CHAPTER 7 174 Molecular or immunohistochemical markers could help predicting response to hormonal treatment.4, 5 Conservative surgical treatment consists of hysteroscopic resection followed by oral or intra-uterine devise of progestin. Those women achieved the highest complete remission rate compared with other fertility-sparing strategies.2 Ovarian preservation needs to be considered in the fertility preserving approach, including other assisted reproductive technologies i.e. oocyte/embryo cryopreservation or ovarian tissue cryopreservation. In which closed vitrification systems are, based on the current available evidence, the safest option for cryopreserved cells.2, 36 There are some limitations inherent to the retrospective design. First, adjuvant treatment was not uniformly applied which could lead to differences in outcome. Second, due to the fact that most of our labs do not run routine complete blood count, platelet- and leukocyte count were not available for all included patients. Finally, complete molecular data according The Cancer Genome Atlas is not available for the patients in this cohort. However, within a subset of the PIPENDO cohort, we do have immunohistochemistry of p53 and mismatch repair proteins. Within patients with p53-abnormal, anaemia was associated with significant reduced DSS and RFS compared to patients with normal haemoglobin (data not shown). To our knowledge, this is the first study that addressed the relationship of all three, often routinely obtained, preoperative abnormal haematological parameters with clinicopathological characteristics and univariable and multivariable outcome in EC. Other strengths of this study includes its multicentre design resulting in the largest patient cohort to date, and a well-documented and long follow-up period. Future studies in a prospective study design, may determine the prognostic and/or predictive value of preoperative abnormal haematological markers (more specific anaemia) in addition to the molecular markers in EC. When confirmed, studies should explore in more detail the cause between for example anaemia and impaired prognosis. Furthermore, the value of haematological parameters in young women who are eligible for fertility-sparing strategies needs to be further elucidated. CONCLUSION Our data demonstrated the independent prognostic impact of preoperative anaemia in patients with EC. In addition, anaemia seems to be associated as predictive biomarker for response to radiotherapy. It remains unclear whether preoperative anaemia reflects tumour aggressiveness or reduced response to radiotherapy. So, prospective validation in a larger study cohort is needed to verify anaemia as predictive biomarker for radiotherapy.
RkJQdWJsaXNoZXIy MTk4NDMw