Nomogram Based on Pan-Immune Inflammation Value and ClinicopathologicalParameters for Predicting the Recurrence of Endometrial Cancer and Providing Postoperative Prognostic Management.

Endometrial cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up

Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Tumor board presentation of a woman with metastatic, hormone receptor‐positive, mismatch repair‐deficient endometrial cancer

Background: Endometrial cancer (EC) is the third most prevalent neoplasm among women in Spain and the most frequent malignancy of the female genital tract. The primary risk factors are associated with increased estrogen levels. The objective of our study is to determine the current specific progression-free survival (PFS) and overall survival (OS) in patients with EC at the University Hospital of Puerto Real. Additionally, we aim to understand the independent role of specific factors in the risk of recurrence and mortality from EC through a multivariate analysis. Methods: A retrospective observational survival analysis of a case series was conducted. The study population included all women diagnosed and treated for EC in Spain between January 2010 and December 2021. The Kaplan-Meier method and Cox regression analysis were performed to evaluate survival based on patient age, tumor stage, histological type, and degree of differentiation, and to quantify survival probabilities for each factor. Results: A total of 324 patients were included. The PFS was 86.6% at 5 years and 81.1% at 10 years. The OS was 91.3% at 5 years and 84.8% at 10 years. The tumor-related mortality rate was 9.3% (N = 30) and the tumor recurrence rate was 5.6% (N = 18). The estimated median follow-up using the inverse Kaplan-Meier method was 4.33 years (95% confidence interval (95% CI): 3.72–4.94) for OS and 4.57 years (95% CI: 4.05–5.09) for PFS. The statistically significant factors affecting PFS and OS were age ≥60 years at diagnosis, advanced International Federation of Gynecology and Obstetrics (FIGO) stage (II–IV), non-endometrioid tumor, high tumor grade, and lymphovascular space invasion. Multivariate Cox regression analysis shows that being 60 years or older at the time of diagnosis, advanced FIGO stages, high tumor grade, and serous-papillary tumors are independent risk factors for recurrence or death in EC. Conclusions: Our study shows that being 60 years or older at the time of diagnosis, advanced FIGO stages (II–IV), non-endometrioid EC, higher histological tumor grade, and lymphovascular space invasion are associated with lower OS and PFS. Additionally, multivariate Cox analysis suggests that age ≥60 years at diagnosis, advanced FIGO stages, high tumor grade, and serous-papillary histological type are independent prognostic factors influencing survival and recurrence in EC. This study should serve as a foundation for further research, incorporating relevant aspects of the molecular biology of EC to refine patient prognosis.

Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

This study aimed to investigate the prognosis value of the clinical parameters and immunohistochemical markers of patients with early-onset endometrial cancer (EC) and establish a nomogram to accurately predict recurrence-free survival (RFS) of early-onset EC after resection. A training dataset containing 458 patients and an independent testing dataset consisting of 170 patients were employed in this retrospective study. The independent risk factors related to RFS were confirmed using Cox regression models. A nomogram model was established to predict RFS at 3 and 5 years post-hysterectomy. The C-index, area under the curve (AUC) of the receiver operating characteristic (ROC) curve, and calibration curve were calculated to assess the predictive accuracy of the nomogram. In all early-onset EC patients, more than half (368/628, 58.6%) were diagnosed in the age range of 45-49 years. Meanwhile, the recurrence rate of early-onset EC is approximately 10.8%. Multivariate Cox regression analyses showed that histological subtype, FIGO stage, myometrial invasion, lymphovascular space invasion (LVSI), P53 expression, and MMR status were independent prognostic factors related to RFS (all P < 0.05) and established the nomogram predicting 3- and 5-year RFS. The C-index and calibration curves of the nomogram demonstrated a close correlation between predicted and actual RFS. Patients were divided into high- and low-risk groups according to the model of RFS. Combining clinical parameters and immunohistochemical markers, we developed a robust nomogram to predict RFS after surgery for early-onset EC patients. This nomogram can predict prognosis well and guide treatment decisions.

This study aimed at developing an available recurrence-free survival (RFS) model of endometrial cancer (EC) for accurate and individualized prognosis assessment. A training cohort of 520 women with EC who underwent initial surgical treatment and an external validation cohort of 445 eligible EC patients from 2006 to 2016 were analyzed retrospectively. Multivariable Cox proportional hazards regression models were used to develop nomograms for predicting recurrence. The concordance index (C-index) and the area under the receiver operating characteristic curve (AUC) were calculated to determine the discrimination of RFS prognostic scoring systems. Calibration plots were generated to examine the performance characteristics of the predictive nomograms. Regression analysis revealed that an advanced International Federation of Gynecology and Obstetrics (FIGO) stage, histological grade 3, primary tumor diameter ≥2 cm, and positive peritoneal cytology were independent prognostic factors for RFS in EC in the training set. The nomograms estimated RFS according to these four variables, with a C-index of 0.860, which was superior to that of FIGO stage (2009 criteria), at 0.809 (P=0.034), in the training cohort. Encouragingly, consistent results were observed in the validation set, with a C-index of 0.875 for the nomogram and a C-index of 0.833 for the FIGO staging (P=0.0137). Furthermore, the calibrations of the nomograms predicting 3- and 5-year RFS strongly corresponded to the actual survival outcome. In conclusion, this study developed an available nomogram with effective external validation and relatively appreciable discrimination and conformity for the accurate assessment of 3- and 5-year RFS in Chinese women with EC.

BackgroundThis study evaluated the prognostic value of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score for postoperative recurrence in endometrial cancer patients. A nomogram was developed based on clinicopathological parameters, HALP score, and immunohistochemical markers to predict recurrence-free survival (RFS) in patients with stage I–III endometrial cancer.MethodsThis retrospective study included 1,083 patients who underwent hysterectomy at the First Affiliated Hospital of Chongqing Medical University from January 2013 to January 2021. Independent risk factors for RFS were identified using univariate and multivariate Cox regression analyses, and a nomogram was established. External validation was performed with data from Zhujiang Hospital of Southern Medical University and Women and Children’s Hospital of Chongqing Medical University (n = 677).ResultsAmong the entire cohort, 241 cases (13.7%) of endometrial cancer experienced recurrence post-hysterectomy. The median RFS time was 47.0 (range: 6.0–91.0) months. Eleven independent prognostic factors were identified, including age, FIGO staging, histologic type, myometrial invasion, lymphovascular space invasion, Ca125, Ki-67 expression, ER expression, molecular classification, adjuvant therapy, and HALP score, and then a nomogram for predicting recurrence of endometrial cancer was established. The nomogram demonstrated improved predictive accuracy, categorizing patients into high- and low-risk groups. High-risk patients receiving adjuvant treatment had better outcomes than those who did not.ConclusionWe developed and validated a nomogram to predict recurrence in endometrial cancer patients. Integrating the HALP score can help clinicians identify high-risk patients and tailor personalized treatment strategies.

Risk grouping for treatment and follow-up strategy of early stage endometrial cancer is confusing to apply in clinical conditions. We investigated the stage-based prognostic factors for tumor recurrence in stage I endometrial cancer with endometrioid histology (EEC).The medical records of women diagnosed with endometrial adenocarcinoma between 1993 and 2013 were retrospectively reviewed. In 521 patients with International Federation of Gynecology and Obstetrics (FIGO) stage I EEC were included. The baseline patient characteristics were analyzed with the chi-square test and Fisher's exact tests. A multivariate analysis with a Cox proportional hazard model and logistic regression were performed to identify the prognostic factors for recurrence-free survival (RFS) in FIGO stage I EEC.The median follow-up period for the included patients was 74.6 months (3.1–264.9 months). Tumor recurrence occurred in 30 patients (5.8%) with a median time span of 22.85 months (2.2–124.7 months). Only 2 factors among the conventional adverse risk factors, including myometrial invasion and histologic grade, affected tumor recurrence in stage I EEC (P = .003 and P = .003, respectively). Myometrial invasion was an independent prognostic factor for RFS in stage IA EEC via multivariate analysis (P = .005). In stage IB EEC, the histologic grade was an independent prognostic factor for RFS. The median RFS of stage IB EEC was 156.0 months in grade 1, 120.0 months in grade 2, and 105.9 months in grade 3 (P = .006).Within stage I EEC, the prognostic factors for tumor recurrence were different between stages IA and IB. Myometrial invasion comprised the prognostic factor in stage IA, whereas the histologic grade comprised the prognostic factor in stage IB.

Background/Objectives: We comparatively evaluated the prognostic performance of the 2009 and 2023 International Federation of Gynecology and Obstetrics (FIGO) staging systems for early-stage endometrial cancer based on histological subtype stratification. Methods: A retrospective cohort of 472 patients with FIGO 2009 stage I-II between 2004 and 2019 was analyzed. Patients were restaged using both systems. Overall survival (OS) and recurrence-free survival (RFS) were determined according to histopathological aggressiveness. Kaplan-Meier survival analysis with log-rank testing compared the performance of the systems. Cox proportional hazards regression identified independent prognostic factors. A hypothetical modification of the FIGO 2023 system was evaluated for aggressive subtypes. Results: In all, 388 patients had nonaggressive histology, and 84 patients had aggressive histology. For cases of nonaggressive histology, FIGO 2023 demonstrated superior prognostic discrimination for OS and RFS (p < 0.05), whereas FIGO 2009 showed significant stratification for OS (p < 0.001) but not RFS (p = 0.149). For cases of aggressive histology, FIGO 2009 showed significant stratification for RFS (p = 0.017) but not OS (p = 0.31), whereas FIGO 2023 showed no significant stratification for either endpoint. The hypothetical modification of the FIGO 2023 staging system showed significantly improved discrimination for RFS (p = 0.019) but not OS. Multivariate analysis identified age and lymphovascular space invasion as independent prognostic factors in nonaggressive cancers, whereas cervical stromal involvement was significant in aggressive subtypes. Conclusions: The prognostic utility of the FIGO staging system is histology dependent. Although FIGO 2023 offers enhanced risk stratification for nonaggressive endometrial cancers, its discriminatory power for aggressive subtypes remains limited, indicating the need for histology-specific refinements of future staging frameworks.

Blood Vessel Invasion Is a Strong Predictor of Postoperative Recurrence in Endometrial Cancer.

ABSTRACTObjectiveTo evaluate the ability of demographic and sonographic variables and the Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE) classification to predict preoperatively tumor recurrence or progression in women with endometrial cancer.MethodsThe study included 339 women with histologically confirmed endometrial cancer who underwent expert transvaginal ultrasound in a single center before surgery as part of the prospective International Endometrial Tumor Analysis 4 study or who were evaluated using the same protocol. The tumors were classified according to histotype, FIGO (International Federation of Gynecology and Obstetrics) grade and FIGO stage. In addition, molecular analysis was performed for classification into the four ProMisE subtypes: polymerase‐ϵ exonuclease domain mutations (POLE EDM), mismatch repair proteins deficiency (MMR‐D), protein 53 wild type (p53 wt) and protein 53 abnormal (p53 abn). Demographic and preoperative sonographic characteristics, tumor recurrence or progression and survival were compared between the ProMisE subgroups. Cox regression analysis was used to identify prognostic factors associated with recurrence or progression, using univariable models to study crude associations and multivariable models to study adjusted associations. Logistic regression and receiver‐operating‐characteristics (ROC)‐curve analysis were used to assess the predictive ability of the preoperative prognostic factors regarding recurrence or progression of cancer within 3 years after surgery, and to compare their predictive ability to that of the European Society for Medical Oncology (ESMO) preoperative (based on depth of myometrial invasion, histotype and grade) and postoperative (based on histotype, grade, surgical stage and lymphovascular space invasion) risk classifications. In a separate subanalysis, cases were stratified according to ProMisE p53 abn status (present vs absent) and sonographic tumor size (anteroposterior (AP) diameter < 2 cm vs ≥ 2 cm).ResultsMedian follow‐up time from surgery was 58 months (interquartile range, 48–71 months; range, 0–102 months). Recurrence or progression of cancer occurred in 51/339 (15%) women, comprising 14% of those with MMR‐D, 8% of those with POLE EDM, 9% of those with p53 wt and 45% of those with p53 abn ProMisE subtype. On multivariable analysis, age, waist circumference, ProMisE subtype and tumor extension and AP diameter on ultrasound were associated with tumor recurrence or progression. A multivariable model comprising ProMisE subtype, age, waist circumference and sonographic tumor extension and size (area under the ROC curve (AUC), 0.89 (95% CI, 0.85–0.93)) had comparable ability to predict tumor recurrence/progression to that of a multivariable model comprising histotype, grade, age, waist circumference and sonographic tumor extension and size (AUC, 0.88 (95% CI, 0.83–0.92)), and better predictive ability than both the preoperative (AUC, 0.74 (95% CI, 0.67–0.82); P < 0.01) and postoperative (AUC, 0.79 (95% CI, 0.72–0.86); P < 0.01) ESMO risk classifications. Women with a combination of non‐p53 abn subtype and tumor size < 2 cm (164/339 (48%)) had a very low risk (1.8%) of tumor recurrence or progression.ConclusionsThe combination of demographic characteristics, sonographic findings and ProMisE subtype had better preoperative predictive ability for tumor recurrence or progression than did the ESMO classification, supporting their use in the preoperative risk stratification of women with endometrial cancer. The combination of p53 status with ultrasound tumor size has the potential to identify preoperatively a large group of women with a very low risk of recurrence or progression. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. ‐ Legal Statement: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Endometrial cancer usually has a good prognosis. The recurrence and survival in endometrial cancer are based on multiple prognostic factors like patient age, histological grade, myometrial invasion, and lymphovascular space invasion. We investigated various clinicopathological features determining tumor recurrence in stage I endometrial cancer with endometrioid histology. We retrospectively reviewed stage I endometrial cancer patients who underwent surgery at the Basavatarakam Indo American Cancer Hospital between 2010 and 2015. Patients who had tumor recurrence were documented. Various risk factors like size, grade, depth, lymphovascular involvement, etc., were studied, their relation with recurrence was noted, and statistical analysis was done. Twenty-three patients exhibited tumor recurrence in stage I EEC (13.3%). When considering the depth of myometrial invasion, the 5-year RFS of stage IA EEC is 90.4% in comparison with 66.6% when the depth of invasion is more than half of myometrial invasion. The 5-year RFS of the patients with stage I EEC is 100% in tumors with size less than 2 cms, 92.15% in tumor size 2–4 cms, and 70.45% when the tumor size is greater than 4 cms. The 5-year RFS of the patients is 94.7% in grade 1, 87.3% in grade 2, and 54.2% in grade 3. Depth of myometrial invasion, grade, and size of the primary tumor are shown to affect recurrence. LUS involvement, intracervical glandular involvement, and the lymphovascular space invasion did not affect recurrence in endometrioid endometrial cancer.

Tumor-related mutations in cell-free DNA in pre-operative plasma as a prognostic indicator of recurrence in endometrial cancer

ObjectivesWe investigated factors associated with cause-specific survival (CSS) after isolated lymphatic recurrence (ILR) in endometrial cancer (EC).MethodsWe identified patients who developed ILR among 4,216 EC patients surgically treated at the...