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Felix AS, Sinnott JA, Cohn DE, Duggan MA, Havrilesky LJ, Olawaiye AB, Mariani A, Rodriquez M, Brett MA, Dinoi G, Meade CE, Hall B, Goldfeld E, Elishaev E, Sherman ME, Suarez AA. Intraluminal tumor cells and prognostic accuracy of endometrial cancer stage criteria: A multi-institution study. Gynecol Oncol 2023; 178:130-137. [PMID: 37862792 PMCID: PMC10842547 DOI: 10.1016/j.ygyno.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Endometrial cancer stage is a strong prognostic factor; however, the current stage classification does not incorporate transtubal spread as determined by intraluminal tumor cells (ILTCs). We examined relationships between ILTCs and survival outcomes according to histological subtype and stage and examined whether identification of ILTCs improves prognostic accuracy of endometrial cancer staging. METHODS We conducted a retrospective cohort study of women diagnosed with endometrial cancer at five academic hospitals between 2007 and 2012. Pathologists determined ILTC presence (no vs. yes) and location (free in lumen vs. attached to epithelial surface) based on pathology review of hematoxylin and eosin-stained sections of fallopian tubes. Associations between ILTCs with time to recurrence (TTR) and overall survival (OS) were examined with Cox proportional hazards models adjusted for other prognostic factors. Model discrimination metrics were used to assess the addition of ILTCs to stage for prediction of 5-year TTR and OS. RESULTS In the overall study population (N = 1303), ILTCs were not independently associated with TTR (HR = 0.95, 95% CI = 0.69-1.32) or OS (HR = 0.97, 95% CI = 0.72-1.31). Among 805 women with stage I disease, ILTCs were independently associated with worse TTR (HR = 2.31, 95% CI = 1.06-5.05) and OS (HR = 2.16, 95% CI = 1.14-4.11). Upstaging early-stage cases with ILTCs present did not increase model discrimination. CONCLUSION While our data do not suggest that endometrial cancer staging guidelines should be revised to include ILTCs, associations between ILTCs and reduced survival observed among stage I cases suggest this tumor feature holds clinical relevance for subgroups of endometrial cancer patients.
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Affiliation(s)
- Ashley S Felix
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, United States of America.
| | - Jennifer A Sinnott
- Department of Statistics, The Ohio State University College of Arts and Sciences, Columbus, OH, United States of America
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Máire A Duggan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada; Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Laura J Havrilesky
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Duke Cancer Institute, Durham, NC, United States of America
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Andrea Mariani
- Gynecology and Obstetrics, Mayo Clinic, Rochester, MN, United States of America
| | - Monica Rodriquez
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada; Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mary Anne Brett
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada; Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Giorgia Dinoi
- Gynecology and Obstetrics, Mayo Clinic, Rochester, MN, United States of America
| | - Caitlin E Meade
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Bobbie Hall
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Ester Goldfeld
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Esther Elishaev
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States of America
| | - Mark E Sherman
- Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Adrian A Suarez
- Division of Pathology, The Ohio State University College of Medicine, Columbus, OH, United States of America
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Cao B, Huang Y. Malignant perivascular epithelioid cell tumor (PEComa) of the uterus. BMC Womens Health 2022; 22:523. [PMID: 36522714 PMCID: PMC9756506 DOI: 10.1186/s12905-022-02119-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Perivascular epithelioid cell tumors (PEComas) of the uterus is a rare type of mesenchymal tumors associated with myelomelanocytic differentiation and distinctive histological appearances. So far, the reported cases of uterine PEComas are usually benign. Documented malignant cases with aggressive behavior appear to be less common. CASE PRESENTATION We report a 37-year-old female who received abdominal hysterectomy for uterine tumor in a local hospital. She was diagnosed with uterine leiomyosarcoma and referred to Hubei Cancer Hospital. Her histological slides were reviewed and immunohistochemical staining for specific markers of epithelial, melanocytic, myoid and some others were analyzed. The pathologic diagnosis was malignant uterine PEComa. Systematic imaging of the patient further revealed an abdominal para-aortic mass. She received pelvic and para-aortic lymph node dissection. Postoperative histology revealed para-aortic lymph nodal metastasis of malignant uterine PEComa. She received 8 cycles of chemotherapy after surgery. The chemotherapy regiment was epirubicin plus ifosfamide The patient is free of recurrence and metastasis 6 years after surgical resection. CONCLUSION Uterine PEComas are indistinguishable from other uterine tumors such as leiomyoma and leiomyosarcoma before pathologic diagnosis could be made. For patients with malignant uterine PEComas, removal of both primary lesions and metastatic foci, if any, needs to be attempted. Postoperative chemotherapy or radiotherapy should also be considered in patients with distant metastases or positive lymph nodes.
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Affiliation(s)
- Bo Cao
- grid.33199.310000 0004 0368 7223Department of Gynecology Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Yi Huang
- grid.33199.310000 0004 0368 7223Department of Gynecology Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
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Dholakia J, Llamocca E, Quick A, Salani R, Felix AS. Guideline-concordant treatment is associated with improved survival among women with non-endometrioid endometrial cancer. Gynecol Oncol 2020; 157:716-722. [PMID: 32217002 DOI: 10.1016/j.ygyno.2020.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Among women diagnosed with non-endometrioid endometrial carcinoma (EC), we investigated associations between race/ethnicity and receipt of guideline-concordant treatment (GCT), as well as relationships between GCT and survival. METHODS We used the National Cancer Database and identified 21,177 non-Hispanic White (NHW), 6657 non-Hispanic Black (NHB), 1689 Hispanic, and 903 Asian/Pacific Islander (AS/PI) women diagnosed with non-endometrioid EC between 2004 and 2014. Year-specific National Comprehensive Cancer Network (NCCN) guidelines were used to classify GCT. We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between race/ethnicity and GCT receipt. Multivariable-adjusted Cox proportional hazards models were used to estimate hazards ratios (HRs) and 95% CIs for relationships between GCT and overall survival in the total study population and stratified by race/ethnicity. RESULTS Overall, 43.8% of women with non-endometrioid EC received GCT. Compared to NHW women, NHB (OR = 1.01, 95% CI = 0.95-1.07), Hispanic (OR = 1.01, 95% CI = 0.91-1.12) and AS/PI women (OR = 1.10, 95% CI = 0.96-1.26) did not have significantly different odds of receiving GCT. GCT was significantly associated with improved survival among NHW (HR = 0.84, 95% CI = 0.80-0.87), NHB (HR = 0.85, 95% CI = 0.80-0.91), and Hispanic women (HR = 0.84, 95% CI = 0.72-0.98) but not among AS/PI women (HR = 0.97, 95% CI = 0.78-1.19). CONCLUSIONS While more than half of women with non-endometrioid EC did not receive GCT, no difference in GCT receipt by race/ethnicity was observed. When received, GCT was associated with improved survival in almost all racial groups. Interventions to improve GCT adherence may improve survival for most women with non-endometrioid EC.
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Affiliation(s)
- Jhalak Dholakia
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States of America
| | - Elyse Llamocca
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Allison Quick
- Department of Radiation Oncology, The Ohio State University, Columbus, OH, United States of America
| | - Ritu Salani
- Division of Gynecologic Oncology, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Ashley S Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America.
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Felix AS, Sinnott JA, Vetter MH, Rhoades J, Cohn DE, Backes FJ, Sherman ME, Suarez AA. Detection of endometrial cancer cells in the fallopian tube lumen is associated with adverse prognostic factors and reduced survival. Gynecol Oncol 2018; 150:38-43. [PMID: 29754740 DOI: 10.1016/j.ygyno.2018.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 04/18/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Stage is a critical determinant of prognosis and treatment for endometrial cancer (EC) patients. Women who have had a tubal ligation for sterilization have improved EC survival, secondary to lower stage at presentation, suggesting that transtubal spread may represent an important route of metastasis. We evaluated detection of intraluminal tumor cells (ILTCs) in relation to tumor characteristics and survival. METHODS One pathologist retrospectively evaluated hematoxylin and eosin sections of routinely collected fallopian tubes for ILTCs from 295 EC patients, masked to outcome. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between demographic (age, race) and clinical [FIGO 2009 stage, lymphovascular space invasion (LVSI), histological subtype] characteristics and ILTCs. Cox regression was used to estimate hazard ratios (HRs) and 95% CIs for associations between ILTCs and recurrence-free survival (RFS) and EC-specific survival, overall and stratified by histological subtype or stage. RESULTS In univariable logistic regression models, age (55-64 vs. ≥65: OR = 3.41, 95% CI = 1.48-7.84), stage (stage IV vs. stage I OR = 14.58, 95% CI = 5.27-40.35), LVSI (OR = 2.93, 95% CI = 1.42-6.04), and histological subtype (serous vs. low-grade endometrioid OR = 3.21, 95% CI = 1.08-9.58), were associated with ILTCs. Only age and stage remained significantly associated with ILTCs in adjusted models. ILTCs were significantly associated with lower EC-specific survival among women with serous EC or stage I disease; however, adjustment for age, stage, and histology attenuated these associations. CONCLUSION Our findings suggest that ILTCs are associated with adverse EC prognostic features and reduced survival in cases of early stage or serous histology.
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Affiliation(s)
- Ashley S Felix
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, United States.
| | - Jennifer A Sinnott
- Department of Statistics, The Ohio State University College of Arts and Sciences, Columbus, OH, United States
| | - Monica Hagan Vetter
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jennifer Rhoades
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, United States
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Floor J Backes
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Mark E Sherman
- Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Adrian A Suarez
- Division of Pathology, The Ohio State University College of Medicine, Columbus, OH, United States
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Felix AS, Lehman A, Foraker RE, Naughton MJ, Bower JK, Kuller L, Sarto GE, Stefanick ML, Van Horn L, Jackson RD, Paskett ED. Risk of cardiovascular disease among women with endometrial cancer compared to cancer-free women in the Women's Health Initiative. Cancer Epidemiol 2017; 51:62-7. [PMID: 29049937 DOI: 10.1016/j.canep.2017.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/04/2017] [Accepted: 10/12/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND The majority of women diagnosed with endometrial cancer (EC) have low cancer-specific mortality; however, a high prevalence of cardiovascular disease (CVD) risk factors places EC patients at high risk of developing CVD. In the Women's Health Initiative (WHI), we assessed the hypothesis that CVD risk was higher among women who developed EC compared with women who did not develop EC. METHODS We compared the incidence of fatal and non-fatal CVD events among 1,179 women who developed Type I EC, 211 women who developed Type II EC, and 92,217 women who did not develop EC. We first estimated univariable cause-specific hazard ratios (CHRs) and 95% confidence intervals (CIs) for the association between an EC diagnosis (overall and by EC type) with CVD risk using Cox proportional hazards regression. Potential confounders were examined using a risk factor modeling approach; final multivariable-adjusted models included covariates that changed univariable CHRs for EC diagnosis by≥5%. RESULTS In multivariable-adjusted models, CVD risk did not significantly differ between women who developed EC compared to women who did not develop EC (CHR=1.01, 95% CI=0.87-1.16), particularly for the subgroup of women who developed Type I EC (CHR=0.98, 95% CI=0.84-1.14); however, there was a positive but statistically nonsignificant association for Type II EC (CHR=1.32, 95% CI=0.88-1.97). CONCLUSION Despite our null findings, women with EC should still receive counseling and support to make lifestyle changes aimed at reducing weight as appropriate, given the high prevalence of CVD risk factors at diagnosis.
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Felix AS, Blair CK, Lehman A, Bower JK, Raman SV, Lazovich D, Cohn DE, Prizment AE. Cardiovascular disease mortality among women with endometrial cancer in the Iowa Women's Health Study. Cancer Causes Control 2017; 28:1043-1051. [PMID: 28864924 DOI: 10.1007/s10552-017-0953-4] [Citation(s) in RCA: 5] [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: 02/09/2017] [Accepted: 08/29/2017] [Indexed: 03/25/2023]
Abstract
PURPOSE Obesity is associated with endometrial cancer (EC) development and cardiovascular disease (CVD) mortality. As the number of obese EC survivors continues to increase, an examination of CVD mortality in this vulnerable population is warranted. METHODS In the Iowa Women's Health Study (1986-2011), we examined CVD mortality among 552 women with EC compared with 2,352 age- and body mass index-matched women without EC (controls). Hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD mortality were estimated using multivariable-adjusted Cox proportional hazards regression models stratified by an indicator for match set. RESULTS Compared to controls, women with EC more often reported a history of diabetes, hypertension, and never smoking. Compared with controls, women with EC had lower CVD mortality (HR 0.75, 95% CI 0.56-0.99), and higher all-cause mortality (HR 1.50, 95% CI 1.30-1.74). CONCLUSIONS Although some CVD risk factors were more common in women with versus without EC, CVD mortality was lower among the former group. Additional well-adjusted analyses with larger study populations are needed to understand interactions between CVD risk factors with CVD mortality among EC survivors. The CVD risk factor profile of EC survivors warrants emphasis on cardiovascular health.
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Affiliation(s)
- Ashley S Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Avenue, 346 Cunz Hall, Columbus, OH, 43210, USA.
| | - Cindy K Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA.,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Amy Lehman
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Julie K Bower
- Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Avenue, 346 Cunz Hall, Columbus, OH, 43210, USA
| | - Subha V Raman
- Division of Cardiology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - David E Cohn
- Division of Gynecologic Oncology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Anna E Prizment
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
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