Prevalence of lymph node involvement in patients with endometrial cancer, Colombia 2009-2016: Exploratory analysis of associated factors
DOI:
https://doi.org/10.18597/rcog.3450Abstract
Objective: To determine the prevalence of lymph node involvement in patients with endometrial cancer and to explore factors associated with lymph node invasion. Materials and methods: Prevalence study with exploratory analysis. The study included patients with endometrial cancer who underwent total abdominal hysterectomy plus bilateral salpyingooophorectomy and pelvic lymphadenectomy with or without para-aortic lymphadenectomy in seven oncology centers in Colombia between 2009 and 2016. Patients who had received prior radiotherapy or chemotherapy, with a histological diagnosis of neuroendocrine tumors, carcinosarcomas or synchronous or metachronous lesions were excluded. Non-probabilistic sampling. Sample size n=290. Measured variables: sociodemographic, clinical and histopathological, and pelvic or para-aortic lymph node involvement. The prevalence for the period is presented. The exploratory analysis was conducted using crude odds ratio (OR) and adjusted OR by means of a multivariate model (unconditional logistic regression). Results: Overall, 467 cases were retrieved. Of them, 163 were excluded because of non-availability of all the variables. In total, 304 patients were studied. The prevalence of lymph node involvement was 15.8% (48/304). In the crude and adjusted analysis, factors associated with lymph node involvement were lymphovascular invasion (adjusted OR: 9.32; 95% CI 4.27-21.15) and myometrial invasion (adjusted OR: 3.95; 95% CI 1.29-14.98). Conclusion: Of the patients undergoing lymphadenectomy, 15% have lymph node involvement. Less invasive diagnostic options than radical surgery to ascertain lymph node invasion should be assessed.
Author Biographies
Robinson Segundo Fernández-Mercado, Unidad de Ginecología Oncológica, Misión Médica, Barranquilla (Colombia).
Unidad de Ginecología Oncológica, Misión Médica, Clínica Bonnadona, Prevenir, Clínica Julio Enrique Medrano, Barranquilla (Colombia).
Mauricio Arturo Miranda-Mejía, Universidad del Norte. Barranquilla (Colombia).
Universidad del Norte. Barranquilla (Colombia).
Angélica Viviana Fletcher-Prieto, Clínica San Diego (CIOSAD), Bogotá (Colombia).
Centro de Investigaciones Oncológicas, Clínica San Diego (CIOSAD), Bogotá (Colombia).
Jorge Alexander Rodríguez-Gallego, Hospital Manuel Uribe Ángel, Medellín (Colombia).
Hospital Manuel Uribe Ángel, Medellín (Colombia).
Edmundo Mora-Padilla, Hospital San José. Bogotá (Colombia).
Hospital San José. Bogotá (Colombia).
Simón Orostegui-Correa, Clínica San Luis, Bucaramanga (Colombia).
Clínica San Luis, Bucaramanga (Colombia).
Álvaro González-Rubio de la Hoz, Unidad de Ginecología Oncológica Misión Médica, Barranquilla (Colombia).
Unidad de Ginecología Oncológica Misión Médica. Barranquilla (Colombia).
Carlos Alberto Vallejo-Bertel, Fundación Universitaria de Ciencias de la Salud. Bogotá (Colombia).
Fundación Universitaria de Ciencias de la Salud. Bogotá (Colombia).
James Sáenz-Salazar, Instituto Nacional de Cancerología. Bogotá (Colombia).
Instituto Nacional de Cancerología. Bogotá (Colombia).
María Alejandra Fernández-Cásseres, Unidad de Ginecología oncológica, Misión Médica. Barranquilla (Colombia).
Unidad de Ginecología oncológica, Misión Médica. Barranquilla (Colombia).
Karen Cecilia Flórez-Lozano, Universidad del Norte, Barranquilla (Colombia).
Universidad del Norte, Barranquilla (Colombia).
Édgar Navarro-Lechuga, Universidad del Norte. Barranquilla (Colombia).
Universidad del Norte. Barranquilla (Colombia).
References
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin. 2018;68(6):394-424. https://doi.org/10.3322/caac.21492
Pardo C, Cendales R. Incidencia, mortalidad y prevalencia de cáncer en Colombia, 2007-2011. Bogotá: Instituto Nacional de Cancerología; 2015. p. 148.
Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105:103-4. https://doi.org/10.1016/j.ijgo.2009.02.012
Prat J. Prognostic parameters of endometrial carcinoma. Hum Pathol. 2004;35(6):649-62. https://doi.org/10.1016/j.humpath.2004.02.007
Milam MR, Java J, Walker JL, Metzinger DS, Parker LP, Coleman RL; Gynecologic Oncology Group. Nodal metastasis risk in endometrioid endometrial cancer. Obstet Gynecol. 2012;119(2Pt 1):286-92. https://doi.org/10.1097/AOG.0b013e318240de51
Dinkelspiel HE, Wright JD, Lewin SN, Herzog TJ. Contemporar y clinical management of endometrial cancer. Obstet Gynecol Int. 2013;2013:583891. https://doi.org/10.1155/2013/583891
ASTEC study group, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): A randomised study. Lancet. 2009;373(9658):125-36. https://doi.org/10.1016/S0140-6736(08)61766-3
Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987;60(8 Suppl): 2035-41. https://doi.org/10.1002/1097-0142(19901015)60:8+<2035::AID-CNCR2820601515>3.0.CO;2-8
Todoa Y, Yamamotob R, Minobea S, Suzukia Y, Takeshia U, Nakatania M, et al. Risk factors for postoperative lower extremity lymphedema in endometrial cancer survivors who had treatment including lymphadenectomy. Gynecol Oncol. 2010;119:60-64. https://doi.org/10.1016/j.ygyno.2010.06.018
Abu-Rustum NR, Alektiar K, Iasonos A, et al. The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: A 12-year experience at Memorial Sloan-Kettering Cancer Center. Gynecol Oncol. 2006;103:714. https://doi.org/10.1016/j.ygyno.2006.03.055
Mariani A, Webb MJ, Keeney GL, Haddock MG, Aletti G, Podratz KC. Stage IIIC endometrioid corpus cancer includes distinct subgroups. Gynecol Oncol. 2002;87(1):112-7. https://doi.org/10.1006/gyno.2002.6789
Zhang H, Zuo Z, Wang Y, Wang L, Zhu Z. A cohort study evaluating paraaortic lymphadenectomy in endometrial cancer. Oncol Lett. 2012;4(6):1361-5. https://doi.org/10.3892/ol.2012.919
Kang S, Yoo HJ, Hwang JH, Lim MC, Seo SS, Park SY, et al. Sentinel lymph node biopsy in endometrial cancer: Meta-analysis of 26 studies. Gynecol Oncol. 2011;123:522-7. https://doi.org/10.1016/j.ygyno.2011.08.034
Robison K, Holman LL, Moore RG. Update on sentinel lymph node evaluation in gynecologic malignancies. Curr Opin Obstet Gynecol. 2011;23:8-12. https://doi.org/10.1097/GCO.0b013e32834156fb
Bogani G, Dowdy SC, Cliby WA, Ghezzi F, Rossetti D, Mariani A. Role of pelvic and para-aortic lymphadenectomy in endometrial cancer: Current evidence. J Obstet Gynaecol Res. 2014;40(2):301-11. https://doi.org/10.1111/jog.12344
Kitajima K, Murakami K, Yamasaki E, et al. Accuracy of integrated FDG- PET/contrast-enhanced CT in detecting pelvic and paraaortic lymph nodemetastasis in patients with uterine cancer. Eur Radiol 2009;19:1529. https://doi.org/10.1007/s00330-008-1271-8
Haldorsen IS, Salvesen HB. Staging of endometrial carcinomas with MRI using traditional and novel MRI techniques. Clin Radiol Jan. 2012;67(1):2-12. https://doi.org/10.1016/j.crad.2011.02.018
Olawaiye AB, Rauh-Hain JA, Withiam-Leitch M, Rueda B, Goodman A, Del Carme MG. Utility of pre-operative serum CA-125 in the management of uterine papillar y serous carcinoma. Gynecol Oncol. 2008;110:293-8. https://doi.org/10.1016/j.ygyno.2008.05.027
Convery PA, Cantrell LA, Di Santo N, Broadwater G, Modesitt SC, Secord AA, et al. Retrospective review of an intraoperative algorithm to predict lymph nodemetastasis in low-grade endometrial adenocarcinoma. Gynecol Oncol. 2011;123(1):65-70. https://doi.org/10.1016/j.ygyno.2011.06.025
Berek JS, Hacker NF. Cancer uterino. En: Berek JS, Hacker NF, editors. Oncología Ginecológica de Berek & Hacker. 5 ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 396-442.
Kazuaki I, Hisamori K, Kayoko K, Kazuho N, Aiko K, Ayaka I, et. al. A preoperative risk-scoring system to predict lymph node metastasis endometrial cancer and stratify patients for lymphadenectomy. Gynecol Oncol. 2016;142(2):273-7. https://doi.org/10.1016/j.ygyno.2016.06.004
Jorge S, Hou JY, Tergas AI, Burke WM, Huang Y, Hu JC, et al. Magnitude of risk for nodal metastasis associated with lymphvascular space invasion for endometrial cancer. Gynecol Oncol. 2016;140(3):387-93. https://doi.org/10.1016/j.ygyno.2016.01.002
Kumar S, Mariani A, Bakkum-Gamez JN, Weaver AL, McGree ME, Keeney GL, et al. Risk factors that mitigate the role of paraaortic lymphadenectomy in uterine endometrioid cancer. Gynecol Oncol. 2013;130(3):441-5. https://doi.org/10.1016/j.ygyno.2013.05.035
Vargas R, Rauh-Hain JA, Clemmer J, Clark RM, Goodman A, Growdon WB, et al. Tumor size, depth of invasion, and histologic grade as prognostic factors of lymph node involvement in endometrial cancer: ASEER analysis. Gynecol Oncol. 2014;133(2):216-20. https://doi.org/10.1016/j.ygyno.2014.02.011
Schiaffino A, Rodriguez M, Pasarin MI, Regidor E, Borrell C, Fernández E. Odds ratio o razón de proporciones? Su utilización en estudios transversales. Gac Sani. 2003;17(1):70-4. https://doi.org/10.1016/S0213-9111(03)71694-X
Chi DS, Barakat RR, Palayekar MJ, et al. The incidence of pelvic lymph node metástasis by FIGO standing for patients with adecuquately surgically staged endometrial adenocarcinoma of endometrioid hystology. Int J Gynecol Cancer. 2008;18:269-73. https://doi.org/10.1111/j.1525-1438.2007.00996.x
Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: A paradigm shift in surgical staging. Gynecol Oncol. 2008;109(1):11-8. https://doi.org/10.1016/j.ygyno.2008.01.023
Ortoft G, Hogdall C, Juhl C, et al. The effect of introducing pelvic lymphadenectomy on survival and recurrence rates in Danish endometrial cancer patients at high risk: A Danish Gynecological Cancer group study. Int J Cancer Gynecol. 2019;29:68-76. https://doi.org/10.1136/ijgc-2018-000023
Wakayama A, Kudaka W, Matsumoto H, Aoyama H, Ooyama T, Taira Y, et al. Lymphatic vessel involvement is predictive for lymph node metastasis and an important prognostic factor in endometrial cancer. Int J Clin Oncol. 2018;23(3):532-8. https://doi.org/10.1007/s10147-017-1227-6
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