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

3 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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    Multinu, F., Ducie, J. A., Eriksson, A. G. Z., Schlappe, B. A., Cliby, W. A., Glaser, G. E., Grassi, T., Keeney, G. L., Weaver, A. L., Abu-Rustum, N. R., Leitao, M. M., & 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, 155(2), 177-185. https://doi.org/10.1016/j.ygyno.2019.09.011