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Ayhan A, Tunç M, Akıllı H, Haberal N, Haberal A. Fertility-sparing approach to malignant ovarian germ cell tumors - Oncologic and obstetric outocome: A retrospective study. Int J Gynaecol Obstet 2024; 164:1074-1079. [PMID: 37737565 DOI: 10.1002/ijgo.15141] [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: 08/09/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To evaluate oncologic (such as disease-free and overall survival) and obstetric outcomes in patients diagnosed with malignant ovarian germ cell tumors (MOGCTs). METHODS Patients diagnosed with MOGCTs between March 2007 and February 2022 were evaluated and patients who underwent fertility sparing surgery were included in this retrospective study. The obstetric and oncologic outcomes were evaluated by collecting data up until the patient's last follow-up visit from the hospital records and patient files. The study was approved by Başkent University Institutional Review Board (KA23/124). RESULTS Seventy FSS patients were included in this study. The median age of the patients was 22.5 years (range: 11-37). The median follow-up time was 92.0 months (10-189). Immature teratoma was the most common histological subtype (32.9%). Bilateral involvement was detected in only one patient with immature teratoma (1.4%). The 5-year DFS rates of immature teratoma, dysgerminoma, yolk sac, and mixed germ cell histologic types were 91.1%, 94.1%, 82.4%, and 88.9%, respectively (P: 0.716). The 5-year OS rates of the same histologic types were 95.7%, 100%, 88.2%, and 88.9%, respectively (P = 0.487). All patients (100%) had a regular menstrual cycle after the completion of adjuvant treatment. The mean time between the last chemotherapy and menstruation was 4.38 months. To date, a total of 34 patients tried to conceive after the completion of disease treatment. A total of 23 (67.6%) patients conceived, resulting in 27 live births in 22 (100%) patients. CONCLUSION Fertility preservation should be the first treatment option in MOGCTs in young patients due to the unilateral involvement of the disease and its chemosensitive nature.
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Affiliation(s)
- Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Başkent University Hospital, Ankara, Turkey
| | - Mehmet Tunç
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Başkent University Hospital, Ankara, Turkey
| | - Hüseyin Akıllı
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Başkent University Hospital, Ankara, Turkey
| | - Nihan Haberal
- Department of Pathology, Başkent University Hospital, Ankara, Turkey
| | - Ali Haberal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Başkent University Hospital, Ankara, Turkey
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Vasta FM, Cormio G, Cassani C, Bergamini A, Scarfone G, Ferrandina G, De Vivo R, Marinaccio M, Danese S, Raspagliesi F, Pignata S, Mangili G. Reproductive outcomes after conservative treatment in early and advanced stage MOGCTs. Gynecol Oncol 2024; 181:28-32. [PMID: 38104526 DOI: 10.1016/j.ygyno.2023.11.023] [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: 08/02/2023] [Revised: 11/05/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Malignant ovarian germ cell tumors usually occur in young women. The standard of care is fertility sparing surgery and comprehensive surgical staging followed by adjuvant chemotherapy with BEP (bleomycin, etoposide, cisplatin) if needed. The aim of this study was to analyze the reproductive outcomes after conservative treatment in patients diagnosed, treated and followed up in MITO (Multicenter Italian Trials in Ovarian Cancer) centers. METHODS A questionnaire concerning gynecological symptoms, reproductive outcomes and fertility treatment was administered to 164 MOGCTs survivors. Data regarding patients deceased were collected from MITO-9 database. There were 114 patients diagnosed at reproductive age between 1983 and 2019 included. RESULTS 109 patients answered the questionnaire and 5 patients decesased were included (median age 24.9 years). 78.1% were stage I,4.4% stage II, 14.9% stage III and 2.6% stage IV. 57.9% received chemotherapy, the mean number of cycles was 4.1. Median time to menstrual recovery after BEP was of 5.6 months range, only 1 case of premature ovarian failure was reported. Among the 114 patients 38 (33.3%) attempted to become pregnant, 29/38 (76.3%) got pregnant with a total of 44 conceptions. 40.9% received chemotherapy and 22.9% did not (p 0.048). Pregnancy desire was the only predictive factor associated with live births among women who attempted pregnancy after treatment. CONCLUSIONS As MOGCTs affect women of child-bearing age, fertility preservation represents a major treatment issue. Our results are consistent with the available evidence, confirming that adjuvant chemotherapy for MOGCT does not impact the reproductive function and fertility.
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Affiliation(s)
- Francesca M Vasta
- Department of Obstetrics and Gynecology, IRCCS San Raffaele, Milan, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori di Bari, Italy; Department of Interdisciplinary Medicine, University of Bari, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Policlinico San Matteo-University of Pavia, Pavia, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy.
| | | | - Gabriella Ferrandina
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy
| | - Rocco De Vivo
- Department of Oncology, Ospedale san Bartolo, Vicenza, Italy
| | - Marco Marinaccio
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Italy
| | - Saverio Danese
- Deparment of Obstetrics and Gynecology, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | | | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, IRCCS San Raffaele, Milan, Italy
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Piątek S, Szymusik I, Sobiczewski P, Michalski W, Kowalska M, Ołtarzewski M, Bidziński M. Obstetric Results after Fertility-Sparing Management of Non-Epithelial Ovarian Cancer. Cancers (Basel) 2023; 15:4170. [PMID: 37627198 PMCID: PMC10453521 DOI: 10.3390/cancers15164170] [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: 08/01/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE To assess the recurrence and birth rates among patients with non-epithelial ovarian cancer. METHODS The study included 146 patients with germ cell (GCT, n = 84) and sex cord-stromal tumors (SCST, n = 62), who underwent fertility-sparing surgery. Adjuvant chemotherapy was administered to 86 (58.9%) patients. Most cases (133 out of 146) were staged FIGO I. RESULTS The 5- and 10-year disease-free survival rates were 91% and 83%, respectively. The recurrence risk was not associated with tumor histology, stage or age. Twenty-four months after the treatment, the rate of recurrence was higher than the rate of childbearing. The childbearing rates kept rising after the treatment and exceeded the rate of recurrence after 2 years. The cumulative incidence rates of birth 36, 60 and 120 months after treatment were 13.24%, 20.75%, and 42.37%, respectively. Chemotherapy was not related to childbearing. The patients' age was related to the chance of childbearing. CONCLUSIONS The prognoses of GCT and SCST are similar. Close follow-ups along with contraception should be offered to women during the first two years after treatment due to the increased risk of recurrence. After this period, relapses are rare and women can safely become pregnant.
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Affiliation(s)
- Szymon Piątek
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (W.M.); (M.K.); (M.B.)
- Faculty of Medical Sciences and Health Sciences, Kazimierz Pulaski University of Technology and Humanities in Radom, 26-610 Radom, Poland
| | - Iwona Szymusik
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, 80 Ceglowska Street, 00-001 Warsaw, Poland;
| | - Piotr Sobiczewski
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (W.M.); (M.K.); (M.B.)
| | - Wojciech Michalski
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (W.M.); (M.K.); (M.B.)
| | - Magdalena Kowalska
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (W.M.); (M.K.); (M.B.)
| | | | - Mariusz Bidziński
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.S.); (W.M.); (M.K.); (M.B.)
- Faculty of Medical Sciences and Health Sciences, Kazimierz Pulaski University of Technology and Humanities in Radom, 26-610 Radom, Poland
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Alhusaini H, Elshenawy MA, Badran A, Elshentenawy A, Mohieldin A, Mostafa Gad A, Omar A, Shaheen A, Elhassan T, Soudy H. Adult-Type Ovarian Granulosa Cell Tumour: Treatment Outcomes From a Single-Institution Experience. Cureus 2022; 14:e31045. [DOI: 10.7759/cureus.31045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/07/2022] Open
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Saeed Usmani A, Yasin I, Asif RB, Kahlid N, Syed A. Incidence and Survival Rates for Female Malignant Germ Cell Tumors: An Institutional Review. Cureus 2022; 14:e24497. [PMID: 35651446 PMCID: PMC9135046 DOI: 10.7759/cureus.24497] [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] [Accepted: 04/26/2022] [Indexed: 11/05/2022] Open
Abstract
Background Germ cell tumor survival rates have improved over the past few decades. However, there is a lack of data on survival rates and the incidence of female germ cell tumors. This study aims to determine the incidence and survival rates of female germ cell tumors in our institution. Methodology This retrospective cross-sectional study was carried out at Shaukat Khanum Memorial Hospital and Research Centre, and the records over 10 years, from January 2010 to December 2020 were examined. The data of 290 females with malignant germ cell tumors were selected from 1387 females with ovarian masses, and their survival records were examined. For statistical analysis, SPSS software (version 24.0; IBM Corp. Armonk, NY) was utilized. The survival analysis was determined using the Kaplan-Meier method. Results The mean age of patients was 21.45 ± 9.28 years. The mean duration of diagnosis was 4.53 ± 2.59 years. In 245 (84.5%) patients, ovarian malignancy was involved while uterine malignancy was observed in 44 (15.2%) cases and there was one (0.3%) case of cervical carcinoma. The most common stage at diagnosis of malignancy was IA (96 (33.1%)), followed by IIIC (58 (20.0%)), IV (56 (19.3%)) and IC (26 (9.0%)). Chemotherapy was given in 244 (84.1%) cases. Out of 290 cases, 26 (9.0%) had a recurrence of the tumor while 264 (91.0%) did not have a recurrence of the tumor. Out of 290 cases, 46 (15.9%) died during follow-up, 129 (44.4%) had disease-free survival while 115 (39.7%) were healthy till the end of the study. The mean duration of survival was 3.56 ± 2.33 years. When patients' survival was compared between treatment groups, patients who did not receive chemotherapy fared better than those who did. Conclusion Female germ cell tumor patients have a good overall survival rate of more than 20% after 10 years of follow-up with effective adjuvant therapy and conservative surgery. However, more research is needed to determine the long-term effects of chemotherapy on ovarian function.
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Primary Ovarian Choriocarcinoma: Rare Entity. Case Rep Obstet Gynecol 2021; 2021:4545375. [PMID: 34608421 PMCID: PMC8487380 DOI: 10.1155/2021/4545375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/13/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background Primary pure ovarian choriocarcinoma is a rare aggressive tumor which can be nongestational arising from germ cells or gestational origin. Preoperative diagnosis of extrauterine choriocarcinoma is challenging due to nonspecific clinical presentation. Case Presentation. This article reports primary ovarian choriocarcinoma, likely gestational in a 25-year-old para 2 woman presenting with lower abdominal pain and swelling of two-week duration. Diagnosis was suspected by serum beta-human chorionic gonadotropin and confirmed histologically after surgery. Postoperatively, she was managed with multiple courses of chemotherapy using a bleomycin, etoposide, and cisplatin regimen, and the treatment was effective. Conclusion In patients with adnexal mass presenting with nonspecific symptoms especially with high Doppler blood flow of the mass on ultrasound evaluation, serum beta-human chorionic gonadotropin determination is recommended before laparotomy. In setups where the genomic test is not available, histological and clinical effort to differentiate gestational versus nongestational choriocarcinoma is useful for specific management decision.
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Li C, Aishajiang R, Teng Y, Xu T, Ding L, Dong L. Non-Peutz-Jeghers syndrome-associated ovarian sex cord tumor with annular tubules treated by radiotherapy: a case report and literature review. J Int Med Res 2021; 49:300060521996563. [PMID: 33715493 PMCID: PMC7952844 DOI: 10.1177/0300060521996563] [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] [Indexed: 11/21/2022] Open
Abstract
There are no standard treatment options for metastatic and recurrent non-Peutz–Jeghers syndrome (PJS)-associated sex cord tumor with annular tubules (SCTAT). The effects of chemotherapy and/or radiotherapy are still not well-defined. Herein, we present a case of a metastatic and recurrent non-PJS-associated SCTAT showing high serum estradiol and progesterone concentrations after surgery and chemotherapy. Radiotherapy (50 Gy/25 fractions) triggered a sharp reduction in the sizes of the metastatic and recurrent masses, and estradiol and progesterone concentrations. Accordingly, we consider that radiotherapy might be effective and safe for metastatic and recurrent SCTAT. The roles of radiotherapy in non-PJS SCTAT should be further validated in large-scale prospective clinical trials.
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Affiliation(s)
- Cheng Li
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, China
| | - Reyida Aishajiang
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, China
| | - Yongliang Teng
- Department of Pathology, The First Hospital of Jilin University, Changchun, China
| | - Tiankai Xu
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, China
| | - Lijuan Ding
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, China
| | - Lihua Dong
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, China
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Zhu H, Ai Y, Zhang J, Zhang J, Jin J, Xie C, Su H, Jin X. Preoperative Nomogram for Differentiation of Histological Subtypes in Ovarian Cancer Based on Computer Tomography Radiomics. Front Oncol 2021; 11:642892. [PMID: 33842352 PMCID: PMC8027335 DOI: 10.3389/fonc.2021.642892] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/03/2021] [Indexed: 12/27/2022] Open
Abstract
Objectives Non-invasive method to predict the histological subtypes preoperatively is essential for the overall management of ovarian cancer (OC). The feasibility of radiomics in the differentiating of epithelial ovarian cancer (EOC) and non-epithelial ovarian cancer (NEOC) based on computed tomography (CT) images was investigated. Methods Radiomics features were extracted from preoperative CT for 101 patients with pathologically proven OC. Radiomics signature was built using the least absolute shrinkage and selection operator (LASSO) logistic regression. A nomogram was developed with the combination of radiomics features and clinical factors to differentiate EOC and NEOC. Results Eight radiomics features were selected to build a radiomics signature with an area under curve (AUC) of 0.781 (95% confidence interval (CI), 0.666 -0.897) in the discrimination between EOC and NEOC. The AUC of the combined model integrating clinical factors and radiomics features was 0.869 (95% CI, 0.783 -0.955). The nomogram demonstrated that the combined model provides a better net benefit to predict histological subtypes compared with radiomics signature and clinical factors alone when the threshold probability is within a range from 0.43 to 0.97. Conclusions Nomogram developed with CT radiomics signature and clinical factors is feasible to predict the histological subtypes preoperative for patients with OC.
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Affiliation(s)
- Haiyan Zhu
- Department of Gynecology, Shanghai First Maternal and Infant Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Gynecology, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yao Ai
- Department of Radiotherapy Center, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jindi Zhang
- Department of Gynecology, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ji Zhang
- Department of Radiotherapy Center, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Juebin Jin
- Department of Medical Engineering, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Congying Xie
- Department of Radiation and Medical Oncology, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Radiation and Medical Oncology, The 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huafang Su
- Department of Radiation and Medical Oncology, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiance Jin
- Department of Gynecology, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Reproductive Outcomes and Fertility Preservation Strategies in Women with Malignant Ovarian Germ Cell Tumors after Fertility Sparing Surgery. Biomedicines 2020; 8:biomedicines8120554. [PMID: 33265938 PMCID: PMC7761340 DOI: 10.3390/biomedicines8120554] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 12/19/2022] Open
Abstract
Malignant ovarian germ cell tumors are rare tumors that mainly affect patients of reproductive age. The aim of this study was to investigate the reproductive outcomes and fertility preservation strategies in malignant ovarian germ cell tumors after fertility-sparing surgery. Data in literature support that fertility-sparing surgery is associated with an excellent oncological outcome not only in early stages malignant ovarian germ cell tumors but also in advanced stages. Moreover, the possibility of performing conservative treatment should be considered even in case of relapse or advanced disease, given the high chemosensitivity. Indeed, available data have shown that menstrual function is maintained after platinum-based regimens in over 85-95% of patients with malignant ovarian germ cell tumors and rate of premature menopause reported in literature ranges between 3% and 7.4%, while premature ovarian failure rates are between 3.4% and 5%. Moreover, reproductive outcomes are about 80% with no increase in the risk of teratogenicity compared to general population. Therefore, conservative surgery for malignant ovarian germ cell tumors currently may represent a therapeutic option in patients who wish to preserve fertility but must be available for extended follow-up and after subscribing to informed consent.
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Fertility preservation treatment of gynecological cancer patients in Spain: a national survey (GOFER study). Arch Gynecol Obstet 2020; 301:793-800. [DOI: 10.1007/s00404-020-05468-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/13/2020] [Indexed: 02/07/2023]
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Li Y, Jiao Y, Hao J, Xing H, Li C. Long noncoding RNA TP73-AS1 accelerates the epithelial ovarian cancer via epigenetically repressing p21. Am J Transl Res 2019; 11:2447-2454. [PMID: 31105851 PMCID: PMC6511761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/13/2019] [Indexed: 06/09/2023]
Abstract
Evidence has indicated the important roles of long non-coding RNAs (lncRNAs) in the human cancer biology, providing potential targets for cancer intervention. However, the expression profile and function of lncRNA TP73-AS1 in human epithelial ovarian cancer (EOC) remain to be investigated. In the EOC specimens and cell lines, TP73-AS1 was identified to be significantly up-regulated. EOC patients with high TP73-AS1 expression had poor survival rate. The gain and loss of functional assay uncovered that TP73-AS1 promoted the proliferation, invasion and reduced the apoptosis of EOC cells in vitro. And, the knockdown of TP73-AS1 inhibited the tumor growth in vivo. By using chromatin immunoprecipitation and luciferase reporter assay, we identified TP73-AS1 epigenetically repressed p21 via recruiting EZH2. In conclusion, this finding supports that TP73-AS1 promotes the EOC progression via epigenetically repressing p21, serving as a prognosis predictor for EOC patients.
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Affiliation(s)
- Yun Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan 250021, Shandong, China
- Department of Obstetrics and Gynecology, Weihai Municipal HospitalWeihai 264200, Shandong, China
| | - Yingying Jiao
- Department of Obstetrics and Gynecology, Liaocheng People’s HospitalLiaocheng 252000, Shandong, China
| | - Jing Hao
- Department of Obstetrics and Gynecology, Weihai Municipal HospitalWeihai 264200, Shandong, China
| | - Hongbo Xing
- Department of Stomatology, Weihai Municipal HospitalWeihai 264200, Shandong, China
| | - Changzhong Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan 250021, Shandong, China
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