目的:卵巢子宫内膜异位症和卵巢癌之间的所谓关联是否可以通过在癌症发生之前诊断的子宫内膜异位症的遗传分析来证实?
结论:数据表明卵巢癌并非起源于具有癌症样遗传特征的卵巢子宫内膜异位症;然而,一个共同的前兆是可能的。
背景:根据流行病学研究和手术时在同步疾病中发现的常见驱动突变,子宫内膜异位症被认为是卵巢癌的前体。子宫内膜样卵巢癌和透明细胞卵巢癌是最常见的子宫内膜异位症相关卵巢癌(EAOCs)。
方法:对瑞典两家大学医院的病理生物库进行了仔细检查,以确定手术切除子宫内膜瘤的妇女随后发展为卵巢癌(1998-2016年)。只有45例EAOC和以前的子宫内膜异位症的档案病例被确定,经过仔细的病理检查,由于重新分类为非EAOC(n=9)或由于无法确认卵巢子宫内膜异位症(n=16)而排除了25例。由于子宫内膜异位症组织不足或子宫内膜异位症DNA质量差,其他病例被排除在外。癌,或正常组织(n=9)。最终,有11例病例在所有三个位置都具有令人满意的DNA,并且有资格进行进一步分析。
方法:通过激光捕获显微解剖(子宫内膜瘤n=11)或宏观解剖(癌n=11)从福尔马林固定石蜡包埋(FFPE)切片中收集上皮细胞并提取DNA。来自FFPE切片的正常组织(n=5)或在癌症诊断时收集的血液样品(n=6)用作每个包括的患者的种系对照。进行全外显子组测序(n=33个样品)。体细胞变异(单核苷酸变异,indels,和拷贝数改变)进行了表征,并评估了突变特征和kataegis。微卫星不稳定性和错配修复状态用PCR和免疫组织化学证实,分别。
结果:子宫内膜异位症手术的中位年龄为42岁,54年为随后的卵巢癌诊断。子宫内膜异位症和卵巢癌之间的中位时间为10(7-30)年。数据显示,所有配对样品均具有一个或多个共有的体细胞突变。子宫内膜异位症中癌症相关基因的非沉默突变很常见;然而,在随后的癌中从未观察到相同的突变.克隆优势的程度,通过变异等位基因频率证明,与癌症确诊时间呈正相关(Spearman’srho0.853,P<0.001)。与免疫逃逸相关的基因突变在配对样品之间是最保守的,并且携带这些基因的区域经常受到两种样本类型的拷贝数改变的影响。在所有情况下,突变负担和突变特征都表明有缺陷的DNA修复机制。
方法:补充表中提供了数据集。
结论:尽管我们在1998年至2016年间发现了数千个手术切除的子宫内膜瘤,但只有45个配对样本,甚至更少。11例,有资格进行测序。在两组(子宫内膜瘤和癌)中观察到的高水平的内部和内部异质性,为进一步研究所谓的遗传关联提供了依据。
结论:在所有配对样本中观察到的共有体细胞突变支持了卵巢子宫内膜异位症和卵巢癌的共同细胞起源。然而,与先前的结论相矛盾,我们的数据表明,在子宫内膜异位症发生前数年发生的癌症相关突变与恶性转化没有直接关联.相反,弹性卵巢子宫内膜异位症可能会延迟肿瘤发生。此外,数据表明,影响免疫反应的遗传改变是早期和重要的事件。
背景:目前的工作已由Sjöberg基金会资助(2021-01145至K.S.;2022-01-11:4至A.S.),根据瑞典政府和县议会之间的协议,ALF协议(965552至K.S.;40615至I.H.;965065至A.S.),瑞典癌症协会(K.S.21-1848;I.H.21-1684;A.S.22-2080),BioCARE-隆德大学战略研究区(I.H.和S.W.-F.),BertaKamprad夫人的癌症基金会(FBKS-2019-28,I.H.),癌症和过敏基金会(10381,I.H.),VästraGötaland(A.S.),瑞典创新机构(2020-04141,A.S.),瑞典研究委员会(2021-01008,A.S.),罗氏与瑞典妇科肿瘤学会合作(S.W.-F.),AssarGabrielsson基金会(FB19-86,C.M.),和LenaWäpplings基金会(C.M.)。A.S.宣布拥有股权,也是Tulebovaasta的董事会成员,SiMSen诊断,还有IscaffPharma.A.S.还获得了EMBL的旅行支持,精准医学论坛,SLAS,和bioMCC。其余作者宣称,这项研究是在没有任何可能被解释为潜在利益冲突的商业或财务关系的情况下进行的。
OBJECTIVE: Can the alleged association between ovarian endometriosis and ovarian carcinoma be substantiated by genetic analysis of endometriosis diagnosed prior to the onset of the carcinoma?
CONCLUSIONS: The data suggest that ovarian carcinoma does not originate from ovarian endometriosis with a cancer-like genetic profile; however, a common precursor is probable.
BACKGROUND: Endometriosis has been implicated as a precursor of ovarian carcinoma based on epidemiologic studies and the discovery of common driver mutations in synchronous disease at the time of surgery. Endometrioid ovarian carcinoma and clear cell ovarian carcinoma are the most common endometriosis-associated ovarian carcinomas (EAOCs).
METHODS: The pathology biobanks of two university hospitals in Sweden were scrutinized to identify women with surgically removed endometrioma who subsequently developed ovarian carcinoma (1998-2016). Only 45 archival cases with EAOC and previous endometriosis were identified and after a careful pathology review, 25 cases were excluded due to reclassification into non-EAOC (n = 9) or because ovarian endometriosis could not be confirmed (n = 16). Further cases were excluded due to insufficient endometriosis tissue or poor DNA quality in either the endometriosis, carcinoma, or normal tissue (n = 9). Finally 11 cases had satisfactory DNA from all three locations and were eligible for further analysis.
METHODS: Epithelial cells were collected from formalin-fixed and paraffin-embedded (FFPE) sections by laser capture microdissection (endometrioma n = 11) or macrodissection (carcinoma n = 11) and DNA was extracted. Normal tissue from FFPE sections (n = 5) or blood samples collected at cancer diagnosis (n = 6) were used as the germline controls for each included patient. Whole-exome sequencing was performed (n = 33 samples). Somatic variants (single-nucleotide variants, indels, and copy number alterations) were characterized, and mutational signatures and kataegis were assessed. Microsatellite instability and mismatch repair status were confirmed with PCR and immunohistochemistry, respectively.
RESULTS: The median age for endometriosis surgery was 42 years, and 54 years for the subsequent ovarian carcinoma diagnosis. The median time between the endometriosis and ovarian carcinoma was 10 (7-30) years. The data showed that all paired samples harbored one or more shared somatic mutations. Non-silent mutations in cancer-associated genes were frequent in endometriosis; however, the same mutations were never observed in subsequent carcinomas. The degree of clonal dominance, demonstrated by variant allele frequency, showed a positive correlation with the time to cancer diagnosis (Spearman\'s rho 0.853, P < 0.001). Mutations in genes associated with immune escape were the most conserved between paired samples, and regions harboring these genes were frequently affected by copy number alterations in both sample types. Mutational burdens and mutation signatures suggested faulty DNA repair mechanisms in all cases.
METHODS: Datasets are available in the supplementary tables.
CONCLUSIONS: Even though we located several thousands of surgically removed endometriomas between 1998 and 2016, only 45 paired samples were identified and even fewer, 11 cases, were eligible for sequencing. The observed high level of intra- and inter-heterogeneity in both groups (endometrioma and carcinoma) argues for further studies of the alleged genetic association.
CONCLUSIONS: The observation of shared somatic mutations in all paired samples supports a common cellular origin for ovarian endometriosis and ovarian carcinoma. However, contradicting previous conclusions, our data suggest that cancer-associated mutations in endometriosis years prior to the carcinoma were not directly associated with the malignant transformation. Rather, a resilient ovarian endometriosis may delay tumorigenesis. Furthermore, the data indicate that genetic alterations affecting the immune response are early and significant events.
BACKGROUND: The present work has been funded by the Sjöberg Foundation (2021-01145 to K.S.; 2022-01-11:4 to A.S.), Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (965552 to K.S.; 40615 to I.H.; 965065 to A.S.), Swedish Cancer Society (21-1848 to K.S.; 21-1684 to I.H.; 22-2080 to A.S.), BioCARE-A Strategic Research Area at Lund University (I.H. and S.W.-F.), Mrs Berta Kamprad\'s Cancer Foundation (FBKS-2019-28, I.H.), Cancer and Allergy Foundation (10381, I.H.), Region Västra Götaland (A.S.), Sweden\'s Innovation Agency (2020-04141, A.S.), Swedish Research Council (2021-01008, A.S.), Roche in collaboration with the Swedish Society of Gynecological Oncology (S.W.-F.), Assar Gabrielsson Foundation (FB19-86, C.M.), and the Lena Wäpplings Foundation (C.M.). A.S. declares stock ownership and is also a board member in Tulebovaasta, SiMSen Diagnostics, and Iscaff Pharma. A.S. has also received travel support from EMBL, Precision Medicine Forum, SLAS, and bioMCC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.