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Ditto A, Ferla S, Martinelli F, Bogani G, Maggiore ULR, Raspagliesi F. "Pelvic neuro-visualization: an anatomical illustration of the autonomic pelvic nervous network in gynecologic surgery". J Minim Invasive Gynecol 2024:S1553-4650(24)00171-7. [PMID: 38642885 DOI: 10.1016/j.jmig.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/19/2024] [Accepted: 04/15/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE During radical pelvic surgeries fibers of the autonomic pelvic nervous network can be accidentally damaged leading to significant visceral sequelae, which dramatically affect women's quality of life because of urinary, anorectal, and sexual postoperative dysfunctions.1,2 Direct visualization is one way to preserve hypogastric nerves(HNs), pelvic splanchnic nerves(PSNs), and the bladder branches from the inferior hypogastric plexus(IHP). However, the literature lacks critical photos and/or illustrations that are necessary to understand the precise anatomy needed to preserve the pelvic autonomic fibers. DESIGN Narrated laparoscopic video footage for identifying, dissecting, and preserving the autonomic nerve bundles during pelvic surgery. SETTING Tertiary level hospital - "IRCCS Istituto Nazionale dei Tumori", Milano, Italy. INTERVENTIONS Visceral pelvic innervation is established by the superior hypogastric plexus(SHP) located anteriorly to the aortic bifurcation and the median sacral vessels and carries mostly sympathetic fibers. SHP divides in front of the sacrum into the right and left HN. At the level of the paracervix, the HNs join the parasympathetic PSNs coming out from sacral root S2, S3, S4 to form the IHP.2-5 Here, we performed laparoscopic surgery, before "Laparoscopic Approach to Cervical Cancer" trial (LACC) era, identifying key anatomic landmarks useful to highlight the path of the most commonly encountered autonomic pelvic nerves in gynecologic radical surgery: during the narration we describe and illustrate the procedure to identify all autonomic pelvic nerves, the sympathetic fibers, the PSNs, and the bladder branch emerging from the IHP in order to preserve their anatomic and functional integrity. This technique is anatomically and surgically indicated for adequate removal of the parametrial issues and vagina while preserving the total pelvic nervous system. CONCLUSION Nerve-sparing surgery reduces bowel-, bladder- and sexual- dysfunction without decreasing surgical efficacy.1,2 To accomplish safe and effective surgery, comprehension of the three dimensional structure of the vascular and nerve anatomy in the pelvis is essential. This video provides a great resource to educate surgeons, especially the youngest ones, about the retroperitoneal nervous networking: we identified the autonomic nerve pathway from adjacent tissues along the pathway consisting of cardinal, sacro-uterine, rectouterine/vaginal, and vesico-uterine ligaments.
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Affiliation(s)
- Antonino Ditto
- Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy.
| | - Stefano Ferla
- Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Fabio Martinelli
- Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy
| | - Giorgio Bogani
- Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy
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Leone Roberti Maggiore U, Bogani G, Paolini B, Martinelli F, Chiarello G, Spanò Bascio L, Chiappa V, Ferrero S, Ditto A, Raspagliesi F. Endometriosis-associated ovarian cancer: a different clinical entity. Int J Gynecol Cancer 2024:ijgc-2023-005139. [PMID: 38531540 DOI: 10.1136/ijgc-2023-005139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE To compare survival outcomes and patterns of recurrence between endometriosis-associated ovarian cancer patients and non-endometriosis-associated ovarian cancer patients. METHODS This retrospective study included data of consecutive patients with endometrioid or clear cell ovarian cancer treated at the Fondazione IRCCS Istituto Nazionale dei Tumori di Milano between January 2010 and June 2021. Patients were assigned to one of two groups according to the absence or presence of endometriosis together with ovarian cancer at final histological examination. Survival outcomes were assessed using Kaplan-Meier and Cox hazard models. Proportions in recurrence rate and pattern of recurrence were evaluated using the Fisher exact test. RESULTS Overall, 83 women were included in the endometriosis-associated ovarian cancer group and 144 in the non-endometriosis-associated ovarian cancer group, respectively. Patients included in the non- endometriosis-associated ovarian cancer group had a shorter disease-free survival than those in the endometriosis-associated ovarian cancer group (23.4 (range 2.0-168.9) vs 60.9 (range 4.0-287.8) months; p<0.001). Univariable and multivariable analyses showed that the association with endometriosis, previous hormonal treatment, early stage at presentation, and endometrioid histology were related to better disease-free survival in the entire study population. Similarly, patients in the non-endometriosis-associated ovarian cancer group had a shorter median (range) overall survival than those in the endometriosis-associated ovarian cancer group (54.4 (range 0.7-190.6) vs 77.6 (range 4.5-317.8) months; p<0.001). Univariable and multivariable analyses showed that younger age at diagnosis, association with endometriosis, and early stage at presentation were related to better overall survival. The recurrence rate was higher in the non-endometriosis-associated ovarian cancer group (63/144 women, 43.8%) than in the endometriosis-associated ovarian cancer group (17/83 women, 20.5%; p<0.001). CONCLUSIONS Endometriosis-associated ovarian cancer patients had significantly longer disease-free survival and overall survival than non-endometriosis-associated ovarian cancer patients, while the recurrence rate was higher in non-endometriosis-associated ovarian cancer patients.
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Affiliation(s)
| | - G Bogani
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Biagio Paolini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabio Martinelli
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia Chiarello
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Ludovica Spanò Bascio
- Minimally Invasive and Robotic Gynecologic Surgery Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Chiappa
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonino Ditto
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Raspagliesi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Ditto A, Longo M, Chiarello G, Mariani L, Paolini B, Leone Roberti Maggiore U, Martinelli F, Bogani G, Raspagliesi F. Are biomarkers expression and clinical-pathological factors predictive markers of the efficacy of neoadjuvant chemotherapy for locally advanced cervical cancer? Eur J Surg Oncol 2024; 50:108311. [PMID: 38554552 DOI: 10.1016/j.ejso.2024.108311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 03/03/2024] [Accepted: 03/24/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION To predict the overall pathologic response to neoadjuvant chemotherapy (NACT) of patients with locally advanced cervical cancer (LACC) creating a prediction model based on clinical-pathological factors and biomarkers (p53, Bcl1 and Bcl2) and to evaluate the prognostic outcomes of NACT. MATERIALS AND METHODS This is a retrospective study of 88 consecutive patients with LACC who underwent NACT followed by nerve sparing surgery with retroperitoneal lymphadenectomy at National Cancer Institute of Milan, between January 2000 and June 2013. Clinical pathologic data were retrieved from the institutional database. Biomarkers (p53, Bcl1 and Bcl2) were evaluated before and after NACT in the specimen. To investigate their role as predictors of response, we tried several statistical machine learning algorithms. RESULTS Responders to NACT showed a 5-years survival between 100%(CR) and 85.7%(PR). Clinical factors were the most important predictor of response. Age, BMI and grade represented the most important predictors of response at random forest analysis. Tree-based boosting revealed that after adjusting for other prognostic factors, age, grade, BMI and tumor size were independent predictors of response to NACT, while p53 was moderately related to response to NACT. Area under the curve (crude estimate): 0.871. Whereas Bcl1 and Bcl2, were not predictors for response to NACT. The final logistic regression reported that grade was the only significant predictor of response to NACT. CONCLUSION Combined model that included clinical pathologic variables plus p53 cannot predict response to NACT. Despite this, NACT remain a safe treatment in chemosensitive patients avoiding collateral sequelae related to chemo-radiotherapy.
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Affiliation(s)
- Antonino Ditto
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy.
| | - Mariangela Longo
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Giulia Chiarello
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Luigi Mariani
- Statistics Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Biagio Paolini
- Pathology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | | | - Fabio Martinelli
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Giorgio Bogani
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Francesco Raspagliesi
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
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Leone Roberti Maggiore U, Spanò Bascio L, Alboni C, Chiarello G, Savelli L, Bogani G, Martinelli F, Chiappa V, Ditto A, Raspagliesi F. Sentinel lymph node biopsy in endometrial cancer: When, how and in which patients. Eur J Surg Oncol 2024; 50:107956. [PMID: 38286085 DOI: 10.1016/j.ejso.2024.107956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/27/2023] [Accepted: 01/08/2024] [Indexed: 01/31/2024]
Abstract
The role of nodal dissection in patients with endometrial cancer has been intensively studied in several studies. Historically, systematic pelvic and para-aortic lymphadenectomy represented the gold standard surgical treatment to assess potential nodal involvement and consequently define the appropriate stage of the tumor. Over the last years, sentinel node biopsy (SLNB) has been introduced as a more targeted alternative to lymph node dissection for lymph node staging and it has become popular among gynecologic oncologists. However, no level A evidence is still available, and several features of the SLNB technique have been matter of discussion among clinicians and a universally accepted methodology is still not currently available. This narrative review aims to summarize the body of knowledge on SLNB to offer the reader a complete picture about the evolution of this technique over the last decades.
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Affiliation(s)
| | - Ludovica Spanò Bascio
- Obstetrics and Gynecology, Policlinico Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Alboni
- Obstetrics and Gynecology, Policlinico Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Chiarello
- Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Luca Savelli
- Obstetrics and Gynecology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Giorgio Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Fabio Martinelli
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Valentina Chiappa
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Antonino Ditto
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Francesco Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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Ditto A, Chiarello G, Leone Roberti Maggiore U, Martinelli F, Bogani G, Raspagliesi F. Low pressure laparoscopic procedure in morbidly obese patients with endometrial carcinoma using a new subcutaneous abdominal wall-retraction device: a surgical challenge. Int J Gynecol Cancer 2023; 33:1974-1975. [PMID: 37586758 DOI: 10.1136/ijgc-2023-004577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Affiliation(s)
- Antonino Ditto
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia Chiarello
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Fabio Martinelli
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Raspagliesi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Ditto A, Ferla S, Martinelli F, Bogani G, Leone Roberti Maggiore U, Raspagliesi F. Real-time Fluorescent ICG and 99m-Tc Nanocolloid Tracer Navigation in Bilateral Sentinel Lymph Node Mapping of Vulvar Cancer. J Minim Invasive Gynecol 2023; 30:780-781. [PMID: 37451504 DOI: 10.1016/j.jmig.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
STUDY OBJECTIVE The effectiveness of sentinel lymph node (SLN) biopsy has been validated by 2 prospective trials, GROINS VI and GOG 173 [1,2]. According to the European Society of Gynaecological Oncology guideline in patients with unifocal tumors with a diameter of <4 cm, in the absence of suspected inguinal lymph nodes, SLN biopsy is recommended. The use of a radioactive tracer is mandatory [2]. Using indocyanine green (ICG) increases the detection of the vulvar sentinel node from 89.7% to 100% [3]. This video aimed to share our experience about the feasibility, safety, and usefulness of the surgical identification of SLN in vulvar cancer using real-time fluorescent ICG with 99m-technetium (Tc) nanocolloid. DESIGN A stepwise demonstration of the technique with narrated video footage. SETTING Tertiary level hospital "IRCCS Istituto Nazionale dei Tumori," Milano, Italy. INTERVENTIONS A 50-year-old woman was diagnosed as having vulvar cancer on biopsy of 1.5 cm size vulvar lesion under the clitoris area and referred to our operative unit. F-18 fluorodeoxyglucose positron emission tomography computed tomography showed no extravulvar disease. The patient was scheduled for radical vulvectomy and bilateral inguinal SLN biopsy. (Video still 1) In this video, the surgical procedure involved double location of SLN, first with the 99m-Tc detector followed by ICG identification. We used an ICG dilution of 2.5 mg/mL in sterile water and injected 4 mL around the tumor 5 to 10 minutes before visualization. First a handheld gamma probe used to identify the location of the SLNs with 99m-Tc. The fluorescence imaging was performed by the quest imaging system (FLUOPTICS, Middenmeer, The Netherlands) that combines autofluorescence and fluorescence perfusion imaging (Video Still 2). Second, we performed the SLN biopsy using a dark mode procedure to identify the IGC tracer (Video Still 3). The fluorescence imaging enables the detection of these markers through some millimeters of tissue, and ICG has the advantage that is visible through the skin [4]. CONCLUSION This video shows a successful combined 99m-Tc and ICG fluorescence image-guided bilateral SLN biopsy in a vulvar cancer patient using a near-infrared optical imaging system (FLUOPTICS). ICG for SLN mapping seems to be safe in women with vulvar cancer with a satisfactory detection rate. This may help in retaining surgical radicality while minimizing operative complications.
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Affiliation(s)
- Antonino Ditto
- Fondazione IRCCS National Cancer Institute of Milan (Drs. Ditto, Ferla, Martinelli, Bogani, Maggiore, and Raspagliesi), Milan, Italy.
| | - Stefano Ferla
- Fondazione IRCCS National Cancer Institute of Milan (Drs. Ditto, Ferla, Martinelli, Bogani, Maggiore, and Raspagliesi), Milan, Italy; Division of Gynaecology and Human Reproduction Physiopathology (Dr. Ferla), IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Fabio Martinelli
- Fondazione IRCCS National Cancer Institute of Milan (Drs. Ditto, Ferla, Martinelli, Bogani, Maggiore, and Raspagliesi), Milan, Italy
| | - Giorgio Bogani
- Fondazione IRCCS National Cancer Institute of Milan (Drs. Ditto, Ferla, Martinelli, Bogani, Maggiore, and Raspagliesi), Milan, Italy
| | - Umberto Leone Roberti Maggiore
- Fondazione IRCCS National Cancer Institute of Milan (Drs. Ditto, Ferla, Martinelli, Bogani, Maggiore, and Raspagliesi), Milan, Italy
| | - Francesco Raspagliesi
- Fondazione IRCCS National Cancer Institute of Milan (Drs. Ditto, Ferla, Martinelli, Bogani, Maggiore, and Raspagliesi), Milan, Italy
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Di Donato V, Bogani G, Casarin J, Ghezzi F, Malzoni M, Falcone F, Petrillo M, Capobianco G, Calò F, D'Augè TG, Muzii L, Benedetti Panici P, Ervas E, Ditto A, Raspagliesi F, Sopracordevole F, Vizza E, Giannini A. Ten-year outcomes following laparoscopic and open abdominal radical hysterectomy for "low-risk" early-stage cervical cancer: A propensity-score based analysis. Gynecol Oncol 2023; 174:49-54. [PMID: 37149905 DOI: 10.1016/j.ygyno.2023.04.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/13/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Accumulating evidence suggested the detrimental effects of adopting minimally invasive surgery in the management of early-stage cervical cancer. However, long-term evidence on the role of minimally invasive radical hysterectomy in "low-risk" patients exists. METHODS This is multi-institutional retrospective study comparing minimally invasive and open radical hysterectomy in low-risk early-stage cervical cancer patients. A propensity-score matching algorithm (1:2) was used to allocate patients into the study groups. Kaplan-Meir model was used to estimate 10-year progression-free and overall survival. RESULTS Charts of 224 "low-risk" patients were retrieved. Overall, 50 patients undergoing radical hysterectomy were matched with 100 patients undergoing open radical hysterectomy. Minimally invasive radical hysterectomy was associated with a longer median operative time (224 (range, 100-310) vs. 184 (range, 150-240) minutes; p < 0.001), lower estimated blood loss (10 (10-100) vs. 200 (100-1000) ml, p < 0.001), and shorter length of hospital stay (3.8 (3-6) vs. 5.1 (4-12); p < 0.001). Surgical approach did not influence the risk of having intra-operative (4% vs. 1%; p = 0.257) and 90-day severe (grade 3+) postoperative complication rates (4% vs. 8%; p = 0.497). Ten-year disease-free survival was similar between groups (94% vs. 95%; p = 0.812; HR:1.195; 95%CI:0.275, 5.18). Ten-year overall survival was similar between groups (98% vs. 96%; p = 0.995; HR:0.994; 95%CI:0.182, 5.424). CONCLUSIONS Our study appears to support emerging evidence suggesting that, for low-risk patients, laparoscopic radical hysterectomy does not result in worse 10-year outcomes compared to the open approach. However, further research is needed and open abdominal radical hysterectomy remains the standard treatment for cervical cancer patients.
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Affiliation(s)
- Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy.
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Francesca Falcone
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giampiero Capobianco
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Filippo Calò
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy; Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Tullio Golia D'Augè
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | | | - Elisa Ervas
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Antonino Ditto
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | | | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Giannini
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy; Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Institute, Rome, Italy
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Ditto A, Leone Roberti Maggiore U, Evangelisti G, Bogani G, Chiappa V, Martinelli F, Raspagliesi F. Diagnostic Accuracy of Magnetic Resonance Imaging in the Pre-Operative Staging of Cervical Cancer Patients Who Underwent Neoadjuvant Treatment: A Clinical–Surgical–Pathologic Comparison. Cancers (Basel) 2023; 15:cancers15072061. [PMID: 37046722 PMCID: PMC10093554 DOI: 10.3390/cancers15072061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Magnetic resonance imaging (MRI) has been proven to ensure high diagnostic accuracy in the identification of vaginal, parametrial, and lymph node involvement in patients affected by cervical cancer (CC), thus playing a crucial role in the preoperative staging of the disease. This study aims to compare the accuracy of MRI for the preoperative staging of patients with CC who underwent neoadjuvant treatment (NAT) or direct surgery. Retrospective data analysis of 126 patients with primary CC International Federation of Gynecology and Obstetrics stage IB3-IIB who underwent NAT before radical surgery (NAT group = 94) or received surgical treatment alone (control arm = 32) was prospectively performed. All enrolled patients were clinically assessed with both a pelvic examination and MRI before surgical treatment. Data from the clinical examination were compared with the histopathological findings to assess the accuracy of MRI for staging purposes after NAT or before direct surgery. MRI showed an overall accuracy of 46.1%, proving it to be not superior to pelvic and physical examination. The overall MRI accuracy for the evaluation of parametrial, vaginal, and lymph node status was 65.8%, 79.4%, and 79.4%, respectively. In the NAT group, the accuracy for the detection of parametrial, lymph node, and vaginal involvement was lower than the control group; however, the difference was not significant (p ≥ 0.05). The overall accuracy of MRI for the preoperative staging of CC after NAT is shown to be not unsatisfactory. The limits of MRI staging are especially evident when dealing with pre-treated patients.
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Giannini A, Di Donato V, Sopracordevole F, Ciavattini A, Ghelardi A, Vizza E, D'Oria O, Simoncini T, Plotti F, Casarin J, Golia D'Augè T, Cuccu I, Serati M, Pinelli C, Bergamini A, Gardella B, Dell'Acqua A, Monti E, Vercellini P, D'Ippolito G, Aguzzoli L, Dario Mandato V, Giannella L, Scaffa C, Ditto A, Falcone F, Borghi C, Malzoni M, Di Giovanni A, Salerno MG, Liberale V, Contino B, Donfrancesco C, Desiato M, Perrone AM, De Iaco P, Ferrero S, Sarpietro G, Matarazzo MG, Cianci A, Cianci S, Bosio S, Ruisi S, Mosca L, Tinelli R, De Vincenzo R, Zannoni GF, Ferrandina G, Petrillo M, Capobianco G, Carlea A, Zullo F, Muschiato B, Palomba S, Greggi S, Spinillo A, Ghezzi F, Colacurci N, Angioli R, Benedetti Panici P, Muzii L, Scambia G, Raspagliesi F, Bogani G. Outcomes of High-Grade Cervical Dysplasia with Positive Margins and HPV Persistence after Cervical Conization. Vaccines (Basel) 2023; 11:vaccines11030698. [PMID: 36992282 DOI: 10.3390/vaccines11030698] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
The objective of this work is to assess the 5-year outcomes of patients undergoing conization for high-grade cervical lesions that simultaneously present as risk factors in the persistence of HPV infection and the positivity of surgical resection margins. This is a retrospective study evaluating patients undergoing conization for high-grade cervical lesions. All patients included had both positive surgical margins and experienced HPV persistence at 6 months. Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratio (HR). The charts of 2966 patients undergoing conization were reviewed. Among the whole population, 163 (5.5%) patients met the inclusion criteria, being at high risk due to the presence of positive surgical margins and experiencing HPV persistence. Of 163 patients included, 17 (10.4%) patients developed a CIN2+ recurrence during the 5-year follow-up. Via univariate analyses, diagnosis of CIN3 instead of CIN2 (HR: 4.88 (95%CI: 1.10, 12.41); p = 0.035) and positive endocervical instead of ectocervical margins (HR: 6.44 (95%CI: 2.80, 9.65); p < 0.001) were associated with increased risk of persistence/recurrence. Via multivariate analyses, only positive endocervical instead of ectocervical margins (HR: 4.56 (95%CI: 1.23, 7.95); p = 0.021) were associated with worse outcomes. In this high-risk group, positive endocervical margins is the main risk factor predicting 5-year recurrence.
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Affiliation(s)
- Andrea Giannini
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, Centro di Riferimento Oncologico-National Cancer Institute, 33081 Aviano, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Alessandro Ghelardi
- Azienda Usl Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, 54100 Massa, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy
| | - Ottavia D'Oria
- Department of Woman's and Child's Health, Obstetrics and Gynecological Unit, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Francesco Plotti
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, 21100 Varese, Italy
| | - Tullio Golia D'Augè
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Ilaria Cuccu
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, 21100 Varese, Italy
| | - Ciro Pinelli
- Ospedale di Circolo Fondazione Macchi, 21100 Varese, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, 20100 Milano, Italy
| | - Barbara Gardella
- IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Andrea Dell'Acqua
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Ermelinda Monti
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giovanni D'Ippolito
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42019 Scandiano, Italy
| | - Lorenzo Aguzzoli
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42019 Scandiano, Italy
| | - Vincenzo Dario Mandato
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42019 Scandiano, Italy
| | - Luca Giannella
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Cono Scaffa
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", 80131 Naples, Italy
| | - Antonino Ditto
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Francesca Falcone
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", 80131 Naples, Italy
| | - Chiara Borghi
- Department of Obstetrics and Gynecology, S. Anna University Hospital, 44121 Ferrara, Italy
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, 83100 Avellino, Italy
| | - Alessandra Di Giovanni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, 83100 Avellino, Italy
| | - Maria Giovanna Salerno
- Department of Woman's and Child's Health, Obstetrics and Gynecological Unit, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Viola Liberale
- Department of Obstetrics and Gynecology, Ospedale Maria Vittoria, 10144 Torino, Italy
| | - Biagio Contino
- Department of Obstetrics and Gynecology, Ospedale Maria Vittoria, 10144 Torino, Italy
| | - Cristina Donfrancesco
- Department of Obstetrics and Gynecology, Azienda ASL Frosinone, Ospedale S Trinità di Sora, 03039 Sora, Italy
| | - Michele Desiato
- Department of Obstetrics and Gynecology, Azienda ASL Frosinone, Ospedale S Trinità di Sora, 03039 Sora, Italy
| | - Anna Myriam Perrone
- Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, 16132 Genova, Italy
| | - Giuseppe Sarpietro
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Via S. Sofia 78, 95124 Catania, Italy
| | - Maria G Matarazzo
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Via S. Sofia 78, 95124 Catania, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Via S. Sofia 78, 95124 Catania, Italy
| | - Stefano Cianci
- Department of Gynecologic Oncology, Università degli Studi di Messina, Policlinico G. Martino, 98122 Messina, Italy
| | - Sara Bosio
- San Paolo Hospital, Università degli Studi di Milano, 20142 Milan, Italy
| | - Simona Ruisi
- San Paolo Hospital, Università degli Studi di Milano, 20142 Milan, Italy
| | - Lavinia Mosca
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Raffaele Tinelli
- Department of Obstetrics and Gynecology, "Valle d'Itria" Hospital, Martina Franca, Via San Francesco da Paola, 74015 Taranto, Italy
| | - Rosa De Vincenzo
- UOC Ginecologia Oncologica, Dipartimento per la Salute Della Donna e del Bambino e Della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Gian Franco Zannoni
- UOC Ginecologia Oncologica, Dipartimento per la Salute Della Donna e del Bambino e Della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento per la Salute Della Donna e del Bambino e Della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Giampiero Capobianco
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Annunziata Carlea
- Department of Neuroscience, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | | | - Stefano Palomba
- Unit of Obstetrics and Gynecology, GOM of Reggio Calabria & University 'Magna Graecia' of Catanzaro, 88100 Catanzaro, Italy
| | - Stefano Greggi
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", 80131 Naples, Italy
| | - Arsenio Spinillo
- IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, 21100 Varese, Italy
- Ospedale di Circolo Fondazione Macchi, 21100 Varese, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la Salute Della Donna e del Bambino e Della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
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10
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Collarino A, Fuoco V, Garganese G, Pasciuto T, de Koster EJ, Florit A, Fragomeni SM, Zagaria L, Fragano A, Martinelli F, Ditto A, Seregni E, Scambia G, Raspagliesi F, Rufini V, Maccauro M. Lymphatic mapping and sentinel node biopsy in vulvar melanoma: the first multicenter study and systematic review. Gynecol Oncol 2023; 170:153-159. [PMID: 36696819 DOI: 10.1016/j.ygyno.2023.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This multicenter study aimed to investigate the role of preoperative lymphatic mapping and sentinel node biopsy (SNB) as well as the impact of negative SNB on loco-regional control and survival in vulvar melanoma patients with clinically negative nodes (cN0). METHODS Patients who had a proven vulvar melanoma with a Breslow thickness of 1-4 mm, cN0 and underwent a preoperative lymphatic mapping followed by SNB between July 2013 and March 2021 were retrospectively included. Groin recurrence and mortality rate were calculated as absolute and relative frequency. Disease-free survival (DFS) and overall survival (OS) were assessed by the Kaplan-Meier method. We provided a systematic review, searching among PubMed/Medline and Embase libraries. A total of 6 studies were identified (48 patients). RESULTS A total of 18 women were included. Preoperative planar images showed 51 SNs in 28 groins. Additional SPECT/CT images were acquired in 5/18 cases; SNs were identified pre- and intra-operatively in all cases. A total of 65 SNs were excised from 28 groins. A total of 13/18 (72.2%) patients (21/28 groins, 75%) had negative SNs with no groin recurrences and 12/13 (92.3%) were still alive at last follow-up. Five out of the 18 (27.8%) patients (7/28 groins, 25%) had positive SNs, 2/5 (40%) patients died of cancer after 26.2 and 33.8 months, respectively. The median DFS and OS for the entire cohort were 17.9 months (95% CI, 10.3-19.9) and 65.0 months (95% CI, 26.2-infinite), respectively. The probability of DFS and OS at 3 years were 15.5% (95% CI, 2.6-38.7) and 64.3% (95% CI, 15.5-90.2), respectively. CONCLUSIONS The use of preoperative lymphatic mapping followed by SNB permits a precise and minimally invasive surgical approach in cN0 vulvar melanoma patients. Negative SNB is associated with low risk of groin relapse and good survival.
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Affiliation(s)
- Angela Collarino
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Valentina Fuoco
- Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Giorgia Garganese
- Department of Life Science and Public Health, Section Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy; Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Tina Pasciuto
- Gynecologic Oncology Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anita Florit
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona M Fragomeni
- Gynecologic Oncology Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Zagaria
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Fragano
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Martinelli
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Antonino Ditto
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Ettore Seregni
- Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Giovanni Scambia
- Department of Life Science and Public Health, Section Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy; Gynecologic Oncology Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Raspagliesi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Vittoria Rufini
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Maccauro
- Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
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11
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Leone Roberti Maggiore U, Bogani G, Martinelli F, Signorelli M, Chiappa V, Lopez S, Granato V, Ditto A, Raspagliesi F. Response to treatment and prognostic significance of supradiaphragmatic disease in patients with high-grade serous ovarian cancer. Eur J Surg Oncol 2022; 48:2551-2557. [PMID: 36089452 DOI: 10.1016/j.ejso.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study was designed to investigate the response to chemotherapy of supradiaphragmatic disease diagnosed by preoperative imaging. As secondary objectives, oncologic outcomes of patients affected by supradiaphragmatic disease and their pattern of recurrence were also evaluated. METHODS Data of consecutive patients with newly diagnosed FIGO stage IV (for supradiaphragmatic disease) epithelial ovarian cancer undergoing either primary debulking surgery or neoadjuvant chemotherapy plus interval debulking surgery between 2004 and 2021, were retrospectively collected. All patients were preoperatively evaluated by chest/abdominal CT scan or 18F-FDG PET/CT preoperatively and at follow-up to evaluate response to chemotherapy. At follow-up visits, site of recurrence diagnosed by imaging techniques was systematically recorded as it occurred. Progression-free and overall survival were measured by using Kaplan-Meier and Cox models. RESULTS A total of 130 patients was included in this study with a median (range) follow-up of 32.9 (12.8-176.7) months. Complete or partial response was achieved in most of the patients after 3 cycles (77.7%) and 6 cycles (85.4%) of chemotherapy. At follow-up, recurrence occurred in 96 (73.8%) patients and the main site of recurrence was abdomen only in 64 (66.7%) patients. At multivariate analysis, residual disease after surgery was the only variable influencing survival outcomes. CONCLUSIONS Supradiaphragmatic disease respond to chemotherapy in most patients affected by advanced EOC and recurrence mainly occurs in the abdomen. Results from this study confirms that abdominal optimal cytoreduction is the main surgical goal in the treatment of women affected by FIGO stage IV EOC.
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Affiliation(s)
| | - G Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F Martinelli
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Signorelli
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - V Chiappa
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Lopez
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - V Granato
- Obstetric and Gynecology Unit, University of Insubria, Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - A Ditto
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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12
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Burg LC, Verheijen S, Bekkers RLM, IntHout J, Holloway RW, Taskin S, Ferguson SE, Xue Y, Ditto A, Baiocchi G, Papadia A, Bogani G, Buda A, Kruitwagen RFPM, Zusterzeel PLM. The added value of SLN mapping with indocyanine green in low- and intermediate-risk endometrial cancer management: a systematic review and meta-analysis. J Gynecol Oncol 2022; 33:e66. [PMID: 35882605 PMCID: PMC9428296 DOI: 10.3802/jgo.2022.33.e66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/09/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the SLN detection rate in presumed early stage, low- and intermediate-risk endometrial cancers, the incidence of SLN metastases, and the negative predictive value of SLN mapping performed with indocyanine green (ICG). METHODS A systematic review with meta-analyses was conducted. Study inclusion criteria were A) low- and intermediate-risk endometrial cancer, B) the use of ICG per cervical injection; C) a minimum of twenty included patients per study. To assess the negative predictive value of SLN mapping, D) a subsequent lymphadenectomy was an additional inclusion criterion. RESULTS Fourteen studies were selected, involving 2,117 patients. The overall and bilateral SLN detection rates were 95.6% (95% confidence interval [CI]=92.4%-97.9%) and 76.5% (95% CI=68.1%-84.0%), respectively. The incidence of SLN metastases was 9.6% (95% CI=5.1%-15.2%) in patients with grade 1-2 endometrial cancer and 11.8% (95% CI=8.1%-16.1%) in patients with grade 1-3 endometrial cancer. The negative predictive value of SLN mapping was 100% (95% CI=98.8%-100%) in studies that included grade 1-2 endometrial cancer and 99.2% (95% CI=97.9%-99.9%) in studies that also included grade 3. CONCLUSION SLN mapping with ICG is feasible with a high detection rate and negative predictive value in low- and intermediate-risk endometrial cancers. Given the incidence of SLN metastases is approximately 10% in those patients, SLN mapping may lead to stage shifting with potential therapeutic consequences. Given the high negative predictive value with SLN mapping, routine lymphadenectomy should be omitted in low- and intermediate-risk endometrial cancer.
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Affiliation(s)
- Lara C Burg
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Shenna Verheijen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Joanna IntHout
- Department for Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert W Holloway
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL, USA
| | - Salih Taskin
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Sarah E Ferguson
- Division of Gynecologic Oncology, Princess Margaret Cancer Center, Toronto, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Yu Xue
- Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Antonino Ditto
- Department of Gynecological Oncology, Fondazione IRCCS, Istituto dei Tumori, Milano, Italy
| | - Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giorgio Bogani
- Department of Maternal and Child Health and Urologynecological Sciences, Sapienza University, Rome, Italy
| | - Alessandro Buda
- Obstetrics and Gynecology Department, Ospedale San Gerardo di Monza, University of Milano Bicocca, Monza, Italy.,Ospedale Michele e Pietro Ferrero, Verduno (cuneo), Italy
| | - Roy F P M Kruitwagen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Petra L M Zusterzeel
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Bounous VE, Robba E, Perotto S, Pasini B, Tomasi Cont N, Ricci MT, Ditto A, Vitellaro M, Raspagliesi F, Biglia N. Gynecological Cancers in Lynch Syndrome: A Comparison of the Histological Features with Sporadic Cases of the General Population. J Clin Med 2022; 11:jcm11133689. [PMID: 35806973 PMCID: PMC9267402 DOI: 10.3390/jcm11133689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction: About 5% of endometrial cancers (ECs) are attributed to an inherited predisposition, for which Lynch syndrome (LS) accounts for the majority of cases. Women with LS have a 40−60% predicted lifetime risk of developing EC, in addition to a 40−80% lifetime risk of developing colorectal cancer and other cancers. In this population, the lifetime risk of developing ovarian cancer (OC) is 10−12%. Object: to compare the histopathological features of LS-associated EC and OC with sporadic cancers in order to evaluate whether there are differences in terms of age at diagnosis, site of occurrence in the uterus, histological type, stage at diagnosis, and tumor grading. Materials and methods: we compared data obtained from 96 patients with LS-associated gynecological cancers (82 with EC and 14 with OC) to a control group (CG) of 209 patients who developed sporadic EC, and a CG of 187 patients with sporadic OC. Results: The mean age at diagnosis of LS-associated EC and OC was much lower than in the control groups. In both groups with EC, the endometrioid histotype was the most frequently occurring histotype. However, among LS women there was a significantly higher incidence of clear cell tumors (11% versus 2.4% in the CG, p = 0.0001). Similar to the sporadic cancer cases, most of the LS-associated ECs presented at an early stage (89% of cases at FIGO I-II stage). In the LS group, the tumor frequently involved only the inner half of the endometrium (77% of cases, p < 0.01). In the LS group, 7.3% of ECs were localized to the lower uterine segment (LUS), whereas no cancer developed in the LUS in the CG. No serous OCs were diagnosed in the LS group (versus 45.5% in the CG, p = 0.0009). Most of the LS-associated OCs presented at an early stage (85% of cases at FIGO I-II stages, p < 0.01). Conclusion: LS-associated EC and OC seem to have peculiar features, occurring at a younger age and at an earlier stage. In LS, EC less frequently involves the outer half of the endometrium, with a more frequent occurrence in the LUS. The presence of clear cell EC was more frequently observed, whereas in OC, the predominant histotype was endometrioid.
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Affiliation(s)
- Valentina Elisabetta Bounous
- Academic Division of Obstetrics and Gynecology—A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (E.R.); (N.B.)
- Correspondence:
| | - Elisabetta Robba
- Academic Division of Obstetrics and Gynecology—A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (E.R.); (N.B.)
| | | | - Barbara Pasini
- Department of Genetics, Biology and Biochemistry, University of Turin, 10128 Turin, Italy;
| | | | - Maria Teresa Ricci
- Unit of Hereditary Digestive Tract Tumors, Fondazione IRCCs—National Cancer Institute, 20133 Milan, Italy; (M.T.R.); (M.V.)
| | - Antonino Ditto
- Division of Gynecologic Oncology, Fondazione IRCCs—National Cancer Institute, 20133 Milan, Italy; (A.D.); (F.R.)
| | - Marco Vitellaro
- Unit of Hereditary Digestive Tract Tumors, Fondazione IRCCs—National Cancer Institute, 20133 Milan, Italy; (M.T.R.); (M.V.)
| | - Francesco Raspagliesi
- Division of Gynecologic Oncology, Fondazione IRCCs—National Cancer Institute, 20133 Milan, Italy; (A.D.); (F.R.)
| | - Nicoletta Biglia
- Academic Division of Obstetrics and Gynecology—A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (E.R.); (N.B.)
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14
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Ditto A, De Cecco L, Paolini B, Alberti P, Martinelli F, Leone Roberti Maggiore U, Bogani G, Chiodini P, Pignata S, Tomassetti A, Raspagliesi F, Mezzanzanica D, Bagnoli M. Validation of MiROvaR, a microRNA-based predictor of early relapse in early stage epithelial ovarian cancer as a new strategy to optimise patients' prognostic assessment. Eur J Cancer 2022; 161:55-63. [DOI: 10.1016/j.ejca.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/26/2021] [Accepted: 11/07/2021] [Indexed: 11/03/2022]
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15
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Bogani G, Ditto A, Raspagliesi F. Sentinel Node Mapping in Endometrial Cancer Using Hysteroscopic Injection of Indocyanine Green and Near-Infrared Fluorescence Imaging. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Ditto A, Leone Roberti Maggiore U, Lopez S, Martinelli F, Bogani G, Lo Vullo S, Brusadelli C, Paolini B, Ducceschi M, Mantiero M, Chiappa V, Signorelli M, Evangelista M, Mariani L, Raspagliesi F. Uterine serous carcinoma: role of surgery, risk factors and oncologic outcomes. Experience of a tertiary center. Eur J Surg Oncol 2021; 48:268-274. [PMID: 34753617 DOI: 10.1016/j.ejso.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate factors impacting survival outcomes in patients with uterine serous carcinoma (USC). METHODS Data of consecutive patients diagnosed with USC undergoing surgery between 2000 and 2020 at Fondazione IRCCS Istituto Nazionale Tumori of Milan (Italy) were reviewed. Progression-free (PFS) and overall survival (OS) outcomes were evaluated using Kaplan-Meier and Cox proportional hazard models. RESULTS Records of 147 consecutive patients meeting the inclusion criteria were analyzed. Stage distribution was: 67 (45.6%) patients with early-stage with uterine confined disease and 80 (54.4%) with advanced stages disease. Minimally invasive surgery was performed in 43 patients (29.5%). The median follow-up period was 78.6 months (IQ range = 35.7-117.3 months). The overall recurrence rate was 41% (60 patients): 19/67 patients (28.4%) with early-stage disease and 41/80 patients (51.3%) with advanced stage. The 5-year PFS rate was 35.0% (95% confidence interval [CI]: 27.5-44.7%). In multivariate analysis, age, BMI, depth of myometrial invasion, cytology, and optimal cytoreduction with postoperative residual tumor absent significantly impacted on PFS. The 5-year OS rates were 46.5% (95% CI: 38.1-56.8). The result of multivariate analysis showed that there was significant difference in OS based only on optimal cytoreduction and accuracy of retroperitoneal surgery. CONCLUSIONS In apparent early-stage USC, peritoneal and retroperitoneal staging allows to identify patients with disease harboring outside the uterus. Optimal cytoreduction is the most significant prognostic factor. Further collaborative studies are warranted in order to improve outcomes of USC patients.
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Affiliation(s)
- Antonino Ditto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | | | - Salvatore Lopez
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Fabio Martinelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, IRCCS National Cancer Institute, Milan, Italy
| | - Claudia Brusadelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Biagio Paolini
- Department of Pathology, IRCCS National Cancer Institute, Milan, Italy
| | - Monika Ducceschi
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Mara Mantiero
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Valentina Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Mauro Signorelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | | | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, IRCCS National Cancer Institute, Milan, Italy
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Leone Roberti Maggiore U, Khamisy-Farah R, Bragazzi NL, Bogani G, Martinelli F, Lopez S, Chiappa V, Signorelli M, Ditto A, Raspagliesi F. Fertility-Sparing Treatment of Patients with Endometrial Cancer: A Review of the Literature. J Clin Med 2021; 10:jcm10204784. [PMID: 34682906 PMCID: PMC8539778 DOI: 10.3390/jcm10204784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/10/2021] [Accepted: 10/14/2021] [Indexed: 12/31/2022] Open
Abstract
Endometrial cancer (EC) is currently the most common malignancy of the female genital tract in developed countries. Although it is more common in postmenopausal women, it may affect up to 25% in the premenopausal age and 3–5% under the age of 40 years. Furthermore, in the last decades a significant shift to pregnancy at older maternal ages, particularly in resource-rich countries, has been observed. Therefore, in this scenario fertility-sparing alternatives should be discussed with patients affected by EC. This study summarizes available literature on fertility-sparing management of patients affected by EC, focusing on the oncologic and reproductive outcomes. A systematic computerized search of the literature was performed in two electronic databases (PubMed and MEDLINE) in order to identify relevant articles to be included for the purpose of this systematic review. On the basis of available evidence, fertility-sparing alternatives are oral progestins alone or in combination with other drugs, levonorgestrel intrauterine system and hysteroscopic resection in association with progestin therapies. These strategies seem feasible and safe for young patients with G1 endometrioid EC limited to the endometrium. However, there is a lack of high-quality evidence on the efficacy and safety of fertility-sparing treatments and future well-designed studies are required.
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Affiliation(s)
- Umberto Leone Roberti Maggiore
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (G.B.); (F.M.); (S.L.); (V.C.); (M.S.); (A.D.); (F.R.)
- Correspondence:
| | - Rola Khamisy-Farah
- Clalit Health Service, Akko, Azrieli Faculty of Medicine, Bar-Ilan University, Safed 13100, Israel;
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada;
| | - Giorgio Bogani
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (G.B.); (F.M.); (S.L.); (V.C.); (M.S.); (A.D.); (F.R.)
| | - Fabio Martinelli
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (G.B.); (F.M.); (S.L.); (V.C.); (M.S.); (A.D.); (F.R.)
| | - Salvatore Lopez
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (G.B.); (F.M.); (S.L.); (V.C.); (M.S.); (A.D.); (F.R.)
| | - Valentina Chiappa
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (G.B.); (F.M.); (S.L.); (V.C.); (M.S.); (A.D.); (F.R.)
| | - Mauro Signorelli
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (G.B.); (F.M.); (S.L.); (V.C.); (M.S.); (A.D.); (F.R.)
| | - Antonino Ditto
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (G.B.); (F.M.); (S.L.); (V.C.); (M.S.); (A.D.); (F.R.)
| | - Francesco Raspagliesi
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (G.B.); (F.M.); (S.L.); (V.C.); (M.S.); (A.D.); (F.R.)
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Casarin J, Bogani G, Piovano E, Falcone F, Ferrari F, Odicino F, Puppo A, Bonfiglio F, Donadello N, Pinelli C, Laganà AS, Ditto A, Malzoni M, Greggi S, Raspagliesi F, Ghezzi F. Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma. J Gynecol Oncol 2021; 31:e64. [PMID: 32808495 PMCID: PMC7440990 DOI: 10.3802/jgo.2020.31.e64] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Uterine serous carcinoma (USC) is a rare highly aggressive disease. In the present study, we aimed to investigate the survival implication of the systematic lymphadenectomy in patients who underwent surgery for apparent early-stage USC. METHODS Consecutive patients with apparent early-stage USC surgically treated at six Italian referral cancer centers were analyzed. A comparison was made between patients who underwent retroperitoneal staging including at least pelvic lymphadenectomy "LND" vs. those who underwent hysterectomy alone "NO-LND". Baseline, surgical and oncological outcomes were analyzed. Kaplan- Meier curves were calculated for disease-free survival (DFS) and disease-specific survival (DSS). Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratio (HR). RESULTS One hundred forty patients were analyzed, 106 LND and 34 NO-LND. NO-LND group (compared to LND group) included older patients (median age, 73 vs.67 years) and with higher comorbidities (median Charlson Comorbidity Index, 6 vs. 5) (p<0.001). No differences in terms of recurrence rate (LND vs. NO-LND, 33.1% vs. 41.4%; p=0.240) were observed. At Cox regression analysis lymphadenectomy did not significantly influence DFS (HR=0.59; 95% confidence interval [CI]=0.32-1.08; p=0.09), and DSS (HR=0.14; 95% CI=0.02-1.21; multivariable analysis p=0.07). Positive node was independently associated with worse DFS (HR=6.22; 95% CI=3.08-12.60; p<0.001) and DSS (HR=5.51; 95% CI=2.31-13.10; p<0.001), while adjuvant chemotherapy was associated with improved DFS (HR=0.38; 95% CI=0.17-0.86; p=0.02) and age was independently associated with worse DSS (HR=1.07; 95% CI=1.02-1.13; p<0.001). CONCLUSIONS Although lymphadenectomy did not show survival benefits in patients who underwent surgery for apparent early-stage USC, the presence of lymph node metastasis was the main adverse prognostic factors, supporting the prognostic role of the retroperitoneal staging also in this histological subtype.
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Affiliation(s)
- Jvan Casarin
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
| | - Giorgio Bogani
- Department of Gynecologic Oncology, National Cancer Institute, Milan, Italy
| | - Elisa Piovano
- Obstetrics and Gynecology Unit, Regina Montis Regalis Hospital, Mondovì, Italy
| | - Francesca Falcone
- Department of Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCSS, "Fondazione G. Pascale", Naples, Italy.,Endoscopica Malzoni - Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Federico Ferrari
- Department of Obstetrics and Gynecology, Spedali Civili, Brescia, Italy
| | - Franco Odicino
- Department of Obstetrics and Gynecology, Spedali Civili, Brescia, Italy
| | - Andrea Puppo
- Obstetrics and Gynecology Unit, Regina Montis Regalis Hospital, Mondovì, Italy
| | | | - Nicoletta Donadello
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | | | - Antonino Ditto
- Department of Gynecologic Oncology, National Cancer Institute, Milan, Italy
| | - Mario Malzoni
- Endoscopica Malzoni - Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Stefano Greggi
- Department of Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCSS, "Fondazione G. Pascale", Naples, Italy
| | | | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
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Barcellini A, Ditto A, Mirandola A, Roccio M, Imparato S, Raspagliesi F, Orlandi E. Is a tailored strategy using proton beam radiotherapy for reirradiation advantageous for elderly women? A case report. Tumori 2021; 107:NP67-NP72. [PMID: 33896256 DOI: 10.1177/03008916211007930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The management of primary or recurrent vaginal tumours in an aging population is challenging for gynecologic and radiation oncologists. In patients unsuited for surgery and already irradiated on the pelvis, proton beam radiotherapy may be worthwhile due to its ballistic advantages. CASE REPORT We report the case of an 80-year-old woman with a squamous cell carcinoma of the vagina after a history of pelvic radiation and vaginal brachytherapy delivered for a previous endometrial adenocarcinoma. She received proton beam radiotherapy with a complete response after 12 months and mild toxicity. CONCLUSIONS The complexity of reirradiation management in the frail and elderly population requires attention. Efforts should be focused on maintaining autonomy and quality of life in order to improve adherence and clinical compliance to the treatment. In the era of the tailored approach, hadrontherapy can play an important role to minimize toxicity, obtain good local control, and reduce the overall treatment time.
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Affiliation(s)
- Amelia Barcellini
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Antonino Ditto
- Gynecologic Oncology Unit, IRCCS National Cancer Institute Foundation, Milan, Italy
| | - Alfredo Mirandola
- Medical Physics, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Marianna Roccio
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Sara Imparato
- Diagnostic Imaging Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | | | - Ester Orlandi
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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20
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Chiappa V, Interlenghi M, Salvatore C, Bertolina F, Bogani G, Ditto A, Martinelli F, Castiglioni I, Raspagliesi F. Using rADioMIcs and machine learning with ultrasonography for the differential diagnosis of myometRiAL tumors (the ADMIRAL pilot study). Radiomics and differential diagnosis of myometrial tumors. Gynecol Oncol 2021; 161:838-844. [PMID: 33867144 DOI: 10.1016/j.ygyno.2021.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/05/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To develop and evaluate the performance of a radiomics and machine learning model applied to ultrasound (US) images in predicting the risk of malignancy of a uterine mesenchymal lesion. METHODS Single-center retrospective evaluation of consecutive patients who underwent surgery for a malignant uterine mesenchymal lesion (sarcoma) and a control group of patients operated on for a benign uterine mesenchymal lesion (myoma). Radiomics was applied to US preoperative images according to the International Biomarker Standardization Initiative guidelines to create, validate and test a classification model for the differential diagnosis of myometrial tumors. The TRACE4 radiomic platform was used thus obtaining a full-automatic radiomic workflow. Definitive histology was considered as gold standard. Accuracy, sensitivity, specificity, AUC and standard deviation of the created classification model were defined. RESULTS A total of 70 women with uterine mesenchymal lesions were recruited (20 with histological diagnosis of sarcoma and 50 myomas). Three hundred and nineteen radiomics IBSI-compliant features were extracted and 308 radiomics features were found stable. Different machine learning classifiers were created and the best classification system showed Accuracy 0.85 ± 0.01, Sensitivity 0.80 ± 0.01, Specificity 0.87 ± 0.01, AUC 0.86 ± 0.03. CONCLUSIONS Radiomics applied to US images shows a great potential in differential diagnosis of mesenchymal tumors, thus representing an interesting decision support tool for the gynecologist oncologist in an area often characterized by uncertainty.
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Affiliation(s)
- V Chiappa
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Italy.
| | | | | | - F Bertolina
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Italy
| | - G Bogani
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Italy
| | - A Ditto
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Italy
| | - F Martinelli
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Italy
| | - I Castiglioni
- Dipartimento di Fisica G. Occhialini, University of Milan-Bicocca, Milan, Italy
| | - F Raspagliesi
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Italy
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21
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Bogani G, DI Donato V, Chiappa V, Lopez S, Monti M, Muzii L, Benedetti Panici P, Ditto A, Raspagliesi F. Minimally invasive surgery in cervical cancer. Minerva Obstet Gynecol 2021; 73:145-148. [PMID: 33306287 DOI: 10.23736/s2724-606x.20.04726-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In recent years, minimally invasive surgery has replaced open surgery for almost all surgical indications in gynecological practice. Recently, the results of the laparoscopic approach to cervical cancer (LACC) trial questioned the role of minimally invasive surgery for patients affected by early-stage cervical cancer. In the present paper, we discussed the current evidence regarding the adoption of minimally invasive surgery for patients with cervical cancer. We evaluated the current evidence focusing on four interesting features: 1) the impact of tumor volume; 2) reasons explaining worse outcomes of patients undergoing minimally invasive surgery; 3) methods to reduce the risk of recurrence during minimally invasive surgery; and 4) the effect of minimally invasive surgery in patients with locally advanced cervical cancer. At the moment, in the light of current evidence, minimally invasive radical hysterectomy should be offered only in the context of clinical trials. Extensive counseling and appropriate patients' selection are needed. Further prospective evidence is warranted to identify the better approach for cervical cancer patients.
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Affiliation(s)
- Giorgio Bogani
- National Cancer Institute of Milan (INT), Milan, Italy -
| | - Violante DI Donato
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | | | | | - Marco Monti
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | | | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Antonino Ditto
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
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22
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Martinelli F, Ditto A, Filippi F, Vinti D, Bogani G, Leone Roberti Maggiore U, Evangelista M, Signorelli M, Chiappa V, Lopez S, Somigliana E, Raspagliesi F. Conization and lymph node evaluation as a fertility-sparing treatment for early stage cervical cancer. Int J Gynecol Cancer 2021; 31:457-461. [PMID: 33649014 DOI: 10.1136/ijgc-2020-001740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION To evaluate oncological and obstetrical outcomes of early stage cervical cancer patients who underwent conservative management to retain childbearing potential. METHODS Data of women (aged <40 years) who underwent fertility sparing treatment for International Federation of Gynecology and Obstetrics (FIGO) stage IA1 with lymphovascular invasion (LVSI) and IB1 cervical cancer were prospectively collected. All patients underwent cervical conization/s and laparoscopic nodal evaluation (pelvic lymphadenectomy/sentinel node mapping). Oncological and obstetrical outcomes were assessed. RESULTS Overall, 39 patients met inclusion criteria; 36 (92.3%) women were nulliparous. There were: 3 (7.7%) IA1-LVSI+; 11 (28.2%) IA2; and 25 (64.1%) IB1 cervical cancers, according to 2018 FIGO stage classification. Histological types were 22 (56.4%) squamous carcinoma and 17 (43.6%) adenocarcinoma. Pelvic lymphadenectomy was performed in 29 (74.4%) patients, while 10 (25.6%) patients had only sentinel node mapping. In 4 (10.3%) patients conservative treatment was discontinued due to nodal involvement and 2 (5.1%) patients requested definitive treatment (hysterectomy) after a negative lymph node evaluation. Among 33 (84.6%) patients who retained their childbearing potential, 17 (51.5%) had a second conization. 2 (6.1%) patients relapsed and underwent definitive treatment. After a median follow-up of 51 months (range 1-184) no deaths were reported. 22 (70.9%) patients attempted to conceive. There were 13 natural pregnancies among 12 (54.5%) women who got pregnant. Live birth rate was 76.9%: 9 (69.2%) term and 1 (7.7%) preterm (at 32 weeks) deliveries. 2 (15.4%) miscarriages (first and second trimester) and 1 (7.7%) termination of pregnancy for medical reasons were recorded. CONCLUSION Conization plus laparoscopic nodal evaluation may be a safe and feasible conservative option in the setting of fertility-sparing treatment for early-stage cervical cancer patients.
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Affiliation(s)
- Fabio Martinelli
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Antonino Ditto
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Francesca Filippi
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Lombardia, Italy
| | - Daniele Vinti
- Obstetrics and Gynecology, ASST Rhodense, Garbagnate Milanese, Italy
| | - Giorgio Bogani
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | | | - Mauro Signorelli
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Valentina Chiappa
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Salvatore Lopez
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Lombardia, Italy.,Università degli Studi di Milano, Milan, Italy
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Rodriguez J, Rauh-Hain JA, Saenz J, Isla DO, Rendon Pereira GJ, Odetto D, Martinelli F, Villoslada V, Zapardiel I, Trujillo LM, Perez M, Hernandez M, Saadi JM, Raspagliesi F, Valdivia H, Siegrist J, Fu S, Hernandez Nava M, Echeverry L, Noll F, Ditto A, Lopez A, Hernandez A, Pareja R. Oncological outcomes of laparoscopic radical hysterectomy versus radical abdominal hysterectomy in patients with early-stage cervical cancer: a multicenter analysis. Int J Gynecol Cancer 2021; 31:504-511. [PMID: 33504547 DOI: 10.1136/ijgc-2020-002086] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Recent evidence has shown adverse oncological outcomes when minimally invasive surgery is used in early-stage cervical cancer. The objective of this study was to compare disease-free survival in patients that had undergone radical hysterectomy and pelvic lymphadenectomy, either by laparoscopy or laparotomy. METHODS We performed a multicenter, retrospective cohort study of patients with cervical cancer stage IA1 with lymph-vascular invasion, IA2, and IB1 (FIGO 2009 classification), between January 1, 2006 to December 31, 2017, at seven cancer centers from six countries. We included squamous, adenocarcinoma, and adenosquamous histologies. We used an inverse probability of treatment weighting based on propensity score to construct a weighted cohort of women, including predictor variables selected a priori with the possibility of confounding the relationship between the surgical approach and survival. We estimated the HR for all-cause mortality after radical hysterectomy with weighted Cox proportional hazard models. RESULTS A total of 1379 patients were included in the final analysis, with 681 (49.4%) operated by laparoscopy and 698 (50.6%) by laparotomy. There were no differences regarding the surgical approach in the rates of positive vaginal margins, deep stromal invasion, and lymphovascular space invasion. Median follow-up was 52.1 months (range, 0.8-201.2) in the laparoscopic group and 52.6 months (range, 0.4-166.6) in the laparotomy group. Women who underwent laparoscopic radical hysterectomy had a lower rate of disease-free survival compared with the laparotomy group (4-year rate, 88.7% vs 93.0%; HR for recurrence or death from cervical cancer 1.64; 95% CI 1.09-2.46; P=0.02). In sensitivity analyzes, after adjustment for adjuvant treatment, radical hysterectomy by laparoscopy compared with laparotomy was associated with increased hazards of recurrence or death from cervical cancer (HR 1.7; 95% CI 1.13 to 2.57; P=0.01) and death for any cause (HR 2.14; 95% CI 1.05-4.37; P=0.03). CONCLUSION In this retrospective multicenter study, laparoscopy was associated with worse disease-free survival, compared to laparotomy.
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Affiliation(s)
- Juliana Rodriguez
- Department of Gynecologic Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia.,Department of Gynecology and Obstetrics, Section of Gynecologic Oncology, Fundacion Santa Fe de Bogota, Bogota, Colombia
| | - Jose Alejandro Rauh-Hain
- Departments of Gynecologic Oncology and Reproductive Medicine and Health Services Research, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - James Saenz
- Department of Gynecologic Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - David Ortiz Isla
- Department of Gynecologic Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - Diego Odetto
- Gynecology Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Fabio Martinelli
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Vladimir Villoslada
- Department of Gynecologic Oncology, Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit. La Paz University Hospital, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Lina Maria Trujillo
- Department of Gynecologic Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Milagros Perez
- Department of Gynecologic Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Marcela Hernandez
- Department of Gynecologic Oncology, Instituto de Cancerologia Las Américas, Medellín, Colombia
| | - Jose Martin Saadi
- Gynecology Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Francesco Raspagliesi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Henry Valdivia
- Department of Gynecologic Oncology, Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
| | - Jaime Siegrist
- Gynecologic Oncology Unit. La Paz University Hospital, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Shuangshuang Fu
- Departments of Gynecologic Oncology and Reproductive Medicine and Health Services Research, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Mindy Hernandez Nava
- Department of Gynecologic Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Lina Echeverry
- Department of Gynecologic Oncology, Instituto de Cancerologia Las Américas, Medellín, Colombia
| | - Florencia Noll
- Gynecology Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Antonino Ditto
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Aldo Lopez
- Department of Gynecologic Oncology, Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
| | - Alicia Hernandez
- Gynecologic Oncology Unit. La Paz University Hospital, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Rene Pareja
- Department of Gynecologic Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia .,Gynecologic Oncology, Clinica Astorga, Professor Universidad Pontificia Bolivariana, Medellin, Colombia
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24
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Bogani G, Sopracordevole F, Di Donato V, Ciavattini A, Ghelardi A, Lopez S, Simoncini T, Plotti F, Casarin J, Serati M, Pinelli C, Valenti G, Bergamini A, Gardella B, Dell'acqua A, Monti E, Vercellini P, Fischetti M, D'ippolito G, Aguzzoli L, Mandato VD, Carunchio P, Carlinfante G, Giannella L, Scaffa C, Falcone F, Borghi C, Ditto A, Malzoni M, Giannini A, Salerno MG, Liberale V, Contino B, Donfrancesco C, Desiato M, Perrone AM, Dondi G, De Iaco P, Chiappa V, Ferrero S, Sarpietro G, Matarazzo MG, Cianci A, Bosio S, Ruisi S, Guerrisi R, Brusadelli C, Mosca L, Lagana' AS, Tinelli R, Signorelli M, De Vincenzo R, Zannoni GF, Ferrandina G, Lovati S, Petrillo M, Dessole S, Carlea A, Zullo F, Angioli R, Greggi S, Spinillo A, Ghezzi F, Colacurci N, Muzii L, Benedetti Panici P, Scambia G, Raspagliesi F. High-risk HPV-positive and -negative high-grade cervical dysplasia: Analysis of 5-year outcomes. Gynecol Oncol 2021; 161:173-178. [PMID: 33514481 DOI: 10.1016/j.ygyno.2021.01.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/17/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the outcomes of high-risk (HR) HPV-positive and -negative women affected by high-grade cervical dysplasia. METHODS This is a retrospective multi-institutional study. Medical records of consecutive patients with high-grade cervical dysplasia undergoing conization between 2010 and 2014 were retrieved. All patients included had at least 5 years of follow-up. A propensity-score matching was adopted in order to reduce the presence of confounding factors between groups. Kaplan-Meir and Cox hazard models were used to estimate 5-year outcomes. RESULTS Overall, data of 2966 women, affected by high-grade cervical dysplasia were reviewed. The study population included 1478 (85%) and 260 (15%) women affected by HR-HPV-positive and HR-HPV-negative high-grade cervical dysplasia. The prevalence of CIN2 and CIN3 among the HR-HPV-positive and -negative cohort was similar (p = 0.315). Patients with HR-HPV-positive high-grade cervical dysplasia were at higher risk of 5-year recurrence (after primary conization) that HR-HPV-negative patients (p < 0.001, log-rank test). Via multivariate analysis, HR-HPV-negative women were at low risk of recurrence (HR: 1.69 (95%CI: 1.05, 4.80); p = 0.018, Cox Hazard model). A propensity-score matched comparison was carried out in order to reduce biases that are related to the retrospective study design. In comparison to HR-HPV-negative patients, thosewith HR-HPV-positive CIN3 was associate with a 8-fold increase in the risk of recurrence (p < 0.001, log-rank test). CONCLUSIONS HR-HPV-negative high-grade cervical dysplasia is not uncommon, accounting for 15% of our study population. Those patients experience more favorable outcomes than patients with documented HR-HPV infection(s). Further prospective studies are needed to corroborate our data.
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Affiliation(s)
- Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Via F. Gallini 2, 33081 Aviano, Italy
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Alessandro Ghelardi
- Azienda Usl Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, Massa, Italy
| | - Salvatore Lopez
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Ciro Pinelli
- Ospedale di circolo Fondazione Macchi, Varese, Italy
| | - Gaetano Valenti
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Barbara Gardella
- IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Dell'acqua
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ermelinda Monti
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Margherita Fischetti
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Giovanni D'ippolito
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Vincenzo D Mandato
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Paola Carunchio
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Gabriele Carlinfante
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Luca Giannella
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Cono Scaffa
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Francesca Falcone
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Chiara Borghi
- Department of Obstetrics and Gynecology, S. Anna University Hospital, Ferrara, Italy
| | - Antonino Ditto
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Andrea Giannini
- Department of Woman's and Child's Health, Obstetrics and Gynecological Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Maria Giovanna Salerno
- Department of Woman's and Child's Health, Obstetrics and Gynecological Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Viola Liberale
- Department of Obstetrics and Gynecology, Ospedale Maria Vittoria, Torino, Italy
| | - Biagio Contino
- Department of Obstetrics and Gynecology, Ospedale Maria Vittoria, Torino, Italy
| | - Cristina Donfrancesco
- Department of Obstetrics and Gynecology, Azienda ASL Frosinone, Ospedale S Trinità di Sora, Sora, Italy
| | - Michele Desiato
- Department of Obstetrics and Gynecology, Azienda ASL Frosinone, Ospedale S Trinità di Sora, Sora, Italy
| | - Anna Myriam Perrone
- Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Giulia Dondi
- Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Valentina Chiappa
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Giuseppe Sarpietro
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Via S. Sofia 78, 95124 Catania, Italy
| | - Maria G Matarazzo
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Via S. Sofia 78, 95124 Catania, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Via S. Sofia 78, 95124 Catania, Italy
| | - Sara Bosio
- San Paolo Hospital, Università degli Studi di Milano, 20142 Milan, Italy
| | - Simona Ruisi
- San Paolo Hospital, Università degli Studi di Milano, 20142 Milan, Italy
| | | | | | - Lavinia Mosca
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Antonio Simone Lagana'
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Raffaele Tinelli
- Department of Obstetrics and Gynecology, "Valle d'Itria" Hospital, Martina Franca, via San Francesco da Paola, 74015 Taranto, Italy
| | - Mauro Signorelli
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Rosa De Vincenzo
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Gian Franco Zannoni
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Sara Lovati
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Salvatore Dessole
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Annunziata Carlea
- Department of Neuroscience, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | | | - Stefano Greggi
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Arsenio Spinillo
- IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy; Ospedale di circolo Fondazione Macchi, Varese, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Ludovico Muzii
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Via F. Gallini 2, 33081 Aviano, Italy
| | | | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Bogani G, Papadia A, Buda A, Casarin J, Di Donato V, Gasparri ML, Plotti F, Pinelli C, Paderno MC, Lopez S, Perrone AM, Barra F, Guerrisi R, Brusadelli C, Cromi A, Ferrari D, Chiapp V, Signorelli M, Leone Roberti Maggiore U, Ditto A, Palaia I, Ferrero S, De Iaco P, Angioli R, Panici PB, Ghezzi F, Landoni F, Mueller MD, Raspagliesi F. Sentinel node mapping vs. sentinel node mapping plus back-up lymphadenectomy in high-risk endometrial cancer patients: Results from a multi-institutional study. Gynecol Oncol 2021; 161:122-129. [PMID: 33485641 DOI: 10.1016/j.ygyno.2021.01.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Sentinel node mapping (SLN) has replaced lymphadenectomy for staging surgery in apparent early-stage low and intermediate risk endometrial cancer (EC). Only limited data about the adoption of SNM in high risk EC is still available. Here, we evaluate the outcomes of high-risk EC undergoing SNM (with or without back-up lymphadenectomy). METHODS This is a multi-institutional international retrospective study, evaluating data of high-risk (FIGO grade 3 endometrioid EC with myometrial invasion >50% and non-endometrioid histology) EC patients undergoing SNM followed by back-up lymphadenectomy and SNM alone. RESULTS Chart of consecutive 196 patients were evaluated. The study population included 83 and 113 patients with endometrioid and non-endometrioid EC, respectively. SNM alone and SNM followed by back-up lymphadenectomy were performed in 50 and 146 patients, respectively. Among patients having SNM alone, 14 (28%) were diagnosed with nodal disease. In the group of patients undergoing SNM plus back-up lymphadenectomy 34 (23.2%) were diagnosed with nodal disease via SNM. Back-up lymphadenectomy identified 2 (1%) additional patients with nodal disease (in the para-aortic area). Back-up lymphadenectomy allowed to remove adjunctive positive nodes in 16 (11%) patients. After the adoption of propensity-matched algorithm, we observed that patients undergoing SNM plus back-up lymphadenectomy experienced similar disease-free survival (p = 0.416, log-rank test) and overall survival (p = 0.940, log-rank test) than patients undergoing SLN alone. CONCLUSIONS Although the small sample size, and the retrospective study design this study highlighted that type of nodal assessment did not impact survival outcomes in high-risk EC. Theoretically, back-up lymphadenectomy would be useful in improving the removal of positive nodes, but its therapeutic value remains controversial. Further prospective evidence is needed.
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Affiliation(s)
- Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy.
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland
| | - Alessandro Buda
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Italy
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland
| | - Francesco Plotti
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Italy
| | - Maria Chiara Paderno
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Salvatore Lopez
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Anna Myriam Perrone
- Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Rocco Guerrisi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Italy.
| | - Claudia Brusadelli
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Italy
| | - Debora Ferrari
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Valentina Chiapp
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Mauro Signorelli
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | | | - Antonino Ditto
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Pierandrea De Iaco
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy
| | | | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Italy
| | - Fabio Landoni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
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Bogani G, Ditto A, De Cecco L, Lopez S, Guerrisi R, Piccioni F, Micali A, Daidone MG, Raspagliesi F. Transmission of SARS-CoV-2 in Surgical Smoke during Laparoscopy: A Prospective, Proof-of-concept Study. J Minim Invasive Gynecol 2020; 28:1519-1525. [PMID: 33373728 PMCID: PMC7833707 DOI: 10.1016/j.jmig.2020.12.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVE There are growing concerns regarding the potential risk of coronavirus disease transmission during surgery and in particular during minimally invasive procedures owing to the aerosolization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) particles. However, no study has demonstrated this hypothesis. Here, we aimed to investigate the presence of SARS-CoV-2 in surgical smoke. DESIGN A prospective pilot study. SETTING A tertiary cancer center in northern Italy. PATIENTS Overall, 17 patients underwent laparoscopic procedures for the management of suspected or documented gynecologic malignancies. The median age was 57 years (range 26-77). The surgical indications included endometrial cancer (n = 11), borderline ovarian tumor (n = 3), early-stage ovarian cancer (n = 1), stage IA cervical cancer after diagnostic conization (n = 1), and an ovarian cyst that turned out to be benign at final histologic examination (n = 1). INTERVENTIONS We evaluated all consecutive women scheduled to have laparoscopic procedures for suspected or documented gynecologic cancers. The patients underwent planned laparoscopic surgery. At the end of the laparoscopic procedures (after extubation), we performed reverse transcription-polymerase chain reaction (RT-PCR) tests for the detection of SARS-CoV-2 from both the endotracheal tube and the filter applied on the trocar valve. MEASUREMENTS AND MAIN RESULTS In 1 patient, both swab tests (endotracheal tube and trocar valve filter) showed amplification of the N gene on RT-PCR analysis. This case was considered to be a presumptive positive case. In another case, the RT-PCR analysis showed an amplification curve for the N gene only in the swab test performed on the filter. No ORF1ab amplification was detected. CONCLUSION Our study suggested the proof of principle that SARS-CoV-2 might be transmitted through surgical smoke and aerosolized native fluid from the abdominal cavity.
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Affiliation(s)
- Giorgio Bogani
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
| | - Antonino Ditto
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
| | - Loris De Cecco
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
| | - Salvatore Lopez
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
| | - Rocco Guerrisi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)..
| | - Federico Piccioni
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
| | - Arianna Micali
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
| | - Maria Grazia Daidone
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
| | - Francesco Raspagliesi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
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27
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Ditto A, Casarin J, Pinelli C, Perrone AM, Scollo P, Martinelli F, Bogani G, Leone Roberti Maggiore U, Signorelli M, Chiappa V, Giorda G, Scibilia G, De Iaco P, Evangelista M, Ghezzi F, Paolini B, Lo Vullo S, Mariani L, Montone R, Raspagliesi F. Corrigendum to "Hysteroscopic versus cervical injection for sentinel node detection in endometrial cancer: A multicenter prospective randomised controlled trial from the Multicenter Italian Trials in Ovarian cancer (MITO) study group" [European Journal of Cancer. Volume 140, November 2020, Pages 1-10]. Eur J Cancer 2020; 144:399. [PMID: 33342624 DOI: 10.1016/j.ejca.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Antonino Ditto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
| | - Jvan Casarin
- Academic Unit of Obstetrics and Gynaecology, Insubria University of Varese, Varese, Italy
| | - Ciro Pinelli
- Academic Unit of Obstetrics and Gynaecology, Insubria University of Varese, Varese, Italy
| | - Anna M Perrone
- Unit Gynaecologic Oncology, Sant'Orsola Malpighi of Bologna, Bologna, Italy
| | - Paolo Scollo
- Unit of Obstetrics and Gynaecology, Cannizzaro Hospital of Catania, Italy
| | - Fabio Martinelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | | | - Mauro Signorelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Valentina Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Giorgio Giorda
- Department of Gynecologic Oncology, IRCCS CRO Oncologic Institute of Aviano, Aviano, Italy
| | - Giuseppe Scibilia
- Unit of Obstetrics and Gynaecology, Cannizzaro Hospital of Catania, Italy
| | - Pierandrea De Iaco
- Unit Gynaecologic Oncology, Sant'Orsola Malpighi of Bologna, Bologna, Italy
| | | | - Fabio Ghezzi
- Academic Unit of Obstetrics and Gynaecology, Insubria University of Varese, Varese, Italy
| | - Biagio Paolini
- Department of Pathology, IRCCS National Cancer Institute, Milan, Italy
| | - Salvatore Lo Vullo
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy; Unit of Clinical Epidemiology and Trial Organization, IRCCS National Cancer Institute, Milan, Italy
| | - Luigi Mariani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy; Unit of Clinical Epidemiology and Trial Organization, IRCCS National Cancer Institute, Milan, Italy
| | - Rosanna Montone
- Ufficio Operativo per La Ricerca Clinica - Clinical Trial Center Fondazione IRCCS Istituto Nazionale Dei Tumori, Italy
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Bogani G, DI Donato V, Chiappa V, Lopez S, Monti M, Muzii L, Benedetti Panici P, Ditto A, Raspagliesi F. Minimally invasive surgery in cervical cancer. Minerva Obstet Gynecol 2020. [PMID: 33306287 DOI: 10.23736/s0026-4784.20.04726-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In recent years, minimally invasive surgery has replaced open surgery for almost all surgical indications in gynecological practice. Recently, the results of the laparoscopic approach to cervical cancer (LACC) trial questioned the role of minimally invasive surgery for patients affected by early-stage cervical cancer. In the present paper, we discussed the current evidence regarding the adoption of minimally invasive surgery for patients with cervical cancer. We evaluated the current evidence focusing on four interesting features: 1) the impact of tumor volume; 2) reasons explaining worse outcomes of patients undergoing minimally invasive surgery; 3) methods to reduce the risk of recurrence during minimally invasive surgery; and 4) the effect of minimally invasive surgery in patients with locally advanced cervical cancer. At the moment, in the light of current evidence, minimally invasive radical hysterectomy should be offered only in the context of clinical trials. Extensive counseling and appropriate patients' selection are needed. Further prospective evidence is warranted to identify the better approach for cervical cancer patients.
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Affiliation(s)
- Giorgio Bogani
- National Cancer Institute of Milan (INT), Milan, Italy -
| | - Violante DI Donato
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | | | | | - Marco Monti
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | | | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Antonino Ditto
- Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
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Bogani G, Apolone G, Ditto A, Scambia G, Panici PB, Angioli R, Pignata S, Greggi S, Scollo P, Delia M, Franchi M, Martinelli F, Signorelli M, Lopez S, Di Donato V, Valabrega G, Ferrandina G, Palaia I, Bergamini A, Bocciolone L, Savarese A, Ghezzi F, Casarin J, Pinelli C, Trojano V, Chiantera V, Giorda G, Sopracordevole F, Malzoni M, Salerno G, Sartori E, Testa A, Zannoni G, Zullo F, Vizza E, Trojano G, Chiantera A, Raspagliesi F. Impact of COVID-19 in gynecologic oncology: a Nationwide Italian Survey of the SIGO and MITO groups. J Gynecol Oncol 2020; 31:e92. [PMID: 33078597 PMCID: PMC7593217 DOI: 10.3802/jgo.2020.31.e92] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/29/2020] [Accepted: 08/09/2020] [Indexed: 12/22/2022] Open
Abstract
Objective Coronavirus disease 2019 (COVID-19) has caused rapid and drastic changes in cancer management. The Italian Society of Gynecology and Obstetrics (SIGO), and the Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) promoted a national survey aiming to evaluate the impact of COVID-19 on clinical activity of gynecologist oncologists and to assess the implementation of containment measures against COVID-19 diffusion. Methods The survey consisted of a self-administered, anonymous, online questionnaire. The survey was sent via email to all the members of the SIGO, and MITO groups on April 7, 2020, and was closed on April 20, 2020. Results Overall, 604 participants completed the questionnaire with a response-rate of 70%. The results of this survey suggest that gynecologic oncology units had set a proactive approach to COVID-19 outbreak. Triage methods were adopted in order to minimize in-hospital diffusion of COVID-19. Only 38% of gynecologic surgeons were concerned about COVID-19 outbreak. Although 73% of the participants stated that COVID-19 has not significantly modified their everyday practice, 21% declared a decrease of the use of laparoscopy in favor of open surgery (19%). However, less than 50% of surgeons adopted specific protection against COVID-19. Additionally, responders suggested to delay cancer treatment (10%–15%), and to perform less radical surgical procedures (20%–25%) during COVID-19 pandemic. Conclusions National guidelines should be implemented to further promote the safety of patients and health care providers. International cooperation is of paramount importance, as heavily affected nations can serve as an example to find out ways to safely preserve clinical activity during the COVID-19 outbreak.
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Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | - Giovanni Apolone
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Antonino Ditto
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Gynecology, Università Campus Bio-Medico, Rome, Italy
| | - Sandro Pignata
- Urogynaecological Medical Oncology Unit Istituto Nazionale Tumori, IRCCS, Naples, Italy
| | - Stefano Greggi
- Urogynaecological Medical Oncology Unit Istituto Nazionale Tumori, IRCCS, Naples, Italy
| | - Paolo Scollo
- Department of Gynecology, Cannizzaro Hospital, Catania, Italy
| | | | - Massimo Franchi
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Fabio Martinelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mauro Signorelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Salvatore Lopez
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giorgio Valabrega
- Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy.,Department of Oncology, University of Torino, Torino, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Bocciolone
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Savarese
- Oncologia Medica 1, IRCCS Istituto Nazionale Tumori Regina Elena, Roma, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Vito Trojano
- Department of Obstetrics and Gynaecology, Mater Dei Hospital, Bari, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Giorgio Giorda
- Gynaecological Oncology Unit, Centro di Riferimento Oncologico (CRO) di Aviano, IRCCS, Aviano, Italy
| | - Francesco Sopracordevole
- Gynaecological Oncology Unit, Centro di Riferimento Oncologico (CRO) di Aviano, IRCCS, Aviano, Italy
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Giovanna Salerno
- Department of Gynecology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Enrico Sartori
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonia Testa
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Gianfranco Zannoni
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Trojano
- Department of Obstetrics and Gynecology, University Medical School "A. Moro", Bari, Italy
| | - Antonio Chiantera
- President of the Scientific Society, Italian Society of Gynecology and Obstetrics (SIGO), Bologna, Italy
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Bogani G, Ghezzi F, Chiva L, Casarin J, Ditto A, Raspagliesi F. Patterns of Recurrence after Laparoscopic and Open Abdominal Radical Hysterectomy for Cervical Cancer: A Propensity-Matched Analysis. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ditto A, Casarin J, Pinelli C, Perrone AM, Scollo P, Martinelli F, Bogani G, Leone Roberti Maggiore U, Signorelli M, Chiappa V, Giorda G, Scibilia G, De Iaco P, Evangelista M, Ghezzi F, Paolini B, Lo Vullo S, Mariani L, Montone R, Raspagliesi F. Hysteroscopic versus cervical injection for sentinel node detection in endometrial cancer: A multicenter prospective randomised controlled trial from the Multicenter Italian Trials in Ovarian cancer (MITO) study group. Eur J Cancer 2020; 140:1-10. [PMID: 33027722 DOI: 10.1016/j.ejca.2020.08.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/18/2020] [Accepted: 08/22/2020] [Indexed: 01/05/2023]
Abstract
AIM During the last years, the role of sentinel lymph node mapping (SLNM) for endometrial cancer (EC) surgical treatment has increased in popularity. However, several controversies remain about different technical steps of SLNM. Thus, a randomised control trial was designed to compare cervical (CI) and hysteroscopic (HI) indocyanine green (ICG) injection for SLNM of newly diagnosed EC undergoing surgical staging. The primary end-point of the study was to compare these two techniques in terms of para-aortic detection rate. METHODS Patients with apparent stage I or II histologically confirmed EC undergoing surgery were included in the study. This randomised trial distinguished patients in two study groups according to two different techniques of ICG SLNM: CI versus HI injection. Patients who met the inclusion criteria were randomly assigned to CI or HI injection in a 1:1 ratio. The central randomisation system allocated patient randomisation numbers sequentially in the order in which the patients were enrolled. This randomised trial was not blinded for either patients or the surgeons. RESULTS From March 2017 until April 2019, a total of 165 patients were randomised in this study: 85 (51.5%) in the CI group and 80 (48.5%) in the HI group. After randomisation, 14 (8.5%) patients were excluded from the study. Finally, 151 patients were included in the analysis: 82 (54.3%) in the CI group and 69 (45.7%) in the HI group. Hysteroscopy injection shows an ability to detect Sentinel nodes (SNLs) in the para-aortic area of about 10% greater compared with CI injection, although this difference did not reach statistical significance. The HI technique was superior in detecting isolated para-aortic SLNs (5.8% Versus 0%). The CI injection was correlated with higher SLN detection rates at the pelvic level compared with HI injection. Pelvic and overall detection was higher in the CI group. CONCLUSIONS The present study supports the adoption of CI instead of HI injection because the former allows better identification of sentinel nodes (especially in the pelvic area). Detection of SLN in the para-aortic area was slightly higher in patients receiving a HI injection, but the difference with the CI route was not statistically significant.
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Affiliation(s)
- Antonino Ditto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
| | - Jvan Casarin
- Academic Unit of Obstetrics and Gynaecology, Insubria University of Varese, Varese, Italy
| | - Ciro Pinelli
- Academic Unit of Obstetrics and Gynaecology, Insubria University of Varese, Varese, Italy
| | - Anna M Perrone
- Unit Gynaecologic Oncology, Sant'Orsola Malpighi of Bologna, Bologna, Italy
| | - Paolo Scollo
- Unit of Obstetrics and Gynaecology, Cannizzaro Hospital of Catania, Italy
| | - Fabio Martinelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | | | - Mauro Signorelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Valentina Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Giorgio Giorda
- Department of Gynecologic Oncology, IRCCS CRO Oncologic Institute of Aviano, Aviano, Italy
| | - Giuseppe Scibilia
- Unit of Obstetrics and Gynaecology, Cannizzaro Hospital of Catania, Italy
| | - Pierandrea De Iaco
- Unit Gynaecologic Oncology, Sant'Orsola Malpighi of Bologna, Bologna, Italy
| | | | - Fabio Ghezzi
- Academic Unit of Obstetrics and Gynaecology, Insubria University of Varese, Varese, Italy
| | - Biagio Paolini
- Department of Pathology, IRCCS National Cancer Institute, Milan, Italy
| | - Salvatore Lo Vullo
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy; Unit of Clinical Epidemiology and Trial Organization, IRCCS National Cancer Institute, Milan, Italy
| | - Luigi Mariani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy; Unit of Clinical Epidemiology and Trial Organization, IRCCS National Cancer Institute, Milan, Italy
| | - Rosanna Montone
- Clinical Study Coordinator, Ufficio Operativo per la Ricerca Clinica - Clinical Trial Center Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
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Bogani G, Raspagliesi F, di Donato V, Brusadelli C, Guerrisi R, Pinelli C, Casarin J, Ghezzi F, Del Fabro A, Ditto A, Simoncini T, Ciavattini A, Sopracordevole F. Spotlight on the role of human papillomavirus vaccines. Gynecol Oncol 2020; 160:346-350. [PMID: 32943207 DOI: 10.1016/j.ygyno.2020.08.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/29/2020] [Indexed: 12/24/2022]
Abstract
In high income setting, the massive implementation of screening programs has reduced the incidence of cervical cancer, dramatically. However, cervical cancer still remains a major health concern, being one of the most common cause of death for cancer among women. The adoption of primary prevention through vaccination against HPV aims to reduce the prevalence of HPV-related lesions and cervical cancer. Accumulating data highlighted the cost-effectiveness of introducing HPV vaccination for adolescent and young adults. In the present review, we critically evaluated the role of vaccination against HPV, focusing much more on the role of vaccination in specific cluster of subjects (eg, post-treatment and older adults). Additionally, we evaluated the available evidence on the role of vaccination in HIV-positive subjects and in women receiving solid organs transplantation. We observed that although vaccination might be considered effective in those cluster of subjects; further evidence is needed to assess the cost-effectiveness of vaccination in these settings.
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Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | | | - Violante di Donato
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Claudia Brusadelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Univerity of Insubria, Varese, Italy
| | - Rocco Guerrisi
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Univerity of Insubria, Varese, Italy
| | | | | | | | - Anna Del Fabro
- Gynaecological Oncology Unit, Centro di Riferimento Oncologico (CRO) di Aviano, IRCCS, Via Franco Gallini 2, 33081 Aviano, Italy
| | - Antonino Ditto
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Andrea Ciavattini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Francesco Sopracordevole
- Gynaecological Oncology Unit, Centro di Riferimento Oncologico (CRO) di Aviano, IRCCS, Via Franco Gallini 2, 33081 Aviano, Italy
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Bogani G, Sopracordevole F, Casarin J, Pinelli C, Leone Roberti Maggiore U, Brusadelli C, Guerrisi R, Ditto A, Dell'Acqua A, Serati M, Lopez S, Ferrero S, Ghezzi F, Raspagliesi F. The impact of HPV-specific infection in women diagnosed with atypical glandular cells: Results from the HPV-AGC study. Pathol Res Pract 2020; 216:153184. [PMID: 32916447 DOI: 10.1016/j.prp.2020.153184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/12/2020] [Accepted: 08/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the impact of various HPV types on the risk of developing lesions of the uterus (either uterine cervix and endometrium) in women diagnosed with "atypical glandular cells" (AGC) at Pap smear. METHODS This is a multi-institutional retrospective study. Data of women diagnosed with AGC were retrospectively reviewed. All patients included had data about HPV DNA testing and 1-year clinical follow-up. RESULTS Overall, chart of 480 patients were evaluated. After the exclusion of 286 patients, data of 194 patients were available for the analysis. Mean age was 43.9 (±6.0) years. HPV infection was documented in 136 women (70.1 %). Among HPV positive patients the risk of having/developing a lesion was 33.8 % (n = 46). Lesions included low- (L-SIL) and high- (H-SIL) squamous intraepithelial lesions, in situ adenocarcinoma of the uterine cervix, invasive cancer of the uterine cervix, endometrial hyperplasia and endometrial cancer in 16 (11.7 %), 18 (13.2 %), 6 (4.4 %), 3 (2.2 %), 2 (1.5 %) and 1 (1%), respectively. Among HPV negative patients the risk of having/developing a lesion was 15.5 %. They included l-SIL, H-SIL, in situ adenocarcinoma, endometrial hyperplasia and endometrial cancer in 1 (1.7 %), 1 (1.7 %), 1 (1.7 %), 3 (5.1 %) and 3 (5.1 %), respectively. Patients diagnosed with HPV16 were at higher risk of having/developing cervical lesions in comparison to patients with other HPV infections (p < 0.01). In comparison to other HPV types, the presence of HPV 18, 31, 33, and 45 did not increase the risk of developing a lesion over the time (p > 0.2). HPV positive patients were at higher risk of being diagnosed with a cervical lesion within 6 months from detection of AGC. CONCLUSIONS Patients diagnosed with AGC are at risk to have / developing cervical and uterine lesions. Further prospective evidence is needed.
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Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Francesco Sopracordevole
- Gynecologic Oncology Unit, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Pordenone, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy.
| | | | - Claudia Brusadelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy; Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Rocco Guerrisi
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy; Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Antonino Ditto
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Andrea Dell'Acqua
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Salvatore Lopez
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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Bogani G, DI Donato V, Sopracordevole F, Ciavattini A, Ghelardi A, Lopez S, Simoncini T, Plotti F, Casarin J, Serati M, Pinelli C, Valenti G, Bergamini A, Gardella B, Dell'acqua A, Monti E, Vercellini P, Fischetti M, D'Ippolito G, Aguzzoli L, Mandato VD, Carunchio P, Carlinfante G, Giannella L, Scaffa C, Falcone F, Borghi C, Ditto A, Malzoni M, Giannini A, Salerno MG, Liberale V, Contino B, Donfrancesco C, Desiato M, Perrone AM, Dondi G, De Iaco P, Leone Roberti Maggiore U, Signorelli M, Chiappa V, Ferrero S, Sarpietro G, Matarazzo MG, Cianci A, Bosio S, Ruisi S, Guerrisi R, Brusadelli C, Mosca L, Tinelli R, DE Vincenzo R, Zannoni GF, Ferrandina G, Petrillo M, Dessole S, Angioli R, Greggi S, Spinillo A, Ghezzi F, Colacurci N, Muzii L, Benedetti Panici P, Scambia G, Raspagliesi F. Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study. Gynecol Oncol 2020; 159:636-641. [PMID: 32893030 DOI: 10.1016/j.ygyno.2020.08.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/21/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Conization aims to remove pre-neoplastic lesions of the uterine cervix. Several techniques for conization have been compared, but evidence regarding the most effective therapeutic option is scant. Here, we aimed to compare the recurrence rate following laser conization and loop electrosurgical excision procedure (LEEP) in patients with high-grade cervical dysplasia (HSIL/CIN2+). METHODS This is a retrospective multi-institutional study. Medical records of consecutive patients with HSIL/CIN2+ undergoing conization between 2010 and 2014 were retrieved. A propensity-score matching (PSM) was applied in order to reduce allocation bias. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. RESULTS Overall, 2966 patients had conization over the study period, including 567 (20%) and 2399 (80%) patients having laser conization and LEEP, respectively. Looking at predictors of recurrence, diagnosis of CIN3 (HR:3.80 (95%CI:2.01,7.21); p < 0.001) and HPV persistence (HR:1.81 (95%CI:1.11,2.96); p < 0.001) correlated with an increased risk of recurrence. After applying a PSM we selected 500 patients undergoing laser conization and 1000 undergoing LEEP. Patients undergoing LEEP were at higher risk of having positive surgical margins in comparison to patients undergoing laser conization (11.2% vs. 4.2%). The risk of having persistence of HPV was similar between the two groups (15.0% vs. 11.6%;p = 0.256). Five-year recurrence rate was 8.1% and 4% after LEEP and laser conization, respectively (p = 0.023). HPV persistence was the only factor associated with [5-]year recurrence after both laser conization (p = 0.003) and LEEP (p = 0.001). CONCLUSIONS HPV persistence is the only factor associated with an increased risk of recurrence after either laser conization or LEEP. Owing to the lack of data regarding obstetrical outcomes, we are not able to assess the best therapeutic option for women with cervical dysplasia.
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Affiliation(s)
- Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via G Venezian 1, Milano, 20133, MI, Italy.
| | - Violante DI Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Via F. Gallini 2, 33081, Aviano, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Alessandro Ghelardi
- Azienda Usl Toscana Nord-Ovest, UOC Ostetricia e Ginecologia, Ospedale Apuane, Massa, Italy
| | - Salvatore Lopez
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via G Venezian 1, Milano, 20133, MI, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Ciro Pinelli
- Ospedale di circolo Fondazione Macchi, Varese, Italy
| | - Gaetano Valenti
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Via F. Gallini 2, 33081, Aviano, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Barbara Gardella
- IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Dell'acqua
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ermelinda Monti
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Margherita Fischetti
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | - Giovanni D'Ippolito
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Vincenzo D Mandato
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Paola Carunchio
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Gabriele Carlinfante
- Division of Obstetrics and Gynecology, Cesare Magati Hospital, Scandiano, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Luca Giannella
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Cono Scaffa
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Francesca Falcone
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Chiara Borghi
- Department of Obstetrics and Gynecology, S. Anna University Hospital, Ferrara, Italy
| | - Antonino Ditto
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via G Venezian 1, Milano, 20133, MI, Italy
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Andrea Giannini
- Department of Woman's and Child's Health, Obstetrics and Gynecological Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Maria Giovanna Salerno
- Department of Woman's and Child's Health, Obstetrics and Gynecological Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Viola Liberale
- Department of Obstetrics and Gynecology, Ospedale Maria Vittoria, Torino, Italy
| | - Biagio Contino
- Department of Obstetrics and Gynecology, Ospedale Maria Vittoria, Torino, Italy
| | - Cristina Donfrancesco
- Department of Obstetrics and Gynecology, Azienda ASL, Frosinone, Ospedale S Trinità di Sora, Sora, Iatly
| | - Michele Desiato
- Department of Obstetrics and Gynecology, Azienda ASL, Frosinone, Ospedale S Trinità di Sora, Sora, Iatly
| | - Anna Myriam Perrone
- Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, 40138, Bologna, Italy
| | - Giulia Dondi
- Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, 40138, Bologna, Italy
| | - Pierandrea De Iaco
- Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, 40138, Bologna, Italy
| | - Umberto Leone Roberti Maggiore
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via G Venezian 1, Milano, 20133, MI, Italy
| | - Mauro Signorelli
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via G Venezian 1, Milano, 20133, MI, Italy
| | - Valentina Chiappa
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via G Venezian 1, Milano, 20133, MI, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Giuseppe Sarpietro
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Via S. Sofia 78, 95124, Catania, Italy
| | - Maria G Matarazzo
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Via S. Sofia 78, 95124, Catania, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Via S. Sofia 78, 95124, Catania, Italy
| | - Sara Bosio
- San Paolo Hospital, Università degli Studi di Milano, 20142, Milan, Italy
| | - Simona Ruisi
- San Paolo Hospital, Università degli Studi di Milano, 20142, Milan, Italy
| | | | | | - Lavinia Mosca
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Raffaele Tinelli
- Department of Obstetrics and Gynecology, "Valle d'Itria" Hospital, Martina Franca, via San Francesco da Paola, 74015, Taranto, Italy
| | - Rosa DE Vincenzo
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Gian Franco Zannoni
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Salvatore Dessole
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Stefano Greggi
- Gynecology Oncology Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Arsenio Spinillo
- IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy; Ospedale di circolo Fondazione Macchi, Varese, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Ludovico Muzii
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy
| | | | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via G Venezian 1, Milano, 20133, MI, Italy
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Bogani G, Chiappa V, Pinelli C, Lopez S, Signorelli M, Taverna F, Lombardo C, Ditto A, Raspagliesi F. Trends in prevalence in human papillomavirus types and their association with cervical dysplasia: an analysis on 15 138 women over 20 years. Eur J Cancer Prev 2020; 29:452-457. [PMID: 32740171 DOI: 10.1097/cej.0000000000000565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To investigate trends in prevalence of various human papillomavirus types in order to assess the unmet clinical needs for women affected by human papillomavirus-related disease. Data of consecutive 15 138 patients undergoing human papillomavirus DNA testing from 1998 to 2018 were retrospectively identified. Human papillomavirus types were classified at high-risk according to the classification of the International Agency for Research on Cancer. The International Agency for Research on Cancer included seven human papillomavirus types covered by nine-valent vaccine and five not yet covered by any available vaccines. Overall, 4159 (65.3%), 1500 (23.5%) and 714 (11.2%) women had human papillomavirus types covered by nine-valent vaccination, not covered by nine-valent vaccination and co-infections of human papillomavirus types of both groups. At least one high-risk human papillomavirus type(s) was detected in 1241 patients with genital dysplasia: 832 (67.1%), 291 (23.4%) and 118 (9.5%) women had human papillomavirus types covered by nine-valent vaccination, not covered by nine-valent vaccination and co-infections of human papillomavirus types of both groups. Over the twenty-year study period, the number of human papillomavirus types not covered by nine-valent vaccine increased dramatically (from 4 to 16%; P < 0.001, P for trend). Similarly, looking at patients with genital dysplasia, high-risk human papillomavirus types not covered by nine-valent vaccine increased from 3 to 13% (P < 0.001, P for trend). Our data highlight that human papillomavirus types covered by nine-valent vaccine represent are the main types associated with genital dysplasia. However, over the study period, we observed an increasing prevalence of confections and high-risk human papillomavirus types not covered by the nine-valent vaccine, thus suggesting the need of developing more complete vaccines against human papillomavirus.
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Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Bogani G, Pinelli C, Chiappa V, Martinelli F, Lopez S, Ditto A, Raspagliesi F. Age-specific predictors of cervical dysplasia recurrence after primary conization: analysis of 3,212 women. J Gynecol Oncol 2020; 31:e60. [PMID: 32808492 PMCID: PMC7440983 DOI: 10.3802/jgo.2020.31.e60] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022] Open
Abstract
Objective This study aimed to identify predictors of recurrence/persistence of cervical intraepithelial neoplasia grade 2+ (CIN2+) lesion (r-CIN2+) after primary conization. Methods Retrospective analysis involving all consecutive women having conization for CIN2+ between 1998 and 2018. The risk of r-CIN2+ was assessed using Kaplan-Meier and Cox models. Results Data of 3,212 women were retrospectively identified. After a mean follow-up of 47 (±22.2) months, 112 (3.5%) patients developed r-CIN2+. Mean time interval between prior conization and diagnosis of r-CIN2+ was 26.2 (±13.2) months. Via multivariate analysis, presence of high-risk human papillomavirus (HPV) types at the time of CIN2+ diagnosis, hazard ratio (HR)=3.40 (95% confidence interval [CI]=1.66–6.95) for HPV16/18 and HR=2.59 (95% CI=1.21–5.55) for HPV types other than 16/18, positive margins at primary conization, HR=4.11 (95% CI=2.04–8.26) and HPV persistence after conization, HR=16.69 (95% CI=8.20–33.9), correlated with r-CIN2+, independently. Considering age-specific HPV types distribution, we observed that HPV16/18 infection correlated to an increased risk of r-CIN2+ only in young women (aged ≤25 years; p=0.031, log-rank test); while in the older population (>25 years) HPV type(s) involved had not impact on r-CIN2+ risk (p>0.200, log-rank test). Conclusion HPV persistence is the main factor predicting r-CIN2+. Infection from HPV16/18 has a detrimental effect in young women, thus highlighting the need of implementing vaccination against HPV in this population. Further prospective studies are warranted for tailoring clinical decision-making for post-conization follow-up on the basis of risk factors.
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Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | - Ciro Pinelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Valentina Chiappa
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Fabio Martinelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Salvatore Lopez
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Antonino Ditto
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Lopez S, Guerrisi R, Brusadelli C, Bogani G, Ditto A, Raspagliesi F. The role of sentinel lymph node mapping in lower genital tract melanoma. ACTA ACUST UNITED AC 2020; 72:384-390. [PMID: 32744452 DOI: 10.23736/s0026-4784.20.04628-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Vulvar and vaginal melanomas are rare cancers of the female genital tract and account for 1% to 3% of all melanomas diagnosed in women. Due to the rarity of the disease, few data are available on the clinical and pathologic features of these cancers. Furthermore, treatment options are generally based on extrapolations of the information available for the more common cutaneous counterparts. Surgery represents the mainstay of treatment for lower genital tract melanoma. Moreover, the role of sentinel lymph node (SLN) assessment is controversial because no prospective data are available. EVIDENCE ACQUISITION Data were collected from Medline, Embase, Web of Sciences and Scopus databases. On July 10, 2020, we used the search comprising the terms "vulvar melanoma," "genital melanoma" and "vulvovaginal melanoma" including only studies in which SLN biopsy was performed. EVIDENCE SYNTHESIS Ten retrospective studies have been found. No randomized trials have been reported. The studies included 132 patients while only 63 (47%) undergone SLN. 99mTC with or without blue dye followed by ultrastaging was highly accurate and is currently the gold standard. Mean detection rate was 98.3%. No clear evidence supported the execution of back lymphadenectomy (after SLN mapping), in fact, extrapolating data from cutaneous melanomas of other sites, completion of lymphadenectomy does not confer a melanoma-specific survival advantage. CONCLUSIONS Although the small amount of available data, sentinel lymph node procedure is feasible and capable of identifying patients who have occult lymph node metastases. However, the potential role of the sentinel lymph node procedure as an alternative method of lymph node staging in patients with vulvar or vaginal melanoma needs further investigation.
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Affiliation(s)
- Salvatore Lopez
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy - .,Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy -
| | - Rocco Guerrisi
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy
| | - Claudia Brusadelli
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy
| | - Giorgio Bogani
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy
| | - Antonino Ditto
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy
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Raspagliesi F, Bogani G, Pinelli C, Casarin J, Cerrotta AM, Delle Curti CT, Ditto A, Chiappa V, Bosio S, Bertolina F, Sarpietro G, Dell'Acqua A, Di Donato V, Ghezzi F. Patterns of failure after adjuvant "sandwich" chemo-radio-chemotherapy in locally advanced (stage III-IVA) endometrial cancer. J Cancer Res Clin Oncol 2020; 147:813-820. [PMID: 32734325 DOI: 10.1007/s00432-020-03339-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 07/23/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate oncological outcomes and patterns of recurrence of patients undergoing adjuvant "sandwich" chemo-radio-chemotherapy for locally advanced endometrial cancer. METHODS This is a multi-institutional retrospective study evaluating chart of consecutive patients undergoing chemo-radio-chemotherapy for FIGO stage III-IVA endometrial caner. RESULTS The study population included 45 patients who had adjuvant sandwich regimen. Median age of the study population was 66 years. The majority of patients were diagnosed with endometrioid histology and with stage III disease. After a median follow-up of 35 months, 15 patients developed recurrent disease. Three-year disease-free and overall survivals was 45% and 81%, respectively. Three-years site-specific disease-free survival was 85%, 92% and 48% for local, loco-regional, and distant recurrence, respectively. All patients included in the study had nodal dissection. Nodal assessment included: sentinel node mapping, sentinel node mapping plus backup lymphadenectomy and lymphadenectomy in 15, 6 and 24 patients, respectively. The latter group included four patients detected by suspected enlarged nodes, intraoperatively. Even after the exclusion of patients with enlarged nodes, the type of nodal assessment did not impact on survival outcomes (p > 0.2). Positive peritoneal cytology was the only factor associated with an increased risk of developing (any site) recurrence and distant-specific recurrence, independently. No factor predicted for overall survival. CONCLUSION Adjuvant "sandwich" chemo-radio-chemotherapy for locally advanced endometrial cancer guarantee promising local and loco-regional controls, but distant failure rate is high, thus suggesting the need for applying other systemic treatment strategies for these patients.
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Affiliation(s)
- Francesco Raspagliesi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Anna Maria Cerrotta
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
| | - Clelia Teresa Delle Curti
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
| | - Antonino Ditto
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
| | - Valentina Chiappa
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
| | - Sara Bosio
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
| | - Francesca Bertolina
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
| | - Giuseppe Sarpietro
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy.
| | - Andrea Dell'Acqua
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
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Lorusso D, Marchetti C, Conte C, Giudice E, Bolomini G, Vertechy L, Ceni V, Ditto A, Ferrandina G, Raspagliesi F, Scambia G, Fagotti A. Bevacizumab as maintenance treatment in BRCA mutated patients with advanced ovarian cancer: A large, retrospective, multicenter case-control study. Gynecol Oncol 2020; 159:95-100. [PMID: 32703631 DOI: 10.1016/j.ygyno.2020.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/12/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the correlation between BRCA mutational status and response to bevacizumab in a large advanced ovarian cancer (AOC) series. METHODS This is a multicenter, retrospective case-control study including upfront AOC treated between January 2015 and June 2019. The main inclusion criteria were: having received three weekly carboplatin-paclitaxel as first-line treatment, with or without Bevacizumab maintenance, knowledge of the BRCA mutational status. RESULTS Overall, 441 patients were included; 183 (41.5%) patients received bevacizumab (Cases), and 258 (58.5%) did not receive it (Controls). The BRCA mutated patients (BRCAmut) were 58 (39%) in the Cases group and 90 (34.9%) in the Controls group (p = .77). Patients who received bevacizumab had a significant 4-months increase in median progression free survival (mPFS: 21 vs. 17 months, p = .033). Concerning BRCAmut patients, no differences were shown between those who received bevacizumab or not in terms of mPFS (24 vs. 22 months, p = .3). Conversely, in BRCA wild-type (BRCAwt) population bevacizumab administration significantly prolonged mPFS (20 vs 15 months, p = .019). At multivariate analysis, independent factors of prolonged PFS were BRCA status (OR = 0.60), having received PDS (OR = 0.69), and complete cytoreduction (OR = 0.50), but not the bevacizumab administration (OR = 0.83, p = .22). CONCLUSIONS No evidence of oncological benefit in terms of PFS and OS related to bevacizumab maintenance therapy was found in BRCAmut patients. Differently, BRCAwt patients seem to benefit from antiangiogenic treatment in terms of mPFS.
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Affiliation(s)
- D Lorusso
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Marchetti
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Conte
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Giudice
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Bolomini
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Vertechy
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - V Ceni
- Department of Obstetrics and Gynecology of Parma, Parma, Italy
| | - A Ditto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - G Ferrandina
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Raspagliesi
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - G Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - A Fagotti
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
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Bogani G, Ditto A, Chiappa V, Pinelli C, Sonetto C, Raspagliesi F. Primary conization overcomes the risk of developing local recurrence following laparoscopic radical hysterectomy in early stage cervical cancer. Int J Gynaecol Obstet 2020; 151:43-48. [PMID: 32511745 DOI: 10.1002/ijgo.13260] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/06/2019] [Accepted: 06/02/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate whether primary conization might overcome the risk of local dissemination in patients undergoing laparoscopic radical hysterectomy. METHODS Consecutive data of 262 patients with early stage cervical cancer were retrieved: 88 women had conization followed by radical hysterectomy. A propensity-matched comparison (1:1) was carried out in order to compare laparoscopy and open surgery. Accumulating data highlighted that minimally invasive surgery has been associated with higher recurrence rates and worse overall survival than open surgery in women with early stage cervical cancer. RESULTS Data of 35 paired patients (total 70 patients) were analyzed. No between-group differences in baseline, disease, and pathological variables were observed. Patients undergoing laparoscopy correlated with lower blood loss (50 [range 30-100] vs 150 [range 50-500] mL; P<0.001) and shorter length of stay (3 ± 0.8 vs 5.4 ± 1.4 days; P<0.001) compared to open surgery. One local recurrence was observed per group (P=1.00). Type of surgical approach did not influence site of recurrence (P=1.00) or survival outcomes, in terms of 10-year disease-free (P=0.549, log-rank test) and overall survivals (P=0.615, log-rank test). CONCLUSIONS The data show that primary conization might overcome the risk of local recurrence after laparoscopic radical hysterectomy in early stage cervical cancer. Further prospective evidence is needed.
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Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Antonino Ditto
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Valentina Chiappa
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Ciro Pinelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Cristina Sonetto
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Bogani G, Signorelli M, Ditto A, Raspagliesi F. Surgical oncology at the time of COVID-19 outbreak. J Surg Oncol 2020; 122:115-116. [PMID: 32497294 PMCID: PMC7300708 DOI: 10.1002/jso.25975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mauro Signorelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Antonino Ditto
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Bogani G, Ditto A, Pinelli C, Lopez S, Chiappa V, Raspagliesi F. Ten‐year follow‐up study of long‐term outcomes after conservative surgery for early‐stage ovarian cancer. Int J Gynaecol Obstet 2020; 150:169-176. [DOI: 10.1002/ijgo.13199] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/28/2020] [Accepted: 05/12/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
| | - Antonino Ditto
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
| | - Ciro Pinelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
| | - Salvatore Lopez
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
| | - Valentina Chiappa
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Milan Italy
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Bogani G, Casarin J, Pinelli C, Di Donato V, Bosio S, Ruisi S, Brusadelli C, Guerrisi R, Sarpietro G, Ditto A, Ghezzi F, Raspagliesi F. Management of patients with ovarian cancer in the COVID-19 era. J Surg Oncol 2020; 122:122-123. [PMID: 32476155 PMCID: PMC7300981 DOI: 10.1002/jso.26057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/14/2022]
Abstract
At the beginning of 2020, coronavirus disease 2019 (COVID‐19) spreads worldwide. Patients with ovarian cancer should be considered at high‐risk of developing severe morbidity related to COVID‐19. Most of them are diagnosed in advanced stages of disease, and they are fragile. Here, we evaluated the major impact of COVID‐19 on patients with ovarian cancer, discussing the effect of the outbreak on medical and surgical treatment.
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Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Jvan Casarin
- Obstetrics and Gynecology Department of the University of Insubria, Varese, Italy
| | - Ciro Pinelli
- Obstetrics and Gynecology Department of the University of Insubria, Varese, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Sara Bosio
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Department of Obstetrics and Gynecology, Ospedale San Paolo, University of Milan, Milan, Italy
| | - Simona Ruisi
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Department of Obstetrics and Gynecology, Ospedale San Paolo, University of Milan, Milan, Italy
| | - Claudia Brusadelli
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Obstetrics and Gynecology Department of the University of Insubria, Varese, Italy
| | - Rocco Guerrisi
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Obstetrics and Gynecology Department of the University of Insubria, Varese, Italy
| | - Giuseppe Sarpietro
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic University of Catania, Catania, Italy
| | - Antonino Ditto
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Fabio Ghezzi
- Obstetrics and Gynecology Department of the University of Insubria, Varese, Italy
| | - Francesco Raspagliesi
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Bogani G, Brusadelli C, Guerrisi R, Lopez S, Signorelli M, Ditto A, Raspagliesi F. Gynecologic oncology at the time of COVID-19 outbreak. J Gynecol Oncol 2020; 31:e72. [PMID: 32458597 PMCID: PMC7286755 DOI: 10.3802/jgo.2020.31.e72] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 12/19/2022] Open
Abstract
The World Health Organization (WHO) classified the novel coronavirus (i.e., coronavirus disease 2019 [COVID-19]) as a global public health emergency. COVID-19 threatens to curtail patient access to evidence-based treatment. Medicine is changing, basically due to the limited available resources. In the field of gynecologic oncology, we have to re-design our treatments' paradigm. During COVID-19 pandemic outbreak, the highest priority is to achieve the maximum benefit from less demanding procedures. Extensive procedures should be avoided, in order to reduce hospitalization and postoperative events that might increase the in-hospital spread of the virus. There are ongoing concerns on the use of laparoscopic procedures, related to the possible contamination of the staff working in the operation room. Other minimally invasive techniques, including, vaginal surgery as well as robotic-assisted and isobaric procedures would be preferred over laparoscopy. A fair allocation of resources is paramount adequate treatments.
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Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy.
| | - Claudia Brusadelli
- Univerity of Insubria, Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - Rocco Guerrisi
- Univerity of Insubria, Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - Salvatore Lopez
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Mauro Signorelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Antonino Ditto
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
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Bogani G, Ghezzi F, Chiva L, Gisone B, Pinelli C, Dell'Acqua A, Casarin J, Ditto A, Raspagliesi F. Patterns of recurrence after laparoscopic versus open abdominal radical hysterectomy in patients with cervical cancer: a propensity-matched analysis. Int J Gynecol Cancer 2020; 30:987-992. [DOI: 10.1136/ijgc-2020-001381] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 12/16/2022] Open
Abstract
ObjectiveRecent evidence has suggested that laparoscopic radical hysterectomy is associated with an increased risk of recurrence in comparison with open abdominal radical hysterectomy. The aim of our study was to identify patterns of recurrence after laparoscopic and open abdominal radical hysterectomy for cervical cancer.MethodsThis a retrospective multi-institutional study evaluating patients with recurrent cervical cancer after laparoscopic and open abdominal surgery performed between January 1990 and December 2018. Inclusion criteria were: age ≥18 years old, radical hysterectomy (type B or type C), no recurrent disease, and clinical follow-up >30 days. The primary endpoint was to evaluate patterns of first recurrence following laparoscopic and open abdominal radical hysterectomy. The secondary endpoint was to estimate the effect of the primary surgical approach (laparoscopy and open surgery) in post-recurrence survival outcomes (event-free survival and overall survival). In order to reduce possible confounding factors, we applied a propensity-matching algorithm. Survival outcomes were estimated using the Kaplan-Meier model.ResultsA total of 1058 patients were included in the analysis (823 underwent open abdominal radical hysterectomy and 235 patients underwent laparoscopic radical hysterectomy). The study included 117 (14.2%) and 35 (14.9%) patients who developed recurrent cervical cancer after open or laparoscopic surgery, respectively. Applying a propensity matched comparison (1:2), we reduced the population to 105 patients (35 vs 70 patients with recurrence after laparoscopic and open radical hysterectomy). Median follow-up time was 39.1 (range 4–221) months and 32.3 (range 4–124) months for patients undergoing open and laparoscopic surgery, respectively. Patients undergoing laparoscopic radical hysterectomy had shorter progression-free survival than patients undergoing open abdominal surgery (HR 1.98, 95% CI 1.32 to 2.97; p=0.005). Patients undergoing laparoscopic radical hysterectomy were more likely to develop intrapelvic recurrences (74% vs 34%; p<0.001) and peritoneal carcinomatosis (17% vs 1%; p=0.005) than patients undergoing open surgery.ConclusionsPatients undergoing laparoscopic radical hysterectomy are at higher risk of developing intrapelvic recurrences and peritoneal carcinomatosis. Further evidence is needed in order to corroborate our findings.
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Bogani G, Casarin J, Leone Roberti Maggiore U, Ditto A, Pinelli C, Dell'acqua A, Lopez S, Chiappa V, Brusadelli C, Guerrisi R, Ferrero S, Ghezzi F, Raspagliesi F. Survival outcomes in endometrial cancer patients having lymphadenectomy, sentinel node mapping followed by lymphadectomy and sentinel node mapping alone: Long-term results of a propensity-matched analysis. Gynecol Oncol 2020; 158:77-83. [PMID: 32389376 DOI: 10.1016/j.ygyno.2020.04.691] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/15/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Jvan Casarin
- Obstetrics and Gynecology Department of the University of Insubria, Varese, Italy
| | | | - Antonino Ditto
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Ciro Pinelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy; Obstetrics and Gynecology Department of the University of Insubria, Varese, Italy.
| | - Andrea Dell'acqua
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Salvatore Lopez
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | | | - Claudia Brusadelli
- Obstetrics and Gynecology Department of the University of Insubria, Varese, Italy
| | - Rocco Guerrisi
- Obstetrics and Gynecology Department of the University of Insubria, Varese, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Fabio Ghezzi
- Obstetrics and Gynecology Department of the University of Insubria, Varese, Italy
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Casarin J, Bogani G, Papadia A, Ditto A, Pinelli C, Garzon S, Donadello N, Laganà AS, Cromi A, Mueller M, Raspagliesi F, Ghezzi F. Preoperative Conization and Risk of Recurrence in Patients Undergoing Laparoscopic Radical Hysterectomy for Early Stage Cervical Cancer: A Multicenter Study. J Minim Invasive Gynecol 2020; 28:117-123. [PMID: 32320800 DOI: 10.1016/j.jmig.2020.04.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVE To investigate the factors associated with poorer oncologic outcomes in patients undergoing laparoscopic radical hysterectomy (LRH) for early stage cervical cancer. DESIGN Multicenter retrospective study. SETTING Three gynecologic oncology referral centers. PATIENTS Patients with International Federation of Gynecology and Obstetrics 2009 stage IA (positive lymphovascular space invasion)-IB1 cervical cancer between January 2006 and June 2018. INTERVENTIONS LRH (Piver type II-III hysterectomies). Lymph-node dissection was accomplished according to the tumor characteristics. MEASUREMENTS AND MAIN RESULTS Surgical and oncologic outcomes were analyzed. Overall, 186 patients met the inclusion criteria, 16 (8.6%) experienced a recurrence, and 9 (4.8%) died of the disease (median follow-up period 37.9 months). Surgery-related complications did not influence disease-free survival. All the recurrences (16/16; 100%) occurred in patients with stage IB1 disease (p = .02), and 15 (93.7%) in cases involving tumors ≥2 cm. No association between positive lymph node and recurrence was detected (p =.82). Patients who had a preoperative diagnosis through conization (93; 50%) had a significantly lower rate of recurrence than those who underwent cervical biopsy (93; 50%): 1/93 (1.1%) vs 15/93 (16.1%); p <.001). The subanalysis of patients with International Federation of Gynecology and Obstetrics stage IB1 cervical cancer showed that patients undergoing preoperative conization (vs cervical biopsy) were less likely to experience a recurrence (odds ratio 0.09; 95% confidence interval 0.01-0.55). CONCLUSION We confirmed that LRH was associated with a recurrence rate similar to that reported in the Laparoscopic Approach to Cervical Cancer trial. Tumor size ≥2 cm represents the most important risk factor influencing disease-free survival. However, we found that preoperative conization plays a potentially protective role in patients with an IB1 tumor.
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Affiliation(s)
- Jvan Casarin
- Department of Obstetrics and Gynecology, University of Insubria, Varese (Drs. Casarin, Pinelli, Garzon, Donadello, Laganà, Cromi, and Ghezzi).
| | - Giorgio Bogani
- Department of Gynecologic Oncology, National Cancer Institute, Milan (Drs. Bogani, Ditto, and Raspagliesi), Italy
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland (Drs. Papadia and Mueller)
| | - Antonino Ditto
- Department of Gynecologic Oncology, National Cancer Institute, Milan (Drs. Bogani, Ditto, and Raspagliesi), Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, University of Insubria, Varese (Drs. Casarin, Pinelli, Garzon, Donadello, Laganà, Cromi, and Ghezzi)
| | - Simone Garzon
- Department of Obstetrics and Gynecology, University of Insubria, Varese (Drs. Casarin, Pinelli, Garzon, Donadello, Laganà, Cromi, and Ghezzi)
| | - Nicoletta Donadello
- Department of Obstetrics and Gynecology, University of Insubria, Varese (Drs. Casarin, Pinelli, Garzon, Donadello, Laganà, Cromi, and Ghezzi)
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, University of Insubria, Varese (Drs. Casarin, Pinelli, Garzon, Donadello, Laganà, Cromi, and Ghezzi)
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, University of Insubria, Varese (Drs. Casarin, Pinelli, Garzon, Donadello, Laganà, Cromi, and Ghezzi)
| | - Michael Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland (Drs. Papadia and Mueller)
| | - Francesco Raspagliesi
- Department of Gynecologic Oncology, National Cancer Institute, Milan (Drs. Bogani, Ditto, and Raspagliesi), Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese (Drs. Casarin, Pinelli, Garzon, Donadello, Laganà, Cromi, and Ghezzi)
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Bogani G, Ditto A, Lopez S, Bertolina F, Murgia F, Pinelli C, Chiappa V, Raspagliesi F. Adjuvant chemotherapy vs. observation in stage I clear cell ovarian carcinoma: A systematic review and meta-analysis. Gynecol Oncol 2020; 157:293-298. [PMID: 31980220 DOI: 10.1016/j.ygyno.2019.12.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/19/2019] [Accepted: 12/29/2019] [Indexed: 01/01/2023]
Abstract
The role of adjuvant chemotherapy in surgically staged stage I clear cell ovarian cancer (OCCC) is unclear. Here, we performed a systematic review and meta-analysis in order to evaluate the role of chemotherapy vs. observation in stage I OCCC. This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; ID: #129628). A protocol was defined prior to the search include the population criteria, description of interventions, comparisons, and the outcomes of interest, according to the PRIMA guidelines. Overall, the study population included 5073 women. Stage I OCCC experienced a 5-year disease-free survival and a 5-year overall survival of 83.7% and 86.9%, respectively. Pooled data suggested that in the overall population adjuvant chemotherapy did not impact on 5-year disease free survival (test for overall effect, Z = 0.18; p = 0.86) and 5-year overall survival (test for overall effect, Z = 0.62; p = 0.53). Focusing on 2264 stage IC OCCC we observed that adjuvant correlated with an improvement in overall survival (OR: 0.70 (95%CI: 0.52 to 0.93); Z = 2.44; p = 0.01). In conclusion our study underlines that adjuvant chemotherapy could be reserved for patients with stage IC OCCC; while in stage IA and IB it could be safely omitted. Owing to the inherent biases of the studies included in the meta-analysis further prospective evidences are needed.
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Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy.
| | - Antonino Ditto
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Salvatore Lopez
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | | | | | - Ciro Pinelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
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Martinelli F, Ditto A, Bogani G, Leone Roberti Maggiore U, Signorelli M, Chiappa V, Raspagliesi F. Sentinel lymph node mapping in endometrial cancer: performance of hysteroscopic injection of tracers. Int J Gynecol Cancer 2020; 30:332-338. [PMID: 31911536 DOI: 10.1136/ijgc-2019-000930] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/30/2019] [Accepted: 12/05/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To report on the performance of hysteroscopic injection of tracers (indocyanine green (ICG) and technetium-99m (Tc-99m)) for sentinel lymph node (SLN) mapping in endometrial cancer. METHODS Single-center retrospective evaluation of consecutive patients who underwent SLN mapping following hysteroscopic peritumoral injection of tracer. Detection rate (overall/bilateral/aortic) diagnostic accuracy, and oncologic outcomes were evaluated. RESULTS A total of 221 procedures met the inclusion criteria. Mean patient age was 60 (range 28-84) years and mean body mass index was 26.9 (range 15-47) kg/m2 . In 164 cases (70.9%) mapping was performed laparoscopically. The overall detection rate of the technique was 94.1% (208/221 patients). Bilateral pelvic mapping was found in 62.5% of cases with at least one SLN detected and was more frequent using ICG than with Tc-99m (73.8% vs 53.3%; p<0.001). In 47.6% of cases SLNs mapped in both pelvic and aortic nodes, and in five cases (2.4%) only in the aortic area. In eight patients (3.8%) SLNs were found in aberrant (parametrial/presacral) areas. Mean number of detected SLNs was 3.7 (range 1-8). In 51.9% of cases at least one node other than SLNs was removed. Twenty-six patients (12.5%) had nodal involvement: 12 (46.2%) macrometastases, six (23.1%) micrometastases, and eight (30.7%) isolated tumor cells. In 12 cases (46.8%) the aortic area was involved. Overall, 6/221 (2.7%) patients had isolated para-aortic nodes. Three false-negative results were found, all in the Tc-99m group. All had isolated aortic metastases. Overall sensitivity was 88.5% (95% CI 71.7 to 100.0) and overall negative predictive value was 96.5% (95% CI 86.8 to 100.0). There were 10 (4.8%) recurrences: five abdominal/distant, four vaginal, and one nodal (in the aortic area following a unilateral mapping plus side-specific pelvic lymphadenectomy). Most recurrences (9/10 cases) were patients in whom a completion lymphadenectomy was performed. No deaths were reported after a mean follow-up of 47.7 months. CONCLUSIONS Hysteroscopic injection of tracers for SLN mapping in endometrial cancer is as accurate as cervical injection with a higher detection rate in the aortic area. ICG improves the bilateral detection rate. Adding lymphadenectomy to SLN mapping does not reduce the risk of relapse.
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Affiliation(s)
- Fabio Martinelli
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonino Ditto
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giorgio Bogani
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Mauro Signorelli
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valentina Chiappa
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Bogani G, Ditto A, Signorelli M, Chiappa V, Martinelli F, Raspagliesi F. Sentinel Node Mapping in Endometrial Cancer. J INVEST SURG 2019; 34:677-678. [PMID: 31851540 DOI: 10.1080/08941939.2019.1680778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Milan, Italy
| | - Antonino Ditto
- Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Milan, Italy
| | - Mauro Signorelli
- Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Milan, Italy
| | - Valentina Chiappa
- Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Milan, Italy
| | - Fabio Martinelli
- Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Milan, Italy
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