Evaluation of tumor‑free distance and depth of myometrial invasion as prognostic factors in endometrial cancer

Abstract

Abstract. The aim of the study was to investigate whether the tumor free distance (TFD), which is the distance in millimeters between the deepest point of invasion and the serosal surface, and absolute depth of invasion (DMI), the distance in millimeters between the endomyometrial junction and the deepest point of myometrial invasion, are useful in surgical staging and in predicting prognosis. The present study retrospectively analyzed 62 cases of endometrial carcinoma with complete surgical staging, carried out over a 4 and half-year period (January 2003 to June 2007). All surgicopathological findings including surgical stages, histological type and grade, myometrial invasion, lymphovascular space invasion, cervical and adnexal involvement, and lymph node metastasis were abstracted from medical records and pathological reports. Univariate and multivariate analyses were performed comparing TFD, DMI and the percentage of mypmetrial invasion (MI) with established prognostic factors. A total of 62 patients were included in the study. A total of 52 (84%) had endometrioid carcinomas and 31 patients (60%) had grade 1 cancer. The deepest MI was <50% in 32 patients (52%). Median DMI was 2.7 mm (range 0-15 mm). Median TFD was 3 mm (range 0-19 mm). There was lymphovascular space invasion (LVSI) in 11 patients (17.5%), cervical involvement in 11 patients (17.5%), extra-uterine extension in 9 cases (14%) and lymph node metastasis in 12 patients (22%). It was demonstrated that 50% MI was significantly associated with prognostic factors (cervical involvement, type 2 carcinomas and LVSI, and was a significant predictor of the 5-year overall survival rate and recurrence-free survival (P=0.05, P=0.01). No significant association was observed between DMI and TFD with clinicopathological parameters and survival rates. The importance of DMI in predicting recurrence of disease was observed to be highest in terms of sensitivity and specificity. The cut-off value with the highest sensitivity and specificity crossing the receive operating characteristic curve was calculated to be 3 mm for DMI and 2.5 mm for TFD. The results indicate that DMI is a superior predictive factor of recurrence of the disease compared with TFD. However, further studies are required in order to prove the prognostic usefulness of these parameters and then to improve management of endometrial cancer. IntroductionEndometrial carcinoma is the most common of all the gynecologic malignancies and its incidence is rising (1,2). Surgical staging is an important determinant of adjuvant therapy. Whilst most patients with early stage disease have a good prognosis, the prognosis for patients with recurrent or advanced disease at presentation, i.e., advanced stage, incurable by surgery or radiotherapy, is poor. The most important parameter to elaborate the surgical stage is the depth of myometrial invasion (3,4). The percentage of myometrial invasion (%MI) is routinely determined in hysterectomy specimens and categorized as greater than or less than 50% and it is one of the ...

RETRACTED: Clinical Significance, Cellular Function, and Potential Molecular Pathways of CCT7 in Endometrial Cancer

“…Tumor histology and histological grade may be evaluated preoperatively by endometrial biopsy. The MI depth of EC has a close relationship with lymph node involvement and distant metastasis and is the most important risk factor in apparent early-stage EC, but it is difficult to determine preoperatively (8)(9)(10). Therefore, based on comprehensive MI assessment preoperatively, it may assist in better planning of surgical procedures and avoiding unnecessary lymph node dissections (11).…”

Analysis of CCT7 Expression and Its Clinical Significance in Endometrial Cancer

“…The tumor histology and grade may be evaluated preoperatively by endometrial biopsy, but it is di cult to determine the extent of MI accurately using the techniques in clinical practices. MI by the EC was associated with lymph node involvement, and both prognostic signi cance for EC patients were well documented [30,31]. Thus, methods to assess the extent of MI are important.…”

“…Tumor histology and histological grade may be evaluated preoperatively by endometrial biopsy. MI depth of EC has closely relationship with lymph node involvement and distant metastasis, and is the most important risk factor in apparent early-stage EC, but it is di cult to determine preoperatively [8][9][10]. Therefore, based on comprehensive MI assessment preoperatively, may assist in better planning surgical procedures and to avoid unnecessary lymph node dissections [11].…”

Analysis of CCT7 Expression and Its Clinical Significance in Endometrial Cancer

“…The tumor histology and grade may be evaluated preoperatively by endometrial biopsy, but it is difficult to determine the extent of MI accurately using the techniques in clinical practices. MI by the EC was associated with lymph node involvement, and both prognostic significance for EC patients were well documented [30,31]. Thus, methods to assess the extent of MI are important.…”

“…Tumor histology and histological grade may be evaluated preoperatively by endometrial biopsy. MI depth of EC has closely relationship with lymph node involvement and distant metastasis, and is the most important risk factor in apparent early-stage EC, but it is difficult to determine preoperatively [8][9][10]. Therefore, based on comprehensive MI assessment preoperatively, may assist in better planning surgical procedures and to avoid unnecessary lymph node dissections [11].…”