Prevalence of cysts in epithelial ovarian cancer

Intratumoral and peritumoral MRI-based radiomics for predicting extrapelvic peritoneal metastasis in epithelial ovarian cancer

OBJECTIVES

To investigate the potential of intratumoral and peritumoral radiomics derived from T2-weighted MRI to preoperatively predict extrapelvic peritoneal metastasis (EPM) in patients with epithelial ovarian cancer (EOC).

METHODS

In this retrospective study, 488 patients from four centers were enrolled and divided into training (n = 245), internal test (n = 105), and external test (n = 138) sets. Intratumoral and peritumoral models were constructed based on radiomics features extracted from the corresponding regions. A combined intratumoral and peritumoral model was developed via a feature-level fusion. An ensemble model was created by integrating this combined model with specific independent clinical predictors. The robustness and generalizability of these models were assessed using tenfold cross-validation and both internal and external testing. Model performance was evaluated by the area under the receiver operating characteristic curve (AUC). The Shapley Additive Explanation method was employed for model interpretation.

RESULTS

The ensemble model showed superior performance across the tenfold cross-validation, with the highest mean AUC of 0.844 ± 0.063. On the internal test set, the peritumoral and ensemble models significantly outperformed the intratumoral model (AUC = 0.786 and 0.832 vs. 0.652, p = 0.007 and p < 0.001, respectively). On the external test set, the AUC of the ensemble model significantly exceeded those of the intratumoral and peritumoral models (0.843 vs. 0.750 and 0.789, p = 0.008 and 0.047, respectively).

CONCLUSION

Peritumoral radiomics provide more informative insights about EPM than intratumoral radiomics. The ensemble model based on MRI has the potential to preoperatively predict EPM in EOC patients.

CRITICAL RELEVANCE STATEMENT

Integrating both intratumoral and peritumoral radiomics information based on MRI with clinical characteristics is a promising noninvasive method to predict EPM to guide preoperative clinical decision-making for EOC patients.

KEY POINTS

Peritumoral radiomics can provide valuable information about extrapelvic peritoneal metastasis in epithelial ovarian cancer. The ensemble model demonstrated satisfactory performance in predicting extrapelvic peritoneal metastasis. Combining intratumoral and peritumoral MRI radiomics contributes to clinical decision-making in epithelial ovarian cancer.

Overexpression and clinical significance of IBP in epithelial ovarian carcinoma

Interferon regulatory factor-4 binding protein (IBP) is as a type of ρ GTPase suggested to serve an important role in tumor occurrence and development through the effects of cytoskeletal remodeling, and cell conduction mechanism. IBP is widely expressed in the immune system and expressed in several types of tumors. However, its expression and prognostic value in epithelial ovarian carcinoma (EOC) remain unclear. The present study aimed to investigate the expression of IBP in EOC, and its effect on clinicopathological variables and prognosis. A total of 107 and 30 cases of epithelial ovarian carcinoma and benign ovarian disease tissue sections, respectively, were examined using immunohistochemistry. The results indicated that the IBP expression status was negative or markedly weak in normal tissues, but highly expressed in EOC tissues. A significant association was observed between IBP overexpression and various clinicopathological factors, including advanced International Federation of Gynecology and Obstetrics stage (P<0.001), poor histologic grade (P=0.002), peritoneal carcinomatosis (P<0.001), lymph-node metastasis (P=0.023) and recurrence (P<0.001). Multivariate Cox regression analysis additionally suggested that IBP overexpression was an independent factor affecting recurrence-free survival [hazard ratio (HR)=4.099; 95% confidence interval (CI), 2.209-7.606; P<0.001) and overall survival (HR=2.317; 95% CI, 1.484-3.617; P<0.001) in patients with EOC. The results of the present study demonstrated that IBP overexpression may be associated with tumor development and progression in EOC, and therefore may serve as a novel target for treating this disease.

Migration-inducing gene 7 promotes tumorigenesis and angiogenesis and independently predicts poor prognosis of epithelial ovarian cancer

Epithelial ovarian carcinomas (EOC) cause more mortality than any other cancer of the female reproductive system. New therapeutic approaches to reduce EOC mortality have been largely unsuccessful due to the poor understanding of the mechanisms underlying EOC proliferation and metastasis. Progress in EOC treatment is further hampered by a lack of reliable prognostic biomarkers for early risk assessment. In this study, we identify that Migration-Inducting Gene 7 (MIG-7) is specifically induced in human EOC tissues but not normal ovaries or ovarian cyst. Ovarian MIG-7 expression strongly correlated with EOC progression. Elevated MIG-7 level at the time of primary cytoreductive surgery was a strong and independent predictor of poor survival of EOC patients. Cell and murine xenograft models showed that MIG-7 was required for EOC proliferation and invasion, and MIG-7 enhanced EOC-associated angiogenesis by promoting the expression of vascular endothelial growth factor. Inhibiting MIG-7 by RNA interference in grafted EOC cells retarded tumor growth, angiogenesis and improved host survival, and suppressing MIG-7 expression with a small molecule inhibitor D-39 identified from the medicinal plant Liriope muscari mitigated EOC growth and invasion and specifically abrogated the expression of vascular endothelial growth factor. Our data not only reveal a critical function of MIG-7 in EOC growth and metastasis and support MIG-7 as an independent prognostic biomarker for EOC, but also demonstrate that therapeutic targeting of MIG-7 is likely beneficial in the treatment of EOC.

Early inflammatory response in epithelial ovarian tumor cyst fluids

Mortality rates for epithelial ovarian cancer (EOC) are high, mainly due to late-stage diagnosis. The identification of biomarkers for this cancer could contribute to earlier diagnosis and increased survival rates. Given that chronic inflammation plays a central role in cancer initiation and progression, we selected and tested 15 cancer-related cytokines and growth factors in 38 ovarian cyst fluid samples. We used ovarian cyst fluid since it is found in proximity to the pathology and mined it for inflammatory biomarkers suitable for early detection of EOC. Immunoprecipitation and high-throughput sample fractionation were obtained by using tandem antibody libraries bead and mass spectrometry. Two proteins, monocyte chemoattractant protein-1 (MCP-1/CCL2) and interleucin-8 (IL-8/CXCL8), were significantly (P < 0.0001) higher in the malignant (n = 16) versus benign (n = 22) tumor cysts. Validation of MCP-1, IL-8, and growth-regulated protein-α (GROα/CXCL1) was performed with ELISA in benign, borderline, and malignant cyst fluids (n = 256) and corresponding serum (n = 256). CA125 was measured in serum from all patients and used in the algorithms performed. MCP-1, IL-8, and GROα are proinflammatory cytokines and promoters of tumor growth. From 5- to 100-fold higher concentrations of MCP-1, IL-8 and GROα were detected in the cyst fluids compared to the serum. Significant (P < 0.001) cytokine response was already established in borderline cyst fluids and stage I EOC. In serum a significant (P < 0.01) increase of IL-8 and GROα was found, but not until stage I and stage III EOC, respectively. These findings confirm that early events in tumorigenesis can be analyzed and detected in the tumor environment and we conclude that ovarian cyst fluid is a promising source in the search for new biomarkers for early ovarian tumors.

Over-expression of LAPTM4B is associated with poor prognosis and chemotherapy resistance in stages III and IV epithelial ovarian cancer

BACKGROUND

The purpose of this study was to determine whether LAPTM4B over-expression is associated with the prognosis and chemotherapy resistance in patients with stages III and IV epithelial ovarian carcinoma, i.e., patients with peritoneal metastasis or lymph node metastasis of epithelial ovarian carcinoma.

METHODS

LAPTM4B expression was evaluated in 10 normal ovarian and 113 stages III-IV ovarian carcinomas specimens by Western blotting analyses and immunohistochemistry. Univariate and multivariate analyses were performed to determine the association between LAPTM4B expression and prognosis and the relationship between LAPTM4B over-expression and chemotherapy resistance.

RESULTS

Western blotting analysis demonstrated that LAPTM4B was overexpressed in ovarian cancers, and immunohistochemistry results revealed that 80 patients were LAPTM4B over-expression. The five-year overall survival (OS) rates for patients with high LAPTM4B expression and low LAPTM4B expression were 27.36% and 90.7%, respectively (hazard ratio = 20.611, 95% CI: 5.916-71.808, P < 0.0001). The five-year progression-free survival (PFS) rate was 17.68% for patients in the high-expression group and 84.42% for patients in the low-expression group (hazard ratio = 17.852, 95% CI: 6.31-5.935, P < 0.0001); The presence of chemotherapy resistance was significantly associated with LAPTM4B expression (OR: 36.609, 95% CI: 4.737-282.941, P = 0.0006).

CONCLUSIONS

LAPTM4B over-expression is an independent factor in stages III-IV epithelial ovarian carcinoma prognosis and chemotherapy resistance, and it may be an important potential biomarker.