How low is low enough? Evaluation of various risk-assessment models for lymph node metastasis in endometrial cancer: a Korean multicenter study

Abstract

ObjectiveThe aim of this study was to identify a standard for the evaluation of future models for prediction of lymph node metastasis in endometrial cancer through estimation of performance of well-known surgicopathological models.MethodsUsing the medical records of 947 patients with endometrial cancer who underwent surgical management with lymphadenectomy, we retrospectively assessed the predictive performances of nodal metastasis of currently available models.ResultsWe evaluated three models included: 1) a model modified from the Gynecologic Oncology Group (GOG) pilot study; 2) one from the GOG-33 data; and 3) one from Mayo Clinic data. The three models showed similar negative predictive values ranging from 97.1% to 97.4%. Using Bayes' theorem, this can be translated into 2% of negative post-test probability when 10% of prevalence of lymph node metastasis was assumed. In addition, although the negative predictive value was similar among these models, the proportion that was classified as low-risk was significantly different between the studies (56.4%, 44.8%, and 30.5%, respectively; p<0.001).ConclusionThe current study suggests that a false negativity of 2% or less should be a goal for determining clinical usefulness of preoperative or intraoperative prediction models for low-risk of nodal metastasis.

Systematic pelvic and paraaortic lymphadenectomy in early high-risk or advanced endometrial cancer

“…Therefore, the discussion about the value of lymphadenectomy in intermediate or high-risk patients with EC is still ongoing. In addition, it is of debate, how far the para-aortic lymphadenectomy should be conducted, as isolated lymph node metastases up to the renal vessel region or above the IMA have been reported [23,24]. Our data are in line with previously reported frequencies of lymph node metastases and it seems that there is a correlation between the number of resected and the number of metastatic lymph nodes.…”

Clinical significance of tumor volume in endometrial cancer: A Japan–Korea cooperative study

“…The three models included criteria modified from the gynecologic oncology group (GOG) pilot study proposed by Boronow [13], criteria modified from the GOG-33 data proposed by Creasman et al [14], and the Mayo clinic criteria proposed by Mariani et al [7]. They finally showed that these three models had similar negative predictive powers and proposed a false-negative rate of b2% as an index for determining the clinical usefulness of preoperative prediction models for low risk of nodal metastasis, assuming that the prevalence of lymph node metastasis is 10% in the target patient cohort [12]. This proposal is acceptable considering the fact that false-negative rates for detecting nodal metastasis using sentinel node biopsy have been reported be 5% for breast cancer [15].…”

“…The reproducibility of its performance was confirmed in a Korea-Japan cooperative study using two Japanese cohorts [6]. In addition, the predictive performances of three prediction models for identifying a low-risk group in endometrial cancer were compared [12]. The three models included criteria modified from the gynecologic oncology group (GOG) pilot study proposed by Boronow [13], criteria modified from the GOG-33 data proposed by Creasman et al [14], and the Mayo clinic criteria proposed by Mariani et al [7].…”

Upregulation of microRNA-337 promotes the proliferation of endometrial carcinoma cells via targeting PTEN

“…Endometrial carcinoma (EC) is a gynecological malignancy that occurs predominantly in Western countries, and is the fourth leading cancer among females worldwide (1,2). The carcinogenic effect of uninhibited estrogen stimulation on the endometrium is well understood (3); however, the specific events that mediate estrogen stimulation resulting in tumor development remain to be elucidated.…”