Endometrial Cancer: Incidence of Retroperitoneal Lymph Node Metastasis and Clinico-pathological Factors Predicting Retroperitoneal Lymph Node Metastasis

Abstract

Endometrial Cancer: Incidence of Retroperitoneal Lymph Node Metastasis and Clinico-pathological Factors Predicting Retroperitoneal Lymph Node Metastasis

Surawute Leelahakorn MD*

Siriwan Tangjitgamol MD*

Sumonmal Manusirivithaya MD, MSc (Clinical Epidemiology)*

Jakkapan Khunnarong MD*

* Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital

Objectives: To evaluate the incidence of retroperitoneal lymph node (RLN) metastasis in endometrial carcinoma (EMC) and to assess the clinico-pathological factors predicting RLN metastasis.

Study design: Retrospective study.

Subjects: Two hundred and twenty five patients with clinical stage I-II EMC who underwent surgical staging at our institute during January 1993 and December 2007.

Methods: Medical and pathological records of all EMC patients were reviewed. Clinico-pathological characteristics and other data were extracted and analyzed.

Main outcome measures: Retroperitoneal lymph node metastasis.

Results: Mean age of the patients was 55.0 ± 9.8 years (30-84 years). All patients had total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node resection. One hundred and seventy seven patients (78.7%) also had para-aortic lymph node resection. The most common histopathologic type was endometrioid adenocarcinoma (90.7%). Mean number of lymph nodes obtained was 23.2 ± 10.6 nodes. Retroperitoneal lymph node metastasis was found in 28 patients (12.4%): pelvic lymph node metastasis in 25 patients (11.1%) and para-aortic lymph node metastasis in 10 patients (4.4%). By univariable analysis, clear cell or papillary serous adenocarcinoma type, high grade (II-III) tumor, tumor size > 2 cm, tumor located in lower uterine segment, cervical involvement, gross intra-abdominal metastasis, myometrial invasion more than inner half, lymph vascular space invasion and positive peritoneal cytology were significantly associated with RLN metastases. By multivariable analysis, only myometrial invasion more than inner half and lymph vascular space invasion were independently associated with RLN metastasis.

Conclusion: RLN metastases were found in 12.4% of patients with clinical stage I and II EMC. Presence of myometrial invasion more than inner half and lymph vascular space invasion were significantly associated with RLN metastasis by multivariable analysis.

Vajira Med J 2008 ; 52 : 129 - 138