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Oncol."],"abstract":"<jats:sec><jats:title>Study design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Debates remain regarding the role of lymphadenectomy in patients with apparent stage IA endometrial cancer, especially subtypes with a favorable prognosis. This study aimed to explore the prognostic value of staging surgeries in apparent stage IA endometrial endometrioid cancer patients in a retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cases from June 1, 2010 to June 1, 2017 were reviewed in patients with pathologically confirmed endometrial endometrioid carcinoma limited to &amp;lt;1\/2 of the myometrium, without extrauterine metastasis on preoperative evaluation and during surgical inspection. Survival outcomes were compared between patients with and without lymphadenectomy and between patients with and without metastasis to lymph nodes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 1,312 eligible patients were included, among which 836 underwent staging surgeries and 476 underwent simple hysterectomy. Twenty-eight patients were found with metastasis to retroperitoneal lymph nodes. After a median follow-up of 57.4 months, lost to follow-up, recurrence, death, and cancer-specific death occurred in 28, 39, 24, and 16 patients, respectively. In a univariate analysis, lymphadenectomy of the pelvis with or without para-aortic lymph nodes had no significant impact on disease-free survival, overall survival or cancer-specific overall survival (<jats:italic>p<\/jats:italic> values &amp;gt;0.05). However, after adjusting for important baseline risk factors [menopausal status, tumor differentiation, maximum diameter and location, lymph-vascular space invasion (LVSI) status, and postoperative adjuvant therapy), lymphadenectomy resulted in significantly improved survival outcomes (<jats:italic>p<\/jats:italic> values &amp;lt;0.05). Menopause (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.3\u201316.4, <jats:italic>p<\/jats:italic>=0.015), tumor diameter larger than 2\u00a0cm (OR 4.6, 95% CI 1.3\u201316.0, <jats:italic>p<\/jats:italic>=0.016), grade 3 tumors (OR 3.0, 95% CI 1.0\u20138.5, <jats:italic>p<\/jats:italic>=0.042), positive LVSI (OR 8.7, 95% CI 3.7\u201320.4, <jats:italic>p<\/jats:italic>&amp;lt;0.001) and lower uterine segment involvement (OR 3.1, 95% CI 1.4\u20137.2, <jats:italic>p<\/jats:italic>=0.007) had more extrauterine metastases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In cases of apparent stage IA endometrioid endometrial carcinoma, staging surgeries should be considered in patients with larger, higher grade tumors, positive LVSI, or lower uterine segment involvement.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2020.618499","type":"journal-article","created":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T15:59:35Z","timestamp":1613663975000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["The Prognostic Value of Retroperitoneal Lymphadenectomy in Apparent Stage IA Endometrial Endometrioid Cancer"],"prefix":"10.3389","volume":"10","author":[{"given":"Zhao","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinghe","family":"Lang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.21551","article-title":"Cancer statistics, 2019","volume":"69","author":"Siegel","year":"2019","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21338","article-title":"Cancer statistics in China, 2015","volume":"66","author":"Chen","year":"2016","journal-title":"CA Cancer J Clin"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(15)00130-0","article-title":"Endometrial cancer","volume":"387","author":"Morice","year":"2016","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(08)61766-3","article-title":"Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study","volume":"373","author":"Kitchener","year":"2009","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djn397","article-title":"Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial","volume":"100","author":"Benedetti Panici","year":"2008","journal-title":"J Natl Cancer Inst"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200508000-00050","article-title":"ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer","volume":"106","year":"2005","journal-title":"Obstet Gynecol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.ygyno.2009.12.025S0090-8258(09)01026-9","article-title":"Lymphadenectomy for endometrial cancer: the controversy","volume":"117","author":"Seamon","year":"2010","journal-title":"Gynecol Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2009.10.065","article-title":"ASTEC lymphadenectomy and radiation therapy studies: are conclusions valid","volume":"116","author":"Creasman","year":"2010","journal-title":"Gynecol Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60677-2","article-title":"Lymphadenectomy in endometrial cancer","volume":"373","author":"Uccella","year":"2009","journal-title":"Lancet"},{"key":"B10","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1093\/jnci\/djp124","article-title":"Re: Systematic pelvic lymphadenectomy vs no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial","volume":"101","author":"Uccella","year":"2009","journal-title":"J Natl Cancer Inst"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1177\/107327480901600104","article-title":"The role of comprehensive surgical staging in patients with endometrial cancer","volume":"16","author":"Frederick","year":"2009","journal-title":"Cancer Control"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/583891","article-title":"Contemporary clinical management of endometrial cancer","volume":"2013","author":"Dinkelspiel","year":"2013","journal-title":"Obstet Gynecol Int"},{"key":"B13","unstructured":"Uterine Neoplasms. 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