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Sahin EA, Toprak S, Sayal HB, Ekinci T, Yılmaz E, Bakay K, Melekoğlu R, Sezgin B, Tohma YA, Şahin H. Analysis of prognostic factors in Grade 3 endometrioid type endometrial carcinoma. Int J Gynaecol Obstet 2022; 159:719-726. [PMID: 35598153 DOI: 10.1002/ijgo.14277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/25/2022] [Accepted: 05/17/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the prognostic factors of patients with Grade 3 endometrioid endometrial cancer (G3EEC). METHODS This four-center, retrospective study included a total of 129 women with G3EEC. Demographic, clinicopathologic, and survival data were collected. Kaplan-Meier method was used for survival analysis. Predictors of outcome were analyzed using Cox proportional hazards models. RESULTS Median age at the time of diagnosis was 63 (range 39-87) years and median follow up was 37 (range 6-126) months. For the entire cohort, the 5-year disease-free survival (DFS) and overall survival (OS) were 54.3% and 63.6%, respectively. The 5-year DFS rates for lymphovascular space invasion (LVSI) -positive and -negative patients were 41.6% and 88.3%, respectively (P < 0.001). The 5-year OS rates for LVSI-positive and -negative patients were 54.7% and 88.3%, respectively (P = 0.001). Positive LVSI status was identified as the independent prognostic factor for decreased DFS and OS (hazard ratio [HR] 5.5, 95% confidence interval [CI] 1.65-18.86; P = 0.006 versus HR 4.4, 95% CI 1.33-14.58; P = 0.013, respectively). CONCLUSION LVSI seems to be an independent prognostic factor for decreased DFS and OS in G3EEC patients.
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Affiliation(s)
- Eda Adeviye Sahin
- Department of Obstetrics and Gynecology, Kolan international Hospital, Istanbul, Turkey
| | - Serhat Toprak
- Department of Pathology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Hasan Berkan Sayal
- Department of Obstetrics and Gynecology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Tekin Ekinci
- Department of Obstetrics and Gynecology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Ercan Yılmaz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Kadir Bakay
- Department of Obstetrics and Gynecology, Faculty of Medicine, 19 Mayıs University, Samsun, Turkey
| | - Rauf Melekoğlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Burak Sezgin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Yusuf Aytaç Tohma
- Department of Obstetrics and Gynecology, Bahçeci Health Group, Ankara, Turkey
| | - Hanifi Şahin
- Department of Gynecologic Oncology, Privata Clinic, Istanbul, Turkey
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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] [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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Rasmussen LA, Jensen H, Virgilsen LF, Jeppesen MM, Blaakaer J, Hansen DG, Jensen PT, Mogensen O, Vedsted P. Identification of endometrial cancer recurrence - a validated algorithm based on nationwide Danish registries. Acta Oncol 2021; 60:452-458. [PMID: 33306454 DOI: 10.1080/0284186x.2020.1859133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Recurrence of endometrial cancer is not routinely registered in the Danish national health registers. The aim of this study was to develop and validate a register-based algorithm to identify women diagnosed with endometrial cancer recurrence in Denmark to facilitate register-based research in this field. MATERIAL AND METHODS We conducted a cohort study based on data from Danish health registers. The algorithm was designed to identify women with recurrence and estimate the accompanying diagnosis date, which was based on information from the Danish National Patient Registry and the Danish National Pathology Registry. Indicators of recurrence were pathology registrations and procedure or diagnosis codes suggesting recurrence and related treatment. The gold standard for endometrial cancer recurrence originated from a Danish nationwide study of 2612 women diagnosed with endometrial cancer, FIGO stage I-II during 2005-2009. Recurrence was suspected in 308 women based on pathology reports, and recurrence suspicion was confirmed or rejected in the 308 women based on reviews of the medical records. The algorithm was validated by comparing the recurrence status identified by the algorithm and the recurrence status in the gold standard. RESULTS After relevant exclusions, the final study population consisted of 268 women, hereof 160 (60%) with recurrence according to the gold standard. The algorithm displayed a sensitivity of 91.3% (95% confidence interval (CI): 85.8-95.1), a specificity of 91.7% (95% CI: 84.8-96.1) and a positive predictive value of 94.2% (95% CI: 89.3-97.3). The algorithm estimated the recurrence date within 30 days of the gold standard in 86% and within 60 days of the gold standard in 94% of the identified patients. DISCUSSION The algorithm demonstrated good performance; it could be a valuable tool for future research in endometrial cancer recurrence and may facilitate studies with potential impact on clinical practice.
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Affiliation(s)
- Linda A. Rasmussen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus, Denmark
| | - Henry Jensen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus, Denmark
| | - Line F. Virgilsen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus, Denmark
| | - Mette M. Jeppesen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Jan Blaakaer
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Dorte G. Hansen
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Pernille T. Jensen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Mogensen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus, Denmark
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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] [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] [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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Limbachiya DJ. Surgicopathological Outcomes and Survival in Carcinoma Body Uterus: A Retrospective Analysis of Cases Managed by Laparoscopic Staging Surgery in Indian Women. Gynecol Minim Invasive Ther 2020; 9:139-144. [PMID: 33101914 PMCID: PMC7545049 DOI: 10.4103/gmit.gmit_96_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/11/2020] [Accepted: 03/16/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives: The context of this article is based on two main titles those being Gynecologic Oncology and Minimal invasive surgery. The aim of this study was to report the laparoscopic management of a series of cases of endometrial carcinoma managed by laparoscopic surgical staging in Indian women. Materials and Methods: This study was conducted in a private hospital (referral minimally invasive gynecological center). This was a retrospective study (Canadian Task Force Classification II-3). Eighty-eight cases of clinically early-stage endometrial carcinoma staged by laparoscopic surgery and treated as per final surgicopathological staging. All patients underwent laparoscopic surgical staging of endometrial carcinoma, followed by adjuvant therapy when needed. Data were retrieved regarding surgical and pathological outcomes. Recurrence-free and overall survival durations were measured at follow-up. Survival analysis was calculated using Kaplan–Meier survival analysis. Results: The median age of presentation was 56 years, whereas the median body mass index was 28.3 kg/m2. Endometroid variety was the most commonly diagnosed histopathology. There were no intraoperative complications reported. The median blood loss was 100 cc, and the median intraoperative time was 174 min. There were a total of 5 recurrences (5.6%). The outcome of this study was comparable to studies conducted in Caucasian population. The predicted 5-year survival rate according to Kaplan–Meier survival analysis is 95.45%, which is comparable to Caucasian studies. Conclusion: Laparoscopic management of early-stage endometrial carcinoma is a standard practice worldwide. However, there is still a paucity of data from the Indian subcontinent regarding the outcomes of laparoscopic surgery in endometrial carcinoma. The Asian perspective has been highlighted by a number of studies from China and Japan. To our knowledge, this study is the first from India to analyze the surgicopathological outcomes following laparoscopic surgery in endometrial carcinoma. The outcome of this study was comparable to studies conducted in Caucasian population.
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Su MH, Chen GY, Lin JH, Lee HH, Chung KC, Wang PH. Paclitaxel-related dermatological problems: Not only alopecia occurs. Taiwan J Obstet Gynecol 2019; 58:877-879. [DOI: 10.1016/j.tjog.2019.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 01/05/2023] Open
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