Isolated lymphatic recurrence in endometrial cancer: characteristics of patients, primary tumor, and related recurrence details
| Characteristic | All ILR n=66 | Site of recurrence | ||||
| Pelvic ILR n=9 (13.6%) | Para-aortic ILR n=15 (22.7%) | Distant ILR n=16 (24.2%) | Multiple ILR sites n=26 (39.4%) | P* value | ||
| Age at primary surgery (years), mean (SD) | 63.8 (10.1) | 70.2 (11.8) | 61.3 (12.8) | 63.6 (7.1) | 63.1 (8.8) | 0.31 |
| Tumor diameter (mm), median (IQR) | 42 (32–65) | 54 (40–72) | 50 (36–65) | 42 (30–70) | 40 (30–62) | 0.64 |
| Tumor diameter, N (%) | 0.35 | |||||
| ≤2 cm | 5 (7.6) | – | – | 3 (18.8) | 2 (7.7) | |
| >2 cm | 57 (86.4) | 9 (100.0) | 15 (100.0) | 12 (75.0) | 21 (80.8) | |
| Unknown | 4 (6.1) | – | – | 1 (6.3) | 3 (11.5) | |
| Histology, N (%) | 0.89 | |||||
| Endometrioid | 41 (62.1) | 5 (55.6) | 10 (66.7) | 9 (56.3) | 17 (65.4) | |
| Non-endometrioid† | 25 (37.9) | 4 (44.4) | 5 (33.3) | 7 (43.8) | 9 (34.6) | |
| FIGO stage, N (%) | 0.10 | |||||
| I–II | 15 (22.7) | 4 (44.4) | 5 (33.3) | 1 (6.3) | 5 (19.2) | |
| III–IV | 51 (77.3) | 5 (55.6) | 10 (66.7) | 15 (93.8) | 21 (80.8) | |
| FIGO grade, N (%) | 0.80 | |||||
| 1 | 13 (19.7) | 1 (11.1) | 3 (20.0) | 4 (25.0) | 5 (19.2) | |
| 2 | 14 (21.2) | 1 (11.1) | 5 (33.3) | 2 (12.5) | 6 (23.1) | |
| 3 | 39 (59.1) | 7 (77.8) | 7 (46.7) | 10 (62.5) | 15 (57.7) | |
| LVSI, N (%) | 0.51 | |||||
| No | 30 (45.5) | 4 (44.4) | 10 (66.7) | 5 (31.3) | 11 (42.3) | |
| Yes | 31 (47.0) | 4 (44.4) | 5 (33.3) | 9 (56.3) | 13 (50.0) | |
| Unknown | 5 (7.6) | 1 (11.1) | – | 2 (12.5) | 2 (7.7) | |
| Myometrial invasion, N (%) | 0.83 | |||||
| <50% | 26 (39.4) | 3 (33.3) | 5 (33.3) | 6 (37.5) | 12 (46.2) | |
| ≥50% | 40 (60.6) | 6 (66.7) | 10 (66.7) | 10 (62.5) | 14 (53.8) | |
| Lymph node assessment details | ||||||
| Lymphadenectomy, N (%) | 0.40 | |||||
| None | 6 (9.1) | – | 1 (6.7) | 3 (18.8) | 2 (7.7) | |
| Para-aortic only | 1 (1.5) | – | – | – | 1 (3.8) | |
| Pelvic only | 20 (30.3) | 1 (11.1) | 5 (33.3) | 3 (18.8) | 11 (42.3) | |
| Pelvic and para-aortic | 39 (59.1) | 8 (88.9) | 9 (60.0) | 10 (62.5) | 12 (46.2) | |
| Number of LNs removed via LND, median (IQR)‡ | ||||||
| Total | 31 (18–45) | 44 (40–46) | 33 (22–49) | 29 (6–45) | 20 (10–35) | 0.12 |
| Pelvic | 24 (13–33) | 29 (25–33) | 26 (21–35) | 24 (6–34) | 20 (12–30) | 0.34 |
| Para-aortic | 10 (5–18) | 13 (11–19) | 15 (5–18) | 8 (4–11) | 6 (3–11) | 0.25 |
| Positive LNs via LND, N (%) | 0.52 | |||||
| No LND | 6 (9.1) | – | 1 (6.7) | 3 (18.8) | 2 (7.7) | |
| LND with negative nodes | 19 (28.8) | 5 (55.6) | 4 (26.7) | 3 (18.8) | 7 (26.9) | |
| LND with positive nodes | 41 (62.1) | 4 (44.4) | 10 (66.7) | 10 (62.5) | 17 (65.4) | |
| Adjuvant therapy details | ||||||
| Adjuvant therapy, N (%) | 0.53 | |||||
| Observation±VBT | 19 (29.2) | 4 (44.4) | 5 (33.3) | 2 (12.5) | 8 (32.0) | |
| EBRT±VBT | 22 (33.8) | 2 (22.2) | 7 (46.7) | 7 (43.8) | 6 (24.0) | |
| Chemotherapy±VBT | 17 (26.2) | 2 (22.2) | 3 (20.0) | 4 (25.0) | 8 (32.0) | |
| Chemotherapy and EBRT±VBT | 7 (10.8) | 1 (11.1) | – | 3 (18.8) | 3 (12.0) | |
| Unknown | 1 | – | – | – | 1 | |
| Recurrence details | ||||||
| Timing of recurrence following surgery (years), median (IQR) | 1.0 (0.6–2.4) | 1.2 (1.2–1.6) | 1.2 (0.7–2.4) | 0.7 (0.5–2.0) | 0.8 (0.4–2.8) | 0.62 |
| LR in an area that was not previously irradiated,§ N (%) | 0.005 | |||||
| No | 11 (16.7) | 3 (33.3) | – | – | 8 (30.8) | |
| Yes | 54 (81.8) | 6 (66.7) | 15 (100.0) | 16 (100.0) | 17 (65.4) | |
| Unknown | 1 (1.5) | – | – | – | 1 (3.8) | |
| Treatment of ILR | 0.52 | |||||
| Observation or hormonal therapy only | 15 (22.7) | 2 (22.2) | 3 (20.0) | 3 (18.8) | 7 (26.9) | |
| Chemotherapy and/or radiotherapy | 33 (50.0) | 4 (44.4) | 5 (33.3) | 9 (56.3) | 15 (57.7) | |
| Surgery±other treatments | 18 (27.3) | 3 (33.3) | 7 (46.7) | 4 (25.0) | 4 (15.4) | |
*Kruskal-Wallis p value reported for continuous variables and Χ2, or Fisher’s exact p value reported for categorical variables obtained comparing the four groups with a different site of ILR.
†Non-endometrioid histology includes: 20 serous, 2 clear cell, 1 carcinosarcoma, 1 undifferentiated, and 1 mixed (endometrioid serous).
‡Among those who had the lymphadenectomy; one patient with an unknown number of nodes removed.
§In the case of multiple sites of ILR, such as pelvic and para-aortic recurrence, all the areas need to be not irradiated to consider the ILR as a recurrence in a non-irradiated area.
EBRT, external beam radiation therapy; FIGO, International Federation of Gynecology and Obstetrics; ILR, isolated lymphatic recurrence; LN, lymph node; LND, lymphadenectomy; LR, lymphatic recurrence; LVSI, lymphovascular space invasion; VBT, vaginal brachytherapy.