Predictive Value of Kanagawa Cancer Center Scoring System for Lymph Node Metastasis and Need for Lymphadenectomy in Patients With Endometrial Cancer: A Validation Study

Momtahan, Mozhdeh; Hosseini, Marjan; Robati, Minoo; Najib, Fatemesadat

doi:10.1097/igc.0000000000001301

Cited by 6 publications

(7 citation statements)

References 25 publications

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“…Based on title and abstract, 525 studies were relevant. After full‐text screening, 83 studies, comprising 18,205 patients, were included in the systematic review (supplemental online Appendix 2) . Three studies lacked raw data, and because the authors did not respond after being contacted, these publications were excluded .…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

et al. 2019

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Background In endometrial carcinoma (EC), preoperative classification is based on histopathological criteria, with only moderate diagnostic performance for the risk of lymph node metastasis (LNM). So far, existing molecular classification systems have not been evaluated for prediction of LNM. Optimized use of clinical biomarkers as recommended by international guidelines might be a first step to improve tailored treatment, awaiting future molecular biomarkers. Aim To determine the diagnostic accuracy of preoperative clinical biomarkers for the prediction of LNM in endometrial cancer. Methods A systematic review was performed according to the Meta‐analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Studies identified in MEDLINE and EMBASE were selected by two independent reviewers. Included biomarkers were based on recommended guidelines (cancer antigen 125 [Ca‐125], lymphadenopathy on magnetic resonance imaging, computed tomography, and 18F‐fluorodeoxyglucose positron emission tomography/computed tomography [18FDG PET‐CT]) or obtained by physical examination (body mass index, cervical cytology, blood cell counts). Pooled sensitivity, specificity, area under the curve (AUC), and likelihood ratios were calculated with bivariate random‐effects meta‐analysis. Likelihood ratios were classified into small (0.5–1.0 or 1–2.0), moderate (0.2–0.5 or 2.0–5.0) or large (0.1–0.2 or ≥ 5.0) impact. Results Eighty‐three studies, comprising 18,205 patients, were included. Elevated Ca‐125 and thrombocytosis were associated with a moderate increase in risk of LNM; lymphadenopathy on imaging with a large increase. Normal Ca‐125, cytology, and no lymphadenopathy on 18FDG PET‐CT were associated with a moderate decrease. AUCs were above 0.75 for these biomarkers. Other biomarkers had an AUC <0.75 and incurred only small impact. Conclusion Ca‐125, thrombocytosis, and imaging had a large and moderate impact on risk of LNM and could improve preoperative risk stratification. Implications for Practice Routine lymphadenectomy in clinical early‐stage endometrial carcinoma does not improve outcome and is associated with 15%–20% surgery‐related morbidity, underlining the need for improved preoperative risk stratification. New molecular classification systems are emerging but have not yet been evaluated for the prediction of lymph node metastasis. This article provides a robust overview of diagnostic performance of all clinical biomarkers recommended by international guidelines. Based on these, at least measurement of cancer antigen 125 serum level, assessment of thrombocytosis, and imaging focused on lymphadenopathy should complement current preoperative risk stratification in order to better stratify these patients by risk.

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Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

et al. 2019

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“…To our knowledge, in the literature, there are no other validated scores to date for analyzing the risk of lymph node invasion in cervical cancer. On the other hand, there are many studies on the Kanagawa Cancer Center (KCC) preoperative scoring system (21,22) and other systems (23) proposed for prediction of lymph nodes invasion in the endometrial cancer. The KCC preoperative scoring system is useful to predict lymph nodal metastases risk, and thereby prevent unnecessary lymphadenectomy or to determine its extent in endometrial cancer patients.…”

Section: Results In the Context Of Published Literaturementioning

confidence: 99%

Estimation risk of lymph nodal invasion in patients with early-stage cervical cancer: Cervical cancer application

Guani

Gaillard²,

Teo-Fortin³

et al. 2022

Front. Oncol.

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IntroductionLymph node status is a major prognostic factor in early-stage cervical cancer. Predicting the risk of lymph node metastasis is essential for optimal therapeutic management. The aim of the study was to develop a web-based application to predict the risk of lymph node metastasis in patients with early-stage (IA1 with positive lymph vascular space invasion, IA2 and IB1) cervical cancer.Materials and methodsWe performed a secondary analysis of data from two prospective multicenter trials, Senticol 1 and 2 pooled together in the training dataset. The histological risk factors were included in a multivariate logistic regression model in order to determine the most suitable prediction model. An internal validation of the chosen prediction model was then carried out by a cross validation of the ‘leave one out cross validation’ type. The prediction model was implemented in an interactive online application of the ‘Shinyapp’ type. Finally, an external validation was performed with a retrospective cohort from L’Hôtel-Dieu de Québec in Canada.ResultsThree hundred twenty-one patients participating in Senticol 1 and 2 were included in our training analysis. Among these patients, 280 did not present lymph node invasion (87.2%), 13 presented isolated tumor cells (4%), 11 presented micrometastases (3.4%) and 17 macrometastases (5.3%). Tumor size, presence of lymph-vascular space invasion and stromal invasion were included in the prediction model. The Receiver Operating Characteristic (ROC) Curve from this model had an area under the curve (AUC) of 0.79 (95% CI [0.69– 0.90]). The AUC from the cross validation was 0.65. The external validation on the Canadian cohort confirmed a good discrimination of the model with an AUC of 0.83.DiscussionThis is the first study of a prediction score for lymph node involvement in early-stage cervical cancer that includes internal and external validation. The web application is a simple, practical, and modern method of using this prediction score to assist in clinical management.

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“…KCC score was 100% sensitive, 95.5% specific, the positive predictive value was 80%, negative predictive value was 100% and 96.2% accurate as a marker for prediction of lymph node involvement. While, Momtahan et al [26] demonstrate that All the patients who had lymph node involvement had KCC higher than 1 with sensitivity, specificity, positive predictive value and negative predictive value of 35.3%, 100%, 100%, and 64% respectively. They also demonstrate that the KCC scoring system has a moderate accuracy for prediction of lymph node involvement.…”

Section: Discussionmentioning

confidence: 95%

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

Azzo¹,

Abdulameer²

2021

Int. J. Clin. Obstet. Gynaecol.

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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.

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Predictive Value of Kanagawa Cancer Center Scoring System for Lymph Node Metastasis and Need for Lymphadenectomy in Patients With Endometrial Cancer: A Validation Study

Abstract: The KCC scoring system has a moderate accuracy for predicting the lymph node involvement in patients with endometrial cancer.

Cited by 6 publications

References 25 publications

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

Estimation risk of lymph nodal invasion in patients with early-stage cervical cancer: Cervical cancer application

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

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