Impact of lymph node ratio and adjuvant therapy in node-positive endometrioid endometrial cancer
Identifieur interne : 007824 ( Ncbi/Merge ); précédent : 007823; suivant : 007825Impact of lymph node ratio and adjuvant therapy in node-positive endometrioid endometrial cancer
Auteurs : Nicole D. Fleming [États-Unis] ; Pamela T. Soliman [États-Unis] ; Shannon N. Westin [États-Unis] ; Ricardo Dos Reis [Brésil] ; Mark Munsell [États-Unis] ; Ann H. Klopp [États-Unis] ; Michael Frumovitz [États-Unis] ; Alpa M. Nick [États-Unis] ; Kathleen Schmeler [États-Unis] ; Pedro T. Ramirez [États-Unis]Source :
- International journal of gynecological cancer : official journal of the International Gynecological Cancer Society [ 1048-891X ] ; 2015.
Abstract
To determine if the ratio of positive to negative lymph nodes, or lymph node ratio (LNR), is a prognostic variable in patients with node-positive endometrial cancer and the impact of adjuvant therapy on survival.
After IRB approval, a retrospective review of patients diagnosed with stage IIIC endometrioid or mixed endometrioid endometrial cancer at a single institution from January 2000 through October 2011 was performed. Clinicopathologic and adjuvant treatment data was collected. Univariate and multivariate analysis were used to identify prognostic factors for progression-free (PFS) and overall survival (OS).
One hundred twenty-four patients with stage IIIC1 (n=64) and IIIC2 (n=60) endometrial cancer were included in the analysis. Median age was 60 years (range 25-84) and median follow-up was 49.4 months (range 0.1-301.6). Age >70 years was identified as a prognostic factor for worse PFS (p=0.0002) and OS (p=0.0002) on multivariate analysis. Patients in this cohort receiving any adjuvant radiotherapy showed improved PFS (HR 0.34, 95% CI 0.13-0.90, p=0.03) compared to those receiving any adjuvant chemotherapy (HR 2.33, 95% CI 1.16-4.65, p=0.02). In a subgroup analysis, patients with ≥ 10 nodes removed (n=81) with a LNR >50% had a PFS of 25.2 months compared to 135.6 months with a LNR ≤50% (HR 3.87, 95% CI 1.15-13.04, p=0.03).
LNR may define a subgroup of stage IIIC endometrial cancers at increased risk for recurrence. Adjuvant radiotherapy was associated with decreased recurrence risk.
Url:
DOI: 10.1097/IGC.0000000000000510
PubMed: 26332387
PubMed Central: 4581897
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Klopp</name><affiliation wicri:level="2"><nlm:aff id="A4">Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston</wicri:cityArea></affiliation></author><author><name sortKey="Frumovitz, Michael" sort="Frumovitz, Michael" uniqKey="Frumovitz M" first="Michael" last="Frumovitz">Michael Frumovitz</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston</wicri:cityArea></affiliation></author><author><name sortKey="Nick, Alpa M" sort="Nick, Alpa M" uniqKey="Nick A" first="Alpa M." last="Nick">Alpa M. Nick</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston</wicri:cityArea></affiliation></author><author><name sortKey="Schmeler, Kathleen" sort="Schmeler, Kathleen" uniqKey="Schmeler K" first="Kathleen" last="Schmeler">Kathleen Schmeler</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston</wicri:cityArea></affiliation></author><author><name sortKey="Ramirez, Pedro T" sort="Ramirez, Pedro T" uniqKey="Ramirez P" first="Pedro T." last="Ramirez">Pedro T. 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Fleming</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston</wicri:cityArea></affiliation></author><author><name sortKey="Soliman, Pamela T" sort="Soliman, Pamela T" uniqKey="Soliman P" first="Pamela T." last="Soliman">Pamela T. Soliman</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston</wicri:cityArea></affiliation></author><author><name sortKey="Westin, Shannon N" sort="Westin, Shannon N" uniqKey="Westin S" first="Shannon N." last="Westin">Shannon N. Westin</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston</wicri:cityArea></affiliation></author><author><name sortKey="Dos Reis, Ricardo" sort="Dos Reis, Ricardo" uniqKey="Dos Reis R" first="Ricardo" last="Dos Reis">Ricardo Dos Reis</name><affiliation wicri:level="3"><nlm:aff id="A2">Department of Gynecologic Oncology, Hospital de Cancer de Barretos, Sao Paulo, Brazil</nlm:aff><country xml:lang="fr">Brésil</country><wicri:regionArea>Department of Gynecologic Oncology, Hospital de Cancer de Barretos, Sao Paulo</wicri:regionArea><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Munsell, Mark" sort="Munsell, Mark" uniqKey="Munsell M" first="Mark" last="Munsell">Mark Munsell</name><affiliation wicri:level="2"><nlm:aff id="A3">Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston</wicri:cityArea></affiliation></author><author><name sortKey="Klopp, Ann H" sort="Klopp, Ann H" uniqKey="Klopp A" first="Ann H." last="Klopp">Ann H. Klopp</name><affiliation wicri:level="2"><nlm:aff id="A4">Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston</wicri:cityArea></affiliation></author><author><name sortKey="Frumovitz, Michael" sort="Frumovitz, Michael" uniqKey="Frumovitz M" first="Michael" last="Frumovitz">Michael Frumovitz</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston</wicri:cityArea></affiliation></author><author><name sortKey="Nick, Alpa M" sort="Nick, Alpa M" uniqKey="Nick A" first="Alpa M." last="Nick">Alpa M. Nick</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston</wicri:cityArea></affiliation></author><author><name sortKey="Schmeler, Kathleen" sort="Schmeler, Kathleen" uniqKey="Schmeler K" first="Kathleen" last="Schmeler">Kathleen Schmeler</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston</wicri:cityArea></affiliation></author><author><name sortKey="Ramirez, Pedro T" sort="Ramirez, Pedro T" uniqKey="Ramirez P" first="Pedro T." last="Ramirez">Pedro T. Ramirez</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Texas</region></placeName><wicri:cityArea>Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston</wicri:cityArea></affiliation></author></analytic><series><title level="j">International journal of gynecological cancer : official journal of the International Gynecological Cancer Society</title><idno type="ISSN">1048-891X</idno><idno type="eISSN">1525-1438</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objectives</title><p id="P1">To determine if the ratio of positive to negative lymph nodes, or lymph node ratio (LNR), is a prognostic variable in patients with node-positive endometrial cancer and the impact of adjuvant therapy on survival.</p></sec><sec id="S2"><title>Methods</title><p id="P2">After IRB approval, a retrospective review of patients diagnosed with stage IIIC endometrioid or mixed endometrioid endometrial cancer at a single institution from January 2000 through October 2011 was performed. Clinicopathologic and adjuvant treatment data was collected. Univariate and multivariate analysis were used to identify prognostic factors for progression-free (PFS) and overall survival (OS).</p></sec><sec id="S3"><title>Results</title><p id="P3">One hundred twenty-four patients with stage IIIC1 (n=64) and IIIC2 (n=60) endometrial cancer were included in the analysis. Median age was 60 years (range 25-84) and median follow-up was 49.4 months (range 0.1-301.6). Age >70 years was identified as a prognostic factor for worse PFS (p=0.0002) and OS (p=0.0002) on multivariate analysis. Patients in this cohort receiving any adjuvant radiotherapy showed improved PFS (HR 0.34, 95% CI 0.13-0.90, p=0.03) compared to those receiving any adjuvant chemotherapy (HR 2.33, 95% CI 1.16-4.65, p=0.02). In a subgroup analysis, patients with ≥ 10 nodes removed (n=81) with a LNR >50% had a PFS of 25.2 months compared to 135.6 months with a LNR ≤50% (HR 3.87, 95% CI 1.15-13.04, p=0.03).</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">LNR may define a subgroup of stage IIIC endometrial cancers at increased risk for recurrence. Adjuvant radiotherapy was associated with decreased recurrence risk.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">9111626</journal-id><journal-id journal-id-type="pubmed-jr-id">22047</journal-id><journal-id journal-id-type="nlm-ta">Int J Gynecol Cancer</journal-id><journal-id journal-id-type="iso-abbrev">Int. J. Gynecol. Cancer</journal-id><journal-title-group><journal-title>International journal of gynecological cancer : official journal of the International Gynecological Cancer Society</journal-title></journal-title-group><issn pub-type="ppub">1048-891X</issn><issn pub-type="epub">1525-1438</issn></journal-meta><article-meta><article-id pub-id-type="pmid">26332387</article-id><article-id pub-id-type="pmc">4581897</article-id><article-id pub-id-type="doi">10.1097/IGC.0000000000000510</article-id><article-id pub-id-type="manuscript">NIHMS693391</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Impact of lymph node ratio and adjuvant therapy in node-positive endometrioid endometrial cancer</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Fleming</surname><given-names>Nicole D.</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Soliman</surname><given-names>Pamela T.</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Westin</surname><given-names>Shannon N.</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>dos Reis</surname><given-names>Ricardo</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Munsell</surname><given-names>Mark</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Klopp</surname><given-names>Ann H.</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Frumovitz</surname><given-names>Michael</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Nick</surname><given-names>Alpa M.</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Schmeler</surname><given-names>Kathleen</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Ramirez</surname><given-names>Pedro T.</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</aff><aff id="A2"><label>2</label>Department of Gynecologic Oncology, Hospital de Cancer de Barretos, Sao Paulo, Brazil</aff><aff id="A3"><label>3</label>Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</aff><aff id="A4"><label>4</label>Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030</aff><author-notes><corresp id="FN1">Please send correspondence to: Nicole D. Fleming, MD, 1155 Pressler Drive, Unit 1362, Houston, TX 77030, Phone: (713) 563-1792, Fax: (713) 792-7586, <email>nfleming@mdanderson.org</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>26</day><month>5</month><year>2015</year></pub-date><pub-date pub-type="ppub"><month>10</month><year>2015</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>10</month><year>2016</year></pub-date><volume>25</volume><issue>8</issue><fpage>1437</fpage><lpage>1444</lpage><pmc-comment>elocation-id from pubmed: 10.1097/IGC.0000000000000510</pmc-comment>
<abstract><sec id="S1"><title>Objectives</title><p id="P1">To determine if the ratio of positive to negative lymph nodes, or lymph node ratio (LNR), is a prognostic variable in patients with node-positive endometrial cancer and the impact of adjuvant therapy on survival.</p></sec><sec id="S2"><title>Methods</title><p id="P2">After IRB approval, a retrospective review of patients diagnosed with stage IIIC endometrioid or mixed endometrioid endometrial cancer at a single institution from January 2000 through October 2011 was performed. Clinicopathologic and adjuvant treatment data was collected. Univariate and multivariate analysis were used to identify prognostic factors for progression-free (PFS) and overall survival (OS).</p></sec><sec id="S3"><title>Results</title><p id="P3">One hundred twenty-four patients with stage IIIC1 (n=64) and IIIC2 (n=60) endometrial cancer were included in the analysis. Median age was 60 years (range 25-84) and median follow-up was 49.4 months (range 0.1-301.6). Age >70 years was identified as a prognostic factor for worse PFS (p=0.0002) and OS (p=0.0002) on multivariate analysis. Patients in this cohort receiving any adjuvant radiotherapy showed improved PFS (HR 0.34, 95% CI 0.13-0.90, p=0.03) compared to those receiving any adjuvant chemotherapy (HR 2.33, 95% CI 1.16-4.65, p=0.02). In a subgroup analysis, patients with ≥ 10 nodes removed (n=81) with a LNR >50% had a PFS of 25.2 months compared to 135.6 months with a LNR ≤50% (HR 3.87, 95% CI 1.15-13.04, p=0.03).</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">LNR may define a subgroup of stage IIIC endometrial cancers at increased risk for recurrence. Adjuvant radiotherapy was associated with decreased recurrence risk.</p></sec></abstract></article-meta></front></pmc><affiliations><list><country><li>Brésil</li><li>États-Unis</li></country><region><li>Texas</li><li>État de São Paulo</li></region><settlement><li>São Paulo</li></settlement></list><tree><country name="États-Unis"><region name="Texas"><name sortKey="Fleming, Nicole D" sort="Fleming, Nicole D" uniqKey="Fleming N" first="Nicole D." last="Fleming">Nicole D. Fleming</name></region><name sortKey="Frumovitz, Michael" sort="Frumovitz, Michael" uniqKey="Frumovitz M" first="Michael" last="Frumovitz">Michael Frumovitz</name><name sortKey="Klopp, Ann H" sort="Klopp, Ann H" uniqKey="Klopp A" first="Ann H." last="Klopp">Ann H. Klopp</name><name sortKey="Munsell, Mark" sort="Munsell, Mark" uniqKey="Munsell M" first="Mark" last="Munsell">Mark Munsell</name><name sortKey="Nick, Alpa M" sort="Nick, Alpa M" uniqKey="Nick A" first="Alpa M." last="Nick">Alpa M. Nick</name><name sortKey="Ramirez, Pedro T" sort="Ramirez, Pedro T" uniqKey="Ramirez P" first="Pedro T." last="Ramirez">Pedro T. Ramirez</name><name sortKey="Schmeler, Kathleen" sort="Schmeler, Kathleen" uniqKey="Schmeler K" first="Kathleen" last="Schmeler">Kathleen Schmeler</name><name sortKey="Soliman, Pamela T" sort="Soliman, Pamela T" uniqKey="Soliman P" first="Pamela T." last="Soliman">Pamela T. Soliman</name><name sortKey="Westin, Shannon N" sort="Westin, Shannon N" uniqKey="Westin S" first="Shannon N." last="Westin">Shannon N. Westin</name></country><country name="Brésil"><region name="État de São Paulo"><name sortKey="Dos Reis, Ricardo" sort="Dos Reis, Ricardo" uniqKey="Dos Reis R" first="Ricardo" last="Dos Reis">Ricardo Dos Reis</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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