Nejat ÖZGÜL, Kunter YÜCE, Mehmet Coşkun SALMAN, Murat GÜLTEKİN, Dilek YÜKSEL, Caner ÇAKIR, Işın ÜREYEN, İsmet Çigdem KILIÇ, Yasin DURMUŞ, Gökhan BOYRAZ, Yalın Ay KARYAL, Mustafa Alper KARALÖK, Ahmet Taner TURAN

Does tumor size have prognostic value in patients undergoing lymphadenectomy in endometrioid-type endometrial cancer confined to the uterine corpus?

Background/aim: We aimed to define the effect of tumor size on recurrence and survival rates in patients with stage I–II endometrioidtype endometrial cancer.Materials and methods: A total of 550 patients who had total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvicparaaortic lymphadenectomy were included. Patients with extrauterine spread, sarcomatous components, or synchronized tumor andthose who did not undergo lymphadenectomy or did not have data on tumor size were excluded.Results: The median tumor size was 35 mm (range: 3–335 mm). According to the 2009 International Federation of Obstetrics andGynecology (FIGO) criteria, 245 cases were defined as stage IA, 271 as stage IB, and 34 as stage II. The 5-year disease-free survival (DFS)rate was 92% and the 5-year disease-specific survival (DSS) rate was 99%. The effects of prognostic factors on DFS were evaluated. Olderage, stage II disease, deep myometrial invasion, and receiving adjuvant radiotherapy were associated with decreased DFS. There was nostatistically significant association between tumor size and DFS. The 5-year DFS for patients with a tumor diameter of 35 mm (P = 0.128).Conclusion: Tumor size was not a risk factor predicting recurrence in patients with stage I or II endometrioid-type endometrial cancerwho had lymphadenectomy.

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1. Parazzini F, La Vecchia C, Bocciolone L, Franceschi S. The epidemiology of endometrial cancer. Gynecologic Oncology 1991; 41 (1): 1-16.
2. Prat J, Gallardo A, Cuatrecasas M, Catasús L. Endometrial carcinoma: Pathhology and genetics. Pathology 2007; 39 (1): 72-78. doi: 10.1080/00313020601136153
3. Cresman WT, Odicino F, Mausinneuve P, Quinn MA, Beller U et al. Carcinoma of the corpus uteri. FIGO Annual Report, Vol 26. International Journal of Gynecology & Obstetrics 2006; 95 (Suppl. 1): 105-143. doi: 10.1016/S0020-7292(06)60031-60033
4. Colombo N, Preti E, Landoni F, Carinelli S, Colombo A et al. Endometrial cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology 2013; 24 (Suppl. 6): vi33-38. doi: 10.1093/annonc/mdt353
5. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. International Journal of Gynecology & Obstetrics 2009; 105 (2): 103-104.
6. Schink JC, Lurain JR, Wallemark CB, Chmiel JS. Tumor size in endometrial cancer: a prognostic factor for lymph node metastasis. Obstetrics and Gynecology 1987; 70 (1): 216-299.
7. Al Hilli MM, Podratz KC, Dowdy SC, Bakkum-Gamez JN, Weaver AL. Preoperative biopsy and intraoperative tumor diameter predict lymph node dissemination in endometrial cancer. Gynecologic Oncology 2013; 128 (2): 294-299. doi: 10.1016/j.ygyno.2012.10.009
8. Schink JC, Rademaker AW, Miller DS, Lurain JR. Tumor size in endometrial cancer. Cancer 1991; 67 (11): 2791- 2794. doi:10.1002/1097-0142(19910601)67:11<2791::aidcncr2820671113>3.0.co;2-s
9. Laufer J, Scasso S, Papadia A, Sosa C, Cirillo F et al. Association between tumor diameter and lymphovascular space invasion among women with early-stage endometrial cancer. International Journal of Gynecology & Obstetrics 2013; 123 (2): 142-145. doi: 10.1016/j.ijgo.2013.05.012
10. Todo Y, Watari H, Okamoto K, Hareyama H, Minobe S et al. Tumor volume successively reflects the state of disease progression in endometrial cancer. Gynecologic Oncology 2013; 129 (3): 472-477. doi: 10.1016/j.ygyno.2013.02.034
11. Hellman S. Karnovsky memorial lecture. Natural history of small breast cancers. Journal Clinical of Oncology 1994; 12 (10): 2229-2234. doi: 10.1200/JCO.1994.12.10.2229
12. Mariani A, Webb MJ, Galli L, Podratz KC. Potential therapeutic role of para-aortic lymphadenectomy in node-positive endometrial cancer. Gynecologic Oncology 2000; 76 (3): 348- 356. doi: 10.1006/gyno.1999.5688
13. Gusberg SB, Jones HC Jr, Tovell HM. Selection of treatment for corpus cancer. American Journal of Obstetrics and Gynecology 1960; 80: 374-380. doi: 10.1016/0002-9378(60)90141-1
14. Shah C, Johnson EB, Everett E, Tamimi H, Greer B et al. Does size matter? Tumor size and morphology as predictors of nodal status and recurrence in endometrial cancer. Gynecologic Oncology 2005; 99 (3): 564-570. doi: 10.1016/j. ygyno.2005.06.011
15. Ozgul N, Boyraz G, Salman MC, Gultekin M, Yuce K et al. Oncological outcomes of stage II endometrial cancer: a retrospective analysis of 250 cases. International Journal of Gynecological Cancer 2018; 28 (1): 161-167. doi: 10.1097/ IGC.0000000000001133
16. Chambers JT, Merino M, Kohorn EI, Peschel RE, Schwartz PE. Uterine papillary serous carcinoma. Obstetrics and Gynecology 1987; 69 (1): 109-113.
17. Carcangiu ML, Chambers JT. Early pathologic stage clear cell carcinoma and uterine papillary serous carcinoma of the endometrium: comparison of clinicopathologic features and survival. International Journal of Gynecological Pathology 1995; 14 (1): 30-38.
18. Vargas R, Rauh-Hain JA, Clemmer J, Clark RM, Goodman A et al. Tumor size, depth of invasion, and histologic grade as prognostic factors of lymph node involvement in endometrial cancer: a SEER analysis. Gynecologic Oncology 2014; 133 (2): 216-220. doi: 10.1016/j.ygyno.2014.02.011
19. Boyraz G, Salman MC, Gultekin M, Basaran D, Cagan M et al. Incidence of lymph node metastasis in surgically staged FIGO IA G1/G2 endometrial cancer with a tumor size of more than 2 cm. International Journal of Gynecological Cancer 2017; 27 (3): 486-492. doi: 10.1097/IGC.0000000000000919
20. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE et al. Surgical pathologic spread patterns of endometrial cancer. Cancer 1987; 60 (Suppl. 8): 2035-2041. doi: 10.1002/1097-0142(19901015)60:8+<2035::aidcncr28206 01515>3.0.co;2-8
21. Sozzi G, Uccella S, Berretta R, Petrillo M, Fanfani F et al. Tumor size, an additional risk factor of local recurrence in low-risk endometrial cancer: a large multicentric retrospective study. International Journal of Gynecological Cancer 2018; 28 (4): 684-691. doi: 10.1097/IGC.0000000000001223
22. Senol T, Polat M, Ozkaya E, Karateke A. Tumor diameter for prediction of recurrence, disease free and overall survival in endometrial cancer cases. Asian Pacific Journal of Cancer Prevention 2015; 16 (17): 7463-7466. doi: 10.7314/ apjcp.2015.16.17.7463
23. Chattopadhyay S, Cross P, Nayar A, Galaal K, Naik R. Tumor size: a better independent predictor of distant failure and death than depth of myometrial invasion in International Federation of Gynecology and Obstetrics stage I endometrioid endometrial cancer. International Journal of Gynecological Cancer 2013; 23 (4): 690-697. doi: 10.1097/IGC.0b013e31828c85c6
24. Ballester M, Bendifallah S, Daraï E. European guidelines (ESMO-ESGO-ESTRO consensus conference) for the management of endometrial cancer. Bulletin du Cancer 2017; 104 (12): 1032-1038. doi: 10.1016/j.bulcan.2017.10.006