术前诊断为子宫内膜不典型增生的子宫内膜癌患者的处理

目的分析和总结术前诊断为子宫内膜不典型增生的子宫内膜癌患者的临床特点及治疗方法。方法 2005年1月至2010年12月北京协和医院妇产科行全子宫切除术后病理诊断为子宫内膜样癌的患者共计404例,其中44例术前子宫内膜活检病理提示子宫内膜不典型增生(AEH),回顾性分析这些患者的临床特点,采用SPSS 13.0统计学软件进行分析。结果 44例术前诊断为AEH的患者中,39例(89%)患者未行子宫内膜癌分期术,子宫切除术后病理均为高分化子宫内膜样癌(100%),14例(32%)年轻患者保留了双侧卵巢,9例(20%)患者给予辅助放疗。中位随诊时间52个月,无复发病例。和绝经后患者相比,绝经前患者术后深肌层浸润(1/22及4/22)及淋巴血管间隙浸润(0/22及3/22)更少,但无统计学差异。比较AEH组和术前诊断为子宫内膜样癌的患者(EC组),AEH组高分化子宫内膜样癌的比例明显高于EC组(P=0.000);辅助化疗率和复发率明显低于EC组(P=0.003和0.019)。结论术前诊刮为AEH的子宫内膜癌患者预后好,年轻患者充分评估后可以考虑保留卵巢,绝经后患者AEH伴发子宫内膜样癌的风险增高,且更容易合并深肌层浸润、淋巴血管间隙受累等高危因素。     

宫颈癌子宫内膜癌术后阴道残端复发28例临床研究

目的总结宫颈癌、子宫内膜癌初次手术后阴道残端再复发的临床特点、治疗方法及预后分析,为宫颈癌、子宫内膜癌复发诊治提供依据。方法回顾性分析2002年9月至2014年7月收治的28例宫颈癌、子宫内膜癌行广泛性子宫切除术或次广泛子宫切除术后阴道残端复发患者的临床、病理资料。28例阴道残端癌患者根据病情采用部分阴道切除、全阴道切除和阴道扩大切除等手术方式;比较28例患者预后是否与淋巴结转移、阴道旁受累、再次复发时间间隔、组织分化程度等相关。结果高分化及中低分化患者平均生存时间分别是40个月及15个月,3年生存率分别是66.1%和30.7%,差异有统计学意义(P=0.03)。有无淋巴结转移的患者中位生存时间分别是18个月及40个月(P0.05);3年生存率依次是0和24%(P0.05)。复发距离初次手术时间大于24个月及小于等于24个月的中位数生存时间分别是28个月及16个月(P0.05)。结论阴道残端癌的手术治疗安全、有效,预后较好。阴道残端癌的预后与是否淋巴结转移、是否阴道旁受累、再次复发时间间隔、组织分化程度等密切相关。     

子宫内膜癌腹水细胞学阳性的危险因素和预后意义

目的探讨子宫内膜癌患者腹水细胞学阳性的危险因素和预后意义。方法收集2005年1月1日至2010年12月31日北京协和医院收治的486例初治子宫内膜癌患者的临床资料进行回顾性分析,单因素及多因素分析腹水细胞学阳性对预后的影响。结果 1)子宫内膜癌患者中腹水细胞学检查阳性率为4.8%。2)非子宫内膜样癌(P=0.000)、FIGO分期(2009)为Ⅲ-Ⅳ期(P=0.000)、子宫深肌层受累(P=0.001)、宫颈间质浸润(P=0.018)是子宫内膜癌腹水细胞学阳性的影响因素。3)子宫内膜癌腹水细胞学阳性患者的5年无进展生存率(70.9%vs90.0%)、5年总生存率(72.2%vs 96.0%)均低于腹水细胞学阴性患者;单因素分析腹水细胞学阳性对无进展生存时间和总生存时间的影响,差异均具有统计学意义(P=0.005,P=0.000);4)多因素分析显示腹水细胞学阳性并不是无进展生存时间、总生存时间的独立危险因素(RR=3.812,95%CI 0.897~16.200,P=0.070;RR=3.426,95%CI 0.800~14.673,P=0.097)。结论子宫内膜癌的腹水细胞学阳性与非子宫内膜样的病理类型、FIGO分期(2009)、深肌层浸润、宫颈间质浸润相关。腹水细胞学阳性不是子宫内膜癌的独立预后影响因素。     

子宫内膜癌淋巴结转移的危险因素及预后分析

目的探讨子宫内膜癌腹膜后淋巴结转移的高危因素及淋巴结转移对于预后的影响。方法回顾性分析2005年1月至2010年12月期间在北京协和医院妇产科进行诊治的289例行腹膜后淋巴结切除的子宫内膜癌患者的临床病理资料,对影响子宫内膜癌腹膜后淋巴结转移的高危因素和影响子宫内膜癌患者预后的因素进行统计分析。结果 1)289例患者中位发病年龄55岁,Ⅰ期224例(77.5%),Ⅱ期13例(4.5%),Ⅲ期45例(15.6%),Ⅳ期7例(2.4%)。289例行盆腔淋巴结切除,30例(10.4%)有盆腔淋巴结转移;96例行腹主动脉旁淋巴结切除,11例(11.5%)有腹主动脉旁淋巴结转移。复发21例(7.3%),死亡11例(3.8%),中位随访时间37个月,中位无瘤生存时间34个月。2)单因素分析显示术前CA125≥35 U/m L、非子宫内膜样癌、组织学分级为G3、深肌层浸润、肿瘤≥2 cm、宫颈间质受累、腹腔冲洗液细胞学阳性及阴道或宫旁受累是淋巴结转移率的高危因素(P0.05)。多因素分析显示术前CA125值≥35 U/m L、低分化、肌层浸润深度≥1/2是淋巴结转移的独立危险因素(P0.05)。3)Kaplan-Meier单因素分析显示,腹腔冲洗液细胞学阳性、阴道或宫旁受累、附件受累及淋巴结转移缩短无瘤生存时间(P0.05);非子宫内膜样癌、低分化、肌层浸润深度≥1/2、腹腔冲洗液细胞学阳性、附件受累及淋巴结转移缩短总生存时间(P0.05)。COX回归多因素分析显示,腹膜后淋巴结转移是5年无瘤生存率的独立预后因素(未转移者92.1%vs转移者65.3%,P=0.002,95%CI 0.078~0.552);虽不是5年总生存率的独立预后因素,但无淋巴结转移者的5年总生存率有高于淋巴结转移者的趋势(未转移者96.1%vs转移者70.0%,P=0.086,95%CI 0.039~1.238)。结论本研究发现:1)肿瘤分化程度和肌层浸润深度对淋巴结转移有预测意义,能够指导子宫内膜癌患者是否进行淋巴结切除术,为个体化治疗奠定理论基础。2)淋巴结转移患者仍然有较无淋巴结转移者预后更差的趋势,因此对于淋巴结转移的患者需要进行辅助治疗,减少复发风险。     

高效孕激素治疗子宫内膜复杂不典型增生及子宫内膜癌的预后分析

目的探讨子宫内膜复杂不典型增生及高分化子宫内膜癌患者经高效孕激素治疗后的肿瘤学预后及生育结局。方法回顾性收集了2000年1月1日-2011年12月31日之间在北京协和医院就诊的子宫内膜复杂不典型增生及高分化子宫内膜癌(无子宫肌层浸润)患者的临床病理资料。所有患者接受口服醋酸甲羟孕酮(250~500 mg/d)或醋酸甲地孕酮(160~480 mg/d),持续至少6个月。结果患者中位年龄32岁(21~41岁)。在55例患者中,41例(75%)获得完全缓解,中位时间为6(3~24)个月。完全缓解率在肥胖患者中较非肥胖患者低(4/12[33%]比37/43[86%];P=0.001)。获得完全缓解的患者中10例(24%)复发。55例患者的5年无复发生存率为71%。在33例有生育愿望的患者中,17例(52%)妊娠。结论采用高效孕激素进行保留生育功能的治疗是有效和安全的。肥胖与预后不良相关。     

子宫内膜癌的预后因素分析

目的影响子宫内膜癌预后的因素很多,目前这些因素对子宫内膜癌预后的影响,并没有得到一致的认同。因此,我们进一步分析了影响子宫内膜癌预后的相关因素。方法回顾性地分析了中国医科大学第一附属医院妇科.2004年8月到2014年8月共361例子宫内膜癌患者,采用卡方检验进行子宫内膜癌预后因素的单因素分析,并采用COX回归模型对其进行多因素分析。结果单因素分析表明,年龄、雌激素受体、孕激素受体、肌层浸润深度、FIGO(2009)分期、组织学类型、病理分级、宫颈转移、输卵管卵巢转移、淋巴结转移、淋巴血管间隙浸润(LVSI)影响子宫内膜癌的预后(P0.05),而身高体重指数(BMI)、发病时绝经情况、糖尿病、高血压,与子宫内膜癌的预后无关(P0.05)。COX回归分析表明,肌层浸润深度、FIGO(2009)分期、病理分级、淋巴血管间隙浸润为子宫内膜癌独立的预后因素。结论对具有独立预后影响因素的子宫内膜癌患者,在接受手术的同时,应采取积极的放化疗。     

子宫内膜癌中S100A4和Snail的表达及临床意义

目的分析正常子宫内膜、内膜不典型增生及子宫内膜癌组织中S100A4和Snail的表达及与子宫内膜癌临床病理特征及患者预后的关系。方法采用免疫组化SP法检测S100A4和Snail蛋白的表达,分析两者表达与子宫内膜癌临床病理特征的关系;采用Spearman等级相关分析两者表达的相关性;采用Kaplan-Meier法绘制生存曲线及Log-rank检验进行生存分析。结果正常子宫内膜、内膜不典型增生和子宫内膜癌组织中S100A4和Snail蛋白的阳性率均呈升高趋势,分别为3.33%和3.33%、30.00%和23.33%、54.55%和49.09%。S100A4表达与子宫内膜癌组织学分级、FIGO分期、肌层浸润深度和淋巴结转移相关(P均0.05);Snail表达与子宫内膜癌FIGO分期和淋巴结转移相关(P均0.05)。子宫内膜癌中S100A4和Snail的表达呈正相关(r=0.531,P0.001)。生存分析发现,S100A4和Snail阳性子宫内膜癌患者的术后生存时间明显短于阴性组(P均0.05)。结论 S100A4和Snail在子宫内膜癌发生、发展中异常表达,S100A4/Snail阳性子宫内膜癌更易发生淋巴结转移,并且与内膜癌患者的不良预后有关,S100A4和Snail有望成为子宫内膜癌靶向治疗和预后评估的指标。     

早期宫颈腺癌的预后分析

目的探讨影响临床早期宫颈腺癌预后的相关因素,并分析不同辅助治疗方法对预后的影响。方法回顾性分析自1995年11月至2012年2月间于北京协和医院治疗的118例FIGOⅠa2期-Ⅱa2期宫颈腺癌患者的临床资料,记录人口统计学信息、诊断及治疗信息,并记录随访及生存资料,采用SPSS11.5软件Cox回归分析进行肿瘤复发相关因素分析。结果 118例患者的中位年龄为41岁(19～74岁),其中有102例(86.4%)初次治疗时采取了根治性子宫切除和/或双附件切除和/或盆腔腹主动脉旁淋巴结切除术。平均随诊29.8月(2～132月),19例患者在随访过程中肿瘤复发,7例患者死亡。与肿瘤复发相关的单因素分析显示,患者年龄大(P=0.008)、期别晚(P=0.008)、肿瘤≥4 cm(P=0.006)、淋巴结阳性(P=0.001)、宫颈有深肌层浸润(P=0.016)均是复发的高危因素,而淋巴血管间隙浸润及腺癌的病理类型与复发无明显相关性。多因素分析显示,仅淋巴结转移是肿瘤复发的独立高危因素(P=0.006)。淋巴结阴性和阳性患者的5年无瘤生存率分别为79.1%和12.7%,5年总生存率分别为94.0%和40.0%。淋巴结转移与肿瘤≥4 cm(P=0.018)、宫颈深肌层浸润(P=0.001)显著相关,而与年龄(P=0.746)、FIGO分期(P=0.155)、淋巴血管间隙浸润(P=0.802)不相关。对于高危患者,手术后辅助放化疗可延长患者无瘤生存期,但未达到统计学意义(P=0.201)。结论宫颈腺癌预后较差,早期患者的独立预后因素是盆腔淋巴结转移,对于高危患者于根治性子宫切除术后进行辅助放化疗可能延缓肿瘤复发。     

腹腔镜下C1型子宫切除术治疗宫颈癌的临床价值

目的 探讨腹腔镜下保留盆腔自主神经(PAN)的子宫切除术治疗宫颈癌的临床应用效果。方法 纳入我院收治的106例宫颈癌患者进行前瞻性研究,采用随机数字表法将患者分为对照组和观察组,每组53例。观察组患者行腹腔镜下C1型子宫切除术(保留PAN),对照组行腹腔镜下C2型子宫切除术(不保留PAN)。记录并比较2组患者围术期相关指标、术后性功能、膀胱功能及生存情况。结果 2组患者术中出血量及淋巴结切除数目比较,差异无统计学意义(P 0. 05);观察组患者手术时间长于对照组(P 0. 05),但尿管留置时间、术后排气时间、术后排便时间及术后住院时间短于对照组(P 0. 05)。观察组患者术后3个月女性性功能指数(FSFI)各项评分均高于对照组(P 0. 05),术后膀胱功能障碍总发生率较对照组低(P 0. 05)。随访期间,Kaplan-Meier分析显示,2组患者累积总生存率、累积无病生存率比较,差异无统计学意义(Log-rankχ2=0. 062、0. 306,P=0. 803、0. 580)。结论 腹腔镜下C1型子宫切除术不仅可以促进宫颈癌患者术后康复,而且对患者直肠、膀胱及性功能具有较好的保护作用。     

CyclinD1和PCNA在子宫内膜癌中表达及临床意义

目的探讨CycliD1和PCNA在子宫内膜癌中的表达及临床意义。方法应用免疫组化法检测50例子宫内膜癌,22例子宫内膜不典型增生和8例正常子宫内膜中CyclinD1,PCNA的表达。结果 CyclinD1和PCNA在子宫内膜癌中的阳性表达率分别为54%(27/50)和68%(34/50),明显高于正常子宫内膜组(P0.05)。子宫内膜癌中,CyclinD1的表达与FIGO分期和淋巴结转移密切相关(P0.05),PCNA的表达与病理分级和淋巴结转移密切相关(P0.05)。相关性分析显示,CyclinD1和PCNA在子宫内膜癌中的表达呈正相关(r=0.742,P0.05)。二者协同异常表达者生物学行为较好。结论 CyclinD1和PCNA可能在子宫内膜癌发生发展中起重要作用,可作为评估预后的指标。     

Coexisting endometrial and ovarian carcinomas: a retrospective clinicopathological study

The purpose of this study was to characterize patients diagnosed with synchronous primary carcinomas of the endometrium and ovary. Between 1985 and 2002, 46 patients with synchronous primary carcinomas of the endometrium and ovary were identified. Clinical and pathological information was obtained from the database and pathological reports. Kaplan-Meier survival analysis, log rank tests of survival differences, and multivariate Cox regression analysis were performed. Median age at diagnosis was 55 years. Twenty-one patients (46%) had an endometrioid histology both of their endometrial and ovarian cancers. Patients with younger age, high uterine differentiation grade, and early-stage ovarian cancer had a more favorable prognosis than those with older age, low grade of differentiation, and advanced stage disease. The Cox proportional hazards model analysis indicates that young age and high grade of differentiation are independent prognostic factors. In this series of patients, women with synchronous primary cancer of the endometrium and ovary were young; the survival rate was greater in patients aged less than 50 years and in patients with an early stage. No significantly different survival between patients with endometrioid carcinoma and patients with non-endometrioid carcinomas was detected.     

Conservative treatment of early-stage breast cancer in a medically indigent population.

The compliance with a program of breast-conservation treatment for early-stage breast cancer and the results of that treatment among women treated between January 1983 and January 1992 was investigated in a large inner-city public hospital serving a primarily black population. Medical records and charts were reviewed for 25 consecutive patients with stage I and II breast cancer seen in consultation in the radiation oncology department. Of those 25 patients, 20 underwent lumpectomy and radiation therapy. Survival, disease-free survival, and local recurrence-free survival were computed using the Kaplan-Meier method. Compliance was evaluated based on time to complete the prescribed course of radiotherapy after a lumpectomy. Five-year local recurrence-free survival for stage I and II patients was 95% (confidence interval [CI]: 71% to 99%). Five-year overall survival for stage II patients was 71% (CI: 31% to 92%), and disease-free survival was 74% (CI: 36% to 91%). This study demonstrates that a program of breast-conservation treatment for early-stage breast cancer can be implemented with good results, excellent treatment compliance, and 100% follow-up in a population of medically indigent women.     

The safety of tibolone in epithelial ovarian cancer patients

OBJECTIVES: We evaluated whether tibolone had an adverse effect on the progression free survival and overall survival of epithelial ovarian cancer patients. METHODS: Forty-two tibolone users and 33 non-users who had been surgically managed for epithelial ovarian cancer at Gil Medical Center, Inchon, Korea, from January 1997 to December 2003 were reviewed retrospectively. RESULTS: There were no statistically significant differences in age, stage, histology, grade and surgical optimality between tibolone users and non-users. The progression free survival at 36 months was 60.0% among the users compared with 61.5% among the non-users (p=0.92). There was also no significant difference in the overall survival between two groups (p=0.30). For stage IIIc patients according to tibolone using, there were no significant differences in the progression free survival (p=0.86) and overall survival (p=0.36) between tibolone users and non-users. CONCLUSIONS: There was no evidence that tibolone had detrimental effects on the progression free survival and overall survival of epithelial ovarian cancer patients. So, tibolone could be used in these patients.     

Endometrial cancer patients and tibolone: a matched case-control study

OBJECTIVE: To evaluate whether tibolone had adverse effects on the prognosis of endometrial cancer patients. METHODS: In this retrospective matched case-control study, out of 396 patients with endometrial cancer from January 1997 to December 2002, 68 patients who underwent complete surgical staging were identified as tibolone users (cases). For each case, one control as tibolone non-user was matched for stage and grade of disease, in this order of priority (ratio users: non-users, 1:1). RESULTS: There were no significant differences in age (p = 0.11), stage (p = 1.00), grade (p = 0.96) and treatment modality (p = 0.55) between two arms. The mean duration of follow-up for tibolone users and tibolone non-users is 48.0 months and 54.4 months, respectively (p = 0.12). In tibolone users, a total of four patients recurred and two out of four patients died of disease. In tibolone non-users, there were three recurrences and all of three patients died of disease. There were no significant differences in disease free survival (p = 0.52) and overall survival (p = 0.61) between two arms. And there was no significant difference in disease free survival according to the duration of tibolone use (p = 0.14). CONCLUSION: There was no evidence that tibolone had adverse effects on the disease free survival and overall survival of endometrial cancer patients. So, tibolone could be used in these patients.     

Sarcopenia as a Predictor of Prognosis in Early Stage Ovarian Cancer

BackgroundTo identify sarcopenia as a predictive prognostic factor of ovarian cancer in terms of survival outcome in patients with early-stage ovarian cancer.MethodsData of Konkuk University Medical Center from March 2002 to December 2017 were reviewed retrospectively. Eighty-two patients who underwent surgery due to early-stage (International Federation of Gynecology and Obstetrics stage I/II) ovarian cancer and had computed tomography (CT) images taken at the initial diagnosis were included. The initial CT scan images were analyzed with SliceOmatic software (TomoVision). A sarcopenia cutoff value was defined as a skeletal muscle index of ≤ 38.7 cm²/m². Overall survival (OS) times were compared according to the existence of sarcopenia, and subgroup analyses were performed.ResultsA Kaplan-Meier analysis showed a significant survival disadvantage for patients with early-stage ovarian cancer when they had sarcopenia (P < 0.001; log-rank test). Sarcopenia remained a significant prognostic factor for OS in early-stage ovarian cancer, in a Cox proportional hazards model regression analysis (HR, 21.9; 95% CI, 2.0–199.9; P = 0.006).ConclusionThis study demonstrated that sarcopenia was predictive of OS in patients with early-stage ovarian cancer. Further prospective studies with a larger number of patients are warranted to determine the extent to which sarcopenia can be used as a prognostic factor in ovarian cancer.     

Fertility-preserving treatment with progestin, and pathological criteria to predict responses, in young women with endometrial cancer

BACKGROUND: There are therapeutic dilemmas regarding conservative management of endometrial cancer in young women. METHODS: We planned a prospective study to conservatively treat women aged under 40 years with clinical stage 1A, grade 1 endometrioid adenocarcinoma from 1999 to 2005. There were nine women (aged 28-40) who fulfilled the criteria, and medroxyprogesterone acetate (400 mg/day) was continued for 6 months. Curettage materials were pathologically evaluated according to our criteria including partial response (PR) (a small amount of cancer tissue with remarkable hormonal effects or atypical hyperplasia). To predict complete response (CR) to progestin, immunohistochemical staining for insulin-like growth factor type 1 receptor, phosphatase and tensin homolog deleted on chromosome ten, progesterone receptor (PgR), estrogen receptor and Ki67 were assessed. RESULTS: Seven (78%) and two cases presented complete and PRs, respectively. Two patients developed recurrent disease 10 and 22 months after the last dilatation and curettage, and both had synchronous ovarian cancer. However, all nine patients were alive and disease-free for a mean of 39 months. Of eight married patients, four (50%) conceived and three delivered full-term singletons. CR was related to positive expression of PgR (P=0.008). CONCLUSIONS: Patients with an initial PR can obtain CR after further treatment, and the PgR may be useful in predicting CR to fertility-preserving treatment in young women with endometrial cancer.     

外科手术与内镜介入治疗可切除肺腺样囊性癌的疗效比较

目的 探讨外科手术与内镜介入两种方法治疗可切除肺腺样囊性癌的临床疗效。方法 回顾性研究。纳入天津市胸科医院2010年1月—2017年12月收治的可切除肺腺样囊性癌患者25例。其中,男18例、女7例,年龄42~87（56.6±12.5）岁。25例患者根据治疗方式不同分为2组,行内镜介入治疗的11例患者为内镜组,行外科手术治疗的14例患者为手术组。对比2组患者手术时间、术中出血量、术后住院时间,以及2组患者围手术期呼吸系统疾病、心血管系统疾病并发症发生情况;术后定期随访,比较2组患者肿瘤复发和转移情况,以及总体生存期和无复发生存期。结果 2组患者性别、年龄、体质量指数及肿瘤大小、位置、分期等基线资料比较,差异均无统计学意义（P值均>0.05）。患者均顺利完成手术,无R2切除患者。手术组患者手术时间（187.4±37.6）min、术中出血量为（107.2±31.3）mL,分别大于内镜组的（105.8±19.6）min、（45.89±14.66）mL,差异均有统计学意义（t=7.00、6.51,P值均<0.001）。手术组发生呼吸系统并发症8例、心血管系统并发症3例,内镜组发生呼吸系统并发症4例、心血管系统并发症2例,差异均无统计学意义（P值均>0.05）。25例患者术后随访6~91个月,中位随访时间62.3个月。随访期间,手术组患者死亡2例,内镜组患者死亡5例。内镜组术后胃肠部位转移1例、局部进展4例,手术组术后同侧肺转移1例、无局部复发,2组复发转移率比较,差异无统计学意义（P=0.056）。内镜组总体生存期平均为61.9 [95%可信区间（CI） 48.0~75.9]个月、无复发生存期平均为50.7 （95%CI 31.6~69.8）个月,分别短于手术组的83.1 （95%CI 75.8~90.4）个月、86.7 （95%CI 78.6~94.8）个月,仅无复发累积生存期差异有统计学意义（χ²=5.46,P=0.020）。结论 外科手术治疗可切除的肺腺样囊性癌,患者总体生存期和无复发生存期优于内镜治疗,且手术治疗的患者复发率较低,因此推荐其为可切除的肺腺样囊性癌的首选治疗方案。     

Adjuvant therapy with GnRH agonists/tamoxifen in breast cancer should be a good council for patients with hormone receptor-positive tumours and wish to preserve fertility

Infertility represents one of the main long-term consequences of the chemotherapy used for the adjuvant treatment of breast cancer. Approximately 60-65% of breast cancers express the nuclear hormone receptor in premenopausal women. Adjuvant endocrine therapy is an integral component of care for patients with hormone receptor-positive (HR+) tumours. The GnRH agonist (GnRHa) alone or in combination with tamoxifen produces results at least similar to those obtained with the different chemotherapy protocols in patients with HR+ breast cancer with respect to recurrence-free survival and overall survival. It is time to indicate adjuvant therapy with GnRHa associated with tamoxifen for patients with breast cancer (HR+ tumours) if they want to preserve their reproductive function. The evaluation of ovarian reserve tests: follicle stimulating hormone (FSH), anti-Mullerian hormone (AMH), inhibin B, antral follicle count (AFC) and ovarian volume 6 months, and 1 year after the end of therapy with GnRHa/tamoxifen must be realised. The recurrence-free survival and overall survival should be analysed. The major implication of this hypothesis will be to avoid adjuvant chemotherapy for patients with breast cancer (HR+ tumours) that request fertility preservation. It is expected that ovarian function should not be altered in almost all cases and subsequent pregnancy a real possibility.     

Impact of gynecological screening in Lynch syndrome carriers with an MSH2 mutation

Lifetime risk of developing endometrial cancer in Lynch syndrome carriers is very high and females are also at an increased risk of developing ovarian cancer. The aim of the study was to determine the impact of gynecological screening in MSH2 mutation carriers. Gynecological cancer incidence and overall survival was compared in female mutation carriers who received gynecological screening (cases) and in matched controls. Controls were randomly selected from non‐screened mutation carriers who were alive and disease‐free at the age the case entered the screening program. Median age to diagnosis of gynecological cancer was 54 years in the screened group compared to 56 years in controls (p = 0.50). Stage I or II cancer was diagnosed in 92% of screened patients compared to 71% in the control group (p = 0.17). Two of three deaths in the screened group were the result of ovarian cancer. Mean survival in the screened group was 79 years compared to 69 years in the control group (p = 0.11), likely associated with concomitant colonoscopy screening. Gynecological screening did not result in earlier gynecologic cancer detection and despite screening two young women died from ovarian cancer suggesting that prophylactic hysterectomy with bilateral salpingo‐oophorectomy be considered in female mutation carriers who have completed childbearing.