Risk factors for pelvic lymph node metastasis in endometrial cancer

Purpose To evaluate the risk factors for pelvic lymph node metastasis (LNM) in endometrial cancer (EC). Methods Clinicopathological characteristics and preoperative laboratory results were retrospectively analyzed in 393 surgically staged patients with EC (January 2014–February 2019). Results Pelvic LNM was detected in 45 (11.5%) patients. Univariate analysis showed that increased preoperative levels of human epididymis protein 4 (HE4), carbohydrate antigen 125 (CA125), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), and decreased absolute lymphocyte count (ALC), as well as non-endometrioid histology, grade 3 tumor, deep myometrial invasion, vaginal or para-uterine involvement, adnexal involvement, positive peritoneal cytology, and lymphovascular space invasion (LVSI) were risk factors for pelvic LNM (All p < 0.05). Multivariate analysis revealed that preoperative serum HE4 ≥ 132 pmol/L (odds ratio (OR) 4.25, 95% confidence interval (CI) 1.65–10.94, p = 0.003), serum CA 125 ≥ 27.6 U/mL (OR 6.10, 95% CI 2.31–16.07, p = 0.000), non-endometrioid histology (OR 16.64, 95% CI 5.96–46.47, p = 0.000), myometrial invasion ≥ 50% (OR 5.30, 95% CI 2.07–13.55, p = 0.001), positive peritoneal cytology (OR 4.70, 95% CI 1.21–18.27, p = 0.025), and LVSI (OR 3.11, 95% CI 1.09–8.92, p = 0.034) remained as independent risk factors for pelvic LNM in EC. With the increase of these independent risk factors, the rate of pelvic LNM was increased significantly. Conclusions Higher preoperative levels of serum HE4 and CA125, non-endometrioid histology, deep myometrial invasion, positive peritoneal cytology, and LVSI are independent risk factors for pelvic LNM in EC, which can provide scientific basis for lymphadenectomy.