Sonographic, demographic characteristics, and the Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE) in the prediction of tumor recurrence or progression.

OBJECTIVES To identify and assess demographic, sonographic and Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE) prognostic factors for recurrence or progression in endometrial cancer (EC). METHODS We prospectively included 339 women with EC, undergoing expert transvaginal ultrasound before surgery. Tumors were classified according to FIGO, and ProMisE (MMR-D, POLE EDM, p53wt and p53abn). ProMisE subtypes were compared regarding demographic, sonographic characteristics, recurrence or progression, and survival. Cox regression was used to identify prognostic factors associated with recurrence or progression, with univariable models to study crude associations and multivariable models to study adjusted associations. Logistic regression and ROC curves analysis was used to assess the predictive ability of the prognostic factors, regarding recurrence or progression within three years, and to compared their predictive ability to that of the European Society for Medical Oncology (ESMO) classification. In separate sub analysis, tumors were stratified by p53 status (present/absent) and ultrasound tumor size (< 2 cm/≥ 2 cm). RESULTS Median follow-up time was 58 (IQR, 48-71, range 0-102) months. Recurrence/progression occurred in 51/339 (15%), in MMR-D 14%, POLE EDM 8%, p53wt 9%, and p53abn 46%. The multivariable 'ProMisE model' (ProMisE subtype, age, waist circumference, ultrasound tumor extension and ultrasound tumor size) (AUC 0.89, 95% CI 0.85-0.93) predicted recurrence/progression with comparable ability to the multivariable 'histotype and grade model' (histotype and grade, age, waist circumference, ultrasound tumor extension and ultrasound tumor size) (AUC 0.88, 95% CI 0.83-0.92) and with higher ability than both the preoperative (AUC 0.74, 95% CI 0.67-0.82), p <0.01), and postoperative (AUC 0.79, 95% CI 0.72-0.86), p <0.01) ESMO classification. The 48% with the combination of non-p53abn subtype and tumor size <2cm had a very low risk (1.8%) of recurrence/progression. CONCLUSION A combination of demographic, sonographic and ProMisE prognostic factors had higher ability to predict recurrence or progression than the ESMO classification, supporting their use in preoperative risk stratification. The p53 status combined with ultrasound tumor size has the potential to preoperatively identify a large group of women with a very low risk of recurrence or progression. This article is protected by copyright. All rights reserved

Stress among medical students during clinical courses : a longitudinal study using contextual activity sampling system

Objectives: To investigate medical students’ experiences of stress and other emotions related to their professional roles, as defined by the CanMEDS framework, by using the Contextual Activity Sampling System (CASS). Methods: Ninety-eight medical students agreed to participate of whom 74 completed this longitudinal cohort study. Data was collected between 6th and 8th term via CASS methodology: A questionnaire was e-mailed to the participants every 3rd week (21questionnaires/measurements) during clinical rotations and scientific project work term. Emotions were measured by a 7-point Likert scale (e.g., maximum stress = 7). Answers were registered through mobile technology. We used a linear mixed-model regression approach to study the association between stress over time in relation to socio-demographic and learning activities related to CanMEDS roles. Results: Participants completed 1390 questionnaires. Mean stress level over all time points was 3.6. Stress was reported as highest during the scientific project term. Learning activities related to ‘Communicator,’ ‘Collaborator,’ ‘Scholar,’ ‘Manager’ and ‘Professional’ were associated with increased stress, e.g. ’Scholar’ increased stress with 0.5 points (t=3.91, p&lt;0.001). A reduced level of stress was associated with ’Health Advocate’ of 0.39 points (t=-2.15, p=0.03). No association between perceived stress and demographic factors, such as gender or age was found. Conclusions: An association between different learning activities related to CanMEDS Roles and feelings of stress were noted. The CASS methodology was found to be useful when observing learning experiences and might support educational development by identifying course activities linked to stress