Predictors for lymph nodes involvement in low risk endometrial cancer

Abstract

Neutrophil-lymphocyte ratio (NLR) and BMI were examined as pre-operative predictors for lymph node metastases in patients with low-risk endometrial cancer. The study was a retrospective analysis of 534 endometrial cancer patients that underwent hysterectomy and lymph node dissection. Included subjects had a preoperative diagnosis of a grade 1 or 2 endometrioid carcinoma and no macroscopic extrauterine disease. We compared node-negative to node-positive patients to identify correlates of node-positive disease. The node-positive group presented with lower BMI than the node-negative group, 31.5 and 34.4, respectively (p = .03). The mean NLR was higher in the node-positive group 3.4 vs 2.9 (p = .08), showing a trend towards significance on univariate analysis. On multivariate analysis, lower BMI was found to be an independent predictor for nodal metastasis. Our data suggest that lower BMI is a risk factor for lymph nodes involvement in low-risk endometrial cancer. Impact statement Most endometrial cancer patients have low-risk disease with low risk for lymph nodes metastasis. In order to reduce the number of patients that will undergo unnecessary lymph node dissection, different types of preoperative predictors for lymph node involvement were studied. CA 125 and different imaging modalities were found as useful predictors for more advanced disease. Less studied predictors are the systemic inflammatory response markers and patient's BMI. This study suggests that lower BMI is a risk factor for lymph node involvement in low-risk endometrial cancer. The neutrophil to lymphocyte ratio was close to significance as a predictor for lymph node involvement. In practice, physicians might favour comprehensive lymph node dissection when there is a doubt regarding the procedure but the patient is lean. The study's conclusion can be utilised for triaging patients to general gynaecologist vs gynaecologic oncologist. Further research should focus on combining predictors such as age, BMI, NLR, CA 125 and imaging to better predict lymph nodes involvement in low-risk endometrial cancer.

Cervical invasion, lymphovascular space invasion, and ovarian metastasis as predictors of lymph node metastasis and poor outcome on stages I to III endometrial cancers: a single-center retrospective study

“…In a nation-wide study, the Swedish gynecological cancer group [28] put forward that MI ≥ 50%, atypia histology, and FIGO grade 3 had a strong association with lymph node metastasis. A study by Kadan et al [29] raised that lower body mass index was a danger factor of nodal metastasis in low-risk endometrial cancer. Wang et al [8] proposed that CA125 could indicate whether a lymphadenectomy was required.…”

Pretreatment Neutrophil-to-Lymphocyte Ratio Was a Predictor of Lymph Node Metastasis in Endometrial Cancer Patients

“…Endometrial cancers frequently occur in an obese population, and the CA125 value might be potentially influenced by obesity. NLR might be more useful than CA125 in endometrial cancer patients because it is not affected by obesity [21]. …”

Grade I-II Küçük Tümörlü (<4 cm) Endometrioid Tip Endometriyum Kanserinde İnflamasyon Belirteçlerinin Prognostik Faktörler ile İlişkisi

“…Endometriyal kanser hastalarında NLO, PLO değerlerinin ileri evre hastalık, derin myometriyal invazyon, servikal invazyon ve lenf nodu metastaz durumlarında anlamlı olarak daha yüksek olduğu gösterildi (9-11). Grade I-II endometriyum kanseri olan hastalar ile yapılan çalışmada, lenf nodu metastazı olan hastalarda NLO oranlarının daha yüksek olduğu gösterildi ancak sonucun istatistiksel anlamlı olmadığı bulunmuştur (12). Servikal stromal invazyon varlığında NLO değerinin anlamlı olarak daha yüksek olduğu ancak PLO değerinin anlamlı artış göstermediğini raporlayan çalışmalarda mevcuttur (13).…”