Extracorporeal Spread and Its Prognostic Impact in Stages I and II (FIGO) Endometrial Carcinoma

Abstract

Prognostic risk factors were statistically analyzed from the histopathologic data obtained from 90 Japanese women with stages I and II endometrial carcinoma treated surgically, including systemic retroperitoneal lymph node dissection, between June 1979 and June 1989. In stage Ia endometrial carcinoma, pelvic and paraaortic nodes metastasis were seen in 13.8(4/29)% and 0.0(0/19)% of patients, respectively. In stage Ib, the incidence of pelvic and paraaortic node metastasis was 25.6(11/43)% and 9.7(3/31)%, respectively. In stage II, the incidence was 38.9(7/18)% and 13.3(2/15)%, respectively. Prognosis of patients even with deep myometrial invasion (>=2/3) or G3 tumor was fairly good (5‐year survival rate: 87.5% and 85.7%, respectively) if the disease was histologically confined to the uterine corpus. Once the tumor spread outside the corpus uteri, the survival rate of patients was strongly affected by the grade of the tumor, moderate to marked lymph‐vascular space invasion of tumor cells, or tumor invading middle or outer third of myometrium (P<0.05 for each factor). In summary, endometrial cancer frequently metastasize to pelvic and paraaortic lymph nodes even in the early stages, and lymph node metastasis and other extracorporeal spread of disease have a serious impact on patient survival. Prognosis of patients with extra‐corporeal spread of disease seems to be determined by the high grade of tumor and lymph‐vascular space invasion. These results suggest that surgical exploration including paraaortic lymph node dissection to accurately evaluate the extent of the disease is essential to estimate the patient's prognostic risk and to individualize the treatment schedule.

Retrospective analysis on coexisting ovarian cancer in 976 patients with clinical stage I endometrial carcinoma

“…Thus, it is reasonable to consider whether the ovaries should be routinely removed and evaluate how high the risk is for residual cancer in preserved ovaries at surgery for early endometrial carcinoma, especially clinical stage I disease. It has been reported that the rate is about 1.7–11% in clinical stage I endometrial carcinoma, 5–9 but the reported results are not consistent. Takeshima et al 9 .…”

“…13 Thus, it is reasonable to consider whether the ovaries should be routinely removed and evaluate how high the risk is for residual cancer in preserved ovaries at surgery for early endometrial carcinoma, especially clinical stage I disease. It has been reported that the rate is about 1.7-11% in clinical stage I endometrial carcinoma, [5][6][7][8][9] but the reported results are not consistent. Takeshima et al 9 reported that the rate of ovarian implant was 5% in 439 patients with clinical stage I endometrioid adenocarcinoma, but 4.5% if those with nonendometrioid adenocarcinoma, extrauterine spread other than ovary, and pelvic lymph node metastasis were excluded.…”

“…However, it remains a debatable topic whether bilateral ovaries should be removed routinely at the time of operation. It has been estimated that the incidence of ovarian metastasis or synchronous ovarian primary neoplasm in clinical stage I endometrial carcinoma is approximately 1.7–11% 5–9 . This incidence level may provide the possibility of residual cancer if ovaries are not removed.…”

“…It has been estimated that the incidence of ovarian metastasis or synchronous ovarian primary neoplasm in clinical stage I endometrial carcinoma is approximately 1.7-11%. [5][6][7][8][9] This incidence level may provide the possibility of residual cancer if ovaries are not removed. Contrarily, routine removal of both ovaries may harm quality of life for most of patients without coexisting ovarian cancer, especially young women.…”

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

“…Many pathologic factors have a direct effect on the prognosis (3,7,18,19) , but extrauterine involvement (including lymph node metastasis) is particularly important (20) . In several reports, it was reported that patients with para-aortic lymph node metastasis have a worse prognosis than those who are only positive for pelvic lymph node metastasis (4,10) , and para-aortic lymph node metastasis has also been shown to affect the prognosis (8,(20)(21)(22)(23)(24)(25)(26)(27)(28) . Though such findings suggest that the presence of para-aortic lymph node metastasis is one of the factors worsening the prognosis, the therapeutic meaning of para-aortic lymph node dissection is uncertain.…”