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Bassette E, Ducie JA. Endometrial Cancer in Reproductive-Aged Females: Etiology and Pathogenesis. Biomedicines 2024; 12:886. [PMID: 38672240 PMCID: PMC11047839 DOI: 10.3390/biomedicines12040886] [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: 02/01/2024] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Endometrial cancer is the most common gynecologic malignancy in developed countries, and the incidence is rising in premenopausal females. Type I EC is more common than Type II EC (80% vs. 20%) and is associated with a hyperestrogenic state. Estrogen unopposed by progesterone is considered to be the main driving factor in the pathogenesis of EC. Studies show that BMI > 30 kg/m2, prolonged duration of menses, nulliparity, presence of polycystic ovarian syndrome, and Lynch syndrome are the most common causes of EC in premenopausal women. Currently, there are no guidelines established to indicate premenopausal patients who should be screened. This review aims to synthesize current data on the etiology, risk factors, presentation, evaluation, and prognosis of endometrial cancer in this population.
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Affiliation(s)
- Emma Bassette
- Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, NE 68178, USA;
| | - Jennifer A. Ducie
- Methodist Gynecology Oncology, Nebraska Methodist Hospital, Omaha, NE 68114, USA
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2
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Han M, Wang N, Han W, Liu X, Sun T, Xu J. Highly specific vaginal microbiome signature for gynecological cancers. Open Life Sci 2024; 19:20220850. [PMID: 38633411 PMCID: PMC11022122 DOI: 10.1515/biol-2022-0850] [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: 09/22/2023] [Revised: 12/03/2023] [Accepted: 03/08/2024] [Indexed: 04/19/2024] Open
Abstract
To investigate the vaginal microbiota signature of patients with gynecologic cancer and evaluate its diagnostic biomarker potential. We incorporated vaginal 16S rRNA-seq data from 529 women and utilized VSEARCH to analyze the raw data. α-Diversity was evaluated utilizing the Chao1, Shannon, and Simpson indices, and β-diversity was evaluated through principal component analysis using Bray-Curtis distances. Linear discriminant analysis effect size (LEfSe) was utilized to determine species differences between groups. A bacterial co-abundance network was constructed utilizing Spearman correlation analysis. A random forest model of gynecologic tumor risk based on genus was constructed and validated to test its diagnostic efficacy. In gynecologic cancer patients, vaginal α-diversity was significantly greater than in controls, and vaginal β-diversity was significantly separated from that of controls; there was no correlation between these characteristics and menopause status among the subject women. Women diagnosed with gynecological cancer exhibited a reduction in the abundance of vaginal Firmicutes and Lactobacillus, while an increase was observed in the proportions of Bacteroidetes, Proteobacteria, Prevotella, Streptococcus, and Anaerococcus. A random forest model constructed based on 56 genus achieved high accuracy (area under the curve = 84.96%) in gynecological cancer risk prediction. Furthermore, there were discrepancies observed in the community complexity of co-abundance networks between gynecologic cancer patients and the control group. Our study provides evidence that women with gynecologic cancer have a unique vaginal flora structure and microorganisms may be involved in the gynecologic carcinogenesis process. A gynecological cancer risk prediction model based on characteristic genera has good diagnostic value.
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Affiliation(s)
- Mengzhen Han
- Department of Breast Medicine 1, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang110000, China
| | - Na Wang
- Department of Breast Medicine 1, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang110000, China
| | - Wenjie Han
- Department of Breast Medicine 1, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang110000, China
| | - Xiaolin Liu
- Liaoning Microhealth Biotechnology Co., Ltd, Shanlin Road, Dadong District, Shenyang110000, China
| | - Tao Sun
- Department of Breast Medicine 1, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, Liaoning110000, China
| | - Junnan Xu
- Department of Breast Medicine 1, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital and Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, Liaoning110000, China
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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.
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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.)
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Shen Y, Li L, Wang H, Hu Y, Deng X, Lian X, Tan Y, Liang L, Zhang Y, Yang W. Triage method for endometrial biopsy in postmenopausal women: a multicenter retrospective cohort study. Menopause 2023; 30:1206-1212. [PMID: 38019035 DOI: 10.1097/gme.0000000000002271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To identify the optimal triage procedure for endometrial biopsies in postmenopausal women. METHODS The clinical information of 470 postmenopausal women with endometrial biopsy results and postmenopausal bleeding (PMB) and/or transvaginal ultrasonography (TVU) abnormalities were collected at the gynecology departments of four general hospitals from March 2021 to March 2022. In the validation cohort, 112 women with TVU abnormalities who underwent endometrial biopsy at Xiangya hospital between May 2022 and May 2023 were enrolled. The endpoint was the final diagnosis based on hysteroscopy reports and biopsy pathology results. The sensitivity, specificity, positive predictive value, and negative predictive value were compared among the three triage methods. A nomogram prediction model was developed and validated. RESULTS Referring women with TVU abnormalities for endometrial biopsy identified 100% malignant/premalignant lesions despite low specificity (19.7%). Among women with measurable endometrial thickness (ET), we suggest that the ET cutoff value for biopsy referral should be ≥4 mm. The PMB (odds ratio [OR], 3.241; 95% confidence interval [CI], 1.073-9.789), diabetes (OR, 10.915; 95% CI, 3.389-35.156), and endometrial thickness (OR, 1.277; 95% CI, 1.156-1.409) were independent predictive factors for endometrial (pre)malignancy. A nomogram prediction model was constructed (area under curve [AUC] = 0.802, 95% CI: 0.715 to 0.889). The ideal cutoff point was 22.5, with a sensitivity of 100.0% and a specificity of 15.7%. The external validation achieved an AUC of 0.798 (95% CI, 0.685-0.911). CONCLUSIONS It was possible to refer all postmenopausal women with TVU abnormity (ET ≥ 4 mm or other abnormal findings) for endometrial biopsy. Among women with TVU abnormalities, a nomogram was constructed, and a score greater than 22.5 suggested the need for referral for endometrial biopsy, while a score less than 22.5 suggested that regular follow-up was required, further improving the triage procedure.
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Affiliation(s)
- Yufei Shen
- From the Department of Gynecology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lucia Li
- From the Department of Gynecology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hailong Wang
- Department of Gynecology, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, Hunan, China
| | - Yi Hu
- Department of Gynecology, Xiangdong Hospital Affiliated to Hunan Normal University, Liling, Hunan, China
| | - Xi Deng
- Department of Gynecology, Xiangya Changde Hospital, Changde, Hunan, China
| | - Xiaoling Lian
- Department of Gynecology, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, Hunan, China
| | - Yanlin Tan
- Department of Gynecology, Xiangdong Hospital Affiliated to Hunan Normal University, Liling, Hunan, China
| | - Liling Liang
- Department of Gynecology, Xiangya Changde Hospital, Changde, Hunan, China
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Zhang X, Huangfu Z, Wang S. Review of mendelian randomization studies on age at natural menopause. Front Endocrinol (Lausanne) 2023; 14:1234324. [PMID: 37766689 PMCID: PMC10520463 DOI: 10.3389/fendo.2023.1234324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Menopause marks the end of the reproductive phase of life. Based on epidemiological studies, abnormal age at natural menopause (ANM) is thought to contribute to a number of adverse outcomes, such as osteoporosis, cardiovascular disease, and cancer. However, the causality of these associations remains unclear. A powerful epidemiological method known as Mendelian randomization (MR) can be used to clarify the causality between ANM and other diseases or traits. The present review describes MR studies that included ANM as an exposure, outcome and mediator. The findings of MR analyses on ANM have revealed that higher body mass index, poor educational level, early age at menarche, early age at first live birth, early age at first sexual intercourse, and autoimmune thyroid disease appear to be involved in early ANM etiology. The etiology of late ANM appears to be influenced by higher free thyroxine 4 and methylene tetrahydrofolate reductase gene mutations. Furthermore, early ANM has been found to be causally associated with an increased risk of osteoporosis, fracture, type 2 diabetes mellitus, glycosylated hemoglobin, and the homeostasis model of insulin resistance level. In addition, late ANM has been found to be causally associated with an increased systolic blood pressure, higher risk of breast cancer, endometrial cancer, endometrioid ovarian carcinoma, lung cancer, longevity, airflow obstruction, and lower risk of Parkinson's disease. ANM is also a mediator for breast cancer caused by birth weight and childhood body size. However, due to the different instrumental variables used, some results of studies are inconsistent. Future studies with more valid genetic variants are needed for traits with discrepancies between MRs or between MR and other types of epidemiological studies.
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Affiliation(s)
- Xiao Zhang
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhao Huangfu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shaowei Wang
- Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
- Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Katagiri R, Iwasaki M, Abe SK, Islam MR, Rahman MS, Saito E, Merritt MA, Choi JY, Shin A, Sawada N, Tamakoshi A, Koh WP, Sakata R, Tsuji I, Kim J, Nagata C, Park SK, Kweon SS, Shu XO, Gao YT, Tsugane S, Kimura T, Yuan JM, Kanemura S, Lu Y, Sugawara Y, Wada K, Shin MH, Ahsan H, Boffetta P, Chia KS, Matsuo K, Qiao YL, Rothman N, Zheng W, Inoue M, Kang D. Reproductive Factors and Endometrial Cancer Risk Among Women. JAMA Netw Open 2023; 6:e2332296. [PMID: 37669051 PMCID: PMC10481237 DOI: 10.1001/jamanetworkopen.2023.32296] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/28/2023] [Indexed: 09/06/2023] Open
Abstract
Importance Despite evidence of an association between reproductive factors and endometrial cancer risk, prospective studies have been conducted mainly in non-Asian countries. Objective To assess the association between reproductive factors, such as number of deliveries, age at menarche, or menopause, and endometrial cancer risk. Design, Setting, and Participants This cohort study used pooled individual data from 13 prospective cohort studies conducted between 1963 and 2014 in the Asia Cohort Consortium. Participants were Asian women. Data analysis was conducted from September 2019 to April 2023. Exposures Reproductive factors were assessed using a questionnaire in each cohort. Main Outcomes and Measures The main outcome was time to incidence of endometrial cancer. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% CIs. Results A total of 1005 endometrial cancer cases were detected among 332 625 women (mean [SD] age, 54.3 [10.4] years) during a mean (SD) of 16.5 (6.4) years of follow-up. Increasing number of deliveries was associated with a decreased endometrial cancer risk in a dose-response manner (≥5 deliveries vs nulliparous [reference]: HR, 0.37; 95% CI, 0.26-0.53; P for trend < .001). Compared with menarche at younger than 13 years, menarche at 17 years or older had an HR of 0.64 (95% CI, 0.48-0.86; P for trend < .001). Late menopause (age ≥55 years) showed an HR of 2.84 (95% CI, 1.78-4.55; P for trend < .001) compared with the youngest age category for menopause (<45 years). Age at first delivery, hormone therapy, and breastfeeding were not associated with endometrial cancer risk. Conclusions and Relevance This large pooled study of individual participant data found that late menarche, early menopause, and a higher number of deliveries were significantly associated with a lower risk of endometrial cancer. These convincing results from Asian prospective studies add to the growing body of evidence for the association between reproductive factors and endometrial cancer.
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Affiliation(s)
- Ryoko Katagiri
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Motoki Iwasaki
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Sarah Krull Abe
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Md. Rashedul Islam
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Md. Shafiur Rahman
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Eiko Saito
- Institute for Global Health Policy Research, National Center for Global Health and Medicine, Tokyo, Japan
| | - Melissa A. Merritt
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Ji-Yeob Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
| | - Aesun Shin
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore
| | - Ritsu Sakata
- Radiation Effects Research Foundation, Hiroshima, Japan
| | - Ichiro Tsuji
- Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Jeongseon Kim
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Sue K. Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Xiao-Ou Shu
- Division of Epidemiology, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Takashi Kimura
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Seiki Kanemura
- Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yukai Lu
- Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yumi Sugawara
- Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Keiko Wada
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Keitaro Matsuo
- Division Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
- Department of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - You-Lin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, Occupational and Environmental Epidemiology Branch, National Cancer Institute, Bethesda, Maryland
| | - Wei Zheng
- Division of Epidemiology, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Manami Inoue
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Daehee Kang
- Seoul National University College of Medicine, Seoul, Korea
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Biagetti B, Puig-Domingo M. Age-Related Hormones Changes and Its Impact on Health Status and Lifespan. Aging Dis 2023; 14:605-620. [PMID: 37191429 PMCID: PMC10187696 DOI: 10.14336/ad.2022.1109] [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: 10/11/2022] [Accepted: 11/09/2022] [Indexed: 05/17/2023] Open
Abstract
The increase in life expectancy is accompanied with an increased consultation of age-related pathologies including endocrine disorders. Two main areas are focusing the attention of medical and social research in older population: the diagnosis and care of this heterogeneous population, and the interventional measures potentially useful to mitigate age-related functional declines and to increase health and quality of lifespan. Thus, better understanding the physiopathology of aging and establishing accurate diagnostic and personalized approaches are a priority and currently an unmet need of the medical community. The endocrine system plays a major role in survival and lifespan through regulating vital processes such as energy consumption and optimizing the stress response among others. The aim of this paper is to review the physiological evolution of the main hormonal functions in aging and its clinical translation to improve our approach to the aging patient.
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Affiliation(s)
- Betina Biagetti
- Endocrinology & Nutrition Service, Vall d’Hebron University Hospital and Vall d'Hebron Research Institute (VHIR), Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
| | - Manel Puig-Domingo
- Endocrinology & Nutrition Service, Germans Trias Hospital and Research Institute, Badalona, Department of Medicine, Autonomous University of Barcelona, Badalona, Spain.
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8
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Han M, Wang N, Han W, Ban M, Sun T, Xu J. Vaginal and tumor microbiomes in gynecological cancer (Review). Oncol Lett 2023; 25:153. [PMID: 36936020 PMCID: PMC10018329 DOI: 10.3892/ol.2023.13739] [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: 09/27/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Cervical, ovarian and endometrial cancer are the three most common types of gynecologic cancer. As a hub, the vagina connects the site of gynecological cancer with the external environment. Lactobacilli participate in the formation of a healthy vaginal microenvironment as the first line of defense against pathogen invasion; a dysbiotic vaginal microenvironment loses its original protective function and is associated with the onset, metastasis, poor efficacy and poor prognosis of gynecological cancer. The early diagnosis of cancer is the key to improve the survival time of patients with cancer. The screening of Porphyromonas, Sneathia and Atopobium vaginae, and other microbial markers, can assist the diagnosis of gynecological cancer, and screen out the high-risk population as early as possible. With the in-depth study of the microbes in tumor tissues, reasearchers have analyzed the immunological associations of microorganisms in tumor tissues. Due to the structural-functional interconnection between the organ of gynecological tumorigenesis and the vagina, the present study aims to review the relationship between vaginal and tumor microorganisms and gynecological cancer in terms of occurrence, screening, treatment and prognosis.
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Affiliation(s)
- Mengzhen Han
- Department of Breast Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, Liaoning 110000, P.R. China
| | - Na Wang
- Department of Breast Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, Liaoning 110000, P.R. China
| | - Wenjie Han
- Department of Breast Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital, Shenyang, Liaoning 110000, P.R. China
| | - Meng Ban
- Liaoning Microhealth Biotechnology Co., Ltd., Shenyang, Liaoning 110000, P.R. China
| | - Tao Sun
- Department of Breast Medicine, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital, Shenyang, Liaoning 110000, P.R. China
| | - Junnan Xu
- Department of Breast Medicine, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital, Shenyang, Liaoning 110000, P.R. China
- Correspondence to: Professor Junnan Xu, Department of Breast Medicine, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital, 44 Xiaoheyan Road, Dadong, Shenyang, Liaoning 110000, P.R. China, E-mail:
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Ion Channels in Endometrial Cancer. Cancers (Basel) 2022; 14:cancers14194733. [PMID: 36230654 PMCID: PMC9564232 DOI: 10.3390/cancers14194733] [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: 08/19/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Uterine or endometrial cancer is one of the most common types of cancer among the female population. Different alterations of molecules are related to many types of cancer. Some molecules called ion channels have been described as involved in the development of cancer, including endometrial cancer. We review the scientific evidence about the involvement of the ion channels in endometrial cancer and how some treatments can be developed with these molecules as a target. Even though they are involved in the progression of endometrial cancer, since they are present throughout the whole body, some possible treatments based on these could be studied. Abstract Uterine or endometrial cancer (EC) is the sixth most common neoplasia among women worldwide. Cancer can originate from a myriad of causes, and increasing evidence suggests that ion channels (IC) play an important role in the process of carcinogenesis, taking part in many pathways such as self-sufficiency in growth signals, proliferation, evasion of programmed cell death (apoptosis), angiogenesis, cell differentiation, migration, adhesion, and metastasis. Hormones and growth factors are well-known to be involved in the development and/or progression of many cancers and can also regulate some ion channels and pumps. Since the endometrium is responsive and regulated by these factors, the ICs could make an important contribution to the development and progression of endometrial cancer. In this review, we explore what is beyond (ion) flow regulation by investigating the role of the main families of ICs in EC, including as possible targets for EC treatment.
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Identifying potential causal effects of age at menopause: a Mendelian randomization phenome-wide association study. Eur J Epidemiol 2022; 37:971-982. [PMID: 36057072 PMCID: PMC9529691 DOI: 10.1007/s10654-022-00903-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/10/2022] [Indexed: 12/03/2022]
Abstract
Age at natural menopause (ANM) is associated with a range of health-related traits, including bone health, female reproductive cancers, and cardiometabolic health. Our objective was to conduct a Mendelian randomization phenome-wide association study (MR-pheWAS) of ANM. We conducted a hypothesis-free analysis of the genetic risk score (GRS) for ANM with 18,961 health-related traits among 181,279 women in UK Biobank. We also stratified the GRS according to the involvement of SNPs in DNA damage response. We sought to replicate our findings in independent cohorts. We conducted a negative control MR-pheWAS among men. Among women, we identified potential effects of ANM on 221 traits (1.17% of all traits) at a false discovery rate (P value ≤ 5.83 × 10-4), and 91 (0.48%) potential effects when using Bonferroni threshold (P value ≤ 2.64 × 10-6). Our findings included 55 traits directly related to ANM (e.g. hormone replacement therapy, gynaecological conditions and menstrual conditions), and liver function, kidney function, lung function, blood-cell composition, breast cancer and bone and cardiometabolic health. Replication analyses confirmed that younger ANM was associated with HbA1c (adjusted mean difference 0.003 mmol/mol; 95% CI 0.001, 0.006 per year decrease in ANM), breast cancer (adjusted OR 0.96; 95% CI 0.95, 0.98), and bone-mineral density (adjusted mean difference - 0.05; 95% CI - 0.07, - 0.03 for lumbar spine). In men, 30 traits were associated with the GRS at a false discovery rate (P value ≤ 5.49 × 10-6), and 11 potential effects when using Bonferroni threshold (P value ≤ 2.75 × 10-6). In conclusion, our results suggest that younger ANM has potential causal effects on a range of health-related traits.
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11
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Endometrial Cancer in Pre-Menopausal Women and Younger: Risk Factors and Outcome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159059. [PMID: 35897440 PMCID: PMC9330568 DOI: 10.3390/ijerph19159059] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/04/2022]
Abstract
Endometrial cancer is the sixth most common malignancy in women, and it is known to be a disease among postmenopausal women, but there is rising in the number of endometrial cancers among premenopausal women. This study aims to determine the clinical characteristic, risk factors, outcomes, and survival in pre and postmenopausal women with endometrial cancer in Malaysia. A retrospective study was conducted in Hospital Melaka that involved all women who were diagnosed with endometrial cancer in Hospital Melaka from January 2002 until July 2020. All subjects’ histopathological examination result was confirmed, and their clinical data were extracted and transferred into a standardized data checklist and analysed. A total number of 392 cases was obtained from the Annual Cancer Registry Hospital Melaka. However, only 281 cases were studied, including 44.8% premenopausal and 55.2% postmenopausal women. In the premenopausal group, there were higher incidence of obesity (30.8 + 8.6 vs. 28.9 + 7.1), younger age at menarche (12.7 + 1.5 vs. 13.3 + 1.6), lesser parity (1.47 vs. 3.26), and a higher number of nulliparous women (46.8% vs. 19.4%) as compared to postmenopausal group. The premenopausal group tends to be presented with a well-differentiated grading of tumour (52.4%) and a higher incidence of having concomitant endometrial hyperplasia (41.3%). The mean survival among the premenopausal group (200.3 + 7.9 months) is higher compared to postmenopausal group (153.9 + 6.5 months). These findings correlate with good survival and prognosis among the premenopausal group compared to the postmenopausal group.
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12
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Qian D, Wang ZF, Cheng YC, Luo R, Ge SW, Xu G. Early Menopause May Associate With a Higher Risk of CKD and All-Cause Mortality in Postmenopausal Women: An Analysis of NHANES, 1999–2014. Front Med (Lausanne) 2022; 9:823835. [PMID: 35372385 PMCID: PMC8971204 DOI: 10.3389/fmed.2022.823835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/11/2022] [Indexed: 12/19/2022] Open
Abstract
Background Chronic kidney disease (CKD) in women is often accompanied by hormone disorders such as sex hormones, and most women with CKD are in the post-menopausal age group. Due to the close relationship between menopause and sex hormones, we aimed to explore the association between early menopause and CKD in post-menopausal women, and the influence of early menopause on longevity in the CKD population. Methods Information regarding 4,945 post-menopausal women was extracted from the database of the National Health and Nutrition Examination Survey (NHANES) 1999–2014, and then divided into 4 groups according to the type of menopause (natural or surgical) and early menopause (menopause at age <45) or not. The association between early menopause and CKD prevalence was examined using multivariable logistic regression, while we used multivariable Cox proportional hazards models to investigate the possible relationship between early menopause and all-cause mortality in CKD and non-CKD populations. The differences in the levels of sex hormones between women with and without CKD were also explored. Results Compared with women with natural menopause
at age ≥45, women experiencing early natural menopause had a higher risk of CKD [OR = 1.26 (1.01–1.56)]. Similarly, as compared to women with surgical menopause at age ≥ 45, women in the early surgical menopause group were more likely to have CKD [OR = 1.38 (1.05–1.81)]. In addition, early surgical menopause was associated with higher mortality in the non-CKD group [HR = 1.62 (1.06–2.49)], but not in the CKD group. Women with CKD had a higher level of luteinizing hormone and follicle-stimulating hormone, combined with a lower level of testosterone and estradiol than the non-CKD women. Conclusion Both early natural and surgical menopause were associated with a higher risk of CKD. Early surgical menopause was a hazard factor for survival in the non-CKD group, but not in the CKD group. Further research is required to understand the mechanisms.
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The histological type of endometrial cancer is not associated with menopause status at diagnosis. Biosci Rep 2022; 42:230977. [PMID: 35237786 PMCID: PMC8935384 DOI: 10.1042/bsr20212192] [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: 09/12/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
The latest evidence suggests that type 2 endometrial cancer may not be completely estrogen-independent, indicating that the status of hormonal change may not be associated with the traditional classification of endometrial cancer, including the histological subtypes. however, this has not been investigated. Menopause is commonly considered a state of hormonal change in women. In this study, we investigated the association of menopause with the histological types of endometrial cancer. Data on the histological type, menopause status at diagnosis, age at diagnosis, parity, body mass index (BMI), and overall survival rate from 2,122 cases were collected. The difference in risk in developing type 1 or type 2 endometrial cancer between premenopausal and postmenopausal patients was 5.457%. A statistical difference in the association of menopause with the histological types between the two groups was seen in endometrioid and serous carcinoma, with a risk difference of 5.6% or 3.8%. A statistical difference in the association of menopause with parity between the groups was only seen in endometrioid and adenosquamous carcinoma, with a risk difference of 7.1% or 3.7%. However, BMI was not associated with histological type and the overall survival rate was not associated with menopause (p=0.764). We reported a relatively small difference in the association of menopause with type 1 or type 2, or the histological types of endometrial cancer. The survival rate was not associated with menopause. Our study suggests that menopause status at diagnosis was not strongly associated with the histological subtypes of endometrial cancer.
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An Assessment of Serum Selenium Concentration in Women with Endometrial Cancer. Nutrients 2022; 14:nu14050958. [PMID: 35267933 PMCID: PMC8912795 DOI: 10.3390/nu14050958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Numerous studies have shown a relationship between low serum selenium levels and an increased risk of developing cancer. Methods: A total of 306 women participated in the study: 153 patients diagnosed with endometrial cancer and 153 healthy women who were matched, in terms of birth year (+/−3 years), to the patients from the study group. The quantitative measurement of selenium content in the collected blood samples was performed using a mass spectrometer with excitation in inductively coupled plasma. In order to determine the relationship between the risk factors and the incidence of endometrial cancer, analyses based on single- and multi-factor conditional logistic regression models were performed. Results: The mean concentration of selenium was lower in patients with endometrial cancer than in healthy controls (60.63 µg/L (0.77 µmol/L) vs. 78.74 µg/L (0.99 µmol/L), respectively). When compared in quartiles, a significant association of lower selenium concentration with the incidence of endometrial cancer was recorded. The highest OR was observed in the first and second quartiles (OR-22.0, p-value < 0.001; medium selenium level 46.95 µg/L (0.59 µmol/L), and OR-5.94; p-value < 0.001; medium selenium level 63.60 µg/L (0.80 µmol/L), respectively). Conclusion: A strong correlation between the level of selenium in the blood serum and the risk of endometrial cancer indicates that patients with low levels should be a candidate group requiring appropriate preventive examinations. Further research on a larger group of patients is required.
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Guo JZ, Wu QJ, Liu FH, Gao C, Gong TT, Li G. Review of Mendelian Randomization Studies on Endometrial Cancer. Front Endocrinol (Lausanne) 2022; 13:783150. [PMID: 35615721 PMCID: PMC9124776 DOI: 10.3389/fendo.2022.783150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/30/2022] [Indexed: 01/04/2023] Open
Abstract
Endometrial cancer (EC) is a common gynecological cancer. In some parts of the world, the incidence and mortality of EC are on the rise. Understanding the risk factors of EC is necessary to prevent the occurrence of this disease. Observational studies have revealed the association between certain modifiable environmental risk factors and EC risk. However, due to unmeasured confounding, measurement errors, and reverse causality, observational studies sometimes have limited ability to judge robust causal inferences. In recent years, Mendelian randomization (MR) analysis has received extensive attention, providing valuable insights for cancer-related research, and is expected to identify potential therapeutic interventions. In MR analysis, genetic variation (alleles are randomly assigned during meiosis and are usually independent of environmental or lifestyle factors) is used instead of modifiable exposure to study the relationship between risk factors and disease. Therefore, MR analysis can make causal inference about exposure and disease risk. This review briefly describes the key principles and assumptions of MR analysis; summarizes published MR studies on EC; focuses on the correlation between different risk factors and EC risks; and discusses the application of MR methods in EC research. The results of MR studies on EC showed that type 2 diabetes, uterine fibroids, higher body mass index, higher plasminogen activator inhibitor-1 (PAI-1), higher fasting insulin, early insulin secretion, longer telomere length, higher testosterone and higher plasma cortisol levels are associated with increased risk of EC. In contrast, later age of menarche, higher circulatory tumor necrosis factor, higher low-density lipoprotein cholesterol, and higher sex hormone-binding globulin levels are associated with reduced risk of EC. In general, despite some limitations, MR analysis still provides an effective way to explore the causal relationship between different risk factors and EC.
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Affiliation(s)
- Jian-Zeng Guo
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fang-Hua Liu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chang Gao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ting-Ting Gong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Gang Li, ; Ting-Ting Gong,
| | - Gang Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Gang Li, ; Ting-Ting Gong,
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Duraisamy KY, Ezhilmani M, Balasubramaniam D, Periyasamy K. A Prospective Analysis of Laparoscopic Management of Endometrial Cancer in a Tertiary Care Centre. J Obstet Gynaecol India 2021; 71:621-628. [PMID: 34898901 DOI: 10.1007/s13224-020-01405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/20/2020] [Indexed: 10/21/2022] Open
Abstract
Background Laparoscopic management of endometrial cancer is beneficial in view of decreased operative morbidity and post-operative recovery. In the case of early gynaecological malignancies, it is a safe and feasible mode of surgery. Methods A prospective study was conducted in our tertiary centre in the period January 2017-December 2019. The study included 51 patients diagnosed with endometrial carcinoma. Demographic details and operative findings have been recorded. Results The mean age was 55.47 years; 64.7% were post-menopausal. 86.2% had stage IA disease. All patients underwent laparoscopic staging. The mean operative time was 115 min, estimated blood loss was 82.5 ml, pelvic nodal yield was 13.53, and para-aortic nodes were 20.78. There were no conversions to laparotomy or any intra-operative complications, and none of the patients had recurrence. During post-operative follow-up, 2 patients had lymphocyst, 1 had chylous ascites and 1 had port site hernia. Average hospital stay was 3 days. Conclusion In our study, we found that laparoscopic management of endometrial cancer is less morbid and has better post-operative recovery.
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Affiliation(s)
- Kavitha Yogini Duraisamy
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Malathi Ezhilmani
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Devi Balasubramaniam
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Kodeeswari Periyasamy
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
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Mulita F, Liolis E, Kehagias D, Tchabashvili L, Kaplanis C, Iliopoulos F, Perdikaris I, Kehagias I. An enormous pelvic tumor in a 46-year-old woman with an elevated serum CA 125 level, what lies beneath it? Investigation of uterine tumors in postmenopausal women. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2021; 20:154-157. [PMID: 34703417 PMCID: PMC8525254 DOI: 10.5114/pm.2021.109773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/09/2021] [Indexed: 02/07/2023]
Abstract
Abdominal and pelvic pain with an associated pelvic mass is a very common emergency situation. There is always a management dilemma for most emergency physicians regarding these patients. A 46-year-old postmenopausal woman was admitted to our emergency department (ED) with complaints of massive abdominal distention. Abdominal and pelvis magnetic resonance imaging (MRI) was performed, which revealed a huge pelvic abdominal mass. All tumor markers were within normal limits. However, the ovarian cancer antigen (CA 125) level was elevated. As there was a strong suspicion of malignancy, the patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Her final histopathology report was suggestive of uterine leiomyoma. Uterine leiomyomas are the most common benign uterine tumors in women. Surgical treatment is the gold standard, especially for older women with severe symptoms and no desire for future fertility. Although the combination of a pelvic tumor and a high-level of CA 125 arouses suspicion of gynecological malignancy, other benign conditions should always be considered in the differential diagnosis. There is limited evidence to support an association between elevated CA 125 levels and uterine fibroids so far. However, conditions such as the coexistence of adenomyosis and tumor size can affect the level of this marker in uterine fibroids.
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Affiliation(s)
- Francesk Mulita
- Corresponding author: Dr. Francesk Mulita, Department of Surgery, General University Hospital of Patras, Rio, Greece , e-mail:
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18
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Manga SM, Ye Y, Szychowski JM, Nulah KL, Ngalla C, Kincaid K, Boitano TK, Tita AT, Scarinci I, Huh WK, Sando Z, Liang MI. Pathology findings among women with alterations in uterine bleeding patterns in cameroon. Gynecol Oncol Rep 2021; 37:100821. [PMID: 34258361 PMCID: PMC8253902 DOI: 10.1016/j.gore.2021.100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Endometrial cancer is on the rise in high-income countries but it has not been adequately studied in low-and-middle income countries especially in sub-Saharan Africa (SSA), likely due to scarce pathology facilities. The purpose of this study was to characterize and quantify the prevalence of endometrial hyperplasia or cancer in a cohort of women with abnormal uterine bleeding (AUB) who underwent endometrial biopsy in Cameroon. METHODS We designed a cross-sectional study using medical records to characterize women who underwent endometrial biopsy in the Cameroon Baptist Convention Health Services (CBCHS) from 2008 to 2019. Pathologic diagnoses were classified as either endometrial hyperplasia, endometrial cancer, or no endometrial hyperplasia/cancer. We reported the overall prevalence of endometrial hyperplasia or cancer. Bivariate analyses compared patient characteristics between women with endometrial cancer, endometrial hyperplasia, and neither. RESULTS The average age was 46.2 years and women had an average of 5.1 parity. We found that, 61 [(36.7% of 166 women; 95% CI (27.6-47.0%)] had endometrial hyperplasia or cancer. There were no cases of hyperplasia with atypia and 13 women had endometrial cancer. The remainder were comprised of benign or infectious pathologic findings. In bivariate analysis, mean ages were statistically different among the three groups (hyperplasia, cancer, and no hyperplasia/cancer), p < 0.001, and women with cancer had the highest age. Parity was statistically significantly different among the three groups (p = 0.002) and women with endometrial cancer had higher parity. CONCLUSION We found that just over 1 in 3 women with AUB who underwent endometrial biopsy at a health system in SSA were found to have pathologic findings of endometrial hyperplasia or cancer, with no cases of hyperplasia with atypia. Women with endometrial cancer had higher mean age and parity.
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Affiliation(s)
- Simon M. Manga
- Women’s Health Program, Cameroon Baptist Convention Health Services, Bamenda, P.O. Box 1, Nkwen, Bamenda, Cameroon
- Center for Women’s Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10270, Birmingham, AL 35233, USA
| | - Yuanfan Ye
- Center for Women’s Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10270, Birmingham, AL 35233, USA
| | - Jeff M. Szychowski
- Center for Women’s Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10270, Birmingham, AL 35233, USA
| | - Kathleen L. Nulah
- Women’s Health Program, Cameroon Baptist Convention Health Services, Bamenda, P.O. Box 1, Nkwen, Bamenda, Cameroon
| | - Calvin Ngalla
- Women’s Health Program, Cameroon Baptist Convention Health Services, Bamenda, P.O. Box 1, Nkwen, Bamenda, Cameroon
| | - Kaitlyn Kincaid
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6 Avenue South, Suite 10360, Birmingham, AL 35233, USA
| | - Teresa K.L. Boitano
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6 Avenue South, Suite 10360, Birmingham, AL 35233, USA
| | - Alan T. Tita
- Center for Women’s Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10270, Birmingham, AL 35233, USA
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6 Avenue South, Suite 10360, Birmingham, AL 35233, USA
| | - Isabel Scarinci
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, MT Birmingham, AL 35233, USA
| | - Warner K. Huh
- Center for Women’s Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10270, Birmingham, AL 35233, USA
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite10250, Birmingham, AL 35233, USA
| | - Zacharie Sando
- Department of Pathology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon
| | - Margaret I. Liang
- Center for Women’s Reproductive Health, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10270, Birmingham, AL 35233, USA
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite10250, Birmingham, AL 35233, USA
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Baron JA, Nichols HB, Anderson C, Safe S. Cigarette Smoking and Estrogen-Related Cancer. Cancer Epidemiol Biomarkers Prev 2021; 30:1462-1471. [PMID: 33990391 DOI: 10.1158/1055-9965.epi-20-1803] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/13/2021] [Accepted: 05/10/2021] [Indexed: 12/23/2022] Open
Abstract
Cigarette smoking is a known cause of many cancers, yet epidemiologic studies have found protective associations with the risk of four "estrogen-related" malignancies: endometrial cancer, endometrioid and clear cell ovarian cancers, and thyroid cancer. This review considers epidemiologic and biological aspects of these associations, focusing particularly on estrogen signaling, and contrasts them with those for breast cancer, another estrogen-related malignancy. The observational findings regarding the inverse associations are consistent and remain after adjustment for possible confounding factors. In general, women who smoke do not have lower circulating estrogen levels than nonsmokers, eliminating one possible explanation for reduced risks of these malignancies. For endometrial and endometrioid ovarian cancer, the negative associations could plausibly be explained by interference with signaling through the estrogen receptor α. However, this is unlikely to explain the lower risks of thyroid and clear cell ovarian cancers. For thyroid cancer, an anti-inflammatory effect of nicotine and reduced TSH levels from smoking have been proposed explanations for the inverse association, but both lack convincing evidence. While the overall impact of cigarette smoking is overwhelmingly negative, protective associations such as those discussed here can provide potential clues to disease etiology, treatment, and prevention.
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Affiliation(s)
- John A Baron
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. .,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Chelsea Anderson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Stephen Safe
- Department of Veterinary Physiology & Pharmacology, Texas A&M University, College Station, Texas
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20
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Histopathological Findings in Iranian Patients with Postmenopausal Uterine Bleeding. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00515-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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McGrath IM, Mortlock S, Montgomery GW. Genetic Regulation of Physiological Reproductive Lifespan and Female Fertility. Int J Mol Sci 2021; 22:2556. [PMID: 33806348 PMCID: PMC7961500 DOI: 10.3390/ijms22052556] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 12/30/2022] Open
Abstract
There is substantial genetic variation for common traits associated with reproductive lifespan and for common diseases influencing female fertility. Progress in high-throughput sequencing and genome-wide association studies (GWAS) have transformed our understanding of common genetic risk factors for complex traits and diseases influencing reproductive lifespan and fertility. The data emerging from GWAS demonstrate the utility of genetics to explain epidemiological observations, revealing shared biological pathways linking puberty timing, fertility, reproductive ageing and health outcomes. The observations also identify unique genetic risk factors specific to different reproductive diseases impacting on female fertility. Sequencing in patients with primary ovarian insufficiency (POI) have identified mutations in a large number of genes while GWAS have revealed shared genetic risk factors for POI and ovarian ageing. Studies on age at menopause implicate DNA damage/repair genes with implications for follicle health and ageing. In addition to the discovery of individual genes and pathways, the increasingly powerful studies on common genetic risk factors help interpret the underlying relationships and direction of causation in the regulation of reproductive lifespan, fertility and related traits.
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Affiliation(s)
| | | | - Grant W. Montgomery
- Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Road, St Lucia, QLD 4072, Australia; (I.M.M.); (S.M.)
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Ding H, Fan GL, Yi YX, Zhang W, Xiong XX, Mahgoub OK. Prognostic Implications of Immune-Related Genes' (IRGs) Signature Models in Cervical Cancer and Endometrial Cancer. Front Genet 2020; 11:725. [PMID: 32793281 PMCID: PMC7385326 DOI: 10.3389/fgene.2020.00725] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/15/2020] [Indexed: 01/30/2023] Open
Abstract
Cervical cancer and endometrial cancer remain serious threats to women's health. Even though some patients can be treated with surgery plus chemoradiotherapy as a conventional option, the overall efficacy is deemed unsatisfactory. As such, the development for new treatment approaches is truly necessary. In recent years, immunotherapy has been widely used in clinical practice and it is an area of great interest that researchers are keeping attention on. However, a thorough immune-related genes (IRGs) study for cervical cancer and endometrial cancer is still lacking. We therefore aim to make a comprehensive evaluation of IRGs through bioinformatics and large databases, and also investigate the relationship between the two types of cancer. We reviewed the transcriptome RNAs of IRGs and clinical data based on the TCGA database. Survival-associated IRGs in cervical/endometrial cancer were identified using univariable and multivariable Cox proportional-hazard regression analysis for developing an IRG signature model to evaluate the risk of patients. In the end, this model was validated based on the enrichment analyses through GO, KEGG, and GSEA pathways, Kaplan-Meier survival curve, ROC curves, and immune cell infiltration. Our results showed that out of 25/23 survival-associated IRGs for cervical/endometrial cancer, 13/12 warranted further examination by multivariate Cox proportional-hazard regression analysis and were selected to develop an IRGs signature model. As a result, enrichment analyses for high-risk groups indicated main enriched pathways were associated with tumor development and progression, and statistical differences were found between high-risk and low-risk groups as shown by Kaplan-Meier survival curve. This model could be used as an independent measure for risk assessment and was considered relevant to immune cell infiltration, but it had nothing to do with clinicopathological characteristics. In summary, based on comprehensive analysis, we obtained the IRGs signature model in cervical cancer (LTA, TFRC, TYK2, DLL4, CSK, JUND, NFATC4, SBDS, FLT1, IL17RD, IL3RA, SDC1, PLAU) and endometrial cancer (LTA, PSMC4, KAL1, TNF, SBDS, HDGF, LTB, HTR3E, NR2F1, NR3C1, PGR, CBLC), which can effectively evaluate the prognosis and risk of patients and provide justification in immunology for further researches.
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Affiliation(s)
- Hao Ding
- Department of Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Guan-Lan Fan
- Department of Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yue-Xiong Yi
- Department of Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Zhang
- Department of Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiao-Xing Xiong
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
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Casas-Arozamena C, Abal M. Endometrial Tumour Microenvironment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1296:215-225. [PMID: 34185295 DOI: 10.1007/978-3-030-59038-3_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Endometrial cancer (EC) is the most common gynaecological tumour in developed countries, and its incidence is increasing in part due to the prevalence of obesity and its related hormone dysregulation. As described in this chapter, the tumour microenvironment plays a principal role in unopposed oestrogen stimulation promoting tumour cell proliferation. Factors and cytokines secreted by the different cell types defining the reactive tumour stroma also determine the invasive abilities of the tumour cells. Cancer-associated fibroblasts and tumour-associated macrophages actively participate through SDF-1, TGF-b or HGF to promote epithelial-to-mesenchymal transition or to generate an appropriate tumour niche. Likewise, endothelial cells facilitate lymph node and vascular infiltration through VEGF. Finally, the possibility to balance the immunosuppressive phenotypes in advanced endometrial cancer through the tumour microenvironment will probably represent a main therapeutic strategy in the near future.
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Affiliation(s)
- Carlos Casas-Arozamena
- Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
| | - Miguel Abal
- Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, Spain. .,Centro de Investigacion Biomedica en Red de Cancer (CIBERONC), Madrid, Spain.
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Diongue FB, Faye A, Niang K, Tine JAD, Diallo AI, Eyema RM, Tal-Dia A. Study of Factors Associated with the Age of Natural Menopause in Menopausal Women Aged 30 to 80 Years from the Keur Massar Health District in 2015 (Senegal). Health (London) 2020. [DOI: 10.4236/health.2020.1210095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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