scholarly journals 425 Patterns of recurrence in low-risk endometrial cancer- evidence for a change in follow-up

2020 ◽  
Author(s):  
Y Naaman ◽  
T Hodge ◽  
A Jones ◽  
F Chin ◽  
D Neesham ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Low Risk ◽  
Patterns Of Recurrence

scholarly journals Clinical patterns and genomic profiling of recurrent ‘ultra-low risk’ endometrial cancer

2020 ◽  
Vol 30 (6) ◽  
pp. 717-723 ◽  
Author(s):  
Marina Stasenko ◽  
Noah Feit ◽  
Simon S K Lee ◽  
Cassandra Shepherd ◽  
Robert A Soslow ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Massively Parallel Sequencing ◽  
Tumor Grade ◽  
Low Risk ◽  
Small Subset ◽  
Low Grade ◽  
Primary Tumors ◽  
Gynecology And Obstetrics ◽  
Endometrial Cancers

ObjectiveDespite good prognosis for patients with low-risk endometrial cancer, a small subset of women with low-grade/low-stage endometrial cancer experience disease recurrence and death. The aim of this study was to characterize clinical features and mutational profiles of recurrent, low-grade, non-myoinvasive, ‘ultra-low risk’ endometrioid endometrial adenocarcinomas.MethodsWe retrospectively identified patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA endometrioid endometrial cancers who underwent primary surgery at our institution, between January 2009 and February 2017, with follow-up of ≥12 months. ‘Ultra-low risk’ was defined as FIGO tumor grade 1, non-myoinvasive, and lacking lymphovascular space invasion. Tumor-normal profiling using massively parallel sequencing targeting 468 genes was performed. Microsatellite instability was assessed using MSIsensor. DNA mismatch repair (MMR) protein proficiency was determined by immunohistochemistry.ResultsA total of 486 patients with ultra-low risk endometrioid endometrial cancers were identified: 14 (2.9%) of 486 patients developed a recurrence. Median follow-up for non-recurrent endometrioid endometrial cancers: 34 (range 12–116) months; for recurrent endometrioid endometrial cancers: 50.5 (range 20–116) months. Patients with recurrent disease were older, had lower body mass index, and were most commonly non-White (p=0.025, p<0.001, and p<0.001, respectively). Other clinical characteristics did not differ. MMR immunohistochemistry was obtained for 211 (43%) tumors: 158 (75%) MMR-proficient and 53 (25%) MMR-deficient. Primary tumors of 9 recurrent and 27 non-recurrent endometrioid endometrial cancers underwent mutational profiling. Most were microsatellite stable (6/9, 67% recurrent; 25/27, 93% non-recurrent). Recurrent PTEN and PIK3CA mutations were present in both groups. Exon 3 CTNNB1 hotspot mutations were found in 4/9 (44%) recurrent and 8/27 (30%) non-recurrent (p=0.44).ConclusionsPatients diagnosed with ultra-low risk endometrioid endometrial cancers have an overall excellent prognosis. However, in our study, 2.9% of patients with no identifiable clinical or pathologic risk factors developed recurrence. Further work is warranted to elucidate the mechanism for recurrence in this population.

Patient-initiated follow-up after treatment for low risk endometrial cancer: a prospective audit of outcomes and cost benefits

2020 ◽  
Vol 30 (8) ◽  
pp. 1177-1182
Author(s):  
Sarah Coleridge ◽  
Jo Morrison
Keyword(s):  
Endometrial Cancer ◽  
Health Service ◽  
Gynecological Cancer ◽  
Low Risk ◽  
Cancer Center ◽  
Prospective Audit ◽  
Cost Benefits ◽  
Gynecology And Obstetrics ◽  
Clinical Records

ObjectiveRecurrence of low-risk endometrioid endometrial cancer is rare, and traditional hospital follow-up has a cost to both the patient and the healthcare system, without evidence of benefit. We examined the uptake of patient-initiated follow-up, pattern of recurrences, and survival for women following surgical treatment of low-risk endometrial cancer and compared estimated costs with hospital follow-up.MethodsThis study was a prospective audit of outcomes following implementation of a patient-initiated follow-up policy in a UK-based gynecological cancer center for women with low-risk endometrial cancer treated surgically (International Federation of Gynecology and Obstetrics (FIGO) stage 1A, G1-2) from January 2010 to December 2015. Women were identified following multidisciplinary team meetings and data were collected from the electronic cancer register, paper, and electronic clinical records. Health service costs were calculated based on standard tariffs for follow-up appointments; patient costs were estimated from mileage traveled from home postcode and parking charges. Progression-free survival and overall survival were assessed. Estimated financial costs to the health service and patients of hospital follow-up were compared with actual patient-initiated follow-up costs.ResultsA total of 129 women were offered patient-initiated follow-up (declined by four; accepted by another 11 after hospital follow-up for 6 months to 3.5 years) with median follow-up of 60.7 months (range 1.4–109.1 months). Ten women recurred: four vaginal vault recurrences (all salvaged), three pelvic recurrences (all salvaged), and three distant metastatic disease (all died). Five-year disease-specific survival was 97.3%. Ten women in the cohort died: three from endometrial cancer and seven from unrelated causes. The cost saving to the health service of patient-initiated follow-up compared with a traditional hospital follow-up regimen was £116 403 (median £988.60 per patient,range £0–£1071). Patients saved an estimated £7122 in transport and parking costs (median £57.22 per patient,range £4.98–£147.70).ConclusionPatient-initiated follow-up for low risk endometrial cancer has cost benefits to both health service and patients. Those with pelvic or vault recurrence had salvageable disease, despite patient-initiated follow-up.

Patient-initiated follow-up for low-risk endometrial cancer: a cost-analysis evaluation

2020 ◽  
Vol 30 (7) ◽  
pp. 1000-1004
Author(s):  
Iqra Luqman ◽  
Rochelle Wickham-Joseph ◽  
Nicola Cooper ◽  
Louise Boulter ◽  
Nafisa Patel ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Low Risk ◽  
Financial Benefit ◽  
Time Saving ◽  
Primary Surgery ◽  
Time Distance ◽  
The Mean ◽  
Telephone Calls ◽  
Potential Impact

ObjectiveRisk stratification has resulted in patient-initiated follow-up being introduced for low-risk endometrial cancer in place of routine hospital follow-up. The financial benefit to the patient and the healthcare economy of patient-initiated follow-up, as compared with hospital follow-up, has yet to be explored. In this study, we explored the potential impact for both the healthcare economy and patients of patient-initiated follow-up.MethodsWomen diagnosed with low-risk endometrial cancer enrolled on a patient-initiated follow-up scheme between November 2014 and September 2018 were included. Data on the number of telephone calls to the nurse specialists and clinic appointments attended were collected prospectively. The number of clinic appointments that would have taken place if the patient had continued on hospital follow-up, rather than starting on patient-initiated follow-up, was calculated and costs determined using standard National Health Service (NHS) reference costs. The time/distance traveled by patients from their home address to the hospital clinic was calculated and used to determine patient-related costs.ResultsA total of 187 patients with a median of 37 (range 2–62) months follow-up after primary surgery were enrolled on the scheme. In total, the cohort were scheduled to attend 1673 appointments with hospital follow-up, whereas they only attended 69 clinic appointments and made 107 telephone contacts with patient-initiated follow-up. There was a 93.5% reduction in costs from a projected £194 068.00 for hospital follow-up to £12 676.33 for patient-initiated follow-up. The mean patient-related costs were reduced by 95.6% with patient-initiated follow-up. The total mileage traveled by patients for hospital follow-up was 30 891.4 miles, which was associated with a mean traveling time per patient of 7.41 hours and clinic/waiting time of 7.5 hours compared with 1165.8 miles and 0.46 hours and 0.5 hours, respectively, for patient-initiated follow-up.ConclusionThe introduction of a patient self-management follow-up scheme for low-risk endometrial cancer was associated with financial/time saving to both the patient and the healthcare economy as compared with hospital follow-up.

P166 Patient-initiated follow-up for low-risk endometrial cancer: an economic evaluation

2019 ◽  
Author(s):  
R Wickham-Joseph ◽  
I Luqman ◽  
N Cooper ◽  
L Boulter ◽  
N Patel ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Economic Evaluation ◽  
Low Risk

Stratified follow-up for endometrial cancer: a move to more personalized cancer care

2021 ◽  
pp. ijgc-2021-002903
Author(s):  
Asma Sarwar ◽  
Jennifer Van Griethuysen ◽  
Jasmine Waterhouse ◽  
Hakim-Moulay Dehbi ◽  
Gemma Eminowicz ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
High Risk ◽  
European Society ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Intermediate Risk ◽  
Eligibility Criteria ◽  
Gynecology And Obstetrics

ObjectiveHospital based follow-up has been the standard of care for endometrial cancer. Patient initiated follow-up is a useful adjunct for lower risk cancers. The purpose of this study was to evaluate outcomes of endometrial cancer patients after stratification into risk groupings, with particular attention to salvageable relapses.MethodsAll patients treated surgically for International Federation of Gynecology and Obstetrics (FIGO) stage I–IVA endometrial cancer of all histological subtypes, from January 2009 until March 2019, were analyzed. Patient and tumor characteristics, treatment details, relapse, death, and last follow-up dates were collected. Site of relapse, presence of symptoms, and whether relapses were salvageable were also identified. The European Society of Medical Oncology–European Society of Gynecological Oncology 2020 risk stratification was assigned, and relapse free and overall survival were estimated.Results900 patients met the eligibility criteria. Median age was 66 years (range 28–96) and follow-up duration was 35 months (interquartile range 19–57). In total, 16% (n=144) of patients relapsed, 1.3% (n=12) from the low risk group, 3.9% (n=35) from the intermediate risk group, 2.2% (n=20) from the high–intermediate risk group, and 8.7% (n=77) from the high risk group. Salvageable relapses were less frequent at 2% (n=18), of which 33% (n=6) were from the low risk group, 22% (n=4) from the intermediate risk group, 11% (n=2) from the high–intermediate risk group, and 33% (n=6) from the high risk group. There were only three asymptomatic relapses in the low risk patients, accounting for 0.33% of the entire cohort.ConclusionsRelapses were infrequent and most presented with symptoms; prognosis after relapse remains favorable. Overall salvageable relapses were infrequent and cannot justify intensive hospital based follow-up. Use of patient initiated follow-up is therefore appropriate, as per the British Gynaecological Cancer Society's guidelines, for all risk groupings.

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