Risk factors for paraaoritc lymph node metastasis in endometrioid type endometrial cancer

The aim of this study was to determine the risk factors for paraaortic lymph node (LN) metastasis in endometiroid type endometrial cancer (EEC) patients who underwent comprehensive surgical staging. The data of patients who underwent surgery for endometrial cancer at Baskent University Ankara Hospital between 2007 and 2018 were reviewed retrospectively. A total of 894 patients with EEC who underwent surgery including pelvic and paraaortic lymphadenectomy included in this study. Patient data were analyzed with respect to paraaortic lymph node metastasis (PALNM), and univariate and multivariate logistic regression models were used to identify the predictive factors for PALNM. Lymph node metastasis was detected in 87 (%9.7) patients, isolated pelvic LN metastasis in 48 (%5.4), isolated PALNM in 6 (%0.7), and both pelvic and paraaortic metastasis in 33 (%3.7) patients, respectively. The risk of PALNM was shown to significantly increase in patients with deep myometrial invasion, grade 3 tumor, primary tumor diameter (≥2 cm), cervical stromal invasion, elevated serum Ca-125 level, lymphovascular space invasion (LVSI), serosal invasion, adnexal involvement, pelvic LN metastasis and two or more positive pelvic LNs (p < 0.001) whereas age at diagnosis (p=0.83) and the diameter of the metastatic pelvic LN (p=0.50) did not seem to have a significant effect, at the end of univariate analysis. Multivariate analysis showed that the presence of pelvic LN metastasis [odds ratio (OR), 13,1; 95% confidence interval (CI), 3.27-52.9; p < 0.001] and two or more positive pelvic LNs [OR, 4,4; 95% CI, 1.25-15.8; p =0.021] as independent risk factors for PALNM in women with EEC. The presence of two or more metastatic pelvic LNs besides pelvic LN involvement appear to be independent risk factors for PALNM in patients with EEC. Keywords: Endometrial cancer, Metastasis, Lymhadenectomy, Paraaortic lymph node, Risk factors