1
|
Fusegi A, Nomura H, Ueki A, Abe A, Kamata M, Misaka S, Aoki Y, Tanigawa T, Yunokawa M, Kanao H. Ovarian surveillance including endometrial cytology for patients with hereditary breast and ovarian cancer before risk-reducing salpingo-oophorectomy: A retrospective analysis. J Obstet Gynaecol Res 2024; 50:1002-1009. [PMID: 38528763 DOI: 10.1111/jog.15935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
AIM Ovarian surveillance in women with hereditary breast and ovarian cancer who do not undergo risk-reducing salpingo-oophorectomy has been controversial. Therefore, this study aimed to demonstrate the clinical features of ovarian surveillance at our institution using a technique that combines serum cancer antigen 125 measurements, transvaginal ultrasonography, and uterine endometrial cytology. METHODS We retrospectively examined 65 women, who had not undergone risk-reducing salpingo-oophorectomy diagnosed with hereditary breast and ovarian cancer between 2000 and 2021 at our hospital. Clinical information was obtained and analyzed through a chart review. The details of the treatment course were reviewed for patients who had developed ovarian cancer. RESULTS Overall, 5 of the 65 women were diagnosed with ovarian cancer based on abnormal findings during periodic surveillance. All patients who developed ovarian cancer were asymptomatic, even if the cancer was at an advanced stage. Two of the 65 patients had endometrial cytology abnormalities, both of whom had ovarian cancer. All patients who developed ovarian cancer underwent primary debulking surgery, and complete gross resection was achieved. None of the patients experienced ovarian cancer recurrence. CONCLUSIONS The ovarian surveillance strategy at our institution for women with hereditary breast and ovarian cancer who do not undergo risk-reducing salpingo-oophorectomy can identify asymptomatic ovarian cancer and contribute to achieving complete gross resection during primary surgery. Ovarian surveillance may contribute to a reduction in ovarian cancer mortality.
Collapse
Affiliation(s)
- Atsushi Fusegi
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidetaka Nomura
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Arisa Ueki
- Department of Clinical Genetic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Abe
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mayumi Kamata
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoki Misaka
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoichi Aoki
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Terumi Tanigawa
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mayu Yunokawa
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| |
Collapse
|
2
|
Abay M, Ozgen L, Yalcin Y, Ozerkan K. Clinical significance of risk-reducing salpingo-oophorectomy in patients with BRCA1/2 mutation. J Gynecol Obstet Hum Reprod 2023; 52:102642. [PMID: 37573025 DOI: 10.1016/j.jogoh.2023.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 08/06/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion which is located in the distal fallopian tube and causes high grade serous ovarian carcinoma (HGSOC). The incidence of STIC for women underwent risk reducing salpingo-oophorectomy for BRCA mutation varies from 0.6 to 7% and its clinical outcomes are still unclear. The aim of this study was to demonstrate the incidence of STIC and HGSOC in BRCA1/2 mutation carriers after risk reducing salpingo-oophorectomy (RRSO) and the clinical outcomes of these patients. MATERIAL AND METHODS We retrospectively reviewed the records of 48 BRCA1 and/or 2 mutation carriers who underwent prophylactic salpingo-oophorectomy with or without hysterectomy at the Department of Obstetrics and Gynecology, Bursa Uludag University between January 2000 and January 2022. INCLUSION CRITERIA BRCA 1 and/or 2 mutation carriers diagnosed by genetic testing, asymptomatic patients with no abnormal findings on pelvic examination. EXCLUSION CRITERIA patients with no abnormal findings on pelvic examination and a presence of a personal history of ovarian, fallopian tube or peritoneal cancer. RESULTS A total of 48 BRCA 1 and/or 2 mutation carriers underwent RRSO. STIC was diagnosed in 1 (2,0%) patient and restaging surgery was not performed. Primary peritoneal carcinoma (PPC) did not develop during the 20 months follow-up period. One (2.0%) patient was diagnosed with occult ovarian cancer. Restaging surgery was performed and chemotherapy treatments were given after surgery. A pelvic recurrence developed 25 months after the occult cancer diagnosis in the follow up period. One (2.0%) patient with normal histopathological findings after RRSO was diagnosed with peritoneal cancer 57 months after the operation. CONCLUSION The risk of PPC continues after RRSO. Therefore, close follow-up procedure is very important for early diagnosis and effective treatment of patients with PPC after RRSO.
Collapse
Affiliation(s)
- Merve Abay
- Faculty of Medicine Gynecological Oncology Surgery, Uludag University, Bursa 16059, Turkey
| | - Levent Ozgen
- Faculty of Medicine Gynecological Oncology Surgery, Uludag University, Bursa 16059, Turkey.
| | - Yakup Yalcin
- Faculty of Medicine Gynecological Oncology Surgery, Uludag University, Bursa 16059, Turkey
| | - Kemal Ozerkan
- Faculty of Medicine Gynecological Oncology Surgery, Uludag University, Bursa 16059, Turkey
| |
Collapse
|
3
|
Korzun T, Moses AS, Diba P, Sattler AL, Olson B, Taratula OR, Pejovic T, Marks DL, Taratula O. Development and Perspectives: Multifunctional Nucleic Acid Nanomedicines for Treatment of Gynecological Cancers. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023:e2301776. [PMID: 37518857 PMCID: PMC10827528 DOI: 10.1002/smll.202301776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/11/2023] [Indexed: 08/01/2023]
Abstract
Gynecological malignancies are a significant cause of morbidity and mortality across the globe. Due to delayed presentation, gynecological cancer patients are often referred late in the disease's course, resulting in poor outcomes. A considerable number of patients ultimately succumb to chemotherapy-resistant disease, which reoccurs at advanced stages despite treatment interventions. Although efforts have been devoted to developing therapies that demonstrate reduced resistance to chemotherapy and enhanced toxicity profiles, current clinical outcomes remain unsatisfactory due to treatment resistance and unfavorable off-target effects. Consequently, innovative biological and nanotherapeutic approaches are imperative to strengthen and optimize the therapeutic arsenal for gynecological cancers. Advancements in nanotechnology-based therapies for gynecological malignancies offer significant advantages, including reduced toxicity, expanded drug circulation, and optimized therapeutic dosing, ultimately leading to enhanced treatment effectiveness. Recent advances in nucleic acid therapeutics using microRNA, small interfering RNA, and messenger RNA provide novel approaches for cancer therapeutics. Effective single-agent and combinatorial nucleic acid therapeutics for gynecological malignancies have the potential to transform cancer treatment by giving safer, more tailored approaches than conventional therapies. This review highlights current preclinical studies that effectively exploit these approaches for the treatment of gynecological malignant tumors and malignant ascites.
Collapse
Affiliation(s)
- Tetiana Korzun
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 SW Bond Avenue Portland, Portland, OR, 97239, USA
- Medical Scientist Training Program, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
- Papé Family Pediatric Research Institute, Oregon Health & Science University, SW Sam Jackson Park Rd, Mail Code L481, Portland, OR, 97239, USA
| | - Abraham S Moses
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Parham Diba
- Medical Scientist Training Program, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
- Papé Family Pediatric Research Institute, Oregon Health & Science University, SW Sam Jackson Park Rd, Mail Code L481, Portland, OR, 97239, USA
| | - Ariana L Sattler
- Papé Family Pediatric Research Institute, Oregon Health & Science University, SW Sam Jackson Park Rd, Mail Code L481, Portland, OR, 97239, USA
- Knight Cancer Institute, Oregon Health & Science University, 2720 S Moody Avenue, Portland, Oregon, 97201, USA
- Brenden-Colson Center for Pancreatic Care, Oregon Health & Science University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Brennan Olson
- Mayo Clinic Department of Otolaryngology-Head and Neck Surgery, 200 First St. SW, Rochester, MN, 55905, USA
| | - Olena R Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Tanja Pejovic
- Departments of Obstetrics and Gynecology and Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Daniel L Marks
- Papé Family Pediatric Research Institute, Oregon Health & Science University, SW Sam Jackson Park Rd, Mail Code L481, Portland, OR, 97239, USA
- Knight Cancer Institute, Oregon Health & Science University, 2720 S Moody Avenue, Portland, Oregon, 97201, USA
- Brenden-Colson Center for Pancreatic Care, Oregon Health & Science University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Oleh Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 SW Bond Avenue Portland, Portland, OR, 97239, USA
| |
Collapse
|
4
|
Ladke P, Mitra K, Dhok A, Ansari A, Dalvi V. Magnetic Resonance Imaging in the Diagnosis of Female Adnexal Masses: Comparison With Histopathological Examination. Cureus 2023; 15:e42392. [PMID: 37621820 PMCID: PMC10446504 DOI: 10.7759/cureus.42392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction Adnexal masses present a special diagnostic challenge because it is difficult to differentiate between benign and malignant lesions clinically. The diagnosis of malignancy is vital, and imaging is the most important part of the evaluation of adnexal masses. This study was conducted with the goal of comparing the accuracy of magnetic resonance imaging (MRI) in diagnosing female adnexal masses in comparison with histopathology examination (HPE). A total of 70 female patients with suspected adnexal lesions were selected for the study. After obtaining informed consent from the patients, an MRI was performed with a subsequent histopathological examination of the lesion. Results The study revealed that MRI demonstrated 27% non-neoplastic, 47% benign, and 26% malignant lesions. HPE, the gold standard for identifying and classifying pathological masses, positively identified the lesions and classified them as non-neoplastic, surface epithelial-stromal, germ cell, and sex cord-stromal tumors. The present study of 70 cases with adnexal masses showed a strong positive correlation between MRI and HPE findings. Conclusion MRI provides the added advantage of visualization of the tumor matrix with differential identification of the fatty and cystic tissue through heterogeneous signals and enhancement indicating aggressiveness and local spread. MRI has greater diagnostic accuracy when compared to ultrasonography (USG), with HPE as the gold standard for discriminating between benign and malignant adnexal masses.
Collapse
Affiliation(s)
- Pooja Ladke
- Radiodiagnosis, N. K. P. Salve Institute of Medical Sciences and Research Centre (NKPSIMS) and Lata Mangeshkar Hospital (LMH), Nagpur, IND
| | - Kajal Mitra
- Radiodiagnosis, N. K. P. Salve Institute of Medical Sciences and Research Centre (NKPSIMS) and Lata Mangeshkar Hospital (LMH), Nagpur, IND
| | - Avinash Dhok
- Radiodiagnosis, N. K. P. Salve Institute of Medical Sciences and Research Centre (NKPSIMS) and Lata Mangeshkar Hospital (LMH), Nagpur, IND
| | - Ameen Ansari
- Radiodiagnosis, N. K. P. Salve Institute of Medical Sciences and Research Centre (NKPSIMS) and Lata Mangeshkar Hospital (LMH), Nagpur, IND
| | - Vrushali Dalvi
- Radiodiagnosis, N. K. P. Salve Institute of Medical Sciences and Research Centre (NKPSIMS) and Lata Mangeshkar Hospital (LMH), Nagpur, IND
| |
Collapse
|
5
|
Chitra Veena S, Vajagathali M, Ramakrishnan V. A systematic review on the association between ovarian and prostate cancer with <I>BRCA1</I> and <I>BRCA2</I> gene. SIBERIAN JOURNAL OF ONCOLOGY 2023; 21:145-155. [DOI: 10.21294/1814-4861-2022-21-6-145-155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Background. BRCA1 and BRCA2 were discussed as the basis of inherited adenocarcinoma and breast and ovarian malignancy. Ovarian cancer is uncommon in women below 40 years of age, and prostate cancer mainly occurs in older men cause 90 % in those above sixty-fve.Objective. The main objective of this paper is to investigate the relationship between ovarian and prostate cancer with the BRCA1 and BRCA2 genes.Material and Methods. The ovarian and prostate cancer mechanism is discussed in detail, and their preventive measures with screening techniques are also demonstrated. This systematic review collected the related articles from online databases using the key terms ovarian cancer, prostate cancer, BRCA genes, mutation, polymorphism, carcinoma, sarcoma, and genetic association.Results. Based on the obtained information, it is found that the BRCA genes are highly associated with prostate cancer in men, and in women, it is significantly linked with breast cancer than ovarian cancer.Conclusion. Therefore, early diagnosis and genetic testing for BRCA1&BRCA2 genes in both men and women are necessary. In some cases, these genes might even cause different types of cancer like pancreatic cancers. Identifying individuals with tumour-HRD through mutations in the homologous repair pathway and determining this gene expression is essential to improve treatment techniques developed during the previous decade and rapidly make their way into clinical trials practice. However, the safe introduction of these medicines into everyday practice will require a thorough understanding of treatment targets and associated adverse effects.
Collapse
Affiliation(s)
- Sarpparajan Chitra Veena
- Human Cytogenetics and Genomics Laboratory, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam
| | - Mohammed Vajagathali
- Human Cytogenetics and Genomics Laboratory, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam
| | - Veerabathiran Ramakrishnan
- Human Cytogenetics and Genomics Laboratory, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam
| |
Collapse
|
6
|
Manganaro L, Celli V, Viggiani V, Berardelli E, Granato T, Tartaglione S, Farina A, Catalano C, Angeloni A, Anastasi E. CT imaging phenotypes linked to CA125 and HE4 biomarkers are highly predictive in discriminating between hereditary and sporadic ovarian cancer patients. Tumour Biol 2022; 44:171-185. [DOI: 10.3233/tub-211557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Hereditary ovarian cancers (HOC) represent about 23% of ovarian cancer (OC) cases: they are most frequently related to germline mutations in the BRCA genes. OBJECTIVE: We aimed to compare CA125/HE4 serum levels and Computed Tomography (CT) features at time of ovarian cancer (OC) diagnosis in two populations: BRCA mutant and BRCA wild-type (WT) OC, and to investigate the relationship between this laboratory and radiological biomarker and BRCA mutation status. METHODS: This retrospective study included 60 newly diagnosed OC patients with FIGO stage IIIC-IV disease, tested for BRCA1/2 germline mutation status of which preoperative CT scan and serum tumor marker assay were available. RESULTS: The median level of CA125 (708 U/mL) was significantly higher (p < 0.002) in BRCA1/2 mutated patients than in WT patients (176 U/mL), whereas the median level of HE4 (492 pmol/L) was significantly higher (p < 0.002) in WT than in BRCA-mutated patients (252 pmol/L). BRCA mutation carriers showed a higher incidence of bilateral ovarian masses (p = 0.0303) characterized by solid structures (p < 0.00001), higher peritoneal tumor load, macronodular implants >2 cm (p = 0.000099), increased frequency of lymphadenopathies (p = 0.019), and metastasis (p = 0.052) compared to patients with BRCA WT. CONCLUSIONS: Tumor markers and CT patterns may help in identifying BRCA mutation status in OC directing patients towards a personalized treatment.
Collapse
Affiliation(s)
- Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Veronica Celli
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Valentina Viggiani
- Department of Molecular Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Elena Berardelli
- Department of Experimental Medicine “Sapienza” University of Rome, Rome, Italy
| | - Teresa Granato
- CNR-IBPM, National Research Council, Institute of Molecular Biology and Pathology, Rome, Italy
| | - Sara Tartaglione
- Department of Experimental Medicine “Sapienza” University of Rome, Rome, Italy
| | - Antonella Farina
- Department of Experimental Medicine “Sapienza” University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Antonio Angeloni
- Department of Experimental Medicine “Sapienza” University of Rome, Rome, Italy
| | - Emanuela Anastasi
- Department of Experimental Medicine “Sapienza” University of Rome, Rome, Italy
| |
Collapse
|
7
|
Abe A, Imoto I, Tange S, Nishimura M, Iwasa T. Prevalence of Pathogenic Germline BRCA1/2 Variants and Their Association with Clinical Characteristics in Patients with Epithelial Ovarian Cancer in a Rural Area of Japan. Genes (Basel) 2022; 13:genes13061085. [PMID: 35741847 PMCID: PMC9223158 DOI: 10.3390/genes13061085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 02/01/2023] Open
Abstract
The prevalence of germline BRCA1 or BRCA2 pathogenic variants (gBRCA1/2-PV) in patients with primary epithelial ovarian cancer (OC) in a rural area of Japan and their association with clinical characteristics, including treatment response and survival outcome, were investigated. A total of 123 unbiased patients with OC were tested for gBRCA1 and gBRCA2 using next-generation sequencing-based targeted amplicon sequencing. Clinical characteristics of OC patients with and without gBRCA1/2 status were compared. The overall prevalence of gBRCA1/2-PV was 15.4% (19 cases), with gBRCA2-PV (10.5%, 13 cases) being more common than gBRCA1-PV (4.9%, 6 cases). Among the observed gBRCA1/2-PV, several novel variants were included, suggesting that gBRCA1/2-PV unique to the local area exist. gBRCA1/2-PV was significantly more prevalent in OC patients at an older age, with high-grade serous carcinoma, with advanced-stage tumors, and with a family history of breast cancer or hereditary breast and ovarian cancer syndrome (HBOC)-associated cancers. Patients with advanced-stage OC with gBRCA1/2-PV showed a significantly lower recurrence rate and tended to have better progression-free and overall survival than those with wild-type gBRCA1/2. Genetic testing for gBRCA1/2 status in all OC patients is useful not only for diagnosing HBOC in patients and their relatives to assess the risk of HBOC-associated cancers, but also to estimate therapy response and outcomes in patients.
Collapse
Affiliation(s)
- Akiko Abe
- Department of Gynecology, Cancer Institute Hospital of JCFR, Tokyo 135-8550, Japan
- Department of Obstetrics and Gynecology, Tokushima University, Tokushima 770-8503, Japan; (M.N.); (T.I.)
- Correspondence: ; Tel.: +81-3-3520-0111
| | - Issei Imoto
- Aichi Cancer Center Research Institute, Nagoya 464-8681, Japan;
| | - Shoichiro Tange
- Department of Medical Genome Sciences, Research Institute for Frontier Medicine, Sapporo Medical University, Sapporo 060-8556, Japan;
| | - Masato Nishimura
- Department of Obstetrics and Gynecology, Tokushima University, Tokushima 770-8503, Japan; (M.N.); (T.I.)
| | - Takeshi Iwasa
- Department of Obstetrics and Gynecology, Tokushima University, Tokushima 770-8503, Japan; (M.N.); (T.I.)
| |
Collapse
|
8
|
Kostov S, Watrowski R, Kornovski Y, Dzhenkov D, Slavchev S, Ivanova Y, Yordanov A. Hereditary Gynecologic Cancer Syndromes - A Narrative Review. Onco Targets Ther 2022; 15:381-405. [PMID: 35422633 PMCID: PMC9005127 DOI: 10.2147/ott.s353054] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/18/2022] [Indexed: 12/11/2022] Open
Abstract
Hereditary cancer syndromes are defined as syndromes, where the genetics of cancer are the result of low penetrant polymorphisms or of a single gene disorder inherited in a mendelian fashion. During the last decade, compelling evidence has accumulated that approximately 5-10% of all cancers could be attributed to hereditary cancer syndromes. A tremendous progress has been made over the last decade in the evaluation and management of these syndromes. However, hereditary syndromes associated with gynecologic malignancies still present significant challenge for oncogynecologists. Oncogynecologists tend to pay more attention to staging, histological type and treatment options of gynecological cancers than thinking of inherited cancers and taking a detailed family history. Moreover, physicians should also be familiar with screening strategies in patients with inherited gynecological cancers. Lynch syndrome and hereditary breast-ovarian cancer syndrome are the most common and widely discussed syndromes in medical literature. The aim of the present review article is to delineate and emphasize the majority of hereditary gynecological cancer syndromes, even these, which are rarely reported in oncogynecology. The following inherited cancers are briefly discussed: Lynch syndrome; "site-specific" ovarian cancer and hereditary breast-ovarian cancer syndrome; Cowden syndrome; Li-Fraumeni syndrome; Peutz-Jeghers syndrome; ataxia-telangiectasia; DICER1- syndrome; gonadal dysgenesis; tuberous sclerosis; multiple endocrine neoplasia type I, II; hereditary small cell carcinoma of the ovary, hypercalcemic type and hereditary undifferentiated uterine sarcoma; hereditary diffuse gastric cancer and MUTYH-associated polyposis. Epidemiology, pathogenesis, diagnosis, pathology and screening of these syndromes are discussed. General treatment recommendations are beyond the scope of this review.
Collapse
Affiliation(s)
- Stoyan Kostov
- Department of Gynecology, University Hospital "Saint Anna", Medical University "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria.,Faculty of Health Care, Medical University Pleven, Pleven, Bulgaria
| | - Rafał Watrowski
- Faculty of Medicine, University of Freiburg, Freiburg, 79106, Germany
| | - Yavor Kornovski
- Department of Gynecology, University Hospital "Saint Anna", Medical University "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Deyan Dzhenkov
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Division of General and Clinical Pathology, Faculty of Medicine, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Stanislav Slavchev
- Department of Gynecology, University Hospital "Saint Anna", Medical University "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Yonka Ivanova
- Department of Gynecology, University Hospital "Saint Anna", Medical University "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, Pleven, Bulgaria
| |
Collapse
|
9
|
Elshami M, Tuffaha A, Yaseen A, Alser M, Al-Slaibi I, Jabr H, Ubaiat S, Khader S, Khraishi R, Jaber I, Abu Arafeh Z, Al-Madhoun S, Alqattaa A, Abd El Hadi A, Barhoush O, Hijazy M, Eleyan T, Alser A, Abu Hziema A, Shatat A, Almakhtoob F, Mohamad B, Farhat W, Abuamra Y, Mousa H, Adawi R, Musallam A, Abu-El-Noor N, Bottcher B. Awareness of ovarian cancer risk and protective factors: A national cross-sectional study from Palestine. PLoS One 2022; 17:e0265452. [PMID: 35312720 PMCID: PMC8936444 DOI: 10.1371/journal.pone.0265452] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/01/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Having a good awareness of ovarian cancer (OC) risk and protective factors could facilitate early diagnosis. This study aimed to assess Palestinian women's awareness about OC risk and protective factors and to identify the factors associated with having good awareness. METHODS A cross-sectional study was conducted from July 2019 to March 2020 in the two main areas of Palestine: the West Bank and Jerusalem (WBJ) and the Gaza Strip. A translated-into-Arabic version of the validated OC awareness measure was utilized. Adult women attending hospitals, primary healthcare centers, and public spaces at 11 governorates were invited to participate. The awareness level was categorized based on the number of factors recognized: poor (0 to 5), fair (6 to 10) and good (11 to 15). RESULTS Of the 6095 women approached, 5618 agreed and completed the questionnaire (response rate = 92.1%). The final analysis included 5411 questionnaires. The most identified modifiable OC risk factor was 'being a smoker' (n = 4024, 74.4%), whereas the least identified was 'having in vitro fertilization treatment' (n = 1652, 30.5%). The most identified non-modifiable OC risk factor was 'having ovarian cysts' (n = 3136, 58.0%), whereas the least identified was 'having endometriosis' (n = 1880, 34.7%). The most identified OC protective factor was 'breastfeeding' (n = 4770, 88.2%), whereas the least identified was 'using the pill for a long time' (n = 930, 17.2%). Only 820 women (15.2%) displayed good awareness of OC risk and protective factors. Women from the Gaza Strip were slightly more likely than women from the WBJ to have good awareness (16.4% vs. 14.2%). In contrast, post-secondary education, higher monthly income, being married, and knowing someone with cancer were associated with an increase in the likelihood of displaying good awareness. CONCLUSION The overall awareness of OC risk and protective factors in this study was low. Educational interventions are needed to improve Palestinian women's awareness.
Collapse
Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
- Ministry of Health, Gaza, Palestine
| | - Aya Tuffaha
- Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | - Areej Yaseen
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | - Hadeel Jabr
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Sara Ubaiat
- Faculty of Medicine, Al-Quds University, Bethlehem, Palestine
| | - Salma Khader
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Reem Khraishi
- Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | - Inas Jaber
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | - Aya Alqattaa
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Ola Barhoush
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Maysun Hijazy
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Tamara Eleyan
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Amal Abu Hziema
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Amany Shatat
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | | | - Walaa Farhat
- Faculty of Medicine, Al-Quds University, Jenin, Palestine
| | - Yasmeen Abuamra
- Faculty of Medicine, Al-Azhar university-Gaza, Gaza, Palestine
| | - Hanaa Mousa
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Reem Adawi
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| |
Collapse
|
10
|
Fanale D, Pivetti A, Cancelliere D, Spera A, Bono M, Fiorino A, Pedone E, Barraco N, Brando C, Perez A, Guarneri MF, Russo TDB, Vieni S, Guarneri G, Russo A, Bazan V. BRCA1/2 variants of unknown significance in hereditary breast and ovarian cancer (HBOC) syndrome: looking for the hidden meaning. Crit Rev Oncol Hematol 2022; 172:103626. [PMID: 35150867 DOI: 10.1016/j.critrevonc.2022.103626] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 01/04/2023] Open
Abstract
Hereditary breast and ovarian cancer syndrome is caused by germline mutations in BRCA1/2 genes. These genes are very large and their mutations are heterogeneous and scattered throughout the coding sequence. In addition to the above-mentioned mutations, variants of uncertain/unknown significance (VUSs) have been identified in BRCA genes, which make more difficult the clinical management of the patient and risk assessment. In the last decades, several laboratories have developed different databases that contain more than 2000 variants for the two genes and integrated strategies which include multifactorial prediction models based on direct and indirect genetic evidence, to classify the VUS and attribute them a clinical significance associated with a deleterious, high-low or neutral risk. This review provides a comprehensive overview of literature studies concerning the VUSs, in order to assess their impact on the population and provide new insight for the appropriate patient management in clinical practice.
Collapse
Affiliation(s)
- Daniele Fanale
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
| | - Alessia Pivetti
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
| | - Daniela Cancelliere
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
| | - Antonio Spera
- Department of Radiotherapy, San Giovanni di Dio Hospital, ASP of Agrigento, Agrigento, Italy
| | - Marco Bono
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
| | - Alessia Fiorino
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
| | - Erika Pedone
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
| | - Nadia Barraco
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
| | - Chiara Brando
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
| | - Alessandro Perez
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
| | | | - Tancredi Didier Bazan Russo
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
| | - Salvatore Vieni
- Division of General and Oncological Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy
| | - Girolamo Guarneri
- Gynecology Section, Mother - Child Department, University of Palermo, 90127 Palermo, Italy
| | - Antonio Russo
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy.
| | - Viviana Bazan
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy
| |
Collapse
|
11
|
Recurrent Mutations in BRCA1, BRCA2, RAD51C, PALB2 and CHEK2 in Polish Patients with Ovarian Cancer. Cancers (Basel) 2021; 13:cancers13040849. [PMID: 33670479 PMCID: PMC7921976 DOI: 10.3390/cancers13040849] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of the study was to analyze the frequency and magnitude of association of 21 recurrent founder germline mutations in BRCA1, BRCA2, PALB2, RAD51C, and CHEK2 genes with ovarian cancer risk among unselected patients in Poland. We genotyped 21 recurrent germline mutations in BRCA1 (9 mutations), BRCA2 (4 mutations), RAD51C (3 mutations), PALB2 (2 mutations), and CHEK2 (3 mutations) among 2270 Polish ovarian cancer patients and 1743 healthy controls, and assessed the odds ratios (OR) for developing ovarian cancer for each gene. Mutations were detected in 369 out of 2095 (17.6%) unselected ovarian cancer cases and 117 out of 1743 (6.7%) unaffected controls. The ovarian cancer risk was associated with mutations in BRCA1 (OR = 40.79, 95% CI: 18.67-114.78; p = 0.29 × 10-15), in BRCA2 (OR = 25.98; 95% CI: 1.55-434.8; p = 0.001), in RAD51C (OR = 6.28; 95% CI 1.77-39.9; p = 0.02), and in PALB2 (OR 3.34; 95% CI: 1.06-14.68; p = 0.06). There was no association found for CHEK2. We found that pathogenic mutations in BRCA1, BRCA2, RAD51C or PALB2 are responsible for 12.5% of unselected cases of ovarian cancer. We recommend that all women with ovarian cancer in Poland and first-degree female relatives should be tested for this panel of 18 mutations.
Collapse
|
12
|
Pietragalla A, Arcieri M, Marchetti C, Scambia G, Fagotti A. Ovarian cancer predisposition beyond BRCA1 and BRCA2 genes. Int J Gynecol Cancer 2020; 30:1803-1810. [PMID: 32895312 DOI: 10.1136/ijgc-2020-001556] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/22/2022] Open
Abstract
Several genes associated with hereditary ovarian cancer have been discovered as a result of the work done with next generation sequencing. It is estimated that approximately 23% of ovarian carcinomas have a hereditary predisposition. The most common hereditary condition is represented by germline mutations in BRCA1 or BRCA2 genes that account for 20-25% of high grade serous ovarian cancer. A number of other hereditary ovarian cancers are associated with different genes, with a crucial role in the DNA damage response pathway, such as the mismatch repair genes in Lynch syndrome, TP53 in Li-Fraumeni syndrome, STK11 in Peutz-Jeghers syndrome, CHEK2, RAD51, BRIP1, and PALB2. The goal of this manuscript is to summarize the published data regarding the molecular pathways involved in the pathogenesis of non-BRCA related hereditary ovarian cancer and to provide a tool that might be useful in discussing risk assessment, genetic testing, prevention strategies, as well as clinical and therapeutic implications for patients with ovarian cancer.
Collapse
Affiliation(s)
- Antonella Pietragalla
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Martina Arcieri
- Department of Obstetrics and Gynecology, University of Eastern Piedmont, Novara, Italy
| | - Claudia Marchetti
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy .,Catholic University of Sacred Heart, Rome, Italy
| | - Anna Fagotti
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
| |
Collapse
|
13
|
Yadav G, Vashisht M, Yadav V, Shyam R. Molecular Biomarkers for Early Detection and Prevention of Ovarian Cancer-A Gateway for Good Prognosis: A Narrative Review. Int J Prev Med 2020; 11:135. [PMID: 33088463 PMCID: PMC7554434 DOI: 10.4103/ijpvm.ijpvm_75_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/12/2019] [Indexed: 11/13/2022] Open
Abstract
Gynecological cancers are one of the most lethal and deadliest cancers in the world. In India, the prevalence of ovarian cancer accounts for 2.5% to 3%. Despite the availability of improved treatment option along with improved technology, the survival rate of ovarian cancer in the early-stage and the advanced stage is poor. Therefore, due to the heterogeneity of ovarian cancer, to detect it at an early stage and to prevent further mortality turns out to be a big challenge. Researchers are still in the process to identify any single biomarker with good sensitivity and specificity. Various traditional and serum approaches to identify ovarian cancer have been successful in the early stages. The invention of molecular biomarkers such as the use of genomic profiling, DNA methylation, and other approaches have proven to be of higher sensitivity and specificity, which overall affects the prognosis of ovarian cancer. With the use of whole-genome analysis, the detection of possible location of critical tumor suppressor gene (TSGs) in the paired region of chromosomes has been identified, which are associated with BRCA1 and BRCA2 which further makes these novel molecular biomarkers as potential biomarkers. Moreover, studies are required to assess the combined use of traditional, molecular biomarkers that might be useful for enhanced sensitivity and specificity for early detection and prevention of ovarian cancer in early stages which will lead to reduced mortality and good prognosis.
Collapse
Affiliation(s)
- Geetanjali Yadav
- Department of Zoology, Baba Math Nath University, Rohtak, Haryana, India
| | - Minakshi Vashisht
- Department of Genetics, Maharishi Dayanand University, Rohtak, Haryana, India
| | - Vipul Yadav
- Department of Public Health Dentistry, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Radhey Shyam
- Department of Public Health Dentistry, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| |
Collapse
|
14
|
Remon J, Besse B, Leary A, Bièche I, Job B, Lacroix L, Auguste A, Mauduit M, Audigier-Valette C, Raimbourg J, Madroszyk A, Michels S, Bayar MA, Jimenez M, Soria JC, Rouleau E, Barlesi F. Somatic and Germline BRCA 1 and 2 Mutations in Advanced NSCLC From the SAFIR02-Lung Trial. JTO Clin Res Rep 2020; 1:100068. [PMID: 34589950 PMCID: PMC8474245 DOI: 10.1016/j.jtocrr.2020.100068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/17/2020] [Accepted: 06/03/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Molecular profiling is considered a standard of care in advanced NSCLC. A comprehensive next-generation sequencing panel can discover somatic or germline BRCA1/2 mutations that are new druggable molecular alterations. However, the phenotypic and potential therapeutic relevance of BRCA1/2 mutation in NSCLC remains poorly defined. Methods From April 2014 to March 2017, 600 newly diagnosed, EGFR/ALK negative patients with advanced NSCLC were enrolled in the SAFIR02-Lung trial. Molecular profiling was done at study entry on archival tissue or frozen tissue collected from a new biopsy specimen before the third cycle of platinum-based chemotherapy. The prevalence of BRCA1/2 variants and its biological relevance were assessed. A homologous recombinant deficiency (HRD) score was based on the copy number variation data, and the germline status was determined by blood analysis. The BRCA Share database and the French CGG consortium were the references for the variant classification. Results Of 379 patients with a molecular profile discussed in a tumor molecular board, BRCA1/2 variants were identified in 20 patients (5.3%), including eight patients (2.1%) with a confirmed pathogenic BRCA mutation. Two patients (0.5%) harbored a germline BRCA2 mutation, and for six others, a somatic BRCA mutation was identified (1.6%). All were men and mainly smokers (88%). The overall response rate to chemotherapy was 13%. BRCA variants of unknown significance were detected in 12 patients (3.2%), achieving an 8.3% overall response rate with chemotherapy. One-third of tumors carrying pathogenic BRCA mutations or variants of unknown significance had biallelic inactivation and high HRD score. Overall survival of this cohort was 12.8 months. Conclusions Pathogenic BRCA1/2 mutations occur in 2.1% of patients with advanced NSCLC. The predictive role of BRCA mutation for making treatment decisions in NSCLC seems limited based on clinical response (low platinum sensitivity) and molecular features (discrepancy between biallelic inactivation and high HRD score).
Collapse
Affiliation(s)
- Jordi Remon
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
| | - Benjamin Besse
- Cancer Medicine Department, Gustave Roussy, Villejuif, France.,University Paris-Saclay, Orsay, France
| | - Alexandra Leary
- Cancer Medicine Department, Gustave Roussy, Villejuif, France.,Service de Génétique des Tumeurs, Département de Biologie et Pathologie Médicale, INSERM U981, Gustave Roussy, Villejuif, France
| | - Ivan Bièche
- Service de Génétique, Institut Curie, Paris, France
| | - Bastien Job
- Laboratoire de Recherche Translationnelle, AMMICA, INSERM US23/CNRS UNS3655, Gustave Roussy, Villejuif, France
| | - Ludovic Lacroix
- Laboratoire de Recherche Translationnelle, AMMICA, INSERM US23/CNRS UNS3655, Gustave Roussy, Villejuif, France
| | - Aurélie Auguste
- Service de Génétique des Tumeurs, Département de Biologie et Pathologie Médicale, INSERM U981, Gustave Roussy, Villejuif, France.,Laboratoire de Recherche Translationnelle, AMMICA, INSERM US23/CNRS UNS3655, Gustave Roussy, Villejuif, France
| | | | | | - Judith Raimbourg
- Oncology Department, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Anne Madroszyk
- Pneumology Department, Institut Paoli Calmettes, Marseille, France
| | - Stefan Michels
- Service de Biostatistics and Epidemiology, Gustave Roussy and CESP, INSERM, University Paris-Saclay, Villejuif, France
| | - Mohammed Amine Bayar
- Service de Biostatistics and Epidemiology, Gustave Roussy and CESP, INSERM, University Paris-Saclay, Villejuif, France
| | | | - Jean-Charles Soria
- Cancer Medicine Department, Gustave Roussy, Villejuif, France.,University Paris-Saclay, Orsay, France
| | - Etienne Rouleau
- Service de Génétique des Tumeurs, Département de Biologie et Pathologie Médicale, INSERM U981, Gustave Roussy, Villejuif, France.,Service de Génétique, Institut Curie, Paris, France
| | - Fabrice Barlesi
- Cancer Medicine Department, Gustave Roussy, Villejuif, France.,Aix Marseille University, CNRS, INSERM, CRCM, APHM, Marseille, France
| |
Collapse
|
15
|
Frequency of mutations in BRCA genes and other candidate genes in high-risk probands or probands with breast or ovarian cancer in the Czech Republic. Mol Biol Rep 2020; 47:2763-2769. [PMID: 32180084 DOI: 10.1007/s11033-020-05378-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/12/2020] [Indexed: 01/08/2023]
Abstract
Breast cancer is currently the most common form of malignant tumour in womenboth in the Czech Republic and in most countries of the western world, and its incidence is constantly increasing. Many risk factors are known to play a major role in the development of this form of cancer. One of them is genetics, especially the BRCA1/2 genes. A higher risk of ovarian cancer is also associated with these genes. With the development of laboratory diagnostics massive parallel sequencing methods (NGS) are now routinely employed, enabling the detection of other pathogenic sequence variants, or variants of uncertain significance (VUS) not previously detected. Besides the high penetrance BRCA1/2 genes, medium and low penetrant genes also come to the fore. There were 2046 probands examined in the study, men and women, mainly from eastern part of the Czech Republic. These were selected for a genetic examination, after meeting indication criteria (probands from high-risk families or with breast or ovarian cancer). From this group only women, 2033 probands, were selected and were given a genetic examination for the possible presence of patogenic sequence variants in BRCA1/2 genes, or other candidate genes. Analyses were conducted in the laboratory using DHPLC or next generation sequencing. MLPA method is used for large rearrangements in genes. From all examined women 212 mutations were detected. The most mutations (128) were found in the BRCA1 gene (60%). In the BRCA2 gene 71 mutations (34%) were found and 13 more mutations (6%) were detected in another candidate genes (CHEK2, PALB2, ERCC4). The most frequent sequence variant was c.5266dupC in the BRCA1 gene. The results show that 72% of women with a confirmed mutation in the BRCA1 gene and 77.5% of women with the sequence variant BRCA2, already had breast cancer and 16.4% of women with BRCA1 and 7% of women with BRCA2 already had ovarian cancer. Only 21 high risk families used the possibility to be tested and had undergone targeted mutation testing. The study results suggest a reflection of the causes and needs for examination of patients and women predisposed to breast or ovarian cancer.
Collapse
|
16
|
You Y, Li L, Lu J, Wu H, Wang J, Gao J, Wu M, Liang Z. Germline and Somatic BRCA1/2 Mutations in 172 Chinese Women With Epithelial Ovarian Cancer. Front Oncol 2020; 10:295. [PMID: 32211327 PMCID: PMC7077344 DOI: 10.3389/fonc.2020.00295] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/20/2020] [Indexed: 12/17/2022] Open
Abstract
Objective: Despite several nationwide cohort studies of germline BRCA1/2 mutations and several small cohort studies of somatic BRCA1/2 mutations in Chinese epithelial ovarian cancer (EOC) patients, little is known about the impact of these findings on survival outcomes in this population. In this study of 172 retrospectively recruited Chinese EOC patients, germline and somatic BRCA1/2 mutations and their value for predicting survival outcomes were evaluated. Methods: Unselected patients who visited the study center from January 1, 2011, to January 1, 2015, were recruited and asked to provide peripheral blood samples for this study if they were pathologically confirmed to have primary EOC. All patients received staging surgeries or debulking surgeries involving systemic platinum-based chemotherapy, and the patients were then followed up to December 1, 2017. DNA was extracted from formalin-fixed, paraffin-embedded (FFPE) sections and peripheral blood and sequenced for somatic and germline testing, respectively. The demographic and clinicopathological characteristics of the patients were collected to analyze the distribution of BRCA mutations in subgroups. Survival outcomes were compared among various BRCA mutation statuses using univariate and multivariate models. Results: In 58 (33.7%) patients, 63 variants were identified, including variants of unknown significance (VUS) in 18 patients (10.5%) and pathogenic or likely pathogenic variants in a partially overlapping set of 41 patients (23.8%). Germline BRCA mutations, somatic BRCA mutations, BRCA1 mutations in general, and BRCA2 mutations in general were found in 35 (20.3%), 7 (4.1%), 28 (16.3%), and 13 (7.6%) patients, respectively. Five recurrent mutations were identified. Personal and family cancer histories as well as hereditary breast and ovarian cancer (HBOC) criteria were associated with deleterious BRCA mutations both overall and in the germline specifically, whereas only age at diagnosis of EOC was associated with somatic BRCA mutations. In univariate and Cox regression analyses, patients with BRCA1/2 mutations in general had significant improvements in progression-free survival (PFS) and overall survival (OS). Conclusions: In Chinese EOC patients, the distributions and risk factors associated with germline and somatic BRCA1/2 mutations were similar to those previously reported in international studies. Deleterious BRCA mutations in general were associated with improved survival outcomes in this cohort.
Collapse
Affiliation(s)
- Yan You
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Lei Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Junliang Lu
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Huanwen Wu
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Jing Wang
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Jie Gao
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Zhiyong Liang
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| |
Collapse
|
17
|
Rahbar A, AlKharusi A, Costa H, Pantalone MR, Kostopoulou ON, Cui HL, Carlsson J, Rådestad AF, Söderberg-Naucler C, Norstedt G. Human Cytomegalovirus Infection Induces High Expression of Prolactin and Prolactin Receptors in Ovarian Cancer. BIOLOGY 2020; 9:biology9030044. [PMID: 32121009 PMCID: PMC7150842 DOI: 10.3390/biology9030044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 11/30/2022]
Abstract
One of the potential biomarkers for ovarian cancer patients is high serum level of prolactin (PRL), which is a growth factor that may promote tumor cell growth. The prolactin receptor (PRLR) and human cytomegalovirus (HCMV) proteins are frequently detected in ovarian tumor tissue specimens, but the potential impact of HCMV infection on the PRL system have so far not been investigated. In this study, HCMV’s effects on PRL and PRLR expression were assessed in infected ovarian cancer cells (SKOV3) by PCR and Western blot techniques. The levels of both PRL and PRLR transcripts as well as the corresponding proteins were highly increased in HCMV-infected SKOV3 cells. Tissue specimens obtained from 10 patients with ovarian cancer demonstrated high expression of PRLR, HCMV-IE, and pp65 proteins. Extensive expression of PRLR was detected in all examined ovarian tumor tissue specimens except for one from a patient who had focal expression of PRLR and this patient was HCMV-negative in her tumor. In conclusion, PRL and PRLR were induced to high levels in HCMV-infected ovarian cancer cells and PRLR expression was extensively detected in HCMV-infected ovarian tissue specimens. Highly induced PRL and PRLR by HCMV infection may be of relevance for the oncomodulatory role of this virus in ovarian cancer.
Collapse
Affiliation(s)
- Afsar Rahbar
- Department of Medicine, Solna, Division of Microbial Pathogenesis, BioClinicum, Karolinska Institutet, 171 64 Solna, Sweden; (H.C.); (M.R.P.); (O.N.K.); (H.L.C.); (C.S.-N.)
- Division of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden
- Correspondence: (A.R.); (A.K.)
| | - Amira AlKharusi
- Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 135, Oman
- Correspondence: (A.R.); (A.K.)
| | - Helena Costa
- Department of Medicine, Solna, Division of Microbial Pathogenesis, BioClinicum, Karolinska Institutet, 171 64 Solna, Sweden; (H.C.); (M.R.P.); (O.N.K.); (H.L.C.); (C.S.-N.)
- Division of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden
| | - Mattia Russel Pantalone
- Department of Medicine, Solna, Division of Microbial Pathogenesis, BioClinicum, Karolinska Institutet, 171 64 Solna, Sweden; (H.C.); (M.R.P.); (O.N.K.); (H.L.C.); (C.S.-N.)
- Division of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden
| | - Ourania N. Kostopoulou
- Department of Medicine, Solna, Division of Microbial Pathogenesis, BioClinicum, Karolinska Institutet, 171 64 Solna, Sweden; (H.C.); (M.R.P.); (O.N.K.); (H.L.C.); (C.S.-N.)
- Division of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden
| | - Huanhuan L. Cui
- Department of Medicine, Solna, Division of Microbial Pathogenesis, BioClinicum, Karolinska Institutet, 171 64 Solna, Sweden; (H.C.); (M.R.P.); (O.N.K.); (H.L.C.); (C.S.-N.)
- Division of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden
| | - Joseph Carlsson
- Division of Pathology and Cytology, Karolinska University Hospital, 171 77 Stockholm, Sweden;
- Department of Oncology and Pathology, BioClinicum, Karolinska Institutet, 171 64 Solna, Sweden
| | - Angelique Flöter Rådestad
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Division of Obstetrics and Gynecology, Karolinska University Hospital, 171 77 Stockholm, Sweden
| | - Cecilia Söderberg-Naucler
- Department of Medicine, Solna, Division of Microbial Pathogenesis, BioClinicum, Karolinska Institutet, 171 64 Solna, Sweden; (H.C.); (M.R.P.); (O.N.K.); (H.L.C.); (C.S.-N.)
- Division of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden
| | - Gunnar Norstedt
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 135, Oman;
| |
Collapse
|
18
|
Enomoto T, Aoki D, Hattori K, Jinushi M, Kigawa J, Takeshima N, Tsuda H, Watanabe Y, Yoshihara K, Sugiyama T. The first Japanese nationwide multicenter study of BRCA mutation testing in ovarian cancer: CHARacterizing the cross-sectionaL approach to Ovarian cancer geneTic TEsting of BRCA (CHARLOTTE). Int J Gynecol Cancer 2020; 29:1043-1049. [PMID: 31263023 DOI: 10.1136/ijgc-2019-000384] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/26/2019] [Accepted: 05/02/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION BRCA gene mutations are associated with hereditary ovarian cancer. BRCA plays a key role in genome integrity, and mutations result in an increased risk for ovarian cancer. Although various guidelines recommend BRCA testing in patients with ovarian cancer, data on germline BRCA (gB RCA) mutation frequency in ovarian cancer in Japan are scarce. OBJECTIVE This study aimed to determine gBRCA1/2 mutations in Japanese patients with ovarian cancer, stratified by clinicopathological characteristics, and to assess patients' satisfaction with pre-test genetic counseling. METHODS The CHARLOTTE study (CHARacterizing the cross-sectionaL approach to Ovarian cancer: geneTic TEsting of BRCA; UMIN000025597) is the first large multicenter epidemiological survey of Japanese women, aged ≥20, with newly diagnosed ovarian cancer (epithelial, primary peritoneal, or fallopian tube cancer), with histologically confirmed specimens. Patients were enrolled sequentially and underwent pre-test genetic counseling for BRCA testing. Blood samples were centrally tested for the presence or absence of known gBRCA mutations. A questionnaire was used to assess patient satisfaction with pre-test genetic counseling. RESULTS A total of 634 patients with a mean age of 56.9 years were included. Most patients (84.2%) had epithelial ovarian cancer, and 51.1% had FIGO stage III-IV cancer. Nearly all patients (99.5%) received genetic counseling before the BRCA testing, either by an obstetrician-gynecologist (42.0%) or a clinical geneticist (42.0%). The overall prevalence of gBRCA1/2 mutations was 14.7% (93/634), with gBRCA1 mutations (9.9%) more common than gBRCA2 mutations (4.7%). High-grade serous carcinoma showed a prevalence of gBRCA mutations of 28.5%. Most patients were satisfied with pre-test counseling, irrespective of the service provider's professional position. DISCUSSION Patients with high-grade serous carcinoma and family history of ovarian cancer had a slightly higher prevalence of gBRCA mutations, but none of the subgroups had considerably high gBRCA mutation prevalence. These data suggest that gBRCA testing should be carried out in all patients with ovarian cancer.
Collapse
Affiliation(s)
- Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kana Hattori
- Medical Department, AstraZeneca K.K, Osaka, Japan
| | | | - Junzo Kigawa
- Department of Obstetrics and Gynecology, Matsue City Hospital, Matsue, Japan
| | | | - Hitoshi Tsuda
- Department of Basic Pathology, National Defense Medical College, Tokorozawa, Japan
| | - Yoh Watanabe
- Department of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toru Sugiyama
- Women's Cancer Center, Takagi Hospital, Okawa, Japan
| |
Collapse
|
19
|
Association of expression of p53, livin, ERCC1, BRCA1 and PARP1 in epithelial ovarian cancer tissue with drug resistance and prognosis. Pathol Res Pract 2020; 216:152794. [DOI: 10.1016/j.prp.2019.152794] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/28/2019] [Accepted: 12/12/2019] [Indexed: 01/01/2023]
|
20
|
Ma YN, Bu HL, Jin CJ, Wang X, Zhang YZ, Zhang H. Peritoneal cancer after bilateral mastectomy, hysterectomy, and bilateral salpingo-oophorectomy with a poor prognosis: A case report and review of the literature. World J Clin Cases 2019; 7:3872-3880. [PMID: 31799317 PMCID: PMC6887594 DOI: 10.12998/wjcc.v7.i22.3872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/19/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary peritoneal cancer (PPC) patients with BRCA mutations have a good prognosis; however, for patients with BRCA mutations who are diagnosed with PPC after prophylactic salpingo-oophorectomy (PSO), the prognosis is poor, and survival information is scarce.
CASE SUMMARY We treated a 56-year-old woman with PPC after bilateral mastectomy, hysterectomy, and bilateral salpingo-oophorectomy. This patient had primary drug resistance and died 12 mo after the diagnosis of PPC. The genetic test performed on this patient indicated the presence of a germline BRCA1 mutation. We searched the PubMed, Scopus, and Cochrane databases and extracted studies of patients with BRCA mutations who developed PPC after PSO. After a detailed literature search, we found 30 cases, 7 of which had a history of breast cancer, 14 of which had no history of breast cancer, and 9 of which had an unknown history. The average age of PSO patients was 48.86 years old (range, 31-64 years). The average time interval between the diagnosis of PPC and preventive surgery was 61.03 mo (range, 12-292 mo). The 2-year survival rate for this patient population was 78.26% (18/23), the 3-year survival rate was 50.00% (9/18), and the 5-year survival rate was 6.25% (1/16).
CONCLUSION Patients with BRCA mutations who are diagnosed with PPC after preventative surgery have a poor prognosis. Prevention measures and treatments for these patients need more attention.
Collapse
Affiliation(s)
- Ya-Na Ma
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Hua-Lei Bu
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Cheng-Juan Jin
- Department of Obstetrics and Gynecology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 201620, China
| | - Xia Wang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - You-Zhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Hui Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| |
Collapse
|
21
|
Kyo S, Ishikawa N, Nakamura K, Nakayama K. The fallopian tube as origin of ovarian cancer: Change of diagnostic and preventive strategies. Cancer Med 2019; 9:421-431. [PMID: 31769234 PMCID: PMC6970023 DOI: 10.1002/cam4.2725] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 01/20/2023] Open
Abstract
Ovarian cancer is the leading cause of gynecologic cancer death in the world, and its prevention and early diagnosis remain the key to its treatment, especially for high‐grade serous carcinoma (HGSC). Accumulating epidemiological and molecular evidence has shown that HGSC originates from fallopian tube secretory cells through serous tubal intraepithelial carcinoma. Comprehensive molecular analyses and mouse studies have uncovered the key driver events for serous carcinogenesis, providing novel molecular targets. Risk‐reducing bilateral salpingo‐oophorectomy (RRSO) has been proposed to reduce the subsequent occurrence of serous carcinoma in high‐risk patients with BRCA mutations. However, there is no management strategy for isolated precursors detected at RRSO, and the role of subsequent surgery or chemotherapy in preventing serous carcinoma remains unclear. Surgical menopause due to RRSO provides a variety of problems related to patients’ quality of life, and the risks and benefits of hormone replacement are under investigation, especially for women without a previous history of breast cancer. An additional surgical option, salpingectomy with delayed oophorectomy, has been proposed to prevent surgical menopause. The number of opportunistic salpingectomies at the time of surgery for benign disease to prevent the future occurrence of HGSC has increased worldwide. Thus, the changing concept of the origin of serous carcinoma has provided us a great opportunity to develop novel diagnostic and therapeutic approaches.
Collapse
Affiliation(s)
- Satoru Kyo
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Noriyoshi Ishikawa
- Department of Pathology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kohei Nakamura
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kentaro Nakayama
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| |
Collapse
|
22
|
Contraception options for patients with known hereditary risk for ovarian cancer. JAAPA 2019; 32:37-41. [PMID: 31663894 DOI: 10.1097/01.jaa.0000586384.47435.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
For patients with a known hereditary risk of ovarian cancer, primary prevention typically is accomplished through prophylactic bilateral salpingo-oophorectomy. However, some patients may wish to preserve fertility or delay menopause and its associated comorbidities. This article discusses appropriate methods of contraception for these patients.
Collapse
|
23
|
Cheng A, Li L, Wu M, Lang J. Pathological findings following risk-reducing salpingo-oophorectomy in BRCA mutation carriers: A systematic review and meta-analysis. Eur J Surg Oncol 2019; 46:139-147. [PMID: 31521389 DOI: 10.1016/j.ejso.2019.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/23/2019] [Accepted: 09/04/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate the benefit of risk-reducing salpingo-oophorectomy (RRSO) by estimating the pathological positive rate of occult lesions, including serous tubal intraepithelial carcinoma (STIC) and occult cancers (OCCs). METHODS BRCA1/2 mutation carriers who underwent RRSO in a Chinese study center between 2014 and 2018 were included. A literature review was performed, followed by a meta-analysis of the literature to further validate the findings. RESULTS Twenty-four BRCA1/2 mutation carriers who underwent RRSO were identified; one patient (4.2%) had STIC, and one patient (4.2%) had occult fallopian tube cancer complicated by STIC. Thirty-four articles were ultimately included in the meta-analysis. Of the reported cases of OCC, 61.3% occurred in the fallopian tubes and 32.3% in the ovaries, and 81.5% were in the early stages. The estimated rate of overall pathological positive events was 5%. The estimated rates of overall STIC events and OCC were 1% and 3%, respectively. The rates of STIC and OCC were 1% and 3%, respectively, for BRCA1 mutation carriers and 1% and 1%, respectively, for BRCA2 mutation carriers. No significant difference was observed between the results of a routine examination of pathological sections and those of the Sectioning and Extensively Examining the Fimbriae (SEE-FIM) protocol. CONCLUSIONS This study is the first report of RRSO results in China. In this systematic review, the positive rates of STIC or OCC after RRSO were no more than 3%, which are 200-fold higher than the risk of the general population. The use of a strict SEE-FIM protocol would likely increase positive results.
Collapse
Affiliation(s)
- Aoshuang Cheng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, 100730, China.
| | - Lei Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, 100730, China.
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, 100730, China.
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, 100730, China.
| |
Collapse
|
24
|
Li W, Shao D, Li L, Wu M, Ma S, Tan X, Zhong S, Guo F, Wang Z, Ye M. Germline and somatic mutations of multi-gene panel in Chinese patients with epithelial ovarian cancer: a prospective cohort study. J Ovarian Res 2019; 12:80. [PMID: 31472684 PMCID: PMC6717355 DOI: 10.1186/s13048-019-0560-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/27/2019] [Indexed: 01/11/2023] Open
Abstract
Background Multiple targeted gene sequencing is seldom performed in both germline and somatic testing for ovarian cancer. This study is to evaluate the specific genetic alterations, including both somatic and germline mutations, in Chinese patients with epithelial ovarian cancer (EOC) in a prospective cohort study. Materials and methods Mutations in a customed 21-gene panel that included BRCA1, BRCA2, and 19 other tumor suppressor genes related to homologous recombination (HR) deficiency or non-HR deficiency were detected by targeted exon capture and next-generation sequencing (NGS) technology across all coding exons and exon-intron (±20 base pairs) boundaries. Patients were enrolled consecutively and unselectively without age or family history consideration. Sixty-two unselected patients with epithelial ovarian cancer were enrolled in our study to be tested for paired somatic and germline mutations. All patients were tested using a 21-gene panel that included BRCA1, BRCA2, CHEK2, PALB2, BRIP1, TP53, PTEN, STK11, CDH1, ATM, BARD1, MLH1, MRE11A, MSH2, MSH6, MUTYH, NBN, PMS1, PMS2, RAD50, and RAD51C. Results Mutation analysis revealed that 77.4% (48/62) of patients carried one or more of 64 identified genetic alterations, including 19 germline and 45 somatic deleterious mutations. Twelve individuals shared both germline and somatic mutations. BRCA mutants existed in 17 of 62 (27.4%) patients. Of the 64 mutations detected, 46 (74.2%) were in 7 other HR or non-HR genes, including TP53, PTEN, ATM, CHEK2, PALB2, RAD51C, and STK11. In somatic mutation analysis, TP53 showed frequent pathogenic or likely pathogenic mutations in 56.5% (35/62) of enrolled cases, among which six cases harbored a loss of heterozygosity. Conclusions This is the first report of multi-gene panel testing for germline and somatic mutations among Chinese EOC patients, which revealed a broader deleterious variants than only BRCA testing. Registration Registration No. NCT03015376, clinicaltrials.gov, registered on January 10, 2017. Electronic supplementary material The online version of this article (10.1186/s13048-019-0560-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Wenhui Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Di Shao
- BGI Genomics, BGI-Shenzhen, Shenzhen, 518083, China.,BGI-Guangzhou Medical Laboratory, BGI-Shenzhen, Guangzhou, 510006, China
| | - Lei Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
| | - Shuiqing Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Xianjie Tan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Sen Zhong
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Fengming Guo
- BGI Genomics, BGI-Shenzhen, Shenzhen, 518083, China.,BGI-Guangzhou Medical Laboratory, BGI-Shenzhen, Guangzhou, 510006, China
| | - Zhe Wang
- BGI Genomics, BGI-Shenzhen, Shenzhen, 518083, China
| | - Mingzhi Ye
- BGI Genomics, BGI-Shenzhen, Shenzhen, 518083, China.,BGI-Guangzhou Medical Laboratory, BGI-Shenzhen, Guangzhou, 510006, China
| |
Collapse
|
25
|
Knockdown of long noncoding RNA-taurine-upregulated gene 1 inhibits tumor angiogenesis in ovarian cancer by regulating leucine-rich α-2-glycoprotein-1. Anticancer Drugs 2019; 30:562-570. [DOI: 10.1097/cad.0000000000000734] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
26
|
Ponandai-Srinivasan S, Lalitkumar PG, Garcia L, Varghese SJ, Carlson JW, Gemzell-Danielsson K, Floter Radestad A. Mifepristone mediates anti-proliferative effect on ovarian mesenchymal stem/stromal cells from female BRCA 1-/2- carriers. Acta Obstet Gynecol Scand 2018; 98:250-261. [PMID: 30325501 DOI: 10.1111/aogs.13485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/03/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Women with hereditary mutation in breast cancer-associated genes (BRCA1-/2- ) have a higher lifetime risk of developing ovarian cancer. Here, we aimed to investigate the effect of mifepristone, a selective progesterone receptor modulator of ovarian mesenchymal stem/stromal cells (MSC) from BRCA1-/2- carriers. MATERIAL AND METHODS Ovarian BRCA1-/2- MSC were positively selected using the markers CD90, CD73 and CD105 from nine healthy women. The effect of dose response and combination treatment with mifepristone and analogs of progesterone- or glucocorticoid-receptors were investigated on BRCA1-/2- MSC in vitro using a panel of markers for proliferation (ki67, BrdU, CDK2, p21CIP ), apoptosis (BAX, BCL2, CASPASE3), tumor suppression (TP53, PTEN) and cell survival (PI3KCA, MAPK3, mTOR). RESULTS The dose response with mifepristone treatment suggested an optimal effect with 10 μm mifepristone, exhibiting >90% viability and significantly reducing growth signaling markers (TP53 and MAPK3). Furthermore, combined treatment with progesterone plus mifepristone (PG+MIFE) gave an enhanced anti-proliferative effect in comparison with hydrocortisone plus mifepristone (HC+MIFE) by significantly reducing markers of proliferation (BrdU+ and Ki67 expression) and tumor suppressors (PTEN, TP53), and increasing the percentage of pro-apoptotic cells. Consequently, accumulation of p21CIP together with reduced levels of CDK2 confirms growth inhibition by reversibly arresting cell-cycle progression at the G1-S phase, not by inducing apoptosis. CONCLUSIONS Our study showed an anti-proliferative effect on ovarian BRCA1-/2- MSC on in vitro combined treatment with mifepristone and progesterone. These findings suggest that mifepristone or other selective progesterone receptor modulators could be developed as a preventive treatment and postpone early use of prophylactic salpingo-oophorectomy as well as reduce the risk of ovarian cancer.
Collapse
Affiliation(s)
- Sakthivignesh Ponandai-Srinivasan
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Parameswaran G Lalitkumar
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Laura Garcia
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Suby Jo Varghese
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Joseph W Carlson
- Division of Pathology and Cytology, Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Gemzell-Danielsson
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Angelique Floter Radestad
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
27
|
Kim J, Park EY, Kim O, Schilder JM, Coffey DM, Cho CH, Bast RC. Cell Origins of High-Grade Serous Ovarian Cancer. Cancers (Basel) 2018; 10:cancers10110433. [PMID: 30424539 PMCID: PMC6267333 DOI: 10.3390/cancers10110433] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/03/2018] [Accepted: 11/07/2018] [Indexed: 12/21/2022] Open
Abstract
High-grade serous ovarian cancer, also known as high-grade serous carcinoma (HGSC), is the most common and deadliest type of ovarian cancer. HGSC appears to arise from the ovary, fallopian tube, or peritoneum. As most HGSC cases present with widespread peritoneal metastases, it is often not clear where HGSC truly originates. Traditionally, the ovarian surface epithelium (OSE) was long believed to be the origin of HGSC. Since the late 1990s, the fallopian tube epithelium has emerged as a potential primary origin of HGSC. Particularly, serous tubal intraepithelial carcinoma (STIC), a noninvasive tumor lesion formed preferentially in the distal fallopian tube epithelium, was proposed as a precursor for HGSC. It was hypothesized that STIC lesions would progress, over time, to malignant and metastatic HGSC, arising from the fallopian tube or after implanting on the ovary or peritoneum. Many clinical studies and several mouse models support the fallopian tube STIC origin of HGSC. Current evidence indicates that STIC may serve as a precursor for HGSC in high-risk women carrying germline BRCA1 or 2 mutations. Yet not all STIC lesions appear to progress to clinical HGSCs, nor would all HGSCs arise from STIC lesions, even in high-risk women. Moreover, the clinical importance of STIC remains less clear in women in the general population, in which 85–90% of all HGSCs arise. Recently, increasing attention has been brought to the possibility that many potential precursor or premalignant lesions, though composed of microscopically—and genetically—cancerous cells, do not advance to malignant tumors or lethal malignancies. Hence, rigorous causal evidence would be crucial to establish that STIC is a bona fide premalignant lesion for metastatic HGSC. While not all STICs may transform into malignant tumors, these lesions are clearly associated with increased risk for HGSC. Identification of the molecular characteristics of STICs that predict their malignant potential and clinical behavior would bolster the clinical importance of STIC. Also, as STIC lesions alone cannot account for all HGSCs, other potential cellular origins of HGSC need to be investigated. The fallopian tube stroma in mice, for instance, has been shown to be capable of giving rise to metastatic HGSC, which faithfully recapitulates the clinical behavior and molecular aspect of human HGSC. Elucidating the precise cell(s) of origin of HGSC will be critical for improving the early detection and prevention of ovarian cancer, ultimately reducing ovarian cancer mortality.
Collapse
Affiliation(s)
- Jaeyeon Kim
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
- Indiana University Melvin & Bren Simon Cancer Center, Indianapolis, IN 46202, USA.
| | - Eun Young Park
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
| | - Olga Kim
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
| | - Jeanne M Schilder
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
- Indiana University Melvin & Bren Simon Cancer Center, Indianapolis, IN 46202, USA.
| | - Donna M Coffey
- Department of Pathology and Genomic Medicine, Houston Methodist and Weill Cornell Medical College, Houston, TX 77030, USA.
| | - Chi-Heum Cho
- Department of Obstetrics and Gynecology, School of Medicine, Keimyung University, Daegu 41931, Korea.
| | - Robert C Bast
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| |
Collapse
|
28
|
Zhong H, Chen C, Tammali R, Breen S, Zhang J, Fazenbaker C, Kennedy M, Conway J, Higgs BW, Holoweckyj N, Raja R, Harper J, Pierce AJ, Herbst R, Tice DA. Improved Therapeutic Window in BRCA-mutant Tumors with Antibody-linked Pyrrolobenzodiazepine Dimers with and without PARP Inhibition. Mol Cancer Ther 2018; 18:89-99. [DOI: 10.1158/1535-7163.mct-18-0314] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/31/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022]
|
29
|
Sharma B, Kanwar SS. Phosphatidylserine: A cancer cell targeting biomarker. Semin Cancer Biol 2018; 52:17-25. [DOI: 10.1016/j.semcancer.2017.08.012] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/12/2017] [Accepted: 08/30/2017] [Indexed: 12/11/2022]
|
30
|
Rådestad AF, Estekizadeh A, Cui HL, Kostopoulou ON, Davoudi B, Hirschberg AL, Carlson J, Rahbar A, Söderberg-Naucler C. Impact of Human Cytomegalovirus Infection and its Immune Response on Survival of Patients with Ovarian Cancer. Transl Oncol 2018; 11:1292-1300. [PMID: 30172882 PMCID: PMC6121833 DOI: 10.1016/j.tranon.2018.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 12/12/2022] Open
Abstract
Human cytomegalovirus (HCMV) has been detected in various types of tumors. We studied the prevalence of HCMV in ovarian cancer and its relation to clinical outcome. Paraffin-embedded tissues obtained prospectively from 45 patients with ovarian cancer and 30 patients with benign ovarian cystadenoma were analyzed for expression of HCMV immediate-early protein (IE) and HCMV tegument protein (pp65) by immunohistochemistry. Plasma was analyzed for HCMV serology. HCMV-IgG levels were higher in patients with ovarian cancer or benign cystadenoma than in age-matched controls (P = .002, P < .0001, respectively). HCMV IgM was detected in 12% of ovarian cancer patients and 3% of patients with benign tumors but was absent in controls. In patients with ovarian cancer, higher IgG levels were associated with better outcomes (P = .04). Extensive HCMV-IE protein expression was detected in 75% of ovarian cancers and 26% of benign tumors; pp65 was detected in 67% of ovarian cancers and 14% of benign tumors. A higher grade of HCMV infection was associated with higher stage of disease. Extensive HCMV-pp65 expression was associated with shorter median overall survival than focal expression (39 versus 42.5 months, P = .03). At study closure, 58% of ovarian cancer patients with focal pp65 expression were alive versus 27% of patients with extensive pp65 expression (P = .03). Thus, HCMV proteins are detected at different levels in ovarian tumors and benign cystadenomas. Ovarian cancer patients with focal HCMV-pp65 expression in their tumors and high IgG levels against HCMV lived longer, highlighting a need for in-depth studies of the oncomodulatory role of HCMV in ovarian cancer.
Collapse
Affiliation(s)
- Angelique Flöter Rådestad
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Division of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Atosa Estekizadeh
- Department of Medicine Solna, Microbial Pathogens Unit and Department of Neurology, Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Huanhuan L Cui
- Department of Medicine Solna, Microbial Pathogens Unit and Department of Neurology, Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ourania N Kostopoulou
- Department of Medicine Solna, Microbial Pathogens Unit and Department of Neurology, Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Belghis Davoudi
- Department of Medicine Solna, Microbial Pathogens Unit and Department of Neurology, Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Division of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden; Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Joseph Carlson
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Afsar Rahbar
- Department of Medicine Solna, Microbial Pathogens Unit and Department of Neurology, Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Cecilia Söderberg-Naucler
- Department of Medicine Solna, Microbial Pathogens Unit and Department of Neurology, Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden.
| |
Collapse
|
31
|
You W, Symonds I, Henneberg M. Low fertility may be a significant determinant of ovarian cancer worldwide: an ecological analysis of cross- sectional data from 182 countries. J Ovarian Res 2018; 11:68. [PMID: 30115095 PMCID: PMC6097201 DOI: 10.1186/s13048-018-0441-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 08/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ageing, socioeconomic level, obesity, fertility, relaxed natural selection and urbanization have been postulated as the risk factors of ovarian cancer (OC56). We sought to identify which factor plays the most significant role in predicting OC56 incidence rate worldwide. METHODS Bivariate correlation analysis was performed to assess the relationships between country-specific estimates of ageing (measured by life expectancy), GDP PPP (Purchasing power parity), obesity prevalence, fertility (indexed by the crude birth rate), opportunity for natural selection (Ibs) and urbanization. Partial correlation was used to compare contribution of different variables. Fisher A-to-Z was used to compare the correlation coefficients. Multiple linear regression (Enter and Stepwise) was conducted to identify significant determinants of OC56 incidence. ANOVA with post hoc Bonferroni analysis was performed to compare differences between the means of OC56 incidence rate and residuals of OC56 standardised on fertility and GDP respectively between the six WHO regions. RESULTS Bivariate analyses revealed that OC56 was significantly and strongly correlated to ageing, GDP, obesity, low fertility, Ibs and urbanization. However, partial correlation analysis identified that fertility and ageing were the only variables that had a significant correlation to OC56 incidence when the other five variables were kept statistically constant. Fisher A-to-Z revealed that OC56 had a significantly stronger correlation to low fertility than to ageing. Stepwise linear regression analysis only identified fertility as the significant predictor of OC56. ANOVA showed that, between the six WHO regions, multiple mean differences of OC56 incidence were significant, but all disappeared when the contributing effect of fertility on OC56 incidence rate was removed. CONCLUSIONS Low fertility may be the most significant determining predictor of OC56 incidence worldwide.
Collapse
Affiliation(s)
- Wenpeng You
- Adelaide Medical School, The University of Adelaide, Adelaide, SA Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, SA Australia
| | - Maciej Henneberg
- Adelaide Medical School, The University of Adelaide, Adelaide, SA Australia
- Institute of Evolutionary Medicine, University of Zürich, 8057 Zurich, Switzerland
| |
Collapse
|
32
|
Lim MC, Won YJ, Lim J, Salehi T, Yoo CW, Bristow RE. Second primary cancer after primary peritoneal, epithelial ovarian, and fallopian tubal cancer: a retrospective study. BMC Cancer 2018; 18:800. [PMID: 30089478 PMCID: PMC6083613 DOI: 10.1186/s12885-018-4700-3] [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: 04/02/2018] [Accepted: 07/27/2018] [Indexed: 02/06/2023] Open
Abstract
Background In this retrospective study, data from patients listed in the Korea Central Cancer Registry during 1993–2014 were analysed, to investigate the incidence and survival of second primary cancers (SPCs) after a diagnosis of primary peritoneal, epithelial ovarian, and fallopian tubal (POFT) cancer. Methods The standardised incidence ratio (SIR) and survival outcomes of patients with SPCs among POFT cancer survivors were analysed. Results Among 20,738 POFT cancer survivors, 798 (3.84%) developed SPCs, at an average interval of 5.50 years. SPC risk in POFT survivors (SIR, 1.29) was higher compared to the general population. The most high-risk type of SPC was leukaemia (3.07) followed by the lung and bronchus (1.80), colon (1.58), rectum and rectosigmoid junction (1.42), thyroid (1.34), and breast (1.26). In women aged < 60 years, cancer of the breast (1.30), ascending colon (2.26), and transverse colon (4.07) as SPCs increased. Up to 10 years after POFT cancer treatment, leukaemia risk increased, especially in those < 60 years, with serous histology, and with distant stage, which required aggressive chemotherapy. The median overall survival time was 12.8 years and 14.3 years in women with POFT cancer and SPCs, respectively. Thyroid and breast cancers were favourable prognostic markers among SPCs. Conclusions The overall SPC risk increases in POFT cancer survivors, especially in those < 60 years. The cancer risk of breast and the proximal colon increase based on hereditary predisposition, while leukaemia likely develops from aggressive treatment. The median overall survival is favourable in POFT cancer survivors with SPCs. Electronic supplementary material The online version of this article (10.1186/s12885-018-4700-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Myong Cheol Lim
- Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, California, USA.,Center for Uterine Cancer and Center for Clinical Trials, Hospital, National Cancer Center, Goyang, Republic of Korea.,Cancer Healthcare Research Branch, Research Institute, National Cancer Center, Goyang, Republic of Korea.,Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Young-Joo Won
- Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea. .,Cancer Registration and Statistics Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
| | - Jiwon Lim
- Cancer Registration and Statistics Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Tahereh Salehi
- Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, California, USA
| | - Chong Woo Yoo
- Center for Uterine Cancer and Center for Clinical Trials, Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Robert E Bristow
- Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, California, USA
| |
Collapse
|
33
|
Choi MC, Bae JS, Jung SG, Park H, Joo WD, Song SH, Lee C, Kim JH, Lee KC, Lee S, Lee JH. Prevalence of germline BRCA mutations among women with carcinoma of the peritoneum or fallopian tube. J Gynecol Oncol 2018; 29:e43. [PMID: 29770616 PMCID: PMC5981097 DOI: 10.3802/jgo.2018.29.e43] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/29/2018] [Accepted: 02/09/2018] [Indexed: 01/04/2023] Open
Abstract
Objective The aim of the present study was to assess the frequency of germline mutations in patients with peritoneal carcinoma (PC) or the fallopian tube carcinoma (FTC), using a multi-gene panel. Methods Twenty-six patients diagnosed with either PC or FTC between January 2013 and December 2016 were recruited consecutively. Germline DNA was sequenced using a 6-gene next generation sequencing (NGS) panel following genetic counseling. Surgico-medical information was obtained from hospital records. Genetic variations were detected using the panel and were cross-validated by Sanger direct sequencing. Results Germline BRCA1/2 mutations were identified in 6 patients (23.1%). Four were detected in patients with PC and 2 were in FTC patients. No mutations were detected in TP53, PTEN, CDH1, or PALB2. We identified 11 variant of uncertain significance (VUS) in 9 patients; 2 in BRCA1, 3 in BRCA2, 2 in TP53, and 4 in CDH1. We also detected a CDH1 c.2164+16->A VUS in 3 patients. Conclusion The prevalence of germline BRCA1/2 mutations in patients with PC or FTC is comparable to that of BRCA1/2 mutations in epithelial ovarian cancer patients.
Collapse
Affiliation(s)
- Min Chul Choi
- Hereditary Gynecologic Cancer Clinic, Precision Medicine Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.,Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
| | - Jin Sik Bae
- Eone-Diagnomics Genome Center (EDGC), Incheon, Korea
| | - Sang Geun Jung
- Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hyun Park
- Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Won Duk Joo
- Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seung Hun Song
- Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chan Lee
- Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ji Ho Kim
- Eone-Diagnomics Genome Center (EDGC), Incheon, Korea
| | - Ki Chan Lee
- Eone-Diagnomics Genome Center (EDGC), Incheon, Korea
| | - Sunghoon Lee
- Eone-Diagnomics Genome Center (EDGC), Incheon, Korea.
| | - Je Ho Lee
- Hereditary Gynecologic Cancer Clinic, Precision Medicine Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.,Department of Obstetrics and Gynecology, Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| |
Collapse
|
34
|
Moga MA, Dimienescu OG, Arvătescu CA, Ifteni P, Pleş L. Anticancer Activity of Toxins from Bee and Snake Venom-An Overview on Ovarian Cancer. Molecules 2018; 23:E692. [PMID: 29562696 PMCID: PMC6017821 DOI: 10.3390/molecules23030692] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/11/2018] [Accepted: 03/14/2018] [Indexed: 11/16/2022] Open
Abstract
Cancer represents the disease of the millennium, a major problem in public health. The proliferation of tumor cells, angiogenesis, and the relationship between the cancer cells and the components of the extracellular matrix are important in the events of carcinogenesis, and these pathways are being used as targets for new anticancer treatments. Various venoms and their toxins have shown possible anticancer effects on human cancer cell lines, providing new perspectives in drug development. In this review, we observed the effects of natural toxins from bee and snake venom and the mechanisms through which they can inhibit the growth and proliferation of cancer cells. We also researched how several types of natural molecules from venom can sensitize ovarian cancer cells to conventional chemotherapy, with many toxins being helpful for developing new anticancer drugs. This approach could improve the efficiency of standard therapies and could allow the administration of decreased doses of chemotherapy. Natural toxins from bee and snake venom could become potential candidates for the future treatment of different types of cancer. It is important to continue these studies concerning therapeutic drugs from natural resource and, more importantly, to investigate their mechanism of action on cancer cells.
Collapse
Affiliation(s)
- Marius Alexandru Moga
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, Brasov 500019, Romania.
| | - Oana Gabriela Dimienescu
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, Brasov 500019, Romania.
| | - Cristian Andrei Arvătescu
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, Brasov 500019, Romania.
| | - Petru Ifteni
- Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University of Brasov, Brasov 500019, Romania.
| | - Liana Pleş
- Clinical Department of Obstetrics and Gynecology, The Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania.
| |
Collapse
|
35
|
Carlson JW, Rådestad AF, Söderberg-Naucler C, Rahbar A. Human cytomegalovirus in high grade serous ovarian cancer possible implications for patients survival. Medicine (Baltimore) 2018; 97:e9685. [PMID: 29369188 PMCID: PMC5794372 DOI: 10.1097/md.0000000000009685] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Patients diagnosed with high grade serous ovarian adenocarcinoma have a poor prognosis. Recently human cytomegalovirus (HCMV) has been detected in several tumors. Here, we evaluated HCMV in ovarian cancer tissue specimens obtained at pre- and postchemotherapy tumor resection.Available paraffin embedded ovarian cancer tissues from matched pre- and postchemotherapy tumor resection specimens (i.e., diagnostic excisional biopsy prechemotherapy; DEBPC) and neoadjuvant chemotherapy followed by interval debulking surgery (NACT + IDS) from 10 patients with stage IIIC-IV high grade serous ovarian carcinoma (HGS) diagnosed between years 2007 and 2008 at Karolinska University Hospital were examined for HCMV immediate-early protein (HCMV-IE), tegument protein pp65, and nucleic acid (β2.7) by immunohistochemistry and in situ hybridization.HCMV-IE and pp65 were detected in 8/10 (80%), 4/9 (44%) and in 4/10 (40%), 5/8 in ovarian cancer tissue specimens from DEBPC and NACT + IDS, respectively. HCMV-β2.7 was detected in all available tissue sections obtained from DEBPC and NACT + IDS. Patients with HCMV-IE or pp65 positive cells in their ovarian tumors at IDS after NACT had a median overall survival of 23.4 and 18.2 months, respectively, compared to 29.6 and 54 months, respectively, in those who did not express HCMV proteins in their tumors.In conclusion, HCMV proteins and nucleic acids are frequently detected at different levels in HGS ovarian carcinoma. Despite the limitation of our study, shorter median overall survival of patients with HCMV-IE and pp65 in their tumor highlights the need to further investigate the role of HCMV in ovarian cancer patients.
Collapse
Affiliation(s)
- Joseph W. Carlson
- Department of Pathology and Cytology, Institute for Oncology-Pathology
| | - Angelique Flöter Rådestad
- Department of Women's and Children's Health, Karolinska Institutet and Division of Obstetrics and Gynecology, Karolinska University Hospital
| | - Cecilia Söderberg-Naucler
- Department of Medicine Solna, Unit of Microbial Pathogenesis and Department of Neurology, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Afsar Rahbar
- Department of Medicine Solna, Unit of Microbial Pathogenesis and Department of Neurology, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
36
|
Harmsen MG, Steenbeek MP, Hoogerbrugge N, van Doorn HC, Gaarenstroom KN, Vos MC, Massuger LFAG, de Hullu JA, Hermens RPMG. A patient decision aid for risk-reducing surgery in premenopausal BRCA1/2 mutation carriers: Development process and pilot testing. Health Expect 2017; 21:659-667. [PMID: 29281161 PMCID: PMC5980589 DOI: 10.1111/hex.12661] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 01/01/2023] Open
Abstract
Background BRCA1/2 mutation carriers’ choice between risk‐reducing salpingo‐oophorectomy (RRSO) and salpingectomy with delayed oophorectomy is very complex. Aim was to develop a patient decision aid that combines evidence with patient preferences to facilitate decision making. Design Systematic development of a patient decision aid in an iterative process of prototype development, alpha testing by patients and clinicians and revisions using International Patient Decision Aid Standards (IPDAS) quality criteria. Information was based on the available literature and current guidelines. A multidisciplinary steering group supervised the process. Setting and participants Pre‐menopausal BRCA1/2 mutation carriers choosing between RRSO and salpingectomy with delayed oophorectomy in Family Cancer Clinics in the Netherlands. Main outcome measures IPDAS quality criteria, relevance, usability, clarity. Results The patient decision aid underwent four rounds of alpha testing and revisions. Finally, two paper decision aids were developed: one for BRCA1 and one for BRCA2. They both contained a general introduction, three chapters and a step‐by‐step plan containing a personal value clarification worksheet. During alpha testing, risk communication and information about premature menopause and hormone therapy were the most revised items. The patient decision aids fulfil 37 of 43 (86%) IPDAS criteria for content and development process. Discussion and conclusions Both BRCA1/2 mutation carriers and professionals are willing to use or offer the developed patient decision aids for risk‐reducing surgery. The patient decision aids have been found clear, balanced and comprehensible. Future testing among patients facing the decision should point out its effectiveness in improving decision making.
Collapse
Affiliation(s)
- Marline G Harmsen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Miranda P Steenbeek
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helena C van Doorn
- Department of Gynaecology, Erasmus MC Cancer Clinic, Rotterdam, The Netherlands
| | - Katja N Gaarenstroom
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Caroline Vos
- Department of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Leon F A G Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
37
|
Dietary inflammatory index and ovarian cancer risk in a New Jersey case-control study. Nutrition 2017; 46:78-82. [PMID: 29290361 DOI: 10.1016/j.nut.2017.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/10/2017] [Accepted: 08/28/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Diet may influence the development of ovarian cancer. Although it has been shown that inflammation plays an important etiologic role in ovarian carcinogenesis, little is known about the influence of the inflammatory potential of food consumption. The aim of this study was to evaluate the effect of a proinflammatory diet, as indicated by a high dietary inflammatory index (DII®) score, on ovarian cancer risk, in a New Jersey population. METHODS Data from a case-control study conducted in New Jersey were used to estimate the relation between DII score and the risk for ovarian cancer. The study consisted of 205 cases with incident, histologically confirmed ovarian cancer, and 390 controls identified by random-digit dialing, based on Centers for Medicare & Medicaid Service lists, and area sampling. Computation of the DII was based on the intake of selected dietary factors assessed by a validated food frequency questionnaire (FFQ). Logistic regression models were fit to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for potential covariates. RESULTS Although there was no significant association observed in pre- and perimenopausal women, a significant association was observed between the most proinflammatory DII scores and ovarian cancer among postmenopausal women (ORQuartile4 vs1, 1.89; 95% CI, 1.02-3.52; Ptrend = 0.03). CONCLUSION Findings from the present study suggested that a proinflammatory diet may increase risk for ovarian cancer among postmenopausal women, and warrants further study to confirm this association.
Collapse
|
38
|
Challenging Salpingectomy as a Risk-Reducing Measure for Ovarian Cancer: Histopathological Analysis of the Tubo-Ovarian Interface in Women Undergoing Risk-Reducing Salpingo-oophorectomy. Int J Gynecol Cancer 2017; 27:703-707. [DOI: 10.1097/igc.0000000000000954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ObjectiveOpportunistic bilateral salpingectomy is now promoted for women at the time of hysterectomy for a benign disease, consequent to the fimbrial end of the fallopian tube emerging as the primary site for carcinogenesis in high-grade serous carcinomas. In high-risk women with an identified germ line mutation, bilateral salpingo-oophorectomy offers the greatest risk reduction for ovarian cancer. Currently, no prospective evidence exists with respect to the effectiveness of opportunistic salpingectomy alone in preventing ovarian cancer. Although it is thought that there is no direct connection between the ovary and its adjacent fallopian tube, we often find remnants of the fimbria adherent to the ovary at the time of surgery. If this tubo-ovarian interface is not separate, then practices such as salpingectomy and radical fimbriectomy may be incomplete, and the effectiveness of this technique as a prophylactic strategy may need reconsideration. We aimed to establish whether there might exist a direct attachment of the fimbria to the ovary by examining this interface in surgically removed specimens.MethodsThe tubes and ovaries of 20 women undergoing risk-reducing salpingo-oophorectomy were examined using the Sectioning and Extensively Examining the Fimbriated End of the Tubes protocol and p53 immunohistochemistry for lesions suspicious of serous intraepithelial tubal carcinoma.ResultsThree specimens showed fimbria adherent to the ovary at the histopathological analysis. One p53 signature was identified, but there were no occult cancers or serous intraepithelial tubal carcinomas.ConclusionsAlthough only a small study, the findings show that microscopic fimbriae are adherent to the ovary. This relationship challenges the recommendation for bilateral salpingectomy alone for risk-reducing surgery because the primary site of carcinogenesis may be left on the ovary to later develop into a high-grade serous carcinoma. A larger study is needed to assess our findings related to the tubo-ovarian interface and its implications for long-term ovarian cancer development. Until then, caution on using this technique alone in the high-risk patient should be adopted.
Collapse
|
39
|
|
40
|
Keng SL, Abdul Wahab SB, Chiu LB, Yusuf A. Awareness of ovarian cancer risk factors among women in Malaysia: a preliminary study. Asian Pac J Cancer Prev 2015; 16:537-40. [PMID: 25684484 DOI: 10.7314/apjcp.2015.16.2.537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ovarian cancer is recognized as the fourth leading cancer in Malaysia. However, women do not always seek help in a timely manner and gaps in awareness may influence screening uptake and presentation. The purpose of this study was to determine levels of awareness of ovarian cancer risk factors in female population in Penang, Malaysia. MATERIALS AND METHODS A cross-sectional study was conducted in Penang, Malaysia from January until February 2014. Eighty-seven women were selected by convenient sampling. Awareness of risk factors of ovarian cancer was assessed using a self-administered questionnaire. Data were analyzed using statistical package for the social sciences (SPSS) version 20.0 for descriptive statistics and Pearson chi-square test for the association between socio-demographic data and awareness. A p value ≤0.05 was considered statistically significant. RESULTS In all, 74.7% of participants answered correctly for the risk factor of increasing age, although 94.3% were unaware of increased risk of tall women. A majority, 71.3%, had a low level of awareness of ovarian cancer risk factors. There was a significant association between age and knowledge (p=0.047). Additionally, there was a significant association between higher education level and level of awareness of ovarian cancer risk factors (p=0.039). CONCLUSIONS This study revealed that awareness of ovarian cancer risk factors among Malaysian women is low. The results show a need for improved public understanding about ovarian cancer risks and provision of important information for health professionals about initiatives needed for future awareness, prevention and screening programs.
Collapse
Affiliation(s)
- Soon Lean Keng
- School of Health Sciences, School of Health Sciences, Universiti Sains Malaysia, Malaysia E-mail :
| | | | | | | |
Collapse
|
41
|
Sakamoto I, Hirotsu Y, Nakagomi H, Ouchi H, Ikegami A, Teramoto K, Amemiya K, Mochizuki H, Omata M. BRCA1 and BRCA2 mutations in Japanese patients with ovarian, fallopian tube, and primary peritoneal cancer. Cancer 2015; 122:84-90. [PMID: 26439132 DOI: 10.1002/cncr.29707] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/04/2015] [Accepted: 08/06/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND The contribution of BRCA1 and BRCA2 to ovarian cancer in Japanese patients is still unclear. This study investigated the frequency of germline mutations in BRCA1/2 in Japanese patients with ovarian, peritoneal, or fallopian tube cancer, regardless of their family histories, which were suggestive of hereditary breast and ovarian cancer. METHODS Ninety-five unselected women with ovarian cancer who were seen from 2013 to 2015 at Yamanashi Prefectural Central Hospital were enrolled. Analyses of BRCA1/2 gene mutations were performed with next-generation sequencing. RESULTS Twelve of the 95 patients (12.6%), including 5 in the BRCA1 (5.3%) and 7 in the BRCA2 (7.4%), had deleterious mutations. Among the 36 cases with a family history, 6 (16.7%) were found to carry mutations in BRCA1 and BRCA2. Notably, 6 of the 59 cases (10.2%) without a family history also had BRCA1/2 germline mutations. There was no statistical difference between the 2 groups (P = .36). The presence of mutations and their clinical relevance were studied. Mutation carriers were diagnosed at advanced stages (100% of positive cases among stage III or IV cases) and had poor prognostic histological subtypes (100% of positive cases had high-grade serous adenocarcinomas). CONCLUSIONS In this unselected Japanese population, approximately 13% of the cases with ovarian cancer appeared to be associated with an inherited risk, regardless of a family history. This finding indicates that BRCA1/2 genetic testing should be performed for all patients with ovarian cancers.
Collapse
Affiliation(s)
- Ikuko Sakamoto
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Yosuke Hirotsu
- Department of Genome Analysis Center, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Hiroshi Nakagomi
- Department of Breast Surgery, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Hidetaka Ouchi
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Atsushi Ikegami
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Katsuhiro Teramoto
- Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Kenji Amemiya
- Department of Genome Analysis Center, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Hitoshi Mochizuki
- Department of Genome Analysis Center, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Masao Omata
- Department of Genome Analysis Center, Yamanashi Prefectural Central Hospital, Kofu, Japan.,Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| |
Collapse
|
42
|
Harmsen MG, Arts-de Jong M, Hoogerbrugge N, Maas AHEM, Prins JB, Bulten J, Teerenstra S, Adang EMM, Piek JMJ, van Doorn HC, van Beurden M, Mourits MJE, Zweemer RP, Gaarenstroom KN, Slangen BFM, Vos MC, van Lonkhuijzen LRCW, Massuger LFAG, Hermens RPMG, de Hullu JA. Early salpingectomy (TUbectomy) with delayed oophorectomy to improve quality of life as alternative for risk-reducing salpingo-oophorectomy in BRCA1/2 mutation carriers (TUBA study): a prospective non-randomised multicentre study. BMC Cancer 2015; 15:593. [PMID: 26286255 PMCID: PMC4541725 DOI: 10.1186/s12885-015-1597-y] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/11/2015] [Indexed: 01/12/2023] Open
Abstract
Background Risk-reducing salpingo-oophorectomy (RRSO) around the age of 40 is currently recommended to BRCA1/2 mutation carriers. This procedure decreases the elevated ovarian cancer risk by 80–96 % but it initiates premature menopause as well. The latter is associated with short-term and long-term morbidity, potentially affecting quality of life (QoL). Based on recent insights into the Fallopian tube as possible site of origin of serous ovarian carcinomas, an alternative preventive strategy has been put forward: early risk-reducing salpingectomy (RRS) and delayed oophorectomy (RRO). However, efficacy and safety of this alternative strategy have to be investigated. Methods A multicentre non-randomised trial in 11 Dutch centres for hereditary cancer will be conducted. Eligible patients are premenopausal BRCA1/2 mutation carriers after completing childbearing without (a history of) ovarian carcinoma. Participants choose between standard RRSO at age 35–40 (BRCA1) or 40–45 (BRCA2) and the alternative strategy (RRS upon completion of childbearing and RRO at age 40–45 (BRCA1) or 45–50 (BRCA2)). Women who opt for RRS but do not want to postpone RRO beyond the currently recommended age are included as well. Primary outcome measure is menopause-related QoL. Secondary outcome measures are ovarian/breast cancer incidence, surgery-related morbidity, histopathology, cardiovascular risk factors and diseases, and cost-effectiveness. Mixed model data analysis will be performed. Discussion The exact role of the Fallopian tube in ovarian carcinogenesis is still unclear. It is not expected that further fundamental research will elucidate this role in the near future. Therefore, this clinical trial is essential to investigate RRS with delayed RRO as alternative risk-reducing strategy in order to improve QoL. Trial registration ClinicalTrials.gov (NCT02321228)
Collapse
Affiliation(s)
- Marline G Harmsen
- Department of Obstetrics & Gynaecology, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Marieke Arts-de Jong
- Department of Obstetrics & Gynaecology, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Steven Teerenstra
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Eddy M M Adang
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Jurgen M J Piek
- Gynaecologic Oncologic Center South location Elisabeth-TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands. .,Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Helena C van Doorn
- Department of Gynaecology, Erasmus MC Cancer Clinic, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Marc van Beurden
- Center for Gynaecological Oncology Amsterdam (CGOA), Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Marian J E Mourits
- Department of Gynaecology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Ronald P Zweemer
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Katja N Gaarenstroom
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - M Caroline Vos
- Gynaecologic Oncologic Center South, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
| | - Luc R C W van Lonkhuijzen
- Center for Gynaecological Oncology Amsterdam (CGOA), AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Leon F A G Massuger
- Department of Obstetrics & Gynaecology, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Joanne A de Hullu
- Department of Obstetrics & Gynaecology, Radboud University Medical Center, PO Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| |
Collapse
|
43
|
Harmsen MG, Hermens RPMG, Prins JB, Hoogerbrugge N, de Hullu JA. How medical choices influence quality of life of women carrying a BRCA mutation. Crit Rev Oncol Hematol 2015; 96:555-68. [PMID: 26299336 DOI: 10.1016/j.critrevonc.2015.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 05/19/2015] [Accepted: 07/16/2015] [Indexed: 12/24/2022] Open
Abstract
Germline mutations in BRCA1 and BRCA2 genes were discovered twenty years ago. Female BRCA mutation carriers have an increased risk of breast and ovarian cancer at a relatively young age. Several choices have to be made with respect to cancer risk management, and consequences of these choices may affect quality of life. A review of the literature was performed to evaluate quality of life in unaffected BRCA mutation carriers and the influence of these medical choices. Overall, general quality of life appears not to be permanently affected in BRCA mutation carriers or by their choices. Risk-reducing salpingo-oophorectomy and its subsequent premature menopause affect (menopause specific) quality of life most. Hormone replacement therapy does not fully alleviate climacteric symptoms and therefore, there is a strong need for alternative strategies to reduce ovarian cancer risk and/or for improvements in postoperative care. Future research should focus on these needs.
Collapse
Affiliation(s)
- Marline G Harmsen
- Department of Obstetrics & Gynaecology, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics & Gynaecology, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| |
Collapse
|
44
|
Higuchi T, Flies DB, Marjon NA, Mantia-Smaldone G, Ronner L, Gimotty PA, Adams SF. CTLA-4 Blockade Synergizes Therapeutically with PARP Inhibition in BRCA1-Deficient Ovarian Cancer. Cancer Immunol Res 2015; 3:1257-68. [PMID: 26138335 DOI: 10.1158/2326-6066.cir-15-0044] [Citation(s) in RCA: 224] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/13/2015] [Indexed: 12/13/2022]
Abstract
Immune checkpoint blockade has shown significant therapeutic efficacy in melanoma and other solid tumors, but results in ovarian cancer have been limited. With evidence that tumor immunogenicity modulates the response to checkpoint blockade, and data indicating that BRCA-deficient ovarian cancers express higher levels of immune response genes, we hypothesized that BRCA(-) ovarian tumors would be vulnerable to checkpoint blockade. To test this hypothesis, we used an immunocompetent BRCA1-deficient murine ovarian cancer model to compare treatment with CTLA-4 or PD-1/PD-L1 antibodies alone or combined with targeted cytotoxic therapy using a PARP inhibitor. Correlative studies were performed in vitro using human BRCA1(-) cells. We found that CTLA-4 antibody, but not PD-1/PD-L1 blockade, synergized therapeutically with the PARP inhibitor, resulting in immune-mediated tumor clearance and long-term survival in a majority of animals (P < 0.0001). The survival benefit of this combination was T-cell mediated and dependent on increases in local IFNγ production in the peritoneal tumor environment. Evidence of protective immune memory was observed more than 60 days after completion of therapy. Similar increases in the cytotoxic effect of PARP inhibition in the presence of elevated levels of IFNγ in human BRCA1(-) cancer cells support the translational potential of this treatment protocol. These results demonstrate that CTLA-4 blockade combined with PARP inhibition induces protective antitumor immunity and significant survival benefit in the BRCA1(-) tumor model, and support clinical testing of this regimen to improve outcomes for women with hereditary ovarian cancer.
Collapse
Affiliation(s)
- Tomoe Higuchi
- The University of New Mexico Cancer Center, Albuquerque, New Mexico
| | - Dallas B Flies
- The University of New Mexico Cancer Center, Albuquerque, New Mexico
| | - Nicole A Marjon
- The University of New Mexico Cancer Center, Albuquerque, New Mexico
| | | | - Lukas Ronner
- Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Sarah F Adams
- The University of New Mexico Cancer Center, Albuquerque, New Mexico.
| |
Collapse
|
45
|
Park RW, Kim TM, Kasif S, Park PJ. Identification of rare germline copy number variations over-represented in five human cancer types. Mol Cancer 2015; 14:25. [PMID: 25644941 PMCID: PMC4381456 DOI: 10.1186/s12943-015-0292-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 01/08/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Copy number variations (CNVs) are increasingly recognized as significant disease susceptibility markers in many complex disorders including cancer. The availability of a large number of chromosomal copy number profiles in both malignant and normal tissues in cancer patients presents an opportunity to characterize not only somatic alterations but also germline CNVs, which may confer increased risk for cancer. RESULTS We explored the germline CNVs in five cancer cohorts from the Cancer Genome Atlas (TCGA) consisting of 351 brain, 336 breast, 342 colorectal, 370 renal, and 314 ovarian cancers, genotyped on Affymetrix SNP6.0 arrays. Comparing these to ~3000 normal controls from another study, our case-control association study revealed 39 genomic loci (9 brain, 3 breast, 4 colorectal, 11 renal, and 12 ovarian cancers) as potential candidates of tumor susceptibility loci. Many of these loci are new and in some cases are associated with a substantial increase in disease risk. The majority of the observed loci do not overlap with coding sequences; however, several observed genomic loci overlap with known cancer genes including RET in brain cancers, ERBB2 in renal cell carcinomas, and DCC in ovarian cancers, all of which have not been previously associated with germline changes in cancer. CONCLUSIONS This large-scale genome-wide association study for CNVs across multiple cancer types identified several novel rare germline CNVs as cancer predisposing genomic loci. These loci can potentially serve as clinically useful markers conferring increased cancer risk.
Collapse
Affiliation(s)
- Richard W Park
- Bioinformatics Program, Boston University, Boston, MA, USA. .,Center for Biomedical Informatics, Harvard Medical School, 10 Shattuck St, Boston, MA, 02115, USA.
| | - Tae-Min Kim
- Center for Biomedical Informatics, Harvard Medical School, 10 Shattuck St, Boston, MA, 02115, USA. .,Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, 137-701, South Korea.
| | - Simon Kasif
- Bioinformatics Program, Boston University, Boston, MA, USA. .,Department of Biomedical Engineering, Boston University, Boston, MA, USA. .,Children's Hospital Informatics Program, Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA.
| | - Peter J Park
- Center for Biomedical Informatics, Harvard Medical School, 10 Shattuck St, Boston, MA, 02115, USA. .,Children's Hospital Informatics Program, Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA.
| |
Collapse
|
46
|
Lee JY, Kim HS, Suh DH, Kim MK, Chung HH, Song YS. Ovarian cancer biomarker discovery based on genomic approaches. J Cancer Prev 2014; 18:298-312. [PMID: 25337559 PMCID: PMC4189448 DOI: 10.15430/jcp.2013.18.4.298] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 12/15/2013] [Accepted: 12/16/2013] [Indexed: 12/20/2022] Open
Abstract
Ovarian cancer presents at an advanced stage in more than 75% of patients. Early detection has great promise to improve clinical outcomes. Although the advancing proteomic technologies led to the discovery of numerous ovarian cancer biomarkers, no screening method has been recommended for early detection of ovarian cancer. Complexity and heterogeneity of ovarian carcinogenesis is a major obstacle to discover biomarkers. As cancer arises due to accumulation of genetic change, understanding the close connection between genetic changes and ovarian carcinogenesis would provide the opportunity to find novel gene-level ovarian cancer biomarkers. In this review, we summarize the various gene-based biomarkers by genomic technologies, including inherited gene mutations, epigenetic changes, and differential gene expression. In addition, we suggest the strategy to discover novel gene-based biomarkers with recently introduced next generation sequencing.
Collapse
Affiliation(s)
- Jung-Yun Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine
| | - Mi-Kyung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine
| | - Yong-Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine ; Cancer Research Institute, Seoul National University College of Medicine ; Major in Biomodulation, World Class University, Seoul National University, Seoul, Korea
| |
Collapse
|
47
|
Added value of family history in counseling about risk of BRCA1/2 mutation in early-onset epithelial ovarian cancer. Int J Gynecol Cancer 2014; 23:1406-10. [PMID: 23975082 DOI: 10.1097/igc.0b013e3182a1cf71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Epithelial ovarian cancer in women 40 years or younger is rare; diagnosis at this age justifies referral for genetic testing. We evaluated clinical data, family history, and risk of identifying BRCA1/2 mutations in women with early-onset epithelial ovarian cancer. MATERIALS/METHODS Women 40 years or younger with epithelial ovarian cancer tested for BRCA1/2 mutation at our department of human genetics between 1996 and 2012 were included. The rate of BRCA1/2 mutation was obtained; carriers were compared to noncarriers regarding clinical data. RESULTS Ten (19%) of 52 women had a BRCA1/2 mutation. This mutation was detected in 67% of women with and in 9% of the women without first-degree relatives with breast and/or ovarian cancer (P < 0.001; Fisher exact test). The median age at diagnosis was lower in the noncarriers compared to the carriers (30 vs 38 years; P = 0.014). Among the BRCA1/2 mutation carriers, 60% had serous tumors, 80% had moderately to poorly differentiated tumors, and 70% had International Federation of Gynecology and Obstetrics stage III/IV compared to 55%, 43%, and 45%, respectively, in the noncarriers. CONCLUSIONS The risk of finding a BRCA1/2 mutation in women 40 years or younger is comparable to women of all ages with epithelial ovarian cancer. Prior probability of finding a BRCA1/2 mutation in these young women is largely determined by their family history, which can help caregivers in informing ahead of genetic counseling and testing.
Collapse
|
48
|
O’Sullivan CC, Moon DH, Kohn EC, Lee JM. Beyond Breast and Ovarian Cancers: PARP Inhibitors for BRCA Mutation-Associated and BRCA-Like Solid Tumors. Front Oncol 2014; 4:42. [PMID: 24616882 PMCID: PMC3937815 DOI: 10.3389/fonc.2014.00042] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 02/18/2014] [Indexed: 12/14/2022] Open
Abstract
Poly(ADP-ribose) polymerase inhibitors (PARPi) have shown clinical activity in patients with germline BRCA1/2 mutation (gBRCAm)-associated breast and ovarian cancers. Accumulating evidence suggests that PARPi may have a wider application in the treatment of cancers defective in DNA damage repair pathways, such as prostate, lung, endometrial, and pancreatic cancers. Several PARPi are currently in phase I/II clinical investigation, as single-agents and/or combination therapy in these solid tumors. Understanding more about the molecular abnormalities involved in BRCA-like phenotype in solid tumors beyond breast and ovarian cancers, exploring novel therapeutic trial strategies and drug combinations, and defining potential predictive biomarkers are critical to expanding the scope of PARPi therapy. This will improve clinical outcome in advanced solid tumors. Here, we briefly review the preclinical data and clinical development of PARPi, and discuss its future development in solid tumors beyond gBRCAm-associated breast and ovarian cancers.
Collapse
Affiliation(s)
- Ciara C. O’Sullivan
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Dominic H. Moon
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
- Medical Research Scholars Program, National Institutes of Health, Bethesda, MD, USA
| | - Elise C. Kohn
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Jung-Min Lee
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| |
Collapse
|
49
|
BRCA1/2 mutation carriers are potentially at higher cardiovascular risk. Crit Rev Oncol Hematol 2014; 91:159-71. [PMID: 24529552 DOI: 10.1016/j.critrevonc.2014.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/24/2013] [Accepted: 01/14/2014] [Indexed: 01/03/2023] Open
Abstract
BRCA1/2 mutation carriers have an elevated risk of developing breast and ovarian cancer at a relatively young age. Risk-reducing salpingo-oophorectomy is an established strategy to tremendously reduce the risk of ovarian cancer. It is recommended to perform this surgery at age 35-40 years (BRCA1) and at age 40-45 years (BRCA2) resulting in an early and abrupt menopause. BRCA1/2 mutation carriers are potentially at higher risk of cardiovascular diseases due to early surgical menopause, and cardiotoxic effects of adjuvant treatment for breast cancer. Furthermore, preliminary results of experimental studies suggest a possible causative function of the BRCA genes in cardiovascular risk. More research on cardiovascular health risks in BRCA1/2 mutation carriers is needed, especially in the field of cardio-oncology, requiring additional attention to potentially cumulative effects on cardiovascular risks in this specific group of women.
Collapse
|
50
|
Oral contraceptive and reproductive risk factors for ovarian cancer within sisters in the breast cancer family registry. Br J Cancer 2014; 110:1074-80. [PMID: 24398512 PMCID: PMC3929882 DOI: 10.1038/bjc.2013.803] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 12/01/2013] [Accepted: 12/04/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Oral contraceptive use has been consistently associated with a reduced risk of ovarian cancer in unrelated, average risk women; however little data exist on whether this benefit extends to higher risk women from cancer families. To examine this, we conducted family-based analyses using the Breast Cancer Family Registry. METHODS We used generalised estimating equations to obtain the population average effect across all families (n=389 cases, n=5643 controls) and conditional logistic regression to examine within-family differences in a subset with at least two sisters discordant on ovarian cancer status (n=109 cases, n=149 unaffected sister controls). RESULTS In the multivariable generalised estimating equation model there was a reduced risk of ovarian cancer for ever use of oral contraceptives compared with never use (OR=0.58, 95% CI: 0.37, 0.91), and in the conditional logistic model there was a similar inverse association; however, it was not statistically significant (OR=0.52, 95% CI: 0.23, 1.17). We examined this association by BRCA1/2 status and observed a statistically significant reduced risk in the non-carriers only. CONCLUSION We observed a decreased risk of ovarian cancer with oral contraceptive use supporting that this association observed in unrelated women extends to related women at higher risk.
Collapse
|