Endometrial cancer of the very elderly: Management and survival in the Francogyn population

INTRODUCTION

We aimed to describe management and survival of patients with endometrial cancer (EC) ≥80 years to identify poor prognosis criteria.

METHODS

We collected clinical, histologic, surgical and follow-up data for patients with EC ≥ 80 years included in a multicenter French cohort (FRANCOGYN) who underwent primary surgical treatment from 1999 to 2019. The outcomes were overall survival (OS) and disease-free survival (DFS). We performed a descriptive analysis then a survival time analysis and comparison using the Kaplan Meier method and log-rank test.

RESULTS

Of the 1647 patients with EC who received treatment during the study period, 184 (11.17%) were ≥80 years. The mean age was 84 years (±3.34). Thirty-three patients (25.4%) died during the follow-up period and 26 relapsed (18.4%). Forty-nine patients were lost to follow-up (27.37%). The median follow-up time was 15.3 months (4.9-28.8). The median OS and DFS was 16.4 months (6.3-24.9) and 13.6 months (4.5-26.6), respectively. Eighty-three patients received adjuvant therapy (45.11%), out of 95 who had a formal or relative indication. Four patients received adjuvant chemotherapy (2.6%), out of 61 who had a formal or relative indication. Inappropriate or underuse of chemotherapy was significantly associated with a lower median OS of 12.6 months [3.73-24] versus 17.3 months [7.93-41.77] when performed appropriately (HR = 4.14, CI 95% [1.62-10.56]), and a lower median DFS of 10.83 months [3.73-24] versus 17.3 months [7.93-28.5] (HR = 9.04, CI 95% [2.04-40.12]).

CONCLUSION

Our results suggest that very elderly patients with EC should receive adjuvant chemotherapy according to the standard care guidelines.

A Preoperative Scoring System for Adnexal Mass in Children and Adolescents to Preserve Their Future Fertility

STUDY OBJECTIVE

To develop a predictive score for ovarian malignancy to avoid unnecessary adnexectomy in cases of adnexal mass in pediatric and adolescent girls.

DESIGN

A population-based retrospective study on girls who underwent surgery for an ovarian mass with normal levels of human chorionic gonadotrophin and alpha fetoprotein between 1996 and 2016.

SETTING

Rennes University Hospital, Rennes, France.

PARTICIPANTS

Eighty-one patients who received surgery for ovarian tumor.

MAIN OUTCOME MEASURES

The main outcome measure was the rate of malignant and borderline tumor. A preoperative scoring system was constructed after multivariate analysis.

RESULTS

The rate of malignant ovarian tumor was 6/81 (7%), borderline tumor was 7/81 (9%) (ie, outcome measure: 16%), and benign tumor was 84%. In a univariate analysis, the characteristics significantly associated with malignancy were early puberty, palpable mass, size and content of the tumor, and positive epithelial tumor markers (carcinoma antigen 125, carcinoembryonic antigen, and carcinoma antigen 19-9). The predictive malignancy score was on the basis of 2 variables obtained after multivariate analysis: tumor size and cystic content. The score defined 3 groups at risk for malignancy: low risk, middle-risk, and high-risk. The sensitivity for detecting malignancy was 1.3% (95% confidence interval [CI], 0.1-18.4), 26.2% (95% CI, 11.6-49.0), and 53.1% (95% CI, 29.1-75.8), respectively.

CONCLUSION

We set up a simple predictive score of malignancy on the basis of objective criteria to help decision-making on whether or not ovarian-sparing surgery is feasible in case of children and adolescents with ovarian tumors and normal human chorionic gonadotrophin and alpha fetoprotein levels while ensuring oncologic safety.

Sequential chromosome aberration analysis following radiotherapy - no evidence for enhanced genomic instability

Chromosome analysis of peripheral blood lymphocytes using block staining was performed on 18 cancer patients who had received fractionated radiotherapy doses totalling 35-80 Gy. Samples were obtained from 13 individuals within 1 year of treatment and thereafter approximately annually up to a maximum of eight times (range: three to eight samples per individual). Sampling of the remaining five patients started later. Frequencies of cells with unstable chromosome aberrations showed a steady decline whereas frequencies of cells with just chromatid aberrations and gaps were initially low and remained so. There was no subsequent rise in any aberrant cell type in later years and thus no suggestion that the radiation exposure had induced a persistent or late manifesting state of genomic instability.

Esophageal foreign body: a case presentation

A case report is presented of a 10-month-old child with a 1-month history of respiratory symptoms, followed by 3 to 4 days of fever, progressing to poor feeding, vomiting, and weight loss. The child is cared for by his mentally disabled young parents. A chest radiograph revealed a metallic foreign body obstructing the proximal esophagus. Esophagoscopy and removal of a penny resulted in immediate resolution of the acute gastrointestinal symptoms; the respiratory symptoms resolved shortly thereafter. Diagnostic and therapeutic considerations in the management of pediatric aerodigestive foreign bodies are discussed. High-risk parenting, such as in this case, is a risk factor for pediatric foreign-body ingestion.

The role of pith, tube, and stalk density in determining sugarcane sucrose content and stalk weight

Selection against pith and tube is one of the major criteria used to eliminate inferior sugarcane (Saccharum spp.) cultivars in early stages of new cultivar evaluation. Understanding the genetic relationships for these traits would facilitate crossing and selection decisions. This study was conducted to determine heritability, genetic coefficient of variation, and the potential for genetic advance by selection for pith, tube, and stalk density. Correlation and path-coefficient analysis studies were conducted to determine the effects of Brix, pith, and stalk density on sucrose content and the effects of stalk volume, tube, and pith on stalk weight. Eighty randomly selected cultivars (four progeny from each of 20 crosses), representing a first clonal stage of a Louisiana sugarcane breeding population, and their parents were planted at St. Gabriel/LA, and yield data were collected in 1986, 1987, and 1988. Pith and tube exhibited large genotype and genotype-by-year variation, whereas variation in stalk density was nonsignificant. Broad-sense and narrow-sense heritabilities were high, moderately high, and low for pith, tube, and stalk density, respectively. Path-coefficient analysis revealed that stalk volume was the major factor determining stalk weight. Tube and pith were factors that decreased stalk weight. As expected, Brix was the single most important factor determining sucrose content, however, high stalk density and low pith were also associated with high sucrose content. Sugarcane breeders should practice stringent selection for low pith across years to increase stalk weight and sucrose content. Since stalk density was effectively increased by high sucrose content and low pith, the use of stalk density in breeding and selection should be avoided. The minimal effect of tube on stalk weight suggests that its use as selection criteria be minimized or dropped.

Intraspecific measurements of photorespiration

The relative magnitudes of (a) CO(2) compensation concentration, (b) zero CO(2) intercept of the CO(2) response curve, (c) O(2) suppression of net photosynthesis, (d) differential (12)CO(2) and (14)CO(2) uptake, and (e) (14)CO(2) efflux into CO(2)-free air were determined in the dry bean (Phaseolus vulgaris L.) varieties Michelite-62 (M-62) and Red Kidney (RK). In comparing the two varieties for each of the above processes, there were three categories of response, M-62 > RK, M-62 = RK, and M-62 < RK. Since these processes did not give the same relative difference for the two varieties being studied, it was concluded that these phenomena cannot validly be used to estimate the magnitude of photorespiration, although they do identify its presence. The results suggest that photorespiration is but one component of O(2) inhibition of net photosynthesis and that photorespiration itself has two or more component metabolic pathways.