Mehmet Mutlu MEYDANLI, İbrahim YALÇIN, Nazlı ÖZKAN TOPFEDAİSİ, Vakkas KORKMAZ KORKMAZ, Mustafa Erkan SARI, Tayfun GÜNGÖR, Hanifi ŞAHİN

Evre 3C Endometrioid Tip Endometrium Kanserlerinin Analizi: Evre IIIC1 ve Evre IIIC2 Arasında Sağ Kalım Farkı Var mı?

Amaç: Bu çalışmanın amacı evre IIIC1 ve IIIC2 endometrioid tip endometrium kanserinin genel ve hastalıksız sağ kalım analizlerini karşılaştırarak tek merkez deneyimimizi aktarmaktır.Gereç ve Yöntem: Kliniğimizde cerrahi olarak komplet evrelenmiş ve histopatolojik inceleme sonucunda evre IIIC tanısı alan endometrioid tip endometrium kanseri tanısı alan olgular n=47 çalışmaya dâhil edildi. Olgular iki gruba ayrıldı. Grup 1’e evre IIIC1 tanısı konulan hastalar n=21, %44,7 alınırken, Grup 2’de ise evre IIIC2 tanısı konulan olgular n=26, %55,3 yer aldı. Hastaların ortanca yaşı 61 34-74 idi. İki grup arasında yaş, sitoloji, lenfovasküler alan invazyonu, tümör çapı, miyometrial invazyon derinliği, grade, lenf nodu sayısı, serum Ca-125 seviyesi, servikal stromal tutulum ve adneksial tutulum açısından anlamlı bir fark izlenmedi p>0.05 . İki grup arasında hastalıksız sağ kalım DFS ve genel sağkalım OS açısından anlamlı farklılık bulunamadı. Beş yıllık DFS oranları ise sırasıyla % 53,9 ve % 49,3 olarak bulundu p=0.915 . 5 yıllık OS oranları sırası ile % 53,1 ve % 60,5 olarak tespit edildi p= 0.664 . Çalışmamızda evre IIIC1 ve evre IIIC2 olguları arasında onkolojik akıbet açısından fark bulunmadı.Sonuç: Çalışmamızda evre IIIC1 ve evre IIIC2 endometrioid tip endometrium kanserli olguların hastalıksız sağkalım ve genel sağkalım açısından anlamlı fark bulunmadı.

Analaysis Of Stage 3C Endometroid Type Endometrium Cancer: Is There Any Survival Difference Between Stage IIIC1 And IIIC2 ?

Aim: The objective of this study was to compare the survival outcomes of stage IIIC1 and IIIC2 endometrioid type endometrial cancer and to share our single center experience.Material and Methods: The patients who underwent complete surgical staging and diagnosed as stage IIIC endometrioid type endometrial cancer after final histopathological examination were included in this study. A total of 47 women were included in this retrospective study. The patients were divided into two groups. The patients with stage IIIC1 n=21, 44.7 % were included in Group 1 whereas the patients with stage IIIC2 n=26, 55.3 % were included in Group 2.Result: The median age of the patients was 61 34-74 . There was also no statistically significant difference between the two groups in terms of age, peritoneal cytology, lymphovascular space involvement, tumor diameter, depth of myometrial invasion, FIGO grade, number of positive lymph nodes, preoperative serum CA-125 level, cervical stromal involvement and adnexial involvement p>0.05 . There was no statistically significant difference in terms of disesase-free survival DFS and overall survival OS between the two groups. Five-year DFS rates were 53.9 % in Group 1 and 49.3 % in Group 2, respectively p=0.915 . Five-year of OS rates were found to be 53.1 % in Group 1 and 60.5 % in Group 2, respectively p=0.664 .Conclusion: The relationship between lymph node involvement and survival in advanced stage endometrioid endometrial cancer is controversial in the current literature and our study did not show any survival difference between stage IIIC1 and IIIC2 disease.

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Colombo N, Creutzberg C, Amant F, Bosse T, Gonzalez-Martin A, Ledermann J, et al. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: Diagnosis, treatment and follow-up. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2015;117(3):559-81.
Lee NK, Cheung MK, Shin JY, Husain A, Teng NN, Berek JS, et al. Prognostic factors for uterine cancer in reproductive-aged women. Obstetrics and gynecology. 2007;109(3):655-62.
ACOG practice bulletin, clinical management guidelines for obstetrician- gynecologists, number 65, August 2005: management of endometrial cancer. Obstetrics and gynecology. 2005;106(2):413-25.
Ueda SM, Kapp DS, Cheung MK, Shin JY, Osann K, Husain A, et al. Trends in demographic and clinical characteristics in women diagnosed with corpus cancer and their potential impact on the increasing number of deaths. American journal of obstetrics and gynecology. 2008;198(2):218.e1-6.
Van Wijk FH, Huikeshoven FJ, Abdulkadir L, Ewing PC, Burger CW. Stage III and IV endometrial cancer: a 20-year review of patients. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2006;16(4):1648-55.
Mittal KR, Schwartz PE, Barwick KW. Architectural (FIGO) grading, nuclear grading, and other prognostic indicators in stage I endometrial adenocarcinoma with identification of high-risk and low-risk groups. Cancer. 1988;61(3):538-45.
Petru E, Luck HJ, Stuart G, Gaffney D, Millan D, Vergote I. Gynecologic Cancer Intergroup (GCIG) proposals for changes of the current FIGO staging system. European journal of obstetrics, gynecology, and reproductive biology. 2009;143(2):69-74.
Ayhan A, Taskiran C, Celik C, Aksu T, Yuce K. Surgical stage III endometrial cancer: analysis of treatment outcomes, prognostic factors and failure patterns. European journal of gynaecological oncology. 2002;23(6):553- 6.
Van Wijk FH, van der Burg ME, Burger CW, Vergote I, van Doorn HC. Management of surgical stage III and IV endometrioid endometrial carcinoma: an overview. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2009;19(3):431-46.
Bristow RE, Zahurak ML, Alexander CJ, Zellars RC, Montz FJ. FIGO stage IIIC endometrial carcinoma: resection of macroscopic nodal disease and other determinants of survival. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2003;13(5):664-72.
Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet (London, England). 2010;375(9721):1165-72.
Watari H, Todo Y, Takeda M, Ebina Y, Yamamoto R, Sakuragi N. Lymph- vascular space invasion and number of positive para-aortic node groups predict survival in node-positive patients with endometrial cancer. Gynecologic oncology. 2005;96(3):651-7.
Mariani A, Webb MJ, Galli L, Podratz KC. Potential therapeutic role of para-aortic lymphadenectomy in node-positive endometrial cancer. Gynecologic oncology. 2000;76(3):348-56.
Havrilesky LJ, Cragun JM, Calingaert B, Synan I, Secord AA, Soper JT, et al. Resection of lymph node metastases influences survival in stage IIIC endometrial cancer. Gynecologic oncology. 2005;99(3):689-95.
Sari ME, Yalcin I, Sahin H, Meydanli MM, Gungor T. Risk factors for paraaortic lymph node metastasis in endometrial cancer. International journal of clinical oncology. 2017.
Akbayir O, Corbacioglu A, Goksedef BP, Numanoglu C, Akca A, Guraslan H, et al. The novel criteria for predicting pelvic lymph node metastasis in endometrioid adenocarcinoma of endometrium. Gynecologic oncology. 2012;125(2):400-3.
Zhang C, Wang C, Feng W. Clinicopathological risk factors for pelvic lymph node metastasis in clinical early-stage endometrioid endometrial adenocarcinoma. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2012;22(8):1373-7.
Barlin JN, Puri I, Bristow RE. Cytoreductive surgery for advanced or recurrent endometrial cancer: a meta-analysis. Gynecologic oncology. 2010;118(1):14-8.
Secord AA, Geller MA, Broadwater G, Holloway R, Shuler K, Dao NY, et al. A multicenter evaluation of adjuvant therapy in women with optimally resected stage IIIC endometrial cancer. Gynecologic oncology. 2013;128(1):65-70.
Klopp AH, Jhingran A, Ramondetta L, Lu K, Gershenson DM, Eifel PJ. Node-positive adenocarcinoma of the endometrium: outcome and patterns of recurrence with and without external beam irradiation. Gynecologic oncology. 2009;115(1):6-11.
Randall ME, Filiaci VL, Muss H, Spirtos NM, Mannel RS, Fowler J, et al. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2006;24(1):36-44.