Tumor Size, an Additional Risk Factor of Local Recurrence in Low-Risk Endometrial Cancer: A Large Multicentric Retrospective Study

Sozzi, Giulio; Uccella, Stefano; Berretta, Roberto; Petrillo, Marco; Fanfani, Francesco; Monterossi, Giorgia; Ghizzoni, Viola; Frusca, T.; Ghezzi, Fabio; Chiàntera, Vito; Scambia, Giovanni

doi:10.1097/igc.0000000000001223

Cited by 28 publications

(15 citation statements)

References 28 publications

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“…Interestingly, when comparing the whole‐tumor radiomic signatures to tumor volume alone, we found no significant differences in their diagnostic performance metrics except for prediction of high‐grade tumors (E3), for which the whole‐tumor radiomic signature yielded significantly higher AUC T than that of tumor volume alone. These findings reaffirm the well‐established predictive‐ and prognostic role of tumor size/volume in EC, with a vast literature consistently linking large tumor size to advanced stage and poor survival 8–10,29,30 …”

Section: Discussionsupporting

confidence: 72%

“…These findings suggest a possible advantage of whole‐tumor over single‐slice radiomic profiling in EC, incorporating information from the entire tumor and not only from a central part of the tumor. Importantly, the radiomic signatures also yielded comparable (for predicting DMI, LNM, advanced FIGO stage, and NE histology) or slightly better (for high‐grade histology) diagnostic performance to that of MRI‐based tumor volume (analyzed individually), confirming the well‐known role of tumor volume as a predictor of high‐risk surgicopathological features and poor outcome in EC 8–10,29,30 …”

Section: Discussionsupporting

confidence: 55%

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Whole‐Volume Tumor MRI Radiomics for Prognostic Modeling in Endometrial Cancer

Fasmer

Hodneland

Dybvik

et al. 2020

Magnetic Resonance Imaging

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Background In endometrial cancer (EC), preoperative pelvic MRI is recommended for local staging, while final tumor stage and grade are established by surgery and pathology. MRI‐based radiomic tumor profiling may aid in preoperative risk‐stratification and support clinical treatment decisions in EC. Purpose To develop MRI‐based whole‐volume tumor radiomic signatures for prediction of aggressive EC disease. Study Type Retrospective. Population A total of 138 women with histologically confirmed EC, divided into training (nT = 108) and validation cohorts (nV = 30). Field Strength/Sequence Axial oblique T1‐weighted gradient echo volumetric interpolated breath‐hold examination (VIBE) at 1.5T (71/138 patients) and DIXON VIBE at 3T (67/138 patients) at 2 minutes postcontrast injection. Assessment Primary tumors were manually segmented by two radiologists with 4 and 8 years' of experience. Radiomic tumor features were computed and used for prediction of surgicopathologically‐verified deep (≥50%) myometrial invasion (DMI), lymph node metastases (LNM), advanced stage (FIGO III + IV), nonendometrioid (NE) histology, and high‐grade endometrioid tumors (E3). Corresponding analyses were also conducted using radiomics extracted from the axial oblique image slice depicting the largest tumor area. Statistical Tests Logistic least absolute shrinkage and selection operator (LASSO) was applied for radiomic modeling in the training cohort. The diagnostic performances of the radiomic signatures were evaluated by area under the receiver operating characteristic curve in the training (AUCT) and validation (AUCV) cohorts. Progression‐free survival was assessed using the Kaplan–Meier and Cox proportional hazard model. Results The whole‐tumor radiomic signatures yielded AUCT/AUCV of 0.84/0.76 for predicting DMI, 0.73/0.72 for LNM, 0.71/0.68 for FIGO III + IV, 0.68/0.74 for NE histology, and 0.79/0.63 for high‐grade (E3) tumor. Single‐slice radiomics yielded comparable AUCT but significantly lower AUCV for LNM and FIGO III + IV (both P < 0.05). Tumor volume yielded comparable AUCT to the whole‐tumor radiomic signatures for prediction of DMI, LNM, FIGO III + IV, and NE, but significantly lower AUCT for E3 tumors (P < 0.05). All of the whole‐tumor radiomic signatures significantly predicted poor progression‐free survival with hazard ratios of 4.6–9.8 (P < 0.05 for all). Data Conclusion MRI‐based whole‐tumor radiomic signatures yield medium‐to‐high diagnostic performance for predicting aggressive EC disease. The signatures may aid in preoperative risk assessment and hence guide personalized treatment strategies in EC. Level of Evidence 4 Technical Efficacy Stage 2

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Section: Discussionsupporting

confidence: 72%

Section: Discussionsupporting

confidence: 55%

Whole‐Volume Tumor MRI Radiomics for Prognostic Modeling in Endometrial Cancer

Fasmer

Hodneland

Dybvik

et al. 2020

Magnetic Resonance Imaging

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“…Maybe, in that first period, we were less selective and managed cases with worse prognosis, such as those with larger tumors. Tumor size is considered associated with prognosis [13,20,21], but we did not have access to consistent information about it, as in preoperative exams as in pathologic reports.…”

Section: Commentmentioning

confidence: 99%

Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome

Cândido

Neto

Toledo

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective To evaluate the indication and performance of systematic lymphadenectomy (SL) in Stage I endometrioid endometrial carcinoma (EEC), at intermediate risk (FIGO IAG2/G3, IBG1/G2) on recurrence, disease-free survival (DFS) and survival. Study design 194 women underwent hysterectomies by laparotomy, with SL (n = 95) or without SL (n = 99) between 1990 and 2014 was evaluated. Diagnosis period, age, BMI, comorbidities, stage, and adjuvant radiotherapy were analyzed. DFS and cancer-specific survival were analyzed by Kaplan-Meier and log-rank test, and recurrences by Cox regression. Results SL was performed in 93% (41/44) of women managed before 1998 and decreasing after that (p < 0.001). SL was also more frequent if BMI under 35.0 kg/m 2 (p < 0.001) and in women without comorbidities (p = 0.017). Distribution of age, stage and postoperative radiotherapy were not different between groups. There were 14 recurrences (7.4%), concentrated in the SL group (12 cases) and associated with Stage IAG3 (35.7%, p = 0.009). Longitudinal evaluation exhibited 95% of 5-year cancer-specific survival rate for non-SL group vs. 88% for the SL group (p = 0.039), and DFS rate was 97% for the non-SL group vs. 85% for the SL group (p = 0.004). Cox regression analyses exhibited Stage IAG3 (HR 6.48, IC95% 1.88–22.39; p = 0.003) associated with less DFS. Conclusion SL in surgical staging of EEC at intermediate risk presented no benefits regarding recurrences, DFS, and cancer-specific survival rate when compared to patients not submitted to complete surgical staging. Stage IAG3 had poor prognosis regardless treatment modality. Our results provide further evidence to support the current trend to avoid SL in the surgical approach to selected women.

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“… 4 – 6 , 19 – 22 The present study defined low-risk endometrial cancer with the most commonly used criteria: endometrioid carcinoma with histologic grade 1 or 2 and myometrial invasion <50%. 3 , 4 , 23 However, some investigations have included tumor diameter ≤2 cm as an additional criterion for low-risk endometrial cancer, 5 , 24 and recent studies have suggested optimal tumor size cutoff values of 2.5 cm 25 and 3.5 cm. 26 …”

Section: Discussionmentioning

confidence: 99%

<p>Effect of Pelvic Lymphadenectomy on Survival in Patients with Low-Risk Early-Stage Endometrial Cancer Diagnosed Intraoperatively Using Frozen Tissue Sections: A Retrospective Analysis</p>

Liu

Zhao

et al. 2020

CMAR

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Purpose To determine whether pelvic lymphadenectomy improved survival in patients diagnosed with low-risk early-stage endometrial cancer by intraoperative pathology. Methods This retrospective analysis included 238 patients at our hospital. Results The lymphadenectomy and non-lymphadenectomy groups contained 121 and 117 patients, respectively. In both groups, more than half the patients had tumor size ≥2 cm, and most had myometrial invasion <50%, stage Ia disease and no lymphovascular space invasion. Age, tumor size, myometrial invasion, surgical-pathologic stage and postoperative adjuvant therapy use were comparable between groups. The non-lymphadenectomy group had more patients treated laparoscopically (36.8% vs 10.7%; P <0.001) and fewer patients with histologic grade 2 disease (35.9% vs 62.8%; P <0.001) than the lymphadenectomy group. In the non-lymphadenectomy group, intraoperative frozen section pathology disagreed with postoperative pathology in only 31/117 cases for histologic grade (none upgraded to grade 3), 1/117 cases for myometrial invasion (one case revised from <50% to ≥50%) and 3/117 cases for surgical-pathologic stage (upgraded from Ia to Ib or II). Disease recurrence rate and overall survival did not differ significantly between the lymphadenectomy and non-lymphadenectomy groups. In multivariate Cox regression analysis, only surgical-pathologic stage >Ia (odds ratio, 47.7; 95% confidence interval, 6.7–340.8; P =0.031) was associated with increased odds of disease recurrence. Conclusion Pelvic lymphadenectomy may not be necessary in patients with an intraoperative diagnosis of low-risk endometrial cancer.

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Tumor Size, an Additional Risk Factor of Local Recurrence in Low-Risk Endometrial Cancer: A Large Multicentric Retrospective Study

Abstract: In this very large series, tumor size emerges as an independent prognostic factor of local recurrence in women with low-risk EC and could be a valuable additional criterion to personalize the treatment approach to these patients.

Cited by 28 publications

References 28 publications

Whole‐Volume Tumor MRI Radiomics for Prognostic Modeling in Endometrial Cancer

Whole‐Volume Tumor MRI Radiomics for Prognostic Modeling in Endometrial Cancer

Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome

<p>Effect of Pelvic Lymphadenectomy on Survival in Patients with Low-Risk Early-Stage Endometrial Cancer Diagnosed Intraoperatively Using Frozen Tissue Sections: A Retrospective Analysis</p>

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