Demographic Factors Predict Risk of Lymph Node Involvement in Patients with Endometrial Adenocarcinoma

SIMPLE SUMMARY: The presence of lymph node involvement for patients with endometrial cancer guides treatment after surgery. Demographic factors in addition to pathologic tumor characteristics may more accurately predict the risk of lymph node involvement in this population. This study utilized a publicly available database of endometrial cancer patients diagnosed between 2004 and 2016. Pathologic primary tumor predictors of lymph node involvement were identified using statistical analysis. Among the 35,170 patients included, 2864 were node positive. Analysis revealed that younger patient age, black versus white race, increasing primary tumor stage and biologic aggressiveness, and tumor size were predictive of lymph node involvement. Both black versus white and other versus white race strongly predicted paraaortic lymph node involvement. Independent subset analyses of black and white women revealed that tumor grade was a stronger predictor of lymph node involvement among black women. In addition to standard pathologic tumor features, patient age and race are associated with a higher risk of regional lymph node involvement. This information may inform adjuvant treatment decisions and guide future studies. ABSTRACT: The presence of lymph node positivity (LN+) guides adjuvant treatment for endometrial adenocarcinoma (EAC) patients, but recommendations regarding LN evaluation at the time of primary surgery remain variable. Sociodemographic factors in addition to pathologic tumor characteristics may more accurately predict risk of LN+ in EAC patients. Patients diagnosed between 2004 and 2016 with pathologic T1-T2 EAC who had at least one lymph node sampled at the time of surgery in the National Cancer Data Base were included. Pathologic primary tumor predictors of LN+ were identified using logistic regression. To predict overall, pelvic only, and paraaortic and/or pelvic LN+, nomograms were generated. Among the 35,170 EAC patients included, 2864 were node positive. Using multivariable analysis, younger patient age (OR 0.98, 95% CI 0.98–0.99, p < 0.001), black versus white race (OR 1.19, 95% CI 1.01–1.40, p = 0.04), increasing pathologic tumor stage and grade, increase in tumor size, and presence of lymphovascular invasion were predictive of regional LN+. Both black versus white (OR 1.64, 95% CI 1.27–2.09, p < 0.001) and other versus white race (OR 1.54, 95% CI 1.12–2.07, p = 0.006) strongly predicted paraaortic LN+ in the multivariable analysis. Independent subset analyses of black and white women revealed that tumor grade was a stronger predictor of LN+ among black women. In addition to standard pathologic tumor features, patient age and race were associated with a higher risk of regional LN+ generally and paraaortic LN+ specifically. This information may inform adjuvant treatment decisions and guide future studies.