1001
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Sinreih M, Štupar S, Čemažar L, Verdenik I, Frković Grazio S, Smrkolj Š, Rižner TL. STAR and AKR1B10 are down-regulated in high-grade endometrial cancer. J Steroid Biochem Mol Biol 2017; 171:43-53. [PMID: 28232277 DOI: 10.1016/j.jsbmb.2017.02.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 02/16/2017] [Accepted: 02/18/2017] [Indexed: 11/25/2022]
Abstract
Endometrial cancer is the most frequent gynecological malignancy in the developed world. The majority of cases are estrogen dependent, and are associated with diminished protective effects of progesterone. Endometrial cancer is also related to enhanced inflammation and decreased differentiation. In our previous studies, we examined the expression of genes involved in estrogen and progesterone actions in inflammation and tumor differentiation, in tissue samples from endometrial cancer and adjacent control endometrium. The aims of the current study were to examine correlations between gene expression and several demographic characteristics, and to evaluate changes in gene expression with regard to histopathological and clinical characteristics of 51 patients. We studied correlations and differences in expression of 38 genes involved in five pathophysiological processes: (i) estrogen-stimulated proliferation; (ii) estrogen-dependent carcinogenesis; (iii) diminished biosynthesis of progesterone: (iv) enhanced formation of progesterone metabolites; and (v) increased inflammation and decreased differentiation. Spearman correlation coefficient analysis shows that expression of PAQR7 correlates with age, expression of SRD5A1, AKR1B1 and AKR1B10 correlate with body mass, while expression of SRD5A1 and AKR1B10 correlate with body mass index. When patients with endometrial cancer were stratified based on menopausal status, histological grade, myometrial invasion, lymphovascular invasion, and FIGO stage, Mann-Whitney U tests revealed significantly decreased expression of STAR (4.4-fold; adjusted p=0.009) and AKR1B10 (9-fold; adjusted p=0.003) in high grade versus low grade tumors. Lower levels of STAR might lead to decreased de-novo steroid hormone synthesis and tumor differentiation, and lower levels of AKR1B10 to diminished elimination of toxic electrophilic carbonyl compounds in high-grade endometrial cancer. These data thus reveal the potential of STAR and AKR1B10 as prognostic biomarkers, which calls for further validation at the protein level.
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Affiliation(s)
- Maša Sinreih
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Saša Štupar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Luka Čemažar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Snježana Frković Grazio
- Department of Pathology, Division of Gynaecology and Obstetrics University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Špela Smrkolj
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tea Lanišnik Rižner
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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1002
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Sinreih M, Knific T, Anko M, Hevir N, Vouk K, Jerin A, Frković Grazio S, Rižner TL. The Significance of the Sulfatase Pathway for Local Estrogen Formation in Endometrial Cancer. Front Pharmacol 2017; 8:368. [PMID: 28690541 PMCID: PMC5481366 DOI: 10.3389/fphar.2017.00368] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/29/2017] [Indexed: 01/27/2023] Open
Abstract
Endometrial cancer (EC) is the most common estrogen-dependent gynecological malignancy in the developed World. To investigate the local formation of estradiol (E2), we first measured the concentrations of the steroid precursor androstenedione (A-dione) and the most potent estrogen, E2, and we evaluated the metabolism of A-dione, estrone-sulfate (E1-S), and estrone (E1) in cancerous and adjacent control endometrium. Furthermore, we studied expression of the key genes for estradiol formation via the aromatase and sulfatase pathways. A-dione and E2 were detected in cancerous and adjacent control endometrium. In cancerous endometrium, A-dione was metabolized to testosterone, and no E2 was formed. Both, E1-S and E1 were metabolized to E2, with increased levels of E2 seen in cancerous tissue. There was no significant difference in expression of the key genes of the aromatase (CYP19A1) and the sulfatase (STS, HSD17B1, HSD17B2) pathways in cancerous endometrium compared to adjacent control tissue. The mRNA levels of CYP19A1 and HSD17B1 were low, and HSD17B14, which promotes inactivation of E2, was significantly down-regulated in cancerous endometrium, especially in patients with lymphovascular invasion. At the protein level, there were no differences in the levels of STS and HSD17B2 between cancerous and adjacent control tissue by Western blotting, and immunohistochemistry revealed intense staining for STS and HSD17B2, and weak staining for SULT1E1 and HSD17B1 in cancerous tissue. Our data demonstrate that in cancerous endometrium, E2 is formed from E1-S via the sulfatase pathway, and not from A-dione via the aromatase pathway.
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Affiliation(s)
- Maša Sinreih
- Institute of Biochemistry, Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
| | - Tamara Knific
- Institute of Biochemistry, Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
| | - Maja Anko
- Institute of Biochemistry, Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
| | - Neli Hevir
- Institute of Biochemistry, Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
| | - Katja Vouk
- Institute of Biochemistry, Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
| | - Aleš Jerin
- Institute of Clinical Chemistry and Biochemistry, University Medical CentreLjubljana, Slovenia
| | - Snježana Frković Grazio
- Division of Obstetrics and Gynecology, Department of Pathology, University Medical CentreLjubljana, Slovenia
| | - Tea Lanišnik Rižner
- Institute of Biochemistry, Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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1003
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Ma AY, Xie SW, Zhou JY, Zhu Y. Nomegestrol Acetate Suppresses Human Endometrial Cancer RL95-2 Cells Proliferation In Vitro and In Vivo Possibly Related to Upregulating Expression of SUFU and Wnt7a. Int J Mol Sci 2017. [PMID: 28640224 PMCID: PMC5535830 DOI: 10.3390/ijms18071337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Nomegestrol acetate (NOMAC) has been successfully used for the treatment of some gynecological disorders, and as a combined oral contraceptive with approval in many countries. In this study, we investigated the effects of NOMAC on human endometrial cancer cells in vitro and in vivo. The proliferation of human endometrial cancer cells (RL95-2 and KLE) were assessed using CCK-8 and EdU incorporation assays. Whole-genome cDNA microarray analysis was used to identify the effects of NOMAC on gene expression profiles in RL95-2 cells. RL95-2 xenograft nude mice were treated with NOMAC (50, 100, and 200 mg/kg) or medroxyprogesterone acetate (MPA; 100 and 200 mg/kg) for 28 consecutive days. The results showed that NOMAC significantly inhibited the growth of RL95-2 cells in a concentration-dependent manner, but not in KLE cells. Further investigation demonstrated that NOMAC produced a stronger inhibition of tumor growth (inhibition rates for 50, 100, and 200 mg/kg NOMAC were 24.74%, 47.04%, and 58.06%, respectively) than did MPA (inhibition rates for 100 and 200 mg/kg MPA were 41.06% and 27.01%, respectively) in the nude mice bearing the cell line of RL95-2. NOMAC altered the expression of several genes related to cancer cell proliferation, including SUFU and Wnt7a. The upregulation of SUFU and Wnt7a was confirmed using real-time quantitative polymerase chain reaction and Western blotting in RL95-2 cells and RL95-2 xenograft tumor tissues, but not in KLE cells. These data indicate that NOMAC can inhibit the proliferation of RL95-2 cell in vitro and suppress the growth of xenografts in the nude mice bearing the cell line of RL95-2 in vivo. This effect could be related to the upregulating expression of SUFU and Wnt7a.
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Affiliation(s)
- A-Ying Ma
- Lab of Reproductive Pharmacology, Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai 200032, China.
| | - Shu-Wu Xie
- Lab of Reproductive Pharmacology, Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai 200032, China.
| | - Jie-Yun Zhou
- Lab of Reproductive Pharmacology, Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai 200032, China.
| | - Yan Zhu
- Lab of Reproductive Pharmacology, Key Lab of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai 200032, China.
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1004
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Jones NL, Xiu J, Chatterjee-Paer S, Buckley de Meritens A, Burke WM, Tergas AI, Wright JD, Hou JY. Distinct molecular landscapes between endometrioid and nonendometrioid uterine carcinomas. Int J Cancer 2017; 140:1396-1404. [PMID: 27905110 DOI: 10.1002/ijc.30537] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/16/2016] [Indexed: 12/21/2022]
Abstract
Endometrial carcinoma (EC) is traditionally characterized as endometrioid and nonendometrioid based on histopathologic phenotypes. Molecular-based classifications have been proposed, but are not widely implemented. Herein we examine molecular profiles between EC histologic subtypes. 3133 ECs were submitted between March 2011 and July 2014: 1634 Type I and 1226 Type II. In situ hybridization and immunohistochemistry were used to assess copy number and protein expression of selected genes. Sequenced variants in 47 genes were analyzed using the Illumina TruSeq Amplicon Cancer Panel. Type II EC included 628 cases of uterine serous cancer (USC), 136 cases of clear cell (CC), 361 cases of carcinosarcoma (CS), 38 cases of mucinous, and 36 cases of squamous cell. PI3K/Akt/mTOR pathway was most frequently dysregulated within Type I and mucinous histologies, least altered in CS and squamous. PD-L1 expression was highest in mucinous, absent in squamous. ER/PR expression was common in Type II, most frequent in USC, mucinous, and squamous. Receptor tyrosine kinase was frequently dysregulated in Type II disease: HER2 amplification highest in USC and CC, EGFR mutations exclusively seen in mucinous EC, KRAS mutations common in mucinous, squamous, and Type I, and c-MET overexpression high in CC and mucinous. BRCA1 and BRCA2 were most frequently mutated in CS. Grade 3 EC shares features of G1 tumor and Type II disease, most notably resembling CS. Endometrial carcinomas are a molecularly heterogeneous group of tumors. A histology-based molecular map can identify rational targets to optimize treatment and guide future clinical trials.
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Affiliation(s)
- Nathaniel L Jones
- Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY
| | | | - Sudeshna Chatterjee-Paer
- Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY
| | | | - William M Burke
- Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY
| | - Ana I Tergas
- Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY
| | - June Y Hou
- Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY
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1005
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Gentilin E, Minoia M, Bondanelli M, Tagliati F, Degli Uberti EC, Zatelli MC. Growth Hormone differentially modulates chemoresistance in human endometrial adenocarcinoma cell lines. Endocrine 2017; 56:621-632. [PMID: 27585662 DOI: 10.1007/s12020-016-1085-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/09/2016] [Indexed: 02/06/2023]
Abstract
Growth Hormone may influence neoplastic development of endometrial epithelium towards endometrial adenocarcinoma, which is one of the most occurring tumors in acromegalic patients. Since chemoresistance often develops in advanced endometrial adenocarcinoma, we investigated whether Growth Hormone might influence the development of chemoresistance to drugs routinely employed in endometrial adenocarcinoma treatment, such as Doxorubicin, Cisplatin, and Paclitaxel. Growth Hormone and Growth Hormone receptor expression was assessed by immunofluorescence in two endometrial adenocarcinoma cell lines, AN3 CA and HEC-1-A cells. Growth Hormone effects were assessed investigating cell viability, caspase3/7 activation, ERK1/2, and protein kinase C delta protein expression. AN3 CA and HEC-1-A cells display Growth Hormone and Growth Hormone receptor. Growth Hormone does not influence cell viability in both cells lines, but significantly reduces caspase 3/7 activation in AN3 CA cells, an effect blocked by a Growth Hormone receptor antagonist. Growth Hormone rescues AN3 CA cells from the inhibitory effects of Doxorubicin and Cisplatin on cell viability, while it has no effect on Paclitaxel. Growth Hormone does not influence the pro-apoptotic effects of Doxorubicin, but is capable of rescuing AN3 CA cells from the pro-apoptotic effects of Cisplatin. On the other hand, Growth Hormone did not influence the effects of Doxorubicin and Paclitaxel on HEC-1A cell viability. The protective action of Growth Hormone towards the effects of Doxorubicin may be mediated by ERK1/2 activation, while the pro-apoptotic effects of Cisplatin may be mediated by protein kinase C delta inhibition. All together our results indicate that Growth Hormone may differentially contribute to endometrial adenocarcinoma chemoresistance. This may provide new insights on novel therapies against endometrial adenocarcinoma chemoresistant aggressive tumors.
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Affiliation(s)
- Erica Gentilin
- Section of Endocrinology and Internal Medicine, Dept. of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Mariella Minoia
- Section of Endocrinology and Internal Medicine, Dept. of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marta Bondanelli
- Section of Endocrinology and Internal Medicine, Dept. of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Federico Tagliati
- Section of Endocrinology and Internal Medicine, Dept. of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ettore C Degli Uberti
- Section of Endocrinology and Internal Medicine, Dept. of Medical Sciences, University of Ferrara, Ferrara, Italy
- Laboratorio in rete del Tecnopolo "Tecnologie delle terapie avanzate" (LTTA) of the University of Ferrara, Ferrara, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology and Internal Medicine, Dept. of Medical Sciences, University of Ferrara, Ferrara, Italy.
- Laboratorio in rete del Tecnopolo "Tecnologie delle terapie avanzate" (LTTA) of the University of Ferrara, Ferrara, Italy.
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1006
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Park JY, Lee JJ, Choi HJ, Song IH, Sung CO, Kim HO, Chae SY, Kim YT, Nam JH. The Value of Preoperative Positron Emission Tomography/Computed Tomography in Node-Negative Endometrial Cancer on Magnetic Resonance Imaging. Ann Surg Oncol 2017; 24:2303-2310. [DOI: 10.1245/s10434-017-5901-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Indexed: 11/18/2022]
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1007
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Compliance with adjuvant treatment guidelines in endometrial cancer: room for improvement in high risk patients. Gynecol Oncol 2017; 146:380-385. [PMID: 28552255 DOI: 10.1016/j.ygyno.2017.05.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Compliance of physicians with guidelines has emerged as an important indicator for quality of care. We evaluated compliance of physicians with adjuvant therapy guidelines for endometrial cancer patients in the Netherlands in a population-based cohort over a period of 10years. METHODS Data from all patients diagnosed with endometrial cancer between 2005 and 2014, without residual tumor after surgical treatment, were extracted from the Netherlands Cancer Registry (N=14,564). FIGO stage, grade, tumor type and age were used to stratify patients into risk groups. Possible changes in compliance over time and impact of compliance on survival were assessed. RESULTS Patients were stratified into low/low-intermediate (52%), high-intermediate (21%) and high (20%) risk groups. Overall compliance with adjuvant therapy guidelines was 85%. Compliance was highest in patients with low/low-intermediate risk (98%, no adjuvant therapy indicated). The lowest compliance was determined in patients with high risk (61%, external beam radiotherapy with/without chemotherapy indicated). Within this group compliance decreased from 64% in 2005-2009 to 57% in 2010-2014. In high risk patients with FIGO stage III serous disease compliance was 55% (chemotherapy with/without radiotherapy indicated) and increased from 41% in 2005-2009 to 66% in 2010-2014. CONCLUSION While compliance of physicians with adjuvant therapy guidelines is excellent in patients with low and low-intermediate risk, there is room for improvement in high risk endometrial cancer patients. Eagerly awaited results of ongoing randomized clinical trials may provide more definitive guidance regarding adjuvant therapy for high risk endometrial cancer patients.
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1008
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Bartosch C, Lopes JM, Jerónimo C. Epigenetics in endometrial carcinogenesis - part 1: DNA methylation. Epigenomics 2017; 9:737-755. [PMID: 28470096 DOI: 10.2217/epi-2016-0166] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Carcinogenesis is a multistep multifactorial process that involves the accumulation of genetic and epigenetic alterations. In the past two decades, there has been an exponential growth of knowledge establishing the importance of epigenetic changes in cancer. Our work focused on reviewing the main role of epigenetics in the pathogenesis of endometrial carcinoma, highlighting the reported results concerning each epigenetic mechanistic layer. The present review is the first part of this work, in which we examined the contribution of DNA methylation alterations for endometrial carcinogenesis.
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Affiliation(s)
- Carla Bartosch
- Department of Pathology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal.,Cancer Biology & Epigenetics Group, Research Center (CI-IPOP), Portuguese Oncology Institute of Porto, Porto, Portugal.,Department of Pathology & Oncology, Medical Faculty, University of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (P.ccc), Porto, Portugal
| | - José Manuel Lopes
- Department of Pathology & Oncology, Medical Faculty, University of Porto, Porto, Portugal.,Department of Pathology, Centro Hospitalar São João (CHSJ), Porto, Portugal.,IPATIMUP - Institute of Molecular Pathology & Immunology, University of Porto, Porto, Portugal.,I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Carmen Jerónimo
- Cancer Biology & Epigenetics Group, Research Center (CI-IPOP), Portuguese Oncology Institute of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (P.ccc), Porto, Portugal.,Department of Pathology & Molecular Immunology, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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1009
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Han KH, Kim HS, Lee M, Chung HH, Song YS. Prognostic factors for tumor recurrence in endometrioid endometrial cancer stages IA and IB. Medicine (Baltimore) 2017; 96:e6976. [PMID: 28538399 PMCID: PMC5457879 DOI: 10.1097/md.0000000000006976] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Risk grouping for treatment and follow-up strategy of early stage endometrial cancer is confusing to apply in clinical conditions. We investigated the stage-based prognostic factors for tumor recurrence in stage I endometrial cancer with endometrioid histology (EEC).The medical records of women diagnosed with endometrial adenocarcinoma between 1993 and 2013 were retrospectively reviewed. In 521 patients with International Federation of Gynecology and Obstetrics (FIGO) stage I EEC were included. The baseline patient characteristics were analyzed with the chi-square test and Fisher's exact tests. A multivariate analysis with a Cox proportional hazard model and logistic regression were performed to identify the prognostic factors for recurrence-free survival (RFS) in FIGO stage I EEC.The median follow-up period for the included patients was 74.6 months (3.1-264.9 months). Tumor recurrence occurred in 30 patients (5.8%) with a median time span of 22.85 months (2.2-124.7 months). Only 2 factors among the conventional adverse risk factors, including myometrial invasion and histologic grade, affected tumor recurrence in stage I EEC (P = .003 and P = .003, respectively). Myometrial invasion was an independent prognostic factor for RFS in stage IA EEC via multivariate analysis (P = .005). In stage IB EEC, the histologic grade was an independent prognostic factor for RFS. The median RFS of stage IB EEC was 156.0 months in grade 1, 120.0 months in grade 2, and 105.9 months in grade 3 (P = .006).Within stage I EEC, the prognostic factors for tumor recurrence were different between stages IA and IB. Myometrial invasion comprised the prognostic factor in stage IA, whereas the histologic grade comprised the prognostic factor in stage IB.
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Affiliation(s)
- Kyung Hee Han
- Department of Obstetrics and Gynecology, Seoul National University Hospital Healthcare System Gangnam Center
- Department of Obstetrics and Gynecology
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology
- Cancer Research Institute, Seoul National University College of Medicine
| | - Maria Lee
- Department of Obstetrics and Gynecology
| | | | - Yong Sang Song
- Department of Obstetrics and Gynecology
- Cancer Research Institute, Seoul National University College of Medicine
- Major in Biomodulation, World Class University, Seoul National University, Seoul, Republic of Korea
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1010
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Bodurtha Smith AJ, Fader AN, Tanner EJ. Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol 2017; 216:459-476.e10. [PMID: 27871836 DOI: 10.1016/j.ajog.2016.11.1033] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/05/2016] [Accepted: 11/10/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND In the staging of endometrial cancer, controversy remains regarding the role of sentinel lymph node mapping compared with other nodal assessment strategies. OBJECTIVE We conducted a systematic review to evaluate the diagnostic accuracy and clinical impact of sentinel lymph node mapping in the management of endometrial cancer. DATA SOURCES We searched Medline, Embase, and the Cochrane Central Registry of Controlled trials for studies published in English before March 25, 2016 (PROSPERO CRD42016036503). STUDY ELIGIBILITY CRITERIA Studies were included if they contained 10 or more women with endometrial cancer and reported on the detection rate, sensitivity, and/or impact on treatment or survival of sentinel lymph node mapping. STUDY APPRAISAL AND SYNTHESIS METHODS Two authors independently reviewed abstracts and full-text articles for inclusion and assessed study quality. The detection rate, sensitivity, and factors associated with successful mapping (study size, body mass index, tumor histology and grade, injection site, dye type) were synthesized through random-effects meta-analyses and meta-regression. RESULTS We identified 55 eligible studies, which included 4915 women. The overall detection rate of sentinel lymph node mapping was 81% (95% confidence interval, 77-84) with a 50% (95% confidence interval, 44-56) bilateral pelvic node detection rate and 17% (95% confidence interval, 11-23) paraaortic detection rate. There was no difference in detection rates by patient body mass index or tumor histology and grade. Use of indocyanine green increased the bilateral detection rate compared with blue dye. Additionally, cervical injection increased the bilateral sentinel lymph node detection rate but decreased the paraaortic detection rate compared with alternative injection techniques. Intraoperative sentinel lymph node frozen section increased the overall and bilateral detection rates. The sensitivity of sentinel node mapping to detect metastases was 96% (95% confidence interval, 91-98); ultrastaging did not improve sensitivity. Compared with women staged with complete lymphadenectomy, women staged with sentinel lymph node mapping were more likely to receive adjuvant treatment. CONCLUSION Sentinel lymph node mapping is feasible and accurately predicts nodal status in women with endometrial cancer. The current data favors the use of cervical injection techniques with indocyanine green. Sentinel lymph mapping may be considered an alternative standard of care in the staging of women with endometrial cancer.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Amanda Nickles Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Edward J Tanner
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD.
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1011
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Conza D, Mirra P, Calì G, Tortora T, Insabato L, Fiory F, Schenone S, Amato R, Beguinot F, Perrotti N, Ulianich L. The SGK1 inhibitor SI113 induces autophagy, apoptosis, and endoplasmic reticulum stress in endometrial cancer cells. J Cell Physiol 2017; 232:3735-3743. [PMID: 28177128 DOI: 10.1002/jcp.25850] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/07/2017] [Indexed: 12/14/2022]
Abstract
Endometrial cancer is often characterized by PI3K/AKT pathway deregulation. Recently it has been suggested that SGK1, a serine/threonine protein kinase that shares structural and functional similarities with the AKT family, might play a role in cancer, since its expression and/or activity has been found to be deregulated in different human tumors. However, the role of SGK1 in endometrial cancer has been poorly investigated. Here, we show that SGK1 expression is increased in tissue specimens from neoplastic endometrium. The SGK1 inhibitor SI113 induced a significant reduction of endometrial cancer cells viability, measured by the (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay. This effect was associated to the increase of autophagy, as revealed by the increase of the markers LC3B-II and beclin I, detected by both immunofluorescence and western blot analysis. SI113 treatment caused also apoptosis of endometrial cancer cells, evidenced by the cleavage of the apoptotic markers PARP and Caspase-9. Intriguingly, these effects were associated to the induction of endoplasmic reticulum stress markers GRP78 and CHOP evaluated by both Real-Time RT-PCR and Western Blot analysis. Increased expression of SGK1 in endometrial cancer tissues suggest a role for SGK1 in this type of cancer, as reported for other malignancies. Moreover, the efficacy of SI113 in affecting endometrial cancer cells viability, possibly via endoplasmic reticulum stress activation, identifies SGK1 as an attractive molecular target for new tailored therapeutic intervention for the treatment of endometrial cancer.
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Affiliation(s)
- Domenico Conza
- Department of Medical and Translational Sciences of the University of Naples "Federico II" & URT dell'Istituto di Endocrinologia e Oncologia Sperimentale 'Gaetano Salvatore', Consiglio Nazionale delle Ricerche, Naples, Italy
| | - Paola Mirra
- Department of Medical and Translational Sciences of the University of Naples "Federico II" & URT dell'Istituto di Endocrinologia e Oncologia Sperimentale 'Gaetano Salvatore', Consiglio Nazionale delle Ricerche, Naples, Italy
| | - Gaetano Calì
- Istituto di Endocrinologia e Oncologia Sperimentale 'Gaetano Salvatore', Consiglio Nazionale delle Ricerche, Naples, Italy
| | - Teresa Tortora
- Department of Medical and Translational Sciences of the University of Naples "Federico II" & URT dell'Istituto di Endocrinologia e Oncologia Sperimentale 'Gaetano Salvatore', Consiglio Nazionale delle Ricerche, Naples, Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Francesca Fiory
- Department of Medical and Translational Sciences of the University of Naples "Federico II" & URT dell'Istituto di Endocrinologia e Oncologia Sperimentale 'Gaetano Salvatore', Consiglio Nazionale delle Ricerche, Naples, Italy
| | | | - Rosario Amato
- Department of "Scienze della Salute", University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Francesco Beguinot
- Department of Medical and Translational Sciences of the University of Naples "Federico II" & URT dell'Istituto di Endocrinologia e Oncologia Sperimentale 'Gaetano Salvatore', Consiglio Nazionale delle Ricerche, Naples, Italy
| | - Nicola Perrotti
- Department of "Scienze della Salute", University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Luca Ulianich
- Department of Medical and Translational Sciences of the University of Naples "Federico II" & URT dell'Istituto di Endocrinologia e Oncologia Sperimentale 'Gaetano Salvatore', Consiglio Nazionale delle Ricerche, Naples, Italy
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1012
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Yamawaki K, Ishiguro T, Mori Y, Yoshihara K, Suda K, Tamura R, Yamaguchi M, Sekine M, Kashima K, Higuchi M, Fujii M, Okamoto K, Enomoto T. Sox2-dependent inhibition of p21 is associated with poor prognosis of endometrial cancer. Cancer Sci 2017; 108:632-640. [PMID: 28188685 PMCID: PMC5406528 DOI: 10.1111/cas.13196] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/12/2017] [Accepted: 01/24/2017] [Indexed: 12/11/2022] Open
Abstract
Sex‐determining region Y‐box 2 (SOX2) is an essential factor involved in the self‐renewal and pluripotency of embryonic stem cells and has functions in cell survival and progression in many types of cancers. Here, we found that several endometrial cancer cell lines expressed SOX2, which was required for cell growth. Additionally, SOX2 overexpression regulated the expression of cyclin‐dependent kinase inhibitor 1A (CDKN1A), and SOX2 specifically bound to p21 promoter DNA in endometrial cancer cell lines expressing SOX2. Expressions of SOX2 in endometrial cancer patients were significantly correlated with histological grade and poor prognosis. Moreover, low p21 together with high SOX2 expressions in advanced endometrial cancer patients were associated with the most unfavorable outcomes of patients. These results indicated that simultaneous measurement of SOX2 and p21 expression in endometrial cancer patients may be a useful biomarker for patient prognosis.
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Affiliation(s)
- Kaoru Yamawaki
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuya Ishiguro
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yutaro Mori
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuaki Suda
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryo Tamura
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masayuki Yamaguchi
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masayuki Sekine
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Katsunori Kashima
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masaya Higuchi
- Department of Virology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masahiro Fujii
- Department of Virology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Koji Okamoto
- Division of Cancer Differentiation, National Cancer Center Research Institute, Tokyo, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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1013
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Mang C, Birkenmaier A, Cathomas G, Humburg J. Endometrioid endometrial adenocarcinoma: an increase of G3 cancers? Arch Gynecol Obstet 2017; 295:1435-1440. [PMID: 28421274 DOI: 10.1007/s00404-017-4370-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/10/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Endometrial cancer can be divided into two types: endometrioid Type 1 (G1, G2) has a hormonal driven etiology, while Type 2 is more aggressive (G3 endometrioid, clear cell and serous cancer type) and estrogen independent. We noticed an increase of more aggressive G3 endometrioid endometrial adenocarcinomas. This observation is of relevance for daily clinical practice because therapy depends on the histopathological grading and myometrial invasion. G3 cancers or myometrial invasion of more than 50% should be hysterectomized including bilateral adnexectomy with pelvine and paraaortal lymphadenectomy. In G1/G2 and lower infiltration levels, hysterectomy with adnexectomy without lymphadenectomy is sufficient. METHODS Data of the ASF Statistic were used to analyze the changes in the incidences of patients with endometrioid cancer, grading groups and their first diagnosed stages between 2006 and 2014. RESULTS 2611 patients, with 243-341 women per year, were analyzed. The number of diagnosed G1 tumors increased from 25 to 37% and the G3 tumors from 18 to 32%, whereas the G2 cancers decreased from 58 to 31%. Despite the rise of G3 tumors, an increase in age at diagnosis was not observed. The proportions of initial diagnosed stages (FIGO I-IV) in each grading remained constant over time. CONCLUSION Potential consequences in treatment recommendations and prognosis urge attention to the detected increase of G3 endometrioid cancers.
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Affiliation(s)
- C Mang
- Department of Obstetrics and Gynecology, Bethesda Spital Basel, Gellertstrasse 144, 4052, Basel, Switzerland.
| | - A Birkenmaier
- Department of Obstetrics and Gynecology, Bethesda Spital Basel, Gellertstrasse 144, 4052, Basel, Switzerland
| | - G Cathomas
- Institute of Pathology, Cantonal Hospital Baselland, Mühlemattstrasse 11, 4410, Liestal, Switzerland
| | - J Humburg
- Department of Obstetrics and Gynecology, Bethesda Spital Basel, Gellertstrasse 144, 4052, Basel, Switzerland.
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1014
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Turco MY, Gardner L, Hughes J, Cindrova-Davies T, Gomez MJ, Farrell L, Hollinshead M, Marsh SGE, Brosens JJ, Critchley HO, Simons BD, Hemberger M, Koo BK, Moffett A, Burton GJ. Long-term, hormone-responsive organoid cultures of human endometrium in a chemically defined medium. Nat Cell Biol 2017; 19:568-577. [PMID: 28394884 PMCID: PMC5410172 DOI: 10.1038/ncb3516] [Citation(s) in RCA: 372] [Impact Index Per Article: 53.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 03/16/2017] [Indexed: 02/07/2023]
Abstract
In humans, the endometrium, the uterine mucosal lining, undergoes dynamic changes throughout the menstrual cycle and pregnancy. Despite the importance of the endometrium as the site of implantation and nutritional support for the conceptus, there are no long-term culture systems that recapitulate endometrial function in vitro. We adapted conditions used to establish human adult stem cell-derived organoid cultures to generate 3D cultures of normal and decidualised human endometrium. These organoids expand long-term, are genetically stable and differentiate following treatment with reproductive hormones. Single cells from both endometrium and decidua can generate a fully functional organoid. Transcript analysis confirmed great similarity between organoids and the primary tissue of origin. On exposure to pregnancy signals, endometrial organoids develop characteristics of early pregnancy. We also derived organoids from malignant endometrium, and so provide a foundation to study common diseases, such as endometriosis and endometrial cancer, as well as the physiology of early gestation.
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Affiliation(s)
- Margherita Y Turco
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK.,Centre for Trophoblast Research, University of Cambridge, Cambridge CB2 3EG, UK
| | - Lucy Gardner
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK.,Centre for Trophoblast Research, University of Cambridge, Cambridge CB2 3EG, UK
| | - Jasmine Hughes
- Department of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 2SP, UK
| | - Tereza Cindrova-Davies
- Centre for Trophoblast Research, University of Cambridge, Cambridge CB2 3EG, UK.,Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
| | - Maria J Gomez
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK
| | - Lydia Farrell
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK.,Centre for Trophoblast Research, University of Cambridge, Cambridge CB2 3EG, UK
| | | | - Steven G E Marsh
- Anthony Nolan Research Institute, Royal Free Hospital, London, NW3 2QU, UK
| | - Jan J Brosens
- Division of Reproductive Health, Clinical Science Research Laboratories, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Hilary O Critchley
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Benjamin D Simons
- Gurdon Institute and Department of Physics, University of Cambridge, Cambridge CB2 1QN, UK.,Wellcome Trust-Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge CB2 1QR, UK
| | - Myriam Hemberger
- Centre for Trophoblast Research, University of Cambridge, Cambridge CB2 3EG, UK.,Epigenetics Programme, The Babraham Institute, Babraham Research Campus, Cambridge CB22 3AT, UK
| | - Bon-Kyoung Koo
- Wellcome Trust-Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge CB2 1QR, UK.,Department of Genetics, University of Cambridge, Cambridge CB2 3EH, UK
| | - Ashley Moffett
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK.,Centre for Trophoblast Research, University of Cambridge, Cambridge CB2 3EG, UK
| | - Graham J Burton
- Centre for Trophoblast Research, University of Cambridge, Cambridge CB2 3EG, UK.,Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3EG, UK
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1015
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Riggio AI, Blyth K. The enigmatic role of RUNX1 in female-related cancers - current knowledge & future perspectives. FEBS J 2017; 284:2345-2362. [PMID: 28304148 DOI: 10.1111/febs.14059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/15/2017] [Accepted: 03/13/2017] [Indexed: 12/15/2022]
Abstract
Historically associated with the aetiology of human leukaemia, the runt-related transcription factor 1 (RUNX1) gene has in recent years reared its head in an assortment of epithelial cancers. This review discusses the state-of-the-art knowledge of the enigmatic role played by RUNX1 in female-related cancers of the breast, the uterus and the ovary. The weight of evidence accumulated so far is indicative of a very context-dependent role, as either an oncogene or a tumour suppressor. This is corroborated by high-throughput sequencing endeavours which report different genetic alterations affecting the gene, including amplification, deep deletion and mutations. Herein, we attempt to dissect that contextual role by firstly giving an overview of what is currently known about RUNX1 function in these specific tumour types, and secondly by delving into connections between this transcription factor and the physiology of these female tissues. In doing so, RUNX1 emerges not only as a gene involved in female sex development but also as a crucial mediator of female hormone signalling. In view of RUNX1 now being listed as a driver gene, we believe that greater knowledge of the mechanisms underlying its functional dualism in epithelial cancers is worthy of further investigation.
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Affiliation(s)
| | - Karen Blyth
- Cancer Research UK Beatson Institute, Bearsden, Glasgow, UK
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1016
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Benati M, Montagnana M, Danese E, Paviati E, Giudici S, Ruzzenente O, Franchi M, Lippi G. The clinical significance of DJ-1 and HE4 in patients with endometrial cancer. J Clin Lab Anal 2017; 32. [PMID: 28374920 DOI: 10.1002/jcla.22223] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 03/05/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The non-invasive diagnostic approach for early detection of endometrial cancer (EC) remains limited. To date, human epididymis protein 4 (HE4) has been intensively studied but its diagnostic is controversial in EC. DJ-1 is an oncoprotein secreted by cancer cells, recently identified as a potential diagnostic biomarker for breast cancer, melanoma, and pancreatic cancer. The aim of this study was to compare the diagnostic performances of DJ-1 and HE4 measured in EC patients and healthy controls (HC). METHODS Forty-five patients (63.9±12.0 years) with EC and 29 (63.2±13.3 years) HC were enrolled. Serum concentrations of DJ-1 and HE4 were measured using ELISA kits developed by R&D (Minneapolis, USA) and Fujirebio Diagnostic (Malvern, PA, USA), respectively. Differences between EC patients and HC were assessed by Mann-Whitney test and associations were tested by Spearman's correlation. The diagnostic performance was assessed using receiver operating characteristics (ROC) curves analysis. RESULTS Serum DJ-1 concentrations were found to be higher in EC patients than in HC (9533.6 vs 1988.5 pg/mL; P<.0001). The area under the ROC curve (ROC-AUC) was 0.95 (P<.0001). At the cut-off of 3654 pg/mL, the sensitivity and specificity were 0.89 and 0.90, respectively. HE4 serum levels were higher in EC patients than in HC (75.3 vs 56.2 pmol/L; P=.019), with an AUC of 0.66 (P=.020). The AUC obtained by the combination of the two markers resulted 0.96 (P<.0001). CONCLUSION These results suggest that increased serum DJ-1 levels are associated with EC and that this biomarker may be potentially useful for diagnosing EC.
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Affiliation(s)
- Marco Benati
- Department of Neurological, Biomedical and Movement Sciences, Clinical Biochemistry Section, University of Verona, Verona, Italy
| | - Martina Montagnana
- Department of Neurological, Biomedical and Movement Sciences, Clinical Biochemistry Section, University of Verona, Verona, Italy
| | - Elisa Danese
- Department of Neurological, Biomedical and Movement Sciences, Clinical Biochemistry Section, University of Verona, Verona, Italy
| | - Elisa Paviati
- Department of Neurological, Biomedical and Movement Sciences, Clinical Biochemistry Section, University of Verona, Verona, Italy
| | - Silvia Giudici
- Department of Surgery, Obstetrics and Gynaecology Section, University of Verona, Verona, Italy
| | - Orazio Ruzzenente
- Department of Neurological, Biomedical and Movement Sciences, Clinical Biochemistry Section, University of Verona, Verona, Italy
| | - Massimo Franchi
- Department of Surgery, Obstetrics and Gynaecology Section, University of Verona, Verona, Italy
| | - Giuseppe Lippi
- Department of Neurological, Biomedical and Movement Sciences, Clinical Biochemistry Section, University of Verona, Verona, Italy
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1017
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Bendifallah S, Perrin M, Ouldamer L, Lavoué V, Canlorbe G, Raimond E, Hudry D, Coutant C, Graesslin O, Touboul C, Collinet P, Daraï E, Ballester M. Honing the classification of high-risk endometrial cancer with inclusion of lymphovascular space invasion. Surg Oncol 2017; 26:1-7. [PMID: 28317578 DOI: 10.1016/j.suronc.2016.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The purpose of this study was to analyse the clinical impact of LVSI status in a large French multicentre cohort of women with high-risk ECs according to the ESMO classification. METHODS Data of 258 women with high-risk EC who received primary surgical treatment between January 2001 and December 2012 were abstracted from prospective multicentre database. The end points were the recurrence and the lymph node metastasis (LNM) rates. Recurrence free survival (RFS) and overall survival (OS) were analyzed. RESULTS The recurrence and LNM rates in the whole population were 32.9% and 34.5%, respectively. The median follow-up and initial recurrence times were 27 (range: 1-151) and 23.5 (range: 1-151) months, respectively. The respective 3-year RFS rates according to the LNM and LVSI status were, 78.3% (95% CI, 70.1-87.3), 53.7% (95% CI, 40.8-70.6), 65.5% (95% CI, 46.1-93.2), 43.5% (95% CI, 30.3-62.3) for women with no LN metastasis/no LVSI; no LN metastasis/LVSI present; LN metastasis/no LVSI; LN metastasis/LVSI present, respectively (p = 0.0005). CONCLUSIONS LVSI status remains a strong prognostic factor in high-risk ECs associated with a higher recurrence rate and lower RFS and OS whatever the histological type and lymph node status. It could thus be considered in future trials to guide decision-making about adjuvant therapy in high-risk ECs.
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Affiliation(s)
- Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France; INSERM UMR_S_707, "Epidemiology, Information Systems, Modeling", University Pierre and Marie Curie, Paris 6, France.
| | - Morgane Perrin
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France
| | - Lobna Ouldamer
- Department of Obstetrics and Gynaecology, Centre hospitalier régional universitaire de Tours, hôpital Bretonneau, Tours, France
| | - Vincent Lavoué
- CRLCC Eugène-Marquis, service de gynécologie, CHU de Rennes, université de Rennes 1, France
| | - Geoffroy Canlorbe
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Delphine Hudry
- Centre de lutte contre le cancer Georges François Leclerc, Dijon, France
| | - Charles Coutant
- Centre de lutte contre le cancer Georges François Leclerc, Dijon, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Pierre Collinet
- Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire, Lille, France
| | - Emile Daraï
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France; INSERM UMR_S_938, University Pierre et Marie Curie, Paris 6, France
| | - Marcos Ballester
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France; INSERM UMR_S_938, University Pierre et Marie Curie, Paris 6, France
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1018
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Anveden Å, Taube M, Peltonen M, Jacobson P, Andersson-Assarsson JC, Sjöholm K, Svensson PA, Carlsson LMS. Long-term incidence of female-specific cancer after bariatric surgery or usual care in the Swedish Obese Subjects Study. Gynecol Oncol 2017; 145:224-229. [PMID: 28259424 DOI: 10.1016/j.ygyno.2017.02.036] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/14/2017] [Accepted: 02/22/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the long-term effects of bariatric surgery on female-specific cancer in women with obesity. METHODS The prospective, matched Swedish Obese Subjects (SOS) study was designed to examine outcomes after bariatric surgery. This study includes 1420 women from the SOS cohort that underwent bariatric surgery and 1447 contemporaneously matched controls who received conventional obesity treatment. Age was 37-60years and BMI was ≥38kg/m2. Information on cancer events was obtained from the Swedish National Cancer Registry. Median follow-up time was 18.1years (interquartile range 14.8-20.9years, maximum 26years). This study is registered with ClinicalTrials.gov, NCT01479452. RESULTS Bariatric surgery was associated with reduced risk of overall cancer (hazard ratio=0.71; 95% CI 0.59-0.85; p<0.001). About half of the observed cancers were female-specific, and the incidence of these were lower in the surgery group compared with the control group (hazard ratio=0.68; 95% CI 0.52-0·88; p=0.004). The surgical treatment benefit with respect to female-specific cancer was significantly associated with baseline serum insulin (interaction p value=0.022), with greater relative treatment benefit in patients with medium or high insulin levels. Separate analyses of different types of female-specific cancers showed that bariatric surgery was associated with reduced risk of endometrial cancer (hazard ratio=0.56: 95% CI 0.35-0.89; p=0.014). CONCLUSIONS In this long-term study, bariatric surgery was associated with reduced risk of female-specific cancer, especially in women with hyperinsulinemia at baseline. FUNDING This project was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number R01DK105948 (the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health), the Swedish Research Council K2013-99X-22279-01, K2013-54X-11285-19, Sahlgrenska University Hospital ALF research grant and Swedish Diabetes Foundation.
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Affiliation(s)
- Åsa Anveden
- Department of Molecular and Clinical medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Hallands Hospital, Halmstad, Sweden
| | - Magdalena Taube
- Department of Molecular and Clinical medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Markku Peltonen
- Department of Chronic Disease Prevention, National Institute of Health and Welfare, Helsinki, Finland
| | - Peter Jacobson
- Department of Molecular and Clinical medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johanna C Andersson-Assarsson
- Department of Molecular and Clinical medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kajsa Sjöholm
- Department of Molecular and Clinical medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per-Arne Svensson
- Department of Molecular and Clinical medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Lena M S Carlsson
- Department of Molecular and Clinical medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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1019
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Sexual Function and Quality of Life Among Patients With Endometrial Cancer After Surgery. Int J Gynecol Cancer 2017; 27:608-612. [DOI: 10.1097/igc.0000000000000905] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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1020
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Kang SY, Cheon GJ, Lee M, Kim HS, Kim JW, Park NH, Song YS, Chung HH. Prediction of Recurrence by Preoperative Intratumoral FDG Uptake Heterogeneity in Endometrioid Endometrial Cancer. Transl Oncol 2017; 10:178-183. [PMID: 28167243 PMCID: PMC5293736 DOI: 10.1016/j.tranon.2017.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/20/2016] [Accepted: 01/05/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE: To investigate the prognostic value of preoperative intratumoral 18F-FDG uptake heterogeneity (IFH) derived from positron emission tomography (PET)/computed tomography (CT) in patients with endometrioid endometrial cancer. METHODS: We retrospectively evaluated clinicopathological data from patients with pathologically proven endometrioid endometrial cancer who had undergone 18F-FDG PET/CT scans before surgery. Patients were divided into two groups according to their IFH. The main outcome measure was disease-free survival (DFS). RESULTS: Between January 2010 and January 2015, data from 72 patients were available for analysis. The median duration of DFS was 23 months (range, 6 to 57 months), and 4 (5.6%) patients experienced recurrence. There were significant differences in tumor size, IFH, and DFS between patients with and without recurrence. In regression analysis, high IFH value [P = .007, hazard ratio (HR) 2.545, 95% confidence interval (CI) 1.468-8.674] was the only independent risk factor for recurrence. The Kaplan-Meier survival graphs showed that DFS significantly differed in groups categorized based on IFH (P < .001, log-rank test). CONCLUSIONS: Preoperative IFH measured by 18F-FDG PET/CT was associated with recurrence of endometrioid endometrial cancer. The finding supports evidence that FDG-based heterogeneity can be a novel and useful predictor of endometrioid endometrial cancer recurrence.
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Affiliation(s)
- Seo Young Kang
- Department of Nuclear Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Noh-Hyun Park
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Sang Song
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea..
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1021
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Trop-Steinberg S, Azar Y. AP-1 Expression and its Clinical Relevance in Immune Disorders and Cancer. Am J Med Sci 2017; 353:474-483. [PMID: 28502334 DOI: 10.1016/j.amjms.2017.01.019] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/26/2017] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
The inflammatory response is known to have a significant role in certain autoimmune diseases and malignancies. We review current knowledge regarding the functions of activator protein 1 (AP-1) as an important modulator in several immune disorders and carcinomas. AP-1 is overexpressed in rheumatoid arthritis and in long-term allogeneic hematopoietic stem cell transplantation survivors; however, decreased expression of AP-1 has been observed in psoriasis, systematic lupus erythematosus and in patients who do not survive after hematopoietic stem cell transplantation. AP-1 also is implicated in the control of various cancer cells. Higher levels of AP-1 components are present in breast and endometrial carcinomas, colorectal cancer and in acute myeloid leukemia, Hodgkin׳s lymphoma and anaplastic large cell lymphoma, with downregulation in ovarian and gastric carcinomas and in patients with chronic myelogenous leukemia. AP-1 may enable the development of helpful markers to identify early-stage disease or to predict severity.
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Affiliation(s)
| | - Yehudit Azar
- Bone Marrow Transplantation Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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1022
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Hendrickson S, Bystrzonowski N, Kokkinos C, Butler P. Necrotising fasciitis caused by metastatic endometrial cancer: a rare cause of a life-threatening condition. Ann R Coll Surg Engl 2017; 99:e72-e74. [PMID: 27869494 PMCID: PMC5392845 DOI: 10.1308/rcsann.2016.0341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 12/18/2022] Open
Abstract
We report a case of necrotising fasciitis caused by metastatic endometrial adenocarcinoma. Metastases to the lumbar spine with local invasion to the iliopsoas muscle led to an iliopsoas abscess, which subsequently progressed to necrotising fasciitis of the flank. This patient lacked common risk factors for necrotising fasciitis. There are no previous reports in the literature of necrotising fasciitis with this aetiology. We discuss the available evidence for aetiology of and risk factors for necrotising fasciitis, and the relation of time to surgery with prognosis.
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Affiliation(s)
- S Hendrickson
- Plastic Surgery Department, Royal Free Hospital NHS Foundation Trust , London , UK
| | - N Bystrzonowski
- Plastic Surgery Department, Royal Free Hospital NHS Foundation Trust , London , UK
| | - C Kokkinos
- Plastic Surgery Department, Royal Free Hospital NHS Foundation Trust , London , UK
| | - P Butler
- Plastic Surgery Department, Royal Free Hospital NHS Foundation Trust , London , UK
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1023
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Dai M, Zhu XL, Liu F, Xu QY, Ge QL, Jiang SH, Yang XM, Li J, Wang YH, Wu QK, Ai ZH, Teng YC, Zhang ZG. Cholesterol Synthetase DHCR24 Induced by Insulin Aggravates Cancer Invasion and Progesterone Resistance in Endometrial Carcinoma. Sci Rep 2017; 7:41404. [PMID: 28112250 PMCID: PMC5256103 DOI: 10.1038/srep41404] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/19/2016] [Indexed: 12/27/2022] Open
Abstract
3β-Hydroxysteroid-Δ24 reductase (DHCR24), the final enzyme of the cholesterol biosynthetic pathway, has been associated with urogenital neoplasms. However, the function of DHCR24 in endometrial cancer (EC) remains largely elusive. Here, we analyzed the expression profile of DHCR24 and the progesterone receptor (PGR) in our tissue microarray of EC (n = 258), the existing EC database in GEO (Gene Expression Omnibus), and TCGA (The Cancer Genome Atlas). We found that DHCR24 was significantly elevated in patients with EC, and that the up-regulation of DHCR24 was associated with advanced clinical stage, histological grading, vascular invasion, lymphatic metastasis, and reduced overall survival. In addition, DHCR24 expression could be induced by insulin though STAT3, which directly binds to the promoter elements of DHCR24, as demonstrated by ChIP-PCR and luciferase assays. Furthermore, genetically silencing DHCR24 inhibited the metastatic ability of endometrial cancer cells and up-regulated PGR expression, which made cells more sensitive to progestin. Taken together, we have demonstrated for the first time the crucial role of the insulin/STAT3/DHCR24/PGR axis in the progression of EC by modulating the metastasis and progesterone response, which could serve as potential therapeutic targets for the treatment of EC with progesterone receptor loss.
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Affiliation(s)
- Miao Dai
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600 Yishan Road, Shanghai 200233, P. R. China
| | - Xiao-Lu Zhu
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600 Yishan Road, Shanghai 200233, P. R. China
| | - Fei Liu
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600 Yishan Road, Shanghai 200233, P. R. China
| | - Qin-Yang Xu
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600 Yishan Road, Shanghai 200233, P. R. China
| | - Qiu-Lin Ge
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600 Yishan Road, Shanghai 200233, P. R. China
| | - Shu-Heng Jiang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Xiao-Mei Yang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Jun Li
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Ya-Hui Wang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Qing-Kai Wu
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600 Yishan Road, Shanghai 200233, P. R. China
| | - Zhi-Hong Ai
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600 Yishan Road, Shanghai 200233, P. R. China
| | - Yin-Cheng Teng
- Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600 Yishan Road, Shanghai 200233, P. R. China
| | - Zhi-Gang Zhang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
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1024
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Owens GL, Lawrence KM, Jackson TR, Crosbie EJ, Sayan BS, Kitchener HC, Townsend PA. Urocortin suppresses endometrial cancer cell migration via CRFR2 and its system components are differentially modulated by estrogen. Cancer Med 2017; 6:408-415. [PMID: 28109061 PMCID: PMC5313640 DOI: 10.1002/cam4.967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/20/2016] [Accepted: 09/23/2016] [Indexed: 11/24/2022] Open
Abstract
Urocortin (UCN1) peptide shares structural and functional homology with corticotropin‐releasing factor (CRF). UCN1 is significantly reduced in endometrial adenocarcinoma compared to healthy controls. However, there are no data which evaluate the effects of UCN1 in the endometrium, or how it is modulated. We used proliferation and transwell assays to determine the effect of UCN1 on the proliferation and migration of Ishikawa and HEC1A cells. We also determined the expression levels of UCN1 and its receptors produced by estrogen receptor agonists, and the effect of UCN1 on estrogen receptor expression, using quantitative polymerase chain reaction. UCN1 suppressed migration of endometrial cancer cells in vitro. This effect appears to be specific to CRF receptor 2 (CRFR2), as selective antagonism of CRFR2 but not CRFR1 completely eliminated suppression of migration. Activation of ERA reduced UCN1 expression, but only had a small effect on the expression of CRFR1. However, expression of CRFR2 was more notably reduced at both the mRNA and protein levels by activation of ERB. UCN1 in turn reduced both ERA and ERB expression, as assessed by real‐time quantitative PCR. We demonstrate that UCN1 significantly suppresses the migration of endometrial cancer cells but has no effect on their proliferation. Thus, loss of UCN1 in endometrial cancer may promote invasion and metastatic spread. There is a complex relationship between the UCN1 system and estrogen receptors, which may provide insights into endometrial carcinogenesis, a disease known to be driven by estrogen excess.
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Affiliation(s)
- Gemma L Owens
- Division of Molecular & Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, M20 4QL, United Kingdom
| | - Kevin M Lawrence
- Division of Molecular & Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, M20 4QL, United Kingdom
| | - Tom R Jackson
- Division of Molecular & Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, M20 4QL, United Kingdom
| | - Emma J Crosbie
- Division of Molecular & Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, St Mary's Hospital, University of Manchester, Oxford Road, Manchester, M13 9WL, United Kingdom
| | - Berna S Sayan
- Division of Molecular & Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, M20 4QL, United Kingdom
| | - Henry C Kitchener
- Division of Molecular & Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, St Mary's Hospital, University of Manchester, Oxford Road, Manchester, M13 9WL, United Kingdom
| | - Paul A Townsend
- Division of Molecular & Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, M20 4QL, United Kingdom
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1025
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Zanagnolo V, Garbi A, Achilarre MT, Minig L. Robot-assisted Surgery in Gynecologic Cancers. J Minim Invasive Gynecol 2017; 24:379-396. [PMID: 28104497 DOI: 10.1016/j.jmig.2017.01.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 11/30/2022]
Abstract
Robotic-assisted surgery is a technological advancement that facilitates the application of minimally invasive techniques for complex operations in gynecologic oncology. The objective of this article was to review the literature regarding the role of robotic-assisted surgery to treat women with gynecologic cancers. The majority of publications on robotic surgery are still retrospective or descriptive in nature; however, the data for managing patients with a robotic-assisted approach show comparable, and at times improved, outcomes compared with both laparoscopy (2-dimensional) and laparotomy approaches. Robotic-assisted surgery has been used for patients with endometrial cancer and resulted in the increased use of minimally invasive surgery with improved outcomes compared with laparotomy and partially with laparoscopy. This has been shown in large cohorts of patients as well as in obese patients in whom the complication rates have significantly decreased. For early cervical cancer, robotic radical hysterectomy seems to be safe and feasible and to be preferable to laparotomy with seemingly comparable oncologic outcomes. Robotic-assisted surgery and conventional laparoscopy to stage women with early-stage ovarian cancer seem to have similar surgical and oncologic outcomes, with a shorter learning curve for robotic-assisted surgery. However, robotic-assisted surgery appears to be more expensive than laparotomy and traditional laparoscopy. In conclusion, robotic-assisted surgery appears to facilitate the surgical approach for complex operations to treat women with gynecologic cancers. Although randomized controlled trials are lacking to further elucidate the equivalence of robot-assisted surgery with conventional methods in terms of oncologic outcome and patients' quality of life, the technology appears to be safe and effective and could offer a minimally invasive approach to a much larger group of patients.
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Affiliation(s)
- Vanna Zanagnolo
- Gynecology Department, European Institute of Oncology, Milan, Italy.
| | - Annalisa Garbi
- Gynecology Department, European Institute of Oncology, Milan, Italy
| | | | - Lucas Minig
- Gynecology Department, Instituto Valenciano de Oncología, Valencia, Spain
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1026
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Moschetta M, Mak G, Hauser J, Davies C, Uccello M, Arkenau HT. Dabrafenib and trametinib activity in a patient with BRAF V600E mutated and microsatellite instability high (MSI-H) metastatic endometrial cancer. Exp Hematol Oncol 2017; 6:1. [PMID: 28078189 PMCID: PMC5223353 DOI: 10.1186/s40164-016-0061-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/29/2016] [Indexed: 01/05/2023] Open
Abstract
Background Targeting BRAF V600E mutation has been proven effective in the treatment of several types of cancer. In endometrial adenocarcinoma, the BRAF V600E mutation has been rarely reported. Whether targeting BRAF oncogene may represent a plausible therapeutic strategy for the rare patients with BRAF-mutated endometrial cancer remains to be ascertained in prospective studies. Case presentation We report herein the case of a heavily pre-treated patient with recurrent microsatellite instability high (MSI-H) BRAF V600E mutated endometrial adenocarcinoma, which was successfully treated with the V600E targeting agent dabrafenib. After developing resistance to this agent, the MEK targeting agent trametinib was added to dabrafenib achieving again a therapeutic response. Conclusions This case shows that dabrafenib both as monotherapy and when combined with trametinib may exert significant therapeutic activity in heavily pretreated BRAF V600E mutated endometrial adenocarcinoma, and highlight potential benefits of personalized treatment in this disease.
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Affiliation(s)
- Michele Moschetta
- Drug Development Unit, Sarah Cannon Research Institute, 93 Harley Street, London, W1G 6AD UK ; University College London, London, UK
| | - Gabriel Mak
- Drug Development Unit, Sarah Cannon Research Institute, 93 Harley Street, London, W1G 6AD UK ; University College London, London, UK
| | - Joana Hauser
- Drug Development Unit, Sarah Cannon Research Institute, 93 Harley Street, London, W1G 6AD UK
| | - Catriona Davies
- Drug Development Unit, Sarah Cannon Research Institute, 93 Harley Street, London, W1G 6AD UK
| | - Mario Uccello
- Drug Development Unit, Sarah Cannon Research Institute, 93 Harley Street, London, W1G 6AD UK ; University College London, London, UK
| | - Hendrik-Tobias Arkenau
- Drug Development Unit, Sarah Cannon Research Institute, 93 Harley Street, London, W1G 6AD UK ; University College London, London, UK
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1027
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Sperling CD, Verdoodt F, Friis S, Dehlendorff C, Kjaer SK. Statin use and risk of endometrial cancer: a nationwide registry-based case-control study. Acta Obstet Gynecol Scand 2017; 96:144-149. [DOI: 10.1111/aogs.13069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/19/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Cecilie D. Sperling
- Virus, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Freija Verdoodt
- Virus, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Søren Friis
- Unit of Statistics, Bioinformatics and Registry; Danish Cancer Society Research Center; Copenhagen Denmark
- Department of Public Health; University of Copenhagen; Copenhagen Denmark
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
| | - Christian Dehlendorff
- Unit of Statistics, Bioinformatics and Registry; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Susanne K. Kjaer
- Virus, Lifestyle and Genes; Danish Cancer Society Research Center; Copenhagen Denmark
- Department of Gynecology; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
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1028
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Talhouk A, McConechy MK, Leung S, Yang W, Lum A, Senz J, Boyd N, Pike J, Anglesio M, Kwon JS, Karnezis AN, Huntsman DG, Gilks CB, McAlpine JN. Confirmation of ProMisE: A simple, genomics-based clinical classifier for endometrial cancer. Cancer 2017; 123:802-813. [DOI: 10.1002/cncr.30496] [Citation(s) in RCA: 358] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Aline Talhouk
- Department of Pathology and Laboratory Medicine; University of British Columbia and British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Melissa K. McConechy
- Department of Human Genetics; McGill University, Research Institute of the McGill University Health Network; Montreal Quebec Canada
| | - Samuel Leung
- Genetic Pathology Evaluation Center; Department of Pathology and Laboratory Medicine, University of British Columbia; Vancouver British Columbia Canada
| | - Winnie Yang
- Department of Pathology and Laboratory Medicine; University of British Columbia and British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Amy Lum
- Department of Pathology and Laboratory Medicine; University of British Columbia and British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Janine Senz
- Department of Pathology and Laboratory Medicine; University of British Columbia and British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Niki Boyd
- Department of Pathology and Laboratory Medicine; University of British Columbia and British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Judith Pike
- Department of Gynecology and Obstetrics; Division of Gynecologic Oncology, University of British Columbia; Vancouver British Columbia Canada
| | - Michael Anglesio
- Department of Pathology and Laboratory Medicine; University of British Columbia and British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Janice S. Kwon
- Department of Gynecology and Obstetrics; Division of Gynecologic Oncology, University of British Columbia; Vancouver British Columbia Canada
| | - Anthony N. Karnezis
- Department of Pathology and Laboratory Medicine; University of British Columbia and British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - David G. Huntsman
- Department of Pathology and Laboratory Medicine; University of British Columbia and British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - C. Blake Gilks
- Department of Pathology and Laboratory Medicine; University of British Columbia and Vancouver General Hospital; Vancouver British Columbia Canada
| | - Jessica N. McAlpine
- Department of Gynecology and Obstetrics; Division of Gynecologic Oncology, University of British Columbia; Vancouver British Columbia Canada
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1029
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Gupta V, McGunigal M, Prasad-Hayes M, Kalir T, Liu J. Adjuvant radiation therapy is associated with improved overall survival in high-intermediate risk stage I endometrial cancer: A national cancer data base analysis. Gynecol Oncol 2017; 144:119-124. [DOI: 10.1016/j.ygyno.2016.10.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/11/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
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1030
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Poupon C, Bendifallah S, Ouldamer L, Canlorbe G, Raimond E, Hudry N, Coutant C, Graesslin O, Touboul C, Collinet P, Bricou A, Huchon C, Daraï E, Ballester M, Levêque J, Lavoue V. Management and Survival of Elderly and Very Elderly Patients with Endometrial Cancer: An Age-Stratified Study of 1228 Women from the FRANCOGYN Group. Ann Surg Oncol 2016; 24:1667-1676. [DOI: 10.1245/s10434-016-5735-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Indexed: 12/20/2022]
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1031
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Talhouk A, McAlpine JN. New classification of endometrial cancers: the development and potential applications of genomic-based classification in research and clinical care. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:14. [PMID: 27999680 PMCID: PMC5154099 DOI: 10.1186/s40661-016-0035-4] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/22/2016] [Indexed: 01/13/2023]
Abstract
Endometrial carcinoma (EC) is the fourth most common cancer in women in the developed world. Classification of ECs by histomorphologic criteria has limited reproducibility and better tools are needed to distinguish these tumors and enable a subtype-specific approach to research and clinical care. Based on the Cancer Genome Atlas, two research teams have developed pragmatic molecular classifiers that identify four prognostically distinct molecular subgroups. These methods can be applied to diagnostic specimens (e.g., endometrial biopsy) with the potential to completely change the current risk stratification systems and enable earlier informed decision making. The evolution of genomic classification in ECs is shared herein, as well as potential applications and discussion of the essential research still needed in order to optimally integrate molecular classification in to current standard of care.
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Affiliation(s)
- A Talhouk
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, Vancouver, BC Canada
| | - J N McAlpine
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of British Columbia, 2775 Laurel St. 6th Floor, Vancouver, BC Canada V5Z 1M9
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1032
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Alkatout I, Mettler L, Maass N, Ackermann J. Robotic surgery in gynecology. J Turk Ger Gynecol Assoc 2016; 17:224-232. [PMID: 27990092 DOI: 10.5152/jtgga.2016.16187] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/27/2016] [Indexed: 01/24/2023] Open
Abstract
Robotic surgery is the most dynamic development in the sector of minimally invasive operations currently. It should not be viewed as an alternative to laparoscopy, but as the next step in a process of technological evolution. The advancement of robotic surgery, in terms of the introduction of the Da Vinci Xi, permits the variable use of optical devices in all four trocars. Due to the new geometry of the "patient cart," an operation can be performed in all spatial directions without re-docking. Longer instruments and the markedly narrower mechanical elements of the "patient cart" provide greater flexibility as well as access similar to those of traditional laparoscopy. Currently, robotic surgery is used for a variety of indications in the treatment of benign gynecological diseases as well as malignant ones. Interdisciplinary cooperation and cooperation over large geographical distances have been rendered possible by telemedicine, and will ensure comprehensive patient care in the future by highly specialized surgery teams. In addition, the second operation console and the operation simulator constitute a new dimension in advanced surgical training. The disadvantages of robotic surgery remain the high costs of acquisition and maintenance as well as the laborious training of medical personnel before they are confident with using the technology.
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Affiliation(s)
- Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Liselotte Mettler
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Johannes Ackermann
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
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1033
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Patient and provider factors associated with endometrial Pipelle sampling failure. Gynecol Oncol 2016; 144:324-328. [PMID: 27912906 DOI: 10.1016/j.ygyno.2016.11.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore risk factors associated with sampling failure in women who underwent Pipelle biopsy. METHODS A consecutive sample of 201 patient records was selected from women who underwent Pipelle biopsy procedures for suspected uterine pathology in a large healthcare system over a 6-month period (January 2013 through June 2013). Personal and medical data including age, BMI, gravidity and parity, and previous history of Pipelle biopsy were abstracted from medical records for each patient. Logistic regression analyses were used to determine factors associated with biopsy sampling failure. RESULTS Pipelle biopsy sampling failed in 46 out 201 women (22.89%), where 8 (17.39%) were due to inability to access the endometrium, 37 (80.43%) were inadequate samples, and 1 (2.18%) was due to unknown reasons. Personal and medical factors found to be related to sampling failure included: postmenopausal bleeding as biopsy indication (OR 7.41, 95% CI 2.27-24.14); history of prior biopsy failure (OR 23.87, 95% CI 3.76-151.61); and provider type (physician vs. midlevel provider) (OR 9.152, 95% CI 2.49-33.69). CONCLUSION We identified several risk factors for biopsy failure that suggest the need for particular care with Pipelle sampling procedures among women with certain characteristics, including postmenopausal bleeding and a history of prior failed Pipelle biopsy. Our finding of a significantly higher risk of sampling failure based on personal and clinical data suggests that providers must take into account additional considerations to improve sampling success.
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1034
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Bourgin C, Lambaudie E, Houvenaeghel G, Foucher F, Levêque J, Lavoué V. Impact of age on surgical staging and approaches (laparotomy, laparoscopy and robotic surgery) in endometrial cancer management. Eur J Surg Oncol 2016; 43:703-709. [PMID: 27955835 DOI: 10.1016/j.ejso.2016.10.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/18/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the different surgical approaches, perioperative morbidity and surgical staging according to age in patients with endometrial cancer. METHODS Multicentre retrospective study. Cancer characteristics and perioperative data were collected for patients surgically treated for endometrial cancer. The patients were divided into 2 groups according to their age: younger or older than 75 years. RESULTS Surgery was performed on 270 women <75 years old and on 74 ≥ 75 years old. Minimally invasive surgery was performed less often in the elderly compared with their younger counterparts (58.2% vs. 74.8%; p = 0.006). Independently of the surgical approach, the rate of pelvic and para-aortic lymphadenectomy was lower in women older than 75 years old than their younger counterparts (52.7% vs. 74.8%; p < 0.001; 8.1% vs. 21.8%; p = 0.007 respectively). According to the guidelines, more frequent surgical understaging was seen in the elderly compared with the younger (37% vs. 15.2%; p = 0.002). In the comparison of complications for each surgical approach, there was no statistical difference in the ≥75-year-old age group in terms of intra- or postoperative complications between the laparotomy, laparoscopy or robotic surgery group. We found a shorter length of hospital stay for the women who underwent laparoscopy or robotic surgery compared with laparotomy (p < 0.0001). CONCLUSION Elderly women with endometrial cancer are often surgically understaged whereas there is no evidence of greater perioperative complications than for their younger counterparts. They should benefit from minimally invasive surgery and optimal surgical staging to the same extent as younger women.
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Affiliation(s)
- C Bourgin
- Rennes University Hospital, Department of Gynaecology, Hôpital Sud, 16 boulevard de Bulgarie, 35000 Rennes, France; University of Rennes 1, Faculty of Medicine, 2 rue Henri le Guilloux, 35000 Rennes, France.
| | - E Lambaudie
- Comprehensive Cancer Centre, Department of Surgical Oncology, Institut Paoli Calmette, 223 Boulevard Ste Marguerite, 13009 Marseille, France
| | - G Houvenaeghel
- Comprehensive Cancer Centre, Department of Surgical Oncology, Institut Paoli Calmette, 223 Boulevard Ste Marguerite, 13009 Marseille, France
| | - F Foucher
- Rennes University Hospital, Department of Gynaecology, Hôpital Sud, 16 boulevard de Bulgarie, 35000 Rennes, France
| | - J Levêque
- Rennes University Hospital, Department of Gynaecology, Hôpital Sud, 16 boulevard de Bulgarie, 35000 Rennes, France; University of Rennes 1, Faculty of Medicine, 2 rue Henri le Guilloux, 35000 Rennes, France; INSERM, ER440, Oncogenesis, Stress and Signaling (OSS), Eugène Marquis Comprehensive Cancer Centre, Rennes, France
| | - V Lavoué
- Rennes University Hospital, Department of Gynaecology, Hôpital Sud, 16 boulevard de Bulgarie, 35000 Rennes, France; University of Rennes 1, Faculty of Medicine, 2 rue Henri le Guilloux, 35000 Rennes, France; INSERM, ER440, Oncogenesis, Stress and Signaling (OSS), Eugène Marquis Comprehensive Cancer Centre, Rennes, France
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1035
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Establishment and characterization of a novel uterine carcinosarcoma cell line, TU-ECS-1, with mutations of TP53 and KRAS. Hum Cell 2016; 30:140-148. [PMID: 27889902 DOI: 10.1007/s13577-016-0154-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
A new human uterine carcinosarcoma (UCS) cell line, TU-ECS-1, was established and characterized. The morphological appearance of the cultured cells was an insular of epithelial-like cells arranged in the form of a jigsaw puzzle and mesenchymal-like cells with a spindle-shaped or fibroblast-like morphology. A relatively high proliferation rate was observed with a doubling time of 18.2 h. The chromosome number ranged from 44 to 49 and had an extra chromosome 12 (trisomy 12). The respective half-maximal inhibitory concentrations of cisplatin, paclitaxel, and doxorubicin were 2.9 µM, 154 nM, and 219 ng/mL, respectively. Mutational analysis revealed that TU-ECS-1 cells have mutations of TP53 in exons 4, 6, and 8 and of KRAS at codon 12 (G12D) in exon 2, which is a mutation hot spot on this gene. Western blot analysis showed that p53 protein was overexpressed in TU-ECS-1 cells. Immunostaining of the cultured cells and in vivo tumors showed that the TU-ECS-1 cells and xenografts were positive for epithelial marker cytokeratin AE1/3 and mesenchymal marker vimentin. These results suggested that TU-ECS-1 cells might have both epithelial and mesenchymal characteristics. This cell line may be useful to study the carcinogenesis of UCS and contribute to the development of novel treatment strategies.
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1036
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Ouldamer L, Bendifallah S, Body G, Touboul C, Graesslin O, Raimond E, Collinet P, Coutant C, Lavoué V, Lévêque J, Daraï E, Ballester M. Predicting poor prognosis recurrence in women with endometrial cancer: a nomogram developed by the FRANCOGYN study group. Br J Cancer 2016; 115:1296-1303. [PMID: 27824810 PMCID: PMC5129824 DOI: 10.1038/bjc.2016.337] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/14/2016] [Accepted: 09/23/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to develop a nomogram to predict 'poor prognosis recurrence' (PPR) in women treated for endometrial cancer (EC). METHODS The data of 861 women who received primary surgical treatment between January 2001 and December 2013 were abstracted from a prospective multicenter database. Data were randomly split into two sets: training and validation with a predefined 2/3 ratio. A Cox proportional hazards multivariate model of selected prognostic features was performed in the training cohort (n=574) to develop a nomogram predicting PPRs. The nomogram was validated in the validation cohort of 287 patients. RESULTS In the training cohort, 82 (14.3%) developed subsequent PPR. Age, histologic type and grade, lymphovascular space invasion status, FIGO stage, and nodal staging (SLN±pelvic and/or para-aortic lymphadenectomy) were independently associated with subsequent PPR. The nomogram showed an area under the receiver operating characteristic curve (AUC) of 0.82 (95% confidence interval (CI), 0.73-0.89) in the training set. The validation set showed a good discrimination with an AUC of 0.75 (95% CI, 0.65-0.83). CONCLUSIONS We have developed a robust tool that is able to predict subsequent PPRs in women with FIGO I-III EC.
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Affiliation(s)
- Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France
- INSERM U1069; Université François-Rabelais, 10 Boulevard Tonnellé, 3704 Tours, France
| | - Sofiane Bendifallah
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, Paris, France
- UMR S 707, Epidemiology, Information Systems, Modeling, Université Pierre et Marie Curie, Paris, France
| | - Gilles Body
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France
- INSERM U1069; Université François-Rabelais, 10 Boulevard Tonnellé, 3704 Tours, France
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Pierre Collinet
- Department of Gynecological surgery, Jeanne de Flandre University Hospital, Lille, France
| | - Charles Coutant
- Centre de lutte Contre le Cancer Georges François Leclerc, Dijon, France
| | - Vincent Lavoué
- Departement of Gynecological Surgery, Rennes University Hospital, Rennes, France
| | - Jean Lévêque
- Departement of Gynecological Surgery, Rennes University Hospital, Rennes, France
| | - Emile Daraï
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, Paris, France
- INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
| | - Marcos Ballester
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, Paris, France
- INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
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1037
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Rižner TL. Discovery of biomarkers for endometrial cancer: current status and prospects. Expert Rev Mol Diagn 2016; 16:1315-1336. [DOI: 10.1080/14737159.2016.1258302] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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1038
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Wang Y, Han C, Teng F, Bai Z, Tian W, Xue F. Predictive value of serum HE4 and CA125 concentrations for lymphatic metastasis of endometrial cancer. Int J Gynaecol Obstet 2016; 136:58-63. [PMID: 28099710 DOI: 10.1002/ijgo.12010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 08/01/2016] [Accepted: 10/10/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the predictive value of serum HE4 and CA125 concentrations in the preoperative prediction of risk of lymph node metastasis in endometrial cancer. METHODS A retrospective study was undertaken of data for patients with endometrial carcinoma treated surgically at a university hospital in China between August 2011 and December 2015. The preoperative serum levels of HE4 and CA125 were measured and analyzed by clinicopathologic characteristics. RESULTS Overall, 258 patients were included. The HE4 and CA125 concentrations were significantly elevated in patients with large lesions (≥2 cm), deep myometrial invasion (≥50%), an advanced disease stage, or lymph node metastasis (P<0.05 for all). HE4 concentrations also rose with age and histologic grade (P<0.01 for both). For lymph node metastasis, HE4 had higher sensitivity and negative predictive value than did CA125. The diagnostic performance of HE4 and CA125 in combination was superior to that of either marker alone. CONCLUSION The combined evaluation of serum HE4 and CA125 could provide gynecologic oncologists with improved information to guide the decision of whether to perform lymphadenectomy.
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Affiliation(s)
- Yingmei Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Cha Han
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Fei Teng
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhaoyi Bai
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Wenyan Tian
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
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1039
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Lax SF, Tamussino KF, Lang PF. [Metastatic mechanisms of uterine malignancies and therapeutic consequences]. DER PATHOLOGE 2016; 37:549-556. [PMID: 27757531 DOI: 10.1007/s00292-016-0243-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Malignancies of the uterus metastasize by direct invasion of neighboring structures, lymphatically or hematogenously. Endometrial and cervical cancers lymphatically spread to the pelvic and para-aortic lymph nodes. For endometrial cancer the depth of myometrial invasion, lymphosvascular space involvement (LVSI) and a microcystic, elongated and fragmented (MELF) glandular invasion pattern are predictors for lymph node metastases. Metastases to the pelvic lymph nodes occur in approximately 10 % of endometrial cancer patients and in 30 % of these cases the para-aortic lymph nodes are also involved. Sentinel lymph node biopsy is possible for clinical stage I endometrial cancer and early stages of cervical cancer but is not yet routine. The presence of LVSI is considered to be the strongest predictor of distant metastases, particularly if assessed by immunohistochemistry with antibodies against factor VIII-related antigen or CD31. Endometrioid and clear cell carcinomas can hematogenously metastasize to the lungs, bones, liver and brain and can rarely be manifested as a solitary metastasis. In contrast, serous carcinomas can show extensive peritoneal spread. To date molecular biomarkers cannot predict the occurrence of distant metastasis. Overexpression of P53, p16 and L1CAM have been identified as negative prognostic factors and are associated with the prognostically unfavorable serous tumor type. The metastatic spread of squamous cell cervical cancer is strongly associated with tumor volume. Microinvasive carcinomas have a very low rate of parametrial and lymph node involvement and do not require radical hysterectomy. In contrast, lymph node metastases occur in up to 50 % of bulky stages IB and II cervical cancers. Distant metastases can occur in the lungs, liver, bones and brain. Molecular biomarkers have not been shown to predict metastatic spread. In well-differentiated adenocarcinoma of the cervix the pattern of invasion is strongly predictive for the presence of lymph node metastases, irrespective of tumor size and depth of invasion.
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Affiliation(s)
- S F Lax
- Institut für Pathologie, LKH Graz Süd-West, Standort West, Akademisches Lehrkrankenhaus der Medizinischen Universität Graz, Göstingerstrasse 22, 8020, Graz, Österreich.
| | - K F Tamussino
- Klinische Abteilung für Gynäkologie, Universitätsklinik für Frauenheilkunde, LKH-Universitätsklinikum Graz, Graz, Österreich
| | - P F Lang
- Gynäkologische Abteilung, Krankenhaus der Barmherzigen Brüder, Graz, Österreich
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1040
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Abnormal vaginal bleeding in women with gynaecological malignancies. Best Pract Res Clin Obstet Gynaecol 2016; 40:134-147. [PMID: 27856158 DOI: 10.1016/j.bpobgyn.2016.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 09/23/2016] [Indexed: 02/06/2023]
Abstract
Abnormal vaginal bleeding is a common gynaecological symptom, and most causes are benign. International Federation of Gynaecology and Obstetrics proposed a PALM-COEIN classification in 2011 to decrease heterogeneity in studies. The gynaecological malignancies that present with abnormal bleeding vary according to the age of the patient and the origin (upper versus lower genital tract). It is important that a thorough history and examination is performed to make this distinction. The common malignancies presenting symptoms and treatment are discussed in this article according to the age of the patient. There is a considerable overlap between the reproductive age and menopause. This article focuses on children, adolescents and women in the reproductive age group.
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1041
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Martinelli F, Ditto A, Bogani G, Signorelli M, Chiappa V, Lorusso D, Haeusler E, Raspagliesi F. Laparoscopic Sentinel Node Mapping in Endometrial Cancer After Hysteroscopic Injection of Indocyanine Green. J Minim Invasive Gynecol 2016; 24:89-93. [PMID: 27725278 DOI: 10.1016/j.jmig.2016.09.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To report the detection rate (DR) of sentinel lymph nodes (SLNs) in endometrial cancer (EC) patients after hysteroscopic injection of indocyanine green (ICG) and laparoscopic near-infrared (L-NIR) fluorescence mapping. DESIGN Prospectively collected data (Canadian Task Force classification II-2). SETTING Gynecologic oncology referral center. PATIENTS Consecutive patients with apparent early-stage endometrioid EC scheduled for surgical treatment: total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, SLN mapping. INTERVENTIONS The mapping technique consisted in an intraoperative hysteroscopic peritumoral injection of 5 mg ICG followed by L-NIR fluorescence mapping. Evaluations of the SLN DR and sites of mapping were performed. MEASUREMENTS AND MAIN RESULTS A total of 57 procedures was performed. Patient mean age was 60 years (range, 28-80) and mean body mass index was 28.2 kg/m2 (range, 19-43). At least 1 SLN was detected in 89.5% of the whole population (51/57). After the first 16 cases, L-NIR camera technical improvement led to a 95% DR (39/41). The mean number of harvested SLNs was 4.1 (range. 1-8), and in 47% of cases SLNs mapped to aortic nodes (24/51). Bilateral pelvic mapping was found in 74.5% of cases (38/51). Three patients had SLN metastases: 1 in the pelvic area only, 1 both in the pelvic and aortic area, and 1 presented with 2 metastatic aortic SLNs with negative pelvic SLNs. Overall, 2 of 3 node-positive patients (67%) had aortic SLN involvement. No adverse events were reported. CONCLUSIONS Laparoscopic SLN mapping after the hysteroscopic injection of ICG has comparable DRs with both radioactive tracer series and ICG series with cervical injection, overcoming the need for radioactive substances. Hysteroscopic injection leads to a higher mapping in the aortic area compared with cervical injection. Further investigation is warranted on this topic.
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Affiliation(s)
- Fabio Martinelli
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - Antonino Ditto
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mauro Signorelli
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Valentina Chiappa
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Domenica Lorusso
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Edward Haeusler
- Department of Anesthesiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Francesco Raspagliesi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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1042
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Ge QL, Liu SH, Ai ZH, Tao MF, Ma L, Wen SY, Dai M, Liu F, Liu HS, Jiang RZ, Xue ZW, Jiang YH, Sun XH, Hu YM, Zhao YX, Chen X, Tao Y, Zhu XL, Ding WJ, Yang BQ, Liu DD, Zhang XR, Teng YC. RelB/NF-κB links cell cycle transition and apoptosis to endometrioid adenocarcinoma tumorigenesis. Cell Death Dis 2016; 7:e2402. [PMID: 27711077 PMCID: PMC5133976 DOI: 10.1038/cddis.2016.309] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/18/2016] [Accepted: 08/30/2016] [Indexed: 12/13/2022]
Abstract
Dysfunction of nuclear factor-κB (NF-κB) signaling has been causally associated with numerous human malignancies. Although the NF-κB family of genes has been implicated in endometrial carcinogenesis, information regarding the involvement of central regulators of NF-κB signaling in human endometrial cancer (EC) is limited. Here, we investigated the specific roles of canonical and noncanonical NF-κB signaling in endometrial tumorigenesis. We found that NF-κB RelB protein, but not RelA, displayed high expression in EC samples and cell lines, with predominant elevation in endometrioid adenocarcinoma (EEC). Moreover, tumor cell-intrinsic RelB was responsible for the abundant levels of c-Myc, cyclin D1, Bcl-2 and Bcl-xL, which are key regulators of cell cycle transition, apoptosis and proliferation in EEC. In contrast, p27 expression was enhanced by RelB depletion. Thus, increased RelB in human EC is associated with enhanced EEC cell growth, leading to endometrial cell tumorigenicity. Our results reveal that regulatory RelB in noncanonical NF-κB signaling may serve as a therapeutic target to block EC initiation.
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Affiliation(s)
- Qiu-Lin Ge
- Department of Obstetrics and Gynecology, The Sixth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - San-Hong Liu
- Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Hong Ai
- Department of Obstetrics and Gynecology, The Sixth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Min-Fang Tao
- Department of Obstetrics and Gynecology, The Sixth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Li Ma
- Department of Obstetrics and Gynecology, The Sixth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Shan-Yun Wen
- Department of Obstetrics and Gynecology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Miao Dai
- Department of Obstetrics and Gynecology, The Sixth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Fei Liu
- Department of Obstetrics and Gynecology, The Sixth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Han-Shao Liu
- Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong-Zhen Jiang
- Department of Obstetrics and Gynecology, The Sixth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Zhuo-Wei Xue
- Department of Obstetrics and Gynecology, The Sixth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Hang Jiang
- Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Hua Sun
- Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Ming Hu
- Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong-Xu Zhao
- Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi Chen
- Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Tao
- Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Lu Zhu
- Department of Obstetrics and Gynecology, The Sixth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Jing Ding
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Bing-Qing Yang
- Department of Obstetrics and Gynecology, The Sixth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
| | - Dan-Dan Liu
- Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Ren Zhang
- Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yin-Cheng Teng
- Department of Obstetrics and Gynecology, The Sixth People's Hospital affiliated with Shanghai Jiao Tong University, Shanghai, China
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1043
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L1CAM: amending the “low-risk” category in endometrial carcinoma. J Cancer Res Clin Oncol 2016; 143:255-262. [DOI: 10.1007/s00432-016-2276-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/20/2016] [Indexed: 11/25/2022]
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1044
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Li Z, Wei D, Yang C, Sun H, Lu T, Kuang D. Overexpression of long noncoding RNA, NEAT1 promotes cell proliferation, invasion and migration in endometrial endometrioid adenocarcinoma. Biomed Pharmacother 2016; 84:244-251. [PMID: 27664948 DOI: 10.1016/j.biopha.2016.09.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/05/2016] [Accepted: 09/05/2016] [Indexed: 01/17/2023] Open
Abstract
Long noncoding RNAs (lncRNAs) are emerging as important modulators in the biological processes and tumorigenesis. However, whether lncRNAs are involved in endometrial endometrioid adenocarcinoma (EEC) remains unclear. In the present study, we explored the expression pattern, clinical significance and biological function of nuclear enriched abundant transcript 1 (NEAT1) in EEC. The expression levels of NEAT1 were elevated in EEC tissues and cell lines, and higher expression levels of NEAT1 were positively correlated with FIGO stage and lymph node metastasis. Overexpression of NEAT1 in HEC-59 cells transfected with pGCMV-NEAT1 promotes cell growth, colony formation ability as well as invasive and migratory ability; while knock-down of NEAT1 in HEC-59 cells by siNEAT1 transfection exhibited the opposite effects. Flow cytometry analysis showed that overexpression of NEAT1 led to an increase in S-phase cells and attenuated cell apoptosis, and knock-down of NEAT1 induced G0/G1 arrest and also induced cell apoptosis in HEC-59 cells. Tumor metastasis real-time PRC array showed that six metastasis-related genes (c-myc, insulin like growth factor 1(IGF1), matrix metallopeptidase 2 (MMP-2) and matrix metallopeptidase 7(MMP-7) were up-regulated, and Cadherin 1 and TIMP metallopeptidase inhibitor 2 were down-regulated) in NEAT1-overexpressing HEC-59 cells. Further qRT-PCR and western blot results confirmed that c-myc, IFG1, MMP-2 and MMP-7 were dys-regulated by NEAT1. Together, our data underscore the significance of NEAT1 in EEC development, and NEAT1 may a potential therapeutic target for EEC.
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Affiliation(s)
- Zhiguo Li
- Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, Tianjin City, China
| | - Dianjun Wei
- Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, Tianjin City, China
| | - Chao Yang
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Medical University, Xi'an City, Shaanxi Province, China
| | - Honggang Sun
- Deparment of Clinical Laboratory, The Shaoxing People's Hospital, Shaoxing City, Zhejiang Province, China
| | - Tao Lu
- Deparment of Clinical Laboratory, The Shaoxing People's Hospital, Shaoxing City, Zhejiang Province, China
| | - Defeng Kuang
- Department of Obstetrics, The Second Hospital of Tianjin Medical University, Tianjin City, China.
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1045
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Afrogheh AH, Meserve E, Sadow PM, Stephen AE, Nosé V, Berlin S, Faquin WC. Molecular Characterization of an Endometrial Endometrioid Adenocarcinoma Metastatic to a Thyroid Hürthle Cell Adenoma Showing Cancerization of Follicles. Endocr Pathol 2016; 27:213-9. [PMID: 26687112 DOI: 10.1007/s12022-015-9412-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Tumor-to-tumor metastasis is rare. Herein, we present a unique case of endometrial endometrioid adenocarcinoma metastatic to a thyroid Hürthle cell adenoma 9 years after initial diagnosis. On histologic examination of the thyroid, the malignant endometrioid glands and single cells (donor tumor) were dispersed within the Hürthle cell adenoma (recipient tumor). In several sections of the adenoma with still preserved microfollicular architecture, malignant endometrial adenocarcinoma cells were admixed within oncocytic adenomatous epithelium (so-called "cancerization of the follicles"). This unusual phenomenon, to our knowledge, is a novel finding in the thyroid gland. Immunohistochemistry, subsequently elicited clinical history, and morphologic comparison of the tumor in the thyroid to the primary endometrial tumor confirmed the origin of the donor tumor cells. Molecular analysis of both the metastatic and primary endometrial tumors demonstrated PIK3CA and PTEN mutations in both tumors, as is characteristic of well-differentiated endometrioid tumors of the endometrium. Amplification of chromosome 1q was detected in both sites; however, only the metastatic tumor showed loss of chromosomes 2, 9, and 22. The morphologic differential diagnosis of metastatic endometrioid adenocarcinoma in the thyroid includes columnar cell variant of papillary thyroid carcinoma (CCVPTC) arising in a preexisting adenoma, endocrine glandular atypia within an adenoma, and metastasis from other anatomic sites. Histomorphologic differences among these entities may be subtle; therefore, knowledge of and morphologic comparison with prior malignancies and immunohistochemistry can be helpful in rendering the correct diagnosis.
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Affiliation(s)
- Amir H Afrogheh
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Emily Meserve
- Department of Pathology, Brigham & Women's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Antonia E Stephen
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Vânia Nosé
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - Suzanne Berlin
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02114, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, 02114, USA.
- Pathology Service, WRN219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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1046
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Qiao Q, Li H. LncRNA FER1L4 suppresses cancer cell proliferation and cycle by regulating PTEN expression in endometrial carcinoma. Biochem Biophys Res Commun 2016; 478:507-12. [DOI: 10.1016/j.bbrc.2016.06.160] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 01/08/2023]
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1047
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Almomen A, Jarboe EA, Dodson MK, Peterson CM, Owen SC, Janát-Amsbury MM. Imiquimod Induces Apoptosis in Human Endometrial Cancer Cells In vitro and Prevents Tumor Progression In vivo. Pharm Res 2016; 33:2209-17. [PMID: 27245465 PMCID: PMC4967407 DOI: 10.1007/s11095-016-1957-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/25/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE The increasing incidence of endometrial cancer (EC), in younger age at diagnosis, calls for new tissue-sparing treatment options. This work aims to evaluate the potential of imiquimod (IQ) in the treatment of low-grade EC. METHODS Effects of IQ on the viabilities of Ishikawa and HEC-1A cells were evaluated using MTT assay. The ability of IQ to induce apoptosis was evaluated by testing changes in caspase 3/7 levels and expression of cleaved caspase-3, using luminescence assay and western blot. Apoptosis was confirmed by flow cytometry and the expression of cleaved PARP. Western blot was used to evaluate the effect of IQ on expression levels of Bcl-2, Bcl-xL, and BAX. Finally, the in vivo efficacy of IQ was tested in an EC mouse model. RESULTS There was a decrease in EC cell viability following IQ treatment as well as increased caspase 3/7 activities, cleaved caspase-3 expression, and Annexin-V/ 7AAD positive cell population. Western blot results showed the ability of IQ in cleaving PARP, decreasing Bcl-2 and Bcl-xL expressions, but not affecting BAX expression. In vivo study demonstrated IQ's ability to inhibit EC tumor growth and progression without significant toxicity. CONCLUSIONS IQ induces apoptosis in low-grade EC cells in vitro, probably through its direct effect on Bcl-2 family protein expression. In, vivo, IQ attenuates EC tumor growth and progression, without an obvious toxicity. Our study provides the first building block for the potential role of IQ in the non-surgical management of low-grades EC and encouraging further investigations.
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Affiliation(s)
- Aliyah Almomen
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Utah, Salt Lake City, UT, 84132, USA
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, 84112, USA
| | - Elke A Jarboe
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Utah, Salt Lake City, UT, 84132, USA
- Department of Pathology, University of Utah, Salt Lake City, UT, 84112, USA
| | - Mark K Dodson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Utah, Salt Lake City, UT, 84132, USA
| | - C Matthew Peterson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Utah, Salt Lake City, UT, 84132, USA
| | - Shawn C Owen
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, 84112, USA
| | - Margit M Janát-Amsbury
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Utah, Salt Lake City, UT, 84132, USA.
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, 84112, USA.
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1048
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Yahata T, Yagi S, Mabuchi Y, Tanizaki Y, Kobayashi A, Yamamoto M, Mizoguchi M, Nanjo S, Shiro M, Ota N, Minami S, Terada M, Ino K. Prognostic impact of primary tumor SUV max on preoperative 18F-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography in endometrial cancer and uterine carcinosarcoma. Mol Clin Oncol 2016; 5:467-474. [PMID: 27703679 DOI: 10.3892/mco.2016.980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/06/2016] [Indexed: 01/03/2023] Open
Abstract
The objective of the present study was to investigate the usefulness of the maximum standardized uptake value (SUVmax) of the primary tumor on preoperative 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography and computed tomography (PET/CT) as a prognostic indicator in patients with endometrial neoplasms. A total of 75 patients with endometrial cancer or uterine carcinosarcoma who underwent surgical treatment were included in the present study. All patients underwent preoperative PET/CT, and the correlation between the SUVmax of the primary tumor and clinical outcomes was analyzed. The SUVmax was significantly higher in patients with stage II/III disease, a histology of grade 3 endometrioid adenocarcinoma and carcinosarcoma, a positive lymph node (LN) status, positive lymph-vascular space involvement (LVSI), and deep (≥1/2) myometrial invasion. Receiver operating characteristic curve analysis revealed that the optimal cut-off values of SUVmax for predicting a positive LN, LVSI and deep myometrial invasion were 7.49, 6.45 and 6.45, respectively. The overall survival (OS) and progression-free survival (PFS) of patients with a high SUVmax were significantly lower compared with those of patients with a low SUVmax using the cut-off value of 7.30. However, no significant difference was observed in the OS or PFS between the high and low SUVmax groups when analyzed in carcinosarcoma patients alone. Finally, multivariate analyses demonstrated that the SUVmax of the primary tumor was an independent prognostic factor for impaired PFS in 55 endometrioid adenocarcinoma patients; however, not in all patients, including those with carcinosarcoma. The present findings demonstrated that the SUVmax of the primary tumor may be a useful biomarker for predicting clinical outcomes of patients with endometrial cancer, although its prognostic impact appears to be limited in patients with uterine carcinosarcoma.
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Affiliation(s)
- Tamaki Yahata
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Shigetaka Yagi
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Yasushi Mabuchi
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Yuko Tanizaki
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Aya Kobayashi
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Madoka Yamamoto
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Mika Mizoguchi
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Sakiko Nanjo
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Michihisa Shiro
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Nami Ota
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Sawako Minami
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Masaki Terada
- Wakayama Minami Radiology Clinic, Wakayama 641-0012, Japan
| | - Kazuhiko Ino
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan
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1049
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Macchia G, Cilla S, Deodato F, Ianiro A, Legge F, Marucci M, Cammelli S, Perrone AM, De Iaco P, Gambacorta MA, Autorino R, Valentini V, Morganti AG, Ferrandina G. Simultaneous Integrated Boost Volumetric Modulated Arc Therapy in the Postoperative Treatment of High-Risk to Intermediate-Risk Endometrial Cancer: Results of ADA II Phase 1-2 Trial. Int J Radiat Oncol Biol Phys 2016; 96:606-13. [PMID: 27681755 DOI: 10.1016/j.ijrobp.2016.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/13/2016] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE A prospective phase 1-2 clinical trial aimed at determining the recommended postoperative dose of simultaneous integrated boost volumetric modulated arc therapy (SIB-VMAT) in a large series of patients with high-risk and intermediate-risk endometrial cancer (HIR-EC) is presented. The study also evaluated the association between rate and severity of toxicity and comorbidities and the clinical outcomes. METHODS AND MATERIALS Two SIB-VMAT dose levels were investigated for boost to the vaginal vault, whereas the pelvic lymph nodes were always treated with 45 Gy. The first cohort received a SIB-VMAT dose of 55 Gy in 25 consecutive 2.2-Gy fractions, and the subsequent cohort received higher doses (60 Gy in 2.4-Gy fractions). RESULTS Seventy consecutive HIR-EC patients, roughly half of whom were obese (47.1%) or overweight (37.1%), with Charlson Age-Comorbidity Index >2 (48.5%), were enrolled. Thirty-one patients (44.3%) were administered adjuvant chemotherapy before starting radiation therapy. All patients (n=35 per dose level) completed irradiation without any dose-limiting toxicity. Proctitis (any grade) was associated with radiation therapy dose (P=.001); not so enterocolitis. Grade ≥2 gastrointestinal (GI) and genitourinary (GU) toxicity were recorded in 17 (24.3%) and 14 patients (20.0%), respectively, and were not associated with radiation dose. As for late toxicity, none of patients experienced late grade ≥3 GI or grade ≥2 GU toxicity. The 3-year late grade ≥2 GI and GU toxicity-free survival were 92.8% and 100%, respectively, with no difference between the 2 dose levels. With a median follow-up period of 25 months (range, 4-60 months), relapse/progression of disease was observed in 10 of 70 patients (14.2%). The 3-year cumulative incidence of recurrence was 1.5% (95% confidence interval (CI): 0.2-10.7), whereas the 3-year disease-free survival was 81.3% (95% CI: 65.0-90.0). CONCLUSIONS This clinical study showed the feasibility of this technique and its good profile in terms of acute and late toxicity at the recommended doses even in aged and frail patients.
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Affiliation(s)
- Gabriella Macchia
- Radiotherapy Unit, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Campobasso, Italy.
| | - Savino Cilla
- Medical Physics Unit, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Anna Ianiro
- Medical Physics Unit, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Legge
- Gynecologic Oncology Unit, F. Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Martina Marucci
- Radiotherapy Unit, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Silvia Cammelli
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine, Azienda Ospedaliera Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Anna Myriam Perrone
- Gynecologic Oncology Unit, Azienda Ospedaliera Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Pierandrea De Iaco
- Gynecologic Oncology Unit, Azienda Ospedaliera Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Maria Antonietta Gambacorta
- Department of Radiotherapy, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosa Autorino
- Department of Radiotherapy, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Radiotherapy Unit, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Campobasso, Italy; Department of Radiotherapy, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio G Morganti
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine, Azienda Ospedaliera Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Gabriella Ferrandina
- Department of Medicine and health sciences, Università del Molise, Campobasso/Ginecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
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1050
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Molecular classification of endometrial carcinoma on diagnostic specimens is highly concordant with final hysterectomy: Earlier prognostic information to guide treatment. Gynecol Oncol 2016; 143:46-53. [PMID: 27421752 DOI: 10.1016/j.ygyno.2016.07.090] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/30/2016] [Accepted: 07/06/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Categorization and risk stratification of endometrial carcinomas is inadequate; histomorphologic assessment shows considerable interobserver variability, and risk of metastases and recurrence can only be derived after surgical staging. We have developed a Proactive Molecular Risk classification tool for Endometrial cancers (ProMisE) that identifies four distinct prognostic subgroups. Our objective was to assess whether molecular classification could be performed on diagnostic endometrial specimens obtained prior to surgical staging and its concordance with molecular classification performed on the subsequent hysterectomy specimen. METHODS Sequencing of tumors for exonuclease domain mutations (EDMs) in POLE and immunohistochemistry for mismatch repair (MMR) proteins and p53 were applied to both pre- and post-staging archival specimens from 60 individuals to identify four molecular subgroups: MMR-D, POLE EDM, p53 wild type, p53 abn (abnormal). Three gynecologic subspecialty pathologists assigned histotype and grade to a subset of samples. Concordance of molecular and clinicopathologic subgroup assignments were determined, comparing biopsy/curetting to hysterectomy specimens. RESULTS Complete molecular and pathologic categorization was achieved in 57 cases. Concordance metrics for pre- vs. post-staging endometrial samples categorized by ProMisE were highly favorable; average per ProMisE class sensitivity(0.9), specificity(0.96), PPV(0.9), NPV(0.96) and kappa statistic 0.86(95%CI, 0.72-0.93), indicating excellent agreement. We observed the highest level of concordance for 'p53 abn' tumors, the group associated with the worst prognosis. In contrast, grade and histotype assignment from original pathology reports pre- vs. post-staging showed only moderate levels of agreement (kappa=0.55 and 0.44 respectively); even with subspecialty pathology review only moderate levels of agreement were observed. CONCLUSION Molecular classification can be achieved on diagnostic endometrial samples and accurately predicts the molecular features in the final hysterectomy specimens, demonstrating concordance superior to grade and histotype. This biologically relevant information, available at initial diagnosis, has the potential to inform management (surgery, adjuvant therapy) from the earliest time point in cancer care.
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