High-Risk Factors and Prognostic analysis of Pelvic Nodal Metastasis in Patients with Endometrial Carcinoma
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Objective: To investigate the high-risk factors of retroperitoneal lymph nodes metastasis (LNM) and the effect of lymph nodes metastasis on prognosis in patients with endometrial carcinoma (EM). Methods: Retrospective research were carried out from January 2005 to December 2010 to identify 289 endometrial cancer patients treated with retroperitoneal lymphadenectomy at Peking Union Medical College Hospital. The high-risk factors of retroperitoneal LNM and prognostic factors of this disease were studied. Results: (1) The median age of at diagnosis was 55 years. Patients of stage I, II, III and IV were 224 (77.5%), 13 (4.5%), 45 (15.6%) and 7 (2.4%), respectively. Two hundred and eighty-nine patients received pelvic lymphadenectomy, of that 30 (10.4%) patients were found the pelvic LNM. Ninety-six patients received periaortic lymphadenectomy, of that 11 (11.5%) patients were found the periaortic LNM. Twenty-one (7.3%) patients developed recurrent disease and 11 (3.8 %) were dead. The median follow-up was 37 months and the median disease-free survival (DFS) was 34 months. (2) In univariate analysis, the incidence of LNM significantly increased in patients with CA125 ≥ 35u/L preoperatively , non-endometrioid adenocarcinoma, low grade, deep myometrium invasion, diameter of tumor ≥ 2cm, cervical stroma involvement, positive peritoneal cytology and vagina or parametrial involvement (P ＜ 0.05). In multivariate analysis, CA125 ≥ 35u/L preoperatively, low grade, deep myometrium invasion was the independent high-risk factors of LNM (P ＜ 0.05). (3) The Kaplan-Meier analysis showed a significant difference between positive peritoneal cytology, vagina or parametrial involvement, appendix involvement, LNM and DFS (P ＜ 0.05). We also found a significant difference on the impact of non-endometrioid adenocarcinoma, low grade, deep myometrium invasion, positive peritoneal cytology, appendix involvement and LNM on overall survival (OS) (P ＜ 0.05). Cox regression analysis revealed retroperitoneal LNM is the independent prognostic factor of 5-year DFS (patients without LNM 92.1% vs patients with LNM 65.3%, P=0.002, 95%CI 0.078-0.552). We also found the trend that the 5-year OS was higher in patients without LNM than them with LNM, even though there was no significant difference (patients without LNM 96.1% vs patients with LNM 70.0%, P=0.086, 95%CI 0.039-1.238). Conclusion: Our study found that (1) there was the predictive value of low grade and deep myometrium invasion for EC patients with LNM. This finding may give the clinician a guild of lymphadenectomy and lay the foundation for individualized treatment; (2) there was the trend that patients with LNM have poorer prognosis than them without LNM. Therefore, patients with LNM should receive adjuvant therapy to reduce the risk of recurrence.