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de Freitas D, Aguiar FN, Anton C, de Almeida DC, Bacchi CE, Carvalho JP, Carvalho FM. Clinicopathological characteristics of endometrial carcinomas according to DNA mismatch repair protein status. Heliyon 2023; 9:e17495. [PMID: 37408903 PMCID: PMC10319187 DOI: 10.1016/j.heliyon.2023.e17495] [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: 04/23/2023] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
DNA mismatch repair protein deficiency (MMRd) in endometrial carcinoma is associated with the risk of Lynch syndrome and response to immune checkpoint inhibitors. It is also related to microsatellite instability and corresponds to a molecular subtype of endometrial tumor with an unclear prognosis. Here, we evaluated the clinicopathological characteristics and prognosis of 312 consecutive endometrial carcinoma cases submitted to complete surgical staging at a single institution. We compared MMRd and mismatch repair protein-proficient (MMRp) tumors and examined the effects of the MMR protein loss type (MLH1/PMS2 vs. MSH2/MSH6) and influence of L1CAM and p53 expression. The median follow-up period was 54.5 (range, 0-120.5) months. No difference was observed between MMRd [n = 166 (37.2%)] and MMRp [n = 196 (62.8%)] cases in terms of age, body mass index, FIGO stage, tumor grade, tumor size, depth of myometrial infiltration, or lymph node metastasis. More MMRd than MMRp tumors had endometrioid histology (87.9% vs. 75.5%) and despite MMRd had more lymphovascular space invasion (LVSI; 27.2% vs. 16.9%), they presented fewer recurrences and no difference in lymph node metastasis and disease-related death. Relative to those with MLH1/MSH6 loss, tumors with MSH2/MSH6 loss were diagnosed at earlier FIGO stages, were smaller, and had less ≥50% myometrial invasion, LVSI and lymph node metastasis. Outcomes, however, did not differ between these groups. L1CAM positivity and mutation-type p53 expression were more common in MMRp than in MMRd tumors and did not differ between the MLH1/PMS2 and MSH2/MSH6 loss groups. In the entire cohort, L1CAM and mutation p53 expression were associated with worse prognosis, but only non-endometrioid histology, FIGO stage III/IV, and deep myometrial infiltration were significant predictors. In the subgroup of endometrioid carcinomas, only FIGO stage III/IV was associated with poor outcomes. The risk of lymph node metastasis was associated with tumor size, non-endometrioid histology, and multifocal LVSI. For MMRd tumors, only tumor size and myometrial invasion depth were predictive of lymph node involvement. In our cohort, MMRd tumors were associated with greater recurrence-free, but not overall, survival. The precise identification of MMRd status, present in a substantial proportion of endometrial cancer cases, is a challenge to be overcome for proper patient management. MMRd status serves as a marker for Lynch syndrome, and a significant number of these tumors are high risk and candidate to immunotherapy.
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Affiliation(s)
- Daniela de Freitas
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 251, ZIP code 01246-000, Sao Paulo, SP, Brazil
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, room 1465, ZIP code 01246-903, Sao Paulo, SP, Brazil
| | - Fernando Nalesso Aguiar
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 251, ZIP code 01246-000, Sao Paulo, SP, Brazil
| | - Cristina Anton
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 251, ZIP code 01246-000, Sao Paulo, SP, Brazil
| | | | - Carlos Eduardo Bacchi
- Consultoria em Patologia, Rua Major Leônidas Cardoso, 739, ZIP code 18602-010, Botucatu, SP, Brazil
| | - Jesus Paula Carvalho
- Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 251, ZIP code 01246-000, Sao Paulo, SP, Brazil
- Department of Obstetrics and Gynecology, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, ZIP code 05403-000, Sao Paulo, SP, Brazil
| | - Filomena Marino Carvalho
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, room 1465, ZIP code 01246-903, Sao Paulo, SP, Brazil
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Temporal trends and factors associated with the cancer diagnosed at stage IV in patients included in the integrated hospital-based cancer registry system in Brazil in two decades. Cancer Epidemiol 2022; 80:102242. [PMID: 36087358 DOI: 10.1016/j.canep.2022.102242] [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: 05/09/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND In several countries, such as Brazil, the oncological diagnosis usually occurs at an advanced stage of the disease. Thus, the aim of this study was to investigate temporal trends and factors associated with the cancer diagnosed at stage IV in Brazil in two decades. METHODS Secondary-based study, with time series analysis for trend assessment and cross-sectional of factors associated with diagnosis of female breast, prostate, cervix uteri, colorectal, lung, stomach, lip and oral cavity, thyroid, esophagus or corpus uteri at stage IV. RESULTS 1,218,322 cases were evaluated. The types of cancer with the highest proportion of stage IV at diagnosis in men and women, respectively, were: lung (53.7% and 57.4%), stomach (48.4% and 45.0%) and lip/oral cavity (53.5% and 43.4%). Most showed an increasing trend of annual percent change of cancer diagnosed at stage IV, being more pronounced in corpus uteri cancer (2013-2019: +7.4%, p < 0.001). The odds of cancer diagnosed at stage IV were associated with different factors, according to primary tumor site, but marked by the inverse association with female sex [odds ratio (OR) ranging from 0.42 to 0.91, p < 0.001] and direct association in cases with < 7 years of study (OR ranging from 1.08 to 1.81, p < 0.001), living without a partner (OR ranging from 1.06, p < 0.050 to1.27, p < 0.001), living in the South and Southeast regions (OR ranging from 1.04 to 1.13, p < 0.001), with more than one tumor (OR ranging from 1.19, p < 0.050 to 1.54, p < 0.001) and treated in Centers of High Complexity in Oncology (OR ranging from 1.03, p < 0.050 to1.24, p < 0.001). CONCLUSION There was a high frequency of cancer diagnosed at stage IV and an increasing trend in different cancer types, which were associated with distinct sociodemographic, lifestyle, and clinical factors.
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Ye L, Wang X, Li B. Expression profile of epithelial-mesenchymal transition-related genes as a prognostic biomarker for endometrial cancer. J Cancer 2021; 12:6484-6496. [PMID: 34659539 PMCID: PMC8489121 DOI: 10.7150/jca.62729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/22/2021] [Indexed: 12/20/2022] Open
Abstract
Epithelial-mesenchymal transition (EMT) is regulated by inducible factors, transcription factors, and a series of genes involved in diverse signaling pathways, which are correlated with tumor invasion and progression. In the present study, we analyzed the expression profile data of 1169 EMT-related genes in endometrial cancer (EC) from the Cancer Genome Atlas (TCGA) dataset, and performed consistency clustering to divide EC samples into two subgroups based on overall survival. The genes differentially expressed between the two subtypes included EMT-related genes. Univariate Cox analysis and least absolute shrinkage and selection operator (LASSO) were applied to construct a prognostic model based on the 44 genes signature. Five genes (L1CAM, PRKCI, ESR1, CDKN2A, and VIM) were finally included to establish a formula for prognostic risk score. The low-risk group showed significantly better prognosis compared with the high-risk group in the TCGA dataset. In addition, the risk-scoring model successfully predicted prognosis in an external GEO dataset (GSE102073). The relationship between ERα and vimentin levels was confirmed through immunohistochemistry. In conclusion, these data indicate that the expression profile of EMT-related genes could predict prognosis in EC.
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Affiliation(s)
- Lei Ye
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Xiaojun Wang
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Bilan Li
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China
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Januszek SM, Wita-Popow B, Kluz M, Janowska M, Januszek R, Wróbel A, Rogowski A, Malinowski KP, Zuzak T, Kluz T. Risk Factors for Surgical Treatment of Endometrial Cancer Using Traditional and Laparoscopic Methods. J Clin Med 2021; 10:429. [PMID: 33499336 PMCID: PMC7865410 DOI: 10.3390/jcm10030429] [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: 12/05/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 11/22/2022] Open
Abstract
Surgical treatment is the most important part of therapy for endometrial cancer. The aim of the study was to define factors having the most significant impact on surgical treatment of endometrial cancer when using traditional and laparoscopic methods. In the study, we evaluated 75 females who were treated for endometrial cancer via laparoscopic surgery in 2019 and used a historical control of 70 patients treated by laparotomy in 2011. The evaluated risk factors included the method of surgery, type of lymphadenectomy, patient's age, various obesity parameters, histological grading, cancer clinical staging, pelvic dimensions, previous abdominal surgeries, comorbidities, and number of deliveries. The duration of hospitalization, operation time, loss of hemoglobin, and procedure-related complications were used as parameters of perioperative outcomes. Multivariable linear regression analysis confirmed the following factors as being predictors of worse perioperative outcomes: laparotomy, abdominal obesity (waist circumstance and waist-to-hip ratio), range of lymphadenectomy, prior abdominal surgeries, and larger pelvic dimensions. Abdominal obesity is a significant risk factor in the treatment of endometrial cancer. Laparotomy continues to be utilized frequently in the management of endometrial cancer in Poland as well as elsewhere, and adopting a minimally invasive approach is likely to be beneficial for patient outcome.
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Affiliation(s)
- Sławomir M. Januszek
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
| | - Barbara Wita-Popow
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
| | - Marta Kluz
- Department of Pathology, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland;
| | - Magdalena Janowska
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
| | - Rafał Januszek
- Department of Clinical Rehabilitation, University of Physical Education, 31-571 Kraków, Poland;
| | - Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland;
| | - Artur Rogowski
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warsaw, Poland;
- Department of Obstetrics and Gynecology, Mother and Child Institute, 01-211 Warsaw, Poland
| | - Krzysztof P. Malinowski
- Faculty of Health Sciences, A Institute of Public Health, Jagiellonian University Medical College, 31126 Kraków, Poland;
| | - Tomasz Zuzak
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
| | - Tomasz Kluz
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
- Department of Gynecology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszów, Poland
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