Article Text

Download PDFPDF
Clinical relevance of high–intermediate risk endometrial cancer according to European risk classification
  1. Agnieszka Rychlik1,
  2. Ignacio Zapardiel2,
  3. Laura Baquedano3,
  4. María Ángeles Martínez Maestre4,
  5. Denis Querleu5 and
  6. Pluvio J Coronado Martín6
  1. 1Gynecologic Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
  2. 2Gynecologic Oncology, Hospital Universitario La Paz, Madrid, Spain
  3. 3Obstetrics and Gynecology, Hospital Universitario Miguel Servet, Zaragoza, Spain
  4. 4Obstetrics and Gynecology, Hospital Virgen del Rocío, Sevilla, Spain
  5. 5University of Toulouse, Toulouse, France
  6. 6Gynecologic Oncology, Hospital Clínico San Carlos, Madrid, Spain
  1. Correspondence to Dr Agnieszka Rychlik, Gynecologic Oncology, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, 02-781 Warsaw, Poland; agarychlik{at}


Objective Risk models in endometrial cancer define prognosis and indicate adjuvant therapy. One of the currently used classifications was designed in 2016 in collaboration with the European Society of Medical Oncology (ESMO), the European Society of Gynecologic Oncology (ESGO), and the European Society of Radiotherapy (ESTRO). A high–intermediate risk group was introduced within the intermediate risk group. The purpose of this study was to evaluate the clinical relevance of this subclassification.

Methods A multicenter retrospective study was carried out at five international tertiary institutions. Patients diagnosed with intermediate risk endometrial cancer on the basis of definitive pathology findings were included. Patients were stratified into intermediate and high–intermediate risk groups. Incidence of nodal metastases, and disease free and overall survival were compared between the two risk groups in univariate and multivariate analysis.

Results 477 patients were included: 325 (68%) patients were identified as intermediate and 152 (32%) as high–intermediate endometrial cancer patients. Nodal metastases were found in 18 patients (11.8%) in the high–intermediate risk endometrial cancer group and 16 patients (4.9%) in the intermediate risk group. Lymphovascular space invasion was found to be a strong predictive factor of lymph node involvement. High–intermediate risk was found to be an independent factor of disease free survival (hazard ratio (HR) 1.76; 95% confidence interval (CI) 1.00 to 3.08; p=0.050) and overall survival (HR 1.99; 95% CI 1.10 to 3.60; p=0.022) in the multivariate analysis.

Conclusions The study validates the clinical significance of the intermediate risk endometrial cancer subclassification. Prognosis for high–intermediate risk endometrial cancer was significantly poorer. The prevalence of lymph node metastases was higher in this group of patients.

  • endometrial neoplasms

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Correction notice This article has been corrected since it was published Online First. The acknowledgements statement was previously omitted and has now been added.

  • Contributors AR: conceptualization, data curation, methodology, and writing–original draft. IZ: conceptualization, project administration, and methodology writing–review. LB: conceptualization and methodology writing–review. MAMM: conceptualization and methodology writing–review. DQ: conceptualization, data curation, methodology, and writing–original draft. PJCM: conceptualization, project administration, statistical analyses, methodology, and writing–original draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was submitted and approved by the San Carlos Clinico Hospital Institutional Review Board (Spain), approval No 20/407-E. The samples from the French tumor archives were centralized in the Biological Resources Centers of Institut Bergonié which the French authorities authorized for scientific research (AC-2008-812).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party and are not publicly available.