Nodal distribution and its significance in FIGO stage IIIc endometrial cancer

Objective. The aim of this study was to describe the distribution of nodal disease in FIGO Stage IIIc endometrial cancer (EC) and to evaluate whether nodal distribution is related to recurrence and survival. Methods. Charts from EC patients with FIGO Stage IIIc disease from 1989 to 1998 were abstracted for clinicopathologic data, pelvic (PLN) and para-aort ic (PALN) nodal involvement, number of positive/removed nodes, and extranod al disease spread. Patterns of nodal distribution were evaluated for site o f first recurrence and survival. Associations between variables were tested by chi (2) and Wilcoxon rank sums. Survival analyses were performed by the Kaplan-Meier method. Results. Of 607 EC patients evaluated, 47 were identified with FIGO Stage I IIc disease. All 47 patients underwent hysterectomy and PLN sampling, and 4 2/47 had PALN sampling. The median number of PLN removed was 16 (range 2-35 ), and the median number of PALN was 7 (0-18). Stage IIIc disease was defin ed by positive PLN alone in 43%, positive PLN and PALN in 40%, and positive PALN alone in 17%. Positive peritoneal cytology and/or adnexal metastasis were present in 12 patients. Only 1/12 of these patients had isolated posit ive PLN whereas 11/12 had positive PALN (P = 0.007). An increasing number o f positive PLN was associated with PALN metastasis (P = 0.0001), and of the 10 patients with bilateral PLN involvement, 9/10 also had positive PALN (P = 0.001). Sites of first recurrence were similar regardless of whether PAL N were positive. At a median follow-up of 37 months, the 3-year survival es timate was 70% for patients with positive PALN versus 87% for those with is olated PLN disease (P = 0.22). For all patients neither the total number of positive PLN nor the total number of PLN or PALN removed was associated wi th survival. Conclusions. PALN involvement is common in patients with FIGO Stage IIIc en dometrial cancer, suggesting that PLN sampling alone may result in underdia gnosis of disease. Patients with positive PALN had more extensive disease, but survival and patterns of failure were not significantly different from those with disease confined to PLN, suggesting that lymph node dissection m ay have a therapeutic role. (C) 2001 Academic Press.