Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.746
Filtrar
1.
Zhonghua Fu Chan Ke Za Zhi ; 55(2): 112-119, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32146740

RESUMO

Objective: To investigate the surgical complications in the treatment of stage Ⅰ endometrial cancer by robotic-assisted laparoscopy, the risk degree of Clavein-Dindo complications and the main risk factors affecting the occurrence of surgical complications. Methods: A retrospective case-control study was conducted in the First Affiliated Hospital of Zhengzhou University from October 2014 to June 2019. The patients were divided into robotic-assisted laparoscopy group and traditional laparoscopy group according to the operation mode, including 131 cases in robot group and 290 cases in traditional laparoscopy group. To compare the complications during and after operation and the risk degree of complications between the two groups by Clavein-Dindo classification standard, the age, body mass index (BMI), comorbidities, past history of pelvic surgery, American Society of Anesthesiologists (ASA) grade, preoperative anemia, number of pelvic lymph node resection, number of abdominal aortic lymph node resection, the total number of lymph node resection, operation time, surgical methods (robot surgery or traditional laparoscopic surgery) and other clinicopathological data were analyzed by logistic regression analysis. Results: (1) Complications of operation: the incidence of operative complications (including intraoperative and postoperative complications) in robot group was significantly lower than that in traditional laparoscopy group [(20.6%, 27/131) vs (34.8%, 101/290); χ(2)=8.620, P=0.003)]. The incidence of intraoperative complications in robot group was lower than that in traditional laparoscopy group [1.5% (2/131) vs 6.2% (18/290); χ(2)=4.368, P=0.037]. The incidence of intraoperative vascular injury in robot group was significantly lower than that in traditional laparoscopy group [0.8% (1/131) vs 5.2% (15/290); χ(2)=4.798, P=0.022]. The incidence of postoperative complications in robot group was also lower than that in traditional laparoscopy group [19.1% (25/131) vs 28.6% (83/290); χ(2)=4.303, P=0.038], but the incidence of postoperative lymphatic leakage in robot group was higher than that in traditional laparoscopy group [10.7% (14/131) vs 5.2% (15/290); χ(2)=4.279, P=0.039]. (2) Clavein-Dindo classification: the incidence of Clavein-Dindo Ⅰ, Ⅲ, Ⅲ, Ⅳ and Ⅴ grade between two groups were respectively 3.8% (5/131) vs 11.0% (32/290), 13.7% (18/131) vs 14.5% (42/290), 3.1% (4/131) vs 8.6% (25/290), 0 (0/131) vs 0.3% (1/290), 0 (0/131) vs 0.3% (1/290), and the incidence of grade Ⅰ (χ(2)=5.684, P=0.015) and Ⅲ (χ(2)=4.361, P=0.037) complications were statistically significant. The incidence of severe complications in robot group (grade Ⅲ and above) was lower than that in traditional laparoscopy group [3.1% (4/131) vs 9.3% (27/290); χ(2)=5.179, P=0.023]. (3) Analysis of influencing factors of surgical complications: univariate analysis showed that BMI (χ(2)=15.801, P=0.000), preoperative anemia (χ(2)=14.299, P=0.000), total number of lymph node resection (χ(2)=10.425, P=0.001), surgical methods (χ(2)=8.620, P=0.003) were related to the occurrence of surgical complications of endometrial carcinoma. Multivariate analysis showed that BMI (OR=0.289, 95%CI: 0.097-0.864, P=0.026), preoperative anemia (OR=0.309, 95%CI: 0.129-0.740, P=0.008), the total number of lymph node resection (OR=0.624, 95%CI: 0.403-0.966, P=0.034) and surgical methods (OR=3.491, 95%CI: 1.030-11.840, P=0.045) were independent risk factors for surgical complications of endometrial carcinoma. Conclusions: Compared with traditional laparoscopic surgery, robot-assisted laparoscopic surgery has fewer complications and lower incidence of severe complications. BMI, preoperative anemia, the total number of lymph node resection and surgical methods are independent risk factors for the occurrence of surgical complications of stage Ⅰ endometrial cancer.


Assuntos
Neoplasias do Endométrio/cirurgia , Laparoscopia , Excisão de Linfonodo/métodos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Estudos de Casos e Controles , China/epidemiologia , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Incidência , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento
2.
Gynecol Oncol ; 156(1): 147-153, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31780238

RESUMO

OBJECTIVE: To compare the prevalence of patient-reported lower-extremity lymphedema (LEL) with sentinel lymph node (SLN) mapping versus comprehensive lymph node dissection (LND) for the surgical management of newly diagnosed endometrial carcinoma. METHODS: Patients who underwent primary surgery for endometrial cancer from 01/2006-12/2012 were mailed a survey that included a validated 13-item LEL screening questionnaire in 08/2016. Patients diagnosed with LEL prior to surgery and those who answered ≤6 survey items were excluded. RESULTS: Of 1275 potential participants, 623 (49%) responded to the survey and 599 were evaluable (180 SLN, 352 LND, 67 hysterectomy alone). Median BMI was similar among cohorts (P = 0.99). External-beam radiation therapy (EBRT) was used in 10/180 (5.5%) SLN and 35/352 (10%) LND patients (P = 0.1). Self-reported LEL prevalence was 27% (49/180) and 41% (144/352), respectively (OR, 1.85; 95% CI, 1.25-2.74; P = 0.002). LEL prevalence was 51% (23/45) in patients who received EBRT and 35% (170/487) in those who did not (OR, 1.95; 95% CI, 1.06-3.6; P = 0.03). High BMI was associated with increased prevalence of LEL (OR, 1.04; 95% CI, 1.02-1.06; P = 0.001). After controlling for EBRT and BMI, LND retained independent association with an increased prevalence of LEL over SLN (OR, 1.8; 95% CI, 1.22-2.69; P = 0.003). Patients with self-reported LEL had significantly worse QOL compared to those without self-reported LEL. CONCLUSIONS: This is the first study to assess patient-reported LEL after SLN mapping for endometrial cancer. SLN mapping was independently associated with a significantly lower prevalence of patient-reported LEL. High BMI and adjuvant EBRT were associated with an increased prevalence of patient-reported LEL.


Assuntos
Neoplasias do Endométrio/cirurgia , Excisão de Linfonodo/estatística & dados numéricos , Linfedema/epidemiologia , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/epidemiologia , Feminino , Humanos , Perna (Membro)/patologia , Excisão de Linfonodo/efeitos adversos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Linfedema/etiologia , Linfedema/patologia , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prevalência , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela/efeitos adversos , Inquéritos e Questionários
3.
Gynecol Oncol ; 156(1): 185-193, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31839336

RESUMO

OBJECTIVE: The majority of endometrial cancer patients are overweight or obese at cancer diagnosis. Obesity is a shared risk factor for both endometrial cancer and diabetes, but it is unknown whether endometrial cancer patients have increased diabetes risks. The aim of our study was to investigate diabetes risk among endometrial cancer patients. METHODS: Endometrial cancer patients diagnosed between 1997 and 2012 in Utah (n = 2,314) were identified. Women from the general population (n = 8,583) were matched to the cancer patients on birth year and birth state. Diabetes diagnoses were identified from electronic medical records and statewide healthcare facility databases. Cox proportional hazards models were used to estimate hazard ratios for diabetes after cancer diagnosis. RESULTS: Endometrial cancer survivors had a significantly higher risk of type II diabetes when compared to women from the general population in the first year after cancer diagnosis (HR = 5.22, 95% CI = 4.05, 6.71), >1-5 years after cancer diagnosis (HR = 1.67, 95% CI = 1.31, 2.12), and >5 years after cancer diagnosis (HR = 1.65, 95% CI = 1.29, 2.11). Endometrial cancer patients who were obese at cancer diagnosis had a three-fold increase in type II diabetes risk (HR = 2.99, 95%CI = 2.59, 3.45). Although endometrial cancer patients diagnosed at distant stage had a higher risk of diabetes, cancer treatment did not appear to contribute to any diabetes risks. CONCLUSIONS: In conclusion, endometrial cancer survivors had a higher risk of diabetes than women in the general population. These results suggest that long term monitoring for diabetes is indicated for endometrial cancer survivors.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Diabetes Mellitus Tipo 2/epidemiologia , Neoplasias do Endométrio/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Neoplasias do Endométrio/mortalidade , Feminino , Humanos , Pessoa de Meia-Idade , Risco , Programa de SEER , Estados Unidos/epidemiologia
4.
Gynecol Oncol ; 156(1): 162-168, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31839339

RESUMO

OBJECTIVE: To evaluate risk factors for 30-day unplanned readmission and increased length of stay (LOS) following minimally invasive surgery (MIS) for endometrial cancer. METHODS: This was a retrospective, case-control study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). Multivariable logistic regression was used to assess perioperative variables associated with readmission and increased LOS after MIS for endometrial cancer. RESULTS: The study population included 10,840 patients who met the criteria of having undergone MIS with a resultant endometrial malignancy confirmed on postoperative pathology. Common reasons for readmission included organ/space surgical site infection (65 cases), sepsis/septic shock (19 cases), and venous thromboembolism (20 cases). Notable risk factors for readmission included (Odds Ratio, Confidence Interval, p-value): dialysis dependence (6.77, 2.51-17.80, <0.01), increased length of stay (3.00, 2.10-4.10, <0.01), and preoperative weight loss (2.80, 1.06-7.17, 0.03); notable risk factors for increased LOS: ascites (8.51, 2.00-36.33, <0.01), operation duration >5 h (6.93, 5.29-9.25, <0.01), and preoperative blood transfusion (5.37, 2.05-14.04, <0.01). CONCLUSIONS: Identification of risk factors for adverse postoperative outcomes is necessary to inform and improve standards of care in MIS for endometrial cancer. Using nationally reported data from the ACS NSQIP, this study identifies independent risk factors for unplanned readmission and prolonged LOS, and in doing so, highlights potential avenues for quality improvement.


Assuntos
Neoplasias do Endométrio/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Idoso , Estudos de Casos e Controles , Neoplasias do Endométrio/epidemiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Sepse/epidemiologia , Sepse/etiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Estados Unidos/epidemiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
5.
Gynecol Oncol ; 156(1): 169-177, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31718832

RESUMO

OBJECTIVE: To evaluate endometrial cancer (EC) risk assessment and early detection strategies in high-risk populations, we designed a large, prospective cohort study of women undergoing endometrial evaluation to assess risk factors and collect novel biospecimens for future testing of emerging EC biomarkers. Here we report on the baseline findings of this study. METHODS: Women aged ≥45 years were enrolled at the Mayo Clinic from February 2013-June 2018. Risk factors included age, body mass index (BMI), smoking, oral contraceptive and hormone therapy use, and parity. We collected vaginal tampons, endometrial biopsies, and Tao brush samples. We estimated mutually-adjusted odds ratios (OR) and 95% confidence intervals (CI) using multinomial logistic regression; outcomes included EC, atypical hyperplasia, hyperplasia without atypia, disordered proliferative endometrium, and polyps, versus normal endometrium. RESULTS: Subjects included 1205 women with a mean age of 55 years; 55% were postmenopausal, and 90% had abnormal uterine bleeding. The prevalence of EC was 4.1% (n = 49), predominantly diagnosed in postmenopausal women (85.7%). Tampons and Tao brushings were obtained from 99% and 68% of women, respectively. Age (OR 1.14, 95% CI 1.1-1.2) and BMI (OR 1.39, 95% CI 1.1-1.7) were positively associated with EC; atypical hyperplasia (OR 1.07, 95% CI 1.0-1.1; OR 2.00, 95% CI 1.5-2.6, respectively), and polyps (OR 1.06, 95% CI 1.0-1.1; OR 1.17, 95% CI 1.0-1.3, respectively); hormone therapy use and smoking were inversely associated with EC (OR 0.42, 95%, 0.2-0.9; OR 0.43, 95% CI, 0.2-0.9, respectively). Parity and past oral contraception use were not associated with EC. CONCLUSIONS: Well-established EC risk factors may have less discriminatory accuracy in high-risk populations. Future analyses will integrate risk factor assessment with biomarker testing for EC detection.


Assuntos
Neoplasias do Endométrio/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Coortes , Neoplasias do Endométrio/diagnóstico , Feminino , Humanos , Metrorragia/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia
6.
Int J Cancer ; 146(6): 1523-1531, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31173648

RESUMO

Many pregnancy-related factors are associated with reduced endometrial cancer risk. However, it remains unclear whether pregnancy-related complications (e.g., hypertensive conditions) are associated with risk and whether these associations vary by endometrial cancer subtype. Thus, we evaluated the risk of endometrial cancer, overall and by subtype, in relation to pregnancy-related factors, pregnancy complications and birth characteristics. Utilizing population-based register data from four Nordic countries, we conducted a nested case-control analysis of endometrial cancer risk. We included 10,924 endometrial cancer cases and up to 10 matched controls per case. Odds ratios (ORs) with 95% confidence intervals (CIs) were derived from unconditional logistic regression models. We further evaluated associations by individual histology (i.e., endometrioid, serous, etc.) or, for rare exposures (e.g., pregnancy complications), by dualistic type (Type I [n = 10,343] and Type II [n = 581]). Preexisting and pregnancy-related hypertensive conditions were associated with increased endometrial cancer risk (OR [95% CI]: preexisting hypertension 1.88 [1.39-2.55]; gestational hypertension 1.47 [1.33-1.63]; preeclampsia 1.43 [1.30-1.58]), with consistent associations across dualistic type. Increasing number of pregnancies (≥4 vs. 1 birth: 0.64 [0.59-0.69]) and shorter time since last birth (<10 vs. ≥30 years: 0.34 [0.29-0.40]) were associated with reduced endometrial cancer risk, with consistent associations across most subtypes. Our findings support the role for both hormonal exposures and cell clearance as well as immunologic/inflammatory etiologies for endometrial cancer. This research supports studying endometrial hyperplasia, a precursor condition of endometrial cancer, in the context of pregnancy-related exposures, as this may provide insight into the mechanisms by which pregnancy affects subsequent cancer risk.


Assuntos
Neoplasias do Endométrio/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Estudos de Casos e Controles , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Paridade , Gravidez , Sistema de Registros , Risco , Países Escandinavos e Nórdicos/epidemiologia , Adulto Jovem
7.
Zhonghua Fu Chan Ke Za Zhi ; 54(12): 848-853, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874475

RESUMO

Objective: To study influencing factors which cause the endometrial diseases in patients with breast cancer after operation. Methods: A retrospective study was performed on 212 breast cancer post-operation patients with endometrial diseases between June 2006 and January 2018 in Women's Hospital School of Medicine Zhejiang University to analyse the factors which influenced the endometrial diseases. Results: The abnormal uterine bleeding and endometrial thickness were related to the severity of endometrial disease in patients with breast cancer, and they were independent risk factors for breast cancer patients to have endometrial cancer (P<0.05) . When the diagnostic cut off value of endometrial thickness was ≥0.49 cm, the sensitivity and specificity to endometrial cancer were 78% and 25%, respectively. The average endometrial thickness was (0.56±0.39) cm in patients who were treated by selective estrogen receptor modulator (SERM) after gynecological surgery, which was significantly thicker than that of aromatase inhibitor (AI) group [ (0.33±0.23) cm] and no treatment group [ (0.44±0.28) cm, P<0.05]. The endometrial disease recurrent rate and reoperation rate in SERM group were (26.2%, 14.3%) slightly higher than that of AI group (9.5%, 4.8%) and no treatment group (21.6%, 4.9%), but there were not significant differences (all P>0.05). Conclusions: The clinical symptom of abnormal uterine bleeding and thickening endometrium are risk factors for breast cancer patients to have endometrial cancer. The endometrial thickness has high predictive value for breast cancer patients to diagnose endometrial cancer. The SERM treatment increases the endometrial thickness, recurrent rate and reoperation rate in post-operation patients.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Inibidores da Aromatase/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Hiperplasia Endometrial/induzido quimicamente , Neoplasias do Endométrio/induzido quimicamente , Endométrio/efeitos dos fármacos , Moduladores de Receptor Estrogênico/efeitos adversos , Moduladores Seletivos de Receptor Estrogênico/efeitos adversos , Hemorragia Uterina/etiologia , Antineoplásicos Hormonais/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/patologia , Quimioterapia Adjuvante , Terapia Combinada , Hiperplasia Endometrial/epidemiologia , Hiperplasia Endometrial/patologia , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/patologia , Endométrio/patologia , Moduladores de Receptor Estrogênico/uso terapêutico , Feminino , Humanos , Estudos Retrospectivos , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Índice de Gravidade de Doença , Ultrassonografia
8.
BMC Public Health ; 19(1): 1387, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660927

RESUMO

BACKGROUND: Endometrial carcinoma burden is on the rise globally. The objective of this study was to determine the risk factors for endometrial carcinoma among postmenopausal women in Western province in Sri Lanka. METHODS: A case control study was conducted recruiting 83 incident cases of endometrial carcinoma and 332 unmatched hospital controls from all the secondary and tertiary care hospitals in the province using consecutive sampling technique. A case was defined as a postmenopausal woman who had been residing in the province for at least a period of 1 year, diagnosed to have endometrial carcinoma with histological confirmation within 3 months of the initiation of data collection of the study. Data were collected using validated interviewer administered questionnaire. Risk factor were identified through multiple logistic regression and results were expressed as adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS: The independent risk factors of endometrial carcinoma are having family history of any type of cancer among first degree relative (AOR = 12.6; 95% CI:5.14-30.9), generalized obesity (BMI ≥25 kg/m2) (AOR = 11.85; 95% CI:5.12-27.4), never conceived (AOR = 3.84; 95% CI:1.37-10.7), age at menarche ≤11 years (AOR = 4.07; 95% CI:1.16-14.2), age > 55 years (AOR = 4.69; 95% CI:2.16-10.2), monthly family income of ≤20,000 Rupees (AOR = 2.65; 95% CI:1.31-5.39), sub-optimal consumption of deep fried food (AOR = 0.17; 95% CI:0.06-0.46), and low level household activities (AOR = 2.82; 95% CI:1.34-5.92). CONCLUSIONS: There were eight independent risk factors of endometrial carcinoma specific for Sri Lankan postmenopausal women identified. Some modifiable risk factors such as generalized obesity, sub-optimal dietary practices and low level physical activities need to be addressed at primary prevention level.


Assuntos
Neoplasias do Endométrio/epidemiologia , Pós-Menopausa , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Sri Lanka/epidemiologia
9.
Gulf J Oncolog ; 1(31): 52-59, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31591991

RESUMO

BACKGROUND: Endometrial cancer occupies the 2nd or 3rd position in the hierarchy of common gynecological cancers in many low- and middle-income countries. However, little is known about its epidemiology, trend and characteristics in many African countries including Nigeria. The study aims to describe the trend in the prevalence, risk factors, symptomatology and types of endometrial cancers in Lagos, Nigeria. MATERIALS AND METHODS: A five-year descriptive retrospective study of the case records of women diagnosed with endometrial cancer at the Lagos University Teaching Hospital from 1 January 2008 to 31 December 2012. Relevant information was retrieved and data analysis was done using SPSS version 20.0. RESULTS: Endometrial cancer was the third most common gynecological malignancy (16.0%) with a rise in its prevalence rate, from 0.9% in 2008 to 1.4% in 2012. It occurred commonly in postmenopausal (81.8%) and parous women with mean age of 62.2 ± 5.5years, median parity of 4, and mean BMI of 32.3 ± 6.4kg/m2. Most women presented with postmenopausal bleeding (88.6%), vaginal discharge (36.4%), usually in stage I (45.5%) and III (22.7%) disease. The most common risk factors for endometrial cancer were advanced age (90.9%) and overweight/obesity (90.9%). Type 1 endometrial cancers accounted for 68.2% of cases, while serous papillary adenocarcinoma was the most common type 2 endometrial cancer. CONCLUSION: There is a rising trend in the prevalence of endometrial cancer in Lagos, Nigeria, with type 1 endometrial cancer being the most common type. Most women present in the postmenopausal period with early stage disease.


Assuntos
Neoplasias do Endométrio/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Nigéria
10.
BMC Cancer ; 19(1): 942, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604465

RESUMO

BACKGROUND: Studies on relationship between tubal ligation and endometrial cancer have led to contradictory findings. In several studies, however, a reduced endometrial cancer risk was suggested following tubal ligation. Therefore, a systematic review and meta-analysis was conducted to examine the relationship between tubal ligation and endometrial cancer risk. METHODS: In this systematic review and meta-analysis, PubMed/Medline, Web of Science, Scopus, Embase, and Google Scholar were searched for relevant studies published up to May 30th, 2018. We compared endometrial cancer risk in women with and without tubal ligation in retrieved studies. RESULTS: Two hundred nine studies were initially retrieved from the data bases. After exclusion of duplicates and studies which did not meet inclusion criteria, ten cohort and case-control studies, including 6,773,066 cases, were entered into the quantitative meta-analysis. There was 0.90% agreement between two researchers who searched and retrieved the studies. The summary OR (SOR) was reported using a random effect model. Begg's test suggested that there was no publication bias, but a considerable heterogeneity was observed (I2 = 95.4%, P = 0.001). We pooled the raw number of tables cells (i.e. a, b, c, and d) of eight studies. The SOR suggested that tubal ligation was significantly associated with a lower risk of endometrial cancer (SOR = 0.577, 95% CI = 0.420-0.792). Also, given the rare nature of endometrial cancer (< 5%), different effect sizes were considered as comparable measures of risk. Therefore we pooled ten studies and SOR of these studies revealed that tubal ligation was significantly associated with a lower risk of endometrial cancer (SOR = 0.696, 95% CI = 0.425-0.966). Besides that, we pooled eight studies in which adjusted effect sizes were reported and a subsequent analysis revealed that the summary estimate of adjusted odds ratio (SAOR) was significant (SAOR = 0.862, 95% CI = 0.698-1.026). CONCLUSIONS: This study revealed a protective effect of tubal ligation on endometrial cancer risk (approximately 42% lower risk of cancer). It is recommended that studies should be designed to reveal mechanisms of this relationship.


Assuntos
Neoplasias do Endométrio/epidemiologia , Esterilização Tubária/métodos , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Razão de Chances , Risco , Adulto Jovem
11.
Pan Afr Med J ; 33: 130, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558929

RESUMO

Introduction: Cancer is a public health problem that affect women more than men. The aim of the study was to describe the epidemiological and histopathological features of gynecological malignancies in the city of Yaoundé, Cameroon. Methods: This was a descriptive cross-sectional study of histologically proven gynecological cancers over a 10-year period (2008-2017) in the Gynecology and Pathological Anatomy Departments of the University Teaching Hospital of Yaoundé. Results: A total of 682 cancers were identified among which, 342 gynecological cancers, for an overall frequency of 50.1% and an annual frequency of 34.2 cases on average. There was a trend suggesting an increase annual frequency over time. The cervix was the most frequent location with 182 cases (53.2%); followed by breast with 96 cases (28.1%); endometrium with 33 cases (9.7%) and ovaries 15 cases (4.4%). These patients were on average 51.9±13.7 years old, mostly housewives (56.8%), married (60.4%), multiparous (61.3%) and referred (62.6%). Histopathologically, cervical cancer was predominantly squamous cell carcinoma (86.8%), invasive (80.9%) and well differentiated (45.5%). For breast cancers, the majority were ductal carcinomas (78.1%), invasive (92%), and histological grade SBR II (50.6%). The most common histopathological types of endometrial and ovarian cancer were adenocarcinoma (72.2%) and serous cystadenocarcinoma (46.7%), respectively. Conclusion: Gynecological cancers are common. Screening is expected to increase at 30 years for cervical cancer and start at age 40 with mammography for breast cancer.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias dos Genitais Femininos/epidemiologia , Programas de Rastreamento/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Camarões/epidemiologia , Carcinoma Ductal de Mama/epidemiologia , Carcinoma Ductal de Mama/patologia , Estudos Transversais , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/patologia , Feminino , Neoplasias dos Genitais Femininos/patologia , Hospitais Universitários , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/patologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Adulto Jovem
12.
Nat Rev Cancer ; 19(9): 510-521, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31388127

RESUMO

Endometrial cancer accounts for ~76,000 deaths among women each year worldwide. Disease mortality and the increasing number of new diagnoses make endometrial cancer an important consideration in women's health, particularly in industrialized countries, where the incidence of this tumour type is highest. Most endometrial cancers are carcinomas, with the remainder being sarcomas. Endometrial carcinomas can be classified into several histological subtypes, including endometrioid, serous and clear cell carcinomas. Histological subtyping is currently used routinely to guide prognosis and treatment decisions for endometrial cancer patients, while ongoing studies are evaluating the potential clinical utility of molecular subtyping. In this Review, we summarize the overarching molecular features of endometrial cancers and highlight recent studies assessing the potential clinical utility of specific molecular features for early detection, disease risk stratification and directing targeted therapies.


Assuntos
Neoplasias do Endométrio/genética , Neoplasias do Endométrio/terapia , Animais , Biomarcadores Tumorais , Carcinoma/genética , Carcinoma/terapia , Neoplasias do Endométrio/epidemiologia , Feminino , Humanos , Imunoterapia/métodos , Camundongos , Mutação , Prognóstico , Proteômica , Risco , Medição de Risco , Sarcoma/genética , Sarcoma/terapia , Pesquisa Médica Translacional
13.
BMJ ; 366: l4693, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412996

RESUMO

OBJECTIVE: To explore the association between pregnancy duration and risk of endometrial cancer. DESIGN: Nationwide register based cohort study. SETTING: Denmark. PARTICIPANTS: All Danish women born from 1935 to 2002. MAIN OUTCOME MEASURES: Relative risk (incidence rate ratio) of endometrial cancer by pregnancy number, type, and duration, estimated using log-linear Poisson regression. RESULTS: Among 2 311 332 Danish women with 3 947 650 pregnancies, 6743 women developed endometrial cancer during 57 347 622 person years of follow-up. After adjustment for age, period, and socioeconomic factors, a first pregnancy was associated with a noticeably reduced risk of endometrial cancer, whether it ended in induced abortion (adjusted relative risk 0.53 (95% confidence interval 0.45 to 0.64) or childbirth (0.66, 0.61 to 0.72). Each subsequent pregnancy was associated with an additional reduction in risk, whether it ended in induced abortion (0.81, 0.77 to 0.86) or childbirth (0.86, 0.84 to 0.89). Duration of pregnancy, age at pregnancy, spontaneous abortions, obesity, maternal birth cohort, fecundity, and socioeconomic factors did not modify the results. CONCLUSIONS: The risk of endometrial cancer is reduced regardless of whether a pregnancy ends shortly after conception or at 40 weeks of gestation. This reduction in risk could be explained by a biological process occurring within the first weeks of pregnancy, as pregnancies ending in induced abortions were associated with similar reductions in risk as pregnancies ending in childbirth.


Assuntos
Aborto Induzido/estatística & dados numéricos , Neoplasias do Endométrio/epidemiologia , Gravidez/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Adulto , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , História Reprodutiva , Fatores de Risco , Fatores Socioeconômicos , Fatores de Tempo
14.
Anticancer Res ; 39(8): 4581-4588, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366563

RESUMO

BACKGROUND/AIM: Initial treatment of endometrial cancer with surgery and platinum and taxane-based chemotherapy is often successful, but it remains unclear as to whether certain types of the disease relapse. The aim of this study was to identify the clinical features of recurrence in patients without residual tumour in endometrial cancer. PATIENTS AND METHODS: Clinical features, histological type, and time to recurrence were analyzed in 640 endometrial cancer patients without residual tumours. RESULTS: Of 640 patients, 517 were type I and 123 were type II. For type I, early recurrent (ER) disease and late recurrent (LR) disease were noted in 80 and 8 patients, respectively, and 97.5% of ER occurred within 2 years. After recurrence, 76.2% of ER and 50% of LR patients died. In type II, ER and LR were noted in 41 and 1 patients, respectively, and 97.6% of ER occurred within 2 years, of which 75.6% died after recurrence. One LR case died of disease. CONCLUSION: Most patients recurred within 2 years irrespective of clinical stage or type.


Assuntos
Neoplasias do Endométrio/epidemiologia , Recidiva Local de Neoplasia/epidemiologia , Neoplasia Residual/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Neoplasias do Endométrio/tratamento farmacológico , Neoplasias do Endométrio/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Neoplasia Residual/tratamento farmacológico , Neoplasia Residual/patologia , Estudos Retrospectivos
15.
Gynecol Oncol ; 155(1): 39-50, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31427143

RESUMO

OBJECTIVE: To examine the association between ovarian conservation and oncologic outcome in surgically-treated young women with early-stage, low-grade endometrial cancer. METHODS: This multicenter retrospective study examined women aged <50 with stage I grade 1-2 endometrioid endometrial cancer who underwent primary surgery with hysterectomy from 2000 to 2014 (US cohort n = 1196, and Japan cohort n = 495). Recurrence patterns, survival, and the presence of a metachronous secondary malignancy were assessed based on ovarian conservation versus oophorectomy. RESULTS: During the study period, the ovarian conservation rate significantly increased in the US cohort from 5.4% to 16.4% (P = 0.020) whereas the rate was unchanged in the Japan cohort (6.3-8.7%, P = 0.787). In the US cohort, ovarian conservation was not associated with disease-free survival (hazard ratio [HR] 0.829, 95% confidence interval [CI] 0.188-3.663, P = 0.805), overall survival (HR not estimated, P = 0.981), or metachronous secondary malignancy (HR 1.787, 95% CI 0.603-5.295, P = 0.295). In the Japan cohort, ovarian conservation was associated with decreased disease-free survival (HR 5.214, 95% CI 1.557-17.464, P = 0.007) and an increased risk of a metachronous secondary malignancy, particularly ovarian cancer (HR 7.119, 95% CI 1.349-37.554, P = 0.021), but was not associated with overall survival (HR not estimated, P = 0.987). Ovarian recurrence or metachronous secondary ovarian cancer occurred after a median time of 5.9 years, and all cases were salvaged. CONCLUSION: Our study suggests that adoption of ovarian conservation in young women with early-stage low-grade endometrial cancer varies by population. Ovarian conservation for young women with early-stage, low-grade endometrial cancer may be potentially associated with increased risks of ovarian recurrence or metachronous secondary ovarian cancer in certain populations; nevertheless, ovarian conservation did not negatively impact overall survival.


Assuntos
Carcinoma Endometrioide/epidemiologia , Carcinoma Endometrioide/terapia , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/terapia , Segunda Neoplasia Primária/epidemiologia , Tratamentos com Preservação do Órgão/estatística & dados numéricos , Ovário/fisiologia , Adulto , Estudos de Coortes , Intervalo Livre de Doença , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia/métodos , Histerectomia/estatística & dados numéricos , Japão/epidemiologia , Gradação de Tumores , Estudos Retrospectivos , Estados Unidos/epidemiologia
16.
Gynecol Oncol ; 155(1): 112-118, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31378374

RESUMO

OBJECTIVES: We aimed to clarify if endometrial cancer patients are at higher risk of venous thromboembolism (VTE) following hysterectomy, compared to patients undergoing hysterectomy for benign gynecological disease. METHODS: In a nationwide registry-based cohort study, patients undergoing hysterectomy for endometrial cancer or benign disease were followed 30 days after surgery. The Danish Gynecological Cancer Database (DGCD) and the Danish National Patient Register (DNPR) were linked with four other administrative registries to describe the population and retrieve data on venous thromboembolism and mortality. Multivariable logistic regression models were used to estimate odds ratios (ORs) for 30-day postoperative VTE. RESULTS: We identified 5513 patients with endometrial cancer, and 45,825 patients with benign disease undergoing hysterectomy in the period 2005-2014. The overall incidence of 30-day VTE following hysterectomy was 0.2% (103/51,338). Thirty (0.5%) patients with endometrial cancer and 73 (0.16%) patients with benign disease developed VTE. In a multivariable logistic regression analysis, significant predictors of 30-day OR for VTE were open surgery (minimally invasive surgery vs. open: OR = 0.46; 95% CI, 0.30-0.71; p < 0.001), lymphadenectomy (OR = 4.00; 95% CI, 1.89-8.46; p < 0.001), BMI > 40 (OR = 2.34;95% CI, 1.10-5.01; p = 0.03) and previous VTE (OR = 34; 95% CI, 22.7-51.3; p < 0.001). There was no statistically significant difference in the 30-day OR for VTE in endometrial cancer compared to benign disease (OR = 1.47; 95% CI, 0.74-2.91; p = 0.27). CONCLUSIONS: This study did not identify endometrial cancer to be an independent risk factor for VTE following hysterectomy compared to benign disease. We identified open surgery, lymphadenectomy, BMI above 40 and previous VTE as independent risk factors for 30-day postoperative VTE.


Assuntos
Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/cirurgia , Histerectomia/estatística & dados numéricos , Tromboembolia Venosa/epidemiologia , Adulto , Estudos de Coortes , Dinamarca/epidemiologia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Histerectomia/efeitos adversos , Incidência , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Sistema de Registros , Tromboembolia Venosa/etiologia
17.
Cancer Causes Control ; 30(9): 1013-1022, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31286336

RESUMO

PURPOSE: The primary objectives in this review were to (1) assess the association between socioeconomic deprivation and survival in endometrial cancer patients (2) investigate if there is an association between socioeconomic deprivation and peri-operative morbidity in endometrial cancer patients. METHODS: We performed a systematic review using Medline (1946-2018), Embase (1980-2018), Cinahl (1981-2018) and the Cochrane Controlled Register of Trials to identify studies that reported on the association between socioeconomic deprivation and survival or peri-operative outcomes in endometrial cancer patients. Included were adult women (age ≥ 18 years) diagnosed with primary endometrial cancer. Two reviewers independently selected studies and assessed bias using the Newcastle-Ottawa assessment scale. Data extraction was completed using pre-determined forms, and summary tables of evidences from the included studies were created. RESULTS: Nine studies were included in this review with a total number of 369,900 patients. Eight studies investigated survival and socioeconomic deprivation, and the majority showed that socioeconomic deprivation is associated with poorer survival in endometrial cancer patients. One study assessed the association between deprivation and peri-operative morbidity and found no difference in 30-day postoperative mortality. CONCLUSIONS: Socioeconomic deprivation seems to be associated with worse survival in endometrial cancer patients, even after adjusting for stage at diagnosis. However, the impacts of important confounders such as BMI, smoking and comorbidities are unclear and should be assessed. The relationship between socioeconomic deprivation and peri-operative morbidity is unclear, and further research is needed to evaluate this aspect. A standardised measure for socioeconomic deprivation is needed in order to establish adequate comparison between studies.


Assuntos
Neoplasias do Endométrio/epidemiologia , Fatores Socioeconômicos , Feminino , Humanos , Estudos Retrospectivos
18.
BMC Cancer ; 19(1): 730, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340777

RESUMO

BACKGROUND: The relationship between statin use and the risk of ovarian or endometrial cancer remains controversial. Here, we investigated the relationship between statin use and the risk of ovarian and endometrial cancers. METHODS: We conducted a meta-analysis using articles retrieved from the PubMed, Embase, and Web of Science databases. All original comparative studies published in English that were related to statin use and the risk of ovarian or endometrial cancer were included. RESULTS: This meta-analysis included 19 studies enrolling 1,999,362 female subjects and 19,849 cancer cases (7,948 ovarian cancer cases and 11,901 endometrial cancer cases). The overall analysis indicated that statin use did not significantly reduce the risk of ovarian cancer [relative risk (RR) = 0.88, 95% confidence interval (CI) 0.76-1.03, p = 0.12] or the risk of endometrial cancer (RR = 0.88, 95% CI 0.78-1.00, p = 0.05.) Subgroup analyses based on study type, percentage of cancer cases, study location, and quality of studies also supported our conclusions. No association was found between long-term statin use (> 5 years) and the risk of ovarian cancer (RR = 0.73, 95% CI 0.51-1.04, p = 0.08) or endometrial cancer (RR = 0.79, 95% CI 0.58-1.08, p = 0.14). CONCLUSIONS: Statin use did not lower the risk of ovarian cancer or endometrial cancer. The long-term use of statins (> 5 years) was not associated with a reduction in the risk of ovarian or endometrial cancer.


Assuntos
Neoplasias do Endométrio/epidemiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Neoplasias Ovarianas/epidemiologia , Neoplasias do Endométrio/prevenção & controle , Feminino , Humanos , Incidência , Neoplasias Ovarianas/prevenção & controle , Resultado do Tratamento
19.
J Surg Oncol ; 120(5): 864-872, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31355450

RESUMO

In the era of advanced cancer genomics, our recognition of hereditary cancer mutations continues to increase. Two of these conditions, which carry an increased risk of female cancers including endometrial, ovarian, breast, are hereditary breast and ovarian cancer syndrome and Lynch syndrome. Risk-reducing surgery, such as mastectomy, salpingo-oophorectomy, and hysterectomy may decrease cancer risk for mutation carriers. Background, indications, techniques, and consequences of these surgical procedures are reviewed.


Assuntos
Detecção Precoce de Câncer/métodos , Neoplasias do Endométrio/diagnóstico , Predisposição Genética para Doença , Síndromes Neoplásicas Hereditárias/diagnóstico , Neoplasias Ovarianas/diagnóstico , Procedimentos Cirúrgicos Operatórios/métodos , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/genética , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Síndromes Neoplásicas Hereditárias/epidemiologia , Síndromes Neoplásicas Hereditárias/genética , Síndromes Neoplásicas Hereditárias/cirurgia , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/cirurgia , Prevalência , Fatores de Risco
20.
Gynecol Obstet Invest ; 84(5): 512-518, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31311015

RESUMO

BACKGROUND: In the literature, there is no detailed analysis on the prediction factors for premalignancy/malignancy within endometrial polyps (EPs) in infertile patients. In this study, we aimed to determine the frequency of endometrial premalignancy/malignancy within EPs in infertile patients undergoing office hysteroscopic polypectomy and identify the factors that can potentially predict an endometrial premalignancy/malignancy within EPs. METHOD: A total of 957 infertile patients undergoing office hysteroscopy were diagnosed with EPs between February 2011 and August 2018. Patients were divided into 2 groups according to the pathological examination of EPs as benign (Group 1; n = 939) and premalignant/malignant (Group 2; n = 18). The medical records of all patients included in the study were reviewed retrospectively. RESULTS: In this cohort, prevalence of endometrial premalignancy/malignancy within EPs was 18/957 (1.88%). On univariate analysis, age, polyp size, diabetes, hypertension, and causes of infertility did not differ between the 2 groups. On multivariate analysis, diffuse polypoid appearance of the endometrial cavity on office hysteroscopy (hazard ratio [HR] 4.1; 95% CI 1.576-10.785), duration of infertility, (HR 4; 95% CI 1.279-12.562), and body mass index (HR 7.9; 95% CI 2.591-24.258) were found to be independent predictors of endometrial premalignancy/malignancy within polyps in infertile patients. CONCLUSION: When diffuse polypoid appearance of the endometrial cavity is detected in an infertile patient during office hysteroscopy, hysteroscopy-guided resection and endometrial curettage should be performed. The pathological specimen should be sent for histopathological evaluation to diagnose possible endometrial premalignancy/malignancy within polyps.


Assuntos
Neoplasias do Endométrio/diagnóstico , Infertilidade Feminina/patologia , Pólipos/patologia , Lesões Pré-Cancerosas/diagnóstico , Doenças Uterinas/patologia , Adulto , Índice de Massa Corporal , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/epidemiologia , Endométrio/patologia , Endométrio/cirurgia , Feminino , Humanos , Histeroscopia/estatística & dados numéricos , Infertilidade Feminina/etiologia , Infertilidade Feminina/cirurgia , Pessoa de Meia-Idade , Análise Multivariada , Pólipos/complicações , Pólipos/cirurgia , Lesões Pré-Cancerosas/complicações , Lesões Pré-Cancerosas/epidemiologia , Gravidez , Prevalência , Estudos Retrospectivos , Doenças Uterinas/complicações , Doenças Uterinas/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA