Impact of Metastatic Lymph Node to Total Lymph Node Ratio on Survival of Endometrial Cancer Patients

Objective: To evaluate the prognostic role of metastatic lymph node (MLN), total lymph nodes (TLN) and MLN to TLN ratio in advanced-stage endometrial cancer (EMC). -Methods: EMC patients who had complete surgical staging between January 1995 and May 2017 and were in stage IIIC-IVB with pelvic and/or para-aortic nodal metastasis were identified. Data collected were age, stage, histopathology, TLN and MLN numbers, adjuvant treatment, disease status, and living status. The association of lymph node ratio (LNR), presented as a percentage of MLN to TLN, and other clinicopathologic factors with progression-free survival (PFS) and cancer-specific survival (CSS) was studied. Results: Among 82 patients identified, mean age was 59.5 +/- 10.7 years. Majority had stage IIIC1 (45.1%) and endometrioid histopathology (65.9%). After surgery, 71 patients (86.6%) had adjuvant treatment. After a median follow-up of 29.8 months (range 0.40-257.5 months), 43 patients (52.4%) had progression or recurrences. Total of 40 patients (48.8%) were dead from cancer. By univariable analyses, significant poor prognostic factors for PFS and CSS (hazard ratios [HRs]) were age >= 50 years (2.43), stage IV (3.26), nonendometrioid histopathology (2.87), ovarian involvement (2.40), TLN (2.07), LNR (2.82), and adjuvant treatment (3.58). Only adjuvant radiation with or without chemotherapy, but none of LN features, remained significant by multivariable analyses with HR of 2.27 for PFS and 3.04 for CSS. Conclusion: This study found that TLN, LNR, age, stage, histopathology, ovarian involvement, and adjuvant treatment were prognostic factors for survival in advanced-stage EMC. Only the adjuvant treatment of radiation with or without chemotherapy was the only independent significant prognostic factor.