J 2019

A Novel Approach to Preoperative Risk Stratification in Endometrial Cancer: The Added Value of Immunohistochemical Markers

WEINBERGER, Vít, Markéta BEDNAŘÍKOVÁ, Jitka HAUSNEROVÁ, Petra OVESNÁ, Petra VINKLEROVÁ et. al.

Basic information

Original name

A Novel Approach to Preoperative Risk Stratification in Endometrial Cancer: The Added Value of Immunohistochemical Markers

Authors

WEINBERGER, Vít (203 Czech Republic, belonging to the institution), Markéta BEDNAŘÍKOVÁ (203 Czech Republic, belonging to the institution), Jitka HAUSNEROVÁ (203 Czech Republic, belonging to the institution), Petra OVESNÁ (203 Czech Republic, belonging to the institution), Petra VINKLEROVÁ (203 Czech Republic, belonging to the institution), Luboš MINÁŘ (203 Czech Republic, belonging to the institution), Michal FELSINGER (203 Czech Republic, belonging to the institution), Eva JANDÁKOVÁ (203 Czech Republic, belonging to the institution), Marta ČÍHALOVÁ (203 Czech Republic, belonging to the institution) and Michal ZIKÁN (203 Czech Republic, guarantor, belonging to the institution)

Edition

Frontiers in Oncology, Lausanne, Frontiers, 2019, 2234-943X

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30204 Oncology

Country of publisher

Switzerland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

Impact factor

Impact factor: 4.848

RIV identification code

RIV/00216224:14110/19:00110914

Organization unit

Faculty of Medicine

UT WoS

000464373800001

Keywords in English

endometrial cancer; ER; imaging method; L1CAM; PR; preoperative biopsy; p53; risk stratification

Tags

International impact, Reviewed
Změněno: 29/1/2020 09:55, Mgr. Tereza Miškechová

Abstract

V originále

Background: The current model used to preoperatively stratify endometrial cancer (EC) patients into low-and high-risk groups is based on histotype, grade, and imaging method and is not optimal. Our study aims to prove whether a new model incorporating immunohistochemical markers, L1CAM, ER, PR, p53, obtained from preoperative biopsy could help refine stratification and thus the choice of adequate surgical extent and appropriate adjuvant treatment. Materials and Methods: The following data were prospectively collected from patients operated for EC from January 2016 through August 2018: age, pre- and post-operative histology, grade, lymphovascular space invasion, L1CAM, ER, PR, p53, imaging parameters obtained from ultrasound, CT chest/abdomen, final FIGO stage, and current decision model (based on histology, grade, imaging method). Results: In total, 132 patients were enrolled. The current model revealed 48% sensitivity and 89% specificity for high-risk group determination. In myometrial invasion >50%, lower levels of ER (p = 0.024), PR (0.048), and higher levels of L1CAM (p = 0.001) were observed; in cervical involvement a higher expression of L1CAM (p = 0.001), lower PR (p = 0.014); in tumors with positive LVSI, higher L1CAM (p = 0.014); in cases with positive LN, lower expression of ER/PR (p < 0.001), higher L1CAM (p = 0.002) and frequent mutation of p53 (p = 0.008). Cut-offs for determination of high-risk tumors were established: ER <78% (p = 0.001), PR <88% (p = 0.008), and L1CAM >= 4% (p < 0.001). The positive predictive values (PPV) for ER, PR, and L1CAM were 87% (60.8-96.5%), 63% (52.1-72.8%), 83% (70.5-90.8%); the negative predictive values (NPV) for each marker were as follows: 59% (54.5-63.4%), 65%(55.6-74.0%), and 77%(67.3-84.2%). Mutation of p53 revealed PPV 94% (67.4-99.1%) and NPV 61% (56.1-66.3%). When immunohistochemical markers were included into the current diagnostic model, sensitivity improved (48.4 vs. 75.8%, p < 0.001). PPV was similar for both methods, while NPV (i.e., the probability of extremely low risk in negative test cases) was improved (66 vs. 78.9%, p < 0.001). Conclusion: We proved superiority of new proposed model using immunohistochemical markers over standard clinical practice and that new proposed model increases accuracy of prognosis prediction. We propose wider implementation and validation of the proposed model.