title: The incidence of pelvic and para-aortic lymph node metastasis in uterine papillary serous and clear cell carcinoma according to the SEER registry.
abstract: OBJECTIVE
  In this study we utilized the Surveillance, Epidemiology and End-Results (SEER) registry to identify risk factors for lymphatic spread and determine the incidence of pelvic and para-aortic lymph node metastases in patients with uterine papillary serous carcinoma (UPSC) and uterine clear cell carcinoma (UCCC) who underwent complete surgical staging and lymph node dissection.
  
  
  METHODS
  Nine hundred seventy-two eligible patients diagnosed between 1998 to 2009 with International Federation of Gynecology and Obstetrics (FIGO) 1988 stage IA-IVA UPSC (n=685) or UCCC (n=287) were identified for analysis. Binomial logistic regression was used to determine risk factors for lymph node metastasis, with the incidence of pelvic and para-aortic lymph node metastases reported for each FIGO primary tumor stage. The Cox proportional hazards regression model was used to determine factors associated with overall survival.
  
  
  RESULTS
  FIGO primary tumor stage was the only independent risk factor for lymph node metastasis (p<0.01). The incidence of pelvis-only and para-aortic lymph node involvement according to the FIGO primary tumor stage were as follows: IA (2.3%/3.8%), IB (7.5%/5.2%), IC (22.5%/16.9%), IIA (20.8%/13.2%), IIB (25.7%/14.9%), and III/IV (25.7%/24.3%). Prognostic factors for overall survival included lymph node involvement (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.09 to 1.85; p<0.01), patient age >60 years (HR, 1.70; 95% CI, 1.21 to 2.41; p<0.01), and advanced FIGO primary tumor stage (p<0.01). Tumor grade, histologic subtype, and patient race did not predict for either lymph node metastasis or overall survival.
  
  
  CONCLUSIONS
  There is a high incidence of both pelvic and para-aortic lymph node metastases for FIGO stages IC and above uterine papillary serous and clear cell carcinomas, suggesting a potential role for lymph node-directed therapy for these patients.
authors.affiliation: Department of Radiation Oncology, West Virginia University, Mograntown, WV, USA. malcolm.mattes@gmail.com.
authors.forename: Malcolm D
authors.initials: MD
authors.lastname: Mattes
authors.affiliation: Department of Radiation Oncology, New York Methodist Hospital, Brooklyn, NY, USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, New York Methodist Hospital, Brooklyn, NY, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Metzger
authors.affiliation: Department of Radiation Oncology, New York Methodist Hospital, Brooklyn, NY, USA.
authors.forename: Hani
authors.initials: H
authors.lastname: Ashamalla
authors.affiliation: Department of Radiation Oncology, New York Methodist Hospital, Brooklyn, NY, USA.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Katsoulakis
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000453:epidemiology / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal; D018283:Cystadenocarcinoma, Papillary / Q000453:epidemiology / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D018284:Cystadenocarcinoma, Serous / Q000453:epidemiology / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010388:Pelvis; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery
keywords: Adenocarcinoma Clear Cell; Lymphatic Metastasis; Pelvis; Registries; Risk Factors