Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
Department of Obstetrics and Gynaecology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
Oncologist. 2019 Sep;24(9):e880-e890. doi: 10.1634/theoncologist.2019-0117. Epub 2019 Jun 11.
In endometrial carcinoma (EC), preoperative classification is based on histopathological criteria, with only moderate diagnostic performance for the risk of lymph node metastasis (LNM). So far, existing molecular classification systems have not been evaluated for prediction of LNM. Optimized use of clinical biomarkers as recommended by international guidelines might be a first step to improve tailored treatment, awaiting future molecular biomarkers.
To determine the diagnostic accuracy of preoperative clinical biomarkers for the prediction of LNM in endometrial cancer.
A systematic review was performed according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Studies identified in MEDLINE and EMBASE were selected by two independent reviewers. Included biomarkers were based on recommended guidelines (cancer antigen 125 [Ca-125], lymphadenopathy on magnetic resonance imaging, computed tomography, and F-fluorodeoxyglucose positron emission tomography/computed tomography [FDG PET-CT]) or obtained by physical examination (body mass index, cervical cytology, blood cell counts). Pooled sensitivity, specificity, area under the curve (AUC), and likelihood ratios were calculated with bivariate random-effects meta-analysis. Likelihood ratios were classified into (0.5-1.0 or 1-2.0), (0.2-0.5 or 2.0-5.0) or (0.1-0.2 or ≥ 5.0) impact.
Eighty-three studies, comprising 18,205 patients, were included. Elevated Ca-125 and thrombocytosis were associated with a increase in risk of LNM; lymphadenopathy on imaging with a increase. Normal Ca-125, cytology, and no lymphadenopathy on FDG PET-CT were associated with a decrease. AUCs were above 0.75 for these biomarkers. Other biomarkers had an AUC <0.75 and incurred only impact.
Ca-125, thrombocytosis, and imaging had a and impact on risk of LNM and could improve preoperative risk stratification.
Routine lymphadenectomy in clinical early-stage endometrial carcinoma does not improve outcome and is associated with 15%-20% surgery-related morbidity, underlining the need for improved preoperative risk stratification. New molecular classification systems are emerging but have not yet been evaluated for the prediction of lymph node metastasis. This article provides a robust overview of diagnostic performance of all clinical biomarkers recommended by international guidelines. Based on these, at least measurement of cancer antigen 125 serum level, assessment of thrombocytosis, and imaging focused on lymphadenopathy should complement current preoperative risk stratification in order to better stratify these patients by risk.
在子宫内膜癌（EC）中，术前分类基于组织病理学标准，对淋巴结转移（LNM）的风险仅有中等的诊断性能。到目前为止，现有的分子分类系统尚未被评估用于预测 LNM。优化国际指南推荐的临床生物标志物的使用可能是改善针对性治疗的第一步，等待未来的分子生物标志物。
确定术前临床生物标志物预测子宫内膜癌 LNM 的诊断准确性。
根据观察性研究荟萃分析（MOOSE）指南进行系统评价。通过两名独立审查员从 MEDLINE 和 EMBASE 中选择研究。纳入的生物标志物基于推荐的指南（癌抗原 125 [Ca-125]、磁共振成像、计算机断层扫描和 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描 [FDG PET-CT] 上的淋巴结病）或通过体格检查获得（体重指数、宫颈细胞学、血细胞计数）。使用双变量随机效应荟萃分析计算汇总敏感性、特异性、曲线下面积（AUC）和似然比。似然比分为 （0.5-1.0 或 1-2.0）、 （0.2-0.5 或 2.0-5.0）或 （0.1-0.2 或 ≥ 5.0）影响。
共纳入 83 项研究，包括 18205 例患者。升高的 Ca-125 和血小板增多症与 LNM 风险增加 相关；影像学上的淋巴结病与风险增加 相关。正常的 Ca-125、细胞学和 FDG PET-CT 上无淋巴结病与风险降低 相关。这些生物标志物的 AUC 均高于 0.75。其他生物标志物的 AUC<0.75，仅产生 影响。
Ca-125、血小板增多症和影像学检查对 LNM 风险有 和 影响，可以改善术前风险分层。
在临床早期子宫内膜癌中常规行淋巴结切除术并不能改善预后，并且与 15%-20%的手术相关发病率相关，这强调了需要改善术前风险分层。新的分子分类系统正在出现，但尚未被评估用于预测淋巴结转移。本文提供了国际指南推荐的所有临床生物标志物的诊断性能的可靠概述。基于这些，至少应测量血清 CA125 水平、评估血小板增多症并重点评估淋巴结病的影像学检查，以补充当前的术前风险分层，以便更好地根据风险对这些患者进行分层。
