Predictive value of Kanagawa cancer center scoring system for lymph node metastasis in patients with endometrial cancer and comparing it to Al-Hilli scoring system

Abstract

Background: Lymph node metastasis (LNM) is an indicator of poor prognosis and requires adjuvant therapy in patient with endometrial cancer (EC). Lymphadenectomy is still the standard technique to assess the lymphatic spread of EC. However, the evaluation of the LNM preoperatively is an important factor in determining the outcome of patients with endometrial cancer. The Kanagawa Cancer Center (KCC) scoring system allows to identify patients risk of developing LNM based on tumor volume, myometrium invasion, histological type, and serumCA125 levels. Objective: To determine the predictive value of Kanagawa Cancer Centre (KCC) scoring system for lymph node metastasis in patients with endometrial cancer and compare it with Alhilli scoring. Patients and Methods: A prospective observational cross-sectional study carried out in the Department of Obstetrics and Gynecology / Baghdad Teaching Hospital, Baghdad, Iraq over a period of 20 months starting from December 2018 to August 2020. A total number of 52 patients with endometrial cancer were included. Preoperative assessment included histology and CA125. Results: The cut point of KCC score was 2, so KCC > 2 is predictive for lymph node involvement. The sensitivity, specificity, positive predictive value, and negative predictive value of KCC for lymph node involvement was found to be 100%, 95.5%, 80%, and 100%, respectively, with an accuracy of 96.2%. Lymph node involvement was seen significantly in patients with positive CA125 level, grade 3, nonendometrioid type, myometrium invasion ≥ 50%, and higher tumor volume. Regarding Al-hilli scoring system, the sensitivity, specificity, positive predictive value and negative predictive value was 100%, 40.9%, 23.5%, 100% respectively, with an accuracy of 50%. Conclusions: The KCC scoring system has a high accuracy for the prediction of lymph node involvement in patients with endometrial cancer with better accuracy than Al-hilli scoring.