title: Are uterine risk factors more important than nodal status in predicting survival in endometrial cancer?
abstract: OBJECTIVE
  To evaluate factors associated with survival after lymphadenectomy for endometrial cancer and to address their effect relating to systemic therapy.
  
  
  METHODS
  This was a retrospective, population-based cohort study of 316 women with endometrial cancer who underwent surgery including lymphadenectomy in Ontario, Canada, from 1996-2000. Data obtained from administrative databases included comorbidities, socioeconomic status, grade, myometrial invasion, cervical involvement, lymphovascular-space invasion, nodal status, and adjuvant pelvic radiotherapy. Primary outcome was 5-year overall survival. Factors associated with survival were identified in a multivariable Cox proportional hazards model.
  
  
  RESULTS
  Mean age was 62.2 years (+/-11.6 years). Thirty-eight women (12%) had positive pelvic nodes. Seventy-five (23.7%) received adjuvant pelvic radiotherapy. Age older than 60, grade 3 tumor, deep myometrial invasion (greater than 50%), and cervical stromal involvement were associated with a higher risk of death compared with reference categories. There were no survival differences according to comorbidities, socioeconomic status, or lymphovascular-space invasion. Five-year overall survival was 53.1% for node-negative patients with two or three uterine risk factors and 75.0% for node-positive patients with none or only one uterine risk factor. Pelvic-node status was not an independent determinant of survival (positive nodes: hazard ratio 1.39, 95% confidence interval 0.89-2.18).
  
  
  CONCLUSIONS
  High-risk uterine factors including grade 3 tumor, deep myometrial invasion, and cervical stromal involvement are more significant determinants of survival in endometrial cancer than pelvic-node status. Uterine risk factors should be considered, regardless of nodal status, when offering systemic therapy to maximize survival outcomes.
  
  
  METHODS
  II.
authors.affiliation: From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; and the Department of Programming and Biostatistics, Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Janice S
authors.initials: JS
authors.lastname: Kwon
authors.forename: Feng
authors.initials: F
authors.lastname: Qiu
authors.forename: Refik
authors.initials: R
authors.lastname: Saskin
authors.forename: Mark S
authors.initials: MS
authors.lastname: Carey
mesh_terms: D000368:Aged; D018269:Carcinoma, Endometrioid / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis / Q000473:pathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D016019:Survival Analysis