Landmark Gynae Studies Flashcards
Inclusion criteria LACE trial?
Stage I endometrial cancer. Endometrioid adenocarcinoma of any grade.
LACE trial disease free survival 4.5years for control and intervention groups?
TAH = 81.3%
TLH 81.6%
7% conversion from TLH to TAH
2% requested TLH instead of TAH after assigned to TAH
Secura et al findings hormonal IUD?
acceptable- 32% uptake
Failure rate 5.1/1000 teen-years (compared to 158.5/1000 population stats)
Continuation of use at 24 months by 2/3rds
Follow up time of Secura et al?
2-3 years
Design of Secura et al trial?
Cohort
Design of Zhang et al 2005 misoprostol trial?
RCT. Compared 800mcg PV misoprostol Day 1 and 3 with vacuum aspiration
Advantages of misoprostol management of missed miscarriage vs. vacuum aspiration?
- less surgical risk
- no anaesthetic
- usually start treatment same day
- 84% success day 8
- can be at home
- no increased risk posed to future fertility/pregnancy (cervical incompetence, Asherman’s Syndrome)
Disadvantages of misoprostol medical management miscarriage?
- 16% failure (vs. 3% vacuum)
- refractory pain, nausea
- unscheduled hospital visit
- more likely to have 3g/dL Hb drop
- may require surgery anyway for failure, bleeding.
PLCO trial aim?
Does screening for ovarian cancer with Ca125 and TVUSS reduce mortality?
Protocol PLCO trial?
- TVUSS baseline + annual: ovarian volume >10cm3, ovarian cyst >10cm3, solid/papillary component, mixed component.
- Ca 125 baseline + annual
Outcomes PLCO trial?
- no difference in stage at diagnosis (77 vs. 78% stage III & IV)
- incidence non-significantly different
- mortality same
- 7.7 vs 5.8% risk of oophorectomy in intervention group (RR 1.33)
WHI 2002 E+P hazard ratio outcomes?
VTE 2.11 (1.26-3.55) trend towards - increased invasive breast cancer - decreased colorectal cancer 37% - osteoporotic fractures reduced 23%
AMS: transdermal preparation reduces risk VTE. Micronised progesterone and dydrogesterone = lower risk profile.
breast cancer = risk increased with duration of use, decreased after cessation, increased with use after 60yo.
SPIN trial question?
use of LMWH and aspirin reduce rate of pregnancy loss in women with 2 or more losses?
Inclusion criteria SPIN study?
<7w
confirmed IUP on USS
normal FBC, RCA, TFT
excluded if APLS or thrombophilia or any other known cause.
Outcomes SPIN trial?
No difference in pregnancy loss rate
Kaandorp 2010 study question?
does aspirin and LMWH improve live birth rate in women with recurrent unexplained miscarriage?
Exclusion criteria Kaandorp 2010?
<6w since conception, other indication for VTE prophylaxis, endocrine disorders
Outcome Kaandorp SP?
no difference between aspirin, aspirin + heparin or placebo groups.
Live birth ranged 54.5-57%
Million women study question?
What are the effects of HRT use and the incidence of fatal breast cancer?
Design Milliion women study?
cohort
Results Million women study?
O+P HRT increases breast cancer and death. Proportional to duration of use
- current O+P >10y = RR 2.31 (2.08-2.56)
- current O >10y = RR 1.37 (1.22-1.54)
Past use does not increase risk. Not different by type of oestrogen or progesterone used, or whether cyclical or continuous.
Parker 2005 study question?
At what age is prophylactic oophorectomy at time of hysterectomy for benign disease beneficial?
Parker 2005 findings?
Ovarian conservation without HRT reduces death from CHD (15%–> 7%), Hip fracture (5% –> 3.4%).
Above age 64yo, confidence interval bands for groups overlap.
Overlap earlier if using HRT. Ages 50-54yo, survival @ 80yo:
- conservation + ET= 62.5%
- oophorectomy + ET= 62.2%
