The effect of complete surgical staging and adjuvant chemotherapy on survival in stage I, grade 1 and 2 endometrioid ovarian carcinoma

ObjectivesTo assess the effect of complete surgical staging and adjuvant chemotherapy on survival in stage I, low grade endometrioid ovarian cancer.MethodsThis retrospective study was conducted at two cancer centers from July 2001 to December 2019. Inclusion criteria were all stage I, grade 1 and 2 endometrioid ovarian cancer patients. Patients with mixed histology, concurrent endometrial cancer, neoadjuvant chemotherapy, and patients who did not undergo follow-up at our centers were excluded. Clinical, pathologic, recurrence, and follow-up data were collected. Cox proportional hazard model evaluated predictive factors. Recurrence-free survival and overall survival were calculated using the Kaplan-Meier method.ResultsThere were 131 eligible stage I patients: 83 patients (63.4%) were stage IA, 5 (3.8%) were stage IB, and 43 (32.8%) were stage IC, with 80 patients (61.1%) having grade 1 and 51 (38.9%) patients having grade 2 disease. Complete lymphadenectomy was performed in 34 patients (26.0%), whereas 97 patients (74.0%) had either partial (n=22, 16.8%) or no (n=75, 57.2%) lymphadenectomy. Thirty patients (22.9%) received adjuvant chemotherapy. Median follow-up was 51.5 (95% CI 44.3 to 57.2) months. Five-year recurrence-free survival was 88.0% (95% CI 81.6% to 94.9%) and 5 year overall survival was 95.1% (95% CI 90.5% to 99.9%). In a multivariable analysis, only grade 2 histology had a significantly higher recurrence rate (HR 3.42, 95% CI 1.03 to 11.38; p=0.04). There was no difference in recurrence-free survival (p=0.57) and overall survival (p=0.30) in patients with complete lymphadenectomy. In stage IA/IB, grade 2 there was no benefit of adjuvant chemotherapy (p=0.19), and in stage IA/IB, low grade without complete surgical staging there was no benefit of adjuvant chemotherapy (p=0.16). Twelve patients (9.2%) had recurrence; 3 (25%) were salvageable at recurrence and are alive with no disease.ConclusionsPatients with stage I, low grade endometrioid ovarian cancer have a favorable prognosis, and adjuvant chemotherapy and staging lymphadenectomy did not improve survival.

A Review of the Clinical Characteristics and Novel Molecular Subtypes of Endometrioid Ovarian Cancer

Ovarian cancer is one of the most common gynecologic cancers that has the highest mortality rate. Endometrioid ovarian cancer, a distinct subtype of epithelial ovarian cancer, is associated with endometriosis and Lynch syndrome, and is often accompanied by synchronous endometrial carcinoma. In recent years, dysbiosis of the microbiota within the female reproductive tract has been suggested to be involved in the pathogenesis of endometrial cancer and ovarian cancer, with some specific pathogens exhibiting oncogenic having been found to contribute to cancer development. It has been shown that dysregulation of the microenvironment and accumulation of mutations are stimulatory factors in the progression of endometrioid ovarian carcinoma. This would be a potential therapeutic target in the future. Simultaneously, multiple studies have demonstrated the role of four molecular subtypes of endometrioid ovarian cancer, which are of particular importance in the prediction of prognosis. This literature review aims to compile the potential mechanisms of endometrioid ovarian cancer, molecular characteristics, and molecular pathological types that could potentially play a role in the prediction of prognosis, and the novel therapeutic strategies, providing some guidance for the stratified management of ovarian cancer.

Genital endometriosis: pathogenesis, diagnosis, and association with malignancies

Endometriosis is a hormone-dependent genetic disease that develops in impaired immune homeostasis. However, its pathogenesis remains an enigma. It is known that eutopic endometrium in women with endometriosis is different from that in healthy women. Morphologic examination of eutopic endometrium sample allows diagnosing endometriosis at an early stage. To date, the association between endometriosis and the risk of malignancies is in strong focus. Endometriosis is a benign disorder but shares similarities with malignancies, e.g., apoptosis resistance and stimulation of angiogenesis. Recent findings suggest that endometriosis is a precursor of clear cell and endometrioid ovarian cancer. Further studies are needed to identify novel markers of endometriosis for its timely diagnosis. Timely and adequate therapy reduces the prevalence of ovarian tumors. Further development of molecular studies on endometriosis and ovarian cancer predictors will uncover pathogenic mechanisms and find potential preventive and treatment modalities. KEYWORDS: endometriosis, ovarian cancer, eutopic endometrium, ectopic endometrium, apoptosis, angiogenesis. FOR CITATION: Il’ina I.Yu., Burdin D.V., Narimanova M.R., Ibragimova D.M. Genital endometriosis: pathogenesis, diagnosis, and association with malignancies. Russian Journal of Woman and Child Health. 2021;4(4):339–345 (in Russ.). DOI: 10.32364/2618-8430- 2021-4-4-339-345.

Thymic Hyperplasia after Adjuvant Chemotherapy in Endometrioid Ovarian Cancer-A Rare Case Report

We present this case to illustrate the fact that doctors need to be cognizant of the unusual presentation of thymic hyperplasia in patients receiving adjuvant chemotherapy for endometrioid ovarian cancer to avoid needless investigations and therapies. Furthermore, this case highlights the need for further studies in order to specify the correlation between thymic hyperplasia and the primary malignancy.