title: Parametrial spread is a prognostic factor in endometrial carcinoma.
abstract: OBJECTIVE
  Parametrial spread of endometrial carcinoma, including the histopathological pattern of the spread and its significance as a prognostic factor, as well as its correlation with other prognostic factors are not well understood.
  
  
  METHODS
  We reviewed histopathologically the resected parametria from 269 patients with endometrial carcinoma who underwent radical or modified radical hysterectomy with pelvic lymphadenectomy. The relationship between parametrial spread and other histopathological features, including histological type, tumor grade, depth of myometrial invasion, lymph vascular space invasion (LVSI) of the myometrium, cervical invasion, adnexal metastasis, lymph node metastasis and peritoneal cytology was studied. Clinical outcomes of the patients with parametrial spread were also evaluated.
  
  
  RESULTS
  Parametrial spread was demonstrated in 16 patients (5.9%). Direct invasion of cancer cells to connective tissue, LVSI and lymph-node metastasis in the parametrium were seen in 13, seven and three cases, respectively. Three patients had all three spread patterns. According to the FIGO surgical stage, parametrial spread was found in none of the 164 patients in Stage I, two (6.3%) of 32 in Stage II, 12 (16.9%) of 71 in Stage III, and two (100%) of two in Stage IV. The presence of parametrial involvement was significantly correlated with depth of myometrial invasion, cervical involvement, lymph-node metastasis, adnexal metastasis. LVSI in the myometrium and peritoneal cytology (each, p < 0.01). With a median follow-up of 68.3 months, six (37.5%) of 16 patients with parametrial involvement developed recurrence and died.
  
  
  CONCLUSIONS
  Direct parametrial extension or lymphatic involvement within the parametrium can occur in endometrial carcinoma. Patients with parametrial spread have a poor prognosis.
authors.affiliation: Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Kitasato, Sagamihara, Kanagawa, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Sato
authors.forename: T
authors.initials: T
authors.lastname: Jobo
authors.forename: H
authors.initials: H
authors.lastname: Kuramoto
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001707:Biopsy, Needle; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007150:Immunohistochemistry; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D015996:Survival Rate