Para‐aortic lymphadenectomy did not improve overall survival among women with type I endometrial cancer

Li, Lin; Tang, Mingming; Nie, Dan; Gou, Jinhai; Li, Zhengyu

doi:10.1002/ijgo.13228

Cited by 8 publications

(8 citation statements)

References 25 publications

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“…In our institution, EC patients with MI ≤ 1/2, G1/2, and endometrioid histology, with no further evidence of invasion/metastasis, used to undergo a surgery without pelvic and para-aortic lymphadenectomy, all the others would receive lymphadenectomy, with sentinel lymphadenectomy (SLND) optional for patients of relatively low risk. Nevertheless, non-therapeutic systemic lymphadenectomy still existed in most cases (71.4%, unpublished data), which gives rise to an augment in the complication morbidity, e.g., blood loss, lymphatic cyst, and lower limb edema [ 34 ]. Meanwhile, variables employed to determine lymphadenectomy were mostly those significantly correlated with LNM.…”

Section: Discussionmentioning

confidence: 99%

Expression of EMT-related genes in lymph node metastasis in endometrial cancer: a TCGA-based study

Junzhu

et al. 2023

World J Surg Onc

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Background Endometrial cancer (EC) with metastasis in pelvic/para-aortic lymph nodes suggests an unsatisfactory prognosis. Nevertheless, there is still rare literature focusing on the role of epithelial-mesenchymal transition (EMT) in lymph node metastasis (LNM) in EC. Methods Transcriptional data were derived from the TCGA database. Patients with stage IA–IIIC2 EC were included, constituting the LN-positive and LN-negative groups. To evaluate the extent of EMT, an EMT signature composed of 315 genes was adopted. The EMT-related genes (ERGs) were obtained from the dbEMT2 database, and the differentially expressed ERGs (DEERGs) between these two groups were screened. On the basis of DEERGs, pathway analysis was carried out. We eventually adopted the logistic regression model to build an ERG-based gene signature with predictive value for LNM in EC. Results A total of 498 patients were included, with 75 in the LN-positive group. Median EMT score of tumor tissues from LN-negative group was − 0.369, while that from the LN-positive group was − 0.296 (P < 0.001), which clearly exhibited a more mesenchymal phenotype for LNM cases on the EMT continuum. By comparing expression profiles, 266 genes were identified as DEERGs, in which 184 were upregulated and 82 were downregulated. In pathway analysis, various EMT-related pathways were enriched. DEERGs shared between molecular subtypes were comparatively few. The ROC curve and logistic regression analysis screened 7 genes with the best performance to distinguish between the LN-positive and LN-negative group, i.e., CIRBP, DDR1, F2RL2, HOXA10, PPARGC1A, SEMA3E, and TGFB1. A logistic regression model including the 7-gene-based risk score, age, grade, myometrial invasion, and histological subtype was built, with an AUC of 0.850 and a favorite calibration (P = 0.074). In the validation dataset composed of 83 EC patients, the model exhibited a satisfactory predictive value and was well-calibrated (P = 0.42). Conclusion The EMT status and expression of ERGs varied in LNM and non-LNM EC tissues, involving multiple EMT-related signaling pathways. Aside from that, the distribution of DEERGs differed among molecular subtypes. An ERG-based gene signature including 7 DEERGs exhibited a desirable predictive value for LNM in EC, which required further validation based upon clinical specimens in the future.

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Section: Discussionmentioning

confidence: 99%

Expression of EMT-related genes in lymph node metastasis in endometrial cancer: a TCGA-based study

Junzhu

et al. 2023

World J Surg Onc

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“…The benefit of lymphadenectomy in EC patients has been a controversial topic for over a decade (12)(13)(14). The survival advantage associated with lymphadenectomy exists primarily in patients with a relatively high risk of recurrence (14)(15)(16)(17)(18), and improperly expanding the indication of lymphadenectomy might result in more adverse effects instead (19)(20)(21)(22)(23)(24)(25). Our research didn't support the role of lymphadenectomy in preventing LNR in terms of the scope and number of LNs harvest, with agreement with Mariani et al (5).…”

Section: Discussionmentioning

confidence: 99%

A detailed analysis of lymph node recurrence in endometrial carcinoma

Li¹,

Dong²,

Dai³

et al. 2022

Transl Cancer Res TCR

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Background: The lymph node (LN) is one of the main sites of recurrence in patients with endometrial carcinoma (EC). Literature specifically analyzing LN recurrence (LNR) in EC remains limited in number.Methods: Patients with EC undergoing surgery between 2006 and 2021 in Peking University People's Hospital was included, clinicopathological data of whom were collected and analyzed retrospectively by R 4.0.3.Results: A total of 792 patients were included, with 73 patients having recurrence, among whom 21 patients had LNR. Median recurrence-free survival (RFS) in patients with LNR was 16 [4-39] months. LNR was extensive, with pelvic LNs most commonly involved (9/21). There are various patterns of LNR, with 33.3% (7/21) LN-only recurrence. Multivariable analysis suggested advanced stage, larger tumor diameter and poor histology were independent risk factors for LNR. Patients with LN metastasis (LNM) diagnosed at initial treatment accounted for 47.6% (10/21) of cases with LNR, 60.0% (6/10) of whom had recurrent LNs beyond the region of LNM, 90.0% (9/10) of whom had recurrence nodes overlapping with the range of lymphadenectomy. Uni-and multi-variable analysis suggested lymphadenectomy was not a protective factor for LNR, with both the range and number of LNs harvested considered.Conclusions: LNR is common in patients with EC, with an extensive range and various patterns of recurrence. The International Federation of Gynecology and Obstetrics (FIGO) stage, tumor diameter and histology were independent risk factors for LNR, but lymphadenectomy seemed not a protective factor for LNR.

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“…However, non-therapeutic systemic lymphadenectomy still existed in most cases (71.4%, unpublished data), resulting in an increase in the complication morbidity, e.g. blood loss, lymphatic cyst and lower limb edema (29). Meanwhile, variables used to determine lymphadenectomy were mostly those signi cantly related to LNM.…”

Section: Discussionmentioning

confidence: 99%

Expression of EMT-Related Genes in Lymph Node Metastasis in Endometrial Cancer: A TCGA-based study

Zhao

et al. 2022

Preprint

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Background Endometrial cancer (EC) identified in pelvic/para-aortic lymph nodes suggests a poorer prognosis. Literature focusing on the role of epithelial-mesenchymal transition (EMT) in lymph node metastasis (LNM) remains few. Methods Transcriptional data were acquired from TCGA database. Patients with stage IA-IIIC2 EC were included, constituting the LN positive and negative groups. To evaluate the extent of EMT, an EMT signature composed of 315 genes was adopted. EMT-related genes (ERGs) were obtained from dbEMT2 database, differentially expressed ERGs (DEERGs) of which between the two groups were screened out. On the basis of DEERGs, pathway analysis was carried out. We finally used the logistic regression model to build an ERG-based gene signature with diagnostic value for LNM in EC. Results A total of 498 patients were included, with 75 in the LN positive group. Median EMT score of tumor tissues from LN negative group was − 0.369, while that from LN positive group was − 0.296 (P < 0.001), suggesting a more mesenchymal phenotype for LNM cases on the EMT continuum. By comparing the expression profiles, 266 genes were identified as DEGs, in which 184 were upregulated and 82 were downregulated. In pathway analyses, various EMT-related pathways were enriched. DEERGs shared between molecular subtypes were relatively few. The ROC curve and logistic regression analysis screened 7 genes with the best performance to discriminate between the LN positive and negative group, i.e. CIRBP, DDR1, F2RL2, HOXA10, PPARGC1A, SEMA3E and TGFB1. A logistic regression model including the 7-genes based risk score, age, grade, myometrial invasion and histological subtype was built, with an AUC of 0.850 and a good calibration (P = 0.074). In a validation dataset composed of 83 EC patients, the model exhibited a promising diagnostic value and was well calibrated (P = 0.42). Conclusion The EMT status and expression of ERGs varied in EC tissues from LN positive and negative cases, involving multiple EMT-related signalling pathways, and the distribution of DEGs differed among molecular subtypes. An ERG-based gene signature including 7 DEERGs exhibited a potential application value.

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Para‐aortic lymphadenectomy did not improve overall survival among women with type I endometrial cancer

Cited by 8 publications

References 25 publications

Expression of EMT-related genes in lymph node metastasis in endometrial cancer: a TCGA-based study

Expression of EMT-related genes in lymph node metastasis in endometrial cancer: a TCGA-based study

A detailed analysis of lymph node recurrence in endometrial carcinoma

Expression of EMT-Related Genes in Lymph Node Metastasis in Endometrial Cancer: A TCGA-based study

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