Cancer Research and Treatment

Original Articles

Validation of 2023 FIGO Stage IA1–IIIC2 Endometrial Carcinoma: A Retrospective Analysis of Two Tertiary Centers in South Korea and Taiwan: Myeong-Seon Kim, Yen-Ling Lai, Yurimi Lee, Hyun-Soo Kim, Yu-Li Chen, Yoo-Young Lee; Received December 11, 2024 Accepted February 10, 2025 Published online February 17, 2025; DOI: https://doi.org/10.4143/crt.2024.1190 [Accepted]

Abstract PDF: Purpose
As understanding of the molecular pathogenesis of endometrial carcinoma (EC) advanced, the International Federation of Gynecology and Obstetrics (FIGO) staging system was revised in 2023. This study compared EC survival outcomes using the 2009 and 2023 FIGO staging systems.
Materials and Methods
We retrospectively analyzed 3,029 patients diagnosed with 2009 FIGO stage I–III EC between 1985 and 2022 in South Korea, and between 2020 and 2022 in Taiwan. All patients were reclassified using the 2023 FIGO staging, and survival and risk factors were examined under both systems.
Results
Transitioning from the 2009 to 2023 FIGO resulted in 549 (18.0%) patients being upstaged and their survival curves being diversified, indicating significant prognostic value of the 2023 FIGO. Re-classification using the 2023 FIGO upstaged the 2009 FIGO stage IA high-risk ECs, allowing more intensive treatment and potentially improving survival outcomes. The most significant changes occurred in the 2009 FIGO stages IA, IB, and IIIA ECs: upstaging in 16.5%, 49.0%, and 2.0% of IA, IB, and IIIA tumors, respectively, and downstaging 0.3% and 40.8% of IB and IIIA tumors, respectively. The risk factors for poor survival included old age (≥60), menopause, diabetes, substantial lymphovascular space invasion, aberrant p53 expression, and some aggressive histological types (carcinosarcoma, undifferentiated carcinoma, mesonephric-like adenocarcinoma, and neuroendocrine carcinoma).
Conclusion
The 2023 FIGO staging provides more refined stratification of early-stage EC than the 2009 version. Thus, the 2023 FIGO may more accurately guide prognosis and therapeutic decision-making.

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Gynecologic cancer

Nationwide Comparison of Surgical and Oncologic Outcomes in Endometrial Cancer Patients Undergoing Robotic, Laparoscopic, and Open Surgery: A Population-Based Cohort Study: Kyung-Jin Eoh, Eun-Ji Nam, Sang-Wun Kim, Minkyung Shin, Stella J-H Kim, Jung-Ae Kim, Yong-Tae Kim; Cancer Res Treat. 2021;53(2):549-557. Published online October 22, 2020; DOI: https://doi.org/10.4143/crt.2020.802

Abstract PDF Supplementary Material PubReader ePub

Purpose
Population-based comparisons between minimally invasive surgery (MIS) (robotic surgery [RS] and laparoscopic surgery [LS]) and open surgery (OS) for managing endometrial cancer are lacking. This study aimed to compare surgical and oncologic outcomes between endometrial cancer patients who underwent surgical staging via MIS or OS.
Materials and Methods
A population-based retrospective cohort study was performed using claims data from the Korean National Health Insurance database from January 2012 to December 2016. All patients who underwent hysterectomy under diagnosis of endometrial cancer were identified. Patients were classified into RS, LS, and OS groups. Operative and oncologic outcomes were compared among the three groups after adjustments for age group, risk group (adjuvant therapy status), modified Charlson comorbidity index, income level, insurance type, and index year using propensity scores obtained via the inverse probability of treatment weighted method.
Results
After adjustment, 5,065 patients (RS, n=315; LS, n=3,248; OS, n=1,503) were analyzed. Patient demographics were comparable. Hospital stay, postoperative complications, and cost were more favorable in the RS and LS groups than in the OS group (all p < 0.001). Five-year overall survival was significantly longer in the RS and LS groups than in the OS group (94.8%, 91.9%, and 86.9%, respectively; p < 0.001). Moreover, the survival benefit of RS was shown in the subgroup analysis of low-risk endometrial cancer patients.
Conclusion
Our study provides further evidence for the RS being a safe surgical alternative to the LS and OS, especially in low-risk endometrial cancer patients, offering surgical and oncologic outcomes equivalent to other surgical approaches.

Citations

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Surgical staging in early endometrial cancer without intra-uterine manipulator using the da Vinci SP robotic system
Eun Bi Jang, Yong-hee Park, Kyeong A So, Sun Joo Lee, Tae Jin Kim, Seung-Hyuk Shim
International Journal of Gynecological Cancer.2025; 35(2): 101615. CrossRef
Comparing robotic, laparoscopic, and laparotomy in endometrial cancer: a network meta-analysis
Wen-Rui Huang, Xing-Yan Ou, Xing-Zi Fang, Xiao-Xuan Tang, Lei Chen, Jing Ling, Wen-Cong Song, Xue-Lian Du
International Journal of Surgery.2025; 111(2): 2208. CrossRef
Robotic-assisted versus laparoscopic surgery for colorectal cancer in high-risk patients: a systematic review and meta-analysis
S. Gahunia, J. Wyatt, S. G. Powell, S. Mahdi, S. Ahmed, K. Altaf
Techniques in Coloproctology.2025;[Epub] CrossRef
Robot-assisted pelvic and renal surgery compared with laparoscopic or open surgery: Literature review of cost-effectiveness and clinical outcomes
Thomas Davidson, Rune Sjödahl, Åke Aldman, Claes Lennmarken, Ann-Sofi Kammerlind, Elvar Theodorsson
Scandinavian Journal of Surgery.2024; 113(1): 13. CrossRef
Progress of Research on the Application of Robotic Surgical System in Gynecologic Malignancies
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Advances in Clinical Medicine.2024; 14(03): 327. CrossRef
Sociodemographic, clinical characteristics, and treatment patterns of endometrial cancer cases in Puerto Rico during the period 2009 to 2015: A retrospective study
Yisel Pagán Santana, Maira Castañeda Ávila, Ruth Ríos Motta, Karen J. Ortiz Ortiz, Asmerom Tesfamariam Sengal
PLOS ONE.2024; 19(5): e0302253. CrossRef
Comparison of Long-Term Outcomes in Early-Stage Endometrial Cancer: Robotic Single-Site vs. Multiport Laparoscopic Surgery
Heeju Kang, Hyewon Chung, Seungmee Lee, Tae-Kyu Jang, So-Jin Shin, Sang-Hoon Kwon, Chi-Heum Cho
Journal of Personalized Medicine.2024; 14(6): 601. CrossRef
Impact of Robotic Assistance on Minimally Invasive Surgery for Type II Endometrial Cancer: A National Cancer Database Analysis
Kelly Lamiman, Michael Silver, Nicole Goncalves, Michael Kim, Ioannis Alagkiozidis
Cancers.2024; 16(14): 2584. CrossRef
Clinical Relevance of Uterine Manipulation on Oncologic Outcome in Robot-Assisted versus Open Surgery in the Management of Endometrial Cancer
Kyung Jin Eoh, Yoo-Na Kim, Eun Ji Nam, Sang Wun Kim, Young Tae Kim
Journal of Clinical Medicine.2023; 12(5): 1950. CrossRef
Trend and characteristics of minimally invasive surgery for patients with endometrial cancer in Japan
Hiroshi Yoshida, Hiroko Machida, Koji Matsuo, Yoshito Terai, Takuma Fujii, Masaki Mandai, Kei Kawana, Hiroaki Kobayashi, Mikio Mikami, Satoru Nagase
Journal of Gynecologic Oncology.2023;[Epub] CrossRef
Clinical Relevance of Red Blood Cell Distribution Width (RDW) in Endometrial Cancer: A Retrospective Single-Center Experience from Korea
Kyung-Jin Eoh, Tae-Kyung Lee, Eun-Ji Nam, Sang-Wun Kim, Young-Tae Kim
Cancers.2023; 15(15): 3984. CrossRef
Robot-Assisted Surgery in the Treatment of Gynecological Carcinoma and Malignancies: Introduction to the da Vinci Robotic Surgery System
Arnav Goel, Soumya Pamnani, Ashish Anjankar
Cureus.2023;[Epub] CrossRef
Robot-assisted versus conventional laparoscopic surgery for endometrial cancer: long-term comparison of outcomes
Kyung Jin Eoh, Tae-Joong Kim, Jeong-Yeol Park, Hee Seung Kim, Jiheum Paek, Young Tae Kim
Frontiers in Oncology.2023;[Epub] CrossRef
Comparison of Single-Port Laparoscopy with Other Surgical Approaches in Endometrial Cancer Surgical Staging: Propensity-Score-Matched Analysis
Sang Hyun Cho, Jung-Yun Lee, Eun Ji Nam, Sunghoon Kim, Young Tae Kim, Sang Wun Kim
Cancers.2023; 15(22): 5322. CrossRef
Short-Term Outcome of Robotic versus Laparoscopic Hysterectomy for Endometrial Cancer in Women with Diabetes: Analysis of the US Nationwide Inpatient Sample
Huang-Pin Shen, Chih-Jen Tseng
Journal of Clinical Medicine.2023; 12(24): 7713. CrossRef
Laparoscopic vs. open procedure for intermediate‑ and high‑risk endometrial cancer: a minimum 4-year follow-up analysis
Xing Zhou, Sitian Wei, Qingchun Shao, Jun Zhang, Rong Zhao, Rui Shi, Wei Zhang, Kejun Dong, Wan Shu, Hongbo Wang
BMC Cancer.2022;[Epub] CrossRef
Oncologic safety of laparoscopic surgery for women with apparent early‐stage uterine serous carcinoma: A multi‐institutional retrospective cohort study
Yu Xu, Juan Shen, Qianwen Zhang, Yuedong He, Cheng Chen, Yong Tian
International Journal of Gynecology & Obstetrics.2022; 158(1): 162. CrossRef
Impact of lymphadenectomy on short- and long-term complications in patients with endometrial cancer
Louisa Proppe, Ibrahim Alkatout, Ricarda Koch, Sascha Baum, Christos Kotanidis, Achim Rody, Lars C. Hanker, Georgios Gitas
Archives of Gynecology and Obstetrics.2022; 306(3): 811. CrossRef
Survival Analysis in Endometrial Carcinomas by Type of Surgical Approach: A Matched-Pair Study
Pluvio J. Coronado, Agnieszka Rychlik, Laura Baquedano, Virginia García-Pineda, Maria A. Martínez-Maestre, Denis Querleu, Ignacio Zapardiel
Cancers.2022; 14(4): 1081. CrossRef
Robot-assisted versus laparoscopic minimally invasive surgery for the treatment of stage I endometrial cancer
Peter A. Argenta, Jordan Mattson, Colleen L. Rivard, Elizabeth Luther, Alexandra Schefter, Rachel I. Vogel
Gynecologic Oncology.2022; 165(2): 347. CrossRef
Effects of Quantitative Nursing Combined with Psychological Intervention in Operating Room on Stress Response, Psychological State, and Prognosis of Patients Undergoing Laparoscopic Endometrial Cancer Surgery
Xiaojing Chen, Huiyan Li, Shouyan Wang, Yu Wang, Li Zhang, Dandan Yao, Li Li, Ge Gao, Shakeel Ahmad
Computational and Mathematical Methods in Medicine.2022; 2022: 1. CrossRef
Increased HSF1 Promotes Infiltration and Metastasis in Cervical Cancer via Enhancing MTDH-VEGF-C Expression
Xueyan Shi, Zhenghao Deng, Shouman Wang, Shuai Zhao, Lan Xiao, Jiang Zou, Tao Li, Sichuang Tan, SipAin Tan, Xianzhong Xiao
OncoTargets and Therapy.2021; Volume 14: 1305. CrossRef
Surgical and Patient Outcomes of Robotic Versus Conventional Laparoscopic Hysterectomy: A Systematic Review
Khadija Alshowaikh, Katarzyna Karpinska-Leydier, Jashvini Amirthalingam , Gokul Paidi, Anuruddhika I Iroshani Jayarathna, Divya Bala Anthony Manisha R Salibindla, Huseyin Ekin Ergin
Cureus.2021;[Epub] CrossRef
Surgical outcomes of robotic-assisted surgery in endometrial cancer:comparison with laparoscopic surgery and laparotomy
Yoshitsugu Chigusa, Sae Yu, Naoki Horikawa, Haruko Okamoto, Masumi Sunada, Ukita Masayo, Koji Yamanoi, Ken Yamaguchi, Akihito Horie, Masaki Mandai
JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY.2021; 37(2): 10. CrossRef

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Adherence to Cancer Prevention Guidelines and Endometrial Cancer Risk: Evidence from a Systematic Review and Dose-Response Meta-analysis of Prospective Studies: Hui Sun, Qing Chang, Ya-Shu Liu, Yu-Ting Jiang, Ting-Ting Gong, Xiao-Xin Ma, Yu-Hong Zhao, Qi-Jun Wu; Cancer Res Treat. 2021;53(1):223-232. Published online September 14, 2020; DOI: https://doi.org/10.4143/crt.2020.546

Abstract PDF PubReader ePub

Purpose
The evidence of adherence to cancer prevention guidelines and endometrial cancer (EC) risk has been limited and controversial. This study summarizes and quantifies the relationship between adherence to cancer prevention guidelines and EC risk.
Materials and Methods
The online databases PubMed, Web of Science, and EMBASE were searched for relevant publications up to June 2, 2020. This study had been registered at PROSPERO. The registration number is CRD42020149966. Study quality evaluation was performed based on the Newcastle-Ottawa Scale. The I² statistic was used to estimate heterogeneity among studies. Egger’s and Begg’s tests assessed potential publication bias. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) for the relationship between adherence to cancer prevention guidelines score was assigned to participants by summarizing individual scores for each lifestyle-related factor. The scores ranged from least healthy (0) to most healthy (20) and the EC risk was calculated using a randomeffects model.
Results
Five prospective studies (four cohort studies and one case‑cohort study) consisted of 4,470 EC cases, where 597,047 participants were included. Four studies had a low bias risk and one study had a high bias risk. Summary EC HR for the highest vs. lowest score of adherence to cancer prevention guidelines was 0.54 (95% CI, 0.40 to 0.73) and had a high heterogeneity (I²=86.1%). For the dose-response analysis, an increment of 1 significantly reduced the risk of EC by 6%. No signiﬁcant publication bias was detected.
Conclusion
This study suggested that adherence to cancer prevention guidelines was negatively related to EC risk.

Citations

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Expression of EMT-related genes in lymph node metastasis in endometrial cancer: a TCGA-based study
He Li, Junzhu Wang, Liwei Li, Luyang Zhao, Zhiqi Wang
World Journal of Surgical Oncology.2023;[Epub] CrossRef
Advances on Prevention and Screening of Gynecologic Tumors: Are We Stepping Forward?
Andrea Giannini, Giorgio Bogani, Enrico Vizza, Vito Chiantera, Antonio Simone Laganà, Ludovico Muzii, Maria Giovanna Salerno, Donatella Caserta, Ottavia D’Oria
Healthcare.2022; 10(9): 1605. CrossRef

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Postoperative Radiotherapy Alone Versus Chemoradiotherapy in Stage I-II Endometrial Carcinoma: An Investigational and Propensity Score Matching Analysis: Jong Hoon Lee, Hyo Chun Lee, Sung Hwan Kim, Mi Joo Chung, Song Mi Jeong, Sung Jong Lee, Joo Hee Yoon, Dong Choon Park; Cancer Res Treat. 2015;47(2):298-305. Published online September 15, 2014; DOI: https://doi.org/10.4143/crt.2014.038

Abstract PDF PubReader ePub

Purpose
The purpose of this study was to compare the results of postoperative adjuvant radiotherapy (RT) and concurrent chemoradiotherapy (CRT) in stage I-II endometrial carcinoma. Materials and Methods We analyzed a total of 64 patients with surgically staged I-II endometrial carcinoma who were treated with postoperative adjuvant RT or concurrent CRT between March 1999 and July 2013. Thirty-two patients who received postoperative RT alone were matched with those who received postoperative CRT (n=32) in accordance to age, stage, and tumor histology. Overall survival and relapse-free survival, as well as toxicity of the RT and CRT arms were evaluated and compared. Results The 5-year overall survival rate was 90.0% for the RT arm and 91.6% for the CRT arm. There was no significant difference in overall survival between the two treatment arms (p=0.798). The 5-year relapse-free survival rate was 87.2% in the RT arm and 88.0% in the CRT arm. Again, no significant difference in relapse-free survival was seen between the two arms (p=0.913). In a multivariate analysis, tumor histology was an independent prognostic factor for relapse-free survival (hazard ratio, 3.67; 95% of CI, 2.34 to 7.65; p=0.045). Acute grade 3 or 4 hematologic toxicities in the CRT arm were significantly higher than in the RT alone arm (6.2% vs. 31.2%, p=0.010). Conclusion Adjuvant pelvic concurrent chemoradioherapy did not show superior results in overall survival and relapse-free survival compared to RT alone in stage I-II endometrial carcinoma.

Citations

Citations to this article as recorded by

Impacts of Postoperative Adjuvant Therapies on the Survival of Women with High-Risk Early-Stage Endometrial Cancer: A Cohort Study
Hee Joong Lee, Banghyun Lee
Cancers.2025; 17(2): 187. CrossRef
Adjuvant Therapy Use and Survival in Stage II Endometrial Cancer
Nataniel H. Lester-Coll, Melissa R. Young, Henry S. Park, Elena S. Ratner, Babak Litkouhi, Shari Damast
International Journal of Gynecological Cancer.2017; 27(9): 1904. CrossRef

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Patterns of Failure after Postoperative Radiation Therapy for Endometrial Carcinoma: Suzy Kim, Hong-Gyun Wu, Hyo-Pyo Lee, Soon-Beom Kang, Yong-Sang Song, Noh-Hyun Park, Sung Whan Ha; Cancer Res Treat. 2006;38(3):133-138. Published online June 30, 2006; DOI: https://doi.org/10.4143/crt.2006.38.3.133

Abstract PDF PubReader ePub

Purpose

We tried to investigate the outcome and patterns of failure of endometrial cancer patients who were treated with surgery and postoperative radiation therapy (RT).

Materials and Methods

Eighty-three patients with endometrial cancer who received postoperative RT between May 1979 and August 2000 were included in this retrospective study. Forty-one patients received total abdominal hysterectomy, 41 patients received Wertheim's operation and 1 underwent vaginal hysterectomy. Pelvic lymph node dissection or pelvic lymph node sampling was done in 56 patients and peritoneal cytology was done in 35. All the patients were staged according to 1988 FIGO (International Federation of Gynecology and Obstetrics) staging system; 2 were stage IA, 23 were stage IB, 20 were stage IC, 4 were stage IIA, 5 were stage IIB, 9 were stage IIIA, 2 were stage IIIB and 18 were stage IIIC. The histologic diagnoses were adenocarcinoma in seventy-four patients (89%). The histologic grades were Grade 1, 2 and 3 in 21 (25%), 43 (52%) and 10 (12%) patients, respectively. All the patients received external beam RT (EBRT) with a median dose of 5,040 cGy (range: 4,500~5,075 cGy) to the whole pelvis. Five patients with pathologically confirmed paraaortic lymph node metastasis received 4500 cGy to the paraaortic lymph nodes. Fifteen patients received low-dose intracavitary brachytherapy after their EBRT. A total dose of 7,500~9,540 cGy (median dose: 8511) was prescribed to the vaginal surface.

Results

Overall, 11 patients (13%) experienced disease relapse: 4 with initial stage I or II disease and 7 with initial stage III disease. Among the 54 stage I or II patients, 1 (2%) relapsed in the pelvis only, 2 (4%) relapsed in the vagina and distant organs, and 1 (2%) relapsed in the paraaortic lymph nodes (PANs). Among the 29 stage III patients, 1 (3%) relapsed in the vagina. The most common sites of failure for the stage III patients were the peritoneum (3 patients, 10%), PANs (2 patients, 7%), and lung (2 patients, 7%). With a median follow-up period of 86 months, the overall survival (OS) and disease-free survival (DFS) rates at 5 years were 87% for both. The five-year DFS rate was 93%, 100% and 74% for the stage I, II and III patients, respectively. Three patients experienced severe radiation-related late complications: RTOG (Radiation Therapy Oncology Group) grade 3 radiation cystitis was seen in one patient, and grade 3 bowel obstruction was seen in two patients.

Conclusions

Postoperative RT was useful for controlling pelvic disease. The major patterns of failure for stage III patients were peritoneal seeding and distant metastasis. Selective use of whole abdominal radiotherapy or adjuvant chemotherapy may improve the therapeutic outcome of these patients.

Citations

Citations to this article as recorded by

Pattern of care and clinical outcome of patients with carcinoma endometrium and the impact of central histopathological review on management: A tertiary cancer centre experience
Rakhi Verma, Ajeet K. Gandhi, Madhup Rastogi, Vachaspati K. Mishra, Vikas Sharma, Akash Agarwal, Saumya Shukla, Rohini Khurana, Rahat Hadi, Anoop K. Srivastava, Nuzhat Husain
Journal of Cancer Research and Therapeutics.2024; 20(5): 1557. CrossRef
Does Prophylactic Paraortic Lymph Node Irradiation Improve Outcomes in Women With Stage IIIC1 Endometrial Carcinoma?
Jennifer Yoon, Halle Fitzgerald, Yaqun Wang, Qingyang Wang, Irina Vergalasova, Mohamed A. Elshaikh, Irina Dimitrova, Shari Damast, Jessie Y. Li, Emma C. Fields, Sushil Beriwal, Andrew Keller, Elizabeth A. Kidd, Melissa Usoz, Shruti Jolly, Elizabeth Jawors
Practical Radiation Oncology.2022; 12(2): e123. CrossRef
Efficacy of Para-Aortic Lymphadenectomy in Early-Stage Endometrioid Uterine Corpus Cancer
Seo-Yun Tong, Jong-Min Lee, Jae-Kwan Lee, Jae Weon Kim, Chi-Heum Cho, Seok-Mo Kim, Sang-Yoon Park, Chan-Yong Park, Ki-Tae Kim
Annals of Surgical Oncology.2011; 18(5): 1425. CrossRef
Current status in the management of uterine corpus cancer in Korea
Nan-Hee Jeong, Jong-Min Lee, Seon-Kyung Lee
Journal of Gynecologic Oncology.2010; 21(3): 151. CrossRef

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