Preoperative predictive factor analysis of ovarian malignant involvement in premenopausal patients with clinical stage I 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 included 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 logistic analysis revealed significant association of preoperative imaging of myometrial invasion depth and serum CA125 with prediction of ovarian malignant involvement in patients. Multivariate logistic analysis further validated preoperative imaging of myometrial invasion depth and serum CA125 as independent risk predictors of postoperative ovarian malignant involvement. Receiver operating characteristic (ROC) curves were individually generated for preoperative myometrial invasion depth and serum CA125 as well as a combination of the two factors. The area under the curve (AUC) was 0.772 (95% confidence interval [CI], 0.661–0.884) for combined preoperative myometrial invasion depth and serum CA125.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 and serum CA125 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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Preoperative predictive factor analysis of ovarian malignant involvement in premenopausal patients with clinical stage I endometrioid endometrial carcinoma

10.21203/rs.2.17501/v2 ◽

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

Scientific Reports ◽

10.1038/s41598-020-78953-4 ◽

2021 ◽

Vol 11 (1) ◽

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 ◽

Ovarian Preservation ◽

Two Factors ◽

Endometrioid Endometrial Carcinoma ◽

Risk Predictors

AbstractEarlier literature suggests that ovarian preservation in young premenopausal clinical stage I endometrioid endometrial carcinoma patients does not negatively impact prognosis. The main purpose of this study was to clarify the incidence of ovarian malignant involvement in this group and further identify potential preoperative predictive factors of ovarian malignant involvement. A total of 511 premenopausal (age ≤ 50 years) patients were enrolled for the study at Women’s Hospital, Zhejiang University School of Medicine, between January 2002 and December 2016. Ovarian malignant involvements were detected in 23 of the patients (4.5%). Univariate and multivariate logistic analysis validated preoperative imaging of myometrial invasion depth and preoperative serum carbohydrate antigen 125 (CA125) level as independent risk predictors of postoperative ovarian malignant involvement. Receiver operating characteristic (ROC) curves was generated for a combination of the two factors. The area under curve (AUC) was 0.772 (95% confidence interval [CI] 0.661–0.884) for the combined two factors. The incidence of postoperative ovarian malignant involvement was relatively minimal. Preoperative imaging of myometrial invasion depth 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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Intraoperative frozen section examination of myometrial invasion depth in patients with endometrial carcinoma

International Journal of Gynecological Cancer ◽

10.1046/j.1525-1438.1994.04050352.x ◽

1994 ◽

Vol 4 (5) ◽

pp. 352-355 ◽

Cited By ~ 16

Author(s):

J. Atad ◽

Y. Ben-David ◽

M. Hallak ◽

O. Klein ◽

H. Abramovici ◽

...

Keyword(s):

Endometrial Carcinoma ◽

Frozen Section ◽

Myometrial Invasion ◽

Accurate Method ◽

Figo Stage ◽

Stage I ◽

Frozen Sections ◽

Invasion Depth ◽

Surgical Specimen ◽

Deep Myometrial Invasion

The objective of this study was to evaluate the accuracy of frozen sections (FS) as a method for estimation of the depth of myometrial invasion in patients with stage I endometrial carcinoma. During a 3-year period (1989–1992), 46 consecutive patients with FIGO stage I endometrial carcinoma were included in this study. The depth of myometrial invasion was estimated by FS examination performed during surgery. The final histologic findings of the surgical specimen were compared to the FS evaluation. The results of this study demonstrate that deep or superficial myometrial invasions were correctly diagnosed by FS in 42 out of 46 cases (91.3%). Three cases (6.6%) with deep myometrial invasion were falsely diagnosed as superficially invasive. One case with superficial invasion (2.1%) was falsely diagnosed as deeply invasive. In conclusion, intraoperative FS examination of depth of myometrial invasion by endometrial carcinoma is a simple and accurate method, providing a good correlation with the final histologic report of the surgical specimen.

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Faculty Opinions recommendation of Comparison of a sentinel lymph node and a selective lymphadenectomy algorithm in patients with endometrioid endometrial carcinoma and limited myometrial invasion.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726064980.793527256 ◽

2017 ◽

Author(s):

Paola Gehrig

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Endometrial Carcinoma ◽

Myometrial Invasion ◽

Selective Lymphadenectomy ◽

Endometrioid Endometrial Carcinoma

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Prognostic parameters in FIGO stage I endometrial carcinoma of endometrioid type

Vojnosanitetski pregled ◽

10.2298/vsp0612006s ◽

2006 ◽

Vol 63 (12) ◽

pp. 1006-1010 ◽

Cited By ~ 1

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.

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Magnetic resonance imaging in the preoperative assessment of clinical stage I endometrial carcinoma

Computerized Medical Imaging and Graphics ◽

10.1016/0895-6111(90)90059-k ◽

1990 ◽

Vol 14 (3) ◽

pp. 191-195 ◽

Cited By ~ 7

Author(s):

Connie D. Harrill ◽

Kenyon K. Kopecky ◽

Sharon R. Weaver ◽

Gregory P. Sutton

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Endometrial Carcinoma ◽

Clinical Stage ◽

Preoperative Assessment ◽

Stage I ◽

Resonance Imaging

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Tailored surgical staging and radiation therapy in clinical stage I endometrioid endometrial adenocarcinoma (EEA)

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16511 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16511-e16511

Author(s):

K. M. Bermudez Wagner ◽

M. B. Thomas ◽

C. Miyamoto ◽

B. Micaily ◽

E. Hernandez

Keyword(s):

Adjuvant Therapy ◽

Proportional Hazards ◽

Clinical Stage ◽

Endometrial Adenocarcinoma ◽

Myometrial Invasion ◽

Retrospective Chart Review ◽

Progression Free Survival ◽

Cox Proportional Hazards ◽

Stage I ◽

Outcome Analysis

e16511 Background: Pelvic lymph node dissection (LND) requirement to adequately stage endometrial cancer has been subject of debate. We conducted an outcome analysis of clinical stage I endometrioid endometrial adenocarcinoma (EEA) patients who underwent surgery with tailored LND and adjuvant therapy (radiation (RT) or chemotherapy) between 1997 and 2008. Methods: Retrospective chart review was performed at our institution. All patients underwent exploratory laparotomy, cytology, total abdominal hysterectomy and bilateral salpingoophorectomy. Pelvic and para-aortic LND was perforned in high-risk patients when technically possible. Cox proportional hazards and the Kaplan Meier method were used for data analysis. Results: 119 patients (stage I 92, II 11, III 15, and IV 1) were identified. Median BMI was 34 and 81% had significant co-morbidities. 50% underwent para-aortic LND (median 4 nodes) and 25% underwent pelvic LND (median 15 nodes), of whom 8% and 10% were positive, respectively. Postoperative complications occurred in 22%. 26% received RT. With a mean follow-up of 20 months, 5-year progression-free survival (PFS) and overall survival (OS) was 71% and 84%. The OS for stage I and IIIC was 88% and 83%, respectively. OS for patients with or without LND was not statistically different ( 73% vs.82%). 12 (10%) recurrences were noted, 8 of which were hematological (HF) with a 5-year HF probability of 21%. On multivariate analysis only myometrial invasion > 50% was independent risk factor for HF. Patients receiving RT showed a trend toward decreased in local recurrences ( 0% vs.30% p = 0.1) but no improvement in OS. Conclusions: In patients with EEA, a tailored approach to LND and adjuvant therapy results in good outcome, but many still have therapy-associated adverse events. Although no difference was found in OS between patients who underwent LND and those who did not, similar survival for patients with stages I and IIIC suggests that therapy directed by the knowledge of nodal status may have an impact on survival. No significant financial relationships to disclose.

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