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Okugawa K, Yahata H, Hachisuga K, Tomonobe H, Yasutake N, Kodama K, Kenjo H, Yagi H, Ohgami T, Yasunaga M, Onoyama I, Asanoma K, Hori E, Ohishi Y, Oda Y, Kato K. Evaluation of Clinical Significance of Lymphovascular Space Invasion in Stage IA Endometrial Cancer. Oncology 2021; 100:195-202. [PMID: 34915516 DOI: 10.1159/000521382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/06/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The prognostic significance of lymphovascular space invasion (LVSI) in stage IA endometrial cancer remains unclear. The aim of this study was to evaluate the clinical significance of LVSI in stage IA endometrial cancer. METHODS Clinical data of patients with stage IA endometrial cancer who underwent initial surgery at our institution between January 2008 and December 2018 were reviewed retrospectively. Information of patients, surgery, and characteristics of cancer were obtained from medical records and pathological reports. RESULTS Two hundred ninety-seven patients were enrolled in this study. With a median follow-up of 60 months, 15 patients experienced recurrence (5.1%) and four patients died of endometrial cancer (1.3%). The recurrence and mortality rates did not differ significantly between the LVSI-positive and -negative groups (P=0.07 and P=0.41, respectively). Recurrence-free survival and endometrial cancer-specific survival also did not differ significantly between these groups (P=0.11 and P=0.49, respectively). The 5-year endometrial cancer-specific survival rates for tumors with and without LVSI were 97.0% and 98.9%, respectively. Among patients with low-grade tumors, recurrence-free survival and endometrial cancer-specific survival did not differ significantly between patients with tumors with and without LVSI (P=0.92 and P=0.72, respectively). The 5-year endometrial cancer-specific survival rates for low-grade tumors with and without LVSI were 100% and 99.3%, respectively. CONCLUSION LVSI was not a prognostic factor of not only stage IA endometrial cancer, but also stage IA low-grade cancer.
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Affiliation(s)
- Kaoru Okugawa
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideaki Yahata
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhisa Hachisuga
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Tomonobe
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuko Yasutake
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keisuke Kodama
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hironori Kenjo
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Yagi
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tatsuhiro Ohgami
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Yasunaga
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ichiro Onoyama
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuo Asanoma
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Emiko Hori
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Ohishi
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Diagnostic Pathology, Iizuka Hospital, Iizuka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Narayan K, Lin MY, Kondalsamy-Chennakesavan S, Mukhopadhyay A. Lymphovascular Space Invasion (LVSI)-Based Prognostic Clusters in Endometrial Cancer Patients Treated with Primary Surgery and Adjuvant Radiotherapy. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00566-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cuylan ZF, Akilli H, Gungorduk K, Demirkiran F, Oz M, Salman MC, Sozen H, Celik H, Gokcu M, Bese T, Meydanli MM, Ozgul N, Topuz S, Kuscu E, Kuru O, Gokmen S, Gultekin M, Ayhan A. Is the extent of lymphadenectomy a prognostic factor in International Federation of Gynecology and Obstetrics stage II endometrioid endometrial cancer? J Obstet Gynaecol Res 2021; 47:1134-1144. [PMID: 33426779 DOI: 10.1111/jog.14648] [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: 09/01/2020] [Revised: 11/23/2020] [Accepted: 12/25/2020] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to evaluate the prognostic significance of adequate lymph node dissection (LND) (≥10 pelvic lymph nodes (LNs) and ≥ 5 paraaortic LNs removed) in patients with International Federation of Gynecology and Obstetrics (FIGO) stage II endometrioid endometrial cancer (EEC). METHODS A multicenter department database review was performed to identify patients who had been operated and diagnosed with stage II EEC at seven centers in Turkey retrospectively. Demographic, clinicopathological, and survival data were collected and analyzed. RESULTS We identified 284 women with stage II EEC. There were 170 (59.9%) patients in the adequate lymph node dissection (LND) group and 114 (40.1%) in the inadequate LND group. The 5-year overall survival (OS) rate of the inadequate LND group was significantly lower than that of the adequate LND group (84.1% vs. 89.1%, respectively; p = 0.028). In multivariate analysis, presence of lymphovascular space invasion (LVSI) (hazard ratio [HR]: 2.39, 95% confidence interval [CI]: 1.23-4.63; p = 0.009), age ≥ 60 (HR: 3.30, 95% CI: 1.65-6.57; p = 0.001], and absence of adjuvant therapy (HR: 2.74, 95% CI: 1.40-5.35; p = 0.003) remained as independent risk factors for decreased 5-year disease-free survival (DFS). Inadequate LND (HR: 2.34, 95% CI: 1.18-4.63; p < 0.001), age ≥ 60 (HR: 2.67, 95% CI: 1.25-5.72; p = 0.011), and absence of adjuvant therapy (HR: 4.95, 95% CI: 2.28-10.73; p < 0.001) were independent prognostic factors for decreased 5-year OS in multivariate analysis. CONCLUSION Adequate LND and adjuvant therapy were significant for the improvement of outcomes in FIGO stage II EEC patients. Furthermore, LVSI was associated with worse 5-year DFS rate in stage II EEC.
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Affiliation(s)
| | - Huseyin Akilli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Kemal Gungorduk
- Department of Gynecologic Oncology, Izmir Tepecik Education and Research Hospital, Izmır, Turkey
| | - Fuat Demirkiran
- Department of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Oz
- Department of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Coskun Salman
- Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hamdullah Sozen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Husnu Celik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Mehmet Gokcu
- Department of Gynecologic Oncology, Izmir Tepecik Education and Research Hospital, Izmır, Turkey
| | - Tugan Bese
- Department of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Nejat Ozgul
- Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Samet Topuz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esra Kuscu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Oguzhan Kuru
- Department of Gynecologic Oncology, Izmir Tepecik Education and Research Hospital, Izmır, Turkey
| | - Sibel Gokmen
- Department of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Gultekin
- Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
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Li R, Shinde A, Han E, Lee S, Beriwal S, Harkenrider M, Kamrava M, Chen YJ, Glaser S. A proposal for a new classification of "unfavorable risk criteria" in patients with stage I endometrial cancer. Int J Gynecol Cancer 2019; 29:1086-1093. [PMID: 31474587 DOI: 10.1136/ijgc-2019-000264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/16/2019] [Accepted: 04/22/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Randomized trials describe differing sets of high-intermediate risk criteria. OBJECTIVE To use the National Cancer Database to compare the impact of radiation therapy in patients with stage I endometrial cancer meeting different criteria, and define a classification of "unfavorable risk." METHODS Patients with stage I endometrial cancer between January 2010 and December 2014 were identified in the National Cancer Database and stratified into two cohorts: (1) patients meeting Gynecologic Oncology Group (GOG)-99 criteria only for high-intermediate risk, but not Post-Operative Radiation Therapy in Endometrial Carcinoma (PORTEC)-1 criteria and (2) those meeting PORTEC-1 criteria only. High-risk stage I patients with both FIGO stage IB (under FIGO 2009 staging) and grade 3 disease were excluded. In each cohort, propensity score-matched survival analyses were performed. Based on these analyses, we propose a new classification of unfavorable risk. We then analyzed the association of adjuvant radiation with survival, stratified by this classification. RESULTS We identified 117,272 patients with stage I endometrial cancer. Of these, 11,207 patients met GOG-99 criteria only and 5,920 patients met PORTEC-1 criteria only. After propensity score matching, adjuvant radiation therapy improved survival (HR=0.73; 95% CI 0.60 to 0.89; p=0.002) in the GOG-99 only cohort. However, there was no benefit of adjuvant radiation (HR=0.89; 95% CI 0.69 to 1.14; p=0.355) in the PORTEC-1 only cohort. We, therefore, defined unfavorable risk stage I endometrial cancer as two or more of the following risk factors: lymphovascular invasion, age ≥70, grade 2-3 disease, and FIGO stage IB. Adjuvant radiation improved survival in stage I patients with adverse risk factors (HR=0.74; 95% CI 0.68 to 0.80; p<0.001), but not in other stage I patients (HR=1.02; 95% CI 0.91 to 1.15; p=0.710; p interaction <0.001). CONCLUSION Our study showed that adjuvant radiation was associated with an overall survival benefit in patients meeting GOG-99 criteria only; however, no survival benefit was seen in patients meeting PORTEC-1 criteria only. We propose a definition of unfavorable risk stage I endometrial cancer: ≥2 risk factors from among lymphovascular invasion, age ≥70, grade 2-3 disease, and FIGO stage IB disease.
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Affiliation(s)
- Richard Li
- Radiation Oncology, City of Hope Medical Center, Duarte, California, USA
| | - Ashwin Shinde
- Radiation Oncology, City of Hope Medical Center, Duarte, California, USA
| | - Ernest Han
- Gynecologic Oncology, City of Hope Medical Center, Duarte, California, USA
| | - Stephen Lee
- Gynecologic Oncology, City of Hope Medical Center, Duarte, California, USA
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Matthew Harkenrider
- Radiation Oncology, Stritch School of Medicine; Loyola University Chicago, Maywood, Illinois, USA
| | - Mitchell Kamrava
- Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Yi-Jen Chen
- Radiation Oncology, City of Hope Medical Center, Duarte, California, USA
| | - Scott Glaser
- Radiation Oncology, City of Hope Medical Center, Duarte, California, USA
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Peters EEM, Bartosch C, McCluggage WG, Genestie C, Lax SF, Nout R, Oosting J, Singh N, Smit HCSH, Smit VTHBM, Van de Vijver KK, Bosse T. Reproducibility of lymphovascular space invasion (LVSI) assessment in endometrial cancer. Histopathology 2019; 75:128-136. [PMID: 31155736 PMCID: PMC6852322 DOI: 10.1111/his.13871] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 02/02/2023]
Abstract
Aims Lymphovascular space invasion (LVSI) in endometrial cancer (EC) is an important prognostic variable impacting on a patient's individual recurrence risk and adjuvant treatment recommendations. Recent work has shown that grading the extent of LVSI further improves its prognostic strength in patients with stage I endometrioid EC. Despite this, there is little information on the reproducibility of LVSI assessment in EC. Therefore, we designed a study to evaluate interobserver agreement in discriminating true LVSI from LVSI mimics (Phase I) and reproducibility of grading extent of LVSI (Phase II). Methods and results Scanned haematoxylin and eosin (H&E) slides of endometrioid EC (EEC) with a predefined possible LVSI focus were hosted on a website and assessed by a panel of six European gynaecological pathologists. In Phase I, 48 H&E slides were included for LVSI assessment and in Phase II, 42 H&E slides for LVSI grading. Each observer was instructed to apply the criteria for LVSI used in daily practice. The degree of agreement was measured using the two‐way absolute agreement average‐measures intraclass correlation coefficient (ICC). Reproducibility of LVSI assessment (ICC = 0.64, P < 0.001) and LVSI grading (ICC = 0.62, P < 0.001) in EEC was substantial among the observers. Conclusions Given the good reproducibility of LVSI, this study further supports the important role of LVSI in decision algorithms for adjuvant treatment.
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Affiliation(s)
- Elke E M Peters
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Pathology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Carla Bartosch
- Department of Pathology, Portuguese Oncology Institute-Porto, Porto, Portugal
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Catherine Genestie
- Department of BioPathology, University Paris-Saclay, Gustave-Roussy Cancer Center, Villejuif, France
| | - Sigurd F Lax
- Department of Pathology, Hospital Graz II and Medical University of Graz, Graz, Austria
| | - Remi Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Oosting
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Huub C S H Smit
- Department of Pathological Anatomy, Ghent University Hospital, Ghent, Belgium
| | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
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6
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Associations between lymphovascular space invasion, nodal recurrence, and survival in patients with surgical stage I endometrioid endometrial adenocarcinoma. World J Surg Oncol 2019; 17:80. [PMID: 31077193 PMCID: PMC6511118 DOI: 10.1186/s12957-019-1620-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/23/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the predictive value of lymphovascular space invasion (LVSI) for nodal recurrence and overall survival (OS) in patients with stage I endometrioid endometrial cancer (EC) following surgical staging that included adequate lymph node sampling. Methods Retrospective analyses of patients undergoing surgical staging for FIGO stage I endometrioid EC between 1998 and 2015 were performed using an institutional database and the National Cancer Database (NCDB). Using the institutional database, logistic regression modeling identified predictors of nodal recurrence; Cox proportional hazards modeling was used to predict progression-free survival (PFS). Utilizing NCDB, Cox proportional hazards modeling was used to predict OS. The Kaplan-Meier method was used to estimate hazard ratios (HR). Survival curves were compared using the log-rank test. Results Among 275 institutional cases, LVSI was present in 48 (17.5%). There were 11 nodal recurrences: 18.8% (9/48) of cases with LVSI had a nodal recurrence compared to 0.88% (2/227) of those without LVSI. In multivariate analysis of institutional data, LVSI was the only significant predictor of nodal recurrence (p = 0.002). Among 28,076 NCDB cases, LVSI was present in 3766 (13.5%). In multivariate analysis of NCDB, grade 3, LVSI, and depth of invasion (all p < 0.001) were prognostic for OS after adjusting for adjuvant radiation. Conclusion LVSI is an independent prognostic factor for nodal recurrence in stage I endometrial cancer with lymph node assessment. LVSI is associated with lower OS in NCDB. Given these findings, adjuvant therapy could be considered in these patients.
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Sahin H, Meydanli MM, Sari ME, Kocaman E, Cuylan ZF, Yalcin I, Coban G, Özen Ö, Sirvan L, Güngör T, Ayhan A. Recurrence patterns and prognostic factors in lymphovascular space invasion-positive endometrioid endometrial cancer surgically confined to the uterus. Taiwan J Obstet Gynecol 2019; 58:82-89. [DOI: 10.1016/j.tjog.2018.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 10/27/2022] Open
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Lin MY, Dobrotwir A, McNally O, Abu-Rustum NR, Narayan K. Role of imaging in the routine management of endometrial cancer. Int J Gynaecol Obstet 2018; 143 Suppl 2:109-117. [PMID: 30306593 DOI: 10.1002/ijgo.12618] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Endometrial cancer is the most common gynecologic cancer in women today. It is surgically staged, and while surgery is the primary treatment modality, the identification of disease extent-in particular extrauterine spread-prior to surgery is important to optimize treatment decision making. Ultrasound and MRI are useful for evaluating the extent of local disease, while CT and PET are used for detecting lymph node or distant metastases. Diffusion-weighted MRI has also been used for detecting small metastatic deposits in lymph nodes and omentum. Extrauterine soft tissue involvement can be detected by ultrasound, CT, MRI, and PET. Recently, intraoperative visualization techniques, such as sentinel lymph node mapping, are increasingly used to avoid extensive surgical staging without compromising treatment. Imaging is also used for planning adjuvant treatment and detection of postoperative residual disease in high-risk patients, monitoring and detecting recurrent disease, and in post-treatment surveillance of asymptomatic patients with high risk of relapse.
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Affiliation(s)
- Ming Yin Lin
- Gyne-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Andrew Dobrotwir
- Department of Radiology, Royal Women's Hospital, Parkville, Australia
| | - Orla McNally
- Gyne-Oncology Unit, Royal Women's Hospital, Parkville, Australia.,Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Centre, New York, NY, USA.,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Kailash Narayan
- Gyne-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia
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Sarı ME, Meydanlı MM, Yalçın I, Şahin H, Çoban G, Çelik H, Kuşçu E, Gungor T, Ayhan A. Risk Factors for Lymph Node Metastasis among Lymphovascular Space Invasion-Positive Women with Endometrioid Endometrial Cancer Clinically Confined to the Uterus. Oncol Res Treat 2018; 41:750-754. [DOI: 10.1159/000492585] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/31/2018] [Indexed: 01/15/2023]
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10
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Lin WV, De La Garza MM, Vickers A, Pasha H, Powell S, Lee AG. Third Nerve Palsy as the Presenting Sign of Metastatic Endometrial Carcinoma with Lymphovascular Space Invasion. Neuroophthalmology 2018; 43:397-400. [PMID: 32165900 DOI: 10.1080/01658107.2018.1520904] [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: 07/26/2018] [Revised: 09/01/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022] Open
Abstract
We present a case of endometrial carcinoma (EC) presenting with a third cranial nerve palsy due to metastasis to the cavernous sinus. Although the tumour was only stage 1B, histopathologic features including higher grade and lymphovascular space invasion (LVSI) increase the risk of recurrent and metastatic disease. To our knowledge, this is the first case of EC presenting as a third cranial nerve palsy in the English-language ophthalmic literature. Clinicians should be aware that the risk of metastatic EC including neuro-ophthalmic presentations depends upon not only stage and grade but also the presence of unique histopathological findings such as LVSI.
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Affiliation(s)
| | | | - Aroucha Vickers
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Hamza Pasha
- Department of Ophthalmology, UT Medical Branch, Galveston, Texas, USA
| | - Suzanne Powell
- Department of Pathology, Houston Methodist Hospital, Houston, Texas, USA
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA.,Department of Ophthalmology, UT Medical Branch, Galveston, Texas, USA.,Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, NY, New York, USA.,Department of Ophthalmology, UT MD Anderson Cancer Center, Houston, Texas, USA.,Department of Ophthalmology, Texas A&M College of Medicine, College Station, Texas, USA.,Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.,Department of Ophthalmology, Center for Space Medicine, Houston, Texas, USA.,Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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11
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Prognostic Significance of Lymphovascular Space Invasion in the Absence of Lymph Node Metastases in Early-Stage Endometrial Cancer. Int J Gynecol Cancer 2018. [DOI: 10.1097/igc.0000000000001229] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveLymphovascular space invasion (LVSI) has been defined as a significant adverse prognostic factor in early-stage endometrial cancer, primarily because of its high association with nodal metastases. This study aimed to determine if LVSI provides any prognostic significance in pathologic node-negative surgically staged (T1N0) endometrial cancer patients.Methods/MaterialsThis retrospective cohort study included all patients with pathologic stage T1N0 endometrial carcinoma treated at The Ottawa Hospital Cancer Centre from 1998 to 2007. Patient demographics, pathologic findings, treatment, and outcome data were collected. Univariate and multivariate cox regression modeling was used to assess significance and adjust for demographic and histopathologic covariates. Kaplan-Meier curves were used to estimate the 5-year overall and recurrence-free survival.ResultsOur study included 400 pathologic stage T1N0 patients who received an initial total hysterectomy and bilateral salpingo-oophorectomy with lymphadenectomy. The median age at diagnosis was 62 years, and the median follow-up was 66 months. Fifty-four patients (13.5%) had a positive LVSI status, and 346 (86.5%) had a negative LVSI status. The 5-year overall survival was 97.3% in patients without LVSI and 90.9% in those with LVSI (P < 0.001). The 5-year recurrence-free survival was 95.2% in patients without LVSI and 85.9% in those with LVSI (P = 0.006). Univariate analysis identified grade, stage, and LVSI as the covariates significantly associated with time to recurrence, and identified age, grade, stage, and LVSI to be significantly associated with overall survival. There were no significant covariates for recurrence-free survival by multivariate analysis, and only age and LVSI were significant for overall survival.ConclusionsLymphovascular space invasion is an overall poor prognostic factor in T1N0 endometrial cancer. After adjusting for other factors, LVSI remains an independent risk factor for worse overall survival. Therefore, estimation of overall survival in patients with early-stage, node-negative endometrial cancer should take into account LVSI status.
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12
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Cuylan ZF, Oz M, Ozkan NT, Comert GK, Sahin H, Turan T, Akbayir O, Kuscu E, Celik H, Dede M, Gungor T, Meydanli MM, Ayhan A. Prognostic factors and patterns of recurrence in lymphovascular space invasion positive women with stage IIIC endometriod endometrial cancer. J Obstet Gynaecol Res 2018. [DOI: 10.1111/jog.13615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Zeliha F. Cuylan
- Department of Gynecologic Oncology, Faculty of Medicine; Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Murat Oz
- Department of Gynecologic Oncology, Faculty of Medicine; Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Nazli T. Ozkan
- Department of Gynecologic Oncology, Faculty of Medicine; Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Gunsu K. Comert
- Department of Gynecologic Oncology, Faculty of Medicine; Etlik Zubeyde Hanim Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Hanifi Sahin
- Department of Gynecologic Oncology, Faculty of Medicine; Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Taner Turan
- Department of Gynecologic Oncology, Faculty of Medicine; Etlik Zubeyde Hanim Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Ozgur Akbayir
- Department of Gynecologic Oncology, Faculty of Medicine; Kanuni Sultan Suleyman Teaching and Research Hospital, University of Health Sciences; Istanbul Turkey
| | - Esra Kuscu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine; Baskent University; Ankara Turkey
| | - Husnu Celik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine; Baskent University; Ankara Turkey
| | - Murat Dede
- Department of Obstetrics and Gynecology, Faculty of Medicine; Gulhane Training and Researh Hospital, University of Health Sciences; Ankara Turkey
| | - Tayfun Gungor
- Department of Gynecologic Oncology, Faculty of Medicine; Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Mehmet M. Meydanli
- Department of Gynecologic Oncology, Faculty of Medicine; Zekai Tahir Burak Women's Health Training and Research Hospital, University of Health Sciences; Ankara Turkey
| | - Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine; Baskent University; Ankara Turkey
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Tailoring Adjuvant Radiotherapy in Endometrial Cancer. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2017. [DOI: 10.1007/s40944-017-0136-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ding L, Ding Y, Mao XH, Zhao JF, Zhou HJ. Retrospective study of the prognostic significance of neutrophil-to-lymphocyte ratio for postsurgical outcomes of patients with endometrial carcinoma. Int J Gynaecol Obstet 2017; 138:311-319. [PMID: 28599056 DOI: 10.1002/ijgo.12230] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/20/2017] [Accepted: 06/06/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate the significance of postoperative inflammatory system response markers in predicting the prognosis of patients with endometrial cancer undergoing surgery. METHODS The present retrospective study included patients who underwent surgical treatment for pathology-confirmed endometrial cancer between January 1, 2007, and June 30, 2013, at the Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China. Potential prognostic factors were investigated by Cox proportional hazards analysis and survival rates were compared using Kaplan-Meier analyses. RESULTS There were 185 patients with surgically treated endometrial cancer included. Multivariate analyses demonstrated that a preoperative neutrophil-to-lymphocyte ratio (NLR) above 1.81 (P=0.010) and a postoperative NLR above 7.54 (P=0.008) were both independently associated with lower disease free survival. Elevated preoperative and postoperative NLRs were associated with higher tumor stage (P=0.021 and P=0.009, respectively), and only elevated preoperative NLR was associated with lymph node involvement (P=0.023). CONCLUSION Preoperative and postoperative NLRs were independently associated with inflammatory system response markers and could be combined to evaluate the prognosis of patients with endometrial cancer following surgery.
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Affiliation(s)
- Ling Ding
- Department of Gynecology and Obstetrics, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yi Ding
- Department of Gynecology and Obstetrics, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Xiao-Hua Mao
- Department of Gynecology and Obstetrics, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Jian-Fei Zhao
- Department of Gynecology and Obstetrics, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Huai-Jun Zhou
- Department of Gynecology and Obstetrics, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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Martin OA, Anderson RL, Narayan K, MacManus MP. Does the mobilization of circulating tumour cells during cancer therapy cause metastasis? Nat Rev Clin Oncol 2016; 14:32-44. [PMID: 27550857 DOI: 10.1038/nrclinonc.2016.128] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite progressive improvements in the management of patients with locoregionally confined, advanced-stage solid tumours, distant metastasis remains a very common - and usually fatal - mode of failure after attempted curative treatment. Surgery and radiotherapy are the primary curative modalities for these patients, often combined with each other and/or with chemotherapy. Distant metastasis occurring after treatment can arise from previously undetected micrometastases or, alternatively, from persistent locoregional disease. Another possibility is that treatment itself might sometimes cause or promote metastasis. Surgical interventions in patients with cancer, including biopsies, are commonly associated with increased concentrations of circulating tumour cells (CTCs). High CTC numbers are associated with an unfavourable prognosis in many cancers. Radiotherapy and systemic antitumour therapies might also mobilize CTCs. We review the preclinical and clinical data concerning cancer treatments, CTC mobilization and other factors that might promote metastasis. Contemporary treatment regimens represent the best available curative options for patients who might otherwise die from locally confined, advanced-stage cancers; however, if such treatments can promote metastasis, this process must be understood and addressed therapeutically to improve patient survival.
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Affiliation(s)
- Olga A Martin
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,Molecular Radiation Biology Laboratory, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia
| | - Robin L Anderson
- Metastasis Research Laboratory, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia
| | - Kailash Narayan
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia
| | - Michael P MacManus
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia
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Lymphovascular Space Invasion Portends Poor Prognosis in Low-Risk Endometrial Cancer. Int J Gynecol Cancer 2016; 25:1292-9. [PMID: 26067863 DOI: 10.1097/igc.0000000000000490] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The prognostic significance of lymphovascular space invasion (LVSI) in patients with early-stage endometrial cancer is not established. We sought to determine if LVSI status in patients with early-stage low-risk endometrial cancer correlates with recurrence and survival. METHODS The records of all women who underwent hysterectomy for primary treatment of endometrial cancer from January 2006 through January 2011 at 1 academic institution were reviewed. Patients with grade 1 or 2 endometrioid histology, myometrial invasion less than 50%, and disease confined to the uterus (clinical International Federation of Obstetrics and Gynecology stage IA) were analyzed. Fisher exact test and the Wilcoxon rank-sum test were applied to compare patients with and without LVSI. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method. RESULTS Two hundred forty patients met the inclusion criteria. Forty (16.7%) had LVSI. Ninety-one patients (37.9%) underwent lymphadenectomy. Median tumor size was 30 mm in patients with and 26 mm in patients without LVSI (P = 0.150). Thirty patients (12.5%) received adjuvant therapy. Site of recurrence did not differ between patients with and without LVSI. Patients with LVSI were more likely to have myometrial invasion (P < 0.001), postoperative pathologic grade 2 disease (P < 0.001), to undergo lymphadenectomy (P = 0.049) and receive adjuvant therapy (P < 0.001). The 5-year cumulative incidence of recurrence was 3.8% in the no-LVSI group and 14.2% in the LVSI group (P = 0.053). The presence of LVSI was significantly associated with worse RFS (P = 0.002) and OS (P = 0.013). CONCLUSIONS Patients with low-risk endometrial cancer and LVSI have worse RFS and OS despite being more likely to undergo lymphadenectomy and adjuvant therapy.
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van Barneveld E, Allen DG, Bekkers RLM, Grant PT. Lymphovascular space invasion in early-stage endometrial cancer: adjuvant treatment and patterns of recurrence. SOUTHERN AFRICAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 2016. [DOI: 10.1080/20742835.2016.1175708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lymphovascular space invasion and the treatment of stage I endometrioid endometrial cancer. Int J Gynecol Cancer 2015; 25:75-80. [PMID: 25356534 DOI: 10.1097/igc.0000000000000306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Treatment of clinical early-stage endometrioid endometrial cancer (EEC) in The Netherlands consists of primary hysterectomy and bilateral salpingo-oophorectomy. Adjuvant radiotherapy is given when 2 or more the following risk factors are present: 60 years or older, grade 3 histology, and 50% or more myometrial invasion. Lymphovascular space invasion (LVSI) is a predictor of poor prognosis and early distant spread. It is unclear whether adjuvant radiotherapy is sufficient in patients with LVSI-positive EEC. METHODS/MATERIALS Eighty-one patients treated from 1999 until 2011 for stage I LVSI-positive EEC in 11 Dutch hospitals were included. The outcomes of patients with 0 to 1 risk factors were compared with those with 2 to 3 risk factors, and both were compared with the known literature. RESULTS Eighteen patients presented with recurrent disease, and 12 of those recurrences had a distant component. Overall and distant recurrence rates were 19.2% and 11.5% in patients with 0 to 1 risk factors followed by observation and 25.5% and 17% in patients with 2 to 3 risk factors who received adjuvant radiotherapy. Only 1 patient with grade 1 disease had a recurrence. CONCLUSIONS In stage I LVSI-positive EEC with 0 to 1 risk factors, observation might not be adequate. Moreover, despite adjuvant radiotherapy, a high overall and distant recurrence rate was observed in patients with 2 to 3 risk factors. The use of systemic treatment in these patients, with the exception of patients with grade 1 disease, should be investigated.
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Anton C, di Fávero GM, Köhler C, Carvalho FM, Baracat EC, Carvalho JP. Surgical treatment of endometrial cancer in developing countries: reasons to consider systematic two-step surgical treatment. Clinics (Sao Paulo) 2015; 70. [PMID: 26222815 PMCID: PMC4498149 DOI: 10.6061/clinics/2015(07)02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the lymph node status in a large cohort of women with endometrial cancer from the public health system who were referred to an oncology reference center in Brazil to identify candidates for the omission of lymphadenectomy based on clinicopathological parameters. METHODS We retrospectively analyzed a cohort of 310 women with endometrial cancer (255 endometrioid, 40 serous, and 15 clear cell tumors) treated between 2009 and 2014. We evaluated the histological type, grade (low vs. high), tumor size (cm), depth of myometrial invasion (≤50%, >50%) and lymphovascular space invasion to determine which factors were correlated with the presence of lymph node metastasis. RESULTS The factors related to lymph node involvement were tumor size (p=0.03), myometrial invasion (p<0.01), tumor grade (p<0.01), and lymphovascular space invasion (p<0.01). The histological type was not associated with the nodal status (p=0.52). Only twelve of 176 patients (6.8%) had low-grade endometrioid carcinoma, tumor size ≤2 cm and <50% myometrial infiltration. CONCLUSIONS The omission of lymphadenectomy based on the histological type, grade, tumor size and depth of myometrial invasion is not likely to have a large impact on the surgical treatment of endometrial cancer in our population because most patients present with large and advanced tumors. New strategies are proposed that prioritize hysterectomy performed in a general hospital as soon as possible after diagnosis, followed by an evaluation of the need for lymph node dissection at a reference center.
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Affiliation(s)
- Cristina Anton
- Faculdade de Medicina da Universidade de São Paulo, Department of Obstetrics and Gynecology, São Paulo/SP, Brazil
| | - Giovanni Mastrantonio di Fávero
- Faculdade de Medicina da Universidade de São Paulo, Department of Obstetrics and Gynecology, São Paulo/SP, Brazil
- Asklepios Hospital Hamburg, Department of Advanced Operative and Oncologic Gynecology. Hamburg, Germany
| | - Christhardt Köhler
- Asklepios Hospital Hamburg, Department of Advanced Operative and Oncologic Gynecology. Hamburg, Germany
| | - Filomena Marino Carvalho
- Instituto do Câncer do Estado de São Paulo – Octavio Frias de Oliveira (ICESP), Department of Pathology, São Paulo/SP, Brazil
| | - Edmund Chada Baracat
- Faculdade de Medicina da Universidade de São Paulo, Department of Obstetrics and Gynecology, São Paulo/SP, Brazil
| | - Jesus Paula Carvalho
- Faculdade de Medicina da Universidade de São Paulo, Department of Obstetrics and Gynecology, São Paulo/SP, Brazil
- Corresponding author: E-mail:
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Nomograms for Prediction of Outcome With or Without Adjuvant Radiation Therapy for Patients With Endometrial Cancer: A Pooled Analysis of PORTEC-1 and PORTEC-2 Trials. Int J Radiat Oncol Biol Phys 2015; 91:530-9. [DOI: 10.1016/j.ijrobp.2014.11.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 11/08/2014] [Accepted: 11/12/2014] [Indexed: 11/17/2022]
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Chen M, Jin Y, Bi Y, Li Y, Shan Y, Pan L. Prognostic significance of lymphovascular space invasion in epithelial ovarian cancer. J Cancer 2015; 6:412-9. [PMID: 25874004 PMCID: PMC4392049 DOI: 10.7150/jca.11242] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/19/2015] [Indexed: 11/06/2022] Open
Abstract
Object: To assess the effects of lymphovascular space invasion (LVSI) on cancer recurrence and survival in patients with primary epithelial ovarian cancer. Methods: A retrospective study was conducted of patients with stage I-IV primary epithelial ovarian cancer who underwent cytoreductive surgery. LVSI is defined as the presence of tumor cells within an endothelium-lined space, and the patients' pathologic slides were reevaluated by gynecological pathologists. Survival analysis was performed to compare risk factors. Results: A total of 492 patients were included in the analysis. The incidence of LVSI was 58.5% in our cohort (288 cases), and it was significantly associated with advanced stage, high-grade serous histology, high grade, and lymph node metastasis (P<0.001). Kaplan-Meier analysis demonstrated that LVSI was only correlated with decreased PFS (5-year rate, 39% vs. 66%, P<0.001) and OS (5-year rate, 44% vs. 78%, P<0.001) in patients at early stage but not at advanced stage (5-year rate, PFS: 14% vs. 11%, P<0.001; OS: 29% vs. 29%, P=0.141). Multivariate analysis showed that LVSI remained a significant variable with PFS and OS in early-stage ovarian cancer (PFS: HR 2.29, 95% CI 1.45-3.57; OS: HR 2.20, 95% CI 1.59-3.44, both P<0.001). Conclusion: LVSI is an independent predictor of progression and survival in patients with primary epithelial ovarian cancer at early stage but not at advanced stage.
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Affiliation(s)
- Ming Chen
- 1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Jin
- 1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yalan Bi
- 2. Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Li
- 1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Shan
- 1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingya Pan
- 1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kong TW, Chang SJ, Paek J, Lee Y, Chun M, Ryu HS. Risk group criteria for tailoring adjuvant treatment in patients with endometrial cancer: a validation study of the Gynecologic Oncology Group criteria. J Gynecol Oncol 2014; 26:32-9. [PMID: 25376915 PMCID: PMC4302283 DOI: 10.3802/jgo.2015.26.1.32] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 10/19/2014] [Accepted: 10/21/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of this study is to validate the Gynecologic Oncology Group (GOG) criteria for adjuvant treatment in a different cohort of patients and to evaluate the simplified risk criteria predicting the prognosis and tailoring adjuvant treatment in patients with surgically staged endometrial cancer. METHODS We performed a retrospective analysis of 261 consecutive patients with surgically staged endometrial cancer between January 2000 and February 2013. All patients had complete staging procedures and were surgically staged according to the 2009 International Federation of Gynecology and Obstetrics staging system. Clinical and pathologic data were obtained from medical records. We designed the simplified risk criteria for adjuvant treatment according to the risk factors associated with survival. The patients were divided into low and low-intermediate, high-intermediate, and high-risk groups according to the GOG criteria and simplified criteria and their survivals were compared. Receiver-operating characteristic curve analysis was used to evaluate the prognostic significance of both criteria. RESULTS Median follow-up time was 48 months (range, 10 to 122 months). According to the GOG criteria, we identified 197 low and low-intermediate risk patients, 20 high-intermediate risk patients, and 44 high-risk patients. There were significant differences in disease-free (p<0.001) and overall survival (p<0.001) among the three groups. Using the simplified risk criteria, we identified 189 low and low-intermediate risk patients, 28 high-intermediate risk patients, and 44 high-risk patients. There were significant differences in disease-free (p<0.001) and overall survival (p<0.001) among the three groups. The performance of the simplified criteria (area under the curve [AUC]=0.829 and 0.916 for disease recurrences and deaths, respectively) was as good as the GOG criteria (AUC=0.836 and 0.921 for disease recurrences and deaths, respectively). CONCLUSION The simplified criteria may be easily applicable and offer useful information for planning strategy of adjuvant treatment in patients with surgically staged endometrial cancer as the GOG criteria.
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Affiliation(s)
- Tae Wook Kong
- Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.; Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Suk Joon Chang
- Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.; Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
| | - Jiheum Paek
- Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.; Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Yonghee Lee
- Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.; Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Mison Chun
- Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.; Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Hee Sug Ryu
- Gynecologic Cancer Center, Ajou University School of Medicine, Suwon, Korea.; Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
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Hiller J, Ismail H, Riedel B. Improved quality of anesthesia and cancer recurrence studies. Anesth Analg 2014; 119:751-752. [PMID: 25137012 DOI: 10.1213/ane.0000000000000290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Jonathan Hiller
- Department of Cancer Anaesthesia and Pain Medicine Peter MacCallum Cancer Center Melbourne, Australia
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Rajasooriyar C, Bernshaw D, Kondalsamy-Chennakesavan S, Mileshkin L, Narayan K. The survival outcome and patterns of failure in node positive endometrial cancer patients treated with surgery and adjuvant radiotherapy with curative intent. J Gynecol Oncol 2014; 25:313-9. [PMID: 25142629 PMCID: PMC4195302 DOI: 10.3802/jgo.2014.25.4.313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 07/07/2014] [Accepted: 08/03/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the patterns of failure, overall survival (OS), disease-free survival (DFS) and factors influencing outcome in endometrial cancer patients who presented with metastatic lymph nodes and were treated with curative intent. METHODS One hundred and twenty-six patients treated between January 1996 to December 2008 with surgery and adjuvant radiotherapy were identified from our service's prospective database. Radiotherapy consisted of 45 Gy in 1.8 Gy fractions to the whole pelvis. The involved nodal sites were boosted to a total dose of 50.4 to 54 Gy. RESULTS The 5-year OS rate was 61% and the 5-year DFS rate was 59%. Grade 3 endometrioid, serous, and clear cell histologies and involvement of upper para-aortic nodes had lower OS and DFS. The number of positive nodes did not influence survival. Among the histological groups, serous histology had the worst survival. Among the 54 patients relapsed, only three (6%) failed exclusively in the pelvis and the rest of the 94% failed in extrapelvic nodal or distant sites. Patients with grade 3 endometrioid, serous and clear cell histologies did not influence pelvic failure but had significant extrapelvic failures (p<0.001). CONCLUSION Majority of node positive endometrial cancer patients fail at extrapelvic sites. The most important factors influencing survival and extrapelvic failure are grade 3 endometrioid, clear cell and serous histologies and involvement of upper para-aortic nodes.
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Affiliation(s)
| | - David Bernshaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | | | - Linda Mileshkin
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Kailash Narayan
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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Gynecologic Cancer InterGroup (GCIG) Endometrial Cancer Clinical Trials Planning Meeting: taking endometrial cancer trials into the translational era. Int J Gynecol Cancer 2014; 23:1528-34. [PMID: 24257568 DOI: 10.1097/igc.0b013e3182a26edb] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The second Gynecologic Cancer InterGroup (GCIG) Endometrial Cancer Clinical Trials Planning Meeting was held on December 1, 2012, and included international multidisciplinary representatives of the 24 member groups. The aims were to review recent advances in molecular pathology of endometrial cancer, focusing on molecular-based therapy, and to identify key hypotheses and issues to be addressed through international collaborative clinical trials. METHODS Reviews and summaries of current knowledge were presented followed by parallel working group sessions for surgery, adjuvant and systemic therapy, and translational research. Plenary discussions were held to integrate translational and clinical issues, and a final discussion session to agree on key trial concepts. RESULTS AND CONCLUSIONS Proposals to take forward on the following trials were agreed: (1) lymphadenectomy to direct adjuvant treatment in women with high-risk endometrial cancer, including a sentinel node substudy; (2) conservative therapy for low-risk endometrial cancers in morbidly obese women with high surgical risks and for fertility-sparing treatment in premenopausal patients; (3) adjuvant therapy for women with early-stage carcinosarcoma. A proposal was made that a GCIG Early Phase Consortium be developed to serve as an international platform for rapid assessment of biomarkers.
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Current World Literature. Curr Opin Obstet Gynecol 2013; 25:81-9. [DOI: 10.1097/gco.0b013e32835cc6b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sorbe B. Predictive and prognostic factors in definition of risk groups in endometrial carcinoma. ISRN OBSTETRICS AND GYNECOLOGY 2012; 2012:325790. [PMID: 23209924 PMCID: PMC3504391 DOI: 10.5402/2012/325790] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 09/27/2012] [Indexed: 11/23/2022]
Abstract
Background. The aim was to evaluate predictive and prognostic factors in a large consecutive series of endometrial carcinomas and to discuss pre- and postoperative risk groups based on these factors. Material and Methods. In a consecutive series of 4,543 endometrial carcinomas predictive and prognostic factors were analyzed with regard to recurrence rate and survival. The patients were treated with primary surgery and adjuvant radiotherapy. Two preoperative and three postoperative risk groups were defined. DNA ploidy was included in the definitions. Eight predictive or prognostic factors were used in multivariate analyses. Results. The overall recurrence rate of the complete series was 11.4%. Median time to relapse was 19.7 months. In a multivariate logistic regression analysis, FIGO grade, myometrial infiltration, and DNA ploidy were independent and statistically predictive factors with regard to recurrence rate. The 5-year overall survival rate was 73%. Tumor stage was the single most important factor with FIGO grade on the second place. DNA ploidy was also a significant prognostic factor. In the preoperative risk group definitions three factors were used: histology, FIGO grade, and DNA ploidy. Conclusions. DNA ploidy was an important and significant predictive and prognostic factor and should be used both in preoperative and postoperative risk group definitions.
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Affiliation(s)
- Bengt Sorbe
- Department of Oncology, Örebro University Hospital, 701 85 Örebro, Sweden
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Fisher SB, Patel SH, Kooby DA, Weber S, Bloomston M, Cho C, Hatzaras I, Schmidt C, Winslow E, Staley III CA, Maithel SK. Lymphovascular and perineural invasion as selection criteria for adjuvant therapy in intrahepatic cholangiocarcinoma: a multi-institution analysis. HPB (Oxford) 2012; 14:514-22. [PMID: 22762399 PMCID: PMC3406348 DOI: 10.1111/j.1477-2574.2012.00489.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Criteria for the selection of patients for adjuvant chemotherapy in intrahepatic cholangiocarcinoma (IHCC) are lacking. Some authors advocate treating patients with lymph node (LN) involvement; however, nodal assessment is often inadequate or not performed. This study aimed to identify surrogate criteria based on characteristics of the primary tumour. METHODS A total of 58 patients who underwent resection for IHCC between January 2000 and January 2010 at any of three institutions were identified. Primary outcome was overall survival (OS). RESULTS Median OS was 23.0 months. Median tumour size was 6.5 cm and the median number of lesions was one. Overall, 16% of patients had positive margins, 38% had perineural invasion (PNI), 40% had lymphovascular invasion (LVI) and 22% had LN involvement. A median of two LNs were removed and a median of zero were positive. Lymph nodes were not sampled in 34% of patients. Lymphovascular and perineural invasion were associated with reduced OS [9.6 months vs. 32.7 months (P= 0.020) and 10.7 months vs. 32.7 months (P= 0.008), respectively]. Lymph node involvement indicated a trend towards reduced OS (10.7 months vs. 30.0 months; P= 0.063). The presence of either LVI or PNI in node-negative patients was associated with a reduction in OS similar to that in node-positive patients (12.1 months vs. 10.7 months; P= 0.541). After accounting for adverse tumour factors, only LVI and PNI remained associated with decreased OS on multivariate analysis (hazard ratio 4.07, 95% confidence interval 1.60-10.40; P= 0.003). CONCLUSIONS Lymphovascular and perineural invasion are separately associated with a reduction in OS similar to that in patients with LN-positive disease. As nodal dissection is often not performed and the number of nodes retrieved is frequently inadequate, these tumour-specific factors should be considered as criteria for selection for adjuvant chemotherapy.
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Affiliation(s)
- Sarah B Fisher
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory UniversityAtlanta, GA, USA
| | - Sameer H Patel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory UniversityAtlanta, GA, USA
| | - David A Kooby
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory UniversityAtlanta, GA, USA
| | - Sharon Weber
- Division of Surgical Oncology, Department of Surgery, University of WisconsinMadison, WI, USA
| | - Mark Bloomston
- Division of Surgical Oncology, Department of Surgery, Ohio State UniversityColumbus, OH, USA
| | - Clifford Cho
- Division of Surgical Oncology, Department of Surgery, University of WisconsinMadison, WI, USA
| | - Ioannis Hatzaras
- Division of Surgical Oncology, Department of Surgery, Ohio State UniversityColumbus, OH, USA
| | - Carl Schmidt
- Division of Surgical Oncology, Department of Surgery, Ohio State UniversityColumbus, OH, USA
| | - Emily Winslow
- Division of Surgical Oncology, Department of Surgery, University of WisconsinMadison, WI, USA
| | - Charles A Staley III
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory UniversityAtlanta, GA, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory UniversityAtlanta, GA, USA
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