scholarly journals Risk Stratification of Endometrial Cancer Patients: FIGO Stage, Biomarkers and Molecular Classification

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5848
Author(s):  
Jenneke C. Kasius ◽  
Johanna M. A. Pijnenborg ◽  
Kristina Lindemann ◽  
David Forsse ◽  
Judith van Zwol ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Risk Stratification ◽  
Adjuvant Treatment ◽  
Molecular Classification ◽  
Figo Stage ◽  
Developed Countries ◽  
Surgical Staging ◽  
Molecular Profile ◽  
Prognostic Information ◽  
Main Challenge

Endometrial cancer (EC) is the most common gynaecologic malignancy in developed countries. The main challenge in EC management is to correctly estimate the risk of metastases at diagnosis and the risk to develop recurrences in the future. Risk stratification determines the need for surgical staging and adjuvant treatment. Detection of occult, microscopic metastases upstages patients, provides important prognostic information and guides adjuvant treatment. The molecular classification subdivides EC into four prognostic subgroups: POLE ultramutated; mismatch repair deficient (MMRd); nonspecific molecular profile (NSMP); and TP53 mutated (p53abn). How surgical staging should be adjusted based on preoperative molecular profiling is currently unknown. Moreover, little is known whether and how other known prognostic biomarkers affect prognosis prediction independent of or in addition to these molecular subgroups. This review summarizes the factors incorporated in surgical staging (i.e., peritoneal washing, lymph node dissection, omentectomy and peritoneal biopsies), and its impact on prognosis and adjuvant treatment decisions in an era of molecular classification of EC. Moreover, the relation between FIGO stage and molecular classification is evaluated including the current gaps in knowledge and future perspectives.

Molecular classification of endometrial carcinoma: protocol for a cohort study (Preprint)

2021 ◽  
Author(s):  
Inês Moreira ◽  
Carla Bartosch ◽  
Manuel Teixeira ◽  
Marta Ferreira
Keyword(s):  
Clinical Practice ◽  
Endometrial Carcinoma ◽  
Adjuvant Treatment ◽  
Prognostic Value ◽  
Molecular Classification ◽  
Developed Countries ◽  
The Cancer Genome Atlas ◽  
Molecular Profile ◽  
Individual Risk ◽  
Histologic Subtype

UNSTRUCTURED Endometrial carcinoma (EC) is the most common gynaecologic malignancy in developed countries and the fourth most frequent in women worldwide. Incidence of EC has been increasing in the past several years, mainly due to increasing rates of metabolic syndrome. The cornerstone of treatment for EC is surgery. Clinicopathological features are currently used to help determine the individual risk of recurrence and the need for adjuvant treatment after surgery. Nonetheless, there is a significant inter-observer variability in assigning histologic subtype when using a morphological classification, revealing the need for a more unified approach. The Cancer Genome Atlas (TCGA) project identified four distinct prognostic EC subtypes based on genomic abnormalities. Surrogate assays including three immunohistochemical markers (p53, MSH6 and PMS2) and one molecular test (mutation analysis of the exonuclease domain of POLE), allowed the development and validation of a simplified molecular classifier that correlates with the TCGA classification, has prognostic value and can easily be used in clinical practice. This molecular classification categorizes EC in 4 subtypes: POLE mutated, mismatch repair deficient, p53 abnormal and no specific molecular profile. Applying this classification in clinical practice will help tailor adjuvant treatment decisions. The aim of this study is to retrospectively apply this novel molecular classification on a cohort of EC patients treated in a comprehensive cancer centre, to assess its applicability in clinical practice, to evaluate clinical outcomes by molecular subtypes and assess its prognostic value.

scholarly journals Challenges Posed by Embryonic and Anatomical Factors in Systematic Lymphadenectomy for Endometrial Cancer

2020 ◽  
Vol 9 (12) ◽  
pp. 4107
Author(s):  
Damaris Freytag ◽  
Julian Pape ◽  
Juhi Dhanawat ◽  
Veronika Günther ◽  
Nicolai Maass ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Surgical Staging ◽  
Current Evidence ◽  
Lymph Node Status ◽  
Prognostic Information ◽  
Systematic Lymphadenectomy ◽  
Lymph Node Mapping ◽  
Node Status ◽  
Wide Range

Lymph node involvement has been shown to be one of the most relevant prognostic factors in a variety of malignancies; this is also true of endometrial cancer. The determination of the lymph node status is crucial in order to establish the tumor stage, and to consider adjuvant treatment. A wide range of surgical staging practices are currently used for the treatment of endometrial cancer. The necessity and extent of lymph node dissection is an ongoing controversial issue in gynecological oncology. Lymph node surgery in endometrial cancer is technically challenging, and can be time consuming because of the topographic complexity of lymphatic drainage as such, and the fact that the lymph nodes are directly adjacent to both blood vessels and nerves. Therefore, profound and exact knowledge of the anatomy is essential. Sentinel lymph node mapping was recently introduced in surgical staging with the aim of reducing morbidity, whilst also obtaining useful prognostic information from a patient’s lymph node status. The present review summarizes the current evidence on the role of lymph node surgery in endometrial cancer, focusing on the embryological, anatomical, and technical aspects.

Retrospective analysis of stage IC uterine cancer patients: A single center experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15573-e15573
Author(s):  
Nadire Kucukoztas ◽  
Selim Yalcin ◽  
Samed Rahatli ◽  
Ozlem Ozen ◽  
Nihan Haberal ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Early Stage ◽  
Uterine Cancer ◽  
Endometrial Adenocarcinoma ◽  
Cell Cancer ◽  
Disease Free Survival ◽  
Figo Stage ◽  
Surgical Staging ◽  
Increased Risk

e15573 Background: Stage IC patients are at an increased risk of recurrence and overall worse prognosis compared with stage IA and IB patients. Adjuvant chemoherapy is utilized based on specific pathologic factors. The objective of this study is to evaluate treatment outcomes at a single institution in patients with 1988 FIGO stage IC endometrial adenocarcinoma. Methods: Records of the patients with FIGO stage IB (formerly IC) endometrial cancer were retrospectively evaluated. All patients were initially treated surgically with comprehensive staging lymphadenectomy. Results: A total of 85 patients were included. Patient and tumor characteristics are shown in the table. Median age of the patients was 60 (range 27-95). Fifty-nine patients had at least one co-morbid disease. Complete surgical staging including pelvic and paraaortic lymph node dissection was performed in all the patients. Sixteen patients (19%) received adjuvant chemotherapy, including 6 patients with serous cancer and one patient with small cell cancer. Paclitaxel/carboplatin was the preferred regimen in Median follow up was 30 months (range 10-61 months). Seven patients (8%) relapsed and 4 patients (5%) died on follow up. 5 year disease free survival was 89% and overall survival was 95%. One of the 16 patients (6.2%) who received chemotherapy and 6 of the 69 patients (8.7%) who did not receive relapsed/died on follow up. Survival analysis was not performed because of the low number of events in both groups. Conclusions: We found similar rates of recurrence and death with previous studies in stage IC endometrial cancer. Complete surgical staging is the mainstay of treatment. Marginally lower recurrence rate in chemotherapy treated patients delineate the need for prospective randomized data addressing the role of adjuvant systemic therapy in early-stage patients with endometrial adenocarcinoma. [Table: see text]

scholarly journals The emerging role of molecular pathology in directing the systemic treatment of endometrial cancer

2021 ◽  
Vol 13 ◽  
pp. 175883592110359
Author(s):  
Amy Jamieson ◽  
Tjalling Bosse ◽  
Jessica N. McAlpine
Keyword(s):  
Endometrial Cancer ◽  
Molecular Subtypes ◽  
Treatment Decision ◽  
Molecular Classification ◽  
The Cancer Genome Atlas ◽  
Molecular Profile ◽  
Therapeutic Implications ◽  
Treatment Decision Making ◽  
Exciting Time ◽  
Classification Tool

Following the discovery of the four molecular subtypes of endometrial cancer (EC) by The Cancer Genome Atlas (TCGA) in 2013, subsequent studies used surrogate markers to develop and validate a clinically relevant EC classification tool to recapitulate TCGA subtypes. Molecular classification combines focused sequencing ( POLE) and immunohistochemistry (mismatch repair and p53 proteins) to assign patients with EC to one of four molecular subtypes: POLEmut, MMRd, p53abn and NSMP (no specific molecular profile). Unlike histopathological evaluation, the molecular subtyping of EC offers an objective and reproducible classification system that has been shown to have prognostic value and therapeutic implications. It is an exciting time in EC care where we have moved beyond treatment based on histomorphology alone, and molecular classification will now finally allow assessment of treatment efficacy within biologically similar tumours. It is now recommended that molecular classification should be considered for all ECs, and should be performed routinely in all high grade tumours. It is also recommended to incorporate molecular classification into standard pathology reporting and treatment decision-making algorithms. In this review, we will discuss how the molecular classification of EC can be used to guide both conventional and targeted therapy in this new molecular era.

scholarly journals Re-staging surgery in endometrial cancer: an audit on its value

2020 ◽  
Vol 9 (12) ◽  
pp. 4898
Author(s):  
Sanjay Badesara ◽  
Ashitha R. Gangadharan ◽  
Rambeer Singh ◽  
Adarsh Dharmarajan
Keyword(s):  
Endometrial Cancer ◽  
Figo Stage ◽  
International Federation ◽  
Surgical Staging ◽  
Carcinoma Endometrium ◽  
Gynecology And Obstetrics ◽  
Anticancer Treatment ◽  
Staging Surgery ◽  
Completion Surgery

Background: Incomplete surgical staging in carcinoma endometrium is not an uncommon entity in developing world. Proper surgical staging has got a role in prognostication and planning adjuvant treatment. So, an audit was done to assess the extent of upstaging in women with endometrial cancers who were referred to index centre from outside hospitals with incomplete surgical staging.Methods: It is a retrospective study. The demographic, clinical and treatment details of women with complete data having at-least one follow up after completion surgery were analyzed. Patients who had any other anticancer treatment elsewhere were excluded. The extent of upstaging was studied based on International federation of gynecology and obstetrics (FIGO) 2008 staging.Results: A total of 88 patients of endometrial cancer were evaluated retrospectively, of which 10 had completion surgery. 10% of the patients were upstaged according to the FIGO stage (one from IA to IB), while one patient upstaged from IIIA to IVB after slide review by index centre. According to FIGO Grade, 40% patient upgraded (one upgraded from I to II, three from II to III) while one downgraded from II to I. Recurrence rate was 40%.Conclusions: Upstaging is seen in 10% of patient after completion surgery, which requires the necessity of evaluation by gynecologic oncologist selectively. However, larger and multi-centric studies needed to draw definite conclusion. There is a significant discordance in grade and histology after the review at index centre.

Preoperative risk stratification using 18F-FDG PET/CT in women with endometrial cancer

2011 ◽  
Vol 50 (05) ◽  
pp. 204-213 ◽  
Author(s):  
H. J. Lee ◽  
C. M. Hong ◽  
B. I. Song ◽  
H. W. Kim ◽  
S. Kang ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
High Risk ◽  
Risk Stratification ◽  
Fdg Pet ◽  
Figo Stage ◽  
Low Risk ◽  
Histologic Grade ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

SummaryThe aim of this study is to evaluate the usefulness of 18F-FDG PET/CT for preoperative stratification of high-risk and low-risk carcinomas in patients with endometrial cancer. Patients, methods: 60 women (mean age 53.8 ± 9.9 years) with endometrial cancer, who underwent 18F-FDG PET/CT for preoperative staging work-up, followed by primary cytoreductive surgery, were enrolled in this study. Maximum and mean standardized uptake values (SUVmax, SUVmean) of endometrial tumors were measured, and compared with the various clinicopathologic findings obtained after surgery. Tumour aggressiveness was classified as high-risk and low-risk carcinomas. Patients with stage I or II, endometrioid adenocarcinoma, histologic grade 1 or 2, invasion of less than half of the myometrium, maximum tumor size less than 2.0 cm, and absence of cervical invasion and lymphovascular space involvement (LVSI) were classified as the lowrisk carcinoma group. The remaining patients were classified as the high-risk carcinoma group. Results: In univariate analysis, SUVmax of the primary endometrial tumor was significantly higher in patients who were in a postmenopausal state (p = 0.047), large (> 2 cm) primary tumor (p <0.001), nonendometrioid subtype (p = 0.024), invasion of more than half of the myometrium (p = 0.020), or LVSI (p = 0.004). SUVmax differed significantly according to FIGO stage (p = 0.013) and histologic grade (p <0.001). In multivariate analysis, FIGO stage, histologic grade, LVSI, and maximum tumor size demonstrated a significant association with SUVmax (p <0.001; r = 0.843, r2 = 0.711). SUVmean showed similar results. Forty-one (68.3%) patients were diagnosed postoperatively as high-risk and 19 patients (31.7%) as low-risk carcinoma. Patients with high-risk carcinoma (12.1 ± 6.1) showed significantly higher SUVmax than patients with low-risk carcinoma (5.8 ± 2.8, p <0.001). The optimal SUVmax cut-off value of 8.7, determined by ROC analysis, revealed 75.6% sensitivity, 89.5% specificity, and 81.7% accuracy for risk stratification. Conclusion: High-risk endometrial cancer might be differentiated by means of higher SUVmax from low-risk endometrial cancer. 18F-FDG FDG PET/CT can be applied preoperatively for stratification of risk in patients with endometrial cancer.

Revision of FIGO surgical staging in 2009 for endometrial cancer validates to improve risk stratification

2012 ◽  
Vol 125 (1) ◽  
pp. 103-108 ◽  
Author(s):  
H.M.J. Werner ◽  
J. Trovik ◽  
J. Marcickiewicz ◽  
S. Tingulstad ◽  
A.C. Staff ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Risk Stratification ◽  
Surgical Staging ◽  
Improve Risk Stratification

scholarly journals Clinical features of ProMisE groups identify different phenotypes of patients with endometrial cancer

2021 ◽  
Author(s):  
Antonio Raffone ◽  
Antonio Travaglino ◽  
Olimpia Gabrielli ◽  
Mariacarolina Micheli ◽  
Valeria Zuccalà ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endometrial Cancer ◽  
Clinical Features ◽  
Adjuvant Treatment ◽  
Meta Analysis ◽  
Figo Stage ◽  
Stage I ◽  
Pooled Prevalence ◽  
Prognostic Groups

Abstract Background The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) groups has identified four molecular prognostic groups of endometrial cancer (EC): POLE-mutated (POLE-mt), mismatch repair-deficient (MMR-d), p53-abnormal (p53-abn), p53-wild-type (p53-wt). These groups might have different pathogenesis and risk factors, and might occur in different phenotypes of patients. However, these data are still lacking. Objective To provide a clinical characterization of the ProMisE groups of EC. Methods A systematic review and meta-analysis was performed by searching seven electronic databases from their inception to December 2020, for all studies reporting clinical characteristics of EC patients in each ProMisE group. Pooled means of age and BMI and pooled prevalence of FIGO stage I and adjuvant treatment in each ProMisE group were calculated. Results Six studies with 1, 879 women were included in the systematic review. Pooled means (with standard error) and prevalence values were: in the MMR-d group, age = 66.5 ± 0.6; BMI = 30.6 ± 1.2; stage I = 72.6%; adjuvant treatment = 47.3%; in the POLE-mt group, age = 58.6 ± 2.7; BMI = 27.2 ± 0.9; stage I = 93.7%; adjuvant treatment = 53.6%; in the p53-wt group, age = 64.2 ± 1.9; BMI = 32.3 ± 1.4; stage I = 80.5%; adjuvant treatment = 45.3%; in the p53-abn group, age = 71.1 ± 0.5; BMI = 29.1 ± 0.5; stage I = 50.8%; adjuvant treatment = 64.4%. Conclusion The ProMisE groups identify different phenotypes of patients. The POLE-mt group included the youngest women, with the lower BMI and the highest prevalence of stage I. The p53-wt group included patients with the highest BMI. The p53-abn group included the oldest women, with the highest prevalence of adjuvant treatment and the lowest prevalence of stage I. The MMR-d group showed intermediate values among the ProMisE groups for all clinical features.

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