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  • EP152/#356  The prognostic significance of para-aortic lymph node metastases in endometrial cancer: Japanese gynecologic oncology group study JGOG2043 post HOC analysis

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AS04. Endometrial/Uterine corpus cancers
EP152/#356  The prognostic significance of para-aortic lymph node metastases in endometrial cancer: Japanese gynecologic oncology group study JGOG2043 post HOC analysis
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  1. Hiroko Matsumiya1,
  2. Yosuke Konno1,
  3. Hidemichi Watari2,
  4. Michinori Mayama3,
  5. Jiro Suzuki4,
  6. Nobuyuki Susumu5,
  7. Kenichi Harano6,
  8. Kei Nakagawa7,
  9. Toru Nakanishi8,
  10. Wataru Yamagami9,
  11. Kosuke Yoshihara10,
  12. Hiroyuki Nomura11,
  13. Yoshihito Yokoyama12,
  14. Kazuhiro Takehara13 and
  15. Aikou Okamoto4
  1. 1Hokkaido University Hospital, Department of Gynecology, Sapporo, Japan
  2. 2Hokkaido University school of medicine, Department of Obsterics and Gynecology, Sapporo, Japan
  3. 3University of Pennsylvania, School of Veterinary Medicine, Biomedical Science, Philadelphia, USA
  4. 4The Jikei University, Department of Obstetrics and Gynecology, Tokyo, Japan
  5. 5International University of Health and Welfare, Department of Obstetrics and Gynecology, Narita, Japan
  6. 6National Cancer Center Hospital East, Department of Medical Oncology, Kashiwa, Japan
  7. 7Osaka University, Department of Obstetrics and Gynecology, Suita, Japan
  8. 8Tohoku medical and pharmaceutical University, Department of Obstetrics and Gynecology, Sendai, Japan
  9. 9Keio University School of Medicine, Department of Gynecologic Oncology, Tokyo, Japan
  10. 10Niigata University Graduate School of Medical and Dental Sciences, Department of Obstetrics and Gynecology, Niigata, Japan
  11. 11Fujita Health University, Department of Obstetrics and Gynecology, Toyoake, Japan
  12. 12Hirosaki University, Department of Obstetrics and Gynecology, Hirosaki, Japan
  13. 13National Hospital Organization Shikoku Cancer Center, Department of Gynecologic Oncology,, Matsuyama, Japan

Abstract

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.

https://doi.org/10.1136/ijgc-2023-IGCS.245

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