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de Almeida BC, dos Anjos LG, Dobroff AS, Baracat EC, Yang Q, Al-Hendy A, Carvalho KC. Epigenetic Features in Uterine Leiomyosarcoma and Endometrial Stromal Sarcomas: An Overview of the Literature. Biomedicines 2022; 10:2567. [PMID: 36289829 PMCID: PMC9599831 DOI: 10.3390/biomedicines10102567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
There is a consensus that epigenetic alterations play a key role in cancer initiation and its biology. Studies evaluating the modification in the DNA methylation and chromatin remodeling patterns, as well as gene regulation profile by non-coding RNAs (ncRNAs) have led to the development of novel therapeutic approaches to treat several tumor types. Indeed, despite clinical and translational challenges, combinatorial therapies employing agents targeting epigenetic modifications with conventional approaches have shown encouraging results. However, for rare neoplasia such as uterine leiomyosarcomas (LMS) and endometrial stromal sarcomas (ESS), treatment options are still limited. LMS has high chromosomal instability and molecular derangements, while ESS can present a specific gene fusion signature. Although they are the most frequent types of "pure" uterine sarcomas, these tumors are difficult to diagnose, have high rates of recurrence, and frequently develop resistance to current treatment options. The challenges involving the management of these tumors arise from the fact that the molecular mechanisms governing their progression have not been entirely elucidated. Hence, to fill this gap and highlight the importance of ongoing and future studies, we have cross-referenced the literature on uterine LMS and ESS and compiled the most relevant epigenetic studies, published between 2009 and 2022.
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Affiliation(s)
- Bruna Cristine de Almeida
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), São Paulo 05403-010, Brazil
| | - Laura Gonzalez dos Anjos
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), São Paulo 05403-010, Brazil
| | - Andrey Senos Dobroff
- UNM Comprehensive Cancer Center (UNMCCC), University of New Mexico, Albuquerque, NM 87131, USA
- Division of Molecular Medicine, Department of Internal Medicine, (UNM) School of Medicine, UNM Health Sciences Center, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Edmund Chada Baracat
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), São Paulo 05403-010, Brazil
| | - Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA
| | - Katia Candido Carvalho
- Laboratório de Ginecologia Estrutural e Molecular (LIM 58), Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), São Paulo 05403-010, Brazil
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2
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Chapel DB, Sharma A, Lastra RR, Maccio L, Bragantini E, Zannoni GF, George S, Quade BJ, Parra-Herran C, Nucci MR. A novel morphology-based risk stratification model for stage I uterine leiomyosarcoma: an analysis of 203 cases. Mod Pathol 2022; 35:794-807. [PMID: 35121810 DOI: 10.1038/s41379-022-01011-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/23/2022]
Abstract
Uterine leiomyosarcoma is the most common uterine mesenchymal malignancy. The majority present at stage I, and clinical outcomes vary widely. However, no widely accepted risk stratification system for stage I uterine leiomyosarcoma is currently available. We studied 17 routinely evaluated clinicopathologic parameters in 203 stage I uterine leiomyosarcoma from three institutions to generate a novel risk stratification model for these tumors. Mitoses >25 per 2.4 mm2 (10 high-power fields), atypical mitoses, coagulative necrosis, lymphovascular invasion, and serosal abutment were significantly associated with disease-free and disease-specific survival in univariate and multivariate analyses. These prognostic parameters were each scored as binary ("yes" or "no") variables and fitted to a single optimized algebraic risk model:Risk score = (coagulative necrosis)(1) + (mitoses > 25 per 2.4 mm2)(2) + (atypical mitoses)(2) + (lymphovascular invasion)(3) + (serosal abutment)(5)By logistic regression, the risk model was significantly associated with 5-year disease-free (AUC = 0.9270) and 5-year disease-specific survival (AUC = 0.8517). Internal and external validation substantiated the model. The continuous score (range, 0-13) was optimally divided into 3 risk groups with distinct 5-year disease-free and disease-specific survival: low risk (0-2 points), intermediate risk (3-5 points), and high risk (6-13 points) groups. Our novel risk model performed significantly better than alternative uterine leiomyosarcoma risk stratification systems in predicting 5-year disease-free and disease-specific survival in stage I tumors. A simplified risk model, omitting terms for serosal abutment and lymphovascular invasion, can be accurately applied to myomectomy or morcellated specimens. We advocate routine application of this novel risk model in stage I uterine leiomyosarcoma to facilitate patient counseling and proper risk stratification for clinical trials.
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Affiliation(s)
- David B Chapel
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
- Department of Pathology, University of Michigan - Michigan Medicine, Ann Arbor, MI, 48109, USA.
| | - Aarti Sharma
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
- Department of Pathology, University of Chicago Medicine, Chicago, IL, 60637, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago Medicine, Chicago, IL, 60637, USA
| | - Livia Maccio
- Unit of Surgical Pathology, S. Chiara Hospital, Trient, Italy
| | - Emma Bragantini
- Unit of Surgical Pathology, S. Chiara Hospital, Trient, Italy
| | | | - Suzanne George
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Bradley J Quade
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Carlos Parra-Herran
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Marisa R Nucci
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
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Kang CW, Hannan KM, Blackburn AC, Loh AHP, Hong KC, Yuan GJ, Hein N, Drygin D, Hannan RD, Coupland LA. The therapeutic potential of RNA Polymerase I transcription inhibitor, CX-5461, in uterine leiomyosarcoma. Invest New Drugs 2022; 40:529-536. [PMID: 35201535 PMCID: PMC9098598 DOI: 10.1007/s10637-022-01222-w] [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: 09/28/2021] [Accepted: 02/07/2022] [Indexed: 12/01/2022]
Abstract
Background. Uterine leiomyosarcoma is a rare aggressive smooth muscle cancer with poor survival rates. RNA Polymerase I (Pol I) activity is elevated in many cancers supporting tumour growth and prior studies in uterine leiomyosarcoma revealed enlarged nucleoli and upregulated Pol I activity-related genes. This study aimed to investigate the anti-tumour potential of CX-5461, a Pol I transcription inhibitor currently being evaluated in clinical trials for several cancers, against the human uterine leiomyosarcoma cell line, SK-UT-1. Methods. SK-UT-1 was characterised using genome profiling and western blotting. The anti-tumour effects of CX-5461 were investigated using cell proliferation assays, expression analysis using qRT-PCR, and BrdU/PI based cell cycle analysis. Results. Genetic analysis of SK-UT-1 revealed mutations in TP53, RB1, PTEN, APC and TSC1 & 2, all potentially associated with increased Pol I activity. Protein expression analysis showed dysregulated p53, RB1 and c-Myc. CX-5461 treatment resulted in an anti-proliferation response, G2 phase cell-cycle arrest and on-target activity demonstrated by reduced ribosomal DNA transcription. Conclusions. SK-UT-1 was confirmed as a representative model of uterine leiomyosarcoma and CX-5461 has significant potential as a novel adjuvant for this rare cancer.
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Affiliation(s)
- Chang-Won Kang
- ACRF Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
| | - Katherine M Hannan
- ACRF Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia.,Department of Biochemistry and Molecular Biology, University of Melbourne, Parkville, 3010, Australia
| | - Anneke C Blackburn
- ACRF Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
| | - Amos H P Loh
- VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, Bukit Timah, Singapore
| | - Kuick Chik Hong
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Bukit Timah, Singapore
| | - Goh Jian Yuan
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Bukit Timah, Singapore
| | - Nadine Hein
- ACRF Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
| | - Denis Drygin
- Regulus Therapeutics, 4224 Campus Point C, San Diego, CA, USA
| | - Ross D Hannan
- ACRF Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia.,Department of Biochemistry and Molecular Biology, University of Melbourne, Parkville, 3010, Australia.,Department of Biochemistry and Molecular Biology, Monash University, Clayton, 3800, Australia.,School of Biomedical Sciences, University of Queensland, 4067, St Lucia, Australia
| | - Lucy A Coupland
- ACRF Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia.
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Patel V, Rajanbabu A, Nair IR, Pillai PR, Ravindran GC. Impact of Intraoperative Tumor Spillage in Uterine Leiomyosarcoma: a Retrospective Single-Institution Analysis. Indian J Surg Oncol 2021; 12:581-586. [PMID: 34658588 DOI: 10.1007/s13193-021-01406-5] [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: 09/22/2020] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Uterine leiomyosarcoma is a rare female reproductive system tumor which is difficult to distinguish from uterine leiomyoma preoperatively. Manual and power morcellation are used to remove the large uterus through the vagina or small abdominal incision. Worse outcome with use of power morcellation is now clear but impact of manual morcellation on survival outcome not established till date. The objective of the present study was to find impact of tumor spillage and to evaluate influencing factors for oncological outcome and prognosis in uterine leiomyosarcoma patients. This is a single-institutional retrospective cohort study including all uterine leiomyosarcoma patients from January 2005 to December 2017. Role of intraoperative tumor spillage and other influencing factors on oncological outcome were assessed. Thirty-three patients with median follow-up period of 49.7 months were evaluated. Stage 1 and absence of tumor spill had significant association with prolonged progression-free survival. Stage 1 uterine leiomyosarcoma (56.8 vs 6.8 months, p = < 0.001), intraoperative tumor spillage (p = 0.03) and progression-free survival > 15 months (68.5 vs 12.2 months, p = < 0.001) were favourable prognostic factors to predict better survival outcome but unable to establish significance on multivariate analysis. Survival plot did not reach median limit for stage I uterine leiomyosarcoma patients with preoperative suspicion. Age, site of recurrence and mitotic index had no significant association with better survival in the present study. Stage I disease and absence of tumor spillage during surgery improved progression-free survival but did not affect overall survival. Progression-free survival more than 15 months can predict better overall survival.
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Affiliation(s)
- Viral Patel
- Department of Gynaecological Oncology, Amrita Institute of Medical Sciences, Kerala Kochi, 682041 India
| | - Anupama Rajanbabu
- Department of Gynaecological Oncology, Amrita Institute of Medical Sciences, Kerala Kochi, 682041 India
| | - Indu R Nair
- Department of Pathology, Amrita Institute of Medical Sciences, Kerala Kochi, 682041 India
| | - Pramod R Pillai
- Department of Pediatric Surgery, Bangalore Medical College, Karanataka Bangalore, 560002 India
| | - Greeshma C Ravindran
- Department of Biostatistics, Amrita Institute of Medical Sciences, Kerala Kochi, 682041 India
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5
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Kim HS, Nam CM, Jang SY, Choi SK, Han M, Kim S, Moneta MV, Lee SY, Cho JM, Novick D, Rha SY. Characteristics and Treatment Patterns of Patients with Advanced Soft Tissue Sarcoma in Korea. Cancer Res Treat 2019; 51:1380-1391. [PMID: 30776883 PMCID: PMC6790845 DOI: 10.4143/crt.2018.476] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 02/15/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE A soft tissue sarcoma (STS) is a rare type of cancer, accounting for 1% of adult solid cancers. The aim of the present study is to determine the incidence of localized and advanced STS in Korean patients, their treatment patterns, and the survival of patients by disease status. MATERIALS AND METHODS The STS patient cohort was defined using National Health Insurance Service medical data from 2002 to 2015. Incidence, distribution, anatomical location of tumors, survival rates (Kaplan-Meyer survival function) and treatment patterns were analyzed by applying different algorithms to the STS cohort containing localized and advanced STS cases. RESULTS A total of 7,813 patients were diagnosed with STS from 2007 to 2014, 4,307 were localized STS and 3,506 advanced STS cases. The total incidence of STS was 2.49 per 100,000 person- years: 1.37 per 100,000 person-years for localized STS and 1.12 per 100,000 person-years for advanced STS. The 5-year survival rate after diagnosis was 56.4% for all STS, 82.4% for localized, and 27.2% for advanced STS. Half of the advanced STS patients (49.98%) received anthracycline-containing chemotherapy as initial treatment after diagnosis. CONCLUSION This study provides insights into localized and advanced STS epidemiology, treatment patterns and outcomes in Korea, which could be used as fundamental data in improving clinical outcomes of STS patients in the future.
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Affiliation(s)
- Hyo Song Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Suk-Yong Jang
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Sun Kyu Choi
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Minkyung Han
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
| | - Seonmin Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Maria Victoria Moneta
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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6
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Bizzarri N, Ghirardi V, Di Fiore GLM, De Iaco P, Gadducci A, Casarin J, Perrone AM, Pasciuto T, Scambia G, Fagotti A. Secondary cytoreductive surgery in recurrent uterine leiomyosarcoma: a multi-institutional study. Int J Gynecol Cancer 2019; 29:1134-1140. [PMID: 31420411 DOI: 10.1136/ijgc-2019-000355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/29/2019] [Accepted: 06/04/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Uterine leiomyosarcoma (uLMS) represents a rare gynecological malignancy with high incidence of recurrence. Evidence in literature about the management of recurrent uLMS is limited, and the role of secondary cytoreduction has been evaluated in small and heterogeneous populations. The objective of this study is to assess the prognostic role of secondary cytoreductive surgery and its related complications in a large and homogeneous group of patients. METHODS All consecutive patients who underwent surgery for recurrent uLMS between 01/2010-01/2018 at four Italian tertiary referral centers, were included. Relevant demographic and clinico-pathologic data were retrieved. Survival curves were estimated by Kaplan-Meier method and compared by log-rank test. Cox-proportional hazard model was used to assess the effect of the most predictive prognostic variables. RESULTS 38 patients with recurrent uLMS were treated with secondary cytoreductive surgery in the study period. Recurrence presented as isolated disease in 17 (44.7%) cases. Bowel, bladder and upper abdominal surgery was performed in 50.0%, 18.4% and 28.9% of the cases, respectively. No residual tumor was the final surgical result in 35 (92.1%) patients. Median hospital stay was 7 days (range, 1-24). No women had major intra-operative and 4 (33.3%) had major post-operative complications. No patient died within 30-days from the secondary cytoreduction. Median time to the first cycle of adjuvant chemotherapy was 41-days (range, 29-78). Median recurrence-free survival was 16.0months (95%CI,11.6 to 26.1). 5-year overall survival (OS) was 76% (95%CI,53 to 89%). Time to first recurrence >12months significantly affected OS (p=0.04). DISCUSSION Secondary cytoreduction in recurrent uLMS often requires complex and extensive surgical procedures. Referral to tertiary centers guarantees low peri-operative morbidity, short length of hospitalization and median time to chemotherapy within the standard of care. Therefore, secondary cytoreduction to no residual disease is an option that may be considered in recurrent uLMS, especially in patients with time to first recurrence >12months.
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Affiliation(s)
- Nicolò Bizzarri
- Division of Gynecologic Oncology, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Valentina Ghirardi
- Division of Gynecologic Oncology, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giacomo Lorenzo Maria Di Fiore
- Division of Gynecologic Oncology, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Pierandrea De Iaco
- Department of General Surgery and Gynecologic Oncology Unit, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Emilia-Romagna, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, Universita degli Studi di Pisa, Pisa, Toscana, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, Universita degli Studi dell'Insubria, Varese, Lombardia, Italy
| | - Anna Myriam Perrone
- Department of General Surgery and Gynecologic Oncology Unit, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Tina Pasciuto
- Statistics Technology Archiving Research (STAR) Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy .,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna Fagotti
- Division of Gynecologic Oncology, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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7
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Nakamura K, Kajiyama H, Utsumi F, Suzuki S, Niimi K, Sekiya R, Sakata J, Yamamoto E, Shibata K, Kikkawa F. Secondary cytoreductive surgery potentially improves the oncological outcomes of patients with recurrent uterine sarcomas. Mol Clin Oncol 2018; 8:499-503. [PMID: 29556383 DOI: 10.3892/mco.2018.1560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 10/26/2017] [Indexed: 11/05/2022] Open
Abstract
Uterine sarcomas are some of the most malignant and aggressive tumor types among the gynecologic malignancies, and they are associated with a high rate of recurrence and a poor prognosis. Due to their rarity and diversity, the optimal treatment for recurrent uterine sarcomas has not yet been elucidated. The aim of the present study was to investigate the potential of secondary cytoreductive surgery (SCS) for patients with recurrent uterine sarcomas. A total of 18 patients with recurrent uterine sarcomas were retrospectively identified at the Department of Obstetrics and Gynecology, Nagoya University (Nagoya, Japan) between January 2002 and December 2015. This included 8 patients with leiomyosarcoma, 6 with carcinosarcoma, 3 with endometrial stromal sarcoma and 1 with adenosarcoma. All patients underwent primary debulking surgery as the initial treatment. In summary, 9 patients were treated with SCS when they experienced their first recurrence, and the other 9 patients were treated with non-SCS methods, including chemotherapy or radiotherapy. In the SCS group, 5/9 patients had confined pelvic recurrences, 3 patients had extra-pelvic diseases, including pulmonary metastasis, and one patient had intra- and extra-pelvic recurrence. The 3-year overall survival (OS) rates were 77.8 and 11.1% in the SCS and non-SCS groups, respectively. The patients who underwent SCS experienced a significantly longer OS time compared with those in the non-SCS group (P=0.006). In addition, the disease-free survival after second-line therapy was significantly longer in the SCS group than in the non-SCS group (P=0.0496). These findings suggest that resection of recurrent uterine sarcomas may be beneficial for the improvement of patient survival. Prospective studies with sufficient statistical power are warranted for further evaluation of the effect of SCS.
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Affiliation(s)
- Kenichi Nakamura
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Fumi Utsumi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Shiro Suzuki
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Kaoru Niimi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Ryuichiro Sekiya
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Jun Sakata
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Kiyosumi Shibata
- Department of Obstetrics and Gynecology, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya 454-8509, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
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8
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Saya S, Killick E, Thomas S, Taylor N, Bancroft EK, Rothwell J, Benafif S, Dias A, Mikropoulos C, Pope J, Chamberlain A, Gunapala R, Izatt L, Side L, Walker L, Tomkins S, Cook J, Barwell J, Wiles V, Limb L, Eccles D, Leach MO, Shanley S, Gilbert FJ, Hanson H, Gallagher D, Rajashanker B, Whitehouse RW, Koh DM, Sohaib SA, Evans DG, Eeles RA. Baseline results from the UK SIGNIFY study: a whole-body MRI screening study in TP53 mutation carriers and matched controls. Fam Cancer 2017; 16:433-440. [PMID: 28091804 PMCID: PMC5487773 DOI: 10.1007/s10689-017-9965-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the United Kingdom, current screening guidelines for TP53 germline mutation carriers solely recommends annual breast MRI, despite the wide spectrum of malignancies typically seen in this group. This study sought to investigate the role of one-off non-contrast whole-body MRI (WB MRI) in the screening of asymptomatic TP53 mutation carriers. 44 TP53 mutation carriers and 44 population controls were recruited. Scans were read by radiologists blinded to participant carrier status. The incidence of malignancies diagnosed in TP53 mutation carriers against general population controls was calculated. The incidences of non-malignant relevant disease and irrelevant disease were measured, as well as the number of investigations required to determine relevance of findings. In TP53 mutation carriers, 6 of 44 (13.6, 95% CI 5.2-27.4%) participants were diagnosed with cancer during the study, all of which would be considered life threatening if untreated. Two were found to have two primary cancers. Two participants with cancer had abnormalities on the MRI which were initially thought to be benign (a pericardial cyst and a uterine fibroid) but transpired to be sarcomas. No controls were diagnosed with cancer. Fifteen carriers (34.1, 95% CI 20.5-49.9%) and seven controls (15.9, 95% CI 6.7-30.1%) underwent further investigations following the WB MRI for abnormalities that transpired to be benign (p = 0.049). The cancer detection rate in this group justifies a minimum baseline non-contrast WB MRI in germline TP53 mutation carriers. This should be adopted into national guidelines for management of adult TP53 mutation carriers in addition to the current practice of contrast enhanced breast MRI imaging.
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Affiliation(s)
- Sibel Saya
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
| | - Emma Killick
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | | | - Jeanette Rothwell
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Sarah Benafif
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
| | - Alexander Dias
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
| | - Christos Mikropoulos
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
- Cancer Unit, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Jenny Pope
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
| | - Anthony Chamberlain
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
| | | | - Louise Izatt
- Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Lucy Side
- Great Ormond Street Hospital & UCL Institute for Women's Health, London, UK
| | | | - Susan Tomkins
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jackie Cook
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | | | | | | | - Diana Eccles
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Martin O Leach
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Susan Shanley
- Royal Marsden NHS Foundation Trust, London, UK
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | - Bala Rajashanker
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | - Dow-Mu Koh
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - D Gareth Evans
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Rosalind A Eeles
- The Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, London, UK.
- Royal Marsden NHS Foundation Trust, London, UK.
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Schwameis R, Grimm C, Petru E, Natter C, Staudigl C, Lamm W, Koelbl H, Krainer M, Brodowicz T, Reinthaller A, Polterauer S. The Prognostic Value of C-Reactive Protein Serum Levels in Patients with Uterine Leiomyosarcoma. PLoS One 2015; 10:e0133838. [PMID: 26248232 PMCID: PMC4527693 DOI: 10.1371/journal.pone.0133838] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 06/01/2015] [Indexed: 01/30/2023] Open
Abstract
Objective C-reactive protein (CRP) has previously been shown to serve as a prognostic parameter in women with gynecologic malignancies. Due to the lack of valid prognostic markers for uterine leiomyosarcoma (ULMS) this study set out to investigate the value of pre-treatment CRP serum levels as prognostic parameter. Methods Data of women with ULMS were extracted from databases of three Austrian centres for gynaecologic oncology. Pre-treatment CRP serum levels were measured and correlated with clinico-pathological parameters. Univariate and multivariable survival analyses were performed. Results In total, 53 patients with ULMS were included into the analysis. Mean (SD) CRP serum level was 3.46 mg/dL (3.96). Solely, an association between pre-treatment CRP serum levels and tumor size (p = 0.04) but no other clinic-pathologic parameter such as tumor stage (p = 0.16), or histological grade (p = 0.07), was observed. Univariate and multivariable survival analyses revealed that CRP serum levels (HR 2.7 [1.1–7.2], p = 0.037) and tumor stage (HR 6.1 [1.9–19.5], p = 0.002) were the only independent prognostic factors for overall survival (OS) in patients with ULMS. Patients with high pre-treatment CRP serum levels showed impaired OS compared to women with low levels (5-year-OS rates: 22.6% and 52.3%, p = 0.007). Conclusion High pre-treatment CRP serum levels were independently associated with impaired prognosis in women with ULMS and might serve as a prognostic parameter in these patients.
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Affiliation(s)
- Richard Schwameis
- Department of General Gynaecology and Gynaecological Oncology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christoph Grimm
- Department of General Gynaecology and Gynaecological Oncology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Edgar Petru
- Department of Obstetrics and Gynaecology of the Medical University of Graz, Graz, Austria
| | - Camilla Natter
- Department of General Gynaecology and Gynaecological Oncology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christine Staudigl
- Department of Gynaecology, Barmherzige Schwestern Hospital Linz, Linz, Austria
| | - Wolfgang Lamm
- Clinical Division of Oncology, Department of Medicine 1, Comprehensive Cancer Cente, Medical University Vienna, Vienna, Austria
| | - Heinz Koelbl
- Department of General Gynaecology and Gynaecological Oncology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Michael Krainer
- Clinical Division of Oncology, Department of Medicine 1, Comprehensive Cancer Cente, Medical University Vienna, Vienna, Austria
| | - Thomas Brodowicz
- Clinical Division of Oncology, Department of Medicine 1, Comprehensive Cancer Cente, Medical University Vienna, Vienna, Austria
| | - Alexander Reinthaller
- Department of General Gynaecology and Gynaecological Oncology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria
| | - Stephan Polterauer
- Department of General Gynaecology and Gynaecological Oncology, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- * E-mail:
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