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Tumoral volume measured preoperatively by magnetic resonance imaging is related to survival in endometrial cancer

Pluvio J. Coronado
Pluvio J. Coronado
, 
Javier de Santiago-López
Javier de Santiago-López
, 
Javier de Santiago-García
Javier de Santiago-García
, 
Ramiro Méndez
Ramiro Méndez
, 
Maria Fasero
Maria Fasero
 y 
Miguel A. Herraiz
Miguel A. Herraiz
   | 12 ene 2021
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Article Category: Research Article
Publicado en línea: 12 ene 2021
Páginas: 35 - 41
Recibido: 16 may 2020
Aceptado: 05 oct 2020
DOI: https://doi.org/10.2478/raon-2020-0064
© 2021 Pluvio J. Coronado, Javier de Santiago-López, Javier de Santiago-García, Ramiro Méndez, Maria Fasero, Miguel A. Herraiz, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Kaplan Meier curves representing the survival in relation of tumoral volume measured by magnetic resonance. (A) Disease-free survival; (B) Overall Survival.
Kaplan Meier curves representing the survival in relation of tumoral volume measured by magnetic resonance. (A) Disease-free survival; (B) Overall Survival.

Predictor factors of lymph node metastases in 216 cases of endometrial cancer with known lymph node status

VariablesNo lymph node metastases N = 179Lymph node metastases N = 37p value
Age (years)
    < 6578 (43.6%)12 (32.4%)0.211
    ≥ 65101 (56.4%)25 (67.6%)
Histologic subtype
    Endometrioid147 (82.1%)23 (62.2%)0.007
    Non endometrioid32 (17.9%)14 (37.8%)
Histological Grade
    G1–G2118 (56.9%)13 (35.1%)< 0.001
    G361 (43.1%)24 (64.9%)
Myometrial invasion
    < 50%90 (50.3%)8 (21.6%)0.001
    ≥ 50%89 (49.7%)29 (78.4%)
Maximum tumor size
     < 2 cm43 (24.0%)6 (16.2%)0.390
    ≥ 2 cm136 (76.0%)31 (83.8%)
MR tumor volume
    < 10 cm361 (34.1%)5 (13.5%)0.013
    ≥ 10 cm3118 (65.9%)32 (86.5%)

Baseline patient´s characteristics

VariableN=341
Age (years)65.7 [58.0–74.0]
    < 65y186 (54.5%)
    ≥ 65y155 (45.5%)
BMI (kg/m2)29.3 [24.8–33.0]
    < 30200 (58.7%)
    ≥ 30141 (41.3%)
Histologic subtype
    Endometrioid278 (81.5%)
    Mucinous5 (1.5)
    Squamous6 (1.8%)
    Serous Papillary23 (6.7%)
    Clear cells13 (3.8%)
    Mixed mesodermal tumors12 (3.5%)
    Undifferenced1 (0.3%)
Histological Grade
    G1159 (46.6%)
    G286 (25.2%)
    G396 (28.25%)
Myometrial invasion
    < 50%207 (60.7%)
    ≥ 50%134 (39.3%)
FIGO stage
    I270 (79.2%)
    II15 (4.4%)
    III45 (13.2%)
    IV11 (3.2%)
Surgical treatment
    HT & BSO alone
    With pelvic lymphadenectomy96 (37.4%)
    With pelvic & paraaortic74 (28.8%)
    lymphadenectomy87 (33.9%)
Lymph nodes status (N = 216)
    Negatives179 (82.9%)
    Positives37 (17.1%)
Adjuvant treatment
    None150 (44.0%)
    Irradiation146 (42.8%)
    Chemotherapy9 (2.6%)
    Irradiation and Chemotherapy36 (10.6%)
Follow-up (months)30.5 (18.5–46.2)
Recurrence51 (15.0%)
Decrease29 (8.5%)

Multivariant analysis of disease-free and overall survival using Cox regression model with the classic histological prognostic factors

VariablesDisease-free survivalp valueOverall survivalp value
MRI tumor volume
    < 10 cm311
    ≥ 10 cm32.20 (1.09–4.45)0.0293.88 (1.34–11.24)0.012
Histologic subtype
    Endometrioid11
    Non endometrioid1.06 (0.50–2.24)0.8731.16 (0.43–3.16)0.766
Histological Grade
    G1–G211
    G33.60 (1.95–6.66)< 0.0013.07 (1.47–6.41)0.003
Myometrial invasion
    < 50%11
    ≥ 50%1.77 (1.01–4.46)0.0471.51 (0.72–3.17)0.279

Analysis of disease-free and overall survival using Cox regression model

VariablesDisease-freep valueoverallp value
Age (continue, years)1.06 (1.03–1.09)< 0.0011.09 (1.05–1.13)< 0.001
MRI tumor volume
    < 10 cm311
    ≥ 10 cm32.99 (1.50–5.99)0.0014.50 (1.56–12.93)0.005
Histologic subtype
    Endometrioid11
    Non endometrioid2.55 (1.30–5.01)0.0062.40 (0.97–5.95)0.052
Histological Grade
    G1–G211
    G34.02 (2.31–6.98)< 0.0013.55 (1.71–7.37)0.001
Myometrial invasion
    < 50%11
    ≥ 50%2.10 (1.20–3.64)0.0091.89 (0.91–3.93)0.088
FIGO stage
    I–II11
    III–IV6.70 (3.83–11.72)< 0.0013.94 (1.79–8.68)0.001

Relation between tumor volume measured by magnetic resonance and pathological factors in 341 endometrial cancer

    VariablesMR tumor volume cm3p value

* = Mann-Whitney U independent sample test; BMI = body mass index; FIGO = International Federation of Gynecology and Obstetrics

Tumoral volume8.2 (1.9–20.4)-
Age (years)
    < 655.4 (1.5–15.4)0.001
    ≥ 6511.0 (2.8–30.0)
BMI (kg/m2)
    < 309.1 (2.3–22.3)0.525
    ≥ 307.5 (1.6–23.6)
Histologic subtype
    Endometrioid7.9 (1.8–20.4)0.859
    Non endometrioid12.4 (3.3–40.1)
Histological Grade
    G1–G26.7 (1.3–17.2)< 0.001
    G313.8 (4.6–41.0)
Myometrial invasion
    < 50%4.6 (1.2–15.4)< 0.001
    ≥ 50%14.1 (5.7–35.1)
FIGO stage
    I–II7.6 (1.5–19.6)< 0.001
    III–IV15.6 (6.5–44.7)
Lymph node status (N = 216)
    Negatives9.3 (3.3–20.9)0.008
    Positives15.6 (6.3–40.7)
Recurrence
    No7.6 (1.7–17.4)< 0.001
    Yes22.4 (5.6–49.2)
Overall Survival
    Alive8.0 (1.8–18.6)< 0.001
    Death30.5 (9.6–56.4)
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Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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