A Model to Identify Candidates for Lymph Node Dissection Among Patients With High-Risk Endometrial Endometrioid Carcinoma According to Mayo Criteria

Abstract

BackgroundThe Mayo criteria are the most widely accepted algorithm for predicting the risk of lymph node metastasis in endometrial endometrioid carcinoma (EEC). However, the clinical value of these criteria in high-risk patients is limited and inconclusive.MethodsA total of 240 patients with EEC meeting the Mayo high-risk criteria between January 1, 2015, and December 31, 2018 were included in our study. We retrospectively collected the laboratory reports, basic clinical information, clinicopathological and immunohistochemistry (IHC) findings, and the sequences of molecular pathological markers of these patients. A nomogram for predicting the likelihood of positive lymph node status was established based on these parameters.ResultsAmong the 240 patients, 17 were diagnosed with lymph node metastasis. The univariable analyses identified myometrial invasion >50%, aberrant p53 expression, microsatellite instable (MSI), and cancer antigen 125 (CA125) ≥35 U/ml as potential risk factors for lymph node metastasis. The multivariable analyses showed that aberrant p53 expression, MSI, and CA125 ≥35 U/ml were independent predictors of lymph node metastasis. The area under the curve (AUC) for the nomogram was 0.870, as compared to 0.665 for the Mayo criteria.ConclusionsOur novel prediction model effectively identifies patients at high risk for lymphatic metastasis. This model is a promising strategy for personalized surgery in patients with high risk according to the Mayo criteria.

Advancing Tailored Treatments: A Predictive Nomogram, Based on Ultrasound and Laboratory Data, for Assessing Nodal Involvement in Endometrial Cancer Patients

“…Regarding laboratory parameters, in our cases we observed a correlation between a CA 125 value > 35 U/mL and lymph node positivity, with an odds ratio of 7.74 (95% CI 1.86-32.2). This aligns with findings from Lu et al's study, reporting a similar association between CA 125 > 35 U/mL and lymph node metastasis, with an odds ratio of 6.865 (95% CI, 2.481-20.840) [33]. Apart from CA 125, another laboratory parameter correlating with our observed outcomes is the preoperative platelet count.…”

“…In contrast, it is not included in the standard diagnostic work-up of EC, due to its inability to offer differential diagnostic information. However, numerous studies have indicated that a preoperative CA 125 level > 35 IU/mL represents an independent risk factor for nodal positivity [28][29][30][31][32][33][34]. Additionally, growing evidence suggests that systemic inflammatory responders, such as the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, C-reactive protein, platelets, and fibrinogen, may play a crucial role in the development and progression of solid tumors.…”