The Impact of Tumor Grade on Survival End Points and Patterns of Recurrence of 949 Patients With Early-Stage Endometrioid Carcinoma: A Single Institution Study

2014 ◽  
Vol 24 (1) ◽  
pp. 97-101 ◽  
Author(s):  
Omar H. Gayar ◽  
Suketu Patel ◽  
Daniel Schultz ◽  
Meredith Mahan ◽  
Nabila Rasool ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Early Stage ◽  
Tumor Grade ◽  
International Federation ◽  
Endometrioid Carcinoma ◽  
End Points ◽  
Gynecology And Obstetrics ◽  
Grade 3 ◽  
The Impact ◽  
Patterns Of Recurrence

ObjectivesThis study aimed to determine the impact of tumor grade on patterns of recurrence and survival end points in patients with endometrioid carcinoma 2009 International Federation of Gynecology and Obstetrics stages I-II.MethodsWe identified 949 patients who underwent hysterectomy between 1988 and 2011. Patients were divided into 3 groups based on tumor grade. Kaplan-Meier plots were generated for each group for recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS).ResultsMedian follow-up was 52 months. Median age was 60 years. All patients underwent total abdominal hysterectomy and salpingo-oophorectomy. Eighty percent of patients underwent lymph node dissection, 83% had peritoneal cytology. There were 76 (8%) patients who developed tumor recurrence. Tumor recurrence rates were significantly higher in patients with grade 3 tumors compared to grade 1 (P = 0.006). Additionally, patients with grade 3 tumors developed significantly more frequent distant metastases compared to patients with grade 1 (P = 0.002). Five-year RFS for the patients with grade 1, 2, and 3 were 95%, 82%, and 68%, respectively (P = <0.001). Five-year DSS was 99%, 93%, and 79%, respectively (P = <0.001). Five-year OS was 89%, 84%, and 63%, respectively (P = <0.001). Lymphovascular space involvement and grade were significant independent predictors of RFS and DSS. For OS age, lymphovascular space involvement, grade, and body mass index were significant predictors.ConclusionsInternational Federation of Gynecology and Obstetrics grade is a strong predictor of clinical survival end points in women with early-stage endometrioid carcinoma. The pattern of recurrence in patients with grade 3 tumors is mainly distant rather than locoregional. Further studies incorporating systemic therapy in the adjuvant settings in these patients are warranted.

Revised 2018 International Federation of Gynecology and Obstetrics (FIGO) cervical cancer staging: A review of gaps and questions that remain

2020 ◽  
Vol 30 (6) ◽  
pp. 873-878 ◽  
Author(s):  
Gloria Salvo ◽  
Diego Odetto ◽  
Rene Pareja ◽  
Michael Frumovitz ◽  
Pedro T Ramirez
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Staging System ◽  
Cancer Staging ◽  
International Federation ◽  
Imaging Modalities ◽  
Early Stage Disease ◽  
Figo Staging ◽  
Gynecology And Obstetrics ◽  
Parametrial Involvement

Recently the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer was published. In this most recent classification, imaging modalities and pathologic information have been added as tools to determine the final stage of the disease. Although there are many merits to this new staging for cervical cancer, including more detailed categorization of early-stage disease as well as information on nodal distribution, the classification falls short in clarifying areas of controversy in the staging system. Many unanswered questions remain and, as such, a number of gaps lead to further debate in the interpretation of relevant clinical data. Factors such as measurement of tumor size, definition of parametrial involvement, ovarian metastases, lower uterine segment extension, lymph node metastasis, and imaging modalities are explored in this review. The goal is to focus on items that deserve further discussion and clarification in the most recent FIGO staging for cervical cancer.

The impact of racial disparity on outcomes of patients with early-stage uterine endometrioid carcinoma in an equal-access environment.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5088-5088
Author(s):  
Jared R. Robbins ◽  
Benjamin S. Laser ◽  
Neal Bhat ◽  
Chad Cogan ◽  
Adnan Munkarah ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
African American ◽  
Racial Disparity ◽  
Molecular Mechanisms ◽  
Early Stage ◽  
Uterine Cancer ◽  
Peritoneal Cytology ◽  
Endometrioid Carcinoma ◽  
The Impact ◽  
Disease Specific

5088 Background: To determine if racial disparity exists between African American (AA) and non-African American (NAA) patients with early stage uterine endometrioid carcinoma who had similar multidisciplinary management. Methods: Our prospectively-maintained database of 1,450 uterine cancer patients was reviewed for this IRB-approved study. We identified 766 consecutive patients with endometrioid carcinoma 1988 FIGO stages I-II who underwent hysterectomy between 1987-2009. Patients with non-endometrioid carcinoma, mixed histologies and those who received preoperative treatments were excluded. For the purpose of data analysis, patients were divided into two groups; AA and NAA. Recurrence-free survival (RFS), disease specific (DSS) and overall survival (OS) was calculated from the date of hysterectomy using the Kaplan-Meier method. Cox regression modeling was used to explore the risks of various factors on recurrence. Results: Median follow-up was 5.1 years. 27% were AA and 73% were NAA. All patients underwent hysterectomy and oophorectomy. 80% had peritoneal cytology and 69% underwent lymphadenectomy. AA patients were more likely to have higher grade tumors, and more lymphovascular space involvement (LVSI). Although the two groups were balanced in regards to surgical staging and adjuvant treatment received, the five-year RFS and DSS were significantly lower in AA compared to NAA patients (91% vs 84%, p=0.030; 95% vs 88%, p=0.011, respectively). Between the two groups, OS was not significantly different. On multivariate analysis and after adjusting for other prognostic factors, race (AA vs NAA) was not a significant predictor of outcome. Grade 3 tumors and the presence of LVSI were the only two independent predictors of RFS and DSS with p=<0.001 and p=<0.001, respectively. Conclusions: In this large hospital-based study, AA race was associated with a higher incidence of adverse pathological features and worse recurrence-free and disease-specific survival. However, on multivariate analysis race was not an independent prognostic factor. Further studies are needed to elucidate possible underlying molecular mechanisms for these poorer outcomes.

Clinical and prognostic features of adult patients with gangliogliomas.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 2063-2063
Author(s):  
Shlomit Yust-Katz ◽  
Mark Daniel Anderson ◽  
Diane Liu ◽  
Ying Yuan ◽  
Greg Fuller ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Histological Grade ◽  
Univariate Analysis ◽  
Progression Free Survival ◽  
Tumor Grade ◽  
Histologic Grade ◽  
Low Grade ◽  
Prognostic Features ◽  
Grade 3 ◽  
The Impact

2063 Background: Gangliogliomas (GG) represent less than 1% of primary brain tumors in adults. Little is known regarding prognostic features, clinical characteristics or the impact of treatment on patient (pt) outcomes. Methods: In this IRB approved retrospective study, our neuro-oncology longitudinal database was screened for pts with GG from 1992-2012. 67 adult pts (age>18) were identified. Results: 60 pts presented with low grade GG and 7 with anaplastic GG. The median age at diagnosis was 27 years (18-59). 22 pts developed recurrent disease (18 low grade and 4 high grade) with a median time to recurrence of 87 weeks from surgery. 7 of the pts with low grade GG had malignant transformation to a malignant tumor (anaplastic GG or GBM). 22 pts received radiation therapy, 16 at diagnosis. 14 pts received chemotherapy at recurrence. Pts with incomplete resections or higher grade tumors were more likely to receive chemotherapy or radiation. The median overall survival (OS) time for these pts was not reached with a median follow-up time of 4.6 years. The 2-, 5- and 10-year OS were 98%, 87%, and 76%. Factors on univariate analysis that were significantly associated with OS were KPS at presentation (HR 10.1; 95% CI 2.6, 39.1; p = 0.0008), extent of resection (EOR) (biopsy vs gross total; HR 12.1; 95% CI 2.3, 63.6; p = 0.003), histologic grade (Grade 1-2 vs Grade 3-4; HR 0.06; 95% CI 0.01, 0.3; p = 0.0002), and seizure control following surgery (Engel I vs Engel 2-3; HR 0.1; 95% CI 0.01, 0.9; p = 0.02). Factors on univariate analysis that were significantly associated with progression free survival (PFS) were EOR (biopsy vs gross total; HR 4.0; 95% CI 1.4, 11.9; p = 0.01) and histologic grade (Grade 1-2 vs .Grade 3-4; HR 0.3; 95% CI 0.08, 0.8; p = 0.02). On multivariate analysis, EOR is most significant for PFS (p = 0.01), while tumor grade is most significant for OS (p = 0.004). Conclusions: While GG have an excellent prognosis, malignant histological grade, diagnosis with a biopsy only, poor initial KPS, and presence of seizures following surgery could indicate a worse prognosis. The role of chemotherapy and radiation therapy for incompletely resected or inaccessible low grade GG is unclear.

Clinical Significance of Preoperative Serum Sialic Acid Levels in Colorectal Cancer: Utility in the Detection of Patients at High Risk of Tumor Recurrence

2004 ◽  
Vol 19 (1) ◽  
pp. 38-45 ◽  
Author(s):  
C. Feijoo-Carnero ◽  
F.J. Rodríguez-Berrocal ◽  
M. Pez de la Cadena ◽  
D. Ayude ◽  
A. de Carlos ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Survival Analysis ◽  
Sialic Acid ◽  
High Risk ◽  
Tumor Recurrence ◽  
Early Stage ◽  
Thiobarbituric Acid ◽  
Preoperative Serum ◽  
Serum Sialic Acid ◽  
The Impact

This study was conducted to evaluate the significance of preoperative serum sialic acid levels in the diagnosis and prognosis of colorectal cancer (CRC). Total sialic acid (TSA) was determined by the thiobarbituric acid method and normalized to total protein (TP). A postoperative follow-up of CRC patients classified as Dukes’ stages A, B or C was performed and survival analysis was carried out to evaluate the impact of sialic acid levels on tumor recurrence. Our diagnostic studies indicate that TSA/TP is a better marker than either TSA or carcinoembryonic antigen (CEA), especially for the detection of CRC patients at an early stage. At a cutoff of 30.90 nmol/mg of protein, TSA/TP showed a sensitivity of 85% with a specificity of 97% to discriminate CRC patients from healthy donors. In survival analysis, both TSA and TSA/TP were found to be significant prognostic factors for tumor recurrence in CRC. Furthermore, TSA/TP could distinguish patients at high risk of recurrence within Dukes’ stage B and in multivariate analysis it was identified as the best independent prognostic factor. According to our results, preoperative serum TSA/TP content could supply additional information to that provided by Dukes’ stage about the prognosis of CRC patients.

The impact of lymphadenectomy on survival endpoints in women with early stage uterine endometrioid carcinoma: A matched analysis

2017 ◽  
Vol 210 ◽  
pp. 225-230 ◽  
Author(s):  
Ahmed I Ghanem ◽  
Nadia T. Khan ◽  
Meredith Mahan ◽  
Ahmed Ibrahim ◽  
Thomas Buekers ◽  
...  
Keyword(s):  
Early Stage ◽  
Endometrioid Carcinoma ◽  
Survival Endpoints ◽  
The Impact

Patterns of Recurrence in Stage I Endometrioid Endometrial Adenocarcinoma With Lymphovascular Space Invasion

2013 ◽  
Vol 23 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Fiona Simpkins ◽  
Andrea Papadia ◽  
Charles Kunos ◽  
Chad Michener ◽  
Heidi Frasure ◽  
...  
Keyword(s):  
Radiation Treatment ◽  
Early Stage ◽  
Endometrial Adenocarcinoma ◽  
Myometrial Invasion ◽  
Adjuvant Radiation ◽  
Recurrence Rates ◽  
Stage Ib ◽  
Gynecology And Obstetrics ◽  
Patterns Of Recurrence ◽  
Related Survival

ObjectiveThe objective of this study was to determine the patterns of recurrence of stage IB–IIA endometrioid endometrial adenocarcinoma (EMCA) with lymphovascular invasion (LVSI).MethodsA multicenter retrospective study of 1988 International Federation of Gynecology and Obstetrics stage IB–IIA EMCA patients with LVSI treated with surgery with or without radiation was conducted. Those with papillary serous or clear cell histologies and women treated with chemotherapy were excluded. Data regarding surgical-pathologic factors, treatment, and outcome were collected. Data were analyzed using χ2test, Kaplan-Meier estimates, and Cox multivariate proportional hazards models.ResultsFrom 1997 to 2008, we identified 131 patients with LVSI who met entry criteria among 5 institutions. Median age was 67 years (25%–75%: 60–75 years), and median follow-up was 4.25 years (25%–75%: 3–10 years). Following surgery, 45 patients were observed (Obs), and 86 patients received adjuvant radiation. We observed 30 total relapses 30/131 (23%): 11/45 (24%) in the Obs group and 19/86 (22%) in the adjuvant radiation group. Recurrence rates were similar between staged and unstaged patients: 24% (20/84) and 21% (10/47), respectively. Among Obs patients, 82% of relapses were local, whereas in patients treated with adjuvant radiation, 84% were distant. Relapses were significantly associated with invasion of the lower uterine segment (LUS) (P= 0.035). Both cancer-related survival and overall survival (OS) were not significantly impacted by adjuvant radiation, because of distant failure rates. Adjuvant radiation significantly improved pelvic control (P= 0.007). In a multivariate analysis, OS correlated with LUS invasion (P= 0.008) and was borderline-associated with stage (P= 0.06), whereas age (P= 0.12), grade (P= 0.31), myometrial invasion (P= 0.99), and radiation treatment (P= 0.23) were not.ConclusionsOverall recurrence rates for stage IB–IIA EMCA patients with LVSI are high (23%). Although adjuvant radiation therapy improved pelvic control, it did not impact recurrence rates, cancer-related survival, and OS, likely secondary to distant failures. The role of systemic therapy with or without radiotherapy for early-stage EMCA with LVSI should be evaluated, particularly in patients with high-grade tumors or involvement of the LUS.

scholarly journals Prognostic Factors of Early Stage Epithelial Ovarian Carcinoma

2019 ◽  
Vol 16 (4) ◽  
pp. 637 ◽  
Author(s):  
Shu-Feng Hsieh ◽  
Hei-Yu Lau ◽  
Hua-Hsi Wu ◽  
Heng-Cheng Hsu ◽  
Nae-Fang Twu ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Adjuvant Chemotherapy ◽  
Ovarian Carcinoma ◽  
Cox Regression ◽  
Clear Cell ◽  
Early Stage ◽  
Disease Free Survival ◽  
Tumor Grade ◽  
Epithelial Ovarian Carcinoma ◽  
Gynecology And Obstetrics

We aimed to determine prognostic factors of early stage (I/II) epithelial ovarian carcinoma (EOC) including clinicopathologic and chemotherapeutic regimens. Four hundred and thirty-seven women who underwent primary staging surgery with adjuvant chemotherapy between January 1, 2000 and December 31, 2010 were retrospectively reviewed and analyzed from two medical centers. The prognostic factors were determined from multivariate survival analyses using Cox regression models. The majority of women were diagnosed with stage Ic (244/437, 55.8%). The histopathologic types were clear cell (37.5%), endometrioid (27.2%), serous (14.0%), and mucinous (13.3%). Fifty-seven percent (249/437) of the women received taxane-based (platinum plus paclitaxel) regimens and 43.0% received non-taxane (platinum plus cyclophosphamide) regimens as frontline adjuvant chemotherapy. Clear cell tumors (adjusted Hazard ratio (aHR) 0.37, 95% confidence interval (CI) 0.21–0.73, p = 0.001) showed better 5-year disease-free survival (DFS) than serous tumors. Women diagnosed at FIGO (International Federation of Gynecology and Obstetrics) stage II (aHR 5.97, 95% CI = 2.47–14.39, p < 0.001), grade 3 tumor without clear cell (aHR 2.28, 95% CI = 1.02–5.07, p = 0.004) and who received 3–5 cycles of non-taxane regimens (aHR 3.29, 95% CI = 1.47–7.34, p = 0.004) had worse 5-year overall survival (OS). Clear cell histology treated with taxane-based regimens showed significantly higher 5-year DFS (91.2% vs. 82.0%, aHR = 0.45, 95% CI = 0.21–0.93, p = 0.043) and 5-year OS (93.5% vs. 79.0%, aHR = 0.30, 95% CI = 0.13–0.70, p = 0.005) than those treated with non-taxane-based regimens. We conclude that stage, tumor grade, and chemotherapeutic regimens/cycles are independent prognostic factors for early stage ovarian cancer.

Effect of adjuvant chemotherapy on survival in FNCLCC grade 3 soft tissue sarcomas: A multivariate analysis of the French Sarcoma Group database

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 10504-10504
Author(s):  
A. Italiano ◽  
F. Delva ◽  
V. Brouste ◽  
P. Terrier ◽  
M. Trassard ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Adjuvant Chemotherapy ◽  
Soft Tissue ◽  
Meta Analysis ◽  
Soft Tissue Sarcomas ◽  
Tumor Grade ◽  
Grade 3 ◽  
The Impact

10504 Background: The SMAC meta-analysis failed to demonstrate that adjuvant chemotherapy (AC) significantly improves overall survival (OS) in adult patients with localised resectable soft-tissue sarcoma (STS). We report here the analysis of the impact of AC in the population of STS patients included in the prospective database of the French Sarcoma Group. Methods: Between 1980 and 1999, 2,029 pts with STS were admitted to one of the 20 tertiary cancer centers of the GSF for the management of a first tumoral event and were included prospectively in a comprehensive database. 152 pts were excluded from the study because of metastatic disease at diagnosis. All the cases were reviewed by the pathology subcommittee of the GSF. Tumor grade was assessed according to the FNCLCC system based on tumor differentiation, mitotic count, and necrosis. Results: 283 pts (14.5%) had grade 1, 736 (39.5%) grade 2 and 858 (46%) grade 3 tumors. 1,102 pts (59%) had extremity tumors. The commonest pathological subtypes were MFH 22.5%, liposarcoma 18%, leiomyosarcoma 13%, and synovial sarcoma 10%. 1,122 pts (60%) received adjuvant radiotherapy. AC was delivered in 16 grade 1 pts (6%), 167 grade 2 pts (23%) and 323 grade 3 pts (38%). The majority of patients who received AC had tumors with a deep topography (91%) and/or > 5 cm (75%) and/or located in the limbs (61%). The median follow-up was 9 years. The 5 year-OS was 90% for grade 1 pts, 63% for grade 2 pts and 46% for grade 3 pts. On multivariate analysis ( table 1 ), AC was strongly associated with improved metastasis-free survival (MFS) (5 year MFS: 53% vs 47%, HR 0.7 [0.5–0.9], p=0.003) and overall survival (OS) (5 year OS: 56% vs 44%, HR 0.7 [0.5–0.8], p=0.004) in grade 3 pts. This association was not observed in grade 2 pts (5 year MFS: 73% vs 72%, HR 0.9 [0.6–1.4], p=0.9; 5 year OS: 73% vs 65%, HR 0.7 [0.5–1.1]). Conclusions: This large cohort-based analysis with long-term follow-up indicates that FNCLCC grade 3 pts are likely to benefit from AC. [Table: see text] [Table: see text]

Relatively Poor Survival of Mucinous Ovarian Carcinoma in Advanced Stage: A Systematic Review and Meta-analysis

2017 ◽  
Vol 27 (4) ◽  
pp. 651-658 ◽  
Author(s):  
Michiel Simons ◽  
Leon Massuger ◽  
Jolien Bruls ◽  
Johan Bulten ◽  
Steven Teerenstra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ovarian Carcinoma ◽  
Early Stage ◽  
Meta Analysis ◽  
International Federation ◽  
Advanced Stage ◽  
Gynecology And Obstetrics ◽  
Meta Analyses ◽  
Mucinous Ovarian Carcinoma ◽  
Worse Prognosis

ObjectiveOverall, patients with mucinous ovarian carcinoma (MOC) are considered to have a better prognosis compared with the whole group of nonmucinous carcinomas. However, some studies indicate that patients with advanced-stage MOC might have a worse prognosis than those with advanced-stage serous ovarian carcinoma (SOC). We carried out a systematic review and meta-analysis of the current literature.Materials and MethodsA comprehensive literature search was carried out identifying 19 articles that compare survival of patients with MOC and patients with SOC. Meta-analyses were performed for risk ratio (RR) and hazard ratio (HR) for all International Federation of Gynecology and Obstetrics stages together, as well as for early- and advanced-stage diseases separately.ResultsOverall, patients with MOC showed a lower risk of dying within 5 years (RR, 0.67; 95% confidence interval [CI], 0.64–0.69; n = 45 333) and a longer survival (HR, 0.66; 95% CI, 0.58–0.75; HR, 0.88; 95% CI, 0.78–0.98, for univariate and multivariate analyses, respectively; n = 5540) compared with those with SOC. In contrast, in advanced-stage (International Federation of Gynecology and Obstetrics stages III and IV) disease, patients with MOC have a higher risk of dying within 5 years (RR, 1.15; 95% CI, 1.13–1.17; n = 36 113) and a shorter survival (HR, 1.82; 95% CI, 1.71–1.94; n = 19 907).ConclusionsPatients with advanced-stage MOC have a significantly worse prognosis compared with patients with SOC, whereas in early stage, the prognosis of patients with MOC is better.

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