Abstract
OBJECTIVES:To evaluate the postoperative pathological characteristics of hysterectomy specimens, preoperative cancer antigen (CA)-125 levels and imaging modalities in patients with endometrial cancer and to build a risk matrix model to identify and recruit patients for retroperitoneal lymphadenectomy.METHODS:A total of 405 patients undergoing surgical treatment for endometrial cancer were retrospectively reviewed and analyzed. Clinical (age and body mass index), laboratory (CA-125), radiological (lymph node evaluation), and pathological (tumour size, grade, lymphovascular space invasion, lymph node metastasis, and myometrial invasion) parameters were used to test the ability to predict lymph node metastasis. Four parameters were selected by logistic regression to create a risk matrix for nodal metastasis.RESULTS:Of the 405 patients, 236 (58.3%) underwent complete pelvic and para-aortic lymphadenectomy, 96 (23.7%) underwent nodal sampling, and 73 (18%) had no surgical lymph node assessment. The parameters predicting nodal involvement obtained through logistic regression were myometrial infiltration >50%, lymphovascular space involvement, pelvic lymph node involvement by imaging, and a CA-125 value >21.5 U/mL. According to our risk matrix, the absence of these four parameters implied a risk of lymph node metastasis of 2.7%, whereas in the presence of all four parameters the risk was 82.3%.CONCLUSION:Patients without deep myometrial invasion and lymphovascular space involvement on the final pathological examination and with normal CA-125 values and lymph node radiological examinations have a relatively low risk of lymph node involvement. This risk assessment matrix may be able to refer patients with high-risk parameters necessitating lymphadenectomy and to decide the risks and benefits of lymphadenectomy.
Highlights
Lymph node (LN) metastasis is the most important prognostic factor in endometrial cancer [1]
10% of patients diagnosed with clinically apparent early-stage endometrial cancer will be upstaged due to LN involvement [2]
The present study aimed to evaluate the postoperative pathological characteristics of hysterectomy specimens, a preoperative analysis of a tumour marker (cancer antigen (CA)-125) and the imaging results to build a risk matrix model for the identification and recruitment of patients for lymphadenectomy following hysterectomy for seemingly early-stage disease
Summary
Lymph node (LN) metastasis is the most important prognostic factor in endometrial cancer [1]. 10% of patients diagnosed with clinically apparent early-stage endometrial cancer will be upstaged due to LN involvement [2]. The role of pelvic lymphadenectomy in early-stage disease was depicted as controversial by two prospective randomized trials, the analysis of the available retrospective data in high-risk patients demonstrated a survival benefit [3,4,5]. This information is crucial for correctly defining the prognosis and tailoring the use of adjuvant oncological therapies. The experience of the surgical team with the procedure reduces major intraoperative risks, the risk of postoperative complications, such as deep venous thromboses, potentially fatal pulmonary emboli, chylous ascites formation, lymphocele formation, and lymphedema, remains considerable [6]
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