Impact of adjuvant chemotherapy and pelvic radiation on pattern of recurrence and outcome in stage I non-invasive uterine papillary serous carcinoma. A multi-institution study

Mahdi, Haider; Elshaikh, Mohamed A.; DeBenardo, Robert; Munkarah, Adnan; Isrow, Derek; Singh, Sareena; Waggoner, Steven; Ali-Fehmi, Rouba; Morris, R.; Harding, J.; Moslemi-Kebria, Mehdi

doi:10.1016/j.ygyno.2015.01.544

Cited by 18 publications

(12 citation statements)

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“…The highly aggressive biological behavior of UPSC determines that its recurrent pattern is significantly different from type I endometrial carcinoma, which tends to recur at distant sites and often in multiple sites. 22 , 23 The recurrence rate in other studies varied from 17.4% to 58.8%. 7 , 23 In this series, 35.8% of the patients experienced recurrence.…”

Section: Discussionmentioning

confidence: 88%

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Clinicopathological and survival analysis of uterine papillary serous carcinoma: a single institutional review of 106 cases

Wang¹,

Yu²,

Yang³

et al. 2018

CMAR

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ObjectivesThe objectives of this study were to analyze clinicopathological features and to investigate the prognostic determinants in patients with uterine papillary serous carcinoma (UPSC).Materials and methodsA cohort of 106 UPSC patients diagnosed and treated at Peking Union Medical College Hospital between 2000 and 2016 were retrospectively reviewed. The Kaplan–Meier method and Cox regression analysis were used for survival analysis. Differences between categorical data were calculated by using the chi-squared test.ResultsThe median follow-up was 29.0 months (range =2–170 months), with an overall recurrence rate of 35.8%. The coincidence rate between preoperative endometrial sampling and postoperative definitive pathology of hysteroscopy group was significantly higher than that of the dilation and curettage group (88.5% vs 65.0%, P=0.019). Adjuvant therapy-treated patients with stage I UPSC experienced significantly fewer recurrences than those receiving observation (P=0.003). Patients with advanced-stage UPSC who received combination therapy demonstrated a lower risk of local recurrence compared with those who received chemotherapy alone with a borderline significance (P=0.051). Elevated serum cancer antigen 125 level was associated with advanced-stage disease and recurrence (P<0.001). In multivariate analysis, tumor stage and optimal cytoreduction were independent predictors of survival. In substage analysis, complete surgical staging was associated with better overall survival (OS; yes vs no, HR: 0.05 [95% CI: 0.01–0.51], P=0.037) in patients with stage I UPSC. As for advanced stage, paclitaxel–platinum chemotherapy regimen and optimal cytoreduction were independent favorable prognostic factors for progression-free survival (paclitaxel–carboplatin [TC] vs other; HR =0.38, P=0.010; yes vs no, HR =0.45, P=0.032) and OS (TC vs other, HR =0.38, P=0.022; yes vs no, HR =0.54, P=0.013).ConclusionIn patients with stage I UPSC, complete staging was associated with better OS, and therefore, it should be performed in all patients. Tumor stage and optimal cytoreduction are the most significant prognostic factors. Recurrence can be improved in stage I patients treated with adjuvant therapy and in patients with advanced-stage disease treated with combined therapy. TC regimen may be the preferred regimen for chemotherapy.

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Section: Discussionmentioning

confidence: 88%

“… 22 , 23 The recurrence rate in other studies varied from 17.4% to 58.8%. 7 , 23 In this series, 35.8% of the patients experienced recurrence. Furthermore, recurrences were limited to the pelvis in 21.1% (n=8) of the patients, and 78.9% recurrences (n=30) occurred in distant sites with or without pelvis.…”

Section: Discussionmentioning

confidence: 88%

Clinicopathological and survival analysis of uterine papillary serous carcinoma: a single institutional review of 106 cases

Wang¹,

Yu²,

Yang³

et al. 2018

CMAR

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“…Other retrospective studies have also shown similar findings. 23,24,26 In our study, patients with stage I disease had a significant improvement in overall survival (102 months vs 116 months vs not reached; P = 0.01) and disease-specific survival (median was not reached for all; P = 0.0004) over time. The same significant improvement was observed for patients with stage II disease, with overall survival (44 months vs 54 months vs not reached; P = 0.06) and disease-specific survival (110 months vs not reached vs not reached; P = 0.02).…”

Section: Discussionmentioning

confidence: 48%

“…2,6 Retrospective studies have demonstrated a survival advantage with complete surgical staging including lymphadenectomy for early-stage USC. 23,24 Given the rarity of this histology and the large proportion presenting at an advanced stage, adjuvant treatment strategies for early-stage USC have been difficult to study in a randomized fashion. However, evidence in the literature from retrospective studies has reported significant improvement in outcome and lower risk of recurrence with adjuvant chemotherapy in patients with early-stage USC.…”

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confidence: 99%

Trends in Survival of Patients With Uterine Serous Carcinoma From 1988 to 2011: A Population-Based Study

Mahdi

Xiao

Moulton

et al. 2017

Int J Gynecol Cancer

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“…Type I EC is usually well or moderately differentiated and has a good prognosis. Type II (serous EC), on the other hand, is E2 independent, more common in postmenopausal women, poorly differentiated, more aggressive, and carries an unfavorable prognosis (7, 8, 11, 12). Most common molecular alterations found in Type I disease are microsatellite instabilities and mutations in PTEN, K-ras, and β-catenin (13).…”

Section: Introductionmentioning

confidence: 99%

Imiquimod Induces Apoptosis in Human Endometrial Cancer Cells In vitro and Prevents Tumor Progression In vivo

et al. 2016

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Purpose The increasing incidence of endometrial cancer (EC), in younger age at diagnosis, calls for new tissue-sparing treatment options. This work aims to evaluate the potential of imiquimod (IQ) in the treatment of low-grade EC. Methods Effects of IQ on the viabilities of Ishikawa and HEC-1A cells were evaluated using MTT assay. The ability of IQ to induce apoptosis was evaluated by testing changes in caspase 3/7 levels and expression of cleaved caspase-3, using luminescence assay and western blot. Apoptosis was confirmed by flow cytometry and the expression of cleaved PARP. Western blot was used to evaluate the effect of IQ on expression levels of Bcl-2, Bcl-xL, and BAX. Finally, the in vivo efficacy of IQ was tested in an EC mouse model. Results There was a decrease in EC cell viability following IQ treatment as well as increased caspase 3/7 activities, cleaved caspase-3 expression, and Annexin-V/ 7AAD positive cell population. Western blot results showed the ability of IQ in cleaving PARP, decreasing Bcl-2 and Bcl-xL expressions, but not affecting BAX expression. In vivo study demonstrated IQ’s ability to inhibit EC tumor growth and progression without significant toxicity. Conclusions IQ induces apoptosis in low-grade EC cells in vitro, probably through its direct effect on Bcl-2 family protein expression. In, vivo, IQ attenuates EC tumor growth and progression, without an obvious toxicity. Our study provides the first building block for the potential role of IQ in the non-surgical management of low-grades EC and encouraging further investigations.

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Impact of adjuvant chemotherapy and pelvic radiation on pattern of recurrence and outcome in stage I non-invasive uterine papillary serous carcinoma. A multi-institution study

Cited by 18 publications

References 20 publications

Clinicopathological and survival analysis of uterine papillary serous carcinoma: a single institutional review of 106 cases

Clinicopathological and survival analysis of uterine papillary serous carcinoma: a single institutional review of 106 cases

Trends in Survival of Patients With Uterine Serous Carcinoma From 1988 to 2011: A Population-Based Study

Imiquimod Induces Apoptosis in Human Endometrial Cancer Cells In vitro and Prevents Tumor Progression In vivo

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