Lymphadenectomy for high-grade endometrial cancer: Does it impact lymph node recurrence?

Area of Science:

• Gynecologic Oncology
• Surgical Pathology
• Cancer Research

Background:

• Lymph node (LN) assessment is crucial for diagnosing and staging endometrial cancer.
• The oncologic benefit of surgically removing metastatic LNs in high-grade endometrial cancer requires further investigation.

Purpose of the Study:

• To assess if surgical removal of metastatic LNs provides oncologic benefit in high-grade endometrial cancer.
• To determine the relationship between the number of LNs removed and recurrence-free survival (RFS) in patients with positive LNs.

Main Methods:

• Retrospective collection of high-grade endometrial cancer cases from two tertiary cancer centers (2000-2010).
• Comparison of RFS based on the number of LNs removed in patients with at least one positive LN.
• Exploration of factors predicting nodal recurrence (NR) using univariate and multivariable analyses (log rank test, Cox proportional hazards model).

Main Results:

• Of 570 patients, 334 underwent staging lymphadenectomy, with 74 (22.2%) having positive LNs.
• Median RFS was significantly longer when >15 LNs were removed (87.1 months) compared to 5-15 LNs (16.9 months) or <5 LNs (17.3 months) in patients with positive LNs (p=0.02).
• Positive LNs at surgical staging were identified as the sole predictor of NR (HR 3.8, 95% CI 1.4-10.2).

Conclusions:

• Positive lymph nodes are significant predictors of nodal recurrence in high-grade endometrial cancer.
• More extensive lymph node dissection, indicated by a higher number of LNs removed, is associated with improved RFS in patients with positive LNs.
• Prospective studies are warranted to confirm the oncologic benefit of surgical removal of metastatic LNs.