Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes.
Few reports have described the clinical and prognostic characteristics of endometrial cancer, which is increasing worldwide, in large patient series in Brazil. Our objective was to analyze the clinicopathological characteristics, prognostic factors, and outcomes of patients with endometrial cancer t...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2020-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0229543 |
| _version_ | 1818678041237258240 |
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| author | Cristina Anton Rodolpho Truffa Kleine Eric Mayerhoff Maria Del Pilar Esteves Diz Daniela de Freitas Heloisa de Andrade Carvalho João Paulo Mancusi de Carvalho Alexandre Silva E Silva Maria Luiza Nogueira Dias Genta André Lopes de Faria E Silva Rafael Calil Salim Andrea Aranha Rossana Veronica Mendoza Lopez Filomena Marino Carvalho Edmund Chada Baracat Jesus Paula Carvalho |
| author_facet | Cristina Anton Rodolpho Truffa Kleine Eric Mayerhoff Maria Del Pilar Esteves Diz Daniela de Freitas Heloisa de Andrade Carvalho João Paulo Mancusi de Carvalho Alexandre Silva E Silva Maria Luiza Nogueira Dias Genta André Lopes de Faria E Silva Rafael Calil Salim Andrea Aranha Rossana Veronica Mendoza Lopez Filomena Marino Carvalho Edmund Chada Baracat Jesus Paula Carvalho |
| author_sort | Cristina Anton |
| collection | DOAJ |
| description | Few reports have described the clinical and prognostic characteristics of endometrial cancer, which is increasing worldwide, in large patient series in Brazil. Our objective was to analyze the clinicopathological characteristics, prognostic factors, and outcomes of patients with endometrial cancer treated and followed at a tertiary Brazilian institution over a 10-year period.This retrospective study included 703 patients diagnosed with endometrial cancer who were treated at a public academic tertiary hospital between 2008 and 2018. The following parameters were analyzed: age at diagnosis, race, body mass index, serum CA125 level before treatment; histological type and grade, and surgical stage. Outcomes were reported relative to histological type, surgical staging, serum CA125, lymph-vascular space involvement (LVSI), and lymph-node metastasis. The median patient age at diagnosis was 63 (range, 27-93) years (6.4% were <50 years). Minimally invasive surgeries were performed in 523 patients (74.4%). Regarding histological grade, 468 patients (66.5%) had low-grade endometrioid histology and 449 patients (63.9%) had stage I tumors. Tumors exceeded 2.0 cm in 601 patients (85.5%). Lymphadenectomy was performed in 551 cases (78.4%). LVSI was present in 208 of the patients' tumors (29.5%). Ninety-three patients (13.2%) had recurrent tumors and 97 (13.7%) died from their malignant disease. The robust prognostic value of FIGO stage and lymph node status were confirmed. Other important survival predictors were histological grade and LVSI [overall survival: hazard ratio (HR) = 3.75, p < 0.001 and HR = 2.01, p = 0.001; recurrence: HR = 2.49, p = 0.004 and HR = 3.22, p = 0.001, respectively). Disease-free (p = 0.087) and overall survival (p = 0.368) did not differ significantly between patients with stage II and III disease. These results indicate that prognostic role of cervical involvement should be explored further. This study reports the characteristics and outcomes of endometrial cancer in a large population from a single institution, with systematic surgical staging, a predominance of minimally invasive procedures, and well-documented outcomes. Prognostic factors in the present study population were generally similar to those in other countries, though our patients' tumors were larger than in studies elsewhere due to later diagnosis. Our unexpected finding of similar prognoses of stage II and III patients raises questions about the prognostic value of cervical involvement and possible differences between carcinomas originating in the lower uterine segment versus those originating in the body and fundus. The present findings can be used to guide public policies aimed at improving the diagnosis and treatment of endometrial cancer in Brazil and other similar countries. |
| first_indexed | 2024-12-17T09:08:57Z |
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| id | doaj.art-bbdcc97d16ea4abc9672eea4208a629a |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-17T09:08:57Z |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-bbdcc97d16ea4abc9672eea4208a629a2022-12-21T21:55:20ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01153e022954310.1371/journal.pone.0229543Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes.Cristina AntonRodolpho Truffa KleineEric MayerhoffMaria Del Pilar Esteves DizDaniela de FreitasHeloisa de Andrade CarvalhoJoão Paulo Mancusi de CarvalhoAlexandre Silva E SilvaMaria Luiza Nogueira Dias GentaAndré Lopes de Faria E SilvaRafael Calil SalimAndrea AranhaRossana Veronica Mendoza LopezFilomena Marino CarvalhoEdmund Chada BaracatJesus Paula CarvalhoFew reports have described the clinical and prognostic characteristics of endometrial cancer, which is increasing worldwide, in large patient series in Brazil. Our objective was to analyze the clinicopathological characteristics, prognostic factors, and outcomes of patients with endometrial cancer treated and followed at a tertiary Brazilian institution over a 10-year period.This retrospective study included 703 patients diagnosed with endometrial cancer who were treated at a public academic tertiary hospital between 2008 and 2018. The following parameters were analyzed: age at diagnosis, race, body mass index, serum CA125 level before treatment; histological type and grade, and surgical stage. Outcomes were reported relative to histological type, surgical staging, serum CA125, lymph-vascular space involvement (LVSI), and lymph-node metastasis. The median patient age at diagnosis was 63 (range, 27-93) years (6.4% were <50 years). Minimally invasive surgeries were performed in 523 patients (74.4%). Regarding histological grade, 468 patients (66.5%) had low-grade endometrioid histology and 449 patients (63.9%) had stage I tumors. Tumors exceeded 2.0 cm in 601 patients (85.5%). Lymphadenectomy was performed in 551 cases (78.4%). LVSI was present in 208 of the patients' tumors (29.5%). Ninety-three patients (13.2%) had recurrent tumors and 97 (13.7%) died from their malignant disease. The robust prognostic value of FIGO stage and lymph node status were confirmed. Other important survival predictors were histological grade and LVSI [overall survival: hazard ratio (HR) = 3.75, p < 0.001 and HR = 2.01, p = 0.001; recurrence: HR = 2.49, p = 0.004 and HR = 3.22, p = 0.001, respectively). Disease-free (p = 0.087) and overall survival (p = 0.368) did not differ significantly between patients with stage II and III disease. These results indicate that prognostic role of cervical involvement should be explored further. This study reports the characteristics and outcomes of endometrial cancer in a large population from a single institution, with systematic surgical staging, a predominance of minimally invasive procedures, and well-documented outcomes. Prognostic factors in the present study population were generally similar to those in other countries, though our patients' tumors were larger than in studies elsewhere due to later diagnosis. Our unexpected finding of similar prognoses of stage II and III patients raises questions about the prognostic value of cervical involvement and possible differences between carcinomas originating in the lower uterine segment versus those originating in the body and fundus. The present findings can be used to guide public policies aimed at improving the diagnosis and treatment of endometrial cancer in Brazil and other similar countries.https://doi.org/10.1371/journal.pone.0229543 |
| spellingShingle | Cristina Anton Rodolpho Truffa Kleine Eric Mayerhoff Maria Del Pilar Esteves Diz Daniela de Freitas Heloisa de Andrade Carvalho João Paulo Mancusi de Carvalho Alexandre Silva E Silva Maria Luiza Nogueira Dias Genta André Lopes de Faria E Silva Rafael Calil Salim Andrea Aranha Rossana Veronica Mendoza Lopez Filomena Marino Carvalho Edmund Chada Baracat Jesus Paula Carvalho Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes. PLoS ONE |
| title | Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes. |
| title_full | Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes. |
| title_fullStr | Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes. |
| title_full_unstemmed | Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes. |
| title_short | Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes. |
| title_sort | ten years of experience with endometrial cancer treatment in a single brazilian institution patient characteristics and outcomes |
| url | https://doi.org/10.1371/journal.pone.0229543 |
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