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Wang N, Zhang J, Fan X, Ma J, He J, Kang S, Cheng J, Ma J. Identification of risk factors for the prognosis of Chinese patients with endometrial carcinoma. Medicine (Baltimore) 2021; 100:e27305. [PMID: 34559145 PMCID: PMC8462610 DOI: 10.1097/md.0000000000027305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/07/2021] [Indexed: 01/05/2023] Open
Abstract
This study aimed to retrospectively analyze risk factors for the prognosis of Chinese patients with endometrial carcinoma.Total 600 patients who were admitted to the Department of Gynecology, the Fourth Hospital of Hebei Medical University and were pathologically diagnosed as endometrial carcinoma after surgery from January 1, 1997 to December 31, 2006 were selected, and the related factors affecting their prognosis were analyzed.The survival of 600 patients with endometrial carcinoma was 2 to 136.5 months (average survival 57.39 ± 33.55 months), and 109 cases (18.2%) died from endometrial cancer. The overall survival rate of 1, 3, and 5 years after surgery was 96.8%, 89.9%, and 82.1%, respectively. Univariate analysis showed that age, menopausal status, pathological type, histological grade, pathological staging, tumor size, myometrial invasion, cervical involvement, ovarian metastasis, lymph node metastasis, and treatment method were the factors affecting the prognosis of endometrial carcinoma. Multivariate regression analysis showed that pathological type, histological grade, pathological staging, and cervical involvement were independent risk factors for the prognosis of endometrial carcinoma. The patients with high-grade and deep myometrial invasion, cervical involvement, full cavity tumor, and lymph node metastasis had a high incidence of ovarian metastasis.Pathological type, histological grade, pathological staging, and cervical involvement are independent risk factors affecting the prognosis of Chinese patients with endometrial carcinoma.
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Larish A, Kumar A, Weaver A, Mariani A. Impact of hysteroscopy on course of disease in high-risk endometrial carcinoma. Int J Gynecol Cancer 2020; 30:1513-1519. [PMID: 32848025 DOI: 10.1136/ijgc-2020-001627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Previous studies have investigated the impact of preoperative hysteroscopy on the staging and survival of predominantly grade 1 endometrial cancers. We sought to evaluate the effect of hysteroscopy on the peritoneal spread of tumor cells and disease course in a large series of patients with high-risk endometrial cancer. METHODS Patients who underwent hysterectomy for grade 3 endometrial carcinoma on final surgical pathology at the Mayo Clinic in Rochester, MN between January 2009 to June 2016 were included, noting hysteroscopy within 6 months from surgery. Intra-peritoneal disease was defined as any positive cytology OR adnexal invasion OR stage IV. The presence of intra-peritoneal disease OR peritoneal recurrence within 2 years from surgery was defined as peritoneal dissemination. Cox proportional hazards models were fit to evaluate associations between hysteroscopy exposure and progression within 5 years following surgery. RESULTS Among 831 patients, 133 underwent hysteroscopy. There was no difference in age, body mass index, ASA ≥3, or serous histology between patients who did or did not undergo hysteroscopy. Advanced stage disease (III/IV) was less common among patients who underwent hysteroscopy (30.1% vs 43.8%, P=0.003). No difference was observed between those with vs without hysteroscopy in the rate of positive cytology (22.0% vs 29.7%, P=0.09), stage IV (16.5% vs 21.9%, P=0.16), intra-peritoneal disease (28.6% vs 36.1%, P=0.09), or peritoneal dissemination (30.8% vs 39.3%, P=0.06). On stratifying by stage, hysteroscopy did not increase the risk of progression (HR 1.06, 95% CI 0.59 to 1.92 for stage I/II; HR 0.96, 95% CI 0.62 to 1.48 for stage III/IV). CONCLUSION In this retrospective study of grade 3 endometrial cancer, we did not observe any significant association between pre-operative hysteroscopy and the incidence of positive cytology, peritoneal disease, peritoneal dissemination, or cancer progression.
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Affiliation(s)
- Alyssa Larish
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanika Kumar
- Gynecologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Amy Weaver
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biostatistics, Mayo Clinic Minnesota, Rochester, New York, USA
| | - Andrea Mariani
- Gynecologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Hefler-Frischmuth K, Hirtl-Goergl E, Unterrichter V, Lafleur J, Brunnmayr-Petkin G, Moinfar F, Hefler L. One-stop clinical assessment of risk for endometrial hyperplasia (OSCAR-Endo): a fast-track protocol for evaluating endometrial pathologies. Arch Gynecol Obstet 2017; 295:959-964. [PMID: 28265757 DOI: 10.1007/s00404-017-4326-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/07/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate a one-stop clinical assessment of risk for assessing endometrial pathologies (OSCAR-Endo), consisting of a fast-track protocol with hysteroscopy, dilation and curettage (D&C) with intraoperative frozen section analysis of the removed tissue in cases of hysteroscopic suspicion of malignancy. METHODS In this prospective clinical trial, a total of 304 consecutive women with sonographically suspected endometrial hyperplasia and/or postmenopausal bleeding, underwent D&C with intraoperative frozen section analysis between May 2013 and September 2015. Based on the results of the hysteroscopy and/or frozen section, the OSCAR-Endo score was reported: negative, when no frozen section was regarded necessary or the frozen section yielded a negative result; equivocal, when the frozen section reported an equivocal result; positive, when frozen section reported either complex hyperplasia with atypia or cancer. RESULTS Frozen sections were required by the surgeons in 59 (19.4%) of cases. When compared with the final histology after D&C, frozen section showed a sensitivity, specificity, PPV, NPV, and overall test accuracy of 91.3, 100, 100, 94.1, and 96.3% for predicting malignant disease, respectively. The OSCAR-Endo score showed a sensitivity, specificity, PPV, NPV, and overall test accuracy of 84, 100, 100, 98.6, and 98.7% for predicting malignant disease, respectively. CONCLUSION The OSCAR-Endo protocol is easy to perform in daily clinical practice reaching an excellent test accuracy. It helps in immediate postoperative counseling of affected patients. Clinical Trial Registration http://www.clinicaltrials.gov ; NCT01961102.
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Affiliation(s)
- Katrin Hefler-Frischmuth
- Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria.
- Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria.
| | - Elisabeth Hirtl-Goergl
- Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria
- Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria
| | - Verena Unterrichter
- Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria
- Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria
| | - Judith Lafleur
- Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria
- Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria
| | - Gudrun Brunnmayr-Petkin
- Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria
- Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria
| | - Farid Moinfar
- Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria
- Department of Pathology, Ordensklinikum Linz, Linz, Austria
- Department of Pathology, Medical University of Graz, Graz, Austria
| | - Lukas Hefler
- Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria
- Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria
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