Analysis of clinicopathologic factors predicting para-aortic lymph node metastasis in endometrial cancer

Abstract

The purposes of this study were to compare the relationships between para-aortic lymph node metastasis and various clinicopathologic factors to evaluate whether para-aortic lymph node dissection is necessary when treating endometrial cancer. A retrospective study was performed on 841 patients with endometrial cancer, who underwent the initial surgery at the Keio University Hospital. Clinicopathologic factors related to para-aortic lymph node metastasis significant on a univariate analysis were analyzed in a multivariate fashion using a logistic model. According to the multivariate analysis, the clinicopathologic factor most strongly related to the existence of para-aortic lymph node metastasis was positive pelvic lymph node metastasis (P < 0.01). Among the 155 patients who underwent pelvic and para-aortic lymph node dissection, the difference of 5-year overall survival by the presence of retroperitoneal lymph node metastasis was examined by Kaplan-Meier method. The prognosis was poor even if para-aortic lymph node dissection was performed in cases of positive para-aortic lymph node metastasis. In conclusion, when deciding whether to perform para-aortic lymph node dissection in patients with endometrial cancer, it is necessary to consider the pelvic lymph nodal status. If there is no pelvic lymph node metastasis, it could not be necessary to perform para-aortic lymph node dissection.

Prospective assessment of lymphatic dissemination in endometrial cancer: A paradigm shift in surgical staging

“…We previously reported that 47% of patients with pelvic node metastasis had para-aortic lymph node involvement detected either at surgical staging or during subsequent recurrence [27]. These observations were consistent with previous estimates of 40% to 57% [5,8,21,[36][37][38]. In light of the high frequency of para-aortic involvement with lymphatic dissemination and the limitations of retrospective analyses, we sought to assess the prevalence of pelvic and para-aortic node involvement in at-risk patients.…”

“…Although 84% of patients with lymphatic dissemination had documented involvement of the pelvic nodes, 67% had metastases in the para-aortic nodes. These findings suggest a higher prevalence of para-aortic involvement in endometrial cancer than that reported either by our group previously [21,27,39] or by other contemporary authors [5,8,21,[36][37][38], which authenticates the importance of para-aortic lymphadenectomy in defining both the extent of disease and the strategies for adjuvant therapies. In addition, a therapeutic approach that omits lymphadenectomy in favor of hysterectomy with oophorectomy followed by pelvic radiotherapy would undertreat most of the patients who have lymphatic metastases because of the high frequency of simultaneous involvement in the para-aortic area.…”

“…The most controversial management issue relates to the requirement for, and the extent and therapeutic value of, lymphadenectomy concomitant with hysterectomy. Assessment of regional node-bearing basins varies from elective omission to sampling (selective assessment) to systematic pelvic and para-aortic lymphadenectomy [2][3][4][5][6][7]. Furthermore, the anatomic extent and level of dissection remain ill defined for patients undergoing para-aortic node sampling or systematic dissection [5,[7][8][9].…”

Prevention and Therapeutic Strategies in Endometrial Cancer

“…Lymphadenectomy is highly important for determining a prognosis and in tailoring adjuvant therapies. Prognostic factors for para-aortic spread are similar to those for pelvic nodal disease and include depth of myometrial invasion and the presence of lymphovascular space invasion [Fotopoulou, 2010;Park, 2010;Nomura, 2006]. Many authors suggest a lymphadenectomy for intermediate-high risk endometrial cancer (stage IA G3 and IB) [Colombo, 2011].…”

Controversies in the management of early endometrial carcinoma: an update

“…Among patients who underwent systemic pelvic and paraaortic lymphadennectomy 96.2% has negative paraaortic nodes when the pelvic nodes were negative but when pelvic nodes were positive 48% of them had positive paraaortic nodes so paraaortic lymphadenectomy is advised in all high-risk patients or in patients with two or more positive pelvic lymphnodes. 14 Lymphadenectomy could be important in determining prognosis and in tailoring adjuvant treatment.…”