Prognostic Significance of Size, Location, and Number of Lymph Node Metastases in Endometrial Carcinoma

Abstract

Regional lymph node metastasis is a well-established negative predictive prognostic factor in endometrial carcinomas. Recently, our approach to the pathologic evaluation of lymph nodes in endometrial carcinomas has changed, mainly due to the utilization of immunohistochemical stains in the assessment of sentinel lymph nodes, which may result in the identification of previously unrecognized disease [particularly isolated tumor cells (ITCs)] on hematoxylin and eosin stained slides. However, the clinical significance of this finding is not entirely clear. Following the experience in other organs systems such as breast, the Eight Edition of the American Joint Committee on Cancer’s Cancer Staging Manual has recommended utilizing the N0(i+) terminology for this finding, without impact in the final tumor stage. We performed a comparative retrospective multi-institutional survival analysis of 247 patients with endometrial carcinoma with regional lymph node metastasis of various sizes identified in nonsentinel lymphadenectomy, demonstrating that the cumulative survival of patients with isolated tumor cells in regional lymph nodes is not statistically different from patient with negative lymph nodes, and is statistically different from those with lymph nodes showing micrometastasis or larger metastatic deposits. In addition, we evaluated the prognostic implications of the number of involved regional lymph nodes, demonstrating a worsening prognosis as the number of involved lymph nodes increases from none to one, and from one to more than one. Our data suggests that regional lymph nodes with isolated tumor cells in patients with endometrial carcinoma should likely be considered, for staging purposes, as negative lymph nodes, simply indicating their presence with the (i+) terminology.

Number of Positive Lymph Nodes and Survival in Endometrial Carcinoma: A Proposal for a Modified Staging

“…The number of positive lymph nodes was divided into three categories according to X-tile software: 0, 1-6 and ≥7. Combined FIGO staging with the number of positive lymph nodes, we obtained IA, IB, II, IIIA, IIIB, IIIC1 (1-6), IIIC1 (≥7), IIIC2 (1-6), IIIC2 (≥7), IVA (0), IVA (1)(2)(3)(4)(5)(6), IVA (≥7), IVB (0), and IVB (1-6), and IVB (≥7). After combining the above stages according to the KM curve, they were eventually divided into IA, IB, II, IIIA, IIB (IIIB or IIIC+ positive lymph nodes <7), IVA (IVA or IIIC + positive lymph nodes≥7), IVB (IVB + positive lymph nodes<7), IVC (IVC + positive lymph nodes≥7).…”

“…Previous evidence suggested that lymph node involvement is an important factor affecting the survival of endometrial carcinoma patients. 5 The 5-year survival rate of endometrial carcinoma patients is more than 80% for those without lymph node metastasis, but only about 60% for those with lymph node metastasis. 6 , 7 …”

“…Previous evidence suggested that lymph node involvement is an important factor affecting the survival of endometrial carcinoma patients. 5 The 5-year survival rate of endometrial carcinoma patients is more than 80% for those without lymph node metastasis, but only about 60% for those with lymph node metastasis. 6,7 Currently, the International Federation of Obstetrics and Gynecology (FIGO) and the American Joint Committee on Cancer (AJCC) staging systems are the main tools for assessing the prognosis of endometrial carcinoma, and both staging systems assess lymph node involvement based on the site of lymph node metastasis (pelvic/para-aortic).…”

Metastases and Recurrence Risk Factors in Endometrial Cancer—The Role of Selected Molecular Changes, Hormonal Factors, Diagnostic Methods and Surgery Procedures

“…The most common site of EC metastases is the pelvic lymph nodes. Their presence is crucial in predicting cancer recurrence [ 7 , 8 , 9 ]. Lymphatic mapping of the lymph nodes, including the sentinel lymph node technique, increases the rate of metastasis detection, but it should be stressed that more than 5% of results may be false negatives [ 10 ].…”