1
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Aisagbonhi O, Zare SY, Hasteh F, Binder P, Roma AA, Fadare O. PTEN Loss and ARID1A Mutation in an HPV-positive Metastatic Adenocarcinoma Diagnosed Almost 18 yr After an Intact Cone Excision for Endocervical Adenocarcinoma In Situ. Int J Gynecol Pathol 2022; 41:307-312. [PMID: 34282106 DOI: 10.1097/pgp.0000000000000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There have been previous reports of neoplasms with the morphology of endocervical adenocarcinoma in situ (AIS) that secondarily involve the ovaries, presumably through transtubal spread, with a smaller subset metastasizing to distant sites. These ovarian metastases have been discovered up to 7 yr postexcision of the endocervical lesion, consistent with the known potential for overtly invasive cervical carcinomas to recur late after primary curative management. Herein, we present a case of a premenopausal woman with a pelvic mass classified as metastatic human papillomavirus (HPV)-associated endocervical adenocarcinoma (p16-block immunoreactive, high-risk HPV positive by in situ hybridization with PTEN loss, ARID1A, and PBRM1 mutations detected by qualitative next-generation sequencing), identified 17.7 yr (212 mo) after a fertility-sparing cone excision with negative margins for endocervical AIS [HPV-associated, p16-block immunoreactive; PTEN, and BAF250a (ARID1a) expression retained]. Our case highlights: (1) the potential for a subset of lesions with the morphology of AIS to metastasize, and the extraordinarily long timeframe (almost 18 y, the longest reported to date) during which metastases may still be identified; (2) alterations in PTEN and ARID1A may play a role in the progression of a subset of endocervical carcinomas; and (3) the need for studies to evaluate the utility of incorporating ovarian/pelvic imaging into surveillance protocols following fertility-sparing excisions or ovarian-preserving hysterectomies, during the management of endocervical adenocarcinomas, as well as the need to counsel patients about the small but real risk of delayed discovery of ovarian metastases following fertility-preserving surgeries for AIS.
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Patrono MG, Calvo MF, Franco JVA, Garrote V, Vietto V. A systematic review and meta-analysis of the prevalence of therapeutic targets in cervical cancer. Ecancermedicalscience 2021; 15:1200. [PMID: 33889209 PMCID: PMC8043690 DOI: 10.3332/ecancer.2021.1200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Indexed: 02/04/2023] Open
Abstract
Cervical Cancer (CC) is a significantly prevalent disease in developing countries. Currently, targeted therapies are not a primary standard of care in CC. This information could be crucial for developing directed therapies and patient screening for biomarkers that would allow personalised treatment of CC. This systematic review aimed to estimate the prevalence of potential therapeutic targets such as the epidermal growth factor receptor (EGFR) and the PI3K/Akt/mTOR and Ras/Raf/MAPK pathways in patients with CC, identified through genomic and non-genomic testing. Studies were identified through an ad-hoc search strategy from the available on MEDLINE (Ovid), CENTRAL, LILACS, SCOPUS, through the Clinical Trial registry on Clinicaltrials.gov, International Clinical Trials Registry Platform, RENIS (Argentine National Registry of Health Research) and grey literature sources. We included 74 studies which represented a total pool of 7,862 participants. Forty-five studies informed mutations of EGFR, with a combined positivity rate of 53% (95%CI: 45%-60%; I2 = 95%). Twenty studies informed the presence of mutations in PIK3CA with a combined positivity rate of 30% (95%CI: 21%-39%; I2 = 96%). Twenty-three studies reported a mutation in Ras, with a combined positivity rate of 14% (95%CI: 8%-21%; I2 = 95%). Raf mutations were informed in six studies. Six studies informed the presence of Akt mutations, two studies informed mTOR mutations and only one study reported mutations of MAPK. The most frequently described therapeutic targets were EGFR, and the PIK3CA and Ras pathways, though inconsistency in positivity rates was significant. Our study did not allow the identification of any specific clinical characteristics that might explain the observed heterogeneity. Despite the overall good quality of the included studies, the applicability of these results to patients' general population with CC is still unclear.
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Affiliation(s)
- Maria Guadalupe Patrono
- Department of Gynecology, Hospital Italiano de Buenos Aires, Gascon 450, Buenos Aires C1181ACH, Argentina
- https://orcid.org/0000-0002-1309-2114
| | - Maria Florencia Calvo
- Department of Gynecology, Hospital Italiano de Buenos Aires, Gascon 450, Buenos Aires C1181ACH, Argentina
- https://orcid.org/0000-0002-2224-1564
| | - Juan Victor Ariel Franco
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Gascon 450, Buenos Aires C1181ACH, Argentina
- Argentine Cochrane Centre, Instituto Universitario Hospital Italiano, Potosí 4265, Buenos Aires C1199ABB, Argentina
- https://orcid.org/0000-0003-0411-899X
| | - Virginia Garrote
- Central Library, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, Tte. J. D. Perón 4190, 1º floor, stair J. C1199ABB, Argentina
- https://orcid.org/0000-0002-7328-6228
| | - Valeria Vietto
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Gascon 450, Buenos Aires C1181ACH, Argentina
- Argentine Cochrane Centre, Instituto Universitario Hospital Italiano, Potosí 4265, Buenos Aires C1199ABB, Argentina
- https://orcid.org/0000-0003-4619-9812
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3
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Pulido R, Mingo J, Gaafar A, Nunes-Xavier CE, Luna S, Torices L, Angulo JC, López JI. Precise Immunodetection of PTEN Protein in Human Neoplasia. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a036293. [PMID: 31501265 DOI: 10.1101/cshperspect.a036293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PTEN is a major tumor-suppressor protein whose expression and biological activity are frequently diminished in sporadic or inherited cancers. PTEN gene deletion or loss-of-function mutations favor tumor cell growth and are commonly found in clinical practice. In addition, diminished PTEN protein expression is also frequently observed in tumor samples from cancer patients in the absence of PTEN gene alterations. This makes PTEN protein levels a potential biomarker parameter in clinical oncology, which can guide therapeutic decisions. The specific detection of PTEN protein can be achieved by using highly defined anti-PTEN monoclonal antibodies (mAbs), characterized with precision in terms of sensitivity for the detection technique, specificity for PTEN binding, and constraints of epitope recognition. This is especially relevant taking into consideration that PTEN is highly targeted by mutations and posttranslational modifications, and different PTEN protein isoforms exist. The precise characterization of anti-PTEN mAb reactivity is an important step in the validation of these reagents as diagnostic and prognostic tools in clinical oncology, including their routine use in analytical immunohistochemistry (IHC). Here, we review the current status on the use of well-defined anti-PTEN mAbs for PTEN immunodetection in the clinical context and discuss their potential usefulness and limitations for a more precise cancer diagnosis and patient benefit.
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Affiliation(s)
- Rafael Pulido
- Biocruces Bizkaia Health Research Institute, Barakaldo 48903, Spain.,Ikerbasque, Basque Foundation for Science, Bilbao 48011, Spain
| | - Janire Mingo
- Biocruces Bizkaia Health Research Institute, Barakaldo 48903, Spain
| | - Ayman Gaafar
- Department of Pathology, Cruces University Hospital, Barakaldo 48903, Spain
| | - Caroline E Nunes-Xavier
- Biocruces Bizkaia Health Research Institute, Barakaldo 48903, Spain.,Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital Radiumhospitalet, Oslo N-0310, Norway
| | - Sandra Luna
- Biocruces Bizkaia Health Research Institute, Barakaldo 48903, Spain
| | - Leire Torices
- Biocruces Bizkaia Health Research Institute, Barakaldo 48903, Spain
| | - Javier C Angulo
- Department of Urology, University Hospital of Getafe, Getafe, Madrid 28904, Spain.,Clinical Department, European University of Madrid, Laureate Universities, Madrid 28904, Spain
| | - José I López
- Biocruces Bizkaia Health Research Institute, Barakaldo 48903, Spain.,Department of Pathology, Cruces University Hospital, Barakaldo 48903, Spain.,University of the Basque Country, Leioa 48940, Spain
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4
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Yang J, Tian G, Pan Z, Zhao F, Feng X, Liu Q, Lyu J. Nomograms for predicting the survival rate for cervical cancer patients who undergo radiation therapy: a SEER analysis. Future Oncol 2019; 15:3033-3045. [PMID: 31452393 DOI: 10.2217/fon-2019-0029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: To integrate multiple independent risk factors to establish prognostic nomograms for better predicting overall survival and disease-specific survival in patients with cervical cancer receiving radiation therapy. Materials & methods: Cox analysis used to construct nomograms. The C-index, time-dependent receiver operating characteristic and calibration plots were used to evaluate the performance. The discrimination abilities were compared using the decision curve analysis, net reclassification improvement and integrated discrimination improvement. Results: After randomization, 2869 and 1230 cervical cancer patients were included in the training and validation sets, respectively. Nomograms that incorporated all of the significant independent factors for predicting the 3- and 5-year overall survival and disease-specific survival in the training cohort were established. Conclusion: Compared with the International Federation of Gynecology and Obstetrics staging system, the proposed nomograms exhibit superior prognostic discrimination and survival prediction.
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Affiliation(s)
- Jin Yang
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Guoxiang Tian
- Seventh Medical Center, PLA General Hospital, Beijing, 100853, PR China
| | - Zhenyu Pan
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China.,Department of Pharmacy, The Affiliated Children Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China
| | - Fanfan Zhao
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Xiaojie Feng
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Qingqing Liu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Jun Lyu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
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5
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Naseem A, Bhat ZI, Kalaiarasan P, Kumar B, Bin Hafeez Z, Tiwari RR, Wahabi K, Gandhi G, Alam Rizvi MM. Assessment of epigenetic alterations and in silico analysis of mutation affecting PTEN expression among Indian cervical cancer patients. J Cell Biochem 2019; 120:15851-15866. [PMID: 31074114 DOI: 10.1002/jcb.28856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/06/2019] [Accepted: 02/21/2019] [Indexed: 02/04/2023]
Abstract
Genetic and epigenetic anomalies accountable for genetic dysregulation are the most common aberrations that determine the underlying heterogeneity of the tumor cells. Currently, phosphatase and tensin homolog (PTEN) incongruity has emerged as potent and persuasive malfunctioning in varied human malignancies. In this study, we have analysed the promoter hypermethylation and expression status of PTEN. We identified different mutations in the exonic region of PTEN. Functional consequences of these mutations were explored using in silico techniques. Promoter hypermethylation of PTEN was detected using methylation-specific polymerase chain reaction (MS-PCR), expression analysis was performed with immunohistochemistry (IHC) and mutation by direct sequencing in a total of 168 uterine cervix tumor cases. The findings were statistically correlated with the clinical parameters. In addition, the effect of nonsynonymous mutations was studied with molecular dynamics simulations. PTEN promoter hypermethylation (45.8%) was found to be significantly associated with the of PTEN loss (57.14%, P < 0.0001). Tumor stages, tumor size, lymph node (LN) were found to be significantly correlated with both PTEN promoter hypermethylation and PTEN loss. Histological grade, however, showed a significant association with only PTEN loss. In total, 11.76% of tumors exhibited mutations in exon 5 and 7, out of which E150K of exon 5 showed the highest deviations in the crystal structure of PTEN by in silico analysis. This study provides valuable insights into oncology and paves the path in the development of efficient biomarker and/or imperative therapeutic tool for cervical cancer treatment.
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Affiliation(s)
- Afreen Naseem
- Genome Biology Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | - Zafar Iqbal Bhat
- Genome Biology Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | | | - Bhupender Kumar
- Department of Biochemistry, Institute of Home Economics, University of Delhi, Delhi, India
| | - Zubair Bin Hafeez
- Genome Biology Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | - Raj Ranjan Tiwari
- Genome Biology Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | - Khushnuma Wahabi
- Genome Biology Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | - Gauri Gandhi
- Department of Obstetrics & Gynecology, LNJP/MAMC Campus, New Delhi, India
| | - M Moshahid Alam Rizvi
- Genome Biology Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi, India
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6
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Yang M, Wang M, Li X, Xie Y, Xia X, Tian J, Zhang K, Tang A. The role of lncRNAs in signaling pathway implicated in CC. J Cell Biochem 2018; 120:2703-2712. [PMID: 30552693 DOI: 10.1002/jcb.26835] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 03/09/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Min Yang
- Department of Laboratory Medicine The Second Xiangya Hospital, Central South University Changsha Hunan China
- Department of Laboratory Medicine The Sixth Affiliated Hospital of Sun Yat‐Sen University Guangzhou China
| | - Min Wang
- Department of Laboratory Medicine The Second Xiangya Hospital, Central South University Changsha Hunan China
| | - Xianping Li
- Department of Laboratory Medicine The Second Xiangya Hospital, Central South University Changsha Hunan China
| | - Yixin Xie
- Department of Laboratory Medicine The Second Xiangya Hospital, Central South University Changsha Hunan China
| | - Xiaomeng Xia
- Department of Obstetrics and Gynecology The Second Xiangya Hospital, Central South University Changsha Hunan China
| | - Jingjing Tian
- Department of Laboratory Medicine The Second Xiangya Hospital, Central South University Changsha Hunan China
| | - Kan Zhang
- Department of Laboratory Medicine The Second Xiangya Hospital, Central South University Changsha Hunan China
| | - Aiguo Tang
- Department of Laboratory Medicine The Second Xiangya Hospital, Central South University Changsha Hunan China
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7
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Wang C, Yang C, Wang W, Xia B, Li K, Sun F, Hou Y. A Prognostic Nomogram for Cervical Cancer after Surgery from SEER Database. J Cancer 2018; 9:3923-3928. [PMID: 30410596 PMCID: PMC6218784 DOI: 10.7150/jca.26220] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/01/2018] [Indexed: 12/11/2022] Open
Abstract
Background: To develop and validate a nomogram based on the conventional measurements and log of odds between the number of positive lymph node and the number of negative lymph node (LODDS) in predicting prognosis for cervical cancer patients after surgery. Methods: A total of 8202 cervical cancer patients with pathologically confirmed between 2004 and 2014 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. All the patients were divided into training (n=3603) and validation (n=4599) cohorts based on consecutive age of diagnosis. Demographic and clinical pathological factors were evaluated the association with overall survival (OS). Parameters significantly correlating with OS were used to create a nomogram. An independent external validation cohort was subsequently used to assess the predictive performance of the model. Results: In the training set, age at diagnosis, race, marital status, tumor grade, FIGO stage, histology, size and LODDS were correlated significantly with outcome and used to develop a nomogram. The calibration curve for probability of survival showed excellent agreement between prediction by nomogram and actual observation in the training cohort, with a bootstrap-corrected concordance index of 0.749(95% CI, 0.731-0.767). Importantly, our nomogram performed favorably compared to the currently utilized FIGO model, with concordance indices of 0.786 (95% CI, 0.764 to 0.808) vs 0.685 (95%CI, 0.660 to 0.710) for OS in the validation cohort, respectively. Conclusions: By incorporating LODDS, our nomogram may be superior to the currently utilized FIGO staging system in predicting OS in cervical cancer patients after surgery.
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Affiliation(s)
- Ce Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Harbin Medical University, Harbin, 150086, China
| | - Chunyan Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Harbin Medical University, Harbin, 150086, China
| | - Wenjie Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Harbin Medical University, Harbin, 150086, China
| | - Bairong Xia
- Department of Gynecology Oncology, the Tumor Hospital, Harbin Medical University, Harbin 150086, China
| | - Kang Li
- Department of Epidemiology and Biostatistics, School of Public Health, Harbin Medical University, Harbin, 150086, China
| | - Fengyu Sun
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Cardiovascular Institute, Harbin Medical University, Harbin, China
| | - Yan Hou
- Department of Epidemiology and Biostatistics, School of Public Health, Harbin Medical University, Harbin, 150086, China
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8
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Cardoso MDFS, Castelletti CHM, Lima-Filho JLD, Martins DBG, Teixeira JAC. Putative biomarkers for cervical cancer: SNVs, methylation and expression profiles. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2017; 773:161-173. [PMID: 28927526 DOI: 10.1016/j.mrrev.2017.06.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 02/08/2023]
Abstract
Cervical cancer is primarily caused by Human papillomavirus (HPV) infection, but other factors such as smoking habits, co-infections and genetic background, can also contribute to its development. Although this cancer is avoidable, it is the fourth most frequent type of cancer in females worldwide and can only be treated with chemotherapy and radical surgery. There is a need for biomarkers that will enable early diagnosis and targeted therapy for this type of cancer. Therefore, a systems biology pipeline was applied in order to identify potential biomarkers for cervical cancer, which show significant reports in three molecular aspects: DNA sequence variants, DNA methylation pattern and alterations in mRNA/protein expression levels. CDH1, CDKN2A, RB1 and TP53 genes were selected as putative biomarkers, being involved in metastasis, cell cycle regulation and tumour suppression. Other ten genes (CDH13, FHIT, PTEN, MLH1, TP73, CDKN1A, CACNA2D2, TERT, WIF1, APC) seemed to play a role in cervical cancer, but the lack of studies prevented their inclusion as possible biomarkers. Our results highlight the importance of these genes. However, further studies should be performed to elucidate the impact of DNA sequence variants and/or epigenetic deregulation and altered expression of these genes in cervical carcinogenesis and their potential as biomarkers for cervical cancer diagnosis and prognosis.
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Affiliation(s)
- Maria de Fátima Senra Cardoso
- Molecular Prospection and Bioinformatics Group (ProspecMol), Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego s/n, Recife - PE, 50670-901, Brazil.
| | - Carlos Henrique Madeiros Castelletti
- Molecular Prospection and Bioinformatics Group (ProspecMol), Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego s/n, Recife - PE, 50670-901, Brazil; Agronomic Institute of Pernambuco (IPA), Av. General San Martin 1371, Bongi, Recife - PE, 50761-000, Brazil
| | - José Luiz de Lima-Filho
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego s/n, Recife - PE, 50670-901, Brazil; Biochemistry Department, Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego s/n, Recife - PE, 50670-901, Brazil
| | - Danyelly Bruneska Gondim Martins
- Molecular Prospection and Bioinformatics Group (ProspecMol), Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego s/n, Recife - PE, 50670-901, Brazil; Biochemistry Department, Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego s/n, Recife - PE, 50670-901, Brazil
| | - José António Couto Teixeira
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego s/n, Recife - PE, 50670-901, Brazil; Department of Biological Engineering, University of Minho (UM), Campus de Gualtar, 4710-057 Braga, Portugal
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9
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Prognostic Impact of Epidermal Growth Factor Receptor Overexpression in Patients with Cervical Cancer: A Meta-Analysis. PLoS One 2016; 11:e0158787. [PMID: 27438047 PMCID: PMC4954718 DOI: 10.1371/journal.pone.0158787] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/22/2016] [Indexed: 11/30/2022] Open
Abstract
Clinical trials have provided conflicting results regarding whether epidermal growth factor receptor (EGFR) overexpression predicts poor survival in cervical cancer patients. In this study, we perform a meta-analysis of the association between EGFR expression and survival in cervical cancer patients. We searched clinical studies in the Medline, PubMed, Embase, and Web of Science databases. A total of 22 studies with 2,505 patients were included, and pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for each study. Heterogeneity was assessed using Higgins I2 to select a Mantel-Haenszel fixed effects model (I2 ≤50%) or a DerSimonian-Laird random effects model (I2 ≥50%). High EGFR levels predicted poor overall survival (OS) (HR: 1.40, 95% CI: 1.10–1.78) and disease-free survival (DFS) (HR: 1.84, 95% CI: 1.51–2.24). Stratified analyses showed that EGFR overexpression was significantly related to poor DFS in patients treated with chemoradiation or surgery. Moreover, the pooled odds ratios (ORs) revealed associations between EGFR expression and clinicopathological features, such as lymph node metastasis (OR: 1.72, 95% CI: 1.23–2.40) and tumor size ≥4 cm (OR: 1.64, 95% CI: 1.20–2.23). This meta-analysis demonstrates that EGFR overexpression is closely associated with reduced survival in patients with cervical cancer. These results may facilitate the individualized management of clinical decisions for anti-EGFR therapies in cervical cancer patients.
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10
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Hou MM, Liu X, Wheler J, Naing A, Hong D, Coleman RL, Tsimberidou A, Janku F, Zinner R, Lu K, Kurzrock R, Fu S. Targeted PI3K/AKT/mTOR therapy for metastatic carcinomas of the cervix: A phase I clinical experience. Oncotarget 2015; 5:11168-79. [PMID: 25426553 PMCID: PMC4294378 DOI: 10.18632/oncotarget.2584] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/09/2014] [Indexed: 11/25/2022] Open
Abstract
Background Activated PI3K/AKT/mTOR pathway frequently occurs in metastatic or recurrent cervical carcinomas. However, the clinical benefits of matched therapy, a therapeutic approach targeting a specific mutational abnormality, have not yet been established. Methods We analyzed the outcomes of patients with metastatic or recurrent cervical carcinomas who had a test for PIK3CA mutation and/or PTEN loss/mutation, and received ≥1 phase I therapeutic regimen between January 2006 and June 2013. Results Patients with adenocarcinoma had fewer PIK3CA mutations (14%), and survived longer (median, 14.2 months) than those with squamous cell carcinoma (48% and 7.2 months; p = 0.016, and 0.001, respectively). Matched therapy targeting the activated PI3K/AKT/mTOR pathway led to a favorable rate of SD ≥ 6 months/CR/PR (53%) and significantly longer progression-free survival (median, 6.0 months) than non-matched therapy (11% and 1.5 months; p = 0.08 and 0.026; respectively). In patients with squamous cell carcinoma of the cervix, the presence of PIK3CA mutations was associated with a significantly longer overall survival (median, 9.4 months) than the absence of PIK3CA mutations (median, 4.2 months; p = 0.019). Conclusions Matched therapy targeting the activated PI3K/AKT/mTOR pathway provided meaningful clinical benefits. Thus, further evaluation of PI3K/AKT/mTOR pathway targeted therapy is warranted, especially in metastatic or recurrent squamous cell carcinoma.
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Affiliation(s)
- Ming-Mo Hou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas. Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Xiaochun Liu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer Wheler
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert L Coleman
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Apostolia Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ralph Zinner
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen Lu
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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11
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Bumrungthai S, Munjal K, Nandekar S, Cooper K, Ekalaksananan T, Pientong C, Evans MF. Epidermal growth factor receptor pathway mutation and expression profiles in cervical squamous cell carcinoma: therapeutic implications. J Transl Med 2015. [PMID: 26209091 PMCID: PMC4513684 DOI: 10.1186/s12967-015-0611-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Cervical squamous cell carcinoma (CSCC) is a major cause of female mortality worldwide. This study has examined epidermal growth factor receptor (EGFR) pathway markers that represent actionable pharmacological targets. Methods HPV16 positive CSCCs (n = 105 patients) from Madhya Pradesh, India were screened for KRAS and PIK3CA mutations by PNA-clamp real-time PCR. Immunohistochemistry (IHC) was performed for EGFR, PIK3CA, PTEN, phospho-AKT, phospho-mTOR and phospho-44/42 MAPK (ERK1/2). Results KRAS mutations were detected in 0/91 (0%) and PIK3CA mutations in 19/95 (20.0%) informative specimens: exon 9, E542 (n = 3) and E545 (n = 15); exon 20, H1047R (n = 1). PIK3CA mutation detection was associated with older mean patient age [48.2 vs. 56.6 years (P = 0.007)] and with post-menopausal age: 5/45 (11.1%) patients <50 years vs. 14/50 (28.0%) patients ≥50 years (P = 0.045; OR = 3.11). EGFR expression was present in 60/101 (59.4%) CSCCs and was associated with PIK3CA mutation detection (P < 0.05) but not age (P > 0.05). EGFR and phospho-AKT staining showed associations with tumor grade and/or lymph node status (P < 0.05). Significant associations were not found for the other study markers (P > 0.05). Conclusion These data show that PIK3CA mutation acquisition is related to patient age and EGFR expression. The absence of KRAS mutations supports the potential of anti-EGFR therapies for CSCC treatment. The relatively high PIK3CA mutation rates indicate that PI3K may be a therapeutic target for a significant subset of CSCC patients. Qualitatively distinct IHC staining profiles for the marker panel were noted patient to patient; however, across patients, consistent linear relationships between up- and downstream pathway markers were not observed. Evaluation of the expression status of potential cancer pathway targets may be of value in addition to molecular profiling for choosing among therapeutic options. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0611-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Kavita Munjal
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, 453555, India.
| | - Shirish Nandekar
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, 453555, India.
| | - Kumarasen Cooper
- Department of Pathology and Laboratory Medicine, Pearlman School of Medicine, University of Pennsylvania, Philadelphia, 19104-4283, USA.
| | | | - Chamsai Pientong
- Department of Microbiology, Khon Kaen University, Khon Kaen, 40002, Thailand. .,HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Mark Francis Evans
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, 05405, VT, USA. .,University of Vermont Cancer Center, Burlington, VT, 05405, USA.
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12
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Chen J. Signaling pathways in HPV-associated cancers and therapeutic implications. Rev Med Virol 2015; 25 Suppl 1:24-53. [DOI: 10.1002/rmv.1823] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 10/15/2014] [Accepted: 12/27/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Jiezhong Chen
- School of Biomedical Sciences and Australian Institute for Bioengineering and Nanotechnology; The University of Queensland; Brisbane Queensland Australia
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13
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Zeng T, Li G. MicroRNA‑10a enhances the metastatic potential of cervical cancer cells by targeting phosphatase and tensin homologue. Mol Med Rep 2014; 10:1377-82. [PMID: 25018014 DOI: 10.3892/mmr.2014.2370] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 04/24/2014] [Indexed: 11/05/2022] Open
Abstract
Cervical cancer is one of the leading causes of cancer‑related mortality worldwide. Previously, the upregulation of microRNA (miR)‑10a has been identified in human cervical cancer. The present study firstly demonstrated that miR‑10a was markedly upregulated in primary tumor tissues in patients with positive lymph node metastasis (LN+) compared with negative (LN‑) by quantitative polymerase chain reaction. miR‑10a mimics markedly enhanced cervical cancer cell migration and invasion abilities, and accordingly the miR‑10a inhibitor suppressed those functions. Furthermore, these data suggested that the phosphatase and tensin homologue (PTEN) was inhibited by miR‑10a through an miR‑10a binding site within the 3'‑untranslated region of PTEN at the posttranscriptional level, and that miR‑10a mimics promoted nuclear translocation of β‑catenin. Therefore, it was concluded that the overexpression of miR‑10a contributes to metastasis in cervical cancer by targeting PTEN. miR‑10a may therefore be used clinically as a molecular marker for patients with cervical cancer lymph node metastasis.
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Affiliation(s)
- Tianhe Zeng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430023, P.R. China
| | - Guiling Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430023, P.R. China
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14
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Qi Q, Ling Y, Zhu M, Zhou L, Wan M, Bao Y, Liu Y. Promoter region methylation and loss of protein expression of PTEN and significance in cervical cancer. Biomed Rep 2014; 2:653-658. [PMID: 25054006 DOI: 10.3892/br.2014.298] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/06/2014] [Indexed: 12/11/2022] Open
Abstract
The genetic basis underlying cervical tumorigenesis and progression are largely unknown. Phosphatase and tensin homologue (PTEN) is a tumor suppressor gene, and genetic changes of PTEN occurs in various types of cancer suggesting that the inactivation of PTEN may play an important role in the pathogenesis of a variety of human malignancies. In the present study, 102 cervical cancer specimens were examined for the expression of the PTEN gene and promoter methylation using methylation-specific-polymerase chain reaction and immunohistochemistry. The PTEN gene mutation was also assessed using PCR single-strand conformational polymorphism. We examined the correlation between PTEN expression and its associated methylation status and the clinical characteristics of cervical cancer. The results showed that there was one case of an A to G point mutation on exon 9 of the PTEN gene in the cervical cancer tissues. This mutation caused the change of aspartic acid to glycine, and the rate of mutation was 1%. The PTEN gene methylation rate of cervical cancer was 62% (63/102) and the rate was associated with the International Federation of Gynecology and Obstetrics stage, cell differentiation, tumor size and lymph node metastasis (P<0.05). The positive rate of PTEN expression was 49% (50/102) in cervical carcinoma and the PTEN expression between stage I-II and III-IV [60 (27/45) vs. 40% (23/57)] was statistically significant (P<0.01). The PTEN gene expression between the metastasis and no lymph node metastasis groups [26 (10/38) vs. 63% (40/64)] was significantly different (P<0.01). The PTEN gene promoter methylation and its protein expression had a significant correlation (P=0.042). These results suggest that hypermethylation can inactivate the transcription of PTEN and reduce its protein expression. Downregulated PTEN expression is involved in the pathogenesis, invasion and metastasis of cervical cancer, possibly by regulating the balance between apoptosis and proliferation. Therefore, the PTEN expression may be a good marker for the prognosis of cervical cancer.
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Affiliation(s)
- Qiufeng Qi
- Clinical Oncology Laboratory, Changzhou Tumor Hospital Affiliated to Suzhou University, Changzhou, Jiangsu 213002, P.R. China
| | - Yang Ling
- Department of Oncology, Changzhou Tumor Hospital Affiliated to Suzhou University, Changzhou, Jiangsu 213002, P.R. China
| | - Ming Zhu
- Clinical Oncology Laboratory, Changzhou Tumor Hospital Affiliated to Suzhou University, Changzhou, Jiangsu 213002, P.R. China
| | - Linyan Zhou
- Department of Pathology, Changzhou Tumor Hospital Affiliated to Suzhou University, Changzhou, Jiangsu 213002, P.R. China
| | - Meizhen Wan
- Department of Pathology, Changzhou Tumor Hospital Affiliated to Suzhou University, Changzhou, Jiangsu 213002, P.R. China
| | - Yanqing Bao
- Clinical Oncology Laboratory, Changzhou Tumor Hospital Affiliated to Suzhou University, Changzhou, Jiangsu 213002, P.R. China
| | - Yongping Liu
- Clinical Oncology Laboratory, Changzhou Tumor Hospital Affiliated to Suzhou University, Changzhou, Jiangsu 213002, P.R. China ; Department of Oncology, Changzhou Tumor Hospital Affiliated to Suzhou University, Changzhou, Jiangsu 213002, P.R. China
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15
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EGFR promoter methylation detection in cervical cancer by a hybridization-fluorescence polarization assay. ACTA ACUST UNITED AC 2014; 22:102-6. [PMID: 23628821 DOI: 10.1097/pdm.0b013e31827744ad] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The methylation status of the epidermal growth factor receptor (EGFR) promoter is of potential predictive value for benefitting from EGFR inhibition therapy. Stratified therapy assignment for cervical cancer patients based on the EGFR promoter methylation status requires a simple detection method in the daily practice of diagnosis. A novel assay detecting the EGFR promoter methylation status in cervical cancer tissue samples using a hybridization-fluorescence polarization (FP) technique was developed. A pair of primers was used to amplify a 156 bp fragment in the promoter region of EGFR. Two probes specific for either methylated or unmethylated EGFR promoter DNA labeled with different fluorophores hybridized, respectively, with their target amplicons. The EGFR promoter methylation status was determined by the FP values. A total of 273 cervical cancer tissue samples were simultaneously analyzed using the new assay technique and combined bisulfite restriction analysis. The new assay was more sensitive compared with the combined bisulfite restriction analysis, and it allowed the discrimination of the EGFR promoter methylation status directly in solution without the restriction enzyme digestion. Sensitivity, specificity, and stability of the hybridization-FP assay had been recorded. The minimum detection level established with the new assay was 50 copies/μL, and it was able to detect the minor population of the EGFR promoter methylation status even when its contents were as low as 10%. No cross-reaction was observed in the assay when the amount of plasmids used accounted for no more than 10(9) copies/μL. The coefficient of variation of the reproducibility for the assay was <10%.
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16
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Melchers LJ, Bruine de Bruin L, Schnell U, Slagter-Menkema L, Mastik MF, de Bock GH, van Dijk BAC, Giepmans BNG, van der Laan BFAM, van der Wal JE, Roodenburg JLN, Schuuring E. Lack of claudin-7 is a strong predictor of regional recurrence in oral and oropharyngeal squamous cell carcinoma. Oral Oncol 2013; 49:998-1005. [PMID: 23953778 DOI: 10.1016/j.oraloncology.2013.07.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 06/24/2013] [Accepted: 07/18/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Adequate treatment of oral and oropharyngeal squamous cell carcinoma (OSCC) is dependent on correctly predicting the presence of lymph node metastases. Current methods to diagnose nodal metastases partly result in overtreatment with associated morbidity and undertreatment with decreased disease-free survival. E-cadherin has been studied extensively as potential marker for lymph node metastases. EpCAM and claudin-7 have a functional relationship with E-cadherin, forming a complex that promotes tumourigenicity in vitro. We hypothesize that the co-expression patterns of these related molecules is a better prognostic marker for nodal status and regional recurrences. MATERIALS AND METHODS We constructed separate tissue microarrays of tumour centre and tumour invasive front of 227 OSCC with complete clinicopathological and follow-up data, including HPV status, and performed immunohistochemistry for these molecules. RESULTS Lack of E-cadherin and presence of cytoplasmic EpCAM expression in the tumour front were predictive for nodal metastasis, but no co-expression pattern was found clinically relevant. Lack of claudin-7 in the tumour centre was highly and independently predictive for shorter regional disease-free survival (HR=0.19; 95%CI: 0.06-0.62) and disease-specific survival (HR=0.43; 95%CI: 0.21-0.87). High-risk HPV was not associated with any marker. CONCLUSIONS The expression of E-cadherin and EpCAM, depending on the specific tumour sublocalization, is predictive for nodal status. However, co-expression did not improve the prediction of nodal status, indicating that the proposed in vitro complex is not functional in clinical samples. Additionally, lack of claudin-7 expression in the tumour centre may be used to identify patients with increased risk for regional recurrence.
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Affiliation(s)
- L J Melchers
- Dept. of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands; Dept. of Pathology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700RB Groningen, The Netherlands.
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Zampronha RDAC, Freitas-Junior R, Murta EFC, Michelin MA, Barbaresco AA, Adad SJ, Oliveira AMD, Rassi AB, Oton GJB. Human papillomavirus types 16 and 18 and the prognosis of patients with stage I cervical cancer. Clinics (Sao Paulo) 2013; 68:809-14. [PMID: 23778490 PMCID: PMC3674251 DOI: 10.6061/clinics/2013(06)14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 02/16/2013] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE This study sought to evaluate the prevalence of human papillomavirus (HPV) types 16 and 18 in women with clinical stage IB cervical cancer treated by radical hysterectomy with pelvic lymphadenectomy as well as to establish a correlation between HPV type and cancer prognosis. METHODS A single-center cohort study was conducted with 86 patients who had undergone radical hysterectomy for stage I cervical cancer. Prognostic factors and the presence of HPV 16 and 18 were analyzed using a polymerase chain reaction assay. A univariate analysis using Kaplan-Meier curves was conducted to estimate survival. RESULTS The prevalence of HPV 16 in the study group was 65.3%, and the prevalence of HPV 18 was 33.3%. The prevalence of infection with both viruses was 26.9%. Overall survival at 5 years was 91% among women with HPV 18 and 96% among those without this virus type (p=0.133). Among the women with HPV 16, the overall survival was 94%, whereas this rate was 96% among those without this virus type (p=0.663). Disease-free survival was unaffected by the presence of HPV type 16 or 18. CONCLUSION In the present study, despite the high prevalence of HPV types 16 and 18, the presence of these virus types did not affect the prognosis of patients with stage I cervical cancer who underwent radical hysterectomy.
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18
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Zhang F, Tang JM, Wang L, Shen JY, Zheng L, Wu PP, Zhang M, Yan ZW. Phosphorylation of epidermal growth factor receptor and chromosome 7 polysomy in gastric adenocarcinoma. J Dig Dis 2012; 13:350-9. [PMID: 22713084 DOI: 10.1111/j.1751-2980.2012.00597.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the phosphorylation of epidermal growth factor receptor (EGFR) and its potentially associated chromosomal aberrations in gastric adenocarcinoma. METHODS Phosphorylated EGFR (pEGFR) was detected by immunohistochemistry on 145 specimens including 60 tumoral, 60 non-tumoral, 12 tumor-adjacent intramucosal dysplasia from patients with gastric adenocarcinoma and 13 mucosae from cancer-free patients. EGFR gene amplification and chromosome 7 (Chr-7) polysomy were detected by fluorescence in situ hybridization. RESULTS Positivity of pEGFR was found in 50 tumoral (83.3%) and 42 non-tumoral specimens (70.0%). There was an association between tumoral and non-tumoral zones on immunostains of pEGFR (r = 0.353, P = 0.006). Nuclear pEGFR usually presented in mucosae with Helicobacter pylori infection, stromal reaction or vascular invasion. Cytoplasmic pEGFR was correlated with local cancer extension (r = 0.337, P = 0.014) and inversely related with gastrokine 2, which had been previously detected in the same specimens. Eleven intramucosal dysplastic specimens were also positive for pEGFR while 13 mucosae from cancer-free patients were all negative. No EGFR gene amplification was observed. However, seven tumor specimens showed Chr-7 polysomy (11.7%) in which 5 were strongly positive for pEGFR. CONCLUSIONS EGFR phosphorylation may be one of the mechanisms that promote tumor initiation and expansion in gastric adenocarcinoma. Detection of pEGFR with analysis of its nuclear or cytoplasmic patterns could be clinicopathologically valuable. Chr-7 polysomy may partially contribute to EGFR activation in gastric adenocarcinoma, although its role does not predominate.
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Affiliation(s)
- Fan Zhang
- Department of Pathology, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
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Klopp AH, Eifel PJ. Biological predictors of cervical cancer response to radiation therapy. Semin Radiat Oncol 2012; 22:143-50. [PMID: 22385921 DOI: 10.1016/j.semradonc.2011.12.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The addition of cisplatin-based chemotherapy to standard radiation therapy reduces the risk of recurrence and disease-related death rates from locally advanced cervical cancers by as much as 50%. However, the absolute gains are relatively small for patients with early tumors, many of whom would have been cured with radiation alone, and recurrence rates are still high for patients who have very large or advanced-stage tumors. As a result, there is a pressing need for more accurate predictors of radiocurability. A variety of types of biomarkers have been shown to correlate with cervical cancer response to radiation therapy. These include traditional clinical and morphologic predictors, non-molecular biomarkers, including hypoxia and fluorodeoxyglucose-positron emission tomography (FDG-PET) avidity, as well as molecular biomarkers, which include single-gene markers or array-based multigene predictors. Multi-gene predictors of response remain immature in cervical cancer, but studies thus far have paved the way for future studies to validate these findings. Methods will need to be standardized and markers will need to be validated on homogeneous patient populations and treatment approaches before they can become useful tools for clinical decision making. In addition, new biomarkers will be of major value only if they add to the predictive value of traditional clinical and morphologic predictors. Ultimately, the most useful biomarkers will identify patients who will benefit from specific molecularly targeted agents in addition to radiation therapy or perhaps identify patient who are at low risk for recurrence, for whom the dose of radiation or chemotherapy can be reduced.
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Affiliation(s)
- Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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