ENDORISK-2: A personalized Bayesian network for preoperative risk stratification in endometrial cancer, integrating molecular classification and preoperative myometrial invasion assessment

• Autoři: LOMBAERS Marike S; REIJNEN Casper; SPRIK Ally; BRETOVÁ Petra; GRUBE Marcel; VREDE Stephanie; BERG Hege F; ASBERGER Jasmin; COLAS Eva; HAUSNEROVÁ Jitka; HUVILA Jutta; GIL-MORENO Antonio; MATIAS-GUIU Xavier; SIMONS Michiel; SNIJDERS Marc P L M; VISSER Nicole C M; KOMMOSS Stefan; WEINBERGER Vít; AMANT Frederic; BRONSERT Peter; HALDORSEN Ingfrid S; KOSKAS Martin; KRAKSTAD Camilla; KUSTERS-VANDEVELDE Heidi V N; MANCEBO Gemma; VAN DER PUTTEN Louis J M; IRENE De La Calle; LUCAS Peter J F; HOMMERSOM Arjen; PIJNENBORG Johanna M A
• Rok publikování: 2025
• Druh: Článek v odborném periodiku
• Časopis / Zdroj: European Journal of Cancer
• Fakulta / Pracoviště MU: Lékařská fakulta
• www: https://www.sciencedirect.com/science/article/pii/S095980492500944X?pes=vor&utm_source=clarivate&getft_integrator=clarivate
• Doi: https://doi.org/10.1016/j.ejca.2025.116058
• Klíčová slova: Endometrial cancer; Risk estimation; Lymph node metastasis; Bayesian network; Molecular classification; Myometrial invasion
• Popis: Background: ENDORISK is a Bayesian network that can assist in preoperative risk estimation of lymph node metastasis (LNM) risk in endometrial cancer (EC) with consistent performance in external validations. To reflect state of the art care, ENDORISK was optimized by integrating molecular classification and preoperative assessment of myometrial invasion (MI). Methods: Variables for POLE, MSI, and preoperative assessment of MI, either by expert transvaginal ultrasound or pelvic magnetic resonance imaging (MRI), were added to develop ENDORISK-2. The p53 biomarker, part of the molecular classification, was already included in ENDORISK. External validation of ENDORISK-2 for LNM pre-diction was performed in two independent cohorts from: Brno (CZ), (n = 581) and T & uuml;bingen (DE), (n = 247). Findings: ENDORISK-2 yielded AUCs of 0.85 (95 % CI 0.80-0.90) (CZ) and 0.86 (95 % CI 0.77-0.96) (DE) for predicting LNM. In patients with low-grade histology, 83 % (CZ) and 89 % (DE) were estimated having less than 10 % risk of LNM, with false negative rates (FNR) of 4.3 % (CZ) and 2.2 % (DE). The previously defined set of minimally required variables, i.e.: preoperative tumor grade, three of the four immunohistochemical (IHC) markers, and one clinical marker, could be interchanged with the new variables, with comparable validation metrics, including AUC values of 0.79-0.87 for LNM prediction. Interpretation. Incorporation of molecular data and preoperative MI improved the flexibility of ENDORISK with comparable diagnostic accuracy for estimating LNM as when based on low-cost immunohistochemical bio-markers. In addition, the high diagnostic accuracy in patients with low-grade EC demonstrates how ENDORISK-2 could aid clinicians in identifying patients in whom surgical lymph node assessment may safely be omitted. These results underline its power for clinical use in both high and low resource countries.