Women with early-stage endometrial cancer are often treated with radiation after surgery if they are at particularly high risk for recurrence.
These risk factors should probably include abnormal beta-catenin expression, say a team of researchers from Stanford University, California.
Beta-catenin is an intracellular protein involved in cell proliferation, differentiation, and apoptosis that is increasingly being linked to oncologic outcomes.
The team found that women with endometrial cancer and abnormal beta-catenin expression are at increased risk for vaginal recurrence, but it can be prevented with adjuvant radiation.
The finding was published in the May 2023 edition of Gynecologic Oncology.
It comes from a review of 80 women, from a total patient population of 213 (38%), who had abnormal expression on surgical tumor sections assessed by immunohistochemistry.
There were no vaginal recurrences among the 23 women with abnormal expression who had adjuvant radiation therapy, but there were 10 vaginal recurrences among the 57 women (17.5%) with abnormal expression who did not have radiation.
The finding held regardless of the type of radiation women received, be it brachytherapy, external-beam radiation, or both.
“Abnormal beta-catenin expression was associated with increased risk of vaginal recurrence” in early-stage endometrial cancer patients, the authors conclude. Radiation therapy “should be considered in these patients to decrease risk of vaginal recurrences,” they add. The team was led by Caressa Hui, MD, a radiation oncology resident at Stanford, where the women were treated.
Approached for comment, Siddhartha Yadav, MD, a breast and gynecologic cancer specialist at the Mayo Clinic in Rochester, Minnesota, said the study “builds on the prior work on aberrant beta-catenin expression as a biomarker for poor prognosis in early endometrial cancer. While these results are fascinating, we need larger prospective studies to confirm these findings before implementing beta-catenin assessment for endometrial cancer patients in clinical practice.”
Study Details
Women in the study had FIGO 2018 stage I-II endometrioid endometrial cancer and underwent surgery from 2009 to 2021. Median follow-up was almost 4.5 years.
Abnormal beta-catenin expression remained significantly associated with vaginal recurrences after age, tumor grade, depth of myometrial invasion, and lymphovascular space invasion were controlled for.
The association was particularly robust in the 114 women who had no specific molecular profile (NSMP) to their tumors, the most common molecular subtype of endometrial cancer. Almost half had abnormal beta-catenin expression.
Among NSMP women with abnormal expression who didn’t have radiation, 21.4% had a vaginal recurrence vs none who had radiation.
Adjuvant radiation was offered on a case-by-case basis, typically to women with risk factors for recurrence such as myometrial or lymphovascular space invasion.
“Despite this potentially higher risk group of patients, those who received radiation therapy had significantly improved local control in patients with abnormal beta-catenin expression,” the investigators said.
Only vaginal recurrences were increased with abnormal expression, and overall survival was similar between women with wild-type and those with abnormal expression.
There was no external funding for the work. Hui and the other study investigators report having no disclosures. Yadav reports having no disclosures.
Gynecol Oncol. Published online May 5, 2023. Abstract
M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape. Alex is also an MIT Knight Science Journalism fellow. Email: [email protected]
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