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Lombaers MS, Cornel KMC, Visser NCM, Bulten J, Küsters-Vandevelde HVN, Amant F, Boll D, Bronsert P, Colas E, Geomini PMAJ, Gil-Moreno A, van Hamont D, Huvila J, Krakstad C, Kraayenbrink AA, Koskas M, Mancebo G, Matías-Guiu X, Ngo H, Pijlman BM, Vos MC, Weinberger V, Snijders MPLM, van Koeverden SW, Haldorsen IS, Reijnen C, Pijnenborg JMA. Preoperative CA125 Significantly Improves Risk Stratification in High-Grade Endometrial Cancer. Cancers (Basel) 2023; 15:cancers15092605. [PMID: 37174070 PMCID: PMC10177432 DOI: 10.3390/cancers15092605] [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: 02/28/2023] [Revised: 04/03/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Patients with high-grade endometrial carcinoma (EC) have an increased risk of tumor spread and lymph node metastasis (LNM). Preoperative imaging and CA125 can be used in work-up. As data on cancer antigen 125 (CA125) in high-grade EC are limited, we aimed to study primarily the predictive value of CA125, and secondarily the contributive value of computed tomography (CT) for advanced stage and LNM. Patients with high-grade EC (n = 333) and available preoperative CA125 were included retrospectively. The association of CA125 and CT findings with LNM was analyzed by logistic regression. Elevated CA125 ((>35 U/mL), (35.2% (68/193)) was significantly associated with stage III-IV disease (60.3% (41/68)) compared with normal CA125 (20.8% (26/125), [p < 0.001]), and with reduced disease-specific-(DSS) (p < 0.001) and overall survival (OS) (p < 0.001). The overall accuracy of predicting LNM by CT resulted in an area under the curve (AUC) of 0.623 (p < 0.001) independent of CA125. Stratification by CA125 resulted in an AUC of 0.484 (normal), and 0.660 (elevated). In multivariate analysis elevated CA125, non-endometrioid histology, pathological deep myometrial invasion ≥50%, and cervical involvement were significant predictors of LNM, whereas suspected LNM on CT was not. This shows that elevated CA125 is a relevant independent predictor of advanced stage and outcome specifically in high-grade EC.
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Affiliation(s)
- Marike S Lombaers
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Radboud Institute of Health Sciences, 6525 GA Nijmegen, The Netherlands
| | - Karlijn M C Cornel
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Obstetrics and Gynecology, Division Gynecologic Oncology, University of Toronto, Toronto, ON M5G 1E2, Canada
| | - Nicole C M Visser
- Department of Pathology, Eurofins PAMM, 5623 EJ Eindhoven, The Netherlands
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | | | - Frédéric Amant
- Department of Oncology, KU Leuven, 3000 Leuven, Belgium
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute and Amsterdam University Medical Center, 1066 CX Amsterdam, The Netherlands
| | - Dorry Boll
- Department of Gynecology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
| | - Peter Bronsert
- Institute of Pathology, University Medical Center, 79104 Freiburg, Germany
| | - Eva Colas
- Biomedical Research Group in Gynecology, Vall Hebron Institute of Research, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red Cáncer, 08193 Barcelona, Spain
| | - Peggy M A J Geomini
- Department of Obstetrics and Gynecology, Maxima Medical Centre, 5631 BM Veldhoven, The Netherlands
| | - Antonio Gil-Moreno
- Biomedical Research Group in Gynecology, Vall Hebron Institute of Research, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red Cáncer, 08193 Barcelona, Spain
- Department of Gynecology, Vall Hebron University Hospital, Centro de Investigación Biomédica en Red Cáncer, 08035 Barcelona, Spain
| | - Dennis van Hamont
- Department of Obstetrics and Gynecology, Amphia Hospital, Breda, 4818 CK Breda, The Netherlands
| | - Jutta Huvila
- Department of Pathology, University of Turku, 20500 Turku, Finland
| | - Camilla Krakstad
- Department of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway
| | - Arjan A Kraayenbrink
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
| | - Martin Koskas
- Department of Obstetrics and Gynecology, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Gemma Mancebo
- Department of Obstetrics and Gynecology, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain
| | - Xavier Matías-Guiu
- Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, Centro de Investigación Biomédica en Red Cáncer, 25003 Lleida, Spain
| | - Huy Ngo
- Department of Obstetrics and Gynecology, Elkerliek Hospital, 5751 CB Helmond, The Netherlands
| | - Brenda M Pijlman
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 5223 GZ 's-Hertogenbosch, The Netherlands
| | - Maria Caroline Vos
- Department of Obstetrics and Gynecology, Elisabeth-TweeSteden Hospital, 5000 LC Tilburg, The Netherlands
| | - Vit Weinberger
- Department of Gynecology and Obstetrics, University Hospital Brno, Faculty of Medicine, Masaryk University, 601 77 Brno, Czech Republic
| | - Marc P L M Snijders
- Department of Obstetrics and Gynecology, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Sebastiaan W van Koeverden
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Ingfrid S Haldorsen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, 5021 Bergen, Norway
| | - Casper Reijnen
- Department of Radiation Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Radboud Institute of Health Sciences, 6525 GA Nijmegen, The Netherlands
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Li Q, Zhang X. Prediction of high-risk factors for ovarian metastasis in patients with endometrial cancer: A large-sample retrospective case-control study. Int J Gynaecol Obstet 2023; 161:144-150. [PMID: 36453189 DOI: 10.1002/ijgo.14606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/23/2022] [Accepted: 10/14/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To determine the high-risk factors of ovarian metastasis of endometrial cancer and their impact on prognosis. METHODS A retrospective case-control study was conducted on a large cohort of patients with endometrial cancer. RESULTS A total of 1240 patients with endometrial cancer were eligible for analysis, of whom 120 (9.7%) had ovarian metastasis. The patients with endometrial cancer with ovarian metastasis were more likely to have deep myometrial infiltration, lymph node metastasis, and elevated levels of CA125. The median survival was 39 months in patients with ovarian metastasis and 111 months in those without ovarian metastasis (P < 0.001). According to the stratified analysis, the progression-free survival (PFS) and overall survival in the low-risk group and PFS in the high-risk group of patients with endometrial cancer with ovarian metastasis were significantly shorter than those without ovarian metastasis (P < 0.0001, P = 0.0034, and P < 0.0001, respectively). CONCLUSION Deep myometrial invasion, lymph node metastasis, and elevated levels of CA125 may be independent high-risk factors for ovarian metastasis in patients with endometrial cancer. Ovarian metastasis has a greater impact on the prognosis of patients with low-risk endometrial cancer.
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Affiliation(s)
- Qian Li
- Department of Gynaecological Oncology, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Liaoning, China
| | - Xin Zhang
- Department of Gynaecological Oncology, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Liaoning, China
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Tutkun Kilinc EC, Korkmaz V, Yalcin HR. Factor affecting lymph node metastasis in uterine papillary serous carcinomas: a retrospective analysis. J OBSTET GYNAECOL 2023; 42:3725-3730. [PMID: 36927276 DOI: 10.1080/01443615.2022.2158311] [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: 03/18/2023]
Abstract
The aim of this study was to investigate the risk factors for lymph node metastasis (LNM) in patients with uterine serous cancer (USC) who underwent systematic staging surgery. Eighty patients who were operated on for pure uterine serous papillary carcinoma between 2008 and 2020 in our clinic were retrospectively analysed. The effects of demographic information and clinicohistopathological characteristics of the included patients on LNM were examined. The median age of the patients included in the study was 64.3 and the tumour diameter was 3.8 cm. At the time of diagnosis, 65.8% of the cases were in the advanced stage, while 34.2% were in the early stage. There was no LNM in 42 (52.5%) of the cases, only pelvic in six (7.5%), only paraaortic LNM in four (5%) patients, and both pelvic and paraaortic LNM in 24 (30%) patients. When factors that may affect LNM were evaluated with multivariate analysis, lymphovascular space invasion (LVSI) and cytology positivity were found to be independent risk factors (p < 0.05). In addition, the rate of isolated paraaortic lymph node involvement in LNM positive patients is 5%, which is 100% associated with LVSI.Impact StatementWhat is already known on this subject? Uterine papillary serous carcinomas (UPSC) are an uncommon and aggressive histological subtype of endometrial cancer. The high risk of recurrence and tendency to migrate into the abdomen of these tumours is not always connected with lymph node and distant organ metastasis, tumour size, LVSI positive and depth of myometrial invasion.What do the results of this study add? Most patients with UPSC are diagnosed at an advanced stage. In this study, in which 80 patients with pure serous histology were evaluated retrospectively, and LVSI and peritoneal cytology positivity were found to be two important prognostic factors for lymph node metastasis.What are the implications of these findings for clinical practice and/or further research? In this study, cytology and LVSI positivity were identified as two predictive markers for LNM, and it is seen that cytology positivity still maintains its importance in these tumours with peritoneal spread. Furthermore, patients with isolated paraaortic lymph node involvement were shown to be LVSI positive, and isolated paraaortic LNM should be investigated in patients with LVSI positivity.
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Affiliation(s)
| | - Vakkas Korkmaz
- Department of Gynecologic Oncology, Faculty of Medicine, Etlik City Hospital, University of Health Sciences, Ankara, Turkey
| | - Hakan Rasit Yalcin
- Department of Gynecologic Oncology, Faculty of Medicine, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Matanes E, Eisenberg N, Mitric C, Yasmeen A, Ismail S, Raban O, Cantor T, Knigin D, Lau S, Salvador S, Gotlieb W, Kogan L. Surgical and oncological outcomes of sentinel lymph node sampling in elderly patients with intermediate to high-risk endometrial carcinoma. Int J Gynecol Cancer 2022; 32:875-881. [PMID: 35680137 DOI: 10.1136/ijgc-2022-003431] [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: 11/04/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the surgical and oncological outcomes of elderly patients with intermediate to high-risk endometrial cancer undergoing staging with sentinel lymph node (SLN) sampling and pelvic lymphadenectomy. METHODS We conducted a retrospective study of elderly (>65-year-old) patients diagnosed with endometrial cancer between December 2007 and August 2017. These patients had been treated at a single center in Montreal, Canada. We compared the surgical and oncological outcomes of three cohorts undergoing surgical staging in non-overlapping eras: 1) lymphadenectomy, 2) lymphadenectomy and SLN sampling, 3) SLN sampling alone. Using life tables, Kaplan-Meier survival curves and log-rank tests, we analyzed 2-year progression-free survival, overall survival, and disease-specific survival. RESULTS Our study included 278 patients with a median age of 73 years (range; 65-91): 84 (30.2%) underwent lymphadenectomy, 120 (43.2%) underwent SLN sampling with lymphadenectomy, and 74 (26.6%) had SLN sampling alone. The SLN sampling alone group had shorter operative times with a median duration of 199 minutes (range, 75-393) compared with 231 (range, 125-403) and 229 (range, 151-440) minutes in the SLN sampling with lymphadenectomy and lymphadenectomy cohorts; respectively (p<0.001). The SLN sampling alone group also had lower estimated blood loss with a median loss of 20 mL (range, 5-150) vs 25 mL (range, 5-800) and 40 mL (range, 5-400) in the SLN sampling with lymphadenectomy and lymphadenectomy cohorts, respectively (p=0.002). The 2 year overall survival and progression-free survival were not significantly different between the three groups (p=0.45, p=0.51, respectively). On multivariable analysis after adjusting for age, American Society of Anesthesiologists (ASA) score, stage, grade, and lymphovascular space invasion, adding SLN sampling was associated with better overall survival, (HR 0.2, CI [0.1 to 0.6], p=0.006) and progression-free survival (HR 0.5, CI [0.1 to 1.0], p=0.05). CONCLUSION Sentinel lymph node-based surgical staging is feasible and associated with better surgical outcomes and comparable oncological outcomes in elderly patients with intermediate and high-risk endometrial cancer.
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Affiliation(s)
- Emad Matanes
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada .,Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Neta Eisenberg
- Yitzhak Shamir Medical Center Assaf Harofeh, Zerifin, Center, Israel
| | - Cristina Mitric
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Amber Yasmeen
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Sara Ismail
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Oded Raban
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Tal Cantor
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - David Knigin
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Walter Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Liron Kogan
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
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Larish A, Mariani A, Langstraat C. Controversies in the Management of Early-stage Serous Endometrial Cancer. In Vivo 2021; 35:671-680. [PMID: 33622859 DOI: 10.21873/invivo.12307] [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: 08/03/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Early-stage uterine serous carcinoma (USC) has one of the highest recurrence rates and mortality among early-stage uterine epithelial cancers. Research into the clinical management of USC has begun to progress, guided by surgical and pathological advances. This article summarizes the available literature regarding diagnosis, management, and possible future uses of molecular analysis of women with early-stage USC. MATERIALS AND METHODS PubMed was searched for all pertinent English language research articles published from January 1, 2006 through March 1, 2020 which included a study population of women diagnosed with stage 1 USC. Due to the scarcity of prospective or large-scale data, studies were not limited by design or numbers of patients. Studies performed at earlier dates were incorporated to provide context. RESULTS A total of 86 studies were included in the review. Multiple well-designed studies have confirmed the safety of a minimally invasive surgical approach for surgical management of USC. The role of sentinel node biopsy has been validated with both prospective and retrospective multi-center data. Stage I USC is associated with a highly variable risk of recurrence, even following completion of adjuvant chemoradiation. This aggressive phenotype has been linked to high numbers of somatic copy number alterations, tumor protein 53, and phosphatidylinositol 3 kinase mutations, which have been shown to be predictive of prognosis. CONCLUSION Early-stage USC demonstrates a lack of predictable recurrence patterns, with reports noting distant recurrence in patients with disease confined to polyps. Unless no residual tumor is found on hysterectomy, chemotherapy and radiotherapy should be discussed and individualized by stage and treatment goals.
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Affiliation(s)
- Alyssa Larish
- Department of Obstetrics and Gynecology. Mayo Clinic, Rochester, MN, U.S.A.
| | - Andrea Mariani
- Department of Obstetrics and Gynecology. Mayo Clinic, Rochester, MN, U.S.A
| | - Carrie Langstraat
- Department of Obstetrics and Gynecology. Mayo Clinic, Rochester, MN, U.S.A
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Yilmaz Baran Ş, Alemdaroğlu S, Doğan Durdağ G, Yüksel Şimşek S, Bolat F, Köse F, Çelik H. What is the predictive value of preoperative CA 125 level on the survival rate of type 1 endometrial cancer? Turk J Med Sci 2021; 51:335-341. [PMID: 32979897 PMCID: PMC7991883 DOI: 10.3906/sag-2005-331] [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: 05/26/2020] [Accepted: 09/26/2020] [Indexed: 01/22/2023] Open
Abstract
Background/aim To investigate the utility of preoperative serum cancer antigen 125 (CA 125) levels in type 1 endometrial carcinoma (EC) as a marker for determining poor prognostic factors and survival. Material and methods All patients with endometrial cancer, who had been treated between 2012 and 2020, were retrospectively reviewed, and finally, 256 patients with type 1 endometrium carcinoma were included in the study. The relationship between the clinicopathological characteristics, CA 125 level, and survival rates were analyzed. The cut-off value for the preoperative serum CA 125 level was defined as 16 IU/L. Results The median serum CA 125 levels were significantly higher in patients with deep myometrial invasion, lymph node metastasis, lymphovascular space invasion, cervical stromal and adnexal involvement, advanced stage, positive peritoneal cytology, recurrence, and adjuvant therapy requirement. Serum CA 125 cut-off values determined according to clinicopathologic factors ranged from 15.3 to 22.9 IU/L (sensitivity 61%–77%, specificity 52%–73%). The disease-specific survival rate was significantly higher in patients with CA 125 levels < 16 IU/L (P = 0.047). Conclusion The data showed that choosing a lower threshold value for the CA 125 level (16 IU/L) instead of 35 IU/L, could be more useful in type 1 EC patients with negative prognostic factors.
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Affiliation(s)
- Şafak Yilmaz Baran
- Department of Obstetrics and Gynecology, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Songül Alemdaroğlu
- Department of Obstetrics and Gynecology, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Gülşen Doğan Durdağ
- Department of Obstetrics and Gynecology, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Seda Yüksel Şimşek
- Department of Obstetrics and Gynecology, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Filiz Bolat
- Department of Pathology, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Fatih Köse
- Department of Medical Oncology, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Hüsnü Çelik
- Department of Obstetrics and Gynecology, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
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Nasioudis D, Heyward Q, Gysler S, Giuntoli RL, Cory L, Kim S, Morgan MA, Haggerty AF, Ko EM, Latif NA. Is there a benefit of performing an omentectomy for clinical stage I high-grade endometrial carcinoma? Surg Oncol 2021; 37:101534. [PMID: 33667893 DOI: 10.1016/j.suronc.2021.101534] [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: 11/25/2020] [Revised: 01/25/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Routine omentectomy is generally not performed in patients with endometrial cancer unless there is evidence of gross omental metastases. The aim of the current study was to evaluate the role of omentectomy in the staging of clinical stage I high-grade endometrial carcinoma and its impact on overall survival. METHODS Patients in the National Cancer Database who presented between 2010 and 2015 with clinical stage I serous, clear cell, carcinosarcoma, or grade 3 endometrioid carcinoma and underwent hysterectomy with lymphadenectomy were selected. Patients who did and did not receive an omentectomy were identified and clinico-pathological characteristics were compared. Overall survival was evaluated for patients diagnosed between 2010 and 2014 who had at least one month of follow-up following generation of Kaplan-Meier curves and comparison with the log-rank test. A Cox model was constructed to control for confounders. RESULTS A total of 9097 patients were identified, and 36.3% underwent an omentectomy. Patients who underwent omentectomy were more likely to be managed in academic institutions (50% vs. 44%, p < 0.001). They were also more likely to have an open surgery (48.2% vs. 27.2%, p < 0.001) and receive adjuvant chemotherapy (54.7% vs. 38.2%, p < 0.001). There was no difference in overall survival between patients who did and did not undergo omentectomy, p = 0.61; the 3-year OS rates were 82.3% and 82.2%, respectively. After controlling for confounders, the performance of an omentectomy was not associated with better survival (hazard ratio [HR]: 0.94, 95% confidence intervals [CI]: 0.84, 1.05). CONCLUSIONS Routine omentectomy may not be associated with a survival benefit for patients with clinical stage I high-grade endometrial carcinoma.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Quetrell Heyward
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stefan Gysler
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert L Giuntoli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lori Cory
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark A Morgan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley F Haggerty
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Nawar A Latif
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Ling X, Zheng Z, Xu J, Xu G, Zhou H, Lin Z, Li Y, Liang J, Lu H. Elevated CA-125 Level and ER-Negative as Prognostic Factors for Ovarian Metastasis in Patients with Endometrial Cancer: A Retrospective Cohort Study. Med Sci Monit 2020; 26:e928826. [PMID: 33361739 PMCID: PMC7771201 DOI: 10.12659/msm.928826] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The utility of cancer antigen 125 (CA-125), estrogen receptor (ER), and progesterone receptor (PR) in evaluation for ovarian metastasis of endometrial cancer has yet to be determined. The purpose of this study was to investigate the incidence and the possible risk factors of ovarian metastasis. MATERIAL AND METHODS A retrospective study was performed in endometrial cancer patients who accepted surgical intervention of hysterectomy and oophorectomy during 2002-2013 in Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China. Clinico-pathologic characteristics and the possible risk factors were investigated. RESULTS A total of 565 patients were identified, of which 5.7% had ovarian metastasis. Univariate analysis and multivariate analysis revealed that deeper myometrial invasion, tubal involvement, and parametrial involvement were independent risk factors. In subgroup analysis, univariate analysis showed that elevated CA-125 level and negative ER were associated with ovarian metastasis (P<0.05), however multivariate analysis revealed that only high CA-125 level was an independent risk factor (P<0.05). The incidence of ovarian metastasis in patients with high CA-125 level and who were ER-negative was 24%. For patients with normal CA-125 level and who were ER-positive, the incidence was 1.19%. The optimal cutoff value that provided the best sensitivity and specificity was 110.5 U/ml. CONCLUSIONS The incidence of ovarian metastasis in endometrial cancer is low. Ovarian preservation should be considered for women without abnormal CA-125 level and who have deeper myometrial invasion, tubal involvement, parametrial involvement, and who are ER-negative. These findings may facilitate clinical decision-making.
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Affiliation(s)
- Xiaoting Ling
- Department of Gynecology Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Zheyu Zheng
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Jing Xu
- Department of Gynecology Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Guocai Xu
- Department of Gynecology Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Hui Zhou
- Department of Gynecology Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Zhongqiu Lin
- Department of Gynecology Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Yangyang Li
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Jinxiao Liang
- Department of Gynecology Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Huaiwu Lu
- Department of Gynecology Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
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Uterine serous carcinoma: Molecular features, clinical management, and new and future therapies. Gynecol Oncol 2020; 160:322-332. [PMID: 33160694 DOI: 10.1016/j.ygyno.2020.10.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/14/2020] [Indexed: 12/14/2022]
Abstract
Uterine serous carcinoma (USC) is an aggressive subtype of endometrial cancer. Multimodality treatment with surgery, radiotherapy, and chemotherapy is commonly used, given its propensity for extrauterine spread, distant recurrences, and poor prognosis. However, the use of molecularly-based therapy is expanding. Here, we review key molecular features of USC, discuss current management, and assess the landscape of novel therapies and combinations.
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Risk factors for lymph nodes involvement in obese women with endometrial carcinomas. Gynecol Oncol 2019; 155:27-33. [DOI: 10.1016/j.ygyno.2019.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 11/18/2022]
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