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Rovirosa A, Zhang Y, Chargari C, Cooper R, Bownes P, Wojcieszek P, Stankiewicz M, Hoskin P, Van der Steen-Banasik E, Segedin B, Najjari D, Pötter R, Tanderup K, Van Limbergen E. Exclusive 3D-brachytherapy as a good option for stage-I inoperable endometrial cancer: a retrospective analysis in the gynaecological cancer GEC-ESTRO Working Group. Clin Transl Oncol 2021; 24:254-265. [PMID: 34272660 DOI: 10.1007/s12094-021-02680-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/30/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Analyse outcomes of stage-I inoperable endometrial cancer (EC) patients from seven European centres treated with 3D-image-guided brachytherapy (IGBT) alone. MATERIALS AND METHODS From 2004 to 2018, 62 patients (41 stage-IA and 21 IB) were retrospectively studied, analysing anaesthetic procedure, applicator type, BT-planning imaging, clinical target volume (CTV), BT schedule, overall daily-dose equivalent to 2 Gy (EQD2(α/β=4.5 or 3)) to the CTV(α/β=4.5) and D2 cm3(α/β=3) for organs at risk. Complications were evaluated using CTCAEv4 scores. The 2 and 5 year survival was calculated [cancer-specific survival (CSS), disease-free survival (DFS), local relapse-free survival (LRFS), loco-regional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS)]. Descriptive analysis and the Kaplan-Meier method were used for survival analysis. RESULTS Mean follow-up: 32.8 months (SD 33.7). Spinal anaesthesia (38/62) followed by none (16/62) were the most common. Y-shaped Rotte applicators were used in 74% of patients. High-dose rate brachytherapy was administered in 89%. Median D90 to the CTV was 58.9 Gy (8.66-144 Gy). Eight patients presented relapse: four uterine, four nodal and four distant. The 2 and 5 year CSS was 93.3 and 80.5%, DFS 84.8 and 80.5%, LRFS was 93.1 and 88.7%, LRRFS was 91 and 91% and DMFS was 90.2 and 90.2%, respectively, CSS was better in stage-IA vs. IB (p = 0.043). Late vaginal and bladder G3-complication rates were 2.1%, respectively. CONCLUSION Inoperable EC patients can be safely treated by BT with 2 and 5 year CSS of 93 and 80.5%, respectively, with even better results for IA cases. Prospective studies on 3D-IGBT are necessary to better analyse EC patient outcomes based on dose and treated volumes.
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Affiliation(s)
- Angeles Rovirosa
- Fonaments Clinics Department, Faculty of Medicine, Universitat de Barcelona, C/Casanovas 153, 08036, Barcelona, Spain.
| | - Yaowen Zhang
- Cancer Center, Henan Provincial People's Hospital, Zhengzhou, China
| | - Cyrus Chargari
- Radiation Oncology Department, Institute Gustave Roussy, 114, rue Édouard-Vaillant, 94805, Villejuif Cedex, France
| | - Rachel Cooper
- Leeds Cancer Centre, Beckett Street, Leeds, LS9 7TF, UK
| | - Peter Bownes
- Leeds Cancer Centre, Beckett Street, Leeds, LS9 7TF, UK
| | - Piotr Wojcieszek
- Maria Sklodowska-Curie National Research Institute of Oncology, Oddział w Gliwicach Ul Wybrzeże Armii Krajowej, 15 44-102, Gliwice, Poland
| | - Magdalena Stankiewicz
- Maria Sklodowska-Curie National Research Institute of Oncology, Oddział w Gliwicach Ul Wybrzeże Armii Krajowej, 15 44-102, Gliwice, Poland
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, HA6 2RN, UK
| | | | - Barbara Segedin
- Institute of Oncology of Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | - Dina Najjari
- Institut Català D'Oncologia, Avinguda Granvia de l'Hospitalet 199-203, 08908, l', Hospitalet de Llobregat, Barcelona, Spain
| | - Richard Pötter
- Department of Radiation Oncology, Medical University of Vienna, Spitalgasse, 23 1090, Vienna, Austria
| | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard, 8200, Aarhus N, Denmark
| | - Erik Van Limbergen
- Radiation Oncology Department, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
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Collins A, Miles GJ, Powley IR, Hew R, Pringle JH, MacFarlane M, Pritchard C, Moss EL. Development of a patient-derived explant model for prediction of drug responses in endometrial cancer. Gynecol Oncol 2020; 160:557-567. [PMID: 33309417 DOI: 10.1016/j.ygyno.2020.11.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/27/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To undertake a pilot study to develop a novel Patient-Derived-Explant (PDE) model system for use in endometrial cancer (EC) that is capable of monitoring differential drug responses in a pre-clinical setting. METHODS Fresh tumour was obtained post-hysterectomy from 27 patients with EC. Tumours were cut into 1-3 mm3 explants that were cultured at the air-liquid interface for 16-24 h in culture media. Explants were cultured in different media conditions to optimise viability. Explants were also treated with carboplatin/paclitaxel or pembrolizumab for 24 h and processed into histology slides. Multiplexed immunofluorescence for Ki67 (proliferation marker), cPARP (apoptosis marker) and CAM 5.2 (tumour mask) was performed followed by image analysis and quantitation of biomarker expression. RESULTS EC samples are amenable to PDE culture with preserved histological architecture and PDE viability for up to 48 h, with the addition of autologous serum in culture media facilitating EC-PDE viability. Our PDE platform provides evidence of differential drug-response to conventional chemotherapeutics and immune checkpoint inhibition, and these responses can be assessed in the context of a preserved tumour microenvironment. CONCLUSIONS Our PDE platform represents a rapid, low-cost pre-clinical model which can be easily integrated into drug development pipelines. PDE culture preserves original tumour architecture and enables evaluation of spatial relationships in the tumour microenvironment. PDE culture has the potential for personalised drug-testing in a pre-clinical setting which is increasingly important in an era of personalised medicine in the treatment of EC.
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Affiliation(s)
- Anna Collins
- Leicester Cancer Research Centre, University of Leicester, Clinical Sciences Building, Leicester LE2 7LX, UK
| | - Gareth J Miles
- Leicester Cancer Research Centre, University of Leicester, Clinical Sciences Building, Leicester LE2 7LX, UK
| | - Ian R Powley
- Leicester Cancer Research Centre, University of Leicester, Clinical Sciences Building, Leicester LE2 7LX, UK
| | - Roger Hew
- Department of Pathology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Sandringham Building, Leicester LE1 5WW, UK
| | - J Howard Pringle
- Leicester Cancer Research Centre, University of Leicester, Clinical Sciences Building, Leicester LE2 7LX, UK
| | - Marion MacFarlane
- MRC Toxicology Unit, Hodgkin Building, Lancaster Road, Leicester LE1 9HN, UK
| | - Catrin Pritchard
- Leicester Cancer Research Centre, University of Leicester, Clinical Sciences Building, Leicester LE2 7LX, UK.
| | - Esther L Moss
- Leicester Cancer Research Centre, University of Leicester, Clinical Sciences Building, Leicester LE2 7LX, UK.
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3
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Expression of ER/PR Receptor, Her-2/neu, Ki67 and p53 in Endometrial Carcinoma: Clinicopathological Implication and Prognostic Value. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00436-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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4
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Adomaitienė L, Nadišauskienė R, Nickkho-Amiry M, Čižauskas A, Palubinskienė J, Holland C, Seif MW. Proliferation in Postmenopausal Endometrial Polyps-A Potential for Malignant Transformation. ACTA ACUST UNITED AC 2019; 55:medicina55090543. [PMID: 31466367 PMCID: PMC6780687 DOI: 10.3390/medicina55090543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/31/2019] [Accepted: 08/22/2019] [Indexed: 12/26/2022]
Abstract
Background and objectives: Endometrial polyps in asymptomatic postmenopausal women are often incidentally found, yet only 1.51% of them are malignant. Their potential for malignant transformation has not been adequately addressed. The aim of this study was to investigate the proliferation within endometrial polyps as one of the indicators of their malignization potential in asymptomatic postmenopausal women. Materials and Methods: Immunohistochemical studies of Ki-67 were performed. Cases included 52 benign postmenopausal polyps, 19 endometrioid carcinoma with coexisting benign polyps, 12 polyps with foci of carcinoma and 4 cases of polyps, which later developed carcinoma. The control group included 31 atrophic endometria and 32 benign premenopausal polyps. Ki-67 was scored in either 10 or 20 “hot spot” fields, as percentage of positively stained cells. Results: The median epithelial Ki-67 score in postmenopausal benign polyps (4.7%) was significantly higher than in atrophic endometria (2.41%, p < 0.0001) and significantly lower than in premenopausal benign polyps (11.4%, p = 0.003) and endometrial cancer (8.3%, p < 0.0001). Where endometrial polyps were found in association with endometrial carcinoma, Ki-67 was significantly higher in cancer (p < 0.0001). No significant difference was found between Ki-67 scores of cancer focus and of the polyps tissue itself, respectively 2.8% and 4.55%, p = 0.37. Ki-67 expression, where polyps were resected and women later developed cancer, was not significantly different (p = 0.199). Conclusion: Polyps from asymptomatic postmenopausal women showed significantly more proliferation in both epithelial and stromal components than inactive atrophic endometria but less than premenopausal benign polyps and/or endometrial cancer. Benign postmenopausal endometrial polyps exhibit low proliferative activity, suggesting low malignant potential and may not require resection in asymptomatic women.
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Affiliation(s)
- Lina Adomaitienė
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania.
| | - Rūta Nadišauskienė
- Department of Obstetrics and Gynaecology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Mahshid Nickkho-Amiry
- Department of Obstetrics and Gynaecology, University of Manchester and St. Mary's Hospital, Manchester M13 9WL, UK
| | - Arvydas Čižauskas
- Department of Patological Anatomy, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Jolita Palubinskienė
- Department of Histology and Embryology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Cathrine Holland
- Department of Obstetrics and Gynaecology, University of Manchester and St. Mary's Hospital, Manchester M13 9WL, UK
| | - Mourad W Seif
- Department of Obstetrics and Gynaecology, University of Manchester and St. Mary's Hospital, Manchester M13 9WL, UK
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Endometrial Carcinoma Diagnosis: Use of FIGO Grading and Genomic Subcategories in Clinical Practice: Recommendations of the International Society of Gynecological Pathologists. Int J Gynecol Pathol 2019; 38 Suppl 1:S64-S74. [PMID: 30550484 PMCID: PMC6295928 DOI: 10.1097/pgp.0000000000000518] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this review, we sought to address 2 important issues in the diagnosis of endometrial carcinoma: how to grade endometrial endometrioid carcinomas and how to incorporate the 4 genomic subcategories of endometrial carcinoma, as identified through The Cancer Genome Atlas, into clinical practice. The current International Federation of Gynecology and Obstetrics grading scheme provides prognostic information that can be used to guide the extent of surgery and use of adjuvant chemotherapy or radiation therapy. We recommend moving toward a binary scheme to grade endometrial endometrioid carcinomas by considering International Federation of Gynecology and Obstetrics defined grades 1 and 2 tumors as "low grade" and grade 3 tumors as "high grade." The current evidence base does not support the use of a 3-tiered grading system, although this is considered standard by International Federation of Gynecology and Obstetrics, the American College of Obstetricians and Gynecologists, and the College of American Pathologists. As for the 4 genomic subtypes of endometrial carcinoma (copy number low/p53 wild-type, copy number high/p53 abnormal, polymerase E mutant, and mismatch repair deficient), which only recently have been identified, there is accumulating evidence showing these categories can be reproducibly diagnosed and accurately assessed based on biopsy/curettage specimens as well as hysterectomy specimens. Furthermore, this subclassification system can be adapted for current clinical practice and is of prognostic significance independent of conventional variables used for risk assessment in patients with endometrial carcinoma (eg, stage). It is too soon to recommend the routine use of genomic classification in this setting; however, with further evidence, this system may become the basis for the subclassification of all endometrial carcinomas, supplanting (partially or completely) histotype, and grade. These recommendations were developed from the International Society of Gynecological Pathologists Endometrial Carcinoma project.
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Hugdahl E, Bachmann IM, Schuster C, Ladstein RG, Akslen LA. Prognostic value of uPAR expression and angiogenesis in primary and metastatic melanoma. PLoS One 2019; 14:e0210399. [PMID: 30640942 PMCID: PMC6331131 DOI: 10.1371/journal.pone.0210399] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/21/2018] [Indexed: 11/18/2022] Open
Abstract
Angiogenesis is important for the progression of cutaneous melanoma. Here, we analyzed the prognostic impact of the angiogenic factor urokinase plasminogen activator resecptor (uPAR), vascular proliferation index (VPI) and tumor necrosis as a measure of hypoxia in a patient series of nodular melanomas (n = 255) and matched loco-regional metastases (n = 78). Expression of uPAR was determined by immunohistochemistry and VPI was assessed by dual immunohistochemistry using Factor-VIII/Ki67 staining. Necrosis was recorded based on HE-slides. As novel findings, high uPAR expression and high VPI were associated with each other, and with increased tumor thickness, presence of tumor necrosis, tumor ulceration, increased mitotic count and reduced cancer specific survival in primary melanoma. In matched cases, VPI was decreased in metastases, whereas the frequency of necrosis was increased. Our findings demonstrate for the first time the impact on melanoma specific survival of uPAR expression and VPI in primary tumors, and of increased necrosis as an indicator of tumor hypoxia in loco-regional metastases. These findings support the importance of tumor angiogenesis in melanoma aggressiveness, and suggest uPAR as an indicator of vascular proliferation and a potential biomarker in melanoma.
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Affiliation(s)
- Emilia Hugdahl
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Dermatology, Haukeland University Hospital, Bergen, Norway
| | - Ingeborg M. Bachmann
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Dermatology, Haukeland University Hospital, Bergen, Norway
| | - Cornelia Schuster
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Oncology Haukeland University Hospital, Bergen, Norway
| | - Rita G. Ladstein
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Dermatology, Haukeland University Hospital, Bergen, Norway
| | - Lars A. Akslen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
- * E-mail:
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7
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Kusonmano K, Halle MK, Wik E, Hoivik EA, Krakstad C, Mauland KK, Tangen IL, Berg A, Werner HMJ, Trovik J, Øyan AM, Kalland KH, Jonassen I, Salvesen HB, Petersen K. Identification of highly connected and differentially expressed gene subnetworks in metastasizing endometrial cancer. PLoS One 2018; 13:e0206665. [PMID: 30383835 PMCID: PMC6211718 DOI: 10.1371/journal.pone.0206665] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/17/2018] [Indexed: 12/22/2022] Open
Abstract
We have identified nine highly connected and differentially expressed gene subnetworks between aggressive primary tumors and metastatic lesions in endometrial carcinomas. We implemented a novel pipeline combining gene set and network approaches, which here allows integration of protein-protein interactions and gene expression data. The resulting subnetworks are significantly associated with disease progression across tumor stages from complex atypical hyperplasia, primary tumors to metastatic lesions. The nine subnetworks include genes related to metastasizing features such as epithelial-mesenchymal transition (EMT), hypoxia and cell proliferation. TCF4 and TWIST2 were found as central genes in the subnetwork related to EMT. Two of the identified subnetworks display statistically significant association to patient survival, which were further supported by an independent validation in the data from The Cancer Genome Atlas data collection. The first subnetwork contains genes related to cell proliferation and cell cycle, while the second contains genes involved in hypoxia such as HIF1A and EGLN3. Our findings provide a promising context to elucidate the biological mechanisms of metastasis, suggest potential prognostic markers and further identify therapeutic targets. The pipeline R source code is freely available, including permutation tests to assess statistical significance of the identified subnetworks.
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Affiliation(s)
- Kanthida Kusonmano
- Computational Biology Unit, Department of Informatics, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Bioinformatics and Systems Biology Program, School of Bioresources and Technology, King Mongkut’s University of Technology Thonburi, Bangkok, Thailand
- * E-mail:
| | - Mari K. Halle
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Elisabeth Wik
- Centre for Cancer Biomarkers, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pathology, The Gade Institute, Haukeland University Hospital, Bergen, Norway
| | - Erling A. Hoivik
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Camilla Krakstad
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Karen K. Mauland
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ingvild L. Tangen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anna Berg
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Henrica M. J. Werner
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jone Trovik
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anne M. Øyan
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Karl-Henning Kalland
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Inge Jonassen
- Computational Biology Unit, Department of Informatics, University of Bergen, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Informatics, University of Bergen, Bergen, Norway
| | - Helga B. Salvesen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kjell Petersen
- Computational Biology Unit, Department of Informatics, University of Bergen, Bergen, Norway
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8
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Combined ASRGL1 and p53 immunohistochemistry as an independent predictor of survival in endometrioid endometrial carcinoma. Gynecol Oncol 2018; 149:173-180. [PMID: 29486992 DOI: 10.1016/j.ygyno.2018.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/16/2018] [Accepted: 02/18/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE In clinical practise, prognostication of endometrial cancer is based on clinicopathological risk factors. The use of immunohistochemistry-based markers as prognostic tools is generally not recommended and a systematic analysis of their utility as a panel is lacking. We evaluated whether an immunohistochemical marker panel could reliably assess endometrioid endometrial cancer (EEC) outcome independent of clinicopathological information. METHODS A cohort of 306 EEC specimens was profiled using tissue microarray (TMA). Cost- and time-efficient immunohistochemical analysis of well-established tissue biomarkers (ER, PR, HER2, Ki-67, MLH1 and p53) and two new biomarkers (L1CAM and ASRGL1) was carried out. Statistical modelling with embedded variable selection was applied on the staining results to identify minimal prognostic panels with maximal prognostic accuracy without compromising generalizability. RESULTS A panel including p53 and ASRGL1 immunohistochemistry was identified as the most accurate predictor of relapse-free and disease-specific survival. Within this panel, patients were allocated into high- (5.9%), intermediate- (29.5%) and low- (64.6%) risk groups where high-risk patients had a 30-fold risk (P<0.001) of dying of EEC compared to the low-risk group. CONCLUSIONS P53 and ASRGL1 immunoprofiling stratifies EEC patients into three risk groups with significantly different outcomes. This simple and easily applicable panel could provide a useful tool in EEC risk stratification and guiding the allocation of treatment modalities.
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9
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Abstract
Accurate staging of cancers is an important determinant of prognosis and guides optimal patient treatment. Although the International Collaboration on Cancer Reporting recommends that endometrial cancers (including carcinosarcomas) are pathologically staged using the International Federation of Gynecology and Obstetrics (FIGO) 2009 system, in many areas TNM [American Joint Committee on Cancer (AJCC) or Union for International Cancer Control (UICC)] staging is used or even mandated; these latter systems are based on FIGO 2009. In this review, areas of difficulty in the pathologic staging of endometrial carcinomas are covered with practical advice for the reporting pathologist. These include issues regarding the assessment of the depth of myometrial involvement (which may be rendered difficult due to a variety of factors), tumor involvement of adenomyosis, and assessment of cervical and uterine serosal involvement. Although not included in the FIGO staging system, the issue of lymphovascular space invasion (LVSI) is covered as this is of prognostic importance and there are multiple problems in the pathologic assessment of this. One important point is that tumors should not be upstaged based on the presence of LVSI alone without tissue involvement; for example, the presence of LVSI in the outer half of the myometrium or in cervical or adnexal vessels in a carcinoma with myoinvasion confined to the inner half of the myometrium is still FIGO stage IA. The issue of simultaneously occurring tumors of the endometrium and adnexa is also covered with advice on how to distinguish between synchronous independent and metastatic neoplasms of both endometrioid and nonendometrioid types. Recent molecular evidence showing that simultaneously occurring endometrioid carcinomas of the endometrium and ovary are clonal and thus probably represent metastatic disease from the endometrium to the ovary rather than synchronous independent neoplasms, as is widely assumed, is discussed.
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10
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Visser NCM, Werner HMJ, Krakstad C, Mauland KK, Trovik J, Massuger LFAG, Nagtegaal ID, Pijnenborg JMA, Salvesen HB, Bulten J, Stefansson IM. Type of vascular invasion in association with progress of endometrial cancer. APMIS 2017; 125:1084-1091. [PMID: 28975668 DOI: 10.1111/apm.12774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 08/22/2017] [Indexed: 02/02/2023]
Abstract
Vascular invasion (VI) is a well-established marker for lymph node metastasis and outcome in endometrial cancer. Our study explored whether specific types of VI, defined as lymphatic (LVI) or blood vessel invasion (BVI), predict pattern of metastasis. From a prospectively collected cohort, we conducted a case-control study by selecting three groups of endometrial cancer patients (n = 183): 52 with positive lymph nodes at primary surgery, 33 with negative nodes at primary surgery and later recurrence and death from disease, and 98 with negative nodes and no recurrence. All patients underwent hysterectomy with lymphadenectomy. Immunohistochemical staining with D2-40 and CD31 antibodies was used to differentiate between BVI and LVI. By immunohistochemical staining, detection of VI increased from 24.6 to 36.1% of the cases. LVSI was significantly more often seen in patients with positive lymph nodes compared with patients with negative nodes (p = 0.001). BVI was significantly more often seen in node-negative patients with recurrence compared with node-negative patients without recurrence (p = 0.011). In multivariable analysis, BVI, age, and tumor grade were predictors separating patients with and without recurrence. Lymph node-positive patients showed more often LVI compared with lymph node-negative patients, while BVI seems to be a predictor for recurrent disease.
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Affiliation(s)
- Nicole C M Visser
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henrica M J Werner
- Center for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Camilla Krakstad
- Center for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Karen K Mauland
- Center for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Jone Trovik
- Center for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Leon F A G Massuger
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helga B Salvesen
- Center for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ingunn M Stefansson
- Department of Clinical medicine, Section for Pathology, Haukeland University Hospital, Bergen, Norway.,Center for Cancer Biomarkers, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway
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11
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Zinovkin DA, Pranjol MZI, Petrenyov DR, Nadyrov EA, Savchenko OG. The Potential Roles of MELF-Pattern, Microvessel Density, and VEGF Expression in Survival of Patients with Endometrioid Endometrial Carcinoma: A Morphometrical and Immunohistochemical Analysis of 100 Cases. J Pathol Transl Med 2017; 51:456-462. [PMID: 28934825 PMCID: PMC5611532 DOI: 10.4132/jptm.2017.07.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/06/2017] [Accepted: 07/19/2017] [Indexed: 11/23/2022] Open
Abstract
Background In this study, we hypothesized that microcystic, elongated, fragmented (MELF)-pattern, vascular endothelial growth factor (VEGF) expression by cancer cells and microvessel density of cancer stroma may be associated with progression of endometrioid adenocarcinoma. Methods The study used data from the Belarus Cancer Registry and archival histological material of 100 patients with retrospectively known good (survival) and poor (disease progression and death) outcomes. All cases were immunohistochemically stained for CD34 and VEGF. Two independent samples were compared for the characteristics of signs, and obtained results were analyzed by receiver operating characteristic analysis, Mann-Whitney U test, χ2 test (Yates correction), and Mantel-Cox test. Multivariate Cox hazard analysis and Spearman correlation test were used. A p-value of less than .05 was considered statistically significant. Results The observed survival rate of patients with endometrioid adenocarcinoma was significantly lower (p = .002) in MELF-pattern positive patients when compared with MELF-pattern negative patients. The overall survival rate of patients whose tumors had more than 114 vessels/mm2 of tissue was significantly low (p < .001). Interestingly, a similar observation was found in patients with increased vessel area, evidenced by VEGF expression in the glandular tumor component. Conclusions Our study suggests, for the first time, that these criteria may be used as risk factors of endometrioid adenocarcinoma progression during 5 years after radical surgical treatment. However, a large independent cohort of samples should be considered in the future to validate our findings.
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Affiliation(s)
| | - Md Zahidul Islam Pranjol
- University of Exeter Medical School, Institute of Biomedical and Clinical Science, Exeter, Devon, United Kingdom
| | - Daniil Rudolfovich Petrenyov
- Laboratory of Endocrinology and Biochemistry, Institute of Radiobiology National Academy of Sciences, Gomel, Belarus
| | - Eldar Arkadievich Nadyrov
- Laboratory of Clinical Research, Republican Research Center for Radiation Medicine and Human Ecology, Gomel, Belarus
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12
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Kitson S, Sivalingam VN, Bolton J, McVey R, Nickkho-Amiry M, Powell ME, Leary A, Nijman HW, Nout RA, Bosse T, Renehan AG, Kitchener HC, Edmondson RJ, Crosbie EJ. Ki-67 in endometrial cancer: scoring optimization and prognostic relevance for window studies. Mod Pathol 2017; 30:459-468. [PMID: 27910946 PMCID: PMC5337118 DOI: 10.1038/modpathol.2016.203] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/23/2016] [Accepted: 10/18/2016] [Indexed: 11/13/2022]
Abstract
Ki-67, a marker of cellular proliferation, is increasingly being used in pre-surgical window studies in endometrial cancer as a primary outcome measure. Unlike in breast cancer, however, there are no guidelines standardizing its measurement and its clinical relevance as a response biomarker is undetermined. It is, therefore, imperative that Ki-67 scoring protocols are optimized and its association with patient survival rigorously evaluated, in order to be able to clinically interpret the results of these studies. Using the International Ki-67 in Breast Cancer Working Group guidelines as a basis, whole slide, hot spot and invasive edge scoring protocols were evaluated using endometrial biopsies and hysterectomy specimens from 179 women. Whole sections and tissue microarrays, manual and semi-automated scoring using Definiens Developer software were additionally compared. Ki-67 scores were related to clinicopathological variables and cancer-specific survival in uni- and multivariate analysis. Against criteria of time efficiency, intra- and inter-observer variability and consistency, semi-automated hot spot scoring was the preferred method. Ki-67 scores positively correlated with grade, stage and depth of myometrial invasion (P-values all <0.03). By univariate analysis, higher Ki-67 scores were associated with a significant reduction in cancer-specific survival (P≤0.05); however, this effect was substantially attenuated in the multivariate model. In conclusion, hot spot scoring of whole sections using Definiens is an optimal method to quantify Ki-67 in endometrial cancer window study specimens. Measured this way, it is a clinically relevant marker, though further work is required to determine whether reductions in Ki-67 in neoadjuvant intervention studies translate into improved patient outcome.
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Affiliation(s)
- Sarah Kitson
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK,Department of Obstetrics and Gynaecology, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Vanitha N Sivalingam
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK,Department of Obstetrics and Gynaecology, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - James Bolton
- Department of Histopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Rhona McVey
- Department of Histopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Mashid Nickkho-Amiry
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK,Department of Obstetrics and Gynaecology, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Melanie E Powell
- Department of Clinical Oncology, Barts Health NHS Trust, London, UK
| | - Alexandra Leary
- INSERM U981 and Department of Medicine, Gynecology Unit, Gustave Roussy, Villejuif, France
| | - Hans W Nijman
- Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Remi A Nout
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew G Renehan
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Henry C Kitchener
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Richard J Edmondson
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK,Department of Obstetrics and Gynaecology, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Emma J Crosbie
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK,Department of Obstetrics and Gynaecology, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK,Gynaecological Oncology Research Group, Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 5th Floor—Research, St Mary's Hospital, Oxford Road, Manchester M13 9WL, UK. E-mail.
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13
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Abstract
Although endometrial cancer is surgicopathologically staged, preoperative imaging is recommended for diagnostic work-up to tailor surgery and adjuvant treatment. For preoperative staging, imaging by transvaginal ultrasound (TVU) and/or magnetic resonance imaging (MRI) is valuable to assess local tumor extent, and positron emission tomography-CT (PET-CT) and/or computed tomography (CT) to assess lymph node metastases and distant spread. Preoperative imaging may identify deep myometrial invasion, cervical stromal involvement, pelvic and/or paraaortic lymph node metastases, and distant spread, however, with reported limitations in accuracies and reproducibility. Novel structural and functional imaging techniques offer visualization of microstructural and functional tumor characteristics, reportedly linked to clinical phenotype, thus with a potential for improving risk stratification. In this review, we summarize the reported staging performances of conventional and novel preoperative imaging methods and provide an overview of promising novel imaging methods relevant for endometrial cancer care.
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Affiliation(s)
- Ingfrid S Haldorsen
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, Postbox 7800, 5021, Bergen, Norway.
- Section for Radiology, Department of Clinical Medicine, University of Bergen, 5020, Bergen, Norway.
| | - Helga B Salvesen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, 5020, Bergen, Norway
- Department of Clinical Science, University of Bergen, 5020, Bergen, Norway
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14
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The significance of markers in the diagnosis of endometrial cancer. MENOPAUSE REVIEW 2016; 15:176-185. [PMID: 27980530 PMCID: PMC5137482 DOI: 10.5114/pm.2016.63500] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/03/2016] [Indexed: 01/21/2023]
Abstract
Endometrial cancer is one of the most common cancers experienced by women throughout the world. It is also the most common malignancy within the female reproductive system, representing 37.7% of all disorders. The incidence increases with age, and is diagnosed most frequently in women between 45 and 65 years old. In the last few years, numerous studies have been performed to identify tumour biomarkers. Biomarkers include not only protein routinely used as tumour markers but also genes and chromosomes. The limiting factor in the use of markers in the diagnosis of endometrial cancer is their lack of specificity. However, specific markers for endometrial cancer are the subject of much research attention. Although moderately elevated levels of markers are present in a number of inflammatory or non-malignant diseases, significantly increased levels of markers indicate the development of cancer. Recently, research has been focused on the identification of molecular changes leading to different histological subtypes of endometrial cancer. In this paper the authors reviewed several currently investigated markers. Progress in these investigations is very important in the diagnostics and treatment of endometrial cancer. In particular, the identification of novel mutations and molecular profiles should enhance our ability to personalise adjuvant treatment with genome-guided targeted therapy.
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15
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Comparative study of different histologic classifications in the degree of differentiation in endometrial adenocarcinoma. TUMORI JOURNAL 2016; 102:488-495. [PMID: 27514311 DOI: 10.5301/tj.5000528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the concordance among the available histologic classifications for endometrial adenocarcinoma using interobserver and intraobserver agreement as well as the association of tumor histologic degree in the above mentioned classifications with cellular proliferation measured by Ki-67. METHODS Seventy women who underwent surgical treatment of endometrial adenocarcinoma with histologic confirmation of endometrioid type were included in the study. Two experienced pathologists randomly analyzed the slides in 3 distinct timeframes with a maximum of 25 slides/timeframe. Tumor slides were classified according to the degree of differentiation using 4 different classifications: International Federation of Gynecology and Obstetrics (FIGO), modified FIGO, Lax, and Alkushi. RESULTS Intraobserver agreement was reasonable for classification of FIGO (k 0.469 and 0.538), very good for modified FIGO (k 0.661 and 0.768), moderate for Lax classification (k 0.496 and 0.466), and moderate/good for Alkushi classification (k 0.528 and 0.736). Interobserver concordance was regular for FIGO classification (k = 0.271 and 0.343), good/moderate for modified FIGO classification (k = 0.661 and 0.522, respectively), regular/moderate for Lax classification (k = 0.258 and 0.465, respectively), and regular for Alkushi classification (k = 0.283 and 0.402). CONCLUSIONS The prognostic value of histologic grading in endometrial carcinoma and its importance for a successful therapeutic plan have been documented repeatedly, but the best grading system, in terms of prognostication, reproducibility, ease of use, and universality (e.g., applicability to all tumor cell types), has not been unequivocally defined.
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16
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Tumor necrosis is an important hallmark of aggressive endometrial cancer and associates with hypoxia, angiogenesis and inflammation responses. Oncotarget 2016; 6:39676-91. [PMID: 26485755 PMCID: PMC4741854 DOI: 10.18632/oncotarget.5344] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/26/2015] [Indexed: 02/01/2023] Open
Abstract
Aims Tumor necrosis is associated with aggressive features of endometrial cancer and poor prognosis. Here, we investigated gene expression patterns and potential treatment targets related to presence of tumor necrosis in primary endometrial cancer lesions. Methods and Results By DNA microarray analysis, expression of genes related to tumor necrosis reflected multiple tumor-microenvironment interactions like tissue hypoxia, angiogenesis and inflammation pathways. A tumor necrosis signature of 38 genes and a related patient cluster (Cluster I, 67% of the cases) were associated with features of aggressive tumors such as type II cancers, estrogen receptor negative tumors and vascular invasion. Further, the tumor necrosis signature was increased in tumor cells grown in hypoxic conditions in vitro. Multiple genes with increased expression are known to be activated by HIF1A and NF-kB. Conclusions Our findings indicate that the presence of tumor necrosis within primary tumors is associated with hypoxia, angiogenesis and inflammation responses. HIF1A, NF-kB and PI3K/mTOR might be potential treatment targets in aggressive endometrial cancers with presence of tumor necrosis.
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17
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Stefansson IM, Raeder M, Wik E, Mannelqvist M, Kusonmano K, Knutsvik G, Haldorsen I, Trovik J, Øyan AM, Kalland KH, Staff AC, Salvesen HB, Akslen LA. Increased angiogenesis is associated with a 32-gene expression signature and 6p21 amplification in aggressive endometrial cancer. Oncotarget 2016; 6:10634-45. [PMID: 25860936 PMCID: PMC4496381 DOI: 10.18632/oncotarget.3521] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/17/2015] [Indexed: 12/14/2022] Open
Abstract
Background Angiogenesis is a hallmark of cancer. The aim of this study was to explore whether microvessel proliferation is associated with gene expression profiles or copy number alterations in endometrial cancer. Methods A prospective series of endometrial carcinomas was studied for angiogenesis markers, gene expression profiles, and gene copy number data. For validation, an independent series of endometrial carcinomas as well as an external cohort of endometrial cancer patients were examined by gene expression microarrays. Results Increased microvessel proliferation (MVP) was associated with aggressive tumor features and reduced survival, and a 32-gene expression signature was found to separate tumors with high versus low MVP. An increased 32-gene signature score was confirmed to associate with high-grade tumor features and reduced survival by independent cohorts. Copy number studies revealed that amplification of the 6p21 region was significantly associated with MVP, a high 32-gene score, as well as reduced survival. Conclusion Increased MVP was significantly associated with aggressive endometrial cancer and reduced survival. Integrated analyses demonstrated significant associations between increased vascular proliferation, amplification of the 6p21 region, VEGF-A mRNA expression, and the 32-gene angiogenesis signature. Our findings indicate amplification of 6p21 as a possible driver of tumor vascular proliferation in endometrial cancer.
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Affiliation(s)
- Ingunn M Stefansson
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Maria Raeder
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - Elisabeth Wik
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Monica Mannelqvist
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Kanthida Kusonmano
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - Gøril Knutsvik
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Ingfrid Haldorsen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Section for Radiology, University of Bergen, Bergen, Norway
| | - Jone Trovik
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - Anne M Øyan
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Karl-H Kalland
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Anne Cathrine Staff
- Department of Obstetrics and Gynaecology, Women and Children's Division, Oslo University Hospital, University of Oslo, Norway
| | - Helga B Salvesen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - Lars A Akslen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
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18
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Sivalingam VN, Kitson S, McVey R, Roberts C, Pemberton P, Gilmour K, Ali S, Renehan AG, Kitchener HC, Crosbie EJ. Measuring the biological effect of presurgical metformin treatment in endometrial cancer. Br J Cancer 2016; 114:281-9. [PMID: 26794276 PMCID: PMC4742583 DOI: 10.1038/bjc.2015.453] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/26/2015] [Accepted: 12/02/2015] [Indexed: 12/25/2022] Open
Abstract
Background: Preclinical studies in endometrial cancer (EC) show that metformin reduces cellular proliferation by PI3K-AKT-mTOR inhibition. We tested the hypothesis that short-term presurgical metformin reduces cellular proliferation in atypical endometrial hyperplasia (AEH) and endometrioid EC, and assessed the feasibility of using phosphorylated PI3K-AKT-mTOR proteins as tissue end points. Methods: Women with AEH or EC received metformin 850 mg twice a day or no drug in the presurgical window between diagnosis and hysterectomy. Before and after the window, tissue samples were obtained; serum markers of insulin resistance (e.g. homeostasis model of assessment of insulin resistance index) were determined; and anthropometrics measured (e.g. BMI). Cell proliferation (Ki-67) and PI3K-AKT-mTOR phosphostatus were assessed by immunohistochemistry and scored blinded to treatment. Results: Twenty-eight metformin-treated and 12 untreated patients, well matched for age and BMI, completed the study. Metformin treatment (median 20 days, range 7–34) was associated with a 17.2% reduction in tumour Ki-67 (95% CI −27.4, −7.0, P=0.002), in a dose-dependent manner. Tumour PI3K-AKT-mTOR protein phosphostatus varied but the effects were not significant after adjusting for changes in controls. Conclusions: Short-term metformin was associated with reduced Ki-67 expression in EC. Changes in tumour PI3K-AKT-mTOR protein phosphostatus were seen in both groups. Future studies should address the variability attributed to different sampling techniques including devascularisation of the uterus at hysterectomy.
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Affiliation(s)
- V N Sivalingam
- Gynaecological Oncology Research Group, Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Oxford Road, Manchester M13 9WL, UK
| | - S Kitson
- Gynaecological Oncology Research Group, Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Oxford Road, Manchester M13 9WL, UK
| | - R McVey
- Department of Histopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - C Roberts
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - P Pemberton
- Clinical Biochemistry Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - K Gilmour
- Obstetrics and Gynaecology Department, Tameside General Hospital, Tameside, UK
| | - S Ali
- Obstetrics and Gynaecology Department, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Oldham, UK
| | - A G Renehan
- Cancer Studies and Surgery Research Group, Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - H C Kitchener
- Gynaecological Oncology Research Group, Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Oxford Road, Manchester M13 9WL, UK
| | - E J Crosbie
- Gynaecological Oncology Research Group, Institute of Cancer Sciences, University of Manchester, St Mary's Hospital, Oxford Road, Manchester M13 9WL, UK
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19
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Xu W, Kong X, Jiang C, Liu X, Xu L. The anti-tumor effect of a polypeptide extracted from Tegillarca granosa Linnaeus on renal metastatic tumor OS-RC-2 cells. Arch Med Sci 2015; 11:849-55. [PMID: 26322097 PMCID: PMC4548037 DOI: 10.5114/aoms.2015.53305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/26/2013] [Accepted: 08/16/2013] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Renal cell carcinoma is a type of malignant tumor often diagnosed in the urinary system. The aim of this study is to evaluate the anti-tumor effects and mechanisms of a polypeptide, Haishengsu (TG-1), with different concentrations (125, 250, 500 mg/kg) on renal metastatic tumor OS-RC-2 cells. MATERIAL AND METHODS We first established the renal metastatic tumor model. After being administered with TG-1, the weight of tumors was measured and the microstructural changes of renal carcinoma OS-RC-2 cells were compared using transmission electron microscopy before and after the therapy. The Ki67 expression in renal carcinoma OS-RC-2 cells was analyzed by RT-PCR and downstream signal molecule caspase-3 was measured by Western blot assay. RESULTS After treatment with different doses of TG-1, the tumor weights in the positive control group and experimental groups were smaller than those in the untreated control group, suggesting that TG-1 could effectively inhibit tumor growth in mice. The transmission electron microscopy and flow cytometry results indicated that TG-1 induces tumor cell apoptosis (p < 0.05). The tumor cells exhibited polymorphism changes and chromatin edge clustering. TG-1 also inhibited Ki67 expression and promoted caspase-3 expression in the tumor significantly (p < 0.05). CONCLUSIONS TG-1 inhibits the growth of the tumor and induces apoptosis of the tumor cells by inducing caspase-3 expression. The results provide a basis for clinical application of TG-1 in the future.
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Affiliation(s)
- Wenhua Xu
- The Medical College of Qingdao University, Qingdao, China
| | | | - Changqing Jiang
- Department of Pathology, Municipal Hospital of Qingdao, Qingdao, China
| | - Xiaoyan Liu
- The Garrison Command Hospital of Qingdao, Qindao, China
| | - Luo Xu
- The Medical College of Qingdao University, Qingdao, China
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20
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Yi BR, Kim SU, Choi KC. Additional effects of engineered stem cells expressing a therapeutic gene and interferon-β in a xenograft mouse model of endometrial cancer. Int J Oncol 2015; 47:171-8. [PMID: 25963746 DOI: 10.3892/ijo.2015.2999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/04/2015] [Indexed: 11/06/2022] Open
Abstract
Endometrial cancer is the most common gynecologic malignancy in women worldwide. In the present study, we evaluated the effects of neural stem cell-directed enzyme/prodrug therapy (NDEPT) designed to more selectively target endometrial cancer. For this, we employed two different types of neural stem cells (NSCs), HB1.F3.CD and HB1.F3.CD.IFN-β cells. Cytosine deaminase (CD) can convert the non-toxic prodrug, 5-fluorocytosine (5-FC), into a toxic agent, 5-fluorouracil (5-FU), which inhibits DNA synthesis. IFN-β is a powerful cytotoxic cytokine that is released by activated immune cells or lymphocytes. In an animal model xenografted with endometrial Ishikawa cancer cells, the stem cells stained with CM-DiI were injected into nearby tumor masses and 5-FC was delivered by intraperitoneal injection. Co-expression of CD and IFN-β significantly inhibited the growth of cancer (~50-60%) in the presence of 5-FC. Among migration-induced factors, VEGF gene was highly expressed in endometrial cancer cells. Histological analysis showed that the aggressive nature of cancer was inhibited by 5-FC in the mice treated with the therapeutic stem cells. Furthermore, PCNA expression was more decreased in HB1.F3.CD.IFN-β treated mice rather than HB1.F3.CD treated mice. To confirm the in vitro combined effects of 5-FU and IFN-β, 5-FU was treated in Ishikawa cells. 5-FU increased the IFN-β/receptor 2 (IFNAR2) and BXA levels, indicating that 5-FU increased sensitivity of endometrial cancer cells to IFN-β, leading to apoptosis of cancer cells. Taken together, these results provide evidence for the efficacy of therapeutic stem cell-based immune therapy involving the targeted expression of CD and IFN-β genes at endometrial cancer sites.
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Affiliation(s)
- Bo-Rim Yi
- Laboratory of Biochemistry and Immunology, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Seung U Kim
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kyung-Chul Choi
- Laboratory of Biochemistry and Immunology, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
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21
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Edqvist PHD, Huvila J, Forsström B, Talve L, Carpén O, Salvesen HB, Krakstad C, Grénman S, Johannesson H, Ljungqvist O, Uhlén M, Pontén F, Auranen A. Loss of ASRGL1 expression is an independent biomarker for disease-specific survival in endometrioid endometrial carcinoma. Gynecol Oncol 2015; 137:529-37. [PMID: 25858696 DOI: 10.1016/j.ygyno.2015.03.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/26/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE For endometrial carcinoma, prognostic stratification methods do not satisfactorily identify patients with adverse outcome. Currently, histology, tumor grade and stage are used to tailoring surgical treatment and to determine the need for adjuvant treatment. Low-risk patients are not considered to require adjuvant therapy or staging lymphadenectomy. For patients with intermediate or high risk, some guidelines recommend tailoring adjuvant treatment according to additional negative prognostic factors. Our objective was to evaluate the biomarker potential of the ASRGL1 protein in endometrial carcinoma. METHODS Using The Human Protein Atlas (www.proteinatlas.org), the l-asparaginase (ASRGL1) protein was identified as an endometrial carcinoma biomarker candidate. ASRGL1 expression was immunohistochemically evaluated with an extensively validated antibody on two independent endometrial carcinoma cohorts (n=229 and n=286) arranged as tissue microarrays. Staining results were correlated with clinical features. RESULTS Reduced expression of ASRGL1, defined as <75% positively stained tumor cells, was significantly associated with poor prognosis and reduced disease-specific survival in endometrioid endometrial adenocarcinoma (EEA). In multivariate analysis the hazard ratios for disease-specific survival were 3.55 (95% CI=1.10-11.43; p=0.003) and 3.23 (95% CI=1.53-6.81; p=0.002) in the two cohorts, respectively. Of the 48 cases with Grade 3 Stage I tumor all disease-related deaths were associated with low ASRGL1 expression. CONCLUSIONS Loss of ASRGL1 in EEA is a powerful biomarker for poor prognosis and retained ASRGL1 has a positive impact on survival. ASRGL1 immunohistochemistry has potential to become an additional tool for prognostication in cases where tailoring adjuvant treatment according to additional prognostic factors besides grade and stage is recommended.
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Affiliation(s)
- Per-Henrik D Edqvist
- Uppsala University, Department of Immunology, Genetics and Pathology, Sweden; Science for Life Laboratory, Uppsala, Sweden.
| | - Jutta Huvila
- Department of Pathology, University of Turku, Turku, Finland; Department of Gynecology and Obstetrics, University of Turku, Turku, Finland; Department of Pathology, Turku University Hospital, Turku, Finland; Department of Gynecology and Obstetrics, Turku University Hospital, Turku, Finland
| | - Björn Forsström
- Science for Life Laboratory, Royal Institute of Technology, Stockholm, Sweden
| | - Lauri Talve
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Olli Carpén
- Department of Pathology, University of Turku, Turku, Finland; Department of Pathology, Turku University Hospital, Turku, Finland
| | - Helga B Salvesen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Camilla Krakstad
- Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Seija Grénman
- Department of Gynecology and Obstetrics, University of Turku, Turku, Finland; Department of Gynecology and Obstetrics, Turku University Hospital, Turku, Finland
| | - Henrik Johannesson
- Atlas Antibodies AB, AlbaNova University Center, 106 91 Stockholm, Sweden
| | - Oscar Ljungqvist
- Atlas Antibodies AB, AlbaNova University Center, 106 91 Stockholm, Sweden
| | - Mathias Uhlén
- Science for Life Laboratory, Royal Institute of Technology, Stockholm, Sweden
| | - Fredrik Pontén
- Uppsala University, Department of Immunology, Genetics and Pathology, Sweden; Science for Life Laboratory, Uppsala, Sweden
| | - Annika Auranen
- Department of Gynecology and Obstetrics, University of Turku, Turku, Finland; Department of Gynecology and Obstetrics, Turku University Hospital, Turku, Finland
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Wik E, Trovik J, Kusonmano K, Birkeland E, Raeder MB, Pashtan I, Hoivik EA, Krakstad C, Werner HMJ, Holst F, Mjøs S, Halle MK, Mannelqvist M, Mauland KK, Oyan AM, Stefansson IM, Petersen K, Simon R, Cherniack AD, Meyerson M, Kalland KH, Akslen LA, Salvesen HB. Endometrial Carcinoma Recurrence Score (ECARS) validates to identify aggressive disease and associates with markers of epithelial-mesenchymal transition and PI3K alterations. Gynecol Oncol 2014; 134:599-606. [PMID: 24995579 DOI: 10.1016/j.ygyno.2014.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/21/2014] [Accepted: 06/25/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Our previously reported 29-gene expression signature identified an aggressive subgroup of endometrial cancer patients with PI3K activation. We here wanted to validate these findings by independent patient series. PATIENTS AND METHODS The 29-gene expression signature was assessed in fresh frozen tumor tissue from 280 primary endometrial carcinomas (three independent cohorts), 19 metastatic lesions and in 333 primary endometrial carcinomas using TCGA data, and expression was related to clinico-pathologic features and survival. The 29-gene signature was assessed by real-time quantitative PCR, DNA oligonucleotide microarrays, or RNA sequencing. PI3K alterations were assessed by immunohistochemistry, DNA microarrays, DNA sequencing, SNP arrays or fluorescence in situ hybridization. A panel of markers of epithelial-mesenchymal transition (EMT) was also correlated to the 29-gene signature score. RESULTS High 29-gene Endometrial Carcinoma Recurrence Score (ECARS) values consistently validated to identify patients with aggressive clinico-pathologic phenotype and reduced survival. Within the presumed favorable subgroups of low grade, endometrioid tumors confined to the uterus, high ECARS still predicted a poor prognosis. The score was higher in metastatic compared to primary lesions (P<0.001) and was significantly associated with potential measures of PI3K activation, markers of EMT and vascular invasion as an indicator of metastatic spread (all P<0.001). CONCLUSIONS ECARS validates to identify aggressive endometrial carcinomas in multiple, independent patients cohorts. The higher signature score in metastatic compared to primary lesions, and the potential link to PI3K activation and EMT, support further studies of ECARS in relation to response to PI3K and EMT inhibitors in clinical trials of metastatic endometrial carcinoma.
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Affiliation(s)
- E Wik
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Norway; Department of Pathology, The Gade Institute, Haukeland University Hospital, Bergen, Norway.
| | - J Trovik
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Norway
| | - K Kusonmano
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Computational Biology Unit, University of Bergen, Bergen, Norway
| | - E Birkeland
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Norway; Department of Pathology, The Gade Institute, Haukeland University Hospital, Bergen, Norway
| | - M B Raeder
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Norway
| | - I Pashtan
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - E A Hoivik
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Norway
| | - C Krakstad
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Norway
| | - H M J Werner
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Norway
| | - F Holst
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Norway
| | - S Mjøs
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Norway
| | - M K Halle
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Norway
| | - M Mannelqvist
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Norway; Department of Pathology, The Gade Institute, Haukeland University Hospital, Bergen, Norway
| | - K K Mauland
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Norway
| | - A M Oyan
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - I M Stefansson
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Norway; Department of Pathology, The Gade Institute, Haukeland University Hospital, Bergen, Norway
| | - K Petersen
- Computational Biology Unit, University of Bergen, Bergen, Norway
| | - R Simon
- Department of Pathology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - A D Cherniack
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - M Meyerson
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - K H Kalland
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Norway; Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - L A Akslen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Norway; Department of Pathology, The Gade Institute, Haukeland University Hospital, Bergen, Norway
| | - H B Salvesen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Norway
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Ding J, Li XM, Liu SL, Zhang Y, Li T. Overexpression of Platelet-derived Growth Factor-D as a Poor Prognosticator in Endometrial Cancer. Asian Pac J Cancer Prev 2014; 15:3741-5. [DOI: 10.7314/apjcp.2014.15.8.3741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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24
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Kreizman-Shefer H, Pricop J, Goldman S, Elmalah I, Shalev E. Distribution of estrogen and progesterone receptors isoforms in endometrial cancer. Diagn Pathol 2014; 9:77. [PMID: 24684970 PMCID: PMC4022268 DOI: 10.1186/1746-1596-9-77] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/25/2014] [Indexed: 12/21/2022] Open
Abstract
Background 70–80% of sporadic endometrial carcinomas are defined as endometrioid carcinoma (EC). Early-stage, well differentiated endometrial carcinomas usually retain expression of estrogen and progesterone receptors (ER and PR, respectively), as advanced stage, poorly differentiated tumors often lack one or both of these receptors. Well-described EC prognosis includes tumor characteristics, such as depth of myometrial invasion. Therefore, in the current study, we evaluated the expression profile of ER and PR isoforms, including ER-α, PR-A and PR–B, in correlation to EC tumor histological depth. Methods Using immunohistochemistry and image analysis software, the expression of ER-α, PR-A, PR–B and Ki67 was assessed in endometrial stroma and epithelial glands of superficial, deep and extra-tumoral sections of 15 paraffin embedded EC specimens, and compared to 5 biopsies of non-malignant endometrium. Results Expression of PR-A and ER-α was found to be lower in EC compared to nonmalignant tissue, as the stromal expression was dramatically reduced compared to epithelial cells. Expression ratios of both receptors were significantly high in superficial and deep portions of EC; in non-tumoral portion of EC were close to the ratios of nonmalignant endometrium. PR-B expression was low in epithelial glands of EC superficial and deep portions, and high in the extra-tumoral region. Elevated PR-B expression was found in stroma of EC, as well. Conclusions The ratio of ER-α and PR-A expression in the epithelial glands and the stroma of EC biopsies may serve as an additional parameter in the histological evaluation of EC tumor. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1155060506119016
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Affiliation(s)
| | | | | | | | - Eliezer Shalev
- Laboratory for Research in Reproductive Sciences and Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.
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25
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Correlation of TNFAIP8 overexpression with the proliferation, metastasis, and disease-free survival in endometrial cancer. Tumour Biol 2014; 35:5805-14. [PMID: 24590269 DOI: 10.1007/s13277-014-1770-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/18/2014] [Indexed: 01/24/2023] Open
Abstract
Tumor necrosis factor alpha-induced protein 8 (TNFAIP8) is an apoptosis regulator proven to have an important function in the proliferation, invasion, metastasis, and progression of malignancies. In this study, we investigated the clinical role of TNFAIP8 overexpression in endometrial cancer (EC) and determined the relationship of TNFAIP8 with the proliferative antigen Ki-67 and metastasis-related gene matrix metallopeptidase 9 (MMP9) in 225 tumor specimens by immunohistochemistry and western blot, in order to elucidate more information on the role of TNFAIP8 protein with regard to the pathogenesis of EC. An association was observed between TNFAIP8 overexpression and clinicopathologic factors, such as advanced International Federation of Gynecology and Obstetrics stage (P<0.001), higher histologic grade (P=0.017), deep myometrial invasion (P=0.030), lymphovascular space invasion (P=0.011), lymph node metastasis (P<0.001), and recurrence. Furthermore, TNFAIP8 overexpression was strongly correlated with MMP9 and Ki-67 expression in the progression of ECs. Patients with high expression of TNFAIP8 (P<0.001 for both) and Ki-67 (P=0.007 and P=0.008) had poor overall survival and disease-free survival (DFS) rates. MMP9 overexpression did not affect survival outcomes (P>0.05). Multivariate Cox regression analysis revealed that TNFAIP8 (P=0.029) and lymph node metastasis (P=0.022) were independent factors of DFS in patients with EC. These findings suggested that TNFAIP8 may be used as a prognostic marker for the recurrence of EC, and its promotion of the proliferation and metastasis in EC may be due to its mediation of Ki-67 and MMP9.
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Wik E, Birkeland E, Trovik J, Werner HM, Hoivik EA, Mjos S, Krakstad C, Kusonmano K, Mauland K, Stefansson IM, Holst F, Petersen K, Oyan AM, Simon R, Kalland KH, Ricketts W, Akslen LA, Salvesen HB. High Phospho-Stathmin(Serine38) Expression Identifies Aggressive Endometrial Cancer and Suggests an Association with PI3K Inhibition. Clin Cancer Res 2013; 19:2331-41. [DOI: 10.1158/1078-0432.ccr-12-3413] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Leslie KK, Sill MW, Fischer E, Darcy KM, Mannel RS, Tewari KS, Hanjani P, Wilken JA, Baron AT, Godwin AK, Schilder RJ, Singh M, Maihle NJ. A phase II evaluation of gefitinib in the treatment of persistent or recurrent endometrial cancer: a Gynecologic Oncology Group study. Gynecol Oncol 2013; 129:486-94. [PMID: 23438670 DOI: 10.1016/j.ygyno.2013.02.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 02/07/2013] [Accepted: 02/13/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND A phase II trial was performed to evaluate the efficacy and safety of gefitinib in patients with persistent/recurrent endometrial cancer. METHODS Women with histologically confirmed persistent/recurrent endometrial cancer were treated with 500mg oral gefitinib daily until progression or severe toxicity, with progression-free survival (PFS) at six months as the primary endpoint. Tumor expression of total epidermal growth factor receptor (EGFR), estrogen receptor (ER), progesterone receptor A (PRA) and B (PRB), Ki67, pEGFR and activated extracellular signal-regulated kinase (pERK) were examined pre- and post-treatment. EGFR was sequenced, and serum concentrations of soluble EGFR (sEGFR) at baseline also were examined. RESULTS Of 29 patients enrolled, 26 were evaluable for efficacy and toxicity. Four patients experienced PFS ≥6 months, and one had a complete response which was not associated with an EGFR mutation. The concentration of sEGFR in pretreatment serum was positively correlated with overall survival (OS), but not with responsiveness to gefitinib in this small patient cohort. Expression of tumor biomarkers was not associated with PFS or OS. Co-expression of ER with PRA in primary and recurrent tumors, and pEGFR with pERK in primary tumors was observed. CONCLUSIONS This treatment regimen was tolerable but lacked sufficient efficacy to warrant further evaluation in this setting. The possible association between serum sEGFR concentrations and OS, and temporal changes in expression of pEGFR and pERK and the documented CR of one patient are interesting and warrant additional investigation.
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Affiliation(s)
- Kimberly K Leslie
- University of New Mexico Health Sciences Center, Albuquerque, NM 87131, United States.
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28
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Wik E, Ræder MB, Krakstad C, Trovik J, Birkeland E, Hoivik EA, Mjos S, Werner HMJ, Mannelqvist M, Stefansson IM, Oyan AM, Kalland KH, Akslen LA, Salvesen HB. Lack of estrogen receptor-α is associated with epithelial-mesenchymal transition and PI3K alterations in endometrial carcinoma. Clin Cancer Res 2013; 19:1094-105. [PMID: 23319822 DOI: 10.1158/1078-0432.ccr-12-3039] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We hypothesized that estrogen receptor-α (ER-α) status in endometrial carcinomas, associated with poor prognosis, is reflected in transcriptional signatures suggesting targets for new therapy. EXPERIMENTAL DESIGN Endometrial carcinoma samples in a primary investigation cohort (n = 76) and three independent validation cohorts (n = 155/286/111) were analyzed through integrated molecular profiling. Biomarkers were assessed by immunohistochemistry (IHC), DNA oligonucleotide microarray, quantitative PCR (qPCR), single-nucleotide polymorphism (SNP) array, and Sanger sequencing in the cohorts, annotated for comprehensive histopathologic and clinical data, including follow-up. RESULTS ER-α immunohistochemical staining was strongly associated with mRNA expression of the receptor gene (ESR1) and patient survival (both P < 0.001). ER-α negativity associated with activation of genes involved in Wnt-, Sonic Hedgehog-, and TGF-β signaling in the investigation cohort, indicating epithelial-mesenchymal transition (EMT). The association between low ER-α and EMT was validated in three independent datasets. Furthermore, phosphoinositide 3-kinase (PI3K) and mTOR inhibitors were among the top-ranked drug signatures negatively correlated with the ER-α-negative tumors. Low ER-α was significantly associated with PIK3CA amplifications but not mutations. Also, low ER-α was correlated to high expression of Stathmin, a marker associated with PTEN loss, and a high PI3K activation signature. CONCLUSION Lack of ER-α in endometrial cancer is associated with EMT and reduced survival. We present a rationale for investigating ER-α's potential to predict response to PI3K/mTOR inhibitors in clinical trials and also suggest EMT inhibitors to ER-α-negative endometrial carcinomas.
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Affiliation(s)
- Elisabeth Wik
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
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Momeni M, Kolev V, Cardenas-Goicoechea J, Getrajdman J, Fishman D, Chuang L, Kalir T, Rahaman J, Zakashansky K. Does the type of surgery for early-stage endometrial cancer affect the rate of reported lymphovascular space invasion in final pathology specimens? Am J Obstet Gynecol 2013; 208:71.e1-6. [PMID: 23099190 DOI: 10.1016/j.ajog.2012.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 10/01/2012] [Accepted: 10/09/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Laparoscopically assisted vaginal hysterectomy (LAVH), which usually involves the use of an intrauterine manipulator for optimal surgical control, has been shown to be as effective and safe as conventional total abdominal hysterectomy (TAH) for the staging of endometrial carcinoma. The purpose of this study was to determine whether the use of an intrauterine manipulator was associated with an increase in the pathologic reporting of lymphovascular space invasion (LVSI), which is an important determinant in choosing adjuvant therapy. We hypothesized that intracavitary manipulation and an increase of the intrauterine pressure could cause pseudolymphovascular invasion. STUDY DESIGN We performed a retrospective chart review of endometrial cancer patients treated at our institution from January 1996 through January 2006. Records were reviewed for patient's age, preoperative diagnosis, procedure type, final surgical staging, and final pathology report. Using the 2009 International Federation of Gynecology and Obstetrics staging, we included all patients having stage IA or IB endometrioid-type endometrial cancer who had undergone either a TAH or LAVH with or without pelvic and paraaortic lymph node dissection. The χ2 and Fisher exact tests were used to measure the association between risk of positive lymphovascular invasion and surgical groups. RESULTS Of 568 women identified as having endometrioid-type endometrial cancer, 486 (85.6%) met criteria for stage IA-IB endometrioid histology, grade 1, 2, or 3. LVSI was reported in 553/568 cases, with LVSI positivity in 16.9% (n = 96/568). The mean ages of the LAVH and TAH groups were significantly different (59.4 vs 62.4 years, respectively, P = .0050). Also, mean estimated blood loss and uterine weight significantly varied between TAH and LAVH groups (P = .0001 and .008, respectively). For stage IA, 17/220 (7.7%) who had been treated with LAVH had positive LVSI compared with 20/199 (10.1%) of patients receiving TAH (P = .73). For stage IB, 11/25 (44.0%) of patients treated with LAVH had positive LVSI compared with 10/31 (32.3%) of patients receiving TAH (P = .53). The stage I cancer patients were further subdivided into histological grades 1, 2, and 3, and LVSI was not significantly different between TAH and LAVH groups per grade of cancer. We found no differences between TAH and LAVH in early-stage endometrial cancer (stage IA and IB), with respect to the presence of positive peritoneal washings. CONCLUSION In early-stage endometrial cancer (stage IA and IB), there were no differences between TAH and LAVH in the final pathologic report of LVSI. The use of an intrauterine manipulator for LAVH was not associated with an increased detection of LVSI.
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Abstract
The significance of tumor necrosis in cutaneous melanoma has not been well elucidated. The purpose of this study was to explore the prognostic impact of necrosis in comparison with other known clinicopathologic factors in these tumors. Initially, 457 consecutive cases of nodular cutaneous melanoma (1981 to 2008) were included in this series. Tumor necrosis was assessed on hematoxylin and eosin-stained sections and was recorded as significant when an area of at least a quarter of a high-power field (×400; 0.07 mm) was occupied by necrotic cells and as sparse when clusters of at least 5 necrotic cells were observed. Tumor necrosis (26% of the cases) was associated with increased tumor thickness, high mitotic count, presence of tumor ulceration, and decreased survival. Stratified analyses (univariate and multivariate) with standard microscopic variables indicated the strongest prognostic influence of necrosis in tumors thicker than 4 mm. Notably, in the stratum of pT4 tumors, presence of necrosis was a stronger prognostic predictor than was ulceration. Tumor necrosis was a significant prognostic indicator providing additional information to established predictors of patient outcome in this series of nodular cutaneous melanoma, predominantly among thick tumors (>4 mm). Presence of necrosis was a stronger indicator for worse outcome compared with ulceration in pT4 tumors.
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Salvesen HB, Haldorsen IS, Trovik J. Markers for individualised therapy in endometrial carcinoma. Lancet Oncol 2012; 13:e353-61. [DOI: 10.1016/s1470-2045(12)70213-9] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Mannelqvist M, Stefansson IM, Wik E, Kusonmano K, Raeder MB, Øyan AM, Kalland KH, Moses MA, Salvesen HB, Akslen LA. Lipocalin 2 expression is associated with aggressive features of endometrial cancer. BMC Cancer 2012; 12:169. [PMID: 22559235 PMCID: PMC3493289 DOI: 10.1186/1471-2407-12-169] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/19/2012] [Indexed: 01/21/2023] Open
Abstract
Background Increased expression of lipocalin 2 (LCN2) has been observed in several cancers. The aim of the present study was to investigate LCN2 in endometrial cancer in relation to clinico-pathologic phenotype, angiogenesis, markers of epithelial-mesenchymal transition (EMT), and patient survival. Methods Immunohistochemical staining was performed using a human LCN2 antibody on a population-based series of endometrial cancer patients collected in Hordaland County (Norway) during 1981-1990 (n = 256). Patients were followed from the time of primary surgery until death or last follow-up in 2007. The median follow-up time for survivors was 17 years. Gene expression data from a prospectively collected endometrial cancer series (n = 76) and a publicly available endometrial cancer series (n = 111) was used for gene correlation studies. Results Expression of LCN2 protein, found in 49% of the cases, was associated with non-endometrioid histologic type (p = 0.001), nuclear grade 3 (p = 0.001), >50% solid tumor growth (p = 0.001), ER and PR negativity (p = 0.028 and 0.006), and positive EZH2 expression (p < 0.001). LCN2 expression was significantly associated with expression of VEGF-A (p = 0.021), although not with other angiogenesis markers examined (vascular proliferation index, glomeruloid microvascular proliferation, VEGF-C, VEGF-D or bFGF2 expression). Further, LCN2 was not associated with several EMT-related markers (E-cadherin, N-cadherin, P-cadherin, β-catenin), nor with vascular invasion (tumor cells invading lymphatic or blood vessels). Notably, LCN2 was significantly associated with distant tumor recurrences, as well as with the S100A family of metastasis related genes. Patients with tumors showing no LCN2 expression had the best outcome with 81% 5-year survival, compared to 73% for intermediate and 38% for the small subgroup with strong LCN2 staining (p = 0.007). In multivariate analysis, LCN2 expression was an independent prognostic factor in addition to histologic grade and FIGO stage. Conclusion Increased LCN2 expression is associated with aggressive features and poor prognosis in endometrial cancer.
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Affiliation(s)
- Monica Mannelqvist
- The Gade Institute, Section for Pathology, University of Bergen, Bergen, Norway
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Mannelqvist M, Stefansson IM, Bredholt G, Hellem Bø T, Oyan AM, Jonassen I, Kalland KH, Salvesen HB, Akslen LA. Gene expression patterns related to vascular invasion and aggressive features in endometrial cancer. THE AMERICAN JOURNAL OF PATHOLOGY 2011; 178:861-71. [PMID: 21281818 DOI: 10.1016/j.ajpath.2010.10.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 08/31/2010] [Accepted: 10/13/2010] [Indexed: 01/09/2023]
Abstract
The presence of tumor cells entering vascular channels is a prognostic marker for many cancers, including endometrial carcinoma. Vascular invasion is considered to be an early step in the metastatic process and important for the progress of malignant tumors. Here, we investigated the gene expression patterns related to vascular involvement in 57 primary endometrial cancers, using DNA microarray and quantitative PCR techniques. A vascular invasion signature of 18 genes was significantly associated with patient survival and clinicopathological phenotype. Vascular involvement was also related to gene sets for epithelial-mesenchymal transition, wound response, endothelial cells, and vascular endothelial growth factor (VEGF) activity. With immunohistochemical validation, both collagen 8 and matrix metalloproteinase 3 (MMP3) were associated with vascular invasion, whereas ANGPTL4 and IL-8 were associated with patient survival. Our findings indicate that vascular involvement within primary tumors is associated with gene expression profiles related to angiogenesis and epithelial-mesenchymal transition. These data could contribute to an improved understanding of potential targets for metastatic spread and may provide clinically important information for better management of endometrial cancer.
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Affiliation(s)
- Monica Mannelqvist
- Section for Pathology, The Gade Institute, University of Bergen, Bergen, Norway
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35
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Girling JE, Donoghue JF, Lederman FL, Cann LM, Achen MG, Stacker SA, Rogers PAW. Vascular endothelial growth factor-D over-expressing tumor cells induce differential effects on uterine vasculature in a mouse model of endometrial cancer. Reprod Biol Endocrinol 2010; 8:84. [PMID: 20615255 PMCID: PMC2909246 DOI: 10.1186/1477-7827-8-84] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 07/08/2010] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND It has been hypothesised that increased VEGF-D expression may be an independent prognostic factor for endometrial cancer progression and lymph node metastasis; however, the mechanism by which VEGF-D may promote disease progression in women with endometrial cancer has not been investigated. Our aim was to describe the distribution of lymphatic vessels in mouse uterus and to examine the effect of VEGF-D over-expression on these vessels in a model of endometrial cancer. We hypothesised that VEGF-D over-expression would stimulate growth of new lymphatic vessels into the endometrium, thereby contributing to cancer progression. METHODS We initially described the distribution of lymphatic vessels (Lyve-1, podoplanin, VEGFR-3) and VEGF-D expression in the mouse uterus during the estrous cycle, early pregnancy and in response to estradiol-17beta and progesterone using immunohistochemistry. We also examined the effects of VEGF-D over-expression on uterine vasculature by inoculating uterine horns in NOD SCID mice with control or VEGF-D-expressing 293EBNA tumor cells. RESULTS Lymphatic vessels positive for the lymphatic endothelial cell markers Lyve-1, podoplanin and VEGFR-3 profiles were largely restricted to the connective tissue between the myometrial circular and longitudinal muscle layers; very few lymphatic vessel profiles were observed in the endometrium. VEGF-D immunostaining was present in all uterine compartments (epithelium, stroma, myometrium), although expression was generally low. VEGF-D immunoexpression was slightly but significantly higher in estrus relative to diestrus; and in estradiol-17beta treated mice relative to vehicle or progesterone treated mice. The presence of VEGF-D over-expressing tumor cells did not induce endometrial lymphangiogenesis, although changes were observed in existing vessel profiles. For myometrial lymphatic and endometrial blood vessels, the percentage of profiles containing proliferating endothelial cells, and the cross sectional area of vessel profiles were significantly increased in response to VEGF-D in comparison to control tumor cells. In contrast, no significant changes were noted in myometrial blood vessels. In addition, examples of invading cells or tumor emboli were observed in mice receiving VEGF-D expressing 293EBNA cells. CONCLUSIONS These results illustrate that VEGF-D over-expression has differential effects on the uterine vasculature. These effects may facilitate VEGF-D's ability to promote endometrial cancer metastasis and disease progression.
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MESH Headings
- Animals
- Carcinoma, Endometrioid/blood supply
- Carcinoma, Endometrioid/genetics
- Carcinoma, Endometrioid/metabolism
- Carcinoma, Endometrioid/pathology
- Cells, Cultured
- Disease Models, Animal
- Endometrial Neoplasms/blood supply
- Endometrial Neoplasms/genetics
- Endometrial Neoplasms/metabolism
- Endometrial Neoplasms/pathology
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Mice
- Mice, Inbred C57BL
- Mice, Inbred NOD
- Mice, SCID
- Mice, Transgenic
- Transplantation, Heterologous
- Up-Regulation/genetics
- Uterus/blood supply
- Uterus/metabolism
- Uterus/pathology
- Vascular Endothelial Growth Factor D/genetics
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Affiliation(s)
- Jane E Girling
- Centre for Women's Health Research, Monash Institute of Medical Research and Monash University Department of Obstetrics and Gynaecology, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC 3168, Australia
| | - Jacqueline F Donoghue
- Centre for Women's Health Research, Monash Institute of Medical Research and Monash University Department of Obstetrics and Gynaecology, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC 3168, Australia
| | - Fiona L Lederman
- Centre for Women's Health Research, Monash Institute of Medical Research and Monash University Department of Obstetrics and Gynaecology, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC 3168, Australia
| | - Leonie M Cann
- Centre for Women's Health Research, Monash Institute of Medical Research and Monash University Department of Obstetrics and Gynaecology, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC 3168, Australia
| | - Marc G Achen
- Ludwig Institute for Cancer Research, PO Box 2008, Royal Melbourne Hospital, Victoria, Australia
| | - Steven A Stacker
- Ludwig Institute for Cancer Research, PO Box 2008, Royal Melbourne Hospital, Victoria, Australia
| | - Peter AW Rogers
- Centre for Women's Health Research, Monash Institute of Medical Research and Monash University Department of Obstetrics and Gynaecology, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC 3168, Australia
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36
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Stewart CJR, Crook ML, Doherty DA. Micro-anatomical variation in cellular proliferation in endometrial adenocarcinoma, and inverse correlation between Ki67 and cytokeratin 7 expression. Histopathology 2010; 57:46-54. [DOI: 10.1111/j.1365-2559.2010.03588.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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37
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Clarke BA, Gilks CB. Endometrial carcinoma: controversies in histopathological assessment of grade and tumour cell type. J Clin Pathol 2010; 63:410-5. [DOI: 10.1136/jcp.2009.071225] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Histopathological assessment of tumour grade and cell type is central to the management of endometrial carcinoma, guiding the extent of surgery and the use of adjuvant radiation therapy and chemotherapy. Endometrioid carcinomas are usually low grade but high-grade examples are encountered, and they have a significantly worse prognosis, similar to that of high-grade subtypes such as serous and clear cell carcinoma. This article reviews the various grading systems that have been proposed for use with endometrioid endometrial carcinoma, and discusses the recent progress in cell type assignment, including the use of immunohistochemistry as a diagnostic adjunct.
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38
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McCluggage WG. Problematic areas in the reporting of endometrial carcinomas in hysterectomy specimens. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.mpdhp.2009.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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39
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How to deal with prognostic factors and radiotherapy results in uterine neoplasms with a sarcomatous component? Clin Transl Oncol 2009; 11:681-7. [DOI: 10.1007/s12094-009-0424-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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ENGELSEN INGEBORGB, AKSLEN LARSA, SALVESEN HELGAB. Biologic markers in endometrial cancer treatment. APMIS 2009; 117:693-707. [DOI: 10.1111/j.1600-0463.2009.02467.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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41
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Stewart C, Brennan B, Leung Y, Little L. MELF pattern invasion in endometrial carcinoma: association with low grade, myoinvasive endometrioid tumours, focal mucinous differentiation and vascular invasion. Pathology 2009; 41:454-9. [DOI: 10.1080/00313020903041135] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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42
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Orezzoli JP, Sioletic S, Olawaiye A, Oliva E, del Carmen MG. Stage II endometrioid adenocarcinoma of the endometrium: Clinical implications of cervical stromal invasion. Gynecol Oncol 2009; 113:316-23. [DOI: 10.1016/j.ygyno.2009.03.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 02/28/2009] [Accepted: 03/03/2009] [Indexed: 02/07/2023]
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43
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Mannelqvist M, Stefansson I, Salvesen HB, Akslen LA. Importance of tumour cell invasion in blood and lymphatic vasculature among patients with endometrial carcinoma. Histopathology 2009; 54:174-83. [PMID: 19207942 DOI: 10.1111/j.1365-2559.2008.03201.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIMS Vascular invasion is a prognostic marker for many cancers, including endometrial carcinoma. Immunohistochemistry using D2-40 and CD31 antibodies makes it possible to differentiate between lymphatic vascular invasion (LVI) and blood vessel invasion (BVI). The aim was to examine lymphatic and blood vessel invasion separately and their associations with clinicopathological characteristics and prognosis. METHODS AND RESULTS Immunohistochemistry was performed on a retrospective population-based series of endometrial carcinoma. Altogether, 31% of the 276 tumours showed lymphatic involvement, whereas 18% showed blood vessel invasion. LVI and BVI were associated with histopathological variables such as histological grade and tumour growth pattern. Patients without vascular invasion had the best prognosis and those with BVI (with or without LVI) had the worst outcome, whereas patients with LVI had an intermediate survival on univariate analysis. Multivariate models indicated that both LVI and especially BVI had independent prognostic importance. Among endometrioid carcinomas, BVI was still significant. CONCLUSIONS Our findings support the biological importance of vascular spread through the haematogenic and lymphatic routes in endometrial cancer. The significant correlation found with clinical phenotype indicates that these markers may be relevant for patient management.
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Affiliation(s)
- Monica Mannelqvist
- The Gade Institute, Section for Pathology, Haukeland University Hospital, Bergen, Norway
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44
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Gemer O, Uriev L, Voldarsky M, Gdalevich M, Ben-Dor D, Barak F, Anteby E, Lavie O. The reproducibility of histological parameters employed in the novel binary grading systems of endometrial cancer. Eur J Surg Oncol 2009; 35:247-51. [DOI: 10.1016/j.ejso.2008.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 07/10/2008] [Accepted: 07/21/2008] [Indexed: 11/27/2022] Open
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45
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Abstract
Endometrial carcinoma is the most common malignancy of the female genital tract in industrialized countries, and occurs predominantly after the menopause. Although most endometrial carcinomas are detected at low stage, there is still a significant mortality from the disease. In postmenopausal women, prolonged life expectancy, changes in reproductive behavior and prevalence of overweight and obesity, as well as hormone replacement therapy use, may partially account for the observed increases of incidence rates in some countries. In order to improve treatment and follow-up of endometrial carcinoma patients, the importance of various prognostic factors has been extensively studied. The identification of high-risk groups would make it possible to avoid unnecessary adjuvant treatment among patients with a good prognosis. Over the past few decades, several studies have demonstrated the prognostic importance of different parameters including lymph node status, histological type of carcinoma (serous carcinoma and clear cell carcinomas are poor prognostic types), histological grade, stage of disease, depth of myometrial invasion, lymphovascular space involvement and cervical involvement. Other factors currently being investigated are estrogen and progesterone receptor status, p53 status, flow cytometric analysis for ploidy and S-phase fraction, and oncogenes such as HER-2/neu (c-erbB-2).
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Affiliation(s)
- Peter Uharcek
- Department of Obstetrics and Gynecology, Faculty Hospital Nitra, Slovakia.
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46
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Kapucuoglu N, Bulbul D, Tulunay G, Temel MA. Reproducibility of grading systems for endometrial endometrioid carcinoma and their relation with pathologic prognostic parameters. Int J Gynecol Cancer 2008; 18:790-6. [PMID: 17892460 DOI: 10.1111/j.1525-1438.2007.01067.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The FIGO grading for endometrial endometrioid carcinomas is widely accepted. In 2000, a novel binary architectural grading system was suggested that divided endometrioid carcinomas into low- and high-grade tumors. We aimed to evaluate the interobserver reproducibility of the FIGO, the architectural binary, and nuclear grading systems and the correlation between these grading systems and pathologic prognostic factors for endometrial endometrioid carcinoma. Eighty-eight endometrial endometrioid carcinomas from hysterectomy specimens were reevaluated by two pathologists independently. Kappa values for the FIGO, the binary, and the nuclear grading systems were 0.65, 0.67, and 0.09, respectively. The reproducibility of the FIGO and the binary grading systems was similar and substantial. FIGO grade 1 (60.2%) patients were comparable to binary low-grade (63.6%) patients. Most of the FIGO grade 3 (83%) patients were binary high grade. FIGO grade 2 patients were distributed between binary low and high grades. The FIGO grade 1 and 2 cases judged to be of binary high grade had deep myometrial invasion, and more cases had vascular invasion in comparison with FIGO grade 1 and 2 cases judged to be of binary low grade. In uni- and multivariate analyses, both grading systems, depth of myometrial invasion, vascular invasion, cervical involvement, and stage had no effect on overall survival. But binary high grade and vascular involvement are adverse prognostic factors on recurrence-free survival. Binary high-grade patients can be assigned as high-risk patients.
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Affiliation(s)
- N Kapucuoglu
- Department of Pathology, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey.
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47
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Engelsen IB, Mannelqvist M, Stefansson IM, Carter SL, Beroukhim R, Øyan AM, Otte AP, Kalland KH, Akslen LA, Salvesen HB. Low BMI-1 expression is associated with an activated BMI-1-driven signature, vascular invasion, and hormone receptor loss in endometrial carcinoma. Br J Cancer 2008; 98:1662-9. [PMID: 18475299 PMCID: PMC2391115 DOI: 10.1038/sj.bjc.6604360] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We studied the expression of polycomb group (PcG) protein BMI-1 in a large population-based patient series of endometrial carcinomas in relation to clinical and molecular phenotype. Also, 57 fresh frozen endometrial carcinomas were studied for the relationship between BMI-1 protein expression, BMI-1 mRNA level, and activation of an 11-gene signature reported to represent a BMI-1-driven pathway. BMI-1 protein expression was significantly weaker in tumours with vascular invasion (P<0.0001), deep myometrial infiltration (P=0.004), and loss of oestrogen receptor (ER) (P<0.0001) and progesterone receptors (PR) (P=0.03). Low BMI-1 protein expression was highly associated with low BMI-1 mRNA expression (P=0.002), and similarly low BMI-1 mRNA expression correlated significantly with vascular invasion, ER and PR loss, and histologic grade 3. In contrast, activation of the reported 11-gene signature, supposed to represent a BMI-1-driven pathway, correlated with low mRNA expression of BMI-1 (P<0.001), hormone receptor loss, presence of vascular invasion, and poor prognosis. We conclude that BMI-1 protein and mRNA expression are significantly correlated and that BMI-1 expression is inversely associated with activation of the 11-gene signature. Loss of BMI-1 seems to be associated with an aggressive phenotype in endometrial carcinomas.
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Affiliation(s)
- I B Engelsen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen 5021, Norway.
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48
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Vascular “Pseudo Invasion” in Laparoscopic Hysterectomy Specimens: A Diagnostic Pitfall. Am J Surg Pathol 2008; 32:560-5. [DOI: 10.1097/pas.0b013e31816098f0] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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49
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Tamoxifen: Important considerations of a multi-functional compound with organ-specific properties. Cancer Treat Rev 2007; 33:91-100. [DOI: 10.1016/j.ctrv.2006.09.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2006] [Revised: 09/19/2006] [Accepted: 09/20/2006] [Indexed: 11/23/2022]
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50
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McCluggage WG. Immunohistochemical and functional biomarkers of value in female genital tract lesions. Int J Gynecol Pathol 2006; 25:101-20. [PMID: 16633059 DOI: 10.1097/01.pgp.0000192269.14666.68] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
There has been a marked expansion in the literature pertaining to the use of immunohistochemical markers in female genital tract pathology, especially with regard to diagnosis. This review provides a survey of the antibodies commonly used in the diagnosis of gynecological lesions grouped as to function or type. Prognostic or predictive markers are also discussed where appropriate, although few of these are of value in everyday practice. It is stressed that when immunohistochemistry is used diagnostically, panels of markers provide better information than reliance on a single antibody.
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Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Royal Group of Hospitals Trust, Belfast, Northern Ireland.
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