Redefining stage I endometrial cancer: Incorporating histology, a binary grading system, myometrial invasion, and lymph node assessment Journal Article
| Authors: | Barlin, J. N.; Soslow, R. A.; Lutz, M.; Zhou, Q. C.; St. Clair, C. M.; Leitao, M. M. Jr; Iasonos, A.; Hensley, M. L.; Barakat, R. R.; Matias-Guiu, X.; Abu-Rustum, N. R. |
| Article Title: | Redefining stage I endometrial cancer: Incorporating histology, a binary grading system, myometrial invasion, and lymph node assessment |
| Abstract: | Objective: We propose a new staging system for stage I endometrial cancer and compare its performance to the 1988 and 2009 International Federation of Gynecology and Obstetrics (FIGO) systems. Methods: We analyzed patients with 1988 FIGO stage I endometrial cancer from January 1993 to August 2011. Low-grade carcinoma consisted of endometrioid grade 1 to grade 2 lesions. High-grade carcinoma consisted of endometrioid grade 3 or nonendometrioid carcinomas (serous, clear cell, and carcinosarcoma). The proposed system is as follows: IA. Low-grade carcinoma with less than half myometrial invasion IA1: Negative nodes IA2: No nodes removed IB. High-grade carcinoma with no myometrial invasion IB1: Negative nodes IB2: No nodes removed IC. Low-grade carcinoma with half or greater myometrial invasion IC1: Negative nodes IC2: No nodes removed ID. High-grade carcinoma with any myometrial invasion ID1: Negative nodes ID2: No nodes removed Results: Data from 1843 patients were analyzed. When patients were restaged with our proposed system, the 5-year overall survival significantly differed (P < 0.001): IA1, 96.7%; IA2, 92.2%; IB1, 92.2%; IB2, 76.4%; IC1, 83.9%; IC2, 78.6%; ID1, 81.1%; and ID2, 68.8%. The bootstrap-corrected concordance probability estimate for the proposed system was 0.627 (95% confidence interval, 0.590-0.664) and was superior to the concordance probability estimate of 0.530 (95% confidence interval, 0.516-0.544) for the 2009 FIGO system. Conclusions: By incorporating histological subtype, grade, myometrial invasion, and whether lymph nodes were removed, our proposed system for stage I endometrial cancer has a superior predictive ability over the 2009 FIGO staging system and provides a novel binary grading system (low-grade including endometrioid grade 1-2 lesions; high-grade carcinoma consisting of endometrioid grade 3 carcinomas and nonendometrioid carcinomas). Copyright © 2013 by IGCS and ESGO. |
| Keywords: | adult; cancer survival; major clinical study; overall survival; cancer staging; follow up; endometrial cancer; endometrioid carcinoma; endometrium carcinoma; endometrium cancer; practice guideline; reference database; histology; lymph node; age distribution; clear cell carcinoma; figo; carcinosarcoma; tumor invasion; stage i; human; female; priority journal; article |
| Journal Title: | International Journal of Gynecological Cancer |
| Volume: | 23 |
| Issue: | 9 |
| ISSN: | 1048-891X |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2013-11-01 |
| Start Page: | 1620 |
| End Page: | 1628 |
| Language: | English |
| DOI: | 10.1097/IGC.0b013e3182a5055e |
| PROVIDER: | scopus |
| PUBMED: | 24126219 |
| PMCID: | PMC4405774 |
| DOI/URL: | |
| Notes: | Export Date: 2 January 2014 -- CODEN: IJGCE -- Source: Scopus |
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