Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling

From 1969 to 1990, 649 patients with adenocarcinoma of the endometrium were surgically managed by gynecologic oncologists from the University of Alabama at Birmingham. All patients underwent TAH-BSO and washings. Two hundred twelve patients had multiple-site pelvic node sampling (mean number of nodes, 11), 205 patients had limited site pelvic node sampling (mean number of nodes, 4), and in 208 patients, nodes were not sampled. Historical prognostic features, including tumor grade, depth of invasion, adnexal metastasis, cervical involvement, and positive cytology, were equally distributed in the three groups. Mean follow-up was 3 years. Patients undergoing multiple-site pelvic node sampling had significantly better survival than patients without node sampling (P = 0.0002). When patients were categorized as low risk (disease confined to the corpus) or as high risk (disease in the cervix, adnexa, uterine serosa, or washings) multiple-site pelvic node sampling again provided a significant survival advantage compared to patients without node sampling (high risk, P = 0.0006; low risk, P = 0.026). In a comparison of patients receiving whole pelvic radiation for grade III lesions or deep myometrial invasion, patients with multiple-site pelvic node sampling had better survival than those in whom nodes were not sampled (P = 0.0027). The significant survival advantage for patients having multiple-site node sampling, overall and in high- and low-risk groups, strongly suggests a therapeutic benefit. Additionally, adjuvant therapy may be more appropriate directed in these patients.