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Shin W, Yang SJ, Park SY, Kang S, Lee DO, Lim MC, Seo SS. A predictive model based on site-specific risk factors of recurrence regions in endometrial cancer patients. BMC Cancer 2022; 22:1111. [PMID: 36316771 PMCID: PMC9620664 DOI: 10.1186/s12885-022-10193-3] [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: 04/18/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Objective This study investigated site-specific differences in clinical factors for recurrence in patients who were newly diagnosed and treated for endometrial cancer. A model for predicting recurrence sites was generated. Methods Electronic medical records’ data were retrieved from January 2006 to December 2018 for patients who were diagnosed with endometrial cancer at the National cancer center in Korea. Recurrence sites were classified as local, regional, or distant. We used multinomial logistic regression models that modeled the log-odds for the three recurrence sites relative to non-recurrence as a linear combination of possible risk factors for the recurrence of endometrial cancer. Results The data of 611 patients were selected for analysis; there were 20, 12, and 25 cases of local, regional, and distant recurrence, respectively, and 554 patients had no recurrence. High-grade disease was associated with local recurrence; non-endometrioid histology and parametrial invasion were risk factors for regional recurrence; additionally, parametrial invasion and no lymphadenectomy were associated with distant metastasis. Conclusion We identified different risk factors specific for each type of recurrence site. Using these risk factors, we suggest that individually tailored adjuvant treatments be introduced for patients.
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Affiliation(s)
- Wonkyo Shin
- grid.410914.90000 0004 0628 9810Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea ,grid.254230.20000 0001 0722 6377Department of Obstetrics & Gynecology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Seong J. Yang
- grid.411545.00000 0004 0470 4320Department of Statistics (Institute of Applied Statistics), Jeonbuk National University, Jeonju, Republic of Korea
| | - Sang-Yoon Park
- grid.410914.90000 0004 0628 9810Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sokbom Kang
- grid.410914.90000 0004 0628 9810Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Dong Ock Lee
- grid.410914.90000 0004 0628 9810Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Myong Cheol Lim
- grid.410914.90000 0004 0628 9810Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Soo Seo
- grid.410914.90000 0004 0628 9810Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea ,grid.410914.90000 0004 0628 9810National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, 10408 Goyang-si Gyeonggi-do, Republic of Korea
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Nasioudis D, Mastroyannis SA, Ko EM, Haggerty AF, Cory L, Giuntoli RL, Kim SH, Latif NA. Safety of ovarian preservation for premenopausal patients with FIGO stage I grade 2 and 3 endometrioid endometrial adenocarcinoma. Int J Gynecol Cancer 2022; 32:ijgc-2022-003450. [PMID: 35882426 DOI: 10.1136/ijgc-2022-003450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the utilization and outcomes of ovarian preservation for premenopausal patients with International Federation of Gynecology and Obstetrics (FIGO) stage I grade 2 and 3 endometrioid endometrial carcinoma undergoing hysterectomy. METHODS The National Cancer Database was accessed; patients aged ≤45 years diagnosed between January 2004 and December 2015 with FIGO stage I grade 2 or 3 endometrioid endometrial carcinoma, who underwent hysterectomy with or without bilateral salpingo-oophorectomy and had at least 1 month of follow-up, were identified. Overall survival was assessed following generation of Kaplan-Meier curves and compared with the log-rank test. A Cox model was constructed to control for a priori selected variables. RESULTS A total of 2941 patients who met the inclusion criteria were identified; 200 (6.8%) patients did not undergo bilateral salpingo-oophorectomy. Rate of ovarian preservation was comparable between patients with grade 2 (n=163, 6.6%) and grade 3 (n=37, 7.7%) tumors (p=0.38). Patients who did not undergo bilateral salpingo-oophorectomy were younger (median 39 vs 41 years, p<0.001) and less likely to undergo surgical lymph node assessment (52% vs 76.2%, p<0.001). There was no difference in overall survival between patients who did and did not undergo bilateral salpingo-oophorectomy (p=0.94); 5 year overall survival rates were 96.6% and 97%, respectively. After controlling for confounders, including tumor grade, ovarian preservation was not associated with worse overall survival (HR 0.92, 95% CI 0.47 to 1.84). CONCLUSIONS For patients with grade 2 and 3 FIGO stage I endometrioid carcinoma undergoing hysterectomy, ovarian preservation is rarely performed while no clear detrimental effect on overall survival was found.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Spyridon A Mastroyannis
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashley F Haggerty
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lori Cory
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert L Giuntoli
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah H Kim
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nawar A Latif
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Akgor U, Ayhan A, Shushkevich A, Ozdal B, Angelou K, Akbayır O, Kaidarova D, Ulrikh E, Stepanyan A, Ortac F, Aliyev S, Ozgul N, Taranenka S, Haberal A, Salman C, Seyhan A, Selcuk I, Haidopoulos D, Akıllı H, Bolatbekova R, Alaverdyan A, Taskin S, Murshudova S, Batur M, Berlev I, Gultekin M. OPEC study: An international multicenter study of ovarian preservation in endometrial cancers. Int J Gynaecol Obstet 2022; 159:550-556. [PMID: 35323994 DOI: 10.1002/ijgo.14190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/17/2022] [Accepted: 03/16/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the feasibility and oncological safety of ovarian preservation in early stage endometrial adenocarcinoma (EC) patients aged 40 and below. METHODS A total of 11 institutions from eight countries participated in the study. 169 of 5898 patients aged ≤40 years were eligible for the study. Patients with EC treated between March 2007 and January 2019 were retrospectively assessed. RESULTS The median duration of follow-up after EC diagnosis was 59 months (4-187). Among 169 participants, ovarian preservation surgery (OPS) was performed in 54 (31.9%), and BSO was performed in 115 (68.1%) patients. Although patients younger than 30 years of age were more likely to have OPS than patients aged 30 to 40 years (20.4% vs. 9.6%, P = 0.021), there was no significant difference by the mean age. There were no other relevant baseline differences between OPS and BSO groups. The Kaplan-Meier analysis revealed no difference in either the overall survival (P = 0.955) or recurrence-free survival (P = 0.068) among patients who underwent OPS, and BSO. CONCLUSION OPS appears to be safe without having any adverse impact on survival in women aged ≤40 years with FIGO Stage I EC.
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Affiliation(s)
- Utku Akgor
- 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
| | - Alexander Shushkevich
- Department of Gynecologic Oncology, N.N. Alexandrov Cancer Center of Belarus, Minsk, Belarus
| | - Bulent Ozdal
- Department of Gynecologic Oncology, Ankara, Turkey
| | - Kyveli Angelou
- Gynecologic Oncology Unit, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, University of Athens, Athens, Greece
| | - Ozgur Akbayır
- Department of Gynecologic Oncology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Dilyara Kaidarova
- Oncogynecology Center, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Elena Ulrikh
- North-Western State Medical University, N.N. Petrov Research Institute of Oncology, Saint-Petersburg, Russian Federation
| | - Artem Stepanyan
- Department of Gynecologic Oncology, NAIRI Medical Center, Yerevan, Armenia
| | - Fırat Ortac
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, School of Medicine, Ankara University, Ankara, Turkey
| | | | - Nejat Ozgul
- Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Siarhei Taranenka
- Department of Gynecologic Oncology, N.N. Alexandrov Cancer Center of Belarus, Minsk, Belarus
| | - Ali Haberal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Coskun Salman
- Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alper Seyhan
- Department of Gynecologic Oncology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Ilker Selcuk
- Department of Gynecologic Oncology, Ankara, Turkey
| | - Dimitrios Haidopoulos
- Gynecologic Oncology Unit, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, University of Athens, Athens, Greece
| | - Huseyin Akıllı
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Raikhan Bolatbekova
- Oncogynecology Center, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Areg Alaverdyan
- Department of Gynecologic Oncology, NAIRI Medical Center, Yerevan, Armenia
| | - Salih Taskin
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, School of Medicine, Ankara University, Ankara, Turkey
| | | | - Meltem Batur
- Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Igor Berlev
- North-Western State Medical University, N.N. Petrov Research Institute of Oncology, Saint-Petersburg, Russian Federation
| | - Murat Gultekin
- Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Liu X, Wu Y, Liu P, Zhang X. Developing a validated nomogram for predicting ovarian metastasis in endometrial cancer patients: a retrospective research. Arch Gynecol Obstet 2021; 305:719-729. [PMID: 34495379 DOI: 10.1007/s00404-021-06214-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore risk factors and develop a prediction model for ovarian metastasis in endometrial cancer (EC), as well as providing provide a reference for clinical ovarian preservation. METHODS We conducted a retrospective observational study enrolling 1496 EC patients having received complete staging surgery from Qilu Hospital of Shandong University from 2012 to 2018. These patients were randomly divided into two cohorts: training cohort (n = 1046) and validation cohort (n = 448). A nomogram prediction model was developed based on univariate, least absolute shrinkage and selection operator (Lasso), and multivariate logistic regression. Then, the nomogram model's performance was evaluated in discrimination, calibration, and clinical utility three aspects. RESULTS Parametrium invasion, lymph node metastasis, and oviduct metastasis were finally contained in the nomogram prediction model. The AUC of the model in the training cohort was 0.85 compared with 0.72 in the validation cohort. It also behaved well in calibration and had good clinical utility. With a threshold probability of 20% ~ 80%, the nomogram increased the net benefit by 0 ~ 13.6 per 100 patients than surgery for all patients upon validation. CONCLUSIONS We develop a nomogram with good performances for predicting ovarian metastasis in EC patients, which may help clinicians identify candidate patients appropriate for ovarian preservation in premenopausal EC patients.
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Affiliation(s)
- Xiaodie Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100029, China
| | - Yaohai Wu
- Department of Urology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,Department of Urology, Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, People's Republic of China
| | - Peishu Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
| | - Xiaolei Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
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