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SENECA study: staging endometrial cancer based on molecular classification.

Enrique Chacon1, Felix Boria2, R Rajagopalan Lyer3

  • 1Department of Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain.

International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society
|April 14, 2025
PubMed
Summary

Sentinel lymph node (SLN) involvement in early-stage endometrial cancer varies significantly by molecular subtype. Understanding these differences is key for accurate staging and personalized treatment strategies.

Keywords:
Endometrial NeoplasmsSentinel Lymph Node

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Area of Science:

  • Gynecologic Oncology
  • Molecular Pathology
  • Surgical Pathology

Background:

  • Accurate staging is critical for effective endometrial cancer management.
  • Sentinel lymph node (SLN) assessment is a key component of staging.
  • Molecular subtyping is increasingly important for understanding endometrial cancer behavior.

Purpose of the Study:

  • To evaluate sentinel lymph node (SLN) involvement in early-stage endometrial cancer (stages I-II).
  • To analyze SLN involvement across different molecular subtypes.
  • To correlate SLN involvement with the European Society of Gynaecological Oncology (ESGO) risk classification.

Main Methods:

  • Retrospective analysis of 2139 patients with stage I-II endometrial cancer from the SENECA study.
  • Data collected from 66 centers across 16 countries between January 2021 and December 2022.
  • Molecular analysis of pre-operative biopsies or hysterectomy specimens, with SLN assessment following ESGO guidelines.

Main Results:

  • Overall SLN involvement was 9.6%, with 67.8% being low-volume metastases.
  • Significant differences in SLN involvement were observed between molecular subtypes: p53 abnormal (12.50%) and mismatch repair deficient (12.40%) showed higher rates than non-specific molecular profile (7.80%) and POLE mutated (6.30%).
  • SLN involvement rates also varied significantly across ESGO risk groups, ranging from 2.84% (low-risk) to 22.51% (high-risk).

Conclusions:

  • Molecular subtypes of endometrial cancer are associated with significant differences in sentinel lymph node (SLN) involvement.
  • These findings highlight the necessity of integrating molecular characteristics into staging and treatment planning for early-stage endometrial cancer.
  • Considering molecular profiles can lead to more precise risk stratification and tailored patient management.