Prognostic effect of isolated paraaortic nodal spread in endometrial cancer

Abstract

Objective: To evaluate the prognostic effect of isolated paraaortic lymph node metastasis in endometrial cancer (EC).Material and Methods: This retrospective study included patients with FIGO 2009 stage IIIC2 disease due to isolated paraaortic lymph nodemetastasis (LNM). Patients with sarcomatous histology, synchronous gynecologic cancers and patients with concurrent pelvic lymph nodemetastases or patients that have intraabdominal tumor spread were excluded. Kaplan-Meier method was used for calculation of progressionfree survival (PFS) and overall survival.Results: One thousand six hundred and fourteen patients were operated for EC during study period. Nine hundred and sixty-one patientsunderwent lymph node dissection and 25 (2.6%) were found to have isolated LNM in paraaortic region and these constituted the study cohort.Twenty (80%) patients had endometrioid EC. Median number of retrieved lymph nodes from pelvic region and paraaortic region was 21.5 (range:5-41) and 34.5 (range: 1-65), respectively. Median number of metastatic paraaortic nodes was 1 (range: 1-32). The median follow-up time was15 months (range 5-94). Seven (28%) patients recurred after a median of 20 months (range, 3-99) from initial surgery. Three patients recurredonly in pelvis, one patient had upper abdominal spread and 3 had isolated extraabdominal recurrence. Involvement of uterine serosa, positiveperitoneal cytology and presence of adnexal metastasis were significantly associated with diminished PFS (p