Endometrioid-type Endometrial Cancer Research Articles

Abstract PR004: CD73 is a novel repressor of mutant β-catenin oncogenic activity in endometrial cancer

Abstract β-catenin is an important oncogene commonly (20-30%) activated by somatic missense exon 3 CTNNB1 mutations in low grade, early stage endometrioid-type endometrial cancer (EEC). Although exon 3 CTNNB1 mutation is associated with increased risk of recurrence in many (~50%) patients with low grade, early-stage EEC, an equal number of patients with β-catenin mutant tumors will not recur. It remains unclear why patient outcomes are so variable. The variability suggests there are unknown determinants of β-catenin mutant tumor aggressiveness. The purpose of this study was to evaluate CD73, a cell surface 5’-nucleotidase, as a critical factor controlling mutant β-catenin oncogenic activity in EEC. We previously identified CD73 downregulation in exon 3 CTNNB1 mutant EEC predicts recurrence and reported, using a highly homologous Xenopus exon 3 β-catenin mutant, that CD73 restrains mutant β-catenin to the membrane. For this study, we interrogated patient-relevant exon 3 CTNNB1 mutation frequencies in 5 publicly available databases and developed 7 (D32N, S33F, S33Y, G34R, S37C, S37F, and S45F) myc-tagged β-catenin mutant lentiviral vectors for expression in HEC-1-A and Ishikawa cells in which we applied CRISPR-Cas9 deletion or the re-expression of CD73. Reporter assays showed all patient-relevant β-catenin mutants at baseline induce transcriptional activity compared to endogenous levels. With CD73 loss, transcriptional activity for all mutants increased significantly in HEC-1-A cells (normally CD73+/+). With re-expression of CD73 in Ishikawa cells (normally CD73−/−), transcriptional activity of several but not all β-catenin mutants decreased, which provides evidence for the first time that β-catenin mutants are differentially controlled in endometrial cancer. Cell viability assays also demonstrated mutant-specific control by CD73. Using RNA-seq data from TCGA, we assessed whether β-catenin mutants in EECs lacking CD73 exhibited unique tumorigenic transcriptomes. Contrary to current paradigms for exon 3 mutant β-catenin, a dependency on expression of canonical Wnt/β-catenin gene targets was not observed in CD73-deficient β-catenin mutant tumors. In contrast, unique gene signatures (e.g., neuron biology and alcohol metabolic process) that have not previously been linked to β-catenin mutant EEC were identified. Specifically, loss of NAAA and SRD5A3 (encoding N-acylethanolamine-hydrolyzing acid amidase and steroid 5-alpha reductase 3, respectively) were found in β-catenin mutant CD73 low EECs. Loss of these genes are associated with poor outcomes in EEC. Ongoing computational studies of pooled EEC datasets are assessing the unique transcriptomes of individual patient-specific β-catenin mutants in the context of CD73 loss. Our results describe CD73 as a novel determinant controlling mutant β-catenin in EEC. Furthermore, we provide mechanistic rationale to explain the variability in outcomes in endometrial cancer patients with exon 3 β-catenin mutant tumors. Citation Format: Rebecca M. Hirsch, Xingyuan Zhang, Lilly F. Chiou, Sunthoshini Premsankar, Hannah N. Lee, Katherine C. Kurnit, Russell R. Broaddus, Cyrus Vaziri, Jessica L. Bowser. CD73 is a novel repressor of mutant β-catenin oncogenic activity in endometrial cancer [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr PR004.

Minimally invasive approach is preferred for clinical stage 1 endometrioid-type endometrial cancer.

Minimally invasive approach is preferred for clinical stage 1 endometrioid-type endometrial cancer.

Increasing incidence of endometrial cancer in Aotearoa New Zealand: Health professionals' perspective.

The incidence of endometrial cancer is globally increasing. Aotearoa New Zealand is no exception with a 59% increase in cases over that last ten years. We report a sub-set of themes which pertain to provider reflections of rising endometrioid-type endometrial cancer incidence in individuals with high weight. Fifteen semi-structured interviews with healthcare professionals experienced in providing care to women with endometrial cancer were audio-recorded and transcribed. Interviews were analysed using reflexive thematic analysis. Two main themes emerged: (1) concerns for the future; and (2) impact on fertility and treatment options. Healthcare professionals discussed rising incidence in younger people and a need for increased awareness about the association of excess weight as a risk factor for developing the disease. The concern extended to workforce and equipment shortfalls of meeting the needs of individuals with higher weight, which subsequently influenced treatment options, health outcomes and survivorship. Rising incidence of endometrial cancer in individuals with high weight presents multiple chances for inequitable access and health outcomes over the care continuum for endometrial cancer. Action is required to address incidence, awareness, access to equitable and inclusive treatment, and survivorship.

Comparison of frozen section accuracy with final pathology results in early clinical stage of endometrioid type endometrial cancer

Objectives: We aimed to compare the accuracy of the depth of myometrial invasion determined by intraoperative frozen section in the early clinical stage of endometrioid type endometrial cancer, with the result of the final postoperative paraffin section. Methods: The study was carried out with 102 patients who were diagnosed with type 1-2 endometrioid endometrial cancer in the gynecology clinic of the state hospital between January 2015 and 2019. Retrospective demographic data, clinical characteristics, and pathology results of the patients who underwent surgical staging were recorded. Results: The mean age of the patients was 59.3 ± 9.1 years and 82.3% of the patients were in the postmenopausal period. The mean age of patients with a depth of myometrial invasion<1/2 was lower than myometrial invasion>1/2, which was statistically significant (p < 0.001). According to the final postoperative pathology results, 93.1% (n = 95) of the cases were diagnosed as FIGO stage 1. The subgroups were 66.7% stage 1a and 26.4% stage 1b. When the stage and grade distribution was made according to the final postoperative pathology result, stage 1a grade 2 endometrial cancer was the most common with a rate of 43.1%. Concordance of the intraoperative and postoperative pathology results for the depth of myometrial invasion was 84.3%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 86.76%. Conclusions: The accuracy of the intraoperative frozen section in endometrial cancers is quite higher. For this reason, intraoperative pathological examination results are important in terms of minimizing the complications of unnecessary surgery.

Prognostic Importance of Lymph-Vascular Space Involvement in Stage I Endometrioid Type Endometrial Cancer

Prognostic Importance of Lymph-Vascular Space Involvement in Stage I Endometrioid Type Endometrial Cancer

Pretreatment carcinoembryonic antigen combined with cancer antigen-125 for predicting lymph node metastasis in endometrial carcinoma: a retrospective cohort study.

To investigate whether the cost-effective, pretreatment tumor markers carcinoembryonic antigen (CEA) and carbohydrate antigen-125 (CA-125) can be used to predict lymph node metastasis (LNM) in endometrioid-type endometrial cancer (EC) and to develop a predictive model. This was a single-center retrospective study of patients with endometrioid-type EC who underwent complete staging surgery between January 2015 and June 2022. We identified the optimal cut-off values of CEA and CA-125 for predicting LNM using receiver operating characteristic (ROC) curves. Stepwise multivariate logistic regression analysis was used to identify independent predictors. A nomogram for predicting LNM was constructed and validated by bootstrap resampling. The optimal cut-off values of CEA and CA-125 were 1.4ng/mL (area under the ROC curve (AUC) 0.62) and 40 U/mL (AUC 0.75), respectively. Multivariate analysis showed that CEA (odds ratio (OR) 1.94; 95% confidence interval (CI) 1.01-3.74) and CA-125 (OR 8.75; 95% CI 4.42-17.31) were independent predictors of LNM. Our nomogram showed adequate discrimination with a concordance index of 0.78. Calibration curves for the probability of LNM showed optimal agreement between the predicted and actual probabilities. The risk of LNM for markers below the cut-offs was 3.6%. The negative predictive value and negative likelihood ratio were 96.6% and 0.26, respectively, with moderate ability to rule out the possibility of LNM. We report a cost-effective method of using pretreatment CEA and CA-125 levels to identify patients with endometrioid-type EC who are at a low risk for LNM, which may guide decision-making regarding aborting lymphadenectomy.

Erken Evre Grade 1 ve 2 Endometrioid Tip Endometrium Kanseri Tanılı Olgularda Uzun Dönem Sonuçları

Aims: Early-stage endometrioid-type endometrial cancer (EC) has a favorable prognosis. The recurrence is still the biggest issue. There are differences in the literature in terms of treatment modalities in early-stage. We investigated long-term survival outcomes of early-stage grade 1 and 2 endometrioid-type EC patients. Methods: Out of 327 cases, 294 cases in stage 1 and 33 cases in stage 2 were evaluated. Age, stage, tumor size, histologic grade, degree of myometrial invasion, presence of lymphovascular invasion (LVSI), peritoneal cytology positive, presence of recurrence, overall survival (OS), and disease-free survival (DFS) between two groups were evaluated statistically. Results: The mean age of 327 patients was 64.0±10.0 years. Out of 327, 65.7% were ≥60 years, 90% were stage 1, 74.6% were grade 1, 1.8% had positive peritoneal cytology, 8.3% had LVSI and 86% had ≤50% myometrial invasion. Recurrence was detected in 6.4% of patients. 40.7% of patients received adjuvant radiotherapy. Only the adjuvant radiotherapy was found a significant association between two groups. Only presence of recurrence in terms of OS and DFS durations was a significant parameter in the regression analysis. Conclusions: Development of recurrence in early-stage endometrioid-type EC is the main prognostic predictor for survival. The early diagnosis and treatment of recurrence have a positive impact on the prognosis.

Effect of mucinous differentiation in endometrioid type endometrial cancers on prognosis.

To evaluate the influence of mucinous differentiation in endometrioid endometrial cancer regarding spread and prognosis. Endometrioid endometrial cancer cases between 2015 and 2020 were collected retrospectively and divided into two groups according to the cytoplasmic mucin including. Prognostic factors and cancer spread related parameters were evaluated. A total of 219 patients were enrolled in this study. One hundred twenty-two (55.7%) were endometrioid and 97 (44.3%) were in the mucinous differentiated endometrioid catagory. Age was similar between the groups (59.3 vs 58.7, p = 0.62), however, grade 3 lesions were more frequent in endometrioid type endometrial cancer (8.7% vs 1.4%, p < 0.01). Poor prognostic factors including myometrial invasion, lymphovascular space invasion (LVSI), lymph node metastases, peritoneal cytology, endocervical involvement, and stage were not significantly different between groups (p = 0.23, p = 0.49, p = 0.40, p = 0.15, p = 0.17, p = 0.55). The median overall survival time of endometrioid and mucinous differentiated endometrioid type endometrial cancer patients was determined 88.5 and 96.8 months, respectively (p = 0.46). Mucinous differentiation in the endometrioid type of endometrial cancer does not seem to affect the prognosis in endometrioid endometrial cancer patients.

Is Substantial Lymphovascular Space Invasion Prognostic in Patients With Pathologically Lymph Node-Negative Endometrial Cancer?

Lymphovascular space invasion (LVSI) predicts for higher rates of recurrence and increased mortality in endometrial cancer. Using three-tier LVSI scoring, a PORTEC 1&2 trials analysis demonstrated that substantial LVSI was associated with worse locoregional (LR-DFS) and distant metastasis disease free survival (DM-DFS), and these patients possibly benefited from external beam radiation therapy (EBRT). Furthermore, LVSI is a predictor for lymph node (LN) involvement, but the significance of substantial LVSI is unknown in patients with a pathologically negative LN assessment. We aimed to evaluate clinical outcomes of these patients in relation to the three-tier LVSI scoring system. We performed a single-institutional retrospective review of patients with stage I endometrioid-type endometrial cancer who underwent surgical staging with pathologically negative LN evaluation from 2017 - 2019 with three-tier LVSI scoring (none, focal or substantial). Clinical outcomes (LR-DFS, DM-DFS, and overall survival [OS]) were analyzed using Kaplan-Meier method. A total of 335 patients with pathologically LN negative stage 1 endometrioid-type endometrial carcinoma were identified. Substantial LVSI was present in 17.6% of patients. 39.7% of patients received adjuvant vaginal brachytherapy, and 6.9% of patients received EBRT. Adjuvant radiation treatment varied by LVSI status. In patient with focal LVSI, 81.0% received vaginal brachytherapy. Among patients with substantial LVSI, 57.9% received vaginal brachytherapy alone, and 31.6% of patients received EBRT. The 2-year LR-DFS rates were 92.5%, 98.0%, and 91.4% for no LVSI, focal LVSI, and substantial LVSI, respectively. The 2-year DM-DFS rates were 95.5%, 93.3%, and 93.8% for no LVSI, focal LVSI, and substantial LVSI, respectively. In our institutional study, patients with pathologically LN negative stage I endometrial cancer with substantial LVSI had similar rates of LR-DFS and DM-DFS compared to patients with none/focal LVSI. These findings highlight the need for multi-institutional studies to validate the prognostic value of substantial LVSI in this patient population.

Evaluation of risk factors for pelvic and paraaortic lymph node metastasis in endometrioid type endometrial cancer

Aim:&#x0D; Determining the relationship between clinical and pathological features in endometrial cancer is essential for both prognostic and potential therapeutic benefits. In this study, we aimed to investigate the relationship between pelvic and paraaortic lymph node (PLN and PALN) metastasis and prognostic factors in patients with endometrial cancer (EC).&#x0D; Materials and Method:&#x0D; Medical records of patients who underwent primary surgery for EC in our gynecological oncology center between the 2016 and 2018 were reviewed retrospectively. The relationship between pelvic and paraaortic lymph node metastasis was evaluated with data such as patient age, body mass index, serum CA 125 level, macroscopic tumor diameter, and patients’ risk groups.&#x0D; Results:&#x0D; Fifty-seven patients with EC were evaluated. Lymph node involvement was detected in 10 patients (17.5%). Acording to Modiffied Mayo criterias ; the patients with grade 3 EC had a higher risk of metastasis compared to other grades (p=0.025). Patients with lymph node metastases had a greater depth of invasion (p=0.001). There was no relationship between tumor size and lymph node metastasis (p=0.494). In the logistic regression analysis, the depth of invasion was found to be an independent risk factor for lymph node metastasis. There was no significant relationship between the presence of PLN and PALN metastases in patients with high-risk endometrial cancer, but the presence of PALN metastasis was significant in patients with low-risk endometrial cancer with PLN metastasis (p=0.002).&#x0D; Conclusion:&#x0D; These findings support the idea that routine evaluation of tumor invasion depth during endometrial cancer surgery may be useful in predicting lymph node metastasis and guiding the operation.

Analysis of vanishing endometrial cancer by pathological types.

We asked why endometrial cancer sometimes vanishes. A total of 454 patients diagnosed with endometrioid-type endometrial cancer (EC) (via endometrial sampling) and treated in our clinic over the past 5 years were enrolled. The patients were divided into two groups: vanishing and residual, depending on whether a tumor was detected in the postoperative hysterectomy specimen. Patient age, numbers of pregnancies and deliveries, menopausal status, systemic disease status, hemogram parameters, International Federation of Gynecology and Obstetrics (FIGO) grade, and invasion status (evident on magnetic resonance imaging [MRI]) were compared between the groups. ECs vanished in 42 (9.25%) patients. The vanishing rates were 19.7% (37/187) in FIGO grade 1 patients, 2.1% (5/238) in grade 2 patients, and 0% (0/29) in grade 3 patients. The average age was lower in the vanishing than the residual group, but the premenopausal status and grade 1 tumor rates were higher (both p < 0.001). An absence of invasion (as revealed by MRI) was more common in the vanishing group (p < 0.001). No recurrence developed in the vanishing group, but recurrences were noted in 3.3% (14/412) of the residual group. There were no significant between-group differences in any of the numbers of pregnancies or births, systemic disease status, or hemogram parameters (all p > 0.05). Vanishing EC is more likely in premenopausal women with endometrioid grade 1 EC (as revealed by endometrial biopsy) who lack myometrial invasion on MRI.

Quantitative Measurement of Progesterone Receptor Immunohistochemical Expression to Predict Lymph Node Metastasis in Endometrial Cancer.

Background: Previous studies have shown that loss of progesterone receptor (PR) in endometrial cancer (EC) is associated with poor outcomes. Evaluating lymph node metastasis (LNM) is essential, especially before surgical staging. The aim of this study was to investigate the role of PR expression and other clinicopathological parameters in LNM and to develop a prediction model. Methods: We retrospectively evaluated endometrioid-type EC patients treated with staging surgery between January 2015 and March 2020. We analyzed PR status using immunohistochemical staining, and the expression was quantified using the H-score. We identified optimal cut-off values of H-score and CA125 for predicting LNM using receiver operating characteristic curves, and used stepwise multivariate logistic regression analysis to identify independent predictors. A nomogram for predicting LNM was constructed and validated using bootstrap resampling. Results: Of the 310 patients evaluated, the optimal cut-off values of PR H-score and CA125 were 162.5 (AUC 0.670, p = 0.001) and 40 U/mL (AUC 0.739, p < 0.001), respectively. Multivariate analysis showed that CA125 ≥ 40 U/mL (OR: 8.03; 95% CI: 3.44–18.77), PR H-score < 162.5 (OR: 5.22; 95% CI: 1.87–14.60), and tumor grade 2/3 (OR: 3.25; 95% CI: 1.33–7.91) were independent predictors. These three variables were incorporated into a nomogram, which showed effective discrimination with a concordance index of 0.829. Calibration curves for the probability of LNM showed optimal agreement between the probability as predicted by the nomogram and the actual probability. Our model gave a negative predictive value and a negative likelihood ratio of 98.4% and 0.14, respectively. Conclusions: PR H-score along with tumor grade and CA125 are helpful to predict LNM. In addition, our nomogram can aid in decision making with regard to lymphadenectomy in endometrioid-type EC.

Effect of coexisting adenomyosis on patients with endometrioid adenocarcinoma: Determination of intraoperative risk factors for tumor metastasis and estimation of prognosis

We sought to clarify the impact of adenomyosis on the clinical and pathological prognosis of endometrial cancer to aid the selection of appropriate surgical intervention based on the diagnosis of adenomyosis. Our study aimed to report the frequency of adenomyosis in patients with endometrioid cancer and correlate its incidence rate with the survival and prognostic factors. This retrospective study included 357 patients. Patients with endometrioid adenocarcinoma were divided into two groups based on the presence of adenomyosis. The groups were compared in terms of tumor diameter, lymphovascular space invasion (LVSI), low-high risk pathologic status, stage of the disease, and survival outcome. Continuous variables were analyzed using the Student's t or Mann-Whitney U-test. Survival data were analyzed using the Kaplan-Meier test. The average age was similar between the two groups. In total, 47 (13.2%) of 357 patients had adenomyosis. A total of 43 (91.4%) cases with adenomyosis and 258 (83.2%) cases without adenomyosis had Stage I endometrioid adenocarcinoma (n = 301, 84.3%). Moreover, 32 (68.1%) cases with adenomyosis and 187 (60.3%) cases without adenomyosis were in the low-risk group. There was no statistically significant correlation between the risk groups (P = 0.309) and overall survival between the two groups (P = 0.416). No correlation was seen between the characteristics of endometrioid type endometrial cancer and survival rates in patients with or without adenomyosis. The impact of adenomyosis as a factor in evaluating the perioperative prognosis and planning postoperative adjuvant therapy for endometrial cancer should be assessed by further studies.

Features of recurrence of endometrioid type endometrial cancer of I stage.

The study included 968patients with stage I endometrioid EC, who underwent surgical treatment in the Department of Oncogynecology of the National Cancer Institute in 2015-2019. Surveillance of patients lasted from January 2015to December 2020, with a minimum follow-up period of 1year from the date of surgery. Adjuvant radiation or chemotherapy was performed depending on the clinical and pathological characteristics of the EC case. During the follow-up period, recurrences were observed in7.0% of cases and were most often found in stage IC of low differentiation grade. It was found that during surgical treatment without adjuvant therapy relapses occurred in 12-36months after the start of treatment, with adjuvant radiation therapy- in 6-18months, and with adjuvant chemotherapy- in 32-60months. Recurrences most often occurred in patients with EC who underwent surgical treatment in combination with chemotherapy (p < 0.05). The lowest number of recurrences was recorded among patients who underwent surgery as an only treatment. The best 5-year survival rate was observed in the group of patients with surgical treatment (93%), and the worst- in the patients treated with combination of surgery and chemotherapy (57%). In patients without recurrences, thesurvival rate after treatment was 97%, while in patients diagnosed with relapses, the survival rate was 65%. Despite the predominantly favorable course of EC stage I, some patients develop relapses. The rate and localization of recurrences depend on the histological structure of the tumor and treatment regimens of the EC patients.

Prognostic factors determining survival after extrapelvic recurrence in endometrioid type endometrial cancer

ObjectiveTo define the factors that determine survival after extrapelvic recurrence in patients with endometrioid type endometrial cancer (EC).objective Materials and methodsClinicopathological and survival data of surgically treated endometrioid type EC patients who recurred outside pelvis were reviewed. Patients who had non-endometrioid tumor, sarcomatous component in the final pathology and synchronous tumor were excluded. The period from surgery to recurrence was defined as time to recurrence (TTR) and the period from recurrence to death or last visit was defined as post-recurrence survival (PRS). ResultsSixty-six patients with extrapelvic recurrence were included in the study. No residual disease was achieved in all patients at initial surgery. Median TTR was 18 months (range, 2–84). Recurrence developed within 1 year in 24 (36.4%) patients and between 13 and 24 months in 22 (33.3%) patients. Fifty-three of 66 patients (80.3%) had extraabdominal recurrence. The 2-year PRS of the all cohort with extrapelvic recurrence was 56%. In the univariate analysis, advanced FIGO stage, lymph node metastasis, adnexal metastasis and short TTR were associated with diminished PRS (p < 0.05). The salvage chemotherapy for recurrence had a tendency to be associated with improved PRS in the univariate analysis. Two-year survival was 81% and 37% in the patients who received chemotherapy and radiotherapy, respectively (p = 0.057). ConclusionAlmost half of the patients with extrapelvic recurrence died of disease within 2 years. Chemotherapy seemed to be more effective than radiotherapy as the salvage therapy of extrapelvic recurrences.

Prophylactic ligation of uterine arteries at its origin in laparoscopic surgical staging for endometrial cancer.

The aim of this study was to compare the surgical outcomes between patients who were staged laparoscopically for early-stage endometrioid-type endometrial cancer (EC) between those who underwent prophylactic ligation of uterine arteries (UAs) prior to pelvic lymphadenectomy and the patients who were operated with standard procedure. This retrospective study was conducted in women diagnosed with early-stage and low/intermediate-risk endometrioid-type EC. The control group included patients who underwent standard laparoscopic pelvic lymphadenectomy and the study group concerned patients who underwent prophylactic ligation of UA prior to pelvic lymphadenectomy. The prophylactic ligation of UA procedure was performed at a point just proximal to its origin. The mean lymph node count dissected in the study group was higher in terms of statistical significance (17.5 ± 2.2 vs. 19.8 ± 3.6, p=0.003 and p˂0.05). The rate of the patients who had a positive pelvic lymph node detected did not differ between groups (7.4% vs. 16.7%, p=0.258 and p˂0.05). The operation time (OT) of the patients in the study group did not differ between groups (p=0.546 and p˂0.05). Hemoglobin drop (-0.5 ± 0.7) and hematocrite drop (-0.8 ± 0.9) values in the study group were found to be lower in the study group (p=0.000, p=0.000, and p˂0.05). Performing prophylactic ligation of UA at its origin prevents unwanted bleeding and facilitates the laparoscopic pelvic lymphadenectomy procedure.

Tumor diameter as a predictor of lymph node involvement in endometrioid type endometrial adenocarcinomas.

To analyze the risk factors of lymph node involvement in pure endometrioid type endometrial cancer and assess factors that necessitate lymphadenectomy. Patients who had been operated on due to endometrial cancer and whose final pathology was reported as pure endometrioid carcinoma between January 2014 and January 2020 were assessed. Hysterectomy, bilateral salpingo-oophorectomy, and systematic lymphadenectomy were performed in all patients. All specimens were reported by expert gynecopathologists. The lymph node positivity rate was 14.4%. When the study population was classified according to the Mayo risk criteria; lymph node involvement in the low-risk and high-risk groups was 9.1% and 14.8%, respectively and there was no statistically difference (p > 0.05). The median of tumor size and the rate of deep myometrial invasion, lymphovascular space invasion, adnexal involvement, FIGO grade 3 tumor were found significantly higher in the positive lymph node group in univariate analysis. In the receiver operating characteristic curve analysis, the cut-off value of the tumor diameter was determined as 47.5 mm (sensitivity 85%, specificity 62%). Every 10 mm increase in tumor diameter increased the risk of lymph node involvement 10 times. This study defined that the tumor diameter is an independent predictor for lymphatic dissemination. In the future, it could be shown that even with new modeling based on tumor diameter, lymphadenectomy or adjuvant radiotherapy requirements would be reevaluated.

The prognostic value of squamous differentiation in endometrioid type endometrial cancer: a matched analysis

We aimed to examine the effect of the squamous differentiation on survival outcomes of women with endometrioid adenocarcinoma. We retrospectively reviewed the patients with endometrioid adenocarcinoma who underwent primary surgical treatment in a tertiary referral hospital. Sixty-nine patients having squamous differentiation constituted the case group. Each woman in the case group was matched with two patients in the control group based on age, disease stage, tumour grade, lymphovascular space invasion, tumour size, myometrial invasion, type of surgery and adjuvant therapy. During the follow-up, the recurrence rates were similar between the case (5/69, 7.2%) and control (10/138, 7.2%) groups (p = 1.0). The 5-year disease-free survival rate was 90.2% for the case group and 88.6% for the control group (p = .51). The 5-year overall survival rate was 94.6% for the case group and 91.8% for the control group (p = .12). Squamous differentiation seems to have no impact on the prognosis of patients with endometrioid adenocarcinoma. IMPACT STATEMENT What is already known on this subject? A focus of squamous differentiation is recognised in 12.8–25% of women with endometrioid adenocarcinoma. The prognostic value of the squamous differentiation was evaluated in several previous studies. However, it could not be clarified due to the conflicting results of these studies. What do the results of this study add? The probable confounding effects of well-known prognostic factors including age at diagnosis, International Federation of Gynaecology and Obstetrics stage, tumour grade, lymphovascular space invasion, tumour size, myometrial invasion, type of surgery and adjuvant therapy were eliminated with the case-control study design in the current study. Our findings indicate that the presence of squamous differentiation does not have any prognostic effect in endometrioid type endometrial cancer. What are the implications of these findings for clinical practice and/or further research? The molecular prognosticators of endometrial cancer were extensively studied in recent years. It is likely that clinicopathological and molecular prognostic factors will be integrated for predicting prognosis as a part of routine clinical practice soon. In this context, the prognostic value of the squamous differentiation in endometrioid adenocarcinomas may further be clarified by larger and multicentric studies that utilise central pathology review.

Trends over time in the incidence and use of hormonal therapy in endometrial cancer: a population-based study in the Netherlands

IntroductionAccording to current guidelines, hormonal therapy may be applied in endometrioid type endometrial cancer as an alternative to surgery for fertility preservation and in medically unfit patients. Since it is...

Risk factors for cervical stromal involvement in endometrioid-type endometrial cancer.

The aim of this study was to identify predictors of cervical stromal involvement in women with endometrioid-type endometrial cancer (EEC). A total of 795 patients with EEC who underwent comprehensive surgical staging including pelvic and para-aortic lymph node dissection between January 2007 and December 2018 were retrospectively analyzed. Data including age, menopausal status, serum CA-125 levels, tumor size, lymphovascular space invasion (LVSI), depth of myometrial invasion, positive peritoneal cytology, cervical stromal involvement, histologic grade, recurrence, and follow-up duration were recorded. Median follow up was 49months. Cervical stromal invasion was found in 88 patients. Multivariate analysis revealed that presence of LVSI (hazard ratio [HR] 2, 95% confidence interval [CI] 1.02-4.25, P=0.045), a primary tumor diameter of at least 3cm (HR 3, 95% CI 1.31-7.25, P=0.010), and at least 50% deep myometrial invasion (HR 2.7, 95% CI 1.37-5.41, P=0.004) were independent risk factors for cervical stromal involvement in patients with EEC. Our study results suggest that presence of LVSI, a primary tumor diameter of at least 3cm, and LVSI of at least 50% seem to be independent predictors of cervical involvement in women with EEC.