Preoperative assessment of lymph node metastasis in endometrial cancer: A Korean Gynecologic Oncology Group study

Sokbom Kang, Joo Hyun Nam, Duk Soo Bae, Jae Weon Kim, Moon Hong Kim, Xiaojun Chen, Jae Hong No, Jong Min Lee, Jae Hoon Kim, Hidemich Watari, Seok Mo Kim, Sung Hoon Kim, Seok Ju Seong, Ki Tae Kim, Seung Cheol Kim, Jong Hyeok Kim, Myung Cheol Lim, Jung Yun Lee, Sang Young Ryu, Bingyi YangByoung Gie Kim

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND: Previously proposed criteria for preoperatively identifying endometrial cancer patients at low risk for lymph node metastasis remain to be verified. For this purpose, a prospective, multicenter observational study was performed. METHODS: Eligible patients with histologically confirmed endometrial cancer underwent magnetic resonance imaging (MRI) and serum cancer antigen 125 (CA 125) testing before surgery. The following criteria were used to identify low-risk patients: 1) endometrioid-type cancer, 2) no evidence of deep myometrial invasion on MRI, 3) no enlarged lymph nodes on MRI, 4) no suspicious metastasis out of the uterine corpus, and 5) serum CA 125 levels less than 35 U/mL. Systematic pelvic and/or para-aortic lymphadenectomy was performed for all patients. The primary endpoint was estimation of the negative predictive value (NPV). RESULTS: From January 2012 to December 2014, 529 patients from 20 hospitals in 3 Asian countries were consecutively enrolled. According to our criteria, 272 patients (51.4%) were categorized into the low-risk group. Fifty-three of the 529 patients (10.0%) had lymph node metastases; these patients included 8 (2.9%) falsely categorized as low-risk. The sensitivity and specificity of the criteria were 84.9% and 55.5%, respectively. The NPV of 97.1% was higher than the predefined target endpoint of 96%. CONCLUSIONS: The low-risk criteria based on preoperative tests were confirmed to be reliable and accurate for identifying patients at low risk for lymph node metastasis. These criteria may facilitate patient counseling and surgical decision making. Cancer 2017;123:263–272.

Original languageEnglish
Pages (from-to)263-272
Number of pages10
JournalCancer
Volume123
Issue number2
DOIs
Publication statusPublished - 2017 Jan 1

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Endometrial Neoplasms
Lymph Nodes
Neoplasm Metastasis
Magnetic Resonance Imaging
Neoplasms
Antigens
Lymph Node Excision
Serum
Multicenter Studies
Observational Studies
Counseling
Decision Making
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Kang, S., Nam, J. H., Bae, D. S., Kim, J. W., Kim, M. H., Chen, X., ... Kim, B. G. (2017). Preoperative assessment of lymph node metastasis in endometrial cancer: A Korean Gynecologic Oncology Group study. Cancer, 123(2), 263-272. https://doi.org/10.1002/cncr.30349
Kang, Sokbom ; Nam, Joo Hyun ; Bae, Duk Soo ; Kim, Jae Weon ; Kim, Moon Hong ; Chen, Xiaojun ; No, Jae Hong ; Lee, Jong Min ; Kim, Jae Hoon ; Watari, Hidemich ; Kim, Seok Mo ; Kim, Sung Hoon ; Seong, Seok Ju ; Kim, Ki Tae ; Kim, Seung Cheol ; Kim, Jong Hyeok ; Lim, Myung Cheol ; Lee, Jung Yun ; Ryu, Sang Young ; Yang, Bingyi ; Kim, Byoung Gie. / Preoperative assessment of lymph node metastasis in endometrial cancer : A Korean Gynecologic Oncology Group study. In: Cancer. 2017 ; Vol. 123, No. 2. pp. 263-272.
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title = "Preoperative assessment of lymph node metastasis in endometrial cancer: A Korean Gynecologic Oncology Group study",
abstract = "BACKGROUND: Previously proposed criteria for preoperatively identifying endometrial cancer patients at low risk for lymph node metastasis remain to be verified. For this purpose, a prospective, multicenter observational study was performed. METHODS: Eligible patients with histologically confirmed endometrial cancer underwent magnetic resonance imaging (MRI) and serum cancer antigen 125 (CA 125) testing before surgery. The following criteria were used to identify low-risk patients: 1) endometrioid-type cancer, 2) no evidence of deep myometrial invasion on MRI, 3) no enlarged lymph nodes on MRI, 4) no suspicious metastasis out of the uterine corpus, and 5) serum CA 125 levels less than 35 U/mL. Systematic pelvic and/or para-aortic lymphadenectomy was performed for all patients. The primary endpoint was estimation of the negative predictive value (NPV). RESULTS: From January 2012 to December 2014, 529 patients from 20 hospitals in 3 Asian countries were consecutively enrolled. According to our criteria, 272 patients (51.4{\%}) were categorized into the low-risk group. Fifty-three of the 529 patients (10.0{\%}) had lymph node metastases; these patients included 8 (2.9{\%}) falsely categorized as low-risk. The sensitivity and specificity of the criteria were 84.9{\%} and 55.5{\%}, respectively. The NPV of 97.1{\%} was higher than the predefined target endpoint of 96{\%}. CONCLUSIONS: The low-risk criteria based on preoperative tests were confirmed to be reliable and accurate for identifying patients at low risk for lymph node metastasis. These criteria may facilitate patient counseling and surgical decision making. Cancer 2017;123:263–272.",
author = "Sokbom Kang and Nam, {Joo Hyun} and Bae, {Duk Soo} and Kim, {Jae Weon} and Kim, {Moon Hong} and Xiaojun Chen and No, {Jae Hong} and Lee, {Jong Min} and Kim, {Jae Hoon} and Hidemich Watari and Kim, {Seok Mo} and Kim, {Sung Hoon} and Seong, {Seok Ju} and Kim, {Ki Tae} and Kim, {Seung Cheol} and Kim, {Jong Hyeok} and Lim, {Myung Cheol} and Lee, {Jung Yun} and Ryu, {Sang Young} and Bingyi Yang and Kim, {Byoung Gie}",
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Kang, S, Nam, JH, Bae, DS, Kim, JW, Kim, MH, Chen, X, No, JH, Lee, JM, Kim, JH, Watari, H, Kim, SM, Kim, SH, Seong, SJ, Kim, KT, Kim, SC, Kim, JH, Lim, MC, Lee, JY, Ryu, SY, Yang, B & Kim, BG 2017, 'Preoperative assessment of lymph node metastasis in endometrial cancer: A Korean Gynecologic Oncology Group study', Cancer, vol. 123, no. 2, pp. 263-272. https://doi.org/10.1002/cncr.30349

Preoperative assessment of lymph node metastasis in endometrial cancer : A Korean Gynecologic Oncology Group study. / Kang, Sokbom; Nam, Joo Hyun; Bae, Duk Soo; Kim, Jae Weon; Kim, Moon Hong; Chen, Xiaojun; No, Jae Hong; Lee, Jong Min; Kim, Jae Hoon; Watari, Hidemich; Kim, Seok Mo; Kim, Sung Hoon; Seong, Seok Ju; Kim, Ki Tae; Kim, Seung Cheol; Kim, Jong Hyeok; Lim, Myung Cheol; Lee, Jung Yun; Ryu, Sang Young; Yang, Bingyi; Kim, Byoung Gie.

In: Cancer, Vol. 123, No. 2, 01.01.2017, p. 263-272.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Preoperative assessment of lymph node metastasis in endometrial cancer

T2 - A Korean Gynecologic Oncology Group study

AU - Kang, Sokbom

AU - Nam, Joo Hyun

AU - Bae, Duk Soo

AU - Kim, Jae Weon

AU - Kim, Moon Hong

AU - Chen, Xiaojun

AU - No, Jae Hong

AU - Lee, Jong Min

AU - Kim, Jae Hoon

AU - Watari, Hidemich

AU - Kim, Seok Mo

AU - Kim, Sung Hoon

AU - Seong, Seok Ju

AU - Kim, Ki Tae

AU - Kim, Seung Cheol

AU - Kim, Jong Hyeok

AU - Lim, Myung Cheol

AU - Lee, Jung Yun

AU - Ryu, Sang Young

AU - Yang, Bingyi

AU - Kim, Byoung Gie

PY - 2017/1/1

Y1 - 2017/1/1

N2 - BACKGROUND: Previously proposed criteria for preoperatively identifying endometrial cancer patients at low risk for lymph node metastasis remain to be verified. For this purpose, a prospective, multicenter observational study was performed. METHODS: Eligible patients with histologically confirmed endometrial cancer underwent magnetic resonance imaging (MRI) and serum cancer antigen 125 (CA 125) testing before surgery. The following criteria were used to identify low-risk patients: 1) endometrioid-type cancer, 2) no evidence of deep myometrial invasion on MRI, 3) no enlarged lymph nodes on MRI, 4) no suspicious metastasis out of the uterine corpus, and 5) serum CA 125 levels less than 35 U/mL. Systematic pelvic and/or para-aortic lymphadenectomy was performed for all patients. The primary endpoint was estimation of the negative predictive value (NPV). RESULTS: From January 2012 to December 2014, 529 patients from 20 hospitals in 3 Asian countries were consecutively enrolled. According to our criteria, 272 patients (51.4%) were categorized into the low-risk group. Fifty-three of the 529 patients (10.0%) had lymph node metastases; these patients included 8 (2.9%) falsely categorized as low-risk. The sensitivity and specificity of the criteria were 84.9% and 55.5%, respectively. The NPV of 97.1% was higher than the predefined target endpoint of 96%. CONCLUSIONS: The low-risk criteria based on preoperative tests were confirmed to be reliable and accurate for identifying patients at low risk for lymph node metastasis. These criteria may facilitate patient counseling and surgical decision making. Cancer 2017;123:263–272.

AB - BACKGROUND: Previously proposed criteria for preoperatively identifying endometrial cancer patients at low risk for lymph node metastasis remain to be verified. For this purpose, a prospective, multicenter observational study was performed. METHODS: Eligible patients with histologically confirmed endometrial cancer underwent magnetic resonance imaging (MRI) and serum cancer antigen 125 (CA 125) testing before surgery. The following criteria were used to identify low-risk patients: 1) endometrioid-type cancer, 2) no evidence of deep myometrial invasion on MRI, 3) no enlarged lymph nodes on MRI, 4) no suspicious metastasis out of the uterine corpus, and 5) serum CA 125 levels less than 35 U/mL. Systematic pelvic and/or para-aortic lymphadenectomy was performed for all patients. The primary endpoint was estimation of the negative predictive value (NPV). RESULTS: From January 2012 to December 2014, 529 patients from 20 hospitals in 3 Asian countries were consecutively enrolled. According to our criteria, 272 patients (51.4%) were categorized into the low-risk group. Fifty-three of the 529 patients (10.0%) had lymph node metastases; these patients included 8 (2.9%) falsely categorized as low-risk. The sensitivity and specificity of the criteria were 84.9% and 55.5%, respectively. The NPV of 97.1% was higher than the predefined target endpoint of 96%. CONCLUSIONS: The low-risk criteria based on preoperative tests were confirmed to be reliable and accurate for identifying patients at low risk for lymph node metastasis. These criteria may facilitate patient counseling and surgical decision making. Cancer 2017;123:263–272.

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