Clinicopathologic Features and Risk Factors for Pelvic Lymph Node Metastasis in Uterine Endometrioid Cancer: 358 Cases Report

Abstract

Objective To study risk factors for pelvic lymph node metastasis in uterine endometrioid cancer(EC). Methods Single institution retrospective study of 358 patients with Federation International of Gynecology and Obstetrics (FIGO) stage Ⅰ-Ⅳ EC. All patients were treated with primary surgery consisting of total abdominal (n = 326) or laparoscopic (n = 32) hysterectomy, bilateral salpingooophorectomy, pelvic and (or) paraaortic lymphadenectomy and peritoneal cytology. Follow-up methods were outpatient visit and telephone interview. Univariate and multivariate analyses to predict distant recurrence or survival from disease were performed comparing known risk factors. Multivariable logistic regression analysis identified predictors of pelvic lymph node metastasis. All tested for significance using two-tailed tests at the α =0.05 level. Significance was set at the P <0.05 level in all analyses. Statistical analysis was carried out by means of the statistical package for the social sciences (SPSS) software version 18.0. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital, Sichuan University. Informed consent was obtained from all participants. Results The surgical-pathological stages among 358 patients were stageⅠ (n =313, 87.43%) ; stageⅡ (n=12, 3.35%) ; stageⅢ (n=27, 7.54%) ; stageⅣ (n=6, 1.68%) ．The histological types include endometrioid (n =318, 88.83%) , and no-endometrioid adenocarcinoma (n =40, 11.17%) ．The median age of 358 patients was 52 years old (20-78 years old) ．The median follow-up of 358 patients was 18 months, and their median overall survival(OS) time was 18 months (7-43 months) ．There had significant difference in rates of 3-year OS between patients with positive and negative of pathological results of pelvic lymph node [76.2% (16/ 21) vs．97.3% (327/ 336) ; χ2 =23.423, P<0.01]．There had no significant difference in rates of 3-year OS between patients with endometrioid carcinoma and non endometrioid carcinoma[96.2%(306/ 318) vs．95.0%(38/ 40) , P=0.478]．The 3-year rates of OS among 358 patients was 90.1% (323/ 358) ．The 3-year rates of OS in patients of FIGO stageⅠ-Ⅲwere: StageⅠ, 97.1%; stageⅡ, 91.7%; stageⅢ, 85.2%．During the period of follow-up, mortality rate of 358 patients was 3.07%(25/ 358) ．On univariate logistic regression analysis, FIGO stage [OR=4.169, 95%CI(2.693-6.454) , P=0.000], tumor size[OR=7.175, 95%CI(2.590-19.876) , P=0.000], lymph vascular space invasion(LVSI)[OR=6.277, 95 %CI(2.410-16.348) , P=0.000], depth of myometrial invasion[OR = 3.598, 95%CI(1.651-7.841) , P=0.001] and parametrial invasion[OR=9.382 ,95%CI(3.349-26.284) , P=0.000] were significantly associated with pelvic lymph node metastasis．On multivariate non conditional logistic regression analysis, FIGO stage [OR =3.787, 95%CI (2.113-6.786 ) , P=0.000] was highly associated with pelvic lymph node metastasis. Conclusions FIGO clinical stage, tumor size (diameter> 2 cm) , LVSI, depth of myometrial invasion, parametrial invasion were related to pelvic lymph node metastasis, and surgical-pathological stages were significantly associated with pelvic lymph node metastasis. Key words: Endometrial neoplasms; Overall survival rate; Lymph node; Pelvic lymph node metastasis; Risk factor