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Pöschke P, Gass P, Krückel A, Keller K, Erber R, Hartmann A, Beckmann MW, Emons J. Clinical and Surgical Evaluation of Sentinel Node Biopsy in Patients with Early-Stage Endometrial Cancer and Atypical Hyperplasia. Geburtshilfe Frauenheilkd 2024; 84:470-476. [PMID: 38817597 PMCID: PMC11136525 DOI: 10.1055/a-2293-5700] [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: 01/29/2024] [Accepted: 03/20/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction The medical and surgical treatment of endometrial cancer (EC) is evolving toward a more patient-centered and personalized approach. The role of laparoscopic sentinel node biopsy (SNB) for early-stage EC is unclear, and very few data are available for atypical endometrial hyperplasia (AEH). The present study investigated the effectiveness of SNB combined with laparoscopic hysterectomy in patients with early-stage EC and AEH. Patients and Methods This was a retrospective, single-center cohort study for the period from January 2018 to December 2023. A total of 102 patients with atypical hyperplasia (n = 20) and early-stage EC (n = 82) findings on diagnostic curettage underwent pelvic sentinel node biopsy during the final operation. Results Eleven patients (55%) who had initially been diagnosed with AEH were found to have EC in the final pathology report. No lymph node metastases were detected in patients who had initially been diagnosed with AEH; a 3.6% rate of positive SNBs was found in patients with EC. Changes in tumor grade occurred in 31.3% of the patients and changes in FIGO stage in 33%. Bilateral sentinel node (SN) mapping was successful in 94.1% of the patients. The postoperative outcomes were comparable to those of routine clinical practice without SNB. Conclusions SNB can be safely offered to patients who have precursor lesions and early-stage EC without notably extending surgical times or increasing postoperative morbidity. This approach can be considered and is safe for patients diagnosed with AEH, but it appears to have a rather small impact on these patients.
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Affiliation(s)
- Patrik Pöschke
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
| | - Annika Krückel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
| | - Katharina Keller
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
| | - Ramona Erber
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen, Germany
| | - Arndt Hartmann
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen, Germany
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Friedrich Alexander University of Erlangen–Nuremberg, Erlangen, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
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Otsuka I, Kadooka M, Matsuura T. Long-term survival of a patient with stage IIIC2 grade 3 endometrioid endometrial carcinoma treated with surgery alone. Gynecol Oncol Rep 2021; 38:100869. [PMID: 34926754 PMCID: PMC8651900 DOI: 10.1016/j.gore.2021.100869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 11/24/2022] Open
Abstract
The therapeutic benefit of lymphadenectomy in endometrial carcinoma is controversial. Long-term survival was achieved in a stage IIIC2 patient treated with surgery alone. Pelvic and para-aortic lymphadenectomy may have a therapeutic benefit.
Background The therapeutic benefit of lymphadenectomy in endometrial carcinoma is controversial. Case A 70-year-old woman with grade 3 endometrioid endometrial carcinoma with deep myometrial invasion underwent surgical staging comprising total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal cytology, and pelvic and para-aortic lymphadenectomy. Pathological examination revealed micro-metastases in the para-aortic node, pelvic node, and left ovary. Peritoneal cytology was negative, and abnormal p53 expression was not detected. The patient was diagnosed with stage IIIC2 endometrial carcinoma. Adjuvant chemotherapy was advised, but the patient refused chemotherapy and was followed up regularly thereafter. The patient survived without any evidence of disease 67 months after surgery. Conclusion Pelvic and para-aortic lymphadenectomy may have a therapeutic benefit in a patient with high-grade endometrioid carcinoma, but without p53 abnormality.
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Affiliation(s)
- Isao Otsuka
- Department of Obstetrics and Gynecology, Kameda Medical Center, Kamogawa, Japan
| | - Mizuho Kadooka
- Department of Obstetrics and Gynecology, Kameda Medical Center, Kamogawa, Japan
| | - Takuto Matsuura
- Department of Obstetrics and Gynecology, Kameda Medical Center, Kamogawa, Japan
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3
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Li W, Jiang J, Fu Y, Shen Y, Zhang C, Yao S, Xu C, Xia M, Lou G, Liu J, Lin B, Wang J, Zhao W, Zhang J, Cheng W, Guo H, Guo R, Xue F, Wang X, Han L, Zhao X, Li X, Zhang P, Zhao J, Ma J, Yao Q, Yang X, Dou Y, Wang Z, Liu J, Fang Y, Li K, Wang B, Chen G, Cheng X, Sun C, Kong B. Implications of Isolated Para-Aortic Lymph Node Metastasis in Endometrial Cancer: A Large-Scale, Multicenter, and Retrospective Study. Front Med (Lausanne) 2021; 8:754890. [PMID: 34746191 PMCID: PMC8566710 DOI: 10.3389/fmed.2021.754890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/20/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: To systematically evaluate lymph node metastasis (LNM) patterns in patients with endometrial cancer (EC) who underwent complete surgical staging, which included systematic pelvic and para-aortic lymphadenectomy. Methods: Four thousand and one patients who underwent complete surgical staging including systematic pelvic and para-aortic lymphadenectomy for EC were enrolled from 30 centers in China from 2001 to 2019. We systematically displayed the clinical and prognostic characteristics of patients with various LNM patterns, especially the PLN-PAN+ [para-aortic lymph node (PAN) metastasis without pelvic lymph node (PLN) metastasis]. The efficacy of PAN+ (para-aortic lymph node metastasis) prediction with clinical and pathological features was evaluated. Results: Overall, 431 of the 4,001 patients (10.8%) showed definite LNM according to pathological diagnosis. The PAN+ showed the highest frequency (6.6%) among all metastatic sites. One hundred fourteen cases (26.5%) were PLN-PAN+ (PAN metastasis without PLN metastasis), 167 cases (38.7%) showed PLN+PAN-(PLN metastasis without PAN metastasis), and 150 cases (34.8%) showed metastasis to both regions (PLN+PAN+). There was also 1.9% (51/2,660) of low-risk patients who had PLN-PAN+. There are no statistical differences in relapse-free survival (RFS) and disease-specific survival (DSS) among PLN+PAN-, PLN-PAN+, and PLN+PAN+. The sensitivity of gross PLNs, gross PANs, and lymphovascular space involvement (LVSI) to predict PAN+ was 53.8 [95% confidence interval (CI): 47.6–59.9], 74.2 95% CI: 65.6–81.4), and 45.8% (95% CI: 38.7–53.2), respectively. Conclusion: Over one-fourth of EC patients with LMN metastases were PLN-PAN+. PLN-PAN+ shares approximate survival outcomes (RFS and DSS) with other LNM patterns. No effective clinical methods were achieved for predicting PAN+. Thus, PLN-PAN+ is a non-negligible LNM pattern that cannot be underestimated in EC, even in low-risk patients.
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Affiliation(s)
- Wenting Li
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Jiang
- Department of Obstetrics and Gynecology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Jinan, China
| | - Yu Fu
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanming Shen
- School of Medicine, Women's Hospital, Zhejiang University, Hangzhou, China
| | - Chuyao Zhang
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Congjian Xu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Min Xia
- Department of Gynecology and Obstetrics, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Shandong, China
| | - Ge Lou
- Department of Gynecology Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jihong Liu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bei Lin
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Shenyang, China
| | - Jianliu Wang
- Peking University People's Hospital, Beijing, China
| | - Weidong Zhao
- Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, University of Science and Technology of China, Hefei, China
| | - Jieqing Zhang
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Guangxi, China
| | - Wenjun Cheng
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongyan Guo
- The Third Hospital of Peking University, Beijing, China
| | - Ruixia Guo
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xipeng Wang
- Department of Gynecology and Obstetrics, Xin Hua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Lili Han
- Department of Gynecology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Xia Zhao
- Department of Gynecology and Obstetrics, Development and Related Disease of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Xiaomao Li
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ping Zhang
- Department of Gynecology, The Second Hospital of Shandong University, Jinan Shandong, China
| | - Jianguo Zhao
- Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Affiliated Hospital of Nankai University, Tianjin, China.,Tianjin Clinical Research Center for Gynecology and Obstetrics, Branch of National Clinical Research Center for Gynecology and Obstetrics, Tianjin, China
| | - Jiezhi Ma
- Department of Obstetrics and Gynecology, Xiangya Third Hospital, Central South University, Changsha, China
| | - Qin Yao
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaohang Yang
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yingyu Dou
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zizhuo Wang
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jingbo Liu
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Fang
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Kezhen Li
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Beibei Wang
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Chen
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaodong Cheng
- School of Medicine, Women's Hospital, Zhejiang University, Hangzhou, China
| | - Chaoyang Sun
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Gynecology and Obstetrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Jinan, China
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4
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Taran FA, Jung L, Waldschmidt J, Huwer SI, Juhasz-Böss I. Status of Sentinel Lymph Node Biopsy in Endometrial Cancer. Geburtshilfe Frauenheilkd 2021; 81:562-573. [PMID: 34035551 PMCID: PMC8137276 DOI: 10.1055/a-1228-6189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 03/01/2021] [Indexed: 11/26/2022] Open
Abstract
The role of lymphadenectomy in surgical staging remains one of the biggest controversies in the management of endometrial cancer. The concept of sentinel lymph node biopsy in endometrial cancer has been evaluated for a number of years, with promising sensitivity rates and negative predictive values. The possibility of adequate staging while avoiding systematic lymphadenectomy leads to a significant reduction in the rate of peri- and postoperative morbidity. Nevertheless, the status of sentinel lymph node biopsy in endometrial cancer has not yet been fully elucidated and is variously assessed internationally. According to current European guidelines and recommendations, sentinel lymph node biopsy in endometrial cancer should be performed only in the context of clinical studies. In this review article, the developments of the past decade are explored concisely. In addition, current data regarding the technical aspects, accuracy and prognostic relevance of sentinel lymph
node biopsy are explained and evaluated critically.
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Affiliation(s)
- Florin Andrei Taran
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Lisa Jung
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Julia Waldschmidt
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | | | - Ingolf Juhasz-Böss
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
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Altin D, Taskin S, Tokgozoglu N, Vatansever D, Guler AH, Gungor M, Tasci T, Turan H, Kahramanoglu I, Yalcin I, Celik C, Kose F, Ortac F, Arvas M, Ayhan A, Taskiran C. Can risk groups accurately predict non-sentinel lymph node metastasis in sentinel lymph node-positive endometrial cancer patients? A Turkish Gynecologic Oncology Group Study (TRSGO-SLN-004). J Surg Oncol 2020; 123:638-645. [PMID: 33259650 DOI: 10.1002/jso.26310] [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: 07/07/2020] [Revised: 10/11/2020] [Accepted: 11/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to find out the risk factors associated with non-sentinel lymph node metastasis and determine the incidence of non-sentinel lymph node metastasis according to risk groups in sentinel lymph node (SLN)-positive endometrial cancer patients. METHODS Patients who underwent at least bilateral pelvic lymphadenectomy after SLN mapping were retrospectively analyzed. Patients were categorized into low, intermediate, high-intermediate, and high-risk groups defined by ESMO-ESGO-ESTRO. RESULTS Out of 395 eligible patients, 42 patients had SLN metastasis and 16 (38.1%) of them also had non-SLN metastasis. Size of SLN metastasis was the only factor associated with non-SLN metastasis (p = .012) as 13/22 patients with macrometastasis, 2/10 with micrometastasis and 1/10 with isolated tumor cells (ITCs) had non-SLN metastasis. Although all 4 metastases (1.8%) among the low-risk group were limited to SLNs, the non-SLN involvement rate in the high-risk group was 42.9% and all of these were seen in patients with macrometastatic SLNs. CONCLUSIONS Non-SLN metastasis was more frequent in higher-risk groups and the risk of non-SLN metastasis increased with the size of SLN metastasis. Proceeding to complete lymphadenectomy when SLN is metastatic should further be studied as the effect of leaving metastatic non-SLNs in-situ is not known.
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Affiliation(s)
- Duygu Altin
- Ordu University Training and Teaching Hospital, Ordu, Turkey
| | - Salih Taskin
- Department of Gynecology and Obstetrics, Ankara University School of Medicine, Ankara, Turkey
| | | | - Dogan Vatansever
- Department of Gynecology and Obstetrics, Koç University School of Medicine, İstanbul, Turkey
| | - Adbul H Guler
- Department of Gynecology and Obstetrics, Selçuk University School of Medicine, Konya, Turkey
| | - Mete Gungor
- Department of Gynecology and Obstetrics, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Tolga Tasci
- Bahçeşehir University Medical Park Göztepe Hospital, İstanbul, Turkey
| | - Hasan Turan
- İstanbul Training and Teaching Hospital, İstanbul, Turkey
| | - Ilker Kahramanoglu
- Diyarbakır Gazi Yaşargil Training and Teaching Hospital, Diyarbakır, Turkey
| | - Ibrahim Yalcin
- Department of Gynecology and Obstetrics, Şanlıurfa Training and Teaching Hospital, Şanlıurfa, Turkey
| | - Cetin Celik
- Department of Gynecology and Obstetrics, Selçuk University School of Medicine, Konya, Turkey
| | - Faruk Kose
- Department of Gynecology and Obstetrics, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Firat Ortac
- Department of Gynecology and Obstetrics, Ankara University School of Medicine, Ankara, Turkey
| | - Macit Arvas
- Department of Gynecology and Obstetrics, Istanbul University - Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ali Ayhan
- Department of Gynecology and Obstetrics, Başkent University School of Medicine, Ankara, Turkey
| | - Cagatay Taskiran
- Department of Gynecology and Obstetrics, Koç University School of Medicine, İstanbul, Turkey
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6
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Onal C, Yildirim BA, Sari SY, Yavas G, Gultekin M, Guler OC, Yildiz F, Akyurek S. Treatment outcomes of endometrial cancer patients with paraaortic lymph node metastasis: a multi-institutional analysis. Int J Gynecol Cancer 2019; 29:94-101. [DOI: 10.1136/ijgc-2018-000029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/26/2018] [Accepted: 09/06/2018] [Indexed: 01/22/2023] Open
Abstract
ObjectiveTo analyze the prognostic factors and treatment outcomes in endometrial cancer patients with paraaortic lymph node metastasis.MethodsData from four centers were collected retrospectively for 92 patients with endometrial cancer treated with combined radiotherapy and chemotherapy or adjuvant radiotherapy alone postoperatively, delivered by either the sandwich or sequential method. Prognostic factors affecting overall survival and progression-free survival were analyzed.ResultsThe 5-year overall survival and progression-free survival rates were 35 % and 33 %, respectively, after a median follow-up time of 33 months. The 5-year overall survival and progression-free survival rates were significantly higher in patients receiving radiotherapy and chemotherapy postoperatively compared with patients treated with adjuvant radiotherapy alone (P < 0.001 and P < 0.001, respectively). In a subgroup analysis of patients treated with adjuvant combined chemotherapy and radiotherapy, the 5-year overall survival and progression-free survival rates were significantly higher in patients receiving chemotherapy and radiotherapy via the sandwich method compared with patients treated with sequential chemotherapy and radiotherapy (P = 0.02 and P = 0.03, respectively). In the univariate analysis, in addition to treatment strategy, pathology, depth of myometrial invasion, and tumor grade were significant prognostic factors for both overall survival and progression-free survival. In the multivariate analysis, grade III disease, myometrial invasion greater than or equal to 50%, and adjuvant radiotherapy alone were negative predictors for both overall survival and progression-free survival.ConclusionWe demonstrated that adjuvant combined treatment including radiotherapyand chemotherapy significantly increases overall survival and progression-free survival rates compared with postoperative pelvic and paraaortic radiotherapy.
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7
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Aloisi A, Casanova JM, Tseng JH, Seader KA, Nguyen NT, Alektiar KM, Makker V, Chiang S, Soslow RA, Leitao MM, Abu-Rustum NR. Patterns of FIRST recurrence of stage IIIC1 endometrial cancer with no PARAAORTIC nodal assessment. Gynecol Oncol 2018; 151:395-400. [PMID: 30286945 DOI: 10.1016/j.ygyno.2018.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/10/2018] [Accepted: 09/19/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the rates and distribution of first recurrence in patients with FIGO stage IIIC1 endometrial cancer (EC) who did not undergo paraaortic dissection at surgical staging. METHODS We retrospectively selected all (n = 207) stage IIIC1 patients treated at a single institution from 5/1993-1/2017. Sites of first recurrence were identified, disease-free (DFS) and overall survival (OS) calculated, multivariate logistic regression performed to identify factors associated with recurrence. RESULTS Three-year DFS and OS were 66.5% and 85.7%, respectively. The most common histology was endometroid (64.2%). Three-year DFS was 81% (SE±3.8%) endometrioid vs. 39.5% (SE±6.6%) non-endometrioid (P < 0.001). Three-year OS was 96.9% (SE±1.8%) endometrioid vs. 65.6% (SE±6.7%) non-endometrioid (P < 0.001). Sixty-two (30.1%) patients recurred. Patterns of recurrence were: 14 (8.3%) multiple sites, 17 (8.2%) abdominal, 14 (6.8%) extra-abdominal, 17 (8.3%) isolated nodal (8 of these (3.9%) paraaortic). Patients with isolated tumor cells (ITCs) in lymph nodes only had 12/71 (17%) recurrence rate vs. 50/135 (37%) for patients with micro-/macrometastasis. On univariate analysis, grade (HR 4.67 95%CI 1.5-14.5, P = 0.008), histology (HR 4.9 95%CI 2.6-9.3, P < 0.001), myometrial invasion (HR 1.9 95%CI 1.04-3.5, P = 0.04), pelvic washing (HR 2.2 95%CI 1.1-4.5, P = 0.03), tumor volume in pelvic LNs (ITC vs. micro-/macrometastasis; HR 0.3 95%CI 0.2-0.7, P = 0.003) were associated with recurrence. On multivariate analysis, only histology was associated with recurrence (HR 7.88 95%CI 3.43-18.13, P < 0.001). CONCLUSIONS Isolated paraaortic recurrence in stage IIIC1 EC is uncommon. Micro-/macrometastasis were associated with twice the recurrence rate compared to ITC. These data will help clinicians counsel patients with stage IIIC1 EC regarding paraaortic assessment.
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Affiliation(s)
- Alessia Aloisi
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | | | - Jill H Tseng
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Kristina A Seader
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Nancy Thi Nguyen
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Kaled M Alektiar
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Weill Cornell Medical College, New York, NY, United States of America
| | - Vicky Makker
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Weill Cornell Medical College, New York, NY, United States of America
| | - Sarah Chiang
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Robert A Soslow
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Weill Cornell Medical College, New York, NY, United States of America
| | - Mario M Leitao
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Weill Cornell Medical College, New York, NY, United States of America
| | - Nadeem R Abu-Rustum
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Weill Cornell Medical College, New York, NY, United States of America.
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8
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Todo Y, Takeshita S, Okamoto K, Yamashiro K, Kato H. Implications of para-aortic lymph node metastasis in patients with endometrial cancer without pelvic lymph node metastasis. J Gynecol Oncol 2017; 28:e59. [PMID: 28657221 PMCID: PMC5540719 DOI: 10.3802/jgo.2017.28.e59] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/21/2017] [Accepted: 05/04/2017] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to confirm the incidence and implications of a lymphatic spread pattern involving para-aortic lymph node (PAN) metastasis in the absence of pelvic lymph node (PLN) metastasis in patients with endometrial cancer. Methods We carried out a retrospective chart review of 380 patients with endometrial cancer treated by surgery including PLN dissection and PAN dissection at Hokkaido Cancer Center between 2003 and 2016. We determined the probability of PAN metastasis in patients without PLN metastasis and investigated survival outcomes of PLN−PAN+ patients. Results The median numbers of PLN and PAN removed at surgery were 41 (range: 11–107) and 16 (range: 1–65), respectively. Sixty-four patients (16.8%) had lymph node metastasis, including 39 (10.3%) with PAN metastasis. The most frequent lymphatic spread pattern was PLN+PAN+ (7.9%), followed by PLN+PAN− (6.6%), and PLN−PAN+ (2.4%). The probability of PAN metastasis in patients without PLN metastasis was 2.8% (9/325). The 5-year overall survival rates were 96.5% in PLN−PAN−, 77.6% in PLN+PAN−, 63.4% in PLN+PAN+, and 53.6% in PLN−PAN+ patients. Conclusion The likelihood of PAN metastasis in endometrial cancer patients without PLN metastasis is not negligible, and the prognosis of PLN−PAN+ is likely to be poor. The implications of a PLN−PAN+ lymphatic spread pattern should thus be taken into consideration when determining patient management strategies.
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Affiliation(s)
- Yukiharu Todo
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
| | - Sho Takeshita
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Kazuhira Okamoto
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Katsushige Yamashiro
- Division of Pathology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
| | - Hidenori Kato
- Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan
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Baiocchi G, Faloppa CC, Mantoan H, Camarço WR, Badiglian-Filho L, Kumagai LY, De Brot L, da Costa AABA. Para-aortic lymphadenectomy can be omitted in most endometrial cancer patients at risk of lymph node metastasis. J Surg Oncol 2017; 116:220-226. [DOI: 10.1002/jso.24651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/27/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Glauco Baiocchi
- Department of Gynecologic Oncology; AC Camargo Cancer Center; Sao Paulo Brazil
| | | | - Henrique Mantoan
- Department of Gynecologic Oncology; AC Camargo Cancer Center; Sao Paulo Brazil
| | | | | | | | - Louise De Brot
- Department of Anatomic Pathology; AC Camargo Cancer Center; Sao Paulo Brazil
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10
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Kassem L, Abdel-Rahman O. Targeting mTOR pathway in gynecological malignancies: Biological rationale and systematic review of published data. Crit Rev Oncol Hematol 2016; 108:1-12. [PMID: 27931828 DOI: 10.1016/j.critrevonc.2016.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/06/2016] [Accepted: 10/11/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND mTOR inhibitors are widely used in different malignancies with several trials testing their efficacy and safety in gynecological malignancies. We aimed to review the current evidence that support the expansion of using such drugs in the treatment of advanced gynecological cancers. METHODS A comprehensive systematic review of literature has been conducted to include prospective trials that used everolimus, temsirolimus or ridaforolimus in the management of gynecological cancers and have available efficacy and toxicity results. RESULTS A total of 23 studies including 980 patients were considered eligible for our review. Our review included 16 phase II and 7 phase I studies with the majority of patients having uterine cancers. Regarding Endometrial cancer, the CBR ranged from 21% to 60% and median PFS from 2.8 months to 7.3 months. In Ovarian cancers, CBR ranged from 24% to 50% and median PFS from 3.2 months to 5.9 months. In the single phase II study in cervical cancer the CBR was 61% and median PFS was 3.5 months. The toxicity profile was consistent with what was observed previously in other malignancies with fatigue, mucositis, and hematological toxicities being the most common adverse events observed. CONCLUSION mTOR inhibitors seem to be a promising option in the second line management of advanced gynecological cancers with best safety and efficacy outcomes when given as a single agent or in combination with hormonal treatment. More research is needed for better patient selection.
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Affiliation(s)
- Loay Kassem
- Clinical Oncology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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