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Prevalence of Lynch Syndrome-Associated Tumors in Minority Patients with Endometrial Cancer
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Abstracts / Gynecologic Oncology 143 (2016) 194–223
relevant education regarding sexual dysfunction is warranted for clinicians who treat this population.
doi:10.1016/j.ygyno.2016.08.284
Prevalence of Lynch Syndrome-Associated Tumors in Minority Patients with Endometrial Cancer A Crim, M. Greenwade, S. Chen, R. Mannel, S. McMeekin, K. Moore, L.L. Holman. Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA Objectives: Identification of endometrial cancer (EC) patients with Lynch Syndrome (LS) is important and dependent upon appropriate screening programs. The prevalence of LS-associated MMR genetic mutations among minority EC pts is unclear as many studies have included mostly white patients. The objective of this study was to determine the prevalence of LS-associated tumors among minority EC pts. Methods: We identified 100 minority pts who underwent hysterectomy and were diagnosed with EC at our institution from 1/20057/2015. A retrospective chart review was performed to collect clinicopathologic characteristics. Immunohistochemistry testing for MMR was performed on each hysterectomy. This testing has been completed on 47 of the planned 100 specimens. SAS version 9.3 was used for descriptive statistics and multivariate analyses for this interim analysis. Results: The majority of the 47 samples were early stage, grade 2, endometrioid cancers. The minority representation was as follows: 28% African American (AA), 30% Hispanic (H), 30% American Indian (AI), 11% Asian (A), 2% other races. There are 28% of samples with IHC loss of any MMR protein (13/47), and 77% of these had loss in both MLH1 and PMS2. Hispanic pts had the highest prevalence of tumor IHC loss, accounting for 46% (6/13), while 31% (4/13) were AA, 15% (2/13) were AI, and 8% (1/13) of other races. However, this difference is not statistically significant (p = 0.41). The loss of IHC in tumor samples was also evaluated at 2 dichotomies for age of b/≥ 50 yo and b/≥ 60 yo. There were 23% (3/13) of patients b50yo and 29% (10/34) of patients ≥50yo with IHC loss (p = 0.67). There were 23% (9/31) of patients b60yo and 25% (4/16) of patients ≥60yo with IHC loss (p = 0.78). To date, 3 of the 13 pts with IHC loss have been referred for genetic counseling and 1 pt has a confirmed germline mutation. Conclusion: The overall prevalence of tumors with IHC loss in our minority population appears to be consistent with prior studies of primarily white pts. The H and AA subpopulations appear to be trending toward a higher percentage than other races, although a higher sample size will clarify whether this difference is significant. Restricting IHC testing by age appears to miss a significant percentage of possible LS pts. This suggests the importance of universal screening for minority EC patients.
doi:10.1016/j.ygyno.2016.08.285
Patterns of failure and the potential role for localized therapy in patients with recurrent uterine leiomyosarcoma M. Zakhour, M Hodeib, J.G. Cohen, M. Kamrava. University of California Los Angeles Medical Center, Los Angeles, California Objectives: To analyze the patterns of recurrence in a cohort of patients with uterine leiomyosarcoma (LMS) following definitive surgical therapy to evaluate whether there may be a role for local treatment at the time of recurrence.
Methods: An IRB-approved retrospective chart review identified consecutive patients between 1/2003 and 1/2015 with a diagnosis of uterine LMS who underwent hysterectomy at a single institution. Only patients with reviewable pathology reports and at least 6 months of follow-up were included. Demographic and clinical information was abstracted from medical records. Chi-square, Fisher’s exact, and Mann Whitney U tests were used for statistical analysis. Results: 27 patients met inclusion criteria. Median age at diagnosis was 50 years (range 36-77). 78% had stage IA/B, 19% stage IIA/B, and 1 had stage IVB disease. Primary treatment consisted of: hysterectomy in 52%, surgery/chemotherapy in 22%, surgery/radiation in 11%, and surgery/chemotherapy/radiation in 15%. Of those who received chemotherapy as part of adjuvant treatment, 9 received gemcitabine/ docetaxel, and 1 received carboplatin/paclitaxel. Median follow-up interval was 28 months and medial overall survival from the time of diagnosis was 29 months (range 7-140). Median progression free survival was 8 months (range 0-93). 22 (81%) patients developed recurrent disease, and 2 (7%) had progressive disease during upfront treatment. 21 of 24 (88%) had oligometastatic recurrent disease (≤ 5 sites) (Table 1). The most common site of recurrence was the pelvis. 6 of 10 patients (60%) treated with 2nd line chemotherapy alone had persistent or progressive disease, versus 2 of 11 (18%) patients whose regimens included localized treatment with surgery or RT (p = 0.08). There was no difference in overall survival between these two groups; however patients treated with a local modality at the time of recurrence had a significantly longer progression free interval from the time of their first adjuvant treatment (25 versus 5.5 months, p = 0.01). Conclusion: Most patients with uterine LMS develop recurrent disease following their initial treatment. Those with long progression free intervals and limited sites of recurrence may benefit from a local treatment in combination with systemic therapy rather than pursuing second line chemotherapy alone.
Table 1 Characteristics of patients with oligometastatic recurrence stratified by subsequent treatment.
Abstracts / Gynecologic Oncology 143 (2016) 194–223
relevant education regarding sexual dysfunction is warranted for clinicians who treat this population.
doi:10.1016/j.ygyno.2016.08.284
Prevalence of Lynch Syndrome-Associated Tumors in Minority Patients with Endometrial Cancer A Crim, M. Greenwade, S. Chen, R. Mannel, S. McMeekin, K. Moore, L.L. Holman. Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA Objectives: Identification of endometrial cancer (EC) patients with Lynch Syndrome (LS) is important and dependent upon appropriate screening programs. The prevalence of LS-associated MMR genetic mutations among minority EC pts is unclear as many studies have included mostly white patients. The objective of this study was to determine the prevalence of LS-associated tumors among minority EC pts. Methods: We identified 100 minority pts who underwent hysterectomy and were diagnosed with EC at our institution from 1/20057/2015. A retrospective chart review was performed to collect clinicopathologic characteristics. Immunohistochemistry testing for MMR was performed on each hysterectomy. This testing has been completed on 47 of the planned 100 specimens. SAS version 9.3 was used for descriptive statistics and multivariate analyses for this interim analysis. Results: The majority of the 47 samples were early stage, grade 2, endometrioid cancers. The minority representation was as follows: 28% African American (AA), 30% Hispanic (H), 30% American Indian (AI), 11% Asian (A), 2% other races. There are 28% of samples with IHC loss of any MMR protein (13/47), and 77% of these had loss in both MLH1 and PMS2. Hispanic pts had the highest prevalence of tumor IHC loss, accounting for 46% (6/13), while 31% (4/13) were AA, 15% (2/13) were AI, and 8% (1/13) of other races. However, this difference is not statistically significant (p = 0.41). The loss of IHC in tumor samples was also evaluated at 2 dichotomies for age of b/≥ 50 yo and b/≥ 60 yo. There were 23% (3/13) of patients b50yo and 29% (10/34) of patients ≥50yo with IHC loss (p = 0.67). There were 23% (9/31) of patients b60yo and 25% (4/16) of patients ≥60yo with IHC loss (p = 0.78). To date, 3 of the 13 pts with IHC loss have been referred for genetic counseling and 1 pt has a confirmed germline mutation. Conclusion: The overall prevalence of tumors with IHC loss in our minority population appears to be consistent with prior studies of primarily white pts. The H and AA subpopulations appear to be trending toward a higher percentage than other races, although a higher sample size will clarify whether this difference is significant. Restricting IHC testing by age appears to miss a significant percentage of possible LS pts. This suggests the importance of universal screening for minority EC patients.
doi:10.1016/j.ygyno.2016.08.285
Patterns of failure and the potential role for localized therapy in patients with recurrent uterine leiomyosarcoma M. Zakhour, M Hodeib, J.G. Cohen, M. Kamrava. University of California Los Angeles Medical Center, Los Angeles, California Objectives: To analyze the patterns of recurrence in a cohort of patients with uterine leiomyosarcoma (LMS) following definitive surgical therapy to evaluate whether there may be a role for local treatment at the time of recurrence.
Methods: An IRB-approved retrospective chart review identified consecutive patients between 1/2003 and 1/2015 with a diagnosis of uterine LMS who underwent hysterectomy at a single institution. Only patients with reviewable pathology reports and at least 6 months of follow-up were included. Demographic and clinical information was abstracted from medical records. Chi-square, Fisher’s exact, and Mann Whitney U tests were used for statistical analysis. Results: 27 patients met inclusion criteria. Median age at diagnosis was 50 years (range 36-77). 78% had stage IA/B, 19% stage IIA/B, and 1 had stage IVB disease. Primary treatment consisted of: hysterectomy in 52%, surgery/chemotherapy in 22%, surgery/radiation in 11%, and surgery/chemotherapy/radiation in 15%. Of those who received chemotherapy as part of adjuvant treatment, 9 received gemcitabine/ docetaxel, and 1 received carboplatin/paclitaxel. Median follow-up interval was 28 months and medial overall survival from the time of diagnosis was 29 months (range 7-140). Median progression free survival was 8 months (range 0-93). 22 (81%) patients developed recurrent disease, and 2 (7%) had progressive disease during upfront treatment. 21 of 24 (88%) had oligometastatic recurrent disease (≤ 5 sites) (Table 1). The most common site of recurrence was the pelvis. 6 of 10 patients (60%) treated with 2nd line chemotherapy alone had persistent or progressive disease, versus 2 of 11 (18%) patients whose regimens included localized treatment with surgery or RT (p = 0.08). There was no difference in overall survival between these two groups; however patients treated with a local modality at the time of recurrence had a significantly longer progression free interval from the time of their first adjuvant treatment (25 versus 5.5 months, p = 0.01). Conclusion: Most patients with uterine LMS develop recurrent disease following their initial treatment. Those with long progression free intervals and limited sites of recurrence may benefit from a local treatment in combination with systemic therapy rather than pursuing second line chemotherapy alone.
Table 1 Characteristics of patients with oligometastatic recurrence stratified by subsequent treatment.