Predictors of lymphatic failure in endometrial cancer

Andrea Mariani, Maurice J. Webb, Gary Keeney, Giacomo Aletti, Karl C. Podratz

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Objective. The aim of this study was to identify determinants of lymphatic failure in patients with endometrial cancer after definitive primary treatment. Methods. We observed 142 relapses in endometrial cancer patients who had primary surgery at our institution during the decade before 1994. We defined lymphatic failure as a relapse occurring on the pelvic sidewall (PSW), para-aortic area (PAA), or other node-bearing area (i.e., groin, axilla, supraclavicular, mediastinal). Mean follow-up was 72.8 months. Results. We observed 44 instances of lymphatic failure - 6 on the PSW only, 16 in the PAA only, 12 concomitantly in the PAA and on the PSW, and 10 confined in other node-bearing areas. By univariate analysis, body mass index ≥30 kg/m2, para-aortic lymph node biopsy, cervical stromal invasion (CSI), positive adnexa, myometrial invasion ≥50%, primary tumor diameter ≥2 cm, positive peritoneal cytology, positive lymph nodes (pelvic and/or para-aortic), radiotherapy, grade 3 tumor, nonendometrioid histology, and lymph-vascular invasion (LVI) significantly (P ≤ 0.05) correlated with lymphatic failure. However, on Cox regression analysis, only LVI (P < 0.01, relative risk [RR] = 4.27), nodal involvement (P = 0.02, RR = 3.43), and CSI (P = 0.049, RR = 2.26) were independent predictors of lymphatic failure. Moreover, lymph node metastases (P = 0.01, RR = 19.82) and CSI (P = 0.050, RR = 3.57) independently predicted failure on the PSW, and only lymph node involvement (P < 0.01, RR = 10.15) predicted relapse in the PAA. Conclusion. LVI, positive lymph nodes, and CSI were the strongest predictors of lymphatic failure in endometrial cancer (31% of patients with at least one of the above three variables had a failure at 5 years). Patients with none of the above three factors had an extremely low (<1%) risk of lymphatic failure.

Original languageEnglish (US)
Pages (from-to)437-442
Number of pages6
JournalGynecologic Oncology
Volume84
Issue number3
DOIs
StatePublished - 2002

Fingerprint

Endometrial Neoplasms
Lymph Nodes
Lymph
Blood Vessels
Recurrence
Axilla
Groin
Cell Biology
Neoplasms
Histology
Body Mass Index
Radiotherapy
Regression Analysis
Neoplasm Metastasis
Biopsy

Keywords

  • Cervical invasion
  • Endometrial cancer
  • Lymph nodes
  • Lymph-vascular invasion
  • Lymphatic failure
  • Lymphatic metastases

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Mariani, A., Webb, M. J., Keeney, G., Aletti, G., & Podratz, K. C. (2002). Predictors of lymphatic failure in endometrial cancer. Gynecologic Oncology, 84(3), 437-442. https://doi.org/10.1006/gyno.2001.6550

Predictors of lymphatic failure in endometrial cancer. / Mariani, Andrea; Webb, Maurice J.; Keeney, Gary; Aletti, Giacomo; Podratz, Karl C.

In: Gynecologic Oncology, Vol. 84, No. 3, 2002, p. 437-442.

Research output: Contribution to journalArticle

Mariani, A, Webb, MJ, Keeney, G, Aletti, G & Podratz, KC 2002, 'Predictors of lymphatic failure in endometrial cancer', Gynecologic Oncology, vol. 84, no. 3, pp. 437-442. https://doi.org/10.1006/gyno.2001.6550
Mariani, Andrea ; Webb, Maurice J. ; Keeney, Gary ; Aletti, Giacomo ; Podratz, Karl C. / Predictors of lymphatic failure in endometrial cancer. In: Gynecologic Oncology. 2002 ; Vol. 84, No. 3. pp. 437-442.
@article{4449d8da08294d90badc7a82942f1e7e,
title = "Predictors of lymphatic failure in endometrial cancer",
abstract = "Objective. The aim of this study was to identify determinants of lymphatic failure in patients with endometrial cancer after definitive primary treatment. Methods. We observed 142 relapses in endometrial cancer patients who had primary surgery at our institution during the decade before 1994. We defined lymphatic failure as a relapse occurring on the pelvic sidewall (PSW), para-aortic area (PAA), or other node-bearing area (i.e., groin, axilla, supraclavicular, mediastinal). Mean follow-up was 72.8 months. Results. We observed 44 instances of lymphatic failure - 6 on the PSW only, 16 in the PAA only, 12 concomitantly in the PAA and on the PSW, and 10 confined in other node-bearing areas. By univariate analysis, body mass index ≥30 kg/m2, para-aortic lymph node biopsy, cervical stromal invasion (CSI), positive adnexa, myometrial invasion ≥50{\%}, primary tumor diameter ≥2 cm, positive peritoneal cytology, positive lymph nodes (pelvic and/or para-aortic), radiotherapy, grade 3 tumor, nonendometrioid histology, and lymph-vascular invasion (LVI) significantly (P ≤ 0.05) correlated with lymphatic failure. However, on Cox regression analysis, only LVI (P < 0.01, relative risk [RR] = 4.27), nodal involvement (P = 0.02, RR = 3.43), and CSI (P = 0.049, RR = 2.26) were independent predictors of lymphatic failure. Moreover, lymph node metastases (P = 0.01, RR = 19.82) and CSI (P = 0.050, RR = 3.57) independently predicted failure on the PSW, and only lymph node involvement (P < 0.01, RR = 10.15) predicted relapse in the PAA. Conclusion. LVI, positive lymph nodes, and CSI were the strongest predictors of lymphatic failure in endometrial cancer (31{\%} of patients with at least one of the above three variables had a failure at 5 years). Patients with none of the above three factors had an extremely low (<1{\%}) risk of lymphatic failure.",
keywords = "Cervical invasion, Endometrial cancer, Lymph nodes, Lymph-vascular invasion, Lymphatic failure, Lymphatic metastases",
author = "Andrea Mariani and Webb, {Maurice J.} and Gary Keeney and Giacomo Aletti and Podratz, {Karl C.}",
year = "2002",
doi = "10.1006/gyno.2001.6550",
language = "English (US)",
volume = "84",
pages = "437--442",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",
number = "3",

}

TY - JOUR

T1 - Predictors of lymphatic failure in endometrial cancer

AU - Mariani, Andrea

AU - Webb, Maurice J.

AU - Keeney, Gary

AU - Aletti, Giacomo

AU - Podratz, Karl C.

PY - 2002

Y1 - 2002

N2 - Objective. The aim of this study was to identify determinants of lymphatic failure in patients with endometrial cancer after definitive primary treatment. Methods. We observed 142 relapses in endometrial cancer patients who had primary surgery at our institution during the decade before 1994. We defined lymphatic failure as a relapse occurring on the pelvic sidewall (PSW), para-aortic area (PAA), or other node-bearing area (i.e., groin, axilla, supraclavicular, mediastinal). Mean follow-up was 72.8 months. Results. We observed 44 instances of lymphatic failure - 6 on the PSW only, 16 in the PAA only, 12 concomitantly in the PAA and on the PSW, and 10 confined in other node-bearing areas. By univariate analysis, body mass index ≥30 kg/m2, para-aortic lymph node biopsy, cervical stromal invasion (CSI), positive adnexa, myometrial invasion ≥50%, primary tumor diameter ≥2 cm, positive peritoneal cytology, positive lymph nodes (pelvic and/or para-aortic), radiotherapy, grade 3 tumor, nonendometrioid histology, and lymph-vascular invasion (LVI) significantly (P ≤ 0.05) correlated with lymphatic failure. However, on Cox regression analysis, only LVI (P < 0.01, relative risk [RR] = 4.27), nodal involvement (P = 0.02, RR = 3.43), and CSI (P = 0.049, RR = 2.26) were independent predictors of lymphatic failure. Moreover, lymph node metastases (P = 0.01, RR = 19.82) and CSI (P = 0.050, RR = 3.57) independently predicted failure on the PSW, and only lymph node involvement (P < 0.01, RR = 10.15) predicted relapse in the PAA. Conclusion. LVI, positive lymph nodes, and CSI were the strongest predictors of lymphatic failure in endometrial cancer (31% of patients with at least one of the above three variables had a failure at 5 years). Patients with none of the above three factors had an extremely low (<1%) risk of lymphatic failure.

AB - Objective. The aim of this study was to identify determinants of lymphatic failure in patients with endometrial cancer after definitive primary treatment. Methods. We observed 142 relapses in endometrial cancer patients who had primary surgery at our institution during the decade before 1994. We defined lymphatic failure as a relapse occurring on the pelvic sidewall (PSW), para-aortic area (PAA), or other node-bearing area (i.e., groin, axilla, supraclavicular, mediastinal). Mean follow-up was 72.8 months. Results. We observed 44 instances of lymphatic failure - 6 on the PSW only, 16 in the PAA only, 12 concomitantly in the PAA and on the PSW, and 10 confined in other node-bearing areas. By univariate analysis, body mass index ≥30 kg/m2, para-aortic lymph node biopsy, cervical stromal invasion (CSI), positive adnexa, myometrial invasion ≥50%, primary tumor diameter ≥2 cm, positive peritoneal cytology, positive lymph nodes (pelvic and/or para-aortic), radiotherapy, grade 3 tumor, nonendometrioid histology, and lymph-vascular invasion (LVI) significantly (P ≤ 0.05) correlated with lymphatic failure. However, on Cox regression analysis, only LVI (P < 0.01, relative risk [RR] = 4.27), nodal involvement (P = 0.02, RR = 3.43), and CSI (P = 0.049, RR = 2.26) were independent predictors of lymphatic failure. Moreover, lymph node metastases (P = 0.01, RR = 19.82) and CSI (P = 0.050, RR = 3.57) independently predicted failure on the PSW, and only lymph node involvement (P < 0.01, RR = 10.15) predicted relapse in the PAA. Conclusion. LVI, positive lymph nodes, and CSI were the strongest predictors of lymphatic failure in endometrial cancer (31% of patients with at least one of the above three variables had a failure at 5 years). Patients with none of the above three factors had an extremely low (<1%) risk of lymphatic failure.

KW - Cervical invasion

KW - Endometrial cancer

KW - Lymph nodes

KW - Lymph-vascular invasion

KW - Lymphatic failure

KW - Lymphatic metastases

UR - http://www.scopus.com/inward/record.url?scp=0036195367&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036195367&partnerID=8YFLogxK

U2 - 10.1006/gyno.2001.6550

DO - 10.1006/gyno.2001.6550

M3 - Article

C2 - 11855884

AN - SCOPUS:0036195367

VL - 84

SP - 437

EP - 442

JO - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

IS - 3

ER -