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.: To determine whether pelvic lymph node count is associated with patterns of recurrence or survival in patients with FIGO stage I and II endometrial cancer. Methods.: Single institution retrospective study ...Objective.: To determine whether pelvic lymph node count is associated with patterns of recurrence or survival in patients with FIGO stage I and II endometrial cancer. Methods.: Single institution retrospective study of 467 patients with FIGO stage I and II endometrial cancer treated with primary surgery including lymph node dissection. Analysis included pelvic lymph node count, histology, stage, age, race, BMI, year of surgery, depth of myometrial invasion, and adjuvant radiation. Kaplan-Meier life-tables were used to calculate survival; the Cox proportional hazards model was used to identify prognostic factors independently associated with survival. Results.: Mean pelvic lymph node count was 12.6(SD±8). Distant recurrence was associated with decreased pelvic lymph node count, high-risk histology, and postoperative pelvic radiation. Pelvic lymph node countwas not associated with survival by univariate analysis, however, overall(OS) and progression-free(PFS) survival were significantly better with pelvic lymph node counts ≥12 among women with high-risk histology(P< 0.001), but not among women with low-risk histology. Multivariable Cox proportional hazards regression identified increasing age, non-Caucasian race, and high-risk histology as independent negative prognostic factors for both OS and PFI. Among patients with high-risk histology, pelvic lymph node count remained an independent prognostic factor for both overall(OS) and progression-free survival(PFS) in the model, with hazard ratios of 0.28 and 0.29, respectively, when ≥12 pelvic lymph nodes were identi-fied. Pelvic lymph node count had no association with OS or PFS in women with low-risk histology. Conclusion.: Pelvic lymph node count ≥12 is an important prognostic variable in patients with FIGO stage I and II endometrial cancer who have high-risk histology. Most likely, the association of survival and lymph node count in this group is the result of improved staging among patients with higher pelvic lymph node counts.展开更多
Background. Intimate partner violence (IPV) is underreported and creates a complex psychosocial medium that adversely affects the health of its victims. We present the first case report in the literature, though likel...Background. Intimate partner violence (IPV) is underreported and creates a complex psychosocial medium that adversely affects the health of its victims. We present the first case report in the literature, though likely not the first time, in which a patient delayed her cancer treatment due to domestic abuse and her disease progressed. Case. A 41-year-old female with vaginal bleeding was diagnosed with cervical cancer. After several years of declining recommendations for treatment, she was questioned separate from her partner and she revealed a long-standing history of abuse. Conclusions. Physicians must be aware of the signs of spousal abuse to lessen negative impact on the treatment of their patients. Once domestic violence is discovered, there are many resources available to help patients with their needs.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.: To determine whether pelvic lymph node count is associated with patterns of recurrence or survival in patients with FIGO stage I and II endometrial cancer. Methods.: Single institution retrospective study of 467 patients with FIGO stage I and II endometrial cancer treated with primary surgery including lymph node dissection. Analysis included pelvic lymph node count, histology, stage, age, race, BMI, year of surgery, depth of myometrial invasion, and adjuvant radiation. Kaplan-Meier life-tables were used to calculate survival; the Cox proportional hazards model was used to identify prognostic factors independently associated with survival. Results.: Mean pelvic lymph node count was 12.6(SD±8). Distant recurrence was associated with decreased pelvic lymph node count, high-risk histology, and postoperative pelvic radiation. Pelvic lymph node countwas not associated with survival by univariate analysis, however, overall(OS) and progression-free(PFS) survival were significantly better with pelvic lymph node counts ≥12 among women with high-risk histology(P< 0.001), but not among women with low-risk histology. Multivariable Cox proportional hazards regression identified increasing age, non-Caucasian race, and high-risk histology as independent negative prognostic factors for both OS and PFI. Among patients with high-risk histology, pelvic lymph node count remained an independent prognostic factor for both overall(OS) and progression-free survival(PFS) in the model, with hazard ratios of 0.28 and 0.29, respectively, when ≥12 pelvic lymph nodes were identi-fied. Pelvic lymph node count had no association with OS or PFS in women with low-risk histology. Conclusion.: Pelvic lymph node count ≥12 is an important prognostic variable in patients with FIGO stage I and II endometrial cancer who have high-risk histology. Most likely, the association of survival and lymph node count in this group is the result of improved staging among patients with higher pelvic lymph node counts.
文摘Background. Intimate partner violence (IPV) is underreported and creates a complex psychosocial medium that adversely affects the health of its victims. We present the first case report in the literature, though likely not the first time, in which a patient delayed her cancer treatment due to domestic abuse and her disease progressed. Case. A 41-year-old female with vaginal bleeding was diagnosed with cervical cancer. After several years of declining recommendations for treatment, she was questioned separate from her partner and she revealed a long-standing history of abuse. Conclusions. Physicians must be aware of the signs of spousal abuse to lessen negative impact on the treatment of their patients. Once domestic violence is discovered, there are many resources available to help patients with their needs.
