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Raimondo D, Raffone A, Aguzzi A, Bertoldo L, Seracchioli R. Role of sentinel lymph node biopsy with indocyanine green and site of injection in endometrial cancer. Curr Opin Oncol 2024; 36:383-390. [PMID: 39106403 DOI: 10.1097/cco.0000000000001075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
PURPOSE OF REVIEW The aim of the present narrative review is to summarize the state of art on sentinel lymph node biopsy (SLNB) in endometrial cancer, with a special focus on indocyanine green (ICG) as adopted tracer. RECENT FINDINGS Over the years, the surgical nodal staging in patients with endometrial cancer has been intensively investigated. Traditionally, systematic pelvic and para-aortic lymphadenectomy represented the gold standard surgical treatment to assess nodal involvement of the tumor. Through the last two decades, SLNB has gradually replaced lymphadenectomy as a more targeted procedure. A great heterogeneity of tracers and injection techniques have been proposed to perform SLNB. However, no universally accepted recommendations are still available. SUMMARY SLNB has nowadays almost replaced pelvic lymphadenectomy in low-risk endometrial cancers, offering a better safety profile while being related to a comparable nodal involvement sensitivity. Currently, ICG is considered to be the most used tracer among others. Different injection sites have been proposed, with different detection features. While ICG cervical injection is nowadays the suggested technique for SLNB, noncervical injection techniques, such as hysteroscopic and combined procedures, seem to have a better accuracy in para-aortic nodal assessment, which have a role in high-risk endometrial cancers.
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Affiliation(s)
- Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Antonio Raffone
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Alberto Aguzzi
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna
| | - Linda Bertoldo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna
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Massobrio R, Novara L, Mancarella M, Pace L, Giorgi M, Pascotto M, Campigotto B, Fuso L, Sgro LG, Bounous VE, Ferrero A. Nodal staging in high and high-intermediate risk endometrial cancer surgery: Which role in the molecular classification era? J Gynecol Obstet Hum Reprod 2024; 53:102787. [PMID: 38626819 DOI: 10.1016/j.jogoh.2024.102787] [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: 01/17/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 09/02/2024]
Abstract
OBJECTIVES Nodal staging contributes to risk group definition and the indication to adjuvant treatment in endometrial cancer (EC) patients. However, the role of nodal assessment evolved and requires redefinition. Primary outcome of the study was to assess the impact of surgical nodal staging in defining high-risk (HR) EC. Secondary outcome was to evaluate the contribution of nodal assessment to the decision for adjuvant treatment in both high-risk and high-intermediate risk (HIR) patients submitted to surgery. METHODS Clinical stage I-II EC patients with postoperative diagnosis of HR and HIR disease were included. The contribution of nodal staging in prognostic groups allocation was assessed by reviewing HR patients to identify those without any other feature of such class (non-endometrioid histology, p53abn immunohistochemistry, post-operative T3-T4 disease) and HIR cases to assess how nodal staging affected adjuvant treatment indication. Descriptive statistics were conducted to describe the two populations. RESULTS Fifty-seven patients were included, 46 with HR and 11 with HIR disease. Chemotherapy and external-beam radiotherapy (EBRT) were proposed in 40 HR patients. Considering histology, immunohistochemical profile and FIGO stage, high risk classification was exclusively relied on nodal involvement in 2/46 cases (4.3 %). Omitting retroperitoneal staging, one of them would have been classified in the intermediate risk group and the other as HIR: without nodal staging, chemotherapy and EBRT would have been omitted in 1/40 (2.5 %) case. Among HIR patients, chemotherapy was proposed in 7/11 cases and EBRT in all cases. Adjuvant chemotherapy was indicated in 5/6 (83.3 %) and omitted in 1/6 (16.7 %) pN0 patient (stage Ib G2, substantial LVSI). In HIRpN0 patients, omitting nodal staging could have changed adjuvant treatment indication in 1/6 (16.7 %) case. In HIRpNx patients, adjuvant chemotherapy was omitted in one patient (stage II, grade 2 and LVSI negative): nodal staging unavailability might have changed indication to chemotherapy in 1/5 (20 %) case, without changing indication to EBRT. Unavailable nodal staging could globally be related to omission of chemotherapy in 2/57 (3.5 %) patients and of EBRT in 1/57 (1.8 %) patient. CONCLUSIONS In this series, nodal staging had limited impact on definition of HR class and on the choice of adjuvant treatment in HR and HIR EC patients.
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Affiliation(s)
- Roberta Massobrio
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy.
| | - Lorenzo Novara
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | - Matteo Mancarella
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | - Luca Pace
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | - Margherita Giorgi
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | - Maria Pascotto
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | - Beatrice Campigotto
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | - Luca Fuso
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | - Luca Giuseppe Sgro
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | | | - Annamaria Ferrero
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
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Rosati A, Vargiu V, Capozzi VA, Giannarelli D, Palmieri E, Baroni A, Perrone E, Berretta R, Cosentino F, Scambia G, Fanfani F. Concurrent endometrial cancer in atypical endometrial hyperplasia and the role of sentinel lymph nodes: clinical insights from a multicenter experience. Int J Gynecol Cancer 2024; 34:1011-1019. [PMID: 38431287 DOI: 10.1136/ijgc-2023-005202] [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: 03/05/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the prevalence of concurrent endometrial cancer in patients pre-operatively diagnosed with atypical endometrial hyperplasia undergoing hysterectomy. Additionally, we assessed the occurrence of high to intermediate-risk and high-risk tumors according to the ESGO-ESTRO-ESP classification. The study also compared surgical outcomes and complications between patients undergoing simple hysterectomy and those undergoing hysterectomy with sentinel lymph node biopsy. METHODS In this multicenter retrospective study, patients with a pre-operative diagnosis of atypical endometrial hyperplasia were identified and divided into two groups: Group 1, which included patients treated with total hysterectomy with or without bilateral salpingo-oophorectomy, and Group 2, where sentinel lymph node biopsy was incorporated into the standard surgical treatment. RESULTS Among 460 patients with atypical endometrial hyperplasia, 192 received standard surgical management (Group 1) and 268 underwent sentinel lymph node biopsy (Group 2). A total of 47.2% (95% CI 42.6% to 51.7%) of patients were upgraded to endometrial cancer on final histopathological examination. High to intermediate-risk and high-risk tumors constituted 12.3% and 9.2% in Group 2 and 7.4% and 3.7% in Group 1. Lymph node metastases were identified in 7.6% of patients with concurrent endometrial cancer who underwent nodal assessment with at least unilateral mapping. Of the 12 sentinel lymph node metastases, 75.0% were micrometastases, 16.7% macrometastases, and 8.3% isolated tumor cells. No significant differences were found in estimated blood loss, operative time, and intra-operative and post-operative complications between the two groups. The rate of patients undergoing sentinel lymph node biopsy doubled every 2 years (OR 2.010, p<0.001), reaching 79.1% in the last 2 years. CONCLUSION This study found a prevalence of concurrent endometrial cancer of 47.2%, and sentinel lymph node biopsy provided prognostic and therapeutic information in 60.8% of cases. It also allowed for the adjustment of adjuvant therapy in 12.3% of high to intermediate-risk patients without increasing operative time or complication rates.
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Affiliation(s)
- Andrea Rosati
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Virginia Vargiu
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | | | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Emanuele Perrone
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Roberto Berretta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Cosentino
- Department of Medicine and Health Sciences "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Molise, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Ignatov A, Mészáros J, Ivros S, Gennari P, Ignatov T. Oncologic Outcome of Robotic-Assisted and Laparoscopic Sentinel Node Biopsy in Endometrial Cancer. Cancers (Basel) 2023; 15:5894. [PMID: 38136438 PMCID: PMC10741694 DOI: 10.3390/cancers15245894] [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: 11/20/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Recently, sentinel lymph node biopsy (SLNB) has been introduced in the surgical staging of endometrial cancer as an alternative to systematic lymph node dissection (LND). However, the survival impact of SLNB is not yet well characterised. METHODS We performed a retrospective study of 419 patients with endometrial cancer treated with SLNB alone or with pelvic and para-aortic LND. For SLNB mapping, indocyanine green was used. RESULTS Median follow-up was 66 months. After exclusions, 337 patients were eligible for analysis. Of them, 150 underwent SLNB and 187 LND. During the follow-up time, 27 (24.7%) of the 150 who underwent SLNB and 54 (28.9%) of the 187 who underwent LND were diagnosed with recurrent disease (p = 0.459). The estimated 5-year disease-free survival (DFS) rate was 76.7% and 72.2% for patients in the SLNB and LND group, respectively (p = 0.419). The 5-year overall survival (OS) rates were 80.7% and 77.0% in the SLNB and LND group, respectively (p = 0.895). Survival rates were similar in both groups independent of lymph node status. Multivariable analysis confirmed that the staging approach was not associated with oncological outcome. For patients without lymph node metastases, patient outcome was worsened by advanced tumour stage and non-endometrioid tumour histology. In the group of patients with confirmed lymph node metastases, advanced tumour stage and inadequate adjuvant treatment significantly reduced DFS and OS. CONCLUSION Our data suggested that SLNB did not compromise the oncological outcome of patients with endometrial cancer compared to LND.
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Affiliation(s)
- Atanas Ignatov
- Department of Gynecology and Obstetrics, Otto-von-Guericke University, 39108 Magdeburg, Germany; (J.M.); (S.I.); (P.G.); (T.I.)
| | - József Mészáros
- Department of Gynecology and Obstetrics, Otto-von-Guericke University, 39108 Magdeburg, Germany; (J.M.); (S.I.); (P.G.); (T.I.)
| | - Stylianos Ivros
- Department of Gynecology and Obstetrics, Otto-von-Guericke University, 39108 Magdeburg, Germany; (J.M.); (S.I.); (P.G.); (T.I.)
- Gynecologic Oncology Unit, Metropolitan Hospital, 18547 Athens, Greece
| | - Paolo Gennari
- Department of Gynecology and Obstetrics, Otto-von-Guericke University, 39108 Magdeburg, Germany; (J.M.); (S.I.); (P.G.); (T.I.)
| | - Tanja Ignatov
- Department of Gynecology and Obstetrics, Otto-von-Guericke University, 39108 Magdeburg, Germany; (J.M.); (S.I.); (P.G.); (T.I.)
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Ying J, Huang W, Fu L, Yang H, Cheng J. Weakly supervised segmentation of uterus by scribble labeling on endometrial cancer MR images. Comput Biol Med 2023; 167:107582. [PMID: 37922606 DOI: 10.1016/j.compbiomed.2023.107582] [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: 05/07/2023] [Revised: 09/28/2023] [Accepted: 10/15/2023] [Indexed: 11/07/2023]
Abstract
Uterine segmentation of endometrial cancer MR images can be a valuable diagnostic tool for gynecologists. However, uterine segmentation based on deep learning relies on artificial pixel-level annotation, which is time-consuming, laborious and subjective. To reduce the dependence on pixel-level annotation, a method of weakly supervised uterine segmentation on endometrial cancer MRI slices is proposed, which only requires scribble label and is enhanced by pseudo-label technology, exponential geodesic distance loss and input disturbance strategy. Specifically, the limitations caused by the shortage of supervision are addressed by dynamically mixing the two outputs of the dual branch network to generate pseudo-labels, expanding supervision information and promoting mutual supervision training. On the other hand, considering the large difference of grayscale intensity between the uterus and surrounding tissues, the exponential geodesic distance loss is introduced to enhance the ability of the network to capture the edge of the uterus. Input disturbance strategies are incorporated to adapt to the flexible and variable characteristics of the uterus and further improve the segmentation performance of the network. The proposed method is evaluated on MRI images from 135 cases of endometrial cancer. Compared with other four weakly supervised segmentation methods, the performance of the proposed method is the best, whose mean DI, HD95, Recall, Precision, ADP are 92.8%, 11.632, 92.7%, 93.6%, 6.5% and increasing by 2.1%, 9.144, 0.6%, 2.4%, 2.9% respectively. The experimental results demonstrate that the proposed method is more effective than other weakly supervised methods and achieves similar performance as those fully supervised.
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Affiliation(s)
- Jie Ying
- School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai, China.
| | - Wei Huang
- School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Le Fu
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Haima Yang
- School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Jiangzihao Cheng
- School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai, China
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Zhang X, Chen S, Li G, Zheng L, Shang S, Li J, Guan X, Yang J. Investigating the influence of primary uterine tumor site on pelvic and para-aortic lymph node metastatic pattern and evaluating the risk factors for lymph node metastases in endometrial carcinoma: A retrospective study. Medicine (Baltimore) 2023; 102:e36100. [PMID: 38013262 PMCID: PMC10681575 DOI: 10.1097/md.0000000000036100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/23/2023] [Indexed: 11/29/2023] Open
Abstract
To assess the metastatic pattern in pelvic and para-aortic lymph nodes in relation with the primary uterine tumor site and to evaluate risk factors for lymph node metastases. 212 patients with endometrial cancer who underwent surgical treatment from December 2014 to December 2019 were selected. The clinical and pathological data were retrospectively analyzed. The factors and uterine primary tumor site related to lymph node metastasis were analyzed by univariate and multivariate analysis. Among the 212 patients with endometrial cancer, 17 cases had lymph node metastasis, and thus the metastasis rate was 8.02%. Univariate analysis revealed that lymph node metastasis was significantly correlated with Federation of Gynecology and Obstetrics stage, depth of myometrial invasion, tumor size, pathological grade, and lymphovascular space invasion (P < .05) and was not correlated with age, pathological type, and cervical involvement (P > .05). Primary uterine tumor site (fundus, horns, body or lower uterine segment) with or without cervical involvement was associated with different lymph nodes' metastatic sites. The lymph node metastatic pathways of endometrial cancer mainly include obturator lymph nodes and para-aortic lymph nodes, and skip metastasis may occur; endometrial carcinoma may jump and metastasize to para-aortic lymph nodes, specially when the lesion is located in the uterine fundus and uterine horns (cornua of uterus); there is a significant correlation between the location of lymph node metastasis and the location of primary uterine malignant tumor.
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Affiliation(s)
- Xiao Zhang
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Saihua Chen
- Department of Gynecology, Zhejiang People’s Hospital, Tiantai Branch, Taizhou, China
| | - Guangxiao Li
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Limei Zheng
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shanliang Shang
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianqiong Li
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaojing Guan
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianhua Yang
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
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Deng L, Liu Y, Yao Y, Deng Y, Tang S, Sun L, Wang Y. Efficacy of vaginal natural orifice transluminal endoscopic sentinel lymph node biopsy for endometrial cancer: a prospective multicenter cohort study. Int J Surg 2023; 109:2996-3002. [PMID: 37335988 PMCID: PMC10583956 DOI: 10.1097/js9.0000000000000551] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Natural orifice transluminal endoscopic surgery (NOTES) is performed increasingly often despite the lack of high-quality evidence confirming its safety, especially for malignant diseases. The aim of this prospective study is to verify that vaginal NOTES (vNOTES) can be performed safely and effectively in early endometrial cancer staging surgery. MATERIALS AND METHODS This prospective study was conducted in two tertiary hospitals in southern China from January 2021 to May 2022. A total of 120 patients with stage I endometrial cancer were included. vNOTES or multiport laparoscopic staging surgery was selected according to each patient's wishes. The primary outcome was the sentinel lymph node detection rate, analyzed by a noninferiority test. The secondary outcomes were perioperative outcomes. RESULTS Among the 120 patients enrolled, 57 underwent vNOTES, and 63 underwent multiport laparoscopy. The patient-specific detection rates of sentinel lymph nodes were 94.73 and 96.82% in the vNOTES and laparoscopy groups, respectively. Additionally, the bilateral detection rates were 82.46 and 84.13%, and the side-specific detection rates were 88.60 and 90.48% in these two groups, respectively. All three detection rates in the vNOTES group were noninferior to those of laparoscopy group at a noninferiority cutoff of -15%. The median operation times of the vNOTES and laparoscopy groups were 132.35 and 138.73 min ( P =0.362), and the median estimated blood loss were 75 and 50 ml ( P =0.096), respectively. No intraoperative complications occurred in either group. The pain scores on the Numerical Rating Scale at both 12 h and 24 h after operation were significantly lower in the vNOTES group ( P <0.001) and the median postoperative hospital stay was significantly shorter in the vNOTES group ( P =0.001). CONCLUSION This study illustrates the potential applicability of vNOTES in gynecological malignancy surgery by demonstrating its safety and effectiveness in endometrial cancer staging. However, its long-term survival outcomes require further exploration.
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Affiliation(s)
- Li Deng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital (Southwest Hospital), Army Medical University, Chongqing
| | - Yi Liu
- Departments of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital l & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen
| | - Yuanyan Yao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital (Southwest Hospital), Army Medical University, Chongqing
| | - Yuan Deng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital (Southwest Hospital), Army Medical University, Chongqing
| | - Shuai Tang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital (Southwest Hospital), Army Medical University, Chongqing
| | - Li Sun
- Departments of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital l & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen
- Departments of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanzhou Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital (Southwest Hospital), Army Medical University, Chongqing
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Anderson EM, Luu M, Kamrava M. Demographic Factors Predict Risk of Lymph Node Involvement in Patients with Endometrial Adenocarcinoma. BIOLOGY 2023; 12:982. [PMID: 37508411 PMCID: PMC10376236 DOI: 10.3390/biology12070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
The presence of lymph node positivity (LN+) guides adjuvant treatment for endometrial adenocarcinoma (EAC) patients, but recommendations regarding LN evaluation at the time of primary surgery remain variable. Sociodemographic factors in addition to pathologic tumor characteristics may more accurately predict risk of LN+ in EAC patients. Patients diagnosed between 2004 and 2016 with pathologic T1-T2 EAC who had at least one lymph node sampled at the time of surgery in the National Cancer Data Base were included. Pathologic primary tumor predictors of LN+ were identified using logistic regression. To predict overall, pelvic only, and paraaortic and/or pelvic LN+, nomograms were generated. Among the 35,170 EAC patients included, 2864 were node positive. Using multivariable analysis, younger patient age (OR 0.98, 95% CI 0.98-0.99, p < 0.001), black versus white race (OR 1.19, 95% CI 1.01-1.40, p = 0.04), increasing pathologic tumor stage and grade, increase in tumor size, and presence of lymphovascular invasion were predictive of regional LN+. Both black versus white (OR 1.64, 95% CI 1.27-2.09, p < 0.001) and other versus white race (OR 1.54, 95% CI 1.12-2.07, p = 0.006) strongly predicted paraaortic LN+ in the multivariable analysis. Independent subset analyses of black and white women revealed that tumor grade was a stronger predictor of LN+ among black women. In addition to standard pathologic tumor features, patient age and race were associated with a higher risk of regional LN+ generally and paraaortic LN+ specifically. This information may inform adjuvant treatment decisions and guide future studies.
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Affiliation(s)
- Eric M Anderson
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Michael Luu
- Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Durdağ GD, Alemdaroğlu S, Baran ŞY, Şimşek SY, Yetkinel S, Çelik H. Safety of laparoscopic surgery in the management of endometrioid endometrial cancer. Indian J Cancer 2023; 60:366-372. [PMID: 36861713 DOI: 10.4103/ijc.ijc_206_21] [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: 12/02/2022]
Abstract
Background Laparoscopic surgery has increasingly been preferred in recent years. However, data regarding the safety of laparoscopy in endometrial cancer are not sufficient. The aim of this study was to compare perioperative and oncologic outcomes of laparoscopic and laparotomic staging surgery in patients with endometrioid endometrial cancer and to evaluate the safety and efficacy of laparoscopic surgery in this population. Methods Data of 278 patients, who underwent surgical staging for endometrioid endometrial cancer at the gynecologic oncology department of a university hospital between 2012 and 2019, were analyzed retrospectively. Demographic, histopathologic, perioperative, and oncologic characteristics were compared between laparoscopy and laparotomy groups. A subgroup of patients with a body mass index (BMI) >30 was further evaluated. Results Demographic and histopathologic characteristics were similar between the two groups, while laparoscopic surgery was seen to be significantly superior in terms of perioperative outcomes. The number of removed and metastatic lymph nodes was significantly higher in the laparotomy group; however, this difference did not affect the oncologic outcomes, including recurrence and survival rates, and the two groups had similar results in this aspect. The outcomes of the subgroup with BMI >30 were also in accordance with the whole population. Intraoperative complications in laparoscopy were managed successfully. Conclusions Laparoscopic surgery appears to be advantageous over laparotomy, and depending on the surgical experience, it may be performed safely for surgical staging of endometrioid endometrial cancer.
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Affiliation(s)
- Gülşen Doğan Durdağ
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Songül Alemdaroğlu
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Şafak Yilmaz Baran
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Seda Yüksel Şimşek
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Selçuk Yetkinel
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Hüsnü Çelik
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
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Yao H, Luo R, Tong R, Wei Y, Zheng K, Hu X. Impact of sentinel lymph node assessment on the outcomes of patients with advanced endometrial cancer: A meta-analysis. Medicine (Baltimore) 2023; 102:e33465. [PMID: 37058063 PMCID: PMC10101267 DOI: 10.1097/md.0000000000033465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/16/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Sentinel lymph node (SLN) assessment is used to treat early endometrial cancer; however, its application in advanced endometrial cancer remains controversial. Therefore, we assessed the effects of SLN assessment and lymphadenectomy (LND) on the prognosis (survival rate and primary outcome) of patients with advanced endometrial cancer. METHODS Pertinent studies were selected from PubMed, Embase, Web of Science, and the Cochrane Library until March 19, 2022. Relevant studies were strictly screened according to the inclusion and exclusion criteria. Data from the included studies were extracted and their quality was evaluated. Then RevMan5.4 software was used for the meta-analysis. RESULTS Four retrospective studies were included, which enrolled 7181 patients; 492 were treated with SLN and 6689 with LND. In terms of overall survival, there was no significant difference between the 2 groups (odds ratio = 1.14, 95% confidence interval: 0.92-1.41, I2 = 0%, P = .39). CONCLUSIONS SLN assessment is an alternative to LND as a treatment modality for advanced endometrial cancer.
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Affiliation(s)
- Huiyi Yao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ruiwen Luo
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ruoyi Tong
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yanwen Wei
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Kaiteng Zheng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiangdan Hu
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Terada N, Matsuura M, Kurokawa S, Teramoto M, Hanakenaka M, Saito T. Comparative Evaluation of Preoperative Imaging and Postoperative Histopathology in 108 Patients Who Underwent Laparoscopic- or Robot-Assisted Surgery for Endometrial Cancer. Gynecol Minim Invasive Ther 2022; 11:203-208. [PMID: 36660335 PMCID: PMC9844038 DOI: 10.4103/gmit.gmit_114_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/11/2022] [Accepted: 05/03/2022] [Indexed: 01/22/2023] Open
Abstract
Objectives The aim of this study was to compare preoperative imaging evaluation results and postoperative histopathology examinations of patients who underwent laparoscopic- or robot-assisted surgery for suspected Stage IA endometrial carcinoma. Materials and Methods There were 298 patients diagnosed with endometrial cancer at our institution between April 2014 and March 2019. Preoperative imaging evaluation based on magnetic resonance imaging (MRI) and computed tomography (CT) revealed 180 patients suspected of having Stage IA disease. Of these, 72 underwent open surgery, 12 underwent robot-assisted surgery, and 96 underwent laparoscopic surgery. In this study, preoperative imaging evaluation results and postoperative histopathology examinations of 108 patients who underwent laparoscopic- or robot-assisted surgery were retrospectively compared. Results Of the 108 patients, who underwent laparoscopic- or robot-assisted surgery for suspected Stage IA disease, 98 had Stage IA, two had Stage IB, and four had Stages II and III disease. The sensitivity of imaging evaluations based on preoperative MRI and CT was 90.7%. Conclusion Utilizing preoperative MRI and CT imaging resulted in a high rate of successful diagnosis of Stage IA endometrial carcinoma.
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Affiliation(s)
- Noriko Terada
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan,Address for correspondence: Dr. Noriko Terada, Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo 060-8543, Japan. E-mail:
| | - Motoki Matsuura
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Shoko Kurokawa
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Mizue Teramoto
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | | | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
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Sentinel lymph node mapping in endometrial cancer to reduce surgical morbidity: always, sometimes, or never. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2022; 21:207-213. [PMID: 36254127 PMCID: PMC9551362 DOI: 10.5114/pm.2022.119862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
Abstract
Introduction Surgical staging of nodal status is of utmost significance to determine the stage of endometrial cancer and construct a targeted treatment plan. Systematic lymphadenectomy has for years been the procedure of choice for staging purposes, enabling thorough assessment of lymph nodes. Nevertheless, it is associated with increased morbidity and severe postoperative complications. In an attempt to avoid the disadvantages of lymphadenectomy, the use of sentinel lymph node (SLN) biopsy has been examined as an alternative staging procedure.The purpose of the present review is to summarize and provide up-to-date evidence about the role of SLN biopsy in the staging and management of endometrial cancer cases in the terms of optimal technique, efficacy, safety, and postoperative morbidity, as an alternative approach to regional lymphadenectomy. Material and methods A thorough literature search was conducted in MEDLINE and SCOPUS to identify recent primary research and previous review articles that explore the use of SLN mapping as a staging procedure in patients with endometrial cancer. Results There is increasing evidence that SLN mapping is efficient in identifying metastatic nodal disease without compromising oncological safety, achieving comparable or even superior detection rates to those of lymphadenectomy, when optimal technique and careful intraoperative nodal assessment are applied. Conclusions Sentinel lymph node mapping can safely replace lymphadenectomy as an acceptable alternative staging method for endometrial cancer; however, future research might further strengthen this suggestion by resolving potential areas of doubt and debate, especially for high-risk endometrial cancer cases.
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Vanbraband J, Van Damme N, Bouche G, Silversmit G, De Geyndt A, de Jonge E, Jacomen G, Goffin F, Denys H, Amant F. Completeness and selection bias of a Belgian multidisciplinary, registration-based study on the EFFectiveness and quality of Endometrial Cancer Treatment (EFFECT). BMC Cancer 2022; 22:600. [PMID: 35650593 PMCID: PMC9161534 DOI: 10.1186/s12885-022-09671-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the aim of obtaining more uniformity and quality in the treatment of corpus uteri cancer in Belgium, the EFFECT project has prospectively collected detailed information on the real-world clinical care offered to 4063 Belgian women with primary corpus uteri cancer. However, as data was collected on a voluntary basis, data may be incomplete and biased. Therefore, this study aimed to assess the completeness and potential selection bias of the EFFECT database. METHODS Five databases were deterministically coupled by use of the patient's national social security number. Participation bias was assessed by identifying characteristics associated with hospital participation in EFFECT, if any. Registration bias was assessed by identifying patient, tumor and treatment characteristics associated with patient registration by participating hospitals, if any. Uni- and multivariable logistic regression were applied. RESULTS EFFECT covers 56% of all Belgian women diagnosed with primary corpus uteri cancer between 2012 and 2016. These women were registered by 54% of hospitals, which submitted a median of 86% of their patients. Participation of hospitals was found to be biased: low-volume and Walloon-region centers were less likely to participate. Registration of patients by participating hospitals was found to be biased: patients with a less favorable risk profile, with missing data for several clinical-pathological risk factors, that did not undergo curative surgery, and were not discussed in a multidisciplinary tumor board were less likely to be registered. CONCLUSIONS Due to its voluntary nature, the EFFECT database suffers from a selection bias, both in terms of the hospitals choosing to participate and the patients being included by participating institutions. This study, therefore, highlights the importance of assessing the selection bias that may be present in any study that voluntarily collects clinical data not otherwise routinely collected. Nevertheless, the EFFECT database covers detailed information on the real-world clinical care offered to 56% of all Belgian women diagnosed with corpus uteri cancer between 2012 and 2016, and may therefore act as a powerful tool for measuring and improving the quality of corpus uteri cancer care in Belgium.
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Affiliation(s)
- Joren Vanbraband
- Biomedical Sciences Group, Department of Oncology, Unit of Gynecological Oncology, KU Leuven, ON4 Herestraat 49, box 1045, 3000, Leuven, Belgium
| | - Nancy Van Damme
- Belgian Cancer Registry, Koningsstraat 215, box 7, 1210, Brussels, Belgium
| | - Gauthier Bouche
- The Anticancer Fund, Brusselsesteenweg 11, 1860, Meise, Belgium
| | - Geert Silversmit
- Belgian Cancer Registry, Koningsstraat 215, box 7, 1210, Brussels, Belgium
| | - Anke De Geyndt
- Belgian Cancer Registry, Koningsstraat 215, box 7, 1210, Brussels, Belgium
| | - Eric de Jonge
- Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Campus Sint-Jan, Schiepse Bos 6, 3600, Genk, Belgium
| | - Gerd Jacomen
- Laboratory of Pathological Anatomy, AZ Sint-Maarten, Liersesteenweg 435, 2800, Mechelen, Belgium
| | - Frédéric Goffin
- Department of Obstetrics and Gynecology, CHR de La Citadelle, Boulevard du 12ème de Ligne 1, 4000, Liège, Belgium
| | - Hannelore Denys
- Department of Medical Oncology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Frédéric Amant
- Biomedical Sciences Group, Department of Oncology, Unit of Gynecological Oncology, KU Leuven, ON4 Herestraat 49, box 1045, 3000, Leuven, Belgium.
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
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Smith CG, Chen Q, Huang B, Miller RW, DeSimone CP, Dietrich CS, Ueland FR, Gallion HH, Pavlik EJ, van Nagell JR, Baldwin Branch LA. The Log Odds of Positive Lymph Nodes Predict Survival of Advanced-Stage Endometrial Cancer: A Retrospective Analysis of 3230 Patients in the Surveillance, Epidemiology, and End Results Database. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Quan Chen
- Department of Biostatistics, Markey Cancer Center, Markey Cancer Center, Lexington, Kentucky, USA
| | - Bin Huang
- Department of Biostatistics, Markey Cancer Center, Markey Cancer Center, Lexington, Kentucky, USA
| | - Rachel W. Miller
- Department of Obstetrics & Gynecology, Markey Cancer Center, Lexington, Kentucky, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, Kentucky, USA
| | - Christopher P. DeSimone
- Department of Obstetrics & Gynecology, Markey Cancer Center, Lexington, Kentucky, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, Kentucky, USA
| | - Charles S. Dietrich
- Department of Obstetrics & Gynecology, Markey Cancer Center, Lexington, Kentucky, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, Kentucky, USA
| | - Frederick R. Ueland
- Department of Obstetrics & Gynecology, Markey Cancer Center, Lexington, Kentucky, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, Kentucky, USA
| | - Holly H. Gallion
- Department of Obstetrics & Gynecology, Markey Cancer Center, Lexington, Kentucky, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, Kentucky, USA
| | - Edward J. Pavlik
- Department of Obstetrics & Gynecology, Markey Cancer Center, Lexington, Kentucky, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, Kentucky, USA
| | - John R. van Nagell
- Department of Obstetrics & Gynecology, Markey Cancer Center, Lexington, Kentucky, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, Kentucky, USA
| | - Lauren A. Baldwin Branch
- Department of Obstetrics & Gynecology, Markey Cancer Center, Lexington, Kentucky, USA
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, Kentucky, USA
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Ye Z, Ning G, Li X, Koh TS, Chen H, Bai W, Qu H. Endometrial carcinoma: use of tracer kinetic modeling of dynamic contrast-enhanced MRI for preoperative risk assessment. Cancer Imaging 2022; 22:14. [PMID: 35264244 PMCID: PMC8908697 DOI: 10.1186/s40644-022-00452-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 02/24/2022] [Indexed: 01/07/2023] Open
Abstract
Background To compare two tracer kinetic models in predicting of preoperative risk types in endometrial carcinoma (EC) using DCE-MRI. Methods A prospective study of patients with EC was conducted with institutional ethics approval and written informed consent. DCE-MRI data was analyzed using the extended Tofts (ET) and the distributed parameter (DP) models. DCE parameters blood flow (F), mean transit time, blood volume (Vp), extravascular extracellular volume (Ve), permeability surface area product (PS), extraction fraction, transfer constant (Ktrans), and efflux rate (Kep) between high- and low-risk EC were compared using the Mann–Whitney test. Bland–Altman analysis was utilized to compare parameter consistency and Spearman test to assess parameter correlation. Diagnostic performance of DCE parameters was analyzed by receiver-operating characteristic curve and compared with traditional MRI assessment. Results Fifty-one patients comprised the study group. Patients with high-risk EC exhibited significantly lower Ktrans, Kep, F, Vp and PS (P < 0.001). ET-derived Ktrans and DP-derived F attained AUC of 0.92 and 0.91, respectively. Bland–Altman analysis showed that the consistency of Ve or Vp between the two models was low (P < 0.001) while Spearman test showed a strong correlation (r = 0.719, 0.871). Both Ktrans and F showed higher accuracy in predicting EC risk types than traditional MRI assessment. Conclusions Kinetic parameters derived from DCE-MRI revealed a more hypovascular microenvironment for high risk EC than to low- risk ones, providing potential imaging biomarkers in preoperative risk assessment that might improve individualized surgical planning and management of EC.
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Affiliation(s)
- Zhijun Ye
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Gang Ning
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China.
| | - Xuesheng Li
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Tong San Koh
- Department of Oncologic Imaging, National Cancer Center, Singapore, 169610, Singapore
| | - Huizhu Chen
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Wanjing Bai
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Haibo Qu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
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16
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Anderson EM, Luu M, Lu DJ, Chung EM, Kamrava M. Pathologic primary tumor factors associated with risk of lymph node involvement in patients with non-endometrioid endometrial cancer. Gynecol Oncol 2022; 165:281-286. [PMID: 35216809 DOI: 10.1016/j.ygyno.2022.01.016] [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: 09/11/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE/OBJECTIVES Lymph node (LN) involvement is an important factor in guiding adjuvant treatment for patients with endometrial cancer. Risk factors for LN involvement are fairly well-established for endometrial adenocarcinoma, but it is not as well defined whether these factors similarly predict LN positivity in less common histologies. MATERIALS/METHODS Patients diagnosed with pathologic T1-T2 carcinosarcoma, clear cell, uterine papillary serous carcinoma (UPSC), and mixed histologic type endometrial cancer between 2004 and 2016 undergoing primary surgery with at least 1 lymph node sampled in the National Cancer Data Base were identified. Logistic regression was performed to identify primary pathologic tumor predictors of LN positivity. Nomograms were created to predict overall, pelvic only, and paraaortic with or without pelvic LN involvement. RESULTS Among 11,390 patients included, 1950 (18%) were node positive. On multivariable analysis, increasing pathologic tumor stage (pT2 versus pT1a, odds ratio [OR] 3.63, 95% confidence interval [CI] 3.15-4.18, p < 0.001), increase in tumor size per centimeter (OR 1.08, 95% CI 1.06-1.10, p < 0.001), and the presence of lymphovascular invasion (LVI) (OR 4.97, 95% CI 4.43-5.57, p < 0.001) were predictive of overall LN positivity. Relative to carcinosarcoma, both clear cell (OR 1.54, 95% CI 1.22-1.95, p < 0.001) and UPSC (OR 1.73, 95% CI 1.48-2.02, p < 0.001) histology were significantly associated with a higher risk of LN positivity while mixed histology was not (OR 1.07, 95% CI 0.92-1.24, p = 0.42). CONCLUSION Among patients with non-endometrioid endometrial cancer, predictors of LN positivity are similar to endometrial adenocarcinoma. The nomograms provided could be helpful in making adjuvant treatment decisions for these less common histologies.
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Affiliation(s)
- Eric M Anderson
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Michael Luu
- Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Diana J Lu
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Eric M Chung
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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Paraaortic Lymphadenectomy in Gynecologic Oncology—Significance of Vessels Variations. J Clin Med 2022; 11:jcm11040953. [PMID: 35207226 PMCID: PMC8879527 DOI: 10.3390/jcm11040953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Abstract
Lymphadenectomy has been an essential part of the surgical treatment in surgical oncology, as the lymphatic channels and nodes are the main dissemination pathway for most of the gynecological cancers. Pelvic and paraaortic lymphadenectomy are frequent surgical procedures in gynecologic oncology. Paraaortic lymph node dissection facilitates staging, prognosis, surgical and postoperative management of patients. It is one of the most challenging retroperitoneal surgeries. A comprehensive knowledge of the paraaortic region is mandatory. Intraoperative bleeding is the most common complication during lymphadenectomy due to direct vascular injury, poor tissue handling, exuberant retraction and possible anatomical variations of the vessels in the paraaortic region. Approximately, one-third of women will have at least one anatomic variation in the paraaortic region. It must be stressed that anomalous vessels may be encountered in every woman who will undergo surgery. Consequently, detailed knowledge of anatomical vessels variations is required in order to prevent iatrogenic vessel injury. The importance of these variations is well described in urology, vascular and general surgery. Conversely, in oncogynecological surgery, there are few articles, which described some of the vessels variations in the paraaortic region. The present article aims to propose a surgical classification and to describe the majority of vessels variation, which could be encountered during paraaortic lymphadenectomy in gynecologic oncology. Moreover, surgical considerations in order to prevent anomalous vessels injury are well described.
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Gastón B, Muruzábal JC, Lapeña S, Modroño A, Guarch R, García de Eulate I, Alcázar JL. Transvaginal Ultrasound Versus Magnetic Resonance Imaging for Assessing Myometrial Infiltration in Endometrioid Low Grade Endometrial Cancer: A Prospective Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:335-342. [PMID: 33780025 DOI: 10.1002/jum.15708] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To compare the diagnostic accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) for assessing myometrial infiltration (MI) in patients with low grade endometrioid endometrial cancer. METHODS Observational prospective study performed at a single tertiary care center from 2016 to 2020, comprising 156 consecutive patients diagnosed by endometrial sampling as having an endometrioid grade 1/grade 2 endometrial cancer. TVS and MRI were performed prior to surgical staging for assessing MI, which was estimated using subjective examiner's impression and Karlsson's method for both TVS and MRI. During surgery, intraoperative assessment of MI was also performed. Definitive pathological study considered as reference standard. Diagnostic accuracy for ultrasound, MRI, and intraoperative biopsy was estimated and compared. RESULTS Sensitivity and specificity of TVS for detecting deep MI were 75 and 73.5% for subjective impression and 65 and 70% for Karlsson method, respectively (P = .54). Sensitivity and specificity of MRI for detecting deep MI were 80 and 87% for subjective impression and 70 and 71.3% for Karlsson method. MRI subjective impression showed a significant better specificity than MRI Karlsson method (P = .03). MRI showed better specificity than TVS when subjective impression was considered (P <.05), but not for Karlsson method. Sensitivity and specificity of intraoperative were 75 and 97%, respectively. Intraoperative biopsy showed better specificity than ultrasound and MRI either using examiner's impression or Karlsson method (P <.05). CONCLUSIONS MRI revealed a significant higher specificity than TVS when assessing deep myometrial infiltration. However, the intraoperative biopsy offers a significant better diagnostic accuracy than preoperative imaging techniques.
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Affiliation(s)
- Begoña Gastón
- Division of Benign Gynecologic Pathology, Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Juan C Muruzábal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Sonia Lapeña
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Ana Modroño
- Division of Ultrasound, Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Rosa Guarch
- Department of Pathological Anatomy, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | | | - Juan L Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Proppe L, Alkatout I, Koch R, Baum S, Kotanidis C, Rody A, Hanker LC, Gitas G. Impact of lymphadenectomy on short- and long-term complications in patients with endometrial cancer. Arch Gynecol Obstet 2022; 306:811-819. [PMID: 35038040 PMCID: PMC9411244 DOI: 10.1007/s00404-022-06396-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
Introduction Early endometrial cancer is primarily treated surgically via hysterectomy, adenectomy and, depending on tumor stage and subtype, lymphadenectomy. Systematic lymph node dissection is known to cause surgical complications. The aim of the present study was to investigate morbidity and mortality rates associated with lymphadenectomy in patients with endometrial cancer who underwent surgery in a routine clinical setting.
Methods We collected data from 232 patients who were operated for endometrial carcinoma between 2006 and 2018 at the University of Lubeck, Germany. Surgical complications were viewed in relation to surgical risk factors. Additionally, a questionnaire concerning long-term lymphatic complications and survival was completed. Survival was compared between patients who underwent lymphadenectomy (group I) and those who did not (group II).
Results Patients in group I needed revision surgery significantly more often due to postoperative complications (such as lymphoceles) compared to those in group II (p = 0.01). The results indicate more serious complications in patients who underwent a systematic lymphadenectomy and in those with lymph node metastases. 15% of patients who underwent a systematic lymphadenectomy had lymph node metastases. Recurrences occurred in 12.5% of cases and were significantly more frequent in patients who had undergone a lymphadenectomy, even if the lymph nodes were negative (p = 0.02). A comparison of survival data during the follow-up period revealed no significant difference. The study highlighted the need for a better preoperative risk stratification and the avoidance of lymphadenectomy for surgical staging alone. Supplementary Information The online version contains supplementary material available at 10.1007/s00404-022-06396-5.
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Affiliation(s)
- Louisa Proppe
- Department of Gynecology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Ibrahim Alkatout
- Department of Gynecology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ricarda Koch
- Department of Gynecology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Sascha Baum
- Department of Gynecology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | | | - Achim Rody
- Department of Gynecology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Lars C Hanker
- Department of Gynecology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Georgios Gitas
- Department of Gynecology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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Ladbury C, Li R, Shiao J, Liu J, Cristea M, Han E, Dellinger T, Lee S, Wang E, Fisher C, Chen YJ, Amini A, Robin T, Glaser S. Characterizing impact of positive lymph node number in endometrial cancer using machine-learning: A better prognostic indicator than FIGO staging? Gynecol Oncol 2021; 164:39-45. [PMID: 34794840 DOI: 10.1016/j.ygyno.2021.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Number of involved lymph nodes (LNs) is a crucial stratification factor in staging of numerous disease sites, but has not been incorporated for endometrial cancer. We evaluated whether number of involved LNs provide improved prognostic value. PATIENTS AND METHODS Patients diagnosed with node-positive endometrial adenocarcinoma without distant metastasis were identified in the National Cancer Database. We trained a machine-learning based model of overall survival. Shapley additive explanation values (SHAP) based on the model were used to identify cutoffs of number of LNs involved. Results were validated using a Cox proportional hazards regression model. RESULTS We identified 11,381 patients with endometrial cancer meeting the inclusion criteria. Using the SHAP values, we selected the following thresholds: 1-3 LNs, 4-5 LNs, and 6+ LNs. The 3-year OS was 82.0% for 1-3 LNs, 74.3% for 4-5 LNs (hazard ratio [HR] 1.38; p < 0.001), and 59.9% for 6+ LNs (HR 2.23; p < 0.001). On univariate Cox regression, PA nodal involvement was a significant predictor of OS (HR 1.20; p < 0.001) but was not significant on multivariate analysis when number of LNs was included (HR 1.05; p = 0.273). Additionally, we identified an interaction between adjuvant therapy and number of involved LNs. Patients with 1-3 involved LNs had 3-year OS of 85.2%, 78.7% and 74.2% with chemoradiation (CRT), chemotherapy, and radiation, respectively. Patients with 6+ involved LNs had 3-yr OS of 67.8%, 49.6%, and 48.9% with CRT, chemotherapy, and radiation, respectively (p < 0.001). CONCLUSION Number of involved LNs is a stronger prognostic and predictive factor compared to PA node involvement.
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Affiliation(s)
- Colton Ladbury
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Richard Li
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jay Shiao
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jason Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Mihaela Cristea
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Ernest Han
- Department of Gynecologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Thanh Dellinger
- Department of Gynecologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Stephen Lee
- Department of Gynecologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Edward Wang
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Christine Fisher
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yi-Jen Chen
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Tyler Robin
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Scott Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA.
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Li Z, Zhang W, Luo Z, Huang J, Li L. Clinical study of the clinical characteristics and prognosis of 1219 cases of endometrial cancer with lymph node metastasis. Hum Exp Toxicol 2021; 40:1601-1611. [PMID: 33858227 DOI: 10.1177/09603271211008506] [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: 11/15/2022]
Abstract
To analyze the clinical characteristics and prognosis of endometrial cancer patients with lymph node metastasis to provide a reference for lymphadenectomy in endometrial cancer. The data used in this study were extracted from a tertiary hospital in Guangxi, China based on the hospital information system. 1219 patients with endometrial malignancy who were treated in our hospital. The lymph node metastasis rate was 9.8%. The metastasis rate of the abdominal aorta + pelvic lymph nodes (56.7%) was significantly higher than that of the pelvic (24.2%) or para-aortic (19.2%) lymph nodes alone. The proportion of postmenopausal patients with lymph node metastasis was higher than that of premenopausal patients. The proportion of patients with lymph node metastasis with vaginal and uterus involvement, HPV detection, Thinprep Cytologic Testresults, CRP level <10 ug/mL, G3 tumor grade, postoperative pathology indicating cervical invasion, lymphovascular invasion, and muscular infiltration depth > 1/2 was higher than that of patients without lymph node metastasis. The proportion of endometrial cancer patients with lymph node metastasis with CA125 ≥ 35 U/ml was higher than that of those with CA125 < 35 U/ml. The lymph node-positive rate is related to tissue differentiation, lymphangitic infiltration, cervical invasion, muscle infiltration depth > 1/2, and CA125 level. The metastasis rate of pelvic and para-aortic lymph nodes is higher than that of pelvic lymph nodes or para-aortic lymph nodes alone. There was no statistically significant difference in the overall survival rate among the three groups.
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Affiliation(s)
- Z Li
- Department of Gynecologic Oncology, 117981Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People's Republic of China
| | - W Zhang
- Department of Gynecologic Oncology, 117981Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People's Republic of China
| | - Z Luo
- Department of Gynecologic Oncology, 117981Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People's Republic of China
| | - J Huang
- Department of Gynecologic Oncology, 117981Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People's Republic of China
| | - L Li
- Department of Gynecologic Oncology, 117981Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People's Republic of China
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22
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Jung SG, Im SH, Kim M, Choi MC, Joo WD, Song SH, Lee C, Park H. The Association Between the Number of Retrieved Pelvic Lymph Nodes and Ipsilateral Lower Limb Lymphedema in Patients With Gynecologic Cancer. J INVEST SURG 2021; 35:978-983. [PMID: 34545757 DOI: 10.1080/08941939.2021.1980160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE While the risk of lower limb lymphedema (LLE) after radical surgery for gynecologic malignancies is multifactorial, the limited assessment of lymph nodes (LNs), such as sentinel LN biopsy, has been incorporated into a standard procedure. We assessed the relationship between the number of LNs retrieved from the hemipelvis and the incidence of ipsilateral LLE (iLLE). METHODS This retrospective study included 103 women with gynecologic cancer who had LNs removed with minimally invasive surgery between January 2014 and December 2018. For early detection of LLE, the patients were followed up by a lymphedema specialist who complied with the International Society of Lymphedema criteria. Potential risk factors for LLE were collected, and the risk factors were further investigated according to the number of LNs removed in a side-specific manner. RESULTS LLE was diagnosed in 32 (31.1%) patients, and most of them were diagnosed with unilateral (n = 22) LLE rather than bilateral (n = 10). The number of pelvic LNs removed (p = 0.018), no lymphatic mapping (p = 0.034), and radiation (p = 0.020) were associated with the development of one or both LLEs. A side-specific analysis revealed that the incidence of iLLE increased significantly when four or more LNs were removed from the hemipelvis compared with three or fewer LNs (22.9% vs. 8.3%, p = 0.048). CONCLUSIONS The number of pelvic LNs retrieved was associated with the incidence of LLE in patients with early gynecologic cancer. We identified the cutoff number per hemipelvis through side-specific analysis that could minimize the risk of iLLE. Further studies are needed to validate our results.
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Affiliation(s)
- Sang Geun Jung
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University College of Medicine, Gynnggi-do, Korea
| | - Sang Hee Im
- Department and Research Institute of Rehabilitation Medicine, Severance Rehabilitation Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Migang Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University College of Medicine, Gynnggi-do, Korea
| | - Min Chul Choi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University College of Medicine, Gynnggi-do, Korea
| | - Won Duk Joo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University College of Medicine, Gynnggi-do, Korea
| | - Seung Hun Song
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University College of Medicine, Gynnggi-do, Korea
| | - Chan Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University College of Medicine, Gynnggi-do, Korea
| | - Hyun Park
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University College of Medicine, Gynnggi-do, Korea
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23
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Lymphadenectomy in Endometrial Cancers—A Review. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00562-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Kurata Y, Nishio M, Moribata Y, Kido A, Himoto Y, Otani S, Fujimoto K, Yakami M, Minamiguchi S, Mandai M, Nakamoto Y. Automatic segmentation of uterine endometrial cancer on multi-sequence MRI using a convolutional neural network. Sci Rep 2021; 11:14440. [PMID: 34262088 PMCID: PMC8280152 DOI: 10.1038/s41598-021-93792-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/29/2021] [Indexed: 12/29/2022] Open
Abstract
Endometrial cancer (EC) is the most common gynecological tumor in developed countries, and preoperative risk stratification is essential for personalized medicine. There have been several radiomics studies for noninvasive risk stratification of EC using MRI. Although tumor segmentation is usually necessary for these studies, manual segmentation is not only labor-intensive but may also be subjective. Therefore, our study aimed to perform the automatic segmentation of EC on MRI with a convolutional neural network. The effect of the input image sequence and batch size on the segmentation performance was also investigated. Of 200 patients with EC, 180 patients were used for training the modified U-net model; 20 patients for testing the segmentation performance and the robustness of automatically extracted radiomics features. Using multi-sequence images and larger batch size was effective for improving segmentation accuracy. The mean Dice similarity coefficient, sensitivity, and positive predictive value of our model for the test set were 0.806, 0.816, and 0.834, respectively. The robustness of automatically extracted first-order and shape-based features was high (median ICC = 0.86 and 0.96, respectively). Other high-order features presented moderate-high robustness (median ICC = 0.57-0.93). Our model could automatically segment EC on MRI and extract radiomics features with high reliability.
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Affiliation(s)
- Yasuhisa Kurata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Mizuho Nishio
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan.
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yusaku Moribata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
- Preemptive Medicine and Lifestyle-Related Disease Research Center, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Yuki Himoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Satoshi Otani
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Koji Fujimoto
- Department of Real World Data Research and Development, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Masahiro Yakami
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
- Preemptive Medicine and Lifestyle-Related Disease Research Center, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyoku, Kyoto, 606-8507, Japan
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25
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Kong TW, Jo E, Son JH, Paek J, Chang SJ, Ryu HS. Treatment outcomes and complications in FIGO stage IIIC and IVB endometrioid endometrial cancer patients presenting as nodal spreads following systematic lymphadenectomy and adjuvant therapy. J Obstet Gynaecol Res 2021; 47:3322-3330. [PMID: 34196087 DOI: 10.1111/jog.14915] [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: 04/19/2021] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the treatment outcomes and complications of patients with FIGO stage IIIC and IVB endometrioid endometrial cancer (EC) presenting primarily as nodal spreads following systematic lymphadenectomy and adjuvant therapy. MATERIAL AND METHODS Forty-four FIGO stage IIIC and IVB endometrioid EC patients between July 2003 and March 2020 received staging procedures including systematic lymphadenectomy. The survival outcomes and late treatment-related complications were compared between adjuvant chemoradiation-based group and chemotherapy-based group. RESULTS Of the 44 patients, 16 (36.4%) had stage IIIC1, 26 (59.1%) had stage IIIC2, and 2 (4.5%) had stage IVB disease. The median follow-up time was 54 months (range, 10-185 months). There was no statistical difference in mortality between the microscopic and macroscopic nodal groups (6.2% vs 4.3%, p > 0.999). Eleven patients (25.0%) and 33 patients (75.0%) received adjuvant chemoradiation and chemotherapy, respectively. The 5-year disease-free and overall survival rates were not different between the two groups (disease-free survival, 81.8% vs 82.1%, p = 0.743; overall survival, 90.9% vs 95.8%, p = 0.537). The incidence rates of grade 2 lymphedema (36.4% vs 9.1%, p = 0.032) and grade 2/3 gastrointestinal complications (36.4% vs 0.0%, p < 0.001) were higher in the chemoradiation-based group than those in the chemotherapy-based group. CONCLUSIONS Systematic lymphadenectomy and adjuvant chemotherapy might be the preferred treatment for FIGO stage IIIC and IVB endometrioid EC patients presenting as nodal spreads given that no difference in patient survival was found, but a higher incidence of treatment-related complications was observed in the chemoradiation-based group.
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Affiliation(s)
- Tae-Wook Kong
- Division of Gynecologic Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Eunae Jo
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Joo-Hyuk Son
- Division of Gynecologic Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jiheum Paek
- Division of Gynecologic Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Suk-Joon Chang
- Division of Gynecologic Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hee-Sug Ryu
- Division of Gynecologic Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
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Presence of Glandular Cells at the Preoperative Cervical Cytology and Local Recurrence in Endometrial Cancer. Int J Gynecol Pathol 2021; 39:522-528. [PMID: 31651558 DOI: 10.1097/pgp.0000000000000642] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We investigated the correlation between glandular cells (GC) detected at preoperative cervical-smear and the histologic findings and oncologic outcomes in patients undergoing surgery for endometrial cancer (EC). We retrospectively analyzed data of all consecutive EC patients who underwent surgery between January 1, 1990 and December 31, 2012 with preoperative cervical smear performed within 3 mo from the EC diagnosis. Basic descriptive, logistic regression and artificial neural network analyses were used. Five-year disease-free survival and overall survival were assessed using Kaplan-Meier and Cox hazard models. The study included 229 (89%) and 29 (11%) patients with normal cytology (control group) and GC (GC group), respectively. A higher proportion of elderly patients with nonendometrioid and FIGO grade 3 EC was observed in the GC group compared with the control group (P<0.05). No differences in 5-yr disease-free survival and overall survival were observed. However, patients in the GC group experienced a higher local recurrence rate (hazard ratio: 7.6; 95% confidence interval: 1.7-34.2; P=0.008). We observed that age, body mass index, cervical stromal invasion, vaginal brachytherapy, and GC influenced the risk for developing local recurrence. However, at the multivariable analysis, only cervical stromal invasion (odds ratio: 1.2; 95% confidence interval: 1.02-1.4; P=0.02) and GC (odds ratio: 1.07; 95% confidence interval: 1.01-1.14; P=0.03) correlated with the increased risk. In addition, the results of an artificial neural network analysis reported that the most critical predictor of local failure was cervical stromal invasion (importance: 0.352) followed by GC (importance: 0.194). These results suggest that cervical stromal invasion and presence of GC at the preoperative cervical smear might predict the occurrence of local recurrence in EC.
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Preoperative prediction of high-risk endometrial cancer by expert and non-expert transvaginal ultrasonography, magnetic resonance imaging, and endometrial histology. Eur J Obstet Gynecol Reprod Biol 2021; 263:181-191. [PMID: 34218206 DOI: 10.1016/j.ejogrb.2021.05.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/10/2021] [Accepted: 05/22/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify women with high-risk endometrial cancers using expert and non-expert transvaginal ultrasonography (TVS) and MRI. STUDY DESIGN Myometrial involvement was prospectively evaluated in patients with atypical hyperplasia or endometrial cancer on ultrasound by non-experts at first visit (non-expert-TVS: n = 266) and experts (expert-TVS: n = 188) at second visit. MRI (n = 175) was performed when high-risk cancer was suspected on non-expert-TVS. Preoperatively, high-risk cancer was defined as myometrial involvement ≥50 %, or preoperative unfavorable tumor histology (grade 3 endometrioid, non-endometrioid tumors, or tumor in cervical biopsies) obtained by endometrial sampling or hysteroscopic biopsies. Preoperative evaluations were compared with final histopathology obtained at surgery, high-risk cancer being defined as unfavorable tumor histology or patients with FIGO stage ≥1b. RESULTS Preoperative unfavorable tumor histology was seen in 64 women and correctly identified 63 of 128 high-risk cancers. Preoperative diagnosis of unfavorable tumor histology or myometrial involvement ≥50 %, i.e. judged high-risk, had an area under the curve (AUC), sensitivity, and specificity of 79.5 %, 93.8 %, 65.2 % on non-expert-TVS; 85.5 %, 84.4 %, 86.5 % on expert-TVS, and 85.4 %, 89.6 %, 81.2 % on MRI. AUC values were not significantly different between MRI and expert-TVS, but lower on non-expert-TVS (p < 0.02). However, sensitivity was highest on non-expert-TVS, where a low cutpoint for myometrial involvement was used (included potentially deep and difficult evaluations) in contrast to an exact cutpoint of myometrial involvement ≥50 % used on expert-TVS and MRI. The highest AUC, 88.6 %, was seen when MRI was performed in patients with myometrial involvement ≥50 %, determined on non-expert TVS. Sensitivity was reduced to 85.9 %, while specificity increased to 91.3 %. Thus, MRI was needed for risk classification in only 104 (39 %) patients. CONCLUSION Diagnostically, expert-TVS and MRI were comparable and superior to non-expert-TVS. However, non-expert-TVS classified all patients with unclear myometrial involvement ≥50 %, and thereby only misdiagnosed 6.2 % of high-risk cases. Non-expert-TVS combined with MRI when myometrial involvement was ≥50 % on non-expert-TVS was a simple and effective method comparable with expert imaging to identify low- and high-risk cancer and select patients for SLND. Addition of MRI to the diagnostic regimen was needed in only 39 % of our patients.
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A modified technique to perform para-aortic lymphadenectomy up to the renal vein. Taiwan J Obstet Gynecol 2021; 59:541-545. [PMID: 32653126 DOI: 10.1016/j.tjog.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate the safety and feasibility of our modified technique to perform lymph node excision up to the renal vein in cases of gynecological cancer. MATERIALS AND METHODS 87 patients with endometrial or ovarian neoplasms underwent laparoscopic para-aortic lymphadenectomy (LPAL) up to the left renal vein were enrolled prospectively. During surgery, the surgeon was positioned to the right side of the patient and an additional trocar was introduced into the upper right abdomen. The laparoscopic video screen was placed to the side of the patient's head. Three-fan retractor forceps were used to hold up the duodenum and small bowel. The rest of the procedure was the same as conventional LPAL. RESULTS The median operating time for LPAL was 72 min (range: 40-115 min) and the median estimated blood loss was 45 ml (range: 15-1000 mL). There were two cases of intra-operative vascular injury. The median number of retrieved para-aortic lymph nodes (PALNs) was 18 (range: 10-37). Of the 87 patients, 11 patients had positive PALNs. None of the cases required laparotomy. CONCLUSION Our findings demonstrate that our modified LPAL technique is feasible, reproducible, can achieve good exposure and reduces surgical difficulty.
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29
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Namazov A, Helpman L, Eitan R, Vaknin Z, Lavie O, Ben-Arie A, Amit A, Levy T, Volodarsky M, Atlas I, Bruchim I, Gemer O. The diagnosis of endometrial cancer in women with asymptomatic endometrial polyp does not increase survival rates: an israel gynecologic oncology group study. Maturitas 2021; 148:18-23. [PMID: 34024347 DOI: 10.1016/j.maturitas.2021.04.001] [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: 02/16/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare outcomes of symptomatic and asymptomatic women with endometrial cancer and a preoperative diagnosis of an endometrial polyp. DESIGN An Israel Gynecologic Oncology Group multi-center retrospective cohort study. METHODS Of 635 patients with endometrial cancer and a preoperative diagnosis of an endometrial polyp who underwent surgery between 2002 and 2014 in one of 11 centers in Israel were divided into two groups according to the presence of bleeding symptoms. Outcome measures included recurrence-free survival, disease-specific survival and overall survival. Survival data were plotted according to the method of Kaplan and Meier and compared using the log-rank test. RESULTS There were 513 symptomatic and 122 asymptomatic women with endometrial cancer and a preoperative diagnosis of an endometrial polyp. The median follow-up was 52 months (range 12-120 months). There were no differences between patients who experienced bleeding and those who did not in 5-year recurrence-free survival (85.2 % vs. 85.7 %; p=0.83, respectively), disease-specific survival (88.2 % vs. 89.2 %; p=0.71, respectively), or overall survival (80.2% vs. 78.4 %; p=0.97, respectively). CONCLUSION The diagnosis of endometrial cancer in patients with asymptomatic endometrial polyps is not associated with improved outcomes as compared with patients with bleeding. In the absence of factors indicating a high risk of endometrial cancer, clinical and sonographic follow-up is the advised management strategy for these patients.
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Affiliation(s)
- Ahmet Namazov
- Barzilai University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Ashkelon.
| | - Limor Helpman
- Meir Medical Center, Clalit Health Services, Tel Aviv University, Kfar Saba
| | - Ram Eitan
- Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva
| | - Zvi Vaknin
- Assaf Haroffe Medical Center, Sackler School of Medicine, Tel Aviv University, Zrifin
| | - Ofer Lavie
- Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Haifa
| | | | - Amnon Amit
- Rambam Medical Center, Rappaport Faculty of Medicine, Technion, Haifa
| | - Tally Levy
- Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Holon
| | - Michael Volodarsky
- Barzilai University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Ashkelon
| | - Ilan Atlas
- Poriya Medical Center, Bar Ilan University, Tiberia
| | - Ilan Bruchim
- Hillel Yaffe Medical Center, Rappaport Faculty of Medicine, Technion, Hedera
| | - Ofer Gemer
- Barzilai University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Ashkelon
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Guo Q, Yi H, Chen X, Song J, Chen L, Zheng X. Is routine frozen section analysis necessary in patients with non-endometrioid cancer or grade 3 endometrioid cancer? Int J Gynaecol Obstet 2021; 156:256-261. [PMID: 33864253 PMCID: PMC9290841 DOI: 10.1002/ijgo.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 12/24/2022]
Abstract
Objective To explore the accuracy related to type and subtype between frozen section (FS) results and final pathology results in patients with endometrial cancer and to suggest whether it should be routinely performed. Methods Retrospective data were collected from 184 patients with endometrial cancer who underwent surgery at a single center (January 2014–December 2018). FS results were compared with the final pathology results with respect to histotype, tumor grade, and depth of invasion to define the accuracy of FS analysis. Results Frozen section analysis was performed in 141 (76.6%) patients. The accuracy rates and κ values between the FS and final pathology results with respect to histotype, tumor grade, and depth of invasion were 87.23%, 81.15%, and 98.2% and 0.41, 0.7, and 0.9, respectively (P < 0.001). Among the 18 patients with preoperative non‐endometrioid cancer (non‐EC), six underwent FS analysis, and final pathology confirmed EC in three, of whom 75% were detected by FS analysis. Eight of 19 patients with preoperative grade 3 EC underwent FS analysis and the accuracy rate was 87.5%. Conclusion Intraoperative FS analysis is a reliable method that can help intraoperative decision making. It should be performed routinely in patients with non‐EC and grade 3 EC.
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Affiliation(s)
- Qingyong Guo
- Department of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Huan Yi
- Department of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaodan Chen
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jianrong Song
- Department of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Lingsi Chen
- Department of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiangqin Zheng
- Department of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
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Nasioudis D, Byrne M, Ko EM, Giuntoli Ii RL, Haggerty AF, Cory L, Kim SH, Morgan MA, Latif NA. The impact of sentinel lymph node sampling versus traditional lymphadenectomy on the survival of patients with stage IIIC endometrial cancer. Int J Gynecol Cancer 2021; 31:840-845. [PMID: 33853879 DOI: 10.1136/ijgc-2021-002450] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the survival of patients with lymph node positive endometrial carcinoma by type of surgical lymph node assessment. METHODS Patients diagnosed between January 2012 and December 2015 with endometrial carcinoma and uterine confined disease and nodal metastases on final pathology who underwent minimally invasive hysterectomy were identified in the National Cancer Database. Patients who had sentinel lymph node biopsy alone or underwent systematic lymphadenectomy were selected. Overall survival was evaluated following generation of Kaplan-Meier curves and compared with the log rank test. A Cox model was constructed to evaluate survival after controlling for confounders. RESULTS A total of 1432 patients were identified: 1323 (92.4%) and 109 (7.6%) underwent systematic lymphadenectomy and sentinel lymph node biopsy only, respectively. The rate of adjuvant treatment was comparable between patients who had sentinel lymph node biopsy alone and systematic lymphadenectomy (83.5% vs 86.6%, p=0.39). However, patients who had sentinel lymph node biopsy were less likely to receive chemotherapy alone (13.6% vs 36.6%, p<0.001) and more likely to receive radiation therapy alone (19.8% vs 5.4%, p<0.001) compared with patients who had systematic lymphadenectomy. There was no difference in overall survival between patients who had sentinel lymph node biopsy alone and systematic lymphadenectomy (p=0.27 from log rank test), and 3 year overall survival rates were 82.2% and 79.4%, respectively (p>0.05). After controlling for confounders, there was no difference in survival between the systematic lymphadenectomy and sentinel lymph node biopsy alone groups (hazard ratio 0.82, 95% confidence interval 0.46 to 1.45). CONCLUSIONS Performance of sentinel lymph node biopsy alone was not associated with an adverse impact on survival in patients with lymph node positive endometrial cancer.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maureen Byrne
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert L Giuntoli Ii
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashley F Haggerty
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lori Cory
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah H Kim
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark A Morgan
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nawar A Latif
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Capozzi VA, Riemma G, Rosati A, Vargiu V, Granese R, Ercoli A, Cianci S. Surgical complications occurring during minimally invasive sentinel lymph node detection in endometrial cancer patients. A systematic review of the literature and metanalysis. Eur J Surg Oncol 2021; 47:2142-2149. [PMID: 33820674 DOI: 10.1016/j.ejso.2021.03.253] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/13/2021] [Accepted: 03/24/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Endometrial cancer (EC) is the most common gynecological cancer. Sentinel lymph node (SLN) technique has been adopted worldwide and showed lower morbidity and superimposable survival outcomes than the systematic lymphadenectomy (LND). Although these encouraging results, no meta-analyzes were performed on surgical complications during SLN research among patients undergoing laparoscopic (L) versus robotic surgery (R). The present review aims to report surgical complications during laparoscopic versus robotic SLN technique. METHODS The Preferred Reporting Items for Systematic reviews and Meta-Analyzes (PRISMA) and the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines have been followed for the present meta-analysis. RESULTS Six studies, including 769 participants, were included. L-LND resulted in a significantly higher risk of operative complications relative to L-SLN (RR 2.10 [95% CI 1.37 to 3.21]). The risk of complications was comparable between R-SLN and L-SLN (RR 2.32 [95% CI 0.04-121.02]) and between R-LND and L-LND (RR 2.17 [95% CI 0.04-126.69]). According to the SUCRA analysis, L-SLN and R-SLN had the highest chances of being ranked first among proposed surgical procedures (SUCRA 48.9% and 28.4% respectively). CONCLUSIONS Our study reported a lower surgical complications rate in patients undergoing L-SLN technique compared to L-LND. A lower rate of surgical complications was also reported for the R-SLN technique compared to the R-LND. Both laparoscopic and robotic SLN surgical techniques were found to be safe surgical procedures.
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Affiliation(s)
- Vito Andrea Capozzi
- Department of Gynecology and Obstetrics, University of Parma, 43125, Parma, Italy.
| | - Gaetano Riemma
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Andrea Rosati
- Dipartimento per le Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Department of Gynecology and Obstetrics, Roma, Italy
| | - Virginia Vargiu
- Dipartimento per le Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Department of Gynecology and Obstetrics, Roma, Italy
| | - Roberta Granese
- Dipartimento di Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Università degli studi di Messina, Policlinico G. Martino, Messina, Italy
| | - Alfredo Ercoli
- Dipartimento di Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Università degli studi di Messina, Policlinico G. Martino, Messina, Italy
| | - Stefano Cianci
- Dipartimento di Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Università degli studi di Messina, Policlinico G. Martino, Messina, Italy
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Outcomes of sentinel lymph node mapping for patients with FIGO stage I endometrioid endometrial carcinoma. Gynecol Oncol 2021; 161:705-709. [PMID: 33771397 DOI: 10.1016/j.ygyno.2021.03.018] [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: 01/16/2021] [Accepted: 03/16/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Investigate the overall survival of patients with FIGO stage I endometrioid endometrial carcinoma who underwent sentinel lymph node biopsy (SLNBx). METHODS Patients diagnosed between 2012 and 2015 with pathological stage I endometrioid endometrial carcinoma who underwent minimally invasive hysterectomy and had at least one month of follow-up were identified in the National Cancer Database (NCDB). Patients who underwent SLNBx or systematic lymphadenectomy (LND) (defined as at least 20 lymph nodes removed) were selected. Overall survival (OS) was evaluated following generation of Kaplan-Meier curves and compared with the log-rank test. A Cox model was constructed to evaluate survival after controlling for confounders. RESULTS A total of 13,010 patients with endometrioid endometrial carcinoma who met the inclusion criteria were identified; 9861 (75.8%) and 3149 (24.2%) patients had systematic LND and SLNBx, respectively. Patients who had LND were more likely to receive radiation therapy (27.4% vs 19.3%, p < 0.001) and chemotherapy (13% vs 8.7%, p < 0.001) compared to those who had SLNBx. After controlling for patient age, race, insurance status, depth of myometrial invasion, tumor grade, tumor size, presence of lymph-vascular invasion and receipt of radiation therapy, the performance of SLNBx was not associated with worse survival (HR: 0.99, 95% CI: 0.80, 1.21). For high-intermediate risk patients (based on GOG-99 criteria) after controlling for confounders, performance of SLNBx was not associated with worse survival (HR: 1.07, 95% CI: 0.80, 1.44). For intermediate risk patients who did not receive external beam radiation therapy or chemotherapy after controlling for confounders, performance of SLNBx was not associated with worse survival (HR: 1.58, 95% CI: 0.94, 2.65). CONCLUSIONS SLNBx had no negative impact on the survival of patients with FIGO stage I endometrioid endometrial carcinoma who undergo hysterectomy.
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Somashekhar SP, Arvind R, Kumar CR, Ahuja V, Ashwin KR. Sentinel node mapping using indocyanine green and near-infrared fluorescence imaging technology for endometrial cancer: A prospective study using a surgical algorithm in Indian patients. J Minim Access Surg 2021; 17:479-485. [PMID: 33605932 PMCID: PMC8486055 DOI: 10.4103/jmas.jmas_154_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Indocyanine green (ICG) fluorescence with high-definition, three-dimensional imaging systems is emerging as the latest strategy to reduce trauma and improve surgical outcomes during oncosurgery. Materials and Methods: This is a prospective study involving 100 patients with carcinoma endometrium who underwent robotic-assisted Type 1 pan-hysterectomy, with ICG-directed sentinel lymph node (SLN) biopsy from November 2017 to December 2019. The aim was to assess the feasibility and diagnostic accuracy of SLN algorithm and to evaluate the location and distribution of SLN in pelvic, para-aortic and unusual areas and the role of frozen section. Results: The overall SLN detection rate was 98%. Bilateral detection was possible in 92% of the cases. Right side was detected in 98% of the cases and left side was visualised in 92% of the cases. Complete node dissection was done where SLN mapping failed. The most common location for SLN in our series was obturator on the right hemipelvis and internal iliac on the left hemipelvis. SLN in the para-aortic area was detected in 14% of cases. In six cases, SLN was found in atypical locations, that is pre-sacral area. Eight patients had SLN positivity for metastasis and underwent complete retroperitoneal lymphadenectomy. Comparison of final histopathological report with frozen section reports showed no false negatives. Conclusions: SLN mapping holds a great promise as a modern staging strategy for endometrial cancer. In our experience, cervical injection was an optimal method of mapping the pelvis. ICG showed a high overall detection rate, and bilateral mapping appears to be a feasible alternative to the more traditional methods of SLN mapping in patients with endometrial cancer. The ICG fluorescence imaging system is simple and safe and may become a standard in oncosurgery in view of its staging and anatomical imaging capabilities. This approach can reduce the morbidity, operative times and costs associated with complete lymphadenectomy while maintaining prognostic and predictive information.
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Affiliation(s)
- S P Somashekhar
- Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, Karnataka, India
| | - R Arvind
- Department of Surgical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, Karnataka, India
| | - C Rohit Kumar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, Karnataka, India
| | - Vijay Ahuja
- Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, Karnataka, India
| | - K R Ashwin
- Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, Karnataka, India
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Nordskar NJ, Hagen B, Ogarkov A, Vesterfjell EV, Salvesen Ø, Aune G. Initial experience with positron emission tomography/computed tomography in addition to computed tomography and magnetic resonance imaging in preoperative risk assessment of endometrial cancer patients. Eur J Obstet Gynecol Reprod Biol 2021; 259:46-52. [PMID: 33582479 DOI: 10.1016/j.ejogrb.2021.01.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Improved preoperative evaluation of lymph node status could potentially replace lymphadenectomy in women with endometrial cancer. PET/CT was routinely implemented in the preoperative workup of endometrial cancer at St Olav's University Hospital in 2016. Experience with PET/CT is limited, and there is no consensus about the use of PET/CT in the diagnostic workup of endometrial cancer. The aim of the study was to evaluate the diagnostic accuracy of PET/CT compared to standard CT/MRI in identifying lymph node metastases in endometrial cancer with histologically confirmed lymph node metastases as the standard of reference. We especially wanted to look at PET/CT as a supplement to the sentinel lymph node algorithm in the detection of paraaortic lymph nodes. STUDY DESIGN A retrospective study included all women undergoing surgery for endometrial cancer from January 2016 through July 2019 at St Olav's University Hospital. Clinical data, results of CT, MRI, and PET/CT, and histopathological results were analyzed. RESULTS Among 185 patients included, 27 patients (15 %) had lymph node metastases. 17 (63 %) had pelvic lymph node metastases, one (4 %) had isolated paraaortic lymph node metastases, and 9 (33 %) had lymph node metastases in both the pelvis and the paraaortic region. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT for the detection of lymph node metastases were 63 %, 98 %, 85 %, 94 %, and 93 %, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT/MRI were 41 %, 98 %, 73 %, 91 %, and 90 %, respectively (p = 0.07). For the 26 pelvic lymph node metastases, PET/CT had a sensitivity of 58 %, compared to 42 % for CT/MRI (p = 0.22). PET/CT detected all 10 paraaortic lymph node metastases, for a sensitivity of 100 %, compared to 50 % for CT/MRI (p = 0.06). CONCLUSIONS PET is superior to CT/MRI for detection of lymph node metastases in endometrial cancer, particularly in detecting paraaortic lymph node metastases. The ability of preoperative PET to exclude paraaortic lymph node metastases may strengthen the credibility of the sentinel lymph node algorithm.
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Affiliation(s)
- Nina Jebens Nordskar
- Department of Gynecologic Oncology, Dept. of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, 7006, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
| | - Bjørn Hagen
- Department of Gynecologic Oncology, Dept. of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, 7006, Trondheim, Norway.
| | - Aleksei Ogarkov
- Department of Radiology and Nuclear Medicine, St Olav's Hospital, Trondheim University Hospital, 7006, Trondheim, Norway.
| | - Ellen V Vesterfjell
- Department of Pathology, St Olav's Hospital, Trondheim University Hospital, 7006, Trondheim, Norway.
| | - Øyvind Salvesen
- Unit of Applied Clinical Research, Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Guro Aune
- Department of Gynecologic Oncology, Dept. of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, 7006, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
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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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Prospective Non-randomized Control Trial on Role of Systematic High Para-Aortic Lymphadenectomy in Endometrial Cancer: Indian Study. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-020-00482-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Freytag D, Pape J, Dhanawat J, Günther V, Maass N, Gitas G, Laganà AS, Allahqoli L, Meinhold-Heerlein I, Moawad GN, Biebl M, Mettler L, Alkatout I. Challenges Posed by Embryonic and Anatomical Factors in Systematic Lymphadenectomy for Endometrial Cancer. J Clin Med 2020; 9:E4107. [PMID: 33352762 PMCID: PMC7766017 DOI: 10.3390/jcm9124107] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
Lymph node involvement has been shown to be one of the most relevant prognostic factors in a variety of malignancies; this is also true of endometrial cancer. The determination of the lymph node status is crucial in order to establish the tumor stage, and to consider adjuvant treatment. A wide range of surgical staging practices are currently used for the treatment of endometrial cancer. The necessity and extent of lymph node dissection is an ongoing controversial issue in gynecological oncology. Lymph node surgery in endometrial cancer is technically challenging, and can be time consuming because of the topographic complexity of lymphatic drainage as such, and the fact that the lymph nodes are directly adjacent to both blood vessels and nerves. Therefore, profound and exact knowledge of the anatomy is essential. Sentinel lymph node mapping was recently introduced in surgical staging with the aim of reducing morbidity, whilst also obtaining useful prognostic information from a patient's lymph node status. The present review summarizes the current evidence on the role of lymph node surgery in endometrial cancer, focusing on the embryological, anatomical, and technical aspects.
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Affiliation(s)
- Damaris Freytag
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (D.F.); (J.P.); (J.D.); (V.G.); (N.M.); (L.M.)
| | - Julian Pape
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (D.F.); (J.P.); (J.D.); (V.G.); (N.M.); (L.M.)
| | - Juhi Dhanawat
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (D.F.); (J.P.); (J.D.); (V.G.); (N.M.); (L.M.)
| | - Veronika Günther
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (D.F.); (J.P.); (J.D.); (V.G.); (N.M.); (L.M.)
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (D.F.); (J.P.); (J.D.); (V.G.); (N.M.); (L.M.)
| | - Georgios Gitas
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany;
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, Center of Excellence in Minimally-Invasive Gynecology (COEMIG), “Filippo Del Ponte” Hospital, University of Insubria, Piazza Biroldi 1, 21100 Varese, Italy;
| | - Leila Allahqoli
- Endometriosis Research Center, Iran University of Medical Sciences (IUMS), Tehran 1593747811, Iran;
| | - Ivo Meinhold-Heerlein
- Department of Obstetrics and Gynecology, University of Giessen, Klinikstraße 33, 35392 Gießen, Germany;
| | - Gaby N. Moawad
- Department of Obstetrics and Gynecology, Division of Minimally-Invasive Gynecologic Surgery, George Washington University Hospital, Washington, DC 20037, USA;
| | - Matthias Biebl
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Liselotte Mettler
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (D.F.); (J.P.); (J.D.); (V.G.); (N.M.); (L.M.)
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105 Kiel, Germany; (D.F.); (J.P.); (J.D.); (V.G.); (N.M.); (L.M.)
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Cabrera S, Bebia V, Acosta U, Franco-Camps S, Mañalich L, García-Jiménez A, Gil-Moreno A. Survival outcomes and prognostic factors of endometrial stromal sarcoma and undifferentiated uterine sarcoma. Clin Transl Oncol 2020; 23:1210-1219. [PMID: 33210235 DOI: 10.1007/s12094-020-02512-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/10/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To review the diagnostic and therapeutic procedures of patients diagnosed with Endometrial Stromal Sarcoma (ESS) and Undifferentiated Uterine Sarcoma (USS) at our institution and investigate their clinical outcomes and factors affecting prognosis. METHODS We retrospectively collected demographic data, preoperative diagnostic methods and therapeutic management of patients treated for ESS and UUS between January 1995 and December 2019 at Vall d'Hebron Barcelona Hospital Campus, Spain. Overall survival and disease-free survival were calculated. Cox proportional-hazards regression models were calculated. RESULTS Sixty-three patients were included in the study, of which 51(81%) had a diagnosis of ESS and 12(19%) of UUS. Twenty patients (31.7%) were diagnosed after a previous non-oncologic surgery, and 12 of them (60%) suffered from tumor disruption. Cytoreductive procedures were needed in 29 patients (46%), and optimal cytoreduction was achieved in 80.9% of the patients. The median follow-up was 7.6 years (IQR = 0.99-14.31). Five-year overall survival was 57.6% (44.2-68.8) and was significantly better for low-grade ESS (LG-ESS) patients (p < 0.01). Five-year disease-free survival was 57.1% (42.8-69.1) and was also significantly higher in LG-ESS cohort (p = 0.03). After multivariate analysis histological type, age, FIGO stage, optimal surgery and mitotic index were found significantly correlated with survival. For high-grade EES (HG-ESS) and USS patients adjuvant radiotherapy also correlated with improved survival. CONCLUSION Overall survival and disease-free survival are significantly better in patients with LG-ESS cohort. HG-ESS and UUS show similar survival outcomes. Age, FIGO stage, optimal surgery and histological type were significantly correlated with survival in the global cohort, whilst adjuvant radiotherapy correlated with improved survival in HG-ESS and UUS patients.
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Affiliation(s)
- S Cabrera
- Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain. .,Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - V Bebia
- Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - U Acosta
- Gynecology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - S Franco-Camps
- Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - L Mañalich
- Gynecology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - A García-Jiménez
- Universitat Autònoma de Barcelona, Bellaterra, Spain.,Pathology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - A Gil-Moreno
- Universitat Autònoma de Barcelona, Bellaterra, Spain.,Gynecology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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O'Toole SA, Huang Y, Norris L, Power Foley M, Shireen R, McDonald S, Kamran W, Ibrahim N, Ward M, Thompson C, Murphy C, D'Arcy T, Farah N, Heron E, O'Leary JJ, Abu Saadeh F, Gleeson N. HE4 and CA125 as preoperative risk stratifiers for lymph node metastasis in endometrioid carcinoma of the endometrium: A retrospective study in a cohort with histological proof of lymph node status. Gynecol Oncol 2020; 160:514-519. [PMID: 33213897 DOI: 10.1016/j.ygyno.2020.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/05/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate whether HE4 and CA125 could identify endometrioid adenocarcinoma patients who might most benefit from full staging surgery with lymphadenectomy. METHODS Sequential patients with a preoperative banked serum and histology of endometrioid adenocarcinoma of endometrium who had undergone surgical staging with lymph node dissection over a 5-year period between 2011 and 2016 were included from a tertiary Gynaecological Cancer Centre, Dublin, Ireland. Preoperative serum HE4 and CA125 were measured using ELISA, with the cut-offs HE4 81 pmol/L and CA125 35 U/ml. Predictive values were estimated using AUC, sensitivity, specificity and odds ratios. RESULTS 9.5% of the cohort had lymph node metastases. A HE4 cut-off of 81 pmol/L yielded a sensitivity of 78.6% and specificity of 53.4% for predicting lymph node metastases. Sensitivity of CA125 at 35 U/ml was 57% and specificity 91.4%. The AUC was 0.66 (0.52-0.80) for HE4 and 0.74 (0.58-0.91) for CA125. Sensitivity was 92.8% and specificity 51.1% when an elevation of either HE4 or CA125 was included, AUC was 0.72 (0.61-0.83), this combination yielded the highest NPV of 98.6%. Sensitivity was 42.9% and specificity 93.8% if both markers were elevated simultaneously, AUC was 0.68 (0.51-0.86). Preoperative clinical predictors of high-grade preoperative histology and radiology had sensitivities of 21.4% and 41.7%, respectively. Patients with a HE4 above 81 pmol/L had an odds ratio of 4.2 (1.12-15.74), p < 0.05, of lymph node metastases and CA125 had an odds ratio of 14.2 (4.16-48.31), p < 0.001. CONCLUSIONS Serum HE4 and CA125 improved on existing methods for risk stratification of endometrioid carcinomas and warrant further investigation.
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Affiliation(s)
- Sharon A O'Toole
- Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.; Department of Histopathology, Trinity College Dublin and Trinity St James's Cancer Institute, St. James's Hospital, Dublin 8, Ireland.; Emer Casey Molecular Pathology Research Laboratory, Coombe Women & Infants University Hospital, Dublin 8, Ireland..
| | - Yanmei Huang
- Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.; School of Forensic Medicine, Xinxiang Medical University, Xinxiang, Henan, China
| | - Lucy Norris
- Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Megan Power Foley
- Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Rizmee Shireen
- Division of Gynaecological Oncology and Trinity St James's Cancer Institute, St James's Hospital, Dublin 8, Ireland
| | - Seamus McDonald
- Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Waseem Kamran
- Division of Gynaecological Oncology and Trinity St James's Cancer Institute, St James's Hospital, Dublin 8, Ireland
| | - Nadia Ibrahim
- Division of Gynaecological Oncology and Trinity St James's Cancer Institute, St James's Hospital, Dublin 8, Ireland
| | - Mark Ward
- Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.; Department of Histopathology, Trinity College Dublin and Trinity St James's Cancer Institute, St. James's Hospital, Dublin 8, Ireland.; Emer Casey Molecular Pathology Research Laboratory, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Claire Thompson
- Division of Gynaecological Oncology and Trinity St James's Cancer Institute, St James's Hospital, Dublin 8, Ireland
| | - Cliona Murphy
- Department of Obstetrics & Gynaecology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Tom D'Arcy
- Division of Gynaecological Oncology and Trinity St James's Cancer Institute, St James's Hospital, Dublin 8, Ireland.; Department of Obstetrics & Gynaecology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Nadine Farah
- Department of Obstetrics & Gynaecology, Coombe Women & Infants University Hospital, Dublin 8, Ireland.; Department of Gynaecology, Tallaght University Hospital, Tallaght, Dublin 24, Ireland
| | - Elizabeth Heron
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - John J O'Leary
- Department of Histopathology, Trinity College Dublin and Trinity St James's Cancer Institute, St. James's Hospital, Dublin 8, Ireland.; Emer Casey Molecular Pathology Research Laboratory, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Feras Abu Saadeh
- Division of Gynaecological Oncology and Trinity St James's Cancer Institute, St James's Hospital, Dublin 8, Ireland
| | - Noreen Gleeson
- Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.; Division of Gynaecological Oncology and Trinity St James's Cancer Institute, St James's Hospital, Dublin 8, Ireland
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Novelli AA, Puppo A, Ceccaroni M, Olearo E, Monterossi G, Mantovani G, Pelligra S, Olearo PL, Fanfani F, Scambia G. Diagnostic accuracy and economic impact of three work-up strategies identifying risk groups in endometrial cancer, fully incorporating sentinel lymph node algorithm. Facts Views Vis Obgyn 2020; 12:169-177. [PMID: 33123692 PMCID: PMC7580266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND According to the European Society for Medical Oncology/ European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology (ESMO/ESGO/ESTRO) Consensus Conference, the role of preoperative risk groups (RGs) in endometrial cancer (EC) is to direct surgical nodal staging. We compared diagnostic accuracy and economic impact of three work-up strategies to identify RGs. METHODS A retrospective multicentre study including patients with early-stage EC. The three different work-up strategies were as follows:-Mondovì Hospital: transvaginal ultrasonography, pelvic magnetic resonance imaging (MRI); frozen section examination of the uterus in case of imaging discordance. High-risk patients underwent abdominal computed tomography.-Gemelli Hospital: transvaginal ultrasonography, MRI, One-Step Nucleic Acid Amplification (OSNA) of sentinel lymph node (SLN); frozen section examination of the uterus in case of imaging discordance.-Negrar Hospital: positron emission tomography (PET), frozen section examination of the uterus and of SLN. For statistical purposes patients were assigned, preoperatively and postoperatively, to two groups: group A (high-risk) and group B (not high-risk). RESULTS Three hundred eighty-five patients were included (93 Mondovì, 215 Gemelli, 77 Negrar). Endometrial biopsy errors led to 47.3% misclassifications. Test accuracy of Mondovì, Gemelli and Negrar strategies was 0.83 (95%CI 0.734-0.901), 0.95 (95%CI 0.909-0.975) and 0.94 (95%CI 0.866-0.985), respectively. Preoperative work-up mean cost per patient in group A was €514.5 at Mondovì, €868.5 at Gemelli, and €1212.8 at Negrar hospital (p-value < 0.001), while in group B was €378.8 at Mondovì, €941.2 at Gemelli, and €1848.4 at Negrar hospital (p-value < 0.001). CONCLUSIONS In our study, work-up strategies with more relevant economic impact showed a better diagnostic accuracy. Upcoming guidelines should specify recommendations about the gold standard work-up strategy, including the role of SLN.
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Affiliation(s)
- AA Novelli
- Department of Obstetrics and Gynaecology, “Regina Montis Regalis” Hospital, Mondovì (Cuneo), Italy,Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Puppo
- Department of Obstetrics and Gynaecology, “Regina Montis Regalis” Hospital, Mondovì (Cuneo), Italy,Department of Obstetrics and Gynaecology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - M Ceccaroni
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology and Minimally-Invasive Pelvic
Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar (Verona), Italy
| | - E Olearo
- Department of Obstetrics and Gynaecology, “Regina Montis Regalis” Hospital, Mondovì (Cuneo), Italy
| | - G Monterossi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - G Mantovani
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology and Minimally-Invasive Pelvic
Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar (Verona), Italy
| | - S Pelligra
- Università Cattolica del Sacro Cuore, Rome, Italy,Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - PL Olearo
- Department of Obstetrics and Gynaecology, “Regina Montis Regalis” Hospital, Mondovì (Cuneo), Italy
| | - F Fanfani
- Università Cattolica del Sacro Cuore, Rome, Italy,Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - G Scambia
- Università Cattolica del Sacro Cuore, Rome, Italy,Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Huang AB, Huang Y, Hur C, Tergas AI, Khoury-Collado F, Melamed A, St Clair CM, Hou JY, Ananth CV, Neugut AI, Hershman DL, Wright JD. Impact of quality of care on racial disparities in survival for endometrial cancer. Am J Obstet Gynecol 2020; 223:396.e1-396.e13. [PMID: 32109459 DOI: 10.1016/j.ajog.2020.02.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/30/2020] [Accepted: 02/18/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Black women experience poorer survival compared with white women across all endometrial cancer stages and histologies. The incidence of endometrial cancer is 30% lower in black women compared with white women, yet mortality is 80% higher in black women. Differences in adherence to evidence-based guidelines have been proposed to be major contributors to this disparity. OBJECTIVES We examined whether adherence to evidence-based treatment recommendations for endometrial cancer could mitigate survival disparities between black and white women. STUDY DESIGN The National Cancer Database was used to identify women with endometrial cancer treated from 2004 through 2016. We established 5 evidence-based quality metrics based on review of primary literature and accepted guidelines: surgical treatment within 6 weeks of diagnosis (Q1), use of minimally invasive surgery (stage I-IIIC; Q2), pelvic nodal assessment (high-risk tumors; Q3), adjuvant radiation (high intermediate risk; Q4), and systemic chemotherapy (stage III-IV; Q5). The rates of 30 and 90 day mortality and 5 year survival were compared between black and white women. To determine the influence of quality on outcomes, we compared outcomes among perfectly adherent black and white women with stage I and III endometrial cancer. RESULTS We identified 310,208 women including 35,035 (11.3%) black women and 275,173 (88.3%) white women. Black women were less likely than white women to receive Q1 (65.8 vs 75.6%), Q2 (58.5 vs 72.9%), Q3 (71.3 vs 74.2%), and Q5 (72.7 vs 73.2%) (P < .05 for all). Adherence to each quality metrics was associated with improved survival. Among women with stage I disease, perfect adherence to the relative quality metrics was seen in 53.1% of white and 41.5% of black women. Among perfectly adherent stage I patients, outcomes in black women improved relative to unselected black women; however, they still experienced higher risk of 30 day (adjusted relative risk, 2.25; 95% confidence interval, 1.30-3.90), 90 day (adjusted relative risk, 1.84; 95% confidence interval, 1.23-2.76), and 5 year mortality (adjusted hazard ratio, 1.42; 95% confidence interval, 1.26-1.59) compared with similar white women. Among women with stage III tumors, perfect adherence to the relative quality metrics was seen in 56.6% of white and 44.1% of black women. Perfectly adherent black women with stage III disease had improved outcomes but remained at increased risk of 30 day (adjusted relative risk, 1.86; 95% confidence interval, 1.01-3.44) and 5 year mortality (adjusted hazard ratio, 1.35; 95% confidence interval, 1.22-1.50) compared with white women. CONCLUSION Black women are less likely than white women with endometrial cancer to receive evidence-based care. However, receipt of evidence-based care mitigates but does not eliminate racial disparities in outcomes and black women remain at greater risk of death from endometrial cancer.
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Wang L, Zhou W, Li H, Yang H, Shan N. Clinical Significance, Cellular Function, and Potential Molecular Pathways of CCT7 in Endometrial Cancer. Front Oncol 2020; 10:1468. [PMID: 32983981 PMCID: PMC7483479 DOI: 10.3389/fonc.2020.01468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 07/09/2020] [Indexed: 12/24/2022] Open
Abstract
Objective: Endometrial cancer (EC) is a common gynecologic malignancy; myometrial invasion (MI) is a typical approach of EC spreads and an important index to assess tumor metastasis and outcome in EC patients. CCT7 is a member of the TCP1 chaperone family, involved in cytoskeletal protein folding and unfolding. In this study, the role of CCT7 in EC development was investigated. Methods: Clinical data for 87 EC cases and expression of CCT7 were analyzed. CCT7 was knocked out using siRNA-CCT7 in Ishikawa and RL95-2 cells, and their function about proliferation, apoptosis, and invasion was further tested. Bioinformatics methods were used to predict the potential pathways of CCT7 in EC development. Results: The rates of CCT7-positive cells in EC and adjacent normal endometrium tissues had a significant difference (67.8 vs. 51.4%, p = 0.035), and the expression rate increased from low to high pathological stage (39.7% in the I/II stage, 71.4% in the III/IV stage, p = 0.029). A similar change was found in protein level. CCT7 expression differed significantly between the deep MI group (>1/2) and the superficial MI group (≤1/2) (p = 0.039). However, there were no differences with respect to age, pathological type, and histological grade. CCT7 suppression induced a function loss in both Ishikawa and RL95-2 cells. Bioinformatics analysis demonstrated that EC patients with lower-level CCT7 expression had better overall survival (p = 0.0081). Gene ontology enrichment indicated that "RNA binding," "Mitochondrion," "Translation," and "Spliceosome" were most significantly enriched potential pathways. Five hub genes, PSMA5, PSMD14, SNRPB, SNRPG, and TXNL4A, were all significantly upregulated in EC and had a positive correlation with CCT7. Conclusions: CCT7 may be involved in EC development by excessively activating tumor cell function to promote MI or distant/nodal metastasis, which may contribute to the prognosis of EC patients.
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Affiliation(s)
- Liwen Wang
- Department of Gynecology and Obstetrics, Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Wei Zhou
- Department of Gynecology and Obstetrics, Xiangya Hospital, Central South University, Changsha, China
| | - Hui Li
- Xiangya School of Medicine, Central South University, Changsha, China
- Department of Reproductive, Xiangya Hospital, Central South University, Changsha, China
| | - Hui Yang
- Department of Gynecology and Obstetrics, Xiangya Hospital, Central South University, Changsha, China
| | - Nianchun Shan
- Department of Gynecology and Obstetrics, Xiangya Hospital, Central South University, Changsha, China
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Sentinel lymph node intraoperative analysis in endometrial cancer. J Cancer Res Clin Oncol 2020; 146:3199-3205. [PMID: 32815026 DOI: 10.1007/s00432-020-03356-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/07/2020] [Indexed: 01/24/2023]
Abstract
PURPOSE Surgical staging in endometrial cancer has evolved and sentinel lymph node (SLN) mapping has replaced a full pelvic and paraaortic lymphadenectomy in several cases. An intraoperative evaluation of SLN might identify patients who could benefit the most from a full lymphadenectomy. The aim of this study is to evaluate the clinical relevance of frozen section of SLN. METHODS A retrospective analysis in patients with endometrial cancer who underwent SLN mapping with intraoperative evaluation at frozen section between February 2016 and September 2019 was performed. In case of metastatic involvement, a full lymphadenectomy was performed. RESULTS Fifty-eight patients met the inclusion criteria. Clinical-pathologic characteristics of the patients and surgical data were analyzed. Overall, bilateral and unilateral detection rates were 100% (58/58), 89.7% (52/58), and 10.3% (6/58), respectively. Eight patients had a stage IIIC disease at permanent section. Frozen section detected SLN metastases in four of eight patients. Of these, two were micrometastases and two were macrometastases. At frozen section of the SLNs, no macrometastases were misdiagnosed. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of frozen section in detecting metastases was 50%, 100%, 93%, 100% and 92.6%, respectively. CONCLUSION The intraoperative evaluation of SLN in endometrial cancer accurately identifies patients with macrometastases. This is the cohort that might benefit the most of a full lymphadenectomy for a higher risk of additional lymph node metastases.
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Jejunal obstruction due to rare internal hernia between skeletonized external iliac artery and vein as late complication of laparoscopic hysterectomy with pelvic lymphadenectomy-case report and review of literature. Arch Gynecol Obstet 2020; 302:1075-1080. [PMID: 32767070 PMCID: PMC7524845 DOI: 10.1007/s00404-020-05724-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/28/2020] [Indexed: 12/24/2022]
Abstract
Background Internal herniation of small intestine in the lesser pelvis alongside iliac vasculature is a rare occurrence. Skeletonization of iliac vessels during pelvic lymph node dissection (LND), as part of surgical staging or treatment of patients with uterine, ovarian or urogenital cancer, is a strict prerequisite for orifice formation. Case presentation A 68-year-old woman presented at the emergency department with complaints of constipation for the last 3 days and acute-onset abdominal pain, nausea and vomiting since few hours. She had a history of laparoscopic hysterectomy, bilateral salpingo-oophorectomy and para-aortic and pelvic LND 7 years ago. A distended abdomen with diffuse tenderness on palpation was noted. A CT scan demonstrated bowel obstruction secondary to an incarcerated hernia underneath an elongated right external iliac artery. During an emergency exploratory laparotomy, the incarcerated bowel was reduced and the hernial orifice closed with a running suture. The patient had an uneventful postoperative period and was discharged on the fifth postoperative day. Discussion This rare internal hernia can manifest with non-specific symptoms of small bowel obstruction at any given point after index surgery, sometimes even after several years free of complaints. Contrast-enhanced computed tomography is the method of choice for fast and reliable diagnosis and helps in planning the necessary emergency laparotomy. Conclusion This life-threatening complication adds to the current controversy of pelvic and para-aortic lymphadenectomy in patients with endometrial cancer. Primary closure of peritoneal defects should be considered to potentially prevent internal hernias, especially when elongated iliac vessels are present. Electronic supplementary material The online version of this article (10.1007/s00404-020-05724-x) contains supplementary material, which is available to authorized users.
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Ignatov A, Papathemelis T, Ivros S, Ignatov T, Ortmann O, Eggemann H. Comparison of survival of patients with endometrial cancer undergoing sentinel node biopsy alone or systematic lymphadenectomy. Arch Gynecol Obstet 2020; 302:995-1000. [PMID: 32666131 DOI: 10.1007/s00404-020-05698-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/10/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recently, sentinel lymph node mapping was introduced in the surgical staging of endometrial cancer as alternative to systematic lymphadenectomy. However, the survival impact of sentinel node mapping is not well characterized yet. METHODS We performed retrospective study of 104 patients with endometrial cancer treated with sentinel lymph node alone (n = 52) or with pelvic and para-aortic lymphadenectomy (n = 52). For sentinel node mapping, indocyanine green was used. The outcome measure was disease-free survival. RESULTS Median follow-up was 42 months. Fifty-two patients staged by sentinel lymph node mapping were matched in 1:1 ratio with 52 patients staged by lymphadenectomy using patient age, histological type, tumor stage, tumor grade and lymph and vascular space invasion as matching criteria. The median number of removed lymph node was 3 (range 1-6) and 36 (13-63) in the sentinel and lymphadenectomy group, respectively. The rate of lymph node metastases was not significantly higher in the sentinel group (19.2%) in comparison with the lymphadenectomy group (14.3%). The overall detection rate of sentinel lymph nodes was 100% with a bilateral mapping of 98.1%. Most of the 152 lymph nodes identified and removed were localized in upper paracervical pathway (n = 143, 94.1%). During the follow-up period, overall 21 (20.2%) events were observed, 8 (15.4%) in the sentinel group and 13 (25.0%) in the lymphadenectomy group. The estimated disease-free survival was 84.6% and 75.0% for patients in the sentinel and lymphadenectomy groups, respectively. The survival curves demonstrated similar disease-free survival in two groups (p = 0.774). CONCLUSION Sentinel lymph node mapping did not compromise the outcome of patients with endometrial cancer.
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Affiliation(s)
- Atanas Ignatov
- Department of Gynecology and Obstetrics, University Medical Center, Regensburg, Germany.
- Department of Gynecology and Obstetrics, Otto-von-Guericke University, Gerhart-Hauptmann Str. 35, 39108, Magdeburg, Germany.
| | - Thomas Papathemelis
- Department of Gynecology and Obstetrics, Klinikum St. Marien Amberg, Amberg, Germany
| | - Stylianos Ivros
- Gynecologic Oncology Unit, Metropolitan Hospital, Athen, Greece
| | - Tanja Ignatov
- Department of Gynecology and Obstetrics, University Medical Center, Regensburg, Germany
- Department of Gynecology and Obstetrics, Otto-von-Guericke University, Gerhart-Hauptmann Str. 35, 39108, Magdeburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Center, Regensburg, Germany
| | - Holm Eggemann
- Department of Gynecology and Obstetrics, Otto-von-Guericke University, Gerhart-Hauptmann Str. 35, 39108, Magdeburg, Germany
- Department of Gynecology and Obstetrics, Klinikum Magdeburg, Magdeburg, Germany
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Bogani G, Cappuccio S, Casarin J, Narasimhulu DMM, Cilby WA, Glaser GE, Weaver AL, McGree ME, Keeney GL, Weroha J, Petersen IA, Mariani A. Role of adjuvant therapy in stage IIIC2 endometrial cancer. Int J Gynecol Cancer 2020; 30:1169-1176. [PMID: 32646864 DOI: 10.1136/ijgc-2020-001446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The role of the different types of adjuvant treatments in endometrial cancer with para-aortic node metastases is unclear. The aim of this study was to report oncologic outcomes after adjuvant therapy in patients with stage IIIC2 endometrial cancer. METHODS This retrospective single-institution study assessed patients with stage IIIC2 endometrial cancer who underwent primary surgery from January 1984 to December 2014. All patients had hysterectomy (±salpingo-oophorectomy) plus lymphadenectomy (para-aortic nodes, ±pelvic nodes). We included all patients with stage III endometrial cancer and documented para-aortic lymph node metastases (International Federation of Obstetrics and Gynecologists stage IIIC2). We excluded patients who did not provide consent, who had synchronous cancer, or who underwent neoadjuvant chemotherapy. Follow-up was restricted to the first 5 years post-operatively. Cox proportional hazards models, with age as the time scale, was used to evaluate associations of risk factors with disease-free survival and overall survival. RESULTS Among 105 patients with documented adjuvant therapy, external beam radiotherapy was administered to 25 patients (24%), chemotherapy to 24 (23%), and a combination (chemotherapy and external beam radiotherapy) to 56 (53%) patients. Most patients receiving chemotherapy and external beam radiotherapy (80%) had chemotherapy first. The majority of relapses had a distant component (31/46, 67%) and only one patient had an isolated para-aortic recurrence. Non-endometrioid subtypes had poorer disease-free survival (HR 2.57; 95% CI 1.38 to 4.78) and poorer overall survival (HR 2.00; 95% CI 1.09 to 3.65) compared with endometrioid. Among patients with endometrioid histology (n=60), chemotherapy and external beam radiotherapy improved disease-free survival (HR 0.22; 95% CI 0.07 to 0.71) and overall survival (HR 0.28; 95% CI 0.09 to 0.89) compared with chemotherapy or external beam radiotherapy alone. Combination therapy did not improve prognosis for patients with non-endometrioid histology (n=45). CONCLUSIONS In our cohort of patients with stage IIIC2 endometrioid endometrial cancer, those receiving chemotherapy and external beam radiotherapy had improved survival compared with patients receiving chemotherapy or external beam radiotherapy alone. However, the prognosis of patients with non-endometrioid endometrial cancer remained poor, regardless of the adjuvant therapy administered. Distant recurrences were the most common sites of failure.
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Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Serena Cappuccio
- Department of Woman's, Child's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | | | - William A Cilby
- Division of Gynecologic Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Gretchen E Glaser
- Division of Gynecologic Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Gary L Keeney
- Division of Anatomic Pathology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - John Weroha
- Division of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Andrea Mariani
- Division of Gynecologic Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Bruegl AS, Joshi S, Batman S, Weisenberger M, Munro E, Becker T. Gynecologic cancer incidence and mortality among American Indian/Alaska Native women in the Pacific Northwest, 1996-2016. Gynecol Oncol 2020; 157:686-692. [PMID: 32305303 PMCID: PMC7293560 DOI: 10.1016/j.ygyno.2020.03.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/31/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Compare the incidence and mortality of gynecologic cancers among American Indian/Alaska Native (AI/AN) women to the Non-Hispanic White (NHW) population in the Pacific Northwest. METHODS Age-adjusted cancer incidence (1996-2016) and mortality (2006-2016) rates were calculated from population-based state cancer registry and death certificate data obtained from Washington, Oregon, and Idaho, and corrected for AI/AN misclassification. Incidence and mortality rate ratios (RR) were calculated to compare AI/AN and NHW women with gynecologic cancers. RESULTS Across all gynecologic cancer sites, AI/AN women were diagnosed at a younger age compared to NHW women. AI/AN women had a higher incidence of cervical cancer compared to NHW women with a RR of 1.53 (95% CI: 1.34, 1.75). For all age groups, AI/AN women had a higher incidence of cervical cancer and the disparity was greatest in the 50-64 age group with a RR of 1.76 (95% CI: 1.36, 2.30). Cervical cancer mortality was greater among AI/AN women, with an all-ages RR of 1.79 (95% CI: 1.30, 2.46); the disparity was greatest in the 50-64 age group (RR: 2.88, 95% CI: 1.89, 4.38). For uterine cancer, AI/AN women had similar incidence rates as NHW women but higher mortality rates (RR: 1.35, 95% CI: 1.03-1.75). Incidence and mortality for ovarian cancer were similar between groups. CONCLUSION Our analysis of gynecologic cancers among AI/AN in the PNW found significant disparities relative to NHW women in cervical cancer incidence and mortality. These disparities persist despite advances in prevention strategies.
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Affiliation(s)
- Amanda S Bruegl
- Department of Obstetrics and Gynecology, 3181 SW Sam Jackson Park Road, Oregon Health and Science University (OHSU), Portland, OR 97239, USA.
| | - Sujata Joshi
- Northwest Portland Area Indian Health Board Tribal Epidemiology Center, 2121 SW Broadway, Suite 300, Portland, OR 97201, USA
| | - Samantha Batman
- Department of Obstetrics and Gynecology, 3181 SW Sam Jackson Park Road, Oregon Health and Science University (OHSU), Portland, OR 97239, USA
| | - Mercedes Weisenberger
- Department of Obstetrics and Gynecology, 3181 SW Sam Jackson Park Road, Oregon Health and Science University (OHSU), Portland, OR 97239, USA
| | - Elizabeth Munro
- Department of Obstetrics and Gynecology, 3181 SW Sam Jackson Park Road, Oregon Health and Science University (OHSU), Portland, OR 97239, USA
| | - Thomas Becker
- Northwest Portland Area Indian Health Board Tribal Epidemiology Center, 2121 SW Broadway, Suite 300, Portland, OR 97201, USA; OHSU-Portland State University (PSU) School of Public Health, 506 SW Mill Street, Portland, OR 97201, USA
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Petousis S, Christidis P, Margioula-Siarkou C, Papanikolaou A, Dinas K, Mavromatidis G, Guyon F, Rodolakis A, Vergote I, Kalogiannidis I. Combined pelvic and para-aortic is superior to only pelvic lymphadenectomy in intermediate and high-risk endometrial cancer: a systematic review and meta-analysis. Arch Gynecol Obstet 2020; 302:249-263. [PMID: 32468162 DOI: 10.1007/s00404-020-05587-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lymph node metastasis is a principal prognostic factor for the treatment of endometrial cancer. Added value of para-aortic lymphadenectomy to only pelvic lymphadenectomy for intermediate/high-risk endometrial cancer patients remains controversial. OBJECTIVE A systematic review and meta-analysis was performed to assess the impact of combined pelvic and para-aortic lymph node dissection (PPALND) compared to only pelvic lymph node dissection (PLND) on survival outcomes of intermediate and/or high-risk patients. STUDY DESIGN The systematic review and meta-analysis adhered to the PRISMA guidelines for meta-analyses of interventional studies. Pubmed, Scopus, EMBASE and Cochrane were searched up to April 20, 2018. Included studies were those comparing high-risk endometrial cancer patients that had performed pelvic and para-aortic lymph node dissection (PPALND) vs. only pelvic lymph node dissection (PLND) apart from standard procedure (total hysterectomy with bilateral salpingo-oophorectomy, TAHBSO). Primary outcomes of the study were overall survival and disease-free survival rates. Methodological quality of the included studies was assessed using the ROBINS-I tool. Overall quality of the evidence for the primary and secondary outcomes was evaluated as per GRADE guideline using the GRADE pro GD tool. RESULTS There were 13 studies identified with 7349 patients included. All studies were retrospective observational as no RCTs or prospective studies adhering to inclusion criteria were retrieved. Combined pelvic and para-aortic lymphadenectomy was associated with 46% decreased risk for death (HR 0.54, 95% CI 0.35-0.83, I2 = 62.1%) and 49% decreased risk for recurrence (HR 0.51, 95% CI 0.28-0.93). It was also associated with increased 5-year OS rate (RR 1.13, 95% CI 1.04-0.24, I2 = 57.3%) and increased 5-year DFS rate (RR 1.23, 95% CI 1.14-1.31, I2 = 85.5) compared with only pelvic lymphadenectomy. CONCLUSION Combined pelvic and para-aortic lymphadenectomy is associated with improved survival outcomes compared with only pelvic lymphadenectomy in women with intermediate/high-risk endometrial cancers. Further prospective studies should be performed.
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Affiliation(s)
- Stamatios Petousis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloníki, Greece. .,Gynecologic Oncology Unit, Institut Bergonie, Bordeaux, France.
| | - Panagiotis Christidis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Chrysoula Margioula-Siarkou
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloníki, Greece.,Gynecologic Oncology Unit, Institut Bergonie, Bordeaux, France
| | - Alexios Papanikolaou
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Konstantinos Dinas
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - George Mavromatidis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Frederic Guyon
- Gynecologic Oncology Unit, Institut Bergonie, Bordeaux, France
| | - Alexandros Rodolakis
- 1st Department of Obstetrics and Gynecology, Medical School of Athens, Athens, Greece
| | - Ignace Vergote
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, KU University, Leuven, Belgium
| | - Ioannis Kalogiannidis
- 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloníki, Greece
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Li L, Tang M, Nie D, Gou J, Li Z. Para-aortic lymphadenectomy did not improve overall survival among women with type I endometrial cancer. Int J Gynaecol Obstet 2020; 150:163-168. [PMID: 32433783 DOI: 10.1002/ijgo.13228] [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: 10/29/2019] [Revised: 03/13/2020] [Accepted: 04/24/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare outcomes and prognosis among women with type I endometrial cancer undergoing hysterectomy and bilateral salpingo-oophorectomy (H-BSO) with or without systematic pelvic lymphadenectomy (PLD) or para-aortic lymphadenectomy (PALD). METHODS Retrospective review of women postoperatively diagnosed with type I endometrial cancer who underwent H-BSO at a university hospital in Chengdu, China (January 2010 to June 2012). Women were divided into no lymphadenectomy (PLD-/PALD-), systematic pelvic lymphadenectomy (PLD+/PALD-), or combined pelvic and para-aortic lymphadenectomy (PLD+/PALD+) groups. Follow-up was by telephone. Postoperative outcomes and prognosis were compared and risk factors were analyzed. RESULTS In total, 333 women met the inclusion criteria: 121 underwent PLD+/PALD-, 166 underwent PLD+/PALD+, and 46 underwent PLD-/PALD-. There were no differences in pre-operative characteristics among the groups (all P>0.05). The PLD+/PALD+ group had a higher laparotomy rate (P=0.001), the PLD-/PALD- group had shorter operation time (P=0.001) and lower blood loss (P<0.001). There were no differences between the PLD+/PALD- and PLD+/PALD+ groups. Overall, 291 women had sufficient follow-up data; there was no difference in overall survival, and PALD was not a predictor of survival. CONCLUSION Postoperative outcomes were similar among all surgical groups; a survival benefit of PALD was not demonstrated.
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Affiliation(s)
- Lin Li
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Mingming Tang
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Dan Nie
- Department of Obstetrics and Gynecology, The affiliated hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Jinhai Gou
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zhengyu Li
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
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