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Gynecol Oncol. 2019 Nov;155(2):177-185. doi: 10.1016/j.ygyno.2019.09.011. Epub 2019 Oct 8.

Role of lymphadenectomy in endometrial cancer with nonbulky lymph node metastasis: Comparison of comprehensive surgical staging and sentinel lymph node algorithm.

Author information

1
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, United States of America.
2
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, New York, United States of America.
3
Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, United States of America.
4
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States of America.
5
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, New York, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America.
6
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, United States of America. Electronic address: mariani.andrea@mayo.edu.

Abstract

OBJECTIVES:

To compare survival and progression outcomes between 2 nodal assessment approaches in patients with nonbulky stage IIIC endometrial cancer (EC).

METHODS:

Patients with stage IIIC EC treated at 2 institutions were retrospectively identified. At 1 institution, a historical series (2004-2008) was treated with systematic pelvic and para-aortic lymphadenectomy (LND cohort). At the other institution, more contemporary patients (2006-2013) were treated using a sentinel lymph node algorithm (SLN cohort). Outcomes (hazard ratios [HRs]) within the first 5 years after surgery were compared between cohorts using Cox models adjusted for type of adjuvant therapy.

RESULTS:

The study included 104 patients (48 LND, 56 SLN). The use of chemoradiotherapy was similar in the 2 cohorts (46% LND vs 50% SLN), but the use of chemotherapy alone (19% vs 36%) or radiotherapy alone (15% vs 2%) differed. Although there was evidence of higher risk of cause-specific death (HR, 2.10; 95% CI, 0.79-5.58; P = 0.14) and lower risk of para-aortic progression (HR, 0.27; 95% CI, 0.05-1.42; P = 0.12) for the LND group, the associations did not meet statistical significance. The risk of progression was not significantly different between the groups (HR, 1.27; 95% CI, 0.60-2.67; P =0 .53). In parsimonious multivariable models, high-risk tumor characteristics and nonendometrioid type were independently associated with lower cause-specific survival and progression-free survival.

CONCLUSIONS:

In EC patients with nonbulky positive lymph nodes, use of the SLN algorithm with limited nodal dissection does not compromise survival compared with LND. Aggressive pathologic features of the primary tumor are the strongest determinants of prognosis.

KEYWORDS:

Comprehensive surgical staging; Endometrial cancer; Positive lymph node; Sentinel lymph node algorithm; Stage IIIC

PMID:
31604668
DOI:
10.1016/j.ygyno.2019.09.011
[Indexed for MEDLINE]

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