1
|
Gallo A, Di Spiezio Sardo A, Conforti A, Iorio GG, Zizolfi B, Buonfantino C, De Angelis MC, Strina I, Marrone V, Bifulco G, Alviggi C. Assessing ovarian stimulation with letrozole and levonorgestrel intrauterine system after combined fertility-sparing approach for atypical endometrial lesions: a retrospective case-control study. Reprod Biomed Online 2024; 48:103750. [PMID: 38430660 DOI: 10.1016/j.rbmo.2023.103750] [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: 07/13/2023] [Revised: 10/23/2023] [Accepted: 11/23/2023] [Indexed: 03/05/2024]
Abstract
RESEARCH QUESTION Is ovarian stimulation with levonorgestrel intrauterine system (LNG-IUS) in situ and co-treatment with letrozole safe and effective in patients undergoing fertility-sparing combined treatment for atypical endometrial hyperplasia (AEH) or early endometrial cancer limited to the endometrium? DESIGN Retrospective case-control study recruiting women who had undergone fertility-sparing 'combined' treatment and ovarian stimulation with letrozole and LNG-IUS in situ. The 'three steps' hysteroscopic technique was used. Once complete response was achieved, the ovaries were stimulated, and mature oocytes cryopreserved. The LNG-IUS was removed, and embryos transferred. A comparative analysis was conducted between the two control groups of the initial outcomes of ART (number of oocytes and MII oocytes retrieved): healthy infertile women undergoing ovarian stimulation for IVF/ICSI (control group A); and patients diagnosed with breast cancer who underwent ovarian stimulation with letrozole (control group B). RESULTS Of the 75 patients analysed, 15 underwent oocyte cryopreservation after achieving a complete response to fertility-sparing treatment (study group); 30 patients in control group A and B, respectively. No statistically significant differences were observed in retrieved oocytes and mature oocytes between the study and control groups. In the nine patients who underwent embryo transfer, clinical pregnancy (55.6%), cumulative live birth (44.4%) and miscarriage (20%) rates were reported. In three patients with AEH, recurrence occurred (12%) at 3, 6 and 16 months after removing the LNG-IUS to attempt embryo transfer, respectively. CONCLUSION Fertility-sparing hysteroscopic combined treatment and subsequent ovarian stimulation with letrozole and LNG-IUS in situ could be suggested to women with AEH or early endometrial cancer who ask for future fertility preservation.
Collapse
Affiliation(s)
- Alessandra Gallo
- University of Naples 'Federico II'. Department of Public Health. School of Medicine. Naples, Italy
| | - Attilio Di Spiezio Sardo
- University of Naples 'Federico II'. Department of Public Health. School of Medicine. Naples, Italy
| | - Alessandro Conforti
- University of Naples "Federico II". Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine. Naples, Italy.
| | - Giuseppe Gabriele Iorio
- University of Naples "Federico II". Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine. Naples, Italy
| | - Brunella Zizolfi
- University of Naples 'Federico II'. Department of Public Health. School of Medicine. Naples, Italy
| | - Cira Buonfantino
- University of Naples 'Federico II'. Department of Public Health. School of Medicine. Naples, Italy
| | - Maria Chiara De Angelis
- University of Naples 'Federico II'. Department of Public Health. School of Medicine. Naples, Italy
| | - Ida Strina
- University of Naples 'Federico II'. Department of Public Health. School of Medicine. Naples, Italy
| | - Vincenzo Marrone
- University of Naples 'Federico II'. Department of Public Health. School of Medicine. Naples, Italy
| | - Giuseppe Bifulco
- University of Naples 'Federico II'. Department of Public Health. School of Medicine. Naples, Italy
| | - Carlo Alviggi
- University of Naples 'Federico II'. Department of Public Health. School of Medicine. Naples, Italy
| |
Collapse
|
2
|
Sun Y, Han P, Wang Y, Cheng X, Wu W, Liu Q, Ren F. Risk assessment of extra-uterine involvement and prognosis in young type I endometrial carcinoma with high or moderate differentiation and less than 1/2 myometrial invasion. Aging (Albany NY) 2024; 16:6445-6454. [PMID: 38575312 PMCID: PMC11042967 DOI: 10.18632/aging.205714] [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: 10/12/2023] [Accepted: 02/27/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE The aim of this study was to investigate whether young patients with endometrial carcinoma can preserve adnexa and lymph nodes to improve their quality of life without compromising their prognosis. METHODS A total of 319 patients with type I endometrial carcinoma (high or moderate differentiation and less than 1/2 myometrial invasion) hospitalized in the First Affiliated Hospital of Zhengzhou University from May 2012 to July 2021 were included. The patients were divided into four groups: high differentiation without myometrial invasion group (G1MI-), high differentiation with superficial myometrial invasion group (G1MI+), moderate differentiation without myometrial invasion group (G2MI-), and moderate differentiation with superficial myometrial invasion group (G2MI+). Logistic regression analysis was conducted to identify risk factors for extra-uterine involvement. Kaplan-Meier method was used to draw the survival curve to compare the prognosis in subgroups and rates of extra-uterine involvement were also compared using Chi-square test or Fisher's exact test. RESULTS Multivariable logistic regression revealed that differentiation (HR = 14.590, 95%CI = 1.778-119.754, p = 0.013) and myometrial invasion (HR = 10.732, 95%CI = 0.912-92.780, p = 0.037) were the independent risk factors for extra-uterine involvement. The overall difference was statistically significant (p < 0.001). In the subgroups analysis, both adnexal metastasis and lymph node metastasis were statistically significant in the G2MI+ group compared with G1MI- (p = 0.007, p = 0.008). There were no significant differences in the overall survival (OS) rate and progression free survival (PFS) rate among the four subgroups (p > 0.05). CONCLUSIONS Surgery with adnexal preservation and without systematic lymphadenectomy could be employed for the patients who are high differentiation with less than 1/2 myometrial invasion or moderate differentiation without myometrial invasion, but not recommended to the patients with moderate differentiation and superficial myometrial invasion.
Collapse
Affiliation(s)
- Yi Sun
- Deparment of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Pin Han
- Deparment of Gynecology, The Luoyang Maternal and Child Health Care Hospital, Luoyang 471000, China
| | - Yuanpei Wang
- Deparment of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Xiaoran Cheng
- Deparment of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Weijia Wu
- Deparment of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Qianwen Liu
- Deparment of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Fang Ren
- Deparment of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| |
Collapse
|
3
|
Wang Q, Li L, Gao X, Zhang C, Xu C, Song L, Li J, Sun X, Mao F, Wang Y. Targeting GRP75 with a Chlorpromazine Derivative Inhibits Endometrial Cancer Progression Through GRP75-IP3R-Ca 2+-AMPK Axis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2304203. [PMID: 38342610 PMCID: PMC11022737 DOI: 10.1002/advs.202304203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 01/18/2024] [Indexed: 02/13/2024]
Abstract
Tumors often overexpress glucose-regulated proteins, and agents that interfere with the production or activity of these proteins may represent novel cancer treatments. The chlorpromazine derivative JX57 exhibits promising effects against endometrial cancer with minimal extrapyramidal side effects; however, its mechanisms of action are currently unknown. Here, glucose-regulated protein 75 kD (GRP75) is identified as a direct target of JX57 using activity-based protein profiling and loss-of-function experiments. The findings show that GRP75 is necessary for the biological activity of JX57, as JX57 exhibits moderate anticancer properties in GRP75-deficient cancer cells, both in vitro and in vivo. High GRP75 expression is correlated with poor differentiation and poor survival in patients with endometrial cancer, whereas the knockdown of GRP75 can significantly suppress tumor growth. Mechanistically, the direct binding of JX57 to GRP75 impairs the structure of the mitochondria-associated endoplasmic reticulum membrane and disrupts the endoplasmic reticulum-mitochondrial calcium homeostasis, resulting in a mitochondrial energy crisis and AMP-activated protein kinase activation. Taken together, these findings highlight GRP75 as a potential prognostic biomarker and direct therapeutic target in endometrial cancer and suggest that the chlorpromazine derivative JX57 can potentially be a new therapeutic option for endometrial cancer.
Collapse
Affiliation(s)
- Qi Wang
- Department of Gynecologic Oncologythe International Peace Maternity and Child Health HospitalSchool of MedicineShanghai Municipal Key Clinical SpecialtyFemale Tumor Reproductive SpecialtyShanghai Key Laboratory of Embryo Original DiseaseShanghai Jiao Tong UniversityShanghai200025China
- State Key Laboratory of Bioreactor EngineeringShanghai Frontiers Science Center of Optogenetic Techniques for Cell MetabolismFrontiers Science Center for Materiobiology and Dynamic ChemistryShanghai Key Laboratory of New Drug DesignSchool of PharmacyEast China University of Science and TechnologyShanghai200237China
| | - Lijuan Li
- Department of Gynecologic Oncologythe International Peace Maternity and Child Health HospitalSchool of MedicineShanghai Municipal Key Clinical SpecialtyFemale Tumor Reproductive SpecialtyShanghai Key Laboratory of Embryo Original DiseaseShanghai Jiao Tong UniversityShanghai200025China
| | - Xiaoyan Gao
- Department of Gynecologic Oncologythe International Peace Maternity and Child Health HospitalSchool of MedicineShanghai Municipal Key Clinical SpecialtyFemale Tumor Reproductive SpecialtyShanghai Key Laboratory of Embryo Original DiseaseShanghai Jiao Tong UniversityShanghai200025China
| | - Chunxue Zhang
- Department of Gynecologic Oncologythe International Peace Maternity and Child Health HospitalSchool of MedicineShanghai Municipal Key Clinical SpecialtyFemale Tumor Reproductive SpecialtyShanghai Key Laboratory of Embryo Original DiseaseShanghai Jiao Tong UniversityShanghai200025China
| | - Chen Xu
- Department of Gynecologic Oncologythe International Peace Maternity and Child Health HospitalSchool of MedicineShanghai Municipal Key Clinical SpecialtyFemale Tumor Reproductive SpecialtyShanghai Key Laboratory of Embryo Original DiseaseShanghai Jiao Tong UniversityShanghai200025China
| | - Lingyi Song
- State Key Laboratory of Bioreactor EngineeringShanghai Frontiers Science Center of Optogenetic Techniques for Cell MetabolismFrontiers Science Center for Materiobiology and Dynamic ChemistryShanghai Key Laboratory of New Drug DesignSchool of PharmacyEast China University of Science and TechnologyShanghai200237China
| | - Jian Li
- State Key Laboratory of Bioreactor EngineeringShanghai Frontiers Science Center of Optogenetic Techniques for Cell MetabolismFrontiers Science Center for Materiobiology and Dynamic ChemistryShanghai Key Laboratory of New Drug DesignSchool of PharmacyEast China University of Science and TechnologyShanghai200237China
| | - Xiao Sun
- Department of Gynecologic Oncologythe International Peace Maternity and Child Health HospitalSchool of MedicineShanghai Municipal Key Clinical SpecialtyFemale Tumor Reproductive SpecialtyShanghai Key Laboratory of Embryo Original DiseaseShanghai Jiao Tong UniversityShanghai200025China
| | - Fei Mao
- State Key Laboratory of Bioreactor EngineeringShanghai Frontiers Science Center of Optogenetic Techniques for Cell MetabolismFrontiers Science Center for Materiobiology and Dynamic ChemistryShanghai Key Laboratory of New Drug DesignSchool of PharmacyEast China University of Science and TechnologyShanghai200237China
| | - Yudong Wang
- Department of Gynecologic Oncologythe International Peace Maternity and Child Health HospitalSchool of MedicineShanghai Municipal Key Clinical SpecialtyFemale Tumor Reproductive SpecialtyShanghai Key Laboratory of Embryo Original DiseaseShanghai Jiao Tong UniversityShanghai200025China
| |
Collapse
|
4
|
Okumura T, Raja Xavier JP, Pasternak J, Yang Z, Hang C, Nosirov B, Singh Y, Admard J, Brucker SY, Kommoss S, Takeda S, Staebler A, Lang F, Salker MS. Rel Family Transcription Factor NFAT5 Upregulates COX2 via HIF-1α Activity in Ishikawa and HEC1a Cells. Int J Mol Sci 2024; 25:3666. [PMID: 38612478 PMCID: PMC11012216 DOI: 10.3390/ijms25073666] [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: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Nuclear factor of activated T cells 5 (NFAT5) and cyclooxygenase 2 (COX2; PTGS2) both participate in diverse pathologies including cancer progression. However, the biological role of the NFAT5-COX2 signaling pathway in human endometrial cancer has remained elusive. The present study explored whether NFAT5 is expressed in endometrial tumors and if NFAT5 participates in cancer progression. To gain insights into the underlying mechanisms, NFAT5 protein abundance in endometrial cancer tissue was visualized by immunohistochemistry and endometrial cancer cells (Ishikawa and HEC1a) were transfected with NFAT5 or with an empty plasmid. As a result, NFAT5 expression is more abundant in high-grade than in low-grade endometrial cancer tissue. RNA sequencing analysis of NFAT5 overexpression in Ishikawa cells upregulated 37 genes and downregulated 20 genes. Genes affected included cyclooxygenase 2 and hypoxia inducible factor 1α (HIF1A). NFAT5 transfection and/or treatment with HIF-1α stabilizer exerted a strong stimulating effect on HIF-1α promoter activity as well as COX2 expression level and prostaglandin E2 receptor (PGE2) levels. Our findings suggest that activation of NFAT5-HIF-1α-COX2 axis could promote endometrial cancer progression.
Collapse
Affiliation(s)
- Toshiyuki Okumura
- Department of Women’s Health, Tübingen University Hospital, D-72076 Tübingen, Germany; (T.O.); (J.P.R.X.); (J.P.); (C.H.); (Y.S.); (S.Y.B.); (S.K.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan;
| | - Janet P. Raja Xavier
- Department of Women’s Health, Tübingen University Hospital, D-72076 Tübingen, Germany; (T.O.); (J.P.R.X.); (J.P.); (C.H.); (Y.S.); (S.Y.B.); (S.K.)
| | - Jana Pasternak
- Department of Women’s Health, Tübingen University Hospital, D-72076 Tübingen, Germany; (T.O.); (J.P.R.X.); (J.P.); (C.H.); (Y.S.); (S.Y.B.); (S.K.)
| | - Zhiqi Yang
- Department of Women’s Health, Tübingen University Hospital, D-72076 Tübingen, Germany; (T.O.); (J.P.R.X.); (J.P.); (C.H.); (Y.S.); (S.Y.B.); (S.K.)
| | - Cao Hang
- Department of Women’s Health, Tübingen University Hospital, D-72076 Tübingen, Germany; (T.O.); (J.P.R.X.); (J.P.); (C.H.); (Y.S.); (S.Y.B.); (S.K.)
| | - Bakhtiyor Nosirov
- Department of Cancer Research, Luxembourg Institute of Health, L-1210 Luxembourg, Luxembourg
| | - Yogesh Singh
- Department of Women’s Health, Tübingen University Hospital, D-72076 Tübingen, Germany; (T.O.); (J.P.R.X.); (J.P.); (C.H.); (Y.S.); (S.Y.B.); (S.K.)
- Institute of Medical Genetics and Applied Genomics, Eberhard Karls University, D-72074 Tübingen, Germany;
| | - Jakob Admard
- Institute of Medical Genetics and Applied Genomics, Eberhard Karls University, D-72074 Tübingen, Germany;
| | - Sara Y. Brucker
- Department of Women’s Health, Tübingen University Hospital, D-72076 Tübingen, Germany; (T.O.); (J.P.R.X.); (J.P.); (C.H.); (Y.S.); (S.Y.B.); (S.K.)
| | - Stefan Kommoss
- Department of Women’s Health, Tübingen University Hospital, D-72076 Tübingen, Germany; (T.O.); (J.P.R.X.); (J.P.); (C.H.); (Y.S.); (S.Y.B.); (S.K.)
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan;
| | - Annette Staebler
- Institute of Pathology, Eberhard Karls University, D-72074 Tübingen, Germany;
| | - Florian Lang
- Institute of Physiology, Eberhard Karls University, D-72074 Tübingen, Germany;
| | - Madhuri S. Salker
- Department of Women’s Health, Tübingen University Hospital, D-72076 Tübingen, Germany; (T.O.); (J.P.R.X.); (J.P.); (C.H.); (Y.S.); (S.Y.B.); (S.K.)
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
Wang J, Fang Y, Chen T, Xin Z, Wu Y, Yang X. A Case Report of Consecutive Live Birth Twice Through in vitro Fertilization and Embryo Transfer After Endometrial Carcinoma Fertility Preservation Treatment. Int J Womens Health 2024; 16:395-400. [PMID: 38463685 PMCID: PMC10924884 DOI: 10.2147/ijwh.s441984] [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: 09/25/2023] [Accepted: 02/25/2024] [Indexed: 03/12/2024] Open
Abstract
Preserving fertility is a vital concern for young women diagnosed with endometrial carcinoma. The clinical management of such patients is often disappointing. It is rare to have two consecutive successful pregnancies. We present a child-bearing-age woman who underwent fertility preservation therapy due to endometrial carcinoma. Following fertility preservation therapy, she underwent in vitro fertilization and embryo transfer. After receiving her first fresh embryo transfer, she successfully conceived and gave birth to a healthy child. Two years after the first embryo transfer and regular follow-up, she had another frozen embryo transfer of two cleavage embryos and successfully gave birth to another healthy baby. After the delivery of her second child, she underwent surgical treatment for endometrial carcinoma. For endometrial carcinoma patients who intend to preserve fertility, high-quality long-term follow-up and personalized treatment are necessary.
Collapse
Affiliation(s)
- Jingying Wang
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
- Department of Human Reproductive Medicine, Beijing Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Ying Fang
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
- Department of Human Reproductive Medicine, Beijing Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Tong Chen
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
- Department of Human Reproductive Medicine, Beijing Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Zhimin Xin
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
- Department of Human Reproductive Medicine, Beijing Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Yumei Wu
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
- Department of Gynecological Oncology, Beijing Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Xiaokui Yang
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
- Department of Human Reproductive Medicine, Beijing Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| |
Collapse
|
7
|
Satei J, Afrakhteh AN, Aldecoa KAT. Endometrial Adenocarcinoma in Young Women: A Case Report and Review of Literature. Cureus 2023; 15:e45287. [PMID: 37846282 PMCID: PMC10576867 DOI: 10.7759/cureus.45287] [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] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
Endometrial cancer in young women presents a unique challenge to care teams. With over 90% of cases diagnosed in women over the age of 50, its diagnosis can be delayed in younger patients if the medical team does not maintain a high enough index of suspicion. Once diagnosed, treatment options depend on a desire to maintain fertility. We present a case of a 36-year-old female who, following cross-sectional imaging and pathological analysis, was diagnosed with endometrioid endometrial adenocarcinoma. This case explores the epidemiology of endometrial cancer in young women and the importance of a multi-disciplinary approach to the diagnosis and treatment of this rare malignancy.
Collapse
Affiliation(s)
- Jessica Satei
- Medicine, Newcastle University Medical School, Newcastle, GBR
| | | | - Kim Abbegail T Aldecoa
- Internal Medicine, Trinity Health Oakland Hospital/Wayne State University Program, Pontiac, USA
| |
Collapse
|
8
|
Smith AJB, Puttaraju T, Applebaum J, Fader AN. Long-term impact of the Affordable Care Act's dependent coverage mandate on young women with gynecologic cancer. Gynecol Oncol 2023; 175:121-127. [PMID: 37356312 DOI: 10.1016/j.ygyno.2023.06.014] [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: 01/10/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The dependent coverage mandate in the 2010 Affordable Care Act (ACA) allows young adults to stay on a parent's private insurance through age 26. While this mandate is associated with gains in insurance and early-stage cancer diagnosis, its long-term impact on survival is unknown. OBJECTIVE To compare insurance coverage, stage at diagnosis, and overall survival in patients with gynecologic cancer before and after the ACA's dependent coverage mandate. METHODS Using difference-in-differences (DiD) analysis, we conducted a retrospective cohort study comparing outcomes before and after the implementation of the ACA's dependent coverage mandate in young patients with gynecologic cancer, ages 18-26 years (exposure group) to patients ages 27-35 (control group). We analyzed insurance coverage, stage at diagnosis, and 1, 2, and 3-year overall survival, adjusted for age and comorbidities, utilizing the 2004-2017 National Cancer Database. IRB exemption was obtained. RESULTS A total of 3553 cases pre-reform and 4535 cases post-reform were identified for patients 18-26 years compared to 14,420 pre-reform and 19,821 post-reform for patients age 27-35. The ACA's dependent coverage mandate was associated with significant gains in insurance (DiD 2%, 95% CI 0.6-3.5) and early-stage diagnosis (3.1%, 95% CI 0.6-5.7). The ACA's dependent coverage mandate was associated with significant gains in 3-year survival (2.4%, 95% CI 0.4-4.3) and non-significant gains in 1 and 2-year survival. CONCLUSION The ACA's dependent coverage mandate is associated with improvements in early-stage diagnosis and survival for young patients with gynecologic cancer. Maintaining insurance gains-and expanding to the remaining uninsured-are critical for the health of young patients with gynecologic cancer.
Collapse
Affiliation(s)
- Anna Jo Bodurtha Smith
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, USA; Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, USA.
| | | | - Jeremy Applebaum
- Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, USA
| | - Amanda N Fader
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
9
|
Dellino M, Cerbone M, Laganà AS, Vitagliano A, Vimercati A, Marinaccio M, Baldini GM, Malvasi A, Cicinelli E, Damiani GR, Cazzato G, Cascardi E. Upgrading Treatment and Molecular Diagnosis in Endometrial Cancer-Driving New Tools for Endometrial Preservation? Int J Mol Sci 2023; 24:ijms24119780. [PMID: 37298731 DOI: 10.3390/ijms24119780] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
One emerging problem for onco-gynecologists is the incidence of premenopausal patients under 40 years of age diagnosed with stage I Endometrial Cancer (EC) who want to preserve their fertility. Our review aims to define a primary risk assessment that can help fertility experts and onco-gynecologists tailor personalized treatment and fertility-preserving strategies for fertile patients wishing to have children. We confirm that risk factors such as myometrial invasion and The International Federation of Gynecology and Obstetrics (FIGO) staging should be integrated into the novel molecular classification provided by The Cancer Genome Atlas (TCGA). We also corroborate the influence of classical risk factors such as obesity, Polycystic ovarian syndrome (PCOS), and diabetes mellitus to assess fertility outcomes. The fertility preservation options are inadequately discussed with women with a diagnosis of gynecological cancer. A multidisciplinary team of gynecologists, oncologists, and fertility specialists could increase patient satisfaction and improve fertility outcomes. The incidence and death rates of endometrial cancer are rising globally. International guidelines recommend radical hysterectomy and bilateral salpingo-oophorectomy as the standard of care for this cancer; however, fertility-sparing alternatives should be tailored to motivated women of reproductive age, establishing an appropriate cost-benefit balance between childbearing desire and cancer risk. New molecular classifications such as that of TCGA provide a robust supplementary risk assessment tool that can tailor the treatment options to the patient's needs, curtail over- and under-treatment, and contribute to the spread of fertility-preserving strategies.
Collapse
Affiliation(s)
- Miriam Dellino
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Marco Cerbone
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Amerigo Vitagliano
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Antonella Vimercati
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Marco Marinaccio
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | | | - Antonio Malvasi
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Ettore Cicinelli
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gianluca Raffaello Damiani
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gerardo Cazzato
- Department of Emergency and Organ Transplantation, Pathology Section, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Eliano Cascardi
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060 Candiolo, Italy
| |
Collapse
|
10
|
Kim YJ, Park HP, Kim HS, Park S. Preoperative Prognostic Nutritional Index Is a Prognostic Indicator of Cancer-Specific Survival in Patients Undergoing Endometrial Cancer Surgery. J Korean Med Sci 2023; 38:e163. [PMID: 37270918 PMCID: PMC10226847 DOI: 10.3346/jkms.2023.38.e163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/16/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND The prognostic nutritional index (PNI) reflects systemic inflammation and nutritional status. This study aimed to evaluate the effect of preoperative PNI on postoperative cancer-specific survival in patients with endometrial cancer (EC). METHODS Demographic, laboratory, and clinical data were retrospectively collected from 894 patients who underwent surgical resection of EC. Preoperative PNIs were determined from the serum albumin concentration and total lymphocyte count, which were measured within 1 month before surgery. Patients were classified into high PNI (n = 619) and low PNI (n = 275) groups according to the preoperative PNI cut-off value of 50.6. The stabilized inverse probability of treatment weighting (IPTW) method was used to reduce bias: a weighting cohort divided into high PNI (n = 615.4) and low PNI (n = 272.3) groups. The primary outcome measure was postoperative cancer-specific survival. RESULTS The postoperative cancer-specific survival rate was higher in the high PNI group than the low PNI group in the unadjusted cohort (93.1% vs. 81.5%; proportion difference [95% confidence interval; 95% CI], 11.6% [6.6-16.6%]; P < 0.001) and in the IPTW-adjusted cohort (91.4% vs. 86.0%; 5.4% [0.8-10.2%]; P = 0.021). In the multivariate Cox proportional hazard regression model in the IPTW-adjusted cohort, high preoperative PNI (hazard ratio [95% CI], 0.60 [0.38-0.96]; P = 0.032) was an independent determinant of postoperative cancer-specific mortality. The multivariate-adjusted restricted cubic spline curve for the Cox regression model showed a significant negative association between preoperative PNI and postoperative cancer-specific mortality (P < 0.001). CONCLUSION High preoperative PNI was associated with improved postoperative cancer-specific survival in patients undergoing surgery for EC.
Collapse
Affiliation(s)
- Yoon Jung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghon Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| |
Collapse
|
11
|
Fertility-Sparing Strategies for Early-Stage Endometrial Cancer: Stepping towards Precision Medicine Based on the Molecular Fingerprint. Int J Mol Sci 2023; 24:ijms24010811. [PMID: 36614253 PMCID: PMC9821405 DOI: 10.3390/ijms24010811] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/15/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023] Open
Abstract
Endometrial cancer represents the fifth most common cancer in women, and the most common gynecological malignancy in developed countries [...].
Collapse
|
12
|
Donohoe F, O’Meara Y, Roberts A, Comerford L, Kelly CM, Walshe JM, Lundy D, Hickey M, Brennan DJ. Using menopausal hormone therapy after a cancer diagnosis in Ireland. Ir J Med Sci 2023; 192:45-55. [PMID: 35141870 PMCID: PMC9892117 DOI: 10.1007/s11845-022-02947-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Menopause may cause a constellation of symptoms that affect quality of life. Many women will have menopause induced or exacerbated by treatment for cancer whether that be through surgery, chemotherapy, radiotherapy, or anti-endocrine therapy. As treatments advance, the number of people living with and beyond a cancer diagnosis is set to increase over the coming years meaning more people will be dealing with the after effects of cancer and its treatment. AIMS This review aims to summarise available data to guide clinicians treating women with menopausal symptoms after the common cancer diagnoses encountered in Ireland. The use of menopausal hormone therapy is discussed as well as non-hormonal and non-pharmacological options. CONCLUSIONS Managing menopausal symptoms is an important consideration for all physicians involved in the care of people living with and beyond a cancer diagnosis. High-quality data may not be available to guide treatment decisions, and, thus, it is essential to take into account the impact of the symptoms on quality of life as well as the likelihood of recurrence in each individual case.
Collapse
Affiliation(s)
- Fionán Donohoe
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Yvonne O’Meara
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Aidin Roberts
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Louise Comerford
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Catherine M. Kelly
- Dept. of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Janice M. Walshe
- Dept. of Medical Oncology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
| | - Deirdre Lundy
- Reproductive and Sexual Health Co-Ordinator, Irish College of General Practitioners, Lincoln Place, Dublin 2, Ireland
| | - Martha Hickey
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, Melbourne, VIC Australia
| | - Donal J. Brennan
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland ,UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Belfield, Dublin 4, Ireland
| |
Collapse
|
13
|
Shazly SA, Coronado PJ, Yılmaz E, Melekoglu R, Sahin H, Giannella L, Ciavattini A, Carpini GD, Di Giuseppe J, Yordanov A, Karakadieva K, Nedelcheva NM, Vasileva-Slaveva M, Alcazar JL, Chacon E, Manzour N, Vara J, Karaman E, Karaaslan O, Hacıoğlu L, Korkmaz D, Onal C, Knez J, Ferrari F, Hosni EM, Mahmoud ME, Elassall GM, Abdo MS, Mohamed YI, Abdelbadie AS. Endometrial Cancer Individualized Scoring System (ECISS): A machine learning-based prediction model of endometrial cancer prognosis. Int J Gynaecol Obstet 2022; 161:760-768. [PMID: 36572053 DOI: 10.1002/ijgo.14639] [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: 09/12/2022] [Revised: 12/02/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To establish a prognostic model for endometrial cancer (EC) that individualizes a risk and management plan per patient and disease characteristics. METHODS A multicenter retrospective study conducted in nine European gynecologic cancer centers. Women with confirmed EC between January 2008 to December 2015 were included. Demographics, disease characteristics, management, and follow-up information were collected. Cancer-specific survival (CSS) and disease-free survival (DFS) at 3 and 5 years comprise the primary outcomes of the study. Machine learning algorithms were applied to patient and disease characteristics. Model I: pretreatment model. Calculated probability was added to management variables (model II: treatment model), and the second calculated probability was added to perioperative and postoperative variables (model III). RESULTS Of 1150 women, 1144 were eligible for 3-year survival analysis and 860 for 5-year survival analysis. Model I, II, and III accuracies of prediction of 5-year CSS were 84.88%/85.47% (in train and test sets), 85.47%/84.88%, and 87.35%/86.05%, respectively. Model I predicted 3-year CSS at an accuracy of 91.34%/87.02%. Accuracies of models I, II, and III in predicting 5-year DFS were 74.63%/76.72%, 77.03%/76.72%, and 80.61%/77.78%, respectively. CONCLUSION The Endometrial Cancer Individualized Scoring System (ECISS) is a novel machine learning tool assessing patient-specific survival probability with high accuracy.
Collapse
Affiliation(s)
- Sherif A Shazly
- Women's Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Pluvio J Coronado
- Department of Obstetrics and Gynecology, Hospital Clinico San Carlos, Madrid, Spain
| | - Ercan Yılmaz
- Department of Obstetrics and Gynecology, Inonu University, Malatya, Turkey
| | - Rauf Melekoglu
- Department of Obstetrics and Gynecology, Inonu University, Malatya, Turkey
| | - Hanifi Sahin
- Department of Obstetrics and Gynecology, Inonu University, Malatya, Turkey
| | - Luca Giannella
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Di Giuseppe
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University of Pleven, Pleven, Bulgaria
| | | | | | | | - Juan Luis Alcazar
- Gynecologic Oncologic Division, Clinica Universidad de Navarra, Navarra, Spain
| | - Enrique Chacon
- Gynecologic Oncologic Division, Clinica Universidad de Navarra, Navarra, Spain
| | - Nabil Manzour
- Gynecologic Oncologic Division, Clinica Universidad de Navarra, Navarra, Spain
| | - Julio Vara
- Gynecologic Oncologic Division, Clinica Universidad de Navarra, Navarra, Spain
| | - Erbil Karaman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Van Yuzuncu Yıl University, Van, Turkey
| | - Onur Karaaslan
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Van Yuzuncu Yıl University, Van, Turkey
| | - Latif Hacıoğlu
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Van Yuzuncu Yıl University, Van, Turkey
| | - Duygu Korkmaz
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Van Yuzuncu Yıl University, Van, Turkey
| | - Cem Onal
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Jure Knez
- University Medical Center Maribor, Maribor, Slovenia
| | - Federico Ferrari
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Esraa M Hosni
- Middle-Eastern College of Obstetricians and Gynaecologists, Leeds, UK
| | - Mohamed E Mahmoud
- Middle-Eastern College of Obstetricians and Gynaecologists, Leeds, UK
| | - Gena M Elassall
- Middle-Eastern College of Obstetricians and Gynaecologists, Leeds, UK
| | - Mohamed S Abdo
- Middle-Eastern College of Obstetricians and Gynaecologists, Leeds, UK
| | - Yasmin I Mohamed
- Middle-Eastern College of Obstetricians and Gynaecologists, Leeds, UK
| | - Amr S Abdelbadie
- Department of Obstetrics and Gynecology, Aswan University, Aswan, Egypt
| | | |
Collapse
|
14
|
Daley D, Padwick M, Mistry S, Malhotra V, Vikram RS, Stanciu P. Case report: Spontaneous remission of synchronous endometrial and ovarian cancers following pregnancy. Front Oncol 2022; 12:1001677. [DOI: 10.3389/fonc.2022.1001677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022] Open
Abstract
IntroductionEndometrial cancer is one of the most common malignancies affecting women. It is uncommonly diagnosed in young women, particularly in the absence of abnormal vaginal bleeding symptoms.Case presentationA 28-year-old woman was referred to our department with lower abdominal pain. Transvaginal ultrasound showed a complex right adnexal mass with mixed echogenicity. Magnetic resonance imaging (MRI) identified a right-sided, torted, cystic solid ovarian mass, and a polypoid lesion in the uterine cavity.DiagnosisFollowing multidisciplinary team advice, hysteroscopic transcervical resection of endometrial polypoid mass and laparoscopic right salpingo-oophorectomy was performed. Histopathologic assessment of the endometrial tissue showed changes consistent with grade 1 endometrioid endometrial carcinoma, while the right ovarian mass showed a well-differentiated endometrioid carcinoma.InterventionThe patient underwent hormonal treatment and surveillance whilst making a final decision regarding further surgical management. However, the patient stopped hormonal treatment after 2 weeks, went abroad and absconded from treatment for 8 months. On her return, she had conceived naturally and was in the first trimester of pregnancy. Further management was postponed until the patient was 7 weeks postnatal. The patient was not keen on any further surgical management and opted for close surveillance with ultrasound scans and hysteroscopies with endometrial biopsies. All subsequent endometrial biopsies showed normal endometrium, with no evidence of hyperplasia or malignancy.OutcomeTo date, the patient remains on a 6-monthly surveillance plan and is considered to have had complete natural remission of her endometrial and ovarian cancers following pregnancy.ConclusionThis unique case demonstrates a natural phenomenon, in which the complete, natural remission of endometrial and ovarian cancers occurred following pregnancy and childbirth. The aetiology may be related to the high progesterone levels occurring in pregnancy.
Collapse
|
15
|
Cui P, Cong X, Zhang Y, Zhang H, Liu Z. Endometrial clear cell carcinoma: A population-based study. Front Oncol 2022; 12:961155. [DOI: 10.3389/fonc.2022.961155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundA systematic analysis of prognostic factors concerning endometrial clear cell carcinoma (ECCC) is lacking. The current study aimed to construct nomograms predicting the overall survival (OS) of ECCC patients.MethodsWe performed a retrospective study, and predicted nomograms for 3-, 5-, and 10-year OS were established. The nomograms were verified with the consistency index (C-index), calibration curve, and decision curve analysis (DCA).ResultsA total of 1778 ECCC patients, 991 from FIGO stage I/II and 787 from FIGO stage III/IV, were included in this study. The age at diagnosis, marital status, T stage, tumor size, and surgery-independent prognostic factors in FIGO stage I/II, and the age at diagnosis, T stage, lymph node involvement, distant metastasis, tumor size, surgery, radiotherapy, and chemotherapy in FIGO stage III/IV were independent prognostic factors. The C-indexes of the training and validation group were 0.766 and 0.697 for FIGO stage I/II and 0.721 and 0.708 for FIGO stage III/IV, respectively. The calibration curve revealed good agreement between nomogram-predicted and actual observation values. The DCA established that nomograms had better clinical benefits than the traditional FIGO stage.ConclusionsThe predicted nomograms showed good accuracy, excellent discrimination ability, and clinical benefits, depicting their usage in clinical practice.
Collapse
|
16
|
Manning-Geist BL, Rios-Doria E, Aviki EM, Zhou Q, Iasonos A, Abu-Rustum NR, Brown CL, Mueller JJ. Demographic shifts associated with implementation of evidence-based guidelines for ovarian conservation in patients with endometrioid endometrial cancer. Int J Gynecol Cancer 2022; 32:ijgc-2022-003661. [PMID: 35831030 PMCID: PMC10428184 DOI: 10.1136/ijgc-2022-003661] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE In 2018, evidence-based surgical guidelines were introduced to identify appropriate patients with low-grade endometrioid endometrial cancer for ovarian conservation. We sought to identify trends and demographic shifts associated with guideline implementation. METHODS We identified women treated for endometrioid endometrial cancer at our institution from January 2010 to June 2021. Eligibility criteria included age ≤50 years, normal-appearing ovaries on preoperative imaging, no family history of hereditary breast and ovarian cancer syndrome or Lynch syndrome, and no hormone receptor-positive malignancy. Trends in ovarian conservation were examined with the Cochran-Armitage trend test or in a logistic regression model. Associations between ovarian conservation and clinicodemographic factors before and after guideline implementation were compared using Wilcoxon rank-sum and Fisher's exact tests. RESULTS Of 420 women ≤50 years of age undergoing surgery for endometrioid endometrial cancer, 355 (85%) met the criteria for ovarian conservation-267 (75%) before and 88 (25%) after guideline implementation. Median patient age was 45 years (range 25-50); 62% were non-Hispanic White, 10% Hispanic White, 8% non-Hispanic Black, 0% Hispanic Black, and 20% Asian. Patients were significantly more likely to choose ovarian conservation after (48%) compared with before guideline implementation (21%) (p<0.001). Pre-guidelines, non-Hispanic White women were less likely to elect for ovarian conservation (12%) compared with non-Hispanic Black, Asian, or Hispanic White women (28%) (p=0.002). Similarly, older women were less likely to elect for ovarian conservation compared with younger women (p<0.001). There were no differences by obesity (p=0.68), marital status (p=0.86), or insurance (p=0.89). Post-guidelines, there were no differences in ovarian conservation between non-Hispanic White women (36%) and non-Hispanic Black, Asian, or Hispanic White women (50%) (p=0.56). Older women were still less likely to elect for ovarian conservationcompared with younger women (p<0.001). CONCLUSIONS After guideline implementation, ovarian conservation increased and uptake disparities across demographic groups decreased.
Collapse
Affiliation(s)
- Beryl L Manning-Geist
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Eric Rios-Doria
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Emeline M Aviki
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Qin Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Carol L Brown
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Jennifer J Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
17
|
Ran X, Hu T, Li Z. Molecular Classification in Patients With Endometrial Cancer After Fertility-Preserving Treatment: Application of ProMisE Classifier and Combination of Prognostic Evidence. Front Oncol 2022; 12:810631. [PMID: 35664732 PMCID: PMC9160735 DOI: 10.3389/fonc.2022.810631] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/14/2022] [Indexed: 12/21/2022] Open
Abstract
The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) is a molecular classification system that identifies endometrial cancer (EC) into four prognostically distinct subtypes: POLE-mutated, mismatch repair deficiency (MMR-D), p53 wild-type (p53wt), and p53 abnormal (p53abn). However, few reports have applied the ProMisE classifier to EC patients who underwent fertility-preserving treatment (FPT) so far. This study evaluated whether the ProMisE classifier predicted in early-stage EC patients after FPT. We first summarized the three reported outcomes of ProMisE applied to EC patients who received FPT. The hormone-treated patients with EC from 2010 to 2020 in our facility were then analyzed. By sequential immunohistochemistry and Sanger sequencing of POLE according to the ProMisE system, formalin-fixed paraffin-embedded blocks of patients before treatment were collected and classified into POLE-mutated, MMR-D, p53wt, and p53abn subtypes. The primary outcome was a complete response rate after FPT. Thirteen patients were enrolled from our facility, with 3 (3/13) MMR-D, 0 (0/13) POLE, 8 (8/13) p53wt, 1 (1/13) p53abn, and 1 (1/13) failed with DNA amplification. Six (6/8) patients with p53wt, 2 (2/3) patients with MMR-D, and 1 (1/1) patient with p53abn achieved a complete response in 6 months after treatment. The results of our study and the reported outcomes were finally combined. A total of 106 patients who underwent FPT were included. Of these, 23 (21.7%) were classified as MMR-D, 3 (2.8%) as POLE-mutated, 3 (2.8%) as p53abn, and 77 (72.6%) as p53wt. There was no significant difference in the complete response rate (P = 0.152) and recurrence rate (P = 0.174) between MMR-D and p53wt subtypes after FPT. Based on current data, we observed no prognostic significance of the ProMisE classifier in EC patients who underwent FPT. Larger prospective studies are needed to elucidate the precise prognostic meaning of this molecular classifier in these cases.
Collapse
Affiliation(s)
- Xuting Ran
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Tingwenyi Hu
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| |
Collapse
|
18
|
Applications of Photodynamic Therapy in Endometrial Diseases. Bioengineering (Basel) 2022; 9:bioengineering9050226. [PMID: 35621504 PMCID: PMC9138084 DOI: 10.3390/bioengineering9050226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Photodynamic therapy (PDT) is a medical procedure useful for several benign conditions (such as wound healing and infections) and cancer. PDT is minimally invasive, presents few side effects, good scaring, and is able to minimal tissue destruction maintaining organ anatomy and function. Endoscopic access to the uterus puts PDT in the spotlight for endometrial disease treatment. This work systematically reviews the current evidence of PDT’s potential and usefulness in endometrial diseases. Thus, this narrative review focused on PDT applications for endometrial disease, including reports regarding in vitro, ex vivo, animal, and clinical studies. Cell lines and primary samples were used as in vitro models of cancer, adenomyosis and endometrioses, while most animal studies focused the PDT outcomes on endometrial ablation. A few clinical attempts are known using PDT for endometrial ablation and cancer lesions. This review emphasises PDT as a promising field of research. This therapeutic approach has the potential to become an effective conservative treatment method for endometrial benign and malignant lesions. Further investigations with improved photosensitisers are highly expected.
Collapse
|
19
|
Sahin EA, Toprak S, Sayal HB, Ekinci T, Yılmaz E, Bakay K, Melekoğlu R, Sezgin B, Tohma YA, Şahin H. Analysis of prognostic factors in Grade 3 endometrioid type endometrial carcinoma. Int J Gynaecol Obstet 2022; 159:719-726. [PMID: 35598153 DOI: 10.1002/ijgo.14277] [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: 01/18/2022] [Revised: 04/25/2022] [Accepted: 05/17/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the prognostic factors of patients with Grade 3 endometrioid endometrial cancer (G3EEC). METHODS This four-center, retrospective study included a total of 129 women with G3EEC. Demographic, clinicopathologic, and survival data were collected. Kaplan-Meier method was used for survival analysis. Predictors of outcome were analyzed using Cox proportional hazards models. RESULTS Median age at the time of diagnosis was 63 (range 39-87) years and median follow up was 37 (range 6-126) months. For the entire cohort, the 5-year disease-free survival (DFS) and overall survival (OS) were 54.3% and 63.6%, respectively. The 5-year DFS rates for lymphovascular space invasion (LVSI) -positive and -negative patients were 41.6% and 88.3%, respectively (P < 0.001). The 5-year OS rates for LVSI-positive and -negative patients were 54.7% and 88.3%, respectively (P = 0.001). Positive LVSI status was identified as the independent prognostic factor for decreased DFS and OS (hazard ratio [HR] 5.5, 95% confidence interval [CI] 1.65-18.86; P = 0.006 versus HR 4.4, 95% CI 1.33-14.58; P = 0.013, respectively). CONCLUSION LVSI seems to be an independent prognostic factor for decreased DFS and OS in G3EEC patients.
Collapse
Affiliation(s)
- Eda Adeviye Sahin
- Department of Obstetrics and Gynecology, Kolan international Hospital, Istanbul, Turkey
| | - Serhat Toprak
- Department of Pathology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Hasan Berkan Sayal
- Department of Obstetrics and Gynecology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Tekin Ekinci
- Department of Obstetrics and Gynecology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Ercan Yılmaz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Kadir Bakay
- Department of Obstetrics and Gynecology, Faculty of Medicine, 19 Mayıs University, Samsun, Turkey
| | - Rauf Melekoğlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Burak Sezgin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Yusuf Aytaç Tohma
- Department of Obstetrics and Gynecology, Bahçeci Health Group, Ankara, Turkey
| | - Hanifi Şahin
- Department of Gynecologic Oncology, Privata Clinic, Istanbul, Turkey
| |
Collapse
|
20
|
Njoku K, Barr CE, Crosbie EJ. Current and Emerging Prognostic Biomarkers in Endometrial Cancer. Front Oncol 2022; 12:890908. [PMID: 35530346 PMCID: PMC9072738 DOI: 10.3389/fonc.2022.890908] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 12/19/2022] Open
Abstract
Endometrial cancer is the most common gynaecological malignancy in high income countries and its incidence is rising. Whilst most women with endometrial cancer are diagnosed with highly curable disease and have good outcomes, a significant minority present with adverse clinico-pathological characteristics that herald a poor prognosis. Prognostic biomarkers that reliably select those at greatest risk of disease recurrence and death can guide management strategies to ensure that patients receive appropriate evidence-based and personalised care. The Cancer Genome Atlas substantially advanced our understanding of the molecular diversity of endometrial cancer and informed the development of simplified, pragmatic and cost-effective classifiers with prognostic implications and potential for clinical translation. Several blood-based biomarkers including proteins, metabolites, circulating tumour cells, circulating tumour DNA and inflammatory parameters have also shown promise for endometrial cancer risk assessment. This review provides an update on the established and emerging prognostic biomarkers in endometrial cancer.
Collapse
Affiliation(s)
- Kelechi Njoku
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Stoller Biomarker Discovery Centre, University of Manchester, Manchester, United Kingdom
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester, University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Chloe E. Barr
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester, University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Emma J. Crosbie
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester, University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- *Correspondence: Emma J. Crosbie,
| |
Collapse
|
21
|
Endometrial Cancer Management in Young Women. Cancers (Basel) 2022; 14:cancers14081922. [PMID: 35454829 PMCID: PMC9033146 DOI: 10.3390/cancers14081922] [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: 02/04/2022] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023] Open
Abstract
Endometrial cancer (EC) rarely develops in young women. Most cases are associated with known risk factors: BMI > 30, history of Polycystic Ovary Syndrome (PCOs), and race differentiation. The molecular EC classification based on The Cancer Genome Atlas Research Network divides these heterogeneous cancers into four types: Polymerase Epsilon Mutation (POLE), Microsatellite Instability (MSI), Copy Number Low (CNL), and Copy Number High (CNH). This division was introduced to allow for early assessment of neoplastic changes and clinical management, including targeted therapies. The basic technique for imaging endometrium changes is transvaginal sonography. Hysteroscopy is the standard for obtaining endometrial material for histological evaluation. The MRI result permits assessment of the extent of EC cancer infiltration. In young women who want to preserve fertility, apart from surgery, conservative management is often implemented after strict selection based on clinical and pathological data. This pharmacological treatment involves the administration of progestogens MPA (medroxyprogesterone acetate) and MA (megestrol acetate). The use of metformin may increase the effectiveness of such treatment. An alternative option is to apply progestogens locally—via the levonorgestrel-releasing intrauterine device. In addition to pharmacological treatment, hysteroscopic resection may be used—part of the uterine muscle adjacent to the pathologically changed endometrium may also undergo resection. An alternative is the administration of estrogen receptor modulators (e.g., SERMs) or aromatase inhibitors, or GnRH agonists.
Collapse
|
22
|
The Pattern of Recurrence in Carcinoma Endometrium. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00595-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Brennan A, Rees M. Menopausal hormone therapy in women with benign gynaecological conditions and cancer. Best Pract Res Clin Endocrinol Metab 2021; 35:101575. [PMID: 34686433 DOI: 10.1016/j.beem.2021.101575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The efficacy of menopausal hormone therapy for bothersome menopausal symptoms is well established. However, there are a range of benign and malignant gynaecological conditions that pose a challenge in managing menopausal symptoms. Their hormone-dependent nature either raises concerns about symptom recurrence or malignant disease progression making decisions about menopausal hormone therapy complex for both clinicians and patients. It appears there is a small potential for symptom recurrence with menopausal hormone therapy use in menopausal women with a history of severe endometriosis. Malignant transformation of previous endometriotic lesions is likely to be rare but is not adequately understood. In this setting, combined hormone therapy is preferred, including in woman post-hysterectomy. Uterine fibroids are not a contraindication to menopausal hormone therapy use but women with large fibroids at menopause should have regular follow-up of their fibroids. Generally, menopausal hormone therapy is considered appropriate for women with cervical cancer and most ovarian cancers except for low grade serous tumours. Endometrial cancer requires an individualised discussion. The overall quality of data in this area is poor but suggests women with a low risk of recurrence may consider hormonal therapy, balancing symptom impact with prognosis.
Collapse
|
24
|
The use of menopausal hormone therapy after cancer. Best Pract Res Clin Obstet Gynaecol 2021; 81:22-30. [PMID: 34920970 DOI: 10.1016/j.bpobgyn.2021.11.005] [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: 09/26/2021] [Revised: 10/18/2021] [Accepted: 11/07/2021] [Indexed: 11/20/2022]
Abstract
The changing landscape of gynaecological and breast cancers has involved the development of more targeted and effective therapies, and improved survival. Ultimately, these changes result in an increasing number of women surviving their cancer diagnosis, with increasing emphasis on quality-of-life issues by following treatments. Many of these women experience severe menopausal symptoms associated with cancer treatments, but the hormonal nature of many gynaecological and breast cancers complicates the effective management of these symptoms. Generally, there is a paucity of high-quality data directly examining the safety of menopausal hormone therapy (MHT) following many female cancers, and more research is needed with long term follow-up to ensure the provision of comprehensive, patient-focussed care. This article aims to synthesise and evaluate the current evidence to provide comprehensive yet accessible information to clinicians to help guide treatment decisions about the use of MHT in women, who have experienced, or are at increased risk of, both gynaecological and breast cancers. These treatment decisions should often be made in a multi-disciplinary setting which encourages shared decision-making with patients.
Collapse
|
25
|
Della Corte L, Vitale SG, Foreste V, Riemma G, Ferrari F, Noventa M, Liberto A, De Franciscis P, Tesarik J. Novel diagnostic approaches to intrauterine neoplasm in fertile age: sonography and hysteroscopy. MINIM INVASIV THER 2021; 30:288-295. [PMID: 34218728 DOI: 10.1080/13645706.2021.1941119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endometrial carcinoma (EC) is the most common gynecological malignancy in the world. It is mostly detected in postmenopausal women, but it can also occur in women of fertile age who need fertility-sparing therapy. An early diagnosis is the main objective for the correct management of these patients, making it possible to use a fertility-sparing treatment approach without exposing the patients to the risk of cancer progression. In this review, we discuss the role of sonography and hysteroscopy in the detection of intrauterine neoplasm in women of childbearing age.
Collapse
Affiliation(s)
- Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Salvatore Giovanni Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Virginia Foreste
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Federico Ferrari
- Department of Obstetrics and Gynecology, Spedali Civili of Brescia, Brescia, Italy
| | - Marco Noventa
- Department of Women and Children's Health, Unit of Gynecology and Obstetrics, University of Padua, Padua, Italy
| | - Aldo Liberto
- Legal Medicine, Department of Medical, Surgical and Advanced Technologies, "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Jan Tesarik
- Molecular Assisted Reproduction and Genetics, MARGen Clinic, Granada, Spain
| |
Collapse
|
26
|
Fertility-Sparing Surgery in Gynecologic Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13051008. [PMID: 33670929 PMCID: PMC7975326 DOI: 10.3390/cancers13051008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
Fertility-sparing surgery (FSS) is increasingly being offered to women with a gynecological malignancy who wish to preserve fertility. In this systematic review, we evaluate the best evidence currently available on oncological and reproductive outcome after FSS for early stage cervical cancer, epithelial ovarian cancer, and endometrial cancer. An extensive literature search was conducted using the electronic databases Medline (OVID), Embase, and Cochrane Library to identify eligible studies published up to December 2020. In total, 153 studies were included with 7544, 3944, and 1229 patients who underwent FSS for cervical, ovarian, and endometrial cancer, respectively. We assessed the different FSS techniques that are available to preserve fertility, i.e., omitting removal of the uterine body and preserving at least one ovary. Overall, recurrence rates after FSS are reassuring and therefore, these conservative procedures seem oncologically safe in the current selection of patients with low-stage and low-grade disease. However, generalized conclusions should be made with caution due to the methodology of available studies, i.e., mostly retrospective cohort studies with a heterogeneous patient population, inducing selection bias. Moreover, about half of patients do not pursue pregnancy despite FSS and the reasons for these decisions have not yet been well studied. International collaboration will facilitate the collection of solid evidence on FSS and the related decision-making process to optimize patient selection and counseling.
Collapse
|
27
|
Garzon S, Uccella S, Zorzato PC, Bosco M, Franchi MP, Student V, Mariani A. Fertility-sparing management for endometrial cancer: review of the literature. Minerva Med 2020; 112:55-69. [PMID: 33205638 DOI: 10.23736/s0026-4806.20.07072-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Primary surgery is effective in low-risk endometrial cancer (EC). However, in young women, this approach compromises fertility. Therefore, fertility-sparing management in the case of atypical endometrial hyperplasia, or grade 1 EC limited to the endometrium can be considered. EVIDENCE ACQUISITION We performed a literature review to identify studies involving women with EC or atypical hyperplasia who underwent fertility-sparing management. We conducted multiple bibliographic databases research from their inception to May 2020. EVIDENCE SYNTHESIS Oral therapy with medroxyprogesterone acetate and megestrol acetate is recommended based on extensive experience, although without consensus on dosages and treatment length. The pooled complete response rate, recurrence rate, and pregnancy rate of EC were 76.3%, 30.7% and 52.1%, respectively. Endometrial hyperplasia was associated with better outcomes. LNG-IUSs appears an alternative treatment, particularly in patients who do not tolerate oral therapy. In a randomized controlled trial, megestrol acetate plus metformin guaranteed an earlier complete response rate than megestrol acetate alone for endometrial hyperplasia. Hysteroscopic resection followed by progestogens is associated with a higher complete response rate, live birth rate, and lower recurrence rate than oral progestogens alone. Pooled complete response, recurrence, and live birth rates were 98.1%, 4.8% and 52.6%. CONCLUSIONS Fertility preservation appears feasible in young patients with grade 1 EC limited to the endometrium or atypical endometrial hyperplasia. Progestins are the mainstay of such management. The addition of Metformin and hysteroscopic resection seems to provide some improvements. However, fertility preservation is not the standard approach for staging and treatment, potentially worsening oncologic outcomes.
Collapse
Affiliation(s)
- Simone Garzon
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, MN, USA -
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Massimo P Franchi
- Department of Obstetrics and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Vladimir Student
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, MN, USA
| |
Collapse
|
28
|
Brennan A, Brennan D, Rees M, Hickey M. Management of menopausal symptoms and ovarian function preservation in women with gynecological cancer. Int J Gynecol Cancer 2020; 31:352-359. [PMID: 33127864 DOI: 10.1136/ijgc-2020-002032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
Gynecological cancers affect a growing number of women globally, with approximately 1.3 million women diagnosed in 2018. Menopausal symptoms are a significant health concern after treatment for gynecological cancers and may result from oncologic treatments such as premenopausal bilateral oophorectomy, ovarian failure associated with chemotherapy or radiotherapy, and anti-estrogenic effects of maintenance endocrine therapy. Additionally, with the growing availability of testing for pathogenic gene variants such as BRCA1/2 and Lynch syndrome, there is an increasing number of women undergoing risk-reducing oophorectomy, which in most cases will be before age 45 years and will induce surgical menopause. Not all menopausal symptoms require treatment, but patients with cancer may experience more severe symptoms compared with women undergoing natural menopause. Moreover, there is increasing evidence of the long-term implications of early menopause, including bone loss, cognitive decline and increased cardiovascular risk. Systemic hormone therapy is well established as the most effective treatment for vasomotor symptoms and vaginal (topical) estrogen therapy is effective for genitourinary symptoms. However, the role of hormone receptors in many gynecological cancers and their treatment pose a challenge to the management of menopausal symptoms after cancer. Consequently, the use of menopausal hormone therapy in this setting can be difficult for clinicians to navigate and this article aims to provide current, comprehensive guidance for the use of menopausal hormone replacement therapy in women who have had, or are at risk of developing, gynecological cancer to assist with these treatment decisions.
Collapse
Affiliation(s)
| | - Donal Brennan
- Gynaecology Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Martha Hickey
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|