Scientific publications

SENECA study: staging endometrial cancer based on molecular classification. Scientific Publication

Sep 2, 2024 | Magazine: International Journal of Gynecological Cancer

Enrique Chacon  1 , Felix Boria  2 , R Rajagopalan Lyer  3 , Francesco Fanfani  4 , Mario Malzoni  5 , Petra Bretová  6 , Ana Luzarraga Aznar  7 , Robert Fruscio  8   9 , Marcin A Jedryka  10   11 , Richard Tóth  12 , Anna Myriam Perrone  13 , Athanasios Kakkos  14 , Ignacio Cristóbal Quevedo  15 , Luigi Congedo  16   17 , Vanna Zanagnolo  18 , Sergi Fernandez-Gonzalez  19 , Beatriz Ferro  20 , Fabrice Narducci  21 , Tatevik Hovhannisyan  22 , Elif Aksahin  23 , Laura Cardenas  24 , M Reyes Oliver  25 , Gonzalo Nozaleda  26 , Marta Arnaez  27 , Marcin Misiek  28 , Annamaria Ferrero  29 , Flore Anne Pain  30 , Janire Zarragoitia  31 , Cristina Diaz  32 , Lorenzo Ceppi  33 , Shamsi Mehdiyev  34 , Fernando Roldán-Rivas  35   36 , Alberto Rafael Guijarro-Campillo  37 , Joana Amengual  38 , Nabil Manzour  39 , Luisa Sanchez Lorenzo  40 , Jorge M Núñez-Córdoba  41 , Antonio Gonzalez Martin  40 , Jose Angel Minguez  42 , Luis Chiva  39 ; SENECA Working Group


Objective: Management of endometrial cancer is advancing, with accurate staging crucial for guiding treatment decisions. Understanding sentinel lymph node (SLN) involvement rates across molecular subgroups is essential. To evaluate SLN involvement in early-stage (International Federation of Gynecology and Obstetrics 2009 I-II) endometrial cancer, considering molecular subtypes and new European Society of Gynaecological Oncology (ESGO) risk classification.

Methods: The SENECA study retrospectively reviewed data from 2139 women with stage I-II endometrial cancer across 66 centers in 16 countries. Patients underwent surgery with SLN assessment following ESGO guidelines between January 2021 and December 2022. Molecular analysis was performed on pre-operative biopsies or hysterectomy specimens.

Results: Among the 2139 patients, the molecular subgroups were as follows: 272 (12.7%) p53 abnormal (p53abn, 1191 (55.7%) non-specific molecular profile (NSMP), 581 (27.2%) mismatch repair deficient (MMRd), 95 (4.4%) POLE mutated (POLE-mut). Tracer diffusion was detected in, at least one side, in 97.2% of the cases; with a bilateral diffusion observed in 82.7% of the cases. By ultrastaging (90.7% of the cases) or one-step nucleic acid amplification (198 (9.3%) of the cases), 205 patients were identified with affected sentinel lymph nodes, representing 9.6% of the sample. Of these, 139 (67.8%) had low-volume metastases (including micrometastases, 42.9%; and isolated tumor cells, 24.9%) while 66 (32.2%) had macrometastases. Significant differences in SLN involvement were observed between molecular subtypes, with p53abn and MMRd groups having the highest rates (12.50% and 12.40%, respectively) compared with NSMP (7.80%) and POLE-mut (6.30%), (p=0.004); (p53abn, OR=1.69 (95% CI 1.11 to 2.56), p=0.014; MMRd, OR=1.67 (95% CI 1.21 to 2.31), p=0.002). Differences were also noted among ESGO risk groups (2.84% for low-risk patients, 6.62% for intermediate-risk patients, 21.63% for high-intermediate risk patients, and 22.51% for high-risk patients; p<0.001).

Conclusions: Our study reveals significant differences in SLN involvement among patients with early-stage endometrial cancer based on molecular subtypes. This underscores the importance of considering molecular characteristics for accurate staging and optimal management decisions.

CITATION  Int J Gynecol Cancer. 2024 Sep 2;34(9):1313-1321. doi: 10.1136/ijgc-2024-005711