Lymphadenectomy in surgical stage I epithelial ovarian cancer.

OBJECTIVE: To identify the extent of lymphadenectomy performed in women presenting with epithelial ovarian cancer macroscopically confined to the ovary. Furthermore, the effect of lymphadenectomy on overall survival is evaluated. DESIGN: A prospective nationwide case-only study. SETTING: Denmark 2005-2011. SAMPLE: All women registered in the nationwide Danish Gynecologic Cancer Database from 1 January 2005 to 1 May 2011, presenting with a tumor macroscopically confined to the ovary without visible evidence of abdominal spread at the time of the initial exploration (surgical stage I). METHOD: Descriptive and survival analyses of data from Danish Gynecologic Cancer Database. MAIN OUTCOME MEASURES: The annual proportion of women with surgical stage I disease who received lymphadenectomy and the survival in the two groups. RESULTS: Of 2361 women with epithelial ovarian cancer, 627 were identified with surgical stage I. Lymphadenectomy was performed in 216 women (34%) of whom 13 (6%) had lymph node metastases. At 5-year follow up 85% remained alive in the lymphadenectomy group compared with 80% in the control group (p = 0.064). The lymphadenectomy fraction increased from 24% in 2005 to 55% in 2011. When univariate and multivariate analyses were conducted only an insignificant difference in the survival probability was found between lymphadenectomy and no lymphadenectomy in women presenting with tumor macroscopically confined to the ovary. CONCLUSION: Although increasing, the number of women with surgical stage I disease in Denmark who receive lymphadenectomy remains low, but this did not seem to make a difference to survival.

Long-term adherence to follow-up after treatment of cervical intraepithelial neoplasia: nationwide population-based study.

OBJECTIVE: To measure adherence to annual follow-up among women treated for cervical intraepithelial neoplasia. DESIGN: Prospective, population-based, register study. SETTING: Denmark, 1996-2007. POPULATION: All women treated for cervical intraepithelial neoplasia with conization. METHODS: Treated women were routinely recommended to have follow-up with annual smears for at least 5 years. MAIN OUTCOME MEASURES: Using individually linked nationwide register data on conizations and follow-up tests (smears and biopsies), we calculated the cumulative proportion of treated women undergoing the recommended follow-up. We measured this cumulative proportion conservatively in 15-month intervals for 5 years. RESULTS: Adherence to annual follow-up among 45,984 treated women decreased gradually. In total, 90% of these women obtained at least one smear in the first post-treatment year, but only 40% obtained the recommended tests for 5 years. Five-year adherence was substantially better outside the capital area, for example, the odds ratio for women from Jutland compared with women from the capital area was 1.70 (95% confidence interval 1.60-1.82). CONCLUSIONS: Adherence to follow-up after conization was poor in Denmark. Our findings suggest that because of this poor adherence, recommendations for long-term annual follow-up after treatment of cervical intraepithelial neoplasia may not be highly effective. Shorter follow-up schedules using highly sensitive tests appear attractive.

HE4 and CA125 levels in the preoperative assessment of endometrial cancer patients: a prospective multicenter study (ENDOMET).

OBJECTIVE: To evaluate whether human epididymis protein 4 (HE4) and CA125 correlate with known high-risk prognostic factors for endometrial cancer. DESIGN: Prospective multicenter study. SETTING: Three Danish tertiary gynecological oncology centers. POPULATION: A total of 352 patients with endometrial cancer and atypical endometrial hyperplasia consecutively referred between 1 September 2009 and 1 January 2012. METHODS: Preoperative blood samples were obtained from all patients. Biomarker levels were correlated with pathological characteristics of hysterectomy specimens. MAIN OUTCOME MEASURES: FIGO stage, depth of myometrial invasion, cervical involvement, lymph node metastases, and histological type and grade of tumor. RESULTS: We found that both HE4 and CA125 were significantly positively correlated with histological grade (HE4: p = 0.002 and CA125: p = 0.027), lymph node metastases (HE4: p = 0.013 and CA125: p < 0.0001), myometrial invasion (p < 0.0001) and cervical involvement (p < 0.0001). Furthermore, a significant increase was found with increasing FIGO stage for both markers (p < 0.0001). In a combined index including age, the diagnostic value increases. Area under the receiver operating characteristics curves were higher for the index compared with the markers individually for all our endpoints. The calculated plots for the combined index may assist gynecologists in predicting the risk of deep myometrial invasion, cervical involvement and lymph node metastases. The analyses emphasize that the combined markers should be used in the prediction of prognostic factors. CONCLUSION: This study confirmed that the markers are significantly elevated in patients with prognostic high-risk factors and may, therefore, be used as an additional tool in combination with imaging and clinical information when planning the treatment of endometrial cancer patients.