Stage Endometrial Cancer Research Articles

The Impact of Waiting Time-to-Surgery on Survival in Endometrial Cancer Patients.

Endometrial cancer (EC) is the most common gynecological cancer in developed countries and a standard treatment of surgery should be performed as expediently as possible. Delay time to surgery and survival was debated. The aim of this investigation was to evaluate the effect of time-interval between diagnosis and surgery (TDS) in EC patients with regards to prognosis and mortality rates. This retrospective study was conducted between January 2009 and May 2021 at Bhumibol Adulyadej Hospital, Thailand. Subjects were EC cases who underwent primary surgery during the study period. Cases with partial treatment were disqualified from the study. Subjects who underwent surgery before and after 6 weeks were classified as early and delayed surgery groups. Baseline and clinical characteristics were collected and analyzed. During the study period, 419 EC cases were recruited. The mean age of participants was 56.8 years. Two-thirds (338/491) of subjects were menopausal. Endometrioid histology (406/491) was the most common histology subtype. Five years disease free survival (DFS) of early and delayed surgery groups were comparable at a percentage of 82.5 and 83.0, respectively. Among advanced stage and non-endometrioid EC cases, the delayed surgery group had significantly shorter DFS than the early group. Advanced stage, high grade and positive lympho-vascular space invasion (LVSI) were independent factors for poor DFS. Predictive factors for mortality were advanced stage and tumor recurrence. The TDS was not a prognostic factor for disease recurrence or overall mortality. Time to surgery equal to or more than 6 weeks gave worse prognosis for DFS among advanced stage or non-endometrioid histology EC.

Diagnostic value of ICG for sentinel lymph node mapping in patients with stage I endometrial cancer

Background. Lymphatic spread is the main route of metastasis in early stage endometrial cancer. Considering its significance, three risk factors of lymph node metastasis were identified. At a high risk of lymph node metastasis in patients with stage I endometrial cancer, pelvic and lumbar lymph node dissection is recommended. In low-risk patients, lymph node dissection is not performed. Lymph node dissection in medium-risk patients is considered as a staging procedure. However, in patients with aggravating factors that prevent extended hysterectomy, lymph node biopsy with ICG mapping and subsequent microstaging may be an alternative to lymph node dissection. Purpose of the study: to analyze the effectiveness of surgical approaches for staging endometrial cancer at different risk factors for lymphatic metastasis.Material and Methods. The treatment outcomes were retrospectively analyzed in 565 patients with stage I endometrial cancer treated at the gynecological oncology department of Botkin City Clinical Hospital and at the gynecological oncology department of Kaluga Regional Clinical Oncology Center from 2021 to 2023. All women were divided into three groups according to the risk factors of lymph node metastasis. Patients underwent hysterectomy, hysterectomy combined with pelvic or pelvic and lumbar lymphadenectomy, as well as hysterectomy with ICG mapping and sentinel lymph node biopsy.Results. A total of 334 endometrial cancer patients underwent surgery at Botkin City Clinical Hospital. In the medium-risk group patients (n=94), who underwent hysterectomy with pelvic (n=36) and pelvic + lumbar lymphadenectomy (n=31), lymph node metastases were detected in 4 (11.1 %) and 6 (19.4 %) patients, respectively. In the high-risk group (n=50) with similar surgeries, metastatic lymph nodes were identified in 2 (10.5 %, n=19) and 6 (26.1 %, n=23) patients, respectively. At Kaluga Regional Oncology Center, 231 patients underwent hysterectomy with sentinel lymph node biopsy. The low-risk group, the medium-risk group, and the high-risk group showed lymph node metastases in 7 (5.47 %), 6 (10.2 %), and 6 (13.6 %) patients, respectively.Conclusion. In stage I endometrial cancer patients with a low risk of lymph node metastasis, hysterectomy with sentinel lymph node biopsy is recommended. For medium-and high-risk groups, hysterectomy with systemic lymphadenectomy is recommended. If it is not possible to remove the pelvic and lumbar lymph nodes, their biopsy with ICG mapping and microstaging can be recommended. A combination of systemic lymphadenectomy with sentinel lymph node biopsy is a promising technique that could hypothetically demonstrate better results in terms of disease staging.

Prognostic value of hematological indexes in endometrioid type endometrial cancer

Endometrial cancer remains a significant health concern, particularly in developed nations where its prevalence is increasing. Reliable prognostic markers are paramount to enhance disease management and patient outcomes. This study explores the prognostic capabilities of various hematological indices, including the eosinophil-lymphocyte ratio (ELR) and the prognostic nutritional index (PNI), in relation to endometrioid type endometrial cancer (ETEC) staging and grading. We retrospectively analyzed data from ETEC patients, categorizing them by tumor grade and stage, and evaluating their hematological indices from preoperative blood samples. Our results indicated that higher ELR and lower PNI levels correlate with more advanced tumor grades and stages. Additionally, the platelet-lymphocyte ratio (PLR) was found to be the most significant marker for staging, with PLT, SII, SIRI, ELR, and PNI also showing significant differences across stages. These findings suggest that hematological indices such as ELR and PNI could be instrumental in predicting tumor grade and stage, offering valuable insights for clinical practice. Future research should focus on prospective studies to confirm these findings and consider the integration of these markers into standard diagnostic protocols.

Prognostic values of tumor size and location in early stage endometrial cancer patients who received radiotherapy.

To investigate the correlation between tumor size, tumor location, and prognosis in patients with early-stage endometrial cancer (EC) receiving adjuvant radiotherapy. Data of patients who had been treated for stage I-II EC from March 1999 to September 2017 in 13 tertiary hospitals in China was screened. Cox regression analysis was performed to investigate associations between tumor size, tumor location, and other clinical or pathological factors with cancer-specific survival (CSS) and distant metastasis failure-free survival (DMFS). The relationship between tumor size as a continuous variable and prognosis was demonstrated by restricted cubic splines. Prognostic models were constructed as nomograms and evaluated by Harrell's C-index, calibration curves and receiver operating characteristic (ROC) curves. The study cohort comprised 805 patients with a median follow-up of 61 months and a median tumor size of 3.0 cm (range 0.2-15.0 cm). Lower uterine segment involvement (LUSI) was found in 243 patients (30.2%). Tumor size and LUSI were identified to be independent prognostic factors for CSS. Further, tumor size was an independent predictor of DMFS. A broadly positive relationship between poor survival and tumor size as a continuous variable was visualized in terms of hazard ratios. Nomograms constructed and evaluated for CSS and DMFS had satisfactory calibration curves and C-indexes of 0.847 and 0.716, respectively. The area under the ROC curves for 3- and 5-year ROC ranged from 0.718 to 0.890. Tumor size and LUSI are independent prognostic factors in early-stage EC patients who have received radiotherapy. Integrating these variables into prognostic models would improve predictive ability.

Metastases and Recurrence Risk Factors in Endometrial Cancer-The Role of Selected Molecular Changes, Hormonal Factors, Diagnostic Methods and Surgery Procedures.

The presence of metastatic endometrial cancer (EC) is a key problem in treatment failure associated with reduced overall survival rates. The most common metastatic location is the pelvic lymph nodes, and the least common is the brain. The presence of metastasis depends on many factors, including the molecular profile of cancer (according to the TCGA-Genome Atlas), the activity of certain hormones (estrogen, prolactin), and pro-inflammatory adipocytokines. Additionally, an altered expression of microRNAs affecting the regulation of numerous genes is also related to the spread of cancer. This paper also discusses the value of imaging methods in detecting metastases; the primary role is attributed to the standard transvaginal USG with the tumor-free distance (uTFD) option. The influence of diagnostic and therapeutic methods on EC spread is also described. Hysteroscopy, according to the analysis discussed above, may increase the risk of metastases through a fluid medium, mainly performed in advanced stages of EC. According to another analysis, laparoscopic hysterectomy performed with particular attention to avoiding risky procedures (trocar flushing, tissue traumatization, preserving a margin of normal tissue) was not found to increase the risk of EC dissemination.

Preoperative Imaging Evaluation of Endometrial Cancer in FIGO 2023.

The staging of endometrial cancer is based on the International Federation of Gynecology and Obstetrics (FIGO) staging system according to the examination of surgical specimens, and has revised in 2023, 14 years after its last revision in 2009. Molecular and histological classification has incorporated to new FIGO system reflecting the biological behavior and prognosis of endometrial cancer. Nonetheless, the basic role of imaging modalities including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography, as a preoperative assessment of the tumor extension and also the evaluation points in CT and MRI imaging are not changed, other than several point of local tumor extension. In the field of radiology, it has also undergone remarkable advancement through the rapid progress of computational technology. The application of deep learning reconstruction techniques contributes the benefits of shorter acquisition time or higher quality. Radiomics, which extract various quantitative features from the images, is also expected to have the potential for the quantitative prediction of risk factors such as histological types and lymphovascular space invasion, which is newly included in the new FIGO system. This article reviews the preoperative imaging diagnosis in new FIGO system and recent advances in imaging analysis and their clinical contributions in endometrial cancer. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 3.

Evaluation of pre-therapeutic imaging work-up in the staging of endometrial cancer: Interest in a systematic second opinion in a cancer center

Rationale and objectivesTo evaluate the interest of a systematic second opinion in quality assessment and FIGO staging in the pretherapeutic imaging work-up. Materials and methodsA retrospective observational study was conducted on 156 patients who underwent surgery for endometrioid cancer in our institution. 42 % had their initial MRI scans performed in expert centers (University Hospital and Cancer center) and 58 % in non-expert centers. Quality assessment, concordances between initial reports, and second opinions by a junior and a senior ICL radiologist versus histopathological data were analyzed. ResultsMRI scans performed in expert centers were more complete and more likely to be rated as higher quality. The overall accuracy of T staging from initial reports vs gold standard was 0.59 (95 % CI, 0.46–0.71) in expert centers and 0.49 (95 % CI, 0.38–0.60) in non-expert centers. The overall accuracy and Kappa of a second opinion for FIGO 2009 staging from expert center and non-expert center examinations were 0.61 (95 % CI, 0.48–0.72) vs 0.50 (95 % CI, 0.39–0.60) and 0.37 vs 0.27 for junior reader and 0.62 (95 % CI, 0.49–0.74) vs 0.48 (95 % CI, 0.37–0.58) and 0.39 vs 0.24 for senior reader, respectively. There was also a significant lower confidence level of the junior radiologist in MRI FIGO staging for non-expert center examinations (p 0.003). ConclusionAccuracy in the FIGO 2009 staging and quality assessment are higher for MR examinations performed from expert centers than in non-expert centers. A systematic second opinion by radiologists in expert centers should be proposed before pre-treatment multidisciplinary consultation.

Oncologic Outcome of Robotic-Assisted and Laparoscopic Sentinel Node Biopsy in Endometrial Cancer.

Recently, sentinel lymph node biopsy (SLNB) has been introduced in the surgical staging of endometrial cancer as an alternative to systematic lymph node dissection (LND). However, the survival impact of SLNB is not yet well characterised. We performed a retrospective study of 419 patients with endometrial cancer treated with SLNB alone or with pelvic and para-aortic LND. For SLNB mapping, indocyanine green was used. Median follow-up was 66 months. After exclusions, 337 patients were eligible for analysis. Of them, 150 underwent SLNB and 187 LND. During the follow-up time, 27 (24.7%) of the 150 who underwent SLNB and 54 (28.9%) of the 187 who underwent LND were diagnosed with recurrent disease (p = 0.459). The estimated 5-year disease-free survival (DFS) rate was 76.7% and 72.2% for patients in the SLNB and LND group, respectively (p = 0.419). The 5-year overall survival (OS) rates were 80.7% and 77.0% in the SLNB and LND group, respectively (p = 0.895). Survival rates were similar in both groups independent of lymph node status. Multivariable analysis confirmed that the staging approach was not associated with oncological outcome. For patients without lymph node metastases, patient outcome was worsened by advanced tumour stage and non-endometrioid tumour histology. In the group of patients with confirmed lymph node metastases, advanced tumour stage and inadequate adjuvant treatment significantly reduced DFS and OS. Our data suggested that SLNB did not compromise the oncological outcome of patients with endometrial cancer compared to LND.

Registry-derived stage (RD-Stage) for capturing cancer stage at diagnosis for endometrial cancer

BackgroundCapture of cancer stage at diagnosis is important yet poorly reported by health services to population-based cancer registries. In this paper we describe current completeness of stage information for endometrial cancer available in Australian cancer registries; and develop and validate a set of rules to enable cancer registry medical coders to calculate stage using data available to them (registry-derived stage or ‘RD-Stage’).MethodologyRules for deriving RD-stage (Endometrial carcinoma) were developed using the American Joint Commission on Cancer (AJCC) TNM (tumour, nodes, metastasis) Staging System (8th Edition). An expert working group comprising cancer specialists responsible for delivering cancer care, epidemiologists and medical coders reviewed and endorsed the rules. Baseline completeness of data fields required to calculate RD-Stage, and calculation of the proportion of cases for whom an RD stage could be assigned, was assessed across each Australian jurisdiction. RD-Stage (Endometrial cancer) was calculated by Victorian Cancer Registry (VCR) medical coders and compared with clinical stage recorded by the patient’s treating clinician and captured in the National Gynae-Oncology Registry (NGOR).ResultsThe necessary data completeness level for calculating RD-Stage (Endometrial carcinoma) across various Australian jurisdictions varied from 0 to 89%. Three jurisdictions captured degree of spread of cancer, rendering RD-Stage unable to be calculated. RD-Stage (Endometrial carcinoma) could not be derived for 64/485 (13%) cases and was not captured for 44/485 (9%) cases in NGOR. At stage category level (I, II, III, IV), there was concordance between RD-Stage and NGOR captured stage in 393/410 (96%) of cases (95.8%, Kendall’s coefficient = 0.95).ConclusionA lack of consistency in data captured by, and data sources reporting to, population-based cancer registries meant that it was not possible to provide national endometrial carcinoma stage data at diagnosis. In a sample of Victorian cases, where surgical pathology was available, there was very good concordance between RD-Stage (Endometrial carcinoma) and clinician-recorded stage data available from NGOR. RD-Stage offers promise in capturing endometrial cancer stage at diagnosis for population epidemiological purposes when it is not provided by health services, but requires more extensive validation.

Let go of the myth: safety of indocyanine green for sentinel lymph node mapping in endometrial cancer

ObjectiveSentinel lymph node mapping by intracervical indocyanine green injection is the preferred method for surgical staging in endometrial cancer. Adverse reactions to indocyanine green are extremely rare, and information about...

Sentinel lymph node mapping in endometrial cancer: Current evidence and practice.

Surgical staging with total hysterectomy, bilateral salpingo-oophorectomy, and lymph node assessment is the standard of care for patients with clinical early-stage endometrial cancer. Traditionally, complete pelvic and para-aortic lymphadenectomy (LND) was performed to assess for nodal metastases; however, numerous prospective studies have demonstrated that sentinel lymph node biopsy has similar diagnostic accuracy, and is an acceptable alternative to complete LND. This has led to a paradigm shift in endometrial cancer staging.

Path to Precision: Refining Radiation Therapy Guidelines for Early Stage Endometrial Cancer Through Incorporation of Primary Tumor Size, Lower Uterine Segment Invasion, and Molecular Markers

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A multicenter noninferior randomized controlled study of sentinel lymph node biopsy alone versus sentinel lymph node biopsy plus lymphadenectomy for patients with stage I endometrial cancer, INSEC trial concept

BackgroundUp to the present time, there has remained a lack of strong evidence as to whether sentinel lymph node biopsy can replace lymphadenectomy for early endometrial cancer. The traditional surgery for endometrial cancer includes pelvic lymphadenectomy and paraaortic lymph node resection, but complications often seriously affect patients’ quality of life. Two randomized controlled trials with large samples have proved that lymphadenectomy does not improve the overall recurrence rate and survival rate of patients. On the contrary, it increases the incidence of complications and even mortality. The current trial is designed to clarify whether sentinel lymph node biopsy can replace lymphadenectomy for early endometrial cancer patients with negative lymph nodes.MethodsThis study is a randomized, open-label, multicenter and non-inferiority controlled clinical trial in China. Potential participants will be patients with pathologically confirmed endometrial cancer at the Zhejiang Cancer Hospital, Jiaxing Maternity and Child Health Care Hospital, and the First Hospital of Jiaxing in China. The total sample size for this study is 722.Patients will be randomly assigned in a 1:1 ratio to two groups. Patients in one group will undergo sentinel lymph node biopsy + total hysterectomy + bilateral salpingo-oophorectomy ± paraaortic lymph node resection. Patients in the other group will undergo sentinel lymph node biopsy + total hysterectomy + bilateral salpingo-oophorectomy + pelvic lymphadenectomy ± paraaortic lymph node resection. The 3-year disease-free survival rate, overall survival rate, quality of life (use EORTC QLQ-C30 + QLQ-CX24), and perioperative related indexes of the two groups will be compared.ResultsWe expect to find that for patients with early endometrial cancer, the 3-year disease-free survival rate following sentinel lymph node biopsy with indocyanine green combined with near-infrared fluorescence imaging is similar to that following lymphadenectomy. The operation time, as well as incidence of pelvic lymphocyst, lymphedema of lower limb, and edema of vulva in patients who only undergo sentinel lymph node biopsy are expected to be significantly lower than in patients who undergo lymphadenectomy. The quality of life of patients who undergo sentinel lymph node biopsy alone will be significantly better than that of patients who undergo lymph node dissection.ConclusionThis will prove that the prognosis of sentinel lymph node biopsy alone with indocyanine green combined with near-infrared fluorescence imaging is not inferior to that of sentinel lymph node biopsy plus lymphadenectomy for early stage endometrial cancer with negative nodal assessment intraoperatively. In addition, sentinel lymph node biopsy alone with indocyanine green combined with near-infrared fluorescence imaging results in fewer surgical complications and gives patients better quality of life.Trial registrationchictr.org.cn, ChiCTR1900023161. Registered 14 May 2019, http://www.chictr.org.cn/edit.aspx?pid=38659&htm=4.

Abstract B076: Influence of residential segregation and women’s health provider density on advanced stage endometrial cancer diagnoses

Abstract Background. Endometrial cancer (EC) is the most common gynecologic malignancy in the US, with an increasing incidence. Non-Hispanic Black (NHB) women are disproportionately impacted by EC but the complex mechanisms by which this is occurring are not yet fully understood. Taking a social ecological approach to this issue, our objective was to determine if there are associations between county-level OB-GYN provider density and residential segregation as measured by the Index of Concentration at the Extremes (ICE) on late-stage EC diagnoses in Florida. Methods. All malignant EC cases were identified from 2001 to 2016 in the Florida Cancer Database System (FCDS). Using 5-year estimates from the 2013-2017 American Community Survey, five county-level ICE variables were calculated: economic (high vs low), race and/or ethnicity (non-Hispanic white (NHW) vs. NHB and NHW vs. Hispanic), and racialized economic segregation (low-income NHB vs. high-income NHW and low-income Hispanic vs. high-income NHW). County-level provider density was calculated as the number of OB-GYN providers divided by the female population of each county multiplied by 100,000. Early stage was defined as local and late stage was defined as regional/distant. Multivariable-adjusted logistic regression models were specified to estimate the association between each ICE variable and provider density separately on late-stage diagnosis of EC. Results. There were a total of 50,363 EC cases in Florida from 2001 to 2016 with 44,678 (88.7%) having stage information. Of those with stage information, the mean age at diagnosis was 64.1 years (SD: 11.9), 71.8% were NHW, 11.5% were NHB, 14.0% were Hispanic, and 2.8% were other race. The majority of individuals had government insurance (50.6%). More NHB women (27.1%) were diagnosed with aggressive EC histologies relative to NHW (16.4%) and Hispanic women (15.5%) (p<0.001). 14,366 (32.2%) were diagnosed with late-stage EC. A larger proportion of NHB women were diagnosed with later-stage EC compared to NHW women and Hispanic women (43.7% vs. 30.3% and 32.4%, respectively, p<0.001). NHB and Hispanic women had significantly greater odds of being diagnosed with later-stage EC compared to NHW women, regardless of residential segregation (OR: 1.46, 95% CI: 1.36, 1.56 and OR: 1.09, 95% CI: 1.01, 1.17, respectively). Women living in more economically disadvantaged Hispanic segregated counties had a greater odds of being diagnosed with later-stage EC compared to those living in more NHW segregated areas (OR: 1.16, 95% CI: 1.00, 1.65). Provider density was not found to be associated with later-stage diagnosis. Discussion. Advanced stage EC at diagnosis among Black and Hispanic women in Florida seems to be largely independent of provider density and residential segregation, though NHB more commonly present with metastatic disease. Biologic drivers of oncogenesis and barriers to timely care in this group require further exploration. Given the diversity and representation from Afro-Caribbeans in Florida, community-level investigations are required. Citation Format: Ashly Westrick, Zinzi Bailey, Matthew Schlumbrecht. Influence of residential segregation and women’s health provider density on advanced stage endometrial cancer diagnoses [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B076.

Retroperitoneal sentinel lymph node biopsy by transvaginal natural orifice transluminal endoscopic surgery in early stage endometrial cancer: a video

Retroperitoneal sentinel lymph node biopsy by transvaginal natural orifice transluminal endoscopic surgery in early stage endometrial cancer: a video

The progress and prospect of sentinel lymph node mapping in endometrial carcinoma

Sentinel lymph node (SLN) refers to the initial site of the lymphatic drainage from a primary tumor area. Identifying the SLN and analyzing tumor involvement can predict the status of the remaining lymph nodes. Accordingly, sentinel lymph node mapping (SLN mapping) has been brought up and widely applied to cancer therapy for its illuminating role in clinical lymph node resection. Sufficient information to guide surgical pathological staging and adjuvant treatment in endometrial cancer can be rendered by SLN mapping, hence minimizing surgery injury and reducing the incidence of complications. Evidence suggests that using SLN mapping does not affect progression-free survival (PFS) and overall survival (OS) of endometrial cancer patients. Furthermore, there is increasing evidence that using SLN mapping has a high detection rate (DR), sensitivity, and negative predictive value (NPV) for patients with early-stage lower-risk endometrial cancer. This review aims to systematically summarize the advances and application prospects of SLN mapping in endometrial cancer, with an expectation of furnishing reference for the clinical application.

A Review of Laparoscopic Para-aortic Lymphadenectomy for Early-stage Endometrial Cancer: Extraperitoneal Approach May Have the Advantage over Intraperitoneal Approach.

The importance of lymphadenectomy, including para-aortic nodes, for the accurate staging of endometrial cancer, is well established. Although the therapeutic role of lymph node resection in endometrial cancer is still under debate, some studies support its usefulness for survival benefit. To predict the necessity of lymphadenectomy, several preoperative scoring systems have been proposed as being effective. For endometrial cancer, there is a trend towards minimally invasive surgery, including para-aortic lymphadenectomy. For para-aortic lymphadenectomy, there are two different approaches: the extraperitoneal approach and the transperitoneal approach. The extraperitoneal approach has advantages over the transperitoneal approach in terms of better access to the left aortic nodes, no interference of the bowel, and possibly better options for obese or elderly patients. However, the extraperitoneal approach may have a longer learning curve than the transperitoneal approach. Robot-assisted extraperitoneal para-aortic lymphadenectomy is feasible and safe and may be suitable for patients irrespective of their baseline characteristics.

Elevated preoperative hemoglobin A1c is associated with higher stage and grade of endometrial carcinoma

Introduction: The incidence of endometrial cancer (EC) and diabetes mellitus has been linked in many studies. EC patients had more severely impaired glucose tolerance than individuals with other malignancies. An indicator that determines glycemic index control is hemoglobin A1c (HbA1c). This study aimed to assess whether the preoperative level of HbA1c in diabetes mellitus patients is related to the stage and grade of endometrial carcinoma. Methods: This cross-sectional study uses a retrospective observational analytic design. Diabetes mellitus patients diagnosed with EC and measured for HbA1c levels in Dr. Kariadi General Hospital Semarang from January 2018 to December 2021 were involved as the subjects of this study. The data was analyzed using correlation analysis and linear regression analysis. A value of p<0.05 was used to determine the statistical significance. Results: This study involved 27 EC patients who had preoperative HbA1c data. The overall average HbA1c was 7.88±1.35 in the early-stage group and 10.85±1.15 in the advanced-stage group, significantly different between groups (p<0.001). There was also a significant difference between HbA1c in low-grade and high-grade tumors (p<0.001). With an increase of HbA1c in one unit value, the endometrial carcinoma stage also increases by 0.323 units or 32.3%, while the grade of endometrial carcinoma also increases by 0.275 units or 27.5%. Conclusion: HbA1c level significantly correlates with both the stage and grade of EC. This study also found a linear relationship between increased HbA1c levels and higher stage and grade of EC, indicating that HbA1c levels influence the stage and grade of endometrial carcinoma.

Intraluminal tumor cells and prognostic accuracy of endometrial cancer stage criteria: A multi-institution study

ObjectiveEndometrial cancer stage is a strong prognostic factor; however, the current stage classification does not incorporate transtubal spread as determined by intraluminal tumor cells (ILTCs). We examined relationships between ILTCs and survival outcomes according to histological subtype and stage and examined whether identification of ILTCs improves prognostic accuracy of endometrial cancer staging. MethodsWe conducted a retrospective cohort study of women diagnosed with endometrial cancer at five academic hospitals between 2007 and 2012. Pathologists determined ILTC presence (no vs. yes) and location (free in lumen vs. attached to epithelial surface) based on pathology review of hematoxylin and eosin-stained sections of fallopian tubes. Associations between ILTCs with time to recurrence (TTR) and overall survival (OS) were examined with Cox proportional hazards models adjusted for other prognostic factors. Model discrimination metrics were used to assess the addition of ILTCs to stage for prediction of 5-year TTR and OS. ResultsIn the overall study population (N = 1303), ILTCs were not independently associated with TTR (HR = 0.95, 95% CI = 0.69–1.32) or OS (HR = 0.97, 95% CI = 0.72–1.31). Among 805 women with stage I disease, ILTCs were independently associated with worse TTR (HR = 2.31, 95% CI = 1.06–5.05) and OS (HR = 2.16, 95% CI = 1.14–4.11). Upstaging early-stage cases with ILTCs present did not increase model discrimination. ConclusionWhile our data do not suggest that endometrial cancer staging guidelines should be revised to include ILTCs, associations between ILTCs and reduced survival observed among stage I cases suggest this tumor feature holds clinical relevance for subgroups of endometrial cancer patients.

Comparing Surgical and Oncological Outcomes between Indocyanine Green (ICG) Sentinel Lymph Node Mapping with Routine Lymphadenectomy in the Surgical Staging of Early-Stage Endometrioid Endometrial Cancer.

A retrospective single-centre cohort study of patients with early-stage endometrioid endometrial cancer undergoing staging surgery (total hysterectomy, bilateral salpingo-oophorectomy with/without pelvic lymph node, and/or para-aortic lymph node dissection (PLND)) with either SLN mapping or routine lymphadenectomy between July 2017 and December 2018. 203 cases with clinical and radiological International Federation of Gynaecology and Obstetrics (FIGO) stage I endometrioid endometrial cancer were included, out of which 109 cases underwent SLN mapping and 94 cases complete lymphadenectomy. Compared to the PLND group, the SLN group had shorter operative time (129 vs. 162 minutes), less blood loss (100 vs. 300 ml), and decreased length of postoperative hospital stay (3 vs. 4 days) (p < 0.001). The lymph node metastases detection rate was 4.6% and 7.4% for the SLN and PLND groups, respectively (p = 0.389). With a median follow-up of 14 months for the SLN and 15 months for the PLND group, the disease-free (DFS) and overall survival (OS) were comparable for both at 13 months (p = 0.538 and p = 0.333, respectively). SLN mapping has been shown to be an acceptable alternative to routine lymphadenectomy in the surgical staging of early-stage endometrial cancer in our centre, with a comparable lymph node metastases detection rate, DFS and OS, and reduction in operative morbidity. Our results with SLN mapping reproduce comparable outcomes to those reported in the literature.