Research Article
Year 2023,
Volume: 8 Issue: 3, 338 - 344, 06.09.2023
Abstract
Objective: The study aims to investigate the prognostic factors in uterine endometrioid adenocarcinoma that affect survival outcomes.
Materials and Methods: This retrospective study includes 144 cases which underwent surgical treatment for uterine endometrioid adenocarcinoma. Demographic data and tumour characteristics were evaluated for lymph node metastasis. Stage I and grade 1-2 tumours were divided into lymphadenectomy and non-lymphadenectomy groups, and 5-year survival was assessed.
Results: The presence of myometrial invasion of more than 1/2, adnexal metastasis and lymphovascular space invasion were found to be associated with lymph node metastasis (p=0.010 ve 0.019 ve 0.015). In our study, the 5-year survival rate was 87.4%. Survival rate was correlated with age, myometrial invasion, and tumour grade. The 5-year survival rates were 89.8% in lymphadenectomy group and 85.2% in non-lymphadenectomy group, and no statistically significant difference was observed (p=0.575).
Conclusion: Myometrial invasion, grade and the age of diagnosis were detected as important prognostic factors of uterine endometrioid adenocarcinomas. We concluded that lymphadenectomy did not increase the survival rate of stage I grade 1-2 endometrioid tumours. Lymphadenectomy may not be performed in stage I grade 1-2 tumours; thus, the morbidities of lymphadenectomy can be avoided.
References
- Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi:10.3322/caac.21492
- Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48. doi:10.3322/caac.21763
- National Cancer Institute. Cancer Stat Facts: Uterine Cancer. https://seer.cancer.gov/statfacts/html/corp.html. Accessed April 1, 2023.
- Greggi S, Franchi M, Aletti G, et al. Management of endometrial cancer in Italy: a national survey endorsed by the Italian Society of Gynecologic Oncology. Int J Surg. 2014;12(10):1038-44. doi:10.1016/j.ijsu.2014.08.356
- Calle EE, Rodriquez C, Walker-Thurmond K, Thun MJ. Overweight, obesity and mortality from cancer in prospectively studied cohort of US. adults. New England Journal of Medicine. 2003;348(17):1625-1638. doi:10.1056/NEJMoa021423
- Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987;15;60(8 Suppl):2035-2041. doi:10.1002/10970142(19901015)60:8+<2035::aid-cncr2820601515>3.0.co;2-8
- May K, Bryant A, Dickinson HO, Kehoe S, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev. 2010:20;(1):CD007585. Update in: Cochrane Database Syst Rev. 2015;9:CD007585. doi:10.1002/14651858.CD007585.pub2
- Chang SJ, Kim WY, Yoon JH, Yoo SC, Chang KH, Ryu HS. Para-aortic lymphadenectomy improves survival in patients with intermediate to high risk endometrial carcinoma. Acta Obstet and Gynecology Scand. 2008;87:1361-1369. doi:10.1080/00016340802503054
- Lucic N, Draganovic D, Sibincic S, Ecim-Zlojutro V, Milicevic S. Myometrium invasion, tumor size and lymphovascular ınvasion as a prognostic factor in dissemination of pelvic lymphatics at endometrial Carcinoma. Med Arch. 2017;71:325-329. doi:10.5455/medarh.2017.71.325-329
- Poupon C, Bendifallah S, Ouldamer L, et al. Management and Survival of Elderly and Very Elderly Patients with Endometrial Cancer: An Age-Stratified Study of 1228 Women from the FRANCOGYN Group. Ann Surg Oncol. 2017;24(6):1667-1676. doi:10.1245/s10434-016-5735-9
- Donkers H, Bekkers R, Massuger L, Galaal K. Socioeconomic deprivation and survival in endometrial cancer: The effect of BMI. Gynecol Oncol. 2020;156(1):178-184. doi:10.1016/j.ygyno.2019.10.030
- Ayhan A, Şahin H, Sari ME, Yalçin I, Haberal A, Meydanli MM. Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer. Int J Gynecol Cancer. 2019;29(3):505-512. doi:10.1136/ijgc-2018-000069
- Ruterbusch JJ, Ali-Fehmi R, Olson SH, et al. The influence of comorbid conditions on racial disparities in endometrial cancer survival. Am J Obstet Gynecol. 2014;211(6):627.e1-9. doi:10.1016/j.ajog.2014.06.036
- McVicker L, Cardwell CR, Edge L, et al. Survival outcomes in endometrial cancer patients according to diabetes: a systematic review and meta-analysis. BMC Cancer. 2022;20;22(1):427. doi:10.1186/s12885-022-09510-7
- Bak SE, Yoo JG, Lee SJ, Yoon JH, Park DC, Kim SI. Prognostic significance of histological grade in low-risk endometrial cancer. Int J Med Sci. 2022;19(13):1875-1878. doi:10.7150/ijms.77152
- Han KH, Kim HS, Lee M, Chung HH, Song YS. Prognostic factors for tumor recurrence in endometrioid endometrial cancer stages IA and IB. Medicine. 2017;96(21):e6976. doi:10.1097/MD.0000000000006976
- Wang J, Xu P, Yang X, et al. Association of Myometrial Invasion With Lymphovascular Space Invasion, Lymph Node Metastasis, Recurrence, and Overall Survival in Endometrial Cancer: A Meta-Analysis of 79 Studies With 68,870 Patients. Front Oncol. 2021;21;11:762329. doi:10.3389/fonc.2021
- Ignat FL, Irimie A, Costin N, Achimas-Cadariu P, Lisencu IC. Predictors of Limph Node Metastasis in Endometrial Cancer.Clujul Medical. 2013;86(4):362-366.
- Jorge S, Hou JY, Tergas AI, et al. Magnitude of risk for nodal metastasis associated with lymphvascular space invasion for endometrial cancer. Gynecol Oncol. 2016;140(3):387-393. doi:10.1016/j.ygyno.2016.01.002
- Gemer O, Arie AB, Levy T, et al. Lymphvascular space involvement compromises the survival of patients with stage I endometrial cancer: results of a multicenter study. European Journal of Surgical Oncology. 2007;33:644–647. doi:10.1016/j.ejso.2007.01.009
- Wang Z, Zhang S, Ma Y, Li W, Tian J, Liu T. A nomogram prediction model for lymph node metastasis in endometrial cancer patients. BMC Cancer. 2021;21(1):748. doi:10.1186/s12885-021-08466-4
- Stålberg K, Bjurberg M, Borgfeldt C, et al. Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer -a Swedish Gynecologic Cancer Group (SweGCG) study. Acta Oncol. 2019;58(11):1628-1633. doi:10.1080/0284186X.2019.1643036
- Yarandi F, Shirali E, Akhavan S, Nili F, Ramhormozian S. The impact of lymphovascular space invasion on survival in early stage low-grade endometrioid endometrial cancer. Eur J Med Res. 2023;13;28(1):118. doi:10.1186/s40001-023-01084-9
- DiSaia PJ, Creasman WT, Boronow RC, Blessing JA. Risk factors in recurrent patterns in stage I endometrial carcinoma. Am J Obstet Gynecol. 1985;151:1009. doi:10.1016/0002-9378(85)90371-0
- Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial):a randomised study. Lancet. 2009;373:125. doi:10.1016/S0140-6736(08)61766-3
- Benedetti PP, Basile S, Maneschi F, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;3;100(23):1707-16. doi: 10.1093/jnci/djn39728
- Zhang G, Chen H, Liu Y, et al. Is lymph node dissection mandatory among early stage endometrial cancer patients? A retrospective study. BMC Womens Health. 2020;19;20(1):258. doi:10.1186/s12905-020-01128-w
Year 2023,
Volume: 8 Issue: 3, 338 - 344, 06.09.2023
Abstract
Amaç: Uterusun endometrioid tip adenokanserlerinde prognostik faktörlerin sağ kalıma etkisini saptamayı amaçladık.
Materyal ve Metot: Kliniğimizde 2006 Mayıs- 2012 Mayıs arasında endometrium kanseri nedeniyle cerrahi tedavi uygulanan histolojik tipi Endometrioid Adenokarsinom olan 144 olgu çalışmaya dahil edildi. Demografik veriler ve tümör özelliklerinin lenf nodu metastazı ve sağ kalıma ilişkisi değerlendirildi. Evre I grade 1-2 tümörler lenfadenektomi yapılanlar ve yapılmayanlar olarak gruplandırılarak 5 yıllık sağ kalım değerlendirildi.
Bulgular: Miyometriyal invazyonun >1/2 den fazla olmasının, adneksiyal tutulumun ve lenfovasküler alan invazyon varlığının lenf nodu metastazı ile ilişkili olduğu izlenmiştir (p=0,010, 0,019 ve 0,015). 5 yıllık sağ kalım %87,4 olarak bulunmuştur. Yaş, miyometriyal invazyon ve tümorün gradenin sağ kalım ile ilişkili olduğu gözlenmiştir. 5 yıllık sağ kalım lenfadenektomi yapılan grupta %89,8, lenfadenektomi yapılmayan grupta ise %85,2 olarak hesaplanmıştır ve aralarında istatistiksel olarak anlamlı bir fark izlenmemiştir (p=0,575).
Sonuç: Miyometriyal invazyon, adneksiyal tutulum ve lenfovasküler alan invazyon varlığının önemli birer prognostik faktör olduğunu belirledik. Evre I grade 1-2 tümörlerde lenfadenektominin sağ kalımı arttırmadığını saptadık. Evre I grade 1-2 tümör varlığında lenfadenektomi yapılmayabilir. Böylece lenfadenektominin hastaya yükleyeceği morbiditeden kaçınılabilir.
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References
- Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi:10.3322/caac.21492
- Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48. doi:10.3322/caac.21763
- National Cancer Institute. Cancer Stat Facts: Uterine Cancer. https://seer.cancer.gov/statfacts/html/corp.html. Accessed April 1, 2023.
- Greggi S, Franchi M, Aletti G, et al. Management of endometrial cancer in Italy: a national survey endorsed by the Italian Society of Gynecologic Oncology. Int J Surg. 2014;12(10):1038-44. doi:10.1016/j.ijsu.2014.08.356
- Calle EE, Rodriquez C, Walker-Thurmond K, Thun MJ. Overweight, obesity and mortality from cancer in prospectively studied cohort of US. adults. New England Journal of Medicine. 2003;348(17):1625-1638. doi:10.1056/NEJMoa021423
- Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987;15;60(8 Suppl):2035-2041. doi:10.1002/10970142(19901015)60:8+<2035::aid-cncr2820601515>3.0.co;2-8
- May K, Bryant A, Dickinson HO, Kehoe S, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev. 2010:20;(1):CD007585. Update in: Cochrane Database Syst Rev. 2015;9:CD007585. doi:10.1002/14651858.CD007585.pub2
- Chang SJ, Kim WY, Yoon JH, Yoo SC, Chang KH, Ryu HS. Para-aortic lymphadenectomy improves survival in patients with intermediate to high risk endometrial carcinoma. Acta Obstet and Gynecology Scand. 2008;87:1361-1369. doi:10.1080/00016340802503054
- Lucic N, Draganovic D, Sibincic S, Ecim-Zlojutro V, Milicevic S. Myometrium invasion, tumor size and lymphovascular ınvasion as a prognostic factor in dissemination of pelvic lymphatics at endometrial Carcinoma. Med Arch. 2017;71:325-329. doi:10.5455/medarh.2017.71.325-329
- Poupon C, Bendifallah S, Ouldamer L, et al. Management and Survival of Elderly and Very Elderly Patients with Endometrial Cancer: An Age-Stratified Study of 1228 Women from the FRANCOGYN Group. Ann Surg Oncol. 2017;24(6):1667-1676. doi:10.1245/s10434-016-5735-9
- Donkers H, Bekkers R, Massuger L, Galaal K. Socioeconomic deprivation and survival in endometrial cancer: The effect of BMI. Gynecol Oncol. 2020;156(1):178-184. doi:10.1016/j.ygyno.2019.10.030
- Ayhan A, Şahin H, Sari ME, Yalçin I, Haberal A, Meydanli MM. Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer. Int J Gynecol Cancer. 2019;29(3):505-512. doi:10.1136/ijgc-2018-000069
- Ruterbusch JJ, Ali-Fehmi R, Olson SH, et al. The influence of comorbid conditions on racial disparities in endometrial cancer survival. Am J Obstet Gynecol. 2014;211(6):627.e1-9. doi:10.1016/j.ajog.2014.06.036
- McVicker L, Cardwell CR, Edge L, et al. Survival outcomes in endometrial cancer patients according to diabetes: a systematic review and meta-analysis. BMC Cancer. 2022;20;22(1):427. doi:10.1186/s12885-022-09510-7
- Bak SE, Yoo JG, Lee SJ, Yoon JH, Park DC, Kim SI. Prognostic significance of histological grade in low-risk endometrial cancer. Int J Med Sci. 2022;19(13):1875-1878. doi:10.7150/ijms.77152
- Han KH, Kim HS, Lee M, Chung HH, Song YS. Prognostic factors for tumor recurrence in endometrioid endometrial cancer stages IA and IB. Medicine. 2017;96(21):e6976. doi:10.1097/MD.0000000000006976
- Wang J, Xu P, Yang X, et al. Association of Myometrial Invasion With Lymphovascular Space Invasion, Lymph Node Metastasis, Recurrence, and Overall Survival in Endometrial Cancer: A Meta-Analysis of 79 Studies With 68,870 Patients. Front Oncol. 2021;21;11:762329. doi:10.3389/fonc.2021
- Ignat FL, Irimie A, Costin N, Achimas-Cadariu P, Lisencu IC. Predictors of Limph Node Metastasis in Endometrial Cancer.Clujul Medical. 2013;86(4):362-366.
- Jorge S, Hou JY, Tergas AI, et al. Magnitude of risk for nodal metastasis associated with lymphvascular space invasion for endometrial cancer. Gynecol Oncol. 2016;140(3):387-393. doi:10.1016/j.ygyno.2016.01.002
- Gemer O, Arie AB, Levy T, et al. Lymphvascular space involvement compromises the survival of patients with stage I endometrial cancer: results of a multicenter study. European Journal of Surgical Oncology. 2007;33:644–647. doi:10.1016/j.ejso.2007.01.009
- Wang Z, Zhang S, Ma Y, Li W, Tian J, Liu T. A nomogram prediction model for lymph node metastasis in endometrial cancer patients. BMC Cancer. 2021;21(1):748. doi:10.1186/s12885-021-08466-4
- Stålberg K, Bjurberg M, Borgfeldt C, et al. Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer -a Swedish Gynecologic Cancer Group (SweGCG) study. Acta Oncol. 2019;58(11):1628-1633. doi:10.1080/0284186X.2019.1643036
- Yarandi F, Shirali E, Akhavan S, Nili F, Ramhormozian S. The impact of lymphovascular space invasion on survival in early stage low-grade endometrioid endometrial cancer. Eur J Med Res. 2023;13;28(1):118. doi:10.1186/s40001-023-01084-9
- DiSaia PJ, Creasman WT, Boronow RC, Blessing JA. Risk factors in recurrent patterns in stage I endometrial carcinoma. Am J Obstet Gynecol. 1985;151:1009. doi:10.1016/0002-9378(85)90371-0
- Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial):a randomised study. Lancet. 2009;373:125. doi:10.1016/S0140-6736(08)61766-3
- Benedetti PP, Basile S, Maneschi F, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;3;100(23):1707-16. doi: 10.1093/jnci/djn39728
- Zhang G, Chen H, Liu Y, et al. Is lymph node dissection mandatory among early stage endometrial cancer patients? A retrospective study. BMC Womens Health. 2020;19;20(1):258. doi:10.1186/s12905-020-01128-w
There are 28 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Research article |
| Authors | |
| Early Pub Date | August 30, 2023 |
| Publication Date | September 6, 2023 |
| Submission Date | March 8, 2023 |
| Acceptance Date | July 28, 2023 |
| Published in Issue | Year 2023 Volume: 8 Issue: 3 |
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