Cerrahi Evrelenmiş Endometrioid Tip Endometrium Kanserinde İzole Paraaortik Lenf Nodu Metastazı Sıklığı

Abstract

ISOLATED PARAAORIC LYMPH NODE METASTASIA FREQUENCY IN SURGICAL STAGED ENDOMETRIOID TYPE ENDOMETRIUM CARCINOMA Aim: Determination of isolated paraaortic lymph node metastasis frequency and risk factors is important for conservative approaches.Because when paraaortic lymph node dissection is not performed in patients with negative pelvic lymph node or negative sentinel lymph node and in the presence of isolated paraaortic lymph node metastasis; patients with Stage III C2 disease are actually considered to be in the low stage and the adjuvant treatment is inadequate and consequently the prognosis is adversely affected. This study aimed to determine the frequency of lymph node metastasis and the frequency of isolated paraaortic lymph node metastasis in endometrioid type endometrium cancer patients who underwent staging surgery and to question the necessity and anatomical level of lymphadenectomy. Material and Method: Between 2000-2015; there was total 835 endometrium cancer case to whom surgical treatment was applied and among these cases 417 patients with isolated paraaortic lymph node metastasis were included into this study. Histologic grade I-III, pelvic and paraaortic lymph node dissection cases with endometrioid histologic type tumor were included in the study. Cases with non-endometrioid histology and cases to whom para-aortic lymph node dissection was not applied; were excluded. The research was planned retrospectively. Clinicopathologic data of patients were obtained from patient files and hospital information system. Patients were staged according to the FIGO 2009 criteria. In addition, additional criteria such as peritoneal cytology and cervical-glandular involvement were also evaluated in the study patients. Survival and recurrence-related factors were determined by univariate Cox regression analysis and Significant predictors were included in the multivariate Cox regression model and independent predictors were found. xvii Results: Positive LVAI was detected in 23% of the patients, positive cervial-glandular involvement was detected in 25.2% of the patients and positive cervical-stromal involvement was detected in 15.3% of the patients. The rate of patients with positive pelvic lymph node metastasis (LNM) was 10.3% and the rate of positive patients with paraaortic lymph node metastasis was 5.3%. The overall frequency of isolated paraaortic lymph node metastases was found to be 1.19% in total population. The median total lymph node count was 30 (range 5-108). The proportion of patients with a total number of lymph nodes less than 10 was 2.6% (n: 11). There was no significant difference in risk of developing recurrence when patients with isolated paraaortic lymph nodes were compared to patients without isolated paraaortic lymph nodes. In all patients with isolated paraaortic LNM, tumor size was 2 cm and among these patients more than 40% were grade III. In addition, common independent predictors of retroperitoneal LNM and paraaortic LNM were found to be LVAI and cervical-glandular involvement. Conclusion: LVAI and cervical glandular involvement were determined as common independent markers for retroperitoneal LNM and paraaortic LNM in our study. These independent predictors are important because they directly or indirectly cause risk for survival and recurrence depending on the relationship of histological factors to each other. It is important to mention that lymphadenectomy is indicated in these findings. In addition, in patients with isolated paraaortic LNM, a large tumor size and low survival may be considered as an indication of the necessity of lymphadenectomy in these patients. Key words: Endometrial cancer, lymph node metastasis, isolated paraaortic lymph node involvement