Fertility-Sparing Strategies for Early-Stage Endometrial Cancer: Stepping towards Precision Medicine Based on the Molecular Fingerprint

Gullo, Giuseppe; Cucinella, Gaspare; Chiàntera, Vito; Dellino, Miriam; Cascardi, Eliano; Török, Péter; Herman, Tünde; Garzon, Simone; Uccella, Stefano; Laganà, Antonio Simone

doi:10.3390/ijms24010811

Cited by 24 publications

(14 citation statements)

References 35 publications

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“…The integration of molecular classification in EC Risk classes has offered the possibility to improve the risk stratification and management of EC to choose patients eligible for adjuvant therapy or to avoid unnecessary treatment in low-risk EC and may low-volume EC disease. The surgicalpathological staging is standard strategy to assess that EC patients need adjuvant therapy, although available data available suggest that molecular classification may play a more accurate prognostic role than histological analysis [51][52][53][54][55][56]. The available pieces of evidence about the topic are scarce and the existing studies are based on small cohorts.…”

Section: Resultsmentioning

confidence: 99%

Evolution of retroperitoneal staging in endometrial cancer: narrative review and overview of literature

Cuccu¹,

Sgamba²,

Cannicchio³

et al. 2023

Ital J Gynaecol Obstet

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Endometrial cancer (EC) is the most common female genital tract malignant cancer. Lymphatic staging is a major prognostic factor and the main predictor of recurrence. The aim of this review is to explore lymph nodal management in EC up to this day and understand how the new molecular EC classification may affect lymph nodal management. A search was conducted in December 2022 to find all relevant trials and shows how,over the years, staging techniques have evolved, becoming more accurate and less invasive. In 1996, a less invasive staging method was found: the Sentinel Lymph Node (SLN), more safer and reliable in detecting metastatic disease. To date, the available pieces of evidence suggests that lymphadenectomy should not be performed in all patients with EC because it does not increase Overall Survival (OS) or Disease Free Survival (DFS) compared to standard surgery without lymphadenectomy, while it actually increases the risk of postoperative complications,in all EC risk classes. In addition, SLN and lymphadenectomy do not have any difference in terms of Recurrence Free Survival (RFS) in patients with low volume disease. Moreover, data available in literature highlight that the molecular classification may play a more accurate prognostic role than histological analysis. Even though some studies showed that the molecular mutations were not significant predictors of recurrence, several large ongoing trials may set new treatment standards. In conclusion, we can state that SLN mapping is an optimal method of EC staging with good sensibility,specificity and decreased surgical complications. Instead, more studies are needed to understand how molecular mutations can affect lymph nodal management.

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Section: Resultsmentioning

confidence: 99%

Evolution of retroperitoneal staging in endometrial cancer: narrative review and overview of literature

Cuccu¹,

Sgamba²,

Cannicchio³

et al. 2023

Ital J Gynaecol Obstet

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“…For young endometrial cancer patients with reproductive demands, fertility‐preserving treatment has emerged as a viable option. Before opting for fertility‐preserving treatment, risk factors for endometrial cancer, such as lymph node metastasis, obesity, and polycystic ovary syndrome, should be evaluated 26 . Recent studies have provided further evidence supporting the choice of fertility‐preserving treatment for endometrial cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Validating the 2023 FIGO staging system: A nomogram for endometrioid endometrial cancer and adenocarcinoma

Feng,

Miao,

et al. 2024

Cancer Medicine

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BackgroundTo find the factors impacting overall survival (OS) prognosis in patients with endometrioid endometrial carcinoma (EEC) and adenocarcinoma and to establish a nomogram model to validate the 2023 International Federation of Obstetrics and Gynecology (FIGO) staging system for endometrial cancer.MethodsData were obtained from the Surveillance, Epidemiology, and End Results (SEER) training cohort. An independent validation cohort was obtained from the First Affiliated Hospital of Anhui Medical University between 2008 and 2023. Cox regression analysis identified independent prognostic factors for OS in EEC and adenocarcinoma patients. A nomogram predicting OS was developed and validated utilizing the C‐index, calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). The relationship between the tumor grade and prognosis of EEC and adenocarcinoma was quantified using net reclassification improvement (NRI), propensity score matching (PSM), and Kaplan–Meier curves.ResultsCox regression analysis identified age, race, marital status, tumor grade, tumor stage, tumor size, and chemotherapy as independent prognostic factors for OS. A nomogram for predicting OS was developed based on these factors. The C‐indexes for the OS nomogram was 0.743 and 0.720 for the SEER training set and external validation set, respectively. The area under the ROC (AUC) for the OS nomogram was 0.755, 0.757, and 0.741 for the SEER data subsets and 0.844, 0.719, and 0.743 for the external validation subsets. Calibration plots showed high concordance between the nomogram‐predicted and observed OS. DCA also demonstrated the clinical utility of the OS nomogram. NRI, PSM, and survival analyses revealed that tumor grade was the most important histopathological factor for EEC and adenocarcinoma prognosis.ConclusionSeven independent prognostic variables for the OS of patients with EEC and adenocarcinoma were identified. The established OS nomogram has good predictive ability and clinical utility and validates the 2023 endometrial cancer FIGO staging system.

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“…Fertility preservation (FP) emerged as a treatment aiming to preserve future reproductive capacity of individuals facing therapies that could potentially affect their gonads [102] or if needed to perform a fertility sparing surgery treatments in case of diagnosis of malignancies and especially in reproductive age [103][104][105][106][107]. The majority being patients diagnosed with cancer, cryopreservation of oocytes or embryos by vitrification [108] is the most common way to preserve fertility and for future needed especially at the parentinghood time.…”

Section: Discussionmentioning

confidence: 99%

Stem Cells and Infertility: A Review of Clinical Applications and Legal Frameworks

Cucinella,

Gullo,

Catania

et al. 2023

Preprint

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Infertility” is a condition defined by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce either as an individual or with his/her partner’. The authors have set out to succinctly investigate, explore and assess infertility treatments harnessing the potential of stem cells to effectively and safely treat infertility, in addition to the legal and regulatory complexities at the heart of stem cell research, with an overview of the legislative state of affairs in six major European countries. In couples who cannot benefit from assisted reproductive technologies (ART) to treat their infertility, stem cells-based approaches have been shown to be a highly promising approach. Nonetheless, lingering ethical and immunological uncertainties require more conclusive findings and data before such treatment avenues can become mainstream and applied large scale. The isolation of human embryonic stem cells (ESCs) is ethically controversial, since their collection involves the destruction of human embryonic tissue. Overall, stem cell research has resulted in important new breakthroughs in the treatment of infertility. The effort to untangle the complex web of ethical and legal issues associated with such therapeutic approaches will have to rely on evidence-based, broadly shared standards, guidelines and best practices to make sure that the procreative rights of patients can be effectively reconciled with the core values at the heart of medical ethics.

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Fertility-Sparing Strategies for Early-Stage Endometrial Cancer: Stepping towards Precision Medicine Based on the Molecular Fingerprint

Abstract: Endometrial cancer represents the fifth most common cancer in women, and the most common gynecological malignancy in developed countries [...]

Cited by 24 publications

References 35 publications

Evolution of retroperitoneal staging in endometrial cancer: narrative review and overview of literature

Evolution of retroperitoneal staging in endometrial cancer: narrative review and overview of literature

Validating the 2023 FIGO staging system: A nomogram for endometrioid endometrial cancer and adenocarcinoma

Stem Cells and Infertility: A Review of Clinical Applications and Legal Frameworks

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