Redefining Stage I Endometrial Cancer: Incorporating Histology, a Binary Grading System, Myometrial Invasion, and Lymph Node Assessment
Barlin, Joyce N.
Soslow, Robert A.
Zhou, Qin C.
St Clair, Caryn M.
Leitao, Mario M.
Hensley, Martee L.
Barakat, Richard R.
Abu-Rustum, Nadeem R.
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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).
Is part ofInternational Journal of Gynecological Cancer, 2013, vol. 23, núm. 9, p. 1620–1628
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