title: Risk-stratification of endometrial carcinomas revisited: a combined preoperative and intraoperative scoring system for a reliable prediction of an advanced disease.
abstract: OBJECTIVE
  The aim of this study is to develop a risk-scoring system for predicting lymph node and distant metastasis in endometrial carcinoma.
  
  
  METHODS
  A total of 1166 patients, treated at a single institution between 1-2007 and 12-2013, were included in the study. The association of stage IIIC-IV disease with demographic factors (age, body mass index), biochemical factors (complete blood count, serum CA125), preoperative histology and tumor size was examined in unadjusted analyses. Logistic regression analysis was used for the identification of variables that independently predict an advanced disease.
  
  
  RESULTS
  Thrombocytosis, serum CA125>35 U/mL, preoperative high-risk histology (nonendometrioid or grade 3 endometrioid carcinoma) and tumor size≥3 cm were independently associated with an advanced disease. These predictors were internally validated by a bootstrapping method with statistical significance. A risk-scoring system with an area under the receiver operating characteristic curve of 0.852 (95% confidence interval, 0.821-0.883) was developed. Total risk score points ranged from 0 to 8 for individual patients. With a cut-off of 1 point, stratifying 66.3% of patients to surgical staging, the model predicted stage IIIC-IV carcinomas with a sensitivity of 100%, specificity of 38.0%, positive predictive value of 17.1%, and negative predictive value of 100%. With the same cut-off, the corresponding values were 100%, 34.7%, 16.5% and 100% in predicting stage IIIC carcinomas in a subgroup that underwent lymphadenectomy and had a stage I-IIIC disease.
  
  
  CONCLUSIONS
  This risk-scoring system is highly sensitive in predicting an advanced stage endometrial carcinoma at a cut-off of risk score points that is associated with an acceptable lymphadenectomy rate.
authors: Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: taru.tuomi@fimnet.fi.
authors: Taru
authors: T
authors: Tuomi
authors: Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors: Annukka
authors: A
authors: Pasanen
authors: Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors: Anna
authors: A
authors: Luomaranta
authors: Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors: Arto
authors: A
authors: Leminen
authors: Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors: Ralf
authors: R
authors: Bützow
authors: Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors: Mikko
authors: M
authors: Loukovaara
mesh_terms: D000367:Age Factors; D000368:Aged; D018394:CA-125 Antigen / Q000097:blood; D016889:Endometrial Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008565:Membrane Proteins / Q000097:blood; D016343:Monitoring, Intraoperative; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D012306:Risk; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013922:Thrombocytosis / Q000473:pathology
chemical_list: D018394:CA-125 Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins
keywords: Endometrial carcinoma; Lymph node metastasis; Lymphadenectomy; Risk-stratification