The impact of complete surgical staging on adjuvant treatment decisions in endometrial cancer

Goudge, Christine S.; Bernhard, Shana; Cloven, Noelle Gillette; Morris, Peter C.

doi:10.1016/j.ygyno.2004.02.020

Cited by 35 publications

(18 citation statements)

References 12 publications

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“…Our proportion of women receiving adjuvant pelvic radiation (35%) was higher than other contemporary studies (~20%) 7,8 because GOG protocol 0099 11 and the Post-Operative Radiation Therapy in Endometrial Carcinoma (PORTEC) 12 results were unpublished when many women in this retrospective study underwent treatment..…”

Section: Commentmentioning

confidence: 63%

“…2 Obesity also influences completeness of surgical lymph node staging during surgical laparotomy 3,4 and on radiation-related adverse sequelae. 5,6 Despite recommendations for comprehensive surgical staging by gynecologic oncologists, 7,8 obese women may not undergo surgical staging routinely. Comprehensive staging is difficult and may be hazardous in obese women where adequate exposure of the uterus and pelvic and para-aortic lymph nodes are suboptimal.…”

Section: Introductionmentioning

confidence: 99%

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Adjuvant treatment and survival in obese women with endometrial cancer: An international collaborative study

Martra

Kunos

Gibbons

et al. 2008

American Journal of Obstetrics and Gynecology

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Objective-To determine the impact of patient weight on frequency of surgical staging lymphadenectomy and pelvic radiation. Adverse effects, disease relapse, and survival outcomes were investigated.Study Design-Records of 766 women undergoing surgery for presumed corpus-confined endometrial cancer were reviewed. Body mass index (BMI) was calculated categorizing women as obese (BMI ≥ 30) or nonobese (BMI < 30). Radiation-related toxicity was retrospectively scored. Median duration of follow-up was 38 months. Chi-square, logistic regression, correlation, KaplanMeier and Cox multivariate proportional hazards were used for analysis.Results-Lymphadenectomy was completed as often in nonobese as obese women (p=0.24). Adjuvant pelvic radiation treatment was administered more often in nonobese women (p=0.01). Among 681 women with endometrioid histopathology, four-year cancer-related survival in obese women was 10 percent higher than all cause mortality, compared to 6 percent in nonobese women.Conclusion-Obesity was not a barrier to lymphadenectomy, but did influence adjuvant pelvic radiation use.CORRESPONDING AUTHOR and REPRINT REQUESTS: Vivian von Gruenigen, MD,

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Section: Commentmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Adjuvant treatment and survival in obese women with endometrial cancer: An international collaborative study

Martra

Kunos

Gibbons

et al. 2008

American Journal of Obstetrics and Gynecology

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“…However, preoperative clinical staging has been deemed insufficient and failed to identify all patients with LNM. In two studies conducted with 291 and 181 EC patients, endometrial biopsy findings were upgraded to 18 and 19%, respectively, following final pathology reports (Goudge et al, 2004;Ben-Shachar et al, 2005). Several techniques can be used for the preoperative assessment disease invasion.…”

Section: 6353 Risk Factors For Lymph Node Metastases With Endometriamentioning

confidence: 99%

Risk Factors of Lymph Node Metastases with Endometrial Carcinoma

Çetinkaya¹,

Atalay²,

Bacinoglu³

2014

Asian Pacific Journal of Cancer Prevention

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Background: The purpose of this study was to investigate and evaluate risk factors for lymph node metastases (LNM) in cases of endometrial cancer (EC). Materials and Methods: A retrospective single institution analysis of patients surgically staged for EC at Ankara Oncology Education and Research Hospital from 1996 to 2010 was performed. Roles of prognostic factors, such as age, histological type, grade, depth of myometrial invasion, cervical involvement, peritoneal cytology, and tumor size, in the prediction of LNM were evaluated. Fisher's exact test and logistic regression analysis were used to assess the effects of various factors on LNM. Results: LNM was observed in 22 out of 247 patients (8.9%) and was significantly more common in the presence of tumors of higher grade, deep myometrial invasion (DMI), cervical involvement, size >2cm, and with positive peritoneal cytology. Logistic regression analysis revealed that DMI remained the only independent risk factor for LNM. NPV, PPV, sensitivity, and specificity for satisfying LNM risk were 98.0, 19.5, 86.3, and 65.3%, respectively for DMI. Conclusions: The incidence of LNM is influenced independently by DMI. If data support a conclusion of DMI, LND should be seriously considered.

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“…The preoperative and intra-operative evaluation of these high-risk features is often inaccurate, and surgical staging is therefore recommended in most patients diagnosed with endometrial cancer (NCCN guidelines for uterine neoplasms, V.2.2011). The preoperative tumor grade was upgraded on final pathology in approximately 18% patients in different studies (Goudge et al 2004) (Ben-Shachar et al 2005). Neither imaging nor frozen section is very accurate for assessing the depth of myometrial invasion.…”

Section: Surgical Staging and Related Issuesmentioning

confidence: 99%