Comparing risk stratification criteria for predicting lymphatic dissemination in endometrial cancer

Toni P. Kilts, Gretchen E. Glaser, Carrie L. Langstraat, Amanika Kumar, Amy L. Weaver, Michaela E. Mc Gree, Bobbie S. Gostout, Karl C. Podratz, Sean Christopher Dowdy, William Arthur Cliby, Andrea Mariani, Jamie N Bakkum-Gamez

Research output: Contribution to journalArticle

Abstract

Objective: To compare two published risk stratification models (Milwaukee Model vs. Mayo Criteria) to predict lymphatic dissemination (LD) in endometrioid endometrial cancer (EC). Methods: Patients with stage I-III EC undergoing surgery from 1/1/2004–9/30/2013 were retrospectively reviewed and classified as low-risk vs at-risk for LD using two independent risk models. LD was defined as positive nodes at surgery or lymph node recurrence within 2 years of surgery after negative lymph node dissection (LND) or when LND was not performed. False positive (FP) and false negative (FN) rates for each risk model were calculated. Results: Among 1103 patients, 81 (7.3%) had LD (72 positive LN and 9 LN recurrences), and most (90.2%) had stage I EC. The Milwaukee Model yielded a low at-risk rate for LD (38.1%) but a high FN rate (13.6%, 95% CI 7.0–23.0). The traditional Mayo Criteria using a cut-off of 2 cm for tumor diameter (TD) had a higher at-risk rate for LD (69.5%) but a FN rate of 0% (95% CI, 0–4.5). Modifying the Mayo Criteria using a TD cutoff of ≤3 cm identified fewer women at-risk (56.8% vs. 69.5%) and had a lower FP rate (53.6% vs. 67.1%), but had a higher FN rate (3.7%, 95% CI, 0.8–10.4). Conclusions: The Milwaukee Model had the lowest at-risk rate of LD but an unacceptable FN rate. Modifying the Mayo Criteria by increasing the TD cutoff from the traditional ≤2 cm to ≤3 cm would spare an estimated 13.5% of patients LND, but the accompanying FN rate is unacceptably high. The traditional Mayo Criteria for low-risk EC remains the most sensitive in determining which patients LND can be omitted.

Original languageEnglish (US)
JournalGynecologic oncology
DOIs
StateAccepted/In press - Jan 1 2019

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Endometrial Neoplasms
Lymph Node Excision
Recurrence
Neoplasms
Lymph Nodes

Keywords

  • Endometrial cancer
  • Tumor diameter
  • Tumor grade

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Comparing risk stratification criteria for predicting lymphatic dissemination in endometrial cancer. / Kilts, Toni P.; Glaser, Gretchen E.; Langstraat, Carrie L.; Kumar, Amanika; Weaver, Amy L.; Mc Gree, Michaela E.; Gostout, Bobbie S.; Podratz, Karl C.; Dowdy, Sean Christopher; Cliby, William Arthur; Mariani, Andrea; Bakkum-Gamez, Jamie N.

In: Gynecologic oncology, 01.01.2019.

Research output: Contribution to journalArticle

Kilts, Toni P. ; Glaser, Gretchen E. ; Langstraat, Carrie L. ; Kumar, Amanika ; Weaver, Amy L. ; Mc Gree, Michaela E. ; Gostout, Bobbie S. ; Podratz, Karl C. ; Dowdy, Sean Christopher ; Cliby, William Arthur ; Mariani, Andrea ; Bakkum-Gamez, Jamie N. / Comparing risk stratification criteria for predicting lymphatic dissemination in endometrial cancer. In: Gynecologic oncology. 2019.
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abstract = "Objective: To compare two published risk stratification models (Milwaukee Model vs. Mayo Criteria) to predict lymphatic dissemination (LD) in endometrioid endometrial cancer (EC). Methods: Patients with stage I-III EC undergoing surgery from 1/1/2004–9/30/2013 were retrospectively reviewed and classified as low-risk vs at-risk for LD using two independent risk models. LD was defined as positive nodes at surgery or lymph node recurrence within 2 years of surgery after negative lymph node dissection (LND) or when LND was not performed. False positive (FP) and false negative (FN) rates for each risk model were calculated. Results: Among 1103 patients, 81 (7.3{\%}) had LD (72 positive LN and 9 LN recurrences), and most (90.2{\%}) had stage I EC. The Milwaukee Model yielded a low at-risk rate for LD (38.1{\%}) but a high FN rate (13.6{\%}, 95{\%} CI 7.0–23.0). The traditional Mayo Criteria using a cut-off of 2 cm for tumor diameter (TD) had a higher at-risk rate for LD (69.5{\%}) but a FN rate of 0{\%} (95{\%} CI, 0–4.5). Modifying the Mayo Criteria using a TD cutoff of ≤3 cm identified fewer women at-risk (56.8{\%} vs. 69.5{\%}) and had a lower FP rate (53.6{\%} vs. 67.1{\%}), but had a higher FN rate (3.7{\%}, 95{\%} CI, 0.8–10.4). Conclusions: The Milwaukee Model had the lowest at-risk rate of LD but an unacceptable FN rate. Modifying the Mayo Criteria by increasing the TD cutoff from the traditional ≤2 cm to ≤3 cm would spare an estimated 13.5{\%} of patients LND, but the accompanying FN rate is unacceptably high. The traditional Mayo Criteria for low-risk EC remains the most sensitive in determining which patients LND can be omitted.",
keywords = "Endometrial cancer, Tumor diameter, Tumor grade",
author = "Kilts, {Toni P.} and Glaser, {Gretchen E.} and Langstraat, {Carrie L.} and Amanika Kumar and Weaver, {Amy L.} and {Mc Gree}, {Michaela E.} and Gostout, {Bobbie S.} and Podratz, {Karl C.} and Dowdy, {Sean Christopher} and Cliby, {William Arthur} and Andrea Mariani and Bakkum-Gamez, {Jamie N}",
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AU - Kilts, Toni P.

AU - Glaser, Gretchen E.

AU - Langstraat, Carrie L.

AU - Kumar, Amanika

AU - Weaver, Amy L.

AU - Mc Gree, Michaela E.

AU - Gostout, Bobbie S.

AU - Podratz, Karl C.

AU - Dowdy, Sean Christopher

AU - Cliby, William Arthur

AU - Mariani, Andrea

AU - Bakkum-Gamez, Jamie N

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N2 - Objective: To compare two published risk stratification models (Milwaukee Model vs. Mayo Criteria) to predict lymphatic dissemination (LD) in endometrioid endometrial cancer (EC). Methods: Patients with stage I-III EC undergoing surgery from 1/1/2004–9/30/2013 were retrospectively reviewed and classified as low-risk vs at-risk for LD using two independent risk models. LD was defined as positive nodes at surgery or lymph node recurrence within 2 years of surgery after negative lymph node dissection (LND) or when LND was not performed. False positive (FP) and false negative (FN) rates for each risk model were calculated. Results: Among 1103 patients, 81 (7.3%) had LD (72 positive LN and 9 LN recurrences), and most (90.2%) had stage I EC. The Milwaukee Model yielded a low at-risk rate for LD (38.1%) but a high FN rate (13.6%, 95% CI 7.0–23.0). The traditional Mayo Criteria using a cut-off of 2 cm for tumor diameter (TD) had a higher at-risk rate for LD (69.5%) but a FN rate of 0% (95% CI, 0–4.5). Modifying the Mayo Criteria using a TD cutoff of ≤3 cm identified fewer women at-risk (56.8% vs. 69.5%) and had a lower FP rate (53.6% vs. 67.1%), but had a higher FN rate (3.7%, 95% CI, 0.8–10.4). Conclusions: The Milwaukee Model had the lowest at-risk rate of LD but an unacceptable FN rate. Modifying the Mayo Criteria by increasing the TD cutoff from the traditional ≤2 cm to ≤3 cm would spare an estimated 13.5% of patients LND, but the accompanying FN rate is unacceptably high. The traditional Mayo Criteria for low-risk EC remains the most sensitive in determining which patients LND can be omitted.

AB - Objective: To compare two published risk stratification models (Milwaukee Model vs. Mayo Criteria) to predict lymphatic dissemination (LD) in endometrioid endometrial cancer (EC). Methods: Patients with stage I-III EC undergoing surgery from 1/1/2004–9/30/2013 were retrospectively reviewed and classified as low-risk vs at-risk for LD using two independent risk models. LD was defined as positive nodes at surgery or lymph node recurrence within 2 years of surgery after negative lymph node dissection (LND) or when LND was not performed. False positive (FP) and false negative (FN) rates for each risk model were calculated. Results: Among 1103 patients, 81 (7.3%) had LD (72 positive LN and 9 LN recurrences), and most (90.2%) had stage I EC. The Milwaukee Model yielded a low at-risk rate for LD (38.1%) but a high FN rate (13.6%, 95% CI 7.0–23.0). The traditional Mayo Criteria using a cut-off of 2 cm for tumor diameter (TD) had a higher at-risk rate for LD (69.5%) but a FN rate of 0% (95% CI, 0–4.5). Modifying the Mayo Criteria using a TD cutoff of ≤3 cm identified fewer women at-risk (56.8% vs. 69.5%) and had a lower FP rate (53.6% vs. 67.1%), but had a higher FN rate (3.7%, 95% CI, 0.8–10.4). Conclusions: The Milwaukee Model had the lowest at-risk rate of LD but an unacceptable FN rate. Modifying the Mayo Criteria by increasing the TD cutoff from the traditional ≤2 cm to ≤3 cm would spare an estimated 13.5% of patients LND, but the accompanying FN rate is unacceptably high. The traditional Mayo Criteria for low-risk EC remains the most sensitive in determining which patients LND can be omitted.

KW - Endometrial cancer

KW - Tumor diameter

KW - Tumor grade

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