Endometrial cancer is the third most common gynecologic malignancy and the ninth most common malignancy for females overall in Hong Kong. Approximately 80% or more of these cancers are endometrioid endometrial adenocarcinomas. The aim of this study was to reveal genes contributing to the development of endometrioid endometrial cancer, which may impact diagnosis, prognosis and treatment of the disease. Whole-genome gene expression analysis was completed for a set of 55 microdissected sporadic endometrioid endometrial adenocarcinomas and 29 microdissected normal endometrium specimens using the Affymetrix Human U133 Plus 2.0 oligonucleotide microarray. Selected genes of interest were validated by quantitative real-time-polymerase chain reaction (qRT-PCR). Pathway analysis was performed to reveal gene interactions involved in endometrial tumorigenesis. Unsupervised hierarchical clustering displayed a distinct separation between the endometrioid adenocarcinomas and normal endometrium samples. Supervised analysis identified 117 highly differentially regulated genes (⩾4.0-fold change), which distinguished the endometrial cancer specimens from normal endometrium. Twelve novel genes including DKK4, ZIC1, KIF1A, SAA2, LOC16378, ALPP2, CCL20, CXCL5, BST2, OLFM1, KLRC1 and MBC45780 were deregulated in the endometrial cancer, and further validated in an independent set of 56 cancer and 29 normal samples using qRT-PCR. In addition, 10 genes were differentially regulated in late-stage cancer, as compared to early-stage disease, and may be involved in tumor progression. Pathway analysis of the expression data from this tumor revealed an interconnected network consisting of 21 aberrantly regulated genes involved in angiogenesis, cell proliferation and chromosomal instability. The results of this study highlight the molecular features of endometrioid endometrial cancer and provide insight into the events underlying the development and progression of endometrioid endometrial cancer.
Endometrial cancer is the third most common gynecologic malignancy and the ninth most common malignancy for females overall in Hong Kong. Its documented incidence in 2002 was 12.5 per 100 000 women (Hong Kong Cancer Stat., 2005). Although it has a comparatively low mortality rate compared with other gynecologic cancers, a proportion of cases display aggressive characteristics. Approximately 80% or more of endometrial cancers are endometrioid adenocarcinoma whereas only about 10% are serous adenocarcinomas and clear cell tumors (Ilvan et al., 2004; Amant et al., 2005). All three histotypes are associated with a distinct prevalence, etiology and prognosis. Serous endometrial carcinomas occur almost exclusively in postmenopausal women (>60 years), are unrelated to estrogen stimulation, and evolve from atrophic rather than hypertrophic epithelium. Endometrioid endometrial carcinomas are associated with hormonal imbalance, hyperlipidemia and obesity (Hendrickson et al., 1982). Precancerous hyperplasia lesions have been identified in both serous and endometrioid types of endometrial carcinoma, however, they are more frequently seen in association with malignant endometrioid histology. Clear-cell carcinoma of the endometrium is a relatively rare malignancy that is considered to be one of the most aggressive types of endometrial carcinoma (Abeler and Kjorstad, 1991).
Currently, a number of somatic gene mutations are being studied in order to provide insight into the pathogenesis of sporadic endometrial cancer. Although mutations in the mismatch repair genes are found in inherited endometrial cancers and confer a lifetime risk of developing the disease that approaches 60%, these are rarely seen in sporadic cancers. Mutations in the tumor suppressor gene TP53 have been reported in over 90% of serous papillary endometrial cancers (Tashiro et al., 1997). In contrast, none were documented in endometrioid tumors (Lax et al., 2000). These findings suggest that subgroups of endometrial cancers undergo unique genetic events during pathogenesis.
Gene expression profiling has proven invaluable in the identification of molecular pathways contributing to carinogenesis and metastasis. Comparing gene expression patterns in cells or tissues representing distinct phenotypes, for example, normal and malignant cells, can help link cellular phenotype with the transcriptome. Identifying genes that are differentially expressed in endometrial cancer is important for understanding the biology of endometrial tumorigenesis and progression. In this study, we utilized microdissected endometrioid tumor specimens and normal endometrium to identify differentially expressed genes apart from intervening stromal cells and lymphocytic infiltrate. Using the Affymetrix Human U133 Plus 2.0 oligonucleotide microarray, which contains over 55 000 probe sets representing more than 47 000 transcripts derived from approximately 39 500 human genes, we demonstrated a distinct separation between tumor and normal endometrial specimens. We identified genes that were highly deregulated in this common type of endometrial malignancy. Subsequent pathway analysis revealed signaling events, which might contribute to the development and progression of endometrioid endometrial cancer in Hong Kong Chinese women.
Hierarchical clustering of endometrioid tumors and normal endometrium
Genome-wide expression profiles for 84 microdissected endometrioid endometrial tumors and normal isolates were generated using the Affymetrix U133 Plus 2.0 oligonucleotide microarray platform. Data filtering identified 2305 probe sets possessing informative signal intensity values in ⩾20% of the arrays. To characterize the relationships between the tumor and normal endometrial samples, unsupervised hierarchical clustering was applied to all 2305 probe sets. A dendrogram possessing two distinct arms separating endometrioid tumors from normal endometrium was identified (Figure 1). Despite the existence of well-defined clusters between normal and tumor specimens, a single endometrioid tumor specimen was incorrectly classified. Furthermore, the cancers in the same stage were not clustered together as shown in the dendrogram of gene expression profiling.
Identification of differentially regulated genes distinguishing endometrioid specimens from normal endometrium
In order to identify differentially expressed genes, which might contribute to the development or progression of endometrioid endometrial cancer, a supervised analysis was completed. Using a two-sided Welch modified two-sample t-test, 696 of the 2305 probe sets satisfying the filtering criteria were differentially regulated in the endometrial tumors at a P-value <0.01 and possessed a fold change ⩾2.0 (90% lower bound) with a mean difference ⩾100. Permutation analysis returned a 0.0% median false discovery rate for the 696 probe sets under consideration.
To reduce the complexity of the data set, 133 probe sets possessing a ⩾±4.0-fold change were evaluated further. These 133 probe sets comprised 117 unique genes and expressed sequence tags (ESTs), of which 25 were upregulated (Figure 2) and 92 downregulated (Figure 3) in the 55 endometrioid endometrial adenocarcinomas. In all, seven of the 117 differentially expressed genes have previously been reported as differentially expressed in endometrial cancer (Table 1). The remaining 110 genes and ESTs have not been reported to be associated with the endometrial malignancy (Table 2).
In this set of endometrial cancers, there were 41 stage I, four stage II and 10 stage III cases. When early-stage (I–II) and late-stage (III) tumors were compared, 10 transcripts were found to be downregulated in late-stage cancers (Table 3).
To validate the microarray results, nine upregulated genes, DKK4, ZIC1, KIF1A, SAA2, LOC16378, ALPP2, CCL20, CXCL5 and BST2, and three downregulated genes, OLFM, KLRC1 and MBC45780, that displayed significant differential expression between the tumor specimens and normal endometrium, but have not been reported previously in endometrial cancer, were selected for quantitative RT-PCR (qRT-PCR) analysis on an independent set of 56 cancer and 29 normal samples. In addition, GADD45G, which was downregulated in late- stage versus early-stage disease, was also evaluated. For all 13 genes, changes in expression observed by qRT-PCR agreed favorably the array data (Figure 4a and b). The first 12 genes measured by qRT-PCR were also shown to be significantly upregulated or downregulated in cancers when compared to normal counterparts (P<0.01). GADD45G was significantly underexpressed (−5.59 folds) in 10 late-stage cancers compared to 46 early-stage cancers in this independent set of 56 tumors (P<0.01).
To identify signaling pathways that are associated with endometrial tumorigenesis, we analysed our microarray expression data using PathwayAssist version 3.0 software. Inclusion in the pathway required differential expression of ⩾±2.0-fold relative to normal endometrium (P<0.01). Among the 696 probe sets analysed, genes represented by two or more probe sets were averaged to establish a composite fold change value during analysis. Figure 5 contains 21 differentially regulated genes encoding proteins linked to angiogenesis, cell-cycle progression and chromosomal instability in endometrioid endometrial cancer. In addition, a number of estrogen-regulated genes including CCNA1, CCNE1 and metalloproteinase (MMP)-9 were identified in the analysis.
A number of studies have utilized microarray-based platforms to identify genes that are aberrantly expressed in endometrial tumors as compared to normal endometrium (Mutter et al., 2001; Moreno-Bueno et al., 2003; Risinger et al., 2003; Cao et al., 2004; Saidi et al., 2004; Smid-Koopman et al., 2004; Ferguson et al., 2005; Maxwell et al., 2005). These analyses have provided useful data, but all have been limited by a number of factors including heterogeneous tumor populations, an insufficient number of tumor and/or control specimens and microarray formats with relatively few features. To determine a more global assessment of differential gene expression in endometrial tumors in Chinese Hong Kong women, we used the whole-genome Affymetrix U133 Plus 2.0 microarray, and focused on a large microdissected tumor set containing specimens from the most common histologic subtype of endometrial cancer, endometrioid endometrial adenocarcinoma. As normal endometrium is a dynamic organ under hormonal regulation, we evaluated gene expression in proliferative, secretory and postmenopausal specimens in almost equal numbers. This provided a composite view of gene expression in normal endometrium for comparison to the endometrial malignancies.
Unsupervised hierarchical clustering clearly demonstrated that endometrioid endometrial cancer is distinct from normal endometrium. However, the early and late-stage diseases were not hierarchically well clustered, respectively. Despite successful classification of a majority of the samples, a single early stage, well-differentiated tumor clustered with the normal specimens.
To identify genes contributing to the clustering result, a supervised analysis was performed. A total of 696 probe sets were identified as differentially regulated ⩾±2.0-fold (P-value <0.01) in endometrioid tumors versus normal endometrium. Included in this data set were 117 genes possessing a±4.0-fold change in expression. Among them seven genes have been reported previously as differentially expressed in endometrial tumors. Lactotransferrin (LTF) was upregulated (Walmer et al., 1995), whereas six genes including SFRP4, DCN, IGFBP6, HGF, WT1 and WNT4 were downregulated in the endometrial tumors (Rutanen et al., 1994; Bui et al., 1997; Yoshida et al., 2002; Muller-Tidow et al., 2003; Smid-Koopman et al., 2004; Acs et al., 2004; Hrzenjak et al., 2004). Of these genes, only WT1 was been specifically associated with endometrioid cancer (Acs et al., 2004). Repeated identification of these genes as aberrantly regulated in endometrial tumors suggests that they may play a significant role in the development and progression of the disease.
The remaining 110 genes have not been described in endometrioid endometrial cancer. Out of the 110 genes, 36 are associated with non-endometrial tumors (data not shown) whereas the remaining 74 genes are novel cancer-related transcripts that involved in multiple biological processes including cell cycle, protein metabolism, proteolysis and peptidolysis etc. From the 110 genes, 12 including DKK4, ZIC1, KIF1A, SAA2, LOC16378, ALPP2, CCL20, CXCL5, BST2, OLFM1, KLRC1 and MBC45780 were validated in an independent set of tumor and normal endometrium specimens. qRT-PCR data was significant for all 12 genes with fold change values approximating the microarray data. Among these genes, CCL20 together with its unique receptor may contribute to aspects of tumor cell growth and invasion through autocrine and paracrine mechanisms (Schutyser et al., 2003). In addition, concentrations of CXCL5 in peritoneal fluid are markedly elevated in the endometriosis patients, as compared with the controls, especially in women with severe endometriosis, whereas KLRC2 is associated with an increased susceptibility to cancer (Miyashita et al., 2004; Suzumori et al., 2004). These novel, validated genes may provide important insights into the biology underlying endometrioid endometrial cancer.
To reduce the dimensionality of the data set and uncover signaling pathways contributing to tumorigenesis and progression, pathway analysis was completed for all 696 probe sets identified as differentially regulated at a fold change ⩾2.0. Co-regulated signaling events contributing to angiogenesis, cellular proliferation and chromosomal instability were identified. The proangiogenic protein MMP9 featured prominently in the analysis. MMP9 plays a critical role in the development of tumor-associated vasculature and can enhance the invasive potential of tumor cells (Pepper, 2001; Hojilla et al., 2003). Upregulation of this gene may be linked to increased levels of HMGA1 and TFAP2A, which are both positive regulators of MMP9 (Liu et al., 1999; Sivak et al., 2004). In breast cancer patients, TFAP2A is highly associated with MMP9 expression (Pellikainen et al., 2004). NRC3C1 is a nuclear receptor that can inhibit expression of MMP9 (Cha et al., 1988). In conjunction with elevated levels of HMGA1 and TFAP2, reduced expression of this gene may lead to increased MMP9 activity.
Critical modulators of MMP9 were also differentially regulated including lipocalin 2 (LCN2), tissue inhibitors of metalloproteinases (TIMP)2, TIMP3, thrombospondin 2 (THBS2) and proenkephalin (PENK). In human breast carcinoma cells LCN2 can protect MMP9 from degradation preserving its enzymatic activity (Yan et al., 2001). MMP9/LCN2 complexes have also been identified in the urine of breast cancer patients suggesting that this marker may be useful for predicting disease status in endometrioid endometrial cancer patients (Fernandez et al., 2005). TIMP family members are endogenous inhibitors of MMP proteinase activity (Murphy and Knauper, 1997). Downregulation of these genes in tumor cells stimulates MMP9-mediated degradation of the extracellular matrix. TIMP2 has also been shown to negatively regulate angiogenesis through a mechanism that is independent of its anti-MMP activity (Stetler-Stevenson and Seo, 2005). Thrombospondin 2 is another potent inhibitor of angiogenesis (Streit et al., 1999). This effect may be due to its ability to inhibit activation of pro-MMP9 protein, as well as downregulate MMP9 expression through a receptor-mediated event (Bein and Simons, 2000; Kamochi et al., 2003). Decreased THBS2 levels may be the result of enhanced MYB expression, which can antagonize transcription of THBS2 (Bein et al., 1998). The opioid peptide PENK may also mitigate MMP9 expression (Takeba et al., 2001). A coordinated increase in MMP9 expression, along with decreased inhibitor levels, suggests that MMP9 may play a critical role in endometrioid endometrial cancer. Secretion of this protein into the extracellular matrix may help support an extracellular environment that is amenable to vascularization, as well as tumor invasion.
Cancer cells are typically associated with aberrant cell-cycle regulation. As expected, a number of previously described proteins involved in cell proliferation were upregulated in endometrioid endometrial cancer (Milde-Langosch et al., 2001; Muller-Tidow et al., 2003). CCNA1 is the cyclin required for progression from S phase into G2, whereas CCNE1 is necessary for transition through the G1/S and G2/M checkpoints (Schafer, 1998). Increased CCN1A expression may be stimulated by the transcription factors MYB and HMGA1 (Muller et al., 1999; Reeves et al., 2001). In addition, downregulation of WT-1 is associated with increased expression of cyclin E1 (Loeb et al., 2002). WT-1 is also able to negatively regulate expression of MYB, whereas MAF can reduce MYB activity through heterodimeriziation (McCann et al., 1995; Hedge et al., 1998). In vivo and in vitro assays assessing tumor growth and cellular proliferation have demonstrated that 3-hydroxy-3-methylglutaryl coenzyme A reductase can stimulate CCNE1/CDK2 activity (Tanaka et al., 1998; Duncan et al., 2004). In contrast, ZAK, which encodes a serine/threonine kinase, is associated with reduced cyclin E1 levels and cell-cycle arrest (Yang, 2002). SPARC, a secreted matricellular protein, can also impede cell-cycle progression by inhibiting cyclin E1 and cyclin A1 in tumor and vascular smooth muscle cells (Dhanesuan et al., 2002; Motamed et al., 2002). Together these signaling events contribute to a cellular context favoring tumor expansion.
Beyond enhancing the proliferative potential of tumor cells, altered expression of cell-cycle-related proteins can also contribute to chromosomal instability. BUB1B and CDC20 are two regulators of the anaphase-promoting complex (APC). This complex of ubiquitin ligase proteins is responsible for the degradation of critical cell-cycle proteins ensuring checkpoint transitions occur in a normal manner (Harper et al., 2002). BUB1B is required for metaphase arrest in response to a lack of bipolar attachment. Overexpression of this protein is associated with a decrease in chromosomal stability and poor outcome in breast cancer patients (Warren et al., 2002; Dai et al., 2005). CDC20 is necessary for the degradation of an S-phase cyclin, which can antagonize APC activity (Harper 25 et al., 2002). Increased expression of CDC20 is also linked to increased chromosomal instability in breast cancer (Yuan et al., 2006). Phosphorylation of BIRC5 by cyclin B1 is essential for cell survival during mitosis. This observation suggests that BIRC5 may be play an important role in ensuring proper cell division occurs at the G2/M checkpoint (O'Connor et al., 2000). Abnormal regulation of these genes may lead to the accumulation of deleterious chromosomal alterations promoting tumor development and progression.
Estrogen-induced signaling plays a key role in the development and progression of endometrioid endometrial tumors. The necessity of estrogen-mediated signaling was evidenced by the differential regulation of known estrogen response genes including CCNE1, CCNA1, MMP9 and LTF. CCNE1 and CCNA1 have both been linked to estrogen stimulation (Tong and Pollard, 1999). Evidence that HMGA1 can enhance binding of the estrogen receptor to estrogen response elements may help explain increased CCNA1 levels, as well a increased MMP9 expression in the endometrial tumors (Massaad-Massade et al., 2004). The association of MMP9 transcription with estrogen signaling implies that this hormone may play a key role in the development of tumor vasculature required for disease progression (Mizumoto et al., 2002). Estrogen has also been implicated in the regulation of LTF2 (Liu and Teng, 1991). Upregulation of this gene in endometrial carcinoma cell lines has been linked to tamoxifen resistance suggesting a connection between estrogen signaling events and drug resistance (Albright and Kaufman, 2001). Given the hormone-dependent nature of these tumors, targeting estrogen-regulated genes for therapeutic intervention may facilitate the design of novel agents for the treatment of this disease.
To identify genes associated with the progression of endometrioid endometrial cancer, we compared the gene expression profiles of 45 stage I and II, and 10 stage III endometrial tumors. Late-stage tumors displayed similar expression profiles when compared to early-stage tumors, however 10 genes were significantly downregulated in late-stage compared to early-stage endometrial cancer. Among the 10 genes, GADD45G is involved in growth arrest and is inactivated in multiple tumor types (Kalsheker et al., 2002; Ying et al., 2005). Decreased expression of these genes in late-stage endometrial cancers may facilitate the identification of signaling pathways contributing to tumor progression.
Microsatellite instability (MSI) is a molecular phenotype present in ∼25% of endometrial cancers. Recently, Risinger et al. (2005) examined the global gene expression profiles in 24 early-stage endometrioid endometrial cancers including nine cases with and 15 cases without the MSI phenotype. Unsupervised principal component analysis of the expression data from these cases indicated two distinct groupings of cancers based on MSI phenotype. In particular, they found evidence that two members of the secreted frizzled-related protein family (SFRP1 and SFRP4) were more frequently downregulated in MSI cancers as compared with microsatellite stable cancers whereas the WNT target fibroblast growth factor 18 was found to be upregulated in MSI cancers (Risinger et al., 2005). The determination of MSI status in the cancer subjects of our present study, and then analysis of MSI-specific gene expression profiles are undergoing. We would like to further confirm which unique molecular signature exists in the MSI cancers and if it is able to classify histologically similar endometrioid endometrial cancers into two distinct groupings with implications affecting therapy and prevention based on such molecular signature(s).
In conclusion, we have identified differentially regulated genes distinguishing microdissected endometrioid endometrial adenocarcinoma from normal endometrium. In addition to novel cancer-related transcripts, signaling pathways contributing to angiogenesis, cell-cycle progression and chromosomal instability were identified. A number of these pathways may also be modulated through estrogen-related signaling events. Although late- stage an early-stage tumors retained similar gene expression profiles, differentially expressed genes were identified that may contribute to progression of the disease. Together, these findings provide a clearer picture of the pathways contributing to endometrioid endometrial cancer in Hong Kong Chinese women. Furthermore, they serve a starting point for the identification of novel clinical markers and therapeutic targets.
Materials and methods
Study subjects were recruited at the Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong. One hundred and eleven tumor tissue specimens obtained from primary endometrioid endometrial adenocarcinoma were immediately embedded in optimal cutting temperature compound, snap-frozen in liquid nitrogen and stored at −80°C. Fifty-eight normal endometrium tissue specimens were collected from women who underwent a hysterectomy or endometrial curettage for unrelated conditions. Frozen sections from each specimen were stained by hematoxylin and eosin to verify the quality of the tissue sample and the extent of inflammatory infiltrate. Histologic typing of each tumor was according to World Health Organization (WHO) criteria, whereas clinical staging followed International Federation of Gynecology and Obstetrics (FIGO) standards. The mean age of patients with the endometrial cancer was 55.5 (36–82) years, whereas for the normal controls it was 52.8 (38–85) years. There was no statistical difference in age between tumor and control groups. All specimens, and their corresponding clinical information, were obtained under protocols approved by the Clinical Research Ethics Committee of The Chinese University of Hong Kong.
Microdissection and RNA extraction
Microdissection was performed to obtain homogeneous populations of neoplastic and normal glandular cells. Approximately 20 000 cells/specimen were accrued using laser capture microdissection (MicroBeam MicroLaser Systems, PALM Microlaser Technologies GmbH, Bernried, Germany). It is estimated that the epithelial components in both cancer and control samples reached to 90% or more, and were comparable.
Total RNA was extracted from microdissected target cells using a RNeasy Micro Kit (Qiagen, Valena, CA, USA) according to the manufacturer's protocol and stored at −80°C. Isolated RNA was analysed with an Agilent 2100 Bioanalyzer (Agilent Technologies Inc., Palo Alto, CA, USA) to verify sample integrity and quantify total RNA yield.
Total RNA amplification for Affymetrix GeneChip hybridization
Total RNA obtained from 55 endometrial cancer and 29 normal endometrium samples was amplified using the GeneChip Eukaryotic Small Sample Target Labeling Assay. As previously described, it utilizes two cycles of complementary DNA (cDNA) synthesis and in vitro transcription for the amplification of 50–100 ng of total RNA (Bonome et al., 2000). Labeled amplified RNA was then hybridized to the Affymetrix Human Genome U133 Plus 2.0 GeneChip (Affymetrix, Santa Clara, CA, USA), which contains over 55 000 probe sets representing more than 47 000 transcripts derived from well characterized genes. The arrays were scanned with a confocal laser GeneChip scanner. The resulting images were captured using GeneChip Operating Software (GCOS) (Affymetrix, Santa Clara, CA, USA).
Clustering and statistical analysis of expression data
CEL files generated in GCOS were analysed using DNA-Chip analyzer (dCHIP) (Version 1.3). (http://www.dCHIP.org) software platform (Li and Wong, 2003). The 84 CEL files generated by the Affymetrix Microarray Suite version 5.0 were converted into DCP files. Perfect match (PM) and mismatch (MM) probes were normalized before PM/MM model-based expression analysis. The generated gene list was filtered. Only those genes whose expression levels fulfilled the following criteria were included: 1<s.d./mean <10, gene called P (present) in 20% of samples. Global comparisons of data derived from cancer and normal endometrium samples were carried out as follows: Emean/Bmean>4 or Bmean/Emean>4; Emean−Bmean>100 or Bmean−Emean>100; and P for testing Emean=Bmean<0.01 (where E=experimental cancer samples and B=baseline normal endometrium samples). The t statistic was computed as (mean1−mean2)/[SE(mean1)2+SE(mean2)2] and its P computed based on the t distribution, and the degree of freedom was set according to the Welch-modified two-sample t-test. For the subsequent analysis, only probe sets differentially expressed >±2.0-fold in tumor versus normal endometrium were considered.
qRT-PCR was performed on total RNA obtained from an independent set of tumor (56 cases) and normal (29 cases) specimens for which microdissection was also completed. Each reaction was run in duplicate on an ABI Prism 7900 Sequence Analyzer (Applied Biosystems, Foster City, CA, USA). The comparative computed tomography method was used to calculate fold change values as specified by the manufacturer. In brief, 1 μg of total RNA from each sample was reverse-transcribed using SuperScript II Reverse Transcriptase (Invitrogen, Carlsbad, CA, USA). An aliquot of cDNA from each reverse-transcribed sample (1 μl) was PCR amplified using gene-specific Assay-On-Demand TaqMan probes for DKK4, ZIC1, KIF1A, SAA2, LOC16378, ALPP2, CCL20, CXCL5, BST2, OLFM, KLRC1, MBC45780 or GADD45G and TaqMan Universal PCR Master Mix (Applied Biosystems, Foster City, CA, USA). Expression values for each gene were determined using a standard curve constructed from human universal RNA (Clontech, Palo Alto, CA, USA). The housekeeping gene glyceraldehyde phosphate dehydrogenase was selected for normalization. Student's t-test was used to assess the statistical difference of each gene expression level measured by qRT-PCR between the target and control groups.
To identify co-regulated pathways contributing to the distinct biology associated with endometrioid endometrial cancer, 696 probe sets identified as differentially regulated at least >±2.0-fold relative to normal endometrium (P<0.01) were analysed using PathwayAssist version 3.0 software (Iobion Informatics LLC, La Jolla, CA, USA). This software package contains over 500 000 documented protein interactions acquired from PubMed using the natural language processing algorithm MEDSCAN. This proprietary database was used to develop a biological association network and identify putative co-regulated signaling pathways.
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This work was supported by a Hong Kong Research Grant Council Earmarked Grant (RGC) (4427/03M).
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Wong, Y., Cheung, T., Lo, K. et al. Identification of molecular markers and signaling pathway in endometrial cancer in Hong Kong Chinese women by genome-wide gene expression profiling. Oncogene 26, 1971–1982 (2007). https://doi.org/10.1038/sj.onc.1209986
- endometrioid endometrial cancer
- signaling pathway
- gene expression profiling