Risk factors for pelvic lymph node metastasis in endometrial cancer

Abstract

Purpose: To evaluate the risk factors for pelvic lymph node metastasis (LNM) in endometrial cancer (EC).

Methods: Clinicopathological characteristics and preoperative laboratory results were retrospectively analyzed in 393 surgically staged patients with EC (January 2014-February 2019).

Results: Pelvic LNM was detected in 45 (11.5%) patients. Univariate analysis showed that increased preoperative levels of human epididymis protein 4 (HE4), carbohydrate antigen 125 (CA125), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), and decreased absolute lymphocyte count (ALC), as well as non-endometrioid histology, grade 3 tumor, deep myometrial invasion, vaginal or para-uterine involvement, adnexal involvement, positive peritoneal cytology, and lymphovascular space invasion (LVSI) were risk factors for pelvic LNM (All p < 0.05). Multivariate analysis revealed that preoperative serum HE4 ≥ 132 pmol/L (odds ratio (OR) 4.25, 95% confidence interval (CI) 1.65-10.94, p = 0.003), serum CA 125 ≥ 27.6 U/mL (OR 6.10, 95% CI 2.31-16.07, p = 0.000), non-endometrioid histology (OR 16.64, 95% CI 5.96-46.47, p = 0.000), myometrial invasion ≥ 50% (OR 5.30, 95% CI 2.07-13.55, p = 0.001), positive peritoneal cytology (OR 4.70, 95% CI 1.21-18.27, p = 0.025), and LVSI (OR 3.11, 95% CI 1.09-8.92, p = 0.034) remained as independent risk factors for pelvic LNM in EC. With the increase of these independent risk factors, the rate of pelvic LNM was increased significantly.

Conclusions: Higher preoperative levels of serum HE4 and CA125, non-endometrioid histology, deep myometrial invasion, positive peritoneal cytology, and LVSI are independent risk factors for pelvic LNM in EC, which can provide scientific basis for lymphadenectomy.

Keywords: Carbohydrate antigen 125; Endometrial cancer; Human epididymis protein 4; Pelvic lymph node metastasis; Risk factors.