PREDICTIBILITY OF RETROPÉRITONEAL LYMPH NODE METASTASIS IN ENDOMETRIAL CANCER

The purpose of this study was to predict lymphatic involvement in endometrial cancer using clinicopathologic variables of patients treated with surgical staging. Overall, 461 patients treated with an initial surgical staging procedure including complete pelvic–para-aortic lymphadenectomy were included. The mean number of resected lymph nodes was 27 (median 26; range 15–83), and 54 patients (12%) had lymphatic involvement. Of these patients, 32 had only pelvic, 15 had both pelvic and para-aortic, and 7 had isolated para-aortic metastases. In the multivariate analysis, deep myometrial invasion (P = 0.02), lymphvascular space invasion (P = 0.001), positive peritoneal cytology (P = 0.002), and cervical involvement (P = 0.003) predicted retroperitoneal lymph node metastasis (RLN) significantly. Two hundred seventy-four patients (59.4%) had at least one of these poor prognostic factors identified by multivariate analysis. In this patient population, 53 (19.3%) had lymphatic involvement compared to 1 patient in the group of 187 patients with low-risk criteria. Ninety-eight percent of patients with RLN were predicted by this model, and with the advent of accurate diagnostic techniques, 40% of patients could be saved from undergoing lymphadenectomy.

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Predictability of retroperitoneal lymph node metastasis by using clinicopathologic variables in surgically staged endometrial cancer

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2006.00534.x ◽

2006 ◽

Vol 16 (3) ◽

pp. 1342-1347 ◽

Cited By ~ 9

Author(s):

C. TASKIRAN ◽

K. YUCE ◽

P.O. GEYIK ◽

T. KUCUKALI ◽

A. AYHAN

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Retroperitoneal Lymph Node ◽

Node Metastasis

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A nomogram prediction model for lymph node metastasis in endometrial cancer patients

BMC Cancer ◽

10.1186/s12885-021-08466-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhiling Wang ◽

Shuo Zhang ◽

Yifei Ma ◽

Wenhui Li ◽

Jiguang Tian ◽

...

Keyword(s):

Logistic Regression ◽

Endometrial Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

External Validation ◽

Clinicopathological Parameters ◽

Bootstrap Sample ◽

Multivariate Logistic Regression ◽

Node Metastasis ◽

Increased Risk

Abstract Background This study aimed to explore the risk factors for lymph node metastasis (LNM) in patients with endometrial cancer (EC) and develop a clinically useful nomogram based on clinicopathological parameters to predict it. Methods Clinical information of patients who underwent staging surgery for EC was abstracted from Qilu Hospital of Shandong University from January 1st, 2005 to June 31st, 2019. Parameters including patient-related, tumor-related, and preoperative hematologic examination-related were analyzed by univariate and multivariate logistic regression to determine the correlation with LNM. A nomogram based on the multivariate results was constructed and underwent internal and external validation to predict the probability of LNM. Results The overall data from the 1517 patients who met the inclusion criteria were analyzed. 105(6.29%) patients had LNM. According the univariate analysis and multivariate logistic regression analysis, LVSI is the most predictive factor for LNM, patients with positive LVSI had 13.156-fold increased risk for LNM (95%CI:6.834–25.324; P < 0.001). The nomogram was constructed and incorporated valuable parameters including histological type, histological grade, depth of myometrial invasion, LVSI, cervical involvement, parametrial involvement, and HGB levels from training set. The nomogram was cross-validated internally by the 1000 bootstrap sample and showed good discrimination accuracy. The c-index for internal and external validation of the nomogram are 0.916(95%CI:0.849–0.982) and 0.873(95%CI:0.776–0.970), respectively. Conclusions We developed and validated a 7-variable nomogram with a high concordance probability to predict the risk of LNM in patients with EC.

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Prospective evaluation of sentinel node navigation surgery in Japanese patients with low-risk endometrial cancer—safety and occurrence of lymphedema

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa252 ◽

2021 ◽

Author(s):

Hitoshi Niikura ◽

Asami Toki ◽

Tomoyuki Nagai ◽

Satoshi Okamoto ◽

Shogo Shigeta ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Lymph Node Metastasis ◽

Lower Extremity ◽

Lymph Node Biopsy ◽

Occurrence Rate ◽

Node Metastasis ◽

Node Biopsy

Abstract Objective The present study aimed to clarify the occurrence rate of lymphedema and prognosis in patients with endometrial cancer according to sentinel lymph node biopsy alone with intraoperative histopathological examination. Methods The study included 45 consecutive patients with endometrial cancer treated at Tohoku University Hospital between October 2014 and August 2017. All patients had endometrial carcinoma with endometrioid histology Grade 1 or Grade 2 confirmed by biopsy and stage I on magnetic resonance imaging and/or computed tomography at their preoperative evaluation. Sentinel lymph node detection was performed by radioisotope and dye. Patients who were diagnosed intraoperatively as negative for sentinel lymph node metastasis did not undergo further systematic pelvic lymphadenectomy. The occurrence rate of lymphedema and prognosis was evaluated. Results Bilateral sentinel lymph nodes were detected in 44 of 45 patients (97%). Forty-three patients underwent sentinel lymph node biopsy alone, and only two patients underwent systematic lymphadenectomy. Sentinel lymph node metastases were detected in one patient intraoperatively and two patients postoperatively as ITCs. No patients experienced recurrence. New symptomatic lower-extremity lymphedema was identified in one of 43 patients (2.3%) who underwent sentinel lymph node biopsy alone. Conclusion Sentinel lymph node biopsy alone with intraoperative histopathological diagnosis appears to be a safe and effective strategy to detect lymph node metastasis and to reduce the number of patients with lower-extremity lymphedema among patients with endometrial cancer.

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The incidence of pelvic lymph node metastasis by FIGO staging for patients with adequately surgically staged endometrial adenocarcinoma of endometrioid histology

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.00996.x ◽

2008 ◽

Vol 18 (2) ◽

pp. 269-273 ◽

Cited By ~ 121

Author(s):

D. S. Chi ◽

R. R. Barakat ◽

M. J. Palayekar ◽

D. A. Levine ◽

Y. Sonoda ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Myometrial Invasion ◽

Tumor Grade ◽

Pelvic Lymph Node ◽

Study Cohort ◽

Node Metastasis ◽

Figo Staging ◽

Pelvic Lymph Node Metastasis

The seminal Gynecologic Oncology Group study on surgical pathologic spread patterns of endometrial cancer demonstrated the risk of pelvic lymph node metastasis for clinical stage I endometrial cancer based on tumor grade and thirds of myometrial invasion. However, the FIGO staging system assigns surgical stage by categorizing depth of myometrial invasion in halves. The objective of this study was to determine the incidence of pelvic lymph node metastasis in endometrial cancer based on tumor grade and myometrial invasion as per the current FIGO staging system. We reviewed the records of all patients who underwent primary surgical staging for clinical stage I endometrial cancer at our institution between May 1993 and November 2005. To make the study cohort as homogeneous as possible, we included only cases of endometrioid histology. We also included only patients who had adequate staging, which was defined as a total hysterectomy with removal of at least eight pelvic lymph nodes. During the study period, 1036 patients underwent primary surgery for endometrial cancer. The study cohort was composed of the 349 patients who met study inclusion criteria. Distribution of tumor grade was as follows: grade 1, 80 (23%); grade 2, 182 (52%); and grade 3, 87 (25%). Overall, 30 patients (9%) had pelvic lymph node metastasis. The incidence of pelvic lymph node metastasis in relation to tumor grade and depth of myometrial invasion (none, inner half, and outer half) was as follows: grade 1–0%, 0%, and 0%, respectively; grade 2–4%, 10%, and 17%, respectively; and grade 3–0%, 7%, and 28%, respectively. We determined the incidence of pelvic nodal metastasis in a large cohort of endometrial cancer patients of uniform histologic subtype in relation to tumor grade and a one-half myometrial invasion cutoff. These data are more applicable to current surgical practice than the previously described one-third myometrial invasion cutoff results.

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