title: Lymph-vascular space invasion as a significant risk factor for isolated para-aortic lymph node metastasis in endometrial cancer: a study of 203 consecutive patients.
abstract: BACKGROUND
  The purpose of this study was to investigate various pathologic risk factors associated with para-aortic lymph node metastasis (LNM) in surgically staged patients with endometrial cancer.
  
  
  METHODS
  We performed a retrospective analysis of 203 consecutive patients with endometrial cancer who were surgically staged from 2000 to 2009. The association among the various pathologic variables for para-aortic LNM was determined with univariate and multivariate analyses.
  
  
  RESULTS
  Of 203 patients, 29 patients (14.3%) had LNM. Also, 10 patients (4.9%) had only pelvic LNM, 14 (6.9%) had both pelvic and para-aortic LNM, and 5 (2.5%) had para-aortic LNM without pelvic LN involvements. Histologic type (P = .001), tumor grade (P < .001), tumor size (P = .003), depth of myometrial invasion (P < .001), cervical invasion (P < .001), parametrial invasion (P = .002), lymph-vascular space invasion (LVSI) (P < .001), serosal/adnexal invasion (P < .001), positive cytology (P = .002), peritoneal seeding (P < .001), and pelvic LNM (P < .001) were significant pathologic factors for para-aortic LNM. On multivariate analysis, cervical invasion (P = .032), LVSI (P = .018), and positive pelvic LNs (P = .002) were independent factors for para-aortic LNM. With regard to isolated para-aortic LNM, tumor grade (P = .017) and LVSI (P = .002) were significant factors for LN involvements. On multivariate analysis, LVSI (P = .004) was the only significant independent factor.
  
  
  CONCLUSIONS
  LVSI correlates significantly with the risk of isolated para-aortic LNM in endometrial cancer patients.
authors.affiliation: Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea. drchang@ajou.ac.kr
authors.forename: Suk-Joon
authors.initials: SJ
authors.lastname: Chang
authors.forename: Tae Wook
authors.initials: TW
authors.lastname: Kong
authors.forename: Woo Young
authors.initials: WY
authors.lastname: Kim
authors.forename: Seung-Chul
authors.initials: SC
authors.lastname: Yoo
authors.forename: Jong-Hyuck
authors.initials: JH
authors.lastname: Yoon
authors.forename: Ki-Hong
authors.initials: KH
authors.lastname: Chang
authors.forename: Hee-Sug
authors.initials: HS
authors.lastname: Ryu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000556:secondary* / Q000601:surgery; D002296:Carcinosarcoma / Q000556:secondary* / Q000601:surgery; D018284:Cystadenocarcinoma, Serous / Q000556:secondary* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010534:Peritoneal Neoplasms / Q000556:secondary* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome