Intraluminal tumor cells and prognostic accuracy of endometrial cancer stage criteria: A multi-institution study

Ashley S. Felix; Jennifer A. Sinnott; David E. Cohn; Máire A. Duggan; Laura J. Havrilesky; Alexander B. Olawaiye; Andrea Mariani; Monica Rodriquez; Mary Anne Brett; Giorgia Dinoi; Caitlin E. Meade; Bobbie Hall; Ester Goldfeld; Esther Elishaev; Mark E. Sherman; Adrian A. Suarez

doi:10.1016/j.ygyno.2023.10.004

Intraluminal tumor cells and prognostic accuracy of endometrial cancer stage criteria: A multi-institution study

Ashley S. Felix, Jennifer A. Sinnott, David E. Cohn, Máire A. Duggan, Laura J. Havrilesky, Alexander B. Olawaiye, Andrea Mariani, Monica Rodriquez, Mary Anne Brett, Giorgia Dinoi, Caitlin E. Meade, Bobbie Hall, Ester Goldfeld, Esther Elishaev, Mark E. Sherman, Adrian A. Suarez

Quantitative Health Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: Endometrial cancer stage is a strong prognostic factor; however, the current stage classification does not incorporate transtubal spread as determined by intraluminal tumor cells (ILTCs). We examined relationships between ILTCs and survival outcomes according to histological subtype and stage and examined whether identification of ILTCs improves prognostic accuracy of endometrial cancer staging. Methods: We conducted a retrospective cohort study of women diagnosed with endometrial cancer at five academic hospitals between 2007 and 2012. Pathologists determined ILTC presence (no vs. yes) and location (free in lumen vs. attached to epithelial surface) based on pathology review of hematoxylin and eosin-stained sections of fallopian tubes. Associations between ILTCs with time to recurrence (TTR) and overall survival (OS) were examined with Cox proportional hazards models adjusted for other prognostic factors. Model discrimination metrics were used to assess the addition of ILTCs to stage for prediction of 5-year TTR and OS. Results: In the overall study population (N = 1303), ILTCs were not independently associated with TTR (HR = 0.95, 95% CI = 0.69–1.32) or OS (HR = 0.97, 95% CI = 0.72–1.31). Among 805 women with stage I disease, ILTCs were independently associated with worse TTR (HR = 2.31, 95% CI = 1.06–5.05) and OS (HR = 2.16, 95% CI = 1.14–4.11). Upstaging early-stage cases with ILTCs present did not increase model discrimination. Conclusion: While our data do not suggest that endometrial cancer staging guidelines should be revised to include ILTCs, associations between ILTCs and reduced survival observed among stage I cases suggest this tumor feature holds clinical relevance for subgroups of endometrial cancer patients.

Original language	English (US)
Pages (from-to)	130-137
Number of pages	8
Journal	Gynecologic oncology
Volume	178
DOIs	https://doi.org/10.1016/j.ygyno.2023.10.004
State	Published - Nov 2023

Keywords

Disease-specific mortality
Fallopian tube
Patterns of spread
Uterus neoplasm

ASJC Scopus subject areas

Oncology
Obstetrics and Gynecology

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10.1016/j.ygyno.2023.10.004

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Felix, A. S., Sinnott, J. A., Cohn, D. E., Duggan, M. A., Havrilesky, L. J., Olawaiye, A. B., Mariani, A., Rodriquez, M., Brett, M. A., Dinoi, G., Meade, C. E., Hall, B., Goldfeld, E., Elishaev, E., Sherman, M. E., & Suarez, A. A. (2023). Intraluminal tumor cells and prognostic accuracy of endometrial cancer stage criteria: A multi-institution study. Gynecologic oncology, 178, 130-137. https://doi.org/10.1016/j.ygyno.2023.10.004

Felix, AS, Sinnott, JA, Cohn, DE, Duggan, MA, Havrilesky, LJ, Olawaiye, AB, Mariani, A, Rodriquez, M, Brett, MA, Dinoi, G, Meade, CE, Hall, B, Goldfeld, E, Elishaev, E, Sherman, ME & Suarez, AA 2023, 'Intraluminal tumor cells and prognostic accuracy of endometrial cancer stage criteria: A multi-institution study', Gynecologic oncology, vol. 178, pp. 130-137. https://doi.org/10.1016/j.ygyno.2023.10.004

@article{03baf4888a08425d892a93e4d4e42dc3,

title = "Intraluminal tumor cells and prognostic accuracy of endometrial cancer stage criteria: A multi-institution study",

abstract = "Objective: Endometrial cancer stage is a strong prognostic factor; however, the current stage classification does not incorporate transtubal spread as determined by intraluminal tumor cells (ILTCs). We examined relationships between ILTCs and survival outcomes according to histological subtype and stage and examined whether identification of ILTCs improves prognostic accuracy of endometrial cancer staging. Methods: We conducted a retrospective cohort study of women diagnosed with endometrial cancer at five academic hospitals between 2007 and 2012. Pathologists determined ILTC presence (no vs. yes) and location (free in lumen vs. attached to epithelial surface) based on pathology review of hematoxylin and eosin-stained sections of fallopian tubes. Associations between ILTCs with time to recurrence (TTR) and overall survival (OS) were examined with Cox proportional hazards models adjusted for other prognostic factors. Model discrimination metrics were used to assess the addition of ILTCs to stage for prediction of 5-year TTR and OS. Results: In the overall study population (N = 1303), ILTCs were not independently associated with TTR (HR = 0.95, 95% CI = 0.69–1.32) or OS (HR = 0.97, 95% CI = 0.72–1.31). Among 805 women with stage I disease, ILTCs were independently associated with worse TTR (HR = 2.31, 95% CI = 1.06–5.05) and OS (HR = 2.16, 95% CI = 1.14–4.11). Upstaging early-stage cases with ILTCs present did not increase model discrimination. Conclusion: While our data do not suggest that endometrial cancer staging guidelines should be revised to include ILTCs, associations between ILTCs and reduced survival observed among stage I cases suggest this tumor feature holds clinical relevance for subgroups of endometrial cancer patients.",

keywords = "Disease-specific mortality, Fallopian tube, Patterns of spread, Uterus neoplasm",

author = "Felix, {Ashley S.} and Sinnott, {Jennifer A.} and Cohn, {David E.} and Duggan, {M{\'a}ire A.} and Havrilesky, {Laura J.} and Olawaiye, {Alexander B.} and Andrea Mariani and Monica Rodriquez and Brett, {Mary Anne} and Giorgia Dinoi and Meade, {Caitlin E.} and Bobbie Hall and Ester Goldfeld and Esther Elishaev and Sherman, {Mark E.} and Suarez, {Adrian A.}",

note = "Publisher Copyright: {\textcopyright} 2023 Elsevier Inc.",

year = "2023",

month = nov,

doi = "10.1016/j.ygyno.2023.10.004",

language = "English (US)",

volume = "178",

pages = "130--137",

journal = "Gynecologic oncology",

issn = "0090-8258",

publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Intraluminal tumor cells and prognostic accuracy of endometrial cancer stage criteria

T2 - A multi-institution study

AU - Felix, Ashley S.

AU - Sinnott, Jennifer A.

AU - Cohn, David E.

AU - Duggan, Máire A.

AU - Havrilesky, Laura J.

AU - Olawaiye, Alexander B.

AU - Mariani, Andrea

AU - Rodriquez, Monica

AU - Brett, Mary Anne

AU - Dinoi, Giorgia

AU - Meade, Caitlin E.

AU - Hall, Bobbie

AU - Goldfeld, Ester

AU - Elishaev, Esther

AU - Sherman, Mark E.

AU - Suarez, Adrian A.

PY - 2023/11

Y1 - 2023/11

N2 - Objective: Endometrial cancer stage is a strong prognostic factor; however, the current stage classification does not incorporate transtubal spread as determined by intraluminal tumor cells (ILTCs). We examined relationships between ILTCs and survival outcomes according to histological subtype and stage and examined whether identification of ILTCs improves prognostic accuracy of endometrial cancer staging. Methods: We conducted a retrospective cohort study of women diagnosed with endometrial cancer at five academic hospitals between 2007 and 2012. Pathologists determined ILTC presence (no vs. yes) and location (free in lumen vs. attached to epithelial surface) based on pathology review of hematoxylin and eosin-stained sections of fallopian tubes. Associations between ILTCs with time to recurrence (TTR) and overall survival (OS) were examined with Cox proportional hazards models adjusted for other prognostic factors. Model discrimination metrics were used to assess the addition of ILTCs to stage for prediction of 5-year TTR and OS. Results: In the overall study population (N = 1303), ILTCs were not independently associated with TTR (HR = 0.95, 95% CI = 0.69–1.32) or OS (HR = 0.97, 95% CI = 0.72–1.31). Among 805 women with stage I disease, ILTCs were independently associated with worse TTR (HR = 2.31, 95% CI = 1.06–5.05) and OS (HR = 2.16, 95% CI = 1.14–4.11). Upstaging early-stage cases with ILTCs present did not increase model discrimination. Conclusion: While our data do not suggest that endometrial cancer staging guidelines should be revised to include ILTCs, associations between ILTCs and reduced survival observed among stage I cases suggest this tumor feature holds clinical relevance for subgroups of endometrial cancer patients.

AB - Objective: Endometrial cancer stage is a strong prognostic factor; however, the current stage classification does not incorporate transtubal spread as determined by intraluminal tumor cells (ILTCs). We examined relationships between ILTCs and survival outcomes according to histological subtype and stage and examined whether identification of ILTCs improves prognostic accuracy of endometrial cancer staging. Methods: We conducted a retrospective cohort study of women diagnosed with endometrial cancer at five academic hospitals between 2007 and 2012. Pathologists determined ILTC presence (no vs. yes) and location (free in lumen vs. attached to epithelial surface) based on pathology review of hematoxylin and eosin-stained sections of fallopian tubes. Associations between ILTCs with time to recurrence (TTR) and overall survival (OS) were examined with Cox proportional hazards models adjusted for other prognostic factors. Model discrimination metrics were used to assess the addition of ILTCs to stage for prediction of 5-year TTR and OS. Results: In the overall study population (N = 1303), ILTCs were not independently associated with TTR (HR = 0.95, 95% CI = 0.69–1.32) or OS (HR = 0.97, 95% CI = 0.72–1.31). Among 805 women with stage I disease, ILTCs were independently associated with worse TTR (HR = 2.31, 95% CI = 1.06–5.05) and OS (HR = 2.16, 95% CI = 1.14–4.11). Upstaging early-stage cases with ILTCs present did not increase model discrimination. Conclusion: While our data do not suggest that endometrial cancer staging guidelines should be revised to include ILTCs, associations between ILTCs and reduced survival observed among stage I cases suggest this tumor feature holds clinical relevance for subgroups of endometrial cancer patients.

KW - Disease-specific mortality

KW - Fallopian tube

KW - Patterns of spread

KW - Uterus neoplasm

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DO - 10.1016/j.ygyno.2023.10.004

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C2 - 37862792

AN - SCOPUS:85174343934

SN - 0090-8258

VL - 178

SP - 130

EP - 137

JO - Gynecologic oncology

JF - Gynecologic oncology

ER -

Intraluminal tumor cells and prognostic accuracy of endometrial cancer stage criteria: A multi-institution study

Abstract

Keywords

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