Survival impact of cytoreduction to microscopic disease for advanced stage cancer of the uterine corpus: A retrospective cohort study

Alagkiozidis, Ioannis; Grossman, Allison; Tang, Nancy; Weedon, Jeremy; Mize, Benjamin; Salame, Ghadir; Lee, Yi-Chun; Abulafia, Ovadia

doi:10.1016/j.ijsu.2015.01.001

Cited by 20 publications

(8 citation statements)

References 19 publications

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“…Despite a few exceptions, 6 , 46 in our series, compared with most published series analyzing data for CRS alone in treating advanced or recurrent EC, 37 , 38 , 41 , 42 the only independent prognostic factor able to predict outcome was the completeness of cytoreduction. Although it remains conjectural whether HIPEC improved outcome in our series, an outcome finding that emerged from analysis of the 24 patients who had recurrent disease was the site of recurrence.…”

Section: Discussioncontrasting

confidence: 56%

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Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Patients with Peritoneal Metastases from Endometrial Cancer

et al. 2017

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BackgroundMore information is needed for selection of patients with peritoneal metastases from endometrial cancer (EC) to undergo cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC).MethodsThis study analyzed clinical, pathologic, and treatment data for patients with peritoneal metastases from EC who underwent CRS plus HIPEC at two tertiary centers. The outcome measures were morbidity, overall survival (OS), and progression-free survival (PFS) during a median 5 year follow-up period. Uni- and multivariate analyses were performed to identify significant factors related to outcome.ResultsA total of 33 patients met the inclusion criteria and completed the follow-up period. At laparotomy, the median peritoneal cancer index (PCI) was 15 (range 3–35). The CRS procedure required a mean 8.3 surgical procedures per patient, and for 22 patients (66.6%), a complete cytoreduction was achieved. The mean hospital stay was 18 days, and major morbidity developed in 21% of the patients. The operative mortality was 3%. When surgery ended, HIPEC was administered with cisplatin 75 mg/m2 for 60 min at 43 °C. During a median follow-up period of 73 months, Kaplan–Meier analysis indicated a 5 year OS of 30% (median 33.1 months) and a PFS of 15.5% (median 18 months). Multivariate analysis identified the completeness of cytoreduction (CC) score as the only significant factor independently influencing OS. Logistic regression for the clinicopathologic variables associated with complete cytoreduction (CC0) for patients with metachronous peritoneal spread from EC who underwent secondary CRS plus HIPEC identified the PCI as the only outcome predictor.ConclusionsFor selected patients with peritoneal metastases from EC, when CRS leaves no residual disease, CRS plus HIPEC achieves outcomes approaching those for other indications such as colon and ovarian carcinoma.

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Section: Discussioncontrasting

confidence: 56%

“…Bias apart, our outcome results compare well with published data, especially for those patients in whom CRS combined with HIPEC achieved complete cytoreduction. 12 , 37 , 38 , 41 , 42 , 45 , 46 …”

Section: Discussionmentioning

confidence: 99%

Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Patients with Peritoneal Metastases from Endometrial Cancer

et al. 2017

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“…Patients with type I endometrial cancer and no residual disease reported a median survival of 36 months, while those with incomplete debulking reported a median survival of 21 months; in the meantime, patients with type II endometrial cancer -the serous subtype-reported a median overall survival of 22 months when complete cytoreduction was performed and only 12 months for incompletely debulked patients. Moreover, the authors demonstrated that patients submitted to surgery after 2000 benefited more often from radical procedures and experienced a better outcome when compared to those submitted to surgery before 2000 (12). The strength of the study was related to the demonstration of the benefits of debulking surgery for type II endometrial tumors; the authors clearly demonstrated that type II tumors can be also submitted to debulking surgery with good results in terms of survival.…”

Section: Discussionmentioning

confidence: 94%

“…Another study conducted on the survival impact of cytoreduction for advanced-stage endometrial cancer comes from Alagkiozidis et al (12) patients submitted to debulking surgery for advanced-stage endometrial cancer between 1984-2009, with 105 of them being submitted to complete cytoreduction. Among cases in which suboptimally debulking surgery was performed, the most common sites of residual disease included the pelvic area (in 61% of cases), mid-abdomen (in 35% of cases) and upper abdomen (in 35% of cases).…”

Section: Discussionmentioning

confidence: 99%

Debulking Surgery for High-grade Serous Endometrial Cancer with Disseminated Peritoneal Lesions

Bacalbaşa

Bălescu

Filipescu

2017

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Abstract. Endometrial cancer is one of the most common malignancies in postmenopausal womenEndometrial cancer, one of the most common gynecologic malignancies, usually affects postmenopausal women (1). The most commonly reported sign consists of postmenopausal vaginal bleeding, which, most often, determines further investigation. In such a case, the patient is usually diagnosed in early stages of the disease, submitted to surgery with curative intent and reports an excellent result in terms of survival (2-4). However, in certain cases, vaginal bleeding is not seen, with the patient presenting diffuse abdominal pain, weight loss or asthenia. As a result, a longer period of time will pass between the onset of the symptoms and the moment of establishing the right diagnosis. Therefore, the patient will be diagnosed when disseminated lesions are already present with, unfortunately, a poorer outcome. It has been widely demonstrated that, while patients diagnosed in early stages of the disease report a 5-year survival of up to 85%, cases diagnosed in advanced stages will report a 5-year survival rate of less than 15%. Another significant prognostic factor in patients with endometrial cancer was shown to be the histopathological subtype; while cases diagnosed with type I endometrial cancer (endometroid tumors) report a favorable prognosis, women diagnosed with type-II endometrial cancer (serous cell tumors or clear cell tumors) will experience a poorer outcome. However, it seems that applying the principles of debulking surgery can significantly improve the outcomes of these cases (5, 6). Case ReportA 60-year-old, nulliparous patient presented with diffuse abdominal pain, asthenia and weight loss. The preoperative imaging studies revealed the presence of a diffuse endometrial thickening in association with the presence of diffuse peritoneal thickening, mesenteric nodules and ascites. The patient was submitted to endometrial biopsy that revealed the presence of a high-grade endometrial serous carcinoma. After the specific preoperative preparation, the patient was submitted to debulking surgery, a total hysterectomy with bilateral adenexectomy, total colectomy, partial cystectomy with cystoraphy, pelvic, para-aortic lymph node dissection, total omentectomy, pelvic, parietal and left diaphragmatic peritonectomy, with a R0 resection being achieved (Figures 1-3). The terminal ileum was exteriorized in terminal right ileostomy. The postoperative course was uneventful, with the patient being discharged in the fifth postoperative day. The urinary catheter was removed in the 21th postoperative day. Histopathological and immunohistochemical studies revealed the presence of a high-grade serous endometrial carcinoma with three pelvic positive nodes. The patient was submitted to six cycles of adjuvant chemotherapy. Three months after ending the adjuvant treatment, she was submitted to a control computed tomography scan that revealed absence of recurrent disease. Therefore, the continuity of the digestive tract was 719

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“…Several previous studies evaluated the impact of cytoreduction on survival for advanced-stage or disseminated peritoneal lesions of endometrial cancer. They showed that survival was significantly correlated with the presence of residual disease [33,34]. However, the definition of complete cytoreduction varied across studies.…”

Section: Discussionmentioning

confidence: 99%

Impact of Adjuvant Modalities on Survival in Patients with Advanced Stage Endometrial Carcinoma: A Retrospective Analysis from a Tertiary Medical Center

Tai

Hsu

Chiang

et al. 2019

IJERPH

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Adjuvant treatment in advanced-stage (stages III /IV) endometrial carcinomas in terms of tumor grades has not yet been explored. We retrospectively analyzed 194 patients with advanced-stage endometrioid endometrial carcinoma who received surgery, followed by adjuvant therapy, at National Taiwan University Hospital between January 1, 2000 and August 31, 2017. Adjuvant therapies included radiation (RT), chemotherapy alone (CT), and combined modality treatment (CMT: radiation and chemotherapy). The prognostic factors were determined from multivariate survival analyses using Cox regression models. Progression-free survival (PFS) and overall survival (OS) times were estimated with the Kaplan–Meier method. The median follow-up was 45.5 months (range: 6.2–207.9). In grade 1/2 endometrioid carcinoma, neither adjuvant CT nor CMT could prolong PFS significantly compared to RT (CT: HR 1.59, 95% CI 0.64–3.97; CMT: HR 2.03, 95% CI 0.72–5.74). Notably, maximal cytoreduction independently improved PFS (HR 0.31, 95% CI 0.10–0.90). No particular adjuvant treatment provided an OS advantage over the others for grade 1/2 endometrioid carcinomas. However, for grade 3 endometrioid carcinoma, CMT showed OS benefits (HR 0.15, 95% CI 0.03–0.89) compared to RT and CT. In conclusion, maximal cytoreduction should be the goal in patients with grade 1/2 advanced-stage endometrioid carcinomas. Based on our results, patients with grade 3 endometrioid carcinomas might benefit from adjuvant CMT.

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Survival impact of cytoreduction to microscopic disease for advanced stage cancer of the uterine corpus: A retrospective cohort study

Abstract: Cytoreductive surgery to R0 is associated with improved OS in advanced uterine cancer. This effect is uniform among histologies. There is no interaction between histologic subtype and feasibility of complete cytoreduction.

Cited by 20 publications

References 19 publications

Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Patients with Peritoneal Metastases from Endometrial Cancer

Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Patients with Peritoneal Metastases from Endometrial Cancer

Debulking Surgery for High-grade Serous Endometrial Cancer with Disseminated Peritoneal Lesions

Impact of Adjuvant Modalities on Survival in Patients with Advanced Stage Endometrial Carcinoma: A Retrospective Analysis from a Tertiary Medical Center

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