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Outcomes among women diagnosed with cervical cancer at the time of hysterectomy
Abstracts / Gynecologic Oncology 141 (2016) 2–208
(42%), concern for other gynecologic malignancy (39%), and benign gynecologic disease or vaginal bleeding (16%). Of patients diagnosed at the time of hysterectomy, 36% had microscopic disease, 36% had gross disease confined to the cervix and smaller than 4 cm, 22% had locally advanced disease with tumors greater than 4 cm, and 5% had distant metastases. Forty-two patients (74%) received additional treatment after hysterectomy, including 8 (14%) who had additional surgery only, 30 (52%) who underwent radiotherapy only, and 4 (7%) who received additional surgery and radiotherapy. At last follow-up, 44 patients (77%) were alive and free of disease, 4 patients (7%) were living with disease, and 8 patients (14%) were deceased. Patients who underwent incidental hysterectomy were more likely to undergo adjuvant radiation therapy than patients who had hysterectomy after the diagnosis of invasive cancer (52% vs 17%, P b .001). A multivariable Cox proportional model incorporating stage demonstrated that survival estimates of this population were not different from those of the entire cohort who underwent primary surgery (HR 1.01, 95% CI 0.51–2.0). Conclusions: Overall survival was not statistically different for women who underwent incidental hysterectomy, though a greater proportion of these women underwent adjuvant radiotherapy compared with the remainder of the cohort that underwent primary surgery.
OF
which it was derived and the debulking rate at the institution to which it is applied.
183
RO
Fig. 1. Positive Predictive Value.
DP
doi:10.1016/j.ygyno.2016.04.472
TE
441 – Poster Endometrial carcinoma as the presenting malignancy in an 18-year-old patient with Li-Fraumeni syndrome M.B. Clarka, G. Menderesb, M. Azodia,b, K. Finbergb, S. Canosab, V. Parkasha,b. aBridgeport Hospital-Yale New Haven Health, Bridgeport, CT, USA, bYale University School of Medicine, New Haven, CT, USA
EC
Objectives: We describe a patient with a germline TP53 mutation who presented with an endometrial adenocarcinoma as a teenager and who was also found to have a colonic carcinoma. We will review the clinical history, the surgical pathology findings, and the molecular analyses undertaken to identify her mutation. Methods: The patient presented with stage IV disease and underwent tumor debulking followed by chemotherapy. Her initial pathology showed high-grade endometrioid adenocarcinoma with retained mismatch repair protein expression and strongly positive p53 expression. DNA from the tumor was assessed for somatic mutations in a panel of 409 cancer-related genes by next-generation sequencing technology, using DNA isolated from a benign lymph node as the germline reference. A colonoscopy, done as part of her workup, revealed a carcinoma that was also removed and evaluated. Results: A single nucleotide substitution in the TP53 gene, encoding an R273H missense mutation, was identified in the endometrial adenocarcinoma as well as the patient’s germline DNA. The frequencies of the TP53 R273H mutation in DNA sequencing reads obtained from germline DNA and tumor DNA were compatible with a heterozygous germline mutation that had undergone loss of heterozygosity in the tumor. Four novel somatic mutations were also identified in the uterine tumor in PTEN, TSC2, ITGB2, and TAF1L, the latter 3 variants at lower allele frequencies. The patient’s colonic tumor showed strong positivity for p53, as did the endometrial carcinoma. A detailed family history did not suggest a familial syndrome, but rather a de novo mutation. Conclusions: Endometrial cancer is exceedingly rare in young people, especially teenagers, unless associated with hyperestrogenism or Lynch syndrome, neither of which can explain this patient's profile. Endometrial carcinoma is an unusual tumor in families with TP53 germline mutation and to date has not been reported as the sentinel carcinoma. Our patient is unusual also in that this appears to be not a familial case
Fig. 2. Negative Predictive Value.
RR
doi:10.1016/j.ygyno.2016.04.471
CO
440 – Poster Outcomes among women diagnosed with cervical cancer at the time of hysterectomy A.A. Gockleya,b,c, A. Melameda,b,c, E.M. Hinchcliffa,b,c, E.J. Divera,c, L. Contrinob, S. Feldmana,b, W.B. Growdona,c. aHarvard Medical School, Boston, MA, USA, bBrigham and Women's Hospital, Boston, MA, USA, c Massachusetts General Hospital, Boston, MA, USA
UN
Objectives: To describe the outcomes among women diagnosed with cervical cancer at the time of hysterectomy for a diagnosis other than invasive cervical cancer. Methods: We conducted a retrospective cohort study of patients treated for cervical cancer at 2 academic urban hospitals between 1999 and 2013. Patients whose initial pathological diagnosis of cervical cancer was based on a hysterectomy specimen were identified. Demographic, pathologic, and treatment variables were abstracted from the medical record. Outcomes of interest included disease status at last follow-up, receipt of additional surgery, and adjuvant radiotherapy. Results: We identified 1,119 women who received treatment for cervical cancer, among whom 57 (5%) were diagnosed after incidental hysterectomy. Indications for hysterectomy included cervical dysplasia
(42%), concern for other gynecologic malignancy (39%), and benign gynecologic disease or vaginal bleeding (16%). Of patients diagnosed at the time of hysterectomy, 36% had microscopic disease, 36% had gross disease confined to the cervix and smaller than 4 cm, 22% had locally advanced disease with tumors greater than 4 cm, and 5% had distant metastases. Forty-two patients (74%) received additional treatment after hysterectomy, including 8 (14%) who had additional surgery only, 30 (52%) who underwent radiotherapy only, and 4 (7%) who received additional surgery and radiotherapy. At last follow-up, 44 patients (77%) were alive and free of disease, 4 patients (7%) were living with disease, and 8 patients (14%) were deceased. Patients who underwent incidental hysterectomy were more likely to undergo adjuvant radiation therapy than patients who had hysterectomy after the diagnosis of invasive cancer (52% vs 17%, P b .001). A multivariable Cox proportional model incorporating stage demonstrated that survival estimates of this population were not different from those of the entire cohort who underwent primary surgery (HR 1.01, 95% CI 0.51–2.0). Conclusions: Overall survival was not statistically different for women who underwent incidental hysterectomy, though a greater proportion of these women underwent adjuvant radiotherapy compared with the remainder of the cohort that underwent primary surgery.
OF
which it was derived and the debulking rate at the institution to which it is applied.
183
RO
Fig. 1. Positive Predictive Value.
DP
doi:10.1016/j.ygyno.2016.04.472
TE
441 – Poster Endometrial carcinoma as the presenting malignancy in an 18-year-old patient with Li-Fraumeni syndrome M.B. Clarka, G. Menderesb, M. Azodia,b, K. Finbergb, S. Canosab, V. Parkasha,b. aBridgeport Hospital-Yale New Haven Health, Bridgeport, CT, USA, bYale University School of Medicine, New Haven, CT, USA
EC
Objectives: We describe a patient with a germline TP53 mutation who presented with an endometrial adenocarcinoma as a teenager and who was also found to have a colonic carcinoma. We will review the clinical history, the surgical pathology findings, and the molecular analyses undertaken to identify her mutation. Methods: The patient presented with stage IV disease and underwent tumor debulking followed by chemotherapy. Her initial pathology showed high-grade endometrioid adenocarcinoma with retained mismatch repair protein expression and strongly positive p53 expression. DNA from the tumor was assessed for somatic mutations in a panel of 409 cancer-related genes by next-generation sequencing technology, using DNA isolated from a benign lymph node as the germline reference. A colonoscopy, done as part of her workup, revealed a carcinoma that was also removed and evaluated. Results: A single nucleotide substitution in the TP53 gene, encoding an R273H missense mutation, was identified in the endometrial adenocarcinoma as well as the patient’s germline DNA. The frequencies of the TP53 R273H mutation in DNA sequencing reads obtained from germline DNA and tumor DNA were compatible with a heterozygous germline mutation that had undergone loss of heterozygosity in the tumor. Four novel somatic mutations were also identified in the uterine tumor in PTEN, TSC2, ITGB2, and TAF1L, the latter 3 variants at lower allele frequencies. The patient’s colonic tumor showed strong positivity for p53, as did the endometrial carcinoma. A detailed family history did not suggest a familial syndrome, but rather a de novo mutation. Conclusions: Endometrial cancer is exceedingly rare in young people, especially teenagers, unless associated with hyperestrogenism or Lynch syndrome, neither of which can explain this patient's profile. Endometrial carcinoma is an unusual tumor in families with TP53 germline mutation and to date has not been reported as the sentinel carcinoma. Our patient is unusual also in that this appears to be not a familial case
Fig. 2. Negative Predictive Value.
RR
doi:10.1016/j.ygyno.2016.04.471
CO
440 – Poster Outcomes among women diagnosed with cervical cancer at the time of hysterectomy A.A. Gockleya,b,c, A. Melameda,b,c, E.M. Hinchcliffa,b,c, E.J. Divera,c, L. Contrinob, S. Feldmana,b, W.B. Growdona,c. aHarvard Medical School, Boston, MA, USA, bBrigham and Women's Hospital, Boston, MA, USA, c Massachusetts General Hospital, Boston, MA, USA
UN
Objectives: To describe the outcomes among women diagnosed with cervical cancer at the time of hysterectomy for a diagnosis other than invasive cervical cancer. Methods: We conducted a retrospective cohort study of patients treated for cervical cancer at 2 academic urban hospitals between 1999 and 2013. Patients whose initial pathological diagnosis of cervical cancer was based on a hysterectomy specimen were identified. Demographic, pathologic, and treatment variables were abstracted from the medical record. Outcomes of interest included disease status at last follow-up, receipt of additional surgery, and adjuvant radiotherapy. Results: We identified 1,119 women who received treatment for cervical cancer, among whom 57 (5%) were diagnosed after incidental hysterectomy. Indications for hysterectomy included cervical dysplasia