The Risk of Lymph Node Metastasis Based on Myometrial Invasion and Tumor Grade in Endometrioid Uterine Cancers: A Multicenter, Retrospective Korean Study

Lee, Kwang Beom; Ki, Kyung‐Do; Lee, Jong Min; Lee, Jae Kwan; Kim, Jae Weon; Cho, Chi Heum; Kim, Seok Mo; Park, Soo‐Jin; Jeong, Dae Hoon; Kim, Ki Tae

doi:10.1245/s10434-009-0535-0

Cited by 63 publications

(49 citation statements)

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“…This seems to be due to the undifferentiated component of the histology. The median number of removed pelvic LNs was 16 (range, [15][16][17][18][19][20][21][22][23][24][25][26][27], the median number of removed para-aortic LNs was 8 (range, 4-30), and the median number of positive paraaortic LNs was 1 (range, 1-4). All patients had FIGO stage IIIC2 disease.…”

Section: Resultsmentioning

confidence: 99%

“…2,4,5,8,[11][12][13][14][15][16][17] According to the revised FIGO staging system, this is classified as stage IIIC2 disease. However, there have been few studies on pathologic risk factors, and the prognostic outcome associated with isolated para-aortic LNM and the significance of isolated para-aortic LNM at the time of surgical staging of endometrial cancer has not been clearly defined.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12] The incidence of isolated para-aortic LNM ranges from 1% to 8%. 2,4,5,8,[11][12][13][14][15][16][17] There are some studies on various pathologic risk factors for para-aortic LNM. The GOG data showed that patients with positive pelvic LNs, adnexal involvements, or outer one-third myometrial invasion were likely to have para-aortic LNM.…”

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confidence: 99%

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Lymph-Vascular Space Invasion as a Significant Risk Factor for Isolated Para-aortic Lymph Node Metastasis in Endometrial Cancer: A Study of 203 Consecutive Patients

et al. 2010

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Background. The purpose of this study was to investigate various pathologic risk factors associated with para-aortic lymph node metastasis (LNM) in surgically staged patients with endometrial cancer. Materials and Methods. We performed a retrospective analysis of 203 consecutive patients with endometrial cancer who were surgically staged from 2000 to 2009. The association among the various pathologic variables for para-aortic LNM was determined with univariate and multivariate analyses. Results. Of 203 patients, 29 patients (14.3%) had LNM. Also, 10 patients (4.9%) had only pelvic LNM, 14 (6.9%) had both pelvic and para-aortic LNM, and 5 (2.5%) had para-aortic LNM without pelvic LN involvements. Histologic type (P = .001), tumor grade (P \ .001), tumor size (P = .003), depth of myometrial invasion (P \ .001), cervical invasion (P \ .001), parametrial invasion (P = .002), lymph-vascular space invasion (LVSI) (P \ .001), serosal/ adnexal invasion (P \ .001), positive cytology (P = .002), peritoneal seeding (P \ .001), and pelvic LNM (P \ .001) were significant pathologic factors for para-aortic LNM. On multivariate analysis, cervical invasion (P = .032), LVSI (P = .018), and positive pelvic LNs (P = .002) were independent factors for para-aortic LNM. With regard to isolated para-aortic LNM, tumor grade (P = .017) and LVSI (P = .002) were significant factors for LN involvements. On multivariate analysis, LVSI (P = .004) was the only significant independent factor. Conclusions. LVSI correlates significantly with the risk of isolated para-aortic LNM in endometrial cancer patients.Lymph node metastasis (LNM) is one of the important prognostic factors in endometrial cancer. The Gynecologic Oncology Group (GOG) published two large surgicalpathological studies of women with clinical stage I or II endometrial cancer.1,2 A substantial number of patients with clinical stage I disease (22%) had extrauterine disease, and tumor grade, depth of myometrial invasion, cervical invasion, vascular space invasion, positive cytology, adnexal involvement, and certain histologic types were found to be risk factors for pelvic and para-aortic LNM. Based on these results, the International Federation of Gynecology and Obstetrics (FIGO) adopted a surgical staging system to replace the clinical staging system in 1988.3 FIGO stage IIIC disease meant pelvic or para-aortic LN involvement. Several studies demonstrated that stage IIIC disease had diversity in the prognosis and patients with para-aortic LNM had poorer survival than those with negative paraaortic LNs.2,4-8 Recently, the FIGO revised the surgical staging system. 9 Stage IIIC disease was divided into two categories of IIIC1 with positive pelvic LNs and IIIC2 with positive para-aortic LNs, irrespective of the status of pelvic LNs status.Para-aortic LNM occurs mainly by way of pelvic LNM.4,10 However, direct spread to para-aortic LNs via ovarian vessels is a possible route of lymphatic spread, and patients have isolated para-aortic LNM without positive pelvic LNs. [10][11][12] ...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Lymph-Vascular Space Invasion as a Significant Risk Factor for Isolated Para-aortic Lymph Node Metastasis in Endometrial Cancer: A Study of 203 Consecutive Patients

et al. 2010

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“…20,21 No nosso trabalho, a invasão do miométrio > 50% foi o factor que mostrou a associação de maior magnitude com o risco de metastização ganglionar. Mesmo perante tumores do tipo endometrióide e com baixo grau de diferenciação, a presença de invasão miometrial profunda determinou um risco de 15% de envolvimento ganglionar pélvico e/ ou para-aórtico, superior ao risco de 9% calculado por Kwon et al no mesmo contexto.…”

Section: Discussionunclassified

Factores Preditivos de Metastização Ganglionar Retroperitoneal no Cancro do Endométrio

et al. 2014

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Introduction: It has been suggested that a complete staging may be safely omitted in endometrial carcinoma patients at low risk for lymph node metastasis. The purposes of our study were to explore the prognostic significance of pathologic factors for pelvic and paraaortic nodal spread and to validate the Mayo algorithm in order to identify patients in whom lymphadenectomy may be avoided. Material and Methods:We conducted a retrospective review including 208 patients, regarding the evaluation of pathologic variables and nodal metastases. Statistical analysis was performed using the chi-square test, the Fisher exact test and the Student's t-test. Results: Myometrial invasion > 50% (p < 0.001), cervical invasion (p = 0.001), lymphovascular space invasion (p = 0.003) and positive peritoneal cytology (p = 0.03) were significant predictors of retroperitoneal lymph node dissemination. Pelvic lymph node metastases were predictive of positive paraaortic lymph nodes (p < 0.001). Discussion: The Mayo algorithm identified patients without pelvic or paraaortic nodal metastases with a 98.4% negative predictive value (61/62). Myometral invasion ≤ 50% and absence of cervical and lymphovascular invasion presented a negative predictive value of 98.8% (79/80). Conclusion:Although the Mayo criteria predict a very low likelihood of retroperitoneal nodal metastases, the combination of myometral invasion ≤ 50% and absence of cervical or lymphovascular invasion would have safely avoided lymphadenectomy in a larger number of women. Keywords: Endometrial Neoplasms; Lymphatic Metastasis; Lymph Node Excision; Neoplasm Staging; Predictive Value of Tests; Retroperitoneal Space; Portugal. INtRODUÇÃORepresentando a neoplasia ginecológica mais frequente nos países desenvolvidos, o carcinoma do endométrio possui, em Portugal, taxas anuais de incidência e mortalidade cifradas em 10,3 e 1,9 por 100 000 mulheres, respectivamente. Com base na clínica, na histologia e no perfil molecular, descrevem-se dois tipos de carcinoma do endométrio. Responsável por 80% dos casos, o tipo I relaciona--se com condições que configuram um estado prolongado de hiperestrogenismo não contrabalançado (anovulação, nuliparidade, menopausa tardia, administração de tamoxifeno, cirrose hepática), atinge mulheres mais jovens e obesas e corresponde a tumores do tipo endometrióide, bem diferenciados e com melhor prognóstico. O tipo II associa--se a um endométrio atrófico, raramente exibe expressão de receptores hormonais, corresponde a tipos histológicos não endometrióide (células claras, serosos, carcinossarcomas) e cursa com invasão miometrial profunda e metastização ganglionar frequente. Globalmente, o carcinoma do endométrio acomete sobretudo mulheres na sexta e sétima décadas de vida, tendo a sua incidência vindo a aumen-

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“…6,7 Many investigators do not recommend the routine para-aortic lymphadenectomy in low-risk patients, although they emphasize the significance and the survival benefit of paraaortic lymphadenectomy in intermediate-and high-risk endometrial cancer patients. [8][9][10][11][12][13] However, there is still continuing discussion over para-aortic lymphadenectomy in presumed stage I endometrial cancer. Several studies show that pelvic and para-aortic lymphadenectomy should be performed in all patients with endometrial cancer because the preoperative grade 1 endometrial cancer is often upgraded postoperatively, and there is no reliable preoperative and intraoperative evaluation to predict lowrisk disease.…”

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confidence: 99%

Para-aortic Lymphadenectomy in the Management of Preoperative Grade 1 Endometrial Cancer Confined to the Uterine Corpus

et al. 2010

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Background. The aim of this study was to determine the risk of para-aortic lymph node metastasis in surgically staged patients presenting with preoperative grade 1 endometrial cancer and to assess the impact of para-aortic lymphadenectomy. Materials and methods. A total of 131 consecutive patients diagnosed with preoperative grade 1 endometrial cancer from 2004 to 2009 were analyzed. We included women with endometrial cancer that was thought preoperatively to be confined to the uterine corpus, and all patients had complete staging operation including total hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings, pelvic lymphadenectomy, and para-aortic lymphadenectomy.Results. Of 131 patients, 6 (4.6%) had positive para-aortic lymph nodes and only 2 (1.5%) had isolated para-aortic nodal metastasis with negative pelvic nodes. In comparison of preoperative and postoperative histology, 6.8% of patients were upgraded, with 5.3% grade 2 and 1.5% grade 3. Advanced stage disease was found in 12.9%. Deep myometrial invasion by MRI and CA 125 levels of C31 U/ ml were found to be independent preoperative risk factors for para-aortic lymph node metastasis. Conclusions. Some patients with preoperative grade 1 endometrial cancer are found to have upgraded disease and para-aortic nodal metastasis. Para-aortic lymphadenectomy should be considered in patients presenting with preoperative grade 1 endometrial cancer, especially in the setting of preoperative CA 125 levels of [31 U/ml and deep myometrial invasion by MRI.

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The Risk of Lymph Node Metastasis Based on Myometrial Invasion and Tumor Grade in Endometrioid Uterine Cancers: A Multicenter, Retrospective Korean Study

Abstract: Patients with endometrioid uterine cancers with no myometrial invasion and tumor grade I/II might have minimal risk of LNM, whereas others might require complete pelvic and para-aortic lymphadenectomy for surgical staging.

Cited by 63 publications

References 25 publications

Lymph-Vascular Space Invasion as a Significant Risk Factor for Isolated Para-aortic Lymph Node Metastasis in Endometrial Cancer: A Study of 203 Consecutive Patients

Lymph-Vascular Space Invasion as a Significant Risk Factor for Isolated Para-aortic Lymph Node Metastasis in Endometrial Cancer: A Study of 203 Consecutive Patients

Factores Preditivos de Metastização Ganglionar Retroperitoneal no Cancro do Endométrio

Para-aortic Lymphadenectomy in the Management of Preoperative Grade 1 Endometrial Cancer Confined to the Uterine Corpus

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