Role of the Appropriateness of the Pelvic Lymphadenectomy and Adjuvant Radiation Therapy in Early-Stage Poorly Differentiated Endometrial Carcinoma
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With this work, we intend to investigate the prognostic role of the pelvic lymphadenectomy, analyzing the pattern of recurrence in poorly differentiated endometrial carcinoma.
Methods and Materials
Our study analyzes a total of 98 patients affected by early-stage (T1/T2) poorly differentiated endometrial carcinoma. Detailed data concerning clinical presentation, pathology, adjuvant treatment, and outcomes were collected and correlated with disease-free survival (DFS), further distinguished in local and distant DFS, and overall survival (OS). The extent of the lymphadenectomy was considered appropriated when a number of 12 lymph nodes were removed.
The only characteristic significantly associated with locoregional DFS was the use of adjuvant radiation therapy (p: 0.003), whereas the use of adjuvant radiation therapy (RT, p: 0.004), the appropriateness of lymphadenectomy (p: 0.019), and the higher age (> 65 years, p: 0.037) are associated with distance DFS. The only significant variable associated with OS was the higher age (p: 0.025). On multivariate analysis, RT was correlated (p: 0.017) with locoregional DFS, whereas RT (p: 0.019) and age (p: 0.048) were correlated with distance DFS. The multivariate analysis of OS showed that the only parameter associated was the age (p: 0.047).
The results of our study underline the importance of an appropriate lymphadenectomy and the selection of the correct adjuvant strategy in the treatment of early-stage poorly differentiated endometrial carcinoma.
KeywordsPoorly differentiated endometrial carcinoma Lymphadenectomy Radiation therapy Chemotherapy Gynecology oncology
Extension of primary tumor
Lymph nodal status
Compliance with Ethical Standards
Conflict of interest
All the authors declare no conflicts of interest.
- 6.Soliman PT, Frumovitz M, Spannuth W, Greer MJ, Sharma S, Schmeler KM, Ramirez PT, Levenback CF, Ramondetta LM. Lymphadenectomy during endometrial cancer staging: practice patterns among gynecologic oncologists. Gynecol Oncol. 2010;119(2):291–4. https://doi.org/10.1016/j.ygyno.2010.07.011.CrossRefGoogle Scholar
- 7.Kumar S, Mariani A, Bakkum-Gamez JN, Weaver AL, McGree ME, Keeney GL, Cliby WA, Podratz KC, Dowdy SC. Risk factors that mitigate the role of paraaortic lymphadenectomy in uterine endometrioid cancer. Gynecol Oncol. 2013;130(3):441–5. https://doi.org/10.1016/j.ygyno.2013.05.035.CrossRefGoogle Scholar
- 9.Panici PB, Basile S, Maneschi F, Lissoni AA, Signorelli M, Scambia G, Angioli R, Tateo S, Mangili G, Katsaros D, Garozzo G, Campagnutta E, Donadello N, Greggi S, Melpignano M, Raspagliesi F, Ragni N, Cormio G, Grassi R, Franchi M, Giannarelli D, Fossati R, Torri V, Amoroso M, Croce C, Mangioni C. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100(23):1707–16. https://doi.org/10.1093/jnci/djn397.CrossRefGoogle Scholar
- 12.Lutman CV, Havrilesky LJ, Cragun JM, Secord AA, Calingaert B, Berchuck A, Clarke-Pearson DL, Soper JT. Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecol Oncol. 2006;102(1):92–7. https://doi.org/10.1016/j.ygyno.2005.11.032.CrossRefGoogle Scholar
- 13.Abu-Rustum NR, Iasonos A, Zhou Q, Oke E, Soslow RA, Alektiar KM, Chi DS, Barakat RR. Is there a therapeutic impact to regional lymphadenectomy in the surgical treatment of endometrial carcinoma? Am J Obstet Gynecol. 2008;198(4):457-e1. https://doi.org/10.1016/j.ajog.2008.01.010 (discussion 457 e455–e456).CrossRefGoogle Scholar
- 14.Berek JS, Hacker NF. Berek and Hacker’s gynecologic oncology. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2010.Google Scholar
- 18.Ben-Shachar I, Pavelka J, Cohn DE, Copeland LJ, Ramirez N, Manolitsas T, Fowler JM. Surgical staging for patients presenting with grade 1 endometrial carcinoma. Obstet Gynecol. 2005;105(3):487–93. https://doi.org/10.1097/01.AOG.0000149151.74863.c4.CrossRefGoogle Scholar
- 19.Kwon JS, Francis JA, Qiu F, Weir MM, Ettler HC. When is a pathology review indicated in endometrial cancer? Obstet Gynecol. 2007;110(6):1224–30. https://doi.org/10.1097/01.AOG.0000287618.86078.6c.CrossRefGoogle Scholar
- 20.Frei KA, Kinkel K, Bonel HM, Lu Y, Zaloudek C, Hricak H. Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging—a meta-analysis and Bayesian analysis. Radiology. 2000;216(2):444–9. https://doi.org/10.1148/radiology.216.2.r00au17444.CrossRefGoogle Scholar
- 25.Hampl M, Hantschmann P, Michels W, Hillemanns P, German Multicenter Study Group. Validation of the accuracy of the sentinel lymph node procedure in patients with vulvar cancer: results of a multicenter study in Germany. Gynecol Oncol. 2008;111(2):282–8. https://doi.org/10.1016/j.ygyno.2008.08.007.CrossRefGoogle Scholar
- 29.Abu-Rustum NR, Khoury-Collado F, Pandit-Taskar N, Soslow RA, Dao F, Sonoda Y, Levine DA, Brown CL, Chi DS, Barakat RR, Gemignani ML. Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma? Gynecol Oncol. 2009;113(2):163–9. https://doi.org/10.1016/j.ygyno.2009.01.003.CrossRefGoogle Scholar