Just how accurate are the major risk stratification systems for early-stage endometrial cancer?

Abstract

Background:To compare the accuracy of five major risk stratification systems (RSS) in classifying the risk of recurrence and nodal metastases in early-stage endometrial cancer (EC).Methods:Data of 553 patients with early-stage EC were abstracted from a prospective multicentre database between January 2001 and December 2012. The following RSS were identified in a PubMed literature search and included the Post Operative Radiation Therapy in Endometrial Carcinoma (PORTEC-1), the Gynecologic Oncology Group (GOG)-99, the Survival effect of para-aortic lymphadenectomy (SEPAL), the ESMO and the ESMO-modified classifications. The accuracy of each RSS was evaluated in terms of recurrence-free survival (RFS) and nodal metastases according to discrimination.Results:Overall, the ESMO -modified RSS provided the highest discrimination for both RFS and for nodal metastases with a concordance index (C-index) of 0.73 (95% CI, 0.70–0.76) and an area under the curve (AUC) of 0.80 (0.78–0.72), respectively. The other RSS performed as follows: the PORTEC1, GOG-99, SEPAL, ESMO classifications gave a C-index of 0.68 (0.66–0.70), 0.65 (0.63–0.67), 0.66 (0.63–0.69), 0.71 (0.68–0.74), respectively, for RFS and an AUC of 0.69 (0.66–0.72), 0.69 (0.67–0.71), 0.68 (0.66–0.70), 0.70 (0.68–0.72), respectively, for node metastases.Conclusions:None of the five major RSS showed high accuracy in stratifying the risk of recurrence or nodal metastases in patients with early-stage EC, although the ESMO-modified classification emerged as having the highest power of discrimination for both parameters. Therefore, there is a need to revisit existing RSS using additional tools such as biological markers to better stratify risk for these patients.

Laparoscopic Surgery for Large Ovarian Cysts-Review

“…A predictive accuracy of 80% is very promising given that Bendifallah et al recently illustrated that PORTEC-1, GOG-99, SEPAL, ESMO, and ESMO-modified had a predictive accuracy for recurrence of 0.68, 0.65, 0.66, 0.71 and 0.73, respectively [9]. Our clinical combination with nestin merits further research and investigation to validate and enhance the performance of this predictor.…”

“…Most uterine cancers have a favorable prognosis and are cured by surgery alone. Identifying patients at risk of recurrence, particularly those misclassified as low risk by current clinicopathologic standards [3][4][5][6][7][8][9] is of paramount importance. Physicians need better risk stratification tools to identify when and which adjuvant therapy will decrease recurrence.…”

Endometrial Carcinomas with POLE Exonuclease Domain Mutations Have a Favorable Prognosis

“…This raises the possibility of a subset of low-grade endometrial carcinomas, where a biomarker is yet to be identified, that may need additional treatment to prevent recurrence. We may be missing an opportunity for curative therapy, underscoring the need to improve the current systems of endometrial carcinoma risk assessment (33) 23). Through conservation studies with T4 DNA polymerase, it is likely that mutations at the residues L424P, P436R, P441L, and A456P near the exonuclease III domain also reduce proofreading resulting in a mutator phenotype (23,34,36).…”

Molecular classification of endometrial carcinoma on diagnostic specimens is highly concordant with final hysterectomy: Earlier prognostic information to guide treatment

“…This study confirms the previously reported lack of reproducibility of conventional histopathological assessment, both between observers, and in comparing biopsy/curetting to hysterectomy specimens. Attempts at comprehensive treatment guidelines [24, 27], interpretation of past and future clinical trials, and EC research are severely limited by our inability to consistently classify this disease. The tremendous advances made in research and treatment of other cancers have not been realized in EC.…”