Prognostic Impact of Pelvic Lymph Node Count in Surgically Staged Endometrial Cancer

Background and Objectives: The prognostic significance of pelvic lymph node (PLN) count in surgically staged endometrial cancer remains controversial. This study aimed to evaluate the impact of PLN count on overall survival (OS), disease-free survival (DFS), and recurrence patterns in a large cohort of patients with endometrial cancer. Materials and Methods: This retrospective cohort study included 560 patients with endometrial cancer who underwent total hysterectomy, bilateral salpingo-oophorectomy, and pelvic and/or para-aortic lymph node assessment between January 2005 and May 2025 at a tertiary referral center. Patients were stratified according to the number of harvested pelvic lymph nodes (≤20 vs. >20). Clinicopathological characteristics, adjuvant treatments, recurrence patterns, and survival outcomes were analyzed. Survival analyses were performed using Kaplan–Meier estimates and Cox proportional hazards regression models. Results: Of the 560 patients, 262 (46.8%) had ≤20 pelvic lymph nodes harvested and 298 (53.2%) had >20. The median follow-up duration was 64.5 months. Patients with >20 pelvic lymph nodes had larger tumors, higher FIGO stage, and more frequent para-aortic lymphadenectomy. In multivariate analysis, age, non-endometrioid histology, advanced FIGO stage, tumor grade, and lymphatic metastasis were independently associated with both OS and DFS. Pelvic lymph node count was not independently associated with OS or DFS. Overall recurrence rates were similar between groups; however, recurrence patterns differed significantly, with distant recurrences more frequent in the ≤20 PLN group and local recurrences more common in the >20 PLN group. Conclusions: In surgically staged endometrial cancer, a higher pelvic lymph node count (>20 nodes) was not independently associated with survival or recurrence outcomes after adjustment for established prognostic factors, although recurrence patterns differed between groups. Survival was primarily determined by age, histologic subtype, FIGO stage, tumor grade, and lymphatic metastasis. Pelvic lymph node count appears to reflect surgical staging intensity and intraoperative risk assessment rather than serving as an independent determinant of prognosis.