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Risk factors for ly...
Risk factors for lymph node metastases in women with endometrial cancer: A population-based, nation-wide register study - On behalf of the Swedish Gynecological Cancer Group
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- Stålberg, Karin (author)
- Uppsala universitet,Uppsala University,Institutionen för kvinnors och barns hälsa,Uppsala University, Sweden
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- Kjölhede, Preben (author)
- Linköpings universitet,Linköping University,Linkopings Univ, Dept Obstet & Gynecol, Linkoping, Sweden.;Linkopings Univ, Dept Clin & Expt Med, Linkoping, Sweden.,Avdelningen för barns och kvinnors hälsa,Medicinska fakulteten,Region Östergötland, Kvinnokliniken US
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- Bjurberg, M. (author)
- Lund University,Lunds universitet,Tumörmikromiljö,Sektion I,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Huvud- och halscancergruppen,Forskargrupper vid Lunds universitet,Tumor microenvironment,Section I,Department of Clinical Sciences, Lund,Faculty of Medicine,Head and Neck Cancer Research Group,Lund University Research Groups,Skåne University Hospital,Skanes Univ Sjukhus, Dept Hematol Oncol & Radiat Phys, Lund, Sweden.;Lund Univ, Div Oncol & Pathol, Dept Clin Sci, Lund, Sweden.,Skånes University of Sjukhus, Sweden; Lund University, Sweden
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- Borgfeldt, C. (author)
- Lund University,Lunds universitet,Obstetrik och gynekologi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Obstetrics and Gynaecology (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital,Lund Univ, Skane Univ Hosp, Dept Obstet & Gynecol, Lund, Sweden.,Lund University, Sweden
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- Dahm-Kähler, Pernilla, 1964 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology,Sahlgrenska Academy,Univ Gothenburg, Sahlgrenska Acad, Dept Obstet & Gynecol, Gothenburg, Sweden.,University of Gothenburg, Sweden
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- Falconer, H. (author)
- Karolinska Institutet,Karolinska Institute,Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.,Karolinska Institute, Sweden
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- Holmberg, Erik, 1951 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för onkologi,Institute of Clinical Sciences, Department of Oncology,Sahlgrenska Academy,Sahlgrens University Hospital, Sweden; Gothenburg University, Sweden,Regional Cancer Center Western Sweden,Sahlgrens Univ Hosp, Reg Canc Ctr Western Sweden, Gothenburg, Sweden.;Gothenburg Univ, Sahlgrenska Akad, Inst Clin Sci, Gothenburg, Sweden.
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- Staf, C. (author)
- Sahlgrens University Hospital, Sweden,Sahlgrens Univ Hosp, Reg Canc Ctr Western Sweden, Gothenburg, Sweden.
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- Tholander, Bengt (author)
- Uppsala universitet,Experimentell och klinisk onkologi,Uppsala University Hospital, Sweden
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- Åvall-Lundqvist, Elisabeth, 1957- (author)
- Linköpings universitet,Linköping University,Karolinska University Hospital,Linkopings Univ, Dept Oncol, Linkoping, Sweden.;Linkopings Univ, Dept Clin & Expt Med, Linkoping, Sweden.;Karolinska Inst, Dept Pathol & Oncol, Stockholm, Sweden.,Avdelningen för Kirurgi, Ortopedi och Onkologi,Medicinska fakulteten,Region Östergötland, Onkologiska kliniken US,Karolinska Institute, Sweden
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- Rosenberg, Per (author)
- Linköpings universitet,Medicinska fakulteten,Avdelningen för kliniska vetenskaper,Region Östergötland, Onkologiska kliniken US
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- Högberg, T. (author)
- Lund University,Lunds universitet,Medicinsk onkologi,Sektion I,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Medical oncology,Section I,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital,Lund Univ, Skane Univ Hosp, Dept Canc Epidemiol, Lund, Sweden.,Lund University, Sweden
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(creator_code:org_t)
- 2017-04-12
- 2017
- English.
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In: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 140:12, s. 2693-2700
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Abstract
Subject headings
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- The role of lymphadenectomy in the management of early endometrial cancer remains controversial. In the recent ESMO-ESGO-ESTRO guidelines, lymphadenectomy is recommended for patients with endometrioid adenocarcinoma Grade 3 with deep myometrial invasion, but complete agreement was not achieved. In Sweden, DNA aneuploidy has been included as a high-risk factor. The aim of our study was to evaluate the impact of tumor histology, FIGO grade, DNA ploidy and myometrial invasion (MI) on occurrence of lymph node metastasis (LNM) in patients with endometrial cancer. The study design is a retrospective cohort study based on prospectively recorded register data. Endometrial cancer patients registered in the Swedish Quality Registry for Gynecologic Cancer 2010-2015 with FIGO Stages I-III and verified nodal status were included. Data on DNA ploidy, histology, FIGO grade and MI were included in multivariable log-binomial regression analyses with LNM as dependent variable. 1,165 cases fulfilled the inclusion criteria. The multivariable analyses revealed increased risk of LNM in patients with tumors with MI50% (risk ratio [RR]=4.1; 95% confidence interval [CI] 3.0-5.6), nonendometrioid compared to endometrioid histology (RR 1.8; CI 1.4-2.4) and FIGO Grade 3 compared to Grade 1-2 tumors (RR 1.5; CI 1.1-2.0). No statistically significant association between DNA ploidy status and LNM was detected. This population-based, nation-wide study in women with endometrial cancer confirms a strong association between MI50%, nonendometrioid histology and FIGO Grade 3, respectively, and LNM. DNA ploidy should not be included in the preoperative decision making of removing nodes or not. What's new? Whether lymphadenectomy is beneficial for women with endometrial cancer remains uncertain. Moreover, additional studies are needed to explore factors that reliably predict lymph node metastasis (LNM). Here, multiple factors, including tumor histology, grade of differentiation and DNA aneuploidy, were evaluated for associations with LNM risk in women with endometrial cancer and verified lymph node status. Most significantly, deep myometrial invasion in tumors increased LNM risk fourfold, whereas DNA ploidy had essentially no impact on LNM risk. The findings confirm the predictive relevance of myometrial invasion, histology and grade reported in previous single-center and multicenter studies.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Keyword
- endometrial cancer
- lymph node metastases
- risk factor
- epidemiology
- dna-ploidy
- myometrial invasion
- pooled analysis
- flow-cytometry
- stage-i
- carcinoma
- grade
- prevalence
- recurrence
- curettage
- Oncology
- endometrial cancer
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Stålberg, Karin
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Kjölhede, Preben
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Bjurberg, M.
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Borgfeldt, C.
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Dahm-Kähler, Per ...
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Falconer, H.
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show more...
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Holmberg, Erik, ...
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Staf, C.
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Tholander, Bengt
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Åvall-Lundqvist, ...
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Rosenberg, Per
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Högberg, T.
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- By the university
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University of Gothenburg
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Lund University
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Uppsala University
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Karolinska Institutet
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Linköping University