The incidence of pelvic and para-aortic lymph node metastasis in uterine papillary serous and clear cell carcinoma according to the SEER registry.
- Author:
Malcolm D MATTES
1
;
Jennifer C LEE
;
Daniel J METZGER
;
Hani ASHAMALLA
;
Evangelia KATSOULAKIS
Author Information
- Publication Type:Original Article
- Keywords: Adenocarcinoma Clear Cell; Lymphatic Metastasis; Registries; Risk Factors; Pelvis
- MeSH: Adenocarcinoma, Clear Cell/epidemiology/pathology/*secondary/surgery; Adult; Aged; Aged, 80 and over; Aorta, Abdominal; Cystadenocarcinoma, Papillary/epidemiology/pathology/*secondary/surgery; Cystadenocarcinoma, Serous/epidemiology/pathology/*secondary/surgery; Female; Humans; Incidence; Kaplan-Meier Estimate; Lymph Node Excision; Lymphatic Metastasis; Middle Aged; Neoplasm Grading; Neoplasm Staging; Pelvis; SEER Program; United States/epidemiology; Uterine Neoplasms/*epidemiology/pathology/surgery
- From:Journal of Gynecologic Oncology 2015;26(1):19-24
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVE: In this study we utilized the Surveillance, Epidemiology and End-Results (SEER) registry to identify risk factors for lymphatic spread and determine the incidence of pelvic and para-aortic lymph node metastases in patients with uterine papillary serous carcinoma (UPSC) and uterine clear cell carcinoma (UCCC) who underwent complete surgical staging and lymph node dissection. METHODS: Nine hundred seventy-two eligible patients diagnosed between 1998 to 2009 with International Federation of Gynecology and Obstetrics (FIGO) 1988 stage IA-IVA UPSC (n=685) or UCCC (n=287) were identified for analysis. Binomial logistic regression was used to determine risk factors for lymph node metastasis, with the incidence of pelvic and para-aortic lymph node metastases reported for each FIGO primary tumor stage. The Cox proportional hazards regression model was used to determine factors associated with overall survival. RESULTS: FIGO primary tumor stage was the only independent risk factor for lymph node metastasis (p<0.01). The incidence of pelvis-only and para-aortic lymph node involvement according to the FIGO primary tumor stage were as follows: IA (2.3%/3.8%), IB (7.5%/5.2%), IC (22.5%/16.9%), IIA (20.8%/13.2%), IIB (25.7%/14.9%), and III/IV (25.7%/24.3%). Prognostic factors for overall survival included lymph node involvement (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.09 to 1.85; p<0.01), patient age >60 years (HR, 1.70; 95% CI, 1.21 to 2.41; p<0.01), and advanced FIGO primary tumor stage (p<0.01). Tumor grade, histologic subtype, and patient race did not predict for either lymph node metastasis or overall survival. CONCLUSION: There is a high incidence of both pelvic and para-aortic lymph node metastases for FIGO stages IC and above uterine papillary serous and clear cell carcinomas, suggesting a potential role for lymph node-directed therapy for these patients.
