Obstet Gynecol Sci.  2021 Jan;64(1):80-89. 10.5468/ogs.20186.

Impact of lymphadenectomy on the treatment of endometrial cancer using data from the JSOG cancer registry

• Saotome K
• Yamagami W
• Machida H
• Ebina Y
• Kobayashi Y
• Tabata T
• Kaneuchi M
• Nagase S
• Enomoto T
• Aoki D
• Mikami M

• KMID: 2511568
• DOI: http://doi.org/10.5468/ogs.20186

Abstract

Objective
Regional lymph node (LN) dissection is a standard surgical procedure for endometrial cancer, but there is currently no clear consensus on its therapeutic significance. We aimed to determine the impact of regional LN dissection on the outcome of endometrial cancer.
Methods
Study subjects comprised 36,813 patients who were registered in the gynecological tumor registry of the Japan Society of Obstetrics and Gynecology, had undergone initial surgery for endometrial cancer between 2004 and 2011, and whose clinicopathological factors and prognosis were appropriate for our investigation. The following clinicopathological factors were obtained from the registry: age, surgical stage classification, Union for International Cancer Control tumor, node, metastasis classification, histological type, histological differentiation, presence or absence of LN dissection, and postoperative treatment. We retrospectively analyzed the clinicopathological factors and therapeutic outcomes for patients with endometrial cancer.
Results
Analysis of all subjects showed that the group that underwent LN dissection had a significantly better overall survival than the group that did not undergo dissection. Analysis based on stage showed similar results across groups, except for stage Ia. Analysis based on stage and histological type showed similar results across groups, except for stage Ia endometrial carcinoma G1 or Ia G2. Multivariate analysis of prognostic factors indicated that LN dissection is an independent prognostic factor and that it has a greater impact on prognosis than adjuvant chemotherapy.
Conclusion
Despite the limitations of a retrospective study with some biases, the results suggest that LN dissection in endometrial cancer has a prognostic effect.

Keyword

Endometrial cancer; Lymphadenectomy; Registries; Adjuvant chemotherapy; Prognosis

Figure

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  Fig. 1 The subjects of this study, as recorded in the gynecological cancer registry of the Japan Society of Obstetrics and Gynecology. UICC, Union for International Cancer Control; TNM, tumor, node, metastasis; FIGO, International Federation of Gynecology and Obstetrics.

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  Fig. 2 The overall survival rate analyzed by the stage (International Federation of Gynecology and Obstetrics [FIGO] 1988); (A) stage I, (B) stage II, (C) stage III, (D) stage IV. LN, lymph node.

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  Fig. 3 The overall survival rate analyzed by the histological type; (A) endometrioid carcinoma G1, (B) endometrioid carcinoma G2, (C) endometrioid carcinoma G3, (D) non-endometrioid carcinoma. LN, lymph node.

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  Fig. 4 The overall survival rate analyzed by the recurrence risk classification; (A) low-risk cases, (B) intermediate-risk cases, (C) high-risk cases. LN, lymph node.

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  Fig. 5 The overall survival (OS) rate analyzed by the treatment and recurrence risk; (A) low-risk group, (B) intermediate-risk group, (C) high-risk group. LN, lymph node; AC, adjuvant chemotherapy; ns, not significant.

Reference

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