Márcia Appel

P53 and BCL-2 as prognostic markers in endometrial carcinoma.

The objective of this study was to verify the frequency of p53 and BCL-2 immunohistochemical expression in patients with endometrial carcinoma and to correlate it with histological factors (histological type, tumor grade, depth of myometrial invasion, lymph node involvement and surgical staging) and survival. Forty-eight patients with endometrial carcinoma who were submitted to primary surgical treatment were assessed. p53 and BCL-2 immunohistochemical expression was determined using paraffin blocks containing the tumor area. p53 and BCL-2 expression was detected in 39.6% and 58.3% of the tumors, respectively. No significant difference was found regarding the frequency of p53 expression when analyzing histological type (33.3% in endometrioid tumors, 58.3% in non-endometrioid tumors; p = 0.176), depth of myometrial invasion (p = 0.632) and surgical staging (I—11.1%, II—66.7%, III—57.1%; p = 0.061). p53 expression was significantly more frequent in undifferentiated tumors (p = 0.007) and in those showing lymph node involvement (p = 0.030). Univariate analysis showed a positive association with death (RR, 3.358; CI, 1.386–8.134; p = 0.005) and short-term survival. The present study did not reveal any correlation between BCL-2 expression and histopathologic markers or survival. In conclusion, this study showed that p53 expression is directly correlated with undifferentiated tumors, lymph-node involvement and risk of death. On the other hand, BCL-2 expression was not correlated with any known histological factors.

Agreement Between Preoperative Endometrial Sampling and Surgical Specimen Findings in Endometrial Carcinoma

Objectives The aims of the study were to evaluate agreement between preoperative endometrial samples and surgical specimens in endometrial carcinoma and to correlate this agreement with sample and patient characteristics. Methods Patients who received primary surgical treatment for endometrial carcinoma at a tertiary care center and had undergone preoperative endometrial sampling were included. Medical records were reviewed to collect information from pathology reports and data on patient characteristics. Results The study sample comprised 166 patients (mean age, 64.6 years). The histological results of the biopsies were the following: endometrioid cancer (n = 118), nonendometrioid tumor (n = 38), and hyperplasia (n = 10). The agreement rates were 93.2% for endometrioid and 68.9% for nonendometrioid tumors, with a &kgr; coefficient of 0.73 for tumor cell type. Tumor International Federation of Gynecology and Obstetrics (FIGO) grade was distributed as follows: 37.1% G1, 35.7% G2, and 27.1% G3, with agreement rates of 61.5%, 56%, and 78.9%, respectively. The overall &kgr; coefficient for FIGO grading was 0.46. Only 1.9% of the tumors originally classified as G1 were upgraded to G3, whereas 16% of G2 lesions were upgraded. There was no significant difference in agreement rates for tumor cell type and FIGO grade in relation to any of the studied variables, except that biopsy specimens weighing more than 3 g had significantly better agreement in FIGO grading (P = 0.040). Conclusions Preoperative biopsy has suboptimal accuracy for prediction of characteristics in the definitive surgical specimen. Caution must be taken when using preoperative information to determine extent of surgical resection, due to the risk of understaging. Additional information must be combined with the biopsy data to help in the decision-making process.

Cervical Cancer Posttreatment Follow-up: Critical Analysis

Objective The aim of this study was to evaluate the role of follow-up tests and examinations in diagnosing symptomatic and asymptomatic relapses after treatment for cervical cancer. Methods Data were collected from medical records for all patients diagnosed as having cervical cancer from January 1985 to June 2010. The significance level was P < 0.005. Results Sixty-four (17.8%) of the 358 patients investigated suffered tumor relapse. Thirty-four (53.1%) were symptomatic, and 30 (46.9%) were asymptomatic. Most patients had tumor relapse diagnosed during physical examination, both among the symptomatic patients (50%) and the asymptomatic patients (66.7%) (P = 0.27). Cytopathology was responsible for detecting relapse in only 1 case in each group, corresponding to 2.9% and 3.3%, respectively (P = 0.99). Imaging examinations confirmed 10 relapses (29.4%) among symptomatic patients and 8 cases (26.6%) among asymptomatic patients (P = 0.77). There were no statistically significant differences between the 2 groups or between the different methods of detecting relapses. There was still no association after adjustment for potential confounding factors such as age and type of treatment. Conclusions Physical examination was the preeminent method for detecting tumor relapse in this study. None of the other tests or examinations were capable of detecting relapses in both symptomatic and asymptomatic patients. These results highlight the urgent need for prospective studies that compare the efficacy of different follow-up regimens, analyzing factors such as global survival, quality of life, and cost.

Adenocarcinoma de endométrio : epidemiologia, tratamento e sobrevida de pacientes atendidas no Hospital de Clínicas de Porto Alegre

Introducao: Neste estudo, descreve-se o perfil clinico das pacientes e as caracteristicas histopatologicas dos carcinomas de endometrio tratados no setor de Oncologia Genital do Hospital de Clinicas de Porto Alegre (HCPA), assim como as formas de tratamento, fatores prognosticos e sobrevida. Metodos: Estudo de coorte historica incluindo todas as pacientes submetidas a tratamento cirurgico primario entre 1996 a 2012. Apos revisao de prontuarios medicos, foram analisadas as variaveis idade, status hormonal, tipo histologico e grau tumoral, invasao miometrial, estadiamento cirurgico, cirurgia realizada, tratamento complementar e sobrevida. Resultados: Cento e sessenta e quatro pacientes foram incluidas no estudo, com idade media de 64,2 anos (31-95 anos), sendo quase 90% delas pos-menopausicas. O tempo de seguimento variou de 4 dias a 14,6 anos. O tipo histologico endometrioide foi o mais encontrado (78% dos casos). A histerectomia com salpingo-ooforectomia bilateral com linfadenectomia pelvica foi a cirurgia mais realizada (77,5%). Tratamento complementar foi realizado em 57,9% das pacientes, sendo a radioterapia o tratamento de escolha em 87,4% deles. Ocorreram 36 obitos (22%) durante o seguimento, com uma sobrevida media global de 125 meses. Em analise bivariada, idade ≥ 65 anos, tipo histologico nao endometrioide, tumores pouco diferenciados (G3), invasao miometrial ≥ 50% e metastase linfonodal relacionaram-se significativamente a um menor tempo de sobrevida. Em analise multivariada, a histologia nao endometrioide estadio III e IV, e a presenca de comprometimento linfonodal foram significativamente associados ao obito. Conclusao: Os resultados encontrados sao compativeis com a literatura existente e vem em acrescimo a escassa estatistica nacional.

Prevalencia y repercusión en las recidivas de la invasión linfovascular en el cáncer cervicouterino incipiente: prevalencia de la invasión linfovascular en el cáncer cervicouterino

Objetivo. El propósito de este estudio era determinar la prevalencia de la invasión linfovascular (ILV) en el cuello uterino y su repercusión en la supervivencia en mujeres con muestras de cáncer cervical incipiente sometidas a histerectomía radical. Materiales y métodos. Se revisó la invasión linfovascular en 107 casos de cáncer cervicouterino en estadios IB1 y IIA y se comparó con el examen anatomopatológico original. Además, se calculó adecuadamente la repercusión en las recidivas en cada paciente y se comparó con la presencia de ILV. Resultados. Se detectó invasión linfovascular en el cuello uterino en el 17,8% (19/107) de los casos (IC del 95% = 11,37‐ 25,87) en el examen anatomopatológico original, y cuando las muestras se revisaron específicamente en busca de esta alteración en el presente estudio, el 74,8% (80/107) de los casos (IC del 95% = 65,9‐82,31) eran positivos. Se hizo un seguimiento de las pacientes durante una media de 4,87 ± 2,66 años, y la recidiva tumoral no fue diferente entre las pacientes con (27,5%; 22/80) y sin (7,4% 2/27) ILV (p = 0,058), aunque se demostró una fuerte tendencia. Conclusiones. La prevalencia de la ILV se infravalora en los exámenes anatomopatológicos habituales, y su tasa aumenta considerablemente con una revisión meticulosa. Hay que seguir investigando la relación entre su presencia y un pronóstico peor.