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.