Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology

被引:158
作者
Lutman, Christopher V.
Havrilesky, Laura J.
Cragun, Janiel M.
Secord, Angeles Alvarez
Calingaert, Brian
Berchuck, Andrew
Clarke-Pearson, Daniel L.
Soper, John T. [1 ]
机构
[1] Duke Univ, Med Ctr, Dept Obstet & Gynecol, Div Gynecol Oncol, Durham, NC 27710 USA
[2] Riverside Gynecol Oncol, Columbus, OH 43214 USA
[3] Univ S Florida, Div Gynecol Oncol, Tampa, FL 33620 USA
[4] Duke Univ, Med Ctr, Canc Prevent Detect & Control Res Program, Durham, NC 27710 USA
[5] Univ N Carolina, Dept Obstet & Gynecol, Chapel Hill, NC 27599 USA
关键词
endometrial carcinoma prognostic factors; endometrial carcinoma lymph node sampling; endometrial carcinoma surgical staging;
D O I
10.1016/j.ygyno.2005.11.032
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Objective. To determine whether pelvic lymph node count is associated with patterns of recurrence or survival in patients with FIGO stage I and II endometrial cancer. Methods. Single institution retrospective study of 467 patients with FIGO stage I and II endometrial cancer treated with primary surgery including lymph node dissection. Analysis included pelvic lymph node count, histology, stage, age, race, BMI, year of surgery, depth of myometrial invasion, and adjuvant radiation. Kaplan-Meier life-tables were used to calculate survival; the Cox proportional hazards model was used to identify prognostic factors independently associated with survival. Results. Mean pelvic lymph node count was 12.6 (SD 8). Distant recurrence was associated with decreased pelvic lymph node count, high-risk histology, and postoperative pelvic radiation. Pelvic lymph node count was not associated with survival by univariate analysis, however, overall (OS) and progression-free (PFS) survival were significantly better with pelvic lymph node counts >= 12 among women with high-risk histology (P < 0.001), but not among women with low-risk histology. Multivariable Cox proportional hazards regression identified increasing age, non-Caucasian race, and high-risk histology as independent negative prognostic factors for both OS and PFS. Among patients with high-risk histology, pelvic lymph node count remained an independent prognostic factor for both overall (OS) and progression-free survival (PFS) in the model, with hazard ratios of 0.28 and 0.29, respectively, when >= 12 pelvic lymph nodes were identified. Pelvic lymph node count had no association with OS or PFS in women with low-risk histology. Conclusion. Pelvic lymph node count >= 12 is an important prognostic variable in patients with FIGO stage I and II enclometrial cancer who have high-risk histology. Most likely, the association of survival and lymph node count in this group is the result of improved staging among patients with higher pelvic lymph node counts. (c) 2005 Elsevier Inc. All rights reserved.
引用
收藏
页码:92 / 97
页数:6
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