Impact of socio‐economic deprivation on endometrial cancer survival in the North West of England: a prospective database analysis

Njoku, Kelechi; Barr, Chloe E.; Hotchkies, L; Quille, Nomondary; Wan, Y. Louise; Crosbie, Emma J.

doi:10.1111/1471-0528.16618

Cited by 21 publications

(12 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many gynaecological oncology centres are now offering women with low-risk EC patient initiated follow up (PIFU), whereby patients are informed of red flag symptoms and advised to contact secondary care, where they have open access. However, PIFU relies on the woman’s ability to detect recurrence, which is influenced by education level and socioeconomic status [ 107 , 108 ], and may increase fear of recurrence in EC survivors [ 107 ]. Currently, there is a lack of evidence to support routine diagnostic interventions such as biomarkers and imaging to detect recurrence at follow up [ 17 ].…”

Section: He4 As a Biomarker For Recurrencementioning

confidence: 99%

HE4 as a Biomarker for Endometrial Cancer

Behrouzi

Barr

Crosbie

2021

Cancers

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: He4 As a Biomarker For Recurrencementioning

confidence: 99%

HE4 as a Biomarker for Endometrial Cancer

Behrouzi

Barr

Crosbie

2021

Cancers

Self Cite

View full text Add to dashboard Cite

show abstract

“…The study population comprised 333 women with a median age and BMI of 66 years (IQR 56, 73) and 33 kg/m 2 (IQR 27, 41), respectively (Table 1). The modal social deprivation quintile was quintile 1 (most deprived), representing 37.8% (125/331) of the population [28]. Most women were overweight or obese (285/333, 85.6%) with associated comorbidities, including hypothyroidism (…”

Section: Descriptive Characteristics Of the Study Populationmentioning

confidence: 99%

Does Clinical and Biochemical Thyroid Dysfunction Impact on Endometrial Cancer Survival Outcomes? A Prospective Database Study

Barr

Njoku

Hotchkies

et al. 2021

Cancers

Self Cite

View full text Add to dashboard Cite

Endometrial cancer is the commonest gynaecological malignancy in developed countries, and women presenting with high risk or advanced disease have poor outcomes. Thyroid hormones play a key role in cellular metabolism and can influence cancer growth and invasion. Our aim was to evaluate the association between clinical and biochemical thyroid dysfunction and endometrial cancer survival outcomes. This was a prospective cohort study of women treated for endometrial cancer at a specialist centre. Clinical diagnosis of hypothyroidism was based on clinical and biochemical assessment, verified by general practitioner (GP) records. Pre-treatment serum samples were tested for thyrotropin (TSH), thyroid hormones (free T4 and total T3), and thyroid peroxidase antibodies. Kaplan–Meier survival estimates and log-rank tests were used to compare survival between groups, while Cox regression was used for multivariable analysis, adjusting for known confounders and effect modifications. In total, 333 women with median age and body mass index (BMI) of 66 years (interquartile range (IQR) 56, 73) and 33 kg/m2 (IQR 27, 41) respectively were included. A total of 51 (15.3%) women had a diagnosis of hypothyroidism, 39 (11.9%) had biochemical evidence of overt or subclinical hypothyroidism. Median follow-up was 35 months (IQR 21, 45) with 38 (11.7%) relapses and 50 (15.0%) deaths. Women with a diagnosis of hypothyroidism had improved overall survival (adjusted HR = 0.22, 95%CI 0.06–0.74, p = 0.02), cancer-specific survival (adjusted HR = 0.21, 95%CI 0.05–0.98, p = 0.04) and fewer recurrences (adjusted HR = 0.17, 95%CI 0.04–0.77, p = 0.02) than those who did not. Confirmatory studies should explore underlying mechanisms and the potential for therapeutic exploitation.

show abstract

“…Management algorithms also take age, body mass index (BMI) and comorbid status into consideration [ 3 ]. However, there is emerging evidence that prognosis is influenced by factors other than traditional clinico-pathological parameters, and that these may help to refine endometrial cancer risk assessment [ 4 , [8] , [9] , [10] ].…”

Section: Introductionmentioning

confidence: 99%

Pre-treatment inflammatory parameters predict survival from endometrial cancer: A prospective database analysis

Njoku

Ramchander

Wan

et al. 2022

Gynecologic Oncology

View full text Add to dashboard Cite

Purpose Inflammation predisposes to tumorigenesis by damaging DNA, stimulating angiogenesis and potentiating pro-proliferative and anti-apoptotic processes. The aim of this study was to investigate whether pre-treatment biomarkers of systemic inflammation are associated with survival outcomes in endometrial cancer. Patients and methods Women with endometrial cancer were recruited to a prospective database study. Pre-treatment systemic markers of inflammation, including C-reactive protein (CRP), Glasgow Prognostic Score and lymphocyte-based ratios [neutrophil-lymphocyte ratio (NMR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII)], were analysed in relation to overall, endometrial cancer-specific and recurrence-free survival using Kaplan-Meier estimation and multivariable Cox regression. Results In total, 522 women of mostly White British ethnicity, with a median age of 66 years (interquartile range (IQR), 56, 73) and BMI of 32 kg/m 2 (IQR 26, 39) were included in the analysis. Most had low-grade (67.2%), early-stage (85.4% stage I/II), endometrioid (74.5%) tumors. Women with pre-treatment CRP ≥5.5 mg/L had a 68% increase in overall (adjusted HR = 1.68, 95% CI 1.00–2.81, p = 0.049) and a two-fold higher cancer-specific mortality risk than those with CRP <5.5 mg/L (adjusted HR = 2.04, 95%CI 1.03–4.02, p = 0.04). Absolute lymphocyte count, NLR, MLR and SII were associated with adverse clinico-pathologic factors, but not overall, cancer-specific or recurrence-free survival in the multivariable analysis. Conclusion If confirmed in an independent cohort, CRP may offer a simple, low-cost test to refine pre-treatment risk assessment and guide personalised care in endometrial cancer. Our participants were mostly of White British ethnicity and further studies are needed to confirm the utility of CRP as a prognostic biomarker in other populations.

show abstract

Impact of socio‐economic deprivation on endometrial cancer survival in the North West of England: a prospective database analysis

Cited by 21 publications

References 46 publications

HE4 as a Biomarker for Endometrial Cancer

HE4 as a Biomarker for Endometrial Cancer

Does Clinical and Biochemical Thyroid Dysfunction Impact on Endometrial Cancer Survival Outcomes? A Prospective Database Study

Pre-treatment inflammatory parameters predict survival from endometrial cancer: A prospective database analysis

Contact Info

Product

Resources

About