1
|
Azzi PA, Bastos Russomano F, de Andrade CV, de Camargo MJ, Moskovics Jordão P. Frequency of post-treatment disease after excisional procedure in stage IA1 squamous cervical carcinoma - a case series. Women Health 2023; 63:747-755. [PMID: 37779317 DOI: 10.1080/03630242.2023.2264398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
Early stages of cervical cancer in young women need conservative treatments. Electrosurgical therapies (LLETZ, LEEP, SWETZ, NETZ) have been recommended for these women. However, there are recommendations to perform a second excision when the specimen margins are not free of disease. This can lead to some important complications. This article aims to verify the frequency of residual invasive or microinvasive disease after the excisional procedure in women with IA1CC. Data on women with IA1CC diagnosed between 1990 and 2022, were retrieved from medical records. Post-treatment disease was detected during a second surgical procedure or postoperative follow-up. Among the 69 included women, three (4.3 percent; CI95 percent 0-9.2) had residual microinvasive lesions, while none showed invasive disease during a second procedure or follow-up. Only the age of 37 years or more was significantly related to the presence of preinvasive or microinvasive residual lesions. Nearly 80 percent of the women who underwent a second procedure showed no residual lesions. The absence of invasive disease in a second procedure or during the follow-up of these women and the large proportion of women with no residual lesion questions the need for a new surgical procedure even when the surgical margins of the initial specimen are involved.
Collapse
Affiliation(s)
- Pedro Abreu Azzi
- Women's Health Care Area, Colposcopy Unit, Institute of Woman, Child and Adolescent's Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Fábio Bastos Russomano
- Women's Health Care Area, Colposcopy Unit, Institute of Woman, Child and Adolescent's Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Cecilia Vianna de Andrade
- Laboratory of Pathology and Cytopathology, Institute of Woman, Child and Adolescent's Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Maria José de Camargo
- Women's Health Care Area, Colposcopy Unit, Institute of Woman, Child and Adolescent's Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Paula Moskovics Jordão
- Women's Health Care Area, Colposcopy Unit, Institute of Woman, Child and Adolescent's Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| |
Collapse
|
2
|
Golia D'Augè T, Cuccu I, Santangelo G, Muzii L, Giannini A, Bogani G, Di Donato V. Novel Insights into Molecular Mechanisms of Endometrial Diseases. Biomolecules 2023; 13:biom13030499. [PMID: 36979434 PMCID: PMC10046407 DOI: 10.3390/biom13030499] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Endometrial diseases are the most common gynecological pathologies in Western Countries [...].
Collapse
Affiliation(s)
- Tullio Golia D'Augè
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00100 Rome, Italy
| | - Ilaria Cuccu
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00100 Rome, Italy
| | - Giusi Santangelo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00100 Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00100 Rome, Italy
| | - Andrea Giannini
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00100 Rome, Italy
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in "Translational Medicine and Oncology", Sapienza University, 00185 Rome, Italy
| | - Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00100 Rome, Italy
| |
Collapse
|
3
|
Zhang X, Zhao X, Wang C, Lu S, Wang Y, He Y, Wang J, Shen D. Use of clinicopathological factors to predict prognosis of fertility-sparing treatment for endometrial endometrioid carcinoma and atypical hyperplasia. Oncol Lett 2022; 25:52. [PMID: 36644134 PMCID: PMC9811621 DOI: 10.3892/ol.2022.13638] [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: 05/28/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
The incidence of endometrial endometrioid carcinoma (EEC) has been gradually increasing over the past decade. Fertility-sparing therapy with progestin is a treatment option for EEC or endometrial atypical hyperplasia (AH). The present study evaluated the role of numerous prognostic factors following fertility-sparing therapy for EEC or AH. Furthermore, the present study assessed the strength of various clinicopathological indicators for the prediction of treatment efficacy. A retrospective analysis was performed of patients with EEC and AH who received fertility-sparing therapy between August 2013 and September 2021 at Peking University People's Hospital (Beijing, China). Endometrial specimens were obtained from each patient after 3 months of treatment and at the end of the fertility-sparing therapy, before treatment efficacy and prognosis were evaluated using the χ2 test. Furthermore, the protein expression levels of EEC biomarkers, such as estrogen receptor (ER), progesterone receptor (PR), paired box 2 (PAX2), PTEN and p53 were assessed using immunohistochemistry. The overall complete response (CR) rate of fertility-sparing treatment in the EEC group was 67.39% (31/46), whereas that in the AH group was 86.49% (32/37). The difference between the CR rates in the EEC and AH groups was statistically significant (P<0.05). There was no association between prognosis after treatment and ER, PAX2, PTEN or Ki-67 expression in the initially untreated AH or EEC groups. However, tissues with >50% positive PR expression were demonstrated to have a higher CR rate compared with those with ≤50% positive PR expression in both the EEC and AH groups. Furthermore, the PAX2-positive group tended to demonstrate higher CR rates compared with the PAX2-negative group in the patients with EEC. In conclusion, these data suggested that fertility-sparing therapy is effective for patients with EEC and AH who wish to remain fertile after treatment. Specifically, in the AH group, a higher proportion of patients achieved a CR whilst also achieving this more rapidly. Furthermore, PR was demonstrated to be a useful marker for the evaluation of EEC and AH.
Collapse
Affiliation(s)
- Xiaobo Zhang
- Department of Pathology, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Xiaoya Zhao
- Department of Pathology, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Chen Wang
- Department of Pathology, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Shanshan Lu
- Department of Pathology, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Yiqin Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Yijiao He
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, P.R. China,Correspondence to: Professor Jianliu Wang, Department of Obstetrics and Gynecology, Peking University People's Hospital, 11 Xizhimen South Street, Xicheng, Beijing 100044, P.R. China, E-mail:
| | - Danhua Shen
- Department of Pathology, Peking University People's Hospital, Beijing 100044, P.R. China,Professor Danhua Shen, Department of Pathology, Peking University People's Hospital, 11 Xizhimen South Street, Xicheng, Beijing 100044, P.R. China, E-mail:
| |
Collapse
|
4
|
Gallo A, Catena U, Saccone G, Di Spiezio Sardo A. Conservative Surgery in Endometrial Cancer. J Clin Med 2021; 11:183. [PMID: 35011924 PMCID: PMC8745528 DOI: 10.3390/jcm11010183] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 12/30/2022] Open
Abstract
Endometrial cancer (EC) is the sixth most common female cancer worldwide. The median age of diagnosis is 65 years. However, 4% of women diagnosed with EC are younger than 40 years old, and 70% of these women are nulliparous. These data highlight the importance of preserving fertility in these patients, at a time when the average age of the first pregnancy is significantly delayed and is now firmly established at over 30 years of age. National Comprehensive Cancer Network (NCCN guidelines state that the primary treatment of endometrial endometrioid carcinoma, limited to the uterus, is a total hysterectomy, bilateral salpingo-oophorectomy and surgical staging. Fertility-sparing treatment is not the standard of care, and patients eligible for this treatment always have to undergo strict counselling. Nowadays, a combined approach consisting of hysteroscopic resection, followed by oral or intrauterine-released progestins, has been reported to be an effective fertility-sparing option. Hysteroscopic resection followed by progestins achieved a complete response rate of 95.3% with a recurrence rate of 14.1%. The pregnancy rate in women undergoing fertility-sparing treatment is 47.8%, but rises to 93.3% when only considering women who tried to conceive during the study period. The aim of the present review is to provide a literature overview reflecting the current state of fertility-sparing options for the management of EC, specific criteria for considering such options, their limits, the implications for reproductive outcomes and the latest research trends in this direction.
Collapse
Affiliation(s)
- Alessandra Gallo
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy;
| | - Ursula Catena
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy;
| | - Attilio Di Spiezio Sardo
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy;
| |
Collapse
|