In patients with endometrial cancer, obesity is associated with a well-differentiated histological grade but not with prolonged survival. It is possible that this lack of survival advantage is caused ...by incomplete surgical staging.
In total, 716 patients with endometrial cancer were retrospectively reviewed. Obesity was defined as body mass index of ≥30 kg/m(2). The relationships between clinicopathological factors and disease-specific survival were analyzed by Cox regression analysis.
Older age (hazard ratio, 1.6; 95% confidence interval, 1.1-2.4), advanced stage (hazard ratio, 11.2; 95% confidence interval, 7.2-17.5), high-risk histology (hazard ratio, 2.7; 95% confidence interval, 1.8-4.0), no hysterectomy (hazard ratio, 3.1; 95% confidence interval, 1.7-5.8) and no lymphadenectomy (hazard ratio, 2.0; 95% confidence interval, 1.3-3.0) were independently associated with poor disease-specific survival. Survival was similar in obese and non-obese women (hazard ratio, 0.9; 95% confidence interval, 0.5-1.6) despite the fact that obesity was significantly associated with younger age and a well-differentiated histological grade. Although there was no difference in the distribution of disease stage between the two groups, obesity was associated with lower rates of hysterectomy (3.6 vs. 6.1%, P = 0.23) and lymphadenectomy (25.0 vs. 36.4%, P = 0.017). Obese patients who underwent hysterectomy had a significantly better disease-specific survival than those who did not (P = 0.002). The 5-year disease-specific survival rate in obese patients who underwent lymphadenectomy was 6.2% better than that in those who did not 86.0 vs. 79.8%, P = 0.36 (not statistically significant).
Poor-quality surgical staging in obese women may result in worse than expected survival outcomes.
Abstract Objective The circumflex iliac nodes distal to the external iliac nodes (CINDEINs) are included in the regional lymph nodes that are commonly dissected during systematic lymphadenectomy for ...ovarian cancer. Because in recent years CINDEIN dissection has been reported as a significant risk factor for postoperative lower limb lymphedema, we investigated the validity of omitting the CINDEIN dissection by evaluating the distribution pattern of positive lymph nodes in ovarian cancer, in order to improve postoperative quality of life (QOL). Methods We performed a retrospective chart review of 142 patients with ovarian cancer who had undergone systematic lymphadenectomy between 1995 and 2010. We assessed the distribution pattern of lymph node metastasis and the presence of CINDEIN metastasis according to the pT classification (pT1, pT2, and pT3). Results Of the 142 patients, 71, 21, and 50 were classified into pT1, pT2, and pT3, respectively. The lymph nodes most frequently involved were the para-aortic lymph nodes superior to the mesenteric artery (14%), followed by the obturator nodes (11%), the internal iliac nodes (9.4%), and the common iliac nodes (7.4%). Although the frequency of CINDEIN metastasis was 5.3% (6 of 114 cases with CINDEIN dissection), no metastasis to the CINDEINs was observed in pT1 patients. Conclusions It may be acceptable to omit CINDEIN dissection during surgery for pT1 ovarian cancer in view of postoperative QOL.
Growing teratoma syndrome (GTS) is defined as enlarging masses during or after chemotherapy for germ cell tumors, and containing only mature teratoma components. A surgical resection is important to ...confirm a diagnosis and thereby result in the resection of the most appropriate therapeutic management. GTS is a rare event in association with ovarian germ cell tumors. This report presents a case of a 36‐year‐old female treated surgically for GTS found during the follow‐up after chemotherapy and the primary surgical resection of a malignant immature teratoma. Those masses showed fluorodeoxyglucose positron emission tomography positivity and elevated serum CA19‐9 prior to the second operation. The histology revealed a mature teratoma. The patient has been disease free for 6 months after the second operation.
Endometrial stromal sarcoma is known to be a hormone-dependent tumor. Efficacy of hormonal therapy including high-dose progestins, aromatase inhibitors or gonadotropin-releasing hormone analogs has ...been reported. We report a case of recurrent endometrial stromal sarcoma, the tumor cells of which were strongly positive for CD10, estrogen and progesterone receptors. Although almost all of the pelvic tumors infiltrating the rectum or pelvic side wall remained, the patient is alive with slight disease 9 years and 6 months after the initial failure. During the treatment period of 4 years and 3 months, the patient was treated exclusively with dydrogesterone at a daily dose of 10 mg and the tumor clinically disappeared. Dydrogesterone at a daily dose of 10 mg may be effective in treating low-grade endometrial stromal sarcoma.
Clear cell carcinoma of the ovary tends to have a poor response to conventional platinum‐based chemotherapy. Bone recurrence from ovarian cancer is rare and prognosis of patients with such a ...condition is poor. We report a patient with chemo‐refractory ovarian clear cell carcinoma who developed pubic bone recurrence and subsequent para‐aortic node recurrence. The patient achieved long‐term survival after salvage surgery twice in spite of these inauspicious conditions. Surgical treatment should be taken into consideration for skeletal recurrence from ovarian clear cell carcinoma.
Cerebral recurrence from Müllerian cancer is a rare event and prognosis of patients with such a condition is poor. We report a case of cerebral recurrence from International Federation of Gynecology ...and Obstetrics classification stage IV tubal cancer presenting with inguinal lymphadenopathy. The patient achieved more than 7 years' disease‐free survival after irradiation to the brain despite the inauspicious event. The present case had a rare clinical course in terms of primary site, primary symptom, failure site, and clinical outcome. Patients with brain metastasis from Müllerian cancer have a chance for long‐term survival under specified circumstances, such as solitary metastasis, no extracranial metastasis, no recurrence preceding brain metastasis and small tumor size.
The prognosis of uterine leiomyosarcoma (LMS) is notoriously poor and a standard chemotherapy for patients with uterine LMS has not yet been established. Here, we describe two patients with recurrent ...LMS of the uterus who were treated with mesna, doxorubicin, ifosfamide and dacarbazine chemotherapy; one achieved complete and the other partial remission.
Abstract Objective This study aimed to clarify the clinical significance of tumor volume in endometrial cancer. Methods A total of 667 patients with endometrial cancer who underwent preoperative MRI ...and surgical treatment including lymphadenectomy were enrolled. As the surrogate marker of actual tumor volume, the volume index was defined as the product of the maximum longitudinal diameter along the uterine axis, the maximum intersecting anteroposterior diameter of the sagittal section image, and the maximum horizontal diameter of the horizontal section image from the MRI data. The volume index was divided into five categories: Group 1 (< 8), Group 2 (8 to < 27), Group 3 (27 to < 64), Group 4 (64 to < 125), and Group 5 (125 or more). The relationships between various clinicopathologic factors and volume index were investigated, and Cox regression analysis was conducted to assess the significance of volume index with respect to prognosis. Results High-risk clinicopathologic findings increased with tumor volume. The lymph node metastasis rate was 3% in Group 1, 9% in Group 2, 17% in Group 3, 25% in Group 4, and 53% in Group 5. Cox regression analysis showed that the volume index (≥ 36) was a prognostic factor (hazard ratio: 2.0, 95% confidence interval: 1.3–3.1) independent of older age (≥ 58 years), high-risk histological grade/subtype, deep myoinvasion, lymph node metastasis, and type of surgery. Conclusion Tumor volume successively reflects the state of disease progression in endometrial cancer. The volume index can give information on both the staged prognosis and surgical management.
The GOG240 trial established bevacizumab with chemotherapy as standard first-line therapy for metastatic or recurrent cervical cancer. In the BEATcc trial (ENGOT-Cx10–GEICO 68-C–JGOG1084–GOG-3030), ...we aimed to evaluate the addition of an immune checkpoint inhibitor to this standard backbone.
In this investigator-initiated, randomised, open-label, phase 3 trial, patients from 92 sites in Europe, Japan, and the USA with metastatic (stage IVB), persistent, or recurrent cervical cancer that was measurable, previously untreated, and not amenable to curative surgery or radiation were randomly assigned 1:1 to receive standard therapy (cisplatin 50 mg/m2 or carboplatin area under the curve of 5, paclitaxel 175 mg/m2, and bevacizumab 15 mg/kg, all on day 1 of every 3-week cycle) with or without atezolizumab 1200 mg. Treatment was continued until disease progression, unacceptable toxicity, patient withdrawal, or death. Stratification factors were previous concomitant chemoradiation (yes vs no), histology (squamous cell carcinoma vs adenocarcinoma including adenosquamous carcinoma), and platinum backbone (cisplatin vs carboplatin). Dual primary endpoints were investigator-assessed progression-free survival according to Response Evaluation Criteria in Solid Tumours version 1.1 and overall survival analysed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03556839, and is ongoing.
Between Oct 8, 2018, and Aug 20, 2021, 410 of 519 patients assessed for eligibility were enrolled. Median progression-free survival was 13·7 months (95% CI 12·3–16·6) with atezolizumab and 10·4 months (9·7–11·7) with standard therapy (hazard ratio HR=0·62 95% CI 0·49–0·78; p<0·0001); at the interim overall survival analysis, median overall survival was 32·1 months (95% CI 25·3–36·8) versus 22·8 months (20·3–28·0), respectively (HR 0·68 95% CI 0·52–0·88; p=0·0046). Grade 3 or worse adverse events occurred in 79% of patients in the experimental group and in 75% of patients in the standard group. Grade 1–2 diarrhoea, arthralgia, pyrexia, and rash were increased with atezolizumab.
Adding atezolizumab to a standard bevacizumab plus platinum regimen for metastatic, persistent, or recurrent cervical cancer significantly improves progression-free and overall survival and should be considered as a new first-line therapy option.
F Hoffmann-La Roche.
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