Oncological outcomes in fertility-sparing treatment in stage IA-G2 endometrial cancer

Ronsini, Carlo; Mosca, Lavinia; Iavarone, Irene; Nicoletti, Roberta; Vinci, Davide; Carotenuto, Raffaela; Pasanisi, Francesca; Solazzo, Maria Cristina; Franciscis, Pasquale De; Torella, Marco; Verde, Marco La; Colacurci, Nicola; Cobellis, Luigi; Vizzielli, Giuseppe; Restaino, Stefano

doi:10.3389/fonc.2022.965029

Cited by 15 publications

(12 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The current gold standard for the treatment of endometrial cancer is hysterectomy with bilateral salpingooophorectomy (BSO) with lymphadenectomy ( 108 , 109 ). Nevertheless, in selected cases of patients desiring pregnancy, fertility-sparing treatment (FST) can be proposed, however, the status of lymph nodes during FST cannot be well investigated and evaluated ( 110 ). At present, imaging methods such as B-ultrasound, CT and MRI can also be used for the diagnosis of myometrial infiltration and lymph node metastasis ( 111 – 113 ).…”

Section: Resultsmentioning

confidence: 99%

Risk factors associated with false negative rate of sentinel lymph node biopsy in endometrial cancer: a systematic review and meta-analysis

Fan,

Qiu,

Wang

et al. 2024

Front. Oncol.

View full text Add to dashboard Cite

ObjectiveCurrently, sentinel lymph node biopsy (SLNB) is increasingly used in endometrial cancer, but the rate of missed metastatic lymph nodes compared to systemic lymph node dissection has been a concern. We conducted a systematic review and meta-analysis to evaluate the false negative rate (FNR) of SLNB in patients with endometrial cancer and to explore the risk factors associated with this FNR.Data sourcesThree databases (PubMed, Embase, Web of Science) were searched from initial database build to January 2023 by two independent reviewers.Research eligibility criteriaStudies were included if they included 10 or more women diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I or higher endometrial cancer, the study technique used sentinel lymph node localization biopsy, and the reported outcome metrics included false negative and/or FNR.Study appraisal and synthesis methodsTwo authors independently reviewed the abstracts and full articles. The FNR and factors associated with FNR were synthesized through random-effects meta-analyses and meta-regression.The resultsWe identified 62 eligible studies. The overall FNR for the 62 articles was 4% (95% CL 3-5).There was no significant difference in the FNR in patients with high-risk endometrial cancer compared to patients with low-risk endometrial cancer. There was no difference in the FNR for whether frozen sections were used intraoperatively. The type of dye used intraoperatively (indocyanine green/blue dye) were not significantly associated with the false negative rate. Cervical injection reduced the FNR compared with alternative injection techniques. Indocyanine green reduced the FNR compared with alternative Tc-99m. Postoperative pathologic ultrastaging reduced the FNR.ConclusionsAlternative injection techniques (other than the cervix), Tc-99m dye tracer, and the absence of postoperative pathologic ultrastaging are risk factors for a high FNR in endometrial cancer patients who undergo SLNB; therefore, we should be vigilant for missed diagnosis of metastatic lymph nodes after SLNB in such populations.Systematic review registrationhttp://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023433637.

show abstract

Section: Resultsmentioning

confidence: 99%

Risk factors associated with false negative rate of sentinel lymph node biopsy in endometrial cancer: a systematic review and meta-analysis

Fan,

Qiu,

Wang

et al. 2024

Front. Oncol.

View full text Add to dashboard Cite

show abstract

“…For example, lymph node status is crucial for disease management in these patients. The ascertainment of lymph node status has been made easier through the use of the sentinel lymph node [ 71 , 72 , 73 ], but the lymph node positivity range in patients with early lesions is highly variable, and little is known about the actual mode of progression of cancer dissemination in lymph nodes [ 74 , 75 ]. MiRNAs might play a role in this.…”

Section: Discussionmentioning

confidence: 99%

MicroRNA Expression in Endometrial Cancer: Current Knowledge and Therapeutic Implications

Iavarone,

Molitierno,

Fumiento

et al. 2024

Medicina

Self Cite

View full text Add to dashboard Cite

Background and Objectives: An extracellular vesicle is part of a class of submicron particles derived from cells, mediating cellular crosstalk through microRNA (miRNA). MiRNA is a group of RNA molecules, each of which consists of 15–22 nucleotides and post-transcriptionally modulates gene expression. The complementary mRNAs—onto which the miRNAs hybridize—are involved in processes such as implantation, tumor suppression, proliferation, angiogenesis, and metastasis that define the entire tumor microenvironment. The endometrial biopsy is a standard technique used to recognize cellular atypia, but other non-invasive markers may reduce patient discomfort during the use of invasive methods. The present study aims to examine the distribution and the regulation of the differentially expressed miRNAs (DEMs) and EV-derived substances in women with endometrial cancer. Materials and Methods: We systematically searched the PubMed, EMBASE, Scopus, Cochrane Library, and ScienceDirect databases in April 2023, adopted the string “Endometrial Neoplasms AND Exosomes”, and followed the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We selected all the studies that included patients with endometrial cancer and that described the regulation of miRNA molecules in that context. The differences in molecule expression between patients and controls were evaluated as significant when the proteins had a fold change of ±1.5. Results: Seventeen records fulfilled the inclusion criteria: a total of 371 patients and 273 controls were analyzed. The upregulated molecules that had the widest delta between endometrial cancer patients and controls—relative expression ≥ 1 > 3 log2(ratio)—were miR-20b-5p, miR-204-5p, miR-15a-5p, and miR-320a. In particular, miR-20b-5p and miR-204-5p were extracted from both serum and endometrial specimens, whereas miR-15a-5p was only isolated from plasma, and miR-320a was only extracted from the endometrial specimens. In parallel, the most downregulated miRNA in the endometrial cancer patients compared to the healthy subjects was miR-320a, which was found in the endometrial specimens. Conclusions: Although their epigenetic regulation remains unknown, these upregulated molecules derived from EVs are feasible markers for the early detection of endometrial cancer. The modulation of these miRNA molecules should be assessed during different treatments or if recurrence develops in response to a targeted treatment modality.

show abstract

“…The challenge in establishing clear boundaries for FST may be related to multiple factors that impact its efficacy. The most crucial variables include the tumor’s clinicopathological characteristics (such as histological type, grade and the presence of myometrial invasion or LVSI), the type, dose, duration of therapy performed and the follow-up schedule [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Sparing Is Caring: Hormonal Retreatment in Women with Recurrent Endometrial Cancer after Fertility Preservation Management—A Single Centre Retrospective Study

et al. 2023

View full text Add to dashboard Cite

Fertility-sparing treatment (FTS) of endometrial cancer (EC) has a high rate of remission but also a high rate of relapse (10–88%). Many women still wish to conceive at the time of relapse, but results regarding retreatment are still lacking. This study aims to evaluate the safety, oncological and pregnancy outcomes of repeated FST in women with recurrent EC. This is a retrospective single-center study that recruited patients who had uterine recurrence after achieving a complete response (CR) with FST for FIGO stage IA, well-differentiated (G1), endometrioid EC. All eligible women underwent a second FST. Among 26 patients with recurrence, 6 decided to receive a hysterectomy and 20 received fertility-sparing retreatment. In total, 17 out of 20 women (85%) achieved a CR in a median time of 6 months. A total of 2/20 women showed a stable disease and continued the treatment for a further 6 months and finally achieved a CR. In total, 1/20 women showed disease progression and underwent demolitive surgery. After relapse and a CR, 14 patients attempted to become pregnant, among whom 7 became pregnant (pregnancy rate 50%—life birth rate 29%). Secondary FST is a safe and effective option for women who desire to preserve fertility after the recurrence of early-stage EC.

show abstract

Oncological outcomes in fertility-sparing treatment in stage IA-G2 endometrial cancer

Cited by 15 publications

References 52 publications

Risk factors associated with false negative rate of sentinel lymph node biopsy in endometrial cancer: a systematic review and meta-analysis

Risk factors associated with false negative rate of sentinel lymph node biopsy in endometrial cancer: a systematic review and meta-analysis

MicroRNA Expression in Endometrial Cancer: Current Knowledge and Therapeutic Implications

Sparing Is Caring: Hormonal Retreatment in Women with Recurrent Endometrial Cancer after Fertility Preservation Management—A Single Centre Retrospective Study

Contact Info

Product

Resources

About