Isolated para-aortic lymph node metastasis in endometrial cancer: clinical characteristics and survival analysis from...

This study aimed to determine the incidence of isolated para-aortic lymph node metastasis in patients with endometrial cancer and to compare their clinicopathological characteristics and survival outcomes with those of patients exhibiting other lymphatic metastasis patterns.

A retrospective analysis was conducted on 532 patients with surgically staged primary endometrial cancer between January, 1991, to January, 2023. We performed systematic staging surgery based on frozen section findings indicating any of the following: non-endometrioid carcinoma, myometrial invasion ≥50%, grade 3, cervical involvement, or tumor size ≥2 cm. Patients were divided into 3 groups based on lymphatic spread: pelvic only, para-aortic only, or both. Clinical, pathological, and survival data were analyzed.

Isolated pelvic lymph node metastasis, isolated para-aortic lymph node metastasis, and dual (pelvic and para-aortic lymph node metastasis) metastasis were observed in 4.5%, 3.5%, and 7.5% of patients, respectively. Tumor size was significantly associated with metastasis pattern (p=0.03), with the largest tumors observed in the dual metastasis group. Median overall survival was 89 months in the pelvic lymph node metastasis group, 38 months in the isolated para-aortic lymph node metastasis group, and 30 months in the dual group (p=0.038). Disease-free survival followed a similar trend (p=0.020).

Isolated para-aortic lymph node metastasis is relatively rare, but its incidence is increasing, especially in patients with large tumors and older age. In addition, tumor size was an independent risk factor for overall survival. This may necessitate a comprehensive lymphatic assessment including para-aortic evaluation, for accurate staging and optimal treatment planning.