Prognostic effect of isolated paraaortic nodal spread in endometrial cancer

Osman Türkmen,Gökhan Tulunay,Taner Turan,Günsu Cömert Kimyon,Işın Üreyen,Alper Karalok,Derman Başaran,Tolga Taşçı

doi:10.4274/jtgga.2017.0152

Abstract

Objective:To evaluate the prognostic effect of isolated paraaortic lymph node metastasis in endometrial cancer (EC).Material and Methods:This retrospective study included patients with FIGO 2009 stage IIIC2 disease due to isolated paraaortic lymph node metastasis (LNM). Patients with sarcomatous histology, synchronous gynecologic cancers and patients with concurrent pelvic lymph node metastases or patients that have intraabdominal tumor spread were excluded. Kaplan-Meier method was used for calculation of progression free survival (PFS) and overall survival.Results:One thousand six hundred and fourteen patients were operated for EC during study period. Nine hundred and sixty-one patients underwent lymph node dissection and 25 (2.6%) were found to have isolated LNM in paraaortic region and these constituted the study cohort. Twenty (80%) patients had endometrioid EC. Median number of retrieved lymph nodes from pelvic region and paraaortic region was 21.5 (range: 5-41) and 34.5 (range: 1-65), respectively. Median number of metastatic paraaortic nodes was 1 (range: 1-32). The median follow-up time was 15 months (range 5-94). Seven (28%) patients recurred after a median of 20 months (range, 3-99) from initial surgery. Three patients recurred only in pelvis, one patient had upper abdominal spread and 3 had isolated extraabdominal recurrence. Involvement of uterine serosa, positive peritoneal cytology and presence of adnexal metastasis were significantly associated with diminished PFS (p<0.05).Conclusion:The presence of serosal involvement or adnexal involvement is as important as gross peritoneal spread and is related with poor survival in patients with isolated paraaortic nodal spread in EC. Chemotherapy should be the mainstay of treatment in this patient cohort which may eradicate systemic tumor spread.

Highlights

Endometrial cancer (EC) is the most common gynecologic malignancy and the 4th most common cancer of women [1]
These findings indicate that even patients with stage IIIC2 disease due to isolated paraaortic lymph nodes may represent a heterogeneous patient group because of lymphatic spread patterns
The incidence of paraaortic lymph node metastasis (LNM) in EC and the prognostic factors of patients with stage IIIC2 EC have been the subject of various studies in the literature; there are limited data on the prognosis of isolated paraaortic LNM in EC [5,6,7,8,9,11,12]

Summary

Introduction

Endometrial cancer (EC) is the most common gynecologic malignancy and the 4th most common cancer of women [1]. J Turk Ger Gynecol Assoc 2018; 19: 201-5 constitute a very heterogeneous patient cohort in whom either pelvic extrauterine disease or positive pelvic lymph nodes may exist concurrently Another important patient subgroup of FIGO stage IIIC2 disease, with an incidence varying between 1% and 6% among all patients with EC, comprises patients with isolated paraaortic lymph node metastases [5,6,7,8,9]. Tumors of the uterine corpus may spread to the paraaortic region via lymphatic routes of obturator and external iliac chains or the lymphatic pathways through gonadal vessels [10] These findings indicate that even patients with stage IIIC2 disease due to isolated paraaortic lymph nodes may represent a heterogeneous patient group because of lymphatic spread patterns.

Methods

Results

Conclusion