The diagnostic methods for EC had no significant effect on OS (p = 0.577) or DFS (p = 0.294). In addition, type II RH and type III RH did not improve the prognosis of patients with FIGO stage II and III disease (log-rank p = 0.914 and 0.810 for OS; log-rank p = 0.707 and 0.771 for DFS, respectively). CONCLUSION Based on the current study evidence, the use of diagnostic hysteroscopy procedures is safe and does not increase the risk of fallopian tube and ovarian invasion of intraperitoneal dissemination or worsen the prognosis of EC patients. Type II and type III RH did not demonstrate a benefit for stage II-III EC patients.
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Affiliation(s)
- Haiying Sun
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople's Republic of China
| | - Long Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople's Republic of China
| | - Peiying Fu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople's Republic of China
| | - Ronghua Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople's Republic of China
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2
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Monist M, Lewkowicz D, Piętak P, Pilewska-Kozak A, Man YG, Semczuk A. Synchronously occurring endometrioid carcinomas of the uterine corpus and uterine cervix preceded by different precancerous lesions: A case study and a literature review. Pathol Res Pract 2023; 245:154452. [PMID: 37030165 DOI: 10.1016/j.prp.2023.154452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/10/2023]
Abstract
The incidence of two synchronous carcinomas originating from the uterine corpus and uterine cervix, both endometrioid subtypes, is exceedingly rare. Herein, we presented synchronous early stage G1 adenocarcinoma of the uterine corpus with cervical G2 endometrioid adenocarcinoma. Although both neoplasms displayed the same histological subtype, they differed significantly according to the histological grading or clinical stage of the disease. Finally, it is worth emphasizing that both tumors were preceded by different precancerous lesions, atypical endometrial hyperplasia (AEH) and foci of endometriosis localized within the uterine cervix. Although AEH is a well-known precancerous condition of endometrioid carcinoma, the mechanisms resulting in the malignant transformation of endometriosis foci to the cervical endometrioid carcinoma are still a matter of controversy. We briefly summarized the impact of different precancerous lesions on the development of synchronous female genital tract neoplasms with the same histotype.
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Affiliation(s)
- Marta Monist
- II(nd) Department of Gynecology, Lublin Medical University, Lublin, Poland
| | - Dorota Lewkowicz
- Department of Pathology, Lublin Medical University, Lublin, Poland
| | - Patrycja Piętak
- II(nd) Department of Gynecology, Lublin Medical University, Lublin, Poland
| | - Anna Pilewska-Kozak
- Department of Nursing Obstetrics and Gynecology, Lublin Medical University, Lublin, Poland
| | - Yan-Gao Man
- Department of Pathology, Hackensack Meridian Health - Hackensack University Medical Center, Hackensack, New Jersey, NJ, USA
| | - Andrzej Semczuk
- II(nd) Department of Gynecology, Lublin Medical University, Lublin, Poland.
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3
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Koskas M, Amant F, Mirza MR, Creutzberg CL. Cancer of the corpus uteri: 2021 update. Int J Gynaecol Obstet 2021; 155 Suppl 1:45-60. [PMID: 34669196 PMCID: PMC9297903 DOI: 10.1002/ijgo.13866] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endometrial cancer is the most common gynecological malignancy in high‐ and middle‐income countries. Although the overall prognosis is relatively good, high‐grade endometrial cancers have a tendency to recur. Recurrence needs to be prevented since the prognosis for recurrent endometrial cancer is dismal. Treatment tailored to tumor biology is the optimal strategy to balance treatment efficacy against toxicity. Since The Cancer Genome Atlas defined four molecular subgroups of endometrial cancers, the molecular factors are increasingly used to define prognosis and treatment. Standard treatment consists of hysterectomy and bilateral salpingo‐oophorectomy. Lymphadenectomy (and increasingly sentinel node biopsy) enables identification of lymph node‐positive patients who need adjuvant treatment, including radiotherapy and chemotherapy. Adjuvant therapy is used for Stage I–II patients with high‐risk factors and Stage III patients; chemotherapy is especially used in non‐endometrioid cancers and those in the copy‐number high molecular group characterized by TP53 mutation. In advanced disease, a combination of surgery to no residual disease and chemotherapy with or without radiotherapy results in the best outcome. Surgery for recurrent disease is only advocated in patients with a good performance status with a relatively long disease‐free interval. The latest state‐of‐the‐art treatment for endometrial cancer is described, incorporating the most recent new data that influence its clinical management.
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Affiliation(s)
- Martin Koskas
- Division of Gynecologic Oncology, Bichat University Hospital, Paris, France
| | - Frédéric Amant
- Department of Gynecologic Oncology, KU Leuven, Leuven, Belgium.,Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Center for Gynecologic Oncology Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
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4
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Toprak S, Sahin EA, Sahin H, Tohma YA, Yilmaz E, Meydanli MM. Risk factors for cervical stromal involvement in endometrioid-type endometrial cancer. Int J Gynaecol Obstet 2021; 153:51-55. [PMID: 33118165 DOI: 10.1002/ijgo.13449] [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: 03/25/2020] [Revised: 08/18/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to identify predictors of cervical stromal involvement in women with endometrioid-type endometrial cancer (EEC). METHODS A total of 795 patients with EEC who underwent comprehensive surgical staging including pelvic and para-aortic lymph node dissection between January 2007 and December 2018 were retrospectively analyzed. Data including age, menopausal status, serum CA-125 levels, tumor size, lymphovascular space invasion (LVSI), depth of myometrial invasion, positive peritoneal cytology, cervical stromal involvement, histologic grade, recurrence, and follow-up duration were recorded. RESULTS Median follow up was 49 months. Cervical stromal invasion was found in 88 patients. Multivariate analysis revealed that presence of LVSI (hazard ratio [HR] 2, 95% confidence interval [CI] 1.02-4.25, P = 0.045), a primary tumor diameter of at least 3 cm (HR 3, 95% CI 1.31-7.25, P = 0.010), and at least 50% deep myometrial invasion (HR 2.7, 95% CI 1.37-5.41, P = 0.004) were independent risk factors for cervical stromal involvement in patients with EEC. CONCLUSION Our study results suggest that presence of LVSI, a primary tumor diameter of at least 3 cm, and LVSI of at least 50% seem to be independent predictors of cervical involvement in women with EEC.
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Affiliation(s)
- Serhat Toprak
- Department of Pathology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Eda Adeviye Sahin
- Department of Obstetrics and Gynecology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Hanifi Sahin
- Department of Obstetrics and Gynecology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Yusuf Aytac Tohma
- Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Ercan Yilmaz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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5
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Saleh M, Virarkar M, Bhosale P, Elsherif S, Javadi S, Faria SC. Endometrial Cancer, the Current International Federation of Gynecology and Obstetrics Staging System, and the Role of Imaging. J Comput Assist Tomogr 2020; 44:714-729. [PMID: 32842057 DOI: 10.1097/rct.0000000000001025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Imaging plays a crucial role in the diagnosis, staging, and follow-up of endometrial cancer. Endometrial cancer is staged surgically using the International Federation of Gynecology and Obstetrics (FIGO) staging system. Preoperative imaging can complement surgical staging but is not yet considered a required component in the current FIGO staging system. Preoperative imaging can help identify some tumor characteristics and tumor spread, both locally and distally. More accurate assessment of endometrial cancers optimizes management and treatment plan, including degree of surgical intervention. In this article, we review the epidemiology, FIGO staging system, and the importance of imaging in the staging of endometrial cancer.
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Affiliation(s)
- Mohammed Saleh
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mayur Virarkar
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priya Bhosale
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sherif Elsherif
- Department of Internal Medicine, Weiss Memorial Hospital, Affiliate of the University of Illinois at Chicago, Chicago, IL
| | - Sanaz Javadi
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Silvana C Faria
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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6
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Ni T, Huang T, Gu SL, Wang J, Liu Y, Sun X, Wang YD. DRG Neurons Promote Perineural Invasion of Endometrial Cancer via GluR2. J Cancer 2020; 11:2518-2528. [PMID: 32201522 PMCID: PMC7066017 DOI: 10.7150/jca.40055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/19/2020] [Indexed: 01/28/2023] Open
Abstract
Background: Perineural invasion (PNI) is correlated with negative prognosis in multiple cancers, but its role in endometrial cancer (EC) is still largely unknown; thus, targeted treatment for nerve infiltration is lacking as well. Methods: The interaction between nerve and EC cells were investigated by in vitro neural invasion assay and transwell coculture system. Then the nerve-related receptor gene glutamate ionotropic receptor AMPA type subunit 2 (GRIA2) was detected in EC tissues and cells using PCR array, western blotting, and immunohistochemistry. The role of GluR2 (gene name GRIA2) on EC proliferation, migration and invasion was evaluated by a GluR2 antagonist and shRNA. At the same time, the neurotransmitter effect on GluR2 (glutamate) from the cocultured conditional medium was measured using high-performance liquid chromatography (HPLC). Results: EC cell line Ishikawa (ISK) showed the ability to migrate along neurites in vitro and the numbers of migrated/invaded EC cells in the DRG neuron coculture group were significantly increased. The expression of GluR2 in EC tissue was found to be higher than that in para-carcinoma tissue. After GluR2 antagonist and GluR2 shRNA treatment, the proliferation, migration and invasion of ISK cells was markedly inhibited. Moreover, the ability of DRG neurons to promote the migration and invasion of ISK cells could also be attenuated by downregulation of GluR2, and the concentration of the neurotransmitter glutamate was notably increased in the coculture conditional medium compared to that in the DRG neuron or ISK cells alone. Conclusions: DRG neurons promote metastasis of EC cells via GluR2, which might be a risk factor for PNI in EC. Moreover, the perineural system may promote tumor invasion and metastasis under certain circumstances.
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Affiliation(s)
- Ting Ni
- Department of Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No. 910 Hengshan Road, Shanghai 200030, China
| | - Ting Huang
- Department of Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No. 910 Hengshan Road, Shanghai 200030, China
| | - Sheng-Lan Gu
- Department of Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No. 910 Hengshan Road, Shanghai 200030, China
| | - Jing Wang
- Department of Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No. 910 Hengshan Road, Shanghai 200030, China
| | - Yao Liu
- Department of Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No. 910 Hengshan Road, Shanghai 200030, China
| | - Xiao Sun
- Laboratory for Gynecologic Oncology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No. 910 Hengshan Road, Shanghai 200030, China
| | - Yu-Dong Wang
- Department of Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No. 910 Hengshan Road, Shanghai 200030, China.,Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
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7
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The Prognostic Value of Preoperative Serum CA125 in Endometrioid Endometrial Cancer with Cervical Stromal and Parametrial Invasion. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.89998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Hasegawa T, Furugori M, Kubota K, Asai-Sato M, Yashiro-Kawano A, Kato H, Oi Y, Shigeta H, Segawa K, Kitagawa M, Mine Y, Saji H, Numazaki R, Maruyama Y, Ohnuma E, Taniguchi H, Sugiura K, Miyagi E, Matsunaga T. Does the extension of the type of hysterectomy contribute to the local control of endometrial cancer? Int J Clin Oncol 2019; 24:1129-1136. [PMID: 31069549 PMCID: PMC6687671 DOI: 10.1007/s10147-019-01458-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the necessity and sufficiency of different types of hysterectomy for the surgical treatment of endometrial cancer. METHODS This was a multicenter collaborative study conducted by 11 institutions. Among patients with stage I-III endometrial cancer who underwent surgery as the initial treatment (only chemotherapy was provided if adjuvant therapy was needed) from 2001 to 2012, we retrospectively examined the type of hysterectomy, clinicopathological factors, recurrence rate over a maximum period of 5 years, and the site of recurrence. The local recurrence rate was examined by univariate and multivariate analyses. RESULTS Among 1335 patients, 982 (73.6%) underwent simple hysterectomy (SH) and 353 (26.4%) underwent modified radical hysterectomy (mRH) and were observed for a mean duration of 51.8 months. No significant difference was observed in the rate of local recurrence between the SH and mRH groups (p = 0.928). In multivariate analysis, clinicopathological factors independently associated with localized recurrence included postmenopausal status [hazard ratio (HR) 5.036, 95% confidence interval (CI) 1.506-16.841, p = 0.009], with stages II (HR 3.337, 95% CI 1.701-6.547, p < 0.001) and III (HR 2.445, 95% CI 1.280-4.668, p = 0.007), vs stage I and histological type 2 (HR 1.610, 95% CI 0.938-2.762, p = 0.001). CONCLUSIONS For endometrial cancer patients requiring surgery, the selection of a more extensive type of hysterectomy did not reduce the rate of local recurrence. Therefore, there is little significance in performing mRH in such cases.
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Affiliation(s)
- Tetsuya Hasegawa
- Yamato Municipal Hospital, 8-3-6 Fukaminishi, Yamato, Kanagawa 242-8602 Japan
| | - Megumi Furugori
- Yamato Municipal Hospital, 8-3-6 Fukaminishi, Yamato, Kanagawa 242-8602 Japan
| | - Kazumi Kubota
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Mikiko Asai-Sato
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Aiko Yashiro-Kawano
- Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Hisamori Kato
- Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Yuka Oi
- Yokohama Municipal Citizen’s Hospital, 56 Okazawa-chou, Hodogaya-ku, Yokohama, Kanagawa 240-8555 Japan
| | - Hiroyuki Shigeta
- Yokohama Municipal Citizen’s Hospital, 56 Okazawa-chou, Hodogaya-ku, Yokohama, Kanagawa 240-8555 Japan
| | - Keiko Segawa
- Saiseikai Yokohamashi Nanbu Hospital, 3-2-10 Kounanndai, Kounan-ku, Yokohama, Kanagawa 234-0054 Japan
| | - Masakazu Kitagawa
- Yokohama City University Medical Center, 4-57 UraFune-cho, Minami-ku, Yokohama, Kanagawa 232-0024 Japan
| | - Yuko Mine
- Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa, Kanagawa 251-8550 Japan
| | - Haruya Saji
- Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa, Kanagawa 251-8550 Japan
| | - Reiko Numazaki
- Yokohama Minamikyosai Hospital, 1-21-1 Mutsuurahigashi, Kanazawa-ku, Yokohama, Kanagawa 236-0037 Japan
| | - Yasuyo Maruyama
- Odawara Municipal Hospital, 46 Hisano, Odawara, Kanagawa 250-8558 Japan
| | - Emi Ohnuma
- Yokohama Rosai Hospital, 3211 Kodukue-chou, Kouhoku-ku, Yokohama, Kanagawa 222-0036 Japan
| | - Hanako Taniguchi
- Yokosuka Kyosai Hospital, 1-16 Yonegahamadouri, Yokosuka, Kanagawa 238-8558 Japan
| | - Ken Sugiura
- Yokosuka Kyosai Hospital, 1-16 Yonegahamadouri, Yokosuka, Kanagawa 238-8558 Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Tatsuya Matsunaga
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Yokohama City University Gynecologic Oncology Research Group (YCUGO-ReG)
- Yamato Municipal Hospital, 8-3-6 Fukaminishi, Yamato, Kanagawa 242-8602 Japan
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
- Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
- Yokohama Municipal Citizen’s Hospital, 56 Okazawa-chou, Hodogaya-ku, Yokohama, Kanagawa 240-8555 Japan
- Saiseikai Yokohamashi Nanbu Hospital, 3-2-10 Kounanndai, Kounan-ku, Yokohama, Kanagawa 234-0054 Japan
- Yokohama City University Medical Center, 4-57 UraFune-cho, Minami-ku, Yokohama, Kanagawa 232-0024 Japan
- Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa, Kanagawa 251-8550 Japan
- Yokohama Minamikyosai Hospital, 1-21-1 Mutsuurahigashi, Kanazawa-ku, Yokohama, Kanagawa 236-0037 Japan
- Odawara Municipal Hospital, 46 Hisano, Odawara, Kanagawa 250-8558 Japan
- Yokohama Rosai Hospital, 3211 Kodukue-chou, Kouhoku-ku, Yokohama, Kanagawa 222-0036 Japan
- Yokosuka Kyosai Hospital, 1-16 Yonegahamadouri, Yokosuka, Kanagawa 238-8558 Japan
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Khumthong K, Aue-Aungkul A, Kleebkaow P, Chumworathayi B, Temtanakitpaisan A, Nhokaew W. Association of Abnormal Pap Smear with Occult Cervical Stromal Invasion in Patients with Endometrial Cancer. Asian Pac J Cancer Prev 2019; 20:2847-2850. [PMID: 31554386 PMCID: PMC6976850 DOI: 10.31557/apjcp.2019.20.9.2847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Indexed: 12/24/2022] Open
Abstract
Objective: The purpose of this study was to determine the association between abnormal preoperative Pap smear
results and occult cervical stromal invasion in endometrial cancer patients. Methods: Medical records were reviewed of
patients with endometrial cancer who had undergone surgical staging at Srinagarind Hospital. Patients with gross cervical
involvement, with an unsatisfactory Pap smear, without available Pap smear results, with no cervical intraepithelial
lesion/invasive cervical cancer, or who had previously undergone pelvic radiation therapy were excluded. The patients
were assigned to one of two groups according their Pap smear results (negative and epithelial cell abnormalities).
Logistic regression was used to determine the independent association between an abnormal Pap smear and the risk
of cervical stromal invasion. Results: All cervical smears in this study were performed as conventional Pap smears.
Smears were abnormal in 50 (21.0%) of the 238 patients enrolled and normal in the remaining 188 (79.0%). The types
of Pap smear abnormalities included adenocarcinoma (n=22); atypical endometrial cells (n=2); atypical glandular cells
(n=17); high-grade squamous intraepithelial lesions (n=4); atypical squamous cells, cannot exclude high-grade squamous
intraepithelial lesions (n=2); and atypical squamous cells of undetermined significance (n=3). After controlling for type of
endometrial cancer, abnormal Pap smear results were found to be a significant independent factor that indicated cervical
stromal invasion (adjusted OR 2.65; 95% CI 1.35 to 5.21). Conclusion: Endometrial cancer patients with abnormal
Pap smears were strongly and independently associated with histopathologically diagnosed cervical stromal invasion.
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Affiliation(s)
- Kewalin Khumthong
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand.
| | - Apiwat Aue-Aungkul
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand.
| | - Pilaiwan Kleebkaow
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand.
| | - Bandit Chumworathayi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand.
| | - Amornrat Temtanakitpaisan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand.
| | - Wilasinee Nhokaew
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand.
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10
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Iheagwara UK, Vargo JA, Chen KS, Burton DR, Taylor SE, Berger JL, Boisen MM, Comerci JT, Orr BC, Sukumvanich P, Olawaiye AB, Kelley JL, Edwards RP, Courtney-Brooks MB, Beriwal S. Neoadjuvant Chemoradiation Therapy Followed by Extrafascial Hysterectomy in Locally Advanced Type II Endometrial Cancer Clinically Extending to Cervix. Pract Radiat Oncol 2019; 9:248-256. [DOI: 10.1016/j.prro.2019.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/30/2019] [Accepted: 02/14/2019] [Indexed: 11/27/2022]
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11
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Brooks RA, Fleming GF, Lastra RR, Lee NK, Moroney JW, Son CH, Tatebe K, Veneris JL. Current recommendations and recent progress in endometrial cancer. CA Cancer J Clin 2019; 69:258-279. [PMID: 31074865 DOI: 10.3322/caac.21561] [Citation(s) in RCA: 245] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Endometrial cancer is the most common gynecologic cancer in the United States, and its incidence is rising. Although there have been significant recent advances in our understanding of endometrial cancer biology, many aspects of treatment remain mired in controversy, including the role of surgical lymph node assessment and the selection of patients for adjuvant radiation or chemotherapy. For the subset of women with microsatellite-instable, metastatic disease, anti- programmed cell death protein 1 immunotherapy (pembrolizumab) is now approved by the US Food and Drug Administration, and numerous trials are attempting to build on this early success.
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Affiliation(s)
- Rebecca A Brooks
- Associate Professor, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
- Dr. Brooks is now the Associate Professor and Chief of the Division of Gynecologic Oncology, University of California Davis School of Medicine, Davis, CA
| | - Gini F Fleming
- Professor of Medicine and Director, Medical Oncology Breast Program, Department of Medical Oncology, The University of Chicago, Chicago, IL
| | - Ricardo R Lastra
- Assistant Professor, Department of Pathology, The University of Chicago, Chicago, IL
| | - Nita K Lee
- Assistant Professor of Obstetrics and Gynecology, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
| | - John W Moroney
- Associate Professor of Obstetrics and Gynecology, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
| | - Christina H Son
- Assistant Professor, Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Ken Tatebe
- Resident, Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Jennifer L Veneris
- Instructor of Medicine, Division of Gynecologic Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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Alcázar JL, Pérez L, Güell O, Haro N, Manzour N, Chacon E, Jurado M. Diagnostic Performance of Transvaginal Ultrasound for Detecting Cervical Invasion In Women With Endometrial Carcinoma: A Systematic Review and Meta-analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:179-189. [PMID: 29732585 DOI: 10.1002/jum.14682] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/27/2018] [Accepted: 04/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the role of transvaginal ultrasound (TVUS) for diagnosing cervical invasion in the preoperative assessment of endometrial carcinoma. METHODS A search for studies evaluating the role of TVUS for assessing cervical invasion in endometrial carcinoma from January 1990 to December 2016 was performed in the PubMed/MEDLINE, Web of Science, www.ClinicalTrials.gov, and www.who.int/trialsearchdatabases. The quality of the studies was evaluated by the Quality Assessment of Diagnostic Accuracy Studies 2. RESULTS We identified 211 citations. Ultimately, 17 studies comprising 1751 women were included. The mean prevalence of cervical invasion was 16.3%. The risk of bias was high in 7 studies for the domains "patient selection" and "index test," whereas it was considered low for the "reference test" domain. Overall, the pooled estimated sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of TVUS for detecting cervical invasion were 63% (95% confidence interval [CI], 51%-74%), 91% (95% CI, 87%-94%), 10.2 (95% CI, 5.7-18.3), and 0.38 (95% CI, 0.28-0.53), respectively. Heterogeneity was high for both sensitivity and specificity. CONCLUSIONS Transvaginal ultrasound has acceptable diagnostic performance for detecting cervical invasion in women with endometrial carcinoma.
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Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Lidia Pérez
- Department of Obstetrics and Gynecology, Hospital Fundación Jimenez-Diaz, Madrid, Spain
| | - Olga Güell
- Department of Obstetrics and Gynecology, Hospital Santa Caterina de Salt, Girona, Spain
| | - Núria Haro
- Department of Obstetrics and Gynecology, Hospital Santa Caterina de Salt, Girona, Spain
| | - Nabil Manzour
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Enrique Chacon
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Matías Jurado
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
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Abstract
Endometrial cancer is the most common gynecological malignancy in high-income countries. Although the overall prognosis is relatively good, high-grade endometrial cancers have a tendency to recur. Recurrence needs to be prevented since the prognosis for recurrent endometrial cancer is dismal. Treatment tailored to tumor biology is the optimal strategy to balance treatment efficacy against toxicity. Standard treatment consists of hysterectomy and bilateral salpingo-oophorectomy. Lymphadenectomy (with ongoing studies of sentinel node biopsy) enables identification of lymph node positive patients who need adjuvant treatment, including radiotherapy and chemotherapy. Adjuvant radiotherapy is used for Stage I-II patients with high-risk factors and Stage III lymph node negative patients. In advanced disease, a combination of surgery to no residual disease and chemotherapy results in the best outcome. Surgery for recurrent disease is only advocated in patients with a good performance status with a relatively long disease-free interval.
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Affiliation(s)
- Frédéric Amant
- Division of Gynecologic Oncology, University Hospitals Gasthuisberg, Leuven, Belgium.,Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, Netherlands.,Center for Gynecologic Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Koskas
- Division of Gynecologic Oncology, Bichat University Hospital, Paris, France
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
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Zola P, Jacomuzzi ME, Mazzola S, Fuso L, Ferrero A, Landoni F, Gadducci A, Sartori E, Maggino T. Analysis of the Evolution in the Management of Endometrial Cancer in Italy: A CTF Study. TUMORI JOURNAL 2018; 88:481-8. [PMID: 12597143 DOI: 10.1177/030089160208800610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective In 1994 we mailed questionnaires to referral centers in Italy in order to evaluate the different opinions concerning aspects of endometrial cancer treatment, which is still controversial. The data processing showed a significant nonhomogeneity in disease management and prompted the Italian Society of Gynecologic Oncology to define guidelines for endometrial cancer adjuvant treatment. In 2001, we mailed again the same questionnaire to the same referral Centers in Italy. The aim of the second enquiry was the evaluation of changes in endometrial cancer management and the effective impact of the guidelines published. Methods The enquiry used the same questionnaires mailed in 1994; actually, we mailed those questionnaires to the same referral centers in Italy twice: in December 2000 and March 2001. The results of both the enquiries were collected in a relational data base, and the statistical evaluations were calculated using SPSS-statistics (Window ver. 8). Results Endometrial cancer treatment consists in abdominal hysterectomy and bilateral salpingo-oophorectomy. The unique relevant difference as to 1994 consists in the systemic performing of peritoneal cytology in endometrial cancer staging. Unlike the previous enquiry, adjuvant radiotherapy is not systematically performed in disease at stage Ic because of the substantial absence of confirmed data demonstrating a real benefit in terms of survival rate. The comparison between the two enquiries shows a significant change in medical planning and diversification attitude according to patient age and menopausal state. The disease management changes in patients over 75 years old, mainly with respect to surgery and primary therapy. Conclusions We noted a resistance of many centers to accept some trends actually widespread in the literature but not yet performed in practical clinical.
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Affiliation(s)
- Paolo Zola
- Cattedra di Ginecologia Oncologica, Ospedale Mauriziano Umberto 1, Torino, Italy.
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Oncological Outcomes of Stage II Endometrial Cancer: A Retrospective Analysis of 250 Cases. Int J Gynecol Cancer 2018; 28:161-167. [DOI: 10.1097/igc.0000000000001133] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveThe aim of this study was to investigate the effect of different surgical approaches, adjuvant therapy, and pathological characteristics on oncological outcomes in patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage II endometrial cancer (EC).MethodsA multicenter, retrospective department database review was performed to identify patients with FIGO 2009 stage II EC who underwent surgical staging between 2002 and 2015 at 5 gynecologic oncology centers in Turkey.ResultsOriginal pathology reports of 4867 patients who underwent surgical treatment for EC were analyzed. The study group consisted of 250 FIGO stage II patients. Of these patients, 203 (81.2%) had endometrioid and 47 (18.8%) had nonendometrioid histologic subtype of EC. Whereas 199 patients (79.6%) underwent type I hysterectomy, the remaining 51 patients (20.4%) underwent radical hysterectomy. Of the 250 patients, 208 patients (83.2%) had adjuvant therapy including radiotherapy (pelvic external beam radiotherapy and/or vaginal brachytherapy [VBT]) and/or platinum-based chemotherapy. Disease recurred in 29 patients (11.6%). The 5-year disease-free survival (DFS) and overall survival (OS) for the entire cohort were 82% and 85%, respectively. Multivariate analysis showed that only adjuvant treatment (P = 0.001; hazard ratio, 4.02; 95% confidence interval, 1.72–9.36) was significantly associated with DFS. According to multivariate analysis, only age older than 60 years (P = 0.01; hazard ratio, 3.03; 95% confidence interval, 1.3–7.04) was identified as an independent risk factor for OS. However, there were no differences in OS when evaluated by grade, histology, tumor size, type of hysterectomy, or adjuvant treatment.ConclusionsIn stage II EC, adjuvant external beam radiotherapy ± VBT were associated with increased DFS but not OS. However, the benefit of VBT alone on DFS could not be demonstrated. Only age was an independent risk factor for OS. Type of hysterectomy and histologic subtype of the tumor for patients with uterus-confined disease improved neither DFS nor OS in our study group.
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Surgical Outcomes of Patients Undergoing Extrafascial Hysterectomy After Neoadjuvant Radiotherapy With or Without Chemotherapy for Locally Advanced Endometrial Cancer Clinically Extending to the Cervix or Parametria. Int J Gynecol Cancer 2017; 27:1149-1154. [DOI: 10.1097/igc.0000000000000614] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
ObjectivesRecent data have shown high rates of clinical and pathologic responses to neoadjuvant radiation therapy for locally advanced endometrial cancer. There are limited data on the surgical outcomes of these patients in the era of modern radiation and surgical techniques. We sought to characterize surgical outcomes after extrafascial hysterectomy in this population.MethodsPatients with endometrial cancer of all histologies clinically involving the cervix or parametria treated with neoadjuvant brachytherapy followed by extrafascial hysterectomy from 1999 to 2014 were identified. Patient charts were reviewed for data regarding treatment characteristics and postoperative outcomes. Pearson χ2 and logistic regression analyses were used to assess correlations between surgical complications and treatment-related variables.ResultsTwenty-nine patients met inclusion criteria. Mean operating time for the cohort was 115 minutes. Mean estimated blood loss was 100 mL. No visceral injuries occurred. Mean length of hospital stay was 1 and 4 days for the minimally invasive and laparotomy groups, respectively. Rates of postoperative ileus, blood transfusion, wound infection, and readmission were 3%, 3%, 6%, and 3%, respectively. No case of prolonged urodynamic dysfunction was noted. The rate of vaginal complications was significantly higher in the group of patients who underwent minimally invasive surgery as compared with laparotomy (33% vs 5%, P < 0.041).ConclusionsThese data support adjuvant extrafascial hysterectomy after neoadjuvant radiotherapy for endometrial cancer with cervical or parametrial involvement as a safe and viable procedure, with low rates of postoperative complications. Extra care should be taken when closing the vaginal cuff to reduce the risk of vaginal cuff complications.
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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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Phelippeau J, Koskas M. Impact of Radical Hysterectomy on Survival in Patients with Stage 2 Type1 Endometrial Carcinoma: A Matched Cohort Study. Ann Surg Oncol 2016; 23:4361-4367. [DOI: 10.1245/s10434-016-5372-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Indexed: 11/18/2022]
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Amant F, Mirza MR, Koskas M, Creutzberg CL. Cancer of the corpus uteri. Int J Gynaecol Obstet 2015; 131 Suppl 2:S96-104. [DOI: 10.1016/j.ijgo.2015.06.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Ilker S, Nilufer C, Firat CZ, Bulent O, Hatice B, Tayfun G. Predicting lympho-vascular space invasion in endometrial cancers with mucinous carcinomatous components. Asian Pac J Cancer Prev 2015; 16:4247-50. [PMID: 26028080 DOI: 10.7314/apjcp.2015.16.10.4247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine the predictors of lympho-vascular space invasion (LVSI) in endometrial cancers which contain mucinous carcinomatous histology. MATERIALS AND METHODS Clinical and histopathological data of endometrial carcinomas with a mucinous carcinomatous component diagnosed between January 2007 and January 2014 at the Gynecologic Oncology Department of Zekai Tahir Burak Women's Health Education and Research Hospital were reviewed retrospectively. RESULTS Twelve patients (25.5%) were positive for LVSI and 35 (74.5%) patients were negative. Patients with LVSI were mostly staged higher than 1A. Mean age, BMI and parity were not significantly different between patient groups. Larger tumor diameter (≥2 cm) (p=0.04) and elevated Ca125 and Ca-19.9 (p=0.01) levels were significant for predicting LVSI. We also found >1/2 myometrial invasion (p<0.001), cervical stromal involvement (p=0.002) and higher grade (2-3) (p=0.001) significant for predicting LVSI. In multivariate analysis we found only grade significant for predicting LVSI. CONCLUSIONS Especially grade of tumor is a crucial factor for determining LVSI in endometrial cancers with mucinous carcinomatous components.
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Affiliation(s)
- Selcuk Ilker
- Gynecologic Oncology Unit, Zekai Tahir Burak Women's Health, Education and Research Hospital, Ankara, Turkey E-mail :
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Fischerova D, Frühauf F, Zikan M, Pinkavova I, Kocián R, Dundr P, Nemejcova K, Dusek L, Cibula D. Factors affecting sonographic preoperative local staging of endometrial cancer. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:575-585. [PMID: 24281994 DOI: 10.1002/uog.13248] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/02/2013] [Accepted: 10/25/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To identify major factors in the under- and overestimation of cervical and myometrial invasion by endometrial cancer at preoperative staging by ultrasound. METHODS This prospective study involved all patients with histologically confirmed endometrial cancer referred consecutively for surgical staging between January 2009 and December 2011. All patients underwent transvaginal ultrasound examination, obtaining metric and perfusion data, and the results were compared with final histology: myometrial invasion was defined at histology in the final pathology report as being either < or ≥ 50%, while cervical stromal invasion was reported as being either present or absent, and sonographic over-/underestimation was determined relative to these. RESULTS Enrolled prospectively into the study were 210 patients. The proportion of cases with sonographic underestimation, relative to final histology, of myometrial invasion (i.e. false-negative estimation of no or superficial invasion < 50%) and of cervical invasion (i.e. false-negative finding of absence of stromal invasion) was comparable: 8.6% (n = 18) and 10.5% (n = 22), respectively. Myometrial invasion was overestimated by ultrasound (i.e. false-positive estimation of deep invasion ≥ 50%) in 15.7% (n = 33) of cases, and cervical invasion was overestimated (i.e. false-positive finding of presence of stromal invasion) in 4.8% (n = 10) of cases. These outcomes correspond to positive and negative predictive values of 67.6% (95% CI, 57.7-76.6) and 83.3% (95% CI, 74.9-89.8), respectively, for the subjective assessment of myometrial invasion, and 60.0% (95% CI, 38.2-79.2) and 88.1% (95% CI, 82.5-92.4), respectively, for that of cervical stromal invasion. The staging error in subjective assessment was not related to body mass index (BMI), to the position of the uterus in the pelvis or to image quality. Cervical and myometrial invasion were more often underestimated in well-differentiated endometrial cancers that were smaller in size, with thick minimum tumor-free myometrium and lower perfusion, and more often overestimated in moderately and poorly differentiated cancers that were larger in size, with thin minimum tumor-free myometrium and richer perfusion. CONCLUSION The accuracy of subjective assessment of myometrial and cervical invasion by ultrasound was significantly influenced by tumor size, density of tumor vascularization, tumor vessel architecture and histological grading, while it was not significantly affected by BMI, uterine position and image quality.
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Affiliation(s)
- D Fischerova
- Gynecological Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
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Valentin L. Ultrasound deserves to play a prominent role in the diagnosis and management of endometrial cancer. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:483-487. [PMID: 24789303 DOI: 10.1002/uog.13371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, SE 20502, Malmö, Sweden.
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Surgery for endometrial cancers with suspected cervical involvement: is radical hysterectomy needed (a GOTIC study)? Br J Cancer 2013; 109:1760-5. [PMID: 24002604 PMCID: PMC3790173 DOI: 10.1038/bjc.2013.521] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/09/2013] [Accepted: 08/09/2013] [Indexed: 01/12/2023] Open
Abstract
Background: Radical hysterectomy is recommended for endometrial adenocarcinoma patients with suspected gross cervical involvement. However, the efficacy of operative procedure has not been confirmed. Methods: The patients with endometrial adenocarcinoma who had suspected gross cervical involvement and underwent hysterectomy between 1995 and 2009 at seven institutions were retrospectively analysed (Gynecologic Oncology Trial and Investigation Consortium of North Kanto: GOTIC-005). Primary endpoint was overall survival, and secondary endpoints were progression-free survival and adverse effects. Results: A total of 300 patients who underwent primary surgery were identified: 74 cases with radical hysterectomy (RH), 112 patients with modified radical hysterectomy (mRH), and 114 cases with simple hysterectomy (SH). Median age was 47 years, and median duration of follow-up was 47 months. There were no significant differences of age, performance status, body mass index, stage distribution, and adjuvant therapy among three groups. Multi-regression analysis revealed that age, grade, peritoneal cytology status, and lymph node involvement were identified as prognostic factors for OS; however, type of hysterectomy was not selected as independent prognostic factor for local recurrence-free survival, PFS, and OS. Additionally, patients treated with RH had longer operative time, higher rates of blood transfusion and severe urinary tract dysfunction. Conclusion: Type of hysterectomy was not identified as a prognostic factor in endometrial cancer patients with suspected gross cervical involvement. Perioperative and late adverse events were more frequent in patients treated with RH. The present study could not find any survival benefit from RH for endometrial cancer patients with suspected gross cervical involvement. Surgical treatment in these patients should be further evaluated in prospective clinical studies.
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Chattopadhyay S, Bryant A, Al Moundhri M, Galaal K. Surgery plus adjuvant radiotherapy versus surgery alone for stage II endometrial cancer. Hippokratia 2013. [DOI: 10.1002/14651858.cd010353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Supratik Chattopadhyay
- St James's University Hospital; Gynaecological Oncology; Level 4, Bexley Wing Beckett Street Leeds UK LS9 7TF
| | - Andrew Bryant
- Newcastle University; Institute of Health & Society; Medical School New Build Richardson Road Newcastle upon Tyne UK NE2 4AX
| | - Mansour Al Moundhri
- College of Medicine and Health Sciences and Sultan Qaboos University Hospital; Medical Oncology Unit, Department of Medicine; Sutlan Qaboos University Al-Khod Oman 123
| | - Khadra Galaal
- Princess Alexandra Wing, Royal Cornwall Hospital; Gynaecological Oncology; Truro UK TR1 3LJ
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What is the impact of cervical invasion on lymph node metastasis in patients with stage IIIC endometrial cancer? Arch Gynecol Obstet 2011; 285:1119-24. [DOI: 10.1007/s00404-011-2030-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 07/17/2011] [Indexed: 01/29/2023]
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Leitao MM, Barakat RR. Clinical Approach to Diagnosis and Management of Endometrial Hyperplasia and Carcinoma. Surg Pathol Clin 2011; 4:113-30. [PMID: 26837290 DOI: 10.1016/j.path.2010.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article focuses on the most important neoplastic epithelial lesions of the uterus, endometrial hyperplasia and carcinoma. The primary management of hyperplastic lesions and carcinoma is often surgical but nonsurgical options are possible for both, depending on specific patients and tumor characteristics. Many controversies still exist regarding the optimal medical and surgical treatments of hyperplasias and carcinomas of the endometrium. There is a need to more accurately select patients for lymph node sampling or dissection. The role of adjuvant therapies for endometrial carcinomas is still under investigation. This review covers current understanding in the diagnosis and clinical management of endometrial hyperplasias and carcinomas.
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Affiliation(s)
- Mario M Leitao
- Division of Gynecology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Richard R Barakat
- Division of Gynecology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Ware RA, van Nagell JR. Radical hysterectomy with pelvic lymphadenectomy: indications, technique, and complications. Obstet Gynecol Int 2010; 2010:587610. [PMID: 20871657 PMCID: PMC2939408 DOI: 10.1155/2010/587610] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 06/11/2010] [Indexed: 12/03/2022] Open
Abstract
Radical hysterectomy with pelvic lymphadenectomy remains the treatment of choice for women with Stages IA(2) and IB(1) carcinoma of the cervix, and selected patients with Stage II endometrial cancer. Improvement in surgical techniqe, administration of prophylactic antibiotics, thromboemolic prophylaxis, and advances in critical care medicine have resulted in lower operative morbidity associated with this procedure. Major urinary tract complications such as ureteral injury or vesico-vaginal fistula are now extremely rare (<1%). Five-year survival rates following this procedure vary according to a number of clinical and histologic variables, and may be as high as 90% in women without lymph node metastases.
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Affiliation(s)
- Rachel A. Ware
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA
| | - John R. van Nagell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA
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Han CH, Lee KH, Lee HN, Kim CJ, Park TC, Park JS. Does the type of hysterectomy affect the prognosis in clinical stage I endometrial cancer? J Obstet Gynaecol Res 2010; 36:581-7. [PMID: 20598041 DOI: 10.1111/j.1447-0756.2010.01220.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To determine whether clinical outcomes show a benefit from extended hysterectomy in patients with early endometrial cancer. METHODS We reviewed the medical records of 101 patients who had endometrial cancer with clinical stage I disease. All the patients were surgically staged, and two types of hysterectomy, simple hysterectomy (SH) or extended hysterectomy (EH), were performed by surgeon's preference. The postoperative pathology findings, recurrence rate and disease-free survivals (DFS) between the two groups were compared. RESULTS Sixty-six patients and thirty-five patients underwent SH and EH, respectively. At subsequent surgical staging, seven patients (10.6%) in the SH and four (11.4%) in EH group were upgraded to stage II or III disease. The surgical and pathological features were not different between the groups. Though the recurrence rate was lower in the EH group (9.09% for SH vs 2.86% for EH), it showed no statistical significance (P = 0.241). The 5-year DFS (88.2% for SH vs 96.0% for EH) showed no statistically significant difference between the groups either (P = 0.242). CONCLUSION Compared to SH, EH did not have any prognostic benefit in clinical stage I endometrial cancer. Until the therapeutic role of the EH is determined by further studies using a larger sample size, SH remains the treatment of choice in patients with early endometrial cancer, and surgeons should not perform extended operation without definite evidence of the disease.
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Affiliation(s)
- Chan Hee Han
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea
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Controversies in the management of endometrial carcinoma. Obstet Gynecol Int 2010; 2010:862908. [PMID: 20613958 PMCID: PMC2896852 DOI: 10.1155/2010/862908] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 12/01/2009] [Accepted: 04/13/2010] [Indexed: 01/03/2023] Open
Abstract
Endometrial carcinoma is the most common type of female genital tract malignancy. Although endometrial carcinoma is a low grade curable malignancy, the condition of the disease can range from excellent prognosis with high curability to aggressive disease with poor outcome. During the last 10 years many researches have provided some new valuable data of optimal treatments for endometrial carcinoma. Progression in diagnostic imaging, radiation delivery systems, and systemic therapies potentially can improve outcomes while minimizing morbidity. Firstly, total hysterectomy and bilateral salphingo-oophorectomy is the primary operative procedure. Pelvic lymhadenectomy is performed in most centers on therapeutic and prognostic grounds and to individualize adjuvant treatment. Women with endometrial carcinoma can be readily segregated intraoperatively into “low-risk” and “high-risk” groups to better identify those women who will most likely benefit from thorough lymphadenectomy. Secondly, adjuvant therapies have been proposed for women with endometrial carcinoma postoperatively. Postoperative irradiation is used to reduce pelvic and vaginal recurrences in high risk cases. Chemotherapy is emerging as an important treatment modality in advanced endometrial carcinoma. Meanwhile the availability of new hormonal and biological agents presents new opportunities for therapy.
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Controversies in the management of endometrial cancer. Obstet Gynecol Int 2010; 2010:638165. [PMID: 20613951 PMCID: PMC2896844 DOI: 10.1155/2010/638165] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 04/08/2010] [Accepted: 04/10/2010] [Indexed: 11/18/2022] Open
Abstract
Endometrial cancer (EC) remains the most common malignancy of the female genital tract. The median age at diagnosis is the sixth decade, with abnormal uterine bleeding at the presentation in 90% of the patients. Surgical treatment, including complete hysterectomy, removal of remaining adnexal structures, and an appropriate surgical staging, represents the milestone of curative therapy for patients with EC. Adjuvant therapy is necessary in patients at high risk of recurrence. Conservative treatment approaches should be used in selected cases for women with a desire of fertility preservation. This review summarizes the management of EC and discusses current controversies regarding the role of lymphadenectomy and radiotherapy in patients with intermediate-risk tumors confined to the uterus.
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Orezzoli JP, Sioletic S, Olawaiye A, Oliva E, del Carmen MG. Stage II endometrioid adenocarcinoma of the endometrium: Clinical implications of cervical stromal invasion. Gynecol Oncol 2009; 113:316-23. [DOI: 10.1016/j.ygyno.2009.03.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 02/28/2009] [Accepted: 03/03/2009] [Indexed: 02/07/2023]
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Abstract
There is a pressing need to improve our understanding of endometrial cancer (EC) and uterine carcinosarcoma and to develop new treatment strategies to improve outcomes. In recognition of this, a State of the Science meeting on EC was held last November 28 and 29, 2006, in Manchester, United Kingdom. The meeting was cosponsored by the National Cancer Research Institute (UK), the National Cancer Institute (US), and the Gynecological Cancer Intergroup. The objectives of the meeting were as follows: 1. To review current knowledge and understanding of EC and its treatments. 2. To identify key issues for translational research and clinical trials. 3. To identify the most important trials for women with endometrial carcinoma and uterine carcinosarcoma, both those already underway or to be done, for which the Gynecological Cancer Intergroup might facilitate international cooperation.
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Affiliation(s)
- Henry C Kitchener
- UK National Cancer Research Institute and University of Manchester, Manchester, United Kingdom
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Optimizing the management of stage II endometrial cancer: the role of radical hysterectomy and radiation. Am J Obstet Gynecol 2009; 200:419.e1-7. [PMID: 19136095 DOI: 10.1016/j.ajog.2008.11.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Revised: 10/01/2008] [Accepted: 11/05/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The optimal management of stage II endometrial cancer remains uncertain. We examined the role of radical hysterectomy and adjuvant radiotherapy for stage II endometrial cancer. STUDY DESIGN The Surveillance, Epidemiology, and End Results database was used to identify 1577 women with stage II endometrioid type endometrial adenocarcinoma who underwent surgical staging. RESULTS The cohort included 1198 women who underwent simple hysterectomy (76%) and 379 who underwent radical hysterectomy (24%). Radical hysterectomy had no effect on survival (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.61-1.23). Patients who did not receive radiation were 48% (HR, 1.48; 95% CI, 1.14-1.93) more likely to die than those who underwent adjuvant radiotherapy. The survival benefit from radiation was most pronounced in women who underwent radical hysterectomy. CONCLUSION Adjuvant radiation improves survival. Although the routine performance of radical hysterectomy does not appear to be justified, patients with high-risk stage II tumors appear to benefit from combination therapy with radical hysterectomy and radiotherapy.
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ICSI outcome following conservative fertility sparing management of endometrial cancer. Reprod Biomed Online 2009; 18:416-20. [DOI: 10.1016/s1472-6483(10)60102-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Estimation of Optimal Brachytherapy Utilization Rate in the Treatment of Malignancies of the Uterine Corpus by a Review of Clinical Practice Guidelines and the Primary Evidence. Int J Radiat Oncol Biol Phys 2008; 72:849-58. [DOI: 10.1016/j.ijrobp.2008.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 01/09/2008] [Accepted: 01/09/2008] [Indexed: 11/23/2022]
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40
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Reliability of diagnostic fluid hysteroscopy in the assessment of cervical invasion by endometrial carcinoma: A comparative study with transvaginal sonography and MRI. Gynecol Oncol 2008; 111:55-61. [DOI: 10.1016/j.ygyno.2008.06.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Revised: 06/09/2008] [Accepted: 06/11/2008] [Indexed: 11/17/2022]
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Holland C. The Role of Radical Surgery in Carcinoma of the Endometrium. Clin Oncol (R Coll Radiol) 2008; 20:448-56. [DOI: 10.1016/j.clon.2008.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 03/11/2008] [Accepted: 03/28/2008] [Indexed: 01/22/2023]
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Leitao MM. Current and future surgical approaches in the management of endometrial carcinoma. Future Oncol 2008; 4:389-401. [DOI: 10.2217/14796694.4.3.389] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The surgical approach to endometrial carcinoma has been and continues to be inconsistent. It ranges from hysterectomy alone for all patients, hysterectomy with lymphadenectomy based on the surgeon’s criteria for risk of nodal metastasis based on preoperative grading and/or intraoperative assessments, and hysterectomy with limited lymphadenectomy, to hysterectomy with full pelvic and para-aortic lymphadenectomy for all patients. Recent evidence has clearly described the very poor correlation of pre- and/or intraoperative assessments with final hysterectomy pathologic findings. Lymphadenectomy has also been found to be therapeutic in high-risk groups. Despite this, many surgeons have not adopted a policy of comprehensive staging for all patients with endometrial carcinoma. All patients with endometrial carcinoma diagnosed on preoperative endometrial sampling should undergo comprehensive surgical staging if technically and medically possible. Surgical cytoreduction of metastatic disease is also associated with improved outcomes.
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Affiliation(s)
- Mario M Leitao
- Memorial Sloan–Kettering Cancer Center, Gynecology Service, Department of Surgery, 1275 York Avenue, NY 10065, USA
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Cohn DE, Woeste EM, Cacchio S, Zanagnolo VL, Havrilesky LJ, Mariani A, Podratz KC, Huh WK, Whitworth JM, McMeekin DS, Powell MA, Boyd E, Phillips GS, Fowler JM. Clinical and Pathologic Correlates in Surgical Stage II Endometrial Carcinoma. Obstet Gynecol 2007; 109:1062-7. [PMID: 17470583 DOI: 10.1097/01.aog.0000260871.87607.25] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify the surgical, pathologic, and therapeutic factors that influence outcome in patients with surgical stage II endometrial adenocarcinoma. METHODS All patients with comprehensively staged stage II endometrial adenocarcinoma were identified. Data regarding preoperative, surgical, pathologic, adjuvant therapy, and outcomes were collected. Factors were compared with the chi(2) test, and survival curves were generated and compared with the log rank test. RESULTS Of 162 patients with surgical stage II endometrial cancer, the median age was 65 years, and the median body mass index was 31.2 kg/m(2). An extrafascial hysterectomy was performed in 75% of cases, whereas 25% of patients underwent radical hysterectomy. At least 10 nodes were recovered in more than 90% of cases. Stage IIA disease was present in 52% of cases, whereas stage IIB accounted for the remaining 48%. After staging, 48% of patients had adjuvant radiation therapy (16% with brachytherapy alone). The remainder received no adjuvant therapy. At a median follow-up of 26 months, 17% experienced disease recurrence. Five-year overall survival rate was 88% and disease-free survival rate was 81%. A significantly better 5-year disease-free survival rate was seen in patients undergoing radical hysterectomy compared with extrafascial hysterectomy (94% compared with 76%, P=.05). Adjuvant radiation did not lead to improved survival. CONCLUSION In this large series of surgical stage II endometrial cancer cases, improved survival was noted relative to historical controls and in particular with radical compared with extrafascial hysterectomy.
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Affiliation(s)
- David E Cohn
- Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, Ohio, USA
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Gadducci A, Cosio S, Genazzani AR. Old and new perspectives in the pharmacological treatment of advanced or recurrent endometrial cancer: Hormonal therapy, chemotherapy and molecularly targeted therapies. Crit Rev Oncol Hematol 2006; 58:242-56. [PMID: 16436330 DOI: 10.1016/j.critrevonc.2005.11.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2005] [Revised: 10/30/2005] [Accepted: 11/17/2005] [Indexed: 12/20/2022] Open
Abstract
Hormonal therapy and chemotherapy play a major role in the management of advanced or recurrent endometrial cancer. Progesterone therapy obtains overall response rates ranging from 11% to 25% in patients with endometrioid-type tumours, and oral medroxyprogesterone acetate 200mg daily appears to be a reasonable therapeutic option for those lesions that are well differentiated and/or have a high progesterone receptor (PgR) content. However, the activity of progestins is often compromised by the down-regulation of PgR within the target tissues, and therefore therapeutic strategies designed to enhance PgR expression are warranted. Little data are currently available about the new aromatase inhibitors and selective estrogen receptor modulators. As for chemotherapy, the combination of doxorubicin [DOX]+cisplatin [CDDP] achieves overall response rates ranging from 34% to 60%, and the addition of paclitaxel (TAX) seems to improve response rates, progression-free survival and overall survival, but to worsen toxicity profile. A phase III study is currently comparing TAX+DOX+CDDP versus the less toxic combination of TAX+carboplatin. Chemotherapy is active against both endometrioid-type carcinoma and uterine serous papillary carcinoma. However, this latter endometrial malignancy is less chemosensitive than the histologically similar high-grade serous ovarian carcinoma. Interesting fields of research are represented by investigational agents directed against specific intracellular signal transduction pathways involved in the proliferation, invasiveness and metastatic spread of endometrial cancer. Mammalian target of the rapamycin (mTOR) inhibitors, epidermal growth factor receptor inhibitors (gefitinib, erlotinib, lapatinib, the monoclonal antibody cetuximab), imatinib, the monoclonal antibody trastuzumab, and the Clostridium perfrigens enterotoxin are currently under evaluation as molecularly targeted therapies for endometrial cancer. Further investigations addressed to better understand the signal transduction pathways that are disregulated in endometrial carcinogenesis could identify novel biological targets suitable for tailored therapies.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Endometrioid/drug therapy
- Carcinoma, Endometrioid/metabolism
- Clinical Trials, Phase III as Topic
- Cystadenocarcinoma, Papillary/drug therapy
- Cystadenocarcinoma, Papillary/metabolism
- Drug Design
- Endometrial Neoplasms/drug therapy
- Endometrial Neoplasms/metabolism
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Neoplasm Proteins/agonists
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/metabolism
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/metabolism
- Neoplasms, Hormone-Dependent/drug therapy
- Neoplasms, Hormone-Dependent/metabolism
- Signal Transduction/drug effects
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Affiliation(s)
- Angiolo Gadducci
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Via Roma 56, Pisa 56127, Italy.
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Chao A, Chang TC, Ng KK, Hsueh S, Huang HJ, Chou HH, Tsai CS, Yen TC, Wu TI, Lai CH. 18F-FDG PET in the management of endometrial cancer. Eur J Nucl Med Mol Imaging 2005; 33:36-44. [PMID: 16167154 DOI: 10.1007/s00259-005-1876-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Accepted: 05/30/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE Few studies have investigated the clinical impact of whole-body positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) in endometrial cancer. We aimed to assess the value of integrating FDG-PET into the management of endometrial cancer in comparison with conventional imaging alone. METHODS All patients with histologically confirmed primary advanced (stage III/IV) or suspicious/documented recurrent endometrial cancer, with poor prognostic features (serum CA-125 >35 U/ml or unfavourable cell types), or surveillance after salvage therapy were eligible. Before FDG-PET scanning, each patient had received magnetic resonance imaging and/or computed tomography (MRI-CT). The receiver operating characteristic curve method with calculation of the area under the curve (AUC) was used to compare the diagnostic efficacy. Clinical impacts were determined on a scan basis. RESULTS Forty-nine eligible patients were accrued and 60 studies were performed (27 primary staging, 33 post-therapy surveillance or restaging on relapse). The clinical impact was positive in 29 (48.3%) of the 60 scans. Mean standardised uptake values (SUVs) of true-positive lesions were 13.2 (range 5.7-37.4) for central pelvic lesions and 11.1 (range 1.5-37.4) for metastases. The sensitivity of FDG-PET alone (P<0.0001) or FDG-PET plus MRI-CT (P<0.0001) was significantly higher than that of MRI-CT alone in overall lesion detection. FDG-PET plus MRI-CT was significantly superior to MRI-CT alone in overall lesion detection (AUC 0.949 vs 0.872; P=0.004), detection of pelvic nodal/soft tissue metastases (P=0.048) and detection of extrapelvic metastases (P=0.010), while FDG-PET alone was only marginally superior by AUC (P=0.063). CONCLUSION Whole-body FDG-PET coupled with MRI-CT facilitated optimal management of endometrial cancer in well-selected cases.
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Affiliation(s)
- Angel Chao
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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Tebes SJ, Cardosi RJ, Hoffman MS, Grendys EC. Radical Hysterectomy Versus Extrafascial Hysterectomy in the Management of Stage II Endometrial Carcinoma. J Gynecol Surg 2005. [DOI: 10.1089/gyn.2005.21.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stephen J. Tebes
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL
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Abstract
Patients with endometrial cancer have an overall good prognosis. Patients with tumors invading deep into the myometrium or the cervical stroma or with extrauterine spread and patients with uterine papillary serous carcinoma (UPSC) or clear cell carcinoma (CCC) are at increased risk of relapse and represent a therapeutic challenge. Surgical treatment remains the cornerstone of therapy. Hysterectomy with bilateral salpingo-oophorectomy, washings, and careful assessment for intra-abdominal tumor should be performed with pelvic and para-aortic lymph node dissection when indicated based on grade of tumor and depth of invasion. All patients with UPSC or CCC should have pelvic and para-aortic lymph node dissection and omentectomy performed. Gross extrauterine disease should be resected. Radiotherapy has been the traditional adjuvant treatment for all high-risk patients. For patients with advanced disease (stage III-IV) combination chemotherapy with cisplatin and doxorubicin has been found to be superior to radiotherapy. For patients with advanced disease, treatment with a three-drug combination of cisplatin, doxorubicin, and paclitaxel has been shown to increase survival. It remains to be seen whether adjuvant chemotherapy in patients with high-risk disease in a lower stage will improve survival and possibly replace adjuvant radiotherapy in some patient groups.
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Affiliation(s)
- Gunnar Kristensen
- Department of Gynecologic Oncology, The Norwegian Radium Hospital, Montebello, 0310 Oslo, Norway
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Randall TC, Armstrong K. Differences in Treatment and Outcome Between African-American and White Women With Endometrial Cancer. J Clin Oncol 2003; 21:4200-6. [PMID: 14615448 DOI: 10.1200/jco.2003.01.218] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: To investigate disparities in treatment and outcomes between African-American and white women with endometrial cancer. Patients and Methods: We analyzed 1992 to 1998 Surveillance, Epidemiology, and End Results data for 21,561 women with epithelial cancers of the endometrium. Sequential Cox proportional hazard models were used to determine the association between tumor characteristics (stage, grade, and histologic type), sociodemographic characteristics (age and marital status), and treatment (surgery and radiation therapy) and the racial difference in mortality. Results: The unadjusted hazard ratio (HR) for death from endometrial cancer for African-American women compared with white women was 2.57. However, African-American women were significantly more likely to present with advanced-stage disease and have poorly differentiated tumors or tumors with an unfavorable histologic type and were significantly less likely to undergo definitive surgery at all stages of disease. Adjusting for tumor and sociodemographic characteristics lowered the HR for African-American women to 1.80. Further adjustment for the use of surgery reduced the HR to 1.51. The association between surgery and survival was stronger among white women (HR, 0.26) than among African-American women (HR, 0.44). Conclusion: African-American women with endometrial cancer are significantly less likely to undergo primary surgery and have significantly shorter survival than white women with endometrial cancer. Racial differences in treatment are associated with racial differences in survival. The association between use of surgery and survival is weaker among African-American than white women, raising questions about potential racial differences in the effectiveness of surgery.
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MESH Headings
- Adenocarcinoma/ethnology
- Adenocarcinoma/mortality
- Adenocarcinoma/therapy
- Adenocarcinoma, Papillary/ethnology
- Adenocarcinoma, Papillary/mortality
- Adenocarcinoma, Papillary/therapy
- Adult
- Aged
- Aged, 80 and over
- Black People
- Carcinoma, Squamous Cell/ethnology
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/therapy
- Cystadenocarcinoma, Serous/ethnology
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/therapy
- Endometrial Neoplasms/ethnology
- Endometrial Neoplasms/mortality
- Endometrial Neoplasms/therapy
- Female
- Humans
- Lymphatic Metastasis
- Middle Aged
- Neoplasm Staging
- Prognosis
- Registries
- Risk Factors
- SEER Program
- Survival Rate
- Treatment Outcome
- United States
- White People
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Affiliation(s)
- Thomas C Randall
- Department of Obstetrics and Gynecology, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Mariani A, Webb MJ, Keeney GL, Aletti G, Podratz KC. Endometrial cancer: predictors of peritoneal failure. Gynecol Oncol 2003; 89:236-42. [PMID: 12713986 DOI: 10.1016/s0090-8258(03)00052-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess determinants of peritoneal failure in endometrial cancer patients after definitive primary treatment. METHODS Of 599 patients with endometrial cancer who had primary surgery at our institution during the decade before 1994, 131 had relapse. We defined "peritoneal failure" as relapse when it occurred in the upper abdomen or involved the pelvic peritoneum (or both). Mean follow-up was 72.8 months. RESULTS Peritoneal failure was detected in 37 of 599 (6%) patients and represented 28% of identified failures. Stage IV disease, cervical stromal invasion, adnexal involvement, myometrial invasion >50%, primary tumor diameter >2 cm, positive peritoneal cytology, lymph node metastasis, histologic grade 3, nonendometrioid histologic subtype, absence of associated hyperplasia, and lymphovascular invasion correlated significantly (P < 0.01) with peritoneal failure. However, on regression analysis, only stage IV disease (P < 0.001, relative risk [RR] = 7.53), nonendometrioid histologic subtype (P = 0.02, RR = 3.01), and cervical stromal invasion (P = 0.04, RR = 2.83) were independent predictors of peritoneal failure. Because 22 of 37 (59%) peritoneal failures were in patients with stage IV disease, we considered separately the 545 patients with stage I-III disease. On regression analysis, nonendometrioid histologic subtype (P < 0.001, RR = 11.58), positive peritoneal cytology (P = 0.009, RR = 6.72), lymph node metastasis (P = 0.02, RR = 5.10), and cervical stromal invasion (P = 0.04, RR = 3.10) were independent predictors of peritoneal failure. Of the 38 patients in whom at least two of these four predictors were positive, 26% had peritoneal failure at 5 years, compared with 1% of the 507 patients who had none or only 1 predictor (P < 0.001). CONCLUSION Patients with stage IV disease and those with stage I-III disease and at least two of the four independent predictors (nonendometrioid histology, positive peritoneal cytology, cervical stromal invasion, and lymph node metastasis) would be candidates for new therapeutic trials incorporating surgical and adjuvant treatment targeting the entire abdominal cavity.
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Affiliation(s)
- Andrea Mariani
- Section of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55906, USA
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Mariani A, Sebo TJ, Webb MJ, Riehle D, Katzmann JA, Keeney GL, Roche PC, Lesnick TG, Podratz KC. Molecular and histopathologic predictors of distant failure in endometrial cancer. ACTA ACUST UNITED AC 2003; 27:434-41. [PMID: 14642551 DOI: 10.1016/j.cdp.2003.09.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A case-cohort study was designed to correlate various histopathologic and molecular variables with distant failure in endometrial cancer by analyzing phenotypic and molecular indices in hysterectomy specimens. From an overall population of 283 patients with endometrial cancer, we selected a cohort including all 49 patients who experienced any recurrence and 76 randomly chosen patients without recurrence. Expression of nuclear proliferating cell nuclear antigen (PCNA), MIB-1 (a marker of cell proliferation), and p53 was determined with digital image analysis, and cell membrane HER-2/neu and bcl-2 were quantitated visually. Ploidy and DNA indices were determined with flow cytometry. Overall, 6 immunohistochemical and 11 flow cytometric cases were eliminated because of technical inadequacies. Distant failures were defined as primary recurrences that developed outside the pelvis or vagina. Median follow-up was 91 months. Distant failures occurred in 13% of the patients. Cervical stromal invasion, positive adnexae, myometrial invasion >50%, positive lymph nodes, positive peritoneal cytology, lymphovascular invasion, grade 3 histology, nonendometrioid subtype, p53 >33%, strong HER-2/neu membranous staining, aneuploidy, S-phase fraction > or =9%, proliferative index > or =14%, and DNA index > or =1.5 significantly (P<0.05) predicted distant failures. However, a logistic regression model identified only p53 (OR=43.73; P<0.005), lymphovascular invasion (OR=11.59; P<0.001), and cervical stromal invasion (OR=11.29; P=0.001) as cogent predictors of distant failures. Only 3% of patients without any of these three predictors developed distant failures compared with 36% of those with at least one of the three (P<0.01). Thus, locoregional therapy may be insufficient when at least one of these predictors is present.
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Affiliation(s)
- Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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