scholarly journals Residual Disease after Operative Hysteroscopy in Patients with Endometrioid Endometrial Cancer Associated with Polyps

2021 ◽  
Vol 43 (01) ◽  
pp. 035-040
Author(s):  
Marcelo Simonsen ◽  
Henrique Mantoan ◽  
Carlos Chaves Faloppa ◽  
Lillian Yuri Kumagai ◽  
Levon Badiglian Filho ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Surgical Approach ◽  
Medical Records ◽  
Residual Disease ◽  
Myometrial Invasion ◽  
Histologic Grade ◽  
Operative Hysteroscopy ◽  
Pathologic Stage ◽  
Pathological Specimen ◽  
Endometrioid Endometrial Cancer

Abstract Objective To evaluate the presence of residual disease in the uterine specimen after hysteroscopic polypectomy or polyp biopsy in patients with endometrioid endometrial cancer (EC). Methods We analyzed a series of 104 patients (92 cases from the Hospital AC Camargo and 12 from the Hospital do Servidor Público Estadual de São Paulo) with polyps that were diagnosed by hysteroscopy, showing endometrioid EC associated with the polyp or in the final pathological specimen. Patients underwent a surgical approach for endometrial cancer from January 2002 to January 2017. Their clinical and pathological data were retrospectively retrieved from the medical records. Results In 78 cases (75%), the polyp had EC, and in 40 (38.5%), it was restricted to the polyp, without endometrial involvement. The pathologic stage was IA in 96 cases (92.3%) and 90 (86.5%) had histologic grade 1 or 2. In 18 cases (17.3%), there was no residual disease in the final uterine specimen, but only in 9 of them the hysteroscopy suggested that the tumor was restricted to the polyp. In 5 cases (4.8%) from the group without disease outside of the polyp during hysteroscopy, myometrial invasion was noted in the final uterine specimen. This finding suggests the possibility of disease extrapolation through the base of the polyp. Conclusion Patients with endometrioid EC associated with polyps may have the tumor completely removed during hysteroscopy, but the variables shown in the present study could not safely predict which patient would have no residual disease.

Lymph Node Metastasis in Patients With Endometrioid Endometrial Cancer: Overtreatment Is the Main Issue

2017 ◽  
Vol 27 (4) ◽  
pp. 748-753 ◽  
Author(s):  
Alper Karalok ◽  
Taner Turan ◽  
Derman Basaran ◽  
Osman Turkmen ◽  
Gunsu Comert Kimyon ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Histological Grade ◽  
Myometrial Invasion ◽  
Lymph Node Involvement ◽  
Node Metastasis ◽  
Deep Myometrial Invasion ◽  
Endometrioid Endometrial Cancer ◽  
Grade 3

ObjectiveThe aim of this study was to evaluate the effectiveness of histological grade, depth of myometrial invasion, and tumor size to identify lymph node metastasis (LNM) in patients with endometrioid endometrial cancer (EC).MethodsA retrospective computerized database search was performed to identify patients who underwent comprehensive surgical staging for EC between January 1993 and December 2015. The inclusion criterion was endometrioid type EC limited to the uterine corpus. The associations between LNM and surgicopathological factors were evaluated by univariate and multivariate analyses.ResultsIn total, 368 patients were included. Fifty-five patients (14.9%) had LNM. Median tumor sizes were 4.5 cm (range, 0.7–13 cm) and 3.5 cm (range, 0.4–33.5 cm) in patients with and without LNM, respectively (P = 0.005). No LMN was detected in patients without myometrial invasion, whereas nodal spread was observed in 7.7% of patients with superficial myometrial invasion and in 22.6% of patients with deep myometrial invasion (P < 0.0001). Lymph node metastasis tended to be more frequent in patients with grade 3 disease compared with those with grade 1 or 2 disease (P = 0.131).ConclusionsThe risk of lymph node involvement was 30%, even in patients with the highest-risk uterine factors, that is, those who had tumors of greater than 2 cm, deep myometrial invasion, and grade 3 disease, indicating that 70% of these patients underwent unnecessary lymphatic dissection. A precise balance must be achieved between the desire to prevent unnecessary lymphadenectomy and the ability to diagnose LNM.

scholarly journals Fertility Sparing Treatment of Endometrial Cancer with and without Initial Infiltration of Myometrium: A Single Center Experience

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3571
Author(s):  
Paolo Casadio ◽  
Mariangela La Rosa ◽  
Andrea Alletto ◽  
Giulia Magnarelli ◽  
Alessandro Arena ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Conservative Treatment ◽  
Young Women ◽  
Operative Hysteroscopy ◽  
Single Center Experience ◽  
Fertility Sparing ◽  
Feasible Alternative ◽  
Endometrioid Endometrial Cancer ◽  
First Time

Endometrial cancer (EC) is the fourth largest female cancer in Europe and North America. In 5% of cases, the diagnosis is made in women who wish to become pregnant. In our retrospective study, we reported our experience about fertility sparing treatment of G1 endometrioid endometrial cancer (G1 EEC) or atypical endometrial hyperplasia/endometrial intraepithelial neoplasm (AEH/EIN) in young women desiring pregnancy treated in our Center. Conservative treatment was based on operative hysteroscopy and hormone therapy with megestrol acetate (160 mg/die for 9 months). For the first time we included women with G1 EEC with minimal myometrial infiltration. The minimum follow-up period was two years and consisted of serial outpatient hysteroscopies with endometrial biopsies. Among the 36 women with G1 EEC we observed one case of disease persistence and four recurrences and four recurrences among the 46 women diagnosed with AEH/EIN. To date, 35 live births were obtained in both groups. Our results advance the hypothesis that conservative treatment can represent a safe and feasible alternative to propose to young women with desire for pregnancy. Further randomized and multicentric studies are needed to arrive at unambiguous and standardized guidelines on the surgical and medical treatment of young women with EEC or AEH/EIN.

National trends, outcomes, and costs of radiation therapy in the management of low- and high-intermediate risk endometrial carcinoma.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 9-9
Author(s):  
Rudy Sam Suidan ◽  
Weiguo He ◽  
Charlotte C. Sun ◽  
Hui Zhao ◽  
Grace L. Smith ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Multivariate Analyses ◽  
External Beam Radiotherapy ◽  
Myometrial Invasion ◽  
Intermediate Risk ◽  
Increased Risk ◽  
Endometrioid Endometrial Cancer ◽  
National Trends ◽  
Medicare Database ◽  
Morbidity Risk

9 Background: Our objective was to assess treatment patterns, outcomes, and costs for women with low- (LIR) and high-intermediate risk endometrial cancer (HIR) who are treated with and without adjuvant radiotherapy (RT). Methods: All pts with endometrioid endometrial cancer who underwent surgery from 2000 – 2011 were identified from the SEER – Medicare database. LIR was defined as G1-2 tumors with <50% myometrial invasion or G3 with no invasion. HIR was defined as G1-2 tumors with ≥50% or G3 with <50% invasion. Pts were categorized according to whether they received adjuvant RT (vaginal brachytherapy [VBT], external beam radiotherapy [EBRT], or both) or no RT. All costs incurred up to 6 months postoperatively were analyzed. Outcomes were compared using the χ2test and a Cox PH regression model. Multivariate analyses were performed on both survival and costs. Results: 10,842 pts were included, of which 70% were LIR and 30% were HIR. 9% of pts with LIR had RT, compared to 46% of those with HIR. Among all pts who underwent RT, the use of VBT increased from 25% in 2000 to 71% in 2011, while EBRT use declined from 41% to 18%, and concurrent VBT/EBRT declined from 34% to 11% (p<0.001). In the LIR group, there was no difference in 10-year overall survival (OS) between pts who had RT and those who did not (67% vs. 65%, multivariate HR 0.95, 95% CI 0.81 – 1.11). In the HIR group, pts who underwent RT had a significant increase in 10-year OS (60% vs. 47%, multivariate HR 0.75, 95% CI 0.67 – 0.85). Similar outcomes were noted on subgroup analysis stratifying by RT modality. RT was associated with an increased risk of gastrointestinal (7% vs. 4%, p<0.001), genitourinary (2% vs. 1%, p<0.001), and hematologic (16% vs. 12%, p<0.001) 2-year complications. Compared to pts who only had surgery, RT was associated with increased mean adjusted costs ($22.5k vs. $14.4k, p<0.001). Costs for pts receiving VBT, EBRT, and concurrent VBT/EBRT were $20.6k, $23.3k, and $26.5, respectively (p<0.001). Conclusions: RT was associated with improved OS in women with HIR, but not in the LIR cohort. RT also had significantly increased costs and a higher morbidity risk. In the absence of other risk factors, consideration of observation without RT in LIR may be reasonable.

scholarly journals Is Tumor-Free Distance an Independent Prognostic Factor for Early-Stage Endometrioid Endometrial Cancer?

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Tufan Oge ◽  
Duygu Kavak Comert ◽  
Yusuf Cakmak ◽  
Deniz Arık
Keyword(s):  
Endometrial Cancer ◽  
Prognostic Factor ◽  
Myometrial Invasion ◽  
Independent Prognostic Factor ◽  
Depth Of Invasion ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Free Distance ◽  
Stage Ib ◽  
Endometrioid Endometrial Cancer

There are many studies assessing the importance of myometrial invasion using a cut-off limit as 50% of myometrial invasion for endometrial cancer, and there are a limited number of studies evaluating tumor-free distance to the serosa. To evaluate the prognostic performance of tumor-free distance and percentage of myometrial invasion in patients with stage IB endometrioid endometrial cancer, we retrospectively evaluated 133 patients diagnosed and treated as stage IB endometrioid endometrial cancer. Tumor-free distance was assessed, and recurrence and recurrence-free survival were analyzed. Nine patients had recurrent disease (6.8%). Recurrence-free survival was 200 months. Two patients died because of malignancy. In the Cox regression model according to tumor-free distance, depth of invasion, and percentage of myometrial invasion, it was seen that none of these parameters were significant to predict the recurrence (p>0.05). In conclusion, tumor-free distance is not an independent prognostic factor for patients with stage IB endometrioid endometrial cancer.

scholarly journals Squamous differentiation portends poor prognosis in low and intermediate-risk endometrioid endometrial cancer

2019 ◽  
Author(s):  
Diocésio Alves Pinto de Andrade ◽  
Vinicius Duval da Silva ◽  
Graziela de Macedo Matsushita ◽  
Marcos Alves de Lima ◽  
Marcelo de Andrade Vieira ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Myometrial Invasion ◽  
Intermediate Risk ◽  
Tumor Differentiation ◽  
Squamous Differentiation ◽  
Increased Risk ◽  
Endometrioid Endometrial Cancer

ABSTRACTBackgroundEndometrial cancer presents well-defined risk factors (myometrial invasion, histological subtype, tumor grade, lymphovascular space invasion (LVSI)). Some low and intermediate-risk endometrioid endometrial cancer patients exhibited unexpected outcomes. The aim of this study was to investigate other clinical-pathological factors that might influence the recurrence rates of patients diagnosed with low and intermediate-risk endometrioid endometrial cancer.MethodsA case-control study from a cohort retrospective of 196 patients diagnosed with low and intermediate-risk endometrioid endometrial cancer at a single institution between 2009 and 2014 was conducted. Medical records were reviewed to compare clinical (race, smoking, menopause age, body mass index) and pathological (histological characteristics (endometrioid vs endometrioid with squamous differentiation), tumor differentiation grade, tumor location, endocervical invasion, LVSI) features of patients with recurrence (case) and without recurrence (control) of disease. Three controls for each case were matched for age and staging.ResultsTwenty-one patients with recurrence were found (10.7%), of which 14 were stage IA, and 7 were stage IB. In accordance, 63 patients without recurrence were selected as controls. There were no significant differences in any clinical characteristics between cases and controls. Among pathological variables, presence of squamous differentiation (28.6% vs. 4.8%, p=0.007), tumor differentiation grade 2 or 3 (57.1% vs. 30.2%, p=0.037) and presence of endocervical invasion (28.6% vs. 12.7%, p=0.103) were associated with disease recurrence on univariate analysis. On multivariable analysis, only squamous differentiation was a significant risk factor for recurrence (p=0.031).ConclusionOur data suggest that squamous differentiation may be an adverse prognostic factor in patients with low and intermediate-risk endometrioid endometrial cancer, that showed a 5.6-fold increased risk for recurrence.

Adjuvant chemotherapy in early-stage endometrioid endometrial cancer with >50% myometrial invasion and negative lymph nodes

2021 ◽  
Vol 31 (4) ◽  
pp. 537-544
Author(s):  
Francesco Multinu ◽  
Simone Garzon ◽  
Amy L Weaver ◽  
Michaela E. McGree ◽  
Enrico Sartori ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Early Stage ◽  
Myometrial Invasion ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Endometrioid Endometrial Cancer ◽  
Negative Lymph Nodes

ObjectiveThe role of adjuvant chemotherapy as an addition or alternative to radiotherapy for early-stage high-risk endometrioid endometrial cancer is controversial. This study aimed to investigate the role of adjuvant chemotherapy in early-stage high-risk endometrioid endometrial cancer.MethodsWe identified patients with stage I or II endometrioid grade 2 or 3 endometrial cancer with myometrial invasion >50% and negative lymph nodes after pelvic with or without para-aortic lymphadenectomy at four institutions (USA and Italy). Associations between chemotherapy and cause-specific and recurrence-free survival were assessed with Cox proportional hazards models. Hematogenous, peritoneal, and lymphatic recurrences were defined as 'non-vaginal'.ResultsWe identified 329 patients of mean (SD) age 66.4 (9.8) years. The median follow-up among those alive was 84 (IQR 44–133) months. The 5-year cause-specific survival was 86.1% (95% CI 82.0% to 90.4%) and the 5-year recurrence-free survival was 82.2% (95% CI 77.9% to 86.8%). Stage II (vs stage IB) was associated with poorer cause-specific and recurrence-free survival. A total of 58 (90.6%) of 64 patients who had chemotherapy had 4–6 cycles of platinum-based regimen. In adjusted analysis, we did not observe a statistically significant improvement in cause-specific survival (HR 0.34; 95% CI 0.11 to 1.03; p=0.06) or non-vaginal recurrence-free survival (HR 0.36; 95% CI 0.12 to 1.08; p=0.07) with adjuvant chemotherapy. Sixteen of 18 lymphatic recurrences (88.9%; 3/5 pelvic, all 13 para-aortic) were observed in the 265 patients who did not receive adjuvant chemotherapy. Among stage II patients, no deaths (100% 5-year recurrence-free survival) were observed in the eight patients who received adjuvant chemotherapy compared with 66% 5-year recurrence-free survival in the 34 patients who did not.ConclusionAlthough we observed that adjuvant chemotherapy was associated with improved oncologic outcomes in early-stage high-risk endometrioid endometrial cancer, the associations did not meet conventional levels of statistical significance. Further research is warranted in this relatively uncommon subgroup of patients.

Lymphovascular Space Invasion and the Treatment of Stage I Endometrioid Endometrial Cancer

2015 ◽  
Vol 25 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Louis J.M. van der Putten ◽  
Yvette P. Geels ◽  
Nicole P.M. Ezendam ◽  
Hans W.H.M. van der Putten ◽  
Marc P.M.L. Snijders ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Myometrial Invasion ◽  
Distant Recurrence ◽  
Stage I ◽  
Recurrence Rates ◽  
Endometrioid Endometrial Cancer ◽  
Lymphovascular Space Invasion

ObjectivesTreatment of clinical early-stage endometrioid endometrial cancer (EEC) in The Netherlands consists of primary hysterectomy and bilateral salpingo-oophorectomy. Adjuvant radiotherapy is given when 2 or more the following risk factors are present: 60 years or older, grade 3 histology, and 50% or more myometrial invasion. Lymphovascular space invasion (LVSI) is a predictor of poor prognosis and early distant spread. It is unclear whether adjuvant radiotherapy is sufficient in patients with LVSI-positive EEC.Methods/MaterialsEighty-one patients treated from 1999 until 2011 for stage I LVSI-positive EEC in 11 Dutch hospitals were included. The outcomes of patients with 0 to 1 risk factors were compared with those with 2 to 3 risk factors, and both were compared with the known literature.ResultsEighteen patients presented with recurrent disease, and 12 of those recurrences had a distant component. Overall and distant recurrence rates were 19.2% and 11.5% in patients with 0 to 1 risk factors followed by observation and 25.5% and 17% in patients with 2 to 3 risk factors who received adjuvant radiotherapy. Only 1 patient with grade 1 disease had a recurrence.ConclusionsIn stage I LVSI-positive EEC with 0 to 1 risk factors, observation might not be adequate. Moreover, despite adjuvant radiotherapy, a high overall and distant recurrence rate was observed in patients with 2 to 3 risk factors. The use of systemic treatment in these patients, with the exception of patients with grade 1 disease, should be investigated.

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