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Risk factors for lymph node metastases in women with endometrial cancer : A population-based, nation-wide register study—On behalf of the Swedish Gynecological Cancer Group

Stålberg, Karin; Kjølhede, P.; Bjurberg, M. LU ; Borgfeldt, C. LU ; Dahm-Kähler, Pernilla; Falconer, Henrik; Holmberg, E.; Staf, Christian; Tholander, Bengt and Åvall Lundqvist, Elisabeth, et al. (2017) In International Journal of Cancer 140(12). p.2693-2700
Abstract

The role of lymphadenectomy in the management of early endometrial cancer remains controversial. In the recent ESMO-ESGO-ESTRO guidelines, lymphadenectomy is recommended for patients with endometrioid adenocarcinoma Grade 3 with deep myometrial invasion, but complete agreement was not achieved. In Sweden, DNA aneuploidy has been included as a high-risk factor. The aim of our study was to evaluate the impact of tumor histology, FIGO grade, DNA ploidy and myometrial invasion (MI) on occurrence of lymph node metastasis (LNM) in patients with endometrial cancer. The study design is a retrospective cohort study based on prospectively recorded register data. Endometrial cancer patients registered in the Swedish Quality Registry for... (More)

The role of lymphadenectomy in the management of early endometrial cancer remains controversial. In the recent ESMO-ESGO-ESTRO guidelines, lymphadenectomy is recommended for patients with endometrioid adenocarcinoma Grade 3 with deep myometrial invasion, but complete agreement was not achieved. In Sweden, DNA aneuploidy has been included as a high-risk factor. The aim of our study was to evaluate the impact of tumor histology, FIGO grade, DNA ploidy and myometrial invasion (MI) on occurrence of lymph node metastasis (LNM) in patients with endometrial cancer. The study design is a retrospective cohort study based on prospectively recorded register data. Endometrial cancer patients registered in the Swedish Quality Registry for Gynecologic Cancer 2010–2015 with FIGO Stages I–III and verified nodal status were included. Data on DNA ploidy, histology, FIGO grade and MI were included in multivariable log-binomial regression analyses with LNM as dependent variable. 1,165 cases fulfilled the inclusion criteria. The multivariable analyses revealed increased risk of LNM in patients with tumors with MI ≥ 50% (risk ratio [RR] = 4.1; 95% confidence interval [CI] 3.0–5.6), nonendometrioid compared to endometrioid histology (RR 1.8; CI 1.4–2.4) and FIGO Grade 3 compared to Grade 1–2 tumors (RR 1.5; CI 1.1–2.0). No statistically significant association between DNA ploidy status and LNM was detected. This population-based, nation-wide study in women with endometrial cancer confirms a strong association between MI ≥ 50%, nonendometrioid histology and FIGO Grade 3, respectively, and LNM. DNA ploidy should not be included in the preoperative decision making of removing nodes or not.

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publication status
published
subject
keywords
endometrial cancer, epidemiology, lymph node metastases, risk factor
in
International Journal of Cancer
volume
140
issue
12
pages
2693 - 2700
publisher
John Wiley & Sons
external identifiers
  • scopus:85017534425
  • wos:000400158800008
ISSN
0020-7136
DOI
10.1002/ijc.30707
language
English
LU publication?
yes
id
2116e5e1-176e-401a-a865-25a6f85cb1fa
date added to LUP
2017-05-15 12:39:48
date last changed
2018-04-29 04:38:44
@article{2116e5e1-176e-401a-a865-25a6f85cb1fa,
  abstract     = {<p>The role of lymphadenectomy in the management of early endometrial cancer remains controversial. In the recent ESMO-ESGO-ESTRO guidelines, lymphadenectomy is recommended for patients with endometrioid adenocarcinoma Grade 3 with deep myometrial invasion, but complete agreement was not achieved. In Sweden, DNA aneuploidy has been included as a high-risk factor. The aim of our study was to evaluate the impact of tumor histology, FIGO grade, DNA ploidy and myometrial invasion (MI) on occurrence of lymph node metastasis (LNM) in patients with endometrial cancer. The study design is a retrospective cohort study based on prospectively recorded register data. Endometrial cancer patients registered in the Swedish Quality Registry for Gynecologic Cancer 2010–2015 with FIGO Stages I–III and verified nodal status were included. Data on DNA ploidy, histology, FIGO grade and MI were included in multivariable log-binomial regression analyses with LNM as dependent variable. 1,165 cases fulfilled the inclusion criteria. The multivariable analyses revealed increased risk of LNM in patients with tumors with MI ≥ 50% (risk ratio [RR] = 4.1; 95% confidence interval [CI] 3.0–5.6), nonendometrioid compared to endometrioid histology (RR 1.8; CI 1.4–2.4) and FIGO Grade 3 compared to Grade 1–2 tumors (RR 1.5; CI 1.1–2.0). No statistically significant association between DNA ploidy status and LNM was detected. This population-based, nation-wide study in women with endometrial cancer confirms a strong association between MI ≥ 50%, nonendometrioid histology and FIGO Grade 3, respectively, and LNM. DNA ploidy should not be included in the preoperative decision making of removing nodes or not.</p>},
  author       = {Stålberg, Karin and Kjølhede, P. and Bjurberg, M. and Borgfeldt, C. and Dahm-Kähler, Pernilla and Falconer, Henrik and Holmberg, E. and Staf, Christian and Tholander, Bengt and Åvall Lundqvist, Elisabeth and Rosenberg, P and Högberg, T.},
  issn         = {0020-7136},
  keyword      = {endometrial cancer,epidemiology,lymph node metastases,risk factor},
  language     = {eng},
  month        = {06},
  number       = {12},
  pages        = {2693--2700},
  publisher    = {John Wiley & Sons},
  series       = {International Journal of Cancer},
  title        = {Risk factors for lymph node metastases in women with endometrial cancer : A population-based, nation-wide register study—On behalf of the Swedish Gynecological Cancer Group},
  url          = {http://dx.doi.org/10.1002/ijc.30707},
  volume       = {140},
  year         = {2017},
}