Pattern of failure and value of follow-up procedures in endometrial and cervical cancer patients

Sartori, Enrico; Pasinetti, Brunella; Carrara, Luisa; Gambino, Angela; Odicino, Franco; Pecorelli, Sërgio

doi:10.1016/j.ygyno.2007.07.025

Cited by 95 publications

(66 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Women diagnosed at a pre-scheduled visit due to symptoms had a higher educational level and more often high-risk disease compared to symptomatic women diagnosed at regular follow-up. Previous studies have used retrospectively collected survival data to conclude on the efficacy and justification of follow-up visits [3,4,[15][16][17][18][19][20][21]. In addition to the present study, a minority of the studies [3,4] found a better survival of women with asymptomatic recurrence and it seems tempting to conclude that follow-up visits improve survival.…”

Section: Discussionmentioning

confidence: 62%

Detection of recurrence in early stage endometrial cancer – the role of symptoms and routine follow-up

et al. 2017

View full text Add to dashboard Cite

Background: Considerable controversy remains as to the optimal organization of endometrial cancer follow-up. Aim: To evaluate the relationship between the way recurrence was detected and survival after treatment for endometrial cancer. Further, to identify characteristics associated with a pre-scheduled examination in women with symptomatic recurrence. Material and methods: All women with early stage endometrial cancer during [2005][2006][2007][2008][2009] were included in a population-based historical cohort derived from the Danish Gynecological Cancer Database. Women diagnosed with recurrence within three years after primary surgery and the mode of recurrence detection were identified from hospital charts: asymptomatic recurrence detected at regular follow-up, symptomatic recurrence detected at regular follow-up or symptomatic recurrence detected in between follow-up. Survival of women with symptomatic and asymptomatic disease was compared. Furthermore, characteristics associated with self-referral as compared to presenting symptoms at regular follow-ups were identified using univariate analyses. Results: In total, 183 cases of recurrence (7%) were identified in the cohort of 2612 women. Of these, 65.5% were symptomatic with vaginal bleeding as the most prevalent symptom. Asymptomatic women had a significantly better three-year survival rate compared to symptomatic women (80.3% vs. 54.3%, p < 0.01). A total of 2.3% of the entire population had an asymptomatic recurrence. Women diagnosed at a pre-scheduled visit due to symptoms had a higher educational level (p ¼ 0.03) and more often high-risk disease (p ¼ 0.02) than symptomatic women diagnosed at regular follow-up. Conclusion: Early stage endometrial cancer carries a low risk of recurrence. Survival appears to be superior in asymptomatic patients, but length-time bias, i.e. the effect of aggressive tumor biology in symptomatic recurrences, may bias results in non-randomized controlled trials. Well educated patients with symptoms of recurrence more often sought medical attendance compared to less educated counterparts. This should be considered if patient-initiated follow-up is the standard care.

show abstract

Section: Discussionmentioning

confidence: 62%

Detection of recurrence in early stage endometrial cancer – the role of symptoms and routine follow-up

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Several studies have continued to evaluate the efficacy of routine surveillance in the follow-up of uterine cancer [4,10,18,19]. Nevertheless, the optimal method for following these patients long term remains indeterminate.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, there is a relatively low risk for disease recurrence; the preponderance of cases are identified within 3 years from the initial diagnosis [2,3,4]. Despite 5-year relative survival rates approaching 83%, nearly 7,780 patients expired from disease in 2009 [1,5].…”

Section: Introductionmentioning

confidence: 99%

“…In particular, vaginal cytology does not appear to be effective at detecting uterine cancer recurrence [9,10]. Conversely, studies have suggested that both serial physical examination and CA-125 assay testing may provide predictive utility in monitoring these patients [4,10,11,12,13]. Investigators have also indicated that CT imaging has diagnostic value in the follow-up of recurrent disease [14,15], although the clinical utility has been impugned because of the expense and uncertain impact on patient outcomes [4,10,16,17,18].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Utility of Routine Follow-Up Procedures in the Surveillance of Uterine Cancer: A 20-Year Institutional Review

Rettenmaier¹,

Rettenmaier²,

Wojciechowski

et al. 2010

Oncology

View full text Add to dashboard Cite

Objectives: The purpose of this study was to assess the value of routine follow-up procedures during uterine cancer surveillance and the corresponding cost throughout a 20-year period at a single medical institution. Methods: We sought to determine which surveillance method (CA-125, imaging, physical examination or vaginal cytology) detected the highest number of patient recurrences and the corresponding cost vis-à-vis the number of identified progressive disease cases. Results: Serial imaging detected the highest number of progressive disease cases but the cost was rather high (USD 17,174 per patient recurrence), whereas CA-125 testing was the least expensive (USD 6,810 per patient recurrence). We also found that those with a variant histology [for example, adenosquamous and uterine papillary serous carcinoma (p < 0.001) and advanced (III/IV) disease stage (p = 0.001)] were associated with an unfavorable progression-free interval. Conclusions: In the present investigation, serial imaging detected the highest number of progressive disease cases, although no single surveillance method was associated with a sensitive recurrent disease detection rate. Nevertheless, the CA-125 assay appeared to be the most cost-effective method in following patients with epithelial uterine malignancies. Thus, in the context of high-risk disease, a combination of procedures may still be necessary for optimal uterine cancer patient follow-up.

show abstract

“…Most cervical cancers are squamous cell carcinomas (sccs); adenocarcinoma accounts for 10%-15% of cases 2 . Depending on disease stage, treatment consists of surgery, radiation therapy, or a combination of radiation and chemotherapy 2 , and the risk of recurrence ranges from 13% to 17% 3 . Most cases are diagnosed at International Federation of Gynecology and Obstetrics stage i or ii 3 , and the 5-year survival rate for those women is high-that is, 80%-85% for stage ib disease treated with radical hysterectomy and pelvic lymphadenectomy 4 .…”

Section: Introductionmentioning

confidence: 99%

Follow-Up for Cervical Cancer: A Program in Evidence-Based Care Systematic Review and Clinical Practice Guideline Update

2016

View full text Add to dashboard Cite

show abstract

Pattern of failure and value of follow-up procedures in endometrial and cervical cancer patients

Cited by 95 publications

References 16 publications

Detection of recurrence in early stage endometrial cancer – the role of symptoms and routine follow-up

Detection of recurrence in early stage endometrial cancer – the role of symptoms and routine follow-up

The Utility of Routine Follow-Up Procedures in the Surveillance of Uterine Cancer: A 20-Year Institutional Review

Follow-Up for Cervical Cancer: A Program in Evidence-Based Care Systematic Review and Clinical Practice Guideline Update

Contact Info

Product

Resources

About