Risk factors and prognostic analysis of endometrial cancer with para-aortic lymph node metastasis.

Background: Assessment of lymph node involvement plays a pivotal role in the surgical staging of endometrial cancer (EC), offering essential prognostic information. In this study, we aimed to identify predictors of para-aortic lymph node metastasis, assess survival outcomes, and refine surgical strategies for lymphadenectomy in patients with EC.

Methods: A retrospective analysis was performed on 713 patients with endometrial cancer who underwent comprehensive staging surgery between July 2016 and July 2019. Clinical, pathological, and follow-up data were systematically collected. Univariate and multivariate logistic regression analyses were conducted to identify risk factors, and survival outcomes were evaluated using Kaplan-Meier analysis.

Results: Among 713 patients with endometrial cancer, lymph node metastasis was observed in 70 cases (9.8%), including 43 (6.0%) with para-aortic lymph node (PAN) involvement. Multivariate analysis identified LVSI, pelvic lymph node (PLN) metastasis, and elevated CA125 as independent predictors of PAN metastasis. Non-endometrioid histologies, particularly serous carcinoma, were associated with significantly higher PAN involvement. The 5-year survival rate for patients with PAN metastasis was 62.8%. Patients with isolated PAN metastasis (PLN - PAN+) had better 5-year OS (78.6%) than those with both PLN and PAN involvement (55.2%), though not statistically significant (log-rank P = 0.173).

Conclusions: Para-aortic lymph node (PAN) metastasis is rare in early-stage, low-risk endometrial cancer, and routine dissection may be safely omitted. However, para-aortic lymphadenectomy remains essential for patients with high-risk features, such as non-endometrioid histology, lymphovascular space invasion (LVSI), pelvic node metastasis, and elevated CA125 levels. Notably, uterine serous carcinoma is associated with frequent nodal spread and poor five-year survival.