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Katsuma S, Ariyoshi K, Nio A, Taguchi K, Sonoda K. A case report and literature review: A 19-year-old with endometrial carcinoma treated with medroxyprogesterone acetate. Importance of the medical interview and endometrial examination. Clin Case Rep 2024; 12:e9205. [PMID: 39055086 PMCID: PMC11266120 DOI: 10.1002/ccr3.9205] [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: 01/21/2024] [Revised: 06/20/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024] Open
Abstract
A 19-year-old woman had stage IA endometrial carcinoma treated with medroxyprogesterone acetate and experienced a recurrence. This patient's experience illustrates the importance of a thorough history and endometrial assessment in younger patients.
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Affiliation(s)
- Shinichiro Katsuma
- Gynecology ServiceNational Hospital Organization Kyushu Cancer CenterFukuoka CityFukuokaJapan
| | - Kazuya Ariyoshi
- Gynecology ServiceNational Hospital Organization Kyushu Cancer CenterFukuoka CityFukuokaJapan
| | - Ai Nio
- Gynecology ServiceNational Hospital Organization Kyushu Cancer CenterFukuoka CityFukuokaJapan
| | - Kenichi Taguchi
- Department of PathologyNational Hospital Organization Kyushu Cancer CenterFukuoka CityFukuokaJapan
| | - Kenzo Sonoda
- Gynecology ServiceNational Hospital Organization Kyushu Cancer CenterFukuoka CityFukuokaJapan
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2
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Sun X, Yao X, Zeng B, Zhu L, Shang Y, Zhang Q, He L, Jiang L. Association of mismatch repair deficiency in endometrial cancer with 18F-FDG PET/CT and clinicopathological features and their prognostic value. Ann Nucl Med 2023; 37:655-664. [PMID: 37743402 DOI: 10.1007/s12149-023-01869-2] [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: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Identification of the mismatch repair (MMR) deficiency in endometrial cancer (EC) may aid in the screening of patients who may benefit from immunotherapy. Our goal was to investigate the relationship between MMR status and 18F-FDG PET/CT metabolic parameters and clinicopathological features in patients with EC, as well as to explore their prognostic value. METHODS This retrospective study included 106 EC patients who were classified as MMR deficient (dMMR) or MMR proficient (pMMR) group based on MMR protein expression status evaluated by immunohistochemistry. Clinicopathological characteristics and PET metabolic parameters were compared between the dMMR and pMMR groups, and their relationships with MMR status and prognosis were evaluated. RESULTS Of 106 EC patients, 30 patients (28.1%) had dMMR, while 76 (71.7%) had pMMR. Compared with the pMMR group, the dMMR group showed a lower prevalence of overweight (BMI ≥ 25) (17.2% vs. 43.9%, P = 0.019) and more lymph vascular space invasion (43.3% vs. 21.1%, P = 0.029). Although no relationship between glucometabolism parameters and MMR status was observed in all enrolled patients, higher SUVmax was observed in the endometrioid type of EC with MMR deficiency (P = 0.047). Additionally, SUVmax related to MMR status was found in EC patients with advanced FIGO stage (P = 0.026) or deep myometrial invasion (P = 0.026). Multivariate Cox regression analysis revealed that lymph node metastasis was independently predictive of PFS, while advanced FIGO stage was an independent predictor of OS. No significant association between MMR status and prognosis was found in EC. CONCLUSION Higher SUVmax was associated with MMR deficiency in EC patients with endometrioid type, advanced stage, or deep myometrial invasion, which may be useful for predicting the MMR status and thus aiding in determination of immunotherapy for patients with EC.
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Affiliation(s)
- Xiaolin Sun
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Xinchao Yao
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Baozhen Zeng
- Department of Pathology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Linbo Zhu
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Yuxiang Shang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Qing Zhang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Li He
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China.
| | - Lei Jiang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
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Kim MK, So KA, Chun YK, Kim YH, Lim KT, Lee KH, Kim TJ. Clinicopathologic significance of mismatch repair protein expression in endometrioid endometrial cancer. Taiwan J Obstet Gynecol 2023; 62:724-728. [PMID: 37679002 DOI: 10.1016/j.tjog.2023.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To evaluate the association between mismatch repair (MMR) protein expression and clinico-pathologic outcomes in patients with endometrioid endometrial cancer (EC). MATERIALS AND METHODS A retrospective review of the clinico-pathologic outcomes was performed on patients who were diagnosed with EC and had results of MMR protein immunohistochemistry. MMR-deficient (MMR-d) was defined as absence of expression in any of the 4 MMR proteins (MLH1, MSH2, MSH6, and PMS2). Demographics, pathologic variables, and survival outcomes were compared according to the MMR status. RESULTS A total of 193 EC patients with available MMR expression data were included, of whom 163 patients had endometrioid type EC. Overall, 44 patients (27.0%) were classified as MMR-d. Compared with MMR-proficient (MMR-p) group, MMR-d group was associated with more frequent lymphovascular space invasion (LVSI, p = 0.001). MMR-d was also related with higher risk of lymph node (LN) metastasis in endometrioid type EC (p = 0.008), especially para-aortic LN metastasis. During the median follow-up period of 19.1 months (1-44.5), MMR-d group, especially MLH1/PMS2 subgroup, showed a tendency of reduced PFS (p = 0.036 and p = 0.008, respectively). On Cox regression analysis, however, LN metastasis remained as the only independent risk factor for PFS (p = 0.004) in endometrioid EC, and MLH1/PMS2 loss showed a marginally significant association (p = 0.054). CONCLUSION Our findings of the associations between MMR deficiency and poor prognostic factors, such as LVSI and LN metastasis, may suggest the prognostic value of MMR status in EC and need further prospective validation studies.
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Affiliation(s)
- Mi-Kyung Kim
- Department of Obstetrics and Gynecology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Kyeong A So
- Department of Obstetrics and Gynecology, Konkuk University Hospital, Seoul, South Korea
| | - Yi-Kyeong Chun
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Yun Hwan Kim
- Department of Obstetrics and Gynecology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Kyung Taek Lim
- Department of Obstetrics and Gynecology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Ki Heon Lee
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University, Gyeonggi-do, Republic of Korea
| | - Tae Jin Kim
- Department of Obstetrics and Gynecology, Konkuk University Hospital, Seoul, South Korea.
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Atjimakul T, Wattanapaisal P, Suwiwat S, Wanichsuwan W, Hanprasertpong J. Microsatellite instability and oncological outcomes in Thai patients with endometrial cancer. J OBSTET GYNAECOL 2022; 42:3117-3123. [PMID: 35930016 DOI: 10.1080/01443615.2022.2106557] [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: 01/06/2023]
Abstract
Here, we determined the frequency of microsatellite instability (MSI) and the impact of MSI-high (MSI-H) on clinical outcomes of Thai patients with endometrial cancer (EC). Tissue samples of 110 Thai patients with EC, who had undergone surgical staging, were tested for mismatch repair (MMR) gene deficiency, and the patients were grouped into MSI-H and MSI-stable (MSI-S) groups; 24.5% had MSI-H. Unlike MSI-S group patients, MSI-H group patients had synchronous and metachronous cancer. They showed better 3-year disease-free survival (DFS) than those in the MSI-S group (p=.182; 92.3% vs. 82.6%). The 3-year overall survival was 96.2% in MSI-H and 86.4% in MSI-S groups (p=.163). Multivariate analyses showed lower uterine involvement (p=.004), myometrial invasion ≥50% (p=.032), lymphovascular space invasion (p<.001) and MSI-S (p=.006) as prognostic factors for DFS. Our study showed that the prevalence of MMR gene deficiency in Thai patients with EC is common and associated with better outcomes.Impact StatementWhat is already known on this subject? Microsatellite instability (MSI) occurs in approximately 20-40% of endometrial cancer (EC) cases. MSI analysis in EC can identify patients at higher risk of hereditary nonpolyposis colorectal cancer and those having prognostic factors. Additionally, it is predictive of immune checkpoint inhibitor treatment. However, current evidence shows a correlation between clinicopathological characteristics and EC prognosis. Studies on EC and MSI status effect on survival outcome have yielded inconsistent results regarding the pathological significance of MSI in such malignancies.What do the results of this study add? The prevalence of mismatch repair (MMR) gene deficiency in Thai patients with EC is common (24.5%) and associated with better outcomes.What are the implications of these findings for clinical practice and/or further research? This study highlights the prevalence and impact of MSI on oncological outcomes in patients with EC in a low-incidence country. Future studies should focus on the detection of germline mutation to understand the accurate prevalence of Lynch syndrome in Thai patients with EC.
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Affiliation(s)
- Thiti Atjimakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Panote Wattanapaisal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Supaporn Suwiwat
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Worrawit Wanichsuwan
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jitti Hanprasertpong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.,Department of Research and Medical Innovation, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Soylemez T, Kir G, Olgun ZC, Dur SR, Tosun MI, Ankarali H, Demircan B, Kaya IA, Karateke A. The Correlation of Histopathologic Parameters With Mismatch Repair Protein-deficient Subgroups and MLH1 Methylation in Endometrial Carcinomas. Int J Gynecol Pathol 2022; 41:484-495. [PMID: 34723847 DOI: 10.1097/pgp.0000000000000831] [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: 11/25/2022]
Abstract
There are limited data regarding the correlation of clinical and pathologic parameters with mismatch repair (MMR) protein-deficient subgroups and methylation status. In this study, we analyzed the status of MMR proteins in resection specimens of 198 consecutive endometrial carcinomas and the methylation status in tumors with MLH1 and PMS2 deficiency. We, therefore, assessed the correlation of clinical and pathologic parameters with MMR protein-deficient subgroups. Univariate analysis revealed that deeper myometrial invasion and the presence of tumor-associated lymphocytes were more frequently observed in tumors with MMR protein deficiency ( P =0.023 and 0.001, respectively). The multivariate logistic regression analysis revealed that only the presence of tumor-associated lymphocytes was significantly associated with MMR protein deficiency ( P =0.002, odds ratio=2.674, 95% confidence interval=1.418-5.045). We also compared MLH1 and PMS2 deficiency with other protein deficiency regarding clinical and pathologic parameters. Furthermore, we compared MLH1 methylated tumors with MMR protein-deficient nonmethylated tumors regarding clinical and pathologic parameters. MLH1 was methylated in 51 of 54 tumors with MLH1 and PMS2 deficiency. In univariate analysis, a larger tumor size was significantly associated with MLH1 and PMS2 deficiency and with MLH1 methylation ( P =0.004 and 0.005, respectively). The multivariate logistic regression analysis revealed that a larger tumor size was significantly associated with MLH1 and PMS2 deficiency and MLH1 methylation ( P =0.002, odds ratio=14.222, 95% confidence interval=2.560-79.026, P =0.008, odds ratio=22.222, 95% confidence interval=2.220-222.395, respectively). Our results showed a slightly higher rate of MLH1 and PMS2 deficiency (34.3%) than in previous studies. This may likely be due to ethnic differences in frequency of various mutations.
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The Role of Immunohistochemistry Markers in Endometrial Cancer with Mismatch Repair Deficiency: A Systematic Review. Cancers (Basel) 2022; 14:cancers14153783. [PMID: 35954447 PMCID: PMC9367287 DOI: 10.3390/cancers14153783] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023] Open
Abstract
The objective of this systematic review was to summarize our current knowledge of the role of immunohistochemistry (IHC) markers for identifying mismatch repair-deficient (MMRd) tumors in endometrial cancer (EC). Identification of MMRd tumors, which occur in 13% to 30% of all ECs, has become critical for patients with colorectal and endometrial cancer for therapeutic management, clinical decision making, and prognosis. This review was conducted by two authors applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the following terms: “immunohistochemistry and microsatellite instability endometrial cancer” or “immunohistochemistry and mismatch repair endometrial cancer” or “immunohistochemistry and mismatch repair deficient endometrial cancer”. Among 596 retrieved studies, 161 fulfilled the inclusion criteria. Articles were classified and presented according to their interest for the diagnosis, prognosis, and theragnostics for patients with MMRd EC. We identified 10, 18, and 96 articles using IHC expression of two, three, or four proteins of the MMR system (MLH1, MSH2, MHS6, and PMS2), respectively. MLH1 promoter methylation was analyzed in 57 articles. Thirty-four articles classified MMRd tumors with IHC markers according to their prognosis in terms of recurrence-free survival (RFS), overall survival (OS), stage, grade, and lymph node invasion. Theragnostics were studied in eight articles underlying the important concentration of PD-L1 in MMRd EC. Even though the role of IHC has been challenged, it represents the most common, robust, and cheapest method for diagnosing MMRd tumors in EC and is a valuable tool for exploring novel biotherapies and treatment modalities.
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Kim JH, Kwon BS, Kim H, Suh DH, Kim K, Kim YB, No JH. Clinicopathologic significance of DNA mismatch repair protein status in endometrial cancer. Taiwan J Obstet Gynecol 2022; 61:415-421. [PMID: 35595431 DOI: 10.1016/j.tjog.2022.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The prognostic implications of DNA mismatch repair protein (MMRP) have not been determined in endometrial cancer. Therefore, in this study, we aimed to evaluate the clinicopathologic characteristics of DNA MMRP deficiency in endometrial cancer. MATERIALS AND METHODS We examined the MMRP status of 206 patients with endometrial carcinomas, using immunohistochemistry, and analyzed their clinicopathologic factors and survival outcomes stratified by MMRP status using the Kaplan-Meier method and Cox regression analysis. RESULTS Forty-three cases were deficient for at least one MMRP (20.9%). Loss of MLH1 was the most common (13.1%), followed by MSH6 (7.8%). MMRP deficiency was significantly associated with lympho-vascular space invasion, deep myometrial invasion, and adjuvant treatment (P = 0.032, 0.041, and 0.047, respectively). MMRP-deficient patients had a better overall survival (OS), particularly at advanced cancer stages (III/IV) (100% vs. 73.7%, P = 0.170) or if they had received adjuvant treatment (100% vs. 86.7%, P = 0.087). CONCLUSION Although MMRP deficiency was associated with unfavorable prognostic risk factors in endometrial cancer, we found a trend in favor of OS in MMRP-deficient patients. More studies are needed to confirm its prognostic implication.
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Affiliation(s)
- Ju-Hyun Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Byung-Su Kwon
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Hyojin Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Hachisuga K, Ohishi Y, Tomonobe H, Yahata H, Kato K, Oda Y. Endometrial endometrioid carcinoma, grade 1, is more aggressive in the elderly than in the young. Histopathology 2021; 79:708-719. [PMID: 33982792 DOI: 10.1111/his.14400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/04/2021] [Accepted: 05/09/2021] [Indexed: 01/23/2023]
Abstract
AIMS The aim of this study was to characterise grade 1 (G1) endometrioid carcinoma in the elderly, by using clinicopathological features and immunohistochemical features of surrogate markers of molecular subtypes. METHODS AND RESULTS We retrospectively analysed tumour samples from 268 patients with G1 endometrioid carcinoma (<40 years, n = 24; 40-59 years, n = 169; ≥60 years, n = 75) for whom long-term clinical follow-up data were available. G1 endometrioid carcinoma in the elderly (≥60 years) was characterised by frequent deep myometrial invasion, less frequent endometrioid intraepithelial neoplasia (EIN), lack of benign hyperplasia (BH), less frequent squamous differentiation, and occasional aberrant p53 expression. In contrast, this condition in the young (<40 years) was characterised by frequent EIN, BH, and squamous differentiation. Univariate analysis revealed that elderly status (≥60 years), International Federation of Obstetrics and Gynecology (FIGO) 2009 stage and aberrant p53 expression were significantly associated with shorter progression-free survival, and multivariate analysis revealed that elderly status and FIGO 2009 stage were independently associated with a poor prognosis. CONCLUSIONS G1 endometrioid carcinoma in the elderly is more aggressive than that in the young, and elderly status is an independent predictor of shorter progression-free survival in this condition. We propose that type 1 tumours can be subdivided into type 1a (young age at onset and indolent) and type 1b (old age at onset and relatively aggressive).
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Affiliation(s)
- Kazuhisa Hachisuga
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Ohishi
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Diagnostic Pathology, Iizuka Hospital, Fukuoka, Japan
| | - Hiroshi Tomonobe
- Department of Gynaecology and Obstetrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideaki Yahata
- Department of Gynaecology and Obstetrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Gynaecology and Obstetrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Jain E, Prasad S, Dhar A, Kini L, Sharma S, Dewan A. The utility of evaluating mismatch repair proteins in endometrial carcinoma: an experience from a tertiary referral centre in North India. Pathologica 2021; 113:115-120. [PMID: 34042092 PMCID: PMC8167399 DOI: 10.32074/1591-951x-129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022] Open
Abstract
Background Endometrial cancer (EC) is a common gynecological malignancy. Around 25-30% patients have mismatch repair deficiency (MMRd). Lynch syndrome is caused by germline mutations in MMR genes. Lynch-associated tumours have better prognosis, however implications for prognosis and survival is less known. Microsatellite insufficiency (MSI) is associated with high neoantigen loads and number of tumor infiltrating lymphocytes, which overexpresses PD-1 and PD-L1 and are excellent candidates for PD-1-targeted immunotherapies. In this study, we aim to evaluate the utility of MMR in patients with EC and its clinico-pathological correlation. Methods Eighty-two cases of EC which underwent MMR evaluation over a period of five years at our centre were included. Demographics, clinical details including family history, histopathological and immunohistochemical (IHC) parameters were recorded. Tumors with loss-of at least one protein were considered MMR deficient (MMRd) and those with intact expression were MMR proficient (MMRp). Results Of 82 cases tested, 27 (33%) were MMRd. Frequencies of IHC MMR loss of expression were: MLH1/PMS2: 17 (21%), MSH6 loss only: 3 (4%), MSH2/MSH6 loss: 3 (4%), PMS2 loss: 2 (2%). In MMRd cases, most common histologic tumor type was endometrioid adenocarcinoma (70%). Loss of expression was significantly (p < 0.001) more frequent in lower uterine segment involvement and positive family history. Conclusions MSI plays an important role in the progression of endometrial cancer. Lower uterine segment involvement and positive family history are significant predictor of MMR loss. Routine testing of MMR proteins in endometrial cancer can contribute to screening of Lynch syndrome families and make immunotherapy available as a treatment option.
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Kato MK, Yoshida H, Tanase Y, Uno M, Ishikawa M, Kato T. Loss of ARID1A Expression as a Favorable Prognostic Factor in Early-Stage Grade 3 Endometrioid Endometrial Carcinoma Patients. Pathol Oncol Res 2021; 27:598550. [PMID: 34257552 PMCID: PMC8262237 DOI: 10.3389/pore.2021.598550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/12/2021] [Indexed: 11/13/2022]
Abstract
Introduction: High-risk patients with grade 3 endometrioid endometrial carcinoma (G3EEC) who require adjuvant therapy have not been clearly identified. Therefore, the current study aimed to investigate the prognostic impact of ARID1A, p53, and mismatch repair (MMR) protein expressions, previously reported as prognosticators in some gynecological cancers, in patients with early-stage G3EEC. Methods: A total of 67 patients with pathologically confirmed early-stage G3EEC diagnosed between 1997 and 2020 were identified; none received adjuvant chemotherapy. The recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared with a log-rank test. The protein expressions of ARID1A, p53, and MMR were examined via immunohistochemistry, and the associations between these biomarkers and clinical outcomes were evaluated. Results: Recurrence was observed in 9 (13%) of the 67 patients with early stage G3EEC. The respective 5-years RFS and OS rates were 87.7% and 93.7%, and 68.6% and 85.7%, respectively for stages I and II. Multivariate analysis showed significantly longer RFS among patients with ARID1A loss (hazard ratio = 8.7; 95% CI, 1.09–69.6, p = 0.04). No significant differences were observed in RFS and OS of patients according to p53 and MMR expression status. Conclusion: ARID1A expression status was a prognosticator for patients with early stage G3EEC without adjuvant therapy, whereas p53 and MMR expression status showed no impact on survival outcomes. ARID1A may become a useful biomarker for stratification of adjuvant treatment for early stage G3EEC patients.
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Affiliation(s)
| | - Hiroshi Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhito Tanase
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Masaya Uno
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
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Ida N, Nakamura K, Saijo M, Nasu A, Yoshino T, Masuyama H, Yanai H. DNA mismatch repair deficiency and p53 abnormality are age-related events in mixed endometrial carcinoma with a clear cell component. Pathol Res Pract 2021; 220:153383. [PMID: 33676104 DOI: 10.1016/j.prp.2021.153383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
Mixed endometrial carcinoma (MEC) is defined as a tumor composed of two or more spatially distinct subtypes, at least one of which is serous or clear cell carcinoma. In this study, the clinicopathological features of 15 MEC cases containing a clear cell component (MEC-C) were investigated. The ages of patients ranged from 32 to 83 years (median, 61 years). The combinations of carcinoma components observed were endometrioid and clear cell in ten patients; endometrioid, clear cell and serous in three; and clear cell and serous in two. Immunohistochemically, nine had DNA mismatch repair (MMR) protein deficiency (MMR-d), nine had loss of ARID1A and three cases had aberrant p53 expression. MMR-d and loss of ARID1A showed a strong correlation. Only one case showed both MMR-d and aberrant p53 expression. The patients with MMR-d were younger than those without MMR-d (median; 58 years vs. 71 years). Loss of ARID1A also showed significant predilection for younger women than ARID1A intact cases. In conclusion, MMR-d was observed in 60 % of MEC-C, showed predilection for young women, and was associated with ARID1A loss. In contrast, non- MMR-d MEC-C occurred in elder women and some tumors may associate with TP53 mutation. These findings suggest that MEC-C develop via two different molecular mechanisms and they are age-related events.
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Affiliation(s)
- Naoyuki Ida
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Keiichiro Nakamura
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Masayuki Saijo
- Department of Obstetrics and Gynecology, Himeji Red Cross Hospital, Himeji, Japan
| | - Atsuko Nasu
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Tadashi Yoshino
- Department of Pathology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hisashi Masuyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hiroyuki Yanai
- Department of Pathology, Okayama University Hospital, Okayama, Japan.
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Sha D, Jin Z, Budczies J, Kluck K, Stenzinger A, Sinicrope FA. Tumor Mutational Burden as a Predictive Biomarker in Solid Tumors. Cancer Discov 2020; 10:1808-1825. [PMID: 33139244 DOI: 10.1158/2159-8290.cd-20-0522] [Citation(s) in RCA: 366] [Impact Index Per Article: 91.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/03/2020] [Accepted: 09/09/2020] [Indexed: 11/16/2022]
Abstract
Tumor mutational burden (TMB), defined as the number of somatic mutations per megabase of interrogated genomic sequence, varies across malignancies. Panel sequencing-based estimates of TMB have largely replaced whole-exome sequencing-derived TMB in the clinic. Retrospective evidence suggests that TMB can predict the efficacy of immune checkpoint inhibitors, and data from KEYNOTE-158 led to the recent FDA approval of pembrolizumab for the TMB-high tumor subgroup. Unmet needs include prospective validation of TMB cutoffs in relationship to tumor type and patient outcomes. Furthermore, standardization and harmonization of TMB measurement across test platforms are important to the successful implementation of TMB in clinical practice. SIGNIFICANCE: Evaluation of TMB as a predictive biomarker creates the need to harmonize panel-based TMB estimation and standardize its reporting. TMB can improve the predictive accuracy for immunotherapy outcomes, and has the potential to expand the candidate pool of patients for treatment with immune checkpoint inhibitors.
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Affiliation(s)
- Dan Sha
- Departments of Medicine and Gastrointestinal Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Zhaohui Jin
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jan Budczies
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg Partner Site, Heidelberg, Germany
| | - Klaus Kluck
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg Partner Site, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg Partner Site, Heidelberg, Germany
| | - Frank A Sinicrope
- Departments of Medicine and Gastrointestinal Research Unit, Mayo Clinic, Rochester, Minnesota. .,Department of Oncology, Mayo Clinic, Rochester, Minnesota.,Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota
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13
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Rekhi B, Menon S, Deodhar KK, Ghosh J, Chopra S, Maheshwari A. Clinicopathological features of 50 mismatch repair (MMR)-deficient endometrial carcinomas, tested by immunohistochemistry: A single institutional feasibility study, India. Ann Diagn Pathol 2020; 47:151558. [PMID: 32619922 DOI: 10.1016/j.anndiagpath.2020.151558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/30/2020] [Accepted: 06/18/2020] [Indexed: 11/25/2022]
Abstract
There are few comprehensive studies from Asia on clinicopathologic features of mismatch repair (MMR)-deficient endometrial carcinomas, including rarely from our country. One hundred and four cases of endometrial carcinomas were tested for four MMR proteins by immunohistochemistry. Among 50 MMR-deficient (MMRd) tumors(48%), age-range was 27-68 years(median = 53) and tumor size(n = 34) varied from 1.2-10 cm(average = 4.6). Lower uterine segment(LUS) was involved in 21/31 cases(67.7%). Histopathologically, all cases were endometrioid adenocarcinomas(EMACs), of FIGO grade 2(low-grade)(18 cases) and 3(high-grade)(32 cases), displaying de-differentiated, undifferentiated and lymphoepithelioma(LE)-like patterns, in 24 cases(48%). Tumor infiltration ≥ half of myometrium was seen in 30/44 cases (68.1%); lymphovascular emboli in 19/43 cases(44.1%); and lymph node metastasis in 7/22(31.8%) cases. Uncommonly, clear cell component(n = 2) and focal neuroendocrine differentiation (n = 2) were observed. Immunohistochemically, tumor cells showed paired loss of MLH1 and PMS2 in 33(66%) and MSH2 and MSH6 in 14(28%) cases, along with loss of MSH2 and PMS2, in two and a single case, respectively. Nine patients(18%) were treated for another cancer and 9/33(27.2%) disclosed familial history of cancer. MSH2 was the most frequently lost MMR protein in those cases. Additionally, tumor cells displayed ER positivity in 41/50 cases(82%), PR in 38/41cases(92.6%) and wild-type p53 staining in 24/28 cases(85.7%). Tumor with LE-pattern showed PDLI immunoexpression. Certain clinicopathologic features suggestive for MMRd associated ECs, such as relatively large-sized tumors, involving LUS; especially high-grade, infiltrative EMACs, with undifferentiated/de-differentiated, and LE-like patterns; showing deep muscle invasion, frequent PR immunoexpression and invariably, wild-type p53 immunostaining can be useful in screening cases of Lynch syndrome. This constitutes the first report on these tumors from our country.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, HBNI University, Mumbai, India.
| | - Santosh Menon
- Department of Surgical Pathology, Tata Memorial Hospital, HBNI University, Mumbai, India
| | - Kedar K Deodhar
- Department of Surgical Pathology, Tata Memorial Hospital, HBNI University, Mumbai, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Hospital, HBNI University, Mumbai, India
| | - Supriya Chopra
- Department of Surgical Oncology (Gynecology), Tata Memorial Hospital, HBNI University, Mumbai, India
| | - Amita Maheshwari
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI University, Mumbai, India
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14
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Chen FM, Zhang YX, Li XF, Gao JF, Ma H, Wang XL, Li Y, Li C, Zhang YN, Zhang YT, Kan HX, Li H, Zhang SG, Hao FR, Wang MC. The Prognostic Value of Deficient Mismatch Repair in Stage II-IVa Nasopharyngeal Carcinoma in the Era of IMRT. Sci Rep 2020; 10:9690. [PMID: 32546739 PMCID: PMC7298002 DOI: 10.1038/s41598-020-66678-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/26/2020] [Indexed: 01/08/2023] Open
Abstract
In the era of intensity-modulated radiotherapy (IMRT), it is important to analyse the prognostic value of deficient mismatch repair (dMMR) in nasopharyngeal carcinoma (NPC). In this study, in pretreatment biopsies of 69 patients with stage II-IVa NPC, the expression levels of MMR proteins, including MLH1, MSH2, MSH6 and PMS2, were assessed by immunohistochemistry (IHC). The median follow-up time was 37.5 months (3.1-87.4 months). 50.7% of cases (35/69) showed preserved expression of all 4 MMR proteins, which was interpreted as proficient mismatch repair (pMMR). Only 1.5% of cases (1/69) lost expression of all 4 MMR proteins, 26.1% of cases (18/69) have PMS2 loss alone and 21.7% of cases (15/69) lost expression of both PMS2 and MLH1. Thus, 49.3% of cases (34/69) lost expression of one or more MMR proteins, which was interpreted as dMMR. There was no significant difference (P > 0.05) in terms of sex, age, clinical stage, T category, N category or therapy regimens between the dMMR and pMMR groups. The multivariate Cox regression analysis revealed that dMMR was an independent significant prognostic factor for distant metastasis-free survival (DMFS) (dMMR vs pMMR: P = 0.01, HR = 0.25, 95% CI: 0.09~0.75). Therefore, NPC patients with dMMR had significantly superior DMFS compared with patients with pMMR. It can be expected that dMMR will become a new independent prognostic factor for NPC.
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Affiliation(s)
- Fang-Ming Chen
- Department of Radiation Oncology, Rongcheng People's Hospital, Weihai, China
| | - Yun-Xiang Zhang
- Department of Pathology, Weifang People's Hospital, Weifang, China
| | - Xiu-Feng Li
- Department of Pathology, Weifang People's Hospital, Weifang, China
| | - Jian-Fang Gao
- Department of Pathology, Weifang People's Hospital, Weifang, China
| | - Hao Ma
- Department of Pathology, Weifang People's Hospital, Weifang, China
| | - Xiao-Li Wang
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
| | - Yang Li
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China
| | - Cheng Li
- Clinical School, Weifang Medical University, Weifang, China
| | - Ya-Nan Zhang
- Clinical School, Weifang Medical University, Weifang, China
| | - Ya-Ting Zhang
- Clinical School, Weifang Medical University, Weifang, China
| | - Hong-Xing Kan
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Yantai, China
| | - Han Li
- Department of Oncology, The Fourth People's Hospital of Zibo City, Zibo, China
| | - Shi-Geng Zhang
- Department of Radiation Oncology, Taian Tumour Prevention and Treatment Hospital, Taian, China
| | - Fu-Rong Hao
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China.
- Weifang Key Laboratory of Radiophysics and Oncological Radiobiology, Weifang, China.
| | - Ming-Chen Wang
- Department of Radiation Oncology, Weifang People's Hospital, Weifang, China.
- Weifang Key Laboratory of Radiophysics and Oncological Radiobiology, Weifang, China.
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15
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Mariya T, Kubo T, Hirohashi Y, Yanagawa J, Tabuchi Y, Matsuo K, Furumura K, Morita R, Nakatsugawa M, Kanaseki T, Tsukahara T, Hasegawa T, Saito T, Torigoe T. Less correlation between mismatch repair proteins deficiency and decreased expression of HLA class I molecules in endometrial carcinoma: a different propensity from colorectal cancer. Med Mol Morphol 2020; 54:14-22. [PMID: 32410009 DOI: 10.1007/s00795-020-00254-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/03/2020] [Indexed: 11/24/2022]
Abstract
Mismatch repair protein deficiency (dMMR) is a favorable prognostic factor in colorectal cancer. It is also associated with aberrant expression of HLA class I molecules, which are required for cytotoxic T lymphocyte-mediated cancer immunotherapy. Because dMMR is frequently also found in endometrial cancers (ECs), we retrospectively investigated the expression of mismatch repair proteins and HLA class I molecules in 127 EC patients. In this study, EC patients being treated in our hospital were recruited from 2005 to 2009 and observed until December 2017. Lesion specimens were evaluated via immunohistochemistry for MSH6 and PMS2 (mismatch repair proteins) and HLA class I molecules. Expression of these molecules was statistically related to clinical and pathological factors and prognosis. dMMR was detected in 33 patients and did not correlate with the expression level of HLA class I molecules (P = 0.60). On the other hand, unexpectedly, multivariate analysis revealed that intact expression of HLA class I molecules was associated with p53 overexpression (P = 0.004). Neither dMMR nor decreased expression of HLA class I molecules were prognostic factors. These results are inconsistent with previous findings for colorectal cancer. A distinctive local tissue immune microenvironment would underlie the discrepancy in the results between EC and colorectal cancer.
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Affiliation(s)
- Tasuku Mariya
- Department of Obstetrics and Gynecology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Terufumi Kubo
- Department of Pathology, School of Medicine, Sapporo Medical University, Sapporo, Japan.
| | - Yoshihiko Hirohashi
- Department of Pathology, School of Medicine, Sapporo Medical University, Sapporo, Japan.
| | - Junko Yanagawa
- Department of Pathology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Yuta Tabuchi
- Department of Obstetrics and Gynecology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | | | | | - Rena Morita
- Department of Pathology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Munehide Nakatsugawa
- Department of Pathology, School of Medicine, Sapporo Medical University, Sapporo, Japan.,Department of Pathology, Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan
| | - Takayuki Kanaseki
- Department of Pathology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Tomohide Tsukahara
- Department of Pathology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Toshihiko Torigoe
- Department of Pathology, School of Medicine, Sapporo Medical University, Sapporo, Japan
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16
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Son J, Carr C, Yao M, Radeva M, Priyadarshini A, Marquard J, Michener CM, AlHilli M. Endometrial cancer in young women: prognostic factors and treatment outcomes in women aged ≤40 years. Int J Gynecol Cancer 2020; 30:631-639. [PMID: 32213530 DOI: 10.1136/ijgc-2019-001105] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Endometrial cancer in pre-menopausal patients aged ≤40 years is rare and poses both diagnostic and management challenges. The goal of this study was to investigate the clinical and pathologic factors associated with endometrial cancer in this group and their impact on survival. METHODS Patients with endometrial cancer treated between January 2004 and August 2016 were retrospectively reviewed. Patients who underwent either primary surgical treatment or fertility-sparing therapy were included. Exclusion criteria were age >60 years and patients who received neoadjuvant chemotherapy or primary radiation. Age at diagnosis was used to classify patients into two groups: ≤40 and 41-60 years. Clinical and pathologic variables were compared between the groups. Progression-free survival and overall survival were estimated using Cox proportional hazards. RESULTS A total of 551 patients were evaluated, of which 103 (18.7%) patients were ≤40 years and 448 (81.3%) were 41-60 years. Age ≤40 years was associated with higher body mass index (38.8 vs 35.8 kg/m2, p=0.008), non-invasive cancers (54.2% vs 32.6%, p<0.001), lower uterine segment involvement (27.2% vs 22.5%, p<0.001), and less lymphovascular space invasion (16.8% vs 29.1%, p=0.015). The rate of synchronous ovarian cancer was 9.2% vs 0.7% in age 41-60 years (p<0.001), and 19% of women with endometrial cancer aged ≤40 years underwent fertility-sparing therapy. Grade, stage, myometrial invasion, lymphovascular space invasion, and lymph node status were associated with survival, and fertility-sparing therapy adversely affected the recurrence rate of the age ≤40 years cohort. Among all patients aged ≤60 years, mismatch repair deficiency due to MLH1 methylation was associated with worse progression-free survival, 48.6% vs 83.3% (HR 1.98, 95% CI 1.06 to 3.17, p=0.032), and overall survival, 56.5% vs 90.0% (HR 2.58, 95% CI 1.13 to 5.90, p=0.025). CONCLUSIONS Patients aged ≤40 years with endometrial cancer have more favorable prognostic factors and higher rates of synchronous tumors. Fertility-sparing therapy was associated with higher recurrence rates. The prognostic value of MLH1 methylation in this population warrants further investigation.
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Affiliation(s)
- Ji Son
- Women's Health Institute, Department of OBGYN, Cleveland Clinic, Cleveland, Ohio, USA
| | - Caitlin Carr
- Women's Health Institute, Department of OBGYN, Cleveland Clinic, Cleveland, Ohio, USA
| | - Meng Yao
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Milena Radeva
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anju Priyadarshini
- Women's Health Institute, Department of OBGYN, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jessica Marquard
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chad M Michener
- Women's Health Institute, Department of Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio, United States
| | - Mariam AlHilli
- Women's Health Institute, Department of Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio, United States
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17
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Yuan L, Biscotti CV, Zhu H, Booth CN, Abdul-Karim FW, Zhang Y. Significance of atypical endometrial cells in women younger than 40 years of age. J Am Soc Cytopathol 2019; 9:33-37. [PMID: 31353256 DOI: 10.1016/j.jasc.2019.07.001] [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: 05/31/2019] [Revised: 06/27/2019] [Accepted: 07/02/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The presence of atypical endometrial cells in the Papanicolaou (Pap) test has been associated with an increased rate of endometrial malignancy, with reported rates ranging from 14% to 47%. However, most reported studies have focused on patients who were aged >40 years. The purpose of the present study was to investigate the clinical significance of identifying atypical endometrial cells in Pap test samples in women aged <40 years of age. MATERIALS AND METHODS A search of the cytology Pap test database was performed from 2000 to 2014 using the keywords "atypical endometrial cells" or "atypical glandular cells favor endometrial origin" in women aged <40 years. The available ThinPrep slides were reviewed. The patients' clinical presentation, follow-up endometrial biopsy findings, treatment, and clinical follow-up data were recorded. Endometrial carcinoma tissue sections were screened for Lynch syndrome. RESULTS The database search yielded 63 study cases. Of these 63 patients, 52 had subsequently undergone endometrial biopsy. Of the 52 patients with follow-up biopsy findings available, 9 (17.3%) had premalignant (5 with atypical hyperplasia) or malignant (4 with endometrioid adenocarcinoma) lesions. In addition, 16 patients (30.8%) had other endometrial pathologic features. The 9 patients with premalignant or malignant endometrial lesions (8 white, 1 black) were overweight or obese; 3 of the patients did not have any clinical symptoms. All 4 patients with endometrioid adenocarcinoma had negative Lynch syndrome screening findings. CONCLUSIONS Our results suggest that it is important to recognize the presence of atypical endometrial cells in the Pap tests from young patients, given its association with the finding of premalignant and malignant pathologic features in subsequent endometrial biopsies.
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Affiliation(s)
- Lisi Yuan
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Hui Zhu
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Yaxia Zhang
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio; Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York.
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18
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Kumar P, Gupta P, Gupta N, Rajwanshi A, Rai B, Shalini G. Evaluation of DNA Mismatch Repair Protein Deficiency in Primary Endometrial Carcinoma. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pankaj Kumar
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavana Rai
- Department of Radiotherapy, and Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gainder Shalini
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
BACKGROUND Endometrial cancer (EC) is one of the most frequent tumors in women. Despite recent advances in treatment approaches, the prognosis in advanced, recurrent, or metastatic disease remains poor. The aim was to provide the clinician with an update, the current status, and the new developments in the management of EC. Based on the new EC molecular classification, we focused on the impact of immune check-point inhibitors. METHODS Pivotal trials, published literature, and conference proceedings were reviewed. PubMed and Scopus databases were searched to select English-language articles. RESULTS Immune check-point inhibitors are the subject of ongoing studies and their benefit seems to be related to microsatellite instability (MSI) status. CONCLUSIONS Immune check-point inhibitors should be considered a promising treatment option to better personalize therapeutic strategies in EC.
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20
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Fountzilas E, Kotoula V, Pentheroudakis G, Manousou K, Polychronidou G, Vrettou E, Poulios C, Papadopoulou E, Raptou G, Pectasides E, Karayannopoulou G, Chrisafi S, Papakostas P, Makatsoris T, Varthalitis I, Psyrri A, Samantas E, Bobos M, Christodoulou C, Papadimitriou C, Nasioulas G, Pectasides D, Fountzilas G. Prognostic implications of mismatch repair deficiency in patients with nonmetastatic colorectal and endometrial cancer. ESMO Open 2019; 4:e000474. [PMID: 31231557 PMCID: PMC6555870 DOI: 10.1136/esmoopen-2018-000474] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 01/13/2023] Open
Abstract
Background The clinical relevance of mismatch repair (MMR) status in patients with nonmetastatic cancer across tumour types remains unclear. Our goal was to investigate the prognostic role of MMR deficiency in patients with stage I-III colorectal and endometrial cancer. Methods Patients with nonmetastatic colorectal and endometrial cancer with tumour tissue available for analysis were identified through the Hellenic Cooperative Oncology Group (HeCOG)'s tumour repository. Patients had been referred to Departments of Medical Oncology affiliated with HeCOG. MMR protein expression was evaluated by immunohistochemistry. The primary outcome measure was overall survival (OS). Results From May 1990 to September 2012, 1158 patients with nonmetastatic colorectal (N = 991) and endometrial cancer (N = 167) were identified (median age: 64 years, men: 544). All patients with colorectal and 109 (65%) with endometrial cancer had received adjuvant treatment. MMR deficiency was observed in 114 (11.5%) of colorectal and 80 (47.9%) of endometrial tumours. More commonly deficient proteins were PMS2 (69 patients, 7%) and MLH1 (63 patients, 6.5%) in colorectal cancer and MSH2 (58 patients, 34.7%) in endometrial cancer. Colorectal MMR-deficient (dMMR) tumours were more likely to be right sided (65 % dMMR vs 27 % proficient MMR, pMMR; p < 0.001), high grade (31% vs 15%, χ2, p < 0.001) and with a mucinous component (64% vs 42%, p < 0.001). Endometrial dMMR tumours were more often of endometrioid histology (51.4 % endometrioid vs 20 % serous/clear cell, p = 0.020). Compared with MMR proficiency, MMR deficiency was associated with improved OS in patients with endometrial cancer (HR = 0.38, 95% CI 0.20 to 0.76, p = 0.006), but not in patients with colorectal cancer (HR = 0.73, 95% CI 0.49 to 1.09, p = 0.130). After adjusting for age, stage and grade, MMR deficiency maintained its favourable prognostic significance in patients with endometrial cancer (HR = 0.42, 95% CI 0.20 to 0.88, p = 0.021). Conclusions DMMR was associated with improved outcomes in patients with nonmetastatic endometrial cancer, but not in patients with nonmetastatic colorectal cancer who received adjuvant chemotherapy.
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Affiliation(s)
- Elena Fountzilas
- Department of Investigational Cancer Therapeutics, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Vassiliki Kotoula
- Department of Pathology, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece.,Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Kyriaki Manousou
- Section of Biostatistics, Hellenic Cooperative Oncology Group, Data Office, Athens, Greece, Athens, Greece
| | - Genovefa Polychronidou
- Department of Medical Oncology, Papageorgiou Hospital, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece
| | - Eleni Vrettou
- Department of Pathology, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece
| | - Christos Poulios
- Department of Pathology, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece
| | | | - Georgia Raptou
- Department of Pathology, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece
| | - Eirini Pectasides
- Department of Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Georgia Karayannopoulou
- Department of Pathology, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece
| | - Sofia Chrisafi
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Thomas Makatsoris
- Department of Medicine, Division of Oncology, University Hospital, University of Patras Medical School, Patras, Greece
| | | | - Amanda Psyrri
- Section of Medical Oncology, Department of Internal Medicine, Attikon University Hospital, Faculty of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Epaminontas Samantas
- Third Department of Medical Oncology, AgiiAnargiri Cancer Hospital, Athens, Greece
| | - Mattheos Bobos
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Christos Papadimitriou
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Dimitrios Pectasides
- Oncology Section, Second Department of Internal Medicine, Hippokration Hospital, Athens, Greece
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21
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Endometrial Cancer Presentation and Outcomes Based on Mismatch Repair Protein Expression From a Population-Based Study. Int J Gynecol Cancer 2018; 28:1624-1630. [DOI: 10.1097/igc.0000000000001343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveThere is uncertainty about the prognostic significance of mismatch repair (MMR) deficiency in endometrial cancer. The objective was to evaluate clinical characteristics and outcomes of endometrial cancers based on MMR status within a population-based study.MethodsThis was a retrospective population-based cohort study of all endometrial cancer cases from the Vancouver Coastal Health Authority region, evaluated for 4 MMR proteins using immunohistochemistry from 2012 to 2015. Patients were classified as MMR deficient (dMMR, any MMR protein absent) or MMR proficient (pMMR), Demographics, tumor characteristics, recurrences, and survival rates were compared according to MMR status.ResultsThere were 892 patients, with 650 pMMR (72.5%) and 242 dMMR tumors. The dMMR group had more endometrioid tumors (87.6% vs 74.0%, P < 0.001), lymphovascular space invasion (43.8% vs 30.8%, P = 0.001), and dedifferentiation (5.9% vs 1.5%, P < 0.001), but fewer grade 1 tumors compared with the pMMR group (31.8% vs 40.8%, P < 0.001). Median progression-free survival and overall survival have not been reached. After a median follow-up of 31 months (1–99 months), there was no difference in progression or recurrence rates between pMMR and dMMR tumors (19.5% vs 16.5%; P = 0.31). However, among those with nonendometrioid tumors, recurrence and mortality rates were significantly higher for pMMR than dMMR tumors (42.0% vs 10.0%, P = 0.001, and 36.1% vs 13.1%, P = 0.01, respectively), despite similar stage and lymphovascular space invasion distributions.DiscussionIn this population-based study, there were no significant differences in recurrence or survival outcomes according to MMR status in endometrial cancer. However, among those with nonendometrioid tumors, there were lower recurrence and mortality rates associated with MMR-deficient compared with MMR-proficient tumors.
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Kim SR, Pina A, Albert A, McAlpine J, Wolber R, Blake Gilks C, Kwon JS. Does MMR status in endometrial cancer influence response to adjuvant therapy? Gynecol Oncol 2018; 151:76-81. [PMID: 30172479 DOI: 10.1016/j.ygyno.2018.08.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/05/2018] [Accepted: 08/16/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Mismatch repair (MMR) deficiency occurs in 20-40% of endometrial cancers but its therapeutic implication remains uncertain. Our objective was to compare clinical outcomes after adjuvant therapy between MMR deficient and proficient endometrial cancers from a population-based study. METHODS This was a retrospective population-based cohort study of all endometrial cancers from the Vancouver Coastal Health authority region from 2011 to 2016, for which adjuvant therapy (radiotherapy and/or chemotherapy) was administered. Primary outcome measure was recurrence rates, expressed per 100 person-years (p100 py). Progression free survival (PFS) and overall survival (OS) rates were compared using Kaplan-Meier method and log-rank tests, and covariates were evaluated using Cox proportional hazards regression. RESULTS There were 535 patients who received adjuvant therapy (radiotherapy and/or chemotherapy), including 162 (30.3%) and 373 (69.7%) with MMR-deficient and proficient tumors, respectively. Demographic variables were similar except MMR-deficient patients were younger (62.0 vs. 64.8, p = 0.01). Patients with MMR-deficient tumors were more likely to have endometrioid histotype (85.8% vs. 61.4%), more likely to have Stage I disease (62.3% vs 54.7%), and LVSI (65.4% vs. 53.4%) compared to those with MMR-proficient tumors. There was a trend for MMR-proficient group to have higher recurrence rates (10.7 p100 py vs 5.9 p100 py) and MMR deficiency was associated with better OS and PFS, but on multivariable analysis, MMR status was no longer significant. CONCLUSION Women with MMR-deficient endometrial cancers who receive adjuvant therapy have a lower rate of recurrence compared to those with MMR-proficient cancers. However, on multivariable analysis, MMR status does not remain associated with differences in PFS or OS.
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Affiliation(s)
- Soyoun Rachel Kim
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Annick Pina
- BC Cancer Agency, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, Division of Gynecology Oncology, Universite de Montreal, Montreal, QC, Canada
| | - Arianne Albert
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Jessica McAlpine
- BC Cancer Agency, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Vancouver, BC, Canada
| | - Robert Wolber
- BC Cancer Agency, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - C Blake Gilks
- BC Cancer Agency, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Janice S Kwon
- BC Cancer Agency, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Vancouver, BC, Canada.
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Sookram J, Barroeta JE, Aikins JK. Case report of endometrial cancer with a microcytic, elongated, and fragmented pattern of invasion and DNA mismatch repair deficiency. Int J Gynaecol Obstet 2018; 141:252-254. [PMID: 29369342 DOI: 10.1002/ijgo.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/28/2017] [Accepted: 01/23/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Janhvi Sookram
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cooper University Hospital, Camden, NJ, USA
| | | | - James K Aikins
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cooper University Hospital, Camden, NJ, USA
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Tangjitgamol S, Kittisiam T, Tanvanich S. Prevalence and prognostic role of mismatch repair gene defect in endometrial cancer patients. Tumour Biol 2017; 39:1010428317725834. [PMID: 28946809 DOI: 10.1177/1010428317725834] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The study was to evaluate the prevalence of mismatch repair gene defect among Thai patients with endometrial cancer and its association with clinico-pathological features and survivals. The formalin fixed paraffin-embedded blocks of EMC tissue from hysterectomy specimens of patients having surgery in our institution between 1 Jan 1995 and 31 December 2016 were assessed for the immunohistochemical expression of 4 mismatch repair proteins (MLH1, PMS, MSH2, MSH 6). Mismatch repair gene defect was determined by a negative expression of at least 1 protein. Among 385 EMC patients included in the study, mean age was 57.3 ± 10.8 years with 62.3% aged ⩽ 60 years. The most frequent mismatch repair gene defect was MSH6 (38.7%), followed by PMS2 (34.3%), MLH1 (33.2%), and MSH2 (16.4%). Overall, 55.1% showed negative expression of at least one protein. We found significantly higher mismatch repair gene defect in patients aged ⩽ 60 years, with early stage disease, and negative lymph node status than the other comparative groups: 59.2% vs 48.3% for age (p = 0.037), 58.2% vs 45.2% (p = 0.027) for stage, and 58.1% vs 44.6% (p = 0.048) for nodal status. The 5-year progression-free survival, overall survival, and endometrial cancer-specific survival of patients with mismatch repair gene defect was higher than those without gene defect. The differences were statistically significant for only progression-free survival and endometrial cancer-specific survival: 87.7% (95% confidence interval = 83.0%-92.4%) vs 81.5% (95% confidence interval = 75.4%-87.6%) (p = 0.049) for progression-free survival and 91.0% (95% confidence interval = 86.9%-95.1%) vs 85.5% (95% confidence interval = 80.0%-91.0%) (p = 0.044) for endometrial cancer-specific survival, respectively. In conclusion, more than half of Thai endometrial cancer patients had mismatch repair gene defect. The patients with mismatch repair gene defect had significantly younger age (⩽ 60 years) and better prognosis in terms of early stage, negative nodal status, and longer survivals.
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Affiliation(s)
- Siriwan Tangjitgamol
- 1 Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Thannaporn Kittisiam
- 1 Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sujitra Tanvanich
- 2 Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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25
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Ritterhouse LL, Howitt BE. Molecular Pathology: Predictive, Prognostic, and Diagnostic Markers in Uterine Tumors. Surg Pathol Clin 2017; 9:405-26. [PMID: 27523969 DOI: 10.1016/j.path.2016.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article focuses on the diagnostic, prognostic, and predictive molecular biomarkers in uterine malignancies, in the context of morphologic diagnoses. The histologic classification of endometrial carcinomas is reviewed first, followed by the description and molecular classification of endometrial epithelial malignancies in the context of histologic classification. Taken together, the molecular and histologic classifications help clinicians to approach troublesome areas encountered in clinical practice and evaluate the utility of molecular alterations in the diagnosis and subclassification of endometrial carcinomas. Putative prognostic markers are reviewed. The use of molecular alterations and surrogate immunohistochemistry as prognostic and predictive markers is also discussed.
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Affiliation(s)
- Lauren L Ritterhouse
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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26
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Pelletier MP, Trinh VQ, Stephenson P, Mes-Masson AM, Samouelian V, Provencher DM, Rahimi K. Microcystic, elongated, and fragmented pattern invasion is mainly associated with isolated tumor cell pattern metastases in International Federation of Gynecology and Obstetrics grade I endometrioid endometrial cancer. Hum Pathol 2017; 62:33-39. [DOI: 10.1016/j.humpath.2016.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/18/2016] [Accepted: 10/28/2016] [Indexed: 12/13/2022]
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Zakhour M, Cohen JG, Gibson A, Walts AE, Karimian B, Baltayan A, Aoyama C, Garcia L, Dhaliwal SK, Elashoff D, Amneus M, Walsh C. Abnormal mismatch repair and other clinicopathologic predictors of poor response to progestin treatment in young women with endometrial complex atypical hyperplasia and well-differentiated endometrial adenocarcinoma: a consecutive case series. BJOG 2017; 124:1576-1583. [PMID: 28128512 DOI: 10.1111/1471-0528.14491] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To report the response to progestin therapy in young women with endometrial complex atypical hyperplasia (CAH) or FIGO grade 1 endometrial adenocarcinoma (FIGO 1 EAC) based on clinicopathologic features, including abnormal DNA mismatch repair (MMR) by immunohistochemistry (IHC). DESIGN Consecutive case series. SETTING Olive View-UCLA Medical Center in Sylmar, CA, USA, and Cedars-Sinai Medical Center in Los Angeles, CA, USA. POPULATION Women ≤55 years old with CAH or FIGO 1 EAC. METHODS Response to progestin therapy in 84 consecutive patients was assessed based on clinicopathologic factors, including age, body mass index (BMI), initial histology, and IHC staining for MMR proteins. MAIN OUTCOME MEASURES Rates of abnormal MMR protein expression and response to progestin therapy were determined. RESULTS Six (7%) patients had abnormal IHC staining, of whom five (83%) had FIGO 1 EAC at initial diagnosis. Following progestin treatment, none of the endometrial lesions in patients with abnormal IHC for MMR proteins had resolution of hyperplasia or malignancy, in contrast to 41 (53%) with normal staining (P = 0.028). Age ≤40 years and initial lesion (CAH versus FIGO 1 EAC) were predictors of response to progestin; BMI was not. CONCLUSIONS In this cohort, 7% of women ≤55 years of age with CAH or FIGO 1 EAC had loss of MMR proteins by IHC. These patients had a higher incidence of invasive cancer and a lower incidence of resolution with progestin therapy. TWEETABLE ABSTRACT Abnormal MMR protein expression predicts poor response to progestins in young women with CAH or FIGO 1 EAC.
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Affiliation(s)
- M Zakhour
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of California Los Angeles Medical Center, Los Angeles, CA, USA.,Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - J G Cohen
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - A Gibson
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - A E Walts
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - B Karimian
- Department of Pathology & Laboratory Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - A Baltayan
- Department of Pathology & Laboratory Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - C Aoyama
- Department of Pathology & Laboratory Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - L Garcia
- Department of Obstetrics & Gynecology, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - S K Dhaliwal
- Department of Medicine Statistics Core, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - D Elashoff
- Department of Medicine Statistics Core, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - M Amneus
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - C Walsh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Loss of Mismatch Repair Protein Expression in Unselected Endometrial Adenocarcinoma Precursor Lesions. Int J Gynecol Cancer 2016; 26:228-32. [PMID: 26807560 DOI: 10.1097/igc.0000000000000606] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The benefit of evaluating the precursor of endometrial carcinoma, endometrial hyperplasia (intraepithelial neoplasia [EIN]), for loss of mismatch repair (MMR) protein expression and Lynch syndrome has yet to be determined. The present study aims to establish the incidence and type of loss of MMR protein expression in unselected premalignant lesions of endometrial adenocarcinoma, as well as the agreement of immunohistochemical staining in pretreatment endometrial biopsy (EMB) specimens with subsequent uterine resections. METHODS A retrospective review identified 112 endometrial biopsies meeting criteria for endometrial EIN. Slides made from tissue microarray blocks were evaluated using antibodies against MLH1, PMS2, MSH2, and MSH6. Cases with a deficit in MLH1 were evaluated for gene promoter hypermethylation by polymerase chain reaction analysis. Fifty-four subsequent hysterectomy specimens were retrieved and assessed for MMR protein expression. RESULTS Of the 112 endometrial biopsies with EIN, 4.5% (5/112) exhibited loss of MMR protein expression. The majority (4/5) demonstrated a deficit of MLH1, of which all exhibited inactivation via promoter hypermethylation. A single case displayed an absence of MSH6. Age was not significantly associated with MMR deficiency. There was no significant association between MMR status in the EMB and a subsequent diagnosis of cancer. Immunohistochemical staining in all successive hysterectomy cases was concordant with the pattern observed in the EMB specimen. CONCLUSIONS Sporadic hypermethylation of MLH1 seems to be the primary mechanism underlying defective MMR protein expression in EIN. Among our cohort, only 1 patient (<1%) had a mutation suggestive of a hereditary inheritance. Hence, the utility of evaluating EIN for MMR protein expression as a screen for Lynch syndrome is limited, regardless of age.
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Hu MH, Liu SY, Wang N, Wu Y, Jin F. Impact of DNA mismatch repair system alterations on human fertility and related treatments. J Zhejiang Univ Sci B 2016; 17:10-20. [PMID: 26739522 DOI: 10.1631/jzus.b1500162] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
DNA mismatch repair (MMR) is one of the biological pathways, which plays a critical role in DNA homeostasis, primarily by repairing base-pair mismatches and insertion/deletion loops that occur during DNA replication. MMR also takes part in other metabolic pathways and regulates cell cycle arrest. Defects in MMR are associated with genomic instability, predisposition to certain types of cancers and resistance to certain therapeutic drugs. Moreover, genetic and epigenetic alterations in the MMR system demonstrate a significant relationship with human fertility and related treatments, which helps us to understand the etiology and susceptibility of human infertility. Alterations in the MMR system may also influence the health of offspring conceived by assisted reproductive technology in humans. However, further studies are needed to explore the specific mechanisms by which the MMR system may affect human infertility. This review addresses the physiological mechanisms of the MMR system and associations between alterations of the MMR system and human fertility and related treatments, and potential effects on the next generation.
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Affiliation(s)
- Min-hao Hu
- Key Laboratory of Reproductive Genetics (Zhejiang), Ministry of Education, and Centre of Reproductive Medicine, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Shu-yuan Liu
- Key Laboratory of Reproductive Genetics (Zhejiang), Ministry of Education, and Centre of Reproductive Medicine, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Ning Wang
- Key Laboratory of Reproductive Genetics (Zhejiang), Ministry of Education, and Centre of Reproductive Medicine, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Yan Wu
- Key Laboratory of Reproductive Genetics (Zhejiang), Ministry of Education, and Centre of Reproductive Medicine, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Fan Jin
- Key Laboratory of Reproductive Genetics (Zhejiang), Ministry of Education, and Centre of Reproductive Medicine, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
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McMeekin DS, Tritchler DL, Cohn DE, Mutch DG, Lankes HA, Geller MA, Powell MA, Backes FJ, Landrum LM, Zaino R, Broaddus RD, Ramirez N, Gao F, Ali S, Darcy KM, Pearl ML, DiSilvestro PA, Lele SB, Goodfellow PJ. Clinicopathologic Significance of Mismatch Repair Defects in Endometrial Cancer: An NRG Oncology/Gynecologic Oncology Group Study. J Clin Oncol 2016; 34:3062-8. [PMID: 27325856 DOI: 10.1200/jco.2016.67.8722] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The clinicopathologic significance of mismatch repair (MMR) defects in endometrioid endometrial cancer (EEC) has not been definitively established. We undertook tumor typing to classify MMR defects to determine if MMR status is prognostic or predictive. METHODS Primary EECs from NRG/GOG0210 patients were assessed for microsatellite instability (MSI), MLH1 methylation, and MMR protein expression. Each tumor was assigned to one of four MMR classes: normal, epigenetic defect, probable mutation (MMR defect not attributable to MLH1 methylation), or MSI-low. The relationships between MMR classes and clinicopathologic variables were assessed using contingency table tests and Cox proportional hazard models. RESULTS A total of 1,024 tumors were assigned to MMR classes. Epigenetic and probable mutations in MMR were significantly associated with higher grade and more frequent lymphovascular space invasion. Epigenetic defects were more common in patients with higher International Federation of Gynecology and Obstetrics stage. Overall, there were no differences in outcomes. Progression-free survival was, however, worse for women whose tumors had epigenetic MMR defects compared with the MMR normal group (hazard ratio, 1.37; P < .05; 95% CI, 1.00 to 1.86). An exploratory analysis of interaction between MMR status and adjuvant therapy showed a trend toward improved progression-free survival for probable MMR mutation cases. CONCLUSION MMR defects in EECs are associated with a number of well-established poor prognostic indicators. Women with tumors that had MMR defects were likely to have higher-grade cancers and more frequent lymphovascular space invasion. Surprisingly, outcomes in these patients were similar to patients with MMR normal tumors, suggesting that MMR defects may counteract the effects of negative prognostic factors. Altered immune surveillance of MMR-deficient tumors, and other host/tumor interactions, is likely to determine outcomes for patients with MMR-deficient tumors.
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Affiliation(s)
- D Scott McMeekin
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - David L Tritchler
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - David E Cohn
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - David G Mutch
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Heather A Lankes
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Melissa A Geller
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Matthew A Powell
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Floor J Backes
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Lisa M Landrum
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Richard Zaino
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Russell D Broaddus
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Nilsa Ramirez
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Feng Gao
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Shamshad Ali
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Kathleen M Darcy
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Michael L Pearl
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Paul A DiSilvestro
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Shashikant B Lele
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Paul J Goodfellow
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI.
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The Significance of Mismatch Repair Deficiency in Young Patients With Endometrial Cancer. Int J Gynecol Pathol 2016; 34:403-10. [PMID: 26262451 DOI: 10.1097/pgp.0000000000000174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The objective of this study was to identify the tumor characteristics associated with mismatch repair deficiency in young patients with endometrial carcinoma. Young patients (45 yr old or younger) with endometrial carcinoma treated by hysterectomy in our institution between July 2001 and June 2009 were identified. The clinical and pathologic data were obtained by review of clinical records. Among the 122 cases identified, paraffin sections were available in 67 cases for immunohistochemical staining and frozen tissue available in 62 cases for microsatellite instability (MSI) analysis. Both paraffin sections and frozen tissue were available in 36 cases. Among the 67 cases with immunohistochemical staining, 22 (32.8%) showed loss of expression of at least 1 mismatch repair protein. Defective MLH1 or MSH2 expression was associated with poor prognostic factors, including a higher incidence of pelvic lymph nodes metastasis (P=0.018) and higher stage (P=0.022) for MLH1, and an increased risk of lymphovascular permeation (P=0.015) for MSH2. On the contrary, defective MSH6 protein expression was associated with a lower incidence of high-grade tumors (P=0.04). Among the 62 cases with MSI analysis, 12 (19.4%) tumors were classified as microsatellite-high (MSI-H), whereas 2 (3.2%) were classified as microsatellite-low (MSI-L). There was no difference in the pathologic characteristics between MSI-stable and MSI-H tumor. We concluded that defective mismatch repair expression is important in young patients with endometrial carcinoma, with MSH6 protein being most commonly affected. The phenotype resulting from defective MSH6 expression was different from that caused by MLH1 or MSH2 loss.
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Abstract
Women who report a history of endometrial cancer in a first-degree relative are at increased risk of endometrial cancer, with a hazard ratio of 1.5 to 2.0. Only a minority of patients with familial endometrial cancer have a recognized cancer syndrome. Lynch syndrome is the most common genetic syndrome associated with endometrial cancer and a marked increased risk of colon cancer. Cowden syndrome is a rare condition resulting from a mutation in the tumor suppressor gene phosphatase and tensin homolog. The risk for endometrial cancer is about five times higher in women with Cowden syndrome than in the general population. Recently, a novel germline mutation in the POLD1 gene that encodes the catalytic subunit of DNA polymerase δ was described in several families with multiple cases of endometrial cancer. This mutation is also associated with colorectal cancer. The association between BRCA1 mutations and endometrial cancer has been investigated in several studies; it appears that the risk of endometrial cancer is restricted to women with a history of tamoxifen exposure. In recent years, research has focused on genetic polymorphisms that are associated with endometrial cancer risk. Although many polymorphisms have been identified, their clinical significance is unclear and they have not been adapted for clinical practice.
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Burleigh A, Talhouk A, Gilks CB, McAlpine JN. Clinical and pathological characterization of endometrial cancer in young women: identification of a cohort without classical risk factors. Gynecol Oncol 2015; 138:141-6. [PMID: 25870916 DOI: 10.1016/j.ygyno.2015.02.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/28/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Endometrial cancer (EC) is the most common gynecologic malignancy with known risk factors including excess estrogen and hereditary syndromes. The objective of this study was to determine the proportion of young women with EC that could be attributed to these factors and if, as we suspected, there is a third population of young women in which neither factor is identifiable. We were interested in comparing clinicopathologic characteristics and outcomes across subgroups in order to better inform treatment recommendations. METHODS We performed a retrospective chart review of women age 15-49 diagnosed with EC or complex atypical hyperplasia. Demographic, clinicopathologic, treatment, fertility, and outcome parameters were analyzed. RESULTS Of 719 women identified, 327 were fully evaluable. 57.5% fit the "High Estrogen" risk criteria. 8.25% met criteria for suspected Lynch syndrome. 34.25% classified as "Neither" had no classical risk factors identified. There were no statistical differences in age, gravidity, tumor grade, treatment selection and response to hormonal therapy. Age of menarche, stage, histology, and synchronous ovarian cancer differed significantly. Prevalence of synchronous ovarian cancer was 21.0% of "Neither", 23.1% of "Lynch", and 6.6% of "High Estrogen". For women who attempted pregnancy, 2/27 of "High Estrogen", 0/3 of "Lynch", and 2/16 of "Neither" achieved a live birth. CONCLUSIONS This study confirmed that a third population of young women with EC exist that lack classical risk factors and have distinct clinicopathologic parameters. No difference in success of conservative treatment or live births was noted in the small cohort in whom this treatment approach was attempted.
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Affiliation(s)
- Angela Burleigh
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Aline Talhouk
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - C Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Jessica N McAlpine
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of British Columbia, Vancouver, Canada.
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McConechy MK, Talhouk A, Li-Chang HH, Leung S, Huntsman DG, Gilks CB, McAlpine JN. Detection of DNA mismatch repair (MMR) deficiencies by immunohistochemistry can effectively diagnose the microsatellite instability (MSI) phenotype in endometrial carcinomas. Gynecol Oncol 2015; 137:306-10. [PMID: 25636458 DOI: 10.1016/j.ygyno.2015.01.541] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 01/21/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND A proportion of endometrial carcinomas (ECs) are associated with deficient DNA mismatch repair (MMR). These tumors are characterized by high levels of microsatellite instability (MSI). Identification of MSI is important in identifying women who should be tested for Lynch syndrome and identifying a phenotype that may have specific prognostic and predictive implications. Genomic characterization of ECs has shown that MSI tumors form a distinct subgroup. The two most common methodologies for MSI assessment have not been compared in EC. METHODS Pentaplex mono and di-nucleotide PCR for MSI testing was compared to MMR IHC (presence/absence of MLH1, MSH2, MSH6, PMS2) in a cohort of patients with EC. Concordance, Kappa statistic, sensitivity, specificity, positive and negative predictive values were obtained on the cross-tabulation of results. RESULTS Comparison of both MSI and MMR status was complete for 89 cases. Overall agreement between methods (concordance) was 93.3% (95% CI[85.9%-97.5%]). A one-sided test to determine whether the accuracy is better than the "no information rate," which is taken to be the largest class percentage in the data, is significant (p<0.00001). Unweighted Kappa was 0.84, along with the sensitivity (88.5%), specificity (95.2%), PPV (88.5%), and NPV (95.2%). The balanced accuracy (i.e. the average between sensitivity and specificity) was 92%. DISCUSSION We show the equivalence of MSI testing and MMR IHC. We advocate the implementation of MMR IHC in future EC classification schemes, enabling stratification of cases for future clinical trials as well as assisting identification of Lynch syndrome, so that screening and risk reducing interventions can be undertaken.
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Affiliation(s)
- M K McConechy
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, 509-2660 Oak Street, Vancouver V6H 3Z6, BC, Canada
| | - A Talhouk
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, 509-2660 Oak Street, Vancouver V6H 3Z6, BC, Canada
| | - H H Li-Chang
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, 509-2660 Oak Street, Vancouver V6H 3Z6, BC, Canada
| | - S Leung
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, 509-2660 Oak Street, Vancouver V6H 3Z6, BC, Canada
| | - D G Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, 509-2660 Oak Street, Vancouver V6H 3Z6, BC, Canada
| | - C B Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, 509-2660 Oak Street, Vancouver V6H 3Z6, BC, Canada
| | - J N McAlpine
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of British Columbia, 2775 Laurel St. 6th Floor, Vancouver V5Z 1M9, BC, Canada.
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Kato M, Takano M, Miyamoto M, Sasaki N, Goto T, Tsuda H, Furuya K. DNA mismatch repair-related protein loss as a prognostic factor in endometrial cancers. J Gynecol Oncol 2014; 26:40-5. [PMID: 25310854 PMCID: PMC4302284 DOI: 10.3802/jgo.2015.26.1.40] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/07/2014] [Accepted: 09/01/2014] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Recent investigations have revealed DNA mismatch repair (MMR) gene mutations are closely related with carcinogenesis of endometrial cancer; however the impact of MMR protein expression on prognosis is not determined. Correlations between MMR-related protein expression and clinicopathological factors of endometrial cancers are analyzed in the present study. METHODS A total of 191 endometrial cancer tissues treated between 1990 and 2007 in our hospital were enrolled. Immunoreactions for MSH2, MLH1, MSH6, and PMS2 on tissue microarray specimens and clinicopathological features were analyzed retrospectively. RESULTS Seventy-six cases (40%) had at least one immunohistochemical alteration in MMR proteins (MMR-deficient group). There were statistically significant differences of histology, International Federation of Gynecology and Obstetrics (FIGO) stage, and histological grade between MMR-deficient group and the other cases (MMR-retained group). Response rate of first-line chemotherapy in evaluable cases was slightly higher in MMR-deficient cases (67% vs. 44%, p=0.34). MMR-deficient cases had significantly better progression-free and overall survival (OS) compared with MMR-retained cases. Multivariate analysis revealed MMR status was an independent prognostic factor for OS in endometrial cancers. CONCLUSION MMR-related proteins expression was identified as an independent prognostic factor for OS, suggesting that MMR was a key biomarker for further investigations of endometrial cancers.
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Affiliation(s)
- Masafumi Kato
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Japan.
| | - Morikazu Miyamoto
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Naoki Sasaki
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Tomoko Goto
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Hitoshi Tsuda
- Department of Basic Pathology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Kenichi Furuya
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Japan
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Pereira CS, Oliveira MVMD, Barros LO, Bandeira GA, Santos SHS, Basile JR, Guimarães ALS, De Paula AMB. Low expression of MSH2 DNA repair protein is associated with poor prognosis in head and neck squamous cell carcinoma. J Appl Oral Sci 2014; 21:416-21. [PMID: 24212987 PMCID: PMC3881843 DOI: 10.1590/1679-775720130206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/23/2013] [Indexed: 11/22/2022] Open
Abstract
Objective This study aimed to investigate the expression of the MSH2 DNA repair protein in
head and neck squamous cell carcinoma (HNSCC) in order to analyze its association
with clinicopathologic factors and overall survival of patients. Material and Methods Clinical data and primary lesions of HNSSC were collected from 55 patients who
underwent surgical resection with postoperative radiotherapy in Montes Claros,
state of Minas Gerais, Brazil, between 2000 and 2008. Immunohistochemical
reactions were performed to analyze MSH2 protein expression. Results Bivariate analysis showed no significant correlation or association between MSH2
expression and clinicopathologic parameters by Mann-Whitney and Kruskal-Wallis
tests. Patients with locoregional metastatic disease (OR=4.949, p<0.001) and
lower MSH2 immunohistochemical expressions (OR=2.943, p=0.032) presented poorer
survival for HNSCC by Cox regression models. Conclusions Our data demonstrated that lower MSH2 expression might contribute to a higher
clinic aggressiveness of HNSCC by promoting an unfavorable outcome.
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Affiliation(s)
- Camila Santos Pereira
- Nucleus of Epidemiological and Molecular Research Catrumano, Health Research Laboratory, Health Science Post-Graduate Programme, Universidade Estadual de Montes Claros, Montes ClarosMG, Brazil
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Abstract
Context.—Endometrial carcinoma is a disease of older postmenopausal women, and is relatively uncommon in patients younger than 40 years. Endometrial carcinomas in this age group may be familial, associated with Lynch syndrome, or sporadic.
Objectives.—To present our current knowledge of endometrial carcinomas in women younger than 40 years.
Data Sources.—The review is based on previously published articles on this topic.
Conclusions.—Most endometrial carcinomas that occur in this age group are associated with estrogen excess. They are usually low-grade endometrioid carcinomas that present at low stages and are associated with favorable clinical outcomes. Tumors associated with mismatch repair abnormalities and Lynch syndrome appear to be distinct, with worse prognostic factors and, possibly, clinical behavior. Conservative hormonal therapy and ovarian conservation are reasonable considerations in the management of these young patients, but carry the risk of tumor progression, recurrence, and an occult synchronous or metachronous ovarian carcinoma.
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Affiliation(s)
- Karuna Garg
- From the Department of Pathology, University of California San Francisco (Dr Garg); and the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Soslow)
| | - Robert A. Soslow
- From the Department of Pathology, University of California San Francisco (Dr Garg); and the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Soslow)
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Morii-Kashima M, Tsubamoto H, Sato C, Ushioda M, Tomita N, Miyoshi Y, Hashimoto-Tamaoki T, Tamura K, Sawai H, Shibahara H. Development of an integrated support system for hereditary cancer and its impact on gynecologic services. Int J Clin Oncol 2013; 19:1043-51. [PMID: 24346486 DOI: 10.1007/s10147-013-0649-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/26/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Patients with hereditary cancer need an integrated support system. A recently launched project was evaluated in terms of its efficacy in screening patients with hereditary cancer at the gynecologic service. METHODS The project team comprised gynecologists, surgeons, medical geneticists, and certified genetic counselors (CGCs) in our hospital. At the gynecologic service, a newly developed self-administered family history questionnaire (SAFHQ) was given to patients with ovarian, endometrial, or breast cancer as well as a history of multiple cancers. After an interview, a CGC constructed a pedigree and evaluated the risk for hereditary cancer. Patients at risk were recommended by a gynecologist to receive further genetic counseling at the Department of Genetics according to the modified Bethesda criteria, Amsterdam II criteria, and National Comprehensive Cancer Network (NCCN) guidelines 2012 for breast-ovarian cancer syndrome (HBOC). The numbers of newly screened patients were compared before and after the project launch. RESULTS The SAFHQ was administered to 131 patients and 106 (81 %) pedigrees were constructed between August 2012 and July 2013. The number of newly screened patients according to the Bethesda criteria was 4 and 8 at 10 years before and 1 year after the project launch, respectively. Two and 31 patients met the NCCN criteria for HBOC excluding ovarian cancer alone, respectively, at these 2 time points. Of 54 patients who were recommended to undergo further counseling, 10 (19 %) visited the Department of Genetics. CONCLUSION After the launch of an integrated support system, the number of patients with hereditary cancers who were screened increased. The gynecologic service played a pivotal role in patient and family care.
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Affiliation(s)
- Mina Morii-Kashima
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Mukogawa 1-1, Nishinomiya, Hyogo, 663-8501, Japan
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Women 50 Years Or Younger With Endometrial Cancer: The Argument for Universal Mismatch Repair Screening and Potential for Targeted Therapeutics. Int J Gynecol Cancer 2013; 23:853-60. [DOI: 10.1097/igc.0b013e31828eed9c] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
ObjectiveTo identify young patients with endometrial cancer with potential Lynch-related DNA mismatch repair (MMR) protein expression defects and stathmin (STMN1) expression (part of the phosphoinositol 3-kinase pathway) and to correlate clinical data.MethodsThis retrospective study included women with endometrial cancer who were 50 years or younger at diagnosis. Clinical data were abstracted from chart review. Immunohistochemistry for MMR protein expression, STMN1, and pSTMN1 was performed and univariate analyses performed.ResultsThe mean age of 111 patients was 43 years, and the mean body mass index was 39.6 kg/m2. The majority of the endometrial cancers were endometrioid histology (87.4%), International Federation of Gynecology and Obstetrics stage I (73%) and grade 1 (58.6%). Loss of at least one MMR protein on immunohistochemistry was identified in 26% to 41% of patients depending on stringency. Women with loss of MMR protein expression were compared to women with intact tumor protein expression and were less likely to be stage I (58.6% vs 78.0%; P = 0.043), more likely to have grade 3 tumors (32.1% vs 13.9%; P = 0.034), had larger tumors (6.2 vs 3.7 cm; P < 0.001), had positive lymph nodes more often (24.1% vs 3.7%; P < 0.001), and more often reported a first-degree relative with colon cancer (17.2% vs 1.2%; P < 0.001). There were no significant differences in age, weight, body mass index, medical comorbidities, recurrence, or survival. Women with high STMN1 staining had significantly more grade 3 tumors (56.3% vs 15.8%; P = 0.001), more stage III/IV disease (37.5% vs 15.8%; P = 0.04), had higher mean percentage of myometrial invasion (38.9% vs 16.7%; P = 0.003), and more lymphovascular space invasion (43.8% vs 13.7%; P = 0.004).ConclusionsClinical factors failed to differentiate between patients with intact or missing MMR protein expression, which supports universal screening for Lynch-associated protein defects in young women with endometrial cancer. Additionally, STMN1 staining may identify more aggressive tumors, which might benefit from more aggressive treatments or targeted treatment options.
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Colloca G, Venturino A. Anthracycline-based chemotherapy in metastatic endometrial carcinoma: an update. Asia Pac J Clin Oncol 2012; 10:e75-85. [PMID: 23176327 DOI: 10.1111/ajco.12016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2012] [Indexed: 01/31/2023]
Abstract
The purpose of this review is to analyze clinical evidence about the activity and efficacy of anthracycline-based chemotherapy in metastatic endometrial cancer and to identify the most important preclinical findings that would address future clinical trials. A literature search of published studies was undertaken. Studies were selected by predefined criteria. Clinical trials and preclinical studies were analyzed. The search identified eight phase 3 and 13 phase 2 clinical trials of patients with metastatic endometrial carcinoma treated with an anthracycline-based regimen. The planned dose intensity of the anthracycline had no effect on response rates and survival. Survival increased for patients with a good performance status, and sometimes the duration of responses to anthracycline monotherapy can be very long-lasting. The major findings of anthracycline resistance in preclinical models are reported. Possible future biomarkers targeting mechanisms of anthracycline resistance are suggested, and efforts to define a molecular classification of endometrial cancer are desirable.
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Affiliation(s)
- Giuseppe Colloca
- Division of Medical Oncology, "G. Borea" Hospital, Sanremo, Imperia, Italy
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Current world literature. Curr Opin Oncol 2012; 24:587-95. [PMID: 22886074 DOI: 10.1097/cco.0b013e32835793f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arora V, Quinn MA. Endometrial cancer. Best Pract Res Clin Obstet Gynaecol 2012; 26:311-24. [DOI: 10.1016/j.bpobgyn.2011.12.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 11/29/2011] [Accepted: 12/05/2011] [Indexed: 11/24/2022]
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Performance of PREMM(1,2,6), MMRpredict, and MMRpro in detecting Lynch syndrome among endometrial cancer cases. Genet Med 2012; 14:670-80. [PMID: 22402756 DOI: 10.1038/gim.2012.18] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Lynch syndrome accounts for 2-5% of endometrial cancer cases. Lynch syndrome prediction models have not been evaluated among endometrial cancer cases. METHODS Area under the receiver operating curve (AUC), sensitivity and specificity of PREMM(1,2,6), MMRpredict, and MMRpro scores were assessed among 563 population-based and 129 clinic-based endometrial cancer cases. RESULTS A total of 14 (3%) population-based and 80 (62%) clinic-based subjects had pathogenic mutations. PREMM(1,2,6), MMRpredict, and MMRpro were able to distinguish mutation carriers from noncarriers (AUC of 0.77, 0.76, and 0.77, respectively), among population-based cases. All three models had lower discrimination for the clinic-based cohort, with AUCs of 0.67, 0.64, and 0.54, respectively. Using a 5% cutoff, sensitivity and specificity were as follows: PREMM(1,2,6), 93% and 5% among population-based cases and 99% and 2% among clinic-based cases; MMRpredict, 71% and 64% for the population-based cohort and 91% and 0% for the clinic-based cohort; and MMRpro, 57% and 85% among population-based cases and 95% and 10% among clinic-based cases. CONCLUSION Currently available prediction models have limited clinical utility in determining which patients with endometrial cancer should undergo genetic testing for Lynch syndrome. Immunohistochemical analysis and microsatellite instability testing may be the best currently available tools to screen for Lynch syndrome in endometrial cancer patients.
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