Annals of Surgical Oncology

, Volume 16, Issue 10, pp 2882–2887 | Cite as

The Risk of Lymph Node Metastasis Based on Myometrial Invasion and Tumor Grade in Endometrioid Uterine Cancers: A Multicenter, Retrospective Korean Study

  • Kwang-Beom Lee
  • Kyung-Do Ki
  • Jong-Min Lee
  • Jae-Kwan Lee
  • Jae Weon Kim
  • Chi-Heum Cho
  • Seok-Mo Kim
  • Sang-Yoon Park
  • Dae-Hoon Jeong
  • Ki-Tae Kim
Gynecologic Oncology

Abstract

Background

Knowledge of the risk factors for lymph node metastasis (LNM) is necessary to treat patients with endometrioid uterine cancer to optimize and further individualize treatment. This study was designed to determine the risk of LNM based on myometrial invasion and tumor grade in endometrioid uterine cancer.

Methods

The authors retrospectively reviewed the medical records and pathological findings of 834 patients who underwent surgical staging, including pelvic lymphadenectomy with or without para-aortic lymphadenectomy, for endometrioid uterine cancer from 2002 to 2008 in Korea.

Results

Of the 834 patients with endometrioid uterine cancer, 107 (12.8%) patients had LNM. Sixty-one (57%) patients had only pelvic LNM, 39 (36.4%) had pelvic and para-aortic LNM, and 7 (6.6%) had isolated para-aortic LNM. Tumor grade, myometrial invasion, tumor diameter, cervical extension, lymphovascular space invasion, and adnexal involvement were found to be significant predictors of LNM. Of 215 patients with no myometrial invasion and tumor grade I/II, only 1 (0.47%) had LNM. However, in other patients, the risk of LNM was significant and at least > 3.5%. Furthermore, the risk of LNM was found to be well correlated with increases in myometrial invasion and tumor grade based on subgroup analyses, when patients with no myometrial invasion and tumor grade I/II were used as a reference group (p < 0.0001).

Conclusions

Patients with endometrioid uterine cancers with no myometrial invasion and tumor grade I/II might have minimal risk of LNM, whereas others might require complete pelvic and para-aortic lymphadenectomy for surgical staging.

References

  1. 1.
    Parkin DM, Pisani P, Ferlay J. Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer. 1999; 80:827–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Annual Report of Gynecologic Cancer Registry Program in Korea for 2004 (Jan. 1st, 2004–Dec. 31st, 2004). Korean J Obstet Gynecol. 2007;50:28–78.Google Scholar
  3. 3.
    Kitchener H. Management of endometrial cancer. Eur J Surg Oncol. 2006;32:838–43.CrossRefPubMedGoogle Scholar
  4. 4.
    American College of Obstetricians and Gynecologists. ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer. Obstet Gynecol. 2005;106:413–25.Google Scholar
  5. 5.
    Bakkum-Gamez JN, Gonzalez-Bosquet J, Laack NN, Mariani A, Dowdy SC. Current issues in the management of endometrial cancer. Mayo Clin Proc. 2008;83:97–112.CrossRefPubMedGoogle Scholar
  6. 6.
    Announcements. FIGO stages-1988 Revision. Gynecol Oncol. 1989;35:125–7.Google Scholar
  7. 7.
    Chan JK, Kapp DS. Role of complete lymphadenectomy in endometrioid uterine cancer. Lancet Oncol. 2007;8:831–41.CrossRefPubMedGoogle Scholar
  8. 8.
    Creutzberg CL, van Putten WL, Koper PC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Postoperative radiation therapy in endometrial carcinoma. Lancet. 2000;355:1404–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Chee JJ, Ho TH, Tay EH, Low JJ, Yam KL. Endometrioid adenocarcinoma of the uterus: surgico-pathological correlations and role of pelvic lymphadenectomy. Ann Acad Med Singapore. 2003; 32:670–5.PubMedGoogle Scholar
  10. 10.
    Podratz KC, Mariani A, Webb MJ. Staging and therapeutic value of lymphadenectomy in endometrial cancer. Gynecol Oncol. 1998;70:163–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Solhjem MC, Petersen IA, Haddock MG. Vaginal brachytherapy alone is sufficient adjuvant treatment of surgical stage I endometrial cancer. Int J Radiat Oncol Biol Phys. 2005;62:1379–84.PubMedGoogle Scholar
  12. 12.
    Kilgore LC, Partridge EE, Alvarez RD, Austin JM, Shingleton HM, Noojin F III, Conner W. Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol. 1995;56:29–33.CrossRefPubMedGoogle Scholar
  13. 13.
    Mariani A, Webb MJ, Galli L, Podratz KC. Potential therapeutic role of para-aortic lymphadenectomy in node-positive endometrial cancer. Gynecol Oncol. 2000;76:348–56.CrossRefPubMedGoogle Scholar
  14. 14.
    Cragun JM, Havrilesky LJ, Calingaert B, et al. Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J Clin Oncol. 2005;23:3668–75.CrossRefPubMedGoogle Scholar
  15. 15.
    Selman TJ, Mann CH, Zamora J, Khan KS. A systematic review of tests for lymph node status in primary endometrial cancer. BMC Womens Health. 2008;8:8.CrossRefPubMedGoogle Scholar
  16. 16.
    Kitchener H, Redman CW, Swart AM, Amos CL, on behalf of ASTEC Study Group. A study in the treatment of endometrial cancer. A randomised trial of lymphadenectomy in the treatment of endometrial cancer. Gynecol Oncol. 2006;101:S21–2.Google Scholar
  17. 17.
    Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, Graham JE. 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. 1991;40:55–65.CrossRefPubMedGoogle Scholar
  18. 18.
    Carey MS, O’Connell GJ, Johanson CR, et al. Good outcome associated with a standardized treatment protocol using selective postoperative radiation in patients with clinical stage I adenocarcinoma of the endometrium. Gynecol Oncol. 1995;57:138–44.CrossRefPubMedGoogle Scholar
  19. 19.
    Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC. Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol. 2000;182:1506–19.CrossRefPubMedGoogle Scholar
  20. 20.
    Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987;60:2035–41.CrossRefPubMedGoogle Scholar
  21. 21.
    Schink JC, Rademaker AW, Miller DS, Lurain JR. Tumor size in endometrial cancer. Cancer. 1991;67:2791–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Horowitz NS, Dehdashti F, Herzog TJ, et al. Prospective evaluation of FDG-PET for detecting pelvic and para-aortic lymph node metastasis in uterine corpus cancer. Gynecol Oncol. 2004;95:546–51.CrossRefPubMedGoogle Scholar
  23. 23.
    Kinkel K, Kaji Y, Yu KK, Segal MR, Lu Y, Powell CB, Hricak H. Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology. 1999;212:711–8.PubMedGoogle Scholar
  24. 24.
    Kucera E, Kainz C, Reinthaller A, Sliutz G, Leodolter S, Kucera H, Breitenecker G. Accuracy of intraoperative frozen-section diagnosis in stage I endometrial adenocarcinoma. Gynecol Obstet Invest. 2000;49:62–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Lee KB, Lee JM, Park CY, Lee KB, Cho HY, Ha SY. Lymph node metastasis and lymph vascular space invasion in microinvasive squamous cell carcinoma of the uterine cervix. Int J Gynecol Cancer. 2006;16:1184–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Gynecologic Oncology Group. Surgical procedures manual, July 2005. https://gogmember.gog.org/manuals/pdf/surgman.pdf.
  27. 27.
    Panici PB, Scambia G, Baiocchi G, Matonti G, Capelli A, Mancuso S. Anatomical study of para-aortic and pelvic lymph nodes in gynecologic malignancies. Obstet Gynecol. 1992;79:498–502.PubMedGoogle Scholar
  28. 28.
    Mariani A, Webb MJ, Keeney GL, Podratz KC. Routes of lymphatic spread: a study of 112 consecutive patients with endometrial cancer. Gynecol Oncol. 2001;81:100–4.CrossRefPubMedGoogle Scholar
  29. 29.
    Mariani A, Keeney GL, Aletti G, Webb MJ, Haddock MG, Podratz KC. Endometrial carcinoma: paraaortic dissemination. Gynecol Oncol. 2004;92:833–8.CrossRefPubMedGoogle Scholar
  30. 30.
    McMeekin DS, Lashbrook D, Gold M, Johnson G, Walker JL, Mannel R. Analysis of FIGO stage IIIc endometrial cancer patients. Gynecol Oncol. 2001;81:273–8.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Kwang-Beom Lee
    • 1
  • Kyung-Do Ki
    • 2
  • Jong-Min Lee
    • 2
  • Jae-Kwan Lee
    • 3
  • Jae Weon Kim
    • 4
  • Chi-Heum Cho
    • 5
  • Seok-Mo Kim
    • 6
  • Sang-Yoon Park
    • 7
  • Dae-Hoon Jeong
    • 8
  • Ki-Tae Kim
    • 8
  1. 1.Department of Obstetrics and Gynecology, Gil Medical CenterGachon University of Medicine and ScienceIncheonSouth Korea
  2. 2.Department of Obstetrics and Gynecology, East-West Neo Medical CenterKyung Hee UniversitySeoulSouth Korea
  3. 3.Department of Obstetrics and GynecologyKorea University College of MedicineSeoulSouth Korea
  4. 4.Department of Obstetrics and Gynecology & Cancer Research Institute, College of MedicineSeoul National UniversitySeoulSouth Korea
  5. 5.Department of Obstetrics and Gynecology, Dongsan Medical CenterKeimyung UniversityDaeguSouth Korea
  6. 6.Department of Obstetrics and GynecologyChonnam National UniversityGwangjuSouth Korea
  7. 7.Center for Uterine CancerNational Cancer CenterGoyangSouth Korea
  8. 8.Department of Obstetrics and Gynecology, Busan Paik HospitalInje UniversityBusanSouth Korea

Personalised recommendations