[Endometrial cancer: what's new?]

Minichromosome maintenance complex component 6 (MCM6) expression correlates with histological grade and survival in endometrioid endometrial adenocarcinoma

Minichromosome maintenance complex component 6 (MCM6) is involved in initiating DNA replication and is upregulated during licensed G0 phase of the cell cycle. This early expression permits its labeling of more proliferating cells than those by Ki-67. Here using a cohort of 89 endometrioid adenocarcinoma, we report findings made on the prognostic value of MCM6 based on immunohistochemical labeling index (LI) of the protein in comparison with that of Ki67 as no such information is currently available. Additionally, we examined the prognostic values of these markers based on their mRNA expression using a cohort of uterine corpus endometrial carcinoma (UCEC, n = 307) taken from The Cancer Genome Atlas (TCGA) database. Our evidence indicated the presence of a positive correlation between the LI of MCM6 and the histological grade of endometrioid endometrial adenocarcinoma (grade I, 66.7%; grade II, 75.3%; grade III, 81.4%; p < 0.001) and an inverse correlation between the LI of MCM6 and the overall and progression-free survival (p = 0.02 for both). The LI of Ki-67 correlated with grade (p < 0.001), but not survival. The MCM6 and Ki-67 inter-observer intra-class correlation coefficients were excellent: 0.84 (95% confidence interval, 0.83-0.91) and 0.84 (0.77-0.90), respectively. For in silico analyses of the TCGA cohort, both univariate and multivariate Cox analyses (p = 0.003 and p = 0.03, respectively) revealed high MCM6 mRNA Z-scores associated with reduced overall survival. This association was absent for Ki-67. MCM6 is thus a highly reproducible marker of poor prognosis in endometrial cancer. Evaluation of MCM6 should thus be considered in daily practice for risk stratification.

[Radiotherapy for endometrial cancer: experience of the national institute of oncology with 52 cases]

Le cancer de l'endomètre est le cancer gynécologique le plus fréquent en occident. Il concerne principalement les femmes ménopausées. L'objectif de notre travail est de rapporter l'expérience du service de radiothérapie à l'Institut National d'Oncologie (INO) dans la prise en charge du cancer de l'endomètre. Nous avons analysé rétrospectivement 52 cas de cancer de l'endomètre traités dans le service de radiothérapie de l'INO entre 2007 à 2009. Les données collectées à partir des dossiers médicaux de nos patientes concernaient les aspects épidémiologiques, cliniques, thérapeutiques et évolutifs de ce cancer. La médiane d’âge des patientes était de 57 ans, 87% étaient ménopausées. Le délai moyen de consultation était de six mois. Le maitre symptôme était des métrorragies chez 51 patientes. Le diagnostic histologique a été porté sur un curetage biopsique de l'endomètre dans 51% des cas. L'examen anatomopathologique a montré un adénocarcinome endométrioïde dans 92% des cas. Après le bilan, 27% des patientes étaient stade I, 30% stade II, 20% stade III et 1% stade IVA selon la classification de la Fédération Internationale de Gynécologie Obstétrique (FIGO). Après la chirurgie, 51% des patientes ont reçu une radiothérapie externe. La dose délivrée était de 46 Gray (Gy). Une curiethérapie du fond vaginal a été délivrée chez toutes les patientes. Sur le plan évolutif, 83% des patientes étaient toujours suivies en situation de bon contrôle de leur maladie, 8% ont eu une récidive locorégionale et 4% avaient des métastases à distance. Ainsi, le cancer de l'endomètre est un cancer dont le traitement repose sur la chirurgie. La radiothérapie est le traitement adjuvant principal.

[Current position of the sentinel lymph node procedure in endometrial cancer]

Lymph node status is a major prognostic element in endometrial cancer and affects the choice of adjuvant therapy. The sentinel lymph node (SLN) procedure is proposed as an alternative to lymphadenectomy. This review aims to assess its feasibility. To this end, 19 studies have been analysed. It appears that double detection (colorimetric and isotopic) is better than single detection, independent of injection site. Hysteroscopic injection is technically more difficult, yet can be done near the tumoral lesion. The cervical site does not accurately reflect the lymphatic drainage of the uterine body but is easier to access. SLN detection rate is notably identical between these two injections sites. Lomboaortic detection rate is lower for cervical injections than for endometrial ones. The myometrial site is also difficult to access (intraoperatively), due to same limitations as the hysteroscopic route, and can be deceiving (insufficient detection rate and high false-negative rate). The SLN allows for ultrastadification (micrometastases and isolated tumoral cells) with the development of new pathological techniques (serial sections and immunohistochemistry). Data on SLN in endometrial cancer is very heterogeneous in terms of methodology and populations studied. Despite being well-known, the SLN procedure in endometrial cancer remains in its feasibility stage. Its place in therapeutic strategies needs to be further explored and its potential benefit remains to be confirmed.

[Is there an interest in para-aortic lymphadenectomy in operable endometrial cancer?]

The indication and extent of lymph node dissection in the surgical management of endometrial cancer remains controversial especially concerning the para-aortic lymph nodes. The therapeutic benefit of the lymph node dissection is criticized mainly for low-risk patients for extra-uterine spread. Surgically staging patients is the best method to predict node involvement and it allows an optimal decision for adjuvant therapy to be taken. The different prognostic factors for para-aortic lymph nodes metastasis are histological grade and size of the tumour, myometrial wall invasion and lymphovascular dissemination, as well as positive pelvic lymph nodes. However, these elements are not correctly evaluated before and during the surgery. Positive para-aortic lymph nodes can be found without a lymphatic spread to the pelvic area. Even though the prevalence of para-aortic node involvement is weak, it seems legitimate to propose in selected cases of important lymph node involvement, it's complete dissection if a pelvic lymphadenectomy is indicated and if it is surgically possible.