Journal
Borderline Brenner tumor with abnormally high serum level of carbohydrate antigen 199: a rare case report and literature review
Ovarian Brenner tumor with abnormally increased serum carbohydrate antigen 19-9 (CA19-9) level is extremely rare. A 70-year-old woman with abnormally elevated serum CA199 (1289 U/ml) found in routine physical examination. Pelvic CT and MRI scan revealed a large mass with large patches of calcification in the right adnexal area, and the patient achieved total hysterectomy and bilateral adnexectomy. Grossly, the right ovary had a solid enlargement of about 7.0 cm × 6.0 cm × 5.0 cm with irregular nodules and smooth surface and the cut surface of the mass showed that the tumor is cystic and solid. Microscopically, the tumor showed a background of fibrous tissue hyperplasia with nested and adenoid cell clusters with uniform cell size and clear boundaries. The cells were translucent with eosinophilic cytoplasm and calcification. Immunohistochemical staining showed CK7, CA125, and P63 presented diffusely strongly positive staining, while negativity for CK20, GATA3, AR, P53, and CgA. Ki-67 showed weak positive staining, about 1%. The serum CA199 level decreased significantly on the 5th day after surgery. Postoperative pathology and immunohistochemistry confirmed borderline Brenner tumor. This is the first to report a case of borderline Brenner tumor with an abnormally high serum level of CA199 before surgery. In clinical practice, the possibility of ovarian Brenner tumor should be considered when abnormal elevation of serum CA199 level cannot be reasonably explained.
Coexistence of uterine adenomyosis is not associated with a better prognosis in endometrioid-type endometrial cancer
Prognostic value of accompanying adenomyosis in endometrial cancer is the subject of interest due to their common etiology and co-occurrence frequency. However, it is still unclear whether adenomyosis has a role in the prognosis of endometrial cancer. The aim of this study was to determine the effects of adenomyosis on the prognosis of patients with endometrial cancer. In this study, medical records of 552 patients with endometrioid endometrial cancer who underwent surgery between 2007 and 2017 were retrospectively reviewed. The patients were divided into two groups based on the presence or absence of adenomyosis, and these two groups were compared in terms of the clinicopathological factors and survival outcomes of patients. Of these patients, 103 (18.7%) had adenomyosis, and the remaining 449 (81.3%) did not. The endometrial cancer patients with adenomyosis exhibited earlier stages (p < 0.001), lower tumor grades (p < 0.001), tumor sizes ≤ 2 cm (p = 0.002), myometrial invasion < 50% (p < 0.001), and negative lymphovascular space invasion (p < 0.001). The 5-year overall survival rate was comparable between the adenomyosis and non-adenomyosis groups (95 vs. 89.1%, respectively; p = 0.085). The presence of adenomyosis was significantly associated with a higher 5-year disease-free survival rate (95.1 vs. 87.9%; p = 0.047), but adenomyosis did not remain as a prognostic factor in multivariate analysis. The results of our study showed that the endometrioid endometrial cancer patients with adenomyosis are significantly associated with smaller tumor sizes, less myometrial invasion, lower tumor grades, less lymphovascular space invasion, and earlier FIGO stages. Nevertheless, adenomyosis was not found to be an independent prognostic factor for endometrioid endometrial cancer.
Clinical significance of kinesin family member 2A as a facilitating biomarker of disease surveillance and prognostication in cervical cancer patients
Cervical cancer is one of the most common and fatal malignancies among females, and biomarkers are essential for assisting in its management. Kinesin family member 2A (KIF2A) has been exhibited to be a potential maker in various cancers; however, its role in cervical cancer has yet to be reported. Therefore, we aimed to assess the expression of KIF2A and its correlation with clinicopathological characteristics as well as survival profile in cervical cancer patients. A hundred and thirty-five cervical cancer patients who underwent simple trachelectomy or radical hysterectomy were retrospectively analyzed. Tumor tissues and paired adjacent tissues were acquired, in which KIF2A mRNA and protein expressions were determined by reverse transcription quantitative polymerase chain reaction and immunohistochemistry assay, respectively. Disease-free survival (DFS) and overall survival (OS) were documented with a median follow-up duration of 28.0 months. KIF2A protein (P < 0.001) and mRNA (P < 0.001) expressions were both upregulated in tumor tissues compared to paired adjacent tissues in cervical cancer patients. In addition, tumor tissue KIF2A protein and mRNA expressions were positively associated with lymph node metastasis (P = 0.025 and P = 0.010, respectively) and FIGO stage (P = 0.022 and P = 0.015, respectively) in cervical cancer patients. Moreover, patients with tumor tissue KIF2A high expression (mRNA and protein) displayed worse DFS (P = 0.010 and P = 0.046, respectively) and OS (P = 0.042 and P = 0.030, respectively) compared to patients with tumor tissue KIF2A low expression (mRNA and protein). Tumor tissue KIF2A expression could serve as a biomarker enhancing the disease surveillance and prognostication in cervical cancer management.
Sirtuin2 correlates with lymph node metastasis, increased FIGO stage, worse overall survival, and reduced chemosensitivity to cisplatin and paclitaxel in endometrial cancer
This study aimed to investigate the correlation of sirtuin2 (SIRT2) with clinical characteristics, prognosis in endometrial cancer (EC) patients, and its effect on chemosensitivity in EC cell lines. A total of 137 EC patients who underwent surgical resection were retrospectively enrolled. SIRT2 expression in tumor tissues (n = 137) and adjacent tissues (n = 61) was detected by immunohistochemistry (IHC) staining and evaluated by a semiquantitative scoring method. EC patients' clinical characteristics and survival data were collected. Besides, SIRT2 was modulated by plasmid transfection in EC cells, then their chemosensitivity to cisplatin and paclitaxel was evaluated. SIRT2 was increased in tumor tissues compared with adjacent tissues (reflected by both IHC score and high-expression ratio, both P < 0.001). Meanwhile, tumor SIRT2 was positively correlated with lymph node metastasis (P = 0.037) and the International Federation of Gynecology and Obstetrics (FIGO) stage (P = 0.044), but not other clinical characteristics. Moreover, tumor SIRT2 high expression was correlated with worse overall survival (OS) (P = 0.023), while it could not independently predict OS (P = 0.090, hazard ratio = 2.782). Besides, both mRNA and protein levels of SIRT2 were increased in Ishikawa (P = 0.035) and KLE (P < 0.001) cells compared with human endometrial epithelial cells. SIRT2 overexpression decreased chemosensitivity to cisplatin and paclitaxel in Ishikawa cells, while SIRT2 knockdown increased chemosensitivity to cisplatin and paclitaxel in KLE cells (all P < 0.05). SIRT2 correlates with lymph node metastasis, increased FIGO stage, worse OS, and reduced chemosensitivity to cisplatin and paclitaxel in EC.
High keratin 15 expression reflects favorable prognosis in early cervical cancer patients
Keratin 15 (KRT15) exhibits inconsistent prognostic roles in different cancers, and its prognostic value in early cervical cancer patients who receive tumor resection remains unknown. This study aimed to assess the relationship of KRT15 expression with prognosis in these patients. Totally, 147 early cervical cancer patients who received tumor resection were reviewed in this retrospective study. KRT15 was detected in formalin-fixed paraffin-embedded tumor tissue by immunohistochemistry (IHC). KRT15 IHC scores were computed by multiplying the percentage of positively stained cells (scored as 0-4) and corresponding staining intensity (scored as 0-3), ranging from 0 to 12. Elevated KRT15 IHC score was linked with moderate to well differentiation (P = 0.005), tumor size ≤ 4 cm (P = 0.017), and International Federation of Gynecology and Obstetrics (FIGO) stage Ia/Ib (P 0.05). KRT15 IHC score ≥ 3 and KRT15 IHC score ≥ 6 could not predict DFS or OS (all P > 0.05). By subgroup analyses, KRT15 IHC score ≥ 1 forecasted favorable DFS in patients with age > 45 years, human papillomavirus-positive, squamous carcinoma, and tumor size ≤ 4 cm (all P < 0.05). KRT15 IHC score ≥ 1 and KRT15 IHC score ≥ 3 predicted ascended DFS in patients without adjuvant radiotherapy or adjuvant chemotherapy (all P < 0.05). High KRT15 expression reflects favorable tumor features and longer survival in early cervical cancer patients who receive tumor resection.
The effect of HPV vaccination on the rate of high-grade cytology in 25-year-old women attending cervical screening in Ireland
Abstract Introduction Women vaccinated through the initial catch-up HPV vaccination programme (2011/12 to 2013/14) first became eligible for cervical screening in 2019 at age 25. This study aims to examine the changes in detection of HG cytology outcomes in 25-year-olds screened from 2010 to 2022 compared to population data on HPV vaccination in this group. Methods This was an ecological-type study. Cytology results from the CervicalCheck database from 2010 to 2022 (High Grade, Low Grade, and No Abnormality Detected) were plotted against data from the National Immunisation Office on the uptake of HPV vaccinations in females from 2010 to 2022. Results Vaccination rates in the catch-up programme were lower (44–70%) than for routine HPV immunisation at age 12/13 in 2010/11 (81%). The rate of high-grade cytology in 25-year-olds in 2015–2018 was 3.7% of all cytology tests taken in this age group. For the corresponding period from 2019 to 2022 (when vaccinated women were attending screening), the average percentage of HG cytology in 25-year-olds was 1.5%, representing a significant reduction in HG cytology proportions (p < 0.001). Conclusion This study provides early evidence of the potential impact of HPV vaccination on cervical disease in the Republic of Ireland. Despite lower vaccination uptake in the initial catch-up group, we are seeing early signs of the positive protective effect of HPV vaccination in women at the time of their first cervical screening test. Plans to incorporate individual-level HPV vaccination status for women on the cervical screening register will allow more detailed assessment of the impact of HPV vaccination.
Cognitive behavioral stress management is an effective intervention to relieve anxiety and depression, improve the quality of life in patients with cervical cancer
Cognitive behavioral stress management (CBSM) modifies individuals' maladaptive cognition and improves their ability in managing stress. The present study was to inquire about the utility of CBSM in mental health and quality of life in patients with cervical cancer. Totally, 172 postoperative cervical cancer patients were randomly classified into CBSM (N=86) and normal care group (N=86) to receive 8-week CBSM and normal care, correspondingly. Self-rating anxiety/depression scale (SAS/SDS), EuroQol-5 dimensions (EQ-5D), EuroQol-visual analogue scale (EQ-VAS), and quality of life questionnaire-core 30 (QLQ-C30) scores were evaluated at discharge (M0), 1 SAS scores at M6 (P=0.003), M1 (P=0.042), and M3 (P=0.010), and the proportion of patients with SAS-defined anxiety at M3 (P=0.040) and M6 (P=0.019) were reduced in CBSM group versus normal care group. SDS scores at M3 (P=0.020) and M6 (P=0.016), and the proportion of patients with SDS-defined depression at M6 (P=0.036) was descended in CBSM group versus normal care group. EQ-VAS score at M1 (P=0.044), M3 (P=0.014), and M6 (P=0.002) were increased, while EQ-5D score at M3 (P=0.030) was descended in CBSM group versus normal care group. Meanwhile, QLQ-C30 global health status score at M1 (P=0.046), M3 (P=0.037), and M6 (P=0.007), QLQ-C30 function score at M3 (P=0.033) and M6 (P=0.016) were ascended, but QLQ-C30 symptom score at M3 (P=0.042) was declined in CBSM group versus normal care group. CBSM is an effective intervention for decreasing anxiety and depression, and improving quality of life in patients with cervical cancer.
Effects of human papillomavirus and LEEP on sexual function
Human papillomavirus (HPV) infection is the most common sexually transmitted viral infection in humans. We evaluated the sexual function of human papillomavirus positive patients after colposcopy and loop electrosurgical excision procedure (LEEP). This study enrolled 344 patients with an HPV infection detected on routine screening in 2020-2022. Sexual function was evaluated using the Female Sexual Function Index (FSFI), which consists of six sections: desire, arousal, lubrication, orgasm, satisfaction, and pain. The mean age of the 344 HPV-positive patients was 37.2 ± 8.2 years, and 28.2% of them were unmarried. Colposcopy, cervical biopsy, and LEEP were performed in 251 (73.0%), 189 (54.9%), and 42 (12.2%) patients, respectively. The sexual history and FSFI scores of the patients were recorded. The total and individual parameter scores on the FSFI decreased significantly after colposcopy. Similarly, the total and individual parameter scores on the FSFI were lower at 8 weeks after LEEP compared to those before LEEP. Cancer-related fear and anxiety and LEEP may cause sexual dysfunction in HPV-positive patients.
A comprehensive systematic review of prognostic factors, survival outcomes, and the role of targeted therapies in endometrial cancer
Endometrial cancer, ranking as the 6th most prevalent cancer affecting women globally, is characterized by high mortality rates, recurrence, and poor prognosis. The disease lacks comprehensive understanding and effective treatment options. This meta-analysis focuses on randomized controlled trials to investigate targeted therapies, survival outcomes, and prognostic factors in endometrial cancer. The study follows the PICOS protocol and PRISMA guidelines, utilizing Review Manager Software (Version 5.4) for meta-analyses. Predetermined outcomes relevant to the topic guide the study search, with the GRADE tool assessing the quality of evidence and Begg's formula and Kendall's Tau evaluating certainty. Results reveal oral anastrozole and vistusertib's efficacy, reducing progression-free survival (PFS) and enhancing protein detection. The meta-analysis indicates that targeted therapies do not significantly improve PFS but reduce adverse effects. Chemotherapy does not considerably improve survival rates, and interventions show no significant difference in prognostic factors. In conclusion, anastrozole and vistusertib emerge as effective targeted therapies for endometrial cancer, supported by clinical trial evidence demonstrating reduced PFS and improved protein detection. Additionally, the carboplatin-paclitaxel combination and radiotherapy in monotherapy show promising clinical outcomes. These findings contribute to a comprehensive understanding of prognostic factors, targeted therapies, and survival outcomes in endometrial cancer, emphasizing the need for further research and clinical trials for optimal disease management.
Proposing a novel care program: reminiscence therapy involved care for anxiety, depression, and quality of life in postoperative cervical cancer patients
Reminiscence therapy (RT) relieves mental disorders and improves quality of life (QoL) in some cancer survivors, but in postoperative cervical cancer patients, its effect is unclear. This study aimed to assess the impact of reminiscence therapy involved care (RTIC) and usual care (UC) on anxiety, depression, QoL, and survival in postoperative cervical cancer patients. In this randomized control study, 152 eligible postoperative cervical cancer patients were randomized as 1:1 ratio into RTIC (N = 76) and UC (N = 76) groups: the former received routine care and RT, while the latter only received routine care for 12 months. Anxiety, depression, and QoL were evaluated from baseline (month (M) 0) to M12, respectively. Patients were continuously followed up to M36 for overall survival (OS) calculation. HADS-Anxiety score from M6 to M12 was decreased; both HADS-Depression score from M9 to M12 and depression rate at M12 were reduced in RTIC group compared with UC group (all P < 0.05). QLQ-C30 global health status score at M6 and M12, as well as QLQ-C30 function score at M12, was increased in RTIC group compared with UC group (all P < 0.05). However, QLQ-C30 symptom score at each visit and OS exhibited no difference between the two groups. From sub-group analysis, RTIC disclosed a distinct effect on patients whose age ≥ 50 years but not on those < 50 years. RTIC reduces anxiety (partly) and depression and improves QoL in postoperative cervical cancer patients, especially in old patients.
Springer Science and Business Media LLC
0021-1265
