Early oncological outcomes and accuracy of risk stratification and tailoring surgical staging based on preoperative histology, Ca125 and MRI in endometrial cancer: a prospective cohort study

Background: momentum to select patients who will benefit from the extensive procedures. However, the parameters used for risk stratification have variable accuracy outside of tertiary cancer centres. This study looks into the accuracy of risk stratification using preoperative histology, MRI and Ca 125 levels and the oncological outcomes after tailoring surgical staging based on the risk stratification by combining the three variables in a suburban centre with a growing cancer population.Methods: This prospective observational cohort study was undertaken in a suburban cancer center in Pushpagiri Medical College, Tiruvalla, Kerala between June 2014 and December 2018. All patients underwent surgical staging with hysterectomy and salpingo oophorectomy as the least procedure. Lymphadenectomy was tailored according to the preoperative risk grouping and changed only in the presence of gross findings at surgery. Adjuvant treatment and follow up data obtained and collected in Microsoft Excel and analysed using statistical software SPSS version 22.Results: Of 47 patients recruited for the study, 35 patients were available for final analysis. Preoperative histology was accurate in 73%. There was 20 % overestimation and 8% underestimation. Ca 125 levels were elevated in 15%.  MRI had an overall sensitivity of 74% and specificity of 60%. When MRI, Ca125 and histology were combined together, there was patients were deemed to be high risk. On final risk grouping, 9 patients were down staged and none were upstaged.Conclusions: Preoperative histology, MRI and ca 125 levels have moderate accuracy individually as preoperative risk determinates. The three parameters combined together show high specificity and PPV for preoperative risk stratification and the risk stratification has not been detrimental with respect to oncological outcomes of recurrence