Is there a therapeutic impact to regional lymphadenectomy in the surgical treatment of endometrial carcinoma?

OBJECTIVE: The objective of the study was to evaluate whether surgical removal of regional lymph nodes influences the overall survival of women with endometrial carcinoma. STUDY DESIGN: All patients with endometrioid-type endometrial cancer treated at our institution between January 1993 and December 2004 were reviewed. The Classification and Regression Tree ( CART) method, a form of recursive partitioning, was used. RESULTS: In all, 1035 patients were evaluated. International Federal of Gynecology and Obstetrics stage included the following: stage I, 824; stage II, 65; stage III, 109; and stage IV, 37. Lymph nodes were removed in 524 patients (51%). The median number of nodes removed was 16. Using the CART hierarchically, stage, age, adjuvant therapy, and the removal of 10 lymph nodes or more emerged as predictors of overall survival. CONCLUSION: This study emphasizes the importance of lymph node dissection in endometrial cancer. Lymph node dissection is essential for accurate surgical staging, which remains the most important prognostic factor. In addition to well-known clinicopathologic risk factors for survival, the removal of 10 or more regional lymph nodes was associated with improved overall survival in lower-stage, older patients who received no adjuvant therapy or brachytherapy only.