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Chen J, Wang X, Lv H, Zhang W, Tian Y, Song L, Wang Z. Development and external validation of a clinical-radiomics nomogram for preoperative prediction of LVSI status in patients with endometrial carcinoma. J Cancer Res Clin Oncol 2023; 149:13943-13953. [PMID: 37542548 DOI: 10.1007/s00432-023-05044-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/28/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To develop and validate a model that incorporates radiomics based on MRI scans and clinical characteristics to predict lymphovascular invasion (LVSI) in endometrial cancer (EC) patients. METHODS There were 332 patients with EC enrolled retrospectively in this multicenter study. Radiomics score (Radscore) were computed using the valuable radiomics features. The independent predictors of LVSI were identified by univariate logistic analysis. Multivariate logistic regression was used to develop a clinical-radiomics predictive model. Based on the model, a nomogram was developed and validated internally and externally. The nomogram was evaluated with discrimination, calibration, decision curve analysis (DCA), and clinical impact curves (CIC). RESULTS Three predictive models were constructed based on clinicopathological features, radiomic factors and a combination of them, and that the clinic-radiomic model performed best among the three models. Four independent factors comprised the clinical-radiomics model: dynamic contrast enhancement rate of late arterial phase (DCE2), deep myometrium invasion (DMI), lymph node metastasis (LNM), and Radscore. Clinical-radiomics model performance was 0.901 (95% CI 0.84-0.96) in the training cohort, 0.80 (95% CI 0.68-0.92) in the internal validation cohort, and 0.81 (95% CI 0.73-0.9) in the external validation cohort for identifying patients with LVSI, respectively. The model is used to develop a nomogram for clinical use. CONCLUSIONS The MRI-based radiomics nomogram could serve as a noninvasive tool to predict LVSI in EC patients.
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Affiliation(s)
- Jingya Chen
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210009, Jiangsu, China
| | | | - Haoyi Lv
- University of Science and Technology of China, Hefei, Anhui, China
| | - Wei Zhang
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, Jiangsu Province, China
| | - Ying Tian
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210009, Jiangsu, China
| | - Lina Song
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210009, Jiangsu, China
| | - Zhongqiu Wang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210009, Jiangsu, China.
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Rafiee A, Mohammadizadeh F. Association of Lymphovascular Space Invasion (LVSI) with Histological Tumor Grade and Myometrial Invasion in Endometrial Carcinoma: A Review Study. Adv Biomed Res 2023; 12:159. [PMID: 37564444 PMCID: PMC10410422 DOI: 10.4103/abr.abr_52_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 08/12/2023] Open
Abstract
Endometrial carcinoma is one of the most frequent gynecological cancers in developed countries. Lymphovascular space invasion (LVSI), histological grade, and myometrial invasion (MMI) are important prognostic factors of endometrial carcinoma. LVSI is considered an independent poor prognostic factor in endometrial carcinoma. Based on the importance of LVSI, this study aimed to discuss the association of LVSI with tumor grade and MMI. A search of PubMed, EMBASE, Web of Science, Scopus, Google Scholar, and Cochrane Library was carried out to collect related studies. Consequently, most studies showed that LVSI is significantly associated with higher histologic grade and deep MMI.
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Affiliation(s)
- Azita Rafiee
- Pathologist, Iranian Medical and Pathology Laboratory, Zahedan, Iran
| | - Fereshteh Mohammadizadeh
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Fu P, Sun H, Zhou T, Cui P, Wang S, Liu R. Postoperative Adjuvant Treatment in Women with Stage I Endometrial Cancer: A Retrospective Study. Int J Clin Pract 2023; 2023:4007616. [PMID: 37035519 PMCID: PMC10081899 DOI: 10.1155/2023/4007616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
Objective. To evaluate whether postoperative adjuvant treatment is beneficial for patient survival after surgery for early stage endometrial cancer (EC). We analyzed the outcomes of patients treated with radiotherapy, chemotherapy, or progestagen combined with other adjuvant treatments. Methods. We analyzed the outcomes of patients treated with radiotherapy alone, chemotherapy alone, or progestagen treatment with other adjuvant treatments. Women without any adjuvant treatment after operation were used as controls. We retrospectively examined disease-free survival (DFS), overall survival (OS), and high-risk factors that affected the survival status of all patients who received different postoperative adjuvant therapies. Results. In all 192 patients, the total relapse and mortality rates were 5.57% and 1.68%, respectively. Fourteen patients (7.29%) developed isolated local recurrence, and 2 patients died (1.04%) of recurrence during the follow-up period. The 5-year DFS and OS rates of all patients were 95.83% and 93.75%, respectively. No significant differences were observed in the 5-year DFS, 5-year OS, OS, or DFS among the four groups of patients with FIGO stage I endometrial cancer (
, 0.7430, 0.9754, and 0.4534, respectively). The differences in the log-rank test results of the estimates of the 5-year DFS, 5-year OS, DFS, and OS of patients with different disease stages and different ages were all significant, but no differences were observed in these parameters among patients with varying degrees of differentiation. Histologic grade, CA125 level, ER and PR status, and adjuvant therapy had no significant effect on the DFS and OS of all patients according to univariate and multivariate regression analyses, but a significant effect on DFS and OS was found when the patients were stratified by age. Conclusion. This retrospective study showed that adjuvant therapy after surgery was not significantly associated with improved DFS or OS in patients with early stage endometrial cancer. However, FIGO stage and age affected the survival of patients with stage I endometrial cancer.
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Yarandi F, Shirali E, Akhavan S, Nili F, Ramhormozian S. The impact of lymphovascular space invasion on survival in early stage low-grade endometrioid endometrial cancer. Eur J Med Res 2023; 28:118. [PMID: 36915143 PMCID: PMC10012545 DOI: 10.1186/s40001-023-01084-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/03/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND The lymphovascular space invasion (LVSI) is suggested as a prognostic factor for endometrial cancer in many studies, but it has not yet been employed in FIGO staging system. The present study was aimed to evaluate the impact of LVSI on survival in patients with early stage endometrioid endometrial cancer. METHODS This retrospective cohort was conducted on early stage endometrial cancer patients who underwent surgical staging [total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO)] and omental biopsy at Referral Teaching Hospitals of Tehran from 2005 to 2021. Patient's age, menopause status, tumor grade, tumor size, depth of myometrial invasion, LVSI and lower segment involvement were recorded. Data were analyzed with SPSS 22. RESULTS 415 patients with stage I and grade 1-2, endometrioid endometrial cancer were analyzed. 100 patients (24.1%) were LVSI-positive. 3-year and 5-year survival rates were 97.1% and 88.9%, respectively. Recurrence occurred in 53 patients (12.8%). 3-year overall survival rates in LVSI-negative and LVSI-positive were 98.7% and 92%. These rates for 5-year survival were 92.1% and 79%, respectively. Recurrence rates in LVSI-negative were 8.9% while it was 25% in LVSI-positive cases. Multivariate analysis showed that LVSI has significant correlation with 3-year and 5-year overall survival rates. CONCLUSIONS LVSI in early stage endometrial cancer significantly and independently influences 3-year and 5-year survival rates and acts as a strong prognostic factor in these patients. LVSI should be implemented in endometrial cancer staging systems due to its significant correlation with cancer recurrence rates and 5-year survival rates.
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Affiliation(s)
- Fariba Yarandi
- Department of Gynecologic Oncology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Shirali
- Department of Gynecologic Oncology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Setare Akhavan
- Department of Gynecologic Oncology, Vali-Asr Hospital, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex (IKHC), Tehran, Iran
| | - Fatemeh Nili
- Department of Pathology, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Sara Ramhormozian
- Department of Gynecologic Oncology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Rao Q, Liao J, Li Y, Zhang X, Xu G, Zhu C, Tian S, Chen Q, Zhou H, Zhang B. Application of NGS molecular classification in the diagnosis of endometrial carcinoma: A supplement to traditional pathological diagnosis. Cancer Med 2023; 12:5409-5419. [PMID: 36341543 PMCID: PMC10028062 DOI: 10.1002/cam4.5363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE This study aims to demonstrate the advantages of NGS molecular classification in EC diagnosis and to assess whether molecular classification could be performed on curettage specimens and its concordance with subsequent hysterectomy specimens. METHODS 80 patients with hysterectomy specimens and 35/80 patients with paired curettage specimens were stratified as POLE mut, MSI-H, TP53 wt, or TP53 abn group by NGS panel. Histotype, tumor grade, IHC results, and other pathological details were taken from original pathological reports. RESULTS The correlation analysis of 80 patients with hysterectomy specimens between NGS molecular classification and clinicopathological characters displayed that the POLE mut group was associated with EEC (87.5%) and TP53 abn subtype was correlated to a later stage (Stage II-IV, 47.6%), G3 (76.2%), serous histology (61.9%) and myometrial invasion ≥50% (47.6%). A favorable concordance (31/32, 96.9%) was shown in MSI analysis and MMR IHC results, and the agreement rate of p53 IHC and TP53 mutation was 81.5% (53/65). Compared with the p53 IHC abnormal group, the TP53 mutation group had a higher correlation with high-risk factors. A high level of concordance (31/35, 88.0%) of NGS molecular classification was achieved between curettage specimens and hysterectomy specimens while grade and histotype (including unclassified group) from curettage specimens and hysterectomy specimens showed only moderate levels of agreement, 54.3% (19/35) and 68.6% (24/35), respectively. CONCLUSION NGS molecular classification achieved on curettage samples showed high concordance with the final hysterectomy specimens, demonstrating superior to the conventional pathological assessment of grade and histotype and potential utilization in clinical practice.
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Affiliation(s)
- Qunxian Rao
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jianwei Liao
- Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yangyang Li
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin Zhang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guocai Xu
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Changbin Zhu
- Department of Translational Medicine, Amoy Diagnostics Co., Ltd., Xiamen, China
| | - Shengya Tian
- Department of Translational Medicine, Amoy Diagnostics Co., Ltd., Xiamen, China
| | - Qiuhong Chen
- Department of Translational Medicine, Amoy Diagnostics Co., Ltd., Xiamen, China
| | - Hui Zhou
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Bingzhong Zhang
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
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Wang J, Li X, Yang X, Wang J. Development and Validation of a Nomogram Based on Metabolic Risk Score for Assessing Lymphovascular Space Invasion in Patients with Endometrial Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315654. [PMID: 36497730 PMCID: PMC9736227 DOI: 10.3390/ijerph192315654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/05/2022] [Accepted: 11/23/2022] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study assessed the predictive value of the metabolic risk score (MRS) for lymphovascular space invasion (LVSI) in endometrial cancer (EC) patients. METHODS We included 1076 patients who were diagnosed with EC between January 2006 and December 2020 in Peking University People's Hospital. All patients were randomly divided into the training and validation cohorts in a ratio of 2:1. Data on clinicopathological indicators were collected. Univariable and multivariable logistic regression analysis was used to define candidate factors for LVSI. A backward stepwise selection was then used to select variables for inclusion in a nomogram. The performance of the nomogram was evaluated by discrimination, calibration, and clinical usefulness. RESULTS Independent predictors of LVSI included differentiation grades (G2: OR = 1.800, 95% CI: 1.050-3.070, p = 0.032) (G3: OR = 3.49, 95% CI: 1.870-6.520, p < 0.001), histology (OR = 2.723, 95% CI: 1.370-5.415, p = 0.004), MI (OR = 4.286, 95% CI: 2.663-6.896, p < 0.001), and MRS (OR = 1.124, 95% CI: 1.067-1.185, p < 0.001) in the training cohort. A nomogram was established to predict a patient's probability of developing LVSI based on these factors. The ROC curve analysis showed that an MRS-based nomogram significantly improved the efficiency of diagnosing LVSI compared with the nomogram based on clinicopathological factors (p = 0.0376 and p = 0.0386 in the training and validation cohort, respectively). Subsequently, the calibration plot showed a favorable consistency in both groups. Moreover, we conducted a decision curve analysis, showing the great clinical benefit obtained from the application of our nomogram. However, our study faced several limitations. Further external validation and a larger sample size are needed in future studies. CONCLUSION MRS-based nomograms are useful for predicting LVSI in patients with EC and may facilitate better clinical decision-making.
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Liu XF, Yan BC, Li Y, Ma FH, Qiang JW. Radiomics feature as a preoperative predictive of lymphovascular invasion in early-stage endometrial cancer: A multicenter study. Front Oncol 2022; 12:966529. [PMID: 36059674 PMCID: PMC9433783 DOI: 10.3389/fonc.2022.966529] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe presence of lymphovascular space invasion (LVSI) has been demonstrated to be significantly associated with poor outcome in endometrial cancer (EC). No effective clinical tools could be used for the prediction of LVSI preoperatively in early-stage EC. A radiomics nomogram based on MRI was established to predict LVSI in patients with early-stage EC.MethodsThis retrospective study included 339 consecutive patients with early-stage EC with or without LVSI from five centers. According to the ratio of 2:1, 226 and 113 patients were randomly assigned to a training group and a test group, respectively. Radiomics features were extracted from T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), contrast-enhanced (CE), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) maps. The radiomics signatures were constructed by using the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm in the training group. The radiomics nomogram was developed using multivariable logistic regression analysis by incorporating radiomics signatures and clinical risk factors. The sensitivity, specificity, and AUC of the radiomics signatures, clinical risk factors, and radiomics nomogram were also calculated.ResultsThe individualized prediction nomogram was constructed by incorporating the radiomics signatures with the clinical risk factors (age and cancer antigen 125). The radiomics nomogram exhibited a good performance in discriminating between negative and positive LVSI patients with AUC of 0.89 (95% CI: 0.83–0.95) in the training group and of 0.85 (95% CI: 0.75–0.94) in the test group. The decision curve analysis indicated that clinicians could be benefit from the using of radiomics nomogram to predict the presence of LVSI preoperatively.ConclusionThe radiomics nomogram could individually predict LVSI in early-stage EC patients. The nomogram could be conveniently used to facilitate the treatment decision for clinicians.
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Affiliation(s)
- Xue-Fei Liu
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Bi-Cong Yan
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Jin-Wei Qiang, ; Ying Li,
| | - Feng-Hua Ma
- Departments of Radiology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China
| | - Jin-Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Jin-Wei Qiang, ; Ying Li,
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Lin Q, Lu Y, Lu R, Chen Y, Wang L, Lu J, Ye X. Assessing Metabolic Risk Factors for LVSI in Endometrial Cancer: A Cross-Sectional Study. Ther Clin Risk Manag 2022; 18:789-798. [PMID: 35971461 PMCID: PMC9375567 DOI: 10.2147/tcrm.s372371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study analyzed metabolic factors associated with lymphovascular space invasion (LVSI) and compared the difference between type 1 and type 2 endometrial cancer (EC). Methods Four hundred patients primarily diagnosed with EC who underwent hysterectomy with pathological results at Fujian Medical University Cancer Hospital from January 2019 to January 2021 were included. Demographic variable data were collected as well as pathological results. Laboratory evaluations included fasting blood glucose (FBG), serum cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), apolipoprotein A (Apo A) and apolipoprotein B (Apo B). Characterization of binary logistic regression models was used to test the odds ratios (ORs) between LVSI and its metabolic parameters with different subtypes of EC. Results The results indicated that CA125, ROMA, Ki67 score, FBG and TC were higher in EC patients with LVSI (all p<0.05). Negative ER and PR expression was positively associated with LVSI (P<0.05). CA125, ROMA, FBG, TC and ER were found to be independent risk factors for LVSI. CA125, ROMA and FBG were significantly elevated in type 1 EC patients with LVSI compared with those without LVSI (all p<0.05). TC and Ki67 scores were much higher in type 2 EC patients with vs without LVSI (all p<0.05). Negative PR expression was positively related to both type 1 and type 2 EC patients with LVSI. Consequently, CA125, ROMA, FBG and Apo B were found to be independent risk factors for LVSI in type 1 EC, and TC was found to be an independent risk factor for LVSI in type 2 EC. Conclusion FBG and TC were both independent risk factors for LVSI in EC. FBG and Apo B were independent risk factors for LVSI in type 1 EC. TC was an independent risk factor for LVSI in type 2 EC.
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Affiliation(s)
- Qiaoyan Lin
- Department of Blood Transfusion, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Yongwei Lu
- Department of Gyn-Surgical Oncology Section 9, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Rong Lu
- Department of Blood Transfusion, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Yujuan Chen
- Department of Blood Transfusion, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Linghua Wang
- Department of Gynecologic Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Jianping Lu
- Department of Pathology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, People's Republic of China
| | - Xianren Ye
- Department of Blood Transfusion, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, People's Republic of China.,Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, People's Republic of China
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