The risk of less extensive surgical staging in endometrial cancer

Abstract

16587 Background: To evaluate the risk of nodal metastases in endometrial cancer. Methods: Demographic, clinico- pathologic, treatment and surgery information were obtained from the Surveillance, Epidemiology and End Results Program of the National Cancer Institute between 1988 and 2001 on all patients with endometrial cancer who underwent a lymphadenectomy. Kaplan-Meier and Cox regression analyses were used for analyses. Results: Of 15,283 women diagnosed with endometrial cancer, the median age at diagnosis was 64 years (range 22–99). The majority (79.8%) of patients were Caucasian; 6.3% were Hispanic, 5.9% African-American, and 5.7% were Asian. 12,067 had stage I-II disease and 3,216 had stage III-IV disease. 13,419 patients had endometrioid, 1,483 papillary serous, and 381 had clear cell carcinoma. Grade 1, 2, and 3 disease was found in 26.3%, 37.0%, and 30.8%, respectively. 37.6% of women received adjuvant radiation. 13.1% of women with stage I-IV disease had lymph node metastasis. The survival of patients with nodal metastasis was 53.2% vs. 91.4% with negative lymph nodes (p<0.001). In a subset of patients with similar eligibility criteria based on the Post Operative Radiation Therapy in Endometrial Carcinoma (PORTEC) clinical trial (stage IC grade 1 and all grade 2 disease), 10% of these patients had nodal metastasis. After excluding patients with stage IV disease, the risk of nodal metastasis was 6.0%. Of those with grade 2 cancers, the risk of nodal metastasis was 10.8%. In multivariate analysis, age, race, stage, grade, primary surgery, histology, and nodal metastasis all remained as significant independent prognostic factors for survival. Conclusions: In the overall study group, patients with endometrial cancer have a 10% risk of nodal metastases. The information obtained from lymphadenectomy can potentially circumvent or guide adjuvant therapy. No significant financial relationships to disclose.