The clinical value and the cost-effectiveness of follow-up in endometrial cancer patients

The aim of the present article was to evaluate the cost-effectiveness of follow-up in endometrial cancer patients. A literature review was performed regarding the studies that addressed routine follow-up of endometrial cancer. For each published study, the costs of the follow-up program were calculated according to Belgium standards. A mean total of 13% relapsed. Symptomatology and clinical examination detected over 83% of the recurrences. The follow-up cost in euro after 5 and 10 years ranged between 127.68 and 2,028.78 and between 207.48 and 2,353.48, respectively. Based on the available data, there is little evidence of routine follow-up improving survival rates. Multiple protocols are used in practice without an evidence base. There is an urgent need for prospective randomized studies to evaluate the value of the current so-called 'standard medical practice of follow-up.' It is to be expected that the cost of follow-up could be reduced considerably, for instance, by tailoring to low- and high-risk groups, or by abandoning routine follow-up. Symptomatic patients, however, should be evaluated immediately. A reduction in the number of visits and examinations would mean an enormous reduction in costs. This economic benefit would be warmly welcomed in the times of increased health costs and decreased budgets.     

腹腔镜与开腹手术治疗子宫内膜癌效果比较

目的探讨腹腔镜辅助的子宫内膜癌手术与传统开腹手术临床效果的差异。方法回顾性研究2007年1月至2010年3月在上海交通大学附属第一人民医院妇科行子宫内膜癌腹腔镜手术的51例患者临床资料,选择同期同组医生施行的子宫内膜癌传统开腹手术69例作为对照组,比较两组临床效果。结果腹腔镜组与开腹组在手术时间、术中清扫淋巴结数目上差异无统计学意义。腹腔镜组术中失血少、术后发热率低、肠道恢复快、住院时间短,与开腹组差异有统计学意义(P<0.05)。开腹组切口裂开率高于腹腔镜组,而其他并发症组间差异无统计学意义。结论腹腔镜手术是治疗早期子宫内膜癌稳妥可行的选择。     

不同分子学筛查方法在Lynch综合征相关子宫内膜癌患者中的对比分析#br#

Objective?Compare the accuracy of immunohistochemical staining (IHC), microsatellite instability detection (MSI), and the combined detection of the two in the screening of Lynch Syndrome-related endometrial cancer (LS-EC), and analyze the advantages and disadvantages of actual clinical applications, to identify a routine and reasonable screening strategy. This study also reveals the incidence of LS-EC and the mutations of different mismatch repair (MMR) genes in the Chinese population in this region. Methods?IHC MMR protein detection and MSI detection were performed on the pathological tissues of diagnosed EC patients from the Second Hospital of Jilin University from November 2019 to November 2020, and the preoperative venous blood was subjected to next-generation sequencing (NGS) of Lynch syndrome-related mutations. Results?After NGS testing, 8 cases of LS were confirmed, with an incidence rate of 7.90%. 28 cases had lack of expression of MMR protein, 7 cases were diagnosed as LS, 1 case was missed diagnosis; 13 cases had high microsatellite instability (MSI-H), 3 cases were diagnosed as LS, 5 cases were missed; the combined detection of the two tests can screen out all LS patients. Conclusion?IHC combined with MSI screening is highly sensitive but not cost-effective. IHC alone is recommended as the first clinical screening method.     

子宫内膜癌激素替代治疗

子宫内膜癌(endometrial cancer,EMC)患者的激素替代治疗(hormone replacement therapy,HRT)相关研究有限,且至今为止医学界尚未对此达成统一观点。大部分妇产科医生考虑到雌激素是EMC的重要发病因素之一,并不建议给予EMC患者HRT治疗。目前认为EMC并非一定是HRT治疗的禁忌证。选择恰当的剂量和药物种类不会引起EMC的复发和死亡率增加,并可对EMC患者起到适当保护作用。HRT在提高骨密度和减轻未绝经期血管收缩症状已被证实有一定裨益,但在降低冠心病、癌症发病率,以及提高认识力和健康相关生活质量上并没有相关研究支持。由于数据有限,且大部分来自具有选择偏差的回顾性研究或小型前瞻性非随机研究,妇产科医生在评估EMC患者是否需要HRT治疗时一定要充分考虑利弊,个体化治疗。     

Post treatment surveillance of type II endometrial cancer patients

Objective

There are few studies analyzing surveillance for Type II endometrial cancer recurrence. Our objective was to determine the types of post treatment surveillance tests performed in our institution and the efficacy of these tests in detecting recurrence in type II endometrial cancer patients.

Methods

One hundred and thirty six cases of type II endometrial cancers at Cedars-Sinai Medical Center from January of 2000 to August of 2011 were identified and 106 patients met inclusion criteria. Medical charts were reviewed for surveillance methods and number of follow up visits. For patients who underwent a recurrence of disease, the surveillance method utilized for detection was documented.

Results

Forty-seven of the 106 (44%) patients developed recurrence with a mean progression free interval of 11 months. All patients had a history and physical at each surveillance visit, 78% had Pap testing, 57% had CA-125 levels drawn, 59% had CT (computed tomography) scans done, 6% had PET (positron emission tomography) scans done for surveillance. In our cohort, recurrence was detected by symptoms in 16, by CA-125 in 11, by physical exam in 7, by CT scan in 12, and by PET scan in one patient. No patients had recurrence detected by vaginal cytology.

Conclusions

Although performed in the majority of patients, Pap testing did not detect any recurrences within this cohort. History and physical exam detected the most recurrences. These findings suggest that educating patients about relevant symptoms and performing thorough follow-up exams may be the most important aspects of detecting type II endometrial cancer recurrence.     

Survivin蛋白在子宫内膜癌和子宫内膜复杂性增生中的表达及其临床意义

目的 研究凋亡抑制蛋白survivin在子宫内膜癌和子宫内膜复杂性增生中的表达差异以及在子宫内膜癌中表达与内膜癌预后相关因素的关系。方法 应用免疫组化SP法检测41例子宫内膜癌、26例子宫内膜复杂性增，丰和8例正常内膜标本中survivin蛋白的表达情况。结果 survivin蛋白在正常内膜没有表达。在子宫内膜癌中和子守内膜复杂性增生中的阳性表达率分别是85．3％和30．8％，两者的表达有明显的差异（P〈0．001），且子宫内膜癌组阳性细胞的染色强度明显比子宫内膜复杂性增生组强（P〈0．001）。41例子宫内膜癌中，survivin的表达与肿瘤细胞的组织学分级、肌层浸润及临床一病理分期呈正相关（P〈0．01、P〈0．001和P〈0．01）。结论 survivin蛋白与子宫内膜癌的发生有关，升且与子宫内膜癌的不良生物学行为有关，可为临床治疗提供有价值的信息，对估计预后有指导意义。     

Coexisting endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia

AIM: To investigate the possibility of coexisting endometrial cancer (EC) in patients with atypical endometrial hyperplasia (AEH). METHODS: Forty-six consecutive women who underwent hysterectomy for AEH were analyzed. RESULTS: Final histopathological evaluation of hysterectomy specimens revealed EC in 11 patients (23.9%). Preoperative diagnosis of AEH was established by pipelle biopsy in eight patients and curettage was performed in the remaining patients. Of the patients with pipelle biopsy, two had a diagnosis of EC (25%), whereas nine women who underwent curettage, were further diagnosed as having EC (23.7%) (P > 0.05). Four (13.3%) of 30 women who had frozen sections at hysterectomy, were diagnosed with EC. Diagnosis of EC was missed in two patients (50%) at frozen section. In contrast, seven of 16 women (43.7%) who did not have frozen section, had EC. CONCLUSION: A relatively high incidence of EC is seen in patients with a diagnosis of AEH. Diagnostic results of pipelle biopsy and curettage were comparable. Frozen sections of hysterectomy specimens does not guarantee to exclude the possibility of EC, especially in patients with no myometrial invasion.     

Clinical outcomes following 3D image-guided brachytherapy for vaginal recurrence of endometrial cancer

Purpose

To evaluate clinical outcomes for women with recurrent endometrial cancer treated with 3D image-guided brachytherapy

Methods and materials

44 women, of whom 13 had received prior RT, received salvage RT for vaginal recurrence from 9/03 to 8/11. HDR or LDR interstitial brachytherapy was performed under MR or CT guidance in 35 patients (80%); 9 (20%) had CT-guided HDR cylinder brachytherapy. The median cumulative dose in EQD2 was 75.5 Gy. Actuarial estimates of local failure (LF), disease-free (DFS) and overall survival (OS) were calculated by Kaplan–Meier.

Results

Histologic subtypes were endometrioid (EAC, 33), papillary serous/clear cell (UPSC/CC, 5) and carcinosarcoma (CS, 6). The 2-year DFS/OS rates were 75%/89% for EAC and 11%/24% for UPSC/CC/CS (both p < 0.01). On MVA, high tumor grade was associated with recurrence (HR 3.2 for grade 2, 9.6 for grade 3, p < 0.01). The LF rate at 2 years was 4% for patients without versus 39% for those with prior RT (p = 0.1). Patients who had prior RT received lower cumulative doses at recurrence (66.5 Gy vs. 74.4 Gy, p < 0.01). The 2-year DFS/OS rates with and without prior RT were 26%/55% and 72%/80% (both p = 0.1). Four patients (9%) experienced grade 3 late toxicity, including 3 of 13 (23%) in the re-irradiation setting and 1 of 31 (3%) with no prior radiotherapy.

Discussion

3D image-guided brachytherapy results in excellent local control for women with recurrent endometrial cancer, particularly with cumulative EQD2 doses greater than 70 Gy. Successful salvage of vaginal recurrence is related to tumor grade and histologic subtype.     

DNA-content in endometrial carcinoma of tamoxifen-treated breast cancer patients

DNA measurements and histopathologic evaluation were performed in 17 patients treated with adjuvant tamoxifen for early breast cancer and who developed endometrial carcinoma during or after the tamoxifen therapy. The tumors were exclusively characterized by euploid DNA content except for two cases, one mixed mesodermal sarcoma, a highly malignant and rare tumor, and one adenocarcinoma. Although the use of adjuvant tamoxifen therapy most likely enhances the risk of developing endometrial carcinoma, the beneficial effects of adjuvant breast cancer treatment is of well-known clinical importance. The hazards of giving long-term tamoxifen seem to be low since the endometrial tumors were associated with low-grade malignancy and euploid DNA pattern.     

子宫内膜采集器在子宫内膜癌及癌前病变筛查中的应用

目的探讨子宫内膜采集器应用于子宫内膜癌及癌前病变筛查时的准确性和可行性。方法 2012年4月至2012年11月北京大学人民医院妇科收治需行宫腔镜检查的患者131例。应用子宫内膜采集器采集子宫内膜组织,随后应用宫腔镜评价标本采集范围并直视下活检内膜组织。分别组织学制片后,对比二者的病理学结果,并计算敏感性,特异性和准确率。结果满意标本采集率83.21%(109/131)。满意标本109例,其中子宫内膜癌/不典型增生14例,检出13例,采集器筛查的敏感性和特异性分别为92.9%和100.00%,准确率为99.1%。取材不满意的22例患者中,6例(4.58%)组织过少,无法制片。16例(12.21%)擦痕不能遍布整个宫腔,其中11例为双侧输卵管开口处不能见到擦痕,5例为未能进入宫腔。结论子宫内膜采集器可以用来筛查子宫内膜癌及不典型增生;但不适合用于黏膜下子宫肌瘤和子宫内膜息肉的标本采集;需扩大样本量做进一步检验。     

Does the size of pelvic lymph nodes predict metastatic involvement in patients with endometrial cancer?

Whether the size of a retroperitoneal lymph node reflects its status is not clear. We measured the size of 125 positive and 160 negative pelvic lymph nodes in 32 consecutive patients with node-positive endometrial cancer. The measurements were compared with those of 143 pelvic lymph nodes of five randomly selected patients with endometrial cancer without node involvement. Overall, positive lymph nodes were larger than negative lymph nodes in both node-positive patients and node- negative controls ( P < 0.01). There was a positive correlation between the size of positive lymph nodes and the size of the metastasis therein ( P < 0.01). However, 68 of 125 (54%) positive lymph nodes measured less than 10 mm in maximum diameter, while 46 of 160 (29%) negative lymph nodes in node-positive patients measured more than 10 mm in maximum diameter. The metastasis was detected in more than 50% of step-serial sections in only 74% of positive lymph nodes. These data suggest that the size of a lymph node does not reliably reflect its status. Thus, these nodes may be missed if only enlarged nodes are removed. If only one section of a lymph node is performed, at least 26% of metastases will be missed.     

Sensitivity to cisplatin determined by the histoculture drug response assay and clinical response of endometrial cancer

This study investigated the value of the in vitro histoculture drug response assay (HDRA) for predicting the efficacy of chemotherapy in patients with endometrial cancer. Specimens were obtained from 115 patients with endometrial cancer treated at Keio University Hospital between 1994 and 2002. Tumor fragments were cultured on collagen sponge gel with cisplatin for 7 days, and cell viability was assessed. The cutoff value of the 50% inhibitory concentration of cisplatin was set at 23 microg/mL. Sensitivity of stage III or IV disease to chemotherapy was investigated, and differences of 5-year progression-free survival between patients with sensitive and resistant tumors were evaluated by the Kaplan-Meier method. Tumors were evaluable in 93.0% of patients (107/115). Among 38 patients in stages III or IV, 23 received chemotherapy containing cisplatin. Seven sensitive tumors did not recur, while recurrence/progression occurred within 6 months in 8/16 patients with tumors showing low sensitivity. Among stages III and IV patients, there was a significant difference of 5-year progression-free survival (P < 0.05) between those with tumors showing high or low sensitivity. Accordingly, the HDRA may predict the efficacy of chemotherapy for endometrial cancer.     

子宫内膜癌与结直肠癌双原发癌40例临床分析

目的 探讨子宫内膜癌与结直肠癌双原发癌患者的临床病理特征、预后及影响因素.方法 采用查阅病例、电话、门诊随访等方式回顾性分析2001年12月至2017年4月在北京大学肿瘤医院收治的子宫内膜癌与结直肠癌双原发癌患者共40例.结果 40例患者的中位随访时间为49(5～264)个月.2年生存率为91.9％,3年生存率为86....     

435例子宫内膜癌综合治疗疗效分析

目的探讨子宫内膜癌患者综合治疗后的生存情况。方法回顾性分析1992年1月至2009年12月收治的有完整随访资料的435例子宫内膜癌患者的临床病理资料,分析不同治疗方案对患者预后的影响。结果 435例患者的中位随访时间为55.5个月,其中59例(13.6%)患者复发,58例(13.3%)患者死亡,5年总生存率为92.2%,5年无瘤生存率为88.3%。术后单纯辅助孕激素治疗≥12个月者5年无瘤生存率[(95.1±2.7)%]显著高于术后无辅助治疗组[(93.1±2.7)%,P<0.05];术后孕激素+放疗组患者5年总生存率[(94.3±6.5)%]、5年无瘤生存率[(86.1±10.8)%]均显著高于术后单纯放疗组[均为(69.4±14.4)%,P<0.05)];术后单纯化疗组5年总生存率[(84.2±6.3)%]、5年无瘤生存率[(81.9±6.8)%]略低于术后无辅助治疗组,但两组比较,差异无统计学意义(P>0.05);术后放疗+化疗组5年总生存率[(87.9±6.0)%]、5年无瘤生存率[(78.3±8.7)%]与术后化疗组、放疗组和无辅助治疗组比较,差异均无统计学意义(P>0.05)。结论术后辅助孕激素治疗≥12个月、化疗、放疗+化疗可以在一定程度上改善高危子宫内膜癌患者的预后。