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Role of Systematic Lymphadenectomy and Adjuvant Radiation in Early-Stage Endometrioid Uterine Cancer

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

To determine the roles of lymphadenectomy in endometrioid uterine cancer patients and adjuvant radiation in early-stage endometrioid uterine cancer patients who underwent systematic lymphadenectomy.

Methods

A retrospective analysis of 758 patients surgically treated for early-stage endometrioid uterine cancer from 2000 to 2006 was conducted. The primary outcome was 5-year overall survival in relation to systematic lymphadenectomy with or without adjuvant radiation.

Results

Of the 758 patients, 547 (72.2%) underwent complete surgical staging, including systematic lymphadenectomy; adjuvant radiation was administered to 207 patients (27.3%). Within median follow-up of 35 months, systematic lymphadenectomy did not affect overall survival in early-stage patients (P = 0.4480). In the high-risk, early-stage group, however, the 5-year survival rate of the systematic lymphadenectomy group showed better survival compared with the no systematic lymphadenectomy group (P = 0.0095). Also, adjuvant radiation did not affect overall survival in early-stage patients (P = 0.1170), even in the group of high-risk, early-stage patients (P = 0.5680) who underwent systematic lymphadenectomy.

Conclusions

Systematic lymphadenectomy provided a survival benefit in high-risk endometrioid uterine cancer patients. However, in patients who underwent systematic lymphadenectomy, adjuvant radiation was not beneficial, even in high-risk patients.

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References

  1. Annual Report of Gynecologic Cancer Registry Program in Korea for 2003 (January 1st, 2003 December 31st, 2003). Korean J Obstet Gynecol. 2006;49:762–812.

  2. Bray F, Dos Santos Silva I, Moller H, Weiderpass E. Endometrial cancer incidence trends in Europe: underlying determinants and prospects for prevention. Cancer Epidemiol Biomarkers Prev. 2005;14:1132–42.

    Article  PubMed  Google Scholar 

  3. Sankaranarayanan R, Ferlay J. Worldwide burden of gynaecological cancer: the size of the problem. Best Pract Res Clin Obstet Gynaecol. 2006;20:207–25.

    Article  CAS  PubMed  Google Scholar 

  4. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105:103–4.

    Article  PubMed  Google Scholar 

  5. Shepherd JH. Revised FIGO staging for gynaecological cancer. Br J Obstet Gynaecol. 1989;96:889–92.

    CAS  PubMed  Google Scholar 

  6. 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 

  7. Chan JK, Kapp DS. Role of complete lymphadenectomy in endometrioid uterine cancer. Lancet Oncol. 2007;8:831–41.

    Article  PubMed  Google Scholar 

  8. Lee TS, Kim JW, Kim SH, et al. Surgical practice patterns in endometrial cancer: results of the Korean Gynecologic Oncology Group survey. J Gynecol Oncol. 2009;20:107–12.

    Article  PubMed  Google Scholar 

  9. Mohan DS, Samuels MA, Selim MA, et al. Long-term outcomes of therapeutic pelvic lymphadenectomy for stage I endometrial adenocarcinoma. Gynecol Oncol. 1998;70:165–71.

    Article  CAS  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

  13. 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. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet. 2000;355:1404–11.

    Article  CAS  PubMed  Google Scholar 

  14. Blake P, Swart AM, Orton J, et al. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet. 2009;373:137–46.

    Article  CAS  PubMed  Google Scholar 

  15. Creasman WT, Odicino F, Maisonneuve P, et al. Carcinoma of the corpus uteri. Int J Gynaecol Obstet. 2003;83(Suppl 1):79–118.

    Article  PubMed  Google Scholar 

  16. Creasman WT, Kohler MF, Odicino F, Maisonneuve P, Boyle P. Prognosis of papillary serous, clear cell, and grade 3 stage I carcinoma of the endometrium. Gynecol Oncol. 2004;95:593–6.

    Article  PubMed  Google Scholar 

  17. National Comprehensive Cancer Network (2009). NCCN Clinical practice guidelines in oncology, uterine neoplasms. http://www.nccn.org/professionals/physician_gls/PDF/uterine.pdf. Accessed October 31, 2009.

  18. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  20. Aalders J, Abeler V, Kolstad P, Onsrud M. Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma: clinical and histopathologic study of 540 patients. Obstet Gynecol. 1980;56:419–27.

    CAS  PubMed  Google Scholar 

  21. Keys HM, Roberts JA, Brunetto VL, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92:744–51.

    Article  PubMed  Google Scholar 

  22. Ueda SM, Kapp DS, Cheung MK, et al. Trends in demographic and clinical characteristics in women diagnosed with corpus cancer and their potential impact on the increasing number of deaths. Am J Obstet Gynecol. 2008;198:218.e1–6.

    Google Scholar 

  23. Lutman CV, Havrilesky LJ, Cragun JM, et al. Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecol Oncol. 2006;102:92–7.

    Article  PubMed  Google Scholar 

  24. Chan JK, Wu H, Cheung MK, Shin JY, Osann K, Kapp DS. The outcomes of 27,063 women with unstaged endometrioid uterine cancer. Gynecol Oncol. 2007;106:282–8.

    Article  PubMed  Google Scholar 

  25. Tangjitgamol S, Anderson BO, See HT, et al. Management of endometrial cancer in Asia: consensus statement from the Asian Oncology Summit 2009. Lancet Oncol. 2009;10:1119–27.

    Article  PubMed  Google Scholar 

  26. Creutzberg CL, van Putten WL, Koper PC, et al. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol. 2003;89:201–9.

    Article  PubMed  Google Scholar 

  27. Johnson N, Cornes P. Survival and recurrent disease after postoperative radiotherapy for early endometrial cancer: systematic review and meta-analysis. BJOG. 2007;114:1313–20.

    Article  CAS  PubMed  Google Scholar 

  28. Kong A, Johnson N, Cornes P, et al. Adjuvant radiotherapy for stage I endometrial cancer. Cochrane Database Syst Rev 2007;18:CD003916.

    Google Scholar 

  29. Kong A, Simera I, Collingwood M, Williams C, Kitchener H. Adjuvant radiotherapy for stage I endometrial cancer: systematic review and meta-analysis. Ann Oncol. 2007;18:1595–604.

    Article  CAS  PubMed  Google Scholar 

  30. Randall ME, Filiaci VL, Muss H, et al. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2006;24:36–44.

    Article  CAS  PubMed  Google Scholar 

  31. Hogberg T, Rosenberg P, Kristensen G, et al. A randomized phase-III study on adjuvant treatment with radiation (RT) ± chemotherapy (CT) in early-stage high-risk endometrial cancer (NSGO-EC-9501/EORTC 55991). J Clin Oncol. 2007;25 (abstract 5503).

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Acknowledgment

This research was supported by the Kyung Hee University Research Fund in 2010 (KHU-20100651).

Conflict of interest statement

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, School of Medicine, Kyung Hee University, Seoul, Korea

    Nan-Hee Jeong MD, PhD & Jong-Min Lee MD, PhD

  2. Department of Obstetrics and Gynecology College of Medicine, Korea University, Seoul, Korea

    Jae-Kwan Lee MD, PhD

  3. Department of Obstetrics and Gynecology & Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Mi-Kyung Kim MD, PhD

  4. Department of Obstetrics and Gynecology, College of Medicine, Hanyang University, Seoul, Korea

    Young-Jae Kim MD, PhD

  5. Department of Obstetrics and Gynecology, Dongsan Medical Center, Keimyung University, Daegu, Korea

    Chi-Heum Cho MD, PhD

  6. Department of Obstetrics and Gynecology, Chonnam National University, Gwangju, Korea

    Seok-Mo Kim MD, PhD

  7. Center for Uterine Cancer, National Cancer Center, Goyang, Korea

    Sang-Yoon Park MD, PhD

  8. Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea

    Chan-Yong Park MD, PhD

  9. Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University, Busan, Korea

    Ki-Tae Kim MD, PhD

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  1. Nan-Hee Jeong MD, PhD
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  2. Jong-Min Lee MD, PhD
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  5. Young-Jae Kim MD, PhD
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  6. Chi-Heum Cho MD, PhD
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Corresponding author

Correspondence to Jong-Min Lee MD, PhD.

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Jeong, NH., Lee, JM., Lee, JK. et al. Role of Systematic Lymphadenectomy and Adjuvant Radiation in Early-Stage Endometrioid Uterine Cancer. Ann Surg Oncol 17, 2951–2957 (2010). https://doi.org/10.1245/s10434-010-1169-y

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  • DOI: https://doi.org/10.1245/s10434-010-1169-y

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