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1.
Haider Mahdi Cary Jo Schlick Li-Lian Kowk Mehdi Moslemi-Kebria Chad Michener 《Gynecologic oncology》2014
Objective
The objective of this study is to compare survival of Asian (AS), American Indian/Alaskan Native (AI/AN) and non-Hispanic white (NHW) women with endometrial adenocarcinoma (EC).Methods
Patients with EC were identified from the Surveillance, Epidemiology, and End Results program from 1988 to 2009. Kaplan–Meier survival methods and Cox proportional hazards regression were performed.Results
Of the 105,083 women, 97,763 (93%) were NHW, 6699 (6.4%) were AS and 621 (0.6%) were AI/AN. AS and AI/AN were younger than NHW with mean age of 57.7 and 56.5 vs. 64.3 years (p < 0.001 and 0.059). Advanced stage and high-risk histology were more prominent in AS than NHW (15.6% vs. 13.3%, p = 0.04, 10.6% vs. 9.6%, p = 0.041). Lymphadenectomy was performed more frequently in AS than NHW (56.7% vs. 48.2%, p < 0.001). Asian immigrants were younger than Asian natives (mean age 57 vs. 60.5 years, p < 0.001).In multivariate analysis, AS had better overall (OS) (HR 0.86, 95% CI 0.81–0.91, p < 0.001) and cancer-specific survival (CSS) (HR 0.92, 95% CI 0.84–1.00, p = 0.05) than NHW. Further, Asian immigrants had better OS (HR 0.83, 95% CI 0.73–0.94, p = 0.002) and CSS (HR 0.66, 95% CI 0.54–0.80, p < 0.001) than Asian natives. In contrast, AI/AN had worse OS (HR 1.35, 95% CI 1.15–1.59, p < 0.001) but no difference in CSS (HR 1.06, 95% CI 0.80–1.40, p = 0.69) than NHW.Conclusions
Asians were younger at presentation, more likely to have lymphadenectomy and had an improved outcome compared to NHW. Interestingly, Asian immigrants had more favorable outcome than Asians born in the US. Further studies are warranted to find possible explanations for such a difference. 相似文献2.
Rudy S. Suidan Caryn M. St. Clair Stephen J. Lee Joyce N. Barlin Kara C. Long Roche Edward J. Tanner Yukio Sonoda Richard R. Barakat Oliver Zivanovic Dennis S. Chi 《Gynecologic oncology》2014
Objective
To compare survival outcomes for patients with advanced epithelial ovarian cancer (EOC) who received primary intravenous/intraperitoneal (IV/IP) chemotherapy to those who received IV followed by consolidation (treatment given to patients in remission) IP chemotherapy.Methods
Data were analyzed and compared for all patients with stage III–IV EOC who underwent optimal primary cytoreduction (residual disease ≤ 1 cm) followed by cisplatin-based consolidation IP chemotherapy (1/2001–12/2005) or primary IV/IP chemotherapy (1/2005–7/2011).Results
We identified 224 patients; 62 (28%) received IV followed by consolidation IP chemotherapy and 162 (72%) received primary IV/IP chemotherapy. The primary IP group had significantly more patients with serous tumors. The consolidation IP group had a significantly greater median preoperative platelet count, CA-125, and amount of ascites. There were no differences in residual disease at the end of cytoreduction between both groups. The median progression-free survival (PFS) was greater for the primary IP group; however, this did not reach statistical significance (23.7 months vs 19.7 months; HR 0.78; 95% CI, 0.57–1.06; p = 0.11). The median overall survival (OS) was significantly greater for the primary IP group (78.8 months vs 57.5 months; HR 0.56; 95% CI, 0.38–0.83; p = 0.004). On multivariate analysis, after adjusting for confounders, the difference in PFS was not significant (HR 0.78; 95% CI, 0.56–1.11; p = 0.17), while the difference in OS remained significant (HR 0.59; 95% CI, 0.39–0.89; p = 0.01).Conclusions
In our study, primary IV/IP chemotherapy was associated with improved OS compared to IV followed by consolidation IP chemotherapy in patients with optimally cytoreduced advanced EOC. 相似文献3.
Katrina N. Slaughter Theresa ThaiShayla Penaroza Doris M. BenbrookElangovan Thavathiru Kai DingTina Nelson D. Scott McMeekinKathleen N. Moore 《Gynecologic oncology》2014
Objective
There is a lack of reliable indicators to predict who will benefit most from anti-angiogenic therapy, such as bevacizumab. Recognizing obesity is associated with increased levels of VEGF, the main target of bevacizumab, we sought to assess if adiposity, measured in terms of BMI, subcutaneous fat area (SFA), and visceral fat area (VFA) was prognostic.Methods
Reviewed 46 patients with advanced EOC who received primary treatment with bevacizumab-based chemotherapy (N = 21) or chemotherapy alone (N = 25) for whom complete records, CT prior to the first cycle of chemo, and serum were available. CT was used to measure SFA and VFA by radiologists blinded to outcomes. ELISA was used to measure serum levels of VEGF and angiopoietin-2 in the bevacizumab group.Results
BMI, SFA, and VFA were dichotomized using the median and categorized as “high” or “low”. In the bevacizumab group median PFS was shorter for patients with high BMI (9.8 vs. 24.7 months, p = 0.03), while in the chemotherapy group median PFS was similar between high and low BMI (17.6 vs. 11.9 months, p = 0.19). In the bevacizumab group patients with a high BMI had higher median levels of VEGF and angiopoietin-2, 371.9 vs. 191.4 pg/ml (p = 0.05) and 45.9 vs. 16.6 pg/ml (p = 0.09) respectively. On multivariate analysis neither BMI, SFA, nor VFA were associated with PFS (p = 0.13, p = 0.86, p = 0.16 respectively) or OS (p = 0.14, p = 0.93, p = 0.28 respectively) in the chemotherapy group. However, in the bevacizumab group BMI was significantly associated with PFS (p = 0.02); accounting for confounders adjusted HR for high vs. low BMI was 5.16 (95% CI 1.31–20.24). Additionally in the bevacizumab group SFA was significantly associated with OS (p = 0.03); accounting for confounders adjusted HR for high vs. low SFA was 3.58 (95% CI 1.12–11.43).Conclusion
Results provide the first evidence in EOC that patients with high levels of adiposity may not derive benefit from bevacizumab and that measurements of adiposity are likely to be a useful biomarker. 相似文献4.
Objective
To evaluate the feasibility and efficacy of robotic-assisted management of epithelial ovarian cancer.Methods
Retrospective review of robotic-assisted or abdominal ovarian cancer cases presenting with pelvic mass, initial staging, or debulking after neoadjuvant chemotherapy performed by a single surgeon (2008–2012). Patient characteristics and outcomes were compared using chi-squared or Student's t-tests.Results
There were 63 robotic and 26 abdominal cases. Patient characteristics were similar for age, uterine weight, and BMI, with prior abdominal surgery more common in the abdominal group (p = 0.0257). Robotic operative time was longer (p < 0.0001), while blood loss (p < 0.0001) and hospital stay (p = 0.0009) were reduced. Major complication rates (16% vs. 23%, p = 0.4209) and lymphadenectomy yields (13 vs. 11 nodes, p = 0.2310) were similar. Neoadjuvant chemotherapy was more common in the robotic group (52% vs. 15%, p = 0.0013). Residual disease rates for all cases (73% vs. 50%, p = 0.880) and for Stage II–IV cases (61% vs. 40%, p = 0.929) were equivalent. Follow-up was longer for the abdominal group; however, an equivalent percentage of patients had at least 1 year of follow-up (57% vs. 77%, p = 0.0789). At 1 year, survival and no evidence of disease (NED) rates were equivalent for all cases (survival: 97% vs. 90%, p = 0.2501; NED: 81% vs. 85%, p = 0.6773) and for Stage II–IV cases (survival: 96% vs. 88%, p = 0.3080; NED: 76% vs. 81%, p = 0.6920).Conclusions
A robotic approach for the management of epithelial ovarian cancer, including patients treated with neoadjuvant chemotherapy, is feasible and effective. Debulking, recurrence, and survival rates were similar to laparotomy at 1 year. 相似文献5.
6.
Objectives
To examine postoperative 30-day morbidity and mortality in African American (AA) compared to white patients (W) with endometrial cancer (EC).Methods
Patients with EC were identified from the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2011. AA and W subgroups were studied. Multivariable logistic regression models were performed.Results
Of 3248 patients, 2899 (89%) W and 349 (11%) AA were identified. AA were more likely to have diabetes, hypertension, ascites, neurologic morbidities, weight loss, non-independent functional status, higher ASA class, higher serum creatinine ≥ 2 mg/dl, hypoalbuminemia and anemia. Laparoscopic surgery was performed less frequently in AA than W (41.4% vs. 50.3%, p < 0.001). AA had a significantly higher risk of postoperative complications than W (21% vs. 12%, p < 0.001) including surgical (17% vs. 10%, p < 0.001) and non-surgical complications (7% vs. 4%, p = 0.022). Mean length of hospital stay and operative time were longer in AA than W but there was no difference in surgical re-exploration. In multivariable model after adjustment for confounders including surgical complexity and associated morbidities, AA race was not an independent predictor of “any postoperative complications” for both laparotomy group (OR 1.1, 95% CI 0.73–1.61, p = 0.65) and laparoscopic group (OR 1.43, 95% CI 0.80–2.45, p = 0.21). No difference in 30-day mortality was found between AA and W (1% vs. 1%, p = 0.11).Conclusions
AA patients with EC have more preoperative morbidities, postoperative complications and were less likely to undergo minimally invasive surgery. However, AA race was not an independent predictor of poor 30-day outcomes after controlling for other confounders. 相似文献7.
José H.T.G. Fregnani Maria R.D.O. Latorre Pablo R. Novik Ademar Lopes Fernando A. Soares 《European journal of obstetrics, gynecology, and reproductive biology》2009
Objectives
To evaluate risk factors for recurrence of carcinoma of the uterine cervix among women who had undergone radical hysterectomy without pelvic lymph node metastasis, while taking into consideration not only the classical histopathological factors but also sociodemographic, clinical and treatment-related factors.Study design
This was an exploratory analysis on 233 women with carcinoma of the uterine cervix (stages IB and IIA) who were treated by means of radical hysterectomy and pelvic lymphadenectomy, with free surgical margins and without lymph node metastases on conventional histopathological examination. Women with histologically normal lymph nodes but with micrometastases in the immunohistochemical analysis (AE1/AE3) were excluded. Disease-free survival for sociodemographic, clinical and histopathological variables was calculated using the Kaplan–Meier method. The Cox proportional hazards model was used to identify the independent risk factors for recurrence.Results
Twenty-seven recurrences were recorded (11.6%), of which 18 were pelvic, four were distant, four were pelvic + distant and one was of unknown location. The five-year disease-free survival rate among the study population was 88.4%. The independent risk factors for recurrence in the multivariate analysis were: postmenopausal status (HR 14.1; 95% CI: 3.7–53.6; P < 0.001), absence of or slight inflammatory reaction (HR 7.9; 95% CI: 1.7–36.5; P = 0.008) and invasion of the deepest third of the cervix (HR 6.1; 95% CI: 1.3–29.1; P = 0.021). Postoperative radiotherapy was identified as a protective factor against recurrence (HR 0.02; 95% CI: 0.001–0.25; P = 0.003).Conclusion
Postmenopausal status is a possible independent risk factor for recurrence even when adjusted for classical prognostic factors (such as tumour size, depth of tumour invasion, capillary embolisation) and treatment-related factors (period of treatment and postoperative radiotherapy status). 相似文献8.
Carol Aghajanian Barbara Goff Lawrence R. Nycum Yan Wang Amreen Husain Stephanie Blank 《Gynecologic oncology》2014
Objective
OCEANS, a randomized, placebo-controlled, phase III trial, found that adding bevacizumab to gemcitabine–carboplatin (GC) significantly improved investigator-determined progression-free survival (PFS) and objective response rate (ORR) in platinum-sensitive, recurrent ovarian cancer. To evaluate the reliability of assessment of progression and objective response per RECIST, radiologic and clinical data were assessed by an independent review committee (IRC).Methods
Radiologic images and clinical data were provided prospectively to the IRC for all randomized patients (N = 484). Data were reviewed in a blinded fashion per RECIST (modified v1.0). PFS and ORR were analyzed based on the IRC assessment. Concordance between investigator- and IRC-assessed progression and objective response was assessed.Results
The IRC analysis demonstrated a statistically significant increase in PFS (hazard ratio [HR] = 0.451; 95% confidence interval [CI] = 0.351 to 0.580, p < 0.0001) consistent with the benefit reported by investigators (HR = 0.484; 95% CI = 0.388 to 0.605, p < 0.0001). The concordance rate, defined by agreement on progression status, was 74.2% overall, and comparable between treatment arms (bevacizumab, 75.2% vs. placebo, 73.1%). IRC-assessed ORR was significantly improved with bevacizumab (bevacizumab, 74.8% vs. placebo, 53.7%; p < 0.0001), consistent with the investigator-assessed results. The concordance rate for objective response was 79.8% overall, and comparable between treatment arms (bevacizumab, 78.9% vs. placebo, 80.6%).Conclusions
IRC-determined results were highly consistent with those determined by investigators, demonstrating that bevacizumab plus GC provides a significant improvement in PFS and ORR. These results suggest that investigators can reliably assess disease progression and objective response in recurrent ovarian cancer using RECIST, without the necessity of a full IRC review. 相似文献9.
Koji Matsuo Todd B. Sheridan Seiji Mabuchi Kiyoshi Yoshino Kosei Hasegawa Kimberley D. Studeman Dwight D. Im Neil B. Rosenshein Lynda D. Roman Anil K. Sood 《Gynecologic oncology》2014
Objective
Recent studies have demonstrated that lymphovascular space invasion (LVSI) is associated with increased risk of hematogenous and lymphatic metastasis and poor clinical outcome of women with epithelial ovarian cancer. Given the suspected role of estrogen in promoting ovarian cancer metastasis, we examined potential links between estrogen receptor and LVSI in high-grade serous ovarian carcinoma.Methods
Tumoral expression of ER, PR, p53, MDR1, EGFR, HER2, DNA ploidy, and S-phase fraction was examined for 121 cases of stage I–IV high-grade serous ovarian carcinoma samples obtained at primary cytoreductive surgery. Biomarker expression was correlated to LVSI and survival outcomes.Results
LVSI was observed in 101 (83.5%) of all cases. Immunohistochemistry of tested biomarkers showed ER (86.7%) to be the most commonly expressed followed by p53 (71.4%), HER2 (68.3%), EGFR (52.1%), MDR-1 (14.3%), and PR (8.9%). ER expression was positively correlated to PR expression (r = 0.31, p = 0.001). LVSI was only correlated with ER (odds ratio 6.27, 95%CI 1.93–20.4, p = 0.002) but not with other biomarkers. In multivariate analysis, ER remained significantly associated with LVSI (p = 0.039). LVSI remained a significant prognostic factor for decreased progression-free survival (HR 3.01, 95%CI 1.54–5.88, p = 0.001) and overall survival (HR 2.69, 95%CI 1.18–6.23, p = 0.021) while ER-expression did not remain as a significant variable in multivariate analysis.Conclusion
Our data demonstrated that estrogen receptor was positively correlated with LVSI that was an independent prognostic indicator of poor survival outcomes of high-grade serous ovarian carcinoma. This study emphasizes the importance of estrogen pathway in promoting lymphatic or vascular spread of high-grade serous ovarian carcinoma. 相似文献10.
Camille C. Gunderson Eric D. Thomas Katrina N. Slaughter Regina Farrell Kai Ding Ronni E. Farris Jacob K. Lauer LaToya J. Perry D. Scott McMeekin Kathleen N. Moore 《Gynecologic oncology》2014
Objective
The aim of this study is to evaluate the effect of venous thromboembolism (VTE) chronology with respect to surgery on survival with epithelial ovarian cancer (EOC).Methods
An IRB approved, retrospective review was performed of patients treated for Stage I–IV EOC from 1996 to 2011. Cox proportional hazards model was used to assess associations between VTE and the primary outcomes of progression free survival (PFS) and overall survival (OS). SAS 9.3 was used for statistical analyses.Results
586 patients met study criteria. Median age was 63 years (range, 17–94); median BMI was 27.1 kg/m2 (range, 13.7–67.0). Most tumors were high grade serous (68.3%) and advanced stage (III/IV, 75.4%). 3.7% had a preoperative VTE; 13.2% had a postoperative VTE. Upon multivariate analysis adjusting for age, stage, histology, performance status, and residual disease, preoperative VTE was predictive of OS (HR 3.1, 95% CI: 1.6–6.1, p = 0.001) but not PFS (p = 0.55). Postoperative VTE was associated with shorter PFS (HR 1.45, 95% CI: 1.04–2.02, p = 0.03) and OS (HR 1.8, 95% CI: 1.3–2.6, p = 0.001). When VTE timing was modeled, preoperative VTE (HR 3.5, 95% CI: 1.8–6.9, p < 0.001) and postoperative VTE after primary therapy (HR 2.3, 95% CI: 1.4–3.6, p = 0.001) were predictive of OS.Conclusion
Preoperative and postoperative VTE appear to have a detrimental effect on OS with EOC. When modeled as a binary variable, postoperative VTE attenuated PFS; however, when VTE timing was modeled, postoperative VTE was not associated with PFS. It is unclear whether VTE is an inherent poor prognostic marker or if improved VTE prophylaxis and treatment may enable similar survival to patients without these events. 相似文献11.
Chiaojung Jillian Tsai Erik P. Sulman Patricia J. Eifel Anuja Jhingran Pamela K. Allen Michael T. Deavers Ann H. Klopp 《Gynecologic oncology》2013
Objective
We previously found that galectin-7 was upregulated in patients with cervical cancer who remained recurrence-free after chemoradiation. We hypothesized that pretreatment levels of galectin-7 predict radiation response in patients with squamous cell carcinoma (SCC) of the cervix.Methods
Galectin-7 expression was assessed by immunohistochemical staining of a tissue microarray of paraffin-embedded specimens from 161 patients with cervical SCC treated with definitive radiation therapy in 1980–1999. Galectin-7 expression was scored as absent or present. Distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were computed using the Kaplan–Meier method and log-rank tests.Results
The median age at diagnosis was 45 years (range 21–85) and median follow-up interval was 71 months (range 0–285). Of the 161 patients, 105 (65%) had FIGO stage IB disease, 18 (11%) stage IIA, and 38 (24%) stage IIB. Median tumor diameter was 5.5 cm (range 3.5–8). Seven patients (4%) received concurrent chemotherapy; 139 patients (86%) had galectin-7-positive tumors and 22 (14%) galectin-7-negative tumors. Five-year DMFS rates for patients with galectin-7-positive versus -negative tumors were 73% and 55% (p = 0.05); DSS, 65% and 36% (p = 0.004); and OS, 64% and 36% (p = 0.005). In multivariate analysis adjusting for age, stage, and tumor diameter, galectin-7 expression remained a significant predictor of DMFS (hazard ratio [HR] = 0.43, p = 0.03), DSS (HR = 0.34, p = 0.001), and OS (HR = 0.34, p = 0.001).Conclusions
Elevated galectin-7 expression is associated with improved outcomes after radiation therapy for cervical cancer. Further studies are required to validate these findings and clarify the role of galectin-7 in disease progression and radiation response. 相似文献12.
Shitanshu Uppal Ahmed Al-NiaimiLaurel W. Rice Stephen L. RoseDavid M. Kushner Ryan J. SpencerEllen Hartenbach 《Gynecologic oncology》2013
Objective
To quantify the impact of preoperative hypoalbuminemia on 30-day mortality and morbidity after gynecologic cancer surgery.Methods
Patients included in the National Surgical Quality Improvement Program (NSQIP) dataset who underwent any non-emergent surgery for gynecologic malignancy between 1/1/2008 and 12/31/2010 were identified. Analysis was conducted with albumin both as a dichotomous variable (< 3.5 g/dl was defined as low albumin) and as a continuous variable to determine a clinically relevant cut-off value.Results
Of the total 3171 patients identified, 2110 had preoperative albumin levels available for analysis. In addition, 279 (13.3%) of these patients had low albumin levels.According to multivariate analysis, the low albumin group had significantly higher odds of developing one or more post-operative complications (OR-2,CI: 1.47–2.73, p < 0.0001), three or more complications (OR-4.1,CI: 2.31–7.1, p < 0.0001), surgical complications (OR-2.39,CI: 1.59–3.58, p < 0.0001), thromboembolic complications (OR-2.59,CI: 1.33–5.06, p < 0.0001), pulmonary complications (OR-4.06,CI: 2.05–8.03, p < 0.0001), or infectious complications (OR-1.84,CI: 1.26–2.69, p < 0.0001) and a higher 30-day mortality (OR-6.52,CI: 2.51–16.95, p < 0.0001). Upon subgroup analysis, this difference was not found in patients undergoing laparoscopic surgery.In patients undergoing open surgery, the probability of experiencing one or more post-operative complications increased linearly with the decrease in albumin level; however, the probability of patients experiencing three or more complications and 30-day mortality increased sharply as soon as the albumin level decreased below 3 g/dl.Conclusion
Preoperative albumin levels < 3 g/dL identify a population of patients at a very high-risk of experiencing perioperative morbidity and 30-day mortality after open surgery. 相似文献13.
Kyeong A So Jin Hwa Hong Hye Mi Jin Jae Won Kim Jae Yun Song Jae Kwan Lee Nak Woo Lee 《Gynecologic oncology》2014
Objective
Preoperative leukocytosis is known to be a negative prognostic factor for several gynecologic malignancies, but its relationship with epithelial ovarian carcinoma (EOC) is unknown. We sought to evaluate the prognostic implications of preoperative leukocytosis for women with EOC.Methods
We retrospectively reviewed the medical records of patients who underwent primary debulking surgery and adjuvant platinum-based chemotherapy for EOC between January 1993 and October 2011. Associations between leukocytosis and recurrence-free survival (RFS) and overall survival (OS) were determined by univariate analyses. Multivariate Cox proportional hazards regression was used to identify independent prognostic factors for RFS and OS.Results
Of 155 women, 23 (14.8%) had leukocytosis and 132 (85.2%) did not have leukocytosis. RFS and OS were significantly shorter for women with leukocytosis than for women without leukocytosis (P = 0.009 and P < 0.0001, respectively). The mortality rate was also higher among women with leukocytosis (P < 0.0001). Multivariate analysis revealed that preoperative leukocytosis (hazard ratio [HR]: 2.15; 95% confidence interval [CI]: 1.55–4.41; P = 0.009), advanced stage (HR: 3.12; 95% CI: 1.44–6.75; P = 0.004), and optimal cytoreduction (HR: 0.38; 95% CI: 0.14-0.70; P = 0.031) were independent prognostic factors for RFS. Additionally, preoperative leukocytosis was independently associated with decreased OS (HR: 7.66; 95% CI: 2.78–21.16; P < 0.0001).Conclusions
Among women with EOC, preoperative leukocytosis might be an independent prognostic factor for RFS and OS. A larger-scaled, prospective study is needed to verify these results. 相似文献14.
Peter Argenta Charles Svendsen Esther Elishaev Nika Gloyeske Melissa A. Geller Robert P. Edwards Faina Linkov 《Gynecologic oncology》2014
Objective
Obesity increases risk for endometrial neoplasia, but neither the pathophysiology nor the effects of weight loss on the risk are well established. We attempted to characterize the molecular profile of the endometrium of asymptomatic women with morbid obesity before and following bariatric surgery-induced weight loss.Methods
59 asymptomatic, morbidly obese women underwent endometrial sampling before bariatric surgery; 46 (78%) of these returned one year later for re-biopsy (median weight loss of 41 kg). Duplicate samples from these specimens were scored for expression of estrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR), and Ki-67 by two independent, blinded pathologists using an H-score [staining intensity (0–3) × (percent of tissue involved)].Results
The prevalence of hyperplasia pre-operatively was 7% overall and 10% among patients not on an anti-estrogen. ER H-scores were similar before and after surgery overall (median 190 and 196 respectively, p = 0.82), but patients with hyperplasia had higher pre-operative H-scores (median 256, p < 0.001) and experienced greater H-score drops, than those without hyperplasia (− 112 vs + 50, p = 0.028). In two patients with persistent hyperplasia at one year, ER H-scores fell to levels that were similar to those without pathology. One patient who developed hyperplasia during the study period had a rising ER H-score. Patients with hyperplasia had higher median PR H-scores pre-operatively (284 vs 188, p = 0.01), which normalized through greater drops (75 vs 0, p = 0.053). AR H-scores dropped significantly after surgery (13 vs 2, p = 0.015), but were similar between patients with and without hyperplasia (p = 0.33). Weight loss did not affect Ki-67 proliferation index.Conclusion
Asymptomatic morbidly obese patients have a high prevalence of occult hyperplasia, characterized by relatively high hormone receptor expression. These profiles appear to normalize with weight loss and in advance of pathologically identifiable changes. These data suggest a potential role for screening this population as well as the possibility that weight loss may be a valid treatment strategy for risk reduction. 相似文献15.
Megan E. McDonald Pedro T. Ramirez Mark F. Munsell Marilyn Greer William M. Burke Wendel T. Naumann Michael Frumovitz 《Gynecologic oncology》2014
Objective
Despite increasing awareness of physical strain to surgeons associated with minimally invasive surgery (MIS), its use continues to expand. We sought to gather information from gynecologic oncologists regarding physical discomfort due to MIS.Methods
Anonymous surveys were e-mailed to 1279 Society of Gynecologic Oncology (SGO) members. Physical symptoms (numbness, pain, stiffness, and fatigue) and surgical and demographic factors were assessed. Univariate and multivariate analyses were performed to determine risk factors for physical symptoms.Results
We analyzed responses of 350 SGO members who completed the survey and currently performed > 50% of procedures robotically (n = 122), laparoscopically (n = 67), or abdominally (n = 61). Sixty-one percent of members reported physical symptoms related to MIS. The rate of symptoms was higher in the robotic group (72%) than the laparoscopic (57%) or abdominal groups (49%) (p = 0.0052). Stiffness (p = 0.0373) and fatigue (p = 0.0125) were more common in the robotic group. Female sex (p < 0.0001), higher caseload (p = 0.0007), and academic practice (p = 0.0186) were associated with increased symptoms. On multivariate analysis, robotic surgery (odds ratio [OR] 2.38, 95% CI 1.20–4.69) and female sex (OR 4.20, 95% CI 2.13–8.29) were significant predictors of symptoms. There was no correlation between seeking treatment and surgical modality (laparotomy 11%, robotic 20%, laparoscopy 25%, p = 0.12).Conclusions
Gynecologic oncologists report physical symptoms due to MIS at an alarming rate. Robotic surgery and female sex appear to be risk factors for physical discomfort. As we strive to improve patient outcomes and decrease patient morbidity with MIS, we must also work to improve the ergonomics of MIS for surgeons. 相似文献16.
Taek Sang Lee Jung-Yun Lee Jae-Weon Kim Sohee Oh Seok Ju Seong Jong Min Lee Tae Jin Kim Chi Heum Cho Seok-Mo Kim Chan-Yong Park 《Gynecologic oncology》2013
Objective
The aim of this study was to evaluate the impact of ovarian preservation on the recurrence and survival rates of premenopausal women with early-stage endometrial cancer.Methods
Using medical records of premenopausal women who received primary surgical treatment for stage I–II endometrial cancer, the demographics and survival rates were compared retrospectively for patients who had ovarian preservation and those who underwent bilateral salpingo-oophorectomy. Cox proportional hazards models with inverse probability of treatment weighting (IPTW) based on propensity score were performed to adjust for selection bias between the two groups.Results
A total of 495 women were identified, including 176 patients who had ovarian preservation. The ovarian preservation group was younger (P < 0.001) and had an earlier year of diagnosis (P = 0.014), a lower prevalence of lymphadenectomy (P < 0.001), and a marginally significant association with lower tumor grade (P = 0.052). The Kaplan–Meier curve and the log rank test showed no difference in either recurrence-free survival (P = 0.742) or overall survival (P = 0.462) between the two groups. In a multivariate Cox model adjusted by IPTW and covariates, ovarian preservation had no effect on either recurrence (hazard ratio [HR], 0.73; 95% CI, 0.29–1.81) or overall survival (HR, 1.33; 95% CI, 0.43–4.09).Conclusions
Ovarian preservation does not appear to be associated with an adverse impact on the outcomes of premenopausal women with early-stage endometrial cancer. The present study has useful implications for physicians counseling young women who want to preserve their ovaries. 相似文献17.
Fernanda Capella Rugno Bianca Sakamoto Ribeiro Paiva Carlos Eduardo Paiva 《Gynecologic oncology》2014
Objectives
To evaluate some health indicators in women with advanced breast or gynecological cancers (ABGCs) after discontinuation of active cancer treatment in function of the model of care received.Methods
This prospective study included patients who were discontinuing anticancer treatment to be followed up only with palliative care (PC). Patients who had been evaluated at least once in PC were categorized as the integrated care model (ICM); those who had not been consulted by the PC team before, as the traditional care model (TCM). Data were analyzed using chi-square, Mann–Whitney, Kaplan–Meier, and Cox regression model.Results
Among the 87 patients included in the study, 37 (42.5%) had been previously evaluated by the PC team (ICM). Patients who were followed up under an ICM exhibited better QoL (global health, p = 0.02; emotional functioning, p = 0.03; social functioning, p = 0.01; insomnia, p = 0.02) and less depression (p = 0.01). The communication process had no issues in 73% of cases from the ICM group compared with 42% of cases from the TCM group (p = 0.004). Patients who were not previously evaluated in PC received more chemotherapy in the last 6 weeks of life compared to those who had already been evaluated (40% versus 5.9%, p = 0.001). Early evaluation in PC was one of the independent prognostic factors of overall survival.Conclusion
When followed up concurrently by a PC and clinical oncology team, patients reported better QoL and less depression, received less chemotherapy within the last 6 weeks of life and survived longer than those followed up under a TCM. 相似文献18.
Carsten Lindberg Fagö-Olsen Bent Ottesen Henrik Kehlet Sofie L. Antonsen Ib J. Christensen Algirdas Markauskas Berit J. Mosgaard Christian Ottosen Charlotte H. Soegaard Erik Soegaard-Andersen Claus Hoegdall 《Gynecologic oncology》2014
Objective
In Denmark, the proportion of women with ovarian cancer treated with neoadjuvant chemotherapy (NACT) has increased, and the use of NACT varies among center hospitals. We aimed to evaluate the impact of first-line treatment on surgical outcome and median overall survival (MOS).Methods
All patients treated in Danish referral centers with stage IIIC or IV epithelial ovarian cancer from January 2005 to October 2011 were included. Data were obtained from the Danish Gynecological Cancer Database, the Danish National Patient Register and medical records.Results
Of the 1677 eligible patients, 990 (59%) were treated with primary debulking surgery (PDS), 515 (31%) with NACT, and 172 (10%) received palliative treatment. Of the patients referred to NACT, 335 (65%) received interval debulking surgery (IDS). Patients treated with NACT–IDS had shorter operation times, less blood loss, less extensive surgery, fewer intraoperative complications and a lower frequency of residual tumor (p < 0.05 for all). No difference in MOS was found between patients treated with PDS (31.9 months) and patients treated with NACT–IDS (29.4 months), p = 0.099. Patients without residual tumor after surgery had better MOS when treated with PDS compared with NACT–IDS (55.5 and 36.7 months, respectively, p = 0.002). In a multivariate analysis, NACT–IDS was associated with increased risk of death after two years of follow-up (HR: 1.81; CI: 1.39–2.35).Conclusions
No difference in MOS was observed between PDS and NACT–IDS. However, patients without residual tumor had superior MOS when treated with PDS, and NACT–IDS could be associated with increased risk of death after two years of follow-up. 相似文献19.
E.C. Rijkmans R.A. Nout I.H.H.M. Rutten M. Ketelaars K.J. Neelis M.S. Laman V.L.M.A. Coen K.N. Gaarenstroom J.R. Kroep C.L. Creutzberg 《Gynecologic oncology》2014
Objective
Since the Group Européen de Curiethérapie and the European Society for Radiotherapy and Oncology (GEC–ESTRO) published recommendations for 3D MRI-based image-guided adaptive brachytherapy (IGBT) in the treatment of cervical cancer, many institutions have implemented this technique and favourable results were documented. We investigated if introduction of IGBT in our centre indeed improved treatment outcomes and reduced toxicity compared to conventional brachytherapy (CBT).Methods
A retrospective analysis was done of outcomes of patients with stage IB-IVA cervical cancer treated with primary radiation therapy with curative intent between 2000 and 2012. Outcome measures were overall and disease-free survival, pelvic control, distant metastasis and treatment related adverse events (AE).Results
126 patients were analysed; 43 had been treated with CBT between 2000–2007, and 83 with IGBT between 2007–2012. External beam radiation (mean; 46.6 Gy) was combined with concurrent weekly cisplatin (51.6%), or hyperthermia (24.6%); radiation alone was used in 23.8%. Median follow-up was 121.8 months for CBT patients, vs. 42.3 months for IGBT. Complete remission was achieved in 83.7% of patients in the CBT group and in 98.8% of IGBT patients (p < 0.01). Overall survival at 3 years was 51% and 86%, respectively (p = 0.001). Pelvic recurrence was found in 32% vs. 7% (p < 0.001). Most patients had low grade adverse events. High grade (3–4) AE occurred in 15.4% vs. 8.4% at 3 years (p = 0.06).Conclusion
Introduction of IGBT for cervical cancer has led to significantly increased 3-year locoregional control and survival rates, whilst reducing late morbidity. 相似文献20.
Neil B. Desai Marisa A. Kollmeier Vicky Makker Douglas A. Levine Nadeem R. Abu-Rustum Kaled M. Alektiar 《Gynecologic oncology》2014