Biomarkers for improved treatment of endometrial cancer

Endometrial cancer is the most common gynecological cancer among women in Western countries. Patients with endometrial cancer generally have a good prognosis as most are diagnosed at an early stage, and the tumor is removed by primary treatment, which involves surgical removal of the uterus (hysterectomy). Upon diagnosis, patients are risk classified, which determines what treatment they receive. Those who are classified as high-risk will, in addition to surgery, be offered chemotherapy. Nevertheless, 15–20% of patients experience relapse of the disease. The current risk classification is partly inaccurate, which can lead to both over- and under-treatment of patients.

This PhD work addresses the problem through two sub-studies, where the group investigated whether cellular patterns or biomarkers can help identify patients who are inaccurately risk classified. The first study focuses on a subgroup of patients with less advanced disease, who unexpectedly relapse. By using single-cell protein detection, the team was able to identify several different cancer cell types in endometrial cancer. They found that low expression or loss of the protein vimentin is associated with cancer recurrence. This can identify patients who may need closer follow-up or more intensive treatment. In the second sub-study, they investigated cancer stem cell markers to assess their expression and prognostic relevance in endometrial cancer. The team found that high expression of CD44 in cancer cells is associated with better survival, which was unexpected, as expression of cancer stem cell markers is usually associated with more aggressive disease.

Overall, the work has identified markers with prognostic relevance in endometrial cancer, which can contribute to improved risk stratification and thus better treatment of patients.