Impact of lymph node ratio and adjuvant therapy in node-positive endometrioid endometrial cancer

Nicole D. Fleming, Pamela T. Soliman, Shannon N. Westin, Ricardo Dos Reis, Mark Munsell, Ann H. Klopp, Michael Frumovitz, Alpa M. Nick, Kathleen Schmeler, Pedro T. Ramirez

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Objectives To determine if the ratio of positive to negative lymph nodes, or lymph node ratio (LNR), is a prognostic variable in patients with node-positive endometrial cancer and the impact of adjuvant therapy on survival. Methods After institutional review board approval, a retrospective review of patients diagnosed as having stage IIIC endometrioid or mixed endometrioid endometrial cancer at a single institution from January 2000 through October 2011 was performed. Clinicopathologic and adjuvant treatment data were collected. Univariate and multivariate analysis were used to identify prognostic factors for progression-free (PFS) and overall survival. Results One hundred twenty-four patients with stage IIIC1 (n = 64) and IIIC2 (n = 60) endometrial cancer were included in the analysis. Median age was 60 years (range, 25-84 years), and median follow-up was 49.4 months (range, 0.1-301.6 months). Age >70 years was identified as a prognostic factor for worse PFS (P = 0.0002) and overall survival (P = 0.0002) on multivariate analysis. Patients in this cohort receiving any adjuvant radiotherapy showed improved PFS (hazard ratio [HR], 0.34; 95% CI, 0.13-0.90; P = 0.03) compared with those receiving any adjuvant chemotherapy (HR, 2.33; 95% CI, 1.16-4.65; P = 0.02). In a subgroup analysis, patients with at least 10 nodes removed (n = 81) with an LNR greater than 50% had a PFS of 25.2 months compared with 135.6 months with an LNR of 50% or less (HR, 3.87; 95% CI, 1.15-13.04; P = 0.03). Conclusions Lymph node ratio may define a subgroup of stage IIIC endometrial cancers at increased risk for recurrence. Adjuvant radiotherapy was associated with decreased recurrence risk.

Original languageEnglish (US)
Pages (from-to)1437-1444
Number of pages8
JournalInternational Journal of Gynecological Cancer
Issue number8
StatePublished - Oct 1 2015


  • Endometrial cancer
  • Lymph node ratio

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology


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