Outcomes of intermediate-risk to high-risk stage I endometrial cancer

Abstract

Background: There are only very few reports on clinical outcomes using multi-channel applicators (MCA) for patients with endometrial cancer (EC) in China. We aimed to evaluate the clinical experience of treating intermediate-risk (IR) to high-risk (HR) stage I EC using in-house made multi-channel applicators (IH-MCA) in a single institution. Methods: Three hundred and ninety patients with stage I IR to HR EC were treated with hysterectomy and adjuvant radiotherapy from 2003 to 2015. All patients received post-operative vaginal cuff brachytherapy (VBT) alone or as a boost after external beam radiotherapy (EBRT). The prescriptions were 500 cGy per fraction for a total of 5 to 6 fractions with brachytherapy alone or 400 to 600 cGy per fraction for 2 to 3 fractions if it was combined with EBRT. Two types of applicators including a traditional rigid IH-MCA and a recent model custom-made with 3 dimension printing technology were used for treatment. The Kaplan-Meier method was used to calculate survival rate. Results: Follow-up rate was 92.8% and the median follow-up time was 48 months (range 4–172 months). The 5-year overall survival (OS), progression-free survival, local recurrence, and distant metastasis rates for all patients were 96.3%, 92.1%, 2.9%, and 4.8% respectively. Two patients had isolated relapse in vagina outside the irradiated volume. The univariate and multivariate analysis showed that age and grade were the prognostic factors correlated with OS (hazard ratio: 0.368, 95% confidence interval [CI]: 0.131–1.035, P = 0.048; hazard ratio: 0.576, 95% CI: 0.347–0.958, P = 0.026,). Conclusions: For patients with IR to HR stage I EC, adjuvant VBT alone or in combination with EBRT using IH-MCA led to excellent survival and recurrence rates. Age and grade were the prognostic factors correlated with OS.

Analysis of carcinogenic signaling networks in endometrial cancer identifies RAB17 as a potential target

“…Endometrial cancer is one of the most common malignancies in postmenopausal women (Moore & Brewer, 2017), and studies have shown that obesity and aging could lead to increased morbidity (Braun, Overbeek-Wager, & Grumbo, 2016;Haggerty et al, 2017). Other risk factors include diabetes, breast cancer, tamoxifen use, unproductiveness, advanced menopause, and exposure to high levels of estrogen (Hou, Yu, Hu, & Zhang, 2019).…”

Preoperative serum CA125 level and age at diagnosis: An effective prognosis prediction tool for patients with early‐stage endometrial cancer

“…The results of survival analysis show that only preoperative serum CA125 and age at diagnosis were independent prognostic factors for 5‐year OS with early‐stage EC. The results of previous literatures also proved that preoperative tumor markers such as CA125 and age are prognostic factors for EC 6,7 …”

“…Age is another important clinical factor for EC. Our previous results showed that age was an important independent prognostic factor for early‐stage EC and that the disease‐related mortality of patients increased gradually with increasing age 7 …”

“…The results of previous literatures also proved that preoperative tumor markers such as CA125 and age are prognostic factors for EC. 6,7 CA125 is a glycoprotein expressed in mesenchymal cells of the adult pleura, pericardium, and peritoneum, as well as cells derived from embryonic Mullerian tubes, namely, the oviduct, endometrium, and endometrial cells of the cervix. In premenopausal women, its level can be elevated due to a variety of physiological states and benign diseases, including inflammation, endometriosis, and menstruation, among others.…”

“…showed that age was an important independent prognostic factor for early-stage EC and that the disease-related mortality of patients increased gradually with increasing age. 7 Due to the influence of age on CA125, there are different cut-off values of CA125 for different age groups. In this study, the CA125positive group had worse clinicopathological features and OS.…”