Predicting the Risk of nOdal disease with histological and Molecular features in Endometrial cancer: the prospective...

Area of Science:

• Gynecologic Oncology
• Surgical Pathology
• Molecular Diagnostics

Background:

• Sentinel lymph node (SLN) mapping is crucial for staging early-stage endometrial cancer.
• Accurate prediction of nodal metastases is essential for appropriate treatment planning.
• The role of molecular features in predicting lymph node involvement requires further clarification.

Purpose of the Study:

• To evaluate the predictive value of histopathological and molecular features for nodal metastases in apparent early-stage endometrial cancer.
• To determine if molecular classification can guide nodal dissection decisions in this patient cohort.

Main Methods:

• Prospective trial involving patients with apparent early-stage endometrial cancer undergoing SLN mapping.
• Analysis of histopathological and molecular features (POLE mutation, p53 abnormality, MMRd/MSI-H) to predict lymph node positivity.
• Multivariable analysis to identify independent predictors of nodal metastases.

Main Results:

• Overall, 19.5% of patients had positive lymph nodes.
• Molecular features (POLE mutated, p53 abnormal, MMRd/MSI-H) were not significantly associated with the risk of nodal metastases.
• Deep myometrial invasion and lymphovascular space invasion were independently correlated with an increased risk of positive nodes.

Conclusions:

• Molecular classification does not appear to be useful for tailoring nodal dissection in apparent early-stage endometrial cancer.
• p53 abnormality may indicate an increased risk of advanced disease at presentation.
• Further external validation is recommended to confirm these findings.