Impact of lymph node ratio on survival in stage IIIC endometrioid endometrial cancer: a Turkish Gynecologic Oncology Group study

• Published in: Journal of gynecologic oncology Vol. 29; no. 4; pp. 1 - 14
• Main Authors: Ali Ayhan, Nazli Topfedaisi Ozkan, Murat Oz, Gunsu Kimyon Comert, Zeliha Firat Cuylan, Gonca Coban, Osman Turkmen, Baki Erdem, Hanifi Sahin, Ozgur Akbayir, Murat Dede, Ahmet Taner Turan, Husnu Celik, Tayfun Gungor, Ali Haberal, Macit Arvas, Mehmet Mutlu Meydanli
• Format: Journal Article
• Language: Korean
• Published: 대한부인종양학회 01.07.2018
• Subjects: Disease-Free Survival; Endometrial Neoplasms; Endometrioid Carcinoma; Lymph Node Excision; Survival Rate
• ISSN: 2005-0380

Objective: The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in women with stage IIIC endometrioid endometrial cancer (EC). Methods: A multicenter, retrospective department database review was performed to identify patients with stage IIIC pure endometrioid EC at 6 gynecologic oncology centers in Turkey. A total of 207 women were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 2 groups: LNR1 (≤0.15), and LNR2 (>0.15). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models. Results: One hundred and one (48.8%) were classified as stage IIIC1 and 106 (51.2%) as stage IIIC2. The median age at diagnosis was 58 (range, 30-82) and the median duration of follow-up was 40 months (range, 1-228 months). There were 167 (80.7%) women with LNR ≤0.15, and 40 (19.3%) women with LNR >0.15. The 5-year progression-free survival (PFS) rates for LNR ≤0.15 and LNR >0.15 were 76.1%, and 58.5%, respectively (p=0.045). An increased LNR was associated with a decrease in 5-year overall survival (OS) from 87.0% for LNR ≤0.15 to 62.3% for LNR >0.15 (p=0.005). LNR >0.15 was found to be an independent prognostic factor for both PFS (hazard ratio [HR]=2.05; 95% confidence interval [CI]=1.07-3.93; p=0.03) and OS (HR=3.35; 95% CI=1.57-7.19; p=0.002). Conclusion: LNR seems to be an independent prognostic factor for decreased PFS and OS in stage IIIC pure endometrioid EC.