A retrospective review was performed of patients undergoing complete surgical staging for clinical stage 1 endometrioid adenocarcinoma of the uterus. Patients were assessed based on PORTEC 1 high intermediate risk (H-IR) criteria (2 factors : age > 60, grade 3, > 50 % DOI), GOG-99 H-IR criteria (age > 70 + 1 factor, age 50-70 + 2 factors, any age + 3 factors: grade 2 or 3, LVSI, > 50 % DOI), and PORTEC 2 criteria. Rates of nodal involvement, recurrence rates, PFS, and OS were compared.
We identified 352 clinical stage I patients with positive LN in 24 % (87). 175 patients met PORTEC 1 eligibility and 66 met H-IR criteria. Rates of LN positivity were similar among groups (18.4 % vs 19.7 % , p = 0.83) but recurrence rates were dissimilar (7.4 % vs 27.3 % , p = 0.0004). Only 93 met PORTEC 2 criteria for treatment with no association between LN status, recurrence, and eligibility. 188 patients met H-IR eligibility criteria for GOG-99 with LN positive and recurrence rates higher in the H-IR group compared to GOG-99 eligible (34.6 % vs 16.3 % , p = 0.0004, 28.3 % vs. 10.6 % , p = 0.0002).
Patients with H-IR disease based on uterine characteristics alone have substantial risk of nodal involvement. Knowledge of LN status may better define risk, prognosis, and postoperative treatment.