Objective. Surgical staging of endometrial cancer identifies those patients with microscopic metastatic disease most likely to benefit from adjuvant therapy and may also confer therapeutic benefit. Our objective was t...Objective. Surgical staging of endometrial cancer identifies those patients with microscopic metastatic disease most likely to benefit from adjuvant therapy and may also confer therapeutic benefit. Our objective was to compare survival of patients who underwent resection of grossly positive lymph nodes (LN) to those with microscopically positive LN. Methods. Patients had stage IIIC endometrial cancer with pelvic and/or aortic LN metastases and underwent surgery between 1973 and 2002. Exclusion criteria included pre-surgical radiation and second primary cancer. Survival was analyzed using Kaplan-Meier method and Cox proportional hazards model. Results. Mean age of 96 patients with stage IIIC endometrial cancer was 64. There were 45 cases with microscopic LN involvement and 51 with grossly enlarged LN. Overall, 41%had disease in aortic LN, which in 18%represented isolated aortic LN metastasis. Adjuvant therapies were given to 92%of patients (85%radiotherapy, 10%chemotherapy, 10%progestins). Among those with grossly involved LN, 86%were completely resected. Five-year disease-specific survival (DSS) was 63%in 45 patients with microscopic metastatic disease compared to 50%in 44 patients with grossly positive LN completely resected and 43%in 7 with residual macroscopic disease. In multivariable analyses, gross nodal disease not debulked (HR = 6.85, P = 0.009), serosal/adnexal involvement (HR = 2.24, P = 0.036), diagnosis prior to 1989 (HR = 4.33, P < 0.001),older age (HR = 1.09, P < 0.001), and >2 positive lymph nodes (HR = 3.12, P = 0.007) were associated with lower DSS. Conclusion. Grossly involved LN can often be completely resected in patients with stage IIIC endometrial cancer. These retrospective data provide evidence suggestive of a therapeutic benefit for lymphadenectomy in endometrial cancer.展开更多
Objective: The objective of this study was to determine if use of menopausal hormones was associated with ovarian cancer and if risk varied by type of hormone used. Study design: Data from a population-based, case-con...Objective: The objective of this study was to determine if use of menopausal hormones was associated with ovarian cancer and if risk varied by type of hormone used. Study design: Data from a population-based, case-control study of ovarian cancer in North Carolina (364 cases, 370 controls, all postmenopausal) were analyzed to evaluate the relationship between menopausal hormones and ovarian cancer. logistic regression analyses were used to calculate odds ratios (OR) and 95% CIs associated with various patterns of hormone use. Results: Ovarian cancer cases were more likely than controls to report long-term use (≥ 10 years) of unopposed estrogens (OR 2.2; 95% CI 1.2-4.1). No relationship was observed for estrogen always used with progestin. Conclusion: Hormone replacement therapy used according to current recommendations should not increase risk of ovarian cancer; however, clinicians should be aware of possible increased risk among women with a long history of estrogen replacement therapy.展开更多
文摘Objective. Surgical staging of endometrial cancer identifies those patients with microscopic metastatic disease most likely to benefit from adjuvant therapy and may also confer therapeutic benefit. Our objective was to compare survival of patients who underwent resection of grossly positive lymph nodes (LN) to those with microscopically positive LN. Methods. Patients had stage IIIC endometrial cancer with pelvic and/or aortic LN metastases and underwent surgery between 1973 and 2002. Exclusion criteria included pre-surgical radiation and second primary cancer. Survival was analyzed using Kaplan-Meier method and Cox proportional hazards model. Results. Mean age of 96 patients with stage IIIC endometrial cancer was 64. There were 45 cases with microscopic LN involvement and 51 with grossly enlarged LN. Overall, 41%had disease in aortic LN, which in 18%represented isolated aortic LN metastasis. Adjuvant therapies were given to 92%of patients (85%radiotherapy, 10%chemotherapy, 10%progestins). Among those with grossly involved LN, 86%were completely resected. Five-year disease-specific survival (DSS) was 63%in 45 patients with microscopic metastatic disease compared to 50%in 44 patients with grossly positive LN completely resected and 43%in 7 with residual macroscopic disease. In multivariable analyses, gross nodal disease not debulked (HR = 6.85, P = 0.009), serosal/adnexal involvement (HR = 2.24, P = 0.036), diagnosis prior to 1989 (HR = 4.33, P < 0.001),older age (HR = 1.09, P < 0.001), and >2 positive lymph nodes (HR = 3.12, P = 0.007) were associated with lower DSS. Conclusion. Grossly involved LN can often be completely resected in patients with stage IIIC endometrial cancer. These retrospective data provide evidence suggestive of a therapeutic benefit for lymphadenectomy in endometrial cancer.
文摘Objective: The objective of this study was to determine if use of menopausal hormones was associated with ovarian cancer and if risk varied by type of hormone used. Study design: Data from a population-based, case-control study of ovarian cancer in North Carolina (364 cases, 370 controls, all postmenopausal) were analyzed to evaluate the relationship between menopausal hormones and ovarian cancer. logistic regression analyses were used to calculate odds ratios (OR) and 95% CIs associated with various patterns of hormone use. Results: Ovarian cancer cases were more likely than controls to report long-term use (≥ 10 years) of unopposed estrogens (OR 2.2; 95% CI 1.2-4.1). No relationship was observed for estrogen always used with progestin. Conclusion: Hormone replacement therapy used according to current recommendations should not increase risk of ovarian cancer; however, clinicians should be aware of possible increased risk among women with a long history of estrogen replacement therapy.
