Background and purpose: The role of lymphadenectomy for endometrial cancer is still controversial. Few gynecologists in China carry out pelvic and/or para-aortic lymphadenectomy for patients with endometrial cancer. The aim of the current study was to investigate the role of systematic lymphadenectomy in the treatment strategy of endometrial cancer and the feasibility in carrying out the surgery. Methods: We performed a retrospective chart review of all patients with endometrial cancer who experienced surgical staging at Cancer Hospital, Fudan University from January 2005 to July 2008. Lymph nodes metastatic status, alteration of adjuvant therapy and surgical complications were discussed. Results: Nineteen (14.8%) of 128 patients undergoing systematic lymphadanectomy had lymph node metastases: both pelvic and para-aortic in 7 patients, only pelvic in 8 patients, and exclusively isolated to the para-aortic area in 4 patients. Therefore, more than half of the patients with lymphatic dissemination had para-aortic lymph nodes metastases. Tumor grade, histological type, myometrial invasion and lymph-vascular space invasion were associated with lymph nodes metastases. Adjuvant chemotherapy and/or tumor-directed radiotherapy were needed for 15 patients upstaged due to lymph-nodal invasion (P<0.05). Furthermore, adjuvant therapy was eliminated for 50 intermediate/intermediate-high risk patients with negative lymph nodes and extrauterine spread. Complications were found in 8 patients: 3 pelvic infection, 2 residual vaginal bleeding, and 1 pero-bowel obstruction, 1 deep venous thrombosis accompanied with lymphocyst, and 1 lacunar infarction. The median time of the procedure was 150 minutes, median blood loss was 300 mL, and 27 patients received blood transfusion. Conclusion: The findings of the current study suggest that it is safe and feasible to carry out systematic lymphadenectomy in women with endometrial cancer. Surgical staging can assess the status of lymph nodes, provide accurate prognostic information, and help to formulate adjuvant therapy after surgery.

Objective The aim of this study was to find whether modified radical hysterectomy or radical hysterectomy improves local-regional control for patients with stage Ⅰ endometrioid carcinoma. Methods The medical records of patients with stage Ⅰ endometrioid carcinoma who were enrolled in Cancer Hospital of Fudan University between 1996 to 2008 after undergoing modified radical hysterectomy or radical hysterectomy were reviewed.The Kaplan-Meier method was used for time-to-event analysis with recurrence and death as the end points. Results Among 518 women with stage Ⅰendometrioid carcinoma, 474 underwent modified radical/radical hysterectomy and bilateral salpingo-oophorectomy±pelvic lymphadenectomy±peri-aortic lymphadenectomy+cytology.Twelve patients (2.5%) received neoadjuvant chemotherapy or vaginal brachytherapy before operation, and 73 patients (15.4%) received postoperative adjuvant therapy (pelvic external beam radiotherapy or chemotherapy or combination).After a median follow-up of 30 months,16 relapses were observed.Eight patients suffered with distant metastases, 4 with vaginal recurrences and 4 with pelvic recurrences.The 3-year and 5-year cumulative vaginal recurrence rates were 1.4% and 2.0%. The 3-and 5-year cumulative local-ragional recurrence rates were 2.5% and 3.1%. The 3-and 5-year actuarial overall survival rates were both 98.1%.The 5-year local-regional recurrence rates for stage Ⅰa, stage Ⅰb, stage Ⅰc were 3%, 3.7% and 0 (P=0.649), and the 5-year survival rates were 98.3%, 97.8% and 100% (P=0.399). There was no evidence of benefit in terms of lympnadenectomy in patients with stage Ⅰ endometrioid carcinoma(P value were 0.525 and 0.665,respectively).The median operating time was 135 minutes, the median blood loss was 300 mL, and 15.4% of the patients needed blood transfusion. Surgery associated morbidity was 7%, and no one died of surgery associated morbidity. Conclusions Modified radical hysterectomy or radical hysterectomy is a viable and possibly preferable option for patients with stage Ⅰ endometrioid carcinoma.Randomized clinical trials were urgently needed to address the utility of modified radical hysterectomy in stage Ⅰ endometrial cancer.

Objective To evaluate the clinical significance of positive peritoneal cytology in patients with endometrial cancer.Methods The records of 315 patients with endometrial cancer who were operated at Cancer Hospital, Fudan University between January 1996 and December 2008 were reviewed.Peritoneal cytology were performed and diagnosed in all patients.Factors related with peritoneal cytology were analyzed by correlation analysis.Log-rank test and Cox regression test was used for the analysis of prognosis,respectively.Results (1) Peritoneal cytology were positive in 30 (9.5%) patients.Positive peritoneal cytology was associated with pathological subtype ( P = 0.013 ), stage ( P = 0.000 ), myometrial invasion ( P =0.012), lymph-vascular space invasion ( P = 0.012 ), serosal involvement ( P = 0.004 ), cervical involvement ( P = 0.016), adnexal involvement ( P = 0.000), and omental involvement ( P = 0.000), with no association with grade ( P = 0.152 ) and lymph node metastasis ( P = 0.066 ).( 2 ) Three-year overall survival (OS) and progression-free survival(PFS) were 93.0% and 85.5% ,respectively.Positive peritoneal cytology, surgical stage, pathological subtype, myometrial invasion, grade, and lymph-vascular space invasion were significantly associated with worse prognosis by univariate analysis ( P ＜ 0.05 ), while only surgical-pathology stage and myometrial invasion were independent prognostic factors by multivariate analysis ( P ＜ 0.05 ).For 30 cases with positive peritoneal cytology, the patients with no high risk factors shown significantly prognoses better than those with any risk factors.The results shown that for patients with late stage (stage Ⅲ - Ⅳ ) endometrial cancer with positive peritoneal cytology was significantly associated with the worse OS and PFS by multivariate analysis ( P = 0.006).Conclusions Positive peritoneal cytology was associated with serosal involvement, cervical involvement, adnexal involvement, omental involvement, and late stage.Therefore, peritoneal cytology should be performed and reported separately as a part of full surgical staging procedure.

Objective The purpose of this study was to evaluate gene amplification by chromogenic in situ hybridization (CISH) and the protein expression of Her-2/neu gene in patients with uterine papillary serous carcinoma ( UPSC) and to determine its prognostic value.Methods Thirty-six patients with confirmed pathologic diagnosis of UPSC in Cancer Hospital of Fudan University from Jan.1996 to Jan.2006,were analysed retrospectively.CISH was performed to assess Her-2/neu gene amplification,and protein expression was evaluated by immunohistochemistry (IHC).The prognostic factors were analyzed by log-rank test or Cox proportional hazard model.Results Among 36 cases with UPSC,13 patients (36.1% ) showed moderate staining (++) to strong staining (+++) for Her-2/neu protein,while amplification of the Her-2/neu gene by CISH was observed in 4 of the 36 (11.1% ) cases.Her-2/neu protein over-expression was significantly associated with advanced surgical stage and worse prognosis by univariate analysis ( P = 0.030 and P = 0.002,respectively),while the multivariate analysis shown that only Her-2/neu protein over-expression and deep myometrial invasion were associated with a poor prognosis ( P < 0.05 ).In 13patients with Her-2/neu protein over-expression,the mean survival period with chemotherapy was shorter than those without chemotherapy (20 vs.42 months,P = 0.370 ).Conclusion Her-2/neu protein over-expression is significantly associated with advanced surgical stage UPSC and poor survival outcome,and might reduce the chemotherapy sensitivity.