Early oncological outcomes and accuracy of risk stratification and tailoring surgical staging based on preoperative histology, Ca125 and MRI in endometrial cancer: a prospective cohort study (original) (raw)
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Journal of Obstetrics and Gynaecology, 2020
In this study, 683 patients with endometrial cancer (EC) after comprehensive surgical staging were classified into four risk groups as low (LR), intermediate (IR), high-intermediate (HIR) and high-risk (HR), according to the recent consensus risk grouping. Patients with disease confined to the uterus, !50% myometrial invasion (MI) and/or grade 3 histology were treated with vaginal brachytherapy (VBT). Patients with stage II disease, positive/close surgical margins or extra-uterine extension were treated with external beam radiotherapy (EBRT)±VBT. The median follow-up was 56 months. The overall survival (OS) was significantly different between LR and HR groups, and there was a trend between LR and HIR groups. Relapse-free survival (RFS) was significantly different between LR and HIR, LR and HR and IR and HR groups. There was no significant difference in OS and RFS rates between the HIR and HR groups. In HR patients, the OS and RFS rates were significantly higher in stage IBgrade 3 and stage II compared to stage III and non-endometrioid histology without any difference between the two uterine-confined stages and between stage III and non-endometrioid histology. The current risk grouping does not clearly discriminate the HIR and IR groups. In patients with comprehensive surgical staging, a further risk grouping is needed to distinguish the real HR group. IMPACT STATEMENT What is already known on this subject? The standard treatment for endometrial cancer (EC) is surgery and adjuvant radiotherapy (RT) and/or chemotherapy is recommended according to risk factors. The recent European Society for Medical Oncology (ESMO), European Society of Gynaecological Oncology (ESGO) and European Society for Radiotherapy and Oncology (ESTRO) guideline have introduced a new risk group. However, the risk grouping is still quite heterogeneous. What do the results of this study add? This study demonstrated that the current risk grouping recommended by ESMO-ESGO-ESTRO does not clearly discriminate the intermediate risk (IR) and high-intermediate risk (HIR) groups. What are the implications of these findings for clinical practice and/or further research? Based on the results of this study, a new risk grouping can be made to discriminate HIR and IR groups clearly in patients with comprehensive surgical staging.
International Journal of Gynecological Cancer, 2014
Objective: The aim of this study was to investigate the frozen section (FS) accuracy in tailoring the surgical staging of patients affected by endometrial cancer, using 2 different risk classifications. Methods/Materials: A retrospective analysis of 331 women affected by type I endometrial cancer and submitted to FS assessment at the time of surgery. Pathologic features were examined on the frozen and permanent sections according to both the GOG33 and the Mayo Clinic algorithms. We compared the 2 models through the determination of Landis and Koch kappa statistics, concordance rate, sensitivity, specificity, positive predictive value, and negative predictive value for each risk algorithm, to assess whether there are differences in FS accuracy depending on the model used.
Assessment of endometrial sampling as a predictor of final surgical pathology in endometrial cancer
British journal of cancer, 2014
The histology and grade of endometrial cancer are important predictors of disease outcome and of the likelihood of nodal involvement. In most centres, however, surgical staging decisions are based on a preoperative biopsy. The objective of this study was to assess the concordance between the preoperative histology and that of the hysterectomy specimen in endometrial cancer. Patients treated for endometrial cancer during a 10-year period at a tertiary cancer centre were identified from a prospectively collected pathological database. All pathology reports were reviewed to confirm centralised reporting of the original sampling or biopsy specimens; patients whose biopsies were not reviewed by a dedicated gynaecological pathologist at the treating centre were excluded. Surgical pathology data including histology, grade, depth of myometrial invasion, cervical stromal involvement and lymphovascular space invasion (LVSI) as well as preoperative histology and grade were collected. Preoperat...
Clinical and Experimental Obstetrics & Gynecology
Background: We conducted a retrospective study to evaluate the correlation between preoperative and final histologic diagnoses of endometrial cancer and to identify clinicopathologic factors associated with the concordance between initial and final hysterectomy specimens. Methods: Patients who underwent primary surgical treatment for endometrial cancer at our institute from January 2016 through December 2020 were enrolled. The International Federation of Gynecology and Obstetrics (FIGO) grade and histologic subtype in the pathologic reports were recorded. The level of agreement of tumor grade and histologic type were analyzed. Results: A total of 425 cases were recruited. The overall level of agreement between preoperative grading was moderate according to kappa statistics (κ = 0.469, 95% confidence interval [CI]: 0.385, 0.553). Furthermore, agreement related to the histologic subtype was substantial (κ = 0.778, 95% CI: 0.682, 0.874). The most frequently used endometrial sampling methods were the office endometrial sampling and endometrial curettage (49.2% and 32%, respectively). Among each diagnostic method, manual vacuum aspiration and endometrial curettage had high tumor grade correlation between the preoperative sampling and final pathology (κ = 0.743, 95% CI: 0.549, 0.937 and κ = 0.624, 95% CI: 0.512, 0.736, respectively). Negative peritoneal cytology was was the significant factor associated with concordance between preoperative endometrial sampling and final surgical pathology, with an adjusted odds ratio (OR) of 2.01 (95% CI: 1.03, 3.92; p = 0.040). Conclusions: Regardless of the different diagnostic methods, preoperative endometrial biopsy has limitations in predicting tumor grade compared with final hysterectomy specimens in women with endometrial cancer.
Thai Journal of Obstetrics and Gynaecology, 2012
Objectives: To assess the benefit of intraoperative gross depth of myometrial invasion and preoperative grading as a predictor of final surgical staging in patients with low-risk endometrial cancer. Materials and Methods: Retrospective chart review of all patients with endometrial cancer underwent surgery at Rajavithi Hospital from January 1 st , 2002 to December 31 st , 2006 for demographic and clinical data, preoperative tumor grading, intraoperative gross depth of invasion and final surgical staging. Results: A total of 124 patients were eligible for analysis using data on intraoperative assessment of gross depth of myometrial invasion (no myometrial invasion or myometrial invasion less than 50%) and preoperative curettage/biopsy (grade 1 and 2). The intraoperative gross depth of myometrial invasion was upgraded 35.5% and discrepant 42.7% compared with pathologic myometrial invasion, whereas the preoperative tumor grading was upgraded 19.4% and discrepant 28.2% compared with final tumor grading. The predictive staging was clinically significantly upstaged 28 %, 30%, 33.3% and 21.4% of stage IAG1, IAG2, IBG1 and IBG2, respectively. Predictive staging resulted in suboptimal surgical treatment in 30.6% by relinquishment of lymphadenectomy. Conclusions: The combination of preoperative tumor grading and intraoperative gross depth of myometrial invasion is the poor predictor for final staging.
Surgery in Endometrial Cancer: An Audit of Quality Across Centers in India
Indian Journal of Gynecologic Oncology, 2019
Background Surgical management is the cornerstone in the treatment of endometrial cancer. However, there are many controversies involved in the management starting from what constitutes adequate staging to the type of adjuvant treatment. In India, surgeons from several specialties operate on patients with endometrial cancer and there is a lack of guideline-based practice which necessitates an audit on the quality of care offered to women with endometrial cancer. Methods The study was a questionnaire-based study conducted at various conference venues. The study participants included general surgeons, gynecologists, surgical oncologists and gynecologic oncologists who operate on endometrial cancer. Results There is an extensive variation in the management of endometrial cancer among practitioners and lack of consensus regarding lymphadenectomy and its extent during surgery. Also, the use of intraoperative frozen section and comprehensive staging is more commonly seen among oncosurgeons when compared to other specialties.
Frontiers in Oncology
Background: The current model used to preoperatively stratify endometrial cancer (EC) patients into low-and high-risk groups is based on histotype, grade, and imaging method and is not optimal. Our study aims to prove whether a new model incorporating immunohistochemical markers, L1CAM, ER, PR, p53, obtained from preoperative biopsy could help refine stratification and thus the choice of adequate surgical extent and appropriate adjuvant treatment. Conclusion: We proved superiority of new proposed model using immunohistochemical markers over standard clinical practice and that new proposed model increases accuracy of prognosis prediction. We propose wider implementation and validation of the proposed model.
Controversies in Surgical Staging of Endometrial Cancer
Obstetrics and Gynecology International, 2010
Endometrial cancer is the most common gynaecological malignancy and its incidence is increasing. In 1998, international federation of gynaecologists and obstetricians (FIGO) required a change from clinical to surgical staging in endometrial cancer, introducing pelvic and paraaortic lymphadenectomy. This staging requirement raised controversies around the importance of determining nodal status and impact of lymphadenectomy on outcomes. There is agreement about the prognostic value of lymphadenectomy, but its extent, therapeutic value, and benefits in terms of survival are still matter of debate, especially in early stages. Accurate preoperative risk stratification can guide to the appropriate type of surgery by selecting patients who benefit of lymphadenectomy. However, available preoperative and intraoperative investigations are not highly accurate methods to detect lymph nodes and a complete surgical staging remains the most precise method to evaluate extrauterine spread of the disease. Laparotomy has always been considered the standard approach for endometrial cancer surgical staging. Traditional and roboticassisted laparoscopic techniques seem to provide equivalent results in terms of disease-free survival and overall survival compared to laparotomy. These minimally invasive approaches demonstrated additional benefits as shorter hospital stay, less use of pain killers, lower rate of complications and improved quality of life.
Assessment of tumor size as a useful marker for the surgical staging of endometrial cancer
Oncology Reports, 2014
Accumulating evidence suggests that the estimation of tumor size may improve endometrial cancer treatment. We conducted an observational study aimed at elucidating the association between tumor size and other universally accepted prognostic factors in order to identify suitable preoperative parameters which can guide surgery in a subgroup of early corpus endometrial cancer. We found that when tumor size increased, both stage and grading were significantly increased. Tumor size was correlated with CA 125 serum values, node metastasis and peritoneal cytology status. Patients who have grade 1 or 2 endometrioid corpus cancer, myometrial invasion <50% and ≤3 cm largest tumor diameter can only be treated with hysterectomy. The tumor largest diameter should be evaluated as a preoperative parameter that indicates patients who do not require lymphadenectomy.