Format

Send to

Choose Destination
Gynecol Oncol. 2019 Sep;154(3):480-486. doi: 10.1016/j.ygyno.2019.07.006. Epub 2019 Jul 16.

Predictors of extensive lymphatic dissemination and recurrences in node-positive endometrial cancer.

Author information

1
Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America; Academic Department of Gynecology and Obstetrics, Mauriziano Umberto I Hospital, Turin, Italy.
2
Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, United States of America.
3
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States of America.
4
Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America.
5
Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America; Department of Gynecology, IEO, European Institute of Oncology IRCSS, Milan, Italy.
6
Academic Department of Gynecology and Obstetrics, Mauriziano Umberto I Hospital, Turin, Italy.
7
Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, United States of America. Electronic address: glaser.gretchen@mayo.edu.

Abstract

OBJECTIVE:

To identify predictors of extensive lymphatic dissemination and distant recurrences in node-positive endometrial cancer (EC).

METHODS:

Clinicopathologic data were collected of patients who had fully staged EC with at least 1 positive lymph node. Permanent sections of metastatic lymph nodes were reviewed; metastases were characterized according to size (≤2 mm and >2 mm) and location in the lymph node (intra- vs extracapsular). Risk of occurrence of multiple pelvic and para-aortic lymph node dissemination was calculated by combining risk factors identified at multivariate analysis.

RESULTS:

Of 96 patients, 85 had positive pelvic nodes, of whom 71 (83.5%) had high-volume metastases. In the presence of both macrometastasis in the pelvic basin (odds ratio [OR], 13.42; [95% CI, 2.44-73.83]) and uterine serosal involvement of the tumor at final pathologic evaluation (OR, 11.84 [95% CI, 1.22-115.11]), multiple pelvic node dissemination occurred in 91.7% of cases (vs 7.7% in the absence of both). Concomitant presence of pelvic macrometastasis, lymphovascular space invasion (LVSI), and extracapsular invasion led to 85.7% occurrence of para-aortic involvement (vs 11.1% if no factors present). LVSI was independently associated with nonvaginal recurrences (hazard ratio, 2.62 [95% CI, 1.33-5.16]).

CONCLUSIONS:

Presence of high-volume metastases in the pelvic lymph nodes is associated with concomitant presence of multiple positive pelvic nodes, as well as para-aortic node involvement. LVSI is associated with both para-aortic node involvement and occurrence of nonvaginal relapses. In this era of sentinel lymph node mapping, these factors may help predict the extent of lymphatic dissemination in EC.

KEYWORDS:

Endometrial neoplasm; Lymphatic metastasis; Neoplasm recurrence; Sentinel lymph node

PMID:
31324453
DOI:
10.1016/j.ygyno.2019.07.006
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center