To investigate the clinicopathological characteristics, treatment, survival, and prognosis of endometrial cancer in women aged ≤40 years.
Women who underwent surgery for endometrial cancer at a ...single high-volume cancer center between January 1995 and December 2014 were retrospectively reviewed. Women aged >40, patients with missing data, and those who did not undergo surgical staging were excluded. Univariate and multivariate regression models were used to identify the risk factors for overall survival and progression-free survival.
A total of 40 patients with endometrial cancer were assessed. The median age at diagnosis was 38 (range, 21–40) years, and most of the uterine tumors found were early-stage (85%), low-grade (67.5%), and endometrioid carcinomas (97.5%). The median serum cancer antigen 125 level was 10.9 IU/mL (range, 3–1284 IU/mL). Optimal cytoreductive surgery was achieved in 35 patients (87.5%). All patients underwent total abdominal hysterectomy, and 97.5% of the patients underwent hysterectomy plus bilateral salpingo-oophorectomy. Among the total group of 40 patients, 21 (52.5%) underwent pelvic and para-aortic lymph node dissection, and 15 (37.5%) underwent only pelvic lymph node dissection. Multivariate analysis confirmed that a cancer antigen 125 level ≥35 was the only independent prognostic factor for both progression-free survival (hazard ratio, 22.997; 95% confidence interval, 1.783–296.536; p = 0.016) and overall survival (hazard ratio, 22.541; 95% confidence interval, 1.75–290.364; p = 0,017).
Our study demonstrated that a cancer antigen 125 level ≥ 35 is the only independent prognostic factor for both progression-free survival and overall survival in patients aged ≤40 years with endometrial cancer.
•Endometrial cancer is uncommon in patients 40 years of age and younger.•The prognosis for EC among younger patients tends to be more favorable than that for older patients.•CA 125 level ≥35 is the most significant factor affecting survival in patients with aged ≤40 years with endometrial cancer.
Evaluation of the effect of lymphadenectomy in disease-free and overall survival on the low risk corpus cancer.
Between 1994 and 2012, a total of 257 patients with endometrioid type, grade 1 or 2, ...myometrial invasion < 1/2, no intraoperative evidence of macroscopic extrauterine spread was treated surgically. Pelvic lymphadenec-tomy was performed in 184 cases, and not performed in 73 cases.
There was no difference between two groups about tumor sizes. Also lymphovascular space invasion and histo-logic grade of two groups were similar. Omission of LA did not worsen DFS and OS in early stage low risk corpus cancer.
Patients who have low risk corpus cancer, can be treated optimally with hysterectomy only.
Purpose
To investigate clinicopathological characteristics and oncological outcome of women with microinvasive BOTs.
Methods
A retrospective multicenter case–control study was conducted on 902 ...patients with BOT, who underwent surgery from January 2002 to December 2015 at six participating gynecologic oncology centers from Turkey. Among 902 patients, 69 had microinvasive BOT. For every patient with microinvasive BOT, two controls were randomly selected from another database based on decade of age and stage of disease at diagnosis. The clinical–pathological characteristics and oncological outcomes were compared between BOT patients with and without stromal microinvasion. Risk factors for poor oncological outcomes were investigated in a multivariate analysis model. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method.
Results
Patients with microinvasive BOT had a significantly higher rate of recurrence than patients without microinvasive BOT (17.4 vs 7.8%, OR 3.55, %95 CI 1.091–11.59,
p
= 0.03). Stage at diagnosis (stage I versus II/III) and type of surgery (cystectomy versus others) were found as other significant prognostic factors for recurrence in multivariate analysis (OR 8.63, %95 CI 2.48–29.9,
p
= 0.001 and OR 19.4, %95 CI 3.59–105.6,
p
= 0.001, respectively). Stromal microinvasion was found as a prognostic factor for significantly shorter DFS (26.7 vs 11.9 months,
p
= 0.031, log rank). However, there was no significant difference in OS between two groups (
p
= 0.99, log rank).
Conclusion
Stromal microinvasion is significantly associated with decreased DFS. In addition, our study confirms that the risk of recurrence is higher in patients with microinvasive BOT.
Genital tract lymphomas are rare entities that can be diagnosed at advanced stages. The uterine cervix is not generally infiltratedby lymphoma. Nevertheless it can be seen as a consequence of either ...a systemic disease or primary disease. The infrequency ofprimary cervical lymphoma makes the diagnosis challenging.
To examine the effect of lymphadenectomy on survival in patients with squamous cell vulvar carcinoma.
Patients with squamous cell vulvar cancer who underwent surgery were retrospectively analyzed. ...All procedures were performed according to current recommendations/standard of treatment. The clinical and pathological features were examined. Sixty-eight patients were studied. The mean age was 64.7 ± 10.9 years. Twenty-three (33.8%) patients had nodal metastasis. Most patients (60.3%) were in stage IB. Adjuvant radiotherapy and chemo-radiotherapy were administered to 33.8% and 25% of the patients, respectively. The median follow-up time was 28.5 (4-183) months. Recurrence occurred in 18 (26.5%) cases.
There was no significant difference between node-positive and node-negative patients in terms of age, number of dissected lymph nodes and recurrence. Tumor diameter was significantly higher in the metastatic group. Age and surgical margin positivity were independent prognostic factors for overall survival (OS). Surgical margin positivity and lymph node metastasis had no effect on disease-free survival (DFS).
Our results showed that age and surgical margin positivity were independent prognostic factors for OS. Although surgical margin positivity increased the risk of recurrence in univariate analysis, it was not a significant factor affecting DFS. OS was significantly lower in patients with lymph node metastasis.
Aims
The purpose of this study was to investigate the potential roles of pathological variables in the prediction of nodal metastasis in women with endometrioid endometrial cancer (EC).
Materials and ...Methods
Women who underwent surgery for endometrioid EC between 1995 and 2012 were retrospectively reviewed. Those who underwent prior neoadjuvant chemotherapy or radiotherapy and inadequate lymphadenectomy as well as those with nonendometrioid histology, synchronous cancers, International Federation of Gynecology and Obstetrics stage IV disease, gross uterine serosal and/or gross adnexal involvement were excluded. Lymph node dissemination was defined as occurring in the following circumstances: (i) when nodal metastasis with pelvic and/or para‐aortic (P/PA) lymph node dissection (LND) was performed or (ii) when there was recurrence in the P/PA lymph nodes after a negative LND or when LND was not performed. Univariate and multivariate logistic regression models were used to identify the pathological predictors of lymphatic dissemination.
Results
A total of 827 women with endometrioid EC were assessed; 516 (62.4%) of whom underwent P/PA LND and 205 (24.8%) underwent P LND. Sixty‐seven (13%) women in the P/PA LND group and 5 (2.4%) in the P LND group had positive lymph nodes. Multivariate analysis confirmed cervical stromal invasion (OR 4.04, 95% CI 2.02–8.07 (P < 0.001)) and lymphovascular space invasion (LVSI) (OR 110.18, 95% CI 38.43–315.87 (P < 0.001)) as independent predictors of lymphatic dissemination.
Conclusion
Cervical stromal invasion and LVSI are highly associated with LN metastasis. These markers may serve as a surrogate for nodal metastasis.
The purpose of this study is to evaluate the prognostic role of preoperative neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) and the need for para-aortic lymphadectomy in ...patients with primary fallopian tube carcinoma (PFTC).
Ninety-one patients with a diagnosis of PFTC were identified through the gynecologic oncology service database of six academic centers. Clinicopathological, surgical, and complete blood count data were collected.
In univariate analysis, advanced stage, suboptimal surgery, and NLR > 2.7 were significant prognostic factors for progression-free survival, whereas in multivariate analysis, only advanced stage and suboptimal surgery were significant. In addition, in univariate analysis, cancer antigen 125 ≥ 35 U/mL, ascites, advanced stage, suboptimal surgery, NLR > 2.7, PLR > 233.3, platelet count ≥ 400,000 cells/mm(3), staging type, and histological subtype were significant prognostic factors for overall survival (OS); however, in multivariate analysis, only advanced stage, suboptimal surgery, NLR > 2.7, and staging type were significant. Inclusion of pelvic and para-aortic lymphadenectomy in surgery showed significant association with longer OS, with a mean and median OS of 42.0 months and 35.5 months (range, 22 to 78 months), respectively, vs. 33.5 months and 27.5 months (range, 14 to 76 months), respectively, for patients who underwent surgery without para-aortic lymphadenectomy (hazard ratio, 3.1; 95% confidence interval, 1.4 to 5.7; p=0.002).
NLR (in both univariate and multivariate analysis) and PLR (only in univariate analysis) were prognostic factors in PFTC. NLR and PLR are inexpensive and easy tests to perform. In addition, patients with PFTC who underwent bilateral pelvic and para-aortic lymphadenectomy had longer OS.
Aim: This study investigated potential preoperative predictors of pelvic lymph node (PLN) and para-aortic LN (PaLN) involvement in cervical cancer (CC).
Materials and Methods: This study ...retrospectively analyzed 283 patients diagnosed with early (stage IA1-IIA) CC who underwent retroperitoneal LN dissection between January 1992 and February 2015. Several risk factors that are believed to influence PLN and PaLN involvement in CC were analyzed as follows: age >50 years, lymphovascular space invasion (LVSI), tumor size ≥2 cm, hemoglobin <12 g/dL, and nonsquamous cell histologic type.
Results: LVSI (odds ratio OR = 11.3, 95% confidence interval CI = 5.2-24.3) and tumor size (OR = 3.2, 95% CI = 1.4-7.2) were independent predictors of PLN involvement. None of the factors predicted PaLN involvement in a regression analysis. However, all nine patients who had PaLN involvement also had PLN involvement.
Conclusion: LVSI and tumor size independently increase the risk of PLN involvement.
(Abstracted from
Am J Obstet Gynecol
2017;216:145.e1–145.e7)
Postoperative paralytic ileus is a common and uncomfortable complication after elective abdominal surgery and is considered inevitable. ...The incidence of postoperative paralytic ileus among patients who undergo pelvic and para-aortic lymphadenectomy (PPL) as treatment for gynecologic malignancies has been estimated to be 10.6% to 50%.
The aim of this study was to evaluate the effect of an intraoperative hemostatic cellulose agent (BLOODCARE powder Life Line, Brno, Czech Republic) on reducing the incidence of postoperative chylous ...ascites (PCA) after complete pelvic and para-aortic lymphadenectomy (PPALN) in patients with gynecological cancers treated with laparotomy.
This case control study reviewed 150 patients with gynecological cancer who underwent PPALN. In the study group (n = 75), BLOODCARE powder was applied below the left renal vein and bilateral obturator fossa. In the control group (n = 75), no sealant agent was used after the procedure, such as fibrin glue or a hemostatic cellulose agent.
The demographic and surgical characteristics of the patients in both groups were similar. Chylous ascites occurred in 9 cases (6%). The incidence of PCA was lower in the study group (1 1.3% vs 8 10.7%; P = 0.03). Logistic regression analysis indicated that using BLOODCARE powder during the surgery independently protected against the development of PCA.
Using BLOODCARE powder during retroperitoneal surgery may prevent PCA. This simple, effective agent should be used after PPALN for gynecological cancers.
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