J Gynecol Oncol.  2017 Sep;28(5):e59. 10.3802/jgo.2017.28.e59.

Implications of para-aortic lymph node metastasis in patients with endometrial cancer without pelvic lymph node metastasis

• Todo Y
• Takeshita
• Okamoto K
• Yamashiro
• Kato H

• KMID: 2413220
• DOI: http://doi.org/10.3802/jgo.2017.28.e59

Abstract

OBJECTIVE
The aim of this study was to confirm the incidence and implications of a lymphatic spread pattern involving para-aortic lymph node (PAN) metastasis in the absence of pelvic lymph node (PLN) metastasis in patients with endometrial cancer.
METHODS
We carried out a retrospective chart review of 380 patients with endometrial cancer treated by surgery including PLN dissection and PAN dissection at Hokkaido Cancer Center between 2003 and 2016. We determined the probability of PAN metastasis in patients without PLN metastasis and investigated survival outcomes of PLN−PAN+ patients.
RESULTS
The median numbers of PLN and PAN removed at surgery were 41 (range: 11-107) and 16 (range: 1-65), respectively. Sixty-four patients (16.8%) had lymph node metastasis, including 39 (10.3%) with PAN metastasis. The most frequent lymphatic spread pattern was PLN+PAN+ (7.9%), followed by PLN+PAN− (6.6%), and PLN−PAN+ (2.4%). The probability of PAN metastasis in patients without PLN metastasis was 2.8% (9/325). The 5-year overall survival rates were 96.5% in PLN−PAN−, 77.6% in PLN+PAN−, 63.4% in PLN+PAN+, and 53.6% in PLN−PAN+ patients.
CONCLUSION
The likelihood of PAN metastasis in endometrial cancer patients without PLN metastasis is not negligible, and the prognosis of PLN−PAN+ is likely to be poor. The implications of a PLN−PAN+ lymphatic spread pattern should thus be taken into consideration when determining patient management strategies.

Keyword

Endometrial Neoplasms; Lymphatic Metastasis; Lymph Nodes; Prognosis

MeSH Terms

Adult
Aged
Aged, 80 and over
Endometrial Neoplasms/pathology
False Negative Reactions
Female
Humans
Lymph Node Excision
Lymph Nodes/*pathology
Lymphatic Metastasis/*diagnosis/pathology
Middle Aged
*Para-Aortic Bodies
*Pelvis
Prognosis
Retrospective Studies
Sentinel Lymph Node
Survival Rate
Young Adult

Figure

• 

  Fig. 1. Lymphatic spread pattern in 60 patients who underwent PAND up to the renal vein and were diagnosed with LNM. LNM, lymph node metastasis; PAN, para-aortic lymph node; PAND, para-aortic lymph node dissection; PLN, pelvic lymph node.

• 

  Fig. 2. Kaplan-Meier OS curves according to lymphatic spread pattern. OS, overall survival; PAN, para-aortic lymph node; PLN, pelvic lymph node.

Reference

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