[1231] Number of Involved Lymphatic Vessels and Their Distance from Tumor Are Independent Prognostic Factors of Lymph Node Metastases in Low Grade Endometrial Adenocarcinoma. A Multi-Institutional Study

Delia Perez Montiel, Elizabeth Dierksen Euscher, Andres Roma, Elizabeth J Moschiano, Rouba Ali-Fehmi, Elizabeth F Frauenhoffer, Insun Kim, Bojana Djordjevic, Denise A Barbuto, Sun Rang Hong, Anais Malpica, Elvio G Silva. Instituto Nacional de Cancerologia, Mexico City, Mexico; Multi Institutional Study, Los Angeles

Background: Metastasis to lymph node in low-grade endometrial adenocarcinoma (LGEC) are uncommon. Clinical stage is the most important prognostic factor in predicting nodal disease regardless of histological grade. The aim of this study was to investigate whether histological features exist that can predict lymph node involvement.
Design: This is a multi institutional case-control study where 153 patients with LGEC and nodal disease were compared to 336 controls with negative lymph nodes. Studied variables included size and appearance of tumor, depth of myometrial infiltration, cervical stromal and or lower uterine segment involvement (LUS), stromal reaction, intratumoral necrosis, LVI (divided as 0, 1 vessel, 2-5 vessels and more than 5 vessels), distance to LVI (adjacent to neoplasm and deeper than invasive front of tumor). Difference between mean estimates were evaluated by the student´s-T, Chi-square or Fisher exact tests. Multivariate analysis was performed using logistic regression model. P<0.05 was considered statistically significant.
Results: Mean age in the case group was of 58.2 years vs 61 in controls (p=0.010). Average tumor size 5.4 cm vs 4.2 cm (p=0.001), myometrial invasion 58% vs 35% (p=0.0001).

Table 1
 Cases with LNM (n=153)Control cases (n=336)P
LVI (more than 5 foci)39%9%0.0001
Distant LVI28%6%0.0001
Stromal reaction84%55%0.0002
Stromal cervical invasion33%9%0.0001
LUS involvement60%37%0.0002

In multivariate analysis, the distance to LVI (deeper than tumor invasive front) had OR 2.34(CI:1.231– 4.447)(p=0.009), cervical invasion OR 1.588(CI:1.14-2.214)(p=0.006) LVI (more than 5 foci) OR1.57(CI:1.076-2.296)(p=0.019), and myometrial invasion OR 1.124(CI:1.069-1.182)(p=0.0001) were independent predictors of lymph node metastasis.
Conclusions: Patients with larger tumor size, deeper myometrial invasion, LVI, especially deeper than the tumor front, intratumoral necrosis, stromal tumor reaction, and cervical stromal invasion are significantly associated with lymph node metastasis. LVI involving more than five vessesls and LVI deeper than the tumor front are independent factors for nodal metastasis in LGEC.
Category: Gynecologic & Obstetrics

Tuesday, March 20, 2012 9:30 AM

Poster Session III # 183, Tuesday Morning


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