Reviving peritoneal cytology: Exploring its role in endometrial cancer molecular classification

OBJECTIVE

The prognostic significance of positive peritoneal cytology in endometrial cancer has long been debated. In 2009, the Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) removed cytology as a staging criterion from the endometrial cancer staging system. However, there is still evidence that positive peritoneal cytology may decrease survival among patients with endometrial cancer. The aim of this study was to determine the prognostic significance of positive peritoneal cytology among the different molecular subgroups.

METHODS

This study included patients with endometrial cancer who underwent primary surgical treatment between 2004 and 2015 at the Bern University Hospital, Switzerland, with molecular classification of the primary tumor and peritoneal cytology performed.

RESULTS

A total, 250 patients with endometrial cancer were enrolled. Peritoneal cytology was assessed in 206 patients, of whom 24% were positive: 25% of the POLEmut, 16% of the MMRd, 41% of the p53abn, and 24% of the NSMP cases. The mean follow-up was 128.7 months. Presence of positive peritoneal cytology was associated with significantly decreased mean recurrence-free and overall survival in patients with p53abn (p = .003 and p = .001) and NSMP (p = .020 and p = .049) endometrial cancer. In multivariable Cox regression analysis, positive peritoneal cytology remained an independent predictor of recurrence (p = .033) and death (p = .008) in p53abn endometrial cancer patients.

CONCLUSION

Positive peritoneal cytology is associated with worse oncologic outcomes in NSMP and p53abn endometrial cancer and remains an independent predictor of recurrence and death in patients with p53abn endometrial cancer.

Real-World Data on Institutional Implementation of Screening for Mismatch Repair Deficiency and Lynch Syndrome in Endometrial Cancer Patients

Lynch syndrome is an inherited tumor syndrome caused by a pathogenic germline variant in DNA mismatch repair genes. As the leading cause of hereditary endometrial cancer, international guidelines recommend universal screening in women with endometrial cancer. However, testing for Lynch syndrome is not yet well established in clinical practice. The aim of this study was to evaluate adherence to our Lynch syndrome screening algorithm. A retrospective, single-center cohort study was conducted of all endometrial cancer patients undergoing surgical treatment at the Bern University Hospital, Switzerland, between 2017 and 2022. Adherence to immunohistochemical analysis of mismatch repair status, and, if indicated, to MLH1 promoter hypermethylation and to genetic counseling and testing was assessed. Of all 331 endometrial cancer patients, 102 (30.8%) were mismatch repair-deficient and 3 (0.9%) patients were diagnosed with Lynch syndrome. Overall screening adherence was 78.2%, with a notable improvement over the six years from 61.4% to 90.6%. A major reason for non-adherence was lack of provider recommendation for testing, with advanced patient age as a potential patient risk factor. Simplification of the algorithm through standardized reflex screening was recommended to provide optimal medical care for those affected and to allow for cascading testing of at-risk relatives.

Prognostic value of lymphovascular space invasion according to the molecular subgroups in endometrial cancer

OBJECTIVE

Lymphovascular space invasion (LVSI) is a known prognostic factor for oncological outcome in endometrial cancer patients. However, little is known about the prognostic value of LVSI among the different molecular subgroups. The aim of this study was to determine the prognostic dependence of LVSI from the molecular signature.

METHODS

This study included endometrial cancer patients who underwent primary surgical treatment between February 2004 and February 2016 at the Karolinska University Hospital, Sweden and the Bern University Hospital, Switzerland (KImBer cohort). All cases had complete molecular analysis performed on the primary tumor according to the WHO Classification of Tumors, 5th edition. LVSI was reviewed by reference pathologists for all pathology slides.

RESULTS

A total of 589 endometrial cancer patients were included in this study, consisting of 40 POLEmut (polymerase epsilon ultramutated), 198 MMRd (mismatch repair deficient), 83 p53abn (p53 abnormal), and 268 NSMP (non-specific molecular profile) cases. Altogether, 17% of tumors showed LVSI: 25% of the POLEmut, 19% of the MMRd, 30% of the p53abn, and 10% of the NSMP cases. There was a significant correlation of LVSI with lymph node metastasis in the entire study cohort (p<0.001), remaining significant in the MMRd (p=0.020), p53abn (p<0.001), and NSMP (p<0.001) subgroups. Mean follow-up was 89 months (95% CI 86 to 93). The presence of LVSI significantly decreased recurrence-free survival among patients with MMRd, p53abn, and NSMP endometrial cancer, and overall survival in patients with p53abn and NSMP tumors. In patients with NSMP endometrial cancer, evidence of substantial LVSI remained a significant independent predictor of recurrence in multivariable Cox regression analysis including tumor stage and grade (HR 7.5, 95% CI 2.2 to 25.5, p=o.001).

CONCLUSION

The presence of LVSI was associated with recurrence in each subgroup of patients with MMRd, p53abn, and NSMP endometrial cancer, and LVSI remained an independent predictor of recurrence in NSMP endometrial cancer patients.

FACT-Hep increases the accuracy of survival prediction in HCC patients when added to ECOG Performance Status

BACKGROUND AND AIM

The Eastern Cooperative Oncology Group Performance Status (ECOG PS) is a strong predictor of survival for patients with hepatocellular carcinoma (HCC), and is used with liver function and tumour burden in the Barcelona Clinic Liver Cancer (BCLC) staging system. This work assesses whether the health-related quality of life (HRQL), measured by the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire, discriminates HCC patients in terms of survival and adds prognostic information to ECOG PS.

METHODS

A total of 242 patients participating in the prospective Bern HCC Cohort at the University Hospital Bern were analysed. The relationship between FACT-Hep and sociodemographic and clinical factors, including survival, were assessed. An analysis on treatment subgroups was performed using Kaplan-Meier curves and Long-Rank test. Additionally, the ability to predict overall survival was compared between the ECOG PS and FACT-Hep total and subscales using Nagelkerke pseudo-R² .

RESULTS

FACT-Hep subscales were significantly worse in females and in patients with limited liver function. FACT-Hep total and all subscales, except the social/family well-being subscale showed significant differences between ECOG PS groups and were significant predictors of survival. ECOG PS groups, followed by the functional well-being subscale, were the best at predicting survival. In the resection subgroup, significant differences in OS regarding to HRQL were found. When adding the functional well-being subscale to ECOG PS, the accuracy of the survival prediction was significantly increased.

CONCLUSION

HRQL assessed by the FACT-Hep questionnaire is a reliable prognostic predictor of survival for patients with HCC and it adds prognostic information to the ECOG PS.

Characterization and mapping of canine microsatellites isolated from BAC clones harbouring DNA sequences homologous to seven human genes

Human primers specific for the genes LEP, HBB, PAX3, ESR2, TPH1, ABCA4 and ATP2A2 were used to identify clones in a canine BAC library. Subcloning of the positive BACs in plasmids, screening with microsatellite motifs and subsequent sequencing allowed for the identification of eight novel microsatellites. The presence of the gene of interest was confirmed by sequencing the polymerase chain reaction (PCR) products amplified in the positive BACs. Fluorescent in situ hybridization (FISH) using the positive BACs as probes allowed for the chromosomal localization of the insert DNAs in two canid species, dog (Canis familiaris) and red fox (Vulpes vulpes). The use of gene-associated microsatellites may accelerate the identification of candidate genes for phenotypic traits in linkage studies.

[Severe vertigo after a scuba-dive to 29 meters]

A 27-year-old flight instructor experienced 5 to 10 minutes after a scuba-dive to 29 m, which lasted totally 50 minutes, dizziness, nausea and severe vertigo. The symptoms lasted about an hour. The patient vomited several times and noted sudden onset headache and vertigo lasting the following three days. Hyperbaric oxygen therapy was started 30 hours after the event because decompression sickness was suspected. Transthoracic echocardiographic evaluation showed a patent foramen ovale. Diving accidents may be caused by decompression sickness, the formation of a free intravascular gas phase (bubbles) may result in transatrial shunting in the presence of a patent foramen ovale and may lead to neurological signs and symptoms. In this context the diver was advised to undergo closure of the atrial septal defect. Five months after the incident the patient underwent successful transcatheter occlusion of the PFO.

Intracranial facial nerve anastomosis

A technique of intracranial facial nerve anastomosis using fenestrated collagen splints was used in eight patients operated upon for acoustic neuroma or glomus temporale tumor. This technique is rapid and simpler than suturing in the cerebellopontine angle. Clinical results are as good as or even better than those obtained with more peripheral facial nerve anastomosis or grafting. An animal study demonstrated no undue histologic reaction to the collagen splints.

Intraoperative evoked electromyography in Bell's palsy

The technique of intraoperative evoked electromyography is described in detail. Direct intraoperative stimulation of the exposed facial nerve identified the sites of nerve impulse conduction blocks in 16 of 18 patients who needed decompression for Bell' s palsy. In order to determine the site of impulse conduction block the test must be performed before 100 per cent nerve degeneration occurs. The lesions extended only a few millimeters and were found to be proximal to the geniculate ganglion in 15 (94 per cent) of these patients. Schirmer's test correctly identified the sites of the lesions in only 61 per cent of the patients. To locate the precise site of the lesion inducing a conduction block in Bell's palsy, intraoperative evoked electromyography must be used. The limited extent of the blocked motor fibers indicates that segmental rather than total intratemporal decompression is needed in Bell's palsy.