Predictive performance of the final pathology-based low-risk criteria for lymph node metastasis in endometrial cancer

2012 ◽  
Vol 125 ◽  
pp. S153
Author(s):  
S. Kang ◽  
K. Kim ◽  
J. Lee ◽  
C. Park ◽  
J. Lee ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Predictive Performance ◽  
Low Risk ◽  
Final Pathology ◽  
Node Metastasis ◽  
Risk Criteria

scholarly journals Implications of Isolated Para-Aortic Lymph Node Metastasis in Endometrial Cancer: A Large-Scale, Multicenter, and Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Wenting Li ◽  
Jie Jiang ◽  
Yu Fu ◽  
Yuanming Shen ◽  
Chuyao Zhang ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Large Scale ◽  
Low Risk ◽  
Surgical Staging ◽  
Node Metastasis ◽  
Aortic Lymph Node ◽  
Risk Patients ◽  
Metastatic Sites

Objective: To systematically evaluate lymph node metastasis (LNM) patterns in patients with endometrial cancer (EC) who underwent complete surgical staging, which included systematic pelvic and para-aortic lymphadenectomy.Methods: Four thousand and one patients who underwent complete surgical staging including systematic pelvic and para-aortic lymphadenectomy for EC were enrolled from 30 centers in China from 2001 to 2019. We systematically displayed the clinical and prognostic characteristics of patients with various LNM patterns, especially the PLN-PAN+ [para-aortic lymph node (PAN) metastasis without pelvic lymph node (PLN) metastasis]. The efficacy of PAN+ (para-aortic lymph node metastasis) prediction with clinical and pathological features was evaluated.Results: Overall, 431 of the 4,001 patients (10.8%) showed definite LNM according to pathological diagnosis. The PAN+ showed the highest frequency (6.6%) among all metastatic sites. One hundred fourteen cases (26.5%) were PLN-PAN+ (PAN metastasis without PLN metastasis), 167 cases (38.7%) showed PLN+PAN-(PLN metastasis without PAN metastasis), and 150 cases (34.8%) showed metastasis to both regions (PLN+PAN+). There was also 1.9% (51/2,660) of low-risk patients who had PLN-PAN+. There are no statistical differences in relapse-free survival (RFS) and disease-specific survival (DSS) among PLN+PAN-, PLN-PAN+, and PLN+PAN+. The sensitivity of gross PLNs, gross PANs, and lymphovascular space involvement (LVSI) to predict PAN+ was 53.8 [95% confidence interval (CI): 47.6–59.9], 74.2 95% CI: 65.6–81.4), and 45.8% (95% CI: 38.7–53.2), respectively.Conclusion: Over one-fourth of EC patients with LMN metastases were PLN-PAN+. PLN-PAN+ shares approximate survival outcomes (RFS and DSS) with other LNM patterns. No effective clinical methods were achieved for predicting PAN+. Thus, PLN-PAN+ is a non-negligible LNM pattern that cannot be underestimated in EC, even in low-risk patients.

Preoperative Identification of a Low-Risk Group for Lymph Node Metastasis in Endometrial Cancer: A Korean Gynecologic Oncology Group Study

2012 ◽  
Vol 30 (12) ◽  
pp. 1329-1334 ◽  
Author(s):  
Sokbom Kang ◽  
Woo Dae Kang ◽  
Hyun Hoon Chung ◽  
Dae Hoon Jeong ◽  
Sang-Soo Seo ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Risk Group ◽  
False Negative ◽  
False Negative Rate ◽  
Low Risk ◽  
Ca 125 ◽  
Node Metastasis ◽  
Negative Rate

Purpose The aim of this study was to develop a preoperative risk prediction model for lymph node metastasis in patients with endometrial cancer and to identify a low-risk group before surgery. Patients and Methods The medical records of 360 patients with endometrial cancer who underwent surgical staging were collected from four institutions and were retrospectively reviewed. By using serum CA-125 levels, preoperative biopsy data, and magnetic resonance imaging (MRI) data, a multivariate logistic model was created. Patients whose predicted probability was less than 4% were defined as low risk. The developed model was externally validated in 180 patients from two independent institutions. Results Serum CA-125 levels and three MRI parameters (deep myometrial invasion, lymph node enlargement, and extension beyond uterine corpus) were found to be independent risk factors for nodal metastasis. The model classified 53% of patients as part of a low-risk group, and the false negative rate was 1.7%. In the validation cohort, the model classified 43% of patients as low-risk, and the false negative rate was 1.4%. The model showed good discrimination (area under the receiver operator characteristic curve = 0.85) and was calibrated well. The negative likelihood ratio of our low-risk criteria was 0.11 (95% CI, 0.04 to 0.29), which was equivalent to the false-negative rate of 1.3% (95% CI, 0.5% to 3.3%) at the assumed prevalence of nodal metastasis of 10%. Conclusion Using serum CA-125 and MRI as criteria resulted in the accurate identification of a low-risk group for lymph node metastasis among patients with endometrial cancer.

Construction and Validation of a Prognostic Model Based on 11 Lymph Node Metastasis Related Genes for Overall Survival in Endometrial Cancer

2021 ◽  
Author(s):  
Hong Wu ◽  
haiqin Feng ◽  
Xiaoli Miao ◽  
jiancai Ma ◽  
Cairu Liu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Prognostic Model ◽  
Risk Model ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Low Risk ◽  
Node Metastasis

Abstract Background: Endometrial cancer (EC) is one of the most common malignant tumor in the female reproductive system. The incidence of lymph node metastasis (LNM) is only about 10% in clinically suspected early-stage EC patients. Discovering prognostic model and effective biomarkers for early diagnosis is important to reduce the mortality rate. Methods: We downloaded the RNA-sequencing data and clinical information from the TCGA database. Gene ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were used to analyze the differentially expressed genes (DEGs). A least absolute shrinkage and selection operator (LASSO) regression was conducted to identify the characteristic dimension decrease and distinguish prognosis-related LNM related genes signature. Subsequently, a novel prognosis-related nomogram to predict overall survival (OS). A survival analysis was carried out to explore the individual prognostic significance of the risk model and key gene was validated in vitro. Results: In total, 89 LRGs were identified. Based on the LASSO Cox regression, 11 genes were selected for the development of a risk evaluation model. The Kaplan–Meier curve indicated that patients in the low-risk group had considerably better OS (P = 3.583e−08). The area under the curve (AUC) of this model was 0.718 at 5 years of OS. Then, we developed an OS-associated nomogram that included the risk score and clinicopathological features. The concordance index of the nomogram was 0.769. The survival verification performed in three subgroups from the nomogram demonstrated the validity of the model. The AUC of the nomogram was 0.787 at 5 years OS. Proliferation and metastasis of HMGB3 were explored in EC cell line. Finally, we revealed that the most frequently mutated genes in the low-risk and high-risk groups are PTEN and TP53, respectively. Conclusions: Our results suggest that LNM plays an important role in the prognosis, and HMGB3 was potential as a biomarker for EC patients. By detecting the mutation of the risk signature, clinicians can accurately treat patients with targeted therapy, thereby improving their survival rate.

scholarly journals A nomogram prediction model for lymph node metastasis in endometrial cancer patients

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhiling Wang ◽  
Shuo Zhang ◽  
Yifei Ma ◽  
Wenhui Li ◽  
Jiguang Tian ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
External Validation ◽  
Clinicopathological Parameters ◽  
Bootstrap Sample ◽  
Multivariate Logistic Regression ◽  
Node Metastasis ◽  
Increased Risk

Abstract Background This study aimed to explore the risk factors for lymph node metastasis (LNM) in patients with endometrial cancer (EC) and develop a clinically useful nomogram based on clinicopathological parameters to predict it. Methods Clinical information of patients who underwent staging surgery for EC was abstracted from Qilu Hospital of Shandong University from January 1st, 2005 to June 31st, 2019. Parameters including patient-related, tumor-related, and preoperative hematologic examination-related were analyzed by univariate and multivariate logistic regression to determine the correlation with LNM. A nomogram based on the multivariate results was constructed and underwent internal and external validation to predict the probability of LNM. Results The overall data from the 1517 patients who met the inclusion criteria were analyzed. 105(6.29%) patients had LNM. According the univariate analysis and multivariate logistic regression analysis, LVSI is the most predictive factor for LNM, patients with positive LVSI had 13.156-fold increased risk for LNM (95%CI:6.834–25.324; P < 0.001). The nomogram was constructed and incorporated valuable parameters including histological type, histological grade, depth of myometrial invasion, LVSI, cervical involvement, parametrial involvement, and HGB levels from training set. The nomogram was cross-validated internally by the 1000 bootstrap sample and showed good discrimination accuracy. The c-index for internal and external validation of the nomogram are 0.916(95%CI:0.849–0.982) and 0.873(95%CI:0.776–0.970), respectively. Conclusions We developed and validated a 7-variable nomogram with a high concordance probability to predict the risk of LNM in patients with EC.

Prospective evaluation of sentinel node navigation surgery in Japanese patients with low-risk endometrial cancer—safety and occurrence of lymphedema

2021 ◽  
Author(s):  
Hitoshi Niikura ◽  
Asami Toki ◽  
Tomoyuki Nagai ◽  
Satoshi Okamoto ◽  
Shogo Shigeta ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Lymph Node Metastasis ◽  
Lower Extremity ◽  
Lymph Node Biopsy ◽  
Occurrence Rate ◽  
Node Metastasis ◽  
Node Biopsy

Abstract Objective The present study aimed to clarify the occurrence rate of lymphedema and prognosis in patients with endometrial cancer according to sentinel lymph node biopsy alone with intraoperative histopathological examination. Methods The study included 45 consecutive patients with endometrial cancer treated at Tohoku University Hospital between October 2014 and August 2017. All patients had endometrial carcinoma with endometrioid histology Grade 1 or Grade 2 confirmed by biopsy and stage I on magnetic resonance imaging and/or computed tomography at their preoperative evaluation. Sentinel lymph node detection was performed by radioisotope and dye. Patients who were diagnosed intraoperatively as negative for sentinel lymph node metastasis did not undergo further systematic pelvic lymphadenectomy. The occurrence rate of lymphedema and prognosis was evaluated. Results Bilateral sentinel lymph nodes were detected in 44 of 45 patients (97%). Forty-three patients underwent sentinel lymph node biopsy alone, and only two patients underwent systematic lymphadenectomy. Sentinel lymph node metastases were detected in one patient intraoperatively and two patients postoperatively as ITCs. No patients experienced recurrence. New symptomatic lower-extremity lymphedema was identified in one of 43 patients (2.3%) who underwent sentinel lymph node biopsy alone. Conclusion Sentinel lymph node biopsy alone with intraoperative histopathological diagnosis appears to be a safe and effective strategy to detect lymph node metastasis and to reduce the number of patients with lower-extremity lymphedema among patients with endometrial cancer.

The incidence of pelvic lymph node metastasis by FIGO staging for patients with adequately surgically staged endometrial adenocarcinoma of endometrioid histology

2008 ◽  
Vol 18 (2) ◽  
pp. 269-273 ◽  
Author(s):  
D. S. Chi ◽  
R. R. Barakat ◽  
M. J. Palayekar ◽  
D. A. Levine ◽  
Y. Sonoda ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Myometrial Invasion ◽  
Tumor Grade ◽  
Pelvic Lymph Node ◽  
Study Cohort ◽  
Node Metastasis ◽  
Figo Staging ◽  
Pelvic Lymph Node Metastasis

The seminal Gynecologic Oncology Group study on surgical pathologic spread patterns of endometrial cancer demonstrated the risk of pelvic lymph node metastasis for clinical stage I endometrial cancer based on tumor grade and thirds of myometrial invasion. However, the FIGO staging system assigns surgical stage by categorizing depth of myometrial invasion in halves. The objective of this study was to determine the incidence of pelvic lymph node metastasis in endometrial cancer based on tumor grade and myometrial invasion as per the current FIGO staging system. We reviewed the records of all patients who underwent primary surgical staging for clinical stage I endometrial cancer at our institution between May 1993 and November 2005. To make the study cohort as homogeneous as possible, we included only cases of endometrioid histology. We also included only patients who had adequate staging, which was defined as a total hysterectomy with removal of at least eight pelvic lymph nodes. During the study period, 1036 patients underwent primary surgery for endometrial cancer. The study cohort was composed of the 349 patients who met study inclusion criteria. Distribution of tumor grade was as follows: grade 1, 80 (23%); grade 2, 182 (52%); and grade 3, 87 (25%). Overall, 30 patients (9%) had pelvic lymph node metastasis. The incidence of pelvic lymph node metastasis in relation to tumor grade and depth of myometrial invasion (none, inner half, and outer half) was as follows: grade 1–0%, 0%, and 0%, respectively; grade 2–4%, 10%, and 17%, respectively; and grade 3–0%, 7%, and 28%, respectively. We determined the incidence of pelvic nodal metastasis in a large cohort of endometrial cancer patients of uniform histologic subtype in relation to tumor grade and a one-half myometrial invasion cutoff. These data are more applicable to current surgical practice than the previously described one-third myometrial invasion cutoff results.

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