Detailed Information on Publication Record
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.