Benzion Samueli

The prognostic importance of features of myometrial invasion in endometrial endometrioid carcinoma

Abstract Purpose The depth of myometrial invasion (MI) is known to have a prognostic value in endometrial carcinoma (EC), and the FIGO 50% cutoff is widely accepted; however, recent studies have suggested other measurements such as the absolute depth of invasion and tumor-free distance (TFD) from the serosal surface to also be predictive. The aim of this study was to assess the association between the FIGO cutoff and other measures with overall survival and disease-free survival of patients. Methods This is a retrospective analysis of a cohort of 248 women diagnosed with stage I endometrioid endometrial carcinoma, treated at Soroka University Medical Center between 2006 and 2020. Clinical and pathological data were collected and analyzed. ROC analysis was used to define the best cutoffs in all three categories (MI, absolute depth and TDF). Survival analyses were then conducted using Kaplan–Meier curves, log-rank tests, and Cox proportional hazards regression. Results Absolute myometrial invasion (MI) to the depth of 1 cm significantly predicted overall survival (log-rank, p  = 0.009) in univariate analysis; however, this significance was not maintained in multivariate analysis. Additionally, a 33% MI cutoff demonstrated potential for better outcome prediction as compared to the commonly used 50% MI threshold, though it did not reach statistical significance. Tumor-free distance (TFD) from the serosal surface was not significantly associated with outcome. Conclusions MI depth of more than 1 cm may serve as a meaningful prognostic indicator. Additionally, a cutoff of 33% MI probably has a better prognostic value than the current 50% cutoff. These findings show a promising direction for future research, emphasizing the need for larger cohorts and multicenter studies to confirm our findings.

The significance of lower uterine segment involvement in endometrial cancer

Limited data suggests lower uterine segment involvement (LUSI) in endometrial cancer may be associated with other poor prognostic factors. We assessed the unclear impact of LUSI on prognosis in endometrial cancer. ology: A revision of pathological samples following surgical staging between the years 2002-2022 was performed and clinical data collected from patients' records. Characteristics and outcomes of women with and without LUSI were compared and analysed. Kaplan Meyer survival curves compared overall survival (OS) and progression-free survival (PFS). 429 women were included, of which 45 (10.5%) had LUSI. No differences were found between the groups regarding demographic or clinical characteristics. LUSI was significantly associated with lympho-vascular space invasion (40% vs. 22% p = 0.01), lymph node involvement (6.4% vs. 9.1%, p = 0.05), shorter PFS (4 vs. 5.5 years, p = 0.01) and OS (5.6 vs. 11.5 years, p = 0.03). Multivariate analysis showed higher hazard ratios for OS and PFS (1.55 95%CI 0.79-3.04 and 1.29 95%CI 0.66-2.53, respectively) but these were insignificant even in a sub-analysis of endometrioid histology (1.76 95%CI 0.89-3.46 and 1.35 95%CI 0.69-2.65, respectively). A trend towards decreased PFS and OS was demonstrated in the Kaplan Meyer survival curves for all cases (log rank test p = 0.5 and 0.29 respectively), endometrioid histology (log rank test p = 0.06 and 0.51 respectively) and early-stage disease (log rank test p = 0.63 and 0.3 respectively). LUSI may be related to poorer outcome of endometrial cancer and may represent an additional factor to consider when contemplating adjuvant treatment, especially in endometrioid-type and early-stage disease.