2651
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Uccella S, Cha SS, Melton LJ, Bergstralh EJ, Boardman LA, Keeney GL, Podratz KC, Ciancio FF, Mariani A. Risk factors for developing multiple malignancies in patients with endometrial cancer. Int J Gynecol Cancer 2011; 21:896-901. [PMID: 21666488 PMCID: PMC3929041 DOI: 10.1097/igc.0b013e318219711f] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The purposes of this study were to investigate the clinical and pathologic characteristics of patients with endometrial cancer (EC) and associated breast, colorectal, or ovarian cancer, and to define the risk of developing an associated malignancy during follow-up after EC treatment. METHODS/MATERIALS During a 13-year period, 1028 women had a hysterectomy for EC at our institution and available clinical information. An associated malignancy was defined as diagnosis of another malignant disease before or at the time of operation for EC or during follow-up. RESULTS Of these 1028 patients, 208 (20%) had a history of another malignancy besides EC. Most frequent were carcinomas of the breast (10%), colon-rectum (3%), and ovary (4%). Patients with a family history of hereditary nonpolyposis colorectal cancer (HNPCC)-related cancers and presence of EC in the lower uterine segment (LUS) had a higher risk of developing colorectal cancer within 5 years after hysterectomy (2% and 6%, respectively). After multivariate analysis, only LUS involvement remained significantly associated with this risk. Patients with EC and associated ovarian cancer were more likely to be younger and have superficially invasive EC, family history of HNPCC-related tumors, and family history of breast or ovarian cancer. After multivariate analysis, only age younger than 50 years (odds ratio [OR], 4.27; 95% confidence interval [CI], 1.49-12.21) and family history of breast or ovarian cancer (OR, 3.95; 95% CI, 1.60-9.72) were significantly related to risk of having ovarian cancer associated with EC. No significant risk factors were identified for development of an associated breast cancer after EC. CONCLUSIONS Young age, family history of malignancy, and LUS involvement may indicate the need for more intensive preventive strategies for colorectal cancer and for evaluating the risk of synchronous ovarian cancer in patients with EC.
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Affiliation(s)
- Stefano Uccella
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
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2652
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Davies S, Dai D, Pickett G, Thiel KW, Korovkina VP, Leslie KK. Effects of bevacizumab in mouse model of endometrial cancer: Defining the molecular basis for resistance. Oncol Rep 2011; 25:855-62. [PMID: 21240464 PMCID: PMC3433042 DOI: 10.3892/or.2011.1147] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 11/22/2010] [Indexed: 11/05/2022] Open
Abstract
Endometrial cancer is the most frequent gynecologic cancer in women. Long-term outcomes for patients with advanced stage or recurrent disease are poor. Targeted molecular therapy against the vascular endothelial growth factor (VEGF) and its receptors constitute a new therapeutic option for these patients. The goal of our study was to assess the potential effectiveness of inhibition of VEGF/VEGFR signaling in a xenograft model of endometrial cancer using bevacizumab (Avastin, a humanized antibody against VEGFA). We also aimed to identify molecular markers of sensitivity or resistance to this agent. We show that bevacizumab retards tumor growth in athymic mice by inhibiting molecular components of signaling pathways that sustain cell survival and proliferation. We also demonstrate that resistance to bevacizumab may involve up-regulation of anti-apoptotic genes and certain proto-oncogenes. We propose that down-regulation of ARHGAP6 and MMP15 transcripts indicates that tumors are sensitive to bevacizumab whereas inhibition of PKCδ- or S6K-dependent signaling and up-regulation of TNFRS4 or MMP13 and MMP14 mark a developing resistance to bevacizumab therapy. Interestingly, the significant activation of c-Jun oncogene detected in bevacizumab-treated tumors suggests that, in endometrial cancers, the c-Jun-mediated pathway(s) contribute to bevacizumab resistance.
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Affiliation(s)
- Suzy Davies
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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2653
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Arem H, Irwin ML, Zhou Y, Lu L, Risch H, Yu H. Physical activity and endometrial cancer in a population-based case-control study. Cancer Causes Control 2011; 22:219-26. [PMID: 21110224 PMCID: PMC3075067 DOI: 10.1007/s10552-010-9689-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 11/08/2010] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Published studies of physical activity, BMI, and endometrial cancer risk show conflicting results and many do not report on reliability or validity of physical activity questionnaires. METHODS We collected physical activity data on 667 incident cases of endometrial cancer and 662 age-matched controls. Interview-administered questionnaires, collecting demographic and lifestyle information, including a validated questionnaire for physical activity. We performed unconditional logistic regression to examine the relationship between moderate- to vigorous-intensity sports/recreational physical activity (MV PA), sit time, and endometrial cancer risk. RESULTS Compared to women reporting 0 metabolic equivalent (MET) hours per week of MV PA, those who reported 7.5 MET h/wk or more had a 34% lower endometrial cancer risk (odds ratio (OR) = 0.66, 95% CI 0.50-0.87) after adjusting for risk factors including BMI. Those women sitting more than 8 h per day had a 52% increased odds (95% CI 1.07-2.16) of endometrial cancer compared to those sitting less than 4 h per day. We created a composite measure of physical activity and BMI and found that women with a BMI <25 and activity levels ≥7.5 MET h/wk had a 73% lower endometrial cancer risk (OR = 0.27, 95% CI 0.18-0.39) compared with the reference group of overweight (BMI ≥25) and sedentary (MET h/wk = 0). CONCLUSION Our data support an inverse, independent association between physical activity and endometrial cancer risk after adjusting for BMI and other risk factors.
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Affiliation(s)
- Hannah Arem
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, Room 428, PO Box 208034, New Haven, CT 06520-8034, USA
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, Room 428, PO Box 208034, New Haven, CT 06520-8034, USA
| | - Yang Zhou
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, Room 428, PO Box 208034, New Haven, CT 06520-8034, USA
| | - Lingeng Lu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, Room 428, PO Box 208034, New Haven, CT 06520-8034, USA
| | - Harvey Risch
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, Room 428, PO Box 208034, New Haven, CT 06520-8034, USA
| | - Herbert Yu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, Room 428, PO Box 208034, New Haven, CT 06520-8034, USA
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2654
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Mullany SA, Moslemi-Kebria M, Rattan R, Khurana A, Clayton A, Ota T, Mariani A, Podratz KC, Chien J, Shridhar V. Expression and functional significance of HtrA1 loss in endometrial cancer. Clin Cancer Res 2011; 17:427-36. [PMID: 21098697 PMCID: PMC3057564 DOI: 10.1158/1078-0432.ccr-09-3069] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to determine if loss of serine protease HtrA1 in endometrial cancer will promote the invasive potential of EC cell lines. EXPERIMENTAL DESIGN Western blot analysis and immunohistochemistry methods were used to determine HtrA1 expression in EC cell lines and primary tumors, respectively. Migration, invasion assays and in vivo xenograft experiment were performed to compare the extent of metastasis between HtrA1 expressing and HtrA1 knocked down clones. RESULTS Western blot analysis of HtrA1 in 13 EC cell lines revealed complete loss of HtrA1 expression in all seven papillary serous EC cell lines. Downregulation of HtrA1 in Hec1A and Hec1B cell lines resulted in a three- to fourfold increase in the invasive potential. Exogenous expression of HtrA1 in Ark1 and Ark2 cells resulted in three- to fourfold decrease in both invasive and migration potential of these cells. There was an increased rate of metastasis to the lungs associated with HtrA1 downregulation in Hec1B cells compared to control cells with endogenous HtrA1 expression. Enhanced expression of HtrA1 in Ark2 cells resulted in significantly less tumor nodules metastasizing to the lungs compared to parental or protease deficient (SA mutant) Ark2 cells. Immunohistochemical analysis showed 57% (105/184) of primary EC tumors had low HtrA1 expression. The association of low HtrA1 expression with high-grade endometrioid tumors was statistically significant (P = 0.016). CONCLUSIONS Collectively, these data indicate loss of HtrA1 may contribute to the aggressiveness and metastatic ability of endometrial tumors.
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Affiliation(s)
- Sally A. Mullany
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Wake Forest Medical Center, Salem, NC
| | - Mehdi Moslemi-Kebria
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, 55905
| | - Ramandeep Rattan
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic, Rochester, MN, 55905
| | - Ashwani Khurana
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic, Rochester, MN, 55905
| | - Amy Clayton
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, 55905
| | - Takayo Ota
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic, Rochester, MN, 55905
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, 55905
| | - Karl C. Podratz
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, 55905
| | - Jeremy Chien
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic, Rochester, MN, 55905
| | - Viji Shridhar
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic, Rochester, MN, 55905
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2655
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Soliman PT, Cui X, Zhang Q, Hankinson SE, Lu KH. Circulating adiponectin levels and risk of endometrial cancer: the prospective Nurses' Health Study. Am J Obstet Gynecol 2011; 204:167.e1-5. [PMID: 21047616 PMCID: PMC3032826 DOI: 10.1016/j.ajog.2010.08.045] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 07/26/2010] [Accepted: 08/24/2010] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Adiponectin, a protein secreted by adipose cells, is inversely associated with endometrial cancer. Our objective was to assess prediagnostic adiponectin levels in relation to risk of endometrial cancer. STUDY DESIGN This was a prospective nested case-control study within the Nurses' Health Study with 146 cases and 377 controls. Adiponectin was measured using enzyme-linked immunosorbent assay. Logistic regression analyses were performed adjusting for known endometrial cancer risk factors. RESULTS Mean age at diagnosis was 64.6 years. Mean interval between blood draw and diagnosis was 7.4 years (range, 2-13). There was no difference in median adiponectin (cases 12.9 vs controls 12.9 μg/mL; P = .97). Adiponectin >15 μg/mL was not associated with endometrial cancer risk (relative risk = 0.86; 95% confidence interval, 0.53-1.39; P = .48), even among postmenopausal women (odds ratio, 0.66; 95% confidence interval, 0.29-1.5). Results did not vary by time from blood draw to diagnosis (P for heterogeneity = .18). CONCLUSION Prediagnostic adiponectin was not predictive of endometrial cancer risk. Further study will better define the relationship between adiponectin and endometrial cancer.
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Affiliation(s)
- Pamela T. Soliman
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, 1155 Herman Pressler CPB 6.3244, Unit 1362, Houston, Texas 77030, USA.,To whom requests for reprints should be addressed, The Department of Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, PO Box 301439 Unit 1362, Houston, TX 77230-1439. Tel: (713) 745-8902, Fax: (713) 792-7586.
| | - Xiaohui Cui
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115
| | - Qian Zhang
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, 1155 Herman Pressler CPB 6.3244, Unit 1362, Houston, Texas 77030, USA
| | - Susan E. Hankinson
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115,Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115
| | - Karen H. Lu
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, 1155 Herman Pressler CPB 6.3244, Unit 1362, Houston, Texas 77030, USA
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2656
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Abstract
Cytotoxic therapy and surgery have improved outcomes for patients with gynecologic malignancies over the last twenty years, but women's cancers still account for over ten percent of cancer related deaths annually. Insights into the pathogenesis of cancer have led to the development of drugs that target molecular pathways essential to tumor survival including angiogenesis, DNA repair, and apoptosis. This review outlines several of the promising new biologically targeted drugs currently being tested to treat gynecologic malignancies.
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Affiliation(s)
- Amy R. Carroll
- Department of Gynecologic Oncology, M.D. Anderson Cancer Center, Houston, TX 77030
| | - Robert L. Coleman
- Department of Gynecologic Oncology, M.D. Anderson Cancer Center, Houston, TX 77030
- Center for RNAi and Non-Coding RNA, M.D. Anderson Cancer Center, Houston, TX, 77030
| | - Anil K. Sood
- Department of Gynecologic Oncology, M.D. Anderson Cancer Center, Houston, TX 77030
- Department of Cancer Biology, M.D. Anderson Cancer Center, Houston, TX 77030
- Center for RNAi and Non-Coding RNA, M.D. Anderson Cancer Center, Houston, TX, 77030
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2657
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Chen N, Yi X, Abushahin N, Pang S, Zhang D, Kong B, Zheng W. Nrf2 expression in endometrial serous carcinomas and its precancers. Int J Clin Exp Pathol 2010; 4:85-96. [PMID: 21228930 PMCID: PMC3016106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 12/23/2010] [Indexed: 05/30/2023]
Abstract
Endometrial serous carcinoma (ESC) is the most aggressive subtype of endometrial cancer. Its aggressive behavior and poor clinical outcome may be partially attributed to lack of early diagnostic markers and unclear patho-genesis. The transcription factor Erythroid-E2-related factor 2 (Nrf2) is a recently identified protein marker, which plays a role in carcinogenesis as well as responsible for poor prognosis of many human cancers. The aim of this study is to determine the Nrf2 expression in benign endometrium (n=28), endometrial cancers (n=122) as well as their precursor lesions (n=81) trying to see whether Nrf2 has any diagnostic usage and is potentially involved in endometrial carcinogenesis. The level of Nrf2 was evaluated by immunohistochemical (IHC) and verified by using Western blots. Among the malignant cases, Nrf2 was positive in 28 (68%) of 50 ESCs, which was significantly more than in 3 (6%) of 50 endometrioid carcinomas (p < 0.001) and 2 (13%) of 15 clear cell carcinomas (p = 0.001) and other histologic types of endometrial cancers. Among endometrial precursor lesions, both serous endometrial glandular dysplasia (EmGD, 40%) and serous endometrial intraepithelial carcinoma (EIC, 44%) showed a significantly higher Nrf2 expression than that in atypical endometrial hyperplasia or endometrial intraepithelial neoplasia (0%), clear cell EmGD (10%), and clear cell EIC (25%), respectively. We conclude that Nrf2 overexpression is closely associated with endometrial neoplasms with serous differentiation. Alteration of Nrf2 expression may represent one of the early molecular events in ESC carcinogenesis and overexpression of Nrf2 may used as a diagnostic marker in surgical pathology.
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Affiliation(s)
- Ning Chen
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong UniversityChina
- Department of Pathology, University of Arizona College of MedicineTucson, AZ, USA
| | - Xiaofang Yi
- Hospital of Obstetrics and Gynecology, Shanghai Medical College Fudan UniversityChina
| | - Nisreen Abushahin
- Department of Pathology, University of Arizona College of MedicineTucson, AZ, USA
| | - Shujie Pang
- Department of Pathology, University of Arizona College of MedicineTucson, AZ, USA
- Department of Pathology, Tianjin Central Hospital of Obstetrics and GynecologyChina
| | - Donna Zhang
- Department of Pharmacology & Toxicology, University of ArizonaTucson, AZ, USA
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong UniversityChina
| | - Wenxin Zheng
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong UniversityChina
- Department of Pathology, University of Arizona College of MedicineTucson, AZ, USA
- Department of Obstetrics and Gynecology, University of ArizonaTucson, AZ, USA
- Arizona Cancer Center, University of ArizonaTucson, AZ, USA
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2658
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Merritt WM, Kamat AA, Hwang JY, Bottsford-Miller J, Lu C, Lin YG, Coffey D, Spannuth W, Nugent E, Han LY, Landen CN, Nick AM, Stone RL, Coffman KT, Bruckheimer E, Broaddus R, Gershenson DM, Coleman RL, Sood AK. Clinical and biological impact of EphA2 overexpression and angiogenesis in endometrial cancer. Cancer Biol Ther 2010; 10:1306-14. [PMID: 20948320 PMCID: PMC3047089 DOI: 10.4161/cbt.10.12.13582] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE EphA2 overexpression predicts poor prognosis in endometrial cancer. To explore mechanisms for this association and assess its potential as therapeutic target, the relationship of EphA2 expression to markers of angiogenesis was examined using patient samples and an orthotopic mouse model of uterine cancer. EXPERIMENTAL DESIGN Expression of EphA2, estrogen receptor (ER), progesterone receptor (PR), Ki-67, vascular endothelial growth factor (VEGF) and microvessel density (MVD) was evaluated using immunohistochemistry in 85 endometrioid endometrial adenocarcinomas (EEC) by two independent investigators. Results were correlated with clinicopathological characteristics. The effect of EphA2- agonist monoclonal antibody EA5, alone or in combination with docetaxel was studied in vitro and in vivo. Samples were analyzed for markers of angiogenesis, proliferation and apoptosis. RESULTS Of 85 EEC samples, EphA2 was overexpressed in 47% of tumors and was significantly associated with high VEGF expression (p=0.001) and high MVD counts (p=0.02). High EphA2 expression, high VEGF expression and high MVD counts were significantly associated with shorter disease-specific survival. EA5 led to decrease in EphA2 expression and phosphorylation in vitro. In the murine model, while EA5 (33-88%) and docetaxel (23-55%) individually led to tumor inhibition over controls, combination therapy had the greatest efficacy (78-92%, p.
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Affiliation(s)
- William M Merritt
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Aparna A Kamat
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Jee-Young Hwang
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA,Division of Gynecologic Oncology; Department of Obstetrics and Gynecology; Dongguk University College of Medicine; Kyung-ju, Korea
| | - Justin Bottsford-Miller
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Chunhua Lu
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Yvonne G Lin
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | | | - Whitney Spannuth
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Elizabeth Nugent
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Liz Y Han
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Charles N Landen
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Alpa M Nick
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Rebecca L Stone
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | | | | | - Russell Broaddus
- Department of Pathology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - David M Gershenson
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Robert L Coleman
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Anil K Sood
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA,Department of Cancer Biology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA,Center for RNA Interference and Non-Coding RNA; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
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2659
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Taylor SE, Patel II, Singh PB, Nicholson CM, Stringfellow HF, Gopala Krishna RK, Matanhelia SS, Martin-Hirsch PL, Martin FL. Elevated oestrogen receptor splice variant ERαΔ5 expression in tumour-adjacent hormone-responsive tissue. Int J Environ Res Public Health 2010; 7:3871-89. [PMID: 21139866 DOI: 10.3390/ijerph7113871] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 10/27/2010] [Accepted: 10/29/2010] [Indexed: 12/25/2022]
Abstract
Susceptibility to prostate or endometrial cancer is linked with obesity, a state of oestrogen excess. Oestrogen receptor (ER) splice variants may be responsible for the tissue-level of ER activity. Such micro-environmental regulation may modulate cancer initiation and/or progression mechanisms. Real-time reverse transcriptase (RT) polymerase chain reaction (PCR) was used to quantitatively assess the levels of four ER splice variants (ERαΔ3, ERαΔ5, ERβ2 and ERβ5), plus the full-length parent isoforms ERα and ERβ1, in high-risk [tumour-adjacent prostate (n = 10) or endometrial cancer (n = 9)] vs. low-risk [benign prostate (n = 12) or endometrium (n = 9)], as well as a comparison of UK (n = 12) vs. Indian (n = 15) benign prostate. All three tissue groups expressed the ER splice variants at similar levels, apart from ERαΔ5. This splice variant was markedly raised in all of the tumour-adjacent prostate samples compared to benign tissues. Immunofluorescence analysis for ERβ2 in prostate tissue demonstrated that such splice variants are present in comparable, if not greater, amounts as the parent full-length isoform. This small pilot study demonstrates the ubiquitous nature of ER splice variants in these tissue sites and suggests that ERαΔ5 may be involved in progression of prostate adenocarcinoma.
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2660
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Chandran U, Bandera EV, Williams-King MG, Sima C, Bayuga S, Pulick K, Wilcox H, Zauber AG, Olson SH. Adherence to the dietary guidelines for Americans and endometrial cancer risk. Cancer Causes Control 2010; 21:1895-904. [PMID: 20652737 PMCID: PMC3065196 DOI: 10.1007/s10552-010-9617-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 07/09/2010] [Indexed: 11/26/2022]
Abstract
The Healthy Eating Index (HEI) was developed by the US Department of Agriculture with the goal of quantifying adherence to the Dietary Guidelines for Americans. The purpose of this study was to evaluate the impact of the HEI-2005 score and each of its components on endometrial cancer risk in a population-based case-control study in New Jersey. A total of 424 cases and 398 controls completed a Food Frequency Questionnaire, which was used to derive the HEI-2005 score. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression while adjusting for potential covariates, which included all major endometrial cancer risk factors. The adjusted OR for women in the highest quartile when compared to the lowest quartile was 0.83 (95% CI: 0.52-1.34). For the meat and beans component comprising meat, eggs, poultry, fish, and beans, the OR was 0.70 (95% CI: 0.45-1.11; p for trend: 0.07), with little evidence of an association with any of the individual foods. There was no indication of an association for any of the other components of the HEI or of effect modification by body mass index. This study suggested limited value for the HEI-2005 in predicting endometrial cancer risk.
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Affiliation(s)
- Urmila Chandran
- The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ 08903, USA
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2661
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Habeeb O, Goodglick L, Soslow RA, Rao R, Gordon LK, Schirripa O, Horvath S, Braun J, Seligson DB, Wadehra M. Epithelial membrane protein-2 expression is an early predictor of endometrial cancer development. Cancer 2010; 116:4718-26. [PMID: 20578181 PMCID: PMC2950887 DOI: 10.1002/cncr.25259] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Endometrial cancer (EC) is a common malignancy worldwide. It is often preceded by endometrial hyperplasia, whose management and risk of neoplastic progression vary. Previously, the authors have shown that the tetraspan protein epithelial membrane protein-2 (EMP2) is a prognostic indicator for EC aggressiveness and survival. Here the authors validate the expression of EMP2 in EC, and further examine whether EMP2 expression within preneoplastic lesions is an early prognostic biomarker for EC development. METHODS A tissue microarray (TMA) was constructed with a wide representation of benign and malignant endometrial samples. The TMA contains a metachronous cohort of cases from individuals who either developed or did not develop EC. Intensity and frequency of EMP2 expression were assessed using immunohistochemistry. RESULTS There was a stepwise, statistically significant increase in the average EMP2 expression from benign to hyperplasia to atypia to EC. Furthermore, detailed analysis of EMP2 expression in potentially premalignant cases demonstrated that EMP2 positivity was a strong predictor for EC development. CONCLUSIONS EMP2 is an early predictor of EC development in preneoplastic lesions. In addition, combined with our previous findings, these results validate EMP2 as a novel biomarker for EC development.
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Affiliation(s)
- Omar Habeeb
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Lee Goodglick
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Robert A. Soslow
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, 10065
| | - Rajiv Rao
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Lynn K. Gordon
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Osvaldo Schirripa
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Steve Horvath
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
- Department of Biostatistics, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Jonathan Braun
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - David B. Seligson
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Madhuri Wadehra
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
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2662
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Dooley WC, Thropay JP, Schreiber GJ, Puthawala MY, Lane SC, Wurzer JC, Stewart CE, Grado GL, Ahuja HG, Proulx GM. Use of electronic brachytherapy to deliver postsurgical adjuvant radiation therapy for endometrial cancer: a retrospective multicenter study. Onco Targets Ther 2010; 3:197-203. [PMID: 21049086 PMCID: PMC2962306 DOI: 10.2147/ott.s13593] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This retrospective, multicenter study evaluated the feasibility and safety of high-dose rate electronic brachytherapy (EBT) as a postsurgical adjuvant radiation therapy for endometrial cancer. METHODS Medical records were reviewed from 41 patients (age 40-89 years) with endometrial cancer (Federation of International Gynecology and Obstetrics stages IA-IIIC) treated at nine centers between April 2008 and October 2009. Treatment included intracavitary vaginal EBT alone (n = l6) at doses of 18.0-24.0 Gy in 3-4 fractions and EBT in combination with external beam radiation therapy (EBRT, n = 25) at a total radiation dose range of 40.0-80.4 Gy. Doses were prescribed to a depth of 5 mm from the applicator surface and to the upper third (n = 15) and the upper half (n = 26) of the vagina. RESULTS Median follow-up was 3.8 (range 0.5-12.0) months. All 41 patients received the intended dose of radiation as prescribed. Adverse events occurred in 13 of 41 patients and were mild to moderate (Grade 1-2), consisting primarily of vaginal mucositis, rectal mucosal irritation and discomfort, and temporary dysuria and diarrhea. There were no Grade 3 adverse events in the EBT-only treatment group. One patient, who was being treated with the combination of EBT and EBRT for recurrent endometrial cancer, had a Grade 3 adverse event. No recurrences have been reported to date. CONCLUSION Electronic brachytherapy provides a feasible treatment option for postoperative adjuvant vaginal brachytherapy as sole radiation therapy and in combination with EBRT for primary endometrial cancer. Early and late toxicities were mild to moderate.
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Affiliation(s)
- William C Dooley
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
- Correspondence: William C Dooley, The University Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA, Tel +1 405 271 7867, Fax +1 405 271 4443, Email
| | | | | | | | - Steven C Lane
- Signature Healthcare Brockton Hospital, Brockton, MA
| | - James C Wurzer
- AtlantiCare Regional Medical Center, Egg Harbor Township, NJ
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2663
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Wilson KM, Mucci LA, Rosner BA, Willett WC. A prospective study on dietary acrylamide intake and the risk for breast, endometrial, and ovarian cancers. Cancer Epidemiol Biomarkers Prev 2010; 19:2503-15. [PMID: 20693310 PMCID: PMC2952046 DOI: 10.1158/1055-9965.epi-10-0391] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Acrylamide is a probable human carcinogen formed during cooking of many common foods. Epidemiologic studies on acrylamide and breast cancer risk have been null; however, positive associations with ovarian and endometrial cancers have been reported. We studied acrylamide intake and risk for breast, endometrial, and ovarian cancers in a prospective cohort study. METHODS We assessed acrylamide intake among 88,672 women in the Nurses' Health Study using food frequency questionnaires administered every 4 years. Between 1980 and 2006, we identified 6,301 cases of invasive breast cancer, 484 cases of invasive endometrial adenocarcinoma, and 416 cases of epithelial ovarian cancer. We used Cox proportional hazards models to study the association between acrylamide and cancer risk. RESULTS We found no association between acrylamide intake and breast cancer overall or according to estrogen and progesterone receptor status. We found an increased risk for endometrial cancer among high acrylamide consumers (adjusted relative risk for highest versus lowest quintile = 1.41; 95% CI, 1.01-1.97; P for trend = 0.03). We observed a nonsignificant suggestion of increased risk for ovarian cancer overall (relative risk, 1.25; 95% CI, 0.88-1.77; P trend = 0.12), with a significantly increased risk for serous tumors (relative risk, 1.58; 95% CI, 0.99-2.52; P trend = 0.04). Associations did not differ by smoking status. CONCLUSIONS We observed no association between acrylamide and breast cancer. Risk for endometrial cancer and possibly ovarian cancer was greater among high acrylamide consumers. IMPACT This is the second prospective study to report positive associations with endometrial and ovarian cancers. These associations should be further evaluated to inform public health policy.
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Affiliation(s)
- Kathryn M Wilson
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
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2664
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Taylor HS. Hormone therapy: a tale of two cancers - the potential of estrogen/selective estrogen receptor modulator combinations. Expert Rev Endocrinol Metab 2010; 5:633-635. [PMID: 30764017 DOI: 10.1586/eem.10.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Hugh S Taylor
- a Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA.
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2665
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Charneco E, Ortiz AP, Venegas-Ríos HL, Romaguera J, Umpierre S. Clinic-based case-control study of the association between body mass index and endometrial cancer in Puerto Rican women. P R Health Sci J 2010; 29:272-8. [PMID: 20799515 PMCID: PMC3040409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Obesity is an established risk factor for endometrial cancer (EC). This association, however, has not been studied in Puerto Rico, where overweight and obesity have reached epidemic levels (38% and 26%, respectively). METHODS A hospital based case-control study was designed to evaluate the association between body mass index (BMI) and EC in women older than 21 years of age. Seventy-four prevalent EC cases diagnosed between January 2004 and August 2007 and a random sample of 88 healthy controls were recruited from gynecology clinics of the Medical Sciences Campus, University of Puerto Rico. Demographic, reproductive, lifestyle, and clinical information was obtained via structured telephone interviews and medical chart review. Unconditional logistic regression models were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). RESULTS A significant trend was observed between BMI and EC in bivariate analyses (p < 0.05). Results showed that overweight (25.0 > BMI < 29.9 kg/m2) (OR = 4.4, 95% CI = 1.6-12.3) and obese (BMI < or = 30 kg/m2) (OR = 9.9, 95% CI = 3.6-26.9) women were more likely to have EC when compared to non-obese women. In multivariate analysis, obese women had a 4-fold greater possibility of EC (OR = 4.1; 95% CI: 1.8-8.6) than nonobese women, after adjusting for age, education, employment status, hypertension and diabetes diagnosis, use of oral contraceptives and consumption of poultry. CONCLUSION Consistent with previous studies worldwide, adult obesity was a strong predictor for EC in this sample of Puerto Rican women. Thus, cancer control strategies should promote weight reduction strategies to reduce disease risk in this population.
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Affiliation(s)
- Eileen Charneco
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR.
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2666
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Canchola AJ, Chang ET, Bernstein L, Largent JA, Reynolds P, Deapen D, Ursin G, Horn-Ross PL. Body size and the risk of endometrial cancer by hormone therapy use in postmenopausal women in the California Teachers Study cohort. Cancer Causes Control 2010; 21:1407-16. [PMID: 20431936 PMCID: PMC2925506 DOI: 10.1007/s10552-010-9568-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 04/10/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate whether hormone therapy (HT) and obesity are associated with endometrial cancer risk among postmenopausal women in the California Teachers Study cohort. METHODS Of 28,418 postmenopausal women, 395 developed type 1 endometrial cancer between 1995 and 2006. Multivariate Cox regression was performed to estimate relative risks (RR), stratified by HT use (never used, ever estrogen alone (ET) or exclusively estrogen-plus-progestin (EPT)). RESULTS Among women who never used HT, overall and abdominal adiposity were associated with increased risk; when evaluated simultaneously, abdominal adiposity was more strongly associated (RR 2.2, 95% confidence interval (CI): 1.1-4.5 for waist >or=35 vs. <35 inches). Among women who ever used ET, risk was increased in women with BMI >or= 25 kg/m(2) (RR 1.6, 95% CI: 1.1-2.3 vs. <25 kg/m(2)). Neither overall nor abdominal obesity was associated with risk in women who exclusively used EPT (p-interaction <0.001 for BMI by HT use). CONCLUSIONS Among women who never used HT, risk was strongly positively related to obesity and may have been influenced more by abdominal than by overall adiposity; however, due to small numbers, this latter finding requires replication. Among women who ever used ET, being overweight at baseline predicted higher risk, whereas use of EPT mitigated any effects of obesity.
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Affiliation(s)
- Alison J Canchola
- Cancer Prevention Institute of California (formerly the Northern California Cancer Center), Fremont, CA 94538, USA.
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2667
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Kim TH, Franco HL, Jung SY, Qin J, Broaddus RR, Lydon JP, Jeong JW. The synergistic effect of Mig-6 and Pten ablation on endometrial cancer development and progression. Oncogene 2010; 29:3770-80. [PMID: 20418913 DOI: 10.1038/onc.2010.126] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ablation of Mig-6 in the murine uterus leads to the development of endometrial hyperplasia and estrogen-induced endometrial cancer. An additional endometrial cancer mouse model is generated by the ablation of phosphatase and tensin homolog deleted from chromosome 10 (Pten) (either as heterozygotes or by conditional uterine ablation). To determine the interplay between Mig-6 and the PTEN/phosphoinositide 3-kinase signaling pathway during endometrial tumorigenesis, we generated mice with Mig-6 and Pten conditionally ablated in progesterone receptor-positive cells (PR(cre/+)Mig-6(f/f)Pten(f/f); Mig-6(d/d)Pten(d/d)). The ablation of both Mig-6 and Pten dramatically accelerated the development of endometrial cancer compared with the single ablation of either gene. The epithelium of Mig-6(d/d)Pten(d/d) mice showed a significant decrease in the number of apoptotic cells compared with Pten(d/d) mice. The expression of the estrogen-induced apoptotic inhibitors Birc1 was significantly increased in Mig-6(d/d)Pten(d/d) mice. We identified extracellular signal-regulated kinase 2 (ERK2) as an MIG-6 interacting protein by coimmunoprecipitation and demonstrated that the level of ERK2 phosphorylation was increased upon Mig-6 ablation either singly or in combination with Pten ablation. These results suggest that Mig-6 exerts a tumor-suppressor function in endometrial cancer by promoting epithelial cell apoptosis through the downregulation of the estrogen-induced apoptosis inhibitors Birc1 and the inhibition of ERK2 phosphorylation.
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2668
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Benbrook DM, Lightfoot S, Ranger-Moore J, Liu T, Chengedza S, Berry WL, Dozmorov I. Gene expression analysis of biological systems driving an organotypic model of endometrial carcinogenesis and chemoprevention. Gene Regul Syst Bio 2010; 2:21-42. [PMID: 19784388 PMCID: PMC2733085 DOI: 10.4137/grsb.s344] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An organotypic model of endometrial carcinogenesis and chemoprevention was developed in which normal endometrial organotypic cultures exposed to the carcinogen, DMBA (7,12-dimethylbenz[a]anthracene), developed a cancerous phenotype in the absence, but not presence of subsequent treatment with a flexible heteroarotinoid (Flex-Het), called SHetA2. A discriminant function based on karyometric features of cellular nuclei and an agar clonogenic assay confirmed these histologic changes. Interpretation of microarray data using an internal standard approach identified major pathways associated with carcinogenesis and chemoprevention governed by c-myc, p53, TNFα and Jun genes. Cluster analysis of functional associations of hypervariable genes demonstrated that carcinogenesis is accompanied by a stimulating association between a module of genes that includes tumor necrosis factor α (TNFα), c-myc, and epidermal growth factor-receptor (EGF-R) and a module that includes insulin-like growth factor I-receptor (IGF-IR), p53, and Jun genes. Two secreted proteins involved in these systems, tenascin C and inhibin A, were validated at the protein level. Tenascin C is an EGF-R ligand, and therefore may contribute to the increased EGF-R involvement in carcinogenesis. The known roles of the identified molecular systems in DMBA and endometrial carcinogenesis and chemoprevention supports the validity of this model and the potential clinical utility of SHetA2 in chemoprevention.
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Affiliation(s)
- Doris M Benbrook
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
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2669
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Lee JW, Stone RL, Lee SJ, Nam EJ, Roh JW, Nick AM, Han HD, Shahzad MM, Kim HS, Mangala LS, Jennings NB, Mao S, Gooya J, Jackson D, Coleman RL, Sood AK. EphA2 targeted chemotherapy using an antibody drug conjugate in endometrial carcinoma. Clin Cancer Res 2010; 16:2562-70. [PMID: 20388851 PMCID: PMC3955167 DOI: 10.1158/1078-0432.ccr-10-0017] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE EphA2 overexpression is frequently observed in endometrial cancers and is predictive of poor clinical outcome. Here, we use an antibody drug conjugate (MEDI-547) composed of a fully human monoclonal antibody against both human and murine EphA2 (1C1) and the tubulin polymerization inhibitor monomethylauristatin F. EXPERIMENTAL DESIGN EphA2 expression was examined in endometrial cancer cell lines by Western blot. Specificity of MEDI-547 was examined by antibody degradation and internalization assays. Viability and apoptosis were investigated in endometrial cancer cell lines and orthotopic tumor models. RESULTS EphA2 was expressed in the Hec-1A and Ishikawa cells but was absent in the SPEC-2 cells. Antibody degradation and internalization assays showed that the antibody drug conjugate decreased EphA2 protein levels and was internalized in EphA2-positive cells (Hec-1A and Ishikawa). Moreover, in vitro cytotoxicity and apoptosis assays showed that the antibody drug conjugate decreased viability and increased apoptosis of Hec-1A and Ishikawa cells. In vivo therapy experiments in mouse orthotopic models with this antibody drug conjugate resulted in 86% to 88% growth inhibition (P < 0.001) in the orthotopic Hec-1A and Ishikawa models compared with controls. Moreover, the mice treated with this antibody drug conjugate had a lower incidence of distant metastasis compared with controls. The antitumor effects of the therapy were related to decreased proliferation and increased apoptosis of tumor and associated endothelial cells. CONCLUSIONS The preclinical data for endometrial cancer treatment using MEDI-547 show substantial antitumor activity.
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Affiliation(s)
- Jeong-Won Lee
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030,Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 135-710
| | - Rebecca L. Stone
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030
| | - Sun Joo Lee
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030,Department of Obstetrics and Gynecology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 143-729, South Korea
| | - Eun Ji Nam
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030,Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea 120-752
| | - Ju-Won Roh
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030,Department of Obstetrics & Gynecology, Dongguk University Ilsan Hospital, Goyang, Korea 410-050
| | - Alpa M. Nick
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030
| | - Hee-Dong Han
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030
| | - Mian M.K. Shahzad
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77054
| | - Hye-Sun Kim
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030,Department of Pathology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea 100-380
| | - Lingegowda S. Mangala
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030
| | - Nicholas B. Jennings
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030
| | - Shenlan Mao
- Medimmune, LLC, Gaithersburg, Maryland 20878
| | - John Gooya
- Medimmune, LLC, Gaithersburg, Maryland 20878
| | | | - Robert L. Coleman
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030
| | - Anil K. Sood
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030,Department of Cancer Biology, the University of Texas M. D. Anderson Cancer Center, Houston, TX,Center for RNA Interference and Non-Coding RNA, the University of Texas M. D. Anderson Cancer Center
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2670
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McCampbell AS, Harris HA, Crabtree JS, Winneker RC, Walker CL, Broaddus RR. Loss of inhibitory insulin receptor substrate-1 phosphorylation is an early event in mammalian target of rapamycin-dependent endometrial hyperplasia and carcinoma. Cancer Prev Res (Phila) 2010; 3:290-300. [PMID: 20179297 PMCID: PMC4103009 DOI: 10.1158/1940-6207.capr-09-0199] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Insulin-like growth factor-I receptor signaling contributes to the development of endometrial hyperplasia, the precursor to endometrioid-type endometrial carcinoma, in humans and in rodent models. This pathway is under both positive and negative regulation, including S6 kinase (S6K) phosphorylation of insulin receptor substrate-1 (IRS-1) at S636/639, which occurs downstream of mammalian target of rapamycin (mTOR) activation to inhibit this adapter protein. We observed activation of mTOR with a high frequency in human endometrial hyperplasia and carcinoma, but an absence of IRS-1 phosphorylation, despite high levels of activated S6K. To explore when during disease progression mammalian target of rapamycin (mTOR) activation and loss of negative feedback to IRS-1 occurred, we used the Eker rat (Tsc2(Ek/+)) model, where endometrial hyperplasia develops as a result of loss of Tsc2, a "gatekeeper" for mTOR. We observed mTOR activation early in progression in hyperplasias and in some histologically normal epithelial cells, suggesting that event(s) in addition to loss of Tsc2 were required for progression to hyperplasia. In contrast, whereas IRS-1 S636/639 phosphorylation was observed in normal epithelium, it was absent from all hyperplasias, indicating loss of IRS-1 inhibition by S6K occurred during progression to hyperplasia. Treatment with a mTOR inhibitor (WAY-129327) significantly decreased hyperplasia incidence and proliferative indices. Because progression from normal epithelium to carcinoma proceeds through endometrial hyperplasia, these data suggest a progression sequence where activation of mTOR is followed by loss of negative feedback to IRS-1 during the initial stages of development of this disease.
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Affiliation(s)
- Adrienne S. McCampbell
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030
| | - Heather A. Harris
- Endocrinology & Reproductive Disorders Division, Women’s Health and Musculoskeletal Biology, Wyeth Research, 500 Arcola Road, Collegeville, Pennsylvania 19426
| | - Judy S. Crabtree
- Endocrinology & Reproductive Disorders Division, Women’s Health and Musculoskeletal Biology, Wyeth Research, 500 Arcola Road, Collegeville, Pennsylvania 19426
| | - Richard C. Winneker
- Endocrinology & Reproductive Disorders Division, Women’s Health and Musculoskeletal Biology, Wyeth Research, 500 Arcola Road, Collegeville, Pennsylvania 19426
| | - Cheryl L. Walker
- Department of Carcinogenesis, University of Texas, M.D. Anderson Cancer Center, Science Park Research Division, P.O. Box 389, Smithville, Texas 78957,Corresponding Author: Cheryl L. Walker, University of Texas M.D. Anderson Cancer Center Department of Carcinogenesis 1808 Park Road 1C, Smithville, Texas 78957 Tel: 512-237-9550 Fax: 512-237-2975
| | - Russell R. Broaddus
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030
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2671
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Abstract
OBJECTIVES To discuss the novel agents which are being developed for the treatment of advanced and recurrent endometrial carcinoma and to review other molecular targets that may be interesting in the treatment of this disease. While the majority of women with endometrial cancer enjoy a relatively good prognosis, the options for those women who suffer from a disease recurrence are limited and there is a need to identify novel agents. METHODS A review of clinical trials of novel therapeutic agents and their molecular targets is provided. In addition, a review of the current literature on other potential molecular targets for endometrial cancer was performed. RESULTS Several phase II trials of novel agents, both alone and in combination with traditional cytotoxic chemotherapy, have been completed or are nearing completion. It appears that the targeted agents may have the most efficacy in combination with cytotoxic chemotherapy or in a multi-targeted agent approach. CONCLUSIONS Chemotherapy offers the opportunity for a meaningful response rate in women with endometrial cancer, but the responses are often short lived and cure is uncommon in the setting of recurrent disease. The recent increase in molecular targets has led to the availability of many novel therapies. Determining how these agents are to be used, alone or in combination with "standard" therapies, needs to be defined and translational studies are needed to develop rational combinations of these novel agents before we can move into clinical trials.
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Affiliation(s)
- Paola A Gehrig
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7572, USA.
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2672
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Levan K, Partheen K, Osterberg L, Olsson B, Delle U, Eklind S, Horvath G. Identification of a gene expression signature for survival prediction in type I endometrial carcinoma. Gene Expr 2010; 14:361-70. [PMID: 20635577 PMCID: PMC6042025 DOI: 10.3727/105221610x12735213181242] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endometrial cancer is the most common malignancy of the female reproductive tract. In many cases the prognosis is favorable, but 22% of affected women die from the disease. We aimed to study potential differences in gene expression between endometrioid adenocarcinomas from survivors (5-year survival) and nonsurvivors. Forty-five patients were included in the investigation, of which 21 were survivors and 24 were nonsurvivors. The tumors were analyzed with genome-wide expression array analysis, represented by 13,526 genes. Distinct differences in gene expression were found between the groups. A t-test established that 218 genes were significantly differentially expressed (p < 0.001) between the two survival groups, and in a cross-validation test 40 of the 45 (89%) tumors were classified correctly. The 218 differentially expressed genes were subjected to hierachical clustering analysis, which yielded two clusters both exhibiting over 80% homogeneity with respect to survival. When the additional constraint of fold change (FC > 2) was added the hierachical clustering yielded similar results. Stage I tumors are expected to have a favorable prognosis. However, in our tumor material there were six nonsurvivors with stage I tumors. Five out of six stage I nonsurvivors clustered in the nonsurvival fraction. Our findings suggest that a subgroup of early stage endometroid adenocarcinomas can be correctly classified as potentially aggressive by using molecular biology in combination with conventional markers, thereby providing a tool for a more accurate classification and risk evaluation of the individual patient.
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Affiliation(s)
- Kristina Levan
- Department of Oncology, Sahlgrenska Hospital, Gothenburg University, Gothenburg, Sweden.
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2673
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Steinbakk A, Malpica A, Slewa A, Gudlaugsson E, Janssen EAM, Arends M, Kruse AJ, Yinhua Y, Feng W, Baak JP. High frequency microsatellite instability has a prognostic value in endometrial endometrioid adenocarcinoma, but only in FIGO stage 1 cases. Anal Cell Pathol (Amst) 2010; 33:245-255. [PMID: 21079294 PMCID: PMC4605578 DOI: 10.3233/acp-clo-2010-0550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVES to analyze the prognostic value of microsatellite instability (MSI) in a population-based study of FIGO stage 1-4 endometrial endometrioid adenocarcinomas. STUDY DESIGN survival analysis in 273 patients of MSI status and clinico-pathologic features. Using a highly sensitive pentaplex polymerase chain reaction to establish MSI status, cases were divided into microsatellite stable (MSS), MSI-low (MSI-L, 1 marker positive) and MSI-high (MSI-H, 2-5 markers positive). RESULTS after 61 months median follow-up (1-209), 34 (12.5%) of the patients developed metastases but only 6.4% of the FIGO 1. MSI (especially as MSI-H vs. MSS/MSI-Lcombined) was prognostic in FIGO 1 but not in FIGO 2-4. The 5 and 10 year recurrence-free survival rates were 98% and 95% in the MSS/MSI-L vs. 85% and 73% in the MSI-H patients (p=0.005). CONCLUSIONS MSI-H status assessed by pentaplex polymerase chain reaction is an indicator of poor prognosis in FIGO 1, but not in FIGO 2-4 endometrial endometrioid adenocarcinomas.
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Affiliation(s)
- Anita Steinbakk
- Department of PathologyStavanger University HospitalStavangerNorway
- Department of GynaecologyStavanger University HospitalStavangerNorway
- The Gade InstituteUniversity of BergenBergenNorway
| | - Anais Malpica
- Departments of Pathology and Gynecologic OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Aida Slewa
- Department of PathologyStavanger University HospitalStavangerNorway
| | - Einar Gudlaugsson
- Department of PathologyStavanger University HospitalStavangerNorway
- The Gade InstituteUniversity of BergenBergenNorway
| | | | - Mark Arends
- Department of PathologyAddenbrooke’s HospitalUniversity of CambridgeCambridgeEngland
| | - Arnold Jan Kruse
- Department of GynecologyAcademic Medical CenterMaastrichtThe Netherlands
| | - Yu Yinhua
- Department of Experimental MedicineThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Weiwei Feng
- Department of GynecologyObstetrics and Gynecology Hospital of Fudan UniversityShanghaiChina
| | - Jan P. Baak
- Department of PathologyStavanger University HospitalStavangerNorway
- The Gade InstituteUniversity of BergenBergenNorway
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2674
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Mariani A, Cha SS, Bergstralh EJ, Boardman LA, Dowdy SC, Keeney GL, Podratz KC, Melton LJ. Referral and ascertainment bias in patients with synchronous and metachronous endometrial malignancy. EUR J GYNAECOL ONCOL 2010; 31:5-9. [PMID: 20349773 PMCID: PMC3929141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The purpose of this study was to evaluate the frequency in patients with endometrial cancer of other malignancies and the influence of referral and ascertainment biases on these associations. Analysis of 1,028 local and referred patients who had a hysterectomy for endometrial cancer was based on residence at the time of diagnosis. Altogether, 208 patients had a history of another malignancy, most frequently breast, colon, and ovary. At the time of surgery for endometrial cancer, the prevalence of lymphoma and breast and ovarian cancers was greater than expected although the higher prevalence of lymphoma was limited to referred patients. During follow-up after hysterectomy, the incidence of lung cancer was lower than expected, whereas the incidence of lymphoma was higher. Breast, colorectal, and bladder cancers were more common than expected although this finding was limited to local patients. We concluded that results of epidemiologic studies from tertiary care centers may be misleading if they do not account for referral and ascertainment biases.
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Affiliation(s)
- A Mariani
- Department of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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2675
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Abstract
Endometrial cancer is the most common invasive gynecologic malignancy, yet molecular mechanisms and signaling pathways underlying its etiology and pathophysiology remain poorly characterized. We sought to define a functional role for the protein kinase C (PKC) isoform, PKCalpha, in an established cell model of endometrial adenocarcinoma. Ishikawa cells depleted of PKCalpha protein grew slower, formed fewer colonies in anchorage-independent growth assays and exhibited impaired xenograft tumor formation in nude mice. Consistent with impaired growth, PKCalpha knockdown increased levels of the cyclin-dependent kinase (CDK) inhibitors p21(Cip1/WAF1) (p21) and p27(Kip1) (p27). Despite the absence of functional phosphatase and tensin homolog (PTEN) protein in Ishikawa cells, PKCalpha knockdown reduced Akt phosphorylation at serine 473 and concomitantly inhibited phosphorylation of the Akt target, glycogen synthase kinase-3beta (GSK-3beta). PKCalpha knockdown also resulted in decreased basal ERK phosphorylation and attenuated ERK activation following EGF stimulation. p21 and p27 expression was not increased by treatment of Ishikawa cells with ERK and Akt inhibitors, suggesting that PKCalpha regulates CDK expression independently of Akt and ERK. Immunohistochemical analysis of Grade 1 endometrioid adenocarcinoma revealed aberrant PKCalpha expression, with foci of elevated PKCalpha staining, not observed in normal endometrium. These studies demonstrate a critical role for PKCalpha signaling in endometrial tumorigenesis by regulating expression of CDK inhibitors p21 and p27 and activation of Akt and ERK-dependent proliferative pathways. Thus, targeting PKCalpha may provide novel therapeutic options in endometrial tumors.
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Affiliation(s)
- James M Haughian
- Department of Obstetrics and Gynecology, Section of Basic Reproductive Sciences, University of Colorado, Denver School of Medicine, Aurora, CO 80045, USA
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2676
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Westin SN, Broaddus RR, Deng L, McCampbell A, Lu KH, Lacour RA, Milam MR, Urbauer DL, Mueller P, Pickar JH, Loose DS. Molecular clustering of endometrial carcinoma based on estrogen-induced gene expression. Cancer Biol Ther 2009; 8:2126-35. [PMID: 19755863 PMCID: PMC2872176 DOI: 10.4161/cbt.8.22.9740] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Identification of biomarkers potentially provides prognostic information that can help guide clinical decision-making. Given the relationship between estrogen exposure and endometrial cancer, especially low grade endometrioid carcinoma, we hypothesized that high expression of genes induced by estrogen would identify low risk endometrioid endometrial cancers. cDNA microarray and qRT-PCR verification were used to identify six genes that are highly induced by estrogen in the endometrium. These estrogen-induced biomarkers were quantified in 72 endometrial carcinomas by qRT-PCR. Unsupervised cluster analysis was performed, with expression data correlated to tumor characteristics. Time to recurrence by cluster was analyzed using the Kaplan-Meier method. A receiver operating characteristic (ROC) curve was generated to determine the potential clinical utility of the biomarker panel to predict prognosis. Expression of all genes was higher in endometrioid carcinomas compared to non-endometrioid carcinomas. Unsupervised cluster analysis revealed two distinct groups based on gene expression. The high expression cluster was characterized by lower age, higher BMI, and low grade endometrioid histology. The low expression cluster had a recurrence rate 4.35 times higher than the high expression cluster. ROC analysis allowed for the prediction of stage and grade with a false negative rate of 4.8% based on level of gene expression in endometrioid tumors. We have therefore identified a panel of estrogen-induced genes that have potential utility in predicting endometrial cancer stage and recurrence risk. This proof-of-concept study demonstrates that biomarker analysis may play a role in clinical decision making for the therapy of women with endometrial cancer.
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Affiliation(s)
- Shannon N. Westin
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Russell R. Broaddus
- Department of Pathology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA,Correspondence to: Russell R. Broaddus;
| | - Lei Deng
- Department of Pathology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Adrienne McCampbell
- Department of Pathology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Karen H. Lu
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Robin A. Lacour
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Michael R. Milam
- Department of Gynecologic Oncology; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Diana L. Urbauer
- Division of Quantitative Sciences; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | - Peter Mueller
- Division of Quantitative Sciences; University of Texas M.D. Anderson Cancer Center; Houston, TX USA
| | | | - David S. Loose
- Department of Integrative Biology and Pharmacology; University of Texas Health Science Center at Houston; Houston, TX USA
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2677
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Xie R, Schlumbrecht MP, Shipley GL, Xie S, Bassett RL Jr, Broaddus RR. S100A4 mediates endometrial cancer invasion and is a target of TGF-beta1 signaling. J Transl Med 2009; 89:937-47. [PMID: 19506550 DOI: 10.1038/labinvest.2009.52] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The molecular mechanisms of endometrial cancer invasion are poorly understood. S100A4, also known as FSP1 (fibroblast-specific protein 1), has long been known to be a molecular marker of fibrosis in a variety of different fibrotic diseases of the lungs, liver, kidney, and heart. We demonstrate here that increased expression of S100A4 is associated with advanced stage endometrial cancer and decreased recurrence free survival. To verify the essential role of S100A4 in invasiveness of endometrial cancer, S100A4 expression was downregulated by RNAi in HEC-1A cells, which resulted in undetectable S100A4 protein and significantly decreased migration and invasion. Owing to the established connection between TGF-beta1 and S100A4 induction in experimental models of kidney and liver fibrosis, we next examined whether TGF-beta1 could also regulate S100A4 in endometrial cancer cells. TGF-beta1 stimulated endometrial cancer cell migration and invasion with a concomitant increase in S100A4 protein. Induction of S100A4 was associated with the activation of Smads. TGF-beta1-mediated endometrial cancer cell motility was inhibited by S100A4 siRNA. In aggregate, these results suggest that S100A4 is a critical mediator of invasion in endometrial cancer and is upregulated by the TGF-beta1 signaling pathway. These results also suggest that endometrial cancer cell invasion and fibrosis share common molecular mechanisms.
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2678
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Resnick KE, Hampel H, Fishel R, Cohn DE. Current and emerging trends in Lynch syndrome identification in women with endometrial cancer. Gynecol Oncol 2009; 114:128-34. [PMID: 19375789 PMCID: PMC2841434 DOI: 10.1016/j.ygyno.2009.03.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 02/25/2009] [Accepted: 03/04/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Lynch syndrome is a heritable, cancer susceptibility syndrome. This study aims to review current and emerging trends in the identification of Lynch syndrome in the endometrial cancer patient population. METHODS We performed a comprehensive review of past and present screening algorithms for Lynch syndrome, including a review of the utility of both the Amsterdam criteria and Bethesda guidelines. Because non-colon cancers have historically not been the focus of Lynch syndrome research, current literature is ripe with questions regarding screening among this patient population. Low BMI, age less than 50, positive family history and pathologic features have all been identified as risk factors in endometrial cancer patients who might benefit from Lynch screening. Additionally, based on experience at our own institution we offer a feasible screening algorithm for these patients. RESULTS A comprehensive review of the data demonstrated that immunohistochemistry is becoming an efficient, inexpensive way to screen tumors at risk for mismatch repair deficiency. The sensitivity and specificity of immunohistochemistry for predicting Lynch syndrome approaches 100%. Ideally, prospective screening of all endometrial cancer patients with IHC is a feasible, cost-efficient way to detect Lynch in this patient population given the limitations of using personal/family history of malignancy as well as pathologic risk factors. CONCLUSION It is imperative that clinicians be mindful of the risk of Lynch syndrome in women with endometrial cancer. Given the opportunity for colon cancer screening and prevention strategies to be initiated, the identification of probands with endometrial cancer as a result of Lynch syndrome will lead to a reduction in morbidity and mortality for these patients and their families.
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Affiliation(s)
- Kimberly E. Resnick
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Heather Hampel
- Human Cancer Genetics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Richard Fishel
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - David E. Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA
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2679
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Abu-Rustum NR, Khoury-Collado F, Pandit-Taskar N, Soslow RA, Dao F, Sonoda Y, Levine DA, Brown CL, Chi DS, Barakat RR, Gemignani ML. Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma? Gynecol Oncol 2009; 113:163-9. [PMID: 19232699 PMCID: PMC3959736 DOI: 10.1016/j.ygyno.2009.01.003] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 01/11/2009] [Accepted: 01/13/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the accuracy of SLN mapping in patients with a preoperative diagnosis of grade 1 endometrial cancer. METHODS A prospective, non-randomized study of women with a preoperative diagnosis of endometrial cancer and clinical stage I disease was conducted. A subset analysis of patients with a preoperative diagnosis of grade 1 endometrial endometrioid cancer was performed. All patients had preoperative lymphoscintigraphy with Tc99m on the day of or day before surgery followed by an intraoperative injection of 2 cm(3) of isosulfan or methylene blue dye deep into the cervix or both cervix and fundus. All patients underwent hysterectomy, bilateral salpingo-oophorectomy, and regional nodal dissection. Hot and/or blue nodes were labeled as SLNs and sent for histopathological analysis. RESULTS Forty-two patients with a preoperative diagnosis of grade 1 endometrial carcinoma treated from 3/06 to 8/08 were identified. Twenty-five (60%) had laparoscopic surgery; 17 (40%) were treated by laparotomy. Preoperative lymphoscintigraphy visualized SLNs in 30 patients (71%); intraoperative localization of the SLN was possible in 36 patients (86%). A median of 3 SLNs (range, 1-14) and 14.5 non-SLNs (range, 4-55) were examined. In all, 4/36 (11%) had positive SLNs-3 seen on H&E and 1 as cytokeratin-positive cells on IHC. All node-positive cases were picked up by the SLN; there were no false-negative cases. The sensitivity of the SLN procedure in the 36 patients who had an SLN identified was 100%. CONCLUSION Sentinel lymph node mapping using a cervical injection with combined Tc and blue dye is feasible and accurate in patients with grade 1 endometrial cancer and may be a reasonable option for this select group of patients. Regional lymphadenectomy remains the gold standard in many practices, particularly for the approximately 15% of cases with failed SLN mapping.
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Affiliation(s)
- Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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2680
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Salvesen HB, Carter SL, Mannelqvist M, Dutt A, Getz G, Stefansson IM, Raeder MB, Sos ML, Engelsen IB, Trovik J, Wik E, Greulich H, Bø TH, Jonassen I, Thomas RK, Zander T, Garraway LA, Øyan AM, Sellers WR, Kalland KH, Meyerson M, Akslen LA, Beroukhim R. Integrated genomic profiling of endometrial carcinoma associates aggressive tumors with indicators of PI3 kinase activation. Proc Natl Acad Sci U S A 2009; 106:4834-9. [PMID: 19261849 PMCID: PMC2660768 DOI: 10.1073/pnas.0806514106] [Citation(s) in RCA: 221] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Although 75% of endometrial cancers are treated at an early stage, 15% to 20% of these recur. We performed an integrated analysis of genome-wide expression and copy-number data for primary endometrial carcinomas with extensive clinical and histopathological data to detect features predictive of recurrent disease. Unsupervised analysis of the expression data distinguished 2 major clusters with strikingly different phenotypes, including significant differences in disease-free survival. To identify possible mechanisms for these differences, we performed a global genomic survey of amplifications, deletions, and loss of heterozygosity, which identified 11 significantly amplified and 13 significantly deleted regions. Amplifications of 3q26.32 harboring the oncogene PIK3CA were associated with poor prognosis and segregated with the aggressive transcriptional cluster. Moreover, samples with PIK3CA amplification carried signatures associated with in vitro activation of PI3 kinase (PI3K), a signature that was shared by aggressive tumors without PIK3CA amplification. Tumors with loss of PTEN expression or PIK3CA overexpression that did not have PIK3CA amplification also shared the PI3K activation signature, high protein expression of the PI3K pathway member STMN1, and an aggressive phenotype in test and validation datasets. However, mutations of PTEN or PIK3CA were not associated with the same expression profile or aggressive phenotype. STMN1 expression had independent prognostic value. The results affirm the utility of systematic characterization of the cancer genome in clinically annotated specimens and suggest the particular importance of the PI3K pathway in patients who have aggressive endometrial cancer.
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Affiliation(s)
- H. B. Salvesen
- aDepartment of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway;
- bDepartment of Clinical Medicine, University of Bergen, 5020 Bergen, Norway;
- 1To whom correspondence may be addressed. E-mail: , , or
| | - S. L. Carter
- cThe Harvard and MIT Division of Health Sciences and Technology, Cambridge, MA 02142;
- dThe Broad Institute of Harvard and MIT, Cambridge, MA 02142;
| | - M. Mannelqvist
- eThe Gade Institute, Section for Pathology, University of Bergen, 5020 Bergen, Norway;
| | - A. Dutt
- dThe Broad Institute of Harvard and MIT, Cambridge, MA 02142;
- fDepartment of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115;
| | - G. Getz
- dThe Broad Institute of Harvard and MIT, Cambridge, MA 02142;
| | - I. M. Stefansson
- eThe Gade Institute, Section for Pathology, University of Bergen, 5020 Bergen, Norway;
- gDepartment of Pathology, Haukeland University Hospital, 5020 Bergen, Norway;
| | - M. B. Raeder
- aDepartment of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway;
- bDepartment of Clinical Medicine, University of Bergen, 5020 Bergen, Norway;
| | - M. L. Sos
- hMax Planck-Institute for Neurological Research, and Klaus-Joachim-Zülch Laboratories of the Max Planck Society and the Medical Faculty of the University of Cologne, 509315 Cologne, Germany;
| | - I. B. Engelsen
- aDepartment of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway;
| | - J. Trovik
- aDepartment of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway;
- bDepartment of Clinical Medicine, University of Bergen, 5020 Bergen, Norway;
| | - E. Wik
- aDepartment of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway;
- bDepartment of Clinical Medicine, University of Bergen, 5020 Bergen, Norway;
| | - H. Greulich
- dThe Broad Institute of Harvard and MIT, Cambridge, MA 02142;
- fDepartment of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115;
- iDepartment of Medicine, Brigham and Women's Hospital, Boston, MA 02115;
- jDepartment of Medicine, Harvard Medical School, Boston, MA 02115;
| | - T. H. Bø
- kDepartment for Informatics and Computational Biology Unit, University of Bergen, 5020 Bergen, Norway;
| | - I. Jonassen
- kDepartment for Informatics and Computational Biology Unit, University of Bergen, 5020 Bergen, Norway;
| | - R. K. Thomas
- hMax Planck-Institute for Neurological Research, and Klaus-Joachim-Zülch Laboratories of the Max Planck Society and the Medical Faculty of the University of Cologne, 509315 Cologne, Germany;
- lChemical Genomics Center of the Max Planck Society, 44227 Dortmund, Germany;
- mDepartment of Internal Medicine and Center of Integrated Oncology, University of Cologne, 50931 Cologne, Germany;
| | - T. Zander
- hMax Planck-Institute for Neurological Research, and Klaus-Joachim-Zülch Laboratories of the Max Planck Society and the Medical Faculty of the University of Cologne, 509315 Cologne, Germany;
| | - L. A. Garraway
- dThe Broad Institute of Harvard and MIT, Cambridge, MA 02142;
- fDepartment of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115;
- iDepartment of Medicine, Brigham and Women's Hospital, Boston, MA 02115;
- jDepartment of Medicine, Harvard Medical School, Boston, MA 02115;
- nCenter for Cancer Genome Discovery, Dana–Farber Cancer Institute, Boston, MA 02115;
| | - A. M. Øyan
- eThe Gade Institute, Section for Pathology, University of Bergen, 5020 Bergen, Norway;
| | - W. R. Sellers
- oNovartis Institutes for Biomedical Research, Cambridge, MA 02139; and
| | - K. H. Kalland
- eThe Gade Institute, Section for Pathology, University of Bergen, 5020 Bergen, Norway;
- oNovartis Institutes for Biomedical Research, Cambridge, MA 02139; and
| | - M. Meyerson
- dThe Broad Institute of Harvard and MIT, Cambridge, MA 02142;
- fDepartment of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115;
- qDepartment of Pathology, Harvard Medical School, Boston, MA 02115
| | - L. A. Akslen
- eThe Gade Institute, Section for Pathology, University of Bergen, 5020 Bergen, Norway;
- gDepartment of Pathology, Haukeland University Hospital, 5020 Bergen, Norway;
- 1To whom correspondence may be addressed. E-mail: , , or
| | - R. Beroukhim
- dThe Broad Institute of Harvard and MIT, Cambridge, MA 02142;
- fDepartment of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115;
- iDepartment of Medicine, Brigham and Women's Hospital, Boston, MA 02115;
- jDepartment of Medicine, Harvard Medical School, Boston, MA 02115;
- 1To whom correspondence may be addressed. E-mail: , , or
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2681
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Erekson EA, Sung VW, DiSilvestro PA, Myers DL. Urinary symptoms and impact on quality of life in women after treatment for endometrial cancer. Int Urogynecol J 2009; 20:159-63. [PMID: 18985266 PMCID: PMC2887706 DOI: 10.1007/s00192-008-0755-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 10/19/2008] [Indexed: 11/26/2022]
Abstract
The primary objective of our study is to describe urinary symptoms in women treated for endometrial cancer. We performed a cross-sectional survey of women who had undergone surgical treatment for endometrial cancer. Three validated questionnaires were utilized: the Sandvik Severity Index, the Urinary Distress Inventory-6 (UDI-6), and Incontinence Impact Questionaire-7 (IIQ-7). Our study included 70 women treated for endometrial cancer; 35.7% (25/70) of women reported adjuvant radiation therapy after surgical staging. Urinary incontinence was reported in over 80% of women. Mean UDI-6 and IIQ-7 scores for women treated with adjuvant radiation therapy were higher compared to women with no adjuvant radiation therapy [47(+/-26.8) vs. 35.6(+/-21.7; p = 0.05)] and [24.4(+/-28.5) vs. 8.1(+/-16.4; p = 0.004)], respectively. Treatment with adjuvant radiation therapy was associated with more severe incontinence symptoms and impact on quality of life.
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Affiliation(s)
- E A Erekson
- Division of Urogynecology and Pelvic Reconstructive Surgery, Alpert Medical School at Brown University, Women and Infants' Hospital of Rhode Island, 695 Eddy St, Ste. 12, Providence, RI 02903, USA.
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2682
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Carino C, Olawaiye AB, Cherfils S, Serikawa T, Lynch MP, Rueda BR, Gonzalez RR. Leptin regulation of proangiogenic molecules in benign and cancerous endometrial cells. Int J Cancer 2008; 123:2782-90. [PMID: 18798554 PMCID: PMC2892183 DOI: 10.1002/ijc.23887] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Several proangiogenic/proinflammatory factors involved in endometrial cancer are regulated by leptin, but the signaling mechanisms responsible for these leptin-induced actions are largely unknown. Here, we report that in benign (primary and HES) and cancerous-endometrial epithelial cells (EEC) (An3Ca, SK-UT2 and Ishikawa), leptin in a dose-dependent manner regulates vascular endothelial growth factor, (VEGF); interleukin-1 beta, (IL-1beta); leukemia inhibitory factor, (LIF) and their respective receptors, VEGFR2, IL-1R tI and LIFR. Remarkably, leptin induces a greater increase in VEGF/VEGFR2 and LIF levels in cancer than in benign cells. However, IL-1beta was only increased by leptin in benign primary-EEC. Cancer-EEC expressed higher levels of leptin receptor (full-length OB-Rb and short isoforms) in contrast to benign primary-EEC. Leptin-mediated activation of JAK2 (janus kinase 2) was upstream to the activation of PI-3K (phosphatidylinositol-3 kinase) and/or MAPK (mitogen-activated protein kinase) signaling pathways. Leptin induction of cytokines/receptors generally involved JAK2 and MAPK activation, but PI-3K phosphorylation was required for leptin increase of LIF, IL-1/IL-1R tI. Leptin-mediated activation of mTOR (mammalian target of Rapamycin), mainly linked to MAPK, played a central role in leptin regulation of all cytokines and receptors. These results suggest that leptin's effects are cell-specific and could confer a proliferative or cell survival advantage or possibly promote endometrial thickness. Leptin's effects on proangiogenic molecules were more evident in malignant versus benign cells and may imply that there is an underlying shift in leptin-induced cell signaling pathways in endometrial cancer cells.
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Affiliation(s)
- Cecilia Carino
- Boston Biomedical Research Institute (BBRI), 64 Grove St., Watertown, MA 02472
| | - Alexander B. Olawaiye
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
| | | | - Takehiro Serikawa
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
| | - Maureen P. Lynch
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
| | - Bo R. Rueda
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
| | - Ruben R. Gonzalez
- Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310
- Boston Biomedical Research Institute (BBRI), 64 Grove St., Watertown, MA 02472
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA 02114
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2683
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Nishimura S, Tsuda H, Miyagi Y, Hirasawa A, Suzuki A, Kataoka F, Nomura H, Chiyoda T, Banno K, Fujii T, Susumu N, Aoki D. Can ABCF2 protein expression predict the prognosis of uterine cancer? Br J Cancer 2008; 99:1651-5. [PMID: 19002184 PMCID: PMC2584961 DOI: 10.1038/sj.bjc.6604734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/13/2008] [Accepted: 09/23/2008] [Indexed: 11/16/2022] Open
Abstract
Uterine cervical and endometrial cancers are common malignant solid neoplasms for which there are no useful prognostic markers. In this study, we evaluate the relationship between ATP-binding cassette superfamily F2 (ABCF2) expression and clinical factors including clinical stage, histologic type, grade and prognosis in uterine cervical and endometrial cancer. Two hundred and sixty seven cervical and 103 endometrial cancers were studied. ATP-binding cassette superfamily F2 cytoplasmic expression was detected by immunohistochemical staining and scored as positive or negative. Among cervical cancer cases, 149 (55.8%) expressed ABCF2. The overall survival was longer in ABCF2-negative than ABCF2-positive cases (P=0.0069). Statistically significant prognostic factors for survival were ABCF2 positivity (risk ratio (rr)=1.437), old age (rr=1.550) and advanced stage (rr=2.577). ATP-binding cassette superfamily F2 positivity was an independent prognostic factor by multivariate proportional hazard test (P=0.0002). Among endometrial cancer cases, 72 (69.9%) were cytoplasmic ABCF2 positive. However, there was no significant relationship between ABCF2 expression and age, clinical stage, histologic type, histologic grade, oestrogen receptor status or prognosis. ATP-binding cassette superfamily F2 expression may be a useful prognostic marker in cervical but not endometrial cancer. The role of ABCF2 protein may differ depending on the type of cancer.
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Affiliation(s)
- S Nishimura
- Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka, Japan
| | - H Tsuda
- Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka, Japan
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo Japan
| | - Y Miyagi
- Department of Obstetrics and Gynecology, Okayama Ohfuku Clinic, Okayama, Japan
| | - A Hirasawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo Japan
| | - A Suzuki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo Japan
| | - F Kataoka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo Japan
| | - H Nomura
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo Japan
| | - T Chiyoda
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo Japan
| | - K Banno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo Japan
| | - T Fujii
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo Japan
| | - N Susumu
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo Japan
| | - D Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo Japan
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2684
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Hoekstra AV, Kim JJ, Keh P, Schink JC. Absence of progesterone receptors in a failed case of fertility-sparing treatment in early endometrial cancer: a case report. J Reprod Med 2008; 53:869-873. [PMID: 19097521 PMCID: PMC4780569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Fertility-sparing treatment may be offered as an alternative to standard surgical management of early-stage, well-differentiated endometrial cancer in young women. Immunostaining for progesterone receptor (PR) status is not currently part of the standard workup before treatment recommendations are made. CASE We describe a 29-year-old woman who used oral contraceptive pills on a long-term basis in whom early-stage, well-differentiated endometrial cancer was diagnosed. Progestin therapy failed and the tumor was subsequently found to be PR negative. CONCLUSION Combination oral contraceptive pills may stimulate clonal expansion of endometrial cells that lack PR, leading to endometrial adenocarcinoma unresponsive to progestin therapy. Consideration should be given to PR immunostaining for confirmation of the receptor status and evaluation of appropriate management options when counseling patients about fertility-sparing therapy.
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Affiliation(s)
- Anna V Hoekstra
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, USA.
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2685
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Dutt A, Salvesen HB, Chen TH, Ramos AH, Onofrio RC, Hatton C, Nicoletti R, Winckler W, Grewal R, Hanna M, Wyhs N, Ziaugra L, Richter DJ, Trovik J, Engelsen IB, Stefansson IM, Fennell T, Cibulskis K, Zody MC, Akslen LA, Gabriel S, Wong KK, Sellers WR, Meyerson M, Greulich H. Drug-sensitive FGFR2 mutations in endometrial carcinoma. Proc Natl Acad Sci U S A 2008; 105:8713-7. [PMID: 18552176 PMCID: PMC2438391 DOI: 10.1073/pnas.0803379105] [Citation(s) in RCA: 284] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Oncogenic activation of tyrosine kinases is a common mechanism of carcinogenesis and, given the druggable nature of these enzymes, an attractive target for anticancer therapy. Here, we show that somatic mutations of the fibroblast growth factor receptor 2 (FGFR2) tyrosine kinase gene, FGFR2, are present in 12% of endometrial carcinomas, with additional instances found in lung squamous cell carcinoma and cervical carcinoma. These FGFR2 mutations, many of which are identical to mutations associated with congenital craniofacial developmental disorders, are constitutively activated and oncogenic when ectopically expressed in NIH 3T3 cells. Inhibition of FGFR2 kinase activity in endometrial carcinoma cell lines bearing such FGFR2 mutations inhibits transformation and survival, implicating FGFR2 as a novel therapeutic target in endometrial carcinoma.
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Affiliation(s)
- Amit Dutt
- *Department of Medical Oncology and
- †The Broad Institute of MIT and Harvard, Cambridge, MA 02142;
| | - Helga B. Salvesen
- ‡Department of Clinical Medicine and
- §Obstetrics and Gynecology, Haukeland University Hospital, N-5020 Bergen, Norway; and
| | - Tzu-Hsiu Chen
- *Department of Medical Oncology and
- †The Broad Institute of MIT and Harvard, Cambridge, MA 02142;
| | - Alex H. Ramos
- *Department of Medical Oncology and
- †The Broad Institute of MIT and Harvard, Cambridge, MA 02142;
| | | | - Charlie Hatton
- ¶Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA 02115;
- †The Broad Institute of MIT and Harvard, Cambridge, MA 02142;
| | - Richard Nicoletti
- *Department of Medical Oncology and
- †The Broad Institute of MIT and Harvard, Cambridge, MA 02142;
| | - Wendy Winckler
- ¶Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA 02115;
- †The Broad Institute of MIT and Harvard, Cambridge, MA 02142;
| | - Rupinder Grewal
- ¶Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA 02115;
- †The Broad Institute of MIT and Harvard, Cambridge, MA 02142;
| | - Megan Hanna
- ¶Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA 02115;
- †The Broad Institute of MIT and Harvard, Cambridge, MA 02142;
| | - Nicolas Wyhs
- ¶Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA 02115;
- †The Broad Institute of MIT and Harvard, Cambridge, MA 02142;
| | - Liuda Ziaugra
- †The Broad Institute of MIT and Harvard, Cambridge, MA 02142;
| | | | - Jone Trovik
- ‡Department of Clinical Medicine and
- §Obstetrics and Gynecology, Haukeland University Hospital, N-5020 Bergen, Norway; and
| | - Ingeborg B. Engelsen
- ‡Department of Clinical Medicine and
- §Obstetrics and Gynecology, Haukeland University Hospital, N-5020 Bergen, Norway; and
| | - Ingunn M. Stefansson
- ‖The Gade Institute, Section for Pathology, University of Bergen, N-5020 Bergen, Norway;
- Departments of **Pathology and
| | | | | | | | - Lars A. Akslen
- ‖The Gade Institute, Section for Pathology, University of Bergen, N-5020 Bergen, Norway;
- Departments of **Pathology and
| | - Stacey Gabriel
- †The Broad Institute of MIT and Harvard, Cambridge, MA 02142;
| | - Kwok-Kin Wong
- *Department of Medical Oncology and
- ††Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115;
| | | | - Matthew Meyerson
- *Department of Medical Oncology and
- ¶Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA 02115;
- §§Department of Pathology, Harvard Medical School, Boston, MA 02115;
- †The Broad Institute of MIT and Harvard, Cambridge, MA 02142;
- ¶¶To whom correspondence may be addressed. E-mail: or
| | - Heidi Greulich
- *Department of Medical Oncology and
- ††Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115;
- †The Broad Institute of MIT and Harvard, Cambridge, MA 02142;
- ¶¶To whom correspondence may be addressed. E-mail: or
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2686
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Small W, Mell LK, Anderson P, Creutzberg C, De Los Santos J, Gaffney D, Jhingran A, Portelance L, Schefter T, Iyer R, Varia M, Winter K, Mundt AJ. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys 2008; 71:428-34. [PMID: 18037584 PMCID: PMC2752724 DOI: 10.1016/j.ijrobp.2007.09.042] [Citation(s) in RCA: 258] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 09/20/2007] [Accepted: 09/20/2007] [Indexed: 11/17/2022]
Abstract
PURPOSE To develop an atlas of the clinical target volume (CTV) definitions for postoperative radiotherapy of endometrial and cervical cancer to be used for planning pelvic intensity-modulated radiotherapy. METHODS AND MATERIALS The Radiation Therapy Oncology Group led an international collaboration of cooperative groups in the development of the atlas. The groups included the Radiation Therapy Oncology Group, Gynecologic Oncology Group, National Cancer Institute of Canada, European Society of Therapeutic Radiology and Oncology, and American College of Radiology Imaging Network. The members of the group were asked by questionnaire to define the areas that were to be included in the CTV and to outline theses areas on individual computed tomography images. The initial formulation of the group began in late 2004 and culminated with a formal consensus conference in June 2005. RESULTS The committee achieved a consensus CTV definition for postoperative therapy for endometrial and cervical cancer. The CTV should include the common, external, and internal iliac lymph node regions. The upper 3.0 cm of the vagina and paravaginal soft tissue lateral to the vagina should also be included. For patients with cervical cancer, or endometrial cancer with cervical stromal invasion, it is also recommended that the CTV include the presacral lymph node region. CONCLUSION This report serves as an international template for the definition of the CTV for postoperative intensity-modulated radiotherapy for endometrial and cervical cancer.
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Affiliation(s)
- William Small
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA.
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2687
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Nayot D, Kwon J, Carey M, Driedger A. Does preoperative positron emission tomography with computed tomography predict nodal status in endometrial cancer? A pilot study. Curr Oncol 2008; 15:123-5. [PMID: 18596888 PMCID: PMC2442761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Fewer than 20% of women with endometrial cancer have positive nodes, and an accurate noninvasive imaging modality to assess lymph node status would be helpful in selecting those who need lymphadenectomy. The objective of this pilot study was to evaluate positron emission tomography with computed tomography (pet-ct) in predicting nodal status before surgery for endometrial cancer. Twelve patients were enrolled at a single tertiary care centre. The sensitivity and specificity of preoperative pet-ct in predicting nodal status were 53.3% and 99.6% respectively. Using pet-ct, all metastatic nodes may not necessarily be detected, especially nodes with microscopic disease. The sensitivity of this imaging modality has to be improved before it can routinely be used in the preoperative evaluation of endometrial cancer.
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Affiliation(s)
- D. Nayot
- Department of Obstetrics and Gynecology, University of Toronto, ON
| | - J.S. Kwon
- Department of Gynecologic Oncology, M.D. Anderson Cancer Center, Houston, TX, U.S.A,Correspondence to: Janice S. Kwon, Department of Gynecologic Oncology, M.D. Anderson Cancer Center, PO Box 301439, Houston, Texas 77230-1439 U.S.A. E-mail:
| | - M.S. Carey
- Department of Systems Biology, M.D. Anderson Cancer Center, Houston, TX, U.S.A
| | - A. Driedger
- Department of Nuclear Medicine, University of Western Ontario, ON
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2688
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Lee JH, Jung US, Kyung MS, Choi JS. Laparoscopic-assisted staging surgery for Korean women with endometrial cancer. JSLS 2008; 12:150-5. [PMID: 18435887 PMCID: PMC3016180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE In recent years, the incidence of endometrial cancer has gradually increased in Korea, and the use of laparoscopically assisted staging surgery (LASS) is increasing in this field. We conducted this study to evaluate the feasibility of LASS in Korean women with endometrial cancer. METHODS We conducted a retrospective review of 35 Korean women with endometrial cancer who were managed laparoscopically. RESULTS The median age and BMI were 57 years (range, 28 to 81) and 25.8 kg/m2 (range, 20.9 to 37.2), respectively. The median operating time, estimated blood loss, and length of hospital stay were, respectively, 150 minutes (range, 95 to 410), 250 mL (range, 50 to 1000), and 8 days (range, 3 to 20). No conversion to laparotomy was noted. The median number of harvested lymph nodes was 22 (range, 10 to 41) in pelvic lymph nodes and 7 (range, 2 to 21) in paraaortic lymph nodes. No vault recurrence or port-site metastasis was noted until the last follow-up. CONCLUSIONS LASS can be performed without additional morbidity and complications, and might be feasible in Korean women with endometrial cancer.
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2689
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Bulun SE, Chen D, Lu M, Zhao H, Cheng Y, Demura M, Yilmaz B, Martin R, Utsunomiya H, Thung S, Su E, Marsh E, Hakim A, Yin P, Ishikawa H, Amin S, Imir G, Gurates B, Attar E, Reierstad S, Innes J, Lin Z. Aromatase excess in cancers of breast, endometrium and ovary. J Steroid Biochem Mol Biol 2007; 106:81-96. [PMID: 17590327 PMCID: PMC2766613 DOI: 10.1016/j.jsbmb.2007.05.027] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pathogenesis and growth of three common women's cancers (breast, endometrium and ovary) are linked to estrogen. A single gene encodes the key enzyme for estrogen biosynthesis named aromatase, inhibition of which effectively eliminates estrogen production in the entire body. Aromatase inhibitors successfully treat breast cancer, whereas their roles in endometrial and ovarian cancers are less clear. Ovary, testis, adipose tissue, skin, hypothalamus and placenta express aromatase normally, whereas breast, endometrial and ovarian cancers overexpress aromatase and produce local estrogen exerting paracrine and intracrine effects. Tissue-specific promoters distributed over a 93-kb regulatory region upstream of a common coding region alternatively control aromatase expression. A distinct set of transcription factors regulates each promoter in a signaling pathway- and tissue-specific manner. In cancers of breast, endometrium and ovary, aromatase expression is primarly regulated by increased activity of the proximally located promoter I.3/II region. Promoters I.3 and II lie 215 bp from each other and are coordinately stimulated by PGE(2) via a cAMP-PKA-dependent pathway. In breast adipose fibroblasts exposed to PGE(2) secreted by malignant epithelial cells, PKC is also activated, and this potentiates cAMP-PKA-dependent induction of aromatase. Thus, inflammatory substances such as PGE(2) may play important roles in inducing local production of estrogen that promotes tumor growth.
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Affiliation(s)
- Serdar E Bulun
- Robert H. Lurie Comprehensive Cancer Center and Division of Reproductive Biology Research, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611, USA.
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2690
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Wild SH, Bryden JR, Lee RJ, Bishop JL, Finlayson AR, Byrne CD, Brewster DH. Cancer, cardiovascular disease and diabetes mortality among women with a history of endometrial cancer. Br J Cancer 2007; 96:1747-9. [PMID: 17453005 PMCID: PMC2359928 DOI: 10.1038/sj.bjc.6603761] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 03/30/2007] [Accepted: 04/02/2007] [Indexed: 11/17/2022] Open
Abstract
Among 7182 women with endometrial cancer in Scotland, standardised mortality ratios (and 95% confidence intervals (CI)) were 6.38 (5.74-7.15) for all cancers and 1.10 (1.00-1.22) for circulatory diseases as underlying cause of death and 2.81 (2.19-3.70) for diabetes as underlying/contributory cause of death.
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Affiliation(s)
- S H Wild
- Public Health Sciences, University of Edinburgh, Scotland, UK.
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2691
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Jiang S, Dowdy SC, Meng XW, Wang Z, Jones MB, Podratz KC, Jiang SW. Histone deacetylase inhibitors induce apoptosis in both Type I and Type II endometrial cancer cells. Gynecol Oncol 2007; 105:493-500. [PMID: 17303224 PMCID: PMC3273418 DOI: 10.1016/j.ygyno.2007.01.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 12/29/2006] [Accepted: 01/03/2007] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To characterize the molecular pathways involved in apoptosis following administration of histone deacetylase inhibitors to Type I and II endometrial cancer cells. METHODS Ark2, Ishikawa, and AN3 cell lines representing both Type I and II endometrial cancers were treated with various concentrations of oxamflatin and HDAC inhibitor-1. Cell apoptosis was determined by flow cytometry, nuclear staining, Western blotting, and mitochondrial membrane potential assays. RESULTS Compared to controls, there was a 95% reduction in the growth of Ark2 cells following administration of histone deacetylase inhibitors and this response was dose-dependent. These agents also caused profound morphologic changes and loss of mitochondrial membrane potentials consistent with the induction of apoptosis. Cleavage of PARP, caspase-9, and caspase-8 was detected, confirming the activation of apoptotic cascades in endometrial carcinoma cells. This effect was present in both serous and endometrioid cell types. CONCLUSION Our results suggest that oxamflatin and HDAC inhibitor-1 have potent cytotoxicity in endometrial cancer cells by inducing cell apoptosis. Histone deacetylase inhibitors are promising agents for the treatment of both Type I and II endometrial carcinoma.
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Affiliation(s)
| | - Sean C. Dowdy
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA
| | - Xue W. Meng
- Department of Pharmacology, Mayo Clinic, Rochester, MN 55905, USA
| | - Zhaoyu Wang
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA
| | - Monica B. Jones
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA
| | - Karl C. Podratz
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA
| | - Shi-Wen Jiang
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA
- Corresponding author. 200 1st St. SW, Rochester, MN 55905, USA. Fax: +1 507 266 9300. (S.-W. Jiang)
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2692
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Zighelboim I, Babb S, Gao F, Powell MA, Mutch DG, Goodfellow PJ. Excess of early onset multiple myeloma in endometrial cancer probands and their relatives suggests common susceptibility. Gynecol Oncol 2007; 105:390-4. [PMID: 17336372 PMCID: PMC2577217 DOI: 10.1016/j.ygyno.2006.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 11/27/2006] [Accepted: 12/22/2006] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Determine whether there is an association between uterine cancer and multiple myeloma. METHODS Data on second malignancies were obtained for 368 uterine corpus cancer patients treated between 1992 and 2005. Detailed family histories were devised for 192 probands. Diagnoses of multiple myelomas, lymphomas and leukemias in family members were medical record verified. The frequency of multiple myeloma among uterine cancer patients was compared to the female age-adjusted incidence rate of multiple myeloma obtained from the SEER database. The crude rate of multiple myeloma (as well as Hodgkin's, non-Hodgkin's lymphomas and leukemias) among first-degree relatives of patients with uterine cancer was compared to the age-adjusted incidence rate of multiple myeloma in the general population. Descriptive statistics were used to evaluate disease and cohort characteristics. A P value less than 0.05 was considered statistically significant. RESULTS Two of 368 uterine cancer patients were also diagnosed with multiple myeloma, both at age 50. The observed incidence of multiple myeloma in this cohort (543 per 100,000; 95% CI: 66-1962 per 100,000) represents a 120-fold increase based on predicted incidence (P=0.00014). The frequency of multiple myeloma in first-degree relatives was 2/1351 (148 per 100,000; 95% CI: 14.8-533 per 100,000) which represents a 27-fold increase compared to the general population (P=0.0026). The frequencies of leukemias and lymphomas in these family members on the other hand were not significantly increased (P=0.152 and P=0.218). CONCLUSION This specific excess frequency of early onset multiple myeloma in endometrial cancer probands and their relatives suggests shared susceptibility.
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Affiliation(s)
- Israel Zighelboim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center. 4911 Barnes Jewish Plaza, Box 8064, St. Louis, MO 63110
| | - Sheri Babb
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center. 4911 Barnes Jewish Plaza, Box 8064, St. Louis, MO 63110
| | - Feng Gao
- Division of Biostatistics, Washington University School of Medicine and Siteman Cancer Center. 660 South Euclid Avenue, Box 8067, St. Louis, MO 63110
| | - Matthew A. Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center. 4911 Barnes Jewish Plaza, Box 8064, St. Louis, MO 63110
| | - David G. Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center. 4911 Barnes Jewish Plaza, Box 8064, St. Louis, MO 63110
| | - Paul J. Goodfellow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center. 4911 Barnes Jewish Plaza, Box 8064, St. Louis, MO 63110
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Washington University School of Medicine and Siteman Cancer Center. 660 South Euclid Avenue, Box 8067, St. Louis, MO 63110
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2693
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Löf M, Sandin S, Hilakivi-Clarke L, Weiderpass E. Birth weight in relation to endometrial and breast cancer risks in Swedish women. Br J Cancer 2007; 96:134-6. [PMID: 17146473 PMCID: PMC2360202 DOI: 10.1038/sj.bjc.6603504] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Revised: 10/30/2006] [Accepted: 11/03/2006] [Indexed: 11/16/2022] Open
Abstract
An examination of birth weight in a Swedish cohort study of 38,566 women showed no significant association between birth weight and endometrial cancer, but supported a protective role for low birth weight for premenopausal breast cancer.
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Affiliation(s)
- M Löf
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, PO 281, SE-171 77, Stockholm, Sweden.
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2694
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Abstract
Estrogen-related receptor (ERR) was studied in the placenta and uterine endometrium, especially endometrial cancers, among reproductive organs. In the placenta, the estrogen receptor (ER) alpha and beta mRNA levels increased from the first to the second trimester, and then decreased until normal term delivery. Estrogen-related receptor alpha, beta and gamma mRNA levels gradually increased up to the second trimester, and then comparatively rapidly increased until normal term delivery. In endometrial cancers, ER alpha and beta mRNA levels decreased with clinical stage, myometrial invasion and dedifferentiation. Estrogen-related receptor alpha levels increased with clinical stage and myometrial invasion, and the ERR gamma levels increased with myometrial invasion. Estrogen-related receptors can bind to the steroid receptor coactivator family without any ligands, and drive transcription activity of the target genes. The manner of ERR and ER gene expressions might show a competitive interaction associated with the use of common cofactors. It is speculated that the upregulation of ERR is related to the placental growth after the downregulation of ER from the second trimester until delivery, and that ERR alpha and gamma are candidates for prognostic factors in endometrial cancer, although ERR are not directly related to tumor growth and advancement of endometrial cancer. (Reprod Med Biol 2005; 4: 129-131).
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Affiliation(s)
- Jiro Fujimoto
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu City, Japan
| | - Yumiko Nakagawa
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu City, Japan
| | - Hiroshi Toyoki
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu City, Japan
| | - Hideki Sakaguchi
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu City, Japan
| | - Eriko Sato
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu City, Japan
| | - Teruhiko Tamaya
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu City, Japan
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2695
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Zorlu CG, Simsek T, Ari ES. Laparoscopy or laparotomy for the management of endometrial cancer. JSLS 2005; 9:442-6. [PMID: 16381364 PMCID: PMC3015649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility of laparoscopy in the management of early stage endometrial cancer. METHODS Fifty-two patients with endometrial cancer who underwent surgical staging consisting of total hysterectomy, bilateral salpingo-oophorectomy with pelvic lymph node dissection, and cytology between 1998 to 2002 were included in the study. Laparotomy and laparoscopy were randomly offered to patients upon admittance. RESULTS Of 52 patients, 26 underwent laparotomy and the remaining 26 underwent laparoscopic staging surgery. No significant difference existed between the demographic characteristics of the 2 groups. The mean number of harvested lymph nodes was 18.2 in the laparoscopic group and 21.1 in the laparotomic group (P>0.05). Pelvic lymph node metastases were detected in 7.7% of the patients in the laparoscopy group and 15.4% in the laparotomy group, and the difference was not significant. Adjuvant radiotherapy was applied later to 42.3% of the laparoscopy group and 38.5% of the laparotomy group. Operative morbidity was higher in the laparotomy group mainly because of postoperative wound infection, and the patients in the laparotomy group had a longer hospital stay. CONCLUSION Laparoscopic surgery is a method that can be applied as well as laparotomy in the management of endometrial cancer. Lymph node number and detection of lymph node metastasis did not differ significantly in laparotomic and laparoscopic approaches. Wound infections were more frequent in laparotomies.
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2696
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Abstract
Angiogenesis is critical for the growth and metastasis of endometrial cancer and is therefore an important therapeutic target. Vascular endothelial growth factor-A (VEGF-A) is a key molecule in angiogenesis, but the identification of related molecules and the angiopoietins suggests a more complex picture. We investigated the presence of transcripts for VEGF-A, VEGF-B, VEGF-C, VEGF-D, Angiopoietin-1 and Angiopoietin-2 in benign endometrium, atypical complex hyperplasia (ACH) and endometrioid endometrial carcinoma using in situ hybridisation. We confirmed the presence of VEGF-A mRNA in the epithelial cells of cancers examined (13 out of 13), but not in benign endometrium or ACH. We also demonstrate, using quantitative polymerase chain reaction, that levels of VEGF-B mRNA are significantly lower in endometrial cancer than benign endometrium. We conclude that loss of VEGF-B may contribute to the development of endometrial carcinoma by modulating availability of receptors for VEGF-A.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Angiogenesis Inducing Agents/biosynthesis
- Angiogenesis Inducing Agents/genetics
- Angiopoietin-1
- Angiopoietin-2
- Antigens, CD/biosynthesis
- Antigens, CD/genetics
- Antigens, Differentiation, Myelomonocytic/biosynthesis
- Antigens, Differentiation, Myelomonocytic/genetics
- Endometrial Hyperplasia/genetics
- Endometrial Hyperplasia/metabolism
- Endometrial Neoplasms/genetics
- Endometrial Neoplasms/metabolism
- Endothelial Growth Factors/biosynthesis
- Endothelial Growth Factors/genetics
- Epithelium/metabolism
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Immunohistochemistry
- In Situ Hybridization
- Intercellular Signaling Peptides and Proteins/biosynthesis
- Intercellular Signaling Peptides and Proteins/genetics
- Keratins/biosynthesis
- Keratins/genetics
- Lymphokines/biosynthesis
- Lymphokines/genetics
- Membrane Glycoproteins/biosynthesis
- Membrane Glycoproteins/genetics
- Middle Aged
- RNA, Messenger/analysis
- Reverse Transcriptase Polymerase Chain Reaction
- Transcription, Genetic
- Vascular Endothelial Growth Factor A
- Vascular Endothelial Growth Factors
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Affiliation(s)
- C M Holland
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB1 1QP, UK.
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2697
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Ciatto S, Cecchini S, Gervasi G, Landini A, Zappa M, Crocetti E. Surveillance for endometrial cancer with transvaginal ultrasonography of breast cancer patients under tamoxifen treatment. Br J Cancer 2003; 88:1175-9. [PMID: 12698180 PMCID: PMC2747558 DOI: 10.1038/sj.bjc.6600894] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The association of endometrial thickness with the risk of developing endometrial cancer (EC) within 2 years was investigated in a consecutive cohort of 1205 breast cancer patients under tamoxifen treatment, undergoing transvaginal ultrasonography (TVUS) for follow-up purpose (asymptomatic, 1068) or for abnormal uterine bleeding (AUB, 137). Linkage with tumour registry allowed for the follow-up of 3184.3 person-years. According to underlying incidence, 1.85 EC cases were expected in the study cohort while 12 were observed (observed/expected ratio=6.49, 95% CI 3.35-11.33; asymptomatic=4.09, 95% CI 1.65-8.43, symptomatic=35.71, 95% CI 11.59-83.34). No EC was observed with thickness (half layer) <3 mm. Raising this threshold increased specificity with a substantial loss of sensitivity (>or=3, >or=4, >or=6, >or=9 mm; spec.=25.8, 44.5, 76.1, 91.5%, sens.=100, 91.6, 75.0, 66.6%). The presence of AUB was rather specific (88.94%) but poorly sensitive (41.67%). A combination of AUB presence/absence and thickness allowed the best accuracy (AUB + thickness >or=3, >or=4 or >or=5; sens.=100, 81.6 or 91.6%; spec.=22.8, 40.4, or 56.7%). Breast cancer patients under tamoxifen might be selected for further invasive assessment on the basis of AUB and endometrial thickness assessed at TVUS.
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Affiliation(s)
- S Ciatto
- Centro per lo Studio e la Prevenzione Oncologica, Firenze, Italy.
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2698
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Crawford SC, De Caestecker L, Gillis CR, Hole D, Davis JA, Penney G, Siddiqui NA. Staging quality is related to the survival of women with endometrial cancer: a Scottish population based study. Deficient surgical staging and omission of adjuvant radiotherapy is associated with poorer survival of women diagnosed with endometrial cancer in Scotland during 1996 and 1997. Br J Cancer 2002; 86:1837-42. [PMID: 12085172 PMCID: PMC2375426 DOI: 10.1038/sj.bjc.6600358] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2001] [Revised: 03/26/2002] [Accepted: 04/12/2002] [Indexed: 11/09/2022] Open
Abstract
The association between treatment variation and survival of women with endometrial cancer was investigated. A retrospective cohort based upon the complete Scottish population registered on in-patient and day-case hospital discharge data (Scottish Morbidity Record-1) and cancer registration (Scottish Morbidity Record-6) coded C54 and C55 in ICD10, between 1st January 1996 to 31st December 1997 were analysed. Seven hundred and three patients who underwent surgical treatment out of 781 patients that were diagnosed with endometrial cancer in Scotland during 1996 and 1997. The overall quality of surgical staging was poor. The quality of staging was related to both the year that the surgeon passed the Member of the Royal College of Obstetricians and Gynaecologists examination and also to 'specialist' status but was not related to surgeon caseload. Two clinically important prognostic factors were found to be associated with survival; whether the International Federation of Obstetrics and Gynaecology stage was documented, RHR=2.0 (95% CI=1.3 to 3.1) and also to the use of adjuvant radiotherapy, RHR=2.2 (95% CI=1.5 to 3.5). The associations with survival were strongest in patients with advanced disease, International Federation of Obstetrics and Gynaecology stages 1C through to stage 3. Deficiencies in staging and variations in the use of adjuvant radiotherapy represent a possible source of avoidable mortality in patients with endometrial cancer. Consequently, there should be a greater emphasis on improving the overall quality of surgical staging in endometrial cancer.
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Affiliation(s)
- S C Crawford
- Department of Gynaecological Oncology, Stobhill Hospital Glasgow G21 3UW, UK.
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2699
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Holub Z, Jabor A, Bartos P, Eim J, Kliment L. Laparoscopic pelvic lymphadenectomy in the surgical treatment of endometrial cancer: results of a multicenter study. JSLS 2002; 6:125-31. [PMID: 12113415 PMCID: PMC3043417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To analyze the results and determine the contribution of laparoscopic pelvic lymphadenectomy in the surgical treatment of women with endometrial cancer and compare with the open technique. METHODS A prospective multicenter study was carried out on 120 women who underwent laparoscopic surgery (96 women) and open procedures (24 women) for endometrial cancer between April 1996 and March 2000. RESULTS Four patients whose laparoscopic surgery was completed by laparotomy were excluded from the study. The other 92 laparoscopic procedures were successfully completed. Laparoscopically assisted surgical staging (LASS) was performed based on the grade of the tumor and the depth of myometrial invasion. Sixty-seven of the patients underwent hysterectomy, bilateral salpingooophorectomy (BSO), and pelvic lymphadenectomy, and 25 women also had para-aortic lymph node sampling dissection. Eleven of these patients had positive pelvic or para-aortic nodes. The mean operating time for the laparoscopic procedure was significantly longer (173.8 min, P < 0.0001) than the time for the open procedure (135.0 min). The rate of complications was similar in both groups. The recovery time was significantly reduced (P < 0.0001). CONCLUSION The laparoscopic approach to hysterectomy and lymphadenectomy for early stage endometrial carcinoma is an attractive alternative to the abdominal surgical approach. The advantages of laparoscopically assisted surgical staging are patient related. Because the abdominal incision is avoided, the recovery time is reduced. Laparoscopic pelvic lymph node dissection is a procedure that is appropriate, when applicable.
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Affiliation(s)
- Zdenek Holub
- Department of Obstetrics and Gynecology, Baby Friendly Hospital, Kladno, Czech Republic.
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2700
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Noci I, Borri P, Bonfirraro G, Chieffi O, Arcangeli A, Cherubini A, Dabizzi S, Buccoliero AM, Paglierani M, Taddei GL. Longstanding survival without cancer progression in a patient affected by endometrial carcinoma treated primarily with leuprolide. Br J Cancer 2001; 85:333-6. [PMID: 11487260 PMCID: PMC2364073 DOI: 10.1054/bjoc.2001.1900] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report here a case of a patient affected by endometrial cancer and treated primarily with leuprolide, the surgical approach being unfeasible due to her compromised conditions. The therapy was continued for more than 6 years, and no progression of the disease was observed. During this period, some histological and immunohistochemical evaluations of the tumour (morphology, grading, proliferation and apoptotic index, E-cadherin expression) were performed. Furthermore, the expression of m-RNA for luteinizing-hormone releasing hormone (LHRH) receptors was determined. The results showed a discrepancy between some biological parameters of the tumour and its clinical characteristics. In fact, despite features suggestive of a progression of the cancer (such as the increase of both tumour grading and proliferating capacity (MIB-1), and a fall in the reparative process (appearance of mutated p53, reduced expression of both bcl-2 and c-erb-2) being detected, neither local invasion nor metastatic lesions were clinically observed. This discrepancy might be due to the maintenance of high levels of E-cadhezin. Moreover, since this tumour was shown to express mRNA for LHRH receptors, new evidence is provided about the favourable impact of LHRH analogue treatment in patients affected by endometrial cancer.
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Affiliation(s)
- I Noci
- Department of Gynaecology, Perinatal Medicine and Human Reproduction, University of Florence, viale G. B. Morgagni 85, 50134, Firenze, Italy
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