Lymph node metastasis in endometrioid adenocarcinomas of the uterine corpus with occult cervical involvement

ObjectiveSurgical-pathologic studies have defined the risk of lymphatic metastasis in clinical stage I endometrial cancers. However, data on the risk of lymph node metastasis in endometrial cancers involving the uterine cervix are less robust. The aim of this study was to determine the risk of lymphatic metastasis in patients with endometrial cancers with occult tumor extension to the uterine cervix.MethodsOur institutional tumor registry identified all patients with endometrioid endometrial cancers who underwent comprehensive surgical staging. Patients with gross involvement of the cervix and patients with extra-uterine disease were excluded. The risk of lymphatic metastasis associated with cervical involvement was analyzed in the context of known uterine risk factors for lymphatic metastasis such as age, depth of invasion, grade, and lymphovascular space invasion (LVSI).ResultsWe identified 169 patients who met inclusion and exclusion criteria. Univariate analyses revealed that LVSI (p < 0.01), tumor grade (p < 0.01), depth of myometrial invasion (p < 0.01), tumor free distance (p < 0.01), tumor size (p = 0.02), and cervical involvement (p < 0.01) were associated with lymphatic metastasis while age at diagnosis (p = 0.85) was not. Multivariate analyses revealed that only LVSI (p < 0.01), tumor grade (p = 0.02), and depth of myometrial invasion (p = 0.03) were independently associated with lymphatic metastasis.ConclusionCervical involvement is not an independent predictor of lymphatic metastasis in endometrial cancer. In an unstaged patient, decisions regarding adjuvant treatment or additional diagnostic procedures such as lymphadenectomy should be based on uterine factors.

► 29% of patients with cervical involvement of endometrioid endometrial cancer had lymph node metastasis.
► LVSI, tumor grade, and depth of myometrial invasion were associated with lymphatic metastasis in patients with cervical involvement.
► Cervical involvement is not an independent predictor of lymphatic metastasis in endometrioid endometrial cancers.