Association Between Diet Quality and Risk of Ovarian and Endometrial Cancers: A Systematic Review of Epidemiological Studies.

OBJECTIVES: The relationship between diet quality indices and risk of ovarian and endometrial cancers were unclear. We aimed at conducting a systematic review to evaluate the epidemiological evidence. METHODS: Embase, PubMed, Web of Science and Scopus databases were searched for eligible studies up to December 2020. Epidemiological studies reported the association of the diet quality with risk of ovarian and endometrial cancers were evaluated. RESULTS: Eleven eligible studies were identified, of which six studies were case-control studies, four were cohort studies, and one was case-cohort study. All studies were considered as high-quality with low risk of bias. Seven studies evaluated the association of diet quality with risk of ovarian cancer. Four studies reported null association for diet quality indices such as Healthy Eating Index (HEI)-2005, HEI-2010, Mediterranean Diet Score (MDS) and Recommended Foods Score (RFS). Two studies reported significantly inverse association for Alternate Healthy Eating Index (AHEI)-2010 and Healthy Diet Score (HDS) indices. One study reported significantly increased risk of ovarian cancer associated with higher level of Dietary Guidelines for Americans Index. Dose-response analysis showed pooled relative risks of 0.98 (95%Cl: 0.95, 1.01) and 0.94 (95%Cl: 0.77, 1.13) for each 10 points increase in the HEI-2005 and AHEI-2010 indices. Seven studies evaluated the association of diet quality with risk of endometrial cancer. Three studies reported significantly inverse association of diet quality as assessed by the MDS and Diet Score Quintiles with risk of endometrial cancer. Four studies reported null association for other diet quality indices including HEI-2005, HEI-2010, RFS and HDS. Dose-response analysis showed a pooled relative risk of 0.87 (95%CI: 0.81, 0.93) for one unit increment of the MDS. CONCLUSION: This study suggests little evidence on the association between diet quality and risk of ovarian cancer. Adherence to high quality diet, as assessed by MDS, might be associated with lower the risk of endometrial cancer.

Expressions of CD44,CD47,and c-met in Ovarian Clear Cell Carcinoma and Their Clinical Significance.

Objective To investigate the expressions of CD44,CD47,and c-met in ovarian clear cell carcinoma (OCCC) tissue and their correlations with clinical variables and prognosis. Methods Immunohistochemical method was used to investigate the expressions of CD44,CD47,and c-met in tissues from 86 OCCC patients and the relationships of their expressions with the clinicopathological factors of OCCC were analyzed. Results The expressions of CD44,CD47,and c-met were significantly high in OCCC tissues (90.7%,91.9%,and 94.2%,respectively). The strong positive expressions of CD44 and CD47 were significantly correlated with advanced International Federation of Gynecology and Obstetrics stages,chemotherapeutic resistance,and poor prognosis (all P<0.05),the strong positive expression of c-met was significantly correlated with chemotherapeutic resistance and poor prognosis (all P<0.05),whereas there was no correlation between the strong positive expressions of CD44,CD47,and c-met and the lymphatic node metastasis. COX survival analysis revealed that advanced International Federation of Gynecology and Obstetrics stages and high expressions of CD44,CD47 and c-met were independent risk factors for poor prognosis (P<0.05). There was a positive correlation between CD44 (or CD47) and c-met and between CD44 and CD47 (the Spearman correlation coefficient rs was 0.783,0.776,and 0.835,respectively,all P<0.01). Conclusions The expressions of CD44,CD47,and c-met increase in OCCC tissues and are correlated with each other. High expressions of CD44,CD47,and c-met are independent factors for poor prognosis.

Membranous expressions of Lewis y and CAM-DR-related markers are independent factors of chemotherapy resistance and poor prognosis in epithelial ovarian cancer.

BACKGROUND: Chemotherapy resistance is a common problem faced by patients diagnosed with epithelial ovarian cancer (EOC). Currently there are no specific or sensitive clinical biomarkers that maybe implemented to identify chemotherapy resistance and give insight to prognosis. The aim of this study is to investigate the roles of Lewis y antigen and the markers associated with cell-adhesion-mediated drug resistance (CAM-DR) in patients with EOC. METHODS: 92 EOC patients who were treated with systemic chemotherapy after cytoreductive surgery were included in this analysis. Patients were divided into two groups, chemotherapy sensitive (n = 56) and resistant (n = 36). Immunohistochemical (IHC) staining for Lewis y and CAM-DR-related cell surface proteins including CD44, CD147, HE4 (Human epididymis protein 4), integrin α5, ß1, αv and ß3 were conducted on tissues collected during primary debulking surgery. Using multivariate logistic regressions, IHC results were compared to clinical variables and chemotherapy resistance to determine possible correlations. The relationships between IHC expression and progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier method and Cox regression analysis. RESULTS: Membranous expression of Lewis y and all these CAM-DR-related markers were significantly higher in the resistant group than that of the sensitive group (all P < 0.01). Multivariate regression analysis revealed that high expression of Lewis y, CD44, HE4, integrin α5 and ß1 as well as advanced FIGO stage were independent risk factors for chemotherapy resistance (all P < 0.05). Advanced FIGO stage, lymph node metastasis and high expression of Lewis y, CD44, CD147, HE4, integrin α5, ß1 were associated with a shorter PFS and OS (all P < 0.05). Moreover, multivariate COX analysis demonstrated that the following variates were independent predictors of worse PFS and OS survival: late FIGO stage (P = 0.013, 0.049), high expressions of Lewis y (P = 0.010, 0.036), HE4 (P = 0.006, 0.013) and integrin ß1 (PFS, P = 0.003), integrin α5 (OS, P = 0.019). CONCLUSION: Membranous expression of Lewis y and CAM-DR-related markers including CD44, CD147, HE4, integrin α5, ß1, αv and ß3 are associated with the development of chemotherapy resistance. High expression of Lewis y antigen and CAM-DR-related markers including CD44, CD147, HE4, integrin α5 and ß1 are independent markers for PFS and OS, in which Lewis y and HE4 are the most significant.