Predictive clinicopathologic factors for para-aortic nodal involvement in endometrial carcinoma

To identify clinicopathologic risk factors predicting para-aortic lymph node (PALN) metastasis in patients with endometrial carcinoma. A retrospective analysis was conducted on 598 patients with FIGO 2009 stage I–III endometrial carcinoma who underwent comprehensive surgical staging, including pelvic and para-aortic lymphadenectomy, at Bursa Uludag University Hospital between January 2000 and May 2025. Demographic, surgical, and histopathological parameters were extracted from medical records. Univariable and multivariable regression analyses were performed to determine predictors of PALN metastasis. PALN metastasis was identified in 64 patients (10.7%). Isolated PALN involvement occurred in 3.5% of cases. On multivariable analysis, elevated preoperative CA-125 (> 35 U/mL) (OR 2.07, 95% CI 1.11–4.84), deep myometrial invasion (> 50%) (OR 2.62, 95% CI 1.09–6.30), lymphovascular space invasion (OR 1.91, 95% CI 1.12–4.75), and pelvic lymph node metastasis (OR 25.5, 95% CI 12.8–50.9) were independently associated with PALN involvement. Patients with pelvic nodal metastasis had a markedly increased likelihood of para-aortic spread. Para-aortic lymph node metastasis in endometrial carcinoma is independently associated with pelvic lymph node positivity, elevated preoperative CA-125, deep myometrial invasion, and LVSI. These parameters may guide risk stratification and support the development of predictive models to minimize unnecessary lymphadenectomy while ensuring accurate staging and tailored adjuvant therapy.