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Lin G, Hsieh CY, Lai YC, Wang CC, Lin Y, Lu KY, Chai WY, Chen AP, Yen TC, Ng SH, Lai CH. Hyperpolarized [1- 13C]-pyruvate MRS evaluates immune potential and predicts response to radiotherapy in cervical cancer. Eur Radiol Exp 2024; 8:46. [PMID: 38594558 PMCID: PMC11003947 DOI: 10.1186/s41747-024-00445-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/23/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Monitoring pyruvate metabolism in the spleen is important for assessing immune activity and achieving successful radiotherapy for cervical cancer due to the significance of the abscopal effect. We aimed to explore the feasibility of utilizing hyperpolarized (HP) [1-13C]-pyruvate magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) to evaluate pyruvate metabolism in the human spleen, with the aim of identifying potential candidates for radiotherapy in cervical cancer. METHODS This prospective study recruited six female patients with cervical cancer (median age 55 years; range 39-60) evaluated using HP [1-13C]-pyruvate MRI/MRS at baseline and 2 weeks after radiotherapy. Proton (1H) diffusion-weighted MRI was performed in parallel to estimate splenic cellularity. The primary outcome was defined as tumor response to radiotherapy. The Student t-test was used for comparing 13C data between the groups. RESULTS The splenic HP [1-13C]-lactate-to-total carbon (tC) ratio was 5.6-fold lower in the responders than in the non-responders at baseline (p = 0.009). The splenic [1-13C]-lactate-to-tC ratio revealed a 1.7-fold increase (p = 0.415) and the splenic [1-13C]-alanine-to-tC ratio revealed a 1.8-fold increase after radiotherapy (p = 0.482). The blood leukocyte differential count revealed an increased proportion of neutrophils two weeks following treatment, indicating enhanced immune activity (p = 0.013). The splenic apparent diffusion coefficient values between the groups were not significantly different. CONCLUSIONS This exploratory study revealed the feasibility of HP [1-13C]-pyruvate MRS of the spleen for evaluating baseline immune potential, which was associated with clinical outcomes of cervical cancer after radiotherapy. TRIAL REGISTRATION ClinicalTrials.gov NCT04951921 , registered 7 July 2021. RELEVANCE STATEMENT This prospective study revealed the feasibility of using HP 13C MRI/MRS for assessing pyruvate metabolism of the spleen to evaluate the patients' immune potential that is associated with radiotherapeutic clinical outcomes in cervical cancer. KEY POINTS • Effective radiotherapy induces abscopal effect via altering immune metabolism. • Hyperpolarized 13C MRS evaluates patients' immune potential non-invasively. • Pyruvate-to-lactate conversion in the spleen is elevated following radiotherapy.
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Affiliation(s)
- Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St, Guishan, 33382, Taoyuan, Taiwan.
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan.
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
- Research Center for Radiation Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ching-Yi Hsieh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St, Guishan, 33382, Taoyuan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Research Center for Radiation Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Chieh Lai
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St, Guishan, 33382, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chun-Chieh Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
- Research Center for Radiation Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St, Guishan, 33382, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kuan-Ying Lu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St, Guishan, 33382, Taoyuan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wen-Yen Chai
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St, Guishan, 33382, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | | | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shu-Hang Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St, Guishan, 33382, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Division of Gynecologic Oncology, Gynecologic Oncology Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Kobayashi Y, Shimada M, Tamate M, Cho HW, Zhu J, Chou HH, Kajiyama H, Okamoto A, Aoki D, Kang S, Lee JW, Kim JW, Kim JH, Lin Z, Liu J, Wu X, Lai HC, Chang TC, Lai CH, Kim YM, Enomoto T. Current treatment strategies for ovarian cancer in the East Asian Gynecologic Oncology Trial Group (EAGOT). J Gynecol Oncol 2024; 35:35.e87. [PMID: 38606827 DOI: 10.3802/jgo.2024.35.e87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 03/24/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Yusuke Kobayashi
- Department of Obstetrics and Gynecology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
| | - Masato Tamate
- Department of Obstetrics and Gynecology, Sapporo Medical University, Hokkaido, Japan
| | - Hyun Woong Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jun Zhu
- Department of Gynecologic Oncology, Cancer Hospital of Fudan University, Shanghai, China
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- National Tsing Hua University, School of Medicine, Hsinchu, Taiwan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Daisuke Aoki
- International University of Health and Welfare Graduate School, Tokyo, Japan
| | - Sokbom Kang
- Center for Gynecologic Oncology, National Cancer Center, Goyang, Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Hoon Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Zhongqiu Lin
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jihong Liu
- Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaohua Wu
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hung-Cheng Lai
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | | | - Yong Man Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Chou HH, Yang CY, Chao A, Lin H, Lu CH, Ou YC, Hsu ST, Shih YH, Huang HJ, Lin CT, Chen MY, Sun L, Tsai CC, Fu HC, Huang KG, Wu KY, Wu CH, Hsieh WC, Huang YT, Chen LH, Yang LY, Chang WY, Chang TC, Lai CH. Consistency in human papillomavirus type detection between self-collected vaginal specimens and physician-sampled cervical specimens. J Med Virol 2024; 96:e29426. [PMID: 38420851 DOI: 10.1002/jmv.29426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 03/02/2024]
Abstract
With the rising need for accessible cervical cancer screening, self-sampling methods offer a promising alternative to traditional physician-led sampling. This study aims to evaluate the efficacy of the HygeiaTouch Self Sampling Kit for Women in detecting human papillomavirus (HPV) types and predicting cervical lesions. We studied the concordance in identifying high-risk HPV (hrHPV) types between samples collected by physicians and those self-collected by women using a self-sampling kit for validation. Women aged 21-65, fitting into specific categories based on their cervical health history were eligible. Cohen's kappa coefficient to gauge concordance between the two specimen types and relative accuracy metrics in identifying cervical intraepithelial neoplasia (CIN) were also calculated, with physician-sampled specimens serving as a reference. A total of 1210 participants from three institutes were involved. The self-sampling kit closely matched the physician-led method in terms of collecting valid specimens (100% vs. 100%), identifying hrHPV types (kappa: 0.75, 95% confidence interval [95% CI]: 0.72-0.79; agreement: 87.7%, 95% CI: 85.8-89.6) and predicting CIN grade 2 or worse (CIN2+) (relative sensitivity: 0.949, relative accuracy: 0.959). Kappa values varied between 0.71 and 0.83 for different hrHPV types and combinations, with an overall value 0.75 (95% CI: 0.72-0.79) signifying robust compatibility between the two methods. Our study underscores the potential of the HygeiaTouch Self Sampling Kit as a reliable, efficient, and user-friendly alternative to traditional sampling methods. This suggests that self-sampling could be pivotal in expanding cervical cancer screening accessibility and enhancing detection rates.
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Affiliation(s)
- Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Chung-Yao Yang
- Department of Research and Development, Hygeia Touch Inc., Taipei, Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chien-Hsing Lu
- Department of Gynecology and Obstetrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Che Ou
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shih-Tien Hsu
- Department of Gynecology and Obstetrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Hsiang Shih
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Tao Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Min-Yu Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lou Sun
- Department of Gynecology and Obstetrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Chou Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hung-Chun Fu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kai-Yun Wu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chen-Hsuan Wu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wu-Chiao Hsieh
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yi-Ting Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Liang-Hsuan Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Lan-Yan Yang
- Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Yang Chang
- Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Research and Development, Hygeia Touch Inc., Taipei, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Chang SH, Huang KG, Yang LY, Pan YB, Lai CH, Chou HH. Comparison of outcomes of laparotomic and minimally invasive radical hysterectomy in women with early-stage cervical cancer. J Gynecol Oncol 2024:35.e60. [PMID: 38425140 DOI: 10.3802/jgo.2024.35.e60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/03/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE This study compared the outcomes of laparotomic radical hysterectomy (LRH) and minimally invasive radical hysterectomy (MISRH) in patients with early-stage cervical cancer. METHODS The clinical data of patients with early-stage cervical cancer who underwent LRH or MISRH (laparoscopic/robotic) at Chang Gung Memorial Hospital, Linkou Branch, from 2002 to 2017 were retrospectively reviewed. The surgical safety (operation time, blood loss, blood transfusion rate, length of postoperative stay, and perioperative complications), overall survival (OS), disease-free survival (DFS), and recurrence pattern were analyzed. Propensity score matching (PSM) at a 3:1 ratio was performed to balance prognostic variables. RESULTS Of the 760 patients (entire cohort), 614 underwent LRH and 146 underwent MISRH. After PSM, 394 and 140 patients were included in the LRH and MISRH groups, respectively. The 5-year OS rate was significantly lower in the MISRH group than in the LRH group (85.6% vs. 93.2%, p=0.043), and the 5-year DFS rate (p=0.21) did not differ significantly. After PSM, the 5-year OS rates did not differ significantly between the MISRH and LRH groups (87.1% vs. 92.1%, p=0.393). The MISRH group had a significantly shorter operation time (p<0.001), lower intraoperative blood loss (p<0.001), lower blood transfusion rate (p<0.001), and shorter postoperative stay (p<0.001) but a significantly higher rate of intraoperative bladder injury (p<0.001) than the LRH group. CONCLUSION After PSM, MISRH is associated with nonsignificantly lower OS but a significantly higher risk of intraoperative urological complications than LRH.
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Affiliation(s)
- Shu-Han Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Division of Clinical Trial, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Bin Pan
- Clinical Trial Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.
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Chao AS, Chao A, Lai CH, Lin CY, Yang LY, Chang SC, Wu RC. Comparison of immediate germline sequencing and multi-step screening for Lynch syndrome detection in high-risk endometrial and colorectal cancer patients. J Gynecol Oncol 2024; 35:e5. [PMID: 37743058 DOI: 10.3802/jgo.2024.35.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/08/2023] [Accepted: 08/13/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE Lynch syndrome (LS) is a hereditary cancer predisposition syndrome with a significantly increased risk of colorectal and endometrial cancers. Current standard practice involves universal screening for LS in patients with newly diagnosed colorectal or endometrial cancer using a multi-step screening protocol (MSP). However, MSP may not always accurately identify LS cases. To address this limitation, we compared the diagnostic performance of immediate germline sequencing (IGS) with MSP in a high-risk group. METHODS A total of 31 Taiwanese women with synchronous or metachronous endometrial and colorectal malignancies underwent MSP which included immunohistochemical staining of DNA mismatch repair (MMR) proteins, MLH1 promoter hypermethylation analysis, and germline sequencing to identify pathogenic variants. All patients who were excluded during MSP received germline sequencing for MMR genes to simulate IGS for the detection of LS. RESULTS Our findings indicate that IGS surpassed MSP in terms of diagnostic yield (29.0% vs. 19.4%, respectively) and sensitivity (90% vs. 60%, respectively). Specifically, IGS successfully identified nine LS cases, which is 50% more than the number detected through MSP. Additionally, germline methylation analysis revealed one more LS case with constitutional MLH1 promoter hypermethylation, bringing the total LS cases to ten (32.3%). Intriguingly, we observed no significant differences in clinical characteristics or overall survival between patients with and without LS in our cohort. CONCLUSION Our study suggests that IGS may potentially offer a more effective approach compared to MSP in identifying LS among high-risk patients. This advantage is evident when patients have been pre-selected utilizing specific clinical criteria.
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Affiliation(s)
- An-Shine Chao
- Department of Obstetrics and Gynecology, New Taipei Municipal Tu Cheng Hospital, New Taipei City, Taiwan
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chiao-Yun Lin
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Cheng Chang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Pathology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Hung SI, Chu MT, Hou MM, Lee YS, Yang CK, Chu SY, Liu FY, Hsu HC, Pao SC, Teng YC, Chen CB, Chao A, Chung WH, Chang JWC, Lai CH. Personalized neoantigen-based T cell therapy triggers cytotoxic lymphocytes expressing polyclonal TCR against metastatic ovarian cancer. Biomed Pharmacother 2023; 169:115928. [PMID: 38011788 DOI: 10.1016/j.biopha.2023.115928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
Neoantigen-reactive cytotoxic T lymphocytes play a vital role in precise cancer cell elimination. In this study, we demonstrate the effectiveness of personalized neoantigen-based T cell therapy in inducing tumor regression in two patients suffering from heavily-burdened metastatic ovarian cancer. Our approach involved the development of a robust pipeline for ex vivo expansion of neoantigen-reactive T lymphocytes. Neoantigen peptides were designed and synthesized based on the somatic mutations of the tumors and their predicted HLA binding affinities. These peptides were then presented to T lymphocytes through co-culture with neoantigen-loaded dendritic cells for ex vivo expansion. Subsequent to cell therapy, both patients exhibited significant reductions in tumor marker levels and experienced substantial tumor regression. One patient achieved repeated cancer regression through infusions of T cell products generated from newly identified neoantigens. Transcriptomic analyses revealed a remarkable increase in neoantigen-reactive cytotoxic lymphocytes in the peripheral blood of the patients following cell therapy. These cytotoxic T lymphocytes expressed polyclonal T cell receptors (TCR) against neoantigens, along with abundant cytotoxic proteins and pro-inflammatory cytokines. The efficacy of neoantigen targeting was significantly associated with the immunogenicity and TCR polyclonality. Notably, the neoantigen-specific TCR clonotypes persisted in the peripheral blood after cell therapy. Our findings indicate that personalized neoantigen-based T cell therapy triggers cytotoxic lymphocytes expressing polyclonal TCR against ovarian cancer, suggesting its promising potential in cancer immunotherapy.
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Affiliation(s)
- Shuen-Iu Hung
- Cancer Vaccine & Immune Cell Therapy Core Lab, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan; Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, No.155, Section 2, Linong Street, Taipei 112, Taiwan.
| | - Mu-Tzu Chu
- Cancer Vaccine & Immune Cell Therapy Core Lab, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan.
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan; College of Medicine, Chang Gung University, No. 5, De-Ming Road., Taoyuan 333, Taiwan.
| | - Yun-Shien Lee
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Guishan, Taoyuan 333, Taiwan; Department of Biotechnology, Ming-Chuan University, Taoyuan 333, Taiwan.
| | - Chan-Keng Yang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan; College of Medicine, Chang Gung University, No. 5, De-Ming Road., Taoyuan 333, Taiwan.
| | - Sung-Yu Chu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan.
| | - Feng-Yuan Liu
- College of Medicine, Chang Gung University, No. 5, De-Ming Road., Taoyuan 333, Taiwan; Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan; School of Medicine, National Tsing Hua University, No.101, Section 2, Kuang-Fu Road, Hsinchu 300, Taiwan.
| | - Hung-Chih Hsu
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan; College of Medicine, Chang Gung University, No. 5, De-Ming Road., Taoyuan 333, Taiwan.
| | - Shih-Cheng Pao
- Cancer Vaccine & Immune Cell Therapy Core Lab, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan; Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, No.155, Section 2, Linong Street, Taipei 112, Taiwan.
| | - Yu-Chuan Teng
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Guishan, Taoyuan 333, Taiwan.
| | - Chun-Bing Chen
- College of Medicine, Chang Gung University, No. 5, De-Ming Road., Taoyuan 333, Taiwan; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan.
| | - Angel Chao
- College of Medicine, Chang Gung University, No. 5, De-Ming Road., Taoyuan 333, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan.
| | - Wen-Hung Chung
- Cancer Vaccine & Immune Cell Therapy Core Lab, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan; College of Medicine, Chang Gung University, No. 5, De-Ming Road., Taoyuan 333, Taiwan; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan; Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Road., Keelung 204, Taiwan.
| | - John Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan; College of Medicine, Chang Gung University, No. 5, De-Ming Road., Taoyuan 333, Taiwan.
| | - Chyong-Huey Lai
- College of Medicine, Chang Gung University, No. 5, De-Ming Road., Taoyuan 333, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, No. 5. Fuxing Street, Taoyuan 333, Taiwan.
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7
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Lin CY, Wu KY, Chi LM, Tang YH, Huang HJ, Lai CH, Tsai CN, Tsai CL. Starvation-inactivated MTOR triggers cell migration via a ULK1-SH3PXD2A/TKS5-MMP14 pathway in ovarian carcinoma. Autophagy 2023; 19:3151-3168. [PMID: 37505094 PMCID: PMC10621272 DOI: 10.1080/15548627.2023.2239633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
ABBREVIATIONS AMPK: AMP-activated protein kinase; CHX: cycloheximide; RAD001: everolimus; HBSS: Hanks' balanced salt solution; LC-MS/MS: liquid chromatography-mass spectrometry/mass spectrometry; MMP14: matrix metallopeptidase 14; MTOR: mechanistic target of rapamycin kinase; MAPK: mitogen-activated protein kinase; RB1CC1/FIP200: RB1 inducible coiled-coil 1; PtdIns3P: phosphatidylinositol-3-phosphate; PX: phox homology; SH3: Src homology 3; SH3PXD2A/TKS5: SH3 and PX domains 2A; SH3PXD2A-[6A]: S112A S142A S146A S147A S175A S348A mutant; ULK1: unc-51 like autophagy activating kinase 1.
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Affiliation(s)
- Chiao-Yun Lin
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan City, Guishan District, Taiwan
| | - Kai-Yun Wu
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan City, Guishan District, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center And Chang Gung University, Taoyuan City, Guishan District, Taiwan
| | - Lang-Ming Chi
- Molecular Medicine Research Center, Chang Gung University, Taoyuan City, Guishan District, Taiwan
| | - Yun-Hsin Tang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan City, Guishan District, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center And Chang Gung University, Taoyuan City, Guishan District, Taiwan
| | - Huei-Jean Huang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan City, Guishan District, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center And Chang Gung University, Taoyuan City, Guishan District, Taiwan
| | - Chyong-Huey Lai
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan City, Guishan District, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center And Chang Gung University, Taoyuan City, Guishan District, Taiwan
| | - Chi-Neu Tsai
- Graduate Institute of Clinical Medical Science, Chang-Gung University, Taoyuan City, Guishan District, Taiwan
- Department of Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City, Tucheng District, Taiwan
| | - Chia-Lung Tsai
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Taoyuan City, Guishan District, Taiwan
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8
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Chen CC, Lai CH, Chang CL, Cheng WF, Pwu RF, Tsai J, Wang PH, Whang-Peng J, Lai GM. Managing the transition in cervical screening methods for Taiwan: Policy recommendations and perspectives. J Formos Med Assoc 2023; 122:1213-1218. [PMID: 37451959 DOI: 10.1016/j.jfma.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
Since government-provided annual cervical cytology testing for all Taiwanese women aged 30 years or older became available in 1995, both cervical cancer incidence and death have decreased significantly. However, with the 2018 introduction of the national immunization program for human papillomavirus (HPV) vaccination in all schoolgirls aged 13-15 years old, the positive predictive value of cytology testing is expected to decrease with rising vaccination rates, and therefore a transition to more sensitive HPV-based testing may be needed. This position paper, derived from discussions by a panel of experts in cervical cancer screening, provides short-, medium-, and long-term policy recommendations to manage the transition between cervical screening methods for Taiwan. The recommendations include concrete suggestions regarding testing procedures, standards, accreditation, monitoring, promotion, and implementation. It is hoped that comprehensive preparation and management of this transition will enable Taiwan to repeat the previous successes of the cervical cytology testing program.
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Affiliation(s)
- Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, 600, Taiwan; Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, 717, Taiwan; Ph.D. Program in Translational Medicine, Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, 402, Taiwan; Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, 701, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, 333, Taiwan; Chang Gung University, Taoyuan, 333, Taiwan
| | - Chih-Long Chang
- Department of Medicine, MacKay Medical College, New Taipei City, 252 Taiwan; Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, 104, Taiwan
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Raoh-Fang Pwu
- School of Health Care Administration, Taipei Medical University, Taipei, 110, Taiwan; Data Science Center, Fu Jen Catholic University, New Taipei City, 242, Taiwan
| | - Jane Tsai
- Formosa Cancer Foundation, Taipei, 105, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, 112, Taiwan; National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | | | - Gi-Ming Lai
- Formosa Cancer Foundation, Taipei, 105, Taiwan.
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9
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Chao A, Huang HJ, Lin CY, Lee CH, Lin CH, Chao AS, Lai CH, Chang TC, Wu KY, Wu RC. Hypoxia-associated genetic signature in ovarian steroid cell tumor NOS. Endocr Relat Cancer 2023; 30:e230179. [PMID: 37655726 DOI: 10.1530/erc-23-0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/01/2023] [Indexed: 09/02/2023]
Abstract
Steroid cell tumors, not otherwise specified (SCT-NOS), are uncommon ovarian neoplasms accompanied by virilization symptoms due to hyperandrogenism, which are malignant in approximately one-third of the cases. Given the rarity of SCT-NOS, their molecular underpinnings have not yet been studied in depth. In this case series, we performed the first comprehensive analysis of the genetic landscape of this rare ovarian tumor. A detailed clinicopathological description of an index case is also provided. Over a 20-year period, a total of eight patients were seen at our institution. Total nucleic acids (RNA and DNA) were extracted from evaluable formalin-fixed, paraffin-embedded tumor specimens (n = 7) and subjected to TruSight Oncology 500 testing and/or exome sequencing. The results identified pathogenic variants in several hypoxia-related genes - including HIF1A, VHL, SDHB, SRC, IDH2, and FOXO4. As the first comprehensive genetic analysis of SCT-NOS, this study shows that dysregulation in the hypoxia signaling pathway is a key molecular feature of this rare tumor. Clinically, long-term follow-up with periodic measurements of androgen levels should be pursued in all cases since recurrences may occur several years after the initial diagnosis.
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Affiliation(s)
- Angel Chao
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chiao-Yun Lin
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chia-Hwa Lee
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | | | - An-Shine Chao
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, New Taipei Municipal Tu Cheng Hospital, New Taipei City, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kai-Yun Wu
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Anatomic Pathology, Linkou Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
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10
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Chao A, Chen SJ, Chen HC, Tan KT, Hsiao W, Jung SM, Yang LY, Huang KG, Chou HH, Huang HJ, Chang TC, Chao AS, Lee YH, Wu RC, Lai CH. Mutations in circulating tumor DNA detected in the postoperative period predict poor survival in patients with ovarian cancer. Biomed J 2023; 46:100563. [PMID: 36208860 PMCID: PMC10498401 DOI: 10.1016/j.bj.2022.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/01/2022] [Accepted: 09/30/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND We investigated whether mutations in plasma circulating tumor DNA (ctDNA) can provide prognostic insight in patients with different histological types of ovarian carcinoma. We also examined the concordance of mutations detected in ctDNA samples with those identified in the corresponding formalin-fixed paraffin-embedded (FFPE) tumor specimens. METHODS Between July 2016 and December 2017, 29 patients with ovarian carcinoma were prospectively enrolled. FFPE tumor specimens were obtained from all participants. A total of 187 blood samples for ctDNA analysis were collected before surgery (C0), immediate after surgery before adjuvant chemotherapy (C1), and at six-month intervals. Progression-free survival (PFS) and overall survival (OS) served as the main outcome measures. RESULTS The study cohort consisted of 13 (44.8%) patients with high-grade serous carcinomas (HGSC), 9 (31.0%) with clear cell carcinoma, 2 (6.9%) with mucinous carcinomas, 4 (13.8%) with low-grade serous carcinomas, and 1 (3.4%) with endometrioid carcinoma. Twenty-four (82.8%) patients had at least one detectable ctDNA variant. The concordance rate between mutations identified in pretreatment ctDNA and corresponding FFPE tumor specimens was 92.3% for patients with HGSC and 58.6% for the entire cohort. The median follow-up time was 33.15 months (range: 0.79-46.13 months). Patients with an advanced stage disease more likely had detectable ctDNA mutations before surgery (C0) and after surgery at C1, while those with HGSC more likely had ctDNA mutations detected before surgery. The presence of ctDNA mutations at C1 was an independent predictor of worse OS with a hazard ratio of 6.56 (95% confidence interval, (1.07-40.17) for detectable versus undetectable C1 ctDNA variants, p = 0.042). CONCLUSIONS ctDNA mutations are common in patients with ovarian carcinoma. The presence of ctDNA mutations after surgery was an independent predictor of less favorable PFS and OS.
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Affiliation(s)
- Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | | | | | | | - Wen Hsiao
- ACT Genomics, Co. Ltd, Taipei, Taiwan
| | - Shih-Ming Jung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, New Taipei City Municipal Tu Cheng Hospital, New Taipei, Taiwan
| | - Yun-Hsien Lee
- Department of Biotechnology, Ming-Chuan University, Taoyuan, Taiwan; Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ren-Chin Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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11
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Chao A, Wu RC, Lin CY, Chang TC, Lai CH. Small cell neuroendocrine carcinoma of the cervix: From molecular basis to therapeutic advances. Biomed J 2023; 46:100633. [PMID: 37467967 PMCID: PMC10522988 DOI: 10.1016/j.bj.2023.100633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/02/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023] Open
Abstract
Small cell neuroendocrine carcinoma of the cervix (SCNECC) is an uncommon but aggressive uterine malignancy, the cause of which is generally associated with human papillomavirus (HPV) infection. A lack of clinical trials and evidence-based treatment guidelines poses therapeutic challenges to this rare tumor. At present, published data remain limited to case series and case reports. While clinical management has traditionally followed those of small cell neuroendocrine (SCNE) lung cancer relying on surgery, chemoradiation, and systemic chemotherapy, the prognosis remains dismal. Immune checkpoint inhibitors (ICIs), such as monoclonal antibodies that target programmed death-1 (PD-1) or programmed death-ligand 1 (PD-L1), atezolizumab and durvalumab have proven effective in extensive-stage SCNE lung cancer. Moreover, pembrolizumab has also proven beneficial effects when added onto chemotherapy in metastatic and recurrent HPV-associated non-SCNE cervical cancer. It holds promise to use ICIs in combination with chemoradiation to improve the clinical outcomes of patients with SCNECC. Future advances in our understanding of SCNECC biology - associated with the study of its genomic and molecular aberrations as well as knowledge from SCNE of lung and other extrapulmonary sites- would be helpful in discovering new molecular targets for drug development. Collaborative efforts and establishment of a SCNECC-specific biobank will be essential to achieve this goal.
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Affiliation(s)
- Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiao-Yun Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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12
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Hsu CC, Lai CY, Chueh HY, Cheng PJ, Chang YL, Chao AS, Chang SD, Lai CH, Lo LM, Pan YB, Yang LY, Yu YH. Birth outcomes following pelvic ring injury: A retrospective study. BJOG 2023; 130:1395-1402. [PMID: 37039247 DOI: 10.1111/1471-0528.17487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To report obstetric outcomes in pregnant women with previous pelvic ring injury (PRI) and investigate the correlation between residual pelvic deformity and the mode of delivery. DESIGN Retrospective cohort study. SETTING Single medical centre in Taiwan. POPULATION Forty-one women with PRI histories from 2000 to 2021 who subsequently underwent pregnancy and delivery. METHODS All patients had complete PRI treatment and radiological follow up for at least 1 year. The demographic data, radiological outcomes after PRI and obstetric outcomes were collected to investigate the potential factors of delivery modes using non-parametric approaches and logistic regression. Caesarean section (CS) rates among different subgroups were reported. MAIN OUTCOME MEASURES Comparisons of demographic data and radiological outcomes (Matta/Tornetta criteria and Lefaivre criteria) after PRI among patients who had subsequent pregnancy and underwent vaginal deliveries (VD) or CS. RESULTS There were 14 VD and 27 CS in 41 patients. Nine patients underwent CS because of their PRI history, 12 patients underwent CS for other obstetric indications and 20 underwent trial of labour. Based on the logistic regression model, retained trans-iliosacral implants did not significantly increase the risk of CS (odds ratio [OR] 1.20; 95% CI 0.17-8.38). Higher pelvic asymmetry value by Lefaivre criteria was a potential risk factor for CS after previous PRI (OR 1.52; 95% CI 1.043-2.213). CONCLUSIONS VD is possible after PRI. Retained trans-iliosacral implants do not affect the delivery outcome. Residual pelvic asymmetry after PRI by Lefaivre criteria is a potential risk factor for CS.
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Affiliation(s)
- Chin-Chieh Hsu
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yang Lai
- Department of Orthopedic Surgery, Musculoskeletal Research Centre, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, Taoyuan, Taiwan
| | - Ho-Yen Chueh
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Cheng
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Lung Chang
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shuenn-Dyh Chang
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Liang-Ming Lo
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Bin Pan
- Biostatistics Unit, Clinical Trial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Hsun Yu
- Department of Orthopedic Surgery, Musculoskeletal Research Centre, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, Taoyuan, Taiwan
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13
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Enomoto T, Okamoto A, Kim JH, Lai CH, Wu X, Kim YM. East Asian Gynecologic Oncology Trial Group (EAGOT): founding history and future perspective. J Gynecol Oncol 2023; 34:e86. [PMID: 37593814 PMCID: PMC10482583 DOI: 10.3802/jgo.2023.34.e86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/19/2023] Open
Abstract
Racial and regional differences exist in morbidity, histology, drug response, toxicity, and prognosis of gynecologic cancer. However, most large-scale phase III studies have been conducted in Western countries, and these data on Asians, who account for more than half of the world's population, are limited. To build a global clinical trial network in Asia, four clinical trial groups with high expertise and international competitiveness in East Asia, namely the Japanese Gynecologic Oncology Group in Japan, the Korean Gynecologic Oncology Group in Korea, the Taiwanese Gynecologic Oncology Group in Taiwan, and the Chinese Gynecologic Cancer Society in the People's Republic of China, established a new group called the East Asia Gynecologic Oncology Trial Group (EAGOT) on November 19, 2021. It includes four committees: the Cervical Cancer Committee, Uterine Corpus Cancer Committee, Ovarian Cancer Committee, and Translational Research Committee. The purpose of EAGOT is to conduct international clinical trials in an effort to provide the best treatments for Asian women affected by gynecologic cancer. Discussions on new collaborative clinical trials have already begun. The first Annual EAGOT Meeting was held on May 25-27, 2023 in Niigata, Japan. EAGOT, the largest healthcare/investigational innovation network in Asia in the area of gynecologic cancers, will become a platform for establishing standards of care and lead to guidelines for Asian women suffering from gynecologic cancer. The harmonization of regulatory/investigator-initiated clinical trials, simultaneous approval of unapproved drugs in the four countries under a common protocol, and expansion of indications will improve the prognosis of gynecologic cancers in Asia in the near future.
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Affiliation(s)
- Takayuki Enomoto
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jae-Hoon Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chyong-Huey Lai
- Gynecologic Cancer Research Center, Cheng Gung Memorial Hospital, Taoyuan, Taiwan
| | - Xiaohua Wu
- Department of Gynecologic Oncology, Fudan University Cancer Institute, Shanghai, P.R. China
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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14
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Ng PYT, Lui CT, Lau CL, Fung HT, Lai CH, Lee LY. Characteristics of individuals who frequently use emergency departments in Hong Kong: a region-based cohort study. Hong Kong Med J 2023; 29:301-310. [PMID: 37599405 DOI: 10.12809/hkmj219460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Affiliation(s)
- P Y T Ng
- Accident and Emergency Department, Tin Shui Wai Hospital, Hong Kong SAR, China
| | - C T Lui
- Accident and Emergency Department, Tuen Mun Hospital, Hong Kong SAR, China
| | - C L Lau
- Accident and Emergency Department, Tuen Mun Hospital, Hong Kong SAR, China
| | - H T Fung
- Accident and Emergency Department, Tuen Mun Hospital, Hong Kong SAR, China
| | - C H Lai
- Accident and Emergency Department, Tin Shui Wai Hospital, Hong Kong SAR, China
| | - L Y Lee
- Accident and Emergency Department, Tin Shui Wai Hospital, Hong Kong SAR, China
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15
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Wu YH, Lai CH, Chien L, Pan YC, Lin YJ, Feng C, Chang CJ. Economic Burden of Cervical and Head and Neck Cancer in Taiwan from a Societal Perspective. Int J Environ Res Public Health 2023; 20:3717. [PMID: 36834412 PMCID: PMC9967678 DOI: 10.3390/ijerph20043717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Head and neck cancers (HNC) are increasingly recognized as important human papillomavirus (HPV)-related malignancies in addition to cervical cancer (CC). However, data on the socioeconomic impact of HNC and CC in Taiwan are limited. METHODS A retrospective cohort study was conducted to estimate the total direct medical cost and indirect productivity loss from CC and HNC between 2014 and 2015. Patient data from the Taiwan National Cancer Registry were analyzed, with matched non-cancer controls from the Taiwan National Healthcare Reimbursement Database. Indirect costs due to premature deaths were calculated using public data from Taiwanese government reports. RESULTS In the direct cost analysis, 2083 patients with newly diagnosed CC and 11,078 with newly diagnosed HNC (10,036 males) were identified between 2014 and 2015 and followed up through the end of 2016 or until death. The total direct medical costs incurred in 2014 and 2015 due to HNC were 11.54 times higher in males than in females, and 4.55 times higher than CC. Indirect cost analysis showed the total annual productivity loss was New Taiwan Dollar (NTD) $12 billion in 2019, and 79.99% was attributed to male HNC. CONCLUSION In Taiwan, the socioeconomic burden associated with male HNC is high and greater than that seen with CC. While not all HNCs are attributable to HPV infection, prevention of HNC through HPV vaccination should be considered for both sexes.
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Affiliation(s)
| | - Chyong-Huey Lai
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan 33305, Taiwan
| | | | | | - Yu-Jr Lin
- Research Service Center for Health Information, Chang Gung University, Taoyuan 33302, Taiwan
| | | | - Chee-Jen Chang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- Research Service Center for Health Information, Chang Gung University, Taoyuan 33302, Taiwan
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan 33302, Taiwan
- Graduate Institute of Clinical Medical Science, Department of Biomedical Science, Chang Gung University, Taoyuan 33302, Taiwan
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16
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Lin YC, Lin Y, Huang YL, Ho CY, Chiang HJ, Lu HY, Wang CC, Wang JJ, Ng SH, Lai CH, Lin G. Generalizable transfer learning of automated tumor segmentation from cervical cancers toward a universal model for uterine malignancies in diffusion-weighted MRI. Insights Imaging 2023; 14:14. [PMID: 36690870 PMCID: PMC9871146 DOI: 10.1186/s13244-022-01356-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/04/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To investigate the generalizability of transfer learning (TL) of automated tumor segmentation from cervical cancers toward a universal model for cervical and uterine malignancies in diffusion-weighted magnetic resonance imaging (DWI). METHODS In this retrospective multicenter study, we analyzed pelvic DWI data from 169 and 320 patients with cervical and uterine malignancies and divided them into the training (144 and 256) and testing (25 and 64) datasets, respectively. A pretrained model was established using DeepLab V3 + from the cervical cancer dataset, followed by TL experiments adjusting the training data sizes and fine-tuning layers. The model performance was evaluated using the dice similarity coefficient (DSC). RESULTS In predicting tumor segmentation for all cervical and uterine malignancies, TL models improved the DSCs from the pretrained cervical model (DSC 0.43) when adding 5, 13, 26, and 51 uterine cases for training (DSC improved from 0.57, 0.62, 0.68, 0.70, p < 0.001). Following the crossover at adding 128 cases (DSC 0.71), the model trained by combining data from adding all the 256 patients exhibited the highest DSCs for the combined cervical and uterine datasets (DSC 0.81) and cervical only dataset (DSC 0.91). CONCLUSIONS TL may improve the generalizability of automated tumor segmentation of DWI from a specific cancer type toward multiple types of uterine malignancies especially in limited case numbers.
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Affiliation(s)
- Yu-Chun Lin
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan ,grid.145695.a0000 0004 1798 0922Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, 33302 Taiwan ,grid.454210.60000 0004 1756 1461Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Yenpo Lin
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Yen-Ling Huang
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Chih-Yi Ho
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Hsin-Ju Chiang
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan ,grid.454210.60000 0004 1756 1461Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Hsin-Ying Lu
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan ,grid.454210.60000 0004 1756 1461Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Chun-Chieh Wang
- grid.145695.a0000 0004 1798 0922Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, 33302 Taiwan ,grid.145695.a0000 0004 1798 0922Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Jiun-Jie Wang
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan ,grid.145695.a0000 0004 1798 0922Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
| | - Shu-Hang Ng
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Chyong-Huey Lai
- grid.145695.a0000 0004 1798 0922Gynecologic Cancer Research Center, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
| | - Gigin Lin
- grid.413801.f0000 0001 0711 0593Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Keelung, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan ,grid.454210.60000 0004 1756 1461Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan ,grid.145695.a0000 0004 1798 0922Gynecologic Cancer Research Center, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382 Taiwan
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Weng CH, Wu KY, Wang CJ, Huang HJ, Tsai CL, Lin CY, Ro A, Lai CH, Chao AS, Wu RC, Chao A. Massively parallel sequencing of endometrial lavage specimens for the detection of cancer-associated mutations in atypical and non-atypical endometrial hyperplasia. Front Med (Lausanne) 2022; 9:1090788. [PMID: 36619620 PMCID: PMC9813484 DOI: 10.3389/fmed.2022.1090788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background Endometrial hyperplasia (EH), particularly with atypia, is considered an antecedent of endometrial adenocarcinoma. In this study, we aimed to apply massively parallel sequencing of endometrial lavage specimens for the detection of cancer-associated mutations in atypical (AEH) and non-atypical endometrial hyperplasia (NEH). The identified alterations were compared with those detected in tissue samples. Materials and methods Endometrial lavage specimens and parallel biopsy samples (n = 11 for AEH and n = 9 for NEH) were obtained from 18 women (9 with AEH and 9 with NEH) who received an office hysteroscopy for suspected endometrial lesions. All samples were tested for somatic mutations in hotspot regions of 72 cancer-associated genes by massively parallel sequencing. Results On analyzing sequencing data, the presence of at least one cancer-associated gene mutation was identified in 72.7 and 44.4% of endometrial lavage specimens obtained from women with AEH and NEH, respectively (p = 0.362, 95% confidence interval = 0.72-3.70). The concordance rates between mutations identified in endometrial lavage specimens and endometrial biopsies were 54.5 and 0% from women with AEH and NEH, respectively (p = 0.014). A patient with NEH harbored mutations in endometrial lavage with the same mutations found in the tissue specimen at low allele frequency below detection cutoff, raising the suspicion of missed focal atypia. Conclusion Endometrial hyperplasia is characterized by a high burden of cancer-associated mutations, particularly in the presence of atypia. Our study, albeit performed with a relatively small number of samples, indicates that their detection by massively parallel sequencing of endometrial lavage is feasible. Our findings may allow tailoring of endometrial biopsies to the individual risk of AEH; additionally, they can pave the way toward less invasive surveillance protocols in patients with known EH.
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Affiliation(s)
- Cindy Hsuan Weng
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan,Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kai-Yun Wu
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan,Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chin-Jung Wang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan,Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan,Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Lung Tsai
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chiao-Yun Lin
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Aileen Ro
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan,Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan,Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan,Department of Obstetrics and Gynecology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan,Ren-Chin Wu,
| | - Angel Chao
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan,Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan,*Correspondence: Angel Chao,
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18
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Chao A, Chao AS, Lin CY, Weng C, Wu RC, Yeh YM, Huang SS, Lee YS, Lai CH, Huang HJ, Tang YH, Lin YS, Wang CJ, Wu KY. Analysis of endometrial lavage microbiota reveals an increased relative abundance of the plastic-degrading bacteria Bacillus pseudofirmus and Stenotrophomonas rhizophila in women with endometrial cancer/endometrial hyperplasia. Front Cell Infect Microbiol 2022; 12:1031967. [PMID: 36439209 PMCID: PMC9682088 DOI: 10.3389/fcimb.2022.1031967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
The pathogenic influences of uterine bacteria on endometrial carcinogenesis remain unclear. The aim of this pilot study was to compare the microbiota composition of endometrial lavage samples obtained from women with either endometrial hyperplasia (EH) or endometrial cancer (EC) versus those with benign uterine conditions. We hypothesized that specific microbiota signatures would distinguish between the two groups, possibly leading to the identification of bacterial species associated with endometrial tumorigenesis. A total of 35 endometrial lavage specimens (EH, n = 18; EC, n = 7; metastatic EC, n = 2; benign endometrial lesions, n = 8) were collected from 32 women who had undergone office hysteroscopy. Microbiota composition was determined by sequencing the V3−V4 region of 16S rRNA genes and results were validated by real-time qPCR in 46 patients with EC/EH and 13 control women. Surprisingly, we found that Bacillus pseudofirmus and Stenotrophomonas rhizophila – two plastic-degrading bacterial species – were over-represented in endometrial lavage specimens collected from patients with EC/EH. Using computational analysis, we found that the functional profile of endometrial microbiota in EC/EH was associated with fatty acid and amino acid metabolism. In summary, our hypothesis-generating data indicate that the plastic-degrading bacteria Bacillus pseudofirmus and Stenotrophomonas rhizophila are over-represented within the endometrial lavage microbiota of women with EC/EH living in Taiwan. Whether this may be related to plastic pollution deserves further investigation.
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Affiliation(s)
- Angel Chao
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, New Taipei Municipal Tu Cheng Hospital, New Taipei City, Taiwan
| | - Chiao-Yun Lin
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cindy Hsuan Weng
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, New Taipei Municipal Tu Cheng Hospital, New Taipei City, Taiwan
| | - Yuan-Ming Yeh
- Department of Pathology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Sin Huang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yun-Shien Lee
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Biotechnology, Ming-Chuan University, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yun-Hsin Tang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Shan Lin
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, New Taipei Municipal Tu Cheng Hospital, New Taipei City, Taiwan
| | - Chin-Jung Wang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kai-Yun Wu
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- *Correspondence: Kai-Yun Wu,
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19
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Wu HM, Chen LH, Hsu LT, Lai CH. Immune Tolerance of Embryo Implantation and Pregnancy: The Role of Human Decidual Stromal Cell- and Embryonic-Derived Extracellular Vesicles. Int J Mol Sci 2022; 23:ijms232113382. [PMID: 36362169 PMCID: PMC9658721 DOI: 10.3390/ijms232113382] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Embryo–endometrial communication plays a critical role in embryo implantation and the establishment of a successful pregnancy. Successful pregnancy outcomes involve maternal immune modulation during embryo implantation. The endometrium is usually primed and immunomodulated by steroid hormones and embryo signals for subsequent embryo implantation and the maintenance of pregnancy. The roles of extracellular vesicles (EVs) and microRNAs for the embryo–maternal interactions have been elucidated recently. New evidence shows that endometrial EVs and trophectoderm-originated EV cargo, including microRNAs, proteins, and lipids in the physiological microenvironment, regulate maternal immunomodulation for embryo implantation and subsequent pregnancy. On the other hand, trophoblast-derived EVs also control the cross-communication between the trophoblasts and immune cells. The exploration of EV functions and mechanisms in the processes of embryo implantation and pregnancy will shed light on a practical tool for the diagnostic or therapeutic approaches to reproductive medicine and infertility.
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Affiliation(s)
- Hsien-Ming Wu
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
| | - Liang-Hsuan Chen
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
| | - Le-Tien Hsu
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
- Gynecologic Cancer Research Center, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-3-328-1200 (ext. 8254)
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Pai AHY, Wu RC, Liu FY, Lin CY, Lin Y, Lai CH. A case of adult granulosa cell tumor of the ovary with long-term survival after multiple recurrences. Taiwan J Obstet Gynecol 2022; 61:883-888. [PMID: 36088062 DOI: 10.1016/j.tjog.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To illustrate the clinical course of a rare case of recurrent adult granulosa cell tumor (AGCT) and discuss the features and management for recurrences. CASE REPORT A 56-year-old female was first diagnosed with AGCT in 2008 and had uneventful, regular follow-ups until 2013. Recurrence was suspected and proven by computed tomography-guided biopsy. After undergoing complete cytoreductive surgery (CRS) followed by adjuvant megestrol acetate then leuprolide acetate, another recurrence sprouted at the presacral area in 2017. On both occasions, CRS with no visible residual tumor were attained. The patient has remained in complete remission to date with progestin therapy. CONCLUSION There are currently no standardized tumor markers, imaging exams, or therapies for managing AGCT recurrences. Whole exome sequencing analysis of our patient suggested possible association with triosephosphate isomerase 1 mutation. Regular follow-ups with at least two types of imaging exams and indefinite hormone therapy are crucial for this patient's remission.
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Affiliation(s)
- Angel Hsin-Yu Pai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Feng-Yuan Liu
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Chiao-Yun Lin
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Yenpo Lin
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan; Department of Medical Imaging and Intervention, Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan.
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21
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Chao A, Wu KY, Lin CY, Lee YS, Huang HJ, Tang YH, Weng CH, Chao AS, Chang TC, Lai CH, Wu RC. Towards less invasive molecular diagnostics for endometrial cancer: massively parallel sequencing of endometrial lavage specimens in women attending for an office hysteroscopy. J Mol Med (Berl) 2022; 100:1331-1339. [PMID: 35953603 DOI: 10.1007/s00109-022-02239-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/25/2022] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
We aimed to detect endometrial cancer (EC)-associated mutations in endometrial lavage specimens collected in an office setting and to compare the detected mutations with those identified in tissue samples. Participants included 16 women attending for an office hysteroscopy because of suspected EC between July 2020 and October 2021. Massively parallel sequencing was conducted using the targeted 72 cancer-associated genes. Endometrial lavage specimens, endometrial tissue samples, and blood samples were simultaneously sequenced to establish the concordance of genetic alterations. In this study, the vast majority of EC-associated mutations identified in lavage samples (R2 = 0.948) were identical to those detected in endometrial tissues. Of the 13 patients with EC, 12 (92.3%) had at least one mutation identified in endometrial lavage samples. Notably, no mutations in lavage samples were identified in the two patients with a previous history of EC but no actual endometrial lesions, supporting a high negative predictive value of the test. A patient previously diagnosed with EC and with current evidence of atypical hyperplasia showed persisting PTEN, PIK3R1, and KRAS mutations in her endometrial lavage specimen. PTEN was the most commonly mutated gene, followed by PIK3R1, ARID1A, PIK3CA, CTNNB1, and KRAS. In conclusions, our study provides pilot evidence on the actionability of uterine lavage samples sequencing to detect EC-associated mutations in women with suspected endometrial lesions. In a precision medicine framework, the high mutational concordance between uterine lavage samples and tissue specimens may help inform less invasive diagnostic protocols and the need for ongoing surveillance in patients with EC who wished for fertility-preserving treatment. KEY MESSAGES: • Sequencing of uterine lavage samples collected by office hysteroscopy is feasible. • Most EC mutations identified in lavage were identical to endometrial tissues. • Sequencing of uterine lavage samples may help inform diagnostic protocols for EC. • This approach can be used for recurrence surveillance in patients with EC.
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Affiliation(s)
- Angel Chao
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kai-Yun Wu
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chiao-Yun Lin
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yun-Shien Lee
- Department of Biotechnology, Ming Chuan University, Taoyuan, Taiwan.,Genomic Medicine Research Core Laboratory, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yun-Hsin Tang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cindy Hsuan Weng
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, New Taipei Municipal Tu Cheng Hospital, New Taipei City, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Slomovitz B, Mirza M, Lortholary A, Vergote I, Cibula D, Walther A, Savarese A, Ginesta MPB, Ortac F, Papadimitriou C, Bodnar L, Lai CH, Hasegawa K, Chen X, Barber E, Coleman R, Keefe S, Orlowski R, Gorp TV. ENGOT-en11/GOG-3053/KEYNOTE-B21: A phase 3 study of pembrolizumab or placebo in combination with adjuvant chemotherapy with or without radiotherapy in patients with newly diagnosed high-risk endometrial cancer (570). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01791-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lai CH, Lin CY, Wang CC, Yang LY, Chao A. Inhibition of BIRC2 sensitizes α7-HPV related cervical squamous cell carcinoma to chemotherapy (215). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01440-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lin Y, Wu RC, Huang YL, Chen K, Tseng SC, Wang CJ, Chao A, Lai CH, Lin G. Uterine fibroid-like tumors: spectrum of MR imaging findings and their differential diagnosis. Abdom Radiol (NY) 2022; 47:2197-2208. [PMID: 35347386 DOI: 10.1007/s00261-022-03431-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 01/03/2023]
Abstract
Uterine leiomyoma, also known as uterine fibroid, is the most common gynecological tumor, affecting almost 80% of women at some point during their lives. In the same time, other fibroid-like tumors have similar clinical presentations and about 0.5% of resected tumors of which were presumed benign fibroids in the preoperative diagnosis revealed as malignant sarcomas in the final histopathological examination. Amid the emergence of nonsurgical or minimally invasive procedures for symptomatic benign uterine fibroids, such as uterine artery embolization, high-intensity-focused ultrasound, or laparoscopic myomectomy, the preoperative diagnosis of uterine tumors through imaging becomes all the more relevant. Preoperative tissue sampling is challenging because of the variable location of the myometrial mass; thus, the preoperative evaluation of size and location is increasingly performed through magnetic resonance imaging. Features in images might also be useful for examining the full spectrum of such growths, from benign fibroids to neoplasms of uncertain behavior and malignant sarcomas. Benign fibroids include usual-type leiomyomas, myomas with degeneration, and mitotically active leiomyomas. Neoplasms of uncertain behavior include smooth muscle tumors of uncertain malignant potential, leiomyomas with bizarre nuclei, and cellular leiomyomas. Malignant sarcomas comprise leiomyosarcomas, endometrial stromal sarcomas, adenosarcomas, and carcinosarcomas. The purpose of this article is to review the spectrum of MRI findings of uterine fibroid-like tumors, from benign variants, uncertain behavior to malignant sarcomas, and update the advanced imaging modalities, including diffusion-weighted imaging, positron emission tomography/computed tomography, combining texture analysis and radiomics, to tackle this important issue.
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Affiliation(s)
- Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Ren-Chin Wu
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Yen-Ling Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Kueian Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Shu-Chi Tseng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Chin-Jung Wang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Angel Chao
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Chyong-Huey Lai
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
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Tung HJ, Wu RC, Lin CY, Lai CH. Rare Subtype of Endometrial Cancer: Undifferentiated/Dedifferentiated Endometrial Carcinoma, from Genetic Aspects to Clinical Practice. Int J Mol Sci 2022; 23:ijms23073794. [PMID: 35409155 PMCID: PMC8999061 DOI: 10.3390/ijms23073794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 02/01/2023] Open
Abstract
Endometrial cancer (EC) is one of the most common gynecologic cancers worldwide. There were 417,367 newly diagnosed cases and 97,370 deaths due to this disease worldwide in 2020. The incidence rates have increased over time, especially in countries with rapid socioeconomic transitions, and EC has been the most prevalent gynecologic malignancy in Taiwan since 2012. The new EC molecular classifications of The Cancer Genome Atlas (TCGA) Research Network include clear-cell carcinoma, serous carcinoma, and carcinosarcoma, while undifferentiated/dedifferentiated EC (UDEC) is not mentioned, and most previous clinical trials for EC have not included UDEC. UDEC is rare, has an aggressive growth pattern, tends to be diagnosed at an advanced stage, and is resistant to conventional chemotherapy. In this review, case series or case reports on the clinical features and genomic/epigenetic and expression profiles on UDEC data are summarized in order to identify potential molecular targets for current and future research.
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Affiliation(s)
- Hsiu-Jung Tung
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan 333, Taiwan; (H.-J.T.); (C.-Y.L.)
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
| | - Ren-Chin Wu
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan 333, Taiwan
| | - Chiao-Yun Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan 333, Taiwan; (H.-J.T.); (C.-Y.L.)
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan 333, Taiwan; (H.-J.T.); (C.-Y.L.)
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
- Correspondence: ; Tel.: +886-(3)-328-1200; Fax: +886-(3)-328-8252
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Liu FY, Lin G, Tseng JR, Chao A, Huang HJ, Chou HH, Chang YC, Yen TC, Lai CH. Measuring Heterogeneity in 18F-Fluorodeoxyglucose Positron Emission Tomography Images for Classifying Metastatic and Benign Bone Lesions in Patients with Cervical Cancer. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00671-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose
Heterogeneity assessment can be applied for medical imaging analysis. Here, we evaluated first-order and texture analysis (TA) metrics in 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) imaging for classification of metastatic and benign bone lesions in patients with cervical cancer.
Methods
The data of 18F-FDG PET studies performed on a specific PET/CT system from 2016 to 2018 in patients with cervical cancer were retrieved. The data of bone lesions extracted from studies over 2016–2017 and 2018 were used as training and validation datasets, respectively. Metastatic bone lesions were identified in each dataset, with an equal number of benign bone lesions selected. Cuboid volume of interest (VOI) consisting of 3 × 3 × 5 reconstructed voxels was applied for first-order metrics, and cubic VOI consisting of smaller voxels with trilinear interpolation of standardized uptake value (SUV) was adopted for TA metrics. First-order metrics included the maximum SUV (SUVmax) of lesions and the mean voxel SUV and its standard deviation (SUVsd), skewness, and kurtosis in VOI. In total, 4464 TA metrics based on 62 texture features were evaluated. Logistic regression was used for classification with area under the receiver operating characteristic curve (AUC) as the performance measure.
Results
From the training and validation datasets, 98 and 42 metastatic bone lesions were identified, respectively. SUVsd demonstrated higher performance than did SUVmax in both the training (AUC .798 vs .732, P = .001) and validation (AUC .786 vs .684, P < .001) datasets. Top-performing TA metrics demonstrated significantly higher performance in the training dataset, but not in the validation dataset.
Conclusion
A simple first-order measure of heterogeneity, SUVsd, was found to be superior to SUVmax for the classification of metastatic and benign bone lesions. Multiple hypothesis testing can result in false-positive findings in TA with multiple features and parameters; careful validation is required.
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Hung HC, Hsu PJ, Chang TC, Chou HH, Huang KG, Lai CH, Lee CW, Yu MC, You JF, Hsu YJ, Hsu JT, Wu TJ. The Impact of Multidisciplinary Team Approach on Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis. J Pers Med 2021; 11:jpm11121313. [PMID: 34945785 PMCID: PMC8705741 DOI: 10.3390/jpm11121313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/26/2021] [Accepted: 12/05/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a therapeutic approach used to achieve curative treatment in intra-abdominal malignancy with peritoneal carcinomatosis (PC). However, it is a complicated procedure with high post-operative complication rates. Thus, we analyzed our preliminary data to establish whether multidisciplinary teamwork (MDT) implementation is beneficial for CRS-HIPEC outcomes. METHOD A series of 132 consecutive patients with synchronous or recurrent PC secondary to gastrointestinal or gynecologic cancer who received CRS-HIPEC operation between May 2015 and September 2017 were included. Ninety-nine patients were categorized into the MDT group, with the 33 other patients into the non-MDT group. RESULTS The mean PCI score was 16.3 ± 8.8. Patients in the MDT group more often presented a higher PCI score (p value = 0.038). Regarding CRS completeness (CCR 0-1), it was distributed 81.8% and 57.6% in the MDT and the non-MDT group, respectively (p value = 0.005). Although post-operative complications were common (n = 62, 47.0%), post-operative complication rates did not differ between the two groups. The cumulative OS survival rate at the first year was 75.5%. Older age (p = 0.030, HR = 4.58, 95% CI = 1.16-18.10), ECOG 2 (p = 0.030, HR = 6.41, 95% CI = 1.20-34.14), and incomplete cytoreduction (p = 0.048, HR = 2.79, 95% CI = 1.04-8.27) were independent prognostic factors for survival. CONCLUSIONS Our experience suggests that the CRS-HIPEC performed under MDT cooperation may result in higher complete cytoreduction rates without increasing post-operative complications and hospital mortalities.
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Affiliation(s)
- Hao-Chien Hung
- Department of General Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (H.-C.H.); (P.-J.H.); (C.-W.L.); (M.-C.Y.); (J.-T.H.)
| | - Po-Jung Hsu
- Department of General Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (H.-C.H.); (P.-J.H.); (C.-W.L.); (M.-C.Y.); (J.-T.H.)
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (T.-C.C.); (H.-H.C.); (K.-G.H.); (C.-H.L.)
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (T.-C.C.); (H.-H.C.); (K.-G.H.); (C.-H.L.)
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (T.-C.C.); (H.-H.C.); (K.-G.H.); (C.-H.L.)
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (T.-C.C.); (H.-H.C.); (K.-G.H.); (C.-H.L.)
| | - Chao-Wei Lee
- Department of General Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (H.-C.H.); (P.-J.H.); (C.-W.L.); (M.-C.Y.); (J.-T.H.)
| | - Ming-Chin Yu
- Department of General Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (H.-C.H.); (P.-J.H.); (C.-W.L.); (M.-C.Y.); (J.-T.H.)
| | - Jeng-Fu You
- Department of Colon and Rectal Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (J.-F.Y.); (Y.-J.H.)
| | - Yu-Jen Hsu
- Department of Colon and Rectal Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (J.-F.Y.); (Y.-J.H.)
| | - Jun-Te Hsu
- Department of General Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (H.-C.H.); (P.-J.H.); (C.-W.L.); (M.-C.Y.); (J.-T.H.)
| | - Ting-Jung Wu
- Department of General Surgery, Chang-Gung Memorial Hospital at Linkou, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (H.-C.H.); (P.-J.H.); (C.-W.L.); (M.-C.Y.); (J.-T.H.)
- Correspondence: or ; Tel.: +886-3-3281200 (ext. 3366); Fax: +886-3-3285818
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Chen SY, Chang TC, Lin CY, Lai CH, Wu RC, Yang LY, Chang WY, Lee YS, Yang WCV, Chao A. Serum levels of alpha1-antitrypsin isoforms in patients with ovarian clear cell carcinoma: An exploratory study. J Chin Med Assoc 2021; 84:1048-1053. [PMID: 34747901 DOI: 10.1097/jcma.0000000000000604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Ovarian clear cell carcinoma (OCCC) is frequently associated with endometriosis. Since serum levels of cancer antigen 125 (CA125) have limited diagnostic and prognostic value in this malignancy, there is an unmet need for reliable and specific biomarkers. Previous findings indicated that alpha 1-antitrypsin isoforms (isoAAT) are significantly increased in the peritoneal fluid of patients with endometriosis. This study was undertaken to examine whether serum isoAAT levels in patients with OCCC differ from those measured in women with endometriosis or benign ovarian tumors. We also investigated whether this biomarker may be useful for predicting survival in OCCC. METHODS Paired serum samples before and after debulking surgery were collected from 27 patients with OCCC. All sera from patients with endometriosis (n = 44) and benign ovarian tumors (n = 32) were obtained in the pretreatment phase. Serum isoAAT levels were assayed using a proprietary ELISA kit. RESULTS The highest levels of serum isoAAT (median, range) were identified in patients with OCCC (preoperative values: 160.9 ng/mL, range, 101.4-1098.8 ng/mL), followed by patients with endometriosis (125.0 and 83.4-473.2 ng/mL), and those with benign tumors (125.2 and 60.5-191.3 ng/mL). The differences in serum isoAAT levels between patients with OCCC and benign tumors were significant (p = 0.041). Debulking surgery of OCCC resulted in a significant decrease in serum isoAAT levels compared with the preoperative period (median, 160.9 versus 113.0 ng/mL, respectively, p = 0.012). As for prognostic prediction, we found that none of the nine patients with OCCC and serum isoAAT levels ≤130 ng/mL died of disease. CONCLUSION Serum isoAAT levels may be diagnostically useful to distinguish OCCC from benign ovarian tumors and could also serve as a potential prognostic marker.
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Affiliation(s)
- Sung-Yao Chen
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Chiao-Yun Lin
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Ren-Chin Wu
- Department of Pathology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Lan-Yang Yang
- Biostatistics Unit, Clinical Trial Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Wei-Yang Chang
- Biostatistics Unit, Clinical Trial Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Yun-Shien Lee
- Department of Biotechnology, Ming-Chuan University, Taoyuan, Taiwan, ROC
- Genomic Medicine Core Laboratory, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Wei-Chung Vivian Yang
- The PhD Program for Translational Medicine, Taipei Medical University, Center for Reproductive Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Angel Chao
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
- Gynecologic Cancer Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
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Lin CY, Wang CC, Wu RC, Yang LY, Chang CB, Pan YB, Chao A, Lai CH. Inhibition of BIRC2 Sensitizes α7-HPV-Related Cervical Squamous Cell Carcinoma to Chemotherapy. Int J Mol Sci 2021; 22:ijms222011020. [PMID: 34681681 PMCID: PMC8539319 DOI: 10.3390/ijms222011020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/09/2021] [Accepted: 10/10/2021] [Indexed: 01/30/2023] Open
Abstract
The α7-human papillomavirus (HPV)-related cervical squamous cell carcinoma (SCC) is associated with poor prognosis. We compared the genomic profiles of this disease in a cohort corresponding to the 2001–2014 period with various responses to radiotherapy or concurrent chemoradiation through microRNA (miR) profiling involving miR 4.0 array and human transcriptome array 2.0 analyses. A real-time quantitative polymerase chain reaction was then conducted to identify the predictive biomarkers. A significantly lower expression of miR143-3p in recurrent tumors (p = 0.0309) relative to that in nonrecurrent tumors was observed. The miR143-3p targeted the mRNA expression of the baculoviral inhibitor of the apoptosis protein (IAP) repeat-containing 2 (BIRC2; p = 0.0261). The BIRC2 protein levels (p = 0.0023) were significantly higher in recurrent tumors than in nonrecurrent tumors. Moreover, the miR-143-3p sensitized the response of α7-HPV-related cervical SCC to chemotherapy by targeting BIRC2. A combination of BIRC2-inhibitor LCL161 and topotecan exerted synergistic effects on cancer cells and animal tumor models. In a pooled cohort of α7-HPV-related cervical SCC (including mixed infections with non-α7-HPV) treated between 1993 and 2014, high BIRC2 expression was associated with significantly worse outcomes (cancer-specific survival, hazard ratio (HR) = 1.42, p = 0.008; progression-free survival, HR = 1.64; p = 0.005). Summarily, BIRC2 constitutes a novel prognostic factor and therapeutic target for α7-HPV-related cervical SCC.
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Affiliation(s)
- Chiao-Yun Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan 333, Taiwan; (C.-Y.L.); (C.-B.C.); (A.C.)
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch Taoyuan, Taoyuan 333, Taiwan; (C.-C.W.); (R.-C.W.)
| | - Chun-Chieh Wang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch Taoyuan, Taoyuan 333, Taiwan; (C.-C.W.); (R.-C.W.)
- Departments of Radiation Oncology, Chang Gung Memorial Hospital, Linkou Branch Taoyuan, Taoyuan 333, Taiwan
| | - Ren-Chin Wu
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch Taoyuan, Taoyuan 333, Taiwan; (C.-C.W.); (R.-C.W.)
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan 333, Taiwan
| | - Lan-Yan Yang
- Biostatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan;
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
- Correspondence: (L.-Y.Y.); (C.-H.L.); Tel.: +886-3-3281200 (L.-Y.Y. & C.-H.L.); Fax: +886-3-3182501 (L.-Y.Y.); +886-3-3288252 (C.-H.L.)
| | - Chen-Bin Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan 333, Taiwan; (C.-Y.L.); (C.-B.C.); (A.C.)
| | - Yu-Bin Pan
- Biostatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan;
| | - Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan 333, Taiwan; (C.-Y.L.); (C.-B.C.); (A.C.)
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch Taoyuan, Taoyuan 333, Taiwan; (C.-C.W.); (R.-C.W.)
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University College of Medicine, Taoyuan 333, Taiwan; (C.-Y.L.); (C.-B.C.); (A.C.)
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch Taoyuan, Taoyuan 333, Taiwan; (C.-C.W.); (R.-C.W.)
- Correspondence: (L.-Y.Y.); (C.-H.L.); Tel.: +886-3-3281200 (L.-Y.Y. & C.-H.L.); Fax: +886-3-3182501 (L.-Y.Y.); +886-3-3288252 (C.-H.L.)
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Lin Y, Hsieh CY, Huang YL, Chen K, Huang YT, Wu RC, Huang HJ, Chou HH, Chao A, Lai CH, Lin G. Magnetic Resonance Spectroscopy for Risk Stratification of Sonographically Indeterminate Ovarian Neoplasms: Preliminary Study. Diagnostics (Basel) 2021; 11:diagnostics11101847. [PMID: 34679545 PMCID: PMC8534853 DOI: 10.3390/diagnostics11101847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
We aim to assess the additional value of diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) for the risk stratification of sonographically indeterminate ovarian neoplasms. A total of 21 patients with diagnosed adnexal masses between 2014 and 2017 were divided into malignant (four serous cystadenocarcinomas, four endometrioid carcinomas, three clear cell carcinomas, and one carcinosarcoma) and benign (four cystadenomas, two teratomas, one fibroma, one endometrioma, and one corpus luteal cyst) groups. An apparent diffusion coefficient (ADC) value of 1.27 × 10-3 mm2/s was considered as the optimal threshold in distinguishing malignant from benign ovarian tumors (sensitivity and specificity: 100% and 77.8%, respectively). Choline peaks were detected in six of seven O-RADS (Ovarian-Adnexal Imaging-Reporting Data System) 4 lesions and corrected all of the DWI false-negative clear cell carcinoma. Based on the presence of the choline peaks, the diagnostic performance of MRS showed a sensitivity of 77.8%, a specificity of 100%, and an accuracy of 85.7%, respectively. In conclusion, MRS could potentially play a complementary role for DWI in tumor characterization, particularly for O-RADS 4 tumors or clear cell carcinomas.
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Affiliation(s)
- Yenpo Lin
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan;
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Ching-Yi Hsieh
- Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan;
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University, Taoyuan 33382, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 33382, Taiwan
| | - Yen-Ling Huang
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Kueian Chen
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan;
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Yu-Ting Huang
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
- Department of Diagnostic Radiology, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Ren-Chin Wu
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
- Department of Pathology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Angel Chao
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (Y.L.); (Y.-L.H.); (K.C.); (Y.-T.H.)
- Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan;
- Department of Obstetrics and Gynecology and Gynecologic, Cancer Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33382, Taiwan; (R.-C.W.); (H.-J.H.); (H.-H.C.); (A.C.); (C.-H.L.)
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 33382, Taiwan
- Correspondence: ; Tel.: +886-3-328-1200
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Tung HJ, Wang CC, Liu FY, Lai CH. Complete remission of advanced and recurrent cervical cancer with pembrolizumab treatment- 3 case reports. Taiwan J Obstet Gynecol 2021; 60:938-941. [PMID: 34507680 DOI: 10.1016/j.tjog.2021.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Recurrent cervical cancer is hard to treat when occurring in a previous radiated area and unresectable or distant metastasis. We present three such cases who achieved complete remission (CR) after chemoradiotherapy and pembrolizumab. CASE REPORT Case 1 was diagnosed with cervical adenocarcinoma, stage IVB. She obtained CR after concurrent chemoradiotherapy (CCRT) and post-CCRT adjuvant chemotherapy and bevacizumab. Recurrence at previous irradiated sacral bone was controlled with pembrolizumab and CCRT using proton therapy (PT). Case 2 was diagnosed with stage IVB squamous cell carcinoma. First recurrence occurred at inguinal lymph node (LN). Secondary recurrence occurred at paraaortic LN ten years later. PT with chemotherapy and pembrolizumab achieved CR. Case 3 had a small cell carcinoma (stage IVB) with bone metastasis. She had CR to CCRT with etoposide-cisplatin. Liver metastasis was salvaged with CCRT and pembrolizumab. CONCLUSION CCRT with pembrolizumab is potentially curative for recurrent cervical cancer conventionally amenable for palliation.
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Affiliation(s)
- Hsiu-Jung Tung
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Branch, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Chun-Chieh Wang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan; Department of Radiation Oncology, Chang Gung Memorial Hospital Linkou Branch, Taiwan
| | - Feng-Yuan Liu
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan; Department of Nuclear Medicine, Chang Gung Memorial Hospital Linkou Branch, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Branch, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan.
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32
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Cheng CY, Lin CY, Lai CH, Chen CB, Chung WH. Acquired epidermodysplasia verruciformis or generalized verrucosis? A clinical and virological comparative study. J Dermatol 2021; 48:1414-1418. [PMID: 34212429 DOI: 10.1111/1346-8138.15866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/27/2021] [Accepted: 03/08/2021] [Indexed: 11/28/2022]
Abstract
Few articles have described the difference between epidermodysplasia verruciformis (EV) and generalized verrucosis (GV). This study aimed to analyze the clinical findings and virology of the two diseases. The study enrolled patients diagnosed with EV and GV by clinical and histopathological findings. The demographic information, clinical manifestation, treatment, and therapeutic outcome were analyzed. All of the biopsy specimens of enrolled patients were sent for β-human papillomavirus (HPV) DNA detection. A total of 13 cases were included in the present study, including five EV cases and eight GV cases. Legs and feet were significantly affected in GV cases (p = 0.035). All acquired EV cases had immunocompromised conditions, while only three GV cases could be identified as having an immunocompromised history. All EV cases were detected with β-HPV infection, especially HPV5, but none of the GV cases were found to be infected with β-HPV. The therapeutic response was refractory and often relapsed after discontinuation of treatment in both groups.
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Affiliation(s)
- Chun Yu Cheng
- Department of Dermatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Center of Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chiao-Yun Lin
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Chang Gung Immunology Consortium, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Chang Gung Immunology Consortium, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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33
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Lin CC, Lai CH, Lin WS, Lin CS. Severe myocardial bridge presenting as paroxysmal atrioventricular block. J Postgrad Med 2021; 67:171-173. [PMID: 33835057 PMCID: PMC8445129 DOI: 10.4103/jpgm.jpgm_1027_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/09/2020] [Accepted: 12/24/2020] [Indexed: 11/11/2022] Open
Abstract
Chest pain complicated with electrocardiographic changes is not an uncommon scenario in emergency departments, which should be examined cautiously. We describe a 51-years-old man with a myocardial bridge of coronary artery presenting with simultaneous Mobitz type I atrioventricular block on electrocardiography. Echocardiography excluded valvular abnormality and systolic/diastolic dysfunction. Coronary angiography confirmed the diagnosis of a myocardial bridge at the middle segment of the left anterior descending artery, involving the most dominant septal perforator branch with marked systolic compression. The patient underwent coronary artery bypass grafting surgery and was followed up uneventfully at the outpatient department with medical treatment of diltiazem and clopidogrel. The present case is being reported to highlight that clinicians should be alert to such a congenital abnormality as a potential cause of repeated myocardial infarction and conduction abnormality.
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Affiliation(s)
- CC Lin
- Division of Cardiology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung City, Taiwan
| | - CH Lai
- Division of Cardiology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung City, Taiwan
| | - WS Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - CS Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
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Van Gorp T, Mirza MR, Lortholary A, Cibula D, Walther A, Savarese A, Barretina-Ginesta MP, Ortaç F, Papadimitriou C, Bodnar L, Lai CH, Korach J, Marth C, Hasegawa K, Xie X, Barber EL, Coleman RL, Keefe SM, Orlowski R, Slomovitz B. ENGOT-en11/GOG-3053/KEYNOTE-B21: Phase 3 study of pembrolizumab or placebo in combination with adjuvant chemotherapy with/without radiotherapy in patients with newly diagnosed high-risk endometrial cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps5608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS5608 Background: Pembrolizumab, a selective humanized anti–PD-1 monoclonal antibody, has demonstrated activity in patients with previously treated mismatch repair (MMR) deficient (dMMR; 57.1% ORR as monotherapy and 63.6% ORR as combination therapy with lenvatinib) and MMR proficient (pMMR; 36.2% ORR as combination therapy with lenvatinib) endometrial cancer (EC). ENGOT-en11/GOG-3053/KEYNOTE-B21 is a phase 3, randomized, double-blind study of pembrolizumab or placebo in combination with adjuvant chemotherapy with/without radiotherapy in patients with EC. Methods: Eligible patients are ≥18 years old with newly diagnosed, histologically confirmed high-risk (stage I/II non-endometrioid, stage III/IVa, p53 abnormality) EC (carcinoma or carcinosarcoma) following surgery with curative intent with no evidence of disease post-operatively or on imaging, and without prior systemic therapy/radiotherapy. In total, ̃990 patients are randomized to receive pembrolizumab 200 mg or placebo Q3W for 6 cycles + chemotherapy (carboplatin area under the curve [AUC] 5 or 6 + paclitaxel 175 mg/m2 Q3W or carboplatin AUC 2 or 2.7 + paclitaxel 60 mg/m2 QW) in stage 1. Patients receive pembrolizumab 400 mg or placebo Q6W for 6 cycles in stage 2 per their treatment assignment. At the investigator’s discretion, radiotherapy (external beam radiotherapy [EBRT] and/or brachytherapy) ± radiosensitizing cisplatin 50 mg/m2 (days 1 and 29) may be administered after completion of chemotherapy. Randomization is stratified by MMR status (pMMR vs dMMR) and, within pMMR, by planned radiation therapy (cisplatin-EBRT vs EBRT vs no EBRT), histology (endometrioid vs non-endometrioid), and International Federation of Gynecology and Obstetrics (FIGO) surgical stage (I/II vs III/IVA). Dual primary endpoints are disease-free survival (DFS; per investigator assessment) and overall survival (OS), both estimated by the Kaplan-Meier method, with a stratified log-rank test to assess treatment differences and a Cox proportional hazard model with Efron’s method of tie handling to assess the magnitude of treatment differences. Secondary endpoints include DFS (per blinded independent central review), DFS (per investigator assessment) and OS by biomarker status (PD-L1 and tumor mutational burden), safety (per National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0) and quality of life (per European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 [EORTC QLQ-C30] and Endometrial Cancer Module [EORTC QLQ-EN24]). The study began enrollment in December 2020. Clinical trial information: NCT04634877.
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Affiliation(s)
| | - Mansoor Raza Mirza
- NSGO-CTU & Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alain Lortholary
- Centre Catherine de Sienne, Hôpital Privé du Confluent, Nantes, France
| | - David Cibula
- Department of Obstetrics and Gynecology, General Faculty Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Axel Walther
- Bristol Cancer Institute, University Hospitals Bristol, Bristol, United Kingdom
| | | | - Maria Pilar Barretina-Ginesta
- Catalan Institute of Oncology and Girona Biomedical Research Institute, Medical School University of Girona, Girona, Spain
| | - Fırat Ortaç
- Ankara University School of Medicine, Ankara, Turkey
| | - Christos Papadimitriou
- Aretaieio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lubomir Bodnar
- Department of Oncology and Immunooncology, Warmian-Masurian Cancer Center of the Ministry of the Interior and Administration’s Hospital, Olsztyn, Poland
| | - Chyong-Huey Lai
- TGOG and Department of Gynecology and Obstetrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Jacob Korach
- Gynecologic Oncology Department, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Christian Marth
- Department of Obstetrics and Gynecology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University, Hidaka, Saitama Prefecture, Japan
| | - Xing Xie
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Emma L. Barber
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Lai CH, Lin CY, Wu RC, Yang LY, Tseng HJ, Tang YH, Jung SM, Ueng SH, Huang HJ, Chao A. MicroRNAs as predictors of future endometrial malignancies in endometrial hyperplasia without atypia. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e17563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17563 Background: The histological criteria of predicting risk of progression of endometrial hyperplasia (EH) to endometrial cancer (EC) is based on the degree of architectural crowding and nuclear atypia. We aim to investigate the cumulative rate of progression to EC in simple or complex hyperplasia without atypia (SH/CH-nonA) and the molecular biomarkers for risk of developing EC in women with SH/CH-nonA. Methods: EH tissues of EC patients with preceding SH/CH-nonA (case) were compared to SH/CH-nonA patients without progression to EC (control) using miRNA array, followed by reverse transcription and quantitative real-time polymerase chain reaction (RT-qPCR), and verified in an independent cohort. Results: The 10-year and 15-year cumulative rates were 8% and 10%, respectively by the hospital medical records. The median time from EH to EC was 8.71 years (range, 0.55-19.84). Twenty miRNAs (p < 0.05, fold change > 4) were significantly different in SH/CH-nonA cases (n = 6) compared to SH/CH-nonA controls (n = 12) by miRNA array. Multiplex RT-qPCR validation (51 SH/CH-nonA controls and 19 SH/CH-nonA cases) selected miR30a-3p, miR141, miR200a, and miR200b. Area under the curve values for tissue miR30a-3p (p = 0.043), miR141(p = 0.003), miR-200a (p < 0.001), and miR200b (p = 0.004) in discriminating cases from controls were 0.658, 0.734, 0.811, and 0.710, and the sensitivity and specificity rates were 56.9% and 76.5%, 73.7% and 74.5%, and 68.4% and 100%, 47.4% and 100%, respectively. Conclusions: MiR30a-3p, miR141, miR-200a, and miR200b are useful tissue biomarkers for predicting future risk of developing EC for patients with SH/CH-nonA.
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Affiliation(s)
- Chyong-Huey Lai
- Department of OB/GYN, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chiao-Yun Lin
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital and Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University college of Medicine, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital;, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiao-Jung Tseng
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Department of Laboratory Medicine, Chang Gung Memorial Hospital, Ta, Taoyuan, Taiwan
| | - Yun-Hsin Tang
- Chang Gung Memorial Hospital and Department of Obstetrics and Gynecology, New Taipei City, Taiwan
| | - Shih-Ming Jung
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University college of Medicine, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital;, Taoyuan, Taiwan
| | - Shir-Hwa Ueng
- Departmentof Pathology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huei-Jean Huang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Angel Chao
- Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Chen WC, Chou HH, Yang LY, Huang HJ, Chang WY, Lin H, Wu RC, Chen MY, Qiu JT, Huang KG, Chao A, Chang TC, Lai CH. Postoperative adjuvant dose-dense chemotherapy with bevacizumab and maintenance bevacizumab after neoadjuvant chemotherapy for advanced ovarian cancer: A phase II AGOG/TGOG trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5540 Background: The objective of this study is to evaluate the safety and efficacy of adding bevacizumab to dose-dense adjuvant chemotherapy with bevacizumab maintenance after neoadjuvant chemotherapy (NAC) and interval debulking surgery (IDS) for stage III/IV ovarian, tubal, and primary peritoneal cancer. Methods: This phase II clinical trial using Simon's minimax two-stage design was conducted. At the first stage, 13 subjects were enrolled, and the trial would proceed to second stage if ≤3 subjects discontinued treatment for study-defined significant adverse events (AEs). Patients with stage III/IV ovarian, tubal, and primary peritoneal cancer deemed not feasible for primary cytoreductive surgery were enrolled after 3 to 4 cycles of NAC and IDS without disease progression. NAC could be either weekly paclitaxel (80mg/m2) (dose-dense) plus 3-weekly carboplatin (AUC5-6) or 3-weekly conventional schedule. After IDS, postoperative dose-dense adjuvant chemotherapy for 3 cycles at least (best to 6 cycles), and 3-weekly bevacizumab 15mg/kg was given since postoperative cycle 2. Further 3-weekly maintenance bevacizumab 15mg/kg was given intravenously for 17 cycles. Results: Of the 22 enrolled subjects, 13 (59.1%) had no gross lesion after IDS. Of the 13 subjects enrolled on the 1st stage, one study-defined significant AE occurred, therefore the trial proceeded to the 2nd stage (n = 9). The median progression-free survival (PFS) was 22.1 months (95% confidence interval [CI], 13.7 – 30.5), and the median overall survival (OS) was 49.2 months (95% CI, 33.8 – 64.6). Peritoneal Cancer Index score at entering abdomen during IDS was significant for PFS (>12 vs ≤ 12: p = 0.003). One of the 22 subjects did not receive any study treatment. In the safety analysis (n = 21), grade 3/4 AEs included thrombocytopenia of 38.1%, neutropenia 71.4%, and anemia 28.6%. Study-defined significant AEs of bowel perforation, poor-healing wound, and hypertension were found in 1 case each, respectively. Conclusions: This phase II trial demonstrated adding bevacizumab to dose-dense adjuvant chemotherapy with bevacizumab maintenance after NAC was feasible with tolerable toxicity and comparable PFS/OS as compared to other studies using bevacizumab in the NAC phase or dose-dense scheduling throughout. Clinical trial information: NCT02022917.
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Affiliation(s)
- Wei-Chun Chen
- Chang Gung Memorial Hospital of Linkou Main Branch, Taoyuan, Taiwan
| | - Hung-Hseuh Chou
- Chang Gung Memorial Hospital of Linkou Main Branch, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huei-Jean Huang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Yang Chang
- Chang Gung Memorial Hospital of Linkou Main Branch, Taoyuan, Taiwan
| | - Hao Lin
- Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University college of Medicine, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital;, Taoyuan, Taiwan
| | - Min-Yu Chen
- Chang Gung Memorial Hospital of Linkou Main Branch, Taoyuan, Taiwan
| | | | - Kuan-Gen Huang
- Chang Gung Memorial Hospital of Linkou Main Branch, Taoyuan, Taiwan
| | - Angel Chao
- Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Chyong-Huey Lai
- Department of OB/GYN, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Chiang CY, Huang HJ, Chang WY, Yang LY, Wu RC, Wang CC, Tung HJ, Chao A, Lai CH. Adjuvant therapy and prognosis in uterine carcinosarcoma. J Formos Med Assoc 2021; 120:1977-1987. [PMID: 33992491 DOI: 10.1016/j.jfma.2021.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/31/2021] [Accepted: 04/20/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To investigate the prognostic factors and impact of adjuvant treatment on uterine carcinosarcoma (UCS). METHODS A retrospective review of UCS patients treated between 2005 and 2019 was conducted. International Federation of Gynecology and Obstetrics (FIGO) 2009 staging system was used. Multivariate stepwise Cox proportional hazard regression models were used to identify the independent predictors of overall survival (OS) and progression-free survival (PFS). RESULTS A total of 138 patients were eligible for descriptive analysis. Excluding 12 patients without surgery, 126 patients with adequate clinicopathologic data were included for prognostic analysis. The median follow-up for survivors was 51.8 months. 5-year OS and PFS rates for FIGO stage I, II, III, IV were 64.5% and 51.8%, 60.8% and 57.7%, 47.7% and 45.9%, 5.1% and 4.1%, respectively. By multivariate analysis, six models each for PFS and OS were formulated including highly correlated variables alternatively. Adjuvant chemoradiation was consistently selected as an independent prognostic factor for OS (hazard ratio [HR] 0.10-0.22, all p < 0.001) and PFS (HR 0.12-0.23, all p < 0.001), while adjuvant chemotherapy (HR 0.33-0.41), age≥58 years (HR 1.80-1.91), stage III/IV (HR 3.36-13.34), and adnexal metastasis (HR 2.06-5.02) in three to four of the six models for OS. Stratified analyses revealed that adjuvant chemoradiation significantly improved outcome compared with adjuvant chemotherapy for stage IA patients with lymphovascular space invasion and stage IB-IV, lymph node metastasis, and adnexal metastasis. CONCLUSION Adjuvant chemoradiation was confirmed as an independent good prognostic factor, while older age, stage III/IV, and adnexal metastasis were associated with poor outcome in UCS.
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Affiliation(s)
- Chi-Yuan Chiang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Wei-Yang Chang
- Clinical Trial Center, Chang Gung Memorial Hospital, Taiwan
| | - Lan-Yan Yang
- Clinical Trial Center, Chang Gung Memorial Hospital, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiu-Jung Tung
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taiwan.
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Lapke N, Chen CH, Chang TC, Chao A, Lu YJ, Lai CH, Tan KT, Chen HC, Lu HY, Chen SJ. Genetic alterations and their therapeutic implications in epithelial ovarian cancer. BMC Cancer 2021; 21:499. [PMID: 33947352 PMCID: PMC8097933 DOI: 10.1186/s12885-021-08233-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 04/21/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Genetic alterations for epithelial ovarian cancer are insufficiently characterized. Previous studies are limited regarding included histologies, gene numbers, copy number variant (CNV) detection, and interpretation of pathway alteration patterns of individual patients. METHODS We sequenced 410 genes to analyze mutations and CNV of 82 ovarian carcinomas, including high-grade serous (n = 37), endometrioid (n = 22) and clear cell (n = 23) histologies. Eligibility for targeted therapy was determined for each patient by a pathway-based approach. The analysis covered DNA repair, receptor tyrosine kinase, PI3K/AKT/MTOR, RAS/MAPK, cell cycle, and hedgehog pathways, and included 14 drug targets. RESULTS Postulated PARP, MTOR, and CDK4/6 inhibition sensitivity were most common. BRCA1/2 alterations, PTEN loss, and gain of PIK3CA and CCND1 were characteristic for high-grade serous carcinomas. Mutations of ARID1A, PIK3CA, and KRAS, and ERBB2 gain were enriched in the other histologies. PTEN mutations and high tumor mutational burden were characteristic for endometrioid carcinomas. Drug target downstream alterations impaired actionability in all histologies, and many alterations would not have been discovered by key gene mutational analysis. Individual patients often had more than one actionable drug target. CONCLUSIONS Genetic alterations in ovarian carcinomas are complex and differ among histologies. Our results aid the personalization of therapy and biomarker analysis for clinical studies, and indicate a high potential for combinations of targeted therapies.
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MESH Headings
- Adenocarcinoma, Clear Cell/genetics
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Clear Cell/therapy
- Carcinoma/genetics
- Carcinoma/pathology
- Carcinoma/therapy
- Carcinoma, Endometrioid/genetics
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/therapy
- Carcinoma, Ovarian Epithelial/genetics
- Carcinoma, Ovarian Epithelial/pathology
- Carcinoma, Ovarian Epithelial/therapy
- Cell Cycle/genetics
- DNA Copy Number Variations
- DNA Mutational Analysis/methods
- DNA Repair/genetics
- Female
- Gene Expression Regulation, Neoplastic
- Hedgehog Proteins/genetics
- High-Throughput Nucleotide Sequencing/methods
- Humans
- Mutation
- Ovarian Neoplasms/genetics
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/therapy
- Precision Medicine
- Retrospective Studies
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Affiliation(s)
- Nina Lapke
- ACT Genomics, Co. Ltd., 3F., No.345, Xinhu 2nd Rd., Neihu Dist, Taipei City, 114, Taiwan
- ACT Genomics, Co. Ltd., Units 803 - 807, 8F, Building 15W, No.15 Science Park West Avenue, Hong Kong Science Park, Pak Shek Kok. NT, Hong Kong, Hong Kong
| | - Chien-Hung Chen
- ACT Genomics, Co. Ltd., 3F., No.345, Xinhu 2nd Rd., Neihu Dist, Taipei City, 114, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, 5 Fushin St., Guishan District, Taoyuan, 333, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, 5 Fushin St., Guishan District, Taoyuan, 333, Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, 5 Fushin St., Guishan District, Taoyuan, 333, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, 5 Fushin St., Guishan District, Taoyuan, 333, Taiwan
| | - Yen-Jung Lu
- ACT Genomics, Co. Ltd., 3F., No.345, Xinhu 2nd Rd., Neihu Dist, Taipei City, 114, Taiwan.
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, 5 Fushin St., Guishan District, Taoyuan, 333, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, 5 Fushin St., Guishan District, Taoyuan, 333, Taiwan
| | - Kien Thiam Tan
- ACT Genomics, Co. Ltd., 3F., No.345, Xinhu 2nd Rd., Neihu Dist, Taipei City, 114, Taiwan
| | - Hua-Chien Chen
- ACT Genomics, Co. Ltd., 3F., No.345, Xinhu 2nd Rd., Neihu Dist, Taipei City, 114, Taiwan
| | - Hsiao-Yun Lu
- ACT Genomics, Co. Ltd., 3F., No.345, Xinhu 2nd Rd., Neihu Dist, Taipei City, 114, Taiwan
| | - Shu-Jen Chen
- ACT Genomics, Co. Ltd., 3F., No.345, Xinhu 2nd Rd., Neihu Dist, Taipei City, 114, Taiwan
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Chou HH, Chen WC, Yang LY, Huang HJ, Chang WY, Lin H, Wu RC, Chen MY, Qiu JT, Huang KG, Chao A, Chang TC, Lai CH. Postoperative adjuvant dose-dense chemotherapy with bevacizumab and maintenance bevacizumab after neoadjuvant chemotherapy for advanced ovarian cancer: A phase II AGOG/TGOG trial. Eur J Obstet Gynecol Reprod Biol 2021; 262:13-20. [PMID: 33984725 DOI: 10.1016/j.ejogrb.2021.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the safety and efficacy of adding bevacizumab to dose-dense adjuvant chemotherapy with bevacizumab maintenance after neoadjuvant chemotherapy (NAC) and interval debulking surgery (IDS) for stage III/IV ovarian, tubal, and primary peritoneal cancer. STUDY DESIGN This phase II clinical trial using Simon's minimax two-stage design was conducted. At the first stage, 13 subjects were enrolled, and the trial would proceed to second stage if ≤3 subjects discontinued treatment for study-defined significant adverse events (AEs). Patients with stage III/IV ovarian, tubal, and primary peritoneal cancer deemed not feasible for primary cytoreductive surgery were enrolled after 3-4 cycles of NAC and IDS without disease progression. NAC could be either weekly paclitaxel (80 mg/m2) (dose-dense) plus 3-weekly carboplatin (AUC5-6) or 3-weekly conventional schedule. After IDS, postoperative dose-dense adjuvant chemotherapy for 3 cycles at least (best to 6 cycles), and 3-weekly bevacizumab 15 mg/kg was given since postoperative cycle 2. Further 3-weekly maintenance bevacizumab 15 mg/kg was given intravenously for 17 cycles. RESULTS Of the 22 enrolled subjects, 13 (59.1 %) had no gross lesion after IDS. Of the 13 subjects enrolled on the 1 st stage, one study-defined significant AE occurred, therefore the trial proceeded to the 2nd stage (n = 9). The median progression-free survival (PFS) was 22.1 months (95 % confidence interval [CI], 13.7-30.5), and the median overall survival (OS) was 49.2 months (95 % CI, 33.8-64.6). Peritoneal Cancer Index score at entering abdomen during IDS was significant for PFS (>12 vs ≤ 12: p = 0.003). One of the 22 subjects did not receive any study treatment. In the safety analysis (n = 21), grade 3/4 AEs included thrombocytopenia of 38.1 %, neutropenia 71.4 %, and anemia 28.6 %. Study-defined significant AEs of bowel perforation, poor-healing wound, and hypertension were found in 1 case each, respectively. CONCLUSION This phase II trial demonstrated adding bevacizumab to dose-dense adjuvant chemotherapy with bevacizumab maintenance after NAC was feasible with tolerable toxicity and comparable PFS/OS as compared to other studies using bevacizumab in the NAC phase or dose-dense scheduling throughout.
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Affiliation(s)
- Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chun Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Lan-Yan Yang
- Clinical Trial Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
| | - Wei-Yang Chang
- Clinical Trial Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Min-Yu Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
| | - J Timothy Qiu
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan; International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan.
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Wang YC, Wu RC, Jung SM, Hao Lin, Yang LY, Chao AS, Chao A, Lai CH. Detection and prognostic significance of isolated tumor cells and micrometastases in pelvic lymph nodes of patients with early ovarian clear cell carcinoma. J Formos Med Assoc 2021; 120:1869-1875. [PMID: 33883066 DOI: 10.1016/j.jfma.2021.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 03/10/2021] [Accepted: 03/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND/PURPOSE Ovarian clear cell carcinoma (OCCC) accounts for approximately 18% of all epithelial ovarian malignancies in Taiwan and portends a poor prognosis. Here, we sought to investigate whether immunohistochemistry with an anti-pan-cytokeratin antibody cocktail (AE1/AE3) can be used as an adjunct to hematoxylin and eosin (H&E) staining for improving the detection of isolated tumor cells (ITCs) and micrometastasis to pelvic lymph nodes (LNs). We also assessed whether these lesions may predict disease recurrence. METHODS Pelvic lymphadenectomy specimens were obtained from 197 patients with stage 1 OCCC who had undergone surgery between 2000 and 2018 from Linkou and Kaohsiung Chang Gung Memorial Hospital. Immunohistochemical staining with AE1/AE3 was applied to a total of 1186 slides. Clusters of metastatic tumor cells, detected immunohistochemically, were classified as ITCs (clusters with diameters of ≤0.2 mm) or micrometastases (tumor cell clusters of >0.2 but ≤2.0 mm). We also assessed the diameter of metastases in patients with positive lymph nodes (stage IIIA1, n = 3, 7 positive nodes). RESULTS Clusters with a positive AE1/AE3 staining were identified in five (2.53%) of the 197 patients (ITCs, n = 3; micrometastasis, n = 2). Four patients had no evidence of disease recurrence but a patient recurred at follow-up. Metastatic foci of patients with stage IIIA1 disease were all >2.0 mm in size. CONCLUSION Immunohistochemical staining with AE1/AE3 can identify micrometastasis or ITCs in LNs missed on routine H&E staining. The role of micrometastasis in predicting recurrent OCCC and implementing on treatment strategies requires further investigation.
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Affiliation(s)
- You-Chen Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Ren-Chin Wu
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan; Department of Pathology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Shih-Ming Jung
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan; Department of Pathology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Hao Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung Branch, Kaohsiung, Taiwan
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan.
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan.
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Elia J, Do NTK, Chang TNJ, Lai CH, Chou HH, Chang FCS, Huang JJ. Redefining the Reconstructive Ladder in Vulvoperineal Reconstruction: The Role of Pedicled Perforator Flaps. J Reconstr Microsurg 2021; 38:10-26. [PMID: 33853124 DOI: 10.1055/s-0041-1727199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gynecological reconstruction is difficult, particularly in cases with recurrence and received previous surgeries and/or radiotherapy and necessitate secondary reconstruction. Perforator flaps can preserve other donor sites for potential later reconstruction, and they also can be better tailored to the defect. We hypothesized that the use of perforator-based flaps can better restore the defect with less complications. METHODS A retrospective review was conducted of all patients who underwent vulvar-perineum reconstruction between 2011 and 2018 by the senior author, and oncologic and reconstructive outcomes and complications were analyzed. RESULTS Thirty-three patients underwent 55 soft tissue reconstructions for vulvar-perineum defects during the study period. The mean follow-up time was 27.6 ± 28.9 months. Squamous cell carcinoma was the most common cancer (45.5%). For 11 patients (33.3%), the procedures were performed for the treatment of recurrent cancer. The average defect size was 39.8 ± 34.3 cm2. The overall survival rate was 90.3%. Profunda artery perforator flaps were the most commonly applied flap for reconstruction in both the primary and recurrent groups. Poor wound healing was the most common complication which occurred in 10 of the 55 flaps (18.2%). Perforator flaps presented fewer complications than myocutaneous flaps or traditional random flaps. Similarly, Island pedicle flap design also presented fewer complications than traditional rotation flaps. With proper reconstruction, previous surgery or radiotherapy did not contribute to an increase in complications. CONCLUSION In our experience, perforator flaps can provide satisfactory reconstruction for perineum reconstruction with low postoperative complications while preserving other donor sites in the event of disease recurrence for repeat resection and reconstruction. Previous surgery or radiotherapy did not increase the complications or preclude its usage. A redefined reconstructive ladder was created to help selecting the best state-of-the-art technique for reconstruction to achieve better results.
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Affiliation(s)
- Jhonatan Elia
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Nicholas T K Do
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tommy N-J Chang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Hung-Hsueh Chou
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Frank C-S Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Craniofacial Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Jung-Ju Huang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
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Chao A, Huang YL, Lin CY, Chao AS, Lee YS, Wu RC, Lai CH. A Case of Paratubal Serous Borderline Tumor Driven by a Somatic BRAF Mutation in an Adolescent Patient. J Pediatr Adolesc Gynecol 2021; 34:228-230. [PMID: 33188936 DOI: 10.1016/j.jpag.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/28/2020] [Accepted: 11/06/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND We describe a rare paratubal serous borderline tumor occurring in an adolescent and provide insight into its molecular underpinnings. CASE A 14-year-old girl presented with irregular menstrual cycles and a large right pelvic mass. Computed tomography imaging revealed a cystic neoplasm arising from the right ovary with peripheral calcification. During laparotomy, a cystic tumor located at the right parametrium independent of the fallopian tube was identified. The ovary was intact and the tumor was successfully removed. Intraoperative diagnosis using the frozen section technique and subsequent pathology revealed a paratubal serous borderline tumor. Molecular analyses revealed a chromosomally stable tumor genome and a pathogenic somatic mutation (c.1799 T > A, p.Val600Glu) in the B-Raf proto-oncogene, serine/threonine kinase (BRAF) gene. SUMMARY AND CONCLUSION This case shows that the BRAF p.Val600Glu mutation likely acts as an oncogenic driver in this rare neoplasm.
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Affiliation(s)
- Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yen-Ling Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Chiao-Yun Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Taoyuan, Taiwan; Department of Obstetrics and Gynecology, New Taipei City Municipal Tu Cheng Hospital, New Taipei City, Taiwan
| | - Yun-Shien Lee
- Department of Biotechnology, Ming-Chuan University, Taoyuan, Taiwan; Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Taoyuan, Taiwan.
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Kurtz JE, Gebski V, Sukhin V, Carey M, Kong I, Glasspool RM, Berek JS, de Paiva Batista M, Hall M, Kim JW, Yeoshoua E, Fujiwara N, Nam BH, Polleis S, Lee JY, Strojna A, Farrelly L, Schwameis R, Fossati R, Darlington AS, Lai CH, Wright AA, Rosenblat O, Harter P, Roxburgh P, Chowdhury RR, Chang TC, Paoletti X, Friedlander M. Incorporating patient centered benefits as endpoints in randomized trials of maintenance therapies in advanced ovarian cancer: A position paper from the GCIG symptom benefit committee. Gynecol Oncol 2021; 161:502-507. [PMID: 33612336 DOI: 10.1016/j.ygyno.2021.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/08/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Quality of life and patient reported outcome measures (PROMs) are important secondary endpoints and incorporated in most contemporary clinical trials. There have been deficiencies in their assessment and reporting in ovarian cancer clinical trials, particularly in trials of maintenance treatment where they are of particular importance. The Gynecologic Cancer InterGroup (GCIG) symptom benefit committee (SBC) recently convened a brainstorming meeting with representation from all collaborative groups to address questions of how to best incorporate PROMs into trials of maintenance therapies to support the primary endpoint which is usually progression free survival (PFS). These recommendations should harmonize the collection, analysis and reporting of PROM's across future GCIG trials. METHODS Through literature review, trials analysis and input from international experts, the SBC identified four relevant topics to address with respect to promoting the role of PROMs to support the PFS endpoint in clinical trials of maintenance treatment for OC. RESULTS The GCIG SBC unanimously accepted the importance of integrating PROM's in future maintenance trials and developed four guiding principles to be considered early in trial design. These include 1) adherence to SPIRIT-PRO guidelines, 2) harmonization of selection, collection and reporting of PROM's; 3) combining Health Related Quality of Life (HRQL) measures with clinical endpoints and 4) common approaches to dealing with incomplete HRQL data. CONCLUSIONS Close attention to incorporating HRQL and PROM's is critical to interpret the results of ovarian cancer clinical trials of maintenance therapies. There should be a consistent approach to assessing and reporting patient centered benefits across all GCIG trials to enable cross trial comparisons which can be used to inform practice.
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Affiliation(s)
- Jean-Emmanuel Kurtz
- GINECO - Department of Medical and Surgical Oncology & Hematology, ICANS, 17 rue Albert Calmettes, 67200 Strasbourg, France.
| | - Val Gebski
- ANZGOG - NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Australia
| | - Vladyslav Sukhin
- CEEGOG - Grigoriev Institute for Medical Radiology, 82 Pushkinskaya St., Kharkiv, 61024, Ukraine Kharkiv, Ukraine
| | - Mark Carey
- CCTG - Division of Gynecologic Oncology, Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC V5Z 1M9, Canada
| | - Iwa Kong
- CCTG - Department of Oncology, Division of Radiation Oncology, McMaster University and Juravinski Cancer Centre, 699 Concession Street, Hamilton, Ontario, Canada
| | - Rosalind M Glasspool
- SGCTG - Cancer Research UK Trials Unit, Level 0, Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - Jonathan S Berek
- COGI - Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University, 900 Blake Wilbur Dr, Stanford, CA 94305, USA
| | - Mariana de Paiva Batista
- BRASGYN - Hospital Sao Luiz Jabaquara, 1° floor - Cinical Oncology Department, Rua das Perobas, 344 - Jabaquara, São Paulo, SP, 04321-120, Brazil
| | - Marcia Hall
- NCRI - Department of Medical Oncology, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood HA6 2RN, United Kingdom
| | - Jae-Weon Kim
- KGOG - Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Effi Yeoshoua
- ISGO - Department of Obstetrics and Gynecology, Rabin Medical Center, Zeev Jabutinsky Rd 39, Petah Tikva, 49100 Tel Aviv, Israel
| | - Noriko Fujiwara
- GOTIC - Department of Palliative Medicine and Advanced Clinical Oncology, IMSUT Hospital of the Institute of Medical Science, The University of Tokyo, Japan
| | - Byung-Ho Nam
- KGOG - The Institute of Advanced Clinical & Biomedical Research, 560 Eonju-ro, 14F Gangnam-gu, Seoul, 06144, Republic of Korea
| | - Sandra Polleis
- AGO - Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom, Kaiser-Friedrich-Ring 71, 65185 Wiesbaden, Germany
| | - Jung-Yun Lee
- KGOG - Yonsei University, 50 Yonsei-ro, Sinchon-dong, Seodaemun-gu, Seoul, Republic of Korea
| | - Aleksandra Strojna
- CEEGOG - Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Laura Farrelly
- NCRI - Cancer Research UK & University College London Cancer Trials Centre, University College London, 90 Tottenham Court Road, London, United Kingdom
| | - Richard Schwameis
- AGO-Austria Department of Gynecology and Obstetrics Section for Gynecology and Gynecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Roldano Fossati
- MANGO - IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156, Milano, Italy
| | - Anne-Sophie Darlington
- EORTC - Faculty of Health Sciences, University of Southampton, Highfield, SO17 1BJ, Southampton, Hampshire, United Kingdom
| | - Chyong-Huey Lai
- AGOG, Chang Gung Memorial Hospital Linkou Medical Center, Fuxing Street, Guishan District, Taoyuan City, Taiwan
| | - Alexi A Wright
- GOG-F - GOG Foundation - Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Orgad Rosenblat
- ISGO - ISGO - Department of Gynecological oncology, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Phillip Harter
- AGO - Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Henricistrasse 40, 45136 Essen, Germany
| | - Patricia Roxburgh
- SGCTG - Scottish Gynaecological Cancer Trials Group, Wolfson Wohl Cancer Research Center G61 1BD, University of Glasgow, UK
| | - Rahul Roy Chowdhury
- KolGOTrg - Kolkata Gynecological Oncology Trials & Translational Research Group Room 404A, Chittaranjan National Cancer Institute 37, Shyamaprasad Mukherjee Rd, Bakul Bagan, CNCI, 404A, Kolkata, West Bengal 700026,India
| | - Ting-Chang Chang
- AGOG - Chang Gung Memorial Hospital Linkou Medical Center, Fuxing Street, Guishan District, Taoyuan City, Taiwan
| | - Xavier Paoletti
- GINECO - Biostatistics for Personalized Medicine Team, Institut Curie, 26 rue d'Ulm, Paris, France
| | - Michael Friedlander
- ANZGOG - The Prince of Wales Clinical School UNSW and Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
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Wu RC, Chen SJ, Chen HC, Tan KT, Jung SM, Lin CY, Chao AS, Huang KG, Chou HH, Chang TC, Chao A, Lai CH. Comprehensive genomic profiling reveals ubiquitous KRAS mutations and frequent PIK3CA mutations in ovarian seromucinous borderline tumor. Mod Pathol 2020; 33:2534-2543. [PMID: 32616873 DOI: 10.1038/s41379-020-0611-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 01/04/2023]
Abstract
The molecular underpinnings of seromucinous borderline tumor (SMBT) - an uncommon ovarian epithelial neoplasm characterized by association with endometriosis, frequent bilateral ovarian involvement, and occasional progression to invasive carcinoma - remain poorly understood. Here, we sought to comprehensively characterize the mutational landscape of SMBT and elucidate the clonal relationship between bilateral ovarian SMBTs. We also compared the mutational profiles between SMBTs and concurrent invasive carcinomas. Formalin-fixed, paraffin-embedded tissue specimens were retrieved from 28 patients diagnosed with SMBT. Massively parallel sequencing of 409 cancer-related genes was conducted to identify somatic mutations in 33 SMBT samples and four concurrent invasive carcinoma specimens. TERT promoter mutations were assessed by Sanger sequencing, whereas immunohistochemistry was used as a surrogate tool for detecting deletions or epigenetic silencing of relevant tumor suppressor genes. Twenty-six (92.9%) of the 28 patients were diagnosed with stage I SMBTs. Seven (25%) cases showed bilateral ovarian involvement and 13 (46%) had concomitant endometriosis. Concurrent ovarian carcinomas were identified in three patients, whereas one case had a synchronous endometrial carcinoma. Somatic mutations in the KRAS, PIK3CA, and ARID1A genes were identified in 100, 60.7, and 14.3% of SMBT samples, respectively. In contrast, TERT promoter mutations and DNA mismatch repair deficiencies were absent. Sequencing of paired specimens from patients with bilateral SMBT revealed the presence of at least two shared somatic mutations, suggestive of a clonal relationship. Similarly, we identified shared somatic mutations between SMBT samples and concurrent ovarian carcinoma specimens. Taken together, these findings demonstrated a distinct mutational landscape of SMBT in which (1) KRAS is invariably mutated, (2) PIK3CA is frequently mutated, and (3) TERT promoter mutations and DNA mismatch repair deficiencies are absent. Our findings represent the first extensive characterization of this rare ovarian neoplasm, with potential implications for disease classification and molecular diagnostics.
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Affiliation(s)
- Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Taoyuan, Taiwan
| | | | | | | | - Shih-Ming Jung
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Taoyuan, Taiwan
| | - Chiao-Yun Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Taoyuan, Taiwan.,New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Taoyuan, Taiwan. .,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Taoyuan, Taiwan. .,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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45
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Huang HJ, Tung HJ, Yang LY, Chao A, Tang YH, Chou HH, Chang WY, Wu RC, Huang CC, Lin CY, Liao MJ, Chen WC, Lin CT, Chen MY, Huang KG, Wang CJ, Chang TC, Lai CH. Role of human papillomavirus status after conization for high-grade cervical intraepithelial neoplasia. Int J Cancer 2020; 148:665-672. [PMID: 32781482 PMCID: PMC7754315 DOI: 10.1002/ijc.33251] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/26/2020] [Accepted: 07/30/2020] [Indexed: 01/31/2023]
Abstract
Human papillomavirus (HPV) is the well‐established etiologic factor for cervical neoplasia. Cervical conization constitutes an effective treatment for high‐grade cervical intraepithelial neoplasia (HG‐CIN). We conducted an observational study for long‐term outcomes and HPV genotype changes after conization for HG‐CIN. Between 2008 and 2014, patients with newly diagnosed HG‐CIN before conization (surveillance new [SN] group) and those who had undergone conization without hysterectomy (surveillance previous [SP] group) were enrolled. HPV testing and Pap smear were performed periodically for the SN and SP (collectively S) groups. All other patients receiving conization for HG‐CIN during the study period were identified from our hospital database. Those eligible but not enrolled into our study were assigned to the non‐surveillance (non‐S) group. For the S group (n = 493), the median follow‐up period was 74.3 months. Eighty‐four cases had recurrent CIN Grade 2 or worse (CIN2+) (5‐year cumulative rate: 14.8%), of which six had invasive cancer. Among the 84 patients, 65 (77.4%) exhibited type‐specific persistence in the paired HPV results, whereas only 7 (8.3%) harbored new HPV types that belonged to the 9‐valent vaccine types. Among the 7397 non‐S patients, 789 demonstrated recurrent CIN2+, of which 57 had invasive cancer. The stages distribution of those progressed to invasive cancer in the non‐S group were more advanced than the S group (P = .033). Active surveillance might reduce the severity of those progressed to cancer. Because a majority of the patients with recurrent CIN2+ had persistent type‐specific HPV infections, effective therapeutic vaccines are an unmet medical need. What's new? High‐grade cervical intraepithelial neoplasia (HG‐CIN), a cervical carcinoma precursor, frequently is caused by high‐risk human papillomavirus (hr‐HPV) infection. HG‐CIN can be treated by cervical conization, though the procedure does not eradicate hr‐HPV, potentially enabling CIN recurrence. Here, in Taiwanese patients, investigation of HPV genotype changes in relation to HG‐CIN status after conization shows that 77.4 percent of patients with recurrent CIN 2 grade or worse (CIN2+) after conization had persistent type‐specific HPV infections. Vaccination against the remaining high‐risk HPVs prevented recurrent CIN2+ in only 8.3 percent of patients, revealing an unmet need for effective therapeutic vaccines.
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Affiliation(s)
- Huei-Jean Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu-Jung Tung
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Clinical Trial Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yun-Hsin Tang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Yang Chang
- Clinical Trial Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
| | - Chu-Chun Huang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chiao-Yun Lin
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Min-Jie Liao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Chun Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Tao Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Min-Yu Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chin-Jung Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch and Chang Gung University, Taoyuan, Taiwan.,Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Lin CY, Chao A, Wu RC, Lee LY, Ueng SH, Tsai CL, Lee YS, Peng MT, Yang LY, Huang HJ, Wang HS, Lai CH. Synergistic effects of pazopanib and hyperthermia against uterine leiomyosarcoma growth mediated by downregulation of histone acetyltransferase 1. J Mol Med (Berl) 2020; 98:1175-1188. [PMID: 32638047 DOI: 10.1007/s00109-020-01888-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/28/2019] [Accepted: 02/11/2020] [Indexed: 02/04/2023]
Abstract
Pazopanib-a multitargeted tyrosine kinase inhibitor with prominent antiangiogenic effects-has shown promise in the treatment of soft-tissue sarcomas. Hyperthermia has been also applied as an adjunctive treatment to chemotherapy for these malignancies. Here, we show that pazopanib and hyperthermia act synergistically in inhibiting uterine leiomyosarcoma (LMS) cell growth. Compared with either treatment alone, the combination of pazopanib and hyperthermia exerted the highest antitumor activity in a xenograft model. Mechanistically, we found that combined treatment with pazopanib and hyperthermia inhibited histone acetyltransferase 1 (HAT1) expression in LMS cells. The Clock element on the HAT1 promoter was critical for pazopanib- and hyperthermia-induced HAT1 downregulation. Inhibition of HAT1-either by pazopanib and hyperthermia or through HAT1 silencing-was mediated by suppression of Clock. Accordingly, Clock protein reconstitution rescued both HAT1 levels and HAT1-mediated histone acetylation. Immunohistochemistry revealed a higher expression of HAT1 in uterine LMS than in leiomyomas (p = 0.007), with high HAT1 expression levels being associated with poor clinical outcomes (p = 0.007). We conclude that pazopanib and hyperthermia exert synergistic effects against LMS growth by inhibiting HAT1. Further preclinical studies on HAT1 as a potential drug target in uterine LMS are warranted, especially in combination with hyperthermia. KEY MESSAGES: Pazopanib and hyperthermia inhibit the growth of leiomyosarcoma. Their combined use inhibits HAT1 expression in leiomyosarcoma cells. The promoter Clock element is required for HAT1 downregulation. HAT1 expression is higher in leiomyosarcoma than in leiomyomas. An increased HAT1 expression is associated with poor clinical outcomes.
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Affiliation(s)
- Chiao-Yun Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, 5 Fushin St., Guishan, Taoyuan, 333, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan City, Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, 5 Fushin St., Guishan, Taoyuan, 333, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan City, Taiwan
| | - Ren-Chin Wu
- Department of Anatomic Pathology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Li-Yu Lee
- Department of Anatomic Pathology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Shir-Hwa Ueng
- Department of Anatomic Pathology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chia-Lung Tsai
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan City, Taiwan
| | - Yun-Shien Lee
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan City, Taiwan
- Department of Biotechnology, Ming Chuan University, Taoyuan, Taiwan
| | - Meng-Ting Peng
- Department of Medical Oncology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan City, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, 5 Fushin St., Guishan, Taoyuan, 333, Taiwan
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan City, Taiwan
| | - Hsin-Shih Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, 5 Fushin St., Guishan, Taoyuan, 333, Taiwan.
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University, College of Medicine, 5 Fushin St., Guishan, Taoyuan, 333, Taiwan.
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan City, Taiwan.
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47
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Lai CH, Chang SW, Yang LY, Hung SI, Lin CY, Chao A, Lee YS, Huang HJ, Wu RC, Chang TC, Chang CJ, Fann CSJ. Genome-wide association analysis in host genetic characteristics of progression to high-grade cervical intraepithelial neoplasia or higher for women with human papillomavirus infection and normal cytology. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6033 Background: Human papillomavirus (HPV) testing is widely used for cervical cancer screening. The hazard ratio of developing cervical intraepithelial neoplasia grade 2 or higher (CIN2+) in HPV-positive/ normal cytology women is 20–34 fold as compared to those with HPV-negative/normal cytology. HPV-positivity would cause substantial anxiety. Apart from viral factors such as high-risk (hr) types, it is important to identify host characteristics for predicting outcome. Methods: An initial genome-wide association study (GWAS) of single nucleotide polymorphisms (SNPs) by Affymetrix Axiom™ Genome-Wide Human Arrays was conducted on 505 cases with histological diagnosis of CIN2+ (group D1) versus 920 female controls. An additional set of 2315 female controls from the Taiwan Biobank genotype array were added in the discovery stage. The identified 29 CIN2+ -associated SNPs from GWAS (p < 5 x 10−6) were verified in an independent cohort (group D2 [n = 306] versus group N [n = 600]). Group N were HPV-negative/normal cytology women from a population-based cervical cytology and HPV co-test study. A cohort with HPV-positive/normal cytology (group P, n = 755) underwent follow-up and was served as the prediction set. The predictive validity was analyzed by logistic regression and receiver operating characteristic (ROC) curve analysis. Results: Thirty-three individuals of the group P progressed to CIN2+ (median follow-up: 23.7 months, range 4.0–122.1). A risk-predictive panel of 8 SNPs rs3097662, rs35979982, rs7763822, rs4282438, rs3128927, rs7759943, rs213194, rs17835649 which were significant in the replication (p < 0.05) was used to train models for disease risk prediction using the combination of GWAS and verification sets. Two prediction models were finalized and determined using 7 SNPs for hr- and low-risk (lr) HPV groups respectively (sensitivity 0.72 and 0.75, specificity 0.651 and 0.884, area under the ROC curve 0.703 and 0.701). Among group P with hr-HPV, those carried < 6 risk-alleles had significantly decreased hazard (log-rank p < 0·001) of progression to CIN2+ than those with ≧6 risk-alleles, while among group P with lr-HPV, those with predictive probability of ≥ 0·095 had a cumulative risk of progression of 10% at 3 years. Conclusions: Two risk-predictive SNP panels including 7 SNPs with hr- or lr-HPV groups can assist risk stratification among HPV-positive/ normal cytology women. These panels could be further tested in other ethnic populations.
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Affiliation(s)
- Chyong-Huey Lai
- Department of OB/GYN, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital; Department of Laboratory Medicine, Chang Gung Memorial Hospital, Ta, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital; Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shuen-Iu Hung
- Cancer Vaccine & Immune Cell Therapy Core Lab, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Chiao-Yun Lin
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital and Department of Obstetrics and Gynecology, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Angel Chao
- Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yun-Shien Lee
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Department of Biotechnology, Ming-Chuan University, Taoyuan, Taiwan
| | - Huei-Jean Huang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital; Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University college of Medicine, Taiwan; Gynecologic Cancer Research Center, Chang Gung Memorial Hospital;, Taoyuan, Taiwan
| | | | - Chee-Jen Chang
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University; Graduate Institutes of Clinical Medical Sciences, Chang Gung University,Department of Laboratory Medicine, Chang Gung Memorial Hospital;, Taoyuan, Taiwan
| | - Cathy S. J. Fann
- Institute of Biological Medicine, Academia Sinica, Taipei, Taiwan
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Huang HJ, Yang LY, Tung HJ, Ku FC, Wu RC, Tang YH, Chang WY, Jung SM, Wang CC, Lin CT, Liu FY, Lin G, Chen MY, Chou HH, Chang TC, Chao A, Lai CH. Management and clinical outcomes of patients with recurrent/progressive ovarian clear cell carcinoma. J Formos Med Assoc 2020; 119:793-804. [DOI: 10.1016/j.jfma.2019.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/26/2019] [Accepted: 11/20/2019] [Indexed: 01/13/2023] Open
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49
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Huang YL, Ueng SH, Chen K, Huang YT, Lu HY, Ng KK, Chang TC, Lai CH, Lin G. Utility of diffusion-weighted and contrast-enhanced magnetic resonance imaging in diagnosing and differentiating between high- and low-grade uterine endometrial stromal sarcoma. Cancer Imaging 2019; 19:63. [PMID: 31514752 PMCID: PMC6739916 DOI: 10.1186/s40644-019-0247-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 08/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Endometrial stromal sarcoma (ESS) is a rare uterine malignancy that features different prognoses for its high- and low-grade subtypes. We investigated the diagnostic accuracy of magnetic resonance (MR) imaging in diagnosing and differentiating between high- and low-grade ESS. METHODS We retrospectively reviewed the preoperative pelvic MR images of consecutive patients who received histologically confirmed diagnoses of high-grade ESS (n = 11) and low-grade ESS (n = 9) and T2-hyperintense leiomyoma (n = 16). Two radiologists independently evaluated imaging features in T1-, T2-, and diffusion-weighted and contrast-enhanced MR images. Statistical analysis included Mann-Whitney tests and Fisher's exact test, with sensitivity, specificity and diagnostic accuracy of imaging features. RESULTS High-grade ESS was associated with significantly more extensive necrosis and hemorrhage and distinct feather-like enhancement compared with low-grade ESS (P < .05 for all). The feather-like enhancement pattern yielded a diagnostic accuracy of 95%, sensitivity of 91%, and specificity of 100% in differentiating high-grade from low-grade ESS. This imaging characteristic was significantly superior to the necrosis (80%, P = .033) or hemorrhage (75%, P = .007). Both high- and low-grade ESS demonstrated T2 hypointense bands, marginal nodules, intratumoral nodules, and worm-like intra-myometrial nodules, and their tumor apparent diffusion coefficient (ADC) values were significantly lower than those of T2-hyperintense leiomyomas (P < .001). CONCLUSIONS Diffusion-weighted MR imaging is useful in diagnosing ESS against T2-hyperintense leiomyomas, and contrast enhancement aids in further differentiating between high- and low-grade ESS.
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Affiliation(s)
- Yen-Ling Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382
| | - Shir-Hwa Ueng
- Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382
| | - Kueian Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382
| | - Yu-Ting Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, 222, Maijin Rd, Keelung, Taiwan, 20401
| | - Hsin-Ying Lu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382
| | - Koon-Kwan Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, 222, Maijin Rd, Keelung, Taiwan, 20401
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology and Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Clinical Trial Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology and Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Clinical Trial Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382. .,Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382. .,Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.
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Vergote I, Sehouli J, Salutari V, Zola P, Madry R, Wenham RM, Korach J, Pautier P, Cibula D, Lheureux S, Hasegawa K, Kim BG, Lai CH, González-Martín A, Liu Q, Keefe SM, Puglisi M, Topuz S. ENGOT-OV43/KEYLYNK-001: A phase III, randomized, double-blind, active- and placebo-controlled study of pembrolizumab plus chemotherapy with olaparib maintenance for first-line treatment of BRCA-nonmutated advanced epithelial ovarian cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps5603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS5603 Background: There is a significant unmet need to develop new regimens for BRCA1/2-nonmutated advanced ovarian cancer (OC). The PARP inhibitor olaparib is approved for women with platinum-sensitive, recurrent OC regardless of BRCA1/2 status and, more recently, for newly diagnosed women with BRCA-mutated OC. In the TOPACIO/KEYNOTE-162 study, the combination of the PD-1–blocking antibody pembrolizumab (pembro) and niraparib demonstrated efficacy in platinum-resistant relapsed OCirrespective of BRCA1/2 status. ENGOT-OV43/KEYLYNK-001 (ClinicalTrials.gov, NCT03740165) is a phase 3, randomized, double-blind, active- and placebo-controlled study of pembro plus paclitaxel-carboplatin chemotherapy (CT) followed by olaparib maintenance for first-line treatment of patients with BRCA1/2-nonmutated advanced epithelial OC (EOC). Methods: Patients with stage III or IV BRCA-nonmutated EOC, primary peritoneal cancer, or fallopian tube cancer will be stratified by surgery status (no residual tumor after primary debulking surgery [PDS], residual tumor after PDS, or planned interval debulking), bevacizumab use, and PD-L1 status (combined positive score < 10 or ≥10). After one lead-in cycle of CT, patients will be randomized 1:1:1 to receive: CT + pembro followed by olaparib maintenance; CT + pembro followed by placebo; or CT + placebo followed by placebo. The CT regimen will be administered for 5 cycles, and pembro 200 mg Q3W will be administered for 35 infusions. Olaparib 300 mg BID maintenance therapy will start after the end of CT as concomitant treatment with pembro until discontinuation or for 2 years if the patient has a complete response. Bevacizumab use is permitted at investigator’s discretion and determined prerandomization. Primary endpoints are investigator-assessed progression-free survival (PFS) per RECIST 1.1 criteria and overall survival. Key secondary endpoints are PFS per RECIST 1.1 assessed by blinded independent central review, PFS after next-line treatment, and safety. Enrollment is currently ongoing. Clinical trial information: NCT03740165.
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Affiliation(s)
- Ignace Vergote
- BGOG and University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Jalid Sehouli
- AGO and Charité Campus Virchow-Klinikum, Berlin, Germany
| | | | - Paolo Zola
- Division of Gynecology and Obstetrics, AO Mauriziano Umberto I, University of Turin, Turin, Italy
| | - Radoslaw Madry
- Uniwersytet Medyczny im K Marcinkowskiego w Poznaniu and Szpital Kliniczny Przemienienia Pańskiego, Poznań, Poland
| | | | - Jacob Korach
- Gynecologic Oncology Department, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| | | | - David Cibula
- CEECOG, Gynecologic Oncology Center-Department of Obstetrics and Gynecology-General University Hospital in Prague, Prague, Czech Republic
| | - Stephanie Lheureux
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kosei Hasegawa
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Byoung-Gie Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chyong-Huey Lai
- Department of OB/GYN, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Qi Liu
- Merck & Co., Inc., Kenilworth, NJ
| | | | | | - Samet Topuz
- Istanbul Medical Faculty Hospital, Fatih, Turkey
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