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Predicting Lymph Node Metastasis in Endometrial Cancer Using Serum CA125 Combined with Immunohistochemical Markers PR and Ki67, and a Comparison with Other Prediction Models.

Yang B, Shan B, Xue X, Wang H, Shan W, Ning C, Zhou Q, Chen X, Luo X - PLoS ONE (2016)

Bottom Line: The efficiency of the model was compared with three other reported prediction models.In the validation cohort, the model classified 59.5% (119/200) of patients as low-risk, 3 out of these 119 patients (2.5%) has LNM.Our model showed a predictive power similar to those of two previously reported prediction models.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China.

ABSTRACT
We aimed to evaluate the value of immunohistochemical markers and serum CA125 in predicting the risk of lymph node metastasis (LNM) in women with endometrial cancer and to identify a low-risk group of LNM. The medical records of 370 patients with endometrial endometrioid adenocarcinoma who underwent surgical staging in the Obstetrics & Gynecology Hospital of Fudan University were collected and retrospectively reviewed. Immunohistochemical markers were screened. A model using serum cancer antigen 125 (CA125) level, the immunohistochemical markers progesterone receptor (PR) and Ki67 was created for prediction of LNM. A predicted probability of 4% among these patients was defined as low risk. The developed model was externally validated in 200 patients from Shanghai Cancer Center. The efficiency of the model was compared with three other reported prediction models. Patients with serum CA125 < 30.0 IU/mL, either or both of positive PR staining > 50% and Ki67 < 40% in cancer lesion were defined as low risk for LNM. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.82. The model classified 61.9% (229/370) of patients as being at low risk for LNM. Among these 229 patients, 6 patients (2.6%) had LNM and the negative predictive value was 97.4% (223/229). The sensitivity and specificity of the model were 84.6% and 67.4% respectively. In the validation cohort, the model classified 59.5% (119/200) of patients as low-risk, 3 out of these 119 patients (2.5%) has LNM. Our model showed a predictive power similar to those of two previously reported prediction models. The prediction model using serum CA125 and the immunohistochemical markers PR and Ki67 is useful to predict patients with a low risk of LNM and has the potential to provide valuable guidance to clinicians in the treatment of patients with endometrioid endometrial cancer.

No MeSH data available.


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Flowchart of selection of patients in prediction cohort.
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pone.0155145.g001: Flowchart of selection of patients in prediction cohort.

Mentions: This descriptive study was based on a retrospective review of records of patients diagnosed with endometrial endometrioid adenocarcinoma. The research protocol was approved by the Ethics Committee of the Obstetrics & Gynecology Hospital of Fudan University (Ob&Gyn Hospital) and Fudan University Shanghai Cancer Center. All patients signed informed consent. All cases were re-evaluated and classified according to the World Health Organization (WHO) pathological classification (2014). Patients from Ob&Gyn Hospital were used to construct the prediction model. Another group of patients from Shanghai Cancer Center were collected as external validation cohort. Between January 2009 and April 2014, a total of 1098 endometrial cancer patients were treated in Ob&Gyn Hospital. Among these patients, those with endometrioid histological subtype who underwent comprehensive surgical staging with pelvic lymphadenectomy, having available preoperative serum CA125 levels and postoperative immunohistochemical staining of ER, PR, Ki67 and p53 were enrolled in the study. Patients with non-endometrioid histological subtypes or those with incomplete medical record as needed above were excluded. Comprehensive surgical staging included total hysterectomy, bilateral salpingo-oophorectomy, washing cytology, and systemic pelvic lymph node dissection. There were no restrictions on para-aortic lymphadenectomy. Eventually 370 patients from Ob&Gyn Hospital were enrolled in the study (Fig 1). 200 endometrial cancer patients treated in Shanghai Cancer Center from 2009 to 2014 who meet the inclusion criteria mentioned above were randomly selected as the validation group.


Predicting Lymph Node Metastasis in Endometrial Cancer Using Serum CA125 Combined with Immunohistochemical Markers PR and Ki67, and a Comparison with Other Prediction Models.

Yang B, Shan B, Xue X, Wang H, Shan W, Ning C, Zhou Q, Chen X, Luo X - PLoS ONE (2016)

Flowchart of selection of patients in prediction cohort.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4862644&req=5

pone.0155145.g001: Flowchart of selection of patients in prediction cohort.
Mentions: This descriptive study was based on a retrospective review of records of patients diagnosed with endometrial endometrioid adenocarcinoma. The research protocol was approved by the Ethics Committee of the Obstetrics & Gynecology Hospital of Fudan University (Ob&Gyn Hospital) and Fudan University Shanghai Cancer Center. All patients signed informed consent. All cases were re-evaluated and classified according to the World Health Organization (WHO) pathological classification (2014). Patients from Ob&Gyn Hospital were used to construct the prediction model. Another group of patients from Shanghai Cancer Center were collected as external validation cohort. Between January 2009 and April 2014, a total of 1098 endometrial cancer patients were treated in Ob&Gyn Hospital. Among these patients, those with endometrioid histological subtype who underwent comprehensive surgical staging with pelvic lymphadenectomy, having available preoperative serum CA125 levels and postoperative immunohistochemical staining of ER, PR, Ki67 and p53 were enrolled in the study. Patients with non-endometrioid histological subtypes or those with incomplete medical record as needed above were excluded. Comprehensive surgical staging included total hysterectomy, bilateral salpingo-oophorectomy, washing cytology, and systemic pelvic lymph node dissection. There were no restrictions on para-aortic lymphadenectomy. Eventually 370 patients from Ob&Gyn Hospital were enrolled in the study (Fig 1). 200 endometrial cancer patients treated in Shanghai Cancer Center from 2009 to 2014 who meet the inclusion criteria mentioned above were randomly selected as the validation group.

Bottom Line: The efficiency of the model was compared with three other reported prediction models.In the validation cohort, the model classified 59.5% (119/200) of patients as low-risk, 3 out of these 119 patients (2.5%) has LNM.Our model showed a predictive power similar to those of two previously reported prediction models.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China.

ABSTRACT
We aimed to evaluate the value of immunohistochemical markers and serum CA125 in predicting the risk of lymph node metastasis (LNM) in women with endometrial cancer and to identify a low-risk group of LNM. The medical records of 370 patients with endometrial endometrioid adenocarcinoma who underwent surgical staging in the Obstetrics & Gynecology Hospital of Fudan University were collected and retrospectively reviewed. Immunohistochemical markers were screened. A model using serum cancer antigen 125 (CA125) level, the immunohistochemical markers progesterone receptor (PR) and Ki67 was created for prediction of LNM. A predicted probability of 4% among these patients was defined as low risk. The developed model was externally validated in 200 patients from Shanghai Cancer Center. The efficiency of the model was compared with three other reported prediction models. Patients with serum CA125 < 30.0 IU/mL, either or both of positive PR staining > 50% and Ki67 < 40% in cancer lesion were defined as low risk for LNM. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.82. The model classified 61.9% (229/370) of patients as being at low risk for LNM. Among these 229 patients, 6 patients (2.6%) had LNM and the negative predictive value was 97.4% (223/229). The sensitivity and specificity of the model were 84.6% and 67.4% respectively. In the validation cohort, the model classified 59.5% (119/200) of patients as low-risk, 3 out of these 119 patients (2.5%) has LNM. Our model showed a predictive power similar to those of two previously reported prediction models. The prediction model using serum CA125 and the immunohistochemical markers PR and Ki67 is useful to predict patients with a low risk of LNM and has the potential to provide valuable guidance to clinicians in the treatment of patients with endometrioid endometrial cancer.

No MeSH data available.


Related in: MedlinePlus