Abstract
Study designRetrospective cohort study.IntroductionDebates remain regarding the role of lymphadenectomy in patients with apparent stage IA endometrial cancer, especially subtypes with a favorable prognosis. This study aimed to explore the prognostic value of staging surgeries in apparent stage IA endometrial endometrioid cancer patients in a retrospective cohort study.MethodsCases from June 1, 2010 to June 1, 2017 were reviewed in patients with pathologically confirmed endometrial endometrioid carcinoma limited to <1/2 of the myometrium, without extrauterine metastasis on preoperative evaluation and during surgical inspection. Survival outcomes were compared between patients with and without lymphadenectomy and between patients with and without metastasis to lymph nodes.ResultsIn total, 1,312 eligible patients were included, among which 836 underwent staging surgeries and 476 underwent simple hysterectomy. Twenty-eight patients were found with metastasis to retroperitoneal lymph nodes. After a median follow-up of 57.4 months, lost to follow-up, recurrence, death, and cancer-specific death occurred in 28, 39, 24, and 16 patients, respectively. In a univariate analysis, lymphadenectomy of the pelvis with or without para-aortic lymph nodes had no significant impact on disease-free survival, overall survival or cancer-specific overall survival (p values >0.05). However, after adjusting for important baseline risk factors [menopausal status, tumor differentiation, maximum diameter and location, lymph-vascular space invasion (LVSI) status, and postoperative adjuvant therapy), lymphadenectomy resulted in significantly improved survival outcomes (p values <0.05). Menopause (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.3–16.4, p=0.015), tumor diameter larger than 2 cm (OR 4.6, 95% CI 1.3–16.0, p=0.016), grade 3 tumors (OR 3.0, 95% CI 1.0–8.5, p=0.042), positive LVSI (OR 8.7, 95% CI 3.7–20.4, p<0.001) and lower uterine segment involvement (OR 3.1, 95% CI 1.4–7.2, p=0.007) had more extrauterine metastases.ConclusionIn cases of apparent stage IA endometrioid endometrial carcinoma, staging surgeries should be considered in patients with larger, higher grade tumors, positive LVSI, or lower uterine segment involvement.
Highlights
Debates remain regarding the role of lymphadenectomy in patients with apparent stage IA endometrial cancer, especially subtypes with a favorable prognosis
No evidence of benefit exists in terms of overall or recurrence-free survival for pelvic lymphadenectomy in women with early stage endometrial cancer [4, 5], systematic pelvic lymphadenectomy significantly improves the surgical staging [5]
The National Comprehensive Cancer Network (NCCN) panel even recommends that lymphadenectomy should be performed in select highrisk patients with endometrial cancer with para-aortic lymphadenectomy [12, 13]
Summary
Debates remain regarding the role of lymphadenectomy in patients with apparent stage IA endometrial cancer, especially subtypes with a favorable prognosis. No evidence of benefit exists in terms of overall or recurrence-free survival for pelvic lymphadenectomy in women with early stage endometrial cancer [4, 5], systematic pelvic lymphadenectomy significantly improves the surgical staging [5]. These findings are fairly controversial [6,7,8]. The National Comprehensive Cancer Network (NCCN) panel even recommends that lymphadenectomy should be performed in select highrisk patients with endometrial cancer with para-aortic lymphadenectomy [12, 13]
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