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Risk of Uterine Cancer in Women with Deleterious BRCA Mutations Who Undergo Risk Reducing Salpingo-oophorectomy (RRSO)
Abstracts / Gynecologic Oncology 147 (2017) 190–236
Methods: With IRB approval, the records of 260 women with germline BRCA mutations who underwent RRSO between 1/1/2000 and 12/31/2014 were reviewed. All women were asymptomatic at the time of surgery, had normal physical exams, CA 125 levels and transvaginal ultrasounds and were followed for at least 24 months post-op. Censoring occurred at uterine cancer diagnosis or at last follow up. Relative incidence of uterine cancer was compared with rates expected from the Surveillance, Epidemiology and End Results database.
Conclusions: Outside of stage, other important factors including race, depth of invasion, LVSI, and receiving radiation can be used to predict survival in patients with type 2 endometrial cancers. More data is needed to create a comprehensive model to better predict poor prognosis. Fostering increased understanding of factors contributing to diminished survival may help guide initial adjuvant therapy choices in the future.
DP
Results: The cohort included 148 BRCA1 mutation carriers, 98 BRCA2, 6 NOS and 5 BRCA1 AND 2 mutation carriers. The median follow-up time was 72 months. 57% of women had a concomitant hysterectomy at time of RRSO. One BRCA1 mutation carrier had occult stage IIB uterine cancer diagnosed at RRSO and was subsequently treated with chemotherapy and vaginal cuff brachytherapy and remains without evidence of disease. 2 women, ages 69 and 51 had a hysterectomy at 79 and 41 months respectively post RRSO. During 120 women years of follow up, 2 (1%) incident uterine cancers were diagnosed and both patients had BRCA1 mutations. The two patients diagnosed with endometrial cancer after RRSO presented with abnormal uterine bleeding. Neither patient had used hormone replacement therapy, tamoxifen or had a prior diagnosis of breast cancer. Both uterine cancers were of endometroid histology, one was a grade 2 and the other was a grade 3.
OF
Objectives: To report the relative risk and histologic features of uterine cancers in women with deleterious BRCA mutations who have undergone a risk reducing salpingo-oophorectomy (RRSO).
(34%) were advanced stage. In the short-term survivor (STS) group (n= 32), 12 (38%) were early stage and 20 (62%) were advanced stage. Histologic subtypes included Carcinosarcoma (39%), Serous (38%), Mixed (16%), and Clear Cell (7%). In advanced stage patients there was a trend towards younger age increasing survival (mean age LTS 65.2, STS 69.1, p= 0.06). African-American race was associated with decreased survival in advanced stage patients (28% of LTS, 75% of STS, p=0.003), but white race was associated with decreased survival among early stage patients (34% of LTS, 58% of STS, p=0.01). Greater than 50% depth of invasion was associated with decreased survival in both early (24% of LTS, 67% of STS, p=0.013) and advanced (33% of LTS, 80% of STS, p=0.008) stage patients. Lymphovascular space invasion (LVSI) was associated with decreased survival in advanced stage patients (40% of LTS, 90% of STS, p=0.003). Receiving radiation during initial treatment was associated with increased survival in both early (82% of LTS, 42% of STS, p=0.01) and advanced stage (67% of LTS, 30% of STS, p= 0.02) patients. Differences in BMI, diabetes, hypertension, histology, tumor size, and chemotherapy during initial treatment were not associated with length of survival in our data set.
RO
Risk of Uterine Cancer in Women with Deleterious BRCA Mutations Who Undergo Risk Reducing Salpingo-oophorectomy (RRSO) M. Hodeiba, K. McMillena, A. Beavisb, M. Zakhoura, C. Walsha, B.J. Rimela, A. Lia, B. Karlana, I. Cassa. aCedars Sinai Medical Center, Los Angeles, Ca, bJohns Hopkins Medical Center, Baltimore, Md
231
Learning objective: Identify patient, pathologic, and treatment factors that contribute to prognosis in patients with type 2 endometrial cancers.
TE
doi:10.1016/j.ygyno.2017.07.106
Brain metastases from Uterine Cancer: Features, Treatment and Outcomes of a Rare Phenomenon E.C. McClunga, M. Shahzadb. aUniversity at South Florida, Tampa, Fl, b Moffitt Cancer Center, Department of Gynecologic Oncology, Tampa, Fl
EC
Conclusions: In this cohort of 260 patients post RRSO, uterine cancer is rare (1%). Both women who developed endometrial cancer post RRSO were symptomatic and had early stage disease, and none had serous histology. The recommendation for concomitant hysterectomy at the time of RRSO should be balanced against the additional surgical risk of a hysterectomy.
doi:10.1016/j.ygyno.2017.07.105
RR
Learning objective: Identify the risk of uterine cancer in patients with BRCA mutations.
CO
Clinical and Pathologic Characteristics of Long-Term Survivors of Type 2 Endometrial Cancer M. Javellana, J. Ross, C. Liao, K. Laus, I. Alsadan, S.D. Yamada, N. Lee. The University of Chicago, Chicago, IL
UN
Objectives: To elucidate the differences between women who survive type 2 endometrial cancer for greater than 5 years compared to those surviving less than 2 years to aid in understanding clinical and pathologic risk factors for a poor prognosis at time of initial treatment. Methods: Patients with type 2 endometrial cancer surviving less than 2 years and greater than 5 years from diagnosis were selected from a database of women treated for endometrial cancer at our institution between 1/1/2004-8/15/2014. Long-term survivors were compared to short-term survivors in two groups, early stage (1 and 2) and advanced stage (3 and 4). Mann-Whitney and Fisher’s exact tests were used due to small sample size. Results: 85 women were included in our analysis. In the long-term survivor (LTS) group (n= 53), 35 (66%) were early stage and 18
Objectives: Brain metastasis of uterine cancer (UC) is a rare phenomenon and data describing features and outcomes are very limited. We present our experience with the management of endometrial carcinoma and sarcoma with brain involvement at a single institution. Methods: Following IRB approval, institutional databases were searched to identify all patients with a diagnosis of endometrial cancer who received a neurosurgery consultation, CT head or MRI brain from January 1, 1980 to June 1, 2016. A total of 329 medical records were reviewed and 21 patients meeting criteria were identified. Results: Of the 21 patients with brain metastases, median age at diagnosis of UC was 58 (range 37-76). The majority (52%) presented with stage IV disease, 19% were stage III, and 19% were stage I. The primary UC histology was determined was endometrial carcinoma (EC) in 13/21(62%), with 8/13 (62%) endometrioid type, 2/13( 15%) serous type, and the remainder mixed. Of the total 13 patients with EC, 2/13 (15%) were grade 1, 2/13 (15%) grade 2-3, and 8/13 (62%) were grade 3. One patient had no grade documented. Other histologies included leiomyosarcoma in 5/21 ( 24%), carcinosarcoma in 2/21 (10%), and primary uterine sarcoma in 1/ 21 (5%). For the total 21 patients, median time from UC diagnosis to brain metastasis was 29.2 months (range 0.7-146.3). Solitary metastases occurred in 9/21 (43%). Biopsies were obtained in 9/21 (42.8%) and all were consistent with UC primary. Treatment approaches included radiation alone in 10/21 (48%), surgical resection in 5/21 (24%) and combined surgery and radiation in 3/21 (14%). Median overall
Methods: With IRB approval, the records of 260 women with germline BRCA mutations who underwent RRSO between 1/1/2000 and 12/31/2014 were reviewed. All women were asymptomatic at the time of surgery, had normal physical exams, CA 125 levels and transvaginal ultrasounds and were followed for at least 24 months post-op. Censoring occurred at uterine cancer diagnosis or at last follow up. Relative incidence of uterine cancer was compared with rates expected from the Surveillance, Epidemiology and End Results database.
Conclusions: Outside of stage, other important factors including race, depth of invasion, LVSI, and receiving radiation can be used to predict survival in patients with type 2 endometrial cancers. More data is needed to create a comprehensive model to better predict poor prognosis. Fostering increased understanding of factors contributing to diminished survival may help guide initial adjuvant therapy choices in the future.
DP
Results: The cohort included 148 BRCA1 mutation carriers, 98 BRCA2, 6 NOS and 5 BRCA1 AND 2 mutation carriers. The median follow-up time was 72 months. 57% of women had a concomitant hysterectomy at time of RRSO. One BRCA1 mutation carrier had occult stage IIB uterine cancer diagnosed at RRSO and was subsequently treated with chemotherapy and vaginal cuff brachytherapy and remains without evidence of disease. 2 women, ages 69 and 51 had a hysterectomy at 79 and 41 months respectively post RRSO. During 120 women years of follow up, 2 (1%) incident uterine cancers were diagnosed and both patients had BRCA1 mutations. The two patients diagnosed with endometrial cancer after RRSO presented with abnormal uterine bleeding. Neither patient had used hormone replacement therapy, tamoxifen or had a prior diagnosis of breast cancer. Both uterine cancers were of endometroid histology, one was a grade 2 and the other was a grade 3.
OF
Objectives: To report the relative risk and histologic features of uterine cancers in women with deleterious BRCA mutations who have undergone a risk reducing salpingo-oophorectomy (RRSO).
(34%) were advanced stage. In the short-term survivor (STS) group (n= 32), 12 (38%) were early stage and 20 (62%) were advanced stage. Histologic subtypes included Carcinosarcoma (39%), Serous (38%), Mixed (16%), and Clear Cell (7%). In advanced stage patients there was a trend towards younger age increasing survival (mean age LTS 65.2, STS 69.1, p= 0.06). African-American race was associated with decreased survival in advanced stage patients (28% of LTS, 75% of STS, p=0.003), but white race was associated with decreased survival among early stage patients (34% of LTS, 58% of STS, p=0.01). Greater than 50% depth of invasion was associated with decreased survival in both early (24% of LTS, 67% of STS, p=0.013) and advanced (33% of LTS, 80% of STS, p=0.008) stage patients. Lymphovascular space invasion (LVSI) was associated with decreased survival in advanced stage patients (40% of LTS, 90% of STS, p=0.003). Receiving radiation during initial treatment was associated with increased survival in both early (82% of LTS, 42% of STS, p=0.01) and advanced stage (67% of LTS, 30% of STS, p= 0.02) patients. Differences in BMI, diabetes, hypertension, histology, tumor size, and chemotherapy during initial treatment were not associated with length of survival in our data set.
RO
Risk of Uterine Cancer in Women with Deleterious BRCA Mutations Who Undergo Risk Reducing Salpingo-oophorectomy (RRSO) M. Hodeiba, K. McMillena, A. Beavisb, M. Zakhoura, C. Walsha, B.J. Rimela, A. Lia, B. Karlana, I. Cassa. aCedars Sinai Medical Center, Los Angeles, Ca, bJohns Hopkins Medical Center, Baltimore, Md
231
Learning objective: Identify patient, pathologic, and treatment factors that contribute to prognosis in patients with type 2 endometrial cancers.
TE
doi:10.1016/j.ygyno.2017.07.106
Brain metastases from Uterine Cancer: Features, Treatment and Outcomes of a Rare Phenomenon E.C. McClunga, M. Shahzadb. aUniversity at South Florida, Tampa, Fl, b Moffitt Cancer Center, Department of Gynecologic Oncology, Tampa, Fl
EC
Conclusions: In this cohort of 260 patients post RRSO, uterine cancer is rare (1%). Both women who developed endometrial cancer post RRSO were symptomatic and had early stage disease, and none had serous histology. The recommendation for concomitant hysterectomy at the time of RRSO should be balanced against the additional surgical risk of a hysterectomy.
doi:10.1016/j.ygyno.2017.07.105
RR
Learning objective: Identify the risk of uterine cancer in patients with BRCA mutations.
CO
Clinical and Pathologic Characteristics of Long-Term Survivors of Type 2 Endometrial Cancer M. Javellana, J. Ross, C. Liao, K. Laus, I. Alsadan, S.D. Yamada, N. Lee. The University of Chicago, Chicago, IL
UN
Objectives: To elucidate the differences between women who survive type 2 endometrial cancer for greater than 5 years compared to those surviving less than 2 years to aid in understanding clinical and pathologic risk factors for a poor prognosis at time of initial treatment. Methods: Patients with type 2 endometrial cancer surviving less than 2 years and greater than 5 years from diagnosis were selected from a database of women treated for endometrial cancer at our institution between 1/1/2004-8/15/2014. Long-term survivors were compared to short-term survivors in two groups, early stage (1 and 2) and advanced stage (3 and 4). Mann-Whitney and Fisher’s exact tests were used due to small sample size. Results: 85 women were included in our analysis. In the long-term survivor (LTS) group (n= 53), 35 (66%) were early stage and 18
Objectives: Brain metastasis of uterine cancer (UC) is a rare phenomenon and data describing features and outcomes are very limited. We present our experience with the management of endometrial carcinoma and sarcoma with brain involvement at a single institution. Methods: Following IRB approval, institutional databases were searched to identify all patients with a diagnosis of endometrial cancer who received a neurosurgery consultation, CT head or MRI brain from January 1, 1980 to June 1, 2016. A total of 329 medical records were reviewed and 21 patients meeting criteria were identified. Results: Of the 21 patients with brain metastases, median age at diagnosis of UC was 58 (range 37-76). The majority (52%) presented with stage IV disease, 19% were stage III, and 19% were stage I. The primary UC histology was determined was endometrial carcinoma (EC) in 13/21(62%), with 8/13 (62%) endometrioid type, 2/13( 15%) serous type, and the remainder mixed. Of the total 13 patients with EC, 2/13 (15%) were grade 1, 2/13 (15%) grade 2-3, and 8/13 (62%) were grade 3. One patient had no grade documented. Other histologies included leiomyosarcoma in 5/21 ( 24%), carcinosarcoma in 2/21 (10%), and primary uterine sarcoma in 1/ 21 (5%). For the total 21 patients, median time from UC diagnosis to brain metastasis was 29.2 months (range 0.7-146.3). Solitary metastases occurred in 9/21 (43%). Biopsies were obtained in 9/21 (42.8%) and all were consistent with UC primary. Treatment approaches included radiation alone in 10/21 (48%), surgical resection in 5/21 (24%) and combined surgery and radiation in 3/21 (14%). Median overall