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Wijayabahu AT, McGee-Avila JK, Shiels MS, Harsono AAH, Arend RC, Clarke MA. Five-Year Relative Survival Rates of Women Diagnosed with Uterine Cancer by County-Level Socioeconomic Status Overall and across Histology and Race/Ethnicity. Cancers (Basel) 2024; 16:2747. [PMID: 39123474 PMCID: PMC11311553 DOI: 10.3390/cancers16152747] [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: 05/25/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Understanding socioeconomic factors contributing to uterine cancer survival disparities is crucial, especially given the increasing incidence of uterine cancer, which disproportionately impacts racial/ethnic groups. We investigated the impact of county-level socioeconomic factors on five-year survival rates of uterine cancer overall and by histology across race/ethnicity. We included 333,013 women aged ≥ 30 years with microscopically confirmed uterine cancers (2000-2018) from the Surveillance, Epidemiology, and End Results 22 database followed through 2019. Age-standardized five-year relative survival rates were compared within race/ethnicity and histology, examining the differences across tertiles of county-level percent (%)
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Affiliation(s)
- Akemi T. Wijayabahu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA; (J.K.M.-A.); (M.S.S.); (M.A.C.)
| | - Jennifer K. McGee-Avila
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA; (J.K.M.-A.); (M.S.S.); (M.A.C.)
| | - Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA; (J.K.M.-A.); (M.S.S.); (M.A.C.)
| | - Alfonsus Adrian H. Harsono
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35233, USA; (A.A.H.H.); (R.C.A.)
| | - Rebecca C. Arend
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35233, USA; (A.A.H.H.); (R.C.A.)
| | - Megan A. Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA; (J.K.M.-A.); (M.S.S.); (M.A.C.)
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Song S, Zhang D, Wang Y, Song Z. Changing trends in the disease burden of uterine cancer globally from 1990 to 2019 and its predicted level in 25 years. Front Oncol 2024; 14:1361419. [PMID: 38711851 PMCID: PMC11070460 DOI: 10.3389/fonc.2024.1361419] [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: 12/26/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Background We aim to evaluate the global, regional, and national burden of Uterine Cancer (UC) from 1990 to 2019. Methods We gathered UC data across 204 countries and regions for the period 1990-2019, utilizing the Global Burden of Disease Database (GBD) 2019 public dataset. Joinpoint regression analysis was employed to pinpoint the year of the most significant changes in global trends. To project the UC trajectory from 2020 to 2044, we applied the Nordpred analysis, extrapolating based on the average trend observed in the data. Furthermore, the Bayesian Age-Period-Cohort (BAPC) model with integrated nested Laplace approximations was implemented to confirm the stability of the Nordpred analysis predictions. Results Globally, the age-standardized rate (ASR) of incidence for UC has increased from 1990 to 2019 with an Average Annual Percentage Change (AAPC) of 0.50%. The ASR for death has declined within the same period (AAPC: -0.8%). An increase in the ASR of incidence was observed across all Socio-demographic Index (SDI) regions, particularly in High SDI regions (AAPC: 1.12%), while the ASR for death decreased in all but the Low SDI regions. Over the past 30 years, the highest incidence rate was observed in individuals aged 55-59 (AAPC: 0.76%). Among 204 countries and regions, there was an increase in the ASR of incidence in 165 countries and an increase in the ASR of deaths in 77 countries. Our projections suggest that both the incidence and death rates for UC are likely to continue their decline from 2020 to 2044. Conclusions UC has significantly impacted global health negatively, with its influence stemming from a range of factors including geographical location, age-related and racial disparities, and SDI.
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Affiliation(s)
- Shuang Song
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Dandan Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yizi Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zixuan Song
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Tal O, Amram S, Landman T, Feldstein O, Peled O, Levy T. D&C has the best concordance between preoperative and postoperative grades among morbidly obese endometrial cancer patients. J Obstet Gynaecol Res 2024; 50:494-500. [PMID: 38124179 DOI: 10.1111/jog.15862] [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: 08/18/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
AIM Endometrial cancer is diagnosed by obtaining uterine biopsies by pipelle, dilatation and curettage (D&C), or hysteroscopy. In 15%-25% of the cases, the preoperative and postoperative grades do not match. This discrepancy may carry significant clinical and prognostic consequences. We aimed to assess how body mass index (BMI) affects preoperative and postoperative grade mismatches and whether biopsy methods mitigate this effect. METHODS We conducted a retrospective review of patients with endometrial cancer who underwent surgery at our center between 2014 and 2022. We stratified patients into six classes of BMI based on the WHO classification. Preoperative and postoperative grades were compared for concordance with regards to patient BMI and sampling method. RESULTS A total of 158 patients were included, diagnosed by pipelle (n = 99), hysteroscopy (n = 15), or D&C (n = 44). For all methods, every unit increase in BMI increased the odds of having a gap between histology grades by 5.2%. In the pipelle group, the odds of a larger gap between the histology grades was 62% higher than that of women in the other groups. Among the D&C group, the odds of having a bigger difference between histology grades were 91.8% lower compared to the other groups. Patients with BMI over 30 had nearly 50% discrepancy when diagnosed with pipelle or hysteroscopy, but less than 10% with D&C. CONCLUSIONS Increasing BMI is associated with decreasing concordance between preoperative and postoperative grades in endometrial cancer, especially when it exceeds 30. This effect is much less pronounced, however, when the diagnostic method is D&C.
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Affiliation(s)
- Ori Tal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Stav Amram
- Adelson Faculty of Medicine, Ariel University, Ariel, Israel
| | - Tom Landman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ohad Feldstein
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ofri Peled
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tally Levy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Xia C, Xu J, Ding X. Alienation from medical care policy, medical care avoidance, and the role of sex and risk perception. BMC Psychiatry 2023; 23:594. [PMID: 37582725 PMCID: PMC10428645 DOI: 10.1186/s12888-023-05104-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Medical care avoidance affects individuals' health status. Previous studies on medical care avoidance have mainly focused on medical costs and people's satisfaction with medical services. This study investigates whether an individual's sense of policy alienation toward medical care policy (SPA-M) affects behavioral intention of medical care avoidance, and to what extent an intermediary variable-medical financial risk perception-mediates the relationship between SPA-M and medical care avoidance. METHODS A cross-sectional survey was conducted involving 434 people aged 35-59 years from Wuhu, a city in China's Anhui province. A moderated mediation model was constructed to investigate the research question and sex (biological: male and female) was used as a moderating variable between SPA-M and medical financial risk perception. RESULTS We found that SPA-M significantly impacted medical care avoidance, and that medical financial risk perception played a complete mediating role in this relationship, while sex moderated the relationship between SPA-M and medical financial risk perception. CONCLUSION This study contributes to the literature by enhancing our understanding of the factors that influence behavioral intention regarding medical care avoidance, deepening our understanding of the role of SPA-M in medical care policy, and expanding the role of sex differences in the analysis of the relationship between SPA-M, medical financial risk perception, and medical care avoidance, offering implications for public and community health.
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Affiliation(s)
- Chun Xia
- School of Educational Science, Anhui Normal University, Jiuhua-Nan-Road 189, Wuhu, Anhui Province, 241000, China
| | - Jia Xu
- School of Marxism, Anhui Normal University, Jiuhua-Nan-Road 189, Wuhu, Anhui Province, 241000, China.
| | - Xiuzhen Ding
- School of History, Anhui Normal University, Jiuhua-Nan-Road 189, Wuhu, Anhui Province , 241000, China
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Schlumbrecht M, Wright K, George S. Unique Considerations in Early Detection, Risk, and Awareness of Endometrial Cancer in Black Women. Cancer Control 2023; 30:10732748231202952. [PMID: 37732413 PMCID: PMC10515581 DOI: 10.1177/10732748231202952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Endometrial cancer is the most common gynecologic cancer in the United States. Over the last several decades, the incidence of aggressive tumors, and thus the rate of death from disease, has increased significantly. The population most affected by these epidemiologic shifts are Black women. Symptom awareness, lack of treatment access, and failure of providers to provide guideline-concordant care are just some of the drivers behind these changes. Race as a social construct has historically categorized women into groups that are not reflective of the nuanced personalization that is required for cancer prevention strategies and targeted cancer treatments. There is, however, an increasing understanding that disaggregation by place of birth and social context are important to understand care-seeking behaviors, genetic drivers of disease, and factors that lead to deleterious outcomes. In this review, we will focus on specific individual-level influences that impact disease diagnosis and care-seeking among Black women, recognizing that the global disparities which exist in this disease encompass multiple domains. Such considerations are crucial to understanding drivers of self-efficacy and to develop programs for knowledge awareness and empowerment within a framework that is both useful and acceptable to these diverse communities at risk.
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Affiliation(s)
- Matthew Schlumbrecht
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kallia Wright
- School of Communication, University of Miami, Coral Gables, FL, USA
| | - Sophia George
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Gregory J, Foster L, O'Shaughnessy P, Robson S. The socioeconomic gradient in mortality from ovarian, cervical, and endometrial cancer in Australian women, 2001-2018: A population-based study. Aust N Z J Obstet Gynaecol 2022; 62:714-719. [PMID: 35708170 PMCID: PMC9796872 DOI: 10.1111/ajo.13553] [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: 01/31/2022] [Accepted: 05/01/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Socio-economic (SE) status is closely linked to health status and the mechanisms of this association are complex. One important adverse effect of SE disadvantage is vulnerability to cancer and cancer is a major cause of morbidity and mortality in Australia. AIMS We aimed to estimate the effect of SE status on mortality rates from ovarian, cervical, and endometrial cancer. MATERIALS AND METHODS National mortality data were obtained from the Australian Bureau of Statistics (ABS) for the calendar years from 2001 to 2018, inclusive. Individual deaths were grouped by the ABS Index of Relative Socio-economic Advantage and Disadvantage. Population data were obtained to provided denominators allowing calculation of mortality rates (deaths per 100 000 women aged 30-79 years). Statistical analyses performed included tabulating point-estimates of mortality rates and their changes over time and modelling the trends of rates using maximum likelihood method. RESULTS Age-standardised mortality rates for ovarian and cervical cancer fell over the study period but increased for endometrial cancer. There was clear evidence of a SE gradient in the mortality rate for all three cancers. This SE gradient increased over the study period for ovarian and cervical cancer but remained unchanged for endometrial cancer. CONCLUSIONS Women at greater SE disadvantage have higher rates of death from the commonest gynaecological cancers and this gradient has not reduced over the last two decades. After the COVID-19 pandemic efforts must be redoubled to ensure that Australians already at risk of ill health do not face even greater risks because of their circumstances.
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Affiliation(s)
- James Gregory
- Junior Medical OfficerNepean HospitalSydneyNew South WalesAustralia
| | - Leon Foster
- Senior Subspecialty Trainee, Gynaecological OncologyRoyal Hospital for WomenSydneyNew South WalesAustralia
| | - Pauline O'Shaughnessy
- School of Mathematics and Applied StatisticsUniversity of WollongongWollongongNew South WalesAustralia
| | - Stephen J. Robson
- School of Health and MedicineAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
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Dhanis J, Blake D, Rundle S, Pijnenborg JMA, Smits A. Cytoreductive surgery in recurrent endometrial cancer: A new paradigm for surgical management? Surg Oncol 2022; 43:101811. [PMID: 35849994 DOI: 10.1016/j.suronc.2022.101811] [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: 04/03/2022] [Revised: 06/14/2022] [Accepted: 07/03/2022] [Indexed: 11/25/2022]
Abstract
The objective was to review the literature on the effect of surgical cytoreduction in recurrent endometrial cancer on survival, and identify baseline and clinical factors associated with improved survival. In addition, we sought to assess the effect of previous radiotherapy on surgical achievement. This review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We performed a search of PubMed and Cochrane Library to identify studies comparing cytoreductive surgery to medical management and studies reporting on patients receiving cytoreductive surgery as part of multi-modal treatment. Primary outcomes included overall survival and progression free survival, secondary outcomes included factors associated with improved survival. A total of 11 studies fulfilled the inclusion criteria, comprising 1146 patients. All studies were retrospective studies. Cytoreduction as part of treatment for recurrent endometrial cancer was associated with prolonged overall survival and progression free survival. Complete cytoreduction was an independent factor associated with improved survival. Other factors associated with prolonged survival were tumor grade 1, endometrioid histology, ECOG performance status 0, and isolated pelvic recurrences. Factors associated with obtaining complete cytoreduction included solitary disease, tumor size <6 cm and ECOG performance status 0. Previous radiotherapy was not associated with achieving complete cytoreduction. Cytoreductive surgery may benefit patients meeting specific selection criteria based on a limited number of retrospective studies, with complete cytoreduction showing the largest survival gain. However, further prospective studies are needed to validate the survival benefit and aid in patient selection.
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Affiliation(s)
- Joëlle Dhanis
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, the Netherlands; Faculty of Medical Sciences, Radboud University, Geert Grooteplein Noord 21, 6525EZ, Nijmegen, the Netherlands.
| | - Dominic Blake
- Department of Gynaecological Oncology, Queen Elizabeth Hospital, Queen Elizabeth Avenue, NE9 6SX, Gateshead, United Kingdom
| | - Stuart Rundle
- Department of Gynaecological Oncology, Queen Elizabeth Hospital, Queen Elizabeth Avenue, NE9 6SX, Gateshead, United Kingdom
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, the Netherlands
| | - Anke Smits
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, the Netherlands; Department of Gynaecological Oncology, Queen Elizabeth Hospital, Queen Elizabeth Avenue, NE9 6SX, Gateshead, United Kingdom.
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Bedir A, Abera SF, Vordermark D, Medenwald D. Socioeconomic disparities in endometrial cancer survival in Germany: a survival analysis using population-based cancer registry data. J Cancer Res Clin Oncol 2022; 148:1087-1095. [PMID: 35064816 PMCID: PMC9015991 DOI: 10.1007/s00432-021-03908-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/27/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Area-based socioeconomic deprivation has been established as an important indicator of health and a potential predictor of survival. In this study, we aimed to measure the effect of socioeconomic inequality on endometrial cancer survival. METHODS Population-based data on patients diagnosed with endometrial cancer between 2004 and 2014 were obtained from the German Centre for Cancer Registry Data. Socioeconomic inequality was defined by the German Index of Socioeconomic Deprivation. We investigated the association of deprivation and overall survival through Kaplan-Meier curves and Cox proportional regression models. RESULTS A total of 21,602 women, with a mean age of 67.8 years, were included in our analysis. The observed 5-year overall survival time for endometrial cancer patients living in the most affluent districts (first quintile) was 78.6%. The overall survival rate decreased as the level of deprivation increased (77.2%, 73.9%, 76.1%, 74.7%, for patients in the second, third, fourth, and fifth quintile (most deprived patients), respectively). Cox regression models showed stage I patients living in the most deprived districts to have a higher hazard of overall mortality when compared to the cases living in the most affluent districts [Hazard ratio: 1.20; 95% Confidence interval (0.99-1.47)] after adjusting for age, tumor characteristics, and treatment. CONCLUSION Our results indicate differences in endometrial cancer survival according to socioeconomic deprivation among stage I patients. Considering data limitations, future studies with access to individual-level patient information should be conducted to examine the underlying causes for the observed disparity in cancer survival.
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Affiliation(s)
- Ahmed Bedir
- Health Services Research Group, Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Semaw Ferede Abera
- Health Services Research Group, Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Dirk Vordermark
- Health Services Research Group, Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Daniel Medenwald
- Health Services Research Group, Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
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Njoku K, Barr CE, Crosbie EJ. Current and Emerging Prognostic Biomarkers in Endometrial Cancer. Front Oncol 2022; 12:890908. [PMID: 35530346 PMCID: PMC9072738 DOI: 10.3389/fonc.2022.890908] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 12/19/2022] Open
Abstract
Endometrial cancer is the most common gynaecological malignancy in high income countries and its incidence is rising. Whilst most women with endometrial cancer are diagnosed with highly curable disease and have good outcomes, a significant minority present with adverse clinico-pathological characteristics that herald a poor prognosis. Prognostic biomarkers that reliably select those at greatest risk of disease recurrence and death can guide management strategies to ensure that patients receive appropriate evidence-based and personalised care. The Cancer Genome Atlas substantially advanced our understanding of the molecular diversity of endometrial cancer and informed the development of simplified, pragmatic and cost-effective classifiers with prognostic implications and potential for clinical translation. Several blood-based biomarkers including proteins, metabolites, circulating tumour cells, circulating tumour DNA and inflammatory parameters have also shown promise for endometrial cancer risk assessment. This review provides an update on the established and emerging prognostic biomarkers in endometrial cancer.
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Affiliation(s)
- Kelechi Njoku
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Stoller Biomarker Discovery Centre, University of Manchester, Manchester, United Kingdom
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester, University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Chloe E. Barr
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester, University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Emma J. Crosbie
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester, University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- *Correspondence: Emma J. Crosbie,
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Role of Precision Oncology in Type II Endometrial and Prostate Cancers in the African Population: Global Cancer Genomics Disparities. Int J Mol Sci 2022; 23:ijms23020628. [PMID: 35054814 PMCID: PMC8776204 DOI: 10.3390/ijms23020628] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023] Open
Abstract
Precision oncology can be defined as molecular profiling of tumors to identify targetable alterations. Emerging research reports the high mortality rates associated with type II endometrial cancer in black women and with prostate cancer in men of African ancestry. The lack of adequate genetic reference information from the African genome is one of the major obstacles in exploring the benefits of precision oncology in the African context. Whilst external factors such as the geography, environment, health-care access and socio-economic status may contribute greatly towards the disparities observed in type II endometrial and prostate cancers in black populations compared to Caucasians, the contribution of African ancestry to the contribution of genetics to the etiology of these cancers cannot be ignored. Non-coding RNAs (ncRNAs) continue to emerge as important regulators of gene expression and the key molecular pathways involved in tumorigenesis. Particular attention is focused on activated/repressed genes and associated pathways, while the redundant pathways (pathways that have the same outcome or activate the same downstream effectors) are often ignored. However, comprehensive evidence to understand the relationship between type II endometrial cancer, prostate cancer and African ancestry remains poorly understood. The sub-Saharan African (SSA) region has both the highest incidence and mortality of both type II endometrial and prostate cancers. Understanding how the entire transcriptomic landscape of these two reproductive cancers is regulated by ncRNAs in an African cohort may help elucidate the relationship between race and pathological disparities of these two diseases. This review focuses on global disparities in medicine, PCa and ECa. The role of precision oncology in PCa and ECa in the African population will also be discussed.
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Nichols MR, Gaskins JT, Metzinger DS, Todd SL, Eldredge-Hindy HB, Silva SR. Trends in Incidence and Mortality Rates of Uterine Cancer in Kentucky. South Med J 2021; 114:630-635. [PMID: 34599340 DOI: 10.14423/smj.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The objective of this analysis was to gauge how the incidence and mortality of uterine cancer in Kentucky have changed from 1995 through 2017. An assessment of the trends in incidence and mortality across different geographic areas and between different races was also performed. METHODS Age-adjusted annual incidence and mortality rates for uterine cancer were obtained from the Kentucky Cancer Registry. A meta-regression framework was used to assess changes in incidence and mortality rates during the time frame and to determine differences in these rates between rural versus urban counties, Appalachian versus non-Appalachian counties, and Black versus White women. RESULTS The incidence of uterine cancer has significantly increased throughout the state of Kentucky since 1995. Uterine cancer incidence was 10% and 22% higher in rural and Appalachian counties, respectively, compared with urban and non-Appalachian counties (P < 0.0001) from 1995 through 2017. In contrast, urban and non-Appalachian women had higher or equivalent age-adjusted mortality from uterine cancer, compared with rural and Appalachian women, respectively. The incidence of uterine cancer was significantly higher in White women compared with Black women from 1995 through 2006, but since 2007, there has been no significant difference in uterine cancer incidence based on race. Black women had higher age-adjusted mortality than White women throughout the entire time period examined. CONCLUSIONS The incidence of uterine cancer is higher in rural and Appalachian Kentucky, without a corresponding geographic trend in mortality. Uterine cancer mortality is significantly higher in Black women.
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Affiliation(s)
- Matthew R Nichols
- From the Departments of Gynecologic Oncology and Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, the Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, and the Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Jeremy T Gaskins
- From the Departments of Gynecologic Oncology and Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, the Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, and the Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Daniel S Metzinger
- From the Departments of Gynecologic Oncology and Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, the Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, and the Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Sarah L Todd
- From the Departments of Gynecologic Oncology and Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, the Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, and the Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Harriet B Eldredge-Hindy
- From the Departments of Gynecologic Oncology and Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, the Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, and the Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Scott R Silva
- From the Departments of Gynecologic Oncology and Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, the Department of Bioinformatics & Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, and the Department of Radiation Oncology, Medical University of South Carolina, Charleston
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Hu H, Wang Z, Zhang M, Niu F, Yu Q, Ren Y, Ye Z. Clinicopathological Characteristics and Prognosis in Endometrial Cancer With Bone Metastasis: A SEER-Based Study of 584 Women. Front Oncol 2021; 11:694718. [PMID: 34277441 PMCID: PMC8280469 DOI: 10.3389/fonc.2021.694718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/17/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose Bone metastasis from endometrial cancer (EC) is rare and poorly described. The purpose of the present study was to investigate the correlation between the clinically accessible factors and survival time among EC patients with bone metastasis. Patients and Methods We retrospectively identified and reviewed EC patients with bone metastasis from 2010 to 2016, based on the Surveillance, Epidemiology and End Results (SEER) database. Univariable and multivariable Cox regressions were applied to evaluate the effects of clinical variables on survival. Kaplan–Meier plots were used to visually demonstrate the correlation between independent risk factors and survival. Results Clinical data of 584 EC patients with bone metastasis from the SEER database were analyzed. EC patients with bone metastasis experienced extremely poor survival, with 1-year overall survival (OS) and cancer-specific survival (CSS) rates 33.8 and 35.8%, respectively. Variables associated with OS and CSS in the univariable analysis included race, tumor grade, tumor subtype, tumor size, lung, liver and brain metastases, surgery, radiotherapy, and chemotherapy. In the multivariable analysis, tumor grade, tumor subtype, liver and brain metastases, local surgery, and systemic chemotherapy remained independent risk factors for OS and CSS. However, local radiotherapy was an independent predictor of OS, not CSS. Conclusions We identified several factors affect the survival of EC patients with bone metastasis, which is useful for clinicians to assess patients’ outcomes. Our study supports surgery and radiotherapy of primary EC, and systemic chemotherapy for prolonging survival among EC patients with bone metastasis, which lays a solid foundation for defining optimal treatment strategy in this specific cohort.
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Affiliation(s)
- Hejia Hu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Zhan Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Miaofeng Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Feng Niu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Orthopedics, Ningbo Municipal Hospital of TCM, Ningbo, China
| | - Qunfei Yu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Ren
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhaoming Ye
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
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13
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Njoku K, Barr CE, Hotchkies L, Quille N, Wan YL, Crosbie EJ. Impact of socio-economic deprivation on endometrial cancer survival in the North West of England: a prospective database analysis. BJOG 2021; 128:1215-1224. [PMID: 33289967 PMCID: PMC8248174 DOI: 10.1111/1471-0528.16618] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the impact of socio-economic deprivation on endometrial cancer survival. DESIGN Single-centre prospective database study. SETTING North West England. POPULATION Women with endometrial cancer treated between 2010 and 2015. METHODS Areal-level socio-economic status, using the English indices of multiple deprivation from residential postcodes, was analysed in relation to survival using Kaplan-Meier estimation and multivariable Cox regression. MAIN OUTCOME MEASURES Overall survival, cancer-specific survival and patterns and rates of recurrence. RESULTS A total of 539 women, with a median age of 66 years (interquartile range, IQR 56-73 years) and a body mass index (BMI) of 32 kg/m2 (IQR 26-39 kg/m2 ), were included in the analysis. Women in the most deprived social group were younger (median 64 years, IQR 55-72 years) and more obese (median 34 kg/m2 , IQR 28-42 kg/m2 ) than women in the least deprived group (median age 68 years, IQR 60-74 years; BMI 29 kg/m2 , IQR 25-36 kg/m2 ; P = 0.002 and <0.001, respectively). There were no differences in endometrial cancer type, stage or grade between social groups. There was no difference in recurrence rates, however, women in the middle and most deprived social groups were more likely to present with distant/metastatic recurrence (80.6 and 79.2%, respectively) than women in the least deprived group (43.5%, P < 0.001). Women in the middle and most deprived groups had a two-fold (adjusted hazard ratio, HR = 2.00, 95% CI 1.07-3.73, P = 0.030) and 53% (adjusted HR = 1.53, 95% CI 0.77-3.04, P = 0.221) increase in cancer-specific mortality compared with women in the least deprived group. There were no differences in overall survival. CONCLUSIONS We found that socio-economically deprived women with endometrial cancer were more likely to develop fatal recurrence. Larger studies are needed to confirm these findings and to identify modifiable contributing factors. TWEETABLE ABSTRACT Socio-economic deprivation is linked to an increased risk of death from endometrial cancer in the North West of England.
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Affiliation(s)
- K Njoku
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and HealthSt Mary’s HospitalUniversity of ManchesterManchesterUK
- Division of Cancer SciencesFaculty of Biology, Medicine and HealthStoller Biomarker Discovery CentreUniversity of ManchesterManchesterUK
- Department of Obstetrics and GynaecologyManchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - CE Barr
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and HealthSt Mary’s HospitalUniversity of ManchesterManchesterUK
- Department of Obstetrics and GynaecologyManchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - L Hotchkies
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and HealthSt Mary’s HospitalUniversity of ManchesterManchesterUK
| | - N Quille
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and HealthSt Mary’s HospitalUniversity of ManchesterManchesterUK
| | - YL Wan
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and HealthSt Mary’s HospitalUniversity of ManchesterManchesterUK
- Department of Obstetrics and GynaecologyManchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - EJ Crosbie
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and HealthSt Mary’s HospitalUniversity of ManchesterManchesterUK
- Department of Obstetrics and GynaecologyManchester University NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
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14
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Javadian P, Washington C, Mukasa S, Benbrook DM. Histopathologic, Genetic and Molecular Characterization of Endometrial Cancer Racial Disparity. Cancers (Basel) 2021; 13:cancers13081900. [PMID: 33920951 PMCID: PMC8071317 DOI: 10.3390/cancers13081900] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Black patients are diagnosed and die earlier of endometrial cancer in comparison with their White counterparts. Factors that have been implicated in this racial disparity, such as socioeconomic status, increased frequencies of more aggressive tumor histology, and comorbid conditions, do not account for all of the disparity. Molecular defects in the endometrial tumors likely also contribute to the more aggressive tumor biology and the patient disparities. In this study, we reviewed the published data of molecular characteristics of endometrial cancer in different races. The majority of the publications compare Black and White patients, and identify molecules and pathways that can be targeted with existing drugs. These findings encourage molecular profile studies comparing additional races and ethnicities, and development of race-specific treatments. Abstract In contrast to the decline in incidence and mortality of most other cancers, these rates are rising for endometrial cancer. Black women with endometrial cancer have earlier diagnosis, more aggressive histology, advanced stage and worse outcomes compared with their White counterparts. Socioeconomic status, a higher incidence of aggressive histology, and comorbid conditions are known factors leading to racial disparity in patients with endometrial cancer; nevertheless, they do not account for the entire racial disparity; which emphasizes the roles of molecular, histopathological and genetic factors. We performed a comprehensive review of all published scientific literature up to January 2021 reporting histopathologic, genetic and molecular factors associated with racial disparities in patients with endometrial cancer. The interactions and pathways of molecules reported to have significant differential expression in endometrial cancers from Black and White patients were identified with Ingenuity Pathway Analysis. The majority of studies compared Black and White patients; however, limited data are available for other racial and ethnic groups. Reported differences that could account for the worse survival of Black endometrial cancer patients include more aggressive histopathologies and molecular alterations, including upregulation of molecules driving cell cycle progression, and p53 and HER2/NEU signaling. Several of these molecules are targeted by existing pharmaceuticals. These findings encourage further study and the development of race-specific treatment strategies.
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Affiliation(s)
- Pouya Javadian
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
- Correspondence: (P.J.); (D.M.B.)
| | - Christina Washington
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Shylet Mukasa
- Arkansas College of Osteopathic Medicine, Fort Smith, AR 72916, USA;
| | - Doris Mangiaracina Benbrook
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
- Correspondence: (P.J.); (D.M.B.)
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15
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Králíčková M, Vetvicka V, Laganà AS. Endometrial cancer-is our knowledge changing? Transl Cancer Res 2020; 9:7734-7745. [PMID: 35117376 PMCID: PMC8798081 DOI: 10.21037/tcr-20-1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/29/2020] [Indexed: 11/27/2022]
Abstract
In developed countries, endometrial cancer (EC) is the most frequent gynecologic malignancy in postmenopausal women. At the same time, EC has become one of the most common cancers in numerous developing countries, probably influenced by global epidemic of obesity. The majority of patients have low-grade endometrioid cancer with a high 5-year survival rate, but with high-risk EC, the survival rates are still rather low. However, despite intensive research in last decades, our knowledge of the mechanisms, risk factors, diagnosis and treatment have not significantly improved. The standard treatment of all types of EC is still a traditional combination of surgery, irradiation and/or chemotherapy, despite the fact that each of these options is not without having some negative side effects. Despite the fact that on the molecular level, EC is relatively well-studied, but the efforts to transform these findings into either diagnosis or therapies of EC remain elusive. In addition, some research into risk factors involved in the development or progression of EC seems to be more a fishing expedition than a well thought-out approach. The purpose of this review is to summarize the most recent developments in the search for biomarkers and prognostic markers and to discuss the progress in EC treatment.
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Affiliation(s)
- Milena Králíčková
- Department of Histology and Embryology, Faculty of Medicine, Charles University, Karlovarska 48, Plzen, Czech Republic.,Department of Obstetrics and Gynecology, University Hospital, Faculty of Medicine, Charles University, Alej Svobody 80, Plzen, Czech Republic.,Biomedical Centre, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - Vaclav Vetvicka
- Department of Pathology, University of Louisville, Louisville, KY, USA
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Piazza Biroldi 1, Varese, Italy
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