The aim of this study was to determine the risk of para-aortic lymph node metastasis in surgically staged patients presenting with preoperative grade 1 endometrial cancer and to assess the impact of para-aortic lymphadenectomy.
Materials and methods
A total of 131 consecutive patients diagnosed with preoperative grade 1 endometrial cancer from 2004 to 2009 were analyzed. We included women with endometrial cancer that was thought preoperatively to be confined to the uterine corpus, and all patients had complete staging operation including total hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings, pelvic lymphadenectomy, and para-aortic lymphadenectomy.
Of 131 patients, 6 (4.6%) had positive para-aortic lymph nodes and only 2 (1.5%) had isolated para-aortic nodal metastasis with negative pelvic nodes. In comparison of preoperative and postoperative histology, 6.8% of patients were upgraded, with 5.3% grade 2 and 1.5% grade 3. Advanced stage disease was found in 12.9%. Deep myometrial invasion by MRI and CA 125 levels of ≥31 U/ml were found to be independent preoperative risk factors for para-aortic lymph node metastasis.
Some patients with preoperative grade 1 endometrial cancer are found to have upgraded disease and para-aortic nodal metastasis. Para-aortic lymphadenectomy should be considered in patients presenting with preoperative grade 1 endometrial cancer, especially in the setting of preoperative CA 125 levels of >31 U/ml and deep myometrial invasion by MRI.
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FIGO. Annual report on the results of treatment in gynecologic cancer. Int J Gynecol Obstet. 1989;28:189–93.
ACOG. ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists: management of endometrial cancer. Obstet Gynecol. 2005;106:413–25.
Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105:103–4.
Mariani A, Dowdy SC, Podratz KC. New surgical staging of endometrial cancer: 20 years later. Int J Gynaecol Obstet. 2009;105:110–1.
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.
Benedetti-Panici P, Basile S, Maneschi F, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100:1707–16.
ASTEC Study Group, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125–36.
Bristow RE, Zahurak ML, Alexander CJ, Zellars RC, Montz FJ. FIGO stage IIIC endometrial carcinoma: resection of macroscopic nodal disease and other determinants of survival. Int J Gynecol Cancer. 2003;13:664–72.
Mariani A, Keeney GL, Aletti G, Webb MJ, Haddock MG, Podratz KC. Endometrial carcinoma: paraaortic dissemination. Gynecol Oncol. 2004;92:833–8.
Fujimoto T, Nanjyo H, Nakamura A, et al. Para-aortic lymphadenectomy may improve disease-related survival in patients with multipositive pelvic lymph node stage IIIc endometrial cancer. Gynecol Oncol. 2007;107:253–9.
Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, Podratz KC. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008;109:11–8.
Chang SJ, Kim WY, Yoon JH, Yoo SC, Chang KH, Ryu HS. Para-aortic lymphadenectomy improves survival in patients with intermediate to high-risk endometrial carcinoma. Acta Obstet Gynecol Scand. 2008;87:1361–9.
Lee KB, Ki KD, Lee JM, et al. 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. 2009;16:2882–7.
Frumovitz M, Slomovitz BM, Singh DK, et al. Frozen section analyses as predictors of lymphatic spread in patients with early-stage uterine cancer. J Am Coll Surg. 2004;199:388–93.
Ben-Shachar I, Pavelka J, Cohn DE, Copeland LJ, Ramirez N, Manolitsas T, Fowler JM. Surgical staging for patients presenting with grade 1 endometrial carcinoma. Obstet Gynecol. 2005;105:487–93.
Geisler JP, Linnemeier GC, Manahan KJ. Pelvic and para-aortic lymphadenectomy in patients with endometrioid adenocarcinoma of the endometrium. Int J Gynaecol Obstet. 2007;98:39–43.
Neubauer NL, Havrilesky LJ, Calingaert B, et al. The role of lymphadenectomy in the management of preoperative grade 1 endometrial carcinoma. Gynecol Oncol. 2009;112:511–6.
Niloff JM, Klug TL, Schaetzl E, Zurawski VR Jr, Knapp RC, Bast RC Jr. Elevation of serum CA125 in carcinomas of the fallopian tube, endometrium, and endocervix. Am J Obstet Gynecol. 1984;148:1057–8.
Rose PG, Sommers RM, Reale FR, Hunter RE, Fournier L, Nelson BE. Serial serum CA 125 measurements for evaluation of recurrence in patients with endometrial carcinoma. Obstet Gynecol. 1994;84:12–6.
Sood AK, Buller RE, Burger RA, Dawson JD, Sorosky JI, Berman M. Value of preoperative CA 125 level in the management of uterine cancer and prediction of clinical outcome. Obstet Gynecol. 1997;90:441–7.
Dotters DJ. Preoperative CA 125 in endometrial cancer: is it useful? Am J Obstet Gynecol. 2000;182:1328–34.
Todo Y, Okamoto K, Hayashi M, et al. A validation study of a scoring system to estimate the risk of lymph node metastasis for patients with endometrial cancer for tailoring the indication of lymphadenectomy. Gynecol Oncol. 2007;104:623–8.
Yoo SC, Yoon JH, Kim WY, Chang SJ, Joo HJ, Chang KH, Ryu HS. Premenopausal early-stage endometrial carcinoma patients with low CA-125 levels and low tumor grade may undergo ovary-saving surgery. J Gynecol Oncol. 2009;20:181–6.
Han SS, Lee SH, Kim DH, Kim JW, Park NH, Kang SB, Song YS. Evaluation of preoperative criteria used to predict lymph node metastasis in endometrial cancer. Acta Obstet Gynecol Scand. 2010;89:168–74.
Hricak H, Stern JL, Fisher MR, Shapeero LG, Winkler ML, Lacey CG. Endometrial carcinoma staging by MR imaging. Radiology. 1987;162:297–305.
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.
Chung HH, Kang SB, Cho JY, et al. Accuracy of MR imaging for the prediction of myometrial invasion of endometrial carcinoma. Gynecol Oncol. 2007;104:654–9.
Conflict of interest statement
The authors have no conflicts of interest to declare.
Jong-Hyuck Yoon and Seung-Chul Yoo contributed equally to this paper.
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Yoon, J., Yoo, S., Kim, W.Y. et al. Para-aortic Lymphadenectomy in the Management of Preoperative Grade 1 Endometrial Cancer Confined to the Uterine Corpus. Ann Surg Oncol 17, 3234–3240 (2010). https://doi.org/10.1245/s10434-010-1199-5
- Endometrial Cancer
- Myometrial Invasion
- Preoperative Magnetic Resonance Imaging
- Pelvic Lymphadenectomy
- Endometrial Cancer Patient