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Risk factors for lymph node metastases in women with endometrial cancer: A population-based, nation-wide register study - On behalf of the Swedish Gynecological Cancer Group

Artikel i vetenskaplig tidskrift
Författare K. Stalberg
P. Kjolhede
M. Bjurberg
C. Borgfeldt
Pernilla Dahm-Kähler
H. Falconer
Erik Holmberg
C. Staf
B. Tholander
E. Avall-Lundqvist
P. Rosenberg
T. Hogberg
Publicerad i International Journal of Cancer
Volym 140
Nummer/häfte 12
Sidor 2693-2700
ISSN 0020-7136
Publiceringsår 2017
Publicerad vid Institutionen för kliniska vetenskaper, sektionen för onkologi, radiofysik, radiologi och urologi
Institutionen för kliniska vetenskaper, sektionen för kvinnors och barns hälsa, Avdelningen för obstetrik och gynekologi
Sidor 2693-2700
Språk English
Länkar doi.org/10.1002/ijc.30707
Ämnesord endometrial cancer, lymph node metastases, risk factor, epidemiology, dna-ploidy, myometrial invasion, pooled analysis, flow-cytometry, stage-i, carcinoma, grade, prevalence, recurrence, curettage, Oncology
Ämneskategorier Epidemiologi, Cancer och onkologi

Sammanfattning

The role of lymphadenectomy in the management of early endometrial cancer remains controversial. In the recent ESMO-ESGO-ESTRO guidelines, lymphadenectomy is recommended for patients with endometrioid adenocarcinoma Grade 3 with deep myometrial invasion, but complete agreement was not achieved. In Sweden, DNA aneuploidy has been included as a high-risk factor. The aim of our study was to evaluate the impact of tumor histology, FIGO grade, DNA ploidy and myometrial invasion (MI) on occurrence of lymph node metastasis (LNM) in patients with endometrial cancer. The study design is a retrospective cohort study based on prospectively recorded register data. Endometrial cancer patients registered in the Swedish Quality Registry for Gynecologic Cancer 2010-2015 with FIGO Stages I-III and verified nodal status were included. Data on DNA ploidy, histology, FIGO grade and MI were included in multivariable log-binomial regression analyses with LNM as dependent variable. 1,165 cases fulfilled the inclusion criteria. The multivariable analyses revealed increased risk of LNM in patients with tumors with MI50% (risk ratio [RR]=4.1; 95% confidence interval [CI] 3.0-5.6), nonendometrioid compared to endometrioid histology (RR 1.8; CI 1.4-2.4) and FIGO Grade 3 compared to Grade 1-2 tumors (RR 1.5; CI 1.1-2.0). No statistically significant association between DNA ploidy status and LNM was detected. This population-based, nation-wide study in women with endometrial cancer confirms a strong association between MI50%, nonendometrioid histology and FIGO Grade 3, respectively, and LNM. DNA ploidy should not be included in the preoperative decision making of removing nodes or not. What's new? Whether lymphadenectomy is beneficial for women with endometrial cancer remains uncertain. Moreover, additional studies are needed to explore factors that reliably predict lymph node metastasis (LNM). Here, multiple factors, including tumor histology, grade of differentiation and DNA aneuploidy, were evaluated for associations with LNM risk in women with endometrial cancer and verified lymph node status. Most significantly, deep myometrial invasion in tumors increased LNM risk fourfold, whereas DNA ploidy had essentially no impact on LNM risk. The findings confirm the predictive relevance of myometrial invasion, histology and grade reported in previous single-center and multicenter studies.

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