Degree Of Myometrial Invasion Research Articles

The value of dynamic contrast-enhanced MRI and diffusion-weighted sequence in the evaluation of endometrial lesions

Background/Aim: Endometrial abnormalities represent a diagnostic challenge due to overlapping imaging features with normal endometrium. Aim of this study was to assess accuracy of dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging (MRI) in evaluation of endometrial lesions in comparison with T2 and to assess local staging validity and degree of myometrial invasion in malignancy. Methods: Forty patients with abnormal vaginal bleeding or sonographic thickened endometrial were recruited. MRI examination of pelvis was per-formed using 1.5 T scanner with a pelvic array coil. Conventional T1-and T2, dynamic contrast-enhanced (DCE) sequences and diffusion-weighted image (DWI) were performed. Results: Mean age of patients was 53.2 years and 60 % of patients COM-plained of post-menopausal bleeding. Irregular margin, type III enhancement curve, a high signal in T2WI and DWI and low signal of apparent diffusion coefficient (ADC) were significantly associated with malignancy. The optimum ADC threshold value for distinguishing benign from malignant endometrial lesions was 0.905 × 10 -3 mm 2 /S, with 95.5 % sensitivity and 92.9 % specificity. DWI was most sensitive to malignant endometrial lesions, followed by DCE (89.6 %, 98.4 %) and T2 (86.7 %, 91.4 %). DWI and DCE staging correlated with FIGO staging (p = 0.0001 and p = 0.019, respectively). DWI had the best sensitivity for myometrial invasion (95.6 %), followed by DCE (91.9 %) and T2WI (90.1 %). All three sequences had 89.7 % specificity. Conclusion: DWI and DCE MRI were superior to conventional MRI at distinguishing malignant from benign endometrial lesions and can improve myometrial invasion depth evaluation and therapy planning when COM-bined with morphological T2WI. ADC cutoff at a high b value improved MRI diagnostic sensitivity and specificity.

Clinical value of hemoglobin, albumin, lymphocyte, and platelet indexes in predicting lymph node metastasis and recurrence of endometrial cancer: a retrospective study.

To study the clinical importance of hemoglobin, albumin, lymphocyte, and platelet (HALP) indexes in predicting lymph node metastasis and recurrence of endometrial cancer. From July 2016 to July 2020, 158 patients suffering from endometrial cancer who visited the gynecology department of General Hospital of Ningxia Medical University from were collected. Employing the X-Tiles program, the ideal HALP cut-off value was established, and the patients were separated into low and high HALP groups. Univariate and multivariate analysis were used to determine the relationship between HALP score and lymph node metastasis and recurrence of endometrial cancer. The optimal cut-off value of HALP score was established to be 22.2 using X-Tiles software, and the patients were separated into high HALP group (HALP score > 22.2, with 43 cases) and low HALP group (HALP score ≤ 22.2, 115 cases). Endometrial cancer patients' HALP scores were strongly connected with differentiation, the degree of myometrial invasion, and lymph node metastasis (P < 0.05), although not with age, menopausal status, or stage (P > 0.05). Multivariate logistic regression analysis revealed that the HALP score (OR = 2.087) was the influencing factor for lymph node metastasis (P < 0.05). The ROC curve suggested that the AUC of HALP score in predicting lymph node metastasis was 0.871, which had high diagnostic value. When compared to patients without recurrence, HALP scores of patients with recurrence were considerably lower (P < 0.05). Multivariate logistic regression analysis showed that HALP score (OR = 2.216) was the influencing factor for the occurrence of lymph node metastasis (P < 0.05). The ROC curve suggested that the AUC of HALP score in predicting relapse was 0.855, with high diagnostic value. The HALP score shows good predictive performance in predicting lymph node metastasis and recurrence of endometrial cancer, and has high clinical value, which helps in improving the accuracy and effectiveness of clinical diagnosis and prognosis research.

Erken Evre Grade 1 ve 2 Endometrioid Tip Endometrium Kanseri Tanılı Olgularda Uzun Dönem Sonuçları

Aims: Early-stage endometrioid-type endometrial cancer (EC) has a favorable prognosis. The recurrence is still the biggest issue. There are differences in the literature in terms of treatment modalities in early-stage. We investigated long-term survival outcomes of early-stage grade 1 and 2 endometrioid-type EC patients. Methods: Out of 327 cases, 294 cases in stage 1 and 33 cases in stage 2 were evaluated. Age, stage, tumor size, histologic grade, degree of myometrial invasion, presence of lymphovascular invasion (LVSI), peritoneal cytology positive, presence of recurrence, overall survival (OS), and disease-free survival (DFS) between two groups were evaluated statistically. Results: The mean age of 327 patients was 64.0±10.0 years. Out of 327, 65.7% were ≥60 years, 90% were stage 1, 74.6% were grade 1, 1.8% had positive peritoneal cytology, 8.3% had LVSI and 86% had ≤50% myometrial invasion. Recurrence was detected in 6.4% of patients. 40.7% of patients received adjuvant radiotherapy. Only the adjuvant radiotherapy was found a significant association between two groups. Only presence of recurrence in terms of OS and DFS durations was a significant parameter in the regression analysis. Conclusions: Development of recurrence in early-stage endometrioid-type EC is the main prognostic predictor for survival. The early diagnosis and treatment of recurrence have a positive impact on the prognosis.

Clinical and pathological factors affecting the accuracy of estimating myometrial invasion on magnetic resonance imaging in early-stage endometrial cancer

<h3>Objectives:</h3> To determine the accuracy of MRI at estimating myometrial invasion (MI) and the clinical and pathological factors that may affect this accuracy in patients with early stage endometrial cancer undergoing hysterectomy. <h3>Methods:</h3> This IRB approved, retrospective study included all patients who had an MRI within 90 days preceding hysterectomy for endometrial cancer from January 2013 through December 2019 across 3 Mount Sinai-affiliated hospitals. Charts were reviewed for clinical characteristics including BMI, menopausal status, abnormal uterine bleeding, and prior pelvic surgery. MRIs were re-reviewed by 3 radiologists blinded to original interpretations. The radiologists recorded degree of myometrial invasion (MI; <50%, or ≥50%) and presence of benign pathology findings such as fibroids, endometriosis and adenomyosis. The degree of MI from MRI was collapsed to one value representing a combination of the 3 radiologist readers. This reading was compared to the degree of MI from the final pathology specimen to calculate accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of MRI evaluation. The association between patient characteristics and MRI accuracy was assessed by using the Chi-square or Fisher's exact test for categorical characteristics and the Mann-Whitney test for continuous characteristics. <h3>Results:</h3> A total of 53 patients were included; charts and MRIs were reviewed. Median patient age was 61 (range 29-86); median BMI, 29.9 (range 17.6-65.1) kg/m². On final pathology specimen, 29 patients had FIGO stage 1A (53.7%) and 10 patients with FIGO stage 1B (18.5%). The median depth of MI on pathology was 0.5cm (range 0-10cm). Degree of MI was dichotomized into ≥50% vs <50% with MI on final pathology as the gold standard. The accuracy of MRI in evaluating MI across the 3 radiologists ranged from 70-80%; sensitivity of 65-80%; specificity of 65-82%; PPV 57-70%; and NPV of 79-87%. Twenty-nine patients on final pathology were classified as stage 1A and 10 patients were classified as stage 1B. For stage 1A on final pathology, MI was accurately estimated on MRI for 23/28 (82.1%) and overestimated for 5/28 (17.9%). For stage 1B on final pathology, MI was accurately estimated on MRI for 7/10 patients (70.0%) and underestimated for 3/10 (30.0%). Patient characteristics such as BMI, prior pelvic surgery, menopausal status, and presence of abnormal bleeding did not have a statistically significant effect on the accuracy or MI estimation on MRI (p≥0.13). Benign MRI findings including fibroids, adenomyosis, and endometriosis were not found to affect accuracy of MI invasion. <h3>Conclusions:</h3> Pelvic MRI is the best radiologic modality available that is currently utilized in assessment of the depth of myometrial invasion in patients with endometrial cancer. Accurate prediction of presence or absence of invasion has significant implication on clinical management particularly in patients with early stage endometrial cancer desiring fertility preservation. In our study, presence of myometrial invasion was underestimated in 30% of patients. Patients have to be appropriately counseled with regards to MRI accuracy in predicting invasion. Neither patients' clinical characteristics nor presence of other pathological findings on MRI were found to impact the accuracy of MRI estimation of MI.

Correlation between Depth of Myometrial Invasion and Degree of Lymph Node Affection in Cases of Endometrial Cancer

Introduction: Endometrial cancer is the fourth most frequent cancer in females. Many factors can affect prognosis of this type of cancer, these mainly are the degree of myometrial invasion by the tumour, pelvic and paraaortic lymph node spread as well as the tumour histological type (endometrioid vs non-endometrioid type). transvaginal ultrasound (TVS) is a highly accurate and easy method for preoperative evaluation of myometrial invasion. Aim of the Work: The aim of this work is to assess if there is relation between the depth of myometrial invasion by the tumor and the rate of lymph node involvement in cases of endometrial cancer. Results: It was found that there was a significant relation between lymph node affection and the depth of myometrial invasion, all the positive lymph node affections cases had myomterial invasion > 50.0%. Conclusion: The incidence of pelvic lymph node affection is very high in cases where the myometrium is deeply infiltrated with the tumor. Assessment of myometrial invasion preoperatively by TVU and microscopically by pathological examination of the myometrium after hysterectomy provides an accurate estimation of the rate of pelvic lymph node affection and hence necessitates lymphadenectomy procedures in cases where myometrium is deeply infiltrated by the tumor and omitted in cases where it is tumor free.

PET Parameters are Useful in Predicting Endometrial Cancer Risk Classes and Prognosis.

We investigate the role of preoperative PET parameters to determine risk classes and prognosis of endometrial cancer (EC). We enrolled 81 patients with EC who underwent preoperative F-18 FDG PET/CT. PET parameters (SUVmax, SUVmean, MTV, TLG), grade, histology and size of the primary tumor, stage of the disease, the degree of myometrial invasion (MI), and the presence of lymphovascular invasion (LVI), cervical invasion (CI), distant metastasis (DM) and lymph node metastasis (LNM) were recorded. The relationship between PET parameters, clinicopathological risk factors and overall survival (OS) was evaluated. The present study included 81 patients with EC (mean age 60). Of the total sample, 21 patients were considered low risk (endometrioid histology, stage 1A, grade 1 or 2, tumor diameter < 4 cm, and LVI negative) and 60 were deemed high risk. All of the PET parameters were higher in the presence of a high-risk state, greater tumor size, deep MI, LVI and stage 1B-4B. MTV and TLG values were higher in the patients with non-endometrioid histology, CI, grade 3 and LNM. The optimum cut-off levels for differentiating between the high and low risk patients were: 11.1 for SUVmax (AUC = 0.757), 6 for SUVmean (AUC = 0.750), 6.6 for MTV(AUC = 0.838) and 56.2 for TLG(AUC = 0.835). MTV and TLG values were found as independent prognostic factors for OS, whereas SUVmax and SUVmean values were not predictive. The PET parameters are useful in noninvasively differentiating between risk groups of EC. Furthermore, volumetric PET parameters can be predictive for OS of EC.

Prognostic role of PET/CT in endometrial cancer.

The present study evaluates the prognostic value of metabolic parameters related to the primary tumor identifiedin preoperative fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) scans inpatients with endometrial cancer (EC). This study included 120 patients with EC who underwent PET/CT in the preoperative period. Thepatients' age, maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV) and the totallesion glycolysis (TLG) value of the primary tumor on PET/CT; as well as the stage, histological subtype, grade and size ofthe primary EC; the degree of myometrial invasion (MI) cervical invasion (CI), lymphovascular invasion (LVI), lymph nodemetastasis (LNM) and distant metastasis (DM) were all recorded. The relationship of these factors with progression-freesurvival (PFS) and overall survival (OS) was evaluated. The study included 120 patients with EC with a mean age of 62.3 ± 0.02 years. Of the total, 32 patients diedaround the time of the analysis and 38 patients showed disease progression. The mean OS was 32.7 ± 1.6 months and themean PFS was 30.5 ± 2.8 months. No significant relationship was identified between the SUVmax, SUVmean, MTV, TLGvalues, patient age, tumor size, histology, grade and MI degree, and OS or PFS. Disease stage, LVI, CI, LNM and DM wereidentified as prognostic factors for OS and PFS. The present study found no significant relationship between preoperative PET parameters in EC and OS andPFS, although prospective studies involving a larger number of patients are required.

Assessment of Myometrial Invasion in Premenopausal Grade 1 Endometrial Carcinoma: Is Magnetic Resonance Imaging a Reliable Tool in Selecting Patients for Fertility-Preserving Therapy?

The aim of this study was to evaluate the diagnostic ability of magnetic resonance imaging (MRI) in premenopausal women with G1 endometrial carcinoma. Twenty-six patients underwent T2W, diffusion weighted, and dynamic contrast-enhanced 3-T MRI. The degree of myometrial invasion was pathologically classified into no invasion, shallow (3 mm or less), and more. Two radiologists assessed myometrial invasion on MRI. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values, AUC, and interobserver agreement were analyzed. For assessing myometrial invasion, mean accuracy, sensitivity, specificity, positive predictive values, negative predictive values, and AUC, respectively, were as follows: 63%, 42%, 85%, 79%, 47%, and 0.75. Mean interobserver agreement was fair (k = 0.36). Shallow invasions were underestimated as no invasion on MRI in all 6 cases. Magnetic resonance imaging produced false-negative result on half of patients. The misjudgments tended to happen in patients with shallow invasion.

ALCAM shedding at the invasive front of the tumor is a marker of myometrial infiltration and promotes invasion in endometrioid endometrial cancer.

Endometrial cancer (EC) is the sixth deadliest cancer in women. The depth of myometrial invasion is one of the most important prognostic factors, being directly associated with tumor recurrence and mortality. In this study, ALCAM, a previously described marker of EC recurrence, was studied by immunohistochemistry at the superficial and the invasive tumor areas from 116 EC patients with different degree of myometrial invasion and related to a set of relevant epithelial and mesenchymal markers. ALCAM expression presented a heterogeneous functionality depending on its localization, it correlated with epithelial markers (E-cadherin/β-catenin) at the superficial area, and with mesenchymal markers at the invasive front (COX-2, SNAIL, ETV5, and MMP-9). At the invasive front, ALCAM-negativity was an independent marker of myometrial invasion. This negativity, together with an increase of soluble ALCAM in uterine aspirates from patients with an invasive EC, and its positive correlation with MMP-9 levels, suggested that ALCAM shedding by MMP-9 occurs at the invasive front. In vivo and in vitro models of invasive EC were generated by ETV5-overexpression. In those, we demonstrated that ALCAM shedding was related to a more invasive pattern and that full-ALCAM recovery reverted most of the ETV5-cells mesenchymal abilities, partially through a p-ERK dependent-manner.

Laparoscopic staging of endometrial cancer: Does it have any impact on survival?

Objective:To assess whether laporoscopic approach to endometrial cancer is associated with survival.Materials and Methods:In total, 158 patients with endometrial cancer underwent staging surgery at a tertiary referral center, 30 of whom underwent laparoscopy, whereas the remainder received treatment with a conventional approach. Survival between groups was analyzed.Results:The comparison of the groups revealed similar disease-free survival (p=0.791). Histology, cervical, adnexal and serosal involvement were found to be significantly correlated with recurrence in the laparoscopically staged group, whereas CA 125, histology, tumor grade, tumor diameter, cervical involvement, degree of myometrial invasion, adnexal and serosal involvement, and pelvic metastasis were significanly correlated with recurrence in the conventionally managed group.Conclusion:Laparoscopic approach to endometrial cancer, along with its widely accepted postoperative advantages, has similar disease-free survival but different variables affect recurrence rates.

Immunohistochemical Analysis of p16 Expression in Uterine Smooth Muscle Tumors

Objective: Immunohistochemistry with p16 antibody is used as a diagnostic marker in several gynecologic pathologies. The purpose of the present study was to evaluate the diagnostic and prognostic significance of p16 immunohistochemistry in various uterine smooth muscle tumors. Methods: Tissue specimens, including 29 leiomyomas, 13 smooth muscle tumors of uncertain malignant potential (STUMP), and 17 leiomyosarcomas, were obtained from 59 patients with uterine smooth muscle tumors. The prevalence of p16 expression in various uterine smooth muscle tumors was examined using immunohistochemistry methods and we investigated the association between p16 expression and various clinicopathologic parameters, including prognosis of leiomyosarcomas. Results: The prevalence of p16 expression of leiomyomas, STUMP, and leiomyosarcomas tumors was 10.3%, 38.4%, and 76.4%, respectively. The prevalence and immunohistochemistry scores of p16 were significantly higher in the leiomyosarcomas group than in the leiomyomas or STUMP tumor groups. In the leiomyosarcomas groups, p16 immunohistochemistry scores were significantly higher in the groups with more advanced stage, higher mitotic activity, and recurrence. The relationship among p16 immunohistochemistry scores and age, tumor size, extent of necrosis, and degree of myometrial invasion was not significant. High expression of p16 in leiomyosarcomas was linked to shorter disease-free and overall survival. Conclusions: The use of p16 immunohisitochemistry is a useful marker in differential diagnosis in various uterine smooth muscle tumors. Moreover, p16 overexpression possibly plays an important role in tumor progression and we demonstrate that p16 may be a predictor of overall survival in patients with leiomyosarcoma tumors.

P02.09: Study for the revised FIGO staging of the endometrial cancer and sonographic appearance

According to the revised FIGO staging for carcinoma of the endometrium in 2009, to investigate the staging and their correlation with sonographic apperrance. 208 cases (including 71 endometrial cancer patients and 137 patients with endometrial hyperplasia) who underwent both ultrasonography, pathological examine and staging were in this study. Preoperative sonography appearance was compared with the pathological findings. (1) The measurements of the uterine cavity thickness (mean 19.13 ± 10.18 mm) by ultrasound in endometrial cancer group were greater than those (mean 13.3 ± 5.8 mm) in endometrial hyperplasia group (P0.01). The measurements of the uterine cavity thickness were superposition, which > 15 mm and > 10 mm were respectively in 54.93% (39/71 cases), 87.32% (62/71 cases) with endometrial cancer and in 32.85% (45/137 cases), 65.69% (90/137 cases) with endometrial hyperplasia. (2) The pathological finding and staging: 63 cases were confirmed to have type1 endometrial cancer and 8 cases with type 2 endometrial cancer, among which there were in 1 stage 77.46% (55), in 2 stage 11 cases (15.71%), in 3 stage 3 cases (4.29%) and in 4 stage 2 cases (2.86%). 66 cases of 71 resected uterus cases showed myometrial invasion (92.95%), deep myometrial invasion in 13 cases (13/71, 18.0%). In 2 stage 11 cases, which showed superficial myometrial invasion in 8 cases and deep myometrial invasion in 3 cases. In 3 stage 3 cases which showed superficial myometrial invasion. In 4 stage 2 cases, the superficial and deep myometrial invasion were respectively 1 case. When the Tumor confined to the corpus uteri, there exists a certain correlation between degree of myometrial invasion and staging. Once the local and/or regional spread of the tumor, the degree of myometrial invasion was not important for staging.

Neuerungen beim FIGO-Staging gynäkologischer Malignome 2009

The aim of FIGO staging is to compare the treatment results of gynecological malignancies worldwide. At the end of 2009, a revised staging system was published by the FIGO staging committee. For cervical cancer, stage II a was subdivided into stage II a1 and II a2, based on the diameter of the tumor (≤ 4 cm versus > 4 cm, respectively). For endometrial cancer, only two substages, I a and I b, were established for stage I disease. Tumors with no invasion or invasion of less than 50 % of the myometrium are classified as stage I a. Only tumors with cervical stromal involvement are classified as stage II disease. Positive peritoneal cytology alone no longer classifies a patient as having stage III disease. Staging for endometrial cancer can also be used for carcinosarcomas (malignant mixed Muellerian tumor, MMMT). For the first time, a separate staging for the other uterine sarcomas has been established. For leiomyosarcoma, the subdivision of stage I in I a and I b depends on the tumor size ( 5 cm, respectively). Cervical involvement alone does not change the classification. For endometrial stromal sarcoma and uterine adenosarcoma, the prognostically relevant degree of myometrial invasion has been included in the classification. Especially with regard to inguinofemoral lymph node involvement in stage III vulvar cancer, a differentiated staging has been established. The size of metastatic lesions as well as their extracapsular growth have to be stated in order to classify tumors adequately (FIGO stages III a-III c). The future will show whether the necessary diagnostic standard can be maintained internationally.

Antenatal diagnosis of non‐previa placenta increta with histological confirmation

Antenatal diagnosis of non‐previa placenta increta with histological confirmation

A Phase III Trial of Surgery With or Without Adjunctive External Pelvic Radiation Therapy in Intermediate-Risk Endometrial Adenocarcinoma: A Gynecologic Oncology Group Study

Between June 1987 and July 1995, 448 women with endometrial cancer were enrolled in a prospective, randomized trial comparing the use of postoperative radiation versus no postoperative treatment. Participants had stage IB, IC, II, or IIB endometrial adenocarcinoma with an intermediate risk of recurrence (that is, tumor with any degree of myometrial invasion, adenocarcinoma of any grade, and no evidence of lymph node involvement). In addition, an analysis was performed of 2 subgroups. High-risk patients had all of these risk factors: moderate to poorly differentiated tumor, presence of lymphvascular invasion, and myometrial invasion to the outer third; they were 50 years of age or older with 2 of the 3 risk factors; or they were 70 years of age or older and had one additional risk factor. Women who did not qualify for the high-risk subgroup were considered in the low-risk subgroup. Three hundred ninety-two participants met all eligibility requirements for inclusion in the analysis. Two hundred two women were randomized to the whole pelvic radiation group, and 190 received no additional postoperative treatment. Otherwise, both groups had similar clinical and demographic characteristics. In the radiation therapy (RT) group, 13 patients refused postoperative treatment and 5 received less than the prescribed dose. In the no-treatment group, 2 patients received fall-dose postoperative RT. Twenty-four participants were lost to follow up within a median of 50 months. Overall median follow up was 68 months. Forty-four patients, 31 in the unirradiated group and 13 in the radiation group, developed disease recurrence. After a median follow up of 80 months, 15 of the women who recurred were alive with disease. In all, 66 women in the study died, 32 from disease or treatment-related causes. Women who received postoperative radiation therapy were less likely to have a recurrence of disease than those who had no additional treatment Among the 202 patients who had no postoperative treatment, 13 recurred in the vagina, 4 in the pelvis, 1 in the vagina and pelvis, and 13 had distant recurrences. In the RT group, 2 women, both of whom refused treatment with radiation, had a recurrence in the vagina. One other patient recurred in the vagina and pelvis, and 10 had distant recurrences. Patients who were treated with postoperative radiation therapy had a 58% lower risk of ever having a recurrence of disease than women who did not. The overall risk of recurrence in the first 24 months after treatment was 3% (90% confidence interval [CI], 0.02-0.06) for women who received RT and 12% (90% CI, 0.09-0.17) for women who had no additional treatment. The estimated cumulative risk of recurring in the vagina or pelvis within the first 24 months was 1.6% (90% CI, 0.6-3.9) for those in the RT group compared with 7.4% (90% CI, 4.9-11.0) for the no additional treatment group. In the 132 women who were in the high-risk subgroup, 28 (28 of 44; 64%) had a recurrence of disease and 22 died from disease (22 of 32; 67%). The estimated risk of recurrence for high-risk women was 0.46 (90% CI, 0.19-1.11) compared with 0.42 (90% CI, 0.21-0.83) for low-risk women. There were 2 deaths from intestinal injury associated with radiation treatrnent. Overall, there were 6 instances of bowel obstruction in the RT group and 1 in the no additional treatment group.

Predicting Pelvic Lymph Node Metastasis in Endometrial Carcinoma

Background.To determine the possibility of individualizing the pelvic lymph node dissection in patients with endometrial cancer, the relationship between pelvic lymph node (PLN) metastasis and various prognostic factors was retrospectively investigated.Methods.From 1979 to 1994, 175 patients with endometrial carcinoma were treated with either total or radical hysterectomy combined with a PLN dissection as initial therapy. The prognostic factors examined included clinical stage, patient age, histological grade, the microscopic degree of myometrial invasion (DMI), cervical invasion, adnexal metastasis, and macroscopic tumor diameter (TD).Results.Of the 175 patients undergoing PLN dissection, 24 (14%) had PLN metastasis. An endometrial cancer with PLN metastasis had a significantly longer diameter than those without PLN metastasis. The frequency of PLN metastasis increased along with increases in tumor diameter. A logistic regression analysis revealed DMI and TD to be independently correlated with PLN metastasis. The formula based on the coefficients of TD and DMI obtained from the analysis also showed a good correlation, which allowed us to estimate the probability of patients having PLN metastasis.Conclusions.DMI and TD could accurately estimate the status of PLN in endometrial carcinoma patients.

Nm23 expression in endometrial and cervical cancer: inverse correlation with lymph node involvement and myometrial invasion.

The expression of nm23 has been shown to correlate in some solid tumours with their metastatic potential and to be associated with a favourable prognosis in human breast cancer and melanoma. In breast and ovarian cancer nm23 expression is also correlated with lymph node involvement. We analysed the expression of nm23-H1 and -H2 in normal endometrium and in endometrial and cervical cancer by both Northern and Western blotting. Cellular localisation of Nm23-H1 was visualised by immunohistochemistry mostly in the cytoplasm. Both isoforms of Nm23 were present in all the samples analysed, and a clear direct correlation between Nm23-H1 and -H2 levels was evident. Median nm23-H2 levels were higher than than -H1 levels in both tissues. Cervical cancer patients with lymph node involvement were shown to have significantly lower protein levels of Nm23 (P < 0.007 for H1 and P < 0.009 for H2), and a similar trend was also evident in endometrial cancer. Furthermore, the degree of myometrial invasion in endometrial cancer patients was also inversely correlated with Nm23-H1 levels of expression (P < 0.003). Nm23 level may therefore be taken into consideration as a new marker in the prognostic characterisation and in the treatment planning of uterine tumour patients.

Adjuvant chemotherapy with cisplatin, doxorubicin, and cyclophosphamide (PAC) for early-stage high-risk endometrial cancer: A preliminary analysis

Abstract Between October 1985 and January 1989, 33 patients with stage I (31) or clinically occult stage II (2) endometrial cancer at a high risk for recurrence were entered in a prospective study evaluating adjuvant cisplatin, doxorubicin, and cyclophosphamide (PAC) chemotherapy. Eligibility criteria included grade 2 tumors with middle- or outer-third myometrial invasion (16), grade 3 tumors with any degree of myometrial invasion (17), presence of extrauterine disease with no gross residual (17), or a high-risk histologic subtype including papillary serous (4), adenosquamous (5), or clear cell (1) tumors. Patients received PAC (50/50/500 mg/m 2 ) at 4-week intervals for six cycles. Thirty patients (90%) completed therapy. Toxicity included severe neutropenia in 14 patients, neutropenic sepsis in 2 patients, and doxorubicin-related cardiomyopathy in 1 patient. There were no treatment deaths. Current median follow-up is 25 months. Nine patients (27%) have developed a recurrence, 7 of whom died, after a median interval of 14 months. Eight of the 9 with recurrence initially had extrauterine disease ( P = 0.02). The resulting 2-year actuarial progression-free and overall survival rates were 79 and 83%, respectively. The median progression-free interval was 29 months for patients with extrauterine disease and 45 + months for those with no extrauterine disease ( P = 0.02). These results suggest that a phase 3 randomized trial comparing adjuvant PAC with radiation therapy is warranted.

Adjuvant chemotherapy with cisplatin, doxorubicin, and cyclophosphamide (PAC) for early-stage high-risk endometrial cancer: A preliminary analysis

Between October 1985 and January 1989, 33 patients with stage I (31) or clinically occult stage II (2) endometrial cancer at a high risk for recurrence were entered in a prospective study evaluating adjuvant cisplatin, doxorubicin, and cyclophosphamide (PAC) chemotherapy. Eligibility criteria included grade 2 tumors with middle- or outer-third myometrial invasion (16), grade 3 tumors with any degree of myometrial invasion (17), presence of extrauterine disease with no gross residual (17), or a high-risk histologic subtype including papillary serous (4), adenosquamous (5), or clear cell (1) tumors. Patients received PAC (50/50/500 mg/m 2) at 4-week intervals for six cycles. Thirty patients (90%) completed therapy. Toxicity included severe neutropenia in 14 patients, neutropenic sepsis in 2 patients, and doxorubicin-related cardiomyopathy in 1 patient. There were no treatment deaths. Current median follow-up is 25 months. Nine patients (27%) have developed a recurrence, 7 of whom died, after a median interval of 14 months. Eight of the 9 with recurrence initially had extrauterine disease ( P = 0.02). The resulting 2-year actuarial progression-free and overall survival rates were 79 and 83%, respectively. The median progression-free interval was 29 months for patients with extrauterine disease and 45 + months for those with no extrauterine disease ( P = 0.02). These results suggest that a phase 3 randomized trial comparing adjuvant PAC with radiation therapy is warranted.

Cathepsin-D in Human Encjometrium: Induction by Progesterone and Potential Value as a Tumor Marker*

Using an immunoenzymatic assay, cathepsin-D concentrations were measured in the cytosol of human endometrium biopsies. The level of cathepsin-D was higher in the luteal phase than in the follicular phase (P less than 0.01), suggesting increased accumulation by progesterone. Induction by progestin was confirmed by immunoprecipitation of cathepsin-D from a lysate of epithelial endometrial cells previously treated in primary culture with R5020 (10 nM); estradiol (10 nM) had no effect. Immunohistochemistry showed that cathepsin-D is mainly localized in the epithelium and that its level is higher in the luteal phase. The plasma level of cathepsin-D was stable during the menstrual cycle, ranging between 2.5-10 pmol/mL, but increased slightly during pregnancy. The mean level of cathepsin-D was higher in 19 endometrial carcinoma than in 20 normal endometrium, but was not correlated with steroid receptor status. However, using 15 pmol/mg protein as a cut-off level, the cathepsin-D status (high or low) was correlated with the degree of myometrial invasion (greater than or equal to one third) by adenocarcinoma cells, whereas steroid receptor status was not. We conclude that cathepsin-D is induced by progesterone in human endometrium, as it is in normal rat uterus, and we suggest that a low concentration of cathepsin-D in the cytosol of endometrial adenocarcinoma may indicate a favorable prognosis, since it is correlated with low myometrial invasion.