Implications of Isolated Para-Aortic Lymph Node Metastasis in Endometrial Cancer: A Large-Scale, Multicenter, and Retrospective Study

Wenting Li,Min Xia,Beihua Kong,Hongyan Guo,Xipeng Wang,Wenjun Cheng,Bei Lin,Fengxia Xue,Jianliu Wang,Yuanming Shen,Xia Zhao,Yong Fang,Ge Lou,Jie Jiang,Ruixia Guo,Jihong Liu,Shuzhong Yao,Beibei Wang,Zizhuo Wang,Weidong Zhao,Xiaodong Cheng,Chuyao Zhang,Yingyu Dou,Jieqing Zhang,Yu Fu,Ping Zhang,Xiaomao Li,Gang Chen,Congjian Xu,Jingbo Liu,Lili Han,Chaoyang Sun,Xiaohang Yang,Jinmin Zhao ,Ke-Zhen Li ,Qing Yao ,Jin Ma

doi:10.3389/fmed.2021.754890

Abstract

Objective: To systematically evaluate lymph node metastasis (LNM) patterns in patients with endometrial cancer (EC) who underwent complete surgical staging, which included systematic pelvic and para-aortic lymphadenectomy.Methods: Four thousand and one patients who underwent complete surgical staging including systematic pelvic and para-aortic lymphadenectomy for EC were enrolled from 30 centers in China from 2001 to 2019. We systematically displayed the clinical and prognostic characteristics of patients with various LNM patterns, especially the PLN-PAN+ [para-aortic lymph node (PAN) metastasis without pelvic lymph node (PLN) metastasis]. The efficacy of PAN+ (para-aortic lymph node metastasis) prediction with clinical and pathological features was evaluated.Results: Overall, 431 of the 4,001 patients (10.8%) showed definite LNM according to pathological diagnosis. The PAN+ showed the highest frequency (6.6%) among all metastatic sites. One hundred fourteen cases (26.5%) were PLN-PAN+ (PAN metastasis without PLN metastasis), 167 cases (38.7%) showed PLN+PAN-(PLN metastasis without PAN metastasis), and 150 cases (34.8%) showed metastasis to both regions (PLN+PAN+). There was also 1.9% (51/2,660) of low-risk patients who had PLN-PAN+. There are no statistical differences in relapse-free survival (RFS) and disease-specific survival (DSS) among PLN+PAN-, PLN-PAN+, and PLN+PAN+. The sensitivity of gross PLNs, gross PANs, and lymphovascular space involvement (LVSI) to predict PAN+ was 53.8 [95% confidence interval (CI): 47.6–59.9], 74.2 95% CI: 65.6–81.4), and 45.8% (95% CI: 38.7–53.2), respectively.Conclusion: Over one-fourth of EC patients with LMN metastases were PLN-PAN+. PLN-PAN+ shares approximate survival outcomes (RFS and DSS) with other LNM patterns. No effective clinical methods were achieved for predicting PAN+. Thus, PLN-PAN+ is a non-negligible LNM pattern that cannot be underestimated in EC, even in low-risk patients.

Highlights

Endometrial cancer is one of the most common gynecologic cancers with a rising incidence [1]
Referring to the status of lymph node metastasis (LNM), 3,570 (89.2%) cases were recognized as negative LNM, whereas 431 (10.8%) cases were considered positive LNM
In order to investigate the characteristics of LNM status, we collected clinical and pathological records for comparison (Table 1)

Summary

Introduction

Endometrial cancer is one of the most common gynecologic cancers with a rising incidence [1]. According to the International Federation of Gynecology and Obstetrics (FIGO), the lymph node metastasis (LNM) status of patients with endometrial cancer (EC) is an essential reference for assigning a pathological stage, guiding adjuvant treatment, and determining prognostic value [3]. The FIGO 2009 Staging stratified Stage IIIC into Stage IIIC1 (PLN+) and Stage IIIC2 (PAN+ ± PLN+) by the presence of para-aortic lymph node metastasis, indicating a worse prognosis with PAN involvement [5,6,7]. The most common LNM patterns are well-recognized as PLN+PAN- and PLN+PAN+, since the reported incidence of isolated para-aortic lymph node

Methods

Results

Discussion

Conclusion