Critical Overview of Serous Endometrial Intraepithelial Cancer Treatment: Systematic Review of Adjuvant Options

Ronsini, Carlo; Reino, Antonella; Molitierno, Rossella; Vastarella, Maria Giovanna; La Mantia, Elvira; De Franciscis, Pasquale

doi:10.3390/life13071429

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…Lastly, more knowledge regarding miRNAs may help clinicians better understand the natural evolution of this disease. The risk of EC spreading via lymphatic, hematologic, or contiguous routes may influence treatment options in terms of molecular profile, adjuvant therapy, and personalizing surgery with procedures such as lymphadenectomy, omentectomy, or adnexectomy [ 81 , 92 , 93 , 94 , 95 , 96 ]. Moreover, we call attention to other novel molecular signatures, such as circular RNAs and proteins, that are different among EC patients and healthy control subjects [ 97 , 98 ].…”

Section: Discussionmentioning

confidence: 99%

MicroRNA Expression in Endometrial Cancer: Current Knowledge and Therapeutic Implications

Iavarone,

Molitierno,

Fumiento

et al. 2024

Medicina

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Background and Objectives: An extracellular vesicle is part of a class of submicron particles derived from cells, mediating cellular crosstalk through microRNA (miRNA). MiRNA is a group of RNA molecules, each of which consists of 15–22 nucleotides and post-transcriptionally modulates gene expression. The complementary mRNAs—onto which the miRNAs hybridize—are involved in processes such as implantation, tumor suppression, proliferation, angiogenesis, and metastasis that define the entire tumor microenvironment. The endometrial biopsy is a standard technique used to recognize cellular atypia, but other non-invasive markers may reduce patient discomfort during the use of invasive methods. The present study aims to examine the distribution and the regulation of the differentially expressed miRNAs (DEMs) and EV-derived substances in women with endometrial cancer. Materials and Methods: We systematically searched the PubMed, EMBASE, Scopus, Cochrane Library, and ScienceDirect databases in April 2023, adopted the string “Endometrial Neoplasms AND Exosomes”, and followed the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We selected all the studies that included patients with endometrial cancer and that described the regulation of miRNA molecules in that context. The differences in molecule expression between patients and controls were evaluated as significant when the proteins had a fold change of ±1.5. Results: Seventeen records fulfilled the inclusion criteria: a total of 371 patients and 273 controls were analyzed. The upregulated molecules that had the widest delta between endometrial cancer patients and controls—relative expression ≥ 1 > 3 log2(ratio)—were miR-20b-5p, miR-204-5p, miR-15a-5p, and miR-320a. In particular, miR-20b-5p and miR-204-5p were extracted from both serum and endometrial specimens, whereas miR-15a-5p was only isolated from plasma, and miR-320a was only extracted from the endometrial specimens. In parallel, the most downregulated miRNA in the endometrial cancer patients compared to the healthy subjects was miR-320a, which was found in the endometrial specimens. Conclusions: Although their epigenetic regulation remains unknown, these upregulated molecules derived from EVs are feasible markers for the early detection of endometrial cancer. The modulation of these miRNA molecules should be assessed during different treatments or if recurrence develops in response to a targeted treatment modality.

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Section: Discussionmentioning

confidence: 99%

MicroRNA Expression in Endometrial Cancer: Current Knowledge and Therapeutic Implications

Iavarone,

Molitierno,

Fumiento

et al. 2024

Medicina

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“…It is standard practice for radiation therapy (RT) and/or chemotherapy (CTX) to be given as adjuvant treatments. Administration of EC patients with radiation therapy (RT) and/or chemotherapy (CTX) regimens—before surgery also—may decrease the rate of micrometastases, hence the need for lymphadenectomy [ 17 , 18 ]. Nowadays, sentinel lymph node (SLN) mapping is considered a valid alternative to systematic lymphadenectomy in order to assess nodal involvement [ 19 , 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of Adjuvant Therapy for the Treatment of Micrometastases in Endometrial Cancer: A Systematic Review and Meta-Analysis

Ronsini,

Napolitano,

Iavarone

et al. 2024

JCM

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Endometrial cancer is the most incident gynecological cancer. Lymph node dissemination is one of the most important factors for the patient’s prognosis. Pelvic lymph nodes are the primary site of extra-uterine dissemination in endometrial cancer (EC), setting the 5-year survival to 44–52%. It is standard practice for radiation therapy (RT) and/or chemotherapy (CTX) to be given as adjuvant treatments to prevent the progression of micrometastases. Also, administration of EC patients with RT and/or CTX regimens before surgery may decrease micrometastases, hence the need for lymphadenectomy. The primary aim of the systematic review and meta-analysis is to assess whether adjuvant RT and/or CTX improve oncological outcomes through the management of micrometastases and nodal recurrence. We performed systematic research using the string “Endometrial Neoplasms” [Mesh] AND “Lymphatic Metastasis/therapy” [Mesh]. The methods for this study were specified a priori based on the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Outcomes were 5-year overall survival, progression-free survival, recurrence rate, and complications rate. We assessed the quality of studies using the Newcastle–Ottawa Scale (NOS). A total of 1682 patients with stage I-to-IV EC were included. Adjuvant treatment protocols involved external-beam RT, brachytherapy, and CTX either alone or in combination. The no-treatment group showed a non-statistically significant higher recurrence risk than any adjuvant treatment group (OR 1.39 [95% CI 0.68–2.85] p = 0.36). The no-treatment group documented a non-statistically significant higher risk of death than those who underwent any adjuvant treatment (RR 1.47 [95% CI 0.44–4.89] p = 0.53; I2 = 55% p = 0.000001). Despite the fact that early-stage EC may show micrometastases, adjuvant treatment is not significantly associated with better survival outcomes, and the combination of EBRT and CTX is the most valid option in the early stages.

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Prognostic value of the presence of serous endometrial intraepithelial carcinoma in uterine serous carcinoma

Kimyon Cömert,

Ersak,

Tokalıoglu

et al. 2024

Cukurova Medical Journal

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Purpose: To investigate the clinical-pathological findings, prognosis, and survival outcome of uterine serous carcinoma (USC) with or without serous endometrial intraepithelial carcinoma (SEIC) which is still a rare entity in literature. Materials and Methods: A total of 98 patients with USC who underwent at least a hysterectomy were reviewed. After elimination for exclusion criteria, totally 76 patients with USC who had surgical staging were evaluated. SEIC was defined as the replacement of the surface and glands of the adjacent atrophic endometrium without invasion of the stroma by the highly atypical cells resembling invasive high-grade endometrial carcinoma. The period from surgery to death or last visit was defined as overall survival (OS). Results: The presence of SEIC was observed in half (n:38). Patients who had USC with SEIC were older and had a higher polypoid pattern than those without SEIC. The 5-year overall survival (OS) was 44.8% and 62.4% in patients with and without SEIC, respectively. There was no statistical significance for other clinicopathological factors in patients who had USC with or without SEIC. The advanced stage was related to a statistically significant hazard ratio for death of 2.45. Furthermore, the stage was found as the only independent factor of OS for USC. And, lymphovascular space involvement was determined as the only independent prognostic factor for OS in patients that had USC with SEIC. Conclusion: Although the presence of polypoid pattern was significantly higher in patients who had USC including SEIC, it was not associated with survival independently. The stage was the only prognostic factor related to OS for USC. However, the presence of the SEIC had no prognostic effect on the survival of USC.

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Critical Overview of Serous Endometrial Intraepithelial Cancer Treatment: Systematic Review of Adjuvant Options

Cited by 3 publications

References 29 publications

MicroRNA Expression in Endometrial Cancer: Current Knowledge and Therapeutic Implications

MicroRNA Expression in Endometrial Cancer: Current Knowledge and Therapeutic Implications

The Role of Adjuvant Therapy for the Treatment of Micrometastases in Endometrial Cancer: A Systematic Review and Meta-Analysis

Prognostic value of the presence of serous endometrial intraepithelial carcinoma in uterine serous carcinoma

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