Evaluation of Factors Influencing Lymph Node Metastasis in Grade 3
Endometrial Cancers: A Retrospective Study
Abstract
Objective: To evaluate the risk of lymph node metastasis and figure out
necessity of lymphadenectomy in grade 3 endometroid endometrial cancer
(EEC) patients. Methods: From 2009 to 2019, 3751 endometrial cancer (EC)
patients were diagnosed at Gynecology Hospital of Fudan University, 1235
EEC patients were enrolled in multivariable analysis. 381 patients had
survival analysis attributed to sufficient follow-up information.
Kaplan-Meier curve and logrank test were used to analyze the survival
rate. Results: Among 1235 EEC patients, multivariate analysis showed
lymph-vascular invasion (LVSI), adnexal involvement (AI), cervical
stroma involvement (CSI) were independent risk factors of lymph node
metastasis (LNM) in grade 3 (G3) cohort (OR=3.45, 5.83, 8.93; 95% CI
1.12-10.64, 1.52-22.35, 2.85-28.00 respectively). LNM rates increased
from 3.3% to 75% for EEC G3 cohort with the increase of risk factors
from one to three. There were no differences between G3 and grade 1&2
(G1&2) in overall survival or progression free survival. Similarly, no
survival advantage was found for EEC G3 patients at early stage with
different plans of adjuvant treatment. Conclusion: When EEC G3 patients
combine with one or more risk factors including LVSI, AI and CSI,
lymphadenectomy is recommended. For those with only one factor of G3, it
is recommended to evaluate the status of lymph nodes by considering
other methods such as sentinel lymph node biopsy technology to avoid
overtreatment. Survival analysis showed no difference in EEC G3 cohort
compared with G1&2. Also, different plans of adjuvant treatment had no
impact on overall survival for EEC G3 patients.