Efficacy of endometrial cancer follow-up protocols: time to change?

Abstract Objective The aim of the present study was to analyze relapse rates and patterns in patients with endometrial cancer with the aim of evaluating the effectiveness of current follow-up procedures in terms of patient survival, as well as the convenience of modifying the surveillance strategy. Methods Retrospective descriptive study including all patients diagnosed with endometrial cancer relapse at the Department of Gynecology and Obstetrics of the Complejo Hospitalario Insular-Materno Infantil de Canarias, between 2005 and 2014. Results Recurrence was observed in 81 patients (10.04% of the sample); 66.7% of them suffered relapse within 2 years and 80.2% within 3 years after the termination of the primary treatment; 41.9% showed distant metastases while the rest corresponded to local-regional (40.7%) or ganglionar (17.4%) relapse; 42% of these were symptomatic; 14 patients showed more than 1 site of relapse. Relapse was detected mainly through symptoms and physical examination findings (54.3%), followed by elevated serummarker levels (29.6%), computed tomography (CT) images (9.9%) and abnormal vaginal cytology findings (6.2%). No differences in global survival were found between patients with symptomatic or asymptomatic relapse. Conclusion Taking into account that the recurrence rate of endometrial cancer is low, that relapse occurs mainly within the first 3 years post-treatment and that symptom evaluation and physical examination are the most effective follow-up methods, we postulate that a modification of the current model of hospital follow-up should be considered.

Assessment of preoperative endometrial histopathological sampling as a predictor of final surgical pathology in endometrial cancer / Avaliação do diagnóstico histopatológico endometrial pré-operatório como preditor do diagnostico patológico final em câncer de endométrio

Abstract Objective To evaluate the agreement between the histopathological diagnoses of preoperative endometrial samples and surgical specimens and correlate the agreement between the diagnoses with the impact on surgical management and the survival of patients with endometrial adenocarcinomas. Methods Sixty-two patients treated for endometrial cancer at a university hospital from 2002 to 2011 were retrospectively evaluated. The histopathological findings of preoperative endometrial samples and of surgical specimens were analyzed. The patients were subjected to hysterectomy as well as adjuvant treatment, if necessary, and clinical follow-up, according to the institutional protocol. Lesions were classified as endometrioid tumor (type 1) grades 1, 2, or 3 or non-endometrioid carcinoma (type 2). Results The agreement between the histopathological diagnoses based on preoperative endometrial samples and surgical specimens was fair (Kappa: 0.40; p < 0.001). However, the agreement was very significant for tumor type and grade, in which a higher concordance occurred at a higher grade. The percentage of patients with lymph nodes affected was 19.2%;. Although most patients presenting with disease remission or cure were in the early stages (90.5%;), there were no significant differences between those patients who had a misdiagnosis (11/16; 68.8%;) and those who had a correct diagnosis (25/33; 75.8%;) based on preoperative endometrial sampling (p = 0.605). Conclusion Our findings corroborate the literature and confirm the under staging of preoperative endometrial samples based on histopathological assessment, especially for lower grade endometrial tumors. We suggest that the preoperative diagnosis should be complemented with other methods to better plan the surgical management strategy.

Resumo Objetivo Avaliar a concordância entre os diagnósticos histopatológicos de amostras endometriais pré-operatórias e cirúrgicas de pacientes com adenocarcinomas endometriais e avaliar o impacto da concordância entre os diagnósticos no planejamento cirúrgico e sobrevida das pacientes. Métodos Dados de 62 pacientes com câncer de endométrio operadas entre 2002 a 2011 em um hospital universitário foram avaliadas retrospectivamente. As pacientes foram submetidas à histerectomia e tratamento adjuvante, se necessário, e acompanhadas clinicamente de acordo com o protocolo institucional. Foram avaliados os resultados das análises histopatológicas das amostras endometriais pré-operatórias e cirúrgicas. As lesões foram classificadas como tumor endometrioide (tipo 1) graus 1, 2 ou 3 ou carcinoma não endometrioide (tipo 2). Resultados De modo geral, houve uma concordância baixa entre os diagnósticos histopatológicos das amostras endometriais pré-operatórias e cirúrgicas (Kappa: 0,40; p < 0,001). Entretanto, uma alta concordância entre os diagnósticos foi observada nos tumores de graus mais elevados. Comprometimento de linfonodos ocorreu em 19,2%; das pacientes e a maioria das que apresentaram remissão ou cura foram diagnosticadas nos estágios iniciais da doença (90,5%;). Não houve diferença significativa na taxa de remissão ou cura entre as pacientes que tiveram concordância (25/33; 75,8%;) ou divergência (11/16; 68,8%;) entre os resultados histopatológicos pré-operatórios e cirúrgicos (p = 0,605). Conclusão Nossos achados corroboram a literatura e confirmam o sub-estadiamento de amostras endometriais pré-operatórias com base na avaliação histopatológica, especialmente para tumores endometriais de baixo grau. Outros métodos complementares são necessários para um diagnóstico pré-operatório mais preciso a fim de melhorar o planejamento cirúrgico.

Laparoscopic approach in surgical staging of endometrial cancer / Abordagem laparoscópica no estadiamento cirúrgico do carcinoma do endométrio

Abstract Objective To compare laparoscopy with laparotomy for surgical staging of endometrial cancer. Methods A cohort of women with preoperative diagnosis of endometrial cancer who underwent surgical staging was retrospectively evaluated. The main study end points were: morbidity and mortality, hospital length of stay, perioperative adverse events and recurrence rate. Data analysis was performed with the software SPSS v25 (IBM Corp., Armonk, NY, USA), categorical variables using a Chi-square and Fisher test, and continuous variables using the Student t-test. Results Atotal of 162 patientswere analyzed. 138 patientsmet the inclusion criteria, 41of whom underwent staging by laparoscopy and 97 by laparotomy. Conversions from laparoscopy to laparotomy happened in 2 patients (4.9%) and were secondary to technical difficulties and poor exposure. Laparoscopy had fewer postoperative adverse events when compared with laparotomy (7.3% vs 23.7%, respectively; p = 0.005), but similar rates of intraoperative complications, despite having a significantly longer operative time (median, 175 vs 130 minutes, respectively; p < 0.001). Hospital stay was significantly lower in laparoscopy versus laparotomy patients (median, 3 vs 7 days, respectively; p < 0.001). No difference in recurrence or mortality rates were observed. Conclusion Laparoscopic surgical staging for endometrial cancer is feasible and safe. Patients have lower postoperative complication rates and shorter hospital stays when compared with the approach by laparotomy.

Resumo Objetivo Comparar a abordagem laparoscópica com a laparotômica no estadiamento cirúrgico do carcinoma do endométrio. Métodos Avaliação retrospectiva de uma coorte de mulheres com diagnóstico préoperatório de cancro do endométrio submetida a estadiamento cirúrgico. As principais variáveis do estudo foram: morbilidade e mortalidade, tempo de internamento hospitalar, eventos adversos peri-operatórios e taxa de recorrência. A análise dos dados foi realizada com o programa SPSS v25 (IBM Corp, Armonk, NY, EUA), para as variáveis categóricas utilizou-se o teste do Qui-quadrado e o teste de Fisher, e para as variáveis contínuas o teste t de Student. Resultados A amostra foi constituída por 162 doentes. 138 pacientes preencheram os critérios de inclusão, 41 das quais foram submetidas a estadiamento por laparoscopia e 97 por laparotomia. As conversões de laparoscopia para laparotomia ocorreram em 2 doentes (4,9%) e foram secundárias a dificuldades técnicas e má exposição. A laparoscopia teve menos eventos adversos pós-operatórios quando comparada à laparotomia (7,3% versus 23,7%, respectivamente; p = 0,005), mas taxas semelhantes de complicações intraoperatórias, apesar do tempo operatório significativamente maior (mediana 175 a 130 minutos, respetivamente; p < 0,001). A permanência hospitalar foi significativamente menor na abordagem laparoscópica (mediana de 3 versus 7 dias, respectivamente; p < 0,001). Não houve diferenças nas taxas de recorrência ou mortalidade. Conclusão O estadiamento cirúrgico laparoscópico para carcinoma do endométrio é exequível e seguro. As doentes apresentam uma menor taxa de complicações pósoperatórias e tempo de internamento mais curto quando comparados aos da abordagem por laparotomia.

Clinical assessment of 252Californium neutron intracavitary brachytherapy using a two-channel Y applicator combined with external beam radiotherapy for endometrial cancer

OBJECTIVE: The aim of this study was to determine the efficacy of 252Californium neutron intracavitary brachytherapy using a two-channel Y applicator combined with external beam radiotherapy for the treatment of endometrial cancer. METHODS: Thirty-one patients with stage I-III endometrial cancer were recruited for this study. The stage I patients received only 252Californium neutron intracavitary brachytherapy with a two-channel applicator. The stage II and III patients received both 252Californium neutron intracavitary brachytherapy using a two-channel applicator and parallel-opposed whole pelvic radiotherapy. RESULTS: The five-year local control rate was 80.6% (25/31), the overall survival rate was 51.6% (16/31), and the disease-free survival rate was 54.8% (17/31). The incidence of serious late complications was 12.9% (4/31). CONCLUSIONS: 252Californium neutron intracavitary brachytherapy using a two-channel applicator combined with external beam radiotherapy was effective for treating endometrial cancer and the incidence of serious late complications related to this combination was within an acceptable range.

Clinical outcomes of stage I endometrial carcinoma patients treated with surgery alone: Siriraj Hospital experiences / 부인종양

OBJECTIVE: To evaluate the recurrence rates and patterns of failure in patients with stage I endometrial carcinoma after surgical staging without adjuvant therapy. METHODS: Medical records of 229 patients with stage I endometrial carcinoma, treated with surgery alone between 2002 and 2010 at Siriraj Hospital were retrospectively reviewed. The primary objective of this study was recurrence rates. The secondary objectives were patterns of failure, disease-free survival, overall survival, and prognostic factors related to outcomes. RESULTS: During median follow-up time of 53.3 months, 11 recurrences (4.8%) occurred with a median time to recurrence of 21.2 months (range, 7.7 to 77.8 months). Vaginal recurrence was the most common pattern of failure (8/11 patients, 72.7%). Other recurrences were pelvic, abdominal and multiple metastases. Factors that appeared to be prognostic factors on univariate analyses were age and having high intermediate risk (HIR) (Gynecologic Oncology Group [GOG] 99 criteria), none of which showed significance in multivariate analysis. The recurrence rates were higher in the patients with HIR criteria (22.2% vs. 4.1%, p=0.013) or patients with stage IB, grade 2 endometrioid carcinoma (9.4% vs. 4.3%, p=0.199). Five-year disease-free survival and 5-year overall survival were 93.9% (95% CI, 89.9 to 5.86) and 99.5% (95% CI, 97.0 to 99.9), respectively. CONCLUSION: The patients with low risk stage I endometrial carcinoma had excellent outcomes with surgery alone. Our study showed that no single factor was demonstrated to be an independent predictor for recurrence.

The Role of Steroid Sulfatase as a Prognostic Factor in Patients with Endometrial Cancer

PURPOSE: The aim of the study was to determine steroid sulfatase (STS) expression in endometrial cancer patients and its correlation with disease prognosis. MATERIALS AND METHODS: We conducted a retrospective study in 59 patients who underwent surgery with histologically confirmed endometrial cancer from January 2000 to December 2011 at Hanyang University Hospital. Immuno-histochemical staining of STS was performed using rabbit polyclonal anti-STS antibody. RESULTS: Sixteen of the 59 patients (27.1%) were positive for STS expression. Disease free survival (DFS) was 129.83±8.67 [95% confidence interval (CI): 112.84-146.82] months in the STS positive group (group A) and 111.06±7.17 (95% CI: 97.01-125.10) months in the STS negative group (group B) (p=0.92). Overall survival (OS) was 129.01±9.38 (95% CI: 110.63-147.38) months and 111.16±7.10 (95% CI: 97.24-125.07) months for the groups A and B, respectively (p=0.45). Univariate analysis revealed that FIGO stage and adjuvant therapy are significantly associated with DFS and OS. However, in multivariate analysis, FIGO stage and adjuvant therapy did not show any statistical significance with DFS and OS. STS was also not significantly associated with DFS and OS in univariate and multivariate analysis. CONCLUSION: STS expression was not significantly associated with DFS and OS, despite positive STS expression in 27% of endometrial cancer patients. Therefore, the role of STS as a prognostic factor in patients with endometrial cancer remains unclear and requires further research.

Lymph node metastasis and pattern of recurrence in clinically early stage endometrial cancer with positive lymphovascular space invasion / 부인종양

OBJECTIVE: To investigate the rate, predictors of lymph node metastasis (LNM) and pattern of recurrence in clinically early stage endometrial cancer (EC) with positive lymphovascular space invasion (LVSI). METHODS: Women with clinically early stage EC and positive LVSI 2005 to 2012 were identified. Kaplan-Meier curves and logistic regression models were used. RESULTS: One hundred forty-eight women were identified. Of them, 25.7% had LNM (21.7% pelvic LNM, 18.5% para-aortic LNM). Among patients with LNM who had both pelvic and para-aortic lymphadenectomy, isolated pelvic, para-aortic and both LNM were noted in 51.4%, 17.1%, and 31.4% respectively. Age and depth of myometrial invasion were significant predictors of LNM in LVSI positive EC. Node positive patients had high recurrence rate (47% vs. 11.8%, p<0.05) especially distant (60.9% vs. 7.9%, p<0.001) and para-aortic (13.2% vs. 1.8%, p=0.017) recurrences compared to node negative EC. LNM was associated with lower progression-free survival (p=0.002) but not overall survival (p=0.73). CONCLUSION: EC with positive LVSI is associated with high risk of LNM. LNM is associated with high recurrence rate especially distant and para-aortic recurrences. Adjuvant treatments should target prevention of recurrences in these areas.

Synchronous and metachronous malignancy in endometrial cancer patients treated in a tertiary care center of Thailand / 부인종양

OBJECTIVE: To evaluate the prevalence and features of non-endometrial cancers in Thai endometrial cancer (EC) patients. METHODS: EC patients treated in our institution were identified and the following data were collected: age, EC stage, histopathology, adjuvant therapy, other cancers, living status, and cause of death. RESULTS: The mean age of the 344 patients was 56.8+/-10.8 years. Fifty (14.5%) had other synchronous and metachronous cancers. Mean ages of the patients with or without other cancers were not significantly different, 55.7+/-10.04 years versus 57.1+/-11.0 years, respectively (p=0.358). History of any cancer in the family and tumor in the lower uterine segment were more frequent among the patients with other cancers (6.0% vs. 1.7%, p=0.095; 12.0% vs. 1.0%, p or =2 other cancers. Ovarian, breast, and colon were the three most common other cancers. After a median follow-up of 57.1 months, 18.3% of patients had died: 30.0% of patients with other cancers and 16.3% of those without other cancers. The corresponding EC deaths were 14.0% and 11.2%. The 5-year overall survival was significantly lower in patients who had other cancers: 79.3% (95% confidence interval [CI], 68.3 to 90.3) vs. 86.0% (95% CI, 81.7 to 90.3) than in those without (p=0.023). However, the corresponding disease-specific survival was not significantly different: 85.1% (95% CI, 75.5 to 94.7) compared with 89.0% (95% CI, 85.1 to 92.9), respectively (p=0.514). CONCLUSION: Thai EC patients had a high incidence of other cancers. Overall survival of EC patients who had other cancers was worse than those without, while disease-specific survival was not significantly different.

Surgical treatment of clinically early-stage endometrial carcinoma without systematic lymphadenectomy / Tratamento cirúrgico do câncer de endométrio em estágio clínico precoce sem linfadenectomia radical.

Objective: the main aim of this study was to describe the authors’ experience with the surgical treatment of endometrial cancer without systematic lymphadenectomy. Methods: a retrospective cohort study was carried out on a subset of patients suffering of clinically early-stage endometrial carcinoma who underwent hysterectomy and salpingo-oophorectomy without systematic (radical) lymph nodes dissection at our centers from June, 2002, to November, 2011. Descriptive statistics were explored as medians (interquartile range) or frequencies (percentages), as appropriated, and the Kaplan–Meier method was applied for survival estimation. Results: eighty-three patients who underwent surgical treatment with no lymph node dissection (n = 20; 24.1%) or with only a sampling procedure (n=63; 75.98%) were selected for analysis. Among these patients, 27 (32.53%) underwent surgery alone and 56 (67.46%) received some adjuvant treatment. Postoperative complications occurred in five patients (6.02%). Over a median follow-up of 27.4 months (Q25 = 13.7 – Q75 = 46.5), 15 (18.07%) patients suffered from relapses and 11 deaths occurred as result of disease recurrence. Cumulative 1, 2 and 3-year disease- free survivals were 97.32, 91.18 and 78.02%, respectively. Conclusion: on a case-by-case basis, the surgical treatment of clinically early-stage endometrial carcinoma without systematic lymphadenectomy did not seem to decrease survival outcomes and presented low rates of surgical morbidity in our experience, but was also related to a high rate use of adjuvant therapy. .

Objetivo: descrever a experiência dos autores com o tratamento cirúrgico do câncer de endométrio em estádio precoce sem linfadenectomia radical. Métodos: realizou-se estudo de coorte retrospectivo envolvendo um subgrupo de pacientes com câncer de endométrio em estágio clínico precoce tratadas com histerectomia e salpingo-ooforectomia sem linfadenectomia radical, em dois centros pernambucanos, de junho de 2002 a novembro de 2011. As variáveis foram descritas como mediana (intervalo interquartílico) ou frequências (percentuais), utilizando- se o método de Kaplan-Meier para a estimativa das taxas de sobrevivência. Resultados: oitenta e três pacientes submetidas a tratamento cirúrgico sem dissecção linfonodal (n = 20, 24,1%) ou com dissecção apenas por amostragem (n = 63; 75,98%) foram selecionadas para análise. Entre essas pacientes, 27 (32,53%) foram tratadas somente com cirurgia e 56 (67,46%) receberam tratamento adjuvante. Cinco pacientes apresentaram complicações pós-operatórias (6,02%). Durante o acompanhamento mediano de 27,4 meses (Q25 = 13,7 - Q75 = 46,5), 15 (18,07%) pacientes apresentaram recorrência, dentre as quais 11 faleceram em decorrência da recidiva neoplásica. Observou-se sobrevivência cumulativa proporcional livre de doença em um, dois e três anos de 97,32, 91,18 e 78,02%, respectivamente. Conclusão: em um contexto de indicação caso-a-caso, o tratamento cirúrgico do câncer de endométrio em estádio precoce sem linfadenectomia radical parece não ter prejudicado a sobrevivência e apresentou baixas taxas de morbidade cirúrgica em nossa experiência, mas também foi acompanhado de elevada utilização de terapia adjuvante. .

Adjuvant radiotherapy in early stage endometrial cancer / Radioterapia adjuvante para câncer do endométrio estádio inicial

OBJECTIVE: To compare the rates of overall survival (OS), disease-free survival (DFS) and toxicity in different techniques of postoperative radiotherapy for stage IA endometrioid adenocarcionoma of endometrium, histological grades 1and 2. METHODS: A historical comparison between treatment regimens was performed, and 133 women with a minimum follow-up of 5 years were included. Teletherapy (TELE group), with 22 patients treated from 1988 to 1996, with a 10 MV linear accelerator, average dose 46.2 Gy. Low dose rate brachytherapy (LDRB group) was performed between 1992 and 1995, in 19 women, with an insertion of Cesium 137, at a 60 Gy dose. Fourteen women operated between 1990 and 1996 did not receive radiotherapy (NO RT group). High dose rate brachytherapy was performed in 78 patients (HDRB group), from 1996 to 2004, in five weekly 7 Gy insertions, prescribed at 0.5 cm from the vaginal cylinder. RESULTS: The 5-year disease-free survival was 94.6 percent for the HDRB group, 94.1 percent for the LDRB group, 100 percent for the TELE group and NO RT groups (p = 0.681). The 5-year overall survival was 86.6 percent for the HDRB group, 89.5 percent for the LDRB group and 90 percent for the TELE group and NO RT groups (p = 0.962). Grades 3-5 late toxicity was 5.3 percent in LDRB group and 27.3 percent for the TELE group (p < 0.001). CONCLUSION: Patients submitted to adjuvant teletherapy showed very high toxicity, which contraindicates that treatment for those patients. There may be a role for adjuvant HDRB, but randomized controlled trials are still needed to evaluate its benefit.

OBJETIVO: Comparar as taxas de sobrevida global (SG), sobrevida livre de doença (DFS) e de toxicidade em diferentes técnicas de radioterapia pós-operatória para adenocarcionoma endometrioide do endométrio estádio IA, graus histológicos 1 e 2. MéTODOS: Realizou-se uma comparação histórica entre regimes de tratamento, incluindo 133 mulheres com seguimento mínimo de cinco anos. Teleterapia (grupo TELE), com 22 pacientes, de 1988 a 1996, tratadas com acelerador linear 10 MV, dose média de 46,2 Gy. Braquiterapia de baixa taxa de dose (grupo LDRB), realizada entre 1992 e 1995, em 19 mulheres, com uma inserção de Césio 137, dose de 60 Gy. Quatorze mulheres operadas entre 1990 e 1996 não receberam radioterapia (grupo NO RT). Braquiterapia de alta taxa de dose foi realizada em 78 pacientes (grupo BATD), 1996-2004, cinco inserções semanais de 7 Gy, a 0,5 cm do cilindro vaginal. RESULTADOS: A DFS em cinco anos foi de 94,6 por cento para o grupo BATD, 94,1 por cento para o grupo LDRB, 100 por cento para os grupos TELE e RT (p = 0,681). A sobrevida global em cinco anos foi de 86,6 por cento para o grupo BATD, 89,5 por cento para o grupo LDRB e 90 por cento para os grupos TELE e NO RT (p = 0,962). A toxicidade tardia graus 3-5 foi de 5,3 por cento no grupo LDRB e 27,3 por cento para o grupo TELE (p < 0,001). CONCLUSãO: Pacientes submetidos à teleterapia adjuvante apresentaram toxicidade muito elevada, o que contraindica o tratamento para essas pacientes. Pode haver um papel para a BATD adjuvante, mas estudos controlados randomizados são necessários para avaliar seu benefício.

Cánceres ginecológicos y colorectal: riesgos y beneficios con el uso de anticonceptivos / Gynecological and colorectal cancers: risks and benefits with contraceptive use

Los cánceres genecológicos y colorectales se asocian a nivel mundial a importantes tasas de morbilidad y mortalidad. Tanto en estudios de cohorte, como de casos y controles se ha establecido una disminución del riesgo para los cánceres ginecológicos y colorectal asociado al uso de algunos métodos anticonceptivos (MAC)...

Câncer de endométrio: mortalidade populacional e sobrevida de uma coorte Hospitalar no Rio de Janeiro, Brasil / Endometrial cancer: population mortality and survival of a cohort Hospital in Rio de Janeiro, Brazil

Os tumores do corpo do útero ocupam o sétimo lugar entre as neoplasias que acometem as mulheres e 60 por cento dos casos ocorrem nos países desenvolvidos. As taxas de mortalidade relacionadas a este tipo de câncer têm diminuído aproximadamente 60 por cento desde a década de 50 nos países desenvolvidos. A tendência temporal de mortalidade e os fatores associados à sobrevida do câncer de endométrio estão sendo estudados mundialmente, entretanto, pouco se conhece a respeito da temática no Brasil. Esta dissertação tem como objetivos analisar a mortalidade por câncer de endométrio entre mulheres residentes no estado do Rio de Janeiro e estimar a sobrevida dessas pacientes, atendidas no Hospital do Câncer-II do Instituto Nacional de Câncer. O desenvolvimentodeste trabalho deu origem a dois artigos que compõem a estrutura desta dissertação. O primeiro artigo aborda questões relacionadas à mortalidade e aponta para sua tendência estável após correção dos óbitos classificados como câncer de útero SOE. Já o segundoartigo, aponta os fatores associados à sobrevida e demonstra que estadiamentoavançado, baixo grau de diferenciação celular e histologia não endometrióide podem ser considerados marcadores independentes de pior prognóstico. Em resumo, os resultados observados no primeiro artigo apontam uma tendência constante da mortalidade por câncer de corpo do útero, resultado este diferente dos encontrados em alguns paísesdesenvolvidos, onde esta tendência se encontra decrescente. Os resultados do segundo artigo acompanham os resultados de estudos mundiais. O monitoramento das tendências assim como o conhecimento da sobrevida e fatores associados podem ser importantes indicadores das mudanças nos hábitos, exposições a fatores de risco ambientais, efetividade e acesso a serviços de saúde de determinada população.

Abordaje laparoscópico en cáncer de endometrio / Laparoscopic approach for endometrial cancer

El cáncer de endometrio es una neoplasia ginecológica relevante en todo el mundo, con cambios acelerados en su manejo. La cirugía es el tratamiento de elección, pero puede llegar a tener una alta tasa de complicaciones y retraso en el inicio de terapias adyuvantes por el trauma quirúrgico que provoca. Este artículo revisa el rol de la laparoscopia en el manejo de las pacientes con cáncer endometrial, haciendo hincapié en su seguridad oncológica, beneficios y complicaciones. Al comparar la vía clásica por laparotomía, la laparoscopia, en manos experimentadas, tiene similares resultados respecto de sobrevida, recurrencia y etapificación completa, pero con una menor tasa de complicaciones. La vía endoscópica podría ser la herramienta del futuro en el manejo del cáncer de endometrio.

Endometrial cancer is a relevant gynecologic neoplasm, with accelerated changes in its management. Surgery is the treatment of choice, but it can have a high rate of complications and delay in adjuvant therapies due to the surgical trauma that it inflicts. This article reviews the role of laparoscopy in the management of women with endometrial cancer, highlighting the oncologic safety, benefits and complications. Comparing laparotomy with laparoscopy, in experienced hands, it has the same results concerning to survival, recurrence and complete staging, with a lower rate of complications. Celioscopy could be the tool of the future in the management of endometrial cancer.

Clinicopathologic analysis of women with synchronous primary carcinomas of the endometrium and ovary: 10- year experience from Chiang Mai University Hospital.

The aim of this study was to analyze the clinicopathologic features and survival outcomes of women with synchronous primary carcinomas of the endometrium and ovary that were treated at Chiang Mai University Hospital between January 1995 and December 2004. During the study period, 43 women with such tumors were identified. These carcinomas accounted for 0.58% (95%CI=0.42-0.79%) of all gynecologic malignancies. Median age at diagnosis was 49 years (range: 34-60 years). Median body mass index (BMI) was 21.6 kg/m2(range: 15.5-27.7 kg/m(2)). The majority of women (65%) were premenopausal. The most common presenting symptom was abnormal uterine bleeding (42%), followed by a pelvic mass (30%). Twenty-seven (62.8%, 95%CI= 46.7-77.0%) women had concordant endometrioid carcinomas of the endometrium and ovary. Five (11.6%) women experienced tumor recurrence with median follow up 39 months (range: 1-85 months). The overall 5-year survival was 85.2%. There was no significant difference in survival outcomes among the women who had endometrioid/endometrioid histology and those who had other histological subtypes (P=0.674). In conclusion, synchronous primary carcinomas of the endometrium and ovary, although uncommon, should be considered in differential diagnosis in premenopausal women presenting with abnormal uterine bleeding and ovarian tumors. The prognosis of patients with these tumors appears excellent.

Análise da tendência temporal da mortalidade por câncer de endométrio da populaçäo feminina residente no Estado de Säo Paulo - 1980 a 1998 / Analysis of the tendencies over time of the endometrial cancer mortality rate among women in the State of Säo Paulo during the period from 1980 to 1998

Este trabalho é um estudo descritivo de série temporal sobre mortalidade por câncer de endométrio em mulheres residentes no Estado de Säo Paulo, segundo faixa etária, distribuiçäo no Município de Säo Paulo e demais municípios. A partir de informações obtidas no banco de dados do Ministério da Saúde, DATASUS e de outras fontes subsidiárias, foi estudada sua evoluçäo, no período de 1980 a 1998. Quando se avalia mortalidade por câncer de útero sem outra especificaçäo (SOE), se observa um aumento na freqüência de óbitos em torno de 26 por cento para o Estado de Säo Paulo e uma reduçäo de 1,5 por cento no Município de Säo Paulo, no período de 1980 a 1998; e que os óbitos por câncer de útero (SOE) ocorridos no Município de Säo Paulo correspondem a 30,5 por cento dos óbitos pela mesma causa em todo o Estado. Entretanto, quando se avalia especificamente o câncer de corpo de útero (câncer de endométrio), observa-se um aumento de 93,9 por cento no número de óbitos no Estado de Säo Paulo, por esta causa e um aumento nesta freqüência para o Município de Säo Paulo de aproximadamente 50 por cento. Nota-se ainda, que, os óbitos por câncer de útero ocorridos no Município de Säo Paulo correspondem a 46,1 por cento dos óbitos pela mesma causa, ocorridos em todo o Estado. A análise temporal da mortalidade por câncer de endométrio, durante o período de 1980 a 1998 apresenta uma tendência de aumento, enquanto a mortalidade por câncer de útero (SOE) tende a diminuir. Comparando-se os dados encontrados com os internacionais conclui-se que tanto o Estado de Säo Paulo quanto o Município apresentam perfis de países desenvolvidos, quanto às elevadas incidências desta neoplasia, entretanto, näo se enquadram na mesma categoria quanto à consecuçäo de medidas necessárias à prevençäo, diagnóstico precoce e controle da doença, uma vez que as freqüências de mortalidade também aumentam significativamente. Sugestões säo apresentadas, voltadas à populaçäo feminina climatérica, principal grupo alvo para desenvolver câncer de endométrio, e que incluem medidas preventivas e de diagnóstico precoce do câncer de endométrio, tais como a realizaçäo do teste de progesterona e de exames como histeroscopia e ultrassonografia transvaginal.

Clinicopathologic and Biological Parameters Predicting the Prognosis in Endometrial Cancer

Endometrial carcinoma is the most common malignancy of the female genital tract in United States or Europe, but in Korea, its incidence is comparatively low than that of cervical cancer of uterine cervix. Recently the prolonged life expectancy, postmenopausal use of hormone replacement therapy, and the availability of easily applied diagnostic techniques have led to increasing incidence of endometrial cancer. Although during the past several decades, the histopathology, spread patterns, and prognostic factors of endometrial cancers have been better defined, the clinicopathologic and biologic prognostic parameters should be further evaluated for the better treatment results in endometrial cancer.

Results of treatment in endometrial carcinoma: ten years experience.

From 1980 to 1989, 145 patients of histologically proven adenocarcinoma of the endometrium were seen and treated at the Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, Majority of the patients (84/145) presented with FIGO stage I disease. Relationship of myometrial invasion to grade was highly significant (p < 0.001). One hundred and seven patients were treated by surgery in combination with pre-operative or post-operative radiotherapy. The importance of various prognostic factors was assessed and grade of the tumour had statistically highly significant effect on survival (p < 0.005). Postoperative radiotherapy is recommended in patients with poor prognostic factors.

Aparente distribución heterogénea de receptores de progesterona en ciertos casos de carcinoma endometrial / Apparent heterogeneous distribution of progesterone receptors in certain cases of endometrial carcinoma

Se analizó el contenido de receptores de progesterona en el citosol de dos o tres muestras obtenidas del mismo tumor, en 19 casos de cáncer endometrial. La concentración de receptores en una muestra de cada tumor fue obtenida por análisis de Scatchard; en la otra o las otras dos muestras de cada tumor, la concentración de receptores fue calculada a parir de un solo punto. Todos los tumores tuvieron receptores al menos en una de las dos o tres muestras. Diez tumores mostraron cierta consistencia en el contenido de receptores las dos o tres muestras de los nueve tumores restantes, con un rango que va desde cero hasta varios cientos de femtomoles/mg de proteína. En siete casos, en que se pudo seguir la evolución de las pacientes hasta por un período de 66 meses, encontramos que la magnitud de respuesta a progestágenos fue independiente del contenido de receptores de progesterona. Estos resultados hacen pensar que el análisis de un sólo sitio de tumor endometrial revelaría valores que pudieran no ser representativos del tumor total, lo cual explicaría, al menos parcialmente, la respuesta incierta que frecuentemente se obtiene en la terapia progestacional

Distribuiçäo espacial da mortalidade por câncer ginecológico no Município de Säo Paulo em 1992 / Spatial distribution of gynecologic cancer mortality in the Säo Paulo city, Brazil, 1992

Analisa a distribuiçäo geográfica da mortalidade por câncer ginecológico no Município de Säo Paulo no ano de 1992, através de informaçöes constantes no banco de dados da Fundaçäo SEADE. O Município de Säo Paulo foi dividido em 4 Zonas Homogêneas a partir de critérios sócio-econômicos. O câncer de mama foi o que apresentou coeficientes de mortalidade mais elevados em todo o município e em seguida aparece o câncer de colo uterino como 2ª localizaçäo e o câncer de ovário como 3ª localizaçäo. Na área com melhores condiçöes de vida, estas duas últimas localizaçöes se invertem, é o câncer de ovário a 2ª causa e o câncer de colo a 3ª. Calculando-se o indicador APVP, também o câncer de mama é o que se apresenta maior. Ressalta que, embora o coeficiente de mortalidade por câncer ginecológico seja maior na área de melhores condiçöes de vida, o APVP é o menor entre todas as áreas. As diferenças na ocorrência dos óbitos mostra que o Município de Säo Paulo apresenta heterogeneidades que precisam ser consideradas quando se planeja açöes de saúde

Câncer de endométrio: análise de cinco anos no INCa / Endometrial cancer: five years analysis in the INCa

No período de janeiro de l98l a dezembro de 1985, foram analisadas 133 pacientes portadoras de adenocarcinoma de endométrio, que receberam radioterapia em alguma fase de seu tratamento. Noventa e cinco por cento das pacientes foram à resposta completa e, posteriormente, foram seguidas por tempo mediano de 40 meses. Treze por cento das pacientes falharam localmente e nove por cento falharam à distância. Vagina e pulmao foram os sítios de falha mais freqüentes, local e à distância, respectivamente. Posteriormente, as pacientes tiveram suas sobrevidas analisadas segundo os seguintes fatores prognósticos: estadiamento clínico, grau de infiltraçao miometrial e grau de díferenciaçao histológica. A sobrevída global atuarial aos 48 meses foi de 78 por cento. A sobrevida livre de doença locorregional foi de 81 por cento e a sobrevida livre absoluta foi de 74 por cento. Ainda que nao exista significância estatística nos três parâmetros prognósticos analisados, existe tendência de polarizaçao entre infiltraçao profunda em contraposiçao à infiltraçao superficial e média do miométrio. O mesmo ocorrendo com o grau I em contraposiçao aos graus II e III, como também EC-II-III em contraposiçao a EC-I.O presente estudo demonstrou a importância do agrupamento prognóstico dos vários segmentos de uma populaçao portadora de tumor de endométrio. Os autores fazem breve revisao de literatura sobre o assunto.