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Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer.

Publication ,  Journal Article
Cragun, JM; Havrilesky, LJ; Calingaert, B; Synan, I; Secord, AA; Soper, JT; Clarke-Pearson, DL; Berchuck, A
Published in: J Clin Oncol
June 1, 2005

PURPOSE: Selective lymphadenectomy is widely accepted in the management of endometrial cancer. Purported benefits are individualization of adjuvant therapy based on extent of disease and resection of occult metastases. Our goal was to assess effects of the extent of selective lymphadenectomy on outcomes in women with apparent stage I endometrial cancer at laparotomy. PATIENTS AND METHODS: Patients with endometrial cancer who received primary surgical treatment between 1973 and 2002 were identified through an institutional tumor registry. Inclusion criteria were clinical stage I/IIA disease and procedure including hysterectomy and selective lymphadenectomy (pelvic or pelvic + aortic). Exclusion criteria included presurgical radiation, grossly positive lymph nodes, or extrauterine metastases at laparotomy. Recurrence and survival were analyzed using Kaplan-Meier analysis and Cox proportional hazards model. RESULTS: Among 509 patients, the median number of lymph nodes removed was 15 (median pelvic, 11; median aortic, three). Pelvic and aortic node metastases were found in 24 (5%) of 509 patients and 11 (3%) of 373 patients, respectively. Patients with poorly differentiated cancers having more than 11 pelvic nodes removed had improved overall survival (hazard ratio [HR], 0.25; P < .0001) and progression-free survival (HR, 0.26; P < .0001) compared with patients having poorly differentiated cancers with 11 or fewer nodes removed. Number of nodes removed was not predictive of survival among patients with cancers of grade 1 to 2. Performance of aortic selective lymphadenectomy was not associated with survival. Three (27%) of 11 patients with microscopic aortic nodal metastasis are alive without recurrence. CONCLUSION: These data add to the literature documenting the possible therapeutic benefit of selective lymphadenectomy in management of patients with apparent early-stage endometrial cancer.

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Published In

J Clin Oncol

DOI

ISSN

0732-183X

Publication Date

June 1, 2005

Volume

23

Issue

16

Start / End Page

3668 / 3675

Location

United States

Related Subject Headings

  • Survival Rate
  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Lymphatic Metastasis
  • Lymph Node Excision
  • Humans
  • Female
  • Endometrial Neoplasms
 

Citation

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Cragun, J. M., Havrilesky, L. J., Calingaert, B., Synan, I., Secord, A. A., Soper, J. T., … Berchuck, A. (2005). Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J Clin Oncol, 23(16), 3668–3675. https://doi.org/10.1200/JCO.2005.04.144
Cragun, Janiel M., Laura J. Havrilesky, Brian Calingaert, Ingrid Synan, Angeles Alvarez Secord, John T. Soper, Daniel L. Clarke-Pearson, and Andrew Berchuck. “Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer.J Clin Oncol 23, no. 16 (June 1, 2005): 3668–75. https://doi.org/10.1200/JCO.2005.04.144.
Cragun JM, Havrilesky LJ, Calingaert B, Synan I, Secord AA, Soper JT, et al. Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J Clin Oncol. 2005 Jun 1;23(16):3668–75.
Cragun, Janiel M., et al. “Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer.J Clin Oncol, vol. 23, no. 16, June 2005, pp. 3668–75. Pubmed, doi:10.1200/JCO.2005.04.144.
Cragun JM, Havrilesky LJ, Calingaert B, Synan I, Secord AA, Soper JT, Clarke-Pearson DL, Berchuck A. Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J Clin Oncol. 2005 Jun 1;23(16):3668–3675.

Published In

J Clin Oncol

DOI

ISSN

0732-183X

Publication Date

June 1, 2005

Volume

23

Issue

16

Start / End Page

3668 / 3675

Location

United States

Related Subject Headings

  • Survival Rate
  • Retrospective Studies
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Lymphatic Metastasis
  • Lymph Node Excision
  • Humans
  • Female
  • Endometrial Neoplasms