ENDOMETRiYAL KANSERİN PROGNOSTiK FAKTÖRLERİ ÜZERİNDE TÜMÖRSÜZ MESAFENİN ETKİSİ

Year 2024, Volume: 25 Issue: 3, 289 - 294, 18.07.2024

Hasan Beyhekim Fazıl Avcı , Tolgay Tuyan İlhan , Mustafa Gazi Uçar , Ayşegül Kebapçılar , Setenay Yılmaz , Özlem Seçilmiş , Aybike Tazegul , Fatma Beyhekim , Cetin Celik

https://doi.org/10.18229/kocatepetip.1310180

Abstract

AMAÇ: Endometrial kanserin (EK) prognostik faktörlerinde tümörsüz mesafenin (TFD) önemini değerlendirmeyi ve ileri evre EK'ni öngörmek için en iyi TFD cut-off değerini belirlemeyi amaçladık.
GEREÇ VE YÖNTEM: Bu çalışmaya EK tanısı alan 153 olgu dahil edildi. Myometriyal invazyonun derinliği (DOI) ve TFD ölçüldü ve EK için prognostik faktörler ile DOI ve TFD arasındaki ilişkiler değerlendirildi.
BULGULAR: TFD ve DOI'nin ortalama ± standart sapma değerleri sırasıyla 12 ± 6 ve 7 ± 6 mm olarak hesaplandı. TFD ve DOI, lenf nodu (LN) metastazı, lenfovasküler alan invazyonu (LVSI) ve servikal tutulum ile anlamlı şekilde ilişkiliydi. Daha kısa TFD, daha yüksek tümör grade, pozitif sitoloji ve LVSI ile anlamlı şekilde ilişkiliydi. Daha kısa DOI, LN metastazı ve servikal tutulum ile anlamlı şekilde ilişkiliydi. ROC eğrisi analizinde, LN metastazı için optimal TFD cut-off değerinin %48 olduğunu gösterildi ve %47'lik DOI, LN metastazı için en iyi sensitivite ve spesifiteye sahipti.
SONUÇ: TFD, DOI ile karşılaştırıldığında LVSI'yi öngörmede daha üstün iken DOI, LN metastazını öngörmede iyi bir tanısal performans gösterdi. Endometriyal kanserin prognostik faktörleri üzerinde TFD ve DOI’nin etkisini öngörmede daha fazla çalışmalara ihtiyaç vardır.

Keywords

Endometrial kanser, Lenfatik metastaz, Miyometrium, Prognoz

THE EFFECT OF TUMOR FREE DISTANCE ON THE PROGNOSTIC FACTORS OF ENDOMETRIAL CANCER

Abstract

OBJECTIVE: We aimed to evaluate the importance of tumor-free distance (TFD) in prognostic factors of endometrial cancer (EC) and determine the best TFD cut-off value for predicting advanced EC.
MATERIAL AND METHODS: This study included 153 patients diagnosed with EC. The depth of myometrial invasion (DOI) and TFD were measured, and the associations between prognostic factors for EC and DOI and TFD were evaluated.
RESULTS: The mean ± standard deviation values of TFD and DOI were 12 ± 6 and 7 ± 6 mm, respectively. TFD and DOI were significantly related to lymph node (LN) metastasis, lymphovascular space invasion (LVSI) and cervical involvement. A shorter TFD was significantly associated with a higher tumor grade, positive cytology and LVSI. Shorter DOI was significantly associated with LN metastasis and cervical involvement. A receiver operating characteristics curve analysis demonstrated that the optimal TFD cut-off value was 48% for LN metastasis. A DOI of 47% had the best sensitivity and specificity for LN metastasis.
CONCLUSIONS: TFD was superior for predicting LVSI as compared to DOI, whereas DOI showed good diagnostic performance for predicting LN metastasis. Further studies are needed to predict the effect of TFD and DOI on the prognostic factors of endometrial cancer.

Keywords

Endometrial cancer, Lymphatic metastasis, Myometrium, Prognosis.

Supporting Institution

None

References

• 1. Siegel RL MK, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021 Jan;71(1):7-33.
• 2. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49.
• 3. Leslie KK TK, Goodheart MJ, De Geest K, Jia Y, Yang S. Endometrial cancer. Obstet Gynecol Clin North Am. 2012;39(2):255-68.
• 4. Crosbie EJ KS, McAlpine JN, Mukhopadhyay A, Powell ME, Singh N. Endometrial cancer. Lancet. 2022;9:399(10333):1412-28.
• 5. Roguz S, Krowiranda KW, Michalski T, Bieńkiewicz A. Histological grading of endometrial carcinoma. Clinical and patomorphological analysis. Ginekol Pol. 2015;86(5):340-5.
• 6. Solmaz U, Mat E, Dereli ML et al. Stage-III and -IV endometrial cancer: A single oncology centre review of 104 cases. J Obstet Gynaecol. 2016;36(1):81-6.
• 7. Amant F MP, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. Lancet. 2005;6- 12:366(9484):491-505.
• 8. Hamilton CA, Pothuri B, Arend RC et al. Endometrial cancer: A society of gynecologic oncology evidence- based review and recommendations. Gynecol Oncol. 2021;160(3):817-26.
• 9. Creasman W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet. 2009;105(2):109.
• 10. Dowdy SC, Borah BJ, Bakkum-Gamez JN et al. Prospective assessment of survival, morbidity, and cost associated with lymphadenectomy in low-risk endometrial cancer. Gynecol Oncol. 2012;127(1):5-10.
• 11. Cole AJ, Quick CM. Patterns of myoinvasion in endometrial adenocarcinoma: recognition and implications. Adv Anat Pathol. 2013;20(3):141-7.
• 12. van der Putten LJ, van de Vijver K, Bartosch C et al. Reproducibility of measurement of myometrial invasion in endometrial carcinoma. Virchows Arch. 2017;470(1):63-8.
• 13. Koskas M RR, Amant F. Staging for endometrial cancer: The controversy around lymphadenectomy - Can this be resolved? Best Pract Res Clin Obstet Gynaecol. 2015;29(6):845-57.
• 14. Bilgi A GA, Kulhan M, Ateş MC , Keser Şahin HH, Celik, C. The effect of myometrial invasion and histological grade on lymph node metastasis in patient with early stage endometrium cancer . Journal of Health Sciences and Medicine. 2021; 4 (5): 552-6.
• 15. Wang J, Xu P, Yang X et al. Association of Myometrial Invasion With Lymphovascular Space Invasion, Lymph Node Metastasis, Recurrence, and Overall Survival in Endometrial Cancer: A Meta-Analysis of 79 Studies With 68,870 Patients. Front Oncol. 2021;11:762329.
• 16. Morrison J, Balega J, Buckley L, et al. British Gynaecological Cancer Society (BGCS) Uterine Cancer Guidelines: Recommendations for Practice. Eur J Obstet Gynecol Reprod Biol. 2022;270:50–89.
• 17. Creutzberg CL, Nout RA, Lybeert ML, et al. PORTEC Study Group. Fifteen-year radiotherapy outcomes of the randomized PORTEC-1 trial for endometrial carcinoma. Int J Radiat Oncol Biol Phys. 2011;15:81(4):631-8.
• 18. Koskas M AF, Mirza MR, Creutzberg CL. Cancer of the corpus uteri: 2021 update. Int J Gynaecol Obstet. 2021;155:45-60.
• 19. Kaku T, Tsuruchi N, Tsukamoto N, Hirakawa T, Kamura T, Nakanu H. Reassessment of myometrial invasion in endometrial carcinoma. Obstet Gynecol. 1994;84(6):979–82.
• 20. Ali A, Black D, Soslow RA. Difficulties in assessing the depth of myometrial invasion in endometrial carcinoma. Int J Gynecol Pathol. 2007;26(2):115–23.
• 21. Lindauer J, Fowler JM, Manolitsas TP et al. Is there a prognostic difference between depth of myometrial invasion and the tumor-free distance from the uterine serosa in endometrial cancer? Gynecol Oncol. 2003;91(3):547-51.
• 22. Chattopadhyay S GK, Patel A, Fisher A, Nayar A, Cross P, et al. Tumour-free distance from serosa is a better prognostic indicator than depth of invasion and percentage myometrial invasion in endometrioid endometrial cancer. BJOG. 2012;119(10):1162-70.
• 23. Geels YP, Pijnenborg JM, van den Berg-van Erp SH, Snijders MP, Bulten J, Massuger LF. Absolute depth of myometrial invasion in endometrial cancer is superior to the currently used cut-off value of 50%. Gynecol Oncol. 2013;129(2):285-91.
• 24. Ozbilen O, Sakarya DK, Bezircioglu I, Kasap B, Yetimalar H, Yigit S. Comparison of myometrial invasion and tumor free distance from uterine serosa in endometrial cancer. Asian Pac J Cancer Prev. 2015; 16(2):519-22.
• 25. Lee KB, Ki KD, Lee JM, et al. The risk of lymph node metastasis based on myometrial invasion and tumor grade in endometrioid uterine cancers: a multicenter, retrospective Korean study. Ann Surg Oncol. 2009;16(10):2882-7.
• 26. Kondalsamy-Chennakesavan S, van Vugt S, Sanday K et al. Evaluation of tumor-free distance and depth of myometrial invasion as prognostic factors for lymph node metastases in endometrial cancer. Int J Gynecol Cancer. 2010;20(7):1217-21.
• 27. Doghri R CS, Houcine Y, Charfi L, et al. Evaluation of tumor-free distance and depth of myometrial invasion as prognostic factors in endometrial cancer. Mol Clin Oncol. 2018;9(1):87-91.
• 28. Schwab KV, O'Malley DM, Fowler JM, Copeland LJ, Cohn DE. Prospective evaluation of prognostic significance of the tumor-free distance from uterine serosa in surgically staged endometrial adenocarcinoma. Gynecol Oncol. 2009;112(1):146-9.
• 29. Oge T CD, Cakmak Y, Arık D. Is Tumor-Free Distance an Independent Prognostic Factor for Early-Stage Endometrioid Endometrial Cancer? J Oncol. 2020;14:2020:2934291.
• 30. Pergialiotis V, Zachariou E, Vlachos DE, et al. Tumor free distance from serosa and survival rates of endometrial cancer patients: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2023;8:286:16-22.