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Wang DG, Ji LM, Jia CL, Shao MJ. Effect of coexisting adenomyosis on tumour characteristics and prognosis of endometrial cancer: A systematic review and meta-analysis. Taiwan J Obstet Gynecol 2023; 62:640-650. [PMID: 37678989 DOI: 10.1016/j.tjog.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 09/09/2023] Open
Abstract
To compare clinicopathological features and survival outcomes in patients with endometrial cancer, with and without associated adenomyosis. PubMed, Embase and Scopus databases were systematically searched for relevant observational studies. The pooled effect sizes were reported as either hazards ratio (HR) for survival-related outcomes or as odds ratio (OR) for other categorical outcomes. Weighted mean difference (WMD) was reported for continuous outcomes. All the analyses used the random effects model. A total of 21 studies (N = 46,420) were included. Compared to endometrial cancer patients without adenomyosis, patients with associated adenomyosis had improved overall 5-year survival (OS) (HR 0.62, 95% CI: 0.50, 0.79) and disease-free survival (DFS) (HR 0.60, 95% CI: 0.44, 0.82). Disease-specific survival was statistically similar in patients with and without adenomyosis (HR 0.60, 95% CI: 0.35, 1.05). Among patients with adenomyosis, the risk of having an advanced tumour grade (Grade 2 or 3) was lower (OR 0.51, 95% CI: 0.42, 0.62) and a risk of having International Federation of Gynaecology and Obstetrics (FIGO) stage I or II was higher (OR 2.23, 95% CI: 1.65, 3.01). Patients with adenomyosis had lower risk of tumour invasion of adnexa, cervical stromal invasion, deep myometrial involvement (DMI), lympho-vascular space invasion (LVSI) and peritoneal invasion. Presence of adenomyosis in patients with endometrial cancer is associated with favourable tumour characteristics and may improve the survival.
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Affiliation(s)
- Dong-Ge Wang
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, 321000, China
| | - Li-Mei Ji
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, 321000, China
| | - Cen-Lin Jia
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, 321000, China
| | - Ming-Jun Shao
- Department of Obstetrics and Gynecology, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, 321000, China.
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2
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Andleeb A, Fatima K, Nasreen S, Sofi M, Qadri S. Endometrial carcinoma: A single institute experience. JOURNAL OF RADIATION AND CANCER RESEARCH 2021. [DOI: 10.4103/jrcr.jrcr_19_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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3
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An M, Duan H, Zhang Y. Prognostic significance of co‐existent adenomyosis on outcomes and tumor characteristics of endometrial cancer: A meta‐analysis. J Obstet Gynaecol Res 2020; 46:1851-1863. [DOI: 10.1111/jog.14371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/02/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Min An
- Department of Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology HospitalCapital Medical University Beijing China
| | - Hua Duan
- Department of Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology HospitalCapital Medical University Beijing China
| | - Ying Zhang
- Department of Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology HospitalCapital Medical University Beijing China
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4
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Stasenko M, Feit N, Lee SSK, Shepherd C, Soslow RA, Cadoo KA, Alektiar K, Da Silva EM, Martins Sebastião AP, Leitao MM, Gardner G, Selenica P, Abu-Rustum NR, Weigelt B, Mueller JJ. Clinical patterns and genomic profiling of recurrent 'ultra-low risk' endometrial cancer. Int J Gynecol Cancer 2020; 30:717-723. [PMID: 32376737 PMCID: PMC7295026 DOI: 10.1136/ijgc-2020-001241] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Despite good prognosis for patients with low-risk endometrial cancer, a small subset of women with low-grade/low-stage endometrial cancer experience disease recurrence and death. The aim of this study was to characterize clinical features and mutational profiles of recurrent, low-grade, non-myoinvasive, 'ultra-low risk' endometrioid endometrial adenocarcinomas. METHODS We retrospectively identified patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA endometrioid endometrial cancers who underwent primary surgery at our institution, between January 2009 and February 2017, with follow-up of ≥12 months. 'Ultra-low risk' was defined as FIGO tumor grade 1, non-myoinvasive, and lacking lymphovascular space invasion. Tumor-normal profiling using massively parallel sequencing targeting 468 genes was performed. Microsatellite instability was assessed using MSIsensor. DNA mismatch repair (MMR) protein proficiency was determined by immunohistochemistry. RESULTS A total of 486 patients with ultra-low risk endometrioid endometrial cancers were identified: 14 (2.9%) of 486 patients developed a recurrence. Median follow-up for non-recurrent endometrioid endometrial cancers: 34 (range 12-116) months; for recurrent endometrioid endometrial cancers: 50.5 (range 20-116) months. Patients with recurrent disease were older, had lower body mass index, and were most commonly non-White (p=0.025, p<0.001, and p<0.001, respectively). Other clinical characteristics did not differ. MMR immunohistochemistry was obtained for 211 (43%) tumors: 158 (75%) MMR-proficient and 53 (25%) MMR-deficient. Primary tumors of 9 recurrent and 27 non-recurrent endometrioid endometrial cancers underwent mutational profiling. Most were microsatellite stable (6/9, 67% recurrent; 25/27, 93% non-recurrent). Recurrent PTEN and PIK3CA mutations were present in both groups. Exon 3 CTNNB1 hotspot mutations were found in 4/9 (44%) recurrent and 8/27 (30%) non-recurrent (p=0.44). CONCLUSIONS Patients diagnosed with ultra-low risk endometrioid endometrial cancers have an overall excellent prognosis. However, in our study, 2.9% of patients with no identifiable clinical or pathologic risk factors developed recurrence. Further work is warranted to elucidate the mechanism for recurrence in this population.
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Affiliation(s)
- Marina Stasenko
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Noah Feit
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Simon S K Lee
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cassandra Shepherd
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert A Soslow
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Karen A Cadoo
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kaled Alektiar
- Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Edaise M Da Silva
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Mario M Leitao
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ginger Gardner
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Pier Selenica
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Britta Weigelt
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer J Mueller
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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5
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Habiba M, Pluchino N, Petignat P, Bianchi P, Brosens I, Benagiano G. Adenomyosis and Endometrial Cancer: Literature Review. Gynecol Obstet Invest 2018; 83:313-328. [DOI: 10.1159/000487320] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 11/19/2022]
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6
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Capriglione S, Plotti F, Miranda A, Lopez S, Scaletta G, Moncelli M, Luvero D, De Cicco Nardone C, Terranova C, Montera R, Angioli R. Further insight into prognostic factors in endometrial cancer: the new serum biomarker HE4. Expert Rev Anticancer Ther 2016; 17:9-18. [PMID: 27892774 DOI: 10.1080/14737140.2017.1266263] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Endometrial cancer (EC) is one of the most common gynecological cancer worldwide. To date, no good markers are routinely used in clinical practice for prognosis and monitoring. Areas covered: During the last years, an increasing interest in literature has been growing on HE4 (Human epididimis 4). Therefore, we aimed to gather all the evidence reported in literature analysing the potential prognostic value of HE4, compared to the well know tumor's features (histological type and grade, stage of disease, depth of myometrial invasion, lymphovascular space involvement and cervical involvement). Expert commentary: The analysis of data suggests that HE4 seems to have a good performance in prognosis and monitoring of the disease, helping to schedule the appropriste timing of imaging and surgery in a more individualized fashion. However, these findings surely require a validation in a larger cohorts of patients. Probably, in the next five years, prospective randomized trials will be performed to confirm the prognostic role of HE4 in EC and to find a tailored EC management strategy.
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Affiliation(s)
- Stella Capriglione
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Francesco Plotti
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Andrea Miranda
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Salvatore Lopez
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Giuseppe Scaletta
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Michele Moncelli
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Daniela Luvero
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Carlo De Cicco Nardone
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Corrado Terranova
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Roberto Montera
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Roberto Angioli
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
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7
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Petrić A, Živadinović R, Vukomanović P, Stanojević M, Krtinić D. ASSESSMENT OF THE RISK OF METASTASIS IN PATIENTS WITH ENDOMETRIAL CARCINOMA. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Abouhashem NS, Ibrahim DA, Mohamed AM. Prognostic implications of epithelial to mesenchymal transition related proteins (E-cadherin, Snail) and hypoxia inducible factor 1α in endometrioid endometrial carcinoma. Ann Diagn Pathol 2016; 22:1-11. [DOI: 10.1016/j.anndiagpath.2016.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/01/2016] [Accepted: 01/04/2016] [Indexed: 12/11/2022]
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9
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Tejerizo-García A, Jiménez-López JS, Muñoz-González JL, Bartolomé-Sotillos S, Marqueta-Marqués L, López-González G, Gómez JFPR. Overall survival and disease-free survival in endometrial cancer: prognostic factors in 276 patients. Onco Targets Ther 2013; 9:1305-13. [PMID: 24092993 PMCID: PMC3787927 DOI: 10.2147/ott.s51532] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective The aim of the study reported here was to assess the disease-free survival and overall survival
of patients with endometrial cancer and to determine independent factors affecting the
prognosis. Materials and methods This was a retrospective study of a single-center clinical series of 276 patients (mean age 64
years) with histologically confirmed cancer of the corpus uteri. The standard treatments were
extrafascial total hysterectomy and bilateral salpingo-oophorectomy with selective
pelvic/para-aortic node dissection, according to risk for recurrence. Actuarial overall survival and
disease-free survival were estimated according to the Kaplan–Meier method. Univariate and
multivariate Cox proportional hazards analyses were used to assess the prognostic significance of
the different variables. Results The estimated median follow-up, determined using the inverse Kaplan–Meier method, was 45
months (95% confidence interval [CI] 41.2–48.8) for disease-free survival
and 46 months (95% CI 43.0–49.0) for overall survival. The statistically significant
variables affecting disease-free survival and overall survival were age, serous-papillary and
clear-cell histological types, outer-half myometrial invasion, advanced International Federation of
Gynecology and Obstetrics (FIGO) stage, tumor grades G2 and G3, incomplete surgical resection,
positive lymph nodes, lymphovascular space invasion, tumor remnants of >1 cm after surgery,
and high-risk group. In the multivariate Cox regression model, predictors of tumor recurrence
included advanced FIGO stage (hazard ratio [HR] 4.90, 95% CI 2.57–9.36,
P < 0.001) and tumor grades G2 (HR 4.79, 95% CI 1.73–13.27,
P = 0.003) and G3 (HR 7.56, 95% CI 2.75–20.73, P <
0.001). The same variables were also associated with a significantly higher risk of tumor-related
mortality. Conclusion FIGO stage and tumor grade were independent prognostic factors of disease-free survival and
overall survival in endometrial cancer patients. Outcome was also influenced by histopathologic
type, myometrial and lymphovascular space invasion, lymph-node involvement, age, and tumor remnants
after surgery, although a larger study sample is probably needed to demonstrate the independent
association of these variables with survival.
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10
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Gottwald L, Pluta P, Piekarski J, Spych M, Hendzel K, Topczewska-Tylinska K, Nejc D, Bibik R, Korczyński J, Ciałkowska-Rysz A. Long-term survival of endometrioid endometrial cancer patients. Arch Med Sci 2010; 6:937-44. [PMID: 22427770 PMCID: PMC3302708 DOI: 10.5114/aoms.2010.19305] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Revised: 01/07/2010] [Accepted: 03/23/2010] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION To establish risk factors for onset and progression of endometrioid endometrial cancer still remains the aim of scientists. The aim of the study was to determine disease-free survival (DFS) and overall survival (OS) in women with endometrioid endometrial cancer. MATERIAL AND METHODS A retrospective review of 142 patients with endometrioid endometrial cancer after surgery treated with adjuvant radiotherapy and/or chemotherapy in the Regional Cancer Centre in Lodz between 2002 and 2004 was performed. Clinical and pathological data were correlated with clinical outcome and survival. RESULTS In 3 patients (2.1%) clinical progression was diagnosed during the treatment. In 23 patients (16.7%) after primary remission, relapse was diagnosed 2-56 months after treatment. DFS and OS were 81.7% and 83.1% respectively. Better DFS significantly correlated with larger number of pregnancies (> 1), stage I of the disease and optimal surgery. Lower stage of disease, pelvic lymph node dissection, optimal surgery and depth of myometrial infiltration ≤ 50% were independent prognostic factors for better OS. CONCLUSIONS The results of our study provided significant evidence that early detection of endometrioid endometrial cancer enables optimal surgery. It reduces the indications for adjuvant therapy in stage I of the disease, and makes the prognosis significantly better. Other clinical and pathological factors such as numerous pregnancies, pelvic lymphadenectomy, and depth of myometrial infiltration, although important, are of less significance. Further prospective, randomized studies are necessary to prove the role of these factors.
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Affiliation(s)
- Leszek Gottwald
- Palliative Care Unit, Chair of Oncology, Medical University of Lodz, Poland
- Gynecological Cancer Outpatient Clinic, Regional Cancer Center, Copernicus Memorial Hospital of Lodz, Poland
| | - Piotr Pluta
- Department of Surgical Oncology, Chair of Oncology, Medical University of Lodz, Poland
| | - Janusz Piekarski
- Department of Surgical Oncology, Chair of Oncology, Medical University of Lodz, Poland
| | - Michał Spych
- Department of Radiotherapy, Chair of Oncology, Medical University of Lodz, Poland
| | - Katarzyna Hendzel
- Department of Histopathology, Madurowicz Memorial Hospital, Lodz, Poland
| | | | - Dariusz Nejc
- Department of Surgical Oncology, Chair of Oncology, Medical University of Lodz, Poland
| | - Robert Bibik
- Department of Teleradiotherapy, Regional Cancer Center, Copernicus Memorial Hospital of Lodz, Poland
| | - Jerzy Korczyński
- Department of Fetal Medicine and Gynecology, 1 Chair of Obstetrics and Gynecology, Medical University of Lodz, Poland
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11
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Jongen V, Briët J, de Jong R, ten Hoor K, Boezen M, van der Zee A, Nijman H, Hollema H. Expression of estrogen receptor-alpha and -beta and progesterone receptor-A and -B in a large cohort of patients with endometrioid endometrial cancer. Gynecol Oncol 2009; 112:537-42. [DOI: 10.1016/j.ygyno.2008.10.032] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 10/17/2008] [Accepted: 10/31/2008] [Indexed: 11/29/2022]
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12
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Kelly JG, Singh MN, Stringfellow HF, Walsh MJ, Nicholson JM, Bahrami F, Ashton KM, Pitt MA, Martin-Hirsch PL, Martin FL. Derivation of a subtype-specific biochemical signature of endometrial carcinoma using synchrotron-based Fourier-transform infrared microspectroscopy. Cancer Lett 2009; 274:208-17. [DOI: 10.1016/j.canlet.2008.09.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 07/19/2008] [Accepted: 09/10/2008] [Indexed: 11/16/2022]
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13
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Junqueira MG, da Silva IDCG, Nogueira-de-Souza NC, Carvalho CV, Leite DB, Gomes MTV, Baracat EC, Lopes LAF, Nicolau SM, Gonçalves WJ. Progesterone receptor (PROGINS) polymorphism and the risk of endometrial cancer development. Int J Gynecol Cancer 2007; 17:229-32. [PMID: 17291258 DOI: 10.1111/j.1525-1438.2006.00767.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The progesterone receptor gene (PROGINS) has been identified as a risk modifier for benign and malignant gynecological diseases. The present case-control study is to evaluate the role of the PROGINS polymorphisms, as risk factor, for endometrial cancer development and to investigate the association between these genetics variants and clinical/pathologic variables of endometrial cancer. PROGINS polymorphism was examined in a total of 121 patients with endometrial cancer and 282 population-based control subjects, all located at the same area in São Paulo, SP, Brazil. The genotyping of PROGINS polymorphism was determined by polymerase chain reaction. The frequencies of PROGINS polymorphism T1/T1, T1/T2, and T2/T2 were 82.6%, 14.9%, and 2.5% in the endometrial cancer patients and 78.4%, 21.6%, and 0% in the controls, respectively. The chi(2) test showed a higher incidence of the T2/T2 genotype in the endometrial cancer group subjects, these results were statistically different (P= 0.012). However, due to the fact that there were no women in the control group showing homozygosis for the allele T2, the correct evaluation of odds ratio could not be properly calculated. Regarding the clinical and pathologic findings observed within the group of patients with endometrial cancer, there was significant correlation between T1/T2 genotype and the presence of myoma (P= 0.048). No correlations were observed among the other variables. These data suggest that the PROGINS polymorphism T2/T2 genotype might be associated with an increased risk of endometrial cancer.
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Affiliation(s)
- M G Junqueira
- Molecular Gynecology Laboratory, Department of Gynecology, Federal University of São Paulo, Head Rua Pedro de Toledo 781, São Paulo, SP, Brazil 04039-032
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14
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Pijnenborg JMA, Romano A, Dam-de Veen GC, Dunselman GAJ, Fischer DC, Groothuis PG, Kieback DG. Aberrations in the progesterone receptor gene and the risk of recurrent endometrial carcinoma. J Pathol 2005; 205:597-605. [PMID: 15726651 DOI: 10.1002/path.1738] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A case-control study was performed in order to determine whether expression of the progesterone receptor (PR) and/or aberrations of the PR gene contribute to the development of recurrent endometrial carcinoma. Primary tumours from 44 patients with recurrence of stage I endometrial carcinoma (patients) within 3 years after initial treatment were compared with tumours from 44 matched patients who were free of recurrence for a minimum of 3 years (controls). Paraffin wax-embedded primary tumours (n = 88) and recurrent tumours (n = 32) were analysed immunohistochemically for PR expression. A staining index (SI = 0-9) based on the staining intensity and the number of stained cells was calculated. DNA extracted from paraffin wax-embedded tissues was subjected to PCR-restriction fragment length polymorphism analysis (PCR-RFLP) for determination of the PROGINS DNA sequence alterations and the +331G/A-promoter polymorphism. Low PR expression (SI < 1.0) was observed in 7% of primary tumours derived from controls, 25% of primary tumours from patients with recurrence, and 38% of recurrent tumours. The expression of PR was significantly lower in primary tumours from patients with recurrence (SI = 4.0 +/- 0.5) than in the tumours in the control group (SI = 5.6 +/- 0.5) (T-test for paired analysis, p < 0.05). The PROGINS and +331G/A-promoter polymorphism were not related to age at diagnosis, tumour grade or myometrial invasion. The +331G/A-promoter polymorphism was present in 14% of primary tumours from patients without recurrence, compared with 17% of patients with recurrence. The PROGINS polymorphism was observed in 16% of primary tumours from patients without, and in 34% of patients with, recurrence (OR 2.6; 95% CI: 0.9-7.6). Most interestingly, patients who carried the PROGINS variant and in whom a PR-expressing tumour was diagnosed were at significantly enhanced risk of relapse (OR 4.7; 95% CI: 1.3-17.1). In conclusion, low PR expression tended to be associated with recurrent disease, and PR expression in tumours from patients carrying the PROGINS allele was predictive of the risk of recurrence.
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MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/immunology
- Biomarkers, Tumor/metabolism
- Case-Control Studies
- Chromosome Aberrations
- DNA, Neoplasm/genetics
- Endometrial Neoplasms/genetics
- Endometrial Neoplasms/metabolism
- Endometrial Neoplasms/pathology
- Female
- Humans
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Proteins/genetics
- Neoplasm Proteins/immunology
- Neoplasm Proteins/metabolism
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Staging
- Polymorphism, Genetic
- Polymorphism, Restriction Fragment Length
- Prognosis
- Receptors, Progesterone/genetics
- Receptors, Progesterone/immunology
- Receptors, Progesterone/metabolism
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Affiliation(s)
- J M A Pijnenborg
- Research Institute GROW, University of Maastricht, 6202 AZ Maastricht, The Netherlands
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15
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Rubod C, Narducci F, Delattre C, Decocq J, Verbert A, Delahousse G. [Endometrioid adenocarcinoma arising from adenomyosis. A case report and literature review]. ACTA ACUST UNITED AC 2004; 33:140-4. [PMID: 15052180 DOI: 10.1016/s0368-2315(04)96413-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In spite of many references to carcinoma arising from endometriosis, there are few documented cases in the literature of endometrioid adenocarcinoma developed in association with adenomyosis. We report a case of endometrioid adenocarcinoma arising from adenomyosis. Carcinogenic and prognostic factors as well as the therapeutic consequences of this unusual situation are discussed. The use of hormonal replacement therapy by patients with a prior history of adenomyosis is also examined.
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Affiliation(s)
- C Rubod
- Clinique de Gynécologie Obstétrique et Néonatologie, Pavillon Paul Gellé, Centre Hospitalier de Roubaix, 91, avenue Julien-Lagache, 59100 Roubaix
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16
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Stefansson IM, Salvesen HB, Immervoll H, Akslen LA. Prognostic impact of histological grade and vascular invasion compared with tumour cell proliferation in endometrial carcinoma of endometrioid type. Histopathology 2004; 44:472-9. [PMID: 15139995 DOI: 10.1111/j.1365-2559.2004.01882.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The relative impact of different prognostic factors is important for endometrial carcinoma patients. The aim of our study was to examine the combined value of histological grade [International Federation of Gynaecology and Obstetrics (FIGO)] and vascular invasion in comparison with tumour cell proliferation assessed by mitotic count and Ki67. The recently proposed binary architectural grade was also evaluated, in addition to age, depth of myometrial infiltration and FIGO stage in our population-based series of 237 endometrioid carcinomas. METHODS AND RESULTS The tumours were studied for several histological features, including FIGO grade, binary grade, vascular invasion, mitotic count, myometrial invasion and expression of Ki67. FIGO grade was significantly associated with all investigated histological features, including Ki67 expression. Vascular invasion was significantly more frequent in FIGO grade 3 tumours, and was associated with a diffusely infiltrative growth pattern, solid growth, necrosis and deep myometrial invasion. All variables showed a highly significant relationship with patient survival in univariate analysis. In multivariate models, FIGO grade, vascular invasion, and proliferation assessed by Ki67 expression all had independent prognostic influence in this population-based study. Comparing tumour cell proliferation (Ki67) with vascular invasion as a marker of metastatic spread, the latter had a stronger survival impact. CONCLUSIONS Vascular invasion and tumour cell proliferation measured by Ki67 both had independent prognostic influence, and should be considered to identify aggressive tumours of the endometrioid subtype.
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Affiliation(s)
- I M Stefansson
- Department of Pathology, The Gade Institute, Haukeland University Hospital, Bergen, Norway
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Sartori E, Laface B, Gadducci A, Maggino T, Zola P, Landoni F, Zanagnolo V. Factors influencing survival in endometrial cancer relapsing patients: a Cooperation Task Force (CTF) study. Int J Gynecol Cancer 2003; 13:458-65. [PMID: 12911722 DOI: 10.1046/j.1525-1438.2003.13328.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to identify patterns of relapse and to determine the outcome of salvage treatment and the factors influencing survival of endometrial cancer relapsing patients. One thousand six hundred and six endometrial cancer (stages I to IV) patients treated at five Italian institutions were retrospectively reviewed. Of these, 209 (13%) subjects had recurred; the site of relapse was vagina in 35 cases (16.7%), pelvis in 67 (32.1%), and distant locations in 107 (51.2%). Most of the patients relapsed within 24 months: 45% (94) recurred within 1 year, 20.6% (43) between 1 and 2 years. Adjuvant radiotherapy (RT) seemed to reduce the percentage of pelvic recurrence in high risk early stages (IB-IIA) subjects and a higher proportion of patients failed at a distant site when postoperative external-beam pelvic RT was given. However survival curves were not statistically different in the two groups for stage IB endometrial cancer patients. Five and 10-year survival rates of patients with recurrent disease was 26% and 22%, respectively. Relapse of endometrial cancer is often early and at distant sites. Survival rate was related to site of relapse, disease-free interval, and postoperative treatment as independent prognostic variables. The site of relapse is the most important predictor of survival of patients with recurrent disease.
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Affiliation(s)
- E Sartori
- Departments of Obstetrics/Gynecology, University of Brescia, Brescia, Italy.
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Srodon M, Klein WM, Kurman RJ. CD10 imunostaining does not distinguish endometrial carcinoma invading myometrium from carcinoma involving adenomyosis. Am J Surg Pathol 2003; 27:786-9. [PMID: 12766582 DOI: 10.1097/00000478-200306000-00009] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The distinction of involvement of adenomyosis by endometrial carcinoma from endometrial carcinoma invading the myometrium can at times be difficult. This distinction, however, is important from the standpoint of staging, treatment, and prognosis because the outcome of carcinoma invading the myometrium as compared with involving adenomyosis is significantly worse. CD10 has been recently reported to be expressed by normal and neoplastic endometrial stromal cells. We therefore hypothesized that CD10 may be helpful in distinguishing carcinoma within adenomyosis from endometrial carcinoma directly invading the myometrium. Twenty-two cases of invasive endometrioid adenocarcinoma were identified from the surgical pathology files of the Johns Hopkins Hospital and consultation files of one of the authors (R.J.K.) and immunostained for CD10, desmin, and caldesmon. The pattern of staining was compared with five cases in which carcinoma was confined to adenomyosis. As a control, 14 cases of adenomyosis unassociated with carcinoma were included in the analysis. All 22 endometrial carcinomas that invaded the myometrium expressed CD10 to some extent in cells immediately surrounding the neoplastic glands. In 18, all of the invasive nests displayed CD10 in surrounding cells, but in four cases the staining was patchier, involving the surrounding cells of approximately 50-75% of the invasive nests. In four cases of myoinvasive carcinoma, the CD10-positive cells surrounding the nests of invasive carcinoma were also positive for desmin and caldesmon. In the remaining 18 cases with myoinvasive carcinoma, the cells surrounding the carcinomas failed to react with desmin and caldesmon. All five endometrial carcinomas involving adenomyosis displayed CD10 positivity in what appeared to be endometrial stromal cells surrounding the neoplastic glands. The stromal cells were negative for desmin and caldesmon. The control cases of adenomyosis were all positive for CD10, although in four cases the staining was patchy compared with 10 cases in which it was diffuse. Desmin and caldesmon were negative in all of these cases. Although CD10 identifies endometrial stromal cells in the endometrium and in adenomyosis and endometriosis, this study demonstrates that CD10 does not aid in distinguishing myometrial invasion of endometrial carcinoma from involvement of adenomyosis by endometrial carcinoma because the cells surrounding the tumor in the myoinvasive group express CD10.
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Affiliation(s)
- Monica Srodon
- Department of Pathology, John Hopkins Medical Institutions, Baltimore, Maryland 21231-2410, USA
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Hirai M, Hirono M, Oosaki T, Hayashi Y, Yoshihara T, Itami M. Adjuvant chemotherapy in stage I uterine endometrial carcinoma. Int J Gynaecol Obstet 2002; 78:37-44. [PMID: 12113969 DOI: 10.1016/s0020-7292(02)00069-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We have assessed prognostic factors and the efficacy of adjuvant chemotherapy in stage I uterine endometrial carcinoma. METHODS 251 primary surgically treated stage I patients were studied. Prognostic factors were evaluated and 5-year and 10-year survival rates were compared in patients with lymph-vascular space invasion to investigate whether adjuvant chemotherapy improves survival. RESULTS The overall 5-year and 10-year survival rates were 94% and 93%. Multivariate analysis indicates that lymph-vascular space invasion is the most significant prognostic factor in both 5- and 10-year survival rates (P<0.001 at both times) and stage/depth of invasion is significant for the 10-year survival rate (P=0.04). Of 54 patients with lymph-vascular space invasion, statistically significant differences were observed in 10-year survival rate (P=0.02) between patients who had surgery followed by adjuvant chemotherapy (n=23) and patients who had surgery alone (n=31). Toxicities were mild to moderate (30%). CONCLUSIONS The clinical importance of lymph-vascular space invasion and the efficacy of adjuvant chemotherapy were confirmed. This observation warrants a larger comparative study with adjuvant chemotherapy.
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Affiliation(s)
- M Hirai
- Department of Gynecologic Oncology, Chiba Cancer Center, Chiba, Japan.
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20
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Sartori E, Gadducci A, Landoni F, Lissoni A, Maggino T, Zola P, Zanagnolo V. Clinical behavior of 203 stage II endometrial cancer cases: the impact of primary surgical approach and of adjuvant radiation therapy. Int J Gynecol Cancer 2001; 11:430-7. [PMID: 11906545 DOI: 10.1046/j.1525-1438.2001.01061.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to verify the impact of primary surgical approach and adjuvant radiation therapy (RT) on survival, recurrence rate, and pattern of relapse in stage II endometrial cancer patients. Two hundred three subjects were retrospectively reviewed; 135 (66%) underwent simple hysterectomy (SH) and 68 (34%) radical hysterectomy (RH). Sixty-six of 111 (59%) of stage IIA and 67 of 92 (73%) of stage IIB patients underwent adjuvant radiation therapy. Actuarial survival rates for stage IIA and IIB were 86% and 74% at 5 years and 82% and 68% at 10 years, respectively. Survival rates by surgical procedure were 79% in the SH group and 94% in the RH group at 5 years and 74% and 94% at 10 years, respectively (P < 0.05). The overall recurrence rate was 13.8% (28/203); by adjuvant treatment it was 18.6% (13/70) in the observation group and 11.3% (15/133) in the RT group. Most of the relapses were locoregional in the observation group and distant in the RT group. Survival rates by RT were not statistically different. Subjects treated with RH improved their survival compared with the SH group; the difference was significant, but randomized studies should confirm this trend. Although adjuvant RT seemed to reduce the recurrence rate, there was no significant difference in survival, and so the role of RT still needs further verification.
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MESH Headings
- Adenocarcinoma/radiotherapy
- Adenocarcinoma/surgery
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/radiotherapy
- Adenocarcinoma, Clear Cell/surgery
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Adenosquamous/mortality
- Carcinoma, Adenosquamous/radiotherapy
- Carcinoma, Adenosquamous/surgery
- Carcinoma, Papillary/mortality
- Carcinoma, Papillary/radiotherapy
- Carcinoma, Papillary/surgery
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/radiotherapy
- Cystadenocarcinoma, Serous/surgery
- Endometrial Neoplasms/mortality
- Endometrial Neoplasms/radiotherapy
- Endometrial Neoplasms/surgery
- Female
- Humans
- Hysterectomy
- Middle Aged
- Neoplasm Recurrence, Local
- Prognosis
- Radiotherapy, Adjuvant
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- E Sartori
- Department of Obstetrics/Gynecology, University of Brescia, Italy
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Ashman JB, Connell PP, Yamada D, Rotmensch J, Waggoner SE, Mundt AJ. Outcome of endometrial carcinoma patients with involvement of the uterine serosa. Gynecol Oncol 2001; 82:338-43. [PMID: 11531290 DOI: 10.1006/gyno.2001.6189] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The goal of this work was to evaluate the outcome of endometrial carcinoma patients undergoing primary surgery who have serosal involvement (SI). METHODS Between 1980 and 1998, 562 women underwent primary surgery for endometrial cancer at the University of Chicago. Thirty-nine were noted to have SI. FIGO stages were IIIA (19), IIIB (1), IIIC (7), and IV (12). Of the 19 IIIA patients, 15 had solitary SI. Twenty-six patients received pelvic radiation therapy (RT) with or without vaginal brachytherapy (VB). One patient received whole-abdomen radiation therapy, and 13, adjuvant chemotherapy. Solitary SI patients received pelvic RT with or without VB as their sole adjuvant therapy. Disease-free survivals (DFSs) were estimated using the method of Kaplan and Meier and prognostic factors were analyzed by the log-rank test. RESULTS With a median follow-up of 30.3 months, the 5-year actuarial DFS of the entire group was 28.9%. Factors correlated with disease recurrence included tumor stage (P = 0.003) and lymph node involvement (P = 0.04). In addition, patients with solitary SI had a better 5-year DFS (41.5% vs 20%, P = 0.04) than patients with SI plus other extrauterine sites. Relapse occurred in 23 women overall and in 7 of 15 solitary SI patients. The most common site of disease recurrence was distant both in the entire group and in the solitary SI patients. While abdominal recurrences were common in the entire group, they were infrequent in solitary SI patients. CONCLUSION Endometrial carcinoma patients with SI have a high rate of relapse and a poor outcome. Even when patients have extrauterine disease limited to SI, the outcome is relatively unfavorable. Nonetheless, our results demonstrate the need to distinguish patients with solitary SI and those with SI plus other extrauterine disease sites.
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Affiliation(s)
- J B Ashman
- Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Illinois, 60637, USA
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Hirai M, Nakagawara A, Oosaki T, Hayashi Y, Hirono M, Yoshihara T. Expression of vascular endothelial growth factors (VEGF-A/VEGF-1 and VEGF-C/VEGF-2) in postmenopausal uterine endometrial carcinoma. Gynecol Oncol 2001; 80:181-8. [PMID: 11161857 DOI: 10.1006/gyno.2000.6056] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We investigated the expression of two angiogenic vascular endothelial growth factors, VEGF-A/VEGF-1 and VEGF-C/VEGF-2, in 228 cases of uterine endometrial carcinomas from postmenopausal patients to evaluate the correlation with histopathologic features and clinical outcome. METHODS Immunohistochemistry was used to assess VEGF-A/VEGF-1 and VEGF-C/VEGF-2 expression in 228 primary surgically treated cases of postmenopausal endometrial carcinomas and the results were statistically analyzed in relation to vascular invasion, depth of invasion (myometrial vs serosal-parametrial invasion), lymphatic vessel invasion, lymph node metastasis, disease-free 5-year survival rate (DF5YR), and disease-free 10 year-survival rate (DF10YR). RESULTS The results of univariate analysis showed that VEGF-A/VEGF-1 and VEGF-C/VEGF-2 expression correlated with vascular invasion (P < 0.0001, P = 0.0006), depth of invasion (P = 0.0004, P = 0.043), lymphatic vessel invasion (P = 0.021, P < 0.0001), lymph node metastasis (P = 0.0017, P = 0.0008), DF5YR (P = 0.0081, P = 0.0002), and DF10YR (P = 0.0077, P = 0.0001). Multivariate analysis showed that lymph node metastasis (P = 0.0017, P = 0.0008), parametrial-serosal invasion (P < 0.0001, P < 0.0001), and VEGF-C/VEGF-2-positive status (P = 0.03, P = 0.01) were significant factors in DF5YR and DF10YR. CONCLUSIONS We conclude that VEGF-A/VEGF-1 and VEGF-C/VEGF-2 expression was predictive of these histopathologic features of endometrial carcinoma and clinical outcome.
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Affiliation(s)
- M Hirai
- Department of Gynecologic Oncology, Chiba Cancer Center, Chiba 260-8717, Japan
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