Comparison of three different risk-stratification models for predicting lymph node involvement in endometrioid endometrial cancer clinically confined to the uterus

Abstract

ObjectiveTo compare the clinical validity of the Gynecologic Oncology Group-99 (GOG-99), the Mayo-modified and the European Society for Medical Oncology (ESMO)-modified criteria for predicting lymph node (LN) involvement in women with endometrioid endometrial cancer (EC) clinically confined to the uterus.MethodsA total of 625 consecutive women who underwent comprehensive surgical staging for endometrioid EC clinically confined to the uterus were divided into low- and high-risk groups according to the GOG-99, the Mayo-modified, and the ESMO-modified criteria. Lymphovascular space invasion is the cornerstone of risk stratification according to the ESMO-modified criteria. These 3 risk stratification models were compared in terms of predicting LN positivity.ResultsSystematic LN dissection was achieved in all patients included in the study. LN involvement was detected in 70 (11.2%) patients. LN involvement was correctly estimated in 51 of 70 LN-positive patients according to the GOG-99 criteria (positive likelihood ratio [LR+], 3.3; negative likelihood ratio [LR−], 0.4), 64 of 70 LN-positive patients according to the ESMO-modified criteria (LR+, 2.5; LR−, 0.13) and 69 of the 70 LN-positive patients according to the Mayo-modified criteria (LR+, 2.2; LR−, 0.03). The area under curve of the Mayo-modified, the GOG-99 and the ESMO-modified criteria was 0.763, 0.753, and 0.780, respectively.ConclusionThe ESMO-modified classification seems to be the risk-stratification model that most accurately predicts LN involvement in endometrioid EC clinically confined to the uterus. However, the Mayo-modified classification may be an alternative model to achieve a precise balance between the desire to prevent over-treatment and the ability to diagnose LN involvement.

Preoperative 18F-FDG PET/CT tumor markers outperform MRI-based markers for the prediction of lymph node metastases in primary endometrial cancer

“…Some models are inherently postoperative since they are based on tumor biomarker profiles derived from hysterectomy specimens [7][8][9], whereas proposed preoperative models combine preoperative imaging characteristics and biopsy/curettage and serum markers, e.g., cancer antigen (CA 125) [10][11][12]. When applied in independent patient cohorts, these models have been shown to have variable feasibilities [13][14][15], and at present, the best risk stratification model in endometrial cancer is not yet defined, and no uniform risk model is routinely used across centers. Furthermore, sentinel lymph node dissection (SLND) procedures have been increasingly advocated as a feasible alternative to full lymphadenectomy in endometrial cancer patients.…”

Prognostic factors and patterns of recurrence in lymphovascular space invasion positive women with stage IIIC endometriod endometrial cancer

“…These five centers (all of them participated in our previous multicenter studies on EC) were chosen because of their high volume of endometrioid EC presentations. Some of the patients in this study were within the context of one of our previous studies . With the eligible cases, demographic characteristics were extracted from medical records.…”

“…The date of diagnosis, adjuvant treatment modality (radiotherapy, chemoradiotherapy or chemotherapy), recurrence (if applicable), time to recurrence (TTR) (as a continuous variable in months, if applicable), site of recurrence (locoregional, retroperitoneal, distant), length of follow up and survivals were noted. Data were collected from centers with an online standardized form …”

“…All operations were performed by gynecological oncologists. Data on the extent of surgery included number of total LN harvested, number of pelvic LN removed, number of para‐aortic LN removed, number of metastatic pelvic LN and number of metastatic para‐aortic LN …”

Ultrasound‐based risk model for preoperative prediction of lymph‐node metastases in women with endometrial cancer: model‐development study

“…There is no universal definition of "low risk" and "high risk" in endometrial cancer. Numerous risk stratification systems are used for classifying the risk of lymph node metastases and recurrence 2,137,138 , such as the Mayo criteria 6 , PORTEC-1 139 (Post Operative Radiation Therapy in Endometrial Carcinoma), GOG-99 140 (Gyneacologic Oncology Group adjuvant radiation for intermediate-risk endometrial cancers), SEPAL 38 (Survival Effect of Para-Aortic Lymphadenectomy in endometrial cancer), ESMO classification 141 (European Society of Medical Oncology), ESMO modified classification 142 and Mayo-modified criteria 143 (Table 4). When compared, the ESMO modified classification most accurately predicted lymph node metastases 138,144 and risk of recurrence 144 .…”