title: Do uterine risk factors or lymph node metastasis more significantly affect recurrence in patients with endometrioid adenocarcinoma?
abstract: OBJECTIVE
  Controversy continues over the importance of lymph node (LN) status in treating and predicting recurrence in endometrial cancer. Several predictive models are available which use uterine factors to stratify risk groups. Our objective was to determine how LN status affects recurrence and survival compared to uterine factors alone.
  
  
  METHODS
  A retrospective review was performed of patients undergoing complete surgical staging for clinical stage 1 endometrioid adenocarcinoma of the uterus. Patients were assessed based on PORTEC 1 high intermediate risk (H-IR) criteria (2 factors : age>60, grade 3, >50% DOI), GOG-99 H-IR criteria (age >70+1 factor, age 50-70+2 factors, any age +3 factors: grade 2 or 3, LVSI, >50% DOI), and PORTEC 2 criteria. Rates of nodal involvement, recurrence rates, PFS, and OS were compared.
  
  
  RESULTS
  We identified 352 clinical stage I patients with positive LN in 24% (87). 175 patients met PORTEC 1 eligibility and 66 met H-IR criteria. Rates of LN positivity were similar among groups (18.4% vs 19.7%, p=0.83) but recurrence rates were dissimilar (7.4% vs 27.3%, p=0.0004). Only 93 met PORTEC 2 criteria for treatment with no association between LN status, recurrence, and eligibility. 188 patients met H-IR eligibility criteria for GOG-99 with LN positive and recurrence rates higher in the H-IR group compared to GOG-99 eligible (34.6% vs 16.3%, p=0.0004, 28.3% vs. 10.6%, p=0.0002).
  
  
  CONCLUSIONS
  Patients with H-IR disease based on uterine characteristics alone have substantial risk of nodal involvement. Knowledge of LN status may better define risk, prognosis, and postoperative treatment.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Oklahoma Health Science Center, Oklahoma City, OK, USA. elizabeth-nugent@ouhsc.edu
authors.forename: E K
authors.initials: EK
authors.lastname: Nugent
authors.forename: E A
authors.initials: EA
authors.lastname: Bishop
authors.forename: C A
authors.initials: CA
authors.lastname: Mathews
authors.forename: K M
authors.initials: KM
authors.lastname: Moxley
authors.forename: M
authors.initials: M
authors.lastname: Tenney
authors.forename: R S
authors.initials: RS
authors.lastname: Mannel
authors.forename: J L
authors.initials: JL
authors.lastname: Walker
authors.forename: K N
authors.initials: KN
authors.lastname: Moore
authors.forename: L M
authors.initials: LM
authors.lastname: Landrum
authors.forename: D S
authors.initials: DS
authors.lastname: McMeekin
mesh_terms: D000368:Aged; D018269:Carcinoma, Endometrioid / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D003661:Decision Support Techniques; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010388:Pelvis; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate