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Comparison of Myometrial Invasion and Tumor Free Distance from Uterine Serosa in Endometrial Cancer

  • Ozbilen, Ozlem ;
  • Sakarya, Derya Kilic ;
  • Bezircioglu, Incim ;
  • Kasap, Burcu ;
  • Yetimalar, Hakan ;
  • Yigit, Seyran
  • Published : 2015.02.25

Abstract

Background: We aimed to investigate whether the tumor free distance (the distance between the uterine serosa and the tumor at its deepest point) is useful in surgical staging and in predicting prognosis. Materials and Methods: Data from patients who underwent complete surgical staging for endometrial cancer between January 2006 and June 2011 were reviewed retrospectively. All demographic findings, surgical stages, histological type and grade, myometrial invasion, lymphovascular space invasion as well as abdominal cytology, cervical, adnexal, and omental involvement, and lymph node metastasis were recorded. The relations between myometrial invasion and tumor free distance from uterine serosa with prognostic factors were investigated. Results: Seventy patients were included in the study. Sixty-four (91.5%) had endometrioid type cancers and forty-four (62.9%) were grade 1. The deepest myometrial invasion was less than 1/2 in 42 patients (60%). In 18 patients (25.8%) lymphovascular invasion was noted. Eight (11.4%) were found to have cervical involvement, five (7.1%) had adnexal involvement and in 4 cases (5.7%) the peritoneal washings included malignant cells. Four patients had pelvic and one para-aortic node metastasis. We recognized that an invasion of more than 1/2 was correlated significantly with lymphovascular space involvement, histological grade, positive abdominal washing cytology, nodal and cervical involvement, but not with adnexal involvement. Tumor-free myometrial thickness was negative and statistically significant correlated with surgical stage, histological grade, lymphovascular space involvement, positive abdominal washing cytology, cervical and adnexal involvement. The importance of tumor-free myometrial thickness in determinating the lymphovascular space invasion was found to be highest in terms of sensitivity and specificity when crossing the ROC curve at 11 millimeters. Conclusions: Depth of myometrial invasion is more valuable for predicting lymph node metastasis than tumor-free myometrial thickness. The tumor-free myometrial thickness provides a better prediction for adnexal involvement.

Keywords

Endometrium cancer;myometrial invasion;tumor-free distance;cancer staging;prognosis

References

  1. Bertelsen K, Ortoft G, Hansen E (2011). Survival of Danish patients with endometrial cancer in the intermediate-risk group not given postoperative radiotherapy: the Danish Endometrial Cancer Study (DEMCA). Int J Gynecol Cancer, 2, 1191-9.
  2. Cetinkaya K, Atalay F, Bacinoglu A (2014). Risk factors of lymph node metastasis with endometrial carcinoma. Asian Pac J Cancer Prev, 15, 6353-6. https://doi.org/10.7314/APJCP.2014.15.15.6353
  3. Chattopadhyay S, Galaal K, Patel A, et al (2012). Tumor-free distance from serosa is a beter prognostic indicator than depth of invasion and percentage myometrial invasion in endometrioid endometrial cancer. BJOG, 119, 1162-70. https://doi.org/10.1111/j.1471-0528.2012.03427.x
  4. Dinkelspiel HE, Wright JD, Lewin SN, Herzog TJ (2013). Contemporary clinical management of endometrial cancer. Obstet Gynecol Int, 2013, 583891.
  5. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917. https://doi.org/10.1002/ijc.25516
  6. Geels YP, Pijnenborg JM, van den Berg-van Erp SH, et al (2013). Absolute depth of myometrial invasion in endometrial cancer is superior to the currently used cut-off value of 50%. Gynecol Oncol, 129, 285-91. https://doi.org/10.1016/j.ygyno.2013.02.013
  7. Jaishuen A, Kunakornporamat K, Viriyapak B, et al (2014). Incidence and clinical outcomes of non-endometrioid carcinoma of endometrium: Siriraj Hospital experience. Asian Pac J Cancer Prev, 15, 2905-9. https://doi.org/10.7314/APJCP.2014.15.6.2905
  8. Kondalsamy-Chennaksavan S, van Vugt S, Sanday K, et al (2010). Evaluation of tumor-free distance and depth of myometrial invasion as prognostic factors for lymph node metastasis in endometrial cancer. Int J Gynecol Cancer, 20, 1217-21. https://doi.org/10.1111/IGC.0b013e3181ef0a31
  9. Lee KB, Kim KD, Lee JM, et al (2009). 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, 16, 2882-7. https://doi.org/10.1245/s10434-009-0535-0
  10. Quick CM, May T, Horowitz NS, Nucci MR (2012). Low-grade, low-stage endometrioid endometrial adenocarcinoma: a clinicopathologic analysis of 324 cases focusing on frequency and pattern of myoinvasion. Int J Gynecol Pathol, 31, 337-43. https://doi.org/10.1097/PGP.0b013e31823ff422
  11. Rahatli S, Dizdar O, Kucukoztas N, et al (2014). Good outcomes of patients with stage IB endometrial cancer with surgery alone. Asian Pac J Cancer Prev, 15, 3891-3. https://doi.org/10.7314/APJCP.2014.15.9.3891
  12. Schwab KV, O'Malley DM, Fowler JM, Copeland LJ, Cohn DE (2009). Prospective evaluation of prognostic significance of tumor-free distance from uterine serosa in surgically staged endometrial adenocarcinoma. Gynecol Oncol, 112, 146-9. https://doi.org/10.1016/j.ygyno.2008.09.009
  13. Siegel R, Naishadham D, Jemal A (2013). Cancer statistics. CA Cancer J Clin, 63, 11-30. https://doi.org/10.3322/caac.21166
  14. Sorosky JI (2012). Endometrial cancer. Obstet Gynecol, 120, 383-97. https://doi.org/10.1097/AOG.0b013e3182605bf1
  15. Vargas R, Rauh-Hain JA, Clemmer J, et al (2014). Tumor size, depth of invasion, and histologic grade as prognostic factors of lymph node involvement in endometrial cancer: a SEER analysis. Gynecol Oncol, 133, 216-20. https://doi.org/10.1016/j.ygyno.2014.02.011
  16. Wright JD, Barrena Medel NI, Sehouli J, Fujiwara K, Herzog TJ (2012). Contemporary management of endometrial cancer. Lancet, 379, 1352-60. https://doi.org/10.1016/S0140-6736(12)60442-5