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Dexter JM, Brubaker LW, Bitler BG, Goff BA, Menon U, Moore KN, Sundaram KM, Walsh CS, Guntupalli SR, Behbakht K. Ovarian cancer think tank: An overview of the current status of ovarian cancer screening and recommendations for future directions. Gynecol Oncol Rep 2024; 53:101376. [PMID: 38590930 PMCID: PMC10999790 DOI: 10.1016/j.gore.2024.101376] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/10/2024] Open
Abstract
Early diagnosis and screening of ovarian cancer remain significant challenges to improving patient outcomes. There is an urgent need to implement both established and modern strategies to address the "early detection" conundrum, especially as new research continues to uncover the complexities of the disease. The discussion provided is the result of a unique research conference focused on reviewing early detection modalities and providing insight into future approaches.
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Affiliation(s)
- Julia M. Dexter
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Colorado, Aurora, CO, USA
| | - Lindsay W. Brubaker
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Colorado, Aurora, CO, USA
| | - Benjamin G. Bitler
- Department of OB/GYN, Division of Reproductive Sciences, The University of Colorado, Aurora, CO, USA
| | - Barbara A. Goff
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Usha Menon
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Katherine N. Moore
- Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Karthik M. Sundaram
- Department of Radiology, Hospital of University of Pennsylvania, Philadelphia, PA, USA
| | - Christine S. Walsh
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Colorado, Aurora, CO, USA
| | - Saketh R. Guntupalli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Colorado, Aurora, CO, USA
| | - Kian Behbakht
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Colorado, Aurora, CO, USA
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2
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Helm ED, Guntupalli SR. A rare case of cardiac metastasis of squamous cell carcinoma of the cervix with a review of existing case reports and treatment modalities. Gynecol Oncol Rep 2024; 52:101352. [PMID: 38495801 PMCID: PMC10943113 DOI: 10.1016/j.gore.2024.101352] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/19/2024] Open
Abstract
•Cardiac metastasis is a rare complication of squamous cell carcinoma of the cervix.•Biologic agents may be a useful treatment modality for cardiac metastasis of squamous cell carcinoma of the cervix.•Multidisciplinary approach is required to treat cardiac metastasis of squamous cell carcinoma of the cervix.
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Affiliation(s)
- Eric D. Helm
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology
| | - Saketh R. Guntupalli
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology
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3
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Davies KD, Smith LP, Guimaraes-Young A, Corr BR, Fisher CM, Guntupalli SR, Berning AA, Post MD, Pino D, Aisner DL, Wolsky RJ. Prospective Clinical Prognostication of Endometrial Carcinomas Based on Next-Generation Sequencing and Immunohistochemistry-Real-World Implementation and Results at a Tertiary Care Center. Int J Gynecol Pathol 2023:00004347-990000000-00123. [PMID: 37922951 DOI: 10.1097/pgp.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Based on findings from The Cancer Genome Atlas and the Proactive Molecular Risk Classifier for Endometrial Cancer algorithm, endometrial carcinoma can now be stratified into 4 prognostically distinct subgroups based on molecular alterations and immunohistochemical (IHC) aberrations. In this study, we describe the de novo adoption and clinical reporting of prognostic subgroup classification based on next-generation sequencing (NGS) and IHC analyses of all endometrial carcinoma resections at a single institution, framed by the Exploration, Preparation, Implementation, and Sustainment model. Results from the first 13 months show 188 tumors underwent analysis by a combination of IHC and a medium-sized (56 analyzed genes) NGS-based assay. All cases were assigned as either POLE (POLE-mutated) (5.3%), mismatch repair deficient (27.7%), no specific molecular profile (45.7%), or p53 abnormal (21.3%) inclusive of multiple-classifier cases. NGS-based analysis revealed additional distinctions among the subgroups, including reduced levels of PI3K pathway activation in the p53 abnormal subgroup, an increased rate of CTNNB1 activating mutation in the no specific molecular profile subgroup, and lower TP53 mutation variant allele frequencies in POLE and mismatch repair deficient subgroups compared with the p53 abnormal subgroup. Overall, we describe the testing protocol, reporting, and results of a combination of NGS and IHC to prospectively prognosticate endometrial carcinomas at a single tertiary care center.
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4
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Navi BB, Zhang C, Kaiser JH, Liao V, Cushman M, Kasner SE, Elkind MSV, Tagawa ST, Guntupalli SR, Gaudino MFL, Lee AYY, Khorana AA, Kamel H. Cancer and the Risk of Perioperative Arterial Ischemic Events. Eur Heart J Qual Care Clin Outcomes 2023:qcad057. [PMID: 37757472 DOI: 10.1093/ehjqcco/qcad057] [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] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND AND AIMS Most cancer patients require surgery for diagnosis and treatment. This study evaluated whether cancer is a risk factor for perioperative arterial ischemic events. METHODS The primary cohort included patients registered in the National Surgical Quality Improvement Program (NSQIP) between 2006-2016. The secondary cohort included Healthcare Cost and Utilization Project (HCUP) claims data from 11 U.S. states between 2016-2018. Study populations comprised patients who underwent inpatient (NSQIP, HCUP) or outpatient (NSQIP) surgery. Study exposures were disseminated cancer (NSQIP) and all cancers (HCUP). The primary outcome was a perioperative arterial ischemic event, defined as myocardial infarction or stroke diagnosed within 30 days after surgery. RESULTS Among 5,609,675 NSQIP surgeries, 2.2% involved patients with disseminated cancer. The perioperative arterial ischemic event rate was 0.96% among patients with disseminated cancer versus 0.48% among patients without (HR, 2.01; 95% CI, 1.90-2.13). In Cox analyses adjusting for demographics, functional status, comorbidities, surgical specialty, anesthesia type, and clinical factors, disseminated cancer remained associated with higher risk of perioperative arterial ischemic events (HR, 1.37; 95% CI, 1.28-1.46). Among 1,341,658 surgical patients in the HCUP cohort, 11.8% had a diagnosis of cancer. A perioperative arterial ischemic event was diagnosed in 0.74% of patients with cancer versus 0.54% of patients without cancer (HR, 1.35; 95% CI, 1.27-1.43). In Cox analyses adjusted for demographics, insurance, comorbidities, and surgery type, cancer remained associated with higher risk of perioperative arterial ischemic events (HR, 1.31; 95% CI, 1.21-1.42). CONCLUSIONS Cancer is an independent risk factor for perioperative arterial ischemic events.
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Affiliation(s)
- Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Cenai Zhang
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Jed H Kaiser
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Vanessa Liao
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Mary Cushman
- Division of Hematology and Oncology, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Scott T Tagawa
- Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Saketh R Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora, CO
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Agnes Y Y Lee
- Division of Hematology, Department of Medicine, University of British Columbia, BC Cancer, Vancouver, BC
| | - Alok A Khorana
- Department of Hematology and Oncology, Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland Clinic, Cleveland, OH
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
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Abstract
Venous thromboembolism (VTE) is a major cause of both morbidity and mortality in patients with cancer. Venous thromboembolism, which includes both deep vein thrombosis and pulmonary embolism, affects a sizable portion of patients with malignancy and can have potentially life threatening complications. Accurate assessment of risk as well as diagnosis and treatment of this process is paramount to preventing death in this high risk population. Various risk models predictive of venous thromboembolism in patients with cancer have been developed, and knowledge of these rubrics is essential for the treating oncologist. Subgroups of particular interest are inpatients receiving chemotherapy, postoperative patients after surgical debulking, and patients undergoing radiotherapy. Numerous newer drugs have become available for the prevention of venous thromboembolism in patients with cancer who are at high risk of developing the disease. These include the class of drugs called direct oral anticoagulants, (DOACs) which do not require the same monitoring that other modalities have previously required and are taken by mouth, preventing the discomfort associated with subcutaneous strategies. The appropriate risk stratification and intervention to prevent venous thromboembolism are vital to the treatment of patients with cancer.
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Affiliation(s)
- Saketh R Guntupalli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel Spinosa
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stephanie Wethington
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ramez Eskander
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology University of California School of Medicine, San Diego, CA, USA
| | - Alok A Khorana
- Department of Hematology Oncology, Taussig Cancer Institute and Case Comprehensive Cancer Center, Cleveland Clinic, Cleveland, OH, USA
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Nguyen LL, Watson ZL, Ortega R, Woodruff ER, Jordan KR, Iwanaga R, Yamamoto TM, Bailey CA, Jeong AD, Guntupalli SR, Behbakht K, Gbaja V, Arnoult N, Chuong EB, Bitler BG. Combinatory EHMT and PARP inhibition induces an interferon response and a CD8 T cell-dependent tumor regression in PARP inhibitor-resistant models. bioRxiv 2023:2023.02.23.529773. [PMID: 36865165 PMCID: PMC9980116 DOI: 10.1101/2023.02.23.529773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Euchromatic histone lysine methyltransferases 1 and 2 (EHMT1/2), which catalyze demethylation of histone H3 lysine 9 (H3K9me2), contribute to tumorigenesis and therapy resistance through unknown mechanisms of action. In ovarian cancer, EHMT1/2 and H3K9me2 are directly linked to acquired resistance to poly-ADP-ribose polymerase (PARP) inhibitors and are correlated with poor clinical outcomes. Using a combination of experimental and bioinformatic analyses in several PARP inhibitor resistant ovarian cancer models, we demonstrate that combinatory inhibition of EHMT and PARP is effective in treating PARP inhibitor resistant ovarian cancers. Our in vitro studies show that combinatory therapy reactivates transposable elements, increases immunostimulatory dsRNA formation, and elicits several immune signaling pathways. Our in vivo studies show that both single inhibition of EHMT and combinatory inhibition of EHMT and PARP reduces tumor burden, and that this reduction is dependent on CD8 T cells. Together, our results uncover a direct mechanism by which EHMT inhibition helps to overcome PARP inhibitor resistance and shows how an epigenetic therapy can be used to enhance anti-tumor immunity and address therapy resistance.
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Affiliation(s)
- Lily L. Nguyen
- Molecular Cellular Developmental Biology, The University of Colorado Boulder, Boulder, CO 80309, USA
| | - Zachary L. Watson
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Raquel Ortega
- Molecular Cellular Developmental Biology, The University of Colorado Boulder, Boulder, CO 80309, USA
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Elizabeth R. Woodruff
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Kimberly R. Jordan
- Department of Immunology and Microbiology, The University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Ritsuko Iwanaga
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Tomomi M. Yamamoto
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Courtney A. Bailey
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Abigail D. Jeong
- Molecular Cellular Developmental Biology, The University of Colorado Boulder, Boulder, CO 80309, USA
| | - Saketh R. Guntupalli
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, The University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kian Behbakht
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, The University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Nausica Arnoult
- Molecular Cellular Developmental Biology, The University of Colorado Boulder, Boulder, CO 80309, USA
| | - Edward B. Chuong
- Molecular Cellular Developmental Biology, The University of Colorado Boulder, Boulder, CO 80309, USA
| | - Benjamin G. Bitler
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, 80045
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7
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Yamamoto TM, Webb PG, Davis DM, Baumgartner HK, Woodruff ER, Guntupalli SR, Neville M, Behbakht K, Bitler BG. Loss of Claudin-4 Reduces DNA Damage Repair and Increases Sensitivity to PARP Inhibitors. Mol Cancer Ther 2022; 21:647-657. [PMID: 35373300 PMCID: PMC8988515 DOI: 10.1158/1535-7163.mct-21-0827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/31/2021] [Accepted: 01/26/2022] [Indexed: 11/16/2022]
Abstract
High-grade serous ovarian cancer is the deadliest gynecologic malignancy due to progression to resistant disease. Claudin-4 is classically defined as a tight junction protein and is often associated with epithelial cancers. Claudin-4 is aberrantly expressed in nearly 70% of all ovarian cancer tumors and conveys a worse overall prognosis. Elevated claudin-4 expression correlates to increased DNA repair activity and resistance to DNA damaging agents. PARP inhibitors are emerging as an effective therapeutic option for patients with ovarian cancer and function by promoting DNA damage. The study examines the relationship between claudin-4 expression and the response to PARP inhibitors using both genetic and pharmacologic inhibition of claudin-4 in in vitro and ex vivo models of ovarian cancer to examine DNA repair markers and functional activity. Genetic inhibition of claudin-4 results in the downregulation of several DNA damage repair effectors, including 53BP1 and XRCC1. Claudin-4 knockdown did not change homology-directed repair but inhibited nonhomologous end-joining and reduced 53BP1 foci formation. In 15 primary ovarian cancer tumors, higher claudin-4 expression significantly correlated to a dampened PARP inhibitor-mediated antiproliferation response. Further, claudin-4 inhibition in high claudin-4 tumors sensitized tumor sections to PARP inhibition. These data highlight that claudin-4 expression in ovarian cancer tumors could serve as both a marker of PARP inhibitor response and a therapeutic target to improve PARP inhibitor response.
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Affiliation(s)
- Tomomi M Yamamoto
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Patricia G Webb
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Dana M Davis
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Heidi K Baumgartner
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Elizabeth R Woodruff
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Saketh R Guntupalli
- Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Margaret Neville
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Kian Behbakht
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
- Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Benjamin G Bitler
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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8
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Levinson K, Beavis AL, Purdy C, Rositch AF, Viswanathan A, Wolfson AH, Kelly MG, Tewari KS, McNally L, Guntupalli SR, Ragab O, Lee YC, Miller DS, Huh WK, Wilkinson KJ, Spirtos NM, Le LV, Casablanca Y, Holman LL, Waggoner SE, Fader AN. Corrigendum to "Beyond Sedlis-A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysis" [Gynecologic Oncology 162 (2021) 532-538]. Gynecol Oncol 2021; 163:616-617. [PMID: 34654574 DOI: 10.1016/j.ygyno.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kimberly Levinson
- Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Anna L Beavis
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Christopher Purdy
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Anne F Rositch
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Akila Viswanathan
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Aaron H Wolfson
- Sylvester Comprehensive Cancer Center, Miami, FL, United States
| | - Michael G Kelly
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | | | - Leah McNally
- Duke Cancer Institute, Durham, NC, United States
| | | | - Omar Ragab
- Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Yi-Chun Lee
- SUNY Health Science Center at Brooklyn, Brooklyn, NY, United States
| | - David S Miller
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9032, United States
| | - Warner K Huh
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kelly J Wilkinson
- University of Mississippi Medical Center, Jackson, MS, United States
| | | | - Linda Van Le
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | | | - Laura L Holman
- University of Oklahoma Health Sciences Center, Stephenson Cancer Center, 800 Northeast Tenth St., Oklahoma City, OK, United States
| | | | - Amanda N Fader
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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9
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Levinson K, Beavis AL, Purdy C, Rositch AF, Viswanathan A, Wolfson AH, Kelly MG, Tewari KS, McNally L, Guntupalli SR, Ragab O, Lee YC, Miller DS, Huh WK, Wilkinson KJ, Spirtos NM, Van Le L, Casablanca Y, Holman LL, Waggoner SE, Fader AN. Beyond Sedlis-A novel histology-specific nomogram for predicting cervical cancer recurrence risk: An NRG/GOG ancillary analysis. Gynecol Oncol 2021; 162:532-538. [PMID: 34217544 DOI: 10.1016/j.ygyno.2021.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/05/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The Sedlis criteria define risk factors for recurrence warranting post-hysterectomy radiation for early-stage cervical cancer; however, these factors were defined for squamous cell carcinoma (SCC) at an estimated recurrence risk of ≥30%. Our study evaluates and compares risk factors for recurrence for cervical SCC compared with adenocarcinoma (AC) and develops histology-specific nomograms to estimate risk of recurrence and guide adjuvant treatment. METHODS We performed an ancillary analysis of GOG 49, 92, and 141, and included stage I patients who were surgically managed and received no neoadjuvant/adjuvant therapy. Multivariable Cox proportional hazards models were used to evaluate independent risk factors for recurrence by histology and to generate prognostic histology-specific nomograms for 3-year recurrence risk. RESULTS We identified 715 patients with SCC and 105 with AC; 20% with SCC and 17% with AC recurred. For SCC, lymphvascular space invasion (LVSI: HR 1.58, CI 1.12-2.22), tumor size (TS ≥4 cm: HR 2.67, CI 1.67-4.29), and depth of invasion (DOI; middle 1/3, HR 4.31, CI 1.81-10.26; deep 1/3, HR 7.05, CI 2.99-16.64) were associated with recurrence. For AC, only TS ≥4 cm, was associated with recurrence (HR 4.69, CI 1.25-17.63). For both histologies, there was an interaction effect between TS and LVSI. For those with SCC, DOI was most associated with recurrence (16% risk); for AC, TS conferred a 15% risk with negative LVSI versus a 25% risk with positive LVSI. CONCLUSIONS Current treatment standards are based on the Sedlis criteria, specifically derived from data on SCC. However, risk factors for recurrence differ for squamous cell and adenocarcinoma of the cervix. Histology-specific nomograms accurately and linearly represent risk of recurrence for both SCC and AC tumors and may provide a more contemporary and tailored tool for clinicians to base adjuvant treatment recommendations to their patients with cervical cancer.
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Affiliation(s)
- Kimberly Levinson
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Anna L Beavis
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Christopher Purdy
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America.
| | - Anne F Rositch
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Akila Viswanathan
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Aaron H Wolfson
- Sylvester Comprehensive Cancer Center, Miami, FL, United States of America.
| | - Michael G Kelly
- Wake Forest Baptist Medical Center, Winston-Salem, NC, United States of America.
| | | | - Leah McNally
- Duke Cancer Institute, Durham, NC, United States of America.
| | | | - Omar Ragab
- Keck School of Medicine of USC, Los Angeles, CA, United States of America.
| | - Yi-Chun Lee
- SUNY Health Science Center at Brooklyn, Brooklyn, NY, United States of America.
| | - David S Miller
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9032, United States of America.
| | - Warner K Huh
- University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Kelly J Wilkinson
- University of Mississippi Medical Center, Jackson, MS, United States of America.
| | | | - Linda Van Le
- University of North Carolina School of Medicine, Chapel Hill, NC, United States of America.
| | - Yovanni Casablanca
- Walter Reed National Medical Center, Bethesda, MD, United States of America.
| | - Laura L Holman
- University of Oklahoma Health Sciences Center, Stephenson Cancer Center, 800 Northeast Tenth St., Oklahoma City, OK, United States of America.
| | - Steven E Waggoner
- Case Western Reserve University, Cleveland, OH, United States of America.
| | - Amanda N Fader
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
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10
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Guntupalli SR, Nout RA, Dreyer G. Highlights from the recent 2020 Annual Global IGCS Meeting. Gynecol Oncol 2021; 161:333-335. [PMID: 33653610 DOI: 10.1016/j.ygyno.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Saketh R Guntupalli
- Karen M. Jennison Endowed Chair in Gynecologic Oncology, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, USA.
| | - Remi A Nout
- Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 2040, internal postal address NT/558k, 3000, CA, Rotterdam, the Netherlands.
| | - Greta Dreyer
- Department of Obstetrics and Gynaecology, University of Pretoria, Hatfield 0028, South Africa.
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11
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Gillen J, Miller A, Bell-McGuinn KM, Schilder RJ, Walker JL, Mathews CA, Duska LR, Guntupalli SR, O'Cearbhaill R, Hays J, Hagemann AR, Gray HJ, Gordon SW, Armstrong DK, Chen A, Fracasso PM, Aghajanian C, Moore KN. Post hoc analyses of GOG 9923: Does BRCA status affect toxicities?: An NRG oncology study. Gynecol Oncol 2021; 161:512-515. [PMID: 33610319 DOI: 10.1016/j.ygyno.2021.01.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/30/2020] [Accepted: 01/25/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate how women with epithelial ovarian cancer (EOC), dichotomized by BRCA status, tolerate intravenous (IV) or intraperitoneal (IP) chemotherapy given with veliparib and bevacizumab (bev) on a GOG phase I study (GOG 9923, NCT00989651). METHODS This is an unplanned, post hoc analysis of an IRB approved, multi-institutional, prospective study (GOG 9923). Clinical characteristics and toxicity data based on BRCA status were evaluated and descriptive statistics were used to summarize baseline patient characteristics and toxicities. The Kaplan Meier method was used to generate survival estimates. RESULTS Four hundred twenty-four patients were evaluable. Patients were treated with IV carboplatin, paclitaxel, and bev every 21 days (regimen 1), weekly IV paclitaxel with carboplatin and bev (regimen 2) or IV paclitaxel and bev with IP cisplatin (regimen 3). Bev was continued as maintenance in all arms. Within each of these regimens, veliparib was given either twice daily for the entirety of each cycle (continuous) or on days -2 to 5 (intermittent). Ten percent of patients treated on regimen 1, 12% on regimen 2, and 19.8% on regimen 3 had BRCA-associated tumors. Patients with BRCA-associated tumors, when compared to wild type, experienced similar rates of anemia, febrile neutropenia (, abdominal pain, colonic perforation, nausea, vomiting, and peripheral sensory neuropathy. Median progression free survival (PFS) was not significantly different between BRCA-associated and wild type cancers (HR 0.96, CI 0.65-1.42), though this study's primary aim was not to evaluate outcomes. CONCLUSIONS Germline BRCA mutations positively affect chemosensitivity in EOC, but whether differences in toxicities among BRCA-associated and BRCA wild type tumors existed was previously not reported. In this population with newly diagnosed ovarian cancer no differences in reported toxicity between the two groups was observed.
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Affiliation(s)
- Jessica Gillen
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, United States of America.
| | - Austin Miller
- NRG Oncology SDMC, CTD Division, Roswell Park Cancer Institute, Buffalo, NY, United States of America.
| | - Katherine M Bell-McGuinn
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, United States of America.
| | - Russell J Schilder
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America.
| | - Joan L Walker
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, United States of America.
| | - Cara A Mathews
- Women and Infants Hospital of Rhode Island, Providence, RI, United States of America.
| | - Linda R Duska
- University of Virginia School of Medicine, Charlottesville, VA, United States of America.
| | | | - Roisin O'Cearbhaill
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, United States of America.
| | - John Hays
- The Ohio State University, Columbus, OH, United States of America.
| | | | - Heidi J Gray
- University of Washington, Seattle, WA, United States of America.
| | - Sarah W Gordon
- Virginia Commonwealth University, Richmond, VA, United States of America.
| | | | - Alice Chen
- Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, MD, United States of America.
| | - Paula M Fracasso
- University of Virginia School of Medicine, Charlottesville, VA, United States of America.
| | - Carol Aghajanian
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, United States of America.
| | - Kathleen N Moore
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, United States of America.
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Abstract
Ovarian cancer is the third most common gynecologic malignancy worldwide but accounts for the highest mortality rate among these cancers. A stepwise approach to assessment, diagnosis, and treatment is vital to appropriate management of this disease process. An integrated approach with gynecologic oncologists as well as medical oncologists, pathologists, and radiologists is of paramount importance to improving outcomes. Surgical cytoreduction to R0 is the mainstay of treatment, followed by adjuvant chemotherapy. Genetic testing for gene mutations that affect treatment is the standard of care for all women with epithelial ovarian cancer. Nearly all women will have a recurrence, and the treatment of recurrent ovarian cancer continues to be nuanced and requires extensive review of up to date modalities that balance efficacy with the patient's quality of life. Maintenance therapy with poly ADP-ribose polymerase inhibitors, bevacizumab, and/or drugs targeting homologous recombination deficiency is becoming more widely used in the treatment of ovarian cancer, and the advancement of immunotherapy is further revolutionizing treatment targets.
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Affiliation(s)
- Lindsay Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - Saketh R Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO, USA
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13
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Ross ME, Glickman A, Brennecke A, Tayebnejad A, Guntupalli SR. Noncompliance with postoperative prophylactic anticoagulation among gynecologic oncology patients: A subanalysis of a randomized controlled trial. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.07.036] [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: 10/23/2022]
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Glickman A, Brennecke A, Tayebnejad A, Matsuo K, Guntupalli SR, Sheeder J. Cost-effectiveness of apixaban for prevention of venous thromboembolic events in patients after gynecologic cancer surgery. Gynecol Oncol 2020; 159:476-482. [PMID: 32854972 DOI: 10.1016/j.ygyno.2020.07.096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/13/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The cost-effectiveness of apixaban was compared with enoxaparin for prevention of postoperative venothromboembolic events (VTE) in gynecologic oncology patients. Current guidelines recommend thromboprophylaxis with low molecular weight heparin for 28 days following gynecologic cancer surgery, but recent trials suggest that oral apixaban may be a safe, patient-preferred alternative. Apixaban was superior to enoxaparin in a Canadian cost-effectiveness analysis using orthopedics trial data. METHODS Medication costs, adherence rates, event rates, event costs, and utility decrements were estimated using prior clinical trial data and literature review for input into a short-term decision model to simulate outcomes in a hypothetical cohort of 1000 patients. Incremental cost-effectiveness ratios (ICERs) were calculated as net cost difference per quality-adjusted life year (QALY) gained. Input values at which net costs and QALYs were equivalent and ICERs at upper and lower bounds were evaluated. RESULTS Using aggregated costs, apixaban was less expensive and more effective than enoxaparin, and remained so or had high value in all scenarios on sensitivity analysis. Examining disaggregated ICERs, apixaban was cost-effective for deep venous thrombosis (DVT); of high value for clinically-relevant non-major bleeding (CRNMB) ($411); low value for major bleeding ($183,465), VTE-related death ($2,711,229), and all-cause mortality ($297,522); and not cost-effective for pulmonary embolism prevention. CONCLUSIONS Apixaban is more cost-effective than enoxaparin for the prevention of postoperative VTE in patients with gynecologic cancer. This appears to be driven largely by DVT and CRNMB prevention.
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Affiliation(s)
- Amanda Glickman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Alyse Brennecke
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Anna Tayebnejad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Saketh R Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Jeanelle Sheeder
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA.
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Ross ME, Glickman A, Brennecke A, Tayebnejad A, Guntupalli SR. Adherence to postoperative thromboprophylactic medication among gynecologic oncology patients: A subanalysis. Gynecol Oncol 2020; 158:754-759. [PMID: 32641236 DOI: 10.1016/j.ygyno.2020.06.505] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a major cause of morbidity and mortality among gynecologic cancer patients, especially in the immediate postoperative period. We sought to identify patterns related with patient non-adherence to postoperative prophylactic anticoagulation. METHODS Participant data (N = 400) were reviewed from a previously conducted randomized controlled trial comparing the safety and efficacy of prophylactic postoperative anticoagulation with enoxaparin versus apixaban among gynecologic oncology patients. Variables hypothesized to be related to medication adherence were pre-selected by the study authors, and adherence was defined as missing ≤2 days of medication (4 pills or 2 injections) in 28 days postoperatively. For univariate comparisons and multivariate modeling, the threshold for statistical significance was set at p < .05. RESULTS Non-adherence (N = 64) was associated with lower quality of life (QOL) score, history of anxiety disorder, decreased medication satisfaction, taking more medications at baseline, higher baseline heart rate, fewer total intraoperative procedures, not undergoing radical hysterectomy and/or lymph node dissection, not meeting 2-week postoperative milestones, and 28-day emergency department (ED) visit or readmission. African American race, lower mental QOL, difficulty remembering to take medication, and 28-day ED visit or readmission were predictive of non-adherence in a multivariate model. Patients taking enoxaparin versus apixaban more frequently attributed non-adherence to pain or bruising (25.0% vs. 3.1%, P = .01). CONCLUSION Our findings provide new insights into factors associated with medication adherence that are particularly relevant to gynecologic oncology patients after surgery. Preoperative interventions to identify patients with these risk factors for more intensive followup of postoperative anticoagulation regimen may help increase medication adherence.
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Affiliation(s)
- Megan E Ross
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA.
| | - Amanda Glickman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Alyse Brennecke
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Anna Tayebnejad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Saketh R Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
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Guntupalli SR, Brennecke A, Behbakht K, Tayebnejad A, Breed CA, Babayan LM, Cheng G, Ramzan AA, Wheeler LJ, Corr BR, Lefkowits C, Sheeder J, Matsuo K, Flink D. Safety and Efficacy of Apixaban vs Enoxaparin for Preventing Postoperative Venous Thromboembolism in Women Undergoing Surgery for Gynecologic Malignant Neoplasm: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e207410. [PMID: 32589230 PMCID: PMC7320298 DOI: 10.1001/jamanetworkopen.2020.7410] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [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: 12/21/2022] Open
Abstract
IMPORTANCE Current guidelines recommend a 28-day course of enoxaparin for thromboprophylaxis after surgery for gynecologic cancer. The high cost of this medication and the low adherence rates observed in prior studies provide an opportunity to benefit patients by demonstrating the safety of a more cost-effective, easier to use thromboprophylactic. OBJECTIVE To investigate the safety and efficacy of an oral treatment alternative for thromboprophylaxis in postoperative patients with gynecologic cancer. DESIGN, SETTING, AND PARTICIPANTS This was a patient-based, multicenter, open-label, blinded, end point, randomized clinical trial conducted May 2015 to March 2019 in outpatient and inpatient gynecologic oncology settings. Women undergoing surgery for suspected or confirmed gynecologic cancer were approached for recruitment. The trial compared rates of major bleeding and clinically relevant nonmajor bleeding events during a 90-day follow-up period in patients taking apixaban or enoxaparin for postoperative thromboprophylaxis using a modified intent-to-treat analysis. Data analysis was performed from October to December 2019. INTERVENTIONS Women were randomized to 28 days of apixaban (2.5 mg orally twice daily) or enoxaparin (40 mg subcutaneously daily). MAIN OUTCOMES AND MEASURES The primary outcome was major bleeding and clinically relevant nonmajor bleeding events. Secondary outcomes included incidence of venous thromboembolic events, adverse events, medication adherence, participant quality of life, and medication satisfaction. RESULTS Of 500 women recruited for the study, 400 were enrolled and randomized (median age, 58.0 years; range, 18.0-89.0 years); 204 received apixaban and 196 received enoxaparin. Treatment groups did not differ in terms of race/ethnicity, cancer stage, or surgery modality (open vs robotic). There were no statistically significant differences between the apixaban and enoxaparin groups in terms of rates of major bleeding events (1 patient [0.5%] vs 1 patient [0.5%]; odds ratio [OR], 1.04; 95% CI, 0.07-16.76; P > .99), clinically relevant nonmajor bleeding events (12 patients [5.4%] vs 19 patients [9.7%]; OR, 1.88; 95% CI, 0.87-4.1; P = .11), venous thromboembolic events (2 patients [1.0%] vs 3 patients [1.5%]; OR, 1.57; 95% CI, 0.26-9.50; P = .68), adverse events, medication adherence, or quality of life between the groups. Participant satisfaction was significantly greater in the apixaban group with regard to ease of taking the medication (186 patients [98.9%] vs 110 patients [58.8%]; OR, 0.06; 95% CI, 0.01-0.25; P < .001) and pain associated with taking the medication (4 patients [2.1%] vs 92 patients [49.2%]; OR, 9.20; 95% CI, 2.67-31.82; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that oral apixaban is a potentially safe, less painful, and easier-to-take alternative to subcutaneous enoxaparin for thromboprophylaxis after surgery for gynecologic cancer. The efficacy of apixaban to prevent venous thromboembolic events is hypothesized as being equivalent. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02366871.
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Affiliation(s)
- Saketh R. Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora
| | - Alyse Brennecke
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora
| | - Kian Behbakht
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora
| | - Anna Tayebnejad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora
| | - Christopher A. Breed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora
| | - Lisa Marie Babayan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora
| | - Georgina Cheng
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora
| | - Amin A. Ramzan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora
| | - Lindsay J. Wheeler
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora
| | - Bradley R. Corr
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora
| | - Carolyn Lefkowits
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora
| | - Jeanelle Sheeder
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora
| | - Koji Matsuo
- Keck School of Medicine, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Dina Flink
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Aurora
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17
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Levinson K, Beavis A, Purdy C, Rositch A, Viswanathan A, Wolfson AH, Kelly MG, Tewari K, McNally L, Guntupalli SR, Ragab O, Lee YC, Miller DS, Huh WK, Wilkinson KJ, Spirtos NM, Van Le L, Casablanca Y, Holman LL, Nickles Fader A. Beyond Sedlis: A novel, histology-based nomogram for predicting recurrence risk and need for adjuvant radiation in cervical cancer—A NRG/GOG ancillary analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6019] [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: 11/20/2022] Open
Abstract
6019 Background: In GOG 49, factors associated with a 3-year, 30% recurrence risk in squamous cell carcinoma of the cervix (SCC) after surgery alone were defined. These "intermediate" risk factors [tumor size (TS), depth of tumor invasion (DOI), and lymphvascular space invasion (LVSI)] were then studied in GOG 92, which demonstrated the utility of treating patients (pts) with ≥2 intermediate risk factors with adjuvant radiation (RT), Sedlis Criteria. However, pts with < 30% recurrence risk were not eligible and few pts with adenocarcinoma (AC) were included. Our study purpose was 1) to evaluate recurrence risk factors for AC vs SCC, and 2) to define contemporary nomograms for adjuvant treatment in pts with both histologies. Methods: We performed an ancillary analysis of GOG 49, 92, and 141, and included Stage I pts who received no neoadjuvant/adjuvant therapy. Multivariable Cox proportional hazards models were created separately for AC and SCC to evaluate independent risk factors for recurrence. Model accuracy was tested with ROC curves. Prognostic nomograms were generated for 2-year recurrence risk for AC and SCC. Results: We identified 715 with SCC and 105 pts with AC; 142 with SCC (19.9%) and 18 with AC 17.1%) recurred. For SCC, factors associated independently with recurrence were: LVSI [HR 1.58 (CI 1.12-2.22)], DOI [middle 1/3, HR 4.31 (CI 1.81-10.26); deep 1/3, HR 7.05 (CI 2.99-16.64)] and TS [≥4cm HR 2.67 (CI 1.67-4.29)]. In contrast, for AC, only TS ≥4cm was independently associated with recurrence [HR 4.69 (CI 1.25-17.63)]. At 3 years, ROC curves for these models predicted recurrence with 76% and 75% accuracy for SCC and AC, respectively. Utilizing a nomogram generated from these models, for SCC, DOI had the greatest impact on recurrence, with mid 1/3 conferring an 18% risk and deep 1/3 a 32% risk, while LVSI and TS increased risk by 4-10%, respectively. In contrast, for AC, TS alone had the greatest impact on recurrence risk with TS 2-4cm conferring a 20% risk over 3 years and TS ≥4cm, a 28% risk. Conclusions: Our nomogram differs from the Sedlis Criteria in demonstrating that single, as well as a combination of risk factors predict substantial 3-year recurrence rates in Stage I cervical cancer. Furthermore, these factors differ by AC and SCC subtypes, suggesting that distinct, histology-specific nomograms may have greater utility in identifying pts who will most benefit from adjuvant therapy.
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Affiliation(s)
| | - Anna Beavis
- Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Anne Rositch
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Aaron Howard Wolfson
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miami, FL
| | | | | | | | | | - Omar Ragab
- Keck School of Medicine of USC, Los Angeles, CA
| | - Yi-Chun Lee
- SUNY Health Science Center at Brooklyn, Brooklyn, NY
| | - David S. Miller
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | - Linda Van Le
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Laura L. Holman
- The University of Texas MD Anderson Cancer Center, Houston, TX
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18
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Monk BJ, Coleman RL, Moore KN, Herzog TJ, Secord AA, Matulonis UA, Slomovitz BM, Guntupalli SR, O'Malley DM. COVID-19 and ovarian cancer: Exploring alternatives to intravenous (IV) therapies. Gynecol Oncol 2020; 158:34-36. [PMID: 32370991 PMCID: PMC7188656 DOI: 10.1016/j.ygyno.2020.04.703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 12/30/2022]
Abstract
The pandemic COVID-19 requires alternative methods and thinking to keep healthcare professionals and patients safe. In COVID-19 hot spots, oral therapies may be viable alternatives to intravenous therapies for treatment of ovarian cancer. Minimizing patient visits to hospitals and cancer clinics may help mitigate the spread of SARS-CoV-2.
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Affiliation(s)
- Bradley J Monk
- Arizona Oncology (US Oncology Network), Phoenix, AZ, USA; University of Arizona, Phoenix, AZ, USA; Creighton University, Phoenix, AZ, USA.
| | | | - Kathleen N Moore
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
| | - Thomas J Herzog
- University of Cincinnati Cancer Institute, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | | | - Brian M Slomovitz
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | | | - David M O'Malley
- The Ohio State University, James Cancer Center, Columbus, OH, USA
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19
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Chase D, Huang HQ, Monk BJ, Ramondetta LM, Penson RT, Gil K, Landrum LM, Leitao M, Oaknin A, Huh WK, Pulaski HL, Robison K, Guntupalli SR, Richardson D, Salani R, Sill MW, Wenzel LB, Tewari KS. Patient-reported outcomes at discontinuation of anti-angiogenesis therapy in the randomized trial of chemotherapy with bevacizumab for advanced cervical cancer: an NRG Oncology Group study. Int J Gynecol Cancer 2020; 30:596-601. [PMID: 32114513 DOI: 10.1136/ijgc-2019-000869] [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: 10/04/2019] [Revised: 01/18/2020] [Accepted: 02/07/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION To describe patient-reported outcomes and toxicities at time of treatment discontinuation secondary to progression or toxicities in advanced/recurrent cervical cancer patients receiving chemotherapy with bevacizumab. METHODS Summarize toxicity, grade, and health-related quality of life within 1 month of treatment discontinuation for women receiving chemotherapy with bevacizumab in GOG240. RESULTS Of the 227 patients who received chemotherapy with bevacizumab, 148 discontinued study protocol treatment (90 for disease progression and 58 for toxicity). The median survival time from treatment discontinuation to death was 7.9 months (95% CI 5.0 to 9.0) for those who progressed versus 12.1 months (95% CI 8.9 to 23.2) for those who discontinued therapy due to toxicities. The most common grade 3 or higher toxicities included hematologic, gastrointestinal, and pain. Some 57% (84/148) of patients completed quality of life assessment within 1 month of treatment discontinuation. Those patients who discontinued treatment due to progression had a mean decline in the FACT-Cx TOI of 3.2 points versus 2.2 in patients who discontinued therapy due to toxicity. This was a 9.9 point greater decline in the FACT-Cx TOI scores than those who discontinued treatment due to progression (95% CI 2.8 to 17.0, p=0.007). The decline in quality of life was due to worsening physical and functional well-being. Those who discontinued treatment due to toxicities had worse neurotoxicity and pain. DISCUSSION Patients who discontinued chemotherapy with bevacizumab for toxicity experienced longer post-protocol survival but significantly greater declination in quality of life than those with progression. Future trial design should include supportive care interventions that optimize physiologic function and performance status for salvage therapies.
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Affiliation(s)
- Dana Chase
- Arizona Oncology, Paradise Valley, California, USA
| | - Helen Q Huang
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Bradley J Monk
- Ob Gyn/Gyn Onc, Creighton University School of Medicine at St Josephs Hospital and Medical Center, Phoenix, Arizona, USA
| | | | - Richard T Penson
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen Gil
- Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa M Landrum
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Mario Leitao
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Ana Oaknin
- Vall d' Hebron Institute of Oncology, University Hospital, Barcelona, Spain
| | - Warner K Huh
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Heather L Pulaski
- Gynecological Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Katina Robison
- Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Saketh R Guntupalli
- Gynecologic Oncology, University of Colorado Cancer Center, Aurora, Colorado, USA
| | | | - Ritu Salani
- Ob/Gyn, Ohio State University, Columbus, Ohio, USA
| | - Michael W Sill
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Lari B Wenzel
- University of California Irvine School of Medicine, Irvine, California, USA
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Whitmore G, Ramzan A, Sheeder J, Guntupalli SR. African American women with advanced-stage ovarian cancer have worse outcomes regardless of treatment type. Int J Gynecol Cancer 2020; 30:1018-1025. [PMID: 32107316 DOI: 10.1136/ijgc-2019-000555] [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: 05/07/2019] [Revised: 08/07/2019] [Accepted: 08/23/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE There has been an increase in the use of neoadjuvant chemotherapy in recent years. Our objective was to determine if African American women are more likely to receive neoadjuvant chemotherapy than primary debulking surgery, when compared to their Caucasian counterparts, and the impact of such an approach on oncologic outcomes. METHODS A retrospective cohort study was performed using the National Cancer Database (NCDB). Women aged 18-90 years, diagnosed with stage IIIC or IV epithelial ovarian cancer between January 2010 through December 2014 were included. Women with unknown treatment or treatments outside of neoadjuvant chemotherapy or primary debulking surgery were excluded. Only women of Caucasian, African American, or Hispanic origin who received either neoadjuvant chemotherapy or primary debulking surgery were included; all other races were excluded. Descriptive statistics were computed, and continuous variables were assessed for normality. Groups were compared using ANOVA or non-parametric medians tests for continuous variables, and chi-squared tests were used for dichotomous or categorical variables. Logistic regression was used to identify predictors of treatment. A p value of 0.05 was considered statistically significant. RESULTS A total of 19 838 women with stage IIIC and IV epithelial ovarian cancer met the inclusion criteria. A total of 14 988 (75.6%) were treated with primary debulking surgery, while 4850 women (24.4%) were treated with neoadjuvant chemotherapy. Of those treated with neoadjuvant chemotherapy, 24.5% were white, 27.0% were African American, and 22.1% were Hispanic (p=0.005), and when adjusted for confounders, being African American was a predictor of receiving neoadjuvant chemotherapy (adjusted odds ratio (aOR) 1.29, 95% CI 1.10 to 1.51). Ninety-day mortality rates were higher in African American women compared with Caucasian and Hispanic women (2.9% vs 2.0% vs 1.6%, p=0.013). There were no differences in 30-day mortality, 90-day mortality, or status at last contact in African American women, when comparing neoadjuvant chemotherapy and primary debulking surgery. In Caucasian women, outcomes were worse in women receiving neoadjuvant chemotherapy. CONCLUSIONS Compared to other races, African American women with advanced ovarian cancer are more likely to receive neoadjuvant chemotherapy than primary debulking surgery and had a higher 90-day mortality rate. In African American women there was no difference in outcomes based on treatment type.
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Affiliation(s)
- Gabrielle Whitmore
- Obstetrics and Gynecology, University of Colorado at Denver - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amin Ramzan
- Obstetrics and Gynecology, University of Colorado at Denver - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jeanelle Sheeder
- Obstetrics and Gynecology, University of Colorado at Denver - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Saketh R Guntupalli
- Obstetrics and Gynecology, University of Colorado at Denver - Anschutz Medical Campus, Aurora, Colorado, USA
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21
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Moore KN, Miller A, Bell-McGuinn KM, Schilder RJ, Walker JL, O'Cearbhaill RE, Guntupalli SR, Armstrong DK, Hagemann AR, Gray HJ, Duska LR, Mathews CA, Chen A, O'Malley D, Gordon S, Fracasso PM, Aghajanian C. A phase I study of intravenous or intraperitoneal platinum based chemotherapy in combination with veliparib and bevacizumab in newly diagnosed ovarian, primary peritoneal and fallopian tube cancer. Gynecol Oncol 2020; 156:13-22. [PMID: 31708167 PMCID: PMC7048389 DOI: 10.1016/j.ygyno.2019.10.012] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/06/2019] [Accepted: 10/09/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Improvements in disease free survival for epithelial ovarian, peritoneal or fallopian tube cancer (EOC) will only come with improved primary therapy. Incorporation of poly-ADP-ribose inhibitors (PARPi) in the frontline setting may represent one strategy. This study sought to determine the maximum tolerated and feasible doses of the PARPi veliparib in combination with chemotherapy for EOC. METHODS A phase I, 3 + 3 dose escalation evaluated dose-limiting toxicities (DLTs) in cycles 1-2. Once <2/6 patients experienced a DLT, that dose level expanded to evaluate feasibility over 4 cycles. This study opened 10/2009 and closed 8/2016. Eligible patients had untreated, stage II-IV EOC. Veliparib was added either continuous (day 1-21) or intermittent (day - 2 to 5) during 6 cycles of chemotherapy. Three chemotherapy backbones were evaluated (2 intravenous (q3week and weekly) and 1 intraperitoneal (IP)) all inclusive of bevacizumab with and as maintenance to 22 cycles. FINDINGS Dose evaluations for 424 treated patients were available. Regimen 1 (q3 week), continuous (Reg1c) the maximum tolerated dose (MTD) was 250 mg veliparib BID and feasible dose was 150 mg BID. For regimen 1, intermittent (Reg1i) the MTD and feasible dose were 400 and 250 mg BID. For Reg2c (weekly paclitaxel) the MTD and feasible dose were 150 mg BID. For Reg2i the MTD and feasible dose were 250 and 150 mg BID. For Reg3c (IP) the MTD and feasible dose were 150 mg BID and for Reg3i (IP), the MTD and feasible dose were 400 mg and 300 mg BID. INTERPRETATION The feasible dose for Reg1c, 2c, 2i and 3c was 150 mg po BID. For Reg1i and 3i the dose was pushed to 250 and 300 mg po BID respectively. There is no apparent difference in efficacy between continuous and intermittent dosing indicating that the higher doses achieved in intermittent dosing may not be needed. (NCT00989651). FUNDING National Cancer Institute.
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Affiliation(s)
- Kathleen N Moore
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA.
| | - Austin Miller
- NRG Oncology Statistics & Data Management Center, Roswell Park Cancer Institute.
| | | | - Russell J Schilder
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Joan L Walker
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA
| | - Roisin E O'Cearbhaill
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA.
| | | | | | | | | | - Linda R Duska
- University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Cara A Mathews
- Women and Infants Hospital of Rhode Island, Providence, RI, USA.
| | - Alice Chen
- Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, MD, USA.
| | | | - Sarah Gordon
- Virginia Commonwealth University, Richmond, VA, USA.
| | - Paula M Fracasso
- University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Carol Aghajanian
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA.
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22
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Matsuo K, Cripe JC, Kurnit KC, Kaneda M, Garneau AS, Glaser GE, Nizam A, Schillinger RM, Kuznicki ML, Yabuno A, Yanai S, Garofalo DM, Suzuki J, St Laurent JD, Yen TT, Liu AY, Shida M, Kakuda M, Oishi T, Nishio S, Marcus JZ, Adachi S, Kurokawa T, Ross MS, Horowitz MP, Johnson MS, Kim MK, Melamed A, Machado KK, Yoshihara K, Yoshida Y, Enomoto T, Ushijima K, Satoh S, Ueda Y, Mikami M, Rimel BJ, Stone RL, Growdon WB, Okamoto A, Guntupalli SR, Hasegawa K, Shahzad MMK, Im DD, Frimer M, Gostout BS, Ueland FR, Nagao S, Soliman PT, Thaker PH, Wright JD, Roman LD. Recurrence, death, and secondary malignancy after ovarian conservation for young women with early-stage low-grade endometrial cancer. Gynecol Oncol 2019; 155:39-50. [PMID: 31427143 DOI: 10.1016/j.ygyno.2019.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/09/2019] [Revised: 07/29/2019] [Accepted: 08/03/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine the association between ovarian conservation and oncologic outcome in surgically-treated young women with early-stage, low-grade endometrial cancer. METHODS This multicenter retrospective study examined women aged <50 with stage I grade 1-2 endometrioid endometrial cancer who underwent primary surgery with hysterectomy from 2000 to 2014 (US cohort n = 1196, and Japan cohort n = 495). Recurrence patterns, survival, and the presence of a metachronous secondary malignancy were assessed based on ovarian conservation versus oophorectomy. RESULTS During the study period, the ovarian conservation rate significantly increased in the US cohort from 5.4% to 16.4% (P = 0.020) whereas the rate was unchanged in the Japan cohort (6.3-8.7%, P = 0.787). In the US cohort, ovarian conservation was not associated with disease-free survival (hazard ratio [HR] 0.829, 95% confidence interval [CI] 0.188-3.663, P = 0.805), overall survival (HR not estimated, P = 0.981), or metachronous secondary malignancy (HR 1.787, 95% CI 0.603-5.295, P = 0.295). In the Japan cohort, ovarian conservation was associated with decreased disease-free survival (HR 5.214, 95% CI 1.557-17.464, P = 0.007) and an increased risk of a metachronous secondary malignancy, particularly ovarian cancer (HR 7.119, 95% CI 1.349-37.554, P = 0.021), but was not associated with overall survival (HR not estimated, P = 0.987). Ovarian recurrence or metachronous secondary ovarian cancer occurred after a median time of 5.9 years, and all cases were salvaged. CONCLUSION Our study suggests that adoption of ovarian conservation in young women with early-stage low-grade endometrial cancer varies by population. Ovarian conservation for young women with early-stage, low-grade endometrial cancer may be potentially associated with increased risks of ovarian recurrence or metachronous secondary ovarian cancer in certain populations; nevertheless, ovarian conservation did not negatively impact overall survival.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
| | - James C Cripe
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Katherine C Kurnit
- Department of Gynecologic Oncology and Reproductive Medicine, MD-Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Michiko Kaneda
- Department of Gynecology, Hyogo Cancer Center, Hyogo, Japan
| | - Audrey S Garneau
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
| | - Gretchen E Glaser
- Division of Gynecologic Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Aaron Nizam
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Long Island, NY, USA
| | | | - Michelle L Kuznicki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, FL, USA
| | - Akira Yabuno
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shiori Yanai
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Denise M Garofalo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA
| | - Jiro Suzuki
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Tokyo, Japan
| | - Jessica D St Laurent
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ting-Tai Yen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Annie Y Liu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Masako Shida
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
| | - Mamoru Kakuda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuro Oishi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Tottori, Japan
| | - Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Fukuoka, Japan
| | - Jenna Z Marcus
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Sosuke Adachi
- Department of Obstetrics and Gynecology, Niigata University School of Medicine, Niigata, Japan
| | - Tetsuji Kurokawa
- Department of Obstetrics and Gynecology, University of Fukui School of Medicine, Fukui, Japan
| | - Malcolm S Ross
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, PA, USA
| | - Max P Horowitz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Marian S Johnson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
| | - Min K Kim
- Gynecologic Oncology Center, Mercy Medical Center, Baltimore, MD, USA
| | - Alexander Melamed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Karime K Machado
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University School of Medicine, Niigata, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, University of Fukui School of Medicine, Fukui, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University School of Medicine, Niigata, Japan
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Fukuoka, Japan
| | - Shinya Satoh
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Tottori, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
| | - Bobbie J Rimel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rebecca L Stone
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Whitfield B Growdon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Tokyo, Japan
| | - Saketh R Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Mian M K Shahzad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, FL, USA
| | - Dwight D Im
- Gynecologic Oncology Center, Mercy Medical Center, Baltimore, MD, USA
| | - Marina Frimer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Long Island, NY, USA
| | - Bobbie S Gostout
- Division of Gynecologic Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Frederick R Ueland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA
| | - Shoji Nagao
- Department of Gynecology, Hyogo Cancer Center, Hyogo, Japan
| | - Pamela T Soliman
- Department of Gynecologic Oncology and Reproductive Medicine, MD-Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
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Moroney MR, Davies KD, Wilberger AC, Sheeder J, Post MD, Berning A, Fisher C, Lefkowits C, Guntupalli SR, Behbakht K, Corr BR. Molecular markers in recurrent stage I, grade 1 endometrioid endometrial cancers. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.03.179] [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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24
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Armstrong DK, Moore KN, Miller A, Bell-McGuinn KM, Schilder RJ, Fracasso PM, Walker JL, Duska LR, Mathews CA, Chen AP, O'Malley DM, Gray HJ, O'Cearbhaill RE, Guntupalli SR, Hagemann AR, Aghajanian C. A phase I study of veliparib incorporated into front-line platinum based cheotherpy and bevacizumab in epithelial ovarian cancer (NCT00989651): A GOG/nrg trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5523 Background: Veliparib, a poly-(ADP-ribose)-polymerase inhibitor, increases anti-tumor activity when combined with platinum chemotherapy and has monotherapy activity in BRCA deficient tumors. This study was done to determine the recommended phase II dose (RP2D) of veliparib in combination with front line treatment for epithelial ovarian cancer (EOC). Methods: Eligible patients had newly diagnosed, stage II-IV EOC. Six regimens were evaluated, 3 variations of chemo delivery with either continuous (D1-21) or intermittent (days-2-5) veliparib BID. Chemo included 1: IV q3week carboplatin (C) (AUC 6) and paclitaxel(T) (175mg/m2); 2, IV q3week C (AUC 6) and weekly T(80mg/m2); and 3, IV T (135mg/m2, day 1), IP cisplatin (75mg/m2, day 1 or 2) and IP T (60mg/m2, day 8). Bevacizumab 15mg/kg started cycle 2 and continued as monotherapy cycles 7-22. A 3+3 dose escalation design evaluated dose-limiting toxicities (DLTs) in cycles 1 and 2. Once < 2/6 patients experienced a DLT, that dose level was expanded to evaluate feasibility over 4 cycles. Results: The study accrued 424 treated patients. For regimen 1, continuous (Reg1c) the maximum tolerated dose (MTD) was 250mg veliparib BID but the feasible dose was found to be 150mg BID. For regimen 1, intermittent (Reg1i) the MTD and feasible dose were 400 and 250mg BID respectively. For Reg2c the MTD and feasible dose were the same at 150mg BID. For Reg2i the MTD and feasible dose were 250 and 150mg BID respectively. For Reg3c the MTD and feasible dose are both 150mg BID and for Reg3i, the MTD was 400mg BID and the feasible dose felt to be 300mg BID. Median PFS by residual disease and BRCA status is: (Positive residual disease) 14.6, 19.1 and 16.9 months for BRCA+, BRCAwt and BRCA ukn respectively. For no gross residual disease the PFS is NR, 34.2 and 24.5 months respectively. Conclusions: Given the difficulty with toxicity not defined as a DLT, the RP2D for all regimens is veliparib 150mg BID. This data informed the dose that moved into the phase III trial GOG 3005/Velia: NCT02470585. Velia also incorporated maintenance veliparib instead of maintenance bevacizumab among all high grade serous patients (BRCA+ and wt). These results will determine utilization of veliparib in this space. Clinical trial information: NCT00989651.
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Affiliation(s)
- Deborah Kay Armstrong
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Kathleen N. Moore
- Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, OK
| | - Austin Miller
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | | | - Joan L. Walker
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | - Alice P. Chen
- Developmental Therapeutics Clinic/Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | - Heidi J. Gray
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | | | | | - Andrea R. Hagemann
- Washington University School of Medicine in St. Louis and Siteman Cancer Center, St. Louis, MO
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Huang GS, Merritt MA, Hutson A, Strickler HD, Einstein M, Brouwer-Visser J, Ramirez NC, Lankes HA, El-Bahrawy M, Xue X, Yu H, Mannel RS, O'Malley DM, Mutch DG, Disilvestro P, Geller MA, Guntupalli SR, Birrer MJ, Miller DS, Gunter MJ. Sex hormone, insulin, and insulin-like growth factor signaling in recurrence of high stage endometrial cancer: Results from the NRG Oncology/Gynecologic Oncology Group 210 trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5509] [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: 11/20/2022] Open
Abstract
5509 Background: Sex hormone and insulin/insulin-like growth factor (IGF) axis signaling pathways play an important role in endometrial cancer development but their role in endometrial cancer recurrence is unknown. In this study GOG-8015 we evaluated these pathways in a prospective cohort of patients diagnosed with the most common type of endometrial cancer, endometrioid adenocarcinoma. Methods: Stage II-IV endometrioid endometrial adenocarcinoma patients (N = 816) enrolled in the GOG-210 study with pre-treatment specimens were tested for tumor mRNA and protein expression levels of IGF1, IGF2, IGF binding proteins ( IGFBP) -1and -3, the insulin (IR) and IGF-I receptors (IGF1R), and phosphorylated (activated) IR/IGF1R as well as estrogen (ER) and progesterone receptors (PR) using quantitative PCR and immunohistochemistry (IHC). Serum concentrations of insulin, IGF-I, IGFBP-3, estradiol, estrone and sex hormone binding globulin were measured using ELISAs. Hazard ratios (HR) and 95% confidence intervals (CI) for risk of recurrence were obtained from multivariable Cox proportional hazard’s models with adjustment for age, stage and grade. Results: Recurrence occurred in 280 (34%) cases during a mean of 5.4 years of follow-up. ER-positivity (HR 0.67, 95% CI 0.47-0.95), IR-positivity (HR 0.53, 95% CI 0.29-0.98) and serum IGF-I levels (highest versus lowest quartile, HR 0.66, 95% CI 0.47-0.92) were inversely associated with recurrence risk. Conversely, circulating estradiol (highest versus lowest tertile, HR 1.55, 95% CI 1.02-2.36) and insulin (per 10 uU/ml, HR 1.52, 95% CI 1.12-2.06) and phosphorylated IGF1R/pIR expression (HR 1.40, 95% CI 1.02-1.92) were associated with increased risk of recurrence. Conclusions: We identified novel sex hormone and insulin/IGF axis tissue and circulating biomarkers of recurrence in a prospective study of high stage endometrioid endometrial cancer. Circulating insulin and estradiol, and tissue phosphorylated (activated) IGR1R/IR were independently associated with recurrence. These findings support prioritizing studies to establish their clinical utility as prognostic biomarkers and to investigate new strategies that target these pathways for prevention and treatment of endometrial cancer recurrence.
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Affiliation(s)
| | | | | | - Howard D. Strickler
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | | | - Jurriaan Brouwer-Visser
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein Cancer Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Nilsa C. Ramirez
- Gynecologic Oncology Group Tissue Bank, Biopathology Center, Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Heather A. Lankes
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbus, OH
| | | | - Xiaonan Xue
- Albert Einstein College of Medicine, Bronx, NY
| | - Herbert Yu
- Epidemiology Program, University of Hawaii Cancer Centre, Honolulu, HI
| | | | | | | | | | | | | | | | - David S. Miller
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - Marc J. Gunter
- International Agency for Research on Cancer, Lyon, France
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26
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Welton LL, Guntupalli SR, Flink DM. Needs assessment for sexual health support following cancer diagnosis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e23071] [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: 11/20/2022] Open
Abstract
e23071 Background: Women report distress over relationships, body image and sexual function after cancer; those < 50 have a 3-times greater risk of sexual dysfunction following treatment. Survivors desire integrated and multifaceted interventions to maintain optimal sexual health. Methods: We employed a mixed-method (concurrent nested) design to identify women’s need for sexual health support after diagnosis. Women 18-50 years old were recruited at a national conference for young survivors and local breast/gynecologic clinics. Qualitative and quantitative assessments identified sexual health factors and support needs most prevalent. Summary statistics and theme analysis using grounded theory was conducted. Results: Participants included 128 women (mean diagnosis age 35.6) and were: married (71%), breast cancer (46%), mastectomy (40%), hysterectomy (30%), chemotherapy (81%), radiation (51%) and completed treatment (67%). Nearly 1/3 of women reported their relationship worsening, 97% contribute it to less sexual activity; 71% were unsatisfied with their sexual relationship compared to before diagnosis. Women (77%) feel their oncologist should discuss sexual health and 74% prefer information prior to treatment. When asked to identify resources 82% desired helpful products/strategies; other desired resources include: written education (65%), medications/lubricants (68%), personal counseling (37%), sex therapist (41%) and local/web-based support groups (36%). When asked to describe their experience with sexual health women reported the following themes: supportive partners, sexual health status, guilt, stolen identity, loss of desire, isolation, treatment side effects, menopause, vaginal changes, maintaining relationships, coping mechanisms, fertility, self-image, grief, intimacy, and desire for oncologist support. Conclusions: Sexual health support after diagnosis is an unmet need that can be integrated into treatment to greatly improve the quality of life for survivors. Women desire their oncologist to provide information before treatment and through survivorship on products/strategies, education, and medications/lubricants to maintain sexual function. Young women do not desire social support resources.
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Urban RR, Ramzan AA, Doo DW, Sheeder J, Guntupalli SR. The perceptions of gynecologic oncology fellows on readiness for subspecialty training following OB/GYNRESIDENCY. Gynecol Oncol Rep 2019; 28:104-108. [PMID: 30997375 PMCID: PMC6451191 DOI: 10.1016/j.gore.2019.03.007] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/05/2019] [Accepted: 03/10/2019] [Indexed: 11/23/2022] Open
Abstract
A recent survey of fellowship program directors (PD) within gynecologic oncology (GO) noted concerns regarding the abilities of incoming fellows. The objective of this study was to evaluate the perceptions of current and former fellows in gynecologic oncology of their readiness for fellowship training. A previously used survey was modified and distributed in 2016 to current and former fellows in GO. The survey explored domains of independent practice, psychomotor ability, clinical evaluation and scholarship. A standard Likert scale was employed and domains/responses were tailored to the subspecialty. A total of 150 current and recently former fellows responded to the survey, for a response rate of 38.7%. Nearly 70% of respondents reported being able to independently perform a hysterectomy when starting fellowship, and nearly 50% felt they could perform lysis of adhesions either without assistance. Although nearly 95% reported having had the opportunity to develop a plan of action for patients on labor and delivery, only 40.7% felt able to independently manage postoperative complications without assistance. Common themes that emerged in the open-ended responses pertained to self-perception of inadequate surgical skills and knowledge specific to gynecologic oncology. Although the majority of current and former fellows in gynecologic oncology report feeling prepared for fellowship, themes noted in the open-ended responses suggest a lack of confidence in surgical skills and clinical knowledge. The majority of current and former GO fellows report feeling prepared for fellowship. Discrepancies were noted between our study and results of a prior survey of fellowship directors. Open-ended responses suggested lack of confidence in surgical skills and in clinical knowledge.
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Affiliation(s)
- Renata R Urban
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Amin A Ramzan
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Denver, CO, United States of America
| | - David W Doo
- Fellow, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama, Birmingham, AB, United States of America
| | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, Division of Family Planning, University of Colorado School of Medicine, Denver, CO, United States of America
| | - Saketh R Guntupalli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Denver, CO, United States of America
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Moroney MR, Davies KD, Wilberger AC, Sheeder J, Post MD, Berning AA, Fisher C, Lefkowits C, Guntupalli SR, Behbakht K, Corr BR. Molecular markers in recurrent stage I, grade 1 endometrioid endometrial cancers. Gynecol Oncol 2019; 153:517-520. [PMID: 30910249 DOI: 10.1016/j.ygyno.2019.03.100] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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: 01/11/2019] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Stage I, grade 1 endometrial cancers have low recurrence rates and often do not receive adjuvant therapy. We compared recurrent cases to matched non-recurrent controls to evaluate for molecular markers associated with higher risk of recurrence. METHODS A case-control study including all cases of recurrent stage I, grade 1 endometrioid endometrial cancer at one institution in a ten-year period. Cases were matched to controls by age, BMI, weight and stage. Molecular testing and immunohistochemistry were performed on archival tumor specimens: microsatellite instability (MSI-H), mismatch repair status, POLE mutational status, and next-generation sequencing. RESULTS 15 stage I, grade 1 endometrial cancer cases with recurrent disease and available tumor specimens were identified. CTNNB1 and MSI-H were present at significantly higher rates in cases than controls (CTNNB1 60% vs. 28%, OR 3.9, 95%CI 1.1-14.7, p = 0.04 and MSI-H 53% vs. 21%, OR 4.4, 95%CI 1.1-17.0, p = 0.03). POLE mutations were found in 0% of cases vs. 7% of controls (p = 0.54). Among specimens demonstrating microsatellite stability (MSS), 100% of cases vs. 26% of controls had CTNNB1 mutations (p < 0.001). CTNNB1 wild type tumors were MSI-H in 100% of cases vs. 19% of controls (p < 0.001). CONCLUSIONS Compared to controls, CTNNB1 mutation is present at significantly higher rates in recurrent stage I, grade 1 endometrial cancers and is found most commonly in MSS tumors. MSI-H is also present at significantly higher rates in recurrent cases. These markers may be useful for prognostic risk stratification and adjuvant therapy decision-making in this otherwise low-risk population.
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Affiliation(s)
- Marisa R Moroney
- University of Colorado Denver, Department of Obstetrics and Gynecology, Aurora, CO, United States of America.
| | - Kurtis D Davies
- University of Colorado Denver Aurora, Department of Pathology, CO, United States of America
| | - Adam C Wilberger
- University of Colorado Denver Aurora, Department of Pathology, CO, United States of America
| | - Jeanelle Sheeder
- University of Colorado Denver, Department of Obstetrics and Gynecology, Aurora, CO, United States of America
| | - Miriam D Post
- University of Colorado Denver, Department of Obstetrics and Gynecology, Aurora, CO, United States of America; University of Colorado Denver Aurora, Department of Pathology, CO, United States of America
| | - Amber A Berning
- University of Colorado Denver Aurora, Department of Pathology, CO, United States of America
| | - Christine Fisher
- University of Colorado Denver Aurora, Department of Radiation Oncology, CO, United States of America
| | - Carolyn Lefkowits
- University of Colorado Denver Aurora, Department of Gynecologic Oncology, CO, United States of America
| | - Saketh R Guntupalli
- University of Colorado Denver Aurora, Department of Gynecologic Oncology, CO, United States of America
| | - Kian Behbakht
- University of Colorado Denver Aurora, Department of Gynecologic Oncology, CO, United States of America
| | - Bradley R Corr
- University of Colorado Denver Aurora, Department of Gynecologic Oncology, CO, United States of America
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Rose PG, Java JJ, Salani R, Geller MA, Alvarez A, Tewari KS, Bender DP, Mutch DG, Friedlander ML, Van Le L, Method MW, Hamilton CA, Lee RB, Wenham RM, Guntupalli SR, Markman M, Muggia FM, Armstrong DK, Bookman MA, Burger RA, Copeland LJ. Nomogram for Predicting Individual Survival After Recurrence of Advanced-Stage, High-Grade Ovarian Carcinoma. Obstet Gynecol 2019; 133:245-254. [PMID: 30633128 PMCID: PMC6551603 DOI: 10.1097/aog.0000000000003086] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To analyze clinical prognostic factors for survival after recurrence of high-grade, advanced-stage ovarian-peritoneal-tubal carcinoma and to develop a nomogram to predict individual survival after recurrence. METHODS We retrospectively analyzed patients treated in multicenter Gynecologic Oncology Group protocols for stage III and IV ovarian-peritoneal-tubal carcinoma who underwent primary debulking surgery, received chemotherapy with paclitaxel and a platinum compound, and subsequently developed recurrence. Prognostic factors affecting survival were identified and used to develop a nomogram, which was both internally and externally validated. RESULTS There were 4,739 patients included in this analysis, of whom, 84% had stage III and 16% had stage IV ovarian carcinoma. At a median follow-up of 88.8 months (95% CI 86.2-92.0 months), the vast majority of patients (89.4%) had died. The median survival after recurrence was 21.4 months (95% CI 20.5-21.9 months). Time to recurrence after initial chemotherapy, clear cell or mucinous histology, performance status, stage IV disease, and age were significant variables used to develop a nomogram for survival after recurrence, which had a concordance index of 0.67. The time to recurrence alone accounted for 85% of the prognostic information. Similar results were found for patients who underwent second look laparotomy and had a complete pathologic response or received intraperitoneal chemotherapy. CONCLUSION For individuals with advanced-stage ovarian carcinoma who recur after standard first-line therapy, estimated survivals after recurrence are closely related to the time to recurrence after chemotherapy and prognostic variables can be used to predict subsequent survival. CLINICAL TRIAL REGISTRATION ClinialTrials.gov, NCT00002568, NCT00837993, NCT00002717, NCT01074398, and NCT00011986.
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Affiliation(s)
- Peter G Rose
- Cleveland Clinic Foundation and Case Western Reserve University, Cleveland, OH;
| | - James J Java
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY;
| | | | | | | | | | | | - David G Mutch
- Washington University School of Medicine, St. Louis, MO;
| | | | | | - Michael W Method
- Community Health Network and Indiana University School of Medicine, Indianapolis, IN;
| | | | | | | | | | | | | | | | | | - Robert A Burger
- University of Pennsylvania Medical Center, Philadelphia, PA:
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Urban RR, Ramzan AA, Doo DW, Galan HL, Harper L, Omurtag K, Muffly TM, Sheeder J, Guntupalli SR. Fellow Perceptions of Residency Training in Obstetrics and Gynecology. J Surg Educ 2019; 76:93-98. [PMID: 30093331 DOI: 10.1016/j.jsurg.2018.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/01/2018] [Accepted: 06/19/2018] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To evaluate the perceptions of current and former fellows in obstetrics and gynecology (OBG) subspecialties of their readiness for fellowship training. METHODS A previously used survey was modified and distributed in 2016 to current and former fellows in gynecologic oncology, maternal-fetal medicine, reproductive endocrinology-infertility, and female pelvic medicine and reconstructive surgery. The survey explored domains of professionalism, independent practice, psychomotor ability, clinical evaluation, and scholarship. A standard Likert scale was employed and domains/responses were tailored to each subspecialty. Standard statistical models were utilized. RESULTS A total of 478 fellows responded to the survey. Nearly 75% of fellows from each specialty reported feeling prepared or very prepared for fellowship. More than 65% of fellows from each specialty reported feeling very prepared to perform core surgical procedures. More than 90% of respondents reported having opportunities during residency to independently develop a plan of action for patients on labor and delivery. Fewer respondents reported opportunities to independently manage postoperative complications-40.7% of gynecologic oncology and 44.7% of female pelvic medicine and reconstructive surgery reported having such opportunities, whereas 91.9% of maternal-fetal medicine respondents reported having had such opportunities. While 46.4% of respondents received education on scientific writing during residency, 80% reported writing a manuscript as a resident. CONCLUSIONS The majority of current and former fellows in OBG subspecialties report feeling prepared for fellowship in terms of clinical and surgical skills. Their feedback reveals opportunities for improvement of independent practice in gynecologic scenarios, as well as formal education on scientific research, for OBG residencies.
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Affiliation(s)
- Renata R Urban
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, Washington.
| | - Amin A Ramzan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - David W Doo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama, Birmingham, Alabama
| | - Henry L Galan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Lorie Harper
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama School of Medicine, Birmingham, Alabama
| | - Kenan Omurtag
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Tyler M Muffly
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeanelle Sheeder
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Saketh R Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
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Felix AS, Cohn DE, Brasky TM, Zaino R, Park K, Mutch DG, Creasman WT, Thaker PH, Walker JL, Moore RG, Lele SB, Guntupalli SR, Downs LS, Nagel CI, Boggess JF, Pearl ML, Ioffe OB, Randall ME, Brinton LA. Receipt of adjuvant endometrial cancer treatment according to race: an NRG Oncology/Gynecologic Oncology Group 210 Study. Am J Obstet Gynecol 2018; 219:459.e1-459.e11. [PMID: 30096321 DOI: 10.1016/j.ajog.2018.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Black women with endometrial cancer are more likely to die of their disease compared with white women with endometrial cancer. These survival disparities persist even when disproportionately worse tumor characteristics among black women are accounted. Receipt of less complete adjuvant treatment among black patients with endometrial cancer could contribute to this disparity. OBJECTIVE We assessed the hypothesis that black women with endometrial cancer are less likely than their white counterparts to receive adjuvant treatment within subgroups defined by tumor characteristics in the NRG Oncology/Gynecology Oncology Group 210 Study. STUDY DESIGN Our analysis included 615 black and 4283 white women with endometrial cancer who underwent hysterectomy. Women completed a questionnaire that assessed race and endometrial cancer risk factors. Tumor characteristics were available from pathology reports and central review. We categorized women as low-, intermediate-, or high-risk based on the European Society for Medical Oncology definition. Adjuvant treatment was documented during postoperative visits and was categorized as no adjuvant treatment (54.3%), radiotherapy only (16.5%), chemotherapy only (15.2%), and radiotherapy plus chemotherapy (14.0%). We used polytomous logistic regression to estimate odds ratios and 95% confidence intervals for multivariable-adjusted associations between race and adjuvant treatment in the overall study population and stratified by tumor subtype, stage, or European Society for Medical Oncology risk category. RESULTS Overall, black women were more likely to have received chemotherapy only (odds ratio, 1.40; 95% confidence interval, 1.04-1.86) or radiotherapy plus chemotherapy (odds ratio, 2.01; 95% confidence interval, 1.54-2.62) compared with white women in multivariable-adjusted models. No racial difference in the receipt of radiotherapy only was observed. In tumor subtype-stratified models, black women had higher odds of receiving radiotherapy plus chemotherapy than white women when diagnosed with low-grade endometrioid (odds ratio, 2.04; 95% confidence interval, 1.06-3.93) or serous tumors (odds ratio, 1.81; 95% confidence interval, 1.07-3.08). Race was not associated with adjuvant treatment among women who had been diagnosed with other tumor subtypes. In stage-stratified models, we observed no racial differences in the receipt of adjuvant treatment. In models that were stratified by European Society for Medical Oncology risk group, black women with high-risk cancer were more likely to receive radiotherapy plus chemotherapy compared with white women (odds ratio, 1.41; 95% confidence interval, 1.03-1.94). CONCLUSION Contrary to our hypothesis, we observed higher odds of specific adjuvant treatment regimens among black women as compared with white women within specific subgroups of endometrial cancer characteristics.
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Ramzan AA, Behbakht K, Corr BR, Sheeder J, Guntupalli SR. Minority Race Predicts Treatment by Non-gynecologic Oncologists in Women with Gynecologic Cancer. Ann Surg Oncol 2018; 25:3685-3691. [DOI: 10.1245/s10434-018-6694-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Indexed: 12/21/2022]
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Moroney MR, Flink D, Sheeder J, Blake EA, Carrubba AR, Fisher CM, Guntupalli SR. Radiation therapy is not an independent risk factor for decreased sexual function in women with gynecologic cancers. Rep Pract Oncol Radiother 2018; 23:331-336. [PMID: 30127672 DOI: 10.1016/j.rpor.2018.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 10/03/2017] [Revised: 04/07/2018] [Accepted: 07/22/2018] [Indexed: 01/02/2023] Open
Abstract
Aim To evaluate the associations of external beam radiation therapy (EBRT) and intracavitary brachytherapy (IB) with decreased sexual function. Background There's inconsistent evidence on whether radiation for gynecologic cancers has an impact on sexual health. IB, an underutilized treatment modality, is thought to have less adverse effects than EBRT. Materials and methods A cross-sectional study examining decreased sexual function following radiation for gynecologic cancers. A decrease in sexual function was measured as a change in the Female Sexual Function Index (FSFI) from before to after treatment, with a significant decrease determined by Reliable Change Index Statistic (RCIS). Chi-square and t-tests were employed. Results 171 women completed the survey; 35% (n = 60) received radiation, of whom 29 received EBRT and IB (48%), 15 EBRT alone (25%), 16 IB alone (27%). Women who received radiation had similar rates of decreased sexual function as women who did not (47% vs. 38%, P = 0.262). EBRT and IB had similar rates of decreased sexual function compared to women with no radiation (50% vs. 38% P = 0.166 and 47% vs. 38% P = 0.309). Women experiencing decreased sexual function were more likely to be under 50 years old (OR 5.4, 95%CI 1.6-18.1), have received chemotherapy (OR 5.7, 95%CI 1.4-22.9), and have cervical cancer (OR 7.8, 95%CI 2.1-28.8). Conclusions Treatment with EBRT or IB does not appear to impair sexual function in women with gynecologic cancer. Age less than 50, concurrent chemotherapy, and cervical cancer may place women with gynecologic cancer at higher risk for decreased sexual function following radiation.
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Affiliation(s)
- Marisa R Moroney
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Dina Flink
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Erin A Blake
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Aakriti R Carrubba
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
| | - Christine M Fisher
- Department of Radiation Oncology, University of Colorado Denver, Aurora, CO, USA
| | - Saketh R Guntupalli
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO, USA
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Fisher CM, Robin T, Flink DM, Moroney M, Guntupalli SR. Intracavitary Brachytherapy is Not Associated with Significant Change Ii Sexual Function: A Cross Sectional Study in Gynecologic Cancer Patients. Brachytherapy 2018. [DOI: 10.1016/j.brachy.2018.04.013] [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: 10/28/2022]
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Urban RR, Ramzan AA, Doo DW, Galan HL, Harper L, Omurtag K, Muffly TM, Sheeder J, Guntupalli SR. Fellow perceptions of residency training in obstetrics and gynecology. Am J Obstet Gynecol 2018; 218:461-462. [PMID: 29353035 DOI: 10.1016/j.ajog.2018.01.021] [Citation(s) in RCA: 3] [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] [Received: 01/02/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
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Felix AS, Brasky TM, Cohn DE, Mutch DG, Creasman WT, Thaker PH, Walker JL, Moore RG, Lele SB, Guntupalli SR, Downs LS, Nagel C, Boggess JF, Pearl ML, Ioffe OB, Deng W, Miller DS, Brinton LA. Endometrial carcinoma recurrence according to race and ethnicity: An NRG Oncology/Gynecologic Oncology Group 210 Study. Int J Cancer 2017; 142:1102-1115. [PMID: 29063589 DOI: 10.1002/ijc.31127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 06/27/2017] [Revised: 09/20/2017] [Accepted: 10/04/2017] [Indexed: 01/21/2023]
Abstract
Non-Hispanic black (NHB) women are more likely to experience an endometrial carcinoma (EC) recurrence compared to non-Hispanic white (NHW) women. The extent to which tumor characteristics, socioeconomic status (SES) and treatment contribute to this observation is not well defined. In the NRG Oncology/Gynecology Oncology Group (GOG) 210 Study we evaluated associations between race/ethnicity and EC recurrence according to tumor characteristics with adjustment for potential confounders. Our analysis included 3,199 NHW, 532 NHB and 232 Hispanic women with EC. Recurrence was documented during follow-up. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between race/ethnicity and EC recurrence in models stratified by histologic subtype (low-grade endometrioid, high-grade endometrioid, serous, mixed cell, carcinosarcoma, clear cell) or stage (I, II, III) and adjusted for age, SES, body mass index, smoking status and treatment. In histologic subtype-stratified models, higher EC recurrence was noted in NHB women with low-grade endometrioid (HR = 1.94, 95% CI = 1.21-3.10) or carcinosarcomas (HR = 1.66, 95% CI = 0.99-2.79) compared to NHWs. In stage-stratified models, higher EC recurrence was noted among NHB women with stage I (HR = 1.48, 95% CI = 1.06-2.05) and Hispanic women with stage III disease (HR = 1.81, 95% CI = 1.11-2.95). Our observations of higher EC recurrence risk among NHB and Hispanic women, as compared to NHW women, were not explained by tumor characteristics, SES, treatment or other confounders. Other factors, such as racial differences in tumor biology or other patient factors, should be explored as contributors to racial disparities in EC recurrence.
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Affiliation(s)
- A S Felix
- Division of Epidemiology, Ohio State University College of Public Health, Columbus, OH
| | - T M Brasky
- Division of Cancer Prevention and Control, Ohio State University College of Medicine, Columbus, OH
| | - D E Cohn
- Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH
| | - D G Mutch
- Washington University School of Medicine, St. Louis, MO
| | - W T Creasman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| | - P H Thaker
- Washington University School of Medicine, St. Louis, MO
| | - J L Walker
- Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma, OK
| | - R G Moore
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital/Brown University, Providence, RI
| | - S B Lele
- Gynecologic Oncology [SBL] & NRG Statistics and Data Management Center [WD], Roswell Park Cancer Institute, Buffalo, NY
| | - S R Guntupalli
- Gynecologic Oncology, University of Colorado Cancer Center, Aurora, CO
| | - L S Downs
- Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | - Ci Nagel
- Gynecologic Oncology, Case Western Reserve University, Cleveland, OH
| | - J F Boggess
- Gynecologic Oncology Program, University of North Carolina, Chapel Hill, NC
| | - M L Pearl
- Gynecologic Oncology, State University of New York at Stony Brook, Stony Brook, NY
| | - O B Ioffe
- Anatomical Pathology, University of Maryland, College Park, MD
| | - W Deng
- Gynecologic Oncology [SBL] & NRG Statistics and Data Management Center [WD], Roswell Park Cancer Institute, Buffalo, NY
| | - D S Miller
- Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - L A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Matsuo K, Machida H, Horowitz MP, Shahzad MMK, Guntupalli SR, Roman LD, Wright JD. Risk of metachronous ovarian cancer after ovarian conservation in young women with stage I cervical cancer. Am J Obstet Gynecol 2017; 217:580.e1-580.e10. [PMID: 28666700 DOI: 10.1016/j.ajog.2017.06.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 03/31/2017] [Revised: 06/05/2017] [Accepted: 06/20/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND While there is an increasing trend of ovarian conservation at the time of surgical treatment for young women with stage I cervical cancer, the risk for subsequent ovarian cancer after ovarian conservation has not been well studied. OBJECTIVE We sought to examine the incidence of and risk factors for metachronous ovarian cancer among young women with stage I cervical cancer who had ovarian conservation at the time of hysterectomy. STUDY DESIGN The Surveillance, Epidemiology, and End Results Program was used to identify women aged <50 years who underwent hysterectomy with ovarian conservation for stage I cervical cancer from 1983 through 2013 (n = 4365). Time-dependent analysis was performed for ovarian cancer risk after cervical cancer diagnosis. RESULTS Mean age at cervical cancer diagnosis was 37 years, and the majority of patients had stage IA disease (68.2%) and squamous histology (72.9%). Median follow-up time was 10.8 years, and there were 13 women who developed metachronous ovarian cancer. The 10- and 20-year cumulative incidences of metachronous ovarian cancer were 0.2% (95% confidence interval, 0.1-0.4) and 0.5% (95% confidence interval, 0.2-0.8), respectively. Mean age at the time of diagnosis of metachronous ovarian cancer was 47.5 years, and stage III-IV disease was seen in 55.6%. Age (≥45 vs <45 years, hazard ratio, 4.22; 95% confidence interval, 1.16-15.4; P = .018), ethnicity (non-white vs white, hazard ratio, 4.29; 95% confidence interval, 1.31-14.0; P = .009), cervical cancer histology (adenocarcinoma or adenosquamous vs squamous, hazard ratio, 3.50; 95% confidence interval, 1.17-10.5; P = .028), and adjuvant radiotherapy use (yes vs no, hazard ratio, 3.69; 95% confidence interval, 1.01-13.4; P = .034) were significantly associated with metachronous ovarian cancer risk. The presence of multiple risk factors was associated with a significantly increased risk of metachronous ovarian cancer compared to the no risk factor group: 1 risk factor (hazard ratio range, 2.96-8.43), 2 risk factors (hazard ratio range, 16.6-31.0), and 3-4 risk factors (hazard ratio range, 62.3-109), respectively. CONCLUSION Metachronous ovarian cancer risk after ovarian conservation for women with stage I cervical cancer is <1%. Older age, non-white ethnicity, adenocarcinoma or adenosquamous histology, and adjuvant radiotherapy may be associated with an increased metachronous ovarian cancer risk.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
| | - Hiroko Machida
- Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Max P Horowitz
- Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
| | - Mian M K Shahzad
- Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL
| | - Saketh R Guntupalli
- Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of Colorado, Denver, CO
| | - Lynda D Roman
- Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY
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Brasky TM, Felix AS, Cohn DE, McMeekin DS, Mutch DG, Creasman WT, Thaker PH, Walker JL, Moore RG, Lele SB, Guntupalli SR, Downs LS, Nagel CI, Boggess JF, Pearl ML, Ioffe OB, Park KJ, Ali S, Brinton LA. Nonsteroidal Anti-inflammatory Drugs and Endometrial Carcinoma Mortality and Recurrence. J Natl Cancer Inst 2017; 109:1-10. [PMID: 28376204 DOI: 10.1093/jnci/djw251] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/26/2016] [Indexed: 12/21/2022] Open
Abstract
Background Recent data suggest that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with reductions in endometrial cancer risk, yet very few have examined whether their use is related to prognosis among endometrial cancer patients. Methods Study subjects comprised 4374 participants of the NRG Oncology/Gynecology Oncology Group 210 Study with endometrial carcinoma who completed a presurgical questionnaire that assessed history of regular prediagnostic NSAID use and endometrial cancer risk factors. Recurrences, vital status, and causes of death were obtained from medical records and cancer registries. Fine-Gray semiproportional hazards regression estimated adjusted subhazard ratios (HRs) and 95% confidence intervals (CIs) for associations of NSAID use with endometrial carcinoma-specific mortality and recurrence. Models were stratified by endometrial carcinoma type (ie, type I [endometrioid] vs type II [serous, clear cell, or carcinosarcoma]) and histology. Results Five hundred fifty endometrial carcinoma-specific deaths and 737 recurrences occurred during a median of five years of follow-up. NSAID use was associated with 66% (HR = 1.66, 95% CI = 1.21 to 2.30) increased endometrial carcinoma-specific mortality among women with type I cancers. Associations were statistically significant for former and current users, and strongest among former users who used NSAIDs for 10 years or longer (HR = 2.23, 95% CI = 1.19 to 4.18, two-sided P trend = .01). NSAID use was not associated with recurrence or endometrial carcinoma-specific mortality among women with type II tumors. Conclusions In this study, use of NSAIDs was associated with increased endometrial carcinoma-specific mortality, especially in patients with type I tumors. Barring a clear biologic mechanism by which NSAIDs would increase the risk of cause-specific mortality, cautious interpretation is warranted.
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Affiliation(s)
- Theodore M Brasky
- Division of Cancer Prevention and Control, Ohio State University, Columbus, OH, USA
| | - Ashley S Felix
- College of Medicine, and Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA.,Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - David E Cohn
- Division of Gynecologic Oncology, Ohio State University, Columbus, OH, USA
| | - D Scott McMeekin
- Stephenson Oklahoma Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Oklahoma, USA
| | - David G Mutch
- Washington University School of Medicine, St. Louis, MO, USA
| | - William T Creasman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Premal H Thaker
- Washington University School of Medicine, St. Louis, MO, USA
| | - Joan L Walker
- Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA
| | - Richard G Moore
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital/Brown University, Providence, RI, USA
| | - Shashikant B Lele
- Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Levi S Downs
- Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Christa I Nagel
- Division of Gynecologic Oncology, Case Western Reserve University, Cleveland, OH, USA
| | - John F Boggess
- Gynecologic Oncology Program, University of North Carolina, Chapel Hill, NC, USA
| | - Michael L Pearl
- Gynecologic Oncology, State University of New York at Stonybrook, Stonybrook, NY , USA
| | - Olga B Ioffe
- Anatomical Pathology, University of Maryland, College Park, MD, USA
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shamshad Ali
- NRG Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Carrubba AR, Flink DM, Sheeder J, Blake EA, Moroney M, Guntupalli SR. Surgical management is associated with sexual dysfunction in gynecologic cancer. Cogent Medicine 2016. [DOI: 10.1080/2331205x.2016.1265277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Aakriti R. Carrubba
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East, 17th Avenue, B198-6, Aurora, CO 80045, USA
| | - Dina M. Flink
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East, 17th Avenue, B198-6, Aurora, CO 80045, USA
| | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East, 17th Avenue, B198-6, Aurora, CO 80045, USA
| | - Erin A. Blake
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East, 17th Avenue, B198-6, Aurora, CO 80045, USA
| | - Marisa Moroney
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East, 17th Avenue, B198-6, Aurora, CO 80045, USA
| | - Saketh R. Guntupalli
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, Anschutz Medical Campus, 12631 East, 17th Avenue, B198-6, Aurora, CO 80045, USA
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Blake EA, Sheeder J, Behbakht K, Guntupalli SR, Guy MS. Factors Impacting Use of Robotic Surgery for Treatment of Endometrial Cancer in the United States. Ann Surg Oncol 2016; 23:3744-3748. [PMID: 27172774 DOI: 10.1245/s10434-016-5252-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study was designed to examine the impact of patient socioeconomic, clinical, and hospital characteristics on the utilization of robotics in the surgical staging of endometrial cancer. METHODS Patients surgically treated for endometrial cancer at facilities that offered robotic and open approaches were identified from the National Inpatient Sample Database from 2008 to 2012. The groups were compared for socioeconomic, clinical, and hospital differences. Medical comorbidity scores were calculated using the Charlson comorbidity index. T tests and χ (2) were used to compare groups. Multivariable analyses were used to determine factors that were independently associated with a robotic approach. RESULTS A total of 18,284 patients were included (robotic, n = 7169; laparotomy, n = 11,115). Significant differences were noted in all patient clinical and socioeconomic characteristics and all hospital characteristics. Multivariable analyses identified factors that independently predicted patients undergoing robotic surgery. These patients were older [adjusted odds ratio (aOR) 1.008; 95 % confidence interval (CI) 1.004-1.011], white (aOR 1.38; 95 % CI 1.27-1.50), and privately insured (aOR 1.16; 95 % CI 1.07-1.26). Clinically, these women were more likely to be obese (aOR 1.20; 95 % CI 1.11-1.30) and to be undergoing an elective case (aOR 1.25; 95 % CI 1.11-1.40). Hospitals were more likely to be under private control (aOR 1.55, 95 % CI 1.39-1.71) but less likely to be located in the south (aOR 0.87; 0.81-0.93), quantified as large or medium (aOR 0.57; 95 %CI 0.50-0.67), or teaching hospitals (aOR 0.68; 95 % CI 0.63-0.74). CONCLUSIONS Socioeconomic status and hospital characteristics are factors that independently predict robotic utilization in the United States. These racial, socioeconomic, and geographic disparities warrant further study regarding the utilization of this important technology.
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Affiliation(s)
- Erin A Blake
- Department of Obstetrics and Gynecology, University of Colorado, 12631 East 17th Avenue, Room 4007, Aurora, 80045, CO, USA.
| | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, University of Colorado, 12631 East 17th Avenue, Room 4007, Aurora, 80045, CO, USA
| | - Kian Behbakht
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA
| | - Saketh R Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA
| | - Michael S Guy
- Division of Gynecologic Oncology and Advanced Pelvic Surgery, Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, USA
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Amini A, Jones BL, Yeh N, Guntupalli SR, Kavanagh BD, Karam SD, Fisher CM. Disparities in disease presentation in the four screenable cancers according to health insurance status. Public Health 2016; 138:50-6. [PMID: 27091437 DOI: 10.1016/j.puhe.2016.03.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/07/2016] [Accepted: 03/10/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Current guidelines support the use of screening for early detection in breast, prostate, colorectal and cervical cancer. The purpose of this study was to evaluate whether insurance status predicts for more advanced disease in these four currently screened cancers. STUDY DESIGN The Surveillance, Epidemiology, and End Results (SEER) database was queried for breast, prostate, colorectal and cervix in patients aged 18-64 years. The database was queried from 2007 to 2011, with 425,614 patients with known insurance status included. METHODS Multinomial logistic regression was used to evaluate insurance status and cancer presentation. RESULTS Under multivariate analysis for breast cancer, uninsured patients more often had invasive disease (odds ratio [OR]: 1.55), T- (OR: 2.00), N- (OR: 1.59) stage, and metastatic disease (OR: 3.48), and were more often high-grade (OR: 1.21). For prostate cancer, uninsured patients again presented more commonly with higher T-stage (OR: 1.45), nodal (OR: 2.90) and metastatic (OR: 4.98) disease, in addition to higher prostate-specific antigen (OR: 2.85) and Gleason score (OR: 1.65). Colorectal cancer had similar findings with uninsured individuals presenting with more invasive disease (OR: 1.78), higher T (OR: 1.86), N (OR: 1.22), and M (OR: 1.58) stage, in addition to higher carcinoembryonic antigen levels (OR: 1.66). Similar results were seen for cervical cancer with uninsured having higher T (OR: 2.03), N (OR: 1.21), and M (OR: 1.45) stage. CONCLUSION In the four cancers detected by screening exams, those without health insurance present with more advanced disease, with higher stage and grade, and more elevated tumour markers.
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Affiliation(s)
- A Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - B L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - N Yeh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - S R Guntupalli
- Department of Obstetrics and Gynecology, Divisions of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - B D Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - S D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - C M Fisher
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA; Colorado Department of Public Health Breast and Cervical Cancer Screening and Prevention Advisory Board, USA.
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Guy MS, Sheeder J, Behbakht K, Wright JD, Guntupalli SR. Comparative outcomes in older and younger women undergoing laparotomy or robotic surgical staging for endometrial cancer. Am J Obstet Gynecol 2016; 214:350.e1-350.e10. [PMID: 26433173 DOI: 10.1016/j.ajog.2015.09.085] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 03/21/2015] [Revised: 09/15/2015] [Accepted: 09/23/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Older patients are at increased risk of perioperative morbidity and mortality. There are limited data on the safety of a robotic approach in the staging for endometrial cancer. OBJECTIVE We compared outcomes in women undergoing laparotomy or robotic surgical staging for endometrial cancer. STUDY DESIGN Using the Healthcare Cost and Utilization Project National Inpatient Sample database from 2008 through 2010, we abstracted records for patients who had surgery for endometrial cancer with either a robotic approach or laparotomy. Patients were categorized by age (<65 vs ≥65 years and 5-year increments). Medical comorbidity scores were calculated using the Charlson Comorbidity Index. Outcomes included intraoperative/perioperative/medical complications, death, length of stay (LOS), and discharge disposition. Student t and χ(2) tests were used to compare groups and approach. Multiple analysis of variance models were used to compare differences between robotics and laparotomy and age groups. RESULTS We identified 16,980 patients who had surgery for endometrial cancer with either a robotic approach (age ≥65 years, n = 1228; age <65 years, n = 1574) or laparotomy (age ≥65 years, n = 5914; age <65 years, n = 8264). Older patients had a higher Charlson Comorbidity Index score at the time of surgery (2.6 vs 2.5, P < .001). In laparotomy cases, intraoperative complication rates were similar (4.1% vs 3.7%, P = .17). Older patients had higher rates of perioperative surgical (20.5% vs 15.4%, P < .001) and medical (23.3% vs 15.5%, P < .001) complications, longer LOS (5.1 vs 4.2 days, P < .001), and lower rates of discharge to home (71.2% vs 90.1%, P < .001). In robotic cases, rates of intraoperative complications were similar (5.9% vs 6.8%, P = .32). Older patients had higher rates of perioperative surgical (8.3% vs 5.2%, P = .001) and medical (12.3% vs 6.7%, P = .001) complications, longer LOS (2.00 vs 1.67 days, P < .001), and lower rates of discharge to home (88.8% vs 96.8%, P < .001). With both approaches, as age increased, perioperative surgical and medical complications also increased in a linear fashion. In a subanalysis of older patients (n = 7142), there were lower rates of perioperative surgical (8.3% vs 20.5%, P < .001) and medical (12.3% vs 23.3%, P < .001) complications, death (0.0% vs 0.8%, P < .001), shorter LOS (2.00 vs 5.13 days, P < .001) and higher rate of discharge to home (88.8% vs 71.2%, P < .001) in robotic compared to laparotomy cases. CONCLUSION Although the risks of surgery increase with age, in patients age ≥65 years, a robotic approach for endometrial cancer appears to be safe given current selection criteria utilized in the United States.
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Affiliation(s)
- Michael S Guy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO.
| | - Jeanelle Sheeder
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
| | - Kian Behbakht
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Saketh R Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
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Doo DW, Guy MS, Behbakht K, Davidson SA, Sheeder J, Guntupalli SR. Association Between Preoperative Chemotherapy and Postoperative Complications in Patients Undergoing Surgery for Ovarian Cancer. Ann Surg Oncol 2015; 23:968-74. [DOI: 10.1245/s10434-015-4955-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Indexed: 01/22/2023]
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Blake EA, Behbakht K, Sheeder J, Guntupalli SR, Guy MS. Impact of socioeconomic, clinical and hospital characteristics on the utilization of a robotic approach for the treatment of endometrial cancer in the United States. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.07.080] [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: 10/22/2022]
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Doo DW, Powell M, Novetsky A, Sheeder J, Guntupalli SR. Preparedness of Ob/Gyn residents for fellowship training in gynecologic oncology. Gynecol Oncol Rep 2015; 12:55-60. [PMID: 26076160 PMCID: PMC4442653 DOI: 10.1016/j.gore.2015.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/10/2015] [Indexed: 11/25/2022] Open
Abstract
Residency training in obstetrics and gynecology is being challenged by increasingly stringent regulations and decreased operative experience. We sought to determine the perception of preparedness of incoming gynecologic oncology fellows for advanced surgical training in gynecologic oncology. An online survey was sent to gynecologic oncologists involved in fellowship training in the United States. They were asked to evaluate their most recent incoming clinical fellows in the domains of professionalism, level of independence/graduated responsibility, psychomotor ability, clinical evaluation and management, and academia and scholarship using a standard Likert-style scale. The response rate among attending physicians was 40% (n = 105/260) and 61% (n = 28/46) for program directors. Of those who participated, 49% reported that their incoming fellows could not independently perform a hysterectomy, 59% reported that they could not independently perform 30 min of a major procedure, 40% reported that they could not control bleeding, 40% reported that they could not recognize anatomy and tissue planes, and 58% reported that they could not dissect tissue planes. Fellows lacked an understanding of pathophysiology, treatment recommendations, and the ability to identify and treat critically ill patients. In the academic domain, respondents agreed that fellows were deficient in the areas of protocol design (54%), statistical analysis (54%), and manuscript writing (65%). These results suggest that general Ob/Gyn residency is ineffective in preparing fellows for advanced training in gynecologic oncology and should prompt a revision of the goals and objectives of resident education to correct these deficiencies. Ob/Gyn residency programs are facing an increasing number of challenges and restrictions. Recent incoming fellows may be underprepared for training in gynecologic oncology. Potential avenues to improve Ob/Gyn residency training are presented.
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Affiliation(s)
- David W Doo
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Matthew Powell
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University School of Medicine, St Louis, MO, United States
| | - Akiva Novetsky
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University School of Medicine, St Louis, MO, United States
| | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Saketh R Guntupalli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Aurora, CO, United States
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Doo DW, Guntupalli SR, Corr BR, Sheeder J, Davidson SA, Behbakht K, Jarrett MJ, Guy MS. Comparative Surgical Outcomes for Endometrial Cancer Patients 65 Years Old or Older Staged With Robotics or Laparotomy. Ann Surg Oncol 2015; 22:3687-94. [DOI: 10.1245/s10434-015-4428-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Indexed: 11/18/2022]
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Guy MS, Sheeder J, Guntupalli SR, Behbakht K. Comparative Outcomes in Older and Younger Women Undergoing Laparotomy or Robotic Surgical Staging for Endometrial Cancer. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hopkins MR, Richmond AM, Cheng G, Davidson S, Spillman MA, Sheeder J, Post MD, Guntupalli SR. Lymphovascular space invasion in robotic surgery for endometrial cancer. JSLS 2014; 18:e2014.00021. [PMID: 25392608 PMCID: PMC4154398 DOI: 10.4293/jsls.2014.00021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Minimally invasive surgery has become a standard treatment for endometrial cancer and offers significant benefits over abdominal approaches. There are discrepant data regarding lymphovascular space invasion (LVSI) and positive peritoneal cytology with the use of a uterine manipulator, with previous small-scale studies demonstrating an increased incidence of these prognostically important events. We sought to determine if there was a higher incidence of LVSI in patients who underwent robot-assisted surgery for endometrial cancer. METHODS We performed a single-institution review of medical records for patients who underwent open abdominal or robot-assisted hysterectomy for endometrial cancer over a 24-month period. The following data were abstracted: age, tumor grade and stage, size, depth of invasion, LVSI, and peritoneal cytology. For patients with LVSI, slides were reviewed by 2 pathologists for confirmation of LVSI. RESULTS Of 104 patients identified, LVSI was reported in 39 (37.5%) and positive peritoneal cytology in 6 (4.8%). Rates of peritoneal cytology were not significantly different between the 2 groups (odds ratio, 0.55; 95% confidence interval, 0.10-3.17; P=.50). LVSI was reported in significantly fewer robot-assisted hysterectomies than open procedures (odds ratio, 0.39; 95% confidence interval, 0.17-0.92; P=.03). In subgroup analyses restricted to early-stage disease (stage≤II), there was no significant difference in LVSI between open and robot-assisted hysterectomies (odds ratio, 0.64; 95% confidence interval, 0.22-1.85; P=.43). CONCLUSION In this retrospective study, we found that use of a uterine manipulator in robot-assisted surgery did not increase the incidence of LVSI.
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Affiliation(s)
- Mark R Hopkins
- University of Colorado School of Medicine, Aurora, CO, USA
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Kim Y, Guntupalli SR, Lee SJ, Behbakht K, Theodorescu D, Lee JK, Diamond JR. Retrospective analysis of survival improvement by molecular biomarker-based personalized chemotherapy for recurrent ovarian cancer. PLoS One 2014; 9:e86532. [PMID: 24505259 PMCID: PMC3914805 DOI: 10.1371/journal.pone.0086532] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/11/2013] [Indexed: 12/21/2022] Open
Abstract
Aggressive tumors such as epithelial ovarian cancer (EOC) are highly heterogeneous in their therapeutic response, making it difficult to improve overall response by using drugs in unselected patients. The goal of this study was to retrospectively, but independently, examine whether biomarker-based personalized chemotherapy selection could improve survival of EOC patients. Using in vitro drug sensitivity and patient clinical outcome data, we have developed co-expression extrapolation (COXEN) biomarker models for predicting patient response to three standard chemotherapy drugs used to treat advanced EOC: paclitaxel, cyclophosphamide, and topotecan, for which sufficient patient data were available for our modeling and independent validation. Four different cohorts of 783 EOC patients were used in our study, including two cohorts of 499 patients for independent validation. The COXEN predictors for the three drugs independently showed high prediction both for patient short-term therapeutic response and long-term survival for recurrent EOC. We then examined the potential clinical benefit of the simultaneous use of the three drug predictors for a large diverse EOC cohort in a prospective manner, finding that the median overall survival was 21 months longer for recurrent EOC patients who were treated with the predicted most effective chemotherapies. Survival improvement was greater for platinum-sensitive patients if they were treated with the predicted most beneficial drugs. Following the FDA guidelines for diagnostic prediction analysis, our study has retrospectively, yet independently, showed a potential for biomarker-based personalized chemotherapy selection to significantly improve survival of patients in the heterogeneous EOC population when using standard chemotherapies.
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Affiliation(s)
- Youngchul Kim
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
| | - Saketh R. Guntupalli
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Sun J. Lee
- Konkuk University School of Medicine, Seoul, Korea
| | - Kian Behbakht
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Dan Theodorescu
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Jae K. Lee
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
- * E-mail: (JKL); (JRD)
| | - Jennifer R. Diamond
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, Colorado, United States of America
- * E-mail: (JKL); (JRD)
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Guntupalli SR, Cao D, Shroff R, Gao F, Menias C, Stewart Massad L, Powell MA, Mutch DG, Thaker PH. Wilms' tumor 1 protein and estrogen receptor beta expression are associated with poor outcomes in uterine carcinosarcoma. Ann Surg Oncol 2013; 20:2373-9. [PMID: 23344579 DOI: 10.1245/s10434-012-2838-9] [Citation(s) in RCA: 6] [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] [Received: 10/08/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Uterine carcinosarcoma (CS) is an aggressive malignancy. Increased expression of Wilms' tumor 1 (WT1) protein and estrogen receptor beta (ER-β) protein is associated with worse outcomes in gynecologic cancers; therefore, we sought to assess this association in CS patients. METHODS A retrospective analysis was conducted for women diagnosed with uterine CS from departmental databases. WT1/ER-β expression was determined by immunohistochemical staining and scoring of specimens. Univariate and multivariate models were used to correlate progression-free survival (PFS) and overall survival (OS) with WT1/ER-β expression and clinicopathologic factors. RESULTS Ninety four patients had mean follow-up of 27 months. Postoperative treatments included chemotherapy for 52 (55 %) subjects and radiotherapy for 25 (27 %). Sixty-four (68 %) and 74 (79 %) tumor samples expressed WT1 and ER-β by immunohistochemistry, respectively. On univariate analysis, stage (p = .02) and lower uterine segment invasion (LUSI) (p = .001) were associated with decreased PFS. Only stage (p = .003) was linked to OS. In the total sample, increased WT1 expression was marginally associated with impaired PFS (p = .07) and OS (p = .09) but ER-β expression was not associated with PFS (p = .89) or OS (p = .30). WT1 and ER-β concurrent expression was associated with impaired OS (p = .02) and PFS (p = .02). On multivariate analysis, LUSI was a significant prognostic factor for PFS [hazard ratio (HR) 2.21, 95 % confidence interval (CI) = 1.12-4.32, p = .03] and stage for OS (HR 3.20, 95 % CI = 1.23-8.35, p = .02). Increased WT1/ER-β expression was associated with impaired OS (HR 1.31, 95 % CI = 1.02-1.69, p = .04). CONCLUSIONS Concurrent increased WT1 and ER-β expression impairs prognosis for women with uterine CS. Further research is warranted to define how relevant pathways interact and whether targeting these pathways improves OS.
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Affiliation(s)
- Saketh R Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine at Denver, Denver, CO, USA.
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