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Publications

Journal Article Ahead of print

PubMed: 42435643 DOI: 10.1016/j.ijgc.2026.104820

Beyond p53 status: the continued importance of histopathologic features for predicting lymph node metastasis in endometrial cancer.

Int J Gynecol Cancer 36(9):104820

Authors: Amelia Favier, Julia Le Tan, Aurélie Siret, Estelle Sestito, Lucie Jaouen, Justine Varinot, Florence Coulet, Quentin Letourneur, Olivier Buhard, Cyrus Chagari, Yohann Dabi, Cyril Touboul, Catherine Uzan, Alex Duval, Geoffroy Canlorbe

Affiliations

  • Sorbonne University, Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; Sorbonne University, INSERM, Unité Mixte de Recherche Scientifique 938 and SIRIC CURAMUS, Centre de Recherche Saint-Antoine, Equipe Instabilité Des Microsatellites Et Cancer, Equipe Labellisée Par La Ligue Nationale Contre Le Cancer, Paris, France.
  • Sorbonne University, Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
  • Sorbonne University, INSERM, Unité Mixte de Recherche Scientifique 938 and SIRIC CURAMUS, Centre de Recherche Saint-Antoine, Equipe Instabilité Des Microsatellites Et Cancer, Equipe Labellisée Par La Ligue Nationale Contre Le Cancer, Paris, France.
  • Sorbonne University, Department of Anatomical Pathology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
  • Sorbonne University, Department of Medical Genetics, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
  • Sorbonne University, Department of Radiotherapy, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
  • Sorbonne University, Department of Obstetrics and Gynecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
  • Sorbonne University, Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; Sorbonne University, Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Paris, France; University Institute of Cancer, Sorbonne University, Paris, France.

Abstract

OBJECTIVE

To identify predictors of lymph node metastasis according to molecular alterations, including mismatch repair-deficient, POLE-mutated, and p53-abnormal status, while preserving the contribution of established clinicopathologic features in patients with presumed early-stage endometrial cancer.

METHODS

This retrospective multi-center study included 477 patients with presumed early-stage International Federation of Gynecology and Obstetrics stage I to II endometrial cancer who underwent primary surgical management with lymph node staging. Associations between molecular alterations and lymph node metastasis were evaluated using two sequential multi-variable logistic regression models. The first model included histopathologic and molecular variables, and the second additionally incorporated lymphovascular space invasion, which is reliably assessed only post-operatively.

RESULTS

Most tumors were low-grade endometrioid (n = 294, 61.6%), and 118 (24.7%) were non-endometrioid. In the first multi-variable analysis, lymph node metastasis was independently associated with ≥50% myometrial invasion (adjusted odds ratio 9.15, 95% confidence interval 4.85 to 17.28, p =.001), non-endometrioid type (adjusted odds ratio 2.12, 95% confidence interval 1.16 to 3.88, p =.014), and p53-abnormal status (adjusted odds ratio 2.13, 95% confidence interval 1.10 to 4.13, p =.024). When lymphovascular space invasion was included in the model, only ≥50% myometrial invasion (adjusted odds ratio 4.76, 95% confidence interval 2.41 to 9.38, p <.001) and lymphovascular space invasion (adjusted odds ratio 4.32, 95% confidence interval 2.41 to 7.72, p <.001) remained independently associated with nodal metastasis.

CONCLUSIONS

Although p53 abnormalities may help identify patients at higher risk of nodal metastasis before surgery, deep myometrial invasion and lymphovascular space invasion remain key determinants of nodal involvement.

MeSH

Confidence Intervals, Lymph Nodes, Genital Neoplasms, Female, Neoplasms, Multiple Chronic Conditions, Neoplasm Metastasis, Genes, P53, Odds Ratio, Lymph, Endometrial Neoplasms