ENDORISK-2: A personalized Bayesian network for preoperative risk stratification in endometrial cancer, integrating molecular classification and preoperative myometrial invasion assessment
Year: 2025
Type: article
Abstract: 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 prediction was performed in two independent cohorts from: Brno (CZ), (n = 581) and Tübingen (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 biomarkers. 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.
Source: European Journal of Cancer
Authors: Marike S. Lombaers, Casper Reijnen, Ally Sprik, Petra Bretová, Marcel Grube, Stephanie Vrede, Hege F. Berg, Jasmin Asberger, Eva Colas, Jitka Hausnerova, Jutta Huvila, Antonio Gil-Moreno, Xavier Matias-Guiu, Michiel Simons, Marc P.L.M. Snijders, Nicole C.M. Visser, Stefan Kommoss, Vit Weinberger, Frederic Amant, Peter Bronsert, Ingfrid S. Haldorsen, Martin Koskas, Camilla Krakstad, Heidi V.N. Küsters-Vandevelde, Gemma Mancebo, Louis J.M. van der Putten, Irene de la Calle, Peter J.F. Lucas, Arjen Hommersom, Johanna M.A. Pijnenborg
Institutions: Radboud University Medical Center, Radboud University Nijmegen, Masaryk University, University Hospital Brno, Universitätsklinikum Tübingen, University of Tübingen, University of Bergen, University of Freiburg, University Medical Center Freiburg, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Cáncer, University of Turku, Turku University Hospital, Vall d'Hebron Institut de Recerca, Universitat de Lleida, Hospital Universitari Arnau de Vilanova, Instituto de Investigación Biomédica de Lleida, Canisius-Wilhelmina Ziekenhuis, Universitair Ziekenhuis Leuven, Haukeland University Hospital, Hôpital Bichat-Claude-Bernard, Hospital Del Mar, Jeroen Bosch Ziekenhuis, University of Twente, Open University of the Netherlands
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,270
Award: G7448248028
OpenAlex ID: W4415340371