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Para-aortic lymphadenectomy improves survival in patients with intermediate to high-risk endometrial carcinoma.

Authors
Chang, SJ; Kim, WY; Yoon, JH; Yoo, SC; Chang, KH; Ryu, HS
Citation
Acta obstetricia et gynecologica Scandinavica, 87(12):1361-1369, 2008
Journal Title
Acta obstetricia et gynecologica Scandinavica
ISSN
0001-63491600-0412
Abstract
OBJECTIVE: Surgical staging of endometrial carcinoma is practiced to identify the true extent of disease. The impact of para-aortic lymphadenectomy (PALD) on survival is unproven. The purpose of this study was to determine if a staging procedure that includes PALD is associated with improved survival in endometrial carcinoma patients who had been surgically staged.



DESIGN: Retrospective review of patients' records.



SETTING: Ajou University Hospital, a tertiary care hospital in South Korea.



POPULATION: One hundred and sixty patients with endometrial carcinoma.



METHODS: We retrospectively analyzed a total of 160 FIGO stage I-III endometrial carcinoma patients without grossly metastatic para-aortic lymph nodes, who underwent surgery between 1994 and 2007. Exclusion criteria included presurgical radiation, stage IV disease and sarcomas. Two groups were identified: patients who underwent pelvic lymphadenectomy (PLD) and PALD (n=85) versus those who underwent PLD alone (n=75). Survival was analyzed using Kaplan-Meier method and Cox proportional hazards model.



MAIN OUTCOME MEASURES: Disease-free and overall survival.



RESULTS: Overall, patients who underwent PALD demonstrated improved 5-year disease-free survival (81.0 vs 91.2%) and overall survival (85.8 vs 96.2%) compared to those who underwent PLD alone (p=0.019 and p=0.039, respectively). After multivariate analysis, patients' age (p=0.028), FIGO stage (p<0.001) and lymphadenectomy (p=0.014) were independent prognostic factors. The type of lymphadenectomy did not affect survival of low-risk patients. In intermediate to high-risk patients, PALD improved disease-free survival and showed a trend toward improvement of overall survival.



CONCLUSION: These data demonstrate that PALD has a potentially therapeutic benefit on survival in surgically staged patients with intermediate to high-risk endometrial carcinoma.
MeSH terms
Disease-Free SurvivalEndometrial Neoplasms/mortalityEndometrial Neoplasms/surgery*FemaleHumansKaplan-Meier EstimateLymph Node Excision/methods*Lymph Nodes/pathologyLymph Nodes/surgeryLymphatic MetastasisMiddle AgedMultivariate AnalysisNeoplasm StagingPelvisPrognosisProportional Hazards ModelsSurvival Rate
DOI
10.1080/00016340802503054
PMID
18951214
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Obstetrics & Gynecology
Journal Papers > School of Medicine / Graduate School of Medicine > Medical Science
AJOU Authors
장, 석준김, 우영윤, 종혁유, 승철장, 기홍유, 희석
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