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Hao Q, Wu H, Liu E, Wang L. BUB1, BUB1B, CCNA2, and CDCA8, along with miR-524-5p, as clinically relevant biomarkers for the diagnosis and treatment of endometrial carcinoma. BMC Cancer 2023; 23:995. [PMID: 37853361 PMCID: PMC10585751 DOI: 10.1186/s12885-023-11515-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Endometrial carcinoma (EC) is a malignant tumor of the female reproductive tract that has been associated with increased morbidity and mortality. This study aimed to identify biomarkers and potential therapeutic targets for EC. METHODS A publicly available transcriptome data set comprising 587 EC cases was subjected to a comprehensive bioinformatics analysis to identify candidate genes responsible for EC occurrence and development. Next, we used clinical samples and cell experiments for validation. RESULTS A total of 1,617 differentially expressed genes (DEGs) were identified. Analysis of patient survival outcomes revealed that BUB1, BUB1B, CCNA2, and CDCA8 were correlated with prognosis in patients with EC. Moreover, assessment of clinical samples confirmed that BUB1, BUB1B, CCNA2 and CDCA8 were strongly expressed in EC tissues. Additionally, bioinformatics and luciferase reporter assays confirmed that miR-524-5p can target and regulate these four genes. Overexpression of miR-524-5p significantly inhibited EC Ishikawa cells viability, migration and invasion. Inhibition of miR-524-5p showed the opposite results. CONCLUSIONS Expression of miR-524-5p reduced the migration and invasion of Ishikawa EC cells, and decreased BUB1, BUB1B, CCNA2, and CDCA8 expression. miR-524-5p, as well as BUB1, BUB1B, CCNA2, and CDCA8, may be clinically relevant biomarkers for the diagnosis and treatment of EC.
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Affiliation(s)
- Qirong Hao
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, China.
| | - Hongqin Wu
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Erniao Liu
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Lina Wang
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
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Glavy JC, Peterson SL, Strain J, Byrd K, Flint JH. Metastatic Endometrioid Carcinoma Mimicking a Subungual Melanoma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14494. [PMID: 36361369 PMCID: PMC9653594 DOI: 10.3390/ijerph192114494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/23/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
CASE We report a case of a 76-year-old female with a stage IB, grade I endometrioid endometrial carcinoma who presented with right-hip pain and an enlarging black, exophytic, subungual lesion on her right-small-finger distal phalanx. Clinically, the distal phalanx lesion was suspicious for a subungual melanoma; however, advanced imaging suggested metastatic disease, with lesions in the acetabulum, lungs, brain, vulva, and vagina. CONCLUSION Partial amputation of the right, small finger and vulvar biopsies confirmed an endometrial carcinoma. To our knowledge, this is the first described case of endometrial adenocarcinoma metastasis to the phalanx of an upper extremity, mimicking a subungual melanoma.
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Affiliation(s)
- Jena C. Glavy
- Department of OBGYN, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Shian L. Peterson
- Department of Orthopedic Surgery, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Jonathan Strain
- Department of Pathology, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Kevin Byrd
- Department of OBGYN, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - James H. Flint
- Department of Orthopedic Surgery, Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
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Patterns of Myometrial Invasion in Endometrial Adenocarcinoma with Emphasizing on Microcystic, Elongated and Fragmented (MELF) Glands Pattern: A Narrative Review of the Literature. Diagnostics (Basel) 2021; 11:diagnostics11091707. [PMID: 34574048 PMCID: PMC8469256 DOI: 10.3390/diagnostics11091707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
Endometrioid endometrial adenocarcinoma (EEC) is the most common malignancy of the female genital tract. According to the 2009 FIGO staging system, the depth of myometrial invasion (MI), and tumor spread to adjacent organs or tissues are the staging criteria for endometrial carcinoma (EC). Therefore, assessment of the depth of MI is of great importance. There is a spectrum of morphological patterns of MI. Still, their number and features vary according to the scientific literature, with a certain overlap that creates difficulties and controversies in the precise assessment of MI depth. The purpose of this review is to present and discuss the most important and recent information about patterns of MI, focusing on the more aggressive and the elongated and fragmented glands (MELF) pattern in particular. Assessment of MI depth and correct staging of EC is possible only after the precise recognition of each MI pattern.
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Reinhold C, Ueno Y, Akin EA, Bhosale PR, Dudiak KM, Jhingran A, Kang SK, Kilcoyne A, Lakhman Y, Nicola R, Pandharipande PV, Paspulati R, Shinagare AB, Small W, Vargas HA, Whitcomb BP, Glanc P. ACR Appropriateness Criteria® Pretreatment Evaluation and Follow-Up of Endometrial Cancer. J Am Coll Radiol 2020; 17:S472-S486. [PMID: 33153558 DOI: 10.1016/j.jacr.2020.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 11/19/2022]
Abstract
To date, there is little consensus on the role of pelvic imaging in assessing local disease extent during initial staging in patients with endometrial carcinoma, with practices differing widely across centers. However, when pretreatment assessment of local tumor extent is indicated, MRI is the preferred imaging modality. Preoperative imaging of endometrial carcinoma can define the extent of disease and indicate the need for subspecialist referral in the presence of deep myometrial invasion, cervical extension, or suspected lymphadenopathy. If distant metastatic disease is clinically suspected, preoperative assessment with cross-sectional imaging or PET/CT may be performed. However, most patients with low-grade disease are at low risk of lymph node and distant metastases. Thus, this group may not require a routine pretreatment evaluation for distant metastases. Recurrence rates in patients with endometrial carcinoma are infrequent. Therefore, radiologic evaluation is typically used only to investigate suspicion of recurrent disease due to symptoms or physical examination and not for routine surveillance after treatment. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Yoshiko Ueno
- Research Author, Kobe University Graduate School of Medicine, Kobe, Japan, McGill University, Montreal, Quebec, Canada
| | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | | | | | - Anuja Jhingran
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stella K Kang
- New York University Medical Center, New York, New York
| | | | - Yulia Lakhman
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Refky Nicola
- Roswell Park Cancer Institute, Jacobs School of Medicine and Biomedical Science, Buffalo, New York
| | | | - Rajmohan Paspulati
- University Hospitals Medical Group Radiology, Cleveland, Ohio, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Atul B Shinagare
- Brigham & Women's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts
| | - William Small
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | | | - Bradford P Whitcomb
- University of Connecticut, Farmington, Connecticut; Society of Gynecologic Oncology
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Arsène E, Bleu G, Merlot B, Boulanger L, Vinatier D, Kerdraon O, Collinet P. Implications of a two-step procedure in surgical management of patients with early-stage endometrioid endometrial cancer. J Gynecol Oncol 2016; 26:125-33. [PMID: 25872893 PMCID: PMC4397228 DOI: 10.3802/jgo.2015.26.2.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/13/2015] [Accepted: 03/01/2015] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery. METHODS This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied. RESULTS Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1±117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications. CONCLUSION Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity.
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Affiliation(s)
- Emmanuelle Arsène
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.
| | - Géraldine Bleu
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France
| | - Benjamin Merlot
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France
| | - Loïc Boulanger
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France
| | - Denis Vinatier
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.; University of Lille-Nord-de-France, Lille, France
| | - Olivier Kerdraon
- Department of Anatomopathology, University Hospital of Lille, Lille, France
| | - Pierre Collinet
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.; University of Lille-Nord-de-France, Lille, France
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Eo WK, Kwon S, Koh SB, Kim MJ, Ji YI, Lee JY, Suh DS, Kim KH, Kim HY. The Lymphocyte-Monocyte Ratio Predicts Patient Survival and Aggressiveness of Endometrial Cancer. J Cancer 2016; 7:538-45. [PMID: 27053952 PMCID: PMC4820730 DOI: 10.7150/jca.14206] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/22/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE We assessed the prognostic implications of preoperative lymphocyte-monocyte ratio (LMR) in patients with endometrial cancer (EC). METHODS We retrospectively examined the LMR as a prognostic variable in a cohort of 255 patients with EC who underwent surgical resection. Patients were categorized into two groups according to the LMR (LMR-low and LMR-high) using cutoff points determined by receiving operator characteristic (ROC) curve analysis. The primary objective was to correlate the LMR to clinicopathological factors; the secondary objective was to determine the survival significance of the LMR in patients with EC. RESULTS Using data from the entire cohort, the most discriminative LMR cutoff value selected on the ROC curve was 3.28 for both disease-free survival (DFS) and overall survival (OS). The LMR-low and LMR-high groups included 33 (12.9%) and 222 patients (87.1%), respectively. The 5-year DFS rates in the LMR-low and LMR-high groups were 64.5 and 93.9% (P < 0.0001), respectively, and the 5-year OS rates in the two groups were 76.7 and 96.5% (P < 0.0001), respectively. On multivariate analysis, we identified histologic grade, International Federation of Gynecology and Obstetrics (FIGO) stage, and LMR levels as the strongest prognostic factors affecting DFS (P = 0.0037, P < 0.0001, and P < 0.0001, respectively), and FIGO stage and the LMR as the strongest prognostic factors predicting OS (P < 0.0001 and P < 0.0001, respectively). CONCLUSION The LMR is an independent prognostic factor for both DFS and OS after surgical resection, and it provides additional prognostic value beyond standard clinicopathological parameters.
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Affiliation(s)
- Wan Kyu Eo
- 1. Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sanghoon Kwon
- 2. Department of Obstetrics and Gynecology, Keimyung University, School of Medicine, Daegu, Korea
| | - Suk Bong Koh
- 3. Department of Obstetrics and Gynecology, Catholic University of Daegu, School of Medicine, Daegu, Korea
| | - Min Jeong Kim
- 4. Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea
| | - Yong Il Ji
- 5. Department of Obstetrics and Gynecology, College of Medicine, Inje University, Busan, Korea
| | - Ji Young Lee
- 6. Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Dong Soo Suh
- 7. Department of Obstetrics and Gynecology, Pusan National University School of Medicine; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ki Hyung Kim
- 7. Department of Obstetrics and Gynecology, Pusan National University School of Medicine; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Heung Yeol Kim
- 8. Department of Obstetrics and Gynecology, College of Medicine, Kosin University, Busan, Korea
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Lunardi P, Vidal F, Accadbled F, Leguevaque P, Soule-Tholy M, Beauval JB, Motton S. Bilateral femur metastases in low-grade endometrial carcinoma. Clin Case Rep 2015; 3:582-6. [PMID: 26273447 PMCID: PMC4527801 DOI: 10.1002/ccr3.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 01/25/2015] [Accepted: 02/26/2015] [Indexed: 11/20/2022] Open
Abstract
Lower-limb bone metastases are uncommon in low-grade endometrial carcinoma, and are mostly located on the axial skeleton. Here, we present a rare case of bilateral femur metastases in low-grade endometrial carcinoma and performed a review of the current literature.
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Affiliation(s)
- Pierre Lunardi
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil Toulouse, France
| | - Fabien Vidal
- Department of Gynaecology and General Surgery, CHU Rangueil Toulouse, France
| | | | - Pierre Leguevaque
- Department of Gynaecology and General Surgery, CHU Rangueil Toulouse, France
| | - Marc Soule-Tholy
- Department of Gynaecology and General Surgery, CHU Rangueil Toulouse, France
| | - Jean Baptiste Beauval
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil Toulouse, France
| | - Stéphanie Motton
- Department of Gynaecology and General Surgery, CHU Rangueil Toulouse, France
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Mahdi H, Lockhart D, Maurer KA. Impact of age on 30-day mortality and morbidity in patients undergoing surgery for endometrial cancer. Gynecol Oncol 2015; 137:106-11. [DOI: 10.1016/j.ygyno.2015.01.543] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/22/2015] [Indexed: 12/17/2022]
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Semczuk A, Sagan D, Olcha P, Semczuk-Sikora A, Szumiło J, Pyra A, Rechberger T. Multiple recurrences of early-stage, endometrioid-type G2 endometrial cancer with a long-time follow-up: A case study. Pathol Res Pract 2015; 211:478-80. [PMID: 25701363 DOI: 10.1016/j.prp.2015.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 12/26/2014] [Accepted: 01/19/2015] [Indexed: 11/25/2022]
Abstract
The recurrence after a long-time free period of time, in women primarily operated on for early-stage of endometrial cancer (EC), is a unique phenomenon. Currently, we present the case of a 59-year-old woman with multiple recurrences from the moderately-differentiated, stage Ib, endometrioid-type, uterine cancer. All recurrences were pathologically proven to originate from the primary tumor, and the patient expired 12 years after the primary surgery for disseminated neoplasm. We summarize the current data to give a short overview of the role of late recurrences in women operated on for early-stage EC.
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Affiliation(s)
- Andrzej Semczuk
- II(ND) Department of Gynecology, Lublin Medical University, Lublin, Poland.
| | - Dariusz Sagan
- Department of Thoracic Surgery, Lublin Medical University, Lublin, Poland
| | - Piotr Olcha
- II(ND) Department of Gynecology, Lublin Medical University, Lublin, Poland
| | - Anna Semczuk-Sikora
- Department of Obstetrics and Pathology of Pregnancy, Lublin Medical University, Lublin, Poland
| | - Justyna Szumiło
- Department of Clinical Pathology, Lublin Medical University, Lublin, Poland
| | - Andrzej Pyra
- Obstetrics and Gynecology Chair, Municipal Hospital, Nowa Deba, Poland
| | - Tomasz Rechberger
- II(ND) Department of Gynecology, Lublin Medical University, Lublin, Poland
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Saarelainen SK, Staff S, Peltonen N, Lehtimäki T, Isola J, Kujala PM, Vuento MH, Mäenpää JU. Endoglin, VEGF, and its receptors in predicting metastases in endometrial carcinoma. Tumour Biol 2014; 35:4651-7. [PMID: 24420153 DOI: 10.1007/s13277-014-1609-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/02/2014] [Indexed: 01/11/2023] Open
Abstract
Preoperative evaluation of the risk for metastases in endometrial carcinoma is challenging. The growth of new vessels, angiogenesis, is important for tumor growth and purported to be involved in the metastatic process. The aim of this study was to evaluate the significance of preoperative serum levels and immunohistochemical expression of angiogenic markers in predicting a metastasized disease. Preoperative sera from 98 consecutive women presenting with endometrial carcinoma were collected. Serum concentrations of VEGF, sFLT1, and CD105 were assessed by enzyme-linked immunosorbent assay (ELISA). Immunohistochemistry was used to assess the expression of CD105, VEGF, FLT1, and KDR. The results were correlated to the presence of metastases, presence of deep (≥50%) myometrial invasion, and the histological grade of the tumor. Tumors with other than endometrioid histology were excluded. Of the 80 evaluable patients, 11 had a metastasized disease. The serum concentration of VEGF was higher in the group with metastases than in the group without metastases (median [range], 743 pg/mL [546-1,183 pg/mL] vs. 383 pg/mL [31-1,524 pg/mL], p < 0.001, respectively). In the multivariable analysis, the concentration of VEGF was the sole independent, albeit weak predictive factor for the presence of metastases (odds ratio, 1.004, 95% confidence interval, 1.002-1.007; p = 0.001). The immunohistochemical expression of the markers was not associated with any of the clinicopathological features of the tumors. The results of the present study suggest that preoperative serum VEGF concentration correlates with the presence of metastases in endometrioid endometrial carcinoma.
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Affiliation(s)
- Sami K Saarelainen
- Department of Obstetrics and Gynecology, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland,
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Surgical treatment of elderly patients with endometrial cancer (≥65years). J Geriatr Oncol 2013; 4:368-73. [DOI: 10.1016/j.jgo.2013.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 02/26/2013] [Accepted: 07/11/2013] [Indexed: 11/18/2022]
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Predictive value of serum human epididymis protein 4 and cancer antigen 125 concentrations in endometrial carcinoma. Am J Obstet Gynecol 2013; 209:142.e1-6. [PMID: 23583212 DOI: 10.1016/j.ajog.2013.04.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 02/22/2013] [Accepted: 04/04/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the performance of preoperative serum levels of human epididymis protein 4 (HE4) and cancer antigen 125 (CA125) in the prediction of the presence of metastases in endometrial carcinoma. STUDY DESIGN Preoperative sera were collected from 98 women with a diagnosis of endometrial carcinoma. The concentrations of HE4 and CA125 were assessed by enzyme-linked immunosorbent assay and correlated with the results of the final histopathologic report. RESULTS Fourteen patients had metastases (≥stage IIIA, International Federation of Gynecology and Obstetrics 2009 classification). The serum concentrations of HE4 and CA125 were higher in the group with metastases than in the group without metastases (median [interquartile range], 148.6 pmol/L [71.6-219.1 pmol/L] vs 77.2 pmol/L [52.9-99.3 pmol/L]; P = .001; and 20.0 U/mL [10.1-70.8 U/mL] vs 4.3 U/mL [2.9-10.4 U/mL]; P < .001, respectively). By a multivariate analysis, the combination of HE4 and CA125 (a risk score algorithm) was the only predictive factor for the presence of metastases (odds ratio, 21.562; 95% confidence interval, 5.472-84.963; P < .001), and the grade was the predictor for a deep (≥50%) myometrial invasion by the tumor (odds ratio, 2.005; 95% confidence interval, 1.123-3.581; P = .019). The sensitivity, specificity, positive predictive value, and negative predictive value for the combination of the markers to predict the presence of metastases were 71.4%, 89.5%, 55.6%, and 94.4%, respectively. CONCLUSION A combination of preoperative HE4 and CA125 seems to be a better predictor of metastatic disease than either 1 alone in endometrial carcinoma.
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Grade 1 endometrioid endometrial carcinoma presenting with pelvic bone metastasis: a case report and review of the literature. Case Rep Obstet Gynecol 2013; 2013:807205. [PMID: 23710391 PMCID: PMC3654698 DOI: 10.1155/2013/807205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/25/2013] [Indexed: 11/23/2022] Open
Abstract
Most grade 1 endometrioid endometrial cancers are confined to the uterus at the time of diagnosis and confer a good prognosis. Rarely will a grade 1 endometrioid endometrial carcinoma present with distant metastasis, especially to the bone. We present the case of a 56-year-old woman with postmenopausal bleeding and right hip pain due to metastatic grade 1 endometrioid uterine cancer invading into the right ischium. We discuss treatment options as well as provide a review of prior published reports on bony metastasis in grade 1 endometrioid endometrial cancers. To date, this case is one of 10 others which demonstrates that even a well-differentiated, low-grade endometrioid endometrial carcinoma can progress in a highly aggressive manner.
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Zhang GY, Wu LY, Li B, Huang MN, Zhang R, Li XG. Retrospective analysis of prognostic variables and clinical outcomes in surgically staged intermediate risk endometrial carcinoma. Eur J Obstet Gynecol Reprod Biol 2013; 169:309-16. [PMID: 23540792 DOI: 10.1016/j.ejogrb.2013.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 12/10/2012] [Accepted: 02/27/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify independent prognostic variables for surgically staged intermediate risk endometrial carcinoma as defined by the Gynecologic Oncology Group 99 (GOG99) criteria. STUDY DESIGN Retrospective study of 239 patients with FIGO stage IB-occult IIB endometrioid type endometrial cancer, who were primarily treated with comprehensive staging surgery. Data were collected on clinicopathological variables, extent of primary surgery, postoperative adjuvant treatment, and patterns of recurrences. Kaplan-Meier survival curves were used to estimate disease free survival (DFS) and overall survival (OS), and multivariate Cox regression models were used to identify independent prognostic variables. The median follow-up time was 67 months (range, 12-183 months). RESULTS The 5-year DFS and OS were 91.0% and 93.0%, respectively. On univariate Kaplan-Meier analysis, age>60 years, deep myometrial invasion (MI), presence of lymph vascular invasion (LVSI), and negative progesterone receptor (PR) status were significantly associated with diminished 5-year DFS and OS. The univariate analysis on patterns of failures demonstrated that patients with older age or positive LVSI were more inclined to develop locoregional recurrence, while PR status and the depth of MI had a statistically significant impact on distant failure. On multivariate analysis, PR status, age, and the depth of MI were independent prognostic variables for 5-year DFS, and age was the only independent prognostic variable for 5-year OS. LVSI and age were independent prognostic variables for locoregional recurrence, while PR status and depth of MI were independent prognostic variables for distant recurrence. CONCLUSIONS Age, depth of MI, PR status and presence of LVSI are of independent prognostic value for intermediate risk endometrial cancer. The presence of these variables warrants consideration when deciding upon treatment strategies.
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Affiliation(s)
- Gong-yi Zhang
- Department of Gynecological Oncology, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Lowery WJ, Gehrig PA, Ko E, Secord AA, Chino J, Havrilesky LJ. Surgical staging for endometrial cancer in the elderly — Is there a role for lymphadenectomy? Gynecol Oncol 2012; 126:12-5. [DOI: 10.1016/j.ygyno.2012.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/01/2012] [Accepted: 05/05/2012] [Indexed: 11/27/2022]
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Lajer H, Elnegaard S, Christensen RD, Ortoft G, Schledermann DE, Mogensen O. Survival after stage IA endometrial cancer; can follow-up be altered? A prospective nationwide Danish survey. Acta Obstet Gynecol Scand 2012; 91:976-82. [PMID: 22548255 DOI: 10.1111/j.1600-0412.2012.01438.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To present Danish national survival data on women with early stage endometrial cancer and use these data to discuss the relevance of postoperative follow-up. DESIGN Prospective study. SETTING Danish Endometrial Cancer Study (DEMCA). POPULATION Five hundred and seventy-one FIGO stage IA (1988 classification) endometrial cancer patients prospectively included between 1986 and 1999. All patients had total abdominal hysterectomy and bilateral salpingo-oophorectomy without adjuvant therapy. METHODS The patient and the disease characteristics were drawn from the DEMCA database with cross-references to the national death registry and the national pathology database. Statistical methods included Kaplan-Meier, log-rank and Cox regression analysis. MAIN OUTCOME MEASURES Survival rates in relation to histopathology. RESULTS The five year overall survival rate was 88.9% and five year disease-specific survival was 97.3%. Patients with low- (91.8%) and high-risk histopathology (8.2%) were compared. The age-adjusted overall and disease-specific survival differed significantly between women with low- and high-risk histopathology (p = 0.039 and p = 0.004, respectively). The disease-specific survival adjusted for age between patients with well-differentiated endometrioid tumors differed from those with moderately differentiated tumors (p = 0.008, hazard ratio = 3.75, 95% confidence interval 1.41-10.00). Recurrence data were available on 464 patients. Twenty-three (3.9%) experienced recurrence. Of these recurrences, 15 of 23 (65%) were vaginal. Death from recurrence was observed in nine of 23 (39%) patients, and five of these nine had vaginal recurrences. CONCLUSIONS Women with FIGO stage IA endometrial cancer have a very high disease-specific five year survival. Survival was related to histopathology. Follow-up at a highly specialized tertiary care center for patients with an extremely good prognosis may be questioned.
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Affiliation(s)
- Henrik Lajer
- Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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Olcha P, Cybulski M, Skomra D, Obrzut B, Ignatov A, Jóźwik M, Schneider-Stock R, Semczuk A. The pattern of p14ARF expression in primary and metastatic human endometrial carcinomas: correlation with clinicopathological features and TP53 pathway alterations. Int J Gynecol Cancer 2010; 20:993-9. [PMID: 20683407 DOI: 10.1111/igc.0b013e3181e76a4d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Alterations of p53 pathway (p14(ARF)/MDM2/p53) play a crucial role in the development and progression of various human neoplasms, including endometrial carcinoma (EC). The aim of the current research was to examine the p14(ARF) expression pattern in primary ECs and corresponding metastatic lesions. MATERIALS AND METHODS We studied 47 primary ECs and corresponding metastatic lesions applying immunohistochemistry and investigated the relationship between p14(ARF) overexpression and clinicopathological variables of carcinoma as well as TP53 alterations. RESULTS Protein expression was predominantly nuclear, present in 32 (68%) of 47 primary cases and in 28 (60%) of 47 metastatic lesions. There were seven p14(ARF)-positive primary tumors showing negative reactivity in the metastatic lesions. On the other hand, 3 cases lacked protein immunoreactivity in the primary ECs but revealed weak nuclear staining in the corresponding metastases. A case of primary cervical adenocarcinoma metastasizing to the lymph nodes showed p14(ARF) expression both in the primary tumor and the corresponding metastases. A trend was found between the p14(ARF) expression in primary tumors and the presence of the neoplasms in the fallopian tube (P = 0.063), but none of the other clinicopathological variables of carcinoma was related to protein immunoreactivity in advanced-stage uterine neoplasms. The p14(ARF) expression in EC metastases was related to the presence of the primary tumor in the fallopian tube (P = 0.036). The p14(ARF) expression was not associated with unfavorable outcome both in the primary tumors (P = 0.302) and in the corresponding metastases (P = 0.217). There was also no relationship between the p14(ARF) expression pattern and TP53 pathway alterations. CONCLUSIONS Altogether, the p14(ARF) protein is expressed in more than half of the primary ECs and metastatic lesions analyzed and is associated with the transtubal dissemination of the primary tumor. The pattern of the p14(ARF) expression is not associated with the alterations of other TP53 pathway members in advanced-stage human ECs.
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Affiliation(s)
- Piotr Olcha
- 2nd Department of Gynecology, Lublin Medical University, Lublin, Poland
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Neubauer NL, Havrilesky LJ, Calingaert B, Bulusu A, Bernardini MQ, Fleming ND, Bland AE, Secord AA. The role of lymphadenectomy in the management of preoperative grade 1 endometrial carcinoma. Gynecol Oncol 2009; 112:511-6. [DOI: 10.1016/j.ygyno.2008.11.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 11/03/2008] [Accepted: 11/10/2008] [Indexed: 10/21/2022]
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