Related Experiment Video
Updated: Jul 13, 2026
Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy
Published on: August 19, 2021
Beyond p53 status: the continued importance of histopathologic features for predicting lymph node metastasis in
Amelia Favier1, Julia Le Tan2, Aurélie Siret3
1Sorbonne University, Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; Sorbonne University, INSERM, Unité Mixte de Recherche Scientifique 938 and SIRIC CURAMUS, Centre de Recherche Saint-Antoine, Equipe Instabilité Des Microsatellites Et Cancer, Equipe Labellisée Par La Ligue Nationale Contre Le Cancer, Paris, France.
Objective:
To identify predictors of lymph node metastasis according to molecular alterations, including mismatch repair-deficient, POLE-mutated, and p53-abnormal status, while preserving the contribution of established clinicopathologic features in patients with presumed early-stage endometrial cancer.
Methods:
This retrospective multi-center study included 477 patients with presumed early-stage International Federation of Gynecology and Obstetrics stage I to II endometrial cancer who underwent primary surgical management with lymph node staging. Associations between molecular alterations and lymph node metastasis were evaluated using two sequential multi-variable logistic regression models. The first model included histopathologic and molecular variables, and the second additionally incorporated lymphovascular space invasion, which is reliably assessed only post-operatively.
Results:
Most tumors were low-grade endometrioid (n = 294, 61.6%), and 118 (24.7%) were non-endometrioid. In the first multi-variable analysis, lymph node metastasis was independently associated with ≥50% myometrial invasion (adjusted odds ratio 9.15, 95% confidence interval 4.85 to 17.28, p =.001), non-endometrioid type (adjusted odds ratio 2.12, 95% confidence interval 1.16 to 3.88, p =.014), and p53-abnormal status (adjusted odds ratio 2.13, 95% confidence interval 1.10 to 4.13, p =.024). When lymphovascular space invasion was included in the model, only ≥50% myometrial invasion (adjusted odds ratio 4.76, 95% confidence interval 2.41 to 9.38, p <.001) and lymphovascular space invasion (adjusted odds ratio 4.32, 95% confidence interval 2.41 to 7.72, p <.001) remained independently associated with nodal metastasis.
Conclusions:
Although p53 abnormalities may help identify patients at higher risk of nodal metastasis before surgery, deep myometrial invasion and lymphovascular space invasion remain key determinants of nodal involvement.
