Transactions of the Sixty-Seventh Annual Meeting of the Central Association Of Obstetricians and Gynecologists
Low-risk corpus cancer: Is lymphadenectomy or radiotherapy necessary?,☆☆

Presented at the Sixty-seventh Annual Meeting of The Central Association of Obstetricians and Gynecologists, Maui, Hawaii, October 24-27, 1999.
https://doi.org/10.1067/mob.2000.107335Get rights and content

Abstract

Objective: The objective of this study was to find readily ascertainable intraoperative pathologic indicators that would discriminate a subgroup of early corpus cancers that would not require lymphadenectomy or adjuvant radiotherapy. Study Design: Between 1984 and 1993, a total of 328 patients with endometrioid corpus cancer, grade 1 or 2 tumor, myometrial invasion ≤50%, and no intraoperative evidence of macroscopic extrauterine spread were treated surgically. Pelvic lymphadenectomy was performed in 187 cases (57%), and nodes were positive in nine cases (5%). Adjuvant radiotherapy was administered to 65 patients (20%). Median follow-up was 88 months. Results: The 5-year overall cancer-related and recurrence-free survivals were 97% and 96%, respectively. Primary tumor diameter and lymphatic or vascular invasion significantly affected longevity. No patient with tumor diameter ≤2 cm had positive lymph nodes or died of disease. Conclusion: Patients who have International Federation of Gynecology and Obstetrics grade 1 or 2 endometrioid corpus cancer with greatest surface dimension ≤2 cm, myometrial invasion ≤50%, and no intraoperative evidence of macroscopic disease can be treated optimally with hysterectomy only. (Am J Obstet Gynecol 2000;182:1506-19.)

Section snippets

Patients and methods

From 1984 to 1993 a total of 815 patients with endometrial cancer underwent surgical treatment of the disease at the Mayo Clinic, Rochester, Minnesota, and their records were retrieved from the Mayo Clinic's database. We selected 612 patients with epithelial endometrial cancer who satisfied the following inclusion criteria: (1) they were treated with hysterectomy and removal of existing adnexal structures, and (2) no other malignancy was diagnosed within 5 years before or after the diagnosis of

Results

Among the 328 patients who entered the study the mean age was 62.8 ± 10.6 years (range, 22-87 years). The mean body mass index was 30.8 ± 8.6 (range, 17.8-65.5).

The surgical and pathologic demographic characteristics are shown in Table I.

. Surgical and pathologic characteristics of 328 patients with low-risk endometrial cancer (endometrioid histologic subtype, myometrial invasion ≤50%, and histologic grade 1-2)

 CharacteristicNo.%*
Stage
 IA5717
 IB23973
 IIIA237
 IIIC93
FIGO grade
 122368
 210532
Lymph-vascular

Comment

In accord with other authors,4, 5, 6 we described as at low risk for lymph node metastasis and recurrence those patients with endometrioid histologic subtype, myometrial invasion ≤50%, and histologic grade 1 or 2 disease. In fact myometrial invasion and tumor grade are well-recognized prognostic factors in endometrial cancer and are predictors of extrauterine spread.9, 12 Moreover, patients with endometrioid tumors have a better prognosis than do those with the other subtypes.

It is generally

Acknowledgements

Dr Mariani thanks Elio Tucci, MD, for his support and encouragement of her studies on endometrial cancer.

References (40)

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Supported by the Mayo Cancer Center (P30CA15083) and the Rochester Research Committee, Mayo Foundation, Rochester, Minnesota.

☆☆

Reprint requests: Karl C. Podratz, MD, PhD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

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