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Uterine Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Claudia von Arx, Hani Gabra, Christina Fotopoulou
One of the largest studies for serous papillary EC, the Uterine Papillary Serous Carcinoma Consortium Study, included 142 women with serous EC. This was a retrospective, multi-institution analysis of surgically staged I–II patients.112 Following surgery, 23% received no further treatment, whereas 14% and 63% were treated with adjuvant RT alone or adjuvant chemotherapy, respectively. Of those receiving chemotherapy, mainly carboplatin and paclitaxel, 37% also received RT. Of the 206 identified patients, 21% experienced recurrence. On univariate analysis, age, increasing percentage of uterine papillary serous carcinoma (UPSC), LVSI, and tumor size were not significantly associated with recurrence or PFS. However, substage (p = 0.005) and treatment with platinum/taxane-based chemotherapy (p = 0.001) were associated with recurrence/PFS. On multivariate analysis, only chemotherapy (p = 0.01) was a significant factor affecting PFS, whereas age (p = 0.05), substage (p = 0.05), and chemotherapy (p = 0.02) were associated with OS. The authors concluded that traditional risk factors for recurrence and survival in patients with early-stage EC may not be relevant in patients with serous papillary histology and that these patients are at a significant risk for recurrence and poor survival outcomes regardless of the percentage of serous papillary component in their uterine specimens.
Endometrial cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2014
Christina Fotopoulou, Hani Gabra
One of the largest studies for serous papillary EC, the ‘Uterine Papillary Serous Carcinoma Consortium Study,’ included 142 women with serous EC. This was a retrospective, multi-institution analysis of surgically staged I-II patients.56 Following surgery, 23% received no further treatment whereas 14% and 63% were treated with adjuvant RT alone or adjuvant chemotherapy, respectively. Of those receiving chemotherapy, mainly carboplatin and paclitaxel, 37% also received RT. Of the 206 identified patients, 21% experienced recurrence. On univariate analysis, age, increasing per cent of uterine papillary serous carcinoma (UPSC), lymphvascular space invasion (LVSI) and tumour size were not significantly associated with recurrence or PFS. However, substage (p = .005) and treatment with platinum/taxane-based chemotherapy (p = .001) were associated with recurrence/PFS. On multivariate analysis, only chemotherapy (p = .01) was a significant factor affecting PFS, whereas age (p = .05), substage (p = .05), and chemotherapy (p = .02) were associated with OS. The authors concluded that traditional risk factors for recurrence and survival in patients with early stage EC may not be relevant in patients with serous papillary histology and that these patients are at a significant risk for recurrence and poor survival outcomes regardless the percentage of serous-papillary component in their uterine specimens.
Discrepancy between preoperative endometrial sampling and hysterectomy diagnosis in endometrial cancer
Published in Southern African Journal of Gynaecological Oncology, 2020
Sanele E Mhlongo, Thinagrin D Naidoo, Bongumusa S Makhathini
The sensitivity of preoperative endometrial sampling to predict endometrioid adenocarcinoma was 94.7% (36/38); two tumours were reclassified to uterine papillary serous carcinoma (UPSC) on final pathology. The sensitivity of preoperative sampling for serous papillary carcinoma was 42.9% (3/7); of the four tumours, one was reclassified from complex atypical hyperplasia and the other three were reclassified from endometrioid adenocarcinoma. Among the three patients with UPSC preoperatively only one patient had immunohistochemistry (IHC) staining using vimentin and CEA stains only; p53 was not used. Four other patients were diagnosed with UPSC postoperatively; among those three had immunochemistry staining on their endometrial sampling specimens using vimentin, CEA and mucin only; p53 was also not performed in any of them and none of them had IHC staining on their hysterectomy specimens. Sensitivity for carcinosarcoma was 85.7% (6/7) with one tumour reclassified from complex atypical hyperplasia. Sensitivity for atypical hyperplasia was 75% (9/12), three tumours were reclassified to high-grade endometrioid adenocarcinoma, uterine papillary serous carcinoma and carcinosarcoma respectively. The overall sensitivity of endometrial sampling was 83.3% (50/60). A kappa value of 0.825 was obtained with a p-value of 0.000 for agreement between preoperative endometrial sampling and the final postoperative diagnosis. A difference of proportion test was carried out. We used the z-test. All the endometrial cancer subtypes had no statistically significant differences between the post- and preoperative diagnosis as evident by the non-significant p-values.