of findings for the main comparison. Laparoscopy versus laparotomy for early stage endometrial cancer Laparoscopy versus laparotomy for early stage endometrial cancer Patient or population: adult women diagnosed with early stage (I to IIa) endometrial cancer undergoing surgery as primary treatment. Settings: randomised controlled trials (RCTs) Intervention: laparotomy, total abdominal hysterectomy (TAH) Comparison: laparoscopy; laparoscopically assisted vaginal hysterectomy (LAVH) or total laparoscopic hysterectomy (TLH) Illustrative comparative risks* (95% CI) Assumed risk Corresponding risk Outcomes Laparoscopy Laparotomy Relative effect (95% CI) No of participants (studies) Certainty of the evidence (GRADE)
Purpose: We conducted a systematic review to evaluate the overall diagnostic accuracy of miRNAs in detecting endometrial cancer. Materials and Methods: A systematic search of Medline, Embase, Cinahl and the Cochrane Controlled Register of Trials was performed to identify studies reporting on the diagnostic value of miRNA in EC patients. Included were diagnostic studies looking at miRNA expression in women diagnosed with endometrial cancer. Two reviewers independently selected studies and assessed quality of studies using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) score system. Data extraction was completed and the vote-counting strategy was used to rank miRNAs. Results: 26 studies were included with a total number of 1,400 EC patients reporting on 106 differentially expressed miRNAs. The most frequently found upregulated miRNA was miR-205 followed by miR-200c,-223,-182,-183 and-200a. In addition, miR-135b, miR-429, miR-141 and miR-200b were also frequently upregulated. There was less consensus on down-regulated miRNAs. Conclusions: miRNAs yield a promising diagnostic biomarker potential in endometrial cancer, especially miR-205, the miR-200 family and miR-135b,-182,-183 and-223. However, no sufficient high quality data are available to draw hard conclusions. More research is needed to validate the diagnostic potential of these miRNAs in larger studies. In addition, the potential of urine as a non-invasive biofluid should be investigated in more detail.
Objectives To investigate the association between body mass index (BMI) and sexual functioning in gynaecologic cancer patients. To determine the association between socio‐economic deprivation and sexual functioning. Methods This is a prospective cohort study on women undergoing surgery for suspected or proven gynaecological cancer between September 2014 and February 2016 in the Royal Cornwall Hospital Trust. Patients were invited to participate by completing the Female Sexual Function Index (FSFI) at three time points: preoperative, 3 months postoperative, and 1 year postoperative. A semiparametric model of the FSFI score was used to establish the association between BMI and sexual functioning. Results A total of 257 patients were approached of which 166 patients were included. Fifty‐two patients (33.8%) were overweight (BMI, 25‐29.9 kg/m2), 44 (28.6%) were obese (BMI, 30‐39.9 kg/m2), and a further 20 (13.0%) morbidly obese (BMI ≥ 40 kg/m2). Overweight and obese women reported improved sexual functioning compared with normal‐weight women in endometrial, ovarian, and vulvar cancers. Among cervical cancer, worse sexual functioning was seen in women with an increased BMI; however, this was not significant. Younger age was associated with improved sexual function, and sexual functioning was better postoperatively for all patients compared with preoperatively. There was no evidence of relationship between deprivation and sexual functioning in gynaecological cancer patients. Conclusion Higher BMI is associated with improved sexual functioning in endometrial, ovarian, and vulvar cancer; however, this was not seen in cervical cancer patients. There is no evidence of correlation between deprivation and sexual functioning.
Purpose The primary objectives in this review were to (1) assess the association between socioeconomic deprivation and survival in endometrial cancer patients (2) investigate if there is an association between socioeconomic deprivation and peri-operative morbidity in endometrial cancer patients.
Objectives The aims of the study were to evaluate clinicopathologic features, management, and outcomes in vulval melanoma and to review the literature. Materials and Methods Data were collected retrospectively on patients with vulval melanoma from 2001 to 2017 in 5 gynecological oncology cancer centers (Bristol, Taunton, Truro, Plymouth, and Cheltenham). SPSS software was used for univariate and multivariate statistical analysis. Disease-specific median survival was calculated using Kaplan-Meier curves. Results Forty-four patients with vulval melanoma were included, with a median age of 71 years. Forty-three of 44 had wide local excision with full inguinal lymphadenectomy if abnormal lymph nodes. Seven patients had sentinel lymph nodes. However, 2 patients with negative sentinel lymph nodes had distant recurrences within 16 months. On univariate analysis, presence of ulceration (p = .012), perineural invasion (p = .03), and area of lesion (p = .016) were associated with risk of recurrence but only presence of microsatellites (p = .01) was associated with risk of death. There were 31 deaths (70%): 29 (94%) of 31 from melanoma and 28 (64%) of 44 recurrences: 17 local (10 groin, 7 vulval) and 9 distant. Overall median survival was 32.5 months (95% CI, 17.8–46.5 months) and median recurrence-free survival 12.6 months (95% CI, 7.7–17.4 months). Conclusions This retrospective multicenter study highlights the high recurrence rate and poor prognosis of vulval melanoma. Lymph node surgery did not make any difference to recurrence-free survival or overall survival. The presence of microsatellites was associated with a statistically increased risk of death.
Introduction: MicroRNAs (miRNAs) are noncoding RNAs that regulate gene expression and contribute to the development of cancer. They have been shown to be stable in tissue samples and may be promising diagnostic biomarkers for endometrial cancer. Material and methods:A retrospective cohort study of women diagnosed with endometrial cancer between January 2017 and December 2017 was performed at the Royal Cornwall Hospital. Archived formalin-fixed paraffin-embedded samples were obtained from patients with endometrial cancer and healthy women. MicroRNA was isolated and quantitative real-time polymerase chain reaction was used to detect expression levels of miRNAs.Results: A total of 76 women were included: 36 endometrial cancer patients, 40 healthy controls. A distinct panel of miR-200a, miR-200b, miR-200c, miR-205, and miR-182 showed an area under the curve of 0.958, sensitivity 92%, specificity 89%, positive predictive value of 89% (95% CI 82%-94%) and negative predictive value of 91% (95% CI 85%-96%) in diagnosing endometrial cancer. High miR-182 expression levels were significantly related to high-grade endometrioid tumors compared with low-grade tumors. Conclusions:We demonstrated high diagnostic accuracy of miRNA for detecting endometrial cancer. In addition, miRNA contributed to an improvement in distinguishing between high-grade and low-grade endometrioid tumors.
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