Evaluation of models to predict lymph node metastasis in endometrial cancer: A multicentre study

Koskas, Martin; Fournier, Marie; Vanderstraeten, Anke; Walker, Francine; Timmerman, Dirk; Vergote, Ignace; Amant, Frédéric

doi:10.1016/j.ejca.2016.03.079

Cited by 33 publications

(24 citation statements)

References 23 publications

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“…Several risk models for prediction of LNM have been proposed [7][8][9][10][11][12], and in a study from 2015, Koskas et al [13] evaluated ten models in an independent patient cohort and found that the best model (based on CA125 and MRI findings [12]) yielded an AUC of 0.76 and a false negative rate of 4%. The present study shows that a risk model based on MTV cutoff value of 27 ml alone will yield a higher AUC of 0.80 for prediction of LNM, however with a higher false negative rate of 19%.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Objectives To compare the diagnostic accuracy of preoperative 18F-FDG PET/CT and MRI tumor markers for prediction of lymph node metastases (LNM) and aggressive disease in endometrial cancer (EC). Methods Preoperative whole-body 18F-FDG PET/CT and pelvic MRI were performed in 215 consecutive patients with histologically confirmed EC. PET/CT-based tumor standardized uptake value (SUV max and SUV mean), metabolic tumor volume (MTV), and PET-positive lymph nodes (LNs) (SUV max > 2.5) were analyzed together with the MRI-based tumor volume (V MRI), mean apparent diffusion coefficient (ADC mean), and MRI-positive LN (maximum short-axis diameter ≥ 10 mm). Imaging parameters were explored in relation to surgicopathological stage and tumor grade. Receiver operating characteristic (ROC) curves were generated yielding optimal cutoff values for imaging parameters, and regression analyses were used to assess their diagnostic performance for prediction of LNM and progression-free survival. Results For prediction of LNM, MTV yielded the largest area under the ROC curve (AUC) (AUC = 0.80), whereas V MRI had lower AUC (AUC = 0.72) (p = 0.03). Furthermore, MTV > 27 ml yielded significantly higher specificity (74%, p < 0.001) and accuracy (75%, p < 0.001) and also higher odds ratio (12.2) for predicting LNM, compared with V MRI > 10 ml (58%, 62%, and 9.7, respectively). MTV > 27 ml also tended to yield higher sensitivity than PET-positive LN (81% vs 50%, p = 0.13). Both V MRI > 10 ml and MTV > 27 ml were significantly associated with reduced progression-free survival. Conclusions Tumor markers from 18F-FDG PET/CT outperform MRI markers for the prediction of LNM. MTV > 27 ml yields a high diagnostic performance for predicting aggressive disease and represents a promising supplement to conventional PET/CT reading in EC. Key Points • Metabolic tumor volume (MTV) outperforms other 18F-FDG PET/CT and MRI markers for preoperative prediction of lymph node metastases (LNM) in endometrial cancer patients. • Using cutoff values for tumor volume for prediction of LNM, MTV > 27 ml yielded higher specificity and accuracy than V MRI > 10 ml. • MTV represents a promising supplement to conventional PET/CT reading for predicting aggressive disease in EC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Published preoperative risk models in endometrial cancer predict the risk of lymph node metastases 25,[145][146][147][148][149] (Table 5), postoperative high risk 53,61,123 and advanced stage 150 , with 25,53,61,[145][146][147][148][149] or without 123,150 the use of imaging. Some preoperative risk models for lymph node metastases [145][146][147] have been subject to external validation, limited by selective cohorts and missing data, due to the retrospective nature of the studies 151,152 . Comparison of model performance is difficult, as long as the models are not validated on the same identical validation cohort, representative to the target population for the model.…”

Section: Risk Assessment In Endometrial Cancermentioning

confidence: 99%

“…Most preoperative risk classification systems and risk prediction models aim at identifying a low-risk group, where lymphadenectomy can be safely omitted 152 . The definition of what "low risk" is varies with models.…”

Section: The Challenge Of Correct Prediction Of Lymph Node Metastasesmentioning

confidence: 99%

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

Eriksson

Epstein

Testa

et al. 2020

Ultrasound in Obstet & Gyne

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Background: Endometrial cancer is the most common gynecological cancer in the industrialized world, constituting 4.5% of all cancer in Swedish women. Standard surgery is hysterectomy and bilateral salpingo-oophorectomy, with or without lymphadenectomy, depending on the estimated risk of lymph node metastases. Adjuvant therapy is given, depending on the estimated risk of adverse outcome. Numerous risk stratification systems guide the choice on lymphadenectomy, but none is associated with a high accuracy. Lymph node metastases are found in 11-22% of women. If they could be accurately predicted, many lymphadenectomies could be avoided. The aim of this thesis was to improve preoperative risk assessment in women with endometrial cancer, with regard to predicting deep (≥ 50%) myometrial invasion (MI), cervical stromal invasion (CSI), lymph node metastases and recurrence or progression.

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“…Although hysterectomy is curative in most women with ECs, 2–15% of early stage and over 50% of advance stage ECs will eventually recur with poor patient outcome [ 3 , 4 ]. The currently-available clinicopathological classification of EC patients into low, intermediate and high risk sub-groups has been criticized to be of limited specificity in stratifying patients for postsurgical management [ 5 ]. The recently proposed molecular classification of EC is projected to improve this, particularly after integrating the suggested 4 molecular groups with the existing clinicopathological subgroupings [ 6 ]; however, reliable bio-markers to predict response to therapy or recurrence during follow-up, are still lacking.…”

Section: Introductionmentioning

confidence: 99%

High AGR2 protein is a feature of low grade endometrial cancer cells

et al. 2018

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BackgroundBiomarkers for identification of endometrial cancers (ECs) with high risk of recurrence are required to reduce the rising EC-related mortality. AGR2 is a prognostic marker in several hormonally-regulated cancers.AimTo assess the utility of AGR2 as a prognostic marker in EC.MethodsAGR2 immunoexpression was evaluated in 163 human endometrial samples. Change in AGR2 mRNA levels in response to oestrogen and dihydrotestosterone was studied in vitro.ResultsUpregulation of AGR2 (protein and mRNA) was seen in low grade EC, compared to the postmenopausal endometrium (P = 0.013) and to the high-grade EC (P < 0.0001). Elevated AGR2 protein expression-scores were associated with a high expression of estrogen alpha (ERα), progesterone, androgen receptors and early clinical stages. Metastatic lesions maintained higher AGR2 expression relative to matched-primary tumors. High-AGR2 protein levels were associated with better overall survival (P = 0.02) in all ECs, but in highly-ERα-expressing ECs, AGR2 associated with unfavourable patient outcome. Androgen through its receptor, downregulated AGR2 mRNA in the Ishikawa cells.ConclusionsAGR2 is overexpressed in low grade ECs and positively associated with hormone receptors. The association between high AGR2 and progressive disease within the high-ERα-expressing ECs suggests that in this group of patients, AGR2 might be a potential biomarker of poor prognosis.

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Evaluation of models to predict lymph node metastasis in endometrial cancer: A multicentre study

Cited by 33 publications

References 23 publications

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

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

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

High AGR2 protein is a feature of low grade endometrial cancer cells

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