Does the extension of the type of hysterectomy contribute to the local control of endometrial cancer?

OBJECTIVE: To examine the necessity and sufficiency of different types of hysterectomy for the surgical treatment of endometrial cancer. METHODS: This was a multicenter collaborative study conducted by 11 institutions. Among patients with stage I-III endometrial cancer who underwent surgery as the initial treatment (only chemotherapy was provided if adjuvant therapy was needed) from 2001 to 2012, we retrospectively examined the type of hysterectomy, clinicopathological factors, recurrence rate over a maximum period of 5 years, and the site of recurrence. The local recurrence rate was examined by univariate and multivariate analyses. RESULTS: Among 1335 patients, 982 (73.6%) underwent simple hysterectomy (SH) and 353 (26.4%) underwent modified radical hysterectomy (mRH) and were observed for a mean duration of 51.8 months. No significant difference was observed in the rate of local recurrence between the SH and mRH groups (p = 0.928). In multivariate analysis, clinicopathological factors independently associated with localized recurrence included postmenopausal status [hazard ratio (HR) 5.036, 95% confidence interval (CI) 1.506-16.841, p = 0.009], with stages II (HR 3.337, 95% CI 1.701-6.547, p < 0.001) and III (HR 2.445, 95% CI 1.280-4.668, p = 0.007), vs stage I and histological type 2 (HR 1.610, 95% CI 0.938-2.762, p = 0.001). CONCLUSIONS: For endometrial cancer patients requiring surgery, the selection of a more extensive type of hysterectomy did not reduce the rate of local recurrence. Therefore, there is little significance in performing mRH in such cases.

Negative peritoneal washing cytology during interval debulking surgery predicts overall survival after neoadjuvant chemotherapy for ovarian cancer.

OBJECTIVE: Optimal debulking in interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) has been reported as a prognostic factor for patients with ovarian cancer. However, the identification of microscopic residual disease (MRD) using visualization and palpation is subjective. Peritoneal washing cytology (PWC) during IDS is an easy-to-implement, objective approach for assessing disease status, although its clinical relevance and association with MRD is not known. The aim of this study was to evaluate the efficacy of PWC during IDS. METHODS: In total, 164 patients diagnosed with ovarian cancer at our institution were retrospectively evaluated, including 64 who had received NAC. Seventeen patients had undergone an exploratory laparotomy followed by NAC, while the remaining patients were diagnosed based on imaging, peritoneal cytology, and tumor markers. The PWC was performed before intraperitoneal observation at laparotomy during IDS. RESULTS: NAC-treated patients had stage III-IV disease. IDS was performed in 78.1% of NAC-treated patients. Seventeen patients (26.6%) were PWC-negative and 33 patients (51.6%) were PWC-positive. Fourteen patients (21.9%) had progressive disease and were ineligible for IDS. The median overall survival of the PWC-negative, PWC-positive, and non-IDS groups was 47, 18, and 5 months, respectively. The differences were significant (p<0.01). PWC was an independent prognostic factor in the multivariate Cox regression analysis (p<0.001). CONCLUSION: PWC during IDS may be a prognostic factor for NAC-treated patients with ovarian cancer. PWC may be more useful than visualization and palpation in IDS for determining the presence of MRD.

Efficacy of Fibroblast Growth Factor on Epithelialization of the Neovagina in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome Who Underwent Vaginoplasty.

STUDY OBJECTIVE: To evaluate the effect of fibroblast growth factor (FGF) on epithelialization of neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome who underwent vaginoplasty. DESIGN: Observational study. SETTING: University hospital. PARTICIPANTS: Seven patients with Mayer-Rokitansky-Küster-Hauser syndrome. INTERVENTIONS: Cytological examination was done on vaginal smear samples from the site of completed epithelialization, and tissue was collected from the epithelialized part for histological evaluation. Immunostaining for estrogen receptor α, and keratin 13 and 14, and reverse transcription polymerase chain reaction (RT-PCR) analysis of the FGF receptor (FGFR) 1-4 were performed in samples from case 2 three times (ie, during the surgery, during the period of vaginal creation, and at 3 months and 6 months after the surgery). MAIN OUTCOME MEASURES: The primary outcome was the FGF effects on the epithelialization speed and FGFR expression in the neovagina. The second was the role of FGF in the mechanism of vaginal epithelial cell proliferation. RESULTS: The histological structure of the neovagina was consistent with that of normal vagina. RT-PCR analysis revealed that FGFR was expressed in the control vaginas and neovaginas. Among the FGFR subtypes, FGFR-4 was overexpressed during the process of epithelialization and its level decreased after completion of creation of the new vagina. CONCLUSION: The epithelium of the neovagina was morphologically similar to that of normal vagina. It is suggested that FGF plays the role as a growth factor.

A preoperative risk-scoring system to predict lymph node metastasis in endometrial cancer and stratify patients for lymphadenectomy.

OBJECTIVE: This study aimed to validate the preoperative scoring system adopted in the Kanagawa Cancer Center (KCC) to stratify endometrial cancer patients for lymphadenectomy according to the risk of developing lymph node metastasis (LNM). METHODS: The records of 432 and 221 uterine cancer patients treated in the KCC and Yokohama City University (YCU), respectively, were retrospectively analyzed. The KCC classified patients for LNM risk based on tumor volume, myometrial invasion, histological grade, and serum CA125 levels, while YCU used only myometrial invasion. Lymphadenectomy was omitted for 156 patients with 0 LNM risk, while pelvic lymphadenectomy (PLX) or PLX with para-aortic lymphadenectomy (PLAX) were performed for those with low and high LNM risk, respectively. The predicted and actual LNM rates were compared between the KCC and YCU patients, and cancer recurrence and overall survival were analyzed. RESULTS: There was no difference in survival between patients with LNM score 0 who were or were not treated with lymphadenectomy. None (0%) developed LNM and only 1 (0.6%) had recurrence. Patients who underwent PLX but not PLAX (low LNM score) had a low tumor recurrence rate in the para-aortic nodes (1.3%). The KCC scoring system was significantly more accurate than the YCU system in predicting LNM in the high-risk group (P<0.05) and demonstrated that PLAX was unnecessary in almost 50% of the YCU cases. CONCLUSION: The KCC preoperative scoring system is useful to predict LNM risk, and thereby prevent unnecessary lymphadenectomy or to determine its extent in endometrial cancer patients.