Characteristics of progestin-insensitive early stage endometrial cancer and atypical hyperplasia patients receiving second-line fertility-sparing treatment

ObjectiveThis study investigated the characteristics of progestin-insensitive endometrioid endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH) patients receiving fertility-sparing treatments and assessed the therapeutic effects of second-line fertility-preserving treatments.MethodsThree hundred and thirty-eight patients with EEC (n=75) or AEH (n=263) receiving fertility-preserving treatment were retrospectively analyzed. ‘Progestin-insensitive’ was defined as meeting one of the following criteria: 1) presented with progressed disease at any time during conservative treatment, 2) remained with stable disease after 7 months of treatment, and/or 3) did not achieve complete response (CR) after 10 months of treatment. Clinical characteristics and treatment results of progestin-insensitive patients receiving second-line treatment and those of progestin-sensitive patients were compared.ResultsEight-two patients (59 AEH and 23 EEC) were defined as progestin-insensitive and 256 as progestin-sensitive. In multivariate analysis, body mass index ≥28.0 kg/m² (odds ratio [OR]=1.898) and lesion size >2 cm (OR=2.077) were independent predictors of progestin-insensitive status. Compared to AEH patients, progestin-insensitive EEC patients had poorer second-line treatment responses (28-week cumulative CR rate after changing second-line treatment, 56.3% vs. 85.4%, p=0.011). No statistical difference was found in CR rate among different second-line treatments.ConclusionObesity and larger lesion size were independent risk factors associated with progestin-insensitive status. In progestin-insensitive patients receiving second-line treatment, EEC patients had lower CR rate comparing with AEH patients. Further study with larger sample size is needed to evaluate efficacy of different second-line treatments for progestin insensitive patients.     

Comparison of the effect of oral megestrol acetate with or without levonorgestrel-intrauterine system on fertility-preserving treatment in patients with early-stage endometrial cancer: a prospective,open-label,randomized controlled phase II trial (ClinicalTrials.gov NCT03241914)

ObjectiveTo evaluate the effect of levonorgestrel-releasing intrauterine system (LNG-IUS) plus oral megestrol acetate (MA) as fertility-preserving treatment in patients with early-stage endometrial cancer (EEC).MethodsIn this single-center, phase II study with open-label, randomized and controlled design, young patients (18–45 years) diagnosed with primary EEC were screened, who strongly required fertility-preserving treatment. Patients were randomly assigned (1:1) into MA group (160 mg oral daily) or MA (160 mg oral daily) plus LNG-IUS group. Pathologic evaluation on endometrium retrieved by hysteroscopy was performed every 3 months. The primary endpoint was complete response (CR) rate within 16 weeks of treatment. The secondary endpoints were CR rate within 32 weeks of treatment, adverse events, recurrent and pregnancy rate.ResultsBetween July 2017 and June 2020, 63 patients were enrolled and randomly assigned. Totally 56 patients (26 in MA group; 28 in MA + LNG-IUS group) were included into primary-endpoint analyses. The median follow-up was 31.6 months (range, 3.1–94.0). No significant difference in 16-week CR rate were found between MA and MA + LNG-IUS groups (19.2% vs. 25.0%, p=0.610; odds ratio=1.40; 95% confidence interval=0.38–5.12), while the 32-week CR rates were also similar (57.1% and 61.5%, p=0.743), accordingly. More women in MA + LNG-IUS group experienced vaginal hemorrhage (46.4% vs. 16.1%; p=0.012) compared with MA group. No intergroup difference was found regarding recurrence or pregnancy rate.ConclusionCompared with MA alone, the addition of LNG-IUS may not improve the early CR rate for EEC, and may produce more adverse events instead.Trial RegistrationClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT03241914","term_id":"NCT03241914"}}NCT03241914     

Associations between obesity,metabolic syndrome,and endometrial cancer risk in East Asian women

ObjectiveThis study investigated the associations between obesity, metabolic syndrome (MetS), the combination of these two components as a metabolic obesity phenotype, and endometrial cancer risk in East Asian women.MethodsA total of 6,097,686 cancer-free women aged 40–74 years who underwent the National Health Insurance Service health examination between 2009 and 2010 were included. Cancer incidence was identified using the healthcare utilization database. Associations between baseline obesity (body mass index <23 kg/m², 23–24.9 kg/m², ≥25 kg/m²), MetS, each component of MetS, MetS stratified by obesity status, combination of obesity and MetS, and endometrial cancer risk were investigated using hazard ratios (HRs).ResultsObesity, each component of MetS, and MetS increased the endometrial cancer risk. After these factors were mutually adjusted for, the association did not change. When stratified by obesity, MetS and MetS components were not associated with endometrial cancer in normal-weight or overweight women. However, in obese women, MetS and MetS components increased the risk of endometrial cancer (HR=1.29; 95% confidence interval [CI]=1.20–1.39). Compared with normal-weight women without MetS, endometrial cancer risk was not increased in normal-weight women with MetS. Overweight women showed an increased risk of endometrial cancer irrespective of the presence of MetS (HR=1.37 and 1.38, respectively). The HR of obese women with MetS was higher than that of obese women without MetS (HR=2.18 and 1.75).ConclusionThe association between MetS and endometrial cancer was most prominent in obese women, suggesting that obese women with MetS would be more vulnerable to endometrial cancer.     

Fertility-preserving treatment in young patients with endometrial adenocarcinoma

BACKGROUND: Hormone therapy alone for early-stage, low-grade endometrial carcinoma arising in young women has been reported occasionally in case reports or small series. However, a comprehensive guideline for selection, treatment, and follow-up is not available as yet. METHODS: In the current study, the authors' evaluated the outcome of a cohort of young women with clinically diagnosed endometrial adenocarcinoma Stage IA, Grade 1 who were selected for fertility-preserving treatment by stringent staging procedures and treated in a standard protocol using combinations of megestrol acetate, tamoxifen, and gonadotropin-releasing hormone analog (GnRHa). RESULTS: Nine eligible patients were treated between 1991 and 1999. The median age of the patients was 32 years (range, 30-39 years). Of the 9 patients, 8 (88.9%) achieved complete remission after hormone therapy. Four patients had ever conceived (two patients had three term pregnancies and underwent consolidation hysterectomy after completion of family planning). Only one patient underwent hysterectomy for failure to respond, whose tumor was estrogen receptor (ER)/progesterone receptor (PgR) positive by immunostaining but negative by ligand-binding method. Another patient, whose tumor was ER negative/PgR positive, had residual carcinoma on the first assessment and achieved complete remission after replacement of tamoxifen with a GnRHa. Four responders later developed recurrent endometrial carcinoma. One underwent immediate hysterectomy. Two were successfully re-treated with hormone therapy, but the other did not respond and underwent hysterectomy. All nine patients have been alive without evidence of disease 25-113 (median, 69) months from initial diagnosis. CONCLUSIONS: The treatment strategy described in the current study is feasible. A larger multicenter trial of fertility-preserving treatment is warranted for nulliparous young patients with well selected Stage I, Grade 1, endometrial adenocarcinoma.     

Conservative therapy with metformin plus megestrol acetate for endometrial atypical hyperplasia

Objective

To compare the efficacy of metformin plus megestrol acetate (MA) with that of MA alone for treating endometrial atypical hyperplasia (EAH).

Methods

This pilot study included 16 EAH patients who met at least one metabolic syndrome (MS) criterion and received either adjunctive metformin plus MA (MET group) or MA monotherapy (MA group). Each patient in the MA group received 160 mg of MA daily, whereas patients in the MET group received the same dose of MA plus 0.5 g of metformin thrice daily. Treatment response was assessed by histological examination of dilation and curettage specimens obtained after 12 weeks of therapy.

Results

Each group had eight patients, and half of the patients in each group were diagnosed with MS. The complete response (CR) rate was 75% (6/8) in the MET group and 25% (2/8) in the MA group (p=0.105). Complications of MS did not affect the response rates in either group. In the MET group, 75% (3/4) of the patients had CR in the presence or absence of MS. In the MA group, 50% (2/4) of the patients with MS had CR, whereas no patient without MS had CR. No irreversible toxicities were observed.

Conclusion

Metformin plus MA may be a potential alternative therapy for treating EAH, and the MS status of patients may have no effect on the efficacy of metformin plus MA therapy.     

高分化子宫内膜癌或非典型子宫内膜增生患者保守治疗后妊娠结局影响因素分析

目的 探讨对于高分化子宫内膜癌(EC)或非典型子宫内膜增生(AEH)患者醋酸甲羟孕酮(MPA)保守治疗后妊娠建立的影响因素。方法 回顾性研究65例EC/AEH患者,分为妊娠组(34例)和非妊娠组(31例),统计学分析妊娠建立的影响因素。结果 妊娠组和非妊娠组相比临床基本特征均无统计学差异(P＞0.05);妊娠组的MPA治疗的持续时间、病变消失时间、妊娠允许年龄、复发、行刮宫术次数和排卵期间子宫内膜厚度与非妊娠组相比存在统计学差异(P＜0.05);Logistic回归分析显示复发(OR=2.323,P=0.015)、排卵期间子宫内膜厚度(OR=0.283,P＜0.001)和允许妊娠年龄(OR=2.524,P=0.039)是影响妊娠结局的显著性因素。结论 复发、排卵期子宫内膜厚度和怀孕时年龄是MPA保守治疗后妊娠建立的影响因素;MPA治疗肿瘤消失后即采用辅助生殖技术(ART)保育治疗可能有助于肿瘤复发、薄型子宫内膜或高妊娠年龄的患者保留生育力。     

Surgical treatment in older patients with endometrial cancer: A retrospective study

IntroductionOlder patients (OP) diagnosed with endometrial cancer (EC) are less likely to receive an optimal surgical treatment compared with non-older patients (NOP). This undertreatment along with the presence of more aggressive tumours at diagnosis can explain the worse prognosis of EC in OP. There is limited evidence comparing perioperative outcomes between OP and NOP, and the benefit of applying complex procedures to OP is still controversial. The primary objective of the study was to compare intraoperative and postoperative complications between NOP and OP with EC that underwent primary surgery. Secondary objectives were to compare surgical management and survival rates.MethodsThis is a retrospective single-centre observational study including women undergoing surgery for EC between 2010 and 2019. Patients were classified according to age as NOP (younger than 75 years) or OP (75 years or older). Basal characteristics and surgical outcomes of groups were compared using Chi-square, Fisher's exact tests, student T-tests or Mann Whitney tests. Kaplan Meier analysis was used to evaluate survival.ResultsIn total 281 patients underwent primary surgery for EC between 2010 and 2019 in our centre. At diagnosis, 184 patients were younger than 75 years while 97 were 75 and older. No differences were found in disease characteristics. Most of our patients (83,3%) underwent laparoscopic surgery. Pelvic (58,2% vs. 37,1%, p = 0,001) and para-aortic (46,7% vs. 23,7%, p < 0,001) lymphadenectomies were performed more frequently in NOP compared with OP. Rates of intra-operative (6,5% vs. 12,4%, p = 0,116) and post-operative (13,0% vs. 20,6%, p = 0,120) complications were not statistically different between NOP and OP, and neither was the rate of severe complications according to Clavien-Dindo classification (5,4% vs. 8,2% of complications grade III-V respectively, p = 0,387). The 5-year disease-specific survival (DSS) rate tended to be lower in the OP than in the NOP (74,8% vs. 82,5%, p = 0,071). Considering only patients in whom complete surgical staging was performed, OP presented similar DSS to NOP, with comparable complication rate.ConclusionsOP do not present a significantly higher rate of perioperative complications compared to NOP. However, they underwent fewer lymphadenectomies and tended to present poorer DSS. Further studies are needed to standardize the surgical management of these patients.     

Adjuvant sequential chemo and radiotherapy improves the oncological outcome in high risk endometrial cancer

Objective

Evaluation of the impact of sequential chemoradiotherapy in high risk endometrial cancer (EC).

Methods

Two hundred fifty-four women with stage IB grade 3, II and III EC (2009 FIGO staging), were included in this retrospective study.

Results

Stage I, II, and III was 24%, 28.7%, and 47.3%, respectively. Grade 3 tumor was 53.2% and 71.3% had deep myometrial invasion. One hundred sixty-five women (65%) underwent pelvic (+/- aortic) lymphadenectomy and 58 (22.8%) had nodal metastases. Ninety-eight women (38.6%) underwent radiotherapy, 59 (23.2%) chemotherapy, 42 (16.5%) sequential chemoradiotherapy, and 55 (21.7%) were only observed. After a median follow-up of 101 months, 78 women (30.7%) relapsed and 91 women (35.8%) died. Sequential chemoradiotherapy improved survival rates in women who did not undergo nodal evaluation (disease-free survival [DFS], p=0.040; overall survival [OS], p=0.024) or pelvic (+/- aortic) lymphadenectomy (DFS, p=0.008; OS, p=0.021). Sequential chemoradiotherapy improved both DFS (p=0.015) and OS (p=0.014) in stage III, while only a trend was found for DFS (p=0.210) and OS (p=0.102) in stage I-II EC. In the multivariate analysis, only age (≤65 years) and sequential chemoradiotherapy were statistically related to the prognosis.

Conclusion

Sequential chemoradiotherapy improves survival rates in high risk EC compared with chemotherapy or radiotherapy alone, in particular in stage III.     

Implications of a two-step procedure in surgical management of patients with early-stage endometrioid endometrial cancer

Objective

Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery.

Methods

This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied.

Results

Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1±117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications.

Conclusion

Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity.     

The risk of lymphedema after postoperative radiation therapy in endometrial cancer

Objective

Lower extremity lymphedema adversely affects quality of life by causing discomfort, impaired mobility and increased risk of infection. The goal of this study is to investigate factors that influence the likelihood of lymphedema in patients with endometrial cancer who undergo adjuvant radiation with or without chemotherapy.

Methods

A retrospective chart review identified all stage I–III endometrial cancer patients who had a hysterectomy with or without complete staging lymphadenectomy and adjuvant radiation therapy between January 2006 and February 2013. Patients with new-onset lymphedema after treatment were identified. Logistic regression was used to find factors that influenced lymphedema risk.

Results

Of 212 patients who met inclusion criteria, 15 patients (7.1%) developed new-onset lymphedema. Lymphedema was associated with lymph-node dissection (odds ratio [OR], 5.6; 95% CI, 1.01 to 105.5; p=0.048) and with the presence of pathologically positive lymph nodes (OR, 4.1; 95% CI, 1.4 to 12.3; p=0.01). Multivariate logistic regression confirmed the association with lymph-node positivity (OR, 3.2; 95% CI, 1.0007 to 10.7; p=0.0499) when controlled for lymph-node dissection. Median time to lymphedema onset was 8 months (range, 1 to 58 months) with resolution or improvement in eight patients (53.3%) after a median of 10 months.

Conclusion

Lymph-node positivity was associated with an increased risk of lymphedema in endometrial cancer patients who received adjuvant radiation. Future studies are needed to explore whether node-positive patients may benefit from early lymphedema-controlling interventions.     

Risk group criteria for tailoring adjuvant treatment in patients with endometrial cancer: a validation study of the Gynecologic Oncology Group criteria

Objective

The purpose of this study is to validate the Gynecologic Oncology Group (GOG) criteria for adjuvant treatment in a different cohort of patients and to evaluate the simplified risk criteria predicting the prognosis and tailoring adjuvant treatment in patients with surgically staged endometrial cancer.

Methods

We performed a retrospective analysis of 261 consecutive patients with surgically staged endometrial cancer between January 2000 and February 2013. All patients had complete staging procedures and were surgically staged according to the 2009 International Federation of Gynecology and Obstetrics staging system. Clinical and pathologic data were obtained from medical records. We designed the simplified risk criteria for adjuvant treatment according to the risk factors associated with survival. The patients were divided into low and low-intermediate, high-intermediate, and high-risk groups according to the GOG criteria and simplified criteria and their survivals were compared. Receiver-operating characteristic curve analysis was used to evaluate the prognostic significance of both criteria.

Results

Median follow-up time was 48 months (range, 10 to 122 months). According to the GOG criteria, we identified 197 low and low-intermediate risk patients, 20 high-intermediate risk patients, and 44 high-risk patients. There were significant differences in disease-free (p<0.001) and overall survival (p<0.001) among the three groups. Using the simplified risk criteria, we identified 189 low and low-intermediate risk patients, 28 high-intermediate risk patients, and 44 high-risk patients. There were significant differences in disease-free (p<0.001) and overall survival (p<0.001) among the three groups. The performance of the simplified criteria (area under the curve [AUC]=0.829 and 0.916 for disease recurrences and deaths, respectively) was as good as the GOG criteria (AUC=0.836 and 0.921 for disease recurrences and deaths, respectively).

Conclusion

The simplified criteria may be easily applicable and offer useful information for planning strategy of adjuvant treatment in patients with surgically staged endometrial cancer as the GOG criteria.     

Increased ultrasonographic endometrial thickness is associated with poor survival in patients with endometrial cancer: An Israel gynecologic oncology group study

BackgroundWe aimed to assess the association of pre-operatively evaluated ultrasonographic endometrial thickness with outcomes of patients with endometrial cancer.MethodsAn Israel Gynecologic Oncology Group multicenter retrospective cohort study of consecutive patients with endometrial cancer who underwent surgery between 2002 and 2014 in one of eleven academic centers. Patients were categorized by endometrial thickness into two groups: ≤20 mm and >20 mm. Clinical and pathological features were compared using Student T-test for continuous variables and Chi-square or Fisher’s exact test for categorical variables. Survival measures were plotted with the Kaplan-Meier method and compared using the log-rank test. A Cox proportional hazards model was used for multivariable comparison of associations.Results1113 patients in whom endometrial thickness data was recorded were the subject of this study and included 2 groups: ≤20 mm (n = 930), >20 mm (n = 183). The median follow-up was 52 months (range 12–120 months). Patients with endometrial thickness >20 mm had significantly lower recurrence-free survival (log rank, p < .0001), disease-specific survival (log rank, p = .01), and overall survival (log rank, p < .0001). On multivariate Cox proportional hazards analysis, endometrial thickness >20 mm remained independently associated with an increased hazard of recurrence and death (HR = 1.77, 95% CI 1.07–2.96, p = .03 for recurrence; and HR = 1.68; 95% CI 1.07–2.65; p = .03 for overall survival).ConclusionIn patients with endometrial cancer, endometrial thickness>20 mm as measured preoperatively by ultrasound, is independently associated with decreased recurrence-free and overall survival. This finding suggests that thick endometrium may be considered as one of the risk factors for poor prognosis.     

Clinical outcome of adjuvant treatment of endometrial cancer using aperture-based intensity-modulated radiotherapy

PURPOSE: To assess disease control and acute and chronic toxicity with aperture-based intensity-modulated radiotherapy (AB-IMRT) for postoperative pelvic irradiation of endometrial cancer. METHODS AND MATERIALS: Between January and July 2005, after hysterectomy for endometrial cancer, 15 patients received 45 Gy to the pelvis using AB-IMRT. The AB-IMRT plans were generated by an in-house treatment planning system (Ballista). The AB-IMRT plans were used for treatment and were dosimetrically compared with three other approaches: conventional four-field, enlarged four-field, and beamlet-based IMRT (BB-IMRT). Disease control and toxicity were prospectively recorded and compared with retrospective data from 30 patients treated with a conventional four-field technique. RESULTS: At a median follow-up of 27 months (range, 23-30), no relapse was noted among the AB-IMRT group compared with five relapses in the control group (p = 0.1). The characteristics of each group were similar, except for the mean body mass index, timing of brachytherapy, and applicator type used. Patients treated with AB-IMRT experienced more frequent Grade 2 or greater gastrointestinal acute toxicity (87% vs. 53%, p = 0.02). No statistically significant difference was noted between the two groups regarding the incidence or severity of chronic toxicities. AB-IMRT plans significantly improved target coverage (93% vs. 76% of planning target volume receiving 45 Gy for AB-IMRT vs. conventional four-field technique, respectively). The sparing of organs at risk was similar to that of BB-IMRT. CONCLUSION: The results of our study have shown that AB-IMRT provides excellent disease control with equivalent late toxicity compared with the conventional four-field technique. AB-IMRT provided treatment delivery and quality assurance advantages compared with BB-IMRT and could reduce the risk of second malignancy compared with BB-IMRT.     

Systemic therapy in metastatic or recurrent endometrial cancer

Endometrial cancer is one of the most common gynecologic malignancies. In patients with advanced or recurrent endometrial cancer survival is greatly diminished. Hormonal therapy and chemotherapy play a major role in the management of advanced or recurrent endometrial cancer. Endocrine therapy provides a 10-20% response rate (RR) and survival of less than 1 year. Combination chemotherapy offers a RR of 40-60%, but the survival is still less than 1 year. The combination of cisplatin plus doxorubicin is the most commonly used regimen, but carboplatin plus paclitaxel represents an efficacious, low toxicity regimen in advanced or recurrent endometrial cancer. The addition of paclitaxel to cisplatin plus doxorubicin appears to improve response rates, progression-free survival and overall survival, but to worsen toxicity profile. At this time the focus of future research should be on the use of novel targeted agents, since it is unlikely that further significant advances could be made with chemotherapy and endocrine therapy. mTOR inhibitors represent a promising therapeutic strategy for endometrial cancer. Anti-HER-2/neu targeted therapy might be a novel and attractive therapeutic option in patients with biologically aggressive variants (uterine serous papillary carcinoma, clear cell carcinoma) of endometrial cancer. Research in better understanding the signal transduction pathways in endometrial carcinogenesis will allow the development of specific and selective molecularly targeted inhibitors.     

Weekly low-dose paclitaxel and carboplatin in the treatment of advanced or recurrent cervical and endometrial cancer

Background The purpose of this study was to evaluate the toxicity profile of weekly low-dose paclitaxel and carboplatin in patients with gynecologic malignancies. Methods Patients had measurable disease defined by clinical examination or radiographic studies. Each cycle of treatment consisted of carboplatin at an AUC of 2 and paclitaxel at 80 mg/m² on days 1, 8, and 15 of a 28-day cycle. Results Twenty-eight patients with advanced or recurrent cervical and endometrial cancers were included in this study. The overall response rate (ORR) was 39% (2 CR, 9 PR). Among the 15 cervical cancers the ORR was 20%, while the 13 endometrial cancers had a 62% ORR. Median time to progression and overall survival was 3.4 and 7.6 months for those with cervical cancer and 5.5 and 15.4 months for those with endometrial cancer. Grade 3 or 4 hematologic toxicity was uncommon (7% grade 3 anemia, 21% grade 3 or 4 neutropenia, 7% grade 3 or 4 thrombocytopenia). Conclusion A regimen of weekly low-dose paclitaxel and carboplatin has an acceptable toxicity profile that is easily managed by dose adjustment and the use of erythropoietic therapy. This regimen appears to have activity in advanced or recurrent endometrial cancer which warrants further evaluation.     

559例子宫内膜癌临床综合治疗疗效分析

背景与目的:随着对子宫内膜癌预后因素的认识和手术病理分期的应用,子宫内膜癌的治疗模式变化很大.本研究探讨子宫内膜癌的治疗方法、生存情况及影响预后的因素.方法:回顾性分析1996年1月-2006年12月间收治的559例子宫内膜癌手术初治患者的临床病理资料和预后.结果:经过中位随访期36个月,局部复发25例,远处转移24例.3年总生存率为88.7%,3年和5年无病生存率为82.7%和80.9%.Ⅰ期、Ⅱ期、Ⅲ期及Ⅳ期患者3年总生存率分别为95.5%、95.3%、75.9%和32.4%,3年无病生存率分别为Ⅰ期92:1%,Ⅱ期90.8%,Ⅲ期63.5%和Ⅳ期14.7%,早期(Ⅰ、Ⅱ期)与Ⅲ期、Ⅳ期间差异均有显著性(P<0.001).内膜样腺癌和非内膜样腺癌在3年总生存率和3年无病生存率上有显著差异(分别为92.4%vs 64.9%和86.9%vs 57.4%,P均<0.001).分化程度不同子宫内膜癌的3年总生存率和3年无病生存率分别为分化Ⅰ级98.3%和94.2%,分化Ⅱ级89.3%和83.4%,分化Ⅲ级70.8%和62.5%,3者差异均有显著性(P<0.05和<0.001).1996-2002年间收治患者的3年总生存率和3年无病生存率分别为83.4%和76.4%,而2003-2004年间收治患者的3年总生存率和3年无病生存率分别为94.0%和88.6%,但差异无统计学意义(P=0.0732和0.1168).多因素分析显示仅手术病理分期、组织学分级和肌层浸润深度与预后相关(P<0.05).结论:尽管子宫内膜癌的治疗己取得了较好的疗效,日趋规范的子宫内膜癌治疗方式将可能进一步提高患者长期生存.     

营养干预对晚期子宫内膜癌恶液质患者代谢改变

目的 探讨营养干预对晚期子宫内膜癌恶液质患者代谢改变。方法 随机选取本院2015年6月至2017年6月收治的晚期子宫内膜癌恶液质患者70例,按随机数字法将其随机分为对照组和试验组,对照组采用常规自主进食干预,试验组采用营养干预,检测干预前后各营养指标和各代谢相关指标,并统计分析其差异性。结果  经比较对照组干预前后BMI、红细胞、血清白蛋白、血红蛋白各营养指标值之间的差异不具有统计学意义（P＞0.05）;试验组干预前后各营养指标值之间的差异均具有统计学意义（P＜0.05）。干预前试验组各营养指标值与干预前对照组各指标值之间的差异均不具有显著性（P＞0.05）,但是干预后试验组各营养指标值均显著高于干预后对照组各指标值,其差异均具有统计学意义（P＜0.05）。经比较对照组干预前后腰围、高密度脂蛋白、甘油三酯、收缩压、舒张压、血糖各指标值之间的差异无统计学意义（P＞0.05）;试验组干预后腰围、高密度脂蛋白、甘油三酯、血糖各指标值均显著高于试验组干预前各指标值,其差异均具有统计学意义（P＜0.05）,但收缩压和舒张压在两组之间的差异无统计学意义（P＞0.05）;干预前试验组腰围、高密度脂蛋白、甘油三酯、收缩压、舒张压、血糖各指标值与干预前对照组各指标值之间的差异均不具有统计学意义（P＞0.05）。干预后试验组腰围、高密度脂蛋白、甘油三酯、血糖各指标值均要显著高于干预后对照组各指标值,其差异均具有统计学意义（P＜0.05）,但是收缩压、舒张压在干预后试验组和对照组之间的差异不具有统计学意义（P＞0.05）。结论 营养干预能显著改善晚期子宫内膜癌恶液质患者的营养状况和代谢相关指标。     

生酮饮食干预多囊卵巢综合征的有效性和安全性研究

目的 探讨生酮饮食对改善合并超重/肥胖的多囊卵巢综合征(PCOS)患者疾病相关症状的安全性和有效性.方法 2018年12月至2019年5月按照BMI≥24 kg/m2和体脂率≥28％标准招募PCOS患者18例,进行纯生酮饮食干预,其中8例患者试验时间为1个月,其中10例患者试验时间为2个月.对患者进行每日随访监测、每月...     

Lower uterine segment involvement is associated with adverse outcome in patients with stage I endometroid endometrial cancer: Results of a multicenter study

Objective

To quantify the relative risk associated with lower uterine segment involvement (LUSI) on outcome measures in patients with apparent stage I endometroid endometrial cancer.

Methods

A cohort of 769 consecutive patients with endometroid endometrial carcinoma apparent stage I, who underwent surgery in five gynecological oncology centers in Israel; 138 patients with and 631 without LUSI were followed for a median time of 51 months. Local recurrence, recurrence-free and overall survival were compared between the two groups.

Results

LUSI was associated with grade 3 tumor (p = 0.002), deep myometrial invasion (p < 0.001), and the presence of lymphvascular space involvement (p = 0.01). There were 22 cases of local recurrences, 40 cases of distal recurrences and 80 patients died. Univariate survival analysis showed that patients with LUSI had trend toward lower regional recurrence-free survival (p = 0.09), and significant lower distant recurrence-free survival (p = 0.04) and lower overall survival (p = 0.002). The Cox proportional hazards model demonstrated a significantly decreased overall survival (HR = 2.3; 95% CI 1.3, 3.9; p = 0.003) in cases with LUSI.

Conclusions

In patients with apparent stage I endometroid endometrial cancer, the presence of LUSI is a poor prognostic factor, associated with a significantly higher risk of distal recurrence and death. The presence of LUSI warrants consideration when deciding upon surgical staging or postoperative management.