Potential Therapeutic Role of Para-aortic Lymphadenectomy in Node-Positive Endometrial Cancer
Identifieur interne : 00A540 ( Main/Exploration ); précédent : 00A539; suivant : 00A541Potential Therapeutic Role of Para-aortic Lymphadenectomy in Node-Positive Endometrial Cancer
Auteurs : Andrea Mariani ; Maurice J. Webb ; Laura Galli [Italie] ; Karl C. PodratzSource :
- Gynecologic Oncology [ 0090-8258 ] ; 2000.
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Abstract
Objective. The aim of this study was to assess the potential therapeutic role of para-aortic lymphadenectomy (PAL) in high-risk patients with endometrial cancer. Methods. We studied two groups of patients with endometrial cancer who underwent operation at Mayo Clinic (Rochester, MN) during the interval 1984 to 1993: (1) 137 patients at high risk for para-aortic lymph node involvement (myometrial invasion >50%, palpable positive pelvic nodes, or positive adnexae), excluding stage IV disease, and (2) 51 patients with positive nodes (pelvic or para-aortic), excluding stage IV disease. By our definition, PAL required removal of five or more para-aortic nodes. Results. In both groups, no significant difference existed between patients who had PAL (PAL+) and those who did not (PAL−) in regard to clinical or pathologic variables, percentage irradiated, or surgical or radiation complications. Among the 137 high-risk patients, the 5-year progression-free survival was 62% and the 5-year overall survival was 71% for the PAL− group compared with 77 and 85%, respectively, for the PAL+ group (P = 0.12 and 0.06, respectively). For the 51 patients with positive nodes, the 5-year progression-free survival and 5-year overall survival for the PAL− group were 36 and 42% compared with 76 and 77% for the PAL+ group (P = 0.02 and 0.05, respectively). Lymph node recurrences were detected in 37% of the PAL− patients but in none of the PAL+ patients (P = 0.01). Multivariate analysis suggested that submission to PAL was a cogent predictor of progression-free survival (odds ratio = 0.25; P = 0.01) and overall survival (odds ratio = 0.23; P = 0.006). Conclusions. These results suggest a potential therapeutic role for formal PAL in endometrial cancer.
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DOI: 10.1006/gyno.1999.5688
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Webb</name><affiliation><wicri:noCountry code="subField">55905</wicri:noCountry></affiliation></author><author><name sortKey="Galli, Laura" sort="Galli, Laura" uniqKey="Galli L" first="Laura" last="Galli">Laura Galli</name><affiliation wicri:level="3"><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medical Biostatistics, San Raffaele Hospital, University of Milano, Milan</wicri:regionArea><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Podratz, Karl C" sort="Podratz, Karl C" uniqKey="Podratz K" first="Karl C." last="Podratz">Karl C. Podratz</name><affiliation><wicri:noCountry code="subField">55905</wicri:noCountry></affiliation></author></analytic><monogr></monogr><series><title level="j">Gynecologic Oncology</title><title level="j" type="abbrev">YGYNO</title><idno type="ISSN">0090-8258</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2000">2000</date><biblScope unit="volume">76</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="348">348</biblScope><biblScope unit="page" to="356">356</biblScope></imprint><idno type="ISSN">0090-8258</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0090-8258</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>endometrial cancer</term><term>lymphadenectomy</term><term>management</term><term>therapy</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objective. The aim of this study was to assess the potential therapeutic role of para-aortic lymphadenectomy (PAL) in high-risk patients with endometrial cancer. Methods. We studied two groups of patients with endometrial cancer who underwent operation at Mayo Clinic (Rochester, MN) during the interval 1984 to 1993: (1) 137 patients at high risk for para-aortic lymph node involvement (myometrial invasion >50%, palpable positive pelvic nodes, or positive adnexae), excluding stage IV disease, and (2) 51 patients with positive nodes (pelvic or para-aortic), excluding stage IV disease. By our definition, PAL required removal of five or more para-aortic nodes. Results. In both groups, no significant difference existed between patients who had PAL (PAL+) and those who did not (PAL−) in regard to clinical or pathologic variables, percentage irradiated, or surgical or radiation complications. Among the 137 high-risk patients, the 5-year progression-free survival was 62% and the 5-year overall survival was 71% for the PAL− group compared with 77 and 85%, respectively, for the PAL+ group (P = 0.12 and 0.06, respectively). For the 51 patients with positive nodes, the 5-year progression-free survival and 5-year overall survival for the PAL− group were 36 and 42% compared with 76 and 77% for the PAL+ group (P = 0.02 and 0.05, respectively). Lymph node recurrences were detected in 37% of the PAL− patients but in none of the PAL+ patients (P = 0.01). Multivariate analysis suggested that submission to PAL was a cogent predictor of progression-free survival (odds ratio = 0.25; P = 0.01) and overall survival (odds ratio = 0.23; P = 0.006). Conclusions. These results suggest a potential therapeutic role for formal PAL in endometrial cancer.</div></front></TEI><affiliations><list><country><li>Italie</li></country><region><li>Lombardie</li></region><settlement><li>Milan</li></settlement></list><tree><noCountry><name sortKey="Mariani, Andrea" sort="Mariani, Andrea" uniqKey="Mariani A" first="Andrea" last="Mariani">Andrea Mariani</name><name sortKey="Podratz, Karl C" sort="Podratz, Karl C" uniqKey="Podratz K" first="Karl C." last="Podratz">Karl C. Podratz</name><name sortKey="Webb, Maurice J" sort="Webb, Maurice J" uniqKey="Webb M" first="Maurice J." last="Webb">Maurice J. Webb</name></noCountry><country name="Italie"><region name="Lombardie"><name sortKey="Galli, Laura" sort="Galli, Laura" uniqKey="Galli L" first="Laura" last="Galli">Laura Galli</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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