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

Abstract

BackgroundMyometrial invasion (MI), lymphovascular space invasion (LVSI), and lymph node metastasis (LNM) have been found to have independent prognostic factors in endometrial cancer. Tumor size has practical advantages in endometrial cancer. The cutoff values for tumor size conformed with current literature. More and more studies inferred that tumor size >20 mm showed a strong correlation. However, the relationship between tumor size >20 mm and MI, LVSI, LNM, recurrence, and overall survival (OS) remains controversial, and no meta-analysis has been conducted. Therefore, a systematic review and meta-analysis should be performed to discuss this issue later on.MethodsRelevant articles were collected from PubMed, EMBASE, and Cochrane Library databases from January 1990 to June 2021. The predictive value of tumor size >20 mm in endometrial cancer was studied, and data were pooled for meta-analysis using Review Manager 5.1. Additionally, the odds ratio (OR) was analyzed, and cumulative analyses of hazard ratio (HR) and their corresponding 95% CI were conducted.ResultsA total of 40 articles with 53,276 endometrial cancer patients were included in the meta-analysis. It contained 7 articles for MI, 6 for LVSI, 21 for LNM, 7 for recurrence, and 3 for OS. Primary tumor size >20 mm was significantly associated with depth of MI (OR = 5.59, 95% CI [5.02, 6.23], p < 0.001), positive LVSI (OR = 3.35, 95% CI [2.34, 4.78], p < 0.001), positive LNM (OR = 4.11, 95% CI [3.63, 4.66], p < 0.001), and recurrence (OR = 3.52, 95% CI [2.39, 5.19], p < 0.001). Tumor size >20 mm was also related to OS via meta-synthesis of HR in univariate survival (HR 2.13, 95% CI [1.28, 3.53], p = 0.003). There was no significant publication bias in this study by funnel plot analysis.ConclusionPrimary tumor size >20 mm was an independent predictive factor for the depth of MI, positive LVSI, positive LNM, recurrence, and poor OS. Therefore, it is more important to take into account the value of tumor size in the clinicopathological staging of endometrial carcinoma. Tumor size >20 mm should be integrated into the intraoperative algorithm for performing a full surgical staging. Well-designed and multicenter studies, with a larger sample size, are still required to verify the findings.

Predictive Value of Magnetic Resonance Imaging in Risk Stratification and Molecular Classification of Endometrial Cancer

“…We found that the maximum tumor diameter significantly differed between risk groups, echoing previous findings that larger tumor sizes are associated with poorer prognoses [35,36]. The invasive features prevalent in the non-low-risk groups align with the findings of other studies, such as those of Maria Ali et al and Stephanie Nougaret et al, which linked tumor size to lymph node metastasis and myometrial invasion depth, respectively [37,38].…”

Integrating proteomics and explainable artificial intelligence: a comprehensive analysis of protein biomarkers for endometrial cancer diagnosis and prognosis

“…While myometrial invasion, tumor grade, and lymph node metastasis are recognized as individual prognostic factors in endometrial cancer, tumor size holds practical utility in predicting the prognosis of this cancer. The established cutoff values for tumor size align with existing literature, and an increasing body of research suggests a robust correlation with tumor sizes exceeding 20 mm (Jin et al, 2022). Among the machine learning methods used in this study for tumor size classification, XGBoost is the model with the highest performance metrics with accuracy (91.8%), sensitivity (100%), specificity (79.2%), F1-Score (93.7%), and AUC (94.8%).…”

Clinicopathological characteristics of endometrial carcinomas according to DNA mismatch repair protein status

“…In our previous study of 703 patients treated at the same institution from 2008 to 2018, the same low frequency of tumors smaller than 2.0 cm was observed (i.e., 13.7 cm A similarly small proportion of endometrial tumors with diameters <2.0 cm was observed in a sample of 703 patients treated at the same institution from 2008 to 2018 (mean tumor diameter, 13.7 cm) [ 46 ]. This cut-off is critical for the application of more conservative surgical approaches and has been shown to have a prognostic impact [ [47] , [48] , [49] ].…”