Introduction
Endometrial cancer (EC) is the fifth most common gynecological malignancy and the prevalence is increasing1. 569847 new cases of EC were diagnosed in 2018 worldwide2, and the number of EC patients would increase to 42.13/100000 patients in 2030 in USA as prediction3. In China, the incidence of EC had an upward trend for decades4. Around 75% of EC patients were diagnosed at an early stage (FIGO stage I or II) and could be treated timely, therefore EC had a relatively good 5-year overall survival (OS) ranged from 74% to 91%4,5. The main treatment of EC is standard surgery (including hysterectomy, bilateral salpingo-oophorectomy and evaluation of lymph node metastasis). Risk factors of EC are often taken into consideration for the decision of the operation extent.
Grade 3 had been classified as one of the high-risk factors for recommending comprehensive surgery including pelvic or para aortic lymphadenectomy (LND) as to Mayo Clinic standard 6,7. Can we perform systemic lymphadenectomy for every G3 EC patient?
Some researchers suggested treatments like exclusive LND are not always necessary. Two randomized trials evaluated systematic pelvic LND compared with no LND and neither trial showed survival benefit for the LND arm in early EC patients 8,9. For avoiding excessive side effects of LND, the biopsy of sentinel lymph node (SLN) has been used in the high-risk type of endometrial cancer recently10,11, but this technique is not widely used, especially in regions with poor medical resource. In addition, there is also an awkward situation of pathological upgrading to G3 only after the operation. Therefore, it is a challenge to make a decision of surgical spectrum before operations and achieve the goal of maximum resection of lesions and minimum injury.
this retrospective analysis was done to investigate the relevant risk factors for lymph node metastasis (LNM) in EEC G3 patients so that better clinical decisions can be made to avoid overtreatment, especially in hospitals without sentinel biopsy techniques.