Endometrium kanserinde ekstrauterin tümör yayılımını tahmin etmek için kullanılan bir model
Yıl 2023,
Cilt: 5 Sayı: 2, 69 - 74, 28.06.2023
Birkan Karayünlü
,
Mehmet Ünsal
,
Fatih Kılıç
,
Taner Aksoy
,
Fatih Çelik
,
Çiğdem Kılıç
,
Abdurrahman Alp Tokalıoglu
,
Günsu Kimyon Cömert
,
Taner Turan
Öz
Amaç: Endometrium kanseri tanısı ile evreleme cerrahisi uygulanan hastalarda ekstrauterin yayılımı öngören faktörler araştırıldı.
Amaç: Çalışmada ekstrauterin yayılımı tahmin etmek için demografik, cerrahi ve patolojik faktörler kullanılarak bir model oluşturmak amaçlandı.
Yöntemler: Çalışmaya endometrium kanseri tanısı alan ve evreleme cerrahisi uygulanan 355 hasta dahil edildi. Cerrahi prognostik faktörlerin ekstrauterin yayılım üzerindeki etkisi, tek değişkenli analiz ve çok değişkenli lojistik regresyon analizi kullanılarak analiz edildi.
Bulgular: 97 hastada ekstrauterin yayılım tespit edildi. Ekstrauterin yayılımı etkileyen faktörleri belirlemek için oluşturulan çok değişkenli bir lojistik regresyon modeli, lenfovasküler invazyon varlığını, servikal invazyonu, peritoneal sitoloji pozitifliğini ve tümör tipini bağımsız faktörler olarak belirledi. Bu dört bağımsız risk faktörü kullanılarak bir model oluşturulmuştur. Bu modele göre, risk faktörlerine sahip olmayan hastalarda ekstrauterin yayılım oranı %6,4, tüm risk faktörlerine sahip hastalarda %100 idi (p<0,05).
Sonuçlar: Endometrium kanseri tedavisinin planlanmasında ekstrauterin yayılımın tespiti esastır. Bu yayılımın klinik ve patolojik faktörler kullanılarak tanımlanması, yetersiz cerrahi uygulanan veya cerrahinin ciddi morbiditeye neden olacağı bir grup hastada uygun tedavinin belirlenmesine katkı sağlayacaktır.
Kaynakça
- References
1. Mazur MT. Endometrial hyperplasia/adenocarcinoma. A conventional approach Annals of Diagnostic Pathology 2005;9:(3):174-181
- 2. Cheewakriangkrai C, Kietpeerakool C, Charoenkwan K, Pattanittum P, John D, Aue-Aungkul A, Lumbiganon P. Health education interventions to promote early presentation and referral for women with symptoms of endometrial cancer The Cochrane database of systematic reviews 2020;3:(Cd013253
- 3. Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up International Journal of Gynecologic Cancer 2016;26:(1):2-30
- 4. Frost JA, Webster KE, Morrison J. Lymphadenectomy for Treatment of Early-Stage Endometrial Cancer JAMA oncology 2017;3:(1):117-118
- 5. Practice Bulletin No. 149: Endometrial cancer. Obstetrics and gynecology 2015;125:(4):1006-1026
- 6. Barlin JN, Puri I, Bristow RE. Cytoreductive surgery for advanced or recurrent endometrial cancer: a meta-analysis Gynecologic oncology 2010;118:(1):14-18
- 7. Vezzoli M, Ravaggi A, Zanotti L, Miscioscia RA, Bignotti E, Ragnoli M, Gambino A, Ruggeri G, Calza S, Sartori E, Odicino F. RERT: A Novel Regression Tree Approach to Predict Extrauterine Disease in Endometrial Carcinoma Patients Scientific reports 2017;7:(1):10528
- 8. Lin MY, Dobrotwir A, McNally O, Abu-Rustum NR, Narayan K. Role of imaging in the routine management of endometrial cancer International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2018;143 Suppl 2:(109-117
- 9. Dai S, Nahas S, Murphy JK, Lawrence J, May T, Feigenberg T. Impact and cost of preoperative computed tomography imaging on the management of patients diagnosed with high-grade endometrial cancer International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2019;145:(2):219-224
- 10. Guo W, Cai J, Li M, Wang H, Shen Y. Survival benefits of pelvic lymphadenectomy versus pelvic and para-aortic lymphadenectomy in patients with endometrial cancer: A meta-analysis Medicine 2018;97:(1):e9520
- 11. Dowdy SC, Borah BJ, Bakkum-Gamez JN, Weaver AL, McGree ME, Haas LR, Keeney GL, Mariani A, Podratz KC. Prospective assessment of survival, morbidity, and cost associated with lymphadenectomy in low-risk endometrial cancer Gynecologic oncology 2012;127:(1):5-10
- 12. Berg HF, Ju Z, Myrvold M, Fasmer KE, Halle MK, Hoivik EA, Westin SN, Trovik J, Haldorsen IS, Mills GB, Krakstad C, Werner HMJ. Development of prediction models for lymph node metastasis in endometrioid endometrial carcinoma British journal of cancer 2020;122:(7):1014-1022
- 13. Cragun JM, Havrilesky LJ, Calingaert B, Synan I, Secord AA, Soper JT, Clarke-Pearson DL, Berchuck A. Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2005;23:(16):3668-3675
- 14. Turan T, Kimyon Comert G, Turkmen O, Ureyen I, Fadiloglu E, Karalok A, Tasci T, Tulunay G, Basaran D. Therapeutic value of lymphadenectomy and adjuvant radiotherapy in uterine corpus confined endometrioid-type cancer Journal of the Chinese Medical Association : JCMA 2018;81:(8):714-723
- 15. Euscher E, Fox P, Bassett R, Al-Ghawi H, Ali-Fehmi R, Barbuto D, Djordjevic B, Frauenhoffer E, Kim I, Hong SR, Montiel D, Moschiano E, Roma A, Silva E, Malpica A. The pattern of myometrial invasion as a predictor of lymph node metastasis or extrauterine disease in low-grade endometrial carcinoma The American journal of surgical pathology 2013;37:(11):1728-1736
- 16. Koskas M, Bassot K, Graesslin O, Aristizabal P, Barranger E, Clavel-Chapelon F, Haddad B, Luton D, Darai E, Rouzier R. Impact of lymphovascular space invasion on a nomogram for predicting lymph node metastasis in endometrial cancer Gynecologic oncology 2013;129:(2):292-297
- 17. Shah C, Johnson EB, Everett E, Tamimi H, Greer B, Swisher E, Goff B. Does size matter? Tumor size and morphology as predictors of nodal status and recurrence in endometrial cancer Gynecologic oncology 2005;99:(3):564-570
- 18. Turan AT, Dundar B, Gundogdu B, Boztosun A, Ozgul N, Boran N, Tulunay G, Ozfuttu A, Kose MF. The effect of cell type on surgico-pathologic risk factors in endometrial cancer Journal of the Turkish German Gynecological Association 2011;12:(1):9-14
- 19. Cripe J, Handorf E, Brown J, Jain A, Rubin S, Mantia-Smaldone G. National Cancer Database Report of Lymphadenectomy Trends in Endometrial Cancer International journal of gynecological cancer : official journal of the International Gynecological Cancer Society 2017;27:(7):1408-1415
- 20. Koh W-J, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, Chon HS, Chu C, Cohn D, Crispens MA. Uterine neoplasms, version 1.2018, NCCN clinical practice guidelines in oncology Journal of the National Comprehensive Cancer Network 2018;16:(2):170-199
- 21. Nout R, Smit V, Putter H, Juergenliemk-Schulz IM, Jobsen JJ, Lutgens L, van der Steen-Banasik EM, Mens JWM, Slot A, Kroese MS. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial The Lancet 2010;375:(9717):816-823
- 22. McMeekin D, Filiaci V, Aghajanian C, Cho J, Kim J, DiSilvestro P, O'Malley D, Rutherford T, Van Le L, Randall M. 1A randomized phase III trial of pelvic radiation therapy (PXRT) versus vaginal cuff brachytherapy followed by paclitaxel/carboplatin chemotherapy (VCB/C) in patients with high risk (HR), early stage endometrial cancer (EC): A Gynecologic Oncology Group trial Gynecologic oncology 2014;134:(2):438
- 23. de Boer SM, Powell ME, Mileshkin LR, Katsaros D, Bessette P, Haie-Meder C, Ottevanger PB, Ledermann JA, Khaw P, Colombo A. Final results of the international randomized PORTEC-3 trial of adjuvant chemotherapy and radiation therapy (RT) versus RT alone for women with high-risk endometrial cancer. American Society of Clinical Oncology,
A model for predicting extrauterine tumor spread in patients with endometrial cancer
Yıl 2023,
Cilt: 5 Sayı: 2, 69 - 74, 28.06.2023
Birkan Karayünlü
,
Mehmet Ünsal
,
Fatih Kılıç
,
Taner Aksoy
,
Fatih Çelik
,
Çiğdem Kılıç
,
Abdurrahman Alp Tokalıoglu
,
Günsu Kimyon Cömert
,
Taner Turan
Öz
A model for predicting extrauterine tumor spread in patients with endometrial cancer
Abstract
Background: The factors predicting extrauterine spread in patients undergoing staging surgery with the diagnosis of endometrial cancer were investigated.
Aims: The study aimed to create a model using demographic, surgical, and pathological factors to predict extrauterine spread.
Methods: Included in the study were 355 patients with a final diagnosis of endometrial cancer who underwent surgery for staging purposes. The effect of surgical-prognostic factors on extrauterine spread was analyzed using univariate analysis and multivariate logistic regression analysis.
Results: Extrauterine spread was detected in 97 patients. A multivariate logistic regression model that was created to determine the factors affecting extrauterine spread identified the presence of lymphovascular invasion, cervical invasion, peritoneal cytology positivity and tumor type as independent factors. A model was created using these four independent risk factors. According to this model, the rate of extrauterine spread was 6.4% in patients who did not have the risk factors and 100% in patients who had all the risk factors (p <0.05).
Conclusions: The detection of extrauterine spread is essential in planning a patient’s treatment. The definition of this spread by using clinical and pathological factors would contribute to determining the appropriate therapy in a group of patients who underwent insufficient surgery or in whom surgery would otherwise cause significant morbidity.
Kaynakça
- References
1. Mazur MT. Endometrial hyperplasia/adenocarcinoma. A conventional approach Annals of Diagnostic Pathology 2005;9:(3):174-181
- 2. Cheewakriangkrai C, Kietpeerakool C, Charoenkwan K, Pattanittum P, John D, Aue-Aungkul A, Lumbiganon P. Health education interventions to promote early presentation and referral for women with symptoms of endometrial cancer The Cochrane database of systematic reviews 2020;3:(Cd013253
- 3. Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up International Journal of Gynecologic Cancer 2016;26:(1):2-30
- 4. Frost JA, Webster KE, Morrison J. Lymphadenectomy for Treatment of Early-Stage Endometrial Cancer JAMA oncology 2017;3:(1):117-118
- 5. Practice Bulletin No. 149: Endometrial cancer. Obstetrics and gynecology 2015;125:(4):1006-1026
- 6. Barlin JN, Puri I, Bristow RE. Cytoreductive surgery for advanced or recurrent endometrial cancer: a meta-analysis Gynecologic oncology 2010;118:(1):14-18
- 7. Vezzoli M, Ravaggi A, Zanotti L, Miscioscia RA, Bignotti E, Ragnoli M, Gambino A, Ruggeri G, Calza S, Sartori E, Odicino F. RERT: A Novel Regression Tree Approach to Predict Extrauterine Disease in Endometrial Carcinoma Patients Scientific reports 2017;7:(1):10528
- 8. Lin MY, Dobrotwir A, McNally O, Abu-Rustum NR, Narayan K. Role of imaging in the routine management of endometrial cancer International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2018;143 Suppl 2:(109-117
- 9. Dai S, Nahas S, Murphy JK, Lawrence J, May T, Feigenberg T. Impact and cost of preoperative computed tomography imaging on the management of patients diagnosed with high-grade endometrial cancer International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2019;145:(2):219-224
- 10. Guo W, Cai J, Li M, Wang H, Shen Y. Survival benefits of pelvic lymphadenectomy versus pelvic and para-aortic lymphadenectomy in patients with endometrial cancer: A meta-analysis Medicine 2018;97:(1):e9520
- 11. Dowdy SC, Borah BJ, Bakkum-Gamez JN, Weaver AL, McGree ME, Haas LR, Keeney GL, Mariani A, Podratz KC. Prospective assessment of survival, morbidity, and cost associated with lymphadenectomy in low-risk endometrial cancer Gynecologic oncology 2012;127:(1):5-10
- 12. Berg HF, Ju Z, Myrvold M, Fasmer KE, Halle MK, Hoivik EA, Westin SN, Trovik J, Haldorsen IS, Mills GB, Krakstad C, Werner HMJ. Development of prediction models for lymph node metastasis in endometrioid endometrial carcinoma British journal of cancer 2020;122:(7):1014-1022
- 13. Cragun JM, Havrilesky LJ, Calingaert B, Synan I, Secord AA, Soper JT, Clarke-Pearson DL, Berchuck A. Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2005;23:(16):3668-3675
- 14. Turan T, Kimyon Comert G, Turkmen O, Ureyen I, Fadiloglu E, Karalok A, Tasci T, Tulunay G, Basaran D. Therapeutic value of lymphadenectomy and adjuvant radiotherapy in uterine corpus confined endometrioid-type cancer Journal of the Chinese Medical Association : JCMA 2018;81:(8):714-723
- 15. Euscher E, Fox P, Bassett R, Al-Ghawi H, Ali-Fehmi R, Barbuto D, Djordjevic B, Frauenhoffer E, Kim I, Hong SR, Montiel D, Moschiano E, Roma A, Silva E, Malpica A. The pattern of myometrial invasion as a predictor of lymph node metastasis or extrauterine disease in low-grade endometrial carcinoma The American journal of surgical pathology 2013;37:(11):1728-1736
- 16. Koskas M, Bassot K, Graesslin O, Aristizabal P, Barranger E, Clavel-Chapelon F, Haddad B, Luton D, Darai E, Rouzier R. Impact of lymphovascular space invasion on a nomogram for predicting lymph node metastasis in endometrial cancer Gynecologic oncology 2013;129:(2):292-297
- 17. Shah C, Johnson EB, Everett E, Tamimi H, Greer B, Swisher E, Goff B. Does size matter? Tumor size and morphology as predictors of nodal status and recurrence in endometrial cancer Gynecologic oncology 2005;99:(3):564-570
- 18. Turan AT, Dundar B, Gundogdu B, Boztosun A, Ozgul N, Boran N, Tulunay G, Ozfuttu A, Kose MF. The effect of cell type on surgico-pathologic risk factors in endometrial cancer Journal of the Turkish German Gynecological Association 2011;12:(1):9-14
- 19. Cripe J, Handorf E, Brown J, Jain A, Rubin S, Mantia-Smaldone G. National Cancer Database Report of Lymphadenectomy Trends in Endometrial Cancer International journal of gynecological cancer : official journal of the International Gynecological Cancer Society 2017;27:(7):1408-1415
- 20. Koh W-J, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, Chon HS, Chu C, Cohn D, Crispens MA. Uterine neoplasms, version 1.2018, NCCN clinical practice guidelines in oncology Journal of the National Comprehensive Cancer Network 2018;16:(2):170-199
- 21. Nout R, Smit V, Putter H, Juergenliemk-Schulz IM, Jobsen JJ, Lutgens L, van der Steen-Banasik EM, Mens JWM, Slot A, Kroese MS. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial The Lancet 2010;375:(9717):816-823
- 22. McMeekin D, Filiaci V, Aghajanian C, Cho J, Kim J, DiSilvestro P, O'Malley D, Rutherford T, Van Le L, Randall M. 1A randomized phase III trial of pelvic radiation therapy (PXRT) versus vaginal cuff brachytherapy followed by paclitaxel/carboplatin chemotherapy (VCB/C) in patients with high risk (HR), early stage endometrial cancer (EC): A Gynecologic Oncology Group trial Gynecologic oncology 2014;134:(2):438
- 23. de Boer SM, Powell ME, Mileshkin LR, Katsaros D, Bessette P, Haie-Meder C, Ottevanger PB, Ledermann JA, Khaw P, Colombo A. Final results of the international randomized PORTEC-3 trial of adjuvant chemotherapy and radiation therapy (RT) versus RT alone for women with high-risk endometrial cancer. American Society of Clinical Oncology,