Node-negative Endometrial Cancer Research Articles

PD-0913 Is substantial LVSI prognostic in patients with pathological lymph node-negative endometrial cancer?

PD-0913 Is substantial LVSI prognostic in patients with pathological lymph node-negative endometrial cancer?

Lymph node micrometastases and outcome of endometrial cancer

BackgroundThe relationship between nodal micrometastases and clinical outcome of endometrial cancer is unclear. Patients and methodsWe performed a multicenter, retrospective registry-based study of 2392 patients with endometrial cancer with and without nodal micrometastases. The primary outcome measure was disease-free survival. ResultsAfter exclusions, the final study involved 428 patients: 302 (70.6%) with node-negative endometrial cancer, who did not receive adjuvant treatment, 95 (22.2%) with nodal micrometastases who received adjuvant treatment, and 31 (7.2%) with nodal micrometastases who did not receive adjuvant treatment. The median follow-up was 84.8 months. Without adjuvant therapy the disease-free survival in the cohort of patients with micrometastases was significantly reduced as compared with disease-free survival in the node-negative cohort (p = 0.0001). With adjuvant therapy the median disease-free survival of patients with nodal micrometastases was similar with those of node-negative patients (p = 0.648). The adjusted hazard ratio for disease events among patients with micrometastases and no adjuvant therapy, as compared with node-negative patients, was 2.23 (95% confidence interval [CI] 1.26–3.95). In the cohort with micrometastases the relative risk of events was significantly decreased by adjuvant therapy (HR 0.29, 95%CI 0.13–0.65) even after adjustment for age at diagnosis, myometrial invasion, histological grade and type, and performance status. ConclusionsNodal micrometastases are associated with decreased disease-free survival of patients with endometrial cancer. Adjuvant therapy was associated with improved disease-free survival of patients with micrometastases.

Patterns of Failures and Clinical Outcome of Patients with Early-Stage, High-Risk, Node-Negative Endometrial Cancer Treated with Surgery Followed by Adjuvant Platinum-Based Chemotherapy and Vaginal Brachytherapy

Objective: To assess the clinical outcome of patients with high-risk early-stage endometrial cancer and negative pelvic nodes who received adjuvant platinum-based chemotherapy plus vaginal brachytherapy (VBT). Methods: This investigation assessed 80 patients who underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy for stage Ib-II, grade 2–3 endometrioid (n = 43) or stage Ia-II nonendometrioid (n = 37) endometrial cancer. Results: Five-year local control rate, 5-year disease-free survival, and 5-year overall survival were 97, 87, and 97%, respectively, for endometrioid carcinoma, and 66, 50, and 72%, respectively, for nonendometrioid carcinoma. Conclusions: This retrospective study appears to show that adjuvant platinum-based chemotherapy plus VBT achieve very good results in endometrioid carcinoma. This combined treatment seems to be less effective in nonendometrioid carcinoma.

Prognostic Significance of Lymphovascular Space Invasion in the Absence of Lymph Node Metastases in Early-Stage Endometrial Cancer

Lymphovascular space invasion (LVSI) has been defined as a significant adverse prognostic factor in early-stage endometrial cancer, primarily because of its high association with nodal metastases. This study aimed to determine if LVSI provides any prognostic significance in pathologic node-negative surgically staged (T1N0) endometrial cancer patients. This retrospective cohort study included all patients with pathologic stage T1N0 endometrial carcinoma treated at The Ottawa Hospital Cancer Centre from 1998 to 2007. Patient demographics, pathologic findings, treatment, and outcome data were collected. Univariate and multivariate cox regression modeling was used to assess significance and adjust for demographic and histopathologic covariates. Kaplan-Meier curves were used to estimate the 5-year overall and recurrence-free survival. Our study included 400 pathologic stage T1N0 patients who received an initial total hysterectomy and bilateral salpingo-oophorectomy with lymphadenectomy. The median age at diagnosis was 62 years, and the median follow-up was 66 months. Fifty-four patients (13.5%) had a positive LVSI status, and 346 (86.5%) had a negative LVSI status. The 5-year overall survival was 97.3% in patients without LVSI and 90.9% in those with LVSI (P < 0.001). The 5-year recurrence-free survival was 95.2% in patients without LVSI and 85.9% in those with LVSI (P = 0.006). Univariate analysis identified grade, stage, and LVSI as the covariates significantly associated with time to recurrence, and identified age, grade, stage, and LVSI to be significantly associated with overall survival. There were no significant covariates for recurrence-free survival by multivariate analysis, and only age and LVSI were significant for overall survival. Lymphovascular space invasion is an overall poor prognostic factor in T1N0 endometrial cancer. After adjusting for other factors, LVSI remains an independent risk factor for worse overall survival. Therefore, estimation of overall survival in patients with early-stage, node-negative endometrial cancer should take into account LVSI status.

The Value of Preoperative Positron Emission Tomography/Computed Tomography in Node-Negative Endometrial Cancer on Magnetic Resonance Imaging.

The aim of this study was to investigate the value of [18F]fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in predicting lymph node status in node-negative endometrial cancer on preoperative magnetic resonance imaging (MRI). Patients with endometrial cancer who underwent both preoperative MRI and FDG-PET/CT followed by hysterectomy and lymphadenectomy were initially included. We then enrolled patients with MRI-defined node-negative disease (lymph nodes <1cm in the short-axis diameter, or no visible lymph node). Histologic examination was the gold standard for lymph node metastasis diagnosis. The diagnostic performance of FDG-PET/CT in predicting lymph node metastasis was calculated in patient-by-patient and lymph node station-by-station analyses. On preoperative MRI, 362 patients had no lymph node metastasis. All patients underwent pelvic lymph node dissection and 118 patients underwent further para-aortic lymph node dissection. From 2099 lymph node stations, 10,238 lymph nodes were retrieved. Twenty-seven patients (7.5%) had lymph node metastasis in 49 lymph node stations (2.3%) on pathologic examination. FDG-PET/CT identified lymph node metastasis in five patients (18.5%) and eight lymph node stations (16.3%). The median diameter of false-negative metastatic lymph nodes was 6mm (range 1-22) in the long axis and 3mm (range 1-11) in the short axis. For para-aortic lymph nodes, FDG-PET/CT diagnosed 2 of 11 patients (18.1%) with para-aortic lymph node metastasis, and 3 of 12 para-aortic lymph node stations (25%) with metastasis. Preoperative FDG-PET/CT has low value in predicting lymph node metastasis in node-negative endometrial cancer on preoperative MRI.

The value of FDG-PET/CT in node-negative endometrial cancer on MRI

Objectives: To evaluate the diagnostic performance of preoperative fluorodeoxyglucose positron emission tomography–computed tomography (FDG-PET/CT) in predicting lymph node status in node-negative endometrial cancer on preoperative magnetic resonance imaging (MRI). Methods: Patients with endometrial cancer who underwent both preoperative MRI and FDG-PET/CT and then underwent hysterectomy and lymphadenectomy were included. MRI and FDG-PET/CT images were independently reviewed by 2 radiologists and 2 nuclear medicine physicians blinded to the clinical and pathologic information and the results of FDG-PET/CT or MRI. Lymph nodes smaller than 1 cm in short axis diameter were defined as negative lymph nodes on MRI. Lymph nodes were divided into 8 lymph node stations in each patient. The diagnostic performance of PET-CT in predicting lymph node metastasis was calculated in a patient-by-patient analysis and lymph node station-by-station analysis. Results: A total of 362 patients did not have lymph node metastasis on preoperative MRI. All patients underwent pelvic lymph node dissection, and 118 patients underwent para-aortic lymph node dissection. A total of 10,238 lymph nodes were retrieved from 2,099 lymph node stations. Twenty-seven patients had lymph node metastasis on pathologic examination. PET-CT diagnosed only 5 patients (18.5%) with lymph node metastasis. The sensitivity of FDG-PET/CT was 18.5% in patient-by-patient analysis. Lymph node metastasis was found in 49 lymph node stations on pathologic examination. PET-CT diagnosed only 8 lymph node stations (16.3%) with lymph node metastasis. The sensitivity of FDG-PET/CT was 16.3% in lymph node station-by-station analysis. The median diameter of false-negative metastatic lymph nodes was 6 mm (range, 1–22 mm) in long axis and 3 mm (range, 1–11 mm) in short axis. Conclusions: This study indicates the low value of preoperative FDG-PET/CT in predicting lymph node metastasis in node-negative endometrial cancer on preoperative MRI.

Cancer of the corpus uteri.

Cancer of the corpus uteri.

Intraperitoneal Radioactive Chromic Phosphate is a Well-Tolerated Adjuvant Treatment in Patients with Endometrial Cancer

Background: The data assessing overall survival with regard to different adjuvant treatment in the setting of advanced-stage endometrial cancer are limited, as such, the appropriate adjuvant therapy for patients with this condition remains unclear. Objective: The purpose of this study was to evaluate outcomes and demographics of patients with endometrial cancer who received intraperitoneal radioactive chromic phosphate (32P) as part of their cancer treatment. Materials and Methods: This single-institution retrospective review ran from January 2005 to December 2009. All patients underwent comprehensive surgical staging followed by infusion of intraperitoneal 32P and possible chemotherapy, hormonal therapy, or radiation treatment. The follow-up time period ranged from 20 to 68 months. Results: Eight patients with stage III node-negative endometrial cancer with positive cytology who received 32P were identified. The mean follow-up was 45.4 months. The mean time from surgery to intraperitoneal 32P was 4 months. Seven of 8 patients received adjuvant single-agent platinum or combination platinum/taxane chemotherapy. No grade 3 or 4 complications were noted. There has been no evidence of recurrent disease in these patients noted to date. Conclusions: Adjuvant intraperitoneal 32P for treating endometrial cancer patients at risk for intraperitoneal recurrence is well-tolerated with minimal toxicity. (J GYNECOL SURG 31:67)

Nm23 expression in node-positive and node-negative endometrial cancer

Objective To examine the relationships between the expression of protein Nm23 and surgical stage, histologic grade, histopathologic findings, and survival in women with endometrial carcinoma. Methods 19 patients with lymph node involvement were matched with 24 patients without lymph node involvement and the best paraffin-embedded blocks were selected for Nm23 immunohistochemical staining. The slides were evaluated semiquantitatively according to their degree of cytoplasmic staining. Statistical analysis was performed to determine whether there was a relationship between Nm23 expression and surgical stage, histologic grade, depth of myometrial invasion, lymph node metastasis, and/or lymphovascular space involvement. Survival analysis was also performed. Results Slides from 15 patients (79%) with lymph node involvement and 22 patients (88%) without lymph node involvement were found to be positive for Nm23 ( P = 0.01). No significant relations were observed between Nm23 expression and surgical stage, histologic grade, depth of myometrial invasion, or lymphovascular space involvement. Nm23 expression was found to be significantly related to lower rates of lymph node metastasis and longer survival ( P = 0.02). Conclusion Elevated Nm23 expression is related to lower rates of lymph node metastasis and longer survival.

Occult Lymph Node Metastases Detected by Cytokeratin Immunohistochemistry Predict Recurrence in Node-Negative Endometrial Cancer

Objective. Even after curative resection of early endometrial cancer, some patients die as a result of recurrence. We believe that these patients likely had occult lymph node metastases at the time of diagnosis. In an attempt to identify the responsible occult metastases, the clinicopathological significance of cytokeratin expression in lymph nodes with unconfirmed metastasis was evaluated retrospectively in patients with endometrial carcinoma.Methods. We examined 304 pelvic lymph nodes and 46 primary tumors excised from 46 patients with endometrial cancer, including 36 with Stage I disease and 10 with Stage IIIc disease. Formalin-fixed paraffin-embedded tissue sections were stained immunohistochemically using antibodies against cytokeratin, CA125, and macrophage-related antigen. Sections were also stained with hematoxylin and eosin.Results. In 10 patients with Stage IIIc disease, cytokeratin expression was detected in cells other than the tumor cells in all 13 lymph nodes with metastasis and also in 20 (30.3%) of 66 lymph nodes without metastasis. Cytokeratin expression was observed in 37 (16.4%) of 225 lymph nodes with unconfirmed metastasis, which were obtained from 14 of 36 patients with Stage I disease. Five of fourteen patients with lymph nodes expressing cytokeratin had recurrent disease in the pelvic cavity, while all 22 patients with unconfirmed cytokeratin expression in their lymph nodes showed no recurrence. Cytokeratin and CA125 were detected simultaneously on macrophages in lymph nodes. Cytokeratin expression in lymph nodes was closely related to lymph-vascular space involvement of the primary tumor, but was not related to either histological grade or depth of myometrial invasion. Multivariate analysis identified cytokeratin expression as an independent risk factor for recurrence in Stage I endometrial cancer.Conclusions. The immunohistochemical expression of cytokeratin in lymph nodes with undetected metastases predicts occult metastasis to these nodes and is a risk factor for recurrence in early-stage endometrial cancer.