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Chen J, Clark LH, Kong WM, Yan Z, Han C, Zhao H, Liu TT, Zhang TQ, Song D, Jiao SM, Zhou C. Does hysteroscopy worsen prognosis in women with type II endometrial carcinoma? PLoS One 2017; 12:e0174226. [PMID: 28334032 PMCID: PMC5363864 DOI: 10.1371/journal.pone.0174226] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/05/2017] [Indexed: 01/07/2023] Open
Abstract
Background Prior studies evaluating the impact of hysteroscopy on outcomes in endometrial cancer have predominantly evaluated type I tumors. We sought to evaluate whether hysteroscopy worsens prognosis in type II endometrial cancer. Methods A retrospective cohort analysis of 140 patients from two institutions with type II endometrial cancer was performed. Women who underwent either diagnostic hysteroscopy (HSC) or dilation and curettage (D&C) for cancer diagnosis from June 2001 until June 2010 were included. The clinical and pathologic characteristics, including peritoneal cytology results were reviewed. The primary endpoint was disease-specific survival (DSS). The exposure of interest was hysteroscopy. Survival curves were projected using the Kaplan-Meier method and compared using the log-rank test. Results There was no difference in age, histology, stage, depth of myometrial invasion, adnexal involvement, or nodal metastasis between HSC and D&C patients. Positive cytology was found in 16/54 (30%) patients following HSC and in 10/86 (12%) following D&C (p = 0.008). Fourteen patients with stage I and II disease had positive peritoneal cytology, with 11/40 (27.5%) patients in the HSC group and 3/59 (5%) patients in the D&C group(p = 0.002). Median DSS was clinically different for the HSC and D&C groups, but statistical significance was not reached (53 versus 63.5 months, p = 0.34). For stage I and II patients, 18/99 (18%) were dead of EC, with a median DSS of 60 months for HSC and 71 months for D&C (p = 0.82). Overall 46 (33%) patients developed a recurrence, with 18/54 (33%) in the HSC group compared to 28/86 (32%) in the D&C group (p = 0.92). There was no difference in recurrence location between groups. Conclusions Diagnostic hysteroscopy significantly increased the rate of positive peritoneal cytology at the time of surgical staging in this cohort of patients with type II EC. However, we were unable to detect a difference in prognosis as measured by DSS.
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Affiliation(s)
- Jiao Chen
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Leslie H. Clark
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Wei-Min Kong
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- * E-mail: (WMK); (CZ)
| | - Zhen Yan
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Chao Han
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Hui Zhao
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Ting-Ting Liu
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Tong-Qing Zhang
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Dan Song
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Si-Meng Jiao
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Chunxiao Zhou
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, United States of America
- * E-mail: (WMK); (CZ)
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Felix AS, Brinton LA, McMeekin DS, Creasman WT, Mutch D, Cohn DE, Walker JL, Moore RG, Downs LS, Soslow RA, Zaino R, Sherman ME. Relationships of Tubal Ligation to Endometrial Carcinoma Stage and Mortality in the NRG Oncology/ Gynecologic Oncology Group 210 Trial. J Natl Cancer Inst 2015; 107:djv158. [PMID: 26089540 DOI: 10.1093/jnci/djv158] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 05/12/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Stage is a critical determinant of treatment among endometrial carcinoma patients; understanding patterns of tumor spread may suggest approaches to improve staging. Specifically, the importance of exfoliation of endometrial carcinoma cells through the fallopian tubes into the peritoneum is ill defined. We assessed the hypothesis that tubal ligation (TL), which should impede transtubal passage of cells, is associated with lower endometrial carcinoma stage at presentation and, consequently, lower mortality. METHODS The NRG Oncology/Gynecologic Oncology Group (GOG) 210 Trial included 4489 endometrial carcinoma patients who completed a risk factor questionnaire that included TL history. Pathology data were derived from clinical reports and central review. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between TL with stage and peritoneal metastasis, overall and by tumor subtype. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals for TL and mortality. All statistical tests were two-sided. RESULTS Compared with stage I, TL was inversely associated with stage III (OR = 0.63, 95% CI = 0.52 to 0.78) and stage IV carcinomas (OR = 0.14, 95% CI = 0.08 to 0.24) overall and among individual tumor subtypes. TL was inversely related to peritoneal metastasis overall (OR = 0.39, 95% CI = 0.22 to 0.68) and among serous carcinomas (OR = 0.28, 95% CI = 0.11 to 0.68). In multivariable models unadjusted for stage, TL was associated with lower endometrial carcinoma-specific mortality (HR = 0.74, 95% CI = 0.61 to 0.91); however, adjustment for stage eliminated the survival advantage. Similar relationships with all-cause mortality were observed. CONCLUSIONS TL is associated with lower stage and mortality among women with aggressive endometrial carcinomas, suggesting transtubal spread is clinically important. Future studies should evaluate whether detection of intraluminal tumor cells is prognostically relevant.
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Affiliation(s)
- Ashley S Felix
- : Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics (ASF, LAB) and Cancer Prevention Fellowship Program, Division of Cancer Prevention (ASF), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK (SM, JLW); Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (WTC); Washington University School of Medicine, St. Louis, MO (DM); Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH (DEC); Women and Infants Hospital/Brown University, Providence, RI (RGM); University of Minnesota, Minneapolis, MN (LSD); Memorial Sloan Kettering Cancer Center, New York, NY (RAS); Anatomic Pathology, Penn State Milton S. Hersey Medical Center, Hershey, PA (RZ); Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD (MES).
| | - Louise A Brinton
- : Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics (ASF, LAB) and Cancer Prevention Fellowship Program, Division of Cancer Prevention (ASF), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK (SM, JLW); Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (WTC); Washington University School of Medicine, St. Louis, MO (DM); Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH (DEC); Women and Infants Hospital/Brown University, Providence, RI (RGM); University of Minnesota, Minneapolis, MN (LSD); Memorial Sloan Kettering Cancer Center, New York, NY (RAS); Anatomic Pathology, Penn State Milton S. Hersey Medical Center, Hershey, PA (RZ); Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD (MES)
| | - D Scott McMeekin
- : Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics (ASF, LAB) and Cancer Prevention Fellowship Program, Division of Cancer Prevention (ASF), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK (SM, JLW); Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (WTC); Washington University School of Medicine, St. Louis, MO (DM); Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH (DEC); Women and Infants Hospital/Brown University, Providence, RI (RGM); University of Minnesota, Minneapolis, MN (LSD); Memorial Sloan Kettering Cancer Center, New York, NY (RAS); Anatomic Pathology, Penn State Milton S. Hersey Medical Center, Hershey, PA (RZ); Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD (MES)
| | - William T Creasman
- : Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics (ASF, LAB) and Cancer Prevention Fellowship Program, Division of Cancer Prevention (ASF), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK (SM, JLW); Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (WTC); Washington University School of Medicine, St. Louis, MO (DM); Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH (DEC); Women and Infants Hospital/Brown University, Providence, RI (RGM); University of Minnesota, Minneapolis, MN (LSD); Memorial Sloan Kettering Cancer Center, New York, NY (RAS); Anatomic Pathology, Penn State Milton S. Hersey Medical Center, Hershey, PA (RZ); Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD (MES)
| | - David Mutch
- : Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics (ASF, LAB) and Cancer Prevention Fellowship Program, Division of Cancer Prevention (ASF), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK (SM, JLW); Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (WTC); Washington University School of Medicine, St. Louis, MO (DM); Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH (DEC); Women and Infants Hospital/Brown University, Providence, RI (RGM); University of Minnesota, Minneapolis, MN (LSD); Memorial Sloan Kettering Cancer Center, New York, NY (RAS); Anatomic Pathology, Penn State Milton S. Hersey Medical Center, Hershey, PA (RZ); Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD (MES)
| | - David E Cohn
- : Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics (ASF, LAB) and Cancer Prevention Fellowship Program, Division of Cancer Prevention (ASF), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK (SM, JLW); Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (WTC); Washington University School of Medicine, St. Louis, MO (DM); Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH (DEC); Women and Infants Hospital/Brown University, Providence, RI (RGM); University of Minnesota, Minneapolis, MN (LSD); Memorial Sloan Kettering Cancer Center, New York, NY (RAS); Anatomic Pathology, Penn State Milton S. Hersey Medical Center, Hershey, PA (RZ); Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD (MES)
| | - Joan L Walker
- : Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics (ASF, LAB) and Cancer Prevention Fellowship Program, Division of Cancer Prevention (ASF), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK (SM, JLW); Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (WTC); Washington University School of Medicine, St. Louis, MO (DM); Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH (DEC); Women and Infants Hospital/Brown University, Providence, RI (RGM); University of Minnesota, Minneapolis, MN (LSD); Memorial Sloan Kettering Cancer Center, New York, NY (RAS); Anatomic Pathology, Penn State Milton S. Hersey Medical Center, Hershey, PA (RZ); Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD (MES)
| | - Richard G Moore
- : Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics (ASF, LAB) and Cancer Prevention Fellowship Program, Division of Cancer Prevention (ASF), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK (SM, JLW); Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (WTC); Washington University School of Medicine, St. Louis, MO (DM); Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH (DEC); Women and Infants Hospital/Brown University, Providence, RI (RGM); University of Minnesota, Minneapolis, MN (LSD); Memorial Sloan Kettering Cancer Center, New York, NY (RAS); Anatomic Pathology, Penn State Milton S. Hersey Medical Center, Hershey, PA (RZ); Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD (MES)
| | - Levi S Downs
- : Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics (ASF, LAB) and Cancer Prevention Fellowship Program, Division of Cancer Prevention (ASF), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK (SM, JLW); Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (WTC); Washington University School of Medicine, St. Louis, MO (DM); Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH (DEC); Women and Infants Hospital/Brown University, Providence, RI (RGM); University of Minnesota, Minneapolis, MN (LSD); Memorial Sloan Kettering Cancer Center, New York, NY (RAS); Anatomic Pathology, Penn State Milton S. Hersey Medical Center, Hershey, PA (RZ); Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD (MES)
| | - Robert A Soslow
- : Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics (ASF, LAB) and Cancer Prevention Fellowship Program, Division of Cancer Prevention (ASF), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK (SM, JLW); Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (WTC); Washington University School of Medicine, St. Louis, MO (DM); Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH (DEC); Women and Infants Hospital/Brown University, Providence, RI (RGM); University of Minnesota, Minneapolis, MN (LSD); Memorial Sloan Kettering Cancer Center, New York, NY (RAS); Anatomic Pathology, Penn State Milton S. Hersey Medical Center, Hershey, PA (RZ); Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD (MES)
| | - Richard Zaino
- : Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics (ASF, LAB) and Cancer Prevention Fellowship Program, Division of Cancer Prevention (ASF), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK (SM, JLW); Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (WTC); Washington University School of Medicine, St. Louis, MO (DM); Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH (DEC); Women and Infants Hospital/Brown University, Providence, RI (RGM); University of Minnesota, Minneapolis, MN (LSD); Memorial Sloan Kettering Cancer Center, New York, NY (RAS); Anatomic Pathology, Penn State Milton S. Hersey Medical Center, Hershey, PA (RZ); Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD (MES)
| | - Mark E Sherman
- : Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics (ASF, LAB) and Cancer Prevention Fellowship Program, Division of Cancer Prevention (ASF), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK (SM, JLW); Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (WTC); Washington University School of Medicine, St. Louis, MO (DM); Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH (DEC); Women and Infants Hospital/Brown University, Providence, RI (RGM); University of Minnesota, Minneapolis, MN (LSD); Memorial Sloan Kettering Cancer Center, New York, NY (RAS); Anatomic Pathology, Penn State Milton S. Hersey Medical Center, Hershey, PA (RZ); Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD (MES)
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