Kogan Liron, Octeau David, Amajoud Zainab, Abitbol Jeremie, Laskov Ido, Ferenczy Alex, Pelmus Manuela, Eisenberg Neta, Kessous Roy, Lau Susie, Yasmeen Amber, Gotlieb Walter H, Salvador Shannon
Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H3T 1E2, Canada.
Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada.
Gynecol Oncol Rep. 2018 Mar 19;24:43-47. doi: 10.1016/j.gore.2018.03.004. eCollection 2018 May.
Evaluation of the impact of lower uterine segment involvement (LUSI) in type II endometrial cancer, and mutational profile of uterine papillary serous carcinomas (UPSC).
Retrospective cohort study comparing patients with type II endometrial cancer with LUSI to patients without LUSI. Genes commonly implicated in carcinogenesis were analyzed in a subgroup of 42 patients with UPSC using next generation sequencing.
83 patients with type II endometrial cancer were included in the study, of these, LUSI was diagnosed in 31.3%. During a median follow-up of 45.5 months, patients with LUSI developed more local and distant recurrences (local: 19.2% vs. 3.5%, = .03; distant: 50% vs. 17.5%, = .004) and progression events (73.1% vs. 26.3%, < .001), with shorter mean progression-free survival (16 months compared to 26.5 months, < .01). In a multivariate analysis, LUSI was the only significant pathological factor, associated with a 2.9-fold increase in the risk of progression ( = .007), and a 2.6-fold increase in the risk of death ( = .02). In the subgroup of patients with UPSC, mutations were identified in 54 genes, including (80%), (40%), and (22.5%). Frequent mutations in the PTEN-PI3K-AKT signaling pathway were found in patients with tumor in the upper uterine segment only ( = .04), with being mutated in 29% of the samples ( = .07).
Type II endometrial cancers presenting in the LUS have a significantly worse prognosis and this might be associated with a unique mutational profile.
评估子宫下段受累（LUSI）对II型子宫内膜癌的影响，以及子宫浆液性乳头状癌（UPSC）的突变谱。
回顾性队列研究，比较有LUSI的II型子宫内膜癌患者和无LUSI的患者。使用下一代测序技术，对42例UPSC患者亚组中通常与致癌作用相关的基因进行分析。
83例II型子宫内膜癌患者纳入研究，其中31.3%被诊断为LUSI。在中位随访45.5个月期间，LUSI患者发生更多的局部和远处复发（局部：19.2%对3.5%，P = 0.03；远处：50%对17.5%，P = 0.004）和进展事件（73.1%对26.3%，P < 0.001），平均无进展生存期较短（16个月对比26.5个月，P < 0.01）。多因素分析中，LUSI是唯一显著的病理因素，与进展风险增加2.9倍（P = 0.007）和死亡风险增加2.6倍（P = 0.02）相关。在UPSC患者亚组中，在54个基因中鉴定出突变，包括（80%）、（40%）和（22.5%）。仅子宫上段有肿瘤的患者中发现PTEN-PI3K-AKT信号通路频繁突变（P = 0.04），29%的样本中发生突变（P = 0.07）。
LUS出现的II型子宫内膜癌预后明显更差，这可能与独特的突变谱有关。
