Predictors of extensive lymphatic dissemination and recurrences in node-positive endometrial cancer

Valentina Zanfagnin, Yajue Huang, Michaela E. Mc Gree, Amy L. Weaver, Jvan Casarin, Francesco Multinu, Serena Cappuccio, Annamaria Ferrero, Andrea Mariani, Gretchen E. Glaser

Research output: Contribution to journalArticlepeer-review


Objective: To identify predictors of extensive lymphatic dissemination and distant recurrences in node-positive endometrial cancer (EC). Methods: Clinicopathologic data were collected of patients who had fully staged EC with at least 1 positive lymph node. Permanent sections of metastatic lymph nodes were reviewed; metastases were characterized according to size (≤2 mm and >2 mm) and location in the lymph node (intra- vs extracapsular). Risk of occurrence of multiple pelvic and para-aortic lymph node dissemination was calculated by combining risk factors identified at multivariate analysis. Results: Of 96 patients, 85 had positive pelvic nodes, of whom 71 (83.5%) had high-volume metastases. In the presence of both macrometastasis in the pelvic basin (odds ratio [OR], 13.42; [95% CI, 2.44–73.83]) and uterine serosal involvement of the tumor at final pathologic evaluation (OR, 11.84 [95% CI, 1.22–115.11]), multiple pelvic node dissemination occurred in 91.7% of cases (vs 7.7% in the absence of both). Concomitant presence of pelvic macrometastasis, lymphovascular space invasion (LVSI), and extracapsular invasion led to 85.7% occurrence of para-aortic involvement (vs 11.1% if no factors present). LVSI was independently associated with nonvaginal recurrences (hazard ratio, 2.62 [95% CI, 1.33–5.16]). Conclusions: Presence of high-volume metastases in the pelvic lymph nodes is associated with concomitant presence of multiple positive pelvic nodes, as well as para-aortic node involvement. LVSI is associated with both para-aortic node involvement and occurrence of nonvaginal relapses. In this era of sentinel lymph node mapping, these factors may help predict the extent of lymphatic dissemination in EC.

Original languageEnglish
Pages (from-to)480-486
Number of pages7
JournalGynecologic Oncology
Issue number3
Publication statusPublished - Sep 2019


  • Endometrial neoplasm
  • Lymphatic metastasis
  • Neoplasm recurrence
  • Sentinel lymph node

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology


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