Do uterine risk factors or lymph node metastasis more significantly affect recurrence in patients with endometrioid adenocarcinoma?
| Autor: | Katherine M. Moxley, Meaghan Tenney, Cara Mathews, Joan L. Walker, E. Bishop, Lisa M. Landrum, Kathleen N. Moore, Elizabeth K. Nugent, Robert S. Mannel, D.S. McMeekin |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Risk Assessment Gastroenterology Decision Support Techniques Pelvis Recurrence Risk Factors Internal medicine medicine Carcinoma Humans Stage (cooking) Lymph node Survival rate Survival analysis Aged Neoplasm Staging Retrospective Studies Gynecology Models Statistical business.industry Endometrial cancer Obstetrics and Gynecology Retrospective cohort study Middle Aged Prognosis medicine.disease Survival Analysis Endometrial Neoplasms Survival Rate medicine.anatomical_structure Oncology Lymphatic Metastasis Multivariate Analysis Lymph Node Excision Female Risk assessment business Carcinoma Endometrioid |
| Zdroj: | Gynecologic Oncology. 125:94-98 |
| ISSN: | 0090-8258 |
| Popis: | Objectives Controversy continues over the importance of lymph node (LN) status in treating and predicting recurrence in endometrial cancer. Several predictive models are available which use uterine factors to stratify risk groups. Our objective was to determine how LN status affects recurrence and survival compared to uterine factors alone. Methods A retrospective review was performed of patients undergoing complete surgical staging for clinical stage 1 endometrioid adenocarcinoma of the uterus. Patients were assessed based on PORTEC 1 high intermediate risk (H-IR) criteria (2 factors : age>60, grade 3, >50% DOI), GOG-99 H-IR criteria (age >70+1 factor, age 50–70+2 factors, any age +3 factors: grade 2 or 3, LVSI, >50% DOI), and PORTEC 2 criteria. Rates of nodal involvement, recurrence rates, PFS, and OS were compared. Results We identified 352 clinical stage I patients with positive LN in 24% (87). 175 patients met PORTEC 1 eligibility and 66 met H-IR criteria. Rates of LN positivity were similar among groups (18.4% vs 19.7%, p =0.83) but recurrence rates were dissimilar (7.4% vs 27.3%, p =0.0004). Only 93 met PORTEC 2 criteria for treatment with no association between LN status, recurrence, and eligibility. 188 patients met H-IR eligibility criteria for GOG-99 with LN positive and recurrence rates higher in the H-IR group compared to GOG-99 eligible (34.6% vs 16.3%, p =0.0004, 28.3% vs. 10.6%, p =0.0002). Conclusions Patients with H-IR disease based on uterine characteristics alone have substantial risk of nodal involvement. Knowledge of LN status may better define risk, prognosis, and postoperative treatment. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect