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Southworth E, Thomson JP, Croy I, Churchman M, Arends MJ, Hollis RL, Gourley C, Herrington CS. Whole exome sequencing reveals diverse genomic relatedness between paired concurrent endometrial and ovarian carcinomas. Eur J Cancer 2024; 208:114205. [PMID: 38986422 DOI: 10.1016/j.ejca.2024.114205] [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: 05/13/2024] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Concurrent non-serous endometrial and ovarian tumours are often managed clinically as two separate primary tumours, but almost all exhibit evidence of a genomic relationship. METHODOLOGY This study investigates the extent of relatedness using whole exome sequencing, which was performed on paired non-serous endometrial and ovarian carcinomas from 27 patients with concurrent tumours in a cohort with detailed clinicopathological annotation. Four whole exome sequencing-derived parameters (mutation, mutational burden, mutational signatures and mutant allele tumour heterogeneity scores) were used to develop a novel unsupervised model for the assessment of genomic similarity to infer genomic relatedness of paired tumours. RESULTS This novel model demonstrated genomic relatedness across all four parameters in all tumour pairs. Mutations in PTEN, ARID1A, CTNNB1, KMT2D and PIK3CA occurred most frequently and 24 of 27 (89 %) tumour pairs shared identical mutations in at least one of these genes, with all pairs sharing mutations in a number of other genes. Ovarian endometriosis, CTNNB1 exon 3 mutation, and progression and death from disease were present across the similarity ranking. Mismatch repair deficiency was associated with less genomically similar pairs. DISCUSSION Although there was diversity across the cohort, the presence of genomic similarity in all paired tumours supports the hypothesis that concurrent non-serous endometrial and ovarian carcinomas are genomically related and may have arisen from a common origin.
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Affiliation(s)
- Emily Southworth
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - John P Thomson
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Ian Croy
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Michael Churchman
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Mark J Arends
- Edinburgh Pathology, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Robert L Hollis
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Charlie Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - C Simon Herrington
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK; Edinburgh Pathology, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK.
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Porter JM, McFarlane I, Bartos C, Churchman M, May J, Herrington CS, Connolly KC, Ryan NAJ, Hollis RL. The survival benefit associated with complete macroscopic resection in epithelial ovarian cancer is histotype specific. JNCI Cancer Spectr 2024; 8:pkae049. [PMID: 38902938 PMCID: PMC11233146 DOI: 10.1093/jncics/pkae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Complete macroscopic resection is a key factor associated with prolonged survival in ovarian cancer. However, most evidence derives from high-grade serous ovarian carcinoma, and the benefit of complete macroscopic resection in other histotypes is poorly characterized. We sought to determine which histotypes derive the greatest benefit from complete macroscopic resection to better inform future decisions on radical cytoreductive efforts. METHODS We performed multivariable analysis of disease-specific survival across 2 independent patient cohorts to determine the magnitude of benefit associated with complete macroscopic resection within each histotype. RESULTS Across both cohorts (Scottish: n = 1622; Surveillance, Epidemiology, and End Results [SEER]: n = 18 947), complete macroscopic resection was associated with prolonged disease-specific survival; this was more marked in the Scottish cohort (multivariable hazard ratio [HR] = 0.44, 95% confidence interval [CI] = 0.37 to 0.52 vs HR = 0.59, 95% CI = 0.57 to 0.62 in SEER). In both cohorts, clear cell ovarian carcinoma was among the histotypes to benefit most from complete macroscopic resection (multivariable HR = 0.23 and HR = 0.50 in Scottish and SEER cohorts, respectively); high-grade serous ovarian carcinoma patients demonstrated highly statistically significant and clinically meaningful survival benefit, but this was of lower magnitude than in clear cell ovarian carcinoma and endometrioid ovarian carcinoma across both cohorts. The benefit derived in low-grade serous ovarian carcinoma is also high (multivariable HR = 0.27 in Scottish cohort). Complete macroscopic resection was associated with prolonged survival in mucinous ovarian carcinoma patients in the SEER cohort (multivariable HR = 0.65), but the association failed to reach statistical significance in the Scottish cohort. CONCLUSIONS The overall ovarian cancer patient population demonstrates clinically significant survival benefit associated with complete macroscopic resection; however, the magnitude of benefit differs between histotypes.
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MESH Headings
- Humans
- Female
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/surgery
- Ovarian Neoplasms/pathology
- SEER Program
- Middle Aged
- Aged
- Carcinoma, Ovarian Epithelial/mortality
- Carcinoma, Ovarian Epithelial/surgery
- Carcinoma, Ovarian Epithelial/pathology
- Scotland/epidemiology
- Adenocarcinoma, Clear Cell/surgery
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/pathology
- Carcinoma, Endometrioid/mortality
- Carcinoma, Endometrioid/surgery
- Carcinoma, Endometrioid/pathology
- Cytoreduction Surgical Procedures/mortality
- Cystadenocarcinoma, Serous/surgery
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/pathology
- Adenocarcinoma, Mucinous/surgery
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adult
- Neoplasms, Glandular and Epithelial/surgery
- Neoplasms, Glandular and Epithelial/mortality
- Neoplasms, Glandular and Epithelial/pathology
- Proportional Hazards Models
- Multivariate Analysis
- United States/epidemiology
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Affiliation(s)
- Joanna M Porter
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Iona McFarlane
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Clare Bartos
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Michael Churchman
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - James May
- The Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - C Simon Herrington
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- The Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Kathryn C Connolly
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Neil A J Ryan
- The Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Robert L Hollis
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
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McFarlane I, Porter JM, Brownsell E, Ghaoui N, Connolly KC, Herrington CS, Hollis RL. Ovarian carcinosarcoma is highly aggressive compared to other ovarian cancer histotypes. Front Oncol 2024; 14:1399979. [PMID: 38854725 PMCID: PMC11157229 DOI: 10.3389/fonc.2024.1399979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/24/2024] [Indexed: 06/11/2024] Open
Abstract
Background Ovarian carcinosarcoma (OCS) is an unusual ovarian cancer type characterized by distinct carcinomatous and sarcomatous components. OCS has been excluded from many of the pan-histotype studies of ovarian carcinoma, limiting our understanding of its behavior. Methods We performed a multi-cohort cross-sectional study of characteristics and outcomes in ovarian cancer patients from Scotland (n=2082) and the Surveillance, Epidemiology and End Results Program (SEER, n=44946) diagnosed with OCS or one of the other major histotypes: high grade serous (HGSOC), endometrioid (EnOC), clear cell (CCOC), mucinous (MOC) or low grade serous ovarian carcinoma (LGSOC). Differences in overall survival were quantified using Cox regression models to calculate hazard ratios (HR). Results Across both cohorts, OCS patients were significantly older at diagnosis compared to all other histotypes (median age at diagnosis 69 and 67 in Scottish and SEER cohorts) and demonstrated the shortest survival time upon univariable analysis. Within the Scottish cohort, 59.3% and 16.9% of OCS patients presented with FIGO stage III and IV disease, respectively; this was significantly higher than in EnOC, CCOC or MOC (P<0.0001 for all), but lower than in HGSOC (P=0.004). Multivariable analysis accounting for other prognostic factors identified OCS as independently associated with significantly shorter survival time compared to HGSOC, EnOC, LGSOC and MOC in both the Scottish (multivariable HR vs OCS: HGSOC 0.45, EnOC 0.39, LGSOC 0.26, MOC 0.43) and SEER cohorts (multivariable HR vs OCS: HGSOC 0.59, EnOC 0.34, LGSOC 0.30, MOC 0.81). Within the SEER cohort, OCS also demonstrated shorter survival compared to CCOC (multivariable HR 0.63, 95% CI 0.58-0.68), but this was not replicated within the Scottish cohort (multivariable HR for CCOC: 1.05, 95% CI 0.74-1.51). Within early-stage disease specifically (FIGO I-II or SEER localized stage), OCS was associated with the poorest survival of all histotypes across both cohorts. In the context of late-stage disease (FIGO III-IV or SEER distant stage), OCS, MOC and CCOC represented the histotypes with poorest survival. Conclusion OCS is a unique ovarian cancer type that affects older women and is associated with exceptionally poor outcome, even when diagnosed at earlier stage. New therapeutic options are urgently required to improve outcomes.
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Affiliation(s)
- Iona McFarlane
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna M. Porter
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
| | - Elizabeth Brownsell
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
| | - Nidal Ghaoui
- The Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Kathryn C. Connolly
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
| | - C. Simon Herrington
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
| | - Robert L. Hollis
- The Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
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Steinbuch SC, Lüß AM, Eltrop S, Götte M, Kiesel L. Endometriosis-Associated Ovarian Cancer: From Molecular Pathologies to Clinical Relevance. Int J Mol Sci 2024; 25:4306. [PMID: 38673891 PMCID: PMC11050613 DOI: 10.3390/ijms25084306] [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: 03/25/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Endometriosis is a chronic condition affecting reproductive-aged women, characterized by the growth of ectopic endometrial tissue. Despite being benign, endometriosis is associated with an increased risk of certain cancers, including endometriosis-associated ovarian cancer (EAOC). Ovarian cancer is rare, but more common in women with endometriosis, particularly endometrioid and clear-cell carcinomas. Factors such as hormonal imbalance, reproductive history, environmental exposures, and genetic predisposition contribute to the malignant transformation of endometriosis. Thus, understanding potential risk factors causing malignancy is crucial. Over the past few decades, various genetic mutations, microRNAs, as well as tumor microenvironmental factors have been identified, impacting pathways like PI3K/AKT/mTOR, DNA repair mechanisms, oxidative stress, and inflammation. Thus, this review aims to summarize molecular studies involved in EAOC pathogenesis as potential therapeutic targets. However, further research is needed to better understand the molecular and environmental factors driving EAOC development, to target the susceptibility of endometriotic lesions to malignant progression, and to identify effective therapeutic strategies.
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Affiliation(s)
- Sophie Charlotte Steinbuch
- Department of Obstetrics and Gynecology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Anne-Marie Lüß
- Department of Obstetrics and Gynecology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Stephanie Eltrop
- Department of Obstetrics and Gynecology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Martin Götte
- Department of Obstetrics and Gynecology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
- Cells-in-Motion Interfaculty Centre (CiMIC), University of Münster, 48149 Münster, Germany
| | - Ludwig Kiesel
- Department of Obstetrics and Gynecology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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Tian BQ, Wang SW, Xu JY, Wu SG, Zhou J. Trends in survival of ovarian clear cell carcinoma patients from 2000 to 2015. Front Oncol 2024; 14:1360663. [PMID: 38515571 PMCID: PMC10956514 DOI: 10.3389/fonc.2024.1360663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Purpose To analyze changes in survival outcomes in patients with ovarian clear cell carcinoma (OCCC) treated consecutively over a 16-year period using a population-based cohort. Methods We conducted a retrospective analysis of OCCC from 2000 to 2015 using data from the Surveillance, Epidemiology, and End Results (SEER) program. The ovarian cancer-specific survival (OCSS) and overall survival (OS) were analyzed according to the year of diagnosis. Joinpoint Regression Program, Kaplan-Meier analysis, and multivariate Cox regression analyses were used for statistical analysis. Results We included 4257 patients in the analysis. The analysis of annual percentage change in OCSS (P=0.014) and OS (P=0.006) showed that patients diagnosed in later years had significantly better outcomes compared to those diagnosed in early years. The results of the multivariate Cox regression analyses showed that the year of diagnosis was the independent prognostic factor associated with OCSS (P=0.004) and had a borderline effect on OS (P=0.060). Regarding the SEER staging, the OCSS (P=0.017) and OS (P=0.004) of patients with distant stage showed a significant trend toward increased, while no significant trends were found in the survival of patients with localized or regional stage diseases. Similar trends were found in those aged <65 years or those treated with surgery and chemotherapy. However, no statistically significant changes in the survival rate were found in those aged ≥65 years or those receiving surgery alone regardless of SEER stage during the study period. Conclusions Our study observed a significant increase in the survival outcomes in OCCC from 2000 to 2015, and patients aged <65 years and those with distant stage experienced a greater improvement in survival.
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Affiliation(s)
| | - Shu-Wen Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jing-Ying Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Juan Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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6
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Hollis RL, Thomson JP, van Baal J, Ilenkovan N, Churchman M, van de Vijver K, Dijk F, Meynert AM, Bartos C, Rye T, Croy I, Diana P, van Gent M, Creedon H, Nirsimloo R, Lok C, Gourley C, Herrington CS. Distinct histopathological features are associated with molecular subtypes and outcome in low grade serous ovarian carcinoma. Sci Rep 2023; 13:7681. [PMID: 37169775 PMCID: PMC10175560 DOI: 10.1038/s41598-023-34627-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/04/2023] [Indexed: 05/13/2023] Open
Abstract
Low grade serous ovarian carcinoma (LGSOC) demonstrates unique clinical and molecular features compared to other ovarian cancer types. The relationship between common histological features of LGSOC and molecular events, such as hormone receptor expression patterns and MAPK gene mutation status, remains poorly understood. Recent data suggest some of these molecular features may be biomarkers of response to recently introduced biologically-targeted therapies, namely endocrine therapy and MEK inhibitors. We utilize a cohort of 63 pathologically-confirmed LGSOC cases with whole exome sequencing and hormone receptor expression data to investigate these relationships. LGSOC cases demonstrated uniformly high oestrogen receptor (ER) expression, but variable progesterone receptor (PR) expression intensity. 60% and 37% of cases demonstrated micropapillary and macropapillary patterns of stromal invasion, respectively. 63% of cases demonstrated desmoplasia, which was significantly associated with advanced disease stage and visible residual disease after cytoreductive surgery. MAPK-mutant cases (KRAS, BRAF, NRAS) more frequently demonstrated macropapillary stromal invasion, while Chr1p loss was associated with desmoplasia and low PR expression. Presence of micropapillary stromal invasion and low PR expression were associated with significantly poorer survival after accounting for stage and residual disease status. Together, these data identify novel relationships between histopathological features and molecularly-defined subgroups in LGSOC.
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Affiliation(s)
- Robert L Hollis
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK.
| | - John P Thomson
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Juliette van Baal
- Department of Gynaecologic Oncology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Pathology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Narthana Ilenkovan
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK
- Cancer Research UK Scotland Centre, Beatson Institute for Cancer Research, Glasgow, UK
| | - Michael Churchman
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Koen van de Vijver
- Department of Gynaecologic Oncology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Pathology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Frederike Dijk
- Department of Gynaecologic Oncology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Department of Pathology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Alison M Meynert
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Clare Bartos
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Tzyvia Rye
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Ian Croy
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Patricia Diana
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Mignon van Gent
- Department of Gynaecologic Oncology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Department of Pathology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Helen Creedon
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Rachel Nirsimloo
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Christianne Lok
- Department of Gynaecologic Oncology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Pathology, The Netherlands Cancer Institute, Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Charlie Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - C Simon Herrington
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XU, UK.
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7
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Köbel M, Kang E, Weir A, Rambau PF, Lee C, Nelson GS, Ghatage P, Meagher NS, Riggan MJ, Alsop J, Anglesio MS, Beckmann MW, Bisinotto C, Boisen M, Boros J, Brand AH, Brooks‐Wilson A, Carney ME, Coulson P, Courtney‐Brooks M, Cushing‐Haugen KL, Cybulski C, Deen S, El‐Bahrawy MA, Elishaev E, Erber R, Fereday S, Fischer A, Gayther SA, Barquin‐Garcia A, Gentry‐Maharaj A, Gilks CB, Gronwald H, Grube M, Harnett PR, Harris HR, Hartkopf AD, Hartmann A, Hein A, Hendley J, Hernandez BY, Huang Y, Jakubowska A, Jimenez‐Linan M, Jones ME, Kennedy CJ, Kluz T, Koziak JM, Lesnock J, Lester J, Lubiński J, Longacre TA, Lycke M, Mateoiu C, McCauley BM, McGuire V, Ney B, Olawaiye A, Orsulic S, Osorio A, Paz‐Ares L, Ramón y Cajal T, Rothstein JH, Ruebner M, Schoemaker MJ, Shah M, Sharma R, Sherman ME, Shvetsov YB, Singh N, Steed H, Storr SJ, Talhouk A, Traficante N, Wang C, Whittemore AS, Widschwendter M, Wilkens LR, Winham SJ, Benitez J, Berchuck A, Bowtell DD, Candido dos Reis FJ, Campbell I, Cook LS, DeFazio A, Doherty JA, Fasching PA, Fortner RT, García MJ, Goodman MT, Goode EL, Gronwald J, Huntsman DG, Karlan BY, Kelemen LE, Kommoss S, Le ND, Martin SG, Menon U, Modugno F, Pharoah PDP, Schildkraut JM, Sieh W, Staebler A, Sundfeldt K, Swerdlow AJ, Ramus SJ, Brenton JD. p53 and ovarian carcinoma survival: an Ovarian Tumor Tissue Analysis consortium study. J Pathol Clin Res 2023; 9:208-222. [PMID: 36948887 PMCID: PMC10073933 DOI: 10.1002/cjp2.311] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 03/24/2023]
Abstract
Our objective was to test whether p53 expression status is associated with survival for women diagnosed with the most common ovarian carcinoma histotypes (high-grade serous carcinoma [HGSC], endometrioid carcinoma [EC], and clear cell carcinoma [CCC]) using a large multi-institutional cohort from the Ovarian Tumor Tissue Analysis (OTTA) consortium. p53 expression was assessed on 6,678 cases represented on tissue microarrays from 25 participating OTTA study sites using a previously validated immunohistochemical (IHC) assay as a surrogate for the presence and functional effect of TP53 mutations. Three abnormal expression patterns (overexpression, complete absence, and cytoplasmic) and the normal (wild type) pattern were recorded. Survival analyses were performed by histotype. The frequency of abnormal p53 expression was 93.4% (4,630/4,957) in HGSC compared to 11.9% (116/973) in EC and 11.5% (86/748) in CCC. In HGSC, there were no differences in overall survival across the abnormal p53 expression patterns. However, in EC and CCC, abnormal p53 expression was associated with an increased risk of death for women diagnosed with EC in multivariate analysis compared to normal p53 as the reference (hazard ratio [HR] = 2.18, 95% confidence interval [CI] 1.36-3.47, p = 0.0011) and with CCC (HR = 1.57, 95% CI 1.11-2.22, p = 0.012). Abnormal p53 was also associated with shorter overall survival in The International Federation of Gynecology and Obstetrics stage I/II EC and CCC. Our study provides further evidence that functional groups of TP53 mutations assessed by abnormal surrogate p53 IHC patterns are not associated with survival in HGSC. In contrast, we validate that abnormal p53 IHC is a strong independent prognostic marker for EC and demonstrate for the first time an independent prognostic association of abnormal p53 IHC with overall survival in patients with CCC.
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Affiliation(s)
- Martin Köbel
- Department of Pathology and Laboratory MedicineUniversity of Calgary, Foothills Medical CenterCalgaryABCanada
| | - Eun‐Young Kang
- Department of Pathology and Laboratory MedicineUniversity of Calgary, Foothills Medical CenterCalgaryABCanada
| | - Ashley Weir
- School of Clinical MedicineUNSW Medicine and Health, University of NSW SydneySydneyNew South WalesAustralia
- Adult Cancer Program, Lowy Cancer Research CentreUniversity of NSW SydneySydneyNew South WalesAustralia
- The Walter and Eliza Hall Institute of Medical ResearchParkvilleVictoriaAustralia
| | - Peter F Rambau
- Department of Pathology and Laboratory MedicineUniversity of Calgary, Foothills Medical CenterCalgaryABCanada
- Pathology DepartmentCatholic University of Health and Allied Sciences‐BugandoMwanzaTanzania
| | - Cheng‐Han Lee
- Department of Pathology and Laboratory MedicineUniversity of AlbertaEdmontonABCanada
| | - Gregg S Nelson
- Department of Oncology, Division of Gynecologic Oncology, Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Prafull Ghatage
- Department of Oncology, Division of Gynecologic Oncology, Cumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Nicola S Meagher
- School of Clinical MedicineUNSW Medicine and Health, University of NSW SydneySydneyNew South WalesAustralia
- The Daffodil CentreThe University of Sydney, a Joint Venture with Cancer Council NSWSydneyNew South WalesAustralia
| | - Marjorie J Riggan
- Department of Obstetrics and Gynecology, Division of Gynecologic OncologyDuke University Medical CenterDurhamNCUSA
| | - Jennifer Alsop
- Centre for Cancer Genetic Epidemiology, Department of OncologyUniversity of CambridgeCambridgeUK
| | - Michael S Anglesio
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBCCanada
- British Columbia's Gynecological Cancer Research Team (OVCARE)University of British Columbia, BC Cancer, and Vancouver General HospitalVancouverBCCanada
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen‐EMNFriedrich‐Alexander University Erlangen‐Nuremberg, University Hospital ErlangenErlangenGermany
| | - Christiani Bisinotto
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Michelle Boisen
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Jessica Boros
- Centre for Cancer ResearchThe Westmead Institute for Medical Research, University of SydneySydneyNew South WalesAustralia
- Department of Gynaecological OncologyWestmead HospitalSydneyNew South WalesAustralia
- Discipline of Obstetrics and GynaecologyThe University of SydneySydneyNew South WalesAustralia
| | - Alison H Brand
- Department of Gynaecological OncologyWestmead HospitalSydneyNew South WalesAustralia
- Discipline of Obstetrics and GynaecologyThe University of SydneySydneyNew South WalesAustralia
| | | | - Michael E Carney
- Department of Obstetrics and Gynecology, John A. Burns School of MedicineUniversity of HawaiiHonoluluHIUSA
| | - Penny Coulson
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK
| | - Madeleine Courtney‐Brooks
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Kara L Cushing‐Haugen
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Cezary Cybulski
- Department of Genetics and Pathology, International Hereditary Cancer CenterPomeranian Medical UniversitySzczecinPoland
| | - Suha Deen
- Department of HistopathologyNottingham University Hospitals NHS Trust, Queen's Medical CentreNottinghamUK
| | - Mona A El‐Bahrawy
- Department of Metabolism, Digestion and ReproductionImperial College London, Hammersmith HospitalLondonUK
| | - Esther Elishaev
- Department of PathologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Ramona Erber
- Institute of Pathology, Comprehensive Cancer Center Erlangen‐EMN, Friedrich‐Alexander University Erlangen‐Nuremberg, University Hospital ErlangenErlangenGermany
| | - Sian Fereday
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneParkvilleVictoriaAustralia
| | - AOCS Group
- Centre for Cancer ResearchThe Westmead Institute for Medical Research, University of SydneySydneyNew South WalesAustralia
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- QIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Anna Fischer
- Institute of Pathology and Neuropathology, Tuebingen University HospitalTuebingenGermany
| | - Simon A Gayther
- Center for Bioinformatics and Functional Genomics and the Cedars Sinai Genomics Core, Cedars‐Sinai Medical CenterLos AngelesCAUSA
| | | | - Aleksandra Gentry‐Maharaj
- MRC Clinical Trials UnitInstitute of Clinical Trials & Methodology, University College LondonLondonUK
| | - C Blake Gilks
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Helena Gronwald
- Department of Propaedeutics, Physical Diagnostics and Dental PhysiotherapyPomeranian Medical UniversitySzczecinPoland
| | - Marcel Grube
- Department of Women's HealthTuebingen University HospitalTuebingenGermany
| | - Paul R Harnett
- Discipline of Obstetrics and GynaecologyThe University of SydneySydneyNew South WalesAustralia
- Crown Princess Mary Cancer CentreWestmead HospitalSydneyNew South WalesAustralia
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research CenterSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Andreas D Hartkopf
- Department of Women's HealthTuebingen University HospitalTuebingenGermany
- Department of Gynecology and ObstetricsUniversity Hospital of UlmUlmGermany
| | - Arndt Hartmann
- Institute of Pathology, Comprehensive Cancer Center Erlangen‐EMN, Friedrich‐Alexander University Erlangen‐Nuremberg, University Hospital ErlangenErlangenGermany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen‐EMNFriedrich‐Alexander University Erlangen‐Nuremberg, University Hospital ErlangenErlangenGermany
| | - Joy Hendley
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Brenda Y Hernandez
- Cancer Epidemiology ProgramUniversity of Hawaii Cancer CenterHonoluluHIUSA
| | - Yajue Huang
- Department of Laboratory Medicine and Pathology, Mayo ClinicRochesterMNUSA
| | - Anna Jakubowska
- Department of Genetics and Pathology, International Hereditary Cancer CenterPomeranian Medical UniversitySzczecinPoland
- Independent Laboratory of Molecular Biology and Genetic DiagnosticsPomeranian Medical UniversitySzczecinPoland
| | | | - Michael E Jones
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK
| | - Catherine J Kennedy
- Centre for Cancer ResearchThe Westmead Institute for Medical Research, University of SydneySydneyNew South WalesAustralia
- Department of Gynaecological OncologyWestmead HospitalSydneyNew South WalesAustralia
- Discipline of Obstetrics and GynaecologyThe University of SydneySydneyNew South WalesAustralia
| | - Tomasz Kluz
- Department of Gynecology and ObstetricsInstitute of Medical Sciences, Medical College of Rzeszow UniversityRzeszówPoland
| | | | - Jaime Lesnock
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Jenny Lester
- David Geffen School of Medicine, Department of Obstetrics and GynecologyUniversity of California at Los AngelesLos AngelesCAUSA
| | - Jan Lubiński
- Department of Genetics and Pathology, International Hereditary Cancer CenterPomeranian Medical UniversitySzczecinPoland
| | - Teri A Longacre
- Department of PathologyStanford University School of MedicineStanfordCAUSA
| | - Maria Lycke
- Department of Obstetrics and GynecologyInstitute of Clinical Science, Sahlgrenska University Hospital, University of GothenburgGothenburgSweden
| | | | - Bryan M McCauley
- Department of Quantitative Health Sciences, Division of Epidemiology, Mayo ClinicRochesterMNUSA
| | - Valerie McGuire
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCAUSA
| | - Britta Ney
- Institute of Pathology and Neuropathology, Tuebingen University HospitalTuebingenGermany
| | - Alexander Olawaiye
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Sandra Orsulic
- David Geffen School of Medicine, Department of Obstetrics and GynecologyUniversity of California at Los AngelesLos AngelesCAUSA
| | - Ana Osorio
- Genetics Service, Fundación Jiménez DíazMadridSpain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER)Instituto de Salud Carlos IIIMadridSpain
| | - Luis Paz‐Ares
- H12O‐CNIO Lung Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO)MadridSpain
- Oncology DepartmentHospital Universitario 12 de OctubreMadridSpain
| | | | - Joseph H Rothstein
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen‐EMNFriedrich‐Alexander University Erlangen‐Nuremberg, University Hospital ErlangenErlangenGermany
| | - Minouk J Schoemaker
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK
| | - Mitul Shah
- Centre for Cancer Genetic Epidemiology, Department of OncologyUniversity of CambridgeCambridgeUK
| | - Raghwa Sharma
- Tissue Pathology and Diagnostic OncologyWestmead HospitalSydneyNew South WalesAustralia
| | - Mark E Sherman
- Department of Health Sciences Research, Mayo ClinicJacksonvilleFLUSA
| | - Yurii B Shvetsov
- Cancer Epidemiology ProgramUniversity of Hawaii Cancer CenterHonoluluHIUSA
| | - Naveena Singh
- Department of Pathology and Laboratory MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Helen Steed
- Division of Gynecologic Oncology, Department of Obstetrics and GynecologyUniversity of AlbertaEdmontonABCanada
- Section of Gynecologic Oncology Surgery, North Zone, Alberta Health ServicesEdmontonABCanada
| | - Sarah J Storr
- Nottingham Breast Cancer Research CentreBiodiscovery Institute, University of NottinghamNottinghamUK
| | - Aline Talhouk
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBCCanada
- British Columbia's Gynecological Cancer Research Team (OVCARE)University of British Columbia, BC Cancer, and Vancouver General HospitalVancouverBCCanada
| | - Nadia Traficante
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneParkvilleVictoriaAustralia
| | - Chen Wang
- Department of Quantitative Health Sciences, Division of Computational Biology, Mayo ClinicRochesterMNUSA
| | - Alice S Whittemore
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCAUSA
- Department of Biomedical Data ScienceStanford University School of MedicineStanfordCAUSA
| | | | - Lynne R Wilkens
- Cancer Epidemiology ProgramUniversity of Hawaii Cancer CenterHonoluluHIUSA
| | - Stacey J Winham
- Department of Quantitative Health Sciences, Division of Computational Biology, Mayo ClinicRochesterMNUSA
| | - Javier Benitez
- Centre for Biomedical Network Research on Rare Diseases (CIBERER)Instituto de Salud Carlos IIIMadridSpain
- Human Genetics Group, Spanish National Cancer Research Centre (CNIO)MadridSpain
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology, Division of Gynecologic OncologyDuke University Medical CenterDurhamNCUSA
| | - David D Bowtell
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneParkvilleVictoriaAustralia
| | - Francisco J Candido dos Reis
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Ian Campbell
- Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneParkvilleVictoriaAustralia
| | - Linda S Cook
- Epidemiology, School of Public HealthUniversity of ColoradoAuroraCOUSA
- Community Health Sciences, University of CalgaryCalgaryABCanada
| | - Anna DeFazio
- The Daffodil CentreThe University of Sydney, a Joint Venture with Cancer Council NSWSydneyNew South WalesAustralia
- Centre for Cancer ResearchThe Westmead Institute for Medical Research, University of SydneySydneyNew South WalesAustralia
- Department of Gynaecological OncologyWestmead HospitalSydneyNew South WalesAustralia
- Discipline of Obstetrics and GynaecologyThe University of SydneySydneyNew South WalesAustralia
| | - Jennifer A Doherty
- Huntsman Cancer Institute, Department of Population Health SciencesUniversity of UtahSalt Lake CityUTUSA
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen‐EMNFriedrich‐Alexander University Erlangen‐Nuremberg, University Hospital ErlangenErlangenGermany
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ)HeidelbergGermany
- Department of Research, Cancer Registry of NorwayOsloNorway
| | - María J García
- Computational Oncology Group, Structural Biology Programme, Spanish National Cancer Research Centre (CNIO)MadridSpain
| | - Marc T Goodman
- Cancer Prevention and Control Program, Cedars‐Sinai Cancer, Cedars‐Sinai Medical CenterLos AngelesCAUSA
| | - Ellen L Goode
- Department of Quantitative Health Sciences, Division of Epidemiology, Mayo ClinicRochesterMNUSA
| | - Jacek Gronwald
- Department of Genetics and Pathology, International Hereditary Cancer CenterPomeranian Medical UniversitySzczecinPoland
| | - David G Huntsman
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBCCanada
- Department of Molecular Oncology, BC Cancer Research CentreVancouverBCCanada
| | - Beth Y Karlan
- David Geffen School of Medicine, Department of Obstetrics and GynecologyUniversity of California at Los AngelesLos AngelesCAUSA
| | - Linda E Kelemen
- Division of Acute Disease Epidemiology, South Carolina Department of Health & Environmental ControlColumbiaSCUSA
| | - Stefan Kommoss
- Department of Women's HealthTuebingen University HospitalTuebingenGermany
| | - Nhu D Le
- Cancer Control Research, BC Cancer AgencyVancouverBCCanada
| | - Stewart G Martin
- Nottingham Breast Cancer Research CentreBiodiscovery Institute, University of NottinghamNottinghamUK
| | - Usha Menon
- MRC Clinical Trials UnitInstitute of Clinical Trials & Methodology, University College LondonLondonUK
| | - Francesmary Modugno
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Department of EpidemiologyUniversity of Pittsburgh School of Public HealthPittsburghPAUSA
- Women's Cancer Research CenterMagee‐Womens Research Institute and Hillman Cancer CenterPittsburghPAUSA
| | - Paul DP Pharoah
- Centre for Cancer Genetic Epidemiology, Department of OncologyUniversity of CambridgeCambridgeUK
- Department of Computational Biomedicine, Cedars‐Sinai Medical CenterWest HollywoodCAUSA
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Joellen M Schildkraut
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Weiva Sieh
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Annette Staebler
- Institute of Pathology and Neuropathology, Tuebingen University HospitalTuebingenGermany
| | - Karin Sundfeldt
- Department of Obstetrics and Gynecology, Institute of Clinical ScienceSahlgrenska Center for Cancer Research, University of GothenburgGothenburgSweden
| | - Anthony J Swerdlow
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK
- Division of Breast Cancer ResearchThe Institute of Cancer ResearchLondonUK
| | - Susan J Ramus
- School of Clinical MedicineUNSW Medicine and Health, University of NSW SydneySydneyNew South WalesAustralia
- Adult Cancer Program, Lowy Cancer Research CentreUniversity of NSW SydneySydneyNew South WalesAustralia
| | - James D Brenton
- Cancer Research UK Cambridge Institute, University of CambridgeCambridgeUK
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8
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Rangsrikitphoti P, Marquez-Garban DC, Pietras RJ, McGowan E, Boonyaratanakornkit V. Sex steroid hormones and DNA repair regulation: Implications on cancer treatment responses. J Steroid Biochem Mol Biol 2023; 227:106230. [PMID: 36450315 DOI: 10.1016/j.jsbmb.2022.106230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
The role of sex steroid hormones (SSHs) has been shown to modulate cancer cytotoxic treatment sensitivity. Dysregulation of DNA repair associated with genomic instability, abnormal cell survival and not only promotes cancer progression but also resistance to cancer treatment. The three major SSHs, androgen, estrogen, and progesterone, have been shown to interact with several essential DNA repair components. The presence of androgens directly regulates key molecules in DNA double-strand break (DSB) repair. Estrogen can promote cell proliferation and DNA repair, allowing cancer cells to tolerate chemotherapy and radiotherapy. Information on the role of progesterone in DNA repair is limited: progesterone interaction with some DNA repair components has been identified, but the biological significance is still unknown. Here, we review the roles of how each SSH affects DNA repair regulation and modulates response to genotoxic therapies and discuss future research that can be beneficial when combining SSHs with cancer therapy. We also provide preliminary analysis from publicly available databases defining the link between progesterone/PR and DDRs & DNA repair regulation that plausibly contribute to chemotherapy response and breast cancer patient survival.
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Affiliation(s)
- Pattarasiri Rangsrikitphoti
- Graduate Program in Clinical Biochemistry and Molecular Medicine and Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Diana C Marquez-Garban
- UCLA Jonsson Comprehensive Cancer and Department of Medicine, Division of Hematology-Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Richard J Pietras
- UCLA Jonsson Comprehensive Cancer and Department of Medicine, Division of Hematology-Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Eileen McGowan
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Viroj Boonyaratanakornkit
- Graduate Program in Clinical Biochemistry and Molecular Medicine and Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand; Age-related Inflammation and Degeneration Research Unit, Chulalongkorn University, Bangkok 10330, Thailand.
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9
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Hollis RL. Molecular characteristics and clinical behaviour of epithelial ovarian cancers. Cancer Lett 2023; 555:216057. [PMID: 36627048 DOI: 10.1016/j.canlet.2023.216057] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
Ovarian carcinoma (OC) is an umbrella term for multiple distinct diseases (histotypes), each with their own developmental origins, clinical behaviour and molecular profile. Accordingly, OC management is progressing away from a one-size-fits all approach, toward more molecularly-driven, histotype-specific management strategies. Our knowledge of driver events in high grade serous OC, the most common histotype, has led to major advances in treatments, including PARP inhibitor use. However, these agents are not suitable for all patients, most notably for many of those with rare OC histotypes. Identification of additional targeted therapeutic strategies will require a detailed understanding of the molecular landscape in each OC histotype. Until recently, tumour profiling studies in rare histotypes were sparse; however, significant advances have been made over the last decade. In particular, reports of genomic characterisation in endometrioid, clear cell, mucinous and low grade serous OC have significantly expanded our understanding of mutational events in these tumour types. Nonetheless, substantial knowledge gaps remain. This review summarises our current understanding of each histotype, highlighting recent advances in these unique diseases and outlining immediate research priorities for accelerating progress toward improving patient outcomes.
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Affiliation(s)
- Robert L Hollis
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, UK.
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10
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Gilks CB, Selinger CI, Davidson B, Köbel M, Ledermann JA, Lim D, Malpica A, Mikami Y, Singh N, Srinivasan R, Vang R, Lax SF, McCluggage WG. Data Set for the Reporting of Ovarian, Fallopian Tube and Primary Peritoneal Carcinoma: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol 2022; 41:S119-S142. [PMID: 36305537 DOI: 10.1097/pgp.0000000000000908] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The move toward consistent and comprehensive surgical pathology reports for cancer resection specimens has been a key development in supporting evidence-based patient management and consistent cancer staging. The International Collaboration on Cancer Reporting (ICCR) previously developed a data set for reporting of the ovarian, fallopian tube and primary peritoneal carcinomas which was published in 2015. In this paper, we provide an update on this data set, as a second edition, that reflects changes in the 2020 World Health Organization (WHO) Classification of Female Genital Tumours as well as some other minor modifications. The data set has been developed by a panel of internationally recognized expert pathologists and a clinician and consists of "core" and "noncore" elements to be included in surgical pathology reports, with detailed commentary to guide users, including references. This data set replaces the widely used first edition, and will facilitate consistent and accurate case reporting, data collection for quality assurance and research, and allow for comparison of epidemiological and pathologic parameters between different populations.
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11
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Wang Y, Tan S, Pan E, Ma Y, Wu X, Yu Z, Jiang K. An Effective Hormonal Therapy for a Patient with Estrogen Receptor 1 ( ESR1)-Amplified Metastatic Ovarian Cancer: A Case Report. Onco Targets Ther 2022; 15:643-649. [PMID: 35707517 PMCID: PMC9191580 DOI: 10.2147/ott.s363856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/27/2022] [Indexed: 12/24/2022] Open
Abstract
Hormonal therapy is an important treatment option for estrogen receptor (ER)-positive patients with advanced ovarian cancer. Although ER overexpression has been previously used as an indicator for hormonal therapy, the clinical outcomes of advanced ovarian cancer patients receiving hormonal therapy remain unsatisfactory. Additional biomarkers for screening patients are needed to improve its efficacy. In this study, we reported a metastatic ovarian cancer case with estrogen receptor 1 (ESR1) gene amplification and protein overexpression, which showed sustained partial response to hormonal therapy, including letrozole and tamoxifen, and displayed an overall survival of 47 months. The response to the therapy was evaluated by imageological examinations, cancer antigen-125 (CA-125) tests, and circulating tumor DNA (ctDNA) sequencing using capture-based hybrid next-generation sequencing. Our clinical data suggested that ESR1 amplification might be a potential predictor of response to hormonal therapy in ovarian cancer. The combination of tumor detection techniques including imaging, CA-125 and ctDNA would enable confirmation of tumor response with high confidence.
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Affiliation(s)
- Yue Wang
- Department of Medical Oncology, the Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Shuang Tan
- Department of Gynecology, the Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Evenki Pan
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc, Nanjing, Jiangsu, People's Republic of China
| | - Yutong Ma
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc, Nanjing, Jiangsu, People's Republic of China
| | - Xue Wu
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc, Nanjing, Jiangsu, People's Republic of China
| | - Zhe Yu
- Department of Medical Oncology, the Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Kui Jiang
- Department of Medical Oncology, the Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
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12
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The Evolution of Ovarian Carcinoma Subclassification. Cancers (Basel) 2022; 14:cancers14020416. [PMID: 35053578 PMCID: PMC8774015 DOI: 10.3390/cancers14020416] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Historically, cancers presenting with their main tumor mass in the ovary have been classified as ovarian carcinomas (a concise term for epithelial ovarian cancer) and treated with a one-size-fits-all approach. Over the last two decades, a growing molecular understanding established that ovarian carcinomas consist of several distinct histologic types, which practically represent different diseases. Further research is now delineating several molecular subtypes within each histotype. This histotype/molecular subtype subclassification provides a framework of grouping tumors based on molecular similarities for research, clinical trial inclusion and future patient management. Abstract The phenotypically informed histotype classification remains the mainstay of ovarian carcinoma subclassification. Histotypes of ovarian epithelial neoplasms have evolved with each edition of the WHO Classification of Female Genital Tumours. The current fifth edition (2020) lists five principal histotypes: high-grade serous carcinoma (HGSC), low-grade serous carcinoma (LGSC), mucinous carcinoma (MC), endometrioid carcinoma (EC) and clear cell carcinoma (CCC). Since histotypes arise from different cells of origin, cell lineage-specific diagnostic immunohistochemical markers and histotype-specific oncogenic alterations can confirm the morphological diagnosis. A four-marker immunohistochemical panel (WT1/p53/napsin A/PR) can distinguish the five principal histotypes with high accuracy, and additional immunohistochemical markers can be used depending on the diagnostic considerations. Histotypes are further stratified into molecular subtypes and assessed with predictive biomarker tests. HGSCs have recently been subclassified based on mechanisms of chromosomal instability, mRNA expression profiles or individual candidate biomarkers. ECs are composed of the same molecular subtypes (POLE-mutated/mismatch repair-deficient/no specific molecular profile/p53-abnormal) with the same prognostic stratification as their endometrial counterparts. Although methylation analyses and gene expression and sequencing showed at least two clusters, the molecular subtypes of CCCs remain largely elusive to date. Mutational and immunohistochemical data on LGSC have suggested five molecular subtypes with prognostic differences. While our understanding of the molecular composition of ovarian carcinomas has significantly advanced and continues to evolve, the need for treatment options suitable for these alterations is becoming more obvious. Further preclinical studies using histotype-defined and molecular subtype-characterized model systems are needed to expand the therapeutic spectrum for women diagnosed with ovarian carcinomas.
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13
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Clinical factors and biomarker profiles associated with patient outcome in endometrioid ovarian carcinoma - Emphasis on tumor grade. Gynecol Oncol 2021; 164:187-194. [PMID: 34711431 DOI: 10.1016/j.ygyno.2021.10.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The role of clinicopathological factors and molecular markers in prognostic classification of endometrioid ovarian carcinoma (EnOC) is not established. Tumor grade is used in risk assessment, but the role of current 3-tier grading system has been challenged. METHODS Clinicopathological factors and 12 immunohistochemical biomarkers (PR, ER, β-catenin, vimentin, ARID1A, HNF1-β, p53, p16, MIB-1, E-cadherin, c-erb-B2 and L1CAM) were analyzed as regards patient outcome in 215 contemporarily classified EnOCs. RESULTS Of clinical parameters, grade and stage appeared as strong independent prognostic factors both for disease-free and disease-specific overall survival. Grades 1-3 distinguished clearly from each other in the survival analysis, whereas stages I-II and stages III-IV clustered with each other. PR, ER, nuclear β-catenin and vimentin positivity were associated with favorable overall outcome and clinical parameters, whereas abnormal expression of p53, overexpression of p16 and L1CAM positivity were associated with aggressive disease characteristics and poor survival. The frequency of good-prognosis markers PR and β-catenin gradually decreased and poor-prognosis markers p53, p16 and L1CAM gradually increased from grade 1-3. However, vimentin and ER were expressed at similar frequencies across different grades and presented with independent prognostic significance. CONCLUSIONS We found histological grade and disease stage, but not residual tumor, to be independent clinical prognostic factors in EnOC. A set of good-prognosis markers (PR, ER, β-catenin and vimentin) and poor-prognosis markers (p53, p16 and L1CAM) were identified. Our findings support continuation of the use of the 3-tier grading system for EnOC and provide clinically feasible IHC biomarkers for prognostic profiling.
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14
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Chen S, Li Y, Qian L, Deng S, Liu L, Xiao W, Zhou Y. A Review of the Clinical Characteristics and Novel Molecular Subtypes of Endometrioid Ovarian Cancer. Front Oncol 2021; 11:668151. [PMID: 34150634 PMCID: PMC8210668 DOI: 10.3389/fonc.2021.668151] [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: 02/15/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022] Open
Abstract
Ovarian cancer is one of the most common gynecologic cancers that has the highest mortality rate. Endometrioid ovarian cancer, a distinct subtype of epithelial ovarian cancer, is associated with endometriosis and Lynch syndrome, and is often accompanied by synchronous endometrial carcinoma. In recent years, dysbiosis of the microbiota within the female reproductive tract has been suggested to be involved in the pathogenesis of endometrial cancer and ovarian cancer, with some specific pathogens exhibiting oncogenic having been found to contribute to cancer development. It has been shown that dysregulation of the microenvironment and accumulation of mutations are stimulatory factors in the progression of endometrioid ovarian carcinoma. This would be a potential therapeutic target in the future. Simultaneously, multiple studies have demonstrated the role of four molecular subtypes of endometrioid ovarian cancer, which are of particular importance in the prediction of prognosis. This literature review aims to compile the potential mechanisms of endometrioid ovarian cancer, molecular characteristics, and molecular pathological types that could potentially play a role in the prediction of prognosis, and the novel therapeutic strategies, providing some guidance for the stratified management of ovarian cancer.
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Affiliation(s)
- Shuangfeng Chen
- Department of Obstetrics and Gynecology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Yuebo Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Lili Qian
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Sisi Deng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Luwen Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Weihua Xiao
- Division of Molecular Medicine, Hefei National Laboratory for Physical Sciences at Microscale, The CAS Key Laboratory of Innate Immunity and Chronic Disease, School of Life Sciences, University of Science and Technology of China, Hefei, China.,Institute of Immunology, University of Science and Technology of China, Hefei, China
| | - Ying Zhou
- Department of Obstetrics and Gynecology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.,Department of Obstetrics and Gynecology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Integrated molecular characterisation of endometrioid ovarian carcinoma identifies opportunities for stratification. NPJ Precis Oncol 2021; 5:47. [PMID: 34079052 PMCID: PMC8172925 DOI: 10.1038/s41698-021-00187-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/13/2021] [Indexed: 12/24/2022] Open
Abstract
Endometrioid ovarian carcinoma (EnOC) is an under-investigated ovarian cancer type. Recent studies have described disease subtypes defined by genomics and hormone receptor expression patterns; here, we determine the relationship between these subtyping layers to define the molecular landscape of EnOC with high granularity and identify therapeutic vulnerabilities in high-risk cases. Whole exome sequencing data were integrated with progesterone and oestrogen receptor (PR and ER) expression-defined subtypes in 90 EnOC cases following robust pathological assessment, revealing dominant clinical and molecular features in the resulting integrated subtypes. We demonstrate significant correlation between subtyping approaches: PR-high (PR + /ER + , PR + /ER−) cases were predominantly CTNNB1-mutant (73.2% vs 18.4%, P < 0.001), while PR-low (PR−/ER + , PR−/ER−) cases displayed higher TP53 mutation frequency (38.8% vs 7.3%, P = 0.001), greater genomic complexity (P = 0.007) and more frequent copy number alterations (P = 0.001). PR-high EnOC patients experience favourable disease-specific survival independent of clinicopathological and genomic features (HR = 0.16, 95% CI 0.04–0.71). TP53 mutation further delineates the outcome of patients with PR-low tumours (HR = 2.56, 95% CI 1.14–5.75). A simple, routinely applicable, classification algorithm utilising immunohistochemistry for PR and p53 recapitulated these subtypes and their survival profiles. The genomic profile of high-risk EnOC subtypes suggests that inhibitors of the MAPK and PI3K-AKT pathways, alongside PARP inhibitors, represent promising candidate agents for improving patient survival. Patients with PR-low TP53-mutant EnOC have the greatest unmet clinical need, while PR-high tumours—which are typically CTNNB1-mutant and TP53 wild-type—experience excellent survival and may represent candidates for trials investigating de-escalation of adjuvant chemotherapy to agents such as endocrine therapy.
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16
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Expression of hormone receptors predicts survival and platinum sensitivity of high-grade serous ovarian cancer. Biosci Rep 2021; 41:228453. [PMID: 33891016 PMCID: PMC8112847 DOI: 10.1042/bsr20210478] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 01/03/2023] Open
Abstract
High-grade serous ovarian cancer (HGSOC) has abundant expression of hormone receptors, including androgen receptor (AR), estrogen receptor α (ER), and progesterone receptor (PR). The effects of hormone receptors on prognosis of HGSOC were first evaluated in online databases. Their prognostic values were then explored and validated in our inhouse TJ-cohort (92 HGSOC patients) and in a validation cohort (33 HGSOC patients), wherein hormone receptors were detected immunohistochemically. High expression of hormone receptors denoted longer progression-free survival (PFS), overall survival (OS), and platinum-free interval (PFI). Platinum-sensitive patients had higher expression of hormone receptors than their counterparts. Correlation analysis revealed significant positive correlations between hormone receptors expression and survival. AR, ER, and PR had predictive and prognostic values, alone and in combination. By receiver operating characteristic curve (ROC) analysis, co-expression of AR, ER, and PR had an improved predictive performance with an area under the curve (AUC) value of 0.945. Expression of hormone receptors predicts survival and platinum sensitivity of HGSOC. AR, ER, and PR might be feasible prognostic biomarkers for HGSOC by immunohistochemical analysis.
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17
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Aubrey C, Saad N, Köbel M, Mattatall F, Nelson G, Glaze S. Implications for management of ovarian cancer in a transgender man: Impact of androgens and androgen receptor status. Gynecol Oncol 2021; 161:342-346. [PMID: 33663874 DOI: 10.1016/j.ygyno.2021.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 36-year-old transgender man (assigned female at birth) on exogenous testosterone therapy was found to have stage IIA ovarian endometrioid carcinoma, and underwent adjuvant chemotherapy. Diffuse androgen receptor expression in the tumor initiated a multidisciplinary discussion regarding the safety of continuing exogenous testosterone as gender-affirming hormone therapy.
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Affiliation(s)
- Christa Aubrey
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Canada
| | - Nathalie Saad
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Martin Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | - Fiona Mattatall
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - Gregg Nelson
- Department of Oncology, Division of Gynecologic Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, Canada
| | - Sarah Glaze
- Department of Oncology, Division of Gynecologic Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, Canada.
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18
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Hollis RL, Thomson JP, Stanley B, Churchman M, Meynert AM, Rye T, Bartos C, Iida Y, Croy I, Mackean M, Nussey F, Okamoto A, Semple CA, Gourley C, Herrington CS. Molecular stratification of endometrioid ovarian carcinoma predicts clinical outcome. Nat Commun 2020; 11:4995. [PMID: 33020491 PMCID: PMC7536188 DOI: 10.1038/s41467-020-18819-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/11/2020] [Indexed: 01/06/2023] Open
Abstract
Endometrioid ovarian carcinoma (EnOC) demonstrates substantial clinical and molecular heterogeneity. Here, we report whole exome sequencing of 112 EnOC cases following rigorous pathological assessment. We detect a high frequency of mutation in CTNNB1 (43%), PIK3CA (43%), ARID1A (36%), PTEN (29%), KRAS (26%), TP53 (26%) and SOX8 (19%), a recurrently-mutated gene previously unreported in EnOC. POLE and mismatch repair protein-encoding genes were mutated at lower frequency (6%, 18%) with significant co-occurrence. A molecular taxonomy is constructed, identifying clinically distinct EnOC subtypes: cases with TP53 mutation demonstrate greater genomic complexity, are commonly FIGO stage III/IV at diagnosis (48%), are frequently incompletely debulked (44%) and demonstrate inferior survival; conversely, cases with CTNNB1 mutation, which is mutually exclusive with TP53 mutation, demonstrate low genomic complexity and excellent clinical outcome, and are predominantly stage I/II at diagnosis (89%) and completely resected (87%). Moreover, we identify the WNT, MAPK/RAS and PI3K pathways as good candidate targets for molecular therapeutics in EnOC.
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Affiliation(s)
- Robert L Hollis
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - John P Thomson
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Barbara Stanley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Michael Churchman
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Alison M Meynert
- MRC Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Tzyvia Rye
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Clare Bartos
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Yasushi Iida
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.,The Jikei University School of Medicine, Tokyo, Japan
| | - Ian Croy
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Melanie Mackean
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Fiona Nussey
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Aikou Okamoto
- The Jikei University School of Medicine, Tokyo, Japan
| | - Colin A Semple
- MRC Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Charlie Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - C Simon Herrington
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
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19
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Krämer P, Talhouk A, Brett MA, Chiu DS, Cairns ES, Scheunhage DA, Hammond RFL, Farnell D, Nazeran TM, Grube M, Xia Z, Senz J, Leung S, Feil L, Pasternak J, Dixon K, Hartkopf A, Krämer B, Brucker S, Heitz F, du Bois A, Harter P, Kommoss FKF, Sinn HP, Heublein S, Kommoss F, Vollert HW, Manchanda R, de Kroon CD, Nijman HW, de Bruyn M, Thompson EF, Bashashati A, McAlpine JN, Singh N, Tinker AV, Staebler A, Bosse T, Kommoss S, Köbel M, Anglesio MS. Endometrial Cancer Molecular Risk Stratification is Equally Prognostic for Endometrioid Ovarian Carcinoma. Clin Cancer Res 2020; 26:5400-5410. [PMID: 32737030 DOI: 10.1158/1078-0432.ccr-20-1268] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/18/2020] [Accepted: 07/26/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Endometrioid ovarian carcinoma (ENOC) is generally associated with a more favorable prognosis compared with other ovarian carcinomas. Nonetheless, current patient treatment continues to follow a "one-size-fits-all" approach. Even though tumor staging offers stratification, personalized treatments remain elusive. As ENOC shares many clinical and molecular features with its endometrial counterpart, we sought to investigate The Cancer Genome Atlas-inspired endometrial carcinoma (EC) molecular subtyping in a cohort of ENOC. EXPERIMENTAL DESIGN IHC and mutation biomarkers were used to segregate 511 ENOC tumors into four EC-inspired molecular subtypes: low-risk POLE mutant (POLEmut), moderate-risk mismatch repair deficient (MMRd), high-risk p53 abnormal (p53abn), and moderate-risk with no specific molecular profile (NSMP). Survival analysis with established clinicopathologic and subtype-specific features was performed. RESULTS A total of 3.5% of cases were POLEmut, 13.7% MMRd, 9.6% p53abn, and 73.2% NSMP, each showing distinct outcomes (P < 0.001) and survival similar to observations in EC. Median OS was 18.1 years in NSMP, 12.3 years in MMRd, 4.7 years in p53abn, and not reached for POLEmut cases. Subtypes were independent of stage, grade, and residual disease in multivariate analysis. CONCLUSIONS EC-inspired molecular classification provides independent prognostic information in ENOC. Our findings support investigating molecular subtype-specific management recommendations for patients with ENOC; for example, subtypes may provide guidance when fertility-sparing treatment is desired. Similarities between ENOC and EC suggest that patients with ENOC may benefit from management strategies applied to EC and the opportunity to study those in umbrella trials.
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Affiliation(s)
- Pauline Krämer
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aline Talhouk
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
| | - Mary Anne Brett
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Derek S Chiu
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Evan S Cairns
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniëlla A Scheunhage
- Department of Pathology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Rory F L Hammond
- Barts Health National Health Service Trust, Department of Pathology, London, United Kingdom
| | - David Farnell
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tayyebeh M Nazeran
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel Grube
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Zhouchunyang Xia
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janine Senz
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samuel Leung
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lukas Feil
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jana Pasternak
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Katherine Dixon
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andreas Hartkopf
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Bernhard Krämer
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Sara Brucker
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Florian Heitz
- Kliniken Essen Mitte, Department of Gynecology and Gynecologic Oncology, Essen, Germany
- Charité Campus Virchow-Klinikum, Department for Gynecology with the Center for Oncologic Surgery, Berlin, Germany
| | - Andreas du Bois
- Kliniken Essen Mitte, Department of Gynecology and Gynecologic Oncology, Essen, Germany
| | - Philipp Harter
- Kliniken Essen Mitte, Department of Gynecology and Gynecologic Oncology, Essen, Germany
| | - Felix K F Kommoss
- Heidelberg University Hospital, Institute of Pathology, Heidelberg, Germany
| | - Hans-Peter Sinn
- Heidelberg University Hospital, Institute of Pathology, Heidelberg, Germany
| | - Sabine Heublein
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg and National Center for Tumor Diseases, Heidelberg, Germany
| | - Friedrich Kommoss
- Medizin Campus Bodensee, Institute of Pathology, Friedrichshafen, Germany
| | - Hans-Walter Vollert
- Department of Obstetrics and Gynecology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Ranjit Manchanda
- Barts CRUK Cancer Centre, Wolfson Institute of Preventative Medicine, Queen Mary University of London, Charterhouse Square, London, United Kingdom
- Department of Gynaecological Oncology, St. Bartholomew's Hospital, London, United Kingdom
| | - Cornelis D de Kroon
- Department of Gynecology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Hans W Nijman
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marco de Bruyn
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Emily F Thompson
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ali Bashashati
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica N McAlpine
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
| | - Naveena Singh
- Barts Health National Health Service Trust, Department of Pathology, London, United Kingdom
| | - Anna V Tinker
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Annette Staebler
- University Hospital Tuebingen, Institute of Pathology and Neuropathology, Tuebingen, Germany
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Stefan Kommoss
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - Martin Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael S Anglesio
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
- BC Cancer, Vancouver General Hospital, and University of British Columbia, British Columbia's Gynecological Cancer Research Team (OVCARE), Vancouver, British Columbia, Canada
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20
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Langdon SP, Herrington CS, Hollis RL, Gourley C. Estrogen Signaling and Its Potential as a Target for Therapy in Ovarian Cancer. Cancers (Basel) 2020; 12:cancers12061647. [PMID: 32580290 PMCID: PMC7352420 DOI: 10.3390/cancers12061647] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 12/24/2022] Open
Abstract
The estrogen receptor (ER) has functionality in selected ovarian cancer subtypes and represents a potential target for therapy. The majority (>80%) of high grade serous, low grade serous and endometrioid carcinomas and many granulosa cell tumors express ER-alpha (ERα), and these tumor types have demonstrated responses to endocrine therapy (tamoxifen and aromatase inhibitors) in multiple clinical studies. Biomarkers of responses to these drugs are actively being sought to help identify responsive cancers. Evidence for both pro-proliferative and pro-migratory roles for ERα has been obtained in model systems. ER-beta (ERβ) is generally considered to have a tumor suppressor role in ovarian cancer cells, being associated with the repression of cell growth and invasion. The differential expression of the specific ERβ isoforms may determine functionality within ovarian cancer cells. The more recently identified G protein-coupled receptor (GPER1; GPR30) has been shown to mediate both tumor-suppressive and tumor-promoting action in ovarian cancer cells, suggesting a more complex role. This review will summarize recent findings in this field.
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Affiliation(s)
- Simon P. Langdon
- Cancer Research UK Edinburgh Centre and Edinburgh Pathology, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK;
- Correspondence: ; Tel.: +44-(0)131-651-8694
| | - C. Simon Herrington
- Cancer Research UK Edinburgh Centre and Edinburgh Pathology, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK;
- The Nicola Murray Centre for Ovarian Cancer Research, CRUK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK; (R.L.H.); (C.G.)
| | - Robert L. Hollis
- The Nicola Murray Centre for Ovarian Cancer Research, CRUK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK; (R.L.H.); (C.G.)
| | - Charlie Gourley
- The Nicola Murray Centre for Ovarian Cancer Research, CRUK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK; (R.L.H.); (C.G.)
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21
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Irodi A, Rye T, Herbert K, Churchman M, Bartos C, Mackean M, Nussey F, Herrington CS, Gourley C, Hollis RL. Patterns of clinicopathological features and outcome in epithelial ovarian cancer patients: 35 years of prospectively collected data. BJOG 2020; 127:1409-1420. [PMID: 32285600 DOI: 10.1111/1471-0528.16264] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Investigate the clinical landscape of ovarian carcinoma (OC) over time. DESIGN Register-based prospectively collected data. SETTING South East Scotland. SAMPLE A total of 2805 OC patients diagnosed in 1981-2015. METHODS Survival times were visualised using the Kaplan-Meier method; median survival, 5-year survival probabilities and associated restricted mean survival time analyses were used to quantify survival differences. MAIN OUTCOME MEASURES Disease-specific survival. RESULTS A significant increase in disease-specific survival (DSS) from 1981-1985 to 2011-2015 was observed (median 1.73 versus 4.23 years, P < 0.0001). Corresponding increase in progression-free survival (PFS) was not statistically significant (median 1.22 versus 1.58 years, P = 0.2568). An increase in the proportion of cases with low residual disease volume (RD) (<2 cm RD) following debulking was observed (54.0% versus 87.7%, P < 0.0001). The proportion of high grade serous (HGS) cases increased (P < 0.0001), whereas endometrioid and mucinous cases decreased (P = 0.0005 and P = 0.0002). Increases in stage IV HGS OC incidence (P = 0.0009) and stage IV HGS OC DSS (P = 0.0122) were observed. Increasing median age at diagnosis correlated with increasing Eastern Cooperative Oncology Group Performance Status (ECOG PS) over time (r = 0.86). CONCLUSIONS OC DSS has improved over the last 35 years. PFS has not significantly increased, highlighting that improvement in outcome has been limited to extending post-relapse survival. Distribution of stage at diagnosis, histological subtype and RD following debulking has changed over time, reflecting evolution in tumour classification, staging and optimal debulking definitions (from low RD to minimal or zero RD). Histology, stage, RD and ECOG PS remain reliable outcome predictors. Increasing median age at diagnosis and ECOG PS indicates demographic shifts in the clinical population. TWEETABLE ABSTRACT Significant improvement in ovarian carcinoma survival has been seen over time. Most of this improvement is due to an extension of survival following disease relapse.
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Affiliation(s)
- A Irodi
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - T Rye
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - K Herbert
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.,Oxford Cancer Centre, Churchill Hospital, Oxford, UK
| | - M Churchman
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - C Bartos
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - M Mackean
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - F Nussey
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - C S Herrington
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - C Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - R L Hollis
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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