Low-risk Endometrial Cancer Patients Research Articles

Is it safe to operate selected low-risk endometrial cancer patients in secondary hospitals?

IntroductionThe aim of this study was to assess the accuracy of a preoperative screening algorithm in identifying low-risk endometrial cancer (EC) patients to ensure optimal care. MethodsA total of 277 patients with primary EC confirmed through biopsy underwent magnetic resonance imaging (MRI). Patients with risk factors for advanced high-risk EC, such as non-endometrioid histology, high-grade differentiation status, deep myometrial invasion, or spread beyond the uterine corpus, were systematically excluded. The remaining preoperatively screened patients with stage IA low-grade endometrioid EC (EEC) (n = 93) underwent surgery in a tertiary hospital. The accuracy of the preoperative diagnosis was evaluated by comparing the findings with the postoperative histopathological results. Disease-free survival (DFS) and overall survival (OS) were analyzed using 8-year follow-up data. ResultsPostoperative histopathological analysis revealed that all patients had grade 1–2 EEC localized to the corpus uteri. Only three patients had deep myometrial invasion (stage IB), but they remained disease-free after 6–9 years of follow-up. The median follow-up time for all patients was 8.7 years. The DFS was 7.6 years, and the OS was 8.6 years. Two patients with stage IA grade 1 EEC experienced relapse and, despite treatment, died of EC. No other EC-related deaths occurred. ConclusionsThe screening algorithm accurately identified low-risk EC patients without compromising survival. Therefore, the algorithm appears to be feasible for selecting patients for surgery in secondary hospitals.

Where Morphological and Molecular Classifications Meet: The Role of p53 Immunohistochemistry in the Prognosis of Low-Risk Endometrial Carcinoma (GLAMOUR Study).

No prospective study has validated molecular classification to guide adjuvant treatment in endometrial cancer (EC), and not even retrospective data are present for patients with morphological low-risk EC. We conducted a retrospective, multicenter, observational study including 370 patients with low-risk endometrioid EC to evaluate the incidence and prognostic role of p53 abnormal expression (p53abn) in this specific subgroup. Among 370 patients, 18 had abnormal expressions of p53 (4.9%). In 13 out of 370 patients (3.6%), recurrences were observed and two were p53abn. When adjusting for median follow-up time, the odds ratio (OR) for recurrence among those with p53abn versus p53 wild type (p53wt) was 5.23-CI 95% 0.98-27.95, p = 0.053. The most common site of recurrence was the vaginal cuff (46.2%). One recurrence occurred within the first year of follow-up, and the patient exhibited p53abn. Both 1-year and 2-year DFS rates were 94.4% and 100% in the p53abn and p53wt groups, respectively. One patient died from the disease and comprised p53wt. No difference in OS was registered between the two groups; the median OS was 21.9 months (16.4-30.1). Larger multicenter studies are needed to tailor the treatment of low-risk EC patients with p53abn. Performing molecular classification on all EC patients might be cost-effective, and despite the limits of our relatively small sample, p53abn patients seem to be at greater risk of recurrence, especially locally and after two years since diagnosis.

Prediction of final pathology depending on preoperative myometrial invasion and grade assessment in low-risk endometrial cancer patients: A Korean Gynecologic Oncology Group ancillary study.

Fertility-sparing treatment (FST) might be considered an option for reproductive patients with low-risk endometrial cancer (EC). On the other hand, the matching rates between preoperative assessment and postoperative pathology in low-risk EC patients are not high enough. We aimed to predict the postoperative pathology depending on preoperative myometrial invasion (MI) and grade in low-risk EC patients to help extend the current criteria for FST. This ancillary study (KGOG 2015S) of Korean Gynecologic Oncology Group 2015, a prospective, multicenter study included patients with no MI or MI <1/2 on preoperative MRI and endometrioid adenocarcinoma and grade 1 or 2 on endometrial biopsy. Among the eligible patients, Groups 1-4 were defined with no MI and grade 1, no MI and grade 2, MI <1/2 and grade 1, and MI <1/2 and grade 2, respectively. New prediction models using machine learning were developed. Among 251 eligible patients, Groups 1-4 included 106, 41, 74, and 30 patients, respectively. The new prediction models showed superior prediction values to those from conventional analysis. In the new prediction models, the best NPV, sensitivity, and AUC of preoperative each group to predict postoperative each group were as follows: 87.2%, 71.6%, and 0.732 (Group 1); 97.6%, 78.6%, and 0.656 (Group 2); 71.3%, 78.6% and 0.588 (Group 3); 91.8%, 64.9%, and 0.676% (Group 4). In low-risk EC patients, the prediction of postoperative pathology was ineffective, but the new prediction models provided a better prediction.

Practice guidelines for management of uterine corpus cancer in Korea: a Korean Society of Gynecologic Oncology consensus statement.

The Korean Society of Gynecologic Oncology (KSGO) had been making an effort to standardize and enhance the quality of domestic uterine corpus cancer treatment by developing updated clinical practice guidelines in 2021. The KSGO revised the guidelines based on a literature search using 4 key elements: Population, Intervention, Comparison, and Outcome framework. These elements include the evaluation of the efficacy and safety of immune checkpoint inhibitor treatment in recurrent/advanced endometrial cancer patients who have failed platinum-based chemotherapy, as well as the effect of combined treatment with trastuzumab in patients with HER2/neu-positive endometrial cancer. Additionally, the guideline assessed the efficacy and safety of omitting lymph node dissection in low-risk endometrial cancer patients, investigated the effect of sentinel lymph node mapping in early-stage endometrial cancer surgery, addressed the outcome of chemoradiation therapy as a postoperative treatment in patients with advanced (stage III-IVA) endometrial cancer, and explored the impact of initial treatment with immune checkpoint inhibitors on survival in patients with advanced or recurrent endometrial cancer patients.

The prognostic value of P53 index in predicting the recurrence of early low-risk endometrial cancer.

We aimed to clarify the clinical value of P53 index in patients with early low-risk endometrial cancer (EC) and find an optimal cut-off value of P53 index for predicting the recurrence of these patients. The clinicopathological data of 157 patients with early low-risk EC (stage 1A with grade 1 or 2 endometrioid EC) were analyzed. The optimal cut-off value of the P53 index was calculated by the receiver operating characteristic curve analysis and Youden index. Cox regression model was used to evaluate the independent prognostic predictors of recurrence of EC. Then all patients were divided into two groups according to the optimal cut-off value of the P53 index. Differences of the clinicopathological parameters between the two groups were compared. Multivariate analysis showed age PR (p = 0.020) and P53 (p = 0.001) were independent prognostic factors for the recurrence of EC. The value of P53 index was found to be the optimal cut-off point of 17.5% in estimating the recurrence of EC. The 5-year recurrence-free survival rates of patients in the low P53 index group (<17.5%) and the high P53 index group (≥17.5%) were 94.6% and 65.4% (p < 0.001). It has been revealed that the P53 index is a prognostic factor for recurrence in early low-risk EC. The optimal cut-off value of P53 index may contribute to the postoperative individualized treatment options for early low-risk EC patients.

Development and validation of a nomogram involving immunohistochemical markers for prediction of recurrence in early low-risk endometrial cancer.

The purpose of this study was to construct a nomogram based on classical parameters and immunohistochemical markers to predict the recurrence of early low-risk endometrial cancer patients. A total of 998 patients with early low-risk endometrial cancer who underwent primary surgical treatment were enrolled (668 in the training cohort, 330 in the validation cohort). Prognostic factors identified by univariate and multivariate analysis in the training cohort were used to construct the nomogram. Prediction performance of the nomogram was evaluated using the calibration curve, concordance index (C-index), and the time-dependent receiver operating characteristic curve. The cumulative incidence curve was used to describe the prognosis of patients in high-risk and low-risk groups divided by the optimal risk threshold of the model. In the training cohort, grade (P = 0.040), estrogen receptor (P < 0.001), progesterone receptor (P = 0.001), P53 (P = 0.004), and Ki67 (P = 0.002) were identified as independent risk factors of recurrence of early low-risk endometrial cancer, and were used to establish the nomogram. The calibration curve showed that the fitting degree of the model was good. The C-indexes of training and validation cohorts were 0.862 and 0. 827, respectively. Based on the optimal risk threshold of the nomogram, patients were split into a high-risk group and a low-risk group. The cumulative incidence curves showed that the prognosis of the high-risk group was far worse than that of the low-risk group (P < 0.001). This nomogram, with a combination of classical parameters and immunohistochemical markers, can effectively predict recurrence in early low-risk endometrial cancer patients.

Volume Index is a Risk Factor for Recurrence Even in Patients with Clinical Stage IA Endometrial Cancer Undergoing either Laparotomy or Laparoscopy: A Retrospective Study.

Objectives:The objective of the study was to investigate the long-term outcomes, in particular, recurrence risk, especially tumor volume, for Stage IA endometrial cancer and to identify the risk factors for recurrence.Materials and Methods:This single-center retrospective study analyzed women who underwent primary surgical treatment for the International Federation of Gynecology and Obstetrics Stage IA (Grade 1 or 2) endometrioid carcinoma at our institute between January 2010 and July 2018. Patients' demographic characteristics, including age, operative time, number of lymph nodes, final stage, volume index as tumor volume, and final histological type, were reviewed. A total of 168 patients were enrolled, with 95 and 73 patients in the laparotomy and laparoscopy groups, respectively. The Cox proportional hazards model was used to adjust for prognostic factors in the analysis including upstaged patients, tumor histology, lymphovascular invasion, and volume index.Results:There was no difference in the recurrence rate between laparoscopic and open surgeries for Stage IA endometrial cancer. The operative time was longer, and the amount of blood loss was lesser in the laparoscopy group than in the laparotomy group. For all patients undergoing either laparoscopy or open surgery, upstaged ≥IB, nonendometrioid Grade 1 or 2, lymphovascular invasion, and volume index ≥36 were significant independent recurrence risk factors.Conclusion:Laparoscopic surgery for Stage IA endometrial cancer is technically and oncologically safe. Patients with a high-volume index have a higher recurrence risk. Furthermore, the volume index can be a recurrence predictor in low-risk endometrial cancer patients.

MRI radiomics: A machine learning approach for the risk stratification of endometrial cancer patients

PurposeTo investigate radiomics and machine learning (ML) as possible tools to enhance MRI-based risk stratification in patients with endometrial cancer (EC). MethodFrom two institutions, 133 patients (Institution1 = 104 and Institution2 = 29) with EC and pre-operative MRI were retrospectively enrolled and divided in two a low-risk and a high-risk group according to EC stage and grade. T2-weighted (T2w) images were three-dimensionally annotated to obtain volumes of interest of the entire tumor. A PyRadiomics based and previously validated pipeline was used to extract radiomics features and perform feature selection. In particular, feature stability, variance and pairwise correlation were analyzed. Then, the least absolute shrinkage and selection operator technique and recursive feature elimination were used to obtain the final feature set. The performance of a Support Vector Machine (SVM) algorithm was assessed on the dataset from Institution 1 via 2-fold cross-validation. Then, the model was trained on the entire Institution 1 dataset and tested on the external test set from Institution 2. ResultsIn total, 1197 radiomics features were extracted. After the exclusion of unstable, low variance and intercorrelated features least absolute shrinkage and selection operator and recursive feature elimination identified 4 features that were used to build the predictive ML model. It obtained an accuracy of 0.71 and 0.72 in the train and test sets respectively. ConclusionsWhole-lesion T2w-derived radiomics showed encouraging results and good generalizability for the identification of low-risk EC patients.

Patterns of Recurrence in Low-Risk Endometrial Cancer

Objective: Endometrial cancer is the most common gynaecological cancer in high-income countries and has a good prognosis, particularly when diagnosed early. Early stage, low-grade endometrial cancer has a low risk of recurrence, and is detectable on routine follow up. This study aims to identify rates and patterns of recurrence in low-risk endometrial cancer patients and provide evidence for transitioning to community-based follow-up care. Methods: Retrospective study of patients with early-stage, low-grade endometrioid endometrial adenocarcinoma treated with surgery from January 1981 to December 2018. The rate and patterns of recurrence were identified and analysed. Results: Of 1215 eligible patients, 24 developed recurrent disease (1.98%). The majority of recurrences were pelvic (70%), and confined to the vaginal vault (41.7%). The median duration of follow up was 44.4 months, and time from primary surgery to diagnosis of recurrent disease was 30.5 months. No significant differences were found between the group of patients who recurred and the group of patients who did not. Twelve (50%) patients with recurrences were asymptomatic, but of these, 10 (83%) had obvious findings during routine surveillance physical examination. The remaining 12 patients (50%) presented with symptoms that prompted investigation that led to the recurrence diagnosis. 78% of recurrences were treated with combination therapy (surgical excision, chemotherapy, radiotherapy and hormonal). Ten patients (42%) had salvageable disease. For the non-salvageable cases, there was a mean of 2.1 years from recurrence diagnosis to death. Conclusions: The low recurrence rate of low-risk endometrial cancer following primary surgical management, and the feasibility of detection of recurrent disease, support transitioning surveillance to community-based settings.

Prognostic Role of the Removed Vaginal Cuff and Its Correlation with L1CAM in Low-Risk Endometrial Adenocarcinoma.

Simple SummaryIn assessing the risk factors for the recurrence of EC, the length of the vaginal cuff removed during surgery has shown discrepant results. The aim of this study was to investigate the role of the excised vaginal cuff length as a prognostic factor and its correlation with the expression of L1CAM. To our knowledge, this is the first study evaluating this prognostic factor in such a secluded and tidy cohort. According to our results, vaginal cuff length does not seem to be an independent variable in an EC low-risk group in terms of DFS. Moreover, L1CAM seems to be associated with a higher risk of distant recurrence. A prospective randomized trial in an EC low-risk group is needed to confirm its negative prognostic role, and to determine its potential value in clinical practice to detect that subgroup of low-risk patients which is at a higher risk of recurrence, especially at distant.Objective: The aim of our study was to investigate the role of the excised vaginal cuff length as a prognostic factor in terms of DFS and recurrence rate/site, in low-risk endometrial cancer (EC) patients. Moreover, we correlated the recurrence with the expression of L1CAM. Material and Methods: From March 2001 to November 2016, a retrospective data collection was conducted of women undergoing surgical treatment for low-risk EC according to ESMO-ESGO-ESTRO consensus guidelines. Patients were divided into three groups according to their vaginal cuff length: V0 without vaginal cuff, V1 with a vaginal cuff shorter than 1.5 cm and V2 with a vaginal cuff longer than or equal to 1.5 cm. Results: 344 patients were included in the study: 100 in the V0 group, 179 in the V1 group and 65 in the V2 group. The total recurrence rate was 6.1%: the number of patients with recurrence was 8 (8%), 10 (5.6%) and 3 (4.6%), in the V0, V1 and V2 group, respectively. No statistically significant difference was found in the recurrence rate among the three groups. Although the DFS was higher in the V2 group, the result was not significant. L1CAM was positive in 71.4% of recurrences and in 82% of the distant recurrences. Conclusions: The rate of recurrence in patients with EC at low risk of recurrence does not decrease as the length of the vaginal cuff removed increases. Furthermore, the size of the removed vaginal cuff does not affect either the site of recurrence or the likelihood of survival.

Safe obturator nerve identification during pelvic lymphadenectomy for high-risk endometrial cancer—a case report

Background: Endometrial cancer (EC) is the most frequent gynecological cancer and the fourth in western women. To date, although the sentinel lymph node technique is the gold standard in low-risk EC patients, pelvic and lumboaortic lymphadenectomy is still suggested by international guidelines for staging purposes in high-risk EC patients. Pelvic lymphadenectomy is burdened by surgical complications ranging from vascular, nerve, intestinal, and lymphatic-related injuries. Furthermore, due to its proximity to the large pelvic vessels, the obturator nerve is the most frequently injured in gynecological surgery. The identification of the obturator nerve can take place either through the mediolateral approach through the lateral paravesical fossa or with a lateromedial approach through the iliolumbar fossa. To date, no specific approach is recommended and each surgeon will perform the approach they are most confident with.

Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy

Sentinel lymph node (SLN) mapping and biopsy is a promising technique for visualizing and evaluating lymph node status in cancer. This approach has been recommended for low-risk endometrial cancer (EC) patients by authoritative international guidelines, but it has not been performed broadly in China and worldwide. This work aims to describe detailed SLN mapping and biopsy procedures to promote the clinical application. SLN mapping and postoperative pathologic ultrastaging were conducted in a patient with low-risk EC using indocyanine green (ICG) dye to track the SLNs under laparoscopy and resecting them completely for ultrastaging. In conclusion, this protocol describes details of ICG injection, and SLN mapping and biopsy in EC patients based on the experiences gained during clinical practice.

Metastatic and synchronous ovarian involvement in low-risk endometrial cancer; clinicopathological analysis with detection of DNA mismatch repair deficiency.

This study aimed to investigate ovarian involvement in low-risk endometrial cancer, the associated risk factors, and impact on overall survival. We attempted to explore the differences in mismatch repair (MMR) deficiency between metastatic and synchronous ovarian tumoral involvement. This was a retrospective study of patients with low-risk endometrial cancer who were treated at a tertiary center between January 2006 and December 2019. The primary outcome measures were the incidence and risk factors associated with metastatic and synchronous tumoral involvement of the ovary. Overall, survival data were also analyzed. Metastatic and synchronous tumors were compared with each other in terms of MMR deficiency with IHC staining. From a total of 360 low-risk endometrial cancer patients, 10 (2.8%) had ovarian metastasis and 12 (3.3%) had synchronous ovarian involvement. The median age of patients with metastasis was significantly lower than that of patients without ovarian involvement (49 vs 57 years, p = 0.004). Most patients in the metastatic group were in the < 50 age group (p < 0.001) and premenopausal period (p = 0.001). As a result of IHC staining performed on patients with ovarian involvement, MMR deficiency was found in six (60%) patients in the metastatic group and six (50%) patients in the synchronous group. No significant difference was found in overall survival between groups. Younger age and premenopausal status were risk factors associated with ovarian metastasis. Overall survival did not show differences between all groups, and MMR deficiency was similar between metastatic and synchronous groups.

Construction of a Glycolysis-related long noncoding RNA signature for predicting survival in endometrial cancer.

Background: long noncoding RNA (lncRNA) has been widely studied and understood in various cancer types. However, the expression profiles of glycolysis-related lncRNA in endometrial cancer (EC) have poorly been reported.Methods: In this study, we retrieved the “Glycolysis” gene list from Molecular Signatures Database (MSigDB) and screened prognostic glycolysis-related lncRNA using The Cancer Genome Atlas (TCGA) Uterine Corpus Endometrial Carcinoma (UCEC) RNA-seq dataset. Then, TCGA UCEC patients were randomly divided. Lasso algorithm and multivariate cox regression analyses were then performed to further select hub prognostic lncRNA and to develop a prognostic signature. The efficacy of the signature was also evaluated in the TCGA EC cohort. Moreover, we constructed a nomogram to predict EC patient outcomes.Results: Univariate cox analysis identified thirty-six glycolysis-related lncRNA correlated with EC patient prognosis. Among them, five lncRNA were further selected as hub lncRNA that mostly relate to EC patient outcomes, which are AL121906.2, BOLA3-AS1, LINC01833, AC016405.3, and RAB11B-AS1. A prognostic signature was then built based on the expression and coefficiency of five lncRNA. The efficacy of the signature was validated in part of and the entire TCGA EC cohort. In addition, the risk signature could precisely distinguish high- and low-risk EC patients and predict patient outcomes. The nomogram exhibited absolute concordance between the predictions and actual survival observations.Conclusions: The glycolysis-related lncRNA signature model and the nomogram may provide a new perspective for EC patients outcome prediction in clinical use.

Minimally Invasive Surgery and Sentinel Lymph Node Biopsy – a Modern Standart of Uterine Confined Endometrial Cancer Treatment: Reviewing Literature and Presenting the National Cancer Institute Experience

Objectives. To find out sentinel lymph node detection rate of low-risk endometrial cancer patients. To compare postoperative complications rate, lenght of a surgery, lenght of hospital stay and sensitivity of detecting lymph node metastasis between minimally invasive surgery with sentinel lymph node biopsy and abdominal surgery with systemic pelvic lymphadenectomy. Methods. Retrospective analysis of low-risk endometrial cancer patients, treated in National Cancer Institute (n = 103) history cases from 2018 10 untill 2019 12. I group – laparoscopic hysterectomy with sentinel lymph node biopsy (n = 35); II group – abdominal hysterectomy with systemic pelvic lymphadenectomy (n = 68). Both groups were homogeneous according to clinicopathological features. Results. Sentinel lymph node were detected in 97.1% cases. Sentinel lymph nodes in both sides were detected in 85.7% cases. Metastasis in regional lymph nodes were detected in 2 cases (5.7%) in group I and none group II. Postoperative complications rate in group I were 3.8% and 13% in group II. Conclusions. There are significantly less postoperative complications in endoscopic surgery with sentinel node biopsy for low-risk endometrial cancer treatment, also this method is more accurate in surgical staging in National Cancer Institute.

Nationwide Comparison of Surgical and Oncologic Outcomes in Endometrial Cancer Patients Undergoing Robotic, Laparoscopic, and Open Surgery: A Population-Based Cohort Study.

PurposePopulation-based comparisons between minimally invasive surgery (MIS) (robotic surgery [RS] and laparoscopic surgery [LS]) and open surgery (OS) for managing endometrial cancer are lacking. This study aimed to compare surgical and oncologic outcomes between endometrial cancer patients who underwent surgical staging via MIS or OS.Materials and MethodsA population-based retrospective cohort study was performed using claims data from the Korean National Health Insurance database from January 2012 to December 2016. All patients who underwent hysterectomy under diagnosis of endometrial cancer were identified. Patients were classified into RS, LS, and OS groups. Operative and oncologic outcomes were compared among the three groups after adjustments for age group, risk group (adjuvant therapy status), modified Charlson comorbidity index, income level, insurance type, and index year using propensity scores obtained via the inverse probability of treatment weighted method.ResultsAfter adjustment, 5,065 patients (RS, n=315; LS, n=3,248; OS, n=1,503) were analyzed. Patient demographics were comparable. Hospital stay, postoperative complications, and cost were more favorable in the RS and LS groups than in the OS group (all p < 0.001). Five-year overall survival was significantly longer in the RS and LS groups than in the OS group (94.8%, 91.9%, and 86.9%, respectively; p < 0.001). Moreover, the survival benefit of RS was shown in the subgroup analysis of low-risk endometrial cancer patients.ConclusionOur study provides further evidence for the RS being a safe surgical alternative to the LS and OS, especially in low-risk endometrial cancer patients, offering surgical and oncologic outcomes equivalent to other surgical approaches.

Small-Molecule Inhibitors (SMIs) as an Effective Therapeutic Strategy for Endometrial Cancer.

Simple SummaryPatients diagnosed with endometrial cancer (EC), the most common gynaecological malignancy in women worldwide, cope with a disease associated with poor prognosis and limited treatment options after first-line therapy when it reaches an advanced or metastatic stage. Lately, small-molecule inhibitors have emerged as an alternative targeted therapy, renewing hope in the fight against this disease. The aim of this review is to shed light into the current state and future prospects of small-molecule inhibitors on EC treatment by summarizing the extensive number of clinical trials that have been performed during the last years, and to provide a comprehensive up-to-date document with the most remarkable results. Despite the great effort researchers are making to improve the molecular characterization of tumours, to unravel the underlying mechanism of EC progression, and to increase the efficacy of targeted therapy, we might say that there is still a long way to pave to efficiently treat EC patients.Endometrial cancer (EC) is the sixth most common cancer in women. A continued number of low-risk EC patients at diagnosis, as well as patients diagnosed with advanced-stage disease, will experience an aggressive disease. Unfortunately, those patients will present recurrence or overt dissemination. Systemic cytotoxic chemotherapy treatment on advanced, recurrent, or metastatic EC patients has shown poor results, with median survival rates of less than one year, and median progression-free survival rates of four months. Therefore, the search for innovative and alternative drugs or the development of combinatorial therapies involving new targeted drugs and standard regimens is imperative. Over the last few decades, some small-molecule inhibitors have been introduced in the clinics for cancer treatment, but only a few have been approved by the Food and Drug Administration (FDA) for EC treatment. In the present review, we present the current state and future prospects of small-molecule inhibitors on EC treatment, both alone and in combination.

Identification of a metabolism-related gene expression prognostic model in endometrial carcinoma patients

BackgroundMetabolic abnormalities have recently been widely studied in various cancer types. This study aims to explore the expression profiles of metabolism-related genes (MRGs) in endometrial cancer (EC).MethodsWe analyzed the expression of MRGs using The Cancer Genome Atlas (TCGA) data to screen differentially expressed MRGs (DE-MRGs) significantly correlated with EC patient prognosis. Functional pathway enrichment analysis of the DE-MRGs was performed. LASSO and Cox regression analyses were performed to select MRGs closely related to EC patient outcomes. A prognostic signature was developed, and the efficacy was validated in part of and the entire TCGA EC cohort. Moreover, we developed a comprehensive nomogram including the risk model and clinical features to predict EC patients’ survival probability.ResultsForty-seven DE-MRGs were significantly correlated with EC patient prognosis. Functional enrichment analysis showed that these MRGs were highly enriched in amino acid, glycolysis, and glycerophospholipid metabolism. Nine MRGs were found to be closely related to EC patient outcomes: CYP4F3, CEL, GPAT3, LYPLA2, HNMT, PHGDH, CKM, UCK2 and ACACB. Based on these nine DE-MRGs, we developed a prognostic signature, and its efficacy in part of and the entire TCGA EC cohort was validated. The nine-MRG signature was independent of other clinical features, and could effectively distinguish high- and low-risk EC patients and predict patient OS. The nomogram showed excellent consistency between the predictions and actual survival observations.ConclusionsThe MRG prognostic model and the comprehensive nomogram could guide precise outcome prediction and rational therapy selection in clinical practice.

Risk factors for lymphatic complications following lymphadenectomy in patients with endometrial cancer

ObjectiveLymph node (LN) metastasis is among the important prognostic factors for survival in endometrial cancer (EC). This study aimed to evaluate the occurrence of lymphatic complications following lymphadenectomy in patients with EC. Materials and methodsEC patients were retrospectively evaluated. Lower extremity lymphedema (LEL) and pelvic lymphocele (PL) were evaluated according to the International Society of Lymphology guidelines and the National Cancer Institute Common Terminology Criteria for Adverse Events, respectively. ResultsA total of 289 patients were enrolled. Surgery was performed via laparotomy and laparoscopy in 200 (69.2%) and 89 (30.8%) patients, respectively. LEL and PL occurred in 43 (14.9%) and 33 (11.4%) patients, respectively. In multivariate logistic regression analysis, circumflex iliac node (CIN) removal (odds ratio [OR]: 3.22; 95% CI: 1.43–7.98; P = 0.004) was an independent risk factor for LEL, while the surgical approach (OR: 4.46; 95% CI: 1.13–29.9; P = 0.004) was an independent risk factor for PL. ConclusionCIN dissection was a significant risk factor for LEL, while laparotomy was an independent risk factor for PL compared to laparoscopy in EC patients. This suggests that laparoscopic surgery combined with sentinel lymph node navigation surgery will prevent lymphatic complications in low-risk EC patients.

Evaluation of quality of life, body image and surgical outcomes of robotic total laparoscopic hysterectomy and sentinel lymph node mapping in low-risk endometrial cancer patients - A Robotic Gyne Club study.

The aims of the study were to evaluate quality of life, cosmetic results and surgical outcomes of robotic single-site and robotic multiport total laparoscopic hysterectomy with sentinel lymph node mapping in women treated for low-risk endometrial cancer. The study is a prospective, multicenter, case-control study conducted at Ospedale Santa Chiara in Trento and Novara and Pavia University Hospitals. Seventy-six consecutive patients with a biopsy-confirmed diagnosis of low-risk endometrial cancer or atypical endometrial hyperplasia who between January 2017 and January 2019 had undergone robotic total laparoscopic hysterectomy and sentinel lymph node mapping were included. Data on surgical outcomes, quality of life and cosmetic results were prospectively collected and analyzed based on the surgical approach with robotic single-site vs robotic multiport assistance. Patients' clinical characteristics, intra-operative parameters, sentinel lymph node mapping results and postoperative findings were prospectively recorded. Clinical follow up was performed 4 weeks and 6 and 12 months after surgery. Fifty-one patients underwent a robotic multiport procedure and 25 patients a robotic single-site surgery. There was one significant difference between the two groups in terms of patient characteristics: mean body mass index (BMI) in the multiport group was 29 kg/m2 vs 24.8 kg/m2 in the single-site group (P value <.001). After univariate and multivariate analysis on intraoperative and postoperative findings, a shorter surgical time was observed in the single-site cohort than in the multiport group (148.7 vs 158.2 minutes, P value .0182). BMI also had a significant effect on surgical time (P = .022). No differences were seen in terms of sentinel lymph node detection: the bilateral detection rate was 96.1% for multiport (66.7% bilateral, 29.4% monolateral) and 96% for single-site (76% bilateral, 20% monolateral) procedures. No differences between the two approaches were identified with regard to postoperative complications, pain, cosmetic results or quality of life comparisons. For the treatment of low-risk endometrial cancer and atypical endometrial hyperplasia with total hysterectomy and sentinel lymph node mapping, the robotic single-port approach is comparable to the multiport procedure in terms of intraoperative and postoperative findings, and has an advantage in terms of shorter surgical times. Further studies are required to identify possible differences in quality of life and cosmetic results.