| 1. |
- Castro Wersäll, Ofra, et al.
(author)
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Dietary Habits and Daily Routines as Prognostic Factors in Endometrial Cancer : A Machine Learning Approach
- 2023
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In: Nutrition and Cancer. - : Routledge. - 0163-5581 .- 1532-7914. ; 75:1, s. 310-319
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Journal article (peer-reviewed)abstract
- Endometrial cancer (EC) is becoming more common worldwide, primarily due to an increase in life expectancy and obesity. As several modifiable factors may affect EC incidence and progression, we aimed to elucidate how dietary habits and daily routines influence recurrence and survival among women with EC, using a Random Survival Forest (RSF) approach. 481 women who previously underwent hysterectomy due to EC completed two extensive questionnaires on dietary habits and daily routines, and we used RSF to identify risky or protective variables. 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. We conclude that RSF is a suitable approach to study survival in multivariable datasets.
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| 2. |
- Kacperczyk-Bartnik, Joanna, et al.
(author)
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Clinician attitude towards sexual counseling in women with gynecologic malignancies : European Network of Young Gynaecological Oncologists (ENYGO) survey
- 2022
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In: International Journal of Gynecological Cancer. - : BMJ Publishing Group Ltd. - 1048-891X .- 1525-1438. ; 32:10, s. 1309-1315
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Both the location of primary disease and treatment side effects may have an impact on sexual function in oncogynecological patients. The aim of this study was to examine the prevalence, strategies, difficulties, and ideas for improvement in sexual counseling among specialists managing patients with gynecologic malignancies.METHODS: This was a cross-sectional survey study performed among healthcare professionals treating patients with gynecologic malignancies. A self-prepared questionnaire included 61 questions concerning general demographic information and different aspects of sexual counseling in the gynecologic oncology practice. Analysis included attitudes, behaviors, management strategies, difficulties, and ideas for possible systemic improvements. Statistical analysis involved descriptive statistics, two-sided chi-square test, and Fisher's exact test.RESULTS: A total of 150 respondents from 46 countries answered the survey. The majority of survey participants stated that sexual counseling of oncological patients is very important (n=73, 49%) or important (n=46, 31%). One hundred and two (68%) respondents agreed that sexual counseling of gynecologic oncology patients should be routinely provided by the specialist managing the primary disease. However, collecting information concerning sexual function is performed often or always by only 21% of respondents and 19% discuss the topic rarely or never. The most frequently indicated barriers leading to difficulties in sexual counseling include lack of time (74%), lack of specialist knowledge (55%), and patient embarrassment (48%). One hundred and seven (71%) respondents expressed interest in participating in sexual counseling workshops organized by the European Society of Gynaecological Oncology (ESGO)/European Network of Young Gynaecological Oncologists (ENYGO), 74 (49%) would like to access webinars on the topic, and 120 (80%) would be interested in materials in the ESGO online educational resources.CONCLUSION: One of the proposed solutions to insufficient access to sexual care for women with gynecologic malignancies is providing access to specialist educational programs for both patients and healthcare specialists.
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| 3. |
- Razumova, Zoia, et al.
(author)
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22nd meeting of the European Society of Gynaecological Oncology (ESGO 2021) report
- 2022
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In: International Journal of Gynecological Cancer. - : BMJ. - 1048-891X .- 1525-1438. ; 32:11, s. 1363-1369
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Journal article (peer-reviewed)abstract
- 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.
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| 4. |
- Razumova, Zoia, et al.
(author)
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Cadmium intake as a prognostic factor in endometrial cancer : a Swedish cohort-based study
- 2022
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In: Nutrition and Cancer. - Stockholm : Karolinska Institutet, Dept of Women's and Children's Health. - 0163-5581 .- 1532-7914.
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Journal article (peer-reviewed)abstract
- 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.
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| 5. |
- Razumova, Zoia
(author)
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Prognostic factors in endometrial cancer
- 2022
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Doctoral thesis (other academic/artistic)abstract
- 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.
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| 6. |
- Razumova, Zoia, et al.
(author)
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Report from the European Society of Gynaecological Oncology (ESGO) 2020 State-of-the-Art Virtual Meeting
- 2021
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In: International Journal of Gynecological Cancer. - : BMJ. - 1048-891X .- 1525-1438. ; 31:5, s. 658-669
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Journal article (peer-reviewed)abstract
- 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.
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| 7. |
- Razumova, Zoia, et al.
(author)
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The Prognostic Role of LRIG Proteins in Endometrial Cancer
- 2021
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In: Cancers. - Stockholm : MDPI. - 2072-6694. ; 13:6
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Journal article (peer-reviewed)abstract
- 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.
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| 8. |
- Wersäll, Ofra Castro, et al.
(author)
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Which dietary and everyday life habits affect endometrial cancer recurrence? The machine gives the answer
- 2020
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In: International Journal of Gynecological Cancer. - : Lippincott Williams & Wilkins. - 1048-891X .- 1525-1438. ; 30:Suppl. 4, s. A32-A33
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Journal article (other academic/artistic)abstract
- Introduction/Background: The increased life expectancy and westernization of the lifestyle are considered the major contributors to a sustainable rise in endometrial cancer (EC) rates. The factors predicting EC recurrence include patient age and tumour characteristics, such as type, differentiation, and depth of invasion. At the same time, recent studies testify the impact of meal and exercises on the course of various diseases. What are the food preferences and activities that could influence the ultimate risk of EC relapse and death?Methodology: The study included 481 women who previously underwent a hysterectomy due to EC at Karolinska University Hospital. The participants filled an extensive questionnaire on their dietary habits and everyday routines. Related clinical data was obtained through the National e-health system. It resulted in a large dataset with more than 180 variables, which was processed using the Random Survival Forest (RSF) approach. The latter is applied to a right-censored data and uses a collection of decision trees to rank the variables by their importance for the occurrence of an event. The top-ranked variables were further investigated with the Cox proportional hazards model. Analyzes were performed using the RandomForestSRC package for Python.Results: The consumption of the fried potatoes significantly increased the risk of EC relapse and death [HR=8.62 (2.22–33.56), p=0.002; HR=6.00 (1.06–34.01), p=0.043, respectively), the latter persisted after adjustment for body mass index, age and smoking status. Besides, each additional serving of sweetened soda drinks increased the risk of death [3.262 (1.834–5.800), p=0.0001]. In contrast, physical activity was beneficial with each additional Metabolic Equivalent per day decreasing the risk of death by 7.3% [HR=0.927 (0.892–0.964), p< 0.0001).Conclusion: We hypothesise that the fried potatoes’ detrimental effect may be related to the acrylamide, which is formed in starch-rich foods under high-temperature conditions. It acts as a carcinogen and endocrine disruptor, causing the endometrial hyperplasia and EC in animal studies. Sweetened beverages cause a rise in insulin, which in turn inhibits sex-hormone binding protein. This results in higher levels of circulating free oestrogens. Also, insulin has mitogenic and anti-apoptotic properties, further inducing the endometrium proliferation. The favorable influence of regular physical activity on EC relapse and death is in accordance with previous studies, including recent meta-analysis.Therefore, we encourage women treated for EC to consider reducing sweetened beverages and fried potatoes consumption and increasing physical activity.
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