Article Text
PDF
Abstract
Introduction/Background The current sentinel node algorithms in endometrial cancer (EC) do not include the need to perform a surgical study of the aortic area.
Although it is known that isolated aortic involvement is low, it is influenced by the risk of global lymph node metastasis in this cancer. However, in selected groups it represents approximately a 25%. Furthermore, more than half of the cases where pelvis is involved, aortic region is also affected.
The objective of this study is to create a prediction model for aortic involvement, based on preoperative risk factors.
Methodology 376 women who underwent surgery because of EC at the Donostia University Hospital (August 2014 - July 2022) were retrospectively identified.
The prediction model for aortic lymph node involvement was performed using logistic regression. Due to low the frequency of aortic lymph node involvement in EC, a reduced number of variables were specified to reduce the risk of overfitting and the prediction error, as well as their clinical applicability.
Results From 376 patients, metastatic involvement of the aortic SLN was detected in 25 of them (6.65%). The table shows the distribution of risk factors for dissemination between affected women and those who were not. In the univariate analysis, all potential predictors were more prevalent among women with aortic lymph node involvement, and were statistically significantly associated with it, except for non-endometrioid histology, with tumor extension beyond the uterine body being the factor with a greater association with the presence of positive aortic SLN. In the multivariate logistic regression model, this positive association was maintained, but with greater uncertainty, and the extension beyond the uterine body was the only one maintaining its statistical significance.
Conclusion This normogram is useful to calculate the risk of aortic lymph node involvement in EC and may be useful in making decisions about its approach.
Disclosures Nomogram for the prediction of aortic sentinel node involvement in women with endometrial cancer. Instructions: Locate the tumor grade determined by preoperative biopsy ‘Grade’ axis. Draw a straight line up to the ‘Points’ axis to determine how many points toward the probability of positive sentinel aortic nodes the patient receives for her tumor grade. Repeat the process for each variable. Sum the points obtained for each of the predictors. Locate the final sum on the ‘Total Score’ axis. Draw a straight line down to find the patient's probability of having positive aortic nodes.