Low-Volume Nodal Metastasis in Endometrial Cancer: Risk Factors and Prognostic Significance
Abstract
1. Introduction
2. Experimental Section
2.1. Sentinel Lymph Node Protocol
2.2. Histopathological Evaluation
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables | N (%) |
---|---|
Age (years) Median (range) | 65 (32–89) |
BMI Median (range) | 29 (17–50) |
Surgical approach | |
Laparotomy | 27 (10.1%) |
Laparoscopy | 236 (88.4%) |
Vaginal | 4 (1.5%) |
Histology | |
Endometrioid | 228 (84.1%) |
Serous carcinoma | 21(7.7%) |
Clear cell carcinoma | 15(5.5%) |
Carcinosarcoma | 6 (2.2%) |
Other | 1 (0.4%) |
Grade | |
1 | 145 (53.7%) |
2 | 51 (18.9%) |
3 | 74 (27.4%) |
Lymph-vascular invasion | |
Negative | 199 (74.3%) |
Positive | 69 (25.7%) |
Myometrial invasion | |
< 50% | 174 (64.2%) |
≥ 50% | 97 (35.8%) |
FIGO Stage | |
IA | 164 (46.5%) |
IB | 57 (21%) |
II | 8 (3%) |
IIIA | 9 (3.3%) |
IIIB | 3 (1.1%) |
IIIC1 | 20 (7.4%) |
IIIC2 | 8 (3%) |
IVA | 1 (0.4%) |
IVB | 1 (0.4%) |
Lymph node status (n = 230) | |
Negative | 196 (85.2%) |
Isolated tumor cells | 6 (2.6%) |
Micrometastasis | 8 (3.5%) |
Macrometastasis | 20 (8.7%) |
Negative Lymph Nodes | Low Volume Metastasis | Macrometastasis | Univariate | Multivariate | |
---|---|---|---|---|---|
N(%) | N(%) | N(%) | p-Value | p-Value | |
Myometrial invasion | |||||
<50% | 130 (66.3) | 7 (50) | 3 (15) | p < 0.001 | p = 0.032 |
≥50%, cervical stromal invasion | 66 (33.7) | 7 (50) | 17(85) | ||
Histology | |||||
Endometrioid | 164 (83.7) | 12 (85.7) | 15 (75) | p = 0.593 | p = 0.593 |
Non-endometrioid | 32 (16.3) | 2 (14.3) | 5 (25) | ||
Grade | |||||
G1 | 104 (53.1) | 6 (42.9) | 5 (26.3) | p = 0.117 | p = 0.990 |
G2 | 36 (18.4) | 5 (35.7) | 5 (26.3) | p = 0.887 | |
G3 | 56 (28.6) | 3 (21.4) | 9 (47.4) | p = 0.941 | |
Lymphovascular invasion | |||||
No | 152 (78.4) | 6 (42.9) | 6 (31.6) | p < 0.001 | p = 0.054 |
Yes | 42 (21.6) | 8 (57.1) | 13 (68.4) |
Node-Negative | LVM | Macrometastasis | p | |
---|---|---|---|---|
Follow up or VBT | 74.2% (135) | 28.6% (4) | 5.6% (1) | p < 0.001 |
EBRT ± BT | 13.7% (25) | 28.6% (4) | 11.1% (2) | p < 0.001 |
CT ± EBRT | 12.1% (22) | 42.9% (6) | 83.3% (15) | p < 0.001 |
Type LVM | Stage | Histology | Grade | Lymph-Vascular Invasion | Adjuvant Treatment | Recurrence | |
---|---|---|---|---|---|---|---|
Patient 1 | ITC | IB | Endometrioid | 3 | + | CT ± EBRT | None |
Patient 2 | ITC | IB | Carcinosarcoma | 3 | + | CT ± EBRT | Yes |
Patient 3 | ITC | IA | Endometrioid | 2 | - | None | Yes |
Patient 4 | ITC | IA | Endometrioid | 1 | - | EBRT ± BT | None |
Patient 5 | ITC | IB | Endometrioid | 2 | + | CT ± EBRT | None |
Patient 6 | ITC | IA | Endometrioid | 1 | - | None | None |
Patient 7 | MIC | IA | Endometrioid | 1 | + | VBT | None |
Patient 8 | MIC | IB | Endometrioid | 1 | + | EBRT ± BT | Yes |
Patient 9 | MIC | IB | Endometrioid | 1 | + | EBRT ± BT | None |
Patient 10 | MIC | IA | Endometrioid | 1 | + | CT ± EBRT | None |
Patient 11 | MIC | IB | Endometrioid | 2 | + | EBRT ± BT | Yes |
Patient 12 | MIC | IA | Endometrioid | 2 | - | None | None |
Patient 13 | MIC | IA | Endometrioid | 3 | - | CT ± EBRT | None |
Patient 14 | MIC | IB | Endometrioid | 1 | - | CT ± EBRT | None |
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García Pineda, V.; Hernández Gutiérrez, A.; Gracia Segovia, M.; Siegrist Ridruejo, J.; Diestro Tejeda, M.D.; Zapardiel, I. Low-Volume Nodal Metastasis in Endometrial Cancer: Risk Factors and Prognostic Significance. J. Clin. Med. 2020, 9, 1999. https://doi.org/10.3390/jcm9061999
García Pineda V, Hernández Gutiérrez A, Gracia Segovia M, Siegrist Ridruejo J, Diestro Tejeda MD, Zapardiel I. Low-Volume Nodal Metastasis in Endometrial Cancer: Risk Factors and Prognostic Significance. Journal of Clinical Medicine. 2020; 9(6):1999. https://doi.org/10.3390/jcm9061999
Chicago/Turabian StyleGarcía Pineda, Virginia, Alicia Hernández Gutiérrez, Myriam Gracia Segovia, Jaime Siegrist Ridruejo, María Dolores Diestro Tejeda, and Ignacio Zapardiel. 2020. "Low-Volume Nodal Metastasis in Endometrial Cancer: Risk Factors and Prognostic Significance" Journal of Clinical Medicine 9, no. 6: 1999. https://doi.org/10.3390/jcm9061999
APA StyleGarcía Pineda, V., Hernández Gutiérrez, A., Gracia Segovia, M., Siegrist Ridruejo, J., Diestro Tejeda, M. D., & Zapardiel, I. (2020). Low-Volume Nodal Metastasis in Endometrial Cancer: Risk Factors and Prognostic Significance. Journal of Clinical Medicine, 9(6), 1999. https://doi.org/10.3390/jcm9061999