J Gynecol Oncol.  2015 Apr;26(2):134-140. 10.3802/jgo.2015.26.2.134.

Prognostic impact of lymphadenectomy in uterine clear cell carcinoma

• Mahdi H
• Lockhart D
• Moselmi-Kebria M

• KMID: 2160796
• DOI: http://doi.org/10.3802/jgo.2015.26.2.134

Abstract

OBJECTIVE
The aim of this study was to estimate the survival impact of lymphadenectomy in patients diagnosed with uterine clear cell cancer (UCCC).
METHODS
Patients with a diagnosis of UCCC were identified from Surveillance, Epidemiology, and End Results (SEER) program from 1988 to 2007. Only surgically treated patients were included. Statistical analysis using Student t-test, Kaplan-Meier survival methods, and Cox proportional hazard regression were performed.
RESULTS
One thousand three hundred eighty-five patients met the inclusion criteria; 955 patients (68.9%) underwent lymphadenectomy. Older patients (> or =65) were less likely to undergo lymphadenectomy compared with their younger cohorts (64.3% vs. 75.9%, p<0.001). The prevalence of nodal metastasis was 24.8%. Out of 724 women who had disease clinically confined to the uterus and underwent lymphadenectomy, 123 (17%) were found to have nodal metastasis. Lymphadenectomy was associated with improved survival. Patients who underwent lymphadenectomy were 39% (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.52 to 0.72; p<0.001) less likely to die than patient who did not have the procedure. Moreover, more extensive lymphadenectomy correlated positively with survival. Compared to patients with 0 nodes removed, patients with more extensive lymphadenectomy (1 to 10 and >10 nodes removed) were 32% (HR, 0.68; 95% CI, 0.56 to 0.83; p<0.001) and 47% (HR, 0.53; 95% CI, 0.43 to 0.65; p<0.001) less likely to die, respectively.
CONCLUSION
The extent of lymphadenectomy is associated with an improved survival of patients diagnosed with UCCC.

Keyword

Endometrial Neoplasms; Lymph Node Excision; Retrospective Studies; Survival Rate

MeSH Terms

Adenocarcinoma, Clear Cell/*diagnosis/mortality/pathology/*surgery
Adult
Aged
Aged, 80 and over
Endometrial Neoplasms/*diagnosis/mortality/pathology/*surgery
Female
Humans
*Lymph Node Excision
Lymphatic Metastasis
Middle Aged
Pelvis
Prognosis
Retrospective Studies
Survival Rate
Uterine Neoplasms/diagnosis/mortality/pathology/surgery

Figure

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  Fig. 1 Overall survival based on lymph node dissection (LND) in uterine clear cell cancer (A) and early stage uterine clear cell cancer (B).

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  Fig. 2 Overall survival based on lymph node dissection (LND) in uterine clear cell cancer (A), and early stage uterine clear cell cancer (B).

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