Half Myometrial Invasion Research Articles

Exploring metastasis and recurrence patterns in low-risk grade 3 endometrial cancer: A multicenter retrospective cohort study

ObjectiveFemales with low-risk endometrial cancer typically have low lymph node metastasis risk and promising prognosis without lymphadenectomy. However, the impact of grade 3 endometrial cancer on nodal involvement, recurrence, and prognosis within this specific subgroup remains unclear. Therefore, in this study, we aimed to investigate the prognosis, patterns of metastasis, and recurrence in a subgroup of females with grade 3 early-stage low-risk endometrioid endometrial cancer. MethodsWe identified patients from the endometrial cancer cohorts of seven institutional hospitals. The study included patients who underwent hysterectomy between January 2013 and December 2021 with preoperative endometrioid histological type, less than half myometrial invasion, no tumor spread outside the corpus on imaging, normal CA-125 level, and histological grade 3. The clinicopathological characteristics and survival outcomes of the patients were collected. Recurrence-free survival was estimated using the Kaplan–Meier method and compared using the log rank test. ResultsOverall, 36 patients were included in this analysis. Of the 33 patients who underwent lymphadenectomy, 1 (1/33, 3.0 %) had lymph node metastasis and 27 (75.0 %) received adjuvant therapy. At a median follow-up of 58 months, three females (8 %) had recurrence and all cases involved lymph nodes. The 5-year recurrence-free survival was 88.7 %. No significant difference was observed in the recurrence-free survival between females who did and did not undergo lymphadenectomy (p = 0.554). ConclusionFemales diagnosed with low-risk grade 3 endometrial cancer typically have favorable prognosis. However, lymph node metastasis and recurrence risks still exist, with all recorded instances of recurrence involving lymph nodes.

Utility of immunocytochemistry in diagnosing abdominopelvic washings from patients undergoing radical surgery for endometrial cancer.

This study aimed to explore the efficacy of immunocytochemistry in diagnosing abdominopelvic washings (APWs) and evaluate the superiority of cytology combined with immunocytochemistry over cytology alone. Data on APW cytology and available cell blocks from patients who underwent radical surgery for endometrial cancer between January 2021 and December 2022 were reviewed. Cytology was re-evaluated according to a five-tier system. Immunocytochemistry analysis for targets such as Sry box transcription factor 1(SOX17), Paired box gene 2 (Pax-2) protein, Phosphatase and tensin (PTEN), and β-catenin was performed on each case with non-negative cytology. Mismatch repair (MMR) protein and P53 immunocytochemistry analyses were performed using cell blocks from cases with abnormal MMR or P53 expression in their primary lesion. The accuracies of cytology combined with immunocytochemistry and cytology alone were calculated. Overall, 126 patients were included in this study, 18 of whom demonstrated non-negative cytology of APW. Cell blocks were successfully prepared for 16 cases. SOX17 positivity was observed in 16 cases, including 1 of serous carcinoma, 1 of clear cell carcinoma, and 14 of endometrioid carcinoma (EC). Loss of Pax-2 and PTEN expression was observed in the APWs of the 14 patients with EC. MMR deficiency was noted in two patients with EC, and P53 mutation was noted in another two patients with EC. Compared with 10 metastatic carcinomas (10/18, 55.56%) diagnosed by cytology alone, 15 malignant APWs (15/18, 83.33%) were confirmed through combination cytology and immunocytochemistry. APWs were more likely to be observed in cases with more than half myometrial invasion than those with no or less than half myometrial invasion (P = 0.0067). The probability of malignant APW occurrence was slightly elevated in cases of EC exhibiting microcystic, elongated, and fragmented(MELF) infiltrative growth (P = 0.039). SOX17 is a useful Müllerian marker for distinguishing endometrial epithelium in APW. Loss of Pax-2 and PTEN expression offers evidence of metastatic endometrial carcinoma. Furthermore, positive APWs retained molecular features similar to primary lesions. The use of multiple immunocytochemical markers can effectively enhance the diagnostic efficiency of APWs.

Are negative pelvic sentinel lymph nodes reflective of negative para-aortic nodes in high grade endometrial cancer? (071)

<b>Objectives:</b> Whether pelvic sentinel lymph nodes (SLN) in highgrade endometrial cancers reflect the presence of para-aortic (PA) node metastasis is debated in the literature. It is unclear whether negative pelvic SLNs alone may be relied on as an indicator to omit chemotherapy aimed to prevent distant recurrence in high-grade histologies. The objective of this study was to determine the accuracy of pelvic SLNs in detecting positive PA lymph nodes in high-grade uterine cancer and to determine the recurrence rate in patients with high-grade uterine cancers who did not receive adjuvant chemotherapy based on negative pelvic SLNs. <b>Methods:</b> This was a retrospective review of patients with newly diagnosed, clinically uterine-confined high-grade endometrial cancer (grade 3 endometrioid, serous, clear cell, and carcinosarcoma) who underwent surgery at a single tertiary care institution between January 2015 and July 2020. Patients were included if they underwent pelvic SLNs +/- PA node dissection, no visible extrauterine disease intraoperatively, and final pathology revealed high-grade histology. Demographic, pathological, treatment, and outcome data collected were analyzed using descriptive statistics in STATA 14.0. <b>Results:</b> One hundred and twenty-one patients with surgery for high-grade endometrial cancer were identified. After applying exclusion criteria, 110 patients were included. The median age was 68.5 years (range: 37-90 years). The surgical staging was completed laparoscopically in 88.2% of patients. Grade 3 endometrioid, serous, clear cell, and carcinosarcoma accounted for 45.5%, 36.4%, 10.9%, and 7.3% of postoperative pathology, respectively. Bilateral mapping was achieved in 76.4% of patients. On final pathology, 63.7% were stage I, 10.9% were stage II, 1.8% were stage IIIA, and 23.6% were stage IIIC with positive nodes. Adjuvant radiation was given to 66.4%, whereas adjuvant chemotherapy was given to 24.5% of patients. Sixty-three patients had a PA lymph node dissection (56 bilateral, seven unilateral) in addition to the pelvic SLN. Among this group, 5.8% (95% CI: 1.2-16.0%) had positive PA node despite a negative pelvic SLN. These patients had serous or carcinosarcoma histology with outer half myometrial invasion, while only one patient had positive lymphovascular space invasion (LVSI). Among those with a negative pelvic SLN and no adjuvant chemotherapy (<i>n</i>=75), the distant recurrence rate was 14.7%. <b>Conclusions:</b> The rate of isolated PA node metastasis in high-grade endometrial cancers despite a negative pelvic SLN may be higher than the accepted published 1-3% incidence. More evidence is needed to characterize the accuracy of SLN alone in patients with high-grade histology. Adjuvant chemotherapy may require further tailoring based on additional factors outside the stage, such as molecular characterization of high-grade histologies, to improve patient outcomes.

The significance of clinical and hormonal-metabolic parameters in the preoperative prediction of the risk of lymphogenous metastasis in patients with stage I endometrial cancer

In patients with moderately differentiated endometrial cancer with less than half myometrial invasion, there are no specific indications for performing or not performing lymphadenectomy. Given the high prevalence of metabolic syndrome (MS) among patients with endometrial cancer (up to 62%) and a large proportion of G2 tumors in combination with MS, the anthropometric and hormonal-metabolic parameters were considered for predicting the risk of lymphogenous metastasis. To build a model of preoperative prognosis of lymphogenous metastasis, the method of logistic regression was used. Data on 53 patients with stage I endometrial cancer was analyzed. All patients underwent total laparoscopic hysterectomy with bilateral salpingo-ovariectomy and pelvic lymphadenectomy. Positive lymph nodes were found in the surgical specimen of six patients. The additional risk parameters for lymphogenous metastasis were revealed in patients with stage I endometrial cancer, namely: leptin level (AUC = 0.957), visfatin level (AUC = 0.918), body mass index (AUC = 0.911), patient age (AUC = 0.828), and HDL cholesterol (AUC = 0.699). In addition to traditional risk factors (the depth of invasion and tumor differentiation grade), the model of preoperative prediction of the risk of lymphogenous metastasis for patients with intermediate- risk stage I endometrial cancer included the following parameters: age, body mass index, HDL cholesterol, level of adipose hormones leptin and visfatin in blood plasma.. The sensitivity and specificity of the model were 83.3% and 97.9%, respectively.

Predictive Histologic Factors in Carcinosarcomas of the Uterus: A Multi-institutional Study.

Uterine carcinosarcomas are rare aggressive biphasic neoplasms. Because of its rarity, limited data are available on potential prognostic parameters. While several studies support that carcinomatous components predict outcomes, others do not. In this study, we evaluated the clinical and histopathologic features of 196 uterine carcinosarcomas to identify potential prognostic factors. Patients' ages ranged from 34 to 95 yr (median, 68 yr). Seventy-three (38%) patients experienced tumor recurrence during follow-up. Tumors ≥5 cm, outer half myometrial invasion, lymphovascular invasion, lymph node metastasis, advanced stage (International Federation of Gynecology and Obstetrics stages III-IV), sarcomatous component on recurrence, sarcoma dominance, and positive cytology were significantly associated with shorter disease-free interval (P<0.05). In addition, serous histology and rhabdomyoblastic differentiation was significantly associated with worse 3-yr overall survival. Our data supports that both carcinomatous and sarcomatous components play a role in tumor progression and survival of uterine carcinosarcoma patients, suggesting their equal importance in guiding management decisions.

Investigation of Extra-Uterine Tumor Dissemination of Endometrial Cancers with Myometrial Invasion Less Than 50% According to Histologic Subtypes.

Objectives:This study aims to investigate the rates of extra-uterine metastases of non-endometrioid endometrial tumors limited to the half of the myometrium.Methods:Patients operated for endometrial cancer between 2005-2015 in two gynecologic oncology centers were screened from clinical archives. The inclusion criteria were serous, clear cell, undifferentiated or carcinosarcoma histologies and less than half myometrial invasion. Each histological type was analyzed for adnexal metastasis, lymph node metastasis (pelvic/paraaortic) and omental metastasis.Results:A total of 116 patients with the median age of 64 (34-72) were examined. Of the patients, 57 were serous (49.1%), 29 were clear cell (25.0%), 27 were carcinosarcoma (23.3%) and 3 (2.6%) were undifferentiated histologic type. Adnexal metastasis (over/tuba) was detected in 15 patients (12.9 %), nodal metastasis in 10 patients (8.6%), and omental metastasis in 15 patients (12.9%). The rates of adnexal metastases were calculated as 14% for serous type, 10% for clear cell type and 11% for carcinosarcoma. Omental metastasis rates were 11% for serous type, 17% for clear cell type and 15% for carcinosarcoma. The rates of extra-peritoneal nodal metastases were calculated as 12% for serous type, 7% for clear cell type and 4% for carcinosarcoma.Conclusion:According to the findings obtained in this study, the rates of extra-uterine metastasis are high for serous, clear cell or carcinosarcoma types even in the early period. However, the lymph node metastasis in the carcinosarcoma seems to be lower. A comprehensive staging surgery should be planned for these patients, regardless of the depth of myometrial invasion.

Risk factors for pelvic and para-aortic lymph node metastasis in endometrial cancer: A retrospective analysis of 284 patients

Aim: Hysterectomy is generally used to treat patients with endometrial cancer. Although lymphadenectomy can provide prognostic information, there are serious complications that can result from lymph node dissection. In order to avoid unnecessary surgical intervention, predictors related to both pelvic and para-aortic lymph node metastasis can be identified. In this study, we sought to define independent prognosticators for pelvic and para-aortic lymph node metastasis in women with endometrial cancer.Material and Methods: In total, 284 patients who were treated surgically between December 2009 and January 2019 were included in the study. The relationships between histopathological patient characteristics and definitive lymph node status were studied.Results: In multivariate analysis, lymphovascular space invasion (Adjusted Odds Ratio: 4.8, 95% Confidence Interval 2.4–17.5, p = 0.001) and deep myometrial invasion (Adjusted Odds Ratio 3.8, 95% Confidence Interval 1.1–14.3) were independent factors for pelvic lymph node metastasis. In multivariate analysis for para-aortic lymph node metastasis, lymphovascular space invasion (Adjusted Odds Ratio 5.9, 95% Confidence Interval 2.1–10.3) and pelvic lymph node metastasis (Adjusted Odds Ratio 20.8, 95% Confidence Interval 8.9–32.3) were independent prognostic factors significantly associated with the presence of para-aortic lymph node metastasis. Conclusion: The two independent histopathological factors identified for predicting the presence of pelvic lymph node metastasis were lymphovascular space invasion and outer half myometrial penetration of the tumor. Lymphovascular space invasion and pelvic lymph node metastasis were independently associated with the presence of para-aortic lymph node metastasis. Consideration of lymphadenectomy in patients who have evidence of outer half myometrial invasion or pelvic lymph node metastasis on preoperative imaging may be prudent. Lymphovascular space invasion and myometrial invasion findings on frozen section can be used before proceeding with lymphadenectomy in endometrial cancer.

Patterns of Recurrence By Adjuvant Radiation Therapy Type for Stage II Endometrial Cancer: A Provincial Review

Optimal adjuvant treatment of FIGO stage II endometrial cancer is controversial. As surgical practice evolves to include nodal resection, there may be a role for de-intensifying adjuvant therapy. In this province-wide retrospective review, patterns of recurrence were analyzed, alongside adjuvant radiotherapy (RT) practices including pelvic external beam (EB) RT, vaginal vault brachytherapy (BT), and small “minipelvis” (MP) EBRT fields, covering surgical bed, vaginal vault, and parametria, but not the classic elective nodal volumes. We identified patients diagnosed with stage II endometrial cancer between 2000-2014 who received adjuvant RT in Alberta, Canada. We collected demographics, disease characteristics, treatment details, and clinical outcomes. Recurrence-free survival (RFS) was calculated by Kaplan-Meier analysis and factors associated with recurrence were determined by univariate and multivariate analysis. A total of 264 patients (median age 62 [35-87]) met inclusion criteria. 83% had endometrioid adenocarcinoma, 25% grade 3 disease, 56% outer half myometrial invasion, and 44% lymphovascular invasion (LVI). Nodes were surgically assessed in half: 130 (49%) pelvic and 26 (10%) para-aortic. 34 patients (13%) had chemotherapy. RT was predominantly full pelvis (FP) EBRT+BT (114), but included BT alone (63), FP-EBRT alone (42), MP-EBRT+BT (34), and MP-EBRT alone (11). 5 year RFS for the entire cohort was 87%, with median follow-up 93.0 months [5.0-212.7]. 57 patients recurred (22%), including 25% of those treated with FP-EBRT+BT, 16% receiving BT alone, 14% receiving FP-EBRT alone, 21% receiving MP-EBRT+BT, and 55% receiving MP-EBRT alone. On multivariate analysis (reference: FP-EBRT+BT), no treatment group was significantly associated with recurrence. A trend was seen for MP-EBRT alone (hazard ratio [HR] 4.25, p=0.052). Mixed histology and presence of LVI were associated with recurrence (HR 3.73, p=0.008; and HR 3.38, p=0.001, respectively). Chemotherapy was protective (HR 0.20, p=0.012). Pathologic nodal assessment was not correlated with recurrence (p=0.90). Median time to recurrence was 19.9 months [2.9-92.3]. Recurrence was locoregional-only (not para-aortic nor distant) for a minority of patients (N=19/57, 33%), comparable for FP-EBRT+BT (N=8, 7.0%) and MP-EBRT+BT (N=3, 8.8%) groups. Among all patients, 62 (24%) had recorded late toxicity, most frequently gastrointestinal (N=40), including grade 3-4 (N=3) and grade 5 (N=2), with all grades 3-5 having received FP-EBRT+/-BT. No single best adjuvant treatment strategy exists for stage II endometrial cancer. Careful risk stratification is suggested in selecting optimal adjuvant treatment. MP-EBRT+BT is an option for local treatment of the surgical bed, vaginal vault, and parametria, with potential to decrease toxicity.

Analysis of recurrence and survival rates in grade 3 endometrioid endometrial carcinoma.

The aim of the present study was to determine risk factors associated with recurrence and survival in patients with grade 3 endometrioid endometrial carcinoma (G3EEC). A retrospective analysis of 117 patients with G3EEC, who were admitted to the Obstetrics and Gynecology Hospital of Fudan University between January 2000 and December 2011, was performed. The χ2 test or Fisher's exact test were used for the comparison of categorical variables. Kaplan-Meier method was used for estimating recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) rates. Univariate and multivariate Cox proportional hazards model were used to assess the prognostic significance of various patient characteristics. In 117 patients, 16 patients (13.7%) had tumor recurrence, of which 6 (37.5%) developed local-regional recurrence and 10 (62.5%) developed distant recurrence. Out of the 16 patients with tumor recurrence, 14 (87.5%) had a recurrence within 3 years of surgery. Statistically significant characteristics affecting RFS, DSS and OS rates were outer half myometrial invasion (MI ≥50%), advanced International Federation of Gynecology and Obstetrics stage, positive lymph node metastasis (PLNM), lymph vascular space invasion, adnexal involvement and characterization as a high-risk group, according to the Gynecologic Oncology Group 99 stratification algorithm. RFS was associated with the depth of cervical mucosa (stromal) involvement. Furthermore, in the multivariate Cox proportional hazards model, significant independent adverse factors for RFS and DSS included MI ≥50% and adnexal involvement. For OS, there were no statistically significant prognostic factors. In conclusion, MI ≥50% and adnexal involvement are independent prognostic factors for RFS and DSS in G3EEC patients.

Lymphadenectomy in women with early-stage intermediate-to high-risk endometrial cancer (HIR-EC) decreases local recurrence but not overall recurrence or survival: A retrospective cohort study

Objective: There is reasonably strong data to suggest that lymphadenectomy may be safely omitted in women with apparent early-stage endometrioid endometrial cancer (EC) and low-risk uterine specimen features. However, among patients with uterine specimen features that suggest HIR-EC, such as lymphovascular space invasion (LVSI), FIGO grade 2 or 3 histology (G2/3), or outer half myometrial invasion (OI), there is no consensus on the utility of performing lymphadenectomy. Our aim was to review our experience and outcomes among a focused subset of women with HIR-EC who did and did not have lymphadenectomy.

Association of smoking with pulmonary recurrences among women with intermediate- to high-risk early-stage endometrial adenocarcinoma.

5089 Background: While a number of histologic risk factors have been identified in endometrial carcinoma, host factors are less well studied. Our aim was to examine the influence of smoking on the risk of pulmonary recurrences in women with early stage intermediate to high-risk endometrioid uterine cancer (EC). Methods: Women with surgically treated stage I or II EC from 1994 to 2010 were included in this study if they had lymphovascular space invasion (LVSI), FIGO grade 2 or 3 histology (G2/3), or outer half myometrial invasion (OI). All demographic, medical and oncologic data were obtained from chart review. Patients were excluded if their follow-up period was less than six months or if they had a diagnosis of a second primary invasive cancer. We performed univariate and multivariate logistic regression analyses and Fisher’s Exact test for two-way analyses of categorical variables to identify prognostic factors of pulmonary recurrences. Significance was determined by two-sided tests with α=0.05. Results: 349 patients were identified to meet histologic criteria, 3% were excluded. The remaining 337 patients had a median follow-up of 60 months (range 6 to 194). The median age of this cohort was 68 years and median BMI was 30.7 kg/m2. 81 patients (24%) had a past or present history of smoking. There were 14 pulmonary recurrences (4.1%), 36 (10.7%) distant recurrences and 58 (17.2%) total recurrences in the cohort. Smoking (present or past) was significantly associated with pulmonary recurrences, with an odds ratio of 1.09 (95% CI 1.04-1.15; P=0.0002). In a multivariate analysis adjusting for age, BMI, grade, LVSI, OI, cervical invasion, and adjuvant therapy, smoking was still a predictor of pulmonary recurrences. Conclusions: Smoking is a significant and independent predictor of pulmonary recurrences among women with early stage EC. Refining our understanding of host factors that influence risk may further allow us to identify those who may benefit most from adjuvant therapies as well as intensive surveillance.

Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Evaluation of Parametrial Spread in Endometrial Carcinoma

To evaluate the detailed clinicopathologic characteristics of parametrial spread in uterine endometrial cancer. We retrospectively identified 334 individuals with uterine endometrial cancer who had undergone radical hysterectomy between 1988 and 2007. Parametrial spread was determined by histopathological analysis of surgically resected specimens. Twenty-eight (8.4%) individuals had histopathologically confirmed parametrial spread, and lymphatic or blood vessel invasion (22 cases) was the most frequently observed type of parametrial spread; direct invasion to parametrial connective tissue (five cases) or cardinal lymph node metastasis (four cases) were less frequently observed. Parametrial spread occurred not only in individuals with cervical involvement but also in individuals with more than half myometrial invasion, retroperitoneal (pelvic, paraaortic, or both), lymph node metastasis, ovarian metastasis, positive peritoneal cytology results, and lymphovascular space invasion. Twenty-six individuals (92.9%) with parametrial spread showed more than one of these histopathological factors (median number of factors 3, range 1-6); the other two individuals had lymphovascular space invasion alone. In 10 individuals with parametrial spread (35.7%), the condition recurred during the median follow-up period of 49 months, and initial recurrence was observed in the lung in six individuals (60.0%). Although the long-term prognosis for those with parametrial spread was significantly poorer than that of those without parametrial spread, both among all individuals (P<.001) and among individuals with International Federation of Gynecology and Obstetrics stage III (P<.05), multivariate analysis showed that parametrial spread was not an independent prognostic factor for uterine endometrial cancer. Parametrial spread cannot be predicted by cervical involvement alone but may be predicted by various lymphovascular space invasion-related histopathologic factors. Further, parametrial spread may not be an independent prognostic factor in individuals with uterine endometrial cancer. III.

Preoperative evaluation of endometrial carcinoma by contrast‐enhanced ultrasonography

To investigate the potential usefulness of contrast-enhanced ultrasonography in the preoperative evaluation of endometrial carcinoma and observe its enhancement pattern and time-intensity curve. A prospective study. Gynaecological department of a college hospital. A total of 35 women diagnosed with endometrial carcinoma. The patients were evaluated with real-time grey-scale contrast-enhanced ultrasonography. In 21 women, the parameters of time-intensity curve were compared between the endometrial lesion and normal myometrium. Findings about the depth of myometrial invasion on sonograms were compared with histological findings. Enhancement pattern, parameters of time-intensity curve, depth of myometrial invasion detected on sonograms. In visual evaluation, the brightness of the power Doppler signal and the amount of recognisable vascular areas increased in each tumour after contrast agent administration. Feeding vessels of the tumour were shown in 77.1% (27/35) of women. The other 22.9% (8/35) of women revealed that the signals were first visualised in the central portion of the tumour. The arrival time and peak time of endometrial lesion tended to be shorter than normal myometrium. The tumours started to enhance earlier than or at the same time as myometrium in 90.5% (19/21) of women. The peak intensity, enhancement intensity, and rising rate were higher in endometrial lesion than normal myometrium. There was no myometrial invasion in eight women, inner half myometrial invasion in 19 women and the outer half myometrial invasion in eight women. The corresponding values for ultrasound were 9, 17, and 9. The sensitivity of contrast-enhanced ultrasonography in detecting deep invasion was 75.0%, while the specificity was 88.9%, and the accuracy was 85.7%. The overall accuracy of assessment of myometrial invasion was 68.6%. There is some benefit in contrast-enhanced ultrasonography of endometrial carcinoma. It may provide better information in tumour imaging. Large studies are needed to determine the appropriate use and benefit of this new procedure.

Adjuvant chemotherapy as treatment of high-risk stage I and II endometrial cancer

Objective. This study was performed to define the subgroups of patients who benefit from postoperative adjuvant chemotherapy in stage I and II endometrial carcinoma. Methods. A retrospective review of 170 International Federation of Gynecology and Obstetrics (FIGO) stage I and II endometrial carcinoma patients treated between 1988 and 2000 at Niigata University Hospital was performed. All patients underwent surgery, of which 41 patients underwent adjuvant chemotherapy, consisting of intravenous cisplatin, doxorubicin, and cyclophosphamide. Multivariate analysis was performed for the prognostic factors and actuarial techniques were used for the survival and recurrence rates. Results. The patients were divided into low-risk and high-risk groups based on the number of prognostic factors (tumor grade G3, outer half myometrial invasion, lymph-vascular space involvement (LVSI), and cervical invasion). The 5-year disease-free survival and the 5-year overall survival for the low-risk group were 97.4%, and 100%, respectively, which were significantly better than 77.4% and 88.1% for the high-risk group ( P < 0.0001, P < 0.0001), respectively. Among high-risk group patients, the 5-year disease-free survival and the 5-year overall survival were 88.5% and 95.2% in 26 patients treated with adjuvant chemotherapy, and 50.0% and 62.5% in eight cases who underwent only surgery ( P = 0.0150, P = 0.0226). Disease recurrence occurred in 7 (20.6%) of 34 high-risk group patients. Four of seven recurrences occurred in patients who did not receive postoperative chemotherapy, in which all four were distant failure. In the remaining three patients who were in the CAP group, two had vaginal wall recurrence and only one had pulmonary recurrence. Three recurrences were also observed in the 133 low-risk group patients. Only isolated vaginal wall recurrence occurred in three patients without adjuvant chemotherapy after the initial surgery. Conclusions. There is possibility that postoperative adjuvant CAP may be omitted in surgical stage I or II endometrial cancer patients with 0 or 1 prognostic factor. The high-risk group of patients should be treated with postoperative adjuvant CAP to decrease distant failure and improve prognosis.

Assessment of myometrial invasion at the invasion site of an endometrial carcinoma by ultrasonography along with an intrauterine catheter.

To evaluate by transvaginal ultrasonography (TVU) the thickness of the intact myometrium at the presumed tumor-origin site and to establish criteria for a half myometrial invasion. A total of 19 successive patients with endometrial cancer who were treated between January 1, 1997, and January 31, 1998, participated in this study. TVU mode B with and without the use of an intrauterine silicon catheter was performed. Using a catheter, the origin site was correctly detected in 15 cases (79%). The best criterion for half myometrial invasion was a 6-mm thickness of the intact myometrium at the origin site. The sensitivity/specificity/accuracy of TVU with the use of a catheter in cases with the correct estimated origin site, were 1.00/0.67/0.86 for myometrial invasion < 1/2, and 0.67/1.00/0.86 for myometrial invasion > or = 1/2. It is of value to use 6-mm as the criterion for the thickness of the intact myometrium at the estimated tumor-origin site in connection with TVU with the use of a catheter for preoperatively assessing half myometrial invasion.

Preoperative Ultrasound Study in Predicting Lymph Node Metastasis for Endometrial Cancer Patients

Objective.The objective of this study was to evaluate the efficacy of preoperative ultrasound (US) findings such as tumor size, status of myometrial invasion, and intratumoral “resistance index” (RI) in predicting lymph node metastasis in endometrial carcinoma patients.Methods.Forty-two patients with endometrial cancer were enrolled. All patients underwent total abdominal hysterectomy, pelvic lymph node dissection or sampling, and para-aortic lymph node sampling. Two-dimensional and color Doppler US were performed before surgery to measure tumor size, depth of myometrial invasion, and intratumoral arterial RI. Formalin-fixed, paraffin-embedded pathologic slides from surgical specimens were reviewed by a senior pathologist to evaluate histologic type and grade, depth of myometrial invasion, cervical involvement, lymph-vascular emboli, and status of lymph node metastasis.Results.There were 12 patients with pelvic and/or para-aortic lymph node metastases and 30 patients without nodal metastases. Patients with tumors larger than 2.5 cm by US (11/12 vs 14/30,P= 0.008), more than half myometrial invasion by US (9/12 vs 5/30,P< 0.001), and intratumoral RI values less than 0.4 by US (12/12 vs 4/30,P< 0.001) had a significantly higher incidence of nodal metastases as compared with patients with tumors smaller than 2.5 cm, no or superficial myometrial invasion, and RI values higher than 0.4, respectively. Multiple regression analysis showed that only intratumoral RI values less than 0.4 were significantly correlated with nodal metastasis (P< 0.001,r2= 0.650). We used the intratumoral RI value as the parameter to evaluate nodal metastasis in endometrial cancer patients. Twelve of sixteen patients with intratumoral RI values <0.4 had a high incidence of nodal metastases. None of the 26 patients with intratumoral RI values >0.4 had nodal metastases.Conclusions.Preoperative ultrasound features can offer important information for predicting lymph node metastasis in endometrial cancer patients. Patients with tumors with intratumoral RI values less than 0.4 should be highly suspected of having lymph node metastases and further management such as pelvic lymph node dissection or postoperative pelvic radiotherapy would be needed for these patients.

The treatment of early cancer of the corpus uteri.

This paper analyses the results of post-operative radiotherapy in 256 cases of cancer of the corpus uteri. Myometrial invasion by tumour was shown to be significantly related to histological grading (p less than 0.001) as it was to recurrence rates (p less than 0.025). By placing patients into one of three subsets according to the depth of myometrial invasion, survival was sufficiently different for each subset to validate their use, not only for prognostic purposes but to determine the type of radiotherapy indicated. Radiotherapy was given as either local intravaginal treatment using an obturator loaded with 60Co or by a combination of this and external beam teletherapy. The value of using radiotherapy to treat the whole pelvis as opposed to treating only the vaginal tissues was significant (p less than 0.01) in terms of local disease control for the deep myometrial invasive group. In terms of survival, external beam therapy was of benefit for all three subsets, i.e. superficial, not more than half and more than half myometrial invasion. A planned approach to post-operative radiotherapy was significantly better for the series as a whole compared to previous ad hoc approaches (p less than 0.01). The treatment methods used did not produce unacceptable morbidity.