Clinical features related to lymphatic metastasis in grade 3 endometroid endometrial cancer: a retrospective cross-sectional study.

Background Endometrial cancer (EC) has been one of the most general cancers with respect to gynecological malignancies, however, there are debates on clinical strategies concerning treatments especially for patients with grade 3 (G3) endometroid endometrial cancer (EEC). Present study aimed to evaluate the lymphatic metastasis (LM) related factors and figure out the necessity of lymphadenectomy for G3 EEC patients. Methods From January 2009 to April 2019, 3751 EC patients were admitted to Obstetrics and Gynecology Hospital of Fudan University. Clinical characteristics include age, grade, stage, and clinical pathological features. A total of 1235 EEC patients were involved in the multivariable analysis. Three hundred and eighty-one patients were involved in the survival analysis and the data attributed to sufficient follow-up information. Kaplan-Meier curve and log-rank test were utilized to analyze the survival rate. Results Among the 1235 EEC patients, 181 (14.7%) categorized as G3 and 1054 (85.3%) were grade 1 to grade 2 (G1-2). Multivariate analysis demonstrated that lymphovascular space invasion, adnexal involvement, and cervical stroma involvement were independent risk factors of LM in G3 cohort with odds ratio 3.4, 5.8, and 8.9; 95% confidence interval 1.1-10.6, 1.5-22.4, and 2.8-28.0, respectively. LM rates increased from 3.3% (3/92) to 75% (1/3) for G3 EEC cohort as related factor numbers increased from one to three. There were no differences between G3 and G1-2 EEC. Neither in overall survival nor progression free survival. Additionally, no survival advantage was observed for G3 EEC patients at early stage with different plans of adjuvant treatment. Conclusions For G3 patients with no other pathological positive factor, it is reasonable to evaluate the status of lymph nodes by minimally invasive methods such as sentinel lymph node biopsy technology rather than systematic lymphadenectomy to avoid overtreatment. Survival analysis showed no difference concerning treatments in G3 EEC cohort compared with G1-2.