1. ¹Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, San Francisco Comprehensive Cancer Center, 1600 Divisadero Street, Box 1702, San Francisco, CA 94143, USA
2. ²Division of Radiation Therapy, Department of Radiation Oncology, Stanford University School of Medicine, Stanford Cancer Center, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
3. ³Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stanford University School of Medicine, Stanford Cancer Center, 875 Blake Wilbur Drive, MC 5827, Stanford, CA 94305, USA
4. ⁴Division of Hematology and Oncology Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine Medical Center, 101 The City Drive, Orange, CA 92868, USA
5. ⁵Division of Gynecologic Oncology, Department of Obsetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Ohio State University College of Medicine and Public Health, M210 Starling-Loving Hall, 320 West Tenth Avenue, Columbus, OH 43210, USA

Correspondence: Dr JK Chan, E-mail: chanjohn@obgyn.ucsf.edu

Received 24 April 2007; Revised 27 June 2007; Accepted 28 June 2007; Published online 31 July 2007.

Abstract

The aim of the study was to determine the impact of the absolute number and ratio of positive lymph nodes on the survival in node-positive endometrioid uterine cancer. Data were obtained from the National Cancer Institute Registry from 1988 to 2001. Analyses were performed using Kaplan–Meier and Cox proportional hazard methods. A total of 1222 women were diagnosed with stage IIIC-IV node-positive endometrioid corpus cancer. The 5-year disease-specific survival of women with 1, 2–5, and >5 positive nodes were 68.1, 55.1, and 46.1%, respectively (P<0.001). Increasing lymph node ratio, expressed as a percentage of positive nodes to total nodes identified (10, >10–50, and >50%), was associated with a decrease in survival from 77.3 to 60.7 to 40.9%, respectively (P<0.001). The absolute number of positive nodes and the lymph node ratio remained significant after adjusting for stage (IIIC vs IV) and the extent of lymphadenectomy (20 vs >20 nodes). On multivariate analysis, the absolute number of positive nodes and lymph node ratio were significant independent prognostic factors for survival. Increasing absolute number of positive nodes and lymph node ratio are associated with a poorer survival in women with node-positive uterine cancers. The stratification of node-positive uterine cancer for prognostic and treatment purposes warrants further investigation.