Vaginal cuff recurrence after radical cystectomy: an under - studied site of bladder cancer relapse

ABSTRACT Introduction: Vaginal cuff recurrence of tumor following radical cystectomy is a rare site of disease recurrence, however it has never been specifically studied. The aim of the study is to evaluate incidence, risk factors, and long-term oncologic outcomes of vaginal cuff recur- rence in a cohort of female patients treated with radical cystectomy for invasive urothelial carcinoma of the bladder. Materials and Methods: From 1985 to 2012, a prospectively maintained institutional blad- der cancer registry was queried for vaginal cuff recurrence post radical cystectomy. Over- all mortality and cancer-specific mortality were reported using the Kaplan-Meier method for patients with vaginal cuff recurrence, recurrence at another local or distant site, and those without evidence of recurrence. Comparisons were performed using the log-rank test. Cox proportional hazards regression model was performed to assess predictors of vaginal cuff recurrence. Results: From 469 women treated with radical cystectomy for bladder cancer, 34 patients (7.3%) developed vaginal cuff recurrence, 130 patients (27.7%) had recurrence involving ei- ther a local or distant site, and 305 patients (65%) had no evidence of recurrence. The 5-year overall mortality-free survival rate was 32.4% for vaginal cuff recurrence, but 25.0% for other sites of recurrence. Cancer-specific mortality-free survival rate was 32.4% for vaginal cuff recurrence, and 30.3% for the other sites of recurrence. Multivariate Cox proportional hazards regression analysis demonstrated that the presence of tumor in posterior location at radical cystectomy (Hazard Ratio [HR], 0.353 [95% CI, 0.159-0.783]) and anterior vaginec- tomy, compared to no vaginectomy (HR, 2.595 [95% CI, 1.077-6.249]) were independently associated with vaginal cuff recurrence. Conclusion: Anterior vaginectomy, despite our best attempts, is perhaps not sufficient to prevent vaginal cuff recurrence. Therefore, follow-up evaluation is essential, and further studies are necessary to address the optimal approach for initial management. Patient Summary: Although vaginal cuff recurrence is an unusual site of recurrence, careful evaluation is needed before cystectomy and during follow-up to identify patients at risk.

Definitive treatment of primary vaginal cancer with radiotherapy: multi-institutional retrospective study of the Korean Radiation Oncology Group (KROG 12-09) / 부인종양

OBJECTIVE: To assess the outcome of the treatment of primary vaginal cancer using definitive radiotherapy (RT) and to evaluate the prognostic factors of survival. METHODS: The medical records of nine institutions were retrospectively reviewed to find the patients with vaginal cancer treated with definitive RT with or without chemotherapy. A total of 138 patients met the inclusion criteria. None had undergone curative excision. RESULTS: The median follow-up time of the survivors was 77.6 months and the median survival time was 46.9 months. The 5-year overall survival, cancer-specific survival (CSS), and progression-free survival (PFS) rates were 68%, 80%, and 68.7%, respectively. In the survival analysis, the multivariate analysis showed that a lower the International Federation of Gynecology and Obstetrics (FIGO) stage and prior hysterectomy were favorable prognostic factors of CSS, and a lower FIGO stage and diagnosed prior to year 2000 were favorable prognostic factors of PFS. In the subgroup analysis of the patients with available human papillomavirus (HPV) results (n=27), no statistically significant relationship between the HPV status and recurrence or survival was found. Grade 3 or 4 acute and late toxicity were present in 16 and 9 patients, respectively. The FIGO stage and the tumor size were predictors of severe late toxicity. CONCLUSION: The data clearly showed that a higher FIGO stage was correlated with a worse survival outcome and higher severe late toxicity. Therefore, precise RT and careful observation are crucial in advanced vaginal cancer. In this study, the HPV status was not related to the survival outcome, but its further investigation is needed.

Mortalidad femenina: Argentina 1992 / Female mortality: Argentina 1992

Objetivo: Se trata de identificar riesgos diferenciales en distintos grupos de edad y en un conjunto de patologías seleccionadas, por otra parte, describir causas seleccionadas de mortalidad de las mujeres. Diseño: Se realizó un estudio ecológico entre regiones de Argentina sobre causas de muerte en el año 1992. Población: Los datos del denominador provienen de la información producida por el Instituto Nacional de Estadísticas y Censos (INDEC) de los datos registrados en los Censos Nacionales de Población y las Estimaciones y Proyecciones elaboradas por este organismo. La información del numerador proviene del registro de los Informes Estadísticos de defunción para todo el país en 1992. Procedimientos: Para controlar edad, sexo y región geográfica y para resumir el efecto de las tres variables en un modelo único para las patologías seleccionadas, se utilizó el análisis de varianza factorial (ANOVA factorial): two-way ANOVA en las causas exclusivas de mujeres (cáncer mamario y ginecológico) donde no entra el factor sexo, y three-way ANOVA en las restantes. Resultados: La edad es el factor principal en el análisis de la mortalidad. En cada una de las regiones observadas, las tasas de mortalidad dependen de la diferente estructura poblacional de las mismas. Al estandarizar por edad, las diferencias entre regiones se acortan, excepto para las causas externas (accidentes, suicidios y homicidios), para las que se mantienen las diferencias, lo que indicaría que los principales factores están asociados a condiciones conductuales, y estas a su vez explican las diferencias entre sexos. La mortalidad materna, no está influenciada por la edad y sexo de la población, sino por las pautas de fecundidad y reproducción y, además, está fuertemente asociada a condiciones socioeconómicas y al sistema de atención de la salud. Conclusiones: Los resultados aportan nuevas líneas de trabajo para los programas de salud, básicamente por contar con un diagnóstico que contempla el nivel de la mortalidad y las diferencias atribuibles a la situación geográfica y la estructura poblacional