Abstract
ObjectivesTo evaluate the role of the apparent diffusion coefficient (ADC) value in the individualized management of stage I endometrial carcinoma (EC).MethodsA retrospective analysis was performed on 180 patients with stage I EC who underwent 1.5-T magnetic resonance imaging. The mean ADC (mADC), minimum ADC (minADC), and maximum ADC (maxADC) values of each group were measured and compared. We analyzed the relationship between ADC values and stage I EC prognosis by Kaplan-Meier method and Cox proportional hazards analysis.ResultsPatients with lower ADC values were more likely to be characterized by higher grades, specific histological subtypes and deeper myometrial invasion. The mADC, minADC and maxADC values (×10-3 mm2/s) were 1.045, 0.809 and 1.339, respectively, in grade 1/2 endometrioid carcinoma with superficial myometrial invasion, which significantly differed from those in grade 3 or nonendometrioid carcinoma or with deep myometrial invasion (0.929, 0.714 and 1.215) (P=<0.001, <0.001 and <0.001). ADC values could be used to predict these clinicopathological factors. Furthermore, the group with higher ADC values showed better disease-free survival and overall survival.ConclusionsThe present study indicated that ADC values were associated with the high-risk factors for stage I EC and to assess whether fertility-sparing, ovarian preservation or omission of lymphadenectomy represent viable treatment options. Moreover, this information may be applied to predict prognosis. Thus, ADC values could contribute to managing individualized therapeutic schedules to improve quality of life.
Highlights
Endometrial carcinoma (EC) is one of the most common malignant tumors of the female genital tract
Some studies have suggested that conservative treatment, such as continuous progestin-based therapy, is an alternative for patients with G1 endometrioid carcinoma confined to the endometrium [8–12]
Some studies demonstrated that ovarian preservation was an option for some premenopausal patients, such as patients with stage I endometrioid carcinoma, which was not associated with increased cancer-related mortality and could avoid the risk for long-term sequelae of estrogen deprivation [13–16]
Summary
Endometrial carcinoma (EC) is one of the most common malignant tumors of the female genital tract. Some studies have suggested that conservative treatment, such as continuous progestin-based therapy, is an alternative for patients with G1 endometrioid carcinoma confined to the endometrium [8–12]. Some studies demonstrated that ovarian preservation was an option for some premenopausal patients, such as patients with stage I endometrioid carcinoma, which was not associated with increased cancer-related mortality and could avoid the risk for long-term sequelae of estrogen deprivation [13–16]. An increasing number of studies have indicated that lymphadenectomy does not improve the outcome of EC patients; instead, it increases perioperative morbidities and complications, such as lymphedema, lymph cysts, pelvic nerve injury and deep venous thrombosis, resulting in a decrease in quality of life [6, 17, 18]. It is important to accurately assess the high-risk factors (such as nonendometrioid, G3, and deep myometrial invasion) of patients with stage I EC before treatment, and formulate an individualized therapeutic schedule
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