The Results of Surgico-Pathologic Factors in Patients with Non-Endometrioid Type Endometrial Cancer: Is Tumor Type Important for Lymph Node Metastasis?
AbstractAim: To determine the factors identifying lymph node metastasis and the association between tumor types and surgico-pathologic factors in patients with non-endometrioid type endometrial cancer. Materials and Methods: This study included 150 patients with non-endometrioid type endometrial cancer whose staging surgeries had already been performed in our clinic. Results: Tumor types were serous in 65 patients, clear cell in 55, undifferentiated in 23 and mucinous in 8. Sixty-one patients had stage I, 6 patients had stage II, 47 patients had stage III and 36 of them had stage IV disease. Median removed lymph node number was 52 (range; 2-118). Number of the removed lymph node did not change according to tumor type. Lymph node metastasis and non-nodal extra-uterine disease were detected in 47% and 36% of patients, respectively. The type of tumor predicted the lymphatic spread, deep myometrial invasion, serosal involvement, adnexal spread, cervical invasion and omental metastasis (p<0.05). The lymphatic spread rate was 65% for undifferentiated tumor type and 12.5% for mucinous tumor type. The rate of non-nodal extra-uterine disease was 60.9%, 43.8%, 21.8% and none in patients with undifferentiated, serous, clear cell tumor and mucinous type tumor, respectively (p=0.001). In multivariate analysis, it was determined that tumor type (undifferentiated vs. others), cervical invasion and omental metastasis were independent prognostic factors for lymph node metastasis. Conclusion: Whereas the surgical-pathologic factors were significantly worse in the undifferentiated type than other tumor types, the opposite was true in the mucinous type. Mucinous type tumor is different from other non-endometrioid types in terms of nodal/non-nodal spread. Lymphatic spread was observed in slightly more than 10% of patients with mucinous tumor and non-nodal extra-uterine disease did not exist in those.
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