Is lymphadenectomy a prognostic marker in endometrioid adenocarcinoma of the human endometrium?

Background: During surgery for endometrial cancer, a pelvic
lymphadenectomy with or without para-aortic lymphadenectomy is
performed at least in patients with risk factors (stage I, grading
2 and/or histological subtypes with higher risk of lymphatic
spread), and is hence recommended by the International Federation
of Obstetrics and Gynecology (FIGO). Although lymph node metastases
are important prognostic parameters, it has been contentious
whether a pelvic lymph node dissection itself has a prognostic
impact in the treatment of endometrial cancer, especially in
endometrioid adenocarcinoma. Therefore, this study evaluated
whether lymphadenectomy has a prognostic impact in patients with
endometrioid adenocarcinoma. Methods: The benefits of
lymphadenectomy were examined in 214 patients with a histological
diagnosis of endometrial adenocarcinoma. Tumour characteristics
were analysed with respect to the surgical and pathological stage.
Results: Of the 214 patients with endometrial adenocarcinoma, 171
(79.9%) were classified as FIGO stage I, 15 (7.0%) FIGO stage II,
21 (9.8%) FIGO stage III and 7 (3.3%) FIGO stage IV. One hundred
and thirty four (62.6%) of the patients had a histological grade 1
tumour, while 56 (26.2%) and 24 (11.2%) had a histological grade 2
or grade 3 tumour, respectively. Lymphadenectomy was performed in
151 (70.6%) patients. Only 11 (5.1%) patients showed metastatic
disease in the lymph nodes. The performance of a lymphadenectomy
resulted in significantly increased cause-specific and overall
survival, while progression-free survival was not affected by this
operative procedure. Conclusions: The performance of an operative
lymphadenectomy resulted in better survival of patients with
endometrioid adenocarcinoma. This increase was significant for
cause-specific and overall survival, while there was a tendency
only towards increased progression-free survival. Therefore, even
in endometrioid adenocarcinoma, a pelvic and/or para-aortic
lymphadenectomy should be performed.