RESUMEN
BACKGROUND: Most endometrial carcinoma patients are diagnosed at an early stage with a good prognosis. However, a relatively low fraction with lethal disease constitutes a substantial number of patients due to the high incidence rate. Preoperative identification of patients with high risk and low risk for poor outcome is necessary to tailor treatment. Nucleotyping refers to characterization of cell nuclei by image cytometry, including the assessment of chromatin structure by nuclear texture analysis. This method is a strong prognostic marker in many cancers but has not been evaluated in preoperative curettage specimens from endometrial carcinoma. METHODS: The prognostic impact of changes in chromatin structure quantified with Nucleotyping was evaluated in preoperative curettage specimens from 791 endometrial carcinoma patients prospectively included in the MoMaTEC multicenter trial. RESULTS: Nucleotyping was an independent prognostic marker of disease-specific survival in preoperative curettage specimens among patients with Federation Internationale des Gynaecologistes et Obstetristes (FIGO) stage I-II disease (HR=2.9; 95% CI, 1.2-6.5; P = 0.013) and significantly associated with age, FIGO stage, histologic type, histologic grade, myometrial infiltration, lymph node status, curettage histology type, and DNA ploidy. CONCLUSIONS: Nucleotyping in preoperative curettage specimens is an independent prognostic marker for disease-specific survival, with potential to supplement existing parameters for risk stratification to tailor treatment. IMPACT: This is the first study to evaluate the prognostic impact of Nucleotyping in curettage specimens from endometrial carcinoma and shows that this may be a clinically useful prognostic marker in endometrial cancer. External validation is warranted. Cancer Epidemiol Biomarkers Prev; 26(1); 61-67. ©2016 AACR.
Asunto(s)
Biomarcadores de Tumor/análisis , Cromatina/genética , ADN/genética , Neoplasias Endometriales/genética , Neoplasias Endometriales/mortalidad , Adulto , Anciano , Análisis de Varianza , Bases de Datos Factuales , Dilatación y Legrado Uterino/métodos , Neoplasias Endometriales/patología , Neoplasias Endometriales/cirugía , Femenino , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Noruega , Ploidias , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Manejo de Especímenes , Tasa de SupervivenciaAsunto(s)
Revisión de Utilización de Seguros , Mala Praxis , Errores Médicos , Bases de Datos Factuales , Humanos , Revisión de Utilización de Seguros/economía , Revisión de Utilización de Seguros/legislación & jurisprudencia , Mala Praxis/economía , Mala Praxis/legislación & jurisprudencia , Errores Médicos/economía , Errores Médicos/legislación & jurisprudencia , Noruega , Sistema de RegistrosRESUMEN
BACKGROUND: This study aimed to report our initial experience using the Da Vinci, a three-armed Intuitive Surgical robotic unit, in relation to gynae-oncological operations. METHODS: A prospective database was used in this retrospective analysis of 53 consecutive women with gynae-oncological diseases who were operated by the same surgeon in a single institution. All the patients were informed of the risks inherent with each surgical procedure as well as the potential advantages. RESULTS: 125 different procedures were performed, including total robotic radical hysterectomy (n = 25), restaging with total hysterectomy and bilateral salpingo-oophorectomy, total omentectomy, appendectomy, bilateral pelvic and para-aortic node dissections. Mean age of the patients, 45.8 (range 27-70) years; mean operative time, 219 (range 110-530) min; mean console time, 170 (range 60-445) min; mean estimated blood loss, 57 (range 10-300) ml; mean post-operative stay, 3 (range 1-6) days. No robot-related complications occurred. No conversions were reported. Mean follow-up time was 16 (range 0-28) months. CONCLUSIONS: Our preliminary experience with robotic surgery suggest that it is a safe technique and could allow complex radical operations to be performed with greater precision.