The Significance of Pretreatment Thrombocytosis and Its Association With Neutrophilia in Patients With Surgically Treated Endometrial Cancer

2017 ◽  
Vol 27 (7) ◽  
pp. 1399-1407 ◽  
Author(s):  
Ryoko Takahashi ◽  
Seiji Mabuchi ◽  
Hiromasa Kuroda ◽  
Katsumi Kozasa ◽  
Eriko Yokoi ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Proportional Hazards ◽  
Independent Predictor ◽  
Clinical Stage ◽  
Prognostic Significance ◽  
Myometrial Invasion ◽  
Cox Proportional Hazards ◽  
Peritoneal Cytology ◽  
Advanced Stage ◽  
Advanced Clinical Stage

ObjectiveThe aim of this study was to investigate the prognostic significance of a pretreatment thrombocytosis and its association with neutrophilia in patients with surgically treated endometrial cancer.MethodsThe baseline characteristics and outcome data of 508 patients with surgically treated endometrial cancer between January 2000 and December 2010 were collected and retrospectively reviewed. The patients were separated into 4 groups according to their platelet counts and the neutrophil counts, and the progression-free and overall survival rates of the 4 groups were compared. A Cox proportional hazards regression model was used to explore the independent prognostic factors.ResultsPretreatment thrombocytosis was found to be associated with advanced stage (P = 0.0186), nonendometrioid histology (P = 0.0139), a deeper myometrial invasion (P = 0.0103), lymphovascular space involvement (P = 0.0404), cervical involvement (P = 0.004), positive peritoneal cytology (P = 0.0198), lymph node metastasis (P = 0.0301), and more frequent treatment failure (P = 0.0006). Multivariate analysis demonstrated that an older age (hazard ratio [HR], 2.54; 95% confidence interval [CI], 1.46–4.51; P = 0.0009), advanced clinical stage (HR, 5.27; 95% CI, 2.94–9.86; P < 0.0001), lymphovascular space involvement (HR, 3.37; 95% CI, 1.74–7.07; P = 0.0002), and pretreatment thrombocytosis (HR, 4.99; 95% CI, 2.47–9.39; P < 0.0001) were significant predictors of survival. When examined according to clinical stage, pretreatment thrombocytosis was prognostically significant only in patients with stage III–IV disease. The neutrophil count in patients who display thrombocytosis was significantly greater than that observed in patients without thrombocytosis (median, 6702 vs 4406/μL; P < 0.0001). Moreover, patients who displayed both thrombocytosis and neutrophilia had significantly shorter survival than that in those with either thrombocytosis or neutrophilia alone.ConclusionsPresence of thrombocytosis at the time of the initial diagnosis is an independent predictor of shorter survival in patients with advanced-stage (stages III–IV) endometrial cancer. Moreover, pretreatment thrombocytosis and concurrent neutrophilia are an independent predictor of shorter survival regardless of clinical stage.

Prognostic Significance of Pretreatment Thrombocytosis in Cervical Cancer Patients Treated With Definitive Radiotherapy

2015 ◽  
Vol 25 (9) ◽  
pp. 1656-1662 ◽  
Author(s):  
Mahiru Kawano ◽  
Seiji Mabuchi ◽  
Yuri Matsumoto ◽  
Tomoyuki Sasano ◽  
Ryoko Takahashi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Platelet Count ◽  
Cancer Patients ◽  
Proportional Hazards ◽  
Clinical Stage ◽  
Prognostic Significance ◽  
Cox Proportional Hazards ◽  
Initial Diagnosis ◽  
Advanced Clinical Stage ◽  
Definitive Radiotherapy

ObjectiveThe aim of this study was to investigate the prevalence and prognostic significance of an elevated platelet count at the time of the initial diagnosis in patients with cervical cancer who are treated with definitive radiotherapy.MethodsThe baseline characteristics and outcome data of cervical cancer patients who were treated with definitive radiotherapy between November 1993 and December 2011 were collected and retrospectively reviewed. The patients were separated into 2 groups according to their platelet counts. The clinicopathological characteristics and overall survival rates of the 2 groups were compared. A Cox proportional hazards regression model was used to investigate the prognostic significance of an elevated platelet count.ResultsAn elevated platelet count was found to be associated with younger age (P = 0.0003), an advanced clinical stage (P < 0.0001), larger tumors (P = 0.0025), lower hemoglobin levels (P < 0.0001), and more frequent treatment failure (P = 0.0015). Multivariate analysis demonstrated that an advanced clinical stage (hazards ratio [HR], 2.93; 95% confidence interval [CI], 1.47–6.70; P = 0.0015), nonsquamous cell carcinoma histology (HR, 2.67; 95% CI, 1.52–4.42; P = 0.0011), larger tumors (HR, 3.86; 95% CI, 2.18–7.03; P < 0.0001), lower hemoglobin levels (HR, 1.99; 95% CI, 1.34–2.93; P = 0.0008), and an elevated platelet count (HR, 1.65; 95% CI, 1.03–2.56; P = 0.0395) were significant predictors of survival.ConclusionsAn elevated platelet count at the time of the initial diagnosis is an independent prognostic factor in cervical cancer patients who are treated with definitive radiotherapy.

Tailored surgical staging and radiation therapy in clinical stage I endometrioid endometrial adenocarcinoma (EEA)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16511-e16511
Author(s):  
K. M. Bermudez Wagner ◽  
M. B. Thomas ◽  
C. Miyamoto ◽  
B. Micaily ◽  
E. Hernandez
Keyword(s):  
Adjuvant Therapy ◽  
Proportional Hazards ◽  
Clinical Stage ◽  
Endometrial Adenocarcinoma ◽  
Myometrial Invasion ◽  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Outcome Analysis

e16511 Background: Pelvic lymph node dissection (LND) requirement to adequately stage endometrial cancer has been subject of debate. We conducted an outcome analysis of clinical stage I endometrioid endometrial adenocarcinoma (EEA) patients who underwent surgery with tailored LND and adjuvant therapy (radiation (RT) or chemotherapy) between 1997 and 2008. Methods: Retrospective chart review was performed at our institution. All patients underwent exploratory laparotomy, cytology, total abdominal hysterectomy and bilateral salpingoophorectomy. Pelvic and para-aortic LND was perforned in high-risk patients when technically possible. Cox proportional hazards and the Kaplan Meier method were used for data analysis. Results: 119 patients (stage I 92, II 11, III 15, and IV 1) were identified. Median BMI was 34 and 81% had significant co-morbidities. 50% underwent para-aortic LND (median 4 nodes) and 25% underwent pelvic LND (median 15 nodes), of whom 8% and 10% were positive, respectively. Postoperative complications occurred in 22%. 26% received RT. With a mean follow-up of 20 months, 5-year progression-free survival (PFS) and overall survival (OS) was 71% and 84%. The OS for stage I and IIIC was 88% and 83%, respectively. OS for patients with or without LND was not statistically different ( 73% vs.82%). 12 (10%) recurrences were noted, 8 of which were hematological (HF) with a 5-year HF probability of 21%. On multivariate analysis only myometrial invasion > 50% was independent risk factor for HF. Patients receiving RT showed a trend toward decreased in local recurrences ( 0% vs.30% p = 0.1) but no improvement in OS. Conclusions: In patients with EEA, a tailored approach to LND and adjuvant therapy results in good outcome, but many still have therapy-associated adverse events. Although no difference was found in OS between patients who underwent LND and those who did not, similar survival for patients with stages I and IIIC suggests that therapy directed by the knowledge of nodal status may have an impact on survival. No significant financial relationships to disclose.

Correlation between clinical and histopathologic risk factors and lymph node metastases in early endometrial cancer (a multivariate analysis of 183 cases)

1994 ◽  
Vol 4 (5) ◽  
pp. 306-309 ◽  
Author(s):  
A. Ayhan ◽  
R. Tuncer ◽  
Z. S. Tuncer ◽  
K. YÜCe ◽  
T. KÜÇÜKali
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Clinical Stage ◽  
Myometrial Invasion ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Lymph Node Status ◽  
Peritoneal Cytology ◽  
Node Metastases

This study includes 183 patients with clinical stage I endometrial cancer subjected to peritoneal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and para-aortic lymphadenectomy and omental biopsy during a 12-year period in a single institution. The factors analyzed were age, menopausal state, cell type, grade, mitotic activity, myometrial invasion, lymphovascular space invasion, cervical involvement, microscopic vaginal metastases, adnexal metastases, peritoneal cytology, presence of concomitant endometrial hyperplasia and lymph node status. The overall incidences of pelvic and para-aortic lymph node metastases were found to be 15.3% (28/183) and 9.3% (17/183), respectively. In five of 17 patients (29.4%) with para-aortic nodal metastases, pelvic nodes were free of tumor. The most significant prognostic factors for positive pelvic and/or para-aortic nodes were found to be the depth of myometrial invasion, grade of tumor and age.

Prognostic significance of blood-based cancer detection in plasma cell-free DNA (cfDNA): Evaluating risk of overdiagnosis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1545-1545
Author(s):  
Geoffrey R. Oxnard ◽  
Xiaoji Chen ◽  
Eric T. Fung ◽  
Ting Ma ◽  
Jafi Lipson ◽  
...  
Keyword(s):  
Cancer Detection ◽  
Diagnostic Method ◽  
Proportional Hazards ◽  
Multivariate Analyses ◽  
Clinical Stage ◽  
Prognostic Significance ◽  
Cox Proportional Hazards ◽  
Screening Tests ◽  
Screening Methods ◽  
Test Set

1545 Background: Screening tests for early cancer detection are often criticized due to risk of overdiagnosis—detection of good prognosis cancers which may not require immediate treatment. We recently reported development of cfDNA sequencing approaches for cancer detection; longitudinal follow-up (F/U) data were utilized here to evaluate prognostic significance of cancer detection using cfDNA. Methods: Plasma cfDNA samples were subjected to whole-genome bisulfite sequencing (WGBS, 30X) as part of a previously-reported Circulating Cell-free Genome Atlas (CCGA; NCT02889978) substudy. This exploratory analysis evaluated the overall survival (OS) of training and test set participants (pts) with cancer (20 cancer types, any stage I-IV). Combining train and test set pts, univariate and multivariate analyses (Cox proportional hazards) assessed OS association with WGBS result (cancer detected vs not detected, set at 98% specificity), clinical stage (IV vs I-III), diagnostic method (symptom- vs screen-detected), sex, age, and histologic grade. Results: Of 827 pts from the training set with F/U (median 12.2 mo), 334 (40.4%) had WGBS-detected cancer. Among 127 (15.4%) pts with cancer that died during F/U, cancer was detected in 104 (81.9%). Results were similar in the test set. In univariate analyses all variables were associated with prognosis, including WGBS result (HR 7.7 p<0.001). In multivariate analyses accounting for other covariates, the three variables that most significantly remained prognostic were WGBS (HR 3.0, p<0.001), clinical stage (HR 3.3, p<0.001), and diagnostic method (HR 3.0, p<0.001). Validation of these findings is ongoing in an independent cohort of ~5,000 cancer pts from CCGA using an optimized assay; updated performance results will be reported. Conclusions: Cancers detected using WGBS of cfDNA had a worse prognosis than cancers not detected. WGBS cancer detection carried comparable prognostic significance as clinical stage. By preferentially detecting higher risk cancers, cancer detection using plasma cfDNA may avoid some of the overdiagnosis that has been seen with some existing cancer screening methods. Clinical trial information: NCT02889978.

scholarly journals Low preoperative serum ALB level is independently associated with poor overall survival in endometrial cancer patients

2020 ◽  
Author(s):  
Jia Lei ◽  
Yue Wang ◽  
Xiangqian Guo ◽  
Shuping Yan ◽  
Dimeng Ma ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Prognostic Factor ◽  
Proportional Hazards ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Cox Proportional Hazards ◽  
Independent Prognostic Factor ◽  
Poor Overall Survival ◽  
Preoperative Serum

Aim: To reveal the prognostic significance of serum albumin (ALB) concentration in endometrial cancer (EC) patients in China. Patients & methods: 345 EC patients were enrolled in a single center, and the preoperative serum ALB concentration were measured. Kaplan–Meier curve analysis and Cox proportional hazards regression model were performed to evaluate the associations between ALB concentration and overall survival (OS) of EC patients. Results: The EC patients with lower preoperative serum ALB concentration exhibited a significantly poorer OS (p < 0.05). Univariate analysis and multivariate analysis indicated that serum ALB concentration was an independent prognostic factor of unfavorable OS for EC patients. Conclusion: Our results showing that ALB concentration may serve as an independent prognostic factor for EC patients.

Clinicopathological features and their impacts on the prognoses of patients with nonurothelial carcinoma: A hospital-based cancer registry in Japan.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 555-555
Author(s):  
Yoshiyuki Nagumo ◽  
Takahiro Kojima ◽  
Kosuke Kojo ◽  
Tomokazu Kimura ◽  
Shuya Kandori ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Cancer Registry ◽  
Proportional Hazards ◽  
Clinical Stage ◽  
Standard Of Care ◽  
Tumor Location ◽  
Upper Urinary Tract ◽  
Cox Proportional Hazards ◽  
Clinicopathological Features ◽  
Advanced Clinical Stage

555 Background: Urothelial carcinoma (UC) is the most common histology of genitourinary (GU) tract cancer. Non-UC tumors in the GU tract appear to be more aggressive than UC at that location, but the clinicopathological features and their impacts on the prognoses of the non-UC patients are not known due to the low numbers of these patients. Methods: We used Hospital-Based Cancer Registry (HBCR) data in Japan to extract non-UC cases, i.e., patients with adenocarcinoma (AC), squamous cell carcinoma (SCC), or small cell carcinoma (SmCC) of the GU tract who were diagnosed in 2008–2009 with histological confirmation and had received first course of treatment. We retrospectively analyzed the clinicopathological features of these patients, stratified by the bladder and the upper urinary tract (UUT) as tumor locations. We used a Cox proportional hazards regression to identify prognostic factors associated with the overall survival (OS). Results: Of the 8,095 cases at the bladder and 2,580 cases at the UUT, 384 (4.7%) and 131 (5.1%) non-UC cases were identified, respectively. The proportions of histologic subtypes in the bladder were 1.7% AC, 2.4% SCC, and 0.7% SmCC. In the UUT group, these proportions were 1.3%, 3.4%, and 0.4%, respectively. At both tumor locations, the distribution of ages was similar across all subtypes, with the age peak in the 70s. More patients with non-UC were diagnosed at an advanced clinical stage compared to the patients with UC at either location. The 5-yr OS rates of the non-UC patients with a tumor in the bladder and at the UUT were 40% and 26%, whereas the corresponding 5-yr OS rates among the UC patients were 61% and 52%, respectively. A multivariate analysis revealed that the presence of non-UC was significantly associated with increased mortality (hazard ratio 1.66, 95% confidence interval 1.48–1.87) regardless of the tumor location. Conclusions: The clinicopathological features of the non-UC patients were similar between both tumor locations. The presence of non-UC was associated with poor prognosis regardless of the tumor location. A standard of care must be established for non-UC patients, since the prognoses of these patients are not satisfactory.

scholarly journals Prognostic significance of peritoneal cytology in low-risk endometrial cancer: comparison of laparoscopic surgery and laparotomy

2021 ◽  
Author(s):  
Satoe Fujiwara ◽  
Ruri Nishie ◽  
Shoko Ueda ◽  
Syunsuke Miyamoto ◽  
Shinichi Terada ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Laparoscopic Surgery ◽  
Retrospective Study ◽  
Prognostic Significance ◽  
Low Risk ◽  
Peritoneal Cytology ◽  
Chi Square ◽  
Significant Difference ◽  
Chi Square Test ◽  
Positive Peritoneal Cytology

Abstract Background There is uncertainty surrounding the prognostic value of peritoneal cytology in low-risk endometrial cancer, especially in laparoscopic surgery. The objective of this retrospective study is to determine the prognostic significance of positive peritoneal cytology among patients with low-risk endometrial cancer and to compare it between laparoscopic surgery and conventional laparotomy. Methods From August 2008 to December 2019, all cases of pathologically confirmed stage IA grade 1 or 2 endometrial cancer were reviewed at Osaka Medical College. Statistical analyses used the Chi-square test and the Kaplan–Meier log rank. Results A total of 478 patients were identified: 438 with negative peritoneal cytology (232 who underwent laparotomy and 206 who undertook laparoscopic surgery) and 40 with positive peritoneal cytology (20 who underwent laparotomy and 20 who received laparoscopic surgery). Survival was significantly worse among patients with positive peritoneal cytology compared to patients with negative peritoneal cytology. However, there was no significant difference among patients with negative or positive peritoneal cytology between laparoscopic surgery and laparotomy. Conclusion This retrospective study suggests that, while peritoneal cytology is an independent risk factor in patients with low-risk endometrial cancer, laparoscopic surgery does not influence the survival outcome when compared to laparotomy.

Re-thinking the prognostic significance of positive peritoneal cytology in endometrial cancer

2021 ◽  
Vol 161 (1) ◽  
pp. 135-142 ◽  
Author(s):  
Masataka Takenaka ◽  
Misato Kamii ◽  
Yasushi Iida ◽  
Nozomu Yanaihara ◽  
Jiro Suzuki ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Prognostic Significance ◽  
Peritoneal Cytology ◽  
Positive Peritoneal Cytology

Abstract 3115: Ankle Brachial Pressure Index (ABI) Is A Better Predictor Of Cardiovascular Mortality Than Toe-Brachial Index (TBI) Or Abnormal Doppler Flow Curves In Both Diabetic And Non-diabetic Subjects: The Hoorn Study.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Maya S Huijberts ◽  
Isabel Ferreira ◽  
Nicolaas C Schaper ◽  
Jacqueline M Dekker ◽  
Giel Nijpels ◽  
...  
Keyword(s):  
High Risk ◽  
Cardiovascular Mortality ◽  
Proportional Hazards ◽  
Independent Predictor ◽  
Ankle Brachial Index ◽  
Cox Proportional Hazards ◽  
Arterial Calcification ◽  
Flow Curves ◽  
Doppler Flow ◽  
Toe Brachial Index

Introduction: Individuals with peripheral arterial disease (PAD) have a high risk of future cardiovascular events. Many studies have demonstrated that low (<0.9) Ankle Brachial Index (ABI) predicts cardiovascular mortality in both diabetic and non-diabetic subjects. However, in diabetic subjects the measurement of the ABI is complicated by the presence of medial arterial calcification which results in falsely elevated ABI-values despite the presence of significant PAD. Therefore, we investigated whether the Toe-Brachial Index (TBI) or abnormal Doppler flow curves would be better predictors of PAD-associated cardiovascular mortality (CVM). Methods: Associations between measures of PAD and CVM were studied in an age-, sex,- and glucose tolerance stratified sample (n = 631) of a population based cohort aged 50 –75 years followed for 15 years. Measures included Doppler assisted ABI, flow velocity tracings of the femoral, popliteal and crural arteries and measurement of the TBI. Predictors of CVM were determined by Cox proportional hazards multiple regression analysis. Results are described as hazards ratios (HR) and 95% confidence intervals (CI). Results : At baseline ABI < 0.9 was present in 10.5% (6.9% in non-diabetic vs 17.2% in diabetic individuals), TBI < 0.7 was present in 21.0% (18.9% vs 24.3%), and abnormal Doppler flow curves in 20.3% (16.0% vs 29.3%). After 15 years of follow-up 141 patients had died of cardiovascular causes. After adjusting for age, sex, hypertension, total and HDL-cholesterol, triglycerides, BMI and smoking, HR (95% CI) were 3.19 (1.91–5.34) P<0.001 for ABI<0.9, 2.80 (0.97– 8.05) P=0.056 for presence of abnormal flow-curves, and 1.58 (0.97 – 2.57) P=0.068 for TBI<0.7. When entering the three measures simultaneously in the regression model only ABI<0.9 was an independent predictor of CVM, HR=2.81 (1.47 – 5.39) P=0.002. In diabetic individuals this effect was as least as strong, HR=3.30 (1.39 – 7.99) P=0.007. Conclusion: Although an ABI< 0.9 may underestimate the presence of PAD in individuals with type 2 diabetes, this measure is a powerful independent predictor of CVM in both diabetic and non-diabetic subjects. Assessment of the ABI should be used more often to identify high-risk patients, especially in the diabetic population.

scholarly journals Therapeutic Role of Retroperitoneal Lymphadenectomy in 170 Patients With Ovarian Clear Cell Cancer

2022 ◽  
Vol 11 ◽  
Author(s):  
Wen Gao ◽  
Peipei Shi ◽  
Haiyan Sun ◽  
Meili Xi ◽  
Wenbin Tang ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Proportional Hazards ◽  
Clear Cell ◽  
Cell Cancer ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Advanced Stage ◽  
Therapeutic Role ◽  
Retroperitoneal Lymphadenectomy

IntroductionWe evaluated the therapeutic role of retroperitoneal lymphadenectomy in patients with ovarian clear cell cancer (OCCC).Materials and MethodsWe retrospectively reviewed 170 OCCC patients diagnosed at two hospitals in China between April 2010 and August 2020. Clinical data were abstracted, and patients were followed until February 2021. Patients were divided into retroperitoneal lymphadenectomy and no lymphadenectomy groups. The Kaplan–Meier method was used to compare progression-free (PFS) and overall survival (OS) between the two groups. Statistical differences were determined by the log-rank test. The COX proportional hazards regression model was applied to identify predictors of tumor recurrence.ResultsThe median age was 52 years; 90 (52.9%) and 80 (47.1%) patients were diagnosed as early and advanced stage, respectively. Clinically positive and negative nodes was found in 40 (23.5%) and 119 (70.0%) patients, respectively. Of all the 170 patients, 124 (72.9%) patients underwent retroperitoneal lymphadenectomy, while 46 (27.1%) did not. The estimated 2-year PFS and 5-year OS rates were 71.4% and 65.9% in the lymphadenectomy group, and 72.0% and 73.7% in no lymphadenectomy group (p = 0.566 and 0.669, respectively). There was also no difference in survival between the two groups when subgroup analysis was performed stratified by early and advanced stage, or in patients with clinically negative nodes. Multivariate analysis showed that retroperitoneal lymphadenectomy were not an independent predictor of tumor recurrence.ConclusionRetroperitoneal lymphadenectomy provided no survival benefit in patients diagnosed with OCCC. A prospective clinical trial is needed to confirm the present results.

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