Impact of ovarian preservation in women with endometrial cancer

AbstractBackgroundBilateral salpingo-oophorectomy (BSO) is standardly performed in the treatment of endometrial cancer. The purpose of this study was to evaluate the impact of ovarian preservation on the outcome of patients with endometrial cancer.MethodsA retrospective cohort study was performed using the 2000–2010 database of endometrial cancer patients who were treated at Taipei Veterans General Hospital. Information regarding patient age, pathologic reports, and follow-up results was abstracted from medical records.ResultsFive hundred and twenty-nine patients were reviewed in this study. Mean age and follow-up duration were 55.7 ± 11.4 years and 37.5 ± 30.1 months, respectively. The median disease-free survival was 31.2 months (range 0.2–126.9 months). There were no significant differences in disease-free survival between stage I patients with ovarian preservation versus those with oophorectomy (p = 0.473). In a multivariate Cox model, ovarian preservation had no effect on disease-free survival [hazard ratio (HR) = 2.72; 95% confidence interval (CI), 0.48–15.59]; however, it was not significantly related to stage and para-aortic lymph node involvement.ConclusionOvarian preservation may be considered in premenopausal women with early-stage low-risk endometrial cancer

Prognostic factors and adjuvant therapy on survival in early-stage cervical adenocarcinoma/ adenosquamous carcinoma after primary radical surgery: A Taiwanese Gynecologic Oncology Group (TGOG) study

Objective: We aimed to identify prognostic factors of early-stage cervical adenocarcinoma (AC) and adenosquamous carcinoma (ASC) treated with primary radical surgery, and to evaluate the impact of postoperative adjuvant therapy on outcome. ;Methods: The clinical-pathological data of all patients (n = 1132) with stages I-II cervical AC/ASC treated with primary radical surgery at the member hospitals of the Taiwanese Gynecologic Oncology Group were retrospectively reviewed. ;Results: In multivariate analysis, stage II, deep stromal invasion (DSI), lymphovascular space invasion (LVSI), positive pelvic lymph node (PLN), and parametrial involvement (PI) were significant factors for recurrence-free survival (RFS), while only DSI, PI, and positive PLN were independent factors for cancer-specific survival (CSS). Low-and high-risk groups were defined by prognostic scores derived from the four factors (DSI, LVSI, positive PLN, PI) selected by internal validation. Postoperative adjuvant therapy significantly improved outcome for PLN-positive patients (RFS, p = 0.014; CSS, p = 0.016), but not for PLN-negative high-risk group because of higher mean prognostic score (p = 0.028) of adjuvant + than adjuvant - patients. ;Conclusions: PLN metastasis, PI, DSI, and LVSI were independent prognostic factors. Prospective studies of postoperative adjuvant therapy with prognostic score and nodal status stratification for cervical AC/ASC are necessary. (C) 2016 The Authors. Published by Elsevier Ltd

Prognostic Factors of Early Stage Epithelial Ovarian Carcinoma

We aimed to determine prognostic factors of early stage (I/II) epithelial ovarian carcinoma (EOC) including clinicopathologic and chemotherapeutic regimens. Four hundred and thirty-seven women who underwent primary staging surgery with adjuvant chemotherapy between January 1, 2000 and December 31, 2010 were retrospectively reviewed and analyzed from two medical centers. The prognostic factors were determined from multivariate survival analyses using Cox regression models. The majority of women were diagnosed with stage Ic (244/437, 55.8%). The histopathologic types were clear cell (37.5%), endometrioid (27.2%), serous (14.0%), and mucinous (13.3%). Fifty-seven percent (249/437) of the women received taxane-based (platinum plus paclitaxel) regimens and 43.0% received non-taxane (platinum plus cyclophosphamide) regimens as frontline adjuvant chemotherapy. Clear cell tumors (adjusted Hazard ratio (aHR) 0.37, 95% confidence interval (CI) 0.21–0.73, p = 0.001) showed better 5-year disease-free survival (DFS) than serous tumors. Women diagnosed at FIGO (International Federation of Gynecology and Obstetrics) stage II (aHR 5.97, 95% CI = 2.47–14.39, p < 0.001), grade 3 tumor without clear cell (aHR 2.28, 95% CI = 1.02–5.07, p = 0.004) and who received 3–5 cycles of non-taxane regimens (aHR 3.29, 95% CI = 1.47–7.34, p = 0.004) had worse 5-year overall survival (OS). Clear cell histology treated with taxane-based regimens showed significantly higher 5-year DFS (91.2% vs. 82.0%, aHR = 0.45, 95% CI = 0.21–0.93, p = 0.043) and 5-year OS (93.5% vs. 79.0%, aHR = 0.30, 95% CI = 0.13–0.70, p = 0.005) than those treated with non-taxane-based regimens. We conclude that stage, tumor grade, and chemotherapeutic regimens/cycles are independent prognostic factors for early stage ovarian cancer

Epithelial-to-mesenchymal transition in the development of adenomyosis

Adenomyosis is a hormone-related disease that affects 10–66% of women, and women with this disorder suffer from menorrhagia, dysmenorrhea, pelvic pain, abnormal uterine bleeding, and/or infertility. Regarding the etiology of the disease, the current trend of thought is that adenomyosis or adenomyoma results as a down-growth and invagination of the endometrial basalis into the adjacent myometrium after disruption of the normally intact boundary between the two. The eutopic endometrium of adenomyosis presents invasive characteristics, including increased angiogenesis and proliferation, decreased apoptosis, induction of the local production of estrogens, induction of progesterone resistance, and impaired cytokine expression, and these changes enhance the ability of the endometrium to infiltrate the junctional zone myometrium and the growth of ectopic tissue. Hysterectomy is the major strategy to relieve secondary dysmenorrhea caused by adenomyosis. However, fertility and uterine preservation are compromised by such treatment. The traditional pharmacological therapies for adenomyosis are primarily aimed at the suppression of endogenous estrogen production, but the results are not satisfactory. Thus, there is an urgent need to develop novel treatment strategies for adenomyosis. There has been evidence that indicates that the estrogen-induced epithelial–mesenchymal transition (EMT) may play a role in the development of adenomyosis. In this article, we will concentrate on the estrogen-induced EMT in the pathogenesis of adenomyosis

Unilateral salpingo-oophorectomy as fertility-sparing surgery for borderline ovarian tumors

Background: To investigate recurrence rates and fertility outcomes of patients with borderline ovarian tumors (BOTs) treated with fertility-sparing surgery. Methods: This was a retrospective study. All women with BOTs from 2000 to 2006 were evaluated. Clinical outcomes were compared among groups that underwent radical, unilateral salpingo-oophorectomy, or ovarian cystectomy. The effects of clinical characteristics on recurrence were analyzed by independent t test, chi-square test, and Cox proportional hazard model. Results: After a mean follow-up period of 56.5 months, all 61 patients were alive. Seven (11.5%) had developed disease recurrence, and all were in the fertility-sparing group. Of these, five were in the cystectomy-only group and two in the unilateral salpingo-oophorectomy group. There was significant difference in tumor recurrence rates between the two groups (hazard ratio: 0.26, 95% confidence interval: 0.11–0.61). Nine pregnancies were achieved in six women, resulting in five deliveries Conclusion: Fertility-sparing surgery is an acceptable and safe option for women with BOTs who wish to preserve fertility. Unilateral salpingo-oophorectomy must be considered as the first choice

The Relationship Between Human Papillomavirus and Epstein-Barr Virus Infections in Relation to Age Of Patients With Cervical Adenocarcinoma

SummaryObjectiveTo examine the relationship between human papillomavirus (HPV) and Epstein-Barr virus (EBV) infections in relation to age of patients with cervical adenocarcinoma.Materials and MethodsThirty samples of human cervical adenocarcinoma tissue were collected from the surgical pathology archive at Taipei Veterans General Hospital from 1996 to 2008. All samples were examined for EBV, HPV-16 and HPV-18 E6 DNA by conventional and real-time quantitative polymerase chain reaction assays.ResultsHPV-16 DNA was detected in 10 cases (33.3%), HPV-18 DNA in 12 cases (40%), and EBV DNA in three cases (10%); there were negative findings in seven cases (23.3%). EBV combined with HPV-16 or HPV-18 was also detected in one case each. No link could be demonstrated between HPV and EBV in endocervical lesions. When 20 patients £ 45 years old were compared with 10 patients > 45 years old, HPV-18 E6 DNA was detected in 45% vs. 30% (9/20 vs. 3/10), HPV-16 E6 DNA in 40% vs. 20% (8/20 vs. 2/10), EBV DNA in 10% vs. 10% (2/20 vs. 1/10), and no virus DNA was detected in 10% vs. 50% (2/20 vs. 5/10). HPV and EBV were significantly more common in younger women (p < 0.001).ConclusionHPV-18 plays a major role in adenocarcinomas at any age. A high prevalence of HPV DNA is significantly associated with cervical adenocarcinoma, especially in younger women. The results do not support a role for EBV in cervical adenocarcinogenesis or any relationship between EBV and HPV infection in adenocarcinoma

Effect of semisimultaneous morcellation in situ during laparoscopic myomectomy

Objective: The conventional technique of laparoscopic myomectomy (LM) was performed by complete enucleation of the myoma followed by morcellation as described previously. However, the conventional technique of LM presented some inherent problems in the management of larger myomas. Our objective was to compare the surgical outcome of the semisimultaneous morcellation in situ (SSMI group) technique and conventional morcellation (Control group). Materials and methods: In this prospective case–control study 122 patients with symptomatic uterine myomas treated with LM were recruited and divided into two groups. Patients in the Control group underwent LM using the conventional technique of completely enucleating the myoma followed by morcellation. In the SSMI group, morcellation was initiated from the upper half of the myoma and then the lower half was completely enucleated. Results: Fifty-four women underwent SSMI, and 68 women served as controls. There was no difference in the baseline characteristics between the two groups. The SSMI technique significantly reduced surgical time (163.2 ± 46.8 minutes vs. 189.4 ± 56.7 minutes; p = 0.007), although the difference in the mean blood loss was not significant (178 ± 147 mL vs. 203 ± 185 mL; p = 0.417), compared with the control. Furthermore, SSMI technique and myoma weight contributed to longer surgical times in multivariate analysis. Conclusion: The SSMI technique could shorten surgical time when a laparoscopic myomectomy is performed, but uterine size is also important