A Lymph Node Count-Based AJCC Staging System Facilitates a More Accurate Prediction of the Prognosis of Patients With Endometrial Cancer.

Xinlong Huo,Shufang Wang

doi:10.3389/fonc.2021.641962

Abstract

PurposeBoth the International Federation of Gynecology and Obstetrics (FIGO) and the American Joint Committee on Cancer (AJCC) staging system for endometrial cancer (EC) defined the N category by the location of metastatic lymph nodes (LNs) rather than the metastatic LN count. We aimed to compare the accuracy of the AJCC staging system and the LN count-based staging system.Patients and MethodsEC patients were selected from the Surveillance, Epidemiology and End Results (SEER) database between 2004 and 2016. Patients’ characteristics were collected, including age, race, marital status, histological type, grade, therapeutic measures, the number of metastatic LNs, the number of dissected LNs, vital status, and survival in months. Overall survival (OS) was analyzed by the Kaplan–Meier (KM) method and the concordance index (C-index) was used to compare the prognostic value of the AJCC staging system and the LN count-based staging system.ResultsWe identified 4,276 EC cases from the SEER database, including 2,693 patients with stage IIIC1 and 1,583 patients with stage IIIC2. Multivariate analyses showed that independent prognostic factors for patients with stage IIIC1 included age, race, marital status, grade, histology, chemotherapy, and radiotherapy. Independent prognostic factors for patients with stage IIIC2 included age, marital status, grade, histology, chemotherapy, and radiotherapy. The C-index of the AJCC staging system and the LN count-based staging system were 0.483 and 0.617, respectively. At least six LNs should be dissected to ensure the accuracy of the LN count-based staging system.ConclusionA modified AJCC staging system based on the count of metastatic LNs might be superior to the current AJCC staging system, which still had room for improvement and further refinements were required. For accurate staging, we recommended that at least six LNs should be examined in the modified AJCC staging system.

Highlights

Endometrial cancer (EC) is a malignant epithelial carcinoma that originates from the inner lining of the uterus [1]
For EC patients with stage IIIC, the standard approach is a total hysterectomy and bilateral salpingo-oophorectomy with lymph nodes assessment based on the National Comprehensive Cancer Network (NCCN) guidelines [5]
The informed consent of all patients in the SEER database has been obtained before the publication of the database by the National Institutes of Health (NIH) Ethics Office

Summary

Introduction

Endometrial cancer (EC) is a malignant epithelial carcinoma that originates from the inner lining of the uterus [1]. It represents one of the most common cancer types of the female reproductive system, accounting for approximately 4–6% of all cancers in women [2, 3]. For EC patients with stage IIIC, the standard approach is a total hysterectomy and bilateral salpingo-oophorectomy with lymph nodes assessment based on the National Comprehensive Cancer Network (NCCN) guidelines [5]. The 5-year survival rate of patients with LN metastasis is approximately 60%, while that of those without LN metastasis could be over 80% [17]. EC with LN metastasis should be given more attention

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