Is Complete Surgical Staging Necessary in Clinically Early-Stage Endometrial Carcinoma?

2009 ◽  
Vol 19 (6) ◽  
pp. 1057-1061 ◽  
Author(s):  
Nakarin Sirisabya ◽  
Tarinee Manchana ◽  
Pongkasem Worasethsin ◽  
Nipon Khemapech ◽  
Ruangsak Lertkhachonsuk ◽  
...  
Keyword(s):  
Endometrial Carcinoma ◽  
Early Stage ◽  
Clinical Stage ◽  
Myometrial Invasion ◽  
Low Risk ◽  
Histologic Grade ◽  
Surgical Staging ◽  
Pelvic Node ◽  
Node Metastasis ◽  
Deep Myometrial Invasion

The purpose of this study was to evaluate the incidence of pelvic/para-aortic node metastases and the other pathological characteristics from medical records of patients with endometrial carcinoma treated at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between1996 and 2005. The records of 213 patients with endometrial carcinoma who had complete surgical staging were reviewed. A particular focus was on clinically early-stage disease. Clinical staging could be determined in 206 patients. Of the 206 patients, 182 (88.3%) presented with clinical stage I disease. However, only 142 (78%) of these patients were confirmed as surgical stage I and 22% were upstaged. Preoperative histologic grade was diagnosed inaccurately in 15.9% of patients and 7.7% were upgraded. Of patients with preoperative histologic grade 1, 33% had deep myometrial invasion, 8.2% had pelvic node metastasis, and 3.3% had para-aortic node metastasis. Even in clinical stage IaG1, pelvic node metastasis occurred in 5.6% and para-aortic node metastasis in 1.3%. It has been suggested that complete surgical staging may not be necessary in patients with low-risk endometrial carcinoma who have disease limited to the uterus without grade 3 or deep myometrial invasion. However, proper selection of such low-risk patients remains problematic. In situations where there is limited preoperative and intraoperative assessment of high-risk factors, particularly radiographic imaging and frozen section assessment, the role of complete surgical staging is beneficial.

Clinicopathological Risk Factors for Pelvic Lymph Node Metastasis in Clinical Early-Stage Endometrioid Endometrial Adenocarcinoma

2012 ◽  
Vol 22 (8) ◽  
pp. 1373-1377 ◽  
Author(s):  
Chuyao Zhang ◽  
Chao Wang ◽  
Weiwei Feng
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Predictive Value ◽  
Early Stage ◽  
Endometrial Adenocarcinoma ◽  
Myometrial Invasion ◽  
Node Metastasis ◽  
Deep Myometrial Invasion ◽  
Metastasis Rate

ObjectiveTo identify the clinicopathological risk factors for pelvic lymph node (PLN) metastasis and to evaluate the predictive significance of these factors for lymphadenectomy in clinical early-stage endometrioid endometrial adenocarcinoma (EEA).MethodsSix hundred and twenty-one patients with clinical early-stage EEA (tumor confined to uterus, diagnosed preoperatively or intraoperatively) who underwent hysterectomy plus bilateral salpingo-oophorectomy plus pelvic and/or para-aortic lymphadenectomy between 1989 and 2006 in the Obstetrics and Gynecology Hospital of Fudan University were retrieved. The predictive value of the risk factors for PLN metastasis was analyzed.ResultsThe positive PLN metastasis rate was 3.9%. The 5-year disease-related mortality rate in the positive PLN metastasis group was 25%, whereas the rate in the negative group was 0.8%. The positive PLN metastasis rates were higher in patients with higher-grade tumors, deep myometrial invasion, cervical stromal involvement, and lymphovascular space involvement (LVSI). The sensitivity and specificity of old age (≥60 years), grade 3, cancer deep myometrial invasion, cervical stromal involvement, and LVSI in predicting the PLN metastasis were 25.0%, 41.7%, 70.8%, 20.8%, and 41.7%; and 79.1%, 88.4%, 85.6%, 95.6%, and 94.5%, respectively. The multivariate analysis revealed that the deep myometrial invasion and LVSI were independent risk factors for lymph node metastasis. Combined with these 2 factors as the diagnostic criteria, the negative predictive value and specificity were 97.3% and 89.1%, respectively.ConclusionThe patients with clinical early-stage EEA with PLN metastasis showed worse prognoses, although the metastasis rate was low. The deep myometrial invasion and LVSI combination were superior predictive criteria for the PLN metastasis. An accurate evaluation of these factors, both preoperatively or intraoperatively, will be beneficial to predict PLN metastasis and guide the operation.

Surgical pathologic staging in apparent stage I endometrial carcinoma

1993 ◽  
Vol 3 (6) ◽  
pp. 373-384 ◽  
Author(s):  
C. Mangioni ◽  
G. De Palo ◽  
E. Marubini ◽  
M. Del Vecchio
Keyword(s):  
Endometrial Carcinoma ◽  
Myometrial Invasion ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Multicenter Trial ◽  
Stage I ◽  
Surgical Staging ◽  
Poor Differentiation ◽  
Stage Ia ◽  
Deep Myometrial Invasion

A multicenter trial on apparent stage I endometrial carcinoma was performed to establish an intensive surgical staging, to formulate a treatment on the basis of the pathological extent of the disease and to determine the effectiveness of adjuvant medroxyprogesterone acetate therapy. The results of the first objective on 1,055 patients are herein reported. All patients had total abdominal hysterectomy, bilateral salpingo-oophorectomy, colpectomy of the superior third, and biopsy of lymph nodes positive or doubtful at radiological imaging or on surgical inspection. On the basis of the pathologic extent of the disease, patients were classified into five categories: disease outside the uterine corpus (RE); disease limited to endometrium (RO); disease with inner myometrial invasion and high or moderate grade (R1); disease with deep myometrial invasion or poor differentiation (R2); disease with positive retroperitoneal nodes (R3). One hundred and forty-six patients were RE, 163 RO, 382 R1, 341 R2 and 23 R3. The results showed a clinical understaging in 16% of the cases. According to the new FIGO classification, the relapse-free survival at 84 months was 96% for patients at stage IA, 92% for patients with stage IB-C, 86% for stage IIA-B, 76% for stage IIIA-B and 74% for patients at stage IIIC. These data confirm the importance of an intensive surgical staging in apparent stage I endometrial carcinoma.

Lymph Node Metastasis in Patients With Endometrioid Endometrial Cancer: Overtreatment Is the Main Issue

2017 ◽  
Vol 27 (4) ◽  
pp. 748-753 ◽  
Author(s):  
Alper Karalok ◽  
Taner Turan ◽  
Derman Basaran ◽  
Osman Turkmen ◽  
Gunsu Comert Kimyon ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Histological Grade ◽  
Myometrial Invasion ◽  
Lymph Node Involvement ◽  
Node Metastasis ◽  
Deep Myometrial Invasion ◽  
Endometrioid Endometrial Cancer ◽  
Grade 3

ObjectiveThe aim of this study was to evaluate the effectiveness of histological grade, depth of myometrial invasion, and tumor size to identify lymph node metastasis (LNM) in patients with endometrioid endometrial cancer (EC).MethodsA retrospective computerized database search was performed to identify patients who underwent comprehensive surgical staging for EC between January 1993 and December 2015. The inclusion criterion was endometrioid type EC limited to the uterine corpus. The associations between LNM and surgicopathological factors were evaluated by univariate and multivariate analyses.ResultsIn total, 368 patients were included. Fifty-five patients (14.9%) had LNM. Median tumor sizes were 4.5 cm (range, 0.7–13 cm) and 3.5 cm (range, 0.4–33.5 cm) in patients with and without LNM, respectively (P = 0.005). No LMN was detected in patients without myometrial invasion, whereas nodal spread was observed in 7.7% of patients with superficial myometrial invasion and in 22.6% of patients with deep myometrial invasion (P < 0.0001). Lymph node metastasis tended to be more frequent in patients with grade 3 disease compared with those with grade 1 or 2 disease (P = 0.131).ConclusionsThe risk of lymph node involvement was 30%, even in patients with the highest-risk uterine factors, that is, those who had tumors of greater than 2 cm, deep myometrial invasion, and grade 3 disease, indicating that 70% of these patients underwent unnecessary lymphatic dissection. A precise balance must be achieved between the desire to prevent unnecessary lymphadenectomy and the ability to diagnose LNM.

Recurrence of low risk (LR), early stage endometrial carcinoma (EC), a clinicopathologic analysis

2015 ◽  
Vol 139 (3) ◽  
pp. 599
Author(s):  
Tinera Buckley ◽  
Mary Belniak ◽  
Amy Brown ◽  
Srinivas Mandavilli ◽  
X. Clare Zhou
Keyword(s):  
Endometrial Carcinoma ◽  
Early Stage ◽  
Low Risk

scholarly journals Prognostic parameters in FIGO stage I endometrial carcinoma of endometrioid type

2006 ◽  
Vol 63 (12) ◽  
pp. 1006-1010 ◽  
Author(s):  
Zorica Stanojevic ◽  
Biljana Djordjevic
Keyword(s):  
Endometrial Carcinoma ◽  
Myometrial Invasion ◽  
Figo Stage ◽  
Histologic Grade ◽  
Stage I ◽  
Prognostic Parameters ◽  
Vascular Space ◽  
Vascular Space Invasion ◽  
Pathologic Parameters

Background/Aim. Endometrial carcinoma is the most common malignant neoplasm of the female genital tract in developed countries. Endometrioid carcinoma represents about three-fourths of all endometrial carcinoma. The aim of this study was to examine pathologic parameters, age, and the 5-year survival of the patients with FIGO stage I endometrial carcinoma of endometrioid type and to assess the prognostic utility of age, depth of myometrial invasion, hystologic type (endometrioid or variant), histologic grade, nuclear grade, and lymph-vascular space invasion. Methods. Age, pathologic parameters, and survival data were retrospectively collected on 236 patients with FIGO stage I endometrial carcinoma of endometrioid type. All the patients underwent hysterectomy between 1996 and 2000 and follow-up until December 2005. Results. A total of 236 patients (mean age 58.0, range 40?79) were analyzed. During the 5-year period of follow-up, 59 (25.0%) patents died from the disease. An univariate analysis revealed that age, depth of myometrial invasion, histologic grade, nuclear grade, and lymph-vascular space invasion were associated significantly with the 5-year survival of the patients. A multivariate analysis revealed that age, lymph-vascular space invasion, and depth of myometrial invasion were associated significantly with the 5-year survival. Conclusion. Age, lymph-vascular space invasion, and depth of myometrial invasion are independent prognostic parameters for the 5-year survival of the patients with FIGO stage I endometrial carcinoma of endometrioid type.

scholarly journals Cervical invasion, lymphovascular space invasion, and ovarian metastasis as predictors of lymph node metastasis and poor outcome on stages I to III endometrial cancers: a single-center retrospective study

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Min Li ◽  
Shuwei Wu ◽  
Yangqin Xie ◽  
Xiaohui Zhang ◽  
Zhanyu Wang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Regression Models ◽  
Cox Regression ◽  
Myometrial Invasion ◽  
Ovarian Metastasis ◽  
Surgical Staging ◽  
Tumor Diameter ◽  
Node Metastasis

Abstract Background The aim of this study is to determine pathological factors that increase the risk of LNM and indicate poor survival of patients diagnosed with endometrial cancer and treated with surgical staging. Method Between January 2010 and November 2018, we enrolled 874 eligible patients who received staging surgery in the First Affiliated Hospital of Anhui Medical University. The roles of prognostic risk factors, such as age, histological subtype, tumor grade, myometrial infiltration, tumor diameter, cervical infiltration, lymphopoiesis space invasion (LVSI), CA125, and ascites, were evaluated. Multivariable logistic regression models were used to identify the predictors of LNM. Kaplan–Meier and COX regression models were utilized to study the overall survival. Results Multivariable regression analysis confirmed cervical stromal invasion (OR 3.412, 95% CI 1.631–7.141; P < 0.01), LVSI (OR 2.542, 95% CI 1.061–6.004; P = 0.04) and ovarian metastasis (OR 6.236, 95% CI 1.561–24.904; P = 0.01) as significant predictors of nodal dissemination. Furthermore, pathological pattern (P = 0.03), myometrial invasion (OR 2.70, 95% CI 1.139–6.40; P = 0.01), and lymph node metastasis (OR 9.675, 95% CI 3.708–25.245; P < 0.01) were independent predictors of decreased overall survival. Conclusions Cervical invasion, lymphopoiesis space invasion, and ovarian metastasis significantly convey the risk of LNM. Pathological type, myometrial invasion, and lymph node metastasis are all important predictors of survival and should be scheduled for completion when possible in the surgical staging procedure.

scholarly journals Preoperative predictive factor analysis of ovarian malignant involvement in premenopausal patients with clinical stage I endometrioid endometrial carcinoma

2020 ◽  
Author(s):  
Qin Chen ◽  
Yan Feng ◽  
Wenwen Wang ◽  
Weiguo Lv ◽  
Baohua Li
Keyword(s):  
Endometrial Carcinoma ◽  
Clinical Stage ◽  
Myometrial Invasion ◽  
Stage I ◽  
Preoperative Imaging ◽  
Invasion Depth ◽  
Ca125 Level ◽  
Serum Ca125 ◽  
Premenopausal Patients ◽  
Endometrioid Endometrial Carcinoma

Abstract Background Earlier literature suggests that ovarian preservation in young premenopausal clinical stage I endometrioid endometrial carcinoma patients does not negatively impact prognosis and is a more suitable choice for management of the disease. The main purpose of this study was to clarify the incidence of ovarian malignant involvement in premenopausal clinical stage I endometrioid endometrial carcinoma and further identify potential preoperative predictive factors of ovarian malignant involvement. Methods Premenopausal patients (≤50 years) with clinical stage I endometrioid endometrial carcinoma subjected to total hysterectomy and bilateral salpingo-oophorectomy with or without pelvic and/or para-aortic lymph node dissection at Women’s Hospital, Zhejiang University School of Medicine between 2002 and 2016 were enrolled for study. Patients were excluded in cases of gross extra pelvic disease on examination or imaging and family history of colon or gastrointestinal carcinoma. The included patient population was examined for incidence of ovarian malignant involvement and potential preoperative clinical predictive factors.Results A total of 511 premenopausal (age≤50 years) patients diagnosed with clinical stage I endometrioid endometrial carcinoma were enrolled for the study. Ovarian malignant involvements were detected in 23 of the patients (4.5%). Kaplan-Meier analysis showed poorer prognoses of patients with ovarian malignant involvement than those without ovarian involvement. Univariate and multivariate logistic analysis validated preoperative imaging of myometrial invasion depth, the gross appearance of the ovaries, and preoperative serum carbohydrate antigen 125 (CA125) level as independent risk predictors of postoperative ovarian malignant involvement. Receiver operating characteristic (ROC) curves was individually generated for preoperative myometrial invasion depth, the gross appearance of the ovaries, and serum CA125 level as well as a combination of the three factors. The area under curve (AUC) was 0.858 (95% confidence interval [CI], 0.757–0.960) for the combined three factors.Conclusions The incidence of ovarian malignant involvement in premenopausal patients with clinical stage I endometrioid endometrial carcinoma was relatively minimal. Preoperative imaging of myometrial invasion depth, the gross appearance of the ovaries, and serum CA125 level were independent risk predictors of ovarian malignant involvement. These findings may facilitate preoperative counseling of patients and informed clinical decision-making on ovarian preservation in these patients.

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