Factors associated with lymph node metastasis in endometrial cancer

Teuku Mirza  Iskandar; Very Great Eka  Putra; Ediwibowo  Ambari; Endy  Cahyono; Lubena

doi:10.15562/bmj.v11i2.3642

Factors associated with lymph node metastasis in endometrial cancer

Teuku Mirza Iskandar ,

Very Great Eka Putra ,

Ediwibowo Ambari ,

Endy Cahyono ,

Lubena ,

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DOI: https://doi.org/10.15562/bmj.v11i2.3642 |
Published: 2022-08-12

Abstract

Introduction: Lymph node metastasis is considered one of the most significant prognostic markers in endometrial cancer, particularly in the initial stages. As the incidence rate of endometrial cancer increases, appropriate treatment is needed to increase the survival rate, including lymphadenectomy. This study aims to compare the characteristics of endometrial cancer with or without lymph node metastasis.

Methods: A retrospective analytical study of 155 women with a history of endometrial cancer

following complete surgical staging treatment from January 2017 to December 2021 at Dr. Kariadi General Hospital Semarang. All data were obtained using medical records.

Results: All 155 patients were divided into two groups, with and without lymph node metastasis. Of these, 19 patients have lymph node metastasis (12.25%). The body mass index is the only subject characteristic that is statistically significant between the two groups (p=0.024). In our multivariable risk analysis, three clinical variables were identified that might predict the probability of lymph node metastasis, including ovarian metastasis (OR=2.98, p<0.01) and cervical metastasis (OR=8.27, p=0.002), and tumor differentiation grading (OR=6,77, p<0,01).

Conclusion: The study results indicated ovarian metastasis, cervical metastasis, and tumor differentiation grading were independent prognostic factors for lymph node metastasis.

References

Koskas M, Amant F, Mirza MR, Creutzberg CL. Cancer of the corpus uteri: 2021 update. Int J Gynecol Obstet. 2021 Oct 20;155(S1):45–60.
Zhang S, Gong TT, Liu FH, Jiang YT, Sun H, Ma XX, et al. Global, Regional, and National Burden of Endometrial Cancer, 1990-2017: Results From the Global Burden of Disease Study, 2017. Front Oncol. 2019;9:1440.
Mahdy H, Casey MJ, Crotzer D. Endometrial Cancer. StatPearls. 2022.
Talhouk A, McAlpine JN. New classification of endometrial cancers: the development and potential applications of genomic-based classification in research and clinical care. Gynecol Oncol Res Pract. 2016;3(1):1–12.
Faizan U, Muppidi V. Uterine Cancer. StatPearls. 2022.
Ariyanto TB, Askandar B. Perbandingan Luaran Pasien Kanker Endometrium Yang Dilakukan Operasi Laparoskopi Dan Yang Dilakukan Operasi Laparotomi di RSUD Dr. Soetomo Tahun 2017. Med Heal Sci J. 2020;4(1):55–62.
Stålberg K, Kjølhede P, Bjurberg M, Borgfeldt C, Dahm-Kähler P, Falconer H, et al. Risk factors for lymph node metastases in women with endometrial cancer: A population-based, nation-wide register study-On behalf of the Swedish Gynecological Cancer Group. Int J cancer. 2017;140(12):2693–700.
Sorbe B. Prognostic importance of DNA ploidy in non-endometrioid, high-risk endometrial carcinomas. Oncol Lett. 2016 Mar;11(3):2283–9.
Dong Y, Cheng Y, Tian W, Zhang H, Wang Z, Li X, et al. An Externally Validated Nomogram for Predicting Lymph Node Metastasis of Presumed Stage I and II Endometrial Cancer. Front Oncol. 2019 Nov 14;9.
Uccella S, Podratz KC, Aletti GD, Mariani A. Re: Systematic Pelvic Lymphadenectomy vs No Lymphadenectomy in Early-Stage Endometrial Carcinoma: Randomized Clinical Trial. JNCI J Natl Cancer Inst. 2009 Jun 16;101(12):897–8.
Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009 Jan;373(9658):125–36.
Milam MR, Java J, Walker JL, Metzinger DS, Parker LP, Coleman RL. Nodal Metastasis Risk in Endometrioid Endometrial Cancer. Obstet Gynecol. 2012 Feb;119(2, Part 1):286–92.
Lee-may Chen JSB. Endometrial carcinoma: Epidemiology, risk factors, and prevention. https://www.uptodate.com/contents/endometrial-carcinoma-epidemiology-risk-factors-and-prevention?search=endometrial%20cancer&source=search_result&selectedTitle=10~150&usage_type=default&display_rank=10#H6. 2021.
Reeves KW, Carter GC, Rodabough RJ, Lane D, McNeeley SG, Stefanick ML, et al. obesity in relation to endometrial cancer risk and disease characteristics in the Women's Health Initiative. Gynecol Oncol. 2011 May;121(2):376–82.
Muallem MZ, Sehouli J, Almuheimid J, Richter R, Joukhadar R, Plett H. Risk factors of lymph nodes metastases by endometrial cancer: A retrospective one-center study. Anticancer Res. 2016;36(8):4219–25.
Zhou F zhi, Chen Y nan, Zhang G nan. Ovarian metastasis in patient with endometrial carcinoma. Chinese J Cancer Res. 2005 Sep;17(3):230–4.
Boren T, Lea J, Kehoe S, Miller DS, Richardson D. Lymph node metastasis in endometrioid adenocarcinomas of the uterine corpus with occult cervical involvement. Gynecol Oncol. 2012 Oct;127(1):43–6.
Garg G, Gao F, Wright JD, Hagemann AR, Zighelboim I, Mutch DG, et al. The Risk of Lymph Node Metastasis With Positive Peritoneal Cytology in Endometrial Cancer. Int J Gynecol Cancer. 2013 Jan 1;23(1):90–7.
Stålberg K, Kjølhede P, Bjurberg M, Borgfeldt C, Dahm‐Kähler P, Falconer H, et al. Risk factors for lymph node metastases in women with endometrial cancer: A population‐based, nation‐wide register study—On behalf of the Swedish Gynecological Cancer Group. Int J Cancer. 2017 Jun 15;140(12):2693–700.
Kadan Y, Calvino AS, Katz A, Katz S, Moore RG. Predictors for lymph nodes involvement in low risk endometrial cancer. J Obstet Gynaecol (Lahore). 2017 May 19;37(4):514–8.

[1] Koskas M, Amant F, Mirza MR, Creutzberg CL. Cancer of the corpus uteri: 2021 update. Int J Gynecol Obstet. 2021 Oct 20;155(S1):45–60.

[2] Zhang S, Gong TT, Liu FH, Jiang YT, Sun H, Ma XX, et al. Global, Regional, and National Burden of Endometrial Cancer, 1990-2017: Results From the Global Burden of Disease Study, 2017. Front Oncol. 2019;9:1440.

[3] Mahdy H, Casey MJ, Crotzer D. Endometrial Cancer. StatPearls. 2022.

[4] Talhouk A, McAlpine JN. New classification of endometrial cancers: the development and potential applications of genomic-based classification in research and clinical care. Gynecol Oncol Res Pract. 2016;3(1):1–12.

[5] Faizan U, Muppidi V. Uterine Cancer. StatPearls. 2022.

[6] Ariyanto TB, Askandar B. Perbandingan Luaran Pasien Kanker Endometrium Yang Dilakukan Operasi Laparoskopi Dan Yang Dilakukan Operasi Laparotomi di RSUD Dr. Soetomo Tahun 2017. Med Heal Sci J. 2020;4(1):55–62.

[7] Stålberg K, Kjølhede P, Bjurberg M, Borgfeldt C, Dahm-Kähler P, Falconer H, et al. Risk factors for lymph node metastases in women with endometrial cancer: A population-based, nation-wide register study-On behalf of the Swedish Gynecological Cancer Group. Int J cancer. 2017;140(12):2693–700.

[8] Sorbe B. Prognostic importance of DNA ploidy in non-endometrioid, high-risk endometrial carcinomas. Oncol Lett. 2016 Mar;11(3):2283–9.

[9] Dong Y, Cheng Y, Tian W, Zhang H, Wang Z, Li X, et al. An Externally Validated Nomogram for Predicting Lymph Node Metastasis of Presumed Stage I and II Endometrial Cancer. Front Oncol. 2019 Nov 14;9.

[10] Uccella S, Podratz KC, Aletti GD, Mariani A. Re: Systematic Pelvic Lymphadenectomy vs No Lymphadenectomy in Early-Stage Endometrial Carcinoma: Randomized Clinical Trial. JNCI J Natl Cancer Inst. 2009 Jun 16;101(12):897–8.

[11] Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009 Jan;373(9658):125–36.

[12] Milam MR, Java J, Walker JL, Metzinger DS, Parker LP, Coleman RL. Nodal Metastasis Risk in Endometrioid Endometrial Cancer. Obstet Gynecol. 2012 Feb;119(2, Part 1):286–92.

[13] Lee-may Chen JSB. Endometrial carcinoma: Epidemiology, risk factors, and prevention. https://www.uptodate.com/contents/endometrial-carcinoma-epidemiology-risk-factors-and-prevention?search=endometrial%20cancer&source=search_result&selectedTitle=10~150&usage_type=default&display_rank=10#H6. 2021.

[14] Reeves KW, Carter GC, Rodabough RJ, Lane D, McNeeley SG, Stefanick ML, et al. obesity in relation to endometrial cancer risk and disease characteristics in the Women's Health Initiative. Gynecol Oncol. 2011 May;121(2):376–82.

[15] Muallem MZ, Sehouli J, Almuheimid J, Richter R, Joukhadar R, Plett H. Risk factors of lymph nodes metastases by endometrial cancer: A retrospective one-center study. Anticancer Res. 2016;36(8):4219–25.

[16] Zhou F zhi, Chen Y nan, Zhang G nan. Ovarian metastasis in patient with endometrial carcinoma. Chinese J Cancer Res. 2005 Sep;17(3):230–4.

[17] Boren T, Lea J, Kehoe S, Miller DS, Richardson D. Lymph node metastasis in endometrioid adenocarcinomas of the uterine corpus with occult cervical involvement. Gynecol Oncol. 2012 Oct;127(1):43–6.

[18] Garg G, Gao F, Wright JD, Hagemann AR, Zighelboim I, Mutch DG, et al. The Risk of Lymph Node Metastasis With Positive Peritoneal Cytology in Endometrial Cancer. Int J Gynecol Cancer. 2013 Jan 1;23(1):90–7.

[19] Stålberg K, Kjølhede P, Bjurberg M, Borgfeldt C, Dahm‐Kähler P, Falconer H, et al. Risk factors for lymph node metastases in women with endometrial cancer: A population‐based, nation‐wide register study—On behalf of the Swedish Gynecological Cancer Group. Int J Cancer. 2017 Jun 15;140(12):2693–700.

[20] Kadan Y, Calvino AS, Katz A, Katz S, Moore RG. Predictors for lymph nodes involvement in low risk endometrial cancer. J Obstet Gynaecol (Lahore). 2017 May 19;37(4):514–8.

Factors associated with lymph node metastasis in endometrial cancer

Abstract

References

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