Pair box (PAX8) protein to predict disease recurrence and its association with outcome in women with endometrial cancer: A retrospective study of 229 patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5091-5091
Author(s):  
Damanzoopinder Samrao ◽  
Dan Wang ◽  
Paulette Mhawech-fauceglia
Keyword(s):  
Endometrial Cancer ◽  
Strong Association ◽  
Disease Status ◽  
Tumor Grade ◽  
Disease Recurrence ◽  
Recurrence Time ◽  
Depth Of Invasion ◽  
Clinical Parameters ◽  
Exact Test ◽  
Pax Family

5091 Background: Pax-8 is a member of the pair-box (PAX) family of transcription factor genes and it has been found to be overexpressed in numerous cancer cell lines including ovarian and endometrial. Possibly, inhibition of Pax8 activity may even have an impact on cancer treatment. However the role of Pax8 in human endometrial cancer has not yet been explored. Thus, the aim of this study is to determine its predictive value in disease outcome of endometrial cancer. Methods: 229 patients with available clinical data and paraffin-embedded tissue were available for review and analysis. The clinical parameters used for modeling were age, histologic subtypes, myometrial depth of invasion, lympho-vascular invasion (LVI), FIGO grade, lymph nodes positive, recurrence, disease status, recurrence time and survival time. To test the association between Pax8 and the clinical parameters, Fisher’s exact test was performed. For survival analysis, Kaplan-Meier method was performed. Results: We found a strong association between PAX8+ and high tumor grade (p=0.002), LVI + (p<0.018), and type II tumor subtype. Patients with tumor expressing Pax8 were more likely to present with shorter OS and DFS p= 0.00096 and p=0.018 respectively. There was an association of PAX8 with OS (p=0.01486) with 5-years OS probability of 80.04% for patients with Pax8- and 55.9% for patients with Pax8+. There was also an association of PAX8 and DFS probability (p=0.02028) with 5-years DFS probability was of 72.12% for patients with Pax8- versus 49.88% for patients with Pax8+ expression. Conclusions: Pax8 is a reliable marker in endometrial cancer and its overexpression can predict poor outcome.

scholarly journals Study of factors to predict recurrence in early stage endometrial cancer

2016 ◽  
Author(s):  
Shruti Bhatia ◽  
S. K. Das
Keyword(s):  
Endometrial Cancer ◽  
Adjuvant Treatment ◽  
Early Stage ◽  
Univariate Analysis ◽  
Tumor Grade ◽  
Disease Recurrence ◽  
Recurrence Rates ◽  
Nccn Guidelines ◽  
Early Stage Endometrial Cancer

Introduction: Risk stratification of patients with early endometrial cancer for recurrence is inadequate. Objectives: To study factors that influence recurrence in uterus-confined, early stage endometrial cancer (UCD). Patients and Methods: We studied 140 consecutive patients with endometrial cancer, operated at Action Cancer Hospital, Delhi, from August 2010 to September 2015. All patients underwent staging laparotomy, TAH + BSO + BLPND + para-aortic LN sampling, and omental biopsy. Adjuvant treatment was given as per the NCCN guidelines. They were followed up 3 monthly for 2 years, and 6 monthly thereafter. 121 patients (86.4%) had UCD (FIGO stages IA, IB, II). Excluding one post-operative mortality, and 4 who were lost to follow up, we included 116 patients in this study. Results: The median age of these patients was 60.5 years (range: 35-81 years), with median BMI of 31.2 kg/m2 (range=19.8-57.5). Diabetes or hypertension was present in either or both of 76 (65.5%) patients. The median pelvic LN harvest was 17 (range: 4-42). Eight (6.9%) patients had non-endometroid histology, and 5 (4.3%) patients had LVSI. Grade 1, 2, and 3 tumor was found in 74 (63.8%), 30 (25.9%), and 12 (10.3%) patients, respectively. The median follow up was 28 months (range 5-61 months), and recurrence was seen in 13 (11.2%) patients. On univariate analysis we found that age, co-morbidities (DM and HT), LVSI, and non-endometroid histology were related to recurrence. The tumor grade and adjuvant treatment did not influence recurrence rates. On multivariate analysis, presence of comorbidities and non-endometroid histology were independently related to disease recurrence (p=0.044, and 0.011, respectively). Conclusions: Disease recurrence was seen in one in ten patients with UCD, despite stage-appropriate treatment. Presence of co-morbidities and non-endometroid histology were independently related to recurrence.

The incidence of pelvic lymph node metastasis by FIGO staging for patients with adequately surgically staged endometrial adenocarcinoma of endometrioid histology

2008 ◽  
Vol 18 (2) ◽  
pp. 269-273 ◽  
Author(s):  
D. S. Chi ◽  
R. R. Barakat ◽  
M. J. Palayekar ◽  
D. A. Levine ◽  
Y. Sonoda ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Myometrial Invasion ◽  
Tumor Grade ◽  
Pelvic Lymph Node ◽  
Study Cohort ◽  
Node Metastasis ◽  
Figo Staging ◽  
Pelvic Lymph Node Metastasis

The seminal Gynecologic Oncology Group study on surgical pathologic spread patterns of endometrial cancer demonstrated the risk of pelvic lymph node metastasis for clinical stage I endometrial cancer based on tumor grade and thirds of myometrial invasion. However, the FIGO staging system assigns surgical stage by categorizing depth of myometrial invasion in halves. The objective of this study was to determine the incidence of pelvic lymph node metastasis in endometrial cancer based on tumor grade and myometrial invasion as per the current FIGO staging system. We reviewed the records of all patients who underwent primary surgical staging for clinical stage I endometrial cancer at our institution between May 1993 and November 2005. To make the study cohort as homogeneous as possible, we included only cases of endometrioid histology. We also included only patients who had adequate staging, which was defined as a total hysterectomy with removal of at least eight pelvic lymph nodes. During the study period, 1036 patients underwent primary surgery for endometrial cancer. The study cohort was composed of the 349 patients who met study inclusion criteria. Distribution of tumor grade was as follows: grade 1, 80 (23%); grade 2, 182 (52%); and grade 3, 87 (25%). Overall, 30 patients (9%) had pelvic lymph node metastasis. The incidence of pelvic lymph node metastasis in relation to tumor grade and depth of myometrial invasion (none, inner half, and outer half) was as follows: grade 1–0%, 0%, and 0%, respectively; grade 2–4%, 10%, and 17%, respectively; and grade 3–0%, 7%, and 28%, respectively. We determined the incidence of pelvic nodal metastasis in a large cohort of endometrial cancer patients of uniform histologic subtype in relation to tumor grade and a one-half myometrial invasion cutoff. These data are more applicable to current surgical practice than the previously described one-third myometrial invasion cutoff results.

Randomized Double-Blind Trial of Estrogen Replacement Therapy Versus Placebo in Stage I or II Endometrial Cancer: A Gynecologic Oncology Group Study

2006 ◽  
Vol 24 (4) ◽  
pp. 587-592 ◽  
Author(s):  
Richard R. Barakat ◽  
Brian N. Bundy ◽  
Nick M. Spirtos ◽  
Jeffrey Bell ◽  
Robert S. Mannel
Keyword(s):  
Endometrial Cancer ◽  
Placebo Group ◽  
Replacement Therapy ◽  
Recurrence Rate ◽  
Estrogen Replacement Therapy ◽  
Disease Recurrence ◽  
Stage I ◽  
Age At Diagnosis ◽  
Estrogen Replacement

Purpose To determine the effect of estrogen replacement therapy (ERT) on recurrence rate and survival in women who have undergone surgery for stage I or II endometrial cancer. Patients and Methods After surgery, eligible patients were allocated to therapy with ERT or placebo after undergoing hysterectomy with or without pelvic and aortic nodal sampling. Planned duration of hormonal versus placebo treatment was 3 years, with an additional 2 years of follow-up. Results The median follow-up time for all 1,236 eligible and assessable patients was 35.7 months. Stage, grade, histologic subtype, and percentage of patients receiving adjuvant therapy were similarly distributed between the groups. The median age at diagnosis for the 618 patients randomly assigned to ERT was 57 years (range, 26 to 91 years). Two hundred fifty-one patients (41.1%) were compliant with ERT for the entire treatment period. Disease recurrence was experienced in 14 patients (2.3%). Eight patients (1.3%) developed a new malignancy. There were 26 deaths (4.2%), and five deaths (0.8%) were a result of endometrial cancer. The median age at diagnosis for the 618 patients in the placebo group was 57 years (range, 30 to 88 years). Twelve patients (1.9%) experienced disease recurrence. Ten patients (1.6%) developed a new malignancy. There were 9 deaths (3.1%) in the placebo group, and four deaths (0.6%) were a result of endometrial cancer. Conclusion Although this incomplete study cannot conclusively refute or support the safety of exogenous estrogen with regard to risk of endometrial recurrence, it is noteworthy that the absolute recurrence rate (2.1%) and the incidence of new malignancy were low.

scholarly journals Preoperative and intraoperative assesment of myometrial invasion and histological grade in endometrial cancer: Role of MRI and frozen section

2016 ◽  
Author(s):  
Rohit Raghunath Ranade
Keyword(s):  
Endometrial Cancer ◽  
Tumor Size ◽  
Early Stage ◽  
Frozen Section ◽  
Myometrial Invasion ◽  
Tumor Grade ◽  
Endometrial Biopsy ◽  
Intraoperative Frozen Section ◽  
Cervical Involvement

Introduction: The role of systematic lymphadenectomy in clinically early stage endometrial cancer is controversial. A number of factors can predict lymph node metastasis including myometrial invasion, tumor grade in endometrial cancers. The purpose of the present study is to evaluate the accuracy of preoperative MRI and intraoperative frozen section in determining the depth of myometrial invasion, cervical involvement, tumor size and lymph nodal status. We also studied the accuracy of preoperative endometrial biopsy and intraoperative frozen section in determining the grade of the tumor. Materials and Methods: Medical records of 235 consecutive cases of clinically early stage endometrial cancer were reviewed retrospectively. A record of depth of myometrial invasion, tumor size, cervical involvement and presence of enlarged lymph nodes was made on a preoperative MRI. Similarly depth of myometrial invasion, tumor size, cervical involvement and grade of the tumor were recorded on an intraoperative frozen section. The grade of the tumor was also recorded on a preoperative endometrial biopsy. Standard statistical calculations were used. Results: The sensitivity and specificity of MRI for myometrial invasion for the first 160 cases were 81.3 and 75%, respectively while that for frozen section were 80 and 96.2%, respectively. For tumor grade the sensitivity and specificity of preoperative endometrial biopsy were 60 and 95.6%, respectively while that of frozen section were 53.8 and 97.6%, respectively. For cervical involvement the sensitivity of MRI and frozen section was 62.5 and 98.4%, respectively. Updated results of the entire cohort of 235 cases will be presented at the conference if selected. Conclusion: Although the sensitivity of both frozen section and MRI for predicting deep myometrial invasion was similar (80 vs 81.3%) but the specificity (96.2 vs 75%) and negative predictive value (92.7 vs 88.2%) of frozen section were superior to MRI. Both preoperative biopsy and intraoperative frozen section had low sensitivity (60 vs 53.8%) for detecting a high grade lesion.

scholarly journals Clinicopathological Characteristics and Prognosis in Endometrial Cancer With Bone Metastasis: A SEER-Based Study of 584 Women

2021 ◽  
Vol 11 ◽  
Author(s):  
Hejia Hu ◽  
Zhan Wang ◽  
Miaofeng Zhang ◽  
Feng Niu ◽  
Qunfei Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
Bone Metastasis ◽  
Brain Metastases ◽  
Systemic Chemotherapy ◽  
Tumor Grade ◽  
Seer Database ◽  
Tumor Subtype ◽  
Local Surgery ◽  
Independent Risk Factors

PurposeBone metastasis from endometrial cancer (EC) is rare and poorly described. The purpose of the present study was to investigate the correlation between the clinically accessible factors and survival time among EC patients with bone metastasis.Patients and MethodsWe retrospectively identified and reviewed EC patients with bone metastasis from 2010 to 2016, based on the Surveillance, Epidemiology and End Results (SEER) database. Univariable and multivariable Cox regressions were applied to evaluate the effects of clinical variables on survival. Kaplan–Meier plots were used to visually demonstrate the correlation between independent risk factors and survival.ResultsClinical data of 584 EC patients with bone metastasis from the SEER database were analyzed. EC patients with bone metastasis experienced extremely poor survival, with 1-year overall survival (OS) and cancer-specific survival (CSS) rates 33.8 and 35.8%, respectively. Variables associated with OS and CSS in the univariable analysis included race, tumor grade, tumor subtype, tumor size, lung, liver and brain metastases, surgery, radiotherapy, and chemotherapy. In the multivariable analysis, tumor grade, tumor subtype, liver and brain metastases, local surgery, and systemic chemotherapy remained independent risk factors for OS and CSS. However, local radiotherapy was an independent predictor of OS, not CSS.ConclusionsWe identified several factors affect the survival of EC patients with bone metastasis, which is useful for clinicians to assess patients’ outcomes. Our study supports surgery and radiotherapy of primary EC, and systemic chemotherapy for prolonging survival among EC patients with bone metastasis, which lays a solid foundation for defining optimal treatment strategy in this specific cohort.

scholarly journals A preoperative SUVmax greater than the ADCmin of the primary tumour : A predictor of disease recurrence and survival in patients with endometrial cancer

2014 ◽  
Vol 126 (1) ◽  
pp. 11-15
Author(s):  
Keiichiro Nakamura ◽  
Ikuo Joja ◽  
Chikako Fukushima ◽  
Tomoko Haruma ◽  
Chiaki Hayashi ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Primary Tumour ◽  
Disease Recurrence

scholarly journals High Expression of Ecto-Nucleotidases CD39 and CD73 in Human Endometrial Tumors

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Elisabet Aliagas ◽  
August Vidal ◽  
Laura Texidó ◽  
Jordi Ponce ◽  
Enric Condom ◽  
...  
Keyword(s):  
Gene Expression ◽  
Endometrial Cancer ◽  
Genital Tract ◽  
Female Genital Tract ◽  
Tumor Grade ◽  
Type I ◽  
Type Ii ◽  
Extracellular Adenosine ◽  
Serous Tumors ◽  
Female Genital

One of the strategies used by tumors to evade immunosurveillance is the accumulation of extracellular adenosine, which has immunosupressive and tumor promoting effects. The study of the mechanisms leading to adenosine formation at the tumor interstitium are therefore of great interest in oncology. The dominant pathway generating extracellular adenosine in tumors is the dephosphorylation of ATP by ecto-nucleotidases. Two of these enzymes acting sequentially, CD39 and CD73, efficiently hydrolyze extracellular ATP to adenosine. They have been found to play a crucial role in a variety of tumors, but there were no data concerning endometrial cancer, the most frequent of the invasive tumors of the female genital tract. The aim of the present work is to study the expression of CD39 and CD73 in human endometrial cancer. We have analyzed protein and gene expression, as well as enzyme activity, in type I endometrioid adenocarcinomas and type II serous adenocarcinomas and their nonpathological endometrial counterparts. High levels of both enzymes were found in tumor samples, with significantly increased expression of CD39 in type II serous tumors, which also coincided with the higher tumor grade. Our results reinforce the involvement of the adenosinergic system in cancer, emphasizing the relevance of ecto-nucleotidases as emerging therapeutic targets in oncology.

Foodborne Snow Mountain Agent Gastroenteritis in a School Cafeteria

PEDIATRICS ◽  
1987 ◽  
Vol 79 (4) ◽  
pp. 559-563
Author(s):  
Charles Guest ◽  
Kenneth C. Spitalny ◽  
H. Paul Madore ◽  
Katherine Pray ◽  
Raphael Dolin ◽  
...  
Keyword(s):  
Relative Risk ◽  
Strong Association ◽  
Case Definition ◽  
Enzyme Linked Immunosorbent Assay ◽  
Fisher Exact Test ◽  
Confidence Limits ◽  
Serum Samples ◽  
Exact Test ◽  
Relative Risks ◽  
The Mean

In 1984, an outbreak of gastroenteritis occurred at a school with 1,860 students in Brooklyn, NY. In a single-stage cluster sample of 375 students, 129 (34%) had illnesses that met our case definition of vomiting or diarrhea. The mean incubation period was 26 hours, and the mean illness duration was 24 hours. All case students had eaten in the cafeteria on at least one day between Nov 13 and 16, compared with 174/214 (81%) noncase students (P = 10-8, Fisher exact test). Foods implicated were french fries (relative risk 1.7, 95% confidence limits 1.4, 2.0) and hamburgers (relative risk 1.6, 95%, confidence limits 1.2, 2.1). Two cafeteria employees had served those foods while affected by diarrhea. By a recently developed blocking enzyme-linked immunosorbent assay, six of 11 (55%) case students showed fourfold antibody increases between acute-and convalescent-phase serum samples for Snow Mountain agent, a Norwalk-like virus, compared with one of ten (10%) noncase students (P = .04, Fisher exact test). We strongly suspect, but cannot document conclusively, that the Snow Mountain agent was spread to students on a vector of hot foods contaminated by ill food handlers. Implicated foods conferred low relative risks and could only have accounted for 74% of cases of illness. The strong association between cafeteria exposure and illness, therefore, suggests that additional modes of spread occurred.

Tumors With Neuroectodermal Differentiation of the Uterus and Ovary: A Series of 12 Cases and Review of the Literature

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S37-S38
Author(s):  
Li Ge ◽  
Amy Zhou ◽  
John Maksem ◽  
Sarah Gennette ◽  
Veronica Schimp
Keyword(s):  
Disease Status ◽  
Figo Stage ◽  
Giant Cells ◽  
Small Cells ◽  
Serous Carcinoma ◽  
Depth Of Invasion ◽  
Gynecological Tumors ◽  
Stage Disease ◽  
Gynecologic Tumors

Abstract Objectives Primitive neuroectodermal tumors (PNETs) are a group of small round cell tumors most commonly found in the central nervous system, soft tissue, or bone. Such tumors arising in the uterus or ovary are rare. In this study, we describe the clinicopathologic features from a series of gynecological tumors with neuroectodermal differentiation. Methods In a retrospective review, 5 years of departmental archives were searched for gynecological tumors diagnosed at Orlando Health’s Department of Pathology. Clinicopathological information was analyzed, including age at diagnosis, tumor size, depth of invasion, other component, pathologic stage, FIGO stage, immunohistochemical stains, months of follow-up, and current disease status. Results Twelve fully staged tumors with neuroectodermal differentiation were identified. Eleven were of uterine origin and one was of ovarian origin. Ages at diagnosis ranged from 38 to 78 years (median 65). Neuroectodermal component was variable in morphology, including lymphocyte-like small cells in sheets, perivascular pseudorosettes, or cords; larger cells with prominent nucleoli with or without cystic change; and giant cells resembling megakaryocytes. Components other than neuroectodermal differentiation included carcinosarcoma, dedifferentiated endometrioid carcinoma, and high-grade serous carcinoma. Membranous and/or paranuclear dot-like CD99 immunoreactivity were in all cases. Ten patients were deceased due to disease at 1 to 33 months follow-up, while one patient was alive without evidence of disease after 61 months follow-up, possibly due to being able to tolerate a different therapeutic protocol for peripheral PNET. Conclusion Neuroectodermal differentiation may be found as components of other gynecological tumors, especially those with an aggressive phenotype and high-stage disease. The neuroectodermal component comprises a spectrum of cytohistological features. Because of its presentation in the shadow of other components, it may be more common than is generally assumed. Mortality remains high, but recognition of neuroectodermal differentiation in gynecologic tumors might introduce a different therapeutic approach and potentially improve clinical outcomes.

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