Role of systematic lymphadenectomy and adjuvant radiation in early-stage endometrioid uterine cancer

Objective: To determine the roles of lymphadenectomy in endometrioid uterine cancer patients and adjuvant radiation in early-stage endometrioid uterine cancer patients who underwent systematic lymphadenectomy. Methods: A retrospective analysis of 758 patients surgically treated for early-stage endometrioid uterine cancer from 2000 to 2006 was conducted. The primary outcome was 5-year overall survival in relation to systematic lymphadenectomy with or without adjuvant radiation. Results: Of the 758 patients, 547 (72.2%) underwent complete surgical staging, including systematic lymphadenectomy; adjuvant radiation was administered to 207 patients (27.3%). Within median follow-up of 35 months, systematic lymphadenectomy did not affect overall survival in early-stage patients (P = 0.4480). In the high-risk, early-stage group, however, the 5-year survival rate of the systematic lymphadenectomy group showed better survival compared with the no systematic lymphadenectomy group (P = 0.0095). Also, adjuvant radiation did not affect overall survival in early-stage patients (P = 0.1170), even in the group of high-risk, early-stage patients (P = 0.5680) who underwent systematic lymphadenectomy. Conclusions: Systematic lymphadenectomy provided a survival benefit in high-risk endometrioid uterine cancer patients. However, in patients who underwent systematic lymphadenectomy, adjuvant radiation was not beneficial, even in high-risk patients.