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Nguyen NTT, Diaz N, Reid H, Previs R, Havrilesky LJ, Secord AA, Berchuck A. Role of endometrial sampling to differentiate between advanced endometrial versus ovarian malignancy: retrospective cohort study. Int J Gynecol Cancer 2024; 34:528-534. [PMID: 38336373 DOI: 10.1136/ijgc-2023-005104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE Distinguishing between advanced stage endometrial and ovarian cancer at diagnosis can be challenging, especially when patients do not present with abnormal uterine bleeding. Given emerging systemic therapies specific for ovarian versus endometrial cancers, it has become increasingly critical to establish the correct diagnosis at presentation to ensure appropriate treatment. This study evaluates the frequency with which advanced endometrial cancer is mistakenly presumed to be ovarian cancer. METHODS A retrospective analysis was performed of patients with a final diagnosis of advanced endometrial cancer treated consecutively at a single academic institution between 2013 and 2022. Variables abstracted included abnormal uterine bleeding, endometrial sampling, and timing of endometrial cancer diagnosis. We quantified incorrect diagnoses made after 2018, when frontline targeted treatments differentiating advanced endometrial from advanced ovarian cancer became available. RESULTS We identified 270 patients with an ultimate diagnosis of stage III or IV endometrial cancer. The most common presenting symptom was abnormal uterine bleeding (219/270, 81%), followed by abdominal or pelvic pain (48/270, 18%) and bloating (27/270, 10%). Forty-eight patients (18%) received neoadjuvant chemotherapy, of whom 11 (23%) had an incorrect diagnosis of ovarian cancer. Since 2018, six patients have received neoadjuvant chemotherapy for presumed ovarian cancer, three of whom received a systemic regimen specific for ovarian cancer when they, in fact, had endometrial cancer. CONCLUSION In patients with presumed advanced ovarian cancer dispositioned to neoadjuvant chemotherapy, endometrial sampling can identify some cases that are actually primary endometrial cancers. Correct diagnosis guides the use of appropriate antineoplastic therapies, optimizing response and survival outcomes while minimizing toxicity and cost of unindicated therapies.
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Affiliation(s)
| | - Nicole Diaz
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Hadley Reid
- Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Laura J Havrilesky
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Angeles Alvarez Secord
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Andrew Berchuck
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
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Lee MW, Vallejo A, Furey KB, Woll SM, Klar M, Roman LD, Wright JD, Matsuo K. Racial and ethnic differences in early death among gynecologic malignancy. Am J Obstet Gynecol 2024:S0002-9378(24)00432-0. [PMID: 38460831 DOI: 10.1016/j.ajog.2024.03.003] [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: 12/06/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Racial and ethnic differences in early death after cancer diagnosis have not been well studied in gynecologic malignancy. OBJECTIVE This study aimed to assess population-level trends and characteristics of early death among patients with gynecologic malignancy based on race and ethnicity in the United States. STUDY DESIGN The National Cancer Institute's Surveillance, Epidemiology, and End Results Program was queried to examine 461,300 patients with gynecologic malignancies from 2000 to 2020, including uterine (n=242,709), tubo-ovarian (n=119,989), cervical (n=68,768), vulvar (n=22,991), and vaginal (n=6843) cancers. Early death, defined as a mortality event within 2 months of the index cancer diagnosis, was evaluated per race and ethnicity. RESULTS At the cohort level, early death occurred in 21,569 patients (4.7%), including 10.5%, 5.5%, 2.9%, 2.5%, and 2.4% for tubo-ovarian, vaginal, cervical, uterine, and vulvar cancers, respectively (P<.001). In a race- and ethnicity-specific analysis, non-Hispanic Black patients with tubo-ovarian cancer had the highest early death rate (14.5%). Early death racial and ethnic differences were the largest in tubo-ovarian cancer (6.4% for Asian vs 14.5% for non-Hispanic Black), followed by uterine (1.6% for Asian vs 4.9% for non-Hispanic Black) and cervical (1.8% for Hispanic vs 3.8% to non-Hispanic Black) cancers (all, P<.001). In tubo-ovarian cancer, the early death rate decreased over time by 33% in non-Hispanic Black patients from 17.4% to 11.8% (adjusted odds ratio, 0.67; 95% confidence interval, 0.53-0.85) and 23% in non-Hispanic White patients from 12.3% to 9.5% (adjusted odds ratio, 0.77; 95% confidence interval, 0.71-0.85), respectively. The early death between-group difference diminished only modestly (12.3% vs 17.4% for 2000-2002 [adjusted odds ratio for non-Hispanic White vs non-Hispanic Black, 0.54; 95% confidence interval, 0.45-0.65] and 9.5% vs 11.8% for 2018-2020 [adjusted odds ratio, 0.65; 95% confidence interval, 0.54-0.78]). CONCLUSION Overall, approximately 5% of patients with gynecologic malignancy died within the first 2 months from cancer diagnosis, and the early death rate exceeded 10% in non-Hispanic Black individuals with tubo-ovarian cancer. Although improving early death rates is encouraging, the difference among racial and ethnic groups remains significant, calling for further evaluation.
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Affiliation(s)
- Matthew W Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Andrew Vallejo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Katelyn B Furey
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Sabrina M Woll
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
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Bruchim I, Capasso I, Polonsky A, Meisel S, Salutari V, Werner H, Lorusso D, Scambia G, Fanfani F. New therapeutic targets for endometrial cancer: a glimpse into the preclinical sphere. Expert Opin Ther Targets 2024; 28:29-43. [PMID: 38327111 DOI: 10.1080/14728222.2024.2316739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/06/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Endometrial cancer (EC) is the only gynecologic malignancy showing increasing trends in incidence and mortality. While standard treatment has been effective primarily for early-stage EC, precision medicine with tailored therapy has revolutionized the management of this disease. Genome sequencing analyses have identified four sub-types of EC. Treatments for primary and metastatic disease can now be tailored more accurately to achieve better oncologic results. AREAS COVERED This review provides an overview of the most relevant and updated evidence in the literature regarding EC molecular analysis and its role in risk classification, prognostication, and guidance for tailored and target therapies in early and advanced/metastatic stages. In addition, it provides updated information on optimal surgical management based on molecular classification and highlights key advances and future strategies. EXPERT OPINION EC molecular analysis yields the potential of tailoring adjuvant treatment by escalating or deescalating therapy, as shown for POLE-mutated and p53-mutated tumors. Moreover, the expression of specific molecular signatures offers the possibility to employ novel target therapies, such as immune-checkpoint inhibitors that have demonstrated a significant benefit on prognosis. New treatment guidelines are still being established, and ongoing studies are exploring the potential prognostic role of further sub-stratifications of the four molecular classes and treatment options.
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Affiliation(s)
- Ilan Bruchim
- Gynecology and Gynecologic Oncology Department, Hillel Yaffe Medical Center, Hadera, Israel
- Gynecology Laboratory, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
- The Technion, Institute of Technology, Haifa, Israel
| | - Ilaria Capasso
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ariel Polonsky
- Gynecology and Gynecologic Oncology Department, Hillel Yaffe Medical Center, Hadera, Israel
- Gynecology Laboratory, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Shilhav Meisel
- Gynecology Laboratory, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
- The Technion, Institute of Technology, Haifa, Israel
| | - Vanda Salutari
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Haim Werner
- The Technion, Institute of Technology, Haifa, Israel
- Department of Human Molecular Genetics and Biochemistry, School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Domenica Lorusso
- Università Cattolica del Sacro Cuore, Rome, Italy
- Scientific Directorate, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Capozzi VA, Scarpelli E, De Finis A, Rotondella I, Scebba D, Gallinelli A, Montrucchio C, Martignon G, Leotta M, Ghi T, Berretta R. Optimal Management for Stage IVB Endometrial Cancer: A Systematic Review. Cancers (Basel) 2023; 15:5123. [PMID: 37958299 PMCID: PMC10649928 DOI: 10.3390/cancers15215123] [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: 09/07/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: Endometrial cancer (EC) is a common gynecological malignancy, often diagnosed at an early stage with a high overall survival rate. Surgical treatment is the primary approach, guided by pathological and molecular characteristics. Stage IVB EC, characterized by intra and/or extra-abdominal metastasis, presents a significant challenge with no clear consensus on optimal management. (2) Methods: A systematic literature review was conducted from January to May 2023, covering studies from 2000 to 2023. Eligible studies included retrospective case series, prospective trials, and randomized clinical trials. (3) Results: Of 116 studies identified, 21 were deemed relevant: 7 on primary surgery, 10 on neoadjuvant chemotherapy (NACT), and 4 on adjuvant treatment. Notably, the impact of residual tumor after primary surgery was a critical factor affecting survival. The use of NACT followed by interval debulking surgery showed promise, particularly in cases deemed unresectable. Adjuvant treatment, combining radiotherapy and chemotherapy, demonstrated improved survival but lacked consensus regarding its role. (4) Conclusions: Stage IVB EC poses a complex challenge with limited evidence to guide management. Optimal cytoreduction remains crucial, and NACT should be considered for unresectable cases. Multimodality adjuvant therapy may benefit patients, even with disease spread beyond the pelvis. Future advances in molecular classification and targeted therapies are expected to enhance treatment strategies.
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Gordhandas S, Zammarrelli WA, Rios-Doria EV, Green A, Makker V. Current Evidence-Based Systemic Therapy for Advanced and Recurrent Endometrial Cancer. J Natl Compr Canc Netw 2023; 21:217-226. [PMID: 36791759 PMCID: PMC10361357 DOI: 10.6004/jnccn.2022.7254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/16/2022] [Indexed: 02/17/2023]
Abstract
Endometrial cancer (EC) is the most common gynecologic malignancy, with worldwide increasing incidence and disease-associated mortality. Although most patients with EC are diagnosed with early-stage disease, systemic treatment options for patients with advanced or recurrent EC have historically been limited. EC-focused clinical trials and the ensuing therapeutic landscape have expanded since The Cancer Genome Atlas (TCGA) identified 4 distinct EC subgroups associated with differential survival. This endeavor revolutionized our understanding of the genomic characterization of EC as well as molecular drivers of this heterogeneous malignancy, leading to precision oncology approaches to therapeutics and advancement in treatment options. This review describes the current status of and recent advancements in therapeutic options for patients with advanced and recurrent EC. The NCCN Guidelines for Uterine Neoplasms provide detailed recommendations regarding the diagnosis, workup, and management of EC.
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Affiliation(s)
- Sushmita Gordhandas
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - William A. Zammarrelli
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Eric V. Rios-Doria
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Angela Green
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Vicky Makker
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
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Yan G, Li Y, Du Y, Ma X, Xie Y, Zeng X. Survival nomogram for endometrial cancer with lung metastasis: A SEER database analysis. Front Oncol 2022; 12:978140. [PMID: 36276130 PMCID: PMC9585205 DOI: 10.3389/fonc.2022.978140] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/26/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose The lung is the most common distant metastatic organ in patients with endometrial cancer (EC) but is rarely reported. This study examines the association between clinical characteristics and overall survival (OS) in EC with lung metastasis. Methods Patients with EC who had accompanying lung metastasis were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2017. Univariate and multivariate Cox regression were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) and assess OS outcomes related to EC with lung metastasis. A Cox proportional hazards nomogram model for OS was constructed and validated. The calibration plot, receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to evaluate the discriminative ability and clinical benefit of the novel nomogram. Kaplan–Meier curves and scatter diagram analysis were used to investigate the risk stratifications of the nomogram. Results Overall, 1542 EC patients with lung metastasis between 2010 and 2017 were included and randomly divided into training and validation cohorts. A nomogram model was constructed using the clinical characteristics of tumor grade, histological type, surgery, adjuvant chemotherapy, adjuvant radiation, brain metastasis and liver metastasis. The concordance indexes (C-indexes) were 0.750 (95% CI, 0.732-0.767) and 0.743 (95% CI, 0.719-0.767) for the training cohort and validation cohort, respectively. Calibration plots and DCA showed good clinical applicability of the nomogram. The areas under the curves (AUCs) were 0.803 and 0.766 for 1-year and 3-year OS, respectively, indicating that the nomogram model had a stable discriminative ability. An online calculator of our nomogram is available on the internet at https://endometrialcancer.shinyapps.io/DynNomapp/. Additionally, patients in the high-risk group had a significantly worse OS than those in the low-risk group. Conclusion An easy-to-use, highly accurate nomogram was developed for predicting the prognosis of EC patients with lung metastasis.
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Affiliation(s)
| | | | | | | | - Yifei Xie
- *Correspondence: Xianxu Zeng, ; Yifei Xie,
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