Is lymphadenectomy a prognostic marker in endometrioid adenocarcinoma of the human endometrium?

Abstract

Background: During surgery for endometrial cancer, a pelvic lymphadenectomy with or without para-aortic lymphadenectomy is performed at least in patients with risk factors (stage I, grading 2 and/or histological subtypes with higher risk of lymphatic spread), and is hence recommended by the International Federation of Obstetrics and Gynecology (FIGO). Although lymph node metastases are important prognostic parameters, it has been contentious whether a pelvic lymph node dissection itself has a prognostic impact in the treatment of endometrial cancer, especially in endometrioid adenocarcinoma. Therefore, this study evaluated whether lymphadenectomy has a prognostic impact in patients with endometrioid adenocarcinoma.

Methods: The benefits of lymphadenectomy were examined in 214 patients with a histological diagnosis of endometrial adenocarcinoma. Tumour characteristics were analysed with respect to the surgical and pathological stage.

Results: Of the 214 patients with endometrial adenocarcinoma, 171 (79.9%) were classified as FIGO stage I, 15 (7.0%) FIGO stage II, 21 (9.8%) FIGO stage III and 7 (3.3%) FIGO stage IV. One hundred and thirty four (62.6%) of the patients had a histological grade 1 tumour, while 56 (26.2%) and 24 (11.2%) had a histological grade 2 or grade 3 tumour, respectively. Lymphadenectomy was performed in 151 (70.6%) patients. Only 11 (5.1%) patients showed metastatic disease in the lymph nodes. The performance of a lymphadenectomy resulted in significantly increased cause-specific and overall survival, while progression-free survival was not affected by this operative procedure.

Conclusions: The performance of an operative lymphadenectomy resulted in better survival of patients with endometrioid adenocarcinoma. This increase was significant for cause-specific and overall survival, while there was a tendency only towards increased progression-free survival. Therefore, even in endometrioid adenocarcinoma, a pelvic and/or para-aortic lymphadenectomy should be performed.

Figure 1

Progression-free survival. Kaplan-Meier curve of clinical outcome for progression-free survival demonstrates no significant difference arising from lymphadenectomy for patients at FIGO stage I (A), or all stages (B). Follow-up time is defined as the time until progression occurred.

Figure 2

Cause-specific survival. Kaplan-Meier curve of clinical outcome for cause-specific survival demonstrates a significant impact on patients treated with lymphadenectomy (log-rank: p = 0.044) at early FIGO stage (A) and all stages (B). Follow-up time is defined as the time until cause-specific death occurred.

Figure 3

Overall survival. Kaplan-Meier curve of clinical outcome for overall survival demonstrates a significant impact on patients treated with lymphadenectomy for FIGO stage I patients (A) and all stages (B) (log-rank: p < 0.001). Follow-up time is defined as the time until death occurred.

Figure 4

Cause-specific survival for patients at all stages. Kaplan-Meier curve of clinical outcome for cause-specific survival demonstrates a significant impact on patients treated with lymphadenectomy (log-rank: p=0.044) at all stages. Follow-up time is defined as the time until cause-specific death occurred.

Figure 5

Overall survival for patients at FIGO stage I. Kaplan-Meier curve of clinical outcome for overall survival demonstrates a significant impact on patients treated with lymphadenectomy for FIGO stage I patients (log-rank: p<0.001). Follow-up time is defined as the time until death occurred.

Figure 6

Overall survival for patients at all stages. Kaplan-Meier curve of clinical outcome for overall survival demonstrates a significant impact on patients treated with lymphadenectomy for all stages (log-rank: p<0.001). Follow-up time is defined as the time until death occurred.