Analysis of Patients With Stage IIIC Endometrial Cancer

ObjectiveWe aimed to define the factors that are related to recurrence and survival in patients with stage IIIC endometrial carcinoma in this study.Materials and MethodsA total of 147 patients who underwent staging surgery and had a diagnosis of stage IIIC1 to IIIC2 endometrial cancer according to the International Federation of Gynecology and Obstetrics 2009 were included. Patients whose data could not be obtained and patients with a diagnosis of uterine sarcoma and with synchronous tumors were excluded.ResultsMean age of the patients was 58.6 years. Among these patients, 63 had stage IIIC1 and 84 had stage IIIC2 disease. Extrauterine spread was detected in 22% of the patients. Median number of paraaortic (PA) and pelvic lymph nodes removed were 16.5 and 38, respectively. Paraaortic and pelvic nodal involvements were detected in 84 patients and 125 patients, respectively. Radiotherapy was applied more commonly as an adjuvant therapy. Three-year progression-free survival (PFS) and 3-year disease-specific survival (DSS) were 65% and 84%, respectively. Seventy percent of the recurrences were outside the pelvis. Site of metastatic lymph nodes and the number of metastatic PA lymph nodes were associated with 3-year PFS and lymphovascular space invasion; site of metastatic lymph nodes and the presence of recurrence were associated with 3-year DSS in the univariate analysis. Although any surgicopathological factor was not related to 3-year PFS, only the presence of recurrence was an independent prognostic factor for a 3-year DSS in the multivariate analysis (hazard ratio, 0.017; 95% confidence interval, 0.002–0.183).ConclusionsThe number of debulked metastatic lymph nodes and PA involvement were associated with recurrence in the univariate analysis. The presence of recurrence was the only independent prognostic factor detecting survival. Therefore, systematic lymphadenectomy involving PA lymph nodes instead of sampling should be performed in patients with high risk for nodal involvement in endometrial cancer.

Download Full-text

Number of Metastatic Lymph Nodes, but Not Lymph Node Ratio, Is an Independent Prognostic Factor after Resection of Pancreatic Carcinoma

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2010.03.037 ◽

2010 ◽

Vol 211 (2) ◽

pp. 196-204 ◽

Cited By ~ 95

Author(s):

Yoshiaki Murakami ◽

Kenichiro Uemura ◽

Takeshi Sudo ◽

Yasuo Hayashidani ◽

Yasushi Hashimoto ◽

...

Keyword(s):

Lymph Node ◽

Prognostic Factor ◽

Lymph Nodes ◽

Pancreatic Carcinoma ◽

Lymph Node Ratio ◽

Independent Prognostic Factor ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Node Ratio

Download Full-text

Stage IIIC endometrial cancer: the need for novel subgrouping according to the ratio of metastatic lymph nodes

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-014-3409-z ◽

2014 ◽

Vol 291 (2) ◽

pp. 391-398

Author(s):

Tayfun Toptas ◽

Tayup Simsek

Keyword(s):

Endometrial Cancer ◽

Lymph Nodes ◽

Stage Iiic ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph

Download Full-text

Clinical Outcomes of Uterine Carcinosarcoma: Results of 94 Patients

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000347 ◽

2015 ◽

Vol 25 (2) ◽

pp. 279-287 ◽

Cited By ~ 13

Author(s):

Zeynep Kestel Gokce ◽

Taner Turan ◽

Alper Karalok ◽

Tolga Tasci ◽

Isin Ureyen ◽

...

Keyword(s):

Prognostic Factor ◽

Adjuvant Therapy ◽

Lymph Nodes ◽

Independent Prognostic Factor ◽

Peritoneal Cytology ◽

Uterine Carcinosarcoma ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Staging Surgery ◽

Positive Peritoneal Cytology

ObjectiveWe aimed to determine the clinicopathologic features and identify prognostic factors of patients with uterine carcinosarcoma.Materials and MethodsA total of 94 patients with uterine carcinosarcoma who were diagnosed between January 1993 and October 2013 were included. Staging surgery consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, peritoneal cytology, and omentectomy. Staging is undertaken according to the 2009 International Federation of Gynecology and Obstetrics staging system. Kaplan-Meier survival analysis was used to determine the effects of variables on disease-free survival (DFS) and overall survival (OS).ResultsSeventy-nine patients underwent staging surgery and none of them had residual tumor after surgery. Three-year DFS and 3-year OS were 42.7% and 59.2%, respectively. In the univariate analysis, stage, presence of para-aortic metastatic lymph nodes, uterine serosal spread, positive peritoneal cytology, and extrapelvic metastases were associated with 3-year DFS and stage, presence of para-aortic metastatic lymph nodes, uterine serosal spread, positive peritoneal cytology, adnexal involvement, and extrapelvic metastases were associated with 3-year OS. Seventy-four patients received adjuvant therapy. Adjuvant therapy did not reduce recurrence or improve survival. Any of the chemotherapy regimens was not superior to the others. In the multivariate analysis, only age was an independent prognostic factor for 3-year DFS and no parameter was statistically significant for 3-year OS.ConclusionsAge was an independent prognostic factor for 3-year DFS. Older age was associated with poor survival. Extrauterine spread was associated with survival. The aims of surgery should be both staging and providing tumoral debulking. Prospective randomized trials are needed to better define the necessity and modality of the administered adjuvant therapy.

Download Full-text

A Retrospective Analysis of the Diameter of Metastatic Lymph Nodes in Apparently Early Stage Endometrial Cancer

Tumori Journal ◽

10.1177/030089160809400506 ◽

2008 ◽

Vol 94 (5) ◽

pp. 681-685 ◽

Cited By ~ 6

Author(s):

Nurettin Boran ◽

Derya Akdag ◽

Filiz Halici ◽

Gokhan Tulunay ◽

Taner Turan ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Nodes ◽

Retrospective Analysis ◽

Early Stage ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Early Stage Endometrial Cancer

Download Full-text

Increased number of metastatic lymph nodes in adenocarcinoma of the ampulla of Vater as a prognostic factor: A proposal of new nodal classification

Surgery ◽

10.1016/j.surg.2013.08.004 ◽

2014 ◽

Vol 155 (1) ◽

pp. 74-84 ◽

Cited By ~ 27

Author(s):

Hyo Jeong Kang ◽

Soo-Heang Eo ◽

Song Cheol Kim ◽

Kwang-Min Park ◽

Young-Joo Lee ◽

...

Keyword(s):

Prognostic Factor ◽

Lymph Nodes ◽

Ampulla Of Vater ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph

Download Full-text

UGT1A1 polymorphism has a prognostic effect in patients with stage IB or II uterine cervical cancer and one or no metastatic pelvic nodes receiving irinotecan chemotherapy

10.21203/rs.3.rs-27689/v3 ◽

2020 ◽

Author(s):

Hideki Matsuoka ◽

Ryusuke Murakami ◽

Kaoru Abiko ◽

Ken Yamaguchi ◽

Akihito Horie ◽

...

Keyword(s):

Cervical Cancer ◽

Side Effects ◽

Lymph Nodes ◽

Progression Free Survival ◽

Conditional Inference ◽

Free Survival ◽

Metastatic Lymph Nodes ◽

Ugt1a1 Polymorphism ◽

Metastatic Lymph ◽

Gynecology And Obstetrics

Abstract Background : Uridine diphosphate glucuronosyltransferase 1 family polypeptide A1 (UGT1A1 ) is a predictive biomarker for the side-effects of irinotecan; irinotecan chemotherapy reduces the volume of tumors harboring UGT1A1 polymorphisms. We aimed to determine whether UGT1A1 polymorphisms can predict progression-free survival in patients with local cervical cancer treated with irinotecan. Methods : We retrospectively analyzed the data of 51 patients with cervical cancer treated at a single institution between 2010 and 2015. All patients were diagnosed with the 2009 International Federation of Gynecology and Obstetrics (FIGO) stage IB1, IB2, IIA, or IIB squamous cell carcinoma, underwent radical hysterectomy, and received irinotecan chemotherapy as neoadjuvant and/or adjuvant treatment. All patients were examined for irinotecan side effects using UGT1A1 tests. Conditional inference tree and survival analyses were performed considering stage, age, UGT1A1 status, and the number of metastatic lymph nodes to determine primary factors associated with progression-free survival. Results : The tree-structured survival model determined high recurrence-risk factors related to progression-free survival. The most relevant factor was ≥2 metastatic lymph nodes (p = 0.004). The second most relevant was UGT1A1 genotype (p = 0.024). Among patients with ≤1 metastatic lymph node, those with UGT1A1 polymorphisms benefited from irinotecan chemotherapy and demonstrated significantly longer progression-free survival (p = 0.020) than those with wild-type UGT1A1 . Conclusion : Irinotecan chemotherapy has the potential to benefit patients with cervical cancer, UGT1A1 polymorphism, and ≤1 metastatic lymph nodes.

Download Full-text

The Number of Metastatic Lymph Nodes is a Useful Predictive Factor for Recurrence after Surgery for Nonmetastatic Nonfunctional Neuroendocrine Neoplasm of the Pancreas

Gastroenterology Research and Practice ◽

10.1155/2019/6856329 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

G. Capretti ◽

G. Nappo ◽

V. Smiroldo ◽

M. Cereda ◽

B. Branciforte ◽

...

Keyword(s):

Lymph Nodes ◽

Predictive Factors ◽

Pancreatic Surgery ◽

Univariate Analysis ◽

Mitotic Count ◽

Neuroendocrine Neoplasm ◽

Nodal Metastases ◽

Regional Lymph Nodes ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph

Nodal involvement (actually categorized as positive or negative) is an important prognostic factor after surgery for pancreatic neuroendocrine neoplasms (pNENs). We aim to evaluate the predictive role of the number of nodal metastases after pancreatic resection for pNENs. We analyzed from a prospectively maintained database all pancreatic resections for nonmetastatic nonfunctioning pNENs performed in our institution from 2011 to 2016. According to the number of nodal metastases, enhancing the actual categorization, we distinguished the following: N0, no nodal metastases; N1, 1-3 metastatic lymph nodes; and N2, metastases in 4 or more regional lymph nodes. Recurrence and disease-free survival (DFS) were evaluated. The predictive value in terms of recurrence for each clinicopathological data, including the number of metastatic lymph nodes, was calculated. Univariate and multivariate analyses were conducted. 77 patients underwent pancreatic surgery for pNENs. N0, N1, and N2 resections were found in 52 (67.5%), 16 (20.8%), and 9 (11.7%) cases, respectively. Mean follow-up of the entire cohort was 48 (±25) months. The recurrence rate was 11.8%, and the mean time of recurrence was 12 (±14) months. DFS was 83.7 months (76.0 - 91.5). At a univariate analysis, factors associated with recurrence were mitotic count (OR 1.19, p=0.001), Ki67 value (OR 1.06, p=0.001), the presence of nodal metastases (OR 11.54, p=0.002), and metastases in 4 or more regional lymph nodes (N2) (OR 30.19, p=0.002). At a multivariate analysis, only mitotic count (OR 1.51, p=0.005) and N2 resection (OR 134.74, p=0.002) were found to be predictive factors of recurrence. The number of metastatic lymph nodes and mitotic count is the most significant predictive factors of recurrence after pancreatic surgery for nonmetastatic nonfunctioning pNENs.

Download Full-text

Diagnostic value of diffusion-weighted magnetic resonance imaging in discriminating between metastatic and non-metastatic pelvic lymph nodes in endometrial cancer

Acta Radiologica ◽

10.1177/0284185120906660 ◽

2020 ◽

Vol 61 (11) ◽

pp. 1580-1586

Author(s):

Arvin Arian ◽

Ahmed Mohamedbaqer Easa ◽

Mehran Arab-Ahmadi

Keyword(s):

Magnetic Resonance Imaging ◽

Endometrial Cancer ◽

Magnetic Resonance ◽

Lymph Nodes ◽

Cancer Patients ◽

Diagnostic Value ◽

Resonance Imaging ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Weighted Magnetic Resonance Imaging

Background Researchers have recently focused on assessing the accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in predicting pelvic lymph node metastases in gynecological malignancies. Purpose To evaluate the diagnostic value of DW-MRI in discriminating between metastatic and non-metastatic pelvic lymph nodes in endometrial cancer patients. Material and Methods This retrospective database study was conducted with 33 women aged 30–84 years with pathologically proven endometrial cancer that had been assessed by DW-MRI before their first treatment initiation at our referral hospital from March 2016 to April 2019. The diffusion technique (b = 50, 400, and 1000 mm2/s) was used in the imaging, and continuous apparent diffusion coefficient (ADC) metrics (ADCmin, ADCmax, ADCmean, ADCSD, and rADC) were compared between the metastatic and non-metastatic lymph nodes. Results In total, 48 lymph nodes from 33 patients were assessed. All metastatic lymph nodes were restricted, while among the non-metastatic lymph nodes, only 19.3% were restricted. Considering pathological reports of metastatic and non-metastatic lymph nodes as the gold standard, DWI-related restricted and non-restricted features had a sensitivity of 80.6%, a specificity of 100%, and an accuracy of 87.5% to discriminate between a metastatic and non-metastatic pattern. ADC metrics of ADCmin, ADCmax, ADCmean, ADCSD, and rADC showed high values enabling differentiation between metastatic and non-metastatic lymph nodes. The best cut-off values were 0.7 × 10−3, 1.2 × 10−3, 1.01 × 10−3, 123, and 0.78, respectively. Conclusion DW-MRI is a useful quantitative tool for differentiating between metastatic and benign lymph nodes in endometrial cancer patients.

Download Full-text