Transcatheter embolization of uterine fibroid: Effects on quality of life and patient satisfaction

Einleitung: Myome sind die häufigsten benignen Tumoren des Uterus bei Frauen im reproduktionsfähigen Alter. Die Uterusarterienembolisation (UAE) ist eine minimalinvasive, organerhaltende Therapiealternative zur Behandlung von symptomatischen Uterusmyomen. Ziel der Arbeit: Das Ziel dieser Arbeit ist, den Therapieerfolg der UAE bei Patientinnen mit symptomatischen uterinen Leiomyomen zu evaluieren. Materialen und Methoden: Im Rahmen dieser retrospektiven Datenanalyse wurden die „Uterine Fibroid Symptom and Quality of Life“ (UFS-QoL) -Fragebögen der Myompatientinnen ausgewertet, die zwischen Januar 2010 und Dezember 2019 mittels Embolisation in der Klinik für Radiologie an der Charité behandelt wurden und sowohl einen prä- als auch einen post-interventionellen Fragebogen ausgefüllt hatten. Je nach Beantwortungsdatum der post-interventionell beantworteten Fragebögen wurden die Patientinnen den Untergruppen kurz- ( 7 Monate) Verlaufsgruppe zugeordnet. Anhand der prä-interventionell angefertigten MRT-Aufnahmen wurden die Myome nach Durchmesser des dominanten Tumors in kleine (< 10 cm) und große (≥ 10 cm) Uterusmyome unterteilt. Ergebnisse: Insgesamt wurden die Daten von 245 Myompatientinnen ausgewertet. 26 (11%) Patientinnen unterzogen sich einer Re-Intervention. Die Kaplan-Meier-Analyse zeigte, dass 75,8 % aller Patientinnen nach 70 Monaten keine weitere Intervention benötigten. Dieser Anteil blieb bis Ende des Beobachtungszeitraums (9,9 Jahre) konstant. Die Cox-Regressionsanalyse zeigte, dass große Myome (≥ 10 cm) mit einem zweifach erhöhten Re-Interventionsrisiko einhergingen. Die UFS-QoL-Fragebögen der restlichen Patientinnen, die sich keiner Re-Intervention unterziehen mussten, wurden ausgewertet. Verglichen mit den prä-interventionellen Scores kam es kurz- und langfristig nach Embolisation zu einer signifikanten Verbesserung aller Subgruppen des UFS-QoL-Fragebogens (p < 0,001). Patientinnen mit kleinen Myomen wiesen im kurz- und langfristigen Verlauf ein signifikant besseres Therapieansprechen in einigen UFS-QoL-Kategorien gegenüber Patientinnen mit großen Myomen auf. Über 85% der mittels Embolisation behandelten Myompatientinnen waren mit dem Therapieergebnis voll oder zumindest teilweise zufrieden und würden diese minimalinvasive Therapiealternative zur Myombehandlung weiterempfehlen. Schlussfolgerung: Die UAE ist ein effektives minimalinvasives Therapieverfahren zur Behandlung von symptomatischen Uterusmyomen, die mit einem geringen Re-Interventionsrisiko assoziiert ist und zu einer schnellen Symptomlinderung und deutlichen Zunahme der gesundheitsbezogenen Lebensqualität führt. Patientinnen mit kleinen Myomen weisen in Bezug auf einige UFS-QoL-Kategorien ein besseres Therapieansprechen als Patientinnen mit großen Myomen auf. Die meisten Myompatientinnen geben sich mit dem Therapieergebnis zufrieden und würden die UAE zur Myombehandlung weiterempfehlen.Introduction: Myomas are the most common benign uterine tumors in women of reproductive age. Uterine Artery Embolization (UAE) is a minimal-invasive, organ-preserving alternative form of treatment for symptomatic uterine leiomyomas. Purpose: The purpose of this study is the evaluation of UAE as a treatment option for the management of symptomatic uterine fibroids. Materials and Methods: This retrospective study analyzed the “Uterine Fibroid Symptom and Quality of Life’’ (UFS-QoL) questionnaires of patients treated with UAE at the Department of Radiology, Charité-Universitaetsmedizin Berlin, between January 2010 and December 2019. Questionnaires were filled out before and after embolization, respectively. Patients were stratified into a short- ( 7 months) follow-up group depending on the time of completion of the post-interventional UFS-QoL questionnaire. Fibroids were furthermore divided into small (< 10 cm) and large (≥ 10 cm) uterine myomas based on the diameter of the dominant tumor lesion on MRI. Results: A total of 245 patients were included into the data analysis. 26 (11%) patients underwent a re-intervention. The Kaplan-Meier analysis showed a cumulative rate of freedom from re-intervention of 75,8 % after 70 months staying stable until the end of follow-up (9,9 years). Cox regression demonstrated a two-fold higher probability of re-intervention for patients with large fibroids (≥ 10 cm). The results of the UFS-QoL questionnaires of the remaining patients who did not undergo a re-intervention were analyzed. All UFS-QoL subscales improved significantly from baseline to short- and long-term follow-up (p < 0,001). In certain UFS-QoL subscales patients with small fibroids showed a significantly better response to UAE than patients with large myomas after the short- and long-term follow-up. More than 85% of the patients were completely or at least partially satisfied with the outcome and would recommend this minimal invasive treatment alternative to other patients. Conclusion: UAE is an effective treatment method for symptomatic uterine fibroids that is associated with a low risk for re-interventions and leads to quick relief of fibroid-related symptoms and improvement in quality of life. Patients with small fibroids show a better response to UAE in several UFS-QoL subscales compared to patients with large myomas. The majority of the patients is satisfied with the outcome and would recommend the treatment to others

Short- and long-term evaluation of disease-specific symptoms and quality of life following uterine artery embolization of fibroids

Background: The purpose of this study is to evaluate uterine artery embolization (UAE) for the management of symptomatic uterine leiomyomas regarding changes in quality of life after treatment in a large patient collective. This study retrospectively analyzed prospectively acquired standardized questionnaires of patients treated with UAE. Clinical success was evaluated before and after embolization. Patients were stratified into short- (7 months) follow-up groups depending on the time of completion of the post-interventional questionnaire. Uterine leiomyomas were furthermore divided into small (= 10 cm) tumors based on the diameter of the dominant fibroid. Results: A total of 245 patients were included into the final data analysis. The Kaplan-Meier analysis showed a cumulative clinical success rate of 75.8% after 70 months until the end of follow-up (9.9 years). All questionnaire subscales showed a highly significant clinical improvement from baseline to short- and long-term follow-up (p = 10 cm who had a twofold higher probability of re-intervention in the Cox-regression model. Conclusions: UAE is an effective treatment method for symptomatic fibroids that leads to quick relief of fibroid-related symptoms with marked improvement of quality of life and is associated with a low risk for re-interventions. Patients with small fibroids tend to show a better response to UAE compared to patients with large fibroids

The Role of Patient-Derived Organoids in Triple-Negative Breast Cancer Drug Screening

Triple-negative breast cancer (TNBC) is one of the most aggressive breast cancer subtypes, with a grave prognosis and few effective treatment options. Organoids represent revolutionary three-dimensional cell culture models, derived from stem or differentiated cells and preserving the capacity to differentiate into the cell types of their tissue of origin. The current review aims at studying the potential of patient-derived TNBC organoids for drug sensitivity testing as well as highlighting the advantages of the organoid technology in terms of drug screening. In order to identify relevant studies, a literature review was conducted using the MEDLINE and LIVIVO databases. The search terms &ldquo;organoid&rdquo; and &ldquo;triple-negative breast cancer&rdquo; were employed, and we were able to identify 25 studies published between 2018 and 2022. The current manuscript represents the first comprehensive review of the literature focusing on the use of patient-derived organoids for drug sensitivity testing in TNBC. Patient-derived organoids are excellent in vitro study models capable of promoting personalized TNBC therapy by reflecting the treatment responses of the corresponding patients and exhibiting high predictive value in the context of patient survival evaluation

EPH/Ephrin-Targeting Treatment in Breast Cancer: A New Chapter in Breast Cancer Therapy

Breast cancer (BC) is the most common malignant tumor in women. Erythropoietin-producing hepatocellular receptors (EPHs), receptor tyrosine kinases binding the membrane-bound proteins ephrins, are differentially expressed in BC, and correlate with carcinogenesis and tumor progression. With a view to examining available therapeutics targeting the EPH/ephrin system in BC, a literature review was conducted, using the MEDLINE, LIVIVO, and Google Scholar databases. EPHA2 is the most studied EPH/ephrin target in BC treatment. The targeting of EPHA2, EPHA10, EPHB4, ephrin-A2, ephrin-A4, as well as ephrin-B2 in BC cells or xenograft models is associated with apoptosis induction, tumor regression, anticancer immune response activation, and impaired cell motility. In conclusion, EPHs/ephrins seem to represent promising future treatment targets in BC

The Role of Peroxisome Proliferator-Activated Receptors in Preeclampsia

Preeclampsia is a common pregnancy-related hypertensive disorder. Often presenting as preexisting or new-onset hypertension complicated by proteinuria and/or end-organ dysfunction, preeclampsia significantly correlates with maternal and perinatal morbidity and mortality. Peroxisome proliferator-activated receptors (PPARs) are nuclear receptor proteins that regulate gene expression. In order to investigate the role of PPARs in the pathophysiology of preeclampsia, we conducted a literature review using the MEDLINE and LIVIVO databases. The search terms &ldquo;peroxisome proliferator-activated receptor&rdquo;, &ldquo;PPAR&rdquo;, and &ldquo;preeclampsia&rdquo; were employed and we were able to identify 35 relevant studies published between 2002 and 2022. Different study groups reached contradictory conclusions in terms of PPAR expression in preeclamptic placentae. Interestingly, PPAR&gamma; agonists alone, or in combination with well-established pharmaceutical agents, were determined to represent novel, potent anti-preeclamptic treatment alternatives. In conclusion, PPARs seem to play a significant role in preeclampsia

The Role of MicroRNAs in Uterine Leiomyosarcoma Diagnosis and Treatment

Uterine sarcomas are rare gynecological tumors arising from the myometrium or the connective tissue of the endometrium with a relatively poor prognosis. MicroRNAs (miRNAs) represent small, single-stranded, non-coding RNA molecules that can function as oncogenes or tumor suppressors under certain conditions. The current review aims at studying the role of miRNAs in uterine sarcoma diagnosis and treatment. In order to identify relevant studies, a literature review was conducted using the MEDLINE and LIVIVO databases. The search terms “microRNA” and “uterine sarcoma” were employed, and we were able to identify 24 studies published between 2008 and 2022. The current manuscript represents the first comprehensive review of the literature focusing on the particular role of miRNAs as biomarkers for uterine sarcomas. miRNAs were found to exhibit differential expression in uterine sarcoma cell lines and interact with certain genes correlating with tumorigenesis and cancer progression, whereas selected miRNA isoforms seem to be either over- or under-expressed in uterine sarcoma samples compared to normal uteri or benign tumors. Furthermore, miRNA levels correlate with various clinical prognostic parameters in uterine sarcoma patients, whereas each uterine sarcoma subtype is characterized by a unique miRNA profile. In summary, miRNAs seemingly represent novel trustworthy biomarkers for the diagnosis and treatment of uterine sarcoma

The Role of Peroxisome Proliferator-Activated Receptors in Preeclampsia

Preeclampsia is a common pregnancy-related hypertensive disorder. Often presenting as preexisting or new-onset hypertension complicated by proteinuria and/or end-organ dysfunction, preeclampsia significantly correlates with maternal and perinatal morbidity and mortality. Peroxisome proliferator-activated receptors (PPARs) are nuclear receptor proteins that regulate gene expression. In order to investigate the role of PPARs in the pathophysiology of preeclampsia, we conducted a literature review using the MEDLINE and LIVIVO databases. The search terms “peroxisome proliferator-activated receptor”, “PPAR”, and “preeclampsia” were employed and we were able to identify 35 relevant studies published between 2002 and 2022. Different study groups reached contradictory conclusions in terms of PPAR expression in preeclamptic placentae. Interestingly, PPARγ agonists alone, or in combination with well-established pharmaceutical agents, were determined to represent novel, potent anti-preeclamptic treatment alternatives. In conclusion, PPARs seem to play a significant role in preeclampsia

The Impact of Histone Modifications in Endometriosis Highlights New Therapeutic Opportunities

Endometriosis is a chronic disorder of the female reproductive system which afflicts a great number of women worldwide. Histone deacetylases (HDACs) prevent the relaxation of chromatin, thereby positively or negatively modulating gene transcription. The current review aims at studying the impact of histone modifications and their therapeutic targeting in endometriosis. In order to identify relevant studies, a literature review was conducted using the MEDLINE and LIVIVO databases. The current manuscript represents the most comprehensive, up-to-date review of the literature focusing on the particular role of HDACs and their inhibitors in the context of endometriosis. HDAC1, HDAC2, HDAC3, Sirtuin 1, and Sirtuin 3, are the five most studied HDAC enzymes which seem to, at least partly, influence the pathophysiology of endometriosis. Both well-established and novel HDACIs could possibly represent modern, efficacious anti-endometriotic drug agents. Altogether, histone modifications and their therapeutic targeting have been proven to have a strong impact on endometriosis

Thymic Epithelial Neoplasms: Focusing on the Epigenetic Alterations

Thymic Epithelial Neoplasms (TENs) represent the most common tumors of the thymus gland. Epigenetic alterations are generally involved in initiation and progression of various cancer entities. However, little is known about the role of epigenetic modifications in TENs. In order to identify relevant studies, a literature review was conducted using the MEDLINE and LIVIVO databases. The search terms thymoma, thymic carcinoma, thymic epithelial neoplasm, epigenetics, DNA methylation, HDAC and miRNA were employed and we were able to identify forty studies focused on TENs and published between 1997 and 2021. Aberrant epigenetic alterations seem to be involved in the tumorigenesis of thymomas and thymic carcinomas, with numerous studies reporting on non-coding RNA clusters and altered gene methylation as possible biomarkers in different types of TENs. Interestingly, Histone Deacetylase Inhibitors have shown potent antitumor effects in clinical trials, thus possibly representing effective epigenetic therapeutic agents in TENs. Additional studies in larger patient cohorts are, nevertheless, needed to verify the clinical utility and safety of novel epigenetic agents in the treatment of patients with TENs

Thymic Epithelial Neoplasms: Focusing on the Epigenetic Alterations

Thymic Epithelial Neoplasms (TENs) represent the most common tumors of the thymus gland. Epigenetic alterations are generally involved in initiation and progression of various cancer entities. However, little is known about the role of epigenetic modifications in TENs. In order to identify relevant studies, a literature review was conducted using the MEDLINE and LIVIVO databases. The search terms thymoma, thymic carcinoma, thymic epithelial neoplasm, epigenetics, DNA methylation, HDAC and miRNA were employed and we were able to identify forty studies focused on TENs and published between 1997 and 2021. Aberrant epigenetic alterations seem to be involved in the tumorigenesis of thymomas and thymic carcinomas, with numerous studies reporting on non-coding RNA clusters and altered gene methylation as possible biomarkers in different types of TENs. Interestingly, Histone Deacetylase Inhibitors have shown potent antitumor effects in clinical trials, thus possibly representing effective epigenetic therapeutic agents in TENs. Additional studies in larger patient cohorts are, nevertheless, needed to verify the clinical utility and safety of novel epigenetic agents in the treatment of patients with TENs