scholarly journals High tumor tissue concentration of plasminogen activator inhibitor 2 (PAI-2) is an independent marker for shorter progression-free survival in patients with early stage endometrial cancer

2001 ◽  
Vol 97 (3) ◽  
pp. 379-385 ◽  
Author(s):  
Johanna Nordengren ◽  
Margareta Fredstorp Lidebring ◽  
Pär-Ola Bendahl ◽  
Nils Brünner ◽  
Mårten Fernö ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Tumor Tissue ◽  
Tissue Concentration ◽  
Early Stage ◽  
Progression Free Survival ◽  
Plasminogen Activator Inhibitor ◽  
Free Survival ◽  
Independent Marker ◽  
Early Stage Endometrial Cancer ◽  
Activator Inhibitor

scholarly journals Pathologic and Treatment Outcomes Among a Geriatric Population of Endometrial Cancer Patients: An NRG Oncology/Gynecologic Oncology Group Ancillary Data Analysis of LAP2

2017 ◽  
Vol 27 (4) ◽  
pp. 730-737 ◽  
Author(s):  
Erin A. Bishop ◽  
James J. Java ◽  
Kathleen N. Moore ◽  
Joan L. Walker
Keyword(s):  
Endometrial Cancer ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Early Stage ◽  
Gynecologic Oncology ◽  
Progression Free Survival ◽  
Risk Groups ◽  
Gynecologic Oncology Group ◽  
Free Survival ◽  
Early Stage Endometrial Cancer

ObjectivesElderly endometrial cancer patients have worse disease-specific survival than their younger counterparts, but the cause for this discrepancy is unknown. The goal of this analysis is to compare outcomes by age in a fully staged elderly endometrial cancer population.Methods/MaterialsThis is an analysis of patients on Gynecologic Oncology Group Study (GOG) LAP2, which included clinically early stage endometrial cancer patients randomized to laparotomy versus laparoscopy for surgical staging. Patients were divided into risk groups based on criteria defined by GOG protocol 99. Differences in outcomes and adjuvant therapy were assessed within these risk groups.ResultsLAP2 included 715 patients 70 years or older. With increasing age, worse tumor characteristics were seen. Older patients received similar rates of adjuvant therapy when stratified by stage. Patients 70 years or older had significantly worse progression-free survival and overall survival, and on multivariate analysis, older age and high-risk uterine factors were predictors of progression-free survival and overall survival, whereas stage and lymph node metastases were not. When patients were divided into GOG protocol 99 risk categories, most of those who met the high-intermediate risk criteria did so based on age above 70 years and grade 2 to 3 disease. These patients had low risk of recurrence (3.3%) compared with those who met the criteria by age above 70 years and all 3 uterine factors (20.9%).ConclusionsIn early stage endometrial cancer, patients 70 years or older who undergo similar surgical management and adjuvant therapy, age and tumor characteristics independently predict recurrence. Most patients older than 70 years meet the high-intermediate risk criteria for recurrence based on age and 1 other uterine risk factor, and our results suggest that these patients are at low risk for recurrence.

scholarly journals Microsatellite instability leads to poor prognosis in patients with early-stage endometrial cancer? a meta-analysis

2020 ◽  
Author(s):  
Jingping Xiao ◽  
Jisheng Wang ◽  
Yuanyu Zhao ◽  
Miaoquan He ◽  
Jiang Du ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Microsatellite Instability ◽  
Publication Bias ◽  
Poor Prognosis ◽  
Early Stage ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Free Survival ◽  
Independent Marker ◽  
Early Stage Endometrial Cancer

Abstract Background Poor prognosis of early-stage endometrial cancer (EC) is often accompanied by microsatellite instability (MSI). We hypothesized that MSI is an independent marker for poor prognosis of early-stage EC. To demonstrate this hypothesis, we evaluated the correlation between MSI and early-stage EC prognosis by meta-analysis. Methods Databases such as PubMed, EMBASE and the Cochrane Cooperative Library were searched from inception to October 2020, respectively. The disease-free survival (DFS), the overall survival (OS), and the progression-free survival (PFS) were pooled to analyze the correlation between MSI and prognosis in patients with early-stage EC. Besides, Egger's regression and Begg's test were used to detect Publication bias. Results There were 7 studies met the inclusion criteria and were enrolled in our meta-analysis with a sample size of 1150, and the included patients with early-stage EC were all endometrioid endometrial cancer (EEC). The pooled hazard ratios (HRs) in early-stage EC shows that MSI is significantly associated with lower DFS [HR = 3.90, 95%CI (2.81–6.99), p = 0.000], OS [HR = 1.48, 95%CI (1.12–1.96), p = 0.006], and PFS [HR = 2.41, 95%CI (1.05–5.52), p = 0.038]. There was no significant heterogeneity in the studies pooled analysis of DFS, OS, and PFS. There was also no statistical publication bias, the P-value of Egger`s test of OS and DFS is p = 0.535 and p = 0.639 respectively. Conclusion MSI is most likely an independent marker of poor prognosis in early-stage EC, and this correlation is even more significant in patients with EEC.

Adjuvant treatment improves overall survival in women with high-intermediate risk early-stage endometrial cancer with lymphovascular space invasion

2020 ◽  
Vol 30 (11) ◽  
pp. 1738-1747
Author(s):  
Ji Son ◽  
Laura M Chambers ◽  
Caitlin Carr ◽  
Chad M Michener ◽  
Meng Yao ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Early Stage ◽  
Progression Free Survival ◽  
External Beam Radiation ◽  
Intermediate Risk ◽  
Beam Radiation ◽  
Free Survival ◽  
Early Stage Endometrial Cancer ◽  
Lymphovascular Space Invasion

BackgroundAdjuvant therapy in early-stage endometrial cancer has not shown a clear overall survival benefit, and hence, patient selection remains crucial.ObjectiveTo determine whether women with high-intermediate risk, early-stage endometrial cancer with lymphovascular space invasion particularly benefit from adjuvant treatment in improving oncologic outcomes.MethodsA multi-center retrospective study was conducted in women with stage IA, IB, and II endometrial cancer with lymphovascular space invasion who met criteria for high-intermediate risk by Gynecologic Oncology Group (GOG) 99. Patients were stratified by the type of adjuvant treatment received. Clinical and pathologic features were abstracted. Progression-free and overall survival were evaluated using multivariable analysis.Results405 patients were included with the median age of 67 years (range 27–92, IQR 59–73). 75.0% of the patients had full staging with lymphadenectomy, and 8.6% had sentinel lymph node biopsy (total 83.6%). After surgery, 24.9% of the patients underwent observation and 75.1% received adjuvant therapy, which included external beam radiation therapy (15.1%), vaginal brachytherapy (45.4%), and combined brachytherapy + chemotherapy (19.1%). Overall, adjuvant treatment resulted in improved oncologic outcomes for both 5-year progression-free survival (77.2% vs 69.6%, HR 0.55, p=0.01) and overall survival (81.5% vs 60.2%, HR 0.42, p<0.001). After adjusting for stage, grade 2/3, and age, improved progression-free survival and overall survival were observed for the following adjuvant subgroups compared with observation: external beam radiation (overall survival HR 0.47, p=0.047, progression-free survival not significant), vaginal brachytherapy (overall survival HR 0.35, p<0.001; progression-free survival HR 0.42, p=0.003), and brachytherapy + chemotherapy (overall survival HR 0.30 p=0.002; progression-free survival HR 0.35, p=0.006). Compared with vaginal brachytherapy alone, external beam radiation or the addition of chemotherapy did not further improve progression-free survival (p=0.80, p=0.65, respectively) or overall survival (p=0.47, p=0.74, respectively).ConclusionAdjuvant therapy improves both progression-free survival and overall survival in women with early-stage endometrial cancer meeting high-intermediate risk criteria with lymphovascular space invasion. External beam radiation or adding chemotherapy did not confer additional survival advantage compared with vaginal brachytherapy alone.

Why Routine Clinical Follow-up for Patients With Early Stage Endometrial Cancer Is Not Always Necessary: A Study on Women in South Wales

2014 ◽  
Vol 24 (3) ◽  
pp. 556-563 ◽  
Author(s):  
Lilly Aung ◽  
Robert E.J. Howells ◽  
Kenneth C.K. Lim ◽  
Emma Hudson ◽  
Peter W. Jones
Keyword(s):  
Endometrial Cancer ◽  
Confidence Interval ◽  
Endometrial Carcinoma ◽  
Early Stage ◽  
Progression Free Survival ◽  
Disease Recurrence ◽  
Hazard Ratio ◽  
Free Survival ◽  
South Wales

ObjectiveThis study aimed to examine the existing methods of follow-up in women who have undergone treatment of early endometrial carcinoma in South Wales and to assess if they are appropriate.DesignThis study used a retrospective analysis of follow-up data.SettingThis study was performed in the Virtual Gynaecological Oncology Centre, South Wales, United Kingdom.SampleThis study sample is composed of 552 women.MethodsData regarding follow-up were collected retrospectively from patient case notes and computerized data systems. Data were analyzed using the Pearson χ2 test, Cox proportional hazard regression analysis, and Kaplan-Meier curves.Main Outcome MeasuresThis study aimed to determine whether routine follow-up was beneficial in detecting disease recurrence and whether outcome was influenced by routine follow-up.ResultsBetween January 1, 2000, and December 31, 2010, 552 women were treated for early stage endometrial carcinoma. The 5-year survival was 81%, and the 5-year progression-free survival was 77%. Of these 552 women, 81 (15%) developed a disease recurrence; the majority (61/81 [75%]) recurred within 3 years. The median survival was 35 months compared with 47 months in patients who did not develop a recurrence. Of the 81 patients, 73 (90%) were symptomatic and only 5 patients were truly asymptomatic at follow-up. The most important and significant prognostic factor was “recurrent disease” with overall survival (hazard ratio, 2.20; P < 0.001; 95% confidence interval, 1.75–2.65) and progression-free survival (hazard ratio, 2.52; P < 0.001; 95% confidence interval, 2.09–2.95). “Asymptomatic recurrence” was not an independent predictor of outcome.ConclusionsRoutine follow-up for early endometrial cancer is not beneficial for patients because most were symptomatic at the time of detection. It does not significantly improve the outcome. We propose altering the follow-up time regimen and adopting alternative follow-up strategies for women in South Wales.

Definitive radiotherapy for vaginal recurrence of early-stage endometrial cancer: survival outcomes and effect of mismatch repair status

2021 ◽  
pp. ijgc-2021-002536
Author(s):  
Gabriela Alban ◽  
Teresa Cheng ◽  
Jenna Adleman ◽  
Ivan Buzurovic ◽  
Jennifer Pretz ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Mismatch Repair ◽  
Early Stage ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Definitive Radiotherapy ◽  
Image Guided ◽  
Early Stage Endometrial Cancer ◽  
Vaginal Recurrence

ObjectiveTo evaluate clinical outcomes, prognostic factors, and toxicity in patients with vaginal recurrence of early-stage endometrial cancer treated with definitive radiotherapy.MethodsRetrospective review identified 62 patients with stage I–II endometrial cancer and vaginal recurrence treated with external beam radiotherapy and image-guided brachytherapy with definitive intent from November 2004 to July 2017. All patients had prior hysterectomy without adjuvant radiotherapy and >3 months follow-up. Mismatch repair (MMR) status was determined by immunohistochemical staining of the four mismatch repair proteins (MLH1, MSH2, PMS2, and MSH6) when available in the pathology record. Rates of vaginal control, recurrence-free survival, and overall survival were calculated by Kaplan–Meier. Univariate and multivariate analyses were performed by Cox proportional hazards.ResultsMost patients had endometrioid histology (55, 89%), grade 1 or 2 tumor (53, 85%), and vaginal-only recurrence (55, 89%). With a median follow-up of 39 months (range, 3–167), 3- and 5-year rates of vaginal control, recurrence-free survival, and overall survival were 86% and 82%, 69% and 55%, and 80% and 61%, respectively. On multivariate analysis, non-endometrioid histology (HR 12.5, P<0.01) was associated with relapse when adjusted for chemotherapy use. Patients with non-endometrioid histology also had a 4.5-fold higher risk of death when adjusted for age (P=0.02). Twenty patients had known MMR status, all with grade 1–2 endometrioid tumors and 10 (50%) with MMR deficiency. The 3-year recurrence-free survival was 100% for MMR-proficient tumors and 52% for MMR-deficient (P=0.03). Late grade 2 and 3 gastrointestinal, genitourinary and vaginal toxicity was reported in 27% and 3%, 15% and 2%, and 16% and 2% of patients, respectively.ConclusionDefinitive radiotherapy with image-guided brachytherapy resulted in 5-year local control rates exceeding 80% and late severe toxicity rates were under 3%. Distant recurrence was common and highest for those with grade 3 or non-endometrioid tumors and MMR deficient grade 1–2 disease.

scholarly journals Medically unfit women with early-stage endometrial cancer treated with the levonorgestrel intrauterine system

2020 ◽  
Vol 63 (3) ◽  
pp. 337-345
Author(s):  
Manolis Nikolopoulos ◽  
Michelle A.L. Godfrey ◽  
Rekha Wuntakal
Keyword(s):  
Endometrial Cancer ◽  
Early Stage ◽  
Endometrial Adenocarcinoma ◽  
Case Series ◽  
Progression Free Survival ◽  
Morbidly Obese ◽  
Obese Women ◽  
Early Stage Endometrial Cancer

ObjectiveTo assess the clinical efficacy of the levonorgestrel intrauterine system (LNG-IUS) in the treatment of early-stageendometrial cancer in elderly morbidly obese women, whose multiple co-morbidities made the standard surgicaltreatment too risky to undertake.MethodsA retrospective review was conducted and case series reports were prepared of all women diagnosed withendometrial cancer, from April 2011 to December 2016 at the Queen's Hospital, London, to identify women unfit forsurgery and treated with the LNG-IUS.ResultsOut of 438 women with endometrial cancer, Eight women with early-stage endometrial cancer were deemed unfitfor surgery and underwent treatment with the LNG-IUS. All had grade 1 endometrioid endometrial adenocarcinoma,radiologically staged as 1a. Four women died of their co-morbidities, not related to endometrial cancer. One of themhad 68 months of progression-free survival before death due to co-morbidities. One patient required a hysterectomyafter 32 months of treatment with LNG-IUS and oral progestogens due to heavy vaginal bleeding. Three women havecontinued the LNG-IUS treatment with no evidence of progressive disease symptoms till date at a mean follow-up of35.7 months.ConclusionFor women with multiple co-morbidities, the LNG-IUS offers an effective and safe treatment for early-stage, lowgradeendometrial cancer, with no cases of symptomatic progression reported in our case series. In the frail andelderly, where the quality of life is of paramount importance, surgical treatment may not offer additional long-termsurvival benefits.

Chemotherapy as Adjuvant Treatment for Early Stage Endometrial Cancer With High Intermediate Risk Factors

2018 ◽  
Vol 28 (7) ◽  
pp. 1285-1289
Author(s):  
Min Gao ◽  
Naiyi Zhang ◽  
Nan Song ◽  
Hong Zheng ◽  
Xin Yan ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Treatment ◽  
Early Stage ◽  
Disease Free Survival ◽  
Intermediate Risk ◽  
Free Survival ◽  
Platinum Based Chemotherapy ◽  
Disease Free ◽  
Early Stage Endometrial Cancer

ObjectiveThe aim of this study was to explore the role of chemotherapy as adjuvant treatment for early-stage endometrial cancer (EC) with high-intermediate-risk (HIR) factors.MethodsA prospective study of patients with early-stage EC with HIR factors for recurrence was performed between 2006 and 2014. A total of 96 patients were enrolled, and 50 patients received 3 cycles of platinum-based chemotherapy after surgery. Five-year disease-free survival and overall survival were evaluated.ResultsA total of 11 (11.5%) of the 96 patients had recurrence, with a median recurrent time of 15.4 months. Of these 11 patients with recurrence, 2 received adjuvant chemotherapy after surgery, whereas 9 did not receive any treatment. Patients without adjuvant chemotherapy exhibited a significantly higher recurrence rate than those with adjuvant chemotherapy (19.6% vs 4%; P = 0.024). Meanwhile, patients with adjuvant chemotherapy had significantly higher 5-year disease-free survival compared with the control group (92.1% vs 70.0%, P = 0.024).ConclusionsChemotherapy is feasible and safe as adjuvant treatment for early-stage EC with HIR factors. Three cycles of platinum-based chemotherapy are sufficient for reducing the risk of recurrence. Further, large sample randomized studies are needed to confirm these results.

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