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Zhang H, Zhang Y, Xia T, Lu L, Luo M, Chen Y, Liu Y, Li Y. The Role of Keratin17 in Human Tumours. Front Cell Dev Biol 2022; 10:818416. [PMID: 35281081 PMCID: PMC8912659 DOI: 10.3389/fcell.2022.818416] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/03/2022] [Indexed: 12/24/2022] Open
Abstract
Keratins are a group of proteins that can constitute intermediate fibers. It is a component of the cytoskeleton and plays an important role in cell protection and structural support. Keratin 17, a Type I keratin, is a multifunctional protein that regulates a variety of biological processes, including cell growth, proliferation, migration, apoptosis and signal transduction. Abnormal expression of KRT17 is associated with a variety of diseases, such as skin diseases. In recent years, studies have shown that KRT17 is abnormally expressed in a variety of malignant tumours, such as lung cancer, cervical cancer, oral squamous cell carcinoma and sarcoma. These abnormal expressions are related to the occurrence, development and prognosis of malignant tumors. In this review, we summarized the expression patterns of KRT17 in a variety of malignant tumours, the role of KRT17 in the development and prognosis of different malignant tumors and its molecular mechanisms. We also discuss the potential clinical application of KRT17 as a valuable therapeutic target.
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Affiliation(s)
- Hanqun Zhang
- Department of Oncology, Guizhou Provincial People’s Hospital, Guizhou, China
| | - Yun Zhang
- Department of Pathology, Guizhou Provincial People’s Hospital, Guizhou, China
| | - Tingting Xia
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guizhou, China
| | - Liang Lu
- Department of Oncology, Guizhou Provincial People’s Hospital, Guizhou, China
| | - Min Luo
- Department of Oncology, Guizhou Provincial People’s Hospital, Guizhou, China
| | - Yanping Chen
- Department of Oncology, Guizhou Provincial People’s Hospital, Guizhou, China
| | - Yuncong Liu
- Department of Oncology, Guizhou Provincial People’s Hospital, Guizhou, China
- *Correspondence: Yuncong Liu, ; Yong Li,
| | - Yong Li
- Department of Oncology, Guizhou Provincial People’s Hospital, Guizhou, China
- *Correspondence: Yuncong Liu, ; Yong Li,
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Albright BB, Monuszko KA, Kaplan SJ, Davidson BA, Moss HA, Huang AB, Melamed A, Wright JD, Havrilesky LJ, Previs RA. Primary cytoreductive surgery for advanced stage endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 225:237.e1-237.e24. [PMID: 33957111 DOI: 10.1016/j.ajog.2021.04.254] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Endometrial cancer uncommonly presents at an advanced stage and little prospective evidence exists to guide the management thereof. We aimed to summarize the evidence about primary cytoreductive surgery in the treatment of advanced stage endometrial cancer. DATA SOURCES MEDLINE, Embase, and Scopus databases were searched from inception to September 11, 2020, using search terms representing the themes "endometrial cancer," "advanced stage," and "primary cytoreductive surgery." STUDY ELIGIBILITY CRITERIA We included full-text, English reports that included ≥10 patients undergoing primary cytoreductive surgery for advanced stage endometrial cancer and that reported on the outcomes of primary cytoreductive surgery and survival rates based on the residual disease burden. METHODS Two reviewers independently screened the studies and with disagreements between the reviewers resolved by a third reviewer. Data were extracted using a standardized form. The percentage of cases reaching maximal (no gross residual disease) and optimal (<1 cm or <2 cm residual disease) cytoreduction were assessed by summing binomials proportions, and the association with survival was assessed using an inverse variance-weighted meta-analysis of logarithmic hazard ratios. RESULTS From 1219 unique records identified, 34 studies were selected for inclusion. Studies consisted of single or multi-institutional cohorts of patients collected over a period of 6 to 24 years and included various mixes of histologies (endometrioid, serous, clear cell, and carcinosarcoma) and disease stages (III or IV). In a meta-analysis of the extent of residual disease after primary cytoreductive surgery, we found that 52.1% of cases reached no gross residual disease status (n=18 studies; 1329 patients) and 75% reached <1 cm residual disease status (n=27 studies; 2343 patients). The proportion of cytoreduction for both thresholds was lower for studies of stage IV vs stage III to IV disease (41.4% vs 69.8% for no gross residual disease; 63.2% vs 82.2% for <1 cm residual disease) but did not vary notably by histology. In a meta-analysis of the reported hazard ratios, submaximal (any gross residual disease vs no gross residual disease) and suboptimal (≥1 cm vs <1 cm) cytoreduction thresholds were associated with worse progression-free survival (submaximal hazard ratio, 2.16; 95% confidence interval, 1.45-3.21; I2=68%; suboptimal hazard ratio, 2.55; 95% confidence interval, 1.93-3.37; I2=63%) and overall survival rates (submaximal hazard ratio, 2.57; 95% confidence interval, 2.13-3.10; I2=1%; suboptimal hazard ratio, 2.62; 95% confidence interval, 2.20-3.11; I2=15%). Sensitivity analyses limited to high-quality studies demonstrated consistent results. CONCLUSION Among cases of advanced stage endometrial cancer undergoing primary cytoreductive surgery, a significant proportion of patients are left with residual disease, which is associated with worse survival outcomes. Further investigations about the roles of neoadjuvant chemotherapy and primary cytoreductive surgery in prospective trials is warranted in this population.
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Diagnostic value of microRNA panel in endometrial cancer: A systematic review. Oncotarget 2020; 11:2010-2023. [PMID: 32523655 PMCID: PMC7260115 DOI: 10.18632/oncotarget.27601] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/03/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE We conducted a systematic review to evaluate the overall diagnostic accuracy of miRNAs in detecting endometrial cancer. MATERIALS AND METHODS A systematic search of Medline, Embase, Cinahl and the Cochrane Controlled Register of Trials was performed to identify studies reporting on the diagnostic value of miRNA in EC patients. Included were diagnostic studies looking at miRNA expression in women diagnosed with endometrial cancer. Two reviewers independently selected studies and assessed quality of studies using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) score system. Data extraction was completed and the vote-counting strategy was used to rank miRNAs. RESULTS 26 studies were included with a total number of 1,400 EC patients reporting on 106 differentially expressed miRNAs. The most frequently found up-regulated miRNA was miR-205 followed by miR-200c, -223, -182, -183 and -200a. In addition, miR-135b, miR-429, miR-141 and miR-200b were also frequently up-regulated. There was less consensus on down-regulated miRNAs. CONCLUSIONS miRNAs yield a promising diagnostic biomarker potential in endometrial cancer, especially miR-205, the miR-200 family and miR-135b, -182, -183 and -223. However, no sufficient high quality data are available to draw hard conclusions. More research is needed to validate the diagnostic potential of these miRNAs in larger studies. In addition, the potential of urine as a non-invasive biofluid should be investigated in more detail.
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Rajkumar S, Nath R, Lane G, Mehra G, Begum S, Sayasneh A. Advanced stage (IIIC/IV) endometrial cancer: Role of cytoreduction and determinants of survival. Eur J Obstet Gynecol Reprod Biol 2019; 234:26-31. [DOI: 10.1016/j.ejogrb.2018.11.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/05/2018] [Accepted: 11/30/2018] [Indexed: 11/17/2022]
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Antony MA, Ramachandran A, Kottarathil VD. Nerve Sparing Radical Hysterectomy: An Important Tool for the Gynecologic Oncologist. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-015-0009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Solmaz U, Mat E, Dereli ML, Turan V, Ekin A, Tosun G, Dogan A, Ozdemir IA, Oztekin O, Sanci M. Stage-III and -IV endometrial cancer: A single oncology centre review of 104 cases. J OBSTET GYNAECOL 2015; 36:81-6. [PMID: 26467294 DOI: 10.3109/01443615.2015.1041890] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of this study was to evaluate the clinicopathological characteristics, treatment and prognosis of advanced endometrial cancer (EC). Patients who underwent surgery for advanced EC between January 1995 and December 2012 were retrospectively reviewed. Patients with missing data, concurrent cancers or uterine sarcomas and those who did not undergo surgery were excluded. The effects of clinicopathological factors on progression-free survival (PFS) and overall survival (OS) were analyzed. A total of 104 patients were included. Most presented with endometrioid histology (74%) and stage-III disease (87.5%), and 76.9% underwent optimal cytoreduction. A multivariate analysis confirmed that lymphovascular space invasion (LVSI) is an independent poor prognostic factor for PFS [odds ratio (OR): 21.37, p = 0.005] and OS [OR: 8.09, p = 0.044]. Suboptimal cytoreduction is another independent poor prognostic factor for PFS [OR: 5.68, p < 0.001]. Our study demonstrated that LVSI and optimal cytoreduction are the most significant factors affecting the survival of advanced EC patients.
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Affiliation(s)
- U Solmaz
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - E Mat
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - M L Dereli
- b Department of Obstetrics and Gynecology , Tavas State Hospital , Denizli , Turkey
| | - V Turan
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - A Ekin
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - G Tosun
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - A Dogan
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - I A Ozdemir
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - O Oztekin
- c Department of Obstetrics and Gynecology , Medical School of Pamukkale University , Denizli , Turkey
| | - M Sanci
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
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Rabinovich A. Neo-adjuvant chemotherapy for advanced stage endometrial carcinoma: a glimmer of hope in select patients. Arch Gynecol Obstet 2015; 293:47-53. [PMID: 26288978 DOI: 10.1007/s00404-015-3841-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW The objective of this review is to conduct a critical appraisal of the published literature on the use of neo-adjuvant chemotherapy followed by interval debulking in the treatment of stage IVb endometrial carcinoma patients. METHODS Narrative review of the pertinent literature on the application of neo-adjuvant chemotherapy and interval surgery in the treatment of advanced stage endometrial cancers. RESULTS Advanced stage endometrial carcinoma patients are treated by aggressive cytoreduction followed by adjuvant chemotherapy or by chemotherapy alone. The prognosis of patients that cannot undergo surgery is extremely poor. Preoperative reduction of tumor burden by chemotherapy can facilitate surgery in patients previously considered to have an unresectable disease, identify patients with chemo-sensitive tumors that are more likely to benefit from surgery, and enable a less aggressive surgery thus reducing morbidity. However, only 106 cases of neo-adjuvant chemotherapy were documented in the last two decades, majority (76) were described in retrospective case reports and case series. The available data may indicate feasibility of neo-adjuvant treatment in select patients. Compared to patients that had primary surgery, neo-adjuvant setting was associated with improved or equivalent survival and maximal debulking rates and reduced postoperative morbidity. CONCLUSIONS Until further progress is reached, consideration can be given to recommending neo-adjuvant chemotherapy followed by interval debulking to patients with poor performance status or those patients who the surgeon believes would have suboptimal debulking if surgery was attempted.
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Affiliation(s)
- Alex Rabinovich
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Beer-Sheva, Israel.
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Eto T, Saito T, Shimokawa M, Hatae M, Takeshima N, Kobayashi H, Kasamatsu T, Yoshikawa H, Kamura T, Konishi I. Status of treatment for the overall population of patients with stage IVb endometrial cancer, and evaluation of the role of preoperative chemotherapy: A retrospective multi-institutional study of 426 patients in Japan. Gynecol Oncol 2013; 131:574-80. [DOI: 10.1016/j.ygyno.2013.08.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/26/2013] [Accepted: 08/30/2013] [Indexed: 11/27/2022]
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Lan C, Huang X, Cao X, Huang H, Feng Y, Huang Y, Liu J. Adjuvant docetaxel and carboplatin chemotherapy administered alone or with radiotherapy in a "sandwich" protocol in patients with advanced endometrial cancer: a single-institution experience. Expert Opin Pharmacother 2013; 14:535-42. [PMID: 23480059 DOI: 10.1517/14656566.2013.778243] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the outcomes of adjuvant chemotherapy administered alone or with radiotherapy in a "sandwich" protocol in patients with advanced endometrial cancer. METHODS The authors retrospectively reviewed the clinical records of patients with staged III - IV disease who received adjuvant chemotherapy (docetaxel plus carboplatin) administered alone or interposed with radiotherapy between January 2004 and August 2010. RESULTS Of the 35 study patients, 10 (28.6%) had stage IIIA disease, 15 (42.9%) had IIIC1 disease, 7 (20.0%) had IIIC2 disease and 3 (8.6%) had IVB disease. Nine (90.0%) of the 10 patients with stage IIIA disease received four to six cycles of adjuvant docetaxel and carboplatin chemotherapy alone. All 25 patients with stage IIIC - IVB disease and 1 patient with stage IIIA disease received radiotherapy sandwiched between chemotherapy cycles (total, three to six cycles). The 3-year progression-free survival (PFS) and overall survival (OS) rates were 73.0 and 87.0%, respectively, for all patients. For patients with stage IIIC - IVB disease, the 3-year PFS and OS rates were 62.4 and 81.8%, respectively. CONCLUSION Combination chemotherapy with docetaxel and carboplatin interposed with radiotherapy is efficacious and well tolerated for stage IIIC - IVB endometrial cancer. Adjuvant chemotherapy alone with docetaxel and carboplatin might be sufficient for stage IIIA disease.
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Affiliation(s)
- Chunyan Lan
- State Key Laboratory of Oncology in South China, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
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Taşkın S, Ortaç F, Kahraman K, Göç G, Öztuna D, Güngör M. Cervical stromal involvement can predict survival in advanced endometrial carcinoma: a review of 67 patients. Int J Clin Oncol 2011; 18:105-9. [DOI: 10.1007/s10147-011-0351-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 10/31/2011] [Indexed: 10/15/2022]
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Shih K, Yun E, Gardner G, Barakat R, Chi D, Leitao M. Surgical cytoreduction in stage IV endometrioid endometrial carcinoma. Gynecol Oncol 2011; 122:608-11. [DOI: 10.1016/j.ygyno.2011.05.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 05/13/2011] [Accepted: 05/18/2011] [Indexed: 11/28/2022]
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Geels YP, Massuger LFAG, Pijnenborg JMA. Prognostic factors in stage II/III/IV and stages III/IV endometrioid and serous adenocarcinoma of the endometrium. P. Mhawech-Fauceglia, R.F. Herrmann, J. Kesterson, I. Izevbaye, S. Lele, K. Odunsi. Eur J Surg Oncol 2010 Dec;36(12):1195-201. Eur J Surg Oncol 2011; 37:734-5; author reply 736. [PMID: 21680132 DOI: 10.1016/j.ejso.2011.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/23/2011] [Indexed: 10/18/2022] Open
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Leitao MM, Barakat RR. Clinical Approach to Diagnosis and Management of Endometrial Hyperplasia and Carcinoma. Surg Pathol Clin 2011; 4:113-30. [PMID: 26837290 DOI: 10.1016/j.path.2010.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article focuses on the most important neoplastic epithelial lesions of the uterus, endometrial hyperplasia and carcinoma. The primary management of hyperplastic lesions and carcinoma is often surgical but nonsurgical options are possible for both, depending on specific patients and tumor characteristics. Many controversies still exist regarding the optimal medical and surgical treatments of hyperplasias and carcinomas of the endometrium. There is a need to more accurately select patients for lymph node sampling or dissection. The role of adjuvant therapies for endometrial carcinomas is still under investigation. This review covers current understanding in the diagnosis and clinical management of endometrial hyperplasias and carcinomas.
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Affiliation(s)
- Mario M Leitao
- Division of Gynecology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Richard R Barakat
- Division of Gynecology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Mhawech-Fauceglia P, Herrmann RF, Kesterson J, Izevbaye I, Lele S, Odunsi K. Prognostic factors in stages II/III/IV and stages III/IV endometrioid and serous adenocarcinoma of the endometrium. Eur J Surg Oncol 2010; 36:1195-201. [PMID: 20926229 DOI: 10.1016/j.ejso.2010.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 08/18/2010] [Accepted: 09/13/2010] [Indexed: 11/26/2022] Open
Abstract
AIMS To explore and to compare the outcome of patients diagnosed with stage II/III/IV and stage III/IV endometrioid adenocarcinoma (EAC) with their serous carcinoma (USC) counterparts. MATERIALS AND METHODS A total of 107 patients (73 EAC and 34 USC) were evaluated. For statistical analysis, the following baseline variables were considered for their prognostic value: the patient's age at presentation, the tumor size, the depth of myometrial invasion (MI), the lympho-vascular involvement (LVI) and the USC and the EAC subtypes (considered as binary variables). Disease free survival (DFS), death of disease (DOD) and overall survival (OS) were assessed using univariate and multiple Cox proportional hazards models. RESULTS In univariate analysis, USC tends to recur more frequently than EAC (p = 0.004), a finding that disappeared in multivariate analysis. Furthermore, tumor histology had no significance in predicting the tumor outcomes. Among all of the prognostic factors and after adjusting for the aforementioned variables, MI ≥50% was the only independent factor in predicting DOD in stages II/III/IV (p = 0.009) and in stages III/IV (p = 0.004). MI was also an independent predictive factor for OS (p = 0.02) and early recurrences in stages III/IV. LVI was the only independent factor in predicting recurrences (p = 0.004) in stages II/III/IV but not in stages III/IV. CONCLUSION Based on our study, tumor histology was not a significant factor in predicting disease outcome in stages II/III/IV and II/IV. Despite our limited sample size, we believe that our findings provide meaningful insights into the clinical study of endometrial cancer patients which in turn warrants further investigation.
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Barlin JN, Puri I, Bristow RE. Cytoreductive surgery for advanced or recurrent endometrial cancer: a meta-analysis. Gynecol Oncol 2010; 118:14-8. [PMID: 20434198 DOI: 10.1016/j.ygyno.2010.04.005] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 03/29/2010] [Accepted: 04/05/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the relative effect and quantify the impact of multiple prognostic variables on median overall survival time among cohorts of patients with advanced or recurrent endometrial cancer undergoing cytoreductive surgery. METHODS Fourteen retrospective cohorts with advanced or recurrent endometrial cancer (672 patients) meeting study inclusion criteria were identified. Univariate analysis was used to assess the effect on median overall survival time of multiple variables. The limited number of studies available made multivariate analysis impractical. RESULTS Statistically significant clinical variables associated with median overall survival time were the proportion of patients undergoing complete surgical cytoreduction, adjuvant radiation, or receiving adjuvant chemotherapy. Cohort median overall survival time was positively associated with increasing proportion of patients undergoing complete surgical cytoreduction (each 10% increase improving survival by 9.3 months, p=0.04) and receiving post-operative radiation therapy (each 10% increase improving survival by 11.0 months, p=0.004), while an increasing proportion of patients receiving chemotherapy was negatively associated with survival (each 10% increase decreasing survival by 10.4 months, p=0.007). CONCLUSIONS The current analysis suggests that among patients with advanced or recurrent endometrial cancer, complete cytoreduction to no gross residual disease is associated with superior overall survival outcome. The unexpected correlation between treatment modality and survival may be a surrogate marker for more precise factors such as location of disease, performance status, or cytoreductive status post-operatively, which may have influenced the decision to administer adjuvant radiation versus chemotherapy and were not able to be controlled for given the limitations of the extracted data.
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Affiliation(s)
- Joyce N Barlin
- Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, 600 North Wolfe St, Phipps 281, Baltimore, MD 21287, USA.
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Wethington SL, Barrena Medel NI, Wright JD, Herzog TJ. Prognostic significance and treatment implications of positive peritoneal cytology in endometrial adenocarcinoma: Unraveling a mystery. Gynecol Oncol 2009; 115:18-25. [DOI: 10.1016/j.ygyno.2009.06.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 06/11/2009] [Accepted: 06/12/2009] [Indexed: 10/20/2022]
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Barlin JN, Ueda SM, Bristow RE. Cytoreductive Surgery for Advanced and Recurrent Endometrial Cancer: a Review of the Literature. WOMENS HEALTH 2009; 5:403-11. [DOI: 10.2217/whe.09.26] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
There is no standard approach to managing women with advanced or recurrent endometrial cancer; however, there is increasing evidence to support a role for cytoreductive surgery in these women to improve survival outcome. The existing literature is limited by the inherent biases of retrospective studies, as well as small numbers of patients in individual studies; however, the association between optimal or complete cytoreductive surgery in patients with advanced and recurrent endometrial cancer and improved overall survival has been consistent. Furthermore, there is also a strong association between the size of postoperative residual disease and survival; as such, maximal cytoreduction should be the goal in carefully selected patients with advanced or recurrent endometrial cancer who are candidates for surgical management. Additional prospective research is needed in order to further define the role of cytoreductive surgery in advanced and recurrent endometrial cancer, and to develop effective adjuvant therapy to be used postoperatively in order to improve the prognosis in these women.
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Affiliation(s)
- Joyce N Barlin
- Joyce N Barlin, MD, Department of Gynecology & Obstetrics, The Johns Hopkins Hospital, 600 North Wolfe St, Phipps 281, Baltimore, MD 21287, USA, Tel.: +1 410 550 0340, Fax: +1 410 502 6683,
| | - Stefanie M Ueda
- Stefanie M Ueda, MD, Department of Gynecology & Obstetrics, The Johns Hopkins Hospital, 600 North Wolfe St, Phipps 281, Baltimore, MD 21287, USA, Tel.: +1 410 955 8240, Fax: +1 410 614 8718,
| | - Robert E Bristow
- Robert E Bristow, MD, Department of Gynecology & Obstetrics, The Johns Hopkins Hospital, 600 North Wolfe St, Phipps 281, Baltimore, MD 21287, USA, Tel.: +1 410 955 8240, Fax: +1 410 614 8718,
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van Wijk F, van der Burg M, Burger CW, Vergote I, van Doorn H. Management of Surgical Stage III and IV Endometrioid Endometrial Carcinoma: An Overview. Int J Gynecol Cancer 2009; 19:431-46. [DOI: 10.1111/igc.0b013e3181a1a04f] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
This paper covers an overview of the literature on the management of advanced endometrial cancer, concentrating on patients with histopathologic endometrioid type of tumors. The different treatment modalities are described and management recommendations are proposed.The standard surgical procedure includes an extrafacial total hysterectomy with bilateral salpingo-oophorectomy, collection of peritoneal washings for cytology, and exploration of the intraabdominal contents. In cases of extensive disease in the abdomen, an optimal surgical cytoreduction is associated with improved survival. Further treatment with radiotherapy may be indicated based on the pathological staging information to improve loco-regional control. Primary radiotherapy is indicated in cases where surgery is contraindicated. Systemic treatment can either be hormone therapy or chemotherapy. Progesterons are the cornerstone of hormone therapy. Prognostic factors for response are the presence of high levels of progesterone and estrogen receptors and low grade histology. Paclitaxel is the most active single agent drug. The combination therapy with paclitaxel and carboplatin is adopted as first choice in patients with endometrial cancer because of the efficacy and low toxicity, although not proven in a randomized trial.The literature on the management of patients with advanced endometrial cancer is discussed in detail. Each stage of advanced disease is presented separately, and management recommendations are proposed, and alternative approaches are given.Ongoing clinical trials are described, and the focuses of ongoing research are mentioned.
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Leitao MM. Current and future surgical approaches in the management of endometrial carcinoma. Future Oncol 2008; 4:389-401. [DOI: 10.2217/14796694.4.3.389] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The surgical approach to endometrial carcinoma has been and continues to be inconsistent. It ranges from hysterectomy alone for all patients, hysterectomy with lymphadenectomy based on the surgeon’s criteria for risk of nodal metastasis based on preoperative grading and/or intraoperative assessments, and hysterectomy with limited lymphadenectomy, to hysterectomy with full pelvic and para-aortic lymphadenectomy for all patients. Recent evidence has clearly described the very poor correlation of pre- and/or intraoperative assessments with final hysterectomy pathologic findings. Lymphadenectomy has also been found to be therapeutic in high-risk groups. Despite this, many surgeons have not adopted a policy of comprehensive staging for all patients with endometrial carcinoma. All patients with endometrial carcinoma diagnosed on preoperative endometrial sampling should undergo comprehensive surgical staging if technically and medically possible. Surgical cytoreduction of metastatic disease is also associated with improved outcomes.
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Affiliation(s)
- Mario M Leitao
- Memorial Sloan–Kettering Cancer Center, Gynecology Service, Department of Surgery, 1275 York Avenue, NY 10065, USA
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Abstract
PURPOSE OF REVIEW We review the demographic and clinicopathologic characteristics, and prognosis of women diagnosed with uterine papillary serous carcinoma, with a focus on clinical management. RECENT FINDINGS Pathologic evaluation of postmenopausal bleeding is preferred for patients who fit the profile of a high-risk endometrial cancer such as uterine papillary serous carcinoma. Women diagnosed with endometrial cancer who fit this profile and all women with uterine papillary serous carcinoma should undergo comprehensive surgical staging and aggressive cytoreduction of extrauterine disease. Adjuvant therapy remains controversial. Several recent investigations reported on the potential benefit of adjuvant chemotherapy, with many recommending additional loco-regional radiation. SUMMARY Despite the lack of randomized trials on uterine papillary serous carcinoma, several recent reports have provided insight into the diagnosis, surgical management, and adjuvant treatment of this high-risk endometrial cancer.
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