Accuracy and Survival Outcomes after National Implementation of Sentinel Lymph Node Biopsy in Early Stage Endometrial Cancer.

BACKGROUND: Sentinel lymph node (SLN) biopsy has recently been accepted to evaluate nodal status in endometrial cancer at early stage, which is key to tailoring adjuvant treatments. Our aim was to evaluate the national implementation of SLN biopsy in terms of accuracy to detect nodal disease in a clinical setting and oncologic outcomes according to the volume of nodal disease. PATIENTS AND METHODS: A total of 29 Spanish centers participated in this retrospective, multicenter registry including patients with endometrial adenocarcinoma at preoperative early stage who had undergone SLN biopsy between 2015 and 2021. Each center collected data regarding demographic, clinical, histologic, therapeutic, and survival characteristics. RESULTS: A total of 892 patients were enrolled. After the surgery, 12.9% were suprastaged to FIGO 2009 stages III-IV and 108 patients (12.1%) had nodal involvement: 54.6% macrometastasis, 22.2% micrometastases, and 23.1% isolated tumor cells (ITC). Sensitivity of SLN biopsy was 93.7% and false negative rate was 6.2%. After a median follow up of 1.81 years, overall surivial and disease-free survival were significantly lower in patients who had macrometastases when compared with patients with negative nodes, micrometastases or ITC. CONCLUSIONS: In our nationwide cohort we obtained high sensitivity of SLN biopsy to detect nodal disease. The oncologic outcomes of patients with negative nodes and low-volume disease were similar after tailoring adjuvant treatments. In total, 22% of patients with macrometastasis and 50% of patients with micrometastasis were at low risk of nodal metastasis according to their preoperative risk factors, revealing the importance of SLN biopsy in the surgical management of patients with early stage EC.

Organoid (hypermature) ovarian teratomas: Report of four cases, one of which harbored a well-differentiated neuroendocrine tumor / Teratoma hipermaduro u organoide del ovario: descripción de cuatro casos, con un tumor neuroendocrino bien diferenciado en uno de ellos

Organoid (hypermature) teratomas are highly specialized teratomas showing organ formation, most frequently from the digestive tract or bronchial wall. We present four cases of ovarian organoid teratomas, one with a distinguishable mandible with teeth, one with small intestine, one with large intestine containing a well differentiated neuroendocrine tumor and another with both large intestine and bronchial wall. These tumors have a distribution similar to conventional teratomas and usually behave benignly, although cases of malignancy have been reported.(AU)

Los teratomas hipermaduros u organoides son teratomas altamente especializados en los que existe formación de órganos. Los más comunes son del tracto digestivo y de la pared bronquial. Presentamos cuatro casos de teratomas organoides del ovario: uno con formación de mandíbula con estructuras dentales, otro con intestino delgado, otro con intestino grueso con un tumor neuroendocrino bien diferenciado, y otro intestino grueso y pared bronquial. Estos tumores son de comportamiento benigno, aunque se han descrito casos con malignización. Pueden ocurrir en cualquier lugar donde se localicen los teratomas convencionales.(AU)

Organoid (hypermature) ovarian teratomas: Report of four cases, one of which harbored a well-differentiated neuroendocrine tumor.

Organoid (hypermature) teratomas are highly specialized teratomas showing organ formation, most frequently from the digestive tract or bronchial wall. We present four cases of ovarian organoid teratomas, one with a distinguishable mandible with teeth, one with small intestine, one with large intestine containing a well differentiated neuroendocrine tumor and another with both large intestine and bronchial wall. These tumors have a distribution similar to conventional teratomas and usually behave benignly, although cases of malignancy have been reported.

Surgical Management of Vulvar Melanoma: A Case Series.

Vulvar malignant melanoma is the second most common subtype of vulvar cancer, accounting for 5-10% of all vulvar cancers. The prognosis is still very poor, although some advances have been achieved in the last years. One of the most significant changes in its management has been the development of less invasive surgical techniques that diminish the risk of postoperative morbidity and long-lasting sequelae. In this article, we review the surgical management of the pathology, based on the comment of 3 cases with vulvar melanoma treated at our institution.

Prognostic factors in patients with vulvar cancer: the VULCAN study.

OBJECTIVE: This study aimed to analyze the prognostic factors for overall and progression-free survival in patients with vulvar cancer. METHODS: This international, multicenter, retrospective study included 2453 patients diagnosed with vulvar cancer at 100 different institutions. Inclusion criteria were institutional review board approval from each collaborating center, pathologic diagnosis of invasive carcinoma of the vulva, and primary treatment performed at the participating center. Patients with intraepithelial neoplasia or primary treatment at non-participating centers were excluded. Global survival analysis and squamous cell histology subanalysis was performed. RESULTS: After excluding patients due to incomplete data entry, 1727 patients treated for vulvar cancer between January 2001 and December 2005 were registered for analysis (1535 squamous, 42 melanomas, 38 Paget's disease and 112 other histologic types). Melanomas had the worse prognosis (p=0.02). In squamous vulvar tumors, independent factors for increase in local recurrence of vulvar cancer were: no prior radiotherapy (p<0.001) or chemotherapy (p=0.006), and for distant recurrence were the number of positive inguinal nodes (p=0.025), and not having undergone lymphadenectomy (p=0.03) or radiotherapy (p<0.001), with a HR of 1.1 (95% CI 1.2 to 1.21), 2.9 (95% CI 1.4 to 6.1), and 3.1 (95% CI 1.7 to 5.7), respectively. Number of positive nodes (p=0.008), FIGO stage (p<0.001), adjuvant chemotherapy (p=0.001), tumor resection margins (p=0.045), and stromal invasion >5 mm (p=0.001) were correlated with poor overall survival, and large case volume (≥9 vs <9 cases per year) correlated with more favorable overall survival (p=0.05). CONCLUSIONS: Advanced patient age, number of positive inguinal lymph nodes, and lack of adjuvant treatment are significantly associated with a higher risk of relapse in patients with squamous cell vulvar cancer. Case volume per treating institution, FIGO stage, and stromal invasion appear to impact overall survival significantly. Future prospective trials are warranted to establish these prognostic factors for vulvar cancer.

The Effectiveness of Different Doses of Iron Supplementation and the Prenatal Determinants of Maternal Iron Status in Pregnant Spanish Women: ECLIPSES Study.

Iron deficiency (ID), anemia, iron deficiency anemia (IDA) and excess iron (hemoconcentration) harm maternal-fetal health. We evaluated the effectiveness of different doses of iron supplementation adjusted for the initial levels of hemoglobin (Hb) on maternal iron status and described some associated prenatal determinants. The ECLIPSES study included 791 women, randomized into two groups: Stratum 1 (Hb = 110-130g/L, received 40 or 80mg iron daily) and Stratum 2 (Hb > 130g/L, received 20 or 40mg iron daily). Clinical, biochemical, and genetic information was collected during pregnancy, as were lifestyle and sociodemographic characteristics. In Stratum 1, using 80 mg/d instead of 40 mg/d protected against ID on week 36. Only women with ID on week 12 benefited from the protection against anemia and IDA by increasing Hb levels. In Stratum 2, using 20 mg/d instead of 40 mg/d reduced the risk of hemoconcentration in women with initial serum ferritin (SF) ≥ 15 µg/L, while 40 mg/d improved SF levels on week 36 in women with ID in early pregnancy. Mutations in the HFE gene increased the risk of hemoconcentration. Iron supplementation should be adjusted to early pregnancy levels of Hb and iron stores. Mutations of the HFE gene should be evaluated in women with high Hb levels in early pregnancy.

Prevalence of anaemia, risk of haemoconcentration and risk factors during the three trimesters of pregnancy.

OBJECTIVE: To evaluate the prevalence of anaemia and the risk of haemoconcentration and its risk factors during all 3 trimesters of pregnancy in women in a Mediterranean area in the south of Europe. MATERIAL AND METHODS: Longitudinal study of 11,259 women whose pregnancies were monitored at primary care centres between 2007 and 2012. The computerised clinical histories of all the pregnancies were used to collect haemoglobin (Hb) data for each trimester. The histories also provided information on the age of the mother, her socioeconomic status, the presence of obesity, tobacco use, type of pregnancy, and number of previous pregnancies and births. Anaemia was defined as Hb < 110 g/L in the 1st and 3rd trimesters of pregnancy and Hb < 105 g/L in the second. The risk of haemoconcentration was defined as Hb > 130 g/L in the 2nd and 3rd trimesters of pregnancy. RESULTS: The prevalence of anaemia increased from 3.8% in the first trimester to 21.5% in the 3rd trimester. Around 10% of the women had Hb > 130 g/L during the 3rd trimester. Having children previously and/or being younger than 20 increased the chances of anaemia (Adj. OR: 1.4; 95% CI: 1.1-1.9), but being older than 34 increased the chances of Hb > 130 g/L (Adj. OR: 1.3; 95% CI: 1.1-1.5). CONCLUSION: The increased prevalence of anaemia is a moderate public health problem. Understanding the factors that influence these problems may help improve the guidelines regarding the use of iron supplements.

Prevalence of anaemia, risk of haemoconcentration and risk factors during the three trimesters of pregnancy / Prevalencia de anemia y riesgo de hemoconcentración durante los 3 trimestres de embarazo y factores de riesgo

Objective: To evaluate the prevalence of anaemia and the risk of haemoconcentration and its risk factors during all 3 trimesters of pregnancy in women in a Mediterranean area in the south of Europe. Material and methods: Longitudinal study of 11,259 women whose pregnancies were monitored at primary care centres between 2007 and 2012. The computerised clinical histories of all the pregnancies were used to collect haemoglobin (Hb) data for each trimester. The histories also provided information on the age of the mother, her socioeconomic status, the presence of obesity, tobacco use, type of pregnancy, and number of previous pregnancies and births. Anaemia was defined as Hb < 110 g/L in the 1st and 3rd trimesters of pregnancy and Hb < 105 g/L in the second. The risk of haemoconcentration was defined as Hb > 130 g/L in the 2nd and 3rd trimesters of pregnancy. Results: The prevalence of anaemia increased from 3.8% in the first trimester to 21.5% in the 3rd trimester. Around 10% of the women had Hb > 130 g/L during the 3rd trimester. Having children previously and/or being younger than 20 increased the chances of anaemia (Adj. OR: 1.4; 95% CI: 1.1-1.9), but being older than 34 increased the chances of Hb > 130 g/L (Adj. OR: 1.3; 95% CI: 1.1-1.5). Conclusion: The increased prevalence of anaemia is a moderate public health problem. Understanding the factors that influence these problems may help improve the guidelines regarding the use of iron supplements (AU)

Objetivo: valorar la prevalencia de anemia y de riesgo de hemoconcentración y sus factores de riesgo durante los 3 trimestres de embarazo en las mujeres de una zona mediterránea del sur de Europa. Material y métodos: estudio longitudinal con 11.259 mujeres que realizaron el seguimiento de su embarazo en centros de atención primaria entre el 2007 y 2012. A partir de la historia clínica informatizada se recogieron datos de hemoglobina (Hb) de cada trimestre de gestación, edad de la madre, bajo nivel socioeconómico, presencia de obesidad, hábito tabáquico, tipo de embarazo, número de embarazos y partos previos. Se definió anemia como Hb < 110 g/L para el 1er y 3er trimestre de gestación y como Hb < 105 g/L para el 2º trimestre. Se definió riesgo de hemoconcentración a Hb > 130 g/L en el 2º y 3er trimestre. Resultados: la prevalencia de anemia aumentó del 3.8% en el primer trimestre al 21.5% en el 3er trimestre. Alrededor de un 10% de las mujeres tuvieron Hb > 130 g/L en el 3er trimestre. Tener hijos previos y/o ser menor de 20 años predispone a tener anemia (adj. OR: 1.4; 95% CI: 1.1-1.9), pero tener más de 34 años predispone a Hb > 130 g/L (adj. OR: 1.3; 95% CI: 1.1-1.5). Conclusión: la elevada prevalencia de anemia supone un problema moderado de salud pública. El conocimiento de los factores que pueden influir en dichas prevalencias puede ayudar a adaptar mejor la pauta de suplementación con hierro (AU)

Preservación de la fertilidad: revisión y análisis de los tiempos oncológicos / Fertility preservation: a review and analysis of cancer treatment times

La incidencia del cáncer de mama (CM) ha aumentado progresivamente y aproximadamente el 15% de las mujeres son diagnosticados antes de los 45 años. Este subgrupo de pacientes suelen tener tumores más agresivos y serán tratadas con terapia sistémica (quimioterapia, terapia hormonal o ambos). Por otra parte, la tendencia a retrasar la edad de maternidad implica que una gran proporción de pacientes con CM jóvenes no han completado su deseo reproductivo. El impacto del tratamiento oncológico en la reserva ovárica depende de la edad de los pacientes, el tipo de esquema y la dosis recibida. El senólogo debería ser sensible al deseo gestacional y realizar una derivación inmediata a la Unidad de Preservación de la Fertilidad. Esta maniobra no implica un retraso en el inicio terapéutico de la enfermedad como demuestran nuestros resultados. En nuestro centro, 40 pacientes fueron sometidas a crioconservación de ovocitos entre 2010 y 2015. La media de días entre el diagnóstico de CM y el inicio del tratamiento oncológico fue de 37,6 días. El tiempo de estimulación (inicio del tratamiento de estimulación hasta la recuperación de los ovocitos) presentó una media de 12 días (7-21). Por lo tanto, consideramos que las pacientes jóvenes deben ser remitidas a una unidad de asesoramiento reproductivo, tal y como aconseja EUSOMA. La preservación de fertilidad requiere de la participación coordinada tanto del equipo de Oncología y el equipo de Reproducción Humana (AU)

The incidence of breast cancer (BC) has progressively increased, and approximately 15% of women will receive a diagnosis before the age of 45 years. This patient subgroup usually has more aggressive tumours and will be treated with systemic therapy (chemotherapy, hormone therapy, or both). In addition, the tendency to delay maternity implies that a many young patients with BC will not have fulfilled their reproductive wishes. The impact of cancer treatment on ovarian reserve depends on patient age, the type of regimen and the doses received. Senologists should be sensitive to their patients’ reproductive wishes and immediately refer them to Fertility Preservation Units. As shown by our results, referral does not imply a delay in treatment initiation. In our centre, 40 patients underwent ovarian tissue cryopreservation between 2010 and 2015. The mean number of days between BC diagnosis and the start of cancer treatment was 37.6 days. The mean time from stimulation (the start of stimulation until oocyte recovery) was 12 days (7-12). Therefore, we believe that young patients should be referred to a reproductive counselling unit, as recommended by EUSOMA. Fertility preservation requires liaison between the oncology and human reproduction teams (AU)

Adapting iron dose supplementation in pregnancy for greater effectiveness on mother and child health: protocol of the ECLIPSES randomized clinical trial.

BACKGROUND: Currently, there is no consensus regarding iron supplementation dose that is most beneficial for maternal and offspring health during gestation. Recommended iron supplementation dose does not preempt anemia in around 20% of the pregnancies, nor the risk of hemoconcentration in 15%. This deficit, or excess, of iron prejudices the mother-child wellbeing. Therefore the aims of the study are to determine the highest level of effectiveness of iron supplementation adapted to hemoglobin (Hb) levels in early pregnancy, which would be optimum for mother-child health. DESIGN: Randomized Clinical Trial (RCT) triple-blindedSetting: 10 Primary Care Centers from Catalunya (Spain)Study subjects: 878 non-anemic pregnant women at early gestation stage, and their subsequent newborns METHODS: The study is structured as a RCT with 2 strata, depending on the Hb levels before week 12 of gestation. Stratum #1: If Hb from 110 to 130 g/L, randomly assigned at week 12 to receive iron supplement of 40 or 80 mg/d. Stratum #2: If Hb >130 g/L, randomly assigned at week 12 to receive iron supplement of 40 or 20 mg/d. MEASUREMENTS: In the mother: socio-economic data, clinical history, food item frequency, lifestyle and emotional state, and adherence to iron supplement prescription. Biochemical measurements include: Hb, serum ferritin, C reactive protein, cortisol, and alterations in the HFE gene (C282Y, H63D). In children: ultrasound fetal biometry, anthropometric measurements, and temperament development.Statistical analyses, using the SPSS program for Windows, will include bivariate and multivariate analyses adjusted for variables associated with the relationship under study. DISCUSSION: Should conclusive outcomes be reached, the study would indicate the optimal iron supplementation dose required to promote maternal and infant health. These results would contribute towards developing guidelines for good clinical practice.