title: Tumor Size, an Additional Prognostic Factor to Include in Low-Risk Endometrial Cancer: Results of a French Multicenter Study.
abstract: BACKGROUND
  Additional tools are needed to improve the selection of women with early-stage endometrial cancer (EC) at increased risk of nodal metastases and/or recurrence to adapt surgical staging and adjuvant therapies. The aim of this study was to assess the impact of EC tumor size on nodal status and recurrence-free survival (RFS) according to European risk groups for recurrence.
  
  
  METHODS
  Data of 633 women with early-stage EC who received primary surgical treatment between 2001 and 2012 were abstracted from a multicenter database. Optimal tumor size cut-offs were determined by a minimal p value approach according to final nodal status. Logistic regression was used to determine the impact of defined tumor size on nodal involvement, and the Kaplan-Meier method was used to estimate the survival distribution.
  
  
  RESULTS
  The number of women with final low-, intermediate-, and high-risk EC was 302, 204, and 127, respectively. Tumor size was correlated with nodal status and RFS in women with low-risk EC, while no correlation was found for women with intermediate/high-risk EC. Tumor size ≥35 mm emerged as the optimal threshold for a higher rate of nodal involvement (odds ratio 4.318, 95 % CI 1.13-16.51, p = 0.03) and a lower RFS (p = 0.005) in women with low-risk EC.
  
  
  CONCLUSIONS
  Tumor size is an independent prognostic factor of lymph node involvement in women with low-risk EC and could be a valuable additional histological criterion for selecting women at increased risk of lymph node metastases to better adapt surgical staging.
authors.affiliation: Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France. geoffroy.canlorbe@tnn.aphp.fr.|Institut Universitaire de Cancérologie (IUC), University Pierre and Marie Curie, Paris, France. geoffroy.canlorbe@tnn.aphp.fr.|Saint Antoine Research Center, U938, Institut National de la Santé et de la Recherche Médicale (INSERM), University Pierre et Marie Curie-Paris VI, Paris, France. geoffroy.canlorbe@tnn.aphp.fr.
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Canlorbe
authors.affiliation: Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.|Institut Universitaire de Cancérologie (IUC), University Pierre and Marie Curie, Paris, France.|INSERM UMR S 707, Epidemiology, Information Systems, Modeling, University Pierre and Marie Curie, Paris, France.
authors.forename: Sofiane
authors.initials: S
authors.lastname: Bendifallah
authors.affiliation: Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.|Institut Universitaire de Cancérologie (IUC), University Pierre and Marie Curie, Paris, France.
authors.forename: Enora
authors.initials: E
authors.lastname: Laas
authors.affiliation: Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Raimond
authors.affiliation: Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Graesslin
authors.affiliation: Centre de lutte contre le cancer Georges François Leclerc, Dijon, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Hudry
authors.affiliation: Centre de lutte contre le cancer Georges François Leclerc, Dijon, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Coutant
authors.affiliation: Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Touboul
authors.affiliation: Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire, Lille, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Bleu
authors.affiliation: Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire, Lille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Collinet
authors.affiliation: Department of Pathology, Tenon University Hospital, University Pierre and Marie Curie, Paris, France.
authors.forename: Annie
authors.initials: A
authors.lastname: Cortez
authors.affiliation: Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.|Institut Universitaire de Cancérologie (IUC), University Pierre and Marie Curie, Paris, France.|Saint Antoine Research Center, U938, Institut National de la Santé et de la Recherche Médicale (INSERM), University Pierre et Marie Curie-Paris VI, Paris, France.
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
authors.affiliation: Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.|Institut Universitaire de Cancérologie (IUC), University Pierre and Marie Curie, Paris, France.|Saint Antoine Research Center, U938, Institut National de la Santé et de la Recherche Médicale (INSERM), University Pierre et Marie Curie-Paris VI, Paris, France.
authors.forename: Marcos
authors.initials: M
authors.lastname: Ballester
mesh_terms: D000368:Aged; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D047368:Tumor Burden