الفهرس 
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Abstract
Endometrial cancer (EC) ranks as the sixth most prevalent form of cancer in women globally, the fourth most prevalent malignancy among women in industrialized nations, and the most prevalent tumor affecting the female reproductive system. It is the predominant gynecologic malignancy in affluent nations and the second most prevalent gynecologic malignancy in underdeveloped countries, behind cervical cancer. The occurrence of EC has been steadily rising in recent years. This may be attributed to the rise in life expectancy, elevated rates of obesity, and the frequency of metabolic disorders. In addition, unlike several other types of cancer, death rates for EC have also been on the rise. In Egypt, the occurrence rate of uterine cancer is 3.5 cases per 100,000 people, which is the least among all the nations in the Middle East.
Most endometrial cancers (EC) start with continuous growth of the endometrial tissue, which is driven by natural or artificial estrogen without any counterbalance from progesterone or progestins. This growth progresses from basic to more complicated types of endometrial hyperplasia (EH). Risk factors may be classified into two categories: modifiable variables, which include obesity, physical activity, and hormonal factors, and non-modifiable ones, such as age, family history, and genetic factors.
The SLCO4C1 gene, located on chromosome 5q21, encodes the SLCO4C1 protein in humans. SLCO4C1 is a polypeptide that specifically transports organic anions in the human kidney. The function it plays in the genesis and progression of cancer is a subject of controversy. Several studies have reported that this gene functions as a tumor suppressor for primary head and neck squamous cell carcinoma. Methylation of the gene’s promoter or somatic mutations in the gene can potentially trigger or enhance the formation and progression of head and neck cancer. Other studies have asserted its function in controlling the growth, programmed cell death, movement, and other characteristics of cancer cells.
FGF21 is a protein produced by the FGF21 gene in animals. This gene encodes a protein that belongs to the fibroblast growth factor (FGF) family. Initially recognized as a new metabolic regulator, it also has potential as an anti-diabetic medication. Prior research has observed a strong correlation between elevated levels of FGF21 in the bloodstream and improved recurrence-free survival and overall survival rates in many types of cancer. This indicates that FGF21 has the potential to be a novel biomarker for predicting the advancement of tumors. Furthermore, FGF21 promotes autophagy, a process that has recently been discovered to be crucial for suppressing cell growth and inducing programmed cell death in prostate cancer tumor cells.
The current investigation included a total of 120 tissue blocks, consisting of 20 instances of EH, 20 cases of AEH, and 100 cases of EC. These tissue blocks were randomly selected from the archives of the Pathology Department Laboratory at Minia University Hospital, covering the period from January 2015 to January 2020.
Pathology reports were used to acquire clinicopathological data for the patients. The sections were extracted and subjected to the following:
The hematoxylin and eosin staining technique is used to identify the tumor grade, presence of lymphovascular invasion (LVI), and tumor necrosis.
Examine the immunohistochemistry presence of SLCO4C1 and FGF21 in all instances.
A strong correlation was seen in the expression of SLCO4C1 among the three endometrial lesions that were investigated, namely EH, AEH, and EC. Furthermore, a statistically significant correlation was seen in instances of EC between the expression of SLCO4C1 and the grade of the tumor.
Concerning the expression of FGF21, a statistically significant correlation was found in the expression of FGF21 in three categories of lesions. FGF21 expression in EC patients showed a significant statistical association with tumor stage, tumor necrosis, and lymphovascular invasion (LVI).
Conclusion: SLCO4C1 may serve as an unfavorable prognosis indicator in the assessment of individuals with EC, but FGF21 may be utilized as a favorable prognostic marker for EC patients. This might serve as a promising therapeutic target in EC.
Recommendation: - It is advised to conduct more research with a bigger sample size and an appropriate number of patients in each grade and stage in order to thoroughly evaluate the relationship between these markers and clinicopathological data.
- In addition to molecular studies and serum level estimations, it is necessary to use IHC expression to confirm the results and identify the common mechanism of these two markers in the invasiveness, migration, and proliferation of EC cell lines.
- This study aims to enhance our understanding of the mechanism of action and potential use of markers as prognostic and therapeutic targets in the treatment of endometrial cancer (EC) cases, as well as in preventing the progression of premalignant lesions into invasive cancer. To achieve this, a wide range of endometrial lesions and histological subtypes will be included, along with detailed history and clinical data of the cases.