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Elliott CG, Murji A, Matelski J, Adekola AB, Chrzanowski J, Shirreff L. Unexpected malignancy at the time of hysterectomy performed for a benign indication: A retrospective review. PLoS One 2022; 17:e0266338. [PMID: 35363824 PMCID: PMC8975168 DOI: 10.1371/journal.pone.0266338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/19/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To determine the proportion of patients undergoing hysterectomy for a benign indication who have unexpected malignancy (UM) on postoperative pathology and characterize the nature of UMs. Methods This was a multi-center, retrospective study of patients undergoing hysterectomy for a benign indication from July 2016 to December 2019 at 7 Ontario, Canada hospitals (4 academic, 3 community). Hysterectomies for invasive placentation, malignant, and premalignant indications were excluded. Primary outcome was rate of unexpected malignancy as defined by the number of patients with malignancy on final pathology divided by the total number of hysterectomy cases. Data was extracted from health records and electronic charts. Patient, surgical, and surgeon characteristics were compared between benign and UM groups using bivariate methods. Associations between UM status and perioperative variables were assessed using bivariate logistic regression. Results In the study period, 2779 hysterectomies were performed. UM incidence was 1.8% (51 malignancies/2779 cases), with one patient having two malignancies (total UMs = 52). The most common UM types were endometrial (27/52, 51.9%) and sarcoma (13/52, 25%). Patients with UM were older (57.2 ± 11.4 years vs. 52.8 ± 12.5 years, p = .015), had more previous laparotomies (2 (1.25, 2.0) vs. 1 (1.0, 1.0), p < .001), and higher BMI (29.7 ± 7.2 kg/m2 vs. 28.0 ± 5.9 kg/m2, p = .049) and ASA class (p < .028). Regarding surgical factors, patients with UM had more adhesions (p = .001), transfusions (p = .020), and blood loss (p = .006) compared to those with benign pathology. Patient characteristics most strongly associated with UM were age (OR 2.57, 95% CI 1.78–3.72, p < .001) and preoperative diagnosis of pelvic mass (OR 2.76, 95% CI 1.11–6.20, p = .019). Conclusion Incidence of UM at hysterectomy for benign indication was 1.8%. Several perioperative variables are associated with an increased chance of UM.
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Affiliation(s)
- Cara G. Elliott
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ally Murji
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - John Matelski
- Biostatistics Research Unit, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Adebanke Bianca Adekola
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Chrzanowski
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lindsay Shirreff
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Burrows A, Pudwell J, Bougie O. Preoperative Factors of Endometrial Carcinoma in Patients Undergoing Hysterectomy for Atypical Endometrial Hyperplasia. J Obstet Gynaecol Can 2021; 43:822-830. [PMID: 33785467 DOI: 10.1016/j.jogc.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify clinicopathological preoperative factors associated with concurrent endometrial carcinoma in patients undergoing surgical management of atypical endometrial hyperplasia. METHODS The records of all patients who underwent hysterectomy for preoperatively diagnosed atypical endometrial hyperplasia at a tertiary care hospital from April 2017 to April 2020 were retrospectively reviewed. Clinicopathological characteristics of patients were extracted. Patients who did not undergo hysterectomy or who had evidence of simple hyperplasia or carcinoma on initial biopsy were excluded. Univariate analysis was performed. A multivariate regression model for progression to endometrial carcinoma was developed. RESULTS A total of 126 patients were included. Of these patients, 19 (15.1%) had a final diagnosis of endometrial carcinoma, whereas 86 (68.2%) retained the diagnosis of atypical endometrial hyperplasia and 21 (16.7%) were found to have no residual atypical endometrial hyperplasia. The odds of a patient being diagnosed with endometrial carcinoma were 6.1 times higher (95% CI 1.32-27.68) if they had an endometrial stripe thickness >1.1 cm and 13.5 times higher (95% CI 3.56-51.1) if there was histological suspicion of carcinoma. The odds of a patient being diagnosed with endometrial carcinoma were significantly lower if the patient had an initial diagnosis of atypical endometrial hyperplasia in a polyp (OR 0.07; 95% CI 0.02-0.34). CONCLUSION Our results suggest that an endometrial stripe thickness >1.1 cm, a histological suspicion of carcinoma on preoperative pathology, and the absence of polyp involvement on initial diagnosis are the strongest predictors of endometrial carcinoma at the time of hysterectomy in patients with atypical endometrial hyperplasia.
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Affiliation(s)
| | - Jessica Pudwell
- Department of Obstetrics and Gynaecology, Kingston Health Sciences Centre, Kingston, ON
| | - Olga Bougie
- Department of Obstetrics and Gynaecology, Kingston Health Sciences Centre, Kingston, ON.
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McLeod LJ, Nensi A, Robertson D, Kives S. Robotic-Assisted Laparoscopic Hysterectomy for Endometrial Hyperplasia or Grade 1 Endometrial Adenocarcinoma: A 10-year, Single-Centre Experience. J Obstet Gynaecol Can 2021; 43:557-63. [PMID: 33259942 DOI: 10.1016/j.jogc.2020.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the outcomes of patients undergoing robotic-assisted laparoscopic hysterectomy for grade-1 endometroid endometrial cancer or endometrial hyperplasia at our centre. METHODS Retrospective chart review was completed for 160 patients who underwent robotic-assisted laparoscopic hysterectomy by 5 general gynaecologists in a tertiary care setting between September 2008 and September 2018. Outcomes collected included operative time, estimated blood loss, length of stay, perioperative complications, readmissions, and recurrences. Subgroup analysis was completed after stratifying by body mass index (BMI; 3 groups: A, <40 kg/m2; B, 40-50 kg/m2; and C, >50 kg/m2). Subgroups were compared with ANOVA or Fisher exact test. RESULTS The intraoperative complication rate was 3%. The rate of conversion to laparotomy was 2%, and the rate of bowel injury, 1%. The postoperative complication rate was 8%. The rate of major postoperative complications was 4%, and 3% of patients required readmission postoperatively. The mean BMI was 43 (range 21-71) kg/m2. There were no differences in perioperative complication, readmission, or recurrence rates between subgroups. Groups B and C were more likely to have had an ASA of 3-4, suggesting a higher burden of comorbidity. Operating room time, procedure time, and estimated blood loss were higher in group C. CONCLUSION Despite this cohort's mean BMI falling within the category of class III obesity, complication and conversion rates were similar to those reported in the literature and did not increase with BMI, despite an increased comorbidity burden. These results suggest that robotic surgery is a safe and effective method for providing minimally invasive surgery to a technically challenging population.
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Wong J, Murji A, Sunderji Z, Chow O, Shapiro J, Wolfman W, Shirreff L. Unnecessary bilateral salpingo-oophorectomy at the time of hysterectomy and potential for ovarian preservation. Menopause 2020; 28:8-11. [PMID: 32898023 DOI: 10.1097/GME.0000000000001652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate predictors of bilateral salpingo-oophorectomy at hysterectomy and determine rate of unnecessary bilateral salpingo-oophorectomy. METHODS Retrospective review of hysterectomies at six Ontario, Canada hospitals from July 2016 to June 2018. Data was extracted from health records coding and electronic medical records. Of patients with concurrent bilateral salpingo-oophorectomy, age, preoperative diagnoses, surgical factors (presence of endometriosis/adhesions), and surgeon training (fellowship/no fellowship) were recorded. Chi-square tests compared indicated and nonindicated bilateral salpingo-oophorectomy cases based on preoperative diagnosis. Criteria for unnecessary bilateral salpingo-oophorectomy were: age under 51 years, benign preoperative diagnosis, and absence of intraoperative endometriosis and adhesions. RESULTS Concurrent bilateral salpingo-oophorectomy occurred in 749/2,656 (28%) cases with 509/749 (68%) indicated based on preoperative diagnosis. There was interhospital variation in rate of indicated bilateral salpingo-oophorectomy based on preoperative diagnosis (45.3%-76.9%, χ2P < 0.001). Concurrent bilateral salpingo-oophorectomy at academic centers was more likely to have preoperative indications versus those at community hospitals (70% vs 63%, OR 1.42, 95% CI 1.02-1.97, P = 0.04). BSO performed by fellowship-trained surgeons were more likely to be indicated than those performed by generalists (75% vs 63%, OR 1.76, 95% CI 1.26-2.44, P = 0.001). Of patients without preoperative indications for bilateral salpingo-oophorectomy, 105/239 (44%) were under 51 years of age, of which 59 (58%) had no intraoperative endometriosis/adhesions. Ovarian preservation may have been reasonable in 8% (59/749). CONCLUSIONS Concurrent bilateral salpingo-oophorectomy performed by generalists and at community hospitals was less likely to have preoperative indications. Ovarian preservation was potentially possible for 8%.
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Santoro A, Piermattei A, Inzani F, Angelico G, Valente M, Arciuolo D, Spadola S, Martini M, Fanfani F, Fagotti A, Gallotta V, Scambia G, Zannoni GF. Frozen section accurately allows pathological characterization of endometrial cancer in patients with a preoperative ambiguous or inconclusive diagnoses: our experience. BMC Cancer 2019; 19:1096. [PMID: 31718623 PMCID: PMC6852930 DOI: 10.1186/s12885-019-6318-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/31/2019] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study was to assess the agreement rate between intraoperative evaluation (IOE) and final diagnosis (FD) in a series of surgically resected endometrial carcinoma (EC), with a preoperative ambiguous or inconclusive diagnosis by endometrial biopsies and imaging. Methods A retrospective study was performed selecting patients who underwent surgery with IOE for suspected EC at our institution from 2012 to 2018. A K coefficient was determined with respect to the histotype, tumor grade, myometrial infiltration and cervical involvement. Results Data analysis has been performed on 202 women. The IOE evaluation was distributed as Endometrioid (n = 180) and Non-Endometrioid (n = 22). The comparison between the frozen section (FS) and the definitive histological subtype showed an overall agreement rate of 93,07% (k = 0.612) and an agreement of 97.2% for Endometrioid vs 59% for Non-Endometrioid tumors. The FIGO system grading was the same in 91,1% of patients, none was upgraded and in 8,9% downgraded. Observed agreements were 89,11% and 95,54% for myometrial and cervical involvement, respectively. Conclusions The good agreement between intraoperative grading, myometrial invasion and their histological definition on permanent sections highlights that FS is a good predictor for surgical outcome, in particular in presence of a preoperative ambiguous or inconclusive diagnostic evaluation.
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Affiliation(s)
- A Santoro
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - A Piermattei
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - F Inzani
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - G Angelico
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - M Valente
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - D Arciuolo
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - S Spadola
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - M Martini
- Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Roma, Italy.,UOC di Anatomia Patologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - F Fanfani
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - A Fagotti
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - V Gallotta
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - G Scambia
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - G F Zannoni
- Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy. .,Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Roma, Italy.
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Bendifallah S, Ilenko A, Daraï E. High risk endometrial cancer: Clues towards a revision of the therapeutic paradigm. J Gynecol Obstet Hum Reprod 2019; 48:863-871. [PMID: 31176047 DOI: 10.1016/j.jogoh.2019.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/17/2018] [Revised: 05/16/2019] [Accepted: 06/04/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Endometrial cancer (EC) is a major cause of mortality worldwide with nearly 200 000 cases diagnosed annually. The recent ESMO-ESGO-ESTRO guidelines include a new classification defining a heterogeneous high-risk group of recurrence (HR) comprising: (i) endometrioid (type 1) FIGO stage IB grade 3 tumors (type 1/G3ECs), (ii) non-endometrioid tumors (type 2) and (iii) advanced stages whatever the histological type (Colombo et al., 2016). AREAS COVERED The aim of this review is to summarize current evidence for therapeutic approaches in HR-EC according to the updated ESMO-ESGO-ESTRO classification by discussing the following issues: i) HR-EC heterogeneity, (ii) prognostic factors and current classification, and (iii) optimal staging strategies (site and extent) and the role of adjuvant treatment. EXPERT COMMENTARY HR-EC treatment is based on surgery, radiation therapy, brachytherapy, and chemotherapy, either alone or sequentially, in combination with other treatments depending on disease stage, histological grade and risk group. Specific trials are needed to establish the role of systematic pelvic and paraaortic lymphadenectomy, adjuvant therapies and targeted drugs. Although molecular characterization has been reported to customize therapeutic strategies and thereby improve therapeutic outcomes in EC, none of the targeted agents investigated (antiangiogenic and mTOR/PI3K pathway inhibitor agents) have resulted in a change in clinical practice in HR-EC.
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Affiliation(s)
- S Bendifallah
- Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; INSERM UMR S 938, Sorbonne université, Paris 6, France
| | - A Ilenko
- Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France.
| | - E Daraï
- Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; INSERM UMR S 938, Sorbonne université, Paris 6, France
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Singh N, Hirschowitz L, Zaino R, Alvarado-Cabrero I, Duggan MA, Ali-Fehmi R, Euscher E, Hecht JL, Horn LC, Ioffe O, Matias-Guiu X, McCluggage WG, Mikami Y, Ordi J, Parkash V, Quddus MR, Quick CM, Staebler A, Zaloudek C, Nucci M, Malpica A, Oliva E. Pathologic Prognostic Factors in Endometrial Carcinoma (Other Than Tumor Type and Grade). Int J Gynecol Pathol 2019; 38 Suppl 1:S93-S113. [PMID: 30550486 DOI: 10.1097/PGP.0000000000000524] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although endometrial carcinoma (EC) is generally considered to have a good prognosis, over 20% of women with EC die of their disease, with a projected increase in both incidence and mortality over the next few decades. The aim of accurate prognostication is to ensure that patients receive optimal treatment and are neither overtreated nor undertreated, thereby improving patient outcomes overall. Patients with EC can be categorized into prognostic risk groups based on clinicopathologic findings. Other than tumor type and grade, groupings and recommended management algorithms may take into account age, body mass index, stage, and presence of lymphovascular space invasion. The molecular classification of EC that has emerged from the Cancer Genome Atlas (TCGA) study provides additional, potentially superior, prognostic information to traditional histologic typing and grading. This classifier does not, however, replace clinicopathologic risk assessment based on parameters other than histotype and grade. It is envisaged that molecular and clinicopathologic prognostic grouping systems will work better together than either alone. Thus, while tumor typing and grading may be superseded by a classification based on underlying genomic abnormalities, accurate assessment of other pathologic parameters will continue to be key to patient management. These include those factors related to staging, such as depth of myometrial invasion, cervical, vaginal, serosal surface, adnexal and parametrial invasion, and those independent of stage such as lymphovascular space invasion. Other prognostic parameters will also be discussed. These recommendations were developed from the International Society of Gynecological Pathologists Endometrial Carcinoma project.
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Fonnes T, Trovik J, Edqvist PH, Fasmer KE, Marcickiewicz J, Tingulstad S, Staff AC, Bjørge L, Amant F, Haldorsen IS, Werner H, Akslen LA, Tangen IL, Krakstad C. Asparaginase-like protein 1 expression in curettage independently predicts lymph node metastasis in endometrial carcinoma: a multicentre study. BJOG 2018; 125:1695-1703. [PMID: 29989298 DOI: 10.1111/1471-0528.15403] [Citation(s) in RCA: 5] [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] [Accepted: 07/01/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Correct preoperative identification of high-risk patients is important to optimise surgical treatment and improve survival. We wanted to explore if asparaginase-like protein 1 (ASRGL1) expression in curettage could predict lymph node metastases and poor outcome, potentially improving preoperative risk stratification. DESIGN Multicentre study. SETTING Ten hospitals in Norway, Sweden and Belgium. POPULATION Women diagnosed with endometrial carcinoma. METHODS ASRGL1 expression in curettage specimens from 1144 women was determined by immunohistochemistry. MAIN OUTCOME MEASURES ASRGL1 status related to disease-specific survival, lymph node status, preoperative imaging parameters and clinicopathological data. RESULTS ASRGL1 expression had independent prognostic value in multivariate survival analyses, both in the whole patient population (hazard ratio (HR) 1.63, 95% CI 1.11-2.37, P = 0.012) and in the low-risk curettage histology subgroup (HR 2.54, 95% CI 1.44-4.47, P = 0.001). Lymph node metastases were more frequent in women with low expression of ASRGL1 compared with women with high ASRGL1 levels (23% versus 10%, P < 0.001), and low ASRGL1 level was found to independently predict lymph node metastases (odds ratio 2.07, 95% CI 1.27-3.38, P = 0.003). CONCLUSIONS Low expression of ASRGL1 in curettage independently predicts lymph node metastases and poor disease-specific survival. TWEETABLE ABSTRACT Low ASRGL1 expression in curettage predicts lymph node metastasis and poor survival in endometrial carcinoma.
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Affiliation(s)
- T Fonnes
- Department of Clinical Science, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - J Trovik
- Department of Clinical Science, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - P-Hd Edqvist
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Science for Life Laboratory, Uppsala, Sweden
| | - K E Fasmer
- Department of Radiology, Centre for Nuclear Medicine/PET, Haukeland University Hospital, Bergen, Norway.,Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - J Marcickiewicz
- Department of Gynaecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynaecology, Halland's Hospital Varberg, Varberg, Sweden
| | - S Tingulstad
- Department of Gynaecology, St Olav's Hospital, Trondheim, Norway
| | - A C Staff
- Department of Gynaecology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - L Bjørge
- Department of Clinical Science, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - F Amant
- Department of Gynaecologic Oncology, UZGasthuisberg, KU Leuven, Leuven, Belgium.,Centre for Gynaecologic Oncology, Netherlands Cancer Institute and Academic Medical Centre, Amsterdam, the Netherlands
| | - I S Haldorsen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hmj Werner
- Department of Clinical Science, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - L A Akslen
- Section for Pathology, Department of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - I L Tangen
- Department of Clinical Science, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - C Krakstad
- Department of Clinical Science, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
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Coronado PJ, Rychlik A, Martínez-Maestre MA, Baquedano L, Fasero M, García-Arreza A, Morales S, Lubian DM, Zapardiel I. Role of lymphadenectomy in intermediate-risk endometrial cancer: a matched-pair study. J Gynecol Oncol 2018; 29:e1. [PMID: 29185259 PMCID: PMC5709519 DOI: 10.3802/jgo.2018.29.e1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 02/19/2017] [Revised: 08/05/2017] [Accepted: 08/22/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the impact of lymph node dissection (LND) on morbidity, survival, and cost for intermediate-risk endometrial cancers (IREC). METHODS A multicenter retrospective cohort of 720 women with IREC (endometrioid histology with myometrial invasion <50% and grade 3; or myometrial invasion ≥50% and grades 1-2; or cervical involvement and grades 1-2) was carried out. All patients underwent hysterectomy and bilateral salpingo-oophorectomy. A matched pair analysis identified 178 pairs (178 with LND and 178 without it) equal in age, body mass index, co-morbidities, American Society of Anesthesiologist score, myometrial invasion, and surgical approach. Demographic data, pathology results, perioperative morbidity, and survival were abstracted from medical records. Disease-free survival (DFS) and overall survival (OS) was analyzed using Kaplan-Meier curves and multivariate Cox regression analysis. Cost analysis was carried out between both groups. RESULTS Both study groups were homogeneous in demographic data and pathologic results. The mean follow-up in patients free of disease was 61.7 months (range, 12.0-275.5). DFS (hazard ratio [HR]=1.34; 95% confidence interval [CI]=0.79-2.28) and OS (HR=0.72; 95% CI=0.42-1.23) were similar in both groups, independently of nodes count. In LND group, positive nodes were found in 10 cases (5.6%). Operating time and late postoperative complications were higher in LND group (p<0.05). Infection rate was significantly higher in no-LND group (p=0.035). There were no statistical differences between both groups regarding operative morbidity and hospital stay. The global cost was similar for both groups. CONCLUSION Systematic LND in IREC has no benefit on survival, although it does not show an increase in perioperative morbidity or global cost.
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Affiliation(s)
- Pluvio J Coronado
- Department of Obstetrics and Gynecology, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain.
| | - Agnieszka Rychlik
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | | | - Laura Baquedano
- Service of Obstetrics and Gynecology, Hospital Miguel Servet, Zaragoza, Spain
| | - María Fasero
- Service of Obstetrics and Gynecology, Hospital Sanitas La Zarzuela, Madrid, Spain
| | - Aida García-Arreza
- Service of Obstetrics and Gynecology, Hospital Virgen del Rocio, Sevilla, Spain
| | - Sara Morales
- Service of Obstetrics and Gynecology, Hospital Infanta Leonor, Madrid, Spain
| | - Daniel M Lubian
- Service of Obstetrics and Gynecology, Hospital de Puerto Real, Cádiz, Spain
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
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Wakahashi S, Kawakami F, Wakahashi K, Minagawa K, Matsuo K, Katayama Y, Yamada H, Matsui T, Sudo T. Transformed Follicular Lymphoma (TFL) Predicts Outcome in Advanced Endometrial Cancer. Cancer Epidemiol Biomarkers Prev 2018; 27:963-969. [PMID: 29784731 DOI: 10.1158/1055-9965.epi-17-0762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 02/13/2018] [Accepted: 05/15/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Transformed follicular lymphoma (TFL, ZC3H12D) was identified as a candidate tumor suppressor gene that contributes to cell-cycle arrest through regulation of Rb phosphorylation, but the clinical impact of TFL is unknown. The goal of this study was to evaluate the prognostic significance of TFL expression in advanced endometrial cancer.Methods: Tissue samples were obtained from 103 patients with Federation Internationale des Gynaecologistes et Obstetristes stage III-IV endometrial cancer. Associations between TFL expression and outcomes were evaluated using the Kaplan-Meier method and multivariate Cox proportional hazards regression models.Results: There were 24 TFL-low cases (23.3%) and the 10-year progression-free survival (PFS) and overall survival (OS) in these cases were lower than those for patients with normal TFL expression in univariate analysis (PFS, P = 0.003; OS, P = 0.106). In multivariate analysis, TFL status was a significant predictor for PFS [HR = 2.76; 95% confidence interval (CI), 1.45-5.28; P = 0.002] and OS (HR = 1.94; 95% CI, 0.91-4.11; P = 0.085), adjusted for covariates. The TFL gene maps to human chromosome 6q25.1, where estrogen receptor alpha (ERα) gene ESR1 is also located. Lack of ERα expression is a poor prognostic factor in early endometrial cancer. Among 41 ERα-low patients, 10-year PFS was significantly lower in 15 TFL-low cases (univariate analysis, P = 0.055; multivariate analysis, HR = 4.70; 95% CI, 1.68-13.20; P = 0.003).Conclusions: We identified TFL as a strong independent prognostic factor, regardless of ERα status.Impact: An investigation of the mechanism underlying tumor suppression by TFL may lead to new therapies for patients with advanced endometrial cancer. Cancer Epidemiol Biomarkers Prev; 27(8); 963-9. ©2018 AACR.
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Affiliation(s)
- Senn Wakahashi
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Fumi Kawakami
- Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Japan
| | - Kanako Wakahashi
- Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kentaro Minagawa
- Department of Hematology/Oncology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Keitaro Matsuo
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Yoshio Katayama
- Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideto Yamada
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshimitsu Matsui
- Department of Hematology, Nishiwaki Municipal Hospital, Nishiwaki, Hyogo, Japan
| | - Tamotsu Sudo
- Section of Translational Research, Hyogo Cancer Center, Akashi, Japan
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Qu XM, Velker VM, Leung E, Kwon JS, Elshaikh MA, Kong I, Logie NA, Mendez LC, van der Putten LJ, Donovan EK, Munkarah AR, Wiebe EM, Parra-Herran C, Warner A, Louie AV, D'Souza DP. The role of adjuvant therapy in stage IA serous and clear cell uterine cancer: A multi-institutional pooled analysis. Gynecol Oncol 2018; 149:283-90. [PMID: 29544706 DOI: 10.1016/j.ygyno.2018.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/02/2018] [Accepted: 03/03/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE As the optimal adjuvant management of stage IA serous or clear cell endometrial cancer is controversial, a multi-institutional review was conducted with the objective of evaluating the appropriateness of various strategies including observation. METHODS Retrospective chart reviews for 414 consecutive patients who underwent hysterectomy for FIGO stage IA endometrial cancer with serous, clear cell or mixed histology between 2004 and 2015 were conducted in 6 North American centers. Time-to-event outcomes were analyzed by Kaplan-Meier estimates, log-rank test, univariable and multivariable cox proportional hazard regression models. RESULTS Post-operative management included observation (50%), chemotherapy and radiotherapy (RT) (27%), RT only (16%) and chemotherapy only (7%). The 178 RT patients received external beam (EBRT, 16%), vaginal vault brachytherapy (VVB, 56%) or both (28%). Among patients without any adjuvant treatment, 5-year local control (LC), disease free survival (DFS) and cancer-specific survival (CSS) were 82% (95% confidence interval: 74-88), 70% (62-78) and 90% (82-94), respectively. CSS in patients without adjuvant treatment was improved with adequate surgical staging (100% vs. 87% (77-92), log-rank p=0.022). Adjuvant VVB was associated with improved LC (5-year 96% (91-99) vs. 84% (76-89), log-rank p=0.007) and DFS (5-year 79% (66-88) vs. 71% (63-77), log-rank p=0.033). Adjuvant chemotherapy was associated with better LC (5-year 96% (90-98) vs. 84% (77-89), log-rank p=0.014) and DFS (5-year 84% (74-91) vs. 69% (61-76), log-rank p=0.009). On multivariable analysis, adjuvant chemotherapy and VVB were associated with improved LC while adjuvant chemotherapy and age were significant for DFS. CONCLUSIONS In stage IA serous or clear cell uterine cancer, adjuvant RT and chemotherapy were associated with better LC and DFS. Observation may be appropriate in patients who have had adequate surgical staging.
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Lee JY, Kim YH, Lee JM, Kim K, Kang S, Lim MC, Kim BJ, Lee BH, Kim JW. Role of preoperative magnetic resonance imaging and histological assessment in identifying patients with a low risk of endometrial cancer: a Korean Gynecologic Oncology Group ancillary study. Oncotarget 2017; 8:106009-106016. [PMID: 29285310 PMCID: PMC5739697 DOI: 10.18632/oncotarget.22520] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/30/2017] [Indexed: 11/25/2022] Open
Abstract
Preoperative identification of individuals at low risk of lymph node metastasis is key to the proper management of endometrial cancer. This study evaluated the role of preoperative assessment based on magnetic resonance imaging (MRI) and histological analysis in identifying a group having a low risk of lymph node metastasis. Data of 529 patients with endometrial cancer were obtained from a prospective multicenter database, between January 2012 and December 2014. Clinical staging, based on MRI and histological analysis, was compared with final pathology results after the surgical staging procedure. The preoperative low-risk criteria, based on current guidelines from Korea, France, and Canada, and criteria used for fertility-sparing therapies, were applied to our multicenter cohort and the accuracy of each set of criteria for identifying group at low risk of lymph node metastasis was evaluated. When considering grades or MR stages separately, the overall agreement between preoperative and postoperative findings was poor (Kappa 0.45 for grades; 0.41 for stages). However, when combining these two parameters, the low-risk group, as defined by any of the guidelines, had an acceptable rate of lymph node metastasis (below 3%). The French guidelines identified 249 patients (47.1%) as being in the low-risk group. Criteria used to define fertility-sparing therapy candidates identified 48 patients (9.1%) among the study population, only one of whom had extra-uterine disease. This study shows that the current guidelines, using preoperative assessment based on MRI and histological analysis, can identify low-risk patients, who may be candidates for omitting lymphadenectomy.
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Affiliation(s)
- Jung-Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Hwan Kim
- Department of Obstetrics and Gynecology, Ehwa University College of Medicine, Seoul, Korea
| | - Jong-Min Lee
- Department of Obstetrics and Gynecology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sokbom Kang
- Gynecologic Oncology Research Branch, Research Institute and Hospital, and Department of Cancer Control and Public Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Myong Cheol Lim
- Gynecologic Oncology Research Branch, Research Institute and Hospital, and Department of Cancer Control and Public Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Beob-Jong Kim
- Department of Obstetrics and Gynecology, Korea Cancer Hospital, Korea Cancer Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Bang Hyun Lee
- Department of Obstetrics and Gynecology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Bourgioti C, Chatoupis K, Tzavara C, Antoniou A, Rodolakis A, Moulopoulos LA. Predictive ability of maximal tumor diameter on MRI for high-risk endometrial cancer. Abdom Radiol (NY) 2016; 41:2484-95. [PMID: 27714421 DOI: 10.1007/s00261-016-0927-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIM To investigate the predictive ability of tumor size for deep myometrial invasion (≥50%) and metastatic lymphadenopathy, on maximal tumor diameter (MRI) of endometrial cancer. MATERIALS AND METHODS Our study population consisted of 105 patients (mean age: 59.8 years) with histologically confirmed endometrial cancer. All patients underwent preoperative pelvic MRI. Tumor maximal diameter (size) was calculated on multiple sequences, and the largest value was recorded. Logistic regression analysis was performed to investigate the association of maximal tumor diameter (MRI) with the depth of myometrial invasion and the presence of pelvic nodal metastases (histology); optimal tumor size cut-off for the prediction of deep myometrial involvement and nodal metastases was calculated using ROC analysis. Surgicopathological specimen examination was the standard of reference. RESULTS Tumor size on MRI, independently predicted deep myometrial invasion. Optimal maximal tumor diameter cut-off for the prediction of deep myometrial invasion was 2 cm (SE 90%, SP 50.9%). When tumor size was used as a categorical variable in the multiple logistic regression model, tumor size >2 cm had 10.04 times greater odds of deep myometrial invasion (95% CI 3.34-30.17, p < 0.001). Optimal tumor size cut-off for prediction of nodal metastases was 4 cm (SE 60%, SP 76.9%). Multiple logistic regression analysis with nodal metastases as a dependent variable showed that tumor size >4 cm had 4.79 times greater odds for malignant dissemination to the lymph nodes (95% CI 1.00-23.09, p = 0.047). CONCLUSION Maximal tumor diameter on preoperative MRI may be yet another prognosticator for deep myometrial invasion and metastatic lymphadenopathy in patients with endometrial carcinoma.
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Ferraioli D, Chopin N, Beurrier F, Carrabin N, Buenerd A, Mathevet P. The Incidence and Clinical Significance of the Micrometastases in the Sentinel Lymph Nodes During Surgical Staging for Early Endometrial Cancer. Int J Gynecol Cancer 2015; 25:673-80. [DOI: 10.1097/igc.0000000000000408] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IntroductionThe status of regional node remains one of the most important factors to guide adjuvant therapy in endometrial cancer (EC). Pelvic recurrence occurs in up to 15% of early EC patients with negative pelvic lymph nodes (LNs). The prognostic significance of detecting micrometastases (μM) in LN is debated. This retrospective case-control study performed in the Oncological Gynecology Department in Lyon between December 1998 and June 2012 reports the incidence and the clinical significance of μM detected during ultrastaging of negative sentinel lymph node (SLN) in EC.Patients and MethodsNinety-three patients affected by type I and II EC were submitted to surgery with SLN. Dual-labeling method was used to detect SLN. All the SLNs were subjected to ultrastaging researching μM. The patients with a locoregional or distant relapse represented the case-series (CS). The patients without locoregional or distant recurrences were the case-controls (CC).They were matched (1:2 ratio) according to age, International Federation of Gynecology and Obstetrics stage, and histopathologic features.ResultsTen patients presenting a relapse represented CS. In the remaining 83 patients without recurrence, 20 CC were individualized. The detection rate of SLN per hemipelvis was of 17 (85%) of 20 hemipelvis and of 33 (82.5%) of 40 hemipelvis for CS and CC, respectively. Two SLN of CS arm were positives at frozen section. One of the 8 patients of CS arm with negative SLNs was positive for μM by immunohistochemistry analysis.ConclusionsLymph node status is one of the most important histopathologic features to determine the adjuvant treatment. The SLN technique could be proposed in selected patients affected by early EC. The μM in SLN could be researched and could help to modulate the following treatment. The multicenter study must be performed to clarify the optimal method of research of SLN in EC and the significance of μM in the LN.
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Burleigh A, Talhouk A, Gilks CB, McAlpine JN. Clinical and pathological characterization of endometrial cancer in young women: identification of a cohort without classical risk factors. Gynecol Oncol 2015; 138:141-6. [PMID: 25870916 DOI: 10.1016/j.ygyno.2015.02.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 01/15/2015] [Accepted: 02/28/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Endometrial cancer (EC) is the most common gynecologic malignancy with known risk factors including excess estrogen and hereditary syndromes. The objective of this study was to determine the proportion of young women with EC that could be attributed to these factors and if, as we suspected, there is a third population of young women in which neither factor is identifiable. We were interested in comparing clinicopathologic characteristics and outcomes across subgroups in order to better inform treatment recommendations. METHODS We performed a retrospective chart review of women age 15-49 diagnosed with EC or complex atypical hyperplasia. Demographic, clinicopathologic, treatment, fertility, and outcome parameters were analyzed. RESULTS Of 719 women identified, 327 were fully evaluable. 57.5% fit the "High Estrogen" risk criteria. 8.25% met criteria for suspected Lynch syndrome. 34.25% classified as "Neither" had no classical risk factors identified. There were no statistical differences in age, gravidity, tumor grade, treatment selection and response to hormonal therapy. Age of menarche, stage, histology, and synchronous ovarian cancer differed significantly. Prevalence of synchronous ovarian cancer was 21.0% of "Neither", 23.1% of "Lynch", and 6.6% of "High Estrogen". For women who attempted pregnancy, 2/27 of "High Estrogen", 0/3 of "Lynch", and 2/16 of "Neither" achieved a live birth. CONCLUSIONS This study confirmed that a third population of young women with EC exist that lack classical risk factors and have distinct clinicopathologic parameters. No difference in success of conservative treatment or live births was noted in the small cohort in whom this treatment approach was attempted.
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Affiliation(s)
- Angela Burleigh
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Aline Talhouk
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - C Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Jessica N McAlpine
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of British Columbia, Vancouver, Canada.
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How JA, Abitbol J, Lau S, Gotlieb WH, Abenhaim HA. The Impact of Qualitative Research on Gynaecologic Oncology Guidelines. Journal of Obstetrics and Gynaecology Canada 2015; 37:138-144. [DOI: 10.1016/s1701-2163(15)30335-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chiou HY, Chiu LH, Chen CH, Yen YK, Chang CW, Liu WM. Comparing robotic surgery with laparoscopy and laparotomy for endometrial cancer management: A cohort study. Int J Surg 2015; 13:17-22. [DOI: 10.1016/j.ijsu.2014.11.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/08/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
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