J Gynecol Oncol.  2017 Nov;28(6):e78. 10.3802/jgo.2017.28.e78.

Comparison of three different risk-stratification models for predicting lymph node involvement in endometrioid endometrial cancer clinically confined to the uterus

• Korkmaz V
• Meydanli M
• Yalçın I
• Sarı ME
• Sahin H
• Kocaman E
• Haberal A
• Dursun P
• Güngör T
• Ayhan A

• KMID: 2413204
• DOI: http://doi.org/10.3802/jgo.2017.28.e78

Abstract

OBJECTIVE
To compare the clinical validity of the Gynecologic Oncology Group-99 (GOG-99), the Mayo-modified and the European Society for Medical Oncology (ESMO)-modified criteria for predicting lymph node (LN) involvement in women with endometrioid endometrial cancer (EC) clinically confined to the uterus.
METHODS
A total of 625 consecutive women who underwent comprehensive surgical staging for endometrioid EC clinically confined to the uterus were divided into low- and high-risk groups according to the GOG-99, the Mayo-modified, and the ESMO-modified criteria. Lymphovascular space invasion is the cornerstone of risk stratification according to the ESMO-modified criteria. These 3 risk stratification models were compared in terms of predicting LN positivity.
RESULTS
Systematic LN dissection was achieved in all patients included in the study. LN involvement was detected in 70 (11.2%) patients. LN involvement was correctly estimated in 51 of 70 LN-positive patients according to the GOG-99 criteria (positive likelihood ratio [LR+], 3.3; negative likelihood ratio [LR−], 0.4), 64 of 70 LN-positive patients according to the ESMO-modified criteria (LR+, 2.5; LR−, 0.13) and 69 of the 70 LN-positive patients according to the Mayo-modified criteria (LR+, 2.2; LR−, 0.03). The area under curve of the Mayo-modified, the GOG-99 and the ESMO-modified criteria was 0.763, 0.753, and 0.780, respectively.
CONCLUSION
The ESMO-modified classification seems to be the risk-stratification model that most accurately predicts LN involvement in endometrioid EC clinically confined to the uterus. However, the Mayo-modified classification may be an alternative model to achieve a precise balance between the desire to prevent over-treatment and the ability to diagnose LN involvement.

Keyword

Carcinoma, Endometrioid; Endometrial Neoplasms; Lymph Node; Metastasis

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Endometrioid/*pathology/surgery
Endometrial Neoplasms/*pathology/surgery
Female
Humans
Likelihood Functions
Lymph Node Excision
Lymph Nodes/*pathology
Lymphatic Metastasis
Middle Aged
Neoplasm Invasiveness
Neoplasm Staging
Reproducibility of Results
Retrospective Studies
Risk Assessment/*methods