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Risk factors for lymph node metastases in women with endometrial cancer: A population-based, nation-wide register studyOn behalf of the Swedish Gynecological Cancer Group
Uppsala University, Sweden.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
Skånes University of Sjukhus, Sweden; Lund University, Sweden.
Lund University, Sweden.
Vise andre og tillknytning
2017 (engelsk)Inngår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 140, nr 12, 2693-2700 s.Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

The role of lymphadenectomy in the management of early endometrial cancer remains controversial. In the recent ESMO-ESGO-ESTRO guidelines, lymphadenectomy is recommended for patients with endometrioid adenocarcinoma Grade 3 with deep myometrial invasion, but complete agreement was not achieved. In Sweden, DNA aneuploidy has been included as a high-risk factor. The aim of our study was to evaluate the impact of tumor histology, FIGO grade, DNA ploidy and myometrial invasion (MI) on occurrence of lymph node metastasis (LNM) in patients with endometrial cancer. The study design is a retrospective cohort study based on prospectively recorded register data. Endometrial cancer patients registered in the Swedish Quality Registry for Gynecologic Cancer 2010-2015 with FIGO Stages I-III and verified nodal status were included. Data on DNA ploidy, histology, FIGO grade and MI were included in multivariable log-binomial regression analyses with LNM as dependent variable. 1,165 cases fulfilled the inclusion criteria. The multivariable analyses revealed increased risk of LNM in patients with tumors with MI50% (risk ratio [RR]=4.1; 95% confidence interval [CI] 3.0-5.6), nonendometrioid compared to endometrioid histology (RR 1.8; CI 1.4-2.4) and FIGO Grade 3 compared to Grade 1-2 tumors (RR 1.5; CI 1.1-2.0). No statistically significant association between DNA ploidy status and LNM was detected. This population-based, nation-wide study in women with endometrial cancer confirms a strong association between MI50%, nonendometrioid histology and FIGO Grade 3, respectively, and LNM. DNA ploidy should not be included in the preoperative decision making of removing nodes or not. Whats new? Whether lymphadenectomy is beneficial for women with endometrial cancer remains uncertain. Moreover, additional studies are needed to explore factors that reliably predict lymph node metastasis (LNM). Here, multiple factors, including tumor histology, grade of differentiation and DNA aneuploidy, were evaluated for associations with LNM risk in women with endometrial cancer and verified lymph node status. Most significantly, deep myometrial invasion in tumors increased LNM risk fourfold, whereas DNA ploidy had essentially no impact on LNM risk. The findings confirm the predictive relevance of myometrial invasion, histology and grade reported in previous single-center and multicenter studies.

sted, utgiver, år, opplag, sider
John Wiley & Sons, 2017. Vol. 140, nr 12, 2693-2700 s.
Emneord [en]
endometrial cancer; lymph node metastases; risk factor; epidemiology
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-137584DOI: 10.1002/ijc.30707ISI: 000400158800008PubMedID: 28340503Scopus ID: 2-s2.0-85017534425OAI: oai:DiVA.org:liu-137584DiVA: diva2:1097524
Merknad

Funding Agencies|Swedish Cancer Society

Tilgjengelig fra: 2017-05-22 Laget: 2017-05-22 Sist oppdatert: 2017-06-02bibliografisk kontrollert

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Kjölhede, PrebenÅvall-Lundqvist, ElisabethRosenberg, Per
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