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Wang Z, Zhao Z, Li W, Bao X, Liu T, Yang X. A Nomogram for Predicting Progression-free Survival in Patients with Endometrial Cancer. Clin Oncol (R Coll Radiol) 2023; 35:e516-e527. [PMID: 37230875 DOI: 10.1016/j.clon.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 02/25/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023]
Abstract
AIMS Endometrial cancer is one of the most widely known gynaecological malignancies that lacks a prognostic prediction model. This study aimed to develop a nomogram to predict progression-free survival (PFS) in patients with endometrial cancer. MATERIALS AND METHODS Information for endometrial cancer patients diagnosed and treated from 1 January 2005 to 30 June 2018 was collected. The Kaplan-Meier survival analysis and multivariate Cox regression analysis were carried out to determine the independent risk factors and a nomogram was constructed by R based on analytical factors. Internal and external validation were then carried out to predict the probability of 3- and 5-year PFS. RESULTS In total, 1020 patients with endometrial cancer were included in the study and the relationship between 25 factors and prognosis was analysed. Postmenopause (hazard ratio = 2.476, 95% confidence interval 1.023-5.994), lymph node metastasis (hazard ratio = 6.242, 95% confidence interval 2.815-13.843), lymphovascular space invasion (hazard ratio = 4.263, 95% confidence interval 1.802-10.087), histological type (hazard ratio = 2.713, 95% confidence interval 1.374-5.356), histological differentiation (hazard ratio = 2.601, 95% confidence interval 1.141-5.927) and parametrial involvement (hazard ratio = 3.596, 95% confidence interval 1.622-7.973) were found to be independent prognostic risk factors; these factors were selected to establish a nomogram. The consistency index for 3-year PFS were 0.88 (95% confidence interval 0.81-0.95) in the training cohort and 0.93 (95% confidence interval 0.87-0.99) in the verification set. The areas under the receiver operating characteristic curve for the 3- and 5-year PFS predictions are 0.891 and 0.842 in the training set; the same conclusion also appeared in the verification set [0.835 (3-year), 0.803(5-year)]. CONCLUSIONS This study established a prognostic nomogram for endometrial cancer that provides a more individualised and accurate estimation of PFS for patients, which will help physicians make follow-up strategies and risk stratification.
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Affiliation(s)
- Z Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Z Zhao
- Department of Ultrasound, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
| | - W Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - X Bao
- Department of Obstetrics and Gynecology, Weifang People's Hospital, Weifang, China
| | - T Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - X Yang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China.
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2
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Kolehmainen A, Pasanen A, Koivisto-Korander R, Bützow R, Loukovaara M. A Risk-scoring Model for Predicting Post-recurrence Survival in Patients With Endometrial Carcinoma. Clin Oncol (R Coll Radiol) 2023; 35:472-477. [PMID: 37173220 DOI: 10.1016/j.clon.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 02/19/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
AIMS The survival time of patients with recurrent endometrial carcinoma is generally short. However, considerable interindividual variation exists. We developed a risk-scoring model for predicting post-recurrence survival in patients with endometrial carcinoma. MATERIALS AND METHODS Patients with endometrial carcinoma treated at a single institution between 2007 and 2013 were identified. Pearson chi-squared analyses were used to compute odds ratios for the associations between risk factors and short survival after cancer recurrence. The results for biochemical analyses represented values at diagnosis of disease recurrence or values at initial diagnosis for those patients who had a primary refractory disease. Logistic regression models were constructed for the identification of variables that independently predict short post-recurrence survival. The models were used to assign points based on odds ratios for risk factors and risk scores were derived. RESULTS In total, 236 patients with recurrent endometrial carcinoma were included in the study. Based on overall survival analysis, 12 months was selected as the cut-off for short post-recurrence survival. Factors associated with short post-recurrence survival were platelet count, serum CA125 concentration and progression-free survival. A risk-scoring model with an area under the receiver operating characteristic curve (AUC) of 0.782 (95% confidence interval 0.713-0.851) was developed in patients without missing data (n = 182). When patients with a primary refractory disease were excluded, age and blood haemoglobin concentration were identified as additional predictors of short post-recurrence survival. For this subpopulation (n = 152), a risk-scoring model with an AUC of 0.821 (95% confidence interval 0.750-0.892) was developed. CONCLUSIONS We report a risk-scoring model that shows acceptable to excellent accuracy in predicting post-recurrence survival in patients with endometrial carcinoma, with primary refractory diseases included or excluded. This model has potential applications in precision medicine in patients with endometrial carcinoma.
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Affiliation(s)
- A Kolehmainen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Pasanen
- Department of Pathology, Helsinki University Hospital and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - R Koivisto-Korander
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - R Bützow
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Pathology, Helsinki University Hospital and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - M Loukovaara
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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3
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Amirthanayagam A, Boulter L, Millet N, McDermott HJ, Morrison J, Taylor A, Miles T, Coton L, Moss EL. Risk Stratified Follow-Up for Endometrial Cancer: The Clinicians' Perspective. Curr Oncol 2023; 30:2237-2248. [PMID: 36826134 PMCID: PMC9955652 DOI: 10.3390/curroncol30020173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/16/2023] Open
Abstract
Risk-stratified follow-up for endometrial cancer (EC) is being introduced in many cancer centres; however, there appears to be diversity in the structure and availability of schemes across the UK. This study aimed to investigate clinicians' and clinical specialist nurses' (CNS) experiences of follow-up schemes for EC, including patient-initiated follow-up (PIFU), telephone follow-up (TFU) and clinician-led hospital follow-up (HFU). A mixed-methods study was conducted, consisting of an online questionnaire to CNSs, an audience survey of participants attending a national "Personalising Endometrial Cancer Follow-up" educational meeting, and qualitative semi-structured telephone interviews with clinicians involved in the follow-up of EC. Thematic analysis identified three main themes to describe clinicians' views: appropriate patient selection; changing from HFU to PIFU schemes; and the future of EC follow-up schemes. Many participants reported that the COVID-19 pandemic impacted EC follow-up by accelerating the transition to PIFU/TFU. Overall, there was increasing support for non-HFU schemes for patients who have completed primary treatment of EC; however, barriers were identified for non-English-speaking patients and those who had communication challenges. Given the good long-term outcome associated with EC, greater focus is needed to develop resources to support patients post-treatment and individualise follow-up according to patients' personal needs and preferences.
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Affiliation(s)
| | - Louise Boulter
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Nessa Millet
- Leicester Cancer Research Centre, University of Leicester, Leicester LE1 7RH, UK
| | - Hilary J. McDermott
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Jo Morrison
- Somerset NHS Foundation Trust, Taunton TA1 5DA, UK
| | | | - Tracie Miles
- Royal United Hospital Bath NHS Foundation Trust, Bath BA1 3NG, UK
| | - Lorna Coton
- Royal United Hospital Bath NHS Foundation Trust, Bath BA1 3NG, UK
| | - Esther L. Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester LE1 7RH, UK
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
- Correspondence:
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4
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Mandato VD, Palicelli A, Torricelli F, Mastrofilippo V, Leone C, Dicarlo V, Tafuni A, Santandrea G, Annunziata G, Generali M, Pirillo D, Ciarlini G, Aguzzoli L. Should Endometrial Cancer Treatment Be Centralized? BIOLOGY 2022; 11:biology11050768. [PMID: 35625496 PMCID: PMC9138425 DOI: 10.3390/biology11050768] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 05/17/2023]
Abstract
Endometrial cancer (EC) is the most common malignancy of the female genital tract in Western and emerging countries. In 2012, new cancer cases numbered 319,605, and 76,160 cancer deaths were diagnosed worldwide. ECs are usually diagnosed after menopause; 70% of ECs are diagnosed at an early stage with a favorable prognosis and a 5-year overall survival rate of 77%. On the contrary, women with advanced or recurrent disease have extremely poor outcomes because they show a low response rate to conventional chemotherapy. EC is generally considered easy to treat, although it presents a 5-year mortality of 25%. Though the guidelines (GLs) recommend treatment in specialized centers by physicians specializing in gynecologic oncology, most women are managed by general gynecologists, resulting in differences and discrepancies in clinical management. In this paper we reviewed the literature with the aim of highlighting where the treatment of EC patients requires gynecologic oncologists, as suggested by the GLs. Moreover, we sought to identify the causes of the lack of GL adherence, suggesting useful changes to ensure adequate treatment for all EC patients.
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Affiliation(s)
- Vincenzo Dario Mandato
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
- Correspondence:
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.P.); (A.T.); (G.S.)
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Valentina Mastrofilippo
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Chiara Leone
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Vittoria Dicarlo
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Alessandro Tafuni
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.P.); (A.T.); (G.S.)
- Pathology Unit, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Giacomo Santandrea
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.P.); (A.T.); (G.S.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Gianluca Annunziata
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Matteo Generali
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Debora Pirillo
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Gino Ciarlini
- Unit of Surgical Gynecol Oncology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (G.C.); (L.A.)
| | - Lorenzo Aguzzoli
- Unit of Surgical Gynecol Oncology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (G.C.); (L.A.)
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Aimagambetova G, Terzic S, Laganà AS, Bapayeva G, la Fleur P, Terzic M. Contemporary Fertility-Sparing Management Options of Early Stage Endometrioid Endometrial Cancer in Young Nulliparous Patients. J Clin Med 2021; 11:196. [PMID: 35011935 PMCID: PMC8746136 DOI: 10.3390/jcm11010196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/16/2021] [Accepted: 12/25/2021] [Indexed: 12/15/2022] Open
Abstract
Incidence of endometrial cancer (EC) has been increasing in recent years, especially in high-income countries. The disease commonly affects peri- and postmenopausal women; however, about 5% of women are diagnosed with EC in their reproductive age. Due to both the increasing incidence of EC among reproductive age women and trends to delayed childbearing, fertility-sparing treatment for young patients with EC has become extremely important for researchers and practitioners. Because the classic treatment with total hysterectomy and bilateral saplingo-oophorectomy is not an appropriate approach for young women demanding fertility preservation, several fertility-sparing options have been developed and summarized in this review. Utilization of different medications and their combination (progestagens, gonadotropin releasing hormones analogues, and metformin in different formulations) are tested and found as efficient for fertility-sparing treatment. New minimally invasive surgical techniques, combined with progestagens, are also confirmed as valuable. There are many novel conservative and surgical treatment approaches under investigation. Assuming that molecular biomarkers can be both diagnostic and prognostic to assist in prediction of response to a certain therapy, prognostic risk groups' stratification along with specific biomarkers' identification will ensure low recurrence and decrease mortality rates in young women with EC.
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Affiliation(s)
- Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (S.T.); (P.l.F.); (M.T.)
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy;
| | - Gauri Bapayeva
- National Research Center of Mother and Child Health, Clinical Academic Department of Women’s Health, University Medical Center, Nur-Sultan 010000, Kazakhstan;
| | - Philip la Fleur
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (S.T.); (P.l.F.); (M.T.)
| | - Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (S.T.); (P.l.F.); (M.T.)
- National Research Center of Mother and Child Health, Clinical Academic Department of Women’s Health, University Medical Center, Nur-Sultan 010000, Kazakhstan;
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Taylor A, Sundar SS, Bowen R, Clayton R, Coleridge S, Fotopoulou C, Ghaem-Maghami S, Ledermann J, Manchanda R, Maxwell H, Michael A, Miles T, Nicum S, Nordin A, Ramsay B, Rundle S, Williams S, Wood NJ, Yiannakis D, Morrison J. British Gynaecological Cancer Society recommendations for women with gynecological cancer who received non-standard care during the COVID-19 pandemic. Int J Gynecol Cancer 2021; 32:9-14. [PMID: 34795019 DOI: 10.1136/ijgc-2021-002942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/04/2022] Open
Abstract
During the COVID-19 pandemic, pressures on clinical services required adaptation to how care was prioritised and delivered for women with gynecological cancer. This document discusses potential 'salvage' measures when treatment has deviated from the usual standard of care. The British Gynaecological Cancer Society convened a multidisciplinary working group to develop recommendations for the onward management and follow-up of women with gynecological cancer who have been impacted by a change in treatment during the pandemic. These recommendations are presented for each tumor type and for healthcare systems, and the impact on gynecological services are discussed. It will be important that patient concerns about the impact of COVID-19 on their cancer pathway are acknowledged and addressed for their ongoing care.
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Affiliation(s)
- Alexandra Taylor
- Department of Gynaecology Oncology, Royal Marsden Hospital NHS Trust, London, UK
| | - Sudha S Sundar
- Department of Gynaecological Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rebecca Bowen
- Department of Medical Oncology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Rick Clayton
- Department of Gynaecology Oncology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sarah Coleridge
- Department of Gynaecology, Nottingham University Hospitals NHS Trust, Nottingham, Nottingham, UK
| | - Christina Fotopoulou
- Department of Gynaecology Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Sadaf Ghaem-Maghami
- Department of Gynaecology Oncology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Ranjit Manchanda
- Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK
| | - Hilary Maxwell
- Department of Women's Health, Dorset County Hospital NHS Foundation Trust, Dorchester, Dorset, UK
| | - Agnieszka Michael
- Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - Tracie Miles
- Department of Gynaecology Oncology, Royal United Hospital Bath NHS Trust, Bath, UK
| | - Shibani Nicum
- Department of Medical Oncology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Andrew Nordin
- Department of Gynaecology Oncology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Bruce Ramsay
- Department of Gynaecology Oncology, North West Anglia NHS Foundation Trust, Peterborough, Cambridgeshire, UK
| | - Stuart Rundle
- Department of Gynaecology Oncology, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Sarah Williams
- Department of Gynaecological Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nicholas J Wood
- Department of Gynaecology Oncology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Dennis Yiannakis
- Department of Gynaecology Oncology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Jo Morrison
- Department of Gynaecology Oncology, Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK
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7
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Otter S, Stewart A. Cervical and Endometrial Cancer - A Tale of Two Halves? Clin Oncol (R Coll Radiol) 2021; 33:547-549. [PMID: 34332840 DOI: 10.1016/j.clon.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Affiliation(s)
- S Otter
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK.
| | - A Stewart
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
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