FIGO Stage IA Research Articles

Laparoscopic transabdominal cerclage in a pregnant woman after fertility-sparing treatment for early-stage cervical cancer: an operative technique in ten steps.

Fertility-sparing treatments are increasingly used in patients with early-stage cervical cancer. The residual shortened cervix might increase the risk of preterm birth. When a vaginal cerclage is not technically feasible, a laparoscopic transabdominal cerclage (LAC) could be offered before or after conception. In this article, we show how to safely perform a post-conceptional LAC in patients with insufficient residual cervical length for vaginal cerclage. A 34-year-old patient in the twelfth week of gestation who previously underwent repeated conisation for cervical cancer FIGO stage IA1 in 2021 was referred for cervical stenosis, which required a subsequent vaginal tracheoplasty. She became pregnant 3 months later. Ultrasound monitoring of the cervix showed a 15 mm cervical length. A step-by-step LAC in a pregnant woman was performed. Results: The Doppler velocimetry of the uterine arteries at the end of the procedure was normal. No intraoperative or postoperative complications were reported. The estimated blood loss was 100 mL and the total operative time of 120 min. The patient was discharged on the third postoperative day. A caesarean section was performed at 36 weeks of gestation for spontaneous contractions with excellent obstetric (male, 2860 gr) and neonatal outcomes. LAC in pregnancy, although made more difficult due to the size of the uterus, is a safe and feasible procedure combining the advantages of minimally invasive surgery with excellent obstetric result. In this video is shown how to perform a post-conceptional transabdominal laparoscopic cerclage in a young woman with no sufficient cervical length for a vaginal approach.

FcRn Expression in Endometrial Cancer and Its Association with Clinicopathologic Features.

Endometrial cancer (EC) has robust molecular diagnostic evidence that correlates well with prognosis. In various types of cancers, FcRn has been identified as an early marker for prognosis. This study aims to assess FcRn expression and its association with clinicopathological features in endometrial cancer. We employed a tissue microarray (TMA) from a retrospective cohort of 41 patients diagnosed with endometrioid endometrial cancer post hysterectomy between January 2002 and December 2009 at Gyeongsang National University Hospital. Relevant clinical data collection for the cohort involved reviewing patients' electronic medical charts. FcRn expression in microarrays of patient EC tissue was examined in conjunction with clinicopathologic data. Experiments, including siRNA knock-down, PCR mRNA semiquantification, Western blot, and confluence change tests, were conducted on the Ishikawa cell line. The overall FcRn expression rate in EC patients was 41.8%. FIGO stage showed a statistically significant relationship with FcRn expression, while age, lymphovascular invasion, myometrial invasion, and tumor size had no effect. In endometrioid cancer cells of FIGO stage IA, FcRn was less frequently expressed than in other high-staged EC patients (p = 0.021). In experiments on the Ishikawa cell line, the siRNA knock-down group exhibited quantitatively lower FCGRT mRNA expression and lower FcRn protein signal compared to the scrambled RNA control group. The change in confluence over time measured at three hotspots did not show a significant difference between groups. To the best of our knowledge, this study represents the initial assessment of FcRn expression in endometrioid EC samples. FcRn expression was significantly associated with the FIGO stage. Ishikawa cell line proliferation did not significantly change in response to decreased FcRn expression. Further studies are needed to elucidate FcRn expression in EC as a potential molecular parameter.

Case report: prolonged durable clinical benefit and low toxicity from combination endocrine therapy in a patient with recurrent endometrial carcinoma

BackgroundEndometrial carcinoma is the most common gynecologic cancer, with increasing incidence and mortality. Combination endocrine therapy comprised of tamoxifen and progestational agents has demonstrated promising results in treating recurrent disease. This case report describes the prolonged clinical benefit of treatment with tamoxifen and megestrol acetate in a woman with recurrent, metastatic endometrial endometrioid carcinoma positive for estrogen (ER) and progesterone receptors (PR).CaseA 71-year-old gravida 1 para 1 woman presented with postmenopausal bleeding and vaginal discharge. Pelvic ultrasound and magnetic resonance imaging confirmed a 4.7 cm endometrial mass. The patient underwent a total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, and cystoscopy; pathology revealed a FIGO stage IA grade 1 ER/PR-positive endometroid endometrial adenocarcinoma. She continued under active surveillance for approximately 42 months until she experienced bone metastases in her pelvis, for which she received radiation therapy. Five months later, pulmonary metastases were detected, and she received six cycles of carboplatin and paclitaxel. She then started megestrol acetate and tamoxifen and has remained clinically stable with minimal side effects and reasonable quality of life for approximately 57 months.ConclusionOur case suggests that combination endocrine therapy has the potential to provide substantial long-term clinical benefit in women with recurrent endometrial cancer and bone metastases, despite multiple prior treatments, allowing patients to experience stable disease and quality of life. In patients with recurrent endometrioid, ER/PR-positive disease, endocrine therapy alone or in combination with other targeted therapies are regimens that may be considered due to their low overall toxicity.

HPV-related lesions after hysterectomy for high-grade cervical intraepithelial neoplasia and early-stage cervical cancer: A focus on the potential role of vaccination.

To date, no data supports the execution of vaccination after hysterectomy for high-grade cervical intraepithelial neoplasia (CIN2+) and early-stage cervical cancer. We aim to evaluate the potential effect of vaccination after hysterectomy for high-grade cervical intraepithelial neoplasia and early-stage cervical cancer. This is a multi-center retrospective study evaluating data of women who develop lower genital tract dysplasia (including anal, vulvar and vaginal intra-epithelial neoplasia) after having hysterectomy for CIN2+ and FIGO stage IA1- IB1 cervical cancer. Overall, charts for 77 patients who developed lower genital tract dysplasia were collected. The study population included 62 (80.5%) and 15 (19.5%) patients with CIN2+ and early-stage cervical cancer, respectively. The median (range) time between hysterectomy and diagnosis of develop lower genital tract dysplasia was 38 (range, 14-62) months. HPV types covered by the nonavalent HPV vaccination would potentially cover 94.8% of the development of lower genital tract dysplasia. Restricting the analysis to the 18 patients with available HPV data at the time of hysterectomy, the beneficial effect of nonvalent vaccination was 89%. However, considering that patients with persistent HPV types (with the same HPV types at the time of hysterectomy and who developed lower genital tract dysplasia) would not benefit from vaccination, we estimated the potential protective effect of vaccination to be 67% (12 out of 18 patients; four patients had a persistent infection for the same HPV type(s)). Our retrospective analysis supported the adoption of HPV vaccination in patients having treatment for HPV-related disease. Even in the absence of the uterine cervix, HPV vaccination would protect against develop lower genital tract dysplasia. Further prospective studies have to confirm our preliminary research.

Oncologic and Fertility Outcomes After Simple Trachelectomy in Women With Early Cervical Cancer

Study Objectiveto present our case series of patients with early-stage cervical cancer undergoing simple trachelectomy. Currently, radical trachelectomy is considered the most appropriate fertility preserving procedure for the treatment of early-stage cervical cancer. However, there is increasing debate on the appropriate radicality of the surgery in order to preserve oncologic safety. Designdescriptive retrospective analysis of patient records and evaluation of questionaires Settingtwo gynecologic oncologic centers, surgeries performed by one surgical team Patients36 women with early-stage cervical cancer undergoing simple trachelectomy Interventionslaparoscopic assisted simple vaginal trachelectomy MeasurementsDemographic, histological, fertility and follow-up data of all patients who underwent simple trachelectomy between 04/2007 and 7/2021 were prospectively recorded and retrospectively analyzed. Main Results36 women (mean age: 28 years) underwent simple trachelectomy of whom 81% were nulliparous. Indications for simple trachelectomy were multifocal FIGO stage IA1 (n=30), stage IA1 L1 (n=1), stage IA2 (n=2) and stage IB1 (n=3), respectively. Mandatory staging-procedure was laparoscopic pelvic lymphadenectomy, including bilateral sentinel-biopsy in 92% of the cases and systematic in 8%. Residual tumor was histologically confirmed in 8 specimens (22%). 18 women (50%) were seeking parenthood, 13 succeeded (72%). There were 16 live births, all on term, with a median fetal weight of 3110 (2330-4420) gram. One patient had a medical abortion due to fetal congenital malformation. One pregnancy is ongoing. After a median follow-up of 91.5 (9-174) months all women are alive with no evidence of disease. ConclusionSimple trachelectomy represents a de-escalation compared to radical trachelectomy and provides excellent oncologic results with an outstanding fertility rate and obstetrical outcome for patients with early cervical cancer. However, clear indications for this tailored fertility-preserving surgery have to be defined in well-designed trials.

Statement of the Uterus Commission of the Gynecological Oncology Working Group (AGO) on Surgical Therapy for Patients with Stage IA2-IIB1 Cervical Cancer.

The presentation of the results of the prospective randomized international multicenter study AGO-OP.8 - CCTG CX.5 - SHAPE at the annual conference of the American Society of Clinical Oncology (ASCO) in 2023 will affect the surgical treatment of early-stage cervical cancer. In the SHAPE study, simple total hysterectomy (experimental arm) was found to be non-inferior to radical hysterectomy (standard arm) to treat patients with early-stage cervical cancer (FIGO stages [2018] IA2 - IB1 ≤ 2 cm with an infiltration depth of < 1 cm); after 3years' follow-up the pelvic recurrence rate was 2.52% (experimental arm) compared to 2.17% (standard arm) with no statistically significant difference with regards to recurrence-free survival and overall survival rates. After weighing up the results of the SHAPE study published at the conference, the Uterus Organ Commission of AGO is of the opinion that, in addition to the use of radical hysterectomy to treat patients with invasive cervical cancer which is FIGO stage IA2 - IB1 ≤ 2 cm with an infiltration depth of < 1 cm, simple total hysterectomy may also be considered for primary surgical therapy on a case-by-case basis after suitable explanation of the associated risks. It will be necessary to wait for the data of the full publication before discussing whether this approach should be included in official guidelines and defining it as a new therapy standard.

Single Institute Experience Treating Uterine Carcinosarcoma: Outcome Analysis

Uterine carcinosarcoma (UCS) is rare with a poor prognosis. We report over 10 years' experience, reporting prognostic and predictive factors for overall survival (OS) and disease-free survival (DFS). Patient, tumor, treatment and relapse characteristics of 168 women with stages I-IVB UCS treated at our institute between 2010 and 2020 were analyzed. OS and DFS at 2 and 5 years were the primary outcomes, estimated with Kaplan-Meier. The benefit of adjuvant chemotherapy and radiotherapy in the curative cohort was estimated using the log rank test. Median follow up was 23 months (range 1-137 months). 34% had FIGO stage IA disease, 10% IB, 8% II. 16% IIIA-IIIC1, and 10% IIIC2 and 22% IVB. The overall 2-year OS was 52% and 5-year OS 30%. 2-year OS by FIGO stage were: IA 66%; IB 63%; II 54%; IIIA-IIIC1 54%; IIIC2 45%; IVB 26%. Within the curative cohort who were surgically staged, 2-year DFS was 47% and 5-year was 30%. 2-year DFS were 61% in IA disease, 53% IB, 12% II, 51% IIIA-IIIC1, and 45% IIIC2 and 4% IVB. A greater risk of death was conferred by lack of adjuvant treatment (lack of chemo > lack of radiotherapy). The most common chemotherapy regimen used was Carboplatin Paclitaxel and pelvic radiotherapy 45Gy 25F over 5 weeks. The combination of surgery and chemotherapy +/- radiotherapy significantly improved OS compared to surgery +/- radiotherapy (HR 0.5 with CI 0.3 - 0.9) p<0.05. Radiotherapy improved OS compared to surgery only (HR 0.4 with CI 0.2 - 1.1) p<0.05. Relapse rate in all patients following curative treatment is 72% within year 1 and 86% within year 2 from diagnosis. In 52 patients with stage 1A disease treated with surgery +/- radiotherapy only, 42.4% relapsed, median time to relapse was 8 months from diagnosis. Relapse occurred despite 69.2 % stage 1A patients receiving adjuvant pelvic EBRT and in these patients relapse within the pelvis occurred in 50%. This study constitutes the largest retrospective analyses of long-term mortality outcomes in UCS and confirms poor outcomes despite curative surgery and adjuvant therapy. Most patients relapse within the first year following curative treatment. The use of adjuvant chemotherapy improves OS in all stages. In stage 1A disease 42 % patients relapse locally and distantly. This is an area of controversy and this data would strongly suggest that the addition of adjuvant paclitaxel-carboplatin or cisplatin-doxorubicin chemotherapy to EBRT should be considered in all patients including earliest stage disease.

Is minimally invasive radical surgery safe for patients with cervical cancer ≤2 cm in size? (MISAFE): Gynecologic Oncology Research Investigators coLLborAtion study (GORILLA-1003)

ObjectiveTo identify clinicopathological factors associated with disease recurrence for patients with 2018 FIGO stage IA with lymphovascular invasion to IB1 cervical cancer treated with minimally invasive surgery (MIS). MethodsA total of 722 patients with cervical cancer between January 2010 and February 2021 were identified. Clinicopathological factors related to disease recurrence were analyzed. Disease-free survival (DFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method. To determine prognostic factors for DFS, a Cox proportional hazard regression model was used. ResultsOf 722 patients, 49 (6.8%) experienced disease recurrence (37 pelvis, 1 para-aortic lymph node, and 11 peritoneum). Five-year DFS and OS rates were 90.7% and 98.1%, respectively. In multivariate analysis, risk factors associated with disease recurrence were residual disease in the remaining cervix (OR, 3.122; 95% CI, 1.152–8.461; p = 0.025), intracorporeal colpotomy (OR, 3.252; 95% CI, 1.507–7.017; p = 0.003), and positive resection margin (OR, 3.078; 95% CI, 1.031–9.193; p = 0.044). The non-conization group had a higher percentage of stage IB1 (77.4% vs. 64.6%; p = 0.004) and larger tumor (10 mm vs. 7 mm; p < 0.001) than the conization group. Intracorporeal colpotomy and residual disease in the remaining cervix were independent variables associated with disease recurrence in patients undergoing MIS following conization. ConclusionDuring MIS, patients with cervical cancer ≤2 cm in size can be vulnerable to peritoneal recurrences. Patients diagnosed with invasive cancer through conization often have low-risk pathological features, which may affect their survival outcomes.

Effect of modified radical laparoscopic hysterectomy versus open radical hysterectomy on short-term clinical outcomes in early-stage cervical cancer: a single-center, prospective, randomized controlled trial

BackgroundThe long-term prognosis of minimally invasive surgery and open surgery for early cervical cancer is controversial. This study mainly discusses the feasibility and effectiveness of the endocutter in radical laparoscopic hysterectomy for early cervical cancer.MethodsA single-center, prospective, randomized controlled trial of modified radical laparoscopic hysterectomy on patients with FIGO stage IA1 (lymphovascular invasion), IA2, and IB1 cervical cancer, between January 2020 and July 2021. Patients were randomly assigned into laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH) groups. The ORH group used right-angle sealing forceps for vaginal stump closure, whereas the LRH group used endoscopic staplers. The primary outcomes included the evaluation of the patient’s perioperative indicators, as well as short- and long-term complications. Recurrence and overall survival were considered secondary outcomes.ResultsAs of July 2021, 17 patients were enrolled in the laparoscopic surgery group and 17 in the open surgery group. The hospitalization time of the laparoscopic group was significantly shorter than those of the open group (15 min vs. 9 min, P < 0.001). The vaginal stump closure time in the laparoscopic group was longer than that in the open surgery group, and the difference was statistically significant (P < 0.001). Post-operative catheter removal (P = 0.72), drainage tube removal time (P = 0.27), number of lymph node dissections (P = 0.72), and incidence of intraoperative and post-operative complications between the two groups (P > 0.05). The median blood loss in the laparoscopic group was 278 ml, and it was 350 ml in the laparotomy group. The intraoperative blood transfusion rate was lower in the laparoscopic group; however, these differences did not reach statistical significance (P = 0.175). Vaginal margin pathology and peritoneal lavage cytology were negative, and all the patient’s vaginal stumps healed without infection. The median follow-up time of the laparoscopic group was 20.5 months, and it was 22 months for the open surgery group. There was no recurrence in all patients during the follow-up period.ConclusionsModified LRH with endocutter closure of the vaginal stump is an effective approach and not inferior to ORH in treating patients with early-stage cervical cancer.Trial registrationChiCTR2000030160, date of registration February 26, 2020 (https://www.chictr.org.cn/showprojen.aspx?proj=49809).

Sparing Is Caring: Hormonal Retreatment in Women with Recurrent Endometrial Cancer after Fertility Preservation Management—A Single Centre Retrospective Study

Fertility-sparing treatment (FTS) of endometrial cancer (EC) has a high rate of remission but also a high rate of relapse (10-88%). Many women still wish to conceive at the time of relapse, but results regarding retreatment are still lacking. This study aims to evaluate the safety, oncological and pregnancy outcomes of repeated FST in women with recurrent EC. This is a retrospective single-center study that recruited patients who had uterine recurrence after achieving a complete response (CR) with FST for FIGO stage IA, well-differentiated (G1), endometrioid EC. All eligible women underwent a second FST. Among 26 patients with recurrence, 6 decided to receive a hysterectomy and 20 received fertility-sparing retreatment. In total, 17 out of 20 women (85%) achieved a CR in a median time of 6 months. A total of 2/20 women showed a stable disease and continued the treatment for a further 6 months and finally achieved a CR. In total, 1/20 women showed disease progression and underwent demolitive surgery. After relapse and a CR, 14 patients attempted to become pregnant, among whom 7 became pregnant (pregnancy rate 50%-life birth rate 29%). Secondary FST is a safe and effective option for women who desire to preserve fertility after the recurrence of early-stage EC.

Endometrial Carcinomas With Subclonal Loss of Mismatch Repair Proteins: A Clinicopathologic and Genomic Study.

Subclonal loss of mismatch repair (MMR) proteins has been described in a small subset of endometrial carcinomas (ECs), but the genomic basis for this phenomenon has received limited attention. Herein, we retrospectively evaluated all ECs with MMR immunohistochemistry (n=285) for subclonal loss, and in those (n=6), performed a detailed clinicopathologic and genomic comparison of the MMR-deficient and MMR-proficient components. Three tumors were FIGO stage IA, and one each stage IB, II, and IIIC2. Patterns of subclonal loss were as follows: (1) 3 FIGO grade 1 endometrioid carcinomas with subclonal MLH1/PMS2, MLH1 promoter hypermethylation, and no MMR gene mutations; (2) POLE -mutated FIGO grade 3 endometrioid carcinoma with subclonal PMS2, and PMS2 and MSH6 mutations limited to the MMR-deficient component; (3) dedifferentiated carcinoma with subclonal MSH2/MSH6, as well as complete loss of MLH1/PMS2, MLH1 promoter hypermethylation, and PMS2 and MSH6 mutations in both components; (4) dedifferentiated carcinoma with subclonal MSH6, and somatic and germline MSH6 mutations in both components, but with a higher allele frequency in MMR-deficient foci. Recurrences occurred in 2 patients, one consisted of the MMR-proficient component from a FIGO 1 endometrioid carcinoma, while the other was from the MSH6 -mutated dedifferentiated endometrioid carcinoma. At the last follow-up (median: 44mo), 4 patients were alive and disease-free and 2 were alive with disease. In summary, subclonal MMR loss reflects subclonal and often complex genomic and epigenetic alterations, which may have therapeutic implications and therefore must be reported when present. In addition, subclonal loss can occur in both POLE -mutated and Lynch syndrome-associated ECs.

The role of adjuvant treatment for early-stage uterine clear cell carcinomas

BackgroundUterine clear cell carcinoma is a rare and aggressive subtype of endometrial carcinoma. Prospective clinical trials have not been feasible for this rare tumor, and data regarding the optimal adjuvant treatment regimen for early-stage uterine clear cell carcinomas is limited. Our study's objective was to determine if adjuvant chemotherapy or radiation therapy improves patients' outcomes in stage I and II uterine clear cell carcinoma. MethodsPatients with stage I and II uterine clear cell carcinoma were identified at a single institution. All cases were reviewed by a gynecologic pathologist. Both pure and mixed non-serous uterine clear cell carcinomas were included. Primary outcomes were recurrence free survival and overall survival. ResultsA total of 71 patients were identified including 39 (55%) pure and 32 (45%) mixed clear cell carcinoma. Most patients were FIGO stage IA (77.5%). Most patients (n = 58, 82%) received adjuvant therapy, including 43 (61%) receiving chemotherapy, 50 (70%) receiving radiation therapy, and 35 (49%) receiving both. Recurrence free survival was not significantly different among patients receiving no or <6 cycles of chemotherapy versus patients receiving 6 cycles of chemotherapy (p = 0.39). However, median OS was significantly different among patients receiving no or <6 cycles of chemotherapy versus 6 cycles of chemotherapy (p = 0.004). On univariable analysis, 6 cycles of chemotherapy was significantly associated with improved OS (HR 0.1, 95% CI 0.01–0.07). Presence of LVSI, mutated p53, number of pelvic and para-aortic lymph nodes assessed, adjuvant chemotherapy (any number of cycles), and >2 medical co-morbidities were not significant predictors of OS on univariable analysis. On multivariable analysis, 6 cycles of adjuvant chemotherapy remained a significant predictor of improved OS (HR 0.1, 95% CI 0.01–0.8). ConclusionsIn this study, administration of 6 cycles of chemotherapy appears to significantly improve OS. This finding suggests consideration of 6 cycles of adjuvant chemotherapy in patients with early-stage uterine clear cell carcinoma, however clinical trials are needed to confirm these findings.

Disgerminom u trudnoći - prikaz slučaja

Introduction: Malignant germ cell tumors (MGCTs), as a subtype of rare non-epithelial ovarian cancers (NOEC), are most commonly found in pregnancy. Of all MGCTs, 38% are dysgerminoma. Considering the rarity of these entities, the aim of this paper is to show a rare case of ovarian dysgerminoma presented in pregnancy and its influence on course and outcome of the pregnancy. Patient Review: Patient aged 26, gravida 2, para 1, with one vaginal delivery five years before, was admitted to the Clinic for Gynecology and obstetrics in term pregnancy because of uterine contractions accompanied by left thigh pain and tingling sensation in the left leg. Solid hypoechogenic mass with regular borders, 125x90 mm in diameter adjacent to the left side of the uterus was seen by ultrasound, without free fluid in pelvic cavity. Since regular uterine contractions started, the decision was made to terminate pregnancy by Caesarean section (CS) because of tumor previa. Histopathological examination confirmed ovarian dysgerminoma, but after staging operation which was performed two months after CS, following imaging diagnostics, ovarian dysgerminoma was confirmed with FIGO stage IA, meaning that patient's specific oncological treatment was finished. Conclusion: Diagnosis of ovarian dysgerminoma is in general challenging since up to 50% are asymptomatic or symptoms are non-specific. The management of ovarian cancer in pregnancy should be multidisciplinary and individualized in the best interest of the mother and the fetus. The overall five-year survival rate for ovarian dysgerminoma is favorable in more than 90% of cases. Women diagnosed with dysgerminoma in pregnancy are young and in general have good feto-maternal outcome.

Fertility preservation in patients with gynecological cancer - is it possible?

The aim of this review article is to present current options for fertility preservation in young women with gynecological tumors (ovarian, endometrial or cervical cancer). An early pretreatment referral to multidisciplinary team which consists of general gynecologists, gynecologic oncologists, embryologists, radiologists, pathologists, and reproductive endocrinologists should be suggested to young women with gynecologic cancer, concerning the risks and benefits of fertility preservation options. Only a small percentage of patients with ovarian cancer and borderline ovarian tumors, are appropriate candidates for fertility preservation (FIGO stage IA and IC epithelial ovarian cancer). Following oophorectomy, ovarian tissue or oocytes are removed from the ovary for the use of cryopreservation; after completion of oncological treatment patient undergoes orthotopic retransplantation of ovarian tissue whereas oocytes may be used for in vitro fertilization. Live birth rates up to 53.8% have been reported after fertility preservation treatment in selected patients. In patients with endometrial cancer fertility preservation treatment means conserving of the uterus. Appropriate candidates for fertility preservation are younger women with well differentiated endometrial cancer, which does not invade the myometrium. Fertility preservation treatment in endometrial cancer is hormonal, based on progestins. After completion of fertility preservation treatment, frequent follow-ups are necessary, with tissue sampling (via curettage or endometrial biopsy) remaining standard approach in follow- up. Live birth rates after progestin therapy are around 60%, or even higher with the help of assisted reproductive procedures. In cervical cancer, fertility preservation treatment can be considered in women with early-stage disease (FIGO IA1, IA2, or IB1). Cone biopsy or conization followed by laparoscopic lymphadenectomy has been described as an appropriate procedure, with conception rates up to 47%.

Prevalent distribution and survival outcome of HPV infection in patients with early-stage cervical cancer in Hangzhou, China

ObjectivesTo describe the prevalent distribution of human papilloma virus (HPV) infection in patients with early-stage cervical squamous cell carcinoma (CSCC). To provide data on high-risk HPV (HR-HPV) infection and other clinicopathological factors for their correlations with the survival of CSCC patients.MethodsA total of 1425 patients with FIGO stages IA to IIA CSCC who underwent radical surgery between September 2008 and December 2012 were enrolled in the study. The prevalent distribution of HPV infection with different patient characteristics and survivals were analyzed with or without propensity score matching (PSM).ResultsThe overall infection rate of HPV was 84.3%, including 13 carcinogenic HR-HPV genotypes and 8 low-risk HPV genotypes with infection rates of 82.6% and 5.8%, respectively. The distribution of HPV infection were proportional in patients with either different age groups or different FIGO stages. HPV16 was the dominant subtype with an infection rate of 65.1%, followed by the other top four subtypesHPV58 (8.7%), 18 (7.7%) and 52 (4.5%). χ2 analysis revealed that increased preoperative serum squamous cell carcinoma antigen levels and lymphovascular space invasion (LVSI) were statistically associated with HPV status. However, regression analyses indicated that only deep stromal invasion, LVSI and lymph node metastasis were independent prognostic factors on 5-year overall survival (OS), but not HR-HPV infection status even in the second exploratory analysis (P = 0.939) based on the PSM applied to reduce selection bias.ConclusionsThis study provided baseline data on the prevalence characteristics of HPV infections in patients with early-stage CSCC, and HR-HPV infection was not a prognosticator of 5-year OS, other than FIGO stage, LVSI and lymph node metastasis.

Isolated lymph nodal recurrence after 10 years in FIGO Stage IA1 cervical adenocarcinoma treated with conization: case report and review of the literature

Isolated lymph nodal recurrence after 10 years in FIGO Stage IA1 cervical adenocarcinoma treated with conization: case report and review of the literature

Surgical staging of apparent early-stage ovarian mucinous carcinoma

ObjectivesThe aim of the study was to explore the rate of upstaging after complete surgical staging among patients with apparent FIGO stage I ovarian mucinous carcinoma.MethodsOvarian mucinous carcinoma patients with surgical treatment at the Peking Union Medical College Hospital between October 2020 and January 1994 were retrospectively reviewed.ResultsIn total, 163 patients were included in this study. Surgical restaging was performed in 89 patients after initial incomplete surgical staging, and one-step complete surgical staging was performed in 74 patients. Among these initially incompletely staged patients, residual tumors were found in 16 patients (16/89, 17.9%). Among the 19 patients with apparent FIGO stage IA, no patient was found to have residual tumors after incomplete staging surgery, according to the final pathology result of restaging surgery. Ovarian cystectomy (OR=4.932, 95% CI= 1.347–18.058, P=0.016) was an independent risk factor for residual tumors after incomplete staging surgery. Among all 163 patients, upstaging occurred in 15 patients (15/163, 9.2%). Among 44 apparent FIGO stage IA patients, no patient was upstaged to FIGO II–IVB. Moreover, both a history of ovarian mucinous tumor (OR=4.745, 95% CI= 1.132–19.886, P=0.033) and bilateral ovary involvement (OR=9.739, 95% CI= 2.016–47.056, P=0.005) were independent risk factors for upstaging to FIGO stage II–IVB.ConclusionsFor patients with apparent FIGO stage IA disease, the possibility of residual tumors and upstaging is relatively low. For patients with cystectomy, bilateral mucinous carcinomas, or a history of ovarian mucinous tumors, complete staging surgery maintains greater significance.

Is Adnexectomy Mandatory at the Time of Hysterectomy for Uterine Sarcomas? A Systematic Review and Meta-Analysis.

Background and Objectives: Uterine sarcomas represents only 3% of all the female genital tract ones. The tumoral stage is the most significant prognostic factor. The role of the bilateral salpingo-oophorectomy (BSO) in the surgical management of FIGO stage IA and IB appears still controversial. This review aims to investigate the impact of bilateral adnexectomy in the treatment of uterine sarcoma. Methods: Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed, Scopus, Cochrane, Medline, and Medscape databases in February 2022. We applied no language or geographical restrictions, but we considered only English studies. We included the studies containing data about Recurrence Rate (RR), Disease-free Survival (DFS), and Overall Survival (OS). We used comparative studies for meta-analysis. Results: Seventeen studies fulfilled the inclusion criteria; 2 retrospective observational studies, and 15 retrospective comparative studies, And 14 out of the 15 comparative studies were enrolled in meta-analysis. A total of 3743 patients were analyzed concerning the use of adnexectomy with hysterectomy in patients with uterine sarcoma and compared with those who did not. Meta-analysis highlighted a non-significant worsening of the OS in the BSO group compared to the OP group and showed that adnexectomy does not improve the DFS (BSO OR 1.23 (95% CI 0.81–1.85) p = 0.34; I2 = 24% p = 0.22). Conclusions: Most studies selected for our review showed that adnexectomy does not significantly affect the RR, OS, and PFS in treating FIGO stage I uterine sarcomas. Therefore, even if there is a unanimous consensus about bilateral adnexectomy in menopausal patients, preservation of ovarian tissue may be considered in premenopausal women. Nonetheless, there are not enough cases in the literature to recommend this procedure.

Is minimally invasive surgery safe for cervical cancer patients with a diameter of less than 2 cm? (565)

<b>Objectives:</b> Several authors have suggested that minimally invasive surgery was not a poor prognostic factor among those with 2018 FIGO stage IB1. However, it is necessary to accurately analyze risk factors related to pelvic recurrence in this patient group. This study aimed to identify the clinical-pathologic prognostic factors associated with pelvic recurrence for patients with 2018 FIGO stage IA2 and IB1 cervical cancer treated with laparoscopic/robotic radical hysterectomy. <b>Methods:</b> A total of 117 FIGO stage IA2 and IB1 cervical cancer patients were identified between April 2006 and January 2021. One patient with lung metastasis was excluded. Sites of disease recurrence and all possible clinical-pathologic factors related to the risk of pelvic recurrence were analyzed. Disease-free survival (DFS) was estimated using the Kaplan-Meier method, and groups were compared by univariate analysis, employing the log-rank test. The Cox proportional hazard regression model with a backward elimination method was used to determine prognostic factors for DFS. <b>Results:</b> Of the 116 patients, eight (6.9 %) showed disease recurrence (four vaginal stumps, two pelvic lymph nodes, two peritonea). Five- year DFS rates were 92.9%. In multivariate analysis, the risk factors associated with pelvic recurrence during and after surgery were intracorporeal colpotomy (p < 0.044, odds ratio [OR]: 5.281, 95% CI: 1.046-26.665), the size of residual tumor (p < 0.003, OR: 4.081, 95% CI: 1.611-10.340), deep stromal invasion of the outer third of the cervix (p < 0.015, OR: 9.852, 95% CI: 1.563-62.093), and the positivity of the vaginal cuff margin (p < 0.001, OR: 64.912, 95% CI: 6.193-680.414). Conversely preoperative conization reduced the risk of pelvic recurrence (p < 0.044, OR: 0.092, 95% CI: 0.009-0.943). Four patients with vaginal stump recurrence responded to additional chemoradiation and are still alive. However, two patients with peritoneal recurrences showed disease progression with peritoneal carcinomatosis despite additional chemoradiation and died. <b>Conclusions:</b> There is no guarantee that minimally invasive surgery is safe in FIGO stage IB1 patients with tumors less than 2 cm in size. Surgical techniques to prevent tumor spillage during colpotomy should be performed even in patients with tumors less than 2 cm in diameter. In addition, preoperative conization and the absence of residual tumor at the time of surgery might have a preventive effect on the recurrence of minimally invasive radical hysterectomy.

Factors associated with prolonged uterine ischemia time and impact on biomarker expression for patients undergoing surgical management of endometrial cancer (537)

<b>Objectives:</b> The College of American Pathologists recommends < 60 min of ischemia time (IT) for breast cancer specimens to preserve biomarker expression. Our institution implemented a quality improvement initiative in 2019 to limit IT for the uterus to < 60 min for patients undergoing surgery for endometrial cancer (EC) in order to optimize immunohistochemistry (IHC) detection of HER2, ER, PR, and Mismatch Repair (MMR) proteins. We sought to determine patient and surgical factors that influence IT and analyze the association between prolonged IT (≥ 60 min) and biomarker expression in EC specimens. <b>Methods:</b> This is a retrospective review of patients who had a hysterectomy for EC in a comprehensive cancer center from June 2019 to February 2021. Clinical, surgical, and pathologic data were abstracted from medical records. IT was defined as the time between uterine vessel ligation to tissue fixation in formalin. We compared demographic and clinical-pathologic features for patients whose uterine specimens had IT of < 60 min to those with prolonged IT (≥ 60 min). IHC results for HER2, ER, PR, and MMR proteins were also compared between the two groups. Categorical data were compared using Chisquare or Fisher's exact test. Table 1 <b>Results:</b> Two hundred ninety-nine patients underwent hysterectomy for EC with documented IT during the study period. Most patients had endometrioid histology preoperatively (68%), had FIGO stage IA (64%), and underwent minimally invasive surgery (97%). The average length of surgery was 144 min and the average IT was 41 min. Prolonged IT occurred in 37 (12.4%) cases. Demographic factors associated with prolonged IT included age < 50 (p=0.047) and African American race (p<0.001). Uterine weight (p<0.001), need for minilaparotomy (p<0.001), additional procedures performed (p=0.006), and length of surgery (p<0.001) were associated with prolonged IT (Table 1). Day of the week, time of day, trainee involvement, and surgeon were not associated with ischemia time. IHC for HER2, ER, and PR was performed on 10%, 11%, and 10% of specimens, respectively, whereas IHC for MMR proteins was performed in 98% of cases. Though not statistically significant, there was a trend noted toward negative ER expression on IHC in specimens with prolonged IT (p=0.056). There was no association between IT and expression of HER2 (p=0.508), PR (p=0.25), and MMR proteins (p=0.143-1). <b>Conclusions:</b> Approximately 12% of EC specimens had ischemia time > 60 min. Patient factors (age < 50, race) and surgical factors (need for mini-laparotomy, additional procedures, and length of surgery) were associated with prolonged ischemia time. We suspect this is primarily due to uterine size and surgical complexity, which are not modifiable. The potential impact of IT on IHC detection of HER2, ER, PR, and MMR merits further investigation.