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Taşkum İ, Bademkıran MH, Çetin F, Sucu S, Yergin E, Balat Ö, Özkaya H, Uzun E. A novel predictive model of lymphovascular space invasion in early-stage endometrial cancer. Turk J Obstet Gynecol 2024; 21:37-42. [PMID: 38440966 PMCID: PMC10920972 DOI: 10.4274/tjod.galenos.2024.92597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 03/06/2024] Open
Abstract
Objective To predict lymphovascular space invasion (LVSI) positivity in early-stage (stage 1-2) endometrial cancer (EC) using a predictive model with prognostic factors of EC. Materials and Methods We included 461 patients who underwent total hysterectomy and bilateral salpingo-oophorectomy with pelvic-paraaortic lymphadenectomy as the primary treatment for presumed early-stage EC at our clinic between 2010 and 2020. Moreover, all surgical specimens were examined histopathologically for the positivity or negativity of LVSI, and the patients were divided into two groups based on these pathologic outcomes. Age, menopausal status, histological type (type 1-2), histological grade (grades 1-2-3), depth of myometrial invasion, and peritoneal cytology results were recorded and analyzed as clinicopathological and demographic characteristics of the patients. The Loess algorithm determined the relationship between the observed and predicted outcomes. The distinction between the algorithms was evaluated by calculating the C-index. Results LVSI positivity was significantly associated with advanced age, menopause, type 2 EC, advanced histological grade, malignant peritoneal cytology, cervical involvement, and a tumor exceeding 50% of the myometrial depth (p<0.001, respectively). Remarkably, LVSI was most strongly associated with three explanatory variables: 1- More than 50% myometrial invasion [odds ratio (OR): 3.78; 95% confidence interval (CI): 1.80-7.60], 2- Advanced histological grade [OR=1.98 (1.20-3.20) 95% CI], 3- Malignant peritoneal cytology [OR= 3.06 (1.40-6.30) 95% CI]. The penalized maximum likelihood estimation model correctly classified 87% of the included patients (C-index: 0.876). Conclusion Our predictive model may help predict LVSI based on different prognostic factors. The prognostic factors included in the nomogram were significantly associated with LVSI, particularly myometrial invasion depth of more than 50%, advanced histological grade, and malignant peritoneal cytology.
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Affiliation(s)
- İbrahim Taşkum
- Gaziantep City Hospital, Clinic of Obstetrics and Gynecology, Gaziantep, Turkey
| | | | - Furkan Çetin
- Abdulkadir Yüksel State Hospital, Clinic of Obstetrics and Gynecology, Gaziantep, Turkey
| | - Seyhun Sucu
- Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology, Gaziantep, Turkey
| | - Erkan Yergin
- Gaziantep City Hospital, Clinic of Obstetrics and Gynecology, Gaziantep, Turkey
| | - Özcan Balat
- Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology, Gaziantep, Turkey
| | - Halil Özkaya
- Abdulkadir Yüksel State Hospital, Clinic of Obstetrics and Gynecology, Gaziantep, Turkey
| | - Evren Uzun
- Gaziantep University Faculty of Medicine, Department of Medical Pathology, Gaziantep, Turkey
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Guo X, Zhao E, Guan Z, Li W, Zhang J, Tian S, Yao Y. A retrospective study of the effects of uterine manipulators on prognosis in patients with cervical cancer. J Int Med Res 2024; 52:3000605241233966. [PMID: 38553028 PMCID: PMC10981227 DOI: 10.1177/03000605241233966] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/29/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE This retrospective study investigated the effects of uterine manipulator use during minimally invasive radical hysterectomy on prognosis in patients with cervical cancer. METHODS We collected clinical data on 762 patients with stage IA2 to IIB cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy in Chinese PLA General Hospital from 2009 to 2019. Kaplan-Meier analysis and log-rank tests were used to compare the 5-year overall survival rates between patients treated with and without a uterine manipulator. RESULTS Patient demographics did not differ between the two groups. In addition, the incidence of lymphovascular space invasion, tumor size, pathologic types, the International Federation of Gynecology and Obstetrics stage, the histologic grade, and the rate of lymphatic metastases did not differ between the groups. Meanwhile, perioperative clinical indicators were similar in the groups. Furthermore, no significant differences in 5-year survival rates and survival curves were recorded between the groups among both all patients (84.5% vs. 85.6%) and early-stage patients (89.1% vs. 89.2%). CONCLUSIONS The use of uterine manipulators during minimally invasive radical hysterectomy for cervical cancer did not affect clinicopathological markers or increase the risk of death.
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Affiliation(s)
- Xinmeng Guo
- Department of Obstetrics and Gynecology, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, China
- College of Medicine, Nankai University, 94 Weijin Road, Tianjin, China
| | - Enfeng Zhao
- Department of Obstetrics and Gynecology, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, China
| | - Zheng Guan
- Department of Obstetrics and Gynecology, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, China
| | - Weiping Li
- Department of Obstetrics and Gynecology, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, China
| | - Jinning Zhang
- Department of Obstetrics and Gynecology, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, China
| | - Shuang Tian
- Department of Obstetrics and Gynecology, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, China
| | - Yuanqing Yao
- Department of Obstetrics and Gynecology, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, China
- College of Medicine, Nankai University, 94 Weijin Road, Tianjin, China
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Petrila O, Nistor I, Romedea NS, Negru D, Scripcariu V. Can the ADC Value Be Used as an Imaging "Biopsy" in Endometrial Cancer? Diagnostics (Basel) 2024; 14:325. [PMID: 38337842 PMCID: PMC10855861 DOI: 10.3390/diagnostics14030325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/07/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The tumor histological grade is closely related to the prognosis of patients with endometrial cancer (EC). Multiparametric MRI, including diffusion-weighted imaging (DWI), provides information about the cellular density that may be useful to differentiate between benign and malignant uterine lesions. However, correlations between apparent diffusion coefficient (ADC) values and histopathological grading in endometrial cancer remain controversial. MATERIAL AND METHODS We retrospectively evaluated 92 patients with endometrial cancers, including both endometrioid adenocarcinomas (64) and non-endometrioid adenocarcinomas (28). All patients underwent DWI procedures, and mean ADC values were calculated in a region of interest. These values were then correlated with the tumor grading offered by the histopathological examination, which was considered the gold standard. In this way, the patients were divided into three groups (G1, G2, and G3). The ADC values were then compared to the results offered by the biopsy to see if the DWI sequence and ADC map could replace this procedure. We also compared the mean ADC values to the myometrial invasion (>50%) and lymphovascular space invasion. RESULTS We have divided the ADC values into three categories corresponding to three grades: >0.850 × 10-3 mm2/s (ADC1), 0.730-0.849 × 10-3 mm2/s (ADC2) and <0.730 × 10-3 mm2/s (ADC3). The diagnostic accuracy of the ADC value was 85.71% for ADC1, 75.76% for ADC2, and 91.66% for ADC3. In 77 cases out of 92, the category in which they were placed using the ADC value corresponded to the result offered by the histopathological exam with an accuracy of 83.69%. For only 56.52% of patients, the biopsy result included the grading system. For each grading category, the mean ADC value showed better results than the biopsy; for G1 patients, the mean ADC value had an accuracy of 85.71% compared to 66.66% in the biopsy, G2 had 75.76% compared to 68.42%, and G3 had 91.66 compared to 75%. For both deep myometrial invasion and lymphovascular space invasion, there is a close, inversely proportional correlation with the mean ADC value. CONCLUSIONS Mean endometrial tumor ADC on MR-DWI is inversely related to the histological grade, deep myometrial invasion and lymphovascular space invasion. Using this method, the patients could be better divided into risk categories for personalized treatment.
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Affiliation(s)
- Octavia Petrila
- Faculty of General Medicine, The University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania (V.S.)
- Department of Radiology, “Dr. C.I. Parhon” Clinical Hospital, 700503 Iasi, Romania
| | - Ionut Nistor
- Faculty of General Medicine, The University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania (V.S.)
- Department of Nephrology, “Dr. C.I. Parhon” Clinical Hospital, 700503 Iasi, Romania
| | - Narcis Sandy Romedea
- Department of Surgery, “Dr. Iacob Czihac” Clinical Emergency Hospital, 700506 Iasi, Romania;
| | | | - Viorel Scripcariu
- Faculty of General Medicine, The University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania (V.S.)
- Department of Surgery, Regional Oncology Institute, 700483 Iasi, Romania
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Zorzato PC, Uccella S, Biancotto G, Bosco M, Festi A, Franchi M, Garzon S. Intrauterine manipulator during hysterectomy for endometrial cancer: a systematic review and meta-analysis of oncologic outcomes. Am J Obstet Gynecol 2024; 230:185-198.e4. [PMID: 37704174 DOI: 10.1016/j.ajog.2023.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE This study aimed to assess the effects on oncologic outcomes of intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer. DATA SOURCES A systematic literature search was performed by an expert librarian in multiple electronic databases from inception to January 31, 2023. STUDY ELIGIBILITY CRITERIA We included all studies in the English language that compared oncologic outcomes (recurrence-free, cause-specific, or overall survival) between endometrial cancer patients who underwent total laparoscopic or robotic hysterectomy for endometrial cancer with vs without the use of an intrauterine manipulator. Studies comparing only peritoneal cytology status or lymphovascular space invasion were summarized for completeness. No selection criteria were applied to the study design. METHODS Four reviewers independently reviewed studies for inclusion, assessed their risk of bias, and extracted data. Pooled hazard ratios with 95% confidence intervals were estimated for oncologic outcomes using the random effect model. Heterogeneity was quantified using the I2 tests. Publication bias was assessed by funnel plot and Egger test. RESULTS Out of 350 identified references, we included 2 randomized controlled trials and 12 observational studies for a total of 14 studies and 5,019 patients. The use of an intrauterine manipulator during hysterectomy for endometrial cancer was associated with a pooled hazard ratio for recurrence of 1.52 (95% confidence interval, 0.99-2.33; P=.05; I2=31%; chi square P value=.22). Pooled hazard ratio for recurrence was 1.48 (95% confidence interval, 0.25-8.76; P=.62; I2=67%; chi square P value=.08) when only randomized controlled trials were considered. Pooled hazard ratio for overall survival was 1.07 (95% confidence interval, 0.65-1.76; P=0.79; I2=44%; chi square P value=.17). The rate of positive peritoneal cytology or lymphovascular space invasion did not differ using an intrauterine manipulator. CONCLUSION Intrauterine manipulator use during hysterectomy for endometrial cancer was neither significantly associated with recurrence-free and overall survival nor with positive peritoneal cytology or lymphovascular space invasion, but further prospective studies are needed.
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Affiliation(s)
- Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy.
| | - Giulia Biancotto
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Anna Festi
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
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Ozdemir CY, Arioz DT, Celik F, Cicekli N, Chkhikvadze M, Bilir F, Yılmaz S, Vatansever N. The Role of Lymphovascular Space Invasion and Cytology in the Prognosis of Endometrial Cancer. Discov Med 2024; 36:366-371. [PMID: 38409841 DOI: 10.24976/discov.med.202436181.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Lymphovascular space invasion (LVSI) and cytology are both independent and strong prognostic factors in endometrial cancer. This study aims to highlight the impact of LVSI and cytology positivity on prognosis, in addition to molecular classification. METHODS A retrospective review was conducted on the records of 223 patients with endometrial cancer diagnosed between January 2011 and January 2021. The inclusion criteria stipulated that the patients were diagnosed with endometrial cancer by endometrial biopsy and were operated in the clinic. The exclusion criteria included sarcoma in the postoperative pathology report results or synchronous tumor. Staging was performed according to the Fédération internationale de gynécologie et d'obstétrique (FIGO) 2009 criteria. Cytology (using 50 cc saline) was obtained upon entry into the peritoneal cavity. In 20 patients, saline was not used due to the presence of ascites in the abdomen. The Kaplan-Meier method was employed to evaluate overall survival and progression-free survival. Survival rates were compared in terms of cytology and LVSI. RESULTS After analyzing the postoperative pathology results, it was found that the mean tumor size was 4.03 ± 2.3 cm. The most common histological type was endometrioid carcinoma, with stage IA being the most common stage. Out of 223 patients with endometrial cancer, the overall survival rate was 82.4%, and the progression-free survival rate was 88.3%. For patients negative for LVSI, the progression-free survival rate was 93%, while for LVSI-positive patients, it was 77.3% (p < 0.001). Additionally, the progression-free survival rate for patients negative for cytology was 90.4%, whereas for cytology-positive patients, it was 77.1% (p < 0.05). CONCLUSIONS In our study, we observed that LVSI positivity and cytology positivity also reduced the overall survival rate. We aimed to highlight that, in addition to molecular classification, cytology positivity and LVSI positivity are still highly significant and independent factors in prognosis.
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Affiliation(s)
- Cem Yagmur Ozdemir
- Afyonkarahisar Health Sciences University, Faculty of Medicine, Department of Gynecological Oncology, 03030 Afyonkarahisar, Turkey
| | - Dagistan Tolga Arioz
- Afyonkarahisar Health Sciences University, Faculty of Medicine, Department of Gynecological Oncology, 03030 Afyonkarahisar, Turkey
| | - Fatih Celik
- Afyonkarahisar Health Sciences University Hospital, Facutly of Medicine, Department of Obstetrics and Gynecology, 03030 Afyonkarahisar, Turkey
| | - Nayif Cicekli
- Afyonkarahisar Health Sciences University, Faculty of Medicine, Department of Gynecological Oncology, 03030 Afyonkarahisar, Turkey
| | - Mariam Chkhikvadze
- American Hospital Tbilisi, Department of Obstetrics and Gynecology, 0144 Tbilisi, Georgia
| | - Filiz Bilir
- Zeynep Kamil Women and Children Diseases Traning and Research Hospital, Department of Gynecological Oncology, 34668 Istanbul, Turkey
| | - Sezgin Yılmaz
- Afyonkarahisar Health Sciences University, Faculty of Medicine, Department of General Surgery, 03030 Afyonkarahisar, Turkey
| | - Nefize Vatansever
- Izmir Cigli Regional Training and Research Hospital, Department of Gynecological Oncology, 35620 Izmir, Turkey
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Qin ZJ, Wang YS, Chen YL, Zheng A, Han L. Evaluation of prognostic significance of lymphovascular space invasion in early stage endometrial cancer: a systematic review and meta-analysis. Front Oncol 2024; 13:1286221. [PMID: 38273843 PMCID: PMC10808564 DOI: 10.3389/fonc.2023.1286221] [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: 08/31/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Background Studies evaluating the prognostic significance of lymphovascular space invasion (LVSI) in early stage endometrial cancer (EC) are conflicting. Objectives To evaluate whether LVSI identified in stage I EC is associated with worse survival. Search strategy A comprehensive literature search of three databases (Embase, PubMed, and Cochrane) was performed up to April 30th 2023. Selection criteria Cohort studies that have evaluated the relationship between LVSI and prognosis in patients with stage I EC were included. Data collection and analysis Two authors independently assessed the studies for inclusion, extracted the data of recurrence and survival, and conducted meta-analysis using random effects model. Heterogeneity was evaluated by I2 test. Main results A total of 15 studies involving 6,705 patients were included in the meta-analysis. The overall pooled rate of LVSI was 14% [95% confidence interval (CI) CI 0.09-0.18] in stage I EC. LVSI was significantly associated with a higher risk of recurrence [odds ratio (OR) = 2.79, 95%CI 2.07-3.77], reduced overall survival (OS) [hazard ratio (HR)=5.19, 95%CI 3.33-8.07] and recurrence free survival (RFS) [HR = 5.26, 95%CI 3.45-8.02] in stage I EC patients. Similarly, LVSI was associated with an increased risk of recurrence [OR= 3.10, 95%CI 2.13-4.51], decreased OS [HR=5.52, 95%CI 2.16-14.09] and RFS [HR = 4.81, 95%CI 2.34-9.91] in stage IA grade 1 or 2 endometrioid carcinoma patients. Conclusion The presence of LVSI in stage I EC and in stage IA, grade 1 or 2 endometrioid carcinoma is associated with an increased risk of recurrence, lower OS and RFS. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier 42023425231.
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Affiliation(s)
- Zhao-juan Qin
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Yi-si Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Ya-li Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Ai Zheng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Ling Han
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
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Meng X, Yang D, Deng Y, Xu H, Jin H, Yang Z. Diagnostic accuracy of MRI for assessing lymphovascular space invasion in endometrial carcinoma: a meta-analysis. Acta Radiol 2024; 65:133-144. [PMID: 37101417 DOI: 10.1177/02841851231165671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND The lymphovascular space invasion (LVSI) status of endometrial cancer (EC) has guiding significance in lymph node dissection. However, LVSI can only be obtained after surgery. Researchers have tried to extract the information of LVSI using magnetic resonance imaging (MRI). PURPOSE To evaluate the ability of preoperative MRI to predict the LVSI status of EC. MATERIAL AND METHODS A search was conducted by using the PubMed/MEDLINE, EMBASE, Web of Science, and the Cochrane Library databases. Articles were included according to the criteria. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2. A bivariate random effects model was used to obtain pooled summary estimates, heterogeneity, and the area under the summary receiver operating characteristic curve (AUC). A subgroup analysis was performed to identify sources of heterogeneity. RESULTS A total of nine articles (814 patients) were included. The risk of bias was low or unclear for most studies, and the applicability concerns were low or unclear for all studies. The summary AUC values as well as pooled sensitivity and specificity of LVSI status in EC were 0.82, 73%, and 77%, respectively. According to the subgroup analysis, radiomics/non-radiomics features, country/region, sample size, age, MR manufacturer, magnetic field, scores of risk bias, and scores of applicability concern may have caused heterogeneity. CONCLUSION Our meta-analysis showed that MRI has moderate diagnostic efficacy for LVSI status in EC. Large-sample, uniformly designed studies are needed to verify the true value of MRI in assessing LVSI.
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Affiliation(s)
- Xuxu Meng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Dawei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Yuhui Deng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
- Medical Imaging Division, Heilongjiang Provincial Hospital, Harbin Institute of Technology, Harbin, PR China
| | - Hui Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - He Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
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Buechi CA, Siegenthaler F, Sahli L, Papadia A, Saner FAM, Mohr S, Rau TT, Solass W, Imboden S, Mueller MD. Real-World Data Assessing the Impact of Lymphovascular Space Invasion on the Diagnostic Performance of Sentinel Lymph Node Mapping in Endometrial Cancer. Cancers (Basel) 2023; 16:67. [PMID: 38201495 PMCID: PMC10778553 DOI: 10.3390/cancers16010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND SLN mapping has emerged as a standard of care in endometrial cancer due to its high sensitivity and significant reduction in morbidity. Although lymphovascular space invasion (LVSI) is a known risk factor for lymph node metastasis and recurrence, evidence on the reliability of SLN mapping in LVSI-positive patients is scarce. The aim of this study was to determine the impact of LVSI on the diagnostic performance of SLN mapping. METHODS This retrospective cohort study included patients with endometrial cancer who underwent primary surgical treatment at the Bern University Hospital, Switzerland, between 2012 and 2022. RESULTS LVSI was present in 22% of patients and was significantly associated with lymph node metastasis (p < 0.001) and recurrence (p < 0.001). In node-negative patients with only SLN mapping performed, LVSI was an independent predictor of recurrence during multivariable Cox regression analysis (p = 0.036). The negative predictive value of SLN mapping was 91.5% and was significantly lower in tumors with LVSI (75.0%) compared to LVSI-negative tumors (95.6%, p = 0.004). CONCLUSION The presence of LVSI was significantly associated with worse oncological outcomes. LVSI was an independent predictor of recurrence in node-negative patients with only SLN mapping performed. Furthermore, the negative predictive value of SLN mapping was significantly lower in LVSI-positive tumors.
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Affiliation(s)
- Carol A. Buechi
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Laura Sahli
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale of Lugano, 6900 Lugano, Switzerland
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Flurina A. M. Saner
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Stefan Mohr
- Department of Gynecology and Obstetrics, Bürgerspital Solothurn, 4500 Solothurn, Switzerland;
| | - Tilman T. Rau
- Institute of Pathology, Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany
| | - Wiebke Solass
- Institute of Tissue Medicine and Pathology, University of Bern, 3008 Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Michael D. Mueller
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
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Choi Y, Ando Y, Lee D, Kim NY, Lee OEM, Cho J, Seo I, Chong GO, Park NJY. Profiling of Lymphovascular Space Invasion in Cervical Cancer Revealed PI3K/Akt Signaling Pathway Overactivation and Heterogenic Tumor-Immune Microenvironments. Life (Basel) 2023; 13:2342. [PMID: 38137942 PMCID: PMC10744523 DOI: 10.3390/life13122342] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Lymphovascular space invasion (LVSI) is the presence of tumor emboli in the endothelial-lined space at the tumor body's invasive edge. LVSI is one of three Sedlis criteria components-a prognostic tool for early cervical cancer (CC)-essential for indicating poor prognosis, such as lymph node metastasis, distant metastasis, or shorter survival rate. Despite its clinical significance, an in-depth comprehension of the molecular mechanisms or immune dynamics underlying LVSI in CC remains elusive. Therefore, this study investigated tumor-immune microenvironment (TIME) dynamics of the LVSI-positive group in CC. RNA sequencing included formalin-fixed paraffin-embedded (FFPE) slides from 21 CC patients, and differentially expressed genes (DEGs) were analyzed. Functional analysis and immune deconvolution revealed aberrantly enriched PI3K/Akt pathway activation and a heterogenic immune composition with a low abundance of regulatory T cells (Treg) between LVSI-positive and LVSI-absent groups. These findings improve the comprehension of LSVI TIME and immune mechanisms, benefiting targeted LVSI therapy for CC.
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Affiliation(s)
- Yeseul Choi
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea; (Y.C.); (Y.A.); (D.L.); (N.Y.K.); (O.E.M.L.)
| | - Yu Ando
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea; (Y.C.); (Y.A.); (D.L.); (N.Y.K.); (O.E.M.L.)
| | - Donghyeon Lee
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea; (Y.C.); (Y.A.); (D.L.); (N.Y.K.); (O.E.M.L.)
| | - Na Young Kim
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea; (Y.C.); (Y.A.); (D.L.); (N.Y.K.); (O.E.M.L.)
| | - Olive E. M. Lee
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea; (Y.C.); (Y.A.); (D.L.); (N.Y.K.); (O.E.M.L.)
| | - Junghwan Cho
- Clinical Omics Institute, Kyungpook National University, Daegu 41405, Republic of Korea; (J.C.); (I.S.)
| | - Incheol Seo
- Clinical Omics Institute, Kyungpook National University, Daegu 41405, Republic of Korea; (J.C.); (I.S.)
- Department of Immunology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Gun Oh Chong
- Clinical Omics Institute, Kyungpook National University, Daegu 41405, Republic of Korea; (J.C.); (I.S.)
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Nora Jee-Young Park
- Clinical Omics Institute, Kyungpook National University, Daegu 41405, Republic of Korea; (J.C.); (I.S.)
- Department of Pathology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
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Altın D, Akıncı T, Taşkın S, Ortaç F. Predictors of recurrence and survival in lymphovascular space invasion negative early-stage endometrioid endometrial cancer patients. J Turk Ger Gynecol Assoc 2023; 24:261-270. [PMID: 38054418 DOI: 10.4274/jtgga.galenos.2023.2022-6-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Objective The purpose of this study was to assess prognostic factors correlated with recurrence and decreased oncologic outcomes, as well as the role of adjuvant treatment on survival in women with stage I and II endometrioid endometrial cancer without lymphovascular space invasion (LVSI). Material and Methods Patients with LVSI negative, early-stage endometrioid endometrial cancer patients were retrospectively reviewed. Multivariable logistic regression models were used for identifying predictors of recurrence. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method, and survival curves were compared by log-rank test. Univariable and multivariable analyses were performed to establish factors affecting OS and DFS. Hazard ratios with 95% confidence intervals were calculated. Results A total of 289 patients were included, with a mean age of 58 years and the median surveillance time of 45 (6-147) months. The majority of the patients (54%) had grade 1 tumors. Adjuvant therapy was administered to 68 (23.5%). A total of 13 (4.5%) recurred with median time to recurrence of 52 months. Patients receiving adjuvant treatment were more likely to recur (p=0.015), and grade was the only independent predictor of recurrence (p=0.029). Five-year OS and DFS were 95.8% and 97.9%, respectively. While tumor size (p=0.018) and grade 3 histology (p=0.045) were related with shorter DFS, age (p<0.001) was the only related factor for decreased OS. Conclusion Recurrence rate was low among LVSI negative, early-stage endometrioid endometrial cancer patients. Although recurrences were seen more frequently in patients who received adjuvant treatment, it wasn't an independent prognostic factor. Neither recurrence nor adverse uterine risk factors were associated with shorter OS. While age was the only prognostic factor for decreased OS, grade 3 histology and tumor size were associated with decreased DFS.
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Affiliation(s)
- Duygu Altın
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tuğçe Akıncı
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Salih Taşkın
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fırat Ortaç
- Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey
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Petsuksiri J, Setakornnukul J, Berpan A, Thephamongkhol K, Dankulchai P, Jaishuen A. Treatment outcomes of early-stage endometrial cancer patients: A propensity score matching of vaginal brachytherapy versus pelvic radiotherapy. J Obstet Gynaecol Res 2023; 49:2918-2928. [PMID: 37786395 DOI: 10.1111/jog.15800] [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: 04/20/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES This study aimed to report the treatment outcomes of radiation therapy for early-stage endometrial cancer patients. In addition, this study intended to identify high-risk factors that require pelvic radiotherapy (PRT) in addition to vaginal brachytherapy (VBT) for intermediate-risk endometrial cancer patients. METHODS Patients with early-stage endometrial cancer receiving postoperative VBT alone or with PRT were included. Propensity score matching was used to balance the two study groups. The primary endpoint was locoregional recurrence (LRR). Age-adjusted Charlson comorbidity index and substantial lymphovascular space invasion were selected for subgroup analyses to identify the benefits of PRT over VBT alone. RESULTS From 2005 to 2017, a total of 288 patients underwent analysis following propensity score matching. Of these, 144 received VBT and 144 received PRT. There was no significant difference in 5-year LRR between VBT and PRT for both intermediate (0% vs. 0%) and high-intermediate risk patients (3.5% VBT vs. 5.4% PRT; HR 0.54: 0.05-6.00; p = 0.616). The subgroup analyses revealed no significant factors favoring PRT over VBT. Patients with high comorbidities may have higher risks of non-cancer death after receiving PRT. CONCLUSIONS Postoperative VBT alone is sufficient for early-stage intermediate-risk endometrial cancer patients.
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Affiliation(s)
- Janjira Petsuksiri
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Jiraporn Setakornnukul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Aniwat Berpan
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Kullathorn Thephamongkhol
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Pittaya Dankulchai
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Atthapon Jaishuen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
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Wu Y, Wang S, Chen Y, Liao Y, Yin X, Li T, Wang R, Luo X, Xu W, Zhou J, Wang S, Bu J, Zhang X. A Multicenter Study on Preoperative Assessment of Lymphovascular Space Invasion in Early-Stage Cervical Cancer Based on Multimodal MR Radiomics. J Magn Reson Imaging 2023; 58:1638-1648. [PMID: 36929220 DOI: 10.1002/jmri.28676] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND As lymphovascular space invasion (LVSI) was closely related to lymph node metastasis and prognosis, the preoperative assessment of LVSI in early-stage cervical cancer is crucial for patients. PURPOSE To develop and validate nomogram based on multimodal MR radiomics to assess LVSI status in cervical cancer patients. STUDY TYPE Retrospective. POPULATION The study included 168 cervical cancer patients, of whom 129 cases (age 51.36 ± 9.99 years) from institution 1 were included as the training cohort and 39 cases (age 52.59 ± 10.23 years) from institution 2 were included as the external test cohort. FIELD STRENGTH/SEQUENCE There were 1.5 T and 3.0 T MRI scans (T1-weighted imaging [T1WI], fat-saturated T2-weighted imaging [FS-T2WI], and contrast-enhanced [CE]). ASSESSMENT Six machine learning models were built and selected to construct the radiomics signature. The nomogram model was constructed by combining the radiomics signature with the clinical signature, which was then validated for discrimination, calibration, and clinical usefulness. STATISTICAL TESTS The clinical characteristics were compared using t-tests, Mann-Whitney U tests, or chi-square tests. The Spearman and LASSO methods were used to select radiomics features. The receiver operating characteristic (ROC) analysis was performed, and the area under the curve (AUC), accuracy, sensitivity, and specificity were calculated. RESULTS The logistic regression (LR) model performed best in each sequence. The AUC of CE-T1-T2WI-combined was the highest in the LR model, with an AUC of 0.775 (95% CI: 0.570-0.979) in external test cohort. The nomogram showed high predictive performance in the training (AUC: 0.883 [95% CI: 0.823-0.943]) and test cohort (AUC: 0.830 [95% CI: 0.657-1.000]) for predicting LVSI. Decision curve analysis demonstrated that the nomogram was clinically useful. DATA CONCLUSION Our findings suggest that the proposed nomogram model based on multimodal MRI of CE T1WI-T2WI-combined could be used to assess LVSI status in early cervical cancer. EVIDENCE LEVEL 4. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Yu Wu
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Shuxing Wang
- Department of Radiology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Yiqing Chen
- Department of Radiology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | | | - Xuntao Yin
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Ting Li
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Rui Wang
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xiaomei Luo
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Wenchan Xu
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jing Zhou
- Department of Radiology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Simin Wang
- Department of Radiology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Jun Bu
- Department of Radiology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Xiaochun Zhang
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
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Blackman A, Creasman W. A Case for the Conservative Management of Stage IA Cervical Cancer. Cancers (Basel) 2023; 15:5051. [PMID: 37894417 PMCID: PMC10605599 DOI: 10.3390/cancers15205051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/19/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
Cervical cancer remains a significant public health concern within the United States and across the world. Cervical cancer is most frequently diagnosed in women between the ages of 35 and 44 and therefore affects a younger patient population than many other cancers. The management of early-stage disease has frequently utilized radical hysterectomy with the associated increased surgical morbidity, without clear evidence of any benefits. In stage IA disease, there are retrospective pathologic data supporting the safety of conservative surgery and lymphadenectomy over radical hysterectomy. There are also emerging prospective studies supporting conservative management. This editorial presents the evidence for conservative management of stage IA cervical cancer by reviewing the existing retrospective studies as well as the ongoing prospective studies.
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Affiliation(s)
- Alexandra Blackman
- Department of Obstetrics & Gynecology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - William Creasman
- Department of Obstetrics & Gynecology, Medical University of South Carolina, Charleston, SC 29425, USA
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Cheng JM, Luo WX, Tan BG, Pan J, Zhou HY, Chen TW. Whole-tumor histogram analysis of apparent diffusion coefficients for predicting lymphovascular space invasion in stage IB-IIA cervical cancer. Front Oncol 2023; 13:1206659. [PMID: 37404753 PMCID: PMC10315646 DOI: 10.3389/fonc.2023.1206659] [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: 04/16/2023] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
Objectives To investigate the value of apparent diffusion coefficient (ADC) histogram analysis based on whole tumor volume for the preoperative prediction of lymphovascular space invasion (LVSI) in patients with stage IB-IIA cervical cancer. Methods Fifty consecutive patients with stage IB-IIA cervical cancer were stratified into LVSI-positive (n = 24) and LVSI-negative (n = 26) groups according to the postoperative pathology. All patients underwent pelvic 3.0T diffusion-weighted imaging with b-values of 50 and 800 s/mm2 preoperatively. Whole-tumor ADC histogram analysis was performed. Differences in the clinical characteristics, conventional magnetic resonance imaging (MRI) features, and ADC histogram parameters between the two groups were analyzed. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of ADC histogram parameters in predicting LVSI. Results ADCmax, ADCrange, ADC90, ADC95, and ADC99 were significantly lower in the LVSI-positive group than in the LVSI-negative group (all P-values < 0.05), whereas no significant differences were reported for the remaining ADC parameters, clinical characteristics, and conventional MRI features between the groups (all P-values > 0.05). For predicting LVSI in stage IB-IIA cervical cancer, a cutoff ADCmax of 1.75×10-3 mm2/s achieved the largest area under ROC curve (Az) of 0.750, followed by a cutoff ADCrange of 1.36×10-3 mm2/s and ADC99 of 1.75×10-3 mm2/s (Az = 0.748 and 0.729, respectively), and the cutoff ADC90 and ADC95 achieved an Az of <0.70. Conclusion Whole-tumor ADC histogram analysis has potential value for preoperative prediction of LVSI in patients with stage IB-IIA cervical cancer. ADCmax, ADCrange, and ADC99 are promising prediction parameters.
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Affiliation(s)
- Jin-mei Cheng
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Wei-xiao Luo
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Bang-guo Tan
- Department of Radiology, Panzhihua Central Hospital, Panzhihua, Sichuan, China
| | - Jian Pan
- Department of General Practice, Taiping Town Central Health Center, Leshan, Sichuan, China
| | - Hai-ying Zhou
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Tian-wu Chen
- Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
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Oliver-Perez MR, Padilla-Iserte P, Arencibia-Sanchez O, Martin-Arriscado C, Muruzabal JC, Diaz-Feijóo B, Cabrera S, Coronado P, Martín-Salamanca MB, Pantoja-Garrido M, Marcos-Sanmartin J, Cabezas-López E, Lorenzo C, Beric D, Rodriguez-Hernandez JR, Roldan-Rivas F, Gilabert-Estelles J, Sanchez L, Laseca-Modrego M, Tauste-Rubio C, Gil-Ibañez B, Tejerizo-Garcia A. Lymphovascular Space Invasion in Early-Stage Endometrial Cancer (LySEC): Patterns of Recurrence and Predictors. A Multicentre Retrospective Cohort Study of the Spain Gynecologic Oncology Group. Cancers (Basel) 2023; 15:cancers15092612. [PMID: 37174081 PMCID: PMC10177148 DOI: 10.3390/cancers15092612] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
The main aim is to compare oncological outcomes and patterns of recurrence of patients with early-stage endometrioid endometrial cancer according to lymphovascular space invasion (LVSI) status. The secondary objective is to determine preoperative predictors of LVSI. We performed a multicenter retrospective cohort study. A total of 3546 women diagnosed with postoperative early-stage (FIGO I-II, 2009) endometrioid endometrial cancer were included. Co-primary endpoints were disease-free survival (DFS), overall survival (OS), and pattern of recurrence. Cox proportional hazard models were used for time-to-event analysis. Univariate and multivariate logistical regression models were employed. Positive LVSI was identified in 528 patients (14.6%) and was an independent prognostic factor for DFS (HR 1.8), OS (HR 2.1) and distant recurrences (HR 2.37). Distant recurrences were more frequent in patients with positive LVSI (78.2% vs. 61.3%, p < 0.01). Deep myometrial invasion (OR 3.04), high-grade tumors (OR 2.54), cervical stroma invasion (OR 2.01), and tumor diameter ≥ 2 cm (OR 2.03) were independent predictors of LVSI. In conclusion, in these patients, LVSI is an independent risk factor for shorter DFS and OS, and distant recurrence, but not for local recurrence. Deep myometrial invasion, cervical stroma invasion, high-grade tumors, and a tumor diameter ≥ 2 cm are independent predictors of LVSI.
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Affiliation(s)
- M Reyes Oliver-Perez
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 12 de Octubre Research Institute (i+12), 28041 Madrid, Spain
| | - Pablo Padilla-Iserte
- Department of Gynaecologic Oncology, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain
| | - Octavio Arencibia-Sanchez
- Department of Gynecologic Oncology, University Hospital Materno-Infantil de Canarias, 35016 Las Palmas de Gran Canaria, Spain
| | - Cristina Martin-Arriscado
- Scientific Support Unit, Hospital Universitario 12 de Octubre, 12 de Octubre Research Institute (i+12), 28041 Madrid, Spain
| | - Juan Carlos Muruzabal
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Berta Diaz-Feijóo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain
| | - Silvia Cabrera
- Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Pluvio Coronado
- Women's Health Institute of the Hospital Clínico San Carlos, IdISSC, School of Medicine, Complutense University Madrid, 28040 Madrid, Spain
| | | | - Manuel Pantoja-Garrido
- Department of Gynecology and Obstetrics, University Hospital Virgen Macarena, 41009 Sevilla, Spain
| | - Josefa Marcos-Sanmartin
- Departments of Obstetrics and Gynecology, Dr. Balmis General University Hospital, 03010 Alicante, Spain
- Department of Public Health, Miguel Hernandez University, Sant Joan D'Alacant, 03550 Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Elena Cabezas-López
- Department of Gynecologic Oncology, University Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Cristina Lorenzo
- Department of Obstetrics and Gynecology, Hospital Nuestra Señora de la Calendaria, 38010 Santa Cruz de Tenerife, Spain
| | - Duska Beric
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrevieja, 03186 Alicante, Spain
| | | | - Fernando Roldan-Rivas
- Department of Obstetrics and Gynaecology, Clinico Lozano Blesa Hospital, 50009 Zaragoza, Spain
| | - Juan Gilabert-Estelles
- Department of Pediatrics, Obstetrics and Gynecology, University General Hospital of Valencia, 46014 Valencia, Spain
| | - Lourdes Sanchez
- Department of Gynecology and Obstetrics, University General Hospital of Ciudad Real, 13005 Ciudad Real, Spain
| | - Maria Laseca-Modrego
- Department of Gynecologic Oncology, University Hospital Materno-Infantil de Canarias, 35016 Las Palmas de Gran Canaria, Spain
| | - Carmen Tauste-Rubio
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Blanca Gil-Ibañez
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 12 de Octubre Research Institute (i+12), 28041 Madrid, Spain
| | - Alvaro Tejerizo-Garcia
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 12 de Octubre Research Institute (i+12), 28041 Madrid, Spain
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Huang Y, Wen W, Li X, Xu D, Liu L. Prognostic value of lymphovascular space invasion in stage IA to IIB cervical cancer: A meta-analysis. Medicine (Baltimore) 2023; 102:e33547. [PMID: 37058045 PMCID: PMC10101290 DOI: 10.1097/md.0000000000033547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/27/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Lymphovascular space invasion (LVSI) is a prognostic factor in the existing TNM classification system. The present meta-analysis assessed the role of LVSI in predicting the prognosis of stage IA to IIB cervical cancer (CC). MATERIALS AND METHODS PubMed, EMBASE, and Cochrane Library electronic databases were searched to determine relevant articles published in the English language. Our search deadline was May 2022. Critical Appraisal of Prognostic Studies was used to assess the quality for each article. Pooled hazard ratios (HRs) were used to evaluate the performance of LVSI in prognosis prediction. RESULTS We enrolled 8 studies involving 25,352 patients published after 2010. Thus, high LVSI was an unfavorable factor in predicting overall survival (HR, 2.08; 95% confidence interval, 1.63-2.66; P = .006) and disease-free survival (HR, 2.20; 95% confidence interval, 1.79-2.70; P = .000) for patients with CC. However, the disease-free survival and overall survival were significantly different on univariate analysis based on the subgroup analysis stratified by analysis method, but no obvious heterogeneity was found across diverse articles. CONCLUSIONS The present study showed that LVSI predicts the poor prognostic outcome of stage IA to IIB CC. However, well-designed clinical articles should further assess the independent prognosis prediction performance of LVSI in CC.
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Affiliation(s)
- Yuan Huang
- Department of Pathology, Yanbian University Hospital, Yanji, China
| | - Weibo Wen
- Department of Nuclear Medicine, Yanbian University Hospital, Yanji, China
| | - Xiangdan Li
- Center of Morphological Experiment, Medical College of Yanbian University, Yanji, China
| | - Dongyuan Xu
- Center of Morphological Experiment, Medical College of Yanbian University, Yanji, China
| | - Lan Liu
- Department of Pathology, Yanbian University Hospital, Yanji, China
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Li X, Dessi M, Marcus D, Russell J, Aboagye EO, Ellis LB, Sheeka A, Park WHE, Bharwani N, Ghaem-Maghami S, Rockall AG. Prediction of Deep Myometrial Infiltration, Clinical Risk Category, Histological Type, and Lymphovascular Space Invasion in Women with Endometrial Cancer Based on Clinical and T2-Weighted MRI Radiomic Features. Cancers (Basel) 2023; 15:cancers15082209. [PMID: 37190137 DOI: 10.3390/cancers15082209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
PURPOSE To predict deep myometrial infiltration (DMI), clinical risk category, histological type, and lymphovascular space invasion (LVSI) in women with endometrial cancer using machine learning classification methods based on clinical and image signatures from T2-weighted MR images. METHODS A training dataset containing 413 patients and an independent testing dataset consisting of 82 cases were employed in this retrospective study. Manual segmentation of the whole tumor volume on sagittal T2-weighted MRI was performed. Clinical and radiomic features were extracted to predict: (i) DMI of endometrial cancer patients, (ii) endometrial cancer clinical high-risk level, (iii) histological subtype of tumor, and (iv) presence of LVSI. A classification model with different automatically selected hyperparameter values was created. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve, F1 score, average recall, and average precision were calculated to evaluate different models. RESULTS Based on the independent external testing dataset, the AUCs for DMI, high-risk endometrial cancer, endometrial histological type, and LVSI classification were 0.79, 0.82, 0.91, and 0.85, respectively. The corresponding 95% confidence intervals (CI) of the AUCs were [0.69, 0.89], [0.75, 0.91], [0.83, 0.97], and [0.77, 0.93], respectively. CONCLUSION It is possible to classify endometrial cancer DMI, risk, histology type, and LVSI using different machine learning methods.
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Affiliation(s)
- Xingfeng Li
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - Michele Dessi
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - Diana Marcus
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
- Chelsea and Westminster Hospital, 369 Fulham Rd., London SW10 9NH, UK
| | - James Russell
- The Imaging Department, Imperial College Healthcare NHS Trust, UK Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Eric O Aboagye
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - Laura Burney Ellis
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - Alexander Sheeka
- The Imaging Department, Imperial College Healthcare NHS Trust, UK Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Won-Ho Edward Park
- The Imaging Department, Imperial College Healthcare NHS Trust, UK Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Nishat Bharwani
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
- The Imaging Department, Imperial College Healthcare NHS Trust, UK Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Sadaf Ghaem-Maghami
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
| | - Andrea G Rockall
- Department of Surgery and Cancer, Imperial College Hammersmith Campus, Du Cane Road, London W12 0NN, UK
- The Imaging Department, Imperial College Healthcare NHS Trust, UK Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
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Navarro B, Margioula-Siarkou C, Petousis S, Floquet A, Babin G, Guyon F. Surgical restaging of patients with early‑stage endometrial cancer with lymphovascular invasion does not significantly impact their survival outcomes. Oncol Lett 2023; 25:122. [PMID: 36844624 PMCID: PMC9950339 DOI: 10.3892/ol.2023.13708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/02/2022] [Indexed: 02/11/2023] Open
Abstract
Lymphovascular space invasion (LVSI) is considered to be a poor prognostic factor in endometrial cancer. However, management of patients with early-stage endometrial cancer with positive LVSI remains controversial. The main objective of the present study was to investigate whether surgical restaging of such patients has a significant effect on survival outcomes or may be otherwise omitted. A retrospective cohort study was conducted at the Gynaecologic Oncology Unit, Insitut Bergonie, Bordeaux, France for the period January 2003-December 2019. The present study included patients with definitive histopathological diagnosis of early-stage, grade 1-2 endometrial cancer with positive LVSI. Patients were divided into two groups: Those being restaged with pelvic and para-aortic lymphadenectomy (group 1) and those not restaged and receiving complementary therapy (group 2). The primary outcomes of the study were overall survival and progression-free survival. Epidemiological data, clinical and histopathological characteristics as well as complementary treatment received were also studied. Kaplan-Meier and Cox regression analyses were performed. Data from 30 patients were retrieved, of which restaging with lymphadenectomy was performed in 21 patients (group 1), while another 9 patients (group 2) were not restaged and received complementary therapy. Lymph node metastasis was observed in 23.8% of patients in group 1 (n=5). No significant difference was observed between groups 1 and 2 in terms of survival outcomes. The median overall survival was 91.31 months in group 1 and 90.61 months in group 2 [hazard ratio (HR), 0.71; 95% CI, 0.03-16.58; P=0.829]. The median disease-free survival was 87.95 months in group 1 and 81.52 months in group 2 (HR, 0.85; 95% CI, 0.12-5.91; P=0.869). In conclusion, restaging with lymphadenectomy did not alter prognosis of early-stage, LVSI-positive patients. As there was no clinical and therapeutic benefit, restaging with lymphadenectomy could be omitted in such patients.
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Affiliation(s)
- Beatriz Navarro
- Gynaecologic Oncology Unit, Institute Bergonie, Bordeaux 33076, France
| | | | - Stamatios Petousis
- Gynaecologic Oncology Unit, Institute Bergonie, Bordeaux 33076, France,Correspondence to: Dr Stamatios Petousis, Gynaecologic Oncology Unit, Institute Bergonie, Cours de l'Argonne 229, Bordeaux 33076, France, E-mail:
| | - Anne Floquet
- Gynaecologic Oncology Unit, Institute Bergonie, Bordeaux 33076, France
| | - Guillame Babin
- Gynaecologic Oncology Unit, Institute Bergonie, Bordeaux 33076, France
| | - Frederic Guyon
- Gynaecologic Oncology Unit, Institute Bergonie, Bordeaux 33076, France
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Wang W, Fan X, Yang J, Wang X, Gu Y, Chen M, Jiang Y, Liu L, Zhang M. Preliminary MRI Study of Extracellular Volume Fraction for Identification of Lymphovascular Space Invasion of Cervical Cancer. J Magn Reson Imaging 2023; 57:587-597. [PMID: 36094153 DOI: 10.1002/jmri.28423] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 06/12/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Lymphovascular space invasion (LVSI) is a risk factor for poor prognosis of cervical cancer. Preoperative identification of LVSI is very difficult. PURPOSE To evaluate the potential of extracellular volume (ECV) fraction based on T1 mapping in preoperative identification of LVSI in cervical cancer compared with dynamic contrast-enhanced MRI (DCE-MRI). STUDY TYPE Retrospective. SUBJECTS A total of 79 patients (median age 54 years) with cervical cancer were classified into LVSI group (n = 29) and without LVSI group (n = 50) according to postoperative pathology. FIELD STRENGTH/SEQUENCE A 3-T, noncontrast and contrast-enhanced T1 mapping performed with volume interpolated breath hold examination (VIBE) sequence, DCE-MRI applied with 3D T1-weighted VIBE sequence. ASSESSMENT Regions of interest along the medial edge of the lesion were drawn on slices depicting the maximum cross-section of the tumor. The noncontrast and contrast-enhanced T1 value of the tumor and arteries in the same slice were measured, and ECV was calculated from T1 values. The parametric maps (Ktrans , kep , and ve ) derived from DCE-MRI standard Toft's model were evaluated. STATISTICAL TESTS ECV, Ktrans , kep , and ve between groups with and without LVSI were compared using Student's t-test. The receiver operating characteristic (ROC) curve and DeLong test were used to evaluate and compare the diagnostic performance of ECV, Ktrans , kep , and ve for differentiating LVSI. P < 0.05 was considered statistically significant. RESULTS The ECV and Ktrans of the LVSI group were significantly higher than that of non-LVSI group (52.86% vs. 36.77%, 0.239 vs. 0.176, respectively), and no significant differences in Kep or ve values were observed (P = 0.071 and P = 0.168, respectively). The ECV fraction showed significantly higher area under ROC curve than Ktrans for differentiating LVSI (0.874 vs. 0.655, respectively). DATA CONCLUSION ECV measurements based on T1 mapping might improve the discrimination between patients with and without LVSI in cervical cancer, showing better performance for this purpose than DCE-MRI. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Wei Wang
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xiaofei Fan
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jie Yang
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xuemei Wang
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yu Gu
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Mingxin Chen
- Inpatient Service Center, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yueluan Jiang
- MR Scientific Marketing, Diagnostic Imaging, Siemens Healthineers Ltd., Beijing, China
| | - Lin Liu
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Mengchao Zhang
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
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Wang J, Li X, Yang X, Wang J. Development and Validation of a Nomogram Based on Metabolic Risk Score for Assessing Lymphovascular Space Invasion in Patients with Endometrial Cancer. Int J Environ Res Public Health 2022; 19:ijerph192315654. [PMID: 36497730 PMCID: PMC9736227 DOI: 10.3390/ijerph192315654] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/05/2022] [Accepted: 11/23/2022] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study assessed the predictive value of the metabolic risk score (MRS) for lymphovascular space invasion (LVSI) in endometrial cancer (EC) patients. METHODS We included 1076 patients who were diagnosed with EC between January 2006 and December 2020 in Peking University People's Hospital. All patients were randomly divided into the training and validation cohorts in a ratio of 2:1. Data on clinicopathological indicators were collected. Univariable and multivariable logistic regression analysis was used to define candidate factors for LVSI. A backward stepwise selection was then used to select variables for inclusion in a nomogram. The performance of the nomogram was evaluated by discrimination, calibration, and clinical usefulness. RESULTS Independent predictors of LVSI included differentiation grades (G2: OR = 1.800, 95% CI: 1.050-3.070, p = 0.032) (G3: OR = 3.49, 95% CI: 1.870-6.520, p < 0.001), histology (OR = 2.723, 95% CI: 1.370-5.415, p = 0.004), MI (OR = 4.286, 95% CI: 2.663-6.896, p < 0.001), and MRS (OR = 1.124, 95% CI: 1.067-1.185, p < 0.001) in the training cohort. A nomogram was established to predict a patient's probability of developing LVSI based on these factors. The ROC curve analysis showed that an MRS-based nomogram significantly improved the efficiency of diagnosing LVSI compared with the nomogram based on clinicopathological factors (p = 0.0376 and p = 0.0386 in the training and validation cohort, respectively). Subsequently, the calibration plot showed a favorable consistency in both groups. Moreover, we conducted a decision curve analysis, showing the great clinical benefit obtained from the application of our nomogram. However, our study faced several limitations. Further external validation and a larger sample size are needed in future studies. CONCLUSION MRS-based nomograms are useful for predicting LVSI in patients with EC and may facilitate better clinical decision-making.
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Erdem B, Çelebi İ, Aşıcıoğlu O, Akgöl S, Yüksel İT, Özaydin İY, Topbaş F, Akbayir Ö. Preoperative prediction of retroperitoneal lymph node involvement in clinical stage IB and IIA cervical cancer. J Cancer Res Ther 2022; 18:1548-1552. [PMID: 36412408 DOI: 10.4103/jcrt.jcrt_106_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective Lymph node metastasis (LNM) is the most important factor affecting survival in early-stage cervical cancer (CC). International Federation of Gynecology and Obstetrics revised the staging of CC in 2018 and reported LNM as a staging criterion. We investigated the preoperatively assessable risk factors associated with LNM in surgically treated stage IB1-IIA2 CC patients. Materials and Methods This was a retrospective cohort study of women who underwent radical hysterectomy and pelvic lymphadenectomy with or without para-aortic lymphadenectomy for CC stage IB1-IIA2 from 2004 to 2019. All patients included in this study were examined with speculum inspection, parametrial assessment by rectovaginal palpation under general anesthesia, transvaginal ultrasonography, magnetic resonance imaging (MRI), and chest radiography. Clinical staging was done according to the preoperative findings. MRI was used to measure tumor and lymph node dimensions. Results Out of the 149 women included in the study, 29 (19.4%) had LNM. Univariate analysis revealed that larger tumor size (≥30 mm), lymphovascular space invasion (LVSI) detected with diagnostic biopsy, parametrial involvement, and deep stromal invasion status were significantly different between the group with LNM and the group without LNM. In multivariate analysis, specific preoperative risk factors such as MRI based tumor diameter ≥30 mm and LVSI (+) on the diagnostic biopsy were found to be independent risk factors for LNM in the multivariate analysis. Conclusion The rate of LNM is high in patients with CC with a tumor size ≥30 mm and preoperative biopsy LVSI status even if they are clinically in early stages. Surgeons can take this into account while deciding between primary surgery and chemoradiotherapy in the treatment of CC.
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Affiliation(s)
- Baki Erdem
- Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - İbrahim Çelebi
- Department of Obstetrics and Gynecology, İstinye University, Gaziosmanpaşa Medical Park Hospital, Istanbul, Turkey
| | - Osman Aşıcıoğlu
- Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Sedat Akgöl
- Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - İlkbal Temel Yüksel
- Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - İpek Yıldız Özaydin
- Department of Pathology, Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Fitnat Topbaş
- Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Özgür Akbayir
- Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
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Jin X, Shen C, Yang X, Yu Y, Wang J, Che X. Association of Tumor Size With Myometrial Invasion, Lymphovascular Space Invasion, Lymph Node Metastasis, and Recurrence in Endometrial Cancer: A Meta-Analysis of 40 Studies With 53,276 Patients. Front Oncol 2022; 12:881850. [PMID: 35719999 PMCID: PMC9201106 DOI: 10.3389/fonc.2022.881850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Myometrial invasion (MI), lymphovascular space invasion (LVSI), and lymph node metastasis (LNM) have been found to have independent prognostic factors in endometrial cancer. Tumor size has practical advantages in endometrial cancer. The cutoff values for tumor size conformed with current literature. More and more studies inferred that tumor size >20 mm showed a strong correlation. However, the relationship between tumor size >20 mm and MI, LVSI, LNM, recurrence, and overall survival (OS) remains controversial, and no meta-analysis has been conducted. Therefore, a systematic review and meta-analysis should be performed to discuss this issue later on. Methods Relevant articles were collected from PubMed, EMBASE, and Cochrane Library databases from January 1990 to June 2021. The predictive value of tumor size >20 mm in endometrial cancer was studied, and data were pooled for meta-analysis using Review Manager 5.1. Additionally, the odds ratio (OR) was analyzed, and cumulative analyses of hazard ratio (HR) and their corresponding 95% CI were conducted. Results A total of 40 articles with 53,276 endometrial cancer patients were included in the meta-analysis. It contained 7 articles for MI, 6 for LVSI, 21 for LNM, 7 for recurrence, and 3 for OS. Primary tumor size >20 mm was significantly associated with depth of MI (OR = 5.59, 95% CI [5.02, 6.23], p < 0.001), positive LVSI (OR = 3.35, 95% CI [2.34, 4.78], p < 0.001), positive LNM (OR = 4.11, 95% CI [3.63, 4.66], p < 0.001), and recurrence (OR = 3.52, 95% CI [2.39, 5.19], p < 0.001). Tumor size >20 mm was also related to OS via meta-synthesis of HR in univariate survival (HR 2.13, 95% CI [1.28, 3.53], p = 0.003). There was no significant publication bias in this study by funnel plot analysis. Conclusion Primary tumor size >20 mm was an independent predictive factor for the depth of MI, positive LVSI, positive LNM, recurrence, and poor OS. Therefore, it is more important to take into account the value of tumor size in the clinicopathological staging of endometrial carcinoma. Tumor size >20 mm should be integrated into the intraoperative algorithm for performing a full surgical staging. Well-designed and multicenter studies, with a larger sample size, are still required to verify the findings.
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Affiliation(s)
- Xiaoying Jin
- Department of Obstetrics and Gynecology, Jiaxing University Affiliated Maternity and Child Hospital, Jiaxing, China
| | - Chunjuan Shen
- Department of Obstetrics and Gynecology, Jiaxing University Affiliated Maternity and Child Hospital, Jiaxing, China
| | - Xiaodi Yang
- Department of Obstetrics and Gynecology, Jiaxing University Affiliated Maternity and Child Hospital, Jiaxing, China
| | - Yayuan Yu
- Department of Obstetrics and Gynecology, Jiaxing University Affiliated Maternity and Child Hospital, Jiaxing, China
| | - Jianzhang Wang
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xuan Che
- Department of Obstetrics and Gynecology, Jiaxing University Affiliated Maternity and Child Hospital, Jiaxing, China
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Yamamoto M, Motohara T, Iwagoi Y, Tayama S, Tashiro H, Kondoh E, Katabuchi H. Fertility-sparing surgery for early-stage cervical cancer: A case series study on the efficacy and feasibility of cervical conization followed by pelvic lymphadenectomy. J Obstet Gynaecol Res 2022; 48:1444-1450. [PMID: 35315183 DOI: 10.1111/jog.15215] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/03/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the oncologic and obstetric outcomes of cervical conization followed by pelvic lymphadenectomy, which is used as a fertility-sparing procedure, in reproductive-aged patients with early-stage cervical cancer. METHODS We performed a retrospective study of patients with stage IA1-IB1 cervical cancer who underwent cervical conization followed by pelvic lymphadenectomy from 2011 to 2020 at Kumamoto University Hospital. RESULTS In total, eight patients underwent conization followed by pelvic lymphadenectomy. The median age of the patients was 33 (range: 28-36) years. Four (50.0%) patients were nulliparous. Seven (87.5%) patients were diagnosed with squamous cell carcinoma (87.5%) and one (12.5%) with adenocarcinoma. Five (62.5%), two (25.0%), and one (12.5%) presented with stage IA1, IA2, and IB1 disease, respectively. Five (62.5%) patients had lymphovascular space invasion (LVSI) based on the assessment of specimens obtained via conization. However, none had lymph node metastasis based on pelvic lymphadenectomy. Regarding long-term oncologic outcomes, recurrence was not observed at a median follow-up of 60 (range: 8-107) months. In addition, obstetric outcomes were consistently favorable in terms of achieving pregnancy, preterm delivery, and live birth. During the study period, two patients who actively attempted to conceive had four pregnancies, resulting in full-term deliveries, and one was on her first trimester of pregnancy. CONCLUSION Cervical conization combined with pelvic lymphadenectomy represents a feasible conservative management for histologically well-selected patients with early-stage cervical cancer. Furthermore, an optimal histopathological evaluation of conization specimens will contribute to decision-making regarding the use of this fertility-sparing procedure.
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Affiliation(s)
- Mayuko Yamamoto
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, Japan
| | - Takeshi Motohara
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, Japan
| | - Yutaka Iwagoi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, Japan
| | - Shingo Tayama
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, Japan
| | - Hironori Tashiro
- Department of Woman's Health Sciences and Pediatric Nursing, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Chuo-ku, Kumamoto-city, Kumamoto, Japan
| | - Eiji Kondoh
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, Japan
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Gumtorntip P, Poomtavorn Y, Tanprasertkul C. Predicting Factors for Pelvic Lymph Node Metastasis in Patients with Apparently Early-Stage Endometrial Cancer. Asian Pac J Cancer Prev 2022; 23:617-622. [PMID: 35225474 PMCID: PMC9272638 DOI: 10.31557/apjcp.2022.23.2.617] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Performing lymphadenectomy in all patients with early-stage endometrial cancer (EC) is debatable because the procedure may expose patients to unnecessary risks of postoperative complications. Aim of this study was to evaluate the prevalence and risk factors of pelvic lymph node metastasis (PLNM) in patients with apparently early-stage EC. Materials and methods: Two hundred and two patients with apparently early-stage EC who underwent surgical staging at Thammasat University Hospital between the years 2013 and 2020 were included in this retrospective study. Clinicopathological data and preoperative laboratory results were obtained from computer-based medical records. All data were statistically analyzed to determine the prevalence of PLNM and risk factors for developing PLNM. Results: PLNM was detected in 22 (10.9%) patients. Univariate analysis demonstrated that having grade 3 tumor, myometrial invasion of 50% or greater, vaginal involvement, cervical involvement, adnexal involvement, lower uterine segment involvement, lymphovascular space invasion (LVSI), and positive peritoneal cytology were associated with higher risk for developing PLNM. In addition, lower preoperative hemoglobin level and higher preoperative white blood cell count were significantly associated with PLNM. Multivariate analysis demonstrated that myometrial invasion of 50% or greater and LVSI were independent risk factors for developing PLNM (odds ratio (OR) 9.31, 95% confidence interval (CI) 2.58-33.55, p = 0.001, and OR 3.73, 95%CI 1.39-10.02, p = 0.009, respectively). Conclusions: Myometrial invasion of 50% or greater and LVSI were independent risk factors for developing PLNM in patients with apparently early-stage EC and thus lymphadenectomy in these patients should be provided.
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Affiliation(s)
- Pariyed Gumtorntip
- Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University Hospital, Pathumthani 12120, Thailand
| | - Yenrudee Poomtavorn
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University Hospital, Pathumthani 12120, Thailand
| | - Chamnan Tanprasertkul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Thailand
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Huang G, Cui Y, Wang P, Ren J, Wang L, Ma Y, Jia Y, Ma X, Zhao L. Multi-Parametric Magnetic Resonance Imaging-Based Radiomics Analysis of Cervical Cancer for Preoperative Prediction of Lymphovascular Space Invasion. Front Oncol 2022; 11:663370. [PMID: 35096556 PMCID: PMC8790703 DOI: 10.3389/fonc.2021.663370] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 12/17/2021] [Indexed: 01/03/2023] Open
Abstract
Background Detection of lymphovascular space invasion (LVSI) in early cervical cancer (CC) is challenging. To date, no standard clinical markers or screening tests have been used to detect LVSI preoperatively. Therefore, non-invasive risk stratification tools are highly desirable. Objective To train and validate a multi-parametric magnetic resonance imaging (mpMRI)-based radiomics model to detect LVSI in patients with CC and investigate its potential as a complementary tool to enhance the efficiency of risk assessment strategies. Materials and Methods The model was developed from the tumor volume of interest (VOI) of 125 patients with CC. A total of 1037 radiomics features obtained from conventional magnetic resonance imaging (MRI), including a small field-of-view (sFOV) high-resolution (HR)-T2-weighted MRI (T2WI), apparent diffusion coefficient (ADC), T2WI, fat-suppressed (FS)-T2WI, as well as axial and sagittal contrast-enhanced T1-weighted MRI (T1c). We conducted a radiomics-based characterization of each tumor region using pretreatment image data. Feature selection was performed using the least absolute shrinkage and selection operator method on the training set. The predictive performance was compared with single variates (clinical data and single-layer radiomics signatures) analyzed using a receiver operating characteristic (ROC) curve. Three-fold cross-validation performed 20 times was used to evaluate the accuracy of the trained classifiers and the stability of the selected features. The models were validated by using a validation set. Results Feature selection extracted the six most important features (3 from sFOV HR-T2WI, 1 T2WI, 1 FS-T2WI, and 1 T1c) for model construction. The mpMRI-combined radiomics model (area under the curve [AUC]: 0.940) reached a significantly higher performance (better than the clinical parameters [AUC: 0.730]), including any single-layer model using sFOV HR-T2WI (AUC: 0.840), T2WI (AUC: 0.770), FS-T2WI (AUC: 0.710), ADC maps (AUC: 0.650), sagittal, and axial T1c values (AUC: 0.710, 0.680) in the validation set. Conclusion Biomarkers using multi-parametric radiomics features derived from preoperative MR images could predict LVSI in patients with CC.
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Affiliation(s)
- Gang Huang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, China
| | - Yaqiong Cui
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, China.,The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Ping Wang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, China
| | | | - Lili Wang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, China
| | - Yaqiong Ma
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, China
| | - Yingmei Jia
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, China
| | - Xiaomei Ma
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, China
| | - Lianping Zhao
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, China
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Wang J, Xu P, Yang X, Yu Q, Xu X, Zou G, Zhang X. Association of Myometrial Invasion With Lymphovascular Space Invasion, Lymph Node Metastasis, Recurrence, and Overall Survival in Endometrial Cancer: A Meta-Analysis of 79 Studies With 68,870 Patients. Front Oncol 2021; 11:762329. [PMID: 34746002 PMCID: PMC8567142 DOI: 10.3389/fonc.2021.762329] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/30/2021] [Indexed: 12/22/2022] Open
Abstract
Background Myometrial invasion has been demonstrated to correlate to clinicopathological characteristics and prognosis in endometrial cancer. However, not all the studies have the consistent results and no meta-analysis has investigated the association of myometrial invasion with lymphovascular space invasion (LVSI), lymph node metastasis (LNM), recurrence, and overall survival (OS). Therefore, a meta-analysis was performed to evaluate the relationship between myometrial invasion and clinicopathological characteristics or overall survival in endometrial cancer. Materials and Methods A search of Pubmed, Embase, and Web of Science was carried out to collect relevant studies from their inception until June 30, 2021. The quality of each included study was evaluated using Newcastle–Ottawa scale (NOS) scale. Review Manager version 5.4 was employed to conduct the meta-analysis. Results A total of 79 articles with 68,870 endometrial cancer patients were eligible including 9 articles for LVSI, 29 articles for LNM, 8 for recurrence, and 37 for OS in this meta-analysis. Myometrial invasion was associated with LVSI (RR 3.07; 95% CI 2.17–4.35; p < 0.00001), lymph node metastasis (LNM) (RR 4.45; 95% CI 3.29–6.01; p < 0.00001), and recurrence (RR 2.06; 95% CI 1.58–2.69; p < 0.00001). Deep myometrial invasion was also significantly related with poor OS via meta-synthesis of HRs in both univariate survival (HR 3.36, 95% CI 2.35–4.79, p < 0.00001) and multivariate survival (HR 2.00, 95% CI 1.59–2.53, p < 0.00001). Funnel plot suggested that there was no significant publication bias in this study. Conclusion Deep myometrial invasion correlated to positive LVSI, positive LNM, cancer recurrence, and poor OS for endometrial cancer patients, indicating that myometrial invasion was a useful evaluation criterion to associate with clinical outcomes and prognosis of endometrial cancer since depth of myometrial invasion can be assessed before surgery. The large scale and comprehensive meta-analysis suggested that we should pay more attention to myometrial invasion in clinical practice, and its underlying mechanism also deserves further investigation.
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Affiliation(s)
- Jianzhang Wang
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ping Xu
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xueying Yang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qin Yu
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinxin Xu
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gen Zou
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinmei Zhang
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Balaya V, Guani B, Mereaux J, Magaud L, Pache B, Bonsang-Kitzis H, Ngô C, Desseauve D, Mathevet P, Lécuru F, On Behalf Of The Senticol Group. Can Conization Specimens Predict Sentinel Lymph Node Status in Early-Stage Cervical Cancer? A SENTICOL Group Study. Cancers (Basel) 2021; 13:5423. [PMID: 34771586 DOI: 10.3390/cancers13215423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/07/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Lymph node involvement is one of the major prognosis factors for early-stage cervical cancer. Improvement in preoperative identification of node-positive patients may lead to a more accurate triage to primary chemoradiation for these patients instead of radical surgery followed by adjuvant radiotherapy, given the increased morbidity of combined treatment. Several studies have well established risk factors for node involvement, but they are based on final pathologic examination of radical hysterectomy specimens and are usually extrapolated for preoperative risk assessment. Among these risk factors, tumor size, lymphovascular space invasion (LVSI) and depth of stromal invasion might be assessed in conization specimens. Our findings suggest that patients with depth of stromal invasion lower than 10 mm and no LVSI in conization specimens had lower risk of micro- and macrometastatic SLN. In this subpopulation, full node dissection may be questionable in case of SLN unilateral detection. Abstract Background: The prognosis of patients with cervical cancer is significantly worsened in case of lymph node involvement. The goal of this study was to determine whether pathologic features in conization specimens can predict the sentinel lymph node (SLN) status in early-stage cervical cancer. Methods: An ancillary analysis of two prospective multicentric database on SLN biopsy for cervical cancer (SENTICOL I and II) was carried out. Patients with IA to IB2 2018 FIGO stage, who underwent preoperative conization before SLN biopsy were included. Results: Between January 2005 and July 2012, 161 patients from 25 French centers fulfilled the inclusion criteria. Macrometastases, micrometastases and Isolated tumor cells (ITCs) were found in 4 (2.5%), 6 (3.7%) and 5 (3.1%) patients respectively. Compared to negative SLN patients, patients with micrometastatic and macrometastatic SLN were more likely to have lymphovascular space invasion (LVSI) (60% vs. 29.5%, p = 0.04) and deep stromal invasion (DSI) ≥ 10 mm (50% vs. 17.8%, p = 0.04). Among the 93 patients with DSI < 10 mm and absence of LVSI on conization specimens, three patients (3.2%) had ITCs and only one (1.1%) had micrometastases. Conclusions: Patients with DSI < 10 mm and no LVSI in conization specimens had lower risk of micro- and macrometastatic SLN. In this subpopulation, full node dissection may be questionable in case of SLN unilateral detection.
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Vatansever D, Taskiran C, Mutlu Meydanli M, Gungorduk K, Akbayir O, Yalcin I, Demirkiran F, Sozen H, Ozgul N, Celik H, Onan MA, Taskin S, Oge T, Simsek T, Abboud S, Yuksel IT, Ayhan A. Impact of cytoreductive surgery on survival of patients with low-grade serous ovarian carcinoma: A multicentric study of Turkish Society of Gynecologic Oncology (TRSGO-OvCa-001). J Surg Oncol 2021; 123:1801-1810. [PMID: 33657253 DOI: 10.1002/jso.26450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to analyze the factors affecting recurrence-free (RFS) and overall survival (OS) rates of women diagnosed with low-grade serous ovarian cancer (LGSOC). METHODS Databases from 13 participating centers in Turkey were searched retrospectively for women who had been treated for stage I-IV LGSOC between 1997 and 2018. RESULTS Overall 191 eligible women were included. The median age at diagnosis was 49 years (range, 21-84 years). One hundred seventy-five (92%) patients underwent primary cytoreductive surgery. Complete and optimal cytoreduction was achieved in 148 (77.5%) and 33 (17.3%) patients, respectively. The median follow-up period was 44 months (range, 2-208 months). Multivariate analysis showed the presence of endometriosis (p = .012), lymphovascular space invasion (LVSI) (p = .022), any residual disease (p = .023), and the International Federation of Gynecology and Obstetrics (FIGO) stage II-IV disease (p = .045) were negatively correlated with RFS while the only presence of residual disease (p = .002) and FIGO stage II-IV disease (p = .003) significantly decreased OS. CONCLUSIONS The maximal surgical effort is warranted for complete cytoreduction as achieving no residual disease is the single most important variable affecting the survival of patients with LGSOC. The prognostic role of LVSI and endometriosis should be evaluated by further studies as both of these parameters significantly affected RFS.
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Affiliation(s)
- Dogan Vatansever
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, School of Medicine, Koc University, Istanbul, Turkey
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, School of Medicine, Koc University, Istanbul, Turkey
| | - Mehmet Mutlu Meydanli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Zekai Tahir Burak Training and Research Hospital, Ankara, Turkey
| | - Kemal Gungorduk
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ozgur Akbayir
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Ibrahim Yalcin
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Zekai Tahir Burak Training and Research Hospital, Ankara, Turkey
| | - Fuat Demirkiran
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Hamdullah Sozen
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Nejat Ozgul
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Husnu Celik
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, School of Medicine, Adana Baskent University, Adana, Turkey
| | - Mehmet Anil Onan
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, School of Medicine, Gazi University, Ankara, Turkey
| | - Salih Taskin
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, School of Medicine, Ankara University, Ankara, Turkey
| | - Tufan Oge
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, School of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Tayyup Simsek
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Sara Abboud
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Ilkbal Temel Yuksel
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Ali Ayhan
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, School of Medicine, Ankara Baskent University, Ankara, Turkey
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Takahashi M, Sakai K, Iwasa N, Wada M, Hino M, Kurahashi T, Ueno M, Nakagawa H. Validation of the FIGO 2018 staging system of cervical cancer: Retrospective analysis of FIGO 2009 stage IB1 cervical cancer with tumor under 2 cm. J Obstet Gynaecol Res 2021; 47:1871-1877. [PMID: 33611822 DOI: 10.1111/jog.14713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/10/2021] [Accepted: 01/29/2021] [Indexed: 12/01/2022]
Abstract
AIM The International Federation of Gynecology and Obstetrics (FIGO) revised the cervical cancer staging system in 2018. This study aims to validate the revised staging system in patients with tumors <2 cm in size who were classified as FIGO 2009 stage IB1. METHODS We evaluated 62 women with stage IB1 cervical cancer (FIGO 2009) who underwent radical hysterectomy as the initial treatment between November 2004 and August 2018 in our institution. The patients with FIGO 2009 stage IB1 and tumors <2 cm in size were enrolled. We reclassified their stage according to the FIGO 2018 staging system and analyzed their clinicopathological data retrospectively. RESULTS Twenty-five patients met the inclusion criteria. According to the FIGO 2018 classification, 9 (36.0%) patients were classified as stage IA, 13 (52.0%) as stage IB1, and 3 (12.0%) as stage IIIC, respectively. One (11.1%), six (46.2%), and three (100%) patients with lymphovascular space invasion were classified as stage IA, IB1, and IIIC, respectively. No significant differences were found in the 5-year overall survival or progression-free survival among the three stages. CONCLUSIONS As many as 36.0% of patients classified as FIGO 2009 stage IB1 with a tumor <2 cm in size were classified as stage IA in the FIGO 2018 classification. For these cases, a treatment less invasive than radical hysterectomy or radiotherapy might be sufficient. Our results suggest that cervical cancer patients with tumors <2 cm should be carefully diagnosed by performing cervical conization and assessed the pathological findings before hysterectomy.
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Affiliation(s)
- Mio Takahashi
- Department of Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Kensuke Sakai
- Department of Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, Japan.,Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Naomi Iwasa
- Department of Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Michiko Wada
- Department of Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Makiko Hino
- Department of Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Takashi Kurahashi
- Department of Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Mari Ueno
- Department of Pathology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Hiroyuki Nakagawa
- Department of Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, Japan
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Cuylan ZF, Akilli H, Gungorduk K, Demirkiran F, Oz M, Salman MC, Sozen H, Celik H, Gokcu M, Bese T, Meydanli MM, Ozgul N, Topuz S, Kuscu E, Kuru O, Gokmen S, Gultekin M, Ayhan A. Is the extent of lymphadenectomy a prognostic factor in International Federation of Gynecology and Obstetrics stage II endometrioid endometrial cancer? J Obstet Gynaecol Res 2021; 47:1134-1144. [PMID: 33426779 DOI: 10.1111/jog.14648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/23/2020] [Accepted: 12/25/2020] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to evaluate the prognostic significance of adequate lymph node dissection (LND) (≥10 pelvic lymph nodes (LNs) and ≥ 5 paraaortic LNs removed) in patients with International Federation of Gynecology and Obstetrics (FIGO) stage II endometrioid endometrial cancer (EEC). METHODS A multicenter department database review was performed to identify patients who had been operated and diagnosed with stage II EEC at seven centers in Turkey retrospectively. Demographic, clinicopathological, and survival data were collected and analyzed. RESULTS We identified 284 women with stage II EEC. There were 170 (59.9%) patients in the adequate lymph node dissection (LND) group and 114 (40.1%) in the inadequate LND group. The 5-year overall survival (OS) rate of the inadequate LND group was significantly lower than that of the adequate LND group (84.1% vs. 89.1%, respectively; p = 0.028). In multivariate analysis, presence of lymphovascular space invasion (LVSI) (hazard ratio [HR]: 2.39, 95% confidence interval [CI]: 1.23-4.63; p = 0.009), age ≥ 60 (HR: 3.30, 95% CI: 1.65-6.57; p = 0.001], and absence of adjuvant therapy (HR: 2.74, 95% CI: 1.40-5.35; p = 0.003) remained as independent risk factors for decreased 5-year disease-free survival (DFS). Inadequate LND (HR: 2.34, 95% CI: 1.18-4.63; p < 0.001), age ≥ 60 (HR: 2.67, 95% CI: 1.25-5.72; p = 0.011), and absence of adjuvant therapy (HR: 4.95, 95% CI: 2.28-10.73; p < 0.001) were independent prognostic factors for decreased 5-year OS in multivariate analysis. CONCLUSION Adequate LND and adjuvant therapy were significant for the improvement of outcomes in FIGO stage II EEC patients. Furthermore, LVSI was associated with worse 5-year DFS rate in stage II EEC.
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Affiliation(s)
| | - Huseyin Akilli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Kemal Gungorduk
- Department of Gynecologic Oncology, Izmir Tepecik Education and Research Hospital, Izmır, Turkey
| | - Fuat Demirkiran
- Department of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Oz
- Department of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Coskun Salman
- Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hamdullah Sozen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Husnu Celik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Mehmet Gokcu
- Department of Gynecologic Oncology, Izmir Tepecik Education and Research Hospital, Izmır, Turkey
| | - Tugan Bese
- Department of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Nejat Ozgul
- Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Samet Topuz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esra Kuscu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Oguzhan Kuru
- Department of Gynecologic Oncology, Izmir Tepecik Education and Research Hospital, Izmır, Turkey
| | - Sibel Gokmen
- Department of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Gultekin
- Department of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
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Toprak S, Sahin EA, Sahin H, Tohma YA, Yilmaz E, Meydanli MM. Risk factors for cervical stromal involvement in endometrioid-type endometrial cancer. Int J Gynaecol Obstet 2021; 153:51-55. [PMID: 33118165 DOI: 10.1002/ijgo.13449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/18/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to identify predictors of cervical stromal involvement in women with endometrioid-type endometrial cancer (EEC). METHODS A total of 795 patients with EEC who underwent comprehensive surgical staging including pelvic and para-aortic lymph node dissection between January 2007 and December 2018 were retrospectively analyzed. Data including age, menopausal status, serum CA-125 levels, tumor size, lymphovascular space invasion (LVSI), depth of myometrial invasion, positive peritoneal cytology, cervical stromal involvement, histologic grade, recurrence, and follow-up duration were recorded. RESULTS Median follow up was 49 months. Cervical stromal invasion was found in 88 patients. Multivariate analysis revealed that presence of LVSI (hazard ratio [HR] 2, 95% confidence interval [CI] 1.02-4.25, P = 0.045), a primary tumor diameter of at least 3 cm (HR 3, 95% CI 1.31-7.25, P = 0.010), and at least 50% deep myometrial invasion (HR 2.7, 95% CI 1.37-5.41, P = 0.004) were independent risk factors for cervical stromal involvement in patients with EEC. CONCLUSION Our study results suggest that presence of LVSI, a primary tumor diameter of at least 3 cm, and LVSI of at least 50% seem to be independent predictors of cervical involvement in women with EEC.
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Affiliation(s)
- Serhat Toprak
- Department of Pathology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Eda Adeviye Sahin
- Department of Obstetrics and Gynecology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Hanifi Sahin
- Department of Obstetrics and Gynecology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Yusuf Aytac Tohma
- Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Ercan Yilmaz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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Kim SI, Yoon JH, Lee SJ, Song MJ, Kim JH, Lee HN, Jung G, Yoo JG. Prediction of lymphovascular space invasion in patients with endometrial cancer. Int J Med Sci 2021; 18:2828-2834. [PMID: 34220310 PMCID: PMC8241765 DOI: 10.7150/ijms.60718] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/20/2021] [Indexed: 11/05/2022] Open
Abstract
Objective: Predict the presence of lymphovascular space invasion (LVSI), using uterine factors such as tumor diameter (TD), grade, and depth of myometrial invasion (MMI). Develop a predictive model that could serve as a marker of LVSI in women with endometrial cancer (EC). Methods: Data from 888 patients with endometrioid EC who were treated between January 2009 and December 2018 were reviewed. The patients' data were retrieved from six institutions. We assessed the differences in the clinicopathological characteristics between patients with and without LVSI. We performed logistic regression analysis to determine which clinicopathological characteristics were the risk factors for positive LVSI status and to estimate the odds ratio (OR) for each covariate. Using the risk factors and OR identified through this process, we created a model that could predict LVSI and analyzed it further using receiver operating characteristic curve analysis. Results: In multivariate logistic regression analysis, tumor size (P = 0.027), percentage of MMI (P < 0.001), and presence of cervical stromal invasion (P = 0.002) were identified as the risk factors for LVSI. Based on the results of multivariate logistic regression analysis, we developed a simplified LVSI prediction model for clinical use. We defined the "LVSI index" as "TD×%MMI×tumor grade×cervical stromal involvement." The area under curve was 0.839 (95% CI= 0.809-0.869; sensitivity, 74.1%; specificity, 80.5%; negative predictive value, 47.3%; positive predictive value, 8.6%; P < 0.001), and the optimal cut-off value was 200. Conclusion: Using the modified risk index of LVSI, it is possible to predict the presence of LVSI in women with endometrioid endometrial cancer. Our prediction model may be an appropriate tool for integration into the clinical decision-making process when assessed either preoperatively or intraoperatively.
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Affiliation(s)
- Sang Il Kim
- Department of Obstetrics and Gynecology, St. Vincent's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo Hee Yoon
- Department of Obstetrics and Gynecology, St. Vincent's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Jong Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Jong Song
- Department of Obstetrics and Gynecology, Yeouido St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Hwi Kim
- Department of Obstetrics and Gynecology, Uijeongbu St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hae Nam Lee
- Department of Obstetrics and Gynecology, Buchen St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Gyul Jung
- Department of Obstetrics and Gynecology, Daejeon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Geun Yoo
- Department of Obstetrics and Gynecology, Daejeon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Li S, Liu J, Zhang F, Yang M, Zhang Z, Liu J, Zhang Y, Hilbert T, Kober T, Cheng J, Zhu J. Novel T2 Mapping for Evaluating Cervical Cancer Features by Providing Quantitative T2 Maps and Synthetic Morphologic Images: A Preliminary Study. J Magn Reson Imaging 2020; 52:1859-1869. [PMID: 32798294 DOI: 10.1002/jmri.27297] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/04/2020] [Accepted: 07/07/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The application value of T2 mapping in evaluating cervical cancer (CC) features remains unclear. PURPOSE To investigate the role of T2 values in evaluating CC classification, grade, and lymphovascular space invasion (LVSI) in comparison to apparent diffusion coefficient (ADC), and to compare synthetic T2 -weighted (T2 W) images calculated from T2 values to conventional T2 W images for CC staging. STUDY TYPE Retrospective. POPULATION Sixty-three patients with histopathologically confirmed CC. FIELD STRENGTH/SEQUENCE 3T, conventional T2 W turbo spin-echo, diffusion-weighted echo-planar, and accelerated T2 mapping sequence. ASSESSMENT T2 and ADC values between different pathological features of CC were compared. The diagnostic accuracies of conventional and synthetic T2 W images in staging were also compared. STATISTICAL TESTS Parameters were compared using an independent t-test, Wilcoxon signed-rank test, and the chi-square test. Receiver operating characteristic analysis was performed. RESULTS The T2 values varied significantly between well/moderately differentiated and poorly differentiated tumors ([92.8 ± 9.5 msec] vs. [83.8 ± 9.5 msec], P < 0.05) and between LVSI-positive and LVSI-negative CC ([82.2 ± 8.2 msec] vs. [93.9 ± 9.1 msec], P < 0.05). The ADC values showed a significant difference for grade ([0.76 ± 0.10 × 10-3 mm2 /s] vs. [0.65 ± 0.11 × 10-3 mm2 /s], P < 0.05) and no difference for LVSI status ([0.71 ± 0.11× 10-3 mm2 /s] vs. [0.73 ± 0.12× 10-3 mm2 /s], P = 0.472). There was no significant difference in T2 and ADC values between squamous cell carcinoma and adenocarcinoma (P = 0.378 and P = 0.661, respectively). In MRI staging, the conventional and synthetic T2 W images resulted in a similar accuracy (71% vs. 68%, P = 0.698). DATA CONCLUSION The accelerated T2 mapping sequence may facilitate grading and staging of CC by providing quantitative T2 maps and synthetic T2 W images in one acquisition. T2 values may be superior to ADC in predicting LVSI. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 2 J. MAGN. RESON. IMAGING 2020;52:1859-1869.
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Affiliation(s)
- Shujian Li
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Liu
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feifei Zhang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Yang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zanxia Zhang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingjing Liu
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tom Hilbert
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthcare Ltd., Beijing, China
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Abstract
Histopathological evaluation including subtyping and grading is the current cornerstone for endometrial cancer (EC) classification. This provides clinicians with prognostic information and input for further treatment recommendations. Nonetheless, patients with histologically similar ECs may have very different outcomes, notably in patients with high‐grade endometrial carcinomas. For endometrial cancer, four molecular subgroups have undergone extensive studies in recent years: POLE ultramutated (POLEmut), mismatch repair‐deficient (MMRd), p53 mutant (p53abn) and those EC lacking any of these alterations, referred to as NSMP (non‐specific molecular profile). Several large studies confirm the prognostic relevance of these molecular subgroups. However, this ‘histomolecular’ approach has so far not been implemented in clinical routine. The ongoing PORTEC4a trial is the first clinical setting in which the added value of integrating molecular parameters in adjuvant treatment decisions will be determined. For diagnostics, the incorporation of the molecular parameters in EC classification will add a level of objectivity which will yield biologically more homogeneous subclasses. Here we illustrate how the management of individual EC patients may be impacted when applying the molecular EC classification. We describe our current approach to the integrated diagnoses of EC with a focus on scenarios with conflicting morphological and molecular findings. We also address several pitfalls accompanying the diagnostic implementation of molecular EC classification and give practical suggestions for diagnostic scenarios.
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Affiliation(s)
- Lisa Vermij
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Vincent Smit
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Remi Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
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Gulseren V, Kocaer M, Gungorduk O, Ozdemir IA, Gokcu M, Mart EM, Sanci M, Gungorduk K. Preoperative predictors of pelvic and para-aortic lymph node metastases in cervical cancer. J Cancer Res Ther 2020; 15:1231-1234. [PMID: 31898653 DOI: 10.4103/jcrt.jcrt_467_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim This study investigated potential preoperative predictors of pelvic lymph node (PLN) and para-aortic LN (PaLN) involvement in cervical cancer (CC). Materials and Methods This study retrospectively analyzed 283 patients diagnosed with early (stage IA1-IIA) CC who underwent retroperitoneal LN dissection between January 1992 and February 2015. Several risk factors that are believed to influence PLN and PaLN involvement in CC were analyzed as follows: age >50 years, lymphovascular space invasion (LVSI), tumor size ≥2 cm, hemoglobin <12 g/dL, and nonsquamous cell histologic type. Results LVSI (odds ratio [OR] = 11.3, 95% confidence interval [CI] = 5.2-24.3) and tumor size (OR = 3.2, 95% CI = 1.4-7.2) were independent predictors of PLN involvement. None of the factors predicted PaLN involvement in a regression analysis. However, all nine patients who had PaLN involvement also had PLN involvement. Conclusion LVSI and tumor size independently increase the risk of PLN involvement.
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Affiliation(s)
- Varol Gulseren
- Department of Obstetrics and Gynecology, Kaman State Hospital, Kırşehir, Turkey
| | - Mustafa Kocaer
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Ozgu Gungorduk
- Department of Gynecologic Oncology, Mugla Sitki Kocman University, Education and Research Hospital, Mugla, Turkey
| | - Isa Aykut Ozdemir
- Department of Gynecology and Oncology, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Gokcu
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Emre Merter Mart
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Muzaffer Sanci
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Kemal Gungorduk
- Department of Gynecologic Oncology, Mugla Sitki Kocman University, Education and Research Hospital, Mugla, Turkey
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Cokmez H, Yilmaz A. Lower uterine segment involvement in lymphovascular space invasion and lymph node metastasis in endometrioid endometrial cancer. Ginekol Pol 2020; 90:314-319. [PMID: 31276182 DOI: 10.5603/gp.2019.0057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 05/16/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To evaluate the correlation between lymphovascular space invasion (LVSI) indicating lower uterine segment involvement (LUSI) in endometrioid endometrial cancer and lymph node metastasis based on the lymphatic drainage difference between the uterine corpus and the lower segment. MATERIAL AND METHODS Patients who underwent staging surgery for endometrioid endometrial cancer between January 2010 and January 2019 at our institution were reviewed. The clinicopathologic findings and LUSI status of the patients were compared with their LVSI and lymph node metastasis status. RESULTS Of the 253 patients included in this study, 49 (19.4%) had LUSI. Among these patients, none of the 31 LVSI-negative patients had metastatic lymph node involvement. However, of the 18 LVSI-positive patients, half had metastatic lymph node involvement; this difference was significant (p < 0.05). CONCLUSIONS The significant correlation between LVSI and lymph node metastasis in LUSI-positive cases indicates that pathologists should also focus on LVSI findings in the frozen examination required for the decision of staging surgery in patients with endometrioid endometrial cancer limited to the uterus. This is especially important in patients with a lower uterine segment involvement.
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Affiliation(s)
- Hakan Cokmez
- Department of Obstetrics and Gynecology, Izmir Ataturk Education and Research Hospital, Karabaglar, Izmir, Turkey.
| | - Alpay Yilmaz
- Department of Obstetrics and Gynecology, Izmir Ataturk Education and Research Hospital, Karabaglar, Izmir, Turkey
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Imboden S, Tapia C, Scheiwiller N, Kocbek V, Altermatt HJ, Janzen J, Mueller MD, McKinnon B. Early-stage endometrial cancer, CTNNB1 mutations, and the relation between lymphovascular space invasion and recurrence. Acta Obstet Gynecol Scand 2019; 99:196-203. [PMID: 31562818 DOI: 10.1111/aogs.13740] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/16/2019] [Accepted: 09/23/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Women diagnosed with early-stage (FIGO 1) endometrial cancer, grade 1 and 2 can have a good prognosis. Most of these women can be treated successfully with a hysterectomy and bilateral salpingo-oophorectomy and without the additional adjuvant treatment that is accompanied by more risks for complications. However, when recurrence does occur, the consequences can be dire. Accurate decisions must therefore be made by surgeons to avoid either under- or over-treatment. Risk and patient stratification for tailoring treatment still need further improvement. Both histopathology and genetic variants could be integrated into the decision process if relevant factors were identified. MATERIAL AND METHODS Morphological features and the presence of selected genetic mutations in isolated malignant endometrial epithelial cells from these tumors were analyzed in a strictly defined cohort of FIGO 1, grade 1 and 2 low-risk endometrial cancer. Their presence in this cohort, their relation to recurrence, and the association between histopathological features and mutations were determined. This analysis was performed using archival formalin-fixed paraffin-embedded tissue, complete re-evaluation of histopathological features, laser capture microdissection of epithelial cells, and a polymerase chain reaction-based mutational screening assay. RESULTS Twenty-one women with recurrence, after initial identification as low-risk endometrial cancer, were compared with 20 matched control women. The histological marker of lymphovascular invasion was significantly associated with recurrence. There was also a very high prevalence of mutations in CTNNB1 gene, occurring in 50% of this cohort. PTEN mutations were also observed in 27.8% of cases and PIK3CA mutations in 22.2%; none of these mutations were significantly related to recurrence. CONCLUSIONS This study supports the importance of lymphovascular space invasion to identify women with significant risk for recurrence in initially low-risk, early-stage endometrial cancer. It also identifies CTNNB1 as a significant mutation in early-stage disease, and although it may not represent a marker for recurrence its high prevalence in early stage disease could have relevance for both pathogenesis and early treatment.
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Affiliation(s)
- Sara Imboden
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Coya Tapia
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Nadja Scheiwiller
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Vida Kocbek
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Hans J Altermatt
- Division of Histopathology, Institute of Pathology Länggasse, Bern, Switzerland
| | - Jan Janzen
- Histopathology and VascPath, Bern, Switzerland
| | - Michael D Mueller
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Brett McKinnon
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland
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Yan W, Qiu S, Ding Y, Zhang Q, Si L, Lv S, Liu L. Prognostic value of lymphovascular space invasion in patients with early stage cervical cancer in Jilin, China: A retrospective study. Medicine (Baltimore) 2019; 98:e17301. [PMID: 31577720 PMCID: PMC6783197 DOI: 10.1097/md.0000000000017301] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The metastasis of cervical carcinoma is associated with the lymphovascular spread. The primary objective of the present study was to determine the prognostic value of lymphovascular space invasion (LVSI) in patients with early-stage cervical cancer in Jilin, China.In this retrospective cohort study, patients with early-stage cervical cancer (stage IB-IIA) at the Second Hospital of Jilin University from February 2014 to December 2016 were included in the analysis. All included participants underwent radical hysterectomy with pelvic lymphadenectomy. LVSI was identified by hematoxylin and eosin (H&E) staining. The primary outcomes are overall survival (OS) and progression-free survival (PFS). Kaplan-Meier curves were used to calculate the patient's survival. Survival was compared using the log-rank test, while risk factors for the prognosis were assessed by Cox regression analysis.The incidence of LVSI was positively associated with the depth of stromal invasion (P = .009) and lymph node metastasis (LNM, P < .001). LVSI is an independent factor that affects OS (P = .009) and PFS (P = .006) in patients with early stage cervical cancer. LNM status is an independent factor that affects postoperative OS (P = .005).The incidence of lymphatic vessel infiltration is positively associated with the depth of stromal invasion and LNM. LVSI is an independent risk factor for the prognosis of early cervical cancer. The results suggest that further large-scale studies are needed to improve the treatment for patients with LVSI.
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Affiliation(s)
- Wenxing Yan
- Radiotherapy Department of Oncology, Second Hospital of Jilin University,
| | - Shuang Qiu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yaming Ding
- Radiotherapy Department of Oncology, Second Hospital of Jilin University,
| | - Qi Zhang
- Radiotherapy Department of Oncology, Second Hospital of Jilin University,
| | - Lihui Si
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Sha Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Linlin Liu
- Radiotherapy Department of Oncology, Second Hospital of Jilin University,
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Xu H, Pan H, Wang Y, Zhang J. Expanded study on the risk of lymphovascular space invasion and lymph node metastasis of endocervical adenocarcinoma using Pattern Classification: a single-centre analysis of 213 cases. Pathology 2019; 51:570-578. [PMID: 31445810 DOI: 10.1016/j.pathol.2019.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/21/2019] [Accepted: 04/28/2019] [Indexed: 02/08/2023]
Abstract
A new three-tiered Pattern Classification system for usual-type endocervical adenocarcinomas (U-EACs) recommends using tumour invasive patterns rather than depth of invasion (DOI) and horizontal spread to categorise tumours. Tumours categorised by Pattern Classification are associated with lymph node (LN) metastasis and adverse outcomes. The aim of this study is to further explore the potential of Pattern Classification in surgical pathology practice. A total of 213 consecutive cases [201 U-EACs and 12 gastric-type adenocarcinomas (GACs)] diagnosed between 2006 and 2017 was retrospectively analysed. Clinicopathological data included age at diagnosis, DOI measurement, the status of lymphovascular space invasion (LVSI) and LN metastasis, and the number of LVSI foci, dissected and metastatic LNs. Immunostaining for CD34 and D2-40 was performed to identify LVSI in 14 challenging cases. Overall, mean age at diagnosis was 51 years (range 23-75). LVSI and LN metastasis occurred in 128 (60.1%, 128/213) and 42 (20.5%, 42/205) cases, respectively. Also, 28 (13.1%), 21 (9.9%), and 164 (77.0%) patients had pattern A, B, and C tumours, respectively. Patients with pattern C tumours had the oldest age at diagnosis (p=0.007), the highest incidence of LVSI and LN metastasis, and the highest DOI (p<0.001). Due to a highly heterogeneous growth pattern, pattern C U-EACs were stratified into four subgroups: C1, C2 and C3 corresponded to solid, extensive linear destructive, and band-like lymphocytic infiltrate growth patterns, respectively, and C4 included diffuse destructive, confluent, micropapillary and mixed growth pattern. C2 and C3 subgroup tumours had lower incidence of LVSI (20% and 40%, respectively) than the other two subgroups (p<0.001). None of the patients with C2 and C3 subgroup had LN metastasis and ≥3 LVSI foci. All GACs belonged to pattern C and had deeper stromal invasion (p=0.008), higher incidence of LN metastasis (p=0.001), and larger quantity of LVSI foci (p=0.008) and metastatic LNs (p=0.004) than those of pattern C U-ECAs. Number of LVSI foci were moderately positively correlated with LN metastasis status (p<0.001, γ=0.489) or number of metastatic LNs (p<0.001, γ=0.409). Our study further supports that Pattern Classification is a system easy to follow, which has a strong correlation to LVSI and an effective predictability for LN metastasis. Extensive linear destructive and band-like lymphocytic infiltrate growth patterns in pattern C U-EACs need to be recognised, as they behave less aggressively than that for the other growth pattern subgroups. Our study supports that Pattern Classification can be routinely applied to guide therapies for patients with U-EACs.
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Affiliation(s)
- Hong Xu
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Haitao Pan
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yinmei Wang
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jing Zhang
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi, China.
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40
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Yuan Z, Yu M, Shen K, Yang J, Cao D, Zhang Y, Zhou H, Wu H. Corrigendum: Uterine Adenosarcoma: A Retrospective 12-Year Single-Center Study. Front Oncol 2019; 9:657. [PMID: 31396483 PMCID: PMC6668359 DOI: 10.3389/fonc.2019.00657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/06/2019] [Accepted: 07/04/2019] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fonc.2019.00237.].
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Affiliation(s)
- Zhen Yuan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Mei Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Huimei Zhou
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Huanwen Wu
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Peters EEM, Bartosch C, McCluggage WG, Genestie C, Lax SF, Nout R, Oosting J, Singh N, Smit HCSH, Smit VTHBM, Van de Vijver KK, Bosse T. Reproducibility of lymphovascular space invasion (LVSI) assessment in endometrial cancer. Histopathology 2019; 75:128-136. [PMID: 31155736 PMCID: PMC6852322 DOI: 10.1111/his.13871] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 02/02/2023]
Abstract
Aims Lymphovascular space invasion (LVSI) in endometrial cancer (EC) is an important prognostic variable impacting on a patient's individual recurrence risk and adjuvant treatment recommendations. Recent work has shown that grading the extent of LVSI further improves its prognostic strength in patients with stage I endometrioid EC. Despite this, there is little information on the reproducibility of LVSI assessment in EC. Therefore, we designed a study to evaluate interobserver agreement in discriminating true LVSI from LVSI mimics (Phase I) and reproducibility of grading extent of LVSI (Phase II). Methods and results Scanned haematoxylin and eosin (H&E) slides of endometrioid EC (EEC) with a predefined possible LVSI focus were hosted on a website and assessed by a panel of six European gynaecological pathologists. In Phase I, 48 H&E slides were included for LVSI assessment and in Phase II, 42 H&E slides for LVSI grading. Each observer was instructed to apply the criteria for LVSI used in daily practice. The degree of agreement was measured using the two‐way absolute agreement average‐measures intraclass correlation coefficient (ICC). Reproducibility of LVSI assessment (ICC = 0.64, P < 0.001) and LVSI grading (ICC = 0.62, P < 0.001) in EEC was substantial among the observers. Conclusions Given the good reproducibility of LVSI, this study further supports the important role of LVSI in decision algorithms for adjuvant treatment.
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Affiliation(s)
- Elke E M Peters
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Pathology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Carla Bartosch
- Department of Pathology, Portuguese Oncology Institute-Porto, Porto, Portugal
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Catherine Genestie
- Department of BioPathology, University Paris-Saclay, Gustave-Roussy Cancer Center, Villejuif, France
| | - Sigurd F Lax
- Department of Pathology, Hospital Graz II and Medical University of Graz, Graz, Austria
| | - Remi Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Oosting
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Huub C S H Smit
- Department of Pathological Anatomy, Ghent University Hospital, Ghent, Belgium
| | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
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Yuan Z, Shen K, Yang J, Cao D, Zhang Y, Zhou H, Wu H, Yu M. Uterine Adenosarcoma: A Retrospective 12-Year Single-Center Study. Front Oncol 2019; 9:237. [PMID: 31139558 PMCID: PMC6527837 DOI: 10.3389/fonc.2019.00237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/15/2019] [Indexed: 12/02/2022] Open
Abstract
Synopsis: Lymphovascular space invasion is an independent risk factor for disease progression and presence of tumor stalk an independent protective factor. Fertility sparing surgery may be acceptable in cases whose tumors present with stalks and without high risk factors. Objectives: The aim of the present study was to investigate the potential prognostic factors of uterine adenosarcoma. Methods: A total of 49 cases of uterine adenosarcoma were retrospectively reviewed at our institution between April 2006 and October 2018. Results: Median follow-up time was 34 months (range: 1–148). Median age was 47.50 years (19–75). Nineteen (38.9%) patients were uterine cervical adenosarcoma and 30 (61.22%) patients were uterine corpus adenosarcoma. Twenty-nine (59.2%) patients were polypoid with a stalk to the uterine cervix or corpus. Twenty-six (38.8%) patients were stage IA. Fifteen (30.6%) patients showed sarcomatous overgrowth. Six (12.2%) patients displayed lymphovascular space invasion (LVSI). Four (8.16%) patients had heterologous elements. In univariate analysis, Disease-free-survival (DFS) was associated with tumor location, presence of tumor stalk, heterologous elements, LVSI. In multivariate analysis, presence of tumor stalk remained an independently protective factor for recurrence (HR = 0.088, P = 0.005), and LVSI a risk factor for recurrence (HR = 11.953, P = 0.002). Fertility-sparing surgery (FSS) was performed in seven stage IA patients. When patients of stage IA analyzed separately, FSS was not significant with the DFS or OS. Conclusions: Presence of tumor stalk remained an independently protective factor for recurrence. Along with adequate counseling, FSS may be acceptable in cases whose tumors present with stalks and without high risk factors.
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Affiliation(s)
- Zhen Yuan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Huimei Zhou
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Huanwen Wu
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Mei Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Yan BC, Xiao ML, Li Y, Wei Qiang J. The diagnostic performance of ADC value for tumor grade, deep myometrial invasion and lymphovascular space invasion in endometrial cancer: a meta-analysis. Acta Radiol 2019; 60:284185119841988. [PMID: 31042066 DOI: 10.1177/0284185119841988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Disputes exist regarding whether the apparent diffusion coefficient (ADC) can differentiate the tumor grade, deep myometrial invasion and lymphovascular space invasion (LVSI) in endometrial cancer. The aim of this review was to assess the diagnostic performance of the ADC value in endometrial cancer. MATERIAL AND METHODS The PubMed, Web of Science, Embase and Cochrane Library databases were searched for studies that used the ADC value to assess tumor grade, deep myometrial invasion and LVSI in endometrial cancer. We used forest plots to analyze the heterogeneity and generate the pooled sensitivity (SEN) and specificity (SPE). We used summary receiver operating characteristic (SROC) curves to work out the area under the SROC curve (AUC). Likelihood ratios (LRs) were also obtained. RESULTS Of the 460 identified studies, 11 studies met our inclusion criteria and were included. Overall, nine studies (491 patients) aimed at differentiating high tumor grade had a pooled SEN, SPE and AUC of 77%, 73% and 81%, respectively; three studies (181 patients) for differentiating deep myometrial invasion had a pooled SEN, SPE and AUC of 71%, 67% and 77%, respectively; and two studies (106 patients) for differentiating LVSI had a pooled SEN and SPE of 66% and 74%, respectively. The positive and negative LRs were 2.77 and 0.35 for the tumor grade, 2.08 and 0.45 for deep myometrial invasion, and 2.48 and 0.45 for LVSI. CONCLUSION This meta-analysis showed that the ADC value had a moderate diagnostic performance for the tumor grade, deep myometrial invasion and LVSI in endometrial cancer.
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Affiliation(s)
- Bi Cong Yan
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Mei Ling Xiao
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
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Li J, Li S, Chen R, Lu X. Increased risk of poor survival in ovarian cancer patients with high expression of SNAI2 and lymphovascular space invasion. Oncotarget 2018; 8:9672-9685. [PMID: 28039463 PMCID: PMC5354762 DOI: 10.18632/oncotarget.14192] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 11/24/2016] [Indexed: 12/27/2022] Open
Abstract
This study is aimed to conduct a meta-analysis to evaluate the prognostic value of lymphovascular space invasion(LVSI) and to explore the potential association of SNAI1 and SNAI2 with LVSI in ovarian cancer. A systematic literature search in PubMed, ISI Web of Science, and Medline was conducted to identify relevant studies assessing the prognostic value of LVSI in ovarian cancer. The main outcomes analyzed were progression free survival/disease free survival and overall survival. TCGA database was used to explore the potential link of SNAI1 and SNAI2 with LVSI status. A total of 11 eligible studies enrolling 1817 patients were included for the meta-analysis. The overall analysis indicated that LVSI presence was associated with shorter duration of survival in ovarian cancer patients. Multivariate analysis indicated that both advanced stage and SNAI2 expression were associated with increased risk of LVSI presence. Survival analysis indicated that tumors with LVSI presence and high SNAI2 expression were significantly correlated with poorer survival when compared to tumors with both LVSI absence and low SNAI2 expression. In conclusion, LVSI presence was associated with worse clinical outcomes in ovarian cancer. Increased expression of SNAI2 and advanced stage were independent risk factors for LVSI presence. Our findings also emphasizes the potential of SNAI2 in promoting lymphovascular spread of ovarian cancer.
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Affiliation(s)
- Jun Li
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Shufen Li
- State Key Laboratory of Medical Genomics and Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ruifang Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Xin Lu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
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Matsuo K, Wong KK, Fotopoulou C, Blake EA, Robertson SE, Pejovic T, Frimer M, Pardeshi V, Hu W, Choi JS, Sun CC, Richmond AM, Marcus JZ, Hilliard MAM, Mostofizadeh S, Mhawech-Fauceglia P, Abdulfatah E, Post MD, Saglam O, Shahzad MMK, Karabakhtsian RG, Ali-Fehmi R, Gabra H, Roman LD, Sood AK, Gershenson DM. Impact of lympho-vascular space invasion on tumor characteristics and survival outcome of women with low-grade serous ovarian carcinoma. J Surg Oncol 2017; 117:236-244. [PMID: 28787528 DOI: 10.1002/jso.24801] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 05/18/2017] [Accepted: 07/19/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES To examine association of lympho-vascular space invasion (LVSI) with clinico-pathological factors and to evaluate survival of women with low-grade serous ovarian carcinoma containing areas of LVSI. METHODS This is a multicenter retrospective study examining consecutive cases of surgically treated stage I-IV low-grade serous ovarian carcinoma (n = 178). Archived histopathology slides for the ovarian tumors were reviewed, and LVSI was scored as present or absent. LVSI status was correlated to clinico-pathological findings and survival outcome. RESULTS LVSI was seen in 79 cases (44.4%, 95% confidence interval [CI] 37.1-51.7). LVSI was associated with increased risk of omental metastasis (87.0% vs 64.9%, odds ratio [OR] 3.62, P = 0.001), high pelvic lymph node ratio (median 12.9% vs 0%, P = 0.012), and malignant ascites (49.3% vs 32.6%, OR 2.01, P = 0.035). On multivariable analysis, controlling for age, stage, and cytoreductive status, presence of LVSI in the ovarian tumor remained an independent predictor for decreased progression-free survival (5-year rates 21.0% vs 35.7%, adjusted-hazard ratio 1.57, 95%CI 1.06-2.34, P = 0.026). LVSI was significantly associated with increased risk of recurrence in lymph nodes (OR 2.62, 95%CI 1.08-6.35, P = 0.047). CONCLUSION LVSI in the ovarian tumor is associated with adverse clinico-pathological characteristics and decreased progression-free survival in women with low-grade serous ovarian carcinoma.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.,Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kwong-Kwok Wong
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Christina Fotopoulou
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colarodo
| | - Erin A Blake
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | - Sharon E Robertson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Tanja Pejovic
- Department of Pathology, Wayne State University, Detroit, Michigan
| | - Marina Frimer
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Vishakha Pardeshi
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Wei Hu
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jong-Sun Choi
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Charlotte C Sun
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Abby M Richmond
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Jenna Z Marcus
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Maren A M Hilliard
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Sayedamin Mostofizadeh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Paulette Mhawech-Fauceglia
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Eman Abdulfatah
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Miriam D Post
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Ozlen Saglam
- Department of Pathology, University of Southern California, Los Angeles, California
| | - Mian M K Shahzad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Rouzan G Karabakhtsian
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Rouba Ali-Fehmi
- Clinical Discovery Unit, Early Clinical Development, AstraZeneca, Cambridge, UK
| | - Hani Gabra
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colarodo
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.,Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anil K Sood
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - David M Gershenson
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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46
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Hoellen F, Waldmann A, Banz-Jansen C, Rody A, Heide M, Köster F, Ribbat-Idel J, Thorns C, Gebhard M, Oberländer M, Habermann JK, Thill M. Expression of cyclooxygenase-2 in cervical cancer is associated with lymphovascular invasion. Oncol Lett 2016; 12:2351-2356. [PMID: 27698799 PMCID: PMC5038214 DOI: 10.3892/ol.2016.4925] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/23/2016] [Indexed: 12/14/2022] Open
Abstract
Cyclooxygenase-2 (COX-2) is associated with carcinogenesis and tumor progression. The current study analyzed the effect of COX-2 expression in patients with invasive squamous cervical cancer. Tissue samples from 123 cervical cancer patients were collected for a retrospective analysis using immunohistochemistry (IHC) with an antibody against COX-2. The clinical and survival data of the patients were analyzed. Positive staining for COX-2 (defined as an immunoreactivity score of ≥4) was detected in 28 patients (23%), with significantly higher percentages of staining in tumor cells compared with peritumoral stroma cells (P<0.001). COX-2 expression was significantly associated with lymphovascular space invasion (LVSI; P=0.017). The association of COX-2 expression with LVSI suggests a possible effect of COX-2 on tumor progression in cervical cancer. Further studies including larger patient collectives are required in order to perform analyses of clinical subgroups and patient survival.
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Affiliation(s)
- Friederike Hoellen
- Department of Gynecology and Obstetrics, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck Campus, Lübeck D-23538, Germany
| | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck D-23538, Germany
| | - Constanze Banz-Jansen
- Department of Gynecology and Obstetrics, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck Campus, Lübeck D-23538, Germany
| | - Achim Rody
- Department of Gynecology and Obstetrics, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck Campus, Lübeck D-23538, Germany
| | - Maria Heide
- Department of Gynecology and Obstetrics, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck Campus, Lübeck D-23538, Germany
| | - Frank Köster
- Department of Gynecology and Obstetrics, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck Campus, Lübeck D-23538, Germany
| | | | - Christoph Thorns
- Institute for Pathology, University of Lübeck, Lübeck D-23538, Germany
| | | | - Martina Oberländer
- Department of Surgery, Section for Translational Surgical Oncology and Biobanking, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck Campus, Lübeck D-23562, Germany
| | - Jens K Habermann
- Department of Surgery, Section for Translational Surgical Oncology and Biobanking, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck Campus, Lübeck D-23562, Germany
| | - Marc Thill
- Department of Gynecology and Obstetrics, Agaplesion Markus Hospital, Frankfurt D-60431, Germany
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47
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Solmaz U, Mat E, Dereli M, Turan V, Gungorduk K, Hasdemir P, Tosun G, Dogan A, Ozdemir A, Adiyeke M, Sanci M. Lymphovascular space invasion and cervical stromal invasion are independent risk factors for nodal metastasis in endometrioid endometrial cancer. Aust N Z J Obstet Gynaecol 2015; 55:81-6. [PMID: 25688821 DOI: 10.1111/ajo.12321] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/28/2014] [Indexed: 11/28/2022]
Abstract
AIMS The purpose of this study was to investigate the potential roles of pathological variables in the prediction of nodal metastasis in women with endometrioid endometrial cancer (EC). MATERIALS AND METHODS Women who underwent surgery for endometrioid EC between 1995 and 2012 were retrospectively reviewed. Those who underwent prior neoadjuvant chemotherapy or radiotherapy and inadequate lymphadenectomy as well as those with nonendometrioid histology, synchronous cancers, International Federation of Gynecology and Obstetrics stage IV disease, gross uterine serosal and/or gross adnexal involvement were excluded. Lymph node dissemination was defined as occurring in the following circumstances: (i) when nodal metastasis with pelvic and/or para-aortic (P/PA) lymph node dissection (LND) was performed or (ii) when there was recurrence in the P/PA lymph nodes after a negative LND or when LND was not performed. Univariate and multivariate logistic regression models were used to identify the pathological predictors of lymphatic dissemination. RESULTS A total of 827 women with endometrioid EC were assessed; 516 (62.4%) of whom underwent P/PA LND and 205 (24.8%) underwent P LND. Sixty-seven (13%) women in the P/PA LND group and 5 (2.4%) in the P LND group had positive lymph nodes. Multivariate analysis confirmed cervical stromal invasion (OR 4.04, 95% CI 2.02-8.07 (P < 0.001)) and lymphovascular space invasion (LVSI) (OR 110.18, 95% CI 38.43-315.87 (P < 0.001)) as independent predictors of lymphatic dissemination. CONCLUSION Cervical stromal invasion and LVSI are highly associated with LN metastasis. These markers may serve as a surrogate for nodal metastasis.
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Affiliation(s)
- Ulas Solmaz
- Department of Gynaecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
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48
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MATSUO KOJI, GARCIA-SAYRE JOCELYN, MEDEIROS FABIOLA, CASABAR JENNIFERK, MACHIDA HIROKO, MOEINI AIDA, ROMAN LYNDAD. Impact of depth and extent of lymphovascular space invasion on lymph node metastasis and recurrence patterns in endometrial cancer. J Surg Oncol 2015; 112:669-76. [PMID: 26391212 PMCID: PMC7526048 DOI: 10.1002/jso.24049] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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: 07/03/2015] [Accepted: 09/09/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES To determine the significance of depth and extent of lymphovascular space invasion (LVSI) on lymph node metastasis and recurrence in endometrial cancer. METHODS A case-control study was conducted to examine LVSI-positive (n = 70) and LVSI-negative (n = 641) stage I-III endometrial cancer cases that underwent hysterectomy-based surgical staging. The risk of lymph node metastasis and distant recurrence was estimated based on LVSI patterns. RESULTS In multivariate analysis, deep (>50% invasion), and extensive (≥7 foci/slide) LVSI patterns had a significantly increased risk of lymph node metastasis (incidence 57.6% and 72.7%, odds ratio 33.8 and 49.9, respectively, P < 0.001) as compared to other traditional uterine factors (>50% myometrial tumor invasion, cervical stromal invasion, and adnexal involvement: incidence range 30.4-37.9%, odds ratio range 3.80-7.03). Deep and extensive of LVSI patterns were both significantly correlated to distant recurrence (P < 0.001). Among women who received postoperative chemotherapy, deep and extensive LVSI patterns did not have increased risks for distant recurrence compared to no LVSI (P = 0.47 and 0.32, respectively). Among women who received postoperative radiotherapy, the depth of LVSI was significantly associated with recurrence outside the radiated field (P = 0.02). CONCLUSIONS Depth and extent of LVSI are important predictors for lymph node metastasis and distant recurrence in endometrial cancer.
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Affiliation(s)
- KOJI MATSUO
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, University of Southern California, California
| | - JOCELYN GARCIA-SAYRE
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - FABIOLA MEDEIROS
- Department of Pathology, University of Southern California, Los Angeles, California
| | - JENNIFER K. CASABAR
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - HIROKO MACHIDA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - AIDA MOEINI
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - LYNDA D. ROMAN
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, University of Southern California, California
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49
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Solmaz U, Mat E, Dereli ML, Turan V, Ekin A, Tosun G, Dogan A, Ozdemir IA, Oztekin O, Sanci M. Stage-III and -IV endometrial cancer: A single oncology centre review of 104 cases. J OBSTET GYNAECOL 2015; 36:81-6. [PMID: 26467294 DOI: 10.3109/01443615.2015.1041890] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of this study was to evaluate the clinicopathological characteristics, treatment and prognosis of advanced endometrial cancer (EC). Patients who underwent surgery for advanced EC between January 1995 and December 2012 were retrospectively reviewed. Patients with missing data, concurrent cancers or uterine sarcomas and those who did not undergo surgery were excluded. The effects of clinicopathological factors on progression-free survival (PFS) and overall survival (OS) were analyzed. A total of 104 patients were included. Most presented with endometrioid histology (74%) and stage-III disease (87.5%), and 76.9% underwent optimal cytoreduction. A multivariate analysis confirmed that lymphovascular space invasion (LVSI) is an independent poor prognostic factor for PFS [odds ratio (OR): 21.37, p = 0.005] and OS [OR: 8.09, p = 0.044]. Suboptimal cytoreduction is another independent poor prognostic factor for PFS [OR: 5.68, p < 0.001]. Our study demonstrated that LVSI and optimal cytoreduction are the most significant factors affecting the survival of advanced EC patients.
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Affiliation(s)
- U Solmaz
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - E Mat
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - M L Dereli
- b Department of Obstetrics and Gynecology , Tavas State Hospital , Denizli , Turkey
| | - V Turan
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - A Ekin
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - G Tosun
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - A Dogan
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - I A Ozdemir
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - O Oztekin
- c Department of Obstetrics and Gynecology , Medical School of Pamukkale University , Denizli , Turkey
| | - M Sanci
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
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50
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Anton C, di Fávero GM, Köhler C, Carvalho FM, Baracat EC, Carvalho JP. Surgical treatment of endometrial cancer in developing countries: reasons to consider systematic two-step surgical treatment. Clinics (Sao Paulo) 2015; 70. [PMID: 26222815 PMCID: PMC4498149 DOI: 10.6061/clinics/2015(07)02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the lymph node status in a large cohort of women with endometrial cancer from the public health system who were referred to an oncology reference center in Brazil to identify candidates for the omission of lymphadenectomy based on clinicopathological parameters. METHODS We retrospectively analyzed a cohort of 310 women with endometrial cancer (255 endometrioid, 40 serous, and 15 clear cell tumors) treated between 2009 and 2014. We evaluated the histological type, grade (low vs. high), tumor size (cm), depth of myometrial invasion (≤50%, >50%) and lymphovascular space invasion to determine which factors were correlated with the presence of lymph node metastasis. RESULTS The factors related to lymph node involvement were tumor size (p=0.03), myometrial invasion (p<0.01), tumor grade (p<0.01), and lymphovascular space invasion (p<0.01). The histological type was not associated with the nodal status (p=0.52). Only twelve of 176 patients (6.8%) had low-grade endometrioid carcinoma, tumor size ≤2 cm and <50% myometrial infiltration. CONCLUSIONS The omission of lymphadenectomy based on the histological type, grade, tumor size and depth of myometrial invasion is not likely to have a large impact on the surgical treatment of endometrial cancer in our population because most patients present with large and advanced tumors. New strategies are proposed that prioritize hysterectomy performed in a general hospital as soon as possible after diagnosis, followed by an evaluation of the need for lymph node dissection at a reference center.
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Affiliation(s)
- Cristina Anton
- Faculdade de Medicina da Universidade de São Paulo, Department of Obstetrics and Gynecology, São Paulo/SP, Brazil
| | - Giovanni Mastrantonio di Fávero
- Faculdade de Medicina da Universidade de São Paulo, Department of Obstetrics and Gynecology, São Paulo/SP, Brazil
- Asklepios Hospital Hamburg, Department of Advanced Operative and Oncologic Gynecology. Hamburg, Germany
| | - Christhardt Köhler
- Asklepios Hospital Hamburg, Department of Advanced Operative and Oncologic Gynecology. Hamburg, Germany
| | - Filomena Marino Carvalho
- Instituto do Câncer do Estado de São Paulo – Octavio Frias de Oliveira (ICESP), Department of Pathology, São Paulo/SP, Brazil
| | - Edmund Chada Baracat
- Faculdade de Medicina da Universidade de São Paulo, Department of Obstetrics and Gynecology, São Paulo/SP, Brazil
| | - Jesus Paula Carvalho
- Faculdade de Medicina da Universidade de São Paulo, Department of Obstetrics and Gynecology, São Paulo/SP, Brazil
- Corresponding author: E-mail:
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