40 Yaş ve Daha Genç Hastalarda Endometrium Kanserleri

Öz

Amaç: Bu çalışmanın amacı ≤40 yaş kadınlarda endometriyal kanserin (AK) başarılı sonucu ile ilişkili prognostik faktörleri belirlemekti. Yöntemler: Bu çalışma retrospektif bir kohort çalışmasıdır. 1995 ve 2020 yılları arasında endometriyal küretajda EC tanısı almış ≤ 40 yaşındaki tüm kadınların tıbbi kayıtları gözden geçirildi. Histerektomi yapılan ve son histopatolojik değerlendirmesi hastanemizde yapılan veya tümör kurulu üyeleri tarafından değerlendirilerek hastanemizde takip edilen hastalar çalışmaya dahil edildi. Bulgular: Medyan takip 79 aydı (9-192 ay). 44 hastadan 42'sine cerrahi müdahale yapıldı. % 33,4'üne (n: 14) total abdominal histerektomi (TAH), bilateral salpingo-ooferektomi (BSO) ve pelvik paraaortik lenf nodu diseksiyonu (PPLND) yapıldı. % 61,9'una (n: 26) TAH BSO ve PLND uygulandı. Bir hastada (% 2.4) sadece TAH, diğerinde (% 2.4) TAH BSO yapıldı. Miyometriyal invazyon kanıtı olmayan doğurganlığını korumak isteyen ve evre 1 endometrioid adenokarsinomu olan 2 hastaya, medikal tedavi uygulandı ve bu hastaların kapsamlı değerlendirmesinde rahim dışında hastalık kanıtı gözlenmedi. 26 (% 59.1) hastada 1. derece, 15 (% 34.1) hastada 2. derece ve 3. (% 6.8) hastada 3. derece adenokarsinom vardı. CA 125 ≥35 IU / ml istatistiksel olarak lenf nodu metastazı (p = 0,004), ˃% 50 miyometriyal invazyon (p = 0,044) ve ileri evre hastalık (p = 0,048) ile ilişkili bulundu. Sonuçlar: CA 125 ≥35 IU / ml, 40 yaşındaki EC hastalarında istatistiksel olarak lenf nodu metastazı, derin miyometriyal invazyon ve ileri evre hastalık ile ilişkiliydi.

Anahtar Kelimeler

• CA 125
• ENDOMETRİUM KANSERİ
• TEDAVİ
• GENÇ HASTALAR

Endometrial Cancer in 40 Years Old or Younger: A Single Center Experience

Öz

Purpose: The purpose of this study was to identify prognostic factors associated with the successful outcome of endometrial cancer (EC) in women aged ≤40 years. Methods: This was a retrospective cohort study. The medical records of all women aged ≤ 40 years with EC diagnosed on endometrial curettage between 1995 and 2020 were reviewed. Patients who underwent hysterectomy and whose final histopathological evaluation was made in our hospital, or who were evaluated by the members of the tumor board and followed up in our hospital, were included in the study. Results: Median follow-up was 79 months (range 9-192). 42 of 44 patients underwent surgical intervention. 33,4%(n: 14) underwent total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), and pelvic paraaortic lymph node dissection (PPLND). 61.9% (n:26) underwent TAH BSO, and PLND. In one patient (2,4 %) only TAH and in the other patient (2,4%) TAH BSO was performed. Medical treatment was administered to 2 patients who desired to preserve their fertility and had grade 1 endometrioid adenocarcinoma without any evidence of myometrial invasion and a comprehensive evaluation showed no evidence of extra-uterine disease. 26 (59,1%) patients had grade 1, 15(34,1%) had grade 2, and 3(6,8%) had grade 3 adenocarcinoma. CA 125 ≥35 IU/ml was statistically associated with lymph node metastasis (p=0,004), ˃ 50% myometrial invasion (p=0,044), and advanced-stage disease (p=0,048). Conclusions: CA 125 ≥35 IU/ml was statistically associated with lymph node metastasis, deep myometrial invasion, and advanced-stage disease in EC patients ≤ 40 years of age.

Anahtar Kelimeler

• CA 125
• , Endometrial cancer
• treatment
• young patients

Kaynakça

1. 1. Mazzon I, Corrado G, Masciullo V, Morricone D, Ferrandina G, Scambia G. Conservative surgical management of stage IA endometrial carcinoma for fertility preservation. Fertil Steril 2010;93:1286-1289.
2. 2. Sun C, Chen G, Yang Z, Jiang J, Yang X, Li N, et al. Safety of ovarian preservation in young patients with early-stage endometrial cancer: a retrospective study and meta-analysis, Fertil. Steril. 2013;100(3):782-787.
3. 3. Iram S, Musonda P, Ewies AA. Premenopausal bleeding: when should the endometrium be investigated? A retrospective non-comparative study of 3006 women. Eur J Obstet Gynecol Reprod Biol 2010;148:86-89.
4. 4. Navarria I, Usel M, Rapiti E, Neyroud CI, Pelte MF, Bouchardy C, et al. Young patients with endometrial cancer: how many could be eligible for fertility-sparing treatment? Gynecol. Oncol. 2009;114(3):448-451.
5. 5. Farhi DC, Nosanchuk J, and Silverberg SG. Endometrial adenocarcinoma in women under 25 years of age. Obstet Gynecol.1986;68:741–745.
6. 6. Chi DS, Barakat RR, Palayekar MJ, Levine DA, Sonoda Y, Alektiar K, et al. The incidence of pelvic lymph node metastasis by FIGO staging for patients with adequately surgically staged endometrial adenocarcinoma of endometrioid histology Int J Gynecol Cancer. 2008;18:269–273.
7. 7. National Cancer Institute Cancer stat facts: uterine cancer [https://seer.cancer.gov/statfacts/html/corp.html]
8. 8. Lee NK, Cheung MK, Shin JY, Husain A, Teng NN, Berek SS, et al. Prognostic factors for uterine cancer in reproductive-aged women. Obstet Gynecol. 2007;109(3):655- 662. 9. Rodolakis A, Biliatis I, Morice P, Reed N, Mangler M, Kesic V, et al. European Society of Gynecological Oncology Task Force for Fertility Preservation: clinical recommendations for fertility-sparing management in young endometrial cancer patients. Int J Gynecol Cancer. 2015; 25:1258-1265.

9. 10. Silverberg SG, Makowski EL, Roche WD. Endometrial carcinoma in women under 40 years of age: comparisonof cases in oral contraseptive users and non-users. Cancer 1977;39:592-598.
10. 11. Tran BN, Connell PP, Waggoner S, Rotmensch J, Mundt AS. Characteristics and outcome of endometrial carcinoma patients age 45 years and younger. Am J Clin Oncol. 2000;23(59): 476-480.
11. 12. Kaku T, Yoshikawa H, Tsuda H, Sakamoto A, Fukunaga M, Kuwabara Y, et al. Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome. Cancer Lett 2001;167:39-48.
12. 13. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A gynecologic oncology group study Cancer 1987;60(8):2035–2041.
13. 14. Chao A, Tung YH, Lai CH, Chang CJ, Chang SC, Wu TI, et al. Potential of an age stratified CA125 cutt of value to improve the prognostic classification of patients with endometrial cancer. Gynecol Oncol 2013;129:500-504.
14. 15. Yildiz A, Yetimalar H, Kasap B, Aydın C, Tatar S, Soylu F, et al. Preoperative serum CA 125 level in the prediction of the stage of disease in endometrial carcinoma, Eur. J. obstetrics, Gynecol. reproductive Biol. 2012;164(2):191-195.
15. 16. Koskas M, Fournier M, Vanderstraeten A, Walker F, Timmerman D, Vergote I, et al. Evaluation of models to predict lymph node metastasis in endometrial cancer: a multicentre study. Eur J Cancer. 2016;61:52–60.
16. 17. Goksedef PC, Gorgen H, Baran SY, Api M, Cetin A. Preoperative serum CA 125 level as a predictor for metastasis and survival in endometrioid endometrial cancer. J Obstet Gynaecol Can. 2011;33(8):844-850.
17. 18. Guntupalli SR, Zighelboim I, Kizer NT, Zhang Q, Powell MA, Thaker PH, et al. Lymphovascular space invasion is an independent risk factor for nodal disease and poor outcomes in endometrioid endometrial cancer, Gynecol. Oncol. 2012;124(1):31-35.
18. 19. Creutzberg CL, Van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Rodenhuis CC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma, Lancet. 2000;355(9213):1404-1411.
19. 20.Yamazawa K, Seki K, Matsui H, Kihara M, Sekiya S. Prognostic factors in young women with endometrial carcinoma: a report of 20 cases and review of literature. Int J Gynecol. Cancer. 2000;10(3):212-222.
20. 21. Gungor T, Cetinkaya N, Ozdal B, Yalcin H, Erkaya S, Yakut HI. Endometrial. adenocarcinoma in young-aged women: a Turkish population study. Eur. J. Gynaecol. Oncol. 2015;36(6):667-671.
21. 22. Zarbo G, Caruso G, Caruso S, Mangano U, Zarbo R. Endometrial Cancer: prospective evaluation of myometrial infiltration: magnetic resonance imaging versus tranvaginal sonography Eur J Gynaecol Onco.2000;21:95–97.
22. 23. National Comprehensive Cancer Network (US) Uterine neoplasms Plymouth Meeting, PA: National Comprehensive Cancer Network; 2018.
23. 24. Pashov AI, Tskhay VB, Ionouchene SV. The combined GnRH-agonist and intrauterine levonorgestrelreleasing system treatment of complicated atypical hyperplasia and endometrial cancer: a pilot study. Gynecol Endocrinol 2012;28:559-561.
24. 25.Brown AJ, Westin SN, Broaddus RR, Schmeler K. Progestin intrauterine device in an adolescent with grade 2 endometrial cancer. Obstet Gynecol 2012;119(2 ):423-426.
25. 26. Falcone F, Laurelli G, Losito S, Di Napoli M, Granata V, Greggi S. Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer. J Gynecol Oncol. 2017;28(1):2.
26. 27. Kim DH, Seong SJ, Kim MK, Bae HS, Kim M, Yun BS, et al. Dilatation and curettage is more accurate than endometrial aspiration biopsy in early-stage endometrial cancer patients treated with high dose oral progestin and levonorgestrel intrauterine system. J Gynecol Oncol. 2017; 28(1): 1.
27. 28. Ramirez PT, Frumovitz M, Bodurka DC, Sun CC, Levenback C. Hormonal therapy for the management of grade 1 endometrial adenocarcinoma: A literature review. Gynecol. Oncol 2004; 95: 133-138.
28. 29. Park JY, Kim DY, Kim JH, Kim YM, Kim KR, Kim YT, et al. Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer. Eur JCancer 2013; 49(4): 868–874.
29. 30. Erkanli S, Ayhan A. Fertility-sparing therapy in young women with endometrial cancer: 2010 update. Int J Gynecol Cancer 2010; 20: 1170–1187.
30. 31.Wright JD, Jorge S, Tergas AI, Hou JY, Burke WM, Huang Y, et al. Utilization and Outcomes of Ovarian Conservation in Premenopausal Women With Endometrial Cancer. Obstet. Gynecol. 2016; 127 (1):101-108.
31. 32. Lynch HT, Snyder CL, Shaw TG, Heinen CD, Hitchins MP. Milestones of Lynch syndrome: 1895–2015. Nat Rev Cancer. 2015; 15: 181–194.
32. 33. Wong A, Ngeow J. Hereditary Syndromes Manifesting as Endometrial Carcinoma: How Can Pathological Features Aid Risk Assessment? Biomed Res Int. 2015; 2015: 219012.