Uterine serous carcinoma: role of surgery, risk factors and oncologic outcomes. Experience of a tertiary center

ObjectivesUterine serous carcinoma (USC) represents a rare and aggressive histologic subtype of endometrial cancer, associated with a poor prognosis. This article critically reviews the literature pertinent to the epidemiology, pathology, molecular biology, diagnosis, management, and perspectives of patients with USC.MethodsAs one of a series of The Gynecologic Cancer InterGroup (GCIG) Rare Tumor Working Group in London, November 2013, we discussed about USC many times with various experts among international GCIG groups.ResultsBoth USC and approximately 25% of high-grade endometrioid tumors represent extensive copy number alterations, few DNA methylation changes, low estrogen and progesterone levels, and frequent P53mutations. Uterine serous carcinoma shares molecular characteristics with ovarian serous and basal-like breast carcinomas. In addition to optimal surgery, platinum- and taxane-based chemotherapy should be considered in the treatment of both early- and advanced-stage disease. The combination of radiation and chemotherapy appears to be associated with the highest survival rates. The role of radiation therapy in the management of this disease, with a high propensity for distant failures, remains elusive.ConclusionsUterine serous carcinoma is a unique and biologically aggressive subtype of endometrial cancer and should be studied as a distinct entity. Futures studies should identify the optimized chemotherapy and radiation regimens, sequence of therapy and schedule, and the role of targeted biologic therapy.

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Uterine Serous Carcinoma; Molecular Pathways and Role of Micrornas in Early Detection and Target Therapy

Journal of Gynecology and Womens Health ◽

10.19080/jgwh.2017.07.555710 ◽

2017 ◽

Vol 7 (2) ◽

Author(s):

Shiva Rezaei

Keyword(s):

Early Detection ◽

Target Therapy ◽

Serous Carcinoma ◽

Molecular Pathways ◽

Uterine Serous Carcinoma

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The prognostic utility of LDH and CRP for survival after melanoma metastasectomy in the urogenital tract.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e19021 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e19021-e19021

Author(s):

Georgios Gakis ◽

Mohamed F Abdelhafez ◽

Tilman Todenhoefer ◽

Markus Renninger ◽

Christian Schwentner ◽

...

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Metastatic Melanoma ◽

Elevated Serum ◽

Urogenital Tract ◽

Serum Lactate Dehydrogenase ◽

Cox Regression Analysis ◽

Tertiary Center ◽

Risk Factors For Survival

e19021 Background: Recent studies suggest that serum lactate dehydrogenase (LDH) and serum C-reactive protein (CRP) are risk factors for survival in patients with metastatic melanoma. However, due to the relatively low tropism of metastatic melanoma lesions in the urogenital tract the clinical benefit of metastasectomy in this highly selective group of patients remains uncertain. The objective of this study was to address the role of LDH and CRP as preoperative serological risk factors for survival in patients with solitary or concomitant metastatic melanoma lesions in the urogenital tract. Methods: All patients who were referred for metastasectomy in the urogenital tract in a tertiary center within 1999-2008 were considered for this analysis. Demographic, disease and survival data were collected. Elevated LDH activity was defined as >250U/l and elevated serum CRP>0.5mg/dl. The primary endpoint was overall survival (OS), calculated using Kaplan-Meier method with log-rank test and multivariate Cox-regression analysis. Results: Of a total of 21 patients,16 (76%) had solitary urogenital metastases and 5 patients (24%) concomittant non-urogenital metastases.Median OS after metastasectomy was 23 months (range: 3-59 months). LDH>250U/l was significantly associated with decreased OS (27.6 vs. 6.0 months; p=0.001), but elevated CRP did not (24.1 vs. 20.7 months; p=0.93). No further significant differences in survival were found for age (p=0.76), gender (p=0.83), number of urogenital metastatic sites (0.97) and preoperative solitary vs. concomitant distant metastases (p=0.48). In multivariate analysis, adjusted for the TNM-stage grouping (M1a-c) and CRP level, elevated LDH maintained significance as negative prognostic factor for overall survival (p=0.0015). Conclusions: To our knowledge, this is the first study addressing the prognostic role of LDH and CRP in patients with melanoma urogenital metastases. If confirmed in large prospective studies, LDH level may be used for preoperative risk stratification in patients scheduled for melanoma metastasectomy in the urogenital tract to identify those patients who profit most from the surgical approach.

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The role of omentectomy during the surgical staging of uterine serous carcinoma

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200303000-00019 ◽

2003 ◽

Vol 13 (2) ◽

pp. 212-215 ◽

Cited By ~ 4

Author(s):

P. A. Gehrig ◽

L. Van Le ◽

W. C. Fowler

Keyword(s):

Ovarian Cancer ◽

Surgical Procedures ◽

Surgical Staging ◽

Serous Carcinoma ◽

Exact Test ◽

Uterine Serous Carcinoma ◽

Stage Ivb ◽

Sensitivity Specificity ◽

Omental Metastasis

Uterine serous carcinoma (USC) has a propensity for extrauterine spread, and some suggest that this disease be staged as an ovarian cancer, and thus include omental sampling. However, given the primary organ involved, the staging recommendations do not include omental sampling. The aim of this study is to evaluate the role of omental sampling during the surgical staging of USC. We retrospectively identified cases of USC at our institution from January 1990 to June 2000 and abstracted surgical procedures, stage, and sites of metastasis. Fisher's exact test was used to calculate sensitivity, specificity, and positive and negative predictive value. We identified 65 women with USC, of which 52 underwent omental evaluation. Thirty four of the omentums were visually normal and benign on histologic review. Two were visually negative and histologically positive for metastatic serous carcinoma. The remaining 16 specimens were grossly involved with histologic confirmation of disease. The sensitivity of a visually negative omentum is 0.89 (P < 0.0001). Microscopic omental metastasis from USC is rare. When the omentum is involved, thereby upstaging the patient to stage IVB disease, the disease is generally diagnosed by gross visualization. We conclude that omental sampling does not need to be included in the routine surgical staging of USC.

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