Assign ESMO 2020

ref: https://doi.org/10.1136/ijgc-2020-002230 Concin et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. International Journal of Gynecological Cancer 2021

assign_esmo2020(
  stage_full,
  grade,
  hist_gr,
  myo,
  lvi,
  eclass = NULL,
  residual = NULL
)

Arguments

stage_full

FIGO stage: I, II, III, IV with substages

grade

tumour grade: 1, 2, 3

hist_gr

histological subtype group: endometrioid or non-endometrioid

myo

myometrial invasion: none, 1-50%, >50%

lvi

lymphovascular space invasion: negative, positive, focal, extensive

eclass

molecular classification: "MMRd", "POLEmut", "p53abn", or "NSMP/p53wt"

residual

residual disease: "<1cm", ">=1cm", "microscopic", or "no residual". Use if available. Microscopic residual is regarded as no residual disease.

Value

ESMO 2020 assigned into "low", "intermediate", "high-intermediate", "high", "advanced", or "metastatic". Unassignable cases are NA.

Details

Assign ESMO 2020 based on stage, grade, histological subtype group, myometrial invasion, and LVSI. Molecular classification and residual disease can be used if available.

ESMO 2020 is assigned using stage, grade, histological subtype group, myometrial invasion, and LVSI into low, intermediate, high-intermediate, high, advanced, and metastatic risk based on the following criteria with and without molecular classification/residual disease:

With molecular classification

• low:

  • stage I-II, POLEmut, (no residual disease if known)

    • missing residual disease is regarded as no residual disease

  • stage IA, grade 1/2, endometrioid, LVSI negative or focal, MMRd/NSMP

• intermediate:

  • stage IB, grade 1/2, endometrioid, LVSI negative or focal, MMRd/NSMP

  • stage IA, grade 3, endometrioid, LVSI negative or focal, MMRd/NSMP

  • stage IA, no myometrial invasion, (non-endometrioid or mixed subtype or p53abn)

• high-intermediate:

  • stage IA/IB, endometrioid, LVSI positive or extensive, MMRd/NSMP

  • stage IB, grade 3, endometrioid, MMRd/NSMP

  • stage II/IIA, endometrioid, MMRd/NSMP

• high:

  • stage III-IVA, endometrioid, MMRd/NSMP, (no residual disease if known)

  • stage I-IVA, >0% myometrial invasion, p53abn, (no residual disease if known)

    • for stage I-II, missing residual disease is regarded as no residual disease

  • stage IA, non-endometrioid or mixed subtype, >0% myometrial invasion, MMRd/NSMP, (no residual disease if known)

    • missing residual disease is regarded as no residual disease

  • stage IB-IVA, non-endometrioid or mixed subtype, MMRd/NSMP, (no residual disease if known)

    • for stage IB-II, missing residual disease is regarded as no residual disease

• advanced:

  • stage III-IVA, any molecular type, (with residual disease if known)

• metastatic:

  • stage IVB, any molecular type

Without molecular classification

• low:

  • stage IA, grade 1/2, endometrioid, LVSI negative or focal

• intermediate:

  • stage IB, grade 1/2, endometrioid, LVSI negative or focal

  • stage IA, grade 3, endometrioid, LVSI negative or focal

  • stage IA, non-endometrioid or mixed subtype, no myometrial invasion

• high-intermediate:

  • stage IA/IB, endometrioid, LVSI positive or extensive

  • stage IB, grade 3, endometrioid

  • stage II/IIA, endometrioid

• high:

  • stage III-IVA, endometrioid, (no residual disease if known)

  • stage IA, non-endometrioid or mixed subtype, >0% myometrial invasion, (no residual disease if known)

    • missing residual disease is regarded as no residual disease

  • stage IB-IVA, non-endometrioid or mixed subtype, (no residual disease if known)

    • for stage IB-II, missing residual disease is regarded as no residual disease

• advanced:

  • stage III-IVA, (with residual disease if known)

• metastatic:

  • stage IVB

Note

Assignment starts from the low group first.

References

Concin N, Matias-Guiu X, Vergote I, et al ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. International Journal of Gynecologic Cancer Published Online First: 18 December 2020. doi: 10.1136/ijgc-2020-002230

Author

Derek Chiu

Examples

# without molecular classification
esmo2020_wo_eclass <- with(emdb, assign_esmo2020(stage_full, grade_rev,
hist_rev_gr, myo, lvi))
table(esmo2020_wo_eclass)
#> esmo2020_wo_eclass
#>                 low        intermediate   high-intermediate                high 
#>                  51                  77                 141                 238 
#> advanced/metastatic            advanced          metastatic 
#>                  51                  13                   6 

# with molecular classification
eclass <- with(emdb, assign_promise2015(mmr_ihc_2, pole_mut, p53))
esmo2020_w_eclass <- with(emdb, assign_esmo2020(stage_full, grade_rev,
hist_rev_gr, myo, lvi, eclass))
table(esmo2020_w_eclass)
#> esmo2020_w_eclass
#>                 low        intermediate   high-intermediate                high 
#>                  75                  63                  89                 242 
#> advanced/metastatic            advanced          metastatic 
#>                  34                  27                   6 

# with molecular classification and residual disease
esmo2020_w_eclass_res <- with(emdb, assign_esmo2020(stage_full, grade_rev,
hist_rev_gr, myo, lvi, eclass, residual))
table(esmo2020_w_eclass_res)
#> esmo2020_w_eclass_res
#>                 low        intermediate   high-intermediate                high 
#>                  70                  63                  89                 217 
#> advanced/metastatic            advanced          metastatic 
#>                  36                  25                   6