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Possible Risk Factors of Pulmonary Metastases in Patients With International Federation of Gynecology and Obstetrics Stage I Endometrioid-Type Endometrial Cancer
  1. Wei Jiang, MD, PhD*,,
  2. Jun Chen, PhD,
  3. Xiang Tao, MD, PhD§,
  4. Feifei Huang, MS*,
  5. Menghan Zhu, PhD*,
  6. Chao Wang, MD, PhD* and
  7. Weiwei Feng, MD, PhD*,
  1. * Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University;
  2. Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases;
  3. Shanghai Gemple Biotech Co Ltd; and
  4. § Department of Pathology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People’s Republic of China.
  1. Address correspondence and reprint requests to Weiwei Feng, MD, PhD, Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 419 Fangxie Rd, Shanghai 200011, P.R. China. E-mail: wfeng7347{at}aliyun.com.

Abstract

Objective Limited data have been obtained in regard to pulmonary metastasis (PM) in patients with stage I endometrial cancer. The aims of the study were (1) to present the clinical and pathological characteristics of patients with PM in the setting of stage I endometrioid-type endometrial cancer (EEC) and (2) to define possible factors that may be used to predict PM.

Methods Six hundred thirty patients with stage I EEC, including 12 with PM, 19 with extra-PM (EPM), and 599 with no recurrence, were observed. Paired samples of primary and metastatic tumors from a patient were used for exome sequencing to identify potential gene mutations associated with PM.

Results There was no significant difference in the age, Ki-67, lymphatic vascular space invasion, and grade 3 among the 3 groups (P > 0.05). More squamous epithelial differentiation was observed in PM (7/12), as compared with patients with EPM (1/19) (P < 0.05) and no recurrence (20/599) (P < 0.05). The tumor size of the patients with PM was bigger than that of nonrecurrent patients (29.8 ± 16.6 vs 18.5 ± 16.3 mm, P < 0.05). More percentage of patients with deep myometrial invasion (IB) were found in PM (6/12) (P < 0.05) as compared with patients with EPM (3/19) (P < 0.05) and no recurrence (76/599). CDH10, ARID1A, and EMT-associated gene mutations were identified in metastatic tumor tissue but not in primary tumors from a patient with EEC and lung metastases.

Conclusions Squamous epithelial differentiation, large tumor size, and deep myometrial invasion might be risk factors for PM in patients with stage I EEC. CDH10, ARID1A, and EMT-associated gene mutation may promote the initiation of lung recurrence. However, further studies are needed to determine the precise mechanisms associated with lung metastasis in these patients.

  • Endometrial cancer
  • Pulmonary metastases
  • Recurrence

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Footnotes

  • The authors declare no conflicts of interest.

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