Abstract
The role of lymphadenectomy in the management of early endometrial cancer remains controversial. In the recent ESMO-ESGO-ESTRO guidelines, lymphadenectomy is recommended for patients with endometrioid adenocarcinoma Grade 3 with deep myometrial invasion, but complete agreement was not achieved. In Sweden, DNA aneuploidy has been included as a high-risk factor. The aim of our study was to evaluate the impact of tumor histology, FIGO grade, DNA ploidy and myometrial invasion (MI) on occurrence of lymph node metastasis (LNM) in patients with endometrial cancer. The study design is a retrospective cohort study based on prospectively recorded register data. Endometrial cancer patients registered in the Swedish Quality Registry for Gynecologic Cancer 2010-2015 with FIGO Stages I-III and verified nodal status were included. Data on DNA ploidy, histology, FIGO grade and MI were included in multivariable log-binomial regression analyses with LNM as dependent variable. 1,165 cases fulfilled the inclusion criteria. The multivariable analyses revealed increased risk of LNM in patients with tumors with MI ≥ 50% (risk ratio [RR] = 4.1; 95% confidence interval [CI] 3.0-5.6), nonendometrioid compared to endometrioid histology (RR 1.8; CI 1.4-2.4) and FIGO Grade 3 compared to Grade 1-2 tumors (RR 1.5; CI 1.1-2.0). No statistically significant association between DNA ploidy status and LNM was detected. This population-based, nation-wide study in women with endometrial cancer confirms a strong association between MI ≥ 50%, nonendometrioid histology and FIGO Grade 3, respectively, and LNM. DNA ploidy should not be included in the preoperative decision making of removing nodes or not.
Highlights
Lymph node metastasis (LNM) in endometrial cancer (EC) is a strong prognostic factor for survival [1, 2]
myometrial invasion (MI)≥50% presented the strongest association with lymph node metastasis (LNM) (RR=4.1, 95% confidence interval lymph-vascular space invasion (LVSI) (CI)=3.0-5.6) followed in numerically order of the risk ratios (RR) for non-endometrioid and grade 3 tumors
There was no significant difference in the risk for LNM between FIGO grade 1 and grade 2 endometrioid carcinomas
Summary
Lymph node metastasis (LNM) in endometrial cancer (EC) is a strong prognostic factor for survival [1, 2]. The American National Comprehensive Cancer Networks guidelines recommend surgical staging with pelvic and, in patients with high-risk tumors, para-aortic LA, in the primary treatment of early stage EC 4. In the Swedish National Guidelines for EC pelvic and para-aortic LA is recommended in preoperative high-risk tumors (endometrioid adenocarcinoma FIGO grade 3, non-endometrioid histologic subtypes or DNA non-diploid tumors) whereas LA is not recommended in low risk tumors 5. In contrast to most other international guidelines Sweden has a long tradition of using DNA ploidy as a prognostic factor in the pre- and postoperative risk group evaluation 7. The aim of the study was to evaluate the impact of tumor histology, grade, DNA ploidy and myometrial invasion on lymph node metastasis using data from the Swedish Quality Registry for Gynecologic Cancer (SQRGC)
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