An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations

Salani, Ritu; Khanna, Namita; Frimer, Marina; Bristow, Robert E.; Chen, Lee-may

doi:10.1016/j.ygyno.2017.03.022

Cited by 209 publications

(212 citation statements)

References 65 publications

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“…Recurrence is an important contributor to death among EC patients. Typically occurring within three years of the initial diagnosis, recurrent ECs are frequently refractory to treatment . As such, surveillance following completion of primary treatment focuses on symptoms of recurrence .…”

Section: Discussionmentioning

confidence: 99%

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Endometrial carcinoma recurrence according to race and ethnicity: An NRG Oncology/Gynecologic Oncology Group 210 Study

Felix

Brasky

Cohn

et al. 2017

Intl Journal of Cancer

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Non-Hispanic black (NHB) women are more likely to experience an endometrial carcinoma (EC) recurrence compared to non-Hispanic white (NHW) women. The extent to which tumor characteristics, socioeconomic status (SES) and treatment contribute to this observation is not well defined. In the NRG Oncology/Gynecology Oncology Group (GOG) 210 Study we evaluated associations between race/ethnicity and EC recurrence according to tumor characteristics with adjustment for potential confounders. Our analysis included 3,199 NHW, 532 NHB and 232 Hispanic women with EC. Recurrence was documented during follow-up. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between race/ethnicity and EC recurrence in models stratified by histologic subtype (low-grade endometrioid, high-grade endometrioid, serous, mixed cell, carcinosarcoma, clear cell) or stage (I, II, III) and adjusted for age, SES, body mass index, smoking status and treatment. In histologic subtype-stratified models, higher EC recurrence was noted in NHB women with low-grade endometrioid (HR = 1.94, 95% CI = 1.21-3.10) or carcinosarcomas (HR = 1.66, 95% CI = 0.99-2.79) compared to NHWs. In stage-stratified models, higher EC recurrence was noted among NHB women with stage I (HR = 1.48, 95% CI = 1.06-2.05) and Hispanic women with stage III disease (HR = 1.81, 95% CI = 1.11-2.95). Our observations of higher EC recurrence risk among NHB and Hispanic women, as compared to NHW women, were not explained by tumor characteristics, SES, treatment or other confounders. Other factors, such as racial differences in tumor biology or other patient factors, should be explored as contributors to racial disparities in EC recurrence.

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Section: Discussionmentioning

confidence: 99%

“…Endometrial carcinoma (EC) recurs in 2–15% of women with early stage disease and this proportion can reach as high as 50% in women with advanced stage or non‐endometrioid histologic subtypes . Recurrence contributes to worse survival, and compared to white women, black women are more likely to experience an EC recurrence .…”

Section: Introductionmentioning

confidence: 99%

Endometrial carcinoma recurrence according to race and ethnicity: An NRG Oncology/Gynecologic Oncology Group 210 Study

Felix

Brasky

Cohn

et al. 2017

Intl Journal of Cancer

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“…The Society of Gynecologic Oncology recommends that there is a need for prospective research including cost-effectiveness calculations to help determine ideal follow-up care. 4 The most common practice is for the clinician to review a patient on a regular basis, in a hospital-based, outpatient clinic over a number of years, 5 with the aim of checking for local recurrence or distant metastasis. 6 However, there is no prospective evidence that the traditional method of follow-up identifies recurrences earlier or improves overall survival because most recurrences are symptomatic.…”

mentioning

confidence: 99%

Trial of Optimal Personalised Care After Treatment—Gynaecological Cancer (TOPCAT-G)

Morrison¹,

Spencer

Totton

et al. 2018

International Journal of Gynecological Cancer

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“…Clinically, this can result in a scarred cervix or stenotic vaginal canal, making vaginal cytology difficult to perform and/or interpret. As previous literature 5,6 and Table 2 demonstrate, liquid-based cytology samples may only demonstrate low-grade or equivocally abnormal cytologic findings, even for patients who are developing recurrent carcinoma. However, when hr-HPV was present along with cytologic abnormalities, the relative risk of recurrent cervical cancer increased almost 4-fold.…”

Section: Resultsmentioning

confidence: 69%

“…In their most recent consensus statement, the Society of Gynecology Oncology even go so far as suggesting that vaginal Papanicolaou smears could be safely omitted from the surveillance plans for patients who have undergone pelvic radiation. 6 Human papilloma virus is the agent responsible for the most common sexually transmitted infection in the United States. It is widely implicated in malignancies of the cervix, vulva, anus, and oropharyngeal tract.…”

mentioning

confidence: 99%

The Role of High-Risk Human Papilloma Virus Testing in the Surveillance of Cervical Cancer After Treatment

Yu¹,

Austin²,

Lin³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Cervical cancer affects 12 000 women in the United States annually. However, despite its prevalence, there remains no good methodology to detect its recurrence.Objective.-To identify the role of cervicovaginal highrisk human papilloma virus (hr-HPV) testing in predicting cervical cancer recurrence.Design.-This is a retrospective study of patients who underwent hr-HPV testing as part of their routine surveillance for cervical cancer. Standard statistical analyses, including v 2 test and multivariable logistic regression, were performed with IBM SPSS 19.0.Results.-A total of 133 patients were identified, of whom 107 (80%) had squamous cell carcinoma. Ninety patients (68%) had bulky disease and were treated primarily with chemoradiation and brachytherapy. Of patients whose disease recurred, 5 patients (42%) had tested positive for hr-HPV during their surveillance period, compared to 13 patients (11%) for whom disease did not recur (relative risk: 3.88, P ¼ .002). On multivariate logistic regression, hr-HPV status remained significantly predictive of disease recurrence (odds ratio: 12.3, P ¼ .02, 95% confidence interval: 1.5-99.6). Using 2 3 2 table analysis, we found that while cervicovaginal cytology has limited specificity (5.7%) in predicting recurrence, the combination of cytology with hr-HPV testing increases the specificity of testing to 89.3%.Conclusions.-Persistence of hr-HPV is a risk factor for disease recurrence. High-risk-HPV testing is not routinely used during surveillance for cervical cancer, but this study suggests that large, prospective trials investigating the role of hr-HPV testing in cervical cancer surveillance are needed.

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An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations

Cited by 209 publications

References 65 publications

Endometrial carcinoma recurrence according to race and ethnicity: An NRG Oncology/Gynecologic Oncology Group 210 Study

Endometrial carcinoma recurrence according to race and ethnicity: An NRG Oncology/Gynecologic Oncology Group 210 Study

Trial of Optimal Personalised Care After Treatment—Gynaecological Cancer (TOPCAT-G)

The Role of High-Risk Human Papilloma Virus Testing in the Surveillance of Cervical Cancer After Treatment

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