Factors influencing prognosis

Evaluation of different surgical approaches in the treatment of endometrial cancer at FIGO stage I

From January 1, 1970 to December 31, 1979, 425 cases of endometrial carcinoma, FIGO stage I, were treated at the First Department of Obstetrics and Gynecology, University of Milan. Three different surgical approaches were used: total abdominal hysterectomy with bilateral salpingo-oophorectomy and selective pelvic lymphadenectomy was performed in 245 women, total abdominal hysterectomy and bilateral salpingo-oophorectomy without pelvic lymphadenectomy in 100, and vaginal hysterectomy with bilateral salpingo-oophorectomy in 80. Five-year survival was evaluated as a function of risk factors (histological grade, depth of myometrial invasion, metastatic nodes) in the three groups of patients, and we conclude that lymphadenectomy is useful for prognostic purposes but does not confer a therapeutic benefit.

Endometrial carcinoma stage I--comparison of two different treatment regimes--evaluation of risk factors and its influence on prognosis; suggested step by step treatment protocol

Two hundred twenty-four patients with stage I endometrial carcinoma were treated between the years 1964 and 1978. One hundred and fifteen patients were classified as clinical stage Ia (51.3%) and 109 patients as clinical state Ib (48.7%). For stage Ia the standard treatment protocol was total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO). In stage Ib disease, preoperative irradiation was performed followed by TAH + BSO after an interval of 4 to 6 weeks. Postoperative irradiation to the pelvis and vaginal vault was given when extrauterine spread was found and in cases of myometrial penetration beyond the inner one-third of the myometrium. At evaluation in May 1983, the rate of disease recurrence in stage Ia was 20% and in stage Ib 9.1%. Five-year survival in stage Ia was 77.3% and 72.4% in stage Ib. Preoperative irradiation was found justified for G3 disregarding the clinical stage, therefore the approach of routine preoperative irradiation in stage Ib is not recommended. The uterine cavity depth was found to be an inaccurate prognostic parameter. According to the data collected in our material the histological grade and myometrial invasion are much better prognostic parameter and should be taken into consideration while planning the treatment regime.

Epithelial compartment volume density: a proposal of a prognosis score in endometrial adenocarcinoma

The point count method was used to calculate the relative volume density of the epithelial, stromal, and luminal compartments of endometrial adenocarcinoma, according to stereological principles. All three compartments could be correlated with survival in a significant way. The relative volume density of the epithelial compartment further correlated with the histologic grade of the tumor, but not with the clinical stage of disease or age of the patient. Providing the pathologist with a 40% relative volume density of the epithelial compartment as a decision line, this parameter may be useful as a prognostic factor. A prognosis scoring system on a pretherapeutic and postsurgical-pathologic level is proposed and its utility applied to the study group.

Some surgical aspects of gynecologic cancer

The most important developments in gynecologic oncology in recent years have been the advent of supervoltage irradiation that allows the delivery of better and safer therapy; the diligent search for new cancerostatic drugs and hormones and their clinical application, singly and in combination; and studies suggesting the possibility of immunotherapy. Conversely, few noteworthy developments have emerged in the operative management of gynecologic malignancy, even though refinements of surgical technique, improved preoperative and postoperative care, and better control of infectious problems gradually have decreased the operative morbidity and mortality rates and have improved the survival rates significantly. Surgery continues to be the dominant therapy. Irradiation, chemotherapy, and hormones are therapeutic adjuvants in the management of ovarian, endometrial, cervical, vulvar, and other genital malignancies. As a result of earlier diagnosis, with the greatly diminished incidence of far-advanced carcinoma of the cervix, primary surgery is having a larger role in the management of the early stages of this lesion. Aggressive surgical removal of advanced, dissemenated ovarian carcinoma is worthwhile; diminishing the volume of the lesion significantly improves the response of residual tumor to adjuvant therapy.