ABSTRACT
Resumen Antecedentes: La linfadenectomía retroperitoneal y pélvica es parte del proceso quirúrgico de etapificación del cáncer de endometrio y ovario. La asignación de etapa y tratamiento de pacientes con cáncer cervicouterino es clínica; con radioterapia y quimioterapia concomitante, sin conocer factores pronósticos de la enfermedad local, ni el estado de la enfermedad ganglionar pélvica y retroperitoneal. En cáncer ginecológico la evaluación sistemática patológica de los ganglios retroperitoneales es decisiva para asignar la etapa (en ovario y endometrio), pero en el cáncer de cuello uterino tiene menos aprobación en las guías de tratamiento internacionales y existen menos estudios sólidos que estén a favor de la linfadenectomía etapificadora. Objetivo: Revisar el tema y demostrar la pertinencia y ventajas de la estadificación ganglionar retroperitoneal en las distintas neoplasias malignas ginecológicas. Método: Se revisó la bibliografía en la base de datos PubMed con búsqueda de palabras clave: linfadenectomía en cáncer ginecológico y metástasis ganglionares retroperitoneales en cáncer ginecológico. Resultados: Se localizaron 71 artículos con información de las variables de estudio. Al momento de su análisis sólo se incluyeron documentos con información de estudios con asignación al azar, y con información que incluyera al cáncer de endometrio, ovario o cuello uterino, abarcó 31 artículos para su análisis. Conclusiones: Además de la revisión de artículos se presenta una propuesta para evaluar las metástasis retroperitoneales y su utilidad futura como biomarcador. Con la bibliografía expuesta y nuestra propuesta de evaluación ganglionar retroperitoneal se favorece la estadificación del cáncer ginecológico (endometrio, ovario y cuello uterino).
Abstract Background: Retroperitoneal and pelvic lymphadenectomy is part of the surgical process staging of endometrial and ovarian cancer. The stage assignment and treatment of patients with cervical cancer is clinical; with radiotherapy and chemotherapy concomitant, without knowing prognostic factors of the local disease, neither status of pelvic and retroperitoneal lymph node disease. In gynecological cancer the systematic pathological evaluation of the retroperitoneal ganglia is decisive for stablished the stage (in ovarian and endometrial) but in cervical cancer has less approval in international treatment guidelines and there are fewer studies solids that are in favor of staging lymphadenectomy. Objective: To review the topic and demonstrate the relevance and advantages of staging retroperitoneal ganglionar in the different gynecological malignancies. Method: The bibliography was revised in the PubMed database with search of key words: lymphadenectomy in gynecological cancer and lymph node metastases retroperitoneal in gynecological cancer. Results: 71 articles were finded with information on the study variables. At the time of its analysis only documents with study information were included randomized, and with information that included endometrial cancer, ovary or cervix, covered 31 articles for analysis. Conclusions: In addition to the review of articles, a proposal is presented to evaluate retroperitoneal metastases and their future usefulness as a biomarker. With the exposed literature and our proposed retroperitoneal lymph node evaluation is it favors the staging of gynecological cancer (endometrium, ovary and cervix).
ABSTRACT
PURPOSE: The purpose of this study is to evaluate the prognostic role of preoperative neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) and the need for para-aortic lymphadectomy in patients with primary fallopian tube carcinoma (PFTC). MATERIALS AND METHODS: Ninety-one patients with a diagnosis of PFTC were identified through the gynecologic oncology service database of six academic centers. Clinicopathological, surgical, and complete blood count data were collected. RESULTS: In univariate analysis, advanced stage, suboptimal surgery, and NLR > 2.7 were significant prognostic factors for progression-free survival, whereas in multivariate analysis, only advanced stage and suboptimal surgery were significant. In addition, in univariate analysis, cancer antigen 125 > or = 35 U/mL, ascites, advanced stage, suboptimal surgery, NLR > 2.7, PLR > 233.3, platelet count > or =400,000 cells/mm3, staging type, and histological subtype were significant prognostic factors for overall survival (OS); however, in multivariate analysis, only advanced stage, suboptimal surgery, NLR > 2.7, and staging type were significant. Inclusion of pelvic and para-aortic lymphadenectomy in surgery showed significant association with longer OS, with a mean and median OS of 42.0 months and 35.5 months (range, 22 to 78 months), respectively, vs. 33.5 months and 27.5 months (range, 14 to 76 months), respectively, for patients who underwent surgery without para-aortic lymphadenectomy (hazard ratio, 3.1; 95% confidence interval, 1.4 to 5.7; p=0.002). CONCLUSION: NLR (in both univariate and multivariate analysis) and PLR (only in univariate analysis) were prognostic factors in PFTC. NLR and PLR are inexpensive and easy tests to perform. In addition, patients with PFTC who underwent bilateral pelvic and para-aortic lymphadenectomy had longer OS.
Subject(s)
Female , Humans , Ascites , Blood Cell Count , Blood Platelets , Diagnosis , Disease-Free Survival , Fallopian Tubes , Lymph Node Excision , Lymphocytes , Multivariate Analysis , Neutrophils , Platelet CountABSTRACT
AIM: The study objectives were evaluation of clinicopathological characteristics, correlations between the preoperative and postoperative tumor grades, and their implications on lymph node metastasis. MATERIALS AND METHODS: We conducted a retrospective descriptive study of 131 cases of endometrial cancer examined and treated at a tertiary regional cancer institute between the years 2003 and 2009. We reviewed the oncology database as well as the clinical records and surgico‑pathological registry of all these patients. STATISTICAL METHODS USED: All the summary measure computation and Chi‑square test for comparing more than one proportion was done in spreadsheet (Excel). RESULTS: The multiparity association with endometrial cancer was commonly seen 113/131 (86.2%). Twelve (9.7%) patients preoperatively diagnosed as Grade 1 tumors upgraded to Grade 3 changes in postoperative specimens and six of these 12 patients (50%) had lymph node metastasis. A total of 14/131 (10.6%) cases had lymph nodes metastasis. CONCLUSIONS: There is a poor correlation between the preoperative and the postoperative tumor grades. Routine pelvic lymphadenectomy may be a valuable method in low‑risk cases and para‑aortic lymphadenectomy may be limited to high‑risk endometrial cancers.