Association of Myometrial Invasion With Lymphovascular Space Invasion, Lymph Node Metastasis, Recurrence, and Overall Survival in Endometrial Cancer: A Meta-Analysis of 79 Studies With 68,870 Patients

Abstract

BackgroundMyometrial invasion has been demonstrated to correlate to clinicopathological characteristics and prognosis in endometrial cancer. However, not all the studies have the consistent results and no meta-analysis has investigated the association of myometrial invasion with lymphovascular space invasion (LVSI), lymph node metastasis (LNM), recurrence, and overall survival (OS). Therefore, a meta-analysis was performed to evaluate the relationship between myometrial invasion and clinicopathological characteristics or overall survival in endometrial cancer.Materials and MethodsA search of Pubmed, Embase, and Web of Science was carried out to collect relevant studies from their inception until June 30, 2021. The quality of each included study was evaluated using Newcastle–Ottawa scale (NOS) scale. Review Manager version 5.4 was employed to conduct the meta-analysis.ResultsA total of 79 articles with 68,870 endometrial cancer patients were eligible including 9 articles for LVSI, 29 articles for LNM, 8 for recurrence, and 37 for OS in this meta-analysis. Myometrial invasion was associated with LVSI (RR 3.07; 95% CI 2.17–4.35; p < 0.00001), lymph node metastasis (LNM) (RR 4.45; 95% CI 3.29–6.01; p < 0.00001), and recurrence (RR 2.06; 95% CI 1.58–2.69; p < 0.00001). Deep myometrial invasion was also significantly related with poor OS via meta-synthesis of HRs in both univariate survival (HR 3.36, 95% CI 2.35–4.79, p < 0.00001) and multivariate survival (HR 2.00, 95% CI 1.59–2.53, p < 0.00001). Funnel plot suggested that there was no significant publication bias in this study.ConclusionDeep myometrial invasion correlated to positive LVSI, positive LNM, cancer recurrence, and poor OS for endometrial cancer patients, indicating that myometrial invasion was a useful evaluation criterion to associate with clinical outcomes and prognosis of endometrial cancer since depth of myometrial invasion can be assessed before surgery. The large scale and comprehensive meta-analysis suggested that we should pay more attention to myometrial invasion in clinical practice, and its underlying mechanism also deserves further investigation.

Comprehensive Analysis of the Expression and Prognosis for MCM4 in Uterine Corpus Endometrial Carcinoma

“…Endometrial cancer is often associated with the abnormal expression of genes and proteins (Czerwiński et al, 2021). In recent years, mortality rates have been on the rise (Wang J et al, 2021). Therefore, the search and discovery of endometrial cancerrelated regulatory genes are important for the development of new therapeutic targets for UCEC.…”

Association of Tumor Size With Myometrial Invasion, Lymphovascular Space Invasion, Lymph Node Metastasis, and Recurrence in Endometrial Cancer: A Meta-Analysis of 40 Studies With 53,276 Patients

“…Our conclusion showed tumor size >20 mm was characterized by the presence of MI, which has 50% of patients with all FIGO stages in endometrial cancer. MI is vitally important in the development of endometrial cancer and a well-recognized predictor of extra-uterine spread ( 4 , 53 ). MI is quite an early action of cancer cells, which classifies patients with initial stages as low-risk or high-risk patients for surgical planning ( 53 ).…”

“…MI is vitally important in the development of endometrial cancer and a well-recognized predictor of extra-uterine spread ( 4 , 53 ). MI is quite an early action of cancer cells, which classifies patients with initial stages as low-risk or high-risk patients for surgical planning ( 53 ). Depth of MI (>50%) definitely correlated to LVSI, LNM, recurrence, and OS ( 53 ).…”

“…MI is quite an early action of cancer cells, which classifies patients with initial stages as low-risk or high-risk patients for surgical planning ( 53 ). Depth of MI (>50%) definitely correlated to LVSI, LNM, recurrence, and OS ( 53 ).…”

Uterine Neoplasms, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology

“…10,11 Depth of myometrial invasion is considered one of the critical criteria for evaluation of surgical-pathologic staging. 12,13 To further improve outcomes for patients with this disease, physicians need to identify high-risk patients and to tailor treatment appropriately to provide the best long-term survival, including quality of life. The panel suggests that gynecologic oncologists be involved in the primary management of all patients with endometrial cancer.…”