title: Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer.
abstract: OBJECTIVE
  Selective lymphadenectomy is widely accepted in the management of endometrial cancer. Purported benefits are individualization of adjuvant therapy based on extent of disease and resection of occult metastases. Our goal was to assess effects of the extent of selective lymphadenectomy on outcomes in women with apparent stage I endometrial cancer at laparotomy.
  
  
  METHODS
  Patients with endometrial cancer who received primary surgical treatment between 1973 and 2002 were identified through an institutional tumor registry. Inclusion criteria were clinical stage I/IIA disease and procedure including hysterectomy and selective lymphadenectomy (pelvic or pelvic + aortic). Exclusion criteria included presurgical radiation, grossly positive lymph nodes, or extrauterine metastases at laparotomy. Recurrence and survival were analyzed using Kaplan-Meier analysis and Cox proportional hazards model.
  
  
  RESULTS
  Among 509 patients, the median number of lymph nodes removed was 15 (median pelvic, 11; median aortic, three). Pelvic and aortic node metastases were found in 24 (5%) of 509 patients and 11 (3%) of 373 patients, respectively. Patients with poorly differentiated cancers having more than 11 pelvic nodes removed had improved overall survival (hazard ratio [HR], 0.25; P < .0001) and progression-free survival (HR, 0.26; P < .0001) compared with patients having poorly differentiated cancers with 11 or fewer nodes removed. Number of nodes removed was not predictive of survival among patients with cancers of grade 1 to 2. Performance of aortic selective lymphadenectomy was not associated with survival. Three (27%) of 11 patients with microscopic aortic nodal metastasis are alive without recurrence.
  
  
  CONCLUSIONS
  These data add to the literature documenting the possible therapeutic benefit of selective lymphadenectomy in management of patients with apparent early-stage endometrial cancer.
authors.affiliation: Duke University Medical Center, Box 3079, Durham, NC 27710, USA.
authors.forename: Janiel M
authors.initials: JM
authors.lastname: Cragun
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.forename: Brian
authors.initials: B
authors.lastname: Calingaert
authors.forename: Ingrid
authors.initials: I
authors.lastname: Synan
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
authors.forename: John T
authors.initials: JT
authors.lastname: Soper
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Clarke-Pearson
authors.forename: Andrew
authors.initials: A
authors.lastname: Berchuck
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000556:secondary / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000556:secondary / Q000601:surgery; D018284:Cystadenocarcinoma, Serous / Q000556:secondary / Q000601:surgery; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate