Benefit of Paraaortic Lymph Node Evaluation in Endometrioid Endometrial Carcinoma; A 10-year retrospective study in Thailand

Abstract

Objectives: To evaluate 5-year survival in patients with endometrioid endometrial carcinoma, who underwent evaluation of retroperitoneal pelvic lymph nodes alone, compared to evaluation of pelvic with paraaortic lymph nodes. Materials and Methods: This retrospective cohort study enrolled 636 women who were diagnosed with endometrioid endometrial carcinoma and underwent surgical staging at Faculty of Medicine Siriraj Hospital, Mahidol University between January 2006 and December 2015. Patients who underwent pelvic lymph node evaluation (n = 257) and pelvic with paraaortic lymph node evaluation (n = 379) were included. Results: The median follow-up time was 60 months. The 5-year overall survival rate (OS) in the pelvic lymph node (PLN) and pelvic with paraaortic lymph node (PPALN) groups was 81.6% and 87.7%, respectively (p = 0.073). However, the PPALN group had significantly longer survival than the PLN group after adjustment for other prognostic factors (adjusted hazard ratio (HR)) 1.63 (1.06-2.52, p = 0.028)).There was a trend to improve 5-year disease-specific survival (DSS) for the European Society of Gynaecological Oncology (ESGO)/ European Society for Radiotherapy and Oncology (ESTRO)/ European Society of Pathology (ESP) high risk patients, who underwent PPALN evaluation (85.6%) compared with PLN evaluation (70.8%), p = 0.061. Conclusion: In endometrioid endometrial carcinoma patients, the evaluation of pelvic and paraaortic lymph nodes is independently associated with enhanced survival outcomes. Therefore, in situations when a sentinel lymph node biopsy is not feasible, we suggest evaluating the pelvic and paraaortic lymph nodes for all patients diagnosed with endometrioid endometrial cancer.