The aim of this study is to determine the benefits of lymph node dissection (LND) and the pattern of recurrence in low and high risk endometrial cancer (EC) patients.
EC patients who underwent surgery as primary treatment between April 2003 to March 2012 was identified and stratified into low-risk and high-risk groups for lymph node metastasis (LNM) according to these criteria: poor differentiation, non-endometrioid histology, deep myometrial invasion, cervical stromal involvement, adnexal involvement, tumor diameter ≥ 3cm, suspicious node in imaging. Univariate survival analysis followed by Cox-regression model for multivariate analysis was used to find prognostic factors for survival. The χ2 and Fisher’s exact test were used to compare categorical valuables.
A total of 847 patients were included, among whom 524 received LND. After stratification 579 patients were assigned to high-risk group while 268 patients were assigned to low-risk group. LND was performed in 451 high-risk patients and in 73 low-risk patients with a rate of positive nodes of 14.1% (n = 64) and 2.7% (n = 2), respectively. Poor differentiation, non-endometrioid histology, deep myometrial invasion and adnexal involvement were independent prognostic factors. Whereas LNM was an independent prognostic factor for overall survival (OS, p = 0.03) but not for progression-free survival (PFS, p = 0.07). LND did not improve PFS (p = 0.56) or OS (p = 0.47) in the low-risk group and was not associated with OS (p = 0.17) in high-risk group. In 89 patients who had recurrence, 73 (13.9%) occurred in those with LND and 16 (5.0%) in those without LND. In high-risk group no significant difference was noted in recurrence rate (LND 16.0% vs without LND 8.6%, p = 0.06). Distant organs (lung, liver, bone, spleen and brain) and distant lymph nodes were the most common site of recurrence in both patients who underwent (5.9%, n = 31) LND and those who did not undergo (3.4%, n = 11) LND (p = 0.14).
According to our findings LND seemed not to have survival benefit for both high-risk and low-risk patients based on the above criteria, and it could not decrease risk of distance recurrence. A more reliable stratification model should be considered to determine the benefit of LND in EC.
Clinical trial identification
Legal entity responsible for the study
Sun Yet-sen University Cancer Center.
Has not received any funding.
All authors have declared no conflicts of interest.