Clinicopathological factors predicting retroperitoneal lymph node metastasis and survival in endometrial cancer

Background: By clarifying the significance of clinicopathological factors f or retroperitoneal lymph node metastasis and survival of patients with endo metrial cancer, we suggest ideas for optimal treatment of this disease. Methods: A retrospective study was conducted in 310 women with endometrial cancer who underwent surgery with retroperitoneal lymphadenectomy. To evalu ate retroperitoneal lymph node metastasis, age-adjusted and multivariable a nalyses were carried out for six clinicopathological factors including path ological grade, myometrial invasion, cervical invasion, peritoneal cytology , lymphatic permeation and vascular invasion. To evaluate survival, besides the above factors, a positive rate of metastasis of dissected retroperiton eal lymph nodes was included. Results: In 40 patients (13%) with nodal metastasis, the average positive r ate of metastasis of dissected retroperitoneal lymph nodes was 22%, For ret roperitoneal lymph node metastasis, the odds ratio of deep myometrial invas ion, cervical invasion and severe lymphatic permeation were 5.97, 2.72 and 12.01, respectively. For survival, the hazard ratios of the positive rates of metastasis of dissected retroperitoneal lymph nodes (both 25% and <25%), positive peritoneal cytology and poor pathological grade were 7.10, 3.24, 3.82 and 3.27, respectively, and 5-year survival rates for them were 0, 50, 72 and 77%, respectively. Conclusions: For retroperitoneal lymph node metastasis, lymphatic permeatio n, deep myometrial invasion and cervical invasion were the independent prog nostic factors. For survival, retroperitoneal lymph metastasis, poor pathol ogical grades and positive peritoneal cytology were the independent prognos tic factors. The positive rate of metastasis of dissected retroperitoneal l ymph metastasis plays an important role in predicting survival of endometri al cancer. Lymph node biopsy is insufficient in treatment of this disease.