Abstract
We examined the usefulness of evaluating tumor size determined using preoperative magnetic resonance imaging (MRI) for prognosis in patients with endometrial carcinoma (EC). Patients (N = 184) with EC who underwent surgery at Shimane University Hospital between 1997 and 2013 were enrolled. We investigated the association between the tumor size of EC assessed prior to surgery by MRI (anteroposterior [AP], transverse [TV], and craniocaudal [CC] diameters) and various clinical parameters including deep myometrial invasion and lymph node metastases. We subsequently examined the prognostic significance of tumor size in patients with EC. Survival analysis was performed using the Kaplan-Meier method, and prognostic factors were evaluated using the Cox’s proportional hazards regression model.Multivariate analysis identified increased AP diameter as an independent negative prognostic factor for overall survival (OS) (P = 0.037). A long AP diameter has prognostic value and the potential to be a predictive marker for surgical outcomes in patients with EC. Furthermore, AP diameter exhibited the greatest area under the curve (AUC) (0.727) for deep myometrial invasion, and CC diameter had the greatest AUC for lymph node metastases (0.854). Evaluation of tumor size parameters may aid in the identification of high-risk populations, which could improve treatment selection and patient outcomes.
Highlights
Endometrial cancer (EC) is the most common gynecologic malignancy, with an annual incidence of 320,000 and a mortality rate of 76,000 deaths per year worldwide [1, 2]
Using the above threshold values for each tumor size measurement, receiver operating characteristic (ROC) curves indicating the effectiveness of the diameter measurements for predicting deep myometrial invasion (Figure 2A) and lymph node metastases (Figure 2B) demonstrated that the AP diameter had the greatest area under the curve (AUC) (0.727) for deep myometrial invasion, while the CC diameter had the greatest AUC for lymph node metastases (0.854). This is the first cohort study to demonstrate that tumor size is a robust indicator of prognosis in patients with EC
We showed that tumor size is significantly associated with deep myometrial invasion, and lymph node metastases
Summary
Endometrial cancer (EC) is the most common gynecologic malignancy, with an annual incidence of 320,000 and a mortality rate of 76,000 deaths per year worldwide [1, 2]. The International Federation of Gynecology and Obstetrics (FIGO) staging system is used by clinicians for prognostication and to guide surgical management. Patients with the same disease stage may experience very different clinical courses [1, 3]. To understand the reasons for these differences, many investigators have evaluated the influence of various tumor attributes, such as histological subtype and FIGO stage, grade, depth of myometrial invasion, and vascular invasion on prognosis [3,4,5]. Detection and improvements in surgical techniques and chemotherapies have contributed to better prognoses. Precise predictions of prognosis remain a challenge despite being necessary for guiding clinical decision-making regarding optimal treatment
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