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Rottmann DA, Skala SL. Special Considerations in Classification and Workup of Endometrial Carcinomas. Arch Pathol Lab Med 2024; 148:390-397. [PMID: 37931213 DOI: 10.5858/arpa.2023-0098-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 11/08/2023]
Abstract
CONTEXT.— A variety of uncommon malignant endometrial tumors can be challenging to diagnose because of overlapping morphology with more common entities. In some cases, immunohistochemical stains and/or molecular testing allow for more definitive diagnosis or prognostication. OBJECTIVE.— To review classic morphologic features of uncommon endometrial tumors, pathologic features of these tumors and their mimics, and the evidence for use of immunohistochemistry and molecular testing in the diagnosis of these tumors. DATA SOURCES.— University of Michigan (Ann Arbor) cases and review of pertinent literature about each entity. CONCLUSIONS.— Although each of these uncommon endometrial tumors has morphologic mimics, key histologic features, immunohistochemical stains, and molecular testing allow for accurate classification.
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Ronsini C, Reino A, Molitierno R, Vastarella MG, La Mantia E, De Franciscis P. Critical Overview of Serous Endometrial Intraepithelial Cancer Treatment: Systematic Review of Adjuvant Options. Life (Basel) 2023; 13:1429. [PMID: 37511804 PMCID: PMC10416151 DOI: 10.3390/life13071429] [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: 03/31/2023] [Revised: 05/22/2023] [Accepted: 06/13/2023] [Indexed: 07/30/2023] Open
Abstract
SEIC is a non-invasive lesion of the endometrial epithelium considered to be the precursor to uterine serous carcinoma (USC) and is just as aggressive as USC. Currently, there are no reliable data about the behavior and prognosis of SEIC; therefore, the therapeutic management approach is not clear. Method: A systematic search of the Pubmed, Scopus and Embase databases was conducted, following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Of the 296 studies that matched the search criteria, only 9 met the inclusion criteria, covering a total of 81 patients. The main disease-presenting pattern was AUB (abnormal uterine bleeding). In 31 cases, SEIC was associated with extrauterine disease. All patients underwent hysterectomy and salpingo-oophorectomy, while only 15 of the 81 patients received adjuvant treatments. In the patients receiving adjuvant therapy, the RR was 42.67%, the DFS was 35.71% and the OS was 57.13%. In patients subjected to follow-up alone, the RR was only 28.78%, the DFS was 59.1% and the OS was 66.6%. Conclusions: The presence of an extrauterine disease significantly worsens outcomes, regardless of adjuvant treatment. In cases of disease confined to the uterine mucosa alone, the prognosis is good and follow-up allows a good control of the disease; however, adjuvant therapy could further increase survival rates and reduce relapse rates.
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Affiliation(s)
- Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Largo Madonna Delle Grazie, 1, 80138 Naples, Italy; (C.R.); (M.G.V.)
| | - Antonella Reino
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Largo Madonna Delle Grazie, 1, 80138 Naples, Italy; (C.R.); (M.G.V.)
| | - Rossella Molitierno
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Largo Madonna Delle Grazie, 1, 80138 Naples, Italy; (C.R.); (M.G.V.)
| | - Maria Giovanna Vastarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Largo Madonna Delle Grazie, 1, 80138 Naples, Italy; (C.R.); (M.G.V.)
| | - Elvira La Mantia
- Pathology Unit, University of Campania “L. Vanvitelli”, Via Luciano Armanni, 80138 Naples, Italy
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Largo Madonna Delle Grazie, 1, 80138 Naples, Italy; (C.R.); (M.G.V.)
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Alessandrino F, Goncalves N, Metalonis SW, Luna C, Mason MM, Lyu J, Huang M. Uterine serous carcinoma: assessing association between genomics and patterns of metastasis. Front Oncol 2023; 13:1066427. [PMID: 37228503 PMCID: PMC10203475 DOI: 10.3389/fonc.2023.1066427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Background Uterine serous carcinoma (USC) is an aggressive subtype of endometrial carcinoma which has been increasing at alarming rates, particularly among Asian, Hispanic and Black women. USC has not been well characterized in terms of mutational status, pattern of metastases and survival. Objective To investigate the association between sites of recurrence and metastases of USC, mutational status, race, and overall survival (OS). Methods This single-center retrospective study evaluated patients with biopsy-proven USC that underwent genomic testing between January 2015 and July 2021. Association between genomic profile and sites of metastases or recurrence was performed using χ2 or Fisher's exact test. Survival curves for ethnicity and race, mutations, sites of metastasis/recurrence were estimated using the Kaplan-Meier method and compared with log-rank test. Cox proportional hazard regression models were used to examine the association between OS with age, race, ethnicity, mutational status, and sites of metastasis/recurrence. Statistical analyses were performed using SAS Software Version 9.4. Results The study included 67 women (mean age 65.8 years, range 44-82) with 52 non-Hispanic women (78%) and 33 Black women (49%). The most common mutation was TP53 (55/58 women, 95%). The peritoneum was the most common site of metastasis (29/33, 88%) and recurrence (8/27, 30%). PR expression was more common in women with nodal metastases (p=0.02) and non-Hispanic women (p=0.01). ERBB2 alterations were more common in women with vaginal cuff recurrence (p=0.02), while PIK3CA mutation was more common in women with liver metastases (p=0.048). ARID1A mutation and presence of recurrence or metastases to the liver were associated with lower OS (Hazard Ratio (HR): 31.87; 95%CI: 3.21, 316.9; p<0.001 and HR: 5.66; 95%CI: 1.2, 26.79; p=0.01, respectively). In the bivariable Cox model, the presence of metastasis/recurrence to the liver and/or the peritoneum were both independent significant predictors of OS (HR: 9.8; 95%CI: 1.85-52.7; p=0.007 and HR: 2.7; 95%CI: 1.02-7.1; p=0.04, respectively). Conclusions TP53 is often mutated in USC, which most commonly metastasize and recur in the peritoneum. OS was shorter in women with ARID1A mutations and with metastasis/recurrence to the liver. The presence of metastasis/recurrence to liver and/or peritoneum were independently associated with shorter OS.
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Affiliation(s)
| | - Nicole Goncalves
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sarah Wishnek Metalonis
- Division of Biostatistics, Department of Public Health Science, University of Miami, Miami, FL, United States
| | - Cibele Luna
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Matthew M. Mason
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jiangnan Lyu
- Division of Biostatistics, Department of Public Health Science, University of Miami, Miami, FL, United States
| | - Marilyn Huang
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami, FL, United States
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Muthulingeshkumar K, Pandjatcharam J, Chaturvedula L. Clinical Outcomes of Uterine Body Cancers Treated in a Tertiary Cancer Center. South Asian J Cancer 2022; 12:87-92. [PMID: 36860588 PMCID: PMC9970755 DOI: 10.1055/s-0042-1757550] [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: 11/07/2022] Open
Abstract
K. MuthulingeshkumarObjectives This article reports the clinical outcomes of uterine body cancers in South Indian population. The primary outcome of our study was overall survival (OS). The secondary outcomes were disease-free survival (DFS), patterns of recurrence, toxicities of radiation treatment, and the association of patient, disease, and treatment characteristics with survival and recurrence. Materials and Methods Records of the patients diagnosed as malignancy in uterus and treated with surgery alone or with adjuvant treatment from January 2013 to December 2017 were retrieved after Institute Ethics Committee approval. Demographic, surgical, histopathology, and adjuvant treatment details were retrieved. Patients of endometrial adenocarcinoma were stratified according to the European Society of Medical Oncology/European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology consensus for analysis and overall outcomes irrespective of histology were also analyzed. Statistical Analysis For the survival analysis, Kaplan-Meier survival estimator was used. Cox regression was used to test the significance of association of factors with outcomes in terms of hazard ratio (HR). Results A total of 178 patient records were retrieved. The median follow-up of all patients was 30 months (0.5-81 months). The median age of the population was 55 years. Most common histology was endometrioid type of adenocarcinoma (89%), sarcomas comprised only 4%. The mean OS of all patients was 68 months ( n = 178), median was not reached. Five-year OS was 79 %. Five-year OS rates observed in low, intermediate, high-intermediate, and high-risk were 91, 88, 75, and 81.5%, respectively. The mean DFS was 65 months, median not reached. The 5-year DFS was 76%. The 5-year DFS rates observed were 82, 95, 80, and 81.5% for low, intermediate, high-intermediate, and high-risk, respectively. Univariate analysis using Cox regression showed increase in hazard for death in case of node positivity, HR 3.96 ( p 0.033). The HR for disease recurrence was 0.35 ( p = 0.042) in patients who had received adjuvant radiation therapy. No other factors had any significant impact on death or disease recurrence. Conclusion The survival outcomes in terms of DFS and OS were comparable with other Indian and Western data reported in the published literature.
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Affiliation(s)
- K. Muthulingeshkumar
- Department of Radiation Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India,Address for correspondence K. Muthulingeshkumar, MBBS, MD, DNB Department of Radiation Oncology, Jawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
| | - Jagadesan Pandjatcharam
- Department of Radiation Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India,Jagadesan Pandjatcharam, MBBS, MD, DNB Department of Radiation Oncology, Jawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
| | - Latha Chaturvedula
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Matoba Y, Yamagami W, Chiyoda T, Kobayashi Y, Tominaga E, Banno K, Aoki D. Characteristics and clinicopathological features of patients with ovarian metastasis of endometrial cancer: a retrospective study. J OBSTET GYNAECOL 2022; 42:2456-2462. [PMID: 35653769 DOI: 10.1080/01443615.2022.2071148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There are no criteria for patient selection for ovarian-preserving surgery for endometrial cancer (EC). In this study, intraoperative findings of ovarian swelling (OvS) and the clinicopathological features of patients with EC with or without ovarian metastasis were analysed to identify risk factors for ovarian metastasis. Patients who underwent surgery for EC between 2012 and 2019 at our hospital were enrolled. In univariate analysis, all features were significantly higher in metastasis(+) cases. In multivariate analysis, lymphatic space invasion (LSI), cervical stromal involvement (CSI), peritoneal dissemination, and OvS were significant risk factors. In univariate analysis in stage I and II cases classified without adnexal pathological factors, type 2 histologic type, LSI, CSI, and OvS were significantly higher in metastasis(+) cases. LSI, CSI, and OvS were significant risk factors in multivariate analysis. Patients with type 1 histologic type EC without myometrial invasion ≥1/2, CSI and extrauterine lesions are appropriate for ovarian preservation. IMPACT STATEMENTWhat is already known on this subject? The number of premenopausal patients with endometrial cancer (EC) is increasing. Bilateral oophorectomy for EC results in surgical primary ovarian insufficiency, and thus, surgery with ovarian preservation has been examined. However, there are few reports on risk factors for ovarian metastasis of EC and no established criteria for patient background or pathological factors to determine suitability for ovarian preservation surgery.What do the results of this study add? In univariate analysis, all pathological findings suggestive of disease progression were more frequent in cases with ovarian metastases. In multivariate analysis, lymphatic space invasion (LSI), cervical stromal involvement (CSI), peritoneal dissemination, and ovarian swelling (OvS) were identified as significant risk factors for ovarian metastasis. In an analysis of stage I and II cases classified without adnexal pathological factors, type 2 histologic type, LSI, CSI, and OvS were significantly more common in cases with ovarian metastasis, and LSI, CSI, and OvS emerged as significant risk factors for ovarian metastasis in multivariate analysis.What are the implications of these findings for clinical practice and/or further research? Patients with type 1 histologic type EC without depth of myometrial invasion ≥1/2, CSI, or extrauterine lesions may be appropriate cases for ovarian preservation.
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Affiliation(s)
- Yusuke Matoba
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Wataru Yamagami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuyuki Chiyoda
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Kobayashi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Eiichiro Tominaga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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Xu H, Cui SS, Ran L, Liu Y, Hu C, Xu Y, Tian Y. Incidence of omental metastasis in uterine serous carcinoma: a systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2022; 51:102395. [PMID: 35489712 DOI: 10.1016/j.jogoh.2022.102395] [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: 01/23/2022] [Revised: 04/09/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Previous studies examining the incidence of omental metastasis in uterine serous carcinoma generally suffered from the small sample size, retrospective observational design, and single-center setting. So far, there was no systematic review and meta-analysis available on this topic, we conducted this study to quantitatively synthesize the data relating to this topic. DESIGN systematic review and meta-analysis. MATERIAL AND METHODS PubMed, Embase, and Web of Science were searched up until August 15, 2020. Two reviewers independently performed study selection, data extraction, and quality assessment. I2 was employed to assess the heterogeneity among included studies. Effect sizes along with 95% confidence intervals were calculated to analyze outcomes of interest. Funnel plots and the Egger test were used to detect the possibility of publication bias. OUTCOME MEASURES incidence of omental metastasis in uterine serous carcinoma. RESULTS A total of 16 studies involving 1012 women with uterine serous carcinoma were included in this systematic review and meta-analysis. All the included studies were at low risk of bias, and the heterogeneity among them was low. The pooled incidence of overall omental metastasis, occult omental metastasis, and gross omental metastasis in uterine serous carcinoma were 18% (95% CI, 0.15-0.20), 6% (95% CI, 0.04-0.08), and 10% (95% CI, 0.08-0.13), respectively. CONCLUSIONS Uterine serous carcinoma has a high tendency of omental metastasis. The main form of omentum involvement is gross metastasis. However, occult metastasis in the normal-looking omentum is also worthy of note.
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Affiliation(s)
- Hui Xu
- Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Shuang-Shuang Cui
- Department of Obstetrics and Gynecology, Jianshi Hospital of Traditional Chinese Medicine, Jianshi, Hubei, China
| | - Lin Ran
- Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Yi Liu
- Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China
| | - Cui Hu
- Department of Obstetrics and Gynaecology, Mianzhu People's Hospital, Mianzhu, Sichuan, China
| | - Yu Xu
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong Tian
- Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China.
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Toboni MD, Lomonosova E, Bruce SF, Tankou JI, Mullen MM, Schab A, Oplt A, Noia H, Wilke D, Kuroki LM, Hagemann AR, McCourt CK, Thaker PH, Powell MA, Khabele D, Mutch DG, Fuh KC. Inhibition of AXL and VEGF-A Has Improved Therapeutic Efficacy in Uterine Serous Cancer. Cancers (Basel) 2021; 13:5877. [PMID: 34884986 PMCID: PMC8656641 DOI: 10.3390/cancers13235877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/05/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Endometrial cancer remains the most prevalent gynecologic cancer with continued rising incidence. A less common form of this cancer is uterine serous cancer, which represents 10% of endometrial cancer cases. However, this is the most aggressive cancer. The objective was to assess whether inhibiting the receptor tyrosine kinase AXL with AVB-500 in combination with bevacizumab would improve response in uterine serous cancer. To prove this, we conducted multiple angiogenesis assays including tube formation assays and angiogenesis invasion assays. In addition, we utilized mouse models with multiple cells lines and subsequently analyzed harvested tissue through immunohistochemistry CD31 staining to assess microvessel density. The combination treatment arms demonstrated decreased angiogenic potential in each assay. In addition, intraperitoneal mouse models demonstrated a significant decrease in tumor burden in two cell lines. The combination of AVB-500 and bevacizumab reduced tumor burden in vivo and reduced morphogenesis and migration in vitro which are vital to the process of angiogenesis.
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Affiliation(s)
- Michael D. Toboni
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Elena Lomonosova
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Shaina F. Bruce
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Jo’an I. Tankou
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Mary M. Mullen
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Angela Schab
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Alyssa Oplt
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Hollie Noia
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Danny Wilke
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Lindsay M. Kuroki
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Andrea R. Hagemann
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Carolyn K. McCourt
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Premal H. Thaker
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Matthew A. Powell
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Dineo Khabele
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - David G. Mutch
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Katherine C. Fuh
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
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Chambers LM, Chau D, Yao M, Costales AB, Rose PG, Michener CM, Debernardo R, Vargas R. Efficacy of hyperthermic intraperitoneal chemotherapy and interval debulking surgery in women with advanced uterine serous carcinoma. Gynecol Oncol Rep 2021; 38:100876. [PMID: 34761096 PMCID: PMC8567198 DOI: 10.1016/j.gore.2021.100876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022] Open
Abstract
In this small series, HIPEC is well tolerated in patients with advanced USC. HIPEC at IDS is associated with favorable PFS and OS in advanced USC. Further investigation of HIPEC in women with advanced USC is warranted.
Objective(s) To investigate the efficacy and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) at the time of iterval debulking surgery (IDS) in women with advanced uterine serous carcinoma (USC) following neoadjuvant chemotherapy (NACT). Methods An IRB-approved single-institution prospective registry was queried to identify women with incidentally identified USC at the time of IDS + HIPEC for high-grade serous carcinoma. Patient demographic, oncologic, and surgical outcomes data were recorded. Univariate analysis determined progression-free survival (PFS) and overall survival (OS). Results In total, seven patients were found to have advanced USC after undergoing IDS + HIPEC, with a median age of 64.5 years. The majority had stage IV, (n = 6, 85.7%), MMR proficient (n = 5, 71.4%), p53 mutant (n = 6, 85.1%) USC. The median pre-operative CA125 was 24.0U/mL. HIPEC regimen was cisplatin (n = 3, 42.9%) or cisplatin with paclitaxel (n = 4, 57.1%). All patients underwent optimal cytoreduction, with 71.4% (n = 5) having no gross residual disease. Accordion post-operative complications were mild in 14.3% (n = 1), moderate in 57.1% (n = 4) and severe in 14.3% (n = 1); 14.3% (n = 1) had no complications. The median length of stay was 6.5 days (IQR 4–8 days) with a median time to chemotherapy of 33.0 days. The median PFS was 14.0 months (95% CI 3.5–20.8 months), and the median OS was 27.0 months (95% CI 5.1- not reached). Conclusions In this small, prospective series, we demonstrate that IDS + HIPEC is well tolerated in patients with USC and is associated with favorable PFS and OS following NACT. Further prospective investigation is needed to validate these promising findings in larger, heterogeneous cohorts of women with advanced USC who are not candidates for primary surgical management.
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Affiliation(s)
- Laura M Chambers
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States.,Division of Gynecologic Oncology, James Cancer Hospital and Solove Research Institute, The Ohio State University Medical Center, Columbus, OH 43210, United States
| | - Danielle Chau
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Meng Yao
- Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Anthony B Costales
- Department of Gynecologic Oncology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Peter G Rose
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Chad M Michener
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Robert Debernardo
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Roberto Vargas
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
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9
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Minimal uterine serous carcinoma and endometrial polyp: a close clinicopathological relationship. Hum Pathol 2021; 118:1-8. [PMID: 34508766 DOI: 10.1016/j.humpath.2021.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/24/2022]
Abstract
Frequently involving an endometrial polyp, minimal uterine serous carcinoma (MUSC) represents the earliest recognizable forms of endometrial serous carcinoma. The aim of this study was to provide a comprehensive morphological and clinical outcome assessment of MUSC involving endometrial polyp. A total of 77 fully staged MUSCs involving endometrial polyp were identified, including 53 MUSCs confined to polyp and 24 nonpolyp confined tumors. Extrauterine disease was found in 17% (9/53) of polyp-confined MUSCs compared to 41.7% (10/24) of nonpolyp confined tumors (p = 0.02). Lymphovascular invasion was observed in 3.8% (2/53) of polyp-confined cases compared to 25% (6/24) of nonpolyp confined cases (p = 0.047). Lymph node metastasis was observed in 11.3% (6/53) of polyp-confined cases, compared to 29.2% (7/24) of nonpolyp confined cases (p = 0.058). Positive pelvic washing cytology was seen in 18.9% (10/53) of polyp-confined versus 37.5% (9/24) of nonpolyp confined tumors (p = 0.078). Overall, 58 of 77 (75.3%) patients had low tumor stage (57 stage I cases and 1 stage II case) and only two patients (3.5%) had a recurrence. In contrast, 19 of 77 (24.7%) patients had advanced stage (stage III or IV) disease and 17 (89.5%) patients had recurrence (p < 0.0001). Only one of 57 low-stage patient (1.7%) versus 11 of 19 high-stage patients (57.8%) died of the tumor (p < 0.0001). Five of 53 (9.4%) patients with polyp-confined MUSC and 7 of 24 (29.2%) patients with nonpolyp confined MUSC died of the disease (p = 0.03). In conclusion, while a small percentage of MUSCs exist without the involvement of an endometrial polyp, a close topographic relationship between MUSC and the endometrial polyp is confirmed in this largest series, supporting the theory that most if not all MUSCs arise in an EMP. Patients with MUSC without extrauterine spread have an excellent prognosis. Compared to patients with MUSC confined to an endometrial polyp, patients with MUSC extending to the background endometrium have a significantly higher risk for high-stage disease at presentation.
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10
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Casarin J, Bogani G, Piovano E, Falcone F, Ferrari F, Odicino F, Puppo A, Bonfiglio F, Donadello N, Pinelli C, Laganà AS, Ditto A, Malzoni M, Greggi S, Raspagliesi F, Ghezzi F. Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma. J Gynecol Oncol 2021; 31:e64. [PMID: 32808495 PMCID: PMC7440990 DOI: 10.3802/jgo.2020.31.e64] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Uterine serous carcinoma (USC) is a rare highly aggressive disease. In the present study, we aimed to investigate the survival implication of the systematic lymphadenectomy in patients who underwent surgery for apparent early-stage USC. METHODS Consecutive patients with apparent early-stage USC surgically treated at six Italian referral cancer centers were analyzed. A comparison was made between patients who underwent retroperitoneal staging including at least pelvic lymphadenectomy "LND" vs. those who underwent hysterectomy alone "NO-LND". Baseline, surgical and oncological outcomes were analyzed. Kaplan- Meier curves were calculated for disease-free survival (DFS) and disease-specific survival (DSS). Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratio (HR). RESULTS One hundred forty patients were analyzed, 106 LND and 34 NO-LND. NO-LND group (compared to LND group) included older patients (median age, 73 vs.67 years) and with higher comorbidities (median Charlson Comorbidity Index, 6 vs. 5) (p<0.001). No differences in terms of recurrence rate (LND vs. NO-LND, 33.1% vs. 41.4%; p=0.240) were observed. At Cox regression analysis lymphadenectomy did not significantly influence DFS (HR=0.59; 95% confidence interval [CI]=0.32-1.08; p=0.09), and DSS (HR=0.14; 95% CI=0.02-1.21; multivariable analysis p=0.07). Positive node was independently associated with worse DFS (HR=6.22; 95% CI=3.08-12.60; p<0.001) and DSS (HR=5.51; 95% CI=2.31-13.10; p<0.001), while adjuvant chemotherapy was associated with improved DFS (HR=0.38; 95% CI=0.17-0.86; p=0.02) and age was independently associated with worse DSS (HR=1.07; 95% CI=1.02-1.13; p<0.001). CONCLUSIONS Although lymphadenectomy did not show survival benefits in patients who underwent surgery for apparent early-stage USC, the presence of lymph node metastasis was the main adverse prognostic factors, supporting the prognostic role of the retroperitoneal staging also in this histological subtype.
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Affiliation(s)
- Jvan Casarin
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
| | - Giorgio Bogani
- Department of Gynecologic Oncology, National Cancer Institute, Milan, Italy
| | - Elisa Piovano
- Obstetrics and Gynecology Unit, Regina Montis Regalis Hospital, Mondovì, Italy
| | - Francesca Falcone
- Department of Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCSS, "Fondazione G. Pascale", Naples, Italy.,Endoscopica Malzoni - Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Federico Ferrari
- Department of Obstetrics and Gynecology, Spedali Civili, Brescia, Italy
| | - Franco Odicino
- Department of Obstetrics and Gynecology, Spedali Civili, Brescia, Italy
| | - Andrea Puppo
- Obstetrics and Gynecology Unit, Regina Montis Regalis Hospital, Mondovì, Italy
| | | | - Nicoletta Donadello
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | | | - Antonino Ditto
- Department of Gynecologic Oncology, National Cancer Institute, Milan, Italy
| | - Mario Malzoni
- Endoscopica Malzoni - Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Stefano Greggi
- Department of Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCSS, "Fondazione G. Pascale", Naples, Italy
| | | | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
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11
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Shimizu M, Yamanaka K, Azumi M, Tomimoto M, Washio K, Takahashi R, Nagamata S, Murata Y, Yamasaki Y, Terai Y. A case of synchronous serous ovarian cancer and uterine serous endometrial intraepithelial carcinoma. J Ovarian Res 2021; 14:87. [PMID: 34187525 PMCID: PMC8244197 DOI: 10.1186/s13048-021-00835-8] [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: 05/01/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Serous endometrial intraepithelial carcinoma (SEIC) is now considered to represent an early stage of uterine serous carcinoma (USC). It is an intraepithelial lesion but has been reported to cause extrauterine metastases. We report a case of SEIC with serous ovarian carcinoma and lymph node metastasis. CASE PRESENTATION A 57-year-old post-menopausal woman (gravida 3, para 2, SA1) was referred to our hospital with lower abdominal pain. An ultrasound and MRI showed that the ovary had swollen to 8 cm in size and had a solid lesion. The uterus was normal. The patient underwent exploratory laparoscopy on the suspicion of torsion of the ovarian tumor. Intraoperative findings showed a right ovarian tumor, but no ovarian tumor torsion was observed. A small amount of bloody ascites was found in the Douglas fossa, and bleeding was observed from the tumor itself. A right salpingo-oophorectomy was then performed. Histopathological results revealed a high-grade serous carcinoma. Forty days after the first surgery, we performed a staging laparotomy: a total abdominal hysterectomy, left salpingo-oophorectomy, systematic pelvic and paraaortic lymphadenectomy, and a partial omentectomy. A complete cytoreduction was achieved. In the pathological examination, the invasion of the serous carcinoma was observed in the left ovarian ligament, and lymph node metastasis was found in the paraaortic lymph nodes. Atypical columnar cells formed irregular papillary lesions which had proliferated in the endometrium, and this was diagnosed as SEIC. The final diagnosis was serous ovarian cancer, FIGO stage IIIA1(ii), pT2bN1M0, with SEIC. CONCLUSION We report a case of SEIC with synchronous serous carcinoma of the adnexa uteri. Both were serous carcinomas and, thus, it was difficult to identify the primary lesion. The distinction between metastatic cancer and two independent primary tumors is important for an accurate diagnosis and tumor staging. Histological diagnostic criteria remain controversial, and further development of a method for differentiating between both diseases is required.
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Affiliation(s)
- Maho Shimizu
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Keitaro Yamanaka
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Maho Azumi
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Masako Tomimoto
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Keiichi Washio
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Ryosuke Takahashi
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Satoshi Nagamata
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuka Murata
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yui Yamasaki
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
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12
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Shibel R, Sarfstein R, Nagaraj K, Lapkina-Gendler L, Laron Z, Dixit M, Yakar S, Werner H. The Olfactory Receptor Gene Product, OR5H2, Modulates Endometrial Cancer Cells Proliferation via Interaction with the IGF1 Signaling Pathway. Cells 2021; 10:cells10061483. [PMID: 34204736 PMCID: PMC8231575 DOI: 10.3390/cells10061483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 12/19/2022] Open
Abstract
Endometrial cancer is the most common gynecologic malignancy in Western countries. The insulin-like growth factor-1 (IGF1) axis has an important role in endometrial cancer biology and emerged as a promising therapeutic target in oncology. However, there is an urgent need to identify biomarkers that may help in patient stratification and prognosis. Laron syndrome (LS) is a type of dwarfism that results from the mutation of the growth hormone receptor (GHR) gene, leading to congenital IGF1 deficiency. While high circulating IGF1 is regarded as a risk factor in cancer, epidemiological studies have shown that LS patients are protected from cancer development. Recent genome-wide profilings conducted on LS-derived lymphoblastoid cells led to the identification of a series of genes whose over- or under-representation in this condition might be mechanistically linked to cancer protection. The olfactory receptor 5 subfamily H member 2 (OR5H2) was the top downregulated gene in LS, its expression level being 5.8-fold lower than in the control cells. In addition to their typical role in the olfactory epithelium, olfactory receptors (ORs) are expressed in multiple tissues and play non-classical roles in various pathologies, including cancer. The aim of our study was to investigate the regulation of OR5H2 gene expression by IGF1 in endometrial cancer. Data showed that IGF1 and insulin stimulate OR5H2 mRNA and the protein levels in uterine cancer cell lines expressing either a wild-type or a mutant p53. OR5H2 silencing led to IGF1R downregulation, with ensuing reductions in the downstream cytoplasmic mediators. In addition, OR5H2 knockdown reduced the proliferation rate and cell cycle progression. Analyses of olfr196 (the mouse orthologue of OR5H2) mRNA expression in animal models of GHR deficiency or GH overexpression corroborated the human data. In summary, OR5H2 emerged as a novel target for positive regulation by IGF1, with potential relevance in endometrial cancer.
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Affiliation(s)
- Rand Shibel
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (R.S.); (R.S.); (K.N.); (L.L.-G.)
| | - Rive Sarfstein
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (R.S.); (R.S.); (K.N.); (L.L.-G.)
| | - Karthik Nagaraj
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (R.S.); (R.S.); (K.N.); (L.L.-G.)
| | - Lena Lapkina-Gendler
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (R.S.); (R.S.); (K.N.); (L.L.-G.)
| | - Zvi Laron
- Endocrinology and Diabetes Research Unit, Schneider Children’s Medical Center, Petah Tikva 49292, Israel;
| | - Manisha Dixit
- David B. Kriser Dental Center, Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, NY 10010-4086, USA; (M.D.); (S.Y.)
| | - Shoshana Yakar
- David B. Kriser Dental Center, Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, NY 10010-4086, USA; (M.D.); (S.Y.)
| | - Haim Werner
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (R.S.); (R.S.); (K.N.); (L.L.-G.)
- Correspondence:
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13
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Evaluation of Survival, Recurrence Patterns and Adjuvant Therapy in Surgically Staged High-Grade Endometrial Cancer with Retroperitoneal Metastases. Cancers (Basel) 2021; 13:cancers13092052. [PMID: 33922792 PMCID: PMC8123054 DOI: 10.3390/cancers13092052] [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: 03/11/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We seek to evaluate the difference in recurrence patterns and survival among stage IIIC high-grade endometrial cancer treated with surgery followed by adjuvant chemotherapy alone, radiation therapy alone, or both (chemoradiation). METHODS A multicenter retrospective analysis of surgically staged IIIC HGEC receiving adjuvant therapy was conducted. HGEC was defined as grade 3 endometrioid adenocarcinoma, serous, clear cell and carcinosarcoma. Differences in the frequency of recurrence sites and treatment delays were identified using Pearson's χ2 test. Progression-free survival (PFS) and overall survival (OS) were calculated using Kaplan-Meier estimates. RESULTS A total of 155 patients were evaluable: 41.9% carcinosarcoma, 36.8% serous, 17.4% grade 3 and 3.9% clear cell. Of these, 67.1% received chemoradiation, 25.8% received chemotherapy and 7.1% received radiation therapy. There was no difference in the frequency of treatment delays between regimens (p = 0.571). There was a trend towards greater retroperitoneal recurrence with chemotherapy (25.9%) versus chemoradiation (8.4%) and radiation therapy (7.7%) (p = 0.252). Grade 3 tumors had improved progression-free and overall survival (26 and 42 months, respectively) versus serous (17 and 30 months, respectively), carcinosarcoma (14 and 24 months, respectively) and clear cell (24 and 30 months respectively) (p = 0.002, p < 0.001). Overall, chemoradiation was superior to chemotherapy and radiation therapy in PFS (p < 0.001) and OS (p < 0.001). Upon multivariate analysis, only histology and receipt of chemoradiation were independent predictors of survival. CONCLUSION The majority of stage IIIC high-grade endometrial carcinomas recurred. Chemoradiation was associated with improved survival and less retroperitoneal recurrence. Grade 3 tumors demonstrated improved survival versus other histologies regardless of adjuvant treatment modality.
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14
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Hu C, Zhang LL, Cheng Y, Xue FX, Jia Y, Zhao-Juan Q, Yi D, Qian-Wen Z, Yue-Dong H, Ai Z, Xu Y. Incidence of omental metastasis in uterine serous carcinoma: study protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e043141. [PMID: 33455937 PMCID: PMC7813338 DOI: 10.1136/bmjopen-2020-043141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Uterine serous carcinoma accounts for only about 10% of all endometrial cancers but this subtype is the most common amongst non-endometrioid endometrium cancers and contributes to more than half of recurrence and deaths attributed to endometrial cancers. A more extensive surgical staging and adjuvant therapies for uterine serous carcinoma are recommended by many guidelines. However, guidelines vary on recommendations for the methods that should be used for omentum assessment in uterine serous carcinoma and the previously reported incidence of omental metastasis in uterine serous carcinoma had a wide range because of the heterogeneity among these studies. As far as we know, there are no systematic review and meta-analysis available on this topic. The aim of our proposed study is to statistically synthesise the data examining the incidence of omental metastasis in uterine serous carcinoma. METHODS AND ANALYSIS Systematic searches of three databases (PubMed, Embase and Web of Science) will be performed using prespecified search strategies. We will include original studies that reported incidence of omental metastasis in uterine serous carcinoma and are published before 30 August 2020. Our different investigators will independently conduct the eligible study selection, assess the quality of included studies and extract the needed data. If appropriate, the relevant data will be pooled through a random-effect or fixed-effect meta-analysis based on the heterogeneity among included studies. We will evaluate the overall quality of evidence using appropriate methods. ETHICS AND DISSEMINATION This proposed study will be based on published data, and thus, there is no requirement for ethics approval. We aim to publish the results of this study in a peer-reviewed journal with good visibility for the fields of gynaecology and gynecologic oncology. PROSPERO REGISTRATION NUMBER CRD42020200891.
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Affiliation(s)
- Cui Hu
- Department of Obstetrics and Gynaecology, Mianzhu People's Hospital, Mianzhu, China
- Department of Obstetrics and Gynaecology, Southwest Medical University, Luzhou, Sichuan, China
| | - Lin-Lin Zhang
- Department of Obstetrics and Gynaecology, Mianzhu People's Hospital, Mianzhu, China
| | - Yu Cheng
- Department of Obstetrics and Gynaecology, Mianzhu People's Hospital, Mianzhu, China
| | - Fei-Xue Xue
- Department of Obstetrics and Gynaecology, Mianzhu People's Hospital, Mianzhu, China
| | - Ya Jia
- Department of Obstetrics and Gynaecology, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Qin Zhao-Juan
- Department of Obstetrics and Gynaecology, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Du Yi
- Department of Obstetrics and Gynaecology, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Zhang Qian-Wen
- Department of Obstetrics and Gynaecology, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - He Yue-Dong
- Department of Obstetrics and Gynaecology, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Zheng Ai
- Department of Obstetrics and Gynaecology, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Yu Xu
- Department of Obstetrics and Gynaecology, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
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15
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The role of lymphadenectomy in patients with stage III&IV uterine serous carcinoma: Results of multicentric Turkish study. J Gynecol Obstet Hum Reprod 2021; 50:102063. [PMID: 33453448 DOI: 10.1016/j.jogoh.2021.102063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/29/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate clinicopathological features, oncological outcome and prognostic factors for recurrence in advanced stage uterine serous carcinoma (USC) patients. METHODS Patients with 2009 International Federation of Gynecology and Obstetrics stage III&IV uterine serous carcinoma were enrolled from 4 gynecologic oncology centers and a study group was created. Response to therapy was evaluated according to the WHO criteria. Progression-free survival (PFS) and overall survival (OS) estimates were determinated by using the Kaplan-Meier method. Survival curves were compared with the log-rank test. Multivariate analysis was performed using the Cox proportional hazards model. RESULTS Entire cohort included 63 patients. Median age of cohort was 64 years. Thirty-five (55.6 %) patients were stage IV. Lymphadenectomy was performed in 57 (90.5 %) patients and lymph node metastasis was positive in 45 (71.4 %) patients. Maximal cytoreduction (no residue tumor) was achieved in 53 (84.1 %) patients. However, optimal cytoreduction (residue tumor ≤1 cm) was achieved in 6 (9.5 %) patients and suboptimal cytoreduction (residue tumor >1 cm) was achieved in 3 (4.8 %) patients. Median follow-up time was 19 (range;1-152) months. Complete clinical response was obtained in 58 (92.1 %) patients after standard adjuvant therapy. Disease failure was detected in 25 patients. Study group had a 2-year PFS of 51 % and 2-year OS of 80 %. On multivariate analysis, performing lymphadenectomy was an independent prognostic factor for PFS (Odds ratio: 24.794, 95 % Confidence Interval: 4.214-145.869; p < 0.001). CONCLUSION Lymphadenectomy should be a part of the standard surgical therapy in advanced stage USC.
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16
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Sugiyama A, Ohta T, Obata M, Takahashi K, Seino M, Nagase S. xCT inhibitor sulfasalazine depletes paclitaxel-resistant tumor cells through ferroptosis in uterine serous carcinoma. Oncol Lett 2020; 20:2689-2700. [PMID: 32782585 PMCID: PMC7400102 DOI: 10.3892/ol.2020.11813] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/27/2020] [Indexed: 01/17/2023] Open
Abstract
Glutathione (GSH) is a primary antioxidant that protects cells against reactive oxygen species (ROS), and high levels of GSH promote cancer cell survival and resistance to chemotherapy. The glutamine transporter xCT is essential for the intracellular synthesis of GSH, whereby xCT determines the intracellular redox balance. However, whether xCT inhibition can overcome GSH-mediated resistance to chemotherapeutic agents in uterine serous carcinoma (USC) remains unclear. Thus, the present study investigated the effect of the xCT inhibitor, sulfasalazine (SAS) on cytotoxicity in paclitaxel-sensitive and -resistant USC cell lines. The molecular mechanism by which SAS induces ferroptotic cell death in paclitaxel-resistant cells was assessed. The results of the cytotoxicity assay demonstrated that SAS was more cytotoxic in paclitaxel-resistant cells compared with in -sensitive cells; however, paclitaxel cytotoxicity was not enhanced in either of the USC cell lines. Immunoblotting analysis and the cell death assays performed using ferroptosis inhibitors indicated that SAS-mediated cell death was induced through ferroptosis, and not apoptosis, in paclitaxel-resistant cells. Furthermore, ROS production was increased in paclitaxel-resistant but not in -sensitive cells, even at low SAS concentration, and JNK was activated, which is a downstream target in the Ras signaling pathway. Knockdown of JNK reversed the inhibitory effect of SAS on cell proliferation and cell death. The synthetic lethal interaction between ROS accumulation and Ras effector JNK activation may be critical for enhancing the sensitivity to ferroptotic cell death mediated by xCT inhibitor, SAS. Taken together, the results of the present study suggest that xCT inhibition may be an effective treatment for patients with recurrent paclitaxel-resistant USC.
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Affiliation(s)
- Akiko Sugiyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Tsuyoshi Ohta
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Miyuki Obata
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Kanako Takahashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Manabu Seino
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
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Randomized Phase II Trial of Carboplatin–Paclitaxel Compared with Carboplatin–Paclitaxel–Trastuzumab in Advanced (Stage III–IV) or Recurrent Uterine Serous Carcinomas that Overexpress Her2/Neu (NCT01367002): Updated Overall Survival Analysis. Clin Cancer Res 2020; 26:3928-3935. [DOI: 10.1158/1078-0432.ccr-20-0953] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 12/30/2022]
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18
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Schlappe BA, Weaver AL, McGree ME, Ducie J, Zahl Eriksson AG, Dowdy SC, Cliby WA, Glaser GE, Abu-Rustum NR, Mariani A, Leitao MM. Multicenter study comparing oncologic outcomes after lymph node assessment via a sentinel lymph node algorithm versus comprehensive pelvic and paraaortic lymphadenectomy in patients with serous and clear cell endometrial carcinoma. Gynecol Oncol 2019; 156:62-69. [PMID: 31776037 DOI: 10.1016/j.ygyno.2019.11.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/29/2019] [Accepted: 11/02/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To compare survival after nodal assessment using a sentinel lymph node (SLN) algorithm versus comprehensive pelvic and paraaortic lymphadenectomy (LND) in serous or clear cell endometrial carcinoma, and to compare survival in node-negative cases. METHODS Three-year recurrence-free survival (RFS) and overall survival were compared between one institution that used comprehensive LND to the renal veins and a second institution that used an SLN algorithm with ultra-staging with inverse-probability of treatment weighting (IPTW) derived from propensity scores to adjust for covariate imbalance between cohorts. RESULTS 214 patients were identified (118 SLN cohort, 96 LND cohort). Adjuvant therapy differed between the cohorts; 84% and 40% in the SLN and LND cohorts, respectively, received chemotherapy ± radiation therapy. The IPTW-adjusted 3-year RFS rates were 69% and 80%, respectively. The IPTW-adjusted 3-year OS rates were 88% and 77%, respectively. The IPTW-adjusted hazard ratio (HR) for the association of surgical approach (SLN vs LND) with progression and death was 1.46 (95% CI: 0.70-3.04) and 0.44 (95% CI: 0.19-1.02), respectively. In the 168 node-negative cases, the IPTW-adjusted 3-year RFS rates were 73% and 91%, respectively. The IPTW-adjusted 3-year OS rates were 88% and 86%, respectively. In this subgroup, IPTW-adjusted HR for the association of surgical approach (SLN vs LND) with progression and death was 3.12 (95% CI: 1.02-9.57) and 0.69 (95% CI: 0.24-1.95), respectively. CONCLUSION OS was not compromised with the SLN algorithm. SLN may be associated with a decreased RFS but similar OS in node-negative cases despite the majority receiving chemotherapy. This may be due to differences in surveillance.
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Affiliation(s)
- Brooke A Schlappe
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amy L Weaver
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Michaela E McGree
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jennifer Ducie
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ane Gerda Zahl Eriksson
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean C Dowdy
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - William A Cliby
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Gretchen E Glaser
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical Center, New York, NY, USA
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical Center, New York, NY, USA.
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19
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Chen M, Guo P, Tan J, Liu D, Yao S. The role of omentectomy in the surgical treatment of uterine serous carcinoma. Eur J Obstet Gynecol Reprod Biol X 2019; 4:100084. [PMID: 31517308 PMCID: PMC6728717 DOI: 10.1016/j.eurox.2019.100084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/23/2019] [Accepted: 07/08/2019] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aims of this study were to assess the role of omentectomy in the staging of uterine serous carcinoma (USC) and to evaluate its impact on patient outcomes. STUDY DESIGN Patients diagnosed with USC at the First Affiliated Hospital of Sun Yat-sen University of China were retrospectively reviewed. The clinicopathological characteristics and survival data of 187 patients were analyzed. Risk factors for omental metastasis were evaluated. Kaplan-Meier survival curves were used to compare survival status and the presence of omental metastasis. RESULTS We found that 35 of 187 patients (18.7%) had omental metastases. Omental metastasis was significantly associated with adnexal involvement (40.0% vs 19.1%, P = 0.008, OR 2.828, 95% CI 1.286-6.218). Multivariate analysis showed that in addition to lymph node metastases and suboptimal surgery, omental metastasis in USC remained an independent predictor of decreased PFS and OS (PFS, HR 1.48, 95% CI 1.14-4.63, P = 0.024; OS, HR 1.39, 95% CI 1.04-3.60, P = 0.043). CONCLUSIONS The incidence of omental metastasis is not low in patients with USC. Visual assessment and omental biopsy may be insufficient for recognizing occult metastases. Omentectomy should be part of the staging surgery in USC patients because it provides additional information about survival. Prospective studies are needed to confirm these results.
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Affiliation(s)
- Ming Chen
- Department of Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peng Guo
- Department of Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jifan Tan
- Reproductive Medicine Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Duo Liu
- Department of Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuzhong Yao
- Department of Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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20
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Almazyad A, Woo SB, Villa A. Persistent Pain and Gingival Swelling in a Middle-aged Woman. JAMA Otolaryngol Head Neck Surg 2019; 145:676-677. [PMID: 31021379 DOI: 10.1001/jamaoto.2019.0606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Asma Almazyad
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Sook-Bin Woo
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts.,Division of Oral Medicine and Dentistry, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alessandro Villa
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts.,Division of Oral Medicine and Dentistry, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts
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21
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Brooks RA, Fleming GF, Lastra RR, Lee NK, Moroney JW, Son CH, Tatebe K, Veneris JL. Current recommendations and recent progress in endometrial cancer. CA Cancer J Clin 2019; 69:258-279. [PMID: 31074865 DOI: 10.3322/caac.21561] [Citation(s) in RCA: 238] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Endometrial cancer is the most common gynecologic cancer in the United States, and its incidence is rising. Although there have been significant recent advances in our understanding of endometrial cancer biology, many aspects of treatment remain mired in controversy, including the role of surgical lymph node assessment and the selection of patients for adjuvant radiation or chemotherapy. For the subset of women with microsatellite-instable, metastatic disease, anti- programmed cell death protein 1 immunotherapy (pembrolizumab) is now approved by the US Food and Drug Administration, and numerous trials are attempting to build on this early success.
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Affiliation(s)
- Rebecca A Brooks
- Associate Professor, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
- Dr. Brooks is now the Associate Professor and Chief of the Division of Gynecologic Oncology, University of California Davis School of Medicine, Davis, CA
| | - Gini F Fleming
- Professor of Medicine and Director, Medical Oncology Breast Program, Department of Medical Oncology, The University of Chicago, Chicago, IL
| | - Ricardo R Lastra
- Assistant Professor, Department of Pathology, The University of Chicago, Chicago, IL
| | - Nita K Lee
- Assistant Professor of Obstetrics and Gynecology, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
| | - John W Moroney
- Associate Professor of Obstetrics and Gynecology, Department of Gynecologic Oncology, The University of Chicago, Chicago, IL
| | - Christina H Son
- Assistant Professor, Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Ken Tatebe
- Resident, Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Jennifer L Veneris
- Instructor of Medicine, Division of Gynecologic Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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22
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Abstract
BACKGROUND The prognostic factors of uterine serous carcinoma (USC) vary among studies, and there is no report of Chinese USC patients. OBJECTIVE The aim of this study was to investigate the clinicopathological characteristics and prognostic factors in Chinese patients with USC. METHODS Patients with USC from 13 authoritative university hospitals in China and treated between 2004 and 2014 were retrospectively reviewed. Three-year disease-free survival rate (DFSR), cumulative recurrence, and cumulative mortality were estimated by Kaplan-Meier analyses and log-rank tests. Multivariate Cox regression analysis was used to model the association of potential prognostic factors with clinical outcomes. RESULTS Data of a total of 241 patients were reviewed. The median follow-up was 26 months (range, 1-128 months). Median age was 60 years (range, 39-84 years), and 58.0% had stages I-II disease. The 3-year DFSR and cumulative recurrence were 46.8% and 27.7%. Advanced stage (III and IV) (P = 0.004), myometrial invasion (P = 0.001), adnexal involvement (P < 0.001), lymph node metastasis (P = 0.025), and positive peritoneal cytology (P = 0.007) were independently associated with 3-year DFSR. Advanced stage (P = 0.017), myometrial invasion (P = 0.008), adnexal involvement (odds ratio, 2.987; P = 0.001), lymph node metastasis (P = 0.031), and positive peritoneal cytology (P = 0.001) were independently associated with the cumulative recurrence. Myometrial invasion (P = 0.004) and positive peritoneal cytology (P = 0.025) were independently associated with 3-year cumulative mortality. CONCLUSIONS Peritoneal cytology and myometrial invasion could be independent prognostic factors for 3-year DFSR, cumulative recurrence, and cumulative mortality of patients with USC. Prospective studies are needed to confirm these results.
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Remmerie M, Janssens V. PP2A: A Promising Biomarker and Therapeutic Target in Endometrial Cancer. Front Oncol 2019; 9:462. [PMID: 31214504 PMCID: PMC6558005 DOI: 10.3389/fonc.2019.00462] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 05/14/2019] [Indexed: 12/14/2022] Open
Abstract
Over the last decade, the use of targeted therapies has immensely increased in the treatment of cancer. However, treatment for endometrial carcinomas (ECs) has lagged behind, although potential molecular markers have been identified. This is particularly problematic for the type II ECs, since these aggressive tumors are usually not responsive toward the current standard therapies. Therefore, type II ECs are responsible for most EC-related deaths, indicating the need for new treatment options. Interestingly, molecular analyses of type II ECs have uncovered frequent genetic alterations (up to 40%) in PPP2R1A, encoding the Aα subunit of the tumor suppressive heterotrimeric protein phosphatase type 2A (PP2A). PPP2R1A mutations were also reported in type I ECs and other common gynecologic cancers, albeit at much lower frequencies (0-7%). Nevertheless, PP2A inactivation in the latter cancer types is common via other mechanisms, in particular by increased expression of Cancerous Inhibitor of PP2A (CIP2A) and PP2A Methylesterase-1 (PME-1) proteins. In this review, we discuss the therapeutic potential of direct and indirect PP2A targeting compounds, possibly in combination with other anti-cancer drugs, in EC. Furthermore, we investigate the potential of the PP2A status as a predictive and/or prognostic marker for type I and II ECs.
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Affiliation(s)
| | - Veerle Janssens
- Laboratory of Protein Phosphorylation and Proteomics, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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24
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Mills KA, Lopez H, Sun L, Cripe JC, Litz T, Thaker PH, Powell MA, Mutch DG, Fuh KC. Type II endometrial cancers with minimal, non-invasive residual disease on final pathology: What should we do next? Gynecol Oncol Rep 2019; 29:20-24. [PMID: 31193699 PMCID: PMC6541758 DOI: 10.1016/j.gore.2019.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 01/01/2023] Open
Abstract
There are minimal data regarding the management of high risk endometrial cancer histologies lacking invasive disease on the final pathology specimen. This study examines a cohort of these patients and assesses outcomes including time to recurrence and risk of death after management with and without adjuvant therapies. Endometrial cancer patients with minimal or no remaining invasive disease on final pathologic specimen from 1995 to 2010 were included. Surgical procedure was at the discretion of the operating physician. Electronic medical records were used to abstract relevant clinicopathologic data and standard statistical methods were employed. 70 patients met inclusion criteria, of which 26 were high grade histologies. Adjuvant therapies were given in 12 of 26 patients. 6/26 patients recurred, of which 50% were salvaged with therapy at time of recurrence. Overall deaths occurred in 3 of 26 patients in the high risk cohort. Less than half of the high risk cohort received adjuvant therapies after surgical management. No histologic type was found to increase risk of recurrence, and treatment with initial adjuvant therapy did not significantly reduce recurrence risk. Large scale prospective trials are needed to aid in management of this unique endometrial cancer population. This series describes a cohort of high risk with minimal remaining disease on final pathology specimen. Patients with clear cell histology who went on to recur did so quickly and were salvageable. Treatment with adjuvant therapy after primary surgery did not significantly improve risk of recurrence.
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Affiliation(s)
- Kathryn A Mills
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Heather Lopez
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Lulu Sun
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - James C Cripe
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Taylor Litz
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Matthew A Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - David G Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Katherine C Fuh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
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25
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Musselman K, Glynn S, Mosquera JM, Elemento O, Sboner A, Beltran H, Holcomb K. Identification of a therapeutic target using molecular sequencing for treatment of recurrent uterine serous adenocarcinoma. Gynecol Oncol Rep 2019; 28:54-57. [PMID: 30906838 PMCID: PMC6411491 DOI: 10.1016/j.gore.2019.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 12/02/2022] Open
Abstract
Uterine serous adenocarcinoma is a rare but highly malignant form of endometrial cancer, comprising over 50% of recurrences and deaths from endometrial cancer. We report a case of a 68-year old woman with recurrent uterine serous adenocarcinoma who underwent molecular testing and genetic sequencing of her tumor. She was found to have focal amplification of ERBB2 confirmed by amplification and overexpression of HER2/neu via fluorescence in situ hybridization and immunohistochemistry. Given the identification of this potential target and progression of disease, trastuzumab was added to the patient's chemotherapy regimen with ultimate complete response. 68-year old woman with recurrent uterine serous adenocarcinoma who underwent molecular testing of her tumor. Amplification of ERBB2 and overexpression of HER2/neu was confirmed. Trastuzumab was added to the patient's therapy with complete response. Targeted therapies may be advantageous in patients with limited therapeutic options.
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Affiliation(s)
- Kelsey Musselman
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, United States of America
| | - Shannon Glynn
- Department of Medicine, Weill Cornell Medicine, United States of America
| | - Juan Miguel Mosquera
- Englander Institute for Precision Medicine, New York Presbyterian-Weill Cornell Medicine, United States of America
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, United States of America
| | - Olivier Elemento
- Englander Institute for Precision Medicine, New York Presbyterian-Weill Cornell Medicine, United States of America
| | - Andrea Sboner
- Englander Institute for Precision Medicine, New York Presbyterian-Weill Cornell Medicine, United States of America
| | - Himisha Beltran
- Department of Medicine, Weill Cornell Medicine, United States of America
- Englander Institute for Precision Medicine, New York Presbyterian-Weill Cornell Medicine, United States of America
- Department of Medical Oncology, Dana Farber Cancer Institute, United States of America
| | - Kevin Holcomb
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, United States of America
- Corresponding author at: 525 East 68th Street, J-130, New York, NY 10065, United States of America.
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26
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Urick ME, Bell DW. In vitro effects of FBXW7 mutation in serous endometrial cancer: Increased levels of potentially druggable proteins and sensitivity to SI-2 and dinaciclib. Mol Carcinog 2018; 57:1445-1457. [PMID: 29963728 PMCID: PMC6168387 DOI: 10.1002/mc.22867] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/29/2018] [Indexed: 12/20/2022]
Abstract
Serous endometrial cancers (ECs) are clinically aggressive tumors that frequently harbor somatic mutations in FBXW7 (F-box and WD repeat domain-containing 7). The FBXW7 tumor suppressor is part of a SCF (complex of SKP1, Cullin 1, F-box protein) ubiquitin ligase complex which controls the degradation of numerous substrates that, if not properly regulated, can contribute to the initiation or progression of tumorigenesis. Despite reports that up to 30% of serous ECs include somatic mutations in FBXW7, the molecular effects of mutated FBXW7 in ECs have not been determined. Here, we used transient transfection and Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) editing in serous EC cell lines to interrogate the molecular effects of six recurrent FBXW7 mutations. We show that FBXW7 mutations lead to increased Cyclin E1, steroid receptor coactivator 3 (SRC-3), c-MYC, Rictor, glycogen synthase kinase 3 (GSK3), P70S6 kinase, and protein kinase B (AKT) phosphorylated protein levels in serous EC cells. Furthermore, we demonstrate that CRISPR-edited FBXW7-mutant ARK1 serous EC cells exhibit increased sensitivity to SI-2 (a SRC inhibitor) and dinaciclib (a cyclin dependent kinase (CDK) inhibitor) compared to parental ARK1 cells. Collectively, our findings reveal biochemical effects of FBXW7 mutations in the context of EC and provide in vitro evidence of sensitivity to targeted inhibitors.
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Affiliation(s)
- Mary Ellen Urick
- Cancer Genetics and Comparative Genomics Branch, National
Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892,
USA
| | - Daphne W. Bell
- Cancer Genetics and Comparative Genomics Branch, National
Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892,
USA
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27
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Remmerie M, Janssens V. Targeted Therapies in Type II Endometrial Cancers: Too Little, but Not Too Late. Int J Mol Sci 2018; 19:E2380. [PMID: 30104481 PMCID: PMC6121653 DOI: 10.3390/ijms19082380] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/02/2018] [Accepted: 08/08/2018] [Indexed: 01/14/2023] Open
Abstract
Type II endometrial carcinomas (ECs) are responsible for most endometrial cancer-related deaths due to their aggressive nature, late stage detection and high tolerance for standard therapies. However, there are no targeted therapies for type II ECs, and they are still treated the same way as the clinically indolent and easily treatable type I ECs. Therefore, type II ECs are in need of new treatment options. More recently, molecular analysis of endometrial cancer revealed phosphorylation-dependent oncogenic signalling in the phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) pathways to be most frequently altered in type II ECs. Consequently, clinical trials tested pharmacologic kinase inhibitors targeting these pathways, although mostly with rather disappointing results. In this review, we highlight the most common genetic alterations in type II ECs. Additionally, we reason why most clinical trials for ECs using targeted kinase inhibitors had unsatisfying results and what should be changed in future clinical trial setups. Furthermore, we argue that, besides kinases, phosphatases should no longer be ignored in clinical trials, particularly in type II ECs, where the tumour suppressive phosphatase protein phosphatase type 2A (PP2A) is frequently mutated. Lastly, we discuss the therapeutic potential of targeting PP2A for (re)activation, possibly in combination with pharmacologic kinase inhibitors.
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Affiliation(s)
- Michiel Remmerie
- Laboratory of Protein Phosphorylation & Proteomics, Department of Cellular & Molecular Medicine, University of Leuven (KU Leuven), B-3000 Leuven, Belgium.
- Leuven Cancer Institute (LKI), B-3000 Leuven, Belgium.
| | - Veerle Janssens
- Laboratory of Protein Phosphorylation & Proteomics, Department of Cellular & Molecular Medicine, University of Leuven (KU Leuven), B-3000 Leuven, Belgium.
- Leuven Cancer Institute (LKI), B-3000 Leuven, Belgium.
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28
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Ogane N, Hori SI, Yano M, Katoh T, Kamoshida S, Kato H, Kameda Y, Yasuda M. Preponderance of endometrial carcinoma in elderly patients. Mol Clin Oncol 2018; 9:269-273. [PMID: 30155248 PMCID: PMC6109667 DOI: 10.3892/mco.2018.1680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/16/2018] [Indexed: 11/05/2022] Open
Abstract
Elderly patients with endometrial carcinoma (EMC) are considered to have a poor clinical outcome. The present study included 79 patients aged ≥70 years with EMC stage I or II according to the International Federation of Gynecology and Obstetrics classification, and it was conducted to analyse the clinicopathological significance of histological type (I or II), depth of myometrial invasion (<1/2 or ≥1/2), lymphovascular invasion (+ or -) and immunohistochemical profile. The aim of these analyses was to determine whether these factors may adversely affect the patient outcome and the underlying mechanisms. The immunohistochemical markers used were estrogen receptor (ER), Ki-67 and p53. The expression of these markers was evaluated as high (+) or low (-). Accordingly, the patients were divided into groups as follows: 54 cases type I vs. 25 cases type II; 48 cases with myometrial invasion <1/2 vs. 31 cases without myometrial invasion ≥1/2; 63 cases with lymphovascular invasion vs. 16 cases without lymphovascular invasion; 57 cases with ER (+) vs. 22 cases with ER (-); 24 cases with Ki-67 (+) vs. 55 cases with Ki-67 (-); and 29 cases with p53 (+) vs. 50 cases with p53 (-). In conclusion, close attention must be paid to elderly patients with EMC due to the tumor's intrinsic aggressiveness, which may include the ER (-) and p53 (+) pattern as an independent poor prognostic factor.
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Affiliation(s)
- Naoki Ogane
- Department of Pathology, Kanagawa Prefectural Ashigarakami Hospital, Matsuda, Kanagawa 258-0003, Japan
| | - Shin-Ichi Hori
- Department of Gynecology and Obstetrics, Seto Hospital, Tokorozawa, Saitama 359-1128, Japan
| | - Mitsutake Yano
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Tomomi Katoh
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Shingo Kamoshida
- Laboratory of Pathology, Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Hyogo 654-0142, Japan
| | - Hisamori Kato
- Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
| | - Yoichi Kameda
- Department of Pathology, Kanagawa Prefectural Ashigarakami Hospital, Matsuda, Kanagawa 258-0003, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
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Bonazzoli E, Predolini F, Cocco E, Bellone S, Altwerger G, Menderes G, Zammataro L, Bianchi A, Pettinella F, Riccio F, Han C, Yadav G, Lopez S, Manzano A, Manara P, Buza N, Hui P, Wong S, Litkouhi B, Ratner E, Silasi DA, Huang GS, Azodi M, Schwartz PE, Schlessinger J, Santin AD. Inhibition of BET Bromodomain Proteins with GS-5829 and GS-626510 in Uterine Serous Carcinoma, a Biologically Aggressive Variant of Endometrial Cancer. Clin Cancer Res 2018; 24:4845-4853. [PMID: 29941483 DOI: 10.1158/1078-0432.ccr-18-0864] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/18/2018] [Accepted: 06/19/2018] [Indexed: 11/16/2022]
Abstract
Purpose: Uterine serous carcinoma (USC) is a rare and aggressive variant of endometrial cancer. Whole-exome sequencing (WES) studies have recently reported c-Myc gene amplification in a large number of USCs, suggesting c-Myc as a potential therapeutic target. We investigated the activity of novel BET bromodomain inhibitors (GS-5829 and GS-626510, Gilead Sciences Inc.) and JQ1 against primary USC cultures and USC xenografts.Experimental Design: We evaluated c-Myc expression by qRT-PCR in a total of 45 USCs including fresh-frozen tumor tissues and primary USC cell lines. We also performed IHC and Western blot experiments in 8 USC tumors. USC cultures were evaluated for sensitivity to GS-5829, GS-626510, and JQ1 in vitro using proliferation, viability, and apoptosis assays. Finally, the in vivo activity of GS-5829, GS-626510, and JQ1 was studied in USC-ARK1 and USC-ARK2 mouse xenografts.Results: Fresh-frozen USC and primary USC cell lines overexpressed c-Myc when compared with normal tissues (P = 0.0009 and 0.0083, respectively). High c-Myc expression was found in 7 of 8 of primary USC cell lines tested by qRT-PCR and 5 of 8 tested by IHC. In vitro experiments demonstrated high sensitivity of USC cell lines to the exposure to GS-5829, GS-626510, and JQ1 with BET inhibitors causing a dose-dependent decrease in the phosphorylated levels of c-Myc and a dose-dependent increase in caspase activation (apoptosis). In comparative in vivo experiments, GS-5829 and/or GS-626510 were found more effective than JQ1 at the concentrations/doses used in decreasing tumor growth in both USC-ARK1 and USC-ARK2 mouse xenograft models.Conclusions: GS-5829 and GS-626510 may represent novel, highly effective therapeutics agents against recurrent/chemotherapy-resistant USC-overexpressing c-Myc. Clinical studies with GS-5829 in patients with USC harboring chemotherapy-resistant disease are warranted. Clin Cancer Res; 24(19); 4845-53. ©2018 AACR.
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Affiliation(s)
- Elena Bonazzoli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | | | - Emiliano Cocco
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stefania Bellone
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Gary Altwerger
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Gulden Menderes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Luca Zammataro
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Anna Bianchi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Francesca Pettinella
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Francesco Riccio
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Chanhee Han
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Ghanshyam Yadav
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Salvatore Lopez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.,Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Aranzazu Manzano
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Paola Manara
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Natalia Buza
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Serena Wong
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Babak Litkouhi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Elena Ratner
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Dan-Arin Silasi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Gloria S Huang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Masoud Azodi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Peter E Schwartz
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Joseph Schlessinger
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
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30
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Fader AN, Roque DM, Siegel E, Buza N, Hui P, Abdelghany O, Chambers SK, Secord AA, Havrilesky L, O'Malley DM, Backes F, Nevadunsky N, Edraki B, Pikaart D, Lowery W, ElSahwi KS, Celano P, Bellone S, Azodi M, Litkouhi B, Ratner E, Silasi DA, Schwartz PE, Santin AD. Randomized Phase II Trial of Carboplatin-Paclitaxel Versus Carboplatin-Paclitaxel-Trastuzumab in Uterine Serous Carcinomas That Overexpress Human Epidermal Growth Factor Receptor 2/neu. J Clin Oncol 2018; 36:2044-2051. [PMID: 29584549 DOI: 10.1200/jco.2017.76.5966] [Citation(s) in RCA: 268] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose Uterine serous carcinoma is a rare, aggressive variant of endometrial cancer. Trastuzumab is a humanized monoclonal antibody that targets human epidermal growth factor receptor 2 (HER2)/neu, a receptor overexpressed in 30% of uterine serous carcinoma. This multicenter, randomized phase II trial compared carboplatin-paclitaxel with and without trastuzumab in patients with advanced or recurrent uterine serous carcinoma who overexpress HER2/neu. Methods Eligible patients had primary stage III or IV or recurrent HER2/neu-positive disease. Participants were randomly assigned to receive carboplatin-paclitaxel (control arm) for six cycles with or without intravenous trastuzumab (experimental arm) until progression or unacceptable toxicity. The primary end point was progression-free survival, which was assessed for differences between treatment arms via one-sided log-rank tests. Results From August 2011 to March 2017, 61 patients were randomly assigned. Forty progression-free survival-related events occurred among 58 evaluable participants. Among all patients, median progression-free survival was 8.0 months (control) versus 12.6 months (experimental; P = .005; hazard ratio [HR], 0.44; 90% CI, 0.26 to 0.76). Similarly, median progression-free survival was 9.3 (control) versus 17.9 (experimental) months among 41 patients with stage III or IV disease undergoing primary treatment ( P = .013; HR, 0.40; 90% CI, 0.20 to 0.80) and 6.0 (control) versus 9.2 months (experimental), respectively, among 17 patients with recurrent disease ( P = .003; HR, 0.14; 90% CI, 0.04 to 0.53). Toxicity was not different between treatment arms, and no unexpected safety signals emerged. Conclusion Addition of trastuzumab to carboplatin-paclitaxel was well tolerated and increased progression-free survival. These encouraging results deserve further investigation to determine their impact on overall survival in patients with advanced or recurrent uterine serous carcinoma who overexpress HER2/neu.
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Affiliation(s)
- Amanda N Fader
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Dana M Roque
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Eric Siegel
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Natalia Buza
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Pei Hui
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Osama Abdelghany
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Setsuko K Chambers
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Angeles Alvarez Secord
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Laura Havrilesky
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - David M O'Malley
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Floor Backes
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Nicole Nevadunsky
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Babak Edraki
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Dirk Pikaart
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - William Lowery
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Karim S ElSahwi
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Paul Celano
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Stefania Bellone
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Masoud Azodi
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Babak Litkouhi
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Elena Ratner
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Dan-Arin Silasi
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Peter E Schwartz
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
| | - Alessandro D Santin
- Amanda N. Fader, Johns Hopkins School of Medicine; Dana M. Roque, University of Maryland; Paul Celano, Greater Baltimore Medical Center, Baltimore; William Lowery, Walter Reed Medical Center, Bethesda, MD; Eric Siegel, University of Arkansas for Medical Sciences, Little Rock, AR; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz, and Alessandro D. Santin, Yale University School of Medicine, New Haven, CT; Setsuko K. Chambers, University of Arizona, Tucson, AZ; Angeles Alvarez Secord and Laura Havrilesky, Duke University School of Medicine, Durham, NC; David M. O'Malley and Floor Backes, The Ohio State University School of Medicine, Columbus, OH; Nicole Nevadunsky, Montefiore Medical Center, Bronx, NY; Babak Edraki, John Muir Medical Center, Walnut Creek, CA; Dirk Pikaart, Penrose Cancer Center-St Francis, Colorado Springs, CO; and Karim S. ElSahwi, Meridian Health, Neptune, NJ
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Associated characteristics and impact on recurrence and survival of free-floating tumor fragments in the lumen of fallopian tubes in Type I and Type II endometrial cancer. Gynecol Oncol Rep 2018; 23:28-33. [PMID: 29387776 PMCID: PMC5771964 DOI: 10.1016/j.gore.2018.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 11/21/2022] Open
Abstract
Objective This study sought to evaluate characteristics of cases of free-floating tumor fragments within the lumen of fallopian tubes (‘floaters’) on final pathology for Type I and Type II endometrial adenocarcinoma, including relationships with disease recurrence and mortality. Methods A single institution experience of 1022 consecutive cases of uterine cancer presenting between 2005 and 2010 was retrospectively reviewed, with data extraction from electronic medical records. Associations of floaters with baseline characteristics were studied with logistic regression, and relationships with disease recurrence and survival were assessed with Cox proportional hazards models. Results Among 816 included cases of Type I or Type II endometrial adenocarcinoma, floaters were identified on final pathology for 20 patients (2.5%). Patient characteristics of cases with floaters mirrored the overall sample. With adjustment, presence of floaters trended towards association with laparoscopic/robotic approach (OR = 3.84; 95%CI 0.98-15.1), and was significantly associated with lymphovascular invasion (OR = 9.65; 95%CI 2.35-39.6) and higher stage disease. Although floaters were associated with increased risk of recurrence in unadjusted analysis (HR = 3.22; 95%CI 1.41-7.37), after adjustment for disease type, stage, and patient comorbidities, no evidence for impact on disease recurrence or overall survival was found. Conclusions The presence of floaters is rare. Floaters were generally associated with more extensive disease, but no evidence was found to show any independent prognostic impact on risk of recurrence or death. In agreement with prior research, this study found a trend towards association of floaters with laparoscopic/robotic approach, indicating the possibility of floaters sometimes being the result of trauma from uterine manipulator insertion. Floaters are defined as free floating tumor fragments within the fallopian tubes. Floaters are uncommon, but had previously unknown prognostic significance. Presence of floaters was associated with higher stage and lymphovascular invasion. Floaters may be associated with laparoscopy due to trauma from uterine manipulation. Floaters are not associated with increased chance of recurrence or death.
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Abstract
OBJECTIVES The aims of this study were to determine the role of omental sampling in staging of uterine serous carcinoma (USC) and to evaluate its impact on patient outcomes. MATERIALS AND METHODS A retrospective study of 106 women with USC who underwent primary surgery between 2005 and 2014 was done. Overall survival, disease-free survival, and progression and recurrence patterns were studied in 84 patients with follow-up over 1 year. Diagnostic characteristics were evaluated for preoperative imaging and operative findings. Univariate and multivariate analyses were performed to evaluate risk factors for omental metastasis. Survival curves were used to compare omental sampling status and the presence of omental metastasis. RESULTS Of the 106 patients, 66 underwent surgical staging with omental biopsy (54; 82%) or omentectomy (12, 18%). Eight (12%) patients had metastatic disease in the omental samplings. All 6 patients with macrometastasis had visible lesions or palpable nodules and preoperative computed tomography (CT) was suspicious in 3. In 2 (3%) patients, omentum was not suspicious on CT or intraoperatively but had micrometastases. The negative predictive value regarding the staging CT scan was 92% and of the operative findings was 97%. On multivariate analysis, no variable was associated with omental involvement. Disease progressed or recurred in 40 (48%) patients. The most frequent sites of recurrence or progression were the omentum (23; 27%), peritoneum (26; 31%), pelvis (15, 18%), lung (15, 18%), and liver (12, 14%). Comparing the groups with or without omental assessment, no significant difference was found regarding progression and recurrence patterns, overall survival, and disease-free survival. CONCLUSIONS Omental involvement in USC upstages patients to stage IV disease and traditional risk factors fail to predict extrauterine disease. Although omental sampling does not influence disease progression or survival, a comprehensive intraoperative evaluation of the omentum is advised as most cases have grossly visible lesions.
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Evaluation of unusual and highly aggressive variant of endometrium cancer: nonendometrioid endometrium carcinoma of the uterus. TUMORI JOURNAL 2017; 103:551-556. [PMID: 26391760 DOI: 10.5301/tj.5000404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2015] [Indexed: 11/20/2022]
Abstract
AIMS To evaluate the survival and treatment outcomes of patients with nonendometrioid endometrium carcinoma after postoperative radiotherapy. METHODS The records of 94 patients treated with postoperative radiotherapy (RT) between January 2005 and December 2011 were retrospectively reviewed. Postoperative RT was delivered with a dose of 45-50.4 Gy with 1.8 Gy daily fractions and brachytherapy was added to external RT for 62 patients with a dose of 3 × 6 Gy. Median follow-up time was 35 months (range 6-95 months). RESULTS Median age was 63 years (range 43-83 years) and lymph node metastasis (LNM) was positive in 15 (16.0%) patients. The stage distribution of the patients was as follows: stage I, 58 (61.7%); stage II, 16 (17.0%); stage III, 18 (19.1%); stage IV, 2 (2.2%). Five-year locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) rates were 92.3%, 68.2%, and 78.6%, respectively. In univariable analysis, it was determined that the factors affecting OS rates were stage (p = 0.003), presence of LNM (p = 0.003), and presence of lymphovascular space invasion (LVSI) (p = 0.007); factors affecting DFS rates were stage (p = 0.019), presence of LVSI (p = 0.002), and having LNM (p = 0.049); and the factor affecting LRC rates was tumor size (>5 cm) (p = 0.011). In subgroup analyses, among all stage I patients, the DFS rates were lower for those with histologic grade 3 tumors and more than ½ myometrial invasion. CONCLUSIONS Due to its rarity, the prognostic factors and outcomes of nonendometioid endometrium carcinoma are not fully understood. In our analysis, stage, LNM, and presence of LVSI were found to be the most important prognostic factors. In order to tailor the optimal treatment strategy, prospective studies are needed.
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Extent of lymphovascular space invasion may predict lymph node metastasis in uterine serous carcinoma. Gynecol Oncol 2017; 147:24-29. [PMID: 28709703 DOI: 10.1016/j.ygyno.2017.07.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/06/2017] [Accepted: 07/08/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Emerging evidence suggests that extent of lymphovascular space invasion (LVSI) predicts for risk of lymph node metastasis in endometrioid uterine cancers. However, this correlation remains unknown in the setting of uterine serous carcinoma (USC). We sought to examine the association between extent of LVSI and other histopathologic characteristics with risk of nodal metastasis for women with USC. MATERIALS/METHODS Pathological data from all cases of uterine serous carcinoma between July 1998 to July 2015 at our institution were reviewed. Descriptive, univariate, and multivariate logistic regression analysis of selected pathologic features were performed. RESULTS 88 patients with USC underwent total abdominal or laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and selective lymphadenectomy. Surgical staging revealed the following FIGO stage distributions: I (41%), II (8%), III (32%), IV (19%). LVSI was present in 44 (50%) patients. 36 patients (41%) had LN metastases with median number of total nodes removed of 17 (range, 1-49). On univariate analysis, depth of myometrial invasion, LVSI, tumor size, and cervical stromal involvement were significantly associated with nodal involvement. In a multivariate model, LVSI (OR 6.25, 95% CI 2.2-18.0, p<0.01) and cervical stromal involvement (OR 3.33, 95% CI 1.10-10.0, p=0.03) were the only factors that remained significant. Among patients with LVSI-positive disease, extensive LVSI was associated with increased risk of nodal involvement compared to focal LVSI (90% vs 29%, p=0.04). CONCLUSIONS Presence and extent of LVSI, and cervical stromal invasion are important predictors for lymph node metastasis in uterine serous carcinoma.
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Impact of Chemotherapy and Radiotherapy on Management of Early Stage Clear Cell and Papillary Serous Carcinoma of the Uterus. Int J Gynecol Cancer 2017; 27:720-729. [DOI: 10.1097/igc.0000000000000926] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveThe aim of the study was to assess interaction of lymph node dissection (LND), adjuvant chemotherapy (CT), and radiotherapy (RT) in stage I uterine papillary serous carcinoma (UPSC) and uterine clear cell carcinoma (UCC).Methods/MaterialsThe National Cancer Data Base was queried for women diagnosed with International Federation of Gynecology and Obstetrics stage I UPSC and UCC from 1998 to 2012. Overall survival (OS) was estimated for combinations of RT and CT by the Kaplan-Meier method stratified by histology and LND. Multivariate Cox proportional hazard models were generated.ResultsUterine papillary serous carcinoma: 5432 women with UPSC were identified. Uterine papillary serous carcinoma had the highest 5-year OS with CT + RT with (83%) or without LND (76%). On multivariate analyses, CT [hazard ratio (HR), 0.77; P = 0.01] and vaginal cuff brachytherapy (HR, 0.68; P = 0.003) with LND were independently associated with OS. Without LND, vaginal cuff brachytherapy (HR, 0.53; P = 0.03), but not CT (HR, 1.21; P = 0.92), was associated with OS. Uterine clear cell carcinoma: 2516 women with UCC were identified. Uterine clear cell carcinoma with and without LND had comparable 5-year OS for all combinations of CT and RT on univariate and multivariate analyses.ConclusionsIn stage I papillary serous uterine cancer, brachytherapy and CT were associated with increased survival; however, the benefit of chemotherapy was limited to those with surgical staging. In contrast, no adjuvant therapy was associated with survival in stage I uterine clear cell carcinoma, and further investigation to identify more effective therapies is warranted.
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Sundar S, Balega J, Crosbie E, Drake A, Edmondson R, Fotopoulou C, Gallos I, Ganesan R, Gupta J, Johnson N, Kitson S, Mackintosh M, Martin-Hirsch P, Miles T, Rafii S, Reed N, Rolland P, Singh K, Sivalingam V, Walther A. BGCS uterine cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2017; 213:71-97. [PMID: 28437632 DOI: 10.1016/j.ejogrb.2017.04.015] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
The British Gynaecological Cancer Society has issued the first Endometrial (Uterine) Cancer guidelines as recommendation for practice for the UK.
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Affiliation(s)
- Sudha Sundar
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Janos Balega
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Emma Crosbie
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Alasdair Drake
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Richard Edmondson
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Christina Fotopoulou
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom.
| | - Ioannis Gallos
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Raji Ganesan
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Janesh Gupta
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Nick Johnson
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Sarah Kitson
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Michelle Mackintosh
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Pierre Martin-Hirsch
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Tracie Miles
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Saeed Rafii
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Nick Reed
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Phil Rolland
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Kavita Singh
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Vanitha Sivalingam
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Axel Walther
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
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Sumangala G, Premalatha TS, Kulkarni KA, Acharya G, Bidkar VC, Crasta J, Vallikad E. Uterine Papillary Serous Carcinoma—Still an Enigma? INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2017. [DOI: 10.1007/s40944-017-0102-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Foote JR, Gaillard S, Broadwater G, Sosa JA, Davidson B, Adam MA, Secord AA, Jones MB, Chino J, Havrilesky LJ. Disparities in the surgical staging of high-grade endometrial cancer in the United States. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2017; 4:1. [PMID: 28116108 PMCID: PMC5247803 DOI: 10.1186/s40661-016-0036-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 12/28/2016] [Indexed: 11/25/2022]
Abstract
Background The National Comprehensive Cancer Network (NCCN) and the Society of Gynecologic Oncology (SGO) recommend lymph node sampling (LNS) as a key component in the surgical staging of high-grade endometrial cancer. Our goal was to examine surgical staging patterns for high-grade endometrial cancer in the United States. Methods The National Cancer Data Base (NCDB) was searched for patients who underwent surgery for serous, clear cell, or grade 3 endometrioid endometrial cancer. Outcomes were receipt of LNS and overall survival (OS). Multivariate logistic regression was used to examine receipt of LNS in Stage I–III disease based on race (White vs. Black), income, surgical volume, and distance traveled to care. Multivariate Cox proportional hazards regression modeling was used to assess OS based on stage, race, income, LNS, surgical volume, and distance traveled. Results Forty-two thousand nine hundred seventy-three patients were identified: 76% White, 53% insured by Medicare/Medicaid, 24% traveled >30 miles, and 33% stage III disease. LNS was similar among White and Black women (81% vs 82%). LNS was more common among >30 miles traveled (84% vs 81%, p < 0.001), higher surgical volume (83% vs 80%, p < 0.001), and academic centers (84% vs 80%, p < 0.001). In multivariate analysis, higher income, higher surgical volume, Charlson-Deyo score, and distance traveled were predictors of LNS. Stage III disease (HR 3.39, 95% CI 3.28–3.50), age (10-year increase; HR 1.63, 95% CI 1.61–1.66), lack of LNS (HR 1.64, 95% CI 1.56–1.69), and low income (HR 1.20, 95% CI 1.14–1.27) were predictors of lower survival. Conclusions Surgical care for high-grade endometrial cancer in the United States is not uniform. Improved access to high quality care at high volume centers is needed to improve rates of recommended LNS.
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Affiliation(s)
- Jonathan R Foote
- Division of Gynecologic Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA
| | - Stephanie Gaillard
- Division of Gynecologic Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA
| | - Gloria Broadwater
- Biostatistics, Duke Cancer Institute, Duke University, 2301 Erwin Rd, Durham, NC 27710 USA
| | - Julie A Sosa
- Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA.,Duke Clinical Research Institute, Durham, USA
| | - Brittany Davidson
- Division of Gynecologic Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA
| | - Mohamed A Adam
- Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA
| | - Angeles Alvarez Secord
- Division of Gynecologic Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA
| | - Monica B Jones
- Division of Gynecologic Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA
| | - Junzo Chino
- Division of Radiation Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710 USA
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Adjuvant Chemotherapy and Vaginal Vault Brachytherapy With or Without Pelvic Radiotherapy for Stage 1 Papillary Serous or Clear Cell Endometrial Cancer. Int J Gynecol Cancer 2016; 26:301-6. [PMID: 26745699 DOI: 10.1097/igc.0000000000000611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess and compare adjuvant chemotherapy followed by either high-dose-rate vaginal vault brachytherapy (VBT) alone or combined with pelvic external beam radiotherapy (EBRT) for International Federation of Gynaecology and Obstetrics stage 1 serous or clear cell (CC) endometrial cancer. METHODS Between 2006 and 2012, 84 women with stage 1 serous or CC endometrial cancer were evaluated postoperatively for adjuvant treatment at our hospital. More than 80% of patients had pelvic lymphadenectomy. Patients declining or not completing adjuvant treatments were excluded. Twenty-five women received 4 to 6 cycles of carboplatin/paclitaxel followed by EBRT and VBT. Thirty-two women received 6 cycles of carboplatin/paclitaxel followed by VBT. Locoregional control and toxicities were assessed during follow-up. RESULTS The 3-year disease-free survival and overall survival rates for the VBT group compared with the EBRT + VBT group were 88% versus 84%, P = 0.6, and 100% versus 94%, P = 0.6, respectively. Only 1 patient in the EBRT + VBT group developed a distant recurrence. One patient had grade 3 toxicity (chronic gastrointestinal [GI] toxicity) in the EBRT + VBT group. Acute grade 1-to-2 GI and grade 1 genitourinary (GU) toxicities were less frequent in the VBT group compared with the EBRT + VBT group (P = 0.008 and P = 0.019, respectively). Late GI and GU toxicities were comparable. Grade 1 vaginal toxicity was similar in both groups. No acute or late grade 2 GU or vaginal toxicities were reported. CONCLUSIONS According to this study, VBT alone seems to be as effective as EBRT and VBT for stage 1 serous and CC endometrial cancer treated with surgery and adjuvant chemotherapy. Furthermore, less acute GI and GU toxicities were seen in the VBT group.
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Analysis of clinical and pathological characteristics, treatment methods, survival, and prognosis of uterine papillary serous carcinoma. TUMORI JOURNAL 2016; 102:593-599. [PMID: 27514313 DOI: 10.5301/tj.5000531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Uterine papillary serous carcinoma (UPSC) is an atypical variant of endometrial carcinoma with a poor prognosis. It is commonly associated with an increased risk of extrauterine disease. The aim of this study was to investigate clinical and pathological characteristics, therapeutic methods, and prognostic factors in women with UPSC. METHODS All patients who underwent surgery for UPSC at a single high-volume cancer center between January 1995 and December 2010 were retrospectively reviewed. Patients who did not undergo surgical staging and those with mixed tumor histology were excluded. Univariate and multivariate regression models were used to identify the risk factors for overall survival (OS) and progression-free survival (PFS). RESULTS A total of 46 patients were included, the majority of whom having stage I disease (IA, 13 [28.2%] and IB, 12 [26.7%]). Stages II, III, and IV were identified in 5 (10.9%), 8 (17.4%), and 8 (17.4%) women, respectively. Optimal cytoreduction was obtained in 67.3% of patients. Recurrences developed in 8 (17.4%) patients. Multivariate analysis confirmed that lymphovascular space invasion (LVSI) (odds ratio [OR] 26.83, p = 0.003) was the only independent prognostic factor for OS, whereas LVSI and optimal cytoreduction were found to be independent prognostic factors for PFS (OR 6.91, p = 0.013 and OR 2.69, p = 0.037, respectively). The 5-year overall survival rate was 63%. CONCLUSIONS Our study demonstrated that LVSI is the only independent prognostic factor for OS, whereas LVSI and optimal cytoreduction are independent prognostic factors for PFS in patients with UPSC.
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Mo Z, Liu J, Zhang Q, Chen Z, Mei J, Liu L, Yang S, Li H, Zhou L, You Z. Expression of PD-1, PD-L1 and PD-L2 is associated with differentiation status and histological type of endometrial cancer. Oncol Lett 2016; 12:944-950. [PMID: 27446374 PMCID: PMC4950473 DOI: 10.3892/ol.2016.4744] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/26/2016] [Indexed: 02/05/2023] Open
Abstract
Endometrial cancer (EC) is the most frequent gynecological malignancy and a major cause of morbidity and mortality for women worldwide. Programmed cell death protein 1 (PD-1) and its ligands programmed death ligand 1 (PD-L1) and programmed death ligand 2 (PD-L2) have been well studied in lung cancer, melanoma and renal-cell cancer. However, few studies have been performed in EC. The purpose of the present study was to assess the expression of PD-1, PD-L1 and PD-L2 in 35 human normal endometrial tissue samples and 75 human EC tissue samples using immunohistochemical staining. It was found that 61.3% of ECs were positive for PD-1 staining, which was almost exclusively found in the tumor-infiltrating immune cells. By contrast, PD-1 was not expressed in the tumor cells or normal endometrial tissues. It was also found that 14.3% of normal endometria and 17.3% of EC tissues were positive for PD-L1 expression, while 20.0% of normal endometrium and 37.3% of EC tissues were positive for PD-L2 expression; however, there was no statistically significant difference between the normal endometrium and EC tissues. PD-1 expression in the tumor-infiltrating immune cells was more frequently found in the moderately and poorly-differentiated ECs and non-endometrioid (type II) ECs than in the well-differentiated ECs and endometrioid (type I) ECs. Similarly, PD-L1 and PD-L2 expression in the tumor-infiltrating immune cells was more frequently found in the moderately and poorly-differentiated ECs and type II ECs than in the type I ECs. The present findings indicate a possible better outcome for future treatment with anti-PD-1 or anti-PD-L1 antibody-based therapies against these subgroups of endometrial cancers with frequent expression of the PD-1/PD-L1/PD-L2 axis.
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Affiliation(s)
- Zhongfu Mo
- Department of Obstetrics and Gynecology, Shijiazhuang Maternal and Child Health Care Hospital, Shijiazhuang, Hebei 050000, P.R. China
- Department of Structural and Cellular Biology, Tulane University, New Orleans, LA 70112, USA
| | - Jing Liu
- Department of Obstetrics and Gynecology, Shijiazhuang Maternal and Child Health Care Hospital, Shijiazhuang, Hebei 050000, P.R. China
- Department of Structural and Cellular Biology, Tulane University, New Orleans, LA 70112, USA
| | - Qiuyang Zhang
- Department of Structural and Cellular Biology, Tulane University, New Orleans, LA 70112, USA
| | - Zhiquan Chen
- Department of Structural and Cellular Biology, Tulane University, New Orleans, LA 70112, USA
- Department of Thoracic Surgery, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei 063000, P.R. China
| | - Jiandong Mei
- Department of Structural and Cellular Biology, Tulane University, New Orleans, LA 70112, USA
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Shijie Yang
- Department of Structural and Cellular Biology, Tulane University, New Orleans, LA 70112, USA
- Department of Urology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Huina Li
- Department of Pathology, Shijiazhuang Maternal and Child Health Care Hospital, Shijiazhuang, Hebei 050000, P.R. China
| | - Lifei Zhou
- Department of Obstetrics and Gynecology, Shijiazhuang Maternal and Child Health Care Hospital, Shijiazhuang, Hebei 050000, P.R. China
| | - Zongbing You
- Department of Structural and Cellular Biology, Tulane University, New Orleans, LA 70112, USA
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Lynn AAA, King SA, LiVolsi VA. Utility of Proliferation Markers Ki-67 and Proliferating Cell Nuclear Antigen (PCNA) in the Evaluation of Uterine Papillary Serous Carcinomas. Int J Surg Pathol 2016. [DOI: 10.1177/106689699700400403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined proliferation markers Ki-67 and proliferating cell nuclear antigen (PCNA) to determine whether immunohistochemical staining results could predict outcome in 22 uterine papillary serous carcinomas (UPSC). Eighteen tumors (82%) had increased proliferation as demonstrated by Ki-67 immunostaining with 50% of these patients dying of disease. Twenty tumors (91%) showed high PCNA immunoreactivity; 60% of these patients died of disease. Most UPSC exhibit high immunoreactivity to Ki-67 and/or PCNA, which showed no correlation with outcome or stage. These results may reflect the aggressive clinical behavior of UPSC. We conclude that Ki-67 and PCNA immunohistochemistry have limited use as prognostic indicators in UPSC.
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Affiliation(s)
| | | | - Virginia A. LiVolsi
- University of Pennsylvania Medical Center, Department of Pathology and Laboratory Medicine and Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Philadelphia, Pennsylvania
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43
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Dual CCNE1/PIK3CA targeting is synergistic in CCNE1-amplified/PIK3CA-mutated uterine serous carcinomas in vitro and in vivo. Br J Cancer 2016; 115:303-11. [PMID: 27351214 PMCID: PMC4973158 DOI: 10.1038/bjc.2016.198] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/15/2016] [Accepted: 05/26/2016] [Indexed: 01/12/2023] Open
Abstract
Background: Clinical options for patients harbouring advanced/recurrent uterine serous carcinoma (USC), an aggressive variant of endometrial tumour, are very limited. Next-generation sequencing (NGS) data recently demonstrated that cyclin E1 (CCNE1) gene amplification and pik3ca driver mutations are common in USC and may therefore represent ideal therapeutic targets. Methods: Cyclin E1 expression was evaluated by immunohistochemistry (IHC) on 95 USCs. The efficacy of the cyclin-dependent kinase 2/9 inhibitor CYC065 was assessed on multiple primary USC cell lines with or without CCNE1 amplification. Cell-cycle analyses and knockdown experiments were performed to assess CYC065 targeting specificity. Finally, the in vitro and in vivo activity of CYC065, Taselisib (a PIK3CA inhibitor) and their combinations was tested on USC xenografts derived from CCNE1-amplified/pik3ca-mutated USCs. Results: We found that 89.5% of the USCs expressed CCNE1. CYC065 blocked cells in the G1 phase of the cell cycle and inhibited cell growth specifically in CCNE1-overexpressing USCs. Cyclin E1 knockdown conferred increased resistance to CYC065, whereas CYC065 treatment of xenografts derived from CCNE1-amplified USCs significantly reduced tumour growth. The combination of CYC065 and Taselisib demonstrated synergistic effect in vitro and was significantly more effective than single-agent treatment in decreasing tumour growth in xenografts of CCNE1-amplified/pik3ca-mutated USCs. Conclusions: Dual CCNE1/PIK3CA blockade may represent a novel therapeutic option for USC patients harbouring recurrent CCNE1-amplified/pi3kca-mutated tumours.
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44
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Solmaz U, Mat E, Ekin A, Gezer C, Biler A, Peker N, Ayaz D, Sanci M. Optimal cytoreduction, depth of myometrial invasion, and age are independent prognostic factors for survival in women with uterine papillary serous and clear cell carcinomas. Int J Surg 2016; 32:71-7. [PMID: 27365052 DOI: 10.1016/j.ijsu.2016.06.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 05/26/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the clinicopathological characteristics, treatment methods, and prognostic factors in women with uterine papillary serous carcinoma (UPSC) and uterine clear-cell carcinoma (UCCC). STUDY DESIGN All patients who had undergone surgery for UPCS and UCCC between January 1995 and December 2012 were retrospectively reviewed. Patients with missing data, who did not undergo surgical staging and patients with mixed tumor histology were excluded. Multivariate regression models were used to identify the risk factors for overall survival (OS) and progression-free survival (PFS). RESULTS A total of 49 UPSC and 22 UCCC women were included. The majority of the patients were at stage I [IA, 22 (31%) and IB, 18 (25.4%)]. Stages II, III, and IV were identified in 9 (12.7%), 13 (18.3%), and 9 (12.7%) of cases, respectively. Optimal cytoreduction was achieved in 71.8% of cases. Recurrences occurred in 16 patients (22.5%). The 5-year OS rates were 67% for UPSC; 76% for UCCC; 68% for both histology, respectively. Multivariate analysis pointed out that age>67 years (odds ratio (OR): 3.85, p = 0.009 and OR: 3.35, p = 0.014), >50% myometrial invasion (MI) (OR: 2.87, p = 0.037 and OR: 2.46, p = 0.046) and optimal cytoreduction (OR: 3.26, p = 0.006 and OR: 2.77, p = 0.015) were the independent prognostic factors for both PFS and OS. CONCLUSIONS Our study demonstrated that optimal cytoreduction, >50% MI, and age >67 years are the most significant factors affecting survival in women with UPSC and UCCC.
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Affiliation(s)
- Ulas Solmaz
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Emre Mat
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Atalay Ekin
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Cenk Gezer
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Alper Biler
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Nuri Peker
- Department of Obstetrics and Gynecology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Duygu Ayaz
- Department of Pathology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Muzaffer Sanci
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
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45
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Black J, Menderes G, Bellone S, Schwab CL, Bonazzoli E, Ferrari F, Predolini F, De Haydu C, Cocco E, Buza N, Hui P, Wong S, Lopez S, Ratner E, Silasi DA, Azodi M, Litkouhi B, Schwartz PE, Goedings P, Beusker PH, van der Lee MMC, Timmers CM, Dokter WHA, Santin AD. SYD985, a Novel Duocarmycin-Based HER2-Targeting Antibody-Drug Conjugate, Shows Antitumor Activity in Uterine Serous Carcinoma with HER2/Neu Expression. Mol Cancer Ther 2016; 15:1900-9. [PMID: 27256376 DOI: 10.1158/1535-7163.mct-16-0163] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 05/18/2016] [Indexed: 11/16/2022]
Abstract
Uterine serous carcinoma (USC) is an aggressive form of endometrial cancer. Up to 35% of USC may overexpress the HER2/neu oncogene at strong (i.e., 3+) levels by IHC while an additional 40% to 50% express HER2/neu at moderate (2+) or low (1+) levels. We investigated the efficacy of SYD985, (Synthon Biopharmaceuticals), a novel HER2-targeting antibody-drug conjugate (ADC) composed of the mAb trastuzumab linked to a highly potent DNA-alkylating agent (i.e., duocarmycin) in USC. We also compared the antitumor activity of SYD985 in head-to-head experiments to trastuzumab emtansine (T-DM1), a FDA-approved ADC, against multiple primary USC cell lines expressing different levels of HER2/neu in in vitro and in vivo experiments. Using antibody-dependent cellular cytotoxicity (ADCC), proliferation, viability, and bystander killing assays as well as propidium iodide-based flow cytometry assays and multiple in vivo USC mouse xenograft models, we demonstrate for the first time that SYD985 is a novel ADC with activity against USC with strong (3+) as well as low to moderate (i.e., 1+/2+) HER2/neu expression. SYD985 is 10- to 70-fold more potent than T-DM1 in comparative experiments and, unlike T-DM1, it is active against USC demonstrating moderate/low or heterogeneous HER2/neu expression. Clinical studies with SYD985 in patients harboring chemotherapy-resistant USC with low, moderate, and high HER2 expression are warranted. Mol Cancer Ther; 15(8); 1900-9. ©2016 AACR.
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Affiliation(s)
- Jonathan Black
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Gulden Menderes
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Stefania Bellone
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Carlton L Schwab
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Elena Bonazzoli
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Francesca Ferrari
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Federica Predolini
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher De Haydu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Emiliano Cocco
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Natalia Buza
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Serena Wong
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Salvatore Lopez
- Division of Gynecologic Oncology, University Campus Bio-Medico of Roma, Rome, Italy
| | - Elena Ratner
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Dan-Arin Silasi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Masoud Azodi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Babak Litkouhi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Peter E Schwartz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Peter Goedings
- Synthon Biopharmaceuticals BV., Nijmegen, the Netherlands
| | | | | | | | - Wim H A Dokter
- Synthon Biopharmaceuticals BV., Nijmegen, the Netherlands
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
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Ilker S, Elmas K, Emre O, Mengu T, Erkaya S, Tayfun G. Lympho-vascular space invasion indicates advanced disease for uterine papillary serous tumors arising from polyps. Asian Pac J Cancer Prev 2016; 16:4257-60. [PMID: 26028082 DOI: 10.7314/apjcp.2015.16.10.4257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine papillary serous tumors are rarely seen and behave aggressively. Our aim was to evaluate uterine papillary serous tumors arising from polyps. MATERIALS AND METHODS Clinicopathological data of patients with uterine serous cancer arising from a polyp at the Gynecological Oncology Department of Zekai Tahir Burak Women's Health Education and Research Hospital were reviewed retrospectively. RESULTS We analyzed patients according to FIGO 2009 staging system as stage 1A and higher than stage 1A (3 and 6, respectively). All the patients were postmenopausal. Mean CA-125, CA-19.9 and CA15.3 levels were elevated in higher than stage 1A group. However we did not find a statistical difference between age, parity, polyp size, CA-125, CA-15.3, CA-19.9 and CEA levels. Lympho-vascular space invasion (LVSI) showed predictivity for advanced disease (p=0.025). CONCLUSIONS The histopathologic nature of uterine serous carcinoma is a unique entity. LVSI is a prognosticator for defining an advanced stage uterine papillary tumor.
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Affiliation(s)
- Selcuk Ilker
- Gynecologic Oncology Unit, Zekai Tahir Burak Women's Health, Education and Research Hospital, Ankara, Turkey E-mail :
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Sorbe B. Prognostic importance of DNA ploidy in non-endometrioid, high-risk endometrial carcinomas. Oncol Lett 2016; 11:2283-2289. [PMID: 26998163 DOI: 10.3892/ol.2016.4178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 12/04/2015] [Indexed: 01/15/2023] Open
Abstract
The present study investigated the predictive and prognostic impact of DNA ploidy together with other well-known prognostic factors in a series of non-endometrioid, high-risk endometrial carcinomas. From a complete consecutive series of 4,543 endometrial carcinomas of International Federation of Gynecology and Obstetrics (FIGO) stages I-IV, 94 serous carcinomas, 48 clear cell carcinomas and 231 carcinosarcomas were selected as a non-endometrioid, high-risk group for further studies regarding prognosis. The impact of DNA ploidy, as assessed by flow cytometry, was of particular focus. The age of the patients, FIGO stage, depth of myometrial infiltration and tumor expression of p53 were also included in the analyses (univariate and multivariate). In the complete series of cases, the recurrence rate was 37%, and the 5-year overall survival rate was 39% with no difference between the three histological subtypes. The primary cure rate (78%) was also similar for all tumor types studied. DNA ploidy was a significant predictive factor (on univariate analysis) for primary tumor cure rate, and a prognostic factor for survival rate (on univariate and multivariate analyses). The predictive and prognostic impact of DNA ploidy was higher in carcinosarcomas than in serous and clear cell carcinomas. In the majority of multivariate analyses, FIGO stage and depth of myometrial infiltration were the most important predictive (tumor recurrence) and prognostic (survival rate) factors. DNA ploidy status is a less important predictive and prognostic factor in non-endometrioid, high-risk endometrial carcinomas than in the common endometrioid carcinomas, in which FIGO and nuclear grade also are highly significant and important factors.
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Affiliation(s)
- Bengt Sorbe
- Department of Oncology, Faculty of Medicine and Health, Örebro University Hospital, Örebro SE-701 85, Sweden
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48
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Extrauterine Spread, Adjuvant Treatment, and Prognosis in Noninvasive Uterine Papillary Serous Carcinoma of the Endometrium: A Retrospective Multicenter Study. Int J Gynecol Cancer 2016; 27:102-108. [DOI: 10.1097/igc.0000000000000838] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectivesThe aim of this retrospective multicenter study was to investigate the frequency of extrauterine metastasis and to evaluate the importance of surgical staging and adjuvant treatment among patients with noninvasive uterine papillary serous carcinoma (UPSC) of the endometrium.Materials and MethodsA multicenter, retrospective department database review was performed to identify patients with UPSC of the endometrium who underwent surgical staging between 2000 and 2015 at 4 Gynecologic Oncology Centers in Turkey. Demographic, clinicopathological, and survival data were collected.ResultsA total of 182 patients with primary UPSC of the endometrium were identified. Of these, 33 (18.1%) had tumors limited to the endometrium with no myometrial invasion. Twenty (60.6%) of these 33 patients had no extrauterine involvement and International Federation of Gynecology and Obstetrics 2009 stage 1A disease was diagnosed after complete staging. The remaining 13 (39.4%) patients had disease beyond the uterine corpus including 5 with omental, 3 with adnexal, 1 with cervical stromal involvement, 1 with disease in the pelvic lymph nodes, and 1 with isolated para-aortic lymph node metastasis. Two patients had metastases in more than one location including omentum/adnexa/pelvic–para-aortic lymph nodes and omentum/pelvic–para-aortic lymph nodes, respectively. Of the 20 patients with disease confined to the endometrium, 6 (30%) patients received adjuvant treatment.ConclusionsNoninvasive UPSC has a high tendency for extrauterine spread and omentum is the most commonly involved location. Therefore, comprehensive surgical staging including omentectomy and pelvic–para-aortic lymph node dissection is mandatory in this group of patients. Risk of extrauterine spread is significantly associated with the presence of lymphovascular space invasion, elevated preoperative CA 125 levels, and positive peritoneal cytology. Adjuvant therapy for women with endometrium-confined disease improves neither progression-free survival nor overall survival.
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49
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Bellone S, Black J, English DP, Schwab CL, Lopez S, Cocco E, Bonazzoli E, Predolini F, Ferrari F, Ratner E, Silasi DA, Azodi M, Schwartz PE, Santin AD. Solitomab, an EpCAM/CD3 bispecific antibody construct (BiTE), is highly active against primary uterine serous papillary carcinoma cell lines in vitro. Am J Obstet Gynecol 2016; 214:99.e1-8. [PMID: 26272866 DOI: 10.1016/j.ajog.2015.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/30/2015] [Accepted: 08/04/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Uterine serous carcinoma is an aggressive form of endometrial cancer that carries an extremely poor prognosis. Solitomab is a novel bispecific single-chain antibody construct that targets epithelial cell adhesion molecule on tumor cells and also contains a CD3 binding region. We evaluated the expression levels of epithelial cell adhesion molecule and the in vitro activity of solitomab against primary uterine serous carcinoma cell lines in vitro and ex-vivo in the ascites of patients with uterine serous carcinoma. OBJECTIVE The purpose of this study was to determine the frequency of expression of epithelial cell adhesion molecule on uterine serous carcinoma cell lines and the ability of solitomab to modulate immune responses (T-cell proliferation, activation, cytokine production, and tumor killing) to tumor cells when it is combined with lymphocytes and epithelial cell adhesion molecule-positive cell lines or epithelial cell adhesion molecule-positive ascitic fluid in vitro. STUDY DESIGN Epithelial cell adhesion molecule expression was evaluated by flow cytometry in a total of 14 primary uterine serous carcinoma cell lines. Sensitivity to solitomab-dependent cellular-cytotoxicity was tested against a panel of primary uterine serous carcinoma cell lines that express different levels of epithelial cell adhesion molecule in standard 4-hour chromium release assays. The proliferative activity, activation, cytokine secretion (ie, type I vs type II), and cytotoxicity of solitomab in autologous tumor-associated T cells in the ascitic fluid of patients with uterine serous carcinoma was also evaluated by carboxyfluorescein succinimidyl ester and flow-cytometry assays. Differences in epithelial cell adhesion molecule expression, solitomab-dependent cellular-cytotoxicity levels were analyzed with the use of an unpaired t test. T-cell activation marker increase and cytokine release were analyzed by a paired t test. RESULTS Surface expression of epithelial cell adhesion molecule was found in 85.7% (12 of 14) of the uterine serous carcinoma cell lines that were tested by flow cytometry. Epithelial cell adhesion molecule-positive cell lines were found resistant to natural killer cells or T-cell-mediated killing after exposure to peripheral blood lymphocytes in 4-hour chromium-release assays (mean killing ± standard of the mean, 2.7% ± 3.1% after incubation of epithelial cell adhesion molecule-positive cell lines with control bispecific antibody construct). In contrast, after incubation with solitomab, epithelial cell adhesion molecule-positive uterine serous carcinoma cells became highly sensitive to T-cell cytotoxicity (mean killing, 25.7% ± 4.5%; P < .0001) by peripheral blood lymphocytes. Ex vivo incubation of autologous tumor-associated lymphocytes with epithelial cell adhesion molecule that expressed malignant cells in ascites with solitomab resulted in a significant increase in T-cell proliferation in both CD4+ and CD8+ T cells, increase in T-cell activation markers (ie, CD25 and HLA-DR), and a reduction in number of viable uterine serous carcinoma cells in ascites (P < .001). CONCLUSION Solitomab induces robust immunologic responses in vitro that result in increased T-cell activation, proliferation, production of cytokines, and direct killing of tumor cells. These findings suggest that solitomab may represent a novel, potentially effective agent for the treatment of recurrent/metastatic and/or chemo-resistant uterine serous carcinoma-overexpressing epithelial cell adhesion molecule.
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MESH Headings
- Antibodies, Bispecific/pharmacology
- Antigens, Neoplasm/analysis
- Antigens, Neoplasm/drug effects
- Antigens, Neoplasm/immunology
- Antineoplastic Agents/pharmacology
- Ascitic Fluid/pathology
- CD3 Complex/immunology
- CD4-Positive T-Lymphocytes/drug effects
- CD4-Positive T-Lymphocytes/immunology
- Carcinoma, Papillary/chemistry
- Carcinoma, Papillary/drug therapy
- Carcinoma, Papillary/immunology
- Cell Adhesion Molecules/analysis
- Cell Adhesion Molecules/drug effects
- Cell Adhesion Molecules/immunology
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Coculture Techniques
- Cytokines/drug effects
- Cytokines/metabolism
- Cytotoxicity, Immunologic/drug effects
- Epithelial Cell Adhesion Molecule
- Female
- Flow Cytometry
- Humans
- Lymphocyte Activation/drug effects
- Neoplasms, Cystic, Mucinous, and Serous/chemistry
- Neoplasms, Cystic, Mucinous, and Serous/drug therapy
- Neoplasms, Cystic, Mucinous, and Serous/immunology
- T-Lymphocytes, Cytotoxic/drug effects
- T-Lymphocytes, Cytotoxic/immunology
- Uterine Neoplasms/chemistry
- Uterine Neoplasms/drug therapy
- Uterine Neoplasms/immunology
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Affiliation(s)
- Stefania Bellone
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Jonathan Black
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Diana P English
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Carlton L Schwab
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Salvatore Lopez
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Emiliano Cocco
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Elena Bonazzoli
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Federica Predolini
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Francesca Ferrari
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Elena Ratner
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Dan-Arin Silasi
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Masoud Azodi
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Peter E Schwartz
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
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50
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Practical issues in the diagnosis of serous carcinoma of the endometrium. Mod Pathol 2016; 29 Suppl 1:S45-58. [PMID: 26715173 DOI: 10.1038/modpathol.2015.141] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/13/2015] [Accepted: 11/05/2015] [Indexed: 11/08/2022]
Abstract
Serous carcinoma (SC) represents ~10% of endometrial carcinomas, but is responsible for almost 40% of cancer deaths. This article reviews the main pathological features, differential diagnosis, and the usefulness of molecular pathology and immunohistochemistry in its diagnosis. Most helpful features for the diagnosis include: irregularly shaped and sized papillae, slit-like spaces, cell stratification and budding, highly atypical cells, architectural and cytological discordance in pseudoglandular tumors, as well as lack of endometrioid features. SC shows typically a predominant papillary growth, which is also found in some subtypes of endometrioid carcinoma of the endometrium (EEC). Distinction is easy when attention is paid to the presence of diffuse marked nuclear pleomorphism, but also to the complex papillary architecture. SC may also show a solid or pseudoglandular patterns, and in these cases differential diagnosis may be difficult with EEC grade 3. Moreover, a high proportion of SC may exhibit clear cells, and, thus, may be confused with clear cell carcinoma. Finally, it is sometimes difficult to distinguish mixed SC-EEC, from SC that combines papillary and pseudoglandular growths. Although there is not a single immunohistochemical marker for distinguishing SC from its mimickers, some antibodies are useful (p53, p16, IMP2, and IMP3), particularly when used in combination. Diagnosis of SC may be even more problematic in small biopsies; a diagnosis of high-grade endometrial carcinoma, SC component can not be excluded, is acceptable as a managerial approach, so it could be taken into account at the time of final surgery.
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