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BACKGROUND: Isolated positive para-aortic lymph node metastasis in endometrial cancer is an uncommon event, ranging from 1% to 3%. OBJECTIVE: Our aim was to evaluate the impact of sentinel lymph node (SLN) mapping on the risk of isolated positive para-aortic lymph node metastasis. METHODS: We retrospectively evaluated a series of 426 patients who underwent SLN mapping with at least one SLN detected from January 2013 to December 2021 (SLN group) compared with a historical series of 209 cases who underwent a systematic pelvic and para-aortic lymphadenectomy between June 2007 and April 2015 (LND group). Isolated para-aortic lymph node metastasis recurrences were included in the SLN group analysis. RESULTS: In the SLN group, 168 cases (39.4%) had backup systematic lymphadenectomy, and 56 (13.1%) had positive lymph nodes compared with 34 (16.3%) in LND group (p=0.18). The SLN group had higher rates of minimally invasive surgeries (p<0.001) and presence of lymphovascular space invasion (p<0.001). Moreover, SLN group had fewer other uterine risk factors, such as high-grade tumors (p<0.001), and deep myometrial invasion (p<0.001). We found that SLN mapped outside the pelvis at pre-sacral, common iliac areas, and para-aortic regions in 2.8% (n=12), 11.5% (n=49), and 1.6% (n=7) of cases, respectively. Overall, 52 (12.2%) patients had positive SLNs, and 3 (5.7%) positive SLNs were found outside the pelvis-one in the pre-sacral region, one in the common iliac area, and one in the para-aortic region. An isolated para-aortic lymph node was found in only 2 (0.5%) cases in the SLN group compared with 7 (3.3%) cases in the LND group (p=0.004). CONCLUSIONS: SLN protocol accurately predicts lymph node status and may decrease the risk of failed identification of isolated para-aortic lymph node metastasis compared with systematic lymphadenectomy.
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Neoplasias do Endométrio , Linfonodos , Metástase Linfática , Linfonodo Sentinela , Humanos , Feminino , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Linfonodos/patologia , Linfonodos/cirurgia , Biópsia de Linfonodo Sentinela/métodos , Excisão de Linfonodo/métodos , Adulto , Aorta/patologiaRESUMO
Objective: The Cancer Genome Atlas research program (TCGA) developed the molecular classification for endometrial cancer with prognostic and therapeutic utility, which was replaced by the ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) classification by consensus and international guidelines due to its high cost. This article aims to present national recommendations from an expert consensus that allows unification and implementation of the molecular classification for women with endometrial cancer nationwide, with a rational use of resources and technology. Methods: Consensus of 36 experts in clinical oncology, oncological gynecology, pathology, and genetics, with clinical practice in the national territory. The leader group performed a literature review and structuring of questions rated 1 to 9 points. A modified nominal group technique was used. There was a face-to-face meeting with master presentations, deliberative dialogue, and Google Forms (Google LLC, Mountain View, CA, USA) questionnaire voting with analysis and discussion of responses. The non-consensual responses led to a second round of voting. The final manuscript was finally prepared and revised. Results: Seven recommendations were formulated integrating the panelist responses based on evidence, but adjusted to the Colombian context and reality. Recommendation 1. The molecular classification is recommended in all the endometrial cancers using the immunohistochemistry markers as subrogated results from the molecular profile initially proposed in the TCGA classification. Recommendation 2. The sequential test strategy is recommended, starting with the immunohistochemistry markers (p53, MLH1, MSH 2, MSH6, PMS2) simultaneously in all the patients, defining to request POLE (DNA polymerase epsilon) (if available) according to the risk classification based on the surgical piece. Recommendation 3. It is recommended, that the gynecologist oncologist should be the one to request the POLE (if available) according to the final pathology report. This test must be requested for all endometrial cancers stage I-II, except in low risk (stage IA low grade endometrioid histology without linfovascular invasion normal p53) and, stages III-IV without residual disease, without affecting the request of subrogated immunohistochemistry molecular markers upon histology. The consensus proposes that the POLE is requested after the immunohistochemistry and according to the categories in the risk classification established by the 2020 ESGO/ESTRO/ESP guidelines. Recommendation 4. It is recommended to perform immunohistochemistry for hormonal receptors for all women with endometrial cancer and the HER2 in patients with p53abn, simultaneously with the others immunohistochemistry markers. Recommendation 5. It is recommended to perform the immunohistochemistry markers (p53, MLH1, MSH2, MSH6 y PMS2) in an initial endometrial biopsy or curettage when the specimen is adequate and available. In case the initial immunohistochemistry is inconclusive, or there are histological discrepancies between the initial and definitive pathology, it is recommended to repeat the molecular profile in the surgical pathology. The immunohistochemistry markers must be reported in the pathology report according to the CAP (College of American Pathologists) recommendations, independently of the type of sample. Recommendation 6. It is recommended to perform MLH1 promoter methylation testing in patients who exhibit loss of expression of MLH1 in immunohistochemistry whether it is accompanied or not with loss of expression of PMS2. All the patients with deficient MMR (mismatch repair), should be sent for genetic counseling to rule out Lynch syndrome. Recommendation 7. It is recommended to consider the molecular classification in addition to the classical histopathological criteria when making adjuvant judgments, as incorporated by the classification of prognostic groups of the 2020 ESGO/ESTRO/ESP guidelines. Conclusions: It is necessary to implement the molecular classification of endometrial cancer in clinical practice in accordance to the Colombian context, due to its prognostic and probably predictive value. This will enable the characterization of the Colombian population in order to offer individualized guided treatments. This is an academic and nonregulatory document.
Objetivos: el programa Cancer Genome Atlas Research (TCGA) desarrolló la clasificación molecular para cáncer endometrial con utilidad pronóstica y terapéutica, la cual ha sido reemplazada por consensos y guías internacionales por la clasificación ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) debido a su alto costo. El objetivo de este artículo es presentar recomendaciones a nivel nacional derivadas de un consenso de expertos que permitan unificar e implementar la clasificación molecular para mujeres con cáncer endometrial, mediante un uso racional de recursos y tecnología. Materiales y métodos: consenso de 36 expertos en oncología clínica, ginecología oncológica, patología y genética con práctica clínica en el territorio nacional. El grupo líder realizó una revisión de la literatura y estructuración de preguntas calificadas de 1 a 9 puntos. Se utilizó la técnica de grupo nominal modificada. Se efectuaron reuniones presenciales con presentaciones magistrales, diálogo deliberativo y votación de cuestionario Google Forms (Google LLC, Mountain View, CA, USA) con análisis y discusión de respuestas. Las respuestas no consensuadas se llevaron a una segunda ronda de votación. Finalmente, se elaboró y revisó el manuscrito final. Resultados: se formularon siete recomendaciones integrando las respuestas de las panelistas basadas en evidencia, pero ajustadas al contexto y a la realidad colombiana. Recomendación 1. Se recomienda realizar la clasificación molecular en todos los carcinomas endometriales utilizando los marcadores de inmunohistoquímica como resultados subrogados del perfil molecular inicialmente propuesto en la clasificación del TCGA. Recomendación 2. Se recomienda la estrategia secuencial de testeo iniciando por los marcadores de inmunohistoquímica (p53, MLH1, MSH 2, MSH6, PMS2) simultáneamente en todas las pacientes, y definir la solicitud del POLE (polimerasa épsilon del DNA) (si se encuentra disponible) de forma diferida de acuerdo con la clasificación de riesgo basado en la pieza quirúrgica. Recomendación 3. Se recomienda que sea el ginecólogo oncólogo quien solicite el POLE (si se encuentra disponible) de acuerdo con el reporte de patología definitivo. Esta prueba se debe solicitar a todos los cánceres endometriales de estadio I-II, excepto los de bajo riesgo (estadio IA endometrioide de bajo grado sin invasión linfovascular p53 normal) y estadio III-IV sin enfermedad residual, sin afectar la solicitud de los marcadores moleculares subrogados por inmunohistoquímica de acuerdo con la histología. El consenso propone que la solicitud del POLE se realice posterior a la inmunohistoquímica y de acuerdo con la clasificación del riesgo según las categorías establecidas por la guía ESGO/ESTRO/ESP del 2020. Recomendación 4. Se recomienda realizar simultáneamente con los otros marcadores de inmunohistoquímica la prueba para receptores hormonales en todas las pacientes con cáncer endometrial y el HER2 en pacientes con p53abn. Recomendación 5. Se recomienda que los marcadores de inmunohistoquímica (p53, MLH1, MSH2, MSH6 y PMS2) se realicen en la biopsia/legrado endometrial inicial cuando la muestra es adecuada y está disponible. En caso de inmunohistoquímica inicial no concluyente, o discrepancias histológicas entre la patología inicial y definitiva, se recomienda repetir el perfil molecular en la patología quirúrgica. Los marcadores de inmunohistoquímica deben reportarse en el informe de patología de acuerdo con las recomendaciones del CAP (College of American Pathologists), independientemente del tipo de muestra. Recomendación 6. Se recomienda realizar estudio de metilación de promotor de MLH1 en pacientes con pérdida de expresión de MLH1 en la inmunohistoquímica, acompañado o no de pérdida de expresión de PMS2. Todas las pacientes con déficit de MMR (mismatch repair), deben ser enviadas a genética para descartar síndrome de Lynch. Recomendación 7. Se recomienda tener en cuenta la clasificación molecular, además de los criterios histopatológicos clásicos para la toma de decisiones de adyuvancia, tal como los incorpora la clasificación de los grupos pronósticos de la guía ESGO/ ESTRO/ESP del 2020. Conclusiones: es necesario implementar la clasificación molecular de cáncer de endometrio en la práctica clínica acorde al contexto colombiano, dado su valor pronóstico y posiblemente predictivo. Esto permitirá la caracterización de la población colombiana para ofrecer tratamientos guiados de manera individualizada. Se trata de un documento académico y no regulatorio.
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Neoplasias do Endométrio , Humanos , Feminino , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/genética , Colômbia , Prognóstico , Consenso , Técnicas de Diagnóstico Molecular/normas , Biomarcadores TumoraisRESUMO
Molecular characterization of endometrial cancer is allowing for increased understanding of the natural history of tumors and paving a more solid pathway for novel therapies. It is becoming increasingly apparent that molecular classification is superior to histological classification in terms of reproducibility and prognostic discrimination. In particular, the Proactive Molecular Risk Classifier for Endometrial Cancer allows classification of endometrial cancer into groups very close to those determined by the Cancer Genome Atlas Research Network-that is, DNA polymerase epsilon-mutated, mismatch repair-deficient, p53 abnormal, and non-specific molecular profile tumors. The transition from the chemotherapy era to the age of targeted agents and immunotherapy, which started later in endometrial cancer than in many other tumor types, requires widespread availability of specialized pathology and access to novel agents. Likewise, surgical expertise and state-of-the-art radiotherapy modalities are required to ensure adequate care. Nevertheless, Latin American countries still face considerable barriers to implementation of international guidelines. As we witness the dawn of precision medicine as applied to endometrial cancer, we must make continued efforts towards improving the quality of care in this region. The current article discusses some of these challenges and possible solutions.
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Neoplasias do Endométrio , Padrão de Cuidado , Humanos , Feminino , Neoplasias do Endométrio/terapia , Neoplasias do Endométrio/patologia , América Latina/epidemiologiaRESUMO
OBJECTIVE: Three gynecologic oncology clinics located in the USA, Brazil, and Mexico collaborated to evaluate their delivery of hereditary cancer genetics services. This descriptive retrospective review study aimed to establish baseline rates and timeliness of guideline-recommended genetics service delivery to patients with ovarian, fallopian tube, primary peritoneal (ovarian), and endometrial cancers at each clinic. METHODS: Patients who were newly diagnosed with ovarian and endometrial cancers between September 1, 2018 and December 31, 2020 were identified from the medical records of the clinics. Genetics service delivery metrics included the rates of mismatch repair deficiency tumor testing for patients with endometrial cancer (microsatellite instability/immunohistochemistry, MSI/IHC), referral to genetics services for patients with ovarian cancer, completed genetics consultations, and germline genetic testing for patients with ovarian and endometrial cancers. Timeliness was calculated as the average number of days between diagnosis and the relevant delivery metric. Descriptive statistics were used to analyze data. RESULTS: In total, 1195 patients (596 with ovarian cancer, 599 with endometrial cancer) were included in the analysis, and rates of genetics service delivery varied by clinic. For patients with ovarian cancer, referral rates ranged by clinic from 32.6% to 89.5%; 30.4-65.1% of patients completed genetics consultation and 32.6-68.7% completed genetic testing. The timeliness to genetic testing for patients with ovarian cancer ranged by clinic from 107 to 595 days. A smaller proportion of patients with endometrial cancer completed MSI/IHC testing (10.0-69.2%), with the average time to MSI/IHC ranging from 15 to 282 days. Rates of genetics consultation among patients with endometrial cancer ranged by clinic from 10.8% to 26.0% and 12.5-16.6% completed genetic testing. CONCLUSIONS: All clinics successfully established baseline rates and timeliness of delivering hereditary cancer genetics services to patients with ovarian and endometrial cancers. Lower rates of delivering genetics services to patients with endometrial cancer warrant additional research and quality improvement efforts.
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Neoplasias do Endométrio , Testes Genéticos , Neoplasias Ovarianas , Humanos , Feminino , Neoplasias do Endométrio/genética , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/terapia , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/terapia , Estudos Retrospectivos , México/epidemiologia , Brasil/epidemiologia , Pessoa de Meia-Idade , Estados Unidos , Testes Genéticos/estatística & dados numéricos , Testes Genéticos/métodos , Adulto , IdosoRESUMO
INTRODUCTION: Describe factors associated with parametrial involvement, and how these factors modify the prognosis of patients with endometrial carcinoma treated with radical hysterectomy. METHODS: Observational study in which categorized patients according to those with and without parametrial involvement. A descriptive analysis and comparative analysis were performed for associations between parametrial spread and clinical, surgical, and pathology variables. RESULTS: We analyzed 85 patients, which 18 (21%) had parametrial involvement. Pathology factors associated with parametrial involvement were the endometrioid subtype, grade 3, and variants of poor prognosis (odds ratio (OR) 3.41, 95% CI 1.09-10.64; P = 0.035), myometrial invasion of over 50% (OR 7.76, 95% CI 1.65-36.44; P = 0.009), serosal involvement (OR 17.07, 95% CI 3.87-75.35; P < 0.001), ovarian metastasis (OR 5.15, 95% CI 1.36-19.46; P = 0.016), positive peritoneal cytology (OR 3.9, 95% CI 1.04-14.77; P = 0.044), and lymph node metastasis (OR 3.4; 95% CI 1.16-9.97; P = 0.026). Five-year disease-free survival was 74% (95% CI 57.4-85.4) for the group without parametrial spread and 50.8% (95% CI 22.7-73.4) for the group with parametrial spread (P = 0.001). Similarly, 5-year overall survival was 85.2% (95% CI 67.9-93.6) for the group without parametrial spread and 47.5% (95% CI 8.1-80.2) for the group with parametrial spread (P = 0.002). CONCLUSION: Factors associated with parametrial involvement were histologies of poor prognosis, tumors affecting uterine serosa, cervix, or spread beyond the uterus. Additionally, parametrial involvement directly affects prognosis by reducing overall survival, disease-free survival and increasing odds for recurrence.
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Neoplasias do Endométrio , Histerectomia , Invasividade Neoplásica , Humanos , Feminino , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/diagnóstico , Pessoa de Meia-Idade , Idoso , Prognóstico , Adulto , Miométrio/patologia , Miométrio/cirurgia , Idoso de 80 Anos ou mais , Metástase Linfática/patologia , Metástase Linfática/diagnóstico , Carcinoma Endometrioide/cirurgia , Carcinoma Endometrioide/patologia , Carcinoma Endometrioide/mortalidade , Carcinoma Endometrioide/diagnóstico , Estudos RetrospectivosRESUMO
Abstract Objective Endometrial cancer (EC) is a heterogeneous disease with recurrence rates ranging from 15 to 20%. The discrimination of cases with a worse prognosis aims, in part, to reduce the length of surgical staging in cases with a better prognosis. This study aimed to evaluate the association between Insulin-like growth factor II mRNA-binding protein 3 (IMP3) expression and prognostic and morphological factors in EC. Methods This retrospective, cross-sectional, analytical study included 79 EC patients - 70 endometrioid carcinoma (EEC) and 9 serous carcinoma (SC) - and 74 benign endometrium controls. IMP3 expression was evaluated by immunohistochemistry-based TMA (Tissue Microarray), and the results were associated with morphological and prognostic factors, including claudins 3 and 4, estrogen and progesterone receptors, TP53, and KI67. Results IMP3 expression was significantly higher in SC compared to EEC in both extent (p<0.001) and intensity (p=0.044). It was also significantly associated with worse prognostic factors, including degree of differentiation (p=0.024, p<0.001), staging (p<0.001; p<0.001) and metastasis (p=0.002; p<0.001). IMP3 expression was also significant in extent (p=0.002) in endometrial tumors compared with controls. In addition, protein TP53 and KI67 showed significant associations in extent and intensity, respectively. Conclusion IMP3 expression was associated with worse prognostic factors studied. These findings suggest that IMP3 may be a potential biomarker for EC poorer prognosis.
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Humanos , Prognóstico , Fator de Crescimento Insulin-Like II , Imuno-Histoquímica , Estudos Retrospectivos , Neoplasias do EndométrioRESUMO
BACKGROUND: Supernumerary teeth are an alteration of dental developmental and result in the formation of teeth above the usual number. Epidemiologic studies suggested that patients with dentofacial anomalies and their family members may present an increased risk of developing cancer, including female breast cancer and gynecologic cancers. These observations indicate that genetic alterations that result in dental anomalies may be related to cancer development. Thus, the aim of the present study was to evaluate the association between supernumerary teeth and a family history of female breast cancer and gynecologic cancers. METHODS: The diagnosis of supernumerary teeth was based on clinical and radiographic examinations. For data collection, a questionnaire asking for information regarding ethnicity, age, gender, and self-reported family history of cancer up to the second generation was used. Statistical analysis was performed using the Χ2 test and Fisher's exact test with an established α of 5%. RESULTS: A total of 344 patients were included; 47 of them had one or more non-syndromic supernumerary teeth (not associated with any syndrome or cleft lip and palate) and 297 were control patients. Age, ethnicity, and gender distribution were not statistically different between the group with supernumerary teeth and the control group (pâ¯> 0.05). The supernumerary teeth were most commonly observed in the incisors area. Breast cancer (nâ¯= 17) was the most commonly self-reported type of cancer, followed by uterine cervical (nâ¯= 10), endometrial (nâ¯= 2), and ovarian (nâ¯= 1) cancers. Endometrial cancer was significantly associated with the diagnosis of supernumerary teeth (pâ¯= 0.017). CONCLUSION: This study suggests that patients with supernumerary teeth possess a higher risk of having family members with endometrial cancer.
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Introduction: Endometrial cancer is the second most frequent gynecological tumor in Argentina, representing 6% of all cancers in women. The objective of this study is to evaluate the oncological and perioperative results in patients with high-risk endometrial cancer (HREC) limited to the uterus, treated at the Hospital Italiano de Buenos Aires, between January 2010-2018. Methods: Retrospective cohort study that evaluated perioperative results, disease-free survival at 2, 4 years in patients with HREC. Results: Of a total of 123 patients, 74 met the inclusion criteria. Serous tumors were the most frequent histological type, n=38 (51%), while dedifferentiated tumors were the least frequent, n=2 (3%). Of all the patients included, 56 (76%) received at least one adjuvant treatment. Taxol platinum-based chemotherapy was implemented in 28 patients (38%), while 24 (33%) received a combination of chemotherapy and radiotherapy. The median follow-up time was 2.9 years. Disease-free survival in patients with stage IA at 2 and 4 years was 71% (95% CI 55-82) and 63% (CI 46-76), respectively, while those with stage IB were 53 (95% CI 33-70) and 38 (95% CI 19-58). Regarding the surgical approach, no significant differences were found in disease-free or overall survival when comparing the laparoscopic with the laparotomy approach (p=0.06). Conclusion: Only the FIGO stage showed an increased probability of death or relapse regardless of the type of adjuvant treatment and the type of surgery approach. Perioperative complications were similar in both approaches.
Introducción: En Argentina el cáncer de endometrio es el segundo tumor ginecológico más frecuente, representando el 6% de todos los cánceres en mujeres. El objetivo de este trabajo es evaluar los resultados oncológicos y perioperatorios, en pacientes con cáncer de endometrio de alto riesgo (CEAR) limitados al útero tratadas en el Hospital Italiano de Buenos Aires entre enero 2010-2018. Métodos: Estudio de cohorte retrospectivo que evaluó los resultados perioperatorios, la supervivencia libre de enfermedad a los 2, 4 años en pacientes con CEAR. Resultados: 74 pacientes cumplieron con los criterios de inclusión. Los tumores serosos fueron los más frecuente n=38 (51%), mientras que los desdiferenciados, los de menor frecuencia, n=2 (3%). 56 (76%) pacientes recibieron al menos un tratamiento adyuvante. El tratamiento sistémico fue implementado en 28 pacientes (38%), mientras que 24 (33%) recibieron una combinación de quimioterapia y radioterapia. La mediana de seguimiento fue de 2,9 años. La supervivencia libre de enfermedad, en pacientes con estadio IA a los 2 y 4 años fue de 71% (IC 95% 55-82) y 63 % (IC 46 -76) respectivamente, mientras que aquellas que presentaban un estadio IB fue de 53 (IC 95% 33-70) y 38 (IC 95% 19-58). En cuanto a la vía quirúrgica de abordaje, no se encontraron diferencias significativas en la supervivencia libre de enfermedad ni en las complicaciones perioperatorias. Conclusión: Sólo el estadio FIGO mostró un aumento en la probabilidad de muerte o recaída independientemente del tipo de tratamiento adyuvante realizado y de la vía de abordaje seleccionada.
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Neoplasias do Endométrio , Humanos , Feminino , Argentina/epidemiologiaRESUMO
OBJECTIVE: This systematic review and meta-analysis aimed to assess the rate of sentinel lymph node (SLN) metastases in patients with a pre-operative diagnosis of atypical hyperplasia/endometrial intra-epithelial neoplasia and endometrial cancer in hysterectomy specimens. METHODS: A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the protocol was registered in PROSPERO (CRD42023416769). MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus databases were searched from inception until April 2023. The inclusion criteria were patients with a pre-operative diagnosis of atypical hyperplasia/endometrial intra-epithelial neoplasia undergoing hysterectomy who did or did not undergo SLN assessment. RESULTS: Four studies met the inclusion criteria. All studies were non-randomized studies with a total of 10 217 patients, 1044 in the SLN group and 9173 in the non-nodal assessment group. The unilateral and bilateral detection rate was 89% (I2=27.6%, 2 studies, 342 participants, 304 events) and 79% (I2=89.2%, 2 studies, 342 participants, 271 events), respectively. The rate of involved SLNs was 1.6% (I2=0%, 3 studies, 424 participants, 7 involved SLN) and 3.5% (I2=0%, 3 studies, 197 participants, 7 involved SLN) in patients with a pre-operative diagnosis of atypical hyperplasia/endometrial intra-epithelial neoplasia as the denominator and in those with endometrial cancer in the hysterectomy specimen, respectively. The cancer rate in the hysterectomy specimen was 45% (I2=72.8%, 3 studies, 503 participants, 224 events) and the most frequent endometrial cancer International Federation of Gynecology and Obstetrics 2009 stage was IA in 199 (89.2%) patients. The complication rate was similar between the groups. CONCLUSION: The rate of SLN metastases in patients with pre-operative atypical hyperplasia/endometrial intra-epithelial neoplasia is less than 2%, suggesting that routine SLN evaluation may not be necessary in this population.
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Objectives: To report the case of a patient with a uterine collision tumor and to conduct a review of the literature. Material and methods: A 76-year-old patient who presented to the national cancer referral center in Bogota (Colombia), where she was diagnosed with a uterine collision tumor consisting of a seroustype endometrial adenocarcinoma and a cervical adenosarcoma. The patient underwent surgical treatment followed by chemotherapy and supplemental radiotherapy, and died 16 months later. A search was conducted in the Medline via PubMed and Embase databases, including reports and case series of women with a diagnosis of uterine collision tumor, with retrieval of information regarding diagnosis, treatment and prognosis. A narrative summary of the findings was made. Results: The search identified 36 titles, of which 14 studies with 17 patients were included. The most frequent histopathological diagnosis was endometrial adenocarcinoma and high and low grade endometrial sarcoma (47 %). Primary treatment was surgery and adjuvant treatment with chemotherapy and radiotherapy (15 %) was performed in close to 50 % of cases. One-year survival was 75 %. Conclusions: No cases of uterine collision tumors with the histopathology or in the location of the reported case were found in the literature. If this reported case is taken into account, 2-year mortality is 28 %. Further studies to describe the immunohistochemistry, treatment and prognosis of this condition are needed.
Objetivos: reportar el caso de una paciente con tumor de colisión del útero y realizar una revisión de la literatura respecto al diagnóstico histopatológico, tratamiento y pronóstico de esta condición. Materiales y métodos: mujer de 76 años que consultó al centro nacional de referencia del cáncer en Bogotá (Colombia), donde se hizo el diagnóstico de tumor de colisión del útero, compuesto por un adenocarcinoma de endometrio tipo seroso y adenosarcoma de cérvix. Recibió tratamiento quirúrgico más quimioterapia y radioterapia complementaria, falleció a los 16 meses. Se realizó una búsqueda de la literatura en las bases de datos Medline vía PubMed y Embase, que incluía reportes y series de caso de mujeres con diagnóstico de tumor de colisión del útero, y se extrajo información sobre el diagnóstico, tratamiento y pronóstico. Se realizó un resumen narrativo de los hallazgos. Resultados: la búsqueda identificó 36 títulos, de los cuales se incluyeron 14 estudios que incluían 17 pacientes. El diagnóstico histopatológico más frecuente fue el adenocarcinoma endometrioide de endometrio y sarcoma endometrial de alto y bajo grado (47 %). El tratamiento básico fue quirúrgico. Cerca del 50 % recibió tratamiento adyuvante con quimioterapia y radioterapia (15 %). La sobrevida a 1 año fue del 75 %. Conclusiones: en la literatura no se identificaron casos de tumores de colisión de útero con la histopatología y en la ubicación del caso presentado. La mortalidad a dos años es cercana al 28 % si se toma en cuenta el caso reportado. Se necesitan más estudios que describan la inmunohistoquímica, el tratamiento y el pronóstico de esta condición.
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Adenocarcinoma , Feminino , Humanos , Adenocarcinoma/patologia , ColômbiaRESUMO
RESUMEN Investigar la relación de la netrina-1 preoperatoria con factores clinicopatológicos y pronósticos importantes y los niveles de corte adecuados en pacientes con cáncer de endometrio. En este estudio prospectivo y observacional, el grupo de casos y el de controles se seleccionaron entre las pacientes que acudieron a la Clínica de Oncología Ginecológica. Se extrajeron 4 mL de sangre venosa en un tubo de bioquímica de cada paciente durante el período preoperatorio. Los valores de netrina para predecir la presencia de malignidad se analizaron mediante el análisis de la curva ROC (receiver operating characteristics). El valor de corte se calculó según el índice de Youden. En el estudio, el valor de corte de malignidad según el nivel de netrina fue determinado en 645,50 mg/dL en el análisis ROC (utilizando el índice de Youden). La probabilidad de malignidad en individuos con valores de netrina superiores a este punto de corte fue del 78,2% (IC 95%: 0,680 a 0,884). La sensibilidad de la netrina para mostrar la probabilidad de malignidad en este valor de corte fue del 87,5% y la especificidad del 63,6%. La netrina-1 puede ser un biomarcador potencial para la detección del cáncer de endometrio y la evaluación de su pronóstico.
ABSTRACT To investigate the relationship of preoperative netrin-1 with important clinicopathological and prognostic factors and appropriate cut-off levels in patients with endometrial cancer. In this prospective, observational study, the case and control group were selected among patients who applied to the Gynecological Oncology Clinic. Four mL of venous blood was drawn into a biochemistry tube from each patient during the preoperative period. Netrin values in predicting the presence of malignity were analyzed using ROC (receiver operating characteristics) curve analysis. The cut-off value was calculated according to the Youden index. In the study, the cut-off value of malignancy according to the netrin level was determined as 645.50 mg/dL in the ROC analysis (using the Youden index). The probability of malignancy in individuals with Netrin values above this cut-off was 78.2% (95% CI 0.680-0.884). The sensitivity of netrin in showing the probability of malignancy at this cut-off value was 87.5%, and the specificity 63.6%. Netrin-1 can be a potential biomarker for endometrial cancer detection and prognosis evaluation.
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OBJECTIVES: To evaluate the prevalence of post-operative complications and quality of life (QoL) related to sentinel lymph node (SLN) biopsy vs systematic lymphadenectomy in endometrial cancer. METHODS: A prospective cohort included women with early-stage endometrial carcinoma who underwent lymph node staging, grouped as follows: SLN group (sentinel lymph node only) and SLN+LND group (sentinel lymph node biopsy with addition of systematic lymphadenectomy). The patients had at least 12 months of follow-up, and QoL was assessed by European Organization for Research and Treatment of Cervical Cancer Quality of Life Questionnaire 30 (EORTC-QLQ-C30) and EORTC-QLQ-Cx24. Lymphedema was also assessed by clinical evaluation and perimetry. RESULTS: 152 patients were included: 113 (74.3%) in the SLN group and 39 (25.7%) in the SLN+LND group. Intra-operative surgical complications occurred in 2 (1.3%) cases, and all belonged to SLN+LND group. Patients undergoing SLN+LND had higher overall complication rates than those undergoing SLN alone (33.3% vs 14.2%; p=0.011), even after adjusting for confound factors (OR=3.45, 95% CI 1.40 to 8.47; p=0.007). The SLN+LND group had longer surgical time (p=0.001) and need for admission to the intensive care unit (p=0.001). Moreover, the incidence of lymphocele was found in eight cases in the SLN+LND group (0 vs 20.5%; p<0.001). There were no differences in lymphedema rate after clinical evaluation and perimetry. However, the lymphedema score was highest when lymphedema was reported by clinical examination at 6 months (30.1 vs 7.8; p<0.001) and at 12 months (36.3 vs 6.0; p<0.001). Regarding the overall assessment of QoL, there was no difference between groups at 12 months of follow-up. CONCLUSIONS: There was a higher overall rate of complications for the group undergoing systematic lymphadenectomy, as well as higher rates of lymphocele and lymphedema according to the symptom score. No difference was found in overall QoL between SLN and SLN+LND groups.
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Neoplasias do Endométrio , Linfedema , Linfocele , Humanos , Feminino , Qualidade de Vida , Estudos Prospectivos , Biópsia de Linfonodo Sentinela/efeitos adversos , Linfonodos/cirurgia , Linfonodos/patologia , Excisão de Linfonodo/efeitos adversos , Neoplasias do Endométrio/patologia , Prevalência , Linfedema/epidemiologia , Linfedema/etiologia , Linfedema/patologia , Estadiamento de Neoplasias , Estudos RetrospectivosRESUMO
Objetivos: Reportar el caso de una paciente con tumor de colisión del útero y realizar una revisión de la literatura respecto al diagnóstico histopatológico, tratamiento y pronóstico de esta condición. Materiales y métodos: Mujer de 76 años que consultó al centro nacional de referencia del cáncer en Bogotá (Colombia), donde se hizo el diagnóstico de tumor de colisión del útero, compuesto por un adenocarcinoma de endometrio tipo seroso y adenosarcoma de cérvix. Recibió tratamiento quirúrgico más quimioterapia y radioterapia complementaria, falleció a los 16 meses. Se realizó una búsqueda de la literatura en las bases de datos Medline vía PubMed y Embase, que incluía reportes y series de caso de mujeres con diagnóstico de tumor de colisión del útero, y se extrajo información sobre el diagnóstico, tratamiento y pronóstico. Se realizó un resumen narrativo de los hallazgos. Resultados: La búsqueda identificó 36 títulos, de los cuales se incluyeron 14 estudios que incluían 17 pacientes. El diagnóstico histopatológico más frecuente fue el adenocarcinoma endometrioide de endometrio y sarcoma endometrial de alto y bajo grado (47 %). El tratamiento básico fue quirúrgico. Cerca del 50 % recibió tratamiento adyuvante con quimioterapia y radioterapia (15 %). La sobrevida a un año fue del 75 %. Conclusiones: En la literatura no se identificaron casos de tumores de colisión de útero con la histopatología y en la ubicación del caso presentado. La mortalidad a dos años es cercana al 28 % si se toma en cuenta el caso reportado. Se necesitan más estudios que describan la inmunohistoquímica, el tratamiento y el pronóstico de esta condición.
Objectives: To report the case of a patient with a uterine collision tumor and to conduct a review of the literature. Material and methods: A 76-year-old patient who presented to the national cancer referral center in Bogota (Colombia), where she was diagnosed with a uterine collision tumor consisting of a serous-type endometrial adenocarcinoma and a cervical adenosarcoma. The patient underwent surgical treatment followed by chemotherapy and supplemental radiotherapy, and died 16 months later. A search was conducted in the Medline via PubMed and Embase databases, including reports and case series of women with a diagnosis of uterine collision tumor, with retrieval of information regarding diagnosis, treatment and prognosis. A narrative summary of the findings was made. Results: The search identified 36 titles, of which 14 studies with 17 patients were included. The most frequent histopathological diagnosis was endometrial adenocarcinoma and high and low grade endometrial sarcoma (47 %). Primary treatment was surgery and adjuvant treatment with chemotherapy and radiotherapy (15 %) was performed in close to 50 % of cases. One-year survival was 75 %. Conclusions: No cases of uterine collision tumors with the histopathology or in the location of the reported case were found in the literature. If this reported case is taken into account, 2-year mortality is 28 %. Further studies to describe the immunohistochemistry, treatment and prognosis of this condition are needed.
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Humanos , FemininoRESUMO
Abstract Objective To assess the quality of recent meta-analyses reviewing the diagnostic utility of sentinel node biopsy in endometrial cancer. Methods With the MeSH terms endometrial neoplasms and sentinel lymph node biopsy, PubMed and Embase databases were searched on October 21, 2020, and again on November 10, 2021, with meta-analysis and publication date filters set to since 2015. The articles included were classified with the A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) assessment tool. Results The database searches found 17, 7 of which, after the screening, were selected for full review by the author, finally extracting six meta-analyzes for quality analysis. The rating with the AMSTAR 2 assessment tool found that overall confidence in their results was critically low. Conclusion This study found that the quality of recent meta-analyses on the utility of the staging of endometrial cancer with sentinel node biopsy, evaluated by the AMSTAR 2 assessment tool, is classified as critically low, and, therefore, these meta-analyses are not reliable in the summary of their studies.
Resumo Objetivo Avaliar a qualidade de meta-análises recentes que revisaram a utilidade diagnóstica da biópsia do linfonodo sentinela no câncer de endométrio. Métodos Com os termos MeSH endometrial neoplasms e =biópsia do linfonodo sentinela, as bases de dados PubMed e Embase foram pesquisadas em 21 de outubro de 2020 e novamente em 10 de novembro de 2021, com filtros de meta-análise e data de publicação configurados para desde 2015. Os artigos incluídos foram classificados com o instrumento de avaliação A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). Resultados As pesquisas de banco de dados encontraram 17 artigos, sete dos quais, após a triagem, foram selecionados para revisão completa pelo autor, extraindo finalmente 6 meta-análises para análise de qualidade. A classificação com a ferramenta de avaliação AMSTAR 2 descobriu que a confiança geral em seus resultados era criticamente baixa. Conclusão Este estudo constatou que a qualidade de meta-análises recentes sobre a utilidade do estadiamento do câncer de endométrio com biópsia do linfonodo sentinela, avaliada pela ferramenta de avaliação AMSTAR 2, é classificada como criticamente baixa e, portanto, essas meta-análises não são confiáveis no resumo de seus estudos.
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Humanos , Feminino , Neoplasias do Endométrio , Biópsia de Linfonodo SentinelaRESUMO
PURPOSE: In endometrial cancer, the incidence of mutations in mismatch repair genes (MMR) is estimated at 17-30%. Patients with alterations at this level (MSI) are known to have different clinical and anatomopathological characteristics than those without this genetic alteration (MSS). In this study, we aim to identify the MSI phenotype in patients who underwent hysterectomy for endometrial cancer. We assessed the correlation of this phenotype with anatomoclinical parameters such as obesity and histological subtype. METHODS/PATIENTS: Clinical and anatomopathological data were collected from 147 patients diagnosed with endometrial cancer and an immunohistochemical study of MMR system proteins was performed. PMS2 and MSH6 proteins were evaluated as primary screening and subsequent evaluation of MLH1 and MSH6, respectively, if the former were negative. Statistical association between the anatomopathological data and the immunohistochemical result was analyzed. RESULTS AND CONCLUSIONS: 22.4% of our patients were MSI phenotype. We obtained statistically significant differences by multivariate analysis between endometrioid subtype and higher FIGO classification grade with MSI phenotype and obesity with MSS phenotype. Given these statistical results, we propose a function for predicting the probability of being MSI phenotype taking into account the histological subtype (endometrioid/non-endometrioid carcinoma) and FIGO grade as well as obesity. This prediction may be useful prior to hysterectomy, for genetic study of the MLH1 promoter and subsequent genetic counseling.
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Carcinoma Endometrioide , Neoplasias do Endométrio , Algoritmos , Índice de Massa Corporal , Neoplasias do Endométrio/patologia , Feminino , Humanos , Instabilidade de Microssatélites , Proteína 1 Homóloga a MutL/genética , Proteína 1 Homóloga a MutL/metabolismo , Proteína 2 Homóloga a MutS/metabolismo , Obesidade/genética , FenótipoRESUMO
BACKGROUND: Growing evidence suggest that sentinel lymph node (SLN) biopsy in endometrial cancer accurately detects lymph node metastasis. However, prospective randomized trials addressing the oncological outcomes of SLN biopsy in endometrial cancer without lymphadenectomy are lacking. PRIMARY OBJECTIVES: The present study aims to confirm that SLN biopsy without systematic node dissection does not negatively impact oncological outcomes. STUDY HYPOTHESIS: We hypothesized that there is no survival benefit in adding systematic lymphadenectomy to sentinel node mapping for endometrial cancer staging. Additionally, we aim to evaluate morbidity and impact in quality of life (QoL) after forgoing systematic lymphadenectomy. TRIAL DESIGN: This is a collaborative, multicenter, open-label, non-inferiority, randomized trial. After total hysterectomy, bilateral salpingo-oophorectomy and SLN biopsy, patients will be randomized (1:1) into: (a) no further lymph node dissection or (b) systematic pelvic and para-aortic lymphadenectomy. MAJOR INCLUSION AND EXCLUSION CRITERIA: Inclusion criteria are patients with high-grade histologies (endometrioid G3, serous, clear cell, and carcinosarcoma), endometrioid G1 or G2 with imaging concerning for myometrial invasion of ≥50% or cervical invasion, clinically suitable to undergo systematic lymphadenectomy. PRIMARY ENDPOINTS: The primary objective is to compare 3-year disease-free survival and the secondary objectives are 5-year overall survival, morbidity, incidence of lower limb lymphedema, and QoL after SLN mapping ± systematic lymphadenectomy in high-intermediate and high-risk endometrial cancer. SAMPLE SIZE: 178 participants will be randomized in this study with an estimated date for completing accrual of December 2024 and presenting results in 2027. TRIAL REGISTRATION NUMBER: NCT03366051.