Comparing surgical staging methods for type II endometrial cancers.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17107-e17107
Author(s):  
Leda Portia A. Gattoc ◽  
Hyo K. Park ◽  
Laura Carney ◽  
Shashank Srivastava ◽  
Monica Chiu ◽  
...  
Keyword(s):  
African American ◽  
Endometrial Cancer ◽  
Perioperative Complications ◽  
Multivariable Analysis ◽  
Significant Proportion ◽  
Type Ii ◽  
Invasive Approach ◽  
Lymph Node Yield ◽  
Endometrial Cancers ◽  
Mixed Histology

e17107 Background: Type II endometrial cancers account for 10% of endoemetrial cancers, but their aggresive nature account for a significant proportion of the morbidity and mortality. The goal of this study was to compare outcomes type II endometrial cancer patients who underwent staging via laparotomy vs. minimally invasive approach (MIS). Methods: All patients who underwent surgery for Type II endometrial cancer at two cancer centers in Detroit MI from January 2005 and December 2015 were reviewed. Endometrioid histology and those who never had surgery were excluded. Clinical, demographic characteristics, surgical outcomes and progression free survival were examined using univariate and multivariable analysis, Kaplan-Meier estimates and Cox proportional hazards regression. Results: A total of 249 patients were included, 193 underwent laparotomy, and 58 MIS, including laparoscopic or robotic surgery. The majority had stage I disease (IA, 104 [41.3%] and IB, 20[7.9%]). Stages II, III, and IV were identified in 18 (7.1%), 79 (31.6%), and 31 (12.4%) respectively. Multivariate analysis demonstrated being African American (OR 3.43; 95%CI 1.64-7.15), having mixed histology(OR 2.54; 95% CI 1.02-6.32), and stage III-IV disease (OR 2.20; 95%CI 1.04-4.67) was associated with undergoing laparotomy. Higher perioperative complications, EBL >250 cc and blood transfusion were associated with laparotomy. Higher lymph node yield was associated with MIS approaches vs. laparotomy (26 vs. 14 p =<0.001). Recurrence rate was 38 % for the laparotomy group and 19% for MIS. There was no difference in 3 year-PFS after controlling for age, race, procedure, histology, stage and adjuvant therapy. There was no difference in overall survival between laparotomy and MIS for type II endometrial cancers. Conclusions: Being African American race, having mixed histology and stage were associated with undergoing laparotomy for type II endometrial cancers. MIS approaches offered less morbidity and ability to complete staging. However, patient selection likely played a role in this given earlier stage of these cancers. The route of surgery was not associated with PFS or OS, suggesting that MIS approach should be considered especially for ealry stage disease.

CD8, FoxP3, and CD45RO+ Lymphocytic Infiltrates in Type I and Type II Endometrial Cancers in African American and European American Females

2017 ◽  
Vol 36 (6) ◽  
pp. 540-549 ◽  
Author(s):  
Tariq Rashid ◽  
Jennifer L. Young-Pierce ◽  
Elizabeth Garrett-Mayer ◽  
Whitney Graybill ◽  
Shelby Neal ◽  
...  
Keyword(s):  
African American ◽  
European American ◽  
Type I ◽  
Type Ii ◽  
Endometrial Cancers ◽  
Lymphocytic Infiltrates

Lynch Syndrome Identification in Endometrial Cancer Patients: Should Universal Screening be Used for all Histologies?

2021 ◽  
Vol 17 ◽  
Author(s):  
Jessica E. Parker ◽  
Caitlin Mauer ◽  
Wenxin Zheng ◽  
David S. Miller ◽  
Jayanthi S. Lea
Keyword(s):  
Endometrial Cancer ◽  
Genetic Testing ◽  
Family History ◽  
Lynch Syndrome ◽  
Cancer Patients ◽  
Universal Screening ◽  
Type I ◽  
Type Ii ◽  
Screening Approach ◽  
Endometrial Cancers

Background: There is an increased proportion of non-endometrioid histologies in Lynch syndrome-associated compared to sporadic endometrial cancer, however screening recommendations do not differ between type I and type II cancers. Objective: Our objective was to examine the frequency of Lynch syndrome identified in type I and type II endometrial cancers and their associated characteristics. Methods: We reviewed patients with type I and type II endometrial cancer who were screened for Lynch Syndrome or referred for genetic testing according to an age and family-history based screening protocol. All patients were seen and treated at large academic institution affiliated with a county safety-net hospital. Clinical, pathologic, immunohistochemistry, and germline genetic testing results were obtained as well as choice of genetic screening approach, personal and family history, and compliance with testing. Results: 234 women with type I and 29 patients with type II endometrial cancer were identified. Lynch syndrome was diagnosed in a total of eight (3.4%) type I endometrial cancer patients, all identified after age-based tumor screening. In the type II endometrial cancer group, three (10.3%) patients had Lynch syndrome. One was referred for testing after abnormal immunohistochemistry screening under age 60. The other two were >60 years old and identified after abnormal immunohistochemistry screening performed by physician request. Conclusion: Age based screening may not diagnose Lynch Syndrome in women with type II endometrial cancers. Our findings underscore the need for a universal screening approach in patients with type II endometrial cancers, even in a low resource population.

scholarly journals Type II Endometrial Cancer Overexpresses NILCO: A Preliminary Evaluation

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Danielle Daley-Brown ◽  
Gabriela Oprea-Iles ◽  
Kiara T. Vann ◽  
Viola Lanier ◽  
Regina Lee ◽  
...  
Keyword(s):  
African American ◽  
Endometrial Cancer ◽  
Cell Invasion ◽  
Cellular Membrane ◽  
Chinese Patients ◽  
Tissue Array ◽  
Preliminary Evaluation ◽  
Type Ii ◽  
Obesity Status ◽  
Signaling Inhibitors

Objective. The expression of NILCO molecules (Notch, IL-1, and leptin crosstalk outcome) and the association with obesity were investigated in types I and II endometrial cancer (EmCa). Additionally, the involvement of NILCO in leptin-induced invasiveness of EmCa cells was investigated. Methods. The expression of NILCO mRNAs and proteins were analyzed in EmCa from African-American n=29 and Chinese patients (tissue array, n=120 cases). The role of NILCO in leptin-induced invasion of Ishikawa and An3ca EmCa cells was investigated using Notch, IL-1, and leptin signaling inhibitors. Results. NILCO molecules were expressed higher in type II EmCa, regardless of ethnic background or obesity status of patients. NILCO proteins were mainly localized in the cellular membrane and cytoplasm of type II EmCa. Additionally, EmCa from obese African-American patients showed higher levels of NILCO molecules than EmCa from lean patients. Notably, leptin-induced EmCa cell invasion was abrogated by NILCO inhibitors. Conclusion. Type II EmCa expressed higher NILCO molecules, which may suggest it is involved in the progression of the more aggressive EmCa phenotype. Obesity was associated with higher expression of NILCO molecules in EmCa. Leptin-induced cell invasion was dependent on NILCO. Hence, NILCO might be involved in tumor progression and could represent a new target/biomarker for type II EmCa.

Prevalence and clinical implications of mismatch repair (MMR) deficiency in unselected non-serous epithelial ovarian cancer (EOC) patients (pts).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1521-1521
Author(s):  
Mariana Scaranti ◽  
Krithika Murali ◽  
Cecilia Orbegoso ◽  
Katherine Vroobel ◽  
Susana N. Banerjee ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Endometrial Cancer ◽  
Significant Proportion ◽  
Disease Free Survival ◽  
Figo Stage ◽  
Significant Difference ◽  
Serous Epithelial Ovarian Cancer ◽  
Average Body Mass ◽  
Mixed Histology

1521 Background: It has previously been reported that 6-7% of clear cell (CC) and endometrioid (E) ovarian cancers are MMR deficient (MMRd). The prevalence of MMRd in other histological subtypes and correlation with germline (g) MMR (Lynch Syndrome) mutations in unselected non-serous EOC pts is less clear. MMRd in solid tumors has been associated with enhanced response to immunotherapy, hence knowledge of MMR status has therapeutic and familial implications. We aimed to study the prevalence and implications of MMRd and gMMRd in unselected pts with non-serous EOC. Methods: Routine immunohistochemistry (IHC) was performed for the MMR proteins MLH1, MSH2, MSH6 and PMS2 in all non-serous EOC pts from June 2016; retrospective MMR IHC testing in pts in follow-up was performed. Pts with MMRd tumors were referred for gMMR testing. Results: We analyzed 66 unselected pts with non-serous EOC. Median age was 56.4 years (yrs). The majority had E ovarian cancer (54.5%) followed by CC (25.8%), mixed histology (12.1%), mucinous (4.5%) and mullerian (3%) subtypes. Endometriosis was noted in 45.5% of pts, and 75% were FIGO stage I and II at diagnosis. Seventeen pts (25.8%) had concurrent endometrial cancer, all Grade I. On IHC, 15.2% were MMRd: 5 E, 2 CC, 2 mixed and 1 mullerian-type. Of these, 3 pts (30%) had gMMR mutation, 2/3 did not meet the Revised Bethesda criteria for testing. A lower average body mass index (Kg/m2) was noted in MMRd 25.9 versus 30.1 in MMR proficient (MMRp). Median age at diagnosis was 53.5 yrs in the MMRd and 57.7 yrs in MMRp. A higher frequency of concurrent endometrial cancer was observed on the MMRd group (60%) versus (20%) on MMRp (p = 0.007). No statistically significant difference in overall survival or disease-free survival was observed between the MMRd and MMRp population. Conclusions: Our study has shown a higher prevalence of somatic MMRd in non-serous EOC (15.2%) than in previously published literature with a significant proportion found to carry gMMR mutations (4.5%). These interim findings support the role of universal MMR IHC testing in non-serous EOC regardless of family history. [Table: see text]

scholarly journals Combined genetic mutations and DNA-methylated genes as biomarkers for endometrial cancer detection from cervical scrapings

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Phui-Ly Liew ◽  
Rui-Lan Huang ◽  
Tzu-I Wu ◽  
Chi-Chun Liao ◽  
Chien-Wen Chen ◽  
...  
Keyword(s):  
Dna Methylation ◽  
Endometrial Cancer ◽  
Cancer Detection ◽  
Type I ◽  
Type Ii ◽  
Normal Endometrium ◽  
Epigenetic Biomarkers ◽  
Pap Smear Screening ◽  
Endometrial Cancers ◽  
Endometrial Carcinomas

Abstract Background Endometrial cancer is a common gynecologic cancer. Noninvasive molecular biomarkers for triage of high-risk patients for invasive procedures are needed. Based on the success of cytological Pap smear screening, cervical scrapings are a good source of DNA for molecular testing. In addition to genetic lesions, DNA methylation is a promising biomarker. We assessed the usefulness of combining genetic and epigenetic biomarkers from cervical scrapings to detect endometrial carcinomas. Methods We performed a retrospective case–control study of 96 consecutive cervical scrapings from patients with abnormal uterine bleeding who underwent surgery for diagnostic evaluation. Thirty and 16 cases were diagnosed with type I and type II endometrial cancers, respectively. The remaining non-cancer cases included normal endometrium (n = 12), benign uterine lesions (n = 20), and endometrial hyperplasia (n = 18). Quantitative methylation-specific PCR and mass spectrometry were used for DNA methylation and genetic mutation analysis. Logistic regression was used to evaluate the clinical performance of these candidate biomarkers. Results We tested the effectiveness of the methylation status of four genes (BHLHE22, CDO1, TBX5, and HAND2) in endometrial cancer detection. The area under the receiver operating characteristic curves ranged from 0.703 to 0.878, and panels of hypermethylated BHLHE22/CDO1/HAND2 (87.0% sensitivity and 86.0% specificity) and BHLHE22/CDO1/TBX5 (89.1% sensitivity and 80.0% specificity) showed significant differences and could distinguish benign from malignant endometrial lesions. The sensitivity and specificity in endometrial cancer detection for BHLHE22/CDO1 were 84.8% and 88.0%, respectively. Both type I and II endometrial carcinomas could be detected using a BHLHE22/CDO1-based methylation profile, suggesting that they may have common epigenomes. Moreover, PTEN and TP53 mutations were found in 63.3% of type I and 93.6% of type II endometrial cancers. Unexpectedly, PTEN and TP53 mutations were commonly found in cervical scrapings of the normal endometrium (25% and 33.3%, respectively) and in cases with benign uterine lesions (10% and 50%, respectively). Finally, combinations of any one mutation of PTEN and TP53 mutations had a sensitivity of 91.3%, but a specificity of only 42.0%. Conclusions Adding PTEN/TP53 mutation testing to BHLHE22/CDO1-based methylation testing did not improve the detection of endometrial cancer.

Minimally Invasive Approach in Type II Endometrial Cancer: Is It Wise and Safe?

2017 ◽  
Vol 24 (3) ◽  
pp. 438-445 ◽  
Author(s):  
Giorgia Monterossi ◽  
Fabio Ghezzi ◽  
Enrico Vizza ◽  
Gian Franco Zannoni ◽  
Stefano Uccella ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Minimally Invasive ◽  
Type Ii ◽  
Minimally Invasive Approach ◽  
Invasive Approach

scholarly journals Molecular cues on obesity signals, tumor markers and endometrial cancer

2015 ◽  
Vol 21 (1) ◽  
Author(s):  
Danielle Daley-Brown ◽  
Gabriela M. Oprea-Ilies ◽  
Regina Lee ◽  
Roland Pattillo ◽  
Ruben R. Gonzalez-Perez
Keyword(s):  
Endometrial Cancer ◽  
African American Women ◽  
Tumor Markers ◽  
Poor Prognosis ◽  
Interleukin 1 ◽  
Therapy Response ◽  
Type Ii ◽  
Leptin Signaling ◽  
Endometrial Cancers ◽  
Caucasian Women

AbstractTumor markers are important tools for early diagnosis, prognosis, therapy response and endometrial cancer monitoring. A large number of molecular and pathologic markers have been described in types I and II endometrial cancers, which has served to define the main oncogenic, epidemiological, genetic, clinical and histopathological features. Ongoing attempts to stratify biological markers of endometrial cancer are presented. However, data on changes in tumor marker profiles in obesity-related endometrial cancer are scarce. Obesity is a pandemic in Western countries that has an important impact on endometrial cancers, albeit through not very well-defined mechanisms. Although endometrial cancer is more common in Caucasian women, higher mortality is found in African Americans who also show higher incidence of obesity. Here, we describe how obesity signals (estrogen, leptin, leptin induced-molecules, Notch; cytokines and growth factors) could affect endometrial cancer. Leptin signaling and its crosstalk may be associated to the more aggressive and poor prognosis type II endometrial cancer, which affects more postmenopausal and African-American women. In this regard, studies on expression of novel molecular markers (Notch, interleukin-1 and leptin crosstalk outcome) may provide essential clues for detection, prevention, treatment and prognosis.

scholarly journals Type I and II Endometrial Cancers: Have They Different Risk Factors?

2013 ◽  
Vol 31 (20) ◽  
pp. 2607-2618 ◽  
Author(s):  
Veronica Wendy Setiawan ◽  
Hannah P. Yang ◽  
Malcolm C. Pike ◽  
Susan E. McCann ◽  
Herbert Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
Pooled Analysis ◽  
Age At Menarche ◽  
Type I ◽  
Type Ii ◽  
Case Control Studies ◽  
Mixed Cell ◽  
Cancer Risk Factors ◽  
Endometrial Cancers

Purpose Endometrial cancers have long been divided into estrogen-dependent type I and the less common clinically aggressive estrogen-independent type II. Little is known about risk factors for type II tumors because most studies lack sufficient cases to study these much less common tumors separately. We examined whether so-called classical endometrial cancer risk factors also influence the risk of type II tumors. Patients and Methods Individual-level data from 10 cohort and 14 case-control studies from the Epidemiology of Endometrial Cancer Consortium were pooled. A total of 14,069 endometrial cancer cases and 35,312 controls were included. We classified endometrioid (n = 7,246), adenocarcinoma not otherwise specified (n = 4,830), and adenocarcinoma with squamous differentiation (n = 777) as type I tumors and serous (n = 508) and mixed cell (n = 346) as type II tumors. Results Parity, oral contraceptive use, cigarette smoking, age at menarche, and diabetes were associated with type I and type II tumors to similar extents. Body mass index, however, had a greater effect on type I tumors than on type II tumors: odds ratio (OR) per 2 kg/m2 increase was 1.20 (95% CI, 1.19 to 1.21) for type I and 1.12 (95% CI, 1.09 to 1.14) for type II tumors (Pheterogeneity < .0001). Risk factor patterns for high-grade endometrioid tumors and type II tumors were similar. Conclusion The results of this pooled analysis suggest that the two endometrial cancer types share many common etiologic factors. The etiology of type II tumors may, therefore, not be completely estrogen independent, as previously believed.

scholarly journals Predictive Value of Serum Cytokeratin 19 Level for the Feasibility of Conserving Ovaries in Endometrial Cancer

2021 ◽  
Vol 8 ◽  
Author(s):  
Jie Xu ◽  
Can Chen ◽  
Jing Xiong ◽  
Hui Wang ◽  
Hua Linghu
Keyword(s):  
Endometrial Cancer ◽  
Predictive Value ◽  
Multivariable Analysis ◽  
Ovarian Metastasis ◽  
Youden Index ◽  
Cytokeratin 19 ◽  
Type I ◽  
Type Ii ◽  
Ovarian Preservation ◽  
Menopausal Women

Objective: To determine the predictive value of cytokeratin 19 (CK19) for evaluating the safety of ovarian preservation in patients with endometrial cancer (EC).Methods: Five hundred and seventeen EC patients hospitalized from November 2010 to June 2016 were reviewed retrospectively. Pre-operative tumor biomarkers including CA125, HE4, CK19, and CA19-9 were obtained. Predictive biomarkers associated with ovarian metastasis were selected using univariate and multivariate Logistic regression. The cut-off values were determined by receiver operating characteristic (ROC) curves. Kaplan-Meier method and Cox multivariate regression model was used to perform survival analysis.Results: Among clinical parameters and biomarkers included, age &gt; 65, type II EC, CA125 ≥ 35 u/ml, CK19 &gt; 3.3 ng/ml, and myometrial invasion ≥ 50% depth appeared as significant predictors of the risk of ovarian involvement in univariable logistic analysis. In multivariable analysis, CK19 &gt; 3.3 ng/ml (OR = 11.541, 95%CI: 1.968–67.668, P = 0.007) and Type II EC (OR = 8.336, 95%CI: 1.456–47.722, P = 0.017) were independent risk predictors of ovarian metastasis in pre-menopausal women. In pre-menopausal women with Type I EC (n = 142), CK19 level could satisfactorily predict the risk of ovarian metastasis (AUC = 0.860, 95%CI: 0.792–0.912, P &lt; 0.001), and when the cut-off point was set as 2.45 ng/ml, the negative predictive value and negative likelihood ratio were 99% and 0.19, with the maximum Youden index of 0.598.Conclusions: The present study advocates the necessity of incorporating serum CK19 measurement into the pre-operative evaluation of EC, especially as extension of current standard approach with ovarian preservation counseling.

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