Evaluation of risk factors for pelvic and paraaortic lymph node metastasis in endometrioid type endometrial cancer

Year 2023, , 195 - 200, 12.01.2023

Savaş Özdemir , Gul Özel Dogan , Hicran Şirinoğlu

https://doi.org/10.32322/jhsm.1208766

Abstract

Aim: Determining the relationship between clinical and pathological features in endometrial cancer is essential for both prognostic and potential therapeutic benefits. In this study, we aimed to investigate the relationship between pelvic and paraaortic lymph node (PLN and PALN) metastasis and prognostic factors in patients with endometrial cancer (EC).
Material and Method: Medical records of patients who underwent primary surgery for EC in our gynecological oncology center between the 2016 and 2018 were reviewed retrospectively. The relationship between pelvic and paraaortic lymph node metastasis was evaluated with data such as patient age, body mass index, serum CA 125 level, macroscopic tumor diameter, and patients’ risk groups.
Results: Fifty-seven patients with EC were evaluated. Lymph node involvement was detected in 10 patients (17.5%). Acording to Modiffied Mayo criterias ; the patients with grade 3 EC had a higher risk of metastasis compared to other grades (p=0.025). Patients with lymph node metastases had a greater depth of invasion (p=0.001). There was no relationship between tumor size and lymph node metastasis (p=0.494). In the logistic regression analysis, the depth of invasion was found to be an independent risk factor for lymph node metastasis. There was no significant relationship between the presence of PLN and PALN metastases in patients with high-risk endometrial cancer, but the presence of PALN metastasis was significant in patients with low-risk endometrial cancer with PLN metastasis (p=0.002).
Conclusion: These findings support the idea that routine evaluation of tumor invasion depth during endometrial cancer surgery may be useful in predicting lymph node metastasis and guiding the operation.

Keywords

Endometrial cancer, metastasis, lymph node

Supporting Institution

-

Project Number

-

Thanks

-

References

• Braun MM, Overbeek-Wager EA, Grumbo RJ. Diagnosis and Management of Endometrial Cancer. Am Fam Physician 2016; 15: 93: 468-74.
• T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Türkiye Kanser İstatistikleri 2017. Available online: https://hsgm.saglik.gov.tr/depo/birimler/kanser-db/istatistik/Turkiye_Kanser_Istatistikleri_2017.pdf
• Lewin SN, Herzog TJ, Medel NIB, et al. Comparative performance of the 2009 International Federation of Gynecology and Obstetrics’ staging system for uterine corpus cancer. Obstet Gynecol 2010; 116: 1141-9.
• Akbayir O, Corbacioglu A, Goksedef BP, et al. The novel criteria for predicting pelvic lymph node metastasis in endometrioid adenocarcinoma of endometrium. Gynecol Oncol 2012; 125: 400–403.
• Sarı ME, Meydanlı ME, Yalçın İ, et al. Risk factors for lymph node metastasis among lymphovascular space ınvasion-positive women with endometrioid endometrial cancer clinically confi ned to the uterus. Oncol Res Treat 2018; 41: 750-4.
• Aalders JG, Thomas G. Endometrial cancer—revisiting the importance of pelvic and para aortic lymph nodes. Gynecol Oncol 2007; 10: 222-31.
• Creutzberg CL. Lymphadenectomy in apparent early-stage endometrial carcinoma: Do numbers count? J Clin Oncol 2005; 40: 55-65.
• Sorosky JI. Endometrial cancer. Obstet Gynecol 2012; 120: 383-97.
• Todo Y, Takeshita S, Okamoto K, e Yamashiro K, Kato H. Implications of para-aortic lymph node metastasis in patients with endometrial cancer without pelvic lymph node metastasis. J Gynecol Oncol 2017; 28: e59.
• Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC. Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol 2000; 182: 1506–19.
• Fotopoulou C, Savvatis K, Kraetschell R, Schefold JC, Lichtenegger W, Sehouli J. Systematic pelvic and aortic lymphadenectomy in intermediate and high-risk endometrial cancer: lymph-node mapping and identification of predictive factors for lymph-node status. Eur J Obstet Gynecol Reprod Biol 2010; 149: 199-203.
• Karube Y, Fujimoto T, Takahashi O, et al. Histopathological prognostic factors predicting para-aortic lymph node metastasis in patients with endometrioid uterine cancer. Gynecol Oncol 2010; 118: 151-4.
• Nomura H, Aoki D, Suzuki N, et al. Analysis of clinicopathologic factors predicting para-aortic lymph node metastasis in endometrial cancer. Int J Gynecol Cancer 2006; 16: 799-804.
• Turan AT, Yıldırım BA, Üreyen I, et al. Creating a risk model to determine paraaortic lymph node involvement in endometrial carcinoma. Turk J Med Sci 2012; 42: 1259-67.
• Taş EE, Yeğin GF, Keskin HL, Kır EA, Yavuz AF. Assessment of risk factors for lymph node metastasis in endometrial cancer. Istanbul Med J 2019; 20: 8-12.
• Yokoyama Y, Maruyama H, Sato S, Saito Y. Indispensability of pelvic and paraaortic lymphadenectomy in endometrial cancers. Gynecol Oncol 1997; 64: 411-17.