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Śniadecki M, Guani B, Jaworek P, Klasa-Mazurkiewicz D, Mahiou K, Mosakowska K, Buda A, Poniewierza P, Piątek O, Crestani A, Stasiak M, Balaya V, Musielak O, Piłat L, Maliszewska K, Aristei C, Guzik P, Wojtylak S, Liro M, Gaillard T, Kocian R, Gołąbiewska A, Chmielewska Z, Wydra D. Tertiary prevention strategies for micrometastatic lymph node cervical cancer: A systematic review and a prototype of an adapted model of care. Crit Rev Oncol Hematol 2024; 197:104329. [PMID: 38527594 DOI: 10.1016/j.critrevonc.2024.104329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
PURPOSE We found a need for balancing the application of clinical guidelines and tailored approaches to follow-up of cervical cancer (CC) patients in the lymph node micrometastatic (MICs) setting. This review aimed to determine the current knowledge of management of MIC-positive CC cases. METHODOLOGY We addressed prognostic and risk of recurrence monitoring impacts associated with MIC+ cases. The electronic databases for literature and relevant articles were analysed. RESULTS Fifteen studies, (4882 patients), were included in our systematic review. While the results show that MICs significantly worsen prognosis in early CC. A tertiary prevention algorithm for low volume lymph node disease may stratify follow-up according to the burden of nodal disease and provide data that helps improve follow-up performance. CONCLUSION MICs worsen prognosis and should be managed as suggested by the algorithm. However, this algorithm must be externally validated. The clinical impact of isolated tumor cells (ITC) remains unclear.
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Affiliation(s)
- Marcin Śniadecki
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland.
| | - Benedetta Guani
- Hospital of Fribourg HFR, Chemin des Pensionnats 2/6, Villars-sur-Glâne 1752, Switzerland
| | - Paulina Jaworek
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Katia Mahiou
- Breast, Gynaecology and Reconstructive Surgery Unit, Institute Curie, Paris, France
| | - Karolina Mosakowska
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Alessandro Buda
- Department of Gynaecology Oncology, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | | | - Olga Piątek
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Adrien Crestani
- Department of Gynaecological Surgery, Hospital Tenon, Paris, France
| | - Maria Stasiak
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Vincent Balaya
- Department of Obstetrics and Gynaecology, Félix Guyon Hospital, CHU La Réunion, La Reunion Island, France
| | - Oliwia Musielak
- Department of Surgical Oncology, Transplant and General Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Luiza Piłat
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Karolina Maliszewska
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Sant'Andrea delle Fratte, Perugia, Italy
| | - Paweł Guzik
- Clinical Department of Gynaecology and Obstetrics, City Hospital Rzeszów, Rzeszów, Poland
| | - Szymon Wojtylak
- Department of Pathology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Liro
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Thomas Gaillard
- Department of Surgery, Institute Curie, University Paris Cite, Paris, France
| | - Roman Kocian
- Department of Gynaecology, Obstetrics and Neonatology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anna Gołąbiewska
- Department of Environmental Technology, Faculty of Chemistry, University of Gdańsk, Gdańsk, Poland
| | - Zuzanna Chmielewska
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Dariusz Wydra
- Department of Gynaecology and Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
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Bizzarri N, Obermair A, Hsu HC, Chacon E, Collins A, Tsibulak I, Mutombo A, Abu-Rustum NR, Balaya V, Buda A, Cibula D, Covens A, Fanfani F, Ferron G, Frumovitz M, Guani B, Kocian R, Kohler C, Leblanc E, Lecuru F, Leitao MM, Mathevet P, Mueller MD, Papadia A, Pareja R, Plante M, Querleu D, Scambia G, Tanner E, Zapardiel I, Garcia JR, Ramirez PT. Consensus on surgical technique for sentinel lymph node dissection in cervical cancer. Int J Gynecol Cancer 2024; 34:504-509. [PMID: 38378695 DOI: 10.1136/ijgc-2023-005151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE The purpose of this study was to establish a consensus on the surgical technique for sentinel lymph node (SLN) dissection in cervical cancer. METHODS A 26 question survey was emailed to international expert gynecological oncology surgeons. A two-step modified Delphi method was used to establish consensus. After a first round of online survey, the questions were amended and a second round, along with semistructured interviews was performed. Consensus was defined using a 70% cut-off for agreement. RESULTS Twenty-five of 38 (65.8%) experts responded to the first and second rounds of the online survey. Agreement ≥70% was reached for 13 (50.0%) questions in the first round and for 15 (57.7%) in the final round. Consensus agreement identified 15 recommended, three optional, and five not recommended steps. Experts agreed on the following recommended procedures: use of indocyanine green as a tracer; superficial (with or without deep) injection at 3 and 9 o'clock; injection at the margins of uninvolved mucosa avoiding vaginal fornices; grasping the cervix with forceps only in part of the cervix is free of tumor; use of a minimally invasive approach for SLN biopsy in the case of simple trachelectomy/conization; identification of the ureter, obliterated umbilical artery, and external iliac vessels before SLN excision; commencing the dissection at the level of the uterine artery and continuing laterally; and completing dissection in one hemi-pelvis before proceeding to the contralateral side. Consensus was also reached in recommending against injection at 6 and 12 o'clock, and injection directly into the tumor in cases of the tumor completely replacing the cervix; against removal of nodes through port without protective maneuvers; absence of an ultrastaging protocol; and against modifying tracer concentration at the time of re-injection after mapping failure. CONCLUSION Recommended, optional, and not recommended steps of SLN dissection in cervical cancer have been identified based on consensus among international experts. These represent a surgical guide that may be used by surgeons in clinical trials and for quality assurance in routine practice.
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Affiliation(s)
- Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Heng-Cheng Hsu
- Obstetrics and Gynaecology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Enrique Chacon
- Gynaecologic Oncology, Universidad de Navarra, Pamplona, Spain
| | - Anna Collins
- Obstetrics and Gynaecology, Derby Hospitals NHS Foundation Trust, Derby, UK
| | - Irina Tsibulak
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alex Mutombo
- Gynaecology and Obstetrics, University of Kinshasa, Kinshasa, Congo (Democratic Republic of the)
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Vincent Balaya
- Department of Obstetrics and Gynaecology, Felix Guyon Hospital, CHU Nord Réunion, France
| | - Alessandro Buda
- Gynaecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - David Cibula
- Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Allan Covens
- Gynecologic Oncology, Toronto Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gwenaël Ferron
- Department of Surgical Oncology, Institut Claudius Regaud Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Benedetta Guani
- Department of Obstetrics and Gynaecology, Fribourg Hospitals, Fribourg, Switzerland
| | - Roman Kocian
- Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Christhardt Kohler
- Department of Gynaecology, University of Cologne, Koln, Germany
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg-Altona, Asklepios Hospital Group, Hamburg, Germany
| | - Eric Leblanc
- Department of Surgical Oncology, Centre Oscar Lambret, Lille, France
| | - Fabrice Lecuru
- Breast, Gynaecology, and Reconstructive Surgery Unit, Institute Curie, Paris, France
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Patrice Mathevet
- Centre Hospitalier Universitaire Vaudois Departement de gynecologie-obstetrique et genetique medicale, Lausanne, Switzerland
| | - Michael D Mueller
- Gynaecology and Gynaecological Oncology, Inselspital University Hospital Berne Department of Gynaecology, Bern, Switzerland
| | - Andrea Papadia
- Department of Gynaecology and Obstetrics, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Università della Svizzera italiana, Lugano, Switzerland
| | - Rene Pareja
- Department of Gynaecology, Gynaecologic Oncology, Clinica Astorga, Medellin, Colombia
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Denis Querleu
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Edward Tanner
- Department of Obstetrics and Gynecology, Northwestern University, Evanston, Illinois, USA
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Jaime R Garcia
- Department of Academic Analytics and Technology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pedro T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
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Mauro J, Raimondo D, Di Martino G, Gasparri ML, Restaino S, Neola D, Clivio L, Calidona C, Fruscio R, Vizzielli G, Uccella S, Papadia A, Seracchioli R, Buda A. Assessment of sentinel Lymph node mapping with different volumes of Indocyanine green in early-stage ENdometrial cancer: the ALIEN study. Int J Gynecol Cancer 2024:ijgc-2023-005100. [PMID: 38336372 DOI: 10.1136/ijgc-2023-005100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE To evaluate the impact of different volumes of indocyanine green (ICG) on the detection rate and bilateral mapping of sentinel lymph nodes in patients with apparent uterine-confined endometrial cancer. METHODS All patients who underwent surgical staging with sentinel node mapping in six reference centers were included. Two different protocols of ICG intracervical injection were used: (1) 2 mL group: total volume of 2 mL injected superficially; (2) 4 mL group: total volume of 4 mL, 2 mL deeply and 2 mL superficially. Logistic regression was used to analyze factors that could influence dye migration and detection rates. A sensitivity analysis was carried out to determine how independent variables could affect the sentinel node detection rate. RESULTS Of 442 eligible patients, 352 were analyzed (172 in the 2 mL group and 180 in the 4 mL group). The bilateral detection rates of the 2 mL and 4 mL groups were 84.9% and 86.1%, respectively (p=0.76). The overall detection rate was higher with a volume of 4 mL than with 2 mL (97.8% vs 92.4%, respectively; p=0.024). In the univariate analysis the rate of bilateral mapping fell from 87.5% to 73.5% when the International Federation of Gynecology and Obstetrics (FIGO) 2009 tumor stage was >IB (p=0.018). In the multivariate analysis, for both overall and bilateral detection rates a statistically significant difference emerged for the volume of ICG injected and FIGO 2009 stage >IB. Increasing body mass index was associated with worse overall detection rates on univariate analysis (p=0.0006), and significantly decreased from 97% to 91% when the body mass index exceeded 30 kg/m2 (p=0.05). CONCLUSIONS In patients with early-stage endometrial cancer, a volume of 2 mL ICG does not seem to compromise the bilateral detection of sentinel lymph nodes. In women with obesity and FIGO 2009 stage >IB, a 4 mL injection should be preferred.
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Affiliation(s)
- Jessica Mauro
- Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giampaolo Di Martino
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, University of Milano-Bicocca, Monza, Italy
| | - Maria Luisa Gasparri
- Department of Gynecology and Obstetrics, Faculty of Biomedical Science Università della Svizzera Italiana, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Stefano Restaino
- Clinic of Obstetrics and Gynecology, University of Udine, Ospedale Santa Maria della Misericordia, Udine, Italy
| | - Daniele Neola
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Clivio
- Unit of Analytics, Research & Communication - Area ICT, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Carmelo Calidona
- Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, University of Udine, Ospedale Santa Maria della Misericordia, Udine, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Faculty of Biomedical Science Università della Svizzera Italiana, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Alessandro Buda
- Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
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Mauro J, Borghi C, Surace A, Buda A. Laparoscopic ovarian sentinel lymph node mapping using indocyanine green for ovarian restaging purpose. Int J Gynecol Cancer 2024:ijgc-2023-004908. [PMID: 38242548 DOI: 10.1136/ijgc-2023-004908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Affiliation(s)
- Jessica Mauro
- Department of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Chiara Borghi
- Department of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Alessandro Surace
- Department of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Alessandro Buda
- Department of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
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Borghi C, Biagioli E, Mauro J, Roberto A, Borghese M, Buda A. Neoadjuvant chemotherapy prior to radical hysterectomy in locally advanced cervical cancer: a systematic review and meta-analysis. Int J Gynecol Cancer 2023:ijgc-2023-004863. [PMID: 38011989 DOI: 10.1136/ijgc-2023-004863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE The objective of this systematic review was to evaluate the effect of different types of neoadjuvant chemotherapy regimens, in terms of optimal pathological response and oncological outcomes, in patients with locally advanced cervical cancer. METHODS A systematic search of the literature was performed. MEDLINE through PubMed and Embase databases were searched from inception to June 2023. The study was registered in PROSPERO (ID number CRD42023389806). All women with a pathological diagnosis of locally advanced cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009 classification stages IB2-IVA), any age or histology, who underwent intravenous neoadjuvant chemotherapy before radical surgery, and articles only in English language, were included. We conducted a meta-analysis for optimal pathological response after surgery and survival outcomes. The risk of bias was assessed using the Newcastle-Ottawa scale and the Risk of Bias 2 (RoB) tools. The review methods and results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS 25 studies with a total number of 1984 patients fulfilled the eligibility criteria of our review and were included for data extraction and efficacy analysis. When compared with a two-drug regimen, the three-drug combination including cisplatin, paclitaxel, and ifosfamide or anthracyclines showed superior efficacy in terms of optimal pathological response with an odds ratio of 0.38 (95% CI 0.24 to 0.61, p<0.0001), with no difference in disease-free survival (hazard ratio (HR) 0.72, 95% CI 0.50 to 1.03, I2=0%, p=0.07) and higher overall survival (HR 0.63, 95% CI 0.41 to 0.97, I2=0%, p=0.03). CONCLUSIONS The three-drug combination of cisplatin, paclitaxel, and ifosfamide or anthracyclines showed a higher rate of complete or optimal partial response, with the triple regimens having an advantage over the platinum-based schedules in terms of overall survival. Neoadjuvant chemotherapy followed by radical surgery should not be considered a standard of care in locally advanced cervical cancer.
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Affiliation(s)
- Chiara Borghi
- Division of Gynecology Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Piedmont, Italy
| | - Elena Biagioli
- Research, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Jessica Mauro
- Division of Gynecology Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Piedmont, Italy
- University of Udine, Udine, Italy
| | - Anna Roberto
- Research, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Martina Borghese
- Division of Obstetrics and Gynecology, Ospedale Santa Croce, Cuneo, Piemonte, Italy
| | - Alessandro Buda
- Division of Gynecology Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Piedmont, Italy
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Bruno V, Betti M, D'Ambrosio L, Massacci A, Chiofalo B, Pietropolli A, Piaggio G, Ciliberto G, Nisticò P, Pallocca M, Buda A, Vizza E. Machine learning endometrial cancer risk prediction model: integrating guidelines of European Society for Medical Oncology with the tumor immune framework. Int J Gynecol Cancer 2023; 33:1708-1714. [PMID: 37875322 PMCID: PMC10646888 DOI: 10.1136/ijgc-2023-004671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/31/2023] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE Current prognostic factors for endometrial cancer are not sufficient to predict recurrence in early stages. Treatment choices are based on the prognostic factors included in the risk classes defined by the ESMO-ESGO-ESTRO (European Society for Medical Oncology-European Society of Gynaecological Oncology-European Society for Radiotherapy and Oncology) consensus conference with the new biomolecular classification based on POLE, TP53, and microsatellite instability status. However, a minority of early stage cases relapse regardless of their low risk profiles. Integration of the immune context status to existing molecular based models has not been fully evaluated. This study aims to investigate whether the integration of the immune landscape in the tumor microenvironment could improve clinical risk prediction models and allow better profiling of early stages. METHODS Leveraging the potential of in silico deconvolution tools, we estimated the relative abundances of immune populations in public data and then applied feature selection methods to generate a machine learning based model for disease free survival probability prediction. RESULTS We included information on International Federation of Gynecology and Obstetrics (FIGO) stage, tumor mutational burden, microsatellite instability, POLEmut status, interferon γ signature, and relative abundances of monocytes, natural killer cells, and CD4+T cells to build a relapse prediction model and obtained a balanced accuracy of 69%. We further identified two novel early stage profiles that undergo different pathways of recurrence. CONCLUSION This study presents an extension of current prognostic factors for endometrial cancer by exploiting machine learning models and deconvolution techniques on available public biomolecular data. Prospective clinical trials are advisable to validate the early stage stratification.
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Affiliation(s)
- Valentina Bruno
- Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Alice Massacci
- IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Benito Chiofalo
- Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Adalgisa Pietropolli
- Section of Ginecology and Obstetrics, Department of Surgical Sciences, University of Rome Tor Vergata, Roma, Italy
| | - Giulia Piaggio
- IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Paola Nisticò
- IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Alessandro Buda
- Division of Gynecologic Oncology, Michele and Pietro Ferrero Hospital, Verduno, Italy
| | - Enrico Vizza
- Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Mauro J, Filipello F, Tripodi E, Di Guardia G, Buda A. Serous endometrial cancer confined to a polyp with malignant pleural effusion. Int J Gynecol Cancer 2023; 33:1812-1818. [PMID: 37931974 DOI: 10.1136/ijgc-2023-004942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Affiliation(s)
- Jessica Mauro
- Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Cuneo, Italy
- University of Udine, Udine, Italy
| | - Federica Filipello
- Division of Pathology, Ospedale Michele e Pietro Ferrero, Verduno, Cuneo, Italy
| | - Elisa Tripodi
- Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Cuneo, Italy
| | - Giuseppe Di Guardia
- Division of Radiology, Ospedale Michele e Pietro Ferrero, Verduno, Cuneo, Italy
| | - Alessandro Buda
- Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Cuneo, Italy
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Buda A, Signorelli M, Papadia A. Correspondence on 'Long-term survival outcomes in high-risk endometrial cancer patients undergoing sentinel lymph node biopsy alone versus lymphadenectomy' by Capozzi et al. Int J Gynecol Cancer 2023; 33:1668-1669. [PMID: 37666525 PMCID: PMC10579495 DOI: 10.1136/ijgc-2023-004838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/06/2023] Open
Affiliation(s)
- Alessandro Buda
- Gynecologic Oncology Division, Michele and Pietro Ferrero Hospital, Verduno, Italy
| | - Mauro Signorelli
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Lugano, Switzerland
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Mauro J, Viveros-Carreño D, Vizzielli G, De Ponti E, Fanfani F, Ramirez PT, Buda A. Survival after sentinel node biopsy alone in early-stage cervical cancer: a systematic review. Int J Gynecol Cancer 2023; 33:1370-1375. [PMID: 37586759 DOI: 10.1136/ijgc-2023-004692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE To assess the oncologic outcomes of sentinel lymph node biopsy alone as part of surgical management in patients with early-stage cervical cancer. METHODS A systematic search of the literature was performed following the PRISMA checklist. MEDLINE (through PubMed), EMBASE, and Scopus databases were searched from June 1991 to May 2023. Studies of women with early-stage cervical cancer International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA-IIA, of any age or histology, and articles only in English language were included. After the removal of duplicates, only articles including sentinel node mapping alone compared with full pelvic lymphadenectomy were retained. RESULTS Four studies with a total of 2226 patients were included. Among these, 354 (15.9%) underwent sentinel lymph node biopsy alone. A total of 2210 (99.2%) patients had FIGO 2009 stage I disease and 1514 (68%) patients had squamous cell carcinoma. Median body mass index was 25.5 kg/m2 (range 23.5-27). Lymph vascular space invasion was present in 633 patients (34%) who underwent full lymphadenectomy and in 78 patients (22%) who underwent sentinel node biopsy alone. The results of the survival analysis showed that there was no significant difference in the 3-year progression-free survival rates of patients who underwent either sentinel biopsy alone or lymphadenectomy. Three-year recurrence-free survival was 93.1% (95% CI 28.3% to 64.7%) for patients who underwent sentinel node biopsy alone and 92.5% (95% CI 39.0% to 53.4%) for patients who underwent sentinel node biopsy and lymphadenectomy (p=0.773). CONCLUSIONS In patients with early-stage cervical cancer, performing sentinel lymph node biopsy alone compared with pelvic lymphadenectomy does not appear to independently confer a higher risk or recurrence.
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Affiliation(s)
- Jessica Mauro
- Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
- University of Udine, Udine, Italy
| | - David Viveros-Carreño
- Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia
- Gynecologic Oncology, Clínica Universitaria Colombia and Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo - CTIC, Bogotá, Colombia
| | - Giuseppe Vizzielli
- Obstetrics and Gynecology, University of Udine, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Elena De Ponti
- Department of Physical Medicine, San Gerardo Hospital, Monza, Italy
| | - Francesco Fanfani
- Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Pedro T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
| | - Alessandro Buda
- Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
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10
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Buda A, Fanfani F. The patterns of growth of cervical cancer: a challenge to personalized radical surgery. Int J Gynecol Cancer 2023:ijgc-2023-004556. [PMID: 37185140 DOI: 10.1136/ijgc-2023-004556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Affiliation(s)
- Alessandro Buda
- Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Fanfani
- Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
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11
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Buda A, Paniga C, Taskin S, Mueller M, Zapardiel I, Fanfani F, Puppo A, Casarin J, Papadia A, De Ponti E, Grassi T, Mauro J, Turan H, Vatansever D, Gungor M, Ortag F, Imboden S, Garcia-Pineda V, Mohr S, Siegenthaler F, Perotto S, Landoni F, Ghezzi F, Scambia G, Taskiran C, Fruscio R. The Risk of Recurrence in Endometrial Cancer Patients with Low-Volume Metastasis in the Sentinel Lymph Nodes: A Retrospective Multi-Institutional Study. Cancers (Basel) 2023; 15:cancers15072052. [PMID: 37046712 PMCID: PMC10093146 DOI: 10.3390/cancers15072052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
The aim of this study was to assess the impact of low-volume metastasis (LVM) on disease-free survival (DFS) in women with apparent early-stage endometrial cancer (EC) who underwent sentinel lymph node (SLN) mapping. Patients with pre-operative early-stage EC were retrospectively collected from an international collaboration including 13 referring institutions. A total of 1428 patients were included in this analysis. One hundred and eighty-six patients (13%) had lymph node involvement. Fifty-nine percent of positive SLN exhibited micrometastases, 26.9% micrometastases, and 14% isolated tumor cells. Seventeen patients with positive lymph nodes did not receive any adjuvant therapy. At a median follow-up of 33.3 months, the disease had recurred in 114 women (8%). Patients with micrometastases in the lymph nodes had a worse prognosis of disease-free survival compared to patients with negative nodes or LVM. The rate of recurrence was significantly higher for women with micrometastases than those with low-volume metastases (HR = 2.61; p = 0.01). The administration of adjuvant treatment in patients with LVM, without uterine risk factors, remains a matter of debate and requires further evaluation.
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Affiliation(s)
- Alessandro Buda
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
- Division of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, 12060 Verduno, Italy
| | - Cristiana Paniga
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
| | - Salih Taskin
- Department of Obstetrics and Gynecology, School of Medicine, Ankara University, 06620 Ankara, Turkey
| | - Michael Mueller
- Inselspital, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain
| | - Francesco Fanfani
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Women and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Puppo
- Department of Obstetrics and Gynecology, Ospedale Santa Croce e Carle, 12100 Cuneo, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, 21100 Varese, Italy
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, University of the Italian Switzerland, 6900 Lugano, Switzerland
| | - Elena De Ponti
- Medical Physics Department, Foundation IRCCS San Gerardo Hospital, 20900 Monza, Italy
| | - Tommaso Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
| | - Jessica Mauro
- Division of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, 12060 Verduno, Italy
| | - Hasan Turan
- Department of Obstetrics and Gynecology, İstanbul Training and Research Hospital, University of Health Sciences, 34766 İstanbul, Turkey
| | - Dogan Vatansever
- Department of Obstetrics and Gynecology, School of Medicine, Koc University, 34450 İstanbul, Turkey
| | - Mete Gungor
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem University, 34750 İstanbul, Turkey
| | - Firat Ortag
- Department of Obstetrics and Gynecology, School of Medicine, Ankara University, 06620 Ankara, Turkey
| | - Sara Imboden
- Inselspital, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | | | - Stefan Mohr
- Inselspital, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | | | - Stefania Perotto
- Division of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, 12060 Verduno, Italy
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, 21100 Varese, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Women and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, School of Medicine, Koc University, 34450 İstanbul, Turkey
| | - Robert Fruscio
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
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12
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Bogani G, Di Donato V, Papadia A, Buda A, Casarin J, Multinu F, Plotti F, Gasparri ML, Pinelli C, Perrone AM, Ferrero S, Sorbi F, Landoni F, Palaia I, Perniola G, De Iaco P, Cianci S, Alletti SG, Petrillo M, Vizzielli G, Fanfani F, Angioli R, Muzii L, Ghezzi F, Vizza E, Mueller MD, Scambia G, Panici PB, Raspagliesi F. Hysterectomy alone vs. hysterectomy plus sentinel node mapping in endometrial cancer: Perioperative and long-term results from a propensity-score based study. Eur J Surg Oncol 2023; 49:1037-1043. [PMID: 36801150 DOI: 10.1016/j.ejso.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/11/2023] [Accepted: 02/12/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To compare outcomes after hysterectomy and hysterectomy plus sentinel node mapping (SNM) in endometrial cancer (EC) patients. MATERIALS AND METHODS This is a retrospective study, collecting data of EC patients treated between 2006 and 2016 in nine referral centers. RESULTS The study population included 398 (69.5%) and 174 (30.5%) patients having hysterectomy and hysterectomy plus SNM. As the results of the adoption of a propensity-score matched analysis, we selected two homogeneous cohort of patients (150 having hysterectomy only vs. 150 having hysterectomy plus SNM). The SNM group had a longer operative time, but did not correlate with length of hospital stay and estimated blood loss. Overall severe complication rates were similar between groups (0.7% in the hysterectomy group vs. 1.3% in the hysterectomy plus SNM group; p = 0.561). No lymphatic-specific complication occurred. Overall, 12.6% of patients having SNM were diagnosed with disease harboring in their lymph nodes. Adjuvant therapy administration rate was similar between groups. Considering patients having SNM, 4% of patients received adjuvant therapy on the basis of nodal status alone; all the other patients received adjuvant therapy also on the basis of uterine risk factors. Five-year disease-free (p = 0.720) and overall (p = 0.632) survival was not influenced by surgical approach. CONCLUSIONS Hysterectomy (with or without SNM) is a safe and effective method for managing EC patients. Potentially, these data support the omission of side specific lymphadenectomy in case of unsuccessful mapping. Further evidence is warranted in to confirm the role SNM in the era of molecular/genomic profiling.
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Affiliation(s)
- Giorgio Bogani
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy.
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland
| | - Alessandro Buda
- Division of Gynecologic Oncology, Michele e Pietro Ferrero Hospital, 12060, Verduno, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Francesco Multinu
- Division of Gynecologic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Plotti
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Anna Myriam Perrone
- Department of Obstetrics and Gynecology Sant'Orsola Malpighi University Hospital University of Bologna, 40138, Bologna, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Flavia Sorbi
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Fabio Landoni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Giorgia Perniola
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Pierandrea De Iaco
- Department of Obstetrics and Gynecology Sant'Orsola Malpighi University Hospital University of Bologna, 40138, Bologna, Italy
| | - Stefano Cianci
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Rome, Italy
| | - Salvatore Gueli Alletti
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Rome, Italy
| | - Marco Petrillo
- Department of Obstetrics and Gynaecology, University of Cagliari, Cagliari, Sardegna, Italy
| | - Giuseppe Vizzielli
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Francesco Fanfani
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS "Regina Elena" National Cancer Institute, 00144, Rome, Italy
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Giovanni Scambia
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Rome, Italy
| | | | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
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13
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Restaino S, Paglietti C, Arcieri M, Biasioli A, Della Martina M, Mariuzzi L, Andreetta C, Titone F, Bogani G, Raimondo D, Perelli F, Buda A, Petrillo M, Greco P, Ercoli A, Fanfani F, Scambia G, Driul L, Vizzielli G. Management of Patients Diagnosed with Endometrial Cancer: Comparison of Guidelines. Cancers (Basel) 2023; 15:1091. [PMID: 36831434 PMCID: PMC9954548 DOI: 10.3390/cancers15041091] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Endometrial cancer is the most common gynecological malignancy in Europe and its management involves a variety of health professionals. In recent years, big discoveries were made concerning the management of patients diagnosed with endometrial cancer, particularly in the field of molecular biology and minimally invasive surgery. This requires the continuous updating of guidelines and protocols over the years. In this paper, we aim to summarize and compare common points and disparities among protocols for management of patients diagnosed with endometrial cancer by leading international gynecological oncological societies. We therefore systematically report the parallel among the guidelines based on the various steps patients with endometrial cancer usually undergo. The comparison between American and European protocols revealed some relevant disparities, in particular regarding surgical staging, molecular biology application as a prognostic tool and follow up regimens. This could possibly cause differences in interpreting and applying protocols in clinical practice in small centers, leading to a lack of adherence to guidelines or even prompting a confusing mix of them.
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Affiliation(s)
- Stefano Restaino
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Chiara Paglietti
- Medical Area Department (DAME), University of Udine, 33100 Udine, Italy
| | - Martina Arcieri
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, 98125 Messina, Italy
| | - Anna Biasioli
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Monica Della Martina
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Laura Mariuzzi
- Medical Area Department (DAME), Institute of Pathological Anatomy, Chief School of Specialization in Pathological Anatomy, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Claudia Andreetta
- Department of Medical Oncology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Francesca Titone
- Department of Radiation Oncology, S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Giorgio Bogani
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, 40138 Bologna, Italy
| | - Federica Perelli
- Division of Gynaecology and Obstetrics, Santa Maria Annunziata Hospital, USL Toscana Centro, 50012 Florence, Italy
| | - Alessandro Buda
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, Ospedale Michele e Pietro Ferrero, 12060 Verduno, Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Pantaleo Greco
- Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, 44011 Ferrara, Italy
| | - Alfredo Ercoli
- Department of Human Pathology in Adult and Childhood “G. Barresi”, Unit of Gynecology and Obstetrics, University of Messina, 98125 Messina, Italy
| | - Francesco Fanfani
- Dipartimento per le Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Scambia
- Dipartimento per le Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
- Medical Area Department (DAME), University of Udine, 33100 Udine, Italy
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, “S. Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
- Medical Area Department (DAME), University of Udine, 33100 Udine, Italy
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14
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Bazzurini L, Ornaghi S, Colciago E, Penati C, di Gennaro F, Passoni P, Buda A, Locatelli A, Landoni F, Vergani P. Endometriosis-related spontaneous hemoperitoneum in pregnancy: A case series. J Obstet Gynaecol Res 2023; 49:744-752. [PMID: 36366961 DOI: 10.1111/jog.15498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/03/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
Endometriosis can be associated with adverse pregnancy outcomes. We report six cases of endometriosis-related spontaneous hemoperitoneum diagnosed in pregnant and postpartum women over 13 years. Spontaneous hemoperitoneum in pregnancy mainly occurred in the second half of gestation. All women presented with acute abdominal pain; four of them needed an emergent surgery, two were managed expectantly. The median estimated blood loss was 4250 ml, four women required massive transfusion. Three out of six women had a known history of endometriosis, all of them had histologically confirmed endometriosis after surgery. No maternal or perinatal deaths occurred. In one case, reticence to perform a computed tomography scan led to delayed diagnosis. Since delay can lead to lethal consequences, high levels of suspicion for spontaneous hemoperitoneum should be maintained in cases of severe abdominal pain, even with a woman's negative history of endometriosis. Improved knowledge and regular interdisciplinary meetings are pivotal to ameliorate outcomes.
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Affiliation(s)
- Luca Bazzurini
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy
| | - Sara Ornaghi
- Department of Obstetrics and Gynecology, Division of Obstetrics, Foundation MBBM Onlus at San Gerardo Hospital, University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
| | - Elisabetta Colciago
- University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
| | - Cristina Penati
- Department of Obstetrics and Gynecology, Carate Brianza Hospital, Monza e Brianza, Italy
| | | | - Paolo Passoni
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy
| | - Anna Locatelli
- University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy.,Department of Obstetrics and Gynecology, Carate Brianza Hospital, Monza e Brianza, Italy
| | - Fabio Landoni
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy.,University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, Division of Obstetrics, Foundation MBBM Onlus at San Gerardo Hospital, University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
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15
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Bogani G, Papadia A, Casarin J, Buda A, Multinu F, Plotti F, Perrone A, De Iaco P, Ghezzi F, Ferrero S, Angioli R, Muzii L, Landoni F, Mueller M, Benedetti Panici P, Raspagliesi F, di Donato V. Hysterectomy Alone vs. Hysterectomy Plus Sentinel Node Mapping in Endometrial Cancer: Long-Term Results from a Multi-Institutional Study. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Restaino S, Mauro J, Zermano S, Pellecchia G, Mariuzzi L, Orsaria M, Titone F, Biasioli A, Della Martina M, Andreetta C, Poletto E, Arcieri M, Buda A, Driul L, Vizzielli G. CUP-syndrome: Inguinal high grade serous ovarian carcinoma lymph node metastases with unknown primary origin – a case report and literature review. Front Oncol 2022; 12:987169. [PMID: 36300091 PMCID: PMC9589412 DOI: 10.3389/fonc.2022.987169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/15/2022] [Indexed: 01/19/2023] Open
Abstract
Objective High-grade serous ovarian carcinoma (HGSC) often presents lymph node involvement. According to the paths of lymphatic drainage, the most common site of nodal metastasis is in the aortic area. However, pelvic lymph nodes are also involved and inguinal metastases are less frequent. Methods Our report concerns the case of a 78-year-old woman with an inguinal lymph node relapse of HGSC, with the prior positivity of a right inguinal lymph node, after the primary surgery. Ovaries and tubes were negative on histological examination. A comprehensive search of the literature published from January 2000 to October 2021 was conducted on PubMed and Scopus. The papers were selected following the PRISMA guidelines. Nine retrospective studies were evaluated. Results Overall, 67 studies were included in the initial search. Applying the screening criteria, 36 articles were considered eligible for full-text reading of which, after applying the exclusion criteria, 9 studies were selected for the final analysis and included in the systematic review. No studies were included for a quantitative analysis. We divided the results according to the relapse location: loco-regional, abdominal, and extra-abdominal recurrence. Conclusions Inguinal node metastasis is a rare but not unusual occurrence in HGSC. A reasonable level of suspicion should be maintained in patients with inguinal adenopathy and high CA125 values, especially in women with a history of gynecologic surgery, even in the absence of negative imaging for an ovarian origin.
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Affiliation(s)
- Stefano Restaino
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
| | - Jessica Mauro
- Department of Medicine, University of Udine, Udine, Italy
| | - Silvia Zermano
- Department of Medicine, University of Udine, Udine, Italy
| | | | - Laura Mariuzzi
- Department of Medicine, University of Udine, Udine, Italy
| | - Maria Orsaria
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
| | - Francesca Titone
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
- Radiation Oncology Department, Academic Hospital of Udine, Udine, Italy
| | - Anna Biasioli
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
| | - Monica Della Martina
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
| | - Claudia Andreetta
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
- Oncology Department, University Hospital of Udine, Udine, Italy
| | - Elena Poletto
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
- Oncology Department, University Hospital of Udine, Udine, Italy
| | - Martina Arcieri
- Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy
| | - Alessandro Buda
- Division of Gynecologic Oncology, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | - Lorenza Driul
- Department of Medicine, University of Udine, Udine, Italy
- *Correspondence: Lorenza Driul,
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17
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Bogani G, Raspagliesi F, Panici PB, Angioli R, Plotti F, Donato VD, laco PD, Ghezzi F, Papadia A, Gasparri ML, Buda A, Landoni F, Casarin J, Muzii L. Lymphadenectomy, sentinel node mapping plus backup lymphadenectomy and sentinel node mapping alone in low-, intermediate, and high-risk endometrial cancer (555). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01776-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Burg LC, Verheijen S, Bekkers RLM, IntHout J, Holloway RW, Taskin S, Ferguson SE, Xue Y, Ditto A, Baiocchi G, Papadia A, Bogani G, Buda A, Kruitwagen RFPM, Zusterzeel PLM. The added value of SLN mapping with indocyanine green in low- and intermediate-risk endometrial cancer management: a systematic review and meta-analysis. J Gynecol Oncol 2022; 33:e66. [PMID: 35882605 PMCID: PMC9428296 DOI: 10.3802/jgo.2022.33.e66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/09/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the SLN detection rate in presumed early stage, low- and intermediate-risk endometrial cancers, the incidence of SLN metastases, and the negative predictive value of SLN mapping performed with indocyanine green (ICG). METHODS A systematic review with meta-analyses was conducted. Study inclusion criteria were A) low- and intermediate-risk endometrial cancer, B) the use of ICG per cervical injection; C) a minimum of twenty included patients per study. To assess the negative predictive value of SLN mapping, D) a subsequent lymphadenectomy was an additional inclusion criterion. RESULTS Fourteen studies were selected, involving 2,117 patients. The overall and bilateral SLN detection rates were 95.6% (95% confidence interval [CI]=92.4%-97.9%) and 76.5% (95% CI=68.1%-84.0%), respectively. The incidence of SLN metastases was 9.6% (95% CI=5.1%-15.2%) in patients with grade 1-2 endometrial cancer and 11.8% (95% CI=8.1%-16.1%) in patients with grade 1-3 endometrial cancer. The negative predictive value of SLN mapping was 100% (95% CI=98.8%-100%) in studies that included grade 1-2 endometrial cancer and 99.2% (95% CI=97.9%-99.9%) in studies that also included grade 3. CONCLUSION SLN mapping with ICG is feasible with a high detection rate and negative predictive value in low- and intermediate-risk endometrial cancers. Given the incidence of SLN metastases is approximately 10% in those patients, SLN mapping may lead to stage shifting with potential therapeutic consequences. Given the high negative predictive value with SLN mapping, routine lymphadenectomy should be omitted in low- and intermediate-risk endometrial cancer.
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Affiliation(s)
- Lara C Burg
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Shenna Verheijen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Joanna IntHout
- Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert W Holloway
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - Salih Taskin
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Sarah E Ferguson
- Division of Gynecologic Oncology, Princess Margaret Cancer Center, Toronto, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Yu Xue
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Antonino Ditto
- Department of Gynecological Oncology, Fondazione IRCCS, Istituto dei Tumori, Milano, Italy
| | - Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giorgio Bogani
- Department of Maternal and Child Health and Urologynecological Sciences, Sapienza University, Rome, Italy
| | - Alessandro Buda
- Obstetrics and Gynecology Department, Ospedale San Gerardo di Monza, University of Milano Bicocca, Monza, Italy.,Ospedale Michele e Pietro Ferrero, Verduno (cuneo), Italy
| | - Roy F P M Kruitwagen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Petra L M Zusterzeel
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
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19
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Bogani G, Di Donato V, Papadia A, Buda A, Casarin J, Multinu F, Plotti F, Cuccu I, D'Auge TG, Gasparri ML, Pinelli C, Perrone AM, Barra F, Sorbi F, Cromi A, Di Martino G, Palaia I, Perniola G, Ferrero S, De Iaco P, Perrone C, Angioli R, Luvero D, Muzii L, Ghezzi F, Landoni F, Mueller MD, Benedetti Panici P, Raspagliesi F. Evaluating long-term outcomes of three approaches to retroperitoneal staging in endometrial cancer. Gynecol Oncol 2022; 166:277-283. [PMID: 35725656 DOI: 10.1016/j.ygyno.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Sentinel lymph node mapping (SNM) has gained popularity in managing apparent early-stage endometrial cancer (EC). Here, we evaluated the long-term survival of three different approaches of nodal assessment. METHODS This is a multi-institutional retrospective study evaluating long-term outcomes of EC patients having nodal assessment between 01/01/2006 and 12/31/2016. In order to reduce possible confounding factors, we applied a propensity-matched algorithm. RESULTS Overall, 940 patients meeting inclusion criteria were included in the study, of which 174 (18.5%), 187 (19.9%), and 579 (61.6%) underwent SNM, SNM followed by backup lymphadenectomy (LND) and LND alone, respectively. Applying a propensity score matching algorithm (1:1:2) we selected 500 patients, including 125 SNM, 125 SNM/backup LND, and 250 LND. Baseline characteristics of the study population were similar between groups. The prevalence of nodal disease was 14%, 16%, and 12% in patients having SNM, SNM/backup LND and LND, respectively. Overall, 19 (7.6%) patients were diagnosed with low volume nodal disease. The survival analysis comparing the three techniques did not show statistical differences in terms of disease-free (p = 0.750) and overall survival (p = 0.899). Similarly, the type of nodal assessment did not impact survival outcomes after stratification based on uterine risk factors. CONCLUSION Our study highlighted that SNM provides similar long-term oncologic outcomes than LND.
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Affiliation(s)
- Giorgio Bogani
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy.
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland
| | - Alessandro Buda
- Division of Gynecologic Oncology, Michele e Pietro Ferrero Hospital, 12060 Verduno, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Francesco Multinu
- Division of Gynecologic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Plotti
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Ilaria Cuccu
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Tullio Golia D'Auge
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Anna Myriam Perrone
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University, Hospital University of Bologna, 40138 Bologna, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Flavia Sorbi
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Giampaolo Di Martino
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Giorgia Perniola
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Pierandrea De Iaco
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University, Hospital University of Bologna, 40138 Bologna, Italy
| | - Chiara Perrone
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Daniela Luvero
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Fabio Landoni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | | | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
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20
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Restaino S, Mauro J, Cianci S, Buda A, Andreetta C, Poletto E, Pasqual EM, Poli A, Agrimi CV, Armenise D, Buzzelli A, Caccamo D, Driul L, Vizzielli G. HIPEC after Interval Debulking Surgery as Best Clinical Practice in Ovarian Cancer Patients: Case Series and Literature Review. CLIN EXP OBSTET GYN 2022. [DOI: 10.31083/j.ceog4906143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Williams MR, Welikhe P, Bos J, King K, Akland M, Augustine D, Baffaut C, Beck EG, Bierer A, Bosch DD, Boughton E, Brandani C, Brooks E, Buda A, Cavigelli M, Faulkner J, Feyereisen G, Fortuna A, Gamble J, Hanrahan B, Hussain M, Kohmann M, Kovar J, Lee B, Leytem A, Liebig M, Line D, Macrae M, Moorman T, Moriasi D, Nelson N, Ortega-Pieck A, Osmond D, Pisani O, Ragosta J, Reba M, Saha A, Sanchez J, Silveira M, Smith D, Spiegal S, Swain H, Unrine J, Webb P, White K, Wilson H, Yasarer L. P-FLUX: A phosphorus budget dataset spanning diverse agricultural production systems in the United States and Canada. J Environ Qual 2022; 51:451-461. [PMID: 35373848 DOI: 10.1002/jeq2.20351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
Quantifying spatial and temporal fluxes of phosphorus (P) within and among agricultural production systems is critical for sustaining agricultural production while minimizing environmental impacts. To better understand P fluxes in agricultural landscapes, P-FLUX, a detailed and harmonized dataset of P inputs, outputs, and budgets, as well as estimated uncertainties for each P flux and budget, was developed. Data were collected from 24 research sites and 61 production systems through the Long-term Agroecosystem Research (LTAR) network and partner organizations spanning 22 U.S. states and 2 Canadian provinces. The objectives of this paper are to (a) present and provide a description of the P-FLUX dataset, (b) provide summary analyses of the agricultural production systems included in the dataset and the variability in P inputs and outputs across systems, and (c) provide details for accessing the dataset, dataset limitations, and an example of future use. P-FLUX includes information on select site characteristics (area, soil series), crop rotation, P inputs (P application rate, source, timing, placement, P in irrigation water, atmospheric deposition), P outputs (crop removal, hydrologic losses), P budgets (agronomic budget, overall budget), uncertainties associated with each flux and budget, and data sources. Phosphorus fluxes and budgets vary across agricultural production systems and are useful resources to improve P use efficiency and develop management strategies to mitigate environmental impacts of agricultural systems. P-FLUX is available for download through the USDA Ag Data Commons (https://doi.org/10.15482/USDA.ADC/1523365).
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Affiliation(s)
- M R Williams
- National Soil Erosion Research Laboratory, USDA-ARS, West Lafayette, IN, USA
| | - P Welikhe
- National Soil Erosion Research Laboratory, USDA-ARS, West Lafayette, IN, USA
- Dep. of Agronomy, Purdue Univ., West Lafayette, IN, USA
| | - J Bos
- National Soil Erosion Research Laboratory, USDA-ARS, West Lafayette, IN, USA
| | - K King
- Soil Drainage Research Unit, USDA-ARS, Columbus, OH, USA
| | - M Akland
- Dep. of Plant and Soil Sciences, Univ. of Kentucky, Lexington, KY, USA
| | - D Augustine
- Rangeland Resources Research Unit, USDA-ARS, Fort Collins, CO, USA
| | - C Baffaut
- Cropping Systems and Water Quality Research Unit, USDA-ARS, Columbia, MO, USA
| | - E G Beck
- Kentucky Geological Survey, Univ. of Kentucky, Henderson, KY, USA
| | - A Bierer
- Northwest Irrigation and Soils Research Lab, USDA-ARS, Kimberly, ID, USA
| | - D D Bosch
- Southeast Watershed Research Laboratory, USDA-ARS, Tifton, GA, USA
| | - E Boughton
- Buck Island Ranch, Archbold Biological Station, Lake Placid, FL, USA
| | - C Brandani
- Dep. of Animal and Range Science, New Mexico State Univ., Las Cruces, NM, USA
| | - E Brooks
- Dep. of Soil and Water Resources, Univ. of Idaho, Moscow, ID, USA
| | - A Buda
- Systems and Watershed Management Research Unit, USDA-ARS, University Park, PA, USA
| | - M Cavigelli
- Sustainable Agricultural Systems Laboratory, USDA-ARS, Beltsville, MD, USA
| | - J Faulkner
- Dep. of Plant and Soil Science, Univ. of Vermont, Burlington, VT, USA
| | - G Feyereisen
- Soil and Water Management Unit, USDA-ARS, St. Paul, MN, USA
| | - A Fortuna
- Grazinglands Research Laboratory, USDA-ARS, El Reno, OK, USA
| | - J Gamble
- Soil and Water Management Unit, USDA-ARS, St. Paul, MN, USA
| | - B Hanrahan
- Soil Drainage Research Unit, USDA-ARS, Columbus, OH, USA
| | - M Hussain
- W.K. Kellogg Biological Station, Michigan State Univ., Hickory Corners, MI, USA
| | - M Kohmann
- Range Cattle Research and Education Center, Univ. of Florida, Ona, FL, USA
| | - J Kovar
- Agroecosystems Management Research, USDA-ARS, Ames, IA, USA
| | - B Lee
- Dep. of Plant and Soil Sciences, Univ. of Kentucky, Lexington, KY, USA
| | - A Leytem
- Northwest Irrigation and Soils Research Lab, USDA-ARS, Kimberly, ID, USA
| | - M Liebig
- Northern Great Plains Research Laboratory, USDA-ARS, Mandan, ND, USA
| | - D Line
- Dep. of Crop and Soil Sciences, North Carolina State Univ., Raleigh, NC, USA
| | - M Macrae
- Dep. of Geography and Environmental Management, Univ. of Waterloo, Waterloo, ON, Canada
| | - T Moorman
- Agroecosystems Management Research, USDA-ARS, Ames, IA, USA
| | - D Moriasi
- Grazinglands Research Laboratory, USDA-ARS, El Reno, OK, USA
| | - N Nelson
- Dep. of Agronomy, Kansas State Univ., Manhattan, KS, USA
| | - A Ortega-Pieck
- Dep. of Soil and Water Resources, Univ. of Idaho, Moscow, ID, USA
| | - D Osmond
- Dep. of Crop and Soil Sciences, North Carolina State Univ., Raleigh, NC, USA
| | - O Pisani
- Southeast Watershed Research Laboratory, USDA-ARS, Tifton, GA, USA
| | - J Ragosta
- USDA-ARS, Jornada Experimental Range, Las Cruces, NM, USA
| | - M Reba
- USDA-ARS, Delta Water Management Research Unit, Arkansas State Univ., Jonesboro, AR, USA
| | - A Saha
- Buck Island Ranch, Archbold Biological Station, Lake Placid, FL, USA
| | - J Sanchez
- Range Cattle Research and Education Center, Univ. of Florida, Ona, FL, USA
| | - M Silveira
- Range Cattle Research and Education Center, Univ. of Florida, Ona, FL, USA
| | - D Smith
- Grassland, Soil and Water Research Laboratory, USDA-ARS, Temple, TX, USA
| | - S Spiegal
- USDA-ARS, Jornada Experimental Range, Las Cruces, NM, USA
| | - H Swain
- Buck Island Ranch, Archbold Biological Station, Lake Placid, FL, USA
| | - J Unrine
- Dep. of Plant and Soil Sciences, Univ. of Kentucky, Lexington, KY, USA
| | - P Webb
- Dep. of Crop, Soil, and Environmental Sciences, Univ. of Arkansas, Fayetteville, AR, USA
| | - K White
- Sustainable Agricultural Systems Laboratory, USDA-ARS, Beltsville, MD, USA
| | - H Wilson
- Science and Technology Branch, Brandon Research and Development Centre, Agriculture and Agri-Food Canada, Brandon, MB, Canada
| | - L Yasarer
- National Sedimentation Laboratory, USDA-ARS, Oxford, MS, USA
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22
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Restaino S, Buda A, Puppo A, Capozzi VA, Sozzi G, Casarin J, Gallitelli V, Murgia F, Vizzielli G, Baroni A, Corrado G, Pasciuto T, Ferrari D, Novelli A, Berretta R, Legge F, Vizza E, Chiantera V, Ghezzi F, Landoni F, Scambia G, Fanfani F. Anatomical distribution of sentinel lymph nodes in patients with endometrial cancer: a multicenter study. Int J Gynecol Cancer 2022; 32:517-524. [PMID: 35110375 DOI: 10.1136/ijgc-2021-003253] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Sentinel lymph node (SLN) mapping represents the standard approach in uterine confined endometrial cancer patients. The aim of this study was to evaluate the anatomical distribution of SLNs and the most frequent locations of nodal metastasis. METHODS This was an observational retrospective multicenter study involving eight high volume gynecologic cancer centers in Italy. We reviewed 1576 patients with a histologically confirmed diagnosis of endometrial cancer from September 2015 to June 2020. All patients underwent total hysterectomy with salpingo-ophorectomy and SLN mapping. RESULTS A total of 3105 SLNs were mapped and removed, 2809 (90.5%) of these were bilateral and 296 (9.5%) unilateral. The overall detection rate was 93.4% (77.9% bilateral and 15.5% unilateral). The majority of SLNs (80%) and positive SLNs (77.8%) were found at the external iliac and obturator level in both endometrioid and non-endometrioid endometrial cancer. Negative SLNs were more frequent in patients with endometrioid compared with non-endometrioid cancer (91.9% vs 86.1%, p<0.0001). Older patients, a higher body mass index, and non-endometrioid histology were more likely to have 'no mapping' (p<0.0001). Univariate and multivariate analysis showed that higher body mass index and age at surgery were independent predictive factors of empty node packet and fat tissue (p=0.029 and p<0.01, respectively). CONCLUSION The most frequent sites of SLNs and metastases were located in the pelvic area below the iliac vessel bifurcation. Our findings showed that older age, a higher body mass index, and non-endometrioid histology had a negative impact on mapping.
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Affiliation(s)
- Stefano Restaino
- Department of Obstetrics, Gynecology, and Pediatrics, Obstetrics and Gynecology Unit, Udine University Hospital, DAME, Udine, Italy
| | - Alessandro Buda
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Andrea Puppo
- Clinic of Obstetrics and Gynecology, Santa Croce e Carle Hospital, Cuneo, Italy
| | | | - Giulio Sozzi
- Department of Gynecologic Oncology, Università di Palermo, Palermo, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy
| | | | - Ferdinando Murgia
- Obstetrics and Gynecology Unit, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Giuseppe Vizzielli
- Department of Obstetrics, Gynecology, and Pediatrics, Obstetrics and Gynecology Unit, Udine University Hospital, DAME, Udine, Italy.,Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, Udine, Italy
| | | | | | - Tina Pasciuto
- Research Core Facilty Data Collection G-STeP, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Largo Agostino Gemelli 8, Rome, Italy
| | - Debora Ferrari
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Antonia Novelli
- Department of Gynaecology and Obstetrics, Regina Montis Regalis Hospital, Mondovì, Italy
| | - Roberto Berretta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Legge
- Obstetrics and Gynecology Unit, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Enrico Vizza
- Department of Experimental Clinical Oncology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, Università di Palermo, Palermo, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy
| | - Fabio Landoni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy.,UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Francesco Fanfani
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy .,UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
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23
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Guani B, Mahiou K, Crestani A, Cibula D, Buda A, Gaillard T, Mathevet P, Kocian R, Sniadecki M, Wydra DG, Feki A, Paoletti X, Lecuru F, Balaya V. Clinical impact of low-volume lymph node metastases in early-stage cervical cancer: A comprehensive meta-analysis. Gynecol Oncol 2021; 164:446-454. [PMID: 34949436 DOI: 10.1016/j.ygyno.2021.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE In order to define the clinical significance of low-volume metastasis, a comprehensive meta-analysis of published data and individual data obtained from articles mentioning micrometastases (MIC) and isolated tumor cells (ITC) in cervical cancer was performed, with a follow up of at least 3 years. METHODS We performed a systematic literature review and meta-analysis, following Cochrane's review methods guide and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome was the disease-free survival (DFS), and the secondary outcome was the overall survival (OS). The hazard ratio (HR) was taken as the measure of the association between the low-volume metastases (MIC+ITC and MIC alone) and DFS or OS; it quantified the hazard of an event in the MIC (+/- ITC) group compared to the hazard in node-negative (N0) patients. A random-effect meta-analysis model using the inverse variance method was selected for pooling. Forest plots were used to display the HRs and risk differences within individual trials and overall. RESULTS Eleven articles were finally retained for the meta-analysis. In the analysis of DFS in patients with low-volume metastasis (MIC + ITC), the HR was increased to 2.60 (1.55-4.34) in the case of low-volume metastasis vs. N0. The presence of MICs had a negative prognostic impact, with an HR of 4.10 (2.71-6.20) compared to N0. Moreover, this impact was worse than that of MIC pooled with ITCs. Concerning OS, the meta-analysis shows an HR of 5.65 (2.81-11.39) in the case of low-volume metastases vs. N0. The presence of MICs alone had a negative effect, with an HR of 6.94 (2.56-18.81). CONCLUSIONS In conclusion, the presence of MIC seems to be associated with a negative impact on both the DFS and OS and should be treated as MAC.
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Affiliation(s)
- Benedetta Guani
- Department of Gynecology and Obstetrics, CHUV Lausanne, Lausanne, Switzerland; Faculty of Medicine and Biology, UNIL Lausanne, Lausanne, Switzerland; Department of Gynecology and Obstetrics, HFR Fribourg, Fribourg, Switzerland; Faculty of Medicine, University of Fribourg, 1700 Fribourg, Switzerland.
| | - Katia Mahiou
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, Paris, France
| | - Adrien Crestani
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, Paris, France
| | - David Cibula
- Department of Obstetrics and Gynecology of the 1(st) Faculty of Medicine, General University Hospital in Prague, Czech Republic
| | - Alessandro Buda
- Department of Gynecology Oncology, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | - Thomas Gaillard
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, Paris, France
| | - Patrice Mathevet
- Department of Gynecology and Obstetrics, CHUV Lausanne, Lausanne, Switzerland; Faculty of Medicine and Biology, UNIL Lausanne, Lausanne, Switzerland
| | - Roman Kocian
- Department of Obstetrics and Gynecology of the 1(st) Faculty of Medicine, General University Hospital in Prague, Czech Republic
| | - Marcin Sniadecki
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, Poland
| | - Dariusz G Wydra
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, Poland
| | - Anis Feki
- Department of Gynecology and Obstetrics, HFR Fribourg, Fribourg, Switzerland; Faculty of Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Xavier Paoletti
- Faculty of Medicine, University of Paris, 75006 Paris, France; Department of Biostatistics, Institut Curie, Paris, France
| | - Fabrice Lecuru
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, Paris, France; Faculty of Medicine, University of Paris, 75006 Paris, France
| | - Vincent Balaya
- Department of Gynecology and Obstetrics, CHUV Lausanne, Lausanne, Switzerland; Department of Gynecology and Obstetrics, FOCH Hospital, 92150 Suresnes, France
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24
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Bogani G, Ghezzi F, Malzoni M, di Donato V, Casarin J, Ferrero S, Angioli R, Plotti F, Muzii L, De Iaco P, Perrone A, Papadia A, Gasparri M, Buda A, Landoni F, Mueller M, Panici PB, Raspagliesi F. Lymphadenectomy, Sentinel Node Mapping Plus Backup Lymphadenectomy and Sentinel Node Mapping Alone in Endometrial Cancer. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Bogani G, Papadia A, Buda A, Casarin J, Di Donato V, Plotti F, Gasparri ML, Cimmino C, Pinelli C, Perrone AM, Barra F, Cromi A, Di Martino G, Palaia I, Ferrero S, Indini A, De Iaco P, Angioli R, Luvero D, Muzii L, Ghezzi F, Landoni F, Mueller MD, Benedetti Panici P, Raspagliesi F. Factors predicting morbidity in surgically-staged high-risk endometrial cancer patients. Eur J Obstet Gynecol Reprod Biol 2021; 266:169-174. [PMID: 34688098 DOI: 10.1016/j.ejogrb.2021.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate factors predicting the risk of developing 90-day postoperative complications and lymphatic-specific morbidity in patients undergoing surgical staging for high-risk endometrial cancer. METHODS This is a multi-institutional retrospective cohort study. Patients affected by apparent early-stage high-risk endometrial cancer (endometrioid FIGO grade 3 with deep myometrial invasion and non-endometrioid endometrial cancer) undergoing surgical staging between 2007 and 2019. Complications were graded according to the Clavien-Dindo classification system. Martin criteria were applied to improve quality of complications reporting. RESULTS Charts of 279 patients were evaluated. Lymphadenectomy, sentinel node mapping (SNM), and SNM followed by back-up lymphadenectomy were performed in 83 (29.7%), 50 (17.9%), and 146 (52.4%) patients, respectively. The former group of patients included 13 patients who had lymphadenectomy after the failure of the SNM technique. Thirteen (4.6%) patients developed severe postoperative events (grade 3 or worse). At multivariate analysis, body mass index (OR: 1.08 (95%CI: 1.01, 1.17)) and open abdominal surgery (OR: 2.27 (95%CI: 1.02, 5.32)) were the two independent factors predictive of surgery-related morbidity. Seven severe lymphatic complications occurred. The adoption of laparoscopic approach (p < 0.001, log-rank test) and SNM (p = 0.038, log-rank test) correlated with a lower risk of developing surgery-related events. Independently, open abdominal surgery was associated with an increased risk of developing lymphatic morbidity (OR: 37.4 (95%CI: 4.38, 319.5); p = 0.001). CONCLUSION The adoption of the laparoscopic approach and SNM technique were associated with lower 90-day complication rates than open surgery in high-risk endometrial cancer undergoing staging surgery.
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Affiliation(s)
- Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy.
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland
| | - Alessandro Buda
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Francesco Plotti
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland
| | - Chiara Cimmino
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy; Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Anna Myriam Perrone
- Department of Obstetrics and Gynecology Sant'Orsola Malpighi University Hospital University of Bologna, 40138 Bologna, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Giampaolo Di Martino
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Alice Indini
- Unit of Medical Oncology, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Varese, Italy
| | - Pierandrea De Iaco
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Daniela Luvero
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Fabio Landoni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | | | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
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Ghoniem K, Larish AM, Dinoi G, Zhou XC, Alhilli M, Wallace S, Wohlmuth C, Baiocchi G, Tokgozoglu N, Raspagliesi F, Buda A, Zanagnolo V, Zapardiel I, Jagasia N, Giuntoli R, Glickman A, Peiretti M, Lanner M, Chacon E, Di Guilmi J, Pereira A, Laas E, Fishman A, Nitschmann CC, Parker S, Joehlin-Price A, Lees B, Covens A, De Brot L, Taskiran C, Bogani G, Paniga C, Multinu F, Hernandez-Gutierrez A, Weaver AL, McGree ME, Mariani A. Oncologic outcomes of endometrial cancer in patients with low-volume metastasis in the sentinel lymph nodes: An international multi-institutional study. Gynecol Oncol 2021; 162:590-598. [PMID: 34274133 DOI: 10.1016/j.ygyno.2021.06.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess oncologic outcomes in endometrial cancer patients with low-volume metastasis (LVM) in the sentinel lymph nodes (SLNs). METHODS Patients with endometrial cancer and SLN-LVM (≤2 mm) from December 3, 2009, to December 31, 2018, were retrospectively identified from 22 centers worldwide. Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IV, adnexal involvement, or unknown adjuvant therapy (ATx) were excluded. RESULTS Of 247 patients included, 132 had isolated tumor cell (ITC) and 115 had micrometastasis (MM). Overall 4-year recurrence-free survival (RFS) was 77.6% (95% CI, 70.2%-85.9%); median follow-up for patients without recurrence was 29.6 (interquartile range, 19.2-41.5) months. At multivariate analysis, Non-endometrioid (NE) (HR, 5.00; 95% CI, 2.50-9.99; P < .001), lymphovascular space invasion (LVSI) (HR, 3.26; 95% CI, 1.45-7.31; P = .004), and uterine serosal invasion (USI) (HR, 3.70; 95% CI, 1.44-9.54; P = .007) were independent predictors of recurrence. Among 47 endometrioid ITC patients without ATx, 4-year RFS was 82.6% (95% CI, 70.1%-97.2). Considering 18 ITC patients with endometrioid grade 1 disease, without LVSI, USI, or ATx, only 1 had recurrence (median follow-up, 24.8 months). CONCLUSIONS In patients with SLN-LVM, NE, LVSI, and USI were independent risk factors for recurrence. Patients with any risk factor had poor prognosis, even when receiving ATx. Patients with ITC and grade 1 endometrioid disease (no LVSI/USI) had favorable prognosis, even without ATx. Further analysis (with more patients and longer follow-up) is needed to assess whether ATx can be withheld in this low-risk subgroup.
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Affiliation(s)
- Khaled Ghoniem
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Alyssa M Larish
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Giorgia Dinoi
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA; Universita Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Sumer Wallace
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christoph Wohlmuth
- Sunnybrook Health Sciences, University of Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | | | | | | | | | | | | | - Nisha Jagasia
- Mater Hospital Brisbane & Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Robert Giuntoli
- University of Pennsylvania Health System, Philadelphia, PA, USA
| | | | | | | | | | | | - Augusto Pereira
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Ami Fishman
- Meir Medical Center, Faculty of Medicine, Tel-Aviv University, Israel
| | | | | | | | - Brittany Lees
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Allan Covens
- Sunnybrook Health Sciences, University of Toronto, Ontario, Canada
| | | | - Cagatay Taskiran
- Turkish Society of Gynecologic Oncology, Istanbul, Turkey; Department of Gynecologic Oncology, Koc University School of Medicine, Istanbul, Turkey
| | - Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale Tumori -Milan, Milan, Italy
| | | | - Francesco Multinu
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA; IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Amy L Weaver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Michaela E McGree
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
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Comerio C, Jaconi M, Zambetti B, Paderno M, Valente MG, Buda A. Recurrence of vulvar squamous cell carcinoma as an undifferentiated sarcomatoid carcinoma. Int J Gynecol Cancer 2021; 31:627-630. [PMID: 33795407 DOI: 10.1136/ijgc-2020-002193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Chiara Comerio
- Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Marta Jaconi
- Department of Pathology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Benedetta Zambetti
- Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Mariachiara Paderno
- Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Alessandro Buda
- Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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28
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Moloney K, Janda M, Frumovitz M, Leitao M, Abu-Rustum NR, Rossi E, Nicklin JL, Plante M, Lecuru FR, Buda A, Mariani A, Leung Y, Ferguson SE, Pareja R, Kimmig R, Tong PSY, McNally O, Chetty N, Liu K, Jaaback K, Lau J, Ng SYJ, Falconer H, Persson J, Land R, Martinelli F, Garrett A, Altman A, Pendlebury A, Cibula D, Altamirano R, Brennan D, Ind TE, De Kroon C, Tse KY, Hanna G, Obermair A. Development of a surgical competency assessment tool for sentinel lymph node dissection by minimally invasive surgery for endometrial cancer. Int J Gynecol Cancer 2021; 31:647-655. [PMID: 33664126 DOI: 10.1136/ijgc-2020-002315] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Sentinel lymph node dissection is widely used in the staging of endometrial cancer. Variation in surgical techniques potentially impacts diagnostic accuracy and oncologic outcomes, and poses barriers to the comparison of outcomes across institutions or clinical trial sites. Standardization of surgical technique and surgical quality assessment tools are critical to the conduct of clinical trials. By identifying mandatory and prohibited steps of sentinel lymph node (SLN) dissection in endometrial cancer, the purpose of this study was to develop and validate a competency assessment tool for use in surgical quality assurance. METHODS A Delphi methodology was applied, included 35 expert gynecological oncology surgeons from 16 countries. Interviews identified key steps and tasks which were rated mandatory, optional, or prohibited using questionnaires. Using the surgical steps for which consensus was achieved, a competency assessment tool was developed and subjected to assessments of validity and reliability. RESULTS Seventy percent consensus agreement standardized the specific mandatory, optional, and prohibited steps of SLN dissection for endometrial cancer and informed the development of a competency assessment tool. Consensus agreement identified 21 mandatory and three prohibited steps to complete a SLN dissection. The competency assessment tool was used to rate surgical quality in three preselected videos, demonstrating clear separation in the rating of the skill level displayed with mean skills summary scores differing significantly between the three videos (F score=89.4; P<0.001). Internal consistency of the items was high (Cronbach α=0.88). CONCLUSION Specific mandatory and prohibited steps of SLN dissection in endometrial cancer have been identified and validated based on consensus among a large number of international experts. A competency assessment tool is now available and can be used for surgeon selection in clinical trials and for ongoing, prospective quality assurance in routine clinical care.
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Affiliation(s)
- Kristen Moloney
- Gynaecologic Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
| | - Michael Frumovitz
- Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mario Leitao
- Gynecology Service Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Emma Rossi
- Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James L Nicklin
- Gynaecological Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Marie Plante
- Gynecology Oncology Service, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, Quebec, Canada
| | - Fabrice R Lecuru
- Surgical Oncology, Institute Curie, Paris, France.,Surgical Oncology Department for Breast and Gynecology, Universite de Paris, Paris, Île-de-France, France
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy.,Division of Gynecologic Oncology Italy, Ospedale Michele e Pietro Ferrero, Verduno (CN), Italy
| | - Andrea Mariani
- Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Yee Leung
- Obstetrics and Gynaecology, The University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia
| | - Sarah Elizabeth Ferguson
- Gynecologic Oncology, University Health Network, Toronto, Ontario, Canada.,Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Rene Pareja
- Gynecologic Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia.,Gynecologic Oncology, Clínica De Oncología Astorga, Medellín, Colombia
| | - Rainer Kimmig
- Gynecology and Obstetrics, University of Essen, Essen, Germany
| | | | - Orla McNally
- Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia.,Victorian Comprehensive Cancer Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Naven Chetty
- Gynaecologic Oncology, Mater Health Services Brisbane, South Brisbane, Queensland, Australia
| | - Kaijiang Liu
- Gynecology and Obstetrics, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Ken Jaaback
- Gynaecologic Oncology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Julio Lau
- Gynecology Oncology, Hospital General San Juan de Dios, Guatemala, Guatemala.,Gynecology Oncology, University of San Carlos de Guatemala Faculty of Medical Sciences, Guatemala, Guatemala
| | | | - Henrik Falconer
- Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Persson
- Obstetrics and Gynaecology, Skanes Universitetssjukhus Lund, Lund, Skåne, Sweden.,Clinical Sciences, Obstetrics and Gynaecology, Lund University Faculty of Medicine, Lund, Sweden
| | - Russell Land
- Gynaecologic Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Fabio Martinelli
- Gynaecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Garrett
- Gynaecologic Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Alon Altman
- Gynecologic Oncology, University of Manitoba, Winnipeg, Manitoba, Canada.,Gynecologic Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Adam Pendlebury
- Gynaecological Oncology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - David Cibula
- Gynecology and Obstetrics, Charles University First Faculty of Medicine, Praha, Praha, Czech Republic.,Gynecology and Obstetrics, General University Hospital in Prague, Praha, Czech Republic
| | - Roberto Altamirano
- Gynecology Oncology, Universidad de Chile, Santiago de Chile, Chile.,Gynecology Oncology, Hospital Clinico San Borja Arriaran, Santiago, Chile
| | - Donal Brennan
- Gynaecology Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Thomas Edward Ind
- Gynaecological Oncology, Royal Marsden NHS Foundation Trust, London, UK.,Gynaecology, St George's University of London, London, UK
| | - Cornelis De Kroon
- Gynecology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Ka Yu Tse
- Obstetrics and Gynaecology, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| | - George Hanna
- Surgery and Cancer, Imperial College London, London, UK
| | - Andreas Obermair
- Center for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Queensland, Australia .,Queensland Centre for Gynaecologic Cancer Research, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Fanfani F, Pedone Anchora L, Di Martino G, Bizzarri N, Di Meo ML, Carbone V, Paderno M, Fedele C, Paniga C, Fagotti A, Landoni F, Scambia G, Buda A. Oncologic and obstetric outcomes after simple conization for fertility-sparing surgery in FIGO 2018 stage IB1 cervical cancer. Int J Gynecol Cancer 2021; 31:452-456. [PMID: 33649013 DOI: 10.1136/ijgc-2020-001750] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Conization/simple trachelectomy is feasible in patients with early-stage cervical cancer. Retrospective data suggest that conization with negative lymph nodes could be a safe option for these patients. This study aims to provide oncologic and obstetric outcomes of a large series of patients with 2018 International Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical cancer managed by conization. METHODS Patients with early cervical cancer and a desire to preserve fertility who underwent conization and pelvic lymphadenectomy from January 1993 to December 2019 in two Italian centers were included. Inclusion criteria were: age >18 years and ≤45 years, 2018 FIGO stage IB1, no prior irradiation or chemotherapy, absence of pre-operative radiologic evidence of nodal metastases, a strong desire to preserve fertility, and absence of concomitant malignancies. We excluded patients with confirmed infertility, neuroendocrine tumor, clear cell or mucinous carcinoma. RESULTS A total of 42 patients were included. The median age was 32 years (range 19-44) and median tumor size was 11 mm (range 8-20). Squamous cell carcinoma was found in 27 (64.3%). Grade 3 tumor was present in 7 (16.7%) patients and lymphovascular space involvement was detected in 15 (35.7%). At a median follow-up of 54 months (range 1-185), all patients were alive without evidence of disease. In the entire series three patients experienced recurrence resulting in an overall recurrence rate of 7.1%. All the recurrences occurred in the pelvis (2 in the cervix and 1 in the lymph nodes), resulting in a 3-year disease-free survival of 91.6%. Twenty-two (52%) patients tried to conceive; 18 pregnancies occurred in 17 patients and 12 live births were reported (6 pre-term and 6 term pregnancies). Two miscarriages were recorded, one first trimester and one second trimester fetal loss. CONCLUSIONS Our study showed that conization is feasible for the conservative management of women with stage IB1 cervical cancer desiring fertility. Oncologic outcomes appear favorable in this series of patients. Future prospective studies will hopefully provide further insight into this important question.
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Affiliation(s)
- Francesco Fanfani
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy .,Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Rome, Italy
| | - Luigi Pedone Anchora
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Giampaolo Di Martino
- Department of Obstetrics and Gynecology, Gynaecologic Oncology Surgical Unit, ASST-Monza, San Gerardo Hospital, Monza, Italy
| | - Nicolò Bizzarri
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | | | - Vittoria Carbone
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | | | - Camilla Fedele
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Rome, Italy
| | | | - Anna Fagotti
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Rome, Italy
| | - Fabio Landoni
- Department of Obstetrics and Gynecology, Gynaecologic Oncology Surgical Unit, ASST-Monza, San Gerardo Hospital, Monza, Italy
| | - Giovanni Scambia
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Rome, Italy
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Gynaecologic Oncology Surgical Unit, ASST-Monza, San Gerardo Hospital, Monza, Italy
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Bogani G, Papadia A, Buda A, Casarin J, Di Donato V, Gasparri ML, Plotti F, Pinelli C, Paderno MC, Lopez S, Perrone AM, Barra F, Guerrisi R, Brusadelli C, Cromi A, Ferrari D, Chiapp V, Signorelli M, Leone Roberti Maggiore U, Ditto A, Palaia I, Ferrero S, De Iaco P, Angioli R, Panici PB, Ghezzi F, Landoni F, Mueller MD, Raspagliesi F. Sentinel node mapping vs. sentinel node mapping plus back-up lymphadenectomy in high-risk endometrial cancer patients: Results from a multi-institutional study. Gynecol Oncol 2021; 161:122-129. [PMID: 33485641 DOI: 10.1016/j.ygyno.2021.01.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Sentinel node mapping (SLN) has replaced lymphadenectomy for staging surgery in apparent early-stage low and intermediate risk endometrial cancer (EC). Only limited data about the adoption of SNM in high risk EC is still available. Here, we evaluate the outcomes of high-risk EC undergoing SNM (with or without back-up lymphadenectomy). METHODS This is a multi-institutional international retrospective study, evaluating data of high-risk (FIGO grade 3 endometrioid EC with myometrial invasion >50% and non-endometrioid histology) EC patients undergoing SNM followed by back-up lymphadenectomy and SNM alone. RESULTS Chart of consecutive 196 patients were evaluated. The study population included 83 and 113 patients with endometrioid and non-endometrioid EC, respectively. SNM alone and SNM followed by back-up lymphadenectomy were performed in 50 and 146 patients, respectively. Among patients having SNM alone, 14 (28%) were diagnosed with nodal disease. In the group of patients undergoing SNM plus back-up lymphadenectomy 34 (23.2%) were diagnosed with nodal disease via SNM. Back-up lymphadenectomy identified 2 (1%) additional patients with nodal disease (in the para-aortic area). Back-up lymphadenectomy allowed to remove adjunctive positive nodes in 16 (11%) patients. After the adoption of propensity-matched algorithm, we observed that patients undergoing SNM plus back-up lymphadenectomy experienced similar disease-free survival (p = 0.416, log-rank test) and overall survival (p = 0.940, log-rank test) than patients undergoing SLN alone. CONCLUSIONS Although the small sample size, and the retrospective study design this study highlighted that type of nodal assessment did not impact survival outcomes in high-risk EC. Theoretically, back-up lymphadenectomy would be useful in improving the removal of positive nodes, but its therapeutic value remains controversial. Further prospective evidence is needed.
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Affiliation(s)
- Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy.
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland
| | - Alessandro Buda
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Italy
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland
| | - Francesco Plotti
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Italy
| | - Maria Chiara Paderno
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Salvatore Lopez
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Anna Myriam Perrone
- Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Rocco Guerrisi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Italy.
| | - Claudia Brusadelli
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Italy
| | - Debora Ferrari
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Valentina Chiapp
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Mauro Signorelli
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | | | - Antonino Ditto
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Pierandrea De Iaco
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | | | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Italy
| | - Fabio Landoni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
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Buda A, Ramirez PT, Scambia G. In memory of Professor Dr Costantino Mangioni. Int J Gynecol Cancer 2021. [DOI: 10.1136/ijgc-2020-002204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Buda A, Casarin J, Mueller M, Fanfani F, Zapardiel I, Mereu L, Puppo A, De Ponti E, Adorni M, Ferrari D, Gasparri ML, Ghezzi F, Scambia G, Papadia A. The impact of low-volume metastasis on disease-free survival of women with early-stage cervical cancer. J Cancer Res Clin Oncol 2020; 147:1599-1606. [PMID: 33130942 DOI: 10.1007/s00432-020-03435-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE We aimed to assess the impact of low-volume metastasis (micrometastasis and isolated tumor cells) on disease-free survival (DFS) of women with early-stage cervical cancer. METHODS Women with clinically suspected stage 1A-IB2 (FIGO 2018 classification) disease who underwent retroperitoneal nodal staging between October 2010 and April 2018, were retrospectively analyzed. The group of women who had undergone lymphadenectomy and standard node pathologic analysis (H&E group), were compared to the group undergoing sentinel node mapping (SLN) and ultrastaging with or without lymphadenectomy (ultrastaging group). At a median follow-up of 45 months, the DFS curves were analyzed. RESULTS Overall, 573 patients were revised (272 in the H&E group and 302 in the ultrastaging group). Eighty-five patients presented lymph node metastasis (32 in H&E, 53 in ultrastaging). Ultrastaging protocol increased the rate of low-volume metastasis by 5.6%. Twenty patients showed exclusive micrometastasis or ITC's. Seventy-three recurrences occurred (35 in H&E, 38 in ultrastaging). Only 1 out of 53 patients in the ultrastaging group (1.9%) presented with micrometastasis recurred. The 3-year disease-free survival was 89% for the H&E group, and 88% for the ultrastaging group, respectively (p = 0.175). CONCLUSION Ultrastaging analysis allowed increasing the detection of low volume metastasis in women with early-stage cervical cancer. However, the type of nodal staging did not have an impact on patients' 3-year disease-free survival.
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Affiliation(s)
- Alessandro Buda
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
| | - Jvan Casarin
- Obstetrics and Gynecology Department, University of Insubria, Varese, Italy
| | - Michael Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Francesco Fanfani
- Dipartimento della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento Scienze della vita e sanità pubblica, Sacred Heart Catholic University, Rome, Italy
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Liliana Mereu
- Department of Obstetrics and Gynecology, Santa Chiara Hospital, Trento, Italy
| | - Andrea Puppo
- Clinic of Obstetrics and Gynecology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Elena De Ponti
- Department of Physical Medicine, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Marco Adorni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Debora Ferrari
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Maria Luisa Gasparri
- Department of Gynecology and Obstetrics, University of the Italian Switzerland (USI), Ente Ospedaliero Cantonale of Lugano, Lugano, Switzerland
| | - Fabio Ghezzi
- Obstetrics and Gynecology Department, University of Insubria, Varese, Italy
| | - Giovanni Scambia
- Dipartimento della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento Scienze della vita e sanità pubblica, Sacred Heart Catholic University, Rome, Italy
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland.,Department of Gynecology and Obstetrics, University of the Italian Switzerland (USI), Ente Ospedaliero Cantonale of Lugano, Lugano, Switzerland
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Ceppi L, Grassi T, Galli F, Buda A, Aletti G, Lissoni AA, Adorni M, Garbi A, Colombo N, Bonazzi C, Landoni F, Fruscio R. Early-stage clear cell ovarian cancer compared to high-grade histological subtypes: An outcome exploratory analysis in two oncology centers. Gynecol Oncol 2020; 160:64-70. [PMID: 33077259 DOI: 10.1016/j.ygyno.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/11/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE advanced stage clear cell ovarian cancer (CCOC) carries a higher risk of relapse and death compared to other histological subtypes. The prognosis of early-stage CCOC is controversial. METHODS Early-stage high-grade OC patients from two Italian oncologic centers were included. Patients with early-stage CCOC were compared with those with high-grade endometrioid (HGE) and serous (HGS) OC in terms of relapse-free interval (RFI), cancer-specific survival (CSS) and post relapse cancer-specific survival (prCSS). The Cox proportional hazard model and the restricted mean survival time were used. RESULTS Between 1981 and 2012, 134 patients with CC, 152 with HGE and 160 with HGS were treated at two referral centers. Median follow-up was 11.5 years. Ten years RFI rates were 80.6%, 72.1%, 60.6%, and CSS rates were 84.3%, 82.6%, 81.7% respectively. Adjuvant chemotherapy significantly improved RFI (aHR 0.61, 95%CI 0.40 to 0.91, P = 0.015). In the multivariable analysis HGS histotype was associated with a shorter RFI compared to CC, (Hazard Ratio [HR]: 1.81; 95%CI: 1.12-2.93; P = 0.016), whereas CSS was not statistically different. prCSS was longer in HGS compared to CCOC (HR, 0.36; 95% CI, 0.17-0.74; P = 0.006). According to the stage, IA/IB/IC1 HGSOC had a shorter RFI (HR, 2.13; 95% CI, 1.14-3.99; P = 0.018) compared to IA/IB/IC1 CCOC, but similar CSS. For prCSS, CC compared to HGS conferred a worse prognosis regardless of the initial stage. CONCLUSIONS Early-stage CCOC is associated with a longer RFI, similar CSS and a shorter prCSS compared to HGSOC. No prognostic differences were observed between CC and HGE OC. The relapse risk was the lowest in IA/IB/IC1 CC compared to HGS, whereas CC displayed poor sensitivity to chemotherapy after relapse.
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Affiliation(s)
- Lorenzo Ceppi
- Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, Italy; Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy.
| | - Tommaso Grassi
- Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, Italy; Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy
| | - Francesca Galli
- Laboratory of Methodology for Clinical Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Negri 2, 20156 Milan, Italy
| | - Alessandro Buda
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy
| | - Giovanni Aletti
- Division of Gynecologic Oncology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; University of Milan, Department of Oncology and Hemato-oncology, 20122 Milan, Italy
| | - Andrea Alberto Lissoni
- Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, Italy; Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy
| | - Marco Adorni
- Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, Italy; Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy
| | - Annalisa Garbi
- Division of Gynecologic Oncology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Nicoletta Colombo
- Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, Italy; Division of Gynecologic Oncology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Cristina Bonazzi
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, Italy; Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy
| | - Robert Fruscio
- Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, Italy; Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy
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Corezzi M, Bert F, Lo Moro G, Buda A, Gualano MR, Siliquini R. Mediterranean diet and mental health in university students: an Italian cross-sectional study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Well-being is essential for positive mental health among university students, influencing their later attitudinal and career outcomes. Many factors contribute to endanger students' mental health, including academic stressors, as well as unhealthy lifestyles. Following a Mediterranean diet (MD), widespread in Europe, is proved to have a protective role for mental health. Our aim was to investigate mental well-being and adherence to the MD in university students.
Methods
In 2019, a cross-sectional study was performed in Turin, Italy. Totally, 502 university students were enrolled. A socio-demographic form, the Mediterranean Diet Adherence Screener (MEDAS) and Warwick-Edinburgh Mental Wellbeing Scale (WEMBS), were used. Mainly, multivariable linear and logistic regressions were performed to investigate potential predictors of adherence to the MD and of psychological well-being (p < 0.05 considered significant).
Results
The 24% of the sample resulted at high risk of depression (WEMWBS score<40) and the 22.7% at high risk of psychological distress (WEMWBS score 41-45). The median MEDAS score was 6 (IQR=2, non-normal distribution) in a possible range between 0 and 14 (the higher is the score, the higher is the adherence). Preliminary results showed that a MEDAS score ≥6 was associated to a lower risk of depression (OR = 0.78, p = 0.006). Not being on time with university exams (OR = 2.65, p = 0.002) and not having an excellent health status (OR = 1.94, p = 0.23) led to a higher depression risk instead. The main variables that had a negative association with MD adherence were WEMWBS<40 (coef=-0.65, p = 0.001) and not cooking personally (coef=-0.30, p = 0.04).
Conclusions
Students who reported greater adherence to the MD were those with the lowest risk of depression. The potential protective role that MD has for mental health in young adults could be used to help developing more comprehensive intervention strategies of health promotion among European university students.
Key messages
Adherence to the Mediterranean diet and good mental health seem to be related in a sample of university students analyzed through multivariable regressions. European policies and strategies addressing unhealthy lifestyles and encouraging Mediterranean diet adherence could be useful to improve well-being and mental health of university students.
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Affiliation(s)
- M Corezzi
- AOU City of Health and Science, Turin, Italy
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - F Bert
- AOU City of Health and Science, Turin, Italy
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - G Lo Moro
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - A Buda
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - M R Gualano
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - R Siliquini
- AOU City of Health and Science, Turin, Italy
- Department of Public Health Sciences, University of Turin, Turin, Italy
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Frumovitz M, Buda A. Encouraging worldwide adoption of sentinel lymph node biopsies for gynecologic malignancies. Int J Gynecol Cancer 2020; 30:281-282. [PMID: 32122947 DOI: 10.1136/ijgc-2020-001240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Michael Frumovitz
- Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alessandro Buda
- Department Obstetrics and Gynecology, Azienda Ospedaliera San Gerardo, Monza, Italy
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Pesenti C, Paracchini L, Marchette MD, Beltrame L, Bianchi T, Grassi T, Buda A, Landoni F, Ceppi L, Bosetti C, Paderno MC, Adorni M, Vicini D, Perego P, Leone BE, Marchini S, Fruscio R, D'Incalci M. Abstract LB-268: Detection of TP53 clonal mutations in PAP test collected up to six years prior to high-grade serous epithelial ovarian cancer diagnosis. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-lb-268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The low five-years survival rate of High Grade Serous Epithelial Ovarian Cancer (HGS-EOC) is mainly related to late diagnosis. The anticipation of diagnosis constitutes a crucial step to increase the curability of this disease.
Aim: This study explores an innovative potential HGS-EOC screening approach exploiting PAP tests routinely executed for cervical cancer surveillance and the presence of TP53 clonal alterations in almost all HGS-EOCs. Indeed, it investigates the possibility to detect, in DNA purified from PAP tests collected by patients years before the diagnosis, the clonal pathogenic TP53 variant identified in the matched primary tumor biopsy.
Study Design: This retrospective and longitudinal study was conducted on 17 advanced HGS-EOC patients. Next Generation Sequencing (NGS) was used to identify TP53 clonal mutations in tumor tissue. The presence of these TP53 variants was then assessed by the droplet digital PCR (ddPCR) in DNA purified from all available patients' PAP tests executed up to almost six years before diagnosis.
Results: In each patient, one TP53 clonal somatic variant was identified by NGS in the primary tumor samples (Table 1). The presence of the TP53 variant was then investigated by ddPCR in matched Pap tests. In twelve out of 17 patients the TP53 variant was detectable in PAP tests collected within six months before diagnosis (T1) or earlier (T2, T3 and T4) (Table 1). For two patients (21561 and 21521) more PAP tests collected at different time before diagnosis (two/four and three/six years before diagnosis, respectively) were analyzed and the TP53 clonal variant was detected at all time points (Table 1).
Table 1:NGS and ddPCR resultsPatient IDTP53 mutationNGS tumor mutated %PAP test (months before surgery)T1(0-6)T2(7-24)T3(25-48)T4(≥49)Time intervalddPCR mutated %Time intervalddPCR mutated %Time intervalddPCR mutated %Time intervalddPCR mutated %21561c.818G>A65.010.20.24--250.21490.2621585c.817C>T40.94--11.30.21----21567c.281C>A71.9830.07------21587c.469G>T15.122ND------21586c.818G>A79.73--19.30.15----21569c.574C>T62.365.21.18------21624c.820G>T86.72----37.50.0465.3ND21570c.844C>T89.190.32.62------21627c.425_427del76.040.72.4------21640c.993+2T>G70.68--8ND----21507c.1025G>C91.23--9.20.06----21635c.844C>T66.241.3ND------21549c. 393_395del54.06----31.2ND65.3ND21521c. 722 C>G61.15----26.70.0567.30.0721654c.586 C>T49.354.70.09------21665c. 393_395del45.34----37.6ND--21683c.602 T>A33.42--18.50.06----ND Not Detected
Conclusion: This study demonstrates that non-invasive early molecular diagnosis of HGS-EOC is feasible through detection of TP53 clonal mutations in the DNA purified from PAP tests performed during cervical cancer screening. Further developments in highly sensitive molecular approaches could dramatically improve early diagnosis of HGS-EOC.
Citation Format: Chiara Pesenti, Lara Paracchini, Martina Delle Marchette, Luca Beltrame, Tommaso Bianchi, Tommaso Grassi, Alessandro Buda, Fabio Landoni, Lorenzo Ceppi, Cristina Bosetti, Maria Chiara Paderno, Marco Adorni, Debora Vicini, Patrizia Perego, Biagio Eugenio Leone, Sergio Marchini, Robert Fruscio, Maurizio D'Incalci. Detection of TP53 clonal mutations in PAP test collected up to six years prior to high-grade serous epithelial ovarian cancer diagnosis [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr LB-268.
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Affiliation(s)
- Chiara Pesenti
- 1Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Lara Paracchini
- 1Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | - Luca Beltrame
- 1Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | | | | | - Fabio Landoni
- 2Università degli Studi Milano-Bicocca, Monza, Italy
| | | | | | | | - Marco Adorni
- 2Università degli Studi Milano-Bicocca, Monza, Italy
| | - Debora Vicini
- 2Università degli Studi Milano-Bicocca, Monza, Italy
| | | | | | - Sergio Marchini
- 1Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Cibula D, Kocian R, Plaikner A, Jarkovsky J, Klat J, Zapardiel I, Pilka R, Torne A, Sehnal B, Ostojich M, Petiz A, Sanchez OA, Presl J, Buda A, Raspagliesi F, Kascak P, van Lonkhuijzen L, Barahona M, Minar L, Blecharz P, Pakiz M, Wydra D, Snyman LC, Zalewski K, Zorrero C, Havelka P, Redecha M, Vinnytska A, Vergote I, Tingulstad S, Michal M, Kipp B, Slama J, Marnitz S, Bajsova S, Hernandez A, Fischerova D, Nemejcova K, Kohler C. Sentinel lymph node mapping and intraoperative assessment in a prospective, international, multicentre, observational trial of patients with cervical cancer: The SENTIX trial. Eur J Cancer 2020; 137:69-80. [PMID: 32750501 DOI: 10.1016/j.ejca.2020.06.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND SENTIX (ENGOT-CX2/CEEGOG-CX1) is an international, multicentre, prospective observational trial evaluating sentinel lymph node (SLN) biopsy without pelvic lymph node dissection in patients with early-stage cervical cancer. We report the final preplanned analysis of the secondary end-points: SLN mapping and outcomes of intraoperative SLN pathology. METHODS Forty-seven sites (18 countries) with experience of SLN biopsy participated in SENTIX. We preregistered patients with stage IA1/lymphovascular space invasion-positive to IB2 (4 cm or smaller or 2 cm or smaller for fertility-sparing treatment) cervical cancer without suspicious lymph nodes on imaging before surgery. SLN frozen section assessment and pathological ultrastaging were mandatory. Patients were registered postoperatively if SLN were bilaterally detected in the pelvis, and frozen sections were negative. TRIAL REGISTRATION ClinicalTrials.gov (NCT02494063). RESULTS We analysed data for 395 preregistered patients. Bilateral detection was achieved in 91% (355/395), and it was unaffected by tumour size, tumour stage or body mass index, but it was lower in older patients, in patients who underwent open surgery, and in sites with fewer cases. No SLN were found outside the seven anatomical pelvic regions. Most SLN and positive SLN were localised below the common iliac artery bifurcation. Single positive SLN above the iliac bifurcation were found in 2% of cases. Frozen sections failed to detect 54% of positive lymph nodes (pN1), including 28% of cases with macrometastases and 90% with micrometastases. INTERPRETATION SLN biopsy can achieve high bilateral SLN detection in patients with tumours of 4 cm or smaller. At experienced centres, all SLN were found in the pelvis, and most were located below the iliac vessel bifurcation. SLN frozen section assessment is an unreliable tool for intraoperative triage because it only detects about half of N1 cases.
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Affiliation(s)
- David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - Roman Kocian
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Andrea Plaikner
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jaroslav Klat
- Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava Poruba, Czech Republic
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Radovan Pilka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, Olomouc, Czech Republic
| | - Aureli Torne
- Unit of Gynecological Oncology, Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clinic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Borek Sehnal
- Department of Obstetrics and Gynecology, Bulovka Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marcela Ostojich
- Department of Gynecology, Institute of Oncology Angel H. Roffo, University of Buenos Aires, Buenos Aires Autonomous City, Argentina
| | - Almerinda Petiz
- Department of Gynecology, Francisco Gentil Portuguese Oncology Institute, Porto, Portugal
| | - Octavio A Sanchez
- Department of Gynecologic Oncology, University Hospital of the Canary Islands, Las Palmas de Gran Canaria, Spain
| | - Jiri Presl
- Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, Prague, Czech Republic
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology Surgery, San Gerardo Hospital, Monza, Italy
| | | | - Peter Kascak
- Department of Obstetrics and Gynecology, Faculty Hospital Trencin, Trencin, Slovakia
| | - Luc van Lonkhuijzen
- Center for Gynecologic Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marc Barahona
- Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, Barcelona, Spain
| | - Lubos Minar
- Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Pawel Blecharz
- Department of Gynecologic Oncology, Centre of Oncology, M. Sklodowska-Curie Memorial Institute, Cracow Department, Cracow, Poland
| | - Maja Pakiz
- University Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Dariusz Wydra
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, Poland
| | - Leon C Snyman
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Kamil Zalewski
- Department of Gynecologic Oncology, Holycross Cancer Center, Kielce, Poland
| | - Cristina Zorrero
- Gynecology Department, Instituto Valenciano de Oncologia (IVO), Valencia, Spain
| | - Pavel Havelka
- Department of Obstetrics and Gynecology, KNTB a.s Zlin, Czech Republic
| | - Mikulas Redecha
- Department of Gynaecology and Obstetrics, University Hospital, Comenius University, Bratislava, Slovakia
| | | | - Ignace Vergote
- Department of Gynecology and Obstetrics, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Martin Michal
- Department of Obstetrics and Gynaecology, Hospital Ceske Budejovice, JSC, Ceske Budejovice, Czech Republic
| | - Barbara Kipp
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Jiri Slama
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Simone Marnitz
- Department of Radiation Oncology, CyberKnife and Radiotherapy University Hospital Cologne, Cologne, Germany
| | - Sylva Bajsova
- Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava Poruba, Czech Republic
| | - Alicia Hernandez
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Daniela Fischerova
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Kristyna Nemejcova
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Christhardt Kohler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
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Frumovitz M, Obermair A, Coleman RL, Pareja R, Lopez A, Ribero R, Isla D, Rendon G, Bernardini MQ, Buda A, Moretti-Marquez R, Zevallos A, Vieira MA, Zhu T, Land RP, Nicklin J, Asher R, Robledo KP, Gebski V, Ramirez PT. Quality of life in patients with cervical cancer after open versus minimally invasive radical hysterectomy (LACC): a secondary outcome of a multicentre, randomised, open-label, phase 3, non-inferiority trial. Lancet Oncol 2020; 21:851-860. [PMID: 32502445 DOI: 10.1016/s1470-2045(20)30081-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND In the phase 3 LACC trial and a subsequent population-level review, minimally invasive radical hysterectomy was shown to be associated with worse disease-free survival and higher recurrence rates than was open radical hysterectomy in patients with early stage cervical cancer. Here, we report the results of a secondary endpoint, quality of life, of the LACC trial. METHODS The LACC trial was a randomised, open-label, phase 3, non-inferiority trial done in 33 centres worldwide. Eligible participants were women aged 18 years or older with International Federation of Gynaecology and Obstetrics (FIGO) stage IA1 with lymphovascular space invasion, IA2, or IB1 adenocarcinoma, squamous cell carcinoma, or adenosquamous carcinoma of the cervix, with an Eastern Cooperative Oncology Group performance status of 0 or 1, who were scheduled to have a type 2 or 3 radical hysterectomy. Participants were randomly assigned (1:1) to receive open or minimally invasive radical hysterectomy. Randomisation was done centrally using a computerised minimisation program, stratified by centre, disease stage according to FIGO guidelines, and age. Neither participants nor investigators were masked to treatment allocation. The primary endpoint of the LACC trial was disease-free survival at 4·5 years, and quality of life was a secondary endpoint. Eligible patients completed validated quality-of-life and symptom assessments (12-item Short Form Health Survey [SF-12], Functional Assessment of Cancer Therapy-Cervical [FACT-Cx], EuroQoL-5D [EQ-5D], and MD Anderson Symptom Inventory [MDASI]) before surgery and at 1 and 6 weeks and 3 and 6 months after surgery (FACT-Cx was also completed at additional timepoints up to 54 months after surgery). Differences in quality of life over time between treatment groups were assessed in the modified intention-to-treat population, which included all patients who had surgery and completed at least one baseline (pretreatment) and one follow-up (at any timepoint after surgery) questionnaire, using generalised estimating equations. The LACC trial is registered with ClinicalTrials.gov, NCT00614211. FINDINGS Between Jan 31, 2008, and June 22, 2017, 631 patients were enrolled; 312 assigned to the open surgery group and 319 assigned to the minimally invasive surgery group. 496 (79%) of 631 patients had surgery completed at least one baseline and one follow-up quality-of-life survey and were included in the modified intention-to-treat analysis (244 [78%] of 312 patients in the open surgery group and 252 [79%] of 319 participants in the minimally invasive surgery group). Median follow-up was 3·0 years (IQR 1·7-4·5). At baseline, no differences in the mean FACT-Cx total score were identified between the open surgery (129·3 [SD 18·8]) and minimally invasive surgery groups (129·8 [19·8]). No differences in mean FACT-Cx total scores were identified between the groups 6 weeks after surgery (128·7 [SD 19·9] in the open surgery group vs 130·0 [19·8] in the minimally invasive surgery group) or 3 months after surgery (132·0 [21·7] vs 133·0 [22·1]). INTERPRETATION Since recurrence rates are higher and disease-free survival is lower for minimally invasive radical hysterectomy than for open surgery, and postoperative quality of life is similar between the treatment groups, gynaecological oncologists should recommend open radical hysterectomy for patients with early stage cervical cancer. FUNDING MD Anderson Cancer Center and Medtronic.
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Affiliation(s)
- Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, QLD, Australia
| | - Robert L Coleman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rene Pareja
- Instituto Nacional de Cancerología, Bogotá, Colombia; Clínica de Oncología Astorga, Medellín, Colombia
| | - Aldo Lopez
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | | | - David Isla
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Gabriel Rendon
- Instituto de Cancerologia-Las Americas, Medellín, Colombia
| | | | | | - Renato Moretti-Marquez
- Hospital Israelita Albert Einstein, Centro de Oncologia e Hematologia, São Paulo, Brazil
| | | | | | - Tao Zhu
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Hangzhou, China
| | - Russell P Land
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - James Nicklin
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Rebecca Asher
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Kristy P Robledo
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Val Gebski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Paracchini L, Pesenti C, Delle Marchette M, Beltrame L, Bianchi T, Grassi T, Buda A, Landoni F, Ceppi L, Bosetti C, Paderno M, Adorni M, Vicini D, Perego P, Leone BE, D’Incalci M, Marchini S, Fruscio R. Detection of TP53 Clonal Variants in Papanicolaou Test Samples Collected up to 6 Years Prior to High-Grade Serous Epithelial Ovarian Cancer Diagnosis. JAMA Netw Open 2020; 3:e207566. [PMID: 32609349 PMCID: PMC7330718 DOI: 10.1001/jamanetworkopen.2020.7566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE The low 5-year survival rate of women with high-grade serous epithelial ovarian cancer (HGS-EOC) is related to its late diagnosis; thus, improvement in diagnosis constitutes a crucial step to increase the curability of this disease. OBJECTIVE To determine whether the presence of the clonal pathogenic TP53 variant detected in matched primary tumor biopsies can be identified in DNA purified from Papanicolaou test samples collected from women with HGS-EOC years before the diagnosis. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among a single-center cohort of women with histologically confirmed diagnosis of HGS-EOC recruited at San Gerardo Hospital, Monza, Italy, from October 15, 2015, to January 4, 2019. Serial dilutions of DNA derived from tumor samples and DNA extracted from healthy women's Papanicolaou test samples were analyzed to define the sensitivity and specificity of droplet digital polymerase chain reaction assays designed to detect the TP53 variants identified in tumors. All available brush-based Papanicolaou test slides performed up to 6 years before diagnosis were investigated at the Mario Negri Institute, Milano, Italy. Data were analyzed from October 2018 to December 2019. MAIN OUTCOMES AND MEASURES The presence of tumor pathogenic TP53 variants was assessed by the droplet digital polymerase chain reaction approach in DNA purified from Papanicolaou test samples obtained from the same patients before diagnosis during cervical cancer screenings. RESULTS Among 17 included patients (median [interquartile range] age at diagnosis, 60 [53-69] years), Papanicolaou tests withdrawn before diagnosis presented tumor-matched TP53 variants in 11 patients (64%). In 2 patients for whom longitudinal Papanicolaou tests were available, including 1 patient with Papanicolaou tests from 25 and 49 months before diagnosis and 1 patient with Papanicolaou tests from 27 and 68 months before diagnosis, the TP53 clonal variant was detected at all time points. CONCLUSIONS AND RELEVANCE These findings suggest that noninvasive early molecular diagnosis of HGS-EOC is potentially achievable through detection of TP53 clonal variants in the DNA purified from Papanicolaou tests performed during cervical cancer screening.
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Affiliation(s)
- Lara Paracchini
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Pesenti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Martina Delle Marchette
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Luca Beltrame
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Tommaso Bianchi
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Tommaso Grassi
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Fabio Landoni
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Lorenzo Ceppi
- Department of Obstetrics and Gynecology, Azienda Socio Sanitaria Territoriale -Monza, Desio Hospital, Desio, Italy
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Mariachiara Paderno
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Marco Adorni
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Debora Vicini
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Patrizia Perego
- Department of Pathology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Biagio Eugenio Leone
- Department of Pathology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Maurizio D’Incalci
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Sergio Marchini
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Robert Fruscio
- Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Monza, Italy
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Zapardiel I, Iacoponi S, Coronado PJ, Zalewski K, Chen F, Fotopoulou C, Dursun P, Kotsopoulos IC, Jach R, Buda A, Martinez-Serrano MJ, Grimm C, Fruscio R, Garcia E, Sznurkowski JJ, Ruiz C, Noya MC, Barazi D, Diez J, Diaz De la Noval B, Bartusevicius A, De Iaco P, Otero M, Diaz M, Haidopoulos D, Franco S, Blecharz P, Zuñiga MA, Rubio P, Gardella B, Papatheodorou DC, Yildirim Y, Fargas F, Macuks R. Prognostic factors in patients with vulvar cancer: the VULCAN study. Int J Gynecol Cancer 2020; 30:1285-1291. [PMID: 32571891 DOI: 10.1136/ijgc-2019-000526] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/29/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE This study aimed to analyze the prognostic factors for overall and progression-free survival in patients with vulvar cancer. METHODS This international, multicenter, retrospective study included 2453 patients diagnosed with vulvar cancer at 100 different institutions. Inclusion criteria were institutional review board approval from each collaborating center, pathologic diagnosis of invasive carcinoma of the vulva, and primary treatment performed at the participating center. Patients with intraepithelial neoplasia or primary treatment at non-participating centers were excluded. Global survival analysis and squamous cell histology subanalysis was performed. RESULTS After excluding patients due to incomplete data entry, 1727 patients treated for vulvar cancer between January 2001 and December 2005 were registered for analysis (1535 squamous, 42 melanomas, 38 Paget's disease and 112 other histologic types). Melanomas had the worse prognosis (p=0.02). In squamous vulvar tumors, independent factors for increase in local recurrence of vulvar cancer were: no prior radiotherapy (p<0.001) or chemotherapy (p=0.006), and for distant recurrence were the number of positive inguinal nodes (p=0.025), and not having undergone lymphadenectomy (p=0.03) or radiotherapy (p<0.001), with a HR of 1.1 (95% CI 1.2 to 1.21), 2.9 (95% CI 1.4 to 6.1), and 3.1 (95% CI 1.7 to 5.7), respectively. Number of positive nodes (p=0.008), FIGO stage (p<0.001), adjuvant chemotherapy (p=0.001), tumor resection margins (p=0.045), and stromal invasion >5 mm (p=0.001) were correlated with poor overall survival, and large case volume (≥9 vs <9 cases per year) correlated with more favorable overall survival (p=0.05). CONCLUSIONS Advanced patient age, number of positive inguinal lymph nodes, and lack of adjuvant treatment are significantly associated with a higher risk of relapse in patients with squamous cell vulvar cancer. Case volume per treating institution, FIGO stage, and stromal invasion appear to impact overall survival significantly. Future prospective trials are warranted to establish these prognostic factors for vulvar cancer.
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Affiliation(s)
- Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Sara Iacoponi
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Pluvio J Coronado
- Gynecology Department, Hospital Clinico Universitario San Carlos - IdISSC, Madrid, Spain
| | - Kamil Zalewski
- Gynecologic Oncology Department, Maria Sklodowska-Curie Memorial Cancer Center - Institute of Oncology, Warsaw, Poland
| | - Frank Chen
- Department of Gynecology, Campus Virchow-Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Christina Fotopoulou
- Department of Gynecology, Campus Virchow-Klinikum, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Polat Dursun
- Department of Obstetrics and Gynecology Division of Gynecologic Oncology, Baskent University School of Medicine, Ankara, Turkey
| | | | - Robert Jach
- Gynecology Department, University Hospital, Jagiellonian University, Krakow, Poland
| | - Alessandro Buda
- Gynecologic Oncology Department, Hospital San Gerardo, Monza, Lombardia, Italy
| | | | - Christoph Grimm
- Division of General Gynaecology and Gynaecological Oncology, Medical University of Vienna - Vienna General Hospital, Vienna, Austria
| | - Robert Fruscio
- Gynecologic Oncology Department, Hospital San Gerardo, Monza, Lombardia, Italy
| | - Enrique Garcia
- Gynecologic Oncology Department, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Cristina Ruiz
- Gynecologic Oncology Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Maria C Noya
- Gynecology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Dib Barazi
- Gynecologic Oncology Department, Ciudad Sanitaria de Bellvitge, Barcelona, Spain
| | - Javier Diez
- Gynecologic Oncology Department, Hospital de Cruces, Vizcaya, Spain
| | | | - Arnoldas Bartusevicius
- Gynecologic Oncology Department, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania
| | | | - Maria Otero
- Gynecology Department, Complejo Hospitalario de Leon, Leon, Spain
| | - Maria Diaz
- Gynecology Department, Complejo Hospitalario Universitario Juan Canalejo, La Coruña, Spain
| | | | - Silvia Franco
- Gynecology Department, Hospital Vall D'Hebron, Barcelona, Spain
| | - Pawel Blecharz
- Gynecologic Oncology Department, Maria Sklodowska-Curie Memorial Cancer Center, Krakow, Poland
| | - Miguel A Zuñiga
- Gynecology Department, Complejo Hospitalario Torrecardenas, Almeria, Spain
| | - Patricia Rubio
- Gynecology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Barbara Gardella
- Gynecologic Oncology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Yusuf Yildirim
- Gynecologic Oncology Department, Ege Gynaecology Training and Research Hospital, Izmir, Turkey
| | - Francesc Fargas
- Gynecology Department, Instituto Universitario Dexeus, Barcelona, Spain
| | - Ronalds Macuks
- Gynecologic Oncology Department, Riga East Clinical University Hospital Latvian Oncology Center, Riga, Latvia
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Grassi T, Dell'Orto F, Jaconi M, Lamanna M, De Ponti E, Paderno M, Landoni F, Leone BE, Fruscio R, Buda A. Two ultrastaging protocols for the detection of lymph node metastases in early-stage cervical and endometrial cancers. Int J Gynecol Cancer 2020; 30:1404-1410. [PMID: 32376740 DOI: 10.1136/ijgc-2020-001298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To date, there is no universal consensus on which is the optimal ultrastaging protocol for sentinel lymph node (SLN) evaluation in gynecologic malignancies. To estimate the impact of different ultrastaging methods of SLNs on the detection of patients with nodal metastases in early-stage cervical and endometrial cancers and to describe the incidence of low-volume metastases between two ultrastaging protocols. METHODS We retrospectively compared two ultrastaging protocols (ultrastaging-A vs ultrastaging-B) in patients with clinical stage I endometrial cancer or FIGO stage IA-IB1 cervical cancer who underwent primary surgery including SLN biopsy from October 2010 to December 2017 in our institution. The histologic subtypes and grades of the tumors were evaluated according to WHO criteria. Only SLNs underwent ultrastaging, while other lymph nodes were sectioned and examined by routine hematoxylin and eosin (H&E). RESULTS Overall 224 patients were reviewed (159 endometrial cancer and 65 cervical cancer). Lymph node involvement was noted in 15% of patients with endometrial cancer (24/159): 24% of patients (9/38) with the ultrastaging protocol A and 12% (15/121) with the ultrastaging protocol B (p=0.08); while for cervical cancer, SLN metastasis was detected in 14% of patients (9/65): 22% (4/18) in ultrastaging-A and 11% (5/47) in ultrastaging-B (p=0.20). Overall, macrometastasis and low-volume metastases were 50% and 50% for endometrial cancer and 78% and 22% for cervical cancer. Median size of nodal metastasis was 2 (range 0.9-8.5) mm for the ultrastaging-A and 1.2 (range 0.4-2.6) mm for the ultrastaging-B protocol in endometrial cancer (p=0.25); 4 (range 2.5-9.8) mm for ultrastaging-A and 4.4 (range 0.3-7.8) mm for ultrastaging-B protocol in cervical cancer (p=0.64). CONCLUSION In endometrial or cervical cancer patients, the incidence of SLN metastasis was not different between the two different types of ultrastaging protocol.
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Affiliation(s)
- Tommaso Grassi
- Obstetrics and Gynecology, Hospital San Gerardo, Monza, Lombardia, Italy
| | - Federica Dell'Orto
- Obstetrics and Gynecology, Hospital San Gerardo, Monza, Lombardia, Italy
| | - Marta Jaconi
- Pathology, Hospital San Gerardo, Monza, Lombardia, Italy
| | - Maria Lamanna
- Obstetrics and Gynecology, Hospital San Gerardo, Monza, Lombardia, Italy
| | - Elena De Ponti
- Physical Medicine, Hospital San Gerardo, Monza, Lombardia, Italy
| | | | - Fabio Landoni
- Obstetrics and Gynecology, University of Milan-Bicocca, Milano, Lombardia, Italy
| | | | - Robert Fruscio
- Obstetrics and Gynecology, University of Milan-Bicocca, Milano, Lombardia, Italy
| | - Alessandro Buda
- Obstetrics and Gynecology, Hospital San Gerardo, Monza, Lombardia, Italy
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Nemejcova K, Kocian R, Kohler C, Jarkovsky J, Klat J, Berjon A, Pilka R, Sehnal B, Gil-Ibanez B, Lupo E, Petiz A, Arencibia Sanchez O, Kascak P, Martinelli F, Buda A, Presl J, Barahona M, van Lonkhuijzen L, Szatkowski W, Minar L, Pakiz M, Havelka P, Zorrero C, Misiek M, Snyman LC, Wydra D, Vergote I, Vinnytska A, Redecha M, Michal M, Tingulstad S, Kipp B, Szewczyk G, Toth R, de Santiago Garcia FJ, Coronado Martin PJ, Poka R, Tamussino K, Luyckx M, Fastrez M, Staringer JC, Germanova A, Plaikner A, Bajsova S, Dundr P, Mallmann-Gottschalk N, Cibula D. Central Pathology Review in SENTIX, A Prospective Observational International Study on Sentinel Lymph Node Biopsy in Patients with Early-Stage Cervical Cancer (ENGOT-CX2). Cancers (Basel) 2020; 12:cancers12051115. [PMID: 32365651 PMCID: PMC7281480 DOI: 10.3390/cancers12051115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023] Open
Abstract
The quality of pathological assessment is crucial for the safety of patients with cervical cancer if pelvic lymph node dissection is to be replaced by sentinel lymph node (SLN) biopsy. Central pathology review of SLN pathological ultrastaging was conducted in the prospective SENTIX/European Network of Gynaecological Oncological Trial (ENGOT)-CX2 study. All specimens from at least two patients per site were submitted for the central review. For cases with major or critical deviations, the sites were requested to submit all samples from all additional patients for second-round assessment. From the group of 300 patients, samples from 83 cases from 37 sites were reviewed in the first round. Minor, major, critical, and no deviations were identified in 28%, 19%, 14%, and 39% of cases, respectively. Samples from 26 patients were submitted for the second-round review, with only two major deviations found. In conclusion, a high rate of major or critical deviations was identified in the first round of the central pathology review (28% of samples). This reflects a substantial heterogeneity in current practice, despite trial protocol requirements. The importance of the central review conducted prospectively at the early phase of the trial is demonstrated by a substantial improvement of SLN ultrastaging quality in the second-round review.
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Affiliation(s)
- Kristyna Nemejcova
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (K.N.); (P.D.)
| | - Roman Kocian
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (R.K.); (A.G.)
| | - Christhardt Kohler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany; (C.K.); (A.P.)
| | - Jiri Jarkovsky
- Institute for Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic;
| | - Jaroslav Klat
- Department of Obstetrics and Gynecology, University Hospital Ostrava, 708 52 Ostrava Poruba, Czech Republic; (J.K.); (S.B.)
| | - Alberto Berjon
- Department of Pathology, La Paz University Hospital, 28046 Madrid, Spain;
- Molecular Pathology and Therapeutic Targets Group, IdiPAZ, 28046 Madrid, Spain
| | - Radovan Pilka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, 77520 Olomouc, Czech Republic;
| | - Borek Sehnal
- Department of Obstetrics and Gynecology, Bulovka Hospital, First Faculty of Medicine, Charles University, 18081 Prague, Czech Republic;
| | - Blanca Gil-Ibanez
- Unit of Gynecological Oncology, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, 08036 Barcelona, Spain;
| | - Ezequiel Lupo
- Department of Pathology, Institute of Oncology Angel H. Roffo, University of Buenos Aires, Buenos Aires Autonomous City 1214, Argentina;
| | - Almerinda Petiz
- Department of Gynecology, Francisco Gentil Portuguese Oncology Institute, 4200-072 Porto, Portugal;
| | - Octavio Arencibia Sanchez
- Departments of Gynecologic Oncology, University Hospital of the Canary Islands, 35016 Las Palmas de Gran Canaria, Spain;
| | - Peter Kascak
- Department of Obstetrics and Gynecology, Faculty Hospital Trencin, 91171 Trencin, Slovakia;
| | - Fabio Martinelli
- IRCCS Foundation National Cancer Institute in Milan, 20133 Milan, Italy;
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology Surgery, San Gerardo Hospital, 20900 Monza, Italy;
| | - Jiri Presl
- Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, 30460 Prague, Czech Republic;
| | - Marc Barahona
- Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, 08907 Barcelona, Spain;
| | - Luc van Lonkhuijzen
- Center for Gynecologic Oncology, Academic Medical Centre, 1100DD Amsterdam, The Netherlands;
| | - Wiktor Szatkowski
- Department of Gynecologic Oncology, Centre of Oncology, M. Sklodowska-Curie Memorial Institute, Cracow Department, 31-115 Cracow, Poland;
| | - Lubos Minar
- Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, 60200 Brno, Czech Republic;
| | - Maja Pakiz
- University Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, 2000 Maribor, Slovenia;
| | | | - Cristina Zorrero
- Gynecology Department, Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain;
| | - Marcin Misiek
- Department of Gynecologic Oncology, Holycross Cancer Center, 25-734 Kielce, Poland;
| | - Leon Cornelius Snyman
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria 0001, South Africa;
| | - Dariusz Wydra
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, 80-402 Gdansk, Poland;
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, University Hospital Leuven, Leuven Cancer Institute, 3000 Leuven, Belgium;
| | - Alla Vinnytska
- LISOD-Israeli Oncological Hospital, 08720 Plyuty, Ukraine;
| | - Mikulas Redecha
- Department of Gynaecology and Obstetrics, University Hospital, Comenius University, 82101 Bratislava, Slovakia;
| | - Martin Michal
- Department of Obstetrics and Gynaecology, Hospital Ceske Budejovice, JSC, 37001 Ceske Budejovice, Czech Republic;
| | | | - Barbara Kipp
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland;
| | - Grzegorz Szewczyk
- Department of Obstetrics and Gynecology, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Robert Toth
- Oncology Institute of East Slovakia, 04191 Košice, Slovakia;
| | | | | | - Robert Poka
- Institute of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | | | - Mathieu Luyckx
- Department of Gynecology, Universite catholique de Louvain, Cliniques Universitaires St Luc, 1200 Brussels, Belgium;
| | - Maxime Fastrez
- Department of Obstetrics and Gynaecology, St Pierre University Hospital, Universite Libre de Bruxelles, 1000 Brussels, Belgium;
| | - Juan Carlos Staringer
- Department of Gynecology and Obstetrics, Hospital Español de Buenos Aires, Buenos Aires 2975, Argentina;
| | - Anna Germanova
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (R.K.); (A.G.)
| | - Andrea Plaikner
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany; (C.K.); (A.P.)
| | - Sylva Bajsova
- Department of Obstetrics and Gynecology, University Hospital Ostrava, 708 52 Ostrava Poruba, Czech Republic; (J.K.); (S.B.)
| | - Pavel Dundr
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (K.N.); (P.D.)
| | | | - David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (R.K.); (A.G.)
- Correspondence: ; Tel.: +420-224967451
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Abu-Rustum NR, Angioli R, Bailey AE, Broach V, Buda A, Coriddi MR, Dayan JH, Frumovitz M, Kim YM, Kimmig R, Leitao MM, Muallem MZ, McKittrick M, Mehrara B, Montera R, Moukarzel LA, Naik R, Pedra Nobre S, Plante M, Plotti F, Zivanovic O. IGCS Intraoperative Technology Taskforce. Update on near infrared imaging technology: beyond white light and the naked eye, indocyanine green and near infrared technology in the treatment of gynecologic cancers. Int J Gynecol Cancer 2020; 30:670-683. [PMID: 32234846 DOI: 10.1136/ijgc-2019-001127] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Nadeem R Abu-Rustum
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | - Arthur E Bailey
- Research and Development, Stryker Endoscopy, San Jose, California, USA
| | - Vance Broach
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Azienda Ospedaliera San Gerardo, Monza, Italy
| | - Michelle R Coriddi
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Joseph H Dayan
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Michael Frumovitz
- Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yong Man Kim
- Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Rainer Kimmig
- Gynecology and Obstetrics, University Hospital of Duisburg-Essen, Essen, Germany
| | - Mario M Leitao
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Mustafa Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Matt McKittrick
- Research and Development, Stryker Endoscopy, San Jose, California, USA
| | - Babak Mehrara
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Roberto Montera
- Universita Campus Bio-Medico di Roma Facolta di Medicina e Chirurgia, Roma, Lazio, Italy
| | - Lea A Moukarzel
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Raj Naik
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK
| | - Silvana Pedra Nobre
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Marie Plante
- Obstetrics and Gynecology, Centre Hospitalier Universitaire de Quebec, Quebec, Quebec, Canada
| | - Francesco Plotti
- Universita Campus Bio-Medico di Roma Facolta di Medicina e Chirurgia, Roma, Lazio, Italy
| | - Oliver Zivanovic
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Buda A, Yaprak E, MIlani R, Frigerio M, Perego R, Jaconi M, Meregalli S. Locally-advanced vaginal cancer with complete utero-vaginal prolapse. Int J Gynecol Cancer 2020; 30:705-708. [PMID: 32139436 DOI: 10.1136/ijgc-2020-001326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Alessandro Buda
- Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy
| | | | | | - Matteo Frigerio
- Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy
| | - Rosangela Perego
- Department of Radiology, Azienda Ospedaliera San Gerardo, Monza, Italy
| | - Marta Jaconi
- Department of Pathology, San Gerardo Hospital, Monza, Lombardia, Italy
| | - Sofia Meregalli
- Department of Radiotherapy, San Gerardo Hospital, Monza, Italy
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45
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Obermair A, Asher R, Pareja R, Frumovitz M, Lopez A, Moretti-Marques R, Rendon G, Ribeiro R, Tsunoda A, Behan V, Buda A, Bernadini MQ, Zhao H, Vieira M, Walker J, Spirtos NM, Yao S, Chetty N, Zhu T, Isla D, Tamura M, Nicklin J, Robledo KP, Gebski V, Coleman RL, Salvo G, Ramirez PT. Incidence of adverse events in minimally invasive vs open radical hysterectomy in early cervical cancer: results of a randomized controlled trial. Am J Obstet Gynecol 2020; 222:249.e1-249.e10. [PMID: 31586602 DOI: 10.1016/j.ajog.2019.09.036] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Standard treatment of early cervical cancer involves a radical hysterectomy and retroperitoneal lymph node dissection. The existing evidence on the incidence of adverse events after minimally invasive vs open radical hysterectomy for early cervical cancer is either nonrandomized or retrospective. OBJECTIVE The purpose of this study was to compare the incidence of adverse events after minimally invasive vs open radical hysterectomy for early cervical cancer. STUDY DESIGN The Laparoscopic Approach to Carcinoma of the Cervix trial was a multinational, randomized noninferiority trial that was conducted between 2008 and 2017, in which surgeons from 33 tertiary gynecologic cancer centers in 24 countries randomly assigned 631 women with International Federation of Gynecology and Obstetrics 2009 stage IA1 with lymph-vascular invasion to IB1 cervical cancer to undergo minimally invasive (n = 319) or open radical hysterectomy (n = 312). The Laparoscopic Approach to Carcinoma of the Cervix trial was suspended for enrolment in September 2017 because of an increased risk of recurrence and death in the minimally invasive surgery group. Here we report on a secondary outcome measure: the incidence of intra- and postoperative adverse events within 6 months after surgery. RESULTS Of 631 randomly assigned patients, 536 (85%; mean age, 46.0 years) met inclusion criteria for this analysis; 279 (52%) underwent minimally invasive radical hysterectomy, and 257 (48%) underwent open radical hysterectomy. Of those, 300 (56%), 91 (16.9%), and 69 (12.8%) experienced at least 1 grade ≥2 or ≥3 or a serious adverse event, respectively. The incidence of intraoperative grade ≥2 adverse events was 12% (34/279 patients) in the minimally invasive group vs 10% (26/257) in the open group (difference, 2.1%; 95% confidence interval, -3.3 to 7.4%; P=.45). The overall incidence of postoperative grade ≥2 adverse events was 54% (152/279 patients) in the minimally invasive group vs 48% (124/257) in the open group (difference, 6.2%; 95% confidence interval, -2.2 to 14.7%; P=.14). CONCLUSION For early cervical cancer, the use of minimally invasive compared with open radical hysterectomy resulted in a similar overall incidence of intraoperative or postoperative adverse events.
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Affiliation(s)
- Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, University of Queensland, Centre for Clinical Research, RBWH, Herston, QLD Australia.
| | - Rebecca Asher
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Sydney, NSW Australia
| | - Rene Pareja
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá and Clínica de Oncología Astorga, Medellín, Colombia
| | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aldo Lopez
- Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Renato Moretti-Marques
- Gynecologic Oncology Division, Oncologic Center, Hospital Israelita Albert Einstein, São Paulo-SP, Brazil
| | - Gabriel Rendon
- Instituto de Cancerologia-Las Americas, Medellín, Colombia
| | - Reitan Ribeiro
- Department of Surgery, Erasto Gaertner Hospital, Curitiba, Brazil
| | - Audrey Tsunoda
- Department of Surgery, Erasto Gaertner Hospital, Curitiba, Brazil
| | - Vanessa Behan
- Queensland Centre for Gynaecological Cancer Research, University of Queensland, Centre for Clinical Research, RBWH, Herston, QLD Australia
| | - Alessandro Buda
- Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza MB, Italy
| | - Marcus Q Bernadini
- Department of Gynecologic Oncology, Princess Margaret Cancer Center, Ontario, Canada
| | - Hongqin Zhao
- Department of Gynecology, First Affiliated Hospital of Wenzhou Medical College, Ouhai, Wenzhou, China
| | - Marcelo Vieira
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - Joan Walker
- Department of Gynecologic Oncology, Stephenson Cancer Center, University of Oklahoma, Norman, OK
| | - Nick M Spirtos
- Division of Gynecologic Oncology, Women's Cancer Center of Nevada, LV
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Naven Chetty
- Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane, QLD, Australia
| | - Tao Zhu
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - David Isla
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico
| | - Mariano Tamura
- Gynecologic Oncology Division, Oncologic Center, Hospital Israelita Albert Einstein, São Paulo-SP, Brazil
| | - James Nicklin
- Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital and The University of Queensland, Brisbane, QLD, Australia
| | - Kristy P Robledo
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Sydney, NSW Australia
| | - Val Gebski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Sydney, NSW Australia
| | - Robert L Coleman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gloria Salvo
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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46
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Crivellaro C, Landoni C, Elisei F, Buda A, Bonacina M, Grassi T, Monaco L, Giuliani D, Gotuzzo I, Magni S, Di Martino G, Delle Marchette M, Guerra L, Landoni F, Fruscio R, Messa C, De Bernardi E. Combining positron emission tomography/computed tomography, radiomics, and sentinel lymph node mapping for nodal staging of endometrial cancer patients. Int J Gynecol Cancer 2020; 30:378-382. [PMID: 32079712 DOI: 10.1136/ijgc-2019-000945] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To evaluate the combination of positron emission tomography/computed tomography (PET/CT) and sentinel lymph node (SLN) biopsy in women with apparent early-stage endometrial carcinoma. The correlation between radiomics features extracted from PET images of the primary tumor and the presence of nodal metastases was also analyzed. METHODS From November 2006 to March 2019, 167 patients with endometrial cancer were included. All women underwent PET/CT and surgical staging: 60/167 underwent systematic lymphadenectomy (Group 1) while, more recently, 107/167 underwent SLN biopsy (Group 2) with technetium-99m +blue dye or indocyanine green. Histology was used as standard reference. PET endometrial lesions were segmented (n=98); 167 radiomics features were computed inside tumor contours using standard Image Biomarker Standardization Initiative (IBSI) methods. Radiomics features associated with lymph node metastases were identified (Mann-Whitney test) in the training group (A); receiver operating characteristic (ROC) curves, area under the curve (AUC) values were computed and optimal cut-off (Youden index) were assessed in the test group (B). RESULTS In Group 1, eight patients had nodal metastases (13%): seven correctly ridentified by PET/CT true-positive with one false-negative case. In Group 2, 27 patients (25%) had nodal metastases: 13 true-positive and 14 false-negative. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT for pelvic nodal metastases were 87%, 94%, 93%, 70%, and 98% in Group 1 and 48%, 97%, 85%, 87%, and 85% in Group 2, respectively. On radiomics analysis a significant association was found between the presence of lymph node metastases and 64 features. Volume-density, a measurement of shape irregularity, was the most predictive feature (p=0001, AUC=0,77, cut-off 0.35). When testing cut-off in Group B to discriminate metastatic tumors, PET false-negative findings were reduced from 14 to 8 (-43%). CONCLUSIONS PET/CT demonstrated high specificity in detecting nodal metastases. SLN and histologic ultrastaging increased false-negative PET/CT findings, reducing the sensitivity of the technique. PET radiomics features of the primary tumor seem promising for predicting the presence of nodal metastases not detected by visual analysis.
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Affiliation(s)
- Cinzia Crivellaro
- Nuclear Medicine Department, ASST di Monza San Gerardo Hospital, Monza, Lombardia, Italy
| | - Claudio Landoni
- Nuclear Medicine Department, ASST di Monza San Gerardo Hospital, Monza, Lombardia, Italy.,School of Medicine and Surgery, University of Milan-Biocca, Monza, Lombardia, Italy
| | - Federica Elisei
- Nuclear Medicine Department, ASST di Monza San Gerardo Hospital, Monza, Lombardia, Italy
| | - Alessandro Buda
- Gynaecologic Oncology Surgical Unit, Obstetrics and Gynaecology Department, ASST-Monza, San Gerardo Hospital, Milano, Lombardia, Italy
| | | | - Tommaso Grassi
- Gynaecologic Oncology Surgical Unit, Obstetrics and Gynaecology Department, ASST-Monza, San Gerardo Hospital, Milano, Lombardia, Italy
| | | | - Daniela Giuliani
- Gynaecologic Oncology Surgical Unit, Obstetrics and Gynaecology Department, ASST-Monza, San Gerardo Hospital, Milano, Lombardia, Italy
| | - Irene Gotuzzo
- University of Milan-Bicocca, Milano, Lombardia, Italy
| | - Sonia Magni
- University of Milan-Bicocca, Milano, Lombardia, Italy
| | - Giampaolo Di Martino
- Gynaecologic Oncology Surgical Unit, Obstetrics and Gynaecology Department, ASST-Monza, San Gerardo Hospital, Milano, Lombardia, Italy
| | | | - Luca Guerra
- Nuclear Medicine Department, ASST di Monza San Gerardo Hospital, Monza, Lombardia, Italy.,School of Medicine and Surgery, University of Milan-Biocca, Monza, Lombardia, Italy
| | - Fabio Landoni
- School of Medicine and Surgery, University of Milan-Biocca, Monza, Lombardia, Italy.,Gynaecologic Oncology Surgical Unit, Obstetrics and Gynaecology Department, ASST-Monza, San Gerardo Hospital, Milano, Lombardia, Italy
| | - Robert Fruscio
- School of Medicine and Surgery, University of Milan-Biocca, Monza, Lombardia, Italy.,Gynaecologic Oncology Surgical Unit, Obstetrics and Gynaecology Department, ASST-Monza, San Gerardo Hospital, Milano, Lombardia, Italy
| | - Cristina Messa
- University of Milan-Bicocca, Milano, Lombardia, Italy.,Tecnomed Foundation, University of Milan-Bicocca, Milano, Lombardia, Italy
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Fanfani F, Monterossi G, Di Meo ML, La Fera E, Dell'Orto F, Gioè A, Lamanna M, Ferrari D, De Ponti E, Perego P, Restaino S, Carlo R, Zannoni GF, Landoni F, Scambia G, Buda A. Standard ultra-staging compared to one-step nucleic acid amplification for the detection of sentinel lymph node metastasis in endometrial cancer patients: a retrospective cohort comparison. Int J Gynecol Cancer 2020; 30:372-377. [PMID: 31996396 DOI: 10.1136/ijgc-2019-000937] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The objective of this study was to compared standard ultra-staging (SU) with one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node (SLN) metastasis in women with apparent uterine-confined endometrial cancer. METHODS All women underwent SLN identification with complete surgical staging. All SLNs were cut perpendicular to the long axis and two adjacent 5 µm sections were cut at each of two levels 50 µm apart. At each level, one slide was stained with hematoxylin and eosin and the other with immunohistochemistry using the AE1/AE3 anti-cytokeratin antibody, as well as one negative control slide for a total of five slides per block. For OSNA analysis, the 2 mm sections of the lymph nodes were homogenized to form a lysate. The lysate was then centrifuged and inserted into the RD 100i instrument where the isothermal amplification of CK19 mRNA was executed. RESULTS Of the 396 patients included in the retrospective analysis, 214 were in the SU group, and 182 in the OSNA group. Overall 869 SLNs were identified (490 SU, 379 OSNA). Sixty patients exhibited SLN metastasis (34 SU, 26 OSNA). Macrometastasis, micrometastases, and isolated tumor cells (ITC) were 5.1%, 4.1%, and 0.2%, respectively, in the US group, and 2.4%, 6.3%, and 0.1%, respectively, in the OSNA group (p=0.022). CONCLUSIONS The OSNA assay detected a higher rate of micrometastasis and a lower rate of macrometastasis and ITC when compared with SU. The clinical and prognostic impact of ITC is debatable and controversial. Further studies are needed to clarify the respective roles of the OSNA and SU methods, and the possible role of ITC in the prognosis of patients with apparent early-stage endometrial cancer.
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Affiliation(s)
- Francesco Fanfani
- Università Cattolica del Sacro Cuore, Roma, Italy.,Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Giorgia Monterossi
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Maria Letizia Di Meo
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Federica Dell'Orto
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Maria Lamanna
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Debora Ferrari
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Elena De Ponti
- Gynecologic Pathology Unit, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
| | - Patrizia Perego
- Department of Pathology, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Stefano Restaino
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Ronsini Carlo
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Gian Franco Zannoni
- Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Physical Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Fabio Landoni
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giovanni Scambia
- Università Cattolica del Sacro Cuore, Roma, Italy .,Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Alessandro Buda
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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Dell'Orto F, Laven P, Delle Marchette M, Lambrechts S, Kruitwagen R, Buda A. Feasibility of sentinel lymph node mapping of the ovary: a systematic review. Int J Gynecol Cancer 2019; 29:1209-1215. [DOI: 10.1136/ijgc-2019-000606] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/27/2019] [Accepted: 07/02/2019] [Indexed: 01/08/2023] Open
Abstract
Pelvic and para-aortic lymphadenectomy is routinely performed in early ovarian cancer to define the stage of the disease. However, it may be associated with increased blood loss, operative time, and length of hospitalization. The sentinel lymph node technique has been shown to be safe and feasible in vulvar, uterine, and cervical cancer. Data detailing feasibility and outcomes of sentinel lymph node mapping in ovarian cancer are scarce.To summarize the studies evaluating the feasibility of sentinel lymph node detection from the ovary, examining the technique and detection rate.A systematic search of the literature was performed using PubMed and Embase from June 1991 to February 2019. Studies describing the sentinel lymph node technique and lymphatic drainage of the ovaries were incorporated in this review. Ten articles were selected, comprising a total of 145 patients. A variety of agents were used, but the primary markers were technetium-99m radiocolloid (Tc-99m), patent blue, or indocyanine green, and the most common injection site was the ovarian ligaments.The overall sentinel lymph node detection rate was 90.3%.We propose a standardized technique sentinel lymph node mapping in ovarian cancer, using indocyanine green, or Tc-99m and blue dye as alternative tracers, injected in both the suspensory and the infundibulopelvic ligament of the ovary.
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Peiretti M, Candotti G, Buda A, Zapardiel I, Fanni D, Proto A, Fais ML, Mais V. Feasibility of hand-assisted laparoscopic sentinel node biopsy in open endometrial cancer surgery. MINIM INVASIV THER 2019; 29:299-303. [PMID: 31187667 DOI: 10.1080/13645706.2019.1628063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The aim of this preliminary retrospective study was to assess the feasibility and accuracy of Indocyanine Green (ICG) sentinel node (SLN) sampling using a laparoscopic camera during open endometrial cancer surgery.Material and methods: Retrospective study. Fourteen women with endometrial cancer, not fit for a complete laparoscopic staging, underwent SLN mapping using the IMAGE1 camera during open surgery.Results: The median age of patients was 67 (range 33-86) years. Median BMI was 31 (range 23-58). Mean operative time 157.5 minutes and hospital stay three days. The overall detection rate of SLN mapping was 93%. Bilateral detection was 86%. No post-operative short or long-term complications were observed.Conclusions: Real-time NIR technology supported by the IMAGE1 S is a reliable system and represents a promising method for SLN mapping in selected cases with EC and severe surgical risks, during 48 traditional open approaches. The use of laparoscopy ICG in open surgery seems to be a feasible and useful tool for the detection of SLN in endometrial cancer patients with intraoperative and/or postoperative high morbidity risk. It represents a valid alternative to robotic surgery, particularly in countries and centers where the robotic platform or SPY system for open surgery are not available.
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Affiliation(s)
- Michele Peiretti
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Italy
| | - Giorgio Candotti
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Italy
| | - Alessandro Buda
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST-Monza, San Gerardo Hospital, Milano, Italy
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Daniela Fanni
- Division of Pathology, Department of Surgical Sciences, Universita degli Studi di Cagliari Facolta di Medicina e Chirurgia Ringgold standard institution, Monserrato, Italy
| | - Anna Proto
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Italy
| | - Maria Luisa Fais
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Italy
| | - Valerio Mais
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Italy
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Buda A, De Bernardi E, Crivellaro C, Elisei F, Marchette MD, Paderno M, Guerra L, Fruscio R. 18F-FDG PET/CT in preoperative nodal staging of endometrial cancer: The role of radiomics to improve sensitivity in detecting nodal metastases. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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