Significance of Pathologic Patterns of Pelvic Lymph Node Metastases in Endometrial Cancer

Mariani, Andrea; Webb, Maurice J.; Rao, Sudha K.; Lesnick, Timothy G.; Podratz, Karl C.

doi:10.1006/gyno.2000.6050

Cited by 41 publications

(24 citation statements)

References 14 publications

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“…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.…”

Section: Discussionsupporting

confidence: 80%

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

Mariani

Dowdy

Cliby

et al. 2008

Gynecologic Oncology

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528

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Objective-To prospectively assess pelvic and para-aortic lymph node metastases in endometrial cancer with lymphatic dissemination, emphasizing the examination of para-aortic metastases relative to the inferior mesenteric artery (IMA).Methods-Over 36 months, 422 consecutive patients were managed by predefined surgical guidelines differentiating low-risk patients from patients at risk for dissemination requiring systematic lymphadenectomy. Low risk was defined as grade 1 or 2 endometrioid type with myometrial invasion (MI) ≤50% and primary tumor diameter (PTD) ≤2 cm. Pelvic and para-aortic lymph nodes were submitted separately, with nodes identified from all 8 pelvic and 4 para-aortic node-bearing basins. Surgical quality assessments examined median node counts (primary surrogate for quality) and nodes harvested above and below the IMA and excised gonadal veins (secondary surrogates).Results-Lymphadenectomy was not required in 27% of patients (all low risk) and in 33% (n=112) of endometrioid cases. However, 22 patients (20%) of this latter cohort had lymphadenectomy and all lymph nodes were negative. Sixty-three (22%) of 281 patients undergoing lymphadenectomy had lymph node metastases: both pelvic and para-aortic in 51%, only pelvic in 33%, and isolated to the para-aortic area in 16%. Therefore, 67% of patients with lymphatic dissemination had para-aortic lymph node metastases. Furthermore, 77% of patients with para-aortic node involvement had metastases above the IMA, whereas nodes in the ipsilateral para-aortic area below the IMA and ipsilateral common iliac basin were declared negative in 60% and 71%, respectively. Gonadal veins were excised in 25 patients with para-aortic node metastases; 7 patients (28%) had documented metastatic involvement of gonadal veins or surrounding soft tissue.Conclusions-The high rate of lymphatic metastasis above the IMA indicates the need for systematic pelvic and para-aortic lymphadenectomy (vs sampling) up to the renal vessels. The latter should include consideration of excision of the gonadal veins. Conversely, lymphadenectomy does not benefit patients with grade 1 and 2 endometrioid lesions with MI ≤50% and PTD ≤2 cm.

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Section: Discussionsupporting

confidence: 80%

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

Mariani

Dowdy

Cliby

et al. 2008

Gynecologic Oncology

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763

528

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“…Small retrospective studies from single institutions have evaluated the significance of the absolute number and ratio of positive nodes in uterine cancers. Mariani et al (2001) studied 60 patients with endometrial cancer with pelvic nodal metastases. These authors found that patients who recurred or died of disease had a higher percentage of positive lymph nodes at presentation.…”

Section: Discussionmentioning

confidence: 99%

The impact of the absolute number and ratio of positive lymph nodes on survival of endometrioid uterine cancer patients

et al. 2007

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The aim of the study was to determine the impact of the absolute number and ratio of positive lymph nodes on the survival in nodepositive endometrioid uterine cancer. Data were obtained from the National Cancer Institute Registry from 1988 to 2001. Analyses were performed using Kaplan -Meier and Cox proportional hazard methods. A total of 1222 women were diagnosed with stage IIIC-IV node-positive endometrioid corpus cancer. The 5-year disease-specific survival of women with 1, 2 -5, and 45 positive nodes were 68.1, 55.1, and 46.1%, respectively (Po0.001). Increasing lymph node ratio, expressed as a percentage of positive nodes to total nodes identified (p10, 410 -p50, and 450%), was associated with a decrease in survival from 77.3 to 60.7 to 40.9%, respectively (Po0.001). The absolute number of positive nodes and the lymph node ratio remained significant after adjusting for stage (IIIC vs IV) and the extent of lymphadenectomy (p20 vs 420 nodes). On multivariate analysis, the absolute number of positive nodes and lymph node ratio were significant independent prognostic factors for survival. Increasing absolute number of positive nodes and lymph node ratio are associated with a poorer survival in women with node-positive uterine cancers. The stratification of nodepositive uterine cancer for prognostic and treatment purposes warrants further investigation.

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“…The patterns of lymph node metastasis were described in a manner similar to that reported in the study by Mariani et al [27] and included (1) the maximal diameter of metastasis; (2) the capsular integrity (if intracapsular or extracapsular metastasis); and (3) the type of immune response. The four patterns of immune response were defined as follows: (1) lymphocyte predominance, when there was an increased number of small lymphocytes throughout the cortex, paracortex, and medullary regions; (2) germinal center predominance, when germinal centers containing large lymphoid cells and mitotic figures extended throughout the cortex and paracortex; (3) unstimulated, when there were lymphoid follicles without germinal centers in the cortex and hypocellular paracortical areas; and (4) lymphocyte depletion, when the lymph node was fibrotic.…”

Section: Methodsmentioning

confidence: 99%

Lymphatic spread among women with primary peritoneal carcinoma

Eltabbakh

Mount

2002

Journal of Surgical Oncology

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Significance of Pathologic Patterns of Pelvic Lymph Node Metastases in Endometrial Cancer

Cited by 41 publications

References 14 publications

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

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

The impact of the absolute number and ratio of positive lymph nodes on survival of endometrioid uterine cancer patients

Lymphatic spread among women with primary peritoneal carcinoma

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