Isolated lymph node recurrence and prognosis in endometrioid type endometrial cancer

Background: We compared treatment strategies for recurrence in patients who underwent surgery for endometrioid-type endometrial cancer (EC) and developed isolated retroperitoneal lymph node recurrence (ILNR) during follow-up. Additionally, we evaluated prognostic factors affecting post-recurrence survival (PRS). Methods: This retrospective study included patients treated with at least a hysterectomy and oophorectomy for endometrioid-type EC at our clinic between 2004 and 2023. Results: Among the 24 patients who developed ILNR after surgery for endometrioid-type EC, 6 (25.0%) had metastasis confined to the pelvic lymph nodes (PLNs), 7 (29.2%) to the para-aortic lymph nodes (PaLNs) and 11 (45.8%) to both PLNs and PaLNs. PRS ≥24 months was observed in 8 (33.3%) patients. Cox regression analysis was performed to identify significant prognostic factors associated with long-term PRS. In the univariate analysis, grade 3 tumors at initial surgery, disease-free survival (DFS) ≥18 months and surgical resection during recurrence were identified as significant prognostic factors. However, multivariate analysis did not reveal any independent prognostic factors. Conclusions: Although no independent prognostic factors for long-term PRS were identified in patients with ILNR after surgery for endometrioid-type EC, grade 3 tumors at initial surgery are possibly associated with worse outcomes. Prolonged DFS (>18 months) and surgical resection are possible predictors of better outcomes.

Endometrial cancer; Lymph node; Recurrence; Surgery

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