The impact of the absolute number and ratio of positive lymph nodes on survival of endometrioid uterine cancer patients

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.