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Gülseren V, Çakır İ, Özdemir İA, Gökçü M, Sancı M, Görgülü G, Kuru O, Dağgez M, Güngördük K. Prognostic value of lymph node features in patients diagnosed with stage IIIC endometrial adenocancer. J Cancer Res Ther 2023; 19:1831-1836. [PMID: 38376286 DOI: 10.4103/jcrt.jcrt_2378_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/29/2022] [Indexed: 02/21/2024]
Abstract
AIM Our study investigated the lymph node (LN) features most affecting survival in endometrial adenocancer (EAC) patients with LN involvement. MATERIALS AND METHODS This retrospective study was based on a review of the records of patients diagnosed with EAC, who underwent hysterectomy and systematic retroperitoneal lymphadenectomy at the gynecologic oncology clinics of three centers between January 2009 and January 2019. RESULTS A total of 120 stage IIIC endometrioid-type EAC patients were included in the study. The patients were divided into small (<10 mm) and large (≥10 mm) groups according to the size of the largest metastatic LN. Patients were divided into single and multiple metastasis groups according to the number of metastatic LNs. The patients were divided into pelvic and paraaortic groups according to the location of the metastatic LNs. The effects of prognostic factors on disease-free survival (DFS) and overall survival (OS) were evaluated by Cox regression analysis. Large-sized metastatic LNs were an independent prognostic factor for DFS (hazard ratio [HR] = 5.4, 95% confidence interval [CI]: 1.-26.2; P = 0.035) and OS (HR = 9.0, 95% CI: 1.1-68.0; P = 0.033). The number (P = 0.093 for DFS, P = 0.911 for OS) and location (P = 0.217 for DFS, P = 0.124 for OS) of metastatic LNs were not independent prognostic factors for DFS or OS. CONCLUSIONS Large-sized metastatic LNs were an independent prognostic factor for survival in patients with stage IIIC EAC. Larger prospective studies including similar patient populations are required to verify these findings.
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Affiliation(s)
- Varol Gülseren
- Department of Obstetrics and Gynecology, Faculty of Medicine, Division of Gynecologic Oncology, Erciyes University, Kayseri, Turkey
| | - İlker Çakır
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - İsa Aykut Özdemir
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Sadi Konuk Education and Research Hospital, İstanbul, Turkey
| | - Mehmet Gökçü
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Muzaffer Sancı
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Gökşen Görgülü
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Oğuzhan Kuru
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Mine Dağgez
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Kemal Güngördük
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Sıtkı Koçman University, Muğla, Turkey
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Tran L, Christensen P, Barroeta JE, Hunter K, Sookram J, McGregor SM, Wilkinson N, Orsi NM, Lastra RR. Prognostic Significance of Size, Location, and Number of Lymph Node Metastases in Endometrial Carcinoma. Int J Gynecol Pathol 2023; 42:376-389. [PMID: 36044323 DOI: 10.1097/pgp.0000000000000897] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Regional lymph node metastasis is a well-established negative predictive prognostic factor in endometrial carcinomas. Recently, our approach to the pathologic evaluation of lymph nodes in endometrial carcinomas has changed, mainly due to the utilization of immunohistochemical stains in the assessment of sentinel lymph nodes, which may result in the identification of previously unrecognized disease [particularly isolated tumor cells (ITCs)] on hematoxylin and eosin stained slides. However, the clinical significance of this finding is not entirely clear. Following the experience in other organs systems such as breast, the Eight Edition of the American Joint Committee on Cancer's Cancer Staging Manual has recommended utilizing the N0(i+) terminology for this finding, without impact in the final tumor stage. We performed a comparative retrospective multi-institutional survival analysis of 247 patients with endometrial carcinoma with regional lymph node metastasis of various sizes identified in nonsentinel lymphadenectomy, demonstrating that the cumulative survival of patients with isolated tumor cells in regional lymph nodes is not statistically different from patient with negative lymph nodes, and is statistically different from those with lymph nodes showing micrometastasis or larger metastatic deposits. In addition, we evaluated the prognostic implications of the number of involved regional lymph nodes, demonstrating a worsening prognosis as the number of involved lymph nodes increases from none to one, and from one to more than one. Our data suggests that regional lymph nodes with isolated tumor cells in patients with endometrial carcinoma should likely be considered, for staging purposes, as negative lymph nodes, simply indicating their presence with the (i+) terminology.
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Martínez A, Chargari C, Kalbacher E, Gaillard AL, Leary A, Koskas M, Chopin N, Serre AA, Hardy-Bessard AC, Akladios C, Lecuru F. Recommandations pour la pratique clinique Nice/Saint-Paul-de-Vence 2022–2023 : prise en charge du cancer de l'endomètre localisé. Bull Cancer 2023; 110:6S20-6S33. [PMID: 37573036 DOI: 10.1016/s0007-4551(23)00331-4] [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: 08/14/2023]
Abstract
Recommendations for clinical practice, Nice/Saint-Paul-de-Vence 2022-2023: Management of localized endometrial cancer Endometrial cancer is the most frequent gynecological cancers in industrialized countries and its incidence increases. The newmolecularclassification allows determination of the risk of recurrence and helps orienting therapeutic management. Surgery remains the cornerstone of treatment. Minimally invasive approach must be preferred for stages I and II. Surgery includes hysterectomy with bilateral adnexectomy, sentinel lymph node biopsy even in high risk diseases and omentectomy for non-endometrioid tumors (except in case of clear cells tumors). Fertility preservation can be proposed in low grade, stage I tumors without myometrial involvement. In stage III/IV disease, lymph node debulking without totallymphadenectomy is indicated. In case of peritoneal carcinomatosis, first-line cytoreductive surgery is recommended if complete resection can be achieved. Adjuvant therapy is not recommended in low risk tumors. In intermediate risk tumors, curietherapy is indicated. In tumors with high-intermediate risk, curietherapy and external radiotherapy are indicated according to prognostic factors (stage II, lymphovascular invasion); adjuvant chemotherapy can be considered on a case-by-case basis. In high risk tumors, chemotherapy and external radiotherapy are recommended using a concomitant or sequential approach.
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Affiliation(s)
- Alejandra Martínez
- Département de chirurgie oncologique, institut Claudius-Regaud, institut universitaire du cancer Toulouse Oncopole, France; Centre de recherche en cancérologie de Toulouse, UMR 1037 INSERM, France.
| | - Cyrus Chargari
- Département d'oncologie-radiothérapie, hôpital de la Pitié Salpêtrière, France
| | - Elsa Kalbacher
- Département d'oncologie médicale, hôpital de Besançon, France
| | | | - Alexandra Leary
- Département d'oncologie médicale, institut Gustave-Roussy, France
| | - Martin Koskas
- Département de gynécologie-obstétrique, hôpital Bichat, France
| | - Nicolás Chopin
- Département de gynécologie-obstétrique, centre Léon-Bérard, France
| | | | | | - Chérif Akladios
- Département de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, France
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Predictors of extensive lymphatic dissemination and recurrences in node-positive endometrial cancer. Gynecol Oncol 2019; 154:480-486. [DOI: 10.1016/j.ygyno.2019.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/01/2019] [Accepted: 07/04/2019] [Indexed: 11/15/2022]
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Türkmen O, Başaran D, Karalök A, Cömert Kimyon G, Taşçı T, Üreyen I, Tulunay G, Turan T. Prognostic effect of isolated paraaortic nodal spread in endometrial cancer. J Turk Ger Gynecol Assoc 2018; 19:201-205. [PMID: 29588264 PMCID: PMC6250084 DOI: 10.4274/jtgga.2017.0152] [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] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate the prognostic effect of isolated paraaortic lymph node metastasis in endometrial cancer (EC). Material and Methods: This retrospective study included patients with FIGO 2009 stage IIIC2 disease due to isolated paraaortic lymph node metastasis (LNM). Patients with sarcomatous histology, synchronous gynecologic cancers and patients with concurrent pelvic lymph node metastases or patients that have intraabdominal tumor spread were excluded. Kaplan-Meier method was used for calculation of progression free survival (PFS) and overall survival. Results: One thousand six hundred and fourteen patients were operated for EC during study period. Nine hundred and sixty-one patients underwent lymph node dissection and 25 (2.6%) were found to have isolated LNM in paraaortic region and these constituted the study cohort. Twenty (80%) patients had endometrioid EC. Median number of retrieved lymph nodes from pelvic region and paraaortic region was 21.5 (range: 5-41) and 34.5 (range: 1-65), respectively. Median number of metastatic paraaortic nodes was 1 (range: 1-32). The median follow-up time was 15 months (range 5-94). Seven (28%) patients recurred after a median of 20 months (range, 3-99) from initial surgery. Three patients recurred only in pelvis, one patient had upper abdominal spread and 3 had isolated extraabdominal recurrence. Involvement of uterine serosa, positive peritoneal cytology and presence of adnexal metastasis were significantly associated with diminished PFS (p<0.05). Conclusion: The presence of serosal involvement or adnexal involvement is as important as gross peritoneal spread and is related with poor survival in patients with isolated paraaortic nodal spread in EC. Chemotherapy should be the mainstay of treatment in this patient cohort which may eradicate systemic tumor spread.
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Affiliation(s)
- Osman Türkmen
- Clinic of Gynecologic Oncology, Gaziantep Cengiz Gökçek Obstetrics and Children’s Hospital, Gaziantep, Turkey
| | - Derman Başaran
- Clinic of Gynecologic Oncology, University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Alper Karalök
- Clinic of Gynecologic Oncology, University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Günsu Cömert Kimyon
- Clinic of Gynecologic Oncology, University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Tolga Taşçı
- Clinic of Gynecologic Oncology, İstanbul Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Işın Üreyen
- Clinic of Gynecologic Oncology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Gökhan Tulunay
- Clinic of Gynecologic Oncology, TOBB University Hospital, Ankara, Turkey
| | - Taner Turan
- Clinic of Gynecologic Oncology, University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
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Marnitz S, Köhler C, Gharbi N, Kunze S, Jablonska K, Herter J. Evolution of adjuvant treatment in endometrial cancer-no evidence and new questions? Strahlenther Onkol 2018; 194:965-974. [PMID: 30112692 DOI: 10.1007/s00066-018-1339-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/12/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE For endometrial cancer (EC), clinical and pathological risk factors are taken to triage patients and estimate their prognosis. Lymph node involvement (pN+), lymphovascular space involvement (LSVI), grading, age of the patients, and T classification are internationally accepted parameters for treatment decisions. MATERIALS AND METHODS Studies on adjuvant radiation, chemotherapy, and chemoradiation are discussed against the background of risk stratification and clinical decision-making in early-to-advanced stage endometrial cancer. Recent publications on adjuvant treatment in high-risk disease and its implications for the patients with regard to expected oncologic benefit and treatment-related toxicity are discussed. RESULTS Surgery is the mainstay of treatment of EC patients. Well-differentiated tumors and early disease (FIGO IA) should be followed up without further treatment. In FIGO I stage without risk factors, VBT remains the standard treatment after surgery. FIGO I, II patients with one or more risk factors (MI ≥ 50%, Grading[G]3, age >60 years, LVSI) benefit from external beam radiotherapy (EBRT) in terms of survival. There are no data of acceptable quality demonstrating that chemotherapy is superior to radiation in locally advanced carcinomas. Therefore, even in locally advanced disease (FIGO III, IV), EBRT remains the standard of care after surgery. EBRT contributes to the very low rate of local relapses and better DFS in these patients and should not be replaced by chemotherapy only. Whether and which subgroups of patients benefit from an additional (concomitant and/or adjuvant) chemotherapy in terms of disease-free survival remains a controversial issue. The recently published PORTEC-3 trial could not create clear evidence. With a high rate of isolated tumors cells and micrometastases in the specimens, the increasing use of unvalidated sentinel concepts in endometrial cancer raises more questions with regard to indications for adjuvant treatment. In the future, integrated genomic characterization of tumors might be helpful for treatment individualization in the adjuvant setting.
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Affiliation(s)
- S Marnitz
- Medical Faculty, Department of Radiation Oncology, CyberKnife- and Radiation Therapy, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - C Köhler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
| | - N Gharbi
- Medical Faculty, Department of Radiation Oncology, CyberKnife- and Radiation Therapy, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - S Kunze
- Medical Faculty, Department of Radiation Oncology, CyberKnife- and Radiation Therapy, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - K Jablonska
- Medical Faculty, Department of Radiation Oncology, CyberKnife- and Radiation Therapy, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - J Herter
- Medical Faculty, Department of Radiation Oncology, CyberKnife- and Radiation Therapy, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Luteinizing Hormone/Human Chorionic Gonadotropin Receptor Immunohistochemical Score Associated with Poor Prognosis in Endometrial Cancer Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1618056. [PMID: 29808163 PMCID: PMC5902075 DOI: 10.1155/2018/1618056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 02/12/2018] [Accepted: 02/28/2018] [Indexed: 11/18/2022]
Abstract
The aim of this study was to develop a scoring system of the immunohistochemical (IHC) expression of luteinizing hormone/human chorionic gonadotropin receptor (LHCG-R) in endometrial cancer (EC) patients. Nonconsecutive hysterectomy specimens containing EC collected from April 2013 to October 2015 were selected. Hematoxylin-eosin stained sections from each case were reviewed and representative sections from each tumor were selected. IHC staining was performed for the detection of LHCG-R. The percentage of stained cells and the staining intensity were assessed in order to develop an immunohistochemical score. Moreover, we examined the correlation of the score with grading and lymphovascular space invasion (LVSI). There was a statistically significant positive correlation between grading and IHC scoring (p = 0.01) and a statistically significant positive correlation between LVSI and IHC score (p < 0.01). In conclusion, we suggest that the immunohistochemical score presented here could be used as a marker of bad prognosis of EC patients. Nevertheless, further studies are needed in order to validate it. The study was registered in the Careggi Hospital public trials registry with the following number: 2013/0011391.
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8
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Somashekhar SP. Does debulking of enlarged positive lymph nodes improve survival in different gynaecological cancers? Best Pract Res Clin Obstet Gynaecol 2015; 29:870-83. [PMID: 26043964 DOI: 10.1016/j.bpobgyn.2015.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 04/20/2015] [Accepted: 04/28/2015] [Indexed: 11/26/2022]
Abstract
Lymph-node-positive gynaecological cancers remain a pharmacotherapeutic challenge, and patients with lymph-node-positive gynaecological cancers have poor survival. The purpose of this review is to determine whether a survival advantage arises from surgical debulking of enlarged positive lymph nodes in different types of gynaecological cancers. Information from studies published on the survival benefits from debulking lymph nodes in gynaecological cancers was investigated. Pertaining to therapeutic lymphadenectomy, survival benefit can be analysed in two ways, direct survival benefit following therapeutic lymphadenectomy of bulky positive metastatic lymph nodes and indirect survival benefit, which results after a sequela of systematic lymphadenectomy, proper, accurate staging of disease and stage migration and tailor-made adjuvant treatment. The direct hypothesis of therapeutic lymphadenectomy and survival benefit has been prospected in cervical cancers and vulval cancers and in post-chemotherapy residual paraarotic nodal mass in germ cell ovarian cancer. The indirect survival benefit of therapeutic paraarotic lymphadenectomy in high-risk endometrial cancers and advanced epithelial ovarian cancers needs to be tested in randomized controlled trials. More randomized controlled trials are required to investigate this research question. Further, indirect benefit due to tailor-made adjuvant treatment, secondary to accurate staging achieved as a sequela of systematic lymphadenectomy, needs to be analysed in future trials.
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Affiliation(s)
- S P Somashekhar
- Manipal Comprehensive Cancer Center, Manipal Hospital, Bangalore 560017, India.
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Brun JL, Ouldamer L, Bourdel N, Huchon C, Koskas M, Gauthier T. Management of Stage I Endometrial Cancer in France: A Survey on Current Practice. Ann Surg Oncol 2015; 22:2395-400. [DOI: 10.1245/s10434-014-4262-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Indexed: 01/25/2023]
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Prognosis for Endometrial Cancer Patients Treated With Systematic Pelvic and Para-Aortic Lymphadenectomy Followed by Platinum-Based Chemotherapy. Int J Gynecol Cancer 2015; 25:81-6. [DOI: 10.1097/igc.0000000000000268] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveThe purpose of this study was to analyze the prognosis for endometrial cancer patients treated with systematic pelvic and para-aortic lymphadenectomy (PLA and PALA) followed by platinum-based chemotherapy.Materials and MethodsFrom 1994 to 2004, in the Cancer Institute Hospital, 502 patients who were surgically treated with systematic PLA and PALA were enrolled in this study. Their prognosis and clinicopathological features were retrospectively reviewed.ResultsOne hundred ninety-one (38.0%) patients received adjuvant platinum-based chemotherapy. Lymph node (LN) metastasis was observed in 80 (15.9%) patients, pelvic-only LN metastasis in 27 (5.4%), para-aortic-only LN metastasis in 15 (3.0%), and both pelvic and para-aortic LN metastasis in 38 (7.6%). The median number of metastatic LNs was 2 (range, 1–57), 1 (range, 1–4), and 6 (range, 2–50) in patients with pelvic-only, para-aortic-only, and both pelvic and para-aortic LN metastasis, respectively (P< 0.001). Only 2.6% (2/76) of patients with no myometrial invasion had LN metastasis, and no less than 8.9% (22/247) of patients with myometrial invasion (limited to the inner half) had LN metastasis. Five-year overall survival (OS) for LN metastasis–negative and –positive patients was 96.7% and 76% (P< 0.001), respectively. Five-year OS for patients with metastasis in 1 or 2 LNs was 84.8% and was significantly higher than that for patients with metastasis in 3 or more LNs (57.8%;P= 0.011). In patients with LN metastasis, 5-year OS of endometrioid adenocarcinoma and non–endometrioid adenocarcinoma cell types was 90.2% and 56.7% (P= 0.0016), respectively.ConclusionsUnder the settings of thorough PLA and PALA followed by intensive platinum-based chemotherapy for endometrial cancer, metastasis in 1 or 2 LNs seems to have little effect on survival, although para-aortic LNs are involved. This therapeutic strategy could not improve the prognosis of patients with metastasis in 3 or more LNs or patients with non–endometrioid adenocarcinoma cell types along with LN involvement.
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11
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Todo Y, Watari H, Okamoto K, Hareyama H, Minobe S, Kato H, Sakuragi N. Tumor volume successively reflects the state of disease progression in endometrial cancer. Gynecol Oncol 2013; 129:472-7. [DOI: 10.1016/j.ygyno.2013.02.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 02/25/2013] [Accepted: 02/27/2013] [Indexed: 10/27/2022]
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AlHilli MM, Mariani A. The role of para-aortic lymphadenectomy in endometrial cancer. Int J Clin Oncol 2013; 18:193-9. [PMID: 23412768 DOI: 10.1007/s10147-013-0528-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Indexed: 10/27/2022]
Abstract
Endometrial cancer (EC) is the most common malignancy of the female reproductive tract and the fourth most common cancer overall. Approximately 20 % of patients with EC harbor disease outside the uterus, and 10 % of patients initially diagnosed with cancer confined to the uterus are found to have lymph node metastases. Para-aortic lymph node involvement occurs in approximately 7-8 % of EC patients overall and in about 50 % of patients with positive pelvic nodes. Metastases to the para-aortic lymph nodes are associated with poor prognosis. Factors associated with para-aortic lymph node dissemination include advanced stage, high histological grade, deep myometrial invasion, cervical involvement, lymphovascular space involvement, and the presence of pelvic lymph node metastases. Approximately 77 % of patients with para-aortic nodal involvement are found to have metastases above the level of the inferior mesenteric artery. Systematic pelvic and para-aortic lymphadenectomy with dissection optimally carried out to the renal vessels is important in high-risk patients in order to identify nodes present at distant sites, particularly above the inferior mesenteric artery (IMA). While the definitive management of EC varies widely across the gynecological oncology community, there is a consensus that patients at risk for lymphatic metastases (high and intermediate risk) who are targeted with systematic lymphadenectomy may have an improved prognosis. Well-designed prospective studies evaluating the therapeutic role of systematic lymphadenectomy in EC are needed. Herein, we describe the role of para-aortic lymphadenectomy in the surgical staging of EC emphasizing its prerequisites, extent, and diagnostic and potential therapeutic advantages.
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Affiliation(s)
- Mariam M AlHilli
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Eisenberg Lobby 71, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
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Todo Y, Sakuragi N. Systematic lymphadenectomy in endometrial cancer. J Obstet Gynaecol Res 2012; 39:471-7. [DOI: 10.1111/j.1447-0756.2012.02062.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/18/2012] [Indexed: 12/22/2022]
Affiliation(s)
- Yukiharu Todo
- Division of Gynecologic Oncology; National Hospital Organization, Hokkaido Cancer Center; Sapporo; Japan
| | - Noriaki Sakuragi
- Department of Obstetrics and Gynecology; Hokkaido University School of Medicine; Sapporo; Japan
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14
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Todo Y, Suzuki Y, Azuma M, Hatanaka Y, Konno Y, Watari H, Kato H, Matsuno Y, Yamashiro K, Sakuragi N. Ultrastaging of para-aortic lymph nodes in stage IIIC1 endometrial cancer: a preliminary report. Gynecol Oncol 2012; 127:532-7. [PMID: 22940490 DOI: 10.1016/j.ygyno.2012.08.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/17/2012] [Accepted: 08/22/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to determine the rate of occult metastasis, including isolated tumor cells, in para-aortic lymph nodes of patients with stage IIIC1 endometrial cancer who underwent pelvic and para-aortic lymphadenectomy. METHODS A series of 15 patients who had undergone combined pelvic and para-aortic lymphadenectomy during the period from 2004 to 2010 and who were diagnosed as being positive for pelvic node metastasis but negative for para-aortic node metastasis were included in this study. Ultra-staging by multiple slicing, staining with hematoxylin/eosin and cytokeratin, and microscopic inspection was performed on a total of 242 para-aortic lymph nodes. RESULTS Eleven (73.3%) of the 15 patients had occult para-aortic lymph node metastasis. Two patients (13.3%) had macrometastasis and nine patients (60.0%) had isolated tumor cells. Type 2 endometrial cancer tended to have a higher rate of occult metastasis than that of type 1 cancer (90% vs. 40%, P=0.07). The rate of occult para-aortic node metastasis was not related to the number of metastatic pelvic nodes. Five patients suffered recurrence in the lung or in the intraabdomen, but lymph node recurrence was not found in any case. CONCLUSION Patients with stage IIIC1 endometrial cancer have a potentially high rate of occult para-aortic node metastasis. Local treatment of the para-aortic region should be considered in patients with stage IIIC1 endometrial cancer until effective adjuvant therapy is established.
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Affiliation(s)
- Yukiharu Todo
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
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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.
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Prognostic discrimination of subgrouping node-positive endometrioid uterine cancer: location vs nodal extent. Br J Cancer 2011; 105:1137-43. [PMID: 21915131 PMCID: PMC3208487 DOI: 10.1038/bjc.2011.336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The 2009 International Federation of Gynecologists and Obstetricians elected to substage patients with positive retroperitoneal lymph nodes as IIIC 1 (pelvic lymph node metastasis only) and IIIC 2 (paraaortic node metastasis with or with positive pelvic lymph nodes). We have investigated the discriminatory ability of subgrouping patients with retroperitoneal nodal involvement based on location, number, and ratio of positive nodes. METHODS For 1075 patients with stage IIIC endometrioid corpus cancer abstracted from the Surveillance, Epidemiology, and End Results databases for 2003-2007, Kaplan-Meier analyses, Cox proportional hazard models, and other quantitative measures were used to compare the prognostic discrimination for disease-specific survival (DSS) of nodal subgroupings. RESULTS In univariate analysis, the 3-year DSS were significantly different for subgroupings by location (IIIC 1 vs IIIC 2; 80.5% vs 67.0%, respectively, P=0.001), lymph node ratio (≤ 23.2% vs >23.2%; 80.8% vs 67.6%; P<0.001), and number of positive lymph nodes (1, 2-5, >5; 79.5, 75.4, 62.9%, P=0.016). The ratio of positive nodes showed superior discriminatory substaging in Cox models. CONCLUSION Subgrouping of stage IIIC patients by the ratio of positive nodes, either as a dichotomized or continuous parameter, shows the strongest ability to discriminate the survival, controlling for other confounding factors.
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