Histopathological criteria have a huge role in the preoperative categorization in endometrial carcinoma (EC). Due to the danger of lymph node metastasis (LNM), the diagnostic performance is moderate. Molecular categorization procedures have not been utilized for the prognosis of LNM up until this point. International guidelines suggest the usage of clinical biomarkers while waiting for future molecular biomarkers. This is because it is believed to potentially be the initial step in the route to refining customized treatment. The objective here is to ascertain how precisely preoperative clinical biomarkers can foresee LNM in endometrial cancer.

A methodical review was executed in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Two independent reviewers chose studies recognized in MEDLINE and EMBASE. The biomarkers involved were on the basis of suggested guidelines (cancer antigen 125 [Ca-125], computed tomography, 18F-fluorodeoxyglucose positron emission tomography/computed tomography [18FDG PET-CT]) and lymphadenopathy on magnetic resonance imaging, or acquired through physical examination (cervical cytology, blood cell counts, body mass index). Bivariate random-effects meta-analysis was used to calculate the area under the curve (AUC), specificity, likelihood ratios, and pooled sensitivity. The ratios for likelihood were categorized as follows – small (0.5–1.0 or 1–2.0), moderate (0.2–0.5 or 2.0–5.0) or large (0.1–0.2 or ≥ 5.0) impact.

A total of 83 studies were completed encompassing 18,205 patients. There was a moderate rise in the danger of LNM which was connected to thrombocytosis and elevated Ca-125. Also, there was a significant rise in lymphadenopathy on imaging. A moderate reduction in the danger was found to be related to cytology, normal Ca-125, and no lymphadenopathy on 18FDG PET-CT. The AUC for these biomarkers was calculated to be greater than 0.75. The AUC for other biomarkers was calculated to be less than 0.75 and caused just a small impact. The impact on the danger of LNM caused by thrombocytosis, Ca-125, and images were both moderate and large. This could therefore make the classification of preoperative risk better.

Link:theoncologist.onlinelibrary.wiley.com/doi/10.1634/theoncologist.2019-0117