ObjectiveTo evaluate the recurrence rates and patterns of failure in patients with stage I endometrial carcinoma after surgical staging without adjuvant therapy.MethodsMedical records of 229 patients with stage I endometrial carcinoma, treated with surgery alone between 2002 and 2010 at Siriraj Hospital were retrospectively reviewed. The primary objective of this study was recurrence rates. The secondary objectives were patterns of failure, disease-free survival, overall survival, and prognostic factors related to outcomes.ResultsDuring median follow-up time of 53.3 months, 11 recurrences (4.8%) occurred with a median time to recurrence of 21.2 months (range, 7.7 to 77.8 months). Vaginal recurrence was the most common pattern of failure (8/11 patients, 72.7%). Other recurrences were pelvic, abdominal and multiple metastases. Factors that appeared to be prognostic factors on univariate analyses were age and having high intermediate risk (HIR) (Gynecologic Oncology Group [GOG] 99 criteria), none of which showed significance in multivariate analysis. The recurrence rates were higher in the patients with HIR criteria (22.2% vs. 4.1%, p=0.013) or patients with stage IB, grade 2 endometrioid carcinoma (9.4% vs. 4.3%, p=0.199). Five-year disease-free survival and 5-year overall survival were 93.9% (95% CI, 89.9 to 5.86) and 99.5% (95% CI, 97.0 to 99.9), respectively.ConclusionThe patients with low risk stage I endometrial carcinoma had excellent outcomes with surgery alone. Our study showed that no single factor was demonstrated to be an independent predictor for recurrence.

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Aim To compare clinical characteristics and identify factors predictive of resistance to initial treatment with methotrexate‐folinic acid (MTX‐FA) in women with low‐risk gestational trophoblastic neoplasia (GTN). Methods Retrospective chart reviews were conducted in patients diagnosed with low‐risk GTN who were treated with MTX‐FA at Siriraj Hospital between 2002 and 2018. Demographic data, disease characteristics, treatment response, toxicity, and data of the subsequent pregnancy were collected and analyzed. Groups of patients who were responsive or resistant to treatment were compared. Stepwise logistic regression analysis was used to identify factors predictive of resistance to methotrexate chemotherapy. Results Totally, 113 patients were eligible for analysis. The primary remission rate was 55.8% with first‐line MTX‐FA. All other patients achieved remission by subsequent treatment with actinomycin D or multiple‐agent chemotherapy. Relapse of disease occurred in 4.4% and the overall survival rate was 99.1%. Univariate analysis showed that pretreatment serum hCG, neutrophil‐to‐lymphocyte ratio at baseline, and serum hCG ratio of the first three consecutive cycles (C) were significantly associated with resistance to MTX‐FA. Independent factors that predict failure to respond to first‐line MTX‐FA were pretreatment serum hCG ≥15,000 IU/L, a less than 4.8‐fold reduction of serum hCG between cycle 1 and cycle 2 (C1/C2), and a less than seven‐fold reduction of serum hCG from cycle 2 to cycle 3 (C2/C3). Conclusions First‐line MTX‐FA treatment is effective in 55.8% of patients. Pretreatment serum hCG, and serum hCG ratio between consecutive treatment cycles can predict initial treatment failure.

Contentsage of 45 years at the time of diagnosis. Data were abstracted regarding age, parity, diabetes, hypertension, poly cystic ovaries, body mass index (BMI), tumor histology, grade, stage, and survival. Clinical and pathological characteristic were compared, and statistical analyses were performed using SPSS version 22.0. Results: The mean age at the time of diagnosis was 38.50 years (range, 34.50-41.25) and mean BMI (kg/m 2 ) was 30.55 (range, 27.23-38.45). 50% patients were obese (BMI >30 kg/m 2 ) and 40% were overweight (BMI 25-30 kg/m 2 ). Only 5 out 10 women had nulliparity, however, 70% women had history of polycystic ovaries, confirmed with ultrasound or on histopathological specimen. Family history was also found to be strongly associated with endometrial cancer with 70% prevalence rate. The prevalence of diabetes mellitus, hypertension and hypothyroidism were 20%, 10% and 10% respectively. Seven patients (70%) had well differentiated tumors, 2 (20%) moderately differentiated and 1 (10%) had poorly differentiated tumor. Stage 1A disease was found in 7 (70%) patients, stage 1B in 1 (10%), stage 2 in 1(10%) and stage 3 in 1 (10%) patient. 20 % patients had completed 5-years disease free interval, one patient was expired with recurrence and stage 3 disease, while 1 woman was lost to follow up after surgery. Conclusion:We conclude that the obesity, family history and polycystic ovaries are strongly associated risk factors for endometrial cancer in women aged 45 years or younger. We could not find any significant association with medical disorders such as diabetes and hypertension. Nulliparity seems to have less strong relationship with development of endometrial cancer. Majority of young patients have early-stage disease with well differentiated tumors and favorable histology.

Objectives To compare clinical characteristics and factors predictive of resistance to initial treatment with Methotrexate-folinic acid (MTX-FA) in women with low-risk gestational trophoblastic neoplasia (GTN). Design A retrospective study Setting A tertiary center Populations Patients diagnosed with low-risk GTN. Methods: Demographic data, disease characteristics, treatment response, toxicity and data of the subsequent pregnancy were collected and analyzed. Main outcome measures Groups of patients who were responsive or resistance to treatment were compared. Stepwise logistic regression analysis was used to identify factors predictive of resistance to Methotrexate chemotherapy. Results Totally, 113 patients were eligible for analysis. The primary remission rate was 55.8% with first-line MTX-FA. All others patients achieved remission by subsequent treatment with Actinomycin D or multiple-agents chemotherapy. Relapse of disease was found in 4.4% and the overall survival rate was 99.1%. Univariate analysis showed that pre-treatment serum hCG, neutrophil-to-lymphocyte ratio at baseline, and serum hCG ratio of the first three consecutive cycles (C) were significantly associated with resistance to MTX-FA. Independent factors that predict failure to respond to first-line MTX-FA were pre-treatment serum hCG ≥15,000 IU/L (OR 3.95; 95%CI = 1.48-10.52; p=0.006), a less than 4.8-fold reduction of serum hCG between cycle 1 and cycle 2 (C1/C2) (OR 4.08; 95%CI = 1.60-10.39; p=0.003), and a less than 7-fold reduction of serum hCG from cycle 2 to cycle 3 (C2/C3) (OR 10.15; 95%CI = 3.10-33.30; p<0.001). Conclusions First-line MTX-FA treatment is effective in 55.8% of patients. Pre-treatment serum hCG, and hCG ratio between consecutive treatment cycles predicts initial treatment failure.

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Objective: To determine the preoperative clinical characteristics associated with uterine sarcoma in patients with uterine mass. Methods: We retrospectively reviewed medical records of patients who presented with uterine mass undergoing surgery at Ramathibodi Hospital, with a pathologically confirmed diagnosis, from April 1, 2000 to October 31, 2019. The cases were patients with uterine sarcoma, whereas the controls were patients with leiomyoma diagnosed in the same year, with a proportion of 1 case per 4 controls. The association between preoperative clinical characteristics and uterine sarcoma were analyzed. Results: There were 18,218 patients with uterine mass undergoing surgery at Ramathibodi Hospital during the study period. Uterine sarcoma was diagnosed in 68 patients. Thus, the incidence of uterine sarcoma was 0.37%. Patients with uterine mass, patients with age >40 years old, postmenopause, postmenopausal bleeding, abnormal uterine bleeding, palpable mass, recognition of rapid growing mass, and with single tumor nodule identified by ultrasonography were more likely to be diagnosed with uterine sarcoma with adjusted odds ratio (95%