title: Stage IIIC endometrial cancer: the need for novel subgrouping according to the ratio of metastatic lymph nodes.
abstract: BACKGROUND
  The survival rates in endometrial cancer (EC) patients with lymph node (LN) metastasis vary greatly. Many other factors may have impact on the prognosis within this special group. The purpose of this study was to determine factors predicting the progression or death in patients with stage IIIC EC.
  
  
  METHODS
  A single tertiary center, retrospective analysis was conducted in a total of 38 consecutive patients who surgically treated for EC between January 2005 and January 2013. The primary endpoint was the determination of factors predicting the progression, recurrence, or death of any cause. The secondary endpoints were progression-free survival (PFS) and overall survival (OS).
  
  
  RESULTS
  The median age at diagnosis was 64 years, and the median follow-up time was 32.50 months (95 % CI 28.75-40.56). The median number of metastatic positive LNs (pelvic and/or paraaortic) was 2, and the LN ratio, expressed as the percentage of positive nodes to total LNs identified, was 6.3 %. The LN ratio (≥ 6.5 %) was the only independent parameter for progression or death in multiple logistic regression analysis. Patients were stratified according to the LN ratio (<6.5 vs. ≥ 6.5 %) for survival comparisons. The estimated 32-month PFS rates were 90 and 64.8 %, respectively [HR (95 % CI) = 5.07 (1.05-24.56), P = 0.025]. However, the estimated 32-month OS rates were comparable (94.1 vs. 94.1 %), [HR (95 % CI) = 4.26 (0.44-41.30), P = 0.21].
  
  
  CONCLUSIONS
  The stratification of patients with stage IIIC disease according to the LN ratio may allow better identification of prognostic information and selection of individualized patient-tailored adjuvant treatment modalities.
authors.affiliation: Division of Gynecologic Oncological Surgery, Department of Obstetrics and Gynecology, Akdeniz University Hospital, Konyaalti, Antalya, Turkey, drttoptas@gmail.com.
authors.forename: Tayfun
authors.initials: T
authors.lastname: Toptas
authors.forename: Tayup
authors.initials: T
authors.lastname: Simsek
mesh_terms: D000368:Aged; D018450:Disease Progression; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate