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French Multicenter Study Evaluating the Risk of Lymph Node Metastases in Early-Stage Endometrial Cancer: Contribution of a Risk Scoring System

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study was designed to develop a risk scoring system (RSS) for predicting lymph node (LN) metastases in patients with early-stage endometrial cancer (EC).

Methods

Data of 457 patients with early-stage EC who received primary surgical treatment between January 2001 and December 2012 were abstracted from a prospective, multicentre database (training set). A risk model based on factors impacting LN metastases was developed. To assess the discrimination of the RSS, both internal by the bootstrap approach and external validation (validation set) were adopted.

Results

Overall the LN metastasis rate was 11.8 % (54/457). LN metastases were associated with five variables: age ≥60 years, histological grade 3 and/or type 2, primary tumor diameter ≥1.5 cm, depth of myometrial invasion ≥50 %, and the positive lymphovascular space involvement status. These variables were included in the RSS and assigned scores ranging from 0 to 9. The discrimination of the RSS was 0.81 [95 % confidence interval (CI) 0.78–0.84] in the training set. The area under the curve of the receiver-operating characteristics for predicting LN metastases after internal and external validation was 0.80 (95 % CI 0.77–0.83) and 0.85 (95 % CI 0.81–0.89), respectively. A total score of 6 points corresponded to the optimal threshold of the RSS with a rate of LN metastases of 7.5 % (29/385) and 34.7 % (25/72) for low-risk (≤6 points) and high-risk patients (>6 points), respectively. At this threshold, the diagnostic accuracy was 83 %.

Conclusions

This RSS could be useful in clinical practice to determine which patients with early-stage EC should benefit from secondary surgical staging including complete lymphadenectomy.

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Acknowledgment

We thank Professeur Pierre-Yves Boelle who spent time reading and making comments on the manuscript.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France

    Sofiane Bendifallah MD, Geoffroy Canlorbe MD, Emile Daraï MD, PhD & Marcos Ballester MD, PhD

  2. INSERM UMR S 707, “Epidemiology, Information Systems, Modeling”, University Pierre and Marie Curie, Paris, France

    Sofiane Bendifallah MD

  3. Department of Gynecological Surgery, Jeanne de Flandre University Hospital, Lille, France

    Emmanuelle Arsène MD & Pierre Collinet MD, PhD

  4. Department of Radiation Oncology, Tenon University Hospital, University Pierre and Marie Curie, Paris 6, Paris, France

    Florence Huguet MD, PhD

  5. Centre de Lutte Contre le Cancer Georges François Leclerc, Dijon, France

    Charles Coutant MD, PhD & Delphine Hudry MD

  6. Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France

    Olivier Graesslin MD, PhD & Emilie Raimond MD

  7. Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France

    Cyril Touboul MD, PhD

  8. INSERM UMR S 938, University Pierre et Marie Curie, Paris 6, Paris, France

    Emile Daraï MD, PhD & Marcos Ballester MD, PhD

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  1. Sofiane Bendifallah MD
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  2. Geoffroy Canlorbe MD
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  3. Emmanuelle Arsène MD
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  4. Pierre Collinet MD, PhD
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  5. Florence Huguet MD, PhD
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  7. Delphine Hudry MD
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  8. Olivier Graesslin MD, PhD
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  9. Emilie Raimond MD
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  10. Cyril Touboul MD, PhD
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  11. Emile Daraï MD, PhD
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  12. Marcos Ballester MD, PhD
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Correspondence to Sofiane Bendifallah MD.

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Bendifallah, S., Canlorbe, G., Arsène, E. et al. French Multicenter Study Evaluating the Risk of Lymph Node Metastases in Early-Stage Endometrial Cancer: Contribution of a Risk Scoring System. Ann Surg Oncol 22, 2722–2728 (2015). https://doi.org/10.1245/s10434-014-4311-4

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  • DOI: https://doi.org/10.1245/s10434-014-4311-4

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