Search

Endometriosis, affecting 6%–10% of women of reproductive age, can lead to severe symptoms such as chronic pelvic pain and infertility. Among its rarer manifestations is abdominal wall endometriosis (AWE), which has been increasingly reported following cesarean deliveries. This case discusses a 39‐year‐old woman who presented with a 13‐year history of cyclical pain at her cesarean section scar, exacerbated over the last year by the development of a painful abdominal mass. Medical evaluations indicated endometriosis at the scar, with further investigations including ultrasound and magnetic resonance imaging showing involvement of the rectus abdominis muscle. Elevated tumor markers HE4 and CA‐125, along with a biopsy, confirmed adenocarcinoma. The patient underwent extensive surgical treatment, including the resection of the mass, hysterectomy, bilateral salpingo‐oophorectomy, and lymphadenectomy. Pathology confirmed moderately differentiated infiltrative adenocarcinoma originating from endometriosis. Despite the absence of postoperative chemotherapy, the patient showed no recurrence, emphasizing the effectiveness of comprehensive surgical management. This case highlights the critical importance of recognizing the potential for malignant transformation in AWE, particularly following cesarean deliveries, and underscores the necessity for vigilant monitoring and personalized treatment strategies. The management of AWE, especially when malignant transformation is suspected, necessitates a multidisciplinary approach similar to that used in ovarian cancer, focusing on rigorous surgical intervention and the potential for adjuvant therapies. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to construct a competing risk prediction model for predicting specific mortality risks in endometrial cancer patients from the SEER database based on their demographic characteristics and tumor information. Methods: We collected relevant clinical data on patients with histologically confirmed endometrial cancer in the SEER database between 2010 and 2015. Univariate and multivariate competing risk models were used to analyze the risk factors for endometrial cancer‐specific death, and a predictive nomogram was constructed. C‐index and receiver operating characteristic curve (ROC) at different time points were used to verify the accuracy of the constructed nomogram. Results: There were 26 109 eligible endometrial cancer patients in the training cohort and 11 189 in the validation cohort. Univariate and multivariate analyses revealed that Age, Marriage, Grade, Behav, FIGO, Size, Surgery, SurgOth, Radiation, ParaAortic_Nodes, Peritonea, N positive, DX_liver, and DX_lung were independent prognostic factors for specific mortality in endometrial cancer patients. Based on these factors, a nomogram was constructed. Internal validation showed that the nomogram had a good discriminative ability (C‐index = 0.883 [95% confidence interval [CI]: 0.881–0.884]), and the 1‐, 3‐, and 5‐year AUC values were 0.901, 0.886 and 0.874, respectively. External validation indicated similar results (C‐index = 0.883 [95%CI: 0.882–0.883]), and the 1‐, 3‐, and 5‐ AUC values were 0.908, 0.885 and 0.870, respectively. Conclusion: We constructed a competing risk model to predict the specific mortality risk among endometrial cancer patients. This model has favorable accuracy and reliability and can provide a reference for the development and update of endometrial cancer prognostic risk assessment tools. [ABSTRACT FROM AUTHOR]

Background: To investigate the role of CD47 expression and its relationship with tumor‐resident macrophages, specifically at the tumor margin, in patients with type II endometrial cancer. This study aims to elucidate whether CD47 could serve as a prognostic marker and to understand the dynamics between CD47 and macrophages, which could inform new therapeutic strategies. Methods: A retrospective cohort study was conducted involving 75 patients of type II endometrial. Immunohistochemical analysis was performed to assess CD47 expression and macrophage markers (CD68 and CD163). Results: The study found no direct correlation between CD47 expression levels and overall survival (p = 0.32), challenging its role as an independent prognostic marker in type II endometrial cancer. The higher expression of CD47 had significantly less incidence of endometrioid carcinoma G3 (p = 0.047). The negative correlation between CD47 H‐score and the density of CD68‐positive macrophages at tumor margin was statistically significant (p = 0.049). A high density of CD68‐positive macrophages at the tumor margin but a low density of CD163‐positive macrophages at the tumor margin were associated with poorer prognosis (p = 0.036). Conclusions: The complex interaction between CD47 and macrophages, particularly at the tumor margin, suggests new avenues for targeted therapy in type II endometrial cancer. [ABSTRACT FROM AUTHOR]

Aim: Our aim is to investigate the effect of uterine lower segment involvement on prognosis of early‐stage endometrial cancer cases diagnosed and treated in our clinic. Materials and Methods: The file records of 316 cases reviewed retrospectively.Only stage I (a and b, n=209) cases were investigated, because they were more homogeneous group. Results: The lymphovascular invasion rate was found to be higher in patients with stage Ia and uterine lower segment involvement (p < 0.001). Adjuvant treatment requirement was higher in patients with stage Ia and uterine lower segment involvement (p < 0.001). Among stage Ia cases, the recurrence rate between 1 and 3 years was found to be higher in cases with uterine lower segment involvement (p = 0.001). Among the stage Ib cases, lymphovascular invasion was found to be higher in cases with uterine lower segment involvement (p < 0.001). The recurrence rate between 1 and 3 years was found to be higher in stage Ib compared to Ia (p = 0.01). Uterine lower segment involvement was found to be associated with high lymphovascular invasion rate in all stage I cases (p < 0.001). It was determined that the need for adjuvant treatment was higher in cases with uterine lower segment involvement (p < 0.001). It was determined that the probability of recurrence between 1 and 3 years was higher in cases with uterine lower segment involvement (p = 0.007). Conclusion: Uterine lower segment involvement is associated with increased lymphovascular invasion even in the early stages. It is an important risk factor for systemic spread such as lymphovascular invasion, myometrial invasion, and lymph node involvement. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the cost‐effectiveness of lenvatinib plus pembrolizumab (LP) compared to chemotherapy as a second‐line treatment for advanced endometrial cancer (EC) from the United States and Chinese payers' perspective. Methods: In this economic evaluation, a partitioned survival model was constructed from the perspective of the United States and Chinese payers. The survival data were derived from the clinical trial (309‐KEYNOTE‐775), while costs and utility values were sourced from databases and published literature. Total costs, quality‐adjusted life years (QALYs) and incremental cost‐effectiveness ratio (ICER) were estimated. The robustness of the model was evaluated through sensitivity analyses, and price adjustment scenario analyses was also performed. Results: Base‐case analysis indicated that LP wouldn't be cost‐effective in the United States at the WTP threshold of $200 000, with improved effectiveness of 0.75 QALYs and an additional cost of $398596.81 (ICER $531392.20). While LP was cost‐effective in China, with improved effectiveness of 0.75 QALYs and an increased overall cost of $62270.44 (ICER $83016.29). Sensitivity analyses revealed that the above results were stable. The scenario analyses results indicated that LP was cost‐effective in the United States when the prices of lenvatinib and pembrolizumab were simultaneously reduced by 61.95% ($26.5361/mg for lenvatinib and $19.1532/mg for pembrolizumab). Conclusion: LP isn't cost‐effective in the patients with advanced previously treated endometrial cancer in the United States, whereas it is cost‐effective in China. The evidence‐based pricing strategy provided by this study could benefit decision‐makers in making optimal decisions and clinicians in general clinical practice. More evidence about budget impact and affordability for patients is needed. [ABSTRACT FROM AUTHOR]

Aim: The effectiveness of hysteroscopy in diagnosing endometrial lesions has been demonstrated, showing high diagnostic accuracy for malignant endometrial lesions. Although the characteristic appearances of atypical and malignant endometria have been reported, they are not definitive and sometimes complicated. This study aimed to identify a small number of characteristic features to detect endometrial abnormalities using a simple judgment system and analyze the diagnostic characteristics and their accuracy in endometrial malignancy diagnosis. Methods: We performed a retrospective analysis of hysteroscopy video data of 250 patients, of which we selected for analysis based on pathology examination 152 cases with benign changes, 16 with atypical endometrium, and 18 with carcinoma in situ or endometrial cancer. Endometrial characteristics assessed included protrusion, desquamation, extended vessel, atypical vessel, and white/yellow lesion. Results: Multivariable analysis revealed that desquamation (p = 0.001, odds ratio [OR] 5.28), atypical vessels (p < 0.001, OR 8.50), and white/yellow lesions (p = 0.011, OR 1.37) were significant predictors for endometrial malignancy. From their contribution status, scoring points of 4, 6, and 1 were settled according to the odds ratio proportions. When scores ≥5 (at least both desquamation and white/yellow lesions or only atypical vessels) were used to define endometrial malignancy, sensitivity and specificity were 100% and 92%, respectively. When detecting cancer, atypical, and benign cases, sensitivity and specificity were 88% and 90%, respectively. Conclusion: Our characteristics hysteroscopic findings showed a higher predictive ability in detecting endometrial malignancies. However, further examination with more cases would be needed to accurately diagnose endometrial malignancy by hysteroscopy. [ABSTRACT FROM AUTHOR]

Aim: Medroxyprogesterone acetate (MPA) is one of the treatments of atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) to preserve the fertility. Efficacy of MPA therapy and fertility and obstetric outcomes after remission were evaluated in EC or AEH patients. Methods: Among patients diagnosed with EC or AEH at Tokushima University Hospital between January 2002 and October 2020, we retrospectively analyzed patients, ages range from 26 to 40, who underwent conservative management using MPA (400–600 mg/day). Results: In total, 19 patients underwent MPA therapy. The 18 (94%) patients achieved complete response (CR), and 1 (5%) patient achieved partial response (PR). Relapse occurred in 6 (32%) patients who had achieved CR. Of the patients who relapsed, 4 patients resumed MPA therapy and were in remission. Among 19 patients, 13 patients attempted pregnancy after CR. All of them underwent ovulation induction or assisted reproductive technology. As a result, 20 pregnancies in 10 (77%) patients and 12 live births in 9 (69%) patients were achieved. Rate of spontaneous abortion was 35% (7/20). Conclusions: MPA therapy can produce a high remission rate, and be considered an effective treatment for patients who wish fertility preservation. Around 70% patients who attempt to pregnancy can have at least one baby by infertility treatments. Because recurrence rate after MPA therapy is high, it may be desirable to aim for early pregnancy by active intervention. [ABSTRACT FROM AUTHOR]

Aim: Endometrial cancer is diagnosed by obtaining uterine biopsies by pipelle, dilatation and curettage (D&C), or hysteroscopy. In 15%–25% of the cases, the preoperative and postoperative grades do not match. This discrepancy may carry significant clinical and prognostic consequences. We aimed to assess how body mass index (BMI) affects preoperative and postoperative grade mismatches and whether biopsy methods mitigate this effect. Methods: We conducted a retrospective review of patients with endometrial cancer who underwent surgery at our center between 2014 and 2022. We stratified patients into six classes of BMI based on the WHO classification. Preoperative and postoperative grades were compared for concordance with regards to patient BMI and sampling method. Results: A total of 158 patients were included, diagnosed by pipelle (n = 99), hysteroscopy (n = 15), or D&C (n = 44). For all methods, every unit increase in BMI increased the odds of having a gap between histology grades by 5.2%. In the pipelle group, the odds of a larger gap between the histology grades was 62% higher than that of women in the other groups. Among the D&C group, the odds of having a bigger difference between histology grades were 91.8% lower compared to the other groups. Patients with BMI over 30 had nearly 50% discrepancy when diagnosed with pipelle or hysteroscopy, but less than 10% with D&C. Conclusions: Increasing BMI is associated with decreasing concordance between preoperative and postoperative grades in endometrial cancer, especially when it exceeds 30. This effect is much less pronounced, however, when the diagnostic method is D&C. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the effect of vaginal dilation therapy on vaginal length, vaginal stenosis, vaginal elasticity, and sexual function of endometrial cancer patients treated with radiotherapy after surgery. Methods: A total of 117 women were enrolled in this study. They received 6 months of vaginal dilation therapy. We evaluated their vaginal length, vaginal diameter, vaginal elasticity, and sexual function before radiotherapy, after radiotherapy, and after 6 months of vaginal dilation therapy. Their vaginal condition was assessed by customized vaginal dilating molds. Their sexual function was assessed by female sexual function index. The SPSS 25 software was used to analyze all the data. Results: According to multivariate analysis, vaginal diameter (β = 0.300, 95% CI [0.217–1.446], p = 0.010) and sexual intercourse frequency before diagnosis (β = 0.424, 95% CI [0.164–0.733], p = 0.006) were significantly correlated with female sexual function after radiotherapy. Vaginal dilation therapy helped increase vaginal length, improve vaginal stenosis and sexual function (p < 0.05), though most of the figures at the end of the intervention did not fully return to those before radiotherapy. Noticeably, vaginal dilation therapy was ineffective in improving vaginal elasticity and the incidence rate of female sexual dysfunction (p > 0.05). Moreover, patients with medium or good vaginal elasticity benefited more from vaginal dilation therapy than patients with poor vaginal elasticity (p < 0.05). Conclusion: Vaginal dilation therapy should be carried out timely and preventatively in endometrial cancer patients treated with radiotherapy after surgery to improve their vaginal condition and sexual function. [ABSTRACT FROM AUTHOR]

Aim: Most endometrial cancer (EC) patients are diagnosed at an early‐stage (FIGO stage I or II), with a favorable prognosis. However, some high‐grade, early‐stage EC patients have unexpected recurrences and undesirable results, the molecular alterations that underlie these tumors are far from being fully understood. Our goal was to use proteome analysis to examine dysregulated pathways in this specific subgroup of EC. Methods: We used data‐independent acquisition (DIA) quantitative proteomics to analyze cancer and matched paracancerous tissues from 20 EC patients (10 high‐grade and 10 low‐grade). Immunohistochemistry (IHC) analysis was used to validate protein expression of six hub genes. Results: In total, 7107 proteins were quantified, while 225 downregulated and 366 upregulated proteins in high‐grade cancer tissues, 130 downregulated and 413 upregulated proteins in high‐grade paracancerous tissues. The pathway associated with oxidative phosphorylation (OXPHOS) was upregulated and have similar expression patterns in high‐grade EC tissues and matched paracancerous tissues. OXPHOS‐related protein, ATP5F1D showed the best classification and diagnostic ability in distinguishing high‐grade from low‐grade EC. In both cancer and paracancerous tissues, double‐label immunofluorescence demonstrated ITGA4 and COL4A1 co‐localized at the basal membrane. Conclusions: Our present works elucidate that metabolism reprogramming is associated with high‐grade, early‐stage EC, particularly OXPHOS is upregulated. Noticeably, the paracancerous tissues have undergone molecular changes similar to cancer tissues, maybe they have signal exchange via secreted proteins (ITGA4 and COL4A1). The upregulation of OXPHOS‐related proteins may be the potential biomarker for EC diagnosis, and targeting OXPHOS metabolism might be an effective treatment for high‐grade, early‐stage EC. [ABSTRACT FROM AUTHOR]

Aim: Minimally invasive surgeries for endometrial cancer are increasing worldwide. In Japan, some articles have examined surgical outcomes, but only a few have addressed oncological outcomes. This study aims to compare robot surgery, laparoscopic surgery, and laparotomy in terms of surgical and oncological outcomes within a low‐risk group for endometrial cancer recurrence. Methods: This study included patients with endometrial cancer deemed to be at low risk of recurrence and who underwent surgery between January 2011 and December 2020. We studied 99 patients who underwent robot surgery, 85 patients who underwent laparotomy, and 77 patients who underwent laparoscopic surgery. Surgical and oncological outcomes were compared retrospectively for these groups of patients. Results: The median follow‐up period was 47, 61, and 60 months in the laparotomy, laparoscopy, and robotic groups, respectively. The three groups had similar perioperative and pathological data. No significant differences in overall survival and disease‐free survival were observed among the groups. Univariate and multivariate analyses conducted on the overall study population for disease‐free survival and overall survival showed that the surgical approach did not have any influence. Minimally invasive surgery groups had longer operating times compared to the laparotomy group, but they had significantly less blood loss. The number of resected pelvic lymph nodes was similar, and the complication rate was not significant. Conclusions: Robot‐assisted surgery and laparoscopic surgery were found to be less invasive and showed similar oncologic outcomes compared to laparotomy surgery for endometrial cancer in patients with a low risk of recurrence. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to report the treatment outcomes of radiation therapy for early‐stage endometrial cancer patients. In addition, this study intended to identify high‐risk factors that require pelvic radiotherapy (PRT) in addition to vaginal brachytherapy (VBT) for intermediate‐risk endometrial cancer patients. Methods: Patients with early‐stage endometrial cancer receiving postoperative VBT alone or with PRT were included. Propensity score matching was used to balance the two study groups. The primary endpoint was locoregional recurrence (LRR). Age‐adjusted Charlson comorbidity index and substantial lymphovascular space invasion were selected for subgroup analyses to identify the benefits of PRT over VBT alone. Results: From 2005 to 2017, a total of 288 patients underwent analysis following propensity score matching. Of these, 144 received VBT and 144 received PRT. There was no significant difference in 5‐year LRR between VBT and PRT for both intermediate (0% vs. 0%) and high‐intermediate risk patients (3.5% VBT vs. 5.4% PRT; HR 0.54: 0.05–6.00; p = 0.616). The subgroup analyses revealed no significant factors favoring PRT over VBT. Patients with high comorbidities may have higher risks of non‐cancer death after receiving PRT. Conclusions: Postoperative VBT alone is sufficient for early‐stage intermediate‐risk endometrial cancer patients. [ABSTRACT FROM AUTHOR]

The diagnosis of synchronous endometrial and ovarian cancer or metastatic cancer of the same histological type is difficult. In this study, molecular biology analysis was performed to determine ovarian metastasis from endometrial cancer. A 38‐year‐old woman had pathological evidence of endometrial cancer (endometrioid carcinoma, grade 1) and ovarian cancer (endometrioid carcinoma, grade 3); a disseminated nodule in the serosa uteri was also diagnosed as endometrioid carcinoma (grade 3). Customized panel sequencing revealed a common mutation pattern in ovarian cancer and disseminated nodules. Furthermore, endometrial cancer showed the same mutation patterns for FGFR3 and PTEN as ovarian cancer and disseminated nodules. All tumors were microsatellite instability high. Clinicopathological and molecular biology analyses suggested that the patient had ovarian metastasis from endometrial cancer. The patient underwent adjuvant chemotherapy with paclitaxel and carboplatin, with no recurrence. Molecular biology techniques may enable appropriate treatment based on clinically accurate diagnosis. [ABSTRACT FROM AUTHOR]

Aim: To provide information including the trend of gynecological malignancies in Japan, we hereby present the annual patient report for 2020 and the Annual Treatment Report for 2015, on the outcomes of patients who started treatment in 2015. Methods: The Japan Society of Obstetrics and Gynecology maintains an annual tumor registry, where information on gynecological malignancies from various participating institutions is gathered. The data of patients whose treatment with gynecologic malignancies was initiated in 2020 were analyzed retrospectively. Survival of the patients who started treatment with cervical, endometrial, and ovarian cancer in 2015 was analyzed by using the Kaplan–Meier, log‐rank, and Wilcoxson tests. Results: Treatment was initiated in 2020 for 7689 patients with cervical cancer, 13 113 with endometrial cancer, 8004 with ovarian, tubal, and peritoneal cancer, 2152 with ovarian borderline tumors, and with the others (260 vulvar cancer, 157 vaginal cancer, 464 uterine sarcoma, 50 uterine adenosarcoma, 136 trophoblastic diseases). This clinicopathological information was summarized as the patient annual report. The 5‐year survival rates of the patients with cervical cancer were 92.3%, 76.2%, 56.5%, and 32.2% for Stages I, II, III, and IV, respectively. The 5‐year survival rates for the patients with endometrial cancer were 93.9%, 87.6%, 71.4%, and 29.3% for Stages I, II, III, and IV, respectively. The 5‐year survival rates for the patients with ovarian cancer (surface epithelial‐stromal tumors) were 91.7%, 80.6%, 50.8%, and 39.7% for Stages I, II, III, and IV, respectively. Conclusion: The annual tumor report is an important survey that provides knowledge on gynecological malignancy trends in Japan. [ABSTRACT FROM AUTHOR]

Aim: We aimed to clarify the clinical value of P53 index in patients with early low‐risk endometrial cancer (EC) and find an optimal cut‐off value of P53 index for predicting the recurrence of these patients. Methods: The clinicopathological data of 157 patients with early low‐risk EC (stage 1A with grade 1 or 2 endometrioid EC) were analyzed. The optimal cut‐off value of the P53 index was calculated by the receiver operating characteristic curve analysis and Youden index. Cox regression model was used to evaluate the independent prognostic predictors of recurrence of EC. Then all patients were divided into two groups according to the optimal cut‐off value of the P53 index. Differences of the clinicopathological parameters between the two groups were compared. Results: Multivariate analysis showed age PR (p = 0.020) and P53 (p = 0.001) were independent prognostic factors for the recurrence of EC. The value of P53 index was found to be the optimal cut‐off point of 17.5% in estimating the recurrence of EC. The 5‐year recurrence‐free survival rates of patients in the low P53 index group (<17.5%) and the high P53 index group (≥17.5%) were 94.6% and 65.4% (p < 0.001). Conclusion: It has been revealed that the P53 index is a prognostic factor for recurrence in early low‐risk EC. The optimal cut‐off value of P53 index may contribute to the postoperative individualized treatment options for early low‐risk EC patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the ovarian cancer (OC) risk following endometrial cancer (EC) in patients who underwent ovarian preservation as part of the EC staging. Study Design: With permission of the Surveillance, Epidemiology and End Results (SEER) program of the United States National Cancer Institute, clinicopathological information of women diagnosed with EC and following OC were analyzed. Incidence of OC and survival according to the surgical approach were studied. Primary analysis was conducted in women up to and including the age of 49 years. Results: A total of 116 patients up to the age of 49 years were diagnosed with EC and following OC. In this group of patients, no differences in incidence (IRR 0.9, CI 0.56–1.49, p = 0.66) or survival rates (p = 0.71) were found comparing ovarian preservation and bilateral salpingo‐oophorectomy (BSO) performance. In an overall analysis of women diagnosed with EC and following OC at any age, incidence of OC did not differ between groups (IRR 1.07, CI 0.83–1.39, p = 0.59) yet when including patients older than 49 years old survival rates were shorter in ovarian preservation patients compared to patients with BSO performed as part of their EC treatment. Conclusion: Ovarian preservation in EC patients under the age of 49 years may be considered safe, with no impact on OC incidence or survival, benefiting longer natural hormonal status. [ABSTRACT FROM AUTHOR]

Aim: Minimally invasive surgery (MIS) has been introduced as an alternative to more radical surgical procedures. The Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy conducted a cross‐sectional questionnaire survey to ascertain the status of MIS for endometrial cancer. Methods: The survey was conducted between May 10 and June 30, 2022. The questionnaire included information on personal attributes, academic affiliations, qualifications, hysterectomies, and intraoperative procedures performed. Results: The total number of questionnaire respondents was 436 (9.2% of the membership). The hysterectomy methods and percentage performed were as follows: simple total hysterectomy (equivalent to benign surgery), 3%; simple total hysterectomy with care to avoid shaving the cervix, 31%; extended total hysterectomy, 48%; and modified radical hysterectomy, 15%. An analysis of hysterectomies performed using MIS for endometrial cancer by qualified gynecologists of endoscopy or board‐certified gynecologic oncologists showed a tendency not to choose simple total hysterectomy compared to the gynecologists who did not hold certification (p = 0.019, p = 0.045, and p = 0.010, respectively). Additionally, 67% of respondents did not use uterine manipulators, and 59% of the respondents did not perform lymph node dissection following the guidelines for treating endometrial cancer in Japan. Conclusion: This study provided the current status of MIS for endometrial cancer in Japan. The hysterectomy method, use of uterine manipulators, and criteria for omitting lymph node dissection were generally in agreement with the guidelines. Currently, an extra‐fascial simple hysterectomy, including at least not shaving the cervix, was a major method for early invasive endometrial cancer using MIS. [ABSTRACT FROM AUTHOR]

Aim: Sentinel lymph node (SLN) mapping allows node‐negative patients to be spared from the surgical comorbidities associated with total lymphadenectomy. This study aimed to evaluate the oncological outcomes of SLN biopsy versus complete lymph node dissection in patients with early‐stage endometrial carcinoma. Methods: Retrospective analyses were performed in patients with pathologically confirmed endometrioid endometrial carcinoma, who underwent minimally invasive surgical staging with SLN biopsy or complete lymph node dissection at Yonsei Cancer Center between 2015 and 2019. Results: A total of 301 patients were included in this study. Eighty‐two patients underwent SLN biopsy, while 219 underwent complete lymph node dissection. There were no significant differences in patient characteristics between the two groups. In terms of operative characteristics, the SLN biopsy‐only group had a significantly shorter surgical duration (p < 0.001) than the lymphadenectomy group. The mean follow‐up period was 41.4 months. There were no differences in progression‐free survival (PFS) and overall survival (OS) between the two groups (SLN biopsy vs. complete lymph node dissection; p = 0.798 and 0.301, respectively). Multivariate analysis revealed that SLN biopsy was not an independent prognostic factor for PFS or OS. Conclusion: Our results showed that SLN biopsy provided oncological outcomes similar to those of lymphadenectomy. [ABSTRACT FROM AUTHOR]

Only 2% of all breast cancers are metastatic, making them extremely uncommon. They are frequently mistaken for a primary breast tumor. Although it has been observed, metastatic spread from primary uterine cancers is extremely uncommon. In the literature, our case represents the fourth endometroid adenocarcinoma metastasis from the uterus. Clinical, pathological, and immunohistochemical examination and management of metastatic endometrioid adenocarcinoma of the uterus' extragenital organ were described in this 69‐year‐old patient's case. Immunohistochemical analysis was performed on a breast biopsy taken from the patient who underwent therapy and discovered a breast mass two years later. Metastatic endometrial adenocarcinoma was diagnosed with negative signs pointing to mammaglobin, GCDFP‐15 and GATA3 breasts and markers indicating endometroid adenocarcinomas such as p53, PAX8 and VIMENTIN support. As a result, a thorough clinical history is needed, with special attention to diagnoses of concurrent or prior malignancies, along with clinical examination, appropriate radiological evaluation, and immunohistochemistry. This is necessary to prevent unnecessary surgery, to provide appropriate systemic treatment, to ensure correct diagnosis, and to manage treatment. [ABSTRACT FROM AUTHOR]

Aim: To gain a better understanding of the use of sentinel lymph node mapping by Chinese oncologists for endometrial cancer staging and analyze factors influencing its application. Methods: Questionnaires were collected online before and by phone after the symposium to evaluate the general characteristics of oncologists who participated in the endometrial cancer seminar and factors associated with the application of sentinel lymph node mapping in endometrial cancer patients. Results: Gynecologic oncologists from 142 medical centers participated in the survey. 35.4% of doctors employed sentinel lymph node mapping for endometrial cancer staging, 57.3% chose indocyanine green as the tracer. Multivariate analysis revealed that cancer research center (odds ratio = 4.229, 95% CI 1.747–10.237), physician familiarity with sentinel lymph node mapping (odds ratio = 126.188, 95% confidence interval 43.220–368.425) and the use of ultrastaging (odds ratio = 2.657, 95% confidence interval 1.085–6.506) were related to the doctors' selection of sentinel lymph node mapping. There was a significant difference in the surgical procedure for early endometrial cancer, the number of removed sentinel lymph node, and the reason for not adopting sentinel lymph node mapping before and after the symposium. Conclusions: The theoretical knowledge of sentinel lymph node mapping, the use of ultrastaging, and cancer research center are related to a higher acceptance of sentinel lymph node mapping. Distance learning is conducive to the promotion of this technology. [ABSTRACT FROM AUTHOR]

Aim: To explore the relationship between poly(ADP‐ribose) glycohydrolase (PARG) and the occurrence, development, and prognosis of endometrial carcinoma (EC), and investigate whether the PARG inhibitor PDD0017273 could increase the sensitivity of EC cells to cisplatin. Methods: The expression of PARG, phosphatase and tensin homolog (PTEN), and p53 in normal endometrial tissues (NE), endometrial hyperplasia without atypia (EH), atypical endometrial hyperplasia (AH), and EC was detected by immunohistochemistry. AN3CA EC cells with PTEN deficiency were treated with different cisplatin and PDD0017273, alone or in combination. Cell proliferation was detected by MTT method, apoptosis was detected by flow cytometry, and the expression of PARG in EC cells after treatment with different drugs was detected by western blot and immunohistochemistry. Results: Expression of PARG in NE, EH, AH, and EC increased gradually. In addition, compared with low PARG expression in PTEN‐positive EC, patients who had high PARG expression in PTEN‐negative EC had more advanced clinical stages (r = −0.399, p = 0.032) and shorter overall survival time (p = 0.037). A dose of 40 μM PDD0017273 effectively inhibited PARG expression, increased the sensitivity of AN3CA cells to cisplatin. Conclusions: The findings suggest that PARG overexpression is a promising immunohistochemical marker to predict the occurrence and prognosis of EC. Moreover, PARG inhibition produced antitumor effects and increased the sensitivity of EC cells with PTEN deficiency to cisplatin. [ABSTRACT FROM AUTHOR]

The article focuses on the role of reconstructive surgery and assisted reproduction technology (ART) in treating infertility. Topics include the role of tubal surgery in reproductive surgery, how to manage tubal factor in fertility in the era of ART, and the management of hydrosalpinx corrective surgery; and reconstructive surgery and ART are complementary rather than competitive, and proper investigation and individualization of treatment are necessary for better results.

Aim: To evaluate the reliability of sagittal abdominal diameter (SAD)—a surrogate of visceral obesity—in magnetic resonance imaging, and its accuracy to predict the surgical morbidity of aortic lymphadenectomy. Methods: We conducted a multicenter reliability (phase 1) and accuracy (phase 2) cohort study in three Spanish referral hospitals. We retrospectively analyzed data from the STELLA‐2 randomized controlled trial that included high‐risk endometrial cancer patients undergoing minimally invasive surgical staging. Patients were classified into subgroups: conventional versus robotic‐assisted laparoscopy, and transperitoneal versus extraperitoneal technique. In the first phase, we measured the agreement of three SAD measurements (at the umbilicus, renal vein, and inferior mesenteric artery) and selected the most reliable one. In phase 2, we evaluated the diagnostic accuracy of SAD to predict surgical morbidity. Surgical morbidity was the main outcome measure, it was defined by a core outcome set including variables related to blood loss, operative time, surgical complications, and para‐aortic lymphadenectomy difficulty. Results: In phase 1, all measurements showed good inter‐rater and intra‐rater agreement. Umbilical SAD (u‐SAD) was the most reliable one. In phase 2, we included 136 patients. u‐SAD had a good diagnostic accuracy to predict surgical morbidity in patients undergoing transperitoneal laparoscopic lymphadenectomy (0.73 in ROC curve). It performed better than body mass index and other anthropometric measurements. We calculated a cut‐off point of 246 mm (sensitivity: 0.56, specificity: 0.80). Conclusions: u‐SAD is a simple, reliable, and potentially useful measurement to predict surgical morbidity in endometrial cancer patients undergoing minimally invasive surgical staging, especially when facing transperitoneal aortic lymphadenectomy. [ABSTRACT FROM AUTHOR]

Mesonephric‐like carcinoma histologically resembles mesonephric adenocarcinoma (MA) of the cervix. MA arises from mesonephric duct remnants. However, the origin of mesonephric‐like carcinoma is not extensively studied because of its rarity. Here, we present a case of synchronous ovarian and uterine mesonephric‐like carcinoma that potentially arose from endometrioid adenofibroma. A 69‐year‐old woman presented with an abdominal mass with no genital bleeding. She underwent simple total abdominal hysterectomy and bilateral adnexal resection. Histological and immunohistochemical analyses were consistent with mesonephric‐like carcinoma involving both ovaries and the uterus. Endometrioid adenofibroma was present in both ovaries, while adenomyosis was observed in the uterus. The glandular duct of the endometrioid adenofibroma in the right ovary had areas suggestive of precursor lesions of mesonephric‐like carcinoma. All tumors exhibited the KRAS G12D mutation. These findings suggest that the origin of the mesonephric‐like carcinoma was the Müllerian duct, and that the ovarian and uterine tumors were monoclonal. [ABSTRACT FROM AUTHOR]

Background: Endometrial carcinoma (EC) is one of the most common tumors in the female reproductive system. There are nearly 200 000 new cases every year. It is the third most common gynecological malignant tumor leading to female death. The incidence rate is closely related to lifestyle, and the incidence rate varies in different regions. The incidence rate of EC is ranking the first in the female reproductive system cancer just second only to breast, lung, and colorectal cancer in North America and Europe and the incidence rate of EC is only second, followed by breast cancer and cervical cancer in China. Purpose: The potential metabolic markers of endometrial cancer were screened by liquid chromatograph mass spectrometer (LC‐MS), and the tissues of patients with hysteromyoma and endometrial cancer were sequenced to explore the relationship between the disease and change in the content of long‐chain noncoding RNA (lncRNA). Methods: Serum and tissue samples were collected from patients with endometrial dysplasia, endometrial cancer stage I, and endometrial cancer stage III. The metabolites in all serum samples were extracted, and the metabolites in all samples were detected by LC–MS/MS technology. The Pareto‐scaling method was used for normalization, and the MetaboAnalyst 4.0 software was used for different analyses. The T test between groups showed that p ≤ 0.05 was regarded as the metabolite with a difference. Further, the function of differential metabolites was determined by metabolite function enrichment and co‐expression analysis. Meanwhile, the differentially expressed lncRNA was detected by Illumina second‐generation high‐throughput sequencing technology, and the expression was analyzed by DEGseq software. Different lncRNA were screened according to p < 0.05. LncRNA with significant differences were screened by p < 0.01, q < 0.001, fold change ≥2, and false discovery rate (FDR) ≤0.001. Results: Through synthesis of T test, cluster heatmap, and ROC curve analysis, five biomarkers with potential diagnostic ability were obtained, including 2,3‐Pyridinedicarboxylic acid (area under the curve (AUC) = 0.69), Hematommic acid, ethyl ester (AUC = 0.69), Maltitol (AUC = 0.69), 13(S)‐HODE (AUC = 0.88), and D‐Mannitol (AUC = 0.69) had potential diagnostic ability between EC phase I versus EC phase III. At the same time, lncRNA sequencing results showed that when endometrial atypical hyperplasia continued to change, including LINC00511, PVT1, and IQCH‐AS1 (downregulated), and only changed significantly in the endometrial dysplasia group, including MALAT1, CARMN (downregulated) and LINC00648, BISPR, LINC01534, and LINC00930 (upregulated). Moreover, both differential metabolites and differential lncRNA were annotated to the lipid metabolism pathway, suggesting that this pathway played an important role in the occurrence and development of endometrial carcinoma. Conclusions: It can combine the results of metabolomics and lncRNA sequencing to assist in the early diagnosis of endometrial precancerous lesions and endometrial cancer patients, to enhance the sensitivity and specificity of diagnosis, which has a certain clinical application prospect. [ABSTRACT FROM AUTHOR]

Aim: This study aims to examine the association between malignant peritoneal cytology and prognosis in women with endometrial cancer. Methods: We retrospectively analyzed the records of patients with endometrial cancer who underwent surgery with intraoperative peritoneal cytology at our hospital between January 1988 and December 2012. All results were reclassified according to the 2009 International Federation of Gynecology and Obstetrics (FIGO) system, and the relation between intraoperative peritoneal cytology results and recurrence and prognosis was examined. Results: Of the 908 patients analyzed, 205 (22.6%) had positive peritoneal cytology. Patients with positive peritoneal cytology had significantly lower rates of recurrence‐free survival (RFS) and overall survival (OS) than those in the negative cytology group (both p < 0.001). Subgroup analysis of patients with FIGO stage I/II showed significantly lower RFS in the positive‐cytology group (p = 0.005), but there was no significant difference in OS (p = 0.637). In the patients with FIGO stage III/IV or patients classified as "high risk," the RFS and OS were significantly lower in the positive‐cytology group (both p < 0.001). Cox regression analysis identified positive peritoneal cytology as a significant predictor of recurrence in patients with FIGO stage I/II disease. Conclusions: Patients with positive peritoneal cytology for endometrial cancer have a high risk of recurrence, regardless of histopathologic type or FIGO stage. Peritoneal cytology has already been removed from the 2009 FIGO classification of endometrial cancer, but it may deserve reconsideration. [ABSTRACT FROM AUTHOR]

Aim: Westernization of lifestyle has increased the numbers of patients with endometrial cancer and obesity. This study aimed to compare the clinical outcomes of robotic‐assisted surgery according to whether patients are obese, morbidly obese, or nonobese. Methods: Sixty‐three patients with endometrial cancer who underwent robotic‐assisted surgery between March 2014 and June 2022 were categorized according to whether they had a body mass index (BMI) <30 (group A, nonobese, n = 40), ≥30 and <35 (group B, obese, n = 13), or ≥35 (group C, morbidly obese, n = 10). Operation time, blood loss, perioperative complications, and recurrence rate were investigated. Results: Conversion to laparotomy was required in one case in group A and one in group C. There was no difference in total operation time, time for setting (including trocar installation and docking of the da Vinci robot), console time, or time for wound closure between the groups; however, there was a significant between‐group difference in the total time for setting and wound closure. There was no significant difference in blood loss or complications between the groups. Three patients in group A and two in group B received adjuvant treatment; none have shown evidence of recurrent disease during a mean observation time of 21 months (range, 2–29). Two cases in group A and one in group B had recurrence during a mean observation time of 38 months (range, 19–46). Conclusion: Patients with endometrial cancer who are obese can be treated safely by robotic‐assisted surgery with a low risk of complications and few relapses. [ABSTRACT FROM AUTHOR]

Aim: To investigate the recurrence rate, live‐birth rate, and treatment outcomes of levonorgestrel‐releasing intrauterine device (LNG‐IUD) for the management of atypical endometrial hyperplasia (AEH) or Grade‐1 endometrial cancer (EC) in patients who desire fertility‐sparing treatment and those seeking conservative treatment without fertility preservation. Methods: We prospectively enrolled nine patients from a single institution between April 2009 and September 2013 who were followed up for 60 months after LNG‐IUD insertion. Results: The median patient age was 35 (range: 29–39) years. The overall recurrence rate was 56% (5/9). The median interval between removal of the LNG‐IUD and recurrence was 20.5 (range: 2–30) months. Three of the nine patients had Grade‐1 EC, and six had AEH. The response rates to the LNG‐IUD in patients with Grade‐1 EC and AEH were 66% and 100%, respectively. Four patients (three with AEH, one with Grade‐1 EC) experienced recurrence 6 months after MPA treatment and all 4 (100%) had complete response. Eight patients desired fertility preservation, of which 37% (3/8) conceived after receiving fertility treatment and 25% (2/8) had a live birth; the remaining three had previously received MPA for 6 months and had a recurrence; of these, 1 had a live birth. Conclusion: LNG‐IUD is effective for the management of AEH and EC in young patients who desire fertility‐sparing treatment, including those ineligible for MPA owing to the presence of comorbidities and those with recurrence after MPA treatment (6‐month treatment), and patients seeking conservative treatment without fertility preservation. [ABSTRACT FROM AUTHOR]

Aim: Endometrial biopsy is generally performed with a metal uterine curette sonde; however, recently, many types of vacuum aspirators are available, including the manual vacuum aspiration (MVA) system. We used the women's MVA system for endometrial sampling and evaluated its effectiveness in determining the presence of endometrial malignancy. Methods: Forty‐seven samples were examined using the following procedures after measuring endometrial thickness by transvaginal ultrasonography: fractional curettage biopsy (Bx; 20 samples), total curettage under general anesthesia (T/C; 13 samples), and MVA (14 samples). The quality of the endometrial samples was classified into four types: 1–4, where 1 denoted poor and 4, good quality. Results: The mean score of the MVA group was significantly higher than that of the partial curettage biopsy group (p = 0.0065). No differences were observed between the MVA and total curettage groups (p = 1.00). When patients were divided into two groups according to endometrial thickness (<10 mm or ≥10 mm) and analyzed, both the MVA and T/C groups did not show a significant difference in their scores compared to the Bx group when the endometrial thickness was <10 mm. However, when the endometrial thickness was ≥10 mm, the MVA and T/C groups had significantly better scores than the Bx group (p = 0.0225 and p = 0.0244, respectively). Vagal reflex, as an adverse event, was observed only in two patients in the Bx group (2/20, 10%). Conclusion: Considering its quality and safety, Karman‐type MVA for endometrial sampling could be an alternative to fractional curettage using a metallic uterine curette sonde. [ABSTRACT FROM AUTHOR]

Endometrial cancer is generally diagnosed at an early stage and has a good prognosis, although once it recurs, the prognosis is poor because of few therapeutic options. Since endometrial cancer has a high frequency of microsatellite instability‐high/mismatch repair deficiency, the anti‐PD‐1 antibody pembrolizumab is expected to be one of the key therapeutic agents for recurrent endometrial cancer. Immune‐related adverse events (irAEs) are autoimmune‐like unique and occasionally life‐threatening side effects of immune checkpoint inhibitors. Here, we report a rare case of recurrent endometrial cancer that showed long‐term complete remission after developing relapsing severe irAE colitis following the introduction of pembrolizumab. [ABSTRACT FROM AUTHOR]

Background: There is no consensus on the correlation between human epididymis protein 4 (HE4) and prognosis of endometrial cancer (EC). Therefore, we performed a meta‐analysis to assess the relationship between HE4 and prognosis of EC. Methods: In this systematic review and meta‐analysis, the databases were searched. Correlation of serum or tissue HE4 with clinicopathological characteristics was determined by odds ratio (OR) or standardized mean difference (SMD) with 95% confidence interval (CI), respectively. The hazard ratio (HR) with 95% CI was calculated to evaluate the correlation between HE4 and survival outcome. Results: A total of 38 published studies were eligible. We found that high levels of serum HE4 were associated with FIGO III‐IV stage (SMD = 1.58, 95%CI: 1.18–1.98, p < 0.001), grade 3 (SMD = 0.66, 95%CI: 0.39–0.93, p = 0.001), ≥50% myometrial invasion (SMD = 0.78, 95%CI: 0.58–0.99, p < 0.001), lymphovascular space invasion (SMD = 0.82, 95%CI: 0.54–1.11, p = 0.001), lymph node metastasis (SMD = 1.27, 95%CI: 0.84–1.69, p < 0.001), cervical involvement (SMD = 0.71, 95%CI: 0.43–0.98, p = 0.003), parametrial involvement (SMD = 1.03, 95%CI: 0.71–1.35, p < 0.001) and peritoneal cytology (SMD = 0.49, 95%CI: 0.22–0.75, p < 0.001). High expression of tissue HE4 was only significantly associated with lymph node metastasis (OR = 6.19, 95%CI: 2.07–18.50, p = 0.001). High levels of serum HE4 were significantly associated with poor overall survival (univariate: HR = 3.77, 95%CI: 1.94–7.32, p < 0.001; multivariate: HR = 2.15, 95%CI: 1.65–2.80, p < 0.001) and disease‐free survival (univariate: HR = 2.89, 95%CI: 2.14–3.88, p < 0.001; multivariate: HR = 2.31, 95%CI:1.20–2.67, p < 0.001) in EC. Compared with cancer antigen 125, serum HE4 may be a better prognostic indicator for EC. Conclusions: High HE4 expression is associated with poor prognosis of EC and may be a potential prognostic biomarker for EC. [ABSTRACT FROM AUTHOR]

Background: Failure to obtain an office‐based endometrial biopsy for abnormal uterine bleeding is not uncommon. Although operating room‐based procedures are traditionally considered the gold standard assessment tool in these circumstances, outpatient hysteroscopy is a less invasive, more cost‐effective, and safer alternative. However, there is no contemporary Canadian literature on the effectiveness of an outpatient approach for this specific population. Objective: We aim to evaluate the effectiveness and outcomes of outpatient hysteroscopy for uterine cavity evaluation for patients who have failed an in‐office endometrial biopsy attempt. Methods: We conducted a retrospective cohort study of all patients referred to an academic outpatient hysteroscopy unit between January 2015 and January 2018, who underwent an outpatient hysteroscopy following failed endometrial biopsy. Data were collected from electronic medical records. Results: Of the 407 consecutive patients who underwent an outpatient hysteroscopic procedure, 68 met inclusion criteria. Postmenopausal bleeding was the most common indication for initial biopsy, and most failures were attributed to cervical stenosis. Outpatient hysteroscopies were successfully completed in 96% of cases (n = 65/68). Failure resulted from either anxiety and discomfort (n = 2), or severe intrauterine adhesions (n = 1). Overall, 10% of patients subsequently required an operating room‐based hysteroscopy, either to complete a myomectomy or polypectomy, or to allow general anesthesia. Outpatient hysteroscopy identified endometrial hyperplasia and cancer in 4.5% and 3% of patients, respectively. Conclusion: Outpatient hysteroscopy following unsuccessful office endometrial biopsy attempts appears to be a feasible, safe, and cost‐effective investigation strategy that may prevent the need for an operating room‐based procedure in 90% of cases. [ABSTRACT FROM AUTHOR]

Aim: As a special invasive pattern seen in low‐grade endometrial carcinoma, microcystic, elongated and fragmented (MELF) pattern is related to lymph node metastasis. Tumor budding (TB) is another histological marker in many cancers associated with tumor aggressiveness. Herein, we evaluated the impact of MELF pattern combined with TB about clinicopathological features and prognosis in endometrioid endometrial cancer (EEC). To verify the relationship between the two morphological markers and microsatellite status in EEC, the primary mismatch repair (MMR) proteins were detected by immunohistochemistry. Methods: One hundred and seventy‐two cases of ECC diagnosed between 2011 and 2016 were reviewed with a median follow up of 47.5 months. MELF pattern and TB were examined on all H&E‐stained slides. Primary MMR proteins (MLH1, MSH2, MSH6, and PMS2) were also detected. Results: Based on MELF pattern and TB, 172 patients were divided into the following four groups: MELF(−)/TB(+) (n = 41), MELF(+)/TB(−) (n = 15), MELF(+)/TB(+) (n = 20), and MELF(−)/TB(−) (n = 96). Adverse pathological features were observed in the MELF(+)/TB(+) group: 70% presented deep muscular infiltration, 65% were lymphovascular space invasion, and 25% suffered lymph node metastasis. The proportion of MMR deficient in MELF(+)/TB(−) group was the highest (66.7%). The progression‐free survival (PFS) and overall survival (OS) among the four groups were significantly different. MELF(+)/TB(+) group showed the worst PFS and OS. As univariate and multivariate survival analyses revealed, the combination of MELF pattern and TB was confirmed as an independent predictor of poor prognosis. Conclusions: Our research demonstrates that MELF pattern combined with TB, as an independent predictor of adverse outcome, is associated with adverse pathological features, which facilitates better understanding of EEC tumor behavior and more precise prognosis without additional medical expense. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to summarize the clinical characteristics and analyze the independent prognostic factors in patients with high‐grade endometrial neuroendocrine carcinoma (ENC). Methods: Patients diagnosed with ENC, endometrioid adenocarcinoma (EAC), endometrial clear‐cell carcinoma (ECC), endometrial serous carcinoma (ESC), endometrioid carcinoma with mucinous features (EMC) from 1987 to 2016 were screened from the National Cancer Institute database (surveillance, epidemiology, and end results [SEER]). Kaplan–Meier were used to assess survival. Univariate and multivariate Cox proportional hazards analysis were done to examine factors affecting survival. Results: The median survival times of ENC were 11 months, shorter than that of EAC, ECC, ESC, and EMC (p < 0.01). There was no significant difference in ages, survival rate, and median survival time between large‐cell ENC (LCENC) and small‐cell ENC (SCENC), which were all belong to ENC. In a multivariable model, the hazard ratio (HR) of death for women with Federation International of Gynecology and Obstetrics (FIGO) stage I‐II of ENC was 0.37 compared to FIGO stage III‐IV (p < 0.01). The HR of patients who under the surgery was 0.39 compared to the patients who without surgery (p < 0.01), and the HR of patients who received chemotherapy was 0.51 compared to the patients who did not received chemotherapy (p < 0.01). Radiotherapy did not significantly reduce the mortality risk of patients. Conclusion: ENC was a kind of devastating endometrial cancers with the poorest prognosis. Surgical treatment and chemotherapy were necessary for improving prognosis of ENC. Early diagnosis favored better prognosis. There was no prognostic difference between with and without radiotherapy. [ABSTRACT FROM AUTHOR]

Purpose: We asked why endometrial cancer sometimes vanishes. Methods: A total of 454 patients diagnosed with endometrioid‐type endometrial cancer (EC) (via endometrial sampling) and treated in our clinic over the past 5 years were enrolled. The patients were divided into two groups: vanishing and residual, depending on whether a tumor was detected in the postoperative hysterectomy specimen. Patient age, numbers of pregnancies and deliveries, menopausal status, systemic disease status, hemogram parameters, International Federation of Gynecology and Obstetrics (FIGO) grade, and invasion status (evident on magnetic resonance imaging [MRI]) were compared between the groups. Results: ECs vanished in 42 (9.25%) patients. The vanishing rates were 19.7% (37/187) in FIGO grade 1 patients, 2.1% (5/238) in grade 2 patients, and 0% (0/29) in grade 3 patients. The average age was lower in the vanishing than the residual group, but the premenopausal status and grade 1 tumor rates were higher (both p < 0.001). An absence of invasion (as revealed by MRI) was more common in the vanishing group (p < 0.001). No recurrence developed in the vanishing group, but recurrences were noted in 3.3% (14/412) of the residual group. There were no significant between‐group differences in any of the numbers of pregnancies or births, systemic disease status, or hemogram parameters (all p > 0.05). Conclusion: Vanishing EC is more likely in premenopausal women with endometrioid grade 1 EC (as revealed by endometrial biopsy) who lack myometrial invasion on MRI. [ABSTRACT FROM AUTHOR]

Objective: To discuss the impact of chemoradiotherapy (CRT) on the survival of patients with stage III endometrial cancer (EC) compared with chemotherapy (CT) alone. Methods: Articles involving adjuvant CRT versus CT on survival in stage III EC were retrieved from PubMed and EMBASE. Hazard ratios (HRs) of overall survival (OS) and relapse‐free survival (RFS) were collected and pooled, and publication bias was measured by Begg's and Egger's test. Quality of researches was measured by the Newcastle–Ottawa scale and the modified Jadad scale. Results: Eleven were included in the statistical analysis. A significant advantage of CRT over CT on OS was shown (HR 0.59, 95% CI 0.49–0.70). Further subgroup analysis suggested the advantage was mostly associated with stage IIIC (HR 0.63, 95% CI 0.52, 0.76]). A similar result favoring CRT was also reached on RFS (HR 0.66, 95% CI 0.47–0.93). No significant publication bias was observed. Conclusion: CRT was associated with a better OS and RFS than CT alone in stage III EC patients. [ABSTRACT FROM AUTHOR]

Purpose Our purpose was to comparatively investigate the expressions of nidogen‐1 (NID1) and legumain (LGMN) in patients with endometrial cancer, endometrial intraepithelial neoplasia, and proliferative endometrium. Methods: A cross‐sectional, single‐center study was performed by the obstetrics and gynecology and pathology departments of our institution. The relationships between descriptive data, clinicopathologic information, and immunohistochemical expressions of NID1 and LGMN were investigated. Results: The histological grades of endometrial cancers (n = 124) as classified by FIGO included 1 (41, 21.1%), 2 (48, 24.7%), and 3 (35, 18.0%). The medians and ranges of deep and superficial NID1 expressions were 50.00 (0–285) and 5.00 (0–100), respectively. The intensity of legumain expression was noted as negative (30, 24.2%), mild (16, 12.9%), moderate (27, 21.8%), or strong (51, 41.1%). Median disease‐free survival and overall survival were 75.00 (range: 1 to 170) months and 77.00 (range: 1 to 170) months, respectively. Patients with more intense expression of NID1 and LGMN displayed a higher histological grade. These patients were more likely to have a positive peritoneal cytology, larger tumor size, higher tendency for myometrial or lymphovascular invasion, involvement of ovaries, cervix, omentum, as well as lymph node metastasis, and recurrence. Conclusion: Our data indicated that the expressions of NID1 and LGMN may have important diagnostic implications in endometrial pathologies. Further studies should be performed to understand the significance of NID1 and LGMN in the pathogenesis of endometrial tumors. [ABSTRACT FROM AUTHOR]

Aim: Coffee drinking is considered as a risk factor of endometrial cancer (EC). Here, we conducted a meta‐analysis of observational study to evaluate the relationship between coffee drinking and the risk of EC. Methods: The MEDLINE and EMBASE databases were searched until July 2018. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random‐effects model. Results: A total of 24 studies (12 case–control and 12 cohort studies) on coffee intake with 9833 incident cases of EC and 699 234 subjects were included in the meta‐analysis. The pooled RR of endometrial cancer for the highest versus the lowest categories of coffee intake was 0.71 (95% CI: 0.65–0.77; I2 = 14%, p for heterogeneity = 0.26). By study design, the pooled RRs were 0.68 (95% CI: 0.56–0.83) for case–control studies and 0.70 (95% CI: 0.63–0.77) for cohort studies. For different regions, the pooled RRs were 0.74 (95% CI: 0.62–0.88) in Europe, 0.71 (95% CI: 0.64–0.79) in United States/Canada, and 0.40 (95% CI: 0.28–0.57) in Japan. By additional subgroup analysis, a stronger inverse association was shown in caffeinated coffee drinkers (RR 0.66, 95% CI: 0.52–0.83), individuals with the higher body mass index (BMI) (RR 0.65, 95% CI: 0.54–0.79), never smokers (RR 0.68, 95% CI: 0.56–0.84), ever smokers (RR 0.56, 95% CI: 0.45–0.70), and those who never used hormone replacement therapy (HRT) (RR 0.88, 95% CI: 0.79–0.98). The consumption of filtered or boiled coffee showed no significant association. Conclusions: Increased coffee intake is associated with a reduced risk of EC. [ABSTRACT FROM AUTHOR]

Aim: Our study aims to investigate the safety and effectiveness of sentinel lymph node biopsy using indocyanine green (ICG) for the surgical staging of early‐stage endometrial cancer in comparison to technetium‐99 m use. Methods: We conducted an observational retrospective study with patients diagnosed of endometrial cancer and FIGO stages I‐II. All participants were injected technetium‐99m the day prior to the surgery and underwent lymphoscintigraphy along with single‐photon emission computed tomography. In addition, all patients were administered intraoperatively ICG injection to detect sentinel lymph node biopsy. The surgical staging was then completed according to the European Society for Medical Oncology preoperative risk category. Data obtained from the analysis of technetium‐99m detection was compared to ICG detection. Results: A total of 53 women with endometrial cancer were included in the study, 49 (92.5%) of them showed drainage preoperatively in the single‐photon emission computed tomography and/or lymphoscintigraphy. The intraoperative bilateral detection rate for technetium‐99 m was 26 (49.1%) patients compared to 40 (75.5%) patients with ICG (p = 0.013). We observed a 42.5% increase in the mean number of lymph nodes retrieved by ICG compared to technetium‐99m (2.85 vs 2,0 nodes; p = 0.002). We intraoperatively identified 164 lymph nodes, 104 (63.4%) located in both obturator areas and external iliac vessels. Conclusion: The use of ICG for the performance of sentinel node biopsy in patients with endometrial cancer seems safe and could be superior to technetium‐99 m, since it offers a higher bilateral detection rate and nodal retrieval, resulting in the possibility to perform safely less full staging lymphadenectomies. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to compare the surgical outcomes between patients who were staged laparoscopically for early‐stage endometrioid‐type endometrial cancer (EC) between those who underwent prophylactic ligation of uterine arteries (UAs) prior to pelvic lymphadenectomy and the patients who were operated with standard procedure. Methods: This retrospective study was conducted in women diagnosed with early‐stage and low/intermediate‐risk endometrioid‐type EC. The control group included patients who underwent standard laparoscopic pelvic lymphadenectomy and the study group concerned patients who underwent prophylactic ligation of UA prior to pelvic lymphadenectomy. The prophylactic ligation of UA procedure was performed at a point just proximal to its origin. Results: The mean lymph node count dissected in the study group was higher in terms of statistical significance (17.5 ± 2.2 vs. 19.8 ± 3.6, p = 0.003 and p ˂ 0.05). The rate of the patients who had a positive pelvic lymph node detected did not differ between groups (7.4% vs. 16.7%, p = 0.258 and p ˂ 0.05). The operation time (OT) of the patients in the study group did not differ between groups (p = 0.546 and p ˂ 0.05). Hemoglobin drop (−0.5 ± 0.7) and hematocrite drop (−0.8 ± 0.9) values in the study group were found to be lower in the study group (p = 0.000, p = 0.000, and p ˂ 0.05). Conclusions: Performing prophylactic ligation of UA at its origin prevents unwanted bleeding and facilitates the laparoscopic pelvic lymphadenectomy procedure. [ABSTRACT FROM AUTHOR]

Serous endometrial intraepithelial carcinoma is the precursor of invasive uterine serous carcinoma. Here, we present two cases of serous endometrial intraepithelial carcinoma with omental micrometastasis and discuss their clinical significance. Two menopausal patients with abnormal endometrial biopsy findings underwent hysterectomy and comprehensive surgical staging (bilateral salpingo‐oophorectomy, omentectomy, and pelvic and para‐aortic lymphadenectomy). Although gross examination failed to detect tumors, the pathological diagnosis was serous endometrial intraepithelial carcinoma. Both patients had omental micrometastasis; they were diagnosed with International Federation of Gynecology and Obstetrics stage IVB disease and received postoperative chemotherapy. One patient died of the carcinoma 9 months after the hysterectomy, and the other had a recurrence of carcinoma 17 months after the end of the initial therapy. The present cases and literature review highlight the importance of meticulous inspection for micrometastasis in the abdominal cavity, including the omentum and peritoneum, for predicting prognosis. [ABSTRACT FROM AUTHOR]

Cervical cancer is a human papilloma virus‐related disease, whereas endometrial cancer and atypical endometrial hyperplasia (AEH) are hormone‐related diseases, so co‐occurrence of the two is possible. However, scientific studies about such cases are rare. We encountered a case of cervical adenocarcinoma and AEH in a 33‐year‐old nulliparous woman. Two fertility‐sparing treatments were performed, a radical trachelectomy for the cervical cancer and high‐dose medroxyprogesterone acetate treatment for the AEH. After remission of the diseases, the patient became pregnant by in vitro fertilization and delivered a baby at 36 weeks' gestation by cesarean section. Although the patient had two uterine malignancies, proper evaluation of the diseases, consultation with the patient and her husband, and appropriate management led to fertility preservation, and live birth was achieved. [ABSTRACT FROM AUTHOR]

Aims: The tumor budding (TB); poorly differentiated cluster (PDC); desmoplastic reaction (DR); and microcystic, elongated, and fragmented (MELF) patterns of invasion are pathological findings at the tumor invasion front associated with epithelial‐to‐mesenchymal transition. This study aimed to clarify the clinical significance of the TB, PDC, DR, and MELF patterns in endometrioid endometrial carcinomas (EEC). Methods: Two hundred and eight cases of histologically proven EEC retrieved from the archives of the Department of Pathology, Fukui Prefectural Hospital, and diagnosed between January 2000 and August 2020 were retrospectively analyzed. Results: The TB, PDC, DR, and MELF patterns were identified in 29 (13.9%), 47 (22.6%), 45 (21.6%), and 23 (11.1%) cases, respectively. Kaplan–Meier curve analysis with log‐rank test demonstrated that TB, PDC, and DR were associated with a lower progression‐free survival (p = 0.010, 0.002, and <0.0001, respectively), whereas the MELF pattern did not show any association (p = 0.668). In multivariate analyses, only DR was significantly associated with lower progression‐free survival (p = 0.034). Moreover, only PDC was associated with lower overall survival in univariate analysis (p = 0.018), but the association lost significance in multivariate analysis. Conclusions: The present study revealed that the histological confirmation of TB, PDC, and DR at the tumor invasive front predicts poor prognosis in EEC. However, the MELF pattern was not a predictor of poor prognosis in EEC. [ABSTRACT FROM AUTHOR]

Adrenal metastasis from endometrial cancer is extremely rare and has a poor prognosis, especially for bilateral adrenal metastases. It is usually asymptomatic without any adrenal hormonal abnormalities. A 50‐year‐old postmenopausal woman presented with acute right‐sided back pain and history of occasional abnormal uterine bleeding. She was diagnosed with endometrial cancer with ruptured bilateral adrenal metastases. She underwent total hysterectomy and bilateral salpingo‐oophorectomy, and the pathological findings revealed dedifferentiated carcinoma. After three courses of adjuvant chemotherapy, the bilateral adrenal metastases had increased in size, with worsening back pain and adrenal hormone insufficiency. The patient died 6 months after the identification of adrenal tumors. Acute back pain may lead to the identification of a ruptured adrenal metastasis. The possibility of gradual adrenal insufficiency should be considered in bilateral adrenal metastases. Although the prognosis is poor, tumor debulking surgery followed by adjuvant chemotherapy could be suggested to improve the prognosis. [ABSTRACT FROM AUTHOR]

Purpose: To compare the survival outcome between radical hysterectomy and simple hysterectomy with radiation therapy in patients with stage II endometrial cancer. Materials and Methods: This is a retrospective cohort study based on the SEER database from January 1, 1988 to December 31, 2015. Results: Of 577 patients were enrolled in the study, 117 patients received radical hysterectomy and 460 patients received simple hysterectomy combined with vaginal brachytherapy. All patients received external beam radiation therapy after the surgery. The median follow‐up duration was 82.77 ± 1.44 months. No differences were found on the baseline information between two groups. Both the 5‐year overall survival (62.31% vs. 78.48%, p < 0.001) and 5‐year cause‐specific survival (74.60 vs. 85.38%, p = 0.01) were shorter in radical hysterectomy than in simple hysterectomy combined with vaginal brachytherapy group. However, the positive outcomes were further validated in patients with high‐risk endometrial cancer, not in patients with grade 1–2 low‐risk endometrial cancer both on cause‐specific survival and overall survival. In patients with grade 3 low‐risk endometrial cancer, the tendency was only found with lower overall survival not cause‐specific survival. Conclusions: This study revealed that in patients' high‐risk stage II endometrial cancer, radical hysterectomy was associated with shorter survival outcome than simple hysterectomy combined with vaginal brachytherapy. [ABSTRACT FROM AUTHOR]

Aim: To analyze the risk factors of lymph node involvement in pure endometrioid type endometrial cancer and assess factors that necessitate lymphadenectomy. Methods: Patients who had been operated on due to endometrial cancer and whose final pathology was reported as pure endometrioid carcinoma between January 2014 and January 2020 were assessed. Hysterectomy, bilateral salpingo‐oophorectomy, and systematic lymphadenectomy were performed in all patients. All specimens were reported by expert gynecopathologists. Results: The lymph node positivity rate was 14.4%. When the study population was classified according to the Mayo risk criteria; lymph node involvement in the low‐risk and high‐risk groups was 9.1% and 14.8%, respectively and there was no statistically difference (p > 0.05). The median of tumor size and the rate of deep myometrial invasion, lymphovascular space invasion, adnexal involvement, FIGO grade 3 tumor were found significantly higher in the positive lymph node group in univariate analysis. In the receiver operating characteristic curve analysis, the cut‐off value of the tumor diameter was determined as 47.5 mm (sensitivity 85%, specificity 62%). Every 10 mm increase in tumor diameter increased the risk of lymph node involvement 10 times. Conclusion: This study defined that the tumor diameter is an independent predictor for lymphatic dissemination. In the future, it could be shown that even with new modeling based on tumor diameter, lymphadenectomy or adjuvant radiotherapy requirements would be reevaluated. [ABSTRACT FROM AUTHOR]

Objective: The molecular features of high‐grade endometrioid carcinoma (HGEC) are more akin to nonendometrioid high‐grade carcinoma (NEHC). This study aims to explore whether HGEC also has similar clinical pathology and prognosis similar to NEHC. Methods: Using the SEER database (Surveillance, Epidemiology, and End Results), a retrospective study of the clinical‐pathological data and prognosis was carried out. Result: (1) Compared with LGEC (low‐grade endometrioid carcinoma), HGEC patients were older with larger tumor size and a higher proportion of stage III–IV disease. However, the young had a lower proportion of stage III–IV disease than NEHC. (2) Postoperative pathological examination revealed that the positive rate of peritoneal cytology, pelvic lymph nodes and para‐aortic lymph nodes in HGEC were significantly higher than LGEC, but lower than NEHC. LGEC, HGEC, and NEHC, all showed distant organ metastases such as brain metastases, bone metastases, liver metastases, and lung metastases. Notably, the metastasis rates between HGEC and NEHC were not significantly different but were higher than LGEC. (3) The five‐overall survival rates of LGEC, HGEC, and NEHC were 95.1%, 73.2%, and 54.8%, respectively. Notably, the survival rates decreased significantly in stage IV. There were no significant differences between HGEC and NEHC in stage IV (p = 0.665) and both were associated with worsened survival. Also, HGEC survival prognosis was similar to NEHC. Conclusion: HGEC presents mixed or overlapping clinical–pathological features of NEHC. Therefore, based on the unique pathological and prognostic features, HGEC could be classified as an intermediate between LGEC and NEHC. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the treatment outcomes and complications of patients with FIGO stage IIIC and IVB endometrioid endometrial cancer (EC) presenting primarily as nodal spreads following systematic lymphadenectomy and adjuvant therapy. Material and Methods: Forty‐four FIGO stage IIIC and IVB endometrioid EC patients between July 2003 and March 2020 received staging procedures including systematic lymphadenectomy. The survival outcomes and late treatment‐related complications were compared between adjuvant chemoradiation‐based group and chemotherapy‐based group. Results: Of the 44 patients, 16 (36.4%) had stage IIIC1, 26 (59.1%) had stage IIIC2, and 2 (4.5%) had stage IVB disease. The median follow‐up time was 54 months (range, 10–185 months). There was no statistical difference in mortality between the microscopic and macroscopic nodal groups (6.2% vs 4.3%, p > 0.999). Eleven patients (25.0%) and 33 patients (75.0%) received adjuvant chemoradiation and chemotherapy, respectively. The 5‐year disease‐free and overall survival rates were not different between the two groups (disease‐free survival, 81.8% vs 82.1%, p = 0.743; overall survival, 90.9% vs 95.8%, p = 0.537). The incidence rates of grade 2 lymphedema (36.4% vs 9.1%, p = 0.032) and grade 2/3 gastrointestinal complications (36.4% vs 0.0%, p < 0.001) were higher in the chemoradiation‐based group than those in the chemotherapy‐based group. Conclusions: Systematic lymphadenectomy and adjuvant chemotherapy might be the preferred treatment for FIGO stage IIIC and IVB endometrioid EC patients presenting as nodal spreads given that no difference in patient survival was found, but a higher incidence of treatment‐related complications was observed in the chemoradiation‐based group. [ABSTRACT FROM AUTHOR]

Aim: To determine whether hysteroscopy (HSC) increases the risk of intraperitoneal dissemination in endometrial cancer patients. Methods: We conducted a comprehensive review of multiple databases. Quality assessments of eligible studies were performed using the Newcastle‐Ottawa and Jadad scales. Positive peritoneal cytology (PPC) as the outcome of interest was compared between endometrial cancer patients with and without HSC. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated as a measure of effects. Results: Three case–control studies and eight retrospective cohort studies included 3364 patients, of whom 1116 underwent preoperative HSC, which resulted in a significantly higher PPC rate (OR, 1.82; 95% CI, 1.31–2.54; p = 0.0004). I2 was 11%, and the heterogeneity was acceptable. The difference between the groups with stages I–II was statistically insignificant (OR, 1.50; 95% CI, 0.75–2.99; p = 0.25). When liquid was used as the uterine distension medium during HSC and the intrauterine pressure was controlled under 80 mmHg, the difference between the two groups was also insignificant (OR, 1.18; 95% CI, 0.50–2.79; p = 0.71). However, when the intrauterine pressure exceeded 80 mmHg, the difference between the two groups was statistically significant (OR, 2.18; 95% CI, 1.28–3.73; p = 0.004). Conclusion: This meta‐analysis indicates that preoperative HSC in patients with endometrial cancer may increase the risk of intraperitoneal dissemination of malignant cells, which may be associated with intrauterine pressure >80 mmHg but not with stages I–II. There is no reason to avoid HSC for the diagnosis of endometrial cancer, especially in early stages, but intrauterine pressure should possibly be controlled below 80 mmHg. [ABSTRACT FROM AUTHOR]