Megumi Yamamoto

Prognostic significance of tumor budding, poorly differentiated cluster, and desmoplastic reaction in endometrioid endometrial carcinomas

AbstractAimsThe tumor budding (TB); poorly differentiated cluster (PDC); desmoplastic reaction (DR); and microcystic, elongated, and fragmented (MELF) patterns of invasion are pathological findings at the tumor invasion front associated with epithelial‐to‐mesenchymal transition. This study aimed to clarify the clinical significance of the TB, PDC, DR, and MELF patterns in endometrioid endometrial carcinomas (EEC).MethodsTwo hundred and eight cases of histologically proven EEC retrieved from the archives of the Department of Pathology, Fukui Prefectural Hospital, and diagnosed between January 2000 and August 2020 were retrospectively analyzed.ResultsThe TB, PDC, DR, and MELF patterns were identified in 29 (13.9%), 47 (22.6%), 45 (21.6%), and 23 (11.1%) cases, respectively. Kaplan–Meier curve analysis with log‐rank test demonstrated that TB, PDC, and DR were associated with a lower progression‐free survival (p = 0.010, 0.002, and <0.0001, respectively), whereas the MELF pattern did not show any association (p = 0.668). In multivariate analyses, only DR was significantly associated with lower progression‐free survival (p = 0.034). Moreover, only PDC was associated with lower overall survival in univariate analysis (p = 0.018), but the association lost significance in multivariate analysis.ConclusionsThe present study revealed that the histological confirmation of TB, PDC, and DR at the tumor invasive front predicts poor prognosis in EEC. However, the MELF pattern was not a predictor of poor prognosis in EEC.

Learning curve of laparoscopic extraperitoneal para-aortic lymphadenectomy for endometrial carcinoma: A cumulative sum analysis

Minimally invasive surgery including lymphadenectomy for endometrial cancer is widely standardized for the management of endometrial cancer in recent decades. However, the learning curve for laparoscopic para-aortic lymphadenectomy is poorly reported, specifically that for the extraperitoneal approach. We examined the learning curve for laparoscopic extraperitoneal para-aortic lymphadenectomy by cumulative sum (CUSUM) analysis by retrospectively analyzing 134 patients with early-stage endometrial cancer who had undergone laparoscopic extraperitoneal para-aortic lymphadenectomy, including the first case. Data on the surgical factors that improved and were statistically correlated with the number of procedures experienced were extracted and used to create CUSUM curves. The average time for para-aortic lymphadenectomy was 149.4 min to harvest an average of 65.3 para-aortic lymph nodes. Intra- and postoperative complications were observed in nine cases (6.7%). A switch to the transperitoneal approach was necessary in three cases (2.2%). The number of harvested para-aortic lymph nodes and the procedure time were strongly correlated with the number of procedures the patient underwent (p < 0.01). The CUSUM curve of the number of harvested para-aortic lymph nodes indicated an inflection point at the 51st case. The procedure time for para-aortic lymphadenectomy stabilized after the 59th case. CUSUM analysis of "unexpected events," including intra- and postoperative complications and switch to the transperitoneal approach, showed an improved incidence at 60 cases and later. Gaining proficiency in laparoscopic extraperitoneal thorough para-aortic lymphadenectomy is associated with a long learning curve of over 60 procedures. Careful management is required when introducing the procedure.

Unusual Infiltrative Patterns of Malignant Cells in Endometrial Carcinoma and Immunohistochemical Expression of P53

The goal of this observational study is to clarify the significance of TB, PDC, DR, MELF, and immunohistochemical expression of those infiltrative patterns in patients with endometrial carcinomas (EC). The main questions it aims to answer are: 1. What is the relationship between TB, PDC, DR, MELF, and other clinicopathological features of patients with endometrial carcinomas (EC)? 2. What is the association of TB, PDC, DR, and MELF patterns with disease-free survival and overall survival? 3. Will the evaluation of the immunohistochemical expression of P53 in the TB, PDC, DR, and MELF patterns be important?