Could Galectin 3 Be a Good Prognostic Factor in Endometrial Cancer?

Galectin 3 is a modulator of several basic biological functions. It may be involved in the development of obesity and type 2 diabetes—risk factors of endometrial cancer. The study involved 144 patients, after abrasion due to postmenopausal bleeding. Galectin 3 concentrations were quantified in serum by multiplex fluorescent bead-based immunoassays. Median serum galectin 3 concentrations revealed significant differences between FIGO III and IV vs. FIGO I and II patients. Statistically higher concentrations were reported for patients with lymph node metastases compared to patients without it (p = 0.001) as well as in patients with lymphovascular space invasion compared to patients without LVSI (p = 0.02). No statistically significant differences were observed for median of galectin 3 levels depending on the surgical procedure (laparoscopy vs. laparotomy, p = 0.0608). Patients with galectin 3 levels exceeding the median value were characterized by overall survival being shorter by 11.9 months. High levels of galectin 3 were correlated with shorter disease-free survival, the difference is up to 14.8 months. Galectin 3 can be an independent prognostic factor in patients with endometrial cancer. Among the recognized prognostic factors and the concentrations of the galectin 3 marker at the adopted time points, the univariate analysis showed a significant effect of staging, grading, and cutoff galectin 3 on the OS. For multivariate analysis, the galectin 3 cutoff point had the greatest significant impact on OS.

Download Full-text

Expression of L1CAM and KI-67 in Endometrial Cancer of Egyptian Females: Clinical Impact and Survival

Tumori Journal ◽

10.1177/0300891620914173 ◽

2020 ◽

Vol 106 (1_suppl) ◽

pp. 36-36

Author(s):

Fatma Gharib ◽

Dareen Abd elaziz mohamed ◽

Basma Saed Amer

Keyword(s):

Endometrial Cancer ◽

Endometrial Adenocarcinoma ◽

Univariate Analysis ◽

Disease Free Survival ◽

Rank Test ◽

Significant Heterogeneity ◽

Ki 67 ◽

Free Survival ◽

Disease Free ◽

L1cam Expression

Introduction: Endometrial adenocarcinoma is characterized by a good prognosis. However, the disease response shows a significant heterogeneity. Treatment of endometrial cancer (EC) is still based on clinico-pathological parameters, which have limited role in risk stratification. There is a need for more determinant markers, such as L1 Cell Adhesion Molecule (L1CAM), to identify patients at higher risk of relapse and tailor a more convenient treatment. L1CAM has a capacity to enhance cell motility and promote tumor invasion in different malignancies. In Egypt, the incidence rate of EC is growing over time. Especially in Elgharbiah governorate (home of this study). L1CAM expression and Ki-67 was reported and compared with other clinico-pathological criteria. Method: Seventy-six female patients of endometrial carcinomas were involved in this prospective study. The patients were treated and followed up at Tanta University Hospitals in the period between January 2015 to April 2019. L1CAM expression and Ki-67 was detected by immuno-histochemical exam and compared with other clinico-pathological criteria. Survival was assessed and compared by Kaplan-Meier curves and log-rank test. Results: Positive L1CAM expression was detected in 17 patients (22.4%) and was significantly correlated with unfavorable prognostic factors such as higher stage and grade ( P= 0.021 and P =0.001 respectively), lympo-vascular invasion ( P <0.001), non-endometroid type ( P <0.027) and Ki-67 ( P= 0.003). Univariate analysis revealed that: positive L1CAM; higher tumor grade; high stage; and non-endometrioid type were significantly associated with shorter disease-free survival (DFS) but no significant correlation was detected between Ki-67 and DFS. In multivariate analysis, positive L1CAM remained statistically significant with DFS [P =0.045; 95%CI (1.028:11.17); HR=3.38]. Conclusion: Our study indicates that L1CAM expression and Ki-67 are significantly associated with poor tumor characteristics. L1CAM is significantly associated with shorter disease-free survival and may be a helpful tool as a part of a simple clinical molecular classification for EC.

Download Full-text

Relationship between the classification of vascular invasion severity and the prognosis of uterine endometrial cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200301000-00009 ◽

2003 ◽

Vol 13 (1) ◽

pp. 47-52

Author(s):

J. Kuroki ◽

K. Hasegawa ◽

R. Kato ◽

J. Mizukawa ◽

E. Nishio ◽

...

Keyword(s):

Endometrial Cancer ◽

Survival Rate ◽

Prognostic Factor ◽

Vascular Invasion ◽

Disease Free Survival ◽

Free Survival ◽

Uterine Endometrial Cancer ◽

Disease Free Survival Rate ◽

Disease Free

The objective of this research is whether the classification of vascular invasion severity can be used as a prognostic factor in cases of uterine endometrial cancer. Sixty-five patients with stage I to III uterine endometrial cancer were included in the study. All patients were seen between 1987 and 1997, and the types of their cancers were histologically confirmed. The degree of vascular invasion was classified according to three different systems: (1) positive or negative; (2) negative, mild, or severe; and (3) negative, mild, moderate, or severe. For each classification, the disease-free survival rate was calculated according to various pathologic factors using the Wilcoxon test; multivariate analyses were performed using the Cox proportional hazard model.Patients with severe vascular invasion showed a significantly lower disease-free survival rate than did patients with moderate or less severe invasion. In the multivariate analysis, severe vascular invasion was shown to be an independent prognostic factor indicating a high relative risk. We conclude that the severity of vascular invasion is an important histopathologic factor in determining the prognosis of uterine endometrial cancer. Vascular invasion classification systems employing three subjective or four objective categories may be more appropriate than a positive/negative classification system for judging the prognosis in cases of uterine endometrial cancer.

Download Full-text

Predictive Factors of Early Recurrence in Patients with Distal Cholangiocarcinoma after Pancreaticoduodenectomy

Gastroenterology Research and Practice ◽

10.1155/2018/6431254 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Yasuhiro Ito ◽

Yuta Abe ◽

Tomohisa Egawa ◽

Minoru Kitago ◽

Osamu Itano ◽

...

Keyword(s):

Univariate Analysis ◽

Disease Free Survival ◽

Late Recurrence ◽

Early Recurrence ◽

Lymphatic Invasion ◽

Distal Cholangiocarcinoma ◽

Free Survival ◽

Node Metastases ◽

Pancreatic Invasion ◽

Disease Free

Aim. To determine the factors associated with early recurrence in patients with distal cholangiocarcinoma after pancreaticoduodenectomy (PD).Patients and Methods. Sixty-one patients with distal cholangiocarcinoma were enrolled. The clinical data and histopathological findings were collected retrospectively.Results. Patients were divided into two groups as follows: 16 patients (26%) with early recurrence and 45 patients (74%) with late recurrence or no recurrence. In a univariate analysis, lymph node metastases (P=0.0016), lymphatic invasion (P<0.0001), pancreatic invasion (P=0.0006), and perineural invasion (P=0.0004) were significantly different between the two groups. In a multivariate analysis, a higher incidence of lymphatic invasion was the only independent risk factor for early recurrence (odds ratio: 5.772, 95% confidence interval: 1.123–29.682,P=0.036). Moreover, the disease-free survival and overall survival of patients with a higher incidence of lymphatic invasion were significantly worse compared with those of patients with a lower incidence of lymphatic invasion (P<0.001).Conclusions. Our study showed that a higher incidence of lymphatic invasion was a significant predictor of early recurrence in patients with distal cholangiocarcinoma. Therefore, lymphatic invasion might be useful in determining the optimal adjuvant therapy in the early postoperative stage for distal cholangiocarcinoma.

Download Full-text

The prognostic value of histopathologic grading parameters and microvessel density in patients with early squamous cell carcinoma of the uterine cervix.

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200201000-00006 ◽

2002 ◽

Vol 12 (1) ◽

pp. 32-41 ◽

Cited By ~ 3

Author(s):

M Graflund ◽

B Sorbe ◽

A Hussein ◽

M Bryne ◽

M Karlsson

Keyword(s):

Lymph Node ◽

Prognostic Factor ◽

Squamous Cell ◽

Microvessel Density ◽

Lymph Node Metastases ◽

Disease Free Survival ◽

Lymph Node Status ◽

Free Survival ◽

Node Metastases ◽

Disease Free

Abstract.Graflund M, Sorbe B, Hussein A, Bryne M, Karlsson M.The purpose of this study was to investigate the prognostic importance of clinical and histopathologic factors, including malignancy grading systems (MGS), partial index (PI), invasive front grading (IFG), and microvessel density. A complete geographic series of 172 early stage (FIGO I–II) cervical carcinomas treated by Wertheim-Meigs surgery during the period 1965–1990 was studied. The patients were followed up for at least 10 years. Significant prognostic factors for disease-free survival were lymph node status (P < 0.0000001), radical surgical margins (P = 0.00003), and tumor size (P = 0.008). In a multivariate Cox analysis it was shown that lymph node status was the single most important prognostic factor with regard to disease-free survival. The total MGS and the PI scores were highly significantly (P = 0.0001) associated with pelvic lymph node metastases and disease-free survival rate in squamous cell carcinomas. The MGS and the PI systems were superior to the IFG system in predicting lymph node metastases. The total IFG score was also a statistically highly significant (P = 0.003) prognostic factor with regard to disease-free survival in both univariate and multivariate analyses. Microvessel density was a nonsignificant prognostic factor. There was a highly significant (P = 0.002) association between vascular space invasion of tumor cells and the presence of lymph node metastases. In conclusion, histopathologic malignancy grading systems provide valuable prognostic information in patients with early stage squamous cell carcinomas of the uterine cervix.

Download Full-text

Role of adjuvant therapy in stage IIIC2 endometrial cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001446 ◽

2020 ◽

Vol 30 (8) ◽

pp. 1169-1176

Author(s):

Giorgio Bogani ◽

Serena Cappuccio ◽

Jvan Casarin ◽

Deepa Maheswari M Narasimhulu ◽

William A Cilby ◽

...

Keyword(s):

Overall Survival ◽

Endometrial Cancer ◽

Adjuvant Therapy ◽

External Beam Radiotherapy ◽

Disease Free Survival ◽

External Beam ◽

Free Survival ◽

Radiotherapy Alone ◽

Node Metastases ◽

Disease Free

ObjectiveThe role of the different types of adjuvant treatments in endometrial cancer with para-aortic node metastases is unclear. The aim of this study was to report oncologic outcomes after adjuvant therapy in patients with stage IIIC2 endometrial cancer.MethodsThis retrospective single-institution study assessed patients with stage IIIC2 endometrial cancer who underwent primary surgery from January 1984 to December 2014. All patients had hysterectomy (±salpingo-oophorectomy) plus lymphadenectomy (para-aortic nodes, ±pelvic nodes). We included all patients with stage III endometrial cancer and documented para-aortic lymph node metastases (International Federation of Obstetrics and Gynecologists stage IIIC2). We excluded patients who did not provide consent, who had synchronous cancer, or who underwent neoadjuvant chemotherapy. Follow-up was restricted to the first 5 years post-operatively. Cox proportional hazards models, with age as the time scale, was used to evaluate associations of risk factors with disease-free survival and overall survival.ResultsAmong 105 patients with documented adjuvant therapy, external beam radiotherapy was administered to 25 patients (24%), chemotherapy to 24 (23%), and a combination (chemotherapy and external beam radiotherapy) to 56 (53%) patients. Most patients receiving chemotherapy and external beam radiotherapy (80%) had chemotherapy first. The majority of relapses had a distant component (31/46, 67%) and only one patient had an isolated para-aortic recurrence. Non-endometrioid subtypes had poorer disease-free survival (HR 2.57; 95% CI 1.38 to 4.78) and poorer overall survival (HR 2.00; 95% CI 1.09 to 3.65) compared with endometrioid. Among patients with endometrioid histology (n=60), chemotherapy and external beam radiotherapy improved disease-free survival (HR 0.22; 95% CI 0.07 to 0.71) and overall survival (HR 0.28; 95% CI 0.09 to 0.89) compared with chemotherapy or external beam radiotherapy alone. Combination therapy did not improve prognosis for patients with non-endometrioid histology (n=45).ConclusionsIn our cohort of patients with stage IIIC2 endometrioid endometrial cancer, those receiving chemotherapy and external beam radiotherapy had improved survival compared with patients receiving chemotherapy or external beam radiotherapy alone. However, the prognosis of patients with non-endometrioid endometrial cancer remained poor, regardless of the adjuvant therapy administered. Distant recurrences were the most common sites of failure.

Download Full-text

Significance of frailty in prognosis after hepatectomy in older patients with hepatocellular carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.590 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 590-590 ◽

Cited By ~ 1

Author(s):

Shinichiro Yamada ◽

Mitsuo Shimada ◽

Yuji Morine ◽

Satoru Imura ◽

Tetsuya Ikemoto ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factor ◽

Prognostic Score ◽

Univariate Analysis ◽

Disease Free Survival ◽

Independent Prognostic Factor ◽

Tumor Diameter ◽

Free Survival ◽

Significant Difference ◽

Disease Free

590 Background: An aging society has come, and “Frailty” is becoming increasingly important in surgery. Recently, clinical frail scale (CFS), which is simple criteria for frailty, has been reported to be useful for prognostic prediction of non-cardiac surgery (Ann Surg. 2018). Herein we report a new knowledge about frailty for patients with hepatocellular carcinoma (HCC) undergoing hepatectomy. Methods: Eighty-one patients over 75 years who underwent hepatectomy for HCC between 2007 and 2018 were enrolled in this study. Frailty was diagnosed as CFS≥4, and patient were divided into 2 groups, frailty (n = 17) and no frailty (n = 64). Clinicopathological factors were compared between 2 groups. Results: Patients’ background, such as age, gender, preoperative comorbidity, and liver function showed no significant difference between 2 groups. Regarding tumor factors, frailty group showed significant larger tumor diameter, more advanced stage (p < 0.05) and tendency of high PIVKA-II (p = 0.15) compared with no frailty group. Frailty group showed significant high CRP level (p < 0.01), high modified Glasgow prognostic score (mGPS, p = 0.04) and tendency of high neutrophil-lymphocyte ratio (NLR, p = 0.14). Frailty group also showed tendency of higher rate of postoperative complication (p = 0.11) and longer postoperative hospital stay (p = 0.09). Overall and disease-free survival rate were significantly worse in frailty group (p = 0.03). In univariate analysis for overall survival, AFP≥10, PIVKA-II≥400, frailty and mGPS high (1, 2) were prognostic factor. Multivariate analysis revealed that frailty was independent prognostic factor. In univariate analysis of disease-free survival, only frailty was detected as prognostic factor. Conclusions: Frailty is an independent prognostic factor for HCC patients who underwent hepatectomy.

Download Full-text

Prognostic Value of the Hemoglobin/Red Cell Distribution Width Ratio in Resected Lung Adenocarcinoma

Cancers ◽

10.3390/cancers13040710 ◽

2021 ◽

Vol 13 (4) ◽

pp. 710

Author(s):

Francesco Petrella ◽

Monica Casiraghi ◽

Davide Radice ◽

Andrea Cara ◽

Gabriele Maffeis ◽

...

Keyword(s):

Prognostic Factor ◽

Lung Adenocarcinoma ◽

Disease Free Survival ◽

Red Cell Distribution Width ◽

Red Cell ◽

Cell Distribution ◽

Distribution Width ◽

Free Survival ◽

Node Involvement ◽

Disease Free

Background: The ratio of hemoglobin to red cell distribution width (HRR) has been described as an effective prognostic factor in several types of cancer. The aim of this study was to investigate the prognostic role of preoperative HRR in resected-lung-adenocarcinoma patients. Methods: We enrolled 342 consecutive patients. Age, sex, surgical resection, adjuvant treatments, pathological stage, preoperative hemoglobin, red cell distribution width, and their ratio were recorded for each patient. Results: Mean age was 66 years (SD: 9.0). There were 163 females (47.1%); 169 patients (49.4%) had tumors at stage I, 71 (20.8%) at stage II, and 102 (29.8%) at stage III. In total, 318 patients (93.0%) underwent lobectomy, and 24 (7.0%) pneumonectomy. Disease-free survival multivariable analysis disclosed an increased hazard ratio (HR) of relapse for preoperative HRR lower than 1.01 (HR = 2.20, 95%CI: (1.30–3.72), p = 0.004), as well as for N1 single-node (HR = 2.55, 95%CI: (1.33–4.90), p = 0.005) and multiple-level lymph node involvement compared to N0 for both N1 (HR = 9.16, 95%CI:(3.65–23.0), p < 0.001) and N2 (HR = 10.5, 95%CI:(3.44–32.2, p < 0.001). Conclusion: Pre-operative HRR is an effective prognostic factor of disease-free survival in resected-lung-adenocarcinoma patients, together with the level of pathologic node involvement.

Download Full-text

Circulating tumor DNA as a prognostic marker in high-risk endometrial cancer

Journal of Translational Medicine ◽

10.1186/s12967-021-02722-8 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Weiwei Feng ◽

Nan Jia ◽

Haining Jiao ◽

Jun Chen ◽

Yan Chen ◽

...

Keyword(s):

Endometrial Cancer ◽

High Risk ◽

Tumor Recurrence ◽

Disease Free Survival ◽

Circulating Tumor Dna ◽

Plasma Samples ◽

Free Survival ◽

Tumor Relapse ◽

Disease Free ◽

Tumor Dna

Abstract Background Currently, there is no reliable blood-based marker to track tumor recurrence in endometrial cancer (EC) patients. Liquid biopsies, specifically, circulating tumor DNA (ctDNA) analysis emerged as a way to monitor tumor metastasis. The objective of this study was to examine the feasibility of ctDNA in recurrence surveillance and prognostic evaluation of high-risk EC. Methods Tumor tissues from nine high-risk EC patients were collected during primary surgery and tumor DNA was subjected to next generation sequencing to obtain the initial mutation spectrum using a 78 cancer-associated gene panel. Baseline and serial post-operative plasma samples were collected and droplet digital PCR (ddPCR) assays for patient-specific mutations were developed to track the mutations in the ctDNA in serial plasma samples. Log-rank test was used to assess the association between detection of ctDNA before or after surgery and disease-free survival. Results Somatic mutations were identified in all of the cases. The most frequent mutated genes were PTEN, FAT4, ARID1A, TP53, ZFHX3, ATM, and FBXW7. For each patient, personalized ddPCR assays were designed for one-to-three high-frequent mutations. DdPCR analysis and tumor panel sequencing had a high level of agreement in the assessment of the mutant allele fractions in baseline tumor tissue DNA. CtDNA was detected in 67% (6 of 9) of baseline plasma samples, which was not predictive of disease-free survival (DFS). CtDNA was detected in serial post-operative plasma samples (ctDNA tracking) of 44% (4 of 9) of the patients, which predicted tumor relapse. The DFS was a median of 9 months (ctDNA detected) versus median DFS undefined (ctDNA not detected), with a hazard ratio of 17.43 (95% CI, 1.616–188.3). The sensitivity of post-operative ctDNA detection in estimating tumor relapse was 100% and specificity was 83.3%, which was superior to CA125 or HE4. Conclusions Personalized ctDNA detection was effective and stable for high-risk EC. CtDNA tracking in post-operative plasma is valuable for predicting tumor recurrence.

Download Full-text