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Lara Burg,Maite Timmermans,Maaike van der Aa,Dorry Boll,Koen Rovers,Ignace de Hingh,Anne van Altena 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5
Objective: Peritoneal metastases (PM) are a challenge in gynecological cancers, but itsappearance has never been described in a population-based study. Therefore, we describe theincidence of PM and identify predictors that increase the probability of peritoneal spread. Methods: All ovarian, endometrial and cervical cancer patients diagnosed in the Netherlandsbetween 1989 and 2015 were identified from the Netherlands Cancer Registry and stratifiedfor PM. Crude and age-adjusted incidence over time was calculated. Independent predictorsfor PM were identified using uni- and multivariable analyses. Results: The 94,981 patients were diagnosed with ovarian, endometrial or cervicalcancer and respectively 61%, 2% and 1% presented with PM. Predictors for PM in ovariancancer were: age between 50 and 74 years (odds ratio [OR]=1.19; 95% confidence interval[CI]=1.08–1.32), other distant metastases (OR=1.25; 95% CI=1.10–1.41), poor differentiationgrade (OR=2.00; 95% CI=1.73–2.32) and serous histology. Predictors in endometrial cancerwere lymph node metastases (OR=2.32; 95% CI=1.65–3.26), other distant metastases(OR=1.38; 95% CI=1.08–1.77), high-grade tumors (OR=1.95; 95% CI=1.38–2.76) and clearcell (OR=1.49; 95% CI=1.04–2.13) or serous histology (OR=2.71; 95% CI=2.15–3.42). Incervical cancer, the risk is higher in adenocarcinoma than in squamous cell carcinoma(OR=4.92; 95% CI=3.11–7.79). Conclusion: PM are frequently seen in patients with ovarian cancer. In endometrial andcervical cancer PM are rare. Histological subtype was the strongest predictive factor for PMin all 3 cancers. Better understanding of predictive factors for PM and thus the biologicalbehavior is of paramount importance.
Lara C. Burg,Shenna Verheijen,Ruud L.M. Bekkers,Joanna IntHout,Robert W. Holloway,Salih Taskin,Sarah E. Ferguson,Yu Xue,Antonino Ditto,Glauco Baiocchi,Andrea Papadia,Giorgio Bogani,Alessandro Buda,Roy 대한부인종양학회 2022 Journal of Gynecologic Oncology Vol.33 No.5
Objective: The aim of this study was to assess the SLN detection rate in presumed early stage, low- and intermediate-risk endometrial cancers, the incidence of SLN metastases, and the negative predictive value of SLN mapping performed with indocyanine green (ICG). Methods: A systematic review with meta-analyses was conducted. Study inclusion criteria were A) low- and intermediate-risk endometrial cancer, B) the use of ICG per cervical injection; C) a minimum of twenty included patients per study. To assess the negative predictive value of SLN mapping, D) a subsequent lymphadenectomy was an additional inclusion criterion. Results: Fourteen studies were selected, involving 2,117 patients. The overall and bilateral SLN detection rates were 95.6% (95% confidence interval [CI]=92.4%–97.9%) and 76.5% (95% CI=68.1%–84.0%), respectively. The incidence of SLN metastases was 9.6% (95% CI=5.1%–15.2%) in patients with grade 1–2 endometrial cancer and 11.8% (95% CI=8.1%–16.1%) in patients with grade 1–3 endometrial cancer. The negative predictive value of SLN mapping was 100% (95% CI=98.8%–100%) in studies that included grade 1–2 endometrial cancer and 99.2% (95% CI=97.9%–99.9%) in studies that also included grade 3. Conclusion: SLN mapping with ICG is feasible with a high detection rate and negative predictive value in low- and intermediate-risk endometrial cancers. Given the incidence of SLN metastases is approximately 10% in those patients, SLN mapping may lead to stage shifting with potential therapeutic consequences. Given the high negative predictive value with SLN mapping, routine lymphadenectomy should be omitted in low- and intermediate- risk endometrial cancer.