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

Francesco Multinu, Jennifer A. Ducie, Ane Gerda Zahl Eriksson, Brooke A. Schlappe, William A. Cliby, Gretchen E. Glaser, Tommaso Grassi, Gary L. Keeney, Amy L. Weaver, Nadeem R. Abu-Rustum, Mario M. Leitao, Andrea Mariani

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)177-185
Number of pages9
JournalGynecologic oncology
Volume155
Issue number2
DOIs
StatePublished - Nov 2019

Fingerprint

Endometrial Neoplasms
Lymph Node Excision
Lymph Nodes
Neoplasm Metastasis
Survival
Chemoradiotherapy
Proportional Hazards Models
Disease-Free Survival
Dissection
Cause of Death
Neoplasms
Radiotherapy
Sentinel Lymph Node
Drug Therapy
Therapeutics

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Role of lymphadenectomy in endometrial cancer with nonbulky lymph node metastasis : Comparison of comprehensive surgical staging and sentinel lymph node algorithm. / Multinu, Francesco; Ducie, Jennifer A.; Eriksson, Ane Gerda Zahl; Schlappe, Brooke A.; Cliby, William A.; Glaser, Gretchen E.; Grassi, Tommaso; Keeney, Gary L.; Weaver, Amy L.; Abu-Rustum, Nadeem R.; Leitao, Mario M.; Mariani, Andrea.

In: Gynecologic oncology, Vol. 155, No. 2, 11.2019, p. 177-185.

Research output: Contribution to journalArticle

Multinu, F, Ducie, JA, Eriksson, AGZ, Schlappe, BA, Cliby, WA, Glaser, GE, Grassi, T, Keeney, GL, Weaver, AL, Abu-Rustum, NR, Leitao, MM & Mariani, A 2019, 'Role of lymphadenectomy in endometrial cancer with nonbulky lymph node metastasis: Comparison of comprehensive surgical staging and sentinel lymph node algorithm', Gynecologic oncology, vol. 155, no. 2, pp. 177-185. https://doi.org/10.1016/j.ygyno.2019.09.011
Multinu, Francesco ; Ducie, Jennifer A. ; Eriksson, Ane Gerda Zahl ; Schlappe, Brooke A. ; Cliby, William A. ; Glaser, Gretchen E. ; Grassi, Tommaso ; Keeney, Gary L. ; Weaver, Amy L. ; Abu-Rustum, Nadeem R. ; Leitao, Mario M. ; Mariani, Andrea. / Role of lymphadenectomy in endometrial cancer with nonbulky lymph node metastasis : Comparison of comprehensive surgical staging and sentinel lymph node algorithm. In: Gynecologic oncology. 2019 ; Vol. 155, No. 2. pp. 177-185.
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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.",
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T1 - Role of lymphadenectomy in endometrial cancer with nonbulky lymph node metastasis

T2 - Comparison of comprehensive surgical staging and sentinel lymph node algorithm

AU - Multinu, Francesco

AU - Ducie, Jennifer A.

AU - Eriksson, Ane Gerda Zahl

AU - Schlappe, Brooke A.

AU - Cliby, William A.

AU - Glaser, Gretchen E.

AU - Grassi, Tommaso

AU - Keeney, Gary L.

AU - Weaver, Amy L.

AU - Abu-Rustum, Nadeem R.

AU - Leitao, Mario M.

AU - Mariani, Andrea

PY - 2019/11

Y1 - 2019/11

N2 - 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.

AB - 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.

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KW - Endometrial cancer

KW - Positive lymph node

KW - Sentinel lymph node algorithm

KW - Stage IIIC

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