Association of Pelvic and Para-Aortic Lymphadenectomy With Survival in Stage I Endometrioid Endometrial Cancer: Matched Cohort Analyses From the National Cancer Database

2017 ◽  
pp. 1-14
Author(s):  
Brandon-Luke L. Seagle ◽  
Masha Kocherginsky ◽  
Shohreh Shahabi
Keyword(s):  
Endometrial Cancer ◽  
Surgical Margin ◽  
Myometrial Invasion ◽  
Pelvic Lymphadenectomy ◽  
Stage I ◽  
Sensitivity Analyses ◽  
Median Income ◽  
Matched Cohort ◽  
Endometrioid Endometrial Cancer ◽  
Cohort Analyses

Purpose To estimate whether pelvic and para-aortic lymphadenectomy was associated with increased survival in stage I endometrioid endometrial cancer. Methods We performed matched cohort analyses of women with stage I endometrioid endometrial cancer who underwent hysterectomy with no lymphadenectomy, pelvic lymphadenectomy, or combined pelvic and para-aortic lymphadenectomy. Cox proportional hazards survival analyses were performed with inverse probability weights. Hazard ratios (HRs) were covariate and propensity score adjusted. Covariates included cancer center type, age, race, Hispanic ethnicity, insurance type, community median income quartile, comorbidity score, history of prior cancer, depth of myometrial invasion, tumor grade, tumor size, lymphovascular space invasion, cytology status, surgical margin status, hospital volume, and use of adjuvant radiotherapy or chemotherapy. Additional analyses included subset analyses by grade, sensitivity analyses with imputation of missing data, and testing for sensitivity to possible unmeasured confounding. Results Median (interquartile range [IQR]) lymph node counts were 0, 10 (5-15), and 20 (15-27) nodes in the no lymphadenectomy, pelvic, and combined pelvic and para-aortic lymphadenectomy–matched cohorts, respectively. Matched cohorts were well balanced. Two analyses were performed: no lymphadenectomy (n = 7,487) versus pelvic lymphadenectomy (n = 7,487), and pelvic lymphadenectomy (n = 7,060) versus combined pelvic and para-aortic lymphadenectomy (n = 7,060). Performance of pelvic lymphadenectomy was associated with increased survival compared with no lymphadenectomy (5-year survival [95% CI], 91.4% [90.2% to 92.6%] v 87.3% [85.9% to 88.8%]; HR, 0.71 [95% CI, 0.64 to 0.78]; P < .001). Addition of para-aortic lymphadenectomy was associated with increased survival compared with pelvic lymphadenectomy alone (5-year survival [95% CI], 91.0% [89.8% to 92.2%] v 89.8% [88.4% to 91.1%]; HR, 0.85 [95% CI, 0.77 to 0.95]; P = .003). Associations were robust to sensitivity analyses. Conclusion Lymphadenectomy was associated with increased survival in stage I endometrioid endometrial cancer. An adequately powered randomized trial is needed.

Lymphovascular Space Invasion and the Treatment of Stage I Endometrioid Endometrial Cancer

2015 ◽  
Vol 25 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Louis J.M. van der Putten ◽  
Yvette P. Geels ◽  
Nicole P.M. Ezendam ◽  
Hans W.H.M. van der Putten ◽  
Marc P.M.L. Snijders ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Myometrial Invasion ◽  
Distant Recurrence ◽  
Stage I ◽  
Recurrence Rates ◽  
Endometrioid Endometrial Cancer ◽  
Lymphovascular Space Invasion

ObjectivesTreatment of clinical early-stage endometrioid endometrial cancer (EEC) in The Netherlands consists of primary hysterectomy and bilateral salpingo-oophorectomy. Adjuvant radiotherapy is given when 2 or more the following risk factors are present: 60 years or older, grade 3 histology, and 50% or more myometrial invasion. Lymphovascular space invasion (LVSI) is a predictor of poor prognosis and early distant spread. It is unclear whether adjuvant radiotherapy is sufficient in patients with LVSI-positive EEC.Methods/MaterialsEighty-one patients treated from 1999 until 2011 for stage I LVSI-positive EEC in 11 Dutch hospitals were included. The outcomes of patients with 0 to 1 risk factors were compared with those with 2 to 3 risk factors, and both were compared with the known literature.ResultsEighteen patients presented with recurrent disease, and 12 of those recurrences had a distant component. Overall and distant recurrence rates were 19.2% and 11.5% in patients with 0 to 1 risk factors followed by observation and 25.5% and 17% in patients with 2 to 3 risk factors who received adjuvant radiotherapy. Only 1 patient with grade 1 disease had a recurrence.ConclusionsIn stage I LVSI-positive EEC with 0 to 1 risk factors, observation might not be adequate. Moreover, despite adjuvant radiotherapy, a high overall and distant recurrence rate was observed in patients with 2 to 3 risk factors. The use of systemic treatment in these patients, with the exception of patients with grade 1 disease, should be investigated.

Lymph Node Metastasis in Patients With Endometrioid Endometrial Cancer: Overtreatment Is the Main Issue

2017 ◽  
Vol 27 (4) ◽  
pp. 748-753 ◽  
Author(s):  
Alper Karalok ◽  
Taner Turan ◽  
Derman Basaran ◽  
Osman Turkmen ◽  
Gunsu Comert Kimyon ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Histological Grade ◽  
Myometrial Invasion ◽  
Lymph Node Involvement ◽  
Node Metastasis ◽  
Deep Myometrial Invasion ◽  
Endometrioid Endometrial Cancer ◽  
Grade 3

ObjectiveThe aim of this study was to evaluate the effectiveness of histological grade, depth of myometrial invasion, and tumor size to identify lymph node metastasis (LNM) in patients with endometrioid endometrial cancer (EC).MethodsA retrospective computerized database search was performed to identify patients who underwent comprehensive surgical staging for EC between January 1993 and December 2015. The inclusion criterion was endometrioid type EC limited to the uterine corpus. The associations between LNM and surgicopathological factors were evaluated by univariate and multivariate analyses.ResultsIn total, 368 patients were included. Fifty-five patients (14.9%) had LNM. Median tumor sizes were 4.5 cm (range, 0.7–13 cm) and 3.5 cm (range, 0.4–33.5 cm) in patients with and without LNM, respectively (P = 0.005). No LMN was detected in patients without myometrial invasion, whereas nodal spread was observed in 7.7% of patients with superficial myometrial invasion and in 22.6% of patients with deep myometrial invasion (P < 0.0001). Lymph node metastasis tended to be more frequent in patients with grade 3 disease compared with those with grade 1 or 2 disease (P = 0.131).ConclusionsThe risk of lymph node involvement was 30%, even in patients with the highest-risk uterine factors, that is, those who had tumors of greater than 2 cm, deep myometrial invasion, and grade 3 disease, indicating that 70% of these patients underwent unnecessary lymphatic dissection. A precise balance must be achieved between the desire to prevent unnecessary lymphadenectomy and the ability to diagnose LNM.

Prediction of Site-Specific Tumor Relapses in Patients With Stage I–II Endometrioid Endometrial Cancer

2017 ◽  
Vol 27 (5) ◽  
pp. 923-930 ◽  
Author(s):  
Taru Tuomi ◽  
Annukka Pasanen ◽  
Arto Leminen ◽  
Ralf Bützow ◽  
Mikko Loukovaara
Keyword(s):  
Endometrial Cancer ◽  
Stage I ◽  
Site Specific ◽  
Specific Tumor ◽  
Endometrioid Endometrial Cancer

scholarly journals Redefining Stage I Endometrial Cancer: Incorporating Histology, a Binary Grading System, Myometrial Invasion, and Lymph Node Assessment

2013 ◽  
Vol 23 (9) ◽  
pp. 1620-1628 ◽  
Author(s):  
Joyce N. Barlin ◽  
Robert A. Soslow ◽  
Megan Lutz ◽  
Qin C. Zhou ◽  
Caryn M. St. Clair ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Myometrial Invasion ◽  
Staging System ◽  
Stage I ◽  
Low Grade ◽  
List Type ◽  
High Grade ◽  
High Grade Carcinoma ◽  
Concordance Probability ◽  
Grade 3

ObjectiveWe propose a new staging system for stage I endometrial cancer and compare its performance to the 1988 and 2009 International Federation of Gynecology and Obstetrics (FIGO) systems.MethodsWe analyzed patients with 1988 FIGO stage I endometrial cancer from January 1993 to August 2011. Low-grade carcinoma consisted of endometrioid grade 1 to grade 2 lesions. High-grade carcinoma consisted of endometrioid grade 3 or nonendometrioid carcinomas (serous, clear cell, and carcinosarcoma). The proposed system is as follows:IA. Low-grade carcinoma with less than half myometrial invasionIA1: Negative nodesIA2: No nodes removedIB. High-grade carcinoma with no myometrial invasionIB1: Negative nodesIB2: No nodes removedIC. Low-grade carcinoma with half or greater myometrial invasionIC1: Negative nodesIC2: No nodes removedID. High-grade carcinoma with any myometrial invasionID1: Negative nodesID2: No nodes removedResultsData from 1843 patients were analyzed. When patients were restaged with our proposed system, the 5-year overall survival significantly differed (P < 0.001): IA1, 96.7%; IA2, 92.2%; IB1, 92.2%; IB2, 76.4%; IC1, 83.9%; IC2, 78.6%; ID1, 81.1%; and ID2, 68.8%. The bootstrap-corrected concordance probability estimate for the proposed system was 0.627 (95% confidence interval, 0.590–0.664) and was superior to the concordance probability estimate of 0.530 (95% confidence interval, 0.516–0.544) for the 2009 FIGO system.ConclusionsBy incorporating histological subtype, grade, myometrial invasion, and whether lymph nodes were removed, our proposed system for stage I endometrial cancer has a superior predictive ability over the 2009 FIGO staging system and provides a novel binary grading system (low-grade including endometrioid grade 1–2 lesions; high-grade carcinoma consisting of endometrioid grade 3 carcinomas and nonendometrioid carcinomas).

High dose rate post-operative vaginal cuff irradiation alone for stage i endometrial cancer with myometrial invasion

1998 ◽  
Vol 42 (1) ◽  
pp. 318
Author(s):  
John M. Anderson ◽  
Tam Nguyen ◽  
Joel Childers ◽  
Alton V. Hallum ◽  
Earl Surwitt ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Dose Rate ◽  
Myometrial Invasion ◽  
High Dose Rate ◽  
Stage I ◽  
High Dose ◽  
Vaginal Cuff

Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer

2002 ◽  
Vol 12 (1) ◽  
pp. 57-61 ◽  
Author(s):  
K. M Fram
Keyword(s):  
Endometrial Cancer ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Vaginal Hysterectomy ◽  
Intraoperative Complications ◽  
Abdominal Hysterectomy ◽  
Pelvic Lymphadenectomy ◽  
Stage I ◽  
Laparoscopic Treatment ◽  
Laparoscopically Assisted Vaginal Hysterectomy

Abstract.Fram KM. Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer.The purpose of this study was to evaluate and compare laparoscopic treatment for stage I endometrial cancer with the traditional transabdominal approach. From July 1996 to July 1998, 61 patients with clinical stage I endometrial cancer were treated at the Gynaecology Oncology Unit at the Royal North Shore of Sydney, Australia. Twenty-nine patients were treated with laparoscopic assisted vaginal hysterectomy (LAVH) and bilateral salpingo-oophrectomy (BSO) ± laparoscopic pelvic lymphadenectomy (LPLA), while 32 patients were treated with the traditional laparotomy and underwent total abdominal hysterectomy (TAH) and BSO ± pelvic lymphadenectomy (PLA). The main outcomes studied were operative time, blood loss, blood transfusion, intraoperative complications, postoperative complications, duration of hospital stay, and number of lymph nodes obtained. In conclusion, laparoscopic treatment of endometrial cancer is safe in the hands of experienced operators with minimal intraoperative and postoperative complications. This procedure is associated with significantly less blood loss and shorter hospitalization; however, it is associated with significantly longer operating time. Proper selection of patients for the laparoscopic procedure is the vital step in achieving the major goals of this approach.

Assessment of the depth of myometrial invasion in stage I endometrioid endometrial cancer using pancytokeratin immunohistochemistry

2004 ◽  
Vol 14 (4) ◽  
pp. 665-672 ◽  
Author(s):  
F. Alexander-Sefre ◽  
N. Singh ◽  
A. Ayhan ◽  
J. M. Thomas ◽  
I. J. Jacobs
Keyword(s):  
Endometrial Cancer ◽  
Light Microscopy ◽  
Tumor Cells ◽  
Hormone Replacement ◽  
Myometrial Invasion ◽  
Stage I ◽  
Depth Of Invasion ◽  
Isolated Tumor Cells ◽  
Medical Disorders ◽  
Clinical Records

BackgroundThere is a strong correlation between disease mortality and the depth of myometrial invasion in stage I endometrial cancer (EC). Current assessment of the depth of invasion relies on light microscopy. Tumor cells can evade detection by light microscopy if they are vastly outnumbered by myometrial cells. Immunohistochemical (IHC) techniques against pancytokeratins (PCKs) have a great potential in the detection of such isolated cells.ObjectivesTo investigate the application of IHC techniques in the identification of isolated infiltrating tumor cells within myometrium and assess its significance in clinically stage I EC.MethodsA single representative tissue block containing the deepest myometrial invasion by the tumor was selected for 90 patients with stage I EC. Sections from each block were immunostained in accordance with established streptavidin–biotin peroxidase method using a mouse monoclonal antikeratin clone AE1/AE3. Myometrium was re-examined to identify deeper myometrial invasion that had escaped detection on hematoxylin and eosin (H&E) section. The clinical records were reviewed, and following data were collected: age, race, parity, presentation, associated medical disorders (obesity, diabetes, and hypertension), use of tamoxifen or hormone replacement therapy, menopausal state, recurrence, and survival.ResultsOf 90 cases, deeper myometrial invasion was detected on IHC sections in seven cases (7.7%). In five of these seven cases, isolated tumor cells surrounded by inflammatory cells were noted 0.2–1.2 mm deeper within the myometrium than that detected by H&E staining. In the remaining two cases, the deeper extension seen was the result of examining serial levels through the tumor block; in these cases, deeper infiltration should have been apparent on H&E sections. Follow-up data was available in 72 of the 90 cases. A trend was noted between the presence of isolated tumor cells deeper within myometrium on IHC and tumor recurrence (P = 0.056). The 2-year recurrence-free survival was 40% for the group with IHC evidence of deeper invasion compared with 89% for the group without (P = 0.005). Similarly, analysis of cause-specific and overall survival revealed significant differences between the two groups (P = 0.038 and P = 0.026, respectively).ConclusionsIn this study, we have shown that it is possible to identify deeper level of myometrial invasion by tumor cells using an IHC technique. IHC-detected deeper invasion is an uncommon event and may be a feature of more aggressive tumors with greater potential for recurrence and lower survival.

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