The Impact Of Tumor Size On Predicting Lymph Node Metastasis In Endometrial Carcinoma

Year 2017, Volume: 14 Issue: 1, 5 - 8, 01.01.2017

Kadir Çetinkaya Fisun Ardıç Funda Atalay

Abstract

Aim: Lymph node metastasis LNM has an important influence on survival in endometrial carcinoma EC and LNM occurs about 5-15%. If the LNM group of patients predicted before or during surgery, then the remaining patients could avoid exposure to lymph node dissection LND . Tumor size TS is one of risk factors associated with lymph node spread and we aimed to evaluate the impact of TS on predicting LNM during surgery.Material and Methods: Patient chart information of 40 patients who had been treated by surgical staging and applied frozen section peroperatively at Ankara Oncology Education and Research Hospital due to EC between July 2014 and March 2016 were retrospectively reviewed. Factors that were likely to have an effect on LNM in all patients, such as histological type, grade G , myometrial invasion deepness MID , cervical stromal invasion CSI and TS were analyzed. Patients were separated into four groups and TS was studied as >2 cm, >3 cm, >4 cm and >5 cm related to LNM defined as risk groups.Results: The mean age of the patients was 59.09 ± 9.14 years range 38-79, median 59 . Three patients had LNM 7.5% out of 40 surgically staged EC patients. The stages were seen as 75.0% n=30 , 7.5% n=3 , 5.0% n=2 , 5.0% n=2 , 5.0% n=2 , 2.5% n=1 according to the 2009 International Federation of Gynecology and Obstetrics FIGO stages IA, IB, II, IIIA, IIIC1 and IIIC2. There were 28 70.0% , 21 52.5% , 11 27.5% and 7 17.5% patients, as TS >2 cm, >3 cm, >4 cm and >5 cm, respectively. All patients with ≤2 cm TS n=12, 30.0% were stage IA and all patients with LNM n=3, 7.5% were >3 cm TS.Conclusion: In this study, in EC patients with ≤3 cm TS 47.5% showed no LNM. Tumor size might have a value in predicting LNM and deciding LND in EC during surgery.

Keywords

Endometrial cancer, tumor size, lymph node metastasis

Tümör Boyutunun Endometrium Kanserinde Lenf Nodu Metastazına Etkisi

Abstract

Amaç: Endometrium kanseri EK ’nde sağ kalım açısından lenf nodu metastazı LNM ’nın önemli bir etkisi vardır ve LNM %5-15 civarında izlenir. Ameliyat öncesi dönemde ya da ameliyat sırasında LNM olan hastalar tespit edilebilirse, geri kalan diğer hastalar lenf nodu diseksiyonu LND ’na maruz kalmayabilir. Tümör boyutu TB lenfatik yayılımda risk faktörlerinden olup, bu çalışmada ameliyat sırasında LNM’nı tahmin başarısındaki yerini değerlendirmek amaçlanmıştır.Gereç ve Yöntemler: Ankara Onkoloji Eğitim ve Araştırma Hastanesi’nde Temmuz 2014 ile Mart 2016 arasında EK nedeniyle evreleme cerrahisi ve ameliyat sırasında frozen uygulanan 40 hastanın dosya bilgileri geriye dönük olarak incelendi. Tüm hastalarda LNM’nı etkileyen histolojik tip, greyd G , miyometrial invazyon derinliği MİD , servikal stromal invazyon SSİ ve TB analiz edildi. Hastalar LNM riski açısından dört gruba ayrıldı ve TB >2 cm, >3 cm, >4 cm ve >5 cm olarak belirlendi.Bulgular: Hastaların ortalama yaşı 59.09 ± 9.14 yıl 38-79, medyan 59 idi. Toplam 40 cerrahi olarak evrelenmiş EK’li hastadan üçünde %7,5 LNM izlendi. Uluslar arası Jinekoloji ve Obstetrik Federasyonu FİGO 2009 evreleme sistemine göre evreler IA, IB, II, IIIA, IIIC1 ve IIIC2 sırası ile %75,0 n=30 , %7,5 n=3 , %5,0 n=2 , %5,0 n=2 , %5,0 n=2 , %2,5 n=1 olarak izlendi. Hastaların TB >2 cm, >3 cm, >4 cm ve >5 cm şeklinde sırasıyla 28 %70,0 , 21 %52,5 , 11 %27,5 ve 7 %17,5 tespit edildi. Tümör boyutu ≤2 cm n=12, %30,0 olan tüm hastalar evre IA idi ve LNM izlenen tüm hastalarda TB >3 cm olarak tespit edildi.Sonuç: Bu çalışmada TB ≤3 cm olan hiç bir hastada % 47,5 LNM izlenmedi. Ameliyat sırasında LNM tahmini ve LND için karar verme aşamasında TB önemli bir parametre olabilir.

Keywords

Endometrium kanseri, tümör boyutu, lenf nodu metastazı

References

• Amant F, Moerman P, Neven P, ve ark. Endometrial cancer. Lancet. 2005;366:491-505.
• Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105:103-104.
• Salvesen HB, Haldorsen IS, Trovik J. Markers for individualised therapy in endometrial carcinoma. Lancet Oncol. 2012;13:353-361.
• Cetinkaya K, Atalay F, Bacinoglu A. Risk factors of lymph node metastases with endometrial carcinoma Asian Pac J Cancer Prev. 2014;15:6353-6.
• Chan JK, Cheung MK, Huh WK, Osann K, Husain A, Teng NN, Kapp DS. Therapeutic role of lymph node resection in endometrioid corpus cancer. A study of 12,333 patients. Cancer 2006;107:1823–30.
• Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. Survival effect of paraaortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 2010;375:1165–72.
• Mahdi H, Kumar S, Al-Wahab Z, Ali-Fehmi R, Munkarah AR. Prognostic impact of lymphadenectomy in uterine serous cancer. BJOG 2013;120:384–91.
• Benedetti Panici P, Basile S, Maneschi F, Lissoni AA, Signorelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 2008;100:1707–16.
• ASTEC study group. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 2009;373:125–36.
• Mahdi H, Munkarah AR, Ali-Fehmi R, Woessner J, Shah SN, Moslemi- Kebria M. Tumor size is an independent predictor of lymph node metastasis and survival in early stage endometrioid endometrial cancer. Arch Gynecol Obstet. 2015;292:183-90.
• Barrena Medel NI, Herzog TJ, Deutsch I, Burke WM, Sun X, Lewin SN, Wright JD. Comparison of the prognostic significance of uterine factors and nodal status for endometrial cancer. Am J Obstet Gynecol. 2011;204:248.
• Stephan JM, Hansen J, Samuelson M, McDonald M, Chin Y, Bender D, ve ark. Intraoperative frozen section results reliably predict final pathology in endometrial cancer. Gynecol Oncol 2014;133:499–505.
• Kadir Çetinkaya, Fisun Ardıç, Funda Atalay, Ahmet Bacınoğlu, Haluk Dervişoğlu. Endometrium kanserinde risk triajı için frozen kesit ile parafin takip sonuçları ne kadar uyumludur? Acta Oncologica Turcica. 2016;49:80-5.
• Wang X, Li L, Cragun JM, Chambers SK, Hatch KD, Zheng W. Assessment of the Role of Intraoperative Frozen Section in Guiding Surgical Staging for Endometrial Cancer. Int J Gynecol Cancer. 2016 Apr 5.
• Mariani AMF, Dowdy S, Podratz K, Bakkum-Gamez J, Cliby W, Weaver A, McGree M, Keeney G (2011) Reliability of frozen section examination in endometrial carcinoma at a tertiary care center: is it appropriate for intra- operative guidance of treatment decisions? Gynecol Oncol 120:S92.
• AlHilliMM, Podratz KC, Dowdy SC, Bakkum-Gamez JN,Weaver AL, McGree ME, ve ark. Preoperative biopsy and intraoperative tumor diameter predict lymph node dissemination in endometrial cancer. Gynecol Oncol 2013;128:294–9.
• Cetinkaya K, Atalay F, Bacinoglu A, Dervisoglu H. To what extent is risk grouping method successful in deciding surgical staging in endometrial cancer? Tumori. 2016;102:422-5.
• Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, Podratz KC. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol 200;109:11–18.
• Karalok A, Ureyen I, Reis Y, Oktay O, Turan T, Boran N, Bülbül D, Tulunay G, Köse MF. Prediction of staging with preoperative parameters and frozen/section in patients with a preoperative diagnosis of grade 1 endometrioid tumor in endometrial cancer. J Turk Ger Gynecol Assoc. 2014 30;15:41-8.
• Senol T, Polat M, Ozkaya E, Karateke A. Tumor Diameter for Prediction of Recurrence, Disease Free and Overall Survival in Endometrial Cancer Cases. Asian Pac J Cancer Prev. 2015;16:7463-6.
• Shah C, Johnson EB, Everett E, Tamimi H, Greer B, Swisher E, Goff B. Does size matter? Tumor size and morphology as predictors of nodal status and recurrence in endometrial cancer. Gynecol Oncol. 2005;99:564–570.
• Kang S, Todo Y, Watari H. Risk assessment of lymph node metastasis before surgery in endometrial cancer: do we need a clinical trial for low- risk patients. J Obstet Gynaecol Res. 2014;40:322-6.
• Tuomi T, Pasanen A, Luomaranta A, Leminen A, Bützow R, Loukovaara M. Risk-stratification of endometrial carcinomas revisited: a combined preoperative and intraoperative scoring system for a reliable prediction of an advanced disease. Gynecol Oncol. 2015;137:23-7.
• Luomaranta A, Leminen A, Loukovaara M. Prediction of lymph node and distant metastasis in patients with endometrial carcinoma: a new model based on demographics, biochemical factors, and tumor histology. Gynecol Oncol. 2013;129:28-32.
• Bendifallah S, Canlorbe G, Collinet P, ve ark. Just how accurate are the major risk stratification systems for early-stage endometrial cancer? Br J Cancer. 2015;112:793-801.
• Laufer J, Scasso S, Papadia A, Sosa C, Cirillo F, Raspagliesi F. Association between tumor diameter and lymphovascular space invasion among women with early-stage endometrial cancer. Int J Gynaecol Obstet. 2013;123:142-5.