Diagnosis and Management of Endometrial Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 52002

Special Issue Editors

Translational Medical Oncology, CIBERONC, Health Research Institute of Santiago (IDIS), University Hospital of Santiago (SERGAS), 15706 Santiago de Compostela, Spain
Interests: gynecological oncology; endometrial cancer; metastasis; translational research; biomarkers.
Special Issues, Collections and Topics in MDPI journals
Translational Medical Oncology, CIBERONC, Health Research Institute of Santiago (IDIS), University Hospital of Santiago (SERGAS), 15706 Santiago de Compostela, Spain
Interests: gynecological oncology; endometrial cancer; liquid biopsy; circulating tumor cells; ctDNA
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Endometrial cancer (EC) represents the most common gynecological tumor with an increasing incidence. Although EC is considered a tumor with relatively positive prognosis, a relevant percentage of advanced carcinomas and aggressive histologies are still associated with poor prognosis and death. Main challenges for improving EC management include early diagnosis, risk stratification, control of recurrent disease, or more appropriate therapeutic strategies integrating mutational profiles.

This Special Issue proposes a comprehensive perspective on these topics together with an update on those relevant clinical issues in EC, from screening strategies based on molecular imaging and biomarkers, to advances in surgical interventions, liquid biopsy monitoring, preclinical models and translational research, or the perspective from the patients and the social impact of EC.

Dr. Miguel Abal
Guest Editor
Dr. Laura Muinelo-Romay
Co-Guest Editor

Manuscript Submission Information

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Keywords

  • endometrial cancer
  • diagnosis
  • molecular profiling
  • biomarkers
  • surgery
  • radiotherapy, chemotherapy
  • liquid biopsy
  • target therapies
  • preclinical research

Published Papers (12 papers)

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Research

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11 pages, 790 KiB  
Article
Sentinel Lymph Node Biopsy in Endometrial Cancer: Dual Injection, Dual Tracer—A Multidisciplinary Exhaustive Approach to Nodal Staging
by Anna Torrent, Joana Amengual, Catalina Maria Sampol, Mario Ruiz, Jorge Rioja, Gabriel Matheu, Pilar Roca and Octavi Cordoba
Cancers 2022, 14(4), 929; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14040929 - 13 Feb 2022
Cited by 9 | Viewed by 2452
Abstract
Introduction: Sentinel lymph node (SLN) has recently been introduced as a standard staging technique in endometrial cancer (EC). There are some issues regarding team experience and para-aortic detection. Objective: to report the accuracy of SLN detection in EC with a dual tracer (ICG [...] Read more.
Introduction: Sentinel lymph node (SLN) has recently been introduced as a standard staging technique in endometrial cancer (EC). There are some issues regarding team experience and para-aortic detection. Objective: to report the accuracy of SLN detection in EC with a dual tracer (ICG and Tc99) and dual injection site (cervix and fundus) during the learning curve. Methods: A prospective, observational single-center trial including 48 patients diagnosed with early-stage EC. Dual intracervical tracer (Tc99 and ICG) was injected at different times. High-risk patients had a second fundus injection with both tracers. Results: the detection rates were as follows: 100% (48/48) overall for SLNs; 98% (47/48) overall for pelvic SLNs; 89.5% (43/48) for bilateral SLNs; and 2% (1/48) for isolated para-aortic SLNs. In high-risk patients, the para-aortic overall DR was 66.7% (22/33); 60.7% (17/28) with ICG and 51.5% (17/33) with Tc99 (p = 0.048)). Overall rate of lymph node involvement was 14.6% (7/48). Macroscopic pelvic metastasis was found in four patients (8.3%) and microscopic in one case (2%). No metastasis was found in any para-aortic SLNs. Half of the patients with positive pelvic SLNs had positive para-aortic nodes. In high-risk patients, when para-aortic SLNs mapped failed, 36.4% (4/11) had positive nodes in para-aortic lymphadenectomy. The sensitivity and negative predictive value (NPV) of SLN pelvic detection was 100%. Conclusions: Multidisciplinary exhaustive approach gives a suitable accuracy of SLN during learning curve. Dual injection (cervical and fundal) with dual tracer (ICG and Tc99) offers good overall detection rates and increases para-aortic SLN detection. Full article
(This article belongs to the Special Issue Diagnosis and Management of Endometrial Cancer)
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9 pages, 884 KiB  
Article
Clinicopathologic vs. Molecular Integrated Prognostication of Endometrial Carcinoma by European Guidelines
by Mikko Loukovaara, Annukka Pasanen and Ralf Bützow
Cancers 2022, 14(3), 651; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14030651 - 27 Jan 2022
Cited by 9 | Viewed by 1797
Abstract
This was a retrospective study of 604 patients with endometrial carcinoma, classified into ESGO-ESTRO-ESP 2021 clinicopathologic and molecular integrated risk groups. The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) and Leiden classifier were employed for molecular classification. Median follow-up time was 81 [...] Read more.
This was a retrospective study of 604 patients with endometrial carcinoma, classified into ESGO-ESTRO-ESP 2021 clinicopathologic and molecular integrated risk groups. The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) and Leiden classifier were employed for molecular classification. Median follow-up time was 81 months. Clinicopathologic and molecular integrated risk groups were similarly associated with distinct prognoses (p < 0.001). Disease-specific survival was similar for all molecular subgroups within clinicopathologic intermediate-risk, high-risk, and advanced/metastatic groups. In contrast, the p53 abnormal subgroup (hazard ratio 9.1, 95% confidence interval 2.0–41; p = 0.004) and mismatch repair deficient subgroup (hazard ratio 3.5, 95% confidence interval 1.2–10; p = 0.024) were associated with disease-related death within clinicopathologic low-risk and high-intermediate-risk carcinomas, respectively. A risk-group shift occurred in 6.0% (36/604) and 7.4% (38/515) of patients classified by ProMisE and Leiden, respectively (p = 0.341). Of the 36 patients shifted in the ProMisE cohort, 27 were upshifted and 9 downshifted. Based on the Leiden classifier, polymerase-ϵ sequencing could be omitted in 60% (311/515) of patients without affecting the risk-group assessment. ESGO-ESTRO-ESP 2021 guidelines provide a platform for risk classification in future trials on molecularly directed treatment of endometrial carcinoma. Full article
(This article belongs to the Special Issue Diagnosis and Management of Endometrial Cancer)
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11 pages, 605 KiB  
Article
Does an Endometrial Cancer Diagnosis among Asymptomatic Patients Improve Prognosis?
by Petra Vinklerová, Petra Ovesná, Markéta Bednaříková, Luboš Minář, Michal Felsinger, Jitka Hausnerová and Vít Weinberger
Cancers 2022, 14(1), 115; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14010115 - 27 Dec 2021
Cited by 3 | Viewed by 2131
Abstract
Background: Endometrial cancer is the most common gynecological malignancy in developed countries with no screening available. There is still a tendency to provide invasive bioptic verification in asymptomatic women with abnormal ultrasound findings to diagnose carcinoma in a preclinical phase; even though, it [...] Read more.
Background: Endometrial cancer is the most common gynecological malignancy in developed countries with no screening available. There is still a tendency to provide invasive bioptic verification in asymptomatic women with abnormal ultrasound findings to diagnose carcinoma in a preclinical phase; even though, it is not supported by European guidelines. Our goal was to determine DFS (disease-free survival), OS (overall survival), and DSS (disease-specific survival) differences between symptom-free and symptomatic (bleeding, or spotting) endometrial cancer patients with similar stage and tumor/clinical characteristics. Methods: All of our patients with endometrial cancer following surgical treatment between 2006 and 2019 were assessed, evaluating risk factors for recurrence and death while focusing on bleeding using univariable and multivariable analysis. Results: 625 patients meeting the inclusion criteria were divided into asymptomatic (n = 144, 23%) and symptomatic (n = 481, 77%) groups. The median follow-up was 3.6 years. Using univariable analysis, symptomatic patients had a three times higher risk of recurrence (HR 3.1 (95% Cl 1.24–7.77), p = 0.016). OS (HR 1.35 (0.84–2.19), p = 0.219) and DSS (HR 1.66 (0.64–4.28), p = 0.3) were slightly worse without reaching statistical significance. In our multivariable analysis, symptomatology was deemed completely insignificant in all monitored parameters (DFS: HR 2.03 (0.79–5.24), p = 0.144; OS: HR 0.72 (0.43–1.21), p = 0.216). Conclusions: The symptomatic endometrial cancer patients risk factor of earlier recurrence and death is insignificantly higher when compared with the asymptomatic cohort. However, multivariable analysis verifies that prognosis worsens with other clinically relevant parameters, not by symptomatology itself. In terms of survival outcome in EC patients, we recognized symptomatology as a non-significant marker for the patient’s prognosis. Full article
(This article belongs to the Special Issue Diagnosis and Management of Endometrial Cancer)
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10 pages, 1028 KiB  
Article
Comparing Characteristics of Endometrial Cancer in Women of South Asian and White Ethnicity in England
by Seid Mohammed, Konstantinos Polymeros, Rochelle Wickham-Joseph, Iqra Luqman, Creana Charadva, Thomas Morris, Anna Collins, Shaun Barber, Kamlesh Khunti and Esther L. Moss
Cancers 2021, 13(23), 6123; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13236123 - 05 Dec 2021
Cited by 3 | Viewed by 2378
Abstract
Differences in patient demographic and tumour characteristics between patients of South Asian and White ethnicity diagnosed with an endometrial cancer (EC) and currently living in England are not well described. We undertook a retrospective study of EC cases diagnosed at the University Hospitals [...] Read more.
Differences in patient demographic and tumour characteristics between patients of South Asian and White ethnicity diagnosed with an endometrial cancer (EC) and currently living in England are not well described. We undertook a retrospective study of EC cases diagnosed at the University Hospitals of Leicester, UK. A total of 1884 cases were included, with 13% of the patients being of South Asian ethnicity. South Asian women were diagnosed at a significantly younger age (mean age of 60.3 years) compared to women of White ethnicity (mean age of 66.9 years) with a mean difference of 6.6 years (95% CI 5.1 to 8.1, p < 0.001). Rising body mass index (BMI) in the White patient group was significantly correlated with younger age at diagnosis (p < 0.001); however, this association was not seen in South Asian patients. A linear regression that adjusted for diabetes status, BMI, and the interaction terms of diabetes status with BMI and ethnicity with BMI, highlighted a younger age of diagnosis in South Asian patients with a BMI less than 45 kg/m2. The difference was greatest at lower BMIs for both non-diabetics and diabetics. Further investigation is needed to explain these differences and to determine their impact on suspected cancer referral criteria. Full article
(This article belongs to the Special Issue Diagnosis and Management of Endometrial Cancer)
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12 pages, 1797 KiB  
Article
Evaluation of Survival, Recurrence Patterns and Adjuvant Therapy in Surgically Staged High-Grade Endometrial Cancer with Retroperitoneal Metastases
by Jennifer McEachron, Lila Marshall, Nancy Zhou, Van Tran, Margaux J. Kanis, Constantine Gorelick and Yi-Chun Lee
Cancers 2021, 13(9), 2052; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13092052 - 23 Apr 2021
Cited by 5 | Viewed by 1853
Abstract
Background: We seek to evaluate the difference in recurrence patterns and survival among stage IIIC high-grade endometrial cancer treated with surgery followed by adjuvant chemotherapy alone, radiation therapy alone, or both (chemoradiation). Methods: A multicenter retrospective analysis of surgically staged IIIC HGEC receiving [...] Read more.
Background: We seek to evaluate the difference in recurrence patterns and survival among stage IIIC high-grade endometrial cancer treated with surgery followed by adjuvant chemotherapy alone, radiation therapy alone, or both (chemoradiation). Methods: A multicenter retrospective analysis of surgically staged IIIC HGEC receiving adjuvant therapy was conducted. HGEC was defined as grade 3 endometrioid adenocarcinoma, serous, clear cell and carcinosarcoma. Differences in the frequency of recurrence sites and treatment delays were identified using Pearson’s χ2 test. Progression-free survival (PFS) and overall survival (OS) were calculated using Kaplan–Meier estimates. Results: A total of 155 patients were evaluable: 41.9% carcinosarcoma, 36.8% serous, 17.4% grade 3 and 3.9% clear cell. Of these, 67.1% received chemoradiation, 25.8% received chemotherapy and 7.1% received radiation therapy. There was no difference in the frequency of treatment delays between regimens (p = 0.571). There was a trend towards greater retroperitoneal recurrence with chemotherapy (25.9%) versus chemoradiation (8.4%) and radiation therapy (7.7%) (p = 0.252). Grade 3 tumors had improved progression-free and overall survival (26 and 42 months, respectively) versus serous (17 and 30 months, respectively), carcinosarcoma (14 and 24 months, respectively) and clear cell (24 and 30 months respectively) (p = 0.002, p < 0.001). Overall, chemoradiation was superior to chemotherapy and radiation therapy in PFS (p < 0.001) and OS (p < 0.001). Upon multivariate analysis, only histology and receipt of chemoradiation were independent predictors of survival. Conclusion: The majority of stage IIIC high-grade endometrial carcinomas recurred. Chemoradiation was associated with improved survival and less retroperitoneal recurrence. Grade 3 tumors demonstrated improved survival versus other histologies regardless of adjuvant treatment modality. Full article
(This article belongs to the Special Issue Diagnosis and Management of Endometrial Cancer)
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16 pages, 3832 KiB  
Article
Proteomic Analysis of Low-Grade, Early-Stage Endometrial Carcinoma Reveals New Dysregulated Pathways Associated with Cell Death and Cell Signaling
by Álvaro López-Janeiro, Ignacio Ruz-Caracuel, Jorge L. Ramón-Patino, Vivian De Los Ríos, María Villalba Esparza, Alberto Berjón, Laura Yébenes, Alicia Hernández, Ivan Masetto, Ece Kadioglu, Virginie Goubert, Victoria Heredia-Soto, Rodrigo Barderas, José Ignacio Casal, Carlos E. de Andrea, Andrés Redondo, Marta Mendiola, Alberto Peláez-García and David Hardisson
Cancers 2021, 13(4), 794; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13040794 - 14 Feb 2021
Cited by 28 | Viewed by 5897
Abstract
Low-grade, early-stage endometrial carcinoma (EC) is the most frequent malignant tumor of the uterine corpus. However, the molecular alterations that underlie these tumors are far from being fully understood. The purpose of this study is to describe dysregulated molecular pathways from EC patients. [...] Read more.
Low-grade, early-stage endometrial carcinoma (EC) is the most frequent malignant tumor of the uterine corpus. However, the molecular alterations that underlie these tumors are far from being fully understood. The purpose of this study is to describe dysregulated molecular pathways from EC patients. Sixteen samples of tumor tissue and paired healthy controls were collected and both were subjected to mass spectrometry (MS)/MS proteomic analysis. Gene ontology and pathway analysis was performed to discover dysregulated pathways and/or proteins using different databases and bioinformatic tools. Dysregulated pathways were cross-validated in an independent external cohort. Cell signaling, immune response, and cell death-associated pathways were robustly identified. The SLIT/ROBO signaling pathway demonstrated dysregulation at the proteomic and transcriptomic level. Necroptosis and ferroptosis were cell death-associated processes aberrantly regulated, in addition to apoptosis. Immune response-associated pathways showed a dominance of innate immune responses. Tumor immune infiltrates measured by immunofluorescence demonstrated diverse lymphoid and myeloid populations. Our results suggest a role of SLIT/ROBO, necroptosis, and ferroptosis, as well as a prominent role of innate immune response in low-grade, early-stage EC. These results could guide future research in this group of tumors. Full article
(This article belongs to the Special Issue Diagnosis and Management of Endometrial Cancer)
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Review

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13 pages, 1596 KiB  
Review
Liquid Biopsy for Monitoring EC Patients: Towards Personalized Treatment
by Raquel Piñeiro-Pérez, Miguel Abal and Laura Muinelo-Romay
Cancers 2022, 14(6), 1405; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14061405 - 09 Mar 2022
Cited by 5 | Viewed by 2562
Abstract
Endometrial cancer (EC) is the most frequent gynecological cancer in developed countries and its incidence shows an increasing trend. Fortunately, the prognosis of the disease is good when the tumour is diagnosed in an early phase, but some patients recur after surgery and [...] Read more.
Endometrial cancer (EC) is the most frequent gynecological cancer in developed countries and its incidence shows an increasing trend. Fortunately, the prognosis of the disease is good when the tumour is diagnosed in an early phase, but some patients recur after surgery and develop distant metastasis. The therapy options for EC for advanced disease are more limited than for other tumours. Therefore, the application of non-invasive strategies to anticipate the recurrence of localized tumours and guide the treatment in advanced stages represents a clear requirement to improve the survival and quality of life of patients with EC. To achieve this desired precision oncology, it is necessary to invest in the identification and validation of circulating markers that allow a more effective stratification and monitoring of patients. We here review the main advances made for the evaluation of circulating tumour DNA (ctDNA), circulating tumour cells (CTCs), circulating extracellular vesicles (cEVs), and other non-invasive biomarkers as a monitoring tool in the context of localized and advanced endometrial tumours, with the aim of providing a global perspective of the achievements and the key areas in which the use of these markers can be developed into a real clinical tool. Full article
(This article belongs to the Special Issue Diagnosis and Management of Endometrial Cancer)
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14 pages, 1519 KiB  
Review
Recurrent Endometrial Cancer: Local and Systemic Treatment Options
by Heidi Rütten, Cornelia Verhoef, Willem Jan van Weelden, Anke Smits, Joëlle Dhanis, Nelleke Ottevanger and Johanna M. A. Pijnenborg
Cancers 2021, 13(24), 6275; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13246275 - 14 Dec 2021
Cited by 22 | Viewed by 4926
Abstract
The treatment of recurrent endometrial cancer is a challenge. Because of earlier treatments and the site of locoregional recurrence, in the vaginal vault or pelvis, morbidity can be high. A total of about 4 to 20% of the patients with endometrial cancer develop [...] Read more.
The treatment of recurrent endometrial cancer is a challenge. Because of earlier treatments and the site of locoregional recurrence, in the vaginal vault or pelvis, morbidity can be high. A total of about 4 to 20% of the patients with endometrial cancer develop a locoregional recurrence, mostly among patients with locally advanced disease. The treatment options are dependent on previous treatments and the site of recurrence. Local and locoregional recurrences can be treated curatively with surgery or (chemo)radiotherapy with acceptable toxicity and control rates. Distant recurrences can be treated with palliative systemic therapy, i.e., first-line chemotherapy or hormonal therapy. Based on the tumor characteristics and molecular profile, there can be a role for immunotherapy. The evidence on targeted therapy is limited, with no approved treatment in the current guidelines. In selected cases, there might be an indication for local treatment in oligometastatic disease. Because of the novel techniques in radiotherapy, disease control can often be achieved at limited toxicity. Further studies are warranted to analyze the survival outcome and toxicity of newer treatment strategies. Patient selection is very important in deciding which treatment is of most benefit, and better prediction models based on the patient- and tumor characteristics are necessary. Full article
(This article belongs to the Special Issue Diagnosis and Management of Endometrial Cancer)
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16 pages, 333 KiB  
Review
Pharmacological Treatment of Advanced, Persistent or Metastatic Endometrial Cancer: State of the Art and Perspectives of Clinical Research for the Special Issue “Diagnosis and Management of Endometrial Cancer”
by Angiolo Gadducci and Stefania Cosio
Cancers 2021, 13(24), 6155; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13246155 - 07 Dec 2021
Cited by 8 | Viewed by 3174
Abstract
Patients with metastatic or recurrent endometrial cancer (EC) not suitable for surgery and/or radiotherapy are candidates for pharmacological treatment frequently with unsatisfactory clinical outcomes. The purpose of this paper was to review the results obtained with chemotherapy, hormonal therapy, biological agents and immune [...] Read more.
Patients with metastatic or recurrent endometrial cancer (EC) not suitable for surgery and/or radiotherapy are candidates for pharmacological treatment frequently with unsatisfactory clinical outcomes. The purpose of this paper was to review the results obtained with chemotherapy, hormonal therapy, biological agents and immune checkpoint inhibitors in this clinical setting. The combination of carboplatin (CBDCA) + paclitaxel (PTX) is the standard first-line chemotherapy capable of achieving objective response rates (ORRs) of 43–62%, a median progression-free survival (PFS) of 5.3–15 months and a median overall survival (OS) of 13.2–37.0 months, respectively, whereas hormonal therapy is sometimes used in selected patients with slow-growing steroid receptor-positive EC. The combination of endocrine therapy with m-TOR inhibitors or cyclin-dependent kinase 4/6 inhibitors is currently under evaluation. Disappointing ORRs have been associated with epidermal growth factor receptor (EGFR) inhibitors, HER-2 inhibitors and multi-tyrosine kinase inhibitors used as single agents, and clinical trials evaluating the addition of bevacizumab to CBDCA + PTX have reported conflicting results. Immune checkpoint inhibitors, and especially pembrolizumab and dostarlimab, have achieved an objective response in 27–47% of highly pretreated patients with microsatellite instability-high (MSI-H)/mismatch repair (MMR)-deficient (-d) EC. In a recent study, the combination of lenvatinib + pembrolizumab produced a 24-week response rate of 38% in patients with highly pretreated EC, ranging from 64% in patients with MSI-H/MMR-d to 36% in those with microsatellite stable/MMR-proficient tumors. Four trials are currently investigating the addition of immune checkpoint inhibitors to PTX + CBDCA in primary advanced or recurrent EC, and two trials are comparing pembrolizumab + lenvatinib versus either CBDCA + PTX as a first-line treatment of advanced or recurrent EC or versus single-agent chemotherapy in advanced, recurrent or metastatic EC after one prior platinum-based chemotherapy. Full article
(This article belongs to the Special Issue Diagnosis and Management of Endometrial Cancer)
19 pages, 919 KiB  
Review
Risk Stratification of Endometrial Cancer Patients: FIGO Stage, Biomarkers and Molecular Classification
by Jenneke C. Kasius, Johanna M. A. Pijnenborg, Kristina Lindemann, David Forsse, Judith van Zwol, Gunnar B. Kristensen, Camilla Krakstad, Henrica M. J. Werner and Frédéric Amant
Cancers 2021, 13(22), 5848; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13225848 - 22 Nov 2021
Cited by 37 | Viewed by 11734
Abstract
Endometrial cancer (EC) is the most common gynaecologic malignancy in developed countries. The main challenge in EC management is to correctly estimate the risk of metastases at diagnosis and the risk to develop recurrences in the future. Risk stratification determines the need for [...] Read more.
Endometrial cancer (EC) is the most common gynaecologic malignancy in developed countries. The main challenge in EC management is to correctly estimate the risk of metastases at diagnosis and the risk to develop recurrences in the future. Risk stratification determines the need for surgical staging and adjuvant treatment. Detection of occult, microscopic metastases upstages patients, provides important prognostic information and guides adjuvant treatment. The molecular classification subdivides EC into four prognostic subgroups: POLE ultramutated; mismatch repair deficient (MMRd); nonspecific molecular profile (NSMP); and TP53 mutated (p53abn). How surgical staging should be adjusted based on preoperative molecular profiling is currently unknown. Moreover, little is known whether and how other known prognostic biomarkers affect prognosis prediction independent of or in addition to these molecular subgroups. This review summarizes the factors incorporated in surgical staging (i.e., peritoneal washing, lymph node dissection, omentectomy and peritoneal biopsies), and its impact on prognosis and adjuvant treatment decisions in an era of molecular classification of EC. Moreover, the relation between FIGO stage and molecular classification is evaluated including the current gaps in knowledge and future perspectives. Full article
(This article belongs to the Special Issue Diagnosis and Management of Endometrial Cancer)
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28 pages, 427 KiB  
Review
HE4 as a Biomarker for Endometrial Cancer
by Roya Behrouzi, Chloe E. Barr and Emma J. Crosbie
Cancers 2021, 13(19), 4764; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13194764 - 23 Sep 2021
Cited by 31 | Viewed by 4209
Abstract
There are currently no blood biomarkers in routine clinical use in endometrial carcinoma (EC). Human epididymis protein 4 (HE4) is a glycoprotein that is overexpressed in the serum of patients with EC, making it a good candidate for use as a diagnostic and/or [...] Read more.
There are currently no blood biomarkers in routine clinical use in endometrial carcinoma (EC). Human epididymis protein 4 (HE4) is a glycoprotein that is overexpressed in the serum of patients with EC, making it a good candidate for use as a diagnostic and/or prognostic biomarker. HE4 is correlated with poor prognostic factors, including stage, myometrial invasion and lymph node metastases, which means it could be used to guide decisions regarding the extent of surgery and need for adjuvant therapy. Serum HE4 has also shown promise for predicting responses to progestin therapy in early-stage EC. The use of algorithms and indices incorporating serum HE4 and other biomarkers, including clinical and imaging variables, is an area of increasing interest. Serum HE4 levels rise with age and renal dysfunction, which may affect the interpretation of results. This review covers the evidence supporting the use of HE4 as an EC biomarker for diagnosis, prognosis, recurrence monitoring, and prediction of therapy response. The evidence for combining serum HE4 with other biomarkers, including clinical and imaging variables, its value as a biomarker in other biofluids and potential challenges of its clinical use are also discussed. Full article
(This article belongs to the Special Issue Diagnosis and Management of Endometrial Cancer)

Other

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26 pages, 25833 KiB  
Systematic Review
The Role of miRNAs in the Regulation of Endometrial Cancer Invasiveness and Metastasis—A Systematic Review
by Klaudia Klicka, Tomasz M. Grzywa, Alicja Klinke, Aleksandra Mielniczuk and Paweł K. Włodarski
Cancers 2021, 13(14), 3393; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13143393 - 06 Jul 2021
Cited by 15 | Viewed by 7218
Abstract
Endometrial cancer (EC) is the most common genital cancer in women with increasing death rates. MiRNAs are short non-coding RNAs that regulate gene expression on the post-transcriptional levels. Multiple studies demonstrated a fundamental role of miRNAs in the regulation of carcinogenesis. This systematic [...] Read more.
Endometrial cancer (EC) is the most common genital cancer in women with increasing death rates. MiRNAs are short non-coding RNAs that regulate gene expression on the post-transcriptional levels. Multiple studies demonstrated a fundamental role of miRNAs in the regulation of carcinogenesis. This systematic review is a comprehensive overview of the role of miRNAs in the regulation of cancer cell invasiveness and metastasis in EC. The literature was searched for studies investigating the role of miRNAs in the regulation of invasiveness and metastasis in EC. We explored PubMed, Embase, and Scopus using the following keywords: miRNA, metastasis, invasiveness, endometrial cancer. Data were collected from 163 articles that described the expression and role of 106 miRNAs in the regulation of EC invasiveness and metastasis out of which 63 were tumor suppressor miRNAs, and 38 were oncomiRNAs. Five miRNAs had a discordant role in different studies. Moreover, we identified 66 miRNAs whose expression in tumor tissue or concentration in serum correlated with at least one clinical parameter. These findings suggest a crucial role of miRNAs in the regulation of EC invasiveness and metastasis and present them as potential prognostic factors for patients with EC. Full article
(This article belongs to the Special Issue Diagnosis and Management of Endometrial Cancer)
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