The prognostic value of lymphadenectomy in the revised 2009 FIGO staging system for endometrial cancer: A multicenter study.

Abstract

e15568 Background: We sought to evaluate whether pelvic or para-aortic lymphadenectomy increases the prognostic value of the revised 2009 FIGO staging system in patients with endometrial cancer (EC). Methods: We reviewed 786 patients with EC from 6 tertiary medical centers between July 1996 and June 2008. All patients were classified according to the 1988 FIGO staging system for EC: IA (n=234); IB (n=270); IC (n=109); IIA (n=35); IIB (n=29); IIIA (n=37); IIIB (n=3); IIIC (n=69), and the revised 2009 FIGO staging system was also applied to classify them: IA (=542); IB (=125); II (n=29); IIIA (n=18); IIIB (n=3); IIIC1 (n=43); IIIC2 (n=26). Results: In all patients, the 1988 FIGO stage IC, IIB, IIIA+IIIB and IIIC diseases (adjusted HRs, 8.39, 10.79, 12.30 and 15.41; 95% CIs, 1.67-22.15, 1.75-36.62, 1.95-46.16 and 2.94-50.88), and the revised 2009 FIGO stage IB, II, IIIA+IIIB and IIIC2 diseases were poor prognostic factors for PFS (adjusted HRs, 3.39, 4.37, 2.46 and 10.33; 95% CIs, 1.29-8.91, 1.23-15.59, 1.48-12.56 and 3.50-30.46), whereas the 1988 FIGO stage IIB and IIIC diseases (adjusted HRs, 18.92 and 20.93; 95% CIs, 1.54-43.21 and 2.01-40.92), and the revised 2009 FIGO stage II, IIIA+IIIB and IIIC2 diseases were unfavorable prognostic factors for OS by multivariate Cox proportional hazard analyses (adjusted HRs, 9.10, 3.86, 3.86 and 20.14; 95% CIs, 1.67-29.61, 1.37-20.45 and 3.98-41.81). Although these results are similar to those in 595 patients who underwent pelvic or para-aortic lymphadenectomy, the revised 2009 FIGO stage IIIC1 disease was an additional prognostic factor for PFS and OS (adjusted HRs, 4.19 and 11.25; 95% CI, 1.39-12.60 and 2.23-36.74, respectively). Conclusions: These findings suggest that the revised 2009 FIGO staging system may be more prognostic than the 1988 FIGO staging system for EC, and pelvic or para-aortic lymphadenectomy may increase the prognostic value of the revised 2009 FIGO staging system for EC.