Skip to main content
SpringerLink
Log in

Nomogram with potential clinical use to predict lymph node metastasis in endometrial cancer patients diagnosed incidentally by postoperative pathological assessment

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To determine the clinical and pathological risk factors for lymph node metastasis (LNM) in patients with endometrial cancer and to create a nomogram to predict LNM in patients without surgical staging.

Methods

All patients with endometrial adenocarcinoma who were treated surgically at a university based gynecologic oncology clinic between January 2011 and December 2014 were recruited. Women with endometrial adenocarcinoma who were surgically staged including lymphadenectomy were included in the study. Data regarding clinical and pathological risk factors were recorded. The histopathologic slides from the staging surgeries were re-evaluated microscopically by a gynecologic pathologist for all parameters along with lymphovascular space invasion (LVSI).

Results

A total of 279 patients with endometrial cancer were analyzed. Among those, 31 (11.1%) had lymph node metastasis. According to the univariate analyses, elevated CA 125 (>35 U/mL), LVSI, myometrial invasion ≥50%, grade 3 disease, non-endometrioid type, and cervical stromal involvement were significantly associated with LNM. The multivariate logistic regression analysis showed that LVSI, non-endometrioid type, elevated CA 125, and cervical stromal involvement increased the risk of LNM. However, myometrial invasion and grade did not significantly affect the risk of LNM. A nomogram to predict LNM was constructed using these factors (concordance index 0.92).

Conclusions

LVSI is the most important predictor for LNM. The present nomogram can be useful to decide if adjuvant therapy is required for patients who undergo simple hysterectomy for a benign etiology and incidentally diagnosed with endometrial cancer by pathological evaluation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  PubMed  Google Scholar 

  2. Pecorelli S (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105:103–104

    Article  PubMed  Google Scholar 

  3. Colombo N, Creutzberg C, Amant F et al (2016) ESMO–ESGO–ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Int J Gynecol Cancer 26:2–30

    Article  PubMed  Google Scholar 

  4. Frost JA, Webster KE, Bryant A et al (2015) Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev 9:CD007585

    Google Scholar 

  5. Benedetti Panici P, Basile S, Maneschi F et al (2008) Systematic pelvic lymphadenectomy vs no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100:1707–1716

    Article  PubMed  Google Scholar 

  6. Creutzberg CL, van Putten WLJ, Koper PCM et al (2000) Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC study group. Postoperative radiation therapy in endometrial carcinoma. Lancet 355:1404–1411

    Article  CAS  PubMed  Google Scholar 

  7. Hahn HS, Chun YK, Kwon YI et al (2010) Concurrent endometrial carcinoma following hysterectomy for atypical endometrial hyperplasia. Eur J Obstet Gynecol Reprod Biol 150:80–83

    Article  PubMed  Google Scholar 

  8. Solmaz U, Mat E, Dereli M et al (2015) Lymphovascular space invasion and cervical stromal invasion are independent risk factors for nodal metastasis in endometrioid endometrial cancer. Aust N Z J Obstet Gynaecol 55:81–86

    Article  PubMed  Google Scholar 

  9. Solmaz U, Mat E, Dereli ML et al (2015) Lymphovascular space invasion and positive pelvic lymph nodes are independent risk factors for para-aortic nodal metastasis in endometrioid endometrial cancer. Eur J Obstet Gynecol Reprod Biol 186:63–67

    Article  PubMed  Google Scholar 

  10. Hahn HS, Lee IH, Kim TJ et al (2013) Lymphovascular space invasion is highly associated with lymph node metastasis and recurrence in endometrial cancer. Aust N Z J Obstet Gynaecol 53:293–297

    Article  PubMed  Google Scholar 

  11. Pollom EL, Conklin CM, von Eyben R et al (2015) Nomogram to predict risk of lymph node metastases in patients with endometrioid endometrial cancer. Int J Gynecol Pathol. doi:10.1097/PGP.0000000000000246

    Google Scholar 

  12. Akbayir O, Corbacioglu A, Goksedef BP et al (2012) The novel criteria for predicting pelvic lymph node metastasis in endometrioid adenocarcinoma of endometrium. Gynecol Oncol 125:400–403

    Article  PubMed  Google Scholar 

  13. Abu-Rustum NR, Iasonos A, Zhou Q et al (2008) Is there a therapeutic impact to regional lymphadenectomy in the surgical treatment of endometrial carcinoma? Am J Obstet Gynecol 198:457.e1–457.e5

    Article  Google Scholar 

  14. Kitchener H, Swart AM, Qian Q et al (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373:125–136

    Article  CAS  PubMed  Google Scholar 

  15. Cragun JM, Havrilesky LJ, Calingaert B et al (2005) Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J Clin Oncol 23:3668–3675

    Article  PubMed  Google Scholar 

  16. Mariani A, Webb MJ, Keeney GL et al (2002) Predictors of lymphatic failure in endometrial cancer. Gynecol Oncol 84:437–442

    Article  PubMed  Google Scholar 

  17. Cohn DE, Horowitz NS, Mutch DG et al (2002) Should the presence of lymphovascular space involvement be used to assign patients to adjuvant therapy following hysterectomy for unstaged endometrial cancer? Gynecol Oncol 87:243–246

    Article  PubMed  Google Scholar 

  18. Ambros RA, Kurman RJ (1992) Combined assessment of vascular and myometrial invasion as a model to predict prognosis in stage I endometrioid adenocarcinoma of the uterine corpus. Cancer 69:1424–1431

    Article  CAS  PubMed  Google Scholar 

  19. Keys HM, Roberts JA, Brunetto VL et al (2004) A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 92:744–751

    Article  PubMed  Google Scholar 

  20. Weber SK, Sauerwald A, Pölcher M et al (2012) Detection of lymphovascular invasion by D2-40 (podoplanin) immunoexpression in endometrial cancer. Int J Gynecol Cancer 22:1442–1448

    Article  PubMed  Google Scholar 

  21. Alexander-Sefre F, Singh N, Ayhan A et al (2003) Detection of tumour lymphovascular space invasion using dual cytokeratin and CD31 immunohistochemistry. J Clin Pathol 56:786–788

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Turan T, Hizli D, Sarici S et al (2011) Is it possible to predict para-aortic lymph node metastasis in endometrial cancer? Eur J Obstet Gynecol Reprod Biol 158:274–279

    Article  PubMed  Google Scholar 

  23. Kumar S, Bandyopadhyay S, Semaan A et al (2011) The role of frozen section in surgical staging of low risk endometrial cancer. PLoS One 6:e21912

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Karabagli P, Ugras S, Yılmaz BS et al (2015) The evaluation of reliability and contribution of frozen section pathology to staging endometrioid adenocarcinomas. Arch Gynecol Obstet 292:391–397

    Article  PubMed  Google Scholar 

  25. Celik C, Ozdemir S, Esen H et al (2010) The clinical value of preoperative and intraoperative assessments in the management of endometrial cancer. Int J Gynecol Cancer 20:358–362

    Article  PubMed  Google Scholar 

  26. Prat J (2004) Prognostic parameters of endometrial carcinoma. Hum Pathol 35:649–662

    Article  PubMed  Google Scholar 

  27. Jiang T, Huang L, Zhang S (2015) Preoperative CA 125: a useful marker for surgical management of endometrial cancer. BMC Cancer 15:396

    Article  PubMed  PubMed Central  Google Scholar 

  28. Dotters DJ (2000) Preoperative CA 125 in endometrial cancer: is it useful? Am J Obstet Gynecol 182:1328–1334

    Article  CAS  PubMed  Google Scholar 

  29. Nicklin J, Janda M, Gebski V et al (2012) The utility of serum CA-125 in predicting extra-uterine disease in apparent early-stage endometrial cancer. Int J Cancer 131:885–890

    Article  CAS  PubMed  Google Scholar 

  30. Santala M, Talvensaari-Mattila A, Kauppila A (2003) Peritoneal cytology and preoperative serum CA 125 level are important prognostic indicators of overall survival in advanced endometrial cancer. Anticancer Res 23:3097–3103

    CAS  PubMed  Google Scholar 

  31. AlHilli MM, Podratz KC, Dowdy SC et al (2013) Risk-scoring system fort he individualized prediction of lymphatic dissemination in patients with endometrioid endometrial cancer. Gynecol Oncol 131:103–108

    Article  CAS  PubMed  Google Scholar 

  32. Mahdi H, Munkarah AR, Ali-Fehmi R et al (2015) Tumor size is an independent predictor of lymph node metastasis and survival in early stage endometrioid endometrial cancer. Arch Gynecol Obstet 292:183–190

    Article  CAS  PubMed  Google Scholar 

  33. Gilani S, Anderson I, Fathallah L et al (2014) Factors predicting nodal metastasis in endometrial cancer. Arch Gynecol Obstet 290:1187–1193

    Article  PubMed  Google Scholar 

  34. Göksedef BP, Akbayır Ö, Çorbacıoğlu A et al (2012) Comparison of preoperative endometrial biopsy grade and final pathologic diagnosis in patients with endometrioid endometrial cancer. J Turk Ger Gynecol Assoc 13:106–110

    Article  PubMed  PubMed Central  Google Scholar 

  35. Karalok A, Ureyen I, Reis Y et al (2014) Prediction of staging with preoperative parameters and frozen/section in patients with a preoperative diagnosis of grade 1 endometrioid tumor in endometrial cancer. J Turk Ger Gynecol Assoc 15:41–48

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Ankara University School of Medicine, Cebeci, 06100, Ankara, Turkey

    Salih Taşkın, Yavuz Emre Şükür, Bulut Varlı, Kazibe Koyuncu, Mehmet Murat Seval & Fırat Ortaç

  2. Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey

    Can Ateş

  3. Department of Biostatistics, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey

    Selcen Yüksel

  4. Department of Obstetrics and Gynecology, Acıbadem University School of Medicine, Istanbul, Turkey

    Mete Güngör

Authors
  1. Salih Taşkın
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yavuz Emre Şükür
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bulut Varlı
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kazibe Koyuncu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mehmet Murat Seval
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Can Ateş
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Selcen Yüksel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mete Güngör
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fırat Ortaç
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ST: Protocol/project development, interpretation, management. YES: Data management, manuscript writing/editing. BV: Data collection. KK: Data collection. MMS: Interpretation. CA: Data analysis. SY: Data analysis. MG: Interpretation. FO: Interpretation.

Corresponding author

Correspondence to Yavuz Emre Şükür.

Ethics declarations

Conflict of interest

The authors of this article report no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional review board and with the Helsinki declaration or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taşkın, S., Şükür, Y.E., Varlı, B. et al. Nomogram with potential clinical use to predict lymph node metastasis in endometrial cancer patients diagnosed incidentally by postoperative pathological assessment. Arch Gynecol Obstet 296, 803–809 (2017). https://doi.org/10.1007/s00404-017-4477-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-017-4477-7

Keywords

Search

Navigation