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Lymph Node Status Did Not Significantly Improve the Predictability of Survival in Patients With Clinically Early-Stage Endometrial Cancer
  1. Hyo Sook Bae, MD, PhD*,
  2. Jong-Min Lee, MD, PhD,
  3. Jae-Kwan Lee, MD, PhD,
  4. Jae-Weon Kim, MD, PhD§,
  5. Chi-Heum Cho, MD, PhD,
  6. Seok-Mo Kim, MD, PhD,
  7. Sang-Yoon Park, MD, PhD*,
  8. Chan-Yong Park, MD, PhD#,
  9. Ki-Tae Kim, MD, PhD** and
  10. Sokbom Kang, MD, PhD*
  1. *Center for Uterine Cancer, National Cancer Center, Goyang;
  2. Department of Obstetrics and Gynecology, School of Medicine, Kyung Hee University, Seoul;
  3. Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul;
  4. §Department of Obstetrics and Gynecology & Cancer Research Institute, College of Medicine, Seoul National University, Seoul;
  5. Department of Obstetrics and Gynecology, Dongsan Medical Center, Keimyung University, Daegu;
  6. Department of Obstetrics and Gynecology, Chonnam National University, Gwangju;
  7. #Department of Obstetrics and Gynecology, Gachon University Hospital, Incheon; and
  8. **Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University, Busan, South Korea.
  1. Address correspondence and reprint requests to Sokbom Kang, MD, PhD, Center for Uterine Cancer, National Cancer Center, Ilsan-gu Madu-dong, Goyang 410-769, South Korea. E-mail: sokbom{at}


Objective The aim of this study was to determine whether knowledge of lymph node status improves survival prediction in clinically early-stage endometrial cancer.

Methods The records of 661 patients with apparently uterine-confined disease were reviewed. The performance in predicting overall survival and cause-specific survival was compared between a multivariate prognostic model with nodal status and a model without nodal status by calculating Harrell concordance index.

Results Among 661 patients with clinically early-stage endometrial cancer, the lymph node metastasis rate was 8.3% (55/661). Lymph node metastasis independently associated with cause-specific survival only when no stratification according to adjuvant treatment was applied (P = 0.035). After stratification according to adjuvant radiotherapy, lymph node status marginally associated with cause-specific survival (P = 0.073), whereas myometrial invasion retained its strong association with cause-specific survival (P < 0.001). However, there was no significant difference in the performance of the survival model using only uterine factors and the model using lymph node status and uterine factors (concordance index, 0.77 vs 0.77, respectively; P = 0.798).

Conclusions Knowledge of lymph node status did not significantly improve the performance of survival prediction in apparently uterine-confined endometrial cancer, although it was independently associated with survival. In the patients with clinically early-stage endometrial cancer, the accuracy of the prediction of survival was comparable between risk grouping without lymph node status and that including lymph node status.

  • Endometrial cancer
  • Lymph node metastasis
  • Risk factor
  • Survival

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  • The authors declare no conflicts of interest.