Ovarian preservation for premenopausal women with early-stage endometrial cancer: a Chinese retrospective study

Objective This study aimed to retrospectively investigate the safety of ovarian preservation of premenopausal women with stage 1a endometrial carcinoma. Methods We performed a population-based study to identify surgically treated stage Ia endometrial cancer of premenopausal women who were diagnosed between August 1989 and December 2015 in our center. Survival outcomes and recurrence rate were examined for premenopausal women who underwent ovarian preservation. Recurrence-free survival rates were calculated following generation of Kaplan–Meier curves and were compared with the log-rank test. Cox regression analysis was performed to identify the independent factors affecting the recurrence rate. Results Patients with ovarian preservation tended to be significantly younger at diagnosis, have less myometrial invasion, and were less likely to undergo lymphadenectomy compared with women treated with bilateral salpingo-oophorectomy. There was no significant difference in recurrence-free survival between the two groups. In the Cox regression model, ovarian preservation remained an independent prognostic factor for improved overall survival. Conclusion Ovarian preservation does not have a negative effect on oncological outcomes. Ovarian preservation can be applied to premenopausal women with stage Ia endometrial carcinoma.

Download Full-text

Survival Impact of Ovarian Preservation on Women With Early-Stage Endometrial Cancer: A Systematic Review and Meta-analysis

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000857 ◽

2016 ◽

Vol 27 (1) ◽

pp. 77-84 ◽

Cited By ~ 12

Author(s):

Haifeng Gu ◽

Jundong Li ◽

Yangkui Gu ◽

Hua Tu ◽

Yun Zhou ◽

...

Keyword(s):

Endometrial Cancer ◽

Early Stage ◽

Meta Analysis ◽

Grey Literature ◽

Disease Free Survival ◽

Premenopausal Women ◽

Cochrane Library ◽

Ovarian Preservation ◽

Significant Difference ◽

Early Stage Endometrial Cancer

ObjectiveThe aim of this article was to investigate the survival impact of ovarian preservation in surgically treated patients with early-stage endometrial cancer using a meta-analysis.MethodsMajor online databases, including PubMed, EMBASE, Web of Science, the Cochrane Library, as well as Grey Literature database, were searched to collect studies on the effects of ovarian preservation compared with bilateral salpingo-oophorectomy (BSO) for surgical treatment in endometrial cancer patients. The literature search was performed up to April 2016. The results were analyzed using RevMan 5.0 software and Stata/SE 12.0 software.ResultsTotally, 7 retrospective cohort studies including 1419 patients in ovarian preservation group and 15,826 patients in BSO group were enrolled. Meta-analysis showed that there was no significant difference in overall survival between the patients treated with ovarian preservation and BSO (hazards ratio [HR], 1.00; 95% confidence interval [CI], 0.72–1.39; P = 1.00). Similar result was achieved in the young and premenopausal women (HR, 0.99; 95% CI, 0.70–1.39; P = 0.39). Furthermore, the disease-free survival of patients whose ovaries were preserved was slightly compromised but with no statistical significance (HR, 1.49; 95% CI, 0.56–3.93; P = 0.42).ConclusionsOvarian preservation may be safe in patients with early-stage endometrial cancer, and it could be cautiously considered in treating young and premenopausal women because it is not associated with an adverse impact on the patients’ survival. Given the inherent limitations of the included studies, further well-designed randomized controlled trial are needed to confirm and update this analysis.

Download Full-text

Tumor lymphocytic infiltration impacts recurrence in endometrioid-type endometrial carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e15239 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e15239-e15239

Author(s):

Monica Avila ◽

Bryan M. Fellman ◽

Russell Broaddus

Keyword(s):

Endometrial Carcinoma ◽

Cox Regression ◽

Predictive Biomarker ◽

Lymphocytic Infiltration ◽

Tumor Location ◽

Recurrence Free Survival ◽

Free Survival ◽

Tumor Periphery ◽

Endometrial Cancers ◽

Endometrial Carcinomas

e15239 Background: Endometrial cancers that have mismatch repair deficiency are associated with higher numbers of tumor-associated lymphocytes, but the clinical significance of this observation is unknown. Our objective was to quantify CD3+ and CD8+ tumor lymphocytes of MMR intact (MMRi) and MMRd endometrioid-type endometrial carcinomas and determine if there was an association with survival. Methods: MMRd was defined as endometrial carcinomas with loss of MLH1 expression due to MLH1 gene methylation and determined by immunohistochemistry. MMRi was defined as positive expression of MLH1, MSH2, MSH6, and PMS2. This was followed by Aperio image-based quantification was used to assess CD3+ and CD8+ lymphocyte populations in different regions of the primary endometrial carcinomas, including tumor periphery (tumor-myometrial interface), tumor center (bounded on all sides by tumor), and tumor hotspot (area with highest number of lymphocytes). Recurrence-free survival was estimated using Kaplan Meier and Cox regression. Median follow up time was 44 months. Results: 180 patients with endometrial carcinoma were analyzed of which 132 were MMRi and 48MMRd. The MMRd group had significantly higher levels of CD3+ and CD8+ lymphocytes regardless of which tumor region was assessed (Figure 1a, P < 0.001). Lymphocyte counts in both MMRd and MMRi groups had wide standard deviations such that there was some overlap in counts between the groups (Figure 1). Both MMRd and higher CD3+ counts were associated with worse recurrence-free survival. CD3+ quantification in the tumor periphery captured 21/23 recurrences (Figure 1b, HR = 8.04; 95% CI: 1.88 -34.31; p = 0.005); this included all of the MMRd cases that recurred and 7 MMRi cases with higher numbers of CD3+ lymphocytes that also recurred. Conclusions: MMRd endometrial cancers have increased numbers of CD3+ lymphocytic infiltrates within the primary tumor. Higher CD3+ infiltration is associated with greater risk of recurrence regardless of tumor location. In predicting tumor recurrence, lymphocytic counts performed better than assessment of MMR. Thus, quantification of CD3+ lymphocytes should be explored as a predictive biomarker.

Download Full-text

Clinical impact of abdominal versus mediastinal metastases as a prognostic factor for poor outcomes following esophageal cancer surgery: a retrospective study

BMC Cancer ◽

10.1186/s12885-021-08484-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yutaka Miyawaki ◽

Hiroshi Sato ◽

Shuichiro Oya ◽

Hirofumi Sugita ◽

Yasumitsu Hirano ◽

...

Keyword(s):

Esophageal Cancer ◽

Regression Analysis ◽

Lymph Node ◽

Prognostic Factor ◽

Cox Regression ◽

Recurrence Free Survival ◽

Free Survival ◽

Cox Regression Analysis ◽

Systemic Recurrence ◽

Significant Difference

Abstract Background Surgery is still the mainstay of radical treatment for resectable esophageal cancer (EC). It is apparent that the presence or spread of lymph node metastasis (LNM) is a powerful prognostic factor in patients with EC who are eligible for curative treatment. Although the importance and efficacy of lymph node dissection in radical esophagectomy have been reported, the clinical or prognostic relevance of specific metastatic patterns within the mediastinal cavity and abdomen remains unclear. Methods We retrospectively analyzed the association of postoperative survival with clinical mediastinal LNM (cMLNM) and abdominal LNM (cALNM) in 157 patients who underwent radical EC surgery at our hospital between May 2012 and March 2018. Results A significant difference in cause-specific survival (CSS) was observed between patients with and without cALNM (log-rank p = 0.000). A multivariate Cox regression analysis revealed that cALNM and thoracic surgery (mediastinal lymphadenectomy via conventional open right thoracotomy or video-assisted thoracoscopic surgery) independently predicted CSS (p = 0.0007 and 0.021, respectively). Moreover, a significant difference in systemic recurrence-free survival was observed between those with and without cALNM (log-rank p = 0.000). Multivariate Cox regression analysis revealed that cALNM and sex independently predicted systemic recurrence-free survival (p = 0.000 and 0.015, respectively). Conclusion cALNM was an independent poor prognostic factor for CSS after EC surgery. It may also be an independent prognostic factor for postoperative systemic recurrence, which can shorten the CSS. For patients with cALNM-positive EC who have a high potential risk of systemic metastases, more extensive treatment besides the conventional perioperative systemic chemotherapy may be necessary.

Download Full-text

Evaluation of Clinical Significance of Lymphovascular Space Invasion in Stage IA Endometrial Cancer

Oncology ◽

10.1159/000521382 ◽

2021 ◽

Author(s):

Kaoru Okugawa ◽

Hideaki Yahata ◽

Kazuhisa Hachisuga ◽

Hiroshi Tomonobe ◽

Nobuko Yasutake ◽

...

Keyword(s):

Endometrial Cancer ◽

Clinical Significance ◽

Survival Rates ◽

Prognostic Significance ◽

Low Grade ◽

Recurrence Free Survival ◽

Cancer Specific Survival ◽

Free Survival ◽

Stage Ia ◽

Lymphovascular Space Invasion

Introduction: The prognostic significance of lymphovascular space invasion (LVSI) in stage IA endometrial cancer remains unclear. The aim of this study was to evaluate the clinical significance of LVSI in stage IA endometrial cancer. Methods: Clinical data of patients with stage IA endometrial cancer who underwent initial surgery at our institution between January 2008 and December 2018 were reviewed retrospectively. Information of patients, surgery, and characteristics of cancer were obtained from medical records and pathological reports. Results: Two hundred ninety-seven patients were enrolled in this study. With a median follow-up of 60 months, 15 patients experienced recurrence (5.1%) and four patients died of endometrial cancer (1.3%). The recurrence and mortality rates did not differ significantly between the LVSI-positive and -negative groups (P=0.07 and P=0.41, respectively). Recurrence-free survival and endometrial cancer-specific survival also did not differ significantly between these groups (P=0.11 and P=0.49, respectively). The 5-year endometrial cancer-specific survival rates for tumors with and without LVSI were 97.0% and 98.9%, respectively. Among patients with low-grade tumors, recurrence-free survival and endometrial cancer-specific survival did not differ significantly between patients with tumors with and without LVSI (P=0.92 and P=0.72, respectively). The 5-year endometrial cancer-specific survival rates for low-grade tumors with and without LVSI were 100% and 99.3%, respectively. Conclusion: LVSI was not a prognostic factor of not only stage IA endometrial cancer, but also stage IA low-grade cancer.

Download Full-text

Significant Effect of Polymorphisms inCYP2D6andABCC2on Clinical Outcomes of Adjuvant Tamoxifen Therapy for Breast Cancer Patients

Journal of Clinical Oncology ◽

10.1200/jco.2009.25.7246 ◽

2010 ◽

Vol 28 (8) ◽

pp. 1287-1293 ◽

Cited By ~ 162

Author(s):

Kazuma Kiyotani ◽

Taisei Mushiroda ◽

Chiyo K. Imamura ◽

Naoya Hosono ◽

Tatsuhiko Tsunoda ◽

...

Keyword(s):

Breast Cancer ◽

Cox Regression ◽

Plasma Concentrations ◽

Recurrence Free Survival ◽

Free Survival ◽

Cox Regression Analysis ◽

Tag Snps ◽

Risk Alleles ◽

Significant Difference ◽

Variant Alleles

PurposeThe clinical efficacy of tamoxifen is suspected to be influenced by the activity of drug-metabolizing enzymes and transporters involved in the formation, metabolism, and elimination of its active forms. We investigated relationships of polymorphisms in transporter genes and CYP2D6 to clinical outcome of patients receiving tamoxifen.Patients and MethodsWe studied 282 patients with hormone receptor–positive, invasive breast cancer receiving tamoxifen monotherapy, including 67 patients who have been previously reported. We investigated the effects of allelic variants of CYP2D6 and haplotype-tagging single nucleotide polymorphisms (tag-SNPs) of ABCB1, ABCC2, and ABCG2 on recurrence-free survival using the Kaplan-Meier method and Cox regression analysis. Plasma concentrations of tamoxifen metabolites were measured in 98 patients receiving tamoxifen 20 mg/d.ResultsCYP2D6 variants were significantly associated with shorter recurrence-free survival (P = .000036; hazard ratio [HR] = 9.52; 95% CI, 2.79 to 32.45 in patients with two variant alleles v patients without variant alleles). Among 51 tag-SNPs in transporter genes, a significant association was found at rs3740065 in ABCC2 (P = .00017; HR = 10.64; 95% CI, 1.44 to 78.88 in patients with AA v GG genotypes). The number of risk alleles of CYP2D6 and ABCC2 showed cumulative effects on recurrence-free survival (P = .000000055). Patients carrying four risk alleles had 45.25-fold higher risk compared with patients with ≤ one risk allele. CYP2D6 variants were associated with lower plasma levels of endoxifen and 4-hydroxytamoxifen (P = .0000043 and .00052), whereas no significant difference was found among ABCC2 genotype groups.ConclusionOur results suggest that polymorphisms in CYP2D6 and ABCC2 are important predictors for the prognosis of patients with breast cancer treated with tamoxifen.

Download Full-text

Effect of “Time To Surgery” On The Endometrial Cancer Prognosis

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2021.1202 ◽

2021 ◽

pp. 1-9

Author(s):

Engin Celik ◽

Harika Yumru Celiksoy ◽

Hamdullah Sozen ◽

Hale Goksever Celik ◽

Semen Onder ◽

...

Keyword(s):

Endometrial Cancer ◽

Cox Regression ◽

Gynecological Cancer ◽

Progression Free Survival ◽

Disease Specific Survival ◽

Free Survival ◽

Cox Regression Analysis ◽

Study Results ◽

Significant Difference ◽

Disease Specific

OBJECTIVE: Endometrial cancer is the most common gynecological cancer in developed countries. Our study aims to determine the effect of the time between diagnosis and surgery of endometrial cancer on the prognosis of the disease. STUDY DESIGN: Patients who were diagnosed with epithelial type endometrial cancer and did not receive preoperative chemotherapy, radiotherapy, or hormonal therapy were included in the study. RESULTS: Two hundred eighty-five patients were included in the study. We divided the patients into two groups regarding before and after 8 weeks from diagnosis to surgery. Clinical characteristics of the patients were comparable between the groups, except for comorbid conditions and body mass index. Using cox-regression analysis, time to operation did not have a significant effect on both recurrence and cancer-associated death risk. The log-rank test analysis also showed that there was no significant difference in progression-free survival and disease-specific survival between the patients. There was no significant difference between the groups in terms of progression-free survival and disease-specific survival for cases with endometrioid type grade 1-2 tumors. There was also no significant difference between the groups regarding progression-free survival and disease-specific survival in the patients with tumors of endometrioid type grade 3 and non-endometrioid histology. CONCLUSION: Time delay between diagnosis to surgery of the patients with endometrial cancer has no prognostic importance for recurrence and survival outcomes.

Download Full-text

Oncological Outcomes of Adjuvant Radiotherapy for Partial Ureterectomy in Distal Ureteral Urothelial Carcinoma Patients

Frontiers in Oncology ◽

10.3389/fonc.2021.699210 ◽

2021 ◽

Vol 11 ◽

Author(s):

Hong-zhen Li ◽

Xiaoying Li ◽

Xian-shu Gao ◽

Xin Qi ◽

Ming-Wei Ma ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Adjuvant Radiotherapy ◽

Statistical Difference ◽

Cox Regression ◽

Recurrence Free Survival ◽

Radical Nephroureterectomy ◽

Cancer Specific Survival ◽

Free Survival ◽

Oncological Outcomes ◽

Significant Difference

PurposeWe retrospectively analyzed the oncological outcomes of T3 or G3 distal ureteral urothelial carcinoma (DUUC) underwent partial ureterectomy (PU) followed by adjuvant radiotherapy (ART).MethodsFrom January 2008 to September 2019, clinical data from a total of 221 patients with pathologic T3 or G3 who underwent PU or RNU at our hospital were analyzed. 17 patients of them were treated with PU+ART, 72 with PU alone and 132 with radical nephroureterectomy (RNU). Clinicopathologic outcomes were evaluated. Survival was assessed using the Kaplan-Meier method. Cox regression addressed recurrence-free survival (RFS), metastasis-free survival (MFS), cancer specific survival (CSS) and overall survival (OS).ResultsMedian age and follow-up time were 68 (IQR 62-76) years old and 43 (IQR 28-67) months, respectively. In univariate and multivariable analyses, no lymph node metastasis(LNM) and ART were independent prognostic factors of RFS (p=0.031 and 0.016, respectively). ART significantly improved 5-year RFS compared with the PU alone, (67.6% vs. 39.5%, HR: 2.431, 95%CI 1.210-4.883, p=0.039). There was no statistical difference in 5-year RFS between PU+ART and RNU groups (67.6% vs. 64.4%, HR=1.113, 95%CI 0.457-2.712, p=0.821). Compared with PU alone or RNU, PU+ART demonstrated no statistical difference in 5-year MFS (PU+ART 73.2%, PU 57.2%, RNU69.4%), CSS (70.7%, 55.1%, 76.6%, respectively), and OS (70.7%, 54.1%, 69.2%, respectively).ConclusionsFor distal ureteral urothelial carcinoma patients with T3 or G3, adjuvant radiotherapy could significantly improve recurrence-free survival compared with partial ureterectomy alone. There was no significant difference between survival outcomes of PU+ART and radical nephroureterectomy.

Download Full-text

Evaluation of the Safety of Ovarian Preservation at Early Stage of Endometrial Cancer in Premenopausal Women

Journal of Iranian Medical Council ◽

10.18502/jimc.v3i4.5191 ◽

2021 ◽

Author(s):

Elham Shirali ◽

Mitra Modarres Gilani ◽

Fariba Yarandi ◽

Omid Hemmatian ◽

Azar Ahmadzadeh ◽

...

Keyword(s):

Endometrial Cancer ◽

Early Stage ◽

Stage Iv ◽

Premenopausal Women ◽

Stage Ii ◽

Stage Iii ◽

Cross Sectional ◽

Ovarian Preservation ◽

Stage Ib ◽

Stage Ia

Background: Endometrial cancer usually occurs at postmenopause stage of life but its incidence in younger patients is increasing in the last decades. The objective of the study was to evaluate the ovarian preservation in the early stage of endometrial cancer. Methods: In this cross-sectional study, 174 patients with endometrial cancer who underwent Total Abdominal Hysterectomy (TAH) and Bilateral Salpingo-oophorectomy in 5 years were included. Results: The results showed that 51.1% of the patients were at stage IA, 28.7% at stage IB, 6.9% at stage II, 11.5% at stage III and 1.7% at stage IV of endometrial cancer when they underwent surgery. One patient (1.12%) at stage IA of endometrial cancer, one patient (2%) at stage IB and one patient (8.3%) at stage II had micrometastasis in ovaries, and 8 patients (40%) at stage III and 2 patients (66.6%) at stage IV had micrometastasis and co-existing tumor. Conclusion: In conclusion, findings revealed the high safety of ovarian preservation in endometrial cancer at earlier stages of the endometrial cancer with low risk of ovarian involvement.

Download Full-text

Clinical Impact of Abdominal Versus Mediastinal Metastases as a Prognostic Factor for Poor Outcomes Following Esophageal Cancer Surgery: A Retrospective Study

10.21203/rs.3.rs-116824/v1 ◽

2020 ◽

Author(s):

Yutaka Miyawaki ◽

Hiroshi Sato ◽

Shuichiro Oya ◽

Hirofumi Sugita ◽

Yasumitsu Hirano ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Prognostic Factor ◽

Cox Regression ◽

Recurrence Free Survival ◽

Free Survival ◽

Cox Regression Analysis ◽

Systemic Recurrence ◽

Significant Difference ◽

Node Metastases

Abstract BackgroundSurgery is still the mainstay of radical treatment for resectable esophageal cancer (EC). It is apparent that the presence or spread of lymph node metastasis is a powerful prognostic factor in patients with EC who are eligible for curative treatment. Although the importance and efficacy of lymph node dissection in radical esophagectomy have been reported, the clinical or prognostic relevance of specific metastatic patterns within the mediastinal cavity and abdomen remains unclear. MethodsWe retrospectively analyzed the association between postoperative survival with clinical mediastinal lymph node metastases (cMLNMs) and abdominal lymph node metastases (cALNMs) in 143 patients who underwent radical EC surgery at our hospital between May 2012 and July 2017.ResultsA significant difference in cause-specific survival (CSS) was observed between patients with and without cALNM (log-rank p=0.000). A multivariate Cox regression analysis revealed that cALNM and thoracic surgery (mediastinal lymphadenectomy via conventional open right thoracotomy or video-assisted thoracoscopic surgery) independently predicted CSS (p=0.001 and 0.037, respectively). Moreover, a significant difference in systemic recurrence-free survival was observed between those with and without cALNM (log-rank p=0.000). Multivariate Cox regression analysis revealed that cALNM and sex independently predicted systemic recurrence-free survival (p=0.005 and 0.013, respectively). ConclusioncALNM was an independent poor prognostic factor for CSS after EC surgery. It may also be an independent prognostic factor for postoperative systemic recurrence, which can shorten CSS. For patients with cALNM-positive EC who have a high potential risk of systemic metastases, more extensive treatment besides the conventional perioperative systemic chemotherapy may be necessary.

Download Full-text

Individualized Prediction of Stage I Colorectal Cancer Recurrence Using a Nomogram

10.21203/rs.3.rs-468523/v1 ◽

2021 ◽

Author(s):

Aobo Zhuang ◽

Dexiang Zhu ◽

Qi Lin ◽

Pingping Xu ◽

Guodong He ◽

...

Keyword(s):

Colorectal Cancer ◽

Recurrence Rate ◽

Cox Regression ◽

Radical Surgery ◽

Cancer Recurrence ◽

Stage I ◽

Recurrence Free Survival ◽

Curative Surgery ◽

Free Survival ◽

Preoperative Serum

Abstract Background Though the prognosis of stage l colorectal cancer (CRC) is suitable, some patients still recurrence and have a poor prognosis. Few prognostic risk models have been proposed. Therefore, we aimed to identify factors affecting the recurrence in patients with stage I CRC and develop a predictive nomogram. Methods The nomogram was based on a retrospective study on patients who underwent radical surgery for stage I CRC at Zhongshan Hospital (Shanghai, China) between August 2008 and December 2016. Predictive factors for recurrence were determined and a nomogram predicting recurrence-free survival was constructed based on Cox regression. This model was internally validated, and performance was evaluated through calibration plots. Results A total of 1,359 patients who underwent curative surgery for stage I CRC were enrolled. With the 62.0 months median follow-up time,71 (5.2%) experienced recurrence. The median time to recurrence was 24 months, 70% was diagnosed within three years after curative resection and 80% within 5 years. The 5-year cumulative recurrence rate was 5.0%, and the 10-year recurrence rate was 6.6%. In multivariate Cox analysis, age, preoperative serum CEA concentration, preoperative serum CA19-9 concentration, preoperative neutrophil-to-lymphocyte ratio, primary tumor location and lymphovascular invasion were the independent predictors of recurrence. A nomogram based on eight factors for recurrence-free survival was developed and internally validated. The concordance index of the nomogram was 0.716. Conclusions For stage I CRC, more than one in every twenty people may experience recurrence within 10 years after radical surgery. The nomogram we developed and internally validated might be helpfulhelpful in postoperative stage I CRC surveillance.

Download Full-text