Chan JK et al. (2007) The impact of the absolute number and ratio of positive lymph nodes on survival of endometrioid uterine cancer patients. Br J Cancer 97: 605–611

An association between the extent of lymph node involvement and prognosis is well documented in many solid tumors, including lung, breast and cervical cancer. Yet, the International Federation of Gynecology and Obstetrics staging system for uterine cancer does not take into account the extent of nodal disease. Now, Chan and co-workers present data indicating that stratification of patients with node-positive uterine cancer might be appropriate.

The researchers identified 1,222 women with stage IIIC–IV node-positive endometrioid corpus cancer, from data obtained by the National Cancer Institute registry from 1998 to 2001. Patients were stratified according to ratio of positive lymph nodes—expressed as a percentage of positive nodes to total nodes identified—and absolute number of positive lymph nodes. Increasing positive-lymph-node ratio and absolute number of positive lymph nodes were associated with decreased survival, regardless of disease stage and extent of lymphadenectomy. Patients with positive-lymph-node ratios of ≤10%, >10–50% and >50% had 5-year disease-specific survival rates of 77.3%, 60.7% and 40.9%, respectively (P <0.001 for trend), while patients with 1, 2–5 and >5 positive nodes had 5-year disease-specific survival rates of 68.1%, 55.1% and 46.1%, respectively (P <0.001 for trend). Multivariate analysis revealed that both absolute number of positive nodes and positive-lymph-node ratio were independent predictors of survival. The authors conclude that further investigations into the stratification of patients with node-positive uterine cancer are warranted.