Time trends in ovarian cancer mortality in Europe (1955-1993): effect of age, birth cohort and period of death

Ovarian cancer risk score predicts chemo-response and outcome in epithelial ovarian carcinoma patients

OBJECTIVE

Cytoreductive surgery followed by adjuvant chemotherapy is a standard frontline treatment for epithelial ovarian cancer (EOC). We aimed to develop an ovarian cancer risk score (OVRS) based on the expression of 10 ovarian-cancer-related genes to predict the chemoresistance, and outcomes of EOC patients.

METHODS

We designed a case-control study with total 149 EOC women including 75 chemosensitives and 74 chemoresistants. Gene expression was measured using the quantitative real-time polymerase chain reaction. We tested for correlation between the OVRS and chemosensitivity or chemoresistance, disease-free survival (DFS), and overall survival (OS), and validated the OVRS by analyzing patients from the TCGA database.

RESULTS

The chemosensitive group had lower OVRS than the chemoresistant group (5 vs. 15, p≤0.001, Mann-Whitney U test). Patients with disease relapse (13 vs. 5, p<0.001, Mann-Whitney U test) or disease-related death (13.5 vs. 6, p<0.001) had higher OVRS than those without. OVRS ≥10 (hazard ratio=3.29; 95% confidence interval=1.94-5.58; p<0.001) was the only predictor for chemoresistance in multivariate analysis. The median DFS (5 months vs. 24 months) and OS (39 months vs. >60 months) of patients with OVRS ≥10 were significantly shorter than those of patients with OVRS <10). The high OVRS group also had significantly shorter median OS than the low OVRS group in 255 patients in the TCGA database (39 vs. 49 months, p=0.046).

CONCLUSIONS

Specific genes panel can be clinically applied in predicting the chemoresistance and outcome, and decision-making of epithelial ovarian cancer.

[Effects of age-period and cohort on mortality due to ovarian cancer in Brazil and its regions]

This article sought to evaluate the effects of age, period and birth cohort (APC) on the temporal evolution of mortality due to ovarian cancer in Brazil and its regions from 1980 to 2014. This is an ecological, time-trend study using APC models with a Baysean approach and INLA (Integrated Nested Laplace Approximations) deterministic method for parameter inference. Mortality data and population data were obtained from the Brazilian Health Informatics Department. Rates of mortality due to ovarian cancer, according to geographical region, were standardized using the direct method, after correcting deaths for undefined causes and incomplete cancer diagnosis. In the period we studied, Brazil had 4.91 deaths due to ovarian cancer per 100,000 women, the Southern (5.66) and Southeastern regions (5.70) had higher rates per 100,000 women and the Northern region had the lowest rate (3.13/100,000 women). In all regions, there was a progressive increase in mortality as ages advanced. The multivariate best fit APC model showed positive risk of death in the Central and Northeast between 2010-2014 and, beginning in 1995-1999, in the South. We also observed a positive and significant risk of death for older cohorts in the South and Southeast and a reduced risk for younger cohorts. The inverse was opposed in the Northern and Northeastern regions. The data shows a heterogeneous pattern in the temporal evolution of mortality due to ovarian cancer in the Brazilian geographical regions, which may be related to the distinct demographic and epidemiological transition processes experienced in these regions.

Estimate of the penetrance of BRCA mutation and the COS software for the assessment of BRCA mutation probability

We have designed the user-friendly COS software with the intent to improve estimation of the probability of a family carrying a deleterious BRCA gene mutation. The COS software is similar to the widely-used Bayesian-based BRCAPRO software, but it incorporates improved assumptions on cancer incidence in women with and without a deleterious mutation, takes into account relatives up to the fourth degree and allows researchers to consider an hypothetical third gene or a polygenic model of inheritance. Since breast cancer incidence and penetrance increase over generations, we estimated birth-cohort-specific incidence and penetrance curves. We estimated breast and ovarian cancer penetrance in 384 BRCA1 and 229 BRCA2 mutated families. We tested the COS performance in 436 Italian breast/ovarian cancer families including 79 with BRCA1 and 27 with BRCA2 mutations. The area under receiver operator curve (AUROC) was 84.4 %. The best probability threshold for offering the test was 22.9 %, with sensitivity 80.2 % and specificity 80.3 %. Notwithstanding very different assumptions, COS results were similar to BRCAPRO v6.0.

Mesothelin-specific cell-based vaccine generates antigen-specific immunity and potent antitumor effects by combining with IL-12 immunomodulator

Ovarian cancer is a gynecologic malignancy with a high mortality rate. In the present study, we developed a novel cell-based vaccine, Meso-VAX, to generate mesothelin antigen-specific immune responses and immunotherapy against ovarian cancer. Mesothelin, a secreted protein anchored at the cell membrane, has recently been identified as a potential new tumor antigen for ovarian cancer. In this study, mice vaccinated with Meso-VAX and adeno-associated virus (AAV)-IL-12 exhibited dramatic increases in the number of mesothelin-specific CD4(+) helper and CD8(+) cytotoxic T-cell precursors, higher titers of anti-mesothelin Abs and in vitro tumor killing activity, and all of these mice were tumor-free after 60 days of tumor challenge. In addition, a significant reduction in peritoneal tumors and longer survival were noted in the mice vaccinated with Meso-VAX combined with AAV-IL-12. CD4(+) helper and CD8(+) cytotoxic T lymphocytes were essential for the antitumor effect generated by Meso-VAX combined with AAV-IL-12. The post-vaccination sera of the mice vaccinated with Meso-VAX and AAV-IL-12 also showed mesothelin-specific complement-dependent cell-mediated cytotoxicity. Our results suggest that a Meso-VAX cell-based vaccine combined with AAV-IL-12 can generate antigen-specific immunological responses and antitumor effects on ovarian cancer.

In vitro synergistic action of geldanamycin- and docetaxel-containing HPMA copolymer-RGDfK conjugates against ovarian cancer

HPMA copolymer-RGDfK (HPMA-RGDfK) conjugates bearing either aminohexylgeldanamycin (AHGDM) or docetaxel (DOC) were synthesized and characterized. In vitro stability and binding were evaluated. Cytotoxicity toward ovarian cancer cells was evaluated and the ability of the conjugates to induce cell death was assessed by combination index analysis. Conjugates bearing AHGDM were more stable and exhibited slower drug release than those bearing DOC. Both conjugates demonstrated the ability to bind to avb3 integrins. In combination, HPMA-RGDfK conjugates demonstrated marked synergism as compared to their non-targeted counterparts and free drug controls. HPMA-RGDfK conjugates bearing AHGDM and DOC induce synergistic cytotoxicity in vitro, suggesting their potential as a promising combination therapy.

Trends in gynecologic cancer mortality in East Asian regions

OBJECTIVE

To evaluate uterine and ovarian cancer mortality trends in East Asian countries.

METHODS

For three Asian countries and one region (Japan, Korea, Singapore, and Hong Kong), we extracted number of deaths for each year from the World Health Organization (WHO) mortality database, focusing on women ≥20 years old. The WHO population data were used to estimate person-years at risk for women. The annual age-standardized, truncated rates were evaluated for four age groups. We also compared age-specific mortality rates during three calendar periods (1979 to 1988, 1989 to 1998, and 1999 to 2010). Joinpoint regression was used to determine secular trends in mortality. To obtain cervical and uterine corpus cancer mortality rates in Korea, we re-allocated the cases with uterine cancer of unspecified subsite according to the proportion in the National Cancer Incidence Databases.

RESULTS

Overall, uterine cancer mortality has decreased in each of the Asian regions. In Korea, corrected cervical cancer mortality has declined since 1993, at an annual percentage change (APC) of -4.8% (95% confidence interval [CI], -5.3 to -4.4). On the other hand, corrected uterine corpus cancer mortality has abruptly increased since 1995 (APC, 6.7; 95% CI, 5.4 to 8.0). Ovarian cancer mortality was stable, except in Korea, where mortality rates steadily increased at an APC of 6.2% (95% CI, 3.4 to 9.0) during 1995 to 2000, and subsequently stabilized.

CONCLUSION

Although uterine cancer mortality rates are declining in East Asia, additional effort is warranted to reduce the burden of gynecologic cancer in the future, through the implementation of early detection programs and the use of optimal therapeutic strategies.

Trends in incidence and survival outcome of epithelial ovarian cancer: 30-year national population-based registry in Taiwan

Objective

To investigate the changes of incidence and prognosis of epithelial ovarian cancer in thirty years in Taiwan.

Methods

The databases of women with epithelial ovarian cancer during the period from 1979 to 2008 were retrieved from the National Cancer Registration System of Taiwan. The incidence and prognosis of these patients were analyzed.

Results

Totally 9,491 patients were included in the study. The age-adjusted incidences of epithelial ovarian cancer were 1.01, 1.37, 2.37, 3.24, 4.18, and 6.33 per 100,000 person-years, respectively, in every 5-year period from 1979 to 2008. The age-specific incidence rates increased especially in serous, endometrioid and clear cell carcinoma, and the age of diagnosis decreased from sixty to fifty years old in the three decades. Patients with mucinous, endometrioid, or clear cell carcinoma had better long-term survival than patients with serous carcinoma (log rank test, p<0.001). Patients with undifferentiated carcinoma or carcinosarcoma had poorer survival than those with serous carcinoma (log rank test, p<0.001). The mortality risk of age at diagnosis of 30-39 was significantly higher than that of age of 70 years or more (test for trend, p<0.001). The mortality risk decreased from the period of 1996-1999 (hazard ratio [HR], 0.90; p=0.054) to the period after 2000 (HR, 0.74; p<0.001) as compared with that from the period of 1991-1995.

Conclusion

An increasing incidence and decreasing age of diagnosis in epithelial ovarian cancer patients were noted. Histological type, age of diagnosis, and treatment period were important prognostic factors for epithelial ovarian carcinoma.

Depletion of regulatory T lymphocytes reverses the imbalance between pro- and anti-tumor immunities via enhancing antigen-specific T cell immune responses

Background

The regulatory T cells (Tregs) can actively suppress the immune responses. However, literature about detailed changes of host effective and suppressive immunities before and after depletion of Tregs in ovarian carcinomas, is rare.

Materials and Methods

Ovarian cancer patients and the ascitogenic animal model were employed. Immunologic profiles with flow cytometric analyses, immunohistochemistric staining, RT-PCR, ELISA, and ELISPOT assays were performed. In vivo depletion of Treg cells with the mAb PC61was also performed in the animal model.

Results

The cytokines, including IL-4 (p = 0.017) and TNF-α (p = 0.046), significantly decreased while others such as TGF-β (p = 0.013), IL-6 (p = 0.016), and IL-10 (p = 0.018) were elevated in ascites of ovarian cancer patients, when the disease progressed to advanced stages. The ratio of CD8⁺ T cell/Treg cell in ascites was also lower in advanced diseases than in early diseases (advanced 7.37±0.64 vs. early 14.25±3.11, p = 0.037). The kinetic low-dose CD25 Ab depletion group had significantly lower intra-peritoneal tumor weight (0.20±0.03 g) than the sequential high-dose (0.69±0.06 g) and sequential low-dose (0.67±0.07 g) CD25 Ab deletion groups (p = 0.001) after 49 days of tumor challenge in the animal. The kinetic low-dose CD25 Ab depletion group generated the highest number of IFN-γ-secreting, mesothelin-specific T lymphocytes compared to the other groups (p<0.001).

Conclusions

The imbalance between effective and suppressive immunities becomes more severe as a tumor progresses. The depletion of Treg cells can correct the imbalance of immunologic profiles and generate potent anti-tumor effects. Targeting Treg cells can be a new strategy for the immunotherapy of ovarian carcinoma.

Cervical, uterine corpus, and ovarian cancer mortality in Greece during 1980 to 2005: a trend analysis

INTRODUCTION

The aim of the present study was to analyze cervical, uterine corpus, and ovarian cancer mortality, between 1980 and 2005, in Greece.

METHODS

Mortality data and population age distribution were provided by the National Statistical Service of Greece. Time trends of mortality were calculated for each tumor type per 100,000 women in the whole female population of Greece, and 2 different age groups, that is, women aged 49 years and younger and those 50 years and older. Joinpoint regression was used for further analysis of mortality trends.

RESULTS

Overall, cervical and uterine corpus cancer mortality in the whole female population of Greece had a slightly decreasing trend between 1980 and 2005, whereas ovarian cancer mortality rates increased steadily throughout the period studied. Subgroup analyses according to age showed that cervical cancer mortality decreased very slightly only in women older than 50 years, whereas it remained steady in younger women. Uterine corpus cancer mortality decreased slightly in both age groups, but increased during the last years of the study period in the older age group. Ovarian cancer mortality increased in women older than 50 years, whereas it remained steady in the younger age group. Joinpoint regression analysis showed that only the increase after 1997 in the mortality trend for uterine corpus cancer in women 50 years and older was statistically significant (P = 0.0044).

CONCLUSIONS

Although our findings regarding cervical cancer mortality in Greece are encouraging, still more efforts are needed, particularly in preventing cervical cancer in younger women. The increasing trend of uterine corpus and ovarian cancer mortality in older women suggests that development of well-organized tertiary centers for the implementation of modern therapeutic modalities is urgently needed.

Mesothelin inhibits paclitaxel-induced apoptosis through the PI3K pathway

Mesothelin, a secreted protein, is overexpressed in some cancers, but its exact function remains unclear. The aim of the present study was to evaluate the possible function of mesothelin. Real-time PCR, RT (reverse transcription)-PCR, cytotoxicity assays, proliferative assays, apoptotic assays by Hoechst staining, detection of active caspases 3 and 7 by flow cytometric analysis, and immunoprecipitation and immunoblotting were performed. Cancer tissues in paclitaxel-resistant ovarian cancer patients expressed higher levels of mesothelin as assessed using real-time PCR than paclitaxel-sensitive ovarian cancer patients (the mean crossing point value change of mesothelin was 26.9+/-0.4 in the resistant group and 34.3+/-0.7 for the sensitive group; P<0.001). Mesothelin also protected cells from paclitaxel-induced apoptosis. The protein expression of Bcl-2 family members, such as Bcl-2 and Mcl-1, was significantly increased regardless of whether cells were treated with exogenous mesothelin or were mesothelin-transfectants. Furthermore, mesothelin-treated cells revealed rapid tyrosine phosphorylation of the p85 subunit of PI3K (phosphoinositide 3-kinase) and ERK (extracellular-signal-regulated kinase) 1/2 for enhancing MAPK (mitogen-activated protein kinase) activity. The anti-apoptotic ability was suppressed and the expression of Bcl-2 family in response to mesothelin was altered by inhibiting PI3K activity, but not by inhibiting MAPK activity. Thus mesothelin can inhibit paclitaxel-induced cell death mainly by involving PI3K signalling in the regulation of Bcl-2 family expression. Mesothelin is a potential target in reducing resistance to cytotoxic drugs.

High mesothelin correlates with chemoresistance and poor survival in epithelial ovarian carcinoma

The objective of this paper is to investigate the mesothelin expression level to the clinicopathological features, chemoresponse, and to the outcome of patients with epithelial ovarian carcinoma (EOC). Mesothelin mRNA was detected by real-time quantitative reverse-transcription PCR in 139 EOC patients. Clinical characteristics, histopathological items, responses to chemotherapy, progression-free survival (PFS), and overall survival (OS) were recorded. Tumours with advanced stages had higher mesothelin than those with early stages. The chemoresistant patients showed significantly higher mesothelin than did chemosensitive patients (2.81 vs 0.43, P<0.001), irrespective of optimal or suboptimal surgery in those with advanced stages. Highly expressed levels of mesothelin were an independent but poor prognostic factor in the PFS (2.03 (1.23-3.37) P=0.006) and OS (3.72 (1.64-8.45), P=0.002) of the 139 EOC patients in multivariate analysis. In addition, patients in advanced stages with highly expressed mesothelin also had significantly worse OS, regardless of whether they had undergone optimal (13.85 (1.76-125.60), P=0.013) or suboptimal (4.47 (1.83-10.88), P=0.001) debulking surgery in multivariate analysis. Out results provide new evidence that mesothelin expression is associated with chemoresistance and with shorter disease-free survival and worse OS of patients with EOC.

Municipal distribution of ovarian cancer mortality in Spain

BACKGROUND

Spain was the country that registered the greatest increases in ovarian cancer mortality in Europe. This study describes the municipal distribution of ovarian cancer mortality in Spain using spatial models for small-area analysis.

METHODS

Smoothed relative risks of ovarian cancer mortality were obtained, using the Besag, York and Molliè autoregressive spatial model. Standardised mortality ratios, smoothed relative risks, and distribution of the posterior probability of relative risks being greater than 1 were depicted on municipal maps.

RESULTS

During the study period (1989-1998), 13,869 ovarian cancer deaths were registered in 2,718 Spanish towns, accounting for 4% of all cancer-related deaths among women. The highest relative risks were mainly concentrated in three areas, i.e., the interior of Barcelona and Gerona (north-east Spain), the north of Lugo and Asturias (north-west Spain) and along the Seville-Huelva boundary (in the south-west). Eivissa (Balearic Islands) and El Hierro (Canary Islands) also registered increased risks.

CONCLUSION

Well established ovarian cancer risk factors might not contribute significantly to the municipal distribution of ovarian cancer mortality. Environmental and occupational exposures possibly linked to this pattern and prevalent in specific regions, are discussed in this paper. Small-area geographical studies are effective instruments for detecting risk areas that may otherwise remain concealed on a more reduced scale.

Ovarian cancer in Western Australia (1982-98): incidence, mortality and survival

OBJECTIVES

To investigate the trends in incidence and mortality and estimate survival for women diagnosed with ovarian cancer in Western Australia. CASE SELECTION AND METHODS: There were 1,336 women diagnosed with ovarian cancer in 1982-98. Age-standardised rates were calculated by the direct method. Age-period and age-cohort models were analysed by Poisson regression. The Kaplan-Meier method was used to estimate survival and Cox proportional hazards regression evaluated the relative risk of dying.

RESULTS

Trends in age-adjusted incidence and mortality rates showed little changed over the three time periods of diagnosis. A significant birth cohort effect showed a peak in the risk in the 1924 (mid-year) cohort followed by a general decrease in both incidence and mortality risk. Survival at five years was 34% (95% CI 31.3-36.5) overall, but was only 27% (95% CI 17.4-36.7) among women with stage III and IV disease. Aboriginal women showed a risk of dying twice that of non-Aboriginal women.

CONCLUSIONS

The birth cohort analysis of ovarian cancer proved better at explaining disease trends than was time period of diagnosis. Survival continues to be poor, but Aboriginal women and those with serous and unspecified adenocarcinoma tumours fair much worse.

IMPLICATIONS

As the leading cause of death from a gynaecological malignancy, ovarian cancer is of public health importance. Historical trends in birth rates and the use of oral contraceptives help to explain at least some of the observed birth cohort trends in this study. In the long term, an effective diagnostic technique needs to be developed or this disease will continue to be diagnosed at an advanced stage when treatment options for cure are limited.

Cancer in women

Incidence, mortality and survival trends for the most frequent cancers affecting women are presented on a worldwide basis. Data sources are represented by several different cancer databases, as no single world cancer database covers these epidemiological measures. Monitoring cancer incidence, mortality and survival are fundamental indicators which allow estimates and predictions of geographical and temporal changes of these diseases, enabling the design and set-up of adequate cancer control activities and national health programs. The observed differences in cancer incidence, mortality and survival in more developed countries compared with less developed countries (as defined by WHO) are mainly due to different individual and social risk factors between the two geo-political areas. For some cancers, advancements in screening, diagnosis and treatment in the more developed areas were the most effective factors in reducing incidence and mortality as well as prolonging survival. These effects were not detected in the less developed areas because of the limited access to primary and specialist care.

Moderate progress for ovarian cancer in the last 20 years: prolongation of survival, but no improvement in the cure rate

Although ovarian cancer treatment has advanced in the last 20 years, long-term survival remains stable. The purpose of this study was to determine whether survival has improved in line with treatment advances in a population-based prospective cohort of ovarian cancer patients (1978-1997, with a follow-up through to 2000). The 10-year overall survival rate for cancer patients was similar before and after 1988: 32.2% (n=1661) and 34.4% (n=2089). For patients after 1988, a 12-month prolongation of median survival was observed. In terms of stage according to the International Federation of Gynecology and Obstetrics (FIGO), only FIGO I and FIGO II patients showed, in addition to a prolongation in survival, an absolute improvement of 12.9 and 12.6% after 5 years and of 13.2 and 8.6% after 10 years. This hardly affected the survival of the total sample. For the most frequent stage FIGO III patients and for FIGO IV patients, a prolongation in survival time, but no improvement in survival rate, was seen after five or 10 years. The progress in FIGO I and II patients may be due to more accurate staging. More effective chemotherapy may also explain some of the improvement. The prolongation in FIGO-stages III-IV may be due to more radical surgery. Patient selection criteria, not only the treatment modalities, may be responsible for the superior results reported in clinical trials. Cancer registries are important for evaluating the quality of healthcare delivery.