title: Lymphovascular space invasion and positive pelvic lymph nodes are independent risk factors for para-aortic nodal metastasis in endometrioid endometrial cancer.
abstract: OBJECTIVE
  Para-aortic lymph node dissemination in endometrioid endometrial cancer is uncommon, and systematic para-aortic lymph node dissection increases morbidity. The purpose of this study was to identify a subgroup of endometrioid endometrial cancer patients who did not require para-aortic lymphadenectomy.
  
  
  METHODS
  All patients who had undergone surgery for endometrioid endometrial cancer between 1 January 1995 and 31 December 2012 were retrospectively reviewed. Patients with higher risk factors for nodal metastasis and inadequate lymphadenectomy were excluded. Para-aortic lymph node dissemination was defined as nodal metastasis when pelvic and para-aortic lymph node dissection was performed, when para-aortic lymph node recurrence occurred after negative para-aortic lymph node dissection or when para-aortic lymph node dissection was not performed. Multivariate logistic regression models were used to identify the pathological features as predictors for para-aortic lymphatic dissemination.
  
  
  RESULTS
  A total of 827 patients were assessed, 516 (62.4%) of whom underwent pelvic and para-aortic lymph node dissection. Sixty-seven (13%) patients (37 with only pelvic, 26 with pelvic and para-aortic, and 4 with only para-aortic metastasis) had positive lymph nodes in the pelvic and para-aortic lymph node dissection group. Multivariate analysis confirmed positive pelvic nodes (odds ratio 20.58; p<0.001) and lymphovascular space invasion (odds ratio 8.10; p=0.022) as independent predictors of para-aortic lymphatic dissemination. When these two factors were absent (in 83% of patients), the predicted probability of para-aortic lymph node metastasis was 0.1%.
  
  
  CONCLUSIONS
  Positive pelvic nodes and lymphovascular space invasion are highly associated with para-aortic lymph node metastasis. These markers may be useful for identifying those patients who require para-aortic lymph node dissection.
authors: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey. Electronic address: drulassolmaz@gmail.com.
authors: Ulas
authors: U
authors: Solmaz
authors: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors: Emre
authors: E
authors: Mat
authors: Department of Obstetrics and Gynecology, Tavas State Hospital, Denizli, Turkey.
authors: Murat Levent
authors: ML
authors: Dereli
authors: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors: Volkan
authors: V
authors: Turan
authors: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors: Gokhan
authors: G
authors: Tosun
authors: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors: Askin
authors: A
authors: Dogan
authors: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors: Muzaffer
authors: M
authors: Sanci
authors: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors: I Aykut
authors: IA
authors: Ozdemir
authors: Department of Pathology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors: Emel Ebru
authors: EE
authors: Pala
mesh_terms: D000368:Aged; D001011:Aorta; D001808:Blood Vessels / Q000473:pathology; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010388:Pelvis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Endometrial cancer; Lymphadenectomy; Lymphovascular space invasion; Para-aortic lymph nodes; Pelvic lymph nodes