Publications by authors named "Katherine E Tierney"

9 Publications

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Significance of Monocyte Counts at Recurrence on Survival Outcome of Women With Endometrial Cancer.

Int J Gynecol Cancer 2017 02;27(2):302-310

*Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California; and †Norris Comprehensive Cancer Center, Los Angeles; and ‡Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente, Orange County, CA.

Objective: Tumor-associated macrophages (TAMs) are known to have adverse effects on the survival of women with endometrial cancer. Because monocytes function as progenitors of macrophages, this study examined the association between monocyte count at the first recurrence/progression of endometrial cancer and survival time after recurrence/progression (SAR).

Methods: This is a retrospective study evaluating 141 consecutive cases of recurrent endometrial cancer after surgical staging (n = 114) and progression after nonsurgical management (n = 27). Complete blood cell counts with cell differentiation at the time of the first recurrence/progression were correlated to SAR.

Results: Median time of SAR was 7.8 months, and there were 97 (68.8%) patients who died from endometrial cancer with 1-, 2-, and 5-year SAR rates being 51.0%, 32.9%, and 14.2%, respectively. Median monocyte counts at recurrence/progression were 0.5 × 10/L. The strongest correlation to monocyte counts was seen in neutrophil counts (r = 0.57, P < 0.01) followed by platelet counts (r = 0.43, P < 0.01). An elevated monocyte count at recurrence/progression was significantly associated with decreased SAR (hazard ratio per unit, 3.97; 95% confidence interval, 2.00-7.90; P < 0.01). On multivariate analysis controlling for patient demographics, complete blood cell counts, tumor factors, and treatment types for recurrent/progressed disease, higher monocyte counts at recurrence/progression remained an independent predictor for decreased SAR (hazard ratio per unit, 3.12; 95% confidence interval, 1.52-6.67; P < 0.01).

Conclusions: Our study demonstrated that the increased monocyte counts at recurrence/progression may be a useful biomarker for predicting decreased survival outcome of women with endometrial cancer.
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http://dx.doi.org/10.1097/IGC.0000000000000865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531195PMC
February 2017

Endoplasmic reticulum stress in complex atypical hyperplasia as a possible predictor of occult carcinoma and progestin response.

Gynecol Oncol 2016 Dec 19;143(3):650-654. Epub 2016 Oct 19.

Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, University of Southern California, Los Angeles, CA, United States; Women's Cancer Program, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, United States.

Glucose-regulated protein (GRP)-78, the key regulator of endoplasmic reticulum (ER) stress, is associated with endometrial cancer (EC) development and progression. However, its role in the continuum from complex atypical hyperplasia (CAH) to EC is unknown and the focus of this study.

Methods: 252 formalin-fixed, paraffin-embedded endometrial biopsies from patients with CAH diagnosed between 2003 and 2011 were evaluated for GRP78 expression by immunohistochemistry. Expression was also evaluated in subsequent biopsies from those patients treated with progestins. Differences in GRP78 expression were assessed using standard statistical methods.

Results: GRP78 expression was undetectable in 45(18%) patients with CAH, while 120(48%) CAH cases showed moderate/strong expression. Among women who ultimately underwent hysterectomy for CAH (n=134), 54(40%) had occult EC while 57(43%) had persistent CAH. Those with occult EC upon hysterectomy had significantly stronger GRP78 expression than those who did not have occult EC (p=0.007). Greater GRP78 expression within CAH remained independently associated with the presence of an occult EC (p=0.017). Thirty-four of 54 (63%) patients with occult EC had moderate/strong GRP78 expression compared to 36 of 80 (45%) patients with persistent CAH, benign or non-atypical hyperplastic endometrium. In those treated with progestins, samples with persistent CAH and EC were more likely to have high levels of GRP78 expression in the initial biopsies than those who responded (p=0.014).

Conclusions: Increased GRP78 expression in untreated CAH correlates with the presence of an occult EC. In addition, CAH specimens with greater GRP78 expression may identify patients who are less likely to respond to progestin therapy.
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http://dx.doi.org/10.1016/j.ygyno.2016.10.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474546PMC
December 2016

Characteristics of ovarian tumors of low malignant potential in BRCA mutation carriers: A case series.

Gynecol Oncol Rep 2015 Aug 11;13:36-9. Epub 2015 Jun 11.

Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD-Anderson Cancer Center, Houston, TX, USA.

•Tumor characteristics of 5 cases of ovarian tumor of low malignant potential (LMP) with BRCA mutation were examined.•Young age, BRCA1 mutation, and presence of invasive implants may be characteristics of BRCA carriers with ovarian LMP.
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http://dx.doi.org/10.1016/j.gore.2015.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4563586PMC
August 2015

Intraocular metastasis from primary cervical cancer: A case report and review of the literature.

Gynecol Oncol Rep 2015 Apr 17;12:61-3. Epub 2015 Mar 17.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA, USA ; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.

•Metastatic disease should be considered in cervical cancer patients presenting with eye pain and vision complaints.•Distant metastasis involving less common organ sites, such as the eye, suggest a poor prognosis with short life expectancy.•In cases of cervical cancer metastatic to the eye, radiotherapy may decrease the incidence of retinal detachment and vision loss.
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http://dx.doi.org/10.1016/j.gore.2015.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442650PMC
April 2015

Time interval between endometrial biopsy and surgical staging for type I endometrial cancer: association between tumor characteristics and survival outcome.

Obstet Gynecol 2015 Feb;125(2):424-433

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California; and the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Objective: To examine whether wait time between endometrial biopsy and surgical staging correlates with tumor characteristics and affects survival outcomes in patients with type I endometrial cancer.

Methods: A retrospective study was conducted to examine patients with grade 1 and 2 endometrioid adenocarcinoma diagnosed by preoperative endometrial biopsy who subsequently underwent hysterectomy-based surgical staging between 2000 and 2013. Patients who received neoadjuvant chemotherapy or hormonal treatment were excluded. Time interval and grade change between endometrial biopsy and hysterectomy were correlated to demographics and survival outcomes.

Results: Median wait time was 57 days (range 1-177 days) among 435 patients. Upgrading of the tumor to grade 3 in the hysterectomy specimen was seen in 4.7% of 321 tumors classified as grade 1 and 18.4% of 114 tumors classified as grade 2 on the endometrial biopsy, respectively. Wait time was not associated with grade change (P>.05). Controlling for age, ethnicity, body habitus, medical comorbidities, CA 125 level, and stage, multivariable analysis revealed that wait time was not associated with survival outcomes (5-year overall survival rates, wait time 1-14, 15-42, 43-84, and 85 days or more; 62.5%, 93.6%, 95.2%, and 100%, respectively, P>.05); however, grade 1 to 3 on the hysterectomy specimen remained as an independent prognosticator associated with decreased survival (5-year overall survival rates, grade 1 to 3 compared with grade change 1 to 1, 82.1% compared with 98.5%, P=.01). Among grade 1 preoperative biopsies, grade 1 to 3 was significantly associated with nonobesity (P=.039) and advanced stage (P=.019).

Conclusion: Wait time for surgical staging was not associated with decreased survival outcome in patients with type I endometrial cancer.
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http://dx.doi.org/10.1097/AOG.0000000000000636DOI Listing
February 2015

Abdominal aortic resection and Y-graft placement to achieve complete cytoreduction in stage IIIc ovarian carcinoma.

Obstet Gynecol 2014 Feb;123(2 Pt 2 Suppl 2):486-488

Department of Gynecologic Oncology, Southern California Permanente Medical Group, Los Angeles Medical Center, and the Divisions of Gynecologic Oncology and Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.

Background: Major vascular resection with reconstruction in patients with gynecologic malignancy is rarely performed and infrequently reported.

Case: A 40-year-old woman undergoing surgery for stage IIIc ovarian papillary serous adenocarcinoma was left with a 7-cm aortic metastasis not separable from the infrarenal abdominal aorta. An aortic resection with prosthetic graft placement was performed to achieve complete tumor resection. She remains disease-free in excess of 10 years with no evidence of graft complication.

Conclusion: Major vascular reconstructive procedures for the management of malignancy need not be precluded in properly selected circumstances.
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http://dx.doi.org/10.1097/AOG.0000000000000039DOI Listing
February 2014

Recurrent leiomyosarcoma presenting as malignant arterial tumor thrombus.

Gynecol Oncol Case Rep 2013 5;4:32-4. Epub 2013 Jan 5.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.

► The report reviews unique arterial embolic phenomena in the context of newly diagnosed recurrent leiomyosarcoma. ► Metastatic work-up should be initiated in those diagnosed with malignant arterial tumor emboli.
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http://dx.doi.org/10.1016/j.gynor.2012.12.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862300PMC
December 2013

Cervical conization of adenocarcinoma in situ: a predicting model of residual disease.

Am J Obstet Gynecol 2014 Apr 24;210(4):366.e1-366.e5. Epub 2013 Dec 24.

Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, School of Medicine, Los Angeles, CA.

Objective: To determine factors associated with the presence of residual disease in women who have undergone cervical conization for adenocarcinoma in situ (ACIS) of the cervix.

Study Design: We identified women who underwent a cervical conization for a diagnosis of ACIS followed by repeat conization or hysterectomy between Jan. 1, 1995, and April 30, 2010. Data were summarized using standard descriptive statistics.

Results: Seventy-eight patients met study criteria. The presence of ACIS at the internal conization margin or in the postconization endocervical curettage (ECC) correlated with residual ACIS (P < .001). A margin positive for ACIS was associated with residual glandular neoplasia in 68% of cases. An endocervical curettage positive for ACIS was associated with residual ACIS in 95% of cases. If both the margins and the endocervical curettage were positive for the presence of ACIS, 8% did not have residual disease, 77% had residual ACIS, and 15% had invasive adenocarcinoma. If both the internal conization margin and the postconization ECC were negative for the presence of ACIS, 14% of the final specimens had residual ACIS and none had invasive cancer.

Conclusion: The addition of postconization ECC to cone biopsy for ACIS of the cervix provides valuable prognostic information regarding the risk of residual ACIS. Women with ACIS who have both a negative postconization ECC and a negative conization margin have a 14% risk for residual ACIS and can be treated conservatively if desiring fertility. A positive postconization ECC or internal margin incurs significant risk of residual disease and 12-17% will have cancer.
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http://dx.doi.org/10.1016/j.ajog.2013.12.030DOI Listing
April 2014

Significance of perioperative infection in survival of patients with ovarian cancer.

Int J Gynecol Cancer 2012 Feb;22(2):245-53

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles County Medical Center, Los Angeles, CA 90031, USA.

Objectives: Perioperative infectious diseases comprise some of the most common causes of surgical mortality in women with ovarian cancer. This study was aimed to evaluate the significance of perioperative infections in survival of patients with ovarian cancer.

Methods: Patients who underwent primary cytoreductive surgery were included in the analysis (n = 276). The enumeration and speciation of pathogens, antimicrobial agents used, and sensitivity assay results were culled from medical records and correlated to clinicopathologic demographics and survival outcomes. Perioperative infection was determined as a positive microbiology result obtained within a 6-week postoperative period.

Results: The incidence of perioperative infection was 15.9% (common sites: urinary tract, 57.3%, and surgical wound, 21.4%). Commonly isolated pathogens were Enterococcus species (22.4%) and Escherichia coli (19.4%) in urinary tract infection, and Bacteroides fragilis, E. coli, and Klebsiella pneumoniae (all, 16%) in surgical wound infection. Imipenem represents one of the least resistant antimicrobial agents commonly seen in urinary tract and surgical wound infections in our institution. Perioperative infection was associated with diabetes, serous histology, lymph node metastasis, bowel resection, decreased bicarbonate, and elevated serum urea nitrogen in multivariate analysis. Perioperative infections were associated with increased surgical mortality, delay in chemotherapy treatment, decreased chemotherapy response, shorter progression-free survival (median time, 8.4 vs 17.6 months; P < 0.001), and decreased overall survival (29.0 vs 51.8 months; P = 0.011). Multivariate analysis showed that perioperative infections other than urinary tract infection remained a significant risk factor for decreased survival (progression-free survival, P = 0.02; and overall survival, P = 0.019).

Conclusion: Perioperative infectious disease comprises an independent risk factor for survival of patients with ovarian cancer.
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http://dx.doi.org/10.1097/IGC.0b013e31823bd6dbDOI Listing
February 2012