Propensity of retroperitoneal lymph node metastasis in patients with stage I sarcoma of the uterus

Information in the literature about the incidence of nodal spread and its clinical implication in stage I sarcoma of the uterus is limited. The purpose of this study is to provide additional information derived from surgical staging of 20 patients who were treated by primary surgery to include total abdominal hysterectomy, bilateral salpingo-oophorectomy, and selective biopsy of paraaortic and pelvic nodes. Nine out of 20 patients (45%) of this small series had lymph node metastases either to both pelvic and paraaortic nodes (6) or pelvic nodes alone (3). This high rate of nodal involvement was associated with deep myometrial invasion, uteri sounding larger than 8 cm, patients older than 65 years, and leiomyosarcoma. In 12 of 20 patients, clinical staging was an underestimate. In a follow-up from 2 to 12 years, all 9 patients with positive nodes succumbed to their diseases. This result indicates that incidence of nodal spread in stage I sarcoma of the uterus is a frequent occurrence and is related to ultimate survival. Furthermore, it suggests that lymphatic permeation might precede hematogenous spread in early sarcoma of the uterus.