Pierluigi Benedetti Panici1, Stefano Basile2, Maria Giovanna Salerno3, Violante Di Donato1, Claudia Marchetti1, Giorgia Perniola1, Antonio Palagiano1, Alessandra Perutelli3, Francesco Maneschi4, Andrea Alberto Lissoni5, Mauro Signorelli5, Giovanni Scambia6, Saverio Tateo7, Giorgia Mangili8, Dionyssios Katsaros9, Elio Campagnutta10, Nicoletta Donadello11, Stefano Greggi12, Mauro Melpignano13, Francesco Raspagliesi14, Gennaro Cormio15, Roberto Grassi16, Massimo Franchi17, Diana Giannarelli18, Roldano Fossati19, Valter Torri19, Clara Crocè20, Costantino Mangioni5. 1. Department of Obstetrics and Gynecology, Sapienza University Hospital, Rome, Italy. 2. Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. Electronic address: s.basile@ao-pisa.toscana.it. 3. Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. 4. Department of Obstetrics and Gynecology, S. Maria Goretti Hospital, Latina, Italy. 5. Department of Obstetrics and Gynecology, S. Gerardo Hospital, Monza, Italy. 6. Department of Obstetrics and Gynecology, Gemelli Hospital, Rome, Italy. 7. Department of Obstetrics and Gynecology, Fondazione Policlinico S. Matteo Pavia, Milan, Italy. 8. Department of Obstetrics and Gynecology, S. Raffaele Hospital, Milan, Italy. 9. Department of Obstetrics and Gynecology, S. Anna Hospital, Turin, Italy. 10. Department of Obstetrics and Gynecology, Aviano Hospital, Aviano, Italy. 11. Department of Obstetrics and Gynecology, University of Varese, Varese, Italy. 12. Department of Obstetrics and Gynecology, Istituto Nazionale Tumori, Fondazione G. Pascale, Naples, Italy. 13. Department of Obstetrics and Gynecology, Parma University Hospital, Parma, Italy. 14. Department of Obstetrics and Gynecology, Istituto Nazionale Tumori, Milan, Italy. 15. Department of Obstetrics and Gynecology, University of Bari, Bari, Italy. 16. Department of Obstetrics and Gynecology, Treviglio Hospital, Treviglio, Italy. 17. Department of Obstetrics and Gynecology, University of Verona, Verona, Italy. 18. Department of Obstetrics and Gynecology, IFO-Istituto Regina Elena, Rome, Italy. 19. Department of Obstetrics and Gynecology, Mario Negri Institute, Milan, Italy. 20. Department of Obstetrics and Gynecology, Northeast Women's Health and Obstetrics, Concord, NC.
Abstract
OBJECTIVE: The purpose of this study was to explore in greater depth the outcomes of the Italian randomized trial investigating the role of pelvic lymphadenectomy in clinical early stage endometrial cancer. In the attempt to identify the patients with poorer prognosis, the impact of age and body mass index were also thoroughly investigated by cancer-specific survival (CSS) analyses. STUDY DESIGN:Survival outcomes of trial patients were analyzed in relation to age (≤65 years and >65 years) in the 2 arms (lymphadenectomy and no lymphadenectomy) and in the whole population of the trial. RESULTS: Univariate and multivariable analyses of CSS and overall survival (OS) of patients showed that age >65 years is a strong independent poor prognostic factor (5-y OS 92.1% and 78.4% in ≤65 years and >65 years patients, respectively, P < .0001; 5-y CSS 93.8% and 83.5% in ≤65 years and >65 years patients, respectively, P = .003). Among women ≤65 years, node negative patients had 94.4% 5-y OS and 96.3% 5-y CSS vs 74.3% 5-y OS and 74.3% 5-y CSS for node positive patients (P = .009 and P = .002, respectively), while among women >65 y, node negative patients had 75.7% 5-y OS and 83.6% 5-y CSS vs 74.1% 5-y OS and 83.3% 5-y CSS for node positive patients (P = .55 and P = .58, respectively). Univariate and multivariable survival analyses in the whole trial population showed that older age, and higher tumor grade and stage were significantly associated to a worse prognosis. CONCLUSION:Older women faced an intrinsic poorer survival whether or not they underwent lymphadenectomy, and, unexpectedly, irrespective of the presence of nodal metastasis. Only in older patients was obesity (body mass index >30) significantly associated with scarce prognosis.
RCT Entities:
OBJECTIVE: The purpose of this study was to explore in greater depth the outcomes of the Italian randomized trial investigating the role of pelvic lymphadenectomy in clinical early stage endometrial cancer. In the attempt to identify the patients with poorer prognosis, the impact of age and body mass index were also thoroughly investigated by cancer-specific survival (CSS) analyses. STUDY DESIGN: Survival outcomes of trial patients were analyzed in relation to age (≤65 years and >65 years) in the 2 arms (lymphadenectomy and no lymphadenectomy) and in the whole population of the trial. RESULTS: Univariate and multivariable analyses of CSS and overall survival (OS) of patients showed that age >65 years is a strong independent poor prognostic factor (5-y OS 92.1% and 78.4% in ≤65 years and >65 years patients, respectively, P < .0001; 5-y CSS 93.8% and 83.5% in ≤65 years and >65 years patients, respectively, P = .003). Among women ≤65 years, node negative patients had 94.4% 5-y OS and 96.3% 5-y CSS vs 74.3% 5-y OS and 74.3% 5-y CSS for node positive patients (P = .009 and P = .002, respectively), while among women >65 y, node negative patients had 75.7% 5-y OS and 83.6% 5-y CSS vs 74.1% 5-y OS and 83.3% 5-y CSS for node positive patients (P = .55 and P = .58, respectively). Univariate and multivariable survival analyses in the whole trial population showed that older age, and higher tumor grade and stage were significantly associated to a worse prognosis. CONCLUSION: Older women faced an intrinsic poorer survival whether or not they underwent lymphadenectomy, and, unexpectedly, irrespective of the presence of nodal metastasis. Only in older patients was obesity (body mass index >30) significantly associated with scarce prognosis.
Authors: Ashley S Felix; D Scott McMeekin; David Mutch; Joan L Walker; William T Creasman; David E Cohn; Shamshad Ali; Richard G Moore; Levi S Downs; Olga B Ioffe; Kay J Park; Mark E Sherman; Louise A Brinton Journal: Gynecol Oncol Date: 2015-09-01 Impact factor: 5.482
Authors: Pierre Lunardi; Fabien Vidal; Franck Accadbled; Pierre Leguevaque; Marc Soule-Tholy; Jean Baptiste Beauval; Stéphanie Motton Journal: Clin Case Rep Date: 2015-05-25