1
|
Sun Y, Lin S, Wu W, Nie F, Liu Y, Wen J, Cheng X, Liu Q, Wang Y, Ren F. Whether surgical procedure can improve the prognosis of endometrial cancer arising in adenomyosis (EC-AIA)? A systematic review and meta-analysis. Int J Surg 2024; 110:3072-3080. [PMID: 38445439 PMCID: PMC11093450 DOI: 10.1097/js9.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Endometrial cancer arising in adenomyosis (EC-AIA) is frequently detected accidentally following a general hysterectomy for adenomyosis. Whether supplemental lymphadenectomy in patients with EC-AIA can improve the survival outcome remains inconclusive. Herein, the authors summarized the data of patients with EC-AIA and further explored the impact of lymphadenectomy on the prognosis of these patients. METHODS Five electronic databases, namely MEDLINE, Web of Science, PubMed, Embase, and the Cochrane Library were employed for searching articles from inception to May 2023. RESULTS In total, 38 eligible studies enrolling 56 patients were included. Of these, 44 patients had a traceable prognosis. Kaplan-Meier curves demonstrated that patients who had undergone lymphadenectomy had a better progression-free survival (PFS) compared with those who had not undergone lymphadenectomy ( P =0.016), but there was no difference in overall survival. Univariable ( P =0.025, HR=0.25, 95% CI=0.08-0.84) and multivariable ( P =0.042, HR=0.13, 95% CI=0.020-0.930) Cox regression analyses revealed that lymphadenectomy was an independent protective factor for PFS. CONCLUSION For patients diagnosed with EC-AIA following hysterectomy for benign disease, further supplementary lymphadenectomy is recommended to improve PFS.
Collapse
Affiliation(s)
- Yi Sun
- Deparment of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Shitong Lin
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Weijia Wu
- Deparment of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Fangfang Nie
- Deparment of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Yuchen Liu
- Department of Gynecology, The Anyang Cancer Hospital, The Fourth Affiliated Hospital of Henan University, Anyang, People’s Republic of China
| | - Jing Wen
- Deparment of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Xiaoran Cheng
- Deparment of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Qianwen Liu
- Deparment of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Yuanpei Wang
- Deparment of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Fang Ren
- Deparment of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| |
Collapse
|
2
|
Moraru L, Mitranovici MI, Chiorean DM, Moraru R, Caravia L, Tiron AT, Cotoi OS. Adenomyosis and Its Possible Malignancy: A Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13111883. [PMID: 37296736 DOI: 10.3390/diagnostics13111883] [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: 04/23/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Cancer arising from adenomyosis is very rare, with transformation occurring in only 1% of cases and in older individuals. Adenomyosis, endometriosis and cancers may share a common pathogenic mechanism that includes hormonal factors, genetic predisposition, growth factors, inflammation, immune system dysregulation, environmental factors and oxidative stress. Endometriosis and adenomyosis both exhibit malignant behaviour. The most common risk factor for malignant transformation is prolonged exposure to oestrogens. The golden standard for diagnosis is histopathology. Colman and Rosenthal emphasised the most important characteristics in adenomyosis-associated cancer. Kumar and Anderson emphasised the importance of demonstrating a transition between benign and malignant endometrial glands in cancer arising from adenomyosis. As it is very rare, it is difficult to standardize treatment. In this manuscript, we try to emphasize some aspects regarding the management strategy, as well as how heterogenous the studies from the literature are in terms of prognosis in both cancers that develop from adenomyosis or those that are only associated with adenomyosis. The pathogenic mechanisms of transformation remain unclear. As these types of cancer are so rare, there is no standardised treatment. A novel target in the diagnosis and treatment of gynaecological malignancies associated with adenomyosis is also being studied for the development of new therapeutic concepts.
Collapse
Affiliation(s)
- Liviu Moraru
- Department of Anatomy, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Melinda-Ildiko Mitranovici
- Department of Obstetrics and Gynecology, Emergency County Hospital Hunedoara, 14 Victoriei Street, 331057 Hunedoara, Romania
| | - Diana Maria Chiorean
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
| | - Raluca Moraru
- Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Laura Caravia
- Division of Cellular and Molecular Biology and Histology, Department of Morphological Sciences, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Andreea Taisia Tiron
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ovidiu Simion Cotoi
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Department of Pathophysiology, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
| |
Collapse
|
3
|
Wang J, Wang Q, Wang W, Yang J, Xia J, Wei Y. Endometrioid adenocarcinoma arising in adenomyosis in a patient with pelvic organ prolapse-case report. BMC Womens Health 2023; 23:150. [PMID: 36997927 PMCID: PMC10064737 DOI: 10.1186/s12905-023-02310-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Adenomyosis is a frequent finding in endometrial carcinoma patients. Endometrioid adenocarcinoma is the most common type of endometrial carcinoma; however, endometrioid adenocarcinoma arising from adenomyosis is extremely rare. CASE PRESENTATION In this case report, we describe a 69-year-old woman who required surgical treatment for pelvic organ prolapse (POP). The patient had been postmenopausal for 20 years and had no abnormal bleeding after menopause. The patient underwent transvaginal hysterectomy, repair of anterior and posterior vaginal walls, ischium fascial fixation and repair of an old perineal laceration. Histological examination of surgical specimens revealed endometrioid adenocarcinoma of the uterus. Bilateral adnexectomy, pelvic lymphadenectomy and para-aortic lymphadenectomy were then performed. The postoperative histopathological diagnosis was stage IB endometrial cancer (endometrioid carcinoma G2). CONCLUSIONS In summary, endometrioid adenocarcinoma arising from adenomyosis (EC-AIA) is a rare entity and the early diagnosis is difficult. Adequate preoperative assessment and enhanced inquiry of occult clinical symptoms of postmenopausal women before hysterectomy may contribute to the diagnosis of EC-AIA preoperatively.
Collapse
Affiliation(s)
- Jing Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qingyuan Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wenyan Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Jian Yang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jingxian Xia
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yanan Wei
- Department of Obstetrics and Gynecology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, Anhui, China
| |
Collapse
|
4
|
Endometrial Cancer Arising in Adenomyosis (EC-AIA): A Systematic Review. Cancers (Basel) 2023; 15:cancers15041142. [PMID: 36831484 PMCID: PMC9953860 DOI: 10.3390/cancers15041142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/12/2023] Open
Abstract
Endometrial cancer arising in adenomyosis (EC-AIA) is a rare uterine disease characterized by the malignant transformation of the ectopic endometrium within the adenomyotic foci. Clinicopathological and survival data are mostly limited to case reports and a few cohort studies. We aimed to assess the clinicopathological features and survival outcomes of women with EC-AIA through a systematic review of the literature. Six electronic databases were searched, from 2002 to 2022, for all peer-reviewed studies that reported EC-AIA cases. Thirty-seven EC-AIA patients from 27 case reports and four case series were included in our study. In our analysis, EC-AIA appeared as a rare disease that mainly occurs in menopausal women, shares symptoms with endometrial cancer, and is challenging to diagnose preoperatively. Differently from EC, it shows a higher prevalence of the non-endometrioid histotype, advanced FIGO stages, and p53-signature, which might be responsible for its worse prognosis. Future studies are necessary, to confirm our findings and further investigate this rare condition.
Collapse
|
5
|
Clinical Characteristics of Patients with Endometrial Cancer and Adenomyosis. Cancers (Basel) 2021; 13:cancers13194918. [PMID: 34638402 PMCID: PMC8508080 DOI: 10.3390/cancers13194918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/12/2021] [Accepted: 09/27/2021] [Indexed: 11/19/2022] Open
Abstract
Simple Summary Endometrial cancer (EC) reportedly have a better prognosis in patients with coexistent adenomyosis. It is possible to hypothesize that this difference may be attributable to different clinical profiles. On this account, we aimed to define the clinical profile of endometrial cancer (EC) patients with and without adenomyosis through a systematic review and meta-analysis. We included 8 studies with 5681 patients and found that EC women with adenomyosis were less likely to be nulliparous than EC women without adenomyosis, while no significant differences were found with regard to age, BMI, and premenopausal status. Abstract A better endometrial cancer (EC) prognosis in patients with coexistent adenomyosis has been reported. Unfortunately, it is still unclear if this better prognosis is related to a more favorable clinical profile of adenomyosis patients. We aimed to evaluate differences in the clinical profiles of EC patients with and without adenomyosis. A systematic review and meta-analysis was performed by searching seven electronics databases for all studies that allowed extraction of data about clinical characteristics in EC patients with and without adenomyosis. Clinical characteristics assessed were: age, Body Mass Index (BMI), premenopausal status, and nulliparity. Mean difference in mean ± standard deviation (SD) or odds ratio (OR) for clinical characteristics between EC patients with and without adenomyosis were calculated for each included study and as a pooled estimate, and graphically reported on forest plots with a 95% confidence interval (CI). The Z test was used for assessing the overall effect by considering a p value < 0.05 as significant. Overall, eight studies with 5681 patients were included in the qualitative analysis, and seven studies with 4366 patients in the quantitative analysis. Pooled mean difference in mean ± SD between EC women with and without adenomyosis was −1.19 (95% CI: −3.18 to 0.80; p = 0.24) for age, and 0.23 (95% CI: −0.62 to 1.07; p = 0.60) for BMI. When compared to EC women without adenomyosis, EC women with adenomyosis showed a pooled OR of 1.53 (95% CI: 0.92 to 2.54; p = 0.10) for premenopausal status, and of 0.60 (95% CI: 0.41 to 0.87; p = 0.007) for nulliparity. In conclusion, there are not significant differences in clinical characteristics between EC patients with and without adenomyosis, with the exception for nulliparity. Clinical features seem to not underlie the better EC prognosis of patients with adenomyosis compared to patients without adenomyosis.
Collapse
|
6
|
Raimondo D, Raffone A, Travaglino A, Maletta M, Casadio P, Ambrosio M, Chiara Aru A, Santoro A, Franco Zannoni G, Insabato L, Mollo A, Zullo F, Seracchioli R. Impact of adenomyosis on the prognosis of patients with endometrial cancer. Int J Gynaecol Obstet 2021; 157:265-270. [PMID: 34228822 PMCID: PMC9292168 DOI: 10.1002/ijgo.13818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/19/2021] [Accepted: 07/05/2021] [Indexed: 12/13/2022]
Abstract
Background Despite the high prevalence of adenomyosis in hysterectomy specimens of endometrial carcinoma (EC) patients, the relationship between adenomyosis and EC prognosis appears unclear. Objective To assess the prognostic value of coexistent adenomyosis in patients with EC. Methods A systematic review and meta‐analysis was performed by searching six electronic databases for studies reporting data on prognosis of EC patients with and without coexistent adenomyosis. Studies with patient selection based on prognostic factors were excluded. Pooled univariate hazard ratio (HR) analyses for overall survival (OS) and disease‐free survival (DRF) were performed, using EC patients without adenomyosis as a control group. For DFS, pooled multivariate HR analysis was also evaluable. Results Three studies of 2505 EC patients (553 with and 1952 without adenomyosis) were included. Compared with EC patients without adenomyosis, EC patients with coexistent adenomyosis showed a pooled HR of 0.533 (CI 95%, 0.329–0.864) for OS at univariate analysis; 0.536 (CI 95%, 0.334–0.859) for DFS at univariate analysis; and 0.875 (CI 95%, 0.331–2.315) for DFS at multivariate analysis. Conclusion In EC patients with coexistent adenomyosis, the risk of death is halved compared with EC patients without adenomyosis. However, the independence of this association needs to be verified in future studies. The risk of death is halved in EC patients with coexistent adenomyosis compared with EC patients without adenomyosis, whereas the risk of EC recurrence does not appear to be affected.
Collapse
Affiliation(s)
- Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy.,Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Travaglino
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Manuela Maletta
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Marco Ambrosio
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Anna Chiara Aru
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Angela Santoro
- Pathology Unit, Department of Woman and Child Health, Agostino Gemelli University Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Gian Franco Zannoni
- Pathology Unit, Department of Woman and Child Health, Agostino Gemelli University Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Insabato
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Mollo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC, IRCCS Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|
7
|
Hu H, Wang Z, Zhang M, Niu F, Yu Q, Ren Y, Ye Z. Clinicopathological Characteristics and Prognosis in Endometrial Cancer With Bone Metastasis: A SEER-Based Study of 584 Women. Front Oncol 2021; 11:694718. [PMID: 34277441 PMCID: PMC8280469 DOI: 10.3389/fonc.2021.694718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/17/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose Bone metastasis from endometrial cancer (EC) is rare and poorly described. The purpose of the present study was to investigate the correlation between the clinically accessible factors and survival time among EC patients with bone metastasis. Patients and Methods We retrospectively identified and reviewed EC patients with bone metastasis from 2010 to 2016, based on the Surveillance, Epidemiology and End Results (SEER) database. Univariable and multivariable Cox regressions were applied to evaluate the effects of clinical variables on survival. Kaplan–Meier plots were used to visually demonstrate the correlation between independent risk factors and survival. Results Clinical data of 584 EC patients with bone metastasis from the SEER database were analyzed. EC patients with bone metastasis experienced extremely poor survival, with 1-year overall survival (OS) and cancer-specific survival (CSS) rates 33.8 and 35.8%, respectively. Variables associated with OS and CSS in the univariable analysis included race, tumor grade, tumor subtype, tumor size, lung, liver and brain metastases, surgery, radiotherapy, and chemotherapy. In the multivariable analysis, tumor grade, tumor subtype, liver and brain metastases, local surgery, and systemic chemotherapy remained independent risk factors for OS and CSS. However, local radiotherapy was an independent predictor of OS, not CSS. Conclusions We identified several factors affect the survival of EC patients with bone metastasis, which is useful for clinicians to assess patients’ outcomes. Our study supports surgery and radiotherapy of primary EC, and systemic chemotherapy for prolonging survival among EC patients with bone metastasis, which lays a solid foundation for defining optimal treatment strategy in this specific cohort.
Collapse
Affiliation(s)
- Hejia Hu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Zhan Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Miaofeng Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Feng Niu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Orthopedics, Ningbo Municipal Hospital of TCM, Ningbo, China
| | - Qunfei Yu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Ren
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhaoming Ye
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| |
Collapse
|
8
|
Just PA, Moret S, Borghese B, Chapron C. [Endometriosis and adenomyosis]. Ann Pathol 2021; 41:521-534. [PMID: 34183193 DOI: 10.1016/j.annpat.2021.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
Diffuse adenomyosis, focal adenomyosis, ovarian endometrioma, superficial endometriosis and deep infiltrating adenomyosis are all defined by the presence of an endometrioid tissue in an ectopic location that is at distance from the endometrium. Although frequently associated, these lesions represent different clinico-pathological entities that the pathologist should recognized. Herein, we review the clinical and pathological features of these entities, as well as related current physiopathological understandings and differential diagnoses that could be raised by some morphological variants. The statistical association between endometriosis and several ovarian tumors, mainly endometrioid and clear cell carcinomas and seromucinous borderline tumors is well established and we present some molecular and morphological features that support this transformation potential.
Collapse
Affiliation(s)
- Pierre-Alexandre Just
- Université de Paris, service de pathologie, AP-HP, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Sandrine Moret
- Université de Paris, service de pathologie, AP-HP, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Bruno Borghese
- Université de Paris, service de gynécologie obstétrique 2 et médecine de la reproduction, AP-HP, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Charles Chapron
- Université de Paris, service de gynécologie obstétrique 2 et médecine de la reproduction, AP-HP, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| |
Collapse
|
9
|
Sun Y, Gao X, Li P, Song L, Shi L. LncRNA ZFAS1, as a poor prognostic indicator, promotes cell proliferation and epithelial-mesenchymal transition in endometrial carcinoma. Per Med 2020; 18:43-53. [PMID: 33151128 DOI: 10.2217/pme-2020-0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Long noncoding RNA Zinc finger nuclear transcription factor, X-box binding 1-type containing 1 antisense RNA 1 (ZFAS1) has been reported to be an oncogene in various tumors. However, the role of ZFAS1 in endometrial carcinoma (EC) are not fully determined. Methods & results: Here, we found ZFAS1 expression was significantly upregulated in EC patients, which was significantly associated with International Federation of Gynecology and Obstetrics stage, histological grade, myometrial invasion and poor prognosis. The loss-of-function assays showed that knockdown of ZFAS1 significantly suppressed the proliferation, G1/S transition, migration and invasion in EC cells. Moreover, knockdown of ZFAS1 obviously downregulated the expression of CDK4, Cyclin D1 and N-cadherin, but upregulated E-cadherin expression. Conclusion: Collectively, these results suggest that ZFAS1 might be used as potential therapeutic targets for EC treatment.
Collapse
Affiliation(s)
- Yanan Sun
- Department of Gynecology, The Second Affiliated Hospital Harbin Medical University, Harbin, Heilongjiang, PR China.,Department of Gynecology & Obstetrics, Daqing Oilfield General Hospital, Daqing, Heilongjiang, PR China
| | - Xuan Gao
- Department of Gynecology & Obstetrics, Daqing Oilfield General Hospital, Daqing, Heilongjiang, PR China
| | - Peiling Li
- Department of Gynecology, The Second Affiliated Hospital Harbin Medical University, Harbin, Heilongjiang, PR China
| | - Ling Song
- Department of Gynecology & Obstetrics, Daqing Oilfield General Hospital, Daqing, Heilongjiang, PR China
| | - Lei Shi
- Department of Gynecology & Obstetrics, Daqing Oilfield General Hospital, Daqing, Heilongjiang, PR China
| |
Collapse
|
10
|
An M, Duan H, Zhang Y. Prognostic significance of co‐existent adenomyosis on outcomes and tumor characteristics of endometrial cancer: A meta‐analysis. J Obstet Gynaecol Res 2020; 46:1851-1863. [DOI: 10.1111/jog.14371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/02/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Min An
- Department of Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology HospitalCapital Medical University Beijing China
| | - Hua Duan
- Department of Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology HospitalCapital Medical University Beijing China
| | - Ying Zhang
- Department of Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology HospitalCapital Medical University Beijing China
| |
Collapse
|
11
|
The clinicopathological characteristics and survival outcomes of endometrial carcinoma coexisting with or arising in adenomyosis: A pilot study. Sci Rep 2020; 10:5984. [PMID: 32249826 PMCID: PMC7136226 DOI: 10.1038/s41598-020-63065-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
Little is known about the epidemiological and clinicopathological characteristics of endometrial endometrioid carcinoma (EEC) coexisting with or arising in adenomyosis (EEC-A or EEC-AIA) due to their rarity. This study compared EEC-A and EEC-AIA with endometrial carcinoma without adenomyosis. Cases of endometrial cancer treated at the study center from June 1, 2010, to June 1, 2017, were reviewed. The epidemiological, clinicopathological characteristics and survival outcomes were compared among three groups of endometrioid subtypes: group A, stage IA endometrial carcinoma patients without coexisting adenomyosis; group B, patients with EEC-A; and group C, patients with EEC-AIA. Among the 2080 patients reviewed, groups A, B, and C included 1043, 230 and 28 patients, respectively. Patients in group A and group B had similar clinicopathological and survival outcomes. Patients in group C were significantly younger and had less gravidity and parity than patients in groups A and B. More tumors from group C were grade 1, and they had a smaller maximum diameter and less mismatch repair deficiency than those from groups A and B. After a median follow-up of 57.0 months, the 5-year disease-free survival (DFS) rates of groups A, B and C were 96%, 91% and 100% (p = 0.045), respectively; the 5-year overall survival (OS) rates were 98%, 93% and 100%, respectively (p = 0.001), in the Kaplan-Meier analysis. However, these difference disappeared in a subgroup of stage IA patients in univariate and multivariate analysis. Cox regression analysis in stage IA patients also revealed no significant differences in survival outcome across the three groups. In conclusion, EEC-AIA exhibited specific clinicopathological characteristics that were probably associated with favorable survival outcomes. The characteristics and survival outcomes of EEC-A were similar to those of EEC without adenomyosis in stage IA patients.
Collapse
|
12
|
Shen F, Liu Y, Lin L, Zhao M, Chen Q. Association of benign gynaecological diseases and risk of endometrial and ovarian cancers. J Cancer 2020; 11:3186-3191. [PMID: 32231723 PMCID: PMC7097964 DOI: 10.7150/jca.39626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 02/18/2020] [Indexed: 12/27/2022] Open
Abstract
Objective: Gynaecologic benign diseases such uterine fibroids share similar pathogeneses with endometrial and ovarian cancers. Whether a history of uterine fibroids increases the risk of developing endometrial or ovarian cancers is controversial, due to uterine fibroids was self-reported in those studies. Methods: In our current case-control study, 268 women with endometrial cancer and 108 women with ovarian cancer were included. In addition, 500 women without gynaecological cancers were randomly selected as a control group. Uterine fibroids in both groups were clinically diagnosed by pelvic examination and ultrasound. Data on age, parity, gravida, stages of cancers and history of uterine fibroids, endometriosis and adenomyosis were collected from hospital database. Results: After adjusted age and parity, the odds of women with history of uterine fibroids or endometriosis were lower in women with endometrial cancer than controls (odds ratio: 0.148, 95% CI: 0.097, 0.225, or 0.360, 95% CI: 0094, 1.381, respectively). The odds of women with a history of uterine fibroids or endometriosis were lower in women with ovarian cancer than controls (odds ratio: 0.141, 95% CI: 0.085, 0.235, or 1.057, 95% CI: 0.377, 2.963, respectively). However, the odds of women with a history of adenomyosis were higher in women with endometrial or ovarian cancers than controls (odd ratio: 3.757, 95% CI: 1.858, 7.599 or 2.341, 95% CI: 1.086, 5.045, respectively). Conclusion: Our observational data suggested that uterine fibroids or endometriosis may be not associated with the increased risk of developing endometrial or ovarian cancer. However, a history of adenomyosis may do.
Collapse
Affiliation(s)
- Fanghua Shen
- Suzhou Ninth People's Hospital, Suzhou, Jiangsu Province, China
| | - Yang Liu
- Nanjing Medical University, Nanjing, China
| | - Luling Lin
- Liggins Institute, The University of Auckland, New Zealand
| | - Min Zhao
- Department of Gynaecology, The affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, China
| | - Qi Chen
- The Hospital of Obstetrics & Gynaecology, Fudan University, China.,Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand
| |
Collapse
|
13
|
Johnatty SE, Stewart CJR, Smith D, Nguyen A, O' Dwyer J, O'Mara TA, Webb PM, Spurdle AB. Co-existence of leiomyomas, adenomyosis and endometriosis in women with endometrial cancer. Sci Rep 2020; 10:3621. [PMID: 32108150 PMCID: PMC7046700 DOI: 10.1038/s41598-020-59916-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/31/2020] [Indexed: 12/21/2022] Open
Abstract
Leiomyomas, adenomyosis, and endometriosis are reported to be risk factors for endometrial carcinoma (EC), and adenomyosis and endometriosis also for ovarian carcinoma (OC). We aimed to describe the prevalence of these conditions in EC patients with or without an OC diagnosis, and to investigate their relationship with EC risk and prognostic factors in these patients. We evaluated the co-existence of these three conditions in 1399 EC patients, and compared the prevalence of epidemiological risk factors and tumor prognostic features in patients with each condition versus not. Prevalence of conditions was also assessed in the subset of patients with prior/concurrent OC. The observed coexistence of leiomyomas, adenomyosis and endometriosis significantly deviated from that expected (P = 1.2 × 10-8). Patients were more likely to: report a younger age at menarche (PTrend = 0.004) if they had leiomyomas; have used oral contraceptives (P = 6.6 × 10-5) or had ≥2 full-term pregnancies (PTrend = 2.0 × 10-9) if they had adenomyosis; be diagnosed with EC at younger age (P = 5.0 × 10-11) if they had endometriosis. Patients with prior/concurrent OC were more likely to be diagnosed at younger age (P = 5.0 × 10-5), have endometriosis (P = 9.9 × 10-7), and present with higher stage EC (PTrend = 6.6 × 10-5). These findings justify further consideration of these gynecologic conditions as independent risk and prognostic factors for EC.
Collapse
Affiliation(s)
- Sharon E Johnatty
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Colin J R Stewart
- Department of Histopathology, King Edward Memorial Hospital, Perth, WA, Australia.,School for Women's and Infants' Health, University of Western Australia, Perth, WA, Australia
| | - Deborah Smith
- Department of Pathology, The Mater Hospital, Brisbane, Queensland, Australia
| | - Anthony Nguyen
- The Australian e-Health Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - John O' Dwyer
- The Australian e-Health Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - Tracy A O'Mara
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Penelope M Webb
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Amanda B Spurdle
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
| |
Collapse
|
14
|
Shi F, Wang T, Liu Z, Zhang Y, Wang J, Zhang K, Su J. LncRNA miR143HG Up-Regulates p53 In Endometrial Carcinoma By Sponging miR-125a. Cancer Manag Res 2019; 11:10117-10123. [PMID: 31819644 PMCID: PMC6896921 DOI: 10.2147/cmar.s222215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/22/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction MiR143HG is a recently identified tumor suppressor in bladder cancer. We performed bioinformatics prediction and found that miR143HG can form base pairs with miR-125a. This study was therefore carried out to explore the interaction between miR143HG and miR-125a in endometrial carcinoma (EC). Methods Gene expression was analyzed by qPCR and Western blot. Interactions among genes were analyzed by over-expression experiments. Cell apoptosis after transfections was analyzed by cell apoptosis assay. Results We found that the down-regulation of miR143HG in EC predicted poor survival. Bioinformatics analysis showed that miR-125a could bind miR143HG. In EC tissues, miR143HG was positively correlated with p53, not miR-125a. In EC cells, miR143HG and miR-125a over-expression failed to affect the expression of each other. However, miR143HG over-expression led to the up-regulated p53. MiR-125a over-expression played the opposite role and attenuated the effects of miR143HG over-expression. Cell apoptosis analysis showed that miR143HG and p53 over-expression led to an increased cell apoptotic rate. MiR-125a over-expression played the opposite role and attenuated the effects of miR143HG over-expression. Conclusion MiR143HG may up-regulate p53 in EC by sponging miR-125a to promote cancer cell apoptosis.
Collapse
Affiliation(s)
- Fan Shi
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, People's Republic of China
| | - Tao Wang
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, People's Republic of China
| | - Zi Liu
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, People's Republic of China
| | - Yingbing Zhang
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, People's Republic of China
| | - Juan Wang
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, People's Republic of China
| | - Kaishuo Zhang
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, People's Republic of China
| | - Jin Su
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, People's Republic of China
| |
Collapse
|
15
|
Licon E, Matsuzaki S, Opara KN, Machida H, Roman LD, Sasso EB, Matsuo K. Treatment and outcome of placenta percreta: Primary cesarean hysterectomy versus conservative management. Eur J Obstet Gynecol Reprod Biol 2019; 244:201-203. [PMID: 31627939 DOI: 10.1016/j.ejogrb.2019.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/19/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Ernesto Licon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA90033, USA
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA90033, USA
| | - Karen N Opara
- Keck School of Medicine, University of Southern California, Los Angeles, CA90033, USA
| | - Hiroko Machida
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA90033, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA90033, USA
| | - Elizabeth B Sasso
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA90033, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA90033, USA.
| |
Collapse
|
16
|
Malignant transformation of adenomyosis: literature review and meta-analysis. Arch Gynecol Obstet 2018; 299:47-53. [DOI: 10.1007/s00404-018-4991-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
|
17
|
Liu CH, Chang WH, Liu WM, Wang PH. Serous carcinoma arising from adenomyosis. Taiwan J Obstet Gynecol 2018; 56:706-707. [PMID: 29037565 DOI: 10.1016/j.tjog.2017.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Chia-Hao Liu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Hsun Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Min Liu
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
18
|
Zouzoulas OD, Tsolakidis D, Efstratiou I, Pervana S, Pazarli E, Grimbizis G. Correlation between Adenomyosis and Endometrial cancer: 6-year experience of a single center. Facts Views Vis Obgyn 2018; 10:147-152. [PMID: 31191849 PMCID: PMC6548412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Adenomyosis often co-exists in the pathological specimens after surgery for endometrial cancer. The aim of this study is to describe the clinicopathological and oncological characteristics of these patients and further investigate the possibility of malignant transformation in the adenomyotic tissue. METHODS We retrospectively reviewed the medical records of all patients that underwent hysterectomy for endometrial cancer (January 2012 - December 2017). The pathological reports were studied and when adenomyosis was present, the pathological slides were reviewed in order to discover any malignant change in the adenomyotic tissue. The clinicopathological characteristics and oncological results were described. RESULTS Out of 229 cases of endometrial cancer, 64 (28%) patients had concurrently endometrial cancer and adenomyosis. Among these 64 patients, 7 (11%) had malignant transformation of adenomyosis. The mean age of patients suffering from both endometrial cancer and adenomyosis was 63.2 years old and 57 (89%) of these patients, had early endometrial cancer. Concerning the patients with malignant transformation of adenomyosis, their mean age was 65 years old with no premenopausal case. DISCUSSION Adenomyosis has been described in the last decades, but its malignant transformation into endometrial cancer is not fully undercovered. Further investigation is needed in order to clarify the pathologic progression of adenomyotic lesions to endometrial cancer.
Collapse
Affiliation(s)
- OD Zouzoulas
- Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, “Papageorgiou” Hospital, Thessaloniki, 56403, Greece
| | - D Tsolakidis
- Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, “Papageorgiou” Hospital, Thessaloniki, 56403, Greece
| | - I Efstratiou
- Anatomical Pathology Laboratory, “Papageorgiou” Hospital, Thessaloniki, 56403, Greece
| | - S Pervana
- Anatomical Pathology Laboratory, “Papageorgiou” Hospital, Thessaloniki, 56403, Greece
| | - E Pazarli
- Anatomical Pathology Laboratory, “Papageorgiou” Hospital, Thessaloniki, 56403, Greece
| | - G Grimbizis
- Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, “Papageorgiou” Hospital, Thessaloniki, 56403, Greece
| |
Collapse
|
19
|
Impact of coexistent adenomyosis on outcomes of patients with endometrioid endometrial cancer: a propensity score-matched analysis. TUMORI JOURNAL 2018; 104:60-65. [PMID: 29192745 DOI: 10.5301/tj.5000698] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Despite the common occurrence of adenomyosis in endometrial cancer (EC), there is a paucity and conflict in the literature regarding its impact on outcomes of patients. We sought to compare outcomes of patients with endometrioid type EC with or without adenomyosis. METHODS A total of 314 patients were included in the analysis. Patients were divided into 2 groups according to the presence or absence of adenomyosis. Adenomyosis was identified in 79 patients (25.1%). A propensity score-matched comparison (1:1) was carried out to minimize selection biases. The propensity score was developed through multivariable logistic regression model including age, stage, and tumor grade as covariates. After performing propensity score matching, 70 patients from each group were successfully matched. Primary outcome of the study was disease-free survival (DFS), and the secondary outcomes were overall survival (OS) and disease-specific survival (DSS). RESULTS Median follow-up time was 61 months for the adenomyosis positive group and 76 months for the adenomyosis negative group. There were no statistically significant differences in 3- and 5-year DFS, OS, and DSS rates between the 2 groups. Five-year DFS was 92% vs 88% (hazard ratio [HR] 1.54 [0.56-4.27]; p = 0.404), 5-year OS was 94% vs 92% (HR 1.60 [0.49-5.26]; p = 0.441), and 5-year DSS was 94% vs 96% (HR 2.51 [0.46-13.71]; p = 0.290) for patients with and without adenomyosis, respectively. CONCLUSIONS Coexistent adenomyosis in EC is not a prognostic factor and does not impact survival outcomes.
Collapse
|
20
|
Significance of abnormal peritoneal cytology on survival of women with stage I-II endometrioid endometrial cancer. Gynecol Oncol 2018; 149:301-309. [PMID: 29605499 DOI: 10.1016/j.ygyno.2018.02.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/16/2018] [Accepted: 02/17/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine survival of women with stage I-II endometrioid endometrial cancer whose peritoneal cytology showed malignant or atypical cells (abnormal peritoneal cytology). METHODS This is a multi-center retrospective study examining 1668 women with stage I-II endometrioid endometrial cancer who underwent primary hysterectomy with available peritoneal cytology results between 2000 and 2015. Abnormal peritoneal cytology was correlated to clinico-pathological characteristics and oncological outcome. RESULTS Malignant and atypical cells were seen in 125 (7.5%) and 58 (3.5%) cases, respectively. On multivariate analysis, non-obesity, non-diabetes mellitus, cigarette use, and lympho-vascular space invasion were independently associated with abnormal peritoneal cytology (all, P<0.05). Abnormal peritoneal cytology was independently associated with decreased disease-free survival (hazard ratio 3.07, P<0.001) and cause-specific survival (hazard ratio 3.42, P=0.008) on multivariate analysis. Abnormal peritoneal cytology was significantly associated with increased risks of distant-recurrence (5-year rates: 8.8% versus 3.6%, P=0.001) but not local-recurrence (5.2% versus 3.0%, P=0.32) compared to negative cytology. Among women with stage I disease, abnormal peritoneal cytology was significantly associated with an increased risk of distant-recurrence in the low risk group (5-year rates: 5.5% versus 1.0%, P<0.001) but not in the high-intermediate risk group (13.3% versus 10.8% P=0.60). Among 183 women who had abnormal peritoneal cytology, postoperative chemotherapy significantly reduced the rate of peritoneal recurrence (5-year rates: 1.3% versus 9.2%, P=0.039) whereas postoperative radiotherapy did not (7.1% versus 5.5%, P=0.63). CONCLUSION Our study suggests that abnormal peritoneal cytology may be a prognostic factor for decreased survival in women with stage I-II endometrioid endometrial cancer, particularly for low-risk group.
Collapse
|
21
|
Yeh CC, Su FH, Tzeng CR, Muo CH, Wang WC. Women with adenomyosis are at higher risks of endometrial and thyroid cancers: A population-based historical cohort study. PLoS One 2018. [PMID: 29522577 PMCID: PMC5844548 DOI: 10.1371/journal.pone.0194011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective Both adenomyosis and endometriosis are characterized by the presence of ectopic endometrial glands and stroma and have been suggested to share some characteristics with malignant tumors. Although accumulating evidence indicates that endometriosis is associated with some cancer types, the cancer risks in patients with adenomyosis have been rarely examined. In this study, we investigated the relationship between adenomyosis and risks of common cancers. Methods This study included a cohort of 12,447 women with adenomyosis but not endometriosis, born in 1951–1984, and a cohort of 124,470 adenomyosis-free women matched by birth year. Their medical records (collected between 1996 and 2011) were obtained from the National Health Insurance Research Database of Taiwan. We first compared the distribution of cancer-free survival (CFS) between cohorts with and without adenomyosis. Subsequently, within the adenomyosis cohort, we examined whether time-to-onset of the identified cancer type was correlated with time-to-onset of adenomyosis. The Cox proportional hazards model was used to compare the distribution of CFS between the adenomyosis and adenomyosis-free cohorts and between the early- and late-diagnosed adenomyosis groups. For comparison, we further evaluated the cancer risks for a cohort of 10,962 women with endometriosis but not adenomyosis and a birth-year matched cohort of 109,620 endometriosis-free women. Results Compared with adenomyosis-free women, patients with adenomyosis had higher risks of endometrial and thyroid cancers, with estimated hazard ratios (HRs) (95% confidence interval) of 2.19 (1.51–3.16) and 1.70 (1.29–2.24), respectively. For both cancers, distributions of CFS were not significantly different between the early- and late-diagnosed adenomyosis groups. Furthermore, compared with endometriosis-free women, patients with endometriosis had higher risks of endometrial and ovarian cancers, with HRs of 1.89 (1.07–3.35) and 2.01 (1.27–3.16), respectively. Conclusions Women with adenomyosis are at higher risks of endometrial and thyroid cancers, while women with endometriosis are at higher risks of endometrial and ovarian cancers.
Collapse
Affiliation(s)
- Chih-Ching Yeh
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Fu-Hsiung Su
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Division of Family Medicine, Department of Community Medicine and Long Term Care, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Chii-Ruey Tzeng
- Center for Reproductive Medicine and Sciences, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Hsin Muo
- College of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Chang Wang
- The Ph.D. Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
22
|
Tashima L, Hori K, Ono H, Nagano T, Nakatsuka SI, Ito K. Endometrioid adenocarcinoma originating simultaneously from endometrium, sites of adenomyosis and ovarian endometriosis: A case report and review of our cancer database. Int J Surg Case Rep 2017; 41:226-229. [PMID: 29096350 PMCID: PMC5686221 DOI: 10.1016/j.ijscr.2017.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/14/2017] [Accepted: 10/22/2017] [Indexed: 12/04/2022] Open
Abstract
Endometrioid adenocarcinoma was occurred at three sites simultaneously. Independent ovarian cancer may coexist in case of corpus cancer. Adenomyosis can be an origin for adenocarcinoma.
Introduction Although adenomyosis is a common disease, it is a relatively rare site for cancer origin. On the other hand, chocolate cysts have the potential to develop into cancer. We report a case of endometrioid adenocarcinoma occurred at three sites simultaneously; uterine endometrium, adenomyosis and ovarian endometriosis. Presentation of case A 51-year-old woman underwent total hysterectomy and bilateral salpingo-oophorectomy after a diagnosis of corpus cancer (endometrioid adenocarcinoma, G1) stage IA. However, cancer was also found independently at the site of adenomyosis and in endometrioid cysts after a detailed postoperative histological investigation. There has been no sign of recurrence at 12 months after six cycles of chemotherapy with paclitaxel and carboplatin. Discussion We reviewed cases of corpus cancer between January 2011 and December 2015 from our cancer database. Two hundred thirty-three patients with corpus cancer were identified. Ovarian malignancies were found in nine cases and six cases of them were histologically the same with the corpus cancer, but ovarian endometriosis was found in only two cases. On the other hand, adenomyosis was found histologically in 30 of these cases, but the case presented here was the only one diagnosed with cancer at a site of adenomyosis. Conclusion The mechanism by which malignancy develops in the normal endometrial tissue is not clear, but if endometrial cancer is found in the uterus, it could also be present in ectopic endometrial tissues such as sites of adenomyosis or chocolate cysts.
Collapse
Affiliation(s)
- Lena Tashima
- Department of Obstetrics & Gynecology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki city, Hyogo, 660-8511, Japan.
| | - Kensuke Hori
- Department of Obstetrics & Gynecology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki city, Hyogo, 660-8511, Japan
| | - Hitomi Ono
- Department of Obstetrics & Gynecology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki city, Hyogo, 660-8511, Japan; Department of Obstetrics, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-110, Japan
| | - Teruaki Nagano
- Department of Diagnostic Pathology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki city, Hyogo, 660-8511, Japan
| | - Shin-Ichi Nakatsuka
- Department of Diagnostic Pathology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki city, Hyogo, 660-8511, Japan; Department of Diagnostic Pathology, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka, 541-8567, Japan
| | - Kimihiko Ito
- Department of Obstetrics & Gynecology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki city, Hyogo, 660-8511, Japan
| |
Collapse
|
23
|
Hertlein L, Rath J, Zeder-Göss C, Fürst S, Bayer D, Trillsch F, Mahner S, Burges A, Jeschke U. Coexistence of adenomyosis uteri and endometrial cancer is associated with an improved prognosis compared with endometrial cancer only. Oncol Lett 2017; 14:3302-3308. [PMID: 28927080 PMCID: PMC5588003 DOI: 10.3892/ol.2017.6592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/11/2017] [Indexed: 12/13/2022] Open
Abstract
The present study aimed to identify differences in protein expression in cases of endometrioid endometrial cancer (EEC) with and without coexisting adenomyosis uteri (AM), and to evaluate the histopathological and prognostic distinctions. The total cohort included 22 patients in Group A (patients with concomitant AM and EEC) and 35 patients in Group B (patients affected only by EEC). Evaluation of the following factors was performed: Tumour grade, International Federation of Gynaecology and Obstetrics (FIGO) stage, survival, and expression of estrogen receptor β (ERβ), glycodelin and inhibin βB. Group A (AM and EEC) was associated with a lower tumour grade (G1, 90.9 vs. 45.7%; P=0.001) and a lower FIGO stage (FIGO stage I, 100 vs. 80%; P=0.002) compared with Group B (EEC only). In the survival analysis, Group A was associated with a significantly higher 5-year survival rate (95 vs. 82%; P=0.024) than Group B. In addition, the expression of ERβ in Group A was significantly higher (P<0.001), whereas the expression of glycodelin is significantly lower (P=0.028), compared with Group B. The results of the present study indicate that the presence of AM in cases of EEC may be a positive prognostic factor.
Collapse
Affiliation(s)
- Linda Hertlein
- Department of Obstetrics and Gynecology, Ludwig-Maximilian University of Munich, D-81377 Munich, Germany
| | - Johanna Rath
- Department of Obstetrics and Gynecology, Ludwig-Maximilian University of Munich, D-81377 Munich, Germany
| | - Christine Zeder-Göss
- Department of Obstetrics and Gynecology, Ludwig-Maximilian University of Munich, D-81377 Munich, Germany
| | - Sophie Fürst
- Department of Obstetrics and Gynecology, Ludwig-Maximilian University of Munich, D-81377 Munich, Germany
| | - Daniela Bayer
- Department of Obstetrics and Gynecology, Ludwig-Maximilian University of Munich, D-81377 Munich, Germany
| | - Fabian Trillsch
- Department of Obstetrics and Gynecology, Ludwig-Maximilian University of Munich, D-81377 Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, Ludwig-Maximilian University of Munich, D-81377 Munich, Germany
| | - Alexander Burges
- Department of Obstetrics and Gynecology, Ludwig-Maximilian University of Munich, D-81377 Munich, Germany
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, Ludwig-Maximilian University of Munich, D-81377 Munich, Germany
| |
Collapse
|
24
|
Abstract
OBJECTIVE To examine the survival outcomes in women with endometrial cancer who were taking low-dose aspirin (81-100 mg/d). METHODS A multicenter retrospective study was conducted examining patients with stage I-IV endometrial cancer who underwent hysterectomy-based surgical staging between January 2000 and December 2013 (N=1,687). Patient demographics, medical comorbidities, medication types, tumor characteristics, and treatment patterns were correlated to survival outcomes. A Cox proportional hazard regression model was used to estimate adjusted hazard ratio for disease-free and disease-specific overall survival. RESULTS One hundred fifty-eight patients (9.4%, 95% confidence interval [CI] 8.8-11.9) were taking low-dose aspirin. Median follow-up time for the study cohort was 31.5 months. One hundred twenty-seven patients (7.5%) died of endometrial cancer. Low-dose aspirin use was significantly correlated with concurrent obesity, hypertension, diabetes mellitus, and hypercholesterolemia (all P<.001). Low-dose aspirin users were more likely to take other antihypertensive, antiglycemic, and anticholesterol agents (all P<.05). Low-dose aspirin use was not associated with histologic subtype, tumor grade, nodal metastasis, or cancer stage (all P>.05). On multivariable analysis, low-dose aspirin use remained an independent prognostic factor associated with an improved 5-year disease-free survival rate (90.6% compared with 80.9%, adjusted hazard ratio 0.46, 95% CI 0.25-0.86, P=.014) and disease-specific overall survival rate (96.4% compared with 87.3%, adjusted hazard ratio 0.23, 95% CI 0.08-0.64, P=.005). The increased survival effect noted with low-dose aspirin use was greatest in patients whose age was younger than 60 years (5-year disease-free survival rates, 93.9% compared with 84.0%, P=.013), body mass index was 30 or greater (92.2% compared with 81.4%, P=.027), who had type I cancer (96.5% compared with 88.6%, P=.029), and who received postoperative whole pelvic radiotherapy (88.2% compared with 61.5%, P=.014). These four factors remained significant for disease-specific overall survival (all P<.05). CONCLUSION Our results suggest that low-dose aspirin use is associated with improved survival outcomes in women with endometrial cancer, especially in those who are young, obese, with low-grade disease, and who receive postoperative radiotherapy.
Collapse
|
25
|
Machida H, Maeda M, Cahoon SS, Scannell CA, Garcia-Sayre J, Roman LD, Matsuo K. Endometrial cancer arising in adenomyosis versus endometrial cancer coexisting with adenomyosis: are these two different entities? Arch Gynecol Obstet 2017; 295:1459-1468. [PMID: 28444512 DOI: 10.1007/s00404-017-4375-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/18/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE While adenomyosis is one of the most common benign histologic findings in hysterectomy specimens of endometrial cancer, demographics of endometrial cancer arising in adenomyosis (EC-AIA) has not been well elucidated. The aim of this study is to evaluate histopathological findings and disease-free survival (DFS) of EC-AIA in comparison to endometrial cancer coexisting with adenomyosis (EC-A). METHODS EC-AIA cases were identified via a systematic literature search (n = 46). EC-A cases were identified from a historical cohort that underwent hysterectomy-based surgical staging in two institutions (n = 350). Statistical comparisons of the two groups were based on univariate and multivariate analyses. RESULTS The EC-AIA group was significantly older than the EC-A group (58.9 versus 53.8, p = 0.002). As to tumor characteristics, 63.6% of EC-AIA cases reported tumor within the myometrium without endometrial extension. The EC-AIA group was significantly associated with more non-endometrioid histology (23.9 versus 14.8%; p = 0.002) and deep myometrial tumor invasion (51.6 versus 19.4%; p < 0.001) than EC-A. Tumor grade, stage, and nodal metastasis risk were similar (all, p > 0.05). In a univariate analysis, the EC-AIA group had a significantly decreased DFS compared to EC-A (5-year rates, 72.2 versus 85.5%, p = 0.001). After controlling for age, histology, tumor grade, and stage, EC-AIA remained an independent prognostic factor associated with decreased DFS compared to EC-A (adjusted-hazard ratio 2.87, 95% confidence interval 1.44-5.70, p = 0.031). CONCLUSION Our study demonstrated that EC-AIA has distinct tumor characteristics and a poorer survival outcome compared to EC-A. This suggests a benefit of recognition of this unique entity as an aggressive variant of endometrial cancer.
Collapse
Affiliation(s)
- Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA
| | - Midori Maeda
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Sigita S Cahoon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA
| | | | - Jocelyn Garcia-Sayre
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA.,Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA. .,Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
| |
Collapse
|