Faculty Collaboration Database

Do uterine risk factors or lymph node metastasis more significantly affect recurrence in patients with endometrioid adenocarcinoma? Gynecol Oncol 2012 Apr;125(1):94-8

Date

12/14/2011

Pubmed ID

22155415

DOI

10.1016/j.ygyno.2011.11.049

Scopus ID

2-s2.0-84858339800 (requires institutional sign-in at Scopus site)   55 Citations

Abstract

OBJECTIVES: Controversy continues over the importance of lymph node (LN) status in treating and predicting recurrence in endometrial cancer. Several predictive models are available which use uterine factors to stratify risk groups. Our objective was to determine how LN status affects recurrence and survival compared to uterine factors alone.

METHODS: A retrospective review was performed of patients undergoing complete surgical staging for clinical stage 1 endometrioid adenocarcinoma of the uterus. Patients were assessed based on PORTEC 1 high intermediate risk (H-IR) criteria (2 factors : age>60, grade 3, >50% DOI), GOG-99 H-IR criteria (age >70+1 factor, age 50-70+2 factors, any age +3 factors: grade 2 or 3, LVSI, >50% DOI), and PORTEC 2 criteria. Rates of nodal involvement, recurrence rates, PFS, and OS were compared.

RESULTS: We identified 352 clinical stage I patients with positive LN in 24% (87). 175 patients met PORTEC 1 eligibility and 66 met H-IR criteria. Rates of LN positivity were similar among groups (18.4% vs 19.7%, p=0.83) but recurrence rates were dissimilar (7.4% vs 27.3%, p=0.0004). Only 93 met PORTEC 2 criteria for treatment with no association between LN status, recurrence, and eligibility. 188 patients met H-IR eligibility criteria for GOG-99 with LN positive and recurrence rates higher in the H-IR group compared to GOG-99 eligible (34.6% vs 16.3%, p=0.0004, 28.3% vs. 10.6%, p=0.0002).

CONCLUSIONS: Patients with H-IR disease based on uterine characteristics alone have substantial risk of nodal involvement. Knowledge of LN status may better define risk, prognosis, and postoperative treatment.

Author List

Nugent EK, Bishop EA, Mathews CA, Moxley KM, Tenney M, Mannel RS, Walker JL, Moore KN, Landrum LM, McMeekin DS

MESH terms used to index this publication - Major topics in bold

Aged
Carcinoma, Endometrioid
Decision Support Techniques
Endometrial Neoplasms
Female
Humans
Lymph Node Excision
Lymphatic Metastasis
Middle Aged
Models, Statistical
Multivariate Analysis
Neoplasm Staging
Pelvis
Prognosis
Recurrence
Retrospective Studies
Risk Assessment
Risk Factors
Survival Analysis
Survival Rate