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Extensive Lymph-Node Dissection Indicates Improved Survival From Endometrial Cancer: Presented at SGO

By Norra MacReady

PALM SPRINGS, C.A. -- March 28, 2006 -- The extent of lymphadenectomy is an independent prognostic factor for survival of patients with endometrial cancer, researchers reported here at the 37^th Annual Meeting of the Society of Gynecologic Oncologists (SGO).

In a study involving more than 12,000 women, complete lymphadenectomy was associated with better survival of patients with early-stage, endometrioid corpus carcinoma. Even among women with advanced-stage, node-positive cancer, survival was correlated with the extent of lymph-node dissection.

Extensive dissection may yield detailed information that can help clinicians tailor treatment for the greatest survival benefit, or it may be therapeutic in and of itself. Lymph-node dissection might also be a marker of a comprehensive quality of care that, rather than the treatment itself, might be responsible for a superior outcome, said John K. Chan, MD, assistant professor, obstetrics and gynecology, Stanford University Comprehensive Cancer Center, Stanford, California, United States.

To determine the relationship between lymph-node dissection and survival, Dr. Chan and colleagues used data from the Surveillance, Epidemiology, and End Results (SEER) program from 1988 to 2001 that included 12,333 women with endometrioid corpus carcinoma. Patients were excluded from the analysis if they had not had any nodes removed, or if they were diagnosed with papillary serous or clear-cell cancer, or sarcoma.

The patients had a median age of 64 years, and 10,220 (83%) patients had stage I-II disease. Subjects had a median of 10 nodes dissected, although the number ranged from 1 to 90. Most of the patients (77%) had 2 to 20 nodes removed.

For the analysis, the investigators classified patients according to disease stage and nodal dissection: 1, 2-5, 6-10, 11-20, and >20. Among patients with all grades of stage I disease, 5-year disease-free survival increased from 93% when 1 node was removed to 97% when more than 20 were removed (P < .001). For women with stage IV disease, survival jumped from 47% if fewer than 12 nodes were removed to 62% if 12 or more nodes were dissected (P < .001).

Extensive lymphadenectomy remained a highly significant independent prognostic factor even after multivariate analysis (P = .0001), along with younger age at diagnosis, early-stage or low-grade disease, and node-negative disease. Race and a history of radiation therapy were not significant factors.

The number of deaths from uterine cancer has doubled since 1987, suggesting the need to re-evaluate current methods of screening, diagnosis, staging, and treatment, Dr. Chan concluded. Paying more attention to lymph-node dissection might be a way of improving survival, he suggested.


[Presentation title: The Therapeutic Benefit of Extensive Lymph Node Dissection in Endometrioid Uterine Cancer: A Study of 12,333 Women. Abstract 46]

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