Frontiers in medicine · 2026
Deep cervical stromal invasion predicts poor prognosis in endometrioid endometrial cancer with cervical stromal involvement: a risk-stratification model for adjuvant therapy decision-making in endometrial carcinoma.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Wang Yanjiao, Li Qinghui, Li Yaping, Lin Suqin, Su Lifang, Lai Shuhua
Аннотация
BACKGROUND: Endometrioid endometrial cancer with cervical stromal invasion (CSI) has heterogeneous prognoses, but current models inadequately incorporate CSI depth. We evaluated whether deep CSI (≥50% stromal thickness) predicts poor prognosis and developed a risk-stratification model integrating molecular classification to guide adjuvant therapy.
METHODS: We conducted a single-center retrospective cohort study of 412 patients with endometrioid endometrial cancer with cervical stromal invasion treated between January 2021 and January 2023. CSI depth was categorized as deep (≥50%) versus superficial (<50%) based on standardized pathological review. Molecular subtyping was performed per 2023 FIGO criteria. The primary endpoint was 3-year recurrence-free survival (RFS). Multivariable Cox regression identified independent prognostic factors. A weighted four-factor risk score was developed incorporating deep CSI (2 points), G3 histology (1 point), substantial lymphovascular space invasion (LVSI, 1 point), and p53-aberrant subtype (1 point). Propensity score-matched analysis (1:1 matching) evaluated external beam radiotherapy (EBRT) efficacy in deep CSI patients.
RESULTS: Deep CSI was present in 71 patients (17.2%) and was associated with aggressive pathological features: higher grade (G3: 35.2% vs. 18.5%, P = 0.003), deeper myometrial invasion (≥50%: 67.6% vs. 34.9%, P < 0.001), and substantial LVSI (33.8% vs. 12.9%, P = 0.002). Deep CSI independently predicted 3-year recurrence (adjusted HR 2.45, 95% CI 1.52-3.95, P < 0.001) after adjusting for molecular subtype and adjuvant therapy. The three-tier risk stratification identified distinct prognostic groups: low risk (0 points, n = 198, 48.1%): 3-year RFS 91.2%; intermediate risk (1-2 points, n = 163, 39.6%): 79.4%; high risk (3-5 points, n = 51, 12.4%): 52.8% (P < 0.001). In propensity score-matched analysis, EBRT significantly improved 3-year RFS in deep CSI patients (78.6% vs. 48.2%, P = 0.012; HR 0.42, 95% CI 0.20-0.88), with particular benefit for locoregional control (89.3% vs. 62.5%, P = 0.008). The prognostic impact of deep CSI varied by molecular subtype: no significant effect in polymerase epsilon (POLE)-mutated, mismatch repair deficient (MMRd) tumors, but identified high-risk subsets within no specific molecular profile (NSMP) tumors.
CONCLUSIONS: Deep CSI provides critical prognostic information in endometrioid endometrial cancer. Integration of CSI depth with molecular classification enables actionable risk stratification and identifies patients who benefit from EBRT.
METHODS: We conducted a single-center retrospective cohort study of 412 patients with endometrioid endometrial cancer with cervical stromal invasion treated between January 2021 and January 2023. CSI depth was categorized as deep (≥50%) versus superficial (<50%) based on standardized pathological review. Molecular subtyping was performed per 2023 FIGO criteria. The primary endpoint was 3-year recurrence-free survival (RFS). Multivariable Cox regression identified independent prognostic factors. A weighted four-factor risk score was developed incorporating deep CSI (2 points), G3 histology (1 point), substantial lymphovascular space invasion (LVSI, 1 point), and p53-aberrant subtype (1 point). Propensity score-matched analysis (1:1 matching) evaluated external beam radiotherapy (EBRT) efficacy in deep CSI patients.
RESULTS: Deep CSI was present in 71 patients (17.2%) and was associated with aggressive pathological features: higher grade (G3: 35.2% vs. 18.5%, P = 0.003), deeper myometrial invasion (≥50%: 67.6% vs. 34.9%, P < 0.001), and substantial LVSI (33.8% vs. 12.9%, P = 0.002). Deep CSI independently predicted 3-year recurrence (adjusted HR 2.45, 95% CI 1.52-3.95, P < 0.001) after adjusting for molecular subtype and adjuvant therapy. The three-tier risk stratification identified distinct prognostic groups: low risk (0 points, n = 198, 48.1%): 3-year RFS 91.2%; intermediate risk (1-2 points, n = 163, 39.6%): 79.4%; high risk (3-5 points, n = 51, 12.4%): 52.8% (P < 0.001). In propensity score-matched analysis, EBRT significantly improved 3-year RFS in deep CSI patients (78.6% vs. 48.2%, P = 0.012; HR 0.42, 95% CI 0.20-0.88), with particular benefit for locoregional control (89.3% vs. 62.5%, P = 0.008). The prognostic impact of deep CSI varied by molecular subtype: no significant effect in polymerase epsilon (POLE)-mutated, mismatch repair deficient (MMRd) tumors, but identified high-risk subsets within no specific molecular profile (NSMP) tumors.
CONCLUSIONS: Deep CSI provides critical prognostic information in endometrioid endometrial cancer. Integration of CSI depth with molecular classification enables actionable risk stratification and identifies patients who benefit from EBRT.