title: What is the incidence of isolated paraaortic nodal recurrence in grade 1 endometrial carcinoma?
abstract: OBJECTIVE
  To describe the incidence of isolated paraaortic nodal recurrences in patients with a final diagnosis of grade 1 endometrial carcinoma initially treated with surgery.
  
  
  METHODS
  Records from a prospectively maintained endometrial carcinoma database were reviewed to identify sites of recurrence. Patients with any papillary serous or clear cell carcinoma, leiomyosarcoma, endometrial stromal sarcoma, squamous carcinoma, or adenosarcoma were excluded. Recurrence sites were classified into 4 main categories: 1) pelvic (including vaginal and other soft tissue pelvic sites); 2) abdominal (including peritoneum, omentum and liver); 3) distant (including lung, brain, supraclavicular, and groins); and 4) isolated paraaortic nodal recurrence (including any nodal recurrence between the midcommon iliac to renal vessels).
  
  
  RESULTS
  Between 1/93 and 5/06, 1453 patients with endometrial carcinoma met the study inclusion criteria. Final grade distribution included: grade 1 endometrial adenocarcinoma, 310 (21%); grade 2, 578 (40%); grade 3, 481 (33%); and incomplete, 84 (5.8%). In all, 154 patients (11%) had documented recurrences. Recurrence sites for all patients/all grades included: pelvis, 52 (34%); abdomen, 51 (33%); distant, 41 (27%), and isolated paraaortic, 10 (6%). None of the isolated paraaortic recurrences occurred in patients with a final diagnosis of grade 1 carcinoma. Furthermore, 9/10 (90%) isolated paraaortic nodal recurrences were in grade 3 tumors. Only 8 (2.6%) of 310 patients with grade 1 tumors recurred. Sites of recurrence for grade 1 tumors included: abdomen, 3; pelvis, 3; and distant, 2.
  
  
  CONCLUSIONS
  This large series of endometrial carcinoma patients initially treated with surgery confirms that isolated paraaortic nodal recurrence in women with a final diagnosis of grade 1 endometrial carcinoma is extremely rare. These rare isolated paraaortic nodal recurrences appear to be limited to high-grade endometrial carcinomas.
authors.affiliation: Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. monemvag@mskcc.org
authors.forename: Nadeem R
authors.initials: NR
authors.lastname: Abu-Rustum
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
authors.forename: Mario
authors.initials: M
authors.lastname: Leitao
authors.forename: Eniola A
authors.initials: EA
authors.lastname: Oke
authors.forename: Martee L
authors.initials: ML
authors.lastname: Hensley
authors.forename: Kaled M
authors.initials: KM
authors.lastname: Alektiar
authors.forename: Richard R
authors.initials: RR
authors.lastname: Barakat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D009367:Neoplasm Staging; D014481:United States / Q000453:epidemiology