Classification and regression tree (CART) analysis of endometrial carcinoma: Seeing the forest for the trees.

Abstract:

OBJECTIVE:The objectives of the study are to evaluate which clinicopathologic factors influenced overall survival (OS) in endometrial carcinoma and to determine if the surgical effort to assess para-aortic (PA) lymph nodes (LNs) at initial staging surgery impacts OS. METHODS:All patients diagnosed with endometrial cancer from 1/1993-12/2011 who had LNs excised were included. PALN assessment was defined by the identification of one or more PALNs on final pathology. A multivariate analysis was performed to assess the effect of PALNs on OS. A form of recursive partitioning called classification and regression tree (CART) analysis was implemented. Variables included: age, stage, tumor subtype, grade, myometrial invasion, total LNs removed, evaluation of PALNs, and adjuvant chemotherapy. RESULTS:The cohort included 1920 patients, with a median age of 62 years. The median number of LNs removed was 16 (range, 1-99). The removal of PALNs was not associated with OS (P=0.450). Using the CART hierarchically, stage I vs. stages II-IV and grades 1-2 vs. grade 3 emerged as predictors of OS. If the tree was allowed to grow, further branching was based on age and myometrial invasion. Total number of LNs removed and assessment of PALNs as defined in this study were not predictive of OS. CONCLUSION:This innovative CART analysis emphasized the importance of proper stage assignment and a binary grading system in impacting OS. Notably, the total number of LNs removed and specific evaluation of PALNs as defined in this study were not important predictors of OS.

journal_name

Gynecol Oncol

journal_title

Gynecologic oncology

authors

Barlin JN,Zhou Q,St Clair CM,Iasonos A,Soslow RA,Alektiar KM,Hensley ML,Leitao MM Jr,Barakat RR,Abu-Rustum NR

doi

10.1016/j.ygyno.2013.06.009

subject

Has Abstract

pub_date

2013-09-01 00:00:00

pages

452-6

issue

3

eissn

0090-8258

issn

1095-6859

pii

S0090-8258(13)00842-1

journal_volume

130

pub_type

杂志文章
  • First-line treatment regimens and the role of consolidation therapy in advanced ovarian cancer.

    abstract::Current first-line management for advanced ovarian cancer consists of cytoreductive surgery followed by chemotherapy, usually with a platinum/taxane combination. Although this approach has been shown to achieve overall response rates of 70-80% in clinical trials, the majority of patients relapse. A number of different...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章,评审

    doi:10.1016/s0090-8258(03)00472-4

    authors: Stuart GC

    更新日期:2003-09-01 00:00:00

  • Lymphopenia and its association with survival in patients with locally advanced cervical cancer.

    abstract:OBJECTIVE:To evaluate the association between lymphopenia and survival in women with cervical cancer treated with primary chemoradiation. METHODS:A single institution, retrospective analysis of patients with stage IB2-IVA cervical cancer who received upfront chemoradiation from 1998 to 2013 was performed. Complete blo...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2015.11.013

    authors: Wu ES,Oduyebo T,Cobb LP,Cholakian D,Kong X,Fader AN,Levinson KL,Tanner EJ 3rd,Stone RL,Piotrowski A,Grossman S,Roche KL

    更新日期:2016-01-01 00:00:00

  • Implementing specificity of HPV-DNA primary screening in a successful organised cervical cancer prevention programme.

    abstract:OBJECTIVE:This two-arm longitudinal study was performed within a regional organized cervical-cancer-prevention program in which HPV-DNA test is used in primary screening. The aim was to analyze the diagnostic performances of p16INK4a/Ki-67 dual-test and E6/E7-mRNA test in identifying CIN2+ lesion among HPV-DNA positive...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2012.11.030

    authors: Zappacosta R,Caraceni D,Ciccocioppo L,Rotondo T,Capanna S,Gatta DM,D'Angelo C,Rosini S

    更新日期:2013-03-01 00:00:00

  • Malignant struma ovarii: recurrence and response to treatment monitored by thyroglobulin levels.

    abstract::A patient with malignant struma ovarii who had elevated thyroglobulin levels at the time of her original surgery was diagnosed with recurrence on the basis of progressive thyroglobulin level elevation while on thyroid suppressive therapy. Subsequent treatment with therapeutic doses of iodine-137 resulted in normalizat...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1006/gyno.1998.5056

    authors: Rose PG,Arafah B,Abdul-Karim FW

    更新日期:1998-09-01 00:00:00

  • A phase II study of etoposide, cisplatin, and doxorubicin chemotherapy in mixed müllerian tumors (MMT) of the uterus.

    abstract::Mixed Müllerian tumors (MMT) of the uterus are aggressive entities that result in a very poor prognosis even for patients in whom the disease is limited to the uterus. This phase II trial was undertaken in an attempt to improve overall survival as well as progression-free survival of these patients. Forty-two consecut...

    journal_title:Gynecologic oncology

    pub_type: 临床试验,杂志文章

    doi:10.1006/gyno.1995.1065

    authors: Resnik E,Chambers SK,Carcangiu ML,Kohorn EI,Schwartz PE,Chambers JT

    更新日期:1995-03-01 00:00:00

  • Prognostic implications of large volume residual disease in patients with advanced stage epithelial ovarian cancer.

    abstract::Thirty-two patients with Stage III or IV epithelial ovarian cancer and residual tumor volumes in excess of 2 cm in diameter after initial debulking were treated with platinum and cyclophosphamide chemotherapy. Twenty-seven patients (84%) received at least six courses of chemotherapy. Six patients developed grade 3 or ...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/0090-8258(87)90296-4

    authors: Gallion HH,van Nagell JR,Donaldson ES,Hanson MB,Kryscio RJ

    更新日期:1987-06-01 00:00:00

  • HLA-DQB1 and cervical cancer in Venezuelan women.

    abstract:BACKGROUND:Cervical cancer represents a major health problem in Venezuela as well as in other Latin American countries. High-risk human papillomavirus (HR-HPV) infection is known as the major risk factor of cervical cancer. However, whether or not a HR-HPV-infected woman progresses to cervical cancer may depend on the ...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2004.10.002

    authors: Dao DD,Sierra-Torres CH,Robazetti SC,de Gomez MN,König R,Lema C,Lester LJ,Au WW,Tyring SK

    更新日期:2005-02-01 00:00:00

  • HPV status in sentinel nodes might be a prognostic factor in cervical cancer.

    abstract:OBJECTIVE:Although there have been studies that focused on the correlation between the HPV presence of pelvic lymph nodes and pathological metastasis in patients with cervical cancer, the biologic role of HPV DNA in lymph nodes still remains uncertain. We performed this study to investigate the correlation between the ...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2006.12.016

    authors: Lee YS,Rhim CC,Lee HN,Lee KH,Park JS,Namkoong SE

    更新日期:2007-05-01 00:00:00

  • Clinically apparent early stage invasive epithelial ovarian carcinoma: should all be treated similarly?

    abstract:OBJECTIVES:The role of adjuvant therapy in patients with early stage ovarian carcinoma has not been clearly defined. Most randomized trials examining this issue have not used the vigorous staging exploration accepted as today's standard. This report examines the natural history of patients after surgically documented s...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1006/gyno.1999.5440

    authors: Le T,Krepart GV,Lotocki RJ,Heywood MS

    更新日期:1999-08-01 00:00:00

  • A binary histologic grading system for ovarian serous carcinoma is an independent prognostic factor: a population-based study of 4317 women diagnosed in Denmark 1978-2006.

    abstract:OBJECTIVE:To evaluate the prognostic significance of histologic grade on survival of ovarian serous cancer in Denmark during nearly 30 years. METHODS:Using the nationwide Danish Pathology Data Bank, we evaluated 4317 women with ovarian serous carcinoma in 1978-2006. All pathology reports were scrutinized and tumors cl...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2012.02.028

    authors: Hannibal CG,Vang R,Junge J,Kjaerbye-Thygesen A,Kurman RJ,Kjaer SK

    更新日期:2012-06-01 00:00:00

  • The centralization of robotic surgery in high-volume centers for endometrial cancer patients--a study of 6560 cases in the U.S.

    abstract:OBJECTIVE:To evaluate the hospital and patient factors associated with robotic surgery for endometrial cancer in the United States. METHODS:Data was obtained from the Nationwide Inpatient Sample from the year 2010. Chi-squared and multivariate analyses were used for statistical analysis. RESULTS:Of the 6560 endometri...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2015.04.031

    authors: Chan JK,Gardner AB,Taylor K,Blansit K,Thompson CA,Brooks R,Yu X,Kapp DS

    更新日期:2015-07-01 00:00:00

  • The "real-life" variability of CA-125 in ovarian cancer patients.

    abstract:BACKGROUND:The serum CA-125 antigen value has proven to be useful in predicting changes that affect prognosis and management of ovarian cancer; however, interpreting variations in the tumor marker is still not well-defined. Our goal was to further understand the analytical variability of CA-125 in a conventional hospit...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2006.02.010

    authors: Tso E,Elson P,Vanlente F,Markman M

    更新日期:2006-10-01 00:00:00

  • Prolonged oral etoposide in recurrent or advanced non-squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study.

    abstract:OBJECTIVE:Previous studies by the Gynecologic Oncology Group have demonstrated a 7% response rate with bolus etoposide as second-line therapy in nonsquamous cell carcinoma of the cervix. Prolonged oral etoposide, which exploits the schedule dependency of this agent, has demonstrated increased activity in squamous carci...

    journal_title:Gynecologic oncology

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.1016/s0090-8258(03)00079-9

    authors: Rose PG,Blessing JA,Buller RE,Mannel RS,Webster KD

    更新日期:2003-05-01 00:00:00

  • A phase I study of weekly temsirolimus and topotecan in the treatment of advanced and/or recurrent gynecologic malignancies.

    abstract:OBJECTIVE:The mTOR inhibitor, temsirolimus, has clinical activity in the treatment of gynecologic malignancies, particularly endometrial cancer. We sought to determine the tolerability of the combination of weekly topotecan with weekly temsirolimus. METHODS:Women with a history of advanced or recurrent gynecologic mal...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2010.02.022

    authors: Temkin SM,Yamada SD,Fleming GF

    更新日期:2010-06-01 00:00:00

  • Uptake of a cholesterol-rich emulsion by breast cancer.

    abstract:OBJECTIVE:Overexpression of low-density lipoprotein (LDL) receptors occurs in several cancer cell lines and offers a unique strategy for drug targeting by using LDL as vehicle. However, the native lipoprotein is difficult to obtain and handle. Previously, we showed that a lipidic emulsion (LDE) similar to the lipid str...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1006/gyno.2002.6654

    authors: Graziani SR,Igreja FA,Hegg R,Meneghetti C,Brandizzi LI,Barboza R,Amâncio RF,Pinotti JA,Maranhão RC

    更新日期:2002-06-01 00:00:00

  • Neuropilin-1 promotes unlimited growth of ovarian cancer by evading contact inhibition.

    abstract:OBJECTIVE:Neuropilin-1 (NRP-1) is a receptor for both semaphorin and vascular endothelial growth factor and is up-regulated in a variety of human cancers. While there are some reports of NRP-1 expression in ovarian neoplasm, those results differ in pattern of its expression and its role in ovarian cancer is still uncle...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2007.02.005

    authors: Baba T,Kariya M,Higuchi T,Mandai M,Matsumura N,Kondoh E,Miyanishi M,Fukuhara K,Takakura K,Fujii S

    更新日期:2007-06-01 00:00:00

  • Nomograms to predict isolated loco-regional or distant recurrence among women with uterine cancer.

    abstract:OBJECTIVE:While there is ample literature on prognostic factors for uterine cancer, currently there are nomeans to estimate an individual's risk for recurrence or to differentiate the risk of loco-regional recurrence from distant recurrence. We addressed this gap by developing nomograms to individualize the risk of rec...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2012.02.022

    authors: Kondalsamy-Chennakesavan S,Yu C,Kattan MW,Leung Y,Sykes P,Nascimento M,Nicklin J,Perrin L,Crandon A,Chetty N,Land R,Garrett A,Obermair A

    更新日期:2012-06-01 00:00:00

  • Ovarian endometrioid adenocarcinoma arising from an endometriotic cyst in a postmenopausal woman under tamoxifen therapy for breast cancer: a case report.

    abstract:BACKGROUND:Ovarian cancer arising from an endometriotic cyst in a postmenopausal woman under tamoxifen therapy is rare. CASE:We herein report the case of a 67-year-old woman with a history of breast cancer, taking tamoxifen citrate 20 mg/day for 4 years, who underwent an operation for left ovarian tumor. The postopera...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章,评审

    doi:10.1006/gyno.2002.6824

    authors: Okugawa K,Hirakawa T,Ogawa S,Kaku T,Nakano H

    更新日期:2002-11-01 00:00:00

  • High prevalence of genital human papillomavirus type 52 and 58 infection in women attending gynecologic practitioners in South Taiwan.

    abstract:BACKGROUND:We attempted to determine the prevalence of genital human papillomavirus (HPV) infection in women attending gynecologic practitioners in South Taiwan. METHODS:The population included 4383 women aged 16-78 seeking HPV testing at primary gynecologic practitioners regardless of their cervical cytology results....

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2005.09.028

    authors: Lin H,Ma YY,Moh JS,Ou YC,Shen SY,ChangChien CC

    更新日期:2006-04-01 00:00:00

  • The presence of tumor-infiltrating FOXP3+ lymphocytes correlates with intratumoral angiogenesis in endometrial cancer.

    abstract:OBJECTIVES:CD4(+)CD25(+) regulatory T-cells (Tregs), that express the transcription factor FOXP3, suppress effector T-cell populations and can enable tumour cells to evade the host immune response. In this study, we investigated the numbers of FOXP3(+) Tregs in the normal and malignat endometrium and examined potential...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2008.04.021

    authors: Giatromanolaki A,Bates GJ,Koukourakis MI,Sivridis E,Gatter KC,Harris AL,Banham AH

    更新日期:2008-08-01 00:00:00

  • Choriocarcinoma in a term placenta with maternal metastases.

    abstract::Choriocarcinoma of the nonmolar placenta is presumptively a rare entity and is usually associated with widespread maternal metastases at the time of diagnosis. Nonmetastatic disease goes unrecognized and undiagnosed because placental carcinoma can be limited to a few villi, and grossly evident disease is often misinte...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章,评审

    doi:10.1016/0090-8258(92)90264-j

    authors: Christopherson WA,Kanbour A,Szulman AE

    更新日期:1992-08-01 00:00:00

  • The effect of maximal surgical cytoreduction on sensitivity to platinum-taxane chemotherapy and subsequent survival in patients with advanced ovarian cancer.

    abstract:OBJECTIVE:In advanced ovarian cancer, patients cytoreduced to no visible disease appear to have improved survival compared to patients with visible residual tumor < or = 10 mm. It remains unresolved whether this is due to better chemotherapy response and/or simply "re-setting the clock," such that patients with less re...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2007.10.022

    authors: Eisenhauer EL,Abu-Rustum NR,Sonoda Y,Aghajanian C,Barakat RR,Chi DS

    更新日期:2008-02-01 00:00:00

  • Polymorphisms in TP53 and MDM2 combined are associated with high grade endometrial cancer.

    abstract:OBJECTIVES:Determinants of endometrial cancer grade have not been precisely defined, however, cell cycle control is considered to be integrally involved in endometrial cancer development. TP53 and MDM2 are essential components for cell cycle arrest and apoptosis. Polymorphisms in these genes cause TP53 inactivation and...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2008.12.036

    authors: Ashton KA,Proietto A,Otton G,Symonds I,McEvoy M,Attia J,Gilbert M,Hamann U,Scott RJ

    更新日期:2009-04-01 00:00:00

  • Stage IV ovarian cancer: impact of surgical debulking.

    abstract:OBJECTIVE:To evaluate the influence of surgical debulking performed on patients with Stage IV ovarian cancer and to determine prognostic factors which identify pts who may benefit from aggressive initial surgical debulking. METHODS:A retrospective chart review was conducted (1/1/87-12/31/93). Eligible patients include...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1006/gyno.1996.4550

    authors: Curtin JP,Malik R,Venkatraman ES,Barakat RR,Hoskins WJ

    更新日期:1997-01-01 00:00:00

  • Relationship between removal of circumflex iliac nodes distal to the external iliac nodes and postoperative lower-extremity lymphedema in uterine cervical cancer.

    abstract:OBJECTIVE:This study aimed to determine if there is a causal relationship between removal of the circumflex iliac nodes distal to the external iliac nodes (CINDEIN) and postoperative lower-extremity lymphedema (POLEL) after systematic lymphadenectomy in patients with cervical cancer. METHODS:A retrospective chart revi...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2015.09.007

    authors: Yamazaki H,Todo Y,Takeshita S,Ohba Y,Sudo S,Minobe S,Okamoto K,Yamashiro K,Kato H

    更新日期:2015-11-01 00:00:00

  • Heat shock proteins, cell survival and drug resistance: the mitochondrial chaperone TRAP1, a potential novel target for ovarian cancer therapy.

    abstract:BACKGROUND:Protein homeostasis is a highly complex network of molecular interactions governing the health and life span of the organism. Molecular chaperones, mainly heat shock proteins (HSP) and other stress-inducible proteins abundantly expressed in multiple compartments of the cell, are major modulators of protein h...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.ygyno.2009.10.078

    authors: Landriscina M,Amoroso MR,Piscazzi A,Esposito F

    更新日期:2010-05-01 00:00:00

  • Expression of multidrug resistance-1 protein inversely correlates with paclitaxel response and survival in ovarian cancer patients: a study in serial samples.

    abstract:OBJECTIVES:The role of MDR1 in clinical paclitaxel resistance remains poorly characterized. This study sought to identify the incidence and significance of P-glycoprotein (P-gp) over-expression on survival, tumor response to paclitaxel and the effect of prior cytotoxic exposure on P-gp expression in patients with paire...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章

    doi:10.1016/j.ygyno.2003.11.053

    authors: Penson RT,Oliva E,Skates SJ,Glyptis T,Fuller AF Jr,Goodman A,Seiden MV

    更新日期:2004-04-01 00:00:00

  • CYP1A1, GSTM1, and GSTT1 polymorphisms and the risk of cervical squamous intraepithelial lesions in a multiethnic population.

    abstract:OBJECTIVE:In this investigation, we explored the hypothesis that genetic polymorphisms in the cytochrome P4501A1 (T3801C) and glutathione S-transferase classes mu and theta (GSTM1 and GSTT1) gene deletions promote the development of cervical dysplasia by moderating the activation and detoxification of polycyclic hydroc...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章,多中心研究

    doi:10.1006/gyno.2001.6154

    authors: Goodman MT,McDuffie K,Hernandez B,Bertram CC,Wilkens LR,Guo C,Seifried A,Killeen J,Le Marchand L

    更新日期:2001-05-01 00:00:00

  • Adjuvant chemotherapy does not improve disease-free survival in FIGO stage IC ovarian granulosa cell tumors: The MITO-9 study.

    abstract:OBJECTIVE:Evidence-based management of granulosa cell tumors of the ovary (GCT) has been not yet standardized: surgery, including fertility-sparing procedures for young women, has been traditionally the standard treatment; on the other hand, chemotherapy has been used for treatment of advanced and/or recurrent disease....

    journal_title:Gynecologic oncology

    pub_type: 杂志文章,多中心研究

    doi:10.1016/j.ygyno.2016.08.316

    authors: Mangili G,Ottolina J,Cormio G,Loizzi V,De Iaco P,Pellegrini DA,Candiani M,Giorda G,Scarfone G,Cecere SC,Frigerio L,Gadducci A,Marchetti C,Ferrandina G

    更新日期:2016-11-01 00:00:00

  • The NCI-MATCH trial and precision medicine in gynecologic cancers.

    abstract::The Precision Medicine Initiative is a National Cancer Institute (NCI) driven interdisciplinary collaborative effort to test the feasibility of trials incorporating genomic profiling when choosing patient therapies. The goal of the initiative is to generate the scientific evidence needed to move the concept of precisi...

    journal_title:Gynecologic oncology

    pub_type: 杂志文章,评审

    doi:10.1016/j.ygyno.2018.01.008

    authors: Barroilhet L,Matulonis U

    更新日期:2018-03-01 00:00:00