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- Title
Whether intermediate-risk stage 1A, grade 1/2, endometrioid endometrial cancer patients with lesions larger than 2 cm warrant lymph node dissection?
- Authors
Menghan Zhu; Nan Jia; Feifei Huang; Xiaoxia Liu; Yuqing Zhao; Xiang Tao; Wei Jiang; Qin Li; Weiwei Feng; Zhu, Menghan; Jia, Nan; Huang, Feifei; Liu, Xiaoxia; Zhao, Yuqing; Tao, Xiang; Jiang, Wei; Li, Qin; Feng, Weiwei
- Abstract
<bold>Background: </bold>Our research aimed to investigate whether lymphadenectomy was required in patients with intermediate-risk endometrioid endometrial cancer (EEC).<bold>Methods: </bold>Between 1989 and 2015, 1009 patients with intermediate-risk EEC: grade 1 or 2 tumor, <50% myometrial invasion, and a tumor diameter ≥ 2 cm and 818 low-risk patients with grade 1 or 2 tumor, <50% myometrial invasion, and a tumor diameter < 2 cm were enrolled in this study. The rate and risk factors of node metastasis were evaluated and compared between the two risk groups. Survival data were analyzed in patients with intermediate-risk EEC with or without lymphadenectomy.<bold>Results: </bold>In all, 624 of 1009 (61.8%) patients with intermediate-risk EEC underwent pelvic ± para-aortic lymphadenectomy with a nodal metastasis rate of 1.9% (12/624), whereas 394 of 818 (48.2%) patients with low-risk EEC underwent pelvic ± para-aortic lymphadenectomy with a nodal metastasis rate of 0.3% (1/394) (p = 0.021). Notably, intermediate-risk EEC patients with a microcystic, elongated and fragmented (MELF) pattern of invasion, lymphatic vascular space invasion (LVSI), diffuse lesions, or lesions located in the cornua were more likely to have node metastasis. The 5-year overall cancer-related survival and the recurrence-free survival rates of the 742 intermediate-risk EEC patients who were followed for more than 3 years were 99.4% and 94.7%, respectively. In intermediate-risk group, 6 patients (6/443, 1.4%) with lymphadenectomy and 9 patients (9/299, 3.0%) without lymphadenectomy recurred, with a mean recurrence time of 38.3 and 18.7 months respectively. The five-year overall and recurrence-free survival rates of intermediate-risk patients with and without lymphadenectomy were similar (100% vs 98.9%, p = 0.351; 95.2% vs 93.3%, p = 0.464).<bold>Conclusion: </bold>Patients with intermediate-risk EEC have low nodal metastasis rate and a favorable outcome whether lymphadenectomy is performed or not. Omission of lymphadenectomy may be a reasonable option in the surgical management of patients with intermediate-risk EEC.
- Subjects
LYMPHADENECTOMY; ENDOMETRIAL cancer risk factors; GYNECOLOGIC cancer; CANCER-related mortality; HYSTERECTOMY; COMPARATIVE studies; SURGICAL excision; LYMPH node surgery; RESEARCH methodology; MEDICAL cooperation; METASTASIS; PROGNOSIS; RESEARCH; ENDOMETRIAL tumors; EVALUATION research; RELATIVE medical risk; TUMOR grading; DIAGNOSIS
- Publication
BMC Cancer, 2017, Vol 17, p1
- ISSN
1471-2407
- Publication type
journal article
- DOI
10.1186/s12885-017-3671-0