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An Orthotopic Endometrial Cancer Model with Retroperitoneal Lymphadenopathy Made From In Vivo Propagated and Cultured VX2 Cells
Published on: September 12, 2019
Is Pelvic-Paraaortic Lymphadenectomy Necessary in Endometrial Cancer? A Retrospective Analysis of Lymph Node
Zdz Aksakal1, Y Kumtepe2, Y E Topdagi1
1Department of Gynecology and Obstetrics, Atatürk University School of Medicine, Erzurum, Turkey.
Background:
The diagnosis of endometrial cancer is made by surgical staging. Lymph node dissection (LND) in early-stage endometrial cancer is a controversial issue. Detection of pelvic lymph node metastasis in surgical staging is clinically very important. Metastases are associated with a higher risk of recurrence and highlight the importance of postoperative adjuvant treatments.
Aim:
We aimed to investigate the relationship between pelvic lymph node involvement and endometrial cancer prognostic factors and the predictive value of pelvic lymph node metastasis.
Methods:
The relationship and predictive value of pelvic lymph node metastasis (PLNM) in 275 patients, who underwent hysterectomy, bilateral salpingo-oophorectomy and at least pelvic LND for endometrial cancer in our Gynaecological Oncology Clinic between 2008 and 2021 were investigated.
Results:
PLNM was present in 31 (11.2%) patients. In univariate analyses, adnexal involvement, perineural involvement, perinodal involvement, cervical stromal involvement, peritoneal and omentum metastasis, cytology positivity, disease stage, Cerb, and CEA positivity were found to be significant with PLNM. PLNM was statistically found to affect 5-year survival (P < 0.01). PLNM was also interpreted as a predictive criterion for paraaortic lymph node metastasis (PALNM). The most significant predictors in multivariate analysis are LVSI, depth of myometrial invasion and PALNM (LVSI P < 0.01, depth of myometrial invasion P < 0.001, PALNM P < 0.001).
Conclusion:
In this retrospective study, multivariate analyses showed that LVSI and depth of myometrial invasion were independent risk factors for pelvic lymph node involvement. Pelvic lymph node positivity was also a predictive factor for paraaortic lymph node involvement. There is no consensus on the surgical staging of endometrial cancer. Surgical staging therefore serves to identify patients for whom treatment for extrauterine disease is indicated and to avoid overtreatment of the majority of patients with localised disease. Routine paraaortic lymphadenectomy may not be necessary in patients without pelvic LN metastasis.
