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Lymphovascular space involvement is the sole independent predictor of lymph node metastasis in clinical early stage endometrial cancer

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To determine clinicopathological risk factors associated with lymph node metastasis in endometrial cancer (EC).

Methods

Clinicopathological data of patients who underwent comprehensive surgical staging for clinical early stage EC between 2001 and 2010 at Hacettepe University Hospital was retrospectively reviewed.

Results

Two hundred and sixty-one patients were included. There were 26 patients (10.0 %) with lymph node metastasis. Of these, 14 (5.4 %) had pelvic lymph node metastasis, 8 (3.1 %) had both pelvic and paraaortic lymph node metastasis, and 4 (1.5 %) had isolated paraaortic metastasis. Univariate analysis revealed tumor size >2 cm, type II cancer, grade III histology, cervical stromal invasion, deep myometrial invasion, positive peritoneal cytology, adnexal involvement, serosal involvement, and presence of lymphovascular space involvement (LVSI) as significant clinicopathological factors associated with retroperitoneal lymph node metastasis. For paraaortic metastasis either isolated or with pelvic lymph node metastasis, significant factors were grade III disease, cervical stromal invasion, deep myometrial invasion, positive peritoneal cytology, adnexal involvement, serosal involvement, pelvic lymph node metastasis, and presence of LVSI. The only factor associated with isolated paraaortic lymph node metastasis was LVSI. Multivariate analysis revealed LVSI as the only independent factor for both retroperitoneal and paraaortic lymph node metastasis (odds ratio 14.9; 95 % confidence interval 3.8–59.0; p < 0.001, and odds ratio 20.9; 95 % confidence interval 1.9–69.9; p = 0.013, respectively).

Conclusion

Lymphovascular space involvement is the sole predictor of lymph node metastasis in EC. Therefore, LVSI status should be requested from the pathologist during frozen examination whenever possible to consider when a decision to perform or omit lymphadenectomy is made.

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References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127(12):2893–2917

    Article  PubMed  CAS  Google Scholar 

  2. Pecorelli S (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105(2):103–104

    Article  PubMed  Google Scholar 

  3. Kehoe SM, Miller DS (2011) The role of lymphadenectomy in endometrial cancer. Clin Obstet Gynecol 54(2):235–244

    Article  PubMed  Google Scholar 

  4. Lee KB, Ki KD, Lee JM, Lee JK, Kim JW, Cho CH et al (2009) The risk of lymph node metastasis based on myometrial invasion and tumor grade in endometrioid uterine cancers: a multicenter, retrospective Korean study. Ann Surg Oncol 16(10):2882–2887

    Article  PubMed  Google Scholar 

  5. Dowdy SC, Borah BJ, Bakkum-Gamez JN, Weaver AL, McGree ME, Haas LR et al (2012) Prospective assessment of survival, morbidity, and cost associated with lymphadenectomy in low-risk endometrial cancer. Gynecol Oncol 127(1):5–10

    Article  PubMed  CAS  Google Scholar 

  6. Turan T, Hizli D, Sarici S, Boran N, Gundogdu B, Karadag B et al (2011) Is it possible to predict para-aortic lymph node metastasis in endometrial cancer? Eur J Obstet Gynecol Reprod Biol 158(2):274–279

    Article  PubMed  Google Scholar 

  7. Taskiran C, Yuce K, Geyik PO, Kucukali T, Ayhan A (2006) Predictability of retroperitoneal lymph node metastasis by using clinicopathologic variables in surgically staged endometrial cancer. Int J Gynecol Cancer 16(3):1342–1347

    Article  PubMed  CAS  Google Scholar 

  8. 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(9658):125–136

    Article  PubMed  CAS  Google Scholar 

  9. Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G et al (2008) Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100(23):1707–1716

    Article  PubMed  Google Scholar 

  10. Loubeyre P, Undurraga M, Bodmer A, Petignat P (2011) Non-invasive modalities for predicting lymph node spread in early stage endometrial cancer? Surg Oncol 20(2):e102–e108

    Article  PubMed  Google Scholar 

  11. Connor JP, Andrews JI, Anderson B, Buller RE (2000) Computed tomography in endometrial carcinoma. Obstet Gynecol 95(5):692–696

    Article  PubMed  CAS  Google Scholar 

  12. Park JY, Kim EN, Kim DY, Suh DS, Kim JH, Kim YM et al (2008) Comparison of the validity of magnetic resonance imaging and positron emission tomography/computed tomography in the preoperative evaluation of patients with uterine corpus cancer. Gynecol Oncol 108(3):486–492

    Article  PubMed  Google Scholar 

  13. van Doorn HC, van der Zee AG, Peeters PH, Kroeks MV, van Eijkeren MA (2002) Preoperative selection of patients with low-stage endometrial cancer at high risk of pelvic lymph node metastases. Int J Gynecol Cancer 12(2):144–148

    Article  PubMed  Google Scholar 

  14. Kumar S, Medeiros F, Dowdy SC, Keeney GL, Bakkum-Gamez JN, Podratz KC et al (2012) A prospective assessment of the reliability of frozen section to direct intraoperative decision making in endometrial cancer. Gynecol Oncol 127(3):525–531

    Article  PubMed  Google Scholar 

  15. 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(8 Suppl):2035–2041

    Article  PubMed  CAS  Google Scholar 

  16. Chi DS, Barakat RR, Palayekar MJ, Levine DA, Sonoda Y, Alektiar K et al (2008) The incidence of pelvic lymph node metastasis by FIGO staging for patients with adequately surgically staged endometrial adenocarcinoma of endometrioid histology. Int J Gynecol Cancer 18(2):269–273

    Article  PubMed  CAS  Google Scholar 

  17. Milam MR, Java J, Walker JL, Metzinger DS, Parker LP, Coleman RL (2012) Nodal metastasis risk in endometrioid endometrial cancer. Obstet Gynecol 119(2 Pt 1):286–292

    Article  PubMed  Google Scholar 

  18. Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC (2000) Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol 182(6):1506–1519

    Article  PubMed  CAS  Google Scholar 

  19. Gadducci A, Cavazzana A, Cosio S, DIC C, Tana R, Fanucchi A et al (2009) Lymph-vascular space involvement and outer one-third myometrial invasion are strong predictors of distant haematogeneous failures in patients with stage I–II endometrioid-type endometrial cancer. Anticancer Res 29(5):1715–1720

    PubMed  Google Scholar 

  20. Guntupalli SR, Zighelboim I, Kizer NT, Zhang Q, Powell MA, Thaker PH et al (2012) Lymphovascular space invasion is an independent risk factor for nodal disease and poor outcomes in endometrioid endometrial cancer. Gynecol Oncol 124(1):31–35

    Article  PubMed  Google Scholar 

  21. Briet JM, Hollema H, Reesink N, Aalders JG, Mourits MJ, ten Hoor KA et al (2005) Lymphvascular space involvement: an independent prognostic factor in endometrial cancer. Gynecol Oncol 96(3):799–804

    Article  PubMed  Google Scholar 

  22. Zhang C, Wang C, Feng W (2012) Clinicopathological risk factors for pelvic lymph node metastasis in clinical early-stage endometrioid endometrial adenocarcinoma. Int J Gynecol Cancer 22(8):1373–1377

    Article  PubMed  Google Scholar 

  23. Chang SJ, Kong TW, Kim WY, Yoo SC, Yoon JH, Chang KH et al (2011) Lymph-vascular space invasion as a significant risk factor for isolated para-aortic lymph node metastasis in endometrial cancer: a study of 203 consecutive patients. Ann Surg Oncol 18(1):58–64

    Article  PubMed  Google Scholar 

  24. Kumar S, Bandyopadhyay S, Semaan A, Shah JP, Mahdi H, Morris R et al (2011) The role of frozen section in surgical staging of low risk endometrial cancer. PLoS One 6(9):e21912

    Article  PubMed  CAS  Google Scholar 

  25. Cohn DE, Horowitz NS, Mutch DG, Kim SM, Manolitsas T, Fowler JM (2002) Should the presence of lymphvascular space involvement be used to assign patients to adjuvant therapy following hysterectomy for unstaged endometrial cancer? Gynecol Oncol 87(3):243–246

    Article  PubMed  Google Scholar 

  26. McMeekin DS, Lashbrook D, Gold M, Scribner DR, Kamelle S, Tillmanns TD et al (2001) Nodal distribution and its significance in FIGO stage IIIc endometrial cancer. Gynecol Oncol 82(2):375–379

    Article  PubMed  CAS  Google Scholar 

  27. Fujimoto T, Nanjyo H, Nakamura A, Yokoyama Y, Takano T, Shoji T et al (2007) Para-aortic lymphadenectomy may improve disease-related survival in patients with multipositive pelvic lymph node stage IIIc endometrial cancer. Gynecol Oncol 107(2):253–259

    Article  PubMed  Google Scholar 

  28. Fujimoto T, Nanjyo H, Fukuda J, Nakamura A, Mizunuma H, Yaegashi N et al (2009) Endometrioid uterine cancer: histopathological risk factors of local and distant recurrence. Gynecol Oncol 112(2):342–347

    Article  PubMed  Google Scholar 

  29. Todo Y, Kato H, Minobe S, Okamoto K, Suzuki Y, Sudo S et al (2011) Initial failure site according to primary treatment with or without para-aortic lymphadenectomy in endometrial cancer. Gynecol Oncol 121(2):314–318

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Ferdi Vaizoglu & Pinar Calis

  2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey

    Kunter Yuce, Mehmet Coskun Salman, Derman Basaran & Nejat Ozgul

  3. Department of Clinical Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Alp Usubutun

Authors
  1. Ferdi Vaizoglu
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  2. Kunter Yuce
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  3. Mehmet Coskun Salman
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  4. Derman Basaran
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  5. Pinar Calis
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  6. Nejat Ozgul
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  7. Alp Usubutun
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Corresponding author

Correspondence to Derman Basaran.

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Vaizoglu, F., Yuce, K., Salman, M.C. et al. Lymphovascular space involvement is the sole independent predictor of lymph node metastasis in clinical early stage endometrial cancer. Arch Gynecol Obstet 288, 1391–1397 (2013). https://doi.org/10.1007/s00404-013-2913-x

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  • DOI: https://doi.org/10.1007/s00404-013-2913-x

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