Multicenter study comparing oncologic outcomes between two nodal assessment methods in patients with deeply invasive endometrioid endometrial carcinoma

A sentinel lymph node algorithm versus a comprehensive pelvic and paraaortic lymphadenectomy

Brooke A. Schlappe, Amy L. Weaver, Jennifer A. Ducie, Ane Gerda Zahl Eriksson, Sean Christopher Dowdy, William Arthur Cliby, Gretchen E. Glaser, Robert A. Soslow, Kaled M. Alektiar, Vicky Makker, Nadeem R. Abu-Rustum, Andrea Mariani, Mario M. Leitao

Research output: Contribution to journalArticle

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Abstract

Objectives: To compare oncologic outcomes in the staging of deeply invasive endometrioid endometrial carcinoma (EEC) using a sentinel lymph node algorithm (SLN) versus pelvic and paraaortic lymphadenectomy to the renal veins (LND); to compare outcomes in node-negative cases. Methods: At two institutions, patients with deeply invasive (≥50% myometrial invasion) EEC were identified. One institution used LND (2004–2008), the other SLN (2005–2013). FIGO stage IV cases were excluded. Clinical characteristics and follow-up data were recorded. Results: 176 patients were identified (LND, 94; SLN, 82). SLN patients were younger (p = 0.003) and had more LVSI (p < 0.001). 9.8% in the SLN and 29.8% in the LND cohorts, respectively, received no adjuvant therapy (p < 0.001). There was no association between type of assessment and recurrence; adjusted hazard ratio (aHR; LND vs. SLN) 0.87 (95%CI 0.40, 1.89) PFS. After controlling for age and adjuvant therapy, there was no association between assessment method and OS (aHR 2.54; 95%CI 0.81, 7.91). The node-negative cohort demonstrated no association between survival and assessment method: aHR 0.69 (95%CI 0.23, 2.03) PFS, 0.81 (95%CI 0.16, 4.22) OS. In the node-negative cohort, neither adjuvant EBRT+/-IVRT (HR 1.63; 95%CI 0.18, 14.97) nor adjuvant chemotherapy+/-EBRT+/-IVRT (HR 0.49; 95%CI 0.11, 2.22) were associated with OS, compared to no adjuvant therapy or IVRT-only. Conclusion: Use of an SLN algorithm in deeply invasive EEC does not impair oncologic outcomes. Survival is excellent in node-negative cases, irrespective of assessment method. Adjuvant chemotherapy in node-negative patients does not appear to impact outcome.

Original languageEnglish (US)
JournalGynecologic Oncology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Endometrioid Carcinoma
Endometrial Neoplasms
Lymph Node Excision
Multicenter Studies
Adjuvant Chemotherapy
Renal Veins
Survival
Sentinel Lymph Node
Therapeutics
Recurrence

Keywords

  • Deep invasion
  • Endometrial cancer
  • High-risk
  • Sentinel lymph node algorithm

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Multicenter study comparing oncologic outcomes between two nodal assessment methods in patients with deeply invasive endometrioid endometrial carcinoma : A sentinel lymph node algorithm versus a comprehensive pelvic and paraaortic lymphadenectomy. / Schlappe, Brooke A.; Weaver, Amy L.; Ducie, Jennifer A.; Eriksson, Ane Gerda Zahl; Dowdy, Sean Christopher; Cliby, William Arthur; Glaser, Gretchen E.; Soslow, Robert A.; Alektiar, Kaled M.; Makker, Vicky; Abu-Rustum, Nadeem R.; Mariani, Andrea; Leitao, Mario M.

In: Gynecologic Oncology, 01.01.2018.

Research output: Contribution to journalArticle

Schlappe, Brooke A. ; Weaver, Amy L. ; Ducie, Jennifer A. ; Eriksson, Ane Gerda Zahl ; Dowdy, Sean Christopher ; Cliby, William Arthur ; Glaser, Gretchen E. ; Soslow, Robert A. ; Alektiar, Kaled M. ; Makker, Vicky ; Abu-Rustum, Nadeem R. ; Mariani, Andrea ; Leitao, Mario M. / Multicenter study comparing oncologic outcomes between two nodal assessment methods in patients with deeply invasive endometrioid endometrial carcinoma : A sentinel lymph node algorithm versus a comprehensive pelvic and paraaortic lymphadenectomy. In: Gynecologic Oncology. 2018.
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title = "Multicenter study comparing oncologic outcomes between two nodal assessment methods in patients with deeply invasive endometrioid endometrial carcinoma: A sentinel lymph node algorithm versus a comprehensive pelvic and paraaortic lymphadenectomy",
abstract = "Objectives: To compare oncologic outcomes in the staging of deeply invasive endometrioid endometrial carcinoma (EEC) using a sentinel lymph node algorithm (SLN) versus pelvic and paraaortic lymphadenectomy to the renal veins (LND); to compare outcomes in node-negative cases. Methods: At two institutions, patients with deeply invasive (≥50{\%} myometrial invasion) EEC were identified. One institution used LND (2004–2008), the other SLN (2005–2013). FIGO stage IV cases were excluded. Clinical characteristics and follow-up data were recorded. Results: 176 patients were identified (LND, 94; SLN, 82). SLN patients were younger (p = 0.003) and had more LVSI (p < 0.001). 9.8{\%} in the SLN and 29.8{\%} in the LND cohorts, respectively, received no adjuvant therapy (p < 0.001). There was no association between type of assessment and recurrence; adjusted hazard ratio (aHR; LND vs. SLN) 0.87 (95{\%}CI 0.40, 1.89) PFS. After controlling for age and adjuvant therapy, there was no association between assessment method and OS (aHR 2.54; 95{\%}CI 0.81, 7.91). The node-negative cohort demonstrated no association between survival and assessment method: aHR 0.69 (95{\%}CI 0.23, 2.03) PFS, 0.81 (95{\%}CI 0.16, 4.22) OS. In the node-negative cohort, neither adjuvant EBRT+/-IVRT (HR 1.63; 95{\%}CI 0.18, 14.97) nor adjuvant chemotherapy+/-EBRT+/-IVRT (HR 0.49; 95{\%}CI 0.11, 2.22) were associated with OS, compared to no adjuvant therapy or IVRT-only. Conclusion: Use of an SLN algorithm in deeply invasive EEC does not impair oncologic outcomes. Survival is excellent in node-negative cases, irrespective of assessment method. Adjuvant chemotherapy in node-negative patients does not appear to impact outcome.",
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T2 - A sentinel lymph node algorithm versus a comprehensive pelvic and paraaortic lymphadenectomy

AU - Schlappe, Brooke A.

AU - Weaver, Amy L.

AU - Ducie, Jennifer A.

AU - Eriksson, Ane Gerda Zahl

AU - Dowdy, Sean Christopher

AU - Cliby, William Arthur

AU - Glaser, Gretchen E.

AU - Soslow, Robert A.

AU - Alektiar, Kaled M.

AU - Makker, Vicky

AU - Abu-Rustum, Nadeem R.

AU - Mariani, Andrea

AU - Leitao, Mario M.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: To compare oncologic outcomes in the staging of deeply invasive endometrioid endometrial carcinoma (EEC) using a sentinel lymph node algorithm (SLN) versus pelvic and paraaortic lymphadenectomy to the renal veins (LND); to compare outcomes in node-negative cases. Methods: At two institutions, patients with deeply invasive (≥50% myometrial invasion) EEC were identified. One institution used LND (2004–2008), the other SLN (2005–2013). FIGO stage IV cases were excluded. Clinical characteristics and follow-up data were recorded. Results: 176 patients were identified (LND, 94; SLN, 82). SLN patients were younger (p = 0.003) and had more LVSI (p < 0.001). 9.8% in the SLN and 29.8% in the LND cohorts, respectively, received no adjuvant therapy (p < 0.001). There was no association between type of assessment and recurrence; adjusted hazard ratio (aHR; LND vs. SLN) 0.87 (95%CI 0.40, 1.89) PFS. After controlling for age and adjuvant therapy, there was no association between assessment method and OS (aHR 2.54; 95%CI 0.81, 7.91). The node-negative cohort demonstrated no association between survival and assessment method: aHR 0.69 (95%CI 0.23, 2.03) PFS, 0.81 (95%CI 0.16, 4.22) OS. In the node-negative cohort, neither adjuvant EBRT+/-IVRT (HR 1.63; 95%CI 0.18, 14.97) nor adjuvant chemotherapy+/-EBRT+/-IVRT (HR 0.49; 95%CI 0.11, 2.22) were associated with OS, compared to no adjuvant therapy or IVRT-only. Conclusion: Use of an SLN algorithm in deeply invasive EEC does not impair oncologic outcomes. Survival is excellent in node-negative cases, irrespective of assessment method. Adjuvant chemotherapy in node-negative patients does not appear to impact outcome.

AB - Objectives: To compare oncologic outcomes in the staging of deeply invasive endometrioid endometrial carcinoma (EEC) using a sentinel lymph node algorithm (SLN) versus pelvic and paraaortic lymphadenectomy to the renal veins (LND); to compare outcomes in node-negative cases. Methods: At two institutions, patients with deeply invasive (≥50% myometrial invasion) EEC were identified. One institution used LND (2004–2008), the other SLN (2005–2013). FIGO stage IV cases were excluded. Clinical characteristics and follow-up data were recorded. Results: 176 patients were identified (LND, 94; SLN, 82). SLN patients were younger (p = 0.003) and had more LVSI (p < 0.001). 9.8% in the SLN and 29.8% in the LND cohorts, respectively, received no adjuvant therapy (p < 0.001). There was no association between type of assessment and recurrence; adjusted hazard ratio (aHR; LND vs. SLN) 0.87 (95%CI 0.40, 1.89) PFS. After controlling for age and adjuvant therapy, there was no association between assessment method and OS (aHR 2.54; 95%CI 0.81, 7.91). The node-negative cohort demonstrated no association between survival and assessment method: aHR 0.69 (95%CI 0.23, 2.03) PFS, 0.81 (95%CI 0.16, 4.22) OS. In the node-negative cohort, neither adjuvant EBRT+/-IVRT (HR 1.63; 95%CI 0.18, 14.97) nor adjuvant chemotherapy+/-EBRT+/-IVRT (HR 0.49; 95%CI 0.11, 2.22) were associated with OS, compared to no adjuvant therapy or IVRT-only. Conclusion: Use of an SLN algorithm in deeply invasive EEC does not impair oncologic outcomes. Survival is excellent in node-negative cases, irrespective of assessment method. Adjuvant chemotherapy in node-negative patients does not appear to impact outcome.

KW - Deep invasion

KW - Endometrial cancer

KW - High-risk

KW - Sentinel lymph node algorithm

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