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Insights into ovarian cancer care: report from the ANZGOG Ovarian Cancer Webinar Series 2020
Andreas Obermair,Philip Beale,Clare L Scott,Victoria Beshay,Ganessan Kichenadasse,Bryony Simcock,James Nicklin,Yeh Chen Lee,Paul Cohen,Tarek Meniawy 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.6
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Fertility-sparing treatment in early endometrial cancer: current state and future strategies
( Andreas Obermair ),( Franzcog ),( Eva Baxter ),( Donal J. Brennan ),( Jessica N. Mcalpine ),( Jennifer J. Mueller ),( Frédéric Amant ),( Mignon D. J. M. Van Gent ),( Robert L. Coleman ),( Shannon N. 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.4
Endometrial cancer (EC) is the fifth most common cancer in women worldwide. Global estimates show rising incidence rates in both developed and developing countries. Most women are diagnosed postmenopausal, but 14-25% of patients are premenopausal and 5% are under 40 years of age. Established risk factors include age and hyperestrogenic status associated with nulliparity, obesity, and metabolic syndrome. Standard treatment for EC, which involves total hysterectomy and bilateral salpingo-oophorectomy, has excellent survival outcomes, particularly for low-grade endometrioid tumors. However, it leads to permanent loss of fertility among women who wish to preserve their reproductive potential. With current trends of reproductive-age women delaying childbearing, rising EC incidence rates, and a growing epidemic of obesity, particularly in developed countries, research on conservative non-surgical treatment approaches remains a top priority. Fertility-sparing treatment predominantly involves the use of oral progestins and levonorgestrel-releasing intrauterine devices, which have been shown to be feasible and safe in women with early stage EC and minimal or no myometrial invasion. However, data on the efficacy and safety of conservative management strategies are primarily based on retrospective studies. Randomized clinical trials in younger women and high-risk obese patients are currently underway. Here, we have presented a comprehensive review of the current literature on conservative, fertility-sparing approaches, defining the optimal candidates and evaluating tumor characteristics, reproductive and oncologic outcomes, and ongoing clinical trials. We have also summarized current guidelines and recommendations based on the published literature.
Endometrial cancer risk and survival by tumor MMR status
Christina M. Nagle,Christina M. Nagle,Tracy A. O'Mara,Yen Tan,Daniel D. Buchanan,Andreas Obermair,Penny Blomfield,Michael A. Quinn,Penelope M. Webb,Amanda B. Spurdle,Australian Endometrial Cancer Stud 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.3
Objective: The risk of developing endometrial cancer (EC) and/or survival following a diagnosis of EC might differ by tumor DNA mismatch repair (MMR) status. We assessed the association between tumor MMR status (classified as MMR-proficient, somatic MMR-deficient, germline MMR-deficient) and the risk of developing EC and survival following a diagnosis of EC. Methods: We analyzed data from women who participated in the Australian National Endometrial Cancer Study (ANECS) conducted between 2005 and 2007. Risk analyses (698 cases/691 population controls) utilized sociodemographic and lifestyle information obtained from telephone interviews at recruitment. For survival analyses (728 cases), patients' clinical data was abstracted from medical records, and survival data were obtained via linkage with the Australian National Death Index. We used logistic regression analysis to evaluate the associations between tumor MMR status and EC risk, and proportional hazards models to perform survival analyses with adjustment of known prognostic factors. Results: Established risk factors for EC did not differ significantly by tumor MMR status. In analyses including all EC subtypes, overall and EC-specific survival did not differ by tumor MMR status. Among women with the most common endometrioid subtype, EC-specific survival was worse for women with somatic MMR-deficient EC compared to women with MMR-proficient EC (hazard ratio [HR]=2.18; 95% confidence interval [CI]=1.19–4.01). Conclusion: The risk of EC is not associated with MMR status. Accurate separation of germline from somatic causes of MMR deficiency suggests that patients with endometrioid subtype somatic MMR-deficient tumors have poorer EC-specific survival than those with MMR-proficient tumors, after accounting for other prognostic factors.