Diagnosis Of Endometrial Cancer Research Articles

EXPRESSION LEVELS OF FOXO-1, P27KIP1, MIR-27, MIR-186 AND AKT1/AKT-P PROTEINS IN WOMEN WITH ENDOMETRIAL CANCER AND HYPERPLASIA: IMPLICATIONS FOR THE HUMAN REPRODUCTIVE SYSTEM.

Despite extensive research on endometrial cancer (EC) and endometrial hyperplasia, there is still a gap in understanding the molecular mechanisms underlying their development and progression. The aim of this study was to investigate the expression levels of FOXO-1, P27Kip1, miR-27, and miR-186, and Akt1, Akt-P proteins in patients with EC and endometrial hyperplasia compared to control subjects. Samples of the endometrial tumor (n=30), normal (control) (n=30) and endometrial hyperplastic (n=30) tissue were obtained from patients referring to Arash and Imam Khomani hospitals, Tehran, Iran. Expression levels of genes and microRNAs were evaluated by qRT- PCR. Western blot analysis was applied for protein evaluation. The data were analyzed using t-test, Mann -Whitney U, Pearson correlation coefficient analysis, ANCOVA and ANOVA. There was significant decrease in FOXO-1 in EC tissue compared to control tissue (p<0.05). Significant increase was observed in expression of miR-27 in patients with EC (p<0.001) and hyperplasia (p<0.01), whereas miR-186 expression level increased significantly only in patients with EC (p<0.05). P27Kip1 expression level did not significantly change in patients with EC and hyperplasia. There was a significant association between expression levels of miR-27 with FOXO-1 and P27Kip1 in patients with EC. Western blot analysis revealed higher endometrial AKT1-P protein levels in patients with EC and hyperplasia than control subjects (p<0.05). Our findings suggest that FOXO-1, miR-27, miR-186, and Akt1-P/Akt1 protein have the potential to serve as tissue biomarkers for early diagnosis, prognosis, and progression of EC in the human reproductive system.

Thromboelastography Parameters Change Significantly in Patients with Endometrial Cancer and Uterine Fibroids.

The goal was to clarify the changes of TEG parameters in patients with uterine fibroids and endometrial cancer and the clinical diagnostic values of TEG parameters. A total of 57 patients with uterine fibroids and 43 patients with endometrial cancer were included, and their TEG parameters were analyzed and compared with 45 healthy women. Routine coagulation indicators were also collected and compared. For significantly changed TEG indicators, the ROC curves were used to evaluate their diagnostic efficacy and determine the cutoff values. The TEG indicators of patients with endometrial cancer of stag I and II were also compared. APTT, and PT levels in endometrial cancer patients were significantly shorter than those in healthy controls. FIB level in endometrial cancer patients were significantly higher than those in healthy controls. Angle, MA, CI, E, G, and TPI levels were significantly upregulated in endometrial cancer patients while TMA was significantly decreased. According to ROC curve analysis, G and E had a good auxiliary diagnostic efficiency for the detection of uterine fibroids (cutoff value 6,691 d/sec and 133.8 d/sec) and TPI has good sensitivity and specificity for the diagnosis of endometrial cancer (cutoff value 51.3 dyn/cm2). The TEG index of patients with stage I and II endometrial cancer did not reach statistical difference. Thromboelastography parameters change significantly in patients with endometrial cancer and uterine fibroids.

Spillage and displacement of indocyanine green-stained tissues from uterine cervix to pelvic peritoneum: A proof of concept study for colpotomy approach in minimally invasive surgery

ObjectiveTo analyze peritoneal spillage and displacement of indocyanine green (ICG)-stained tissues from uterine cervix to pelvis during intracorporeal/vaginal colpotomy in laparoscopic-assisted hysterectomy. Materials and methodsEleven patients undergoing laparoscopic-assisted hysterectomy were included. One patient with an incidental diagnosis of endometrial cancer was excluded. Of the 10 patients, five underwent intracorporeal colpotomy (IC) and five received vaginal colpotomy (VC) during laparoscopic-assisted hysterectomy. Approximately 5 cm of resected round ligament from each patient was stained with ICG and cut to 1.0 × 1.0 cm in size. Four to five fragments of ICG-stained tissues were placed and sutured on the uterine cervix before colpotomy. During and after colpotomy, serial pictures under white and fluorescence light were taken to document peritoneal spillage and displacement of ICG-stained tissues to the pelvic peritoneum. ResultsPeritoneal spillage of ICG occurred in the entire IC group. Displacement of ICG-stained tissues from uterine cervix to pelvic peritoneum were visualized in three (60%) patients undergoing IC. In the five patients who received VC, peritoneal spillage of ICG and displacement of ICG-stained tissue to pelvic peritoneum did not occur. There were no perioperative complications. ConclusionsIC in minimally invasive radical hysterectomy should not be performed because peritoneal spillage of ICG and displacement of ICG-stained tissues from uterine cervix to pelvis frequently occurs during IC. Therefore, specific measures to prevent tumor exposure during colpotomy should be implemented in cervical cancer patients.

Symptomatic women experience long waits for endometrial cancer diagnosis and treatment in Brazil

The aim of this study was to assess the elapsed time for symptomatic women with endometrial carcinoma to achieve diagnosis and treatment and its impact on staging and survival. A cohort study was carried out with 430 women divided into in two groups: “Type I” (n = 289, endometrioid carcinoma grade 1 or 2); “Type II” (n = 141, nonendometrioid, endometrioid carcinoma grade 3, or carcinosarcoma). Clinical information, diagnostic methods, histology, staging, and time elapsed between symptoms-diagnosis-treatment were considered. Descriptive, survival, and regression analyses were performed. The symptom-to-diagnosis interval was 284 and 249 days in Types I and II (p = 0.014), with only 30% getting a diagnosis within 90 days. The diagnosis-to-treatment interval was shorter for Type II (100 vs. 123 days for Type I; p = 0.001). Only 12.5% of Type I and 22.7% of Type II started treatment within 60 days after diagnosis. There was no association between symptom-to-diagnosis interval and staging (p = 0.377). The symptom-to-treatment interval did not change the overall survival for Type I and had a paradoxical effect for Type II, with greater overall survival associated with a longer elapsed time (p = 0.003). Symptomatic Brazilian women with endometrial carcinomas showed very long wait times for diagnosis and treatment, and less than 23% started treatment within the regulatory period of 60 days. This critical situation does not exhibit any clear effect on cancer staging or overall survival, possibly counterbalanced by the faster care of patients with a poor prognosis, such as those with Type II endometrial carcinomas.

ROMA Index Is an Effective Predictor for Advanced Endometrial Cancer before Surgery.

There is a high rate of inconformity between clinical staging and surgical-pathologic staging in endometrial cancer. Many patients with advanced endometrial cancer are preoperatively understaged and thereby do not receive the optimal therapy. Here, we aimed to develop a predictive model or biomarker for preoperative diagnosis of advanced endometrial cancer via multivariate logistic regression analysis. In this study, 259 eligible patients were included, and 195 patients were assigned to the training dataset and 64 patients to validation dataset. Age, menopause status, sterilization situation, parity, body mass index, hypertension, diabetes mellitus, tumor size, and ovarian malignancy algorithm (ROMA) index were included as predictive variables, and the binary outcome was advanced endometrial cancer or not. When the P value was set as less than 0.01 in forward stepwise regression, only ROMA index was retained. The odds ratio of being positive ROMA index was 15.531 times that of negative value. The area under receiver operating characteristic curve was 0.790 in the training dataset and 0.776 in the validation dataset. The decision curve analysis curve showed that the prediction by ROMA index added more net benefits for almost all threshold probabilities. Therefore, ROMA index is an effective predictor for advanced endometrial cancer before surgery. Since ROMA index is a standard, measurable, and reliable laboratory test, it can be used as a reference tool for gynecologists to design the appropriate therapeutic schedule for patients with high-stage endometrial cancer before surgery.

Refining adjuvant treatment in endometrial cancer based on molecular features: the RAINBO clinical trial program

BackgroundThe endometrial cancer molecular classification has been integrated into the 2020 World Health Organization (WHO) diagnostic classification and European treatment guidelines, and provides direction towards more effective and less toxic...

Clinical, Sonographic, and Hysteroscopic Features of Endometrial Carcinoma Diagnosed after Hysterectomy in Patients with a Preoperative Diagnosis of Atypical Hyperplasia: A Single-Center Retrospective Study.

atypical endometrial hyperplasia (AEH) is a precancerous condition implying a high risk of concurrent endometrial cancer (EC), which might be occult and only diagnosed at postoperative histopathological examination after hysterectomy. Our study aimed to investigate potential differences in preoperative clinical, sonographic, and hysteroscopic characteristics in patients with AEH and postoperative diagnosis of EC. a retrospective single-center study was carried out on a case series of 80 women with AEH undergoing diagnostic workup, including ultrasonography and hysteroscopy, with subsequent hysterectomy. Women with AEH confirmed at the histopathological examination were compared with patients with a postoperative diagnosis of EC. in our population, EC was diagnosed in 53 women, whereas the preoperative diagnosis of AEH was confirmed in 27 cases. At ultrasonography, women with occult EC showed greater endometrial thickness (20.3 mm vs. 10.3 mm, p 0.001) and size of the endocavitary lesion (maximum diameter 25.2 mm vs. 10.6 mm, p 0.001), and a higher prevalence of irregular endometrial-myometrial junction (40.5% vs. 6.7%, p 0.022) and endouterine vascularization at color Doppler (64.2% vs. 34.6%, p 0.017). At hysteroscopy, patients with occult EC showed a higher prevalence of necrosis (44.2% vs. 4.2%, p 0.001) and atypical vessels (70.6% vs. 33.3%, p 0.003), whereas true AEH mainly presented as a protruding intracavitary lesion (77.8% vs. 50.9%, p 0.029). In EC, subjective assessment by the operator was more frequently indicative of cancer (80.0% vs. 12.5%). No difference was found for clinical variables. occult EC in AEH may exhibit some differences in ultrasonographic and hysteroscopic patterns of presentation compared with real AEH, which could prompt a more significant suspect for the possible presence of concurrent EC at preoperative diagnostic workup.

Higher baseline BMI and lower estimated median income associated with increasing BMI after endometrial cancer diagnosis

IntroductionEndometrial cancer is often directly related to obesity and interventions for weight loss have mixed results. Risk factors for continued weight gain after diagnosis are not clearly defined in the literature. The objective of this study is to describe risk factors associated with increased body mass index (BMI) trajectory among endometrial cancer patients. MethodsPatients who were surgically treated for endometrial cancer at a single institution between 2010 and 2015 were identified. Demographics including age, race/ethnicity and estimated median income at diagnosis were obtained. BMI at five time points after diagnosis were calculated. BMI trajectories were estimated by latent class growth modeling using the PROC TRAJ procedure in SAS. Chi-squared tests and ANOVA were used to assess differences between trajectory groups. Statistical significance was set to a p-value < 0.05. ResultsOf 695 patients included in the study, the average age at diagnosis was 62 years and over 70% of patients were obese at baseline. Patients experienced increasing, stable, or decreasing BMI over 2 years following diagnosis. Patients with younger age and lower estimated median income were most likely to be in the increasing BMI group. Among obese patients, those with Class I obesity (BMI 30 to 34.9 kg/m2) were most likely to experience decreasing BMI and those with Class III obesity (BMI > 40 kg/m2) were most likely to experience increasing BMI, p < 0.0001. ConclusionA third of endometrial cancer survivors experience increasing BMI. Severity of obesity at diagnosis matters, patients with severe obesity (Class III) were most likely to experience weight gain.

Point-of-Care Diagnosis of Endometrial Cancer Using the Surgical Intelligent Knife (iKnife)—A Prospective Pilot Study of Diagnostic Accuracy

Introduction: Delays in the diagnosis and treatment of endometrial cancer negatively impact patient survival. The aim of this study was to establish whether rapid evaporative ionisation mass spectrometry using the iKnife can accurately distinguish between normal and malignant endometrial biopsy tissue samples in real time, enabling point-of-care (POC) diagnoses. Methods: Pipelle biopsy samples were obtained from consecutive women needing biopsies for clinical reasons. A Waters G2-XS Xevo Q-Tof mass spectrometer was used in conjunction with a modified handheld diathermy (collectively called the 'iKnife'). Each tissue sample was processed with diathermy, and the resultant surgical aerosol containing ionic lipid species was then analysed, producing spectra. Principal component analyses and linear discriminant analyses were performed to determine variance in spectral signatures. Leave-one-patient-out cross-validation was used to test the diagnostic accuracy. Results: One hundred and fifty patients provided Pipelle biopsy samples (85 normal, 59 malignant, 4 hyperplasia and 2 insufficient), yielding 453 spectra. The iKnife differentiated between normal and malignant endometrial tissues on the basis of differential phospholipid spectra. Cross-validation revealed a diagnostic accuracy of 89% with sensitivity, specificity, positive predictive value and negative predictive value of 85%, 93%, 94% and 85%, respectively. Conclusions: This study is the first to use the iKnife to identify cancer in endometrial Pipelle biopsy samples. These results are highly encouraging and suggest that the iKnife could be used in the clinic to provide a POC diagnosis.

WITHDRAWN: Higher baseline BMI and lower estimated median income associated with increasing BMI after endometrial cancer diagnosis

Endometrial cancer is often directly related to obesity and interventions for weight loss have mixed results. Risk factors for continued weight gain after diagnosis are not clearly defined in the literature. The objective of this study is to describe risk factors associated with increased body mass index (BMI) trajectory among endometrial cancer patients. Patients who were surgically treated for endometrial cancer at a single institution between 2010 and 2015 were identified. Demographics including age, race/ethnicity and estimated median income at diagnosis were obtained. BMI at five time points after diagnosis were calculated. BMI trajectories were estimated by latent class growth modeling using the PROC TRAJ procedure in SAS. Chi-squared tests and ANOVA were used to assess differences between trajectory groups. Statistical significance was set to a p-value<0.05. Of 695 patients included in the study, the average age at diagnosis was 62years and over 70% of patients were obese at baseline. Patients experienced increasing, stable, or decreasing BMI over 2years following diagnosis. Patients with younger age and lower estimated median income were most likely to be in the increasing BMI group. Among obese patients, those with Class I obesity (BMI 30 to 34.9kg/m2) were most likely to experience decreasing BMI and those with Class III obesity (BMI>40kg/m2) were most likely to experience increasing BMI, p<0.0001. A third of endometrial cancer survivors experience increasing BMI. Severity of obesity at diagnosis matters, patients with severe obesity (Class III) were most likely to experience weight gain.

Identification of NRAS Diagnostic Biomarkers and Drug Targets for Endometrial Cancer-An Integrated in Silico Approach.

The diagnosis of endometrial cancer involves sequential, invasive tests to assess the thickness of the endometrium by a transvaginal ultrasound scan. In 6-33% of cases, endometrial biopsy results in inadequate tissue for a conclusive pathological diagnosis and 6% of postmenopausal women with non-diagnostic specimens are later discovered to have severe endometrial lesions. Thus, identifying diagnostic biomarkers could offer a non-invasive diagnosis for community or home-based triage of symptomatic or asymptomatic women. Herein, this study identified high-risk pathogenic nsSNPs in the NRAS gene. The nsSNPs of NRAS were retrieved from the NCBI database. PROVEAN, SIFT, PolyPhen-2, SNPs&GO, PhD-SNP and PANTHER were used to predict the pathogenicity of the nsSNPs. Eleven nsSNPs were identified as "damaging", and further stability analysis using I-Mutant 2.0 and MutPred 2 indicated eight nsSNPs to cause decreased stability (DDG scores &lt; -0.5). Post-translational modification and protein-protein interactions (PPI) analysis showed putative phosphorylation sites. The PPI network indicated a GFR-MAPK signalling pathway with higher node degrees that were further evaluated for drug targets. The P34L, G12C and Y64D showed significantly lower binding affinity towards GTP than wild-type. Furthermore, the Kaplan-Meier bioinformatics analyses indicated that the NRAS gene deregulation affected the overall survival rate of patients with endometrial cancer, leading to prognostic significance. Findings from this could be considered novel diagnostic and therapeutic markers.

CA125 as a predictor of endometrial cancer lymphovascular space invasion and lymph node metastasis for risk stratification in the preoperative setting

Endometrial cancer (EC) is the most common malignancy of the female reproductive system. Cancer antigen 125 (CA125) is a serum tumor marker widely reported in EC patients, particularly those with poor prognostic factors such as grade 3 tumors, deep myometrial invasion, lymph node metastasis (LNM), and extra-uterine disease. This retrospective study stratifies pre-operative CA125 levels to evaluate odds ratios (OR) and relative risk (RR) between CA125 levels and the likelihood of +LNM, lymphovascular space invasion (LVSI), grade, and stage. Patient charts for women 18 years or older with a diagnosis of EC and pre-operative or within one week CA125 measurement from January 2000 to January 2015 at a regional hospital were reviewed. OR and RR were determined by unconditional maximum likelihood estimation for CA125 levels as the predictor with staging, grade, +LVSI and +LNM as outcomes. The largest increase in risk for patients having stage I/II/III disease was 52% greater (1.52-fold risk) while largest increase in risk for patients having stage III/IV disease was 67% greater (1.67-fold risk), both at CA125 ≥ 222U/ml. Patients with CA125 ≥ 122U/ml had significantly increased risk of +LNM, with maximum increase in risk of 98% (1.98-fold risk) at 222U/ml. Patients with CA125 ≥ 175U/ml had significantly increased risk of +LVSI, with maximum increase in risk of 39% (1.39-fold risk) at 222U/ml. This study shows that elevated CA125 levels correspond to increased stage, +LVSI, and +LNM in patients with EC.

Clinical-grade endometrial cancer detection system via whole-slide images using deep learning.

The accurate pathological diagnosis of endometrial cancer (EC) improves the curative effect and reduces the mortality rate. Deep learning has demonstrated expert-level performance in pathological diagnosis of a variety of organ systems using whole-slide images (WSIs). It is urgent to build the deep learning system for endometrial cancer detection using WSIs. The deep learning model was trained and validated using a dataset of 601 WSIs from PUPH. The model performance was tested on three independent datasets containing a total of 1,190 WSIs. For the retrospective test, we evaluated the model performance on 581 WSIs from PUPH. In the prospective study, 317 consecutive WSIs from PUPH were collected from April 2022 to May 2022. To further evaluate the generalizability of the model, 292 WSIs were gathered from PLAHG as part of the external test set. The predictions were thoroughly analyzed by expert pathologists. The model achieved an area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of 0.928, 0.924, and 0.801, respectively, on 1,190 WSIs in classifying EC and non-EC. On the retrospective dataset from PUPH/PLAGH, the model achieved an AUC, sensitivity, and specificity of 0.948/0.971, 0.928/0.947, and 0.80/0.938, respectively. On the prospective dataset, the AUC, sensitivity, and specificity were, in order, 0.933, 0.934, and 0.837. Falsely predicted results were analyzed to further improve the pathologists' confidence in the model. The deep learning model achieved a high degree of accuracy in identifying EC using WSIs. By pre-screening the suspicious EC regions, it would serve as an assisted diagnostic tool to improve working efficiency for pathologists.

Could soluble L1 cell adhesion molecule (sL1CAM) in serum be a new biomarker for endometrial cancer?

The aim of this study is to evaluate the place of serum soluble L1 cell adhesion molecule (sL1CAM) level in the diagnosis of endometrial cancer and its relationship with clinicopathological features. This cross-sectional study was performed with 146 patients who underwent endometrial biopsy and whose pathology results were reported as benign endometrial changes (n = 30), endometrial hyperplasia (n = 32) or endometrial cancer (n = 84). The sL1CAM level between the groups was compared. The relationship between clinicopathological features and serum sL1CAM was evaluated in patients with endometrial cancer. The mean serum sL1CAM level in patients with endometrial cancer was significantly higher than in patients without cancer. The sL1CAM value was statistically significantly higher in the group with endometrial cancer, than the group with endometrial hyperplasia (p < 0.001) and the group with benign endometrial changes (p < 0.001). There was no statistically significant difference in terms of sL1CAM between the group of patients with endometrial hyperplasia and the group of patients with benign endometrial changes (p = 0.954). sL1CAM value in type 2 endometrial cancer was statistically significantly higher than Type1 (p = 0.019). High sL1CAM level in patients with type 1 cancer was associated with poor clinicopathological features. However, no correlation was observed between clinicopathological features and serum sL1CAM level in type 2 endometrial cancers. Serum sL1CAM may be an important marker for evaluating the diagnosis and prognosis of endometrial cancer in the future. There may be a relationship between increased serum sL1CAM level in type 1 endometrial cancers and poor clinicopathological features.

Evaluation of Paraoxonase-1 and Pentraxin-3 in the Diagnosis and Prognosis of Endometrial Cancer.

It is relevant to find new prognostic and diagnostic biomarkers for endometrial cancer. The study group consisted of 94 cases of endometrial cancer, the control group of 65 cases of normal endometrium. We evaluated PON1 and PTX3 serum levels. The ROC curve was plotted. The area under the curve was calculated to characterize the sensitivity and specificity of the studied parameters. Univariate and multivariate analyses were performed simultaneously using the Cox regression model. The Kaplan–Meier curve was used to assess survival. The cut-off level of PON1 was 142.6 ng/mL, with a sensitivity and specificity of 79 and 84% (p = 0.0321). The cut-off level of PTX3 was 4.2 ng/mL, with a sensitivity and specificity of 63 and 57% (p = 0.028). The favorable prognostic factor determined in serum was PON1 (for PFS: HR 0.93, 95% CI 0.86–1.03, p = 0.046; for OS: HR 0.96, 95% CI 0.89–1.08, p = 0.009). PON1 may be considered a potential biomarker in the diagnosis of endometrial cancer. Considering multivariate analysis, the PON1 serum level above the median is an independent favourable prognostic factor affecting PFS and OS. Considering Kaplan–Meier curves, longer recurrence-free survival and overall survival were found in patients with PON1 levels below the median. In view of the inconclusive results, we suggest that further studies should be conducted.

Endometrial cancer prognosis prediction using correlation models based on CDK family genes.

Cyclin-dependent kinases (CDKs) play an important role in cell division. Given that abnormal cell proliferation caused by dysregulation of cell division is one of the major causes of endometrial cancer (EC), it is important to elucidate the role of CDK family genes in the diagnosis and prognosis of EC. In this study, The Cancer Genome Atlas (TCGA) database was used to analyze the frequency of copy number variations and somatic mutations in 26 CDK family genes. Subsequently, the expression of these genes in EC was assessed, and their relationship with overall survival (OS) was examined via Kaplan–Meier analysis to assess their prognostic significance. A prognostic model based on seven CDK genes was constructed using Lasso and Cox regression, and the predictive performance of the model was analyzed using Kaplan–Meier analysis and column line plots. The correlation between CDK genes and immune cells was also examined. Patients with EC in the high-risk group had a poorer prognosis. The results of qRT-PCR and immunohistochemical analyses validated that CDK16 is highly expressed in EC tissues. Patients with EC with high CDK16 expression had worse 10-year OS than patients with low CDK16 expression. These findings suggest that the prognostic model constructed based on CDK genes can help to develop individualized and targeted treatment strategies for patients with EC.

Pathways to diagnosis of endometrial and ovarian cancer in the 45 and Up Study cohort

PurposeTo determine pathways to endometrial or ovarian cancer diagnosis by comparing health service utilization between cancer cases and matched cancer-free controls, using linked health records.MethodsFrom cancer registry records, we identified 238 incident endometrial and 167 ovarian cancer cases diagnosed during 2006–2013 in the Australian 45 and Up Study cohort (142,973 female participants). Each case was matched to four cancer-free controls on birthdate, sex, place of residence, smoking status, and body mass index. The use of relevant health services during the 13–18-, 7–12-, 0–6-, and 0–1-months pre-diagnosis for cases and the corresponding dates for their matched controls was determined through linkage with subsidized medical services and hospital records.ResultsHealthcare utilization diverged between women with cancer and controls in the 0–6-months, particularly 0–1 months, pre-diagnosis. In the 0–1 months, 74.8% of endometrial and 50.3% of ovarian cases visited a gynecologist/gynecological oncologist, 11.3% and 59.3% had a CA125 test, 5.5% and 48.5% an abdominal pelvic CT scan, and 34.5% and 30.5% a transvaginal pelvic ultrasound, respectively (versus ≤ 1% of matched controls). Moreover, 25.1% of ovarian cancer cases visited an emergency department in the 0–1-months pre-diagnosis (versus 1.3% of matched controls), and GP visits were significantly more common for cases than controls in this period.ConclusionMost women with endometrial or ovarian cancer accessed recommended specialists and tests in the 0–1-months pre-diagnosis, but a high proportion of women with ovarian cancer visited an emergency department. This reinforces the importance of timely specialist referral.

High MutS homolog 2 expression predicts poor prognosis and is related to immune infiltration in endometrial carcinoma.

Several studies have shown that MutS homolog 2 (MSH2) is highly expressed in many cancer tissues. Transcriptome expression data were collected from the Cancer Genome Atlas (TCGA) database. We analyzed the expression of MSH2 in normal and tumor tissues, the relationship between MSH2 expression and various prognostic factors, and the relationship between MSH2 expression and overall survival, disease specific survival, and progression free interval. We also examined MSH2 promoter methylation between endometrial cancer and normal endometrial tissues, and identified the prognostic value of MSH2 methylation in endometrial cancer. MSH2 was highly expressed in endometrial cancer tumor tissues compared with normal tissues. High MSH2 expression might be an independent prognostic factor for OS, DSS, and PFI. Further, high MSH2 expression was correlated with age and histological type, but not with BMI, clinical stage, tumor invasion, or other clinical features. MSH2 promoter methylation in endometrial cancer was significantly lower than in normal tissues. Additionally, MSH2 levels, OS, DSS, and PFI were associated with BMI, age, tumor invasion, and histological type. ssGSEA showed that MSH2 expression was positively correlated with the infiltration of Th2 cells, Tcm cells, T helper cells, and Tgd cells, whereas it was negatively correlated with NK CD56 bright cells, pDC cells, iDC cells, cytotoxic cells, and neutrophils. Increased MSH2 expression and reduced MSH2 methylation in endometrial cancer predicts poor prognosis. MSH2 may be used as a biomarker for the diagnosis and prognosis of endometrial cancer and as an immunotherapy target.

On the use of spectroscopy, prediction machines and cybernetics for an affordable and proactive care approach for endometrial cancer

Endometrial cancer is a prominent cancer which affects a considerable number of women globally. The cancer has proven to be challenging to diagnose in its early manifestations as it tends to produce symptoms which are not distinct and can be confused with other diseases. Transvaginal imaging methods are commonly adopted for an invasive visualization of the endometrium in order to arrive at a diagnosis, but this method requires expertise and access to instrumentation which is expensive and inaccessible, particularly for developing countries. This work explores the use of blood spectroscopy as a cheap and high-throughput means towards the diagnosis of endometrial cancer (type 1, type 2, mixed and atypical hyperplasia), potentially allowing for fertility-sparing treatment due to the high turnaround associated with the method.

Multi-level determinants of endometrial cancer diagnosis as experienced by Black women.

107 Background: Black women experience inequity in access to timely endometrial cancer (EC) diagnosis compared to non-Hispanic white women. Delays in obtaining a timely diagnosis and referral for treatment can amplify poorer outcomes in Black women. Communication between Black patients and providers are likely influenced by determinants at multiple levels (e.g., individual, community, systems). Examining determinants at multiple levels can provide insight on how they influence guideline-concordant EC diagnosis in Black women through patient-provider communication. This study reports on Black women’s EC diagnosis experience, from the time of symptom onset to obtaining a diagnosis. Methods: We conducted a qualitative study using semi-structured interviews guided by the socio-cultural framework for the study of health service disparities (SCF-HSD). We used deductive thematic analysis using codes from the SCF-HSD framework, and inductive thematic analysis for new themes arising in the data. Participants were recruited using a study posting on an online patient research platform associated with an academic hospital in North Carolina. Eligible patients had to identify as Black, English-speaking, aged 40 years or older, and have a diagnosis of EC within the last 3 years. Results: Thirteen Black women with EC participated in online &amp; phone interviews ranging from 22-50 minutes. Participants were primarily between 40-49 years of age (mean age = 45), stage II (100%), and either had private (47%), Medicare (23%) or Medicaid (30%) health insurance. Participants identified determinants at 3 levels: individual (symptom misinformation; delay in seeking support for symptoms - competing needs with work and family; fear and anxiety while waiting for tests and results), community (convenience of primary care clinics; existing relationships with providers; delay in referral by primary care providers; lack of information on testing rationale and expectations), and environment (distance to cancer centers; difficulty in obtaining appointments). Many participants reported that the onus was on them to find a cancer center and oncologist to conduct further diagnostic testing after seeing a primary care provider for their symptoms. When asked whether participants felt they were treated differently (positively/negatively) because of their race, many participants mentioned being Black negatively affected their ability to obtain timely appointments for diagnostic testing (e.g. biopsy, vaginal ultrasound). A few participants specifically mentioned reaching out to Black providers for management of their cancer. Conclusions: Black women with EC report several determinants to timely diagnosis at multiple levels. These findings will be mapped onto implementation strategies in a system-strengthening intervention to improve guideline-concordant diagnosis.