scholarly journals The Relationship of Myometrial Invasion Between Other Prognostic Parameters in Endometrial Cancer

2017 ◽  
Vol 23 (3) ◽  
pp. 158
Author(s):  
Mehmet Sait Bakır ◽  
Ali Emre Tahaoğlu ◽  
Emre Erdoğdu ◽  
Cem Dane
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Myometrial Invasion ◽  
Recurrence Rates ◽  
Free Survival ◽  
Aortic Lymph Node ◽  
Deep Myometrial Invasion ◽  
The Relationship

<p><strong>Objective:</strong> The aim of this study is to investigate the relationship between deep myometrial invasion and other prognostic factors in endometrial cancer. Recurrence rates, disease free survival and overall survival rates were evaluated in endometrial cancer patients with MI&gt;50%.</p><p><strong>Sudy Design: </strong>A total of 132 patients with endometrial cancer who underwent surgical treatment between 2001 and 2011 were identified. Demographic, clinicopathological, surgical/adjuvant treatment and follow-up data were extracted.<br /><strong></strong></p><p><strong>Results:</strong> Pelvic lymph node invasion ratio was 28,9% and para-aortic lymph node invasion ratio was 15,5% in patients with myometrial invasion is greater than 50%. Other prognostic factors especially lympho-vascular space invasion and pelvic/para-aortic lymph node metastasis were significantly higher when myometrial invasion is above 50% and also there was significant difference in recurrence rates, overall survival and disease free survival rates between patients with superficial and deep myometrial invasion (p&lt;0.05).</p><p><strong>Conclusion:</strong> Myometrial invasion is an important prognostic parameter and can be determined intraoperatively to decide whether to perform pelvic and para-aortic lymph node dissection.</p>

Heparanase expression in both normal endometrium and endometrial cancer

2006 ◽  
Vol 16 (3) ◽  
pp. 1401-1406 ◽  
Author(s):  
J. Kodama ◽  
T. Kusumoto ◽  
N. Seki ◽  
T. Matsuo ◽  
Y. Ojima ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Survival Rates ◽  
Myometrial Invasion ◽  
Immunohistochemical Analysis ◽  
Figo Stage ◽  
Peritoneal Cytology ◽  
Normal Endometrium ◽  
Deep Myometrial Invasion ◽  
Endometrial Cancers ◽  
The Relationship

The aim of this study was to investigate the relationship between heparanase expression and prognostic factors in endometrial cancer, as well as the relationship between heparanase expression during phases of the normal endometrial cycle. Immunohistochemical analysis of 166 endometrial cancers and 34 normal endometria in various phases of growth was performed. The heparanase expression in the late-proliferative phase of normal endometria was found to be significantly higher than in either the early-proliferative or the secretory phases (P = .012 and P = .044, respectively). Heparanase expression was also significantly higher in endometrial cancer patients with tumors of an advanced FIGO stage (P = .0003) and high FIGO grade (P = .004) and with cancers showing either deep myometrial invasion (P = .023), lymph node metastasis (P = .006), lymphvascular space involvement (P = .048), or positive peritoneal cytology (P = .010). The disease-free and overall survival rates of patients with intense heparanase expression were significantly lower than those of patients with absent or moderate heparanase expression (P = .004 and P = .002, respectively). Heparanase may participate in normal endometrial remodeling and can serve as an indicator of the aggressive potential and poor prognosis of endometrial cancers.

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.

Treatment outcomes of endometrial cancer patients with paraaortic lymph node metastasis: a multi-institutional analysis

2019 ◽  
Vol 29 (1) ◽  
pp. 94-101 ◽  
Author(s):  
Cem Onal ◽  
Berna Akkus Yildirim ◽  
Sezin Yuce Sari ◽  
Guler Yavas ◽  
Melis Gultekin ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Prognostic Factors ◽  
Adjuvant Radiotherapy ◽  
Survival Rates ◽  
Myometrial Invasion ◽  
Progression Free Survival ◽  
Free Survival ◽  
Radiotherapy Alone ◽  
Paraaortic Lymph Node Metastasis

ObjectiveTo analyze the prognostic factors and treatment outcomes in endometrial cancer patients with paraaortic lymph node metastasis.MethodsData from four centers were collected retrospectively for 92 patients with endometrial cancer treated with combined radiotherapy and chemotherapy or adjuvant radiotherapy alone postoperatively, delivered by either the sandwich or sequential method. Prognostic factors affecting overall survival and progression-free survival were analyzed.ResultsThe 5-year overall survival and progression-free survival rates were 35 % and 33 %, respectively, after a median follow-up time of 33 months. The 5-year overall survival and progression-free survival rates were significantly higher in patients receiving radiotherapy and chemotherapy postoperatively compared with patients treated with adjuvant radiotherapy alone (P < 0.001 and P < 0.001, respectively). In a subgroup analysis of patients treated with adjuvant combined chemotherapy and radiotherapy, the 5-year overall survival and progression-free survival rates were significantly higher in patients receiving chemotherapy and radiotherapy via the sandwich method compared with patients treated with sequential chemotherapy and radiotherapy (P = 0.02 and P = 0.03, respectively). In the univariate analysis, in addition to treatment strategy, pathology, depth of myometrial invasion, and tumor grade were significant prognostic factors for both overall survival and progression-free survival. In the multivariate analysis, grade III disease, myometrial invasion greater than or equal to 50%, and adjuvant radiotherapy alone were negative predictors for both overall survival and progression-free survival.ConclusionWe demonstrated that adjuvant combined treatment including radiotherapyand chemotherapy significantly increases overall survival and progression-free survival rates compared with postoperative pelvic and paraaortic radiotherapy.

Evaluation of systemic and local immune responses in patients with endometrial cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5594-5594
Author(s):  
Martin Ore ◽  
Ignacio Romero ◽  
Zaida Garcia-Casado ◽  
Cristina Zorrero ◽  
Carmen Illueca ◽  
...  
Keyword(s):  
Immune Response ◽  
Endometrial Cancer ◽  
Disease Free Survival ◽  
Myometrial Invasion ◽  
Lower Grade ◽  
Roc Curve Analysis ◽  
Free Survival ◽  
Hematoxylin And Eosin ◽  
Infiltrating Lymphocytes ◽  
Disease Free

5594 Background: Several studies suggest that systemic immune response (SIR) and local immune response (LIR) have independent roles in multiple types of cancer. In endometrial cancer (EC), the correlation between SIR and LIR and its prognostic value remains unclear. Methods: A total of 146 EC patients (stage I-IV) who had undergone surgery from 2009 to 2015, were identified from a prospective institutional database. Lymphocyte/monocyte ratio (LMR) to represent SIR was calculated from preoperative blood samples. The presence of intratumoral and peritumoral infiltrating lymphocytes (TILs) on hematoxylin and eosin-stained slides was considered as a surrogate of LIR. LMR and TILs were correlated to pathological findings and survival outcomes (overall survival: OS, disease free survival: DFS). Results: A LMR cutoff value of 4.4 for survival was determined based on receiver operating characteristic (ROC) curve analysis. LMR high was significantly associated with endometrioid histology (p=0.03), lower grade (G1-2; p=0.003), < 50% myometrial invasion (p=0.01) and I-II stage (p=0.02). TILs were correlated with MSI-high (p<0.005), but not with LMR (p=0.3). Low LMR was associated with worse 5-year OS rates (64.5% vs 93.9%; p<0.01) and presence of TILs with better 5-years OS rates (72% vs 27%; p=0.04). On multivariate analysis (table 1) LMR, histology, stage and grade remained independent prognostic factors for OS (p=0.01). Using the combination of LMR and TILs, four groups with decreasing 5-years OS rates were identified: LMR-high/TILs+ (100%) > LMR-high/no-TILs (87%) > LMR-low/TILs+ (71%) > LMR-low/no-TILs (61%). Conclusions: In our series of resected EC patients, SIR (defined by LMR) constituted an independent prognostic factor for OS and LIR for DFS. We did not find any correlation between SIR and LIR, but the combination of both higher SIR and LIR showed better OS. [Table: see text]

scholarly journals The effect of myometrial invasion on prognostic factors and survival analysis in endometrial carcinoma

1970 ◽  
Vol 19 (4) ◽  
pp. 3235-3241
Author(s):  
Cem Dane ◽  
Sait Bakir
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Prognostic Factors ◽  
Survival Rate ◽  
Endometrial Carcinoma ◽  
Myometrial Invasion ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Free Survival ◽  
The Relationship

Background: We investigated the relationship between myometrial invasion and the prognostic factors on overall and progression free survival in endometrial carcinoma.Methods: 122 cases operated with endometrial cancer were included into the study. Progression-free survival and overall survival were evaluated according to degree of myometrial invasion. We also investigated the relationship between myometrial invasion and prognostic factors. Results: The 5- year progression-free survival rate was 90 % in stage I, 66 % in stage II, 32 % in stage III and 60 % in stage IV. The 5- year overall survival rate was 95 % in stage I, 89 % in stage II, 49 % in stage III and 30 % in stage IV. The progression free survival and overall survival for patients with more than 50 % myometrial invasion were detected 67 % at 58 months and 66 % at 60 months, respectively. The clinicopathological variables that significantly correlated with myometrial invasion of more than 50 % were as follows: pelvic lymph node metastasis (p: 0,00029-OR: 11.2), cervical stromal invasion (p: 0008-OR:7.9), LVSI (p< 0.0001-OR: 16.5).Conclusion: The depth of myometrial invasion is one of the most important prognostic indicators and determinants of therapy in endometrial cancer. Keywords: Endometrial carcinoma; Progression free survival; Overall survival; Prognostic factors.

scholarly journals Tissue Infiltrating Immune Cells as Prognostic Biomarkers in Endometrial Cancer: A Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Fang Guo ◽  
Yishan Dong ◽  
Qingqing Tan ◽  
Jing Kong ◽  
Bin Yu
Keyword(s):  
Endometrial Cancer ◽  
T Cell ◽  
Cell Density ◽  
Immune Cells ◽  
Statistical Power ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Free Survival ◽  
Gynecology And Obstetrics ◽  
The Relationship

Background. The association between tumour-infiltrating immune cells and the prognosis of endometrial cancer (EC) is controversial due to the smaller sample sizes and limited statistical power of the extant studies. We carried out a meta-analysis of the relationship between tumour-infiltrating immune cells and EC survival outcomes. Methods. A literature search in multiple databases was carried out up to December 2019. Pooled hazard ratio (HRs) and 95% confidence intervals (CIs) were calculated by the Z-test to assess the association between infiltrating immune cells and overall survival (OS), progression-free survival (PFS), relapse-free survival (RFS), disease-specific survival (DSS), and disease-free survival (DFS). A subgroup analysis was performed based on the localisation of immune cells in tumour parenchyma or stroma, immune markers, and the International Federation of Gynecology and Obstetrics stage. Heterogeneity and publication bias between studies were evaluated by Cochran’s Q-test and Egger regression test, respectively. Results. Seventeen studies were included in the analysis. The pooled HR of OS, PFS, DSS, and DFS indicated that a high CD8+ T cell density was associated with a favorable prognosis in EC patients. A significant relationship was found between a high density of CD45RO+ T cells and a favorable OS in EC patients, but the FoxP3+ T cell density was not associated with either OS or RFS. A high TAM density was associated with a worse PFS. However, a sensitivity analysis indicated that the findings of PFS and DSS in CD8+ T cell and PFS in TAM were not robust results. Conclusion. This is the first meta-analysis of the relationship between tumour-infiltrating immune cells and the prognosis of EC. High CD8+ and CD45RO+ T cell densities in tumours were associated with favorable outcomes in EC patients.

scholarly journals Stage IB Endometrioid Type Endometrial Cancer: The Role of Lymphadenectomy and Adjuvant Radiation Therapy

2018 ◽  
Vol 24 (3) ◽  
pp. 156
Author(s):  
Osman Turkmen ◽  
Tolga Tasci ◽  
Derman Basaran ◽  
Gunsu Comert Kimyon ◽  
Alper Karalök ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Adjuvant Radiotherapy ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Adjuvant Radiation ◽  
Free Survival ◽  
Stage Ib ◽  
Gynecology And Obstetrics ◽  
Disease Free

<p><strong>Objective:</strong> Both performances of lymphadenectomy and benefit of adding adjuvant radiotherapy are controversial for patients with International Federation of Gynecology and Obstetrics stage IB endometrioid type endometrial cancer. We aimed to identify the role of lymphadenectomy and adjuvant radiation therapy as well as clinicopathological prognostic factors for this group of patients.<br /><strong></strong></p><p><strong>Study Design:</strong> Records of all patients (n=132) with stage IB endometrioid endometrial cancer who were referred to or treated in our institution between Jan 1992 and Dec 2013 were retrospectively reviewed. Cox Proportional Hazard Regression Analysis was used to determine the effects of lymphadenectomy and adjuvant radiation as well as other clinicopathological factors on disease free survival and overall survival.</p><p><strong>Results:</strong> Mean age was 59.9 years (range, 45-82). Lymphadenectomy didn't perform in 36 (27.3%) patients and 23 (17.4%) patients did not have any kind of adjuvant treatment. Mean lymph node count was 18.8 (range, 3-67). Federation of Gynecology and Obstetrics grade, lymphovascular space invasion, lymphadenectomy, receiving adjuvant treatment and type of received adjuvant therapy were not associated with disease free survival and overall survival for the entire cohort. In a subgroup of patients with grade1&amp;2 tumor, 5-year disease free survival rates were 80% and 50% (p=0.4), respectively and overall survival rates were 94.8% and 93.8% (p=0.2), respectively for patients who had or didn't have adjuvant radiotherapy. While performance of lymphadenectomy was not significantly associated with disease free survival in this subgroup (p=0.56), this association was statistically significant for overall survival (97.9% vs. 86.4%, p=0.04) <br /><strong></strong></p><p><strong>Conclusion:</strong> Benefit of adjuvant radiotherapy in regard to prevention of recurrence needs to be confirmed by further studies. Lymphadenectomy had a survival benefit for patients with myometrial invasion greater than a half of myometrial thickness.</p>

Impact of Hormone Receptor Status and Ki-67 Expression on Disease-Free Survival in Patients Affected by High-risk Endometrial Cancer

2018 ◽  
Vol 28 (3) ◽  
pp. 505-513 ◽  
Author(s):  
Violante Di Donato ◽  
Valentina Iacobelli ◽  
Michele Carlo Schiavi ◽  
Vanessa Colagiovanni ◽  
Irene Pecorella ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
High Risk ◽  
Disease Free Survival ◽  
Myometrial Invasion ◽  
Depth Of Invasion ◽  
Prognostic Impact ◽  
Ki 67 ◽  
Free Survival ◽  
Gynecology And Obstetrics ◽  
Disease Free

ObjectivesThe aim of this study was to evaluate the immunohistochemical (IHC) expression of Ki-67, estrogen receptors α (ERsα), and progesterone receptors (PRs) in high-risk endometrial cancer patients and to assess their prognostic impact.Methods/MaterialsImmunohistochemical expression of Ki-67, ERsα, and PRs was evaluated in primary untreated endometrial cancer. The correlation among IHC staining and risk factors of recurrence such as age, Federation International of Gynecology and Obstetrics stage, grading, depth of invasion, and metastatic spread was assessed.ResultsEighty-two patients were available for the analysis. Mean ± SD age was 65.05 ± 10.48 years. The IHC assessment revealed a lack of ERα in 46.3% and of PR in 48.7% as well as a high Ki-67 in 31.7%. Loss of ERα and PR was associated with a significant higher rate of advanced stage of disease, a higher frequency of G3 tumors, and a myometrial invasion greater than 50%. A strong Ki-67 expression correlated with a deeper myometrial invasion. Analysis of the interrelationship between receptor immunonegativity revealed a relevant association of ERα immunolocalization with PR and with a high Ki-67 expression. The present study also showed that loss of ERα (P = 0.003), advanced Federation International of Gynecology and Obstetrics stage (P < 0.001), and high Ki-67 (P = 0.004) were independent prognostic factors of a shorter disease-free survival. Importantly, loss of ERα, loss of PR, and a high Ki-67 were correlated with a higher incidence of distant recurrence.ConclusionsA systematic immunohistochemistry should be a key step in the therapeutic algorithm and could contribute to the identification of high-risk tumors.

Correlation between preoperative serum CA 125 and surgicopathologic prognostic factors in endometrial cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16524-e16524
Author(s):  
E. Espino-Strebel ◽  
J. T. Luna
Keyword(s):  
Endometrial Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Cancer Patients ◽  
Myometrial Invasion ◽  
Cutoff Value ◽  
Preoperative Serum ◽  
Aortic Lymph Node ◽  
Serum Ca125 ◽  
Node Involvement

e16524 Background: Poor prognostic factors dictating the need for extended surgical staging among endometrial cancer patients can be accurately determined only after laparotomy. An adequate preoperative work-up is thus necessary to tailor surgical treatment individually. This prospective study was conducted to determine the correlation between preoperative serum CA125 and surgicopathologic prognostic factors in endometrial cancer. It also aimed to determine the CA125 cutoff value which best predicted the prognostic factors to which it was correlated. Methods: Endometrial cancer patients diagnosed from October 2006 to July 2008 who were eligible for primary surgical treatment were included. Serum CA125 determination was done by a chemiluminescent enzyme immunoassay prior to surgery. All patients underwent laparotomy, peritoneal fluid cytology, extrafascial/radical hysterectomy, bilateral salpingooophorectomy, bilateral pelvic lymph node dissection, and para-aortic lymph node sampling. Specimens were examined for tumor differentiation, lymphovascular space invasion, depth of myometrial invasion, cervical, adnexal, and vaginal involvement, pelvic and para-aortic lymph node metastases, and peritoneal fluid cytology. Pearson r correlation test was used to evaluate the correlation of serum CA125 with the prognostic factors. A receiver operating characteristic curve was used to determine the optimal cutoff value of preoperative CA125. Results: Ninety patients with endometrioid endometrial adenocarcinoma were included. Preoperative serum CA125 was significantly correlated with deep myometrial invasion (p = 0.02), adnexal metastasis (p = 0.01), pelvic (p < 0.01), and para-aortic node involvement (p<0.01). It was also significantly correlated with extrauterine disease (p = 0.01). A cutoff value of 55U/mL can predict extrauterine spread with 53.85% sensitivity, 84.38% specificity and 75.56% accuracy. Conclusions: Preoperative serum CA125 has a significant correlation with deep myometrial invasion, adnexal metastasis, pelvic and para-aortic lymph node involvement, and extrauterine disease at a cutoff value of 55U/mL. It is recommended that serum CA125 determination be part of the preoperative work-up of endometrial cancer patients. No significant financial relationships to disclose.

Significance of para-aortic lymph node evaluation in patients with FIGO IIIC1 cervical cancer

2020 ◽  
Vol 50 (10) ◽  
pp. 1150-1156
Author(s):  
Won Kyung Cho ◽  
Yeon Joo Kim ◽  
Hakyoung Kim ◽  
Young Seok Kim ◽  
Won Park
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Disease Free Survival ◽  
Concurrent Chemotherapy ◽  
Node Dissection ◽  
Free Survival ◽  
Aortic Lymph Node ◽  
Disease Free

Abstract Objective This study investigated the effect of para-aortic lymph node sampling or dissection in recently revised International Federation of Gynecology and Obstetrics IIIC1p cervical cancer treated with primary surgery and adjuvant radiation therapy with concurrent chemotherapy. Methods We retrospectively reviewed the records of 343 patients with early-stage cervical cancer and pathologically proven pelvic lymph node metastasis following curative surgery from 2001 to 2014. No patient had imaging evidence of para-aortic lymph node involvement, and all patients received adjuvant concurrent chemotherapy with or without concurrent chemotherapy. We investigated the significance of para-aortic lymph node sampling or dissection on disease-free survival and overall survival. Results After median follow-up of 58.3 months, 5-year disease-free survival and overall survival in all patients were 69.9 and 80.2%, respectively. Disease-free survival and overall survival did not differ between the para-aortic lymph node dissection group and the No para-aortic lymph node dissection group (P = 0.700 and P = 0.605). However, patients with para-aortic lymph node-positive disease had poorer disease-free survival and overall survival compared with those with para-aortic lymph node-negative disease (P &lt; 0.001 and P &lt; 0.001). Conclusions This study found no survival benefit of para-aortic lymph node evaluation among patients with International Federation of Gynecology and Obstetrics IIIC1p cervical cancer who were clinically para-aortic lymph node-negative. Although para-aortic lymph node metastasis is a poor prognosticator, the benefit of para-aortic lymph node dissection in terms of survival needs further investigation.

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