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Wolfman W, Bougie O, Chen I, Tang Y, Goldstein S, Bouteaud J. Guideline No. 451: Asymptomatic Endometrial Thickening in Postmenopausal Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102591. [PMID: 38901794 DOI: 10.1016/j.jogc.2024.102591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
OBJECTIVE To formulate strategies for clinical assessments for endometrial thickening on ultrasound in a postmenopausal woman without bleeding. TARGET POPULATION Postmenopausal women of any age. OUTCOMES To reduce unnecessary invasive interventions and investigations in women with asymptomatic endometrial thickening while selectively investigating women at risk for endometrial cancer. BENEFITS, HARMS, AND COSTS It is anticipated that the adoption of these recommendations would save postmenopausal women unnecessary anxiety, pain, and risk of procedural complications. It is also expected to decrease the cost to the health care system by eliminating unnecessary interventions. EVIDENCE English language articles from Medline, Cochrane, and PubMed databases for relevant peer-reviewed articles dating from 1995 to 2022 (e.g., asymptomatic endometrial thickness, endometrial cancer, postmenopausal bleeding, transvaginal ultrasound, endometrial biopsy, cervical stenosis, hormone therapies and the endometrium, tamoxifen, tibolone, aromatase inhibitors). Results were restricted to systematic reviews and meta-analyses, randomized controlled trials/controlled clinical trials, and observational studies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Physicians, including gynaecologists, obstetricians, family physicians, radiologists, pathologists, and internists; nurse practitioners and nurses; medical trainees, including medical students, residents, and fellows; and other providers of health care of the postmenopausal population. SOCIAL MEDIA ABSTRACT Postmenopausal women often have a thickening of the lining of the uterus found during ultrasound. Without bleeding, an endometrium <11 mm is rarely a serious problem but should be evaluated by a health care provider. SUMMARY STATEMENTS RECOMMENDATIONS.
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Wolfman W, Bougie O, Chen I, Tang Y, Goldstein S, Bouteaud J. Directive clinique n o 451 : Épaississement asymptomatique de l'endomètre chez les femmes ménopausées. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102590. [PMID: 38901795 DOI: 10.1016/j.jogc.2024.102590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
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Olowofolahan A, Fatunsin O, Olorunsogo O. Modulatory effect of ciprofloxacin, a broad spectrum antibacterial drug, on mPT pore using rat model with estradiol benzoate-induced endometrial hyperplasia. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:3331-3341. [PMID: 37943297 DOI: 10.1007/s00210-023-02824-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
Mitochondrial permeability transition (mPT) pore has become a motive for drug evolvement pertinent to dysregulated apoptosis situations. Some chemical compounds impede tumor/cancer via the inception of mPT pore opening. Ciprofloxacin has been demonstrated to hinder growth and effect apoptosis in some cancer cells. However, using a rat model, this study investigated its effect on mitochondrial-mediated cell death via mPT pore opening and estradiol benzoate (EB)-induced endometrial hyperplasia. Mitochondria were isolated using differential centrifugation. The opening of the pore, cytochrome c release (CCR), mitochondrial ATPase (mATPase) activity, mitochondrial lipid peroxidation (mLPO), caspases 3 and 9 levels, and hepatic DNA fragmentation were determined. Histological evaluation of hepatic and uterine sections and immunoexpression levels of Bax, caspase 3, and anti-apoptotic Bcl-2 levels were quantified. The results show that ciprofloxacin caused mPT pore opening, CCR, mATPase activity, effected mLPO, caspases 3 and 9 activations, and hepatic DNA fragmentation. The histology of the liver section showed moderate to marked disseminated congestion at 100 mg/kg, while higher doses showed severe hepatic damage. Severe EH was detected in the EB-treated rats which was attenuated by ciprofloxacin in the treatment group. The Bax and caspase expressions were upregulated by ciprofloxacin while anti-apoptotic Bcl-2 was downregulated. Ciprofloxacin induces mitochondrial-mediated cell death via mPT pore opening and mitigates EB-induced EH in rat models via Bax/caspase/Bcl-2 signaling pathway.
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Affiliation(s)
- Adeola Olowofolahan
- Laboratories for Biomembrane Research and Biotechnology, Department of Biochemistry, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Omowumi Fatunsin
- Laboratories for Biomembrane Research and Biotechnology, Department of Biochemistry, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olufunso Olorunsogo
- Laboratories for Biomembrane Research and Biotechnology, Department of Biochemistry, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia: ACOG Clinical Consensus No. 5. Obstet Gynecol 2023; 142:735-744. [PMID: 37590985 DOI: 10.1097/aog.0000000000005297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Indexed: 08/19/2023]
Abstract
SUMMARY Endometrial intraepithelial neoplasia (EIN) or atypical endometrial hyperplasia (AEH) often is a precursor lesion to adenocarcinoma of the endometrium. Hysterectomy is the definitive treatment for EIN-AEH. When a conservative (fertility-sparing) approach to the management of EIN-AEH is under consideration, it is important to attempt to exclude the presence of endometrial cancer to avoid potential undertreatment of an unknown malignancy in those who have been already diagnosed with EIN-AEH. Given the high risk of progression to cancer, those who do not have surgery require progestin therapy (oral, intrauterine, or combined) and close surveillance. Although data are conflicting and limited, studies have demonstrated that treatment with the levonorgestrel-releasing intrauterine device results in a higher regression rate when compared with treatment with oral progestins alone. Limited data suggest that cyclic progestational agents have lower regression rates when compared with continuous oral therapy. After initial conservative treatment for EIN-AEH, early detection of disease persistence, progression, or recurrence requires careful follow-up. Gynecologists and other clinicians should counsel patients that lifestyle modification resulting in weight loss and glycemic control can improve overall health and may decrease the risk of EIN-AEH and endometrial cancer.
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Jordao H, Herink K, Ka E, McVicker L, Kearns C, McMenamin ÚC. Pre-eclampsia during pregnancy and risk of endometrial cancer: a systematic review and meta-analysis. BMC Womens Health 2023; 23:259. [PMID: 37173714 PMCID: PMC10182685 DOI: 10.1186/s12905-023-02408-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Pre-eclampsia may be associated with the development of endometrial cancer; however, previous findings have been conflicting. OBJECTIVES To investigate if pre-eclampsia is associated with an increased risk of endometrial cancer. METHOD Two independent reviewers screened titles and abstracts of studies identified in MEDLINE, Embase, and Web of Science databases from inception until March 2022. Studies were included if they investigated pre-eclampsia and subsequent risk of endometrial cancer (or precursor lesions). Random-effects meta-analysis was used to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between pre-eclampsia during pregnancy and endometrial cancer risk. MAIN RESULTS There were seven articles identified which investigated endometrial cancer, of which one also investigated endometrial cancer precursors. Overall, the studies include 11,724 endometrial cancer cases. No association was observed between pre-eclampsia and risk of endometrial cancer with moderate heterogeneity observed (pooled HR 1.07, 95% CI 0.79-1.46, I2 = 34.1%). In sensitivity analysis investigating risk of endometrial neoplasia (atypical hyperplasia, carcinoma in situ, or cancer), there was some evidence that pre-eclampsia was associated with an increased risk (HR 1.34, 95% CI 1.15-1.57, I2 = 29.6%). CONCLUSIONS Pre-eclampsia was not associated with an increased risk of endometrial cancer. Additional large studies with information on pre-eclampsia sub-type aiming to investigate endometrial cancer precursor conditions are merited.
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Affiliation(s)
- H Jordao
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences-B Building, Royal Victoria Hospital site, Grosvenor Rd, Belfast, Northern Ireland, BT12 6BJ, UK.
| | - K Herink
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences-B Building, Royal Victoria Hospital site, Grosvenor Rd, Belfast, Northern Ireland, BT12 6BJ, UK
| | - Eastwood Ka
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences-B Building, Royal Victoria Hospital site, Grosvenor Rd, Belfast, Northern Ireland, BT12 6BJ, UK
- Department of St. Michael's Hospital, Bristol, UK
| | - L McVicker
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences-B Building, Royal Victoria Hospital site, Grosvenor Rd, Belfast, Northern Ireland, BT12 6BJ, UK
| | - C Kearns
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences-B Building, Royal Victoria Hospital site, Grosvenor Rd, Belfast, Northern Ireland, BT12 6BJ, UK
| | - Ú C McMenamin
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences-B Building, Royal Victoria Hospital site, Grosvenor Rd, Belfast, Northern Ireland, BT12 6BJ, UK
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Ozdemir S, Dogan GO. Association of Obesity and Surgery Outcomes in Patients with Endometrial Cancer: A Single-Center Analysis. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1117-1121. [PMID: 36580938 PMCID: PMC9800146 DOI: 10.1055/s-0042-1759632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Although obesity can result in high morbidity and mortality in surgical outcomes because of multiple comorbidities, determinants of outcome in obese patients who underwent endometrial cancer surgery remain unclear. The aim of this study is to assess the relationship between body mass index (BMI) and surgical outcomes in obese patients with endometrial cancer. METHODS An institutional retrospective review of the demographic details, clinical characteristics, and follow-up data of 142 patients with endometrial cancer who underwent surgery during a 72-month period was performed. The patients were divided into three groups based on their BMI; patients with BMI < 25 were identified as normal weight, patients with BMI between 25 and 30 were accepted as overweight, and those with BMI ≥ 30 kg/m2 were identified as obese. The groups' demographic and clinical variables were compared. RESULTS Of the 142 patients, 42 were in the normal weight group, 55 in the overweight group, and 45 in the obese group. Age, surgical procedures, blood loss, preoperative health status, and metastatic lymph nodes did not show a significant difference between groups. However, surgery time and total lymph nodes were higher in the obese group. (p = 0.02, p = 0.00, and p = 0.00, respectively). Common complications were anemia, fever, intestinal injury, deep vein thrombosis, fascial dehiscence and urinary infection. There was no significant difference according to the complications. CONCLUSION Our results indicated that higher BMI was significantly associated with a longer duration of endometrial cancer surgery. Minimally invasive surgeries and conventional laparotomy could be performed safely in obese patients.
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Affiliation(s)
- Savas Ozdemir
- Department of Gynecology and Obstetrics, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Gul Ozel Dogan
- Department of Gynecology and Obstetrics, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey,Address for correspondence Gul Ozel Dogan Sisli Hamidiye Etfal Egitim ve Arastirma Hastanesi Halaskargazi Cad.Etfal Sk., Post code: 34371 Sisli/IstanbulTurkey
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Cruz García AM, Pérez Morales E, Ocón Padrón L, Pérez Matos C, Santana Suárez A, Emergui Zrihen Y, Nieto Naya MÁ, Sánchez Sánchez V, Martín Martínez A. Asymptomatic endometrial thickening in postmenopausal women: predictor of malignant pathology? J OBSTET GYNAECOL 2022; 43:2160928. [PMID: 36576124 DOI: 10.1080/01443615.2022.2160928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
It is not standardised what is the endometrial thickness that discriminates between normal and potentially malignant. The objective of this study was to determine the endometrial thickness cut-off point from which the risk of endometrial cancer (EC) increases in asymptomatic postmenopausal women; and to evaluate the risk factors linked to malignant endometrial pathology as well as other associated ultrasound findings.This was a retrospective observational study that included hysteroscopies performed at the Hospital Materno-Infantil on 267 asymptomatic menopausal women with an increase in endometrial thickness (AET) >5 mm, from 2015 to 2019. The results shows that the prevalence of malignant pathology in asymptomatic postmenopausal women with a casual finding of endometrial thickening was 3.7%. This percentage was 16.3% when the cut-off point of AET was established at 10 mm. There was a significant association for the diagnosis of malignant pathology with this cut-off point.There is a significant association between the 10 mm endometrial thickness cut-off point from which the risk of EC increases in asymptomatic postmenopausal women.Impact statementWhat is already known on this subject? Several studies have established the cut-off point for asymptomatic endometrial thickening (AET) for atypical endometrial hyperplasia and endometrial cancer at 10 mm. Although no cut-off point has optimal accuracy for the diagnosis of malignant endometrial pathology, it has been found that with a cut-off value of AET >10 mm no cases are missed. Likewise, a cut-off point of AET > 11 mm may provide a balance between cancer detection and histopathological workup extension.What do the results of this study add? A significant association was found at the cut-off point of AET > 10 mm, which suggests that screening postmenopausal women at this thickness is acceptable and unlikely to miss cases of endometrial hyperplasia and endometrial cancer.What are the implications of these findings for clinical practice and/or further research? After analysing our results we can conclude, like other published studies, that by establishing a cut-off point of 10 mm we obtain a good discrimination between benign and malignant pathology, which would allow us to diagnose 100% of malignant pathology. Above this cut-off point, the risk of endometrial cancer increases, and it would therefore be advisable to extend the study. A multicentre study is needed to confirm the cut-off point at which the risk of endometrial cancer increases in postmenopausal women with asymptomatic endometrial thickening.
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Affiliation(s)
- Alba María Cruz García
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Elena Pérez Morales
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Ludmila Ocón Padrón
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Cristina Pérez Matos
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Alejandra Santana Suárez
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Yonit Emergui Zrihen
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - María Ángeles Nieto Naya
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Victoria Sánchez Sánchez
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
| | - Alicia Martín Martínez
- Service of Gynaecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
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Abstract
The objectives of this Clinical Expert Series on endometrial hyperplasia are to review the etiology and risk factors, histologic classification and subtypes, malignant progression risks, prevention options, and to outline both surgical and nonsurgical treatment options. Abnormal uterine and postmenopausal bleeding remain the hallmark of endometrial pathology, and up to 10-20% of postmenopausal bleeding will be either hyperplasia or cancer; thus, immediate evaluation of any abnormal bleeding with either tissue procurement for pathology or imaging should be undertaken. Although anyone with a uterus may develop atypical hyperplasia, also known as endometrial intraepithelial neoplasia (EIN), genetic predispositions (eg, Lynch syndrome), obesity, chronic anovulation, and polycystic ovarian syndrome all markedly increase these risks, whereas use of oral contraceptive pills or progesterone-containing intrauterine devices will decrease the risk. An EIN diagnosis carries a high risk of concomitant endometrial cancer or eventual progression to cancer in the absence of treatment. The definitive and curative treatment for EIN remains hysterectomy; however, the obesity epidemic, the potential desire for fertility-sparing treatments, the recognition of varying rates of malignant transformation, medical comorbidities, and an aging population all may factor into decisions to employ nonsurgical treatment modalities.
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Saccardi C, Spagnol G, Bonaldo G, Marchetti M, Tozzi R, Noventa M. New Light on Endometrial Thickness as a Risk Factor of Cancer: What Do Clinicians Need to Know? Cancer Manag Res 2022; 14:1331-1340. [PMID: 35401014 PMCID: PMC8985823 DOI: 10.2147/cmar.s294074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/21/2022] [Indexed: 12/21/2022] Open
Abstract
Transvaginal ultrasound (TVUS) represents an accurate and noninvasive technique to investigate endometrial thickness (ET) in the early diagnosis of endometrial cancer (EC). In the literature, for maximum ET there is no consensus on the cutoff value for normal ET in postmenopause for either symptomatic or asymptomatic women. Most patients with EC present with postmenopausal bleeding (PMB) and in these patients is necessary to perform TVUS to evaluate ET as an indicator for endometrial biopsy. On the contrary, if ET is incidentally detected in postmenopausal patients without bleeding, endometrial sampling for a postmenopausal woman without bleeding should not be routinely performed, although it is estimated that up to 15% of EC occurs in women without vaginal bleeding. The aim of our review was to give clinicians necessary and useful knowledge on the role of TVUS and ET for early detection of EC in their daily routine practice. Based on the most important studies in the literature, we summarized that in premenopausal woman with abnormal uterine bleeding, an optimal cutoff for ET has not yet been established. For postmenopausal women with PMB, at low risk, and ET <4 mm, a follow-up scan could be offered, and for women with ET ≥4 mm, office hysteroscopy–guided endometrial sampling is recommended independently of ET results. On the other hand, in postmenopausal women with PMB and at high risk of EC, office hysteroscopy–guided endometrial sampling is necessary. In postmenopausal women without PMB and ET ≥4 mm, arbitrary endometrial sampling is not recommended, but evaluated case by case based on risk factors. In conclusion, there is broad consensus on the importance of TVUS and the need for further investigation based on risk factors of EC.
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Affiliation(s)
- Carlo Saccardi
- Department of Women and Children’s Health, University of Padua, Padua, Italy
| | - Giulia Spagnol
- Department of Women and Children’s Health, University of Padua, Padua, Italy
- Correspondence: Giulia Spagnol, Obstetrics and Gynecology Clinic, Department of Women and Children’s Health, University of Padua, 3 Via Giustiniani, Padua35128, Italy, Tel +39 347 359-8173, Email
| | - Giulio Bonaldo
- Department of Women and Children’s Health, University of Padua, Padua, Italy
| | - Matteo Marchetti
- Department of Women and Children’s Health, University of Padua, Padua, Italy
| | - Roberto Tozzi
- Department of Women and Children’s Health, University of Padua, Padua, Italy
| | - Marco Noventa
- Department of Women and Children’s Health, University of Padua, Padua, Italy
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Executive Summary of the Uterine Cancer Evidence Review Conference. Obstet Gynecol 2022; 139:626-643. [PMID: 35272316 PMCID: PMC8936160 DOI: 10.1097/aog.0000000000004711] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/18/2021] [Indexed: 01/21/2023]
Abstract
Evidence for uterine cancer prevention, diagnosis, and special issues from the Uterine Cancer Evidence Review Conference is summarized. The Centers for Disease Control and Prevention recognized the need for educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. The American College of Obstetricians and Gynecologists convened a panel of experts in evidence review from the Society for Academic Specialists in General Obstetrics and Gynecology and content experts from the Society of Gynecologic Oncology to review relevant literature, best practices, and existing practice guidelines as a first step toward developing evidence-based educational materials for women's health care clinicians about uterine cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at a virtual meeting of stakeholder professional and patient advocacy organizations in January 2021. This article is the evidence summary of the relevant literature and existing recommendations to guide clinicians in the prevention, early diagnosis, and special considerations of uterine cancer. Substantive knowledge gaps are noted and summarized to provide guidance for future research.
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A Traditional Chinese Medicine for the Treatment of Endometrial Hyperplasia via Regulating the HPO Axis in Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5200608. [PMID: 35154346 PMCID: PMC8828340 DOI: 10.1155/2022/5200608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/15/2021] [Accepted: 01/04/2022] [Indexed: 12/17/2022]
Abstract
Dysfunctional uterine bleeding, accompanied by endometrial hyperplasia (EH), is a common gynecological disease that seriously affects female physical and mental health. Some drugs have been prompted to cure the disease, but most medications have certain side effects and limitations. In the present study, we demonstrated an unexploited Chinese traditional medicine, a combination of Saururus chinensis, Celosia cristata, and Spatholobus suberectus (SCS), which could be used for the treatment of EH and associated complications in rats. We identified the active components from the three Chinese herbs via thin-layer chromatography and high-performance liquid chromatography methods. In addition, serum biochemical indexes and histologic section results found that acute high-dose SCS exerted no adverse impacts on the rats. We then showed that SCS shortened coagulation time (p=0.018) and degree of swelling (p=0.021) on rats at 30 min compared to blank control. Further studies proved that recovered endometrial thickness was associated with the modulation of four hormones (follicle-stimulating hormone, luteinizing hormone, estrogen, and progesterone). Specifically, follicle-stimulating hormone and progesterone contents increased gradually with time, and estrogen was decreased, whereas luteinizing hormone content was returned to normal after a short-term elevation (p < 0.05). Besides, SCS increased uterine endometrium's mRNA expression levels of matrix metalloproteinase-1 (p < 0.001) and tissue inhibitor of matrix metalloproteinase-1 (p < 0.001), promoting the repair of proliferating endometrium in the rats. Collectively, our study indicates that SCS harbors a profoundly curative effect on the treatment of EH and relative complications and uncovers the mechanism at molecular and gene expression levels.
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MacLean JA, Hayashi K. Progesterone Actions and Resistance in Gynecological Disorders. Cells 2022; 11:cells11040647. [PMID: 35203298 PMCID: PMC8870180 DOI: 10.3390/cells11040647] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 02/06/2023] Open
Abstract
Estrogen and progesterone and their signaling mechanisms are tightly regulated to maintain a normal menstrual cycle and to support a successful pregnancy. The imbalance of estrogen and progesterone disrupts their complex regulatory mechanisms, leading to estrogen dominance and progesterone resistance. Gynecological diseases are heavily associated with dysregulated steroid hormones and can induce chronic pelvic pain, dysmenorrhea, dyspareunia, heavy bleeding, and infertility, which substantially impact the quality of women’s lives. Because the menstrual cycle repeatably occurs during reproductive ages with dynamic changes and remodeling of reproductive-related tissues, these alterations can accumulate and induce chronic and recurrent conditions. This review focuses on faulty progesterone signaling mechanisms and cellular responses to progesterone in endometriosis, adenomyosis, leiomyoma (uterine fibroids), polycystic ovary syndrome (PCOS), and endometrial hyperplasia. We also summarize the association with gene mutations and steroid hormone regulation in disease progression as well as current hormonal therapies and the clinical consequences of progesterone resistance.
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Vouxinou A, Iatrakis G, Zervoudis S, Dagla M, Orovou E, Palaska E, Sarella A, Antoniou E. The Impact of the Characteristics of Exercise on The Risk of Breast Cancer Instructions. Mater Sociomed 2021; 33:195-198. [PMID: 34759777 PMCID: PMC8565428 DOI: 10.5455/msm.2021.33.195-198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Exercise seems to protect from breast cancer (BC) and this protection is likely mediated through weight control during menopause. Considering that night work is associated with higher risk for BC. Objective: The aim of this study was to examine the possible relation of BC risk to daytime or nighttime hours of exercise. Methods: The material was taken from primary elements of a doctoral thesis at the Department of Midwifery, University of West Attica that examines the impact of the characteristics of exercising on BC. The data were obtained from relevant questionnaires filled in at a big private hospital, following a relevant permit of the scientific committee, and adjusted Google Forms, ensuring anonymity. Results: Almost 3 times more women without a history of BC were exclusively exercising during the daytime compared to the ones with a history of BC who were exclusively exercising during the nighttime (40 vs 15). On the contrary, a smaller number of women without a history of BC were exclusively exercising during the nighttime compared to the ones with a history of BC who were exclusively exercising during the nighttime (17 vs 20) (odds ratio >3 with a confidence interval >1 to >7.5 and p<0.05). Conclusion: It seems that the protective impact of exercising on BC is mitigated when the exercise is performed exclusively during night hours.
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Affiliation(s)
| | | | - Stefanos Zervoudis
- Department of Midwifery, University of West Attica, Athens, Greece.,Department of Midwifery, University of West Attica, Athens, Greece
| | - Maria Dagla
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Eirini Orovou
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Ermioni Palaska
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Angeliki Sarella
- Department of Midwifery, University of West Attica, Athens, Greece
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Hossain SF, Huang M, Ono N, Morita A, Kanaya S, Altaf-Ul-Amin M. Development of a biomarker database toward performing disease classification and finding disease interrelations. DATABASE-THE JOURNAL OF BIOLOGICAL DATABASES AND CURATION 2021; 2021:6168336. [PMID: 33705530 PMCID: PMC7951048 DOI: 10.1093/database/baab011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 12/11/2022]
Abstract
A biomarker is a measurable indicator of a disease or abnormal state of a body that plays an important role in disease diagnosis, prognosis and treatment. The biomarker has become a significant topic due to its versatile usage in the medical field and in rapid detection of the presence or severity of some diseases. The volume of biomarker data is rapidly increasing and the identified data are scattered. To provide comprehensive information, the explosively growing data need to be recorded in a single platform. There is no open-source freely available comprehensive online biomarker database. To fulfill this purpose, we have developed a human biomarker database as part of the KNApSAcK family databases which contain a vast quantity of information on the relationships between biomarkers and diseases. We have classified the diseases into 18 disease classes, mostly according to the National Center for Biotechnology Information definitions. Apart from this database development, we also have performed disease classification by separately using protein and metabolite biomarkers based on the network clustering algorithm DPClusO and hierarchical clustering. Finally, we reached a conclusion about the relationships among the disease classes. The human biomarker database can be accessed online and the inter-disease relationships may be helpful in understanding the molecular mechanisms of diseases. To our knowledge, this is one of the first approaches to classify diseases based on biomarkers. Database URL: http://www.knapsackfamily.com/Biomarker/top.php.
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Affiliation(s)
- Shaikh Farhad Hossain
- Computational Systems Biology Lab, Graduate School of Science and Technology, Nara Institute of Science and Technology (NAIST), 8916-5, Takayama, Ikoma, Nara 630-0192, Japan
| | - Ming Huang
- Computational Systems Biology Lab, Graduate School of Science and Technology, Nara Institute of Science and Technology (NAIST), 8916-5, Takayama, Ikoma, Nara 630-0192, Japan
| | - Naoaki Ono
- Computational Systems Biology Lab, Graduate School of Science and Technology, Nara Institute of Science and Technology (NAIST), 8916-5, Takayama, Ikoma, Nara 630-0192, Japan
| | - Aki Morita
- Computational Systems Biology Lab, Graduate School of Science and Technology, Nara Institute of Science and Technology (NAIST), 8916-5, Takayama, Ikoma, Nara 630-0192, Japan
| | - Shigehiko Kanaya
- Computational Systems Biology Lab, Graduate School of Science and Technology, Nara Institute of Science and Technology (NAIST), 8916-5, Takayama, Ikoma, Nara 630-0192, Japan
| | - Md Altaf-Ul-Amin
- Computational Systems Biology Lab, Graduate School of Science and Technology, Nara Institute of Science and Technology (NAIST), 8916-5, Takayama, Ikoma, Nara 630-0192, Japan
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Aggarwal A, Hatti A, Tirumuru SS, Nair SS. Management of asymptomatic postmenopausal women referred to outpatient hysteroscopy service with incidental finding of thickened endometrium - A UK District General Hospital Experience. J Minim Invasive Gynecol 2021; 28:1725-1729. [PMID: 33610754 DOI: 10.1016/j.jmig.2021.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE The objective of this study was to review the management and outcome of asymptomatic postmenopausal women with increased endometrial thickness as there is lack of robust guidance for the same. DESIGN Retrospective case series over a period of 2 years. SETTING District general hospital. PATIENTS Eighty-three. INTERVENTIONS No prospective interventions were done. Only a review of the interventions done in an outpatient setting, namely, hysteroscopy and endometrial sampling, was carried out. MEASUREMENTS AND MAIN RESULTS Retrospective review of 1453 referrals to outpatient hysteroscopy service over a period of 2 years was carried out, and 83 patients referred with asymptomatic thickened endometrium on imaging were identified. Patients underwent hysteroscopy on the basis of the local policy, that is, if the endometrial thickness was more than 10 mm or in the presence of additional risk factors. The yield rate of endometrial cancer and atypical hyperplasia was 1.2% and 2.4%, respectively, among all patients (n = 83). The yield rate of endometrial cancer and atypical hyperplasia was 1.81% and 3.63%, respectively, among patients referred with endometrial thickness ≤10 mm after considering other risk factors. CONCLUSION It is reasonable to use endometrial thickness of 10 mm or above as a cutoff threshold to offer endometrial biopsy or outpatient hysteroscopy for asymptomatic postmenopausal women. For asymptomatic women with endometrial thickness between 4 and 10 mm, decisions about further investigations should be made on a case-by-case basis, taking into account any risk factors for endometrial pathology. As this study had a reasonably good sample size, it can contribute toward formulation of robust guidance for management of postmenopausal women with asymptomatic endometrial thickening.
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Affiliation(s)
- Aakriti Aggarwal
- Department of Gynaecology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom (all authors).
| | - Archana Hatti
- Department of Gynaecology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom (all authors)
| | - Sakunthala Sahithi Tirumuru
- Department of Gynaecology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom (all authors)
| | - Sabita Sivaraman Nair
- Department of Gynaecology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom (all authors)
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Saccardi C, Vitagliano A, Marchetti M, Lo Turco A, Tosatto S, Palumbo M, De Lorenzo LS, Vitale SG, Scioscia M, Noventa M. Endometrial Cancer Risk Prediction According to Indication of Diagnostic Hysteroscopy in Post-Menopausal Women. Diagnostics (Basel) 2020; 10:E257. [PMID: 32349386 PMCID: PMC7277718 DOI: 10.3390/diagnostics10050257] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 12/15/2022] Open
Abstract
We conducted a prospective observational study investigating the clinical relevance of endometrial thickness (ET) and abnormal uterine bleeding (AUB) on endometrial cancer (EC) risk in a cohort of postmenopausal patients undergoing diagnostic hysteroscopy and endometrial biopsy. Patients were divided into two groups according to the indication of diagnostic hysteroscopy: ET_Group (asymptomatic patients with endometrial thickness ≥ 4 mm) and AUB_Group (patients with a history of abnormal uterine bleeding). We further divided the AUB_Group into two subgroups based on endometrial thickness (AUB_Subgroup1: ET < 4 mm; AUB_Subgroup2: ET ≥ 4 mm). The primary outcome was the risk of endometrial cancer and atypical hyperplasia according to the indications of diagnostic hysteroscopy (AUB, ET ≥ 4 mm or both). The secondary outcome was to determine the best cut-off value of endometrial thickness to predict endometrial cancer in asymptomatic postmenopausal women. The prevalence of endometrial cancer and atypical hyperplasia in AUB_Group and ET_Group was 21% and 6.7% respectively. As well as for EC alone, higher prevalence of both conditions was observed in AUB_Subgroup2 (29.3%) in comparison to AUB_Subgroup1 (10.6%; p < 0.001). In asymptomatic patients the cut-off of endometrial thickness that showed the best sensitivity and specificity to diagnose endometrial cancer (100% and 80% respectively) was 11 mm (AUC of 91.4%; Expβ: 1067; CI 95%). In conclusion, considering the high risk of neoplasia, diagnostic hysteroscopy with endometrial biopsy should be mandatory in cases of abnormal uterine bleeding in postmenopausal patients. Moreover, we want to emphasize the need for further evidence stating the clinical relevance of endometrial thickness value in asymptomatic patients and the impact of individual risk factors on endometrial cancer development.
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Affiliation(s)
- Carlo Saccardi
- Department of Women’s and Children’s Health, University of Padua, 35100 Padua, Italy
| | - Amerigo Vitagliano
- Department of Women’s and Children’s Health, University of Padua, 35100 Padua, Italy
| | - Matteo Marchetti
- Department of Women’s and Children’s Health, University of Padua, 35100 Padua, Italy
| | - Alice Lo Turco
- Department of Women’s and Children’s Health, University of Padua, 35100 Padua, Italy
| | - Sofia Tosatto
- Department of Women’s and Children’s Health, University of Padua, 35100 Padua, Italy
| | - Michela Palumbo
- Department of Women’s and Children’s Health, University of Padua, 35100 Padua, Italy
| | | | - Salvatore Giovanni Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy
| | - Marco Scioscia
- Department of Obstetrics and Gynecology, Policlinico Abano Terme, 35031, Italy
| | - Marco Noventa
- Department of Women’s and Children’s Health, University of Padua, 35100 Padua, Italy
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Smolle MA, Czapiewski P, Lapińska-Szumczyk S, Majewska H, Supernat A, Zaczek A, Biernat W, Golob-Schwarzl N, Haybaeck J. The Prognostic Significance of Eukaryotic Translation Initiation Factors (eIFs) in Endometrial Cancer. Int J Mol Sci 2019; 20:E6169. [PMID: 31817792 PMCID: PMC6941158 DOI: 10.3390/ijms20246169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/01/2019] [Accepted: 12/05/2019] [Indexed: 02/07/2023] Open
Abstract
Whilst the role of eukaryotic translation initiation factors (eIFs) has already been investigated in several human cancers, their role in endometrial cancer (EC) is relatively unknown. In the present retrospective study, 279 patients with EC (1180 samples) were included (mean age: 63.0 years, mean follow-up: 6.1 years). Samples were analysed for expression of 7 eIFs subunits (eIF2α, eIF3c, eIF3h, eIF4e, eIF4g, eIF5, eIF6) through immunohistochemistry and western blotting. Fifteen samples of healthy endometrium served as controls. Density and intensity were assessed and mean combined scores (CS) calculated for each patient. Upon immunohistochemistry, median eIF5 CS were significantly higher in EC as compared with non-neoplastic tissue (NNT, p < 0.001), whilst median eIF6 CS were significantly lower in EC (p < 0.001). Moreover, eIF5 (p = 0.002), eIF6 (p = 0.032) and eIF4g CS (p = 0.014) were significantly different when comparing NNT with EC grading types. Median eIF4g CS was higher in type II EC (p = 0.034). Upon western blot analysis, eIF4g (p < 0.001), peIF2α (p < 0.001) and eIF3h (p < 0.05) were significantly overexpressed in EC, while expression of eIF3c was significantly reduced in EC as compared with NNT (p < 0.001). The remaining eIFs were non-significant. Besides tumour stage (p < 0.001) and patient's age (p < 0.001), high eIF4g CS-levels were independently associated with poor prognosis (HR: 1.604, 95%CI: 1.037-2.483, p = 0.034). The other eIFs had no prognostic significance. Notably, the independent prognostic significance of eIF4g was lost when adding tumour type. Considering the difficulties in differentiating EC type I and II, eIF4g may serve as a novel prognostic marker indicating patient outcome.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria;
- Area 2 Cancer, Center for Biomarker Research in Medicine, Stiftingtalstraße 5, 8010 Graz, Austria;
| | - Piotr Czapiewski
- Department of Pathomorphology, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland; (P.C.); (H.M.); (W.B.)
- Department of Pathology, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Sylwia Lapińska-Szumczyk
- Department of Gynaecology, Gynaecological Oncology and Gynaecological Endocrinology, Medical University of Gdańsk, M. Skłodowskiej-Curie 3a Street, 80-210 Gdańsk, Poland;
| | - Hanna Majewska
- Department of Pathomorphology, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland; (P.C.); (H.M.); (W.B.)
| | - Anna Supernat
- Department of Medical Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdańnsk and Medical University of Gdańsk, Bażyńskiego 1a, 80-952 Gdańsk, Poland; (A.S.); (A.Z.)
| | - Anna Zaczek
- Department of Medical Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdańnsk and Medical University of Gdańsk, Bażyńskiego 1a, 80-952 Gdańsk, Poland; (A.S.); (A.Z.)
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland; (P.C.); (H.M.); (W.B.)
| | - Nicole Golob-Schwarzl
- Area 2 Cancer, Center for Biomarker Research in Medicine, Stiftingtalstraße 5, 8010 Graz, Austria;
- Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036 Graz, Austria
| | - Johannes Haybaeck
- Area 2 Cancer, Center for Biomarker Research in Medicine, Stiftingtalstraße 5, 8010 Graz, Austria;
- Department of Pathology, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
- Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036 Graz, Austria
- Department of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Müllerstraße 44, 6020 Innsbruck, Austria
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Tsuruga T, Hirata T, Akiyama I, Matsumoto Y, Oda K, Fujii T, Osuga Y. Mixed endometrioid and clear cell carcinoma arising from laparoscopic trocar site endometriosis. J Obstet Gynaecol Res 2019; 45:1613-1618. [PMID: 31183953 DOI: 10.1111/jog.14014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/15/2019] [Indexed: 12/19/2022]
Abstract
Laparoscopic port site endometriosis is less common in abdominal wall endometriosis, and malignant transformation of abdominal wall endometriosis is rare. We reported a case of mixed endometrioid and clear cell carcinoma arising from port site endometriosis. The patient was a 49-year-old woman with a history of laparoscopic excision of ovarian endometrioma. Physical examination revealed a subcutaneous solid tumor around the laparoscopic surgical scar. Imaging showed a suspicious malignancy. She underwent radical marginal resection of the abdominal wall tumor, flap reconstruction of the abdominal wall, hysterectomy, bilateral salpingo-oophorectomy and omental biopsy. Histological examination revealed mixed endometrioid and clear cell carcinoma. Computed tomography scan showed no evidence of recurrence after six cycles of chemotherapy. This is the first case of malignant transformation from laparoscopic trocar site endometriosis.
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Affiliation(s)
- Tetsushi Tsuruga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuya Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, Doai Kinen Hospital, Tokyo, Japan
| | - Ikumi Akiyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, Doai Kinen Hospital, Tokyo, Japan
| | - Yoko Matsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Katsutoshi Oda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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19
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Evaluation of serum irisin levels in patients with endometrial hyperplasia: A controlled cross-sectional study. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.536426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Khwaja R, Dessouky R, Heffler MA, Xi Y, Neeland IJ, Chhabra A. Multi-compartment mesenchymal tissue segmentation in pelvic MRI examinations of women: Anthropomorphic and clinical correlations. Eur J Radiol 2019; 112:37-43. [PMID: 30777217 DOI: 10.1016/j.ejrad.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/20/2018] [Accepted: 01/02/2019] [Indexed: 11/25/2022]
Abstract
AIM To investigate the reliability of multicompartmental volumetric mesenchymal segmentations on MRI and their correlations with anthropomorphic and clinical parameters. MATERIALS AND METHODS A consecutive series of middle-age (35-50 year old) female volunteers with variable body mass index (BMI) and MRI scans performed as a part of the Dallas Heart Study were included. A semi-automatic segmentation tool was used to partition different mesenchymal tissues- fat, muscle, and bone on MRI of pelvis. Total volumes of each compartment were calculated and compared between overweight/obese (BMI> = 25 kg/m2) and non-obese (BMI < 25 kg/m2) groups, and with physical performance measurements, i.e. mean activity counts per minute (MVPA) and cardiorespiratory fitness (CRF) estimated by submaximal treadmill test (TT). Kruskal Wallis, Mann-Whitney U test, intraclass correlation coefficient (ICC) and Spearman correlations were used. P value <0.05 was considered statistically significant. RESULTS There were statistically significant positive correlations between fat volume and BMI (p < 0.0001), muscle volume and height (p = 0.03), and bone volume and height (p < 0.0001). Significant inverse correlations were found between bone volume and BMI (p = 0.002). Fair to good interobserver reliability was seen with muscle and fat volumes (ICC = 0.43-0.64) and excellent reliability was seen with bone volumes (ICC = 0.78-0.79). Statistically significant inverse correlations were found between MVPA and age (p = 0.01), and TT with BMI and weight (p = 0.01, 0.03). CONCLUSION Multi-compartment mesenchymal tissue volume quantification on pelvic MRI is reliable in females. Inverse correlation of bone volume with BMI has potential implications for future risk of fracture.
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Affiliation(s)
- Raamis Khwaja
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Riham Dessouky
- Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Yin Xi
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ian J Neeland
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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21
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MacKintosh ML, Derbyshire AE, McVey RJ, Bolton J, Nickkho‐Amiry M, Higgins CL, Kamieniorz M, Pemberton PW, Kirmani BH, Ahmed B, Syed AA, Ammori BJ, Renehan AG, Kitchener HC, Crosbie EJ. The impact of obesity and bariatric surgery on circulating and tissue biomarkers of endometrial cancer risk. Int J Cancer 2019; 144:641-650. [PMID: 30289975 PMCID: PMC6519061 DOI: 10.1002/ijc.31913] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/21/2018] [Accepted: 09/19/2018] [Indexed: 02/03/2023]
Abstract
Obesity is the strongest risk factor for endometrial cancer (EC). To inform targeted screening and prevention strategies, we assessed the impact of obesity and subsequent bariatric surgery-induced weight loss on endometrial morphology and molecular pathways implicated in endometrial carcinogenesis. Blood and endometrial tissue were obtained from women with class III-IV obesity (body mass index ≥40 and ≥50 kg/m2 , respectively) immediately prior to gastric bypass or sleeve gastrectomy, and at two and 12 months' follow up. The endometrium underwent pathological examination and immunohistochemistry was used to quantify proliferation (Ki-67), oncogenic signaling (PTEN, pAKT, pERK) and hormone receptor (ER, PR) expression status. Circulating biomarkers of insulin resistance, reproductive function and inflammation were also measured at each time point. Seventy-two women underwent bariatric surgery. At 12 months, the mean change in total and excess body weight was -32.7 and -62.8%, respectively. Baseline endometrial biopsies revealed neoplastic change in 10 women (14%): four had EC, six had atypical hyperplasia (AH). After bariatric surgery, most cases of AH resolved (5/6) without intervention (3/6) or with intrauterine progestin (2/6). Biomarkers of endometrial proliferation (Ki-67), oncogenic signaling (pAKT) and hormone receptor status (ER, PR) were significantly reduced, with restoration of glandular PTEN expression, at 2 and 12 months. There were reductions in circulating biomarkers of insulin resistance (HbA1c, HOMA-IR) and inflammation (hsCRP, IL-6), and increases in reproductive biomarkers (LH, FSH, SHBG). We found an unexpectedly high prevalence of occult neoplastic changes in the endometrium of women undergoing bariatric surgery. Their spontaneous reversal and accompanying down-regulation of PI3K-AKT-mTOR signaling with weight loss may have implications for screening, prevention and treatment of this disease.
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Affiliation(s)
- Michelle L. MacKintosh
- Department of Obstetrics and GynaecologySt Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Abigail E. Derbyshire
- Department of Obstetrics and GynaecologySt Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Rhona J. McVey
- Department of HistopathologyManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - James Bolton
- Department of HistopathologyManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Mahshid Nickkho‐Amiry
- Department of Obstetrics and GynaecologySt Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Catherine L. Higgins
- Department of HistopathologyManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Martyna Kamieniorz
- Department of HistopathologyManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Philip W. Pemberton
- Department of Clinical BiochemistryManchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Bilal H. Kirmani
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest HospitalLiverpoolUnited Kingdom
| | - Babur Ahmed
- Department of Obesity Medicine, Diabetes & EndocrinologySalford Royal NHS Foundation Trust, Manchester Academic Health Science CentreSalfordUnited Kingdom
| | - Akheel A. Syed
- Department of Obesity Medicine, Diabetes & EndocrinologySalford Royal NHS Foundation Trust, Manchester Academic Health Science CentreSalfordUnited Kingdom
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine & HealthUniversity of ManchesterManchesterUnited Kingdom
| | - Basil J. Ammori
- Department of Obesity Medicine, Diabetes & EndocrinologySalford Royal NHS Foundation Trust, Manchester Academic Health Science CentreSalfordUnited Kingdom
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine & HealthUniversity of ManchesterManchesterUnited Kingdom
| | - Andrew G. Renehan
- Obesity and Cancer Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthManchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, University of ManchesterManchesterUnited Kingdom
| | - Henry C. Kitchener
- Gynaecological Oncology Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUnited Kingdom
| | - Emma J. Crosbie
- Department of Obstetrics and GynaecologySt Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
- Gynaecological Oncology Research Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUnited Kingdom
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Renaud MC, Le T. No. 291-Epidemiology and Investigations forSuspected Endometrial Cancer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e703-e711. [PMID: 30268319 DOI: 10.1016/j.jogc.2018.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To review the evidence relating to the epidemiology of endometrial cancer and its diagnostic workups. OPTIONS Women with possible endometrial cancer can undergo an endometrial evaluation by office biopsy, hysteroscopy, or dilatation and curettage. To assist in treatment planning, pelvic ultrasound, CT scan, or MRI may be considered. OUTCOMES The identification of optimal diagnostic tests to evaluate patients with possible endometrial cancer. EVIDENCE Published literature was retrieved through searches of PubMed, CINAHL, and The Cochrane Library, using appropriate controlled vocabulary (e.g., endometrial neoplasms) and key words (e.g., endometrium cancer, endometrial carcinoma). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 31, 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, national and international medical specialty societies, and recent conference abstracts. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS This document is intended to guide the development of a standardized cost-effective investigation of patients with suspected endometrial cancer. VALIDATION The guideline was reviewed for accuracy by experts in pathology, radiation oncology, and medical oncology. Guideline content was also compared with relevant documents from the American Congress of Obstetricians and Gynecologists. RECOMMENDATIONS
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Renaud MC, Le T. No 291 - Épidémiologie et explorations visant la présence soupçonnée d’un cancer de l’endomètre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e712-e722. [DOI: 10.1016/j.jogc.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kilicci C, Çogendez E, Kumru P, Bostanci Ergen E, Koc N, Abide Yayla C. Cytological assessment of endometrial washings obtained with Karman cannula using a liquid-based preparation method for the detection of endometrial pathologies. Arch Gynecol Obstet 2018; 298:171-177. [PMID: 29777346 DOI: 10.1007/s00404-018-4788-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/10/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic efficacy and utility of liquid-based cytology in ThinPrep (Cytyc Corporation, Boxborough, MA) for endometrial lesions in patients presenting with abnormal uterine bleeding. MATERIALS AND METHODS Two hundred and thirteen women scheduled for dilatation and curettage because of abnormal uterine bleeding were enrolled in the study. After providing informed consent, all the women proceeded sequentially to endometrial cytology and then dilatation and curettage. RESULTS In the premenopausal group, cytological failure was 4.8%, histopathological failure was 2.4%; cytologic insufficiency in the postmenopausal group was 2.1%, and histopathologic insufficiency was 19.6%. When cytologic and histopathological sufficiency rates were compared in all cases, cytologic insufficiency was 4.2% and histopathologic insufficiency was 6.1%. This difference was statistically significant (p < 0.039). The diagnostic accuracy, sensitivity, specificity, PPV, and NPV of the liquid-based endometrial cytology for premenopausal patients were 96.79, 58.33, 97.92, 70, and 96.58%, respectively. In the postmenopausal cases, the accuracy of diagnosis of endometrial cytology was 97.30%, sensitivity 100%, specificity 96.67%, PPV 87.50%, and NPV 100%. When cytologic and histopathologically inadequate cases were excluded, no cytologic and histopathological abnormal findings were found in endometrial thickness cutoff ≤ 5 mm for all patients. CONCLUSION The use of liquid-based cytology with TVS may contribute to increasing the diagnostic accuracy of the test and reduce unnecessary D&C for women. When TVS is used as a triage indicator, regardless of menopausal status in ≤ 5 mm endometrial thickness cases, endometrial cytology is an absolutely reliable method for detecting cancer.
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Affiliation(s)
- Cetin Kilicci
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Üsküdar, 34668, Istanbul, Turkey
| | - Ebru Çogendez
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Üsküdar, 34668, Istanbul, Turkey
| | - Pınar Kumru
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Üsküdar, 34668, Istanbul, Turkey
| | - Evrim Bostanci Ergen
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Üsküdar, 34668, Istanbul, Turkey.
| | - Nermin Koc
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Üsküdar, 34668, Istanbul, Turkey
| | - Cigdem Abide Yayla
- Department of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Üsküdar, 34668, Istanbul, Turkey
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N o 249-Épaississement endométrial asymptomatique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e378-e390. [DOI: 10.1016/j.jogc.2018.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Wolfman W. No. 249-Asymptomatic Endometrial Thickening. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e367-e377. [DOI: 10.1016/j.jogc.2018.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Fertility-Sparing Management Using Progestin for Young Women with Endometrial Cancer From a Population-Based Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:328-333. [PMID: 28986185 DOI: 10.1016/j.jogc.2017.06.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE For young women with complex atypical endometrial hyperplasia (CAH) and endometrial cancer (EC) who choose to preserve fertility, progestin therapy is the mainstay of treatment. The objective of this study was to evaluate oncologic and reproductive outcomes associated with progestin therapy among these women from a population-based cancer registry. METHODS This was a retrospective population-based cohort study of women under age 45 in British Columbia from 2003 to 2015 with CAH or grade I endometrioid EC who used progestins as initial management. Demographics, treatment type, response to treatment, determinants of definitive surgery (hysterectomy), pathologic findings, and obstetrical outcomes were reviewed. RESULTS There were 50 women under age 45 with CAH (n = 29) and EC (n = 21). Median age at diagnosis was 36 years (range 25-41), and most were nulliparous (88%) with a median BMI of 32.9 (range 21-70). After 6 months of therapy, 58% of women had persistent disease, and only 35% had full resolution at last follow-up (median 23 months). There were 32 women who had a hysterectomy, including 27 because of persistent/recurrent disease, and 5 who chose surgery despite complete response to progestins. The majority of hysterectomy specimens (85%) had minimal or no residual pathology, even among those with disease on preoperative biopsy. Only 10% of women had successful pregnancies. CONCLUSION There is a moderate to high risk of persistence of CAH or EC on progestin therapy. However, for those undergoing hysterectomy, the vast majority has low-risk disease confined to the endometrium, implying the possibility of further conservative management of persistent disease.
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Daley-Brown D, Oprea-Iles G, Vann KT, Lanier V, Lee R, Candelaria PV, Quarshie A, Pattillo R, Gonzalez-Perez RR. Type II Endometrial Cancer Overexpresses NILCO: A Preliminary Evaluation. DISEASE MARKERS 2017; 2017:8248175. [PMID: 28659656 PMCID: PMC5474242 DOI: 10.1155/2017/8248175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/27/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The expression of NILCO molecules (Notch, IL-1, and leptin crosstalk outcome) and the association with obesity were investigated in types I and II endometrial cancer (EmCa). Additionally, the involvement of NILCO in leptin-induced invasiveness of EmCa cells was investigated. METHODS The expression of NILCO mRNAs and proteins were analyzed in EmCa from African-American (n = 29) and Chinese patients (tissue array, n = 120 cases). The role of NILCO in leptin-induced invasion of Ishikawa and An3ca EmCa cells was investigated using Notch, IL-1, and leptin signaling inhibitors. RESULTS NILCO molecules were expressed higher in type II EmCa, regardless of ethnic background or obesity status of patients. NILCO proteins were mainly localized in the cellular membrane and cytoplasm of type II EmCa. Additionally, EmCa from obese African-American patients showed higher levels of NILCO molecules than EmCa from lean patients. Notably, leptin-induced EmCa cell invasion was abrogated by NILCO inhibitors. CONCLUSION Type II EmCa expressed higher NILCO molecules, which may suggest it is involved in the progression of the more aggressive EmCa phenotype. Obesity was associated with higher expression of NILCO molecules in EmCa. Leptin-induced cell invasion was dependent on NILCO. Hence, NILCO might be involved in tumor progression and could represent a new target/biomarker for type II EmCa.
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MESH Headings
- Adenocarcinoma, Papillary/complications
- Adenocarcinoma, Papillary/diagnosis
- Adenocarcinoma, Papillary/ethnology
- Adenocarcinoma, Papillary/genetics
- Aged
- Antibodies/pharmacology
- Asian People
- Black People
- Carcinoma, Endometrioid/complications
- Carcinoma, Endometrioid/diagnosis
- Carcinoma, Endometrioid/ethnology
- Carcinoma, Endometrioid/genetics
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Cystadenocarcinoma, Serous/complications
- Cystadenocarcinoma, Serous/diagnosis
- Cystadenocarcinoma, Serous/ethnology
- Cystadenocarcinoma, Serous/genetics
- Diamines/pharmacology
- Disease Progression
- Endometrial Neoplasms/complications
- Endometrial Neoplasms/diagnosis
- Endometrial Neoplasms/ethnology
- Endometrial Neoplasms/genetics
- Endometrium/metabolism
- Endometrium/pathology
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Interleukin-1/antagonists & inhibitors
- Interleukin-1/genetics
- Interleukin-1/metabolism
- Leptin/genetics
- Leptin/metabolism
- Middle Aged
- Neoplasm Staging
- Obesity/complications
- Obesity/diagnosis
- Obesity/ethnology
- Obesity/genetics
- Protein Isoforms/antagonists & inhibitors
- Protein Isoforms/genetics
- Protein Isoforms/metabolism
- Receptor, Notch1/antagonists & inhibitors
- Receptor, Notch1/genetics
- Receptor, Notch1/metabolism
- Signal Transduction
- Thiazoles/pharmacology
- Black or African American
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Affiliation(s)
- Danielle Daley-Brown
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Gabriela Oprea-Iles
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Kiara T. Vann
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Viola Lanier
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Regina Lee
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Pierre V. Candelaria
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Alexander Quarshie
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Roland Pattillo
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Ruben Rene Gonzalez-Perez
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, USA
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Renaud MC, Le T. Épidémiologie et explorations visant la présence soupçonnée d’un cancer de l’endomètre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:S220-S230. [DOI: 10.1016/j.jogc.2016.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Orekoya O, Samson ME, Trivedi T, Vyas S, Steck SE. The Impact of Obesity on Surgical Outcome in Endometrial Cancer Patients: A Systematic Review. J Gynecol Surg 2016; 32:149-157. [PMID: 27274182 DOI: 10.1089/gyn.2015.0114] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Obesity is a significant public health problem in the United States, and many studies have established obesity as a significant risk factor for endometrial cancer. Surgery is the standard of care in staging and treatment of endometrial cancer, and obesity may influence surgical outcomes because of its attendant comorbid conditions. Therefore, assessment of the impact of obesity on surgical outcome is important for decreasing morbidity and improving survival in patients with endometrial cancer. Objective: The aims of this research were to evaluate and review epidemiologic data systematically on the impact of obesity on surgical outcomes and to assess safety and feasibility of newer surgical techniques in obese patients. Materials and Methods: A systematic search of PubMed was conducted to identify articles between 2004 and 2013 that focused on the impact of obesity on surgical outcome. Reference lists of retrieved articles were also used to identify other relevant articles. Thirteen relevant articles were reviewed. Results: Evidence from epidemiologic studies showed that obesity impacts surgical outcome adversely. On average, obese patients have worse surgical outcomes than their nonobese counterparts. In addition, surgical outcome worsens as level of obesity increases. However, surgical procedure also influences this association. Minimally invasive surgeries are more useful and are accompanied with fewer complications than conventional laparotomy and can be performed safely in obese patients. Conclusions: Obesity is a significant risk in the etiology, treatment, and surgical outcomes of patients with endometrial cancer. Future research will need more randomized controlled trials and prospective studies to identify the best procedures for maximal outcomes. (J GYNECOL SURG 32:149).
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Affiliation(s)
- Olubunmi Orekoya
- Department of Epidemiology and Biostatistics, Cancer Prevention and Control Program, and Arnold School of Public Health, University of South Carolina , Columbia, SC
| | - Marsha E Samson
- Department of Epidemiology and Biostatistics, Cancer Prevention and Control Program, and Arnold School of Public Health, University of South Carolina , Columbia, SC
| | - Tushar Trivedi
- Department of Epidemiology and Biostatistics, Cancer Prevention and Control Program, and Arnold School of Public Health, University of South Carolina , Columbia, SC
| | - Shraddha Vyas
- Department of Epidemiology and Biostatistics, Cancer Prevention and Control Program, and Arnold School of Public Health, University of South Carolina , Columbia, SC
| | - Susan E Steck
- Department of Epidemiology and Biostatistics, Cancer Prevention and Control Program, and Arnold School of Public Health, University of South Carolina , Columbia, SC
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31
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Li ZJ, Yang XL, Yao Y, Han WQ, Li BO. Circulating adiponectin levels and risk of endometrial cancer: Systematic review and meta-analysis. Exp Ther Med 2016; 11:2305-2313. [PMID: 27284314 PMCID: PMC4887953 DOI: 10.3892/etm.2016.3251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/30/2016] [Indexed: 12/12/2022] Open
Abstract
Previous epidemiological studies have presented conflicting results regarding associations between circulating adiponectin (APN) levels and the risk of endometrial cancer. Thus a meta-analysis was performed to investigate the association between these factors. Multiple electronic sources, including PubMed, SpringerLink and Google Scholar databases were searched to identify relevant studies for the present meta-analysis. All of the selected studies examined the correlation between circulating APN levels and endometrial cancer. The standardized mean difference (SMD) and 95% confidence intervals (CIs) were estimated and pooled using meta-analysis methods. Overall, 18 case-control studies met the inclusion criteria. A total of 5,692 participants and 2,337 cases of endometrial cancer were included in this meta-analysis. The SMD of the pooled analysis (95% CI) were −1.96 (−2.60, −1.31), P=0.000. When the cancer grades were compared, the APN values were not significantly different between the grades of endometrial cancer [G1 vs. G3, 1.02 (−0.68, 2.72), P>0.05; G1 vs. G2, 0.34 (−0.86, 1.54), P>0.05]. However, there was a significant association between high APN levels and postmenopausal endometrial cancer cases with an SMD (95% CI) of −2.27 (−4.36, −0.18) and P<0.05, however, no association was observed in premenopausal endometrial cancer cases with an SMD (95% CI) of −1.52 (−3.49, 0.45) and P>0.05. The low circulating APN level increases the risk of endometrial cancer, whereas the high APN level decreases this risk in postmenopausal women. Circulating APN as simple biomarkers may be a promising tool for the prevention, early diagnosis and disease monitoring of endometrial cancer.
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Affiliation(s)
- Zhi-Jun Li
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xue-Ling Yang
- Department of Interventional Treatment, Cancer Hospital and Institution, Tianjin Medical University, Tianjin 300060, P.R. China
| | - Yan Yao
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin 130021, P.R. China
| | - Wei-Qing Han
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin 130021, P.R. China
| | - B O Li
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin 130021, P.R. China
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The immunohistochemistry signature of mismatch repair (MMR) proteins in a multiethnic Asian cohort with endometrial carcinoma. Int J Gynecol Pathol 2015; 33:554-9. [PMID: 25272293 DOI: 10.1097/pgp.0000000000000099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Endometrial cancer is the most common gynecologic cancer in developed countries and is rising in incidence globally. Although the 5-year survival rates are >80%, factors beyond conventional pathologic features that predict clinical outcomes are still being elucidated. The aims of this study were to define the prevalence and associations of deficient mismatch repair (dMMR) protein expression (MLH1, MSH2, MSH6, PMS2) by immunohistochemistry in a multiethnic Southeast Asian cohort with endometrioid endometrial cancer. A total of 77 patients with adequate formalin-fixed paraffin-embedded specimens were identified. The sections were stained in 2 centers for 4 MMR proteins and examined by 2 independent specialist histopathologists. The mean age for the cohort was 58.6 yr, with 19.4% (15/77) of patients' cancers showing loss of 2 MMR proteins. All 13 cancers with absent MLH1 showed PMS2 loss (13/15), whereas absent MSH2 correlated with MHS6 loss (2/15). There were no significant differences for dMMR cases in age, body mass index, histopathologic characteristics, and clinical outcomes. In dMMR cases, an overrepresentation of patients of Indian ethnic origin was observed compared with Chinese and Malays. These findings suggest that dMMR protein expression in a Southeast Asian endometrial cancer cohort does not correlate with disease outcomes.
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33
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Sehitoglu I, Bedir R, Ural UM, Gucer H, Yurdakul C, Cure MC, Cure E, Yuce S, Sahin FK. Relationships between C-kit expression and mean platelet volume in benign, preneoplastic and neoplastic endometrium. Asian Pac J Cancer Prev 2015; 16:1495-9. [PMID: 25743820 DOI: 10.7314/apjcp.2015.16.4.1495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND c-Kit is a proto-oncogene that encodes a tyrosine kinase receptor (CD117). Mean platelet volume (MPV) is a useful marker for demonstrating thrombocyte function. We aimed to investigate whether c-kit is expressed in benign, preneoplastic and neoplastic endometrial tissues and whether MPV has a relation with c-kit expression and its intensity. MATERIALS AND METHODS c-Kit expression was investigated immunohistochemically in 10 samples of normal endometrium (n=10), simple endometrial hyperplasia (5 cases with atypia and 10 cases without atypia), complex endometrial hyperplasia (10 cases with atypia and 10 cases without atypia) and endometrial cancer (EC) (10 cases grade I and 10 cases grade II) and MPV of all cases was checked. RESULTS c-Kit expression was observed at very low rates in cases with normal endometrial tissues (NE) and in hyperplasia without atypia. c-Kit expression and immunostaining were strong in endometrial atypia and EC. MPV levels of complex atypical endometrial hyperplasia (CAEH) (p:0.002), EC grade I (ECG I) (p<0.001) and EC grade II (ECG II) (p<0.001) were significantly elevated when compared with the NE group. Both c-kit expression and intensity of immunostaining had a positive correlation with MPV level. CONCLUSIONS While c-kit expression and intensity of immunostaining were mildly positive in NE and hyperplasia without atypia, they were clearly observed in EC and hyperplasia with atypia. As c-kit expression is related to the mutagenesis a long-term follow- up may be needed in these cases. A high MPV level may be a good test for demonstrating c-kit expression and intensity of immunostaining.
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Affiliation(s)
- Ibrahim Sehitoglu
- Department of Pathology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey E-mail :
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34
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Kaiyrlykyzy A, Freese KE, Elishaev E, Bovbjerg DH, Ramanathan R, Hamad GG, McCloskey C, Althouse AD, Huang M, Edwards RP, Linkov F. Endometrial histology in severely obese bariatric surgery candidates: an exploratory analysis. Surg Obes Relat Dis 2014; 11:653-8. [PMID: 25820079 DOI: 10.1016/j.soard.2014.12.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Endometrial pathology risk has been linked to obesity; however, little is known of its prevalence in severely obese women not seeking care for endometrial pathology associated symptoms. This pilot study was designed to explore the frequency and risk factors associated with endometrial pathology in cancer-free, severely obese, bariatric surgery candidates using the Pipelle endometrial sampling technique (SureFlex Preferred Curette, Bioteque America, Inc, New Taipei City, Taiwan). METHODS Twenty-nine severely obese bariatric surgery candidates with intact uteruses and no history of endometrial cancer or endometrial ablation were included in this subanalysis from a larger cohort of 47. Endometrial samples were obtained using a Pipelle endometrial suction curette at a single time point before surgery. Logistic regression was used to assess the relationship between body mass index and endometrial pathology when adjusting for age and race. RESULTS Of the 29 successful biopsies, 8 (27.6%) were classified as abnormal endometrium: 1 was classified as complex atypical hyperplasia, 1 was classified as hyperplasia without atypia, 4 samples were identified with endometrial polyps, and 2 samples were identified with metaplasia. None presented with cancer. Increasing body mass index was significantly associated with higher risk of abnormal endometrium (OR = 1.19, 95% CI [1.03-1.36], P = .01). CONCLUSIONS The findings in this sample suggest that obesity may be associated with increased risk of having undiagnosed endometrial pathology. More thorough examination of relationships between levels of obesity and endometrial pathology are needed to better characterize high cancer risk groups who may benefit from introducing new screening measures.
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Affiliation(s)
- Aiym Kaiyrlykyzy
- Center for Life Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Kyle E Freese
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, PA
| | - Esther Elishaev
- Department of Pathology, Magee-Womens Hospital, Pittsburgh, PA
| | | | - Ramesh Ramanathan
- Division of General Surgery, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Giselle G Hamad
- Division of General Surgery, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Carol McCloskey
- Division of General Surgery, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Andrew D Althouse
- Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, PA
| | - Marilyn Huang
- Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, PA
| | - Robert P Edwards
- Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, PA
| | - Faina Linkov
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, PA.
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35
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Sheikh MA, Althouse AD, Freese KE, Soisson S, Edwards RP, Welburn S, Sukumvanich P, Comerci J, Kelley J, LaPorte RE, Linkov F. USA Endometrial Cancer Projections to 2030: should we be concerned? Future Oncol 2014; 10:2561-8. [DOI: 10.2217/fon.14.192] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
ABSTRACT Aim: As the incidence of endometrial cancer (EC) increased considerably since 2007, this study aimed to project the burden of EC to the year 2030. Methods: Multivariate linear regression was used to project EC incidence by modeling trends in EC incidence from 1990 to 2013, while accounting for temporal changes in obesity, hysterectomy and smoking. Results: The best-fitting model predicting EC rates included a time effect plus effects for hysterectomy (12-year lag), severe obesity (3-year lag) and smoking (9-year lag). The best-fitting model projected an increase to 42.13 EC cases per 100,000 by the year 2030, a 55% increase over 2010 EC rates. Conclusion: The projected increase of EC over next 16 years indicates the need for close monitoring of EC trends.
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Affiliation(s)
- M Aamir Sheikh
- Department of OB/GYN & Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA
| | - Andrew D Althouse
- Department of OB/GYN & Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA
| | - Kyle E Freese
- Department of OB/GYN & Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA 15261, USA
| | - Sean Soisson
- Department of Genetic Epidemiology/Division of Public Health, University of Utah, Salt Lake City, UT 84112, USA
| | - Robert P Edwards
- Department of OB/GYN & Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA
| | - Sharon Welburn
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA 15261, USA
| | - Paniti Sukumvanich
- Department of OB/GYN, Division of Gynecologic Oncology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213, USA
| | - John Comerci
- Department of OB/GYN, Division of Gynecologic Oncology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213, USA
| | - Joseph Kelley
- Department of OB/GYN, Division of Gynecologic Oncology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213, USA
| | - Ronald E LaPorte
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA 15261, USA
| | - Faina Linkov
- Department of OB/GYN & Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, USA
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA 15261, USA
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36
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Argenta P, Svendsen C, Elishaev E, Gloyeske N, Geller MA, Edwards RP, Linkov F. Hormone receptor expression patterns in the endometrium of asymptomatic morbidly obese women before and after bariatric surgery. Gynecol Oncol 2014; 133:78-82. [PMID: 24680595 DOI: 10.1016/j.ygyno.2013.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/15/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Obesity increases risk for endometrial neoplasia, but neither the pathophysiology nor the effects of weight loss on the risk are well established. We attempted to characterize the molecular profile of the endometrium of asymptomatic women with morbid obesity before and following bariatric surgery-induced weight loss. METHODS 59 asymptomatic, morbidly obese women underwent endometrial sampling before bariatric surgery; 46 (78%) of these returned one year later for re-biopsy (median weight loss of 41kg). Duplicate samples from these specimens were scored for expression of estrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR), and Ki-67 by two independent, blinded pathologists using an H-score [staining intensity (0-3)×(percent of tissue involved)]. RESULTS The prevalence of hyperplasia pre-operatively was 7% overall and 10% among patients not on an anti-estrogen. ER H-scores were similar before and after surgery overall (median 190 and 196 respectively, p=0.82), but patients with hyperplasia had higher pre-operative H-scores (median 256, p<0.001) and experienced greater H-score drops, than those without hyperplasia (-112 vs +50, p=0.028). In two patients with persistent hyperplasia at one year, ER H-scores fell to levels that were similar to those without pathology. One patient who developed hyperplasia during the study period had a rising ER H-score. Patients with hyperplasia had higher median PR H-scores pre-operatively (284 vs 188, p=0.01), which normalized through greater drops (75 vs 0, p=0.053). AR H-scores dropped significantly after surgery (13 vs 2, p=0.015), but were similar between patients with and without hyperplasia (p=0.33). Weight loss did not affect Ki-67 proliferation index. CONCLUSION Asymptomatic morbidly obese patients have a high prevalence of occult hyperplasia, characterized by relatively high hormone receptor expression. These profiles appear to normalize with weight loss and in advance of pathologically identifiable changes. These data suggest a potential role for screening this population as well as the possibility that weight loss may be a valid treatment strategy for risk reduction.
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Affiliation(s)
- Peter Argenta
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA.
| | - Charles Svendsen
- Department of Surgery, Park Nicollet Health System, St. Louis Park, MN, USA
| | - Esther Elishaev
- Department of Pathology, Magee Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nika Gloyeske
- Department of Pathology, Magee Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Melissa A Geller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA
| | - Robert P Edwards
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Magee Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Faina Linkov
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Magee Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Fambrini M, Sorbi F, Sisti G, Cioni R, Turrini I, Taddei G, Guaschino S. Endometrial carcinoma in high-risk populations: is it time to consider a screening policy? Cytopathology 2014; 25:71-7. [DOI: 10.1111/cyt.12131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2013] [Indexed: 01/01/2023]
Affiliation(s)
- M. Fambrini
- Department of Biomedical, Clinical and Experimental Sciences; University of Florence; Florence Italy
| | - F. Sorbi
- Department of Biomedical, Clinical and Experimental Sciences; University of Florence; Florence Italy
| | - G. Sisti
- Department of Biomedical, Clinical and Experimental Sciences; University of Florence; Florence Italy
| | - R. Cioni
- Department of Biomedical, Clinical and Experimental Sciences; University of Florence; Florence Italy
| | - I. Turrini
- Department of Biomedical, Clinical and Experimental Sciences; University of Florence; Florence Italy
| | - G. Taddei
- Department of Biomedical, Clinical and Experimental Sciences; University of Florence; Florence Italy
| | - S. Guaschino
- Department of Biomedical, Clinical and Experimental Sciences; University of Florence; Florence Italy
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Peng Q, Mo C, Qin A, Lao X, Chen Z, Sui J, Wu J, Zhai L, Yang S, Qin X, Li S. MDM2 SNP309 polymorphism contributes to endometrial cancer susceptibility: evidence from a meta-analysis. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2013; 32:85. [PMID: 24423195 PMCID: PMC4029393 DOI: 10.1186/1756-9966-32-85] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 10/28/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The SNP309 polymorphism (T-G) in the promoter of MDM2 gene has been reported to be associated with enhanced MDM2 expression and tumor development. Studies investigating the association between MDM2 SNP309 polymorphism and endometrial cancer risk reported conflicting results. We performed a meta-analysis of all available studies to explore this association. METHODS All studies published up to August 2013 on the association between MDM2 SNP309 polymorphism and endometrial cancer risk were identified by searching electronic databases PubMed, Web of Science, EMBASE, and Chinese Biomedical Literature database (CBM). The association between the MDM2 SNP309 polymorphism and endometrial cancer risk was assessed by odds ratios (ORs) together with their 95% confidence intervals (CIs). RESULTS Eight case-control studies with 2069 endometrial cancer cases and 4546 controls were identified. Overall, significant increase of endometrial cancer risk was found when all studies were pooled in the meta-analysis (GG vs. TT: OR = 1.464, 95% CI 1.246-1.721, P < 0.001; GG vs. TG + TT: OR = 1.726, 95% CI 1.251-2.380, P = 0.001; GG + TG vs. TT: OR = 1.169, 95% CI 1.048-1.304, P = 0.005). In subgroup analysis by ethnicity and HWE in controls, significant increase of endometrial cancer risks were observed in Caucasians and studies consistent with HWE. In subgroup analysis according to study quality, significant associations were observed in both high quality studies and low quality studies. CONCLUSIONS This meta-analysis suggests that MDM2 SNP309 polymorphism contributes to endometrial cancer susceptibility, especially in Caucasian populations. Further large and well-designed studies are needed to confirm this association.
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Gallos ID, Devey J, Ganesan R, Gupta JK. Predictive ability of estrogen receptor (ER), progesterone receptor (PR), COX-2, Mlh1, and Bcl-2 expressions for regression and relapse of endometrial hyperplasia treated with LNG-IUS: a prospective cohort study. Gynecol Oncol 2013; 130:58-63. [PMID: 23603367 DOI: 10.1016/j.ygyno.2013.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 04/08/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To test the predictive ability of immunohistochemical estrogen receptor(ER), progesterone receptor (PR), COX-2, Mlh1, and Bcl-2 expressions for predicting the outcomes of regression and relapse in women with endometrial hyperplasia treated with the Levonorgestrel-releasing intrauterine system (LNG-IUS). METHODS We recruited prospectively all women diagnosed with complex or atypical complex hyperplasia that underwent treatment with LNG-IUS from August 1998 until September 2008. Immunohistochemistry was performed with conventional methods and recorded using a semi-quantitative score (Q score) by two blinded assessors. Women were followed with endometrial biopsies to record regression and relapse. The biomarker predictive ability was analysed using the Cox proportional hazards model. RESULTS The median follow-up was 72.1 months (IQR 59.1-89.8). The Q score agreement between assessors was 82.6% (K statistic=0.801 ± 0.036). The majority of study participants initially regressed to normal endometrium following LNG-IUS therapy (n = 164 regressed; n = 10 persisted). From the 164 women that regressed with LNG-IUS we were able to assess 152 women for relapse from which 18 relapsed. We found a weak association for persisted endometrial hyperplasia with ER and PR expressions with Q score on the 5th and 10th centiles. No associations were found for COX-2, Mlh1 and Bcl-2 protein expressions for regression and for any of the biomarkers for relapse. CONCLUSION We found that poor expression of ER and PR is weakly associated with persisting endometrial hyperplasia and COX-2, Mlh1, and Bcl-2 expressions are not predictive. None of the biomarkers is predictive for relapse in women with endometrial hyperplasia treated with LNG-IUS.
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Affiliation(s)
- Ioannis D Gallos
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham Women's Hospital, Birmingham B15 2TG, UK.
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Argenta PA, Kassing M, Truskinovsky AM, Svendsen CA. Bariatric surgery and endometrial pathology in asymptomatic morbidly obese women: a prospective, pilot study. BJOG 2012; 120:795-800. [PMID: 23231632 DOI: 10.1111/1471-0528.12100] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the prevalence of occult uterine pathology in asymptomatic, morbidly obese women before and after bariatric surgery-induced weight loss. DESIGN Prospective, blinded, non-interventional cohort. SETTING Urban teaching hospital. POPULATION Morbidly obese women. METHODS Endometrial biopsies were obtained at the time of Roux-en-Y gastric bypass and again 1 year later. Both the patient and the physician were blinded to the results of the initial biopsy until the conclusion of the study. Specimens were independently reviewed by two blinded pathologists. MAIN OUTCOME MEASURE Effect of bariatric surgery-induced weight loss on the prevalence of endometrial pathology at 1 year. RESULTS Fifty-nine women underwent an endometrial biopsy during bariatric surgery. The mean (range) age, weight, and body mass index (BMI) were 42 years (22-62 years), 127 kg (87-176 kg), and 46.8 kg/m(2) (36-64.3 kg/m(2) ), respectively. Four women had hyperplasia (three simple and one complex), for an overall prevalence of 6.8%. The prevalence among women not receiving some anti-estrogen therapy was 9.5%. Forty-six women (78%) underwent follow-up biopsy after a mean (range) weight loss of 42 kg (19-67 kg). Simple hyperplasia was identified in 3/46 women at the 1-year follow-up (6.5%). Two women had resolution of hyperplasia, two women had persistent, simple hyperplasia, and one had had a normal initial biopsy. No woman showed progressive pathology or cancer. At the end of the follow-up all but one patient had a documented resolution of endometrial pathology. CONCLUSIONS Asymptomatic morbidly obese women are at relatively high risk of harbouring occult endometrial hyperplasia. Bariatric surgery-associated weight loss reduced but did not eliminate this risk for endometrial pathology.
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Affiliation(s)
- P A Argenta
- Department of Obstetrics and Gynecology, The University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
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41
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Diagnosis and Management of Endometrial Hyperplasia. J Minim Invasive Gynecol 2012; 19:562-71. [DOI: 10.1016/j.jmig.2012.05.009] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 05/19/2012] [Accepted: 05/28/2012] [Indexed: 11/16/2022]
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Favero G, Anton C, Silva e Silva A, Ribeiro A, Araújo MP, Miglino G, Baracat EC, Carvalho JP. Vaginal morcellation: A new strategy for large gynecological malignant tumor extraction. Gynecol Oncol 2012; 126:443-7. [DOI: 10.1016/j.ygyno.2012.05.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 05/16/2012] [Accepted: 05/18/2012] [Indexed: 10/28/2022]
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Cormio A, Guerra F, Cormio G, Pesce V, Fracasso F, Loizzi V, Resta L, Putignano G, Cantatore P, Selvaggi LE, Gadaleta MN. Mitochondrial DNA content and mass increase in progression from normal to hyperplastic to cancer endometrium. BMC Res Notes 2012; 5:279. [PMID: 22676897 PMCID: PMC3502111 DOI: 10.1186/1756-0500-5-279] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 06/07/2012] [Indexed: 12/31/2022] Open
Abstract
Background An increase in mitochondrial DNA (mtDNA) content and mitochondrial biogenesis associated with the activation of PGC-1α signalling pathway was previously reported in type I endometrial cancer. The aim of this study has been to evaluate if mtDNA content and the citrate synthase (CS) activity, an enzyme marker of mitochondrial mass, increase in progression from control endometrium to hyperplasia to type I endometrial carcinoma. Results Given that no statistically significant change in mtDNA content and CS activity in endometrium taken from different phases of the menstrual cycle or in menopause was found, these samples were used as control. Our research shows, for the first time, that mtDNA content and citrate synthase activity increase in hyperplastic endometrium compared to control tissues, even if their levels remain lower compared to cancer tissue. In particular, mtDNA content increases seem to precede increases in CS activity. No statistically significant change in mtDNA content and in CS activity was found in relation to different histopathological conditions such as grade, myometrial invasion and stage. Conclusion MtDNA content and citrate synthase activity increases in pre-malignant lesions could be a potential molecular marker for progression from hyperplasia to carcinoma.
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Affiliation(s)
- Antonella Cormio
- Department of Biosciences, Biotechnologies and Pharmacological Sciences, University of Bari, Via Orabona, Bari, 4-70126, Italy.
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Linkov F, Shubnikov E, Padilla N, McCallum A, LaPorte R. Chronic disease epidemiology, cancer and mobile global approaches to disease prevention. Public Health 2012; 126:206-209. [PMID: 22414605 DOI: 10.1016/j.puhe.2011.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2011] [Indexed: 02/08/2023]
Abstract
The focus of this symposium was worldwide prevention of chronic disease through the use of inexpensive Internet pathways, as demonstrated with the Supercourse project, and other initiatives, including promoting mobile phone technology (m-health). This symposium highlighted the need to use the Supercourse to prevent cancer and other chronic diseases. It also highlighted several components of the Supercourse library, including the former Soviet Union network, the Latin American network, and some other initiatives.
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Affiliation(s)
- F Linkov
- Division of Cancer Prevention and Population Science, University of Pittsburgh Cancer Institute, 5150 Centre Ave, Suite 4-C, Room 466, Pittsburgh, PA 15232, USA.
| | - E Shubnikov
- Institute of Internal Medicine, Novosibirsk, Russian Federation
| | - N Padilla
- University of Guanajuato Celaya Campus, Celaya, Mexico
| | | | - R LaPorte
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
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Olson SH, Atoria CL, Cote ML, Cook LS, Rastogi R, Soslow RA, Brown CL, Elkin EB. The impact of race and comorbidity on survival in endometrial cancer. Cancer Epidemiol Biomarkers Prev 2012; 21:753-60. [PMID: 22426148 DOI: 10.1158/1055-9965.epi-11-0735] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Poorer survival from endometrial cancer in blacks than in whites is well documented. The aims of this study were to determine whether diabetes, hypertension, or other conditions influence survival and whether accounting for these conditions reduces this racial disparity. METHODS Using the SEER-Medicare database, we investigated the influence of diabetes, hypertension, and other comorbid conditions on survival in black and white women age ≥66 with endometrial cancer. We used Cox proportional hazards regression to evaluate the influence of comorbidities on survival for blacks and whites separately and to study survival differences between blacks and whites after adjustment for diabetes, hypertension, and other medical conditions, as well as for demographics, tumor characteristics, and treatment. RESULTS In both racial subgroups, women with diabetes or other conditions had poorer overall survival, whereas hypertensive black women experienced better survival [HR, 0.74; 95% confidence interval (CI), 0.60-0.92]. For disease-specific survival, diabetes was associated with poorer survival in white women (HR, 1.19; 95% CI, 1.06-1.35) but not in blacks (HR, 0.97; 95% CI, 0.73-1.30); hypertension and other conditions were not significantly related to survival. After adjustment, black women had poorer survival than white women, with HRs of 1.16 (95% CI, 1.05-1.28) for overall and 1.27 (95% CI, 1.08-1.49) for disease-specific survival. CONCLUSIONS Diabetes influences disease-specific survival in white women but not in blacks. The racial disparity in survival is not explained by the presence of other health conditions. IMPACT Further research should focus on the unknown factors that lead to poorer survival in black women compared with whites.
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Affiliation(s)
- Sara H Olson
- Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Abstract
BACKGROUND Gynaecological cancers are the second most common cancers among women. It has been suggested that centralised care improves outcomes but consensus is lacking. OBJECTIVES To assess the effectiveness of centralisation of care for patients with gynaecological cancer. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Group Trials Register, CENTRAL (The Cochrane Library, Issue 4, 2010), MEDLINE, and EMBASE up to November 2010. We also searched registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, controlled before-and-after studies, interrupted time series studies, and observational studies that examined centralisation of services for gynaecological cancer, and used multivariable analysis to adjust for baseline case mix. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data, and two assessed risk of bias. Where possible, we synthesised the data on survival in a meta-analysis. MAIN RESULTS Five studies met our inclusion criteria; all were retrospective observational studies and therefore at high risk of bias.Meta-analysis of three studies assessing over 9000 women suggested that institutions with gynaecologic oncologists on site may prolong survival in women with ovarian cancer, compared to community or general hospitals: hazard ratio (HR) of death was 0.90 (95% confidence interval (CI) 0.82 to 0.99). Similarly, another meta-analysis of three studies assessing over 50,000 women, found that teaching centres or regional cancer centres may prolong survival in women with any gynaecological cancer compared to community or general hospitals (HR 0.91; 95% CI 0.84 to 0.99). The largest of these studies included all gynaecological malignancies and assessed 48,981 women, so the findings extend beyond ovarian cancer. One study compared community hospitals with semi-specialised gynaecologists versus general hospitals and reported non-significantly better disease-specific survival in women with ovarian cancer (HR 0.89; 95% CI 0.78 to 1.01). The findings of included studies were highly consistent. Adverse event data were not reported in any of the studies. AUTHORS' CONCLUSIONS We found low quality, but consistent evidence to suggest that women with gynaecological cancer who received treatment in specialised centres had longer survival than those managed elsewhere. The evidence was stronger for ovarian cancer than for other gynaecological cancers.Further studies of survival are needed, with more robust designs than retrospective observational studies. Research should also assess the quality of life associated with centralisation of gynaecological cancer care. Most of the available evidence addresses ovarian cancer in developed countries; future studies should be extended to other gynaecological cancers within different healthcare systems.
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Affiliation(s)
- Yin Ling Woo
- Department of Obstetrics and Gynaecology, Affiliated to University of Malaya Cancer Research Institute, Kuala Lumpur, Malaysia.
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Neill AS, Nagle CM, Spurdle AB, Webb PM. Use of talcum powder and endometrial cancer risk. Cancer Causes Control 2012; 23:513-9. [PMID: 22245995 DOI: 10.1007/s10552-011-9894-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 12/22/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE Use of talcum powder in the perineal area has been associated with an increased risk of ovarian cancer, and a recent cohort study found a positive association with endometrial cancer. We sought to confirm this association using data from the Australian National Endometrial Cancer Study (ANECS). METHODS ANECS was a population-based case-control study conducted from 2005 to 2007, in which 1,399 women with newly diagnosed histologically confirmed primary endometrial cancer and 740 control women provided risk factor information via telephone interview. Unconditional logistic regression was used to estimate odds ratios adjusting for potential confounders. RESULTS We found no significant association between ever use of talc in the perineal area (OR 0.88, 95% CI: 0.68-1.14) or upper body area (OR 0.90, 95% CI: 0.71-1.14) and risk of endometrial cancer. The results were similar when stratified by subtype. Composite variables combining frequency and duration of talc use were also not significantly associated with risk (any perineal area use p = 0.07 and any upper body use p = 0.49). CONCLUSIONS The absence of any increase in risk and the similarity of our results for talc use on the upper body and in the perineal area do not support the hypothesis that use of talc in the perineal area is associated with an increased risk of endometrial cancer. Our data do not confirm the positive association between perineal talc use and endometrial cancer observed in the only previous study.
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Affiliation(s)
- Annette S Neill
- Genetics and Population Health Division, Queensland Institute of Medical Research, Herston, Brisbane, Australia.
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Wolfman W, Leyland N, Heywood M, Singh SS, Rittenberg DA, Soucy R, Allaire C, Awadalla A, Best C, Dunn S, Leroux N, Potestio F, Senikas V, Wallace S, Menzies R. Asymptomatic endometrial thickening. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 32:990-9. [PMID: 21176311 DOI: 10.1016/s1701-2163(16)34690-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To formulate clinical recommendations for the assessment of endometrial thickening when it is found on ultrasound in a postmenopausal patient without bleeding. OUTCOMES Ensure that women with asymptomatic thickening and endometrial polyps found on ultrasound are managed appropriately. EVIDENCE Published literature was retrieved through searches of English language articles from the EMBASE, Cochrane, and PubMed databases for relevant peer-reviewed articles dating from 1970 to 2009, using appropriate controlled vocabulary (e.g., "asymptomatic endometrial thickness," "endometrial cancer," "postmenopausal bleeding," "transvaginal ultrasonography," "endometrial biopsy" and "endometrial polyp"). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and incorporated in the guideline to April 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The level of evidence was determined according to the criteria established by the Canadian Task Force on Preventative Health Care (Table). Recommendations are ranked according to this method. BENEFITS, HARMS, AND COSTS It is anticipated that the adoption of these recommendations would save postmenopausal women unnecessary anxiety, pain, and risk of procedural complication. It is also expected to decrease the cost to the health system by eliminating unnecessary interventions.
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Wolfman W, Leyland N, Wolfman W, Heywood M, Singh SS, Rittenberg DA, Soucy R, Allaire C, Awadalla A, Best C, Dunn S, Leroux N, Potestio F, Senikas V. Épaississement endométrial asymptomatique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010. [DOI: 10.1016/s1701-2163(16)34716-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bitto A, Granese R, Triolo O, Villari D, Maisano D, Giordano D, Altavilla D, Marini H, Adamo EB, Nicotina PA, D'Anna R, Squadrito F. Genistein aglycone: a new therapeutic approach to reduce endometrial hyperplasia. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2010; 17:844-850. [PMID: 20570122 DOI: 10.1016/j.phymed.2010.03.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 02/22/2010] [Accepted: 03/31/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Endometrial hyperplasia without cytological atypia is commonly treated with progestins, but other treatment regimes may be available with equivalent efficacy and low side effects. DESIGN A randomized double-blind, placebo and progesterone-controlled clinical trial to evaluate the effects of genistein aglycone in reducing endometrial hyperplasia. PATIENTS A group of 56 premenopausal women with non-atypical endometrial hyperplasia were enrolled and received: genistein aglycone (n=19; 54 mg/day); norethisterone acetate (n=19; 10 mg/day on days 16-25 of the menstrual cycle) or placebo (n=18) for 6 months. MEASUREMENTS Hysteroscopy was performed with biopsies and symptomology assessed at baseline, 3 and 6 months of administration. The effect on estrogen (ER) and progesterone receptors (PR) expression in uterine biopsies were assessed after 3 and 6 months. For each treatment follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), sex hormone-binding globulin (SHBG) and progesterone (PG) levels were also evaluated. RESULTS After 6 months, 42% of genistein aglycone-administered subjects had a significant improvement of symptoms (histologically confirmed in the 29%) compared to 47% of norethisterone acetate subjects (histologically confirmed in the 31%), but only 12% in the placebo group with 19% exhibiting worsening symptoms and increased endometrial thickness. No significant differences were noted for hormone levels for any treatment, but immunohistochemical analysis revealed significantly reduced staining for ER-alpha and PR and enhanced ER-beta1 staining in genistein-administered subjects associated with a complete regression of bleeding. CONCLUSIONS These results suggest that genistein aglycone might be useful for the management of endometrial hyperplasia without atypia in women that cannot be treated with progestin.
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Affiliation(s)
- Alessandra Bitto
- Department of Clinical and Experimental Medicine and Pharmacology, c/o AOU Policlinico G. Martino, Gazzi, Messina, Italy
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