Survival Impact of Paraaortic Lymph Node Evaluation in Clinically Early Stage Endometrial Cancer

초록

Background The survival benefit of adding paraaortic lymph node (PALN) evaluation to pelvic lymph node (PLN) assessment in clinically uterine-confined, early-stage endometrial carcinoma remains uncertain. This study compared survival outcomes between PLN-only and PLN+PALN evaluation according to risk stratification. Methods Among 1,775 surgically staged endometrial carcinoma cases (2006?2023), 644 patients with clinically FIGO stage I?II disease who underwent lymph node evaluation were analyzed. Patients were categorized into PLN-only (n=140) and PLN+PALN (n=504) groups and stratified into low/intermediate-risk (n=414) and high-risk (n=230) categories. Disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan?Meier methods. Results In the low/intermediate-risk group, no significant differences were observed in 2-year DFS (100% vs. 97.6%, p=0.338) or OS (100% vs. 99.7%, p=0.325) between PLN-only and PLN+PALN groups. In the high-risk group, 2-year DFS (92.0% vs. 90.3%, p=0.377) and OS (100% vs. 98.9%, p=0.456) were also comparable. Across the entire cohort, PLN+PALN evaluation did not improve 2-year DFS (98.4% vs. 94.8%, p=0.064) or OS (100% vs. 99.4%, p=0.180) compared with PLN-only evaluation. Conclusions Additional paraaortic lymph node evaluation did not confer a significant survival benefit over pelvic lymph node assessment alone in clinically uterine-confined, early-stage endometrial carcinoma, irrespective of risk group.