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Illah O, Scott M, Redl E, Barrett JE, Schreiberhuber L, Herzog C, Vavourakis CD, Jones A, Evans I, Reisel D, Chandrasekaran D, Doufekas K, Graham R, Kotsopoulos IC, MacDonald N, Arora R, Olaitan A, Rosenthal A, Widschwendter M. High performance of the DNA methylation-based WID-qEC test for detecting uterine cancers independent of sampling modalities. Int J Cancer 2024; 155:800-806. [PMID: 38739012 DOI: 10.1002/ijc.35000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 05/14/2024]
Abstract
Endometrial cancer (EC) is the most prevalent gynaecological cancer in high-income countries and its incidence is continuing to rise sharply. Simple and objective tools to reliably detect women with EC are urgently needed. We recently developed and validated the DNA methylation (DNAme)-based women's cancer risk identification-quantitative polymerase chain reaction test for endometrial cancer (WID-qEC) test that could address this need. Here, we demonstrate that the stability of the WID-qEC test remains consistent regardless of: (i) the cervicovaginal collection device and sample media used (Cervex brush and PreservCyt or FLOQSwab and eNAT), (ii) the collector of the specimen (gynaecologist- or patient-based), and (iii) the precise sampling site (cervical, cervicovaginal and vaginal). Furthermore, we demonstrate sample stability in eNAT medium for 7 days at room temperature, greatly facilitating the implementation of the test into diagnostic laboratory workflows. When applying FLOQSwabs (Copan) in combination with the eNAT (Copan) sample collection media, the sensitivity and specificity of the WID-qEC test to detect uterine (i.e., endometrial and cervical) cancers in gynaecologist-taken samples was 92.9% (95% confidence interval [CI] = 75.0%-98.8%) and 98.6% (95% CI = 91.7%-99.9%), respectively, whilst the sensitivity and specificity in patient collected self-samples was 75.0% (95% CI = 47.4%-91.7%) and 100.0% (95% CI = 93.9%-100.0%), respectively. Taken together these data confirm the robustness and clinical potential of the WID-qEC test.
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Affiliation(s)
- Ojone Illah
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Malcolm Scott
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Elisa Redl
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Universität Innsbruck, Hall in Tirol, Austria
| | - James E Barrett
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Universität Innsbruck, Hall in Tirol, Austria
| | - Lena Schreiberhuber
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Universität Innsbruck, Hall in Tirol, Austria
| | - Chiara Herzog
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Universität Innsbruck, Hall in Tirol, Austria
| | - Charlotte D Vavourakis
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Universität Innsbruck, Hall in Tirol, Austria
| | - Allison Jones
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Iona Evans
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Dan Reisel
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Dhivya Chandrasekaran
- Department of Gynaecological Oncology, University College London Hospital, London, UK
| | - Kostas Doufekas
- Department of Gynaecological Oncology, University College London Hospital, London, UK
| | - Radha Graham
- Department of Gynaecological Oncology, University College London Hospital, London, UK
| | - Ioannis C Kotsopoulos
- Department of Gynaecological Oncology, University College London Hospital, London, UK
| | - Nicola MacDonald
- Department of Gynaecological Oncology, University College London Hospital, London, UK
| | - Rupali Arora
- Department of Pathology, University College London Hospital, London, UK
| | - Adeola Olaitan
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
| | - Adam Rosenthal
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
- Department of Gynaecological Oncology, University College London Hospital, London, UK
| | - Martin Widschwendter
- Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Universität Innsbruck, Hall in Tirol, Austria
- Department of Gynecology and Obstetrics, General Hospital Hall, Tirol Kliniken, Hall in Tirol, Austria
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Francoeur AA, Fontenont V, Tewari KS. Treatment options in the advanced and recurrent setting for endometrial cancer: an update. Expert Rev Anticancer Ther 2024; 24:731-744. [PMID: 38913791 DOI: 10.1080/14737140.2024.2370377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/17/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Uterine cancer is the most common gynecologic malignancy in women and is projected to surpass ovarian cancer as the deadliest gynecologic malignancy in the United States in 2024. Additionally, rates of advanced and high-risk uterine cancer have been on the rise in the United States, demonstrating a need for innovation in treatment options. There have been multiple recent trials investigating the incorporation of novel agents in the treatment of advanced and recurrent endometrial cancer. AREAS COVERED This article will discuss the current landscape of the treatment of advanced and recurrent endometrial cancer, focusing on recent phase III trials published or presented on with the incorporation of immunotherapy and other novel therapeutics while also reviewing promising phase I and II trials in the field. Clinical trials were identified via clinicaltrials.gov and a PubMed literature search was performed (initially February 2024, updated May 2024). EXPERT OPINION The treatment field is promising for patients as many of these trials appear to offer progression free and overall survival benefits in a disease with a historically poor prognosis. Molecular profiling of endometrial cancer will be the backbone of treatment paradigms in the future.
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Affiliation(s)
- Alex Andrea Francoeur
- Department of Obstetrics and Gynecology, University of California Irvine, Orange, CA, USA
| | - Virginia Fontenont
- Department of Obstetrics and Gynecology, University of California Irvine, Orange, CA, USA
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Meade CE, Sinnott JA, Backes FJ, Cosgrove CM, Quick AM, Trabert B, Plascak JJ, Felix AS. Associations between race and ethnicity and treatment setting among gynecologic cancer patients. Gynecol Oncol 2024; 188:111-119. [PMID: 38943692 DOI: 10.1016/j.ygyno.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/11/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
INTRODUCTION Racial and ethnic disparities in gynecologic cancer care have been documented. Treatment at academic facilities is associated with improved survival, yet no study has examined independent associations between race and ethnicity with facility type among gynecologic cancer patients. MATERIALS & METHODS We used the National Cancer Database and identified 484,455 gynecologic cancer (cervix, ovarian, uterine) patients diagnosed between 2004 and 2020. Facility type was dichotomized as academic vs. non-academic, and we used logistic regression to estimate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) between race and ethnicity and facility type. Secondarily, we examined joint effects of race and ethnicity and facility type on overall survival using Cox proportional hazards regression. RESULTS We observed higher odds of treatment at academic (vs. non-academic) facilities among American Indian/Alaska Native (OR = 1.42, 95% CI = 1.28-1.57), Asian (OR = 1.64, 95% CI = 1.59-1.70), Black (OR = 1.69, 95% CI = 1.65-1.72), Hispanic (OR = 1.70, 95% CI = 1.66-1.75), Native Hawaiian/Pacific Islander (OR = 1.74, 95% CI = 1.57-1.93), and other race (OR = 1.29, 95% CI = 1.20-1.40) patients compared with White patients. In the joint effects survival analysis with White, academic facility-treated patients as the reference group, Asian, Hispanic, and other race patients treated at academic or non-academic facilities had improved overall survival. Conversely, Black patients treated at academic facilities [Hazard Ratio (HR) = 1.10, 95% CI = 1.07-1.12] or non-academic facilities (HR = 1.19, 95% CI = 1.16-1.21) had worse survival. DISCUSSION Minoritized gynecologic cancer patients were more likely than White patients to receive treatment at academic facilities. Importantly, survival outcomes among patients receiving care at academic institutions differed by race, requiring research to investigate intra-facility survival disparities.
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Affiliation(s)
- Caitlin E Meade
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Jennifer A Sinnott
- Department of Statistics, The Ohio State University College of Arts and Sciences, Columbus, OH, United States of America
| | - Floor J Backes
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, United States of America
| | - Casey M Cosgrove
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, United States of America
| | - Allison M Quick
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, United States of America
| | - Britton Trabert
- Department of Obstetrics and Gynecology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States of America
| | - Jesse J Plascak
- Division of Cancer Prevention and Control, Department of Internal Medicine College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Ashley S Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America.
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Wijayabahu AT, Shiels MS, Arend RC, Clarke MA. Uterine cancer incidence trends and 5-year relative survival by race/ethnicity and histology among women under 50 years. Am J Obstet Gynecol 2024:S0002-9378(24)00694-X. [PMID: 38925206 DOI: 10.1016/j.ajog.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Uterine cancers diagnosed before age 50 years are increasing in the U.S., but changes in clinical characteristics and survival over time across racial/ethnic groups have not been previously described. OBJECTIVE To investigate age-adjusted, hysterectomy corrected incidence rates and trends, and 5-year relative survival rates of uterine cancer in women aged <50 years, overall and stratified by race/ethnicity and histology. STUDY DESIGN We included microscopically confirmed uterine cancer cases (diagnosed 2000-2019) in women aged 20 to 49 years from the Surveillance, Epidemiology, and End Results Program. Age-adjusted incidence and 5-year relative survival rates, and 95% confidence intervals were computed using Surveillance, Epidemiology, and End Results (SEER) ∗Stat and compared across time periods (2000-2009 and 2010-2019). Incidence rates were adjusted for hysterectomy prevalence using Behavioral Risk Factor Surveillance System data, and trends were computed using the Joinpoint regression program. RESULTS We included 57,128 uterine cancer cases. The incidence of uterine cancer increased from 10.1 per 100,000 in 2000-2009 to 12.0 per 100,000 in 2010-2019, increasing at an annual rate of 1.7%/y for the entire period. Rising trends were more pronounced among women <40 years (3.0%/y and 3.3%/y in 20-29 and 30-39 years, respectively) than in those 40 to 49 years (1.3%/y), and among underrepresented racial/ethnic groups (Hispanic 2.8%/y, non-Hispanic-Black 2.7%, non-Hispanic-Asian/Pacific Islander 2.1%) than in non-Hispanic-White (0.9%/y). Recent (2010-2019) incidence rates were highest for endometrioid (9.6 per 100,000), followed by sarcomas (1.2), and nonendometrioid subtypes (0.9). Rates increased significantly for endometrioid subtypes at 1.9%/y from 2000 to 2019. Recent endometrioid and nonendometrioid rates were highest in non-Hispanic-Native American/Alaska Native (15.2 and 1.4 per 100,000), followed by Hispanic (10.9 and 1.0), non-Hispanic-Asian/Pacific Islander (10.2 and 0.9), non-Hispanic-White (9.4 and 0.8), and lowest in non-Hispanic-Black women (6.4 and 0.8). Sarcoma rates were highest in non-Hispanic-Black women (1.8 per 100,000). The 5-year relative survival remained unchanged over time for women with endometrioid (from 93.4% in 2000-2009 to 93.9% in 2010-2019, P≥.05) and nonendometrioid subtypes (from 73.2% to 73.2%, P≥.05) but decreased for women with sarcoma from 69.8% (2000-2009) to 66.4% (2010-2019, P<.05). CONCLUSION Uterine cancer incidence rates in women <50 years have increased from 2000 to 2019 while survival has remained relatively unchanged. Incidence trends can be primarily attributed to increasing rates of cancers with endometrioid histology, with the greatest increases observed among non-Hispanic-Black, Hispanic, and non-Hispanic-Asian/Pacific Islander. Sarcomas, while much rarer, were the second most common type of uterine cancer among women <50 years and have poor prognosis and apparent decreasing survival over time. Rising rates of uterine cancer and the distinct epidemiologic patterns among women <50 years highlight the need for effective prevention and early detection strategies for uterine cancer in this age group.
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Affiliation(s)
- Akemi T Wijayabahu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD.
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Rebecca C Arend
- Department of Obstetrics and Gynecology-Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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Papatla K, Orfanelli T, Stoffels G, Layne T, Baldwin E, Leibold A, Blank SV, Cohen S. Mitigating disparity?: Treatment patterns, survival, and recurrence rates by race, ethnicity, and hospital site across a large urban health system. Gynecol Oncol Rep 2024; 53:101372. [PMID: 38584803 PMCID: PMC10997945 DOI: 10.1016/j.gore.2024.101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
Objective National data have shown worse endometrial cancer (EC) outcomes among racial and ethnic minorities. We aimed to analyze EC patient outcomes within a large urban academic health system, with a focus on patterns of care and recurrence rates. Methods This was a retrospective chart review of EC patients at three system hospitals from 1/1/07-12/31/17. Demographic and clinical factors, including time from EMB to surgery, rate of chemotherapy completion, persistent or recurrent disease, and palliative care referrals were extracted. Descriptive statistics and survival curves were generated. Analysis was done using SAS version 9.4. Results Black patients had lower overall survival compared to all others on univariate analysis only (p < 0.0001). Hospital site was associated with OS, with the academic anchor and satellite 1 having higher rates of all-cause mortality compared to satellite 2 (HR 4.68 academic anchor, 95 % CI 1.72-12.76, HR 5.36 satellite 1, 95 % CI 1.85-15.52). Time from EMB to surgery and rates of persistent disease following primary treatment were higher in Black patients. After adjusting for stage and grade, chemotherapy completion rate was significantly associated with race. Palliative care was utilized more for Black than White patients after adjusting for stage and grade (p = 0.005). Conclusions Racial disparities in EC are caused by a complex web of interconnected factors that ultimately lead to worse outcomes in Black women. While precision medicine has helped to close the gap, social determinants of health should be addressed, and models focusing on the complex interactions between biologic, genetic, and social factors should be utilized.
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Affiliation(s)
- Katyayani Papatla
- Icahn School of Medicine at the Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Gynecologic Oncology, New York, NY, United States
| | - Theofano Orfanelli
- Stony Brook Medicine, Department of Obstetrics, Gynecology, and Reproductive Medicine, Division of Gynecologic Oncology, Stony Brook, NY, United States
| | | | - Tracy Layne
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Elena Baldwin
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Aurora Leibold
- Mount Sinai West, Department of Obstetrics, Gynecology, and Reproductive Science New York, NY, United States
| | - Stephanie V. Blank
- Icahn School of Medicine at the Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Gynecologic Oncology, New York, NY, United States
| | - Samantha Cohen
- Icahn School of Medicine at the Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Gynecologic Oncology, New York, NY, United States
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Ferris JS, Prest MT, Hur C, Chen L, Elkin EB, Melamed A, Kong CY, Myers ER, Havrilesky LJ, Blank SV, Hazelton WD, Wright JD. Trends in uterine cancer incidence in the United States: The contribution of age, period and cohort effects. Gynecol Oncol 2024; 187:151-162. [PMID: 38781746 DOI: 10.1016/j.ygyno.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/20/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE In the U.S., uterine cancer incidence is rising, with racial and ethnic minorities experiencing the largest increases. We performed age-period-cohort analyses using novel methods to examine the contribution of age at diagnosis (age), year of diagnosis (period), and birth cohort (cohort), to trends in uterine cancer incidence. METHODS We used uterine cancer incidence data from the Surveillance, Epidemiology, and End Result (SEER) 12 database (1992-2019), and performed hysterectomy-correction. We generated hexamaps to visualize age, period, and cohort effects, and used mutual information to estimate the percent contribution of age, period, and cohort effects, individually and combined, on uterine cancer incidence, overall and by race and ethnicity and histology. RESULTS Hexamaps showed an increase in uterine cancer in later time periods, and a cohort effect around 1933 showing a lower incidence compared with earlier and later cohorts. Age, period, and cohort effects combined contributed 86.6% (95% CI: 86.4%, 86.9%) to the incidence. Age effects had the greatest contribution (65.1%, 95% CI: 64.3%, 65.9), followed by cohort (20.7%, 95% CI: 20.1%, 21.3%) and period (14.2%, 95% CI: 13.7%, 14.8%) effects. Hexamaps showed higher incidence in recent years for non-Hispanic Blacks and non-endometrioid tumors. CONCLUSIONS Age effects had the largest contribution to uterine cancer incidence, followed by cohort and period effects overall and across racial and ethnic groups and histologies. IMPACT These findings can inform uterine cancer modeling studies on the effects of interventions that target risk factors which may vary across age, period, or cohort.
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Affiliation(s)
- Jennifer S Ferris
- Department of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Matthew T Prest
- Department of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Chin Hur
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York-Presbyterian Hospital, New York, NY, USA
| | - Ling Chen
- Department of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Elena B Elkin
- Herbert Irving Comprehensive Cancer Center, New York, NY, USA; Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alex Melamed
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Chung Yin Kong
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan R Myers
- Department of Obstetrics and Gynecology at the Duke University Medical Center, Durham, NC, USA
| | - Laura J Havrilesky
- Department of Obstetrics and Gynecology at the Duke University Medical Center, Durham, NC, USA
| | - Stephanie V Blank
- Department of Obstetrics, Gynecology, and Reproductive Science, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William D Hazelton
- Herbold Computational Biology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jason D Wright
- Department of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, New York, NY, USA; New York-Presbyterian Hospital, New York, NY, USA.
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Winkler SS, Tian C, Casablanca Y, Bateman NW, Jokajtys S, Kucera CW, Tarney CM, Chan JK, Richardson MT, Kapp DS, Liao CI, Hamilton CA, Leath CA, Reddy M, Cote ML, O'Connor TD, Jones NL, Rocconi RP, Powell MA, Farley J, Shriver CD, Conrads TP, Phippen NT, Maxwell GL, Darcy KM. Racial, ethnic and country of origin disparities in aggressive endometrial cancer histologic subtypes. Gynecol Oncol 2024; 184:31-42. [PMID: 38277919 DOI: 10.1016/j.ygyno.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE This study investigated the risk of an aggressive endometrial cancer (EC) diagnosis by race, ethnicity, and country of origin to further elucidate histologic disparities in non-Hispanic Black (NHB), Hispanic, Asian/Pacific Islander (API), American Indian/Alaskan Native (AIAN) vs. non-Hispanic White (NHW) patients, particularly in Hispanic or API subgroups. METHODS Patient diagnosed between 2004 and 2020 with low grade (LG)-endometrioid endometrial cancer (ECC) or an aggressive EC including grade 3 EEC, serous carcinoma, clear cell carcinoma, mixed epithelial carcinoma, or carcinosarcoma in the National Cancer Database were studied. The odds ratio (OR) and 95% confidence interval (CI) for diagnosis of an aggressive EC histology was estimated using logistic modeling. RESULTS There were 343,868 NHW, 48,897 NHB, 30,013 Hispanic, 15,015 API and 1646 AIAN patients. The OR (95% CI) for an aggressive EC diagnosis was 3.07 (3.01-3.13) for NHB, 1.08 (1.06-1.11) for Hispanic, 1.17 (1.13-1.21) for API and 1.07 (0.96-1.19) for AIAN, relative to NHW patients. Subset analyses by country of origin illustrated the diversity in the OR for an aggressive EC diagnosis among Hispanic (1.18 for Mexican to 1.87 for Dominican), Asian (1.14 Asian Indian-Pakistani to 1.48 Korean) and Pacific Islander (1.00 for Hawaiian to 1.33 for Samoan) descendants. Hispanic, API and AIAN patients were diagnosed 5-years younger that NHW patients, and the risk for an aggressive EC histology were all significantly higher than NHW patients after correcting for age. Insurance status was another independent risk factor for aggressive histology. CONCLUSIONS Risk of an aggressive EC diagnosis varied by race, ethnicity, and country of origin. NHB patients had the highest risk, followed by Dominican, South/Central American, Cuban, Korean, Thai, Vietnamese, and Filipino descendants.
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Affiliation(s)
- Stuart S Winkler
- Division of Gynecologic Oncology, Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, TX, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Yovanni Casablanca
- Division of Gynecologic Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Nicholas W Bateman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Suzanne Jokajtys
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Calen W Kucera
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Christopher M Tarney
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine, Los Angeles, CA. USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Cheng-I Liao
- Division of Obstetrics and Gynecology, Pingtung Veterans General Hospital, Pingtung, Taiwan
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | - Megan Reddy
- California Pacific Medical Center, San Francisco, CA, USA
| | - Michele L Cote
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN, USA
| | - Timothy D O'Connor
- Institute for Genome Sciences, Department of Medicine, Program in Personalized and Genomic Medicine, University of Maryland School of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Nathaniel L Jones
- Division of Gynecologic Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Rodney P Rocconi
- Division of Gynecologic Oncology, Cancer Center & Research Institute, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Matthew A Powell
- Division of Gynecologic Oncology, Siteman Cancer Center, Washington University, St Louis, MO, USA
| | - John Farley
- Division of Gynecologic Oncology, Center for Women's Health, Cancer Institute, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - G Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA.
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8
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Abril J, Trabert B, Troisi R, Grotmol T, Ekbom A, Engeland A, Gissler M, Glimelius I, Madanat-Harjuoja L, Gulbech Ording A, Sørensen HT, Tretli S, Bjørge T. Associations between pregnancy-related factors and birth characteristics with risk of rare uterine cancer subtypes: a Nordic population-based case-control study. Cancer Causes Control 2024; 35:741-747. [PMID: 38129544 DOI: 10.1007/s10552-023-01832-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Uterine sarcomas are a rare group of uterine malignancies. Due to the low incidence and changes in uterine sarcoma classification, risk factors are not well characterized. Our objective was to evaluate risk factors for uterine sarcoma and compare risk factors between uterine sarcoma, malignant mixed Mullerian tumors (MMMTs), and type I endometrial carcinomas. METHODS This nested case-control study utilized linked data from population-based medical birth and cancer registries in Denmark, Finland, Norway, and Sweden. Up to 10 controls were matched on country and birth year for each uterine cancer case. Using multivariable adjusted multinomial logistic regression, estimates of the associations between pregnancy-related factors and risk of uterine sarcoma, MMMTs, and type I endometrial carcinomas were determined. RESULTS Having a very-low-birth-weight infant (< 1500 vs. 2500-3999 g: OR [95% CI] 2.83 [1.61-4.96]) was associated with an increased risk of uterine sarcoma. Whereas, having a more recent pregnancy was associated with reduced risks of MMMT (< 10 vs. ≥ 30 years: 0.66 [0.20-2.23]) and type 1 endometrial carcinomas (0.35 [0.30-0.41]) but not uterine sarcomas (1.33 [0.90-1.98], p-heterogeneity < 0.01). CONCLUSION Our study provides evidence that risk factors for uterine sarcoma and MMMT, previously grouped with uterine sarcomas, vary substantially. Additionally, MMMT and type I endometrial carcinomas are more similar than uterine sarcoma in that pregnancy complications like gestational hypertension and preeclampsia were associated with reduced risks of both but not uterine sarcoma, suggesting different etiologies.
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Affiliation(s)
- Jazmine Abril
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Britton Trabert
- Department of Obstetrics and Gynecology, Huntsman Cancer Institute at the University of Utah, University of Utah, 2000 Circle of Hope Dr. Research South #4719, Salt Lake City, UT, 84112, USA.
| | - Rebecca Troisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Anders Ekbom
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anders Engeland
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Ingrid Glimelius
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
| | - Laura Madanat-Harjuoja
- Finnish Cancer Registry, Helsinki, Finland
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | | | - Tone Bjørge
- Cancer Registry of Norway, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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9
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Feng Y, Miao F, Li Y, Li M, Cao Y. Validating the 2023 FIGO staging system: A nomogram for endometrioid endometrial cancer and adenocarcinoma. Cancer Med 2024; 13:e7216. [PMID: 38752451 PMCID: PMC11097244 DOI: 10.1002/cam4.7216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND To find the factors impacting overall survival (OS) prognosis in patients with endometrioid endometrial carcinoma (EEC) and adenocarcinoma and to establish a nomogram model to validate the 2023 International Federation of Obstetrics and Gynecology (FIGO) staging system for endometrial cancer. METHODS Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) training cohort. An independent validation cohort was obtained from the First Affiliated Hospital of Anhui Medical University between 2008 and 2023. Cox regression analysis identified independent prognostic factors for OS in EEC and adenocarcinoma patients. A nomogram predicting OS was developed and validated utilizing the C-index, calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). The relationship between the tumor grade and prognosis of EEC and adenocarcinoma was quantified using net reclassification improvement (NRI), propensity score matching (PSM), and Kaplan-Meier curves. RESULTS Cox regression analysis identified age, race, marital status, tumor grade, tumor stage, tumor size, and chemotherapy as independent prognostic factors for OS. A nomogram for predicting OS was developed based on these factors. The C-indexes for the OS nomogram was 0.743 and 0.720 for the SEER training set and external validation set, respectively. The area under the ROC (AUC) for the OS nomogram was 0.755, 0.757, and 0.741 for the SEER data subsets and 0.844, 0.719, and 0.743 for the external validation subsets. Calibration plots showed high concordance between the nomogram-predicted and observed OS. DCA also demonstrated the clinical utility of the OS nomogram. NRI, PSM, and survival analyses revealed that tumor grade was the most important histopathological factor for EEC and adenocarcinoma prognosis. CONCLUSION Seven independent prognostic variables for the OS of patients with EEC and adenocarcinoma were identified. The established OS nomogram has good predictive ability and clinical utility and validates the 2023 endometrial cancer FIGO staging system.
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Affiliation(s)
- Yifan Feng
- Department of Gynecology OncologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Fulu Miao
- Department of Gynecology OncologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Yuyang Li
- Department of Gynecology OncologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Min Li
- Department of Gynecology OncologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University)HefeiAnhuiChina
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of ChinaHefeiAnhuiChina
| | - Yunxia Cao
- Department of Gynecology OncologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University)HefeiAnhuiChina
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of ChinaHefeiAnhuiChina
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10
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Brown JA, Olshan AF, Bae-Jump VL, Ogunleye AA, Smith S, Black-Grant S, Nichols HB. Lymphedema self-assessment among endometrial cancer survivors. Cancer Causes Control 2024; 35:771-785. [PMID: 38175324 PMCID: PMC11045305 DOI: 10.1007/s10552-023-01838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Lower extremity lymphedema (LEL), which causes ankle, leg, and feet swelling, poses a significant challenge for endometrial cancer survivors, impacting physical functioning and psychological well-being. Inconsistent LEL diagnostic methods result in wide-ranging LEL incidence estimates. METHODS We calculated the cumulative incidence of LEL based on survivor-reported Gynecologic Cancer Lymphedema Questionnaire (GCLQ) responses in addition to survivor- and nurse-reported leg circumference measurements among a pilot sample of 50 endometrial cancer survivors (27 White, 23 Black) enrolled in the ongoing population-based Carolina Endometrial Cancer Study. RESULTS Self-leg circumference measurements were perceived to be difficult and were completed by only 17 survivors. Diagnostic accuracy testing measures (sensitivity, specificity, positive and negative predictive value) compared the standard nurse-measured ≥ 10% difference in leg circumference measurements to GCLQ responses. At a mean of ~11 months post-diagnosis, 54% of survivors met established criteria for LEL based on ≥ 4 GCLQ cutpoint while 24% had LEL based on nurse-measurement. Percent agreement, sensitivity, and specificity approximated 60% at a threshold of ≥ 5 GCLQ symptoms. However, Cohen's kappa, a measure of reliability that corrects for agreement by chance, was highest at ≥ 4 GCLQ symptoms (κ = 0.27). CONCLUSION Our findings emphasize the need for high quality measurements of LEL that are feasible for epidemiologic study designs among endometrial cancer survivors. Future studies should use patient-reported survey measures to assess lymphedema burden and quality of life outcomes among endometrial cancer survivors.
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Affiliation(s)
- Jordyn A Brown
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2104F McGavran-Greenberg Hall, CB #7435, 135 Dauer Drive, Chapel Hill, NC, 27599-7435, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2104F McGavran-Greenberg Hall, CB #7435, 135 Dauer Drive, Chapel Hill, NC, 27599-7435, USA
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Victoria L Bae-Jump
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adeyemi A Ogunleye
- Division of Plastic Surgery and Reconstructive Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shawn Smith
- Endometrial Cancer Action Network for African Americans, Seattle, WA, USA
| | | | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2104F McGavran-Greenberg Hall, CB #7435, 135 Dauer Drive, Chapel Hill, NC, 27599-7435, USA.
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
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11
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Massouh N, Jaffa AA, Jaffa MA. Diabetes and the social, biologic, and behavioral determinants of endometrial cancer in the United States. BMC Cancer 2024; 24:540. [PMID: 38684955 PMCID: PMC11057164 DOI: 10.1186/s12885-024-12192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Endometrial cancer is one of the most common types of cancer that affects women's reproductive system. The risk of endometrial cancer is associated with biologic, behavioral and social determinants of health (SDOH). The focus of the work is to investigate the cumulative effect of this cluster of covariates on the odds of endometrial cancer that heretofore have only been considered individually. METHODS We conducted a quantitative study using the Behavioral Risk Factor Surveillance System (BRFSS) national data collected in 2020. Data analysis using weighted Chi-square test and weighted logistic regression were carried out on 84,118 female study participants from the United States. RESULTS Women with diabetes mellitus were approximately twice as likely to have endometrial cancer compared to women without diabetes (OR 1.54; 95%CI: 1.01-2.34). Biologic factors that included obesity (OR 3.10; 95% CI: 1.96-4.90) and older age (with ORs ranging from 2.75 to 7.21) had a significant increase in the odds of endometrial cancer compared to women of normal weight and younger age group of 18 to 44. Among the SDOH, attending college (OR 1.83; 95% CI: 1.12-3.00) was associated with increased odds of endometrial cancer, while renting a home (OR 0.50; 95% CI: 0.28-0.88), having other arrangements (OR 0.05; 95% CI: 0.02-0.16), being divorced (OR 0.55; 95% CI: 0.30-0.99), and having higher incomes ranging from $35,000 to $50,000 (OR 0.35; 95% CI: 0.16-0.78), and above $50,000 (OR 0.29; 95% CI: 0.14-0.62), were all associated with decreased odds of endometrial cancer. As for race, Black women (OR 0.24; 95% CI: 0.07-0.84) and women of other races (OR 0.37; 95% CI: 0.15-0.88) were shown to have lower odds of endometrial cancer compared to White women. CONCLUSION Our results revealed the importance of adopting a comprehensive approach to the study of the associated factors of endometrial cancer by including social, biologic, and behavioral determinants of health. The observed social inequity in endometrial cancer among women needs to be addressed through effective policies and changes in social structures to advocate for a standardized healthcare system that ensures equitable access to preventive measures and quality of care.
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Affiliation(s)
- Nour Massouh
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ayad A Jaffa
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
- Division of Endocrinology, Diabetes & Metabolic Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Miran A Jaffa
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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12
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Matoba Y, Devins KM, Milane L, Manning WB, Mazina V, Yeku OO, Rueda BR. High-Grade Endometrial Cancer: Molecular Subtypes, Current Challenges, and Treatment Options. Reprod Sci 2024:10.1007/s43032-024-01544-5. [PMID: 38658487 DOI: 10.1007/s43032-024-01544-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
Although many recent advancements have been made in women's health, perhaps one of the most neglected areas of research is the diagnosis and treatment of high-grade endometrial cancer (EnCa). The molecular classification of EnCa in concert with histology was a major step forward. The integration of profiling for mismatch repair deficiency and Human Epidermal Growth Factor 2 (HER2) overexpression, can further inform treatment options, especially for drug resistant recurrent disease. Recent early phase trials suggest that regardless of subtype, combination therapy with agents that have distinct mechanisms of action is a fruitful approach to the treatment of high-grade EnCa. Unfortunately, although the importance of diagnosis and treatment of high-grade EnCa is well recognized, it is understudied compared to other gynecologic and breast cancers. There remains a tremendous need to couple molecular profiling and biomarker development with promising treatment options to inform new treatment strategies with higher efficacy and safety for all who suffer from high-grade recurrent EnCa.
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Affiliation(s)
- Yusuke Matoba
- Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 60 Blossom St, 02114, Boston, MA, USA
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 02115, Boston, MA, USA
| | - Kyle M Devins
- Department of Pathology, Massachusetts General Hospital, 021151, Boston, MA, USA
| | - Lara Milane
- Department of Pharmaceutical Sciences, Bouvé College of Health Sciences, Northeastern University, 02115, Boston, MA, USA
| | - William B Manning
- Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 60 Blossom St, 02114, Boston, MA, USA
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 02115, Boston, MA, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 02114, Boston, MA, USA
| | - Varvara Mazina
- Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 60 Blossom St, 02114, Boston, MA, USA
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 02115, Boston, MA, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 02114, Boston, MA, USA
| | - Oladapo O Yeku
- Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 60 Blossom St, 02114, Boston, MA, USA
- Cancer Center, Massachusetts General Hospital, 55 Fruit St, 02114, Boston, MA, USA
| | - Bo R Rueda
- Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 60 Blossom St, 02114, Boston, MA, USA.
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 02115, Boston, MA, USA.
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13
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Kopelman ZA, Tian C, Tumas J, Phippen NT, Tarney CM, Hope ER, Winkler SS, Jokajtys S, Kucera CW, Chan JK, Richardson MT, Kapp DS, Hamilton CA, Leath CA, Jones NL, Rocconi RP, Farley JH, Secord AA, Cosgrove CM, Powell MA, Klopp A, Walker JL, Fleming GF, Bateman NW, Conrads TP, Maxwell GL, Darcy KM. Disease progression, survival, and molecular disparities in Black and White patients with endometrioid endometrial carcinoma in real-world registries and GOG/NRG oncology randomized phase III clinical trials. Gynecol Oncol 2024; 183:103-114. [PMID: 38593674 DOI: 10.1016/j.ygyno.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Investigate racial disparities in outcomes and molecular features in Black and White patients with endometrioid endometrial carcinoma (EEC). METHODS Black and White patients diagnosed with EEC who underwent hysterectomy ± adjuvant treatment in SEER, National Cancer Database (NCDB), the Genomics Evidence Neoplasia Information Exchange (GENIE) project (v.13.0), and eight NCI-sponsored randomized phase III clinical trials (RCTs) were studied. Hazard ratio (HR) and 95% confidence interval (CI) were estimated for cancer-related death (CRD), non-cancer death (NCD), and all-cause death. RESULTS Black (n = 4397) vs. White (n = 47,959) patients in SEER had a HR (95% CI) of 2.04 (1.87-2.23) for CRD and 1.22 (1.09-1.36) for NCD. In NCDB, the HR (95% CI) for death in Black (n = 13,468) vs. White (n = 155,706) patients was 1.52 (1.46-1.58) dropping to 1.29 (1.23-1.36) after propensity-score matching for age, comorbidity, income, insurance, grade, stage, LVSI, and treatment. In GENIE, Black (n = 109) vs. White (n = 1780) patients had fewer PTEN, PIK3R1, FBXW7, NF1, mTOR, CCND1, and PI3K-pathway-related gene mutations. In contrast, TP53 and DNA-repair-related gene mutation frequency as well as tumor mutational burden-high status were similar in Black and White patients. In RCTs, Black (n = 187) vs. White (n = 2877) patients were more likely to have advanced or recurrent disease, higher grade, worse performance status and progressive disease. Risk of death in Black vs. White patients in RCTs was 2.19 (1.77-2.71) persisting to 1.32 (1.09-1.61) after matching for grade, stage, and treatment arm while balancing age and performance status. CONCLUSIONS Differences exist in clinical presentation, outcomes, and molecular features in Black vs. White patients with EEC in real-world registries and RCTs. Targeted-drug development, strategies to modify social determinants, and diverse inclusion in RCTs are approaches to reduce disparities.
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Affiliation(s)
- Zachary A Kopelman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Jordyn Tumas
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Christopher M Tarney
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Erica R Hope
- Division of Gynecologic Oncology, Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, TX, USA
| | - Stuart S Winkler
- Division of Gynecologic Oncology, Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, TX, USA
| | - Suzanne Jokajtys
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Calen W Kucera
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | - Nathaniel L Jones
- Division of Gynecologic Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Rodney P Rocconi
- Division of Gynecologic Oncology, Cancer Center & Research Institute, the University of Mississippi Medical Center, Jackson, MS, USA
| | - John H Farley
- Division of Gynecologic Oncology, Center for Women's Health, Cancer Institute, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | - Casey M Cosgrove
- Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, USA
| | - Matthew A Powell
- Division of Gynecologic Oncology, Siteman Cancer Center, Washington University, St Louis, MO, USA
| | - Ann Klopp
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joan L Walker
- Gynecologic Oncology Division, Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Gini F Fleming
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Nicholas W Bateman
- Division of Gynecologic Oncology, Center for Women's Health, Cancer Institute, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - G Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, Falls Church, VA, USA.
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.
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Baker-Rand H, Kitson SJ. Recent Advances in Endometrial Cancer Prevention, Early Diagnosis and Treatment. Cancers (Basel) 2024; 16:1028. [PMID: 38473385 DOI: 10.3390/cancers16051028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Endometrial cancer is the sixth commonest cancer in women worldwide, with over 417,000 diagnoses in 2020. The disease incidence has increased by 132% over the last 30 years and is set to continue to rise in response to an ageing population and increasing global rates of obesity and diabetes. A greater understanding of the mechanisms driving endometrial carcinogenesis has led to the identification of potential strategies for primary disease prevention, although prospective evaluation of their efficacy within clinical trials is still awaited. The early diagnosis of endometrial cancer is associated with improved survival, but has historically relied on invasive endometrial sampling. New, minimally invasive tests using protein and DNA biomarkers and cytology have the potential to transform diagnostic pathways and to allow for the surveillance of high-risk populations. The molecular classification of endometrial cancers has been shown to not only have a prognostic impact, but also to have therapeutic value and is increasingly used to guide adjuvant treatment decisions. Advanced and recurrent disease management has also been revolutionised by increasing the use of debulking surgery and targeted treatments, particularly immunotherapy. This review summarises the recent advances in the prevention, diagnosis and treatment of endometrial cancer and seeks to identify areas for future research.
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Affiliation(s)
- Holly Baker-Rand
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Sarah J Kitson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
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Johnson CR, Liao CI, Tian C, Richardson MT, Duong K, Tran N, Winkler SS, Kapp DS, Darcy K, Chan JK. Uterine cancer among Asian Americans - Disparities & clinical characteristics. Gynecol Oncol 2024; 182:24-31. [PMID: 38246043 DOI: 10.1016/j.ygyno.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To evaluate the patterns and trends of uterine cancer among Asian subgroups living in the U.S. METHODS Data were obtained from United States Cancer Statistics (2001-2017), National Cancer Database (2004-2015), and World Population Review (2023). SEER*Stat version 8.3.9.2, Joinpoint regression program 4.9.0.0, and SAS v 9.4 were employed for statistical analysis. RESULTS Based on data from 778,891 women in the United States Cancer Statistics database, Asians had a 3.4-fold higher rate of incident uterine cancer compared to White populations (2.14% vs. 0.63%; p < 0.001). Using the National Cancer Database, 7,641 Asian women from six subgroups were analyzed: Filipino, Korean, Indian/Pakistani, Vietnamese, Chinese, and Japanese. Indian and Pakistani women had the greatest increase in the proportion of cancer diagnoses (5.0% to 14.4%; p = 0.0003). Additionally, Indian and Pakistani patients had higher comorbidity scores while Koreans had the lowest (22.7% vs. 10.7%, p < 0.0001). Regarding stage of disease, 25.3% of Filipinos presented with advanced stage disease compared to 19.2% of Indians and Pakistanis (p = 0.0001). Furthermore, Filipinos had the highest proportion of non-endometrioid cancers at 18.4% compared to other subgroups (p = 0.0003). Using the World Population Review, female obesity was highest in Pakistan (8.6%) and the Philippines (7.5%) and lowest in Vietnam (2.6%). CONCLUSION Uterine cancer incidence increased at higher rates among Asians compared to White populations. Specifically, Indian and Pakistani uterine cancer patients were more likely to have higher comorbidity rates and Filipino patients had more advanced stage cancer with non-endometrioid histologies than other Asian subgroups. Further research is warranted to better understand these trends.
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Affiliation(s)
- Caitlin R Johnson
- California Pacific Medical Center Research Institute, 1100 Van Ness, San Francisco, CA 94109, USA.
| | - Cheng-I Liao
- Pingtung Veterans General Hospital, Department of Obstetrics and Gynecology, Pingtung, Taiwan
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence Program, Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Michael T Richardson
- University of California, Los Angeles, Department of Obstetrics and Gynecology, 757 Westwood Blvd, Los Angeles, CA, USA
| | - Kim Duong
- Western University of Health Sciences, College of Osteopathic Medicine, 309 E 2nd St, Pomona, CA 91766, USA
| | - Nathan Tran
- California Pacific Medical Center Research Institute, 1100 Van Ness, San Francisco, CA 94109, USA
| | - Stuart S Winkler
- Brooke Army Medical Center, Department of Obstetrics and Gynecology, 3551 Roger Brooke Dr., Fort Sam Houston, TX, United States of America
| | - Daniel S Kapp
- Stanford University School of Medicine, Department of Radiation Oncology, 875 Blake Wilbur Dr, Stanford, CA 94304, USA
| | - Kathleen Darcy
- Gynecologic Cancer Center of Excellence Program, Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - John K Chan
- California Pacific Medical Center Research Institute, 1100 Van Ness, San Francisco, CA 94109, USA
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Illah O, Adeeko D, Olaitan A, Gentry-Maharaj A. Racioethnic Disparities in Endometrial Cancer Outcomes. Diagnostics (Basel) 2024; 14:417. [PMID: 38396458 PMCID: PMC10887632 DOI: 10.3390/diagnostics14040417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Black women are twice as likely to die from endometrial cancer (EC) compared with white women. This represents one of the worst racioethnic disparities amongst all cancers globally. Compared with white women, black women are more likely to be diagnosed with advanced EC, have more barriers to accessing care and experience increased delays in obtaining an EC diagnosis and commencing treatment. Histological and molecular differences place black women at higher risk of being diagnosed with more aggressive EC subtypes that carry less favourable outcomes. Furthermore, EC diagnostic pathways are less reliable in black women, and black women are less likely to receive evidence-based treatment for EC. This racioethnic disparity in EC outcomes exists both in the UK and US, despite differences in healthcare systems. This review methodically describes the key factors along the patient journey that contribute to the disparity in black women and proposes multifaceted approaches to lessen these gaps.
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Affiliation(s)
- Ojone Illah
- Department of Women’s Cancer, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London WC1E 6DD, UK
| | - Deborah Adeeko
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London WC1E 6AU, UK
| | - Adeola Olaitan
- Department of Women’s Cancer, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London WC1E 6DD, UK
| | - Aleksandra Gentry-Maharaj
- Department of Women’s Cancer, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London WC1E 6DD, UK
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London WC1V 6LJ, UK
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Hagopian GS, Bapat AC, Dottino PR, Lieber M, Kemeny MM, Li X, Kaplowitz E, Beddoe A. The impact of nativity on uterine cancer survival in the public hospital system of Queens, New York. Gynecol Oncol 2024; 181:133-140. [PMID: 38163383 DOI: 10.1016/j.ygyno.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE We studied cis-women with uterine cancer presenting to the two Public Hospitals in Queens, New York from 2006 to 2015 to examine the relationship between nativity (birthplace) and survival. METHODS A retrospective review of tumor registries identified women diagnosed with uterine cancer between January 1, 2006, and December 31, 2015. Data from 259 women were available for this analysis. RESULTS Most women were born outside the United States (US) (76% versus 24%). The majority of US-born women were black (68%). Seventy-seven women (30%) were born in Latin America, 76 in the Caribbean Islands (29%) and 44 in Asia/South Asia (17%). Most women presented with stage I/II disease (70%) and endometrioid/mucinous histology (68%) with no significant differences observed among nativity groups. Kaplan-Meier estimated survival curves stratified by birthplace demonstrated significant differences in survival distributions among the groups using the log-rank test (P < 0.0001). The most favorable survival curves were observed among all foreign-born women, whereas the least favorable survival was demonstrated in US-born women. Time to death was analyzed using the Cox proportional hazards model. Adjusting for age of diagnosis, insurance status, stage, and treatment modality, Latin American and Asia/South Asia birthplace was significantly associated with increased survival time. CONCLUSION An immigrant health paradox was defined for foreign-born Latin American and Asian/South Asian women presenting to the two Public Hospitals of Queens, New York, as women born in these geographic regions were less likely to die at any given time compared to those born in the United States.
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Affiliation(s)
- George S Hagopian
- Department of Obstetrics and Gynecology, Elmhurst Hospital Center, Elmhurst, Queens, NY, USA; Department of Obstetrics and Gynecology, Queens Hospital Center, Jamaica, Queens, NY, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Queens Cancer Center, Queens Hospital Center, Jamaica, Queens, NY, USA.
| | - Alka Chintamani Bapat
- Department of Obstetrics and Gynecology, Queens Hospital Center, Jamaica, Queens, NY, USA
| | - Peter R Dottino
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Molly Lieber
- Division of Global Health, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Margaret Kemeny
- Queens Cancer Center, Queens Hospital Center, Jamaica, Queens, NY, USA; Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xilian Li
- Department of Radiation Oncology, Queens Hospital Center, Jamaica, Queens, NY, USA; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elianna Kaplowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annmarie Beddoe
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Global Health, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mignozzi S, Santucci C, Medina HN, Negri E, La Vecchia C, Pinheiro PS. Cancer mortality in Germany-born Americans and Germans. Cancer Epidemiol 2024; 88:102519. [PMID: 38183748 DOI: 10.1016/j.canep.2023.102519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Comparing cancer mortality and associated risk factors among immigrant populations in a host country to those in their country of origin reveals disparities in cancer risk, access to care, diagnosis, and disease management. This study compares cancer mortality between the German resident population and Germany-born individuals who migrated to the US. METHODS Cancer mortality data from 2008-2018 were derived for Germans from the World Health Organization database and for Germany-born Americans resident in four states (California, Florida, Massachusetts, and New York) from respective Departments of Vital Statistics. We calculated age-standardized mortality rates (ASMRs) using the European standard population and standardized mortality ratios (SMR) compared to the German resident population along with 95% confidence intervals (CIs). RESULTS Germany-born American males had lower ASMRs (253.8 per 100,000) than German resident population (325.6 per 100,000). The difference in females was modest, with ASMRs of 200.7 and 203.7 per 100,000, respectively. For all cancers, Germany-born American males had an SMR of 0.72 (95% CI: 0.70-0.74) and females 0.98 (95% CI: 0.95-1.00). Male SMRs among Germany-born Americans were significantly below one for oral cavity, stomach, colorectal, liver, lung, prostate, and kidney cancer. Among females, SMRs were below one for oral cavity, stomach, colorectal, gallbladder, breast, cervix uteri, and kidney cancer. For both sexes, SMRs were over one for bladder cancer (1.14 for males, 1.21 for females). Mortality was higher for lung cancer (SMR: 1.68), non-Hodgkin's lymphoma (1.18) and uterine cancer (1.22) among Germany-born American females compared to the German resident population. CONCLUSION Germany-born American males but not females showed lower cancer mortality than German resident population. Disparities may stem from variations in risk factors (e.g., smoking and alcohol use) as well as differences in screening practices and participation, cancer treatment, besides some residual potential "healthy immigrant effect".
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Affiliation(s)
- Silvia Mignozzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudia Santucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Heidy N Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Zorzato PC, Uccella S, Biancotto G, Bosco M, Festi A, Franchi M, Garzon S. Intrauterine manipulator during hysterectomy for endometrial cancer: a systematic review and meta-analysis of oncologic outcomes. Am J Obstet Gynecol 2024; 230:185-198.e4. [PMID: 37704174 DOI: 10.1016/j.ajog.2023.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE This study aimed to assess the effects on oncologic outcomes of intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer. DATA SOURCES A systematic literature search was performed by an expert librarian in multiple electronic databases from inception to January 31, 2023. STUDY ELIGIBILITY CRITERIA We included all studies in the English language that compared oncologic outcomes (recurrence-free, cause-specific, or overall survival) between endometrial cancer patients who underwent total laparoscopic or robotic hysterectomy for endometrial cancer with vs without the use of an intrauterine manipulator. Studies comparing only peritoneal cytology status or lymphovascular space invasion were summarized for completeness. No selection criteria were applied to the study design. METHODS Four reviewers independently reviewed studies for inclusion, assessed their risk of bias, and extracted data. Pooled hazard ratios with 95% confidence intervals were estimated for oncologic outcomes using the random effect model. Heterogeneity was quantified using the I2 tests. Publication bias was assessed by funnel plot and Egger test. RESULTS Out of 350 identified references, we included 2 randomized controlled trials and 12 observational studies for a total of 14 studies and 5,019 patients. The use of an intrauterine manipulator during hysterectomy for endometrial cancer was associated with a pooled hazard ratio for recurrence of 1.52 (95% confidence interval, 0.99-2.33; P=.05; I2=31%; chi square P value=.22). Pooled hazard ratio for recurrence was 1.48 (95% confidence interval, 0.25-8.76; P=.62; I2=67%; chi square P value=.08) when only randomized controlled trials were considered. Pooled hazard ratio for overall survival was 1.07 (95% confidence interval, 0.65-1.76; P=0.79; I2=44%; chi square P value=.17). The rate of positive peritoneal cytology or lymphovascular space invasion did not differ using an intrauterine manipulator. CONCLUSION Intrauterine manipulator use during hysterectomy for endometrial cancer was neither significantly associated with recurrence-free and overall survival nor with positive peritoneal cytology or lymphovascular space invasion, but further prospective studies are needed.
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Affiliation(s)
- Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy.
| | - Giulia Biancotto
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Anna Festi
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
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Asakitogum DA, Nutor JJ, Pozzar R, Hammer M, Miaskowski C. Systematic Review of the Literature on Multiple Co-occurring Symptoms in Patients Receiving Treatment for Gynecologic Cancers. Semin Oncol Nurs 2024; 40:151572. [PMID: 38246840 DOI: 10.1016/j.soncn.2023.151572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Patients with gynecologic cancers experience a very high symptom burden that has a negative impact on their quality of life. This systematic review aims to identify the common co-occurring symptoms, the prevalence of common symptoms, common instruments used to measure symptoms, associated risk factors, and the symptom burden in patients with gynecologic cancers. DATA SOURCES A search of four databases (ie, PubMed, Embase, Web of Science, and CINAHL) was done from January 1, 2012, through September 5, 2022. A qualitative synthesis of the extant literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA 2020). CONCLUSION A total of 118 studies met the prespecified inclusion criteria. Ninety-six symptoms were assessed across these studies. The top six symptoms and their grand mean prevalence rates were lack of energy (64.4%), fatigue (62.1%), abdominal pain (53.3%), depression (52.6%), concentration dysfunction (52.0%), and drowsiness (51.9%). Numerous methodologic challenges were evident across studies. Future research needs to develop a disease-specific symptom assessment measure, evaluate for risk factors associated with a higher symptom burden, and determine the impact of multiple symptoms on patient outcomes. IMPLICATION FOR NURSING PRACTICE The results are relevant for oncology clinicians to assess patients with gynecologic cancers for the presence of common symptoms and risk factors for higher symptom burden in the patients and to offer effective management interventions.
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Affiliation(s)
- David Ayangba Asakitogum
- Doctoral student, Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA.
| | - Jerry John Nutor
- Assistant Professor, Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA
| | - Rachel Pozzar
- Nurse Scientist and Instructor, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Marilyn Hammer
- Nurse Scientist and Instructor, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA; Director, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Christine Miaskowski
- Professor, Departments of Physiological Nursing and Anesthesia, School of Nursing and Medicine, University of California, San Francisco, CA
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Blackman A, Rees AC, Bowers RR, Jones CM, Vaena SG, Clark MA, Carter S, Villamor ED, Evans D, Emanuel AJ, Fullbright G, Long DT, Spruill L, Romeo MJ, Helke KL, Delaney JR. MYC is sufficient to generate mid-life high-grade serous ovarian and uterine serous carcinomas in a p53-R270H mouse model. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.24.576924. [PMID: 38352443 PMCID: PMC10862747 DOI: 10.1101/2024.01.24.576924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Genetically engineered mouse models (GEMM) have fundamentally changed how ovarian cancer etiology, early detection, and treatment is understood. However, previous GEMMs of high-grade serous ovarian cancer (HGSOC) have had to utilize genetics rarely or never found in human HGSOC to yield ovarian cancer within the lifespan of a mouse. MYC, an oncogene, is amongst the most amplified genes in HGSOC, but it has not previously been utilized to drive HGSOC GEMMs. We coupled Myc and dominant negative mutant p53-R270H with a fallopian tube epithelium-specific promoter Ovgp1 to generate a new GEMM of HGSOC. Female mice developed lethal cancer at an average of 15.1 months. Histopathological examination of mice revealed HGSOC characteristics including nuclear p53 and nuclear MYC in clusters of cells within the fallopian tube epithelium and ovarian surface epithelium. Unexpectedly, nuclear p53 and MYC clustered cell expression was also identified in the uterine luminal epithelium, possibly from intraepithelial metastasis from the fallopian tube epithelium (FTE). Extracted tumor cells exhibited strong loss of heterozygosity at the p53 locus, leaving the mutant allele. Copy number alterations in these cancer cells were prevalent, disrupting a large fraction of genes. Transcriptome profiles most closely matched human HGSOC and serous endometrial cancer. Taken together, these results demonstrate the Myc and Trp53-R270H transgene was able to recapitulate many phenotypic hallmarks of HGSOC through the utilization of strictly human-mimetic genetic hallmarks of HGSOC. This new mouse model enables further exploration of ovarian cancer pathogenesis, particularly in the 50% of HGSOC which lack homology directed repair mutations. Histological and transcriptomic findings are consistent with the hypothesis that uterine serous cancer may originate from the fallopian tube epithelium.
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22
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Zheng S, Donnelly ED, Strauss JB. Race, Prevalence of POLE and POLD1 Alterations, and Survival Among Patients With Endometrial Cancer. JAMA Netw Open 2024; 7:e2351906. [PMID: 38231514 PMCID: PMC10794941 DOI: 10.1001/jamanetworkopen.2023.51906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024] Open
Abstract
Importance Black patients with endometrial cancer (EC) in the United States have higher mortality than patients of other races with EC. The prevalence of POLE and POLD1 pathogenic alterations in patients of different races with EC are not well studied. Objective To explore the prevalence of and outcomes associated with POLE and POLD1 alterations in differential racial groups. Design, Setting, and Participants This retrospective cohort study incorporated the largest available data set of patients with EC, including American Association for Cancer Research Project GENIE (Genomics Evidence Neoplasia Information Exchange; 5087 participants), Memorial Sloan Kettering-Metastatic Events and Tropisms (1315 participants), and the Cancer Genome Atlas Uterine Corpus Endometrial Carcinoma (517 participants), collected from 2015 to 2023, 2013 to 2021, and 2006 to 2012, respectively. The prevalence of and outcomes associated with POLE or POLD1 alterations in EC were evaluated across self-reported racial groups. Exposure Patients of different racial groups with EC and with or without POLE or POLD1 alterations. Main Outcomes and Measures The main outcome was overall survival. Data on demographic characteristics, POLE and POLD1 alteration status, histologic subtype, tumor mutation burden, fraction of genome altered, and microsatellite instability score were collected. Results A total of 6919 EC cases were studied, of whom 444 (6.4%), 694 (10.0%), and 4869 (70.4%) patients were self-described as Asian, Black, and White, respectively. Within these large data sets, Black patients with EC exhibited a lower weighted average prevalence of pathogenic POLE alterations (0.5% [3 of 590 cases]) compared with Asian (6.1% [26 of 424]) or White (4.6% [204 of 4520]) patients. By contrast, the prevalence of POLD1 pathogenic alterations was 5.0% (21 cases), 3.2% (19 cases), and 5.6% (255 cases) in Asian, Black, and White patients with EC, respectively. Patients with POLD1 alterations had better outcomes regardless of race, histology, and TP53 alteration status. For a total of 241 clinically annotated Black patients with EC, a composite biomarker panel of either POLD1 or POLE alterations identified 7.1% (17 patients) with positive outcomes (1 event at 70 months follow up) in the small sample of available patients. Conclusions and Relevance In this retrospective clinicopathological study of patients of different racial groups with EC, a composite biomarker panel of either POLD1 or POLE alteration could potentially guide treatment de-escalation, which is especially relevant for Black patients.
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Affiliation(s)
- Shuhua Zheng
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Eric D. Donnelly
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Jonathan B. Strauss
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
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Abstract
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes using incidence data collected by central cancer registries (through 2020) and mortality data collected by the National Center for Health Statistics (through 2021). In 2024, 2,001,140 new cancer cases and 611,720 cancer deaths are projected to occur in the United States. Cancer mortality continued to decline through 2021, averting over 4 million deaths since 1991 because of reductions in smoking, earlier detection for some cancers, and improved treatment options in both the adjuvant and metastatic settings. However, these gains are threatened by increasing incidence for 6 of the top 10 cancers. Incidence rates increased during 2015-2019 by 0.6%-1% annually for breast, pancreas, and uterine corpus cancers and by 2%-3% annually for prostate, liver (female), kidney, and human papillomavirus-associated oral cancers and for melanoma. Incidence rates also increased by 1%-2% annually for cervical (ages 30-44 years) and colorectal cancers (ages <55 years) in young adults. Colorectal cancer was the fourth-leading cause of cancer death in both men and women younger than 50 years in the late-1990s but is now first in men and second in women. Progress is also hampered by wide persistent cancer disparities; compared to White people, mortality rates are two-fold higher for prostate, stomach and uterine corpus cancers in Black people and for liver, stomach, and kidney cancers in Native American people. Continued national progress will require increased investment in cancer prevention and access to equitable treatment, especially among American Indian and Alaska Native and Black individuals.
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Affiliation(s)
- Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia, USA
| | | | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Darko N, Millet N, Usman A, Teece L, Moss EL. Exploring the perspectives of underrepresented voices: Perceptions and experiences of uterine cancer for black African, Caribbean, black British, and mixed-black women in the UK to develop strategies for early symptom presentation. Gynecol Oncol 2024; 180:132-138. [PMID: 38091772 DOI: 10.1016/j.ygyno.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVES The uterine cancer (UC) mortality rate in the UK is significantly higher for women who belong to a Black ethnic group compared to those from other ethnic groups. This study aimed to understand the views and experiences of UC amongst Black ethnic minority women in the UK, with a focus on awareness and presentation of red-flag symptoms. METHODS Women of Black African, Caribbean, Black British and Mixed-Black ethnicity were purposefully recruited to participate in focus groups and individual semi-structured interviews. RESULTS Twenty women from different regions in England participated in the study. Reflexive thematic analysis of the data led to the identification of three main themes: 1) Healthcare inequities; 2) Support and sense making with other Black women; and 3) Knowledge dissemination, mobilisation, and empowerment. Perceptions of inequitable healthcare provision and distrust influenced how participants, and their peer networks, approached seeking assistance from healthcare professionals. Concerns were also raised about culturally insensitive information resources, including issues of language, literacy, and representation, all of which served as potential barriers for women within Black ethnic minority groups. CONCLUSIONS The deficiency of targeted knowledge mobilisation and specific UC information aimed at Black ethnicity women living in the UK, reportedly contributes to the dissemination of misconceptions and an atmosphere of apprehension around a UC diagnosis. The insights from this study highlight the significance of designing culturally sensitive strategies to promote informed decision-making and empower the dissemination of accurate health knowledge amongst Black women.
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Affiliation(s)
- N Darko
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - N Millet
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - A Usman
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - L Teece
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - E L Moss
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK; University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK
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25
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Bertrand KA, Delp L, Coogan PF, Cozier YC, Lenzy YM, Rosenberg L, Palmer JR. Hair relaxer use and risk of uterine cancer in the Black Women's Health Study. ENVIRONMENTAL RESEARCH 2023; 239:117228. [PMID: 37821068 PMCID: PMC10842360 DOI: 10.1016/j.envres.2023.117228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Chemical hair relaxers, use of which is highly prevalent among Black women in the US, have been inconsistently linked to risk of estrogen-dependent cancers, such as breast cancer, and other reproductive health conditions. Whether hair relaxer use increases risk of uterine cancer is unknown. METHODS In the Black Women's Health Study, 44,798 women with an intact uterus who self-identified as Black were followed from 1997, when chemical hair relaxer use was queried, until 2019. Over follow-up, 347 incident uterine cancers were diagnosed. We used multivariable Cox proportional hazards regression models, adjusted for age and other potential confounders, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of hair relaxer use with risk of uterine cancer. RESULTS Compared to women who never used hair relaxers or used them infrequently (<4 years and ≤1-2 times/year), the HR for uterine cancer associated with heavy use (≥15 years and at least 5 times/year) was 1.18 (95% CI: 0.81, 1.71). However, among postmenopausal women, compared to never/light use, the HR for moderate use was 1.60 (95% CI: 1.01, 2.53), the HR for heavy use was 1.64 (1.01, 2.64), and the HR for ≥20 years of use regardless of frequency was 1.71 (1.08, 2.72). Results among premenopausal women were null. CONCLUSIONS In this large cohort of Black women, long-term use of chemical hair relaxers was associated with increased risk of uterine cancer among postmenopausal women, but not among premenopausal women. These findings suggest that hair relaxer use may be a potentially modifiable risk factor for uterine cancer.
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Affiliation(s)
- Kimberly A Bertrand
- Slone Epidemiology Center at Boston University, Boston, MA, USA; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Lauren Delp
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | | | - Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Yolanda M Lenzy
- Lenzy Dermatology and Hair Loss Center, Chicopee, MA, USA; University of Connecticut Health Dermatology, Farmington, CT, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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26
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Mutlu L, Manavella DD, Bellone S, McNamara B, Harold JA, Mauricio D, Siegel ER, Buza N, Hui P, Hartwich TMP, Yang-Hartwich Y, Demirkiran C, Verzosa MSZ, Altwerger G, Ratner ES, Huang GS, Clark M, Andikyan V, Azodi M, Dottino PR, Schwartz PE, Santin AD. In Vivo and In Vitro Efficacy of Trastuzumab Deruxtecan in Uterine Serous Carcinoma. Mol Cancer Ther 2023; 22:1404-1412. [PMID: 37676984 DOI: 10.1158/1535-7163.mct-23-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/20/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
Uterine serous carcinoma (USC) is a rare, biologically aggressive variant of endometrial cancer with a high recurrence rate and poor prognosis. HER2 overexpression (3+ positivity) by IHC and/or FISH ERBB2 gene amplification is detected in approximately one-third of patients with USC. Clinical trials incorporating trastuzumab with standard chemotherapy have recently demonstrated improved progression-free and overall survival in advanced-stage or recurrent USC that overexpresses HER2. However, a large number of patients with USC eventually developed resistance to trastuzumab. Trastuzumab deruxtecan (T-DXd) is a novel HER2-directed antibody-drug conjugate with a topoisomerase I inhibitor payload recently approved by the Food and Drug Administration (FDA) for multiple tumor indications. Here, we investigated the in vitro and in vivo efficacy of T-DXd in primary USC cell lines and xenografts with different HER2 expression. T-DXd-induced cell growth suppression in HER2-overexpressing cell lines in vitro, increased early and late apoptosis as assessed by annexin and propidium iodide staining, and, similarly to trastuzumab, T-DXd-induced significant antibody-dependent cellular cytotoxicity in the presence of peripheral blood lymphocytes. While negligible activity was detected against USC cell lines with low HER2 expression, T-DXd demonstrated significant bystander killing against USC tumors with low/negligible HER2 when such cells were admixed with HER2 3+ tumor cells in vitro. T-DXd showed tumor growth suppression in in vivo USC PDX models that overexpress HER2 at 3+ levels, prolonging survival when compared with controls, with minimal toxicity. Future clinical trials are warranted in patients with USC failing trastuzumab treatment.
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Affiliation(s)
- Levent Mutlu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Diego D Manavella
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Stefania Bellone
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Blair McNamara
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Justin A Harold
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Dennis Mauricio
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Natalia Buza
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Tobias Max Philipp Hartwich
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Yang Yang-Hartwich
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Cem Demirkiran
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Miguel Skyler Z Verzosa
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Gary Altwerger
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Elena S Ratner
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Gloria S Huang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Mitchell Clark
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Vaagn Andikyan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Masoud Azodi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Peter R Dottino
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Peter E Schwartz
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
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Sasse SA, Lee SS, Rajeev P, Sharma SR, Kahan T, Pothuri B. Concurrent uterine surgery and uptake of hormone therapy in patients undergoing bilateral salpingo-oophorectomy for risk-reducing or therapeutic indications. Gynecol Oncol 2023; 179:131-137. [PMID: 37988946 DOI: 10.1016/j.ygyno.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE This study aimed to analyze factors associated with concurrent uterine surgery in patients undergoing bilateral salpingo-oophorectomy (BSO) for risk reducing or therapeutic purposes. Additionally, trends in surgical choice and uptake of post-operative hormone therapy (HT) were examined. METHODS A 10-year retrospective study was conducted on patients who underwent risk-reducing or therapeutic BSO at one institution. Multinomial regression analysis of patient and case characteristics was performed evaluating associations with surgery type (BSO, BSO and hysterectomy, or BSO and endometrial sampling). Trends in surgery type and uptake of HT post operatively are described. RESULTS Among the study sample of 643 patients, 140 (22%) patients underwent therapeutic BSO for a history of hormone receptor (HR) positive breast cancer, while the remainder underwent risk-reducing BSO due to a pathogenic variant and/or family history. Pathogenic variants included BRCA1 (141, 40%) BRCA2 (173, 49%), and Lynch syndrome genes (15, 4%). Regression analysis revealed significant associations between concurrent hysterectomy and Black race (RR = 3.55, CI = 1.51-8.38, p = 0.004), history of HR positive breast cancer (RR = 1.88, CI = 1.03-3.42, p = 0.04), and surgeon (Surgeon 1, RR = 2.43, CI = 1.36-4.35, p = 0.003). Among eligible patients under age 51, 36% initiated HT. Over the study period, concurrent hysterectomy rates declined while endometrial sampling increased. CONCLUSIONS Rates of hysterectomy declined over the study period and slightly more than one-third of eligible patients utilized post-operative HT. Further research on concurrent uterine surgery is needed to establish standardized treatment recommendations in the risk-reducing and therapeutic BSO population. Additionally, education regarding the benefits of postoperative HT in eligible patients is warranted.
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Affiliation(s)
- Simone A Sasse
- Department of Obstetrics and Gynecology, New York University Langone Health Center, New York, NY, USA
| | - Sarah S Lee
- Department of Obstetrics and Gynecology, New York University Langone Health Center, New York, NY, USA
| | - Pournami Rajeev
- Department of Obstetrics and Gynecology, New York University Langone Health Center, New York, NY, USA
| | - Sneha R Sharma
- Department of Obstetrics and Gynecology, New York University Langone Health Center, New York, NY, USA
| | - Tamara Kahan
- Department of Obstetrics and Gynecology, New York University Langone Health Center, New York, NY, USA
| | - Bhavana Pothuri
- Department of Obstetrics and Gynecology, New York University Langone Health Center, New York, NY, USA; Department of Medicine, New York University Langone Health Medical Center, Laura & Isaac Perlmutter Cancer Center, New York, NY, USA.
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Sereda Y, Alarid-Escudero F, Bickell NA, Chang SH, Colditz GA, Hur C, Jalal H, Myers ER, Layne TM, Wang SY, Yeh JM, Trikalinos TA. Approaches to developing de novo cancer population models to examine questions about cancer and race in bladder, gastric, and endometrial cancer and multiple myeloma: the Cancer Intervention and Surveillance Modeling Network incubator program. J Natl Cancer Inst Monogr 2023; 2023:219-230. [PMID: 37947329 PMCID: PMC11009510 DOI: 10.1093/jncimonographs/lgad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND We are developing 10 de novo population-level mathematical models in 4 malignancies (multiple myeloma and bladder, gastric, and uterine cancers). Each of these sites has documented disparities in outcome that are believed to be downstream effects of systemic racism. METHODS Ten models are being independently developed as part of the Cancer Intervention and Surveillance Modeling Network incubator program. These models simulate trends in cancer incidence, early diagnosis, treatment, and mortality for the general population and are stratified by racial subgroup. Model inputs are based on large population datasets, clinical trials, and observational studies. Some core parameters are shared, and other parameters are model specific. All models are microsimulation models that use self-reported race to stratify model inputs. They can simulate the distribution of relevant risk factors (eg, smoking, obesity) and insurance status (for multiple myeloma and uterine cancer) in US birth cohorts and population. DISCUSSION The models aim to refine approaches in prevention, detection, and management of 4 cancers given uncertainties and constraints. They will help explore whether the observed racial disparities are explainable by inequities, assess the effects of existing and potential cancer prevention and control policies on health equity and disparities, and identify policies that balance efficiency and fairness in decreasing cancer mortality.
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Affiliation(s)
- Yuliia Sereda
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - Fernando Alarid-Escudero
- Department of Health Policy, School of Medicine, and Stanford Health Policy, Freeman-Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Nina A Bickell
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, WA University School of Medicine, St Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, WA University School of Medicine, St Louis, MO, USA
| | - Chin Hur
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Hawre Jalal
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Tracy M Layne
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Blavatnik Family Women’s Health Research Institute and Center for Scientific Diversity, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer M Yeh
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Thomas A Trikalinos
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
- Departments of Health Services, Policy, & Practice and of Biostatistics, Brown University School of Public Health, Providence, RI, USA
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29
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Lee NK, Tiro JA, Odunsi K. Disparities in Gynecologic Cancers. Cancer J 2023; 29:343-353. [PMID: 37963369 DOI: 10.1097/ppo.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT Gynecologic cancer disparities have different trends by cancer type and by sociodemographic/economic factors. We highlight disparities in the United States arising due to poor delivery of cancer care across the continuum from primary prevention, detection, and diagnosis through treatment and identify opportunities to eliminate/reduce disparities to achieve cancer health equity. Our review documents the persistent racial and ethnic disparities in cervical, ovarian, and uterine cancer outcomes, with Black patients experiencing the worst outcomes, and notes literature investigating social determinants of health, particularly access to care. Although timely delivery of screening and diagnostic evaluation is of paramount importance for cervical cancer, efforts for ovarian and uterine cancer need to focus on timely recognition of symptoms, diagnostic evaluation, and delivery of guideline-concordant cancer treatment, including tumor biomarker and somatic/germline genetic testing.
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30
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Weigelt B, Marra A, Selenica P, Rios-Doria E, Momeni-Boroujeni A, Berger MF, Arora K, Nemirovsky D, Iasonos A, Chakravarty D, Abu-Rustum NR, Da Cruz Paula A, Dessources K, Ellenson LH, Liu YL, Aghajanian C, Brown CL. Molecular Characterization of Endometrial Carcinomas in Black and White Patients Reveals Disparate Drivers with Therapeutic Implications. Cancer Discov 2023; 13:2356-2369. [PMID: 37651310 PMCID: PMC11149479 DOI: 10.1158/2159-8290.cd-23-0546] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023]
Abstract
Although the incidence of endometrial carcinoma (EC) is similar in Black and White women, racial disparities are stark, with the highest mortality rates observed among Black patients. Here, analysis of 1,882 prospectively sequenced ECs using a clinical FDA-authorized tumor-normal panel revealed a significantly higher prevalence of high-risk histologic and molecular EC subtypes in self-identified Black (n = 259) compared with White (n = 1,623) patients. Clinically actionable alterations, including high tumor mutational burden/microsatellite instability, which confer benefit from immunotherapy, were less frequent in ECs from Black than from White patients. Ultramutated POLE molecular subtype ECs associated with favorable outcomes were rare in Black patients. Results were confirmed by genetic ancestry analysis. CCNE1 gene amplification, which is associated with aggressive clinical behavior, was more prevalent in carcinosarcomas occurring in Black than in White patients. ECs from Black and White patients display important differences in their histologic types, molecular subtypes, driver genetic alterations, and therapeutic targets. SIGNIFICANCE Our comprehensive analysis of prospectively clinically sequenced ECs revealed significant differences in their histologic and molecular composition and in the presence of therapeutic targets in Black versus White patients. These findings emphasize the importance of incorporating diverse populations into molecular studies and clinical trials to address EC disparities. This article is featured in Selected Articles from This Issue, p. 2293.
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Affiliation(s)
- Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Antonio Marra
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pier Selenica
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric Rios-Doria
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amir Momeni-Boroujeni
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael F Berger
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kanika Arora
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Nemirovsky
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Debyani Chakravarty
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Arnaud Da Cruz Paula
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kimberly Dessources
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lora H Ellenson
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ying L Liu
- Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Carol Aghajanian
- Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Carol L Brown
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
- Office of Health Equity, Memorial Sloan Kettering Cancer Center, New York, New York
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31
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Gamble C, Woodard TJ, Yakubu AI, Chapman-Davis E. An Intervention-Based Approach to Achieve Racial Equity in Gynecologic Oncology. Obstet Gynecol 2023; 142:957-966. [PMID: 37678907 PMCID: PMC10510810 DOI: 10.1097/aog.0000000000005348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 09/09/2023]
Abstract
Racial inequities within gynecologic oncology exist at every step of the cancer continuum. Although the disparities have been well described, there is a significant gap in the literature focused on eliminating inequities in gynecologic cancer outcomes. The goal of this narrative review is to highlight successful, evidence-based interventions from within and outside of gynecologic oncology that alleviate disparity, providing a call to action for further research and implementation efforts within the field. These solutions are organized in the socioecologic framework, where multiple levels of influence-societal, community, organizational, interpersonal, and individual-affect health outcomes.
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Affiliation(s)
- Charlotte Gamble
- Division of Gynecologic Oncology, MedStar Washington Hospital Center, and Georgetown University, Washington, DC; the Division of Gynecologic Oncology, Washington University School of Medicine in St. Louis, St. Louis, Missouri; the Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia; and the Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
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Chang CS, Lai YL, Choi CH, Kim TJ, Lee JW, Kim BG, Cheng WF, Chen YL, Lee YY. Comparison of Minimally Invasive and Open Surgery for the Treatment of Endometrial Cancer with a High Risk of Recurrence: A Propensity Score Matching Study in Korea and Taiwan. Ann Surg Oncol 2023; 30:6855-6864. [PMID: 37386310 DOI: 10.1245/s10434-023-13695-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/22/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND This study compared oncologic outcomes between minimally invasive surgery (MIS) and open surgery for the treatment of endometrial cancer with a high risk of recurrence. METHODS This study included patients with endometrial cancer who underwent primary surgery at two tertiary centers in Korea and Taiwan. Low-grade advanced-stage endometrial cancer (endometrioid grade 1 or 2) or endometrial cancer with aggressive histology (endometrioid grade 3 or non-endometrioid) at any stage was considered to have a high risk of recurrence. We conducted 1:1 propensity score matching between the MIS and open surgery groups to adjust for the baseline characteristics. RESULTS Of the total of 582 patients, 284 patients were included in analysis after matching. Compared with open surgery, MIS did not show a difference in disease-free survival [hazard ratio (HR) 1.09; 95% confidence interval (CI) 0.67-1.77, P = 0.717] or overall survival (HR 0.67; 95% CI 0.36-1.24, P = 0.198). In the multivariate analysis, non-endometrioid histology, tumor size, tumor cytology, depth of invasion, and lymphovascular space invasion were risk factors for recurrence. There was no association between the surgical approach and either recurrence or mortality in the subgroup analysis according to stage and histology. CONCLUSIONS MIS did not compromise survival outcomes for patients with endometrial cancer with a high risk of recurrence when compared with open surgery.
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Affiliation(s)
- Chi-Son Chang
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si, Korea
| | - Yen-Ling Lai
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Li Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan.
| | - Yoo-Young Lee
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Dou Y, Katsnelson L, Gritsenko MA, Hu Y, Reva B, Hong R, Wang YT, Kolodziejczak I, Lu RJH, Tsai CF, Bu W, Liu W, Guo X, An E, Arend RC, Bavarva J, Chen L, Chu RK, Czekański A, Davoli T, Demicco EG, DeLair D, Devereaux K, Dhanasekaran SM, Dottino P, Dover B, Fillmore TL, Foxall M, Hermann CE, Hiltke T, Hostetter G, Jędryka M, Jewell SD, Johnson I, Kahn AG, Ku AT, Kumar-Sinha C, Kurzawa P, Lazar AJ, Lazcano R, Lei JT, Li Y, Liao Y, Lih TSM, Lin TT, Martignetti JA, Masand RP, Matkowski R, McKerrow W, Mesri M, Monroe ME, Moon J, Moore RJ, Nestor MD, Newton C, Omelchenko T, Omenn GS, Payne SH, Petyuk VA, Robles AI, Rodriguez H, Ruggles KV, Rykunov D, Savage SR, Schepmoes AA, Shi T, Shi Z, Tan J, Taylor M, Thiagarajan M, Wang JM, Weitz KK, Wen B, Williams CM, Wu Y, Wyczalkowski MA, Yi X, Zhang X, Zhao R, Mutch D, Chinnaiyan AM, Smith RD, Nesvizhskii AI, Wang P, Wiznerowicz M, Ding L, Mani DR, Zhang H, Anderson ML, Rodland KD, Zhang B, Liu T, Fenyö D. Proteogenomic insights suggest druggable pathways in endometrial carcinoma. Cancer Cell 2023; 41:1586-1605.e15. [PMID: 37567170 PMCID: PMC10631452 DOI: 10.1016/j.ccell.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/25/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023]
Abstract
We characterized a prospective endometrial carcinoma (EC) cohort containing 138 tumors and 20 enriched normal tissues using 10 different omics platforms. Targeted quantitation of two peptides can predict antigen processing and presentation machinery activity, and may inform patient selection for immunotherapy. Association analysis between MYC activity and metformin treatment in both patients and cell lines suggests a potential role for metformin treatment in non-diabetic patients with elevated MYC activity. PIK3R1 in-frame indels are associated with elevated AKT phosphorylation and increased sensitivity to AKT inhibitors. CTNNB1 hotspot mutations are concentrated near phosphorylation sites mediating pS45-induced degradation of β-catenin, which may render Wnt-FZD antagonists ineffective. Deep learning accurately predicts EC subtypes and mutations from histopathology images, which may be useful for rapid diagnosis. Overall, this study identified molecular and imaging markers that can be further investigated to guide patient stratification for more precise treatment of EC.
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Affiliation(s)
- Yongchao Dou
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Lizabeth Katsnelson
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Marina A Gritsenko
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Yingwei Hu
- Department of Pathology and Oncology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Boris Reva
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Runyu Hong
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Yi-Ting Wang
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Iga Kolodziejczak
- International Institute for Molecular Oncology, 20-203 Poznań, Poland; Postgraduate School of Molecular Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Rita Jui-Hsien Lu
- Department of Medicine and Genetics, Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA; McDonnell Genome Institute, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - Chia-Feng Tsai
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Wen Bu
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Wenke Liu
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Xiaofang Guo
- Division of Gynecologic Oncology, University of South Florida Morsani College of Medicine and Tampa General Hospital Cancer Institute, Tampa, FL 33606, USA
| | - Eunkyung An
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, MD 20850, USA
| | - Rebecca C Arend
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Jasmin Bavarva
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, MD 20850, USA
| | - Lijun Chen
- Department of Pathology and Oncology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Rosalie K Chu
- Environmental Molecular Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Andrzej Czekański
- Wroclaw Medical University and Lower Silesian Oncology, Pulmonology and Hematology Center (DCOPIH), Wrocław, Poland
| | - Teresa Davoli
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Elizabeth G Demicco
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Deborah DeLair
- Department of Pathology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Kelly Devereaux
- Department of Pathology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Saravana M Dhanasekaran
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Peter Dottino
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Bailee Dover
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Thomas L Fillmore
- Environmental Molecular Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - McKenzie Foxall
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Catherine E Hermann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Tara Hiltke
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, MD 20850, USA
| | | | - Marcin Jędryka
- Wroclaw Medical University and Lower Silesian Oncology, Pulmonology and Hematology Center (DCOPIH), Wrocław, Poland
| | - Scott D Jewell
- Van Andel Research Institute, Grand Rapids, MI 49503, USA
| | - Isabelle Johnson
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Andrea G Kahn
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Amy T Ku
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Chandan Kumar-Sinha
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Paweł Kurzawa
- Heliodor Swiecicki Clinical Hospital in Poznan ul. Przybyszewskiego 49, 60-355 Poznań, Poland; Poznań University of Medical Sciences, 61-701 Poznań, Poland
| | - Alexander J Lazar
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rossana Lazcano
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jonathan T Lei
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Yi Li
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Yuxing Liao
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Tung-Shing M Lih
- Department of Pathology and Oncology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Tai-Tu Lin
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - John A Martignetti
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ramya P Masand
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Rafał Matkowski
- Wroclaw Medical University and Lower Silesian Oncology, Pulmonology and Hematology Center (DCOPIH), Wrocław, Poland
| | - Wilson McKerrow
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Mehdi Mesri
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, MD 20850, USA
| | - Matthew E Monroe
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Jamie Moon
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Ronald J Moore
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Michael D Nestor
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Chelsea Newton
- Van Andel Research Institute, Grand Rapids, MI 49503, USA
| | | | - Gilbert S Omenn
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; Department of Human Genetics, University of Michigan, Ann Arbor, MI 48109, USA; School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Samuel H Payne
- Department of Biology, Brigham Young University, Provo, UT 84602, USA
| | - Vladislav A Petyuk
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Ana I Robles
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, MD 20850, USA
| | - Henry Rodriguez
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, MD 20850, USA
| | - Kelly V Ruggles
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Division of Precision Medicine, Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Dmitry Rykunov
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sara R Savage
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Athena A Schepmoes
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Tujin Shi
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Zhiao Shi
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jimin Tan
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Mason Taylor
- Department of Biology, Brigham Young University, Provo, UT 84602, USA
| | - Mathangi Thiagarajan
- Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA
| | - Joshua M Wang
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Karl K Weitz
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Bo Wen
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - C M Williams
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA
| | - Yige Wu
- Department of Medicine and Genetics, Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA; McDonnell Genome Institute, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - Matthew A Wyczalkowski
- Department of Medicine and Genetics, Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA; McDonnell Genome Institute, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - Xinpei Yi
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Xu Zhang
- Office of Cancer Clinical Proteomics Research, National Cancer Institute, Rockville, MD 20850, USA
| | - Rui Zhao
- Environmental Molecular Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - David Mutch
- Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Arul M Chinnaiyan
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Richard D Smith
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Alexey I Nesvizhskii
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Pei Wang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Maciej Wiznerowicz
- International Institute for Molecular Oncology, 60-203 Poznań, Poland; Heliodor Swiecicki Clinical Hospital in Poznan ul. Przybyszewskiego 49, 60-355 Poznań, Poland; Poznań University of Medical Sciences, 61-701 Poznań, Poland
| | - Li Ding
- Department of Medicine and Genetics, Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA; McDonnell Genome Institute, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - D R Mani
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA
| | - Hui Zhang
- Department of Pathology and Oncology, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Matthew L Anderson
- Division of Gynecologic Oncology, University of South Florida Morsani College of Medicine and Tampa General Hospital Cancer Institute, Tampa, FL 33606, USA.
| | - Karin D Rodland
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA; Department of Cell, Developmental, and Cancer Biology, Oregon Health & Science University, Portland, OR 97221, USA.
| | - Bing Zhang
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Tao Liu
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA.
| | - David Fenyö
- Institute for Systems Genetics, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY 10016, USA.
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Lee SS, Weil CR, Boyd LR, DeCesaris C, Gaffney D, Suneja G. Trends in use of radiation therapy, chemotherapy, and combination chemoradiotherapy in advanced uterine cancer before, during, and after GOG 258. Int J Gynecol Cancer 2023; 33:1408-1418. [PMID: 37487661 DOI: 10.1136/ijgc-2023-004617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE To explore the use of Gynecologic Oncology Group 258 (GOG 258) study regimens before, during, and after the study. METHODS Patients aged 18 years or older with endometrial cancer between 2004-2019 were identified in the National Cancer Database. Inclusion criteria were stage III or IVA of any histology and stage I-IVA clear cell or serous histologies with positive washings that received adjuvant therapy. Adjuvant therapy use was examined in the pre-GOG 258 era (before 2009), during GOG 258 enrollment and maturation (2010-2017), and after results presentation in 2017 (2018-2019). Two-sided Cochran-Armitage tests, Wilcoxen rank sum tests, and χ2 tests were used for continuous and categorical variables. Multi-variable logistic regression assessed factors associated with the receipt of chemoradiotherapy compared with chemotherapy only or radiation therapy only. RESULTS From 2004 to 2019, 41 408 high-risk endometrial cancer patients received adjuvant therapy (12% radiation therapy, 38% chemotherapy, 50% chemoradiotherapy). Chemoradiotherapy increased over the GOG 258 study period (40% before study opening, 54% during enrollment, and 59% after results). Serous (OR 0.6, 95% CI 0.6 to 0.7) and clear cell histology (0.7, 0.6 to 0.8), higher grade (0.8, 0.7 to 0.9), and lymph node positivity (0.8, 0.7 to 0.9) were negatively associated with receipt of chemoradiotherapy compared with single-modality treatment. Non-Hispanic Black ethnicity (0.8, 0.8 to 0.9) and residing ≥50 miles from the treatment facility (0.8, 0.7 to 0.9) were also negatively associated with chemoradiotherapy. Private insurance (1.2, 1.0 to 1.4) and treatment at community hospitals (1.2, 1.2 to 1.3) were positively associated with chemoradiotherapy. CONCLUSION Despite the lack of benefit in the GOG 258 experimental arm, chemoradiotherapy use increased during study enrollment and after results publication.
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Affiliation(s)
- Sarah S Lee
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York University Langone Health, New York, New York, USA
| | - Christopher R Weil
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Leslie R Boyd
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York University Langone Health, New York, New York, USA
| | - Cristina DeCesaris
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Gaffney
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
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Zheng W. Molecular Classification of Endometrial Cancer and the 2023 FIGO Staging: Exploring the Challenges and Opportunities for Pathologists. Cancers (Basel) 2023; 15:4101. [PMID: 37627129 PMCID: PMC10452831 DOI: 10.3390/cancers15164101] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
This commentary explores the complexities of the FIGO 2023 staging system and the inclusion of The Cancer Genome Atlas's (TCGA) molecular classification in the management of endometrial cancer. It highlights the importance of histology as a prognostic tool, while scrutinizing the merits and demerits of its application to aggressive endometrial cancers. The commentary review sheds light on the recent introductions of lymphovascular space invasion (LVSI) and lymph node metastasis size in cancer staging. It outlines the difficulties in differentiating between synchronous and metastatic endometrial and ovarian cancers, underlining their implications on treatment strategies. Furthermore, the commentary discusses the integration of molecular classifications within the FIGO 2023 framework, emphasizing the pivotal yet challenging implementation of the pathogenic POLE mutation test. The commentary concludes by reaffirming the vital role of pathologists in executing the FIGO 2023 staging system.
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Affiliation(s)
- Wenxin Zheng
- Department of Pathology, Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Ge J, Fader AN, Dudley JC. Early detection of endometrial cancer. Gynecol Oncol 2023; 174:A1-A2. [PMID: 37356825 DOI: 10.1016/j.ygyno.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Affiliation(s)
- Jiaxin Ge
- Ludwig Center, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda N Fader
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan C Dudley
- Ludwig Center, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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37
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Taylor KN, Li A, Manuel M, Rimel BJ, Kim KH. The association of black race with receipt of hysterectomy and survival in low-risk endometrial cancer. Gynecol Oncol 2023; 175:156-162. [PMID: 37390596 DOI: 10.1016/j.ygyno.2023.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To determine whether Black race is associated with treatment and survival among women with low-risk endometrial cancer. METHODS Black and White women with Stage IA grade 1-2 endometrioid endometrial carcinoma diagnosed from 2010 to 2016 in the SEER 18 dataset were identified (n = 23,431), and clinical and socioeconomic attributes obtained. Five-year cancer-specific survival (CSS) and relative survival (RS) were calculated using SEER*Stat 8.3.9. Cox proportional hazards model was used to determine predictors of overall survival (OS) and CSS. RESULTS There was a significantly higher proportion of Black women who did not have surgery compared to White women (3% vs 1%, respectively; p < 0.0001). Residing in the South, being insured with Medicaid, and residing in a county with low median income were also associated with non-receipt of surgery. Black women remained less likely to undergo hysterectomy on multivariable analysis (OR 0.44, 95% CI 0.32-0.60). Non-receipt of hysterectomy was predictive of decreased CSS (HR 0.14, 95% CI 0.09-0.21) and OS (HR 0.18, 95% 0.14-0.23) on adjusted analysis. Black race was also an independent predictor of increased cancer-specific death (HR 2.07, 95% CI 1.50-2.86) as well as death from any cause (HR 1.74, 95% CI 1.44-2.09) on adjusted analysis. CONCLUSIONS Black women with low-risk endometrial cancer were less likely to undergo hysterectomy and experienced decreased survival relative to White women. Further investigation is warranted to better understand the socioeconomic, geographic, and biologic factors that influence this disparity.
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Affiliation(s)
- Kristin N Taylor
- Cedars-Sinai Medical Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samuel Oschin Cancer Center, 127 South San Vicente Blvd, Los Angeles, CA 90048, USA.
| | - Andrew Li
- Cedars-Sinai Medical Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samuel Oschin Cancer Center, 127 South San Vicente Blvd, Los Angeles, CA 90048, USA
| | - Michael Manuel
- Cedars-Sinai Medical Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samuel Oschin Cancer Center, 127 South San Vicente Blvd, Los Angeles, CA 90048, USA
| | - Bobbie Jo Rimel
- Cedars-Sinai Medical Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samuel Oschin Cancer Center, 127 South San Vicente Blvd, Los Angeles, CA 90048, USA
| | - Kenneth H Kim
- Cedars-Sinai Medical Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samuel Oschin Cancer Center, 127 South San Vicente Blvd, Los Angeles, CA 90048, USA
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Pothuri B, Blank SV, Myers TK, Hines JF, Randall LM, O'Cearbhaill RE, Slomovitz BM, Eskander RN, Alvarez Secord A, Coleman RL, Walker JL, Monk BJ, Moore KN, O'Malley DM, Copeland LJ, Herzog TJ. Inclusion, diversity, equity, and access (IDEA) in gynecologic cancer clinical trials: A joint statement from GOG foundation and Society of Gynecologic Oncology (SGO). Gynecol Oncol 2023; 174:278-287. [PMID: 37315373 DOI: 10.1016/j.ygyno.2023.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023]
Affiliation(s)
- B Pothuri
- NYU Langone Health and Laura & Isaac Perlmutter Cancer Center, New York, NY, USA.
| | - S V Blank
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, Blavatnik Family Women's Health Research Institute, New York, MY, USA
| | - T K Myers
- University of Massachusetts-Baystate, Springfield, MA, USA
| | - J F Hines
- University of Connecticut Health System, Farmington, CT, USA
| | - L M Randall
- Virginia Commonwealth University, Richmond, VA, USA
| | - R E O'Cearbhaill
- Memorial Sloan Kettering Cancer Center; Weill Cornell Medical College, New York, NY, USA
| | | | - R N Eskander
- University of California, San Diego Moores Cancer Center, La Jolla, CA, USA
| | - A Alvarez Secord
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - R L Coleman
- Texas Oncology, US Oncology Network, The Woodlands, TX, USA
| | - J L Walker
- Stephenson Cancer Center, Oklahoma City, OK, USA
| | - B J Monk
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | - K N Moore
- Stephenson Cancer Center, Oklahoma City, OK, USA
| | - D M O'Malley
- The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus, OH, USA
| | - L J Copeland
- The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus, OH, USA
| | - T J Herzog
- University of Cincinnati Cancer Center, University of Cincinnati, Cincinnati, OH, USA
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Eskander RN, Sill MW, Beffa L, Moore RG, Hope JM, Musa FB, Mannel R, Shahin MS, Cantuaria GH, Girda E, Mathews C, Kavecansky J, Leath CA, Gien LT, Hinchcliff EM, Lele SB, Landrum LM, Backes F, O'Cearbhaill RE, Al Baghdadi T, Hill EK, Thaker PH, John VS, Welch S, Fader AN, Powell MA, Aghajanian C. Pembrolizumab plus Chemotherapy in Advanced Endometrial Cancer. N Engl J Med 2023; 388:2159-2170. [PMID: 36972022 PMCID: PMC10351614 DOI: 10.1056/nejmoa2302312] [Citation(s) in RCA: 161] [Impact Index Per Article: 161.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Standard first-line chemotherapy for endometrial cancer is paclitaxel plus carboplatin. The benefit of adding pembrolizumab to chemotherapy remains unclear. METHODS In this double-blind, placebo-controlled, randomized, phase 3 trial, we assigned 816 patients with measurable disease (stage III or IVA) or stage IVB or recurrent endometrial cancer in a 1:1 ratio to receive pembrolizumab or placebo along with combination therapy with paclitaxel plus carboplatin. The administration of pembrolizumab or placebo was planned in 6 cycles every 3 weeks, followed by up to 14 maintenance cycles every 6 weeks. The patients were stratified into two cohorts according to whether they had mismatch repair-deficient (dMMR) or mismatch repair-proficient (pMMR) disease. Previous adjuvant chemotherapy was permitted if the treatment-free interval was at least 12 months. The primary outcome was progression-free survival in the two cohorts. Interim analyses were scheduled to be triggered after the occurrence of at least 84 events of death or progression in the dMMR cohort and at least 196 events in the pMMR cohort. RESULTS In the 12-month analysis, Kaplan-Meier estimates of progression-free survival in the dMMR cohort were 74% in the pembrolizumab group and 38% in the placebo group (hazard ratio for progression or death, 0.30; 95% confidence interval [CI], 0.19 to 0.48; P<0.001), a 70% difference in relative risk. In the pMMR cohort, median progression-free survival was 13.1 months with pembrolizumab and 8.7 months with placebo (hazard ratio, 0.54; 95% CI, 0.41 to 0.71; P<0.001). Adverse events were as expected for pembrolizumab and combination chemotherapy. CONCLUSIONS In patients with advanced or recurrent endometrial cancer, the addition of pembrolizumab to standard chemotherapy resulted in significantly longer progression-free survival than with chemotherapy alone. (Funded by the National Cancer Institute and others; NRG-GY018 ClinicalTrials.gov number, NCT03914612.).
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Affiliation(s)
- Ramez N Eskander
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Michael W Sill
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Lindsey Beffa
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Richard G Moore
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Joanie M Hope
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Fernanda B Musa
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Robert Mannel
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Mark S Shahin
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Guilherme H Cantuaria
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Eugenia Girda
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Cara Mathews
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Juraj Kavecansky
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Charles A Leath
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Lilian T Gien
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Emily M Hinchcliff
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Shashikant B Lele
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Lisa M Landrum
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Floor Backes
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Roisin E O'Cearbhaill
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Tareq Al Baghdadi
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Emily K Hill
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Premal H Thaker
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Veena S John
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Stephen Welch
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Amanda N Fader
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Matthew A Powell
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Carol Aghajanian
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
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Karpel HC, Slomovitz B, Coleman RL, Pothuri B. Treatment options for molecular subtypes of endometrial cancer in 2023. Curr Opin Obstet Gynecol 2023; 35:270-278. [PMID: 36943683 DOI: 10.1097/gco.0000000000000855] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW This article reviews treatment strategies in endometrial cancer by molecular subtype. RECENT FINDINGS The Cancer Genome Atlas (TCGA) classifies four molecular subtypes of endometrial cancer - mismatch repair-deficient (dMMR)/microsatellite instability-high (MSI-H), copy number high (CNH)/p53abn, copy number low (CNL)/no specific molecular profile (NSMP), and POLEmut - which are validated and highly prognostic. Treatment consideration by subtype is now recommended. FDA-approved immune checkpoint inhibitors (ICIs) include pembrolizumab and dostarlimab for previously treated dMMR/MSI-H EC, and pembrolizumab/lenvatinib for mismatch repair-proficient/microsatellite-stable endometrial cancer, including CNH/p53abn and CNL/NSMP. ICIs are being studied as first-line therapy in advanced/recurrent endometrial cancer by MMR status, as well as in combination with other targeted agents. Trastuzumab is NCCN compendium listed for HER2-positive serous endometrial cancer, which are primarily p53-abnormal. Antibody-drug conjugates targeting low and high HER2 levels show promise in breast cancer, and are beginning to be studied in endometrial cancer. In addition to hormonal therapy, maintenance therapy with selinexor (XPO1-inhibitor) showed potential benefit in p53 -wildtype endometrial cancer and is being investigated prospectively. Multiple prospective trials are evaluating de-escalation of care for POLEmut endometrial cancer given favorable survival regardless of adjuvant therapy. SUMMARY Molecular subtyping has important prognostic and therapeutic implications and should be guiding patient management and clinical trial design in endometrial cancer.
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Affiliation(s)
- Hannah C Karpel
- New York University Grossman School of Medicine, New York, New York
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Moss EL, Teece L, Darko N. Uterine cancer mortality and Black women: time to act. Lancet Oncol 2023; 24:586-588. [PMID: 37269839 DOI: 10.1016/s1470-2045(23)00113-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/16/2023] [Accepted: 03/14/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Esther L Moss
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK; Leicester Cancer Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lucy Teece
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK; Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Natalie Darko
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK; College of Life Sciences, University of Leicester, Leicester, UK; School of Media, Communication, and Sociology, University of Leicester, Leicester, UK.
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Chen RJ, Wang JJ, Williamson DFK, Chen TY, Lipkova J, Lu MY, Sahai S, Mahmood F. Algorithmic fairness in artificial intelligence for medicine and healthcare. Nat Biomed Eng 2023; 7:719-742. [PMID: 37380750 PMCID: PMC10632090 DOI: 10.1038/s41551-023-01056-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/13/2023] [Indexed: 06/30/2023]
Abstract
In healthcare, the development and deployment of insufficiently fair systems of artificial intelligence (AI) can undermine the delivery of equitable care. Assessments of AI models stratified across subpopulations have revealed inequalities in how patients are diagnosed, treated and billed. In this Perspective, we outline fairness in machine learning through the lens of healthcare, and discuss how algorithmic biases (in data acquisition, genetic variation and intra-observer labelling variability, in particular) arise in clinical workflows and the resulting healthcare disparities. We also review emerging technology for mitigating biases via disentanglement, federated learning and model explainability, and their role in the development of AI-based software as a medical device.
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Affiliation(s)
- Richard J Chen
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Judy J Wang
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Drew F K Williamson
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tiffany Y Chen
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jana Lipkova
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ming Y Lu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA
- Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sharifa Sahai
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Cancer Program, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Faisal Mahmood
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Cancer Program, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA.
- Cancer Data Science Program, Dana-Farber Cancer Institute, Boston, MA, USA.
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Harvard Data Science Initiative, Harvard University, Cambridge, MA, USA.
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Shi J, Kraft P, Rosner BA, Benavente Y, Black A, Brinton LA, Chen C, Clarke MA, Cook LS, Costas L, Dal Maso L, Freudenheim JL, Frias-Gomez J, Friedenreich CM, Garcia-Closas M, Goodman MT, Johnson L, La Vecchia C, Levi F, Lissowska J, Lu L, McCann SE, Moysich KB, Negri E, O'Connell K, Parazzini F, Petruzella S, Polesel J, Ponte J, Rebbeck TR, Reynolds P, Ricceri F, Risch HA, Sacerdote C, Setiawan VW, Shu XO, Spurdle AB, Trabert B, Webb PM, Wentzensen N, Wilkens LR, Xu WH, Yang HP, Yu H, Du M, De Vivo I. Risk prediction models for endometrial cancer: development and validation in an international consortium. J Natl Cancer Inst 2023; 115:552-559. [PMID: 36688725 PMCID: PMC10165481 DOI: 10.1093/jnci/djad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/01/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Endometrial cancer risk stratification may help target interventions, screening, or prophylactic hysterectomy to mitigate the rising burden of this cancer. However, existing prediction models have been developed in select cohorts and have not considered genetic factors. METHODS We developed endometrial cancer risk prediction models using data on postmenopausal White women aged 45-85 years from 19 case-control studies in the Epidemiology of Endometrial Cancer Consortium (E2C2). Relative risk estimates for predictors were combined with age-specific endometrial cancer incidence rates and estimates for the underlying risk factor distribution. We externally validated the models in 3 cohorts: Nurses' Health Study (NHS), NHS II, and the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. RESULTS Area under the receiver operating characteristic curves for the epidemiologic model ranged from 0.64 (95% confidence interval [CI] = 0.62 to 0.67) to 0.69 (95% CI = 0.66 to 0.72). Improvements in discrimination from the addition of genetic factors were modest (no change in area under the receiver operating characteristic curves in NHS; PLCO = 0.64 to 0.66). The epidemiologic model was well calibrated in NHS II (overall expected-to-observed ratio [E/O] = 1.09, 95% CI = 0.98 to 1.22) and PLCO (overall E/O = 1.04, 95% CI = 0.95 to 1.13) but poorly calibrated in NHS (overall E/O = 0.55, 95% CI = 0.51 to 0.59). CONCLUSIONS Using data from the largest, most heterogeneous study population to date (to our knowledge), prediction models based on epidemiologic factors alone successfully identified women at high risk of endometrial cancer. Genetic factors offered limited improvements in discrimination. Further work is needed to refine this tool for clinical or public health practice and expand these models to multiethnic populations.
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Affiliation(s)
- Joy Shi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bernard A Rosner
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Yolanda Benavente
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid, Spain
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Chu Chen
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Linda S Cook
- Department of Epidemiology, Colorado School of Public Heath, University of Colorado-Anschutz, Aurora, CO, USA
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada
| | - Laura Costas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid, Spain
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), Aviano, Italy
| | - Jo L Freudenheim
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Jon Frias-Gomez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, Barcelona, Spain
- Faculty of Medicine, University of Barcelona (UB), Barcelona, Spain
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB, Canada
| | | | - Marc T Goodman
- Community and Population Health Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lisa Johnson
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Carlo La Vecchia
- Department of Clinical Medicine and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Fabio Levi
- Department of Epidemiology and Health Services Research, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Lingeng Lu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Susan E McCann
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kirsten B Moysich
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Eva Negri
- Department of Clinical Medicine and Community Health, Università degli Studi di Milano, Milan, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Kelli O'Connell
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fabio Parazzini
- Department of Clinical Medicine and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stacey Petruzella
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jerry Polesel
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), Aviano, Italy
| | - Jeanette Ponte
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy R Rebbeck
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Population Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Harvey A Risch
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Veronica W Setiawan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Amanda B Spurdle
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Genetics and Computational Biology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Penelope M Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Wang Hong Xu
- Department of Epidemiology, Fudan University School of Public Health, Shanghai, China
| | - Hannah P Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Herbert Yu
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Mengmeng Du
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Immaculata De Vivo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Radcliffe Institute for Advanced Study, Harvard University, Cambridge, MA, USA
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Gordhandas S, Rios-Doria E, Cadoo KA, Catchings A, Maio A, Kemel Y, Sheehan M, Ranganathan M, Green D, Aryamvally A, Arnold AG, Salo-Mullen E, Manning-Geist B, Sia T, Selenica P, Da Cruz Paula A, Vanderbilt C, Misyura M, Leitao MM, Mueller JJ, Makker V, Rubinstein M, Friedman CF, Zhou Q, Iasonos A, Latham A, Carlo MI, Murciano-Goroff YR, Will M, Walsh MF, Issa Bhaloo S, Ellenson LH, Ceyhan-Birsoy O, Berger MF, Robson ME, Abu-Rustum N, Aghajanian C, Offit K, Stadler Z, Weigelt B, Mandelker DL, Liu YL. Comprehensive analysis of germline drivers in endometrial cancer. J Natl Cancer Inst 2023; 115:560-569. [PMID: 36744932 PMCID: PMC10165491 DOI: 10.1093/jnci/djad016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/12/2022] [Accepted: 01/23/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We sought to determine the prevalence of germline pathogenic variants (gPVs) in unselected patients with endometrial cancer (EC), define biallelic gPVs within tumors, and describe their associations with clinicopathologic features. METHODS Germline assessment of at least 76 cancer predisposition genes was performed in patients with EC undergoing clinical tumor-normal Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT) sequencing from January 1, 2015, to June 30, 2021. In patients with gPVs, biallelic alterations in ECs were identified through analysis of loss of heterozygosity and somatic PVs. Clinicopathologic variables were compared using nonparametric tests. RESULTS Of 1625 patients with EC, 216 (13%) had gPVs, and 15 patients had 2 gPVs. There were 231 gPVs in 35 genes (75 [32%] high penetrance; 39 [17%] moderate penetrance; and 117 [51%] low, recessive, or uncertain penetrance). Compared with those without gPVs, patients with gPVs were younger (P = .002), more often White (P = .009), and less obese (P = .025) and had differences in distribution of tumor histology (P = .017) and molecular subtype (P < .001). Among 231 gPVs, 74 (32%) exhibited biallelic inactivation within tumors. For high-penetrance gPVs, 63% (47 of 75) of ECs had biallelic alterations, primarily affecting mismatch repair (MMR) and homologous recombination related genes, including BRCA1,BRCA2, RAD51D, and PALB2. Biallelic inactivation varied across molecular subtypes with highest rates in microsatellite instability-high (MSI-H) or copy-number (CN)-high subtypes (3 of 12 [25%] POLE, 30 of 77 [39%] MSI-H, 27 of 60 [45%] CN-high, 9 of 57 [16%] CN-low; P < .001). CONCLUSIONS Of unselected patients with EC, 13% had gPVs, with 63% of gPVs in high-penetrance genes (MMR and homologous recombination) exhibiting biallelic inactivation, potentially driving cancer development. This supports germline assessment in EC given implications for treatment and cancer prevention.
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Affiliation(s)
- Sushmita Gordhandas
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Rios-Doria
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karen A Cadoo
- St. James’s Hospital, Trinity St. James’s Cancer Institute, Dublin, Ireland
| | - Amanda Catchings
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anna Maio
- Sloan Kettering Institute, New York, NY, USA
| | | | - Margaret Sheehan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Megha Ranganathan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dina Green
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anjali Aryamvally
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Angela G Arnold
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erin Salo-Mullen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Beryl Manning-Geist
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tiffany Sia
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pier Selenica
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arnaud Da Cruz Paula
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chad Vanderbilt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maksym Misyura
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Jennifer J Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Vicky Makker
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Maria Rubinstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Claire F Friedman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Qin Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alicia Latham
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Maria I Carlo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Yonina R Murciano-Goroff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Marie Will
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Michael F Walsh
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Shirin Issa Bhaloo
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lora H Ellenson
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ozge Ceyhan-Birsoy
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael F Berger
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark E Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Nadeem Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Carol Aghajanian
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kenneth Offit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Zsofia Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Diana L Mandelker
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ying L Liu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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Shiels MS, Lipkowitz S, Campos NG, Schiffman M, Schiller JT, Freedman ND, Berrington de González A. Opportunities for Achieving the Cancer Moonshot Goal of a 50% Reduction in Cancer Mortality by 2047. Cancer Discov 2023; 13:1084-1099. [PMID: 37067240 PMCID: PMC10164123 DOI: 10.1158/2159-8290.cd-23-0208] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
On February 2, 2022, President Biden and First Lady Dr. Biden reignited the Cancer Moonshot, setting a new goal to reduce age-standardized cancer mortality rates by at least 50% over the next 25 years in the United States. We estimated trends in U.S. cancer mortality during 2000 to 2019 for all cancers and the six leading types (lung, colorectum, pancreas, breast, prostate, liver). Cancer death rates overall declined by 1.4% per year from 2000 to 2015, accelerating to 2.3% per year during 2016 to 2019, driven by strong declines in lung cancer mortality (-4.7%/year, 2014 to 2019). Recent declines in colorectal (-2.0%/year, 2010-2019) and breast cancer death rates (-1.2%/year, 2013-2019) also contributed. However, trends for other cancer types were less promising. To achieve the Moonshot goal, progress against lung, colorectal, and breast cancer deaths needs to be maintained and/or accelerated, and new strategies for prostate, liver, pancreatic, and other cancers are needed. We reviewed opportunities to prevent, detect, and treat these common cancers that could further reduce population-level cancer death rates and also reduce disparities. SIGNIFICANCE We reviewed opportunities to prevent, detect, and treat common cancers, and show that to achieve the Moonshot goal, progress against lung, colorectal, and breast cancer deaths needs to be maintained and/or accelerated, and new strategies for prostate, liver, pancreatic, and other cancers are needed. See related commentary by Bertagnolli et al., p. 1049. This article is highlighted in the In This Issue feature, p. 1027.
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Affiliation(s)
- Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Stanley Lipkowitz
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Nicole G Campos
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - John T Schiller
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
- The Institute of Cancer Research, London, United Kingdom
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46
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Taparra K, Ing BI, Ewongwo A, Vo JB, Shing JZ, Gimmen MY, Keli'i KMK, Uilelea J, Pollom E, Kidd E. Racial Disparities in Brachytherapy Treatment among Women with Cervical and Endometrial Cancer in the United States. Cancers (Basel) 2023; 15:cancers15092571. [PMID: 37174037 PMCID: PMC10177217 DOI: 10.3390/cancers15092571] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Brachytherapy improves clinical outcomes among women diagnosed with cervical and endometrial cancers. Recent evidence demonstrates that declining brachytherapy boosts for women with cervical cancer were associated with higher mortality. In this retrospective cohort study, women diagnosed with endometrial or cervical cancer in the United States between 2004 and 2017 were selected from the National Cancer Database for evaluation. Women ≥18 years of age were included for high intermediate risk (PORTEC-2 and GOG-99 definition) or FIGO Stage II-IVA endometrial cancers and FIGO Stage IA-IVA-non-surgically treated cervical cancers. The aims were to (1) evaluate brachytherapy treatment practice patterns for cervical and endometrial cancers in the United States; (2) calculate rates of brachytherapy treatment by race; and (3) determine factors associated with not receiving brachytherapy. Treatment practice patterns were evaluated over time and by race. Multivariable logistic regression assessed predictors of brachytherapy. The data show increasing rates of brachytherapy for endometrial cancers. Compared to non-Hispanic White women; Native Hawaiian and other Pacific Islander (NHPI) women with endometrial cancer and Black women with cervical cancer were significantly less likely to receive brachytherapy. For both NHPI and Black women, treatment at community cancer centers was associated with a decreased likelihood of brachytherapy. The data suggest racial disparities among Black women with cervical cancer and NHPI women with endometrial cancer and emphasize an unmet need for brachytherapy access within community hospitals.
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Affiliation(s)
- Kekoa Taparra
- Department of Radiation Oncology, Stanford Health Care, Stanford, CA 94305, USA
| | - Brandon I Ing
- Department of Obstetrics and Gynecology, Kaiser Permanente, Los Angeles, CA 90027, USA
| | - Agnes Ewongwo
- Department of Radiation Oncology, Stanford Health Care, Stanford, CA 94305, USA
| | - Jacqueline B Vo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Jaimie Z Shing
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | | | | | | | - Erqi Pollom
- Department of Radiation Oncology, Stanford Health Care, Stanford, CA 94305, USA
| | - Elizabeth Kidd
- Department of Radiation Oncology, Stanford Health Care, Stanford, CA 94305, USA
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47
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Do Not Forget about Hormonal Therapy for Recurrent Endometrial Cancer: A Review of Options, Updates, and New Combinations. Cancers (Basel) 2023; 15:cancers15061799. [PMID: 36980685 PMCID: PMC10046539 DOI: 10.3390/cancers15061799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Hormonal therapy has long been a treatment modality for recurrent endometrial cancer. It is appealing for patients with low-grade, slow-growing tumors or in patients for which other treatment types may be too toxic. Hormonal therapy is well tolerated and has response rates ranging from 9 to 33%. Hormonal treatment options take advantage of the estrogen-dependent molecular pathways in endometrial cancers. Current options for hormonal therapies include progesterone therapy (medroxyprogesterone acetate and megestrol acetate) as a single agent or in combination and agents that target the estrogen pathway. Aromatase inhibitors have had modest single-agent activity, but synergistic effects have been found when used in combination with targeted therapy including mTOR inhibitors and cyclin-dependent kinase 4/6 (CDK4/6) inhibitors. Molecular profiling of endometrial cancers has begun to help individualize treatments. This review will report on existing data and ongoing trials investigating novel hormonal therapy agents.
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48
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Kriseman ML, Tang S, Liao Z, Jiang P, Parks SE, Cope DI, Yuan F, Chen F, Masand RP, Castro PD, Ittmann MM, Creighton CJ, Tan Z, Monsivais D. SMAD2/3 signaling in the uterine epithelium controls endometrial cell homeostasis and regeneration. Commun Biol 2023; 6:261. [PMID: 36906706 PMCID: PMC10008566 DOI: 10.1038/s42003-023-04619-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/21/2023] [Indexed: 03/13/2023] Open
Abstract
The regenerative potential of the endometrium is attributed to endometrial stem cells; however, the signaling pathways controlling its regenerative potential remain obscure. In this study, genetic mouse models and endometrial organoids are used to demonstrate that SMAD2/3 signaling controls endometrial regeneration and differentiation. Mice with conditional deletion of SMAD2/3 in the uterine epithelium using Lactoferrin-iCre develop endometrial hyperplasia at 12-weeks and metastatic uterine tumors by 9-months of age. Mechanistic studies in endometrial organoids determine that genetic or pharmacological inhibition of SMAD2/3 signaling disrupts organoid morphology, increases the glandular and secretory cell markers, FOXA2 and MUC1, and alters the genome-wide distribution of SMAD4. Transcriptomic profiling of the organoids reveals elevated pathways involved in stem cell regeneration and differentiation such as the bone morphogenetic protein (BMP) and retinoic acid signaling (RA) pathways. Therefore, TGFβ family signaling via SMAD2/3 controls signaling networks which are integral for endometrial cell regeneration and differentiation.
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Affiliation(s)
- Maya L Kriseman
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
- Center for Drug Discovery, Baylor College of Medicine, Houston, TX, 77030, USA
- Division of Reproductive Endocrinology and Infertility, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Suni Tang
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
- Center for Drug Discovery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Zian Liao
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
- Center for Drug Discovery, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Peixin Jiang
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Thoracic/Head and Neck Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sydney E Parks
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
- Center for Drug Discovery, Baylor College of Medicine, Houston, TX, 77030, USA
- Cancer and Cell Biology Program, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Dominique I Cope
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
- Center for Drug Discovery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Fei Yuan
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
- Center for Drug Discovery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Fengju Chen
- Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ramya P Masand
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Patricia D Castro
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Michael M Ittmann
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Chad J Creighton
- Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Zhi Tan
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
- Center for Drug Discovery, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Pharmacology and Chemical Biology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Diana Monsivais
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA.
- Center for Drug Discovery, Baylor College of Medicine, Houston, TX, 77030, USA.
- Cancer and Cell Biology Program, Baylor College of Medicine, Houston, TX, 77030, USA.
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, 77030, USA.
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49
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Wallner K, Sherertz T, Anderson A, Blau M, Panjwani N. (Potential) mishaps of high dose rate vaginal cuff brachytherapy. Pract Radiat Oncol 2023:S1879-8500(23)00050-4. [PMID: 36889643 DOI: 10.1016/j.prro.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/05/2023] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Considering how commonly vaginal cuff brachytherapy is used, there is relatively little literature regarding the potential, albeit low, risk for complications. We present here three potentially serious mishaps, involving cylinder misplacement, dehiscence, and excessive normal tissue irradiation due to unique anatomy. METHODS Three patients with potentially serious treatment errors were encountered in the authors' usual clinical practice. Each patient's records were reviewed for this report. RESULTS For patient #1, CT simulation revealed grossly inadequate cylinder insertion, most obvious on the sagittal view. For patient #2, CT simulation revealed that the cylinder extended beyond the perforated vaginal cuff and was surrounded by bowel. For patient #3, CT images were used only to verify cylinder depth. A standard library plan, based on cylinder diameter and active length was used. In retrospect, the images revealed an unusually thin rectovaginal septum, with the lateral and posterior vaginal wall thickness estimated to be less than 2 mm. Her fractional normal tissue doses were calculated for this report, revealing a rectal Dmax (per fraction) of 10.8 Gy, D2.0 of 7.4 Gy, and a V100 of 2.8 cc. All doses were far in excess of those anticipated for a minimal 0.5 cm vaginal wall depth. CONCLUSION Vaginal cuff HDR brachytherapy is a high volume, routine procedure. Even in experienced hands, however, it carries a risk of improper cylinder placement, cuff dehiscence, and excessive normal tissue dose, all of which could seriously impact outcomes. These potential mishaps would be better appreciated and avoided with more extensive use of CT-based quality assurance measures.
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Affiliation(s)
- Kent Wallner
- Department of Radiation Oncology, University of Washington, Seattle, WA.
| | - Tracy Sherertz
- Department of Radiation Oncology, Kaiser Permanente, Seattle, WA
| | - August Anderson
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Molly Blau
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Neil Panjwani
- Department of Radiation Oncology, University of Washington, Seattle, WA
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The Global, Regional, and National Uterine Cancer Burden Attributable to High BMI from 1990 to 2019: A Systematic Analysis of the Global Burden of Disease Study 2019. J Clin Med 2023; 12:jcm12051874. [PMID: 36902661 PMCID: PMC10003834 DOI: 10.3390/jcm12051874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
Uterine cancer (UC) is the most common gynecologic malignancy, and high body mass index (BMI) is a poor prognostic factor for UC. However, the associated burden has not been fully assessed, which is crucial for women's health management and the prevention and control of UC. Therefore, we utilized the Global Burden of Disease Study (GBD) 2019 to describe the global, regional, and national UC burden due to high BMI from 1990 to 2019. The data show that globally, women's high BMI exposure is increasing annually, with most regions having higher rates of high BMI exposure than the global average. In 2019, 36,486 [95% uncertainty interval (UI): 25,131 to 49,165] UC deaths were attributed to high BMI globally, accounting for 39.81% (95% UI: 27.64 to 52.67) of all UC deaths. The age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALY) rate (ASDR) for high BMI-associated UC remained stable globally from 1990 to 2019, with significant differences across regions. Higher ASDR and ASMR were found in higher socio-demographic index (SDI) regions, and lower SDI regions had the fastest estimated annual percentage changes (EAPCs) for both rates. Among all age groups, the fatal outcome of UC with high BMI occurs most frequently in women over 80 years old.
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