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Impact of Lymph Node Ratio and Adjuvant Therapy in Node-Positive Endometrioid Endometrial Cancer
  1. Nicole D. Fleming, MD*,
  2. Pamela T. Soliman, MD*,
  3. Shannon N. Westin, MD*,
  4. Ricardo dos Reis, MD,
  5. Mark Munsell, PhD,
  6. Ann H. Klopp, MD, PhD§,
  7. Michael Frumovitz, MD*,
  8. Alpa M. Nick, MD*,
  9. Kathleen Schmeler, MD* and
  10. Pedro T. Ramirez, MD*
  1. *Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX;
  2. Department of Gynecologic Oncology, Hospital de Cancer de Barretos, Sao Paulo, Brazil; and Departments of
  3. Biostatistics and
  4. §Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
  1. Address correspondence and reprint requests to Nicole D. Fleming, MD, Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, 1155 Pressler Dr, Unit 1362, Houston, TX 77030. E-mail:


Objectives To determine if the ratio of positive to negative lymph nodes, or lymph node ratio (LNR), is a prognostic variable in patients with node-positive endometrial cancer and the impact of adjuvant therapy on survival.

Methods After institutional review board approval, a retrospective review of patients diagnosed as having stage IIIC endometrioid or mixed endometrioid endometrial cancer at a single institution from January 2000 through October 2011 was performed. Clinicopathologic and adjuvant treatment data were collected. Univariate and multivariate analysis were used to identify prognostic factors for progression-free (PFS) and overall survival.

Results One hundred twenty-four patients with stage IIIC1 (n = 64) and IIIC2 (n = 60) endometrial cancer were included in the analysis. Median age was 60 years (range, 25–84 years), and median follow-up was 49.4 months (range, 0.1–301.6 months). Age >70 years was identified as a prognostic factor for worse PFS (P = 0.0002) and overall survival (P = 0.0002) on multivariate analysis. Patients in this cohort receiving any adjuvant radiotherapy showed improved PFS (hazard ratio [HR], 0.34; 95% CI, 0.13–0.90; P = 0.03) compared with those receiving any adjuvant chemotherapy (HR, 2.33; 95% CI, 1.16–4.65; P = 0.02). In a subgroup analysis, patients with at least 10 nodes removed (n = 81) with an LNR greater than 50% had a PFS of 25.2 months compared with 135.6 months with an LNR of 50% or less (HR, 3.87; 95% CI, 1.15–13.04; P = 0.03).

Conclusions Lymph node ratio may define a subgroup of stage IIIC endometrial cancers at increased risk for recurrence. Adjuvant radiotherapy was associated with decreased recurrence risk.

  • Lymph node ratio
  • Endometrial cancer

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  • Funding statement: This research is supported, in part, by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant CA016672 (M.F.M.) and the National Institutes of Health K12 Calabresi Scholar Award (K12 CA088084; S.N.W.).

  • The authors declare no conflicts of interest.