A novel model to estimate lymph node metastasis in endometrial cancer patients

Abstract

OBJECTIVES:To evaluate the postoperative pathological characteristics of hysterectomy specimens, preoperative cancer antigen (CA)-125 levels and imaging modalities in patients with endometrial cancer and to build a risk matrix model to identify and recruit patients for retroperitoneal lymphadenectomy.METHODS:A total of 405 patients undergoing surgical treatment for endometrial cancer were retrospectively reviewed and analyzed. Clinical (age and body mass index), laboratory (CA-125), radiological (lymph node evaluation), and pathological (tumour size, grade, lymphovascular space invasion, lymph node metastasis, and myometrial invasion) parameters were used to test the ability to predict lymph node metastasis. Four parameters were selected by logistic regression to create a risk matrix for nodal metastasis.RESULTS:Of the 405 patients, 236 (58.3%) underwent complete pelvic and para-aortic lymphadenectomy, 96 (23.7%) underwent nodal sampling, and 73 (18%) had no surgical lymph node assessment. The parameters predicting nodal involvement obtained through logistic regression were myometrial infiltration >50%, lymphovascular space involvement, pelvic lymph node involvement by imaging, and a CA-125 value >21.5 U/mL. According to our risk matrix, the absence of these four parameters implied a risk of lymph node metastasis of 2.7%, whereas in the presence of all four parameters the risk was 82.3%.CONCLUSION:Patients without deep myometrial invasion and lymphovascular space involvement on the final pathological examination and with normal CA-125 values and lymph node radiological examinations have a relatively low risk of lymph node involvement. This risk assessment matrix may be able to refer patients with high-risk parameters necessitating lymphadenectomy and to decide the risks and benefits of lymphadenectomy.

<p>Increased Serum Calcium Level Promotes the Risk of Lymph Node Metastasis in Endometrial Cancer</p>

“…14 Other studies focused on a risk matrix model to identify high-risk parameters necessitating lymphadenectomy and to decide the risks and benefits of lymphadenectomy. 15 A long-term argument against routine lymph node dissection was that the procedure could cause several complications such as bowel obstruction, deep venous thrombus and chronic lymphedema. 16 To decrease complications related with lymphadenectomy and better select patients who would benefit most from lymphadenectomy, sentinel lymph node biopsy has been developed.…”

Combining Clinicopathological Parameters and Molecular Indicators to Predict Lymph Node Metastasis in Endometrioid Type Endometrial Adenocarcinoma

“…For example, studies have confirmed that high-grade endometrioid adenocarcinoma has great heterogeneous, POLE mutations are significantly associated with favorable clinical outcomes in high-grade endometrioid endometrial cancer, which implies that highgrade endometrioid endometrial cancer should be reevaluated by molecular parameters (32). Therefore, adding molecular classification to the predictive model is the trend of future research (4). In this study, the abovementioned P53 molecular classification was incorporated into our model in the form of immunohistochemical markers.…”

“…Lymph node metastasis (LNM) is a significant risk factor for the prognosis of these patients (3). Recently, the role of systematic lymph node dissection in the treatment of EC has become controversial (4). Random tests have shown that conventional lymph node dissection does not lead to a survival benefit in patients with early-stage EC (3).…”

“…The serological indicator cancer antigen 125 (CA125) is a tumor marker with good sensitivity closely related to the prognosis of endometrial cancer, especially in EC patients with abdominal metastasis (12). Several studies (4,11) have shown that CA125 can predict LNM in EC. Different cutoff values of CA125 have been determined to better predict LNM.…”

Ten years of experience with endometrial cancer treatment in a single Brazilian institution: Patient characteristics and outcomes

“…The type of surgery used to treat endometrial carcinomas changed considerably at our institution over the study period, with a marked increase in the performance of minimally invasive (traditional laparoscopic and robotic) surgeries [27][28][29]. Currently, laparoscopy is the treatment of choice, employed in >90% of cases.…”