The incidence of pelvic and para-aortic lymph node metastasis in uterine papillary serous and clear cell carcinoma according to the SEER registry

Objective

In this study we utilized the Surveillance, Epidemiology and End-Results (SEER) registry to identify risk factors for lymphatic spread and determine the incidence of pelvic and para-aortic lymph node metastases in patients with uterine papillary serous carcinoma (UPSC) and uterine clear cell carcinoma (UCCC) who underwent complete surgical staging and lymph node dissection.

Methods

Nine hundred seventy-two eligible patients diagnosed between 1998 to 2009 with International Federation of Gynecology and Obstetrics (FIGO) 1988 stage IA-IVA UPSC (n=685) or UCCC (n=287) were identified for analysis. Binomial logistic regression was used to determine risk factors for lymph node metastasis, with the incidence of pelvic and para-aortic lymph node metastases reported for each FIGO primary tumor stage. The Cox proportional hazards regression model was used to determine factors associated with overall survival.

Results

FIGO primary tumor stage was the only independent risk factor for lymph node metastasis (p<0.01). The incidence of pelvis-only and para-aortic lymph node involvement according to the FIGO primary tumor stage were as follows: IA (2.3%/3.8%), IB (7.5%/5.2%), IC (22.5%/16.9%), IIA (20.8%/13.2%), IIB (25.7%/14.9%), and III/IV (25.7%/24.3%). Prognostic factors for overall survival included lymph node involvement (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.09 to 1.85; p<0.01), patient age >60 years (HR, 1.70; 95% CI, 1.21 to 2.41; p<0.01), and advanced FIGO primary tumor stage (p<0.01). Tumor grade, histologic subtype, and patient race did not predict for either lymph node metastasis or overall survival.

Conclusion

There is a high incidence of both pelvic and para-aortic lymph node metastases for FIGO stages IC and above uterine papillary serous and clear cell carcinomas, suggesting a potential role for lymph node-directed therapy for these patients.     

Clinical Translation of [68Ga]Ga-NOTA-anti-MMR-sdAb for PET/CT Imaging of Protumorigenic Macrophages

Molecular Imaging and Biology - Macrophage mannose receptor (MMR, CD206) expressing tumor-associated macrophages (TAM) are&nbsp;protumorigenic and was reported to negatively impact therapy...     

Employment Status and Health: Understanding the Health of the Economically Inactive Population in Scotland

ABSTRACT: BACKGROUND: Although the association between health and unemployment has been well examined, less attention has been paid to the health of the economically inactive (EI) population. Scotland has one of the worst health records compared to any Western European country and the EI population account for 23% of the working age population. The aim of this study is to investigate and compare the health outcomes and behaviours of the employed, unemployed and the EI populations (further subdivided into the permanently sick, looking after home and family [LAHF] and others) in Scotland. METHODS: Using data from the 2003 Scottish Health Survey, the differences in health and health behaviours among the employed, unemployed and the subgroups of the EI population were examined. RESULTS: Both low educational attainment and residence in a deprived community were more likely in the permanently sick group. The LAHF and the unemployed showed worse self-reported health and limiting longstanding illness compared to the employed but no significant differences were observed between these groups. The permanently sick group had significantly poorer health outcomes than all the other economic groups. Similar to the unemployed and LAHF they are more likely to smoke than the employed but less likely (along with LAHF and 'others') to exhibit heavy alcohol consumption. Interestingly, the LAHF showed better mental health than the rest of the EI group, but a similar mental health status to the unemployed. On the physical health element of lung function, the LAHF were no worse than the employed. CONCLUSION: While on-going health promotion and vocational rehabilitation efforts need to be directed towards all, our data suggests that the EI group is at higher risk and policies and strategies directed at this group may need particular attention.     

Intravitreal Bevacizumab for Photodynamic Therapy-Induced Massive Macular Detachment in Acute Central Serous Chorioretinopathy

We present a long followed up case of acute central serous chorioretinopathy (CSC) complicated by a severe visual loss due to massive pigment epithelium detachment of the macula after a full-dose photodynamic therapy (PDT). Rapid anatomical and functional improvement was observed after a single intravitreal injection of bevacizumab. To our knowledge, we report the first case of PDT-treated CSC complicated by severe visual loss. We can only speculate that the serous detachment of the posterior pole might have been caused by PDT-induced VEGF overexpression, explaining such an impressive response to Avastin treatment.Key Words: Bevacizumab, Central serous chorioretinopathy, Photodynamic therapy     

A Review of Methods to Assess Parental Feeding Practices and Preschool Children's Eating Behavior: The Need for Further Development of Tools

We reviewed tools developed to measure parental feeding practices and eating behavior and food intake or preferences of children aged 0 to 5 years. Two electronic literature databases (Medline and Psycinfo) were used to search for both observational and experimental studies in human beings. The articles selected for review were those presenting tools with data on internal consistency and/or test–retest reliability and/or construct validity. A total of 3,445 articles were retrieved, and further searching of reference lists and contact with experts produced an additional 18 articles. We identified three tools on the qualitative dimension of children's eating behavior, two tools on food intake or preferences, and one tool on parental feeding practices with rigorous testing of internal consistency, construct validity, and test–retest reliability. All other tools presented in this review need further evaluation of their validity or reliability. Because major gaps exist, we highlight the need for more tools on parental attention to children's hunger and satiety cues, and the need to evaluate the degree of control allowed to children younger than age 2 years in feeding events. Food avoidance (ie, behaviors or strategies to take away and to reject food) and food approach (ie, attractiveness for food stimuli) have not been assessed in children aged 12 to 24 months. Food preference tests based on sensory aspects rather than nutritional quality may be worth investigating. We identified a need for further evaluation of quality, especially test–retest reliability and construct validity, for most tools developed for use in studying children aged 0 to 5 years.