Isolated Para-Aortic Nodal Recurrence in Endometrial Cancer

• 作者: Akimasa Takahashi Hidetaka Nomura Hiroyuki Kanao Kazuyoshi Kato Kohei Omatsu Kuniko Utsugi Maki Matoda Motoki Matsuura Nobuhiro Takeshima Sanshiro Okamoto
• 来源期刊: 妇产科期刊(英文)
• 学科: 医学
• 关键词: ENDOMETRIAL CANCER RECURRENCE ISOLATED Para-Aortic NODAL RECURRENCE
• 年，卷（期）: fckqkyw_2018,（7）
• 页码范围: 669-675
• 页数: 7页
• 分类号: R73

摘要

Aim: While cytoreductive surgery should be considered for patients with regional recurrence of endometrial cancer, the management of isolated para-aortic lymph node recurrence remains controversial. We investigated the frequency of isolated recurrence in the para-aortic lymph nodes and the effectiveness of surgery for such recurrence. Methods: A retrospectively maintained endometrial cancer database at the Cancer Institute Hospital in Japan was reviewed to identify sites of metastasis and recurrence. Results: A total of 2322 patients with endometrial cancer underwent primary treatment with systemic lymphadenectomy between 1984 and 2015. Systematic pelvic and para-aortic lymph node dissection was performed in 889 patients (Group 1), while 1433 patients underwent dissection of only the pelvic lymph nodes (Group 2). Although 16 patients (1.1%) in Group 2 had isolated para-aortic recurrences, only 3 patients (0.3%) in Group 1 had documented recurrences in the para-aortic lymph nodes (p = 0.043). Although second recurrence occurred in 30.0% of patients who underwent surgical recurrence treatment, second recurrence occurred in 77.8% of patients who underwent non-surgical recurrence treatment (p = 0.037). In addition, the overall survival rate for patients who underwent surgical recurrence treatment (80.0%) was significantly higher than that for patients who underwent non-surgical recurrence treatment (33.3%) (p = 0.026). Conclusions: Patients who underwent dissection of only the pelvic lymph nodes had a higher frequency of isolated recurrence in the para-aortic lymph nodes. In addition, a relatively good prognosis could be achieved with surgical treatment for isolated recurrence in the para-aortic lymph nodes, which was better than that achieved using non-surgical methods.