Factors Associated with Para-Aortic Lymph Node Metastasis in High-Risk Endometrial Cancer

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Pathology

Background:

• Para-aortic lymph node metastasis is a critical prognostic factor in high-risk endometrial cancer.
• Accurate identification of metastasis aids surgical decision-making and patient management.

Purpose of the Study:

• To identify factors predicting para-aortic lymph node metastasis in high-risk endometrial cancer.
• To evaluate the predictive value of these factors for surgical planning.

Main Methods:

• Retrospective analysis of 81 high-risk endometrial cancer patients undergoing pelvic and para-aortic lymphadenectomy.
• Evaluation of factors: histologic subtype, lymphovascular space invasion (LVSI), cervical stromal involvement, myometrial invasion depth, tumor diameter.
• Univariate, multivariate logistic regression, and ROC analyses were performed.

Main Results:

• Para-aortic lymph node metastasis occurred in 21.0% of patients.
• Univariate analysis linked pelvic lymph node positivity, LVSI, cervical invasion, deep myometrial invasion, and tumor size ≥ 3.55 cm to para-aortic spread.
• Multivariate analysis identified only pelvic lymph node positivity as an independent predictor (OR 39.0, p < 0.001).

Conclusions:

• Pelvic lymph node status is a robust, independent predictor of para-aortic metastasis in high-risk endometrial cancer.
• Tumor diameter > 3.5 cm may also suggest increased risk.
• Findings support individualized para-aortic assessment for improved staging and surgical planning.