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Predictive factors for adnexal involvement in endometrial cancer FIGO stage IIIA
  1. Giorgia Dinoi1,
  2. Domenica Lorusso1,2,
  3. Eleonora La Fera1,
  4. Stefano Restaino3,
  5. Pia Clara Pafundi4,
  6. Alessandro Gioè1,
  7. Laura Naccarato5,
  8. Emilia Palmieri5,
  9. Lucia Musacchio1,
  10. Ettore Di Stefano5,
  11. Vincenzo Tarantino5,
  12. Giovanni Scambia1,5 and
  13. Francesco Fanfani1,5
    1. 1Department of Woman and Child Health, and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
    2. 2Gynecologic Oncology Unit, Humanitas San Pio X, Humanitas University Rozzano, Milan, Italy
    3. 3Division of Obstetrics and Gynecology, University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
    4. 4Epidemiology and Biostatistics Research Core Facility, Gemelli Science and Technology Park, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
    5. 5Catholic University of the Sacred Heart - Rome Campus, Rome, Italy
    1. Correspondence to Dr Domenica Lorusso, Department of Woman and Child Health, and Public Health Roma, Lazio, IT, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy; Domenica.lorusso{at}hunimed.eu

    Abstract

    Objective Understanding ovarian involvement incidence and risk factors in women with endometrial cancer may inform the decision of ovary preservation.

    Methods Our retrospective study included all consecutive fully surgically staged patients with endometrial cancer who underwent primary surgery between January 2005 and November 2021, assessing the incidence of ovarian metastasis, its role as a prognostic factor for recurrence and death, and evaluated predictors of adnexal involvement.

    Results Women with International Federation of Gynecology and Obstetrics (FIGO) 2009 IIIA endometrial cancer comprised 2.3% of the population (36 of 1535 included patients), 23 (63.9%) with endometrioid histology, and a median age of 57.0 years (range 47.7–66.7). A higher body mass index, post-menopausal status, endometrioid histotype, and β-catenin expression were associated with a lower risk of adnexal involvement. Conversely, dMMR phenotype, p53 expression, myometrial infiltration >50%, lymphovascular space invasion, and cervical stromal invasion were independent predictors of an increased risk of adnexal involvement. A total of 145 (9.5%) patients had adnexal involvement, with an incidence rate of 0.27/100 person-days. Overall survival for FIGO (2009) stage IIIA was 88.9%.

    Conclusions Our study showed that ovarian preservation may be considered for younger patients with low-risk endometrial cancer (G1 and G2 tumors, absence of lymphovascular space invasion, no cervical involvement, and myometrial invasion <50%), adding a favorable predictive role to higher body mass index and high β-catenin expression.

    • Endometrial Neoplasms
    • Adnexal Diseases
    • Gynecology

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @lucia_musacchio

    • Contributors All the authors contributed to the manuscript. Conceptualization, funding acquisition, methodology: GD, ELF, SR, FF; Data curation, investigation: LN, EP, VT, LM, EDS; Formal analysis, methodology: PCP; Writing - original draft: GD; Writing - review and editing: ELF, DL, AG, LM; Approval to submit: DL, FF, GS. Guarantor: GD.

    • Funding The study was supported by internal funds.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.