International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · 2026
Beyond p53 status: the continued importance of histopathologic features for predicting lymph node metastasis in endometrial cancer.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Favier Amelia, Le Tan Julia, Siret Aurélie, Sestito Estelle, Jaouen Lucie, Varinot Justine, Coulet Florence, Letourneur Quentin, Buhard Olivier, Chagari Cyrus, Dabi Yohann, Touboul Cyril, Uzan Catherine, Duval Alex, Canlorbe Geoffroy
Аннотация
OBJECTIVE: To identify predictors of lymph node metastasis according to molecular alterations, including mismatch repair-deficient, POLE-mutated, and p53-abnormal status, while preserving the contribution of established clinicopathologic features in patients with presumed early-stage endometrial cancer.
METHODS: This retrospective multi-center study included 477 patients with presumed early-stage International Federation of Gynecology and Obstetrics stage I to II endometrial cancer who underwent primary surgical management with lymph node staging. Associations between molecular alterations and lymph node metastasis were evaluated using two sequential multi-variable logistic regression models. The first model included histopathologic and molecular variables, and the second additionally incorporated lymphovascular space invasion, which is reliably assessed only post-operatively.
RESULTS: Most tumors were low-grade endometrioid (n = 294, 61.6%), and 118 (24.7%) were non-endometrioid. In the first multi-variable analysis, lymph node metastasis was independently associated with ≥50% myometrial invasion (adjusted odds ratio 9.15, 95% confidence interval 4.85 to 17.28, p =.001), non-endometrioid type (adjusted odds ratio 2.12, 95% confidence interval 1.16 to 3.88, p =.014), and p53-abnormal status (adjusted odds ratio 2.13, 95% confidence interval 1.10 to 4.13, p =.024). When lymphovascular space invasion was included in the model, only ≥50% myometrial invasion (adjusted odds ratio 4.76, 95% confidence interval 2.41 to 9.38, p <.001) and lymphovascular space invasion (adjusted odds ratio 4.32, 95% confidence interval 2.41 to 7.72, p <.001) remained independently associated with nodal metastasis.
CONCLUSIONS: Although p53 abnormalities may help identify patients at higher risk of nodal metastasis before surgery, deep myometrial invasion and lymphovascular space invasion remain key determinants of nodal involvement.
METHODS: This retrospective multi-center study included 477 patients with presumed early-stage International Federation of Gynecology and Obstetrics stage I to II endometrial cancer who underwent primary surgical management with lymph node staging. Associations between molecular alterations and lymph node metastasis were evaluated using two sequential multi-variable logistic regression models. The first model included histopathologic and molecular variables, and the second additionally incorporated lymphovascular space invasion, which is reliably assessed only post-operatively.
RESULTS: Most tumors were low-grade endometrioid (n = 294, 61.6%), and 118 (24.7%) were non-endometrioid. In the first multi-variable analysis, lymph node metastasis was independently associated with ≥50% myometrial invasion (adjusted odds ratio 9.15, 95% confidence interval 4.85 to 17.28, p =.001), non-endometrioid type (adjusted odds ratio 2.12, 95% confidence interval 1.16 to 3.88, p =.014), and p53-abnormal status (adjusted odds ratio 2.13, 95% confidence interval 1.10 to 4.13, p =.024). When lymphovascular space invasion was included in the model, only ≥50% myometrial invasion (adjusted odds ratio 4.76, 95% confidence interval 2.41 to 9.38, p <.001) and lymphovascular space invasion (adjusted odds ratio 4.32, 95% confidence interval 2.41 to 7.72, p <.001) remained independently associated with nodal metastasis.
CONCLUSIONS: Although p53 abnormalities may help identify patients at higher risk of nodal metastasis before surgery, deep myometrial invasion and lymphovascular space invasion remain key determinants of nodal involvement.