Multicenter study comparing oncologic outcomes after lymph node assessment via a sentinel lymph node algorithm versus comprehensive pelvic and paraaortic lymphadenectomy in patients with serous and clear cell endometrial carcinoma
Section snippets
Background
Serous and clear cell carcinomas of the endometrium are rare tumors associated with poor prognoses, even when diagnosed at early stages [1]. Although the use of lymphadenectomy (LND) in low-risk endometrial cancer is somewhat controversial, it is broadly accepted as part of the surgical staging algorithm in cases with serous or clear cell histology, given their propensity for early spread despite minimal myometrial invasion [[2], [3], [4]]. In a series of 50 patients with presumed stage I-II
Methods
Patients with newly diagnosed, apparently uterine-confined serous or clear cell endometrial carcinoma with any degree of myometrial invasion were identified at the Mayo Clinic and Memorial Sloan Kettering Cancer Center using institutional databases. The Memorial Sloan Kettering Cancer Center database review encompassed the years 2006 through 2013 (SLN cohort), and the Mayo Clinic database review encompassed the years 2004 through 2008 (LND cohort). During these time periods, the surgical
Overall cohort
Review of institutional databases identified 214 cases—118 in the SLN cohort and 96 in the LND cohort. Clinical and pathologic characteristics are shown in Table 1. Fifty-six patients (47.5%) in the SLN cohort and 29 (30%) in the LND cohort had no myometrial invasion. Thirty-four (29%) in the SLN cohort and 44 (46%) in the LND cohort had <50% invasion (P = 0.02). Adjuvant therapy differed between the two cohorts; 84% (99/118) in the SLN cohort and 40% (38/96) in the LND cohort received
Discussion
Patients with serous and clear cell endometrial carcinoma are at an increased risk of nodal metastasis compared to patients with endometrioid endometrial carcinoma, regardless of depth of invasion [2]. Therefore, the decision to perform a lymphadenectomy in these tumors should not be based on uterine features. We demonstrated no adverse effect on OS with the use of an SLN algorithm compared to a complete LND in patients with apparent uterine-confined serous and clear cell endometrial carcinoma.
Funding
This study was funded in part through the NIH/NCI Support Grant P30 CA008748 (Drs. Nadeem R. Abu-Rustum and Mario M. Leitao Jr).
Author contributions
Conceptualization: BAS, AM, MML.
Data Curation: BAS, ALW, MEM, JAD, SCD, WAC, GEG, NAR, AM, MML.
Formal Analysis: BAS, ALW, MEM, JAD, SCD, WAC, GEG, NAR, AM, MML.
Investigation: BAS, SCD, WAC, NAR, AM, MML.
Methodology: BAS, ALW, MEM, NAR, AM, MML.
Writing, Original Draft: BAS, MML.
Writing, Review and Editing: All authors.
Declaration of competing interests
Outside the submitted work, Dr. Abu-Rustum reports grants from Stryker/Novadaq, Olympus, and GRAIL. Outside the submitted work, Dr. Leitao is an ad hoc speaker for Intuitive Surgical, Inc. The other authors have no potential conflicts to disclose.
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2022, Gynecologic OncologyCitation Excerpt :Additionally, well designed retrospective comparison observed that patients having SNM experienced similar oncologic outcomes compared to patients having LND for the treatment of low- and high-risk EC [20,21]. Looking both at the general population of EC and at the subgroup at high-risk EC other authors observed the non-inferiority of SNM in comparison to standard pelvic (and para-aortic) LND [11–15]. This evidence is confirmed by the pooled results of a recent meta-analysis on this issue [28], demonstrating that SNM and systematic LND are comparable in terms of detection of para-aortic nodal involvement and recurrence rates (any site and nodal recurrence).
- 1
Currently at The Norwegian Radium Hospital, Oslo, Norway.