scholarly journals Integrating Pathology, Chromosomal Instability and Mutations for Risk Stratification in Early-stage Endometrioid Endometrial Carcinoma

2020 ◽  
Author(s):  
Yuan Li ◽  
Jiaqi Li ◽  
Ensong Guo ◽  
Jia Huang ◽  
Guangguang Fang ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Risk Stratification ◽  
Endometrial Carcinoma ◽  
Molecular Pathology ◽  
Chromosomal Instability ◽  
Risk Model ◽  
Early Stage ◽  
Molecular Characteristics ◽  
Molecular Stratification

Abstract Background: Risk stratifications for endometrial carcinoma (EC) depend on histopathology and molecular pathology. Histopathological risk stratification lacks reproducibility, neglects heterogeneity and contributes little to surgical procedures. Existing molecular stratification is useless in patient with specific pathological or molecular characteristics, and cannot guide postoperative adjuvant radiotherapies. Chromosomal instability (CIN), the numerical and structural alterations of chromosome resulting from ongoing errors of chromosome segregation, is an intrinsic biological mechanism for the evolution of different prognostic factors of histopathology and molecular pathology, which may be applicable to the risk stratification of EC.Results: By analysis of CIN25 and CIN70, two reliable gene expression signatures for CIN, we found that EC with unfavorable prognostic factors of histopathology or molecular pathology had serious CIN. However, POLE-mutant, as a favorable prognostic factor, had elevated CIN signatures, and CTNNB1-mutant, as an unfavorable prognostic factor, had decreased CIN signatures. Only if these two mutations were excluded were CIN signatures strongly prognostic for outcomes in different adjuvant radiotherapy subgroups. Integrating pathology, CIN signatures and POLE / CTNNB1 mutation stratified stageⅠendometrioid EC into four groups with improved risk prognostication and treatment recommendations.Conclusions:We revealed the possibility of integrating histopathology and molecular pathology by CIN for risk stratification in early-stage EC. Our integrated risk model deserves for further improvement and validation.

scholarly journals Integrating Pathology, Chromosomal Instability and Mutations for Risk Stratification in Early-stage Endometrioid Endometrial Carcinoma

2020 ◽  
Author(s):  
Yuan Li ◽  
Jiaqi Li ◽  
Ensong Guo ◽  
Jia Huang ◽  
Guangguang Fang ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Risk Stratification ◽  
Endometrial Carcinoma ◽  
Molecular Pathology ◽  
Chromosomal Instability ◽  
Risk Model ◽  
Early Stage ◽  
Molecular Characteristics ◽  
Molecular Stratification

Abstract Background: Risk stratifications for endometrial carcinoma (EC) depend on histopathology and molecular pathology. Histopathological risk stratification lacks reproducibility, neglects heterogeneity and contributes little to surgical procedures. Existing molecular stratification is useless in patients with specific pathological or molecular characteristics and cannot guide postoperative adjuvant radiotherapies. Chromosomal instability (CIN), the numerical and structural alterations of chromosomes resulting from ongoing errors of chromosome segregation, is an intrinsic biological mechanism for the evolution of different prognostic factors of histopathology and molecular pathology and may be applicable to the risk stratification of EC.Results: By analyzing CIN25 and CIN70, two reliable gene expression signatures for CIN, we found that EC with unfavorable prognostic factors of histopathology or molecular pathology had serious CIN. However, the POLE mutant, as a favorable prognostic factor, had elevated CIN signatures, and the CTNNB1 mutant, as an unfavorable prognostic factor, had decreased CIN signatures. Only if these two mutations were excluded were CIN signatures strongly prognostic for outcomes in different adjuvant radiotherapy subgroups. Integrating pathology, CIN signatures and POLE/CTNNB1 mutation stratified stageⅠendometrioid EC into four groups with improved risk prognostication and treatment recommendations. Conclusions: We revealed the possibility of integrating histopathology and molecular pathology by CIN for risk stratification in early-stage EC. Our integrated risk model deserves further improvement and validation.

scholarly journals Integrating pathology, chromosomal instability and mutations for risk stratification in early-stage endometrioid endometrial carcinoma

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yuan Li ◽  
Jiaqi Li ◽  
Ensong Guo ◽  
Jia Huang ◽  
Guangguang Fang ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Risk Stratification ◽  
Endometrial Carcinoma ◽  
Molecular Pathology ◽  
Chromosomal Instability ◽  
Risk Model ◽  
Early Stage ◽  
Molecular Characteristics ◽  
Molecular Stratification

Abstract Background Risk stratifications for endometrial carcinoma (EC) depend on histopathology and molecular pathology. Histopathological risk stratification lacks reproducibility, neglects heterogeneity and contributes little to surgical procedures. Existing molecular stratification is useless in patients with specific pathological or molecular characteristics and cannot guide postoperative adjuvant radiotherapies. Chromosomal instability (CIN), the numerical and structural alterations of chromosomes resulting from ongoing errors of chromosome segregation, is an intrinsic biological mechanism for the evolution of different prognostic factors of histopathology and molecular pathology and may be applicable to the risk stratification of EC. Results By analyzing CIN25 and CIN70, two reliable gene expression signatures for CIN, we found that EC with unfavorable prognostic factors of histopathology or molecular pathology had serious CIN. However, the POLE mutant, as a favorable prognostic factor, had elevated CIN signatures, and the CTNNB1 mutant, as an unfavorable prognostic factor, had decreased CIN signatures. Only if these two mutations were excluded were CIN signatures strongly prognostic for outcomes in different adjuvant radiotherapy subgroups. Integrating pathology, CIN signatures and POLE/CTNNB1 mutation stratified stageIendometrioid EC into four groups with improved risk prognostication and treatment recommendations. Conclusions We revealed the possibility of integrating histopathology and molecular pathology by CIN for risk stratification in early-stage EC. Our integrated risk model deserves further improvement and validation.

Prognostic Factors in Early-Stage Leiomyosarcoma of the Uterus

2009 ◽  
Vol 19 (3) ◽  
pp. 385-390 ◽  
Author(s):  
Manuela Pelmus ◽  
Frédérique Penault-Llorca ◽  
Louis Guillou ◽  
Françoise Collin ◽  
Gérard Bertrand ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Vascular Invasion ◽  
Early Stage ◽  
Prognostic Significance ◽  
Figo Stage ◽  
Stage I ◽  
Free Interval ◽  
Important Prognostic Factor ◽  
Pathologic Features

Uterine leiomyosarcomas (LMSs) are rare cancers representing less than 1% of all uterine malignancies. Clinical International Federation of Gynecology and Obstetrics (FIGO) stage is the most important prognostic factor. Other significant prognostic factors, especially for early stages, are difficult to establish because most of the published studies have included localized and extra-pelvian sarcomas. The aim of our study was to search for significant prognostic factors in clinical stage I and II uterine LMS. The pathologic features of 108 uterine LMS including 72 stage I and II lesions were reviewed using standardized criteria. The prognostic significance of different pathologic features was assessed. The median follow-up in the whole group was 64 months (range, 6-223 months). The 5-year overall survival (OS) and metastasis-free interval and local relapse-free interval rates in the whole group and early-stage group (FIGO stages I and II) were 40% and 57%, 42% and 50%, 56% and 62%, respectively. Clinical FIGO stage was the most important prognostic factor for OS in the whole group (P = 4 × 10−15). In the stage I and II group, macroscopic circumscription was the most significant factor predicting OS (P = 0.001). In the same group, mitotic score and vascular invasion were associated with metastasis-free interval (P = 0.03 and P = 0.04, respectively). Uterine LMSs diagnosed using standardized criteria have a poor prognosis, and clinical FIGO stage is an ominous prognostic factor. In early-stage LMS, pathologic features such as mitotic score, vascular invasion, and tumor circumscription significantly impact patient outcome.

Undifferentiated endometrial carcinoma: a National Cancer Database analysis of prognostic factors and treatment outcomes

2019 ◽  
Vol 29 (7) ◽  
pp. 1126-1133
Author(s):  
Mariam AlHilli ◽  
Paul Elson ◽  
Lisa Rybicki ◽  
Sudha Amarnath ◽  
Bin Yang ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Prognostic Factors ◽  
Adjuvant Therapy ◽  
Endometrial Carcinoma ◽  
Treatment Outcomes ◽  
Survival Data ◽  
Early Stage ◽  
National Cancer Database ◽  
Early Stage Disease ◽  
Prognostic Groups

BackgroundUndifferentiated endometrioid endometrial carcinoma of the uterus is a rare, highly aggressive, and under-recognized subtype of endometrial cancer.ObjectiveThis study evaluates survival, prognostic factors for survival, and treatment outcomes associated with undifferentiated endometrial cancer.MethodsThe National Cancer Database was queried to identify patients with undifferentiated endometrial cancer who underwent definitive primary surgical treatment. Patients with all other histologic subtypes or incomplete treatment data were excluded. Univariable and multivariable Cox proportional hazards analyses were used to determine independent prognostic factors for survival. Points for each prognostic factor were assigned from regression coefficients in the final multivariable model and summed for a total score. Recursive partitioning analysis was used to determine cut-offs in the score to identify unique prognostic groups.ResultsAmong 349 404 women diagnosed with endometrial cancer from 2004 to 2013, 3994 (1.1%) met the criteria for diagnosis of undifferentiated endometrial cancer and 3486 had survival data. Median age at diagnosis was 65 years (interquartile range (IQR) 57–74) and 58% of patients had early stage disease. Median interval from diagnosis to surgery was 3.7 weeks (IQR 2.0–5.7). Five year overall survival was 57% (standard error (SE) 1%). Stage was the strongest predictor of survival, with a 15–20% decrement in 5 year survival for each advance in stage. Stage, age, race, and presence of comorbidities were independent predictors of survival and were used to categorize patients into five prognostic groups. Adjuvant therapy was associated with improved survival across most disease stages and prognostic groups. Multimodal adjuvant therapy was superior to unimodal treatment particularly in advanced stage unfavorable and very unfavorable groups.ConclusionIn women with undifferentiated endometrial cancer, survival is primarily driven by stage. Despite the poor overall prognosis of undifferentiated endometrial cancer, multimodal adjuvant therapy is a key component of treatment.

scholarly journals Myoinvasive Pattern as a Prognostic Marker in Low-Grade, Early-Stage Endometrioid Endometrial Carcinoma

Cancers ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 1845 ◽  
Author(s):  
Ignacio Ruz-Caracuel ◽  
Jorge L Ramón-Patino ◽  
Álvaro López-Janeiro ◽  
Laura Yébenes ◽  
Alberto Berjón ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Microsatellite Instability ◽  
Endometrial Carcinoma ◽  
Early Stage ◽  
Disease Free Survival ◽  
Figo Stage ◽  
Low Grade ◽  
Gynecology And Obstetrics ◽  
Endometrioid Endometrial Carcinoma ◽  
Endometrial Carcinomas

Low-grade and early Federation for Gynecology and Obstetrics (FIGO) stage endometrioid endometrial carcinomas (EEC) have an excellent prognosis. However, approximately 10% of patients develop recurrence, which cannot be correctly predicted at diagnosis. We evaluated myoinvasive patterns as a prognostic factor of relapse in low-grade, early-stage EEC. Two-hundred and fifty-eight cases were selected according to the following inclusion criteria: (i) endometrioid endometrial carcinomas, (ii) grade 1 or 2 with (iii) FIGO stage I or II, and (iv) clinical follow-up. Slides were reviewed to annotate the myoinvasive pattern present in each case (infiltrative glands, microcystic, elongated and fragmented –MELF-, broad front, adenomyosis-like and adenoma malignum). Microsatellite instability was studied by immunoexpression of mismatch repair proteins (MLH1, PMS2, MSH2, and MSH6). There were 29 recurrences (11.2%) among the 258 cases analysed. A predominant broad front myoinvasive pattern was significantly associated with tumour relapse (p = 0.003). The presence of a pattern of infiltrative glands (p = 0.001) and microsatellite instability (p = 0.004) were associated with lower disease-free survival, without having an impact on overall survival. Our observations suggest the potential value of the pattern of myoinvasion as a prognostic factor in low-grade, early-stage endometrioid endometrial carcinoma.

scholarly journals α-Fetoprotein-Producing Endometrial Carcinoma Is Associated With Fetal Gut-Like and/or Hepatoid Morphology, Lymphovascular Infiltration, TP53 Abnormalities, and Poor Prognosis: Five Cases and Literature Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Tomoyuki Otani ◽  
Kosuke Murakami ◽  
Naoki Shiraishi ◽  
Man Hagiyama ◽  
Takao Satou ◽  
...  
Keyword(s):  
Endometrial Carcinoma ◽  
Early Stage ◽  
Direct Sequencing ◽  
Elevated Serum ◽  
Progesterone Receptors ◽  
Stage I ◽  
Molecular Characteristics ◽  
Gynecology And Obstetrics ◽  
Napsin A

The clinicopathological, immunohistochemical, and molecular characteristics of α-fetoprotein (AFP)-producing endometrial carcinoma (AFP+ EC) are poorly understood. From 284 cases of endometrial carcinoma in our pathology archive, we identified five cases (1.8%) of AFP+ EC with fetal gut–like (4/5) and/or hepatoid (2/5) morphology. All cases exhibited lymphovascular infiltration. In addition, 24 cases of endometrial carcinoma with elevated serum AFP levels were retrieved from the literature. The patient age ranged from 44 to 86 years (median: 63). Of 26 cases whose FIGO (International Federation of Gynecology and Obstetrics) stage and follow-up information was available (mean follow-up 24 months), 15 were stage I or II and 11 were stage III or IV. Even in stage I or II disease, death or relapse occurred in more than half of the patients (8/15). Detailed analysis of our five cases revealed that, on immunohistochemistry, AFP+ EC was positive for SALL4 (4/5), AFP (3/5), and HNF1β (4/5) in >50% of neoplastic cells and negative for estrogen and progesterone receptors (5/5), PAX8 (4/5), and napsin A (5/5). Four cases exhibited aberrant p53 immunohistochemistry and were confirmed to harbor TP53 mutations by direct sequencing. No mutation was found in POLE, CTNNB1, or KRAS. In conclusion, AFP+ EC merits recognition as a distinct subtype of endometrial carcinoma, which occurs in 1.8% of endometrial carcinoma cases, are associated with TP53 abnormalities, exhibit lymphovascular infiltration, and can show distant metastasis even when treated in early stage.

scholarly journals Evaluation of Depth of Invasion and Tumor Thickness as a Prognostic Factor for Early-Stage Oral Squamous Cell Carcinoma: A Retrospective Study

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 20
Author(s):  
You-Jung Lee ◽  
Tae-Geon Kwon ◽  
Jin-Wook Kim ◽  
Sung-Tak Lee ◽  
Su-Hyung Hong ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Prognostic Factors ◽  
Prognostic Factor ◽  
Oral Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Early Stage ◽  
Tumor Thickness ◽  
Depth Of Invasion ◽  
8Th Edition ◽  
T Category

The aim of this study was to compare the effect of using depth of invasion (DOI) versus tumor thickness (TT) as a prognostic factor for early-stage oral squamous cell carcinoma (OSCC). A total of 57 patients with early-stage OSCC treated surgically from 2009 to 2014 at our institution were reviewed retrospectively. Histopathological measurement of DOI and TT was performed. The validation of DOI and TT as prognostic factors was conducted using a Kaplan–Meier survival analysis. TT had no association with disease-specific survival (DSS) or progression-free survival (PFS) in this cohort; however, increased DOI was significantly associated with decreased DSS but not correlated to decreased PFS. The T category of the 7th edition of AJCC was statistically associated with both DSS and PFS; however, the T category of the 8th edition of the AJCC was only associated with DSS. In this study group, TT could not be used as a prognostic factor, and DOI was not by itself sufficient to predict prognosis for early-stage OSCC. The T category in AJCC 8th Edition cannot be considered the sole prognostic factor for early OSCC, so additional prognostic factors may need to be considered.

scholarly journals Status gizi sebagai faktor prognosis penderita karsinoma endometrium

2013 ◽  
Vol 10 (1) ◽  
pp. 10
Author(s):  
Heru Pradjatmo ◽  
Deyna Primavita Pahlevi
Keyword(s):  
Prognostic Factors ◽  
Nutritional Status ◽  
Endometrial Carcinoma ◽  
Early Stage ◽  
Rank Test ◽  
Factors Affecting ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Gynaecologic Cancer ◽  
Clinically Significant

Background: In Indonesia, endometrial cancer is the third gynaecologic cancer after cervical and ovarian cancers. Various factors affect the survival of the patients, however, which factors affect the survival of endometrial carcinoma patients in Dr. Sardjito Hospital remain unclear. A research is therefore needed in order to determine the survival and the prognostic factors.Objective: To investigate the prognostic factors that affect the survival of endometrial carcinoma patients who had been admitted to Dr. Sardjito Hospital.Method: The study design was retrospective cohort. The subjects were patients with endometrial carcinoma who were treated in Dr. Sardjito Hospital from 1st of January 2006 until 31st of December 2011. Kaplan-Meier analysis was performed to analyze several factors that influenced the survival of the patients. The differences of survival were analyzed with log rank test while the prognostic factors influencing the survival were analyzed using Cox regression.Results: 68 endometrial carcinoma patients were recruited as the subjects for the study. The median survival of endometrial carcinoma patients 52 months for those on early stage and 17 months on advanced stage (p≤0.01). The prognostic factors affecting survival that has been found statistically and clinically significant was the stage of the disease (p=0.002; HR=6.175; 95% CI=1.1980 to 19.25). Meanwhile, the nutritional status of patients with low, normal, and high BMIs score showed increased survival rate as indicated by the HR values of 1; 0.768; and 0.311 respectively.Conclusion: The prognostic factor that was clinically and statistically significant influenced the survival was the stage of the disease, while the nutritional status of patients was found clinically significant as the prognostic survival of the patients.

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