Parametrial spread is a prognostic factor in endometrial carcinoma

OBJECTIVE: Parametrial spread of endometrial carcinoma, including the histopathological pattern of the spread and its significance as a prognostic factor, as well as its correlation with other prognostic factors are not well understood. METHODS: We reviewed histopathologically the resected parametria from 269 patients with endometrial carcinoma who underwent radical or modified radical hysterectomy with pelvic lymphadenectomy. The relationship between parametrial spread and other histopathological features, including histological type, tumor grade, depth of myometrial invasion, lymph vascular space invasion (LVSI) of the myometrium, cervical invasion, adnexal metastasis, lymph node metastasis and peritoneal cytology was studied. Clinical outcomes of the patients with parametrial spread were also evaluated. RESULTS: Parametrial spread was demonstrated in 16 patients (5.9%). Direct invasion of cancer cells to connective tissue, LVSI and lymph-node metastasis in the parametrium were seen in 13, seven and three cases, respectively. Three patients had all three spread patterns. According to the FIGO surgical stage, parametrial spread was found in none of the 164 patients in Stage I, two (6.3%) of 32 in Stage II, 12 (16.9%) of 71 in Stage III, and two (100%) of two in Stage IV. The presence of parametrial involvement was significantly correlated with depth of myometrial invasion, cervical involvement, lymph-node metastasis, adnexal metastasis. LVSI in the myometrium and peritoneal cytology (each, p < 0.01). With a median follow-up of 68.3 months, six (37.5%) of 16 patients with parametrial involvement developed recurrence and died. CONCLUSION: Direct parametrial extension or lymphatic involvement within the parametrium can occur in endometrial carcinoma. Patients with parametrial spread have a poor prognosis.     

p53 overexpression as a prognostic indicator in endometrial carcinoma

PURPOSE: To investigate the prognostic value of p53 overexpression in endometrial adenocarcinoma cases of different stages and histologic subtypes. METHODS: One hundred and eleven surgically staged endometrial carcinoma (EC) cases from 1996 to 2000 constituted this retrospective study group. Prognostic factors determined through the evaluation of surgery specimens by co-author pathologist, were surgical stage, tumor size, histology, histologic and nuclear grade, myometrial invasion, adnexal/serosal metastasis, peritoneal cytology, retroperitoneal lymph node involvement p53 overexpression was assessed via immunohistochemical staining. Tissues that expressed p53 were considered as positive p53 staining. In terms of degree of staining, 1-29%, 30-90% and 80-100% of tumoral tissue stained with p53 were considered to be mild, moderate and high p53 staining, respectively. RESULTS: Mean age and follow-up period of the study group were 58.2 +/- 10.6 years and 33.4 +/- 2.7 months, respectively. Percentages of cases surgically staged as early (I-II) and advanced (III-IV) FIGO stages were 65.8% (n: 73) and 34.2% (n: 38), respectively. Cases with positive p53 staining had a significantly high mean survival period compared with those with negative p53 staining (86.6 +/- 6.0 vs 49.1 +/- 8.1, p < 0.001). p53 overexpression was statistically detected to be high in Stage III-IV tumors, non-endometrioid histologic subtypes (p = 0.019), histologic and nuclear grade 2-3 tumors (p < 0.001), adnexal/serosal metastasis (p = 0.001), lymph node involvement (p = 0.012), and positive peritoneal cytology (p = 0.017). The degree of p53 staining was remarkably correlated with survival. In cases with mild and high p53 staining, mean survival times were 47.1 +/- 7.0 months and 57.0 +/- 13.1 months, respectively (p = 0.0003) compared to those with high p53 staining. On univariate analysis, all of the prognosticators, including p53 staining (p < 0.001) and degree of p53 staining (p < 0.001) appeared to be independent risk factors for poor prognosis. On multivariate analysis, only pelvic lymph node involvement (p = 0.03), serosal/adnexal involvement (p = 0.004), and positive peritoneal cytology (p = 0.01) were found to be independent prognosticators of survival while p53 expression (p = 0.743) and degree of p53 staining (p = 0.802) were not detected as independent prognosticators. CONCLUSION: p53 overexpression is strongly related to poor prognostic indicators in endometrial adenocarcinoma. Although in this study p53 overexpression was not detected as an independent prognosticator, additional studies with large data set are needed to evaluate the prognostic value of p53 expression.     

子宫内膜癌患者腹腔细胞学阳性的临床意义及对预后的影响

目的 探讨子宫内膜癌患者腹腔细胞学阳性的临床意义及对预后的影响.方法 对1996年1月至2008年12月复旦大学附属肿瘤医院收治的315例子宫内膜癌患者的临床病理资料进行回顾性分析,所有患者均行手术治疗,且均行术中腹水或腹腔冲洗液细胞学检查.对与腹腔细胞学阳性相关的因素,采用相关分析法进行分析;对影响子宫内膜癌患者预后的因素,采用log-rank检验进行单因素分析,采用Cox回归法进行多因素分析.结果 (1)315例子宫内膜癌患者中,30例(9.5%)患者腹腔细胞学阳性.腹腔细胞学阳性与多个子官内高危因素包括病理类型(P=0.013)、手术病理分期(P=0.000)、肌层浸润(P=0.012)、脉管浸润(P=0.012),以及多个子宫外转移危险因素包括子宫浆膜层侵犯(P=0.004)、宫颈受累(P=0.016)、附件转移(P=0.000)和大网膜转移(P=0.000)明显相关,而与病理分级(P=0.152)、淋巴结转移(P=0.066)无明显相关性.(2)315例子宫内膜癌患者的3年总生存率和3年无疾病进展生存率分别为93.0%和85.5%.单因素分析显示,腹腔细胞学阳性及不同手术病理分期、病理类型、肌层浸润深度、病理分级和脉管浸润是影响子宫内膜癌患者预后的危险因素(P＜0.05);多因素分析显示,手术病理分期、肌层浸润深度是影响子宫内膜癌患者预后的独立危险因素(P＜0.05).30例腹腔细胞学阳性患者中,无高危因素患者的3年生存率和3年无疾病进展生存率均显著高于有高危因素者(P＜0.05);进一步分析显示,腹腔细胞学阳性是影响晚期(Ⅲ～Ⅳ期)子官内膜癌患者预后的独立危险因素(P=0.006).结论 腹腔细胞学阳性与多个子宫内高危因素和子宫外转移危险因素密切相关,是影响晚期子宫内膜癌患者预后的独立危险因素.因此,腹水细胞学检查应继续作为全面分期手术的步骤之一,并将结果单独进行报告,是十分有必要的.

Abstract：

Objective To evaluate the clinical significance of positive peritoneal cytology in patients with endometrial cancer.Methods The records of 315 patients with endometrial cancer who were operated at Cancer Hospital, Fudan University between January 1996 and December 2008 were reviewed.Peritoneal cytology were performed and diagnosed in all patients.Factors related with peritoneal cytology were analyzed by correlation analysis.Log-rank test and Cox regression test was used for the analysis of prognosis,respectively.Results (1) Peritoneal cytology were positive in 30 (9.5%) patients.Positive peritoneal cytology was associated with pathological subtype ( P = 0.013 ), stage ( P = 0.000 ), myometrial invasion ( P =0.012), lymph-vascular space invasion ( P = 0.012 ), serosal involvement ( P = 0.004 ), cervical involvement ( P = 0.016), adnexal involvement ( P = 0.000), and omental involvement ( P = 0.000), with no association with grade ( P = 0.152 ) and lymph node metastasis ( P = 0.066 ).( 2 ) Three-year overall survival (OS) and progression-free survival(PFS) were 93.0% and 85.5% ,respectively.Positive peritoneal cytology, surgical stage, pathological subtype, myometrial invasion, grade, and lymph-vascular space invasion were significantly associated with worse prognosis by univariate analysis ( P ＜ 0.05 ), while only surgical-pathology stage and myometrial invasion were independent prognostic factors by multivariate analysis ( P ＜ 0.05 ).For 30 cases with positive peritoneal cytology, the patients with no high risk factors shown significantly prognoses better than those with any risk factors.The results shown that for patients with late stage (stage Ⅲ - Ⅳ ) endometrial cancer with positive peritoneal cytology was significantly associated with the worse OS and PFS by multivariate analysis ( P = 0.006).Conclusions Positive peritoneal cytology was associated with serosal involvement, cervical involvement, adnexal involvement, omental involvement, and late stage.Therefore, peritoneal cytology should be performed and reported separately as a part of full surgical staging procedure.     

Lymphovascular space involvement is the sole independent predictor of lymph node metastasis in clinical early stage endometrial cancer

Purpose

To determine clinicopathological risk factors associated with lymph node metastasis in endometrial cancer (EC).

Methods

Clinicopathological data of patients who underwent comprehensive surgical staging for clinical early stage EC between 2001 and 2010 at Hacettepe University Hospital was retrospectively reviewed.

Results

Two hundred and sixty-one patients were included. There were 26 patients (10.0 %) with lymph node metastasis. Of these, 14 (5.4 %) had pelvic lymph node metastasis, 8 (3.1 %) had both pelvic and paraaortic lymph node metastasis, and 4 (1.5 %) had isolated paraaortic metastasis. Univariate analysis revealed tumor size >2 cm, type II cancer, grade III histology, cervical stromal invasion, deep myometrial invasion, positive peritoneal cytology, adnexal involvement, serosal involvement, and presence of lymphovascular space involvement (LVSI) as significant clinicopathological factors associated with retroperitoneal lymph node metastasis. For paraaortic metastasis either isolated or with pelvic lymph node metastasis, significant factors were grade III disease, cervical stromal invasion, deep myometrial invasion, positive peritoneal cytology, adnexal involvement, serosal involvement, pelvic lymph node metastasis, and presence of LVSI. The only factor associated with isolated paraaortic lymph node metastasis was LVSI. Multivariate analysis revealed LVSI as the only independent factor for both retroperitoneal and paraaortic lymph node metastasis (odds ratio 14.9; 95 % confidence interval 3.8–59.0; p < 0.001, and odds ratio 20.9; 95 % confidence interval 1.9–69.9; p = 0.013, respectively).

Conclusion

Lymphovascular space involvement is the sole predictor of lymph node metastasis in EC. Therefore, LVSI status should be requested from the pathologist during frozen examination whenever possible to consider when a decision to perform or omit lymphadenectomy is made.     

Endometrial cancer: predictors of peritoneal failure

OBJECTIVE: To assess determinants of peritoneal failure in endometrial cancer patients after definitive primary treatment. METHODS: Of 599 patients with endometrial cancer who had primary surgery at our institution during the decade before 1994, 131 had relapse. We defined "peritoneal failure" as relapse when it occurred in the upper abdomen or involved the pelvic peritoneum (or both). Mean follow-up was 72.8 months. RESULTS: Peritoneal failure was detected in 37 of 599 (6%) patients and represented 28% of identified failures. Stage IV disease, cervical stromal invasion, adnexal involvement, myometrial invasion >50%, primary tumor diameter >2 cm, positive peritoneal cytology, lymph node metastasis, histologic grade 3, nonendometrioid histologic subtype, absence of associated hyperplasia, and lymphovascular invasion correlated significantly (P < 0.01) with peritoneal failure. However, on regression analysis, only stage IV disease (P < 0.001, relative risk [RR] = 7.53), nonendometrioid histologic subtype (P = 0.02, RR = 3.01), and cervical stromal invasion (P = 0.04, RR = 2.83) were independent predictors of peritoneal failure. Because 22 of 37 (59%) peritoneal failures were in patients with stage IV disease, we considered separately the 545 patients with stage I-III disease. On regression analysis, nonendometrioid histologic subtype (P < 0.001, RR = 11.58), positive peritoneal cytology (P = 0.009, RR = 6.72), lymph node metastasis (P = 0.02, RR = 5.10), and cervical stromal invasion (P = 0.04, RR = 3.10) were independent predictors of peritoneal failure. Of the 38 patients in whom at least two of these four predictors were positive, 26% had peritoneal failure at 5 years, compared with 1% of the 507 patients who had none or only 1 predictor (P < 0.001). CONCLUSION: Patients with stage IV disease and those with stage I-III disease and at least two of the four independent predictors (nonendometrioid histology, positive peritoneal cytology, cervical stromal invasion, and lymph node metastasis) would be candidates for new therapeutic trials incorporating surgical and adjuvant treatment targeting the entire abdominal cavity.     

子宫内膜癌卵巢转移危险因素的探讨

目的 探讨子宫内膜癌卵巢转移的危险因素及手术中保留卵巢的可行性.方法 回顾性分析1997年1月至2006年12月在江西省妇幼保健院首治为手术治疗的638例子宫内膜癌患者的临床病理资料.结果 36例(5.6%,36/638)患者发生卵巢转移.单因素分析显示,子宫内膜癌卵巢转移的相关因素为病理类型、病理分级、子宫肌层浸润、腹水或腹腔冲洗液细胞学检查阳性、盆腔淋巴结转移、宫旁浸润、腹主动脉旁淋巴结转移、子宫浆膜浸润(P均＜0.05),而年龄、脉管浸润、宫颈浸润与卵巢转移无明显相关性(P均＞0.05).多因素分析显示,子宫内膜癌卵巢转移的独立危险因素按危险强度排列为:盆腔淋巴结转移、腹水或腹腔冲洗液细胞学检查阳性、病理分级.结论 子宫内膜样腺癌、细胞高分化、无盆腔淋巴结转移、无腹主动脉旁淋巴结转移、元肌层浸润、腹水或腹腔冲洗液细胞学检查阴性、年轻的患者可考虑手术中保留卵巢.     

Lymphvascular space involvement--a prognostic indicator in endometrial adenocarcinoma

The present study evaluates the effects of various prognostic indicators on survival of patients with clinical Stage I endometrial carcinoma. Ninety-three patients who were treated for clinical Stage I endometrial adenocarcinoma at Maimonides Medical Center from October 1979 to October 1987 had sufficient surgical-pathological information for retrospective surgical staging according to the new FIGO classification. Histology was reviewed. A new grade and surgical stage was assigned to each patient in accordance with the recent FIGO guidelines for surgical staging of corpus cancer. Poor prognostic indicators, namely, tumor grade, depth of myometrial invasion, peritoneal cytology, lymph node metastases, and lymphvascular space (LVS) involvement, were correlated with 5-year survival rates. Survival rates were calculated by the life table method. Depth of myometrial invasion, lymph node involvement, and peritoneal cytology had significant statistical correlation with poor survival. Positive finding of each of the prognostic indicators, including LVS involvement, was significantly associated with poor survival (all P less than 0.001). The value of these prognostic indicators in early endometrial carcinoma is discussed.     

Endometrial cancer: factors affecting survival

PURPOSE: To evaluate the influence in survival of clinical and pathological findings in patients with endometrial cancer. METHODS: In 152 women treated for endometrial cancer from 1982 to 1996, personal, obstetrical and oncological data, histology, grade, myometrial invasion, peritoneal cytology, FIGO stage and treatment were correlated with survival. RESULTS: Mean age was of 60.3 +/- 11.1 years old. Eight patients had a previous history of other neoplasms (seven of them gynecological). The mean clinical complaint was abnormal uterine bleeding. The most common histological type was endometrioid (84.9%), only 51 cases did not show myometrial invasion and 119 women were in Stage I at diagnosis. Peritoneal cytology was negative in 113 patients. Seven patients out of 85 in whom lymphadenectomy was performed showed metastasis. Seventeen of the patients died. The factors influencing survival were age, myometrial invasion and lymph node metastasis. CONCLUSION: Lack of myometrial invasion, absence of lymph node metastasis and age younger than 60 years seem to be the most significant predicting factors of survival.     

Correlation between clinical and histopathologic risk factors and lymph node metastases in early endometrial cancer (a multivariate analysis of 183 cases)

This study includes 183 patients with clinical stage I endometrial cancer subjected to peritoneal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and para-aortic lymphadenectomy and omental biopsy during a 12-year period in a single institution. The factors analyzed were age, menopausal state, cell type, grade, mitotic activity, myometrial invasion, lymphovascular space invasion, cervical involvement, microscopic vaginal metastases, adnexal metastases, peritoneal cytology, presence of concomitant endometrial hyperplasia and lymph node status. The overall incidences of pelvic and para-aortic lymph node metastases were found to be 15.3% (28/183) and 9.3% (17/183), respectively. In five of 17 patients (29.4%) with para-aortic nodal metastases, pelvic nodes were free of tumor. The most significant prognostic factors for positive pelvic and/or para-aortic nodes were found to be the depth of myometrial invasion, grade of tumor and age.     

The ability to evaluate prognostic variables on frozen section in hysterectomies performed for endometrial carcinoma

The purpose of this study was to evaluate the ability of the pathologist to assess intraoperatively the hysterectomy specimen in patients with endometrial carcinoma. The past few years have seen the definition of prognostic variables that predict the ultimate outcome of patients with endometrial carcinoma. As a result, the International Federation of Gynecology and Obstetrics (FIGO) revised the staging system to take into account such prognostic factors as grade, depth of myometrial penetration by tumor, cervical involvement, adnexal metastasis, peritoneal cytology, and involvement of pelvic and para-aortic lymph nodes. The need for node evaluation has led to considerable controversy as to whether all hysterectomies for Stage I disease should be performed by gynecologic oncologists. To help predict which patients will need node sampling, several published studies have shown that determination of depth of myometrial penetration can be accomplished by gross evaluation of the uterine specimen, and even more accurately on frozen section. These studies recorded excellent results, but were limited to evaluation by pathologists with specific expertise in gynecologic pathology. The current study evaluated the ability to assess tumor grade, depth of invasion, and presence of cervical invasion by intra-operative evaluation of sixty hysterectomy specimens from patients with clinical Stage I disease. The gross and frozen section reports used for this study were produced by anatomic pathologists ranging in experience level from lecturer to professor, with varying levels of experience in gynecologic pathology. Our results indicate that the level of experience of the pathologist does not affect the ability to accurately assess the specimen for the parameters described. This, in turn, allows the surgeon to correctly determine the need for lymph node sampling in 94% of cases.     

Microvessel density (MVD) as a prognosticator in endometrial carcinoma

PURPOSE: To assess microvessel density (MVD) as a marker for angiogenesis in endometrial carcinoma (EC) and normal endometrium at the proliferative and secretory phase, and to determine its prognostic value on survival among cases with EC. METHODS: Forty-three endometrial carcinoma cases were surgically staged and recruited for this case-control study. Tissue specimens from hysterectomies due to benign conditions (uterine descensus, myoma uteri, chronic pelvic pain, adenomyosis), that belonged to proliferative (n = 10) and secretory (n = 10) endometrium (n = 10), were studied as the control group (n = 20). MVD was assessed in hot areas where a high density of microvessels were detected within tumoral tissue and normal endometrium at proliferative and secretory phases. Among EC, various prognosticators such as tumor stage, histological and nuclear grade, tumor size, lympho-vascular space involvement (LVSI), cervical involvement, myometrial invasion, adnexal and lymph node involvement, peritoneal cytology and MVD were analysed in regard to survival. RESULTS: The mean age of cases with EC was 58.3 +/- 1.4. MVD was apparently high in EC cases (p < 0.05). Among control cases, endometrium from proliferative and secretory phases of the menstrual cycle was not statistically different (48.5 +/- 3.6 vs 47.4 +/- 3.8, respectively). MVD was correlated with high surgical stage (p < 0.001), cervical involvement (p = 0.01), adnexal involvement (p = 0.04), lympho-vascular space involvement (p = 0.02), pelvic and para-aortic lymph node metastasis (p < 0.001) and positive peritoneal cytology (p < 0.001). On univariate analysis, with a MVD cut-off value of 81/0.739 mm2, surgical stage (p < 0.001), LVSI (p < 0.001), retroperitoneal lymph node involvement (p < 0.001), adnexal metastasis (p < 0.001), peritoneal cytology (p = 0.005) and MVD count (p < 0.001) appeared to be independent factors for survival. On multivariate analysis, only pelvic lymph node involvement (p = 0.03) and MVD (p = 0.02) were found to be independent prognosticators on survival. CONCLUSIONS: Angiogenesis is apparent in both initial and further evolution of a tumoral process. MVD appears to have a substantial prognostic value on survival in EC cases.     

盆腔淋巴清扫术对子宫内膜癌预后的影响

目的　探讨子宫内膜癌盆腔淋巴转移的相关因素及盆腔淋巴清扫术对子宫内膜癌预后的影响。方法　选择 1981年 1月至 2 0 0 2年 12月行子宫内膜癌盆腔淋巴清扫术患者 90例 ,淋巴结取样活检术患者 12例 ,分析这 10 2例患者淋巴转移与各临床病理指标的关系。随机选取同期未行淋巴清扫术的 90例患者作为对照与行淋巴清扫术的 90例患者进行比较 ,寿命表法计算两者的生存率。结果　 10 2例患者中 ,低分化、深肌层浸润、宫颈浸润、腹腔冲洗液细胞学检查阳性、附件浸润、远处转移者 ,盆腔淋巴转移的发生率升高 ,分别为 46%、42 %、44%、52 %、75%、10 0 %。盆腔淋巴转移患者的 5年累计生存率 (3 7% )低于无淋巴转移者 (89% ,P <0 0 1)。 90例行盆腔淋巴清扫术患者与对照者的 5年累计生存率分别为 78%和 72 % ,两者比较 ,差异无显著性 (P >0 0 5)。COX逐步回归分析显示 ,盆腔淋巴清扫术不是影响患者预后的独立因素。结论　低分化、深肌层浸润、宫颈浸润、腹腔冲洗液细胞学检查阳性、附件浸润、远处转移是子宫内膜癌盆腔淋巴转移的高危因素 ,有盆腔淋巴转移的患者预后差 ,但盆腔淋巴清扫术并不改善患者预后     

Ovarian metastasis in women with clinical stage I endometrial carcinoma

BACKGROUND: The incidence of ovarian metastasis in women with clinical stage I endometrial carcinoma is generally reported to be 5%, leading to the practice of removing the ovaries at surgery even in young patients. METHODS: A retrospective study of 84 patients with clinical stage I endometrial cancer was carried out. Patients were excluded if the pathologic study revealed any evidence of extrauterine, apart from adnexal, spread or if the peritoneal cytology was positive. Patients with serous papillary or clear cell tumor histology were also excluded. RESULTS: Sixty-seven patients fulfilled the inclusion criteria. Only three (4%) patients were found to be in surgical stage IIIA, all three had grade 3 tumors. Of these patients, two had uterine serosal involvement and one had a microscopic tumor implant in a fallopian tube; none had ovarian metastasis. CONCLUSIONS: The risk of ovarian metastasis in women with well to moderately differentiated endometrial cancer, myometrial invasion limited to less than one half of the myometrium, negative peritoneal cytology and no evidence of metastatic lymph node spread is negligible. Young patients with a preoperative histological diagnosis of well to moderately differentiated endometrial carcinoma may be surgically staged, leaving the final decision regarding removal of the ovaries pending a thorough pathological review of the surgical specimens.     

Thrombospondin-1 expression in epithelial ovarian carcinoma: association with p53 status, tumor angiogenesis, and survival in platinum-treated patients

OBJECTIVE: The aim of this study was to analyze FIGO Stage IIIc endometrial cancer (EC) patients to better define clinicopathologic associations, patterns of failure, and survival. METHODS: Charts were abstracted from EC patients with lymph node metastasis from 1989 to 1998. Data on clinicopathologic variables, adjuvant treatment, site of first recurrence, and survival were collected. Associations between variables were tested by chi(2) and Wilcoxon rank sums. Survival analyses were performed by the Kaplan-Meier method, and multiple regression analysis was done by the Cox proportional hazards model. RESULTS: From 607 EC patients evaluated, 47 (8%) were identified with FIGO Stage IIIc disease. All 47 underwent hysterectomy and pelvic lymph node (PLN) sampling, and 42/47 had para-aortic lymph node (PALN) sampling. Stage IIIc disease was defined by positive PLN alone in 38%, positive PLN and PALN in 41%, and positive PALN alone in 17%. Twelve of 47 also had positive peritoneal cytology and/or adnexal metastases. Grade III tumors were present in 56% and >50% myometrial invasion in 61%. No association between depth of invasion (DOI) and grade was seen, however. Nearly 1/3 of cases had papillary serous or clear cell histology. Postoperative adjuvant treatment included whole abdominal radiation (36%), pelvic radiation with (19%) and without (17%) extended field, chemotherapy (17%), and oral progestins (11%). The 3-year and 5-year survival estimates for all patients were 77 and 65%, respectively. At a median follow-up of 37 months, 5 patients are alive with disease, and 10 are dead of disease. A distant site of first recurrence was most common (21%), followed by pelvic failure (9%). Only 1 patient has had an abdominal recurrence. Univariate predictors of survival included age, DOI, and extranodal disease, but not grade, histology, or PALN involvement. For the 12 patients with nodal disease and positive cytology and/or adnexa, 3-year survival was 39% versus 93% for those patients without evidence of extranodal disease. In a multivariate analysis only DOI was an independent predictor of survival (P = 0.03). CONCLUSIONS: Once lymph node involvement occurs, the importance of additional extranodal disease increases. Consideration of substaging Stage IIIc patients based on positive adnexa or cytology is supported by the data. The extent which adjuvant treatments contributed to the 77% 3-year survival remains to be defined. The patterns of failure suggest a possible role for combined modalities in future treatments.     

The relationship between mutant p53 gene, DNA contents and conventional clinicopathological prognostic variables in cases with endometrial carcinoma

PURPOSE OF INVESTIGATION: To determine whether p53 expression and DNA ploidy are related to traditional prognostic indicators in patients with endometrial cancer. METHODS: Tumor material (n=136) was analyzed regarding flow cytometric DNA ploidy and immunohistochemical p53 expression. Pearson's correlation, Fisher's exact test, Cox's regression analysis and the Kaplan-Meier survival test were used, as appropriate. RESULTS: P53 overexpression and DNA ploidy were higher in patients with nonendometrioid histology, FIGO advanced stage, poor grade, positive peritoneal cytology, lymphovascular space invasion (LVSI) and lymph node involvement (LNI). Histologic subtype, stage, grade, LVSI, LNI, tumor recurrence and overall survival rate correlated with p53 and DNA ploidy. No association of depth of myometrial invasion and age with p53 and DNA ploidy was observed. P53 was related to DNA ploidy. Of the factors analyzed, histologic subtype and myometrial invasion were found to be most important independent determinants of recurrence. Utilizing survival as the endpoint for multivariate analysis, when considering p53 and DNA ploidy together, histologic subtype, stage, peritoneal cytology, LNI and DNA ploidy were independent prognostic indicators. CONCLUSION: p53 expression and DNA ploidy were related to histologic subtype, FIGO stage, grade, LVSI, LNI, peritoneal cytology, tumor recurrence and overall 5-year survival. As compared to p53, DNA ploidy was the stronger independent predictor factor for survival. Neither p53 nor DNA ploidy were significant independent factors for tumor recurrence when submitted to multivariate analysis in this study. However, since p53 or DNA ploidy were found to be significant factors in univariate analysis and were correlated with tumor recurrence, they could be useful factors in making prognoses.     

Peritoneal cytology in endometrial cancer: a review

Utilization of literature review to evaluate peritoneal cytology as a test for the detection of malignant cells in the peritoneal cavity is limited by the size of the study populations, varied use of preoperative radiation, the lack of consistent methodology for specimen retrieval and processing, and the inherent subjectivity of cytologic interpretation. A standardized methodology for retrieval and processing of peritoneal cytologic specimens should be developed to allow meaningful comparisons of future studies. However, certain conclusions are permitted from published data: 1. The incidence of positive peritoneal cytology is 11.4 per cent among 3091 patients with FIGO stage I endometrial cancer. 2. The depth of the uterus does not influence the incidence of positive peritoneal cytology. 3. Positive peritoneal cytology is predictive of other known prognostic factors including advanced histologic grade, depth of myometrial invasion, and pelvic/periaortic lymph node metastases. 4. The presence of malignant cells in the peritoneal washings from some patients with no myometrial invasion and the high incidence of lymph node metastases in other patients with positive peritoneal cytology suggest that malignant cells gain access to the peritoneal cavity in a variety of ways. It is unclear whether each of these modes of access result in viable tumor cells with the potential for viable metastasis. The high incidence of lymph node metastasis in such patients suggests that lymphatic dissemination of malignant cells plays a significant role in the development of positive peritoneal cytology. In this setting positive peritoneal cytology clearly identifies that individual at high risk for recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)     

子宫内膜癌腹膜后淋巴结转移相关因素分析

目的:探讨预测子宫内膜癌腹膜后淋巴结转移的指标,以期为确定子宫内膜癌手术范围提供参考。方法:回顾分析1997年1月至2006年12月初治为手术治疗的641例子宫内膜癌患者的临床与病理资料,单因素分析用χ2检验和Fish确切概率法,多因素分析用Logistic回归模型。结果:经多因素分析显示,病理分级G3、深肌层浸润、附件转移对预测子宫内膜癌盆腔淋巴结(pelvic lymph node,PLN)转移具有统计学意义;盆腔淋巴结转移与腹主动脉旁淋巴结(para-aortic lymph node,PALN)转移显著相关。结论:病理分级G3、深肌层浸润、附件转移是子宫内膜癌盆腔淋巴结转移的重要预测因素;盆腔淋巴结转移对预测腹主动脉旁淋巴结转移具有重要意义。病理分级G3、深肌层浸润、附件转移的子宫内膜癌患者应行盆腔淋巴结清扫术,并根据术中患者的盆腔淋巴结状况决定是否行腹主动脉旁淋巴结清扫术。     

宫腔镜检查诊断子宫内膜癌的价值及与腹腔冲洗液阳性的关系探讨

目的:探讨宫腔镜检查对子宫内膜癌的诊断价值,以及是否增加腹腔冲洗液细胞学阳性率。方法:回顾性分析在本院行手术治疗后病理检查确诊为子宫内膜癌患者113例的临床资料,其中术前行单纯分段诊断性刮宫71例(分段诊刮组),行宫腔镜检查后再行分段诊刮42例(宫腔镜组)。比较两组手术前后的诊断、组织学分级、组织学类型符合率,腹腔冲洗液细胞学的阳性率,并同时分析组织学类型、组织学分级、肌层浸润深度、病灶分布、附件转移等与腹腔冲洗液细胞学的关系。结果:宫腔镜组42例患者,病理诊断符合率97.62%(41/42),高于分段诊刮组的病理诊断符合率83.10%(59/71),差异有统计学意义(P<0.05)。宫腔镜组腹腔冲洗液阳性率28.57%(12/42),高于分段诊刮组的阳性率25.35%(18/71),但两组比较差异无统计学意义(P>0.05)。113例子宫内膜癌患者腹腔冲洗液阳性与宫腔病灶范围大小有关(P<0.05),与附件转移、子宫肌层浸润深度、组织学类型、组织学分级无关(P>0.05)。结论:宫腔镜检查诊断子宫内膜癌准确性优于单纯分段诊刮,并且不增加腹腔冲洗液阳性率。腹腔冲洗液阳性率与宫腔病灶范围大小有关。     

An analysis of prognostic significance of new FIGO staging (1989) of endometrial cancer

Histopathologic factors were investigated in the data for ninety-one patients with endometrial carcinoma who were treated surgically. Each of these subjects was reclassified according to the new FIGO surgical criteria (1989) for stages and the relationship between the new classifications and the prognosis of patients was analyzed. One third of the patients (24/72) with clinical FIGO stage I (1983) had extracorporeal spread of the disease and these cases were reclassified as surgical stages II and III. Among clinical stage Ib patients there were many more with extracorporeal spread than among those in clinical stage Ia (p less than 0.005) although there was no difference between the histopathological characteristics (histologic grade, myometrial invasion, cervical involvement, adnexal involvement and pelvic lymph node metastasis) of the stage Ia and Ib groups. Univariate survival analysis revealed that the histologic grade (p less than 0.05), myometrial invasion (p less than 0.05), cervical involvement (p less than 0.005) and pelvic lymph node metastasis (p less than 0.005) correlated with the patient's prognosis. Multivariate survival analysis with the proportional hazard regression model showed that cervical involvement (p = 0.05) and the new stage classification (p = 0.03) correlated significantly with the prognosis. The cumulative 5-year survival rate by clinical stage (1983) was 87% for stage I (Ia: 96%, Ib: 80%) and 72% for stage II, between which no significant difference was determined. The survival rate for stage III was not calculated because there was only one case with stage III disease in this study.(ABSTRACT TRUNCATED AT 250 WORDS)     

20例早发型子宫内膜癌的临床特点分析

目的：探讨40岁以下子宫内膜癌患者的临床及病理特征。方法：对2004年12月—2012年12月收治的子宫内膜癌病例进行回顾性分析,其中≤40岁的患者（早发组）20例（占4%,20/498）,＞40岁的患者（普通组）478例,比较2组患者的多项临床指标,分析患者的临床特征、高危因素、治疗方法、病理类型、组织学分级、肌层浸润深度、淋巴结转移与附件转移的关系。结果：早发组原发不孕发病率为30.0%（6/20）,普通组为4.2%（20/478）,差异有统计学意义（χ2=25.855,P=0.000）。普通组合并高血压率高于早发组（χ2=7.954,P=0.003）。早发组患者病理类型均为子宫内膜样腺癌,普通组子宫内膜样腺癌78.5%（375/478）,2组患者病理类型差异有统计学意义（χ2=5.433,P=0.020）。早发组、普通组患者细胞分化为G1者分别占90%和49.8%。早发组、普通组临床病理Ⅰ期者分别占80%和74.1%,2组患者细胞分化程度及临床病理分期差异有统计学意义（Z分别为－8.259和－9.488,均P=0.000）。2组患者肌层浸润、宫颈累及、淋巴结转移、附件累及和腹水细胞学检查比较差异均无统计学意义（均P＞0.05）。结论：在子宫内膜癌患者中年轻妇女有着一定的比例,不孕不育是40岁以下子宫内膜癌患者的高危因素,年轻子宫内膜癌患者以子宫内膜样腺癌为主,细胞分化级别高,手术病理期别较早,深肌层浸润、淋巴结转移以及附件转移等情况与年长者相似。