Iranian Society of Gynecology Oncology

Authors

1 Department Gynecology Oncology, Iran University of Medical Sciences, Tehran, Iran

2 Department Gynecology Oncology, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Endometrial carcinoma is the most common cancer of the female genitalia and its prevalence is 2% to 3% along the females’ lifetime. This adenocarcinoma is diagnosed in the early stages because the patients become symptomatic early in the course of disease. The correlation of the lower uterine segment involvement (LUSI) with the recurrence, and the survival rates in patients with endometrial adenocarcinoma are always questionable. Confirming the prognostic significance of LUSI can fundamentally improve the current state of patients’ surveillance. The current study aimed at investigating the association of lower uterine segment involvement with deep myometrial invasion in endometrial adenocarcinoma.
Methods: In the current retrospective cohort study, 54 patients with stage I endometrial endometrioid adenocarcinoma who underwent surgery in Mirza-Koochak-Khan Hospital, Tehran, Iran, from 2004 to 2014 were divided into 2 groups according to the presence of LUSI. In the current cohort study, the data from the patients exposed to LUSI were obtained by questionnaires to measure deep myometrial invasion besides post-operative adjuvant radiotherapy. The median of follow-up period was 48 months for all of the patients, which started after their surgery, and the measurement period for variables were similar to those of the follow-up period, which was 48 months. They were compared regarding to age, tumor grade, depth of myometrial invasion, lymphovascular involvement, extra uterine diseases, the extent of lymphadenectomy, adjuvant therapy, recurrence rate, time, and location. The data analysis was conducted by the SPSS v.16 statistical software (Chicago, IL, USA) at the significance level of 5%. In the investigation, Chi-square, the Kolmogorov-Smirnov, t test, and the Mann-Whitney U tests were used.
Results: Group 1 consisted of 13 patients with LUSI and group 2 had 41 patients without LUSI divided by a non-random sampling method. According to the results of the Mann-Whitney U test, there was a significant difference between the mean age of patients with LUSI and that of the ones without LUSI (P = 0.03). It showed that the mean age in the former group was significantly higher than that of the latter. A Chi-square test showed no significant association between the lymphovascular involvement and the presence of LUSI (P = 0.1). The Fisher exact test showed that patients with LUSI had significantly higher rate of radiotherapy after surgery rather than the ones without LUSI (P < 0.001).
Conclusions: In conclusion, there was a significant association between the lower uterine segment involvements with deep my ometrial invasion in the endometrial endometrioid adenocarcinoma. In other words, there was a significant difference in the depth of myometrial invasion between the groups, and the patients with LUSI had deeper myometrial invasion (the Mann-Whitney U test, P < 0.001).

Keywords

  1. Brown AK, Madom L, Moore R, Granai CO, DiSilvestro P. The prognostic significance of lower uterine segment involvement in surgically staged endometrial cancer patients with negative nodes. Gynecol Oncol. 2007;105(1):55-8. [DOI:10.1016/j.ygyno.2006.10.058] [PMID]
  2. Kizer NT, Gao F, Guntupalli S, Thaker PH, Powell MA, Goodfellow PJ, et al. Lower uterine segment involvement is associated with poor outcomes in early-stage endometrioid endometrial carcinoma. Ann Surg Oncol. 2011;18(5):1419-24. [DOI:10.1245/s10434-010-1454-9] [PMID]
  3. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C. GLOBOCAN 2012 v1. 0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 France: International Agency for Research on Cancer; 2014. Available from: https://www.iarc.fr/Default.aspx.
  4. Lax SF. Pathology of Endometrial Carcinoma. Adv Exp Med Biol. 2017;943:75-96. [DOI:10.1007/978-3-319-43139-0_3] [PMID]
  5. Lavie O, Uriev L, Gdalevich M, Barak F, Peer G, Auslender R, et al. The outcome of patients with stage I endometrial cancer involving the lower uterine segment. Int J Gynecol Cancer. 2008;18(5):1079-83. [DOI:10.1111/j.1525-1438.2007.01150.x] [PMID]
  6. Trimble EL, Harlan LC, Clegg LX, Stevens JL. Pre-operative imaging, surgery and adjuvant therapy for women diagnosed with cancer of the corpus uteri in community practice in the United States. Gynecol Oncol. 2005;96(3):741-8. [DOI:10.1016/j.ygyno.2004.11.041] [PMID]
  7. Carlson MJ, Thiel KW, Leslie KK. Past, present, and future of hormonal therapy in recurrent endometrial cancer. Int J Womens Health. 2014;6:429-35. [DOI:10.2147/IJWH.S40942] [PMID]
  8. Aminimoghaddam S, Shahrabi-Farahani M, Mohajeri-Tehrani M, Amiri P, Fereidooni F, Larijani B, et al. Epistatic interaction between adiponectin and survivin gene polymorphisms in endometrial carcinoma. Pathol Res Practice. 2015;211(4):293-7. [DOI:10.1016/j.prp.2014.11.012] [PMID]
  9. Masuda K, Banno K, Yanokura M, Kobayashi Y, Kisu I, Ueki A, et al. Carcinoma of the Lower Uterine Segment (LUS): Clinicopathological Characteristics and Association with Lynch Syndrome. Curr Genomics. 2011;12(1):25-9. [DOI:10.2174/138920211794520169] [PMID]
  10. Westin SN, Lacour RA, Urbauer DL, Luthra R, Bodurka DC, Lu KH, et al. Carcinoma of the lower uterine segment: a newly described association with Lynch syndrome. J Clin Oncol. 2008;26(36):5965-71. [DOI:10.1200/JCO.2008.18.6296] [PMID]
  11. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277-300. [DOI:10.3322/caac.20073] [PMID]
  12. Ghaemmaghami F, Aminimoghaddam S, Modares-Gilani M, Mousavi A, Khazaeipour Z, Fereidoni F. Assessment of gross examination and frozen section of uterine specimen in endometrial cancer patients. Arch Gynecol Obstet. 2010;282(6):685-9. [DOI:10.1007/s00404-010-1387-3] [PMID]
  13. Phelan C, Montag AG, Rotmensch J, Waggoner SE, Yamada SD, Mundt AJ. Outcome and management of pathological stage I endometrial carcinoma patients with involvement of the lower uterine segment. Gyneco Oncol. 2001;83(3):513-7. [DOI:10.1006/gyno.2001.6407] [PMID]
  14. Gemer O, Gdalevich M, Voldarsky M, Barak F, Arie AB, Schneider D, et al. Lower uterine segment involvement is associated with adverse outcome in patients with stage I endometroid endometrial cancer: Results of a multicenter study. Eur J Surg Oncol. 2009;35(8):865-9. [DOI:10.1016/j.ejso.2008.10.007] [PMID]
  15. Ben-Arie A, Tamir S, Dubnik S, Gemer O, Ben Shushan A, Dgani R, et al. Does hysteroscopy affect prognosis in apparent early-stage endome trial cancer? Int J Gynecol Cancer. 2008;18(4):813-9. [DOI:10.1111/j.1525-1438.2007.01076.x] [PMID]
  16. Gupta V, McGunigal M, Prasad-Hayes M, Kalir T, Liu J. Adjuvant radiation therapy is associated with improved overall survival in high-intermediate risk stage I endometrial cancer: A national cancer data base analysis. Gynecol Oncol. 2017;144(1):119-24. [DOI:10.1016/j.ygyno.2016.10.028] [PMID]
  17. Gemer O, Uriev L, Harkovsky T, Peled R, Ben-Dor D, Barak F, et al. Significance of lower uterine segment involvement in women with stage I endometrial adenocarcinoma. J Reprod Med. 2004;49(9):703-6.