The Prediction of Recurrence in Low-Risk Endometrial Cancer: Is It Time for a Paradigm Shift in Adjuvant Therapy?

Laban, Mohamed; El-Swaify, Seif Tarek; Ali, S. H.; Refaat, Mazen A; Sabbour, M. M.; Farrag, Nourhan; Hassanin, Alaa S.

doi:10.1007/s43032-021-00565-8

Cited by 14 publications

(9 citation statements)

References 56 publications

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“…In parallel, an issue concerning distant sites of EC dissemination is loco-regional recurrence [ 47 ]. It could be attributed to molecular pathways of tumor instability [ 48 , 49 , 50 ]. The tumor microenvironment, involving, for example, LVSI, shows a crucial role in EC relapse [ 51 , 52 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of Adjuvant Therapy for the Treatment of Micrometastases in Endometrial Cancer: A Systematic Review and Meta-Analysis

Ronsini,

Napolitano,

Iavarone

et al. 2024

JCM

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Endometrial cancer is the most incident gynecological cancer. Lymph node dissemination is one of the most important factors for the patient’s prognosis. Pelvic lymph nodes are the primary site of extra-uterine dissemination in endometrial cancer (EC), setting the 5-year survival to 44–52%. It is standard practice for radiation therapy (RT) and/or chemotherapy (CTX) to be given as adjuvant treatments to prevent the progression of micrometastases. Also, administration of EC patients with RT and/or CTX regimens before surgery may decrease micrometastases, hence the need for lymphadenectomy. The primary aim of the systematic review and meta-analysis is to assess whether adjuvant RT and/or CTX improve oncological outcomes through the management of micrometastases and nodal recurrence. We performed systematic research using the string “Endometrial Neoplasms” [Mesh] AND “Lymphatic Metastasis/therapy” [Mesh]. The methods for this study were specified a priori based on the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Outcomes were 5-year overall survival, progression-free survival, recurrence rate, and complications rate. We assessed the quality of studies using the Newcastle–Ottawa Scale (NOS). A total of 1682 patients with stage I-to-IV EC were included. Adjuvant treatment protocols involved external-beam RT, brachytherapy, and CTX either alone or in combination. The no-treatment group showed a non-statistically significant higher recurrence risk than any adjuvant treatment group (OR 1.39 [95% CI 0.68–2.85] p = 0.36). The no-treatment group documented a non-statistically significant higher risk of death than those who underwent any adjuvant treatment (RR 1.47 [95% CI 0.44–4.89] p = 0.53; I2 = 55% p = 0.000001). Despite the fact that early-stage EC may show micrometastases, adjuvant treatment is not significantly associated with better survival outcomes, and the combination of EBRT and CTX is the most valid option in the early stages.

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Section: Discussionmentioning

confidence: 99%

The Role of Adjuvant Therapy for the Treatment of Micrometastases in Endometrial Cancer: A Systematic Review and Meta-Analysis

Ronsini,

Napolitano,

Iavarone

et al. 2024

JCM

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“…However, disease recurrence, either local or distant, occurs in 7% to 15% of diagnosed patients ( 15 ), particularly those with endometrial endometrioid carcinoma (EEC) and those with non-endometrioid histology ( 24 – 26 ). Although 5% to 10% of low-grade EEC patients will experience either local recurrence or distant metastasis ( 17 , 27 , 28 ), the occurrence of distant organ metastasis is still very rare ( 29 ) for the stage I with low-grade EEC. In the domain of endometrial carcinoma, the histological classification embodies a seminal prognostic determinant.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary metastasis of stage I, low-grade endometrioid carcinoma: two case reports and the literature review

Wang,

Li,

Han

2023

Front. Oncol.

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Endometrial cancer (EC) is the most common malignant tumor of the female reproductive system, and the majority of ECs are low histological grade and confined to the uterus, resulting in a good prognosis. However, metastasis to the lung from a low-grade and early-stage endometrial endometrioid carcinoma (EEC) is extremely rare. Therefore, it is crucial to accurately differentiate between primary pulmonary malignancy and extra-thoracic malignancy presenting as metastatic disease, and flexible bronchoscopy with tissue acquisition plays a key role in this process. Despite its importance, there is limited literature available on the cytology of metastatic endometrial carcinoma in liquid-based cytology of bronchial brush (BB). In this article, we present two rare cases of lung metastasis from low-grade and early-stage EEC, along with a detailed analysis of the cytologic features observed in BB samples. These cases highlight the significance of cytological and histological pathology, complemented by immunohistochemistry (ICH) analysis, in the diagnosis and management of EEC patients. Pathologists should pay close attention to these aspects, while gynecologists need to be mindful of the follow-up and management of early-stage, low-grade EEC patients. By focusing on these areas, healthcare professionals can effectively contribute to the improved care and outcomes of patients with EEC.

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“…To contextualize the possible impact of these increasing rates of ovarian conservation, a study of bilateral oophorectomy compared with ovarian conservation in women <50 years of age who had undergone hysterectomy for benign disease reported that eight patients would need to undergo bilateral oophorectomy to cause one all-cause death, and 33 would need to undergo bilateral oophorectomy to cause one death from heart disease 11. While our patient population differs in that all hysterectomies at our institution were performed for malignancy, women with low-grade endometrial cancer are generally considered to be at low risk for oncologic recurrence but high risk for cardiovascular comorbidities 22. For example, among women diagnosed with all stages of low-grade endometrial cancer from 1973 to 1988 captured by the Surveillance, Epidemiology, and End Results database, 42.1% died from cardiovascular causes compared with 7.2% from endometrial cancer 23…”

Section: Discussionmentioning

confidence: 99%

Demographic shifts associated with implementation of evidence-based guidelines for ovarian conservation in patients with endometrioid endometrial cancer

Manning‐Geist

Rios-Doria

Aviki

et al. 2022

Int J Gynecol Cancer

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ObjectiveIn 2018, evidence-based surgical guidelines were introduced to identify appropriate patients with low-grade endometrioid endometrial cancer for ovarian conservation. We sought to identify trends and demographic shifts associated with guideline implementation.MethodsWe identified women treated for endometrioid endometrial cancer at our institution from January 2010 to June 2021. Eligibility criteria included age ≤50 years, normal-appearing ovaries on preoperative imaging, no family history of hereditary breast and ovarian cancer syndrome or Lynch syndrome, and no hormone receptor-positive malignancy. Trends in ovarian conservation were examined with the Cochran-Armitage trend test or in a logistic regression model. Associations between ovarian conservation and clinicodemographic factors before and after guideline implementation were compared using Wilcoxon rank-sum and Fisher’s exact tests.ResultsOf 420 women ≤50 years of age undergoing surgery for endometrioid endometrial cancer, 355 (85%) met the criteria for ovarian conservation—267 (75%) before and 88 (25%) after guideline implementation. Median patient age was 45 years (range 25–50); 62% were non-Hispanic White, 10% Hispanic White, 8% non-Hispanic Black, 0% Hispanic Black, and 20% Asian. Patients were significantly more likely to choose ovarian conservation after (48%) compared with before guideline implementation (21%) (p<0.001). Pre-guidelines, non-Hispanic White women were less likely to elect for ovarian conservation (12%) compared with non-Hispanic Black, Asian, or Hispanic White women (28%) (p=0.002). Similarly, older women were less likely to elect for ovarian conservation compared with younger women (p<0.001). There were no differences by obesity (p=0.68), marital status (p=0.86), or insurance (p=0.89). Post-guidelines, there were no differences in ovarian conservation between non-Hispanic White women (36%) and non-Hispanic Black, Asian, or Hispanic White women (50%) (p=0.56). Older women were still less likely to elect for ovarian conservationcompared with younger women (p<0.001).ConclusionsAfter guideline implementation, ovarian conservation increased and uptake disparities across demographic groups decreased.

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The Prediction of Recurrence in Low-Risk Endometrial Cancer: Is It Time for a Paradigm Shift in Adjuvant Therapy?

Cited by 14 publications

References 56 publications

The Role of Adjuvant Therapy for the Treatment of Micrometastases in Endometrial Cancer: A Systematic Review and Meta-Analysis

The Role of Adjuvant Therapy for the Treatment of Micrometastases in Endometrial Cancer: A Systematic Review and Meta-Analysis

Pulmonary metastasis of stage I, low-grade endometrioid carcinoma: two case reports and the literature review

Demographic shifts associated with implementation of evidence-based guidelines for ovarian conservation in patients with endometrioid endometrial cancer

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