scholarly journals Long-term survival of a patient with stage IIIC2 grade 3 endometrioid endometrial carcinoma treated with surgery alone

2021 ◽  
pp. 100869
Author(s):  
Isao Otsuka ◽  
Mizuho Kadooka ◽  
Takuto Matsuura
2010 ◽  
Vol 20 (6) ◽  
pp. 1000-1005 ◽  
Author(s):  
Masamichi Hiura ◽  
Takayoshi Nogawa ◽  
Takashi Matsumoto ◽  
Takashi Yokoyama ◽  
Yuko Shiroyama ◽  
...  

Objective:The purposes of this study were to assess modified radical hysterectomy including systematic pelvic and para-aortic lymphadenectomy followed by adjuvant chemotherapy in patients with para-aortic lymph node (PAN) metastasis in endometrial carcinoma and to identify the multivariate independent prognostic factors for long-term survival during the past 10 years.Methods:Between December 1987 and December 2002, we performed modified radical hysterectomy with bilateral salpingo-oophorectomy including systematic pelvic and para-aortic lymphadenectomy and peritoneal cytology in 284 endometrial carcinoma patients according to the classification of the International Federation of Gynecology and Obstetrics (stage IA, n = 66; stage IB, n = 96; stage IC, n = 33; stage IIA, n = 5; stage IIB, n = 20; stage IIIA, n = 28; stage IIIC, n = 28; and stage IV, n = 8) who gave informed consents at our institute. Patients with tumor confined to the uterus (stages IC and II) were treated by 3 courses of cyclophosphamide 750 mg/m2, epirubicin 50 mg/m2, and cisplatin 75 mg/m2 regimen 3 to 4 weeks apart, and patients with extrauterine lesions involving adnexa and/or pelvic lymph node (PLN) were treated by 5 courses. In addition, 10 courses were given to patients with PAN metastasis. Patients with PLN metastasis received adjuvant chemotherapy, and adjuvant radiation was not part of our institutional protocol. For multivariate regression modeling with proportional hazards, the regression model of Cox was used. Survival curves were analyzed by the Kaplan-Meier method, and analysis of the differences was performed by the log-rank test.Results:The overall incidence of retroperitoneal lymph node metastasis assessed by systematic pelvic and para-aortic lymphadenectomy was 12.0% (34/284) in stages I to IV endometrial carcinoma, and incidences of PLN and PAN metastases were 9.2% (26/284) and 7.4% (21/284), respectively. However, PAN metastasis rate is 50% (13/26) in patients with PLN metastasis. Univariate analysis of prognostic factors revealed that International Federation of Gynecology and Obstetrics clinical stage (P < 0.0001), histological finding (P = 0.0292), myometrial invasion (P < 0.0001), adnexal metastasis (P < 0.0001), lymphovascular space invasion (P < 0.0001), tumor diameter (P = 0.0108), peritoneal cytology (P = 0.0001), and retroperitoneal lymph node metastasis (P < 0.0001) were significantly associated with 10-year overall survival. Survival was not associated with age (P = 0.1558) or cervical involvement (P = 0.1828). A multivariate analysis showed that adnexal metastasis (P = 0.0418) and lymphovascular space invasion (P = 0.0214) were significantly associated with 10-year overall survival. The 5- and 10-year overall survival rates in patients with negative PAN were 96% and 93% versus 72% and 62% in patients with positive PAN (P = 0.006).Conclusions:It is suggested that surgery with systematic pelvic and para-aortic lymphadenectomy followed by adjuvant chemotherapy could improve long-term survival in patients with PAN metastasis, although there are only 21 patients with PAN metastasis.


2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16011-16011 ◽  
Author(s):  
M. Hiura ◽  
T. Nogawa ◽  
T. Matsumoto ◽  
T. Yokoyama ◽  
Y. Shiroyama ◽  
...  

16011 Background: The purpose of this study was to assess modified radical hysterectomy including systematic pelvic and para- aortic lymphadenectomy followed by adjuvant chemotherapy in patients with para-aortic lymph node metastasis in endometrial carcinoma and to identify the multivariate independent prognostic factors for a long-term survival over the past 10 years. Methods: Between December 1987 and December 2002, we performed modified radical hysterectomy with bilateral salpingo-oophorectomy including systematic pelvic and para-aortic lymphadenectomy, and peritoneal cytology in 284 endometrial carcinoma patients who gave an informed consent at the Department of Gynecologic Oncology of Shikoku Cancer Center. The patients with a tumor confined to the uterus (stage Ic and II) were treated by 3 courses of CEP (cyclophosphamide 750 mg/m2, epirubicin 50 mg/m2, cisplatin 75 mg/m2) regimen 3–4weeks apart, extrauterine lesions involving adnexa and/or pelvic lymph node (PLN), and para-aortic lymph node (PAN) metastasis were treated by 5 and 10 courses, respectively. Multivariate analysis was performed for the prognostic factors and actuarial technique for the survival rate. Results: PLN and PAN metastasis were 9.2% (26/284) and 7.4% (21/284), respectively. The univariate analysis of prognostic factors revealed that FIGO clinical stage, histology, myometrial invasion, adnexal metastasis, lymphvascular space invasion, tumor diameter, peritoneal cytology and retroperitoneal lymph node (RLN) metastasis were significantly associated with 10-year overall survival. A multivariate analysis showed that adnexal metastasis (p=0.0418) and lymphvascular space invasion (p=0.0214) were significantly associated with 10-year overall survival. The 5- and 10-year survival in patients with negative and positive para-aortic lymph node were 96%, 72% and 93%, 62%, respectively (p=0.006). Conclusions: We conclude that surgery with systematic pelvic and para-aortic lymphadenectomy followed by adjuvant chemotherapy might improve a long-term survival in patients with PAN metastasis in endometrial carcinoma. No significant financial relationships to disclose.


2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R C. Hagens Eliza ◽  
A Reijntjes BSc Maud ◽  
M C J Anderegg ◽  
S Gisbertz Suzanne ◽  
Mark I van Berge Henegouwen

Abstract Aim To identify predictors for anastomotic leakage after esophagectomy and to determine the influence of anastomotic leakage on short-term and long-term survival. Background and methods Identifying predictors of anastomotic leakage after esophagectomy may contribute to its prevention. The influence of anastomotic leakage on long-term survival is unclear. A retrospective cohort study was conducted in consecutive patients who underwent an esophagectomy with reconstruction in the Amsterdam UMC, location AMC, between January 1993 and January 2019. Logistic regression and Cox regression models were used to assess predictors for anastomotic leakage and to assess survival. Results 1747 patients were included, of which 326 (18.7%) developed anastomotic leakage. Independent predictors of cervical anastomotic leakage were diabetes mellitus, cT4-stage and a gastroesophageal junction tumor. ASA grade 3-5, a non-radical resection, pT2-stage, pN+ and hand sewn anastomosis were independent predictors of intrathoracic anastomotic leakage (table 1). 30-day mortality was 2% in patients without, and 4% of patients with anastomotic leakage (p=0.076). Anastomotic leakage did not significantly influence long-term survival when corrected for confounders (HR 0.96 95%CI 0.81 – 1.14, p=0.618). Conclusion Independent risk factors for anastomotic leakage after esophagectomy are diabetes mellitus, cT4-stage and a gastroesophageal junction tumor for cervical anastomosis, and ASA grade 3-5, a non-radical resection, pT2-stage, pN+ and hand sewn anastomosis for intrathoracic anastomosis. 30-day mortality was higher in the anastomotic leakage group. We found no correlation between anastomotic leakage and long term survival.


2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 554-554 ◽  
Author(s):  
Michael J. Overman ◽  
Francesca Bergamo ◽  
Raymond S. McDermott ◽  
Massimo Aglietta ◽  
Franklin Chen ◽  
...  

554 Background: Nivolumab (NIVO) provided durable responses (ORR, 32% per central assessment) and disease control (DCR, 64%) in pre-treated pts with dMMR/MSI-H mCRC (NCT02060188; Overman MJ et al Lancet Oncol 2017). NIVO was approved in the US for pts with dMMR/MSI-H mCRC who progress after standard chemotherapy (SC) with a fluoropyrimidine (F), oxaliplatin (Ox), and irinotecan (Iri). Here we present long-term survival and outcomes by prior chemotherapy with NIVO in CheckMate-142. Methods: Pts with dMMR/MSI-H mCRC received NIVO 3 mg/kg Q2W. The primary endpoint was ORR per RECIST 1.1. Other endpoints were DCR, DOR, PFS, OS, and safety/tolerability. Results: Of 74 pts evaluated, 53 had received F, Ox and Iri (group A); 21 pts had ≤ 2 SC regimens (group B). Median follow-up was 21 mo. Efficacy by central assessment is shown in the Table. In the 74 pts, ORR was 34%; CRs increased from 3% in prior database lock (DBL) to 9%. Numerically higher responses were noted in group B vs group A (Table). Grade 3–4 TRAEs were reported in 20% (all pts), 25% (group A), and 10% (group B) of pts. No treatment-related deaths were reported. Conclusions: NIVO continued to provide clinically meaningful durable responses and long-term overall survival in pts with dMMR/MSI-H mCRC. Of note, CR rate increased with longer follow-up. No new safety signals were reported with long-term follow-up. Enhanced responses in pts with ≤ 2 SC regimens support ongoing evaluation of NIVO combinations in first-line setting. Clinical trial information: NCT02060188. [Table: see text]


2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 1-1 ◽  
Author(s):  
Laura Fransen ◽  
Gijs Berkelmans ◽  
Emanuele Asti ◽  
Mark Van Berge Henegouwen ◽  
Felix Berlth ◽  
...  

Abstract Background Esophagectomy has a high incidence of postoperative morbidity. Complications lead to a decreased short-term survival, however the influence of those complications on long-term survival is still unclear. Most of the performed studies are small, single center cohort series with inconclusive or conflicting results. Minimally invasive esophagectomy (MIE) has been shown to be associated with a reduced postoperative morbidity. In this study, the influence of complications on long-term survival for patients with esophageal cancer undergoing a MIE were investigated. Methods Data was collected from the EsoBenchmark database, a collaboration of 13 high-volume centers routinely performing MIE. Patients were included in this database from June 1, 2011 until May 31, 2016. Complications were scored according to the Clavien-Dindo (CD) classification for surgical complications. Major complications were defined as a CD grade ≥ 3. The data were corrected for 90-day mortality to correct for the short-term effect of postoperative complications on mortality. Overall survival was analyzed using the Kaplan Meier, log rank- and (uni- and multivariable) Cox-regression analyses. Results A total of 926 patients were eligible for analysis. Mean follow-up time was 30.8 months (SD 17.9). Complications occurred in 543 patients (59.2%) of which 39.3% had a major complication. Anastomotic leakage (AL) occurred in 135 patients (14.5%) of which 9.2% needed an intervention (CD grade ≥ 3). A significant worse long-term survival was observed in patients with any AL (HR 1.73, 95% CI 1.29–2.32, P < 0.001) and for patients with AL CD grade ≥3 (HR 1.86, 95% CI 1.32–2.63, P < 0.001). Major cardiac complications occurred in 18 patients (1.9%) and were related to a decreased long-term survival (HR 2.72, 95% CI 1.38–5.35, p 0.004). For all other complications, no significant influence on long-term survival was found. Conclusion The occurrence and severity of anastomotic leakage and cardiac complications after MIE negatively affect long-term survival of esophageal cancer patients. Disclosure All authors have declared no conflicts of interest.


2000 ◽  
Vol 111 (1) ◽  
pp. 363-370 ◽  
Author(s):  
Katsuto Takenaka ◽  
Mine Harada ◽  
Tomoaki Fujisaki ◽  
Koji Nagafuji ◽  
Shinichi Mizuno ◽  
...  

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