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Ultrastaging of ‘negative’ pelvic lymph nodes in patients with low- and intermediate-risk endometrioid endometrial cancer who developed non-vaginal recurrences
  1. Sarah E Gill1,
  2. Simone Garzon2,3,
  3. Francesco Multinu4,
  4. Alexis N Hokenstad5,
  5. Jvan Casarin3,
  6. Serena Cappuccio6,
  7. Michaela E McGree7,
  8. Amy L Weaver7,
  9. William A Cliby2,
  10. Gary L Keeney8 and
  11. Andrea Mariani2
  1. 1Division of Gynecologic Oncology, Nancy N and J C Lewis Cancer and Research Pavilion, Savannah, Georgia, USA
  2. 2Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
  4. 4Division of Gynecologic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
  5. 5Department of Obstetrics and Gynecology, Billings Clinic Cancer Center, Billings, Montana, USA
  6. 6Department of Woman's, Child's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  7. 7Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
  8. 8Division of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Andrea Mariani, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA; mariani.andrea{at}mayo.edu

Abstract

Objective Evidence on micrometastases and isolated tumor cells as factors associated with non-vaginal recurrence in low- and intermediate-risk endometrial cancer is limited. The goal of our study was to investigate risk factors for non-vaginal recurrence in low- and intermediate-risk endometrial cancer.

Methods Records of all patients with endometrial cancer surgically managed at the Mayo Clinic before sentinel lymph node implementation (1999–2008) were reviewed. We identified all patients with endometrioid low-risk (International Federation of Gynecology and Obstetrics (FIGO) stage I, grade 1 or 2 with myometrial invasion <50% and negative peritoneal cytology) or intermediate-risk (FIGO stage I, grade 1 or 2 with myometrial invasion ≥50% or grade 3 with myometrial invasion <50% and negative peritoneal cytology) endometrial cancer at definitive pathology after pelvic and para-aortic lymph node assessment. All pelvic lymph nodes of patients with non-vaginal recurrence (any recurrence excluding isolated vaginal cuff recurrences) underwent ultrastaging.

Results Among 1303 women, we identified 321 patients with low-risk (n=236) or intermediate-risk (n=85) endometrial cancer (median age 65.4 years; 266 (82.9%) stage IA; 55 (17.1%) stage IB). Of the total of 321, 13 patients developed non-vaginal recurrence (Kaplan–Meier rate 4.7% by 60 months; 95% CI 2.1% to 7.2%): 11 hematogenous/peritoneal and two para-aortic and distant lymphatic. Myometrial invasion and lymphovascular space invasion were univariately associated with non-vaginal recurrence. In these patients, the original hematoxylin/eosin slides review confirmed all 646 pelvic and para-aortic removed lymph nodes as negative. The ultrastaging of 463 pelvic lymph nodes did not identify any occult metastases (prevalence 0%; 95% CI 0% to 22.8% considering 13 patients; 95% CI 0% to 0.8% considering 463 pelvic lymph nodes).

Conclusion There were no occult metastases in pelvic lymph nodes of patients with low- or intermediate-risk endometrial cancer with non-vaginal recurrence. Myometrial invasion and lymphovascular space invasion appear to be associated with non-vaginal recurrence.

  • uterine cancer

Data availability statement

Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for the reproducibility of this study in other centers if such is requested.

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Data availability statement

Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for the reproducibility of this study in other centers if such is requested.

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Footnotes

  • SEG and SG are joint first authors.

  • Twitter @Fmultinu

  • SEG and SG contributed equally.

  • Contributors Guarantor: AM. Conceived and designed the study: SEG, FM, SG, ANH, JC, SC, and AM. Data collection, analysis, and interpretation: SEG, SG, FM, MM, ALW, WC, and AM. Pathologic review of original slides: GLK. Pathologic review of ultrastaging slides: GLK and SG. Writing, review, and editing: All authors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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