Factores de riesgo para carcinoma de endometrio de alto grado / Risk factors for high-grade endometrial carcinoma

El carcinoma de endometrio (CE) ha sido dividido de forma clásica en 2grupos: el tipo I, considerado de buen pronóstico y estrógeno dependiente y el tipo II, de peor pronóstico y estrógeno independiente. Esta subdivisión etiopatogénica no está tan clara cuando se habla de CE de alto grado. El objetivo del estudio es analizar los factores de riesgo asociados al CE de alto grado. Material y métodos: Estudio retrospectivo de cohortes multicéntrico en 3hospitales españoles de tercer nivel, Hospital Universitario Miguel Servet en Zaragoza, Hospital Clínico San Carlos en Madrid y Hospital Virgen del Rocío en Sevilla, en el que se estudió la presencia de los factores de riesgo asociados al CE de alto grado histológico: endometrioide G3 (CEG3), carcinoma seroso (CS), carcinoma de células claras (CCC) y carcinosarcoma uterino o tumor mülleriano mixto maligno (TMMM). Se analizaron las posibles diferencias entre los subtipos y atendiendo a si se trataba de CE tipo I/II. Se incluyeron 373 CE de alto grado, de ellos, 135 fueron CEG3 o de tipo I y 238 de tipo II: 96 CS, 64 CCC y 78 TMMM. Resultados: La diabetes, obesidad, nuliparidad y utilización de tratamiento hormonal de reemplazo no mostraron diferencias significativas entre los subtipos. El TMMM fue el que con menor frecuencia se asoció a HTA y, por el contrario, el que mostró mayor asociación a la utilización de tamoxifeno. Conclusiones: Los factores de riesgo asociados a CE de alto grado son similares en el tipo I y II

Endometrial carcinoma (EC) has traditionally been divided into 2groups: type I, considered to have a good prognosis and to be oestrogen-dependent and type II, with a poorer prognosis and oestrogen-independent. The aim of the study is to analyse the risk factors associated with high-grade EC. Material and Methods: Retrospective multicentre cohort study in 3Spanish reference hospitals: Hospital Universitario Miguel Servet in Zaragoza, Hospital Clínico San Carlos in Madrid and Hospital Virgen del Rocío in Seville. We studied the presence of risk factors associated with high grade EC: G3 endometrioid (G3EC), serous carcinoma (SC), clear cell carcinoma (CCC) and malignant mixed mesodermal tumours (MMMT). Differences between subtypes were analysed depending on whether the EC was type I or II. A total of 373 cases of high-grade EC were included, of which 135 were G3EC or type I and 238 were type II (96 SC, 64 CCC and 78 MMMT). Results: Diabetes, obesity, nulliparity and use of hormonal replacement therapy showed no significant difference between subtypes. MMMT was less frequently associated with hypertension and conversely it showed greater association with the use of tamoxifen. Conclusions: Risk factors associated with high-grade EC are similar in type I and II

Platinum-based adjuvant chemotherapy on moderate- and high-risk stage I and II epithelian ovarian cancer patients. Long-term single institution experience and literature review

BACKGROUND: Although the optimal management of women with FIGO stages I and II epithelial ovarian cancer (EOC) is still controversial, platinum-based adjuvant chemotherapy (CT) is the mainstay of treatment. Suboptimal survival results have led to major efforts to identify prognostic factors, improve surgical staging and develop adjuvant therapies to improve patients' outcomes. PATIENTS AND METHODS: We evaluate in a retrospective study clinical efficacy and the toxicity profile of a platinum-based adjuvant CT in FIGO stages I and II EOC treated at our institution from March 1984 to December 2006. Grade I FIGO stages IA-IB were excluded from the analysis. In the first period (1984-1997), patients received a platinum-based regimen without taxanes. In the second period from 1997 onwards, patients were treated with carboplatin and paclitaxel. Four to six cycles of adjuvant CT were administered. Potential predictive factors of efficacy and the role of paclitaxel addition were also analysed. RESULTS: One hundred and fifty-eight patients (60 treated with paclitaxel) met inclusion criteria and were evaluable. Median age at diagnosis was 53.7 years (range 19-81) and most patients had an Eastern Cooperative Oncology Group performance status score (ECOG) of 0-1 (91.8%); 82.9% patients had pathological stage I and 17.1% pathological stage II. With a median follow up of 8.34 years (range 4.4-11.6), 103 patients (74.1%) were free of disease and 110 of them were alive (79.1%). Median relapse-free survival (RFS) and median overall survival (OS) had not been reached at the time of the analysis. No survival difference was found between paclitaxel and carboplatin combination or non-paclitaxel-containing regimens. Statistically significant prognostic factors for better RFS in the multivariate analysis were: ECOG 0 (p=0.023; HR 0.32; 95% CI 0.17-0.57); FIGO I stage (p<0.001; HR 0.30; 95% CI 0.15-0.58); I-II histological grade (p=0.005; HR 0.38; 95% CI 0.19-0.75); mucinous histology (p=0.013; HR 0.28; 95% CI 0.13-0.53); non-surgical adherences (p<0.002, HR 0.32; 95% CI 0.15-0.54); paracolic gutters inspection (p=0.033; HR 0.50; 95% CI 0.26-0.95) and liver surface biopsies (p=0.048; HR 0.64; 95% CI 0.41-0.98).Toxicity was generally mild and non-haematologic events were the most commonly found (62.9% of the total). The most frequent haematologic toxicities were neutropenia (41.7% in all grades, 9.5% grade 3-4) and anaemia (29.1% in all grades, 3.2% grade 3-4). CONCLUSIONS: The long-term outcome of this series is comparable to the published evidence and reflects the limited activity of platinum-based CT in the adjuvant setting. The potential survival advantage of the addition of paclitaxel to carboplatin cannot be definitively answered due to the small number of patients, the limited follow-up and the retrospective nature of the study. More effective and specific treatments are clearly required, in particular for those patients with stage II and undifferentiated tumours. Quality of surgery entails prognostic value (AU)

Estudio clinicopatológico de los sarcomas uterinos / Clinicopathologic study of uterine sarcomas

Objetivo: Estudiar las características de los sarcomas uterinos y valorar el impacto pronóstico de los factores clinicopatológicos en la supervivencia. Material y método: Se realizó un estudio retrospectivo de 71 casos de sarcomas uterinos diagnosticados y tratados en el Hospital Clínico San Carlos durante los años 1980-1998. En 66 casos se realizó una histerectomía con doble anexectomía como tratamiento primario. Los tratamientos complementarios fueron la radioterapia y la quimioterapia. Resultados: El sarcoma más frecuentemente encontrado fue el leiomiosarcoma (LMS) (56,3 por ciento), seguido de los tumores mesodermales mixtos malignos (TMMM) (31,1 por ciento), el sarcoma de la estroma endometrial (7,1 por ciento), el rabdomiosarcoma (4,1 por ciento) y el condrosarcoma (1,4 por ciento). La edad de presentación del TMMM es mayor que en los LMS (p < 0,010). La clínica de presentación más frecuente fue la metrorragia (74,6 por ciento). Los tumores se encontraron en estadios precoces en un 64,7 por ciento de los casos. En el análisis de la supervivencia, los factores que predijeron un pronóstico peor fueron el estadio tumoral (p < 0,001), el grado de diferenciación (p = 0,010) y la invasión miometrial profunda (p < 0,001). El tipo histológico no alcanzó significación estadística. En el estudio multivariante de Cox, el estadio fue el único factor clinicopatológico predictivo de mortalidad. Conclusiones: La edad de presentación es variable según el tipo de sarcoma y la manifestación clínica más común es la metrorragia. El factor más importante para la supervivencia es el estadio de la FIGO en el momento del diagnóstico (AU)