Evaluating the Use of a Modified Mayo Criteria for Early Stage Endometrial Cancer Surgical Staging

Evaluating the Use of a Modified Mayo Criteria for Early Stage Endometrial Cancer Surgical Staging

Abstracts / Gynecologic Oncology 147 (2017) 190–236 Learning objective: Learners will be able to identify risk factors for HPV positivity in Central ...

46KB Sizes 1 Downloads 60 Views

Abstracts / Gynecologic Oncology 147 (2017) 190–236

Learning objective: Learners will be able to identify risk factors for HPV positivity in Central Uganda. Learners will be able to describe baseline screening for cervical cancer in Uganda. Learners will be able to list opportunities for improving cervical cancer screening in Uganda. doi:10.1016/j.ygyno.2017.07.103

Evaluating the Use of a Modified Mayo Criteria for Early Stage Endometrial Cancer Surgical Staging M. Zhang, R. Isaksson Vogel, C. Rivard. Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Twin Cities Objectives: To compare the use of the Mayo Criteria (MC) with a Modified Mayo Criteria (MMC) that excludes tumor size at intraoperative frozen section to guide lymph node dissection (LND) during endometrial cancer surgical staging. Methods: A retrospective chart review was performed to identify patients who underwent surgery for endometrial cancer at a large academic institution between March 2011 and December 2015. Data were summarized using descriptive statistics and compared by MC and MMC status using Chi-squared and Fisher’s Exact tests as appropriate for comparisons of node dissection and any positive nodes and Kruskal-Wallis tests for comparison of number of nodes removed and number of positive nodes.

DP

doi:10.1016/j.ygyno.2017.07.102

compiled from similar campaigns in other districts to give more robust population-based estimates of HPV prevalence. Additionally, we will assess frequency and determinants of successful treatment acquisition for women with positive tests obtained in a community-based setting to determine the overall impact of campaign-based screening.

OF

these pts varied: 3 pts received no adjuvant therapy, 6 pts received adjuvant radiation therapy, 6 pts received adjuvant chemotherapy, and 3 pts received a combination of chemotherapy and radiation. Two of the 3 pts who did not receive adjuvant therapy progressed and died of disease before treatment could be started. All pts with stage III/IV disease received adjuvant chemotherapy. The greatest variation was the treatment of early stage disease, with 6 pts receiving adjuvant RT only, 3 receiving chemotherapy + vaginal cuff brachytherapy, and 1 pt receiving chemotherapy alone. The recurrence rate was 40% with a median PFS of 6 months. The median OS was 7 months. However, the median OS for pts that recurred was 5 months with 88% dying of disease within 3 months of recurrence. The median OS was 17 months for pts who did not recur with 100% alive without disease at the time of last follow-up. Conclusions: Dedifferentiated adenocarcinoma of the endometrium is an aggressive subset of EC. Given the rapid progression at the time of recurrence, it is imperative we identify risk factors for recurrence and optimal up-front treatment strategies. We plan a multi-institutional analysis to delineate these factors with a larger subset of pts. Learning objective: Define dedifferentiated endometrial cancer. Identify pathologic factors associated with dedifferentiated endometrial cancer. Outline the how clinical factors differ between dedifferentiated endometrial cancer and other pathologic subsets of endometrial cancer.

RO

230

Results: Four hundred and twenty-nine patients were identified. Using the MC, 314 (73.2%) were categorized as high-risk and 79 (18.4%) were categorized as low-risk. This is compared to the MMC (excluding tumor size), 88 (20.5%) patients were classified as high-risk while 226 (52.7%) were classified as intermediate-risk based on tumor size but with no other high-risk characteristics. Using the MC, 54 (61.4%) had pelvic only and 35 (39.8%) had pelvic and para-aortic LND and 6 (11.1%) had positive pelvic and 5 (14.3%) had positive para-aortic nodes in the highrisk group. This compares to 212 (67.5%) undergoing pelvic only and 144 (45.9%) undergoing pelvic and para-aortic LND and 14 (7.1%) with positive pelvic and 7 (4.9%) with positive para-aortic nodes using the MMC classification. Using the MC, the low-risk group had 21 (26.6%) patients undergo pelvic only and 6 (7.6%) undergo pelvic and paraaortic LND and there were no positive nodes identified. This compares to 158 (69.9%) undergoing pelvic only and 109 (48.2%) undergoing pelvic and para-aortic LND with 9 (5.7%, p=0.22) positive pelvic and 2 (1.8%, p=0.01) positive para-aortic nodes in the MMC group.

TE

HPV positivity among women in Central Uganda participating in a Community Health Campaign offering self-collected HPV-based cervical cancer screening M. Swansona, M. Nakalembeb, M. Huchkob. aUniversity of California at San Francisco, bMakerere University College for Health Sciences School of Medicine

EC

Objectives: To report the proportion of positive tests and to identify predictors of positivity among women undergoing self-collected HPV-DNA screening in Central Uganda.

RR

Methods: We carried out a community health campaign in Kiboga District as part of a larger prospective cohort study of women undergoing cervical cancer screening in a community health campaigns. After outreach and education, women were offered HPV DNA testing using self-collection. HPV-positive women were offered cryotherapy. Baseline demographic and health data were obtained and acceptability of the test was assessed.

UN

CO

Results: Between April and June, 2016, 1033 participants completed self-administered HPV screening, of whom 22% (229) tested positive. Age, marital status, parity, and HIV serostatus were significant risk factors for HPV positivity in univariate analysis. In multivariate analysis, adjusted for age, marital status, parity, pregnancy and HIV serostatus, each additional year of age conferred about a 5% decrease in the odds of testing positive (95% CI 2-8%). HIV positivity also conferred 2.8 times the odds of HPV (95% CI 1.83-4.29). Other variables were not significantly associated with HPV positivity in multivariate analysis. Of note, although virtually all HIV positive women in the study were enrolled in care for their HIV, they were not statistically more likely than their HIV negative counterparts to have ever undergone cervical cancer screening previously, 10% versus 6%, respectively (OR 1.78, 95% CI 0.92-3.45). Conclusions: Our HPV prevalence estimate matches limited population-based prevalence data in the region, suggesting a representative sample. Younger women and women with HIV had higher odds of testing positive. Prior to this study, HIV positive women were no more likely to have ever been screened for cervical caner, missing a key opportunity for cervical cancer prevention. In the future, data will be

Conclusions: Using the original MC for risk stratification, a high number of patients (92.9% and 95.1%) patients underwent unnecessary pelvic and para-aortic LND. After modifying the MC to exclude tumor size from consideration, there was no significant difference in the percentage of intermediate vs high-risk patients who underwent LND. There was, however, a statistically significant reduction in positive nodes found in the intermediate group on para-aortic but not pelvic LND. This demonstrates that this modification to the MC was partially successful in reducing unnecessary LND but needs further adjustment to achieve more optimal staging. Learning objective: Evaluate the current rates of staging lymphadenectomy using the Mayo Criteria. Demonstrate the potential advantage of using a modified Mayo Criteria to reduce these rates without significant under-staging. doi:10.1016/j.ygyno.2017.07.104