title: A validation study of a scoring system to estimate the risk of lymph node metastasis for patients with endometrial cancer for tailoring the indication of lymphadenectomy.
abstract: OBJECTIVE
  The aim of this study was to verify whether a preoperative scoring system to estimate the risk of lymph node metastasis (LNM) in endometrial carcinoma is clinically useful for tailoring the indication of lymphadenectomy.
  
  
  METHODS
  LNM score was set up using volume index, serum CA125 level, and tumor grade/histology, which were found to be independent risk factors for LNM in a pilot study. Based on the LNM score before a validation study was started, the estimated rates of LNM (para-aortic LNM) were 3.4% (0.0%) in a low risk group, 7.7% (5.8%) in an intermediate group, 44.4% (30.6%) in a high risk group and 70.0% (50.0%) in an extremely high risk group. The validation study was carried out using data for 211 patients with endometrial carcinoma for whom three risk factors were preoperatively confirmed. Logistic regression analysis was used to determine whether these factors remain valid. The actual rate of LNM was investigated according to the LNM score.
  
  
  RESULTS
  Volume index, serum CA125 level, and tumor grade/histology were found to be independent risk factors for LNM in the cohort of this study. The actual rates of LNM (para-aortic LNM) were 3.2% (1.0%) in the low risk group, 15.3% (11.9%) in the intermediate group, 30.2% (23.8%) in the high risk group and 78.6% (57.1%) in the extremely high risk group.
  
  
  CONCLUSIONS
  The actual rate of LNM for each score was fairly consistent with the estimated rate of LNM. Para-aortic lymphadenectomy may not be necessary in cases of a low risk group. A large prospective multicenter clinical trial needs to be conducted to establish the clinical usefulness of our preoperative scoring system.
authors.affiliation: Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Kita-15, Nishi-7, Kita-Ku, Sapporo 060-8638, Japan. yukiharu@med.hokudai.ac.jp
authors.forename: Yukiharu
authors.initials: Y
authors.lastname: Todo
authors.forename: Kazuhira
authors.initials: K
authors.lastname: Okamoto
authors.forename: Masaru
authors.initials: M
authors.lastname: Hayashi
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Minobe
authors.forename: Eiji
authors.initials: E
authors.lastname: Nomura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hareyama
authors.forename: Mahito
authors.initials: M
authors.lastname: Takeda
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Ebina
authors.forename: Hidemichi
authors.initials: H
authors.lastname: Watari
authors.forename: Noriaki
authors.initials: N
authors.lastname: Sakuragi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010865:Pilot Projects; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors