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Risk factors for lymph node metastases in women with endometrial cancer: A population-based, nation-wide register study—On behalf of the Swedish Gynecological Cancer Group
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.ORCID iD: 0000-0001-5527-8796
Linkopings Univ, Dept Obstet & Gynecol, Linkoping, Sweden.;Linkopings Univ, Dept Clin & Expt Med, Linkoping, Sweden..
Skanes Univ Sjukhus, Dept Hematol Oncol & Radiat Phys, Lund, Sweden.;Lund Univ, Div Oncol & Pathol, Dept Clin Sci, Lund, Sweden..
Lund Univ, Skane Univ Hosp, Dept Obstet & Gynecol, Lund, Sweden..
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2017 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 140, no 12, 2693-2700 p.Article in journal (Refereed) Published
Abstract [en]

The role of lymphadenectomy in the management of early endometrial cancer remains controversial. In the recent ESMO-ESGO-ESTRO guidelines, lymphadenectomy is recommended for patients with endometrioid adenocarcinoma Grade 3 with deep myometrial invasion, but complete agreement was not achieved. In Sweden, DNA aneuploidy has been included as a high-risk factor. The aim of our study was to evaluate the impact of tumor histology, FIGO grade, DNA ploidy and myometrial invasion (MI) on occurrence of lymph node metastasis (LNM) in patients with endometrial cancer. The study design is a retrospective cohort study based on prospectively recorded register data. Endometrial cancer patients registered in the Swedish Quality Registry for Gynecologic Cancer 2010-2015 with FIGO Stages I-III and verified nodal status were included. Data on DNA ploidy, histology, FIGO grade and MI were included in multivariable log-binomial regression analyses with LNM as dependent variable. 1,165 cases fulfilled the inclusion criteria. The multivariable analyses revealed increased risk of LNM in patients with tumors with MI50% (risk ratio [RR]=4.1; 95% confidence interval [CI] 3.0-5.6), nonendometrioid compared to endometrioid histology (RR 1.8; CI 1.4-2.4) and FIGO Grade 3 compared to Grade 1-2 tumors (RR 1.5; CI 1.1-2.0). No statistically significant association between DNA ploidy status and LNM was detected. This population-based, nation-wide study in women with endometrial cancer confirms a strong association between MI50%, nonendometrioid histology and FIGO Grade 3, respectively, and LNM. DNA ploidy should not be included in the preoperative decision making of removing nodes or not. What's new? Whether lymphadenectomy is beneficial for women with endometrial cancer remains uncertain. Moreover, additional studies are needed to explore factors that reliably predict lymph node metastasis (LNM). Here, multiple factors, including tumor histology, grade of differentiation and DNA aneuploidy, were evaluated for associations with LNM risk in women with endometrial cancer and verified lymph node status. Most significantly, deep myometrial invasion in tumors increased LNM risk fourfold, whereas DNA ploidy had essentially no impact on LNM risk. The findings confirm the predictive relevance of myometrial invasion, histology and grade reported in previous single-center and multicenter studies.

Place, publisher, year, edition, pages
2017. Vol. 140, no 12, 2693-2700 p.
Keyword [en]
endometrial cancer, lymph node metastases, risk factor, epidemiology
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-322505DOI: 10.1002/ijc.30707ISI: 000400158800008PubMedID: 28340503OAI: oai:DiVA.org:uu-322505DiVA: diva2:1103485
Funder
Swedish Cancer Society
Available from: 2017-05-30 Created: 2017-05-30 Last updated: 2017-05-30Bibliographically approved

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