Whether intermediate-risk stage 1A, grade 1/2, endometrioid endometrial cancer patients with lesions larger than 2 cm warrant lymph node dissection?

Menghan Zhu, Nan Jia, Feifei Huang, Xiaoxia Liu, Yuqing Zhao, Xiang Tao, Wei Jiang, Qin Li, Weiwei Feng, Menghan Zhu, Nan Jia, Feifei Huang, Xiaoxia Liu, Yuqing Zhao, Xiang Tao, Wei Jiang, Qin Li, Weiwei Feng

Abstract

Background: Our research aimed to investigate whether lymphadenectomy was required in patients with intermediate-risk endometrioid endometrial cancer (EEC).

Methods: Between 1989 and 2015, 1009 patients with intermediate-risk EEC: grade 1 or 2 tumor, <50% myometrial invasion, and a tumor diameter ≥ 2 cm and 818 low-risk patients with grade 1 or 2 tumor, <50% myometrial invasion, and a tumor diameter < 2 cm were enrolled in this study. The rate and risk factors of node metastasis were evaluated and compared between the two risk groups. Survival data were analyzed in patients with intermediate-risk EEC with or without lymphadenectomy.

Results: In all, 624 of 1009 (61.8%) patients with intermediate-risk EEC underwent pelvic ± para-aortic lymphadenectomy with a nodal metastasis rate of 1.9% (12/624), whereas 394 of 818 (48.2%) patients with low-risk EEC underwent pelvic ± para-aortic lymphadenectomy with a nodal metastasis rate of 0.3% (1/394) (p = 0.021). Notably, intermediate-risk EEC patients with a microcystic, elongated and fragmented (MELF) pattern of invasion, lymphatic vascular space invasion (LVSI), diffuse lesions, or lesions located in the cornua were more likely to have node metastasis. The 5-year overall cancer-related survival and the recurrence-free survival rates of the 742 intermediate-risk EEC patients who were followed for more than 3 years were 99.4% and 94.7%, respectively. In intermediate-risk group, 6 patients (6/443, 1.4%) with lymphadenectomy and 9 patients (9/299, 3.0%) without lymphadenectomy recurred, with a mean recurrence time of 38.3 and 18.7 months respectively. The five-year overall and recurrence-free survival rates of intermediate-risk patients with and without lymphadenectomy were similar (100% vs 98.9%, p = 0.351; 95.2% vs 93.3%, p = 0.464).

Conclusion: Patients with intermediate-risk EEC have low nodal metastasis rate and a favorable outcome whether lymphadenectomy is performed or not. Omission of lymphadenectomy may be a reasonable option in the surgical management of patients with intermediate-risk EEC.

Keywords: Endometrial cancer; Endometrioid, Intermediate-risk; Lymphadenectomy; Prognosis.

Conflict of interest statement

Ethics approval and consent to participate

All enrolled patients provided written consent. The data in the study were collected from the hospital’s archived database and follow-up information. The data were used only for research. The study was approved by the ethics committee of the Obstetrics and Gynecology Hospital of Fudan University (number: 2016–73).

Consent for publication

We have informed all patients in informed consent form that their personal profile including names, phone numbers and family addresses would not be disclosed. And we also informed them in this informed consent form that other information like age, family history, and pathological diagnoses may be published on our manuscript. All enrolled patients provided written consent. The study was approved by the ethics committee of the Obstetrics and Gynecology Hospital of Fudan University (number: 2016–73).

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Diagram of the study design
Fig. 2
Fig. 2
Survival analysis for intermediate-risk EEC patients with and without lymphadenectomy. Recurrence –free survival (a) and overall cancer-related survival (b) were not different between intermediate-risk EEC patients with and without lymphadenectomy

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