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Zheng D, Bhuvan T, Payne NL, Heng TSP. Secondary Lymphoid Organs in Mesenchymal Stromal Cell Therapy: More Than Just a Filter. Front Immunol 2022; 13:892443. [PMID: 35784291 PMCID: PMC9243307 DOI: 10.3389/fimmu.2022.892443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Mesenchymal stromal cells (MSCs) have demonstrated therapeutic potential in inflammatory models of human disease. However, clinical translation has fallen short of expectations, with many trials failing to meet primary endpoints. Failure to fully understand their mechanisms of action is a key factor contributing to the lack of successful commercialisation. Indeed, it remains unclear how the long-ranging immunomodulatory effects of MSCs can be attributed to their secretome, when MSCs undergo apoptosis in the lung shortly after intravenous infusion. Their apoptotic fate suggests that efficacy is not based solely on their viable properties, but also on the immune response to dying MSCs. The secondary lymphoid organs (SLOs) orchestrate immune responses and play a key role in immune regulation. In this review, we will discuss how apoptotic cells can modify immune responses and highlight the importance of MSC-immune cell interactions in SLOs for therapeutic outcomes.
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Affiliation(s)
- Di Zheng
- Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Tejasvini Bhuvan
- Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Natalie L. Payne
- Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton, VIC, Australia
| | - Tracy S. P. Heng
- Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
- ARC Training Centre for Cell and Tissue Engineering Technologies, Monash University, Clayton, VIC, Australia
- *Correspondence: Tracy S. P. Heng,
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Quan Q, Peng H, Gong S, Liu J, Lu Y, Chen R, Mu X. The Preeminent Value of the Apparent Diffusion Coefficient in Assessing High-Risk Factors and Prognosis for Stage I Endometrial Carcinoma Patients. Front Oncol 2022; 12:820904. [PMID: 35251987 PMCID: PMC8888536 DOI: 10.3389/fonc.2022.820904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To evaluate the role of the apparent diffusion coefficient (ADC) value in the individualized management of stage I endometrial carcinoma (EC). Methods A retrospective analysis was performed on 180 patients with stage I EC who underwent 1.5-T magnetic resonance imaging. The mean ADC (mADC), minimum ADC (minADC), and maximum ADC (maxADC) values of each group were measured and compared. We analyzed the relationship between ADC values and stage I EC prognosis by Kaplan-Meier method and Cox proportional hazards analysis. Results Patients with lower ADC values were more likely to be characterized by higher grades, specific histological subtypes and deeper myometrial invasion. The mADC, minADC and maxADC values (×10-3 mm2/s) were 1.045, 0.809 and 1.339, respectively, in grade 1/2 endometrioid carcinoma with superficial myometrial invasion, which significantly differed from those in grade 3 or nonendometrioid carcinoma or with deep myometrial invasion (0.929, 0.714 and 1.215) (P=<0.001, <0.001 and <0.001). ADC values could be used to predict these clinicopathological factors. Furthermore, the group with higher ADC values showed better disease-free survival and overall survival. Conclusions The present study indicated that ADC values were associated with the high-risk factors for stage I EC and to assess whether fertility-sparing, ovarian preservation or omission of lymphadenectomy represent viable treatment options. Moreover, this information may be applied to predict prognosis. Thus, ADC values could contribute to managing individualized therapeutic schedules to improve quality of life.
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Affiliation(s)
- Quan Quan
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hui Peng
- The Department of Obstetrics and Gynecology, Chongqing Wansheng Jingkai District Maternal and Child Health Hospital, Chongqing, China
| | - Sainan Gong
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiali Liu
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunfeng Lu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rongsheng Chen
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoling Mu
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Prospective Non-randomized Control Trial on Role of Systematic High Para-Aortic Lymphadenectomy in Endometrial Cancer: Indian Study. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-020-00482-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Dieterich M, Schröter V, Stubert J, Reimer T, Gerber B, Stachs A. Oncologic Outcome of Patients with (Low-Risk) Endometrial Carcinoma Undergoing Laparotomy versus Minimally Invasive Hysterectomy: A Retrospective Analysis. Oncol Res Treat 2019; 42:636-649. [PMID: 31542781 DOI: 10.1159/000502757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/14/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with endometrial carcinoma (EC) frequently are obese and have various secondary diseases. We investigated the oncologic safety and complication rates of early-stage EC treated with laparotomy (LAP) versus minimally invasive hysterectomy (MIH). A secondary study aim was the evaluation of risk factors for relapse and complications. METHODS Data from the Cancer Registry Rostock, Germany, and the medical records of women diagnosed with type 1 EC between January 2005 and December 2014 were retrospectively evaluated. The baseline characteristics were analyzed with the χ2 test and Fisher's exact test. Multivariate analysis with the Cox proportional-hazards model and logistic regression were performed to identify prognostic factors for time to event and risk factors for complications. Kaplan-Meier analysis was performed for disease-free and overall survival. RESULTS Of 350 evaluated patients, 242 underwent traditional LAP; on 108 patients, MIH was performed. The median follow-up period in the LAP group and the MIH group was 82 ± 31.1 and 71.1 ± 33.6 months, respectively (p = 0.10). The median time to event was 40.3 ± 28.1 months in the LAP group and 38.0 ± 27.5 months in the MIH group (p = 0.476). Significantly longer surgery times (p < 0.001) and more complications (p < 0.001) were observed in the LAP group. Disease-free survival after MIH was not significantly different from that after LAP (log-rank p = 0.052). Multimorbidity remained as the single risk factor for event/recurrence (p = 0.019) in multivariate analysis. CONCLUSIONS MIH for early-stage EC may be an oncologically safe approach when compared to LAP, and its complication rates are lower; therefore, MIH represents the preferred approach for this patient cohort.
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Affiliation(s)
- Max Dieterich
- Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, University of Rostock, Rostock, Germany,
| | - Victoria Schröter
- Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, University of Rostock, Rostock, Germany
| | - Johannes Stubert
- Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, University of Rostock, Rostock, Germany
| | - Toralf Reimer
- Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, University of Rostock, Rostock, Germany
| | - Bernd Gerber
- Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, University of Rostock, Rostock, Germany
| | - Angrit Stachs
- Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, University of Rostock, Rostock, Germany
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Zahnd WE, Hyon KS, Diaz-Sylvester P, Izadi SR, Colditz GA, Brard L. Rural-urban differences in surgical treatment, regional lymph node examination, and survival in endometrial cancer patients. Cancer Causes Control 2018; 29:221-232. [PMID: 29282582 PMCID: PMC6311991 DOI: 10.1007/s10552-017-0998-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 12/21/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Endometrial cancer (EC) is the most common gynecological malignancy and one of few cancers with an increasing US mortality rate. Rural patients may have less access to specialty care affecting their receipt of surgery and adequate lymphadenectomy (AL). We sought to assess rural-urban differences in EC surgery, lymphadenectomy, and survival. METHODS We analyzed data from the Surveillance Epidemiology and End Results database on EC patients (2004-2013). We performed univariate analyses to compare rural and urban patients on demographic and clinical characteristics and receipt of nodal examination and AL. We assessed rural-urban differences in trends of receipt of AL, performed logistic regression to evaluate differences in receipt of surgery, nodal examination, and AL, and performed survival analysis. RESULTS Rural patients were less likely to have any lymph nodes removed, had a smaller median number removed, and a smaller proportion had AL. Even after controlling for established risk factors, rural patients had lower odds of lymph node examination and adequate AL than urban patients and also had poorer survival. CONCLUSIONS Future research should continue to assess the association between access to care and disparities in surgical care and the effect of these disparities on survival.
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Affiliation(s)
- Whitney E Zahnd
- Office of Population Science and Policy, Southern Illinois University School of Medicine, 201 E. Madison St Rm. 235, PO Box 19664, Springfield, IL, 62794-9664, USA.
| | - Katherine S Hyon
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Paula Diaz-Sylvester
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, IL, USA
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Sonya R Izadi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Laurent Brard
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, IL, USA
- Simmons Cancer Institute at SIU, Springfield, IL, USA
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Gong Y, Wang Q, Dong L, Jia Y, Hua C, Mi F, Li C. Different imaging techniques for the detection of pelvic lymph nodes metastasis from gynecological malignancies: a systematic review and meta-analysis. Oncotarget 2017; 8:14107-14125. [PMID: 27802186 PMCID: PMC5355166 DOI: 10.18632/oncotarget.12959] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/22/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the diagnostic performance of different imaging techniques and the corresponding diagnostic criteria for preoperative detection of pelvic lymph node metastasis from gynecological carcinomas. METHODS Six databases were systematically searched for retrieving eligible studies. Study inclusion, data extraction and risk of bias assessment were performed by 2 reviewers independently. STATA 14.0 was used to perform the meta-analysis. RESULTS Eighty eligible studies were collected. The pooled sensitivity, specificity, and area under curve (AUC) of CT, MRI and DWI were 47%, 93%, 0.7424; 50%, 95%, 0.8039 and 84%, 95%, 0.9523 respectively. As regards PET, PET-CT and US, the pooled sensitivity, specificity and AUC were 56%, 97%, 0.9592; 68%, 97%, 0.9363 and 71%, 99%, 0.9008 respectively. The summary receiver operating characteristic (SROC) curve indicated that the systematic diagnostic performances of PET, PET-CT, DWI were superior to other imaging modalities. CONCLUSIONS The present work demonstrated that DWI, PET, PET-CT were the top-priority consideration of imaging modalities for detecting metastatic pelvic lymph node in gynecological carcinoma. DWI was recommended as the first choice for metastasis exclusion and all the other imaging techniques including CT and MRI were suitable for metastasis conformation. However, for the early stage lymph node malignancy, PET or PET-CT could represent a better choice. More studies exploring the diagnostic efficacy of detailed criteria are required in the future.
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Affiliation(s)
- Yi Gong
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qingming Wang
- Department of Hematology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Li Dong
- Department of Cardiology, The Second Affiliated Hospital of Southwest Medical University, Lu Zhou, Sichuan, China
| | - Yiping Jia
- Department of Ultrasound, No.4 West China Teaching Hospital, Sichuan University, Chengdu, China
| | - Chengge Hua
- Department of Oral and Maxillofacial Surgery, Department of Evidence-based Dentistry, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Fanglin Mi
- Department of Stomatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Chunjie Li
- Department of Head and Neck Oncology, Department of Evidence-based Dentistry, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
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Ye S, Wen H, Jiang Z, Wu X. The effect of visceral obesity on clinicopathological features in patients with endometrial cancer: a retrospective analysis of 200 Chinese patients. BMC Cancer 2016; 16:209. [PMID: 26968382 PMCID: PMC4788937 DOI: 10.1186/s12885-016-2230-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/29/2016] [Indexed: 01/09/2023] Open
Abstract
Background To assess the effect of visceral adiposity on clinical and pathological characteristics in patients with endometrial cancer. Methods A retrospective review of medical documentation was performed in surgically treated endometrial cancer patients from January to November 2015 in our institution. The visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured at the level of umbilicus on single-slice computerized tomography. Visceral adiposity (VAT%) was calculated as VAT/(VAT + SAT). Results A total of 200 cases were included in the study. Median age at diagnosis was 54 years old. Most patients presented with early-stage tumor (86.0 % for I + II) and endometrioid histology (90.5 %). Positive lymph node occurred in 11.0 % (22/200) of the patients with the median number of retrieved nodes as 25 (range, 4–56). The entire population had a median body mass index (BMI) of 24.7 kg/m2 and median VAT% of 31.89 %. BMI correlated with total adipose tissue (correlation coefficient = 0.667, P < 0.001), but not with VAT% (P = 0.495). Viscerally obese patients tended to be old and post-menopausal (P < 0.001; P = 0.003). Nodal metastasis and extrauterine disease were more commonly reported in patients with high VAT% (6.0 % vs. 16.0 %, P = 0.024; 9.0 % vs. 19.0 %, P = 0.042, respectively). Univariate and multivariate logistic regressions were performed to discern the contribution of variable factors on the lymph node metastasis. Grade (HR = 15.41, 95 % CI = 1.60–148.76; P = 0.018), lympho-vascular invasion (HR = 449.61, 95 % CI = 31.27–6463.93; P < 0.001) and high VAT% (HR = 6.37, 95 % CI = 1.42–28.69; P = 0.016) retained statistical significance for predicting lymph node metastasis. Conclusions Viscerally obese patients were more likely to be old and have positive lymph node as well as extrauterine disease. Grade, lympho-vascular invasion presence and visceral adiposity were predictors of nodal disease.
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Affiliation(s)
- Shuang Ye
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, No 270 Dong-an Road, Xuhui District, 200032, Shanghai, China
| | - Hao Wen
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, No 270 Dong-an Road, Xuhui District, 200032, Shanghai, China
| | - Zhaoxia Jiang
- Department of Oncology, Shanghai Medical College, Fudan University, No 270 Dong-an Road, Xuhui District, 200032, Shanghai, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaohua Wu
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No 270 Dong-an Road, Xuhui District, 200032, Shanghai, China.
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Myriokefalitaki E, Vorgias G, Vlahos G, Rodolakis A. Prognostic value of preoperative Ca125 and Tag72 serum levels and their correlation to disease relapse and survival in endometrial cancer. Arch Gynecol Obstet 2015; 292:647-54. [DOI: 10.1007/s00404-015-3675-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
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Rathod PS, Shakuntala PN, Pallavi VR, Kundaragi R, Shankaranand B, Vijay CR, Devi KU, Bafna UD. The risk and pattern of pelvic and para aortic lymph nodal metastasis in patients with intermediate and high risk endometrial cancer. Indian J Surg Oncol 2014; 5:109-14. [PMID: 25114462 DOI: 10.1007/s13193-014-0303-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 03/10/2014] [Indexed: 11/28/2022] Open
Abstract
There is a continuous debate about the extent and prognostic value of retroperitoneal lymphadenectomy in endometrial cancer. Systematic pelvic and para-aortic lymphadenectomy in endometrial cancer provides a more accurate assessment of neoplastic spread and may help in better individualization of patients for adjuvant therapy. To evaluate the risk and pattern of retroperitoneal lymph nodes metastasis in patients with endometrial cancers having intermediate and high risk factors for nodal metastasis and recurrence. We conducted a prospective nonrandomized study of 62 cases of high risk endometrial cancers examined and treated at our regional cancer institute between the years 2008 and 2012. The inclusion criteria: The intermediate risk; all patients having grade 3 or undifferentiated adenocarcinomas with less than half MI and the grade 1, 2 tumors having more than half MI with tumor size >2 cm. The high risk group; all the patients having grade 3 or undifferentiated adenocarcinomas with more than half MI, the grade 1, 2 tumors with lymph vascular space invasion (LVSI) or cervical stromal invasion as depicted by pre-operative MRI. The type 2 histology uterine papillary serous, clear cell and squamous cell carcinomas. The patients staging was carried out according to the classification established by the FIGO for endometrial cancer in 2009. The Chi-square test was used to analyze the correlation between tumor grade, myometrial invasion, size of the lesion and lymph nodes metastasis and Fisher's correction done whenever the frequency distribution was less than five. The patients mean age was 58.3 (range 31 to 76 years). A total of 118 endometrial cancer patients were treated during the study period. The 56 (47.5 %) patients belonged to low risk and 62 (52.5 %) patients belonged to high risk endometrial cancers. The 52 of 62 cases were eligible for the analysis. The 10 patients' were excluded from further analysis as the post operative specimens final histopathologic examinations in nine cases revealed carcinosarcoma uterus and one case with yolk sac tumor of endometrium. The total 17(32.7 %) of 52 cases had retroperitoneal nodes metastasis; nine of 17 (52.9 %) in this group had both pelvic and para-aortic lymph nodal metastasis and one of 17 (5.9 %) had isolated para-aortic lymph nodal metastasis. The high grade tumors (grade 3) revealed 41.4 % pelvic and 20.7 % para-aortic lymph nodes metastasis and there was statistically significant higher nodal metastasis in both pelvic and para-aortic lymph nodes with increasing depth of myometrial invasion (P = 0.0119 and P = 0.0001) and increasing size of the lesion. (P = 0.04 and P = 0.0501). The intermediate and high risk endometrial cancer is associated with greater degree of lymph node metastasis. A complete surgical staging which involves extrafascial hysterectomy or a type 3 radical hysterectomy when there is a cervical involvement, along with bilateral salphingo-oophorectomy, pelvic, para-aortic lymphadenectomy and an omentectomy when indicated as in the present study, is a valuable modality of treatment in intermediate and high risk cases of endometrial cancers for determining the prognosis and appropriate categorization of these women for adjuvant therapy. It is also possible to achieve a complete surgical staging in these groups of women with acceptable morbidity when performed by a trained gynaecologic oncologist.
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Affiliation(s)
- Praveen S Rathod
- Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, No.5, Type AB, Block-1, Dr M H Marigowd Road, Bangalore, India 560029
| | - P N Shakuntala
- Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, No.5, Type AB, Block-1, Dr M H Marigowd Road, Bangalore, India 560029
| | - V R Pallavi
- Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, No.5, Type AB, Block-1, Dr M H Marigowd Road, Bangalore, India 560029
| | - Rajashekar Kundaragi
- Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, No.5, Type AB, Block-1, Dr M H Marigowd Road, Bangalore, India 560029
| | - B Shankaranand
- Department of Pathology, Kidwai Memorial Institute of Oncology, Dr M H Marigowd Road, Bangalore, India
| | - C R Vijay
- Department of Biostatistics, Kidwai Memorial Institute of Oncology, Dr M H Marigowd Road, Bangalore, India
| | - K Uma Devi
- Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, No.5, Type AB, Block-1, Dr M H Marigowd Road, Bangalore, India 560029
| | - Uttam D Bafna
- Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, No.5, Type AB, Block-1, Dr M H Marigowd Road, Bangalore, India 560029
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Predictive value of preoperative serum CA-125 levels in patients with uterine cancer: The Asian experience 2000 to 2012. Obstet Gynecol Sci 2013; 56:281-8. [PMID: 24328017 PMCID: PMC3784131 DOI: 10.5468/ogs.2013.56.5.281] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/04/2013] [Accepted: 06/04/2013] [Indexed: 01/09/2023] Open
Abstract
Objective Much of the early investigative work on the usefulness of preoperative serum CA-125 levels in identifying patients with early-stage endometrial carcinoma who have occult metastases were carried out in Europe and the United States. This article reviews CA-125 as a possible index for determining the need for full surgical staging, from the results of large medical centers in Asia, particularly Taiwan and Korea. Methods A Medline search was performed using CA-125 and endometrial cancer as index words from 1981 to 2012. Those publications felt to be the most important especially from institutions from Asia since 2000 were identified in this review. Results Most articles that analyzed the utility of serum CA-125 levels as predictive marker for disease extent or prognosis in uterine cancer used univariate and multivariable logistic regression analysis, and performed receiver operative curves to find the best cut-off values. The main factor of interest was whether clinicians can stratify patients that need lymphadenectomy in early stage disease. Suggested optimal cut-off value ranged from 20 to 210 U/mL. Not only preoperative CA-125 level, but myometrial invasion status by magnetic resonance imaging was the most significant combined parameter for predicting disease extent. Conclusion Elevated CA-125 in patients with apparent early-stage disease is clearly a risk factor for the presence of extra-uterine disease although the optimal cut-off levels vary. The evolution of clinical investigations over the past decade, particularly in Asia, suggests employment of the test in a more focused manner to identify high risk patients preoperatively.
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Zhang H, Zuo Z, Wang Y, Wang L, Zhu Z. A cohort study evaluating paraaortic lymphadenectomy in endometrial cancer. Oncol Lett 2012. [PMID: 23205136 DOI: 10.3892/ol.2012.919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The current study sought to assess the role of paraaortic lymphadenectomy (LNE) in females with endometrial cancer. A retrospective analysis of patients diagnosed with endometrial cancer of stage IA to II preoperatively, between 2009 and 2011 was conducted. Patients were included who had suffered from endometrial cancer without preoperative adjuvant therapy and who underwent hysterectomy plus systematic pelvic LNE and paraaortic LNE by laparoscopy or laparotomy. A total of 54 patients who underwent surgery for preoperative endometrial cancer were selected. All patients underwent LNE. The incidences of pelvic and paraaortic lymph node metastases were 11.1% (6/54) and 7.4% (4/54), with a total positive lymph node rate of 14.8% (8/54). In addition, among the 8 positive cases, 5 patients underwent laparotomy and 3 underwent laparoscopy; 3 cases were classified as stage I and 5 as stage II preoperatively. Of these, 7 patients were identified with pathology-related risk factors, including low differentiation or clear cell adenocarcinoma postoperatively. Discordance of pathological differentiation between the pre- and postoperative stages reached 57.1% (4/7). The results revealed the high occurrence of positive lymph nodes in endometrial cancer which demonstrate the importance of systematic LNE. Additonally, no severe complications were caused by LNE besides lymph cysts. In summary, it is neccesary to perform LNE, particularly the removal of the paraaortic lymph node, in patients with endometrial cancers in order to improve postoperative therapy. Laparoscopy has similar surgical effects as laparotomy, but has a number of advantages.
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Affiliation(s)
- Haiyan Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, P.R. China
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