Lymph node metastasis in early stage endometrial cancer

Abstract

Objective: The aim was to investigate which criteria were most important in predicting the risk of nodal metastasis if deep myometrial invasion occupying less than half of the myometrium in patients with endometrial cancer (EC). Materials and Methods: Among the patients with EC who were operated in the present clinic between 2002 and 2015, and those who had less than half-depth myometrial tumour invasion were included in the study. In these patients, the relationship of pelvic lymph node metastasis (PLNM) with the criteria of age, histologic subtype, grade, tumour size, abdominal fluid cytology, cervical involvement, and lymphovascular space invasion (LVSI) was analysed. Results: A total of 567 patients were examined and 329 of these were analysed. Lymphadenectomy was performed in 89% of the patients, pelvic lymphadenectomy in 53% (156/294) of the patients, and both pelvic and para-aortic lymphadenectomy in 47% (138/294). PLNM was found in 7.9% of the patients (26/329). The rates of non-endometrioid histologic subtypes, LVSI, and peritoneal malignant cytology were found to be significantly higher in the patients with PLNM compared to those without PLNM (p = 0.040, p = 0.001, and p = 0.034). When the effects of age, subtype, tumour size, abdominal fluid, grade, and LVSI were evaluated with logistic regression analysis, it was observed that the effects of subtype and LVSI were statistically significant (OR (95% CI): 4.616 (1.085, 19.636), p = 0.038 and OR (95% CI): 3.530 (1.446, 8.613), p = 0.006, respectively). TThe other variables included in the logistic regression analysis were not statistically significant (p > 0.05). The specificity was 99.6% in this statistical model. Conclusion: It is considerably safe to apply a treatment plan based on the criteria of histologic subtype and LVSI in patients with less than half depth myometrial invasion.