Real-world impact of lymph node assessment on adjuvant management in p53-abnormal endometrial carcinoma: a retrospective multicenter cohort from Central Europe

<h2>Abstract</h2><h3>Objective</h3> To determine how often lymph node assessment alters postoperative risk classification or adjuvant therapy in p53-abnormal endometrial carcinoma, and to calculate the number needed to stage to obtain one management-changing result. <h3>Methods</h3> This multicenter retrospective study included patients with biopsy-confirmed p53-abnormal endometrial carcinoma who underwent preoperative expert ultrasound, molecular classification, and definitive surgery. Preoperative risk groups were based on ultrasound-assessed invasion and molecular subtype; postoperative groups incorporated final pathology and lymph node status. Number needed to stage was defined as the number of patients staged divided by the number with management-changing results. <h3>Results</h3> Among 120 patients, lymph node status was evaluable in 107, with metastases identified in 19 (17.8%) cases. Concordance between preoperative and postoperative risk groups was 84.2%. Reclassification occurred in 15.8% of patients and was driven entirely by uterine pathological findings. Lymph node findings altered guideline-based postoperative management in only 2 of 107 patients (1.9%; 95% CI 0.2–6.6%), both through treatment de-escalation based on negative nodal status. No escalation of adjuvant therapy was triggered by nodal metastases. The number needed to stage was 53.5. <h3>Conclusions</h3> In this multicenter cohort of p53-abnormal endometrial carcinoma, lymph node assessment had a limited impact on guideline-based postoperative management, with treatment decisions largely driven by molecular subtype and uterine pathological factors. Prospective, molecularly stratified studies are needed to clarify the optimal role of nodal staging in this patient population.