Redefining Stage I Endometrial Cancer: Incorporating Histology, a Binary Grading System, Myometrial Invasion, and Lymph Node Assessment

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2013Author
Barlin, Joyce N.
Soslow, Robert A.
Lutz, Megan
Zhou, Qin C.
St Clair, Caryn M.
Leitao, Mario M.
Iasonos, Alexia
Hensley, Martee L.
Barakat, Richard R.
Abu-Rustum, Nadeem R.
Suggested citation
Barlin, Joyce N.;
Soslow, Robert A.;
Lutz, Megan;
Zhou, Qin C.;
St Clair, Caryn M.;
Leitao, Mario M.;
...
Abu-Rustum, Nadeem R..
(2013)
.
Redefining Stage I Endometrial Cancer: Incorporating Histology, a Binary Grading System, Myometrial Invasion, and Lymph Node Assessment.
International Journal of Gynecological Cancer, 2013, vol. 23, núm. 9, p. 1620–1628.
https://doi.org/10.1097/IGC.0b013e3182a5055e.
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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).
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International Journal of Gynecological Cancer, 2013, vol. 23, núm. 9, p. 1620–1628European research projects
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