Over two-thirds of patients with endometrioid
uterine cancer in the Surveillance, Epidemiology and End Results program from 1988 to 2001 did not undergo a
lymphadenectomy. These patients were compared to those who had a
lymphadenectomy.
METHODS: Kaplan-Meier methods and Cox proportional hazards regression analyses were employed.
RESULTS: Of 39,396 women (median age: 65 years) with endometrioid
uterine cancers, 12,333 (31.3%) underwent surgical staging procedures including
lymphadenectomy. The remainder did not receive a
lymphadenectomy. The 5-year disease-specific survival (DSS) of stages I-IV women who underwent
lymphadenectomy were 95.5%, 90.4%, 73.8%, and 53.3% compared to 96.6%, 82.2%, 63.1%, and 26.9% in those without
lymphadenectomy (p>0.05 for stage I; p<0.001 for stages II-IV). In stage I patients, those who did not receive
lymphadenectomy had a higher proportion of
tumors with grade 1 histology and/or disease limited to the endometrium compared to those who underwent
lymphadenectomy (54.8 % vs. 34.7%; p<0.001, grade 1 disease; 26.6% vs. 15.9%; p<0.001, no myometrial invasion). In patients with stage I grade 3 disease, those who underwent
lymphadenectomy had a better 5-year DSS than those without
lymphadenectomy (90% vs. 85%; p=0.0001); however, no benefit for
lymphadenectomy was seen for patients with stage I grade 1 (p=0.26) and grade 2 (p=0.14) disease. On multivariable analysis, younger age, Caucasian race, early-stage disease, low grade histology, and
lymphadenectomy were independent prognostic factors for improved disease-specific survival.
CONCLUSIONS: