Prognostic factors in endometrial cancer

Endometrial cancer (EC) is the most common malignancy of the female reproductive system in Sweden. Patients with EC generally have a good prognosis, though some face recurrence and have a lower survival rate despite treatment. Current prognostic factors for EC are still not able to accurately reflect disease prognosis. Therefore, the overall aim of the present project was to evaluate the impact of different, patient-specific factors on the prognosis of women with EC, with a special focus on the LRIG family of proteins, cadmium, dietary factors, daily routines, and the endometrial microbiome. Identifying these factors could pave the way for better determination of EC prognosis. Study I analysed the role of LRIG1, LRIG2, and LRIG3 proteins on survival rates in women with EC. The analysis demonstrated that most patients had >50% positive cells for all three LRIG proteins. The LRIG1 protein score was high in most patients (97.3%). The percentage of LRIG3-positive cells was positively associated with better overall survival (P=0.019). There was no LRIG3 cell membrane staining in 30.4% of women who died, compared to 7.7% of EC survivors (P=0.01). Consequently, the results reveal a potential prognostic role of LRIG3, not LRIG1 and LRIG2, in EC. Study II assessed the role of cadmium intake on the survival of 416 women with EC residing in Sweden. Median dietary cadmium intake was 13.1 μg/day. High dietary cadmium intake was associated with lower overall survival (P=0.05), but not with progression-free survival (P=0.348). Accordingly, high dietary cadmium intake seems to be an adverse prognostic factor in EC. Study III evaluated the prognostic role of modifiable factors, such as dietary habits and daily routines, in EC using machine learning models. Among the 186 variables considered, consumption of sugar-sweetened beverages and fried potatoes increased the risk of EC recurrence and death, while physical activity decreased the risk of death. As a consequence, modification of specific dietary habits and daily routines might favourably impact EC prognosis. Study IV investigated the role of endometrial microbiota in women with EC and compared it to the bacterial profile of women with benign conditions of the gynaecological tract (endometrial hyperplasia, EH or endometrial polyp, EP). Most women in the EC and EH/EP groups were postmenopausal and had a BMI above the normal range. The median age in the EC group was 10 years higher than that in the EH/EP group. The preliminary analysis showed that patients with EC have endometrial microbiota distinct from that of patients with EH/EP: Atopobium and Porphyromonas were present in patients with EC, while Lactobacillus was present in those with EH/EP. Thereby, endometrial microbiota might play a role in EC prognosis. To conclude, this thesis provides additional knowledge on certain molecular and nonmolecular factors that might play a role in EC, including its prognosis. Moreover, it emphasises the importance of continued investigation of other potential prognostic factors in EC

Cadmium Intake as a Prognostic Factor in Endometrial Cancer: A Swedish Cohort-Based Study

Metalloendocrinology is a new interdisciplinary field, which was established due to the importance of connections between inorganic chemicals and hormonal mechanisms. The role of cadmium in hormone-related tumors is an excellent example of this connection, as cadmium mimics estrogen in the human body. Since endometrial cancer (EC) is hormonerelated, it is well-suited for assessing the estrogenic effects of cadmium. Therefore, the present study aims to explore the role of dietary cadmium intake in the progression-free survival (PFS) and overall survival (OS) in women with EC. Dietary cadmium intake was estimated based on a large cohort of Swedish women (n ¼ 416) with EC. Median dietary cadmium intake was then analyzed in relation to different tumor characteristics and clinical outcomes. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Median daily dietary cadmium intake in the cohort was 13.1 lg (interquartile range 25%-75%¼6.4). High dietary cadmium intake (lg/day) was associated with significantly decreased OS in the study cohort (HR ¼ 0.956, 95% CI ¼ 0.914- 1.001, p ¼ 0.05). Dietary cadmium intake was not associated with PFS (HR ¼ 0.975, 95% CI ¼ 0.924-1.028, p ¼ 0.348). Therefore, our results indicate that high dietary cadmium intake could be associated with poor outcome in women with EC.NonePublishe

Subspecialty training in Europe:a report by the European Network of Young Gynaecological Oncologists

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The prognostic role of lrig proteins in endometrial cancer

Endometrial cancer (EC) is the most common gynecologic malignancy in Sweden and it has various prognostic factors. The LRIG family is a group of three integral surface proteins with a similar domain organization. The study aimed to explore LRIG family as prognostic factor proteins in EC. The initial study cohort included 100 women with EC who were treated at the Department of Women’s and Children’s Health, Karolinska University Hospital Solna, between 2007 and 2012. We assessed the associations between LRIG protein expression and type, grade, and stage of EC, as well as progression‐free and overall survival. Immunohistochemistry results revealed that most women in the analytical sample had >50% LRIG1‐, LRIG2‐ and LRIG3‐positive cells. A statistically significant association was observed between having a high number of LRIG3‐positive cells and superior overall survival (incidence rate ratio = 0.977; 95% confidence interval: 0.958–0.996, p = 0.019). Moreover, positive LRIG3 staining of the cell membrane was associated with reducing in the risk of death (hazard ratio = 0.23; 95% confidence interval: 0.09–0.57). Our results show that LRIG3 expression might be a prognostic factor in EC. The role of LRIG1 and LRIG2 expression remains to be further investigated

Report from the European Society of Gynaecological Oncology (ESGO) 2020 State-of-the-Art Virtual Meeting

This is a report from the European Society of Gynaecological Oncology State-of-the-Art Virtual Meeting held December 14-16, 2020. The unique 3-day conference offered comprehensive state-of-the-art summaries on the major advances in the treatment of different types of gynecological cancers. Sessions opened with a case presentation followed by a keynote lecture and interactive debates with opinion leaders in the field. The speakers also presented scientific reviews on the clinical trial landscape in collaboration with the European Network of Gynecological Oncological Trial (ENGOT) groups. In addition, the new ESGO-ESRTO-ESP endometrial cancer guidelines were officially presented in public. This paper describes the key information and latest studies that were presented for the first time at the conference

22nd meeting of the European Society of Gynaecological Oncology (ESGO 2021) report

This is a report from the 22nd Meeting of the European Society of Gynaecological Oncology, held October 23-25, 2021. The 3-day event offered an educational experience covering the major scientific and clinical advances in gynecological oncology. The Congress program included different session formats, including guidelines updates and state-of-the-art lectures. This article provides an overview of the main Congress activities as well as of the most important studies that were presented at the event for the first time

Gender-related differences in career development among gynecologic oncology surgeons in Europe. European Network of Young Gynecologic Oncologists' Survey based data

Gender-related differences in career development are well known issues in various professions. An international survey on gender-related differences was performed among young gynecologic oncology surgeons in Europe to identify potential gender inequalities in career development. A survey on demographics, clinical and academic working environment, family/parenting, career development, salary and leadership was sent to all members of the European Network of Young Gynecologic Oncologists (ENYGO), which is a network within the European Society of Gynecologic Oncology (ESGO). Gynecologic oncology surgeons and obstetricians/gynecologists who actively work in this field in Europe were included in the study. Responses were analyzed from 192 gynecologic oncology surgeons of whom 65.1% (125/192) were female (median age 37, IQR: 34 - 42) and 34.9% (67/192) were male (median age 38, IQR: 36 - 41). Male reported to perform a median of 15 and female a median of 10 operations per month (p =. 007). Among female, 24.8% had a leadership position vs. 44.8% among male, crude OR = 2.46, 95% CI 1.31-4.62, p<.01. When stratifying for age under 41 and having children, 36.7% of male and 5.6% of female had a leadership position, adjusted OR 10.8, 95% CI 3.28-35.64, p <.001. A significantly higher proportion of female compared to male believed they earned less than their gender counterparts at the same clinical position and with same qualifications (30.4% vs. 2.5%, p<.001). There was not a statistically significant gender difference in the academic qualification PhD degree or professorship (p =.92 and p =.64, respectively). In the previous year, male published more peer-reviewed articles than female (median 3 vs. median 2; p =.017). This first comprehensive survey on gender-differences in gynecologic oncology in Europe revealed that there are gender gaps concerning several aspects during the critical time of career development in the young generation of gynecologic oncology surgeons. These gender gaps are particularly reflected by a lower rate of female leadership positions. ENYGO and ESGO are dedicated to work on solution to overcome the identified obstacles and to support closing gender gap