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Ogunbiyi MO, Oxley S, Graham R, Olaitan A. The oncological and reproductive outcomes of fertility-preserving treatments for stage 1 grade 1 endometrial carcinoma: a systematic review and meta-analysis. J OBSTET GYNAECOL 2024; 44:2294329. [PMID: 38126736 DOI: 10.1080/01443615.2023.2294329] [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: 02/18/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The number of patients desiring fertility-preserving treatment for endometrial cancer rather than standard surgical management continues to increase. OBJECTIVE We aimed to evaluate the efficacies of fertility-preserving treatments on the live birth rate, remission and relapse rates for women with stage 1a grade 1 endometrial carcinoma to support patient counselling. METHODS We performed a meta-analysis for our primary outcomes of overall remission and relapse rate, and for secondary analysis, we divided papers into treatment type: systemic progestins, intrauterine progestins or hysteroscopic resection and adjuvant hormonal treatment. RESULTS Thirty-five observational studies met inclusion criteria, with a total of 624 patients. Overall, conservative treatment of endometrial cancer showed a remission rate of 77% (95% CI: 70-84%), a relapse rate of 20% (95% CI: 13-27%) and a live birth rate of 20% (95% CI: 15-25%) with more favourable outcomes for the hysteroscopic resection group. CONCLUSIONS Hysteroscopic resection and adjuvant hormonal treatment had the most favourable fertility and oncological outcomes. Further high-quality prospective multi-centre trials are warranted to determine the optimal treatment regimen and dosage and risk stratification for these patients.
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Affiliation(s)
| | - Samuel Oxley
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Radha Graham
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Adeola Olaitan
- University College London Hospitals NHS Foundation Trust, London, UK
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2
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Wijayabahu AT, Shiels MS, Arend RC, Clarke MA. Uterine cancer incidence trends and 5-year relative survival by race/ethnicity and histology among women under 50 years. Am J Obstet Gynecol 2024:S0002-9378(24)00694-X. [PMID: 38925206 DOI: 10.1016/j.ajog.2024.06.026] [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: 02/08/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Uterine cancers diagnosed before age 50 years are increasing in the U.S., but changes in clinical characteristics and survival over time across racial/ethnic groups have not been previously described. OBJECTIVE To investigate age-adjusted, hysterectomy corrected incidence rates and trends, and 5-year relative survival rates of uterine cancer in women aged <50 years, overall and stratified by race/ethnicity and histology. STUDY DESIGN We included microscopically confirmed uterine cancer cases (diagnosed 2000-2019) in women aged 20 to 49 years from the Surveillance, Epidemiology, and End Results Program. Age-adjusted incidence and 5-year relative survival rates, and 95% confidence intervals were computed using Surveillance, Epidemiology, and End Results (SEER) ∗Stat and compared across time periods (2000-2009 and 2010-2019). Incidence rates were adjusted for hysterectomy prevalence using Behavioral Risk Factor Surveillance System data, and trends were computed using the Joinpoint regression program. RESULTS We included 57,128 uterine cancer cases. The incidence of uterine cancer increased from 10.1 per 100,000 in 2000-2009 to 12.0 per 100,000 in 2010-2019, increasing at an annual rate of 1.7%/y for the entire period. Rising trends were more pronounced among women <40 years (3.0%/y and 3.3%/y in 20-29 and 30-39 years, respectively) than in those 40 to 49 years (1.3%/y), and among underrepresented racial/ethnic groups (Hispanic 2.8%/y, non-Hispanic-Black 2.7%, non-Hispanic-Asian/Pacific Islander 2.1%) than in non-Hispanic-White (0.9%/y). Recent (2010-2019) incidence rates were highest for endometrioid (9.6 per 100,000), followed by sarcomas (1.2), and nonendometrioid subtypes (0.9). Rates increased significantly for endometrioid subtypes at 1.9%/y from 2000 to 2019. Recent endometrioid and nonendometrioid rates were highest in non-Hispanic-Native American/Alaska Native (15.2 and 1.4 per 100,000), followed by Hispanic (10.9 and 1.0), non-Hispanic-Asian/Pacific Islander (10.2 and 0.9), non-Hispanic-White (9.4 and 0.8), and lowest in non-Hispanic-Black women (6.4 and 0.8). Sarcoma rates were highest in non-Hispanic-Black women (1.8 per 100,000). The 5-year relative survival remained unchanged over time for women with endometrioid (from 93.4% in 2000-2009 to 93.9% in 2010-2019, P≥.05) and nonendometrioid subtypes (from 73.2% to 73.2%, P≥.05) but decreased for women with sarcoma from 69.8% (2000-2009) to 66.4% (2010-2019, P<.05). CONCLUSION Uterine cancer incidence rates in women <50 years have increased from 2000 to 2019 while survival has remained relatively unchanged. Incidence trends can be primarily attributed to increasing rates of cancers with endometrioid histology, with the greatest increases observed among non-Hispanic-Black, Hispanic, and non-Hispanic-Asian/Pacific Islander. Sarcomas, while much rarer, were the second most common type of uterine cancer among women <50 years and have poor prognosis and apparent decreasing survival over time. Rising rates of uterine cancer and the distinct epidemiologic patterns among women <50 years highlight the need for effective prevention and early detection strategies for uterine cancer in this age group.
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Affiliation(s)
- Akemi T Wijayabahu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD.
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Rebecca C Arend
- Department of Obstetrics and Gynecology-Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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Vasileva R, Wohrer H, Gaultier V, Bucau M, Courcier H, Ben Miled S, Gonthier C, Koskas M. Pregnancy and obstetric outcomes after fertility-sparing management of endometrial cancer and atypical hyperplasia: a multicentre cohort study. Hum Reprod 2024; 39:1231-1238. [PMID: 38719783 DOI: 10.1093/humrep/deae089] [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: 02/25/2024] [Revised: 04/08/2024] [Indexed: 06/04/2024] Open
Abstract
STUDY QUESTION What are the pregnancy and obstetric outcomes in women with atypical hyperplasia (AH) or early-stage endometrial cancer (EC) managed conservatively for fertility preservation? SUMMARY ANSWER The study found a live birth rate of 62% in patients with AH or EC after conservative treatment, with higher level of labour induction, caesarean section, and post-partum haemorrhage. WHAT IS KNOWN ALREADY Fertility-sparing treatment is a viable option for women with AH or EC during childbearing years, but the outcomes of such treatments, especially regarding pregnancy and obstetrics, need further exploration. STUDY DESIGN, SIZE, DURATION This retrospective cohort study analysed data from January 2010 to October 2022, involving 269 patients from the French national register of patients with fertility-sparing management of AH/EC. PARTICIPANTS/MATERIALS, SETTING, METHODS Women above 18 years of age, previously diagnosed with AH/EC, and approved for fertility preservation were included. Patients were excluded if they were registered before 2010, if their treatment began <6 months before the study, or if no medical record on the pregnancy was available. MAIN RESULTS AND THE ROLE OF CHANCE In total, 95 pregnancies in 67 women were observed. Pregnancy was achieved using ART in 63 cases (66%) and the live birth rate was 62%, with early and late pregnancy loss at 26% and 5%, respectively. In the 59 cases resulting in a live birth, a full-term delivery occurred in 90% of cases; 36% of cases required labour induction and 39% of cases required a caesarean section. The most common maternal complications included gestational diabetes (17%) and post-partum haemorrhaging (20%). The average (±SD) birthweight was 3110 ± 736 g; there were no significant foetal malformations in the sample. No significant difference was found in pregnancy or obstetric outcomes between ART-obtained and spontaneous pregnancies. However, the incidence of induction of labour, caesarean section, and post-partum haemorrhage appears higher than in the general population. LIMITATIONS, REASONS FOR CAUTION The retrospective nature of the study may introduce bias, and the sample size might be insufficient for assessing rare obstetric complications. WIDER IMPLICATIONS OF THE FINDINGS This study offers valuable insights for healthcare providers to guide patients who received fertility-sparing treatments for AH/EC. These pregnancies can be successful and with an acceptable live birth rate, but they seem to be managed with caution, leading to possible tendency for more caesarean sections and labour inductions. No increase in adverse obstetric outcomes was observed, with the exception of suspicion of a higher risk of post-partum haemorrhaging, to be confirmed. STUDY FUNDING/COMPETING INTEREST(S) No funding was received for this study. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Radostina Vasileva
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
- Faculty of Medicine, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Henri Wohrer
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Victor Gaultier
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Margot Bucau
- Department of Anatomic Pathology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Hélène Courcier
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Selima Ben Miled
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Clementine Gonthier
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Martin Koskas
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
- Faculty of Medicine, Paris Cité University, Paris, France
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Krasnyi AM, Gadzhieva LT, Kokoeva DN, Kosenko MG, Yarotskaya EL, Pavlovich SV, Ashrafyan LA, Sukhikh GT. Analysis of CDO1, PITX2, and CDH13 Gene Methylation in Early Endometrial Cancer for Prediction of Medical Treatment Outcomes. Int J Mol Sci 2024; 25:4892. [PMID: 38732110 PMCID: PMC11084267 DOI: 10.3390/ijms25094892] [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: 02/21/2024] [Revised: 04/15/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
An observational cohort study of patients diagnosed with endometrial cancer (EC) stage IA G1, or atypical endometrial hyperplasia (AEH), undergoing organ-preserving treatment, was conducted. OBJECTIVE OF THE STUDY To determine CDO1, PITX2, and CDH13 gene methylation levels in early endometrial cancer and atypical hyperplasia specimens obtained before organ-preserving treatment in the patients with adequate response and with insufficient response to hormonal treatment. MATERIALS AND METHODS A total of 41 endometrial specimens obtained during diagnostic uterine curettage in women with EC (n = 28) and AEH (n = 13), willing to preserve reproductive function, were studied; 18 specimens of uterine cancer IA stage G1 from peri- and early postmenopausal women (comparison group) were included in the study. The control group included 18 endometrial specimens from healthy women obtained by diagnostic curettage for missed abortion and/or intrauterine adhesions. Methylation levels were analyzed using the modified MS-HRM method. RESULTS All 13 women with AEH had a complete response (CR) to medical treatment. In the group undergoing organ-preserving treatment for uterine cancer IA stage G1 (n = 28), 14 patients had a complete response (EC CR group) and 14 did not (EC non-CR group). It was found that all groups had statistically significant differences in CDO1 gene methylation levels compared to the control group (p < 0.001) except for the EC CR group (p = 0.21). The p-value for the difference between EC CR and EC non-CR groups was <0.001. The differences in PITX2 gene methylation levels between the control and study groups were also significantly different (p < 0.001), except for the AEH group (p = 0.21). For the difference between EC CR and EC non-CR groups, the p-value was 0.43. For CDH13 gene methylation levels, statistically significant differences were found between the control and EC non-CR groups (p < 0.001), and the control and EC comparison groups (p = 0.005). When comparing the EC CR group with EC non-CR group, the p-value for this gene was <0.001. The simultaneous assessment of CDO1 and CDH13 genes methylation allowed for an accurate distinction between EC CR and EC non-CR groups (AUC = 0.96). CONCLUSION The assessment of CDO1 and CDH13 gene methylation in endometrial specimens from patients with endometrial cancer (IA stage G1), scheduled for medical treatment, can predict the treatment outcome.
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Affiliation(s)
- Aleksey M. Krasnyi
- V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, 117198 Moscow, Russia
| | - Lyubov T. Gadzhieva
- Moscow Multidisciplinary Clinical Center “Kommunarka”, 108814 Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Diana N. Kokoeva
- V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, 117198 Moscow, Russia
| | - Mark G. Kosenko
- V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, 117198 Moscow, Russia
| | - Ekaterina L. Yarotskaya
- V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, 117198 Moscow, Russia
| | - Stanislav V. Pavlovich
- V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, 117198 Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Levon A. Ashrafyan
- V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, 117198 Moscow, Russia
| | - Gennady T. Sukhikh
- V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, 117198 Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
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Bassette E, Ducie JA. Endometrial Cancer in Reproductive-Aged Females: Etiology and Pathogenesis. Biomedicines 2024; 12:886. [PMID: 38672240 PMCID: PMC11047839 DOI: 10.3390/biomedicines12040886] [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: 02/01/2024] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Endometrial cancer is the most common gynecologic malignancy in developed countries, and the incidence is rising in premenopausal females. Type I EC is more common than Type II EC (80% vs. 20%) and is associated with a hyperestrogenic state. Estrogen unopposed by progesterone is considered to be the main driving factor in the pathogenesis of EC. Studies show that BMI > 30 kg/m2, prolonged duration of menses, nulliparity, presence of polycystic ovarian syndrome, and Lynch syndrome are the most common causes of EC in premenopausal women. Currently, there are no guidelines established to indicate premenopausal patients who should be screened. This review aims to synthesize current data on the etiology, risk factors, presentation, evaluation, and prognosis of endometrial cancer in this population.
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Affiliation(s)
- Emma Bassette
- Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, NE 68178, USA;
| | - Jennifer A. Ducie
- Methodist Gynecology Oncology, Nebraska Methodist Hospital, Omaha, NE 68114, USA
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6
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Etrusco A, Laganà AS, Chiantera V, Mikuš M, Arsalan HM, d’Amati A, Vitagliano A, Cicinelli E, Favilli A, D’Amato A. Reproductive and Oncologic Outcomes in Young Women with Stage IA and Grade 2 Endometrial Carcinoma Undergoing Fertility-Sparing Treatment: A Systematic Review. Biomolecules 2024; 14:306. [PMID: 38540726 PMCID: PMC10968417 DOI: 10.3390/biom14030306] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Endometrial cancer (EC) is the most common gynecological malignancy in both Europe and the USA. Approximately 3-5% of cases occur in women of reproductive age. Fertility-sparing treatment (FST) options are available, but very limited evidence regarding grade 2 (G2) ECs exists in the current literature. This systematic review aimed to comprehensively evaluate reproductive and oncologic outcomes among young women diagnosed with stage IA or G2EC disease who underwent FST. METHODS A comprehensive search of the literature was carried out on the following databases: MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), the Health Technology Assessment Database, and Web of Science. Only original studies that reported the oncologic and reproductive outcomes of patients with stage IA and G2EC tumors who underwent FST were considered eligible for inclusion in this systematic review (CRD42023484892). Studies describing only the FST for endometrial hyperplasia or G1 EC were excluded. RESULTS Twenty-two papers that met the abovementioned inclusion criteria were included in the present systematic review. Preliminary analysis suggested encouraging oncologic and reproductive outcomes after FST. CONCLUSIONS The FST approach may represent a feasible and safe option for women of childbearing age diagnosed with G2EC. Despite these promising findings, cautious interpretation is warranted due to inherent limitations, including heterogeneity in study designs and potential biases. Further research with standardized methodologies and larger sample sizes is imperative for obtaining more robust conclusions.
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Affiliation(s)
- Andrea Etrusco
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy; (A.E.); (A.S.L.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy; (A.E.); (A.S.L.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
- Unit of Gynecologic Oncology, National Cancer Institute—IRCCS—Fondazione “G. Pascale”, 80131 Naples, Italy
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, 10 000 Zagreb, Croatia;
| | - Hafiz Muhammad Arsalan
- Faculty of General Medicine, Altamimi Bachelor Clinical University, Bishkek 720000, Kyrgyzstan;
| | - Antonio d’Amati
- Gynaecological Pathology Unit, Anatomical Pathology Division, Department of Woman and Child’s Health and Public Health Sciences, “Agostino Gemelli” Foundation IRCCS University Hospital, 00168 Rome, Italy;
- Unit of Human Anatomy and Histology, Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Amerigo Vitagliano
- Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.V.); (E.C.)
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.V.); (E.C.)
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy;
| | - Antonio D’Amato
- Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.V.); (E.C.)
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7
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Green RW, Fischerová D, Testa AC, Franchi D, Frühauf F, Lindqvist PG, di Legge A, Cibula D, Fruscio R, Haak LA, Opolskiene G, Vidal Urbinati AM, Timmerman D, Bourne T, van den Bosch T, Epstein E. Sonographic, Demographic, and Clinical Characteristics of Pre- and Postmenopausal Women with Endometrial Cancer; Results from a Post Hoc Analysis of the IETA4 (International Endometrial Tumor Analysis) Multicenter Cohort. Diagnostics (Basel) 2023; 14:1. [PMID: 38201310 PMCID: PMC10802150 DOI: 10.3390/diagnostics14010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/01/2023] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
In this study, we conducted a comparative analysis of demographic, histopathological, and sonographic characteristics between pre- and postmenopausal women diagnosed with endometrial cancer, while also examining sonographic and anthropometric features in 'low' and 'intermediate/high-risk' cases, stratified by menopausal status. Our analysis, based on data from the International Endometrial Tumor Analysis (IETA) 4 cohort comprising 1538 women (161 premenopausal, 1377 postmenopausal) with biopsy-confirmed endometrial cancer, revealed that premenopausal women, compared to their postmenopausal counterparts, exhibited lower parity (median 1, IQR 0-2 vs. 1, IQR 1-2, p = 0.001), a higher family history of colon cancer (16% vs. 7%, p = 0.001), and smaller waist circumferences (median 92 cm, IQR 82-108 cm vs. 98 cm, IQR 87-112 cm, p = 0.002). Premenopausal women more often had a regular endometrial-myometrial border (39% vs. 23%, p < 0.001), a visible endometrial midline (23% vs. 11%, p < 0.001), and undefined tumor (73% vs. 84%, p = 0.001). Notably, despite experiencing a longer duration of abnormal uterine bleeding (median 5 months, IQR 3-12 vs. 3 months, 2-6, p < 0.001), premenopausal women more often had 'low' risk disease (78% vs. 46%, p < 0.001). Among sonographic and anthropometric features, only an irregular endometrial-myometrial border was associated with 'intermediate/high' risk in premenopausal women. Conversely, in postmenopausal women, multiple features correlated with 'intermediate/high' risk disease. Our findings emphasize the importance of considering menopausal status when evaluating sonographic features in women with endometrial cancer.
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Affiliation(s)
- Rasmus W. Green
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden; (P.G.L.)
| | - Daniela Fischerová
- Department of Gynaecology, Obstetrics and Neonatology, General University Hospital and First Faculty of Medicine, Charles University, Apolinářská 18, 128 51 Prague, Czech Republic; (D.F.); (F.F.); (D.C.)
| | - Antonia C. Testa
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, 00168 Rome, Italy
| | - Dorella Franchi
- Department of Gynecological Oncology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (D.F.); (A.M.V.U.)
| | - Filip Frühauf
- Department of Gynaecology, Obstetrics and Neonatology, General University Hospital and First Faculty of Medicine, Charles University, Apolinářská 18, 128 51 Prague, Czech Republic; (D.F.); (F.F.); (D.C.)
| | - Pelle G. Lindqvist
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden; (P.G.L.)
- Department of Obstetrics and Gynecology, Södersjukhuset, 118 83 Stockholm, Sweden
| | - Alessia di Legge
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - David Cibula
- Department of Gynaecology, Obstetrics and Neonatology, General University Hospital and First Faculty of Medicine, Charles University, Apolinářská 18, 128 51 Prague, Czech Republic; (D.F.); (F.F.); (D.C.)
| | - Robert Fruscio
- UO Gynecology, Department of Medicine and Surgery, IRCCS San Gerardo, University of Milan Bicocca, 20126 Milan, Italy;
| | - Lucia A. Haak
- Institute for the Care of Mother and Child, Prague and Third Faculty of Medicine, Charles University, 147 00 Prague, Czech Republic
| | - Gina Opolskiene
- Center of Obstetrics and Gynecology, Faculty of Medicine, Vilnius University Hospital, 08661 Vilnius, Lithuania;
| | - Ailyn M. Vidal Urbinati
- Department of Gynecological Oncology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (D.F.); (A.M.V.U.)
| | - Dirk Timmerman
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; (D.T.); (T.v.d.B.)
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
| | - Tom Bourne
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; (D.T.); (T.v.d.B.)
- Department of Obstetrics and Gyneacology, Queen Charlotte’s and Chelsea Hospital, Imperial College London, London W12 0HS, UK
| | - Thierry van den Bosch
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; (D.T.); (T.v.d.B.)
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
| | - Elisabeth Epstein
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden; (P.G.L.)
- Department of Obstetrics and Gynecology, Södersjukhuset, 118 83 Stockholm, Sweden
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8
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Ai F, Qin X, Zhou L, Wang S. Analysis of factors related to endometrial cancer in postmenopausal women with endometrial thickening. Menopause 2023; 30:920-926. [PMID: 37555714 DOI: 10.1097/gme.0000000000002232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To investigate the factors related to endometrial cancer (EC) in postmenopausal women with endometrial thickening and the value of endometrial thickness (ET) in predicting EC. METHODS A retrospective study of 385 referrals to our department for hysteroscopic diagnostic curettage assessment was carried out. Univariate analysis and multiple logistic regression analysis were used to identify the independent contributors to the development of EC. The ability of ET to predict EC was evaluated by receiver operating characteristic curve analysis. RESULTS The follow-up period from the identification of endometrial thickening to pathological confirmation of EC was from 2 weeks to 3 months. In the postmenopausal bleeding (PMB) group, a total of 47 participants' specimens were pathologically malignant. Older age and polypoid mass-like lesions ( P < 0.001) were independent factors associated with EC. The optimal critical value of ET in predicting EC was 9.5 mm, with a sensitivity and specificity of 70.21% and 70.67%, respectively. In the non-PMB group, six participants had evidence of malignant pathology, and only polypoid mass-like lesions were an independent factor associated with EC ( P < 0.001). CONCLUSIONS For postmenopausal women with increased ET and PMB, older age, thicker ET, and polypoid mass-like lesions on transvaginal ultrasound were independent associated factors for EC. An ET greater than 9.5 mm is a threshold for predicting EC. For postmenopausal women with increased ET without PMB, the incidence of endometrial malignancy is low. If the woman has polypoid mass-like lesions on transvaginal ultrasound, she should receive further attention.
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Affiliation(s)
- Fangfang Ai
- From the Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
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Kuhn TM, Dhanani S, Ahmad S. An Overview of Endometrial Cancer with Novel Therapeutic Strategies. Curr Oncol 2023; 30:7904-7919. [PMID: 37754489 PMCID: PMC10528347 DOI: 10.3390/curroncol30090574] [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: 06/25/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Endometrial cancer (EC) stands as the most prevalent gynecologic malignancy. In the past, it was classified based on its hormone sensitivity. However, The Cancer Genome Atlas has categorized EC into four groups, which offers a more objective and reproducible classification and has been shown to have prognostic and therapeutic implications. Hormonally driven EC arises from a precursor lesion known as endometrial hyperplasia, resulting from unopposed estrogen. EC is usually diagnosed through biopsy, followed by surgical staging unless advanced disease is expected. The typical staging consists of a hysterectomy with bilateral salpingo-oophorectomy and sentinel lymph node biopsies, with a preference placed on a minimally invasive approach. The stage of the disease is the most significant prognostic marker. However, factors such as age, histology, grade, myometrial invasion, lymphovascular space invasion, tumor size, peritoneal cytology, hormone receptor status, ploidy and markers, body mass index, and the therapy received all contribute to the prognosis. Treatment is tailored based on the stage and the risk of recurrence. Radiotherapy is primarily used in the early stages, and chemotherapy can be added if high-grade histology or advanced-stage disease is present. The risk of EC recurrence increases with advances in stage. Among the recurrences, vaginal cases exhibit the most favorable response to treatment, typically for radiotherapy. Conversely, the treatment of widespread recurrence is currently palliative and is best managed with chemotherapy or hormonal agents. Most recently, immunotherapy has emerged as a promising treatment for advanced and recurrent EC.
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Affiliation(s)
- Theresa M. Kuhn
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL 32804, USA
| | - Saeeda Dhanani
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL 32804, USA
- Philadelphia College of Osteopathic Medicine, Suwanee, GA 30024, USA
| | - Sarfraz Ahmad
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL 32804, USA
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10
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Roškar L, Kokol M, Pavlič R, Roškar I, Smrkolj Š, Rižner TL. Decreased Gene Expression of Antiangiogenic Factors in Endometrial Cancer: qPCR Analysis and Machine Learning Modelling. Cancers (Basel) 2023; 15:3661. [PMID: 37509322 PMCID: PMC10378066 DOI: 10.3390/cancers15143661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Endometrial cancer (EC) is an increasing health concern, with its growth driven by an angiogenic switch that occurs early in cancer development. Our study used publicly available datasets to examine the expression of angiogenesis-related genes and proteins in EC tissues, and compared them with adjacent control tissues. We identified nine genes with significant differential expression and selected six additional antiangiogenic genes from prior research for validation on EC tissue in a cohort of 36 EC patients. Using machine learning, we built a prognostic model for EC, combining our data with The Cancer Genome Atlas (TCGA). Our results revealed a significant up-regulation of IL8 and LEP and down-regulation of eleven other genes in EC tissues. These genes showed differential expression in the early stages and lower grades of EC, and in patients without deep myometrial or lymphovascular invasion. Gene co-expressions were stronger in EC tissues, particularly those with lymphovascular invasion. We also found more extensive angiogenesis-related gene involvement in postmenopausal women. In conclusion, our findings suggest that angiogenesis in EC is predominantly driven by decreased antiangiogenic factor expression, particularly in EC with less favourable prognostic features. Our machine learning model effectively stratified EC based on gene expression, distinguishing between low and high-grade cases.
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Affiliation(s)
- Luka Roškar
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Division of Gynaecology and Obstetrics, General Hospital Murska Sobota, 9000 Murska Sobota, Slovenia
| | - Marko Kokol
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia
- Semantika Research, Semantika d.o.o., 2000 Maribor, Slovenia
| | - Renata Pavlič
- Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Irena Roškar
- Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Špela Smrkolj
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Division of Gynaecology and Obstetrics, University Medical Centre, 1000 Ljubljana, Slovenia
| | - Tea Lanišnik Rižner
- Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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11
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Dellino M, Cerbone M, Laganà AS, Vitagliano A, Vimercati A, Marinaccio M, Baldini GM, Malvasi A, Cicinelli E, Damiani GR, Cazzato G, Cascardi E. Upgrading Treatment and Molecular Diagnosis in Endometrial Cancer-Driving New Tools for Endometrial Preservation? Int J Mol Sci 2023; 24:ijms24119780. [PMID: 37298731 DOI: 10.3390/ijms24119780] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
One emerging problem for onco-gynecologists is the incidence of premenopausal patients under 40 years of age diagnosed with stage I Endometrial Cancer (EC) who want to preserve their fertility. Our review aims to define a primary risk assessment that can help fertility experts and onco-gynecologists tailor personalized treatment and fertility-preserving strategies for fertile patients wishing to have children. We confirm that risk factors such as myometrial invasion and The International Federation of Gynecology and Obstetrics (FIGO) staging should be integrated into the novel molecular classification provided by The Cancer Genome Atlas (TCGA). We also corroborate the influence of classical risk factors such as obesity, Polycystic ovarian syndrome (PCOS), and diabetes mellitus to assess fertility outcomes. The fertility preservation options are inadequately discussed with women with a diagnosis of gynecological cancer. A multidisciplinary team of gynecologists, oncologists, and fertility specialists could increase patient satisfaction and improve fertility outcomes. The incidence and death rates of endometrial cancer are rising globally. International guidelines recommend radical hysterectomy and bilateral salpingo-oophorectomy as the standard of care for this cancer; however, fertility-sparing alternatives should be tailored to motivated women of reproductive age, establishing an appropriate cost-benefit balance between childbearing desire and cancer risk. New molecular classifications such as that of TCGA provide a robust supplementary risk assessment tool that can tailor the treatment options to the patient's needs, curtail over- and under-treatment, and contribute to the spread of fertility-preserving strategies.
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Affiliation(s)
- Miriam Dellino
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Marco Cerbone
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Amerigo Vitagliano
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Antonella Vimercati
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Marco Marinaccio
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | | | - Antonio Malvasi
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Ettore Cicinelli
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gianluca Raffaello Damiani
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gerardo Cazzato
- Department of Emergency and Organ Transplantation, Pathology Section, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Eliano Cascardi
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060 Candiolo, Italy
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12
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Donohoe F, O’Meara Y, Roberts A, Comerford L, Kelly CM, Walshe JM, Lundy D, Hickey M, Brennan DJ. Using menopausal hormone therapy after a cancer diagnosis in Ireland. Ir J Med Sci 2023; 192:45-55. [PMID: 35141870 PMCID: PMC9892117 DOI: 10.1007/s11845-022-02947-6] [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: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Menopause may cause a constellation of symptoms that affect quality of life. Many women will have menopause induced or exacerbated by treatment for cancer whether that be through surgery, chemotherapy, radiotherapy, or anti-endocrine therapy. As treatments advance, the number of people living with and beyond a cancer diagnosis is set to increase over the coming years meaning more people will be dealing with the after effects of cancer and its treatment. AIMS This review aims to summarise available data to guide clinicians treating women with menopausal symptoms after the common cancer diagnoses encountered in Ireland. The use of menopausal hormone therapy is discussed as well as non-hormonal and non-pharmacological options. CONCLUSIONS Managing menopausal symptoms is an important consideration for all physicians involved in the care of people living with and beyond a cancer diagnosis. High-quality data may not be available to guide treatment decisions, and, thus, it is essential to take into account the impact of the symptoms on quality of life as well as the likelihood of recurrence in each individual case.
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Affiliation(s)
- Fionán Donohoe
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Yvonne O’Meara
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Aidin Roberts
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Louise Comerford
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Catherine M. Kelly
- Dept. of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Janice M. Walshe
- Dept. of Medical Oncology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
| | - Deirdre Lundy
- Reproductive and Sexual Health Co-Ordinator, Irish College of General Practitioners, Lincoln Place, Dublin 2, Ireland
| | - Martha Hickey
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, Melbourne, VIC Australia
| | - Donal J. Brennan
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland ,UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Belfield, Dublin 4, Ireland
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13
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Raffone A, Raimondo D, Maletta M, Saccone G, Travaglino A, Seracchioli R, Casadio P, Mollo A. Impact of ovarian preservation on survival for women with endometrial carcinoma. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022. [PMCID: PMC9528924 DOI: 10.1002/14651858.cd015307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objective will be to evaluate the impact of ovarian preservation on survival outcomes of women with endometrial cancer, while secondary objectives will be to evaluate the impact of ovarian preservation on adverse events and quality of life (QoL).
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Affiliation(s)
| | - Antonio Raffone
- Division of Gynaecology and Human Reproduction PhysiopathologyIRCCS Azienda Ospedaliero-Universitaria di BolognaBolognaItaly,Department of Medical and Surgical SciencesDIMEC, University of BolognaBolognaItaly,Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Science and Dentistry, School of MedicineUniversity of Naples Federico IINaplesItaly
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction PhysiopathologyIRCCS Azienda Ospedaliero-Universitaria di BolognaBolognaItaly
| | - Manuela Maletta
- Division of Gynaecology and Human Reproduction PhysiopathologyIRCCS Azienda Ospedaliero-Universitaria di BolognaBolognaItaly,Department of Medical and Surgical Sciences, DIMECUniversity of BolognaBolognaItaly
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Science and DentistrySchool of Medicine, University of Naples Federico IINaplesItaly
| | - Antonio Travaglino
- Pathology Unit, Department of Advanced Biomedical Sciences, School of MedicineUniversity of Naples Federico IINaplesItaly
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction PhysiopathologyIRCCS Azienda Ospedaliero-Universitaria di BolognaBolognaItaly,Department of Medical and Surgical Sciences, DIMECUniversity of BolognaBolognaItaly
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction PhysiopathologyIRCCS Azienda Ospedaliero-Universitaria di BolognaBolognaItaly
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and DentistryUniversity of SalernoBaronissiItaly
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14
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L1CAM Expression in Microcystic, Elongated, and Fragmented (MELF) Glands Predicts Lymph Node Involvement in Endometrial Carcinoma. Cancers (Basel) 2022; 14:cancers14153635. [PMID: 35892892 PMCID: PMC9330485 DOI: 10.3390/cancers14153635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
In endometrial carcinoma, both L1CAM overexpression and microcystic, elongated and fragmented (MELF) patterns of invasion have been related to epithelial-to-mesenchymal transition and metastatic spread. We aimed to assess the association between L1CAM expression, the MELF pattern, and lymph node status in endometrial carcinoma. Consecutive cases of endometrial carcinoma with MELF pattern were immunohistochemically assessed for L1CAM. Inclusion criteria were endometrioid-type, low-grade, stage T1, and known lymph node status. Uni- and multivariate logistic regression were used to assess the association of L1CAM expression with lymph node status. Fifty-eight cases were included. Most cases showed deep myometrial invasion (n = 42, 72.4%) and substantial lymphovascular space invasion (n = 34, 58.6%). All cases were p53-wild-type; 17 (29.3%) were mismatch repair-deficient. Twenty cases (34.5%) had positive nodes. No cases showed L1CAM positivity in ≥10% of the whole tumor. MELF glands expressed L1CAM at least focally in 38 cases (65.5%). L1CAM positivity in ≥10% of the MELF component was found in 24 cases (41.4%) and was the only significant predictor of lymph node involvement in both univariate (p < 0.001) and multivariate analysis (p < 0.001). In conclusion, L1CAM might be involved in the development of the MELF pattern. In uterine-confined, low-grade endometrioid carcinomas, L1CAM overexpression in MELF glands may predict lymph node involvement.
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15
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Zhao M, Wen F, Shi J, Song J, Zhao J, Song Q, Lai Q, Luo Y, Yu T, Jiang X, Jiang W, Dong Y. MRI-based radiomics nomogram for the preoperative prediction of deep myometrial invasion of FIGO I stage endometrial carcinoma. Med Phys 2022; 49:6505-6516. [PMID: 35758644 DOI: 10.1002/mp.15835] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/11/2022] [Accepted: 06/10/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Endometrial carcinoma (EC) is one of the most common gynecological malignancies with an increasing incidence, and an accurate preoperative diagnosis of deep myometrial invasion (DMI) is crucial for personalized treatment. OBJECTIVE To determine the predictive value of an MRI-based radiomics nomogram for the presence of DMI in FIGO I stage EC. METHODS We retrospectively collected 163 patients with pathologically confirmed stage I EC from two centers and divided all samples into a training group (center 1) and a validation group (center 2). Clinical and routine imaging indicators were analyzed by logistical regression to construct a conventional diagnostic model (M1). Radiomics features extracted from the axial T2-weighted (T2W) and axial contrast-enhanced T1-weighted (CE-T1W) images were treated with the intraclass correlation coefficient, Mann-Whitney U test, least absolute shrinkage and selection operator (LASSO), and logistic regression analysis with Akaike information criterion (AIC) to build a combined radiomics signature (M2). A nomogram (M3) was constructed by M1 and M2. Calibration and decision curves were drawn to evaluate the nomogram in the training and validation cohorts. The diagnostic performance of each indicator and model was evaluated by the area under the receiver operating characteristic curve (AUC). RESULT The four most significant radiomics features were finally selected from the CE-T1W MRI. For the diagnosis of DMI, the AUCT /AUCV of M1 was 0.798/0.738, the AUCT /AUCV of M2 was 0.880/0.852, and the AUCT /AUCV of M3 was 0.936/0.871 in the training and validation groups, respectively. The calibration curves showed that M3 was in good agreement with the ideal values. The decision curve analysis suggested potential clinical application values of the nomogram. CONCLUSION A nomogram based on MRI radiomics and clinical imaging indicators can improve the diagnosis of DMI in patients with FIGO I stage EC. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mingli Zhao
- Radiology Department, Liaoning Cancer Hospital & Institute, China Medical University, Shenyang, Liaoning, 110042, China
| | - Feng Wen
- Radiology Department, Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110122, China
| | - Jiaxin Shi
- Department of Biomedical Engineering, School of Intelligent Medicine, China Medical University, Shenyang, Liaoning, 110001, China
| | - Jing Song
- Radiology Department, Shengjing Hospital, China Medical University, Shenyang, Liaoning, 110122, China
| | - Jiaqi Zhao
- Radiology Department, Liaoning Cancer Hospital & Institute, China Medical University, Shenyang, Liaoning, 110042, China
| | - Qingling Song
- Radiology Department, Liaoning Cancer Hospital & Institute, China Medical University, Shenyang, Liaoning, 110042, China
| | - Qingyuan Lai
- Radiology Department, Liaoning Cancer Hospital & Institute, China Medical University, Shenyang, Liaoning, 110042, China
| | - Yahong Luo
- Radiology Department, Liaoning Cancer Hospital & Institute, China Medical University, Shenyang, Liaoning, 110042, China
| | - Tao Yu
- Radiology Department, Liaoning Cancer Hospital & Institute, China Medical University, Shenyang, Liaoning, 110042, China
| | - Xiran Jiang
- Department of Biomedical Engineering, School of Intelligent Medicine, China Medical University, Shenyang, Liaoning, 110001, China
| | - Wenyan Jiang
- Department of Scientific Research and Academic, Liaoning Cancer Hospital & Institute, China Medical University, Shenyang, Liaoning, 110042, China
| | - Yue Dong
- Radiology Department, Liaoning Cancer Hospital & Institute, China Medical University, Shenyang, Liaoning, 110042, China
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16
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Effects of transdermal versus oral hormone replacement therapy in postmenopause: a systematic review. Arch Gynecol Obstet 2022; 307:1727-1745. [PMID: 35713694 PMCID: PMC10147786 DOI: 10.1007/s00404-022-06647-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/25/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To summarize available evidence comparing the transdermal and the oral administration routes of hormone replacement therapy (HRT) in postmenopausal women. METHODS We performed a systematic review of the literature on multiple databases between January 1990 and December 2021. We included randomized controlled trials and observational studies comparing the transdermal and oral administration routes of estrogens for HRT in postmenopausal women regarding at least one of the outcomes of interest: cardiovascular risk, venous thromboembolism (VTE), lipid metabolism, carbohydrate metabolism, bone mineral density (BMD), and risk of pre-malignant and malignant endometrial lesions, or breast cancer. RESULTS The systematic literature search identified a total of 1369 manuscripts, of which 51 were included. Most studies were observational and of good quality, whereas the majority of randomized controlled trials presented a high or medium risk of bias. Oral and transdermal administration routes are similar regarding BMD, glucose metabolism, and lipid profile improvements, as well as do not appear different regarding breast cancer, endometrial disease, and cardiovascular risk. Identified literature provides clear evidence only for the VTE risk, which is higher with the oral administration route. CONCLUSIONS Available evidence comparing the transdermal and oral administration routes for HRT is limited and of low quality, recommending further investigations. VTE risk can be considered the clearest and strongest clinical difference between the two administration routes, supporting the transdermal HRT as safer than the oral administration route.
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17
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Song Z, Liu H, Zhou R, Xiao Z, Wang J, Wang H, Lu Q. The optimal time for the initiation of in vitro fertilization and embryo transfer among women with atypical endometrial hyperplasia and endometrial carcinoma receiving fertility-sparing treatment. Arch Gynecol Obstet 2022; 305:1215-1223. [PMID: 34762188 DOI: 10.1007/s00404-021-06320-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the optimal time for initiating in vitro fertilization and embryo transfer (IVF-ET) in women with complete remission after fertility-sparing treatment for grade I endometrial cancer (EC) or atypical endometrial hyperplasia (AEH). PATIENTS AND METHODS Young women who demonstrated complete remission after fertility-sparing treatment for grade I EC or AEH and underwent IVF-ET treatment were included. A generalized estimating equation (GEE) was used to compare the outcomes of controlled ovarian hyperstimulation (COH) and embryo transfer at different times after discontinuing high-dose progesterone therapy, and patients were divided into three groups: ≤ 3 months (time 1), 3-9 months (time 2) and > 9 months (time 3). RESULTS Thirty-seven women with complete remission after fertility-sparing treatment for grade I EC or AEH underwent 75 IVF-ET cycles. Regarding initiation of COH, 10 cycles for time 1, 31 cycles for time 2 and 34 cycles for time 3 were included. The odds ratios (95% confidence intervals) for the number of available embryos at time 2 and time 3 were 1.82 (1.08-3.08) and 2.45 (1.39-4.33), and those for the number of high-quality embryos at time 2 and time 3 were, respectively, 3.64 (1.34-9.87) and 3.62 (1.10-11.91), compared with that at time 1. Nineteen (51.4%) women had at least one clinical pregnancy and 13 (35.1%) women had live births. During a median follow-up period of 51 months (range 5-168 months), 10 (27.0%) women had disease relapse, with a median interval of 15.5 months (range 5-104 months). CONCLUSION Initiating IVF-ET 3 months after ceasing high-dose progesterone therapy can lead to better outcomes of controlled ovarian hyperstimulation for women with endometrial cancer or atypical endometrial hyperplasia.
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Affiliation(s)
- Ziyi Song
- Center of Reproductive Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Huixin Liu
- Department of Clinical Epidemiology, Peking University People's Hospital, Beijing, China
| | - Rong Zhou
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Zerui Xiao
- Center of Reproductive Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Haibo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, 100191, China.
| | - Qun Lu
- Center of Reproductive Medicine, Peking University People's Hospital, Beijing, 100044, China.
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18
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Njoku K, Barr CE, Crosbie EJ. Current and Emerging Prognostic Biomarkers in Endometrial Cancer. Front Oncol 2022; 12:890908. [PMID: 35530346 PMCID: PMC9072738 DOI: 10.3389/fonc.2022.890908] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 12/19/2022] Open
Abstract
Endometrial cancer is the most common gynaecological malignancy in high income countries and its incidence is rising. Whilst most women with endometrial cancer are diagnosed with highly curable disease and have good outcomes, a significant minority present with adverse clinico-pathological characteristics that herald a poor prognosis. Prognostic biomarkers that reliably select those at greatest risk of disease recurrence and death can guide management strategies to ensure that patients receive appropriate evidence-based and personalised care. The Cancer Genome Atlas substantially advanced our understanding of the molecular diversity of endometrial cancer and informed the development of simplified, pragmatic and cost-effective classifiers with prognostic implications and potential for clinical translation. Several blood-based biomarkers including proteins, metabolites, circulating tumour cells, circulating tumour DNA and inflammatory parameters have also shown promise for endometrial cancer risk assessment. This review provides an update on the established and emerging prognostic biomarkers in endometrial cancer.
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Affiliation(s)
- Kelechi Njoku
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Stoller Biomarker Discovery Centre, University of Manchester, Manchester, United Kingdom
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester, University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Chloe E. Barr
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester, University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Emma J. Crosbie
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester, University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- *Correspondence: Emma J. Crosbie,
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19
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Contreras NA, Sabadell J, Verdaguer P, Julià C, Fernández-Montolí ME. Fertility-Sparing Approaches in Atypical Endometrial Hyperplasia and Endometrial Cancer Patients: Current Evidence and Future Directions. Int J Mol Sci 2022; 23:ijms23052531. [PMID: 35269674 PMCID: PMC8910633 DOI: 10.3390/ijms23052531] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 12/12/2022] Open
Abstract
Endometrial cancer (EC) is the fourth most common cancer in women in developed countries. Although it is usually diagnosed in postmenopausal women, its incidence has increased in young women, as well in recent decades, with an estimated rate of 4% in those under 40 years of age. Factors involved in this increase, particularly in resource-rich countries, include delayed childbearing and the rise in obesity. The new molecular classification of EC should help to personalize treatment, through appropriate candidate selection. With the currently available evidence, the use of oral progestin either alone or in combination with other drugs such as metformin, levonorgestrel-releasing intrauterine devices and hysteroscopic resection, seems to be feasible and safe in women with early-stage EC limited to the endometrium. However, there is a lack of high-quality evidence of the efficacy and safety of conservative management in EC. Randomized clinical trials in younger women and obese patients are currently underway.
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Affiliation(s)
| | - Jordi Sabadell
- Department of Gynaecology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
| | - Paula Verdaguer
- Department of Gynaecology-ASSIR, Ronda General Prim 35, Mataró, 08302 Barcelona, Spain;
| | - Carla Julià
- Department of Gynaecology, Hospital de Viladecans, Avda de Gavà 38, Viladecans, 08840 Barcelona, Spain;
| | - Maria-Eulalia Fernández-Montolí
- Department of Gynaecology, Hospital Universitari de Bellvitge, Universitat de Barcelona-IDIBELL, Feixa Llarga s/n, L´Hospitalet de LLobregat, 08907 Barcelona, Spain
- Correspondence: or
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The Efficacy of Psychological Care and Chinese Herbal Decoction in Postoperative Chemotherapy Patients with Endometrial Cancer. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5700637. [PMID: 35222888 PMCID: PMC8881117 DOI: 10.1155/2022/5700637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/17/2022]
Abstract
Background. In recent years, the incidence of endometrial cancer (EC) has been on the rise worldwide. The purpose of this study was to investigate the efficacy of psychological care and Chinese herbal decoction in EC patients with postoperative chemotherapy. Methods. 80 EC patients with postoperative chemotherapy were randomly divided into the observation group and control group. The control group was given psychotherapy. The observation group was given psychological care plus Chinese herbal decoction treatment. HE4, CA125, traditional Chinese medicine (TCM) syndrome scores, toxic and side effects, and quality of life scores before and after treatment were observed. Results. After treatment, the total effective rate of the observation group was higher than that of the control group. After treatment, serum HE4 and CA125 levels in the observation group were lower than those in the control group. In addition, CD3+ and CD4+ levels in the observation group were higher than those in the control group. Meanwhile, the CD8+ level in the observation group was lower than that in the control group. Compared with the control group, the quality of life in the observation group was significantly improved, and the incidence of adverse reactions was reduced. Conclusion. Chinese herbal decoction combined with psychological care can improve the clinical symptoms, alleviate the toxic and side effects, and improve the life quality of EC patients with postoperative chemotherapy.
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21
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Shoraka M, Wang S, Carbajal-Mamani SL, Han H, Amaro B, Cardenas-Goicoechea J. Oncologic outcomes in older women with endometrial carcinoma (≥70 years). J OBSTET GYNAECOL 2022; 42:2127-2133. [PMID: 35166187 DOI: 10.1080/01443615.2022.2033962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Data are limited in the management of elderly women with endometrial cancer as they are under-represented in clinical trials. The aim of this study was to evaluate the outcomes of women ≥70 years who underwent hysterectomy. One hundred and twenty-one patients met the inclusion criteria. The median age among the cohort was 75 years (range: 70-91), and 52% underwent robotic surgery. The five-year overall survival (OS) rate was 67%. The five-year cumulative incidence of recurrence was 19%. Based on univariate analysis, white race, lower ASA score, higher pre-operative and post-operative haematocrit, lower estimated blood loss, stage I and robotic surgery were associated with improved OS. On multivariable analysis, ASA score, preoperative haematocrit, estimated blood loss and stage were associated with survival.Survival rates among older women were low and disease recurrence was high. Robotic surgery was safe and appeared to improve perioperative outcomes in older women with endometrial cancer.Impact StatementWhat is already known on this subject? Endometrial cancer is the most common gynaecologic cancer with an overall survival above 90%. Surgery is the cornerstone of treatment. With an ageing population, an increased incidence of endometrial cancer is also expected. Increased frailty and comorbid conditions may prevent this population from undergoing surgery; consequently, these patients are often undertreated for a potentially curable disease.What do the results of this study add? Older women with endometrial cancer have low survival rates and high disease recurrence rates. Elderly women can tolerate robotic surgery to reduce the risk of adverse events.What are the implications of these findings for clinical practice and/or further research? It is important to develop best practices to optimise patients for minimally invasive surgery. The benefits of robotic surgery may encourage patients and surgeons to partake in this approach. A multidisciplinary approach with geriatric evaluation may improve post-operative care and survival. Future clinical trials should include elderly women.
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Affiliation(s)
- Massoud Shoraka
- Department of Obstetrics and Gynaecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Shu Wang
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | | | - Haoting Han
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Bernie Amaro
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Joel Cardenas-Goicoechea
- Department of Obstetrics and Gynaecology, University of Florida College of Medicine, Gainesville, FL, USA
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22
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Choi J, Holowatyj AN, Du M, Chen Z, Wen W, Schultz N, Lipworth L, Guo X. Distinct Genomic Landscapes in Early-Onset and Late-Onset Endometrial Cancer. JCO Precis Oncol 2022; 6:e2100401. [PMID: 35108035 PMCID: PMC8820918 DOI: 10.1200/po.21.00401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/26/2021] [Accepted: 12/22/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The spectrum of somatic mutations among women with endometrial cancer (EC) younger than 50 years (early-onset EC) remains unknown. We investigated distinct somatic mutation patterns among early-onset and late-onset (age ≥ 50 years) EC patients. METHODS This cohort study included individuals age 18+ years diagnosed with pathologically confirmed EC in the American Association of Cancer Research (AACR) Genomics Evidence Neoplasia Information Exchange (GENIE, v9.1) consortium. We explored tumor mutational burden (TMB) and genomic patterns of EC by age at clinical sequencing using multivariable regression models adjusted for race, ethnicity, histology, sequencing assay, sample type, and TMB. RESULTS Among 2,425 women with EC, 176 (7.3%) had early-onset EC and 1,923 (79.3%) had nonhypermutated (< 17.78 mutations/Mb) tumors. TMB significantly differed across age and histology groups. Among nonhypermutated ECs, early-onset patients had significantly lower odds of presenting with nonsilent FGFR2 and PIK3R1 somatic mutations compared with late-onset EC patients in adjusted models (FGFR2: odds ratio [OR] = 0.18, 95% CI, 0.04 to 0.76; PIK3R1: OR = 0.54, 95% CI, 0.31 to 0.92). By contrast, early-onset EC patients had increased odds of presenting with nonsilent CTNNB1 and BRCA2 mutations compared with late-onset patients (CTNNB1: OR = 3.32, 95% CI, 2.14 to 5.16; BRCA2: OR = 4.01, 95% CI, 1.55 to 10.38). Subsequent analyses stratified by race, ethnicity, and tumor histology identified distinct patterns of APC, KMT2D, KMT2C, and KRAS by race, ethnicity, and PTEN and APC patterns by histologic subtypes. CONCLUSION Early-onset EC harbors a unique genomic landscape compared with late-onset disease. A distinct molecular phenotype of early-onset EC provides novel insights into a unique etiology and may yield clinical implications for developing targeted treatment modalities for younger patients.
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Affiliation(s)
- Jungyoon Choi
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Andreana N. Holowatyj
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Mengmeng Du
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zhishan Chen
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Wanqing Wen
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Nikolaus Schultz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Loren Lipworth
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Xingyi Guo
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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Cui T, Shi F, Gu B, Jin Y, Guo J, Zhang C, Ren J, Yue Y. Peritumoral Enhancement for the Evaluation of Myometrial Invasion in Low-Risk Endometrial Carcinoma on Dynamic Contrast-Enhanced MRI. Front Oncol 2022; 11:793709. [PMID: 35111676 PMCID: PMC8802826 DOI: 10.3389/fonc.2021.793709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives To explore the clinical value of subendometrial enhancement (SEE), irregular thin-layered peritumoral early enhancement (ITLPE) and focal irregular peritumoral early enhancement (FIPE) on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for myometrial invasion in patients with low-risk endometrial carcinoma. Methods Seventy-seven patients with low-risk endometrial carcinoma who preoperatively underwent DCE-MRI were included. Two radiologists independently evaluated and recorded the occurrences of SEE, ITLPE and FIPE on DCE-MRI in all patients. Interobserver agreement was calculated between the two radiologists, and the relationships between SEE, ITLPE, FIPE, and myometrial invasion were analyzed based on histologic findings. For statistically significant findings, the sensitivity and specificity were calculated, and the differences in myometrial invasion evaluations were analyzed. For those with no statistical significance, images were compared with the histopathologic sections. Results Inter-observer agreement was good (k = 0.80; 95%CI, 0.577–0.955) for SEE, and very good (k = 0.88; 95%CI, 0.761–0.972) (k = 0.86; 95%CI, 0.739–0.973) for ITLPE and FIPE. After consensus, SEE was identified in 12/77 (15.6%) patients; ITLPE and FIPE were found in 53/77 (68.8%) and 30/77 (39.0%) patients, respectively. SEE and ITLPE were significantly correlated with myometrial infiltration (P = 0.000), but FIPE were not (P = 0.725).The sensitivity and specificity of SEE and ITLPE for myometrial invasion in patients with low-risk endometrial carcinoma were 95.0 and 52.9%, and 85.0 and 88.0%, respectively. The area under the curve (AUC) of SEE and ITLPE for myometrial invasion were 0.740 (95%CI, 0.584–0.896), and 0.866 (95%CI, 0.763–0.970), respectively. The sensitivity and specificity were statistically different between SEE and ITLPE for the detection of myometrial invasion (P = 0.031, 0.016). According to the comparison between FIPE and histopathologic findings, the irregular endomyometrial junction was found in 30/77 (38.9%) cases, 24/30 (80.0%) with myometrial infiltration and 6/30 (20.0%) cases without myometrial infiltration. Conclusions FIPE was the irregular endomyometrial junction. It can be found in patients with or without myometrial infiltration and may lead to the overestimation of myometrial invasion by SEE on DCE-MRI. ITLPE presented high diagnostic performance and specificity for myometrial invasion in patients with low-risk endometrial carcinoma.
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Affiliation(s)
- Tingting Cui
- Department of MR, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Feng Shi
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Bei Gu
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yanfang Jin
- Department of MR, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jinsong Guo
- Department of MR, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of MR, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jie Ren
- Department of MR, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yunlong Yue
- Department of MR, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yunlong Yue,
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24
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Zisi M, Zygouris D, Tsonis O, Papadimitriou S, George M, Kalantaridou S, Paschopoulos M. Uterine sparing management in patients with endometrial cancer: a narrative literature review. J OBSTET GYNAECOL 2022; 42:823-829. [PMID: 34989284 DOI: 10.1080/01443615.2021.2006164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Endometrial cancer is the most common malignancy of the female genital tract. Approximately 25% of cases occur in premenopausal women, and up to 5% of cases occur in women who are younger than 40 years old. The survival rate in these cases is 99%; therefore, uterine-sparing management could be considered under strict criteria selection and the strong desire of the woman to preserve uterus and fertility. Diagnosis should be performed after a hysteroscopic biopsy instead of dilatation and curettage. The highest remission rate was achieved after combining a hysteroscopic resection with hormonal therapy compared to single hormonal treatment. The most common regiments are the following progestins: megestrol acetate (MA) and medroxyprogesterone acetate (MPA) taken orally with a daily dosage of 160 mg-320 mg for MA and 250 mg-600 mg for MP. Evaluations at three and six months could be performed by office endometrial biopsy and/or hysteroscopic directed biopsy especially in the presence of levonorgestrel intrauterine system, and in cases of remission, either a pregnancy attempt or maintenance therapy should be considered. After childbearing, hysterectomy with bilateral salpingo-oophorectomy is recommended, whereas ovarian preservation could be considered depending on the patient's age and whether they fulfil the strict criteria selection.
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Affiliation(s)
- Maria Zisi
- Department of Obstetrics and Gynecology, Medical School, University of Ioannina, Ioannina, Greece
| | - Dimitrios Zygouris
- Department of Obstetrics and Gynecology, Medical School, University of Ioannina, Ioannina, Greece
| | - Orestis Tsonis
- Department of Obstetrics and Gynecology, Medical School, University of Ioannina, Ioannina, Greece
| | | | - Mastorakos George
- Endocrinology Unit, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Aretaieio Hospital, Athens, Greece
| | - Sophia Kalantaridou
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, Medical School, University of Ioannina, Ioannina, Greece
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Jiang S, Jiang P, Jiang T, Tu Y, Zhang J, Li N, Kong W, Huang Y, Yuan R. Effect of Number of Retrieved Lymph Nodes on Prognosis in FIGO Stage IA1-IIA2 Cervical Cancer Patients Treated With Primary Radical Surgery. CLINICAL MEDICINE INSIGHTS: ONCOLOGY 2022; 16:11795549221127161. [PMID: 36199803 PMCID: PMC9528045 DOI: 10.1177/11795549221127161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The influence of the number of removed lymph nodes (RLNs) on patients with early-stage cervical cancer (ESCC) is still questionable. The objective of this study was to explore the prognostic value of RLNs on ESCC patients. Methods: A retrospective study was performed including all ESCC patients who underwent radical surgery from January 2016 to December 2018. Cox regression analysis was performed to verify the correlation between the number of RLNs and the prognosis (recurrence-free survival [RFS], disease-specific survival [DSS]) of ESCC. According to the guidelines, all the patients were divided into high-risk and non-high-risk groups. The optimal cut-off values of RLNs were determined by receiver operating characteristic curve analysis and Youden index and further the prognostic value of them was explored. Results: A total 1101 patients were enrolled. The number of RLNs was an independent prognostic influence factor of the prognosis of ESCC ( P < .001 for RFS, P < .001 for DSS). The optimal cut-off values of RLNs (40 in the high-risk group and 23 in the non-high-risk group) were significantly associated with the prognosis of ESCC, in the high-risk group ( P < .001 for RFS, P = .002 for DSS) and non-high-risk group ( P < .001 for RFS, P < .001 for DSS), respectively. Conclusions: More extensive lymph node dissection (RLNs ⩾ 40) could benefit the high-risk ESCC patients. However, in the non-high-risk group, moderate lymph node dissection (RLNs ≈23) could also benefit them and may reduce the incidence of related complications. Those findings may help to determine the scope of lymph node dissection in ESCC patients before operation.
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Affiliation(s)
- Shan Jiang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Jiang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tingting Jiang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Tu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jingni Zhang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ning Li
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Kong
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuzhen Huang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Yuan
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Song W, Zhao Y. A prediction model based on clinical and histological features for predicting recurrence in patients with stage I-II endometrial cancer after surgical treatment. Ann Diagn Pathol 2021; 56:151861. [PMID: 34953233 DOI: 10.1016/j.anndiagpath.2021.151861] [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: 10/30/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study aimed to develop a prediction model combining clinical and histological features to predict recurrence in patients with stage I-II endometrial cancer (EC) after surgical treatment. METHODS A total of 746 stage I-II EC patients who had received primary surgical treatment at Taizhou People's Hospital between 2014 and 2018 were included and randomly divided as a Training cohort (n = 520) and a Validation cohort (n = 226) at a 7:3 ratio. Clinical features including age, body mass index, comorbidities, lymphadenectomy, and adjuvant treatment, and histological features including histologic type, myometrial invasion, cervical stromal invasion, and expression levels of Ki67, estrogen receptor (ER), progesterone receptor (PR), whey acidic protein 4-disulphide core domain 2 (WFDC2), and p53 were used to develop a prediction model for EC recurrence in the Training cohort using a multivariable Cox regression model. Model discrimination and calibration were further evaluated in the Validation cohort. RESULTS EC recurrence was observed in 60 (11.54%) patients in the Training cohort with a median length of follow-up of 39 months. Age, adjuvant treatment, histologic type, cervical stromal invasion, and expression levels of Ki67, ER, PR, and WFDC2 were factors significantly associated with EC recurrence based on univariable Cox regression analysis. After a model selection by AIC in a stepwise algorithm, the final model incorporated the above predictors showed a C-index of 0.85 and fair calibration in the Training cohort. In the Validation cohort, the model still showed good discrimination power (C-index 0.80) but moderate calibration. CONCLUSIONS The developed prediction model combining clinical and histological features can help to predict the EC recurrence in patients with stage I-II EC after surgical treatment.
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Affiliation(s)
- Weiwei Song
- Department of Traditional Chinese Medicine, Taizhou People's Hospital, Taizhou 225300, China.
| | - Yinling Zhao
- Department of Gynecology, Taizhou People's Hospital, Taizhou 225300, China
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The use of menopausal hormone therapy after cancer. Best Pract Res Clin Obstet Gynaecol 2021; 81:22-30. [PMID: 34920970 DOI: 10.1016/j.bpobgyn.2021.11.005] [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: 09/26/2021] [Revised: 10/18/2021] [Accepted: 11/07/2021] [Indexed: 11/20/2022]
Abstract
The changing landscape of gynaecological and breast cancers has involved the development of more targeted and effective therapies, and improved survival. Ultimately, these changes result in an increasing number of women surviving their cancer diagnosis, with increasing emphasis on quality-of-life issues by following treatments. Many of these women experience severe menopausal symptoms associated with cancer treatments, but the hormonal nature of many gynaecological and breast cancers complicates the effective management of these symptoms. Generally, there is a paucity of high-quality data directly examining the safety of menopausal hormone therapy (MHT) following many female cancers, and more research is needed with long term follow-up to ensure the provision of comprehensive, patient-focussed care. This article aims to synthesise and evaluate the current evidence to provide comprehensive yet accessible information to clinicians to help guide treatment decisions about the use of MHT in women, who have experienced, or are at increased risk of, both gynaecological and breast cancers. These treatment decisions should often be made in a multi-disciplinary setting which encourages shared decision-making with patients.
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Cavaliere AF, Perelli F, Zaami S, D'Indinosante M, Turrini I, Giusti M, Gullo G, Vizzielli G, Mattei A, Scambia G, Vidiri A, Signore F. Fertility Sparing Treatments in Endometrial Cancer Patients: The Potential Role of the New Molecular Classification. Int J Mol Sci 2021; 22:12248. [PMID: 34830129 PMCID: PMC8625356 DOI: 10.3390/ijms222212248] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/10/2021] [Indexed: 01/13/2023] Open
Abstract
Endometrial cancer is the most frequent gynecological malignancy, and, although epidemiologically it mainly affects advanced age women, it can also affect young patients who want children and who have not yet completed their procreative project. Fertility sparing treatments are the subject of many studies and research in continuous evolution, and represent a light of hope for young cancer patients who find themselves having to face an oncological path before fulfilling their desire for motherhood. The advances in molecular biology and the more precise clinical and prognostic classification of endometrial cancer based on the 2013 The Cancer Genome Atlas classification allow for the selection of patients who can be submitted to fertility sparing treatments with increasing oncological safety. It would also be possible to predict the response to hormonal treatment by investigating the state of the genes of the mismatch repair.
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Affiliation(s)
- Anna Franca Cavaliere
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Federica Perelli
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, 50012 Florence, Italy
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Marco D'Indinosante
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Irene Turrini
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Marco Giusti
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, 50012 Florence, Italy
| | - Giuseppe Gullo
- Azienda Ospedaliera Ospedali Riuniti (AOOR) Villa Sofia Cervello, IVF Public Center, University of Palermo, 90100 Palermo, Italy
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, Dipartimento di Area Medica (DAME), University Hospital of Udine, University of Udine, 33100 Udine, Italy
| | - Alberto Mattei
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, 50012 Florence, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
| | - Annalisa Vidiri
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
| | - Fabrizio Signore
- Obstetrics and Gynecology Department, Unità Sanitaria Locale (USL) Roma 2, Sant'Eugenio Hospital, 00144 Rome, Italy
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Yan BC, Ma XL, Li Y, Duan SF, Zhang GF, Qiang JW. MRI-Based Radiomics Nomogram for Selecting Ovarian Preservation Treatment in Patients With Early-Stage Endometrial Cancer. Front Oncol 2021; 11:730281. [PMID: 34568064 PMCID: PMC8459685 DOI: 10.3389/fonc.2021.730281] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022] Open
Abstract
Background Ovarian preservation treatment (OPT) was recommended in young women with early-stage endometrial cancer [superficial myometrial invasion (MI) and grades (G) 1/2-endometrioid adenocarcinoma (EEC)]. A radiomics nomogram was developed to assist radiologists in assessing the depth of MI and in selecting eligible patients for OPT. Methods From February 2014 to May 2021, 209 G 1/2-EEC patients younger than 45 years (mean 39 ± 4.3 years) were included. Of them, 104 retrospective patients were enrolled in the primary group, and 105 prospective patients were enrolled in the validation group. The radiomics features were extracted based on multi-parametric magnetic resonance imaging, and the least absolute shrinkage and selection operator algorithm was applied to reduce the dimensionality of the data and select the radiomics features that correlated with the depth of MI in G 1/2-EEC patients. A radiomics nomogram for evaluating the depth of MI was developed by combing the selected radiomics features with the cancer antigen 125 and tumor size. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of the radiomics nomogram and of radiologists without and with the aid of the radiomics nomogram. The net reclassification index (NRI) and total integrated discrimination index (IDI) based on the total included patients to assess the clinical benefit of radiologists with the radiomics nomogram were calculated. Results In the primary group, for evaluating the depth of MI, the AUCs were 0.96 for the radiomics nomogram; 0.80 and 0.86 for radiologists 1 and 2 without the aid of the nomogram, respectively; and 0.98 and 0.98 for radiologists 1 and 2 with the aid of the nomogram, respectively. In the validation group, the AUCs were 0.88 for the radiomics nomogram; 0.82 and 0.83 for radiologists 1 and 2 without the aid of the nomogram, respectively; and 0.94 and 0.94 for radiologists 1 and 2 with the aid of the nomogram, respectively. The yielded NRI and IDI values were 0.29 and 0.43 for radiologist 1 and 0.23 and 0.37 for radiologist 2, respectively. Conclusions The radiomics nomogram outperformed radiologists and could help radiologists in assessing the depth of MI and selecting eligible OPTs in G 1/2-EEC patients.
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Affiliation(s)
- Bi Cong Yan
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China.,Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiao Liang Ma
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Shao Feng Duan
- Precision Health Institution, GE Healthcare, Shanghai, China
| | - Guo Fu Zhang
- Department of Radiology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
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Liu X, Wu Y, Liu P, Zhang X. Developing a validated nomogram for predicting ovarian metastasis in endometrial cancer patients: a retrospective research. Arch Gynecol Obstet 2021; 305:719-729. [PMID: 34495379 DOI: 10.1007/s00404-021-06214-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore risk factors and develop a prediction model for ovarian metastasis in endometrial cancer (EC), as well as providing provide a reference for clinical ovarian preservation. METHODS We conducted a retrospective observational study enrolling 1496 EC patients having received complete staging surgery from Qilu Hospital of Shandong University from 2012 to 2018. These patients were randomly divided into two cohorts: training cohort (n = 1046) and validation cohort (n = 448). A nomogram prediction model was developed based on univariate, least absolute shrinkage and selection operator (Lasso), and multivariate logistic regression. Then, the nomogram model's performance was evaluated in discrimination, calibration, and clinical utility three aspects. RESULTS Parametrium invasion, lymph node metastasis, and oviduct metastasis were finally contained in the nomogram prediction model. The AUC of the model in the training cohort was 0.85 compared with 0.72 in the validation cohort. It also behaved well in calibration and had good clinical utility. With a threshold probability of 20% ~ 80%, the nomogram increased the net benefit by 0 ~ 13.6 per 100 patients than surgery for all patients upon validation. CONCLUSIONS We develop a nomogram with good performances for predicting ovarian metastasis in EC patients, which may help clinicians identify candidate patients appropriate for ovarian preservation in premenopausal EC patients.
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Affiliation(s)
- Xiaodie Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100029, China
| | - Yaohai Wu
- Department of Urology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,Department of Urology, Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, People's Republic of China
| | - Peishu Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
| | - Xiaolei Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
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Multiparametric magnetic resonance imaging facilitates the selection of patients prior to fertility-sparing management of endometrial cancer. Abdom Radiol (NY) 2021; 46:4410-4419. [PMID: 33825929 PMCID: PMC10152338 DOI: 10.1007/s00261-021-03050-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE To compare the diagnostic performance of biparametric magnetic resonance imaging (bpMRI) versus multiparametric MRI (mpMRI) for the staging of well-differentiated endometrioid endometrial cancer (EC) in potential candidates for fertility-sparing management. METHODS This multi-center retrospective study included 48 potential candidates for fertility-sparing management (age <46 years, grade 1 endometroid EC) who did not wish to undergo fertility-sparing management and thus underwent definitive surgery. Two readers (R1, R2) independently reviewed bpMRI (T1, T2, and diffusion-weighted imaging) and mpMRI (bpMRI and dynamic contrast-enhanced imaging, DCE) during two separate sessions spaced one month apart for the presence of myometrial invasion (MI), cervical stromal involvement (CSI), malignant adnexal disease (mAD), and pelvic lymphadenopathy (pLNM). Each reader also recorded maximum tumor diameter, tumor volume, and tumor-to-uterine volume ratio (TVR) on T2-weighted imaging. The diagnostic performance of bpMRI and mpMRI was determined for each reader with surgical pathology serving as a gold standard. RESULTS The area under the receiver operating curve (AUC) for bpMRI versus mpMRI was 0.76/0.78 (R1/R2) versus 0.84/0.83 for MI, 0.79/0.76 versus 0.99/0.80 for CSI, 0.84/0.84 versus 0.84/0.80 for mAD, and 0.82/0.82 for pLMN. The sensitivity and specificity of MRI for detecting tumor spread beyond the endometrium were 71%/77% and 71%/65% for bpMRI (R1/R2) vs. 84%/90% and 71%/65% for mpMRI (R1/R2), respectively. The AUC of maximum tumor diameter, tumor volume, and TVR for MI was 0.71/0.61, 0.73/0.75, and 0.75/0.77 for R1/R2, respectively. CONCLUSION MRI had moderate diagnostic performance across potential candidates for fertility-sparing treatment of EC. mpMRI outperformed bpMRI for detecting EC spreading beyond the endometrium.
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Carugno J, Wong A. Fertility-sparing approach for endometrial cancer: the role of office hysteroscopy. MINIM INVASIV THER 2021; 30:296-303. [PMID: 34292797 DOI: 10.1080/13645706.2021.1949353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endometrial cancer is the most common gynecologic malignancy in developed countries, with increasing incidence among younger, nulliparous patients. These epidemiological shifts are attributed to increasing rates of obesity, in combination with delayed childbearing. This highlights a need for fertility-sparing options for individuals who wish to delay standard surgical management with hysterectomy, bilateral salpingoophorectomy, and assessment of pelvic/para-aortic lymph nodes. Careful consideration should be taken to select which patients are suitable candidates for fertility-sparing methods. Typically, these are patients found to have FIGO grade 1 tumors of the endometrioid subtype without myometrial invasion. Currently, conservative treatment options include the use of oral progestins and levonorgestrel-releasing intrauterine devices, with an emerging role for hysteroscopy for direct visualization of the uterine cavity, targeted tissue sampling, and tumor resection. This paper aims to highlight the role of office hysteroscopy for diagnosis, hysteroscopic tumor resection, and follow-up in suitable endometrial cancer patients who wish to preserve their uterus until childbearing is complete.
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Affiliation(s)
- José Carugno
- Minimally Invasive Gynecology Division, Department of Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Adriana Wong
- Department of Obstetrics and Gynecology, University of California Davis Medical Center, Sacramento, CA, USA
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Tumor Characteristic Variations between Symptomatic and Asymptomatic Endometrial Cancer. Healthcare (Basel) 2021; 9:healthcare9070902. [PMID: 34356280 PMCID: PMC8304100 DOI: 10.3390/healthcare9070902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/24/2022] Open
Abstract
Endometrial cancer is the most common gynecologic malignancy in Europe and usually diagnosed in its initial stage owing to early symptoms of abnormal bleeding. There is no population screening for this disease, although it can sometimes be accidentally diagnosed in asymptomatic patients. Our study aims to determine differences in clinical and tumor characteristics between an asymptomatic and symptomatic group of patients. This unicentric prospective observational study took place in University Hospital Brno between January 2016 and December 2019. A total of 264 patients met inclusion criteria (26% asymptomatic, 74% with reported symptoms). We did not find a statistically significant difference in clinical characteristics (menopausal status, parity, age, BMI, and serum level of CA 125) between groups. According to ultrasound examination, bleeding tumors were larger (19.5 vs. 12.7 mm, p ≤ 0.001). Definitive histology results indicated more frequent lymphovascular space invasion (p < 0.001), along with deep myometrial (p = 0.001) and cervical (p = 0.002) invasion. There was no difference in advanced stages of the tumor. We did not substantiate statistically significant difference in immunohistochemical profile (estrogen and progesterone receptors, L1 cell adhesion molecule, tumor protein p53), which is relevant for tumor recurrence risk and survival capacity. Our conclusions affirmed that bleeding occurs more often among patients with local tumor invasion into the myometrium and cervical stroma. Final International Federation of Gynecology and Obstetrics (FIGO) stage, histology, and immunohistochemical characteristics do not significantly affect symptom appearance.
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Pintican R, Bura V, Zerunian M, Smith J, Addley H, Freeman S, Caruso D, Laghi A, Sala E, Jimenez-Linan M. MRI of the endometrium - from normal appearances to rare pathology. Br J Radiol 2021; 94:20201347. [PMID: 34233457 DOI: 10.1259/bjr.20201347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
MRI was recently included as a standard pre-operative diagnostic tool for patients with endometrial cancer. MR findings allow a better risk assessment and ultimately guides the surgical planning. Therefore, it is vital that the radiological interpretation is as accurate as possible. This requires essential knowledge regarding the appropriate MRI protocol, as well as different appearances of the endometrium, ranging from normal peri- and post-menopausal changes, benign findings (e.g. endometrial hyperplasia, polyp, changes due to exogenous hormones) to common and rare endometrium-related malignancies. Furthermore, this review will emphasize the role of MRI in staging endometrial cancer patients and highlight pitfalls that could result in the underestimation or overestimation of the disease extent.
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Affiliation(s)
- Roxana Pintican
- "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca,Romania; County Clinical Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Vlad Bura
- County Clinical Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Marta Zerunian
- Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Janette Smith
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Helen Addley
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Susan Freeman
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Damiano Caruso
- Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Andrea Laghi
- Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Evis Sala
- Department of Radiology and CRUK Cambridge Center, Cambridge Biomedical Campus, Cambridge, UK
| | - Mercedes Jimenez-Linan
- Department of Histopathology, Cambridge University Hospital NHS foundation Trust, Cambridge, UK
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Akada K, Koyama N, Miura T, Fukunaga E, Miura Y, Aoshima K, Fujiwara K. Real-world database analysis of the characteristics and treatment patterns of patients with endometrial cancer in Japan. Curr Med Res Opin 2021; 37:1171-1178. [PMID: 33792449 DOI: 10.1080/03007995.2021.1903847] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim was to identify the characteristics and treatment patterns of early and advanced stage endometrial cancer patients using real-world data. METHODS Patients' data extracted from a Japanese health insurance claims database were analyzed. RESULTS Of the 12,449 endometrial cancer patients, 74.4% were in stage I, 5.1% in stage II, 12.0% in stage III, and 8.4% in stage IV. Their median age was 60.5 years, higher in advanced stages (III/IV) than in early stages (I/II). Overall, 11,055 patients (88.8%) underwent surgery, and 4977 patients (40.0%) received post-surgery treatment, including chemotherapy (4441: 35.7%), chemoradiation therapy (379: 3.0%), and radiation therapy (157 patients: 1.3%); 1394 patients (11.2%) were not treated by surgery, and 742 patients (6.0%) received other treatment, with chemotherapy (548: 4.4%), radiation therapy (105: 0.8%), and chemoradiation therapy (89: 0.7%). The rate of patients undergoing surgery decreased, and that receiving chemotherapy increased significantly as cancer stage progressed. Paclitaxel/carboplatin was the most frequent first-line regimen (85.4% of patients), whereas various combination and monotherapy regimens were used as second- and third-line regimens. The most frequent second-line monotherapy was paclitaxel. The rate of monotherapy increased as the treatment line progressed (first-line 3.5%, second-line 22.0%, and third-line 36.4%). CONCLUSIONS The characteristics and treatment patterns of endometrial cancer patients differed between early and advanced stages, as did the chemotherapy regimens among first-, second-, and third-lines. Since various regimens were used for second- and third-line chemotherapies, development of appropriate second- and third-line chemotherapy regimens is warranted. A real-world analysis of cancer patients using a nationwide claims database may be a valuable approach to identifying unmet medical needs.
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Affiliation(s)
- Keishi Akada
- hhc Data Creation Center, Eisai Co. Ltd, Tokyo, Japan
| | | | - Takuma Miura
- Japan Asia Clinical Department, Oncology Business Unit, Eisai Co. Ltd, Tokyo, Japan
| | - Eiji Fukunaga
- Japan Medical Department, Eisai Co. Ltd, Tokyo, Japan
| | - Yuji Miura
- hhc Data Creation Center, Eisai Co. Ltd, Tokyo, Japan
| | - Ken Aoshima
- hhc Data Creation Center, Eisai Co. Ltd, Tokyo, Japan
| | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
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Matanes E, Eisenberg N, Lau S, Salvador S, Ferenczy A, Pelmus M, Gotlieb WH, Kogan L. Absence of prognostic value of lymphovascular space invasion in patients with endometrial cancer and negative sentinel lymph nodes. Gynecol Oncol 2021; 162:256-261. [PMID: 34119364 DOI: 10.1016/j.ygyno.2021.05.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate if the prognostic value of lymphovascular space invasion (LVSI) is different in endometrial cancer patients with negative lymph nodes following sentinel lymph node (SLN) mapping or lymph node dissection (LND) as staging procedure. MATERIAL AND METHODS A retrospective study of 510 patients diagnosed with endometrial carcinoma in our institution between 2007 and 2014. We excluded patients that were diagnosed with positive nodes (Stage IIIc). We compared patients' characteristics and survival outcomes as function of their LVSI status (positive LVSI vs negative LVSI subgroups) in each cohort separately. RESULTS 413 patients met the inclusion criteria, out of whom 239 underwent SLN and 174 patients underwent LND only. In the SLN group, life table analysis showed 5-year OS and PFS of 80% and 72% in patients with LVSI compared to 96%, and 93% without LVSI. Same trend was observed among patients with LND with 5-year OS and PFS of 74% and 64% in patients with LVSI compared to 97%, and 90% without LVSI. On multivariable analysis, adjusted for age, FIGO stage, grade and maximal tumor size, the favorable survival of negative LVSI remained only in the LND cohort (SLN cohort: HR 1.2, CI [0.3-4.0], P = 0.8 and HR 1.7, CI [0.7-4.3], p = 0.2 for OS and PFS, respectively; LND cohort: HR 3.1, CI [1.4-6.5], p < 0.001 and HR 2.5, CI [1.2-4.9], p = 0.01 for OS and PFS, respectively). CONCLUSIONS The prognostic value of LVSI disappears when patients undergo staging with SLN and are found to have negative nodes in contrast to those who have undergone LND. Future studies should confirm our observation on patients with negative sentinel nodes, and plan on tailoring adjuvant treatment to this specific subgroup.
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Affiliation(s)
- Emad Matanes
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Neta Eisenberg
- Department of Obstetrics and Gynecology, Yitzhak Shamir Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Susie Lau
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada
| | - Alex Ferenczy
- Department of Pathology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Manuela Pelmus
- Department of Pathology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada.
| | - Liron Kogan
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, Hadassah Medical Center, Affiliated with the Hebrew University Hadassah Medical School, Jerusalem, Israel
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Lucchini SM, Esteban A, Nigra MA, Palacios AT, Alzate-Granados JP, Borla HF. Updates on conservative management of endometrial cancer in patients younger than 45 years. Gynecol Oncol 2021; 161:802-809. [PMID: 33892887 DOI: 10.1016/j.ygyno.2021.04.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/12/2021] [Indexed: 02/01/2023]
Abstract
Endometrial cancer is the most common gynecologic malignancy in developed country. Women under the age of 40 represent 5% of all endometrial cancer and the majority are nulliparous at the time of diagnosis. The aim of this review was to compare oncologic and fertility outcomes among different fertility-preserving therapies in patients under 45 years of age with grade 1 or 2 endometrial cancer. A systematic review was conducted, the MEDLINE, EMBASE, and CINAHL databases were searched for articles published during the period from January 2010 through January 2020 in accordance with PRISMA guidelines, using the terms endometrial cancer, fertility sparing treatment and conservative treatment. A total of 661 patients in 38 studies were included. The median age was 32.3 years (range 13--43). Regardless of the primary treatment, it is always accompanied by systemic or local hormonal treatment. The median follow-up time was 47.92 months (range 1-412), 54.9 months (range 3.4-412) for the progesterone group, 38.97 months (range 3-172) for the hysteroscopic resection group and 23.11 months (range 1-115.5) for the Levonorgestrel Intrauterine Device group. The overall complete response rate was 79.4%, [Hysteroscopic Resection: 90%, hormonal treatment: 77.7%, and Levonorgestrel Intrauterine Device: 71.3%] The p = 0.02 when the primary treatment is Hysteroscopic resection, always followed by hormonal therapy either oral progesterone or Levonorgestrel Intrauterine Device. Patients who had tumor resection had lower progression than those who received hormonal treatment or Levonorgestrel Intrauterine Device 3.5% vs. 12.1% vs. 19.5% respectively (p = 0.03). The complete response time was higher in the Hysteroscopic Resection group (p = 0.04) with fewer patients undergoing hysterectomy (p = 0.0001). Patients who underwent Hysteroscopic Resection had higher pregnancy rates compared to medical treatment or Levonorgestrel Intrauterine Device, 34.5%, 27.6% and 18.4%, respectively (p = 0.002). CONCLUSION: Patients who underwent Hysteroscopic Resection followed progestogens agent was associated to a better complete response, high pregnancy rates and minor numbers of hysterectomies.
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Affiliation(s)
- Sergio M Lucchini
- Department of Gynecologic Oncology, Sanatorio Allende, Córdoba, Argentina.
| | - Agustin Esteban
- Department of Gynecologic Oncology, Sanatorio Allende, Córdoba, Argentina
| | - Mariana A Nigra
- Department of Gynecology and Obstetrics, Sanatorio Allende, Córdoba, Argentina
| | - Ana T Palacios
- Department of Gynecologic Oncology, Fundación Universitaria Ciencias de la Salud, Hospital de San José, Bogotá, Colombia
| | - Juan P Alzate-Granados
- FUCS - Division of investigation, Fundación Universitaria Ciencias de la Salud, Bogotá, Colombia; Direction of planning, evaluation and knowledge management, SANITAS EPS, Bogotá, Colombia
| | - Hernan F Borla
- Department of Gynecology and Obstetrics, Sanatorio Allende, Córdoba, Argentina
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Endometrial Cancer in 40 Years Old or Younger: A Single Center Experience. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.887727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fertility-Sparing Treatment for Atypical Endometrial Hyperplasia and Endometrial Cancer: A Cochrane Systematic Review Protocol. Adv Ther 2021; 38:2717-2731. [PMID: 33830463 DOI: 10.1007/s12325-021-01693-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/02/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Endometrial cancer is the fifth most common cancer in women and atypical endometrial hyperplasia is a precancerous lesion. Obesity is an important risk factor for endometrioid endometrial adenocarcinoma and endometrial hyperplasia. Progesterone is recommended as first-line treatment in endometrial cancer or atypical endometrial hyperplasia in women who wish to preserve fertility, but optimal treatment schedules have not been defined. Metformin or bariatric surgery may also be useful in these women. The effectiveness and safety of fertility-preserving treatments being used for women with atypical endometrial hyperplasia and stage IA grade 1 endometrial cancer is unclear. Therefore, the systematic review aims to determine this point. METHODS We will search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, trial registers, conference proceedings, abstracts, cooperative trial groups and reference lists. We will include randomised controlled trials (RCTs) that compare fertility-preserving therapy including orally administered progesterone versus a levonorgestrel-releasing intrauterine system (IUS), metformin, other pharmacological interventions or bariatric surgery, and any of these interventions with womb-removing surgery. Quasi-randomised trials, non-randomised trials and cohort studies will be included. Two review authors will independently assess study eligibility and risk of bias and extract data. The primary outcomes are complete pathologic response and live birth rate. Secondary outcomes include overall survival, progression-free survival, pregnancy rate, need for hysterectomy, adverse events, psychological symptoms and quality of life. PLANNED OUTCOMES This review aims to clarify the effectiveness and risks of fertility-preserving treatments, including complete pathologic response rate, live birth rates, need for surgical treatment, adverse events, psychological symptoms and quality of life. The broad scope of the review includes the use of progesterone, metformin to reverse insulin resistance, and bariatric surgery or operative hysteroscopy. RESULTS The results may help to determine the optimal fertility-sparing treatment in endometrial cancer and atypical endometrial hyperplasia. SYSTEMATIC REVIEW REGISTRATION Prospero 2019 number CRD42019145991.
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Janda M, Robledo KP, Gebski V, Armes JE, Alizart M, Cummings M, Chen C, Leung Y, Sykes P, McNally O, Oehler MK, Walker G, Garrett A, Tang A, Land R, Nicklin JL, Chetty N, Perrin LC, Hoet G, Sowden K, Eva L, Tristram A, Obermair A. Complete pathological response following levonorgestrel intrauterine device in clinically stage 1 endometrial adenocarcinoma: Results of a randomized clinical trial. Gynecol Oncol 2021; 161:143-151. [PMID: 33762086 DOI: 10.1016/j.ygyno.2021.01.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/24/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Intrauterine levonorgestrel (LNG-IUD) is used to treat patients with endometrial adenocarcinoma (EAC) and endometrial hyperplasia with atypia (EHA) but limited evidence is available on its effectiveness. The study determined the extent to which LNG-IUD with or without metformin (M) or weight loss (WL) achieves a pathological complete response (pCR) in patients with EAC or EHA. PATIENTS AND METHODS This phase II randomized controlled clinical trial enrolled patients with histologically confirmed, clinically stage 1 FIGO grade 1 EAC or EHA; a body mass index > 30 kg/m2; a depth of myometrial invasion of less than 50% on MRI; a serum CA125 ≤ 30 U/mL. All patients received LNG-IUD and were randomized to observation (OBS), M (500 mg orally twice daily), or WL (pooled analysis). The primary outcome measure was the proportion of patients developing a pCR (defined as absence of any evidence of EAC or EHA) after 6 months. RESULTS From December 2012 to October 2019, 165 patients were enrolled and 154 completed the 6-months follow up. Women had a mean age of 53 years, and a mean BMI of 48 kg/m2. Ninety-six patients were diagnosed with EAC (58%) and 69 patients with EHA (42%). Thirty-five participants were randomized to OBS, 36 to WL and 47 to M (10 patients were withdrawn). After 6 months the rate of pCR was 61% (95% CI 42% to 77%) for OBS, 67% (95% CI 48% to 82%) for WL and 57% (95% CI 41% to 72%) for M. Across the three treatment groups, the pCR was 82% and 43% for EHA and EAC, respectively. CONCLUSION Complete response rates at 6 months were encouraging for patients with EAC and EHA across the three groups. TRIAL REGISTRATION U.S. National Library of Medicine, NCT01686126.
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Affiliation(s)
- Monika Janda
- Centre for Health Services Research, The University of Queensland, QLD, Australia
| | - Kristy P Robledo
- University of Sydney NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Val Gebski
- University of Sydney NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Jane E Armes
- Sunshine Coast University Hospital Laboratory, Birtinya, QLD, Australia
| | | | - Margaret Cummings
- University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia; Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Chen Chen
- School of Biomedical Sciences, University of Queensland, Brisbane, Australia
| | - Yee Leung
- Division of Obstetrics and Gynaecology, The University of Western Australia, WA, Australia
| | - Peter Sykes
- Christchurch Women's Hospital, Canterbury District Health Board, Christchurch, New Zealand; University of Otago, Christchurch, New Zealand
| | - Orla McNally
- Department of Oncology and Dysplasia, Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Andrea Garrett
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, QLD, Australia; Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Amy Tang
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, QLD, Australia; Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Russell Land
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, QLD, Australia; Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - James L Nicklin
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, QLD, Australia; Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Naven Chetty
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, QLD, Australia; Mater Health Services, Brisbane, Australia
| | - Lewis C Perrin
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, QLD, Australia; Mater Health Services, Brisbane, Australia
| | - Greet Hoet
- The Townsville Hospital, Townsville, QLD, Australia
| | | | - Lois Eva
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | | | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, QLD, Australia; Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
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Razumova Z, Govorov I, Östensson E, Mints M. Cadmium Intake as a Prognostic Factor in Endometrial Cancer: A Swedish Cohort-Based Study. Nutr Cancer 2021; 74:175-184. [PMID: 33593165 DOI: 10.1080/01635581.2021.1883681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Metalloendocrinology is a new interdisciplinary field, which was established due to the importance of connections between inorganic chemicals and hormonal mechanisms. The role of cadmium in hormone-related tumors is an excellent example of this connection, as cadmium mimics estrogen in the human body. Since endometrial cancer (EC) is hormone-related, it is well-suited for assessing the estrogenic effects of cadmium. Therefore, the present study aims to explore the role of dietary cadmium intake in the progression-free survival (PFS) and overall survival (OS) in women with EC. Dietary cadmium intake was estimated based on a large cohort of Swedish women (n = 416) with EC. Median dietary cadmium intake was then analyzed in relation to different tumor characteristics and clinical outcomes. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Median daily dietary cadmium intake in the cohort was 13.1 μg (interquartile range 25%-75%=6.4). High dietary cadmium intake (μg/day) was associated with significantly decreased OS in the study cohort (HR = 0.956, 95% CI = 0.914-1.001, p = 0.05). Dietary cadmium intake was not associated with PFS (HR = 0.975, 95% CI = 0.924-1.028, p = 0.348). Therefore, our results indicate that high dietary cadmium intake could be associated with poor outcome in women with EC.
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Affiliation(s)
- Zoia Razumova
- Division of Neonatology, Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Igor Govorov
- Division of Neonatology, Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Institute of Perinatology and Paediatrics, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Ellinor Östensson
- Division of Neonatology, Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Miriam Mints
- Division of Neonatology, Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Hamilton CA, Pothuri B, Arend RC, Backes FJ, Gehrig PA, Soliman PT, Thompson JS, Urban RR, Burke WM. Endometrial cancer: A society of gynecologic oncology evidence-based review and recommendations, part II. Gynecol Oncol 2021; 160:827-834. [PMID: 33451724 DOI: 10.1016/j.ygyno.2020.12.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/19/2020] [Indexed: 12/20/2022]
Abstract
In 2014, the Society of Gynecologic Oncology's Clinical Practice Committee published a clinical update reviewing the treatment of women with endometrial cancer. At that time, there had been significant advances in the diagnosis, work-up, surgical management, and available treatment options allowing for more optimal care of affected women. This manuscript, Part II in a two-part series, includes specific recommendations on treatment of recurrent disease, post treatment surveillance and survivorship, considerations for younger women, and special situations. Part I covered histopathology and molecular pathology, risk factors, presentation and diagnostic approach, surgical approach and adjuvant therapy.
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Affiliation(s)
- Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and the Ochsner Cancer Institute, Ochsner Health, New Orleans, LA, United States of America.
| | - Bhavana Pothuri
- Department of Obstetrics and Gynecology, NYU School of Medicine, New York City, NY, United States of America
| | - Rebecca C Arend
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Floor J Backes
- Division of Gynecologic Oncology, Ohio State University and James Cancer Hospital, Columbus, OH, United States of America
| | - Paola A Gehrig
- Professor and Chief, Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, United States of America
| | - Pamela T Soliman
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - J Spencer Thompson
- Division of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, United States of America
| | - Renata R Urban
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - William M Burke
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook University Cancer Center, Stony Brook, NY, United States of America
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Kohn JR, Katebi Kashi P, Acosta-Torres S, Beavis AL, Christianson MS. Fertility-sparing Surgery for Patients with Cervical, Endometrial, and Ovarian Cancers. J Minim Invasive Gynecol 2020; 28:392-402. [PMID: 33373729 DOI: 10.1016/j.jmig.2020.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Nearly 10% of the 1.3 million women living with a gynecologic cancer are aged <50 years. For these women, although their cancer treatment can be lifesaving, it's also life-altering because traditional surgical procedures can cause infertility and, in many cases, induce surgical menopause. For appropriately selected patients, fertility-sparing options can reduce the reproductive impact of lifesaving cancer treatments. This review will highlight existing recommendations as well as innovative research for fertility-sparing treatment in the 3 major gynecologic cancers. TABULATION, INTEGRATION, AND RESULTS For early-stage cervical cancers, fertility-sparing surgeries include cold knife conization, simple hysterectomy with ovarian preservation, or radical trachelectomy with placement of a permanent cerclage. In locally advanced cervical cancer, ovarian transposition before radiation therapy can help preserve ovarian function. For endometrial cancers, fertility-sparing treatment includes progestin therapy with endometrial sampling every 3 to 6 months. After cancer regression, progestin therapy can be halted to allow attempts to conceive. Hysterectomy with ovarian preservation can also be considered, allowing for fertility using assisted reproductive technology and a gestational carrier. For ovarian cancers, fertility-sparing surgery includes unilateral salpingo-oophorectomy or bilateral salpingo-oophorectomy (with lymphadenectomy and staging depending on tumor histology). With higher-risk histology or higher early-stage disease, adjuvant chemotherapy is recommended-however, this carries a 3% to 10% risk of ovarian failure. Use of oocyte or embryo cryopreservation in patients with early-stage ovarian malignancy remains an area of ongoing research. CONCLUSION Overall, fertility-sparing management of gynecologic cancers is associated with acceptable rates of progression-free survival and overall survival and is less life-altering than more radical surgical approaches.
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Affiliation(s)
- Jaden R Kohn
- Kelly Gynecologic Oncology Service (Drs. Kohn, Kashi, Acosta-Torres, and Beavis).
| | - Payam Katebi Kashi
- Kelly Gynecologic Oncology Service (Drs. Kohn, Kashi, Acosta-Torres, and Beavis)
| | | | - Anna L Beavis
- Kelly Gynecologic Oncology Service (Drs. Kohn, Kashi, Acosta-Torres, and Beavis)
| | - Mindy S Christianson
- Division of Reproductive Endocrinology and Infertility (Dr. Christianson), Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
Aim: To evaluate associations between survival and glycemic control in age-matched patients with endometrial or ovarian cancer, with/without diabetes mellitus (DM). Patients & methods: Patients with newly diagnosed ovarian or endometrial cancer with and without DM were compared. Results: The study included 84 patients with ovarian cancer (28, DM); 96 with endometrial cancer (48 with, 48 without DM). DM patients did not have worse overall or progression-free survival than non-DM patients. Glycemic control was not associated with either cancer. Conclusion: There was no association between DM and survival for patients with uterine or ovarian cancer. In addition, there was no association between uterine and ovarian cancer and glycemic control. Additional studies to confirm these observations in larger populations are required. The aim of this study was to evaluate the effect of diabetes mellitus (DM) on survival of patients with ovarian or uterine cancer and to determine whether ovarian and uterine cancer affected glycemic control. From an institutional cancer registry, patients with ovarian or uterine cancer were identified and grouped by DM or no DM. Groups were matched by age at cancer diagnosis. DM did not decrease survival and ovarian and uterine cancer did not significantly affect glycemic control in patients with DM.
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Topçu HO, Kaya C, Oral E. Fertility issue in early stage endometrial cancer patients. Transl Cancer Res 2020; 9:7797-7808. [PMID: 35117382 PMCID: PMC8797551 DOI: 10.21037/tcr-20-2232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/31/2020] [Indexed: 11/14/2022]
Abstract
Endometrial cancer (EC) is the most common cancer of the female reproductive system in developed countries. The incidence of EC has been increasing in young women. Approximately 4% of cases are aged <40 years. These young women may wish to delay therapy until after they have children. Common complaints in patients with EC include irregular vaginal bleeding, pelvic pain, and enlarged uterus. Imaging techniques such as transvaginal ultrasound (TVUS) or magnetic resonance imaging (MRI) can be utilized in detecting EC. Although the recommended treatment of EC is hysterectomy and bilateral salpingo-oophorectomy with or without systemic lymph node dissection, loss of reproductive function is the primary limiting factor of this surgical approach. Some studies have reported favorable results with high-dose oral progestins or levonorgestrel-releasing intrauterine system or hysteroscopic tumor resection followed by treatment with high-dose oral progestins. The most widely utilized medical treatment regimens are medroxyprogesterone acetate (MPA) 250–600 mg/day or megestrol acetate (MA) 160–480 mg/day. However, there is still a lack of evidence to establish the optimal dose and duration of progestin treatment. Patients with complete remission (CR) who wish to conceive must be encouraged, and referral to a fertility clinic should be offered as soon as possible. The key aspect of fertility-sparing management in women with EC appears to be the selection of appropriate candidates. Owing to the rarity of this condition, management may often be suboptimal. The aim of this review is to assess the current approaches to management of young women with EC who wish to preserve their fertility.
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Affiliation(s)
- Hasan Onur Topçu
- Department of Obstetrics and Gynecology, Memorial Hospital Ankara, Ankara, Turkey
| | - Cihan Kaya
- Department of Obstetrics and Gynecology, University of Health Sciences Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Engin Oral
- Private Clinic, Obstetrics and Gynecology, Istanbul, Turkey
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Fertility Sparing Treatment of Endometrial Cancer with and without Initial Infiltration of Myometrium: A Single Center Experience. Cancers (Basel) 2020; 12:cancers12123571. [PMID: 33260382 PMCID: PMC7760930 DOI: 10.3390/cancers12123571] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/14/2020] [Accepted: 11/27/2020] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Endometrial cancer is the most common malignancy of the female genital tract, and in 14% of cases, is diagnosed in premenopausal women, While, the cancer appears in 5% in women of childbearing age. Preserving fertility in these women should be the goal of cancer practice. The aim of our study is to describe pregnancy outcomes of our center in women with G1 endometrial endometrioid cancer and atypical endometrial hyperplasia/endometrial intraepithelial neoplasm undergone conservative treatment. Moreover, for the first time, obstetric and oncological outcomes are described in a long follow up, including women with minimal myometrial infiltration. Abstract Endometrial cancer (EC) is the fourth largest female cancer in Europe and North America. In 5% of cases, the diagnosis is made in women who wish to become pregnant. In our retrospective study, we reported our experience about fertility sparing treatment of G1 endometrioid endometrial cancer (G1 EEC) or atypical endometrial hyperplasia/endometrial intraepithelial neoplasm (AEH/EIN) in young women desiring pregnancy treated in our Center. Conservative treatment was based on operative hysteroscopy and hormone therapy with megestrol acetate (160 mg/die for 9 months). For the first time we included women with G1 EEC with minimal myometrial infiltration. The minimum follow-up period was two years and consisted of serial outpatient hysteroscopies with endometrial biopsies. Among the 36 women with G1 EEC we observed one case of disease persistence and four recurrences and four recurrences among the 46 women diagnosed with AEH/EIN. To date, 35 live births were obtained in both groups. Our results advance the hypothesis that conservative treatment can represent a safe and feasible alternative to propose to young women with desire for pregnancy. Further randomized and multicentric studies are needed to arrive at unambiguous and standardized guidelines on the surgical and medical treatment of young women with EEC or AEH/EIN.
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LA Russa M, Liakou C, Burbos N. Ultra-minimally invasive approaches for endometrial cancer treatment: review of the literature. Minerva Med 2020; 112:31-46. [PMID: 33205639 DOI: 10.23736/s0026-4806.20.07073-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION We conducted a systematic review to evaluate the outcomes and role of ultra-minimally invasive surgical approaches for treatment of women diagnosed with endometrial cancer. Although, there is no agreed definition of the term "ultraminimal," we considered the hysteroscopic surgery, single-port surgery, mini/microlaparoscopy and percutaneous laparoscopy as surgical approaches that would best fit this description. EVIDENCE ACQUISITION The current systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines. We performed a literature search using MEDLINE (PubMed), EMBASE and Cochrane Library databases for English-language studies published before August 1, 2020. We used the following keywords including "endometrial cancer," "endometrial malignancy," "fertility-sparing or preserving," "hysteroscopy," "hysteroscopic resection," "dilatation and curettage," "ultra-minimally invasive surgery," "progestin therapy," "hormone therapy," "single port," "single-site," "minilaparoscopy," "microlaparoscopy," "percutaneous" and "3 mm laparoscopy." EVIDENCE SYNTHESIS A total of 21 studies, reporting on 229 patients were included. 219 (95.6%) of the patients were premenopausal. Among premenopausal women, complete disease response was reported in 186 (84.9%) patients. The complete response rate was 77.1% in patients who underwent focal or extensive endometrial resection, 90.9% in patients who had the two-step approach and 88.9% in the group of patients treated with the three-step technique. Among 98 women who wished and attempted to conceive, 65 (66.3%) women became pregnant. Recurrent disease was diagnosed in 26 of 219 (11.9%) patients. No surgical complications were reported. In 10 postmenopausal patients that underwent hysteroscopic resection, no recurrences were detected after 5 years of follow-up. We identified 11 studies that reported on the use single-port laparoscopic surgery and included a total of 447 patients. The rate of intraoperative and postoperative complications was 2.6% and 5.2%, respectively. The majority of the studies did not report on the duration of follow-up or oncological outcomes. Ten studies, including 296 patients, investigated the role of single-port robotic-assisted laparoscopy. The overall rate of intraoperative and postoperative complications was 1.0% and 7.1%, respectively. Two studies, including 38 patients, reported on the role of minilaparoscopy. None of these cases required conversion to laparotomy. Data on overall survival in the cohort of patients that underwent minilaparoscopy were not reported. We found only one publication reporting on the use of percutaneous laparoscopy. This prospective study included 30 patients. No complication was reported, and with a median follow-up time of 14 months (range 12-36) no recurrences were diagnosed. CONCLUSIONS Several ultra-minimally invasive surgical techniques have been developed and implemented in selected patients with endometrial cancer. The results of this review support the feasibility and perioperative safety of these approaches, while long-term outcomes are not adequately studied. However, further work is required in standardization of the techniques, in determining the learning curve of the operator and establishing their oncological safety.
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Affiliation(s)
- Mariaclelia LA Russa
- Department of Gynecological Oncology, Norfolk and Norwich University Hospital, Norwich, UK -
| | - Chrysoula Liakou
- Department of Gynecological Oncology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Nikolaos Burbos
- Department of Gynecological Oncology, Norfolk and Norwich University Hospital, Norwich, UK
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Garzon S, Uccella S, Zorzato PC, Bosco M, Franchi MP, Student V, Mariani A. Fertility-sparing management for endometrial cancer: review of the literature. Minerva Med 2020; 112:55-69. [PMID: 33205638 DOI: 10.23736/s0026-4806.20.07072-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Primary surgery is effective in low-risk endometrial cancer (EC). However, in young women, this approach compromises fertility. Therefore, fertility-sparing management in the case of atypical endometrial hyperplasia, or grade 1 EC limited to the endometrium can be considered. EVIDENCE ACQUISITION We performed a literature review to identify studies involving women with EC or atypical hyperplasia who underwent fertility-sparing management. We conducted multiple bibliographic databases research from their inception to May 2020. EVIDENCE SYNTHESIS Oral therapy with medroxyprogesterone acetate and megestrol acetate is recommended based on extensive experience, although without consensus on dosages and treatment length. The pooled complete response rate, recurrence rate, and pregnancy rate of EC were 76.3%, 30.7% and 52.1%, respectively. Endometrial hyperplasia was associated with better outcomes. LNG-IUSs appears an alternative treatment, particularly in patients who do not tolerate oral therapy. In a randomized controlled trial, megestrol acetate plus metformin guaranteed an earlier complete response rate than megestrol acetate alone for endometrial hyperplasia. Hysteroscopic resection followed by progestogens is associated with a higher complete response rate, live birth rate, and lower recurrence rate than oral progestogens alone. Pooled complete response, recurrence, and live birth rates were 98.1%, 4.8% and 52.6%. CONCLUSIONS Fertility preservation appears feasible in young patients with grade 1 EC limited to the endometrium or atypical endometrial hyperplasia. Progestins are the mainstay of such management. The addition of Metformin and hysteroscopic resection seems to provide some improvements. However, fertility preservation is not the standard approach for staging and treatment, potentially worsening oncologic outcomes.
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Affiliation(s)
- Simone Garzon
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, MN, USA -
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Massimo P Franchi
- Department of Obstetrics and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Vladimir Student
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, MN, USA
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Brennan A, Brennan D, Rees M, Hickey M. Management of menopausal symptoms and ovarian function preservation in women with gynecological cancer. Int J Gynecol Cancer 2020; 31:352-359. [PMID: 33127864 DOI: 10.1136/ijgc-2020-002032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
Gynecological cancers affect a growing number of women globally, with approximately 1.3 million women diagnosed in 2018. Menopausal symptoms are a significant health concern after treatment for gynecological cancers and may result from oncologic treatments such as premenopausal bilateral oophorectomy, ovarian failure associated with chemotherapy or radiotherapy, and anti-estrogenic effects of maintenance endocrine therapy. Additionally, with the growing availability of testing for pathogenic gene variants such as BRCA1/2 and Lynch syndrome, there is an increasing number of women undergoing risk-reducing oophorectomy, which in most cases will be before age 45 years and will induce surgical menopause. Not all menopausal symptoms require treatment, but patients with cancer may experience more severe symptoms compared with women undergoing natural menopause. Moreover, there is increasing evidence of the long-term implications of early menopause, including bone loss, cognitive decline and increased cardiovascular risk. Systemic hormone therapy is well established as the most effective treatment for vasomotor symptoms and vaginal (topical) estrogen therapy is effective for genitourinary symptoms. However, the role of hormone receptors in many gynecological cancers and their treatment pose a challenge to the management of menopausal symptoms after cancer. Consequently, the use of menopausal hormone therapy in this setting can be difficult for clinicians to navigate and this article aims to provide current, comprehensive guidance for the use of menopausal hormone replacement therapy in women who have had, or are at risk of developing, gynecological cancer to assist with these treatment decisions.
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Affiliation(s)
| | - Donal Brennan
- Gynaecology Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Martha Hickey
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
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Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding. Diagnostics (Basel) 2020; 10:diagnostics10110884. [PMID: 33142970 PMCID: PMC7692264 DOI: 10.3390/diagnostics10110884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/16/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022] Open
Abstract
Abnormal uterine bleeding (AUB) is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to 90% in perimenopausal women. In most cases, AUB is due to a benign cause. However, it can also be a symptom of atypical endometrial hyperplasia or endometrial cancer, a more common disease during menopause which can also affect women in their reproductive age. Considering the high prevalence of this symptom an appropriate diagnostic algorithm is needed. Concerns about the risks, pain, and stress associated with an endometrial biopsy and its impact on the healthcare system make the choice of AUB diagnostic strategy extremely relevant. Even if the scientific community agrees on the definition of AUB, International Guidelines show some differences in the management of women of reproductive age with AUB, especially regarding the age cut-off as an independent indication for endometrial biopsy. This study compared different diagnostic strategies to identify a diagnostic pathway with high sensitivity and specificity but low impact on the health system's resources. The analysis was based on three diagnostic algorithms defined as part of the guidelines of leading scientific societies. Women of reproductive age with AUB (n = 625) and without risk of endometrial cancer were included in the study. Results showed that the best criterion to investigate AUB in women at low risk of endometrial cancer is not age cut-off but the presence or absence of focal endometrial pathology at the ultrasound and the response to the progestin therapy. This approach makes it possible to perform fewer outpatient hysteroscopic biopsies without excluding positive cases from the examination.
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