Impact of lymph node ratio on survival in stage IIIC endometrioid endometrial cancer: a Turkish Gynecologic Oncology Group study

Abstract

ObjectiveThe purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in women with stage IIIC endometrioid endometrial cancer (EC).MethodsA multicenter, retrospective department database review was performed to identify patients with stage IIIC pure endometrioid EC at 6 gynecologic oncology centers in Turkey. A total of 207 women were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 2 groups: LNR1 (≤0.15), and LNR2 (>0.15). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models.ResultsOne hundred and one (48.8%) were classified as stage IIIC1 and 106 (51.2%) as stage IIIC2. The median age at diagnosis was 58 (range, 30–82) and the median duration of follow-up was 40 months (range, 1–228 months). There were 167 (80.7%) women with LNR ≤0.15, and 40 (19.3%) women with LNR >0.15. The 5-year progression-free survival (PFS) rates for LNR ≤0.15 and LNR >0.15 were 76.1%, and 58.5%, respectively (p=0.045). An increased LNR was associated with a decrease in 5-year overall survival (OS) from 87.0% for LNR ≤0.15 to 62.3% for LNR >0.15 (p=0.005). LNR >0.15 was found to be an independent prognostic factor for both PFS (hazard ratio [HR]=2.05; 95% confidence interval [CI]=1.07–3.93; p=0.03) and OS (HR=3.35; 95% CI=1.57–7.19; p=0.002).ConclusionLNR seems to be an independent prognostic factor for decreased PFS and OS in stage IIIC pure endometrioid EC.

Comparison of Different Lymph Node Staging Schemes for Predicting Survival Outcomes in Node-Positive Endometrioid Endometrial Cancer Patients

“…NPLN was divided into NPLN1 (1), NPLN2 (2-6), and NPLN3 (≥7). NNLN was categorized as NNLN1 (<5), NNLN2 (5)(6)(7)(8)(9)(10)(11)(12)(13), and NNLN3 (≥14). LNR was classified into LNR1 (0.01-0.15), LNR2 (0.16-0.66), and LNR3 (≥0.67).…”

“…This new N staging principle made sense from the perspective of regional LN drainage, as the pelvic LN basin harbored almost all of the uterine LN drainage while the para-aortic LN involvement might imply further progression (8,9). However, this staging system did not take LN number or ratio into consideration, and previous studies have revealed that a higher number of positive lymph nodes (NPLN) or lymph node ratio (LNR) was related to more dreadful survival for EEC patients (10)(11)(12). So, it is necessary to further explore the prognostic significance of these LN schemes.…”

Is the extent of lymphadenectomy a prognostic factor in International Federation of Gynecology and Obstetrics stage II endometrioid endometrial cancer?

“…Retroperitoneal LN assessment remains an essential component of the surgical staging of patients with intermediate to high‐risk EC 15,18 . However, the therapeutic value of LND for EC remains a matter of debate 15,16 .…”

Comparison of Survival Outcomes of Lymphovascular Space Invasion-Negative and Lymphovascular Space Invasion - Positive Women with Stage IIIC Endometrioid Endometrial Cancer: A Case - Control Study

“…All patients underwent surgical staging with total hysterectomy ± bilateral salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy, infracolic omentectomy and peritoneal washings by gynecologic oncologists. Lymph node dissection was performed as previously described (14). Adequate pelvic and para-aortic lymphadenectomy have been defined as removal of at least 10 pelvic lymph nodes (LNs) and at least 5 para-aortic LNs (15)(16)(17).…”