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Ozturk Basarir Z, Karaca MO, Balaban K, Basarir K, Yildiz HY. Prognostic factors in endometrial cancer patients with bone metastasis. Jt Dis Relat Surg 2023; 34:207-214. [PMID: 36700284 PMCID: PMC9903106 DOI: 10.52312/jdrs.2023.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/10/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study aims to examine the pattern and prognosis of osseous involvement and the role of orthopedic surgery in patients with endometrial cancer (EC) and to evaluate the quality of life, local tumor control, and survival of patients. PATIENTS AND METHODS Between January 2011 and December 2018, a total of 14 patients (median age: 60.5 years; range, 55 to 73 years) who were surgically treated for osseous metastasis of EC and followed for minimum 12 months were retrospectively analyzed. All patients were evaluated for their primary malignancy, characteristics of bone metastasis, and type of treatment related to musculoskeletal involvement. For evaluating the functional outcomes, the Visual Analog Scale (VAS) for pain and Eastern Cooperative Oncology Group (ECOG) performance status scale were used in the pre- and postoperative period. RESULTS The median follow-up was 34.5 (range, 9 to 89) months. All patients had advanced-stage disease (FIGO Stage III-IV). Four patients had solitary and 10 patients had multiple bone metastases. The mean VAS score and ECOG performance status grades improved (p<0.001 and p<0.05, respectively). The median survival after detection of bone metastasis was 61 (range, 41 to 82) months. CONCLUSION Endometrial cancer patients with musculoskeletal pain should be investigated for the possibility of bone metastasis to tailor a prompt treatment and to achieve a better prognosis. Appropriate surgical treatment of bone metastasis may improve both pain and performance status in carefully selected patients.
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Affiliation(s)
| | - Mustafa Onur Karaca
- Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Kamil Balaban
- Ankara Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 06620 Altındağ, Ankara, Türkiye.
| | - Kerem Basarir
- Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Huseyin Yusuf Yildiz
- Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, Ankara, Türkiye
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Dhamija E, Baby A, Bhatla N, Pulappadi VP, Kumar M, Kumar S, Kumar L, Sharma D. Radiological evaluation of metastatic lymph nodes in carcinoma cervix with emphasis on their infiltrative pattern. Indian J Med Res 2021; 154:383-390. [PMID: 35295016 PMCID: PMC9131760 DOI: 10.4103/ijmr.ijmr_212_21] [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: 11/23/2022] Open
Abstract
BACKGROUND & OBJECTIVES Imaging has been added to the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system of cervical carcinoma. This study was performed to assess the impact of imaging in staging and to ascertain the prevalence and pattern of nodal metastasis on contrast-enhanced computed tomography (CECT) in patients with cervical carcinoma who were treated based on FIGO 2009 staging system. METHODS This retrospective study was conducted to evaluate all patients with biopsy-proven cervical carcinoma who underwent CECT of abdomen at a tertiary cancer centre in north India from April 2017 to April 2019 and for whom either baseline or follow up scans were available. In patients with enlarged or necrotic lymph nodes, the location, size and pattern of infiltration of adjacent organs were recorded. RESULTS A total of 602 patients of cervical carcinoma had undergone CT during the study period, of whom 138 (22.9%) underwent CT at baseline and 464 (77.1%) patients during follow up. The FIGO (2009) stage distribution at the time of presentation was stage IB: 109 (18.1%); stage IIA: 14 (2.3%), stage IIB: 118 (19.6%), stage IIIA: 12 (2%), stage IIIB: 277 (46%), stage IVA: 20 (3.3%) and stage IVB: 52 (8.6%). Ninety of the 138 (65.22%) patients underwent a stage shift according to the FIGO 2018 because of the presence of enlarged lymph nodes at baseline scan. Sixteen (2.7%) patients had infiltrative nodal masses most commonly involving the blood vessels (n=14) followed by ureter (n=8), bones (n=5), muscle and bowel (n=3, each). The majority (14/16) of these patients presented with vague abdominal pain, discomfort and vomiting, while two had bone pain. INTERPRETATION & CONCLUSIONS CECT at baseline helps in accurately assessing the stage in cervical carcinoma. It helps in the identification of lymph node metastasis in cervical carcinoma, which is crucial for guiding accurate management.
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Affiliation(s)
- Ekta Dhamija
- Department of Radiodiagnosis, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,For correspondence: Dr Ekta Dhamija, Room Number 137, First Floor, Department of Radiodiagnosis, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110 029, India e-mail:
| | - Akhil Baby
- Department of Radiodiagnosis, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics & Gynaecology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vishnu Prasad Pulappadi
- Department of Radiodiagnosis, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh Kumar
- Department of Radiodiagnosis, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics & Gynaecology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Dayanand Sharma
- Department of Radiation Oncology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Younis MH, Fuentes-Rivera L, Summers S, Pretell-Mazzini J. Survival in patients with carcinomas presenting with bone metastasis at diagnosis: a SEER population-based cohort study. Arch Orthop Trauma Surg 2021; 141:367-373. [PMID: 32236712 DOI: 10.1007/s00402-020-03417-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Carcinoma metastasis to bone is a common reason for consultation to orthopedic surgeons. The presence of bone metastases (BM) is usually associated with poor prognosis which is worsened in the presence of synchronous metastases. The purpose of this study was to: (1) identify the most common carcinomas presenting with BM at diagnosis, to (2) analyze their survival, and (3) compare this against the survival of patients with additional synchronous metastasis based on a large population analysis. MATERIALS AND METHODS Patients diagnosed with carcinoma between January 2010 and December 2015 were identified from the Surveillance, Epidemiology and End Results (SEER) database. The most common carcinomas presenting with BM at diagnosis were identified. Survival based on the presence of BM and synchronous metastases (lung, brain, liver, lymph nodes) was evaluated with Kaplan-Meier analysis. Five-year survival (%) stratified by carcinoma type was calculated. Hazard ratio (HR) for mortality comparing isolated BM to other synchronous metastases was performed. RESULTS A total of 4.85% of patients (98,606/2,035,204) with carcinoma presented with BM at diagnosis, most commonly from a lung primary. Five-year survival with isolated BM was lowest in patients with pancreatic carcinoma (5.8%, 95% CI 3.0-9.9%), and highest in patients with breast carcinoma (41.1%, 95% CI 38.6-43.5%). Synchronous metastases increased significantly the risk of mortality within the majority of carcinomas. CONCLUSION BM at diagnosis has a poor prognosis which is worsened if synchronous metastases are present; a fact to consider when planning orthopedic interventions. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Manaf H Younis
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Division, University of Miami, Miller School of Medicine, 1400 NW 12th Avenue, Fourth floor, Room 4036, Miami, FL, 33136, USA.,Department of Orthopaedics and Rehabilitation, University of Miami, 1400 NW 12th Avenue, Fourth floor, Room 4036, Miami, FL, 33136, USA
| | - Lorena Fuentes-Rivera
- Escuela de Medicina, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima, 15102, Peru
| | - Spencer Summers
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Division, University of Miami, Miller School of Medicine, 1400 NW 12th Avenue, Fourth floor, Room 4036, Miami, FL, 33136, USA.,Department of Orthopaedics and Rehabilitation, University of Miami, 1400 NW 12th Avenue, Fourth floor, Room 4036, Miami, FL, 33136, USA
| | - Juan Pretell-Mazzini
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Division, University of Miami, Miller School of Medicine, 1400 NW 12th Avenue, Fourth floor, Room 4036, Miami, FL, 33136, USA. .,Department of Orthopaedics and Rehabilitation, University of Miami, 1400 NW 12th Avenue, Fourth floor, Room 4036, Miami, FL, 33136, USA.
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McEachron J, Chatterton C, Hastings V, Gorelick C, Economos K, Lee YC, Kanis MJ. A clinicopathologic study of endometrial cancer metastatic to bone: Identification of microsatellite instability improves treatment strategies. Gynecol Oncol Rep 2020; 32:100549. [PMID: 32099892 PMCID: PMC7031305 DOI: 10.1016/j.gore.2020.100549] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 12/28/2022] Open
Abstract
Metastasis of endometrial cancer (EC) to bone is rare, occurring in <1.0% of cases. The most common sites of bone metastasis in EC are the spine and hip. Diagnosis of bone metastasis is associated with widely metastatic disease and poor prognosis. The median overall survival following a diagnosis of bone metastasis was 11 months in our series. 87.5% of patients with bone metastasis were found to have microsatellite instability.
Metastasis to bone (BM) is an uncommon manifestation of advanced endometrial cancer (EC). The present study will review the clinicopathologic features of a cohort of patients with EC and BM. We conducted a multi-center retrospective review of patients with EC and BM. Demographic and clinical information was extracted from the medical records. Survival outcomes were determined using Kaplan-Meier Curves. Final analysis included 10 patients. The median age was 65 years (range 31–71). 80% had FIGO stage III/IV disease. The most common site of BM was the spine (66%). All patients presented with extraosseous dissemination at the time of diagnosis of BM and 70% were found to have multiple sites of BM. 80% of patients were diagnosed with BM in the recurrent setting. The median time to diagnosis of bone recurrence was 14 months (range: 0–44). Median survival after diagnosis of BM was 11 months (range: 1–22 months). Patients with endometrioid histology and single site of bone metastasis experienced improved survival (p = 0.04 and p = 0.05, respectively). Eight patients had immunohistochemistry or molecular tumor profiles available for review. Seven of these patients (87.5%) were found to have microsatellite instability (MSI). The most common mutation was hypermethylation of MLH-1 (43%). To our knowledge, this is the first report demonstrating a correlation between MSI and metastasis to bone. The identification of BM in EC is uncommon, but will alter treatment strategies and dramatically impact prognosis. Molecular tumor profiling should be performed to identify targeted therapy options and optimize adjuvant treatment strategies.
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Affiliation(s)
- Jennifer McEachron
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Carolyn Chatterton
- Division of Gynecologic Oncology, Good Samaritan Hospital Medical Center, West Islip, NY, United States
| | - Victoria Hastings
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Constantine Gorelick
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Katherine Economos
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
| | - Yi-Chun Lee
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Marguax J Kanis
- Division of Gynecologic Oncology, New York Presbyterian - Brooklyn Methodist Hospital, Brooklyn, NY, United States
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