Correlation between pretreatment prognostic factors and lymph node metastases in endometrial adenocarcinoma. Clinical application.

PURPOSE: To evaluate the prognosis of stage I endometrial adenocarcinoma, which differs by various prognostic factors. Some of them (tumor grading, histotype, myometrial infiltration, the latter evaluated with Magnetic Resonance Imaging) can be assessed before surgery. These prognostic factors correlate with patient survival and the presence of lymph node metastases. MATERIAL AND METHODS: We used tumor grading, histotype, myometrial infiltration for the preoperative and prospective classification into a low- and a high-risk group of 80 patients with endometrial adenocarcinomas stage I. Low-risk patient [group A: G1-G2, pure adenocarcinoma involving the inner portion of the myometrium (M0-M1)] underwent surgery without lymph node resection, while high-risk patients [group B: G3, pure adenocarcinoma with deep infiltration of the myometrium (M2) and/or clear cell, serous papillary, adenosquamous carcinomas] had pelvic and lumboaortic lymphadenectomy. The minimum 36 months' follow-up (median: 61 months) was requested for all patients. RESULTS: Histotype evaluated by dilatation and curettage and hysteroscopic and/or office biopsy, had 100% agreement with tumor histotype. Tumor grading was in agreement in 72/80 patients (81%). The grade of myometrial infiltration was confirmed in 72/80 cases (81%). Eight misdiagnoses were divided in over--(4 cases) and under--(4 cases) estimated infiltration. All 16 mistakes resulted in 10 inclusion in the wrong risk group (8 in the low-risk and two in the high-risk group). Surgical-pathological staging did not change the prognosis but only staging in 6 preoperatively high-risk group. CONCLUSIONS: This initial study confirms the importance of prognostic factors in the treatment of endometrial adenocarcinoma, as well as that of the different surgical choices which can be made after correct pretreatment prognosis.