A CLINICAL AND PATHOLOGICAL-STUDY ON PARAAORTIC LYMPH-NODE METASTASISIN ENDOMETRIAL CARCINOMA

Background: Recent studies have shown that poor survival for patients with early endometrial cancer was related to the extrapelvic spread of the cancer. The purpose of this study was to evaluate the correlation between para-aortic lymph node (PAN) metastasis and histopathologic f indings and to assess the clinical utility of identifying PAN metastas is of endometrial carcinoma. Methods: The correlation of para-aortic l ymph node metastasis to the clinical stages of endometrial carcinoma ( FIGO, 1982), histopathologic findings, and prognosis were investigated in 200 patients with endometrial carcinoma, who were treated by radic al operations, including systematic retroperitoneal lymphadenectomies, between July 1982 and February 1996. Results: Of these, para-aortic l ymph node (PAN) metastasis was seen in 18 (9.0%) and pelvic lymph node (PLN) metastasis in 40 (20.0%). The incidence of PAN metastasis accor ding to clinical stages Ia, Ib, II, and III were 2.5%, 8.5%, 15.7%, an d 33.3%, respectively. The incidence of metastasis was significantly h igher in stage II than in stage Ia (P < 0.05), and in stage III than i n stage Ia (P < 0.01). PAN metastasis occurred significantly more freq uently in the first of each of the following groups: invasion of >1/2 Of the myometrium (15.7%) vs. invasion of <1/2 of the myometrium (3.6% ) (P < 0.01), the group with cervical invasion (23.5%) vs. the group w ithout (4.0%) (P < 0.0001), the group with lymph-vascular space involv ement (17.2%) vs. the group without (1.0%) (P < 0.0005), and PLN-metas tasis-positive group (40.0%) vs. the negative group (1.3%) (P < 0.0001 ). Multivariate analysis showed a significant correlation between PAN and PLN metastases (P < 0.0005). Positive PAN metastasis is not relate d to multiple PLN metastasis (bilateral PLN metastasis and the number of PLN metastatic groups). However, a correlation was seen between PAN metastasis and common iliac node metastasis. The prognosis was signif icantly poorer (P < 0.05) for patients with both PLN and PAN metastase s than for those with PLN metastasis alone. Conclusions: The results o f the present study suggest that PAN metastasis may occur as a consequ ence of PLN metastasis or the two may occur simultaneously as PLN meta stasis and also that careful examination of PAN metastasis is necessar y to determine the prognosis. (C) 1997 Wiley-Liss, Inc.