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Huber D, Hurni Y. Anatomical Distribution of Sentinel Lymph Nodes Harvested by Retroperitoneal vNOTES in 34 Consecutive Patients With Early-Stage Endometrial Cancer: Analysis of 124 Lymph Nodes. J Minim Invasive Gynecol 2024; 31:438-444. [PMID: 38428574 DOI: 10.1016/j.jmig.2024.02.007] [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: 12/14/2023] [Revised: 01/31/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024]
Abstract
STUDY OBJECTIVE To determine the anatomical distribution of sentinel lymph nodes (SLNs), the overall, unilateral, and bilateral detection rates, and the bilateral SLN concordance in patients with endometrial cancer (EC) mapped through a retroperitoneal transvaginal natural orifice transluminal endoscopic surgery (vNOTES) approach. DESIGN Prospective single-center observational study. SETTING Swiss teaching hospital. PATIENTS Patients with EC or endometrial complex atypical hyperplasia who had undergone surgical staging with SLN mapping by a retroperitoneal vNOTES approach between October 2021 and November 2023. INTERVENTIONS Patients were placed in a horizontal dorsal lithotomy position under general anesthesia, and indocyanine green (ICG) was injected into the cervix. Access to the retroperitoneal space was achieved through vaginal incisions. A 7 cm GelPoint V-Path Transvaginal Access Platform was used as a vNOTES port, and CO2 was insufflated to expand the retroperitoneal space. The pelvic retroperitoneal space was inspected for ICG uptake by lymph nodes. After identification, SLNs were removed and sent for definitive histological examination. MEASUREMENT AND MAIN RESULTS A total of 34 patients were included in this study; 33 (97.1%) had a successful procedure (unilateral or bilateral mapping), and 1 (2.9%) had failed mapping. A total of 124 SLNs were identified and removed. SLNs were observed in the obturator region (81.5%), the external iliac region (10.5%), the internal iliac region (4.8%), and the common iliac region (3.2%). Similar proportions were observed on both pelvic sides. No SLNs were detected in other regions. The SLN locations were symmetrical in 22/31 (71.0%) patients. SLNs were negatives in 120 cases (96.8%), while 2 lymph nodes (1.6%) presented isolated tumor cells, and 2 others (1.6%) presented macrometastases. CONCLUSION We report anatomical distributions and detection rates for SLNs mapped by retroperitoneal vNOTES. Our results suggest substantial differences in the localization of SLNs compared to those reported for laparoscopic mapping.
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Affiliation(s)
- Daniela Huber
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Huber and Hurni); Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland (Dr. Huber).
| | - Yannick Hurni
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Huber and Hurni)
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Vidal-Sicart S, Goñi E, Cebrecos I, Rioja ME, Perissinotti A, Sampol C, Vidal O, Saavedra-Pérez D, Ferrer A, Martí C, Ferrer Rebolleda J, García Velloso MJ, Orozco-Cortés J, Díaz-Feijóo B, Niñerola-Baizán A, Valdés Olmos RA. Continuous innovation in precision radio-guided surgery. Rev Esp Med Nucl Imagen Mol 2024; 43:39-54. [PMID: 37963516 DOI: 10.1016/j.remnie.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023]
Abstract
Since its origins, nuclear medicine has faced technological changes that led to modifying operating modes and adapting protocols. In the field of radioguided surgery, the incorporation of preoperative scintigraphic imaging and intraoperative detection with the gamma probe provided a definitive boost to sentinel lymph node biopsy to become a standard procedure for melanoma and breast cancer. The various technological innovations and consequent adaptation of protocols come together in the coexistence of the disruptive and the gradual. As obvious examples we have the introduction of SPECT/CT in the preoperative field and Drop-in probes in the intraoperative field. Other innovative aspects with possible application in radio-guided surgery are based on the application of artificial intelligence, navigation and telecare.
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Affiliation(s)
- Sergi Vidal-Sicart
- Servicio de Medicina Nuclear, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Elena Goñi
- Servicio de Medicina Nuclear, Hospital Universitario de Navarra, Pamplona, Spain
| | - Isaac Cebrecos
- Instituto Clínic de Ginecología, Obstetricia y Neonatología (ICGON), Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Andrés Perissinotti
- Servicio de Medicina Nuclear, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), ISCIII, Madrid, Spain
| | - Catalina Sampol
- Servicio de Medicina Nuclear, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Oscar Vidal
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Cirugía General y Digestiva, ICMDiM, Hospital Clínic de Barcelona, Barcelona, Spain; Departamento de Cirugía, Universitat de Barcelona, Barcelona, Spain
| | - David Saavedra-Pérez
- Cirugía General y Digestiva, ICMDiM, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ada Ferrer
- Servicio de Cirugía Maxilofacial, Hospital Clínic Barcelona, Barcelona, Spain
| | - Carles Martí
- Servicio de Cirugía Maxilofacial, Hospital Clínic Barcelona, Barcelona, Spain
| | - José Ferrer Rebolleda
- Servicio Medicina Nuclear Ascires, Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Jhon Orozco-Cortés
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Barcelona, Spain
| | - Berta Díaz-Feijóo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Instituto Clínic de Ginecología, Obstetricia y Neonatología (ICGON), Hospital Clínic Barcelona, Barcelona, Spain; Departamento de Cirugía, Universitat de Barcelona, Barcelona, Spain
| | - Aida Niñerola-Baizán
- Servicio de Medicina Nuclear, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), ISCIII, Madrid, Spain; Departamento de Biomedicina, Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Renato Alfredo Valdés Olmos
- Department of Radiology, Section of Nuclear Medicine & Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
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Johnston ME, Farooqui ZA, Nagarajan R, Pressey JG, Turpin B, Dasgupta R. Fluorescent-guided surgery and the use of indocyanine green sentinel lymph node mapping in the pediatric and young adult oncology population. Cancer 2023; 129:3962-3970. [PMID: 37740680 DOI: 10.1002/cncr.35023] [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: 02/26/2023] [Revised: 07/16/2023] [Accepted: 08/03/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Technetium-99 (99m Tc) lymphoscintigraphy with blue dye injection is an accepted method for sentinel lymph node (SLN) mapping, but blue dye has known adverse effects, and injection of 99m Tc may increase time under anesthesia for pediatric patients. Indocyanine green (ICG) may serve as an adjunct to assist with visibility and identification of SLNs. We hypothesized that sensitivity of ICG was similar to blue dye in SLN biopsies. METHODS Thirty patients (36 procedures with 96 total specimens) underwent preoperative intradermal injection of 99m Tc, followed by intradermal injection of isosulfan blue and ICG. Test characteristics of blue dye, ICG, and 99m Tc included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS ICG had a sensitivity of 87% and PPV of 83% for detection of 99m Tc-hot lymph nodes; blue dye had a sensitivity of 44% and PPV of 97%. For detection of pathologically confirmed lymph nodes, ICG had a sensitivity of 84% and a positive predictive value (PPV) of 91%. 99m Tc had a sensitivity of 82% and a PPV of 94%. ICG had no significant difference in odds of being positive in pathology-confirmed lymph nodes compared to 99m Tc (odds ratio [OR], 0.818; 95% confidence interval [CI], 0.3-2.172; p = .823) and had higher odds than isosulfan blue (OR, 0.025, 95% CI, 0.001-0.148; p < .001). CONCLUSION This study established the efficacy of ICG as an adjunct to SLNB in the pediatric and young adult population. ICG was safe, more efficacious than blue dye, and may obviate the need for lymphoscintigraphy in selected patients resulting in reduced time under anesthesia.
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Affiliation(s)
- Michael E Johnston
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Zishaan A Farooqui
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rajaram Nagarajan
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Joseph G Pressey
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Brian Turpin
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Roshni Dasgupta
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Ouasti S, Ilic J, Mimoun C, Bendifallah S, Huchon C, Ouldamer L, Lorenzini J, Lavoué V, Raimond E, Dion L, Costaz H, Dupre PF, Graesslin O, Uzan J, Kerbage Y, Chauvet P, Canlorbe G, Touboul C, Dabi Y. Adherence to ESGO guidelines and impact on survival in obese patients with endometrial cancer: a multicentric retrospective study. Int J Gynecol Cancer 2023; 33:1950-1956. [PMID: 37788899 DOI: 10.1136/ijgc-2023-004642] [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: 10/05/2023] Open
Abstract
OBJECTIVES Obesity is known to be both a major risk factor for endometrial cancer and associated with surgical complexity. Therefore, the management of patients with obesity is a challenge for surgeons and oncologists. The aim of this study is to assess the adherence to European Society of Gynaecological Oncology (ESGO) guidelines in morbidly obese patients (body mass index (BMI) >40 kg/m2). The secondary objectives were the impact on overall survival and recurrence-free survival. METHODS All the patients who were treated for an endometrial cancer in the 11 cancer institutes of the FRANCOGYN group were included and classified into three weight groups: morbid (BMI >40 kg/m2), obese (BMI 30-40), and normal or overweight (BMI <30). Adherence to guidelines was evaluated for surgical management, lymph node staging, and adjuvant therapies. RESULTS In total, 2375 patients were included: 1330 in the normal or overweight group, 763 in the obese group, and 282 in the morbid group. The surgical management of the morbid group was in accordance with the guidelines in only 30% of cases, compared with 44% for the obese group and 48% for the normal or overweight group (p<0.001); this was largely because of a lack of lymph node staging. Morbid group patients were more likely to receive the recommended adjuvant therapy (61%) than the obese group (52%) or the normal or overweight group (46%) (p<0.001). Weight had no impact on overall survival (p=0.6) and morbid group patients had better recurrence-free survival (p=0.04). CONCLUSION Adherence to international guidelines for surgical management is significantly lower in morbid group patients, especially for lymph node staging. However, morbidly obese patients had more often the adequate adjuvant therapies. Morbid group patients had a better recurrence-free survival likely because of better prognosis tumors.
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Affiliation(s)
- Samia Ouasti
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Johanna Ilic
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Camille Mimoun
- Department of Gynaecology, Hospital Group Saint-Louis Lariboisiere and Fernand-Widal, Paris, France
| | - Sofiane Bendifallah
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Cyrille Huchon
- Department of Gynaecology, Hospital Group Saint-Louis Lariboisiere and Fernand-Widal, Paris, France
| | - Lobna Ouldamer
- Department of Gynaecology, Hôpital Bretonneau, Tours, France
| | | | - Vincent Lavoué
- Department og Gynecology and Obstetrics, Rennes 1 University, Rennes, France
| | - Emilie Raimond
- Department of Gyneacology and Obstetrics, Reims Champagne-Ardenne University, Reims, France
| | - Ludivine Dion
- Department of Gynecology and Obstetrics, Rennes 1 University, Rennes, France
| | - Hélène Costaz
- Departement of Oncology Surgery, Georges-François Leclerc Centre, Dijon, France
| | | | - Olivier Graesslin
- Department of Obstetrics and Gynecology, Université de Reims Champagne-Ardenne, Reims, France
| | - Jennifer Uzan
- Department of Gynaecology and Obstetrics, Centre Hospitalier Intercommunal de Créteil (CHI Créteil), Créteil, France
| | | | - Pauline Chauvet
- Department of Gynaecology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Cyril Touboul
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Yohann Dabi
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
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Ni S, Wei Z, Li D. Effect of lncRNA LINC00324 on cervical cancer progression through down-regulation of miR-195-5p. J OBSTET GYNAECOL 2023; 43:2285384. [PMID: 38059417 DOI: 10.1080/01443615.2023.2285384] [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: 06/13/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Long non-coding RNAs (lncRNAs) have been widely used in the exploration of diseases in recent years. This paper introduced the significance of lncRNA LINC00324 (LINC00324) on the progression of cervical cancer and explored the mechanism of action and potential prognosis of LINC00324. METHODS The cervical cancer tissues and adjacent normal tissues of 120 people were collected as research samples. The expression level of LINC00324 was assessed by RT-qPCR, as was miR-195-5p. Knockdown of LINC00324 on the proliferation ability of cervical cancer cells was determined with the help of cell counting kit-8 (CCK-8), and the number of cell migration and invasion was detected by the Transwell method. Luciferase reporter gene assay was used to analyse the correlation of LINC00324 and miR-195-5p. Kaplan-Meier survival curves and multivariate Cox analysis explained the potential prognostic significance of LINC00324 in cervical cancer. RESULTS Significantly increased expression of LINC00324 and down-regulated miR-195-5p were negatively correlated in cervical cancer. Knockdown of LINC00324 inhibited the progression of cervical cancer, which was related to its mechanism of targeting and downregulating miR-195-5p. In addition, low expression of LINC00324 may prolong the survival period of patients with cervical cancer. CONCLUSIONS LINC00324 targets miR-195-5p to regulate the progression of cervical cancer and have potential as a prognostic molecular marker for cervical cancer.
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Affiliation(s)
- Suna Ni
- Department of Obstetrics Clinic, ShiJiaZhuang Maternity & Child Healthcare Hospital, ShiJiaZhuang, China
| | - Zhixia Wei
- Department of Obstetrics Clinic, ShiJiaZhuang Maternity & Child Healthcare Hospital, ShiJiaZhuang, China
| | - Dandan Li
- Department of Breast Clinic, ShiJiaZhuang Maternity & Child Healthcare Hospital, ShiJiaZhuang, China
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Hurni Y, Simonson C, Di Serio M, Lachat R, Bodenmann P, Seidler S, Huber D. Feasibility and safety of vNOTES for gynecological procedures in obese patients. J Gynecol Obstet Hum Reprod 2023; 52:102687. [PMID: 37898303 DOI: 10.1016/j.jogoh.2023.102687] [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: 05/10/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION This study aimed to determine the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) to treat benign and malign gynecological conditions in obese patients. MATERIAL AND METHODS We analyzed data from 79 obese patients with a body mass index (BMI) > 30 Kg/m2 operated by vNOTES for gynecological conditions between May 2020 and April 2023. The primary outcome was the feasibility of performing the surgery as initially planned. Data were presented for subgroups of patients with obesity class I (BMI 30.1 - 34.9 Kg/m2), class II (BMI 35.0 - 39.9 Kg/m2), and class III (BMI ≥ 40.0 Kg/m2). RESULTS Patients presented obesity class I in 39 cases (49.4 %), class II in 27 cases (34.2 %), and class III in 13 cases (16.4 %). Fifty-two patients (65.8 %) underwent vNOTES hysterectomy, 26 patients (32.9 %) underwent procedures limited to the adnexa, and 1 patient (1.3 %) underwent myomectomy. The conversion rate was 0 %, 11.1 %, and 7.7 % in obesity class I, II, and III, respectively. Intraoperative bladder injury was observed in 1 case (1.3 %) and rectal serosal tear in 2 cases (2.5 %). Postoperatively, we observed 3 cases (3.8 %) of wound infection, 2 cases (2.5 %) of cystitis, and 1 case (1.3 %) of deep vein thrombosis. DISCUSSION This study demonstrated the feasibility and safety of performing gynecological vNOTES procedures in obese patients. However, obesity could be associated with longer and more complex interventions, especially in obesity class II and III patients.
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Affiliation(s)
- Yannick Hurni
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, Sion 1951, Switzerland.
| | - Colin Simonson
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, Sion 1951, Switzerland
| | - Marcello Di Serio
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, Sion 1951, Switzerland
| | - Régine Lachat
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, Sion 1951, Switzerland
| | - Pauline Bodenmann
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, Sion 1951, Switzerland
| | - Stéphanie Seidler
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, Sion 1951, Switzerland
| | - Daniela Huber
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, Sion 1951, Switzerland; Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva 1205, Switzerland
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Wang ZM, Zhang L, Ren DH, Zhang CY, Zheng HC. Bioinformatics analysis of the clinicopathological and prognostic significance of BAG3 mRNA in gynecological cancers. J OBSTET GYNAECOL 2023; 43:2228899. [PMID: 37377218 DOI: 10.1080/01443615.2023.2228899] [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: 04/03/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023]
Abstract
BAG3 is a co-chaperone BAG family protein that plays important roles in protein homeostasis, cell survival, cell motility, and tumour metastasis. This study aimed to clarify the clinicopathological and prognostic implications of BAG3 mRNA expression in tumours. We performed bioinformatics analysis on BAG3 mRNA expression using TCGA, XIANTAO, UALCAN, and Kaplan-Meier plotter databases. BAG3 mRNA expression was downregulated in breast and endometrial cancers and positively correlated with favourable PAM50 subtyping in breast cancer,clinical stage and short overall survival in ovarian cancer and negatively correlated with T stage, clinical stage, and histological grade in cervical and endometrial cancers. The top BAG3-related pathways included ligand-receptor interactions and activity, DNA packaging and nucleosomes, hormonal responses, membrane regions, microdomains and rafts, and endosomes in breast cancer; ligand-receptor interactions, transmembrane transporters and channels, cell adhesion, and keratinisation in cervical cancer; ligand-receptor interactions, anion transmembrane transporters, lipoproteins, keratinisation, cell adhesion, and protein processing in endometrial cancer; metabolism of porphyrin, chlorophyll, pentose, uronic acid, ascorbate, and alternate and cell adhesion in ovarian cancer. BAG3 expression could represent a potential marker for carcinogenesis, histogenesis, aggressive behaviours, and prognosis in gynecological cancers.IMPACT STATEMENTWhat is already known on this subject? BAG3 regulates cell activity, autophagy, and resistance to apoptosis through multiple domains and plays an important role in tumour development. BAG3 positively regulates tumour cell invasion and migration in cervical and ovarian cancers.What do the results of this study add? BAG3 expression is closely associated with histogenesis, clinicopathology, and prognosis in gynecological cancers and is involved in signalling pathways associated with the control of cell proliferation, migration, invasion, and drug resistance in tumours.What are the implications of these findings for clinical practice and/or further research? Abnormal BAG3 expression can be employed as a possible marker of tumour development, invasion, and prognosis, providing new ideas for treating cancer.
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Affiliation(s)
- Zi-Mo Wang
- Cancer Center, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Li Zhang
- Department of Oncology, The Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Dong-Hui Ren
- Department of Oncology, The Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Cong-Yu Zhang
- Cancer Center, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Hua-Chuan Zheng
- Cancer Center, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
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Capozzi VA, Armano G, Maglietta G, Rosati A, Vargiu V, Scarpelli E, Sozzi G, Chiantera V, Cosentino F, Gioè A, Catena U, Scambia G, Fanfani F, Di Spiezio Sardo A, Ghi T, Berretta R. Hysteroscopic endometrial tumor localization and sentinel lymph node mapping. An upgrade of the hysteroscopic role in endometrial cancer patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106952. [PMID: 37328309 DOI: 10.1016/j.ejso.2023.06.004] [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: 03/09/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Given the growing interest in sentinel node mapping (SLN) biopsy in Endometrial Cancer (EC) patients, many efforts have been made to maximize the SLN bilateral detection rate. However, at present, no previous research assessed the potential correlation between primary EC location in the uterine cavity and SLN mapping. In this context, this study aims to investigate the possible role of intrauterine EC hysteroscopic localization in predicting SLN nodal placement. MATERIALS AND METHODS EC patients surgically treated from January 2017 to December 2021 were retrospectively analyzed. All patients underwent hysterectomy, bilateral salpingo-oophorectomy, and SLN mapping. During hysteroscopy, the location of the neoplastic lesion was described as follows: uterine fundus (comprising the most cranial portion of the uterine cavity up to the tubal ostium including the cornual areas), corpus uteri (from the tubal ostium to the inner uterine orifice), and diffuse (when the tumor invades more than 50% of the uterine cavity). RESULTS Three hundred ninety patients met the inclusion criteria. The tumor pattern diffused to the whole uterine cavity was statistically associated with SLN uptake on common iliac lymph nodes (OR 2.4, 95%CI 1-5.8, p = 0.05). Patients'age is an independent factor associated with SLN failure (OR: 0.95, 95%CI 0.93-0.98, p < 0.001). CONCLUSIONS The study showed a statistically significant association between EC hysteroscopically spread throughout the whole uterine cavity and SLN uptake at the common iliac lymph nodes. Furthermore, patient age negatively affected the SLN detection rate.
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Affiliation(s)
- Vito Andrea Capozzi
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy.
| | - Giulia Armano
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Giuseppe Maglietta
- Clinical and Epidemiological Research Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Andrea Rosati
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Virginia Vargiu
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Oncology, Gemelli Molise Spa, Campobasso, Italy
| | - Elisa Scarpelli
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Giulio Sozzi
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Francesco Cosentino
- Department of Oncology, Gemelli Molise Spa, Campobasso, Italy; Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università del Molise, Campobasso, Italy
| | - Alessandro Gioè
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ursula Catena
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Attilio Di Spiezio Sardo
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Roberto Berretta
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
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Johnson L, Cunningham MJ. Morbid obesity increases the failure rate of sentinel lymph node mapping for endometrial carcinoma. J Robot Surg 2023; 17:2047-2052. [PMID: 37148435 DOI: 10.1007/s11701-023-01609-8] [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: 12/21/2022] [Accepted: 04/23/2023] [Indexed: 05/08/2023]
Abstract
The goal of this study was to examine the relationship between body mass index (BMI) and the success rate of sentinel lymph node (SLN) mapping using indocyanine green and near-infrared imaging. Sentinel lymph node mapping is recommended for patients with endometrial carcinoma to reduce the rate of full lymphadenectomy and its associated morbidity such as lymphedema. A retrospective review was conducted of robotic hysterectomy procedures for patients with a coded diagnosis of endometrial cancer and a cost code for indocyanine green discharged between March, 2016 and August, 2019. Preoperative characteristics included age, BMI, and number of prior abdominal surgeries (includes cervical, adnexal, uterine or rectal procedures, caesarian section, or appendectomy). Intra and postoperative characteristics included procedure time (incision to close), estimated blood loss, the American Society of Anesthesiologists (ASA) physical status classification, uterine weight, uterine diameter, FIGO Grade, myometrial depth, and depth of myometrial invasion. SLN and non-SLN number, location, and pathology were recorded. The primary outcome was the bilateral success rate for SLN mapping. Patients with class III obesity (BMI > 40) were found to have a significantly lower success rate for SLN mapping when compared with all other BMI categories (54.1% vs. 76.1%, respectively, p < 0.01).
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Affiliation(s)
- Lynette Johnson
- Quality Improvement, Crouse Health, 736 Irving Avenue, Syracuse, NY, 13210, USA.
| | - Mary J Cunningham
- Gynecologic Oncology, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
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10
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Fennimore NJ, Fitch K, Kiff J, Nguyen CG, Garg B, Munro EG, Bruegl AS. Success Rates of Sentinel Lymph Node Mapping for Endometrial Cancer in Patients with Body Mass Index < 45 Compared with Body Mass Index ≥ 45. J Minim Invasive Gynecol 2023; 30:735-741. [PMID: 37142090 DOI: 10.1016/j.jmig.2023.04.013] [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: 03/13/2023] [Revised: 04/25/2023] [Accepted: 04/29/2023] [Indexed: 05/06/2023]
Abstract
STUDY OBJECTIVE The objective is to evaluate the rate of sentinel lymph node (SLN) mapping in patients with body mass index (BMI [kg/m2]) BMI ≥ 45 compared with < 45. DESIGN A retrospective chart review. SETTING Three urban referral-based settings-1 academic and 2 community based. PATIENTS Patients age ≥ 18 years, with endometrial intraepithelial neoplasia or clinical stage 1 endometrial cancer who underwent robot-assisted total laparoscopic hysterectomy with attempted SLN mapping between January 2015 and December 2021. INTERVENTIONS Robot-assisted total laparoscopic hysterectomy with attempted SLN mapping. MEASUREMENTS AND MAIN RESULTS A total of 933 subjects were included: 795 (85.2%) with BMI < 45 and 138 (14.8%) with BMI ≥ 45. Comparing the BMI < 45 with BMI ≥ 45 group, bilateral mapping was successful in 541 (68.1%) vs 63 (45.7%), respectively. Unilateral mapping was successful in 162 (20.4%) vs 33 (23.9%), respectively. Failure to map occurred in 92 (11.6%) vs 42 (30.4%) (p <.001), respectively. Exploratory analysis also suggested an inverse relationship between success rate of bilateral SLN mapping and BMI, with patients with BMI < 20 having bilateral SLN mapping rates of 86.5% and patients with BMI ≥ 61 having rates of 20.0%. The steepest decline in bilateral SLN mapping rates was from BMI group 46 to 50 compared to 51 to 55, at 55.4% to 37.5%, respectively. Adjusted odds ratio (compared with those with BMI < 30) for those in the BMI 30 to 44 group was 0.36 (95% confidence interval 0.21-0.60) and for those in the BMI ≥ 45 group was 0.10 (95% confidence interval 0.06-0.19). CONCLUSION There is a statistically significant lower rate of SLN mapping in patients with a BMI ≥ 45 than BMI < 45. Understanding the success of SLN mapping in patients with morbid obesity is essential for preoperative counseling, surgical planning, and developing a risk-appropriate postoperative treatment plan.
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Affiliation(s)
- Nicole J Fennimore
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (Drs. Fennimore, Fitch, Nguyen, Munro, and Bruegl and Garg), Oregon Health and Science University, Portland, OR.
| | - Katherine Fitch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (Drs. Fennimore, Fitch, Nguyen, Munro, and Bruegl and Garg), Oregon Health and Science University, Portland, OR
| | - Jaime Kiff
- Department of Obstetrics and Gynecology (Dr. Kiff), University of Oklahoma, Oklahoma City, OK
| | - Christine G Nguyen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (Drs. Fennimore, Fitch, Nguyen, Munro, and Bruegl and Garg), Oregon Health and Science University, Portland, OR
| | - Bharti Garg
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (Drs. Fennimore, Fitch, Nguyen, Munro, and Bruegl and Garg), Oregon Health and Science University, Portland, OR
| | - Elizabeth G Munro
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (Drs. Fennimore, Fitch, Nguyen, Munro, and Bruegl and Garg), Oregon Health and Science University, Portland, OR
| | - Amanda S Bruegl
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (Drs. Fennimore, Fitch, Nguyen, Munro, and Bruegl and Garg), Oregon Health and Science University, Portland, OR
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Iavazzo C, Kokkali K, Fotiou A. Parameters that may affect detection rates of SLN in morbidly obese patients with endometrial cancer and changes in everyday practice. J Robot Surg 2023; 17:1871. [PMID: 37378795 DOI: 10.1007/s11701-023-01661-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/24/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Christos Iavazzo
- Department of Gynecologic Oncology, "Metaxa" Memorial Cancer Hospital, Piraeus, Greece.
| | - Kalliopi Kokkali
- Department of Gynecologic Oncology, "Metaxa" Memorial Cancer Hospital, Piraeus, Greece
| | - Alexandros Fotiou
- Department of Gynecologic Oncology, "Metaxa" Memorial Cancer Hospital, Piraeus, Greece
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12
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Smits A, Ten Eikelder M, Dhanis J, Moore W, Blake D, Zusterzeel P, Kucukmetin A, Ratnavelu N, Rundle S. Finding the sentinel lymph node in early cervical cancer: When is unusual not uncommon? Gynecol Oncol 2023; 170:84-92. [PMID: 36657244 DOI: 10.1016/j.ygyno.2022.12.013] [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: 11/09/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To report our institutional experience with sentinel lymph node (SLN) detection using indocyanine green for cervical cancer, in terms of detection rates, detection of SLN at unusual locations, and factors associated with unusual SLN locations. In addition, we performed a systematic review of the literature to identify factors associated with unusual SLN localizations. METHODS This is a retrospective cohort study of women with early-stage cervical cancer undergoing sentinel lymph node mapping between 2015 and 2019. Outcome measures were SLN detection rates, detection rates of unusual locations for SLN and risk factors for aberrant lymphatic drainage pathways. In addition, studies evaluating factors associated with unusual SLN locations in cervical cancer were assessed in a systematic review. RESULTS A total of 100 patients were included. The unilateral SLN detection rate was 88%, whereas the bilateral detection rate was 75%. In 37% of all patients, SLN were found in unusual locations, and in 10% of patients SLN were solely found in unusual locations. Body mass index (BMI) was associated with finding SLN in unusual locations, with unusual nodes detected in 52% of patients with BMI <25 kg/m2 and in 28% of patients with BMI ≥25 kg/m2. The systematic review identified three studies, identifying lower BMI, nulliparity and tumor size of >20 mm as factors associated with finding SLN at unusual locations. CONCLUSION Aberrant drainage sites represent a significant proportion of SLN detected in cervical cancer. Factors associated with increased rates of unusual nodal locations are a lower BMI, with a possible association with nulliparity and tumor size of >20 mm.
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Affiliation(s)
- Anke Smits
- Dept. of Obstetrics and Gynaecology, Radboud University Medical Center, 6525, GA, Nijmegen, the Netherlands; Dept. of Gynecological Oncology, Queen Elizabeth Hospital, NE9 6SX, Gateshead, United Kingdom.
| | - Mieke Ten Eikelder
- Dept. of Obstetrics and Gynaecology, Radboud University Medical Center, 6525, GA, Nijmegen, the Netherlands
| | - Joelle Dhanis
- Faculty of Medical Sciences, Radboud University, 6526, GA, Nijmegen, the Netherlands
| | - William Moore
- Faculty of Medical Sciences, Newcastle University, NE2 4HH Newcastle Upon Tyne, United Kingdom
| | - Dominic Blake
- Dept. of Gynecological Oncology, Queen Elizabeth Hospital, NE9 6SX, Gateshead, United Kingdom
| | - Petra Zusterzeel
- Dept. of Obstetrics and Gynaecology, Radboud University Medical Center, 6525, GA, Nijmegen, the Netherlands
| | - Ali Kucukmetin
- Dept. of Gynecological Oncology, Queen Elizabeth Hospital, NE9 6SX, Gateshead, United Kingdom
| | - Nithya Ratnavelu
- Dept. of Gynecological Oncology, Queen Elizabeth Hospital, NE9 6SX, Gateshead, United Kingdom
| | - Stuart Rundle
- Dept. of Gynecological Oncology, Queen Elizabeth Hospital, NE9 6SX, Gateshead, United Kingdom
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13
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Zhang M, Li R, Zhang S, Xu X, Liao L, Yang Y, Guo Y. Analysis of prognostic factors of metastatic endometrial cancer based on surveillance, epidemiology, and end results database. Front Surg 2023; 9:1001791. [PMID: 36684133 PMCID: PMC9852622 DOI: 10.3389/fsurg.2022.1001791] [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: 07/24/2022] [Accepted: 10/24/2022] [Indexed: 01/08/2023] Open
Abstract
Objective To explore the risk factors for survival and prognosis of patients with metastatic endometrial cancer and to build and verify a reliable prediction model. Methods We retrospectively analyzed patients diagnosed with metastatic endometrial cancer in the US Surveillance, Epidemiology, and End Results (SEER) database between January 2010 and December 2015. Univariate and multivariate Cox regression analyses were used to assess clinical variables impact on survival and to construct nomograms. The results of the consistency index (C-index), subject operating characteristic (ROC) curve, and calibration curve were used to evaluate the predictive ability of the nomogram. Results This study included 3,878 patients with metastatic endometrial cancer. In the univariate analysis, variables associated with overall survival (OS) and cancer-specific survival (CSS) included age, race, marital status, pathological type, pathological grade, T-stage, N-stage, surgery, radiotherapy, chemotherapy, bone metastasis, brain metastasis, liver metastasis, and lung metastasis. In the multivariate analysis, age, race, pathological type, pathological grade, T-stage, N-stage, surgery, radiotherapy, chemotherapy, brain metastasis, liver metastasis, and lung metastasis were independent risk factors for OS and CSS (all P < 0.05). Combined with the results of the multiple factors, the 1-, 3-, 5-, and 8-year nomograms were constructed. For OS and CSS, T-stage had the greatest impact on the adverse prognosis of patients with metastatic endometrial cancer. The C-indexes of the OS and CSS nomograms in the training cohort were 0.749 (95% CI, 0.739-0.760) and 0.746 (95% CI, 0.736-0.756), respectively. The C-indices of OS and CSS in the validation cohort were 0.730 (95% CI, 0.714-0.746) and 0.728 (95% CI, 0.712-0.744), respectively. The ROC curve revealed our model's good prediction accuracy and clinical practicability. The calibration curve also confirmed the consistency between the model and actual existence. The Kaplan-Meier curves revealed statistically significant differences between the risk subgroups (P < 0.05). Conclusion Our SEER-based nomograms for predicting survival in patients with metastatic endometrial cancer were helpful for the clinical evaluation of patient prognosis.
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14
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Han X, Wang Z, Huang D, Deng K, Wang Q, Li C, Zhu J. Analysis of the disease burden trend of malignant tumors of the female reproductive system in China from 2006 to 2020. BMC Womens Health 2022; 22:504. [PMID: 36476597 PMCID: PMC9730658 DOI: 10.1186/s12905-022-02104-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Malignant tumors of reproductive system seriously threaten women's life and health. We analyzed the changes in mortality and disease burden of cervical cancer, uterine cancer and ovarian cancer in China from 2006 to 2020 to provide a basis for formulating scientific prevention and control measures. METHODS Annual death data for cervical cancer, uterine cancer and ovarian cancer were collected from the Chinese Cause of Death Surveillance. The crude mortality rate (CMR), age-standardized mortality rate (ASMR), annual percentage change (APC), and average APC (AAPC) were applied to analyze the trend of mortality. Loss of life expectancy (LLE) and years of life lost (YLL) were used to assess disease burden. RESULTS From 2006 to 2020, there was no significant change in the total ASMR and standardized YLL rates of malignant tumors of the reproductive system, leading to an average LLE of 0.18 years. The YLL rate was the highest in the 55-59 age group. The mortality rate and disease burden of the three types of cancer have changed from uterine cancer higher than cervical cancer and ovarian cancer in 2006 to cervical cancer higher than ovarian cancer and uterine cancer in 2020. The ASMR and standardized YLL rate of uterine cancer showed a downward trend, and AAPC was - 5.21% (- 9.31% ~ - 0.91%) and - 6.07% (- 9.45% ~ - 2.58%), respectively. The mortality rates of cervical cancer and ovarian cancer remain high. CONCLUSION The mortality and disease burden of malignant tumors of the female reproductive system in China are still at a high level. It is necessary to improve screening and prevention strategies as soon as possible, improve the techniques of diagnosis and treatment, and take adequate measures to protect women's life and health.
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Affiliation(s)
- Xiting Han
- grid.452842.d0000 0004 8512 7544Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University, 2 Jingba Road, Zhengzhou, 450001 Henan People’s Republic of China
| | - Zhihong Wang
- grid.452842.d0000 0004 8512 7544Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University, 2 Jingba Road, Zhengzhou, 450001 Henan People’s Republic of China
| | - Dongmei Huang
- grid.452842.d0000 0004 8512 7544Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University, 2 Jingba Road, Zhengzhou, 450001 Henan People’s Republic of China
| | - Kehong Deng
- grid.452842.d0000 0004 8512 7544Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University, 2 Jingba Road, Zhengzhou, 450001 Henan People’s Republic of China
| | - Qian Wang
- grid.452842.d0000 0004 8512 7544Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University, 2 Jingba Road, Zhengzhou, 450001 Henan People’s Republic of China
| | - Cancan Li
- grid.452842.d0000 0004 8512 7544Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University, 2 Jingba Road, Zhengzhou, 450001 Henan People’s Republic of China
| | - Jicun Zhu
- grid.452842.d0000 0004 8512 7544Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University, 2 Jingba Road, Zhengzhou, 450001 Henan People’s Republic of China ,grid.207374.50000 0001 2189 3846College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001 Henan People’s Republic of China
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15
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Yuan L, Chen Y, Li X, Jin H, Shi J. Predictive models for overall survival in breast cancer patients with a second primary malignancy: a real-world study in Shanghai, China. BMC Womens Health 2022; 22:498. [PMID: 36474253 PMCID: PMC9724326 DOI: 10.1186/s12905-022-02079-0] [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: 09/03/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The incidents of second primary malignancy (SPM) is increasing among breast cancer (BC) patients with long-term progression, adversely affecting survival. The purpose of this study was to screen independent overall survival (OS) risk factors and establish nomograms to predict the survival probabilities of BC patients with SPM. METHOD A total of 163 BC patients with SPM were recruited during 2002-2015 from a total of 50 hospitals in Shanghai, China. Two nomograms to predict survival from primary BC and SPM diagnosis were constructed based on independent factors screened from multivariable analysis. The calibration and discrimination of nomograms were calculated in the training and validation cohorts. RESULTS The overall survival rates of BC patients with SPM were 88.34%, 64.42% and 54.66% at 5, 10 and 15 years, respectively. Factors of late TNM stage of SPM (HR = 4.68, 95% CI 2.14-10.25), surgery for SPM (HR = 0.60, 95% CI 0.36-1.00), SPM in the colon and rectum (HR = 0.49, 95% CI 0.25-0.98) and thyroid (HR = 0.08, 95% CI 0.01-0.61) independently affected the OS of BC patients with SPM (p < 0.05). In addition, a longer latency (≥ 5 years) was associated with better OS from BC diagnosis (p < 0.001). Older age (≥ 56) was associated with poor OS from SPM diagnosis (p = 0.019). Two nomograms established based on the above factors had better calibration and discrimination. CONCLUSION The TNM stage of SPM, surgery for SPM, SPM sites, latency and age at BC diagnosis are independent factors for survival and the two nomograms may provide more personalized management for BC patients with SPM.
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Affiliation(s)
- Ling Yuan
- grid.16821.3c0000 0004 0368 8293School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 China
| | - Yichen Chen
- Center for Disease Control and Prevention, Pudong New Area, Shanghai, 200136 China ,grid.8547.e0000 0001 0125 2443Fudan University Pudong Institute of Preventive Medicine, Pudong New Area, Shanghai, China
| | - Xiaopan Li
- grid.11841.3d0000 0004 0619 8943Department of Health Management Center, Zhongshan Hospital, Shanghai Medical College of Fudan University, 180 Fenglin RD, Shanghai, 200032 China
| | - Hua Jin
- grid.24516.340000000123704535Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue RD, Shanghai, 200090 China ,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090 China
| | - Jianwei Shi
- grid.24516.340000000123704535Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue RD, Shanghai, 200090 China ,grid.16821.3c0000 0004 0368 8293Department of Social Medicine and Health Management, School of Public Health, Shanghai Jiaotong Universtiy School of Medicine, 227 South Chongqing RD, Shanghai, 200025 China
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Clinical factors associated with failed sentinel lymph node mapping in endometrial cancer. Gynecol Oncol Rep 2022; 44:101080. [PMID: 36249905 PMCID: PMC9554829 DOI: 10.1016/j.gore.2022.101080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/29/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Objective Sentinel lymph node (SLN) mapping is a highly accurate surgical technique for detecting metastases in endometrial cancer. The objective of this study was to identify clinical factors associated with failed mapping. Methods All patients with endometrial cancer undergoing minimally-invasive staging and planned SLN biopsy from 1/1/2017 to 12/31/2020 at a single institution were identified retrospectively. Demographic, clinicopathologic and treatment data were obtained. Data were compared using descriptive statistics. Univariate and multivariable logistic regression were performed to identify predictors of failed mapping. Results 819 patients were identified with a mean age of 64.6 years (range 26-93) and mean BMI of 35.6 kg/m2 (range 18-68). Most (88.5 %, 725/819) had early-stage disease and endometrioid histology (82.3 %, 674/819). A majority (74.2 %, 608/819) had successful bilateral mapping, and 54 (6.6 %) had unsuccessful bilateral mapping. Increasing BMI was significantly associated with unsuccessful bilateral mapping: patients with BMI > 30 were more likely to have unsuccessful SLN mapping (p = 0.033). Among patients with known lymph node status (799/819), patients with macrometastases and micrometastases were more likely to have failed bilateral mapping compared to those with negative SLNs or isolated tumor cells (p = 0.013). On multivariable analysis, higher BMI and histology were associated with failed bilateral mapping (OR = 1.023, 95 % CI (1.005, 1.041) and OR = 1.678, 95 % CI (1.177, 2.394), respectively). Conclusion SLN mapping has a high success in patients undergoing minimally-invasive surgical staging for endometrial cancer. Increasing BMI, high risk histology, and lymph node metastases are risk factors for failed mapping.
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Paredes P, Díaz-Feijoo B, Aguilar Galán E, de Matías Martínez M, Fuertes Cabero S. Controversias en la técnica de detección del ganglio centinela en cáncer de endometrio. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bogani G, Di Donato V, Papadia A, Buda A, Casarin J, Multinu F, Plotti F, Cuccu I, D'Auge TG, Gasparri ML, Pinelli C, Perrone AM, Barra F, Sorbi F, Cromi A, Di Martino G, Palaia I, Perniola G, Ferrero S, De Iaco P, Perrone C, Angioli R, Luvero D, Muzii L, Ghezzi F, Landoni F, Mueller MD, Benedetti Panici P, Raspagliesi F. Evaluating long-term outcomes of three approaches to retroperitoneal staging in endometrial cancer. Gynecol Oncol 2022; 166:277-283. [PMID: 35725656 DOI: 10.1016/j.ygyno.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: 05/04/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Sentinel lymph node mapping (SNM) has gained popularity in managing apparent early-stage endometrial cancer (EC). Here, we evaluated the long-term survival of three different approaches of nodal assessment. METHODS This is a multi-institutional retrospective study evaluating long-term outcomes of EC patients having nodal assessment between 01/01/2006 and 12/31/2016. In order to reduce possible confounding factors, we applied a propensity-matched algorithm. RESULTS Overall, 940 patients meeting inclusion criteria were included in the study, of which 174 (18.5%), 187 (19.9%), and 579 (61.6%) underwent SNM, SNM followed by backup lymphadenectomy (LND) and LND alone, respectively. Applying a propensity score matching algorithm (1:1:2) we selected 500 patients, including 125 SNM, 125 SNM/backup LND, and 250 LND. Baseline characteristics of the study population were similar between groups. The prevalence of nodal disease was 14%, 16%, and 12% in patients having SNM, SNM/backup LND and LND, respectively. Overall, 19 (7.6%) patients were diagnosed with low volume nodal disease. The survival analysis comparing the three techniques did not show statistical differences in terms of disease-free (p = 0.750) and overall survival (p = 0.899). Similarly, the type of nodal assessment did not impact survival outcomes after stratification based on uterine risk factors. CONCLUSION Our study highlighted that SNM provides similar long-term oncologic outcomes than LND.
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Affiliation(s)
- Giorgio Bogani
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy.
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland
| | - Alessandro Buda
- Division of Gynecologic Oncology, Michele e Pietro Ferrero Hospital, 12060 Verduno, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Francesco Multinu
- Division of Gynecologic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Plotti
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Ilaria Cuccu
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Tullio Golia D'Auge
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Anna Myriam Perrone
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University, Hospital University of Bologna, 40138 Bologna, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Flavia Sorbi
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Giampaolo Di Martino
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Giorgia Perniola
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Pierandrea De Iaco
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University, Hospital University of Bologna, 40138 Bologna, Italy
| | - Chiara Perrone
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Daniela Luvero
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Fabio Landoni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | | | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
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Huber D, Hurni Y. Sentinel Node Biopsy for Endometrial Cancer by Retroperitoneal Transvaginal Natural Orifice Transluminal Endoscopic Surgery: A Preliminary Study. Front Surg 2022; 9:907548. [PMID: 35615644 PMCID: PMC9125023 DOI: 10.3389/fsurg.2022.907548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe primary objective was to determine the intraoperative and postoperative surgical complications of sentinel lymph node biopsy (SLNB) by retroperitoneal transvaginal natural orifice transluminal endoscopic surgery (vNOTES). The secondary objective was to assess the feasibility of this surgical technique.MethodsThis was a descriptive study realized in a non-university hospital in Switzerland. Seven patients with endometrial cancer or endometrial complex atypical hyperplasia underwent surgical staging with SLNB by retroperitoneal vNOTES using an indocyanine green-based near-infrared fluorescence imaging technique (October 2021–February 2022).ResultsThe median operative time was 113 (81–211) minutes. The median estimated blood loss was 20 (20–400) mL. The overall bilateral detection rate was 100% (7/7). Upon histopathological examination, 5 patients presented an endometrial adenocarcinoma, and we found endometrial complex atypical hyperplasia in 2 cases. We successfully completed all procedures without significant intraoperative complications, but 1 case required conversion to conventional laparoscopy. The median postoperative stay was 2 (2–4) days, and we observed no postoperative complications during this period. We observed 1 case of postoperative deep vein thrombosis and an asymptomatic vaginal vault hematoma in the same patient.ConclusionsOur preliminary study suggests that retroperitoneal vNOTES could be a feasible, safe, and valuable approach to perform SLNB in endometrial cancer. However, strong evidence of its feasibility, the effective benefits, and the long-term oncological outcomes is needed before expanding the use of vNOTES in endometrial cancer outside study settings.
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Affiliation(s)
- Daniela Huber
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Yannick Hurni
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
- Correspondence: Yannick Hurni
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