title: Prognostic factors for curative pelvic exenterations in patients with recurrent uterine cervical or vaginal cancer.
abstract: OBJECTIVE
  The aim of this study was to assess the prognostic factors after curative pelvic exenterations performed for recurrent uterine cervical or vaginal cancers in the era of concomitant chemoradiotherapy.
  
  
  METHODS
  We retrospectively enrolled 16 patients with recurrent uterine cervical or vaginal cancer and tumor-free resection margins on pelvic exenteration pathological analysis between October 1997 and April 2014.
  
  
  RESULTS
  Pelvic exenterations were performed for 13 recurrent cervical cancers and 3 recurrent vaginal cancers. All of the patients had received pelvic irradiation (external radiotherapy for 14 patients and brachytherapy for 2 patients). The median age at the recurrence was 59.5 years (49-77 years), and the median tumor size was 4.35 cm (2-9 cm). There were no intraoperative or postoperative deaths. The 5-year disease-free survival and overall survival were 30% and 34.1%, respectively. The following 3 factors affected the disease-free survival: tumor size greater than 5 cm (P = 0.05), mesorectal lymph node involvement (P = 0.02), and vascular emboli (P = 0.0093).
  
  
  CONCLUSIONS
  The presence of vascular emboli is a new prognostic factor in cases of recurrent cervical or vaginal cancer. Assessing the presence of vascular emboli on pretherapeutic biopsies could facilitate the selection of patients eligible for curative pelvic exenterations.
authors.affiliation: *Gynecology Department, Tertiary Surgery Center, Teaching Hospital of Rennes; †Faculty of Medicine, Rennes University; ‡Team Death Receptors and Tumor Escape, Inserm U1085; §Inserm, CIC-P0203 Clinical Investigation Centre; ∥Experimental and Clinical Pharmacology Laboratory, University of Rennes 1; and ¶Department of Clinical Pharmacology and #Pathology Department, Teaching Hospital of Rennes, Rennes, France.
authors.forename: Hugo
authors.initials: H
authors.lastname: Sardain
authors.forename: Vincent
authors.initials: V
authors.lastname: Lavoué
authors.forename: Bruno
authors.initials: B
authors.lastname: Laviolle
authors.forename: Sébastien
authors.initials: S
authors.lastname: Henno
authors.forename: Fabrice
authors.initials: F
authors.lastname: Foucher
authors.forename: Jean
authors.initials: J
authors.lastname: Levêque
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010385:Pelvic Exenteration / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014625:Vaginal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*