Escore de risco pré e intra-operatório para predição de metástases linfonodais no câncer do endométrio

• Ano de defesa: 2016
• Autor(a) principal: Teixeira, Andressa Melina Severino [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Endometrial cancer; Lymphadenectomy; Lymph node metastasis; Scoring system; Câncer do endométrio; Linfadenectomia; Metástases linfonodais; Escore de risco
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=3861298; http://repositorio.unifesp.br/handle/11600/46729

Objective: The aim of this study was to identify risk factors to predict lymph node metastasis in patients with endometrial cancer, and to develop a scoring system that guides surgical decision-making regarding the need to perform lymphadenectomy. Methods/materials: A retrospective multicenter study was performed of patients who underwent hysterectomy, bilateral salpingooophorectomy, and lymphadenectomy for endometrial cancer from 2003 to 2014. Pre and intraoperative risk factors for lymph node involvement were analyzed by univariate and multivariate logistic regression. The relevant factors were used to develop a scoring system to predict lymph node metastasis. Results: A total of 329 patients were assessed. The characteristics associated with nodal metastasis in univariate analysis included race, elevated CA-125 level, increased endometrial thickness, preoperative histological grade, and pathologic tumor features (size, extension in myometrium, cervix and adnexa, and lower uterine segment involvement). The following parameters remained significant on multivariate logistic regression analysis: preoperative histological grade, tumor extension, and lower uterine segment involvement. The resulting scoring system showed good accuracy with area under the receiving operating curve of 0.858 (95% confidence interval, 0.80 ? 0.91). With a cut-off of 2 points, the calculated NPV (negative predictive value) of the model was 0.976, which corresponds to approximately 3% probability of positive lymph nodes. Conclusions: A highly accurate scoring system was developed based on three pre and intraoperative risk factors for predicting lymph node metastasis. If further validated, this model could greatly aid clinicians in the surgical management of endometrial cancer. Endometrial cancer; Lymphadenectomy; Lymph node metastasis; Scoring system