Tailored Therapy Based on Molecular Characteristics in Endometrial Cancer

Role of Genomic and Molecular Biology in the Modulation of the Treatment of Endometrial Cancer: Narrative Review and Perspectives

Endometrial cancer (EC) is one of the most common gynecological malignancies in Western countries. Traditionally, loco-reginal dissemination and histological characteristics are the main prognostic factors. Nowadays, molecular and genomic profiling showed exciting results in terms of prognostication. According to the data provided by The Cancer Genome Atlas and other studies, molecular and genomic profiling might be useful in identifying patients al low, intermediate, and high risk of recurrence. However, data regarding the therapeutic value are scant. Several prospective studies are ongoing to identify the most appropriate adjuvant strategy in EC patients, especially for those with positive nodes and low volume disease. The molecular classification has offered the possibility to improve the risk stratification and management of EC. The aim of this review is to focus on the evolution of molecular classification in EC and its impact on the research approach and on clinical management. Molecular and genomic profiling might be useful to tailor the most appropriate adjuvant strategies in apparent early-stage EC.

OTUB2 promotes the progression of endometrial cancer by regulating the PKM2-mediated PI3K/AKT signaling pathway

Endometrial carcinoma (EC) morbidity and mortality have been increasing in recent years. Otubain 2 (OTUB2) was shown to be upregulated in EC patients, so the aim of this study was to explore the role of OTUB2 in EC. Cell Counting Kit-8 (CCK-8), colony formation, enzyme-linked immunosorbent assay, the wound healing assay, and Transwell invasion assays were used to investigate the specific role of OTUB2 in EC tumorigenesis. Real-time polymerase chain reaction and western blot analysis were used to detect the expression of OTUB2 in EC tissues and cells. OTUB2 is upregulated in EC patients and cell lines and is associated with a poor prognosis. The overexpression of OTUB2 promoted glycolysis and induced the proliferation, migration, and invasion of endometrial cancer cells. The silencing of OTUB2 had the opposite effect. In addition, the silencing of OTUB2 significantly suppressed the expression levels of PKM2. Importantly, inhibition of the PKM2/PI3K/AKT signaling pathway significantly reversed the promoting effect of OTUB2 overexpression on EC. OTUB2 regulated the proliferation and invasion of EC cells by regulating the PKM2/PI3K/AKT signaling pathway. OTUB2 may serve as a potential prognostic and therapeutic target in EC.

Laparoendoscopic single-site surgery improves the surgical outcome and life quality of patients with endometrial carcinoma

OBJECTIVE

To evaluate the effect of laparoendoscopic single-site surgery (LESS) on the surgical outcome and quality of life (QoL) of patients with endometrial carcinoma (EC).

METHODS

A total of 120 patients with EC treated in the Shandong Hospital of Traditional Chinese from August 2019 to June 2021 were selected, of which 70 cases treated with LESS were included in the research group and 50 cases treated with traditional laparoscopic surgery were assigned to the control group. The operation indexes, postoperative recovery, incidence of complications and QoL were compared between the two groups.

RESULTS

The data identified that the time to anal exhaust, percentage of postoperative analgesics used, time to ambulation and length of stay in the research group were significantly less than those in the control group. The operation time was significantly longer in the research group compared with the control group. There were no significant differences in intraoperative blood loss, number of lymph nodes dissected, catheter indwelling time and total complication rate between the two groups. The QoL was significantly better in the research group compared with the control group.

CONCLUSIONS

The above results indicate that LESS can improve the surgical outcome and QoL of patients with EC.

Endometrial carcinoma: Angiogenesis and review of the role of vascular endothelial growth factor

Endometrial carcinomas (EC) represent the most common malignant tumors of the female reproductive system and the sixth most common in the female population with an increased incidence of morbidity and mortality over the past three decades. In addition to stage, grade and type of tumor, these are the most significant prognostic factors of the biological behavior of EC and in current clinical practice are based on pathohistological examination. The shortcomings of the current histological classification are cited as one of the key limiting factors in further research, as well as in the understanding of EC carcinogenesis and improving therapeutic protocols. A new molecular classification of EC was formulated, based on the analysis of molecular biological features, recognized as highly related to the specific clinical course. Considerable efforts have been made to understand the process of angiogenesis as one of the key processes in tumor growth. The vascular endothelial growth factor (VEGF) family is a group of proangiogenic ligands that play a central role in the process of physiological and pathological angiogenesis. This factor is the most widely investigated angiogenic one as a potential biomarker and target for targeted therapy. After vast research, clinical studies have shown significant advances in the development of anti-angiogenic therapy directed at VEGF, predominantly in the form of combined therapy. In defining therapeutic groups, this therapy relies on the molecular classification of EC. Antiangiogenic therapy is limited to small specific groups of patients, associated with side effects, and numeorus patients who initially responded to targeted therapy develop resistance over time, which indicates the further need for a better understanding of the mechanisms and factors involved in the angiogenic process of EC. Potentially promising advances in the development of targeted therapeutic options for EC can be expected within the integration of molecular features of EC as a factor in the context of histological classification.

Contemporary Fertility-Sparing Management Options of Early Stage Endometrioid Endometrial Cancer in Young Nulliparous Patients

Incidence of endometrial cancer (EC) has been increasing in recent years, especially in high-income countries. The disease commonly affects peri- and postmenopausal women; however, about 5% of women are diagnosed with EC in their reproductive age. Due to both the increasing incidence of EC among reproductive age women and trends to delayed childbearing, fertility-sparing treatment for young patients with EC has become extremely important for researchers and practitioners. Because the classic treatment with total hysterectomy and bilateral saplingo-oophorectomy is not an appropriate approach for young women demanding fertility preservation, several fertility-sparing options have been developed and summarized in this review. Utilization of different medications and their combination (progestagens, gonadotropin releasing hormones analogues, and metformin in different formulations) are tested and found as efficient for fertility-sparing treatment. New minimally invasive surgical techniques, combined with progestagens, are also confirmed as valuable. There are many novel conservative and surgical treatment approaches under investigation. Assuming that molecular biomarkers can be both diagnostic and prognostic to assist in prediction of response to a certain therapy, prognostic risk groups' stratification along with specific biomarkers' identification will ensure low recurrence and decrease mortality rates in young women with EC.

Two-Way Development of the Genetic Model for Endometrial Tumorigenesis in Mice: Current and Future Perspectives

Endometrial cancer (EC) is the most common malignancy of the female reproductive tract worldwide. Although comprehensive genomic analyses of EC have already uncovered many recurrent genetic alterations and deregulated signaling pathways, its disease model has been limited in quantity and quality. Here, we review the current status of genetic models for EC in mice, which have been developed in two distinct ways at the level of organisms and cells. Accordingly, we first describe the in vivo model using genetic engineering. This approach has been applied to only a subset of genes, with a primary focus on Pten inactivation, given that PTEN is the most frequently altered gene in human EC. In these models, the tissue specificity in genetic engineering determined by the Cre transgenic line has been insufficient. Consequently, the molecular mechanisms underlying EC development remain poorly understood, and preclinical models are still limited in number. Recently, refined Cre transgenic mice have been created to address this issue. With highly specific gene recombination in the endometrial cell lineage, acceptable in vivo modeling of EC development is warranted using these Cre lines. Second, we illustrate an emerging cell-based model. This hybrid approach comprises ex vivo genetic engineering of organoids and in vivo tumor development in immunocompromised mice. Although only a few successful cases have been reported as proof of concept, this approach allows quick and comprehensive analysis, ensuring a high potential for reconstituting carcinogenesis. Hence, ex vivo/in vivo hybrid modeling of EC development and its comparison with corresponding in vivo models may dramatically accelerate EC research. Finally, we provide perspectives on future directions of EC modeling.

Molecular Basis of Endometriosis and Endometrial Cancer: Current Knowledge and Future Perspectives

The human endometrium is a unique tissue undergoing important changes through the menstrual cycle. Under the exposure of different risk factors in a woman's lifetime, normal endometrial tissue can give rise to multiple pathologic conditions, including endometriosis and endometrial cancer. Etiology and pathophysiologic changes behind such conditions remain largely unclear. This review summarizes the current knowledge of the pathophysiology of endometriosis and its potential role in the development of endometrial cancer from a molecular perspective. A better understanding of the molecular basis of endometriosis and its role in the development of endometrial pathology will improve the approach to clinical management.