Pelvic Lymph Node Count is an Important Prognostic Variable for FIGO Stage I and II Endometrial Carcinoma With High-Risk Histology

Abstract

The FIGO (International Federation of Gynecology and Obstetrics) staging system for endometrial adenocarcinoma does not specify the type or extent of lymph node dissection. The present retrospective study included 467 women from a single institution who had FIGO stage I or stage II endometrial cancer and who were operated on as primary treatment and underwent lymph node dissection as part of the procedure. The goals were to learn whether the pelvic node count is a significant prognostic factor for women whose disease is limited to the uterus and cervix, and whether it influences patterns of recurrence in patients with stage I/II disease. A majority of patients had both pelvic and aortic node dissections. Cancer recurred in 42 women, 9% of the total. The median number of pelvic lymph nodes identified was 12 in patients without recurrent disease, 14 in those with vaginal recurrence, and 8 in patients with recurrence at other pelvic sites or distant failure. Women without recurrent disease and those with vaginal recurrence had significantly more pelvic nodes identified than patients with distant recurrences. Although the pelvic node count was not associated with survival on univariate analysis, overall survival (OS) and progression-free survival (PFS) both were significantly better when the pelvic node count was 12 or higher in women with high-risk histology—but not in those with low-risk histology. On multivariable regression analysis, the pelvic node count was an independent prognostic factor for both OS and PFS among patients with high-risk histology when 12 or more pelvic nodes were identified. The pelvic node count had no association with OS or PFS in women with low-risk histology. This study suggests that women with FIGO stage I/II endometrial cancer and high-risk histology do significantly better when a relatively large number of pelvic lymph nodes are evaluated. In this setting, systematic pelvic lymphadenectomy is preferable to lesser procedures such as lymph node biopsy.