Lymphovascular space invasion and positive pelvic lymph nodes are independent risk factors for para-aortic nodal metastasis in endometrioid endometrial cancer

Abstract Objective Para-aortic lymph node dissemination in endometrioid endometrial cancer is uncommon, and systematic para-aortic lymph node dissection increases morbidity. The purpose of this study was to identify a subgroup of endometrioid endometrial cancer patients who did not require para-aort...

Full description

Saved in:
Bibliographic Details
Published in:European journal of obstetrics & gynecology and reproductive biology 2015-03, Vol.186, p.63-67
Main Authors: Solmaz, Ulas, Mat, Emre, Dereli, Murat Levent, Turan, Volkan, Tosun, Gokhan, Dogan, Askin, Sanci, Muzaffer, Ozdemir, I. Aykut, Pala, Emel Ebru
Format: Article
Language:English
Subjects:
Aged
Aorta
Blood Vessels - pathology
Carcinoma, Endometrioid - pathology
Carcinoma, Endometrioid - secondary
Carcinoma, Endometrioid - surgery
Endometrial cancer
Endometrial Neoplasms - pathology
Endometrial Neoplasms - surgery
Female
Humans
Lymph Node Excision
Lymph Nodes - pathology
Lymph Nodes - surgery
Lymphadenectomy
Lymphatic Metastasis
Lymphatic Vessels - pathology
Lymphovascular space invasion
Middle Aged
Neoplasm Invasiveness
Obstetrics and Gynecology
Para-aortic lymph nodes
Pelvic lymph nodes
Pelvis
Retrospective Studies
Risk Factors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Objective Para-aortic lymph node dissemination in endometrioid endometrial cancer is uncommon, and systematic para-aortic lymph node dissection increases morbidity. The purpose of this study was to identify a subgroup of endometrioid endometrial cancer patients who did not require para-aortic lymphadenectomy. Study design All patients who had undergone surgery for endometrioid endometrial cancer between 1 January 1995 and 31 December 2012 were retrospectively reviewed. Patients with higher risk factors for nodal metastasis and inadequate lymphadenectomy were excluded. Para-aortic lymph node dissemination was defined as nodal metastasis when pelvic and para-aortic lymph node dissection was performed, when para-aortic lymph node recurrence occurred after negative para-aortic lymph node dissection or when para-aortic lymph node dissection was not performed. Multivariate logistic regression models were used to identify the pathological features as predictors for para-aortic lymphatic dissemination. Results A total of 827 patients were assessed, 516 (62.4%) of whom underwent pelvic and para-aortic lymph node dissection. Sixty-seven (13%) patients (37 with only pelvic, 26 with pelvic and para-aortic, and 4 with only para-aortic metastasis) had positive lymph nodes in the pelvic and para-aortic lymph node dissection group. Multivariate analysis confirmed positive pelvic nodes (odds ratio 20.58; p < 0.001) and lymphovascular space invasion (odds ratio 8.10; p = 0.022) as independent predictors of para-aortic lymphatic dissemination. When these two factors were absent (in 83% of patients), the predicted probability of para-aortic lymph node metastasis was 0.1%. Conclusion Positive pelvic nodes and lymphovascular space invasion are highly associated with para-aortic lymph node metastasis. These markers may be useful for identifying those patients who require para-aortic lymph node dissection.
ISSN:0301-2115
1872-7654
DOI:10.1016/j.ejogrb.2015.01.006