Risk factors and recurrent patterns in Stage I endometrial cancer

DiSaia, Philip J.; Creasman, William T.; Boronow, Richard C.; Blessing, John A.

doi:10.1016/0002-9378(85)90371-0

Cited by 280 publications

(110 citation statements)

References 2 publications

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“…4,5 However, the majority of parameters such as histologic type, grade of differentiation, and depth of myometrial invasion have been criticized for their subjectivity and poor reproducibility. 6 In particular, because grade of differentiation is categorized into 3 levels, it is known that patients with moderately differentiated tumor (G2), who account for as many as 39% of all cases, 7 represent a group for which prognosis and need for adjuvant treatment are uncertain.…”

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confidence: 99%

Ten‐year results of a prospective study on the prognostic role of ploidy in endometrial carcinoma

Susini

Amunni

Molino

et al. 2007

Cancer

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BACKGROUND.To improve the outcome of endometrial cancer patients, a more accurate prognostic assessment is mandatory. The aims of the study were to evaluate the role of flow cytometric DNA ploidy as an independent prognostic factor in patients with endometrial cancer and to verify if ploidy was able to distinguish patients with different prognosis into homogeneous subgroups for grade of differentiation and stage.METHODS.In a prospective study, DNA ploidy was evaluated from fresh tumor samples in 174 endometrial cancer patients who underwent surgery as the first treatment. Ploidy, as well as classical parameters, were analyzed in relation to the length of disease‐free survival and disease‐specific survival.RESULTS.DNA aneuploidy was found in 49 patients (28.2%). Patients with DNA‐aneuploid tumors had a significantly reduced disease‐free interval and disease‐specific survival (P < .0001). The 10‐year survival probability was 53.2% for DNA‐aneuploid patients and 91.0% for patients with DNA‐diploid tumors. By multivariate analysis DNA‐aneuploid type was the strongest independent predictor of poor outcome, followed by age and stage. Patients with DNA‐aneuploid tumor had a significantly higher risk ratio for recurrence (5.03) and death due to disease (6.50) than patients with DNA‐diploid tumors. Stratification by DNA‐ploidy within each group by grade of differentiation allowed identification of patients with significantly different outcome. In grade 2 tumors, 10‐year survival was 45.0% in aneuploid cases and 91.9% in diploid cases (P < .0001). Patients with advanced‐stage (>I) diploid tumor did significantly better than patients with stage I aneuploid tumor (P = .04).CONCLUSIONS.The presence of DNA‐aneuploid type in endometrial cancer identifies high‐risk cases among the patients considered ‘low risk’ according to stage and grade of differentiation. Cancer 2007. © 2007 American Cancer Society.

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confidence: 99%

Ten‐year results of a prospective study on the prognostic role of ploidy in endometrial carcinoma

Susini

Amunni

Molino

et al. 2007

Cancer

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“…15 De forma interessante, a identificação de células neoplásicas no lavado peritoneal não representou um factor preditivo relevante no grupo GPP, mas a associação tornou-se estatisticamente significativa no grupo GRP. Com uma incidência de 10 a 17% nos casos de carcinoma do endométrio, a citologia peritoneal positiva é mais frequente perante a existência de doença extra-uterina.…”

Section: Discussionunclassified

Factores Preditivos de Metastização Ganglionar Retroperitoneal no Cancro do Endométrio

et al. 2014

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Introduction: It has been suggested that a complete staging may be safely omitted in endometrial carcinoma patients at low risk for lymph node metastasis. The purposes of our study were to explore the prognostic significance of pathologic factors for pelvic and paraaortic nodal spread and to validate the Mayo algorithm in order to identify patients in whom lymphadenectomy may be avoided. Material and Methods:We conducted a retrospective review including 208 patients, regarding the evaluation of pathologic variables and nodal metastases. Statistical analysis was performed using the chi-square test, the Fisher exact test and the Student's t-test. Results: Myometrial invasion > 50% (p < 0.001), cervical invasion (p = 0.001), lymphovascular space invasion (p = 0.003) and positive peritoneal cytology (p = 0.03) were significant predictors of retroperitoneal lymph node dissemination. Pelvic lymph node metastases were predictive of positive paraaortic lymph nodes (p < 0.001). Discussion: The Mayo algorithm identified patients without pelvic or paraaortic nodal metastases with a 98.4% negative predictive value (61/62). Myometral invasion ≤ 50% and absence of cervical and lymphovascular invasion presented a negative predictive value of 98.8% (79/80). Conclusion:Although the Mayo criteria predict a very low likelihood of retroperitoneal nodal metastases, the combination of myometral invasion ≤ 50% and absence of cervical or lymphovascular invasion would have safely avoided lymphadenectomy in a larger number of women. Keywords: Endometrial Neoplasms; Lymphatic Metastasis; Lymph Node Excision; Neoplasm Staging; Predictive Value of Tests; Retroperitoneal Space; Portugal. INtRODUÇÃORepresentando a neoplasia ginecológica mais frequente nos países desenvolvidos, o carcinoma do endométrio possui, em Portugal, taxas anuais de incidência e mortalidade cifradas em 10,3 e 1,9 por 100 000 mulheres, respectivamente. Com base na clínica, na histologia e no perfil molecular, descrevem-se dois tipos de carcinoma do endométrio. Responsável por 80% dos casos, o tipo I relaciona--se com condições que configuram um estado prolongado de hiperestrogenismo não contrabalançado (anovulação, nuliparidade, menopausa tardia, administração de tamoxifeno, cirrose hepática), atinge mulheres mais jovens e obesas e corresponde a tumores do tipo endometrióide, bem diferenciados e com melhor prognóstico. O tipo II associa--se a um endométrio atrófico, raramente exibe expressão de receptores hormonais, corresponde a tipos histológicos não endometrióide (células claras, serosos, carcinossarcomas) e cursa com invasão miometrial profunda e metastização ganglionar frequente. Globalmente, o carcinoma do endométrio acomete sobretudo mulheres na sexta e sétima décadas de vida, tendo a sua incidência vindo a aumen-

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“…tases and death, respectively [1,[16][17][18][19][20][21][22]. G2 patients pro- Table 2 Cox's analysis fitted to the overall survival (OS) and disease-free survival (DFS) gressed at a relatively slow pace, possibly allowing for the detection of local relapse and metastases.…”

Section: Overall Survival Analysismentioning

confidence: 99%

“…Cell differentiation has been shown to be one of the most important prognostic factors in carcinoma of the endometrium [1][2][3][4]. In this retrospective analysis we 2.…”

Section: Introductionmentioning

confidence: 99%

Effect of grade on disease-free survival and overall survival in FIGO stage I adenocarcinoma of the endometrium

Delaloye

Pampallona²,

Coucke

et al. 2000

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective: To analyse the effect of differentiation on disease-free survival (DFS) and overall survival (OS) in patients with stage I adenocarcinoma of the endometrium. Patients and methods: From 1979 to 1995, 350 patients with FIGO stage IA-IC with well (G1), moderately (G2) or poorly (G3) differentiated tumors were treated with surgery and high dose-rate brachytherapy with or without external radiation. Median age was 65 years (39-86 years). Results: The 5-year DFS was 8863% for the G1 tumors, 7764% for the G2 tumors, and 6767% for the G3 tumors (P50.0049). With regard to the events contributing to DFS, the 5-year cumulative percentage of local relapse was 4.6% for the G1 tumors, 9.0% for the G2 tumors, and 4.6% (P50.027) for the G3 tumors. Cumulative percentage of metastasis was 1.4, 6.3 and 7.2% (P,0.001), respectively, whereas percentages of death were 6.0, 7.9 and 20.7% (P,0.001). The 5-year OS was 9163, 8364 and 7667%, respectively (P50.0018). In terms of multivariate hazard ratios (HR), the relative differences between the three differentiation groups correspond to an increase of 77% of the risk of occurrence of either of the three events considered for the DFS (HR51.77,), (P50.078) for the G2 tumors and of 163% (HR52.63,), (P50.009) for the G3 tumors with respect to the G1 tumors. The estimated relative hazards for OS are, respectively, in line with those for DFS: HR51.51 (P50.282) for the G2 tumors; and HR53.37 (P50.003) for the G3 tumors. Conclusion: Patients with grade 1 tumors are those least exposed to either local relapse, metastasis, or death. In contrast patients with grade 2 tumors seem to be at higher risk of metastasis, whereas patients with grade 3 tumors appear at higher risk of death. Since we have looked at the first of three competing events (local relapse, metastasis and death), this suggests that patients with grade 3 tumors probably progress to death so fast that local relapse, if any, cannot be observed.

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Risk factors and recurrent patterns in Stage I endometrial cancer

Cited by 280 publications

References 2 publications

Ten‐year results of a prospective study on the prognostic role of ploidy in endometrial carcinoma

Ten‐year results of a prospective study on the prognostic role of ploidy in endometrial carcinoma

Factores Preditivos de Metastização Ganglionar Retroperitoneal no Cancro do Endométrio

Effect of grade on disease-free survival and overall survival in FIGO stage I adenocarcinoma of the endometrium

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