Introduction Objective. This study aimed to examine the prognostic impact of para-aortic lymphadenectomy (PALX) in endometrial cancer patients at post-operative risk of recurrence.
Methods JGOG2043 was a clinical trial conducted to assess the efficacy of three distinct chemotherapeutic regimens as adjuvant therapy in endometrial cancer patients with post-operative recurrent risk. A retrospective analysis was performed on patients who underwent pelvic lymphadenectomy (PLX) alone or both PLX and PALX in JGOG2043. Cases with residual disease or missing data were excluded. The number of resected and positive nodes and other clinicopathologic risk factors for survival were retrieved.
Results Four hundred two patients underwent PLX and PALX, while 250 underwent PLX alone. It was difficult to evaluate the survival impact of PALX because the PALX was more frequently applied for higher-risk cases with high-risk histology, more than 1/2 myometrial invasion, and positive pelvic lymph nodes. In the PLX and PALX group, Kaplan-Meier analysis showed that patients with two or more para-aortic lymph node (PAN) metastases exhibited significantly inferior overall survival (OS) compared to those with 0–1 metastasis (P<0.0001). Multivariate analysis revealed that two or more metastases in PAN are one of the independent risk factors (HR, 2.52; 95%CI, 1.48–4.27; P<0.001), as well as high-risk histology and advanced age for OS.
Conclusion/Implications The therapeutic significance of PAN removal was difficult to assess in the JGOG 2043 cohort, but two or more PAN metastases were identified as a significant poor prognostic factor.
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