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Three-Year Recurrence-Free Survival in Patients With a Very Low Risk of Endometrial Cancer Who Did Not Undergo Lymph Node Dissection (Tree Retro): A Korean Multicenter Study
  1. Miseon Kim, MD*,
  2. ChelHun Choi, MD,
  3. Kidong Kim, MD*,
  4. Myong Cheol Lim, MD,
  5. Jeong-Yeol Park, MD§,
  6. Jin Hwa Hong, MD,
  7. Maria Lee, MD,
  8. Jiheum Paek, MD#,
  9. Jungyeob Seoung, MD**,
  10. Seungho Lee, MD†† and
  11. Taek Sang Lee, MD‡‡
  1. *Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam;
  2. Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul;
  3. Gynecologic Cancer Branch and Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang;
  4. §Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center;
  5. Department of Obstetrics and Gynecology, Guro Hospital, College of Medicine, Korea University;
  6. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul;
  7. #Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon;
  8. **Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Anyang;
  9. ††Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon; and
  10. ‡‡Department of Obstetrics and Gynecology, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
  1. Address correspondence and reprint requests to Kidong Kim, MD, Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea. E-mail:


Objective Randomized studies have not demonstrated a survival benefit of routine lymph node dissection in early-stage endometrial cancer. Many surgeons nevertheless perform lymph node dissection in all patients with early-stage endometrial cancer. This study aimed to ascertain the survival outcomes of very low-risk endometrial cancer patients (by the Korean Gynecologic Oncology Group [KGOG] criteria) who did not undergo lymph node dissection.

Materials and Methods Medical records of 156 consecutive patients who underwent surgical staging without lymph node dissection were collected from 10 institutions. All patients fulfilled the KGOG criteria: (1) endometrioid corpus cancer diagnosed by preoperative endometrial biopsy, (2) serum cancer antigen-125 level ⩽35 IU/mL, (3) <50% myometrial invasion with no extension beyond the uterine corpus by magnetic resonance imaging (MRI), and (4) no lymph nodes with a short diameter ≥1.0 cm by MRI or computed tomography. Sampling of <5 nodes was allowed at a surgeon's discretion. We evaluated the 3-year recurrence-free survival (RFS) and 5-year overall survival (OS) using the Kaplan-Meier method.

Results The median patient age was 52 years (range, 24–86 years). The median follow-up was 59 months (range, 0–189 months). The 3-year RFS and 5-year OS were 98.6% (95% confidence interval [CI], 96.8%–100.0%) and 98.6% (95% CI, 96.7%–100.0%), respectively. No disease-related mortality occurred. The final pathology report revealed ≥50% myometrial invasion in 29 patients (18.6%) and extension beyond the uterine corpus in 2 patients (1.3%). One patient (0.6%) was diagnosed with lymph node metastasis after lymph node sampling. Eighteen patients (11.5%) received adjuvant therapy after the final pathologic results indicated high risk.

Conclusions Very low-risk patients who did not undergo lymph node dissection had acceptable survival outcomes. Omitting lymph node dissection may be reasonable in patients satisfying the KGOG criteria.

  • Endometrial cancer
  • Lymph node dissection
  • Low risk
  • Recurrence-free survival

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  • Miseon Kim and ChelHun Choi have contributed equally to this work.

  • The authors declare no conflicts of interest.