A preoperative risk-scoring system to predict lymph node metastasis in endometrial cancer and stratify patients for lymphadenectomy.
This study aimed to validate the preoperative scoring system adopted in the Kanagawa Cancer Center (KCC) to stratify endometrial cancer patients for lymphadenectomy according to the risk of developing lymph node metastasis (LNM).



The records of 432 and 221 uterine cancer patients treated in the KCC and Yokohama City University (YCU), respectively, were retrospectively analyzed. The KCC classified patients for LNM risk based on tumor volume, myometrial invasion, histological grade, and serum CA125 levels, while YCU used only myometrial invasion. Lymphadenectomy was omitted for 156 patients with 0 LNM risk, while pelvic lymphadenectomy (PLX) or PLX with para-aortic lymphadenectomy (PLAX) were performed for those with low and high LNM risk, respectively. The predicted and actual LNM rates were compared between the KCC and YCU patients, and cancer recurrence and overall survival were analyzed.



There was no difference in survival between patients with LNM score 0 who were or were not treated with lymphadenectomy. None (0%) developed LNM and only 1 (0.6%) had recurrence. Patients who underwent PLX but not PLAX (low LNM score) had a low tumor recurrence rate in the para-aortic nodes (1.3%). The KCC scoring system was significantly more accurate than the YCU system in predicting LNM in the high-risk group (P<0.05) and demonstrated that PLAX was unnecessary in almost 50% of the YCU cases.



The KCC preoperative scoring system is useful to predict LNM risk, and thereby prevent unnecessary lymphadenectomy or to determine its extent in endometrial cancer patients.
Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan. Electronic address: wing-of-kazu-kun@excite.co.jp.
Kazuaki
K
Imai
Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
Hisamori
H
Kato
Cancer Prevention and Cancer Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, Japan.
Kayoko
K
Katayama
Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
Kazuho
K
Nakanishi
Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
Aiko
A
Kawano
Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
Ayaka
A
Iura
Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
Katsuyuki
K
Konnai
Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
Ryo
R
Onose
Department of Obstetrics and Gynecology, Yokohama City University Hospital, Minami-ku, Yokohama, Japan.
Fumiki
F
Hirahara
Department of Obstetrics and Gynecology, Yokohama City University Hospital, Minami-ku, Yokohama, Japan.
Etsuko
E
Miyagi
D015331:Cohort Studies; 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; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D012189:Retrospective Studies
Cancer antigen 125; Lymph node metastasis; Myometrial invasion; Para-aortic lymphadenectomy; Pelvic lymphadenectomy; Uterine cancer