51
|
Cho SH, Lee JY, Nam EJ, Kim S, Kim YT, Kim SW. Comparison of Single-Port Laparoscopy with Other Surgical Approaches in Endometrial Cancer Surgical Staging: Propensity-Score-Matched Analysis. Cancers (Basel) 2023; 15:5322. [PMID: 38001582 PMCID: PMC10670050 DOI: 10.3390/cancers15225322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
This single-institution, retrospective study aimed to compare the surgical outcomes of single-port, multi-port, and robot-assisted laparoscopy, as well as laparotomy, in patients with endometrial cancer who underwent surgical staging between January 2006 and December 2017. This study evaluated various parameters, including disease-free survival (DFS), overall survival (OS), recurrence rate (RR), recurrence site, and intra- and postoperative complications. Propensity score matching was performed to account for baseline characteristics, and a total of 881 patients were included in the analysis. The 3-year DFS of single-port laparoscopy was similar to that of the other groups, but laparotomy exhibited a lower 3-year DFS compared to multi-port (p = 0.001) and robot-assisted (p = 0.031) laparoscopy. Single-port laparoscopy resulted in a significantly higher 3-year OS than laparotomy (p = 0.013). After propensity score matching, the four groups demonstrated similar survival outcomes (3-year DFS: p = 0.533; 3-year OS: p = 0.328) and recurrence rates (10.3%, 12.1%, 10.3%, and 15.9% in the single-port, multi-port, and robot-assisted laparoscopy and laparotomy groups, respectively, p = 0.552). Recurrence most commonly occurred in distant organs. The single-port laparoscopy group had the longest operative time (205.1 ± 76.9 min) but the least blood loss (69.5 ± 90.8 mL) and the shortest postoperative hospital stay (5.2 ± 2.3 days). In contrast, the laparotomy group had the shortest operative time (163.4 ± 51.0 min) but the highest blood loss (368.3 ± 326.4 mL) and the longest postoperative hospital stay (10.3 ± 4.6 days). The transfusion rate was 0% in the single-port laparoscopy group and 3.7% in the laparotomy group. Notably, the laparotomy group had the highest wound complication rate (p = 0.001), whereas no wound hernias were observed in the three minimally invasive approaches. In conclusion, the survival outcomes were comparable between the methods, with the benefit of lower blood loss and shorter hospital stay observed in the single-port laparoscopy group. This study suggests that single-port laparoscopy is a feasible approach for endometrial cancer surgical staging.
Collapse
Affiliation(s)
- Sang Hyun Cho
- Department of Obstetrics and Gynecology, Graduate School, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
- Department of Obstetrics and Gynecology, St. Vincent’s Hospital, The Catholic University of Korea, Suwon 16247, Republic of Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
| |
Collapse
|
52
|
Chen J, Liu J, Cao D. Urine metabolomics for assessing fertility-sparing treatment efficacy in endometrial cancer: a non-invasive approach using ultra-performance liquid chromatography mass spectrometry. BMC Womens Health 2023; 23:583. [PMID: 37940929 PMCID: PMC10634093 DOI: 10.1186/s12905-023-02730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE This study aimed to reveal the urine metabolic change of endometrial cancer (EC) patients during fertility-sparing treatment and establish non-invasive predictive models to identify patients with complete remission (CR). METHOD This study enrolled 20 EC patients prior to treatment (PT) and 22 patients with CR, aged 25-40 years. Eligibility criteria consisted of stage IA high-grade EC, lesions confined to endometrium, normal hepatic and renal function, normal urine test, no contraindication for fertility-sparing treatment and no prior therapy. Urine samples were analyzed using ultraperformance liquid chromatography mass spectrometry (UPLC-MS), a technique chosen for its high sensitivity and resolution, allows for rapid, accurate identification and quantification of metabolites, providing a comprehensive metabolic profile and facilitating the discovery of potential biomarkers. Analytical techniques were employed to determine distinct metabolites and altered metabolic pathways. The statistical analyses were performed using univariate and multivariate analyses, logistic regression and receiver operating characteristic (ROC) curves to discover and validate the potential biomarker models. RESULTS A total of 108 different urine metabolomes were identified between CR and PT groups. These metabolites were enriched in ascorbate and aldarate metabolism, one carbon pool by folate, and some amino acid metabolisms pathways. A panel consisting of Baicalin, 5beta-1,3,7 (11)-Eudesmatrien-8-one, Indolylacryloylglycine, Edulitine, and Physapubenolide were selected as biomarkers, which demonstrated the best predictive ability with the AUC values of 0.982/0.851 in training/10-fold-cross-validation group, achieving a sensitivity of 0.975 and specificity of 0.967, respectively. CONCLUSION The urine metabolic analysis revealed the metabolic changes in EC patients during the fertility-sparing treatment. The predictive biomarkers present great potential diagnostic value in fertility-sparing treatments for EC patients, offering a less invasive means of monitoring treatment efficacy. Further research should explore the mechanistic underpinnings of these metabolic changes and validate the biomarker panel in larger, diverse populations due to the small sample size and single-institution nature of our study.
Collapse
Affiliation(s)
- Junyu Chen
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, 250012, China
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Jiale Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| |
Collapse
|
53
|
Capaci V, Monasta L, Aloisio M, Sommella E, Salviati E, Campiglia P, Basilicata MG, Kharrat F, Licastro D, Di Lorenzo G, Romano F, Ricci G, Ura B. A Multi-Omics Approach Revealed Common Dysregulated Pathways in Type One and Type Two Endometrial Cancers. Int J Mol Sci 2023; 24:16057. [PMID: 38003247 PMCID: PMC10671314 DOI: 10.3390/ijms242216057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Endometrial cancer (EC) is the most frequent gynecologic cancer in postmenopausal women. Pathogenetic mechanisms that are related to the onset and progression of the disease are largely still unknown. A multi-omics strategy can help identify altered pathways that could be targeted for improving therapeutical approaches. In this study we used a multi-omics approach on four EC cell lines for the identification of common dysregulated pathways in type 1 and 2 ECs. We analyzed proteomics and metabolomics of AN3CA, HEC1A, KLE and ISHIKAWA cell lines by mass spectrometry. The bioinformatic analysis identified 22 common pathways that are in common with both types of EC. In addition, we identified five proteins and 13 metabolites common to both types of EC. Western blotting analysis on 10 patients with type 1 and type 2 EC and 10 endometria samples confirmed the altered abundance of NPEPPS. Our multi-omics analysis identified dysregulated proteins and metabolites involved in EC tumor growth. Further studies are needed to understand the role of these molecules in EC. Our data can shed light on common pathways to better understand the mechanisms involved in the development and growth of EC, especially for the development of new therapies.
Collapse
Affiliation(s)
- Valeria Capaci
- Institute for Maternal and Child Health, IRCCS Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (F.K.); (G.D.L.); (F.R.); (G.R.); (B.U.)
| | - Lorenzo Monasta
- Institute for Maternal and Child Health, IRCCS Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (F.K.); (G.D.L.); (F.R.); (G.R.); (B.U.)
| | - Michelangelo Aloisio
- Institute for Maternal and Child Health, IRCCS Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (F.K.); (G.D.L.); (F.R.); (G.R.); (B.U.)
| | - Eduardo Sommella
- Department of Pharmacy, University of Salerno, 84084 Salerno, Italy; (E.S.); (E.S.); (P.C.); (M.G.B.)
| | - Emanuela Salviati
- Department of Pharmacy, University of Salerno, 84084 Salerno, Italy; (E.S.); (E.S.); (P.C.); (M.G.B.)
| | - Pietro Campiglia
- Department of Pharmacy, University of Salerno, 84084 Salerno, Italy; (E.S.); (E.S.); (P.C.); (M.G.B.)
| | | | - Feras Kharrat
- Institute for Maternal and Child Health, IRCCS Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (F.K.); (G.D.L.); (F.R.); (G.R.); (B.U.)
| | | | - Giovanni Di Lorenzo
- Institute for Maternal and Child Health, IRCCS Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (F.K.); (G.D.L.); (F.R.); (G.R.); (B.U.)
| | - Federico Romano
- Institute for Maternal and Child Health, IRCCS Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (F.K.); (G.D.L.); (F.R.); (G.R.); (B.U.)
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (F.K.); (G.D.L.); (F.R.); (G.R.); (B.U.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Blendi Ura
- Institute for Maternal and Child Health, IRCCS Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (F.K.); (G.D.L.); (F.R.); (G.R.); (B.U.)
| |
Collapse
|
54
|
Mahdi H, Ray-Coquard I, Lorusso D, Mirza MR, Monk BJ, Slomovitz B. Evolving treatment paradigms in metastatic or recurrent low-grade endometrial cancer: When is hormonal-based therapy the preferred option? Int J Gynecol Cancer 2023; 33:1675-1681. [PMID: 37640446 PMCID: PMC10646884 DOI: 10.1136/ijgc-2023-004454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023] Open
Abstract
Endometrial cancer is the most common gynecologic malignancy in developed countries, with increasing incidence and mortality rates worldwide. While most cases are successfully treated with surgery, first-line treatment options for metastatic or recurrent endometrial cancer involve significant toxicities. Imprecise classification of heterogeneous subgroups further complicates treatment decisions and interpretation of clinical trial results. Recent advances in molecular classification are guiding treatment decisions for metastatic or recurrent endometrial cancers. Integrating molecular characteristics with traditional clinicopathology can both reduce overtreatment or undertreatment and help guide the appropriate choice of therapies and effective design of future studies. Here we discuss the treatment of metastatic or recurrent low-grade endometrioid adenocarcinoma of the uterine corpus, which is distinct from high-grade tumors histologically, molecularly, and in treatment response.
Collapse
Affiliation(s)
- Haider Mahdi
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Isabelle Ray-Coquard
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire (GINECO), Centre Leon Berard, Lyon, Rhône-Alpes, France
| | - Domenica Lorusso
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | | | - Bradley J Monk
- HonorHealth Research Institute, University of Arizona, Creighton University, Phoenix, Arizona, USA
| | - Brian Slomovitz
- Division of Gynecologic Oncology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| |
Collapse
|
55
|
Liu J, Wang Z, Zhou J, Wang J, He X, Wang J. Role of steroid receptor-associated and regulated protein in tumor progression and progesterone receptor signaling in endometrial cancer. Chin Med J (Engl) 2023; 136:2576-2586. [PMID: 37144734 PMCID: PMC10617922 DOI: 10.1097/cm9.0000000000002537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Steroid receptor-associated and regulated protein (SRARP) suppresses tumor progression and modulates steroid receptor signaling by interacting with estrogen receptors and androgen receptors in breast cancer. In endometrial cancer (EC), progesterone receptor (PR) signaling is crucial for responsiveness to progestin therapy. The aim of this study was to investigate the role of SRARP in tumor progression and PR signaling in EC. METHODS Ribonucleic acid sequencing data from the Cancer Genome Atlas, Clinical Proteomic Tumor Analysis Consortium, and Gene Expression Omnibus were used to analyze the clinical significance of SRARP and its correlation with PR expression in EC. The correlation between SRARP and PR expression was validated in EC samples obtained from Peking University People's Hospital. SRARP function was investigated by lentivirus-mediated overexpression in Ishikawa and HEC-50B cells. Cell Counting Kit-8 assays, cell cycle analyses, wound healing assays, and Transwell assays were used to evaluate cell proliferation, migration, and invasion. Western blotting and quantitative real-time polymerase chain reaction were used to evaluate gene expression. The effects of SRARP on the regulation of PR signaling were determined by co-immunoprecipitation, PR response element (PRE) luciferase reporter assay, and PR downstream gene detection. RESULTS Higher SRARP expression was significantly associated with better overall survival and disease-free survival and less aggressive EC types. SRARP overexpression suppressed growth, migration, and invasion in EC cells, increased E-cadherin expression, and decreased N-cadherin and Wnt family member 7A ( WNT7A ) expression. SRARP expression was positively correlated with PR expression in EC tissues. In SRARP -overexpressing cells, PR isoform B (PRB) was upregulated and SRARP bound to PRB. Significant increases in PRE-based luciferase activity and expression levels of PR target genes were observed in response to medroxyprogesterone acetate. CONCLUSIONS This study illustrates that SRARP exerts a tumor-suppressive effect by inhibiting the epithelial-mesenchymal transition via Wnt signaling in EC. In addition, SRARP positively modulates PR expression and interacts with PR to regulate PR downstream target genes.
Collapse
Affiliation(s)
- Jie Liu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
- Central Laboratory and Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing 100044, China
| | - Zhiqi Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Jingyi Zhou
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Jiaqi Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Xiangjun He
- Central Laboratory and Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing 100044, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| |
Collapse
|
56
|
Wang T, Yu D, Wang J, Zhu N, Tang XB, Chen X, Su XM, Huang YG. Immune signatures of the POLE mutation in endometrial carcinomas: a systematic study based on TCGA data and clinical cohort validation. Front Oncol 2023; 13:1250558. [PMID: 38023184 PMCID: PMC10652564 DOI: 10.3389/fonc.2023.1250558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background POLE is a critical biomarker for endometrial cancer (ECs) prognosis and therapeutic decision. However, the immune infiltration and immunotherapy-related gene expression in the tumor microenvironment (TME) of POLE-mutated ECs remain unresolved. Methods The TCGA database was used to characterize the TME of POLE mutants, which primarily included immune cells and co-expression genes. We used immunohistochemistry (IHC) to determine immune cell abundance and PD-L1 expression in 104 EC tissues, including 11 POLE mutants and 93 wild-type. Results The bioinformatic study found significant differences in gene expression of the chemokine family, immune-cell markers, and lysozyme in POLE mutants, along with immune response activation. In POLE-mutated ECs, the abundance of CD4+T, CD8+T, M1 macrophages, and dendritic cells increased considerably. Furthermore, POLE mutations may enhance immune cell recruitment or activation and lymphocyte homing in ECs. POLE mutants also had increased expression of immune-checkpoint suppressor genes such as PD-L1, CTLA-4, TIM-3, and others. The tumor mutation burden (TMB) was higher in ECs with POLE mutation. In the validation cohort, we discovered that POLE mutations were related to the immune infiltration abundance of CD8+, CD4+, and Foxp3+ cells and PD-L1 expression by IHC. The prognosis of TCGA-ECs showed that the survival time of the CD8, CD4, PD-L1, or Foxp3 over-expression subgroup of the POLE mutants was significantly prolonged compared to the down-regulation subgroup or the POLE wild-type. Conclusion The infiltration abundance of CD8+ T, CD4+ T, Foxp3+ T cells, and the expression of PD-L1 harbor crucial value for the prognosis or individualized therapy of POLE-mutated ECs.
Collapse
Affiliation(s)
- Tieyan Wang
- Department of Pathology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Dan Yu
- Department of Pathology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Juanjuan Wang
- Department of Immunology, Nankai University School of Medicine, Tianjin, China
| | - Ningning Zhu
- Department of Immunology, Nankai University School of Medicine, Tianjin, China
| | - Xian-bin Tang
- Department of Pathology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Xiuwen Chen
- Department of Pathology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Xiao-min Su
- Department of Immunology, Nankai University School of Medicine, Tianjin, China
| | - Yu-gang Huang
- Department of Pathology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| |
Collapse
|
57
|
Lin Z, Gu W, Guo Q, Xiao M, Li R, Deng L, Li Y, Cui Y, Li H, Qiang J. Multisequence MRI-based radiomics model for predicting POLE mutation status in patients with endometrial cancer. Br J Radiol 2023; 96:20221063. [PMID: 37660398 PMCID: PMC10607390 DOI: 10.1259/bjr.20221063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVES Preoperative identification of POLE mutation status would help tailor the surgical procedure and adjuvant treatment strategy. This study aimed to explore the feasibility of developing a radiomics model to pre-operatively predict the pathogenic POLE mutation status in patients with EC. METHODS The retrospective study involved 138 patients with histopathologically confirmed EC (35 POLE-mutant vs 103 non-POLE-mutant). After selecting relevant features with a series of steps, three radiomics signatures were built based on axial fat-saturation T2WI, DWI, and CE-T1WI images, respectively. Then, two radiomics models which integrated features from T2WI + DWI and T2WI + DWI+CE-T1WI were further developed using multivariate logistic regression. The performance of the radiomics model was evaluated from discrimination, calibration, and clinical utility aspects. RESULTS Among all the models, radiomics model2 (RM2), which integrated features from all three sequences, showed the best performance, with AUCs of 0.885 (95%CI: 0.828-0.942) and 0.810 (95%CI: 0.653-0.967) in the training and validation cohorts, respectively. The net reclassification index (NRI) and integrated discrimination improvement (IDI) analyses indicated that RM2 had improvement in predicting POLE mutation status when compared with the single-sequence-based signatures and the radiomics model1 (RM1). The calibration curve, decision curve analysis, and clinical impact curve suggested favourable calibration and clinical utility of RM2. CONCLUSIONS The RM2, fusing features from three sequences, could be a potential tool for the non-invasive preoperative identification of patients with POLE-mutant EC, which is helpful for developing individualized therapeutic strategies. ADVANCES IN KNOWLEDGE This study developed a potential surrogate of POLE sequencing, which is cost-efficient and non-invasive.
Collapse
Affiliation(s)
| | - Weiyong Gu
- Department of Pathology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China
| | | | - Meiling Xiao
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | | | - Lin Deng
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yanfen Cui
- Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | | | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
58
|
Liu T, Zhang H, Han C, Kong W. Construction and validation of nomograms for predicting the prognosis of elderly patients with uterine serous carcinoma: a SEER-based study. J Cancer Res Clin Oncol 2023; 149:14475-14492. [PMID: 37567988 DOI: 10.1007/s00432-023-05174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/09/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To investigate the prognostic indicators, develop and verify nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) in elderly patients with uterine serous carcinoma (USC). METHODS Data of eligible USC patients aged ≥ 65 years from 2004 to 2015 in the Surveillance, Epidemiology and End Results (SEER) database were collected for retrospective analysis. X-tile software was used to assess the optimal cut-off values. Univariate and multivariate Cox regression analyses were performed to explore the prognostic factors. Nomograms were developed to predict the probability of 1-, 3- and 5-year OS and CSS. Concordance indexes (c-index), receiver operating characteristic analysis and calibration curves were used to evaluate the model. Decision curve analysis (DCA) was introduced to examine the clinical value of the models. RESULTS Age, Federation International of Gynecology and Obstetrics stage, N stage, tumor size, number of lymph nodes resected, and adjuvant therapy were independent prognostic factors for OS and CSS. The C-indexes were 0.736 (OS), 0.754 (CSS) in the training set and 0.731 (OS), 0.759 (CSS) in the validation set. The area under the curve (AUCs) of OS and CSS for 1-, 3-, and 5-years all exceeded 0.75. The calibration plots for the probability of survival were in good agreement. As shown in DCA curves, the nomograms showed better discrimination power and higher net benefits than the 6th American Joint Committee on Cancer staging system. CONCLUSIONS The nomograms constructed based on prognostic risk factors could individually predict the prognosis of elderly USC patients and provide a reference for clinical decision-making.
Collapse
Affiliation(s)
- Tingting Liu
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 17 Qihelou Street, Dongcheng District, Beijing, 100006, China
| | - He Zhang
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 17 Qihelou Street, Dongcheng District, Beijing, 100006, China
| | - Chao Han
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 17 Qihelou Street, Dongcheng District, Beijing, 100006, China
| | - Weimin Kong
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 17 Qihelou Street, Dongcheng District, Beijing, 100006, China.
| |
Collapse
|
59
|
Desmond D, Arter Z, Berenberg JL, Killeen JL, Bunch K, Merritt MA. Racial and ethnic differences in tumor characteristics among endometrial cancer patients in an equal-access healthcare population. Cancer Causes Control 2023; 34:1017-1025. [PMID: 37436537 PMCID: PMC10533614 DOI: 10.1007/s10552-023-01716-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/08/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE There are racial and ethnic differences in endometrial cancer incidence and mortality rates; compared with Non-Hispanic White women, Black women have a similar incidence rate for endometrial cancer, but their mortality is higher. Pacific Islander women may also have worse outcomes compared to their White counterparts. We assessed tumor characteristics and adjuvant therapy by racial and ethnic group among endometrial cancer patients treated within the Military Health System, an equal access healthcare organization. METHODS We retrospectively identified women diagnosed with invasive endometrial cancer among US Department of Defense beneficiaries reported in the Automated Central Tumor Registry database (year of diagnosis: 2001-2018). We compared tumor characteristics and receipt of adjuvant therapy across racial and ethnic groups using Chi-square or Fisher tests. Hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of all cause mortality were calculated using Cox proportional hazards regression models adjusting for age at diagnosis, adjuvant therapy, histology and stage. RESULTS The study included 2574 endometrial cancer patients [1729 Non-Hispanic White, 318 Asian, 286 Black, 140 Pacific Islander and 101 Hispanic women]. Among all cases, a higher proportion of Black patients had non-endometrioid histology (46.5% versus ≤ 29.3% in other groups, P < 0.01) and grade 3-4 tumors (40.1% versus ≤ 29.3% in other groups, P < 0.01). In multivariable Cox models, compared with Non-Hispanic White cases, Black endometrial cancer patients had a higher mortality risk (HR 1.43, 95% CI, 1.13-1.83). There was no difference in mortality risk for other racial and ethnic groups. CONCLUSION Black patients with endometrial cancer presented with more aggressive tumor features and they had worse overall survival compared with patients in other racial and ethnic groups. Further study is needed to better direct preventive and therapeutic efforts in order to correct endometrial cancer disparities in the future.
Collapse
Affiliation(s)
- Daniel Desmond
- Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD, 20814, 301-319-4627, USA.
| | - Zhaohui Arter
- University of California, Irvine Medical Centeur, CA, Irvine, USA
| | - Jeffrey L Berenberg
- Tripler Army Medical Center, Honolulu, HI, USA
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Jeffrey L Killeen
- Department of Pathology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
- Kapiolani Medical Center for Women and Children, Honolulu, HI, USA
| | | | - Melissa A Merritt
- University of Hawaii Cancer Center, Honolulu, HI, USA
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| |
Collapse
|
60
|
Peng T, Zhang C, Chen WJ, Zhao XF, Wu WB, Yang WJ, Liang RJ. Pyroptosis: the dawn of a new era in endometrial cancer treatment. Front Oncol 2023; 13:1277639. [PMID: 37965452 PMCID: PMC10642841 DOI: 10.3389/fonc.2023.1277639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Endometrial cancer (EC) is a malignancy of the inner epithelial lining of the uterus. While early-stage EC is often curable through surgery, the management of advanced, recurrent and metastatic EC poses significant challenges and is associated with a poor prognosis. Pyroptosis, an emerging form of programmed cell death, is characterized by the cleavage of gasdermin proteins, inducing the formation of extensive gasdermin pores in the cell membrane and the leakage of interleukin-1β (IL-1β) and interleukin-18 (IL-18), consequently causing cell swelling, lysis and death. It has been found to be implicated in the occurrence and progression of almost all tumors. Recent studies have demonstrated that regulating tumor cells pyroptosis can exploit synergies function with traditional tumor treatments. This paper provides an overview of the research progress made in molecular mechanisms of pyroptosis. It then discusses the role of pyroptosis and its components in initiation and progression of endometrial cancer, emphasizing recent insights into the underlying mechanisms and highlighting unresolved questions. Furthermore, it explores the potential value of pyroptosis in the treatment of endometrial cancer, considering its current application in tumor radiotherapy, chemotherapy, targeted therapy and immunotherapy.
Collapse
Affiliation(s)
- Tian Peng
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chi Zhang
- Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Wen-Jun Chen
- School of Nursing, Hangzhou Medical College, Hangzhou, Zhejiang, China
- Department of Gynaecology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Xue-Fei Zhao
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wei-Bo Wu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wei-Ji Yang
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ruo-Jia Liang
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Gynaecology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| |
Collapse
|
61
|
Yao Y, Shi L, Zhu X. Serum Anti-Mullerian Hormone Levels Might Indicate Premenopausal Endometrial Lesions. Diagnostics (Basel) 2023; 13:3301. [PMID: 37958197 PMCID: PMC10650321 DOI: 10.3390/diagnostics13213301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Endometrial proliferative lesions (EPL) usually refer to endometrial hyperplasia (EH) and endometrial cancer (EC). Among patients with premenopausal EPL who wish to preserve their fertility, only those with EH and early-stage EC have the possibility to undergo fertility preservation therapy. However, there is currently a lack of specific and reliable screening criteria and models for identifying these patients. METHODS This study utilized a retrospective diagnostic study design. The training set included medical record information that met the criteria between August 2017 and October 2022, while the validation set consisted of medical record information that met the criteria from November 2022 to May 2023. The endometrial pathological test served as the gold standard. The serum anti-Mullerian hormone (AMH) level before endometrial sampling and a regression model were employed to predict EPL. RESULTS The study included a total of 1209 patients with PCOS (1119 in the control group and 90 in the endometrial proliferative lesion group) and 5366 women without PCOS (5249 in the control group and 117 in the proliferative lesion group). In the case of PCOS patients aged 20-39 years, the most effective screening threshold for AMH was found to be a serum AMH level of ≤5.39 ng/mL. The model used for this group was logit(p) = -2.562 - 0.430 × AMH + 0.127 × BMI + 1.512 × hypertension + 0.956 × diabetes -1.145 × regular menstruation. On the other hand, for non-PCOS women aged 20-39 years, the optimal screening threshold for AMH was determined to be a serum AMH value of ≤2.18 ng/mL. The model used for this group was logit(p) = -3.778 - 0.823 × AMH + 0.176 × BMI + 2.660 × diabetes -1.527 × regular menstruation -1.117 × dysmenorrhea. It is important to note that all of these findings have successfully passed internal verification. CONCLUSION For PCOS and non-PCOS women aged 20-39 years, the serum AMH test and related multiple regression models were obtained for the warning of EPL.
Collapse
Affiliation(s)
- Yingsha Yao
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China; (Y.Y.); (L.S.)
| | - Liujing Shi
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China; (Y.Y.); (L.S.)
| | - Xiaoming Zhu
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China; (Y.Y.); (L.S.)
- Key Laboratory of Women’s Reproductive Health of Zhejiang Province, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| |
Collapse
|
62
|
Capozzi VA, Scarpelli E, De Finis A, Rotondella I, Scebba D, Gallinelli A, Montrucchio C, Martignon G, Leotta M, Ghi T, Berretta R. Optimal Management for Stage IVB Endometrial Cancer: A Systematic Review. Cancers (Basel) 2023; 15:5123. [PMID: 37958299 PMCID: PMC10649928 DOI: 10.3390/cancers15215123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: Endometrial cancer (EC) is a common gynecological malignancy, often diagnosed at an early stage with a high overall survival rate. Surgical treatment is the primary approach, guided by pathological and molecular characteristics. Stage IVB EC, characterized by intra and/or extra-abdominal metastasis, presents a significant challenge with no clear consensus on optimal management. (2) Methods: A systematic literature review was conducted from January to May 2023, covering studies from 2000 to 2023. Eligible studies included retrospective case series, prospective trials, and randomized clinical trials. (3) Results: Of 116 studies identified, 21 were deemed relevant: 7 on primary surgery, 10 on neoadjuvant chemotherapy (NACT), and 4 on adjuvant treatment. Notably, the impact of residual tumor after primary surgery was a critical factor affecting survival. The use of NACT followed by interval debulking surgery showed promise, particularly in cases deemed unresectable. Adjuvant treatment, combining radiotherapy and chemotherapy, demonstrated improved survival but lacked consensus regarding its role. (4) Conclusions: Stage IVB EC poses a complex challenge with limited evidence to guide management. Optimal cytoreduction remains crucial, and NACT should be considered for unresectable cases. Multimodality adjuvant therapy may benefit patients, even with disease spread beyond the pelvis. Future advances in molecular classification and targeted therapies are expected to enhance treatment strategies.
Collapse
|
63
|
Shen L, Zhang C, Cui K, Liang X, Zhu G. Low-Density Lipoprotein Contributes to Endometrial Carcinoma Cell Proliferation, Migration, and Invasion by Activating the JAK-STAT Signaling Pathway. Anal Cell Pathol (Amst) 2023; 2023:4015167. [PMID: 37900720 PMCID: PMC10611539 DOI: 10.1155/2023/4015167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Background Cholesterol-rich low-density lipoprotein (LDL) particles have been demonstrated to regulate breast cancer cell proliferation and migration, but their biological function and relevant mechanisms in endometrial carcinoma (EC) remain unclear. Methods Serum and tissue samples were collected from EC patients (n = 50) and patients with benign endometrial hyperplasia (n = 50). Ishikawa and RL95-2 cells were stimulated with different concentrations of LDL, followed by treatment with a JAK2 inhibitor (SD-1029). LDL concentrations were determined by ELISA. The in vitro biological behavior of cells was examined using the CCK-8 assay, EdU staining, and Transwell assay. The tumorigenicity of LDL in vivo was examined using a xenograft mouse model. western blotting, immunofluorescence, and immunohistochemistry studies were performed to measure related protein expression. Results The LDL concentrations and levels of p-JAK2 and p-STAT3 expression were elevated in the clinical samples. Similar trends in expression were detected in EC cells after LDL stimulation. LDL treatment significantly promoted EC cell proliferation, migration, and invasion, and also upregulated p-JAK2 and p-STAT3 expression in a dose-dependent manner. Moreover, SD-1029 dramatically blocked the LDL-mediated effects on EC cells. Intravenous injection of LDLs promoted tumor growth in the xenograft nude mice, and also increased p-JAK2, p-STAT3, and Ki-67 expression, and downregulated caspase-3 expression. Conclusions These findings indicate that LDLs exert an oncogenic effect in EC cells by activating the JAK/STAT signaling pathway, and also suggest the JAK/STAT pathway as a possible therapeutic target for EC.
Collapse
Affiliation(s)
- Lifan Shen
- Department of Gynecology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), 19th Xiuhua Road, Xiuying, Haikou 570000, China
| | - Chen Zhang
- Department of Central Lab, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Kaiying Cui
- Department of Gynecology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), 19th Xiuhua Road, Xiuying, Haikou 570000, China
| | - Xin Liang
- Department of Gynecology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), 19th Xiuhua Road, Xiuying, Haikou 570000, China
| | - Genhai Zhu
- Department of Gynecology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), 19th Xiuhua Road, Xiuying, Haikou 570000, China
| |
Collapse
|
64
|
Wang L, Li Y, Han L. Pulmonary metastasis of stage I, low-grade endometrioid carcinoma: two case reports and the literature review. Front Oncol 2023; 13:1266485. [PMID: 37901321 PMCID: PMC10602667 DOI: 10.3389/fonc.2023.1266485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/20/2023] [Indexed: 10/31/2023] Open
Abstract
Endometrial cancer (EC) is the most common malignant tumor of the female reproductive system, and the majority of ECs are low histological grade and confined to the uterus, resulting in a good prognosis. However, metastasis to the lung from a low-grade and early-stage endometrial endometrioid carcinoma (EEC) is extremely rare. Therefore, it is crucial to accurately differentiate between primary pulmonary malignancy and extra-thoracic malignancy presenting as metastatic disease, and flexible bronchoscopy with tissue acquisition plays a key role in this process. Despite its importance, there is limited literature available on the cytology of metastatic endometrial carcinoma in liquid-based cytology of bronchial brush (BB). In this article, we present two rare cases of lung metastasis from low-grade and early-stage EEC, along with a detailed analysis of the cytologic features observed in BB samples. These cases highlight the significance of cytological and histological pathology, complemented by immunohistochemistry (ICH) analysis, in the diagnosis and management of EEC patients. Pathologists should pay close attention to these aspects, while gynecologists need to be mindful of the follow-up and management of early-stage, low-grade EEC patients. By focusing on these areas, healthcare professionals can effectively contribute to the improved care and outcomes of patients with EEC.
Collapse
Affiliation(s)
- Li Wang
- Department of Gynecology & Obstetrics, Liaocheng People's Hospital, School of Medicine, Liaocheng University, Liaocheng, China
- Biomedical Laboratory, School of Medicine, Liaocheng University, Liaocheng, China
| | - Yingxue Li
- Department of Pathology, Liaocheng People's Hospital, Liaocheng, China
| | - Lin Han
- Department of Pathology, Liaocheng People's Hospital, Liaocheng, China
| |
Collapse
|
65
|
Rosario-Santos A, Torres-Cintrón CR, López-Rexach AG, Gonzalez-Carcache P, Tortolero-Luna G, Umpierre S. A comparative analysis of endometrial cancer disparities in incidence, mortality, and survival between women living in Puerto Rico, Non-Hispanic Blacks, Non-Hispanic Whites, and US Hispanics between 2000-2018. Gynecol Oncol Rep 2023; 49:101275. [PMID: 37791112 PMCID: PMC10542592 DOI: 10.1016/j.gore.2023.101275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 10/05/2023] Open
Abstract
Objective Endometrial cancer diagnosis in younger women is increasing in Puerto Rico and the United States. The study aims to evaluate the endometrial cancer trends in incidence, mortality, and survival by comparing US ethnic groups (NHW, NHB, and Hispanic) to women living in PR to assess whether disparities exist by age and stage at diagnosis on outcomes of interest. Methods We performed a secondary data analysis and comparison of the age-specific and age-adjusted incidence rates, mortality rates, and the survival of endometrial cancer in PR with that of NHB, NHW, and Hispanic using data from the PR Central Cancer Registry, the SEER Program, and PR Demographic Registry from 2000 to 2018. Results PR had the highest incidence rates (41.3 per 100,000 women) of endometrial cancer, followed by NHW, NHB, and Hispanic. Women in PR younger than 65 years old had higher incidence rates of endometrial cancer than compared groups. NHB have higher overall mortality rates (12.5 per 100,000 women). Between ages 20-34 and 35-49, women in PR have the highest mortality rates, and after age 50, mortality rates are higher for NHB. Conclusions Women in PR had higher endometrial cancer incidence rates in increasing trend from 2000 to 2018 compared to similar NHB, Hispanic, and NHW cohorts. Also, women in PR experienced higher incidence and mortality rates below 50 years old among all races and ethnicities. Future studies are needed to evaluate histology, obesity trends, and the impact on the quality of life for this cohort.
Collapse
Affiliation(s)
- Ana Rosario-Santos
- University of Puerto Rico School of Medicine, Gynecologic Oncology Division of Obstetrics and Gynecology Department, United States
| | - Carlos R. Torres-Cintrón
- University of Puerto Rico, Comprehensive Cancer Center. Puerto Rico Central Cancer Registry, United States
| | - Ana G. López-Rexach
- University of Puerto Rico School of Medicine, Gynecologic Oncology Division of Obstetrics and Gynecology Department, United States
| | - Paulina Gonzalez-Carcache
- University of Puerto Rico School of Medicine, Gynecologic Oncology Division of Obstetrics and Gynecology Department, United States
| | - Guillermo Tortolero-Luna
- University of Puerto Rico, Comprehensive Cancer Center. Puerto Rico Central Cancer Registry, United States
| | - Sharee Umpierre
- University of Puerto Rico School of Medicine, Obstetrics and Gynecology Department, Gynecologic Oncology Division, United States
| |
Collapse
|
66
|
Somasegar S, Bashi A, Lang SM, Liao CI, Johnson C, Darcy KM, Tian C, Kapp DS, Chan JK. Trends in Uterine Cancer Mortality in the United States: A 50-Year Population-Based Analysis. Obstet Gynecol 2023; 142:978-986. [PMID: 37678887 PMCID: PMC10510793 DOI: 10.1097/aog.0000000000005321] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To analyze mortality trends in uterine cancer in the United States over 50 years with an emphasis on age and race and ethnicity. METHODS Data on uterine cancer deaths from 1969 to 2018 were obtained from the National Center for Health Statistics. Trends were examined by age and race and ethnicity after adjustment for the hysterectomy rate and pregnancy. RESULTS Uterine cancer mortality decreased between 1969 and 1997 (from 6.03 to 4.00/100,000) but increased between 1997 and 2018 (from 4.00 to 5.02/100,000). From 2001 to 2018, mortality rates increased by 1.25-fold across all age groups. In 2018, the mortality rate from uterine cancer for patients aged 70 years or older and 60-69 years was sixfold and threefold higher, respectively, than in younger patients (aged 50-59 years) (54.87/100,000 vs 27.80/100,000 vs 8.70/100,000). The mortality rate for non-Hispanic Black women was 2.2-fold higher than for non-Hispanic White, Hispanic, and non-Hispanic Asian or Pacific Islander women (17.6/100,000 vs 7.82/100,000, 6.54/100,000, and 4.24/100,000, respectively). On an intersection analysis of age and race, non-Hispanic Black women aged older than 60 years had a threefold higher mortality rate than non-Hispanic White women (72/100,000 vs 24/100,000). A notable finding was that young non-Hispanic Black and Hispanic women (30-39 years) had the highest annual increases in mortality at 3.3% and 3.8% per year compared with 2.2% in non-Hispanic White women. CONCLUSION Since 2001, the uterine cancer mortality rate has increased across all four racial and ethnic groups examined, with the highest increase seen among non-Hispanic Black women. The largest increase in mortality was observed among younger non-Hispanic Black and Hispanic women.
Collapse
Affiliation(s)
- Sahana Somasegar
- Division of Gynecologic Oncology and the Department of Radiation Oncology, Stanford University School of Medicine, and the Division of Gynecologic Oncology, California Pacific/Palo Alto/Sutter Health Research Institute, Palo Alto, California; the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; the Department of Obstetrics & Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; the California Pacific Medical Center Research Institute, San Francisco, California; and the Gynecologic Cancer Center of Excellence Program, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, and the Henry M. Jackson Foundation for Advancement of Military Medicine, Inc., Bethesda, Maryland
| | | | | | | | | | | | | | | | | |
Collapse
|
67
|
Kiewisz J, Waśniewski T, Kieżun J, Skowrońska A, Kaczmarek MM, Szóstak B, Kowalczyk AE, Kmieć Z. WNT4 Gene and Protein Expression in Endometrial Cancer and Its Significance. Cancers (Basel) 2023; 15:4780. [PMID: 37835474 PMCID: PMC10571897 DOI: 10.3390/cancers15194780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The inappropriate action of WNT4 and estrogens affects uterine homeostasis and function, and may lead to endometrial cancer (EC). OBJECTIVE The aim was to evaluate the alterations of WNT4 gene expression and WNT4 protein immunoreactivity (Ir) in EC, considering tumor characteristics, the clinicopathological association and estrogen dependence. METHODS WNT4 mRNA levels were compared between benign (control) endometrium (n = 8) and endometroid EC (EEC) and non-endometroid EC (non-EEC) samples (n = 28) using the real-time PCR technique. The WNT4-Ir and ERα-Ir were evaluated by immunohistochemistry (IHC). WNT4 mRNA gene and WNT4-Ir were correlated with clinicopathological and blood morphological parameters. Overall survival (OS) was assessed. The bioanalysis was utilized to study WNT4 expression in large patient cohort (n = 549). RESULTS WNT4 gene expression was decreased in EC samples (specifically in EEC but not in non-EEC) compared to the control. The WNT4 gene expression was also decreased in EC samples categorized by the tumor characteristics. There was no statistical difference in WNT4-Ir or ERα-Ir between the control and EC. There was no correlation between OS and WNT4 gene expression and WNT4-Ir. Bioanalysis showed that WNT4 and ESR1 gene expression alterations tended to be mutually exclusive. An alteration in WNT4 expression was found in different histological tumor types in a large group of EC patients. CONCLUSIONS There is a great need to evaluate the molecular background of EC. Our study suggests that the WNT4 gene has the potential to be a marker of functional estrogen signaling in EEC.
Collapse
Affiliation(s)
- Jolanta Kiewisz
- Department of Human Histology and Embryology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland; (J.K.); (A.E.K.); (Z.K.)
| | - Tomasz Waśniewski
- Department of Gynecology and Obstetrics, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland;
| | - Jacek Kieżun
- Department of Human Histology and Embryology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland; (J.K.); (A.E.K.); (Z.K.)
| | - Agnieszka Skowrońska
- Department of Human Physiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland
| | - Monika M. Kaczmarek
- Department of Hormonal Action Mechanisms, Institute of Animal Reproduction and Food Research, Polish Academy of Science, 10-748 Olsztyn, Poland
| | - Błażej Szóstak
- Department of Pathomorphology, The Regional Specialist Hospital, 10-561 Olsztyn, Poland
| | - Anna E. Kowalczyk
- Department of Human Histology and Embryology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland; (J.K.); (A.E.K.); (Z.K.)
| | - Zbigniew Kmieć
- Department of Human Histology and Embryology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland; (J.K.); (A.E.K.); (Z.K.)
- Department of Histology, Medical University of Gdansk, 80-211 Gdansk, Poland
| |
Collapse
|
68
|
Yang N, Zhou F. Comparison of the effects of laparoscopic and open hysterectomy on surgical site wound infections in patients with endometrial cancer: A meta-analysis. Int Wound J 2023; 21:e14415. [PMID: 37743352 PMCID: PMC10824626 DOI: 10.1111/iwj.14415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/26/2023] Open
Abstract
This meta-analysis aimed to compare laparoscopic hysterectomy (LH) and open hysterectomy (OH) in terms of surgical site wound infection, length of hospital stay, and postoperative complications in patients with endometrial cancer (EC). PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang databases were comprehensively searched for studies on OH and LH for EC published between 2008 and July 2023, in any language. The literature was screened according to the inclusion and exclusion criteria, and the quality of the included case-control studies was assessed using the Newcastle-Ottawa Scale. Data were collated and analysed using Stata 17.0 software. A total of 1245 articles were screened according to the search strategy, and ultimately 15 studies were included in this meta-analysis, with a total of 1606 patients with EC, of which 751 were treated with LH and 855 with OH. The results showed that the rate of postoperative wound infection was significantly higher (OR: 0.290; 95% CI: 0.169-0.496, p < 0.001), the length of hospital stay was significantly longer (SMD: -1.976, 95% CI: -2.669 to -1.283, p < 0.001), and the incidence of postoperative complications was significantly higher (OR: 0.366; 95% CI: 0.280-0.478, p < 0.001) in the OH group than in the LH group. This study showed that LH was superior to OH for the treatment of EC and is associated with a lower rate of wound infection, shorter length of hospitalisation, and a reduced risk of complications. Thus, our findings support the choice of LH over OH for EC.
Collapse
Affiliation(s)
- Nian Yang
- Department of Obstetrics and Gynaecology, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Fei Zhou
- Department of Obstetrics and Gynaecology, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| |
Collapse
|
69
|
Taylor AH, Konje JC, Ayakannu T. Identification of Potentially Novel Molecular Targets of Endometrial Cancer Using a Non-Biased Proteomic Approach. Cancers (Basel) 2023; 15:4665. [PMID: 37760635 PMCID: PMC10527058 DOI: 10.3390/cancers15184665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The present study was aimed at identifying novel proteins in endometrial cancer (EC), employing proteomic analysis of tissues obtained after surgery. A differential MS-based proteomic analysis was conducted from whole tissues dissected from biopsies from post-menopausal women, histologically confirmed as endometrial cancer (two endometrioid and two serous; n = 4) or normal atrophic endometrium (n = 4), providing 888 differentially expressed proteins with 246 of these previously documented elsewhere as expressed in EC and 372 proteins not previously demonstrated to be expressed in EC but associated with other types of cancer. Additionally, 33 proteins not recorded previously in PubMed as being expressed in any forms of cancer were also identified, with only 26 of these proteins having a publication associated with their expression patterns or putative functions. The putative functions of the 26 proteins (GRN, APP, HEXA, CST3, CAD, QARS, SIAE, WARS, MYH8, CLTB, GOLIM4, SCARB2, BOD1L1, C14orf142, C9orf142, CCDC13, CNPY4, FAM169A, HN1L, PIGT, PLCL1, PMFBP1, SARS2, SCPEP1, SLC25A24 and ZC3H4) in other tissues point towards and provide a basis for further investigation of these previously unrecognised novel EC proteins. The developmental biology, disease, extracellular matrix, homeostatic, immune, metabolic (both RNA and protein), programmed cell death, signal transduction, molecular transport, transcriptional networks and as yet uncharacterised pathways indicate that these proteins are potentially involved in endometrial carcinogenesis and thus may be important in EC diagnosis, prognostication and treatment and thus are worthy of further investigation.
Collapse
Affiliation(s)
- Anthony H. Taylor
- Reproductive Sciences Section, Department of Cancer Studies & Molecular Medicine, University of Leicester, Leicester LE1 7RH, UK; (A.H.T.); (J.C.K.)
- Department of Molecular and Cell Biology, University of Leicester, Leicester LE1 7RH, UK
| | - Justin C. Konje
- Reproductive Sciences Section, Department of Cancer Studies & Molecular Medicine, University of Leicester, Leicester LE1 7RH, UK; (A.H.T.); (J.C.K.)
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
- Weill Cornell Medicine-Qatar, Al Rayyan, Doha P.O. Box 24144, Qatar
| | - Thangesweran Ayakannu
- Reproductive Sciences Section, Department of Cancer Studies & Molecular Medicine, University of Leicester, Leicester LE1 7RH, UK; (A.H.T.); (J.C.K.)
- Department of Obstetrics & Gynaecology, Taylor’s University, Subang Jaya 47500, Selangor, Malaysia
- Sunway Medical Centre, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia
| |
Collapse
|
70
|
Kong W, Huang Y, Jiang P, Tu Y, Li N, Wang J, Zhou Q, Zheng Y, Gou S, Tian C, Yuan R. YAP1 affects the prognosis through the regulation of stemness in endometrial cancer. PeerJ 2023; 11:e15891. [PMID: 37744228 PMCID: PMC10517666 DOI: 10.7717/peerj.15891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background Endometrial cancer stem-like cells (ECSCs) have been proven to be responsible for recurrence, metastasis, and drug-resistance in patients with endometrial cancer. The HIPPO pathway has been shown to play an important role in the development and maintenance of stemness in a variety of tumors. While there was less research about its function in ECSCs. The aim of this study was to explore the role of YAP1, a core molecular of HIPPO pathway, in the stemness of endometrial cancer and to reveal its influence on prognosis. Methods We collected specimens and clinical data from 774 patients with endometrial cancer to analyze the correlation between YAP1 expression and prognosis. We then examined the expression of YAP1 in ECSCs and EC cell lines (Ishikawa; HEC1-A) in vitro experiments. Changes in the stemness of cell lines were detected after YAP1 silencing by siRNA. Finally, high-throughput sequencing was used to predict the potential molecular interactions and mechanisms of YAP1's effect on stemness. Result Down-regulation of YAP1 significantly suppresses the stemness of EC cell lines. High expression of YAP1 leads to poor prognosis in EC by regulation of stemness. Conclusion YAP1 plays an important role in the prognosis of patients with EC by regulation of stemness.
Collapse
Affiliation(s)
- Wei Kong
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuzhen Huang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Jiang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Tu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ning Li
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinyu Wang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Zhou
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunfeng Zheng
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shikai Gou
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chenfan Tian
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Yuan
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
71
|
Ozdemir CY, Telli EU, Oge T, Yalcin OT. Ultrasonography, macroscopy, and frozen section: whıch is better for predicting deep myometrial invasıon in endometrial cancer? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230333. [PMID: 37729223 PMCID: PMC10511276 DOI: 10.1590/1806-9282.20230333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/07/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The aim of this study was to compare the power of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section for predicting deep myometrial invasion in endometrial cancer. METHODS This is a retrospective review involving 68 patients who underwent surgical staging for endometrial cancer from 2014 to 2017. Patients with grade 3 endometrial cancer and non-endometrioid tumors were excluded. The findings related to preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were compared with definitive histopathological diagnosis. RESULTS The mean age, gravidity, and body mass index of the patients were 58.1±8.9 years (range: 30-80 years), 3.2±2.1 (range: 0-9), and 33.5±6.6 kg/m2 (range: 20-52 kg/m2), respectively. Only 11 (16.2%) patients were in the premenopausal period, while 57 (83.8%) were in the postmenopausal period. Grade 1 endometrial cancer was found in 29 patients (42.6%) and grade 2 tumors were specified in 39 patients (57.4%). Stage IA disease was found in 45 (66.2%) patients, while stage IB disease was observed in 23 (33.8%) patients. The 5-year survival rate was 91.2%. The sensitivity of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were 56, 34, and 52%, respectively, for predicting deep myometrial invasion. In contrast, the specificity of preoperative ultrasonography, intraoperative macroscopic examination, and frozen section were 86, 100, and 100%, respectively. CONCLUSION Transvaginal ultrasonography and intraoperative frozen section were found to have similar sensitivity and specificity for predicting deep myometrial invasion. Preoperative transvaginal ultrasonography appears as an efficient approach for predicting endometrial cancers with deep myometrial invasion.
Collapse
Affiliation(s)
- Cem Yagmur Ozdemir
- Afyonkarahisar Health Sciences University Hospital, Facutly of Medicine, Department of Obstetrics and Gynecology – Afyonkarahisar, Turkey
| | - Elcin Uzmez Telli
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Obstetrics and Gynecology – Eskisehir, Turkey
| | - Tufan Oge
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Obstetrics and Gynecology – Eskisehir, Turkey
| | - Omer Tarik Yalcin
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Obstetrics and Gynecology – Eskisehir, Turkey
| |
Collapse
|
72
|
Dou Y, Katsnelson L, Gritsenko MA, Hu Y, Reva B, Hong R, Wang YT, Kolodziejczak I, Lu RJH, Tsai CF, Bu W, Liu W, Guo X, An E, Arend RC, Bavarva J, Chen L, Chu RK, Czekański A, Davoli T, Demicco EG, DeLair D, Devereaux K, Dhanasekaran SM, Dottino P, Dover B, Fillmore TL, Foxall M, Hermann CE, Hiltke T, Hostetter G, Jędryka M, Jewell SD, Johnson I, Kahn AG, Ku AT, Kumar-Sinha C, Kurzawa P, Lazar AJ, Lazcano R, Lei JT, Li Y, Liao Y, Lih TSM, Lin TT, Martignetti JA, Masand RP, Matkowski R, McKerrow W, Mesri M, Monroe ME, Moon J, Moore RJ, Nestor MD, Newton C, Omelchenko T, Omenn GS, Payne SH, Petyuk VA, Robles AI, Rodriguez H, Ruggles KV, Rykunov D, Savage SR, Schepmoes AA, Shi T, Shi Z, Tan J, Taylor M, Thiagarajan M, Wang JM, Weitz KK, Wen B, Williams CM, Wu Y, Wyczalkowski MA, Yi X, Zhang X, Zhao R, Mutch D, Chinnaiyan AM, Smith RD, Nesvizhskii AI, Wang P, Wiznerowicz M, Ding L, Mani DR, Zhang H, Anderson ML, Rodland KD, Zhang B, Liu T, Fenyö D. Proteogenomic insights suggest druggable pathways in endometrial carcinoma. Cancer Cell 2023; 41:1586-1605.e15. [PMID: 37567170 PMCID: PMC10631452 DOI: 10.1016/j.ccell.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/25/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023]
Abstract
We characterized a prospective endometrial carcinoma (EC) cohort containing 138 tumors and 20 enriched normal tissues using 10 different omics platforms. Targeted quantitation of two peptides can predict antigen processing and presentation machinery activity, and may inform patient selection for immunotherapy. Association analysis between MYC activity and metformin treatment in both patients and cell lines suggests a potential role for metformin treatment in non-diabetic patients with elevated MYC activity. PIK3R1 in-frame indels are associated with elevated AKT phosphorylation and increased sensitivity to AKT inhibitors. CTNNB1 hotspot mutations are concentrated near phosphorylation sites mediating pS45-induced degradation of β-catenin, which may render Wnt-FZD antagonists ineffective. Deep learning accurately predicts EC subtypes and mutations from histopathology images, which may be useful for rapid diagnosis. Overall, this study identified molecular and imaging markers that can be further investigated to guide patient stratification for more precise treatment of EC.
Collapse
Affiliation(s)
- Yongchao Dou
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Lizabeth Katsnelson
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Marina A Gritsenko
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Yingwei Hu
- Department of Pathology and Oncology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Boris Reva
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Runyu Hong
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Yi-Ting Wang
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Iga Kolodziejczak
- International Institute for Molecular Oncology, 20-203 Poznań, Poland; Postgraduate School of Molecular Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Rita Jui-Hsien Lu
- Department of Medicine and Genetics, Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA; McDonnell Genome Institute, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - Chia-Feng Tsai
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Wen Bu
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Wenke Liu
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Xiaofang Guo
- Division of Gynecologic Oncology, University of South Florida Morsani College of Medicine and Tampa General Hospital Cancer Institute, Tampa, FL 33606, USA
| | - Eunkyung An
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, MD 20850, USA
| | - Rebecca C Arend
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Jasmin Bavarva
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, MD 20850, USA
| | - Lijun Chen
- Department of Pathology and Oncology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Rosalie K Chu
- Environmental Molecular Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Andrzej Czekański
- Wroclaw Medical University and Lower Silesian Oncology, Pulmonology and Hematology Center (DCOPIH), Wrocław, Poland
| | - Teresa Davoli
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Elizabeth G Demicco
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Deborah DeLair
- Department of Pathology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Kelly Devereaux
- Department of Pathology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Saravana M Dhanasekaran
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Peter Dottino
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Bailee Dover
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Thomas L Fillmore
- Environmental Molecular Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - McKenzie Foxall
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Catherine E Hermann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Tara Hiltke
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, MD 20850, USA
| | | | - Marcin Jędryka
- Wroclaw Medical University and Lower Silesian Oncology, Pulmonology and Hematology Center (DCOPIH), Wrocław, Poland
| | - Scott D Jewell
- Van Andel Research Institute, Grand Rapids, MI 49503, USA
| | - Isabelle Johnson
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Andrea G Kahn
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Amy T Ku
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Chandan Kumar-Sinha
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Paweł Kurzawa
- Heliodor Swiecicki Clinical Hospital in Poznan ul. Przybyszewskiego 49, 60-355 Poznań, Poland; Poznań University of Medical Sciences, 61-701 Poznań, Poland
| | - Alexander J Lazar
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rossana Lazcano
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jonathan T Lei
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Yi Li
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Yuxing Liao
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Tung-Shing M Lih
- Department of Pathology and Oncology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Tai-Tu Lin
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - John A Martignetti
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ramya P Masand
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Rafał Matkowski
- Wroclaw Medical University and Lower Silesian Oncology, Pulmonology and Hematology Center (DCOPIH), Wrocław, Poland
| | - Wilson McKerrow
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Mehdi Mesri
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, MD 20850, USA
| | - Matthew E Monroe
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Jamie Moon
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Ronald J Moore
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Michael D Nestor
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Chelsea Newton
- Van Andel Research Institute, Grand Rapids, MI 49503, USA
| | | | - Gilbert S Omenn
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA; School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Samuel H Payne
- Department of Biology, Brigham Young University, Provo, UT 84602, USA
| | - Vladislav A Petyuk
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Ana I Robles
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, MD 20850, USA
| | - Henry Rodriguez
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, MD 20850, USA
| | - Kelly V Ruggles
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Division of Precision Medicine, Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Dmitry Rykunov
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sara R Savage
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Athena A Schepmoes
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Tujin Shi
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Zhiao Shi
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jimin Tan
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Mason Taylor
- Department of Biology, Brigham Young University, Provo, UT 84602, USA
| | - Mathangi Thiagarajan
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA
| | - Joshua M Wang
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Karl K Weitz
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Bo Wen
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - C M Williams
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA
| | - Yige Wu
- Department of Medicine and Genetics, Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA; McDonnell Genome Institute, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - Matthew A Wyczalkowski
- Department of Medicine and Genetics, Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA; McDonnell Genome Institute, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - Xinpei Yi
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Xu Zhang
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, MD 20850, USA
| | - Rui Zhao
- Environmental Molecular Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - David Mutch
- Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Arul M Chinnaiyan
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Richard D Smith
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Alexey I Nesvizhskii
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Pei Wang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Maciej Wiznerowicz
- International Institute for Molecular Oncology, 60-203 Poznań, Poland; Heliodor Swiecicki Clinical Hospital in Poznan ul. Przybyszewskiego 49, 60-355 Poznań, Poland; Poznań University of Medical Sciences, 61-701 Poznań, Poland
| | - Li Ding
- Department of Medicine and Genetics, Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA; McDonnell Genome Institute, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - D R Mani
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA
| | - Hui Zhang
- Department of Pathology and Oncology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Matthew L Anderson
- Division of Gynecologic Oncology, University of South Florida Morsani College of Medicine and Tampa General Hospital Cancer Institute, Tampa, FL 33606, USA.
| | - Karin D Rodland
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA; Department of Cell, Developmental, and Cancer Biology, Oregon Health & Science University, Portland, OR 97221, USA.
| | - Bing Zhang
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Tao Liu
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA.
| | - David Fenyö
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA.
| |
Collapse
|
73
|
Garuti G, Sagrada PF, Frigoli A, Fornaciari O, Finco A, Mirra M, Soligo M. Hysteroscopic biopsy compared with endometrial curettage to assess the preoperative rate of atypical hyperplasia underestimating endometrial carcinoma. Arch Gynecol Obstet 2023; 308:971-979. [PMID: 37160470 DOI: 10.1007/s00404-023-07060-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To evaluate the rate of atypical hyperplasia (AH) underestimating endometrial cancer (EC) comparing endometrial biopsy (EB) accomplished by hysteroscopic biopsy with dilatation and curettage (D&C). Second, to compare the two techniques to foresee EC grading. METHODS This trial was based on the findings of two Gynecological Departments within the same Public Utility, sharing pathological service and database but routinely performing EB under hysteroscopic visualization (group A) or hysteroscopy followed by D&C (group B). We retrieved the clinical data of patients showing EC on hysterectomy throughout a 10-year period. The accuracy of hysteroscopic-view diagnosis and EB pathology were compared, having the pathologic findings of hysterectomy as reference. RESULTS A total of 161 patients met the inclusion criteria. Among these, 109 and 52 were included in groups A and B, respectively. In group A, 32.1% of patients underwent EB in an out-patient setting. To foresee EC, hysteroscopic view showed a sensitivity of 82.5% and 70.2% in groups A and B, respectively (P = 0.019). An underestimation of EC diagnosed as AH on EB was found in 20 patients (12.4%). Among these, 18 (16.5%) and 2 (3.8%) were included in groups A and B, respectively (P = 0.022). In group A, a fault diagnosis of AH resulted higher when EB was performed as out-patient setting (P = 0.006). EB allowed the grading of EC in 73.3% and 90.3% of patients in groups A and B, respectively. The agreement was 73.7% and 85.1%, leading to moderate (κ = 0.56) and good (κ = 0.77) "κ" coefficient of concordance for groups A and B, respectively. CONCLUSIONS EB performed by D&C lowers the rate of AH underestimating concurrent EC and improves the grading agreement when compared with hysteroscopic sampling.
Collapse
Affiliation(s)
- Giancarlo Garuti
- Obstetrics and Gynecology Department, Hospital of Lodi, Via Savoia 1, 26900, Lodi, Italy.
| | | | - Antonella Frigoli
- Obstetrics and Gynecology Department, Hospital of Lodi, Via Savoia 1, 26900, Lodi, Italy
| | - Ottavia Fornaciari
- Obstetrics and Gynecology Department, Hospital of Lodi, Via Savoia 1, 26900, Lodi, Italy
| | - Andrea Finco
- Obstetrics and Gynecology Department, Hospital of Lodi, Via Savoia 1, 26900, Lodi, Italy
| | - Maurizio Mirra
- Department of Pathology, Via Savoia 1, 26900, Lodi, Italy
| | - Marco Soligo
- Obstetrics and Gynecology Department, Hospital of Lodi, Via Savoia 1, 26900, Lodi, Italy
| |
Collapse
|
74
|
Ma L, Huang W, Liang X, Bai G, Wang X, Jiang H, Xin Y, Hu L, Chen X, Liu C. Inhibition of squalene epoxidase linking with PI3K/AKT signaling pathway suppresses endometrial cancer. Cancer Sci 2023; 114:3595-3607. [PMID: 37438885 PMCID: PMC10475781 DOI: 10.1111/cas.15900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/07/2023] [Accepted: 06/18/2023] [Indexed: 07/14/2023] Open
Abstract
Endometrial cancer (EC) is a common malignant tumor that lacks any therapeutic target and, in many cases, recurrence is the leading ca use of morbidity and mortality in women. Widely known EC has a strongly positive correlation with abnormal lipid metabolism. Squalene epoxidase (SQLE), a crucial enzyme in the cholesterol synthesis pathway regulating lipid metabolic processes has been found to be associated with various cancers in recent years. Here, we focused on studying the role of SQLE in EC. Our study revealed that SQLE expression level was upregulated significantly in EC tissues. In vitro experiments showed that SQLE overexpression significantly promoted the proliferation, and inhibited cell apoptosis of EC cells, whereas SQLE knockdown or use of terbinafine showed the opposite results. Furthermore, we found out that the promotional effect of SQLE on the proliferation of EC cells might be achieved by activating the PI3K/AKT pathway. In vivo, studies confirmed that the knockdown of SQLE or terbinafine can observably inhibit tumor growth in nude mice. These results indicate that SQLE may promote the progression of EC by activating the PI3K/AKT pathway. Moreover, SQLE is a potential target for EC treatment and its inhibitor, terbinafine, has the potential to become a targeted drug for EC treatment.
Collapse
Affiliation(s)
- Liangjian Ma
- Key Laboratory of Gynecologic Oncology Gansu ProvinceThe First Hospital of Lanzhou UniversityLanzhouChina
| | - Wunan Huang
- Key Laboratory of Gynecologic Oncology Gansu ProvinceThe First Hospital of Lanzhou UniversityLanzhouChina
| | - Xiaolei Liang
- Key Laboratory of Gynecologic Oncology Gansu ProvinceThe First Hospital of Lanzhou UniversityLanzhouChina
| | - Guannan Bai
- The Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Xiaochen Wang
- Key Laboratory of Cancer Prevention and Intervention, Department of Breast Surgery and Oncology, Ministry of Education, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Hua Jiang
- Department of Otolaryngology, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Yang Xin
- Department of Genetics and Metabolism, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child HealthNational Children's Regional Medical CenterHangzhouChina
| | - Lidan Hu
- The Children's HospitalZhejiang University School of Medicine, National Clinical Research Center for Child HealthHangzhouChina
| | - Xiangjun Chen
- Eye Center of the Second Affiliated Hospital, Institute of Translational Medicine, School of MedicineZhejiang UniversityHangzhouChina
| | - Chang Liu
- Key Laboratory of Gynecologic Oncology Gansu ProvinceThe First Hospital of Lanzhou UniversityLanzhouChina
| |
Collapse
|
75
|
Lee SJ, Kang HJ, Kwak YK, Kim M, Kim J. Non-endometrioid endometrial cancer: analysis of recurrence pattern and identification of prognostic and treatment factors affecting recurrence and survival. Strahlenther Onkol 2023; 199:828-837. [PMID: 36930247 DOI: 10.1007/s00066-023-02061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/12/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE We investigated the characteristics of recurrence pattern and survival of patients with non-endometrioid endometrial cancer (NEEC) and attempted to identify prognostic and treatment factors affecting disease-free survival (DFS) and overall survival (OS) of these patients. METHODS Fifty-seven patients with histologically confirmed International Federation of Gynecology and Obstetrics (FIGO) stage IA-IVA NEEC from February 2003 to December 2021 were retrospectively analyzed. RESULTS The 5‑year DFS and OS rates of the total cohort were 50.6% and 56.1%, respectively. Recurrence occurred in 28 patients (49.1%) during follow-up, and the most common recurrence pattern was distant metastasis (DM; 78.6% of total recurrences). The occurrence of relapse significantly reduced 5‑year OS (recurrence group vs. non-recurrence group: 12.5% vs. 100%; p < 0.001). In univariate analysis, adjuvant radiotherapy (RT) group showed significantly higher 5‑year DFS (56.7% vs. 37.9%; p = 0.04), local recurrence-free survival (91.6% vs. 50.5%; p = 0.01), and regional recurrence-free survival (88.2% vs. 56.5%; p < 0.01) than the non-RT group. In multivariate analysis, advanced FIGO stage was identified as a negative prognostic factor for DFS and OS. Lymphovascular space invasion (LVSI) and adjuvant RT were independent prognostic factors for DFS. CONCLUSION The most common recurrence pattern observed in patients with NEEC was DM. FIGO stage and LVSI were identified as prognostic factors for survival, and RT was identified as a therapeutic modality that could increase DFS. To improve the OS of patients with NEEC, the addition of effective chemotherapy that can reduce DM may be important.
Collapse
Affiliation(s)
- So Jung Lee
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Republic of)
| | - Hye Jin Kang
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Republic of).
| | - Yoo-Kang Kwak
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Republic of)
| | - Myungsoo Kim
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Republic of)
| | - Jisang Kim
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Republic of)
| |
Collapse
|
76
|
Qiu H, Wang M, Cao T, Feng Y, Zhang Y, Guo R. Low-coverage whole-genome sequencing for the effective diagnosis of early endometrial cancer: A pilot study. Heliyon 2023; 9:e19323. [PMID: 37662762 PMCID: PMC10472246 DOI: 10.1016/j.heliyon.2023.e19323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023] Open
Abstract
Background Endometrial carcinoma (EC) is a disease that predominantly affects peri- and post-menopausal women and its incidence has continued to rise over recent years. Since the gold standard for EC diagnosis-hysteroscopic biopsy-is invasive, expensive, and unsuitable for wide use, there is an urgent need for a non-invasive method that exhibits both high sensitivity and high specificity. We therefore investigated the efficacy of UterCAD (the uterine exfoliated cell chromosomal aneuploidy detector) using tampon-collected specimens for the early detection of EC. Methods We prospectively recruited 51 patients with a history of abnormal bleeding and who planned to undergo hysteroscopic examination or hysterectomy between March 2020 and January 2021. Before executing an invasive procedure, a tampon was inserted into the patient's vagina for 6 h to collect exfoliated cells from the uterine cavity. Total DNA was extracted and low-coverage whole-genome sequencing was performed on an Illumina HiSeq X10, and we analyzed the differences in chromosomal status between women with EC and those bearing benign lesions using UterCAD. Results Thirty EC patients-including 26 with endometrioid carcinoma (EEC) and four with uterine serous carcinoma (USC), as well as 14 benign cases-were enrolled in our final analysis. Copy-number variations (CNVs) were detected in tampon specimens collected from 26 EC patients (83.3%), including 21 with EEC (80.7%) and four with USC (100%). In the benign group, only one woman with focal atypical hyperplasia presented with a 10q chromosomal gain (P < 0.001). In the EC group, the most common CNVs were copy gains of 8q (N = 14), 2q (N = 4), and 10q (N = 3); and copy losses of 2q (N = 3) and 17p (N = 2). When we stratified by FIGO stage, the CNV rates in stages IA, IB, and II/III were 83.3% (15/18), 85.7% (6/7), and 80.0% (4/5), respectively. At the optimal cutoff (|Z| ≥ 2.3), UterCAD discriminated 83.3% of EC cases from benign cases, with a specificity of 92.9%. Conclusions We initially reported that UterCAD could serve as a non-invasive method for the early detection of EC, especially in the rare and aggressive USC subtype. The use of UterCAD might thus avoid unnecessary invasive procedures and thereby reduce the treatment burden on patients.
Collapse
Affiliation(s)
- Haifeng Qiu
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Provincial Medical Key Laboratory for Gynecologic Malignancies Prevention and Treatment, Zhengzhou, China
- Zhengzhou Key Laboratory for Gynecologic Malignancies Prevention and Treatment, Zhengzhou, China
- Henan Province Engineering Research Center of Fertility Preservation in Gynecologic Tumors, Zhengzhou, Henan Province, China
| | - Min Wang
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tingting Cao
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yun Feng
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Zhang
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruixia Guo
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Provincial Medical Key Laboratory for Gynecologic Malignancies Prevention and Treatment, Zhengzhou, China
- Zhengzhou Key Laboratory for Gynecologic Malignancies Prevention and Treatment, Zhengzhou, China
- Henan Province Engineering Research Center of Fertility Preservation in Gynecologic Tumors, Zhengzhou, Henan Province, China
| |
Collapse
|
77
|
Yao Y, Shi L, Zhu X. Four differentially expressed exosomal miRNAs as prognostic biomarkers and therapy targets in endometrial cancer: Bioinformatic analysis. Medicine (Baltimore) 2023; 102:e34998. [PMID: 37653757 PMCID: PMC10470766 DOI: 10.1097/md.0000000000034998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/02/2023] Open
Abstract
Endometrial cancer (EC) is one of the most common gynecological malignancies worldwide. Accumulated evidence has demonstrated exosomes of cancer cells carry microRNAs (miRNAs) to nonmalignant cells to induce metastasis. Our study aimed to find possible biomarkers of EC. Data for miRNA expression related with exosome from EC patients were downloaded from The Cancer Genome Atlas database, and the miRNA expression profiles associated with exosomes of EC were downloaded from the National Center for Biotechnology Information. We used different algorithms to analyze the differential miRNA expression, infer the relative proportion of immune infiltrating cells, predict chemotherapy sensitivity, and comprehensively score each gene set to evaluate the potential biological function changes of different samples. The gene ontology analysis and Kyoto encyclopedia of genome genomics pathway analysis were performed for specific genes. A total of 13 differential miRNAs were identified, of which 4 were up-regulated. The 4 miRNAs, that is hsa-miR-17-3p, hsa-miR-99b-3p, hsa-miR-193a-5p, and hsa-miR-320d, were the hub exosomal miRNAs that were all closely related to the clinic phenotypes and prognosis of patients. This study preliminarily indicates that the 4 hub exosomal miRNAs (hsa-miR-17-3p, hsa-miR-99b-3p, hsa-miR-193a-5p, and hsa-miR-320d) could be used as prognostic biomarkers or therapy targets in EC. Further studies are required to make sure of their real feasibility and values in the EC clinic and the relative research.
Collapse
Affiliation(s)
- Yingsha Yao
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Liujing Shi
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Xiaoming Zhu
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China
- Key Laboratory of Women’s Reproductive Health of Zhejiang Province, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China
| |
Collapse
|
78
|
Sidorkiewicz I, Jóźwik M, Buczyńska A, Erol A, Jóźwik M, Moniuszko M, Jarząbek K, Niemira M, Krętowski A. Identification and subsequent validation of transcriptomic signature associated with metabolic status in endometrial cancer. Sci Rep 2023; 13:13763. [PMID: 37612452 PMCID: PMC10447446 DOI: 10.1038/s41598-023-40994-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/20/2023] [Indexed: 08/25/2023] Open
Abstract
Aberrant metabolism has been identified as a main driver of cancer. Profiling of metabolism-related pathways in cancer furthers the understanding of tumor plasticity and identification of potential metabolic vulnerabilities. In this prospective controlled study, we established transcriptomic profiles of metabolism-related pathways in endometrial cancer (EC) using a novel method, NanoString nCounter Technology. Fifty-seven ECs and 30 normal endometrial specimens were studied using the NanoString Metabolic Panel, further validated by qRT-PCR with a very high similarity. Statistical analyses were by GraphPad PRISM and Weka software. The analysis identified 11 deregulated genes (FDR ≤ 0.05; |FC|≥ 1.5) in EC: SLC7A11; SLC7A5; RUNX1; LAMA4; COL6A3; PDK1; CCNA1; ENO1; PKM; NR2F1; and NAALAD2. Gene ontology showed direct association of these genes with 'central carbon metabolism (CCM) in cancer'. Thus, 'CCM in cancer' appears to create one of the main metabolic axes in EC. Further, transcriptomic data were functionally validated with drug repurposing on three EC cell lines, with several drug candidates suggested. These results lay the foundation for personalized therapeutic strategies in this cancer. Metabolic plasticity represents a promising diagnostic and therapeutic option in EC.
Collapse
Affiliation(s)
- Iwona Sidorkiewicz
- Clinical Research Centre, Medical University of Białystok, Marii Skłodowskiej-Curie 24a, 15-276, Białystok, Poland.
| | - Maciej Jóźwik
- Department of Gynecology and Gynecologic Oncology, Medical University of Białystok, 15-276, Białystok, Poland
| | - Angelika Buczyńska
- Clinical Research Centre, Medical University of Białystok, Marii Skłodowskiej-Curie 24a, 15-276, Białystok, Poland
| | - Anna Erol
- Clinical Research Centre, Medical University of Białystok, Marii Skłodowskiej-Curie 24a, 15-276, Białystok, Poland
| | - Marcin Jóźwik
- Department of Gynecology and Obstetrics, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-045, Olsztyn, Poland
| | - Marcin Moniuszko
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, 15-269, Białystok, Poland
- Department of Allergology and Internal Medicine, Medical University of Bialystok, 15-276, Białystok, Poland
| | - Katarzyna Jarząbek
- Laboratory of Genetic and Molecular Diagnostics, Maria Skłodowska-Curie Białystok Oncology Center, 15-027, Białystok, Poland
| | - Magdalena Niemira
- Clinical Research Centre, Medical University of Białystok, Marii Skłodowskiej-Curie 24a, 15-276, Białystok, Poland
| | - Adam Krętowski
- Clinical Research Centre, Medical University of Białystok, Marii Skłodowskiej-Curie 24a, 15-276, Białystok, Poland
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, 15-276, Białystok, Poland
| |
Collapse
|
79
|
Yoshida H, Takigawa W, Kobayashi-Kato M, Nishikawa T, Shiraishi K, Ishikawa M. Mismatch Repair Protein Expression in Endometrial Cancer: Assessing Concordance and Unveiling Pitfalls in Two Different Immunohistochemistry Assays. J Pers Med 2023; 13:1260. [PMID: 37623510 PMCID: PMC10455692 DOI: 10.3390/jpm13081260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
This study aimed to compare the concordance and interchangeability of the Dako/Agilent and Ventana/Roche mismatch repair (MMR) immunohistochemistry (IHC) assays commonly used in pathology. It also aimed to provide diagnostic insights by examining the frequency and characteristics of the dot-like artifact observed in MLH1 M1 clone staining in endometrial cancer. Fifty endometrial cancer cases with MMR deficiency, excised between 2011 and 2018, were included in the study. IHC was performed using primary antibody clones from Ventana/Roche (MLH1, clone M1; MSH2, G219-1129; MSH6, SP93; PMS2, A16-4) and Dako/Agilent (MLH1, ES05; MSH2, FE11; MSH6, EP49; PMS2, EP51). Both assays were conducted using respective autostainers. The Dako/Agilent assay showed a loss of MLH1 in 26 cases, MSH2 in 12 cases, MSH6 in 23 cases, and PMS2 in 28 cases. The two assays had a complete agreement in MMR protein expression or loss. The dot-like artifact in MLH1 M1 clone staining was observed in 77% (20/26) of cases, predominantly in the surface area of the tumor, ranging from 5% to 40% (median: 10%). These findings highlight the high concordance between the MMR-IHC assays and emphasize the importance of considering the dot-like artifact in MLH1 M1 clone staining when diagnosing endometrial cancer with MMR deficiency.
Collapse
Affiliation(s)
- Hiroshi Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Waku Takigawa
- Department of Gynecology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Mayumi Kobayashi-Kato
- Department of Gynecology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Tadaaki Nishikawa
- Department of Medical Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan;
| | - Kouya Shiraishi
- Division of Genome Biology, National Cancer Center Research Institute, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| |
Collapse
|
80
|
Lin Z, Wang T, Li Q, Bi Q, Wang Y, Luo Y, Feng F, Xiao M, Gu Y, Qiang J, Li H. Development and validation of MRI-based radiomics model to predict recurrence risk in patients with endometrial cancer: a multicenter study. Eur Radiol 2023; 33:5814-5824. [PMID: 37171486 DOI: 10.1007/s00330-023-09685-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/17/2023] [Accepted: 02/26/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To develop a fusion model based on clinicopathological factors and MRI radiomics features for the prediction of recurrence risk in patients with endometrial cancer (EC). METHODS A total of 421 patients with histopathologically proved EC (101 recurrence vs. 320 non-recurrence EC) from four medical centers were included in this retrospective study, and were divided into the training (n = 235), internal validation (n = 102), and external validation (n = 84) cohorts. In total, 1702 radiomics features were respectively extracted from areas with different extensions for each patient. The extreme gradient boosting (XGBoost) classifier was applied to establish the clinicopathological model (CM), radiomics model (RM), and fusion model (FM). The performance of the established models was assessed by the discrimination, calibration, and clinical utility. Kaplan-Meier analysis was conducted to further determine the prognostic value of the models by evaluating the differences in recurrence-free survival (RFS) between the high- and low-risk patients of recurrence. RESULTS The FMs showed better performance compared with the models based on clinicopathological or radiomics features alone but with a reduced tendency when the peritumoral area (PA) was extended. The FM based on intratumoral area (IA) [FM (IA)] had the optimal performance in predicting the recurrence risk in terms of the ROC, calibration curve, and decision curve analysis. Kaplan-Meier survival curves showed that high-risk patients of recurrence defined by FM (IA) had a worse RFS than low-risk ones of recurrence. CONCLUSIONS The FM integrating intratumoral radiomics features and clinicopathological factors could be a valuable predictor for the recurrence risk of EC patients. CLINICAL RELEVANCE STATEMENT An accurate prediction based on our developed FM (IA) for the recurrence risk of EC could facilitate making an individualized therapeutic decision and help avoid under- or over-treatment, therefore improving the prognosis of patients. KEY POINTS • The fusion model combined clinicopathological factors and radiomics features exhibits the highest performance compared with the clinicopathological model and radiomics model. • Although higher values of area under the curve were observed for all fusion models, the performance tended to decrease with the extension of the peritumoral region. • Identifying patients with different risks of recurrence, the developed models can be used to facilitate individualized management.
Collapse
Affiliation(s)
- Zijing Lin
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ting Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qiong Li
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center/Cancer Hospital, 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Qiu Bi
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
- Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, China
| | - Yaoxin Wang
- Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, China
| | - Yingwei Luo
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center/Cancer Hospital, 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Feng Feng
- Department of Radiology, Nantong Tumor Hospital, Nantong University, Nantong, 226361, China
| | - Meiling Xiao
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, 201508, China.
| | - Haiming Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| |
Collapse
|
81
|
Kulkarni A, Wright NMA, Forget AN, Ramsay T, Mallick R, Weberpals JI. Should we abandon hormonal therapy in endometrial cancer? Outcomes of recurrent and metastatic endometrial cancer treated with systemic progestins. Cancer Med 2023; 12:16173-16180. [PMID: 37417528 PMCID: PMC10469659 DOI: 10.1002/cam4.6276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE The objective of this study is to determine primary survival endpoints in women with recurrent and metastatic endometrial carcinoma (RMEC) treated with progestins. METHODS A retrospective chart review was conducted at The Ottawa Hospital using electronic medical records. Inclusion criteria were a diagnosis of RMEC between 2000 and 2019, endometrioid histology, and ≥one line of progestin treatment. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS Of 2342 cases reviewed, 74 met inclusion criteria. Sixty-six (88.0%) patients received megestrol acetate and 9 (12.0%) received a progestin alternative. The distribution of tumors by grade was: 1: 25 (33.3%), 2: 30 (40.0%), and 3: 20 (26.7%). The PFS and OS for the entire study sample was 14.3 months (95% CI 6.2-17.9) and 23.3 months (14.8-36.8), respectively. The PFS for patients with Grade 1-2 RMEC was 15.7 months (8.0, 19.5), compared to 5.0 months (3.0, 23.0) with Grade 3 disease. The OS for patients with Grade 1-2 versus Grade 3, was 25.9 months (15.3, 40.3) versus 12.5 months (5.7, 35.9), respectively. Thirty-four (45.9%) and 40 (54.1%) patients were treated with 0 and ≥1 line of chemotherapy. The PFS for chemotherapy-naïve patients was 17.9 months (14.3, 27.0), versus 6.2 months (3.9, 14.8) following ≥1 line of treatment. The OS was 29.1 months (17.9, 61.1) for chemotherapy-naïve patients versus 23.0 months (10.5, 37.6) for patients previously exposed. CONCLUSIONS This real-world data on RMEC suggests there is a role for progestins in select subgroups of women. The PFS for chemotherapy-naïve patients was 17.9 months (14.3, 27.0), versus 6.2 months (3.9, 14.8) following ≥1 line of treatment. The OS was 29.1 months (17.9, 61.1) for chemotherapy-OS was 29.1 months (17.9, 61.1) for chemotherapy-naïve patients versus 23.0 months (10.5, 37.6) for patients previously exposed.
Collapse
Affiliation(s)
- A. Kulkarni
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | | | - A. N. Forget
- Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - T. Ramsay
- Ottawa Hospital Research InstituteOttawaOntarioCanada
- School of Epidemiology, Public Health and Preventative MedicineUniversity of OttawaOttawaOntarioCanada
| | - R. Mallick
- Ottawa Hospital Research InstituteOttawaOntarioCanada
- School of Epidemiology, Public Health and Preventative MedicineUniversity of OttawaOttawaOntarioCanada
| | - J. I. Weberpals
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
- Ottawa Hospital Research InstituteOttawaOntarioCanada
| |
Collapse
|
82
|
Luna C, Goncalves N, Metalonis SW, Mason MM, Lyu J, Huang M, Alessandrino F. Endometrial carcinoma: association between mutational status, sites of metastasis, recurrence, and correlation with overall survival. Abdom Radiol (NY) 2023; 48:2684-2694. [PMID: 37289213 DOI: 10.1007/s00261-023-03973-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate the association between sites of endometrial carcinoma (EC) recurrence and metastases, mutational status, race, and overall survival (OS). METHODS This single-center retrospective study evaluated patients with biopsy-proven EC that underwent genomic molecular testing between January 2015 and July 2021. Association between genomic profile and sites of metastases or recurrence was performed using Pearson's chi-squared or Fisher exact test. Survival curves for ethnicity and race, mutations, sites of metastases or recurrence were estimated using the Kaplan-Meier method. Univariable and multivariable Cox proportional hazard regression models were used. RESULTS The study included 133 women [median age 64 years (IQR 57-69)]. The most common mutation was TP53 (65/105 patients, 62%). The most common site of metastasis was the peritoneum (35/43, 81%). The most common recurrence was in lymph nodes (34/75, 45%). Mutations of TP53 and PTEN were significantly associated with Black women (p = 0.048, p = 0.004, respectively). In the univariable Cox regression analyses, TP53 mutation and presence of recurrence or metastases to the peritoneum were associated with lower OS (HR 2.1; 95% CI 1.1, 4.3; p = 0.03/ HR 2.9; 95% CI 1.6, 5.4; p = 0.0004; respectively). On multivariable Cox proportional hazards model ER expression (HR 0.4; 95% CI 0.22, 0.91; p = 0.03), peritoneal recurrence or metastases (HR 3.55; 95% CI 1.67, 7.57; p = 0.001), and Black race (HR 2.2; 95% CI 1.1, 4.6; p = 0.03) were significant independent predictors of OS. CONCLUSIONS The integration of EC mutational status and clinicopathological risk assessment demonstrated potential implications on the patterns of metastasis, recurrence, and OS.
Collapse
Affiliation(s)
- Cibele Luna
- Department of Radiology, University of Miami, Miami, FL, 33136, USA
| | - Nicole Goncalves
- University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Sarah Wishnek Metalonis
- Division of Biostatistics, Department of Public Health Science, University of Miami, Miami, FL, 33136, USA
| | - Matthew M Mason
- University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Jiangnan Lyu
- Division of Biostatistics, Department of Public Health Science, University of Miami, Miami, FL, 33136, USA
| | - Marilyn Huang
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, 33136, USA
| | - Francesco Alessandrino
- Department of Radiology, University of Miami, Miami, FL, 33136, USA.
- Division of Abdominal Imaging, Department of Radiology, University of Miami Leonard M. Miller School of Medicine, 1611 NW 12th Ave, West Wing 279, Miami, FL, 33136, USA.
| |
Collapse
|
83
|
Zhai L, Yang X, Cheng Y, Wang J. Glutamine and amino acid metabolism as a prognostic signature and therapeutic target in endometrial cancer. Cancer Med 2023; 12:16337-16358. [PMID: 37387559 PMCID: PMC10469729 DOI: 10.1002/cam4.6256] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION Endometrial cancer (EC) is the most common female reproductive system cancer in developed countries with growing incidence and associated mortality, which may be due to the growing prevalence of obesity. Metabolism reprogramming including glucose, amino acid, and lipid remodeling is a hallmark of tumors. Glutamine metabolism has been reported to participate in tumor proliferation and development. This study aimed to develop a glutamine metabolism-related prognostic model for EC and explore potential targets for cancer treatment. METHOD Transcriptomic data and survival outcome of EC were retrieved from The Cancer Genome Atlas (TCGA). Differentially expressed genes related to glutamine metabolism were recognized and utilized to build a prognostic model by univariate and multivariate Cox regressions. The model was confirmed in the training, testing, and the entire cohort. A nomogram combing prognostic model and clinicopathologic features was established and tested. Moreover, we explored the effect of a key metabolic enzyme, PHGDH, on the biological behavior of EC cell lines and xenograft model. RESULTS Five glutamine metabolism-related genes, including PHGDH, OTC, ASRGL1, ASNS, and NR1H4, were involved in prognostic model construction. Kaplan-Meier curve suggested that patients recognized as high risk underwent inferior outcomes. The receiver operating characteristic (ROC) curve showed the model was sufficient to predict survival. Enrichment analysis recognized DNA replication and repair dysfunction in high-risk patients whereas immune relevance analysis revealed low immune scores in the high-risk group. Finally, a nomogram integrating the prognostic model and clinical factors was created and verified. Further, knockdown of PHGDH showed cell growth inhibition, increasing apoptosis, and reduced migration. Promisingly, NCT-503, a PHGDH inhibitor, significantly repressed tumor growth in vivo (p = 0.0002). CONCLUSION Our work established and validated a glutamine metabolism-related prognostic model that favorably evaluates the prognosis of EC patients. DNA replication and repair may be the crucial point that linked glutamine metabolism, amino acid metabolism, and EC progression. High-risk patients stratified by the model may not be sufficient for immune therapy. PHGDH might be a crucial target that links serine metabolism, glutamine metabolism as well as EC progression.
Collapse
Affiliation(s)
- Lirong Zhai
- Department of Obstetrics and GynecologyPeking University People's HospitalBeijingChina
| | - Xiao Yang
- Department of Obstetrics and GynecologyPeking University People's HospitalBeijingChina
| | - Yuan Cheng
- Department of Obstetrics and GynecologyPeking University People's HospitalBeijingChina
| | - Jianliu Wang
- Department of Obstetrics and GynecologyPeking University People's HospitalBeijingChina
| |
Collapse
|
84
|
Beckmann L, Lennartz M, Poch A, Holstein K, Bokemeyer C, Langer F. Expression and Release of Tumor Cell Tissue Factor Triggers Recurrent Thromboembolism in a Patient with Endometrial Cancer. Hamostaseologie 2023; 43:289-296. [PMID: 36863395 DOI: 10.1055/a-2010-6484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Although cancer-associated thrombosis (CAT) is a frequent complication in patients with malignancies, its treatment remains a challenge in daily practice. Here, we report the clinical course of a 51-year-old woman presenting with a highly thrombogenic paraneoplastic coagulopathy. Despite therapeutic anticoagulation with various agents, including rivaroxaban, fondaparinux, and low-molecular-weight heparin, the patient suffered from recurrent venous and arterial thromboembolism. Locally advanced endometrial cancer was identified. Tumor cells showed strong expression of tissue factor (TF), and significant concentrations of TF-bearing microvesicles were detected in patient plasma. Coagulopathy was controlled only by continuous intravenous anticoagulation with the direct thrombin inhibitor, argatroban. Multimodal antineoplastic treatment, including neoadjuvant chemotherapy followed by surgery and postoperative radiotherapy, resulted in clinical cancer remission, which was paralleled by normalization of tumor markers, CA125 and CA19-9, D-dimer levels, and TF-bearing microvesicles. In summary, continuous anticoagulation with argatroban and multimodal anticancer treatment may be necessary to control TF-driven coagulation activation with recurrent CAT in endometrial cancer.
Collapse
Affiliation(s)
- Lennart Beckmann
- II. Medizinische Klinik und Poliklinik, Hubertus Wald Tumorzentrum - Universitäres Cancer Center Hamburg (UCCH), Universitätsklinikum Eppendorf, Hamburg, Germany
| | | | - Annika Poch
- II. Medizinische Klinik und Poliklinik, Hubertus Wald Tumorzentrum - Universitäres Cancer Center Hamburg (UCCH), Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Katharina Holstein
- II. Medizinische Klinik und Poliklinik, Hubertus Wald Tumorzentrum - Universitäres Cancer Center Hamburg (UCCH), Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- II. Medizinische Klinik und Poliklinik, Hubertus Wald Tumorzentrum - Universitäres Cancer Center Hamburg (UCCH), Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Florian Langer
- II. Medizinische Klinik und Poliklinik, Hubertus Wald Tumorzentrum - Universitäres Cancer Center Hamburg (UCCH), Universitätsklinikum Eppendorf, Hamburg, Germany
| |
Collapse
|
85
|
Ruan P, Wang S, Yang C, Huang X, Sun P, Tan A. m 6A mRNA methylation regulates the ERK/NF-κB/AKT signaling pathway through the PAPPA/IGFBP4 axis to promote proliferation and tumor formation in endometrial cancer. Cell Biol Toxicol 2023; 39:1611-1626. [PMID: 35971034 DOI: 10.1007/s10565-022-09751-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
N6-methyladenosine (m6A) mRNA methylation has been considered a gene modulatory mechanism involved in disease progression and carcinogenesis. Herein, we aimed to explore the specific mechanism of m6A mRNA methylation in endometrial cancer. RT-qPCR was implemented to test the clinical correlation between m6A methylation and endometrial cancer. Bioinformatics analysis was performed to screen the genes related to endometrial cancer, and SRAMP was utilized for the prediction of m6A targets. Western blot assay and MeRIP-qPCR experiments were conducted to verify the effect of m6A methylation on the candidate genes and the signaling pathways involved in the occurrence of endometrial cancer. m6A-seq, RT-qPCR, and polysome profiling were used to confirm the mechanisms of m6A methylation in modulating related genes and pathways. The levels of m6A methylation, METTL3, and IGFBP4 were reduced in tumor tissues of patients with endometrial cancer, and SRAMP analysis confirmed that IGFBP4 and PAPPA had m6A methylation sites. Reduced m6A methylation promoted endometrial cancer cell progression and tumor formation in vivo. m6A methylation of RNA in endometrial cancer cells directly modulated IGFBP4 and PAPPA expression. m6A methylation regulated the PAPPA/IGFBP4 axis, thereby influencing endometrial cancer through the NF-κB and ERK signaling pathways. Knockdown of PAPPA or overexpression of IGFBP4 in endometrial cancer cells partially reduced disease progression caused by reduced m6A methylation. This research suggests that m6A mRNA methylation modulates the ERK/NF-κB/AKT signaling pathway through the PAPPA/IGFBP4 axis to induce cell proliferation and tumor formation in endometrial cancer. 1. METTL3 expressed modestly and m6A methylation of IGFBP4 and PAPPA mRNAs decreased in endometrial cancer; 2. YTHDF1-mediated IGFBP4 translation was reduced in HEC-1-A and AN3CA cells, and YTHDF2-mediated PAPPA mRNA degradation was blunted but its protein expression increased; 3. Increased PAPPA and reduced IGFBP4 activated IGF1-induced ERK, AKT, and NF-κB pathways by binding IGFR, thereby promoting cancer cell malignancy.
Collapse
Affiliation(s)
- Peng Ruan
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, People's Republic of China
| | - Shujun Wang
- Department of Obstetrics & Gynecology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan, Hubei, 430060, People's Republic of China
| | - Chaoyi Yang
- Department of Obstetrics & Gynecology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan, Hubei, 430060, People's Republic of China
| | - Xiaohui Huang
- Department of Obstetrics & Gynecology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan, Hubei, 430060, People's Republic of China
| | - Pengxing Sun
- Department of Obstetrics & Gynecology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan, Hubei, 430060, People's Republic of China
| | - Aili Tan
- Department of Obstetrics & Gynecology, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan, Hubei, 430060, People's Republic of China.
| |
Collapse
|
86
|
Naguib YW, Alhaj-Suliman SO, Wafa EI, Saha S, Ebeid K, Mohammed HHH, Abdel-Rahman SA, Abuo-Rahma GEDA, Geary SM, Salem AK. Ciprofloxacin Derivative-Loaded Nanoparticles Synergize with Paclitaxel Against Type II Human Endometrial Cancer. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023:e2302931. [PMID: 37525558 PMCID: PMC10828114 DOI: 10.1002/smll.202302931] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/07/2023] [Indexed: 08/02/2023]
Abstract
Combinations of chemotherapeutic agents comprise a clinically feasible approach to combat cancers that possess resistance to treatment. Type II endometrial cancer is typically associated with poor outcomes and the emergence of chemoresistance. To overcome this challenge, a combination therapy is developed comprising a novel ciprofloxacin derivative-loaded PEGylated polymeric nanoparticles (CIP2b-NPs) and paclitaxel (PTX) against human type-II endometrial cancer (Hec50co with loss of function p53). Cytotoxicity studies reveal strong synergy between CIP2b and PTX against Hec50co, and this is associated with a significant reduction in the IC50 of PTX and increased G2/M arrest. Upon formulation of CIP2b into PEGylated polymeric nanoparticles, tumor accumulation of CIP2b is significantly improved compared to its soluble counterpart; thus, enhancing the overall antitumor activity of CIP2b when co-administered with PTX. In addition, the co-delivery of CIP2b-NPs with paclitaxel results in a significant reduction in tumor progression. Histological examination of vital organs and blood chemistry was normal, confirming the absence of any apparent off-target toxicity. Thus, in a mouse model of human endometrial cancer, the combination of CIP2b-NPs and PTX exhibits superior therapeutic activity in targeting human type-II endometrial cancer.
Collapse
Affiliation(s)
- Youssef W. Naguib
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242, United States
- Department of Pharmaceutics, and Minia 61519, Egypt
| | - Suhaila O. Alhaj-Suliman
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242, United States
| | - Emad I. Wafa
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242, United States
| | - Sanjib Saha
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242, United States
| | - Kareem Ebeid
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242, United States
- Department of Pharmaceutics, and Minia 61519, Egypt
| | - Hamada H. H. Mohammed
- Department of Medicinal Chemistry, Faculty of Pharmacy, Minia University, Minia 61519, Egypt
| | - Somaya A. Abdel-Rahman
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242, United States
| | | | - Sean M. Geary
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242, United States
| | - Aliasger K. Salem
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242, United States
- Holden Comprehensive Cancer Center, University of Iowa Hospitals & Clinics, Iowa City, IA 52242, United States
| |
Collapse
|
87
|
Capaci V, Arrigoni G, Monasta L, Aloisio M, Rocca G, Di Lorenzo G, Licastro D, Romano F, Ricci G, Ura B. Phospho-DIGE Identified Phosphoproteins Involved in Pathways Related to Tumour Growth in Endometrial Cancer. Int J Mol Sci 2023; 24:11987. [PMID: 37569364 PMCID: PMC10419128 DOI: 10.3390/ijms241511987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Endometrial cancer (EC) is the most common gynecologic malignancy of the endometrium. This study focuses on EC and normal endometrium phosphoproteome to identify differentially phosphorylated proteins involved in tumorigenic signalling pathways which induce cancer growth. We obtained tissue samples from 8 types I EC at tumour stage 1 and 8 normal endometria. We analyzed the phosphoproteome by two-dimensional differential gel electrophoresis (2D-DIGE), combined with immobilized metal affinity chromatography (IMAC) and mass spectrometry for protein and phosphopeptide identification. Quantities of 34 phosphoproteins enriched by the IMAC approach were significantly different in the EC compared to the endometrium. Validation using Western blotting analysis on 13 patients with type I EC at tumour stage 1 and 13 endometria samples confirmed the altered abundance of HBB, CKB, LDHB, and HSPB1. Three EC samples were used for in-depth identification of phosphoproteins by LC-MS/MS analysis. Bioinformatic analysis revealed several tumorigenic signalling pathways. Our study highlights the involvement of the phosphoproteome in EC tumour growth. Further studies are needed to understand the role of phosphorylation in EC. Our data shed light on mechanisms that still need to be ascertained but could open the path to a new class of drugs that could hinder EC growth.
Collapse
Affiliation(s)
- Valeria Capaci
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (G.D.L.); (F.R.); (G.R.); (B.U.)
| | - Giorgio Arrigoni
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy; (G.A.); (G.R.)
- Proteomics Center, University of Padova and Azienda Ospedaliera di Padova, 35131 Padova, Italy
- CRIBI Biotechnology Center, University of Padova, 35131 Padova, Italy
| | - Lorenzo Monasta
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (G.D.L.); (F.R.); (G.R.); (B.U.)
| | - Michelangelo Aloisio
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (G.D.L.); (F.R.); (G.R.); (B.U.)
| | - Giulia Rocca
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy; (G.A.); (G.R.)
- Proteomics Center, University of Padova and Azienda Ospedaliera di Padova, 35131 Padova, Italy
| | - Giovanni Di Lorenzo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (G.D.L.); (F.R.); (G.R.); (B.U.)
| | | | - Federico Romano
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (G.D.L.); (F.R.); (G.R.); (B.U.)
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (G.D.L.); (F.R.); (G.R.); (B.U.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Blendi Ura
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.C.); (M.A.); (G.D.L.); (F.R.); (G.R.); (B.U.)
| |
Collapse
|
88
|
Piergentili R, Gullo G, Basile G, Gulia C, Porrello A, Cucinella G, Marinelli E, Zaami S. Circulating miRNAs as a Tool for Early Diagnosis of Endometrial Cancer-Implications for the Fertility-Sparing Process: Clinical, Biological, and Legal Aspects. Int J Mol Sci 2023; 24:11356. [PMID: 37511115 PMCID: PMC10379073 DOI: 10.3390/ijms241411356] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
This review article explores the possibility of developing an integrated approach to the management of the different needs of endometrial cancer (EC) patients seeking to become pregnant. Life preservation of the woman, health preservation of the baby, a precocious and-as much as possible-minimally invasive characterization of the health and fertility parameters of the patient, together with the concerns regarding the obstetric, neonatal, and adult health risks of the children conceived via assisted reproductive techniques (ART) are all essential aspects of the problem to be taken into consideration, yet the possibility to harmonize such needs through a concerted and integrated approach is still very challenging. This review aims to illustrate the main features of EC and how it affects the normal physiology of pre-menopausal women. We also focus on the prospect of a miR-based, molecular evaluation of patient health status, including both EC early diagnosis and staging and, similarly, the receptivity of the woman, discussing the possible evaluation of both aspects using a single specific panel of circulating miRs in the patient, thus allowing a relatively fast, non-invasive testing with a significantly reduced margin of error. Finally, the ethical and legal/regulatory aspects of such innovative techniques require not only a risk-benefit analysis; respect for patient autonomy and equitable health care access allocation are fundamental issues as well.
Collapse
Affiliation(s)
- Roberto Piergentili
- Istituto di Biologia e Patologia Molecolari del CNR (IBPM-CNR), 00185 Rome, Italy
| | - Giuseppe Gullo
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, 90146 Palermo, Italy
| | | | - Caterina Gulia
- Dipartimento di Urologia, Ospedale della Misericordia, 58100 Grosseto, Italy
| | - Alessandro Porrello
- Lineberger Comprehensive Cancer Center & RNA Discovery Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, 90146 Palermo, Italy
| | - Enrico Marinelli
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, "Sapienza" University of Rome, 00161 Rome, Italy
| |
Collapse
|
89
|
Staropoli N, Salvino A, Falcone F, Farenza V, Costa M, Rossini G, Manti F, Crispino A, Riillo C, Ciliberto D, Arbitrio M, Tassone P, Tagliaferri P. Pembrolizumab plus lenvatinib in advanced endometrial cancer: case report and systematic review of lung toxicity. Front Oncol 2023; 13:1145986. [PMID: 37492471 PMCID: PMC10363977 DOI: 10.3389/fonc.2023.1145986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/07/2023] [Indexed: 07/27/2023] Open
Abstract
Background The optimal strategy for the treatment of recurrent and/or advanced endometrial cancer is still undefined. Recently, despite the lack of any predictive biomarker, the combination of pembrolizumab with lenvatinib has improved survival outcomes. We here report the long-term management of lung toxicity in a patient with endometrial cancer, and we critically review the current therapeutic options for this disease. Results A patient with heavily pretreated endometrial cancer took pembrolizumab plus lenvatinib for 1 year, achieving a persistent partial response with a time to treatment failure of 18 months, despite relevant lung toxicity that did not affect the remarkable overall clinical benefit. A systematic review of this combination underlines the efficacy outcome despite toxicity. Interestingly, the literature review on lung toxicity suggested the role of anti-angiogenetic agents in the pathogenesis of lung cavitation, probably related to direct treatment activity, and disclosed a potential radiological sign predictive of the activity of anti-angiogenetic agents. Conclusion We underline the efficacy of pembrolizumab plus lenvatinib in the current treatment landscape of endometrial cancer, underscoring the relevance of a correct management of toxicity.
Collapse
Affiliation(s)
- Nicoletta Staropoli
- Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Angela Salvino
- Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Federica Falcone
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Valentina Farenza
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Martina Costa
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Giacomo Rossini
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | | | - Antonella Crispino
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Caterina Riillo
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Domenico Ciliberto
- Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
| | - Mariamena Arbitrio
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Catanzaro, Italy
| | - Pierfrancesco Tassone
- Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Pierosandro Tagliaferri
- Medical and Translational Oncology Unit, AOU Renato Dulbecco, Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| |
Collapse
|
90
|
Weiss F, Kaltofen T, Kanitz V, Schröder L, Kost B, König A, Delius M, Mahner S, Alba Alejandre I. Clear cell endometrial carcinoma with high microsatellite instability in a complicated pregnancy: a case report. J Med Case Rep 2023; 17:286. [PMID: 37422672 DOI: 10.1186/s13256-023-03994-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/21/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Endometrial carcinomas are the most common female genital malignancies. They are very rare in pregnancy and worldwide less than 60 cases associated with pregnancy are published. No clear cell carcinoma has been described in a pregnancy with a live birth. CASE PRESENTATION We present the course of a 43-year-old Uyghur female patient with the diagnosis of endometrial carcinoma with a deficiency in the DNA mismatch repair system in the pregnancy. The malignancy with clear cell histology was confirmed by biopsy following the delivery via caesarean section due to preterm birth of a fetus with sonographically suspected tetralogy of Fallot. Earlier whole exome sequencing after amniocentesis had shown a heterozygous mutation in the MSH2 gene, which was unlikely to be related to the fetal cardiac defect. The uterine mass was initially deemed an isthmocervical fibroid by ultrasound and was confirmed as stage II endometrial carcinoma. The patient was consequently treated with surgery, radiotherapy and chemotherapy. Six months after the adjuvant therapy, re-laparotomy was performed due to ileus symptoms and an ileum metastasis was found. The patient is currently undergoing immune checkpoint inhibitor therapy with pembrolizumab. CONCLUSION Rare endometrial carcinoma should be included in the differential diagnosis of uterine masses in pregnant women with risk factors.
Collapse
Affiliation(s)
- Fabian Weiss
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Till Kaltofen
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Veronika Kanitz
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Lennard Schröder
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Bernd Kost
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Alexander König
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Maria Delius
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - Irene Alba Alejandre
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| |
Collapse
|
91
|
Ge J, Fader AN, Dudley JC. Early detection of endometrial cancer. Gynecol Oncol 2023; 174:A1-A2. [PMID: 37356825 DOI: 10.1016/j.ygyno.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Affiliation(s)
- Jiaxin Ge
- Ludwig Center, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda N Fader
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan C Dudley
- Ludwig Center, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
92
|
Gong S, Quan Q, Meng Y, Wu J, Yang S, Hu J, Mu X. The value of serum HE4 and CA125 levels for monitoring the recurrence and risk stratification of endometrial endometrioid carcinoma. Heliyon 2023; 9:e18016. [PMID: 37519747 PMCID: PMC10373916 DOI: 10.1016/j.heliyon.2023.e18016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023] Open
Abstract
To evaluate the role of serum human epididymis secretory protein 4 (HE4) and carbohydrate antigen 125 (CA125) levels for predicting and monitoring the recurrence of endometrial endometrioid carcinoma (EEC) and assessing preoperative risk stratification in EEC patients. A total of 434 EEC patients were selected for this retrospective study between May 2011 and August 2018. Serum HE4 and CA125 levels were analyzed before the initial treatment, at the first postoperative follow-up, and at recurrence or the last follow-up. Patients were risk stratified according to the European Society for Medical Oncology (ESMO), European Society for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) guideline. We compared the ability of these biomarkers for prediction and monitoring by performing receiver operating characteristic curve analysis and identified optimal cut-off values by determining the Youden index. Kaplan-Meier analyses were also performed to determine prognostic value. Preoperative serum HE4 was identified as a significant predictor for the recurrence of EEC (p = 0.014). Preoperative serum HE4 and CA125 levels were related to depth of myometrial invasion, lymph node status and FIGO stage. Serum HE4 and CA125 levels were both statistically significant markers for monitoring the recurrence of EEC (P = 0.000 for each biomarker). When combined, the two markers showed higher levels of sensitivity and specificity. The two biomarkers were also significant biomarkers for evaluating the risk stratification of patients undergoing lymphadenectomy (P = 0.000 for each biomarker). For premenopausal stage I patients, preoperative serum HE4 and CA125 levels were significant predictors of the need for ovarian preservation (P = 0.000 and P = 0.002, respectively). For premenopausal patients with stage I intramucosal differentiation, preoperative serum levels of HE4 were significant predictors for fertility preservation (P = 0.024). Preoperative serum HE4 level can be used to predict the recurrence of EEC. Postoperative serum HE4 and CA125 levels can be used to monitor the recurrence of EEC and are more sensitive when combined. Preoperative serum levels of CA125 and HE4 levels are of significant value for risk stratification in EEC patients.
Collapse
Affiliation(s)
- Sainan Gong
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, PR China
| | - Quan Quan
- Department of Gynecology, The First People's Hospital of Chongqing Liangjiang New Area, 401121 Chongqing, PR China
| | - Yu Meng
- Department of Physical Examination Center, University Town Hospital Affiliated to Chongqing Medical University, 400042 Chongqing, PR China
| | - Jingxian Wu
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, PR China
| | - Shuang Yang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, PR China
| | - Jiaming Hu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, PR China
| | - Xiaoling Mu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, 400016 Chongqing, PR China
| |
Collapse
|
93
|
Jin Y, Qiu Y, Li Y, Jiang Z, Hu S, Dai H. A novel epithelial-mesenchymal transition-related lncRNA signature predicts prognosis and immune status in endometrioid endometrial cancer. Medicine (Baltimore) 2023; 102:e34126. [PMID: 37390286 PMCID: PMC10313257 DOI: 10.1097/md.0000000000034126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/07/2023] [Indexed: 07/02/2023] Open
Abstract
The pathogenesis and progression of endometrial cancer (EC) are associated with epithelial-mesenchymal transition (EMT) and long noncoding RNAs (lncRNAs). In the present study, we aimed to identify an EMT-related lncRNA signature and evaluate its prognostic value in EC. We obtained the expression profile of lncRNAs and clinical information of patients with endometrioid EC from The Cancer Genome Atlas database (N = 401). We identified a signature of 5 EMT-related lncRNAs and calculated the risk score of each patient. Next, we validated the independence of the prognostic value of the EMT-related lncRNA signature. Furthermore, we performed Gene Set Enrichment Analysis to identify potential molecular function and Kyoto Encyclopedia of Genes and Genomes pathways related to the EMT-related lncRNA signature. Tumor microenvironment analysis and immune checkpoint blockade (ICB) response prediction were also assessed. Survival analysis revealed that the high-risk group, based on the EMT-related lncRNA signature, had a poorer prognosis than the low-risk group in the training, testing, and entire sets. The predictive value of the EMT-related lncRNA signature was independent of age, The International Federation of Gynecology and Obstetrics stage, tumor grade, and body mass index. Time-dependent receiver operating characteristic curves also demonstrate the prognostic accuracy of this risk model. Gene Set Enrichment Analysis showed that cytokine-cytokine receptor interaction, glycolysis/gluconeogenesis, and IL-17 signaling pathway were significantly enriched. Furthermore, tumor microenvironment analysis indicated a significant negative correlation between the immune score and EMT-related lncRNA signature risks core, while the low-risk group was more likely to respond to ICB therapy than the high-risk group. A reliable EMT-related lncRNA signature of endometrioid EC was identified that could be utilized as an independent prognostic biomarker to predict patient survival outcomes and provide references for the option of ICB therapy.
Collapse
Affiliation(s)
- Yichao Jin
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yixuan Qiu
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yujing Li
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Ziwei Jiang
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Siwen Hu
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Huihua Dai
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| |
Collapse
|
94
|
Zhang G, Yin Z, Fang J, Wu A, Chen G, Cao K. Construction of the novel immune risk scoring system related to CD8 + T cells in uterine corpus endometrial carcinoma. Cancer Cell Int 2023; 23:124. [PMID: 37349706 DOI: 10.1186/s12935-023-02966-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Uterine corpus endometrial carcinoma (UCEC) is a gynecological malignant tumor with high incidence and poor prognosis. Although immunotherapy has brought significant survival benefits to advanced UCEC patients, traditional evaluation indicators cannot accurately identify all potential beneficiaries of immunotherapy. Consequently, it is necessary to construct a new scoring system to predict patient prognosis and responsiveness of immunotherapy. METHODS CIBERSORT combined with weighted gene co-expression network analysis (WGCNA), non-negative matrix factorization (NMF), and random forest algorithms to screen the module associated with CD8+ T cells, and key genes related to prognosis were selected out by univariate, least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression analyses to develop the novel immune risk score (NIRS). Kaplan-Meier (K-M) analysis was used to compare the difference of survival between high- and low- NIRS groups. We also explored the correlations between NIRS, immune infiltration and immunotherapy, and three external validation sets were used to verify the predictive performance of NIRS. Furthermore, clinical subgroup analysis, mutation analysis, differential expression of immune checkpoints, and drug sensitivity analysis were performed to generate individualized treatments for patients with different risk scores. Finally, gene set variation analysis (GSVA) was conducted to explore the biological functions of NIRS, and qRT-PCR was applied to verify the differential expressions of three trait genes at cellular and tissue levels. RESULTS Among the modules clustered by WGCNA, the magenta module was most positively associated with CD8+ T cells. Three genes (CTSW, CD3D and CD48) were selected to construct NIRS after multiple screening procedures. NIRS was confirmed as an independent prognostic factor of UCEC, and patients with high NIRS had significantly worse prognosis compared to those with low NIRS. The high NIRS group showed lower levels of infiltrated immune cells, gene mutations, and expression of multiple immune checkpoints, indicating reduced sensitivity to immunotherapy. Three module genes were identified as protective factors positively correlated with the level of CD8+ T cells. CONCLUSIONS In this study, we constructed NIRS as a novel predictive signature of UCEC. NIRS not only differentiates patients with distinct prognoses and immune responsiveness, but also guides their therapeutic regimens.
Collapse
Affiliation(s)
- Ganghua Zhang
- Department of Oncology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhijing Yin
- Department of Oncology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Jianing Fang
- Department of Oncology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Anshan Wu
- Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, China
| | - Guanjun Chen
- Department of Oncology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Ke Cao
- Department of Oncology, Third Xiangya Hospital, Central South University, Changsha, China.
| |
Collapse
|
95
|
Miguet C, Jauffret C, Zemmour C, Boher JM, Sabiani L, Houvenaeghel G, Blache G, Brun C, Lambaudie E. Enhanced Recovery after Surgery and Endometrial Cancers: Results from an Initial Experience Focused on Elderly Patients. Cancers (Basel) 2023; 15:3244. [PMID: 37370854 DOI: 10.3390/cancers15123244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/27/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Endometrial cancer is the fifth most common cancer among French women and occurs most frequently in the over-70-year-old population. Recent years have seen a significant shift towards minimally invasive surgery and Enhanced Recovery After Surgery (ERAS) protocols in endometrial cancer management. However, the impact of ERAS on endometrial cancer has not been well-established. We conducted a prospective observational study in a comprehensive cancer center, comparing the outcomes between endometrial cancer patients who received care in an ERAS pathway (261) and those who did not (166) between 2006 and 2020. We performed univariate and multivariate analysis. Our primary objective was to evaluate the impact of ERAS on length of hospital stay (LOS), with the secondary objectives being the determination of the rates of early discharge, post-operative morbidity, and rehospitalization. We found that patients in the ERAS group had a significantly shorter length of stay, with an average of 3.18 days compared to 4.87 days for the non-ERAS group (estimated decrease -1.69, p < 0.0001). This effect was particularly pronounced among patients over 70 years old (estimated decrease -2.06, p < 0.0001). The patients in the ERAS group also had a higher chance of early discharge (47.5% vs. 14.5% in the non-ERAS group, p < 0.0001), for which there was not a significant increase in post-operative complications. Our study suggests that ERAS protocols are beneficial for the management of endometrial cancer, particularly for older patients, and could lead to the development of ambulatory pathways.
Collapse
Affiliation(s)
- Céline Miguet
- Department of Surgical Oncology, Institute Paoli-Calmettes, 13009 Marseille, France
| | - Camille Jauffret
- Department of Surgical Oncology, Institute Paoli-Calmettes, 13009 Marseille, France
| | - Christophe Zemmour
- Biostatistics and Methodology Unit, Department of Clinical Research and Investigation, Institute Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, 13009 Marseille, France
| | - Jean-Marie Boher
- Biostatistics and Methodology Unit, Department of Clinical Research and Investigation, Institute Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, 13009 Marseille, France
| | - Laura Sabiani
- Department of Surgical Oncology, Institute Paoli-Calmettes, 13009 Marseille, France
| | - Gilles Houvenaeghel
- Department of Surgical Oncology, Institute Paoli-Calmettes, 13009 Marseille, France
- Inserm, CNRS, Institute Paoli-Calmettes, CRCM, Aix Marseille University, 13009 Marseille, France
| | - Guillaume Blache
- Department of Surgical Oncology, Institute Paoli-Calmettes, 13009 Marseille, France
| | - Clément Brun
- Department of Anaesthesiology, Institute Paoli-Calmettes, 13009 Marseille, France
| | - Eric Lambaudie
- Department of Surgical Oncology, Institute Paoli-Calmettes, 13009 Marseille, France
- Inserm, CNRS, Institute Paoli-Calmettes, CRCM, Aix Marseille University, 13009 Marseille, France
| |
Collapse
|
96
|
Li Y, Liu G, Gong R, Xi Y. Gut Microbiome Dysbiosis in Patients with Endometrial Cancer vs. Healthy Controls Based on 16S rRNA Gene Sequencing. Curr Microbiol 2023; 80:239. [PMID: 37294364 DOI: 10.1007/s00284-023-03361-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/02/2023] [Indexed: 06/10/2023]
Abstract
Metabolic diseases like obesity, diabetes, and hypertension are considered major risk factors associated with endometrial cancer. Considering that an imbalance in the gut microbiome may lead to metabolic alterations, we hypothesized that alteration in the gut microbioma might be an indirect factor in the development of endometrial cancer. Our aim was to profile the gut microbiota of patients with endometrial cancer compared with healthy controls in this study. Thus, we used 16S rRNA high-throughput gene sequencing on the Illumina NovaSeq platform to profile microbial communities. Fecal samples were collected from 33 endometrial cancer patients (EC group) and 32 healthy controls (N group) between February 2021 and July 2021. The total numbers of operational taxonomic units (OTUs) in the N and EC groups were 28,537 and 18,465, respectively, while the number of OTUs shared by the two groups was 4771. This study was the first to report that the alpha diversity of the gut microbiota was significantly reduced in endometrial cancer patients vs. healthy controls. Also, there was a significant difference in the distribution of microbiome between the two groups: the abundance of Firmicutes, Clostridia, Clostridiales, Ruminococcaceae, Faecalibacterium, and Gemmiger_formicis decreased, while that of Proteobacteria, Gammaproteobacteria, Enterobacteriales, Enterobacteriaceae and Shigella increased significantly in the EC group vs. healthy controls (all p < 0.05). The predominant intestinal microbiota of the endometrial cancer patients was Proteobacteria, Gammaproteobacteria, Enterobacteriales, Enterobacteriaceae, and Shigella. These results imply that adjusting the composition of the gut microbiota and maintaining microbiota homeostasis may be an effective strategy for preventing and treating endometrial cancer.
Collapse
Affiliation(s)
- Yue Li
- Department of Obstetrics and Gynecology, Dalian Municipal Women and Children's Medical Center (Group), No.1, Dunhuang Road, Shahekou District, Dalian, Liaoning, 116033, P.R. China
| | - Geng Liu
- Department of Obstetrics and Gynecology, Dalian Municipal Women and Children's Medical Center (Group), No.1, Dunhuang Road, Shahekou District, Dalian, Liaoning, 116033, P.R. China
| | - Runqi Gong
- Department of Obstetrics and Gynecology, Liaoning Provincial Hospital for women and children, Shenyang, Liaoning, 110004, P.R. China
| | - Yong Xi
- Department of Obstetrics and Gynecology, Dalian Municipal Women and Children's Medical Center (Group), No.1, Dunhuang Road, Shahekou District, Dalian, Liaoning, 116033, P.R. China.
| |
Collapse
|
97
|
Zhou X, Zeng Y, Zheng R, Wang Y, Li T, Song S, Zhang S, Huang J, Ren Y. Natural products modulate cell apoptosis: a promising way for treating endometrial cancer. Front Pharmacol 2023; 14:1209412. [PMID: 37361222 PMCID: PMC10285317 DOI: 10.3389/fphar.2023.1209412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023] Open
Abstract
Endometrial cancer (EC) is a prevalent epithelial malignancy in the uterine corpus's endometrium and myometrium. Regulating apoptosis of endometrial cancer cells has been a promising approach for treating EC. Recent in-vitro and in-vivo studies show that numerous extracts and monomers from natural products have pro-apoptotic properties in EC. Therefore, we have reviewed the current studies regarding natural products in modulating the apoptosis of EC cells and summarized their potential mechanisms. The potential signaling pathways include the mitochondria-dependent apoptotic pathway, endoplasmic reticulum stress (ERS) mediated apoptotic pathway, the mitogen-activated protein kinase (MAPK) mediated apoptotic pathway, NF-κB-mediated apoptotic pathway, PI3K/AKT/mTOR mediated apoptotic pathway, the p21-mediated apoptotic pathway, and other reported pathways. This review focuses on the importance of natural products in treating EC and provides a foundation for developing natural products-based anti-EC agents.
Collapse
Affiliation(s)
- Xin Zhou
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yiwei Zeng
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Runchen Zheng
- School of Chinese Classics, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuemei Wang
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tao Li
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shanshan Song
- School of Chinese Classics, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Su Zhang
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jinzhu Huang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Gynecology, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yulan Ren
- School of Chinese Classics, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| |
Collapse
|
98
|
Xu X, Chen L, Nunez-Smith M, Clark M, Wright JD. Racial disparities in diagnostic evaluation of uterine cancer among Medicaid beneficiaries. J Natl Cancer Inst 2023; 115:636-643. [PMID: 36788453 PMCID: PMC10248843 DOI: 10.1093/jnci/djad027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/22/2023] [Accepted: 01/28/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND To inform reasons contributing to Black-White disparity in early diagnosis of uterine cancer, we compared the quality of diagnostic evaluation received by Black vs White patients with abnormal uterine bleeding (AUB) ultimately diagnosed with uterine cancer. METHODS Using 2008-2019 MarketScan Multi-State Medicaid Database, we identified Black (n = 858) and White (n = 1749) patients with uterine cancer presenting with AUB. Quality of diagnostic evaluation was measured by delayed diagnosis (>1 year after AUB reporting), not receiving guideline-recommended diagnostic procedures, delayed time to first diagnostic procedure (>2 months after AUB reporting), number of diagnostic procedures received, and number of evaluation and management visits for AUB. The association between race and quality indicators was examined by multivariable regressions adjusting for patient characteristics. RESULTS Black patients were more likely than White patients to experience delayed diagnosis (11.3% vs 8.3%, P = .01; adjusted odds ratio [OR] = 1.71, 95% confidence interval [CI] = 1.27 to 2.29) or to not receive guideline-recommended diagnostic procedures (10.1% vs 5.0%, P < .001; adjusted OR = 1.94, 95% CI = 1.40 to 2.68). Even when they did receive recommended diagnostic procedures, Black patients were more likely than White patients to experience delay in time to the first diagnostic procedure (adjusted OR = 1.46, 95% CI = 1.09 to 1.97). In addition, Black patients underwent more evaluation and management visits for AUB before getting diagnosed compared with White patients (adjusted mean ratio = 1.13, 95% CI = 1.04 to 1.23). CONCLUSIONS Black and White patients with uterine cancer differed in the quality of diagnostic evaluation received. Improving equity in this area may help reduce Black-White disparity in stage at diagnosis.
Collapse
Affiliation(s)
- Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - Ling Chen
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - Mitchell Clark
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
99
|
Mirza MR, Chase DM, Slomovitz BM, dePont Christensen R, Novák Z, Black D, Gilbert L, Sharma S, Valabrega G, Landrum LM, Hanker LC, Stuckey A, Boere I, Gold MA, Auranen A, Pothuri B, Cibula D, McCourt C, Raspagliesi F, Shahin MS, Gill SE, Monk BJ, Buscema J, Herzog TJ, Copeland LJ, Tian M, He Z, Stevens S, Zografos E, Coleman RL, Powell MA. Dostarlimab for Primary Advanced or Recurrent Endometrial Cancer. N Engl J Med 2023; 388:2145-2158. [PMID: 36972026 DOI: 10.1056/nejmoa2216334] [Citation(s) in RCA: 169] [Impact Index Per Article: 169.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Dostarlimab is an immune-checkpoint inhibitor that targets the programmed cell death 1 receptor. The combination of chemotherapy and immunotherapy may have synergistic effects in the treatment of endometrial cancer. METHODS We conducted a phase 3, global, double-blind, randomized, placebo-controlled trial. Eligible patients with primary advanced stage III or IV or first recurrent endometrial cancer were randomly assigned in a 1:1 ratio to receive either dostarlimab (500 mg) or placebo, plus carboplatin (area under the concentration-time curve, 5 mg per milliliter per minute) and paclitaxel (175 mg per square meter of body-surface area), every 3 weeks (six cycles), followed by dostarlimab (1000 mg) or placebo every 6 weeks for up to 3 years. The primary end points were progression-free survival as assessed by the investigator according to Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1, and overall survival. Safety was also assessed. RESULTS Of the 494 patients who underwent randomization, 118 (23.9%) had mismatch repair-deficient (dMMR), microsatellite instability-high (MSI-H) tumors. In the dMMR-MSI-H population, estimated progression-free survival at 24 months was 61.4% (95% confidence interval [CI], 46.3 to 73.4) in the dostarlimab group and 15.7% (95% CI, 7.2 to 27.0) in the placebo group (hazard ratio for progression or death, 0.28; 95% CI, 0.16 to 0.50; P<0.001). In the overall population, progression-free survival at 24 months was 36.1% (95% CI, 29.3 to 42.9) in the dostarlimab group and 18.1% (95% CI, 13.0 to 23.9) in the placebo group (hazard ratio, 0.64; 95% CI, 0.51 to 0.80; P<0.001). Overall survival at 24 months was 71.3% (95% CI, 64.5 to 77.1) with dostarlimab and 56.0% (95% CI, 48.9 to 62.5) with placebo (hazard ratio for death, 0.64; 95% CI, 0.46 to 0.87). The most common adverse events that occurred or worsened during treatment were nausea (53.9% of the patients in the dostarlimab group and 45.9% of those in the placebo group), alopecia (53.5% and 50.0%), and fatigue (51.9% and 54.5%). Severe and serious adverse events were more frequent in the dostarlimab group than in the placebo group. CONCLUSIONS Dostarlimab plus carboplatin-paclitaxel significantly increased progression-free survival among patients with primary advanced or recurrent endometrial cancer, with a substantial benefit in the dMMR-MSI-H population. (Funded by GSK; RUBY ClinicalTrials.gov number, NCT03981796.).
Collapse
Affiliation(s)
- Mansoor R Mirza
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Dana M Chase
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Brian M Slomovitz
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - René dePont Christensen
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Zoltán Novák
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Destin Black
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Lucy Gilbert
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Sudarshan Sharma
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Giorgio Valabrega
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Lisa M Landrum
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Lars C Hanker
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Ashley Stuckey
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Ingrid Boere
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Michael A Gold
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Annika Auranen
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Bhavana Pothuri
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - David Cibula
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Carolyn McCourt
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Francesco Raspagliesi
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Mark S Shahin
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Sarah E Gill
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Bradley J Monk
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Joseph Buscema
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Thomas J Herzog
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Larry J Copeland
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Min Tian
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Zangdong He
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Shadi Stevens
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Eleftherios Zografos
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Robert L Coleman
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Matthew A Powell
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| |
Collapse
|
100
|
Zhang W, Liu M, Ji Y, Yu D, Ma C, Zhao J, Qu P. Tanshinone IIA inhibits endometrial carcinoma growth through the MAPK/ERK/TRIB3 pathway. Arch Biochem Biophys 2023:109655. [PMID: 37285895 DOI: 10.1016/j.abb.2023.109655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 05/25/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023]
Abstract
Endometrial carcinoma is the most common gynecological tumor in developed countries. Tanshinone IIA is a traditional herbal medicine which is to treat cardiovascular disease and has been shown to have various biological effects, such as anti-inflammatory, antioxidative and antitumor activities. However, there has been no study about the effect of tanshinone IIA on endometrial carcinoma. Thus, the aim of this study was to determine the antitumor activity of tanshinone IIA against endometrial carcinoma and investigate the associated molecular mechanism. We demonstrated that tanshinone IIA induced cell apoptosis and inhibited migration. We further demonstrated that tanshinone IIA activated the intrinsic (mitochondrial) apoptotic pathway. Mechanistically, tanshinone IIA induced apoptosis by upregulating TRIB3 expression and inhibiting the MAPK/ERK signaling pathway. In addition, knockdown of TRIB3 with an shRNA lentivirus accelerated proliferation and attenuated inhibition mediated by tanshinone IIA. Finally, we further demonstrated that tanshinone IIA inhibited tumor growth by inducing TRIB3 expression in vivo. In conclusion, these findings suggest that tanshinone IIA has a significant antitumor effect by inducing apoptosis and may be used as a drug for the treatment of endometrial carcinoma.
Collapse
Affiliation(s)
- Wenwen Zhang
- Tianjin Central Hospital of Gynecology Obstetrics, No. 156 Nankai San Ma Road, Nankai District, Tianjin, 300100, China; Research Institute of Obstetrics and Gynecology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, 300100, China
| | - Meihua Liu
- Tianjin Central Hospital of Gynecology Obstetrics, No. 156 Nankai San Ma Road, Nankai District, Tianjin, 300100, China; Research Institute of Obstetrics and Gynecology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, 300100, China
| | - Yurou Ji
- Clinical School of Obstetrics and Gynecology Center, Tianjin Medical University, No. 22 Meteorological Observatory Road, Heping District, Tianjin, 300070, China; Tianjin Medical University, No. 22 Meteorological Observatory Road, Heping District, Tianjin, 300070, China
| | - Dake Yu
- Tianjin Central Hospital of Gynecology Obstetrics, No. 156 Nankai San Ma Road, Nankai District, Tianjin, 300100, China
| | - Chuanrui Ma
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300192, China; Tianjin Key Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin, 300192, China
| | - Jianguo Zhao
- Tianjin Central Hospital of Gynecology Obstetrics, No. 156 Nankai San Ma Road, Nankai District, Tianjin, 300100, China.
| | - Pengpeng Qu
- Tianjin Central Hospital of Gynecology Obstetrics, No. 156 Nankai San Ma Road, Nankai District, Tianjin, 300100, China; Research Institute of Obstetrics and Gynecology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, 300100, China.
| |
Collapse
|