Publication details
Real-world impact of lymph node assessment on adjuvant management in p53-abnormal endometrial carcinoma: a retrospective multicenter cohort from Central Europe
| Authors | |
|---|---|
| Year of publication | 2026 |
| Type | Article in Periodical |
| Magazine / Source | International journal of gynecological cancer |
| MU Faculty or unit | |
| Citation | |
| web | https://www.sciencedirect.com/science/article/pii/S1048891X26001647?via%3Dihub |
| Doi | https://doi.org/10.1016/j.ijgc.2026.104633 |
| Keywords | Endometrial Carcinoma; p53-Abnormal; Molecular Classification; Lymph Node Staging; Adjuvant Therapy |
| Description | Objective: To determine how often lymph node assessment alters post-operative risk classification or adjuvant therapy in p53-abnormal endometrial carcinoma and to calculate the number needed to stage to obtain 1 management-changing result. Methods: This multicenter retrospective study included patients with biopsy-confirmed p53-abnormal endometrial carcinoma who underwent pre-operative expert ultrasound, molecular classification, and definitive surgery. Pre-operative risk groups were based on ultrasound-assessed invasion and molecular subtype; post-operative groups incorporated final pathology and lymph node status. The number needed to stage was defined as the number of patients staged divided by the number with management-changing results. Results: Among 120 patients, lymph node status was evaluable in 107, with metastases identified in 19 (17.8%) cases. Concordance between pre-operative and postoperative risk groups was 84.2%. Reclassification occurred in 15.8% of patients and was driven entirely by uterine pathological findings. Lymph node findings altered guideline-based post-operative management in only 2 of 107 patients (1.9%; 95% confidence interval 0.2% to 6.6%), both through treatment de-escalation based on negative nodal status. No escalation of adjuvant therapy was triggered by nodal metastases. The number needed to stage was 53.5. Conclusions: In this multicenter cohort of p53-abnormal endometrial carcinoma, lymph node assessment had a limited impact on guideline-based post-operative management, with treatment decisions largely driven by molecular subtype and uterine pathological factors. Prospective, molecularly stratified studies are needed to clarify the optimal role of nodal staging in this patient population. |