Archives of Gynecology and Obstetrics

, Volume 285, Issue 1, pp 207–214

Lymphadenectomy as a prognostic marker in uterine non-endometrioid carcinoma

Gynecologic Oncology

Abstract

Introduction

A pelvic lymphadenectomy with or without para-aortic lymphadenectomy is performed during surgery for endometrial cancer at least in high-risk patients for recurrence or progression. The question of whether pelvic and/or para-aortic lymphadenectomy improves survival rates of high-risk patients with uterine non-endometrioid carcinoma is still unclear. Therefore, the aim of this study was to evaluate the outcome of patients with uterine non-endometrioid cancer, with regard to the performance of a lymphadenectomy in a well-characterized cohort population.

Materials and methods

The prognostic value of a performed lymphadenectomy was examined in 55 patients with a histological diagnosis of a uterine non-endometrioid carcinoma. A performed lymphadenectomy was analyzed with respect to the surgical and pathological stage and characteristics.

Results

Of the 55 patients with an uterine non-endometrioid carcinoma, 38 (69.1%) and 2 (3.6%) patients were diagnosed in FIGO stage I and II, respectively, while 14 (25.5%) patients had FIGO stage III and 1 patient (1.8%) presented with metastatic disease (FIGO IV). 16 patients (29.1%) demonstrated a myometrial invasion of more than 50%, while a cervical and ovarian involvement could be observed in 7 (12.7%) and 9 (16.4%) cases, respectively. Pelvic and/or para-aortic lymph node sampling was performed for 42 patients (76.4%) while 7 patients (12.7%) demonstrated lymph node metastasis. Univariate survival analysis demonstrated no differences in progression-free survival, cause-specific survival or overall survival for a performed lymphadenectomy. Regression analysis led to a model containing only the FIGO surgical stage as an independent term that was predictive of progression-free survival, cause-specific survival and overall survival.

Discussion

Although a performed lymphadenectomy did not have any positive benefit in the survival of patients with uterine non-endometrioid carcinomas in this study, it might provide important prognostic information with a subsequent adjuvant treatment. However, these results remain to be confirmed in further larger and prospective studies.

Keywords

Endometrial cancer Non-endometrioid carcinoma Lymphadenectomy Prognosis Survival 

References

  1. 1.
    Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59:225–249. doi:10.3322/caac.20006 PubMedCrossRefGoogle Scholar
  2. 2.
    Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I (2005) Endometrial cancer. Lancet 366:491–505PubMedCrossRefGoogle Scholar
  3. 3.
    Gloeckler Ries LA, Reichman ME, Lewis DR, Hankey BF, Edwards BK (2003) Cancer survival and incidence from the Surveillance, Epidemiology, and End Results (SEER) program. Oncologist 8:541–552PubMedCrossRefGoogle Scholar
  4. 4.
    Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Warlam-Rodenhuis CC, De Winter KA, Lutgens LC, van den Bergh AC, van de Steen-Banasik E, Beerman H, van Lent M (2000) Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet 355:1404–1411. doi:S0140673600021395 PubMedCrossRefGoogle Scholar
  5. 5.
    Papanikolaou A, Kalogiannidis I, Goutzioulis M, Misailidou D, Makedos A, Vergote I, Makedos G (2006) Pelvic lymphadenectomy as alternative to postoperative radiotherapy in high risk early stage endometrial cancer. Arch Gynecol Obstet 274:91–96. doi:10.1007/s00404-006-0138-y PubMedCrossRefGoogle Scholar
  6. 6.
    Prat J (2004) Prognostic parameters of endometrial carcinoma. Hum Pathol 35:649–662PubMedCrossRefGoogle Scholar
  7. 7.
    Deligdisch L, Holinka CF (1987) Endometrial carcinoma: two diseases? Cancer Detect Prev 10:237–246PubMedGoogle Scholar
  8. 8.
    Bokhman JV (1983) Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 15:10–17PubMedCrossRefGoogle Scholar
  9. 9.
    Lax SF (2004) Molecular genetic pathways in various types of endometrial carcinoma: from a phenotypical to a molecular-based classification. Virchows Arch 444:213–223PubMedCrossRefGoogle Scholar
  10. 10.
    Jereczek-Fossa B, Badzio A, Jassem J (1999) Surgery followed by radiotherapy in endometrial cancer: analysis of survival and patterns of failure. Int J Gynecol Cancer 9:285–294PubMedCrossRefGoogle Scholar
  11. 11.
    Faratian D, Stillie A, Busby-Earle RM, Cowie VJ, Monaghan H (2006) A review of the pathology and management of uterine papillary serous carcinoma and correlation with outcome. Int J Gynecol Cancer 16:972–978PubMedCrossRefGoogle Scholar
  12. 12.
    Dallenbach-Hellweg G (1999) Histopathologie und Stadieneinteilung des Endometriumkarzinoms inklusive seiner Präkanzerosen. Onkologe 5:388–395CrossRefGoogle Scholar
  13. 13.
    Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer 60:2035–2041PubMedCrossRefGoogle Scholar
  14. 14.
    Pecorelli S (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105:103–104PubMedCrossRefGoogle Scholar
  15. 15.
    (1989) FIGO stages (announcements). Gynecol Oncol 35:125–127Google Scholar
  16. 16.
    Soliman PT, Frumovitz M, Spannuth W, Greer MJ, Sharma S, Schmeler KM, Ramirez PT, Levenback CF, Ramondetta LM (2010) Lymphadenectomy during endometrial cancer staging: practice patterns among gynecologic oncologists. Gynecol Oncol 119:291–294. doi:10.1016/j.ygyno.2010.07.011 PubMedCrossRefGoogle Scholar
  17. 17.
    Sehouli J, Camara O, Stengel D, Kohler G, Lichtenegger W (2003) Multi-institutional survey on the value of lymphadenectomy in endometrial carcinoma in Germany. Gynakol Geburtshilfliche Rundsch 43:104–110PubMedCrossRefGoogle Scholar
  18. 18.
    Bassarak N, Blankenstein T, Bruning A, Dian D, Bergauer F, Friese K, Mylonas I (2010) Is lymphadenectomy a prognostic marker in endometrioid adenocarcinoma of the human endometrium? BMC Cancer 10:224. doi:10.1186/1471-2407-10-224 PubMedCrossRefGoogle Scholar
  19. 19.
    Kilgore LC, Partridge EE, Alvarez RD, Austin JM, Shingleton HM, Noojin F 3rd, Conner W (1995) Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol 56:29–33PubMedCrossRefGoogle Scholar
  20. 20.
    Orr JW Jr, Holimon JL, Orr PF (1997) Stage I corpus cancer: is teletherapy necessary? Am J Obstet Gynecol 176:777–788 (discussion 788-779)PubMedCrossRefGoogle Scholar
  21. 21.
    Ceccaroni M, Savelli L, Bovicelli A, Alboni C, Ceccarini M, Farina A, Bovicelli L (2004) Prognostic value of pelvic lymphadenectomy in surgical treatment of apparent stage I endometrial cancer. Anticancer Res 24:2073–2078PubMedGoogle Scholar
  22. 22.
    Abu-Rustum NR, Chi DS, Leitao M, Oke EA, Hensley ML, Alektiar KM, Barakat RR (2008) What is the incidence of isolated paraaortic nodal recurrence in grade 1 endometrial carcinoma? Gynecol Oncol 111:46–48. doi:10.1016/j.ygyno.2008.06.010 PubMedCrossRefGoogle Scholar
  23. 23.
    Lutman CV, Havrilesky LJ, Cragun JM, Secord AA, Calingaert B, Berchuck A, Clarke-Pearson DL, Soper JT (2006) Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecol Oncol 102:92–97PubMedCrossRefGoogle Scholar
  24. 24.
    Cragun JM, Havrilesky LJ, Calingaert B, Synan I, Secord AA, Soper JT, Clarke-Pearson DL, Berchuck A (2005) Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J Clin Oncol 23:3668–3675PubMedCrossRefGoogle Scholar
  25. 25.
    Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373:125–136. doi:10.1016/S0140-6736(08)61766-3 PubMedCrossRefGoogle Scholar
  26. 26.
    Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, Angioli R, Tateo S, Mangili G, Katsaros D, Garozzo G, Campagnutta E, Donadello N, Greggi S, Melpignano M, Raspagliesi F, Ragni N, Cormio G, Grassi R, Franchi M, Giannarelli D, Fossati R, Torri V, Amoroso M, Croce C, Mangioni C (2008) Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100:1707–1716. doi:10.1093/jnci/djn397 PubMedCrossRefGoogle Scholar
  27. 27.
    Mylonas I (2010) Inhibin-alpha, -betaA and -betaB subunits in uterine non-endometrioid carcinomas: Prognostic significance and clinical implications. Eur J Cancer 46:2485–2493. doi:10.1016/j.ejca.2010.06.001 PubMedCrossRefGoogle Scholar
  28. 28.
    Shabani N, Kuhn C, Kunze S, Schulze S, Mayr D, Dian D, Gingelmaier A, Schindlbeck C, Willgeroth F, Sommer H, Jeschke U, Friese K, Mylonas I (2007) Prognostic significance of oestrogen receptor alpha (ERalpha) and beta (ERbeta), progesterone receptor A (PR-A) and B (PR-B) in endometrial carcinomas. Eur J Cancer 43:2434–2444. doi:10.1016/j.ejca.2007.08.014 PubMedCrossRefGoogle Scholar
  29. 29.
    Mylonas I, Worbs S, Shabani N, Kuhn C, Kunze S, Schulze S, Dian D, Gingelmaier A, Schindlbeck C, Bruning A, Sommer H, Jeschke U, Friese K (2009) Inhibin-alpha subunit is an independent prognostic parameter in human endometrial carcinomas: analysis of inhibin/activin-alpha, -betaA and -betaB subunits in 302 cases. Eur J Cancer 45:1304–1314. doi:10.1016/j.ejca.2009.01.008 PubMedCrossRefGoogle Scholar
  30. 30.
    Käufl SD, Kuhn C, Kunze S, Shabani N, Bruning A, Friese K, Mylonas I (2010) Inhibin/activin-betaC subunit does not represent a prognostic parameter in human endometrial cancer. Arch Gynecol Obstet. doi:10.1007/s00404-010-1614-y
  31. 31.
    Mylonas I (2010) Inhibin-betaA subunit immunolabeling as a prognostic factor in endometrioid adenocarcinomas: a matter of evaluation? Arch Gynecol Obstet. doi:10.1007/s00404-010-1680-1
  32. 32.
    Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481CrossRefGoogle Scholar
  33. 33.
    Cox DR (1972) Regression models and life tables. J R Stat Soc B 34:187–220Google Scholar
  34. 34.
    Mylonas I, Matsingou C, Käufl SD, Brüning A (2011) Inhibin/activin betaE-subunit in uterine endometrioid adenocarcinoma and endometrial cancer cell lines: From immunohistochemistry to clinical testing? Gynecol Oncol. doi:10.1016/j.ygyno.2011.03.019
  35. 35.
    Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, Graham JE (1991) Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol 40:55–65PubMedCrossRefGoogle Scholar
  36. 36.
    Barakat RR, Lev G, Hummer AJ, Sonoda Y, Chi DS, Alektiar KM, Abu-Rustum NR (2007) Twelve-year experience in the management of endometrial cancer: a change in surgical and postoperative radiation approaches. Gynecol Oncol 105:150–156. doi:10.1016/j.ygyno.2006.11.007 PubMedCrossRefGoogle Scholar
  37. 37.
    Smith DC, Macdonald OK, Lee CM, Gaffney DK (2008) Survival impact of lymph node dissection in endometrial adenocarcinoma: a surveillance, epidemiology, and end results analysis. Int J Gynecol Cancer 18:255–261. doi:10.1111/j.1525-1438.2007.01020.x PubMedCrossRefGoogle Scholar
  38. 38.
    May K, Bryant A, Dickinson HO, Kehoe S, Morrison J (2010) Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev:CD007585. doi:10.1002/14651858.CD007585.pub2
  39. 39.
    Seracchioli R, Solfrini S, Mabrouk M, Facchini C, Di Donato N, Manuzzi L, Savelli L, Venturoli S (2010) Controversies in surgical staging of endometrial cancer. Obstet Gynecol Int 2010:181963. doi:10.1155/2010/181963 PubMedGoogle Scholar
  40. 40.
    Delpech Y, Barranger E (2010) Management of lymph nodes in endometrioid uterine cancer. Curr Opin Oncol 22:487–491. doi:10.1097/CCO.0b013e32833b9b75 PubMedCrossRefGoogle Scholar
  41. 41.
    Vorgias G, Fotiou S (2010) The role of lymphadenectomy in uterine carcinosarcomas (malignant mixed mullerian tumours): a critical literature review. Arch Gynecol Obstet doi:10.1007/s00404-010-1649-0
  42. 42.
    Yabushita H, Shimazu M, Yamada H, Sawaguchi K, Noguchi M, Nakanishi M, Kawai M (2001) Occult lymph node metastases detected by cytokeratin immunohistochemistry predict recurrence in node-negative endometrial cancer. Gynecol Oncol 80:139–144PubMedCrossRefGoogle Scholar
  43. 43.
    Gonzalez Bosquet J, Keeney GL, Mariani A, Webb MJ, Cliby WA (2003) Cytokeratin staining of resected lymph nodes may improve the sensitivity of surgical staging for endometrial cancer. Gynecol Oncol 91:518–525PubMedCrossRefGoogle Scholar
  44. 44.
    Sayin NC, Varol FG, Yuce MA, Kaplan P, Ahmet N, Sut N, Gucer F (2009) Do routine preoperative imaging techniques facilitate the operation in endometrial cancer? Arch Gynecol Obstet 280:211–215. doi:10.1007/s00404-008-0893-z PubMedCrossRefGoogle Scholar
  45. 45.
    Chang SJ, Kim WY, Yoon JH, Yoo SC, Chang KH, Ryu HS (2008) Para-aortic lymphadenectomy improves survival in patients with intermediate to high-risk endometrial carcinoma. Acta Obstet Gynecol Scand 87:1361–1369. doi:10.1080/00016340802503054 PubMedCrossRefGoogle Scholar
  46. 46.
    Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N (2010) Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 375:1165–1172. doi:10.1016/S0140-6736(09)62002-X PubMedCrossRefGoogle Scholar
  47. 47.
    Yoon JH, Yoo SC, Kim WY, Chang SJ, Chang KH, Ryu HS (2010) Para-aortic Lymphadenectomy in the Management of Preoperative Grade 1 Endometrial Cancer Confined to the Uterine Corpus. Ann Surg Oncol. doi:10.1245/s10434-010-1199-5

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.1st Department of Obstetrics and GynecologyLudwig-Maximilians-University MunichMunichGermany
  2. 2.Department of Obstetrics and GynecologyKlinium TraunsteinTrostberg, TraunsteinGermany

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