The predictability of lymph node metastasis in patients with endometrial cancer

Abstract

Objective: The aim of this study was to predict lymphatic involvement in endometrial cancer patients using clinicopathological variables in patients treated with surgical staging. Material and Methods: A retrospective chart review was performed in 147 women with pathologically proven endometrial carcinoma (EC) who were treated between January 2006 and January 2011. Surgically staged 125 patients were included in this study. We choose the patients who underwent surgical staging including washing cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node (PLN) and para-aortic lymph node (PALN) dissection. The depth of tumor invasion, cervical extension and the tumor diameter were intraoperatively assessed via fresh frozen sections of the removed uterus. Demographic data, preoperative and postoperative variables were evaluated for association with any lymph node (LN) metastasis. Results: The medical records of 125 patients were eligible for analysis. The presence of LN metastasis was significantly associated with the patient's age (p=0.016) and but not with body mass index (p=0.288). Preoperative findings such as atypical cells in smear (p=0.001), computed tomography (CT) features of malignancy (p=0.014), ultrasonographic findings related with malignancy (p=0.011), presence of myometrial invasion on CT (p=0.011), preoperative serum CA125 level (p<0.001), preoperative serum CA15-3 level (p<0.001), clinical stage (p<0.001), and histologic grade (p=0.001) were significantly associated with LN metastasis. Postoperative findings which were significantly associated with LN metastasis were grade of differentiation, lymphovascular invasion, depth of myometrial invasion, dissemination to omentum or appendix, and positive peritoneal cytology. The mean number of all lymph nodes removed during operation was 38.9±14.194 (range 9- 81), PLN number was 32±11.747 (range 9-75) and PALN number was 7±5.123 (range 0-20). Nodal metastasis was shown in 24 patients (19.2%). Isolated PLN metastasis was shown in 9 patients (37%), isolated PALN metastasis in one (4%); both PLN and PALN metastasis was shown in 14 patients (59%). The most frequently affected LN area was the region of the left external iliac artery, with a ratio of 14%.The p value was set at <0.05 for statistical significance. Conclusion: Lymphatic involvement in EC should be carefully evaluated using clinicopathologic variables of patients. Demographic characteristics, preoperative and postoperative surgical-pathologic factors determine the lymph node metastasis of the tumor. © 2013 by Türkiye Klinikleri.