M.G. del Carmen

Prognostic implication of endometriosis in clear cell carcinoma of the ovary

OBJECTIVE The aim of this study is to investigate whether the presence of endometriosis is a prognostic factor in patients diagnosed with clear cell carcinoma (CCC) of the ovary. METHODS Retrospective chart review was performed to all patients diagnosed with CCC and endometriosis between 1975 and 2002. All pathology reports were reviewed and slides were reviewed when available. Cox regression analysis and Kaplan-Meier test were used to calculate survival prognostic factors. The level of significance was set at 0.05. RESULTS Eighty-four patients with CCC were identified with a 49% rate of coexisting endometriosis. Patients with tumors arising in endometriosis (n=15), with endometriosis found elsewhere in the specimen (n=26), and those without endometriosis (n=43) were analyzed comparatively. Patients with CCCs arising in endometriosis were 10 years younger (95% C.I. 0.6-18 years) than those with CCC not arising in endometriosis (P<0.05). Patients with endometriosis anywhere in the surgical specimen presented at early stage 66% of the times versus 42% for patients without endometriosis (P<0.05). Median overall survival (OS) for patients with endometriosis was 196 months (95% C.I. 28-363) versus 34 months (95% C.I. 13-55) for patients without endometriosis (P=0.01). Advanced tumor stage at diagnosis (HR 13, 95% C.I. 5-29, P=0.001) and absence of endometriosis (HR 2, 95% C.I. 1-3.9, P=0.03) were the only significant prognostic factors associated with poor survival. Disease recurrence or death among optimally and completely cytoreduced patients was 31% and 59% for those with and without endometriosis respectively (P>0.05). CONCLUSIONS Our study suggests that the presence of endometriosis in patients with CCC of the ovary is associated with progression free and OS advantages with no difference in initial resectability.

Impact of bowel obstruction at the time of initial presentation in women with ovarian cancer

Objective  To determine whether the presence of bowel obstruction at the time of initial presentation has any prognostic significance in these women.

Patient, treatment and discharge factors associated with hospital readmission within 30 days after surgery for vulvar cancer

OBJECTIVES The majority of hospital readmissions are unexpected and considered adverse events. The goal of this study was to examine the factors associated with unplanned readmission after surgery for vulvar cancer. METHODS Patient demographic, treatment, and discharge factors were collected on 363 patients with squamous cell carcinoma in situ or invasive cancer who underwent vulvectomy at our institution between January 2001 and June 2014. Clinical variables were correlated using χ2 test and Students t-test as appropriate for univariate analysis. Multivariate analysis was then performed. RESULTS Of 363 eligible patients, 35.6% had in situ disease and 64.5% had invasive disease. Radical vulvectomy was performed in 39.1% and 23.4% underwent lymph node assessment. Seventeen patients (4.7%) were readmitted within 30days, with length of stay ranging 2 to 37days and 35% of these patients required a re-operation. On univariate analyses comorbidities, radical vulvectomy, nodal assessment, initial length of stay, and discharge to a post acute care facility (PACF) were associated with hospital readmission. On multivariate analysis, only discharge to a PACF was significantly associated with readmission (OR 6.30, CI 1.12-35.53, P=0.04). Of those who were readmitted within 30days, 29.4% had been at a PACF whereas only 6.6% of the no readmission group had been discharged to PACF (P=0.003). CONCLUSIONS Readmission affected 4.7% of our population, and was associated with lengthy hospitalization and reoperation. After controlling for patient comorbidities and surgical radicality, multivariate analysis suggested that discharge to a PACF was significantly associated with risk of readmission.

Paradigm shift in the management of high-intermediate risk stage I endometrial cancer.

5103 Background: Recent randomized trials have suggested that high-intermediate risk endometrial cancer patients may safely be treated with adjuvant vaginal brachytherapy (VBT) rather than external beam radiotherapy (EBRT). The purpose of this study was to determine how this paradigm shift might impact clinical outcomes. METHODS All women with stage IA grade 3, stage IA with endocervical gland extension and grade 1-2, or stage IB grade 1-2 endometrioid carcinoma (FIGO 2009 system) treated from 2005 to 2010 at our institution were retrospectively identified. Data was extracted from computerized medical records. Group A consisted of 49 patients in the 1st half of the study and Group B 40 pts in the 2nd half. RESULTS 89 pts underwent abdominal (65%) or minimally invasive (35%) hysterectomy. Group A was more likely to not be surgically staged (28% v 8%; P = 0.02) or have pelvic lymphadenectomy (PLN) only (55% v 33%; P = 0.05). Group B had a much higher rate of both PLN and para-aortic lymphadenectomy (PAALN; 59% v 18%; P < 0.001). Postoperatively, Group A was more likely to receive either EBRT (23% v 0%; P < 0.001) or no radiotherapy (33% v 8%; P = 0.01). Group B more frequently received only VBT (92% v 44%; P < 0.001). 2 of 4 patients with positive/equivocal cytology were the only ones to receive postoperative cytotoxic chemotherapy (6 cycles of paclitaxel and carboplatin). 5 of 89 (6%) patients (3 Group A, 2 Group B) relapsed during the follow-up interval (median 2 years): 2 having positive cytology that did not receive chemotherapy relapsed in the lung and the peritoneum, respectively; 1 staged with PLN only who received postoperative pelvic EBRT relapsed in the para-aortic nodes; 2 relapsed at the vaginal apex, neither of whom had received postoperative radiation. CONCLUSIONS The paradigm shift favoring postoperative VBT cancer is effective at preventing local relapse while avoiding long-term toxicity in women with high-intermediate risk stage I endometrial cancer. Comprehensive PLN and PAALN is integral to this approach by excluding nodal disease. Peritoneal washings, although no longer part of the formal staging system, should be collected and may suggest the need for cytotoxic chemotherapy when positive.