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Horn LC, Emons G, Aretz S, Bock N, Follmann M, Lax S, Nothacker M, Steiner E, Mayr D. [S3 guidelines on the diagnosis and treatment of carcinoma of the endometrium : Requirements for pathology]. DER PATHOLOGE 2019; 40:21-35. [PMID: 30756154 DOI: 10.1007/s00292-019-0574-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The present article summarises the relevant aspects of the S3 guidelines on endometrioid carcinomas. The recommendations include the processing rules of fractional currettings as well as for hysterectomy specimens and lymph node resections (including sentinel lymph nodes). Besides practical aspects, the guidelines consider the needs of the clinicians for appropriate surgical and radiotherapeutic treatment of the patients. Carcinosarcomas are assigned to the endometrial carcinoma as a special variant. For the first time, an algorithmic approach for evaluation of the tumour tissue for Lynch syndrome is given. Prognostic factors based on morphologic findings are summarised.
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Affiliation(s)
- L-C Horn
- Abteilung Mamma‑, Gynäko- & Perinatalpathologie, Institut für Pathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 24, 04103, Leipzig, Deutschland.
| | - G Emons
- Frauenklinik, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - S Aretz
- Institut für Humangenetik, Universitätsklinikum Bonn, Bonn, Deutschland
| | - N Bock
- Frauenklinik, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - M Follmann
- Deutsche Krebsgesellschaft, Berlin, Deutschland
| | - S Lax
- Institut für Pathologie, Landeskrankenhaus Graz West, Graz, Österreich
| | - M Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Berlin, Deutschland
| | - E Steiner
- Frauenklinik, GPR Klinikum Rüsselsheim, Rüsselsheim, Deutschland
| | - D Mayr
- Pathologisches Institut, Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland
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2
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Imboden S, Nastic D, Ghaderi M, Rydberg F, Rau TT, Mueller MD, Epstein E, Carlson JW. Phenotype of POLE-mutated endometrial cancer. PLoS One 2019; 14:e0214318. [PMID: 30917185 PMCID: PMC6436745 DOI: 10.1371/journal.pone.0214318] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/11/2019] [Indexed: 12/21/2022] Open
Abstract
Background and purpose Individualized therapy in endometrial cancer, the most common gynaecologic cancer in the developed world, focuses on identifying specific molecular subtypes. Mutations in the exonuclease domain of the DNA polymerase epsilon (POLE) gene define one such subtype, which causes an ultra-mutated tumour phenotype. These tumours may have an improved progression-free survival and may be receptive to specific therapies. However, the clinical phenotype of these tumours is unknown. The objective of this study was to evaluate the clinical and genetic features of POLE-mutated tumours from a large cohort of women whose cases are characterized by: (1) the availability of detailed clinical and lifestyle data; (2) mutation analysis; and (3) long-term follow-up. Methods A total of 604 patients with endometrial cancer were included in the study. Data from a detailed questionnaire, including lifestyle and family history information, provided extensive pertinent information on the patients. Sequencing of exons 9–14 of the POLE gene was performed. Follow-up data were gathered and analysed. Results Hotspot pathogenic POLE mutations were identified in N = 38/599 patients (6.3%). Patients with a POLE-mutated tumour were significantly younger, were more often nulliparous, and had a history of smoking. POLE-mutated tumours were more frequently aneuploid. Prognosis for patients with hotspot POLE-mutated tumours was significantly better in comparison with patients with non-mutated tumours; however careful selection of pathogenic mutations is essential to the definition of this prognostically favourable group. Conclusions This study demonstrates that POLE-mutated endometrial cancer is significantly associated with previously unknown clinicopathologic characteristics. Outcome in POLE-mutated tumours was excellent in cases with hotspot mutations. Our results suggest that prediction of excellent outcome in cases of POLE-mutated EMCA should be restricted to cases of EMCA with hotspot mutations until further data are available on the rising number of mutations with unknown significance.
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Affiliation(s)
- Sara Imboden
- Department of Obstetrics and Gynaecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Denis Nastic
- Department of Oncology-Pathology, Karolinska Institutet, and Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Mehran Ghaderi
- Department of Oncology-Pathology, Karolinska Institutet, and Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Filippa Rydberg
- Department of Oncology-Pathology, Karolinska Institutet, and Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Tilman T. Rau
- Institute of Pathology, University Bern, Bern, Switzerland
| | - Michael D. Mueller
- Department of Obstetrics and Gynaecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Elisabeth Epstein
- Department of Clinical Science and Education Karolinska Institutet, and Department of Obstetrics and Gynaecology Södersjukhuset, Stockholm, Sweden
| | - Joseph W. Carlson
- Department of Oncology-Pathology, Karolinska Institutet, and Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
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3
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Sardi A, Muñoz‐Zuluaga CA, Sittig M, Diaz‐Montes T. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in seven patients with peritoneal sarcomatosis from uterine sarcoma. Clin Case Rep 2018; 6:1142-1152. [PMID: 29881584 PMCID: PMC5986004 DOI: 10.1002/ccr3.1491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/06/2018] [Accepted: 02/17/2018] [Indexed: 12/14/2022] Open
Abstract
Peritoneal sarcomatosis from uterine sarcoma is a rare disease with no effective treatment and poor prognosis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has successful results in peritoneal carcinomatosis from gastrointestinal/gynecological origins. We show that CRS/HIPEC is safe, feasible, and may benefit selected patients with peritoneal sarcomatosis from uterine sarcoma.
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Affiliation(s)
- Armando Sardi
- The Institute for Cancer CareMercy Medical Center227 St. Paul PlaceBaltimore21202‐2001Maryland
| | - Carlos A. Muñoz‐Zuluaga
- The Institute for Cancer CareMercy Medical Center227 St. Paul PlaceBaltimore21202‐2001Maryland
| | - Michelle Sittig
- The Institute for Cancer CareMercy Medical Center227 St. Paul PlaceBaltimore21202‐2001Maryland
| | - Teresa Diaz‐Montes
- The Institute for Cancer CareMercy Medical Center227 St. Paul PlaceBaltimore21202‐2001Maryland
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4
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Mauland KK, Wik E, Hoivik EA, Kusonmano K, Halle MK, Berg A, Haugland HK, Øyan AM, Kalland KH, Stefansson IM, Akslen LA, Krakstad C, Trovik J, Werner HMJ, Salvesen HB. Aneuploidy related transcriptional changes in endometrial cancer link low expression of chromosome 15q genes to poor survival. Oncotarget 2018; 8:9696-9707. [PMID: 28039471 PMCID: PMC5354764 DOI: 10.18632/oncotarget.14201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/23/2016] [Indexed: 12/01/2022] Open
Abstract
Aneuploidy is a widely studied prognostic marker in endometrial cancer (EC), however, not implemented in clinical decision-making. It lacks validation in large prospective patient cohorts adjusted for currently standard applied prognostic markers, including estrogen/progesterone receptor status (ER/PR). Also, little is known about aneuploidy-related transcriptional alterations, relevant for understanding its role in EC biology, and as therapeutic target. We included 825 EC patients with available ploidy status and comprehensive clinicopathologic characterization to analyze ploidy as a prognostic marker. For 144 patients, gene expression data were available to explore aneuploidy-related transcriptional alterations. Aneuploidy was associated with high age, FIGO stage and grade, non-endometrioid histology, ER/PR negativity, and poor survival (p-values<0.001). In patients with ER/PR negative tumors, aneuploidy independently predicted poor survival (p=0.03), lymph node metastasis (p=0.007) and recurrence (p=0.002). A prognostic ‘aneuploidy signature’, linked to low expression of chromosome 15q genes, was identified and validated in TCGA data. In conclusion, aneuploidy adds prognostic information in ER/PR negative EC, identifying high-risk patients that could benefit from more aggressive therapies. The ‘aneuploidy signature’ equally identifies these aggressive tumors and suggests a link between aneuploidy and low expression of 15q genes. Integrated analyses point at various dysregulated pathways in aneuploid EC, underlining a complex biology.
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Affiliation(s)
- Karen Klepsland Mauland
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Elisabeth Wik
- Center for Cancer Biomarkers CCBIO, Department of Clinical Medicine (K1), Section for Pathology, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Erling A Hoivik
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Kanthida Kusonmano
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Computational Biology Unit, University of Bergen, Bergen, Norway.,Bioinformatics and Systems Biology Program, School of Bioresources and Technology, King Mongkut's University of Technology Thonburi, Bangkhuntien, Bangkok, Thailand
| | - Mari Kyllesø Halle
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Anna Berg
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | | | - Anne Margrete Øyan
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Karl-Henning Kalland
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | | | - Lars A Akslen
- Center for Cancer Biomarkers CCBIO, Department of Clinical Medicine (K1), Section for Pathology, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Camilla Krakstad
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Center for Cancer Biomarkers CCBIO, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Jone Trovik
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Henrica Maria Johanna Werner
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Helga Birgitte Salvesen
- Center for Cancer Biomarkers CCBIO, Department of Clinical Science (K2), University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
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5
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Proctor L, Pradhan M, Leung S, Cheng A, Lee CH, Soslow RA, Gilks CB, Talhouk A, McAlpine JM, Danielsen HE, Hoang LN. Assessment of DNA Ploidy in the ProMisE molecular subgroups of endometrial cancer. Gynecol Oncol 2017. [PMID: 28647100 DOI: 10.1016/j.ygyno.2017.06.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We sought to determine whether DNA ploidy correlates with the four molecular subgroups of endometrial carcinoma (EC) as determined using ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer). METHODS 90 cases of EC previously characterized by clinicopathological parameters, outcomes, and ProMisE molecular subgroup (POLE EDM, MMR-D, p53 wt or p53 abn) were assessed for DNA ploidy using image cytometry. Associations of ploidy with traditional clinicopathological parameters were also tested. RESULTS Abnormal DNA ploidy status differed amongst the ProMisE groups (p<0.001) and was found in 80.9% (17/21) of p53 abn, 37.0% (10/27) of p53 wt, 28.6% (4/14) of POLE EDM and 14.3% (4/28) of MMR-D. Abnormal DNA content was significantly associated with lower BMI (p=0.034) and grade 3 tumors (p=0.001). In the entire cohort, abnormal DNA content was significantly associated with worse progression free survival (p=0.0094) but not disease specific survival (p=0.249) or overall survival (p=0.187). When examining ploidy within each of the ProMisE groups, abnormal DNA content correlated with worse overall survival (p=0.041) and progression free survival (p=0.011) in the MMR-D group. No statistically significant relationship was seen in the remaining 3 groups. CONCLUSION Abnormal DNA ploidy status did correlate with the molecular subgroups of EC; abnormal DNA content was seen in the large majority of p53 abn cases. Abnormal ploidy however was also seen in smaller numbers in the p53 wt, POLE EDM and MMR-D groups; therefore abnormal DNA content was not a specific marker for any one molecular group. The addition of ploidy to the ProMisE molecular categories conferred additional prognostic value within the MMR-D group, which merits further study.
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Affiliation(s)
- L Proctor
- Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Pradhan
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway; Centre for Cancer Biomedicine, University of Oslo, Oslo, Norway
| | - S Leung
- Genetic Pathology Evaluation Center and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - A Cheng
- Genetic Pathology Evaluation Center and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - C H Lee
- Department of Pathology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - R A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - C B Gilks
- Genetic Pathology Evaluation Center and Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Talhouk
- Department of Pathology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - J M McAlpine
- Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - H E Danielsen
- Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway; Centre for Cancer Biomedicine, University of Oslo, Oslo, Norway; Department of Informatics, University of Oslo, Oslo, Norway; Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, United Kingdom
| | - L N Hoang
- Genetic Pathology Evaluation Center and Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Stålberg K, Kjølhede P, Bjurberg M, Borgfeldt C, Dahm-Kähler P, Falconer H, Holmberg E, Staf C, Tholander B, Åvall-Lundqvist E, Rosenberg P, Högberg T. Risk factors for lymph node metastases in women with endometrial cancer: A population-based, nation-wide register study-On behalf of the Swedish Gynecological Cancer Group. Int J Cancer 2017; 140:2693-2700. [PMID: 28340503 DOI: 10.1002/ijc.30707] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/09/2017] [Accepted: 02/17/2017] [Indexed: 11/10/2022]
Abstract
The role of lymphadenectomy in the management of early endometrial cancer remains controversial. In the recent ESMO-ESGO-ESTRO guidelines, lymphadenectomy is recommended for patients with endometrioid adenocarcinoma Grade 3 with deep myometrial invasion, but complete agreement was not achieved. In Sweden, DNA aneuploidy has been included as a high-risk factor. The aim of our study was to evaluate the impact of tumor histology, FIGO grade, DNA ploidy and myometrial invasion (MI) on occurrence of lymph node metastasis (LNM) in patients with endometrial cancer. The study design is a retrospective cohort study based on prospectively recorded register data. Endometrial cancer patients registered in the Swedish Quality Registry for Gynecologic Cancer 2010-2015 with FIGO Stages I-III and verified nodal status were included. Data on DNA ploidy, histology, FIGO grade and MI were included in multivariable log-binomial regression analyses with LNM as dependent variable. 1,165 cases fulfilled the inclusion criteria. The multivariable analyses revealed increased risk of LNM in patients with tumors with MI ≥ 50% (risk ratio [RR] = 4.1; 95% confidence interval [CI] 3.0-5.6), nonendometrioid compared to endometrioid histology (RR 1.8; CI 1.4-2.4) and FIGO Grade 3 compared to Grade 1-2 tumors (RR 1.5; CI 1.1-2.0). No statistically significant association between DNA ploidy status and LNM was detected. This population-based, nation-wide study in women with endometrial cancer confirms a strong association between MI ≥ 50%, nonendometrioid histology and FIGO Grade 3, respectively, and LNM. DNA ploidy should not be included in the preoperative decision making of removing nodes or not.
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Affiliation(s)
- K Stålberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - P Kjølhede
- Department of Obstetrics and Gynecology, Linköpings Universitet, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Linköpings Universitet, Linköping, Sweden
| | - M Bjurberg
- Department of Hematology, Oncology, and Radiation Physics, Skanes Universitetssjukhus, Lund, Sweden.,Division of Oncology and Pathology, Department of Clinical Sciences, Lunds Universitet, Lund, Sweden
| | - C Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Lund, Sweden
| | - P Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - H Falconer
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - E Holmberg
- Regional Cancer Center Western Sweden, Sahlgrenska Universitetssjukhuset, Gothenburg, Sweden.,Institute of Clinical Sciences, Goteborgs Universitet Sahlgrenska Akademin, Göteborg, Sweden
| | - C Staf
- Sahlgrenska Universitetssjukhuset, Regional Cancer Center Western Sweden, Göteborg, Sweden
| | - B Tholander
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - E Åvall-Lundqvist
- Department of Oncology, Linköpings University, Linköping, Sweden.,Department Clinical and Experimental Medicine, Linköpings University, Linköping, Sweden.,Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - P Rosenberg
- Department of Oncology Högberg, Universitetssjukhuset i Linköping, Linköping, Sweden
| | - T Högberg
- Department of Cancer Epidemiology, Skåne University Hospital, Lund University, Lund, Sweden
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Walker CJ, Goodfellow PJ. Traditional Approaches to Molecular Genetic Analysis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 943:99-118. [DOI: 10.1007/978-3-319-43139-0_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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8
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Revisiting tumour aneuploidy - the place of ploidy assessment in the molecular era. Nat Rev Clin Oncol 2015; 13:291-304. [PMID: 26598944 DOI: 10.1038/nrclinonc.2015.208] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chromosome instability (CIN) is gaining increasing interest as a central process in cancer. CIN, either past or present, is indicated whenever tumour cells harbour an abnormal quantity of DNA, termed 'aneuploidy'. At present, the most widely used approach to detecting aneuploidy is DNA cytometry - a well-known research assay that involves staining of DNA in the nuclei of cells from a tissue sample, followed by analysis using quantitative flow cytometry or microscopic imaging. Aneuploidy in cancer tissue has been implicated as a predictor of a poor prognosis. In this Review, we have explored this hypothesis by surveying the current landscape of peer-reviewed research in which DNA cytometry has been applied in studies with disease-appropriate clinical follow up. This area of research is broad, however, and we restricted our survey to results published since 2000 relating to seven common epithelial cancers (those of the breast; endometrium, ovary, and uterine cervix; oesophagus; colon and rectum; lung; prostate; and bladder). We placed particular emphasis on results from multivariate analyses to pinpoint situations in which the prognostic value of aneuploidy as a biomarker is strong compared with that of existing indicators, such as clinical stage, histological grade, and specific molecular markers. We summarize the implications of our findings for the prognostic use of ploidy analysis in the clinic and for the theoretical understanding of the role of CIN in carcinogenesis.
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DNA ploidy in curettage specimens identifies high-risk patients and lymph node metastasis in endometrial cancer. Br J Cancer 2015; 112:1656-64. [PMID: 25897678 PMCID: PMC4430715 DOI: 10.1038/bjc.2015.123] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/24/2015] [Accepted: 03/08/2015] [Indexed: 11/09/2022] Open
Abstract
Background: Preoperative risk stratification is essential in tailoring endometrial cancer treatment, and biomarkers predicting lymph node metastasis and aggressive disease are aspired in clinical practice. DNA ploidy assessment in hysterectomy specimens is a well-established prognostic marker. DNA ploidy assessment in preoperative curettage specimens is less studied, and in particular in relation to the occurrence of lymph node metastasis. Methods: Curettage image cytometry DNA ploidy in relation to established clinicopathological variables and outcome was investigated in 785 endometrial carcinoma patients prospectively included in the MoMaTEC multicentre trial. Results: Diploid curettage status was found in 72.0%, whereas 28.0% were non-diploid. Non-diploid status significantly correlated with traditional aggressive postoperative clinicopathological features, and was an independent predictor of lymph node metastasis among FIGO stage I–III patients in multivariate analysis (OR 1.94, P=0.033). Non-diploid status was related to shorter disease-specific survival (5-year DSS of 74.4% vs 88.8% for diploid curettage, P<0.001). When stratifying by FIGO stage and lymph node status, the prognostic effect remained. However, in multivariate regression analysis, preoperative histological risk classification was a stronger predictor of DSS than DNA ploidy. Conclusions: Non-diploid curettage is significantly associated with aggressive clinicopathological phenotype, lymph node metastasis, and poor survival in endometrial cancer. The prognostic effect was also observed among subgroups with (presumably) less aggressive traits, such as low FIGO stage and negative lymph node status. Our results indicate curettage DNA ploidy as a possible supplement to existing parameters used to tailor surgical treatment.
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10
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Lanza F. Issue highlights--May 2014. CYTOMETRY PART B-CLINICAL CYTOMETRY 2014; 86:147-8. [PMID: 24715384 DOI: 10.1002/cyto.b.21172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Werner HMJ, Salvesen HB. Current Status of Molecular Biomarkers in Endometrial Cancer. Curr Oncol Rep 2014; 16:403. [DOI: 10.1007/s11912-014-0403-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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