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Riedinger CJ, Esnakula A, Haight PJ, Suarez AA, Chen W, Gillespie J, Villacres A, Chassen A, Cohn DE, Goodfellow PJ, Cosgrove CM. Reply to "Mismatch repair and microsatellite instability-Recommendation for an optimal test strategy". Cancer 2024; 130:1713-1714. [PMID: 38430468 DOI: 10.1002/cncr.35257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- Courtney J Riedinger
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ashwini Esnakula
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Paulina J Haight
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Adrian A Suarez
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Wei Chen
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jessica Gillespie
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alyssa Villacres
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alexis Chassen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Paul J Goodfellow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Casey M Cosgrove
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Levine MD, Wagner VM, Riedinger CJ, Khadraoui W, Haight PJ, Morton M, Barrington DA, Calo CA, Castaneda AV, Lightfoot M, Chalif J, Gonzalez A, Cohn DE. Learning to lead: The evolution of a pilot leadership curriculum for gynecologic oncology fellows at the Ohio State University. Gynecol Oncol Rep 2024; 52:101327. [PMID: 38390623 PMCID: PMC10881305 DOI: 10.1016/j.gore.2024.101327] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/14/2024] [Indexed: 02/24/2024] Open
Abstract
•Leadership training is under-emphasized in traditional medical education.•An effective leadership curriculum must be dynamic and requires genuine investment from participants.•Through didactic education, self-reflection, and real-world perspective we can actively mold future leaders in gynecologic oncology.
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Affiliation(s)
- Monica D Levine
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
- Division of Gynecologic Oncology, Hoag Gynecologic Oncology, Newport Beach, CA, USA
| | - Vincent M Wagner
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
- Division of Gynecologic Oncology, University of Iowa Hospitals, Iowa City, IA, USA
| | - Courtney J Riedinger
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Wafa Khadraoui
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Paulina J Haight
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Molly Morton
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - David A Barrington
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
- Division of Gynecologic Oncology, Oschner Health, New Orleans, LA, USA
| | - Corinne A Calo
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
- Division of Gynecologic Oncology, OhioHealth, Columbus, OH, USA
| | - Antonio V Castaneda
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
- Division of Gynecologic Oncology, Hoag Gynecologic Oncology, Newport Beach, CA, USA
| | - Michelle Lightfoot
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
- Division of Gynecologic Oncology, New York University, New York, NY, USA
| | - Julia Chalif
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Anna Gonzalez
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
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Riedinger CJ, Barrington DA, Nagel CI, Khadraoui WK, Haight PJ, Tubbs C, Backes FJ, Cohn DE, O'Malley DM, Copeland LJ, Chambers LM. Cost-effectiveness of chemotherapy and dostarlimab for advanced or recurrent endometrial cancer. Gynecol Oncol 2024; 183:78-84. [PMID: 38554477 DOI: 10.1016/j.ygyno.2024.03.020] [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: 12/19/2023] [Revised: 03/10/2024] [Accepted: 03/21/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVE The combination of dostarlimab with carboplatin and paclitaxel has demonstrated improved progression-free survival (PFS) and overall survival (OS) in primary advanced and recurrent endometrial cancer (EC). However, prior studies have not found immunotherapy to be cost-effective, or cost-effective only in specific subgroups, of recurrent endometrial cancer. This study aimed to determine the cost-effectiveness of combination therapy compared to chemotherapy alone. METHOD A partitioned survival model was developed to compare the cost and effectiveness of dostarlimab in combination with chemotherapy compared to chemotherapy alone in primary advanced or recurrent endometrial cancer. Clinical data was derived from the RUBY trial and drug costs from average sale prices. The incremental cost-effectiveness ratio (ICER) was compared to a set willingness to pay (WTP) of $100,000/QALY to determine cost-effectiveness. One-way and probabilistic sensitivity analyses were performed. RESULTS In the intention-to-treat (ITT) population, the dostarlimab combination incurred an additional cost of $308,430 but provided an additional 5.67 QALYs compared to chemotherapy alone. The ICER was $54,406/QALY. The dostarlimab combination was cost-effective compared to chemotherapy alone irrespective of MMR expression, with an ICER of $32,287/QALY for MMR deficient (MMRd) EC and $85,744/QALY for MMR proficient (MMRp) EC. Probabilistic sensitivity analysis demonstrated that the combination was cost-effective in 98.2% of iterations at the current WTP threshold. CONCLUSIONS Despite the higher cost, adding dostarlimab to platinum chemotherapy significantly improves QALYs, rendering this regimen cost-effective relative to chemotherapy alone for treating primary advanced or recurrent EC. Combination therapy is a cost-effective approach for this patient population compared to chemotherapy alone.
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Affiliation(s)
- Courtney J Riedinger
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, USA.
| | - David A Barrington
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA, USA
| | - Christa I Nagel
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, USA
| | - Wafa K Khadraoui
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, USA
| | - Paulina J Haight
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, USA
| | - Crystal Tubbs
- Department of Pharmacy, The Ohio State University Wexner Medical Center, USA
| | - Floor J Backes
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, USA
| | - David E Cohn
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, USA
| | - David M O'Malley
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, USA
| | - Larry J Copeland
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, USA
| | - Laura M Chambers
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, USA
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Levine MD, Wagner VM, Riedinger CJ, Khadraoui W, Haight PJ, Morton M, Cohn DE. Authentic leadership in action: Experience gained from a gynecologic oncology fellowship leadership curriculum. Gynecol Oncol 2024; 182:176-178. [PMID: 38330810 DOI: 10.1016/j.ygyno.2024.01.036] [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] [Received: 10/20/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Monica D Levine
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA; Division of Gynecologic Oncology, Hoag Gynecologic Oncology, Newport Beach, CA, USA
| | - Vincent M Wagner
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA; Division of Gynecologic Oncology, University of Iowa Hospitals, Iowa City, IA, USA
| | - Courtney J Riedinger
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA.
| | - Wafa Khadraoui
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Paulina J Haight
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - Molly Morton
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, USA
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Riedinger CJ, Esnakula A, Haight PJ, Suarez AA, Chen W, Gillespie J, Villacres A, Chassen A, Cohn DE, Goodfellow PJ, Cosgrove CM. Characterization of mismatch-repair/microsatellite instability-discordant endometrial cancers. Cancer 2024; 130:385-399. [PMID: 37751191 PMCID: PMC10843110 DOI: 10.1002/cncr.35030] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Mismatch-repair (MMR)/microsatellite instability (MSI) status has therapeutic implications in endometrial cancer (EC). The authors evaluated the concordance of testing and factors contributing to MMR expression heterogeneity. METHODS Six hundred sixty-six ECs were characterized using immunohistochemistry (IHC), MSI testing, and mut-L homolog 1 (MLH1) methylation. Select samples underwent whole-transcriptome analysis and next-generation sequencing. MMR expression of metastatic/recurrent sites was evaluated. RESULTS MSI testing identified 27.3% of cases as MSI-high (n = 182), MMR IHC identified 25.1% cases as MMR-deficient (n = 167), and 3.8% of cases (n = 25) demonstrated discordant results. A review of IHC staining explained discordant results in 18 cases, revealing subclonal loss of MLH1/Pms 1 homolog 2 (PMS2) (n = 10) and heterogeneous MMR IHC (mut-S homolog 6 [MSH6], n = 7; MLH1/PMS2, n = 1). MSH6-associated Lynch syndrome was diagnosed in three of six cases with heterogeneous expression. Subclonal or heterogeneous cases had a 38.9% recurrence rate (compared with 16.7% in complete MMR-deficient cases and 9% in MMR-proficient cases) and had abnormal MMR IHC results in all metastatic recurrent sites (n = 7). Tumors with subclonal MLH1/PMS2 demonstrated 74 differentially expressed genes (determined using digital spatial transcriptomics) when stratified by MLH1 expression, including many associated with epithelial-mesenchymal transition. CONCLUSIONS Subclonal/heterogeneous MMR IHC cases showed epigenetic loss in 66.7%, germline mutations in 16.7%, and somatic mutations in 16.7%. MMR IHC reported as intact/deficient missed 21% of cases of Lynch syndrome. EC with subclonal/heterogeneous MMR expression demonstrated a high recurrence rate, and metastatic/recurrent sites were MMR-deficient. Transcriptional analysis indicated an increased risk for migration/metastasis, suggesting that clonal MMR deficiency may be a driver for tumor aggressiveness. Reporting MMR IHC only as intact/deficient, without reporting subclonal and heterogeneous staining, misses opportunities for biomarker-directed therapy. PLAIN LANGUAGE SUMMARY Endometrial cancer is the most common gynecologic cancer, and 20%-40% of tumors have a defect in DNA proofreading known as mismatch-repair (MMR) deficiency. These results can be used to guide therapy. Tests for this defect can yield differing results, revealing heterogeneous (mixed) proofreading capabilities. Tumors with discordant testing results and mixed MMR findings can have germline or somatic defects in MMR genes. Cells with deficient DNA proofreading in tumors with mixed MMR findings have DNA expression profiles linked to more aggressive characteristics and cancer spread. These MMR-deficient cells may drive tumor behavior and the risk of spreading cancer.
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Affiliation(s)
- Courtney J. Riedinger
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
| | - Ashwini Esnakula
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Paulina J. Haight
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
| | - Adrian A. Suarez
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Wei Chen
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jessica Gillespie
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
| | - Alyssa Villacres
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
| | - Alexis Chassen
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
| | - David E. Cohn
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
| | - Paul J. Goodfellow
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
| | - Casey M. Cosgrove
- Department of Obstetrics and Gynecologic, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center/James Cancer Hospital, Columbus, OH
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Haight PJ, Kistenfeger Q, Riedinger CJ, Khadraoui W, Backes FJ, Bixel KL, Copeland LJ, Cohn DE, Cosgrove CM, O'Malley DM, Nagel CI, Spakowicz DJ, Chambers LM. The impact of antibiotic and proton pump inhibitor use at the time of adjuvant platinum-based chemotherapy on survival in patients with endometrial cancer. Gynecol Oncol 2023; 178:14-22. [PMID: 37741201 DOI: 10.1016/j.ygyno.2023.09.005] [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: 05/30/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE We sought to assess the impact of antibiotic (ABX) and proton-pump inhibitor (PPI) use on progression-free (PFS) and overall survival (OS) in patients treated with adjuvant platinum-based chemotherapy (PC) for endometrial cancer (EC). METHODS A retrospective, single-institution cohort study of EC patients treated with ≥four cycles of adjuvant PC following surgical staging from 2014 to 2020. Demographics and clinicopathologic features, including ABX and PPI use, were compared using χ2 and Fisher's exact tests. Univariate and multivariable analyses were performed, and survival outcomes were compared using the log-rank test. RESULTS Of 325 patients, 95 (29%) received ABX, and 80 (24.6%) received PPI. ABX were associated with decreased 3-year PFS (49.9% vs. 66%; p = 0.0237) but not 3-year OS (68.9% vs. 79.9%; p = 0.0649). ABX targeting gram-positive bacteria were associated with decreased 3-year PFS (21.2% vs. 66.0% vs. 55.4%; p = 0.0038) and 3-year OS (36.5% vs. 79.9% vs. 75.6%; p = 0.0014) compared to no ABX and other ABX, respectively. PPI use was associated with decreased 3-year PFS (46.9% vs. 66.0%; p = 0.0001) and 3-year OS (60.7% vs. 81.9%; p = 0.0041) compared to no PPI. On multivariable regression analysis controlling for confounders including stage, histology, grade, radiation, and co-morbidities, PPI use was independently associated with worse PFS (HR 1.96, 95% CI 1.25-3.08; p = 0.0041) and OS (HR 2.06, 95% CI 1.01-4.18, p = 0.04). CONCLUSION In this retrospective cohort study, we demonstrate that PPI use is independently associated with worse PFS and OS in patients with EC treated with PC. ABX use was associated with worse PFS on univariate analysis only. There is an unmet need to understand how PPI, ABX, and, potentially, the microbiome impact the effectiveness of chemotherapy in EC patients.
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Affiliation(s)
- Paulina J Haight
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, United States of America.
| | - Quinn Kistenfeger
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, United States of America
| | - Courtney J Riedinger
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, United States of America
| | - Wafa Khadraoui
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, United States of America
| | - Floor J Backes
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, United States of America
| | - Kristin L Bixel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, United States of America
| | - Larry J Copeland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, United States of America
| | - David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, United States of America
| | - Casey M Cosgrove
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, United States of America
| | - David M O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, United States of America
| | - Christa I Nagel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, United States of America
| | - Daniel J Spakowicz
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America; Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Laura M Chambers
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, United States of America
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Haight PJ, Piver RN, Barrington DA, Baek J, Graves SM, Ardizzone M, Akinduro JA, Busho AC, Fadoju D, Pandit R, Stephens R, Strowder LM, Tadepalli S, VanNoy B, Sriram B, McLaughlin EM, DS Lightfoot M, Chambers LM, Bixel KL, Cohn DE, Cosgrove CM, O'Malley D, Salani R, Backes FJ, I Nagel C. Assessment of the feasibility of same-day discharge following minimally invasive hysterectomy in the elderly population. Gynecol Oncol Rep 2023; 48:101227. [PMID: 37415961 PMCID: PMC10320489 DOI: 10.1016/j.gore.2023.101227] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
Objective To determine the safety and feasibility of same-day discharge (SDD) following minimally invasive hysterectomy (MIH) for elderly patients and to evaluate associations between age, frailty, and postoperative outcomes. Methods Retrospective review was conducted of patients aged ≥ 70 who underwent MIH within a single gynecologic oncology institution from 2018 to 2020. Demographics, peri-operative factors, postoperative complications, and 30-day readmission rates were collected. Frailty was determined by an 11-point modified frailty index ≥ 2. Outcomes were compared between SDD and observation groups using Fisher's exact and Wilcoxon rank-sum tests. Results Of 169 patients included in the analysis, 8.9% (n = 15) underwent SDD, and 91.1% (n = 154) were admitted for OBS following MIH. Demographics, peri-operative factors, and frailty rates (33% SDD vs 43.5% observation; p = 0.59) were similar between groups. 86.7% (n = 13) of SDD cases were completed before 12PM, and none were completed after 6PM. No SDD patients had early post-operative complications or hospital readmissions. Early postoperative complications were diagnosed in 9 (5.8%) patients admitted for OBS, and the 30-day hospital readmission rate for patients who underwent OBS was 8.4% (n = 13). While elderly patients who met objective frailty criteria (n = 72) did not have a higher likelihood of early post-operative complications (44.4% vs 55.6%; p = 0.909), they did have a higher likelihood of ED visit within 30 days of discharge (15.3 vs 3.1%; p = 0.009), and a trend was noted toward a higher rate of 30-day hospital readmission (12.5% vs 4.1%; p = 0.080). Conclusions Elderly patients undergoing SDD following MIH did not have increased morbidity or mortality. Elderly patients who meet objective criteria for frailty, however, represent a more vulnerable population.
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Affiliation(s)
- Paulina J Haight
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Rachael N Piver
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David A Barrington
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Jae Baek
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Stephen M Graves
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Audrey C Busho
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Deborah Fadoju
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Radhika Pandit
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | | | | | - Brianna VanNoy
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Bhargavi Sriram
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Eric M McLaughlin
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Michelle DS Lightfoot
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Laura M Chambers
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Kristin L Bixel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Casey M Cosgrove
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - David O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Ritu Salani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Floor J Backes
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
| | - Christa I Nagel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, James Hospital and Solove Research Institute, Columbus, OH, USA
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Morton M, Haight PJ, Khadraoui W, Backes F, Bixel K, O'Malley DM, Nagel C, Chambers LM. "More than a song and dance": Exploration of patient perspectives and educational quality of gynecologic cancer content on TikTok. Gynecol Oncol 2023; 175:81-87. [PMID: 37329872 DOI: 10.1016/j.ygyno.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/05/2023] [Revised: 05/25/2023] [Accepted: 06/04/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To investigate themes, quality, and reliability of gynecologic cancer-related content on the social media application TikTok. METHODS TikTok was systematically searched for the 100 most popular posts for ovarian cancer (OC), endometrial cancer (EC), cervical cancer (CC), vulvar cancer (VC), and gestational trophoblastic disease (GTD) in August 2022. Data was collected for demographics, tone, and themes. Educational videos were rated for quality and reliability utilizing the modified DISCERN scale. Relationships between content demographics, disease sites, and themes were assessed. RESULTS As of August 2022, the top five hashtags for each gynecologic cancer on TikTok had 466.7 million views. 430 of the top 500 posts were eligible for inclusion (OC: n = 86, CC: n = 93, EC: n = 98, GTD: n = 63, VC: n = 90). The majority of creators (n = 323, 75.1%) were White, 33 (7.7%) were Black, 20 (4.6%) were Asian/Pacific Islander (API), 10 (2.3%) were South Asian, 20 (4.7%) were Hispanic/Latino/a, 24 (5.5%) were unable to determine. Eleven central themes were identified, with significant differences when analyzed by disease site and race. The median DISCERN score for all posts was 1.0, indicating poor educational quality and reliability. When compared by race, South Asian/API posters received the highest scores (3, IQR 2.5) versus Black (2: IQR 3), Hispanic/Latino/a (2: IQR 0), and White posters (1, IQR 2) (p = 0.0013). CONCLUSION(S) Gynecologic cancer-related content on TikTok is of poor educational quality, and racial disparities in gynecologic cancer extend to social media. Opportunities exist to create more diverse content to support racial and cultural experiences in gynecologic cancer treatment.
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Affiliation(s)
- Molly Morton
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA.
| | - Paulina J Haight
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA
| | - Wafa Khadraoui
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA
| | - Floor Backes
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA
| | - Kristin Bixel
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA
| | - David M O'Malley
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA
| | - Christa Nagel
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA
| | - Laura M Chambers
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, Starling Loving Hall, M210, 320 W. 10th Avenue, Columbus, OH 43210, USA
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Haight PJ, Riedinger CJ, Backes FJ, O'Malley DM, Cosgrove CM. The right time for change: A report on the heterogeneity of IVB endometrial cancer and improved risk-stratification provided by new 2023 FIGO staging criteria. Gynecol Oncol 2023; 175:32-40. [PMID: 37321153 DOI: 10.1016/j.ygyno.2023.05.069] [Citation(s) in RCA: 3] [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: 04/17/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE We sought to provide a contemporary report on stage IVB endometrial carcinoma (2009 FIGO criteria) and applied the 2023 FIGO staging criteria to this population. METHODS Retrospective review of patients who underwent cytoreduction for stage IVB endometrial carcinoma (2009 FIGO criteria) from 2014 to 2020 was performed. Demographics, clinicopathologic factors, and outcomes were recorded. Disease burden and distribution were determined by imaging, operative notes, and pathology reports. Patients were re-staged according to 2023 FIGO staging criteria. Categorical variables were compared using χ2 or Fisher's exact test, and Kaplan-Meier curves compared survival outcomes using the log-rank test. RESULTS Eighty-eight cases were included. Most patients (63.6%) were not suspected to have stage IVB (2009 FIGO criteria) disease prior to surgery. Seventy-two percent of patients underwent primary cytoreduction, and 12 (19%) were suboptimal. Median progression-free survival (PFS) was 12 months (95% CI 10-16 months), and median overall survival (OS) was 38 months (95% CI 19-61 months). Degree of cytoreduction (p = 0.0101) and pelvic-confined metastatic disease (p = 0.0149) were significant prognostic factors, while distant metastases were not associated with worse outcomes. For those patients who underwent primary cytoreduction, number (p = 0.0453) and diameter (p = 0.0192) of tumor deposits were associated with PFS. When 2023 FIGO staging criteria were applied, 58% of patients underwent change in stage, and 8% did not meet criteria for complete staging. PFS was significantly different based on 2023 FIGO staging (p = 0.0307); a trend in OS was also noted (p = 0.0550). CONCLUSION Stage IVB endometrial carcinoma (2009 FIGO criteria) encompasses a diverse cohort of patients, where certain clinicopathologic features, tumor burden, and degree of cytoreduction are associated with outcomes. The 2023 FIGO staging criteria significantly improves our ability to risk-stratify patients.
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Affiliation(s)
- Paulina J Haight
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, United States of America.
| | - Courtney J Riedinger
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, United States of America
| | - Floor J Backes
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, United States of America
| | - David M O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, United States of America
| | - Casey M Cosgrove
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, United States of America
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10
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Levine MD, O'Malley DM, Haight PJ, Senter L, Wagner V, Bixel KL, Cohn DE, Copeland LJ, Cosgrove CM, McLaughlin EM, Backes FJ. Recurrence rate in early-stage epithelial ovarian cancer: Is there a role for upfront maintenance with PARP inhibitors in stages I and II? Gynecol Oncol Rep 2023; 46:101173. [PMID: 37082521 PMCID: PMC10111944 DOI: 10.1016/j.gore.2023.101173] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023] Open
Abstract
Objective To determine the recurrence rate and survival among early-stage epithelial ovarian cancer cases considering homologous recombination deficiency (HRD) status. Methods Single institution retrospective study of stage I/II EOC patients from 2017 to 2020. HRD was defined as evidence of germline or somatic BRCA mutation, or loss of heterozygosity (LOH)/genomic instability (GIS) as determined by companion diagnostic tests. Kaplan-Meier analyses were performed. Results 89 stage I/II cases were included. 4/89 (4.5%) had a germline BRCA1/2 mutation, 8 (9%) were germline negative but had a somatic BRCA mutation, and 8 (9%) were BRCA wild-type but had evidence of LOH/GIS on somatic testing; these 20/89 (22%) cases comprised the HRD group. The remaining tumors were confirmed homologous recombination proficient (HRP, 35/89, 39%) or homologous recombination unknown (HRU, 34/89, 38%). The overall recurrence rate was 33/89 (37%). There were more recurrences among HRD cases (14/20, 70%) compared to HRP/HRU cases (19/69, 27.5%, p = 0.0012). Median Recurrence-Free Survival (RFS) was 35 months for HRD cases and 225 months for HRP/HRU cases (p = 0.001). At 2 years, there were 60% HRD cases and 88% HRP/HRU cases recurrence-free. At 5 years there were 29% HRD and 69% HRP/HRU cases recurrence-free (p = 0.001). Conclusions Despite a high rate of complete surgical staging and six cycles of adjuvant chemotherapy, recurrence rate was high in this early-stage cohort. Higher recurrence rates were seen in the HRD group, however these data are likely biased by the clinical practice of tumor testing primarily at the time of recurrence rather than the upfront setting. RFS was significantly lower for HRD cases.
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11
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Haight PJ, Barrington DA, Graves SM, Piver RN, Baek J, Ardizzone M, Akinduro JA, Busho AC, Fadoju D, Pandit R, Stephens R, Strowder LM, Tadepalli S, VanNoy B, Sriram B, McLaughlin EM, Lightfoot MDS, Bixel KL, Cohn DE, Cosgrove CM, O'Malley D, Salani R, Nagel CI, Backes FJ. Safety and feasibility of same-day discharge following minimally invasive hysterectomy in the morbidly obese patient population. Gynecol Oncol 2023; 170:203-209. [PMID: 36709661 DOI: 10.1016/j.ygyno.2023.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/01/2023] [Accepted: 01/12/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To determine whether morbid obesity should serve as an independent factor in the decision for same day discharge following minimally invasive hysterectomy. METHODS Retrospective review was performed of patients with BMI ≥ 40 who underwent minimally invasive hysterectomy within a single comprehensive cancer center between January 2018 - August 2020. Demographics, perioperative factors, post-operative monitoring, complications, and readmissions were compared between patients who underwent same day discharge and overnight observation using Fisher's exact tests and Wilcoxon rank-sum tests. RESULTS 374 patients with BMI ≥ 40 were included. Eighty-three (22.2%) patients underwent same day discharge, and 291 (77.8%) patients underwent overnight observation. Factors associated with increased likelihood of same day discharge included younger age (median age 53 vs 58; p = 0.001), lower BMI (median BMI 45 vs 47; p = 0.005), and fewer medical co-morbidities (Charlson Co-Morbidity Index 2 vs 3; p < 0.001). On multivariate regression analysis, frailty (OR 2.16 [1.14-4.11], p = 0.019) and surgical completion time after 12 PM (OR 3.67 [2.16-6.24], p < 0.001) were associated with increased risk of overnight observation. Few patients admitted for routine overnight observation required medical intervention (n = 14, 4.8%); most of these patients were frail (64.3%). The overall hospital readmission rate within 30 days of discharge was 3.2% (n = 12), with no patients discharged on the day of surgery being readmitted. CONCLUSIONS Morbid obesity alone should not serve as a contraindication to same day discharge following minimally invasive hysterectomy. Admission for observation was associated with low rates of clinically meaningful intervention, and patients who underwent same day discharge were not at increased risk of adverse outcome.
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Affiliation(s)
- Paulina J Haight
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America.
| | - David A Barrington
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Stephen M Graves
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Rachael N Piver
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Jae Baek
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Melissa Ardizzone
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Jenifer A Akinduro
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Audrey C Busho
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Deborah Fadoju
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Radhika Pandit
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Raeshawn Stephens
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Lauren M Strowder
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Shreekari Tadepalli
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Brianna VanNoy
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Bhargavi Sriram
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Eric M McLaughlin
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Michelle D S Lightfoot
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Kristin L Bixel
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Casey M Cosgrove
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - David O'Malley
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Ritu Salani
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Christa I Nagel
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Floor J Backes
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
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Riedinger CJ, Brown M, Haight PJ, Backes FJ, Cohn DE, Goodfellow PJ, Cosgrove CM. Epigenetic MMR defect identifies a risk group not accounted for through traditional risk stratification algorithms in endometrial cancer. Front Oncol 2023; 13:1147657. [PMID: 37091179 PMCID: PMC10117833 DOI: 10.3389/fonc.2023.1147657] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/10/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose We sought to evaluate the contribution of mismatch repair (MMR) status to traditional risk stratification algorithms used to predict nodal involvement and recurrence in a large single-institution cohort. Methods Endometrioid endometrial cancer (EC) cases from 2014-2020 were evaluated. MMR immunohistochemistry (IHC) was performed universally. Uterine factors assessed in the Mayo criteria were used to retrospectively classify patients as low or high risk for lymphatic spread. Patients were classified according to risk for recurrence using GOG 99 and PORTEC criteria. Associations were evaluated using chi-square and t-tests and contributing factors assessed using logistic regression models. Results 1,514 endometrioid EC were evaluated; 392 (25.9%) were MMR (MMR) deficient of which 80.4% of MMR defects were associated with epigenetic silencing of MLH1. Epigenetic MMR defects were significantly more likely to be high risk for lymph node (LN) metastasis based on Mayo criteria (74.9% vs 60.6%, p=<0.001) and with the presence of LN metastasis (20.3 vs 10.5%, p=0.003) compared to MMR proficient tumors. Tumors with epigenetic MMR defects were significantly more likely to be classified as high or high intermediate risk using GOG99 and PORTEC criteria. Furthermore, cases with epigenetic MMR defects classified as low or low intermediate risk were significantly more likely to recur (GOG99 p=0.013; PORTEC p=0.008) and independently associated with worse disease-free survival (DFS). MMR status was found to be independently associated with worse DFS (HR 1.90; 95% CI 1.34-2.70; p=0.003) but not overall survival. Conclusion While MMR deficient EC has been associated with poor prognostic features in prior reports; we demonstrate that only epigenetic MMR defects have poorer outcomes. Epigenetic MMR defect were independently associated with lymph node metastasis after controlling for risk criteria. Epigenetic MMR deficiency was found to be an independent predictor of recurrence beyond the factors considered in traditional risk stratification algorithms. Traditional uterine-based risk stratification algorithms may not fully reflect the risk for recurrence in MMR deficient tumors. Consideration should be given to implementing MMR status and MLH1 hypermethylation alongside traditional risk stratification algorithms. Performing MMR IHC on preoperative pathologic specimens may aid in risk stratification and patient counseling.
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Affiliation(s)
- Courtney J. Riedinger
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- *Correspondence: Courtney J. Riedinger,
| | - Morgan Brown
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Paulina J. Haight
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Floor J. Backes
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - David E. Cohn
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Paul J. Goodfellow
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Casey M. Cosgrove
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G. James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Haight PJ, Castaneda AV, Savage JM, Copeland LJ. Cervical carcinoma with histologic components of sarcomatoid carcinoma and multiple basaloid variants: A case report and review of the literature. Gynecol Oncol Rep 2021; 37:100797. [PMID: 34124329 PMCID: PMC8173268 DOI: 10.1016/j.gore.2021.100797] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/13/2021] [Accepted: 05/21/2021] [Indexed: 11/15/2022] Open
Abstract
Basaloid cervical tumors are well-documented histologic variants and rarely exist in pure forms. Sarcomatoid carcinoma of the cervix is not yet classified as a histologic variant by the WHO. Squamous cell, basaloid and sarcomatoid carcinoma within a single cervical specimen is rare.
Cervical cancer with co-existing pathologic components of squamous cell carcinoma, basaloid morphology and sarcomatoid carcinoma is rare, with limited reports in the literature. Here we present a patient who underwent a modified radical hysterectomy for cervical cancer, with final pathology specimen demonstrating multiple histologic variants including basal carcinoma, adenoid cystic-like areas, basaloid squamous cell carcinoma and areas of high-grade transformation to sarcomatoid carcinoma.
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Affiliation(s)
- Paulina J Haight
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, M210 Starling Loving Hall, 320 W 10 Avenue, Columbus, OH 43210, United States
| | - Antonio V Castaneda
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, M210 Starling Loving Hall, 320 W 10 Avenue, Columbus, OH 43210, United States
| | - Johanna M Savage
- Division of Pathology, The Ohio State University Wexner Medical Center, S305E Rhodes Hall, 410 W 10 Avenue, Columbus, OH 43210, United States
| | - Larry J Copeland
- Division of Gynecologic Oncology, The Ohio State University Wexner Medical Center, M210 Starling Loving Hall, 320 W 10 Avenue, Columbus, OH 43210, United States
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Haight PJ, Ma'ayeh M, Landon MB, Rood KM. 222: Does a week matter? Timing of repeat cesarean delivery for women with prior classical incision. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.238] [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: 11/17/2022]
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Haight PJ, Stewart RE, Saarel EV, Pettersson GB, Najm HK, Aziz PF. Lateral thoracotomy for epicardial pacemaker placement in patients with congenital heart disease. Interact Cardiovasc Thorac Surg 2019; 26:845-851. [PMID: 29300890 DOI: 10.1093/icvts/ivx379] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 10/14/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Our institution adopted a lateral thoracotomy approach to epicaridal pacemaker implantation with the objective of avoiding epicardial scar tissue and to achieve adequate lead pacing and sensing. We sought to assess the short-term outcomes of this approach. METHODS A single-centre review was conducted in paediatric patients and adults with congenital heart disease or inherited arrhythmia syndromes who underwent a lateral thoracotomy for epicardial pacemaker placement from August 2010 to January 2016. Patient histories were recorded along with outcomes including complications, lead and generator performance. RESULTS Twenty-one operations were performed in 20 patients (median age 17 years, range 3 months-49 years), including 19 pacemakers and 2 implantable-cardioverter defibrillators (ICDs). Prior epicardial pacemakers had been placed in 11 (55%) patients, including 3 with multiple pacemakers. Most patients had undergone at least 1 prior cardiac operation, with a mean of 3.2 (range 0-7) prior cardiac operations. Through our lateral thoracotomy approach, 17 of the 19 attempted atrial leads (89%) and 20 of the 20 attempted ventricular leads (100%) were successfully implanted with acceptable pacing thresholds. Complications included 1 (5%) bleeding, 2 (10%) pacemaker pocket revisions and 1 late death at 6 months unrelated to the pacemaker. There were no lead failures at a mean follow-up period of 27.5 months (range of 0.7-56.1 months). CONCLUSIONS The lateral thoracotomy is a useful approach for epicardial pacemaker implantation in patients with congenital heart disease or inherited arrhythmia syndromes including those with multiple prior operations.
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Affiliation(s)
| | - Robert E Stewart
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Elizabeth V Saarel
- Department of Pediatric Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Hani K Najm
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Peter F Aziz
- Department of Pediatric Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
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