J Gynecol Oncol.  2018 Jul;29(4):e48. 10.3802/jgo.2018.29.e48.

Impact of lymph node ratio on survival in stage IIIC endometrioid endometrial cancer: a Turkish Gynecologic Oncology Group study

• Ayhan A
• Topfedaisi Ozkan N
• Öz M
• Kimyon Comert G
• Firat Cuylan Z
• Çoban G
• Turkmen O
• Erdem B
• Åžahin H
• Akbayır O
• Dede M
• Turan AT
• Celik H
• Güngör T
• Haberal A
• Arvas M
• Meydanli M

• KMID: 2417438
• DOI: http://doi.org/10.3802/jgo.2018.29.e48

Abstract

OBJECTIVE
The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in women with stage IIIC endometrioid endometrial cancer (EC).
METHODS
A multicenter, retrospective department database review was performed to identify patients with stage IIIC pure endometrioid EC at 6 gynecologic oncology centers in Turkey. A total of 207 women were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 2 groups: LNR1 (≤0.15), and LNR2 (>0.15). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models.
RESULTS
One hundred and one (48.8%) were classified as stage IIIC1 and 106 (51.2%) as stage IIIC2. The median age at diagnosis was 58 (range, 30-82) and the median duration of follow-up was 40 months (range, 1-228 months). There were 167 (80.7%) women with LNR ≤0.15, and 40 (19.3%) women with LNR >0.15. The 5-year progression-free survival (PFS) rates for LNR ≤0.15 and LNR >0.15 were 76.1%, and 58.5%, respectively (p=0.045). An increased LNR was associated with a decrease in 5-year overall survival (OS) from 87.0% for LNR ≤0.15 to 62.3% for LNR >0.15 (p=0.005). LNR >0.15 was found to be an independent prognostic factor for both PFS (hazard ratio [HR]=2.05; 95% confidence interval [CI]=1.07-3.93; p=0.03) and OS (HR=3.35; 95% CI=1.57-7.19; p=0.002).
CONCLUSION
LNR seems to be an independent prognostic factor for decreased PFS and OS in stage IIIC pure endometrioid EC.

Keyword

Survival Rate; Endometrioid Carcinoma; Endometrial Neoplasms; Lymph Node Excision; Disease-Free Survival

MeSH Terms

Carcinoma, Endometrioid
Diagnosis
Disease-Free Survival
Endometrial Neoplasms*
Female
Follow-Up Studies
Humans
Lymph Node Excision
Lymph Nodes*
Methods
Proportional Hazards Models
Retrospective Studies
Survival Rate
Turkey