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Jiang XY, Hu JJ, Wang R, Zhang WY, Jin QQ, Yang YT, Mei J, Hong L, Yao H, Tao F, Li JJ, Liu Y, Zhang L, Chen SX, Chen G, Song Y, Zhou SG. Cuproptosis-Associated lncRNA Gene Signature Establishes New Prognostic Profile and Predicts Immunotherapy Response in Endometrial Carcinoma. Biochem Genet 2024; 62:3439-3466. [PMID: 38108937 PMCID: PMC11427535 DOI: 10.1007/s10528-023-10574-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/26/2023] [Indexed: 12/19/2023]
Abstract
Uterine corpus endometrial carcinoma (UCEC), a prevalent kind of cancerous tumor in female reproductive system that has a dismal prognosis in women worldwide. Given the very limited studies of cuproptosis-related lncRNAs (CRLs) in UCEC. Our purpose was to construct a prognostic profile based on CRLs and explore its assess prognostic value in UCEC victims and its correlation with the immunological microenvironment. METHODS 554 UCEC tumor samples and 23 normal samples' RNA-seq statistics and clinical details were compiled from data in the TCGA database. CRLs were obtained using Pearson correlation analysis. Using LASSO Cox regression, multivariate Cox regression, and univariate Cox regression analysis, six CRLs are confirmed to develop a risk prediction model at last.We identified two main molecular subtypes and observed that multilayer CRLs modifications were related to patient clinicopathological features, prognosis, and tumor microenvironment (TME) cell infiltration characteristics, and then we verified the prognostic hallmark of UCEC and examined its immunological landscape.Finally, using qRT-PCR, model hub genes' expression patterns were confirmed. RESULTS A unique CRL signature was established by the combination of six differently expressed CRLs that were highly linked with the prognosis of UCEC patients. According to their CRLs signatures, the patients were divided into two groups: the low-risk and the high-risk groups. Compared to individuals at high risk, patients at low risk had higher survival rates (p < 0.001). Additionally, Cox regression reveals that the profiles of lncRNAs linked to cuproptosis may independently predict prognosis in UCEC patients. The 1-, 3-, and 5-year risks' respective receiver operating characteristics (ROC) exhibited AUC values of 0.778, 0.810, and 0.854. Likewise, the signature could predict survival in different groups based on factors like stage, age, and grade, among others. Further investigation revealed differences between the different risk score groups in terms of drug sensitivity,immune cell infiltration,tumor mutation burden (TMB) score and microsatellite instability (MSI) score. Compared to the group of high risk, the low-risk group had greater rates of TMB and MSI. Results from qRT-PCR revealed that in UCEC vs normal tissues, AC026202.2, NRAV, AC079466.2, and AC090617.5 were upregulated,while LINC01545 and AL450384.1 were downregulated. CONCLUSIONS Our research clarified the relationship between CRLs signature and the immunological profile and prognosis of UCEC.This signature will establish the framework for future investigations into the endometrial cancer CRLs mechanism as well as the exploitation of new diagnostic tools and new therapeutic.
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Affiliation(s)
- Xi-Ya Jiang
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
- Department of Gynecology and Obstetrics, The Fifth Clinical College of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Jing-Jing Hu
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
- Department of Reproduction, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Rui Wang
- Department of Clinical Laboratory, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
| | - Wei-Yu Zhang
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
- Department of Gynecology and Obstetrics, The Fifth Clinical College of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Qin-Qin Jin
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
- Department of Gynecology and Obstetrics, The Fifth Clinical College of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Yin-Ting Yang
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
- Department of Gynecology and Obstetrics, The Fifth Clinical College of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Jie Mei
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
- Department of Gynecology and Obstetrics, The Fifth Clinical College of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Lin Hong
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
- Department of Gynecology and Obstetrics, The Fifth Clinical College of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Hui Yao
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
- Department of Gynecology and Obstetrics, The Fifth Clinical College of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Feng Tao
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
- Department of Gynecology and Obstetrics, The Fifth Clinical College of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Jie-Jie Li
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
- Department of Gynecology and Obstetrics, The Fifth Clinical College of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Yu Liu
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
- Department of Gynecology and Obstetrics, The Fifth Clinical College of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Li Zhang
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
- Department of Gynecology and Obstetrics, The Fifth Clinical College of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Shun-Xia Chen
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
- Department of Gynecology and Obstetrics, The Fifth Clinical College of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Guo Chen
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China
- Department of Gynecology and Obstetrics, The Fifth Clinical College of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Yang Song
- Department of Pain, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China.
| | - Shu-Guang Zhou
- Department of Gynecology and Obstetrics, Maternity and Child Healthcare Hospital Affiliated to Anhui Medical University, Anhui Province Maternity and Child Healthcare Hospital, Hefei, 230001, Anhui, China.
- Department of Gynecology and Obstetrics, The Fifth Clinical College of Anhui Medical University, Hefei, 230032, Anhui, China.
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2
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Auranen A, Powell MA, Sukhin V, Landrum LM, Ronzino G, Buscema J, Bauerschlag D, Lalisang R, Bender D, Gilbert L, Armstrong A, Safra T, Nevadunsky N, Sebastianelli A, Slomovitz B, Ring K, Coleman R, Podzielinski I, Stuckey A, Teneriello M, Gill S, Pothuri B, Willmott L, Sharma S, Dabrowski C, Antony G, Stevens S, Mirza MR, Fleming E. Safety of dostarlimab in combination with chemotherapy in patients with primary advanced or recurrent endometrial cancer in a phase III, randomized, placebo-controlled trial (ENGOT-EN6-NSGO/GOG-3031/RUBY). Ther Adv Med Oncol 2024; 16:17588359241277656. [PMID: 39346117 PMCID: PMC11439170 DOI: 10.1177/17588359241277656] [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: 05/21/2024] [Accepted: 08/08/2024] [Indexed: 10/01/2024] Open
Abstract
Background In Part 1 of the phase III RUBY trial (NCT03981796) in patients with primary advanced or recurrent endometrial cancer (EC), dostarlimab plus carboplatin-paclitaxel (CP) significantly improved progression-free survival and overall survival compared with CP alone. Limited safety data have been reported for the combination of immunotherapies plus chemotherapy in this setting. Objectives The objective of this analysis was to identify the occurrence of treatment-related adverse events (TRAEs) and immune-related adverse events (irAEs) and to describe irAE management in Part 1 of the RUBY trial. Design RUBY is a phase III, randomized, double-blind, multicenter study of dostarlimab plus CP compared with CP alone in patients with primary advanced or recurrent EC. Methods Patients were randomized 1:1 to dostarlimab 500 mg, or placebo, plus CP every 3 weeks for 6 cycles, followed by dostarlimab 1000 mg, or placebo, every 6 weeks for up to 3 years. Adverse events (AEs) were assessed according to Common Terminology Criteria for Adverse Events, version 4.03. Results The safety population included 487 patients who received ⩾1 dose of treatment (241 dostarlimab plus CP; 246 placebo plus CP). Treatment-emergent AEs were experienced by 100% of patients in both arms. TRAEs occurred in 97.9% of the dostarlimab arm and 98.8% of the placebo arm.The most common TRAEs occurred at similar rates between arms and were mostly low grade. IrAEs occurred in 58.5% of patients in the dostarlimab arm and 37.0% of patients in the placebo arm. Dostarlimab- or placebo-related irAEs were reported in 40.7% of patients in the dostarlimab arm and 16.3% of the placebo arm. Conclusion The safety profile of dostarlimab plus CP was generally consistent with that of the individual components. Dostarlimab plus CP has a favorable benefit-risk profile and is a new standard of care for patients with primary advanced or recurrent EC. Trial registration NCT03981796.
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Affiliation(s)
- Annika Auranen
- Tays Cancer Centre and FICAN Mid, Tampere University and Tampere University Hospital, Pirkanmaa Hospital District, FM3 2.krs. Biokatu 10, Tampere 33900, Finland
| | - Matthew A. Powell
- National Cancer Institute Sponsored NRG Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Vladyslav Sukhin
- Grigoriev Institute for Medical Radiology and Oncology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | - Lisa M. Landrum
- Indiana University Health and Simon Cancer Center, Indianapolis, IN, USA
| | | | | | - Dirk Bauerschlag
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Roy Lalisang
- Department of Internal Medicine, Maastricht UMC Comprehensive Cancer Center, GROW-School of Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - David Bender
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA
| | - Lucy Gilbert
- Division of Gynecologic Oncology, Gerald Bronfman Department of Oncology, Research Institute—McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Amy Armstrong
- Division of Gynecologic Oncology, University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Tamar Safra
- Department of Oncology, Tel Aviv Sourasky Medical Center, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nicole Nevadunsky
- Department of Obstetrics, Gynecology, and Women’s Health, Montefiore Medical Center, Bronx, NY, USA
| | | | - Brian Slomovitz
- Department of Gynecologic Oncology, Mount Sinai Medical Center, and Department of Obstetrics and Gynecology, Florida International University, Miami Beach, FL, USA
| | - Kari Ring
- University of Virginia Health System, Charlottesville, VA, USA
| | - Robert Coleman
- Texas Oncology, US Oncology Network, The Woodlands, TX, USA
| | - Iwona Podzielinski
- Department of Gynecologic Oncology, Parkview Health, Fort Wayne, IN, USA
| | - Ashley Stuckey
- Women and Infants Hospital of Rhode Island, Providence, RI, USA
| | | | - Sarah Gill
- St. Joseph’s/Candler Gynecologic Oncology and Surgical Specialists, Candler Hospital, Savannah, GA, USA
| | - Bhavana Pothuri
- GOG Foundation and Departments of Obstetrics/Gynecology and Medicine, Division of Gynecologic Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | | | - Sudarshan Sharma
- Department of Obstetrics/Gynecology, AMITA Health Adventist Medical Center, Hinsdale, IL, USA
| | | | | | | | - Mansoor Raza Mirza
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Nordic Society of Gynaecologic Oncology Clinical Trial Unit, Copenhagen, Denmark
| | - Evelyn Fleming
- Division of Gynecologic Oncology, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Jang S, Hwang SO. Risk factors for atypical hyperplasia or endometrial cancer in premenopausal women aged ≤ 45 years with abnormal uterine bleeding. Eur J Obstet Gynecol Reprod Biol 2024; 302:288-293. [PMID: 39348761 DOI: 10.1016/j.ejogrb.2024.09.030] [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: 06/05/2024] [Revised: 09/15/2024] [Accepted: 09/17/2024] [Indexed: 10/02/2024]
Abstract
OBJECTIVES To assess the prevalence and risk factors for atypical hyperplasia (AH) or endometrial cancer (EC) in premenopausal women aged ≤ 45 years with abnormal uterine bleeding (AUB). METHODS This was a retrospective study of premenopausal patients aged 18 to 45 years who underwent hysteroscopy, dilation and curettage, or pipelle sampling at Inha University Hospital, South Korea, from 2014 to 2023. We used multivariable logistic regression analysis to identify risk factors and calculate the predicted probabilities of AH or EC with various combinations of these factors. RESULTS Of 821 patients included in the study, 6.0 % were diagnosed with AH or EC. The significant risk factors identified were nulliparity (odds ratio (OR): 4.75, 95 % confidence interval (CI): 2.11-10.70), PCOS (OR: 2.72, 95 % CI: 1.34-5.52), and multiple polyps (OR: 2.33, 95 % CI: 1.23-4.41). The predicted probabilities of developing AH or EC increased with the number of risk factors present, ranging from 1 % to 33.6 %. CONCLUSIONS The predicted probabilities within combinations of risk factors may be considered helpful in making better clinical decisions regarding endometrial sampling for patients ≤ 45 years with AUB.
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Affiliation(s)
- Shina Jang
- Department of Obstetrics and Gynecology, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea.
| | - Sung-Ook Hwang
- Department of Obstetrics and Gynecology, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea
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4
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Valabrega G, Powell MA, Hietanen S, Miller EM, Novak Z, Holloway R, Denschlag D, Myers T, Thijs AM, Pennington KP, Gilbert L, Fleming E, Zub O, Landrum LM, Ataseven B, Gogoi R, Podzielinski I, Cloven N, Monk BJ, Sharma S, Herzog TJ, Stuckey A, Pothuri B, Secord AA, Chase D, Vincent V, Meyers O, Garside J, Mirza MR, Black D. Patient-reported outcomes in the subpopulation of patients with mismatch repair-deficient/microsatellite instability-high primary advanced or recurrent endometrial cancer treated with dostarlimab plus chemotherapy compared with chemotherapy alone in the ENGOT-EN6-NSGO/GOG3031/RUBY trial. Int J Gynecol Cancer 2024:ijgc-2024-005484. [PMID: 39322611 DOI: 10.1136/ijgc-2024-005484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Abstract
OBJECTIVE In the ENGOT-EN6-NSGO/GOG3031/RUBY trial, dostarlimab+carboplatin-paclitaxel demonstrated significant improvement in progression free survival and a positive trend in overall survival compared with placebo+carboplatin-paclitaxel, with manageable toxicity, in patients with primary advanced or recurrent endometrial cancer. Here we report on patient-reported outcomes in the mismatch repair-deficient/microsatellite instability-high population, a secondary endpoint in the trial. METHODS Patients were randomized 1:1 to dostarlimab+carboplatin-paclitaxel or placebo+carboplatin-paclitaxel every 3 weeks for 6 cycles followed by dostarlimab or placebo monotherapy every 6 weeks for ≤3 years or until disease progression. Patient-reported outcomes, assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Endometrial Cancer Module, were prespecified secondary endpoints. A mixed model for repeated measures analysis, a prespecified exploratory analysis, was conducted to generate least-squares means to compare between-treatment differences while adjusting for correlations across multiple time points within a patient and controlling for the baseline value. Results are provided with 2-sided, nominal p values. RESULTS Of 494 patients enrolled, 118 were mismatch repair-deficient/microsatellite instability-high. In this population, mean change from baseline to end of treatment showed visual improvements in global quality of life (QoL), emotional and social function, pain, and back/pelvis pain for dostarlimab+carboplatin-paclitaxel. Meaningful differences (least-squares mean [standard error]) favoring the dostarlimab arm were reported for change from baseline to end of treatment for QoL (14.7 [5.45]; p=0.01), role function (12.7 [5.92]); p=0.03), emotional function (14.3 [4.92]; p<0.01), social function (13.5 [5.43]; p=0.01), and fatigue (-13.3 [5.84]; p=0.03). CONCLUSIONS Patients with mismatch repair-deficient/microsatellite instability-high primary advanced or recurrent endometrial cancer receiving dostarlimab+carboplatin-paclitaxel demonstrated improvements in several QoL domains over patients receiving placebo+carboplatin-paclitaxel. The observed improvements in progression free survival and overall survival while improving or maintaining QoL further supports dostarlimab+carboplatin-paclitaxel as a standard of care in this setting. TRIAL REGISTRATION ClinicalTrials.gov NCT03981796.
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Affiliation(s)
- Giorgio Valabrega
- Department of Oncology, Ordine Mauriziano Torino, University of Torino, Torino, Italy
| | - Matthew A Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Sakari Hietanen
- Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland
| | - Eirwen M Miller
- Division of Gynecologic Oncology, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Zoltan Novak
- Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary
| | | | - Dominik Denschlag
- Department of Obstetrics and Gynecology, Breast and Gynecologic Oncology Cancer Center, Hochtaunus-Kliniken Bad Homburg, Bad Homburg, Germany
| | - Tashanna Myers
- Baystate Gynecologic Oncology, Springfield, Massachusetts, USA
| | - Anna M Thijs
- Department of Gynecologic Oncology, Catharina Een Santeon Ziekenhuis, Eindhoven, Netherlands
| | | | - Lucy Gilbert
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, Quebec, Canada
- The Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Evelyn Fleming
- Division of Gynecologic Oncology, Billings Clinic, Billings, Montana, USA
| | - Oleksandr Zub
- Ilan Bruchim Hillel Yaffe Medical Center, Hadera, Israel
| | - Lisa M Landrum
- Division of Gynecology Oncology, Indiana University Health and Simon Cancer Center, Indianapolis, Indiana, USA
| | - Beyhan Ataseven
- AGO Study Group, Wiesbaden, Germany
- Evangelische Kliniken Essen-Mitte, Essen, Germany
- Medical School and University Medical Center OWL, Klinikum Lippe, Department of Gynecology, Gynecologic Oncology and Obstetrics, Bielefeld University, Detmold, Germany
| | - Radhika Gogoi
- Department of Gynecologic Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA
| | - Iwona Podzielinski
- Department of Gynecologic Oncology, Parkview Health, Fort Wayne, Indiana, USA
| | | | - Bradley J Monk
- GOG Foundation and the Division of Gynecologic Oncology, Florida Cancer Specialists and Research Institute, West Palm Beach, Florida, USA
| | | | - Thomas J Herzog
- Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ashley Stuckey
- Department of Gynecologic Oncology, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Bhavana Pothuri
- GOG Foundation and the Departments of Obstetrics/Gynecology and Medicine and Division of Gynecologic Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | | | - Dana Chase
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | | | | | | | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynecological Oncology Clinical Trial Unit, Copenhagen, Denmark
| | - Destin Black
- Willis-Knighton Cancer Center, Willis-Knighton Health System, Gynecologic Oncology Associates, Shreveport, Louisiana, USA
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Lin Y, Kong L, Zhao Y, Zhai F, Zhan Z, Li Y, Jingfei Z, Chunhong Y, Jin X. The oncogenic role of EIF4A3/CDC20 axis in the endometrial cancer. J Mol Med (Berl) 2024:10.1007/s00109-024-02486-w. [PMID: 39316093 DOI: 10.1007/s00109-024-02486-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 08/29/2024] [Accepted: 09/06/2024] [Indexed: 09/25/2024]
Abstract
Eukaryotic initiation factor 4A-3 (EIF4A3) is a key component of the exon junction complex (EJC) and is extensively involved in RNA splicing, inducing mRNA decay, and regulating the cell cycle and apoptosis. However, the potential role of EIF4A3 in EC has not been comprehensively investigated and remains unknown. Here, we report that the expression level of EIF4A3 is dramatically elevated in endometrial cancer (EC) samples compared with normal EC samples via bioinformatics analysis and immunohistochemistry analysis, and that high expression of EIF4A3 promotes the proliferation, migration, and invasion of EC cells. Mechanistically, we found that high EIF4A3 expression stabilized cell division cyclin 20 (CDC20) mRNA, and high EIF4A3 expression induced pro-carcinogenic effects in EC cells that were efficiently antagonized upon knockdown of CDC20, as well as Apcin, an inhibitor of CDC20. These findings reveal a novel mechanism by which high expression of EIF4A3 induces CDC20 upregulation, thus leading to EC tumorigenesis and metastasis, indicating a potential treatment strategy for EC patients with high EIF4A3 expression using Apcin. KEY MESSAGES: The expression level of EIF4A3 was dramatically elevated in endometrial cancer (EC) samples compared with normal endometrial cancer samples. High EIF4A3 expression stabilized CDC20 mRNA, and high EIF4A3 expression induced pro-carcinogenic effect in EC cells which was efficiently antagonized upon knockdown of CDC20. Apcin, an inhibitor of CDC20, could effectively counteract high expression of EIF4A3 inducing EC tumourigenesis and metastasis, indicating the potential treatment strategy for EC patients with EIF4A3 high expression by using Apcin.
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Affiliation(s)
- Yan Lin
- Department of Biochemistry and Molecular Biology, Health Science Center, Ningbo University, Ningbo, 315211, China
| | - Lili Kong
- Department of Biochemistry and Molecular Biology, Health Science Center, Ningbo University, Ningbo, 315211, China
| | - Yiting Zhao
- Department of Biochemistry and Molecular Biology, Health Science Center, Ningbo University, Ningbo, 315211, China
| | - Fengguang Zhai
- Department of Biochemistry and Molecular Biology, Health Science Center, Ningbo University, Ningbo, 315211, China
| | - Ziqing Zhan
- Department of Biochemistry and Molecular Biology, Health Science Center, Ningbo University, Ningbo, 315211, China
| | - Yuxuan Li
- Department of Biochemistry and Molecular Biology, Health Science Center, Ningbo University, Ningbo, 315211, China
| | - Zheng Jingfei
- Department of Gynecology, The Affiliated People's Hospital of Ningbo University, Ningbo, 315040, China
| | - Yan Chunhong
- Department of Gynecology, The Affiliated People's Hospital of Ningbo University, Ningbo, 315040, China
| | - Xiaofeng Jin
- Department of Biochemistry and Molecular Biology, Health Science Center, Ningbo University, Ningbo, 315211, China.
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6
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Yao Y, Xu S, Wang T, Jiang R. Efficacy of drugs treatment in patients with endometrial hyperplasia with or without atypia: A systematic review and network meta-analysis. Medicine (Baltimore) 2024; 103:e39619. [PMID: 39312359 PMCID: PMC11419537 DOI: 10.1097/md.0000000000039619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/16/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Endometrial hyperplasia (EH) is a hyperplastic endometrial lesion with irregular gland size, increased glands, and increased glandular interstitial ratio. During follow-up, some EH progressed further to endometrial cancer. It is crucial to provide timely treatment for EH and improve the overall prognosis of EH patients. METHODS We searched the PubMed, ClinicalTrials.gov., and Embase databases for studies published from their inception to March 31, 2023. The methodological quality of each study was evaluated in accordance with the Cochrane Collaboration's tool for assessing the risk of bias. The RevMan5.3 software provided by the Cochrane Collaboration was used for direct meta-analysis statistical analysis; and the relative risk and 95% confidence interval along with the mean difference and 95% confidence interval, were used as evaluation indexes. RESULTS We included 21 randomized controlled trials involving a total of 2276 women with EH, 6 studies were of high quality, and 15 were of moderate quality. The blinding of subjects and intervention providers was identified as the main source of potential bias. Six interventions were addressed in the network meta-analysis: medroxyprogesterone acetate (MPA), plus metformin, norethisterone (NET), levonorgestrel-releasing intrauterine system (LNG-IUD), megestrol acetate, and other drugs. In the direct meta-analysis, we found the probability of endometrial complete regression (CR) in the LNG-IUD group to be significantly higher than those in the NET. In the network meta-analysis, we found the probability of CR in the NET group to be significantly lower than those in the MPA and plus metformin groups, the probability of CR in the LNG-IUD group to be significantly higher than those in the NET, the probability of CR in the other drugs group to be significantly higher than those in the LNG-IUD. The NET group had the lowest incidences of endometrial complete regression, plus metformin could have a better outcome. CONCLUSION According to the 21 randomized controlled trials included in this study, MPA is the most effective for EH endometrial outcome when applied as a single agent, while the combination of metformin can achieve a more significant effect.
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Affiliation(s)
- Yingsha Yao
- Department of Obstetrics and Gynecology, Women’s Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Shuhang Xu
- Department of Obstetrics and Gynecology, Women’s Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Ting Wang
- Department of Obstetrics and Gynecology, Women’s Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Ruoan Jiang
- Department of Obstetrics and Gynecology, Women’s Hospital Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China
- Traditional Chinese Medicine for Reproductive Health Key Laboratory of Zhejiang Province, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Nief CA, Long SE, McCleary TL, Kidd E, Litkouhi B, Howitt B. Diabetes mellitus complications associated with recurrence of stage I endometrioid endometrial cancer: A single-center retrospective study. Gynecol Oncol 2024; 190:298-306. [PMID: 39293358 DOI: 10.1016/j.ygyno.2024.09.007] [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: 07/05/2024] [Revised: 08/29/2024] [Accepted: 09/05/2024] [Indexed: 09/20/2024]
Abstract
OBJECTIVE Identifying clinical features that are associated with recurrence of endometrioid endometrial carcinoma (EEC) in patients with diabetes mellitus (DM). METHODS A single-center retrospective cohort study was performed on patients with a diagnosis of both DM and Stage I EEC. Clinical and pathologic features were analyzed in relation to 5-year progression free survival (PFS). Kaplan-Meier Curves and Cox proportional hazard ratios were utilized to assess effect on 5-year PFS. RESULTS A total of 539 patients were included, with biopsy proven recurrence in 86 (18 %), and 456 (82 %) with no evidence of recurrence. Age, BMI, HgbA1c, metformin use, number of antihyperglycemic medications, use of adjuvant radiation, and surgical approach were not associated with differences in PFS. Presence of end-organ complications associated with diabetes was correlated with worse PFS (HR 1.78, 95 % CI 1.1-2.9, P = 0.02), and specifically diabetic neuropathy was associated with higher rates of recurrence (HR 3.6, 95 % CI 2.1-6.2, P < 0.01). In this cohort, PFS was independently associated with extent of myoinvasion (HR 2.33, 95 % CI 1.4-3.7, P < 0.01) as well as both microsatellite instability (HR 3.43, 95 % CI 1.8-6.6, P < 0.01), and no specific molecular profile (HR 0.3, 95 % CI 0.2-0.6, P < 0.01) molecular subtypes. CONCLUSIONS In patients with DM and EEC, extent of myoinvasion and TCGA molecular subtype correlated with worse PFS. Control of DM as evidenced by HgbA1c, BMI, and use of antihyperglycemic medications did not correlate with PFS in our cohort of patients with Stage I EEC, while the presence of diabetic neuropathy was associated with a higher risk of recurrence. These results highlight importance of evaluating diabetes severity and molecular subtype in endometrial cancer patients.
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Affiliation(s)
- Corrine A Nief
- Stanford Medical School, Stanford University, Stanford, CA, USA.
| | - Sara E Long
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - Elizabeth Kidd
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Babak Litkouhi
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Stanford University, Stanford, CA, USA
| | - Brooke Howitt
- Department of Pathology, Stanford University, Stanford, CA, USA
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8
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Cabrera S, de la Calle I, Baulies S, Gil-Moreno A, Colas E. Screening Strategies to Improve Early Diagnosis in Endometrial Cancer. J Clin Med 2024; 13:5445. [PMID: 39336931 PMCID: PMC11432712 DOI: 10.3390/jcm13185445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 09/07/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
Endometrial cancer is the most common gynecological malignancy in high-income countries and the sixth most common cancer in women. Overall incidence has risen in the last few decades as a consequence of the increase in the prevalence of its risk factors, mainly obesity and the aging of the population, and although diagnoses have increased across all age groups, the incidence rates have doubled in women under the age of 40 years. The survival rates of endometrial cancer are highly dependent on its stage at diagnosis, bringing to the fore the importance of early diagnosis. The aim of a screening strategy in this type of tumor should be to detect the disease in the pre-invasive or early stage (before developing myometrial invasion), which would improve cure rates, reduce the morbidity associated with aggressive treatment and offer uterus-sparing management options for younger women. The ideal screening tool in this scenario would be a minimally invasive, inexpensive and easy-to-perform test or auto-test, which could be implemented in a routine gynecologic checkup of patients at-risk or in the general adult population. In this comprehensive review, we aim to define the populations at higher risk of developing endometrial cancer, to assess the performance of current diagnostic tools when used in a screening setting and to discuss the accuracy of new molecular screening strategies.
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Affiliation(s)
- Silvia Cabrera
- Gynecologic Oncology Unit, Department of Gynecology and Obstetrics, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
- Fundación Santiago Dexeus Font, Gynecology, Obstetrics and Reproductive Medicine Department, Dexeus Mujer, 08028 Barcelona, Spain
| | - Irene de la Calle
- Research Group in Gynecology, Vall d'Hebron Institut de Recerca, 08035 Barcelona, Spain
| | - Sonia Baulies
- Fundación Santiago Dexeus Font, Gynecology, Obstetrics and Reproductive Medicine Department, Dexeus Mujer, 08028 Barcelona, Spain
| | - Antonio Gil-Moreno
- Research Group in Gynecology, Vall d'Hebron Institut de Recerca, 08035 Barcelona, Spain
| | - Eva Colas
- Research Group in Gynecology, Vall d'Hebron Institut de Recerca, 08035 Barcelona, Spain
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Song J, Jiang X, Lu Y, Zhang A, Luo C, Cheng W, Duan S, Qu F, Wu F, Chen T. Multi-modality MRI radiomics phenotypes in intermediate-high risk endometrial cancer: correlations with histopathology and prognosis. Jpn J Radiol 2024:10.1007/s11604-024-01654-9. [PMID: 39254904 DOI: 10.1007/s11604-024-01654-9] [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: 07/22/2024] [Accepted: 08/28/2024] [Indexed: 09/11/2024]
Abstract
OBJECTIVES This study aimed to identify the magnetic resonance imaging (MRI)-based radiomics phenotypes of intermediate-to-high-risk endometrial cancers (ECs), explore their association with histopathologic features, and compare their prognostic ability with the International Federation of Gynecology and Obstetrics (FIGO) stage. METHODS This study retrospectively recruited 355 patients with pathologically confirmed EC from 01/2016 to 06/2023. 166(46.8%) were classified as intermediate-to-high-risk ECs according to the European Society for Medical Oncology guidelines. Radiomics clustering analysis was performed on preoperative MRI to identify the radiomics phenotype of intermediate-to-high-risk ECs. The association between the radiomics phenotypes and the clinicopathologic information was explored, and the added value in predicting the recurrence was also evaluated using concordance index (C-index). RESULTS Of the included 166 patients (average age 56.83 ± 9.25 years), 23 were recurrent patients. The corresponding tumors in various clusters were assigned to phenotypes 1 and 2. Larger tumor diameter (P < .01), cervical mucosa invasion [30(36.15%) vs 15(18.07%), P = .01], deep myometrial infiltration [51(61.45%) vs 31(37.35%), P = .00], and histologic subtype [17(20.48%) vs 5(6.02%), P = .01] were associated with subtype 1. The risk of recurrence (P = .01) was higher in phenotype 1, and the FIGO stage could further differentiate higher recurrence risk in phenotype 1 (P < .01). The C-index was 0.66 for the radiomics phenotype model, 0.69 for the FIGO stage model, and 0.72 for the combined model. CONCLUSIONS MRI-based radiomics consensus clustering enabled the identification of associations between radiomics features and histopathologic features in intermediate-to-high-risk EC. The FIGO stage could further elevate the prediction ability of recurrence risk.
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Affiliation(s)
- Jiacheng Song
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China
| | - Xiaoting Jiang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China
| | - Yao Lu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China
| | - Aining Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China
| | - Chengyan Luo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wenjun Cheng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Shaofeng Duan
- Central Research Institute, UIH Group, Shanghai, China
| | - Feifei Qu
- MR Research Collaboration, Siemens Healthineers, Shanghai, China
| | - Feiyun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China.
| | - Ting Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China.
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Williams L, Henry C, Simcock B, Amataiti T, Perelini O, Filoche S. 'It's not a solution to keep telling me to lose weight!' Exploring endometrial cancer survivors' experiences of nutrition and well-being advice: A qualitative study. Aust N Z J Obstet Gynaecol 2024. [PMID: 39242357 DOI: 10.1111/ajo.13875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 08/11/2024] [Indexed: 09/09/2024]
Abstract
AIMS The aim was to explore Endometrial cancer (EC) survivors' experiences of being offered nutrition and well-being advice. METHODS This qualitative study was conducted at two tertiary centres in Aotearoa New Zealand. Semi-structured conversations with people who had completed treatment for EC in the past 12 months were undertaken to explore how they were offered nutrition and well-being advice as part of standard follow-up care. Interviews were analysed using reflexive thematic analysis. RESULTS Fifteen people of Pacific, Māori and European ethnicity participated. Five themes were derived: (i) isolation and vulnerability, (ii) importance of language, (iii) inconsistent availability and relevance of nutrition and well-being information, (iv) competing priorities and influences and (v) holistic and culturally responsive support. People often experienced judgement associated with their weight as part of their care, with limited understanding of their lived realities. Nutrition and well-being advice was not widely available or accessible, and people had to explicitly ask for it. Social and environmental factors were barriers to making changes to health behaviours. A need for culturally safe holistic care was identified. CONCLUSION Enhancing survivorship after EC is ultimately premised on providing culturally safe and responsive care. Expanding workforce training in communication around high weight as well as education and self-assessment of cultural safety could enable aspects of this. A holistic care program could facilitate wider access to nutrition and well-being advice and better meet the needs of this population.
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Affiliation(s)
- Linda Williams
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Claire Henry
- Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Bryony Simcock
- Department of Gynaecology, Christchurch Hospital, Te Whatu Ora, Waitaha Christchurch - Health New Zealand, Christchurch, New Zealand
| | - Tutangi Amataiti
- Allied Health, Te Whatu Ora (Health New Zealand) - Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Olivia Perelini
- Oncology Service, Te Whatu Ora (Health New Zealand) - Te Toka Tumai, Auckland, New Zealand
| | - Sara Filoche
- Department of Obstetrics, Gynaecology & Women's Health, University of Otago, Wellington, New Zealand
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11
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Guo Y, Yan G, Zhang P, Liu Y, Zhao C, Zeng X. The clinical utility of next generation sequencing in endometrial cancer: focusing on molecular subtyping and lynch syndrome. Front Genet 2024; 15:1440971. [PMID: 39301527 PMCID: PMC11410632 DOI: 10.3389/fgene.2024.1440971] [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: 05/31/2024] [Accepted: 08/19/2024] [Indexed: 09/22/2024] Open
Abstract
Objective To investigate the clinical utility of Next Generation Sequencing (NGS) in molecular typing of endometrial carcinoma and its combined screening for Lynch Syndrome (LS). Methods 90 patients diagnosed with endometrial carcinoma (EC) and receiving treatment at the Third Affiliated Hospital of Zhengzhou University between March 2022 and December 2023 were included in this study. Molecular typing and germline evaluation for LS were conducted using NGS on the Illumina platform. A retrospective analysis was performed to examine the clinical pathological characteristics, molecular mutation spectrum, and LS screening outcomes among patients with four distinct molecular subtyping categories. Results Among the 90 cases of EC, 11 cases (12.2%) of POLE mut type, 19 cases (21.1%) of MMRd type, 6 cases (6.7%) of p53 abn type, and 54 cases (60%) of NSMP type were detected, with detailed analysis of their respective molecular characteristics. LS screening identified 9 cases (10%) of pathogenic germline mutations in MMR genes, including 3 cases of MLH1 germline mutations, 2 cases of PMS2, 2 of MSH2, and 2 of MSH6. Of the 9 LS patients, 7 were MMRd type and 2 NSMP type, with 7 cases showing abnormal MMR protein expression. Additionally, 6 cases with germline variants of uncertain significance in MMR genes were detected, including 2 MLH1, 1 MSH6, 2 MSH6, 1 PMS2, and 1 EPCAM. Conclusion NGS enables precise molecular typing of endometrial carcinoma through the identification of mutations in the POLE, TP53, and MMR genes. Conducting germline mutation testing for MMR genes in all patients with endometrial carcinoma can effectively prevent instances of overlooked LS diagnoses. Nevertheless, the extensive expenses associated with NGS necessitate additional validation and investigation before its clinical implementation can be fully endorsed.
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Affiliation(s)
- Yongzhen Guo
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Zhengzhou Key Laboratory of Gynecological Disease's Early Diagnosis, Zhengzhou, China
| | - Guangwei Yan
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Zhengzhou Key Laboratory of Gynecological Disease's Early Diagnosis, Zhengzhou, China
| | - Pei Zhang
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Zhengzhou Key Laboratory of Gynecological Disease's Early Diagnosis, Zhengzhou, China
| | - Yixuan Liu
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Zhengzhou Key Laboratory of Gynecological Disease's Early Diagnosis, Zhengzhou, China
| | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Xianxu Zeng
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Zhengzhou Key Laboratory of Gynecological Disease's Early Diagnosis, Zhengzhou, China
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12
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Creutzberg CL, Kim JW, Eminowicz G, Allanson E, Eberst L, Kim SI, Nout RA, Park JY, Lorusso D, Mileshkin L, Ottevanger PB, Brand A, Mezzanzanica D, Oza A, Gebski V, Pothuri B, Batley T, Gordon C, Mitra T, White H, Howitt B, Matias-Guiu X, Ray-Coquard I, Gaffney D, Small W, Miller A, Concin N, Powell MA, Stuart G, Bookman MA. Clinical research in endometrial cancer: consensus recommendations from the Gynecologic Cancer InterGroup. Lancet Oncol 2024; 25:e420-e431. [PMID: 39214113 DOI: 10.1016/s1470-2045(24)00192-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 09/04/2024]
Abstract
The Gynecologic Cancer InterGroup (GCIG) Endometrial Cancer Consensus Conference on Clinical Research (ECCC) was held in Incheon, South Korea, Nov 2-3, 2023. The aims were to develop consensus statements for future trials in endometrial cancer to achieve harmonisation on design elements, select important questions, and identify unmet needs. All 33 GCIG member groups participated in the development, refinement, and finalisation of 18 statements within four topic groups, addressing adjuvant treatment in high-risk disease; treatment for metastatic and recurrent disease; trial designs for rare endometrial cancer subgroups and special circumstances; and specific methodology and adaptation for trials in low-resource settings. In addition, eight areas of unmet need were identified. This was the first GCIG Consensus Conference to include patient advocates and an expert on inclusion, diversity, equity, and access to take part in all aspects of the process and output. Four early-career investigators were also selected for participation, ensuring that they represented different GCIG member groups and regions. Unanimous consensus was obtained for 16 of the 18 statements, with 97% concordance for the remaining two. Using the described methodology from previous Ovarian Cancer Consensus Conferences, this conference did not require even one minority statement. The high acceptance rate following active involvement in the preparation, discussion, and refinement of the statements by all representatives confirmed the consensus progress within a global academic setting, and the expectation that the ECCC will lead to greater harmonisation, actualisation, inclusion, and resolution of unmet needs in clinical research for individuals living with and beyond endometrial cancer worldwide.
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Affiliation(s)
- Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands.
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Gemma Eminowicz
- Department of Clinical Oncology, University College London Hospital, London, UK
| | - Emma Allanson
- Division of Obstetrics and Gynaecology, Medical School, University of Western Australia, Perth, WA, Australia
| | - Lauriane Eberst
- Department of Medical Oncology, Institut de Cancérologie de Strasbourg, Strasbourg, France
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Remi A Nout
- Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Jeong-Yeol Park
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Domenica Lorusso
- Gynecologic Oncology Unit, Humanitas San Pio X, Milan, Italy; Humanitas University Rozzano, Milan, Italy
| | - Linda Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, VIC, Australia
| | | | - Alison Brand
- Department of Gynaecological Oncology, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Delia Mezzanzanica
- Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Amit Oza
- Division of Medical Oncology and Hematology, UHN - Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Bhavana Pothuri
- Perlmutter Cancer Center, NYU Langone Health, New York, NJ, USA; Diversity and Health Equity for Clinical Trials, GOG-Foundation, Philadelphia, PA USA
| | - Tania Batley
- Ko Ngai Tūhoe te iwi, Kaitauwhiro Mātātahi Mokopuna Ora, Te Pūtahitanga o Te Waipounamu, Christchurch, New Zealand
| | - Carol Gordon
- Canadian Cancer Trials Group, London, ON, Canada
| | - Tina Mitra
- Kolkata Gynecological Oncology Trials and Translational Research Group (KolGOTrg), New Town, Kolkata, India
| | - Helen White
- Peaches Womb Cancer Trust, Manchester, UK; Cancer Research Advocates Forum, London, UK
| | - Brooke Howitt
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital U de Bellvitge, University of Barcelona, Barcelona, Spain; Department of Pathology, Hospital U Arnau de Vilanova, University of Lleida, Lleida, Spain
| | | | - David Gaffney
- Huntsman Cancer Institute, Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernadin Cancer Center, Loyola University Chicago, Maywood, IL, USA
| | - Austin Miller
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Nicole Concin
- Department of Gynaecology and Gynaecological Oncology, Medical University of Vienna, Vienna, Austria; Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthew A Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA
| | - Gavin Stuart
- Department of Obstetrics and Gynecology, University of British Colombia, Vancouver, BC, Canada
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Nofal HR, Al-Karmalawy AA, Elmaaty AA, Ismail MF, Ali AK, Abbass EM. Pharmacophore-based, rationale design, and efficient synthesis of novel tetrahydrobenzo[b]thiophene candidates as potential dual Topo I/II inhibitors and DNA intercalators. Arch Pharm (Weinheim) 2024; 357:e2400217. [PMID: 38864845 DOI: 10.1002/ardp.202400217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/23/2024] [Accepted: 05/26/2024] [Indexed: 06/13/2024]
Abstract
A series of tetrahydrobenzo[b]thiophene derivatives was designed and synthesized as dual topoisomerase (Topo) I/II inhibitors implicating potential DNA intercalation. Ethyl-2-amino-3-cyano-4,5,6,7-tetrahydrobenzo[b]thiophene-4-carboxylate (1) was prepared by modification of the Gewald reaction procedure using a Fe2O3 nanocatalyst and then it was used as a building block for the synthesis of tetrahydrobenzo[b]thiophene candidates (2-14). Interestingly, compound 14 showed the best cytotoxic potential against hepatocellular, colorectal, and breast cancer cell lines (IC50 = 7.79, 8.10, and 3.53 µM), respectively, surpassing doxorubicin at breast cancer (IC50 = 4.17 µM). Meanwhile, the Topo I and II inhibition assay displayed that compound 3 could exhibit the best inhibitory potential among the investigated candidates (IC50 = 25.26 and 10.01 nM), respectively, in comparison to camptothecin (IC50 = 28.34 nM) and doxorubicin (IC50 = 11.01 nM), as reference standards. In addition, the DNA intercalation assay showed that compound 14 could display the best binding affinity with an IC50 value of 77.82 µM in comparison to doxorubicin (IC50 = 58.03 µM). Furthermore, cell cycle and apoptosis analyses described that compound 3 prompts the G1 phase arrest in michigan cancer foundation-7 cancer cells and increases the apoptosis ratio by 29.31% with respect to untreated cells (2.25%). Additionally, the conducted molecular docking assured the promising binding of the investigated members toward Topo I and II with potential DNA intercalation. Accordingly, the synthesized compounds could be treated as promising anticancer candidates for future optimization.
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Affiliation(s)
- Hager R Nofal
- Department of Chemistry, Faculty of Science, Ain Shams University, Abbassia, Cairo, Egypt
| | - Ahmed A Al-Karmalawy
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Horus University-Egypt, New Damietta, Egypt
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Ahram Canadian University, Giza, Egypt
| | - Ayman Abo Elmaaty
- Medicinal Chemistry Department, Faculty of Pharmacy, Port Said University, Port Said, Egypt
| | - Mahmoud F Ismail
- Department of Chemistry, Faculty of Science, Ain Shams University, Abbassia, Cairo, Egypt
| | - Ali Khalil Ali
- Department of Chemistry, Faculty of Science, Ain Shams University, Abbassia, Cairo, Egypt
| | - Eslam M Abbass
- Department of Chemistry, Faculty of Science, Ain Shams University, Abbassia, Cairo, Egypt
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14
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Zhang Y, Tang L, Liu H, Cheng Y. The Multiple Functions of HB-EGF in Female Reproduction and Related Cancer: Molecular Mechanisms and Targeting Strategies. Reprod Sci 2024; 31:2588-2603. [PMID: 38424408 DOI: 10.1007/s43032-024-01454-6] [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: 08/16/2023] [Accepted: 01/03/2024] [Indexed: 03/02/2024]
Abstract
Heparin-binding growth factor (HB-EGF) is a member of the epidermal growth factor (EGF) ligand family which has a crucial role in women's health. However, there is a lack of comprehensive review to summarize the significance of HB-EGF. Therefore, this work first described the expression patterns of HB-EGF in the endometrium and ovary of different species and gestational time. Then, the focus was on exploring how it promotes the successful implantation and regulates the process of decidualization and the function of ovarian granulosa cells as an intermediate molecule. Otherwise, we also focused on the clinical and prognostic significance of HB-EGF in female-related cancers (including ovarian cancer, cervical cancer, and endometrial cancer) and breast cancer. Lastly, the article also summarizes the current drugs targeting HB-EGF in the treatment of ovarian cancer and breast cancer. Overall, these studies found that the expression of HB-EGF in the endometrium is spatiotemporal and species-specific. And it mediates the dialogue between the blastocyst and endometrium, promoting synchronous development of the blastocyst and endometrium as an intermediate molecule. HB-EGF may serve as a potentially valuable prognostic clinical indicator in tumors. And the specific inhibitor of HB-EGF (CRM197) has a certain anti-tumor ability, which can exert synergistic anti-tumor effects with conventional chemotherapy drugs. However, it also suggests that more research is needed in the future to elucidate its specific mechanisms and to accommodate clinical studies with a larger sample size to clarify its clinical value.
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Affiliation(s)
- Yuwei Zhang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, 99 Zhang Zhidong Road, Wuhan, Hubei, 430060, People's Republic of China
| | - Lujia Tang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, 99 Zhang Zhidong Road, Wuhan, Hubei, 430060, People's Republic of China
| | - Hua Liu
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, 99 Zhang Zhidong Road, Wuhan, Hubei, 430060, People's Republic of China.
| | - Yanxiang Cheng
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, 99 Zhang Zhidong Road, Wuhan, Hubei, 430060, People's Republic of China.
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Tian W, Ren Y, Lu J, Jing C, Zhang W, Li H, Wang T, Hou Z, Yang T, Zhu W, Zhang Y, Shan B, Yang H, Cheng X, Wang H. Camrelizumab plus apatinib in patients with advanced or recurrent endometrial cancer after failure of at least one prior systemic therapy (CAP 04): a single-arm phase II trial. BMC Med 2024; 22:344. [PMID: 39183277 PMCID: PMC11346039 DOI: 10.1186/s12916-024-03564-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The combination of anti-programmed death 1 (PD-1) inhibitors and tyrosine kinase inhibitors is an effective treatment strategy in endometrial cancer. We aimed to explore the efficacy and safety of camrelizumab plus apatinib as an alternative therapeutic option in patients with previously treated endometrial cancer. METHODS This single-arm Simon's two-stage phase II trial was conducted at the Fudan University Shanghai Cancer Center. Patients with advanced or recurrent endometrial cancer who had failed at least one prior systemic therapy were screened for potential participation. Eligible patients were treated with intravenous camrelizumab (200 mg d1 q2w) and oral apatinib (250 mg qd) every 4 weeks. The primary end point was the objective response rate (ORR) per RECIST v1.1 in the intention-to-treat principle. RESULTS Between January 20, 2020, and October 14, 2022, 36 patients (29 with microsatellite stability/mismatch repair proficient [MSS/pMMR] tumors; two with microsatellite instability-high/mismatch repair deficient [MSI-H/dMMR] tumors) were enrolled and treated. The confirmed ORR was 44.4% (95% CI: 27.9, 61.9) and the disease control rate was 91.7% (95% CI: 77.5, 98.2). The median duration of response was 9.3 (95% CI: 4.3, not reached) months, the median progression-free survival was 6.2 (95% CI: 5.3, 11.1) months, and the median overall survival was 21.0 (95% CI: 13.4, not reached) months during a median follow-up of 14.2 (interquartile range: 10.3, 27.6) months. Treatment-related adverse events of grade 3 or 4 occurred in 20 (55.6%) patients, with the most common being increased γ-glutamyl transferase (27.8%), alanine aminotransferase (16.7%) and aspartate aminotransferase (13.9%), and hypertension (11.1%). No treatment-related death occurred. CONCLUSIONS Camrelizumab plus apatinib showed promising antitumor activity with manageable toxicity in patients with advanced or recurrent endometrial cancer who had failed at least one prior systemic therapy. The findings of this study support further investigation of camrelizumab plus apatinib as an alternative therapeutic option, especially for patients with MSS/pMMR tumors. TRIAL REGISTRATION This trial was retrospectively registered with ChiCTR.org.cn, number ChiCTR2000031932.
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Affiliation(s)
- Wenjuan Tian
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yulan Ren
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jing Lu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Department of Radiology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Chuyu Jing
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wei Zhang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Haiming Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Department of Radiology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Tingting Wang
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, Shanghai, 200127, China
- School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Zhiguo Hou
- Department of Medical Affairs, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, 201210, China
| | - Ting Yang
- Department of Medical Affairs, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, 201210, China
| | - Wenqing Zhu
- Department of Medical Affairs, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, 201210, China
| | - Yi Zhang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Boer Shan
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Huijuan Yang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xi Cheng
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Huaying Wang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Song DH, Jo JY, Kim CH, Kim MH, Cho IA, Shin JK, Choi WJ, Baek JC. Hypoxia-Regulated Proteins: Expression in Endometrial Cancer and Their Association with Clinicopathologic Features. Diagnostics (Basel) 2024; 14:1735. [PMID: 39202223 PMCID: PMC11353210 DOI: 10.3390/diagnostics14161735] [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: 07/09/2024] [Revised: 08/08/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Hypoxia-regulated proteins (HIF-1α and GLUT-1) have been identified as prognostic markers in various cancers; however, their role in endometrial cancer remains unclear. This study aimed to evaluate HIF-1α and GLUT-1 expression in endometrial cancer and correlate their expression with clinicopathological features. MATERIALS AND METHODS A tissue microarray (TMA) was constructed using specimens from a retrospective cohort of 51 endometrial cancer patients who underwent hysterectomy at the Gyeongsang National University Hospital between 2002 and 2009. Clinicopathologic data were collected from electronic medical records, and HIF-1α and GLUT-1 expressions were assessed in the tumor tissue. RESULTS GLUT-1 expression in endometrial cancer was categorized as mosaic, central, or diffuse. Most patients (56.0%) exhibited a central pattern, followed by diffuse (32.0%) and mosaic (12.0%) patterns. GLUT-1 expression was not significantly associated with histologic grade (p = 0.365). HIF-1α expression in immune cells, but not tumor cells, was significantly associated with a higher histologic grade. A higher proportion of HIF-1α-positive immune cells, using both thresholds (≤1% vs. >1% and ≤5% vs. >5%), was significantly associated with higher histologic grade (p = 0.032 and p = 0.048, respectively). In addition, a higher proportion of HIF-1α-positive immune cells was significantly associated with a diffuse GLUT-1 expression pattern using >5% as a threshold. There were no significant differences in the proportion of HIF-1α-positive immune cells between groups stratified by age, tumor size, or invasion depth, regardless of whether the 1% or 5% threshold for HIF-1α positivity was used. CONCLUSIONS A higher proportion of HIF-1α-positive immune cells is associated with endometrial cancers with higher histologic grade and diffuse GLUT1 expression patterns. These findings suggest a potential role for HIF-1α as a prognostic marker and highlight the need for further studies into the role of HIF-1α in the tumor microenvironment.
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Affiliation(s)
- Dae Hyun Song
- Department of Pathology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, 11, Changwon-si 51472, Republic of Korea;
- Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea; (J.Y.J.); (C.H.K.); (M.H.K.); (I.A.C.); (J.K.S.); (W.J.C.)
| | - Jae Yoon Jo
- Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea; (J.Y.J.); (C.H.K.); (M.H.K.); (I.A.C.); (J.K.S.); (W.J.C.)
- Department of Obstetrics and Gynecology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Cho Hee Kim
- Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea; (J.Y.J.); (C.H.K.); (M.H.K.); (I.A.C.); (J.K.S.); (W.J.C.)
| | - Min Hye Kim
- Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea; (J.Y.J.); (C.H.K.); (M.H.K.); (I.A.C.); (J.K.S.); (W.J.C.)
- Department of Pathology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - In Ae Cho
- Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea; (J.Y.J.); (C.H.K.); (M.H.K.); (I.A.C.); (J.K.S.); (W.J.C.)
- Department of Obstetrics and Gynecology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Jeong Kyu Shin
- Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea; (J.Y.J.); (C.H.K.); (M.H.K.); (I.A.C.); (J.K.S.); (W.J.C.)
- Department of Obstetrics and Gynecology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Won Jun Choi
- Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea; (J.Y.J.); (C.H.K.); (M.H.K.); (I.A.C.); (J.K.S.); (W.J.C.)
- Department of Obstetrics and Gynecology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Jong Chul Baek
- Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea; (J.Y.J.); (C.H.K.); (M.H.K.); (I.A.C.); (J.K.S.); (W.J.C.)
- Department of Obstetrics and Gynecology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, 11, Changwon-si 51472, Republic of Korea
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Blanco A, Nogueira-Rodrigues A, Carvalho FM, Giornelli G, Mirza MR. Management of endometrial cancer in Latin America: raising the standard of care and optimizing outcomes. Int J Gynecol Cancer 2024; 34:1263-1272. [PMID: 38697755 PMCID: PMC11347231 DOI: 10.1136/ijgc-2023-005017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Molecular characterization of endometrial cancer is allowing for increased understanding of the natural history of tumors and paving a more solid pathway for novel therapies. It is becoming increasingly apparent that molecular classification is superior to histological classification in terms of reproducibility and prognostic discrimination. In particular, the Proactive Molecular Risk Classifier for Endometrial Cancer allows classification of endometrial cancer into groups very close to those determined by the Cancer Genome Atlas Research Network-that is, DNA polymerase epsilon-mutated, mismatch repair-deficient, p53 abnormal, and non-specific molecular profile tumors. The transition from the chemotherapy era to the age of targeted agents and immunotherapy, which started later in endometrial cancer than in many other tumor types, requires widespread availability of specialized pathology and access to novel agents. Likewise, surgical expertise and state-of-the-art radiotherapy modalities are required to ensure adequate care. Nevertheless, Latin American countries still face considerable barriers to implementation of international guidelines. As we witness the dawn of precision medicine as applied to endometrial cancer, we must make continued efforts towards improving the quality of care in this region. The current article discusses some of these challenges and possible solutions.
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Affiliation(s)
- Albano Blanco
- Instituto Alexander Fleming, Buenos Aires, Argentina
| | | | | | | | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet; Copenhagen University Hospital, Copenhagen, Denmark
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18
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Powell MA, Bjørge L, Willmott L, Novák Z, Black D, Gilbert L, Sharma S, Valabrega G, Landrum LM, Gropp-Meier M, Stuckey A, Boere I, Gold MA, Segev Y, Gill SE, Gennigens C, Sebastianelli A, Shahin MS, Pothuri B, Monk BJ, Buscema J, Coleman RL, Slomovitz BM, Ring KL, Herzog TJ, Balas MM, Grimshaw M, Stevens S, Lai DW, McCourt C, Mirza MR. Overall survival in patients with endometrial cancer treated with dostarlimab plus carboplatin-paclitaxel in the randomized ENGOT-EN6/GOG-3031/RUBY trial. Ann Oncol 2024; 35:728-738. [PMID: 38866180 DOI: 10.1016/j.annonc.2024.05.546] [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: 03/03/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Part 1 of the RUBY trial (NCT03981796) evaluated dostarlimab plus carboplatin-paclitaxel compared with placebo plus carboplatin-paclitaxel in patients with primary advanced or recurrent endometrial cancer (EC). At the first interim analysis, the trial met one of its dual primary endpoints with statistically significant progression-free survival benefits in the mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) and overall populations. Overall survival (OS) results are reported from the second interim analysis. PATIENTS AND METHODS RUBY is a phase III, global, double-blind, randomized, placebo-controlled trial. Part 1 of RUBY enrolled eligible patients with primary advanced stage III or IV or first recurrent EC who were randomly assigned (1 : 1) to receive either dostarlimab (500 mg) or placebo, plus carboplatin-paclitaxel every 3 weeks for 6 cycles followed by dostarlimab (1000 mg) or placebo every 6 weeks for up to 3 years. OS was a dual primary endpoint. RESULTS A total of 494 patients were randomized (245 in the dostarlimab arm; 249 in the placebo arm). In the overall population, with 51% maturity, RUBY met the dual primary endpoint for OS at this second interim analysis, with a statistically significant reduction in the risk of death [hazard ratio (HR) = 0.69, 95% confidence interval (CI) 0.54-0.89, P = 0.0020] in patients treated with dostarlimab plus carboplatin-paclitaxel versus carboplatin-paclitaxel alone. The risk of death was lower in the dMMR/MSI-H population (HR = 0.32, 95% CI 0.17-0.63, nominal P = 0.0002) and a trend in favor of dostarlimab was seen in the mismatch repair-proficient/microsatellite stable population (HR = 0.79, 95% CI 0.60-1.04, nominal P = 0.0493). The safety profile for dostarlimab plus carboplatin-paclitaxel was consistent with the first interim analysis. CONCLUSIONS Dostarlimab in combination with carboplatin-paclitaxel demonstrated a statistically significant and clinically meaningful OS benefit in the overall population of patients with primary advanced or recurrent EC while demonstrating an acceptable safety profile.
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Affiliation(s)
- M A Powell
- National Cancer Institute sponsored NRG Oncology, Washington University School of Medicine, St Louis, USA
| | - L Bjørge
- Haukeland University Hospital, Bergen; University of Bergen, Bergen, Norway
| | | | - Z Novák
- Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary
| | - D Black
- Willis-Knighton Cancer Center, Willis-Knighton Health System, Gynecologic Oncology Associates, Shreveport, USA
| | - L Gilbert
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal; Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada
| | - S Sharma
- Department of Obstetrics/Gynecology, AMITA Health Adventist Medical Center, Hinsdale, USA
| | - G Valabrega
- Ordine Mauriziano Torino and University of Torino, Torino, Italy
| | - L M Landrum
- Indiana University Health & Simon Cancer Center, Indianapolis, USA
| | - M Gropp-Meier
- AGO Study Group, Wiesbaden; Oberschwabenklinik, St. Elisabethen-Klinikum, Ravensburg, Germany
| | - A Stuckey
- Women and Infants Hospital of Rhode Island, Providence, USA
| | - I Boere
- Department of Medical Oncology, Erasmus MC Cancer Centre, Rotterdam, The Netherlands
| | - M A Gold
- Oklahoma Cancer Specialists and Research Institute, Tulsa, USA
| | - Y Segev
- Gynecology Oncology Division, Department of Obstetrics and Gynaecology, Carmel Medical Center, Haifa, Israel
| | - S E Gill
- St. Joseph's/Candler Gynecologic Oncology & Surgical Specialists, Candler Hospital, Savannah, USA
| | - C Gennigens
- Department of Medical Oncology, CHU of Liège, Liège; Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven, Belgium
| | | | - M S Shahin
- Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College of Thomas Jefferson University, Willow Grove
| | - B Pothuri
- GOG Foundation; Departments of Obstetrics/Gynecology and Medicine, Division of Gynecologic Oncology, Laura & Isaac Perlmutter Cancer Center, NYU Langone Health, New York
| | - B J Monk
- GOG Foundation; Department of Florida Cancer Specialists and Research Institute, West Palm Beach
| | - J Buscema
- Department of Arizona Oncology, Tucson
| | - R L Coleman
- Department of Texas Oncology, US Oncology Network, The Woodlands
| | - B M Slomovitz
- Department of Gynecologic Oncology, Mount Sinai Medical Center, Miami Beach; Department of Obstetrics and Gynecology, Florida International University, Miami Beach
| | - K L Ring
- University of Virginia Health System, Charlottesville
| | - T J Herzog
- Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, University of Cincinnati, Cincinnati
| | | | | | | | | | - C McCourt
- Division of Gynecologic Oncology, Washington University School of Medicine, Washington University in St Louis, St Louis, USA
| | - M R Mirza
- Rigshospitalet, Copenhagen University Hospital, Copenhagen; Nordic Society of Gynaecologic Oncology-Clinical Trial Unit, Copenhagen, Denmark.
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Shi R, Zhao R, Shen Y, Wei S, Zhang T, Zhang J, Shu W, Cheng S, Teng H, Wang H. IGF2BP2-modified circular RNA circCHD7 promotes endometrial cancer progression via stabilizing PDGFRB and activating JAK/STAT signaling pathway. Cancer Gene Ther 2024; 31:1221-1236. [PMID: 38778089 PMCID: PMC11327104 DOI: 10.1038/s41417-024-00781-9] [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: 10/16/2023] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
Circular RNAs (circRNAs) represent a class of covalently closed, single-stranded RNAs and have been linked to cancer progression. N6-methyladenosine (m6A) methylation is a ubiquitous RNA modification in cancer cells. Increasing evidence suggests that m6A can mediate the effects of circRNAs in cancer biology. In contrast, the post-transcriptional systems of m6A and circRNA in the progression of endometrial cancer (EC) remain obscure. The current study identified a novel circRNA with m6A modification, hsa_circ_0084582 (circCHD7), which was upregulated in EC tissues. Functionally, circCHD7 was found to promote the proliferation of EC cells. Mechanistically, circCHD7 interacted with insulin-like growth factor 2 mRNA-binding protein (IGF2BP2) to amplify its enrichment. Moreover, circCHD7 increased the mRNA stability of platelet-derived growth factor receptor beta (PDGFRB) in an m6A-dependent manner, thereby enhancing its expression. In addition, the circCHD7/IGF2BP2/PDGFRB axis activated the JAK/STAT signaling pathway and promoted EC cell proliferation. In conclusion, these findings provide new insights into the regulation of circRNA-mediated m6A modification, and the new "circCHD7-PDGFRB" model of regulation offers new perspectives on circCHD7 as a potential target for EC therapy.
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Affiliation(s)
- Rui Shi
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, PR China
| | - Rong Zhao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, PR China
| | - Yan Shen
- Health Management Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, PR China
| | - Sitian Wei
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, PR China
| | - Tangansu Zhang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, PR China
| | - Jun Zhang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, PR China
| | - Wan Shu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, PR China
| | - Shuangshuang Cheng
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, PR China
| | - Hua Teng
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, PR China
| | - Hongbo Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, PR China.
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Zhao S, Zhang J, Yan Y, Tian L, Chen L, Zheng X, Sun Y, Tian W, Xue F, Wang Y. Oncological and reproductive outcomes of endometrial atypical hyperplasia and endometrial cancer patients undergoing conservative therapy with hysteroscopic resection: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2024; 103:1498-1512. [PMID: 38382917 PMCID: PMC11266644 DOI: 10.1111/aogs.14815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Our objective was to conduct a systematic review and meta-analysis of studies evaluating the oncological and reproductive outcomes of patients with endometrial atypical hyperplasia (AH) and endometrioid endometrial cancer (EEC) undergoing conservative therapy with hysteroscopic resection (HR). MATERIAL AND METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for systematic reviews and meta-analyses. The study strictly followed the methodological framework proposed by the Cochrane Handbook and was retrospectively registered in PROSPERO (CRD42023469986). Searches were conducted in PubMed, Embase, and the Cochrane Library, from inception to October 10, 2023. A checklist based on items of the Newcastle-Ottawa Scale and the Methodological Index for Non-randomized Studies was used for quality assessment. The primary end points for this meta-analysis were complete response (CR), pregnancy, and live birth rates following HR-based therapy in patients with EEC or AH. The secondary end point was the recurrence rate (RR). RESULTS Twenty-one articles involving 407 patients with clinical stage IA, low or intermediate grade, EEC, and 444 patients with AH managed with HR-based conservative treatment were included for this systematic review. CR to HR-based conservative therapy was achieved in 88.6% of patients with EEC and 97.0% of patients with AH. Of these, 30.6% and 24.2%, respectively, had live births. The overall pooled disease RR was 18.3% and 10.8% in patients with EEC and AH, respectively. Further subset analyses revealed that EEC patients with body mass index (BMI) ≤28 kg/m2 had higher CR rates as well as higher chances of pregnancy and live birth (91.6% CR, 32.9% pregnancy, 31.1% live birth) compared with patients with BMI >28 kg/m2 (86.4% CR, 28.4% pregnancy, 23.0% live birth). The HR followed by oral progestogen subgroup had higher CR rates and higher chances of pregnancy and live birth (91.8% CR, 36.3% pregnancy, 28.2% live birth) than the HR followed by the levonorgestrel intrauterine system subgroup (82.5% CR, 25.3% pregnancy, 16.3% live birth). CONCLUSIONS Hysteroscopic resection followed by progestins appears to be a promising choice for fertility-sparing treatment in young patients with AH and EEC, with effective and safe responses. The live birth rate remains to be improved by providing medical guidance and encouragement.
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Affiliation(s)
- Shuangshuang Zhao
- Department of Gynecology and ObstetricsTianjin Medical University General HospitalTianjinChina
- Tianjin Key Laboratory of Female Reproductive Health and EugenicsTianjin Medical University General HospitalTianjinChina
| | - Jingying Zhang
- Department of Gynecology and ObstetricsTianjin Medical University General HospitalTianjinChina
- Tianjin Key Laboratory of Female Reproductive Health and EugenicsTianjin Medical University General HospitalTianjinChina
| | - Ye Yan
- Department of Gynecology and ObstetricsTianjin Medical University General HospitalTianjinChina
- Tianjin Key Laboratory of Female Reproductive Health and EugenicsTianjin Medical University General HospitalTianjinChina
| | - Lina Tian
- Department of Gynecology and ObstetricsTianjin Medical University General HospitalTianjinChina
- Tianjin Key Laboratory of Female Reproductive Health and EugenicsTianjin Medical University General HospitalTianjinChina
| | - Lingli Chen
- Department of Gynecology and ObstetricsTianjin Medical University General HospitalTianjinChina
- Tianjin Key Laboratory of Female Reproductive Health and EugenicsTianjin Medical University General HospitalTianjinChina
| | - Xingyu Zheng
- Department of Gynecology and ObstetricsTianjin Medical University General HospitalTianjinChina
- Tianjin Key Laboratory of Female Reproductive Health and EugenicsTianjin Medical University General HospitalTianjinChina
| | - Yiqing Sun
- Department of Gynecology and ObstetricsTianjin Medical University General HospitalTianjinChina
- Tianjin Key Laboratory of Female Reproductive Health and EugenicsTianjin Medical University General HospitalTianjinChina
| | - Wenyan Tian
- Department of Gynecology and ObstetricsTianjin Medical University General HospitalTianjinChina
- Tianjin Key Laboratory of Female Reproductive Health and EugenicsTianjin Medical University General HospitalTianjinChina
| | - Fengxia Xue
- Department of Gynecology and ObstetricsTianjin Medical University General HospitalTianjinChina
- Tianjin Key Laboratory of Female Reproductive Health and EugenicsTianjin Medical University General HospitalTianjinChina
| | - Yingmei Wang
- Department of Gynecology and ObstetricsTianjin Medical University General HospitalTianjinChina
- Tianjin Key Laboratory of Female Reproductive Health and EugenicsTianjin Medical University General HospitalTianjinChina
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Zhang X, Yang YX, Lu JJ, Hou DY, Abudukeyoumu A, Zhang HW, Li MQ, Xie F. Active Heme Metabolism Suppresses Macrophage Phagocytosis via the TLR4/Type I IFN Signaling/CD36 in Uterine Endometrial Cancer. Am J Reprod Immunol 2024; 92:e13916. [PMID: 39166450 DOI: 10.1111/aji.13916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/28/2024] [Accepted: 08/02/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Uterine endometrial cancer (UEC) is a common gynecological estrogen-dependent carcinoma, usually accompanied by intermenstrual bleeding. Active heme metabolism frequently plays an increasingly important role in many diseases, especially in cancers. Tumor-associated macrophages (TAMs) are the major population in the immune microenvironment of UEC. However, the roles of heme metabolisms in the crosstalk between UEC cells (UECCs) and macrophages are unclear. MATERIALS AND METHODS In our study, by using TCGA database analysis, integration analysis of the protein-protein interaction (PPI) network and sample RNA transcriptome sequencing were done. The expression level of both heme-associated molecules and iron metabolism-related molecules were measured by quantitative real-time polymerase chain reaction. Heme level detection was done through dehydrohorseradish peroxidase assay. In addition to immunohistochemistry, phagocytosis assay of macrophages, immunofluorescence staining, intracellular ferrous iron staining, as well as enzyme-linked immune sorbent assay were performed. RESULTS In the study, we verified that heme accumulation in UECCs is apparently higher than in endometrial epithelium cells. Low expression of succinate dehydrogenase B under the regulation of estrogen contributes to over-production of succinate and heme accumulation in UECC. More importantly, excessive heme in UECCs impaired macrophage phagocytosis by regulation of CD36. Mechanistically, this process is dependent on toll-like receptor (TLR4)/type I interferons alpha (IFN Iα) regulatory axis in macrophage. CONCLUSION Collectively, these findings elucidate that active heme metabolism of UECCs directly decreases phagocytosis by controlling the secretion of TLR4-mediated IFN Iα and the expression of CD36, and further contributing to the immune escape of UEC.
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Affiliation(s)
- Xing Zhang
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, People's Republic of China
- Medical Center of Diagnosis and Treatment for Cervical and Intrauterine Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Yi-Xing Yang
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, People's Republic of China
| | - Jia-Jing Lu
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, People's Republic of China
| | - Ding-Yu Hou
- Medical Center of Diagnosis and Treatment for Cervical and Intrauterine Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Ayitila Abudukeyoumu
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Jiading District, Shanghai, People's Republic of China
| | - Hong-Wei Zhang
- Medical Center of Diagnosis and Treatment for Cervical and Intrauterine Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Ming-Qing Li
- Laboratory for Reproductive Immunology, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, People's Republic of China
| | - Feng Xie
- Medical Center of Diagnosis and Treatment for Cervical and Intrauterine Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
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Capasso I, Cucinella G, Wright DE, Takahashi H, De Vitis LA, Gregory AV, Kim B, Reynolds E, Fumagalli D, Occhiali T, Fought AJ, McGree ME, Packard AT, Causa Andrieu PI, Fanfani F, Scambia G, Langstraat CL, Famuyide A, Breitkopf DM, Mariani A, Glaser GE, Kline TL. Artificial intelligence model for enhancing the accuracy of transvaginal ultrasound in detecting endometrial cancer and endometrial atypical hyperplasia. Int J Gynecol Cancer 2024:ijgc-2024-005652. [PMID: 39089731 DOI: 10.1136/ijgc-2024-005652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVES Transvaginal ultrasound is typically the initial diagnostic approach in patients with postmenopausal bleeding for detecting endometrial atypical hyperplasia/cancer. Although transvaginal ultrasound demonstrates notable sensitivity, its specificity remains limited. The objective of this study was to enhance the diagnostic accuracy of transvaginal ultrasound through the integration of artificial intelligence. By using transvaginal ultrasound images, we aimed to develop an artificial intelligence based automated segmentation model and an artificial intelligence based classifier model. METHODS Patients with postmenopausal bleeding undergoing transvaginal ultrasound and endometrial sampling at Mayo Clinic between 2016 and 2021 were retrospectively included. Manual segmentation of images was performed by four physicians (readers). Patients were classified into cohort A (atypical hyperplasia/cancer) and cohort B (benign) based on the pathologic report of endometrial sampling. A fully automated segmentation model was developed, and the performance of the model in correctly identifying the endometrium was compared with physician made segmentation using similarity metrics. To develop the classifier model, radiomic features were calculated from the manually segmented regions-of-interest. These features were used to train a wide range of machine learning based classifiers. The top performing machine learning classifier was evaluated using a threefold approach, and diagnostic accuracy was assessed through the F1 score and area under the receiver operating characteristic curve (AUC-ROC). RESULTS 302 patients were included. Automated segmentation-reader agreement was 0.79±0.21 using the Dice coefficient. For the classification task, 92 radiomic features related to pixel texture/shape/intensity were found to be significantly different between cohort A and B. The threefold evaluation of the top performing classifier model showed an AUC-ROC of 0.90 (range 0.88-0.92) on the validation set and 0.88 (range 0.86-0.91) on the hold-out test set. Sensitivity and specificity were 0.87 (range 0.77-0.94) and 0.86 (range 0.81-0.94), respectively. CONCLUSIONS We trained an artificial intelligence based algorithm to differentiate endometrial atypical hyperplasia/cancer from benign conditions on transvaginal ultrasound images in a population of patients with postmenopausal bleeding.
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Affiliation(s)
- Ilaria Capasso
- Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Cucinella
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
| | - Darryl E Wright
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Luigi Antonio De Vitis
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Gynecology, Istituto Europeo di Oncologia, Milano, Italy
| | | | - Bohyun Kim
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Evelyn Reynolds
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Diletta Fumagalli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Gynecologic Surgery, IRCCS San Gerardo dei Tintori Foundation Hospital, Monza, Italy
| | - Tommaso Occhiali
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Obstetrics and Gynecology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Angela J Fought
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Michaela E McGree
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Annie T Packard
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Francesco Fanfani
- Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giovanni Scambia
- Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Carrie L Langstraat
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Abimbola Famuyide
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel M Breitkopf
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gretchen E Glaser
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy L Kline
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Bouttle K, Ingold N, O’Mara TA. Using Genetics to Investigate Relationships between Phenotypes: Application to Endometrial Cancer. Genes (Basel) 2024; 15:939. [PMID: 39062718 PMCID: PMC11276418 DOI: 10.3390/genes15070939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/14/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Genome-wide association studies (GWAS) have accelerated the exploration of genotype-phenotype associations, facilitating the discovery of replicable genetic markers associated with specific traits or complex diseases. This narrative review explores the statistical methodologies developed using GWAS data to investigate relationships between various phenotypes, focusing on endometrial cancer, the most prevalent gynecological malignancy in developed nations. Advancements in analytical techniques such as genetic correlation, colocalization, cross-trait locus identification, and causal inference analyses have enabled deeper exploration of associations between different phenotypes, enhancing statistical power to uncover novel genetic risk regions. These analyses have unveiled shared genetic associations between endometrial cancer and many phenotypes, enabling identification of novel endometrial cancer risk loci and furthering our understanding of risk factors and biological processes underlying this disease. The current status of research in endometrial cancer is robust; however, this review demonstrates that further opportunities exist in statistical genetics that hold promise for advancing the understanding of endometrial cancer and other complex diseases.
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Affiliation(s)
| | | | - Tracy A. O’Mara
- Cancer Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia (N.I.)
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24
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Wang J, Chen Z, Lai Y, Ma Z, Wang L, Fiori PL, Carru C, Capobianco G, Zhou L. Insights into inflammation and implications for the pathogenesis and long-term outcomes of endometrial cancer: genome-wide surveys and a clinical cohort study. BMC Cancer 2024; 24:846. [PMID: 39020272 PMCID: PMC11253470 DOI: 10.1186/s12885-024-12630-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Despite evidence showing a connection between inflammation and endometrial cancer (EC) risk, the surveys on genetic correlation and cohort studies investigating the impact on long-term outcomes have yet to be refined. We aimed to address the impact of inflammation factors on the pathogenesis, progression and consequences of EC. METHODS For the genetic correlation analyses, a two-sample of Mendelian randomization (MR) study was applied to investigate inflammation-related single-nucleotide polymorphisms involved with endometrial cancer from GWAS databases. The observational retrospective study included consecutive patients diagnosed with EC (stage I to IV) with surgeries between January 2010 and October 2020 at the Cancer Hospital of Shantou University Medical College. RESULTS The 2-sample MR surveys indicated no causal relationship between inflammatory cytokines and endometrial cancer. 780 cases (median age, 55.0 years ) diagnosed with EC were included in the cohort and followed up for an average of 6.8 years. Increased inflammatory parameters at baseline were associated with a higher FIGO stage and invasive EC risk (odds ratios [OR] 1.01 to 4.20). Multivariate-cox regression suggested that multiple inflammatory indicators were significantly associated with overall survival (OS) and progression-free survival (PFS) (P < 0.05). Nomogram models based on inflammatory risk and clinical factors were developed for OS and PFS with C-index of 0.811 and 0.789, respectively. LASSO regression for the validation supported the predictive efficacy of inflammatory and clinical factors on the long-term outcomes of EC. CONCLUSIONS Despite the fact that the genetic surveys did not show a detrimental impact of inflammatory cytokines on the endometrial cancer risk, our cohort study suggested that inflammatory level was associated with the progression and long-term outcomes of EC. This evidence may contribute to new strategies targeted at decreasing inflammation levels during EC therapy.
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Affiliation(s)
- Jing Wang
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhichao Chen
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yaozhen Lai
- Department of Gynecologic Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Zebiao Ma
- Department of Gynecologic Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Luanhong Wang
- Department of Gynecologic Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Pier Luigi Fiori
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Giampiero Capobianco
- Gynecologic and Obstetric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Li Zhou
- Department of Gynecologic Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
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Zhang XH, Wu SW, Feng YF, Xie YQ, Li M, Hu P, Cao Y. ZBTB7A regulates LncRNA HOTAIR-mediated ELAVL1/SOX17 axis to inhibit malignancy and angiogenesis in endometrial carcinoma. J Cancer Res Clin Oncol 2024; 150:345. [PMID: 38981872 PMCID: PMC11233420 DOI: 10.1007/s00432-024-05860-w] [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: 03/20/2024] [Accepted: 06/19/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Endometrial cancer (EC) is the sixth most frequent cancer in women worldwide and has higher fatality rates. The pathophysiology of EC is complex, and there are currently no reliable methods for diagnosing and treating the condition. Long non-coding RNA (lncRNA), according to mounting evidence, is vital to the pathophysiology of EC. HOTAIR is regarded as a significant prognostic indicator of EC. ZBTB7A decreased EC proliferation and migration, according to recent studies, however the underlying mechanism still needs to be clarified. METHODS The research utilized RT-qPCR to measure HOTAIR expression in clinical EC tissues and various EC cell lines. Kaplan-Meier survival analysis was employed to correlate HOTAIR levels with patient prognosis. Additionally, the study examined the interaction between ZBTB7A and HOTAIR using bioinformatics tools and ChIP assays. The experimental approach also involved manipulating the expression levels of HOTAIR and ZBTB7A in EC cell lines and assessing the impact on various cellular processes and gene expression. RESULTS The study found significantly higher levels of HOTAIR in EC tissues compared to adjacent normal tissues, with high HOTAIR expression correlating with poorer survival rates and advanced cancer characteristics. EC cell lines like HEC-1 A and KLE showed higher HOTAIR levels compared to normal cells. Knockdown of HOTAIR in these cell lines reduced proliferation, angiogenesis, and migration. ZBTB7A was found to be inversely correlated with HOTAIR, and its overexpression led to a decrease in HOTAIR levels and a reduction in malignant cell behaviors. The study also uncovered that HOTAIR interacts with ELAVL1 to regulate SOX17, which in turn activates the Wnt/β-catenin pathway, promoting malignant behaviors in EC cells. CONCLUSION HOTAIR is a critical regulator in EC, contributing to tumor growth and poor prognosis. Its interaction with ZBTB7A and regulation of SOX17 via the Wnt/β-catenin pathway underlines its potential as a therapeutic target.
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Affiliation(s)
- Xiao-Hui Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, 218, Jixi Road, Hefei, Anhui Province, 230022, P. R. China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China
| | - Shu-Wei Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, 218, Jixi Road, Hefei, Anhui Province, 230022, P. R. China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China
| | - Yi-Fan Feng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, 218, Jixi Road, Hefei, Anhui Province, 230022, P. R. China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China
| | - Yang-Qin Xie
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, 218, Jixi Road, Hefei, Anhui Province, 230022, P. R. China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China
| | - Min Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, 218, Jixi Road, Hefei, Anhui Province, 230022, P. R. China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China
- Anhui Province Key Laboratory of Reproductive Health and Genetics, 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China
| | - Ping Hu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, 230022, P. R. China
| | - Yunxia Cao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, 218, Jixi Road, Hefei, Anhui Province, 230022, P. R. China.
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University), 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China.
- Anhui Province Key Laboratory of Reproductive Health and Genetics, 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China.
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, 218, Jixi Road, Hefei, Anhui Province, 230032, P. R. China.
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Sabry RM, Mahmoud SA, Abdelmagid MS, Abdellatif Mahmoud S, Yassin Ahmed Y. Caveolin-1's dual impact on endometrioid endometrial carcinoma: a histopathological and immunohistochemical study. J Immunoassay Immunochem 2024; 45:325-341. [PMID: 38627940 DOI: 10.1080/15321819.2024.2342825] [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: 07/06/2024]
Abstract
The objectives of this study are to evaluate caveolin-1 expression in endometrioid endometrial cancer and its correlation with clinicopathological parameters. Forty-four cases of endometrioid endometrial carcinomas underwent radical hysterectomy. The archived paraffin sections that were stained for caveolin-1 by immunohistochemistry, caveolin-1 expression were detected in cancerous epithelial cells in 18.2% of the cases, and stromal caveolin-1 was detected in 65.9% of the cases. Caveolin-1 expression in the epithelium showed a significant positive association with the T stage and the FIGO stage. Positive caveolin-1 expression in epithelium has a direct, positive and significant relationship with invasion of other organs and a direct and significant relationship with the advanced FIGO stage. As for caveolin-1 expression in the stroma, it showed a significant negative inversely significant association with myometrial invasion. Also, there is a significant negative association between caveolin-1 expression in the epithelium and its expression in the stroma. We conclude that caveolin-1 expression strongly plays a critical role in endometrioid endometrial carcinoma as a tumor suppressor or promoter of invasion. In early lesions, high stromal levels appear to be protective against progression. While decreased stromal expression and increased epithelial expression were associated with aggressive tumors.
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Affiliation(s)
- Rania Mohamed Sabry
- Department of Anatomic Pathology, Faculty of Medicine Kasralainy, Cairo University, Giza, Egypt
| | - Samira Abdallah Mahmoud
- Department of Anatomic Pathology, Faculty of Medicine Kasralainy, Cairo University, Giza, Egypt
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27
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Matsukawa T, Yoshikawa N, Liu W, Hattori S, Yoshida K, Yoshihara M, Tamauchi S, Yokoi A, Niimi K, Kajiyama H. Spatial distribution of tumor-resident macrophages as predictive biomarkers in endometrial cancer. J Obstet Gynaecol Res 2024; 50:1141-1147. [PMID: 38627199 DOI: 10.1111/jog.15953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/05/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND To investigate the role of CD47 expression and its relationship with tumor-resident macrophages, specifically at the tumor margin, in patients with type II endometrial cancer. This study aims to elucidate whether CD47 could serve as a prognostic marker and to understand the dynamics between CD47 and macrophages, which could inform new therapeutic strategies. METHODS A retrospective cohort study was conducted involving 75 patients of type II endometrial. Immunohistochemical analysis was performed to assess CD47 expression and macrophage markers (CD68 and CD163). RESULTS The study found no direct correlation between CD47 expression levels and overall survival (p = 0.32), challenging its role as an independent prognostic marker in type II endometrial cancer. The higher expression of CD47 had significantly less incidence of endometrioid carcinoma G3 (p = 0.047). The negative correlation between CD47 H-score and the density of CD68-positive macrophages at tumor margin was statistically significant (p = 0.049). A high density of CD68-positive macrophages at the tumor margin but a low density of CD163-positive macrophages at the tumor margin were associated with poorer prognosis (p = 0.036). CONCLUSIONS The complex interaction between CD47 and macrophages, particularly at the tumor margin, suggests new avenues for targeted therapy in type II endometrial cancer.
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Affiliation(s)
- Tetsuya Matsukawa
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Nobuhisa Yoshikawa
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Wenting Liu
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- Bell Research Center, Department of Obstetrics and Gynecology Collaborative Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satomi Hattori
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Kosuke Yoshida
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Satoshi Tamauchi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Akira Yokoi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Kaoru Niimi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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van Maldegem LDPR, van der Zande JA, van Werkhoven LA, Ewing‐Graham PC, Heemskerk‐Gerritsen BAM, van Doorn HC. Recurrent postmenopausal bleeding: Pathological findings and predictive factors. A multicenter, prospective, observational study. Acta Obstet Gynecol Scand 2024; 103:1283-1291. [PMID: 38695570 PMCID: PMC11168275 DOI: 10.1111/aogs.14851] [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: 08/23/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Recurrent postmenopausal bleeding (PMB) occurs in 6%-25% of postmenopausal women who have experienced a previous episode of PMB. The question of whether recurrent PMB leads to a higher risk of endometrial cancer (EC) in comparison to a single episode of PMB is, however, controversial. Furthermore, little is known about predictive factors for recurrent PMB. MATERIAL AND METHODS A multicenter prospective cohort study was conducted over a 5-year period in four hospitals in the Netherlands. Women with PMB undergoing endometrial sampling and aged 40 years and older were included. Occurrence of recurrent PMB was retrospectively determined. Primary outcomes included (1) the incidence of recurrent PMB and (2) differences in pathological findings between patients with a single episode vs recurrent PMB. Secondary outcomes included (1) the association between diagnosis of benign polyps at first PMB and pathological findings at recurrent PMB and (2) factors predictive for recurrent PMB. RESULTS A total of 437 women with PMB were included, of whom 360 were at risk of recurrent PMB. With a median follow-up of 61 months (IQR (Interquartile range) 44-73), 26.4% experienced recurrent PMB. Patients with recurrent PMB were more often diagnosed with benign polyps (34.7% vs. 25.1%, p-value 0.015) and less frequently with a malignancy (5.3% vs. 17.8%, p-value 0.015), compared to patients with a single episode of PMB. Benign polyps at initial PMB were not associated with a (pre)malignancy at recurrence (OR 4.16, 95% CI 0.75-23.03). Predictive factors for recurrent PMB included use of hormone replacement therapy (HRT) (OR 3.32, 95% CI 1.64-6.72), and benign polyps at initial PMB (OR 1.80, 95% CI 1.07-3.04). CONCLUSIONS Recurrent PMB is common in women with a previous episode of PMB. Compared to patients with a single episode of PMB, patients with recurrent PMB and benign histological outcomes at accurate workup during their first episode were less often diagnosed with malignancies and more frequently with benign polyps. Benign polyps at first PMB are predictive for recurrent PMB, but not for a higher risk of (pre)malignancy.
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Affiliation(s)
- Laura D. P. R. van Maldegem
- Department of Gynecologic OncologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
| | - Johanna A. van der Zande
- Department of Gynecologic OncologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
| | - Lucy A. van Werkhoven
- Department of Gynecologic OncologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
| | - Patricia C. Ewing‐Graham
- Department of PathologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
| | | | - Helena C. van Doorn
- Department of Gynecologic OncologyErasmus MC Cancer Institute, University Medical Center RotterdamRotterdamthe Netherlands
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Akkour K, Alanazi IO, Alfadda AA, Masood A, Alhalal H, Joy SS, Bassi A, Alshehri E, Alwehaibi MA, Arafah M, Benabdelkamel H. Plasma-based proteomic profiling identifies the distinct regulation of proteins in hyperplasia and endometrial cancer. BMC Cancer 2024; 24:752. [PMID: 38902713 PMCID: PMC11191338 DOI: 10.1186/s12885-024-12522-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 06/14/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Among gynaecological malignancies, endometrial cancer (EC) is the most prevalent type of uterine cancer affecting women. This study explored the proteomic profiles of plasma samples obtained from EC patients, those with hyperplasia (Hy), and a control group (CO). A combination of techniques, such as 2D-DIGE, mass spectrometry, and bioinformatics, including pathway analysis, was used to identify proteins with modified expression levels, biomarkers and their associated metabolic pathways in these groups. METHODS Thirty-four patients, categorized into three groups-10 with EC, 12 with Hy, and 12 CO-between the ages of 46 and 75 years old were included in the study. Untargeted proteomic analysis was carried out using two-dimensional difference in gel electrophoresis (2D-DIGE) coupled with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). RESULTS In all three groups, 114 proteins that were significantly (p ≤ 0.05 and fold change ≥ 1.5) altered were successfully identified using peptide mass fingerprints (PMFs). Compared with those in the control group (CO), the EC samples had 85 differentially expressed proteins (39 upregulated and 46 downregulated), and in the Hy group, 81 proteins were dysregulated (40 upregulated and 41 downregulated) compared to those in the CO group, while 33 proteins exhibited differential regulation (12 upregulated and 21 downregulated) in the EC plasma samples compared to those in the Hy group. Vitamin D binding protein and complement C3 distinguished Hy and EC from CO with the greatest changes in expression. Among the differentially expressed proteins identified, enzymes with catalytic activity represented the largest group (42.9%). In terms of biological processes, most of the proteins were involved in cellular processes (28.8%), followed by metabolic processes (16.7%). STRING analysis for protein interactions revealed that the significantly differentially abundant proteins in the three groups are involved in three main biological processes: signalling of complement and coagulation cascades, regulation of insulin-like growth factor (IGF) transport and uptake by insulin-like growth factor binding proteins (IGFBPs), and plasma lipoprotein assembly, remodelling, and clearance. CONCLUSION The identified plasma protein markers have the potential to serve as biomarkers for differentiating between EC and Hy, as well as for early diagnosis and monitoring of cancer progression.
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Affiliation(s)
- Khalid Akkour
- Obstetrics and Gynecology Department, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Ibrahim O Alanazi
- Healthy Aging Research Institute, King Abdulaziz City for Science and Technology (KACST), Health Sector, Riyadh, 11442, Saudi Arabia
| | - Assim A Alfadda
- Proteomics Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
- Department of Medicine, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Afshan Masood
- Proteomics Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Hani Alhalal
- Obstetrics and Gynecology Department, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Salini Scaria Joy
- Proteomics Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Ali Bassi
- Obstetrics and Gynecology Department, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Eman Alshehri
- Obstetrics and Gynecology Department, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Moudi A Alwehaibi
- Proteomics Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia
| | - Maria Arafah
- Department of Pathology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, 11461, Saudi Arabia
| | - Hicham Benabdelkamel
- Proteomics Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh, 11461, Saudi Arabia.
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Fan M, Zhang W, Zhou Y, Li M, Wang D, Qiu K, Li M, Guo H, Yan L. A retrospective study on the analysis of influencing factors of neutropenia in endometrial cancer with adjuvant chemoradiotherapy. Radiat Oncol 2024; 19:76. [PMID: 38890652 PMCID: PMC11186186 DOI: 10.1186/s13014-024-02469-8] [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: 02/24/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE This retrospective study aimed to investigate the factors influencing the occurrence of neutropenia in patients with endometrial cancer (EC) following adjuvant chemoradiotherapy (CRT). METHODS Retrospective analysis of EC patients who underwent adjuvant CRT from January 2012 to June 2023 in the Department of Gynecology and Oncology of the First Affiliated Hospital of Shandong First Medical University. Neutropenia was defined as an Absolute Neutrophil Count (ANC) of peripheral blood neutrophils below 2 × 109/L. Factors affecting neutropenia in EC patients treated with CRT using Generalized Estimating Equation (GEE), and Logistic regression was used to further analyze the effect of adding radiotherapy to different chemotherapy cycles on neutropenia, so that patients receive optimal adjuvant CRT while the risk of neutropenia is appropriately controlled. RESULTS A total of 144 patients met the inclusion criteria. They underwent 330 cycles of adjuvant chemotherapy, of whom 96 (66.7%) developed neutropenia, which occurred 140 times. The results of one-way GEE analysis showed that before CRT, White Blood Cell (WBC) (OR = 0.827; 95%CI, 0.701-0.976), ANC (OR = 0.749; 95%CI, 0.586-0.957), Absolute Monocyte Count (AMC) (OR = 0.047; 95%CI, 0.008-0.283), Blood Urea Nitrogen (BUN) (OR = 0.857; 95%CI, 0.741-0.991), platinum and docetaxel (platinum/docetaxel) dosing regimen (OR = 2.284; 95%CI, 1.130-4.618) were associated with neutropenia with adjuvant CRT for EC (p < 0.05), results of multifactorial GEE analysis showed that before adjuvant CRT ANC (OR = 0.552; 95%CI, 0.973-2.231), AMC (OR = 0.047; 95%CI, 0.004-0.052), platinum/docetaxel (OR = 2.437; 95%CI, 1.087-5.464) were an independent influence on neutropenia in adjuvant CRT for EC (p < 0.05). Multifactorial Logistic regression shows addition of radiotherapy to the first cycle of chemotherapy (OR = 4.413; 95%CI, 1.238-18.891) was an independent influence of neutropenia (p < 0.05). CONCLUSIONS Patients with low pre-CRT ANC and AMC, platinum/docetaxel dosing regimens need to be closely monitored during each cycle of CRT. Also, the concurrent addition of radiotherapy should be avoided during the first cycle of chemotherapy.
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Affiliation(s)
- Mengsi Fan
- Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong Second Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Jinan, China
- School of Public Health, Shandong Second Medical University, Weifang, China
| | - Weiwei Zhang
- Department of Gynecology, Tengzhou Maternal and Child Health Hospital, Tengzhou, China
| | - Yuying Zhou
- School of Public Health, Shandong Second Medical University, Weifang, China
| | - Mingzhuo Li
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Data Open innovative Application Laboratory, Jinan, China
| | - Dongyue Wang
- School of Clinical Medicine, Shandong First Medical University, Jinan, China
- Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Kexin Qiu
- Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong Second Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Jinan, China
- School of Public Health, Shandong Second Medical University, Weifang, China
| | - Mengzhen Li
- School of Public Health, Shandong Second Medical University, Weifang, China
| | - Haoran Guo
- School of Public Health, Shandong Second Medical University, Weifang, China
| | - Li Yan
- Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong Second Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Jinan, China.
- Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Jinan, China.
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Pierre ME, Fletcher Prieto AV, Rodríguez J, Hernández Blanquisett A, Gómez Camacho AM, Parra Medina R, Mojica Silva L, Fernández R, Calderón Quiroz PH. Colombian consensus for the molecular diagnosis of endometrial cancer. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2024; 75:4060. [PMID: 39013200 PMCID: PMC11208073 DOI: 10.18597/rcog.4060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 05/02/2024] [Indexed: 07/18/2024]
Abstract
Objective: The Cancer Genome Atlas research program (TCGA) developed the molecular classification for endometrial cancer with prognostic and therapeutic utility, which was replaced by the ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) classification by consensus and international guidelines due to its high cost. This article aims to present national recommendations from an expert consensus that allows unification and implementation of the molecular classification for women with endometrial cancer nationwide, with a rational use of resources and technology. Methods: Consensus of 36 experts in clinical oncology, oncological gynecology, pathology, and genetics, with clinical practice in the national territory. The leader group performed a literature review and structuring of questions rated 1 to 9 points. A modified nominal group technique was used. There was a face-to-face meeting with master presentations, deliberative dialogue, and Google Forms (Google LLC, Mountain View, CA, USA) questionnaire voting with analysis and discussion of responses. The non-consensual responses led to a second round of voting. The final manuscript was finally prepared and revised. Results: Seven recommendations were formulated integrating the panelist responses based on evidence, but adjusted to the Colombian context and reality. Recommendation 1. The molecular classification is recommended in all the endometrial cancers using the immunohistochemistry markers as subrogated results from the molecular profile initially proposed in the TCGA classification. Recommendation 2. The sequential test strategy is recommended, starting with the immunohistochemistry markers (p53, MLH1, MSH 2, MSH6, PMS2) simultaneously in all the patients, defining to request POLE (DNA polymerase epsilon) (if available) according to the risk classification based on the surgical piece. Recommendation 3. It is recommended, that the gynecologist oncologist should be the one to request the POLE (if available) according to the final pathology report. This test must be requested for all endometrial cancers stage I-II, except in low risk (stage IA low grade endometrioid histology without linfovascular invasion normal p53) and, stages III-IV without residual disease, without affecting the request of subrogated immunohistochemistry molecular markers upon histology. The consensus proposes that the POLE is requested after the immunohistochemistry and according to the categories in the risk classification established by the 2020 ESGO/ESTRO/ESP guidelines. Recommendation 4. It is recommended to perform immunohistochemistry for hormonal receptors for all women with endometrial cancer and the HER2 in patients with p53abn, simultaneously with the others immunohistochemistry markers. Recommendation 5. It is recommended to perform the immunohistochemistry markers (p53, MLH1, MSH2, MSH6 y PMS2) in an initial endometrial biopsy or curettage when the specimen is adequate and available. In case the initial immunohistochemistry is inconclusive, or there are histological discrepancies between the initial and definitive pathology, it is recommended to repeat the molecular profile in the surgical pathology. The immunohistochemistry markers must be reported in the pathology report according to the CAP (College of American Pathologists) recommendations, independently of the type of sample. Recommendation 6. It is recommended to perform MLH1 promoter methylation testing in patients who exhibit loss of expression of MLH1 in immunohistochemistry whether it is accompanied or not with loss of expression of PMS2. All the patients with deficient MMR (mismatch repair), should be sent for genetic counseling to rule out Lynch syndrome. Recommendation 7. It is recommended to consider the molecular classification in addition to the classical histopathological criteria when making adjuvant judgments, as incorporated by the classification of prognostic groups of the 2020 ESGO/ESTRO/ESP guidelines. Conclusions: It is necessary to implement the molecular classification of endometrial cancer in clinical practice in accordance to the Colombian context, due to its prognostic and probably predictive value. This will enable the characterization of the Colombian population in order to offer individualized guided treatments. This is an academic and nonregulatory document.
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Affiliation(s)
- Marc Edy Pierre
- Hematólogo oncólogo. Centro de tratamiento e investigación sobre el cáncer Luis Carlos Sarmiento (CTIC). Bogotá, Colombia.Centro de tratamiento e investigación sobre el cáncer Luis Carlos Sarmiento (CTIC)BogotáColombia
| | - Angélica Viviana Fletcher Prieto
- Ginecóloga oncóloga. Centro de Investigaciones Clínica San Diego-CIOSAD, Bogotá. Centro Internacional de Alta tecnología CLINALTEC. Ibagué, Colombia.Centro de Investigaciones Clínica San Diego-CIOSADBogotáColombia
| | - Juliana Rodríguez
- Ginecóloga oncóloga. Fundación Santa Fe de Bogotá. Médica Especialista. Grupo de Investigación clínica y epidemiológica del Cáncer (GICEC). Instituto Nacional de Cancerología. Profesora asistente Departamento de Obstetricia y Ginecología, Universidad Nacional de Colombia. Bogotá, Colombia. Universidad Nacional de ColombiaUniversidad Nacional de ColombiaBogotáColombia
| | - Abraham Hernández Blanquisett
- Oncólogo clínico. Hospital Serena del Mar. Miembro G-CIGO. Cartagena, Colombia. Hospital Serena del MarCartagenaColombia
| | - Ana Milena Gómez Camacho
- Médica genetista. Hospital Universitario San Ignacio. Fundación Santa Fe de Bogotá. Bogotá, Colombia. Fundación Santa Fe de BogotáBogotáColombia
| | - Rafael Parra Medina
- Patólogo oncólogo. Instituto Nacional de Cancerología. Fundación Universitaria de Ciencias de la Salud. Bogotá, Colombia. Fundación Universitaria de Ciencias de la SaludBogotáColombia
| | - Lucrecia Mojica Silva
- Ginecóloga oncóloga. Liga contra el Cáncer. Villavicencio, Colombia. Liga contra el CáncerVillavicencioColombia
| | - Robinson Fernández
- Ginecólogo oncólogo. Clínica La Asunción. Barranquilla, Colombia. Clínica La AsunciónBarranquillaColombia
| | - Pedro Hernando Calderón Quiroz
- Ginecólogo oncólogo. Instituto Nacional de Cancerología. Hospital Universitario Clínica San Rafael. Bogotá, Colombia. Hospital Universitario Clínica San RafaelBogotáColombia
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Liu X, Wang W, Zhang X, Liang J, Feng D, Li Y, Xue M, Ling B. Metabolism pathway-based subtyping in endometrial cancer: An integrated study by multi-omics analysis and machine learning algorithms. MOLECULAR THERAPY. NUCLEIC ACIDS 2024; 35:102155. [PMID: 38495844 PMCID: PMC10943971 DOI: 10.1016/j.omtn.2024.102155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/14/2024] [Indexed: 03/19/2024]
Abstract
Endometrial cancer (EC), the second most common malignancy in the female reproductive system, has garnered increasing attention for its genomic heterogeneity, but understanding of its metabolic characteristics is still poor. We explored metabolic dysfunctions in EC through a comprehensive multi-omics analysis (RNA-seq datasets from The Cancer Genome Atlas [TCGA], Cancer Cell Line Encyclopedia [CCLE], and GEO datasets; the Clinical Proteomic Tumor Analysis Consortium [CPTAC] proteomics; CCLE metabolomics) to develop useful molecular targets for precision therapy. Unsupervised consensus clustering was performed to categorize EC patients into three metabolism-pathway-based subgroups (MPSs). These MPS subgroups had distinct clinical prognoses, transcriptomic and genomic alterations, immune microenvironment landscape, and unique patterns of chemotherapy sensitivity. Moreover, the MPS2 subgroup had a better response to immunotherapy. Finally, three machine learning algorithms (LASSO, random forest, and stepwise multivariate Cox regression) were used for developing a prognostic metagene signature based on metabolic molecules. Thus, a 13-hub gene-based classifier was constructed to predict patients' MPS subtypes, offering a more accessible and practical approach. This metabolism-based classification system can enhance prognostic predictions and guide clinical strategies for immunotherapy and metabolism-targeted therapy in EC.
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Affiliation(s)
- Xiaodie Liu
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100029, China
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Jinan 250000, China
| | - Wenhui Wang
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xiaolei Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, No. 107 Wenhua West Road, Jinan, Shandong 250012, China
| | - Jing Liang
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Dingqing Feng
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yuebo Li
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100029, China
| | - Ming Xue
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100029, China
| | - Bin Ling
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100029, China
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Buttafuoco KA, Mokshagundam S, Henricks A, Shore S, Brown A, Prescott LS. Impact of electronic medical record utilization on obesity screening and intervention for obese patients with endometrial cancer. Int J Gynecol Cancer 2024; 34:830-839. [PMID: 38519088 PMCID: PMC11187359 DOI: 10.1136/ijgc-2023-005247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/06/2024] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE To identify the prevalence of obesity documented within the electronic medical record problem list. METHODS We conducted a retrospective cohort study of adult patients with obesity and endometrial cancer receiving care from January 2018 to March 2021 at a single institution. Obesity intervention was defined as receipt of at least one of the following: referral to weight loss clinic, referral to a nutritionist, completion of obesity intervention tab, or documentation of weight loss counseling. Our secondary objectives were to (1) identify the prevalence of completed obesity interventions, (2) identify the number of patients who have achieved weight loss since their initial visit, and (3) identify covariates associated with presence of obesity on problem list, completion of obesity interventions, and weight loss. RESULTS We identified 372 patients who met inclusion criteria. Of eligible patients, 202 (54%) had obesity documented on their problem list and 171 (46%) completed at least one obesity intervention. Within our cohort, 195 (52%) patients achieved weight loss from diagnosis or initial clinical encounter at our institution to most recent clinical encounter with median weight loss of 3.9 kg (IQR 1.5-8.0). In the multivariable logistic regressions, patients with obesity on the problem list were approximately twice as likely to have completion of obesity intervention (OR 1.91, 95% CI 1.09, 3.35, p=0.024). Although presence of obesity on the problem list was not associated with weight loss, completion of health maintenance obesity intervention tab in the electronic medical record (Epic) was associated with weight loss (OR 2.77, 95% CI 1.11, 6.89, p=0.03). CONCLUSIONS Only half of obese endometrial cancer patients had documentation of obesity within the electronic medical record problem list. The electronic medical record could be leveraged to achieve compliance with weight loss interventions. Further investigation on how the electronic medical record can be optimized to help patients achieve weight loss is needed.
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Affiliation(s)
| | | | - Anna Henricks
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Summer Shore
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alaina Brown
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lauren Shore Prescott
- Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Vasileva R, Wohrer H, Gaultier V, Bucau M, Courcier H, Ben Miled S, Gonthier C, Koskas M. Pregnancy and obstetric outcomes after fertility-sparing management of endometrial cancer and atypical hyperplasia: a multicentre cohort study. Hum Reprod 2024; 39:1231-1238. [PMID: 38719783 DOI: 10.1093/humrep/deae089] [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: 02/25/2024] [Revised: 04/08/2024] [Indexed: 06/04/2024] Open
Abstract
STUDY QUESTION What are the pregnancy and obstetric outcomes in women with atypical hyperplasia (AH) or early-stage endometrial cancer (EC) managed conservatively for fertility preservation? SUMMARY ANSWER The study found a live birth rate of 62% in patients with AH or EC after conservative treatment, with higher level of labour induction, caesarean section, and post-partum haemorrhage. WHAT IS KNOWN ALREADY Fertility-sparing treatment is a viable option for women with AH or EC during childbearing years, but the outcomes of such treatments, especially regarding pregnancy and obstetrics, need further exploration. STUDY DESIGN, SIZE, DURATION This retrospective cohort study analysed data from January 2010 to October 2022, involving 269 patients from the French national register of patients with fertility-sparing management of AH/EC. PARTICIPANTS/MATERIALS, SETTING, METHODS Women above 18 years of age, previously diagnosed with AH/EC, and approved for fertility preservation were included. Patients were excluded if they were registered before 2010, if their treatment began <6 months before the study, or if no medical record on the pregnancy was available. MAIN RESULTS AND THE ROLE OF CHANCE In total, 95 pregnancies in 67 women were observed. Pregnancy was achieved using ART in 63 cases (66%) and the live birth rate was 62%, with early and late pregnancy loss at 26% and 5%, respectively. In the 59 cases resulting in a live birth, a full-term delivery occurred in 90% of cases; 36% of cases required labour induction and 39% of cases required a caesarean section. The most common maternal complications included gestational diabetes (17%) and post-partum haemorrhaging (20%). The average (±SD) birthweight was 3110 ± 736 g; there were no significant foetal malformations in the sample. No significant difference was found in pregnancy or obstetric outcomes between ART-obtained and spontaneous pregnancies. However, the incidence of induction of labour, caesarean section, and post-partum haemorrhage appears higher than in the general population. LIMITATIONS, REASONS FOR CAUTION The retrospective nature of the study may introduce bias, and the sample size might be insufficient for assessing rare obstetric complications. WIDER IMPLICATIONS OF THE FINDINGS This study offers valuable insights for healthcare providers to guide patients who received fertility-sparing treatments for AH/EC. These pregnancies can be successful and with an acceptable live birth rate, but they seem to be managed with caution, leading to possible tendency for more caesarean sections and labour inductions. No increase in adverse obstetric outcomes was observed, with the exception of suspicion of a higher risk of post-partum haemorrhaging, to be confirmed. STUDY FUNDING/COMPETING INTEREST(S) No funding was received for this study. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Radostina Vasileva
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
- Faculty of Medicine, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Henri Wohrer
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Victor Gaultier
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Margot Bucau
- Department of Anatomic Pathology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Hélène Courcier
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Selima Ben Miled
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Clementine Gonthier
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Martin Koskas
- Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
- Faculty of Medicine, Paris Cité University, Paris, France
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Zhou W, Wang J, Tian F, Liu P, Li M, Song C, Zhang Y, Yang X, Nie X, Shi Y. High PLK3 levels are linked with less tumor invasion, lower FIGO stage and better prognosis of endometrial cancer. Biomark Med 2024; 18:523-533. [PMID: 39082977 PMCID: PMC11364079 DOI: 10.1080/17520363.2024.2347192] [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: 07/02/2023] [Accepted: 04/03/2024] [Indexed: 08/30/2024] Open
Abstract
Aim: To evaluate correlations of tumor PLK3 with clinical features and prognosis of resectable endometrial cancer (EC) patients.Methods: Tumor tissues from 200 EC patients receiving surgical resections and adjacent tissues from 50 of them were collected for PLK3 determination using immunohistochemistry.Results: Tumor PLK3 negatively linked with myometrial invasion ≥50%, lymphovascular invasion, stromal cervical invasion, and International Federation of Gynecology and Obstetrics stage (all p < 0.050). High tumor PLK3 independently related to longer disease-free survival (DFS) (p = 0.044) and overall survival (OS) (p = 0.049). Its prognostic value was also validated by time-dependent receiver operating characteristic analyses (area under curve at most timepoints was >0.700).Conclusion: Tumor PLK3 potentially reflects prolonged DFS and OS in EC patients undergoing surgical resections.
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Affiliation(s)
- Weiyue Zhou
- Department of Gynecology, HanDan Central Hospital, Handan, 056000, China
| | - Jurong Wang
- Department of Gynecology, HanDan Central Hospital, Handan, 056000, China
| | - Fen Tian
- Department of Gynecology, HanDan Central Hospital, Handan, 056000, China
| | - Ping Liu
- Department of Gynecology, HanDan Central Hospital, Handan, 056000, China
| | - Meiyan Li
- Department of Gynecology, HanDan Central Hospital, Handan, 056000, China
| | - Chunli Song
- Department of Gynecology, HanDan Central Hospital, Handan, 056000, China
| | - Yixin Zhang
- Department of Gynecology, HanDan Central Hospital, Handan, 056000, China
| | - Xiaoming Yang
- Department of Gynecology, HanDan Central Hospital, Handan, 056000, China
| | - Xiaohuan Nie
- Department of Gynecology, HanDan Central Hospital, Handan, 056000, China
| | - Yuanyuan Shi
- Department of Gynecology, HanDan Central Hospital, Handan, 056000, China
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Shuai X, Xiao D, Han B, Du Y. Type and approach of hysterectomy and oncological survival of women with stage II cancer of endometrium: a large retrospective cohort study. Front Oncol 2024; 14:1404831. [PMID: 38803540 PMCID: PMC11128539 DOI: 10.3389/fonc.2024.1404831] [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: 03/21/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Objective To explore the association between the Type and approach of hysterectomy and oncological survival of women with stage II cancer of the endometrium. Patients and methods 684 women with stage II endometrial cancer were included. Eligible cases were grouped by type of hysterectomy (simple hysterectomy or radical hysterectomy)and approach of hysterectomy (laparoscopy or laparotomy). The baseline characteristics were compared among groups. The survival outcomes (disease-free survival and overall survival) were calculated and compared among groups, and the underlying confounding factors were adjusted by the Cox proportional hazard regression analysis. Results The radical hysterectomy group and the simple hysterectomy group had 217 cases and 467 cases, respectively. Between the groups, the difference in 5-year disease-free survival (87.3% versus 87.9%, HR=0.97, P=0.87) and 5-year overall survival (83.8% versus 83.8%, HR=0.95, P=0.95) was not statistically significant. The laparotomy group and the laparoscopy group had 277 cases and 407 cases, respectively. Between the groups, the difference in 5-year disease-free survival (88.7% versus 87.1%, HR=1.22, P=0.34) and 5-year overall survival (85.5% versus 82.7%, HR=1.00, P=0.99) was not statistically significant. Conclusion For long-term oncological survival, radical hysterectomy is not superior to total hysterectomy in stage II endometrial cancer. Also, for stage II cancer of the endometrium, laparoscopic hysterectomy is as oncologically safe as open hysterectomy.
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Affiliation(s)
- Xu Shuai
- Department of Obstetrics and Gynecology, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
- Geriatric Disease Institute of Chengdu, Cancer Prevention and Treatment institute of Chengdu, Chengdu, China
| | - Dan Xiao
- Department of Obstetrics and Gynecology, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
- Geriatric Disease Institute of Chengdu, Cancer Prevention and Treatment institute of Chengdu, Chengdu, China
| | - Binhua Han
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yixue Du
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
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Umemoto M, Mariya T, Nambu Y, Nagata M, Horimai T, Sugita S, Kanaseki T, Takenaka Y, Shinkai S, Matsuura M, Iwasaki M, Hirohashi Y, Hasegawa T, Torigoe T, Fujino Y, Saito T. Prediction of Mismatch Repair Status in Endometrial Cancer from Histological Slide Images Using Various Deep Learning-Based Algorithms. Cancers (Basel) 2024; 16:1810. [PMID: 38791889 PMCID: PMC11119770 DOI: 10.3390/cancers16101810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/22/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
The application of deep learning algorithms to predict the molecular profiles of various cancers from digital images of hematoxylin and eosin (H&E)-stained slides has been reported in recent years, mainly for gastric and colon cancers. In this study, we investigated the potential use of H&E-stained endometrial cancer slide images to predict the associated mismatch repair (MMR) status. H&E-stained slide images were collected from 127 cases of the primary lesion of endometrial cancer. After digitization using a Nanozoomer virtual slide scanner (Hamamatsu Photonics), we segmented the scanned images into 5397 tiles of 512 × 512 pixels. The MMR proteins (PMS2, MSH6) were immunohistochemically stained, classified into MMR proficient/deficient, and annotated for each case and tile. We trained several neural networks, including convolutional and attention-based networks, using tiles annotated with the MMR status. Among the tested networks, ResNet50 exhibited the highest area under the receiver operating characteristic curve (AUROC) of 0.91 for predicting the MMR status. The constructed prediction algorithm may be applicable to other molecular profiles and useful for pre-screening before implementing other, more costly genetic profiling tests.
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Affiliation(s)
- Mina Umemoto
- Department of Obstetrics and Gynecology, Sapporo Medical University of Medicine, Sapporo 060-8556, Japan; (M.U.); (Y.T.); (S.S.); (M.M.); (M.I.); (T.S.)
| | - Tasuku Mariya
- Department of Obstetrics and Gynecology, Sapporo Medical University of Medicine, Sapporo 060-8556, Japan; (M.U.); (Y.T.); (S.S.); (M.M.); (M.I.); (T.S.)
| | - Yuta Nambu
- Department of Media Architecture, Future University Hakodate, Hakodate 041-8655, Japan; (Y.N.); (M.N.); (Y.F.)
| | - Mai Nagata
- Department of Media Architecture, Future University Hakodate, Hakodate 041-8655, Japan; (Y.N.); (M.N.); (Y.F.)
| | | | - Shintaro Sugita
- Department of Surgical Pathology, Sapporo Medical University of Medicine, Sapporo 060-8556, Japan; (S.S.); (T.H.)
| | - Takayuki Kanaseki
- Department of Pathology, Sapporo Medical University of Medicine, Sapporo 060-8556, Japan; (T.K.); (Y.H.); (T.T.)
| | - Yuka Takenaka
- Department of Obstetrics and Gynecology, Sapporo Medical University of Medicine, Sapporo 060-8556, Japan; (M.U.); (Y.T.); (S.S.); (M.M.); (M.I.); (T.S.)
| | - Shota Shinkai
- Department of Obstetrics and Gynecology, Sapporo Medical University of Medicine, Sapporo 060-8556, Japan; (M.U.); (Y.T.); (S.S.); (M.M.); (M.I.); (T.S.)
| | - Motoki Matsuura
- Department of Obstetrics and Gynecology, Sapporo Medical University of Medicine, Sapporo 060-8556, Japan; (M.U.); (Y.T.); (S.S.); (M.M.); (M.I.); (T.S.)
| | - Masahiro Iwasaki
- Department of Obstetrics and Gynecology, Sapporo Medical University of Medicine, Sapporo 060-8556, Japan; (M.U.); (Y.T.); (S.S.); (M.M.); (M.I.); (T.S.)
| | - Yoshihiko Hirohashi
- Department of Pathology, Sapporo Medical University of Medicine, Sapporo 060-8556, Japan; (T.K.); (Y.H.); (T.T.)
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University of Medicine, Sapporo 060-8556, Japan; (S.S.); (T.H.)
| | - Toshihiko Torigoe
- Department of Pathology, Sapporo Medical University of Medicine, Sapporo 060-8556, Japan; (T.K.); (Y.H.); (T.T.)
| | - Yuichi Fujino
- Department of Media Architecture, Future University Hakodate, Hakodate 041-8655, Japan; (Y.N.); (M.N.); (Y.F.)
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University of Medicine, Sapporo 060-8556, Japan; (M.U.); (Y.T.); (S.S.); (M.M.); (M.I.); (T.S.)
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Espedal H, Fasmer KE, Berg HF, Lyngstad JM, Schilling T, Krakstad C, Haldorsen IS. MRI radiomics captures early treatment response in patient-derived organoid endometrial cancer mouse models. Front Oncol 2024; 14:1334541. [PMID: 38774411 PMCID: PMC11106402 DOI: 10.3389/fonc.2024.1334541] [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: 11/07/2023] [Accepted: 04/23/2024] [Indexed: 05/24/2024] Open
Abstract
Background Radiomics can capture microscale information in medical images beyond what is visible to the naked human eye. Using a clinically relevant mouse model for endometrial cancer, the objective of this study was to develop and validate a radiomic signature (RS) predicting response to standard chemotherapy. Methods Mice orthotopically implanted with a patient-derived grade 3 endometrioid endometrial cancer organoid model (O-PDX) were allocated to chemotherapy (combined paclitaxel/carboplatin, n=11) or saline/control (n=13). During tumor progression, the mice underwent weekly T2-weighted (T2w) magnetic resonance imaging (MRI). Segmentation of primary tumor volume (vMRI) allowed extraction of radiomic features from whole-volume tumor masks. A radiomic model for predicting treatment response was derived employing least absolute shrinkage and selection operator (LASSO) statistics at endpoint images in the orthotopic O-PDX (RS_O), and subsequently applied on the earlier study timepoints (RS_O at baseline, and week 1-3). For external validation, the radiomic model was tested in a separate T2w-MRI dataset on segmented whole-volume subcutaneous tumors (RS_S) from the same O-PDX model, imaged at three timepoints (baseline, day 3 and day 10/endpoint) after start of chemotherapy (n=8 tumors) or saline/control (n=8 tumors). Results The RS_O yielded rapidly increasing area under the receiver operating characteristic (ROC) curves (AUCs) for predicting treatment response from baseline until endpoint; AUC=0.38 (baseline); 0.80 (week 1), 0.85 (week 2), 0.96 (week 3) and 1.0 (endpoint). In comparison, vMRI yielded AUCs of 0.37 (baseline); 0.69 (w1); 0.83 (week 2); 0.92 (week 3) and 0.97 (endpoint). When tested in the external validation dataset, RS_S yielded high accuracy for predicting treatment response at day10/endpoint (AUC=0.85) and tended to yield higher AUC than vMRI (AUC=0.78, p=0.18). Neither RS_S nor vMRI predicted response at day 3 in the external validation set (AUC=0.56 for both). Conclusions We have developed and validated a radiomic signature that was able to capture chemotherapeutic treatment response both in an O-PDX and in a subcutaneous endometrial cancer mouse model. This study supports the promising role of preclinical imaging including radiomic tumor profiling to assess early treatment response in endometrial cancer models.
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Affiliation(s)
- Heidi Espedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Western Australia National Imaging Facility, Centre for Microscopy, Characterization and Analysis, University of Western Australia, Perth, WA, Australia
| | - Kristine E. Fasmer
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Hege F. Berg
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Jenny M. Lyngstad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Tomke Schilling
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Camilla Krakstad
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Ingfrid S. Haldorsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
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Gaffney D, Matias-Guiu X, Mutch D, Scambia G, Creutzberg C, Fotopoulou C, Berek JS, Concin N. 2023 FIGO staging system for endometrial cancer: The evolution of the revolution. Gynecol Oncol 2024; 184:245-253. [PMID: 38447389 DOI: 10.1016/j.ygyno.2024.02.002] [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: 12/15/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Embracing the complex and diverse nature of the heterogenous group of malignancies that are included under the umbrella of "endometrial cancer" (EC) to better align prognosis with treatment recommendations, requires a more comprehensive staging system. Our goal at the development of the new FIGO staging was to provide 1) high accuracy in the predictive prognosis for a patient with EC, which is the genuine purpose of a staging system, and 2) identification of distinct treatment relevant subgroups. Since the publication of the 2009 staging system by the International Federation of Gynecology and Obstetrics (FIGO) 14 years ago (1, 2), our understanding of the biology and natural history of EC has undergone a radical transformation. The TGCA results in 2013 (3), and the many validation reports published since then (4-9), have taught us that "EC" is composed of at least four distinct molecularly defined diseases. Strong histopathologic markers reflecting tumor biology such as lymph vascular space invasion (LVSI) were identified. Importantly, anatomical borders were shown to lose their prognostic relevance for EC patients in the presence of dominant tumor biology-markers such as molecular subtypes/LVSI (10, 11). This emphasizes the integration of these novel markers into a prognostic staging system that aims to be relevant to patients. The 2023 FIGO staging system for EC harmonizes and integrates old and new knowledge on anatomic, histopathologic, and molecular features (12). It requires a change in our perception of a staging system, from a traditional purely anatomical borders-based system to an integrated staging system integrating anatomical borders and tumor biology as pivotal prognostic factors for EC patients while providing important information for treatment decision making. Therefore, the 2023 FIGO staging system demonstrates the logical next step in the evolution of the revolution in a patient-centric staging approach. Below, we elucidate the rationale for the FIGO 2023 endometrial cancer staging system.
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Affiliation(s)
- David Gaffney
- University of Utah, Huntsman Cancer Institute, Department of Radiation Oncology, Salt Lake City, UT, USA
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital U de Bellvitge and Hospital U Arnau de Vilanova, Universities of Lleida and Barcelona, Institut de Recerca Biomèdica de Lleida, Instituto de Investigación Biomédica de Bellvitge, Centro de Investigación Biomédica en Red de Cáncer, Barcelona, Spain
| | - David Mutch
- Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carien Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Christina Fotopoulou
- Gynaecological Oncology, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathan S Berek
- Stanford University School of Medicine, Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, CA, USA
| | - Nicole Concin
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria; Department of Gynaecology and Gynaecological Oncology, Medical University of Vienna, Vienna, Austria.
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Hartup LA, Schenken CM, Kohler KR, Yauger BJ. Fertility After Endometrial Intraepithelial Neoplasia and Early Endometrial Cancer: Ovulation Induction May Shorten Time to Conception. Reprod Sci 2024; 31:1345-1352. [PMID: 38172334 DOI: 10.1007/s43032-023-01441-3] [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: 09/07/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
The purpose of this study was to determine whether utilization of assisted reproductive technology following clearance of endometrial intraepithelial neoplasia (EIN) or early endometrial cancer (EC) shortens time to conception (TTC) and reduces recurrence. Patients aged 18 to 45 with EIN or early EC who achieved pathologic response following progesterone treatment were identified via retrospective chart review. Study groups included patients who pursued ovulation induction (OI), in vitro fertilization (IVF), and spontaneous pregnancy. Primary outcomes were TTC and recurrence rate. Three hundred forty-six charts were reviewed, with 86 patients meeting inclusion criteria and 53 attempting pregnancy. Of those 53 patients, 11 became pregnant and seven had a live birth. Median times to pregnancy were 183 days for IVF, 54 days for OI, and 347 days for spontaneous conception (p < 0.05). No differences were seen in recurrence or progression based on attempted pregnancy method, nor with duration of fertility treatment. Forty-two of 86 patients (49%) were lost to follow-up. For patients with a history of treated EIN or EC, OI may decrease TTC. Larger prospective studies are needed to definitively answer this question. Although no differences in recurrence or progression were identified, the significant loss to follow-up rate in this study is concerning and warrants further investigation.
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Affiliation(s)
- Lindsay A Hartup
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| | - Claire M Schenken
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Kelsey R Kohler
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, 78229, USA
| | - Belinda J Yauger
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, TX, 78229, USA
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Feng Y, Miao F, Li Y, Li M, Cao Y. Validating the 2023 FIGO staging system: A nomogram for endometrioid endometrial cancer and adenocarcinoma. Cancer Med 2024; 13:e7216. [PMID: 38752451 PMCID: PMC11097244 DOI: 10.1002/cam4.7216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND To find the factors impacting overall survival (OS) prognosis in patients with endometrioid endometrial carcinoma (EEC) and adenocarcinoma and to establish a nomogram model to validate the 2023 International Federation of Obstetrics and Gynecology (FIGO) staging system for endometrial cancer. METHODS Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) training cohort. An independent validation cohort was obtained from the First Affiliated Hospital of Anhui Medical University between 2008 and 2023. Cox regression analysis identified independent prognostic factors for OS in EEC and adenocarcinoma patients. A nomogram predicting OS was developed and validated utilizing the C-index, calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). The relationship between the tumor grade and prognosis of EEC and adenocarcinoma was quantified using net reclassification improvement (NRI), propensity score matching (PSM), and Kaplan-Meier curves. RESULTS Cox regression analysis identified age, race, marital status, tumor grade, tumor stage, tumor size, and chemotherapy as independent prognostic factors for OS. A nomogram for predicting OS was developed based on these factors. The C-indexes for the OS nomogram was 0.743 and 0.720 for the SEER training set and external validation set, respectively. The area under the ROC (AUC) for the OS nomogram was 0.755, 0.757, and 0.741 for the SEER data subsets and 0.844, 0.719, and 0.743 for the external validation subsets. Calibration plots showed high concordance between the nomogram-predicted and observed OS. DCA also demonstrated the clinical utility of the OS nomogram. NRI, PSM, and survival analyses revealed that tumor grade was the most important histopathological factor for EEC and adenocarcinoma prognosis. CONCLUSION Seven independent prognostic variables for the OS of patients with EEC and adenocarcinoma were identified. The established OS nomogram has good predictive ability and clinical utility and validates the 2023 endometrial cancer FIGO staging system.
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Affiliation(s)
- Yifan Feng
- Department of Gynecology OncologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Fulu Miao
- Department of Gynecology OncologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Yuyang Li
- Department of Gynecology OncologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Min Li
- Department of Gynecology OncologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University)HefeiAnhuiChina
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of ChinaHefeiAnhuiChina
| | - Yunxia Cao
- Department of Gynecology OncologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract (Anhui Medical University)HefeiAnhuiChina
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of ChinaHefeiAnhuiChina
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Burney IA, Al Ghafri S, Al Noumani J, Al Jabri A, Hasan AO, Bella S, Al-Sayegh H, Al Ajmi R, Al Kalbani M. Clinicopathological Features and Outcomes of Endometrial Cancer: A single institution experience. Sultan Qaboos Univ Med J 2024; 24:203-208. [PMID: 38828257 PMCID: PMC11139370 DOI: 10.18295/squmj.3.2024.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/25/2023] [Accepted: 12/26/2023] [Indexed: 06/05/2024] Open
Abstract
Objectives This study aimed to report the demographic features, clinical presentation, pathological types and long-term outcomes of patients diagnosed with endometrial cancer (EC) in Oman. EC is the sixth most common cancer in women worldwide and the fifth most common cancer in women in Oman. Survival outcomes of EC have not been reported previously from Oman. Methods This retrospective study was carried out on consecutive patients treated at the Sultan Qaboos University Hospital, Muscat, Oman, between 2008 and 2020. Survival was estimated using the Kaplan and Meier method. Results A total of 50 patients with EC were included. The median age was 61 years (range: 31-86 years), and 72% of the patients had type I histology. Most patients were diagnosed with stage IA and IB EC (49% and 20%, respectively), and the majority had grade 1 or 2 tumours (40% and 34%, respectively). Overall, the 5-year survival and 10-year survival rates were estimated to be 70% and 56%, respectively. Weight (>75 kg) and body mass index (>30 kg/m2) were significantly associated with better survival. Tumour histology (type I versus type II or carcinosarcoma), grade (1 versus 2 versus 3) and stage (IA or IB versus II-IV) were associated with better overall survival (P = 0.007, P <0.0001 and P <0.0003, respectively). Patients diagnosed with EC with co-morbidities, other than obesity, had inferior survival compared to those without co-morbidities. Conclusion Median age at presentation, histological sub-type, clinical stage and outcomes are comparable to the published literature. Almost two-thirds of the patients were obese. These data could be used as a benchmark for outcomes of EC in the region.
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Affiliation(s)
- Ikram A. Burney
- Women Health Program, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
| | | | | | - Anisa Al Jabri
- Department of Radiation Oncology, The Royal Hospital, Muscat, Oman
| | - Anjum O. Hasan
- Women Health Program, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
| | - Sarya Bella
- Women Health Program, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
| | - Hasan Al-Sayegh
- Department of Research Laboratories, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
| | - Radhiya Al Ajmi
- Pathology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Moza Al Kalbani
- Women Health Program, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
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McCoy CA, Coleman HG, McShane CM, McCluggage WG, Wylie J, Quinn D, McMenamin ÚC. Factors associated with interobserver variation amongst pathologists in the diagnosis of endometrial hyperplasia: A systematic review. PLoS One 2024; 19:e0302252. [PMID: 38683770 PMCID: PMC11057740 DOI: 10.1371/journal.pone.0302252] [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: 12/04/2023] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE Reproducible diagnoses of endometrial hyperplasia (EH) remains challenging and has potential implications for patient management. This systematic review aimed to identify pathologist-specific factors associated with interobserver variation in the diagnosis and reporting of EH. METHODS Three electronic databases, namely MEDLINE, Embase and Web of Science, were searched from 1st January 2000 to 25th March 2023, using relevant key words and subject headings. Eligible studies reported on pathologist-specific factors or working practices influencing interobserver variation in the diagnosis of EH, using either the World Health Organisation (WHO) 2014 or 2020 classification or the endometrioid intraepithelial neoplasia (EIN) classification system. Quality assessment was undertaken using the QUADAS-2 tool, and findings were narratively synthesised. RESULTS Eight studies were identified. Interobserver variation was shown to be significant even amongst specialist gynaecological pathologists in most studies. Few studies investigated pathologist-specific characteristics, but pathologists were shown to have different diagnostic styles, with some more likely to under-diagnose and others likely to over-diagnose EH. Some novel working practices were identified, such as grading the "degree" of nuclear atypia and the incorporation of objective methods of diagnosis such as semi-automated quantitative image analysis/deep learning models. CONCLUSIONS This review highlighted the impact of pathologist-specific factors and working practices in the accurate diagnosis of EH, although few studies have been conducted. Further research is warranted in the development of more objective criteria that could improve reproducibility in EH diagnostic reporting, as well as determining the applicability of novel methods such as grading the degree of nuclear atypia in clinical settings.
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Affiliation(s)
- Chloe A. McCoy
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Helen G. Coleman
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Charlene M. McShane
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - W. Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - James Wylie
- Department of Obstetrics and Gynaecology, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, Northern Ireland, United Kingdom
| | - Declan Quinn
- Department of Obstetrics and Gynaecology, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, Northern Ireland, United Kingdom
| | - Úna C. McMenamin
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
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Pergialiotis V, Panagiotopoulos M, Koutras A, Daras A, Ntounis T, Liontos M, Daskalakis G, Thomakos N. The Impact of Positive Peritoneal Cytology on the Survival Rates of Early-Stage-Disease Endometrial Cancer Patients: Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:733. [PMID: 38792916 PMCID: PMC11123332 DOI: 10.3390/medicina60050733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/31/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The impact of positive peritoneal cytology has been a matter of controversy in early-stage endometrial cancer for several years. The latest staging systems do not take into consideration its presence; however, emerging evidence about its potential harmful effect on patient survival outcomes suggests otherwise. In the present systematic review and meta-analysis, we sought to accumulate current evidence. Materials and Methods: Medline, Scopus, the Cochrane Central Register of Controlled Trials CENTRAL, Google Scholar and Clinicaltrials.gov databases were searched for relevant articles. Effect sizes were calculated in Rstudio using the meta function. A sensitivity analysis was carried out to evaluate the possibility of small-study effects and p-hacking. Trial sequential analysis was used to evaluate the adequacy of the sample size. The methodological quality of the included studies was assessed using the Newcastle-Ottawa scale. Results: Fifteen articles were finally included in the present systematic review that involved 19,255 women with early-stage endometrial cancer. The Newcastle-Ottawa scale indicated that the majority of included studies had a moderate risk of bias in their selection of participants, a moderate risk of bias in terms of the comparability of groups (positive peritoneal cytology vs. negative peritoneal cytology) and a low risk of bias concerning the assessment of the outcome. The results of the meta-analysis indicated that women with early-stage endometrial cancer and positive peritoneal cytology had significantly lower 5-year recurrence-free survival (RFS) (hazards ratio (HR) 0.26, 95% CI 0.09, 0.71). As a result of the decreased recurrence-free survival, patients with positive peritoneal cytology also exhibited reduced 5-year overall survival outcomes (HR 0.50, 95% CI 0.27, 0.92). The overall survival of the included patients was considerably higher among those that did not have positive peritoneal cytology (HR 12.76, 95% CI 2.78, 58.51). Conclusions: Positive peritoneal cytology seems to be a negative prognostic indicator of survival outcomes of patients with endometrial cancer. Considering the absence of data related to the molecular profile of patients, further research is needed to evaluate if this factor should be reinstituted in future staging systems.
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Affiliation(s)
- Vasilios Pergialiotis
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, “Alexandra” General Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (A.D.); (T.N.); (G.D.); (N.T.)
| | - Michail Panagiotopoulos
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, “Alexandra” General Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (A.D.); (T.N.); (G.D.); (N.T.)
| | - Antonios Koutras
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, “Alexandra” General Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (A.D.); (T.N.); (G.D.); (N.T.)
| | - Andreas Daras
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, “Alexandra” General Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (A.D.); (T.N.); (G.D.); (N.T.)
| | - Thomas Ntounis
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, “Alexandra” General Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (A.D.); (T.N.); (G.D.); (N.T.)
| | - Michalis Liontos
- Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Georgios Daskalakis
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, “Alexandra” General Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (A.D.); (T.N.); (G.D.); (N.T.)
| | - Nikolaos Thomakos
- First Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, “Alexandra” General Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece (A.D.); (T.N.); (G.D.); (N.T.)
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Teng A, Stanley J, Jackson C, Koea J, Lao C, Lawrenson R, Meredith I, Sika-Paotonu D, Gurney J. The growing cancer burden: Age-period-cohort projections in Aotearoa New Zealand 2020-2044. Cancer Epidemiol 2024; 89:102535. [PMID: 38280359 DOI: 10.1016/j.canep.2024.102535] [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: 09/19/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Cancer is a major cause of premature death and inequity, and global case numbers are rapidly expanding. This study projects future cancer numbers and incidence rates in Aotearoa New Zealand. METHODS Age-period-cohort modelling was applied to 25-years of national data to project cancer cases and incidence trends from 2020 to 2044. Nationally mandated cancer registry data and official historical and projected population estimates were used, with sub-groups by age, sex, and ethnicity. RESULTS Cancer diagnoses were projected to increase from 25,700 per year in 2015-2019 to 45,100 a year by 2040-44, a 76% increase (2.3% per annum). Across the same period, age-standardised cancer incidence increased by 9% (0.3% per annum) from 348 to 378 cancers per 100,000 person years, with greater increases for males (11%) than females (6%). Projected incidence trends varied substantially by cancer type, with several projected to change faster or in the opposite direction compared to projections from other countries. CONCLUSIONS Increasing cancer numbers reinforces the critical need for both cancer prevention and treatment service planning activities. Investment in developing new ways of working and increasing the workforce are required for the health system to be able to afford and manage the future burden of cancer.
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Affiliation(s)
- Andrea Teng
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand.
| | - James Stanley
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand
| | - Christopher Jackson
- Department of Medicine (Dunedin), University of Otago, PO Box 56, Dunedin, New Zealand
| | - Jonathan Koea
- General Surgery, Waitakere Hospital, Private Bag 92019, Auckland, New Zealand; Medical Surgery, The University of Auckland, Auckland, New Zealand
| | - Chunhuan Lao
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, New Zealand; Commissioning, Te Whatu Ora, Hamilton, Waikato, New Zealand
| | - Ineke Meredith
- General Surgery, Wakefield Hospital, 30 Florence Street, Wellington, New Zealand
| | - Dianne Sika-Paotonu
- Dean's Department UOW & Division of Health Sciences, University of Otago, PO Box 7343, Wellington, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago, PO Box 7343, Wellington, New Zealand
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Zhang K, Wang T, Liu Z, He J, Sun X, Zhong W, Zhao F, Li X, Li S, Zhu H, Ma Z, Hu K, Zhang F, Hou X, Wei L, Zou L. Clinical characteristics and radiation therapy modality of younger patients with early-stage endometrial cancer, a multicenter study in China's real world. BMC Cancer 2024; 24:360. [PMID: 38509492 PMCID: PMC10956334 DOI: 10.1186/s12885-024-12090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Endometrial cancer is a prevalent gynecologic malignancy found in postmenopausal women. However, in the last two decades, the incidence of early-stage has doubled in women under 40 years old. This study aimed to investigate the clinical and pathological characteristics and adjuvant therapeutic modalities of both young and not -young patients with early-stage endometrial cancer in China's real world. METHODS This retrospective study analyzed patients with early-stage endometrial cancer at 13 medical institutions in China from 1999 to 2015. The patients were divided into two groups: young (≤ 45 years old) and non-young (> 45 years old). Statistical comparisons were conducted between the two groups for clinical characteristics, pathological features, and survival. The study also identified factors that affect local recurrence-free survival (LRFS) using Cox proportional risk regression analysis. Propensity score matching (1:1) was used to compare the effects of local control between vaginal brachytherapy (VBT) alone and pelvic external beam radiotherapy (EBRT) ± VBT. RESULTS The study involved 1,280 patients, 150 of whom were 45 years old or younger. The young group exhibited a significantly higher proportion of stage II, low-risk, lower uterine segment infiltration (LUSI), and cervical invasion compared to the non-young group. Additionally, the young patients had significantly larger maximum tumor diameters. The young group also had a significantly higher five-year overall survival (OS) and a five-year LRFS. Age is an independent risk factor for LRFS. There was no significant difference in LRFS between young patients with intermediate- to high-risk early-stage endometrial cancer who received EBRT ± VBT and those who received VBT alone. CONCLUSIONS In the present study, young patients had better characteristics than the non-young group, while they exhibited higher levels of aggressiveness in certain aspects. The LRFS and OS outcomes were better in young patients. Age is an independent risk factor for LRFS. Additionally, VBT alone may be a suitable option for patients under 45 years of age with intermediate- to high-risk early-stage endometrial cancer, as it reduces the risk of toxic reactions and future second cancers while maintaining similar local control as EBRT.
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Affiliation(s)
- Kun Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital Chin ese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, People's Republic of China
| | - Tiejun Wang
- Department of Radiation Oncology, The second hospital Affiliated by Jilin University, Changchun, People's Republic of China
| | - Zi Liu
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Jianli He
- Department of Radiation Oncology, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People's Republic of China
| | - Xiaoge Sun
- Department of Radiation Oncology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, People's Republic of China
| | - Wei Zhong
- Gynaecological Oncology Radiotherapy, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Fengjv Zhao
- Department of Radiation Oncology, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, People's Republic of China
| | - Xiaomei Li
- Department of Radiation Oncology, Peking University First Hospital, Beijing, People's Republic of China
| | - Sha Li
- Department of Radiation Oncology, The 940th Hospital of Joint Logistics Support force of Chinese People's Liberation Army, Lanzhou, Gansu, People's Republic of China
| | - Hong Zhu
- Department of Radiation Oncology, Xiangya Hospital Central South University, Changsha, Hunan, People's Republic of China
| | - Zhanshu Ma
- Department of Radiation Oncology, Affiliated Hospital of Chi feng University, Chifeng, Inner Mongolia, People's Republic of China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital Chin ese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, People's Republic of China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital Chin ese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, People's Republic of China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital Chin ese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, People's Republic of China.
| | - Lichun Wei
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University of PLA (the Fourth Military Medical University, Xi'an, People's Republic of China.
| | - Lijuan Zou
- Department of Radiation Oncology, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China.
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Fang R, Lin N, Weng S, Liu K, Chen X, Cao D. Multiparametric MRI radiomics improves preoperative diagnostic performance for local staging in patients with endometrial cancer. Abdom Radiol (NY) 2024; 49:875-887. [PMID: 38189937 DOI: 10.1007/s00261-023-04149-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE To determine whether multiparametric magnetic resonance imaging (MRI) radiomics-based machine learning methods can improve preoperative local staging in patients with endometrial cancer (EC). METHODS Data of patients with histologically confirmed EC who underwent preoperative MRI were retrospectively analyzed and divided into a training or test set. Radiomic features extracted from multiparametric MR images were used to train and test the prediction of deep myometrial invasion (DMI) and cervical stromal invasion (CSI). Two radiologists assessed the presence of DMI and CSI on conventional MR images. A combined model incorporating a radiomic signature and conventional MR images was constructed and presented as a nomogram. Performance of the predictive models was assessed using the area under curve (AUC) in the receiver operating curve analysis and pairwise comparison using DeLong's test with Bonferroni correction. RESULTS This study included 198 women (training set = 138, test set = 60). Conventional MRI achieved AUCs of 0.837 and 0.799 for detecting DMI and 0.825 and 0.858 for detecting CSI in the training and test sets, respectively. The nomogram achieved AUCs of 0.928 and 0.869 for detecting DMI and 0.913 and 0.937 for detecting CSI in the training and test sets, respectively. The ability of the nomogram to detect DMI and CSI in the two sets was superior to that of conventional MRI (adjusted p < 0.05), except for the ability to detect CSI in the test set (adjusted p > 0.05). CONCLUSION A nomogram incorporating radiomics signature into conventional MRI improved the efficacy of preoperative local staging of EC.
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Affiliation(s)
- Ruqi Fang
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, People's Republic of China
- Department of Radiology, Fujian Provincial Maternity and Children's Hospital, Fuzhou, 350001, Fujian, People's Republic of China
- Department of Radiology, Fujian Provincial Obstetrics and Gynecology Hospital, Fuzhou, 350011, Fujian, People's Republic of China
| | - Na Lin
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, People's Republic of China
| | - Shuping Weng
- Department of Radiology, Fujian Provincial Maternity and Children's Hospital, Fuzhou, 350001, Fujian, People's Republic of China
- Department of Radiology, Fujian Provincial Obstetrics and Gynecology Hospital, Fuzhou, 350011, Fujian, People's Republic of China
| | - Kaili Liu
- Department of Radiology, Fujian Provincial Maternity and Children's Hospital, Fuzhou, 350001, Fujian, People's Republic of China
- Department of Radiology, Fujian Provincial Obstetrics and Gynecology Hospital, Fuzhou, 350011, Fujian, People's Republic of China
| | - Xiaping Chen
- Department of Radiology, Fujian Provincial Maternity and Children's Hospital, Fuzhou, 350001, Fujian, People's Republic of China
- Department of Radiology, Fujian Provincial Obstetrics and Gynecology Hospital, Fuzhou, 350011, Fujian, People's Republic of China
| | - Dairong Cao
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, People's Republic of China.
- Department of Radiology, Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian, People's Republic of China.
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, Fujian, People's Republic of China.
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Baker-Rand H, Kitson SJ. Recent Advances in Endometrial Cancer Prevention, Early Diagnosis and Treatment. Cancers (Basel) 2024; 16:1028. [PMID: 38473385 DOI: 10.3390/cancers16051028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Endometrial cancer is the sixth commonest cancer in women worldwide, with over 417,000 diagnoses in 2020. The disease incidence has increased by 132% over the last 30 years and is set to continue to rise in response to an ageing population and increasing global rates of obesity and diabetes. A greater understanding of the mechanisms driving endometrial carcinogenesis has led to the identification of potential strategies for primary disease prevention, although prospective evaluation of their efficacy within clinical trials is still awaited. The early diagnosis of endometrial cancer is associated with improved survival, but has historically relied on invasive endometrial sampling. New, minimally invasive tests using protein and DNA biomarkers and cytology have the potential to transform diagnostic pathways and to allow for the surveillance of high-risk populations. The molecular classification of endometrial cancers has been shown to not only have a prognostic impact, but also to have therapeutic value and is increasingly used to guide adjuvant treatment decisions. Advanced and recurrent disease management has also been revolutionised by increasing the use of debulking surgery and targeted treatments, particularly immunotherapy. This review summarises the recent advances in the prevention, diagnosis and treatment of endometrial cancer and seeks to identify areas for future research.
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Affiliation(s)
- Holly Baker-Rand
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Sarah J Kitson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
- Manchester Academic Health Science Centre, Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
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Recio F, Scalise CB, Loar P, Lumish M, Berman T, Peddada A, Kalashnikova E, Rivero-Hinojosa S, Beisch T, Nicosia B, Farmer T, Dutta P, Malhotra M, ElNaggar AC, Liu MC, Vaccarello L, Holloway RW. Post-surgical ctDNA-based molecular residual disease detection in patients with stage I uterine malignancies. Gynecol Oncol 2024; 182:63-69. [PMID: 38262240 DOI: 10.1016/j.ygyno.2023.12.025] [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: 08/15/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Among uterine malignancies, endometrial cancer (EC) is the most common cancer of the female reproductive tract. Traditionally, risk stratification in EC is determined by standard clinicopathological risk factors. Although circulating tumor DNA (ctDNA) has emerged as a prognostic biomarker in various malignancies, its clinical validity in EC remains to be established. METHODS In this analysis of real-world data, 267 plasma samples from 101 patients with stage I EC were analyzed using a tumor-informed ctDNA assay (Signatera™ bespoke mPCR-NGS). Patients were followed post-surgically and monitored with ctDNA testing for a median of 6.8 months (range: 0.37-19.1). RESULTS Patients who tested ctDNA-positive at both their first time point and longitudinally experienced inferior recurrence-free survival (RFS) (HR = 6.2; p = 0.0006 and HR = 15.5; p < 0.0001, respectively), and showed a recurrence rate of 58% and 52%, vs. 6% and 0%, respectively for the ctDNA-negative patients. Most ctDNA-positive patients had high-risk histologies or sarcoma, versus low-risk and high-intermediate risk (H-IR) EC. Furthermore, patients with high-risk histologies who were ctDNA-positive showed shorter RFS compared to those who tested negative (HR = 9.5; p = 0.007), and those who tested positive in the low/H-IR cohort (HR = 0.25; p = 0.04). Post-surgically, detectable ctDNA was highly prognostic of clinical outcome and remained the only significant risk factor for recurrence when adjusted for clinicopathological risk factors, such as histologic risk group, mismatch repair (MMR), and p53 status. CONCLUSION Incorporating ctDNA monitoring along with traditional known risk factors may aid in identifying patients with stage I EC who are at highest risk of recurrence, and possibly aid in treatment stratification.
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Affiliation(s)
- Fernando Recio
- AdventHealth Orlando Gynecologic Oncology, Orlando, FL, USA
| | | | | | | | - Tara Berman
- Inova Schar Cancer Institute, Fairfax, VA, USA
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Shan S, Wang X, Qian L, Wang C, Zhao S. ENST00000534735 inhibits proliferation and migration, promotes apoptosis and pyroptosis of endometrial cancer via OSBPL3 through APMK/SIRT1/NF-κB pathway. Heliyon 2024; 10:e25281. [PMID: 38370231 PMCID: PMC10869759 DOI: 10.1016/j.heliyon.2024.e25281] [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: 07/21/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/20/2024] Open
Abstract
Background The complete understanding of the biological roles of long non-coding RNAs (lncRNAs) in cancer remains elusive. The findings of this study indicate that the newly discovered lncRNA ENST00000534735 exhibited a decreased expression in both endometrial cancer (EC) tissues and cell lines. Methods The expression of ENST00000534735 in EC tissues was detected using RNA-sequencing analysis. The effects of ENST00000534735 on cell proliferation, migration, apoptosis, and pyroptosis were determined via in vitro and in vivo experiments. The proteins that interact with ENST00000534735 were confirmed by RNA pull-down assay. Furthermore, an investigation was conducted on the impact of ENST00000534735 on the in vivo growth of EC through a tumorigenicity assay in nude mice. Results We found that ENST00000534735 was significantly down-regulated in EC tissues compared to their adjacent non-cancerous tissues. The ectopic expression of ENST00000534735 drastically inhibited lung cancer cell proliferation and migration ability and facilitated apoptosis and pyroptosis. Knockdown of ENST00000534735 increased OSBPL3 expression, and the tumor-suppressing effects of ENST00000534735 overexpression were reversed by upregulation of OSBPL3 via the APMK/SIRT1/NF-κB pathway. The in vivo tumorigenic assays conducted on nude mice revealed that the excessive expression of ENST00000534735 impeded the growth of EC. Conclusions All results elucidated the role and molecular mechanism of ENST00000534735 in the malignant development of EC. ENST00000534735, a new antioncogene in EC, may serve as a survival biomarker or therapeutic target for EC.
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Affiliation(s)
- Shuzhi Shan
- Department of Gynecology and Obstetrics, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiao Wang
- Department of Gynecology and Obstetrics, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lijie Qian
- Hebei Women and Children's Health Center, Shijiazhuang, China
| | - Chunxiao Wang
- Department of Gynecology, Cangzhou People's Hospital, Cangzhou, China
| | - Sufen Zhao
- Department of Gynecology and Obstetrics, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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