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Zheng S, Donnelly ED, Strauss JB. Race, Prevalence of POLE and POLD1 Alterations, and Survival Among Patients With Endometrial Cancer. JAMA Netw Open 2024; 7:e2351906. [PMID: 38231514 PMCID: PMC10794941 DOI: 10.1001/jamanetworkopen.2023.51906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024] Open
Abstract
Importance Black patients with endometrial cancer (EC) in the United States have higher mortality than patients of other races with EC. The prevalence of POLE and POLD1 pathogenic alterations in patients of different races with EC are not well studied. Objective To explore the prevalence of and outcomes associated with POLE and POLD1 alterations in differential racial groups. Design, Setting, and Participants This retrospective cohort study incorporated the largest available data set of patients with EC, including American Association for Cancer Research Project GENIE (Genomics Evidence Neoplasia Information Exchange; 5087 participants), Memorial Sloan Kettering-Metastatic Events and Tropisms (1315 participants), and the Cancer Genome Atlas Uterine Corpus Endometrial Carcinoma (517 participants), collected from 2015 to 2023, 2013 to 2021, and 2006 to 2012, respectively. The prevalence of and outcomes associated with POLE or POLD1 alterations in EC were evaluated across self-reported racial groups. Exposure Patients of different racial groups with EC and with or without POLE or POLD1 alterations. Main Outcomes and Measures The main outcome was overall survival. Data on demographic characteristics, POLE and POLD1 alteration status, histologic subtype, tumor mutation burden, fraction of genome altered, and microsatellite instability score were collected. Results A total of 6919 EC cases were studied, of whom 444 (6.4%), 694 (10.0%), and 4869 (70.4%) patients were self-described as Asian, Black, and White, respectively. Within these large data sets, Black patients with EC exhibited a lower weighted average prevalence of pathogenic POLE alterations (0.5% [3 of 590 cases]) compared with Asian (6.1% [26 of 424]) or White (4.6% [204 of 4520]) patients. By contrast, the prevalence of POLD1 pathogenic alterations was 5.0% (21 cases), 3.2% (19 cases), and 5.6% (255 cases) in Asian, Black, and White patients with EC, respectively. Patients with POLD1 alterations had better outcomes regardless of race, histology, and TP53 alteration status. For a total of 241 clinically annotated Black patients with EC, a composite biomarker panel of either POLD1 or POLE alterations identified 7.1% (17 patients) with positive outcomes (1 event at 70 months follow up) in the small sample of available patients. Conclusions and Relevance In this retrospective clinicopathological study of patients of different racial groups with EC, a composite biomarker panel of either POLD1 or POLE alteration could potentially guide treatment de-escalation, which is especially relevant for Black patients.
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Affiliation(s)
- Shuhua Zheng
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Eric D. Donnelly
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Jonathan B. Strauss
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
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Tarcha Z, Konstantinoff KS, Ince S, Fraum TJ, Sadowski EA, Bhosale PR, Derenoncourt PR, Zulfiqar M, Shetty AS, Ponisio MR, Mhlanga JC, Itani M. Added Value of FDG PET/MRI in Gynecologic Oncology: A Pictorial Review. Radiographics 2023; 43:e230006. [PMID: 37410624 DOI: 10.1148/rg.230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Fluorine 18-fluorodeoxyglucose (FDG) PET and MRI independently play a valuable role in the management of patients with gynecologic malignancies, particularly endometrial and cervical cancer. The PET/MRI hybrid imaging technique combines the metabolic information obtained from PET with the excellent soft-tissue resolution and anatomic details provided by MRI in a single examination. MRI is the modality of choice for assessment of local tumor extent in the pelvis, whereas PET is used to assess for local-regional spread and distant metastases. The authors discuss the added value of FDG PET/MRI in imaging gynecologic malignancies of the pelvis, with a focus on the role of FDG PET/MRI in diagnosis, staging, assessing treatment response, and characterizing complications. PET/MRI allows better localization and demarcation of the extent of disease, characterization of lesions and involvement of adjacent organs and lymph nodes, and improved differentiation of benign from malignant tissues, as well as detection of the presence of distant metastasis. It also has the advantages of decreased radiation dose and a higher signal-to-noise ratio of a prolonged PET examination of the pelvis contemporaneous with MRI. The authors provide a brief technical overview of PET/MRI, highlight how simultaneously performed PET/MRI can improve stand-alone MRI and PET/CT in gynecologic malignancies, provide an image-rich review to illustrate practical and clinically relevant applications of this imaging technique, and review common pitfalls encountered in clinical practice. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Ziad Tarcha
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Katerina S Konstantinoff
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Semra Ince
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Tyler J Fraum
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Elizabeth A Sadowski
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Priya R Bhosale
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Paul-Robert Derenoncourt
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Anup S Shetty
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Maria R Ponisio
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Joyce C Mhlanga
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St. Louis, MO, 63110-8131 (Z.T., K.S.K., S.I., T.J.F., P.R.D., A.S.S., M.R.P., J.C.M., M.I.); Department of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, Wis (E.A.S.); Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Tex (P.R.B.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.Z.)
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