Journal of Gynecologic Oncology

Korean Society of Gynecologic Oncology (대한부인종양학회)
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Survival in clinical stage I endometrial cancer with single vs. multiple positive pelvic nodes: results of a multi-institutional Italian study

  • Uccella, Stefano (Department of Woman and Child Health, Fondazione Policlinico Gemelli, I.R.C.C.S., Catholic University of the Sacred Heart) ;
  • Falcone, Francesca (Department of Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale", I.R.C.C.S.) ;
  • Greggi, Stefano (Department of Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale", I.R.C.C.S.) ;
  • Fanfani, Francesco (Department of Medicine and Ageing Sciences, G. D'Annunzio University of Chieti-Pescara) ;
  • De Iaco, Pierandrea (Department of General Surgery and Gynecologic Oncology Unit, Sant'Orsola Hospital) ;
  • Corrado, Giacomo (Department of Woman and Child Health, Fondazione Policlinico Gemelli, I.R.C.C.S., Catholic University of the Sacred Heart) ;
  • Ceccaroni, Marcello (Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital) ;
  • Mandato, Vincenzo Dario (Unit of Obstetrics and Gynecology, Azienda USL-I.R.C.C.S. di Reggio Emilia) ;
  • Bogliolo, Stefano (Unit of Gynecologic Cancer Surgery European Institute of Oncology) ;
  • Casarin, Jvan (Department of Obstetrics and Gynecology, University of Insubria) ;
  • Monterossi, Giorgia (Department of Woman and Child Health, Fondazione Policlinico Gemelli, I.R.C.C.S., Catholic University of the Sacred Heart) ;
  • Pinelli, Ciro (Department of Obstetrics and Gynecology, University of Insubria) ;
  • Mangili, Giorgia (Department of Gynecology and Obstetrics, I.R.C.C.S. San Raffaele Hospital) ;
  • Cormio, Gennaro (Gynecologic Oncology Unit, I.R.C.C.S., National Cancer Institute "Giovanni Paolo II") ;
  • Roviglione, Giovanni (Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital) ;
  • Bergamini, Alice (Department of Gynecology and Obstetrics, I.R.C.C.S. San Raffaele Hospital) ;
  • Pesci, Anna (Department of Pathology, Sacred Heart Hospital) ;
  • Frigerio, Luigi (Department of Obstetrics and Gynecology, Ospedale Papa Giovanni XXIII) ;
  • Uccella, Silvia (Department of Medicine and Surgery, Unit of Pathology, University of Insubria) ;
  • Vizza, Enrico (Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute) ;
  • Scambia, Giovanni (Department of Woman and Child Health, Fondazione Policlinico Gemelli, I.R.C.C.S., Catholic University of the Sacred Heart) ;
  • Ghezzi, Fabio (Department of Obstetrics and Gynecology, University of Insubria)
  • Received : 2018.05.24
  • Accepted : 2018.08.24
  • Published : 2018.11.10
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Abstract

Objective: To investigate survival outcomes in endometrioid endometrial cancer (EEC) patients with single vs. multiple positive pelvic lymph nodes. Methods: We performed a retrospective evaluation of all consecutive patients with histologically proven International Federation of Gynecology and Obstetrics (FIGO) stage IIIC1 EEC who underwent primary surgical treatment between 2004 and 2014 at seven Italian gynecologic oncology referral centers. Patients with pre- or intra-operative evidence of extra-uterine disease (including the presence of bulky nodes) and patients with stage IIIC2 disease were excluded, in order to obtain a homogeneous population. Results: Overall 140 patients met the inclusion criteria. The presence of >1 metastatic pelvic node was significantly associated with an increased risk of recurrence and mortality, compared to only 1 metastatic node, at both univariate (recurrence: hazard ratio [HR]=2.19; 95% confidence interval [CI]=1.2-3.99; p=0.01; mortality: HR=2.8; 95% CI=1.24-6.29; p=0.01) and multivariable analysis (recurrence: HR=1.91; 95% CI=1.02-3.56; p=0.04; mortality: HR=2.62; 95% CI=1.13-6.05; p=0.02) and it was the only independent predictor of prognosis in this subset of patients. Disease-free survival (DFS) and disease-specific survival (DSS) were significantly longer in patients with only 1 metastatic node compared to those with more than 1 metastatic node (p=0.008 and 0.009, respectively). Conclusion: The presence of multiple metastatic nodes in stage IIIC1 EEC represents an independent predictor of worse survival, compared to only one positive node. Our data suggest that EEC patients may be categorized according to the number of positive nodes.

Keywords

References

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