Significance of pathologic patterns of pelvic lymph node metastases in endometrial cancer

Objective. The aim of this study was to correlate the pathologic characteri stics of pelvic lymph node metastases with survival, recurrence, and patter ns of recurrence in endometrial cancer. Methods. Sixty patients with epithelial endometrial cancer and pelvic node metastasis were managed surgically between 1984 and 1993 at the Mayo Clinic . The mean number of nodes harvested was 16.7 and the mean number of nodes positive was 3.0. Mean follow-up was 45.5 months, The pathologic patterns o f lymph node metastases were characterized. Results. Outcome was related to pathologic patterns of pelvic node metastas is. Both diameter of lymph node metastasis (P < 0.01) and capsular integrit y (P <less than or equal to> 0.01) influenced 5-year disease-related surviv al and 5-year progression-free survival. The percentage of biopsied pelvic lymph nodes harboring metastatic disease and the proportion of the involved lymph nodes occupied by tumor significantly influenced death rates and rec urrence rates (P < 0.05). The immune response and the absolute number of po sitive pelvic nodes did not impact recurrence or survival. The above charac teristics of pelvic node metastasis correlated also with patterns of recurr ence. Regression analysis indicated that capsular integrity (RR = 2.97; P = 0.005) and proportion of positive pelvic nodes biopsied (RR = 3.84; P = 0. 01) were significant predictors of recurrence, whereas diameter of metastas is (RR = 3.68; P = 0.02) and proportion of positive pelvic nodes biopsied ( RR = 4.04; P = 0.02) were most predictive of survival. Conclusions. The pathologic patterns of pelvic node metastasis appear to be significantly related to survival, recurrence, and patterns of recurrence. (C) 2001 Academic Press.