Matrix metalloproteinases and their inhibitors and inducer in gestational trophoblastic diseases and normal placenta

Objectives

This study aimed to investigate the expression of recently identified matrix metalloproteinases (MMPs), their inhibitors (TIMPs), and inducer (CD147) in a wide range of gestational trophoblastic diseases (GTD) thereby expanding our understanding of the potential role of MMPs in GTD.

Methods

Paraffin sections of 10 normal first-trimester placentas (NP), 10 partial moles (PM), 10 complete moles (CM), 5 choriocarcinomas (CCA) and 5 placental site trophoblastic tumors (PSTT) were studied immunohistochemically for expression of MMP-7, MMP-14, MMP-21, MMP-28, TIMP-3, TIMP-4 and CD147. Immunolocalization of MMP-1, MMP-2, MMP-3, MMP-9, MMP-13 and TIMP-1 was performed on 5 CCA and 5 PSTTs.

Results

CCA showed stronger intensity for MMP-14 and MMP-28 than PSTT (p < 0.05, p < 0.05). CCA and PSTT had stronger expression of MMP-21 than NP, PM and CM (p < 0.05, p < 0.05, p < 0.01). PSTT (p < 0.05, p < 0.05), NP (p < 0.01, p < 0.01) and CM (p < 0.01, p < 0.05) showed stronger staining for TIMP-3 and TIMP-4 than CCA.

Conclusion

Choriocarcinoma's high expression of MMPs and low expression of MMP inhibitors may contribute to its invasiveness and metastatic potential. Similarly, PSTT's lower expression of MMPs and high expression of MMP inhibitors may partly explain its lower invasiveness. Agents that inhibit MMP may prove useful in treating GTD.     

Protective effect of infliximab on ischemia/reperfusion injury in a rat ovary model: biochemical and histopathologic evaluation

Objective

The aim of this study was to investigate the effect of infliximab on experimentally induced ovarian ischemia/reperfusion injury (IRi).

Study design

A total of 42 female rats were equally divided into 6 experimental groups; group 1: sham operation, group 2: 3-h ischemia, group 3 and 4: 3-h ischemia, 3-h reperfusion, group 5 and 6: 3-h ischemia, 24 h reperfusion. In group 4 and group 6, 30 min before reperfusion, infliximab was administered intraperitoneally at a dose of 5 mg/kg. Bilateral ovaries were removed for histopathologic and biochemical analysis. Serum MDA (sMDA), tissue MDA (tMDA), serum NO (sNO), tissue NO (tNO) and serum catalase concentrations were analyzed. Tissue damage of ovarian tissue was scored by histological examination.

Results

The infliximab administration significantly lowered the sNO, tNO and sMDA concentrations in group 4 compared to group 3 (p = 0.041, p = 0.025 and p = 0.035, respectively). sNO, tNO and sMDA concentrations were also lower in group 6 when compared to group 5, but this differences were not significant (p > 0.05). On the other hand, tMDA concentrations were lower in infliximab-applied groups when compared to ischemia/reperfusion groups (group 3 vs. 4 and 5 vs. 6) (p = 0.045 and p = 0.048, respectively). Moreover, histopathologic tissue damage scores in infliximab administration groups were significantly lower than in ischemia/reperfusion groups (p < 0.001).

Conclusion

Infliximab attenuates I/R-induced ovarian tissue injury in rats subjected to ischemia/reperfusion.     

The effect of tobacco exposure on maternal and fetal thyroid function

Objective

To determine the effect of smoking on maternal and fetal thyroid function.

Study design

This prospective cohort study involved healthy women undergoing elective cesarean section for term singleton infants. Maternal and fetal thyroid indices were compared between smokers (n = 21) and non-smokers (n = 83).

Results

Maternal thyrotropin (TSH) concentrations were significantly lower in smokers than non-smokers (1.75 mIU/L versus 2.15 mIU/L, respectively, p = 0.007), with similar free thyroxine (FT4) concentrations (9.59 pmol/L versus 9.56 pmol/L, p = 0.755). For women who smoked, the correlation between the average number of cigarettes smoked per day and maternal TSH concentrations was −0.427, p = 0.054. Infants of smokers and non-smokers had similar umbilical TSH (5.43 mIU/L versus 5.82 mIU/L, p = 0.124) and FT4 concentrations (13.06 pmol/L versus 13.57 pmol/L, p = 0.049).

Conclusion

We demonstrated for the first time that women who smoke during pregnancy have significantly lower TSH concentrations than non-smokers.     

Effect of tamoxifen on extracellular signal-regulated kinases in the urethra of castrated female rats

Objective

The aim was to evaluate the effects of tamoxifen in activating extracellular signal-regulated kinases (ERKs) 1 and 2 in the urethras of castrated female rats.

Study design

Twelve castrated adult female rats were divided into a control group (n = 6) in which the animals received vehicle, and the experimental group (n = 6) in which the rats received tamoxifen 250 μg/day by gavage for 28 days. Then, the animals were sacrificed and their urethras removed. Proteins were extracted, quantified and processed by Western blot analysis with specific phospho-ERK1 and 2 antibodies. Data were analyzed using Student's t-test (p < 0.05).

Results

A significant increase occurred in phospho-ERK1 levels in the experimental group compared to the control group (p < 0.01), while no difference was found in phospho-ERK2 levels between the groups (p = 0.313).

Conclusion

The present results indicate that, at the doses and during the time of treatment used, tamoxifen significantly increased phospho-ERK1 levels in the urethras of castrated female rats.     

Ovarian reserve testing before and after laparoscopic tubal bipolar electrodesiccation and transection

Objective

To find out whether tubal sterilization leads to loss of ovarian reserve, we assessed the hormonal and ultrasonographic parameters of ovarian reserve in women who underwent laparoscopic tubal sterilization by bipolar electrodesiccation and transection.

Study design

In this preliminary study, laparoscopic tubal sterilization was performed on 49 healthy women who had voluntarily requested elective surgical sterilization. Among the current ovarian reserve indicators, in the early proliferative phases, preoperative (baseline) and postoperative (third month) serum follicle-stimulating hormone (FSH), estradiol (E2), and anti-Mullerian hormone (AMH) levels, ovarian volume, and antral follicle counts (AFCs) were determined. Analysis of these hormonal and ultrasonographic parameters of ovarian reserve preoperatively and postoperatively was the main outcome measure.

Results

Preoperative and third-month postoperative FSH, LH, E2, and AMH levels did not reveal statistically significant differences (p = 0.101, p = 0.180, p = 0.254, and p = 0.079; respectively). The ultrasonographic indicators of ovarian reserve did not change in terms of total ovarian volume and total AFC (p = 0.793 and p = 0.098, respectively).

Conclusions

Short-term follow-up study results revealed a slight but non-significant change in the current ovarian reserve markers, especially in the AMH levels.     

Idiopathic urinary findings and fetal growth restriction in low risk pregnancy

Objective

To determine whether maternal urinary findings in the first trimester of pregnancy are associated with fetal growth restriction.

Study design

The prevalence of urinary findings in singleton pregnancies complicated by fetal growth restriction were compared with a low-risk control group of pregnancies who gave birth to normal weight babies, in the same condition.

Results

There were significant statistical differences in the mean gestational age (p < 0.001), isolated asymptomatic bacteriuria (p < 0.001), hematuria (p = 0.002, OR = 6.6, CI = 1.8–24.2) and proteinuria (p = 0.016, OR = 4.1, CI = 1.2–13.3). There was no recognizable relation between ketonuria and fetal growth restriction.

Conclusion

Our data showed a relation between the increase of adverse pregnancy outcomes, including fetal growth restriction, and hematuria, proteinuria and asymptomatic bacteriuria. Appropriate monitoring of pregnant women using these findings may be helpful in the identification of more complications.     

Association between a single nucleotide polymorphism in MTHFR gene and polycystic ovary syndrome

Objective

The aim of the present study was to investigate whether there is an association between the C677T polymorphism in MTHFR and PCOS in a Korean population.

Study design

The prevalence of MTHFR gene was compared between women with PCOS (n = 227) and normal patients (n = 115) using restriction fragment length polymorphism (RFLP) analysis. The HapAnalyzer was used to analyze the genotype of MTHFR polymorphism in PCOS and control subjects. We considered a p-value less than 0.05 as statistically significant.

Results

The frequency of C/C, C/T, and T/T genotype showed similar proportion between PCOS and control subjects. In addition, the frequencies of co-dominant (p-value = 0.8334, odds ratio (OR) = 1.04), dominant (p-value = 0.8749, OR = 0.96) and recessive alleles (p-value = 0.5574, OR = 1.22) did not show any association between PCOS and control subjects.

Conclusion

Our data demonstrate that the C677T polymorphism of MTHFR gene is not associated with PCOS in a Korean population, suggesting that the C677T polymorphism in MTHFR may have different influences in various ethnic groups and diseases.     

Injury in adult female sexual assault complainants and related factors

Objective

This study was undertaken to document physical injuries and ascertain associated variables in female complainants of sexual assault.

Study design

164 cases of sexual assault between 2002 and 2006 in Belfast were included. 162 women consented to body examination and 153 to genital examination. Data for the study were obtained from the contemporaneous notes of a forensic doctor who examined the victims.

Results

Of 164 females, 44% were less than 20 years of age, mean age was 24.2, range 13–74 years; two-thirds reported alcohol consumption prior to assault. Non-genital (body) injury was observed in 61%, genital injury in 39%, both in 20% and 18% had no injury. Body injury was associated with time to examination (OR = 4.0, p < 0.01), alcohol intake prior to assault (OR = 3.33, p < 0.001), assault occurring outdoors (OR = 3.45, p < 0.01), previous sexual intercourse (OR = 3.19, p < 0.01) and genital injury (OR = 2.24, p < 0.05). Genital injury was related to acquaintance assault (OR = 2.33, p < 0.05), time to examination (OR = 3.70, p < 0.05), reported virgin status (OR = 3.03, p < 0.01) and absence of hormonal contraception (OR = 2.04, p < 0.10).

Conclusion

Almost half the victims of sexual assault were less than 20 years old and injury was detected in over 80%. Time to examination and prior sexual experience were related to genital and body injury. Assault occurring outdoors and alcohol intake were associated with body injury. Genital injury was more frequent in acquaintance assault and victims not using hormonal contraception. Young females drinking alcohol are at a very high risk for sexual assault.     

Determinants of postpartum infectious complications among HIV uninfected and antiretroviral naïve-HIV infected women following vaginal delivery: A prospective cohort study

Objective

To determine the incidence rate of postpartum infectious morbidity among HIV uninfected women compared to antiretroviral naïve-HIV infected women who were eligible for vaginal delivery.

Study design

A nested study was conducted within a large prospective trial in which HIV infected women eligible for vaginal delivery at term were compared with HIV uninfected women. Women were reviewed within 72 h post delivery, at 1, 2 and 6 weeks for clinical signs of puerperal infection.

Results

241 HIV infected women were compared with 427 HIV uninfected controls. Both groups were comparable in terms of baseline parameters. The infectious morbidity rate was similar between the HIV infected and uninfected women (p = 0.977). Factors which significantly increased puerperal infections in both groups were the presence of an episiotomy, p < 0.001, the number of vaginal examinations after rupture of amniotic membranes, p = 0.026, and a CD4 count of <200 μ/L, p = 0.017 in the HIV infected group.

Conclusion

There was no difference in postpartum infections amongst HIV infected compared to uninfected women, but an episiotomy was associated with a 2-fold increased risk of infectious morbidity.     

Determinant factors of fertility outcomes after laparoscopic colorectal resection for endometriosis

Objective

The aims of this prospective study were to evaluate fertility, pregnancy outcomes and their determinant factors after laparoscopic segmental colorectal resection for endometriosis.

Study design

We studied 83 women who underwent colorectal resection for endometriosis. Thirty-nine women (47%) had an associated infertility and 51 (61.4%) wished to conceive after surgery. Surgical route was exclusive laparoscopy in 77 cases (92.7%) and laparoconversion in 6 (7.3%).

Results

Twenty-nine pregnancies were obtained in 24 patients (43.6%) including 20 spontaneous (69%) and 9 by IVF (31%). The median time to conceive spontaneously was 6 months and 20 months by IVF. Among the 39 infertile women, 18 (46%) conceived during the study period. A relation was found between pregnancy rate and patient age (p = 0.02). Reduction in pregnancy rate was correlated to the presence of adenomyosis (p = 0.04) and high ASRM total score (p < 0.001) as well as exclusive laparoscopy compared to conversion to laparotomy for colorectal resection (p = 0.01).

Conclusion

Adenomyosis and conversion to laparotomy as well as patient age, ASRM score appeared determinant factors of fertility outcome.     

Short-term effects of two continuous combined oestrogen–progestogen therapies on several cardiovascular risk markers in healthy postmenopausal women: A randomised controlled trial

Objective

To compare the short-term effects of two oral continuous combined oestrogen–progestogen treatment regimens on blood concentrations of several cardiovascular risk markers in healthy postmenopausal women.

Study design

In a 12-week randomised controlled study, 48 healthy non-hysterectomised postmenopausal women, aged 41–58 years, received either no treatment (control group; n = 16), or daily oral continuous combined treatment with 1 mg micronised 17β-oestradiol plus 5 mg dydrogesterone (E/D group; n = 18) or 0.625 mg conjugated equine oestrogens plus 5 mg medroxyprogesterone acetate (CEE/MPA group; n = 14).Fasting blood sampling was performed at baseline and after 12 weeks of follow-up.

Results

Compared with the control group, 12-week treatment with E/D or CEE/MPA reduced fibrinogen (−7.7%, p = 0.004 and −3.3%, p = 0.083, respectively), factor VII-act (−8.7%, p = 0.14 and −9.7%, p = 0.06, respectively), homocysteine (−20.5%, p = 0.02 and −26.7%, p = 0.005, respectively), and IGF-1 (−27.9%, p < 0.001 and −18.1%, p = 0.002, respectively), but increased factor VII-ag (+10.1%, p = 0.03 and +4.4%, p = 0.46, respectively), endothelin-1 (+15.2%, p = 0.12 and +20.0%, p = 0.13, respectively) and C-reactive protein (+88.8%, p = 0.18 and +71.0%, p = 0.44, respectively). Fibrinolytic factors were not affected by either hormone therapy (HT).

Conclusions

Short-term oral continuous combined therapy with oestradiol/dydrogesterone and conjugated equine oestrogens/medroxyprogesterone acetate had comparable effects on the investigated cardiovascular risk markers.     

Does hysterectomy affect ovarian function? Histopathologic evaluation and serum FSH,inhibin A,and inhibin B levels in an experimental rat model

Objective

To evaluate the effects of hysterectomy with ovarian conservation on ovarian histology, and FSH, inhibin A, and inhibin B plasma levels.

Study design

Forty-five female Wistar albino rats were used in this study and randomly divided into two groups: hysterectomy (n = 30) and sham-operated (n = 15). Blood samples were collected before and after (50 and 100 days) abdominal hysterectomy from both groups to measure plasma levels of FSH, inhibin A, and inhibin B. All animals were sacrificed by decapitation to obtain ovaries for histological examination. For statistical analyses, Mann–Whitney U, Chi-square, Wilcoxon matched pairs signed rank sum tests, and two-sided variance analysis were used and statistical significance was defined as p < 0.05.

Results

There was no difference in hormonal variables between groups when the time interval was considered completely [p > 0.05 (for FSH p = 0.962; for inhibin A p = 0.321; for inhibin B p = 0.476)]. In the hysterectomy group, the inhibin B level at postoperative day 50 was significantly lower than the control group (p = 0.007) and at postoperative day 100, inhibin A concentrations were increased significantly when compared with the levels at both baseline and postoperative day 50 (p < 0.001). Histopathologic evaluation of ovaries 100 days after hysterectomy showed that ovaries from the hysterectomy group had significantly fewer primary (p = 0.01), preantral (p < 0.001), and antral follicles (p < 0.001), and significantly more corpora lutea (p < 0.001), atretic (p = 0.02), and cystic follicles (p = 0.003).

Conclusion

The results of this experimental rat model suggest that hysterectomy may affect ovarian function.     

Altered CD16 expression on vaginal neutrophils from women with vaginitis

Objective

Reduced CD16 expression is associated with neutrophil apoptosis. This study aimed to compare CD16 expression on neutrophils in the vagina from women with normal bacterial flora and with vaginitis.

Study design

Vaginal lavages were sampled from volunteers diagnosed with bacterial vaginosis (BV, n = 34), vulvovaginal candidiasis (VC, n = 43), BV plus VC (BV + VC, n = 14), and normal flora (NF, n = 51). Neutrophils were identified by expression of CD15, CD16 and CD24 surface markers as assessed by flow cytometry.

Results

CD16 expression was elevated in neutrophils from women with vaginitis (BV p < 0.0001; VC p = 0.01; BV + VC p = 0.0027) as compared to women with NF.

Conclusion

The reduction in CD16 down-regulation is consistent with prolonged neutrophil viability and activity in the vagina of women with vaginitis. This may contribute to greater microbial clearance and, conversely, with inflammation-associated pathology.     

Relationship between minimally invasive hysterectomy,pelvic cytology,and lymph vascular space invasion: A single institution study of 458 patients

Objective

The aim of this study is to determine whether a minimally invasive approach to hysterectomy is associated with an increased rate of lymph vascular space invasion (LVSI) and/or malignant pelvic peritoneal cytology in endometrial cancer.

Methods

We performed a single institution analysis of 458 women with endometrial cancer who underwent either total abdominal hysterectomy (TAH) or minimally invasive hysterectomy (MIH) with use of a disposable uterine manipulator. All patients had endometrial cancer diagnosed by endometrial biopsy at a single academic institution between 2002 and 2012. Exclusion criteria were pre-operative D&C and/or hysteroscopy, uterine perforation or morcellation, and conversion to laparotomy. Multivariate logistic regression models to determine if type of hysterectomy predicts either LVSI or presence of abnormal cytology were controlled for grade, stage, depth of invasion, tumor size, cervical and adnexal involvement.

Results

LVSI was identified in 39/214 (18%) MIH and 44/242 (18%) TAH (p = 0.99). Pelvic washings were malignant in 14/203 (7%) MIH and 16/241 (7%) TAH (p = 1.0). Washings were atypical or inconclusive in 16/203 (8%) MIH and 6/241 (2.5%) TAH (p = 0.014). In multivariate analyses, type of hysterectomy was not a significant predictor of either LVSI (p = 0.29) or presence of malignant washings (p = 0.66), but was a predictor of atypical or inconclusive washings (p = 0.03).

Conclusion

Minimally invasive hysterectomy with use of a uterine manipulator for endometrial cancer is not associated with LVSI or malignant cytology. Algorithms that better determine the etiology and implications of inconclusive or atypical pelvic cytology are needed to inform the possible additional risk associated with a minimally invasive approach to endometrial cancer.     

Gene expression and protein localization of TLR-1, -2, -4 and -6 in amniochorion membranes of pregnancies complicated by histologic chorioamnionitis

Objectives

To determine whether histologic chorioamnionitis is associated with changes in gene expression of TLR-1, -2, -4 and -6, and to describe the localization of these receptors in fetal membranes.

Study design

A total of 135 amniochorion membranes with or without histologic chorioamnionitis from preterm or term deliveries were included. Fragments of membranes were submitted to total RNA extraction. RNA was reverse transcribed and the quantification of TLRs expression measured by real time PCR.

Results

All amniochorion membranes expressed TLR-1 and TLR-4, whereas 99.1% of membranes expressed TLR-2 and 77.4% expressed TLR-6. TLR-1 and TLR-2 expressions were significantly higher in membranes with histologic chorioamnionitis as compared to membranes without chorioamnionitis in preterm pregnancies (p = 0.003 and p < 0.001, respectively). Among the membranes of term pregnancies there were no differences in the expressions of such receptors regardless of inflammatory status. Regarding TLR-4 and TLR-6 expression, there was no difference among membranes with or without histologic chorioamnionitis, regardless gestational age at delivery. TLR-1, TLR-2, TLR-4 and TLR-6 expressions were observed in amniotic epithelial, chorionic and decidual cells.

Conclusion

Amniochorion membranes express TLR-1, TLR-2, TLR-4 and TLR-6 and increased expression of TLR-1 and TLR-2 is related to the presence of histologic chorioamnionitis in preterm pregnancies. This study provides further evidence that amniochorion membranes act as a mechanical barrier to microorganisms and as components of the innate immune system.     

Sialidase activity in aerobic vaginitis is equal to levels during bacterial vaginosis

Objective

To evaluate levels of proinflammatory cytokines and sialidase activity in aerobic vaginitis (AV) in relation to normal vaginal flora and bacterial vaginosis (BV).

Study design

In this cross-sectional study, a total of 682 consecutive non-pregnant women attending the gynecology service were assessed and 408 women were included. Vaginal rinsing samples were collected from 223 women with microscopic finding of BV (n = 98), aerobic vaginitis (n = 25) and normal flora (n = 100). Samples were tested for interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor (TNF)-α, and sialidase activity.

Results

Compared to women with normal flora, vaginal levels of IL-1β were highly increased in both BV and AV (p < 0.0001). Significantly higher vaginal IL-6 was detected in AV (p < 0.0001) but not in BV, in relation to normal flora. Women with AV also presented increased IL-8 levels (p < 0.001), while those with BV presented levels similar to normal flora. Sialidase was increased in BV and AV compared with the normal group (p < 0.0001) but no difference in sialidase activity was observed between BV and AV.

Conclusion

A more intense inflammatory host response occurs for AV than for BV when compared with normal flora. Furthermore, the increased sialidase activity in AV and BV indicates that both abnormal vaginal flora types can be harmful to the maintenance of a healthy vaginal environment.     

Laparoscopic restaging of borderline ovarian tumours (BLOT): a retrospective study of 142 cases

Objectives

Primary objective: To analyse the impact of restaging, on recurrences and survival, in BLOT. Secondary objective: To cluster patients who could be exempted from restaging.

Study design

This retrospective study, included patients operated for a BLOT, between January 1990, and December 2007, in gynaecological surgery units of the University Hospital of Clermont-Ferrand.Two groups were evaluated: patients with and without optimal restaging.

Results

One hundred and forty-two patients were included. Optimal initial staging rate was 38.7% (n = 55). Among the eighty-seven women not initially staged, two groups were compared: restaged (n = 45) and non-restaged patients (n = 42). Mean follow-up was 80.5 months. Overall survival was 93.7%. Relapse rate was 7.7% (n = 11). Disease free survival (DFS) was 88% after a mean follow-up of 80.5 months. One death was noted.Optimal restaging rate was 31.7% (n = 45, 43 by laparoscopy). Mean follow-up was of 87.1 months among restaged patients, 84.5 months among non-restaged patients (p = 0.93).Relapse incidence was significantly higher in non restaged, than in restaged patients (p = 0.008). DFS was significantly longer among restaged than non-restaged patients, (p = 0.072). Younger age (p = 0.04), conservative treatment (p < 10⁻⁴) or non-diploidy (p = 0.04) increased the incidence of relapse.

Conclusions

When initial staging is missing, restaging improves the patients outcome in comparison to non-restaged groups. Laparoscopy is a valuable surgical option. This study suggests that a selected group of patients, older than 30 years old, submitted to a radical treatment, presenting a diploid, non micropapillar, mucinous BLOT, without visible implants during careful peritoneal inspection, could be exempted from restaging. They represented 11.6% of our population.     

Comparison of perioperative outcomes and cost of robotic-assisted laparoscopy,laparoscopy and laparotomy for endometrial cancer

Objective

To analyze the perioperative outcomes and cost of three surgical approaches in the treatment of endometrial cancer: robotic, laparoscopy and laparotomy.

Study design

We studied 347 patients with endometrial cancer treated in a single institution: 71 patients were operated by robotics, 84 by conventional laparoscopy and 192 by laparotomy. All patients underwent total hysterectomy, bilateral salpingoophorectomy and pelvic and para-aortic lymphadenectomy depending on the pathological features.

Results

Operative time was longer in the laparoscopy group as compared to robotics and laparotomy (218.2 min, 189.2 min, and 157.4 min respectively, p = 0.000). The estimated blood loss was lower in the robotic group relative to the other groups (99.4 ml in robotic, 190.0 ml in laparoscopy and 231.5 ml in laparotomy, p = 0.000). Similar findings were observed for the pre- and post-operative mean hemoglobin levels (−1.3 g/dl, −2.3 g/dl and −2.5 g/dl respectively, p = 0.000), and transfusion rate (4.2%, 7.1% and 14.1% respectively, p = 0.036). The length of hospital stay was higher in the laparotomy group compared to robotics and laparoscopy (8.1, 3.5 and 4.6 days respectively; p = 0.000). The conversion rate to laparotomy was lower for robotics (2.4% for robotics and 8.1% for laparoscopy, p = 0.181). Overall complications were similar for robotics and laparoscopy (21.1%, 28.5%) (p = 0.079). Robotic complications were significantly lower as compared to laparotomy (21.2 vs 34.9% (p = 0.036). No differences were found relative to disease-free or overall survival among the three groups. The global costs were similar for the three approaches (p = 0.566).

Conclusion

Robotics is a safe alternative to laparoscopy and laparotomy for endometrial cancer patients, offering improved perioperative outcomes and similar cost as compared to the other two surgical approaches.     

Comparison of outcomes in early stage uterine carcinosarcoma and uterine serous carcinoma

Objective

To assess whether contemporary adjuvant management of early stage uterine carcinosarcoma (CS) produces equal outcomes as in uterine serous carcinoma (USC).

Methods

We reviewed 172 women treated from 2000 to 2011 for stage I–II USC (n = 112, 65%) or CS (n = 60, 35%). Adjuvant therapy was initiated in 154 (90%) patients, with 111 patients receiving intravaginal radiotherapy (IVRT)/chemotherapy. Median follow up was 4.6 years for surviving patients.

Results

Characteristics for USC vs. CS did not differ significantly by age ≥ 60, pelvic or para-aortic node sampling, stage, lymphovascular invasion, chemotherapy use, RT use or omission of adjuvant therapy. Outcomes were better for USC vs. CS in 5-year actuarial rates of recurrence [17% (C.I. 10–25%) vs. 45% (C.I. 31–59%), p < 0.001],disease-related mortality (DRM) [11% (5–17%) vs. 30% (16–44%), p = 0.016], and all-cause mortality [12% (C.I. 6–18%) vs. 34% (C.I. 20–48%), p = 0.007]. In multivariable analysis, CS histology remained a significant predictor of risk for recurrence [HR 3.1 (C.I. 1.7–5.7), p < 0.001], DRM [HR 2.4 (C.I. 1.1–5.1), p = 0.024], and all-cause mortality [HR 2.4 (C.I. 1.2–4.8), p = 0.012]. On sub-group analysis of 111 patients (77 USC, 34 CS) able to receive IVRT/chemotherapy, CS no longer was associated significantly with increased recurrence (29% vs. 15%, p = 0.18), DRM (22% vs. 10%, p = 0.39), or all-cause mortality (22% vs. 10%, p = 0.45).

Conclusions

CS was associated with worse outcomes than USC. However, that difference was not maintained in patients able to receive IVRT and chemotherapy. While intriguing, this result may be due in part to selection against rapid early relapsing CS patients in this group.