Tae Hun Kim1, Hee Seung Kim2, Tae-Joong Kim3, Suk-Joon Chang4, Dae-Yeon Kim5, Sang-Young Ryu1, Byoung-Gie Kim3, Young-Tak Kim6, Duk-Soo Bae3, Hee-Sug Ryu4, Joo-Hyun Nam6. 1. Department of Obstetrics and Gynecology, Korean Cancer Center Hospital, Korean Institute of Radiological and Medical Sciences, Seoul, Republic of Korea. 2. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea. 3. Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 4. Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea. 5. Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: kdyog@amc.seoul.kr. 6. Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Abstract
OBJECTIVE: To investigate whether the number of lymph nodes obtained during lymphadenectomy affects the survival of patients with intermediate- or high-risk endometrioid-type endometrial cancer. METHODS: A total of 476 patients who were diagnosed with FIGO stage IB to IIIC2 endometrioid adenocarcinoma through surgical staging, including hysterectomy and pelvic lymphadenectomy with or without paraaortic lymphadenectomy between 2000 and 2013 were retrospectively enrolled from four tertiary centers in Korea. Sentinel lymph node mapping was not performed in any patient. The number of nodes obtained and positive nodes, was extracted from pathologic report. RESULTS: Paraaortic lymphadenectomy was performed in 298 (62.6%) patients and 164 (34.4%) had stage IIIC disease. The isolated paraaortic lymph node metastasis rate decreased as the number of pelvic nodes obtained increased. In the total study population, an increase of negative pelvic and paraaortic nodes was associated with improved recurrence-free survival (RFS) and overall survival (OS) independent of other prognostic factors. In the node-positive group, an increase of negative pelvic nodes was an independent prognostic factor for RFS [hazard ratio (HR), 0.946; 95% confidence interval (CI), 0.906-0.988] and OS [HR, 0.907; 95% CI, 0.849-0.968]. In stage IIIC2 patients, 14 or less negative pelvic nodes was associated with poor RFS and OS. CONCLUSIONS: Removing as many pelvic nodes as possible is required to warrant accurate nodal staging and improve survival in patients with intermediate- or high-risk endometrial cancer. Sentinel lymph node mapping can be a resolution to minimize lymph node dissection without compromising staging accuracy.
OBJECTIVE: To investigate whether the number of lymph nodes obtained during lymphadenectomy affects the survival of patients with intermediate- or high-risk endometrioid-type endometrial cancer. METHODS: A total of 476 patients who were diagnosed with FIGO stage IB to IIIC2 endometrioid adenocarcinoma through surgical staging, including hysterectomy and pelvic lymphadenectomy with or without paraaortic lymphadenectomy between 2000 and 2013 were retrospectively enrolled from four tertiary centers in Korea. Sentinel lymph node mapping was not performed in any patient. The number of nodes obtained and positive nodes, was extracted from pathologic report. RESULTS: Paraaortic lymphadenectomy was performed in 298 (62.6%) patients and 164 (34.4%) had stage IIIC disease. The isolated paraaortic lymph node metastasis rate decreased as the number of pelvic nodes obtained increased. In the total study population, an increase of negative pelvic and paraaortic nodes was associated with improved recurrence-free survival (RFS) and overall survival (OS) independent of other prognostic factors. In the node-positive group, an increase of negative pelvic nodes was an independent prognostic factor for RFS [hazard ratio (HR), 0.946; 95% confidence interval (CI), 0.906-0.988] and OS [HR, 0.907; 95% CI, 0.849-0.968]. In stage IIIC2 patients, 14 or less negative pelvic nodes was associated with poor RFS and OS. CONCLUSIONS: Removing as many pelvic nodes as possible is required to warrant accurate nodal staging and improve survival in patients with intermediate- or high-risk endometrial cancer. Sentinel lymph node mapping can be a resolution to minimize lymph node dissection without compromising staging accuracy.
Authors: Brooke A Schlappe; Amy L Weaver; Jennifer A Ducie; Ane Gerda Zahl Eriksson; Sean C Dowdy; William A Cliby; Gretchen E Glaser; Robert A Soslow; Kaled M Alektiar; Vicky Makker; Nadeem R Abu-Rustum; Andrea Mariani; Mario M Leitao Journal: Gynecol Oncol Date: 2018-08-31 Impact factor: 5.482
Authors: Pluvio J Coronado; Agnieszka Rychlik; Maria A Martínez-Maestre; Laura Baquedano; María Fasero; Aida García-Arreza; Sara Morales; Daniel M Lubian; Ignacio Zapardiel Journal: J Gynecol Oncol Date: 2018-01 Impact factor: 4.401