Liang Fengyi, Xin Weijuan, Yang Shaoliang, Wang Haiyan
Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
J Gynecol Oncol. 2025 Jan;36(1):e1. doi: 10.3802/jgo.2025.36.e1. Epub 2024 Jun 10.
The objective of this study was to identify the risk factors for postoperative pathological escalation of endometrial cancer in patients with a pathologic diagnosis of endometrial intraepithelial neoplasia (EIN) before surgery. Some of the clues from the preoperative assessment were used to build a nomogram to predict the likely pathological escalation after surgery, and to explore the feasibility of sentinel lymph node biopsy in these patients with possible pathological escalation.
This was a retrospective analysis of patients who underwent surgical treatment for EIN diagnosed before surgery between 2018 and 2023 in The Obstetrics and Gynecology Hospital of Fudan University. parameters including clinical, radiological and histopathological factors were analyzed by univariate and multivariate logistic regression to determine the correlation with pathology upstaging. A nomogram based on the multivariate results was developed to predict the probability of pathology upstaging. A total of 729 patients were included, divided into training set and validation set. 484 patients were used to build the model. This nomogram was subsequently validated using 245 patients.
Upstaging to endometrial carcinoma occurred in 115 (23.8 percent) of 484 women treated between 2018 and 2023 in training set. A lager endometrial thickness (at least 15 mm), menopause, hypertension, HE4, and endometrial blood were significantly associated with upstaging. A nomogram developed using these factors demonstrated good predictive performance (area under the receiver operating characteristic curve (AUC)=0.6808; 95% confidence interval [CI]=0.6246-0.7369). The nomogram showed similar predictive performance in the validation data set, based on another 245 women (AUC=0.7821; 95% CI=0.7076-0.8567).
This study developed a novel nomogram based on the 5 most important factors, which can accurately predict invasive cancer. It is common for women with preoperative diagnosis of EIN to experience pathological progression to endometrial cancer. For some patients with postoperative pathological escalation, we found lymph node metastasis. This nomogram may be useful to help doctor decide whether to perform sentinel lymph node biopsy for surgical staging in these EIN patients. According to the nomogram, simultaneous sentinel lymph node biopsy in patients with high probability of postoperative pathological upgrading can provide better guidance for postoperative adjuvant treatment of endometrial cancer and avoid the occurrence of secondary surgery.
本研究旨在确定术前病理诊断为子宫内膜上皮内瘤变（EIN）的患者术后子宫内膜癌病理升级的危险因素。利用术前评估中的一些线索构建列线图，以预测术后可能的病理升级情况，并探讨在这些可能发生病理升级的患者中进行前哨淋巴结活检的可行性。
这是一项对2018年至2023年在复旦大学附属妇产科医院接受手术治疗的术前诊断为EIN的患者的回顾性分析。通过单因素和多因素逻辑回归分析包括临床、放射学和组织病理学因素在内的参数，以确定与病理分期升级的相关性。基于多因素结果开发列线图以预测病理分期升级的概率。共纳入729例患者，分为训练集和验证集。484例患者用于构建模型。随后使用245例患者对该列线图进行验证。
在训练集中，2018年至2023年接受治疗的484例女性中有115例（23.8%）病理分期升级为子宫内膜癌。子宫内膜厚度较大（至少15mm）、绝经、高血压、人附睾蛋白4（HE4）以及子宫内膜血流与分期升级显著相关。利用这些因素开发的列线图显示出良好的预测性能（受试者操作特征曲线下面积（AUC）=0.6808；95%置信区间[CI]=0.6246-0.7369）。基于另外245例女性的验证数据集中，该列线图显示出相似的预测性能（AUC=0.7821；95%CI=0.7076-0.8567）。
本研究基于5个最重要的因素开发了一种新型列线图，可准确预测浸润性癌。术前诊断为EIN的女性病理进展为子宫内膜癌很常见。对于一些术后病理升级的患者，我们发现了淋巴结转移。该列线图可能有助于医生决定是否对这些EIN患者进行前哨淋巴结活检以进行手术分期。根据该列线图，对术后病理升级可能性高的患者同时进行前哨淋巴结活检可为子宫内膜癌术后辅助治疗提供更好的指导，并避免二次手术的发生。
