J Gynecol Oncol.
2018 Nov;29(6):e100. 10.3802/jgo.2018.29.e100.
Survival in clinical stage I endometrial cancer with single vs. multiple positive pelvic nodes: results of a multi-institutional Italian study
- Uccella S
- Falcone F
- Greggi S
- Fanfani F
- De Iaco P
- Corrado G
- Ceccaroni
- Mandato VD
- Bogliolo S
- Casarin J
- Monterossi G
- Pinelli C
- Mangili G
- Cormio G
- Roviglione G
- Bergamini
- Pesci A
- Frigerio L
- Uccella S
- Vizza E
- Scambia G
- Ghezzi F
- Affiliations
-
- 1Department of Woman and Child Health, Fondazione Policlinico Gemelli, I.R.C.C.S., Catholic University of the Sacred Heart, Rome, Italy.
- 2Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
- 3Department of Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale", I.R.C.C.S., Naples, Italy. francesca.falcone3@libero.it
- 4Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
- 5Department of Medicine and Ageing Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy.
- 6Department of General Surgery and Gynecologic Oncology Unit, Sant'Orsola Hospital, Bologna, Italy.
- 7Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
- 8Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy.
- 9Unit of Obstetrics and Gynecology, Azienda USL-I.R.C.C.S. di Reggio Emilia, Reggio Emilia, Italy.
- 10Unit of Gynecologic Cancer Surgery European Institute of Oncology, Milan, Italy.
- 11Department of Obstetrics and Gynaecology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
- 12Department of Gynecology and Obstetrics, I.R.C.C.S. San Raffaele Hospital, Milan, Italy.
- 13Gynecologic Oncology Unit, I.R.C.C.S., National Cancer Institute "Giovanni Paolo II", Bari, Italy.
- 14Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
- 15Department of Pathology, Sacred Heart Hospital, Negrar, Verona, Italy.
- 16Department of Obstetrics and Gynecology, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
- 17Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy.
- KMID: 2431245
- DOI: http://doi.org/10.3802/jgo.2018.29.e100
Abstract
OBJECTIVE
To investigate survival outcomes in endometrioid endometrial cancer (EEC) patients with single vs. multiple positive pelvic lymph nodes.
METHODS
We performed a retrospective evaluation of all consecutive patients with histologically proven International Federation of Gynecology and Obstetrics (FIGO) stage IIIC1 EEC who underwent primary surgical treatment between 2004 and 2014 at seven Italian gynecologic oncology referral centers. Patients with pre- or intra-operative evidence of extra-uterine disease (including the presence of bulky nodes) and patients with stage IIIC2 disease were excluded, in order to obtain a homogeneous population.
RESULTS
Overall 140 patients met the inclusion criteria. The presence of >1 metastatic pelvic node was significantly associated with an increased risk of recurrence and mortality, compared to only 1 metastatic node, at both univariate (recurrence: hazard ratio [HR]=2.19; 95% confidence interval [CI]=1.2-3.99; p=0.01; mortality: HR=2.8; 95% CI=1.24-6.29; p=0.01) and multivariable analysis (recurrence: HR=1.91; 95% CI=1.02-3.56; p=0.04; mortality: HR=2.62; 95% CI=1.13-6.05; p=0.02) and it was the only independent predictor of prognosis in this subset of patients. Disease-free survival (DFS) and disease-specific survival (DSS) were significantly longer in patients with only 1 metastatic node compared to those with more than 1 metastatic node (p=0.008 and 0.009, respectively).
CONCLUSION
The presence of multiple metastatic nodes in stage IIIC1 EEC represents an independent predictor of worse survival, compared to only one positive node. Our data suggest that EEC patients may be categorized according to the number of positive nodes.
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