1
|
Bhatnagar AR, Ghanem AI, Alkamachi B, Allo G, Lin CH, Hijaz M, Elshaikh MA. The prognostic impact of substantial lymphovascular space invasion in women with node negative FIGO stage I uterine carcinoma. Gynecol Oncol 2024; 188:44-51. [PMID: 38936280 DOI: 10.1016/j.ygyno.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/10/2024] [Accepted: 06/16/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Substantial lymphovascular space invasion (LVSI) is an important predictor of lymph node (LN) involvement in women with endometrial carcinoma. We studied the prognostic significance of substantial LVSI in patients with 2009-FIGO stage-I uterine endometrioid adenocarcinoma (EC) who all had pathologic negative nodal evaluation (PNNE). METHODS Pathologic specimens were retrieved and LVSI was quantified (focal or substantial) in women with stage-I EC who had a hysterectomy and PNNE. In addition to multivariate analysis (MVA), recurrence-free (RFS), disease-specific (DSS), and overall (OS) survival was compared between women with focal vs. substantial LVSI. RESULTS 1052 patients were identified with a median follow-up of 9.7 years. 358 women (34%) received adjuvant radiotherapy. 907 patients (86.2%) had no LVSI, 87 (8.3%) had focal, and 58 (5.5%) had substantial LVSI. Five-year RFS was 93.3% (95% CI: 91.5-95.1), 76.8% (95% CI: 67.2-87.7) and 79.1% (95% CI: 67.6-95.3) for no, focal, and substantial LVSI(p < 0.0001). There was no statistically significant difference in 5-year RFS, DSS, OS, and in the patterns of initial recurrence between women with focal vs substantial LVSI. On MVA with propensity score matching, substantial LVSI was not independently associated with any survival endpoint compared to focal LVSI, albeit both were detrimental when compared to no LVSI. Age ≥ 60 years and higher grade were predictors of worse RFS, DSS, and OS. Additionally, comorbidity burden was an independent predictor for OS. CONCLUSIONS Our results suggest that substantial LVSI does not predict worse survival endpoints or different recurrence patterns in women with stage-I EC with PNNE when compared to focal LVSI.
Collapse
Affiliation(s)
- Aseem Rai Bhatnagar
- Department of Radiation Oncology, Henry Ford Health-Cancer, Detroit, MI 48202, USA
| | - Ahmed I Ghanem
- Department of Radiation Oncology, Henry Ford Health-Cancer, Detroit, MI 48202, USA; Clinical Oncology Department, University of Alexandria, Faculty of Medicine, Alexandria, Egypt
| | - Bassam Alkamachi
- Department of Pathology and Laboratory Medicine, Henry Ford Health, Detroit, MI 48202, USA
| | - Ghassan Allo
- Department of Pathology and Laboratory Medicine, Henry Ford Health, Detroit, MI 48202, USA
| | - Chun-Hui Lin
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI 48202, USA
| | - Miriana Hijaz
- Division of Gynecologic Oncology, Department of Women's Health Services, Henry Ford Health-Cancer, MI 48202, USA
| | - Mohamed A Elshaikh
- Department of Radiation Oncology, Henry Ford Health-Cancer, Detroit, MI 48202, USA.
| |
Collapse
|
2
|
Feng J, Zhang Y, Huang C, Li L, Liu J, Wang J, Guo H, Yao S, Cui Z, Chen G, Gao Q, Sun C, Ma D, Wang B, Li Y, Chu R, Kong B. Prognostic evaluation of lymph-vascular space invasion in patients with endometrioid and non-endometrioid endometrial cancer: A multicenter study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108261. [PMID: 38484494 DOI: 10.1016/j.ejso.2024.108261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/19/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION The prognostic value of lymph-vascular space invasion (LVSI) on endometrial cancer (EC) remains controversial. This study aimed to explore the impact of LVSI on patients with endometrioid and non-endometrioid EC in China. MATERIALS AND METHODS We analyzed EC patients who underwent surgery from 2010 to 2019 in seven Chinese hospitals retrospectively and stratified patients based on histopathologic types and LVSI status. Endpoints were disease-free survival (DFS) and overall survival (OS). Propensity score matching (PSM) algorithm was used to balance the confounding factors. The survival was examined using Kaplan-Meier analysis. Cox proportional hazards regression analyses were used to find prognostic independent risk factors. RESULTS Among 3715 EC patients, LVSI positive rate was 9.31% (346/3715). After matching, LVSI present group had shorter DFS (P = 0.005), and similar OS (P = 0.656) than LVSI absent group for endometrioid EC patients. For non-endometrioid EC patients, there was no statistical difference in either DFS (P = 0.536) or OS (P = 0.512) after matching. The multivariate Cox analysis showed that LVSI was an independent risk factor of DFS [hazard ratio (HR) 2.62, 95% confidence intervals (CI) 1.35-5.10, P = 0.005] and not OS (HR 1.24, 95%CI 0.49-3.13, P = 0.656) for endometrioid EC patients. It was not a prognostic factor of either DFS (HR 1.28, 95%CI 0.58-2.81, P = 0.539) or OS (HR 1.33, 95%CI 0.55-3.13, P = 0.515) for non-endometrioid EC patients. CONCLUSION LVSI is an adverse prognostic factor for endometrioid EC patients and has no impact on non-endometrioid EC patients. Necessity of postoperative adjuvant therapy based on LVSI needs to be carefully considered for non-endometrioid EC patients.
Collapse
Affiliation(s)
- Jie Feng
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China; Division of Gynecology Oncology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Yue Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China; Division of Gynecology Oncology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Changzhen Huang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China; Division of Gynecology Oncology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Li Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Jihong Liu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Jianliu Wang
- Peking University People's Hospital, Beijing, 100044, China
| | - Hongyan Guo
- The Third Hospital of Peking University, Beijing, 100191, China
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat- Sen University, Guangzhou, 510080, China
| | - Zhumei Cui
- Department of Gynecology and Obstetrics, The Affiliated Yantai Yuhuangding Hospital of Qindao University, Yantai, 264000, China
| | - Gang Chen
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430000, China
| | - Qinglei Gao
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430000, China
| | - Chaoyang Sun
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430000, China
| | - Ding Ma
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430000, China
| | - Beibei Wang
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430000, China.
| | - Yang Li
- Women's Hospital, School of Medicine, Zhejiang University, Zhejiang, 310006, China.
| | - Ran Chu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China; Division of Gynecology Oncology, Qilu Hospital of Shandong University, Jinan, 250012, China.
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China; Division of Gynecology Oncology, Qilu Hospital of Shandong University, Jinan, 250012, China.
| |
Collapse
|
3
|
Qin ZJ, Wang YS, Chen YL, Zheng A, Han L. Evaluation of prognostic significance of lymphovascular space invasion in early stage endometrial cancer: a systematic review and meta-analysis. Front Oncol 2024; 13:1286221. [PMID: 38273843 PMCID: PMC10808564 DOI: 10.3389/fonc.2023.1286221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Background Studies evaluating the prognostic significance of lymphovascular space invasion (LVSI) in early stage endometrial cancer (EC) are conflicting. Objectives To evaluate whether LVSI identified in stage I EC is associated with worse survival. Search strategy A comprehensive literature search of three databases (Embase, PubMed, and Cochrane) was performed up to April 30th 2023. Selection criteria Cohort studies that have evaluated the relationship between LVSI and prognosis in patients with stage I EC were included. Data collection and analysis Two authors independently assessed the studies for inclusion, extracted the data of recurrence and survival, and conducted meta-analysis using random effects model. Heterogeneity was evaluated by I2 test. Main results A total of 15 studies involving 6,705 patients were included in the meta-analysis. The overall pooled rate of LVSI was 14% [95% confidence interval (CI) CI 0.09-0.18] in stage I EC. LVSI was significantly associated with a higher risk of recurrence [odds ratio (OR) = 2.79, 95%CI 2.07-3.77], reduced overall survival (OS) [hazard ratio (HR)=5.19, 95%CI 3.33-8.07] and recurrence free survival (RFS) [HR = 5.26, 95%CI 3.45-8.02] in stage I EC patients. Similarly, LVSI was associated with an increased risk of recurrence [OR= 3.10, 95%CI 2.13-4.51], decreased OS [HR=5.52, 95%CI 2.16-14.09] and RFS [HR = 4.81, 95%CI 2.34-9.91] in stage IA grade 1 or 2 endometrioid carcinoma patients. Conclusion The presence of LVSI in stage I EC and in stage IA, grade 1 or 2 endometrioid carcinoma is associated with an increased risk of recurrence, lower OS and RFS. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier 42023425231.
Collapse
Affiliation(s)
- Zhao-juan Qin
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Yi-si Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Ya-li Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Ai Zheng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Ling Han
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| |
Collapse
|
4
|
Meng X, Yang D, Deng Y, Xu H, Jin H, Yang Z. Diagnostic accuracy of MRI for assessing lymphovascular space invasion in endometrial carcinoma: a meta-analysis. Acta Radiol 2024; 65:133-144. [PMID: 37101417 DOI: 10.1177/02841851231165671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND The lymphovascular space invasion (LVSI) status of endometrial cancer (EC) has guiding significance in lymph node dissection. However, LVSI can only be obtained after surgery. Researchers have tried to extract the information of LVSI using magnetic resonance imaging (MRI). PURPOSE To evaluate the ability of preoperative MRI to predict the LVSI status of EC. MATERIAL AND METHODS A search was conducted by using the PubMed/MEDLINE, EMBASE, Web of Science, and the Cochrane Library databases. Articles were included according to the criteria. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2. A bivariate random effects model was used to obtain pooled summary estimates, heterogeneity, and the area under the summary receiver operating characteristic curve (AUC). A subgroup analysis was performed to identify sources of heterogeneity. RESULTS A total of nine articles (814 patients) were included. The risk of bias was low or unclear for most studies, and the applicability concerns were low or unclear for all studies. The summary AUC values as well as pooled sensitivity and specificity of LVSI status in EC were 0.82, 73%, and 77%, respectively. According to the subgroup analysis, radiomics/non-radiomics features, country/region, sample size, age, MR manufacturer, magnetic field, scores of risk bias, and scores of applicability concern may have caused heterogeneity. CONCLUSION Our meta-analysis showed that MRI has moderate diagnostic efficacy for LVSI status in EC. Large-sample, uniformly designed studies are needed to verify the true value of MRI in assessing LVSI.
Collapse
Affiliation(s)
- Xuxu Meng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Dawei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Yuhui Deng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
- Medical Imaging Division, Heilongjiang Provincial Hospital, Harbin Institute of Technology, Harbin, PR China
| | - Hui Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - He Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| |
Collapse
|
5
|
Yoneoka Y, Amano T, Tsuji S, Uno M, Ishikawa M, Kato T, Murakami T. The efficacy of adjuvant chemotherapy on the survival of early stage endometrial cancer. Eur J Obstet Gynecol Reprod Biol 2023; 287:155-160. [PMID: 37343413 DOI: 10.1016/j.ejogrb.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/28/2023] [Accepted: 06/03/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE No consensus exists on the adjuvant chemotherapy for the International Federation of Gynecology and Obstetrics (FIGO) Stage I-II endometrial cancer with risk factors for recurrence. This study evaluated adjuvant chemotherapy's efficacy in improving these patients' survival. STUDY DESIGN We conducted a retrospective chart review of patients with FIGO Stage I-II endometrial cancer with recurrence risk factors. The patients received no adjuvant therapy at the National Cancer Center Hospital (NCCH) but received platinum-based chemotherapy at Shiga University of Medical Science (SUMS). RESULTS Six hundred thirty-eight patients with endometrial cancer were identified. Of these, 118 met the inclusion criteria, 321 were excluded from NCCH, while 49 met the inclusion criteria, and 150 were excluded from SUMS. Multivariate analyses of age, surgery, para-aortic lymphadenectomy, omentectomy, histological type, myometrial invasion, cervical stromal invasion, and adjuvant therapy revealed that in patients aged > 60 years with type II histology, the outer half of myometrial invasion, cervical stromal invasion, and positive peritoneal cytology had significantly worse recurrence-free survival (RFS) rates, and patients aged > 60 years with type II histology, outer half of myometrial invasion, and positive peritoneal cytology had significantly worse overall survival (OS) rates. Patients that received adjuvant chemotherapy showed equivalent effects on RFS (hazard ratio [HR] = 2.13; 95% confidence interval [CI] = 0.82-5.53) and worse on OS ([HR = 5.20; 95 %CI = 1.26-21.50) than patients who did not. CONCLUSION This study did not show that adjuvant chemotherapy for FIGO Stages I-II endometrial cancer with recurrence risk factors has survival benefit. Further large-scale studies are necessary to validate our findings.
Collapse
Affiliation(s)
- Yutaka Yoneoka
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan.
| | - Tsukuru Amano
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Masaya Uno
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| |
Collapse
|
6
|
Espenel S, Pointreau Y, Genestie C, Durdux C, Haie-Meder C, Chargari C. [Molecular-integrated risk profile: An opportunity for therapeutic de-escalation in intermediate and high-intermediate risk endometrial cancer]. Cancer Radiother 2022; 26:931-937. [PMID: 36031498 DOI: 10.1016/j.canrad.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 10/15/2022]
Abstract
In Europe, endometrial cancer is the fourth most common cancer among women. The majority of patients are diagnosed at a localized stage. For these patients, the standard of care is based on an hysterectomy with salpingo oophorectomy±lymph node staging. Through the assessment of histopathologic features, risk groups are determined: low, intermediate, high-intermediate, and high risk. Adjuvant strategies are guided by these risk groups. While the prognosis of low-risk and high-risk is well known, that of intermediate and high-intermediate risk is more heterogeneous, and the therapeutic index of adjuvant treatments is more questionable. Several trials (PORTEC [Post Operative Radiation Therapy in Endometrial Carcinoma] I, GOG [Gynecologic Oncology Group] 99, ASTEC [A Study in the Treatment of Endometrial Cancer] EN.5, PORTEC II, Sorbe et al trial) have assessed observation, vaginal cuff brachytherapy and/or pelvic external beam radiotherapy in this population. Vaginal cuff brachytherapy reduces the local recurrence rate, and pelvic external beam radiotherapy the pelvic recurrence rate. However, no benefit in terms of overall survival or occurrence of distant metastases is highlighted. Compared to observation, brachytherapy and above all external beam radiotherapy are associated with an increased morbidity, and with a decreased quality of life. In order to improve the therapeutic ratio and to optimize medico-economic decisions, therapeutic de-escalation strategies, based on the molecular profiles, are emerging in clinical trials, and in the recommendations for the management of intermediate and high-intermediate risk endometrial cancers. The four main molecular profiles highlighted by the genomic analyzes of The Cancer Genome Atlas (TCGA) - POLE (polymerase epsilon) mutation, non-specific molecular profile, MMR (MisMatch repair) deficiency, and p53 mutation - but also the quantification of lymphovascular space invasion (absent, focal or substantial), and the assessment of L1CAM (L1 cell adhesion molecule) overexpression represent growing concerns. Thus, the use of molecular-integrated risk profile to determine the best adjuvant treatment represent a major way to personalize adjuvant treatment of endometrial cancers, with therapeutic de-escalation opportunity for around half of the high-intermediate risks. However, in the absence of prospective data, inclusion in clinical trials assessing molecular profile-based treatment remains the best therapeutic opportunity.
Collapse
Affiliation(s)
- S Espenel
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
| | - Y Pointreau
- Département de radiothérapie, ILC-Institut interrégionaL de cancérologie, centre Jean-Bernard, 72000 Le Mans, France; Département de radiothérapie, centre régional universitaire de cancérologie Henry-S.-Kaplan, 37044 Tours, France
| | - C Genestie
- Département d'anatomopathologie, Gustave-Roussy, 94805 Villejuif, France
| | - C Durdux
- Département de radiothérapie, hôpital européen Georges-Pompidou, 75015 Paris, France
| | - C Haie-Meder
- Département d'oncologie radiothérapie, Centre de cancérologie, 92250 La Garenne-Colombes, France
| | - C Chargari
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Institut de recherche biomédicale des armées, 91220 Brétigny-sur-Orge, France
| |
Collapse
|
7
|
Nasioudis D, Oh J, Ko EM, Haggerty AF, Cory L, Giuntoli Ii RL, Kim SH, Morgan MA, Latif NA. Adjuvant chemotherapy for stage I high-intermediate risk endometrial carcinoma with lymph-vascular invasion. Int J Gynecol Cancer 2022; 32:ijgc-2022-003496. [PMID: 35649658 DOI: 10.1136/ijgc-2022-003496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The goal of this study was to evaluate if addition of adjuvant chemotherapy to radiation therapy improves overall survival in patients with high-intermediate risk stage I endometrial carcinoma with lymphovascular invasion. METHODS Patients diagnosed between January 2010 and December 2015 with FIGO (International Federation of Gynecology and Obstetrics) stage I endometrioid endometrial carcinoma with lymphovascular invasion who underwent hysterectomy with lymphadenectomy and met the GOG-99 criteria for high-intermediate risk were identified in the National Cancer Database. Patients who received adjuvant radiotherapy with or without adjuvant chemotherapy (administered within 6 months of surgery) and had at least 1 month of follow-up were selected for further analysis. Overall survival was compared with the log-rank test following stratification by type of radiation treatment. A Cox model was constructed to control for a priori selected confounders. RESULTS A total of 2881 patients who met the inclusion criteria were identified; 2417 (83.9%) patients received radiation therapy alone while 464 (16.1%) received chemoradiation. Rate of adjuvant chemotherapy administration was comparable between patients who received vaginal brachytherapy alone (16.2%), and external beam radiation therapy (with or without vaginal brachytherapy) (15.8%), p=0.78. Rate of chemoradiation was higher for patients with grade 3 (28.8%) tumors compared with those with grade 2 (9.9%) and grade 1 (8.3%) tumors, p<0.001. After controlling for confounders for patients receiving external beam radiation, addition of chemotherapy was not associated with improved overall survival (HR 0.90, 95% CI 0.56 to 1.46). For patients receiving vaginal brachytherapy addition of chemotherapy was associated with better overall survival (HR 0.644, 95% CI 0.45 to 0.92). Benefit was limited to patients with grade 3 tumors, p=0.026; 4-year overall survival rate was 81.1% versus 74.9%. CONCLUSIONS In patients with high-intermediate risk FIGO stage I endometrioid endometrial carcinoma and lymphovascular invasion, addition of chemotherapy to radiation therapy was associated with a survival benefit for patients with grade 3 tumors receiving vaginal brachytherapy.
Collapse
Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jinhee Oh
- Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashley F Haggerty
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lori Cory
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert L Giuntoli Ii
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah H Kim
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark A Morgan
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nawar A Latif
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
8
|
Ma X, Ren X, Shen M, Ma F, Chen X, Zhang G, Qiang J. Volumetric ADC histogram analysis for preoperative evaluation of LVSI status in stage I endometrioid adenocarcinoma. Eur Radiol 2021; 32:460-469. [PMID: 34137929 DOI: 10.1007/s00330-021-07996-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/17/2021] [Accepted: 04/12/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To investigate the value of volumetric ADC histogram metrics for evaluating lymphovascular space invasion (LVSI) status in stage I endometrioid adenocarcinoma (EAC). METHODS Preoperative MRI of 227 patients with stage I EAC were retrospectively analyzed. ADC histogram data were derived from the whole tumor with ROIs drawn on all slices of DWI scans (b = 0, 1000 s/mm2). The Student t-test was performed to compare ADC histogram metrics (minADC, maxADC, and meanADC; 10th, 25th, 50th, 75th, and 90th percentiles of ADC; skewness; and kurtosis) between the LVSI-positive and LVSI-negative groups, as well as between stage Ia and Ib EACs. ROC curve analysis was carried out to evaluate the diagnostic performance of ADC histogram metrics in predicting LVSI status in EAC. RESULTS The minADC and meanADC and 10th, 25th, 50th, 75th, and 90th percentiles of ADC were significantly lower in LVSI-positive EACs compared with those in the LVSI-negative groups for stage I, Ia, and Ib EACs (all p < 0.05). MeanADC ≤ 0.857 × 10-3 mm2/s, meanADC ≤ 0.854 × 10-3 mm2/s, and the 90th percentile of ADC ≤ 1.06 × 10-3 mm2/s yielded the largest AUC of 0.844, 0.844, and 0.849 for evaluating LVSI positivity in stage I, Ia, and Ib tumors, respectively, with sensitivity of 75.4%, 75.0%, and 76.2%; specificity of 80.0%, 83.1%, and 82.1%; and accuracy of 79.3%, 81.5%, and 79.6%, respectively. CONCLUSION Volumetric ADC histogram metrics might be helpful for the preoperative evaluation of LVSI status and personalized clinical management in patients with stage I EAC. KEY POINTS • Volumetric ADC histogram analysis helps evaluate LVSI status preoperatively. • LVSI-positive EAC is associated with a reduction in multiple volumetric ADC histogram metrics. • MeanADC and the 90th percentile of ADC were shown to be best in evaluating LVSI- positivity in stage Ia and Ib EACs, respectively.
Collapse
Affiliation(s)
- Xiaoliang Ma
- Department of Radiology, Jinshan Hospital, Fudan University, Longhang Road, Shanghai, People's Republic of China
| | - Xiaojun Ren
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road, Shanghai, People's Republic of China
| | - Minhua Shen
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road, Shanghai, People's Republic of China
| | - Fenghua Ma
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road, Shanghai, People's Republic of China
| | - Xiaojun Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road, Shanghai, People's Republic of China
| | - Guofu Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road, Shanghai, People's Republic of China.
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Longhang Road, Shanghai, People's Republic of China.
| |
Collapse
|
9
|
Matanes E, Eisenberg N, Lau S, Salvador S, Ferenczy A, Pelmus M, Gotlieb WH, Kogan L. Absence of prognostic value of lymphovascular space invasion in patients with endometrial cancer and negative sentinel lymph nodes. Gynecol Oncol 2021; 162:256-261. [PMID: 34119364 DOI: 10.1016/j.ygyno.2021.05.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate if the prognostic value of lymphovascular space invasion (LVSI) is different in endometrial cancer patients with negative lymph nodes following sentinel lymph node (SLN) mapping or lymph node dissection (LND) as staging procedure. MATERIAL AND METHODS A retrospective study of 510 patients diagnosed with endometrial carcinoma in our institution between 2007 and 2014. We excluded patients that were diagnosed with positive nodes (Stage IIIc). We compared patients' characteristics and survival outcomes as function of their LVSI status (positive LVSI vs negative LVSI subgroups) in each cohort separately. RESULTS 413 patients met the inclusion criteria, out of whom 239 underwent SLN and 174 patients underwent LND only. In the SLN group, life table analysis showed 5-year OS and PFS of 80% and 72% in patients with LVSI compared to 96%, and 93% without LVSI. Same trend was observed among patients with LND with 5-year OS and PFS of 74% and 64% in patients with LVSI compared to 97%, and 90% without LVSI. On multivariable analysis, adjusted for age, FIGO stage, grade and maximal tumor size, the favorable survival of negative LVSI remained only in the LND cohort (SLN cohort: HR 1.2, CI [0.3-4.0], P = 0.8 and HR 1.7, CI [0.7-4.3], p = 0.2 for OS and PFS, respectively; LND cohort: HR 3.1, CI [1.4-6.5], p < 0.001 and HR 2.5, CI [1.2-4.9], p = 0.01 for OS and PFS, respectively). CONCLUSIONS The prognostic value of LVSI disappears when patients undergo staging with SLN and are found to have negative nodes in contrast to those who have undergone LND. Future studies should confirm our observation on patients with negative sentinel nodes, and plan on tailoring adjuvant treatment to this specific subgroup.
Collapse
Affiliation(s)
- Emad Matanes
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Neta Eisenberg
- Department of Obstetrics and Gynecology, Yitzhak Shamir Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Susie Lau
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Alex Ferenczy
- Department of Pathology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Manuela Pelmus
- Department of Pathology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada.
| | - Liron Kogan
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, Hadassah Medical Center, Affiliated with the Hebrew University Hadassah Medical School, Jerusalem, Israel
| |
Collapse
|
10
|
Alexa M, Hasenburg A, Battista MJ. The TCGA Molecular Classification of Endometrial Cancer and Its Possible Impact on Adjuvant Treatment Decisions. Cancers (Basel) 2021; 13:cancers13061478. [PMID: 33806979 PMCID: PMC8005218 DOI: 10.3390/cancers13061478] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/02/2021] [Accepted: 03/15/2021] [Indexed: 12/09/2022] Open
Abstract
Simple Summary The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) is a recently developed tool to identify four distinct molecular subgroups of endometrial cancer. Patients identified as Polymerase Epsilon exonuclease domain mutated (POLE EDM) or p53-mutated have significantly altered prognosis compared to patients allocated to the mismatch repair deficient (MMRd) or p53 wt groups. The aim of this review is to give a broad overview over the initial development and refinement of the classifier as well as possible effects on the recommended adjuvant treatment. We have summarized the clinical data of 8 studies including 3650 endometrial cancer patients and analyzed the distribution of tumor stage and adjuvant treatment received in respect to the molecular subgroups. Based on the findings of the summarized studies treatment de-escalation might be feasible for POLE EDM patients while p53 abn patients should receive adjuvant (chemo-)radiotherapy. Abstract Adjuvant treatment decisions for endometrial cancer (EC) are based on stage, the histological grade of differentiation, histological subtype, and few histopathological markers. The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) identified four risk groups of EC patients using a combination of immunohistochemistry and mutation analysis: Polymerase Epsilon exonuclease domain mutated (POLE EDM), mismatch repair deficient (MMRd), p53 wild-type/copy-number-low (p53 wt), and p53-mutated/copy-number-high (p53 abn). Patients allocated to the POLE or abnormal p53 expression subtype are faced with a significantly altered outcome possibly requiring a modified adjuvant treatment decision. Within this review, we summarize the development of ProMisE, characterize the four molecular subtypes, and finally discuss its value in terms of a patient-tailored therapy in order to prevent significant under or overtreatment.
Collapse
|
11
|
Nwachukwu C, Baskovic M, Von Eyben R, Fujimoto D, Giaretta S, English D, Kidd E. Recurrence risk factors in stage IA grade 1 endometrial cancer. J Gynecol Oncol 2021; 32:e22. [PMID: 33470064 PMCID: PMC7930446 DOI: 10.3802/jgo.2021.32.e22] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/03/2020] [Accepted: 11/29/2020] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Patients with early-stage endometrial cancers (EC) with disease recurrences have worse survival outcomes. The purpose of this study was to identify clinical and pathologic factors that predict for all recurrences in stage IA grade 1 (IAG1) EC. METHODS Records from patients diagnosed with EC were retrospectively reviewed. Baseline characteristics of 222 patients with IAG1 EC who underwent surgical resection were analyzed. Cox proportional hazard analysis was used to identify univariate and multivariate risk factors that predict for recurrence. RESULTS Seventeen (7.65%) patients had recurrences. The 3-year cumulative incidence of recurrence were significantly higher for patients with time from biopsy to surgery ≥6 months (54% vs. 8%, p=0.003), simple hysterectomy with ovarian preservation vs. total hysterectomy and bilateral salpingo-oophorectomy (31% vs. 9%, p=0.032), any myometrial invasion vs. no invasion (18% vs. 2%, p=0.004), and tumor size ≥2 cm (15% vs. 2%, p=0.021). On, multivariate analysis, any myometrial invasion, increasing time from biopsy to surgery, and larger tumor size were independent predictors of any recurrence. Patients with recurrences had worse outcomes than those without (5-year overall survival [OS]=60%; 95% confidence interval [CI]=16%-86% vs. 5-year OS=95%; 95% CI=87%-99%, respectively, p=0.003). CONCLUSION Time from biopsy to surgery, larger tumors, and myometrial invasion are the most important predictors of recurrence. Though the recurrence rates are generally low in IAG1 EC, the survival rate for the patients with recurrences was worse than those without. Identification of additional recurrence risk factors can help select patients who may benefit from adjuvant treatment.
Collapse
Affiliation(s)
- Chika Nwachukwu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Mana Baskovic
- Division of Gynecologic Oncology, Department of Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Rie Von Eyben
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Dylann Fujimoto
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Stephanie Giaretta
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Diana English
- Division of Gynecologic Oncology, Department of Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Elizabeth Kidd
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA.
| |
Collapse
|
12
|
Rychlik A, Zapardiel I, Baquedano L, Martínez Maestre MÁ, Querleu D, Coronado Martín PJ. Clinical relevance of high-intermediate risk endometrial cancer according to European risk classification. Int J Gynecol Cancer 2020; 30:1528-1534. [PMID: 32817200 DOI: 10.1136/ijgc-2020-001693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Risk models in endometrial cancer define prognosis and indicate adjuvant therapy. One of the currently used classifications was designed in 2016 in collaboration with the European Society of Medical Oncology (ESMO), the European Society of Gynecologic Oncology (ESGO), and the European Society of Radiotherapy (ESTRO). A high-intermediate risk group was introduced within the intermediate risk group. The purpose of this study was to evaluate the clinical relevance of this subclassification. METHODS A multicenter retrospective study was carried out at five international tertiary institutions. Patients diagnosed with intermediate risk endometrial cancer on the basis of definitive pathology findings were included. Patients were stratified into intermediate and high-intermediate risk groups. Incidence of nodal metastases, and disease free and overall survival were compared between the two risk groups in univariate and multivariate analysis. RESULTS 477 patients were included: 325 (68%) patients were identified as intermediate and 152 (32%) as high-intermediate endometrial cancer patients. Nodal metastases were found in 18 patients (11.8%) in the high-intermediate risk endometrial cancer group and 16 patients (4.9%) in the intermediate risk group. Lymphovascular space invasion was found to be a strong predictive factor of lymph node involvement. High-intermediate risk was found to be an independent factor of disease free survival (hazard ratio (HR) 1.76; 95% confidence interval (CI) 1.00 to 3.08; p=0.050) and overall survival (HR 1.99; 95% CI 1.10 to 3.60; p=0.022) in the multivariate analysis. CONCLUSIONS The study validates the clinical significance of the intermediate risk endometrial cancer subclassification. Prognosis for high-intermediate risk endometrial cancer was significantly poorer. The prevalence of lymph node metastases was higher in this group of patients.
Collapse
Affiliation(s)
- Agnieszka Rychlik
- Gynecologic Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Laura Baquedano
- Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | |
Collapse
|
13
|
Is the risk of substantial LVSI in stage I endometrial cancer similar to PORTEC in the North American population? - A single-institution study. Gynecol Oncol 2020; 159:23-29. [PMID: 32718729 DOI: 10.1016/j.ygyno.2020.07.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/14/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES A pooled analysis of PORTEC-1 & 2 identified substantial lymphovascular space invasion (LVSI) in 4.8% of patients, which predicted for pelvic recurrence, distant metastasis, and overall survival. Our institution implemented the PORTEC three-tier system of LVSI reporting (absent, focal, or substantial). We aimed to quantify the incidence of substantial LVSI in a North American population and to correlate extent of LVSI with lymph node (LN) involvement. METHODS A retrospective review was conducted on patients with clinically uterine-confined, endometrioid type endometrial cancer who underwent surgical staging and were found to have pT1a-b disease. Binary logistic regression was used to assess predictors of LN involvement (defined as ITC, micrometastases, or macrometastases). RESULTS In total, 438 patients with pT1a-b disease were identified. In the overall cohort and in the subset meeting PORTEC-1 inclusion criteria (n = 195), no LVSI was present in 67.4% and 50.8%; focal LVSI was present in 16.7% and 24.1%; and substantial LVSI was present in 16.0% and 25.1%, respectively. Among patients who underwent surgical LN assessment (79.2%, n = 347), LNs were involved in 3.3% without LVSI, 7.5% with focal LVSI (OR 2.4), and 15.2% with substantial LVSI (OR 5.3) (p = .005), with a similar trend in the PORTEC-1 cohort. Extent of LVSI correlated with disease burden in LN metastases. CONCLUSION Our incidence of substantial LVSI was three to five times higher than reported by PORTEC and correlated with LN involvement. This questions the reproducibility of the three-tier LVSI reporting system and emphasizes the need for multi-institutional data outside PORTEC for confirmation of our findings.
Collapse
|
14
|
Factors predicting recurrence in patients with stage IA endometrioid endometrial cancer: what is the importance of LVSI? Arch Gynecol Obstet 2019; 301:737-744. [PMID: 31883046 DOI: 10.1007/s00404-019-05418-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study is to define the clinical and pathological prognostic factors for recurrence and to evaluate the recurrence patterns and adjuvant therapies used in this group of patients with stage IA endometrioid type endometrial cancer (FIGO 2009-International Federation of Gynecology and Obstetrics). METHODS Among the patients with epithelial endometrial cancer operated between January 1993 and May 2013 in a single institution, 720 patients with stage IA endometrioid endometrial cancer were included. Patients with a tumor type of serous, clear cell, mucinous, undifferentiated, and mixed type and with a tumor containing sarcomatous component and the patients with a secondary primer cancer were excluded from the study. RESULTS Lympho-vascular space invasion (LVSI) was present in 60 (8.3%) patients. Pelvic and para-aortic lymphadenectomy was performed in 266 (36.9%) patients. Median follow-up time was 48 months (range 3-240). Recurrence occurred in 23 (3.4%) patients and 6 (0.9%) died of disease. The median time-to recurrence (TTR) was 24 months (range 4-52 months) in the patients with recurrence. LVSI was associated with recurrence in the univariate analysis. Five-year disease-free survival (DFS) decreased from 96.8 to 80.1% in the presence of LVSI (p < 0.001). This association could not be shown in patients who had had lymphadenectomy (p = 0.136). Extra-pelvic recurrence occurred in 6.7% and 1% of the patients with and without LVSI, respectively, (p = 0.001). Any independent prognostic factor could not be detected in the multivariate analysis. CONCLUSIONS Only LVSI and tumor grade were associated with DFS and disease-specific survival (DSS), respectively, in the 686 patients with stage IA endometrial cancer in the univariate analysis, since these associations could not be shown in multivariate analysis.
Collapse
|
15
|
Zhang Q, Yu X, Lin M, Xie L, Zhang M, Ouyang H, Zhao X. Multi-b-value diffusion weighted imaging for preoperative evaluation of risk stratification in early-stage endometrial cancer. Eur J Radiol 2019; 119:108637. [DOI: 10.1016/j.ejrad.2019.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/09/2019] [Accepted: 08/09/2019] [Indexed: 01/14/2023]
|
16
|
Reboux PA, Azaïs H, Canova CH, Bendifallah S, Ouldamer L, Raimond E, Hudry D, Coutant C, Graesslin O, Touboul C, Collinet P, Bricou A, Huchon C, Daraï E, Ballester M, Lévêque J, Lavoué V, Koskas M, Uzan C, Canlorbe G. Impact of vaginal brachytherapy in intermediate and high-intermediate risk endometrial cancer: a multicenter study from the FRANCOGYN group. J Gynecol Oncol 2019; 30:e53. [PMID: 31074238 PMCID: PMC6543117 DOI: 10.3802/jgo.2019.30.e53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/26/2018] [Accepted: 01/09/2019] [Indexed: 11/30/2022] Open
Abstract
Objective According to recent European Society of Medical Oncology, European Society of Gynaecological Oncology and European Society of Radiotherapy and Oncology guidelines, adjuvant vaginal brachytherapy (VB) is optional in patients with intermediate risk (IR) and high-intermediate risk (HIR) endometrial cancer (EC). The aim of this French retrospective, multicenter study was to assess the impact of VB in these groups on local recurrence rate, local recurrence-free survival (RFS) and overall survival (OS). Methods Data of 191 patients with IR and HIR EC who underwent primary surgery with or without VB and no other adjuvant treatment between 2000 and 2016 were extracted from the FRANCOGYN database. Rate of local recurrence, OS and local RFS in these two groups were compared using the Kaplan-Meier method. Results The number of patients with IR and HIR EC were 118 and 73 respectively. VB was used in 92 patients in IR group and 43 in HIR group. Median follow-up was 22 months. In the HIR group, the local recurrence rate was significantly higher in the no adjuvant therapy group in comparison with the VB group (16.7% and 0% respectively, p=0.02). There was also a significant improvement in local RFS (p=0.01) in VB group. In IR EC, there is no significant difference on local recurrence rate (4.2% and 3.2%, respectively, p=1.00) or local RFS (p=0.54) between the two groups. Conclusions VB is an efficient adjuvant treatment for patients with HIR EC. VB is not associated with an improvement of RFS or OS in IR EC patient.
Collapse
Affiliation(s)
- Pierre Alain Reboux
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Henri Azaïs
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Charles Henry Canova
- Department of Radiation Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics", Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France
| | - Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France; INSERM U1069, Université François-Rabelas, Tours, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Delphine Hudry
- Center de Lutte Contre le Cancer Georges François Leclerc, Dijon, France
| | - Charles Coutant
- Center de Lutte Contre le Cancer Georges François Leclerc, Dijon, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Pierre Collinet
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire, Lille, France
| | - Alexandre Bricou
- Department of Gynaecology and Obstetrics, Jean Verdier University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris 13, Bondy, France
| | - Cyrille Huchon
- Department of Gynaecology and Obstetrics, Centre Hospitalier Intercommunal, Poissy, France
| | - Emile Daraï
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Marcos Ballester
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - Jean Lévêque
- CHU de Rennes, Service de Gynécologie, Hopital Sud, Université de Rennes 1, Rennes, France
| | - Vincent Lavoué
- CHU de Rennes, Service de Gynécologie, Hopital Sud, Université de Rennes 1, Rennes, France.,INSERM 1242, Oncogenesis, Stress and Signaling, CRLC Eugène Marquis, Rennes, France
| | - Martin Koskas
- Division of Gynecologic Oncology, Bichat University Hospital, Paris, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics", Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Institut Universitaire de Cancérologie (IUC), Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics", Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France.
| |
Collapse
|
17
|
Intrauterine Manipulator Use During Minimally Invasive Hysterectomy and Risk of Lymphovascular Space Invasion in Endometrial Cancer. Int J Gynecol Cancer 2019; 28:208-219. [PMID: 29324541 DOI: 10.1097/igc.0000000000001181] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to examine an association between intrauterine manipulator (IUM) use and frequency of lymphovascular space invasion (LVSI) in women with endometrial cancer undergoing minimally invasive hysterectomy. METHODS A retrospective case-control study was conducted among stage I-IV endometrial cancer patients who underwent hysterectomy between 2008 and 2015. Medical records were reviewed for patient demographics, surgical details, and tumor characteristics. Women who underwent total laparoscopic hysterectomy (TLH) with IUM use were compared with women who underwent total abdominal hysterectomy (TAH). Review of archived medical record for data collection and propensity score matching were performed to adjust for background differences between TLH-IUM and TAH groups. A systematic literature review with pooled analysis was performed to examine frequency of LVSI. RESULTS There were 687 women who underwent hysterectomy for endometrial cancer. Of those, 419 women underwent TLH with IUM use and 194 women underwent TAH. The most common type of IUM was VCare (89.5%). There was no statistically significant difference in the frequency of LVSI between the 2 groups: 15.1% for TLH-IUM vs 19.9% for TAH (P = 0.14). After propensity score matching, frequencies of LVSI were similar between the 2 groups: 21.2% for TLH-IUM vs 19.6% for TAH (P = 0.78). Systematic literature review identified 1371 cases of TLH-IUM and 1246 cases of TAH performed for endometrial cancer, and frequencies of LVSI were similar between the 2 groups (15.0% vs 13.6%, P = 0.31). CONCLUSION Our study suggests that IUM use during TLH for endometrial cancer is not associated with increased frequency of LVSI.
Collapse
|
18
|
Takahashi K, Yunokawa M, Sasada S, Takehara Y, Miyasaka N, Kato T, Tamura K. A novel prediction score for predicting the baseline risk of recurrence of stage I-II endometrial carcinoma. J Gynecol Oncol 2018; 30:e8. [PMID: 30479092 PMCID: PMC6304400 DOI: 10.3802/jgo.2019.30.e8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/15/2018] [Accepted: 09/17/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To develop and validate a 3-year recurrence prediction score (RPS) system for predicting the baseline risk of recurrence of stage I-II endometrial carcinoma. METHODS We reviewed 427 patients with International Federation of Gynecology and Obstetrics staging I-II endometrial carcinoma underwent surgery without any adjuvant therapy from 2005 to 2013. The patients were divided into 2 groups: the test cohort (n=251) comprising those who underwent surgery in odd-numbered years, and the validation cohort (n=176) comprising those who underwent surgery in even-numbered years. Multivariate analysis was performed using 7 candidate predictors to identify the risk factors for 3-year recurrence-free interval (RFI) in the test cohort. Each risk factor was scored based on logistic regression analyses of the test data set, and the sum of the risk factor scores was defined as the RPS system. We then applied the system in the validation cohort. RESULTS Multivariate analysis revealed that the significant risk factors were age ≥60 years, pathological type II, positive cervical stromal invasion, and positive peritoneal cytology. In the test cohort, the 3-year RFI rates were 100%, 95.8%, 79.9%, and 33.3% for RPSs of 0, 1, 2, and 3, respectively. In the validation cohort, the 3-year RFI was significantly higher in the low-RPS group (RPS 0 or 1) than in the high-RPS group (RPS 2 or 3) (95.2% vs. 79.9%, p<0.01). CONCLUSIONS The RPS system shows significant reproducibility for predicting the baseline risk of recurrence. The system could potentially impact the choice of adjuvant therapy for stage I-II endometrial carcinoma.
Collapse
Affiliation(s)
- Kenta Takahashi
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Mayu Yunokawa
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation of Cancer Research, Tokyo, Japan.
| | - Shinsuke Sasada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yae Takehara
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoyuki Miyasaka
- Department of Perinatal and Woman's Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Kenji Tamura
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
19
|
Influence of Prognostic Factors on Lymph Node Involvement in Endometrial Cancer. Int J Gynecol Cancer 2018; 28:1145-1152. [DOI: 10.1097/igc.0000000000001290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
20
|
Akhavan S, Ahmadzadeh A, Mousavi A, Gilany MM, Kazemi Z, Rahim F, Shirali E. The Impact of Lymphovascular Space Invasion on Recurrence and Survival in Iranian Patients With Early Stage Endometrial Cancer. World J Oncol 2016; 7:70-74. [PMID: 28983367 PMCID: PMC5624702 DOI: 10.14740/wjon981w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 12/24/2022] Open
Abstract
Background The aim of this study was to assess the impact of lymphovascular space involvement (LVSI) on recurrence and survival in early stage of endometrial cancer (EC). Methods Patients with EC referred to Imam Khomeini Hospital in Tehran were examined and enrolled over a 10-year period (2004 - 2015). The effect of LVSI on recurrence and overall survival was analyzed using the Kaplan-Meier and log-rank test methods. Results A total of 160 patients with early stage EC were identified. Out of 160 women with EC, 135 (84.4%) underwent primary surgery. One hundred and twenty-one (76.2%) patients were not found to have LVSI, whereas 38 (23.8%) were found to have LVSI. Of the 38 patients with LVSI, 21 (55.3%) had endometrioid cell type tumor, 10 (26.3%) had serous, one (2.6%) had clear cell and six (15.8%) had adeno-squamous cell type tumor. Conclusion The presence of LVSI represents a factor strongly associated with high risk of recurrence and poor survival in early stage EC. Patients with lower International Federation of Obstetrics and Gynecology (FIGO) stages may be at increased risk of recurrence and a poor overall survival if the pathological findings confirm the presence of LVSI. Thus, LVSI should be added to the traditional factors used to decide whether patients with early stage EC are at high risk of recurrence and adjuvant therapy planning.
Collapse
Affiliation(s)
- Setareh Akhavan
- Department of Obstetrics and Gynecology, Valieasr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azar Ahmadzadeh
- Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Azamsadat Mousavi
- Department of Obstetrics and Gynecology, Valieasr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Modares Gilany
- Department of Obstetrics and Gynecology, Valieasr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Kazemi
- Department of Obstetrics and Gynecology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fakher Rahim
- Health Research Institute, Research Center of Thalassemia and Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elham Shirali
- Department of Obstetrics and Gynecology, Moheb Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
21
|
Neal SA, Graybill WS, Garrett-Mayer E, McDowell ML, McLean VE, Watson CH, Pierce JY, Kohler MF, Creasman WT. Lymphovascular space invasion in uterine corpus cancer: What is its prognostic significance in the absence of lymph node metastases? Gynecol Oncol 2016; 142:278-82. [DOI: 10.1016/j.ygyno.2016.05.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/28/2016] [Accepted: 05/30/2016] [Indexed: 11/16/2022]
|
22
|
van Barneveld E, Allen DG, Bekkers RLM, Grant PT. Lymphovascular space invasion in early-stage endometrial cancer: adjuvant treatment and patterns of recurrence. SOUTHERN AFRICAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 2016. [DOI: 10.1080/20742835.2016.1175708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
23
|
|
24
|
Jorge S, Hou JY, Tergas AI, Burke WM, Huang Y, Hu JC, Ananth CV, Neugut AI, Hershman DL, Wright JD. Magnitude of risk for nodal metastasis associated with lymphvascular space invasion for endometrial cancer. Gynecol Oncol 2016; 140:387-93. [PMID: 26768835 DOI: 10.1016/j.ygyno.2016.01.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/31/2015] [Accepted: 01/03/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES While lymphvascular space invasion (LVSI) is a risk factor for nodal metastasis in endometrial cancer, the magnitude of risk is poorly described. We examined the risk of nodal metastasis associated with LVSI for various combinations of tumor grade and depth of invasion and examined the effect of LVSI on survival. METHODS We identified patients with T1A (<50% myoinvasion) and T1B (>50% myoinvasion) endometrioid adenocarcinomas of the endometrium diagnosed between 2010 and 2012 and recorded in the National Cancer Database. The risk of nodal metastasis associated with LVSI stratified by grade and stage is reported. The association of LVSI and survival was examined using Kaplan-Meier analyses and Cox proportional hazards models. RESULTS We identified 25,907 patients, including 3928 (15.2%) with LVSI. Among patients with LVSI, 21.0% had positive lymph nodes, compared to 2.1% in patients without LVSI (P<0.0001). In analyses stratified by stage and grade, LVSI was associated with increased risks of LN metastasis by a magnitude of 3 to over 10-fold. In a multivariable model controlling for clinical and demographic characteristics, the risk ratio of nodal disease with LVSI was 9.29 (95% CI, 7.29-11.84) for T1A tumors and 4.64 (95% CI 3.99-5.39) for T1B tumors. LVSI was associated with decreased survival even after adjustment for the presence of lymph node metastases (HR=1.92, 95% CI 1.56-2.36). CONCLUSIONS LVSI is independently associated with lymph node metastases in women with apparent early-stage endometrial cancer and an independent predictor of survival even after adjustment for the presence of lymph node metastases.
Collapse
Affiliation(s)
- Soledad Jorge
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States
| | - June Y Hou
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States
| | - Ana I Tergas
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States
| | - William M Burke
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States
| | - Jim C Hu
- Department of Urology, Weill Cornell Medical College, United States; New York Presbyterian Hospital, United States
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, United States
| | - Alfred I Neugut
- Department of Medicine, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States
| | - Dawn L Hershman
- Department of Medicine, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
| |
Collapse
|
25
|
Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR, Sessa C. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. Int J Gynecol Cancer 2016; 26:2-30. [PMID: 26645990 PMCID: PMC4679344 DOI: 10.1097/igc.0000000000000609] [Citation(s) in RCA: 426] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11-13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically-relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article.
Collapse
Affiliation(s)
- Nicoletta Colombo
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Carien Creutzberg
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Frederic Amant
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Tjalling Bosse
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Antonio González-Martín
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Jonathan Ledermann
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Christian Marth
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Remi Nout
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Denis Querleu
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Mansoor Raza Mirza
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Cristiana Sessa
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| |
Collapse
|
26
|
Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR, Sessa C, Altundag O, Amant F, van Leeuwenhoek A, Banerjee S, Bosse T, Casado A, de Agustín L, Cibula D, Colombo N, Creutzberg C, del Campo JM, Emons G, Goffin F, González-Martín A, Greggi S, Haie-Meder C, Katsaros D, Kesic V, Kurzeder C, Lax S, Lécuru F, Ledermann J, Levy T, Lorusso D, Mäenpää J, Marth C, Matias-Guiu X, Morice P, Nijman H, Nout R, Powell M, Querleu D, Mirza M, Reed N, Rodolakis A, Salvesen H, Sehouli J, Sessa C, Taylor A, Westermann A, Zeimet A. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol 2015; 27:16-41. [PMID: 26634381 DOI: 10.1093/annonc/mdv484] [Citation(s) in RCA: 695] [Impact Index Per Article: 77.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/05/2015] [Indexed: 12/27/2022] Open
Abstract
The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11-13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article.
Collapse
Affiliation(s)
- N Colombo
- Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy
| | - C Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - F Amant
- Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - A González-Martín
- Department of Medical Oncology, GEICO Cancer Center, Madrid Department of Medical Oncology, MD Anderson Cancer Center, Madrid, Spain
| | - J Ledermann
- Department of Oncology and Cancer Trials, UCL Cancer Institute, London, UK
| | - C Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - R Nout
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - D Querleu
- Department of Surgery, Institut Bergonié, Bordeaux, France Department of Gynecology and Obstetrics, McGill University Health Centre, Montreal, Canada
| | - M R Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
ESMO–ESGO–ESTRO consensus conference on endometrial cancer: Diagnosis, treatment and follow-up. Radiother Oncol 2015; 117:559-81. [DOI: 10.1016/j.radonc.2015.11.013] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 11/18/2015] [Indexed: 12/13/2022]
|
28
|
Lymphovascular space invasion and the treatment of stage I endometrioid endometrial cancer. Int J Gynecol Cancer 2015; 25:75-80. [PMID: 25356534 DOI: 10.1097/igc.0000000000000306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Treatment of clinical early-stage endometrioid endometrial cancer (EEC) in The Netherlands consists of primary hysterectomy and bilateral salpingo-oophorectomy. Adjuvant radiotherapy is given when 2 or more the following risk factors are present: 60 years or older, grade 3 histology, and 50% or more myometrial invasion. Lymphovascular space invasion (LVSI) is a predictor of poor prognosis and early distant spread. It is unclear whether adjuvant radiotherapy is sufficient in patients with LVSI-positive EEC. METHODS/MATERIALS Eighty-one patients treated from 1999 until 2011 for stage I LVSI-positive EEC in 11 Dutch hospitals were included. The outcomes of patients with 0 to 1 risk factors were compared with those with 2 to 3 risk factors, and both were compared with the known literature. RESULTS Eighteen patients presented with recurrent disease, and 12 of those recurrences had a distant component. Overall and distant recurrence rates were 19.2% and 11.5% in patients with 0 to 1 risk factors followed by observation and 25.5% and 17% in patients with 2 to 3 risk factors who received adjuvant radiotherapy. Only 1 patient with grade 1 disease had a recurrence. CONCLUSIONS In stage I LVSI-positive EEC with 0 to 1 risk factors, observation might not be adequate. Moreover, despite adjuvant radiotherapy, a high overall and distant recurrence rate was observed in patients with 2 to 3 risk factors. The use of systemic treatment in these patients, with the exception of patients with grade 1 disease, should be investigated.
Collapse
|
29
|
Bosse T, Peters EE, Creutzberg CL, Jürgenliemk-Schulz IM, Jobsen JJ, Mens JWM, Lutgens LC, van der Steen-Banasik EM, Smit VT, Nout RA. Substantial lymph-vascular space invasion (LVSI) is a significant risk factor for recurrence in endometrial cancer – A pooled analysis of PORTEC 1 and 2 trials. Eur J Cancer 2015; 51:1742-50. [DOI: 10.1016/j.ejca.2015.05.015] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/12/2015] [Accepted: 05/14/2015] [Indexed: 11/26/2022]
|
30
|
Koskas M, Rouzier R, Amant F. Staging for endometrial cancer: The controversy around lymphadenectomy - Can this be resolved? Best Pract Res Clin Obstet Gynaecol 2015; 29:845-57. [PMID: 25817745 DOI: 10.1016/j.bpobgyn.2015.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 02/03/2015] [Indexed: 11/18/2022]
Abstract
Endometrial cancer remains the most common malignancy of the female genital tract. Lymph node metastasis is one of the most important prognostic factors, and stratification into pelvic lymph node invasion (stage IIIC1) and para-aortic lymph node invasion (stage IIIC2) improved the predictive value of the 2009 International Federation of Gynecology and Obstetrics (FIGO) classification. Radiological examination methods such as magnetic resonance imaging and positron emission tomography-computed tomography do not have good-enough sensitivity to avoid lymphadenectomy for the assessment of lymph node invasion. Prediction scores are becoming increasingly valuable to exclude lymph node metastasis in low-risk groups, and biomarkers could help to identify patients with high-risk lymph node metastatic probability. The therapeutic role of lymph node dissection remains a matter of debate. Several end points can be considered to evaluate the opportunity of lymphadenectomy in endometrial cancer. First, we compare survival according to the realization, the extent, and the numbers of nodes removed during lymphadenectomy. Second, we assess the opportunity of lymphadenectomy in order to tailor adjuvant treatment modalities. Third, we analyze the surgical complication rate after pelvic lymphadenectomy.
Collapse
MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adenocarcinoma, Clear Cell/diagnosis
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Clear Cell/surgery
- Adenocarcinoma, Papillary/diagnosis
- Adenocarcinoma, Papillary/pathology
- Adenocarcinoma, Papillary/surgery
- Carcinoma, Endometrioid/diagnosis
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/surgery
- Carcinosarcoma/diagnosis
- Carcinosarcoma/pathology
- Carcinosarcoma/surgery
- Endometrial Neoplasms/diagnosis
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/surgery
- Female
- Humans
- Lymph Node Excision
- Lymph Nodes/diagnostic imaging
- Lymph Nodes/pathology
- Lymphatic Metastasis
- Magnetic Resonance Imaging
- Multimodal Imaging
- Neoplasm Staging
- Neoplasms, Cystic, Mucinous, and Serous/diagnosis
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Pelvis
- Positron-Emission Tomography
- Prognosis
- Radiography
Collapse
Affiliation(s)
- Martin Koskas
- Department of Obstetrics and Gynaecology, APHP Hôpital Bichat, Paris, France; Paris Diderot University Paris 07, Paris, France
| | - Roman Rouzier
- Department of Gynaecology Institut Curie, Paris, France
| | - Frederic Amant
- Gynecologic Oncology, University Hospitals Leuven, and Department of Oncology, KU Leuven, Leuven, Belgium.
| |
Collapse
|
31
|
Prognostic significance of lymphovascular space invasion and nodal involvement in intermediate- and high-risk endometrial cancer patients treated with curative intent using surgery and adjuvant radiotherapy. Int J Gynecol Cancer 2012; 22:260-6. [PMID: 22080878 DOI: 10.1097/igc.0b013e318230c264] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess whether lymphovascular space invasion (LVSI) and nodal status provide adequate prognostic information in comparison with the entire set of traditional prognostic factors in intermediate- and high-risk endometrial cancer patients treated and staged with primary surgery and adjuvant radiotherapy. METHODS Three hundred twenty-four previously untreated high-intermediate- and high-risk endometrial cancer patients with FIGO (International Federation of Gynecology and Obstetrics) stage I to IIIC; endometrioid, serous, or clear cell histology; diagnosed between November 1995 and December 2006; who presented to Peter MacCallum Cancer Centre for adjuvant radiotherapy were included in these analyses. All traditionally recognized prognostic factors and newly created 4 pairs of combination of LVSI and nodal status were studied with respect to survival and patterns of failure. RESULTS The median follow-up time was 4.8 years. Five-year failure-free survival for all patients according to FIGO stage I, II, and III were 87.4%, 89.0%, and 62.4 %, respectively. In multivariable analysis for relapse, positive LVSI had a hazard ratio of 4.9 (P = 0.000), which increased to 8.8 (P = 0.004) in the presence of positive nodes. For overall survival, only LVSI was significant, with a hazard ratio of 3.02 (P = 0.003). In particular, in the presence of LVSI and nodes, histological type, grade, and myometrial invasion were not significant prognosticators for relapse or overall survival. CONCLUSIONS This model enables the separation of good prognosis patients even among poorly differentiated endometrioid, serous, and clear cell carcinoma patients and can be used in simplifying the staging of endometrial cancer and for selecting patients for high-risk endometrial cancer studies.
Collapse
|
32
|
Abstract
Based on two randomized trials and a meta-analysis, the recommendations of the National Cancer Institute (INCa) have validated the absence of systematic pelvic lymphadenectomy for patients with endometrial cancer at low risk (type 1 histology stage IA grade 1-2) and intermediate (type 1 histology stage IA grade 3 and IB grade 1-2) but without taking into account the contribution of the sentinel node (SN) procedure. The senti-endo trial assessing the role of the SN procedure in patients with early stages endometrial cancer showed that the detection rate by hemi-pelvis right and left were 77 and 76%, respectively. The detection rate per patient was 89%. Among patients with at least a SN detected, the detection was unilateral in 34 cases (31%) and bilateral in 77 cases (69%). Of the 111 patients with at least a SN detected, 19 had lymph node metastases (17%). Considering the hemi-pelvis right and left as a unit, no false negative case was observed, hence the sensitivity and NPV was 100%. Considering the NPV per patient, three false negative cases were observed. Among the 57 patients at low risk, six (11%) had lymph node metastases on SN with negative non sentinel nodes. Of the 33 patients at intermediate risk, five (15%) had lymph node metastases on SN with negative non sentinel nodes. Senti-endo results emphasize the contribution of the SN procedure to assess the nodal status in patients with low or intermediate risk group raising the issue on new definition of the recommendations of INCa.
Collapse
|
33
|
Temporal pattern of recurrence of stage I endometrial cancer in relation to histological risk factors. Eur J Surg Oncol 2012; 38:166-9. [DOI: 10.1016/j.ejso.2011.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 09/05/2011] [Accepted: 10/20/2011] [Indexed: 11/18/2022] Open
|
34
|
Recommandations professionnelles pour le cancer de l’endomètre 2010 : utilisation pratique et questions encore émergentes. Bull Cancer 2012; 99:107-11. [DOI: 10.1684/bdc.2011.1524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
35
|
|
36
|
Panggid K, Cheewakriangkrai C, Khunamornpong S, Siriaunkgul S. Factors related to recurrence in non-obese women with endometrial endometrioid adenocarcinoma. J Obstet Gynaecol Res 2010; 36:1044-8. [DOI: 10.1111/j.1447-0756.2010.01289.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
Chakravarty D, Gupta N, Goda JS, Srinivasan R, Patel FD, Dhaliwal L. Steroid receptors, HER2/neu and Ki-67, in endometrioid type of endometrial carcinoma: Correlation with conventional histomorphological features of prognosis. Acta Histochem 2010; 112:355-63. [PMID: 19446313 DOI: 10.1016/j.acthis.2009.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 02/25/2009] [Accepted: 03/02/2009] [Indexed: 11/16/2022]
Abstract
Endometrial proliferation is regulated by steroid receptors such as estrogen receptor alpha (ERalpha), estrogen receptor beta (ERbeta) and progesterone receptor (PR). HER2/neu is an important growth factor receptor which affects cell proliferation and Ki67 is a marker of cellular proliferation. Their interaction in endometrioid type of endometrial carcinoma is still not fully understood. In this study, we analyzed the immunolocalisation of ERalpha and ERbeta with particular attention to the ERbetacx isoform, PR, HER2/neu and Ki67 in endometrioid carcinoma. Their correlations with each other and with the conventional morphological prognostic parameters of myoinvasion and tumor grade were analyzed with respect to overall survival. Out of a total 54 cases, 14 showed evidence of local recurrence or metastatic disease within 5 years with poor outcome, whereas the rest had no evidence of disease. ERalpha, ERbeta, ERbetacx, PR, HER2/neu and Ki67 were detected using immunohistochemistry. The histological grade of the tumor correlated inversely with the intensity of immunolabelling of ERalpha and PR, and this was highly significant. The depth of myoinvasion showed an inverse correlation only with the ERbeta2/betacx immunopositivity and was not significantly associated with any other receptor evaluated. Analysis of the inter-relationship between receptor immunopositivity revealed a significant association of ERalpha immunolocalisation with ERbeta and with PR. Immunodetection of HER2/neu receptor correlated positively with both ERalpha and PR immunolabelling. The Ki-67 proliferation index correlated only with ERalpha immunopositivity. Preliminary observations suggested that with the exception of ERalpha, there was no correlation of any of the receptors evaluated with survival.
Collapse
Affiliation(s)
- Dimple Chakravarty
- Department of Cytology and Gynecological Pathology and Cancer Biology Laboratory, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | | |
Collapse
|
38
|
Qian X, Xi X, Jin Y. The Grading of Lymphovascular Space Invasion in Epithelial Ovarian Carcinoma. Int J Gynecol Cancer 2010; 20:895-9. [DOI: 10.1111/igc.0b013e3181e02fc7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction:To assess the prognostic value of lymphovascular space invasion (LVSI) in epithelial ovarian carcinoma.Methods:We reexamined single representative hematoxylin and eosin-stained sections of 66 patients with epithelial ovarian carcinoma to identify LVSI. A 4-grade system was used to classify LVSI: absent (no LVSI), mild (1-2 foci of LVSI), moderate (3-8 foci of LVSI), and severe (≥9 foci of LVSI). We investigated the possible associations between the grade of LVSI and clinicopathologic factors.Results:Lymphovascular space invasion was present in 36 patients (54.5%) and absent in 30 (45.5%). Statistical analysis indicated that LVSI was significantly associated with advanced clinical stage, poor histological grade, and lymph node metastasis. Follow-up studies indicated that the disease-free survival time for patients without LVSI was significantly longer than that for patients with moderate LVSI (P = 0.01) and severe LVSI (P = 0.001). The overall survival (OS) time for patients with moderate or severe LVSI was significantly shorter than that for patients with mild or no LVSI. The grade of LVSI was found to be significantly associated with OS (P = 0.004). The grade of LVSI showed poor correlation with disease-free survival and OS.Conclusions:The grade of LVSI is an important predictive factor for disease recurrence and poor survival of patients with epithelial ovarian carcinoma.
Collapse
|
39
|
Gemer O, Gdalevich M, Voldarsky M, Barak F, Ben Arie A, Schneider D, Levy T, Anteby E, Lavie O. Lower uterine segment involvement is associated with adverse outcome in patients with stage I endometroid endometrial cancer: Results of a multicenter study. Eur J Surg Oncol 2009; 35:865-9. [DOI: 10.1016/j.ejso.2008.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 08/03/2008] [Accepted: 10/14/2008] [Indexed: 11/30/2022] Open
|
40
|
O’Brien DJ, Flannelly G, Mooney EE, Foley M. Lymphovascular space involvement in early stage well-differentiated endometrial cancer is associated with increased mortality. BJOG 2009; 116:991-4. [DOI: 10.1111/j.1471-0528.2009.02162.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
41
|
Gemer O, Uriev L, Voldarsky M, Gdalevich M, Ben-Dor D, Barak F, Anteby E, Lavie O. The reproducibility of histological parameters employed in the novel binary grading systems of endometrial cancer. Eur J Surg Oncol 2009; 35:247-51. [DOI: 10.1016/j.ejso.2008.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 07/10/2008] [Accepted: 07/21/2008] [Indexed: 11/27/2022] Open
|
42
|
Narayan K, Rejeki V, Herschtal A, Bernshaw D, Quinn M, Jobling T, Allen D. Prognostic significance of several histological features in intermediate and high-risk endometrial cancer patients treated with curative intent using surgery and adjuvant radiotherapy. J Med Imaging Radiat Oncol 2009; 53:107-13. [DOI: 10.1111/j.1754-9485.2009.02045.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
43
|
Orr JW, Naumann WR, Escobar P. “Attitude is a little thing that makes a big difference” Winston Churchill. Gynecol Oncol 2008; 109:147-51; author reply 151-3. [DOI: 10.1016/j.ygyno.2007.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 12/14/2007] [Indexed: 10/22/2022]
|
44
|
Arndt-Miercke H, Martin A, Briese V, Fietkau R, Gerber B, Reimer T. Transection of vaginal cuff is an independent prognostic factor in stage I endometrial cancer. Eur J Surg Oncol 2008; 34:241-6. [PMID: 17822868 DOI: 10.1016/j.ejso.2007.07.199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Accepted: 07/25/2007] [Indexed: 11/20/2022] Open
Abstract
AIMS The objective was to identify prognostic factors of disease-free and overall survival in stage I endometrial carcinoma, thereby potentially facilitating the selection of patients who are on high risk for recurrence and who may benefit from transection of a vaginal cuff. METHODS In a retrospective review between 1994 and 2004, 340 patients with stage I endometrial carcinoma were managed surgically at two different hospitals in Rostock. The median follow-up was 79 (range 12-161) months. Clinical and histological parameters were compared using the SPSS software package. RESULTS In the univariate analysis the factors associated with poor disease-free survival in stage I carcinoma were higher tumor grade (P=0.013), and no removed vaginal cuff (P=0.025). The corresponding factor for impaired overall survival was no removed vaginal cuff (P=0.003). All parameters with a P-value<0.25 in the univariate setting were entered into a multivariate analysis. The factors that maintained associated with poor disease-free and overall survival were higher tumor grade and lack of vaginal cuff. CONCLUSIONS The removal of a vaginal cuff during abdominal hysterectomy was found to be an independent prognostic factor in stage I endometrial carcinomas. A prospective surgical trial is needed to validate our results before changing current clinical practice.
Collapse
Affiliation(s)
- H Arndt-Miercke
- Department of Obstetrics and Gynecology, University of Rostock, Klinikum Suedstadt, Suedring 81, 18059 Rostock, Germany
| | | | | | | | | | | |
Collapse
|