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Zhang Z, Sun C, Li C, Jiao X, Griffin BB, Dongol S, Wu H, Zhang C, Cao W, Dong R, Yang X, Zhang Q, Kong B. Upregulated MELK Leads to Doxorubicin Chemoresistance and M2 Macrophage Polarization via the miR-34a/JAK2/STAT3 Pathway in Uterine Leiomyosarcoma. Front Oncol 2020; 10:453. [PMID: 32391256 PMCID: PMC7188922 DOI: 10.3389/fonc.2020.00453] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/13/2020] [Indexed: 12/25/2022] Open
Abstract
Uterine leiomyosarcoma (ULMS) is the most lethal gynecologic malignancy with few therapeutic options. Chemoresistance prevails as a major hurdle in treating this malignancy, yet the mechanism of chemoresistance remains largely unclear. In this study, we certified MELK as a poor prognostic marker through bioinformatic analysis of the GEO database. Cellular experiments in vitro revealed that MELK played an essential role in ULMS cells' chemoresistance and that a high expression of MELK could lead to doxorubicin resistance. mRNA profiling uncovered the pathways that MELK was involved in which led to doxorubicin resistance. MELK was found to affect ULMS cells' chemoresistance through an anti-apoptotic mechanism via the JAK2/STAT3 pathway. miRNA profiling also revealed that upregulated MELK could induce the decrease of miRNA-34a (regulated by JAK2/STAT3 pathway). We detected that MELK overexpression could induce M2 macrophage polarization via the miR-34a/JAK2/STAT3 pathway, contributing to doxorubicin chemoresistance in the tumor microenvironment. OTSSP167, a MELK inhibitor, may increase ULMS sensitivity to doxorubicin. Our investigation could propose novel targets for early diagnosis and precision therapy in ULMS patients.
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Affiliation(s)
- Zhiwei Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, China
| | - Chenggong Sun
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, China
| | - Chengcheng Li
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, China
| | - Xinlin Jiao
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, China
| | - Brannan B Griffin
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Samina Dongol
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, China
| | - Huan Wu
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, China
| | - Chenyi Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, China
| | - Wenyu Cao
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, China
| | - Ruifen Dong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, China
| | - Xingsheng Yang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, China
| | - Qing Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, China
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2
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Matsuo K, Takazawa Y, Ross MS, Elishaev E, Yunokawa M, Sheridan TB, Bush SH, Klobocista MM, Blake EA, Takano T, Baba T, Satoh S, Shida M, Ikeda Y, Adachi S, Yokoyama T, Takekuma M, Yanai S, Takeuchi S, Nishimura M, Iwasaki K, Johnson MS, Yoshida M, Hakam A, Machida H, Mhawech-Fauceglia P, Ueda Y, Yoshino K, Kajiwara H, Hasegawa K, Yasuda M, Miyake TM, Moriya T, Yuba Y, Morgan T, Fukagawa T, Pejovic T, Nagano T, Sasaki T, Richmond AM, Post MD, Shahzad MMK, Im DD, Yoshida H, Enomoto T, Omatsu K, Ueland FR, Kelley JL, Karabakhtsian RG, Roman LD. Significance of Lymphovascular Space Invasion by the Sarcomatous Component in Uterine Carcinosarcoma. Ann Surg Oncol 2018; 25:2756-2766. [PMID: 29971677 DOI: 10.1245/s10434-018-6547-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of this study was to examine the significance of lymphovascular space invasion (LVSI) with a sarcomatous component on the tumor characteristics and clinical outcomes of women with uterine carcinosarcoma (UCS). METHODS This was a secondary analysis of a prior multicenter retrospective study that examined women with stage I-IV UCS who underwent primary hysterectomy. Archived histopathology slides were reviewed and LVSI was scored as follows: LVSI with a carcinomatous component alone (LVSI-carcinoma; n = 375, 76.8%) or LVSI containing a sarcomatous component with or without a carcinomatous component (LVSI-sarcoma; n = 113, 23.2%). Qualitative metrics of LVSI were correlated to clinicopathological factors and survival outcome. RESULTS Tumors in the LVSI-sarcoma group were more likely to have sarcoma dominance (82.1 vs. 26.4%) heterologous sarcomatous component (51.3 vs. 37.9%), low-grade carcinoma (42.5 vs. 22.4%), and large tumor size (81.0 vs. 70.2%) in the primary tumor site compared with tumors in the LVSI-carcinoma group (all p < 0.05). On multivariate analysis, LVSI-sarcoma was independently associated with decreased progression-free survival (5-year rates: 34.9 vs. 40.8%, adjusted hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.36-2.50, p < 0.001), and cause-specific survival (5-year rates: 41.8 vs. 55.9%, adjusted HR 1.95, 95% CI 1.39-2.75, p < 0.001) compared with LVSI-carcinoma. Postoperative radiotherapy for women with LVSI-sarcoma had a higher reduction rate of recurrence/progression of disease (54% reduction, p = 0.04) compared with postoperative radiotherapy for women with LVSI-carcinoma (26% reduction, p = 0.08). CONCLUSION In UCS, the presence of a sarcomatous component in LVSI is particularly prevalent when a tumor has sarcoma dominance. Our study suggests that LVSI containing a sarcomatous component may be a predictor of decreased survival for women with UCS.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
| | - Yutaka Takazawa
- Department of Pathology, Cancer Institute Hospital, Tokyo, Japan
| | - Malcolm S Ross
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, MaGee-Womens Hospital, University of Pittsburgh, Pittsburgh, PA, USA
| | - Esther Elishaev
- Department of Pathology, MaGee-Womens Hospital, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mayu Yunokawa
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Todd B Sheridan
- Department of Pathology, Mercy Medical Center, Baltimore, MD, USA
| | - Stephen H Bush
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Merieme M Klobocista
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY, USA
| | - Erin A Blake
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, Boulder, CO, USA
| | - Tadao Takano
- Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan
| | - Tsukasa Baba
- Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan
| | - Shinya Satoh
- Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan
| | - Masako Shida
- Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan
| | - Yuji Ikeda
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - Sosuke Adachi
- Department of Obstetrics and Gynecology, Niigata University, Niigata, Japan
| | - Takuhei Yokoyama
- Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Shiori Yanai
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Satoshi Takeuchi
- Department of Obstetrics and Gynecology, Iwate Medical University, Morioka, Japan
| | - Masato Nishimura
- Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan
| | - Keita Iwasaki
- Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan
| | - Marian S Johnson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Masayuki Yoshida
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Ardeshir Hakam
- Department of Pathology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | | | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan
| | | | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takahito M Miyake
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan
| | - Takuya Moriya
- Department of Pathology, Kawasaki Medical School, Okayama, Japan
| | - Yoshiaki Yuba
- Department of Pathology, Kitano Hospital, Osaka, Japan
| | - Terry Morgan
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | | | - Tanja Pejovic
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Tadayoshi Nagano
- Department of Obstetrics and Gynecology, Kitano Hospital, Osaka, Japan
| | - Takeshi Sasaki
- Department of Pathology, The University of Tokyo, Tokyo, Japan
| | - Abby M Richmond
- Department of Pathology, University of Colorado, Boulder, CO, USA
| | - Miriam D Post
- Department of Pathology, University of Colorado, Boulder, CO, USA
| | - Mian M K Shahzad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Dwight D Im
- Department of Gynecology, Mercy Medical Center, Baltimore, MD, USA
| | - Hiroshi Yoshida
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University, Niigata, Japan
| | - Kohei Omatsu
- Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan
| | - Frederick R Ueland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Joseph L Kelley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, MaGee-Womens Hospital, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rouzan G Karabakhtsian
- Department of Pathology, University of Kentucky Medical Center, Lexington, KY, USA.,Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
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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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Xiu XX, Wang HL, Yun-Yi L, Fan-Dou K, Jin-Ping H. Endometrial stromal sarcoma in combination with mixed type endometrial carcinomas: A case report and literature review. Medicine (Baltimore) 2017; 96:e8928. [PMID: 29245257 PMCID: PMC5728872 DOI: 10.1097/md.0000000000008928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Endometrial stromal sarcoma (ESS) is rare, representing only approximately 0.2% of all uterine malignancies. Mixed type endometrial carcinomas (MT-ECs) are rare tumors with both type I and II features, and are difficult to diagnose. Cases of ESS and MT-ECs coexisting in the same patient are extremely rare. This study aimed to describe a case of ESS in combination with MT-ECs in a 47-year-old premenopausal woman. PATIENT CONCERNS A woman presented to the hospital complaining of occasional abdominal pain and had high tumor markers: cancer antigen (CA) 19-9 (263.6 U/mL) and CA 125 (428.0 U/mL). Transvaginal ultrasound examination revealed a complex mass (12.3 × 9.1 × 6.3 cm) with solid and cystic components on the right rear wall of the uterus. Abdominopelvic computed tomography images showed a pelvic cystic-solid mixed mass. The patient underwent an exploratory midline laparotomy. The mass was hypothesized to be malignant on the uterine posterior wall. Tumor deposits were found on bilateral parametrium. On peritoneal implantation, multiple metastases were seen on the serosal surface of the bowel and greater omentum. A frozen section revealed a spindle cell sarcoma. DIAGNOSES Pathological reports following surgery revealed concurrent ESS and MT-ECs. INTERVENTIONS The patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, and macroscopic clearance of the tumor. Adjuvant chemotherapy was given. OUTCOMES The patient was still alive when this report was written. LESSONS Considering the rarity of ESS in combination with MT-ECs, this study presented an overview of the literature and discussed a number of histological and clinical issues. Nevertheless, etiology and pathogenesis of these tumors need further investigation.
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Affiliation(s)
| | - Hua-Li Wang
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Lv Yun-Yi
- Department of Gynecology and Obstetrics
| | | | - Hou Jin-Ping
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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5
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Sardi A, Sipok A, Baratti D, Deraco M, Sugarbaker P, Salti G, Yonemura Y, Sammartino P, Glehen O, Bakrin N, Díaz-Montes TP, Gushchin V. Multi-institutional study of peritoneal sarcomatosis from uterine sarcoma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 2017; 43:2170-2177. [PMID: 28967566 DOI: 10.1016/j.ejso.2017.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/11/2017] [Accepted: 08/23/2017] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Uterine sarcoma (US) is a rare tumor representing 1% of female genital tract malignancies. Peritoneal sarcomatosis (PS) after US, diminishes median overall survival (OS) and progression-free survival (PFS) with cytoreductive surgery (CRS) alone, with or without systemic chemotherapy is <1 year and 6 months, respectively. A multi-institutional review of PS from US was conducted to evaluate CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) and effects on survival outcomes. METHODS A retrospective review of 36 patients from 7 specialized international centers was performed. Selection criteria included PS of uterine origin with CRS/HIPEC treatment. Clinical data were analyzed. OS and PFS were estimated with Kaplan-Meier method. RESULTS Thirty-six patients underwent a total 38 HIPEC procedures performed from 2005 to 2014; 35 previous treatment and 1 primary treatment. Twenty-nine (81%) LMS patients, 3 (8%) endometrial stromal sarcoma (ESS), 3 (8%) adeneosarcoma (AS), and 1 (3%) categorized as other. Median PCI was 16 (range: 2-39), 10 patients had PCI ≥20. Thirty-four patients (94%) had complete cytoreduction (CC 0-1), 19 patients recurred. CRS/HIPEC OS at 1, 3, and 5-years was 75%, 53%, and 32% respectively, with median OS of 37 months (CI 95%: 20-54). PFS in 32 patients with CC at 1, 3, and 5-years was 67%, 32% and 32%, respectively with median PFS of 18.9 months (CI 95%: 6.7-31). CONCLUSIONS CRS/HIPEC is a promising treatment modality for patients with PS. Histological subtype may influence survival. A global prospective registry of patients to further assess the efficacy of CRS/HIPEC is needed.
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Affiliation(s)
- Armando Sardi
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, 227 St. Paul Place, Baltimore, MD, 21202, USA.
| | - Arkadii Sipok
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, 227 St. Paul Place, Baltimore, MD, 21202, USA.
| | - Dario Baratti
- Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Department of Surgery, Peritoneal Surface Malignancies Program, Via Venezian, 1, Milano, MI Cap 20133, Italy.
| | - Marcello Deraco
- Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Department of Surgery, Peritoneal Surface Malignancies Program, Via Venezian, 1, Milano, MI Cap 20133, Italy.
| | - Paul Sugarbaker
- Department of Surgery, MedStar Washington Hospital Center, 106 Irving St NW, Washington, DC 20010, USA.
| | - George Salti
- Division of Surgical Oncology, University of Illinois at Chicago Hospital and Health Sciences System, 1740 W Taylor St, Chicago, Illinois, 60612, USA.
| | - Yutaka Yonemura
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka, 596-8522, Japan.
| | - Paolo Sammartino
- Department of Surgery Pietro Valdoni, Sapienza University of Rome, 5 Piazzale Aldo Moro, Rome, 00185, Italy.
| | - Olivier Glehen
- Department of General and Oncologic Surgery, Centre Hospitalier Lyon Sud, 69495, Pierre Bénite, France.
| | - Naoual Bakrin
- Department of General and Oncologic Surgery, Centre Hospitalier Lyon Sud, 69495, Pierre Bénite, France.
| | - Teresa P Díaz-Montes
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, 227 St. Paul Place, Baltimore, MD, 21202, USA.
| | - Vadim Gushchin
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, 227 St. Paul Place, Baltimore, MD, 21202, USA.
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Uterine sarcoma Part II-Uterine endometrial stromal sarcoma: The TAG systematic review. Taiwan J Obstet Gynecol 2017; 55:472-9. [PMID: 27590366 DOI: 10.1016/j.tjog.2016.04.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2016] [Indexed: 12/16/2022] Open
Abstract
Endometrial stromal tumors are rare uterine tumors (<1%). Four main categories include endometrial stromal nodule, low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), and uterine undifferentiated sarcoma (UUS). This review is a series of articles discussing the uterine sarcomas. LG-ESS, a hormone-dependent tumor harboring chromosomal rearrangement, is an indolent tumor with a favorable prognosis, but characterized by late recurrences even in patients with Stage I disease, suggesting the requirement of a long-term follow-up. Patients with HG-ESS, based on the identification of YWHAE-NUTM2A/B (YWHAE-FAM22A/B) gene fusion, typically present with advanced stage diseases and frequently have recurrences, usually within a few years after initial surgery. UUS is, a high-grade sarcoma, extremely rare, lacking a specific line of differentiation, which is a diagnosis of exclusion (the wastebasket category, which fails to fulfill the morphological and immunohistochemical criteria of translocation-positive ESS). Surgery is the main strategy in the management of uterine sarcoma. Due to rarity, complex biological characteristics, and unknown etiology and risk factors of uterine sarcomas, the role of adjuvant therapy is not clear. Only LG-ESS might respond to progestins or aromatase inhibitors.
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8
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Pioglitazone induces cell growth arrest and activates mitochondrial apoptosis in human uterine leiomyosarcoma cells by a peroxisome proliferator-activated receptor γ-independent mechanism. Naunyn Schmiedebergs Arch Pharmacol 2016; 390:37-48. [PMID: 27664035 DOI: 10.1007/s00210-016-1291-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 08/19/2016] [Indexed: 12/13/2022]
Abstract
The peroxisome proliferator-activated receptor γ (PPARγ) agonists, thiazolidinediones, including pioglitazone (PIO) exhibit anti-tumour activities in cancer cells. The present study investigates the effects of PIO on cell proliferation and apoptosis in SK-UT-1 cells, a human uterine leiomyosarcoma cell line, and human uterine smooth muscle cells (HUtSMC). The proliferation and viability of SK-UT-1 cells treated with vehicle or PIO were assessed by cell counting and WST-1 assay. The activity of MEK/ERK and p38 MAPK signalling pathways and the expression of p53, the cyclin-dependent kinase inhibitor, p21, Bax, Bad and Bim proteins and cleaved caspase-3 were analysed by Western blotting. Quiescent SK-UT-1 cells intensively proliferate and display high levels of phosphorylated, activated MEK1/2, ERK1/2 and p38 MAPK. PIO (10 or 25 μM) induced time- and dose-dependently cell-growth arrest, reduced the cell numbers and effectively suppressed the over-activated MEK/ERK and p38 MAPK signalling pathways as evidenced by the abolished levels of phosphorylated MEK1/2, ERK1/2 and p38 MAPK. PIO activated the intrinsic apoptotic pathway, i.e. up-regulated the p53, p21, Bax and Bad proteins and cleaved caspase-3. PIO also reduced cell numbers of highly proliferative SK-UT-1 cells cultured in growth medium. The anti-proliferative and pro-apoptotic actions of PIO were not PPARγ dependent and exclusive for SK-UT-1 cells as PIO did not interfere with the proliferation of HUtSMC. The pronounced anti-tumorigenic effects of PIO in SK-UT-1 cells address an important issue about the relevance of the PPARγ agonist in the treatment of the human uterine leiomyosarcoma.
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9
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Impact of chemotherapy in uterine sarcoma (UtS): review of 13 clinical trials from the EORTC Soft Tissue and Bone Sarcoma Group (STBSG) involving advanced/metastatic UtS compared to other soft tissue sarcoma (STS) patients treated with first line chemotherapy. Gynecol Oncol 2016; 142:95-101. [DOI: 10.1016/j.ygyno.2016.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/10/2016] [Accepted: 05/15/2016] [Indexed: 01/12/2023]
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10
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Babichev Y, Kabaroff L, Datti A, Uehling D, Isaac M, Al-Awar R, Prakesch M, Sun RX, Boutros PC, Venier R, Dickson BC, Gladdy RA. PI3K/AKT/mTOR inhibition in combination with doxorubicin is an effective therapy for leiomyosarcoma. J Transl Med 2016; 14:67. [PMID: 26952093 PMCID: PMC4782390 DOI: 10.1186/s12967-016-0814-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/11/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Leiomyosarcoma (LMS) is a common type of soft tissue sarcoma that responds poorly to standard chemotherapy. Thus the goal of this study was to identify novel selective therapies that may be effective in leiomyosarcoma by screening cell lines with a small molecule library comprised of 480 kinase inhibitors to functionally determine which signalling pathways may be critical for LMS growth. METHODS LMS cell lines were screened with the OICR kinase library and a cell viability assay was used to identify potentially effective compounds. The top 10 % of hits underwent secondary validation to determine their EC50 and immunoblots were performed to confirm selective drug action. The efficacy of combination drug therapy with doxorubicin (Dox) in vitro was analyzed using the Calcusyn program after treatment with one of three dosing schedules: concurrent treatment, initial treatment with a selective compound followed by Dox, or initial treatment with Dox followed by the selective compound. Single and combination drug therapy were then validated in vivo using LMS xenografts. RESULTS Compounds that targeted PI3K/AKT/mTOR pathways (52 %) were most effective. EC50s were determined to validate these initial hits, and of the 11 confirmed hits, 10 targeted PI3K and/or mTOR pathways with EC50 values <1 μM. We therefore examined if BEZ235 and BKM120, two selective compounds in these pathways, would inhibit leiomyosarcoma growth in vitro. Immunoblots confirmed on-target effects of these compounds in the PI3K and/or mTOR pathways. We next investigated if there was synergy with these agents and first line chemotherapy doxorubicin (Dox), which would allow for earlier introduction into patient care. Only combined treatment of BEZ235 and Dox was synergistic in vitro. To validate these findings in pre-clinical models, leiomyosarcoma xenografts were treated with single agent and combination therapy. BEZ235 treated xenografts (n = 8) demonstrated a decrease in tumor volume of 42 % whereas combining BEZ235 with Dox (n = 8) decreased tumor volume 68 % compared to vehicle alone. CONCLUSIONS In summary, this study supports further investigation into the use of PI3K and mTOR inhibitors alone and in combination with standard treatment in leiomyosarcoma patients.
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Affiliation(s)
- Yael Babichev
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, M5G 1X5, Canada.
| | - Leah Kabaroff
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, M5G 1X5, Canada.
| | - Alessandro Datti
- Sinai-McLaughlin Assay and Robotic Technologies Facility, Lunenfeld-Tanenbaum Research Institute, Toronto, M5G 1X5, Canada.
- Department of Agricultural, Food, and Environmental Sciences, University of Perugia, 06121, Perugia, Italy.
| | - David Uehling
- Drug Discovery Group, Ontario Institute for Cancer Research, Toronto, M5G 0A3, Canada.
| | - Methvin Isaac
- Drug Discovery Group, Ontario Institute for Cancer Research, Toronto, M5G 0A3, Canada.
| | - Rima Al-Awar
- Drug Discovery Group, Ontario Institute for Cancer Research, Toronto, M5G 0A3, Canada.
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Canada.
| | - Michael Prakesch
- Drug Discovery Group, Ontario Institute for Cancer Research, Toronto, M5G 0A3, Canada.
| | - Ren X Sun
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Canada.
- Informatics and Biocomputing Program, Ontario Institute for Cancer Research, Toronto, M5G 0A3, ON, Canada.
| | - Paul C Boutros
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Canada.
- Informatics and Biocomputing Program, Ontario Institute for Cancer Research, Toronto, M5G 0A3, ON, Canada.
- Department of Medical Biophysics, University of Toronto, Toronto, M5S 1A1, ON, Canada.
| | - Rosemarie Venier
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, M5G 1X5, Canada.
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, M5G 1X5, ON, Canada.
| | - Rebecca A Gladdy
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, M5G 1X5, Canada.
- Department of Surgery, University of Toronto, Toronto, M5S 1A1, Canada.
- Institute of Medical Science, University of Toronto, Toronto, M5S 1A1, Canada.
- Cancer Stem Cell Program, Ontario Institute for Cancer Research, Toronto, M5G 0A3, ON, Canada.
- Lunenfeld-Tanenbaum Research Institute, 25 Orde Street, Room 5-1015-2, Toronto, ON, M5T 3H7, Canada.
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11
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Mäkinen N, Aavikko M, Heikkinen T, Taipale M, Taipale J, Koivisto-Korander R, Bützow R, Vahteristo P. Exome Sequencing of Uterine Leiomyosarcomas Identifies Frequent Mutations in TP53, ATRX, and MED12. PLoS Genet 2016; 12:e1005850. [PMID: 26891131 PMCID: PMC4758603 DOI: 10.1371/journal.pgen.1005850] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 01/17/2016] [Indexed: 11/29/2022] Open
Abstract
Uterine leiomyosarcomas (ULMSs) are aggressive smooth muscle tumors associated with poor clinical outcome. Despite previous cytogenetic and molecular studies, their molecular background has remained elusive. To examine somatic variation in ULMS, we performed exome sequencing on 19 tumors. Altogether, 43 genes were mutated in at least two ULMSs. Most frequently mutated genes included tumor protein P53 (TP53; 6/19; 33%), alpha thalassemia/mental retardation syndrome X-linked (ATRX; 5/19; 26%), and mediator complex subunit 12 (MED12; 4/19; 21%). Unlike ATRX mutations, both TP53 and MED12 alterations have repeatedly been associated with ULMSs. All the observed ATRX alterations were either nonsense or frameshift mutations. ATRX protein levels were reliably analyzed by immunohistochemistry in altogether 44 ULMSs, and the majority of tumors (23/44; 52%) showed clearly reduced expression. Loss of ATRX expression has been associated with alternative lengthening of telomeres (ALT), and thus the telomere length was analyzed with telomere-specific fluorescence in situ hybridization. The ALT phenotype was confirmed in all ULMSs showing diminished ATRX expression. Exome data also revealed one nonsense mutation in death-domain associated protein (DAXX), another gene previously associated with ALT, and the tumor showed ALT positivity. In conclusion, exome sequencing revealed that TP53, ATRX, and MED12 are frequently mutated in ULMSs. ALT phenotype was commonly seen in tumors, indicating that ATR inhibitors, which were recently suggested as possible new drugs for ATRX-deficient tumors, could provide a potential novel therapeutic option for ULMS. Uterine leiomyosarcomas are rare, malignant smooth muscle tumors with a poor 5-year survival and high recurrence rate. They account for 1–2% of all uterine malignancies with an estimated incidence of 0.4/100,000 women per year. The symptoms and signs of this tumor type widely overlap with those of common benign uterine leiomyomas, making early diagnosis of uterine leiomyosarcomas difficult. Currently, the diagnosis of these tumors is often incidental and postoperative. Despite previous cytogenetic and molecular studies, their molecular background has remained elusive. Identification of novel molecular genetic characteristics in uterine leiomyosarcomas is clinically relevant to further improve the diagnosis and prognosis of the patients. Here, we performed exome sequencing on 19 tumors, revealing frequent mutations in TP53, ATRX, and MED12. The discovery of frequent inactivating ATRX mutations provides a potential novel therapeutic target for uterine leiomyosarcomas.
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Affiliation(s)
- Netta Mäkinen
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
- Department of Medical and Clinical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Mervi Aavikko
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
- Department of Medical and Clinical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Tuomas Heikkinen
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
- Department of Medical and Clinical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Minna Taipale
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
- Science for Life Laboratory, Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Jussi Taipale
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
- Science for Life Laboratory, Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Riitta Koivisto-Korander
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ralf Bützow
- Department of Pathology, The Laboratory of Helsinki University Hospital (HUSLAB), Helsinki University Hospital and Medicum, University of Helsinki, Helsinki, Finland
| | - Pia Vahteristo
- Genome-Scale Biology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
- Department of Medical and Clinical Genetics, Medicum, University of Helsinki, Helsinki, Finland
- * E-mail:
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12
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Lange SES, Liu J, Adkins DR, Powell MA, Van Tine BA, Mutch DG. Improved clinical trial enrollments for uterine leiomyosarcoma patients after gynecologic oncology partnership with a sarcoma center. Gynecol Oncol 2016; 140:307-12. [PMID: 26718726 PMCID: PMC4861068 DOI: 10.1016/j.ygyno.2015.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/16/2015] [Accepted: 12/18/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE A retrospective chart review was performed to determine patient outcomes before and after partnership by gynecologic oncologists (GYN/ONC) with a sarcoma center (SC) for patients with recurrent unresectable/metastatic (RM) uterine leiomyosarcoma (uLMS). METHODS 58 RM patients, identified from medical records of uLMS patients cared for by either GYN/ONC service and/or the SC between 1/1/2000-4/1/2014, were audited for patient and tumor characteristics, outcomes, and clinical trials enrollments. RESULTS Of the 58 patients, 26 patients (48%) were treated by GYN/ONC alone and 32 were treated by a combination of GYN/ONC and SC (52%). Age, race, tumor size, grade, presence of lymphovascular invasion, cervical involvement, and FIGO stage at diagnosis were not statistically different between the two groups. There was a significant difference between the number of clinical trial enrollments (0.07 vs 0.84 trials/patient, p<0.001) and the number of chemotherapy regimens prescribed (2.67 vs 4.29/patient, p=0.03) by GYN/ONC vs SC; the latter was driven by the number of clinical trial enrollments by the SC. Sixty-nine percent of patients referred to the SC were enrolled in at least one clinical trial, while just 8% of patients in the GYN/ONC group were enrolled in at least one clinical trial, a difference that is significant (p<0.0001). CONCLUSIONS Referral of RM uLMS patients by GYN/ONC to a dedicated clinical trials-based SC resulted in an increase in the number of chemotherapy regimens prescribed and clinical trial enrollments. Partnership between GYN/ONC and a dedicated SC with access to clinical trials should be encouraged for all RM uLMS patients.
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Affiliation(s)
- S E S Lange
- Division of Gynecologic Oncology, Washington University in St. Louis, St. Louis, MO 63110, United States.
| | - J Liu
- Division of Public Health Sciences, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - D R Adkins
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, MO 63110, United States; Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - M A Powell
- Division of Gynecologic Oncology, Washington University in St. Louis, St. Louis, MO 63110, United States; Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - B A Van Tine
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, MO 63110, United States; Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - D G Mutch
- Division of Gynecologic Oncology, Washington University in St. Louis, St. Louis, MO 63110, United States; Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, United States
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13
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Caractéristiques clinicopathologiques et facteurs pronostiques des sarcomes utérins dans le centre tunisien. Bull Cancer 2014; 101:669-80. [DOI: 10.1684/bdc.2014.1921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Rovirosa A, Ascaso C, Arenas M, Ríos I, Del Pino M, Ordi J, Morales J, Gascón M, Pahisa J, Biete A. Pathologic prognostic factors in stage I-III uterine carcinosarcoma treated with postoperative radiotherapy. Arch Gynecol Obstet 2014; 290:329-34. [PMID: 24633893 DOI: 10.1007/s00404-014-3202-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/28/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyse the impact of prognostic factors on specific overall survival (SOS) after postoperative radiotherapy (P-RT) in carcinosarcomas. METHODS We retrospectively analysed 81 patients who received P-RT from 1977 to 2010 after the diagnosis of carcinosarcomas. 2009 FIGO stage: 25-IA, 20-IB, 6-II, 9-IIIA, 11-IIIC. Age, stage, vascular and lymphatic space invasion (VLSI), myometrial invasion, grade, mitotic index, sarcomatous/epithelial components, tumour size and necrosis were considered for the analysis. STATISTICS we used the Kaplan-Meier method for survival analysis and the Cox model for risk factor evaluation. RESULTS The mean follow-up of the series was 78.86 months (range 7-381). The median age was 72 years (range 51-89). 30 out 81 (37 %) patients relapsed and died (22.2 % pelvic and abdominal, 13.5 % exclusive distant metastasis). On univariate and multivariate analysis only stage had a significant impact on SOS. At 5 years, stage I-II had a SOS of 66 % in comparison with stage III with 30 %. CONCLUSIONS Two groups of patients showing different outcome were found after P-RT in uterine carcinosarcomas: stage I-II patients had a life expectancy 2.5-fold longer compared to stage III patients. New therapeutic strategies are warranted in carcinosarcomas considering the high incidence of distant metastasis.
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Affiliation(s)
- Angeles Rovirosa
- Gynecological Cancer Unit, Radiation Oncology Department, Hospital Clinic, ICMHO, IDIBAPS, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain,
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Ridolfi C, Pasini G, Drudi F, Barzotti E, Santelmo C, Polselli A, Ravaioli A. Long lasting clinical response to chemotherapy for advanced uterine leiomyosarcoma: a case report. J Med Case Rep 2013; 7:29. [PMID: 23347560 PMCID: PMC3565880 DOI: 10.1186/1752-1947-7-29] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/19/2012] [Indexed: 12/27/2022] Open
Abstract
Introduction Uterine leiomyosarcoma is one of the most frequent uterine sarcomas. In the metastatic setting it is sensitive to doxorubicin, ifosfamide, gemcitabine, docetaxel and a few other drugs, but time to progression is generally short. For this reason prognosis is often poor and there are few reports in the literature of long responders. Case presentation We report a case of a 40-year-old Caucasian woman with metastatic uterine leiomyosarcoma who began treatment six years before the presentation of this case report and for the following six years underwent ten lines of chemotherapy, achieving excellent results and a good quality of life. Among the treatments administered we observed a long response to temolozomide, an unconventional drug for this kind of disease. Conclusion Although there are few chemotherapeutic options for the management of metastatic uterine leiomyosarcoma, a small number of patients have an unexpected long lasting response to treatment. For this reason further research is needed to identify new therapeutic agents and the predictive factors for the achievement of response.
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Affiliation(s)
- Claudio Ridolfi
- Oncology Department, 'Infermi' Hospital, Via Settembrini 2, Rimini, 47923, Italy.
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