Adnexal Metastasis Research Articles

P3.02a-024 Response to Crizotinib in a Lung Adenocarcinoma Patient Harbouring EML4-ALK Translocation with Adnexal Metastasis: Topic: ALK Clinical

P3.02a-024 Response to Crizotinib in a Lung Adenocarcinoma Patient Harbouring EML4-ALK Translocation with Adnexal Metastasis: Topic: ALK Clinical

Prognostic factors for adnexal metastasis in endometrial cancer and its implication for ovarian preservation

Prognostic factors for adnexal metastasis in endometrial cancer and its implication for ovarian preservation

Tumor Diameter for Prediction of Recurrence, Disease Free and Overall Survival in Endometrial Cancer Cases.

To analyse the predictors of recurrence, disease free survival and overall survival in cases with endometrial cancer. A total of 152 women diagnosed with endometrial cancer were screened using a prospectively collected database including age, smoking history, menopausal status, body mass index, CA125, systemic disorders, tumor histology, tumor grade, lymphovascular space invasion, tumor diameter, cervical involvement, myometrial invasion, adnexal metastases, positive cytology, serosal involvement, other pelvic metastases, type of surgery, fertility sparing approach to assess their ability to predict recurrence, disease free survival and overall survival. In ROC analyses tumor diameter was a significant predictor of recurrence (AUC:0.771, P<0.001). The optimal cut off value was 3.75 with 82% sensitivity and 63% specificity. In correlation analyses tumor grade (r=0.267, p=0.001), tumor diameter (r=0.297, p<0.001) and the serosal involvement (r=0.464, p<0.001) were found to significantly correlate with the recurrence. In Cox regression analyses when some different combinations of variables included in the model which are found to be significantly associated with the presence of recurrence, tumor diameter was found to be a significant confounder for disease free survival (OR=1.2(95 CI,1.016-1.394, P=0.031). On Cox regression for overall survival only serosal involvement was found to be a significant predictor (OR=20.8 (95 % CI 2.4-179.2, P=0.006). In univariate analysis of tumor diameter > 3.75 cm and the recurrence, there was 14 (21.9 %) cases with recurrence in group with high tumor diameter where as only 3 (3.4 %) cases group with smaller tumor size (Odds ratio:7.9 (95 %CI 2.2-28.9, p<0.001). Although most of the significantly correlated variables are part of the FIGO staging, tumor diameter was also found to be predictor for recurrence with higher values than generally accepted.

Cancer of the corpus uteri.

Cancer of the corpus uteri.

Microscopic Omental Metastasis in Clinical Stage I Endometrial Cancer: A Meta-analysis.

A patient with early-stage endometrial cancer may possibly have microscopic metastasis in the omentum, which is associated with a poor prognosis. The purpose of this study was to identify risk factors for microscopic omental metastasis in patients with clinical stage I endometrial cancer to establish the indications for selective omentectomy. We searched the PubMed, EMBASE, and Cochrane Library databases for published studies from inception to August 2014, using terms such as 'endometrial cancer' or 'uterine cancer' for disease, 'omentectomy' or 'omental biopsy' for intervention, and 'metastasis' for outcome. Two reviewers independently identified the studies that matched the selection criteria. We calculated the pooled risk ratios (RRs) with 95 % confidence intervals (CI) of each surgicopathologic finding for microscopic omental metastases in clinical stage I endometrial cancer. We also calculated the prevalence of microscopic omental metastases. Among 1163 patients from ten studies, 22 cases (1.9 %) of microscopic omental metastases were found, which accounted for 26.5 % of all omental metastases. Positive lymph nodes (RR 8.71, 95 % CI 1.38-54.95), adnexal metastases (RR 16.76, 95 % CI 2.60-107.97), and appendiceal implants (RR 161.67, 95 % CI 5.16-5061.03) were highly associated with microscopic omental metastases. Microscopic omental metastases were not negligible in patients with clinical stage I endometrial cancer. Those with a risk factor of microscopic omental metastases were recommended for selective omentectomy.

Determinants of pelvic and para-aortic lymph node metastasis in endometrial cancer and its role in tailoring lymphadenectomy

Objectives: Complete lymphadenectomy may be omitted in selected cases in which the risk of lymph node spread is low (low-risk cancer). In this study, we aimed to study the various clinicopathologic variables affecting lymph node metastasis, to evaluate the incidence and distribution of pelvic lymph nodes (PLN) and paraaortic lymph node (PALN) metastases in endometrial cancer, and to study intraoperative and postoperative complications of pelvic and para-aortic lymphadenectomy. Methods: Our study included 78 patients with endometrial cancer between June 2005 and May 2011. The surgical procedure involved peritoneal cytology, total or radical hysterectomy, and bilateral salpingooophorectomywith pelvic and para-aortic lymphadenectomy. Statistical analysiswas performed using Fisher's exact probability test, and P b 0.05 was considered statistically significant. Results: Positive LN metastasis was diagnosed in 41% of patients: 23% with PLN and PALN metastasis, 10.3% with PLN metastasis only, and 7.7% with PALN metastasis only. The most commonly involved PLN groups were internal iliac and obturator LNs (67.9% and 61.5%). In the aortic area, the most commonly involved group (66.6%) was the preaortic LNs (supraand inframesentric). PLN and PALN metastasis in stages III and IV was significantly higher than in stages I and II. Myometrial invasion, cervical invasion, adnexal metastasis, and lymphovascular invasion were significantly correlated with PLN metastasis, while myometrial invasion, adnexal metastasis, and lymphovascular invasion were significantly correlated with PALN metastasis. Postoperative complications were observed in 50 patients (64.1%). The most common complication was pelvic lymphocysts in 46.1%. Ileus and deep venous thrombosis were seen in 7.6%. None of the complications resulted in death. Conclusions: Our findings suggest that systemic lymphadenectomy can be omitted in endometrial carcinoma patients who have favorable clinicopathological determinants (stage I, endometroid type, myometrial invasion b50%, and absence of lymphovascular invasion) because of low risk for LN metastasis and to avoid perioperative complications. However, these results should be confirmed in prospective large-scale, randomized clinical trials.

Treatment failure in endometrial cancer.

e16537 Background: To evaluate the clinical features and the outcomes of endometrial cancer with treatment failure after primary definitive surgery. Methods: A total of 89 patients who received primary definitive surgery between 2000 and 2010 with treatment failure were retrospectively reviewed. The correlation of clinicopathological features, primary treatment, failure pattern, and salvage treatment with outcomes were analyzed. Results: Twenty of the 89 patients with persistent or progressive diseases died at a median of 7.6 months (range, 1.9-14.0 months). The remaining 69 patients with initial disease controlled but subsequent relapse had a median time to recurrence of 13.9 months (range, 3.2 – 97.1). Assessable failure patterns included vaginal only in 14.5%, pelvic in 2.9%, distant in 59.4%, distant and loco-regional in 23.2%. The median survival after recurrence (SAR) was 25.5 months (range 1.5-121.7 months). The 5-year SAR rate was 52.7%. By univariate analysis, FIGO stage, grade of differentiation, histologic cell type, cervical invasion, adnexal metastasis, and status of lymph node metastasis when initial diagnosis, and bone or/and lung metastasis, radiotherapy after recurrence, and CA-125 ≥ 35 U/mL at recurrence were significant factors of 5-year survival after recurrence. By multivariate analysis, high-grade cancer (HR 3.05, 1.17-8.01; p = 0.023), bone and/or lung metastasis at recurrence (HR2.81, 1.15-6.85; p = 0.023), and CA-125 ≥ 35 U/mL (HR 2.85, 1.18-6.87; p = 0.013) were significantly poor prognostic factors for SAR. Six patients achieved long-term survival with more than one recurrence after aggressive multimodal salvage therapy along with deliberate restaging and post-therapy surveillance. Conclusions: High-grade, bone and/or lung metastasis and CA-125 ≥ 35 U/mL at recurrence were significantly poor prognostic factors for SAR. After intensive treatment, patients with recurrent endometrial cancer may have long-term survival.

Role of ultrasonography and contrast-enhanced ultrasonography in a case of Krukenberg tumor

We report a case of Krukenberg tumor of gastric origin with adnexal metastasis, in which ultrasonography (US) and contrast-enhanced US (CEUS) played a key diagnostic role. An 64-year-old female patient was referred to our department for abdominal pain, nausea and ascites. US examination was performed as first line diagnostic imaging approach, confirming the presence of ascites and detecting marked thickness of the gastric wall and a right adnexal mass. CEUS was immediately performed and showed arterial enhancement followed by wash-out in the venous phase of both the gastric wall and the adnexal mass, suggesting the diagnosis of gastric cancer with right adnexal metastasis (Krukenberg syndrome). The patient underwent US-guided paracentesis and esophagogastroduodenoscopy that showed linitis plastica. Cytologic examination of the peritoneal fluid revealed the presence of signet-ring cells, and histologic examination of the specimen obtained by endoscopic biopsy showed primary gastric mucus-producing adenocarcinoma with signet-ring cells. Although transvaginal US is undoubtedly the method of choice to evaluate ovarian tumors, abdominal US and CEUS can provide key diagnostic elements, supporting clinicians in the first steps of the diagnostic work-up of abdominal and pelvic masses.

Incidence of adnexal metastasis requiring surgical intervention in women with advanced cervical cancer

Incidence of adnexal metastasis requiring surgical intervention in women with advanced cervical cancer

An Iranian male with syringoid eccrine carcinoma misdiagnosed as basal cell carcinoma: a case report

Syringoid carcinoma (syringoid eccrine carcinoma, or eccrine epithelioma) is a rare cutaneous tumor with some controversy regarding its correct definition. This tumor shows a slow growth and has often been for many years, some decades before diagnosis. It may also be difficult to differentiate from its benign counterpart (syringoma) or other adnexal carcinoma and cutaneous metastasis. There have been limited case reports of syringoid carcinoma in foreign literatures but none from Iran. Here we report a case of syringoid carcinoma in a 52 year-old Iranian man. Syringoid eccrine carcinoma is a very rare and uncommon diagnosed tumor thought to be derived from eccrine sweat apparatus. It locally invasive, destructive and often shows recurrence. It may also be difficult to differentiate from metastatic adenocarcinoma.

Correlation Between Preoperative Serum CA 125 and Surgicopathologic Prognostic Factors in Endometrial Cancer

Objective: This prospective study was conducted to determine the correlation between preoperative serum CA 125 and the presence of surgicopathologic prognostic factors in endometrial cancer. It also aimed to determine the CA 125 value which best predicted the prognostic factors to which it was significantly correlated. Methods: Patients with endometrioid endometrial cancer eligible for primary surgery were included. CA 125 determination using a chemiluminescent enzyme immunoassay (CLEIA) was done before surgery. Patients underwent laparotomy, peritoneal fluid cytology, extrafascial/radical hysterectomy, bilateral salpingooophorectomy, bilateral pelvic lymph node dissection and para-aortic lymph node sampling. Specimens were examined for tumor differentiation, lymphovascular space invasion, myometrial invasion, cervical, adnexal and vaginal involvement, pelvic and para-aortic lymph node metastases and for the presence of tumor cells in the peritoneal fluid. Correlation between CA 125 and the prognostic factors was analyzed using Pearson r correlation test. A receiver operating characteristic curve (ROC) was constructed to determine the CA 125 cutoff value. Results: Ninety patients were included in the analysis. Preoperative serum CA 125 was significantly correlated with deep myometrial invasion (σ = 0.24, p = 0.02), adnexal metastasis (σ = 0.26, p = 0.01) and pelvic (σ = 0.31, p < 0.01) and para-aortic lymph node involvement (σ = 0.43, p < 0.01). It was also significantly correlated with the presence of extrauterine disease (σ = 0.26, p = 0.01). A value of 55 U/mL can predict extrauterine spread with sensitivity of 53.85%, specificity of 84.38% and accuracy of 75.56%. Using this cutoff, the odds of a positive test is 3.44 and the odd of a negative test is 0.54. Conclusion: Preoperative serum CA 125 has a statistically significant correlation with deep myometrial invasion, adnexal metastasis, pelvic and para-aortic lymph node involvement and extrauterine disease, at a cutoff value of 55 U/mL. CA 125 determination should be routinely performed as part of the preoperative work-up for patients with endometrioid endometrial cancer.

Creating a risk model to determine paraaortic lymph node involvement in endometrial carcinoma

To define a high-risk group for paraaortic (PA) lymph node metastasis among endometrial carcinoma patients. Materials and methods: Prognostic factors determining PA lymph node metastasis were defined. Using these factors in different combinations, 14 risk groups were formed. A patient with at least one of these factors was considered as high-risk for PA lymph node metastasis. Results: This study included 152 patients. Of these patients, 18 had tumors in the PA region. Lymphovascular space invasion (LVSI) and pelvic lymph node metastasis were independent prognostic factors for PA lymph node involvement. In the risk modeling system, pelvic lymph node metastasis was an important factor in predicting PA lymph node status, and in groups where this factor was included for risk modeling, PA lymph node involvement was significantly increased in high-risk patients. Best results were obtained with the risk group model (group 10) involving cell type, LVSI, serosal spread, adnexal metastasis, and pelvic lymph node as prognostic factors. In this group sensitivity was 94%, specificity was 53.7%, and negative and positive predictive values were 98.6% and 21.5%, respectively. According to this model, 52% of all patients were in the high-risk group. Conclusion: Group 10 seemed to include the guiding properties for a decision on paraaortic lymphadenectomy and it was possible to reduce unnecessary paraaortic lymphadenectomies by 50%.

Tumor volume and lymphovascular space invasion as a prognostic factor in early invasive adenocarcinoma of the cervix

ObjectiveThe aim of this study was to investigate the risk and recurrence of early invasive adenocarcinoma of the cervix, and to determine whether non-radical methods of management could be performed.MethodsThe medical and histopathological records of 50 patients with early invasive adenocarcinoma of the cervix treated at Keio University Hospital between 1993 and 2005 were reviewed, and compared with the literature.ResultsThe median follow-up period was 64.3 months. The depth of stromal invasion was ≤3 mm in 33 cases and >3 mm, but ≤5 mm in 17 cases. The horizontal spread was ≤7 mm in 25 cases and >7 mm in 25 cases. One of the 33 cases that had tumor volumes of ≤500 mm3, and three of the 17 cases with tumor volumes of >500 mm3 were positive for lymph node metastasis. When our data were combined with previously reported results, statistically significant differences were observed between the tumor volume and the frequency of pelvic lymph node metastasis/the rate of recurrence (p<0.0001). The frequency of pelvic lymph node metastases was significantly higher in the lymphovascular space invasion (LVSI)-positive group than in the LVSI-negative group (p=0.02). No adnexal metastasis or parametrial involvement was noted.ConclusionAssessment of the depth of stromal invasion, tumor volume, and LVSI is critical for selecting an appropriate therapeutic modality. Non-radical methods of management are considered suitable for patients with LVSI-negative adenocarcinoma of the cervix exhibiting a stromal invasion depth of ≤5 mm and a tumor volume of ≤500 mm3.

Immunohistochemical detection of a specific receptor for lipocalin2 (solute carrier family 22 member 17, SLC22A17) and its prognostic significance in endometrial carcinoma

Background We previously reported the overexpression of lipocalin2 (LCN2), a 25 kDa secretory protein involved in iron-transportation, in endometrial carcinoma and its possible contribution to endometrial carcinogenesis. Recently, a specific receptor for LCN2, solute carrier family 22 member 17 (SLC22A17), was identified. The present study was undertaken to investigate the expression of SLC22A17 in endometrial carcinoma. Methods The expression of the SLC22A17 and LCN2 proteins was examined immunohistochemically using 69 cases of endometrial carcinoma and adjacent normal endometrial tissues. Immunoreactivity was evaluated according to the percentage of positive cells and described as a positivity index (PI, full score 100). Results The expression of SLC22A17 was negligible in normal endometria, but positive staining for SLC22A17 (PI ≧ 1) was observed in 35 cases of endometrial carcinoma. The PI for SLC22A17 was significantly higher in cases with histological grade 3 ( P < 0.0005), advanced FIGO stage ( P = 0.002), deep myometrial invasion ( P = 0.029), positive lymph-vascular space invasion ( P = 0.029), positive intraperitoneal cytology ( P = 0.020) and adnexal metastasis ( P = 0.029). The expression of SLC22A17 and LCN2 was positively correlated with a significant difference ( P = 0.002), and the patients who overexpressed both SLC22A17 and LCN2 showed poorer survival than those without the expression of SLC22A17 or LCN2 ( P = 0.002). Moreover, the overexpression of both SLC22A17 and LCN2 was indicated to be an independent prognostic factor by multivariable analysis. Conclusions These results suggested that SLC22A17, in cooperation with LCN2, to be involved in the acquisition of aggressive behavior among endometrial carcinoma cells.

Is it possible to predict para-aortic lymph node metastasis in endometrial cancer?

Objective The purpose of this study was to determine the histopathologic risk factors for pelvic lymph node (PLN) and para-aortic lymph node (PALN) metastasis in endometrial cancer (EC) and to identify in which patients PALN dissection should be performed. Study design A total of 204 consecutive patients, with EC and underwent systematic pelvic and para-aortic lymphadenectomy extending to the renal vessels, were studied retrospectively. Statistical significance between risk factors was examined using multivariant logistic regression analysis. Results Cell type, depth of myometrial invasion and tumor size were found to be independently related to PLN metastasis. PLN metastasis in any site and lymphovascular invasion (LVSI) were independent prognostic factors for predicting PALN metastasis. The sensitivity, specificity and the NPV of PLN metastasis for detecting PALN metastasis were 80.8%, 89.3% and 97%, respectively. Furthermore, the 204 patients were divided into two groups according to the presence of one of these following factors: (1) non-endometrioid cell type, (2) PLN metastasis, (3) LVSI, (4) adnexal metastasis and (5) serosal involvement. Among these 204 patients, 104 had one or more of these factors (group A), and 100 patients had none of these factors (group B). PALN metastasis was significantly greater in group A, compared to group B. The sensitivity and the NPV of these combined prognostic factors for predicting PALN metastasis were 96.2% and 99%, respectively. Conclusions Presence of non-endometrioid cell type, PLN metastasis, LVSI, adnexal metastasis or serosal involvement diagnosed by frozen section (FS) seem to be poor prognostic factor for PALN metastasis in EC. Also, PALN dissection should be extended to the level of the renal vessels in all patients who will undergo PALN dissection, due to frequent involvement of the supramesenterial region.

Incidence of lymph node and adnexal metastasis in endometrial stromal sarcoma

ObjectiveTo determine the incidence of adnexal and lymph node (LN) metastasis in newly diagnosed endometrial stromal sarcoma (ESS). MethodsWe identified all cases with a diagnosis of ESS evaluated at our institution from January 1, 1980 to October 31, 2009. All uterine pathology was reviewed at our center. High-grade or undifferentiated tumors and ESS arising in extrauterine sites were excluded. Pertinent clinical data were abstracted from electronic medical records. Appropriate statistical tests were performed using SPSS16.0. ResultsWe identified 94 cases of ESS. LN metastasis was identified in 7 (19%) of 36 patients who underwent LN evaluation. Six of the 7 cases with LN metastasis had lymphovascular invasion (LVI). LVI status was not reported in the other case. Five of the 7 patients with LN metastasis had grossly positive LNs with or without other gross extrauterine disease. Of 20 patients with disease grossly limited to the uterus and grossly normal LNs, 2 (10%) had LN metastasis. Both of these cases had LVI and extensive myoinvasion. Eighty-seven cases (93%) underwent salpingo-oophorectomy. Adnexal metastasis was identified in 11 (13%) of 87 cases, all manifested by gross adnexal tumor and occurring in patients with other gross pelvic extrauterine disease. ConclusionThe incidence of LN metastasis in ESS is commonly associated with gross extrauterine disease, extensive myoinvasion, and LVI. Since myoinvasion and LVI status often are not assessable at the time of hysterectomy, LN dissection remains a reasonable option at primary surgery. The rate of adnexal metastasis appears to be negligible in the absence of gross adnexal and extrauterine tumor.

Long-Term Survival in Patients With Para-Aortic Lymph Node Metastasis With Systematic Retroperitoneal Lymphadenectomy Followed by Adjuvant Chemotherapy in Endometrial Carcinoma

The purposes of this study were to assess modified radical hysterectomy including systematic pelvic and para-aortic lymphadenectomy followed by adjuvant chemotherapy in patients with para-aortic lymph node (PAN) metastasis in endometrial carcinoma and to identify the multivariate independent prognostic factors for long-term survival during the past 10 years. Between December 1987 and December 2002, we performed modified radical hysterectomy with bilateral salpingo-oophorectomy including systematic pelvic and para-aortic lymphadenectomy and peritoneal cytology in 284 endometrial carcinoma patients according to the classification of the International Federation of Gynecology and Obstetrics (stage IA, n = 66; stage IB, n = 96; stage IC, n = 33; stage IIA, n = 5; stage IIB, n = 20; stage IIIA, n = 28; stage IIIC, n = 28; and stage IV, n = 8) who gave informed consents at our institute. Patients with tumor confined to the uterus (stages IC and II) were treated by 3 courses of cyclophosphamide 750 mg/m2, epirubicin 50 mg/m2, and cisplatin 75 mg/m2 regimen 3 to 4 weeks apart, and patients with extrauterine lesions involving adnexa and/or pelvic lymph node (PLN) were treated by 5 courses. In addition, 10 courses were given to patients with PAN metastasis. Patients with PLN metastasis received adjuvant chemotherapy, and adjuvant radiation was not part of our institutional protocol. For multivariate regression modeling with proportional hazards, the regression model of Cox was used. Survival curves were analyzed by the Kaplan-Meier method, and analysis of the differences was performed by the log-rank test. The overall incidence of retroperitoneal lymph node metastasis assessed by systematic pelvic and para-aortic lymphadenectomy was 12.0% (34/284) in stages I to IV endometrial carcinoma, and incidences of PLN and PAN metastases were 9.2% (26/284) and 7.4% (21/284), respectively. However, PAN metastasis rate is 50% (13/26) in patients with PLN metastasis. Univariate analysis of prognostic factors revealed that International Federation of Gynecology and Obstetrics clinical stage (P < 0.0001), histological finding (P = 0.0292), myometrial invasion (P < 0.0001), adnexal metastasis (P < 0.0001), lymphovascular space invasion (P < 0.0001), tumor diameter (P = 0.0108), peritoneal cytology (P = 0.0001), and retroperitoneal lymph node metastasis (P < 0.0001) were significantly associated with 10-year overall survival. Survival was not associated with age (P = 0.1558) or cervical involvement (P = 0.1828). A multivariate analysis showed that adnexal metastasis (P = 0.0418) and lymphovascular space invasion (P = 0.0214) were significantly associated with 10-year overall survival. The 5- and 10-year overall survival rates in patients with negative PAN were 96% and 93% versus 72% and 62% in patients with positive PAN (P = 0.006). It is suggested that surgery with systematic pelvic and para-aortic lymphadenectomy followed by adjuvant chemotherapy could improve long-term survival in patients with PAN metastasis, although there are only 21 patients with PAN metastasis.

The use of MRI for selecting patients with endometrial cancer and significant co-morbidities for vaginal hysterectomy

The objective of this study is to ascertain the presence of extrauterine spread in radiologically early stage and grade endometrial cancer. This could be the basis for offering vaginal hysterectomy without salpingo-oophorectomy as an alternative option to primary radical radiotherapy in women with significant medical co-morbidities in whom laparotomy will be contraindicated. A retrospective cohort study assessing patients with clinically early stage endometrioid adenocarcinoma of the endometrium, treated at the Gynaecological Oncology Centre, Norfolk and Norwich University Hospital and James Paget University Hospital between January 2003 and July 2008. The cancer registry was reviewed, and 542 endometrial cancer cases were identified during the study period, of these 439 were endometrioid type. MR is the standard staging investigation unless there are contraindications. Demographic, clinic-pathologic and surveillance data were collected from hospital records, operative notes and histopathology reports. The histology included tumour type, stage and grade. Post-operative histopathological findings served as a reference standard. Sensitivity and specificity of pre-operative MRI scan were assessed. Of the 439 cases treated during the study periods, 415 patients had an MRI pre-operatively imaging and 14% of these cases showed signs of extrauterine spread. MRI staging was then compared with the histopathology staging; the latter was taken as the gold standard. In 8% of the cases where no spread was seen on MRI, the disease was actually spread outside uterine corpus mainly to the cervix and pelvic lymph nodes. The sensitivity, specificity, positive predictive value and negative predictive value for MRI were 56, 93, 60, and 92, respectively, while predicting early stage disease. There were three cases of adnexal metastases, where the tumour had already spread to uterine serosa. Two cases had poorly differentiated and one had moderately differentiated tumour. The risk of adnexal metastasis is less than 1% in clinically early stage disease and highly unlikely if MRI suggests that the disease is confined to the inner half of the myometrium and low-grade disease. MRI has a high specificity and negative predictive value in endometrial cancer staging with reduced sensitivity of detecting cervical, adnexal and lymphatic spread. We suggest that vaginal hysterectomy might be a safe alternative to laparotomy in the treatment of radiological early stage disease in medically compromised elderly patients. The possibility of converting a vaginal approach to an abdominal route should be always taken into consideration.

Systemic Lymphadenectomy Cannot Be Recommended for Low‐Risk Corpus Cancer

Objective. The objective of this study is to ascertain whether omission of lymphadenectomy could be possible when uterine corpus cancer is considered low-risk based on intraoperative pathologic indicators. Patient and Methods. Between 1998 and 2007, a total of 83 patients with low risk corpus cancer (endometrioid type, grade 1 or 2, myometrial invasion ≦50%, and no intraoperative evidence of macroscopic extrauterine spread, including pelvic and paraaortic lymph node swelling and adnexal metastasis) underwent the total abdominal hysterectomy and bilateral salpingo-oophorectomy without lymphadenectomy. A retrospective review of the medical records was performed, and the disease-free survival (DFS), overall survival (OS), peri- and postoperative morbidities and complications were evaluated. Results. The 5-year DFS rates and the 5-year OS rates were 97.6% and 98.8%, respectively. No patient presented postoperative leg lymphedema and deep venous thrombosis. Conclusion. Omission of lymphadenectomy did not worsen the DFS or OS. The present findings suggest that systemic lymphadenectomy could be omitted in low-risk endometrial carcinoma.

Stage IIIA Endometrial Carcinoma

To examine predictors of survival for stage IIIA endometrial cancer and to compare the outcome of stage IIIA neoplasms to that of endometrial tumors confined to the uterus. : Women with stage IIIA endometrioid adenocarcinomas of the uterus treated between 1998 and 2004 were examined. Patients were stratified into two groups: positive cytology only (IIIA1) or ovarian or pelvic metastases (IIIA2). The clinical characteristics and outcome of stage IIIA1 and IIIA2 patients were compared. To further examine patients with positive cytology alone, women with IIIA1 tumors were compared with women with stage IB and IC tumors. Survival was examined using Cox proportional hazards models and the Kaplan-Meier method. : A total of 1,257 women, including 485 (39%) with IIIA1 and 772 (61%) with IIIA2 lesions, were identified. In a proportional hazards model incorporating known prognostic variables, there was no difference in survival (hazard ratio 1.06, 95% confidence interval [CI] 0.85-1.32) between IIIA1 and IIIA2 tumors. Five-year survival was 67% (95% CI 61-72%) for IIIA1 and 55% (95% CI 53-58%) for IIIA2 cancers. The results were unchanged when only women who underwent staging lymphadenectomy were included. Mortality was higher for IIIA1 tumors than stage IB and IC cancers. At 5 years, 90% (95% CI 89-90%) of patients with IB and 77% (95% CI 75-79%) with stage IC tumors were alive compared with 67% (95% CI 61-72%) of women with IIIA1 neoplasms. : Patients with stage IIIA1 tumors seem to have an outcome that is similar to that of women with serosal or adnexal metastases. The outcome of stage IIIA1 endometrial cancer is inferior to that of tumors confined to the corpus (stage IB and IC). : II.